[Senate Report 108-345]
[From the U.S. Government Publishing Office]
Calendar No. 699
108th Congress Report
SENATE
2d Session 108-345
======================================================================
DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND
RELATED AGENCIES APPROPRIATION BILL, 2005
_______
September 15, 2004.--Ordered to be printed
_______
Mr. Specter, from the Committee on Appropriations,
submitted the following
R E P O R T
[To accompany S. 2810]
The Committee on Appropriations, to which was referred the
bill (H.R. 0000) making appropriations for the Departments of
Labor, Health and Human Services, and Education and related
agencies for the fiscal year ending September 30, 2005, and for
other purposes, reports the same to the Senate with amendments
and recommends that the bill as amended do pass. deg.
The Committee on Appropriations reports the bill (S. 2810)
making appropriations for Departments of Labor, Health and
Human Services, and Education and related agencies for the
fiscal year ending September 30, 2005, and for other purposes,
reports favorably thereon and recommends that the bill do pass.
Amount of budget authority
Total bill as reported to Senate........................$494,272,611,000
Amount of adjusted appropriations, 2004................. 479,592,665,000
Budget estimates, 2005.................................. 490,903,284,000
The bill as reported to the Senate:
Over the adjusted appropriations for 2004........... +14,679,946,000
Over the budget estimates for 2005.................. +3,369,327,000
C O N T E N T S
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Page
Summary of Budget Estimates and Committee Recommendations........ 4
Overview and Bill Highlights..................................... 4
Highlights of the Bill........................................... 4
Title I--Department of Labor:
Employment and Training Administration....................... 12
Employee Benefit Security Administration..................... 22
Pension Benefit Guaranty Corporation......................... 22
Employment Standards Administration.......................... 23
Occupational Safety and Health Administration................ 26
Mine Safety and Health Administration........................ 27
Bureau of Labor Statistics................................... 28
Office of Disability Policy.................................. 28
Departmental Management...................................... 29
General Provisions........................................... 33
Title II--Department of Health and Human Services:
Health Resources and Services Administration................. 35
Centers for Disease Control and Prevention................... 64
NIH Preamble................................................. 95
Substance Abuse and Mental Health Services Administration.... 176
Agency for Healthcare Research and Quality................... 185
Centers for Medicare & Medicaid Services..................... 187
Administration for Children and Families..................... 195
Administration on Aging...................................... 215
Office of the Secretary...................................... 220
General Provisions........................................... 227
Title III--Department of Education:
Education for the Disadvantaged.............................. 230
Impact Aid................................................... 236
School Improvement Programs.................................. 237
Indian Education............................................. 246
Innovation and Improvement................................... 246
Safe Schools and Citizenship Education....................... 254
English Language Acquisiton.................................. 259
Special Education............................................ 259
Rehabilitation Services and Disability Research.............. 262
Special Institutions for Persons With Disabilities:
American Printing House for the Blind.................... 268
National Technical Institute for the Deaf................ 268
Gallaudet University..................................... 269
Vocational and Adult Education............................... 269
Student Financial Assistance................................. 272
Student Aid Administration................................... 275
Higher Education............................................. 275
Howard University............................................ 283
College Housing and Academic Facilities Loans................ 283
Historically Black College and University Capital Financing
Program.................................................... 283
Institute of Education Science............................... 284
Departmental Management:
Program Administration................................... 286
Office for Civil Rights.................................. 286
Office of the Inspector General.......................... 287
General Provisions........................................... 287
Title IV--Related Agencies:
Armed Forces Retirement Home................................. 288
Corporation for National and Community Service............... 288
Corporation for Public Broadcasting.......................... 291
Federal Mediation and Conciliation Service................... 291
Federal Mine Safety and Health Review Commission............. 292
Institute of Museum and Library Services..................... 292
Medicare Payment Advisory Commission......................... 294
National Commission on Libraries and Information Science..... 294
National Council on Disability............................... 294
National Labor Relations Board............................... 295
National Mediation Board..................................... 295
Occupational Safety and Health Review Commission............. 296
Railroad Retirement Board.................................... 296
Social Security Administration............................... 297
U.S. Institute of Peace...................................... 301
Title V--General Provisions...................................... 302
Budgetary Impact of Bill......................................... 303
Compliance With Paragraph 7, Rule XVI of the Standing Rules of
the Sen-
ate............................................................ 303
Compliance With Paragraph 7(C), Rule XXVI of the standing rules
of the Senate.................................................. 304
Compliance With Paragraph 12, Rule XXVI of the Standing Rules of
the Senate..................................................... 305
Comparative Statement of New Budget Authority.................... 306
SUMMARY OF BUDGET ESTIMATES AND COMMITTEE RECOMMENDATIONS
For fiscal year 2005, the Committee recommends total budget
authority of $494,272,611,000 for the Departments of Labor,
Health and Human Services, and Education, and Related Agencies.
Of this amount, $142,317,000,000 is current year discretionary
funding.
OVERVIEW AND BILL HIGHLIGHTS
The Labor, HHS, and Education and Related Agencies bill
constitutes the largest of the non-defense Federal
appropriations bills being considered by Congress this year. It
is the product of extensive deliberations, driven by the
realization that no task before Congress is more important than
safeguarding and improving the health and well-being of all
Americans. This bill is made up of over 300 programs, spanning
three Federal Departments and numerous related agencies. But
the bill is more than its component parts. Virtually every
element of this bill reflects the traditional ideal of
democracy: that every citizen deserves the right to a basic
education and job skills training; protection from illness and
want; and an equal opportunity to reach one's highest
potential.
This bill at the same time provides a safety net of social
protections for the needy while stimulating advances in human
achievement and the life sciences. At its core, this bill
embodies those defining principles by which any free society
must be guided: compassion for the less fortunate; respect for
family and loved ones; acceptance of personal responsibility
for one's actions; character development; and the avoidance of
destructive behavior.
HIGHLIGHTS OF THE BILL
Job Training.--The Committee recommendation includes
$5,377,662,000 for job training programs, an increase of
$235,067,000 over the enacted 2004 level. In addition,
$3,636,235,000 is recommended for State unemployment and
employment service operations, an increase of $48,331,000 over
the 2004 level.
Worker Protection.--The Committee bill includes
$1,536,800,000 to ensure the health and safety of workers,
including $468,645,000 for the Occupational Safety and Health
Administration and $280,002,000 for the Mine Safety and Health
Administration. The recommendation is an increase of
$51,900,000 over the 2004 level.
Child Labor.--The Committee bill includes $82,000,000 for
activities designed to end abusive child labor. This is
$71,000,000 above the budget request, but the same as the 2004
level.
National Institutes of Health.--A total of $28,900,300,000
is recommended to fund biomedical research at the 27 Institutes
and Centers that comprise the NIH. This represents an increase
of $1,100,252,000 over the fiscal year 2004 level and
$373,429,000 over the budget request.
Centers for Disease Control.--The Committee bill provides
$4,807,692,000 for the Centers for Disease Control and
Prevention, an increase of $228,393,000 over the fiscal 2004
level. Included in this amount is $862,195,000 for chronic
disease prevention and health promotion.
Wellness Initiative.--The Committee recommendation includes
a total of $809,539,000 for programs to increase physical
activity, improve nutrition, and reduce obesity and overweight,
an increase of $100,568,000 over the fiscal year 2004
appropriation.
Health Centers.--The recommendation includes $1,867,381,000
for health centers, $31,456,000 above the budget request and
$250,000,000 over the fiscal 2004 level.
Substance Abuse.--The Committee bill provides
$3,484,729,000 for substance abuse prevention and treatment
programs. Included in this amount is $2,256,222,000 for
substance abuse treatment, $94,455,000 for substance abuse
prevention and $913,279,000 for mental health programs.
Head Start.--The Committee recommendation includes
$6,935,306,000 for the Head Start Program. This represents an
increase of $168,586,000 over the 2004 level and is the same as
the request.
Low-income Home Energy Assistance State Grants.--The
Committee recommends $2,000,500,000 for heating and cooling
assistance for low-income individuals and families, the same as
the budget request and $111,710,000 more than the 2004 level.
Persons With Disabilities.--To promote independent living
in home and community-based settings, the Committee has
included $5,135,963,000 for services to persons with
disabilities. This includes $47,555,000 for the Office of
Disability Policy at the Department of Labor, $14,912,000 for
Disabled Voter Services and $40,000,000 for Real Choice Systems
Change Grants through the Center for Medicaid and Medicare
Services.
Education for the Disadvantaged.--The Committee has
provided $15,500,684,000 in grants to enhance educational
opportunities for disadvantaged children, an increase of
$1,057,043,000 over the fiscal year 2004.
Educator Professional Development.--The Committee
recommends $2,975,126,000 for State grants to improve teacher
quality. This is $45,000,000 more than the budget request.
English Language Acquisition.--The Committee recommends
$700,000,000 for bilingual education, $18,785,000 more than the
budget request.
Student Financial Aid.--The Committee recommends
$14,859,694,000 for student financial assistance, an increase
of $852,807,000 over the fiscal year 2004 level. The amount
provided for the Pell Grant Program will allow for a maximum
grant award of $4,050.
Higher Education Initiatives.--The Committee bill provides
$2,148,458,000 for initiatives to provide greater opportunities
for higher education, including $844,500,000 for Federal TRIO
programs and $302,500,000 for GEAR UP.
Education for Individuals With Disabilities.--The Committee
bill provides $12,063,344,000 to help ensure that all children
have access to a free and appropriate education, and that all
infants and toddlers with disabilities have access to early
intervention services. This represents an increase of
$1,163,176,000 over the 2004 level and $140,958,000 above the
budget request.
Rehabilitation Services.--The bill recommends
$3,077,328,000 for rehabilitation services, an increase of
$66,058,000 above the amount provided in 2004. These funds are
essential for families with disabilities seeking employment.
The Committee restored funding for several important programs
proposed for elimination, such as Supported Employment State
Grants, Projects with Industry, Recreational programs and
programs for migrant and seasonal farmworkers.
Services for Older Americans.--For programs serving older
Americans, the Committee recommendation includes
$3,018,098,000, an increase of $105,242,000 over the fiscal
year 2004 level. This recommendation includes $218,884,000 for
senior volunteer programs, $440,200,000 for community service
employment for older Americans, $357,000,000 for supportive
services and centers, $157,000,000 for family caregiver support
programs and $718,814,000 for senior nutrition programs. For
the medical research activities of the National Institute on
Aging, the Committee recommends $1,094,500,000. The Committee
recommendation also includes not less than $31,700,000 for the
Medicare insurance counseling program.
Corporation for Public Broadcasting.--The Committee bill
recommends an advance appropriation for fiscal year 2007 of
$400,000,000 for the Corporation for Public Broadcasting. In
addition, the Committee bill includes $49,705,000 for
conversion to digital broadcasting and $50,000,000 for the
replacement project of the interconnection system in fiscal
year 2005 funding.
REPROGRAMMING AND TRANSFER AUTHORITY
Reprogramming and transfers are the utilization of funds
for purposes other than those contemplated at the time of
appropriation enactment. These actions do not represent
requests for additional funds from the Congress, rather, the
reapplication of resources already available. A reprogramming
is the shifting of budgetary resources within a Treasury
account, whereas a transfer is the shifting of budgetary
resources between Treasury accounts.
The Committee has a particular interest in approving
transfers and reprogrammings which, although they may not
change either the total amount available or any of the purposes
for which appropriations are is legally available, represent a
significant departure from budget plans presented to the
Committee in an agency's budget justification.
For the Departments of Labor and HHS, the Committee has
included bill language permitting reprogramming or transfers up
to 1 percent between discretionary programs, projects, or
activities, as long as no such program, project, or activity is
increased by more than 3 percent by such reprogramming or
transfer; however, the Appropriations Committees of both Houses
of Congress must be notified at least 15 days in advance of any
such action. For the Department of Health and Human Services, a
program, project, or activity may be increased by an additional
2 percent subject to written approval by the House and Senate
Committees on Appropriations.
For the Department of Education, the Committee directs that
it make a written request to the chairman of the Committee
prior to reprogramming or transfer of funds in excess of 10
percent, or $500,000, whichever is less, between programs,
projects, or activities, unless an alternate amount for the
agency in question is specified elsewhere in this report. The
Committee desires to have the requests for actions which
involve less than the above-mentioned amounts if such actions
would have the effect of changing an agency's funding
requirements in future years, if programs, projects, or
activities specifically cited in the Committee's reports are
affected or if the action can be considered to be the
initiation of a new program or activity.
The Committee directs that it be notified regarding
reorganization of offices, agency employees programs, projects,
or activities at least 15 days prior to the planned
implementation of such reorganizations.
The Committee further directs that each agency under its
jurisdiction submit to the Committee statements on the effect
of this appropriation act within 45 days of final enactment of
this Act.
Prior Committee notification is also required for actions
requiring the use of general transfer authority unless
otherwise provided for in this Act. Such transfers specifically
include taps, or other assessments made between agencies, or
between offices within agencies. Funds have been appropriated
for each office funded by this Committee; it is not the
intention of this Committee to augment those funding levels
through the use of special assessments. This directive does not
apply to working capital funds or other fee-for-service
activities.
For purposes of implementing this provision, the term
``program, project, or activity'' shall mean the most specific
level of budgetary resources referred to in the House or Senate
Committee reports or conference report and accompanying
statement of the managers associated with the Departments of
Labor, Health and Human Services, and Education Appropriations
Act for fiscal year 2005. The 1 percent total referred to
involves discretionary funds available for obligation in fiscal
year 2005, including those available from prior years, user
fees, offsetting collections or any other source of
discretionary spending.
WELLNESS INITIATIVE
The United States spends more than $1,500,000,000,000 each
year on health care. That figure has doubled over the past 5
years, and if current patterns hold, it is expected to double
again within 6 years.
The consequences of future increases are clear: More
Americans will be left without access to health care, and more
communities will suffer the closure of local hospitals and
clinics. As a result, many Americans will forgo basic health
maintenance visits, making it more likely that illnesses will
go undiagnosed at early stages--a situation that will send
health care costs spiraling even further.
Many programs in this appropriations bill, especially those
designed to improve the Nation's public health system and
increase access to health care for underserved populations,
directly confront the problems associated with rising health
care costs, and the Committee remains committed to supporting
them. But this year, the Committee is also placing an
unprecedented emphasis on programs that encourage Americans to
avoid getting sick in the first place--programs that promote
the idea of ``wellness.''
Wellness can take many forms. It means developing healthy
habits like exercising regularly and eating right in order to
prevent major illness or injury. It also means staying healthy
mentally and avoiding tobacco and other harmful substances. All
these ideals have the same goal: to change the system of care
in America from a ``sick care'' paradigm, one focused almost
exclusively on providing payments and support for the detection
and treatment of illness, to a prevention paradigm that will
provide incentives and supports to Americans to remain healthy.
This initiative has four major components: physical
activity, nutrition, mental health and tobacco cessation.
Physical Activity
The Centers for Disease Control and Prevention recently
determined that obesity is now the second leading cause of
death in the United States, contributing to at least 400,000
deaths annually. More than two-thirds of Americans are now
overweight or obese, and more than 15 percent of our children
are overweight. The Surgeon General estimates that direct and
indirect costs of obesity in the United States come close to
$120,000,000,000 annually, and research shows that being obese
has an effect that is roughly comparable to aging 20 years.
Promoting regular physical activity and creating an
environment that supports these behaviors are essential steps
to reduce this epidemic of obesity. Regular physical activity
helps to control weight and is associated with fewer
hospitalizations, physician visits, and medications. Despite
the proven benefits of physical activity, more than 50 percent
of American adults do not get enough physical activity to
provide health benefits.
Nutrition
Research shows that good nutrition lowers people's risk for
many chronic diseases, including heart disease, stroke,
osteoporosis, diabetes, and certain types of cancer. Yet, a
large gap currently remains between recommended dietary
patterns and what Americans actually eat. Only about one-fourth
of U.S. adults, and only one-fifth of young people, eat the
recommended 5 or more servings of fruits and vegetables each
day.
Adding to the lack of fruits and vegetables is a reported
increase in calorie intake for both American men and women.
Survey data collected over the last 30 years by the U.S.
Department of Agriculture reports that this caloric increase
can be traced to factors including an increase in consumption
of food away from home, increased consumption of snacks, and
increased portion sizes.
Mental Health
The Surgeon General reports that mental disorders
collectively account for 15 percent of the overall burden of
disease from all causes--slightly more than the burden
associated with all forms of cancer. The Substance Abuse and
Mental Health Services Administration estimates that under-
treated and untreated mental disorders cost the Nation over
$204,000,000,000 annually. In fact, 30,000 Americans die by
suicide each year, with mental disorders a factor in 90 percent
of those instances.
Despite the cost and prevalence of depression, Americans
still do not act to prevent and treat situational depression.
According to the U.S. Surgeon General's report on mental
health, nearly half of all Americans with a severe mental
illness fail to seek treatment. Many people do not receive
treatment for mental health problems due to a lack of awareness
of the problem, fear of stigma, or lack of access to
appropriate services.
Tobacco Cessation
Tobacco use is the No. 1 killer of Americans, primarily due
to its role in various cancers, and is a major contributing
factor to heart disease, COPD and asthma. In fact, the latest
Surgeon General's report on smoking finds that tobacco use
causes diseases in nearly every organ of the body.
Despite the availability of data on lung cancer, 61 million
or 1 in 4 Americans smoke cigarettes. Every day in America,
more than 4,000 kids try their first cigarette. Another 2,000
children become new daily smokers. One-third of these newly
addicted smokers will eventually die from smoking-caused
diseases.
The Committee strongly believes a commitment to wellness
will encourage Americans to stay healthy, enhance the quality
of life in America and reduce the demand on the Nation's
healthcare system. For this reason, the Committee has included
a total of $809,539,000 for the following programs designed to
encourage healthy lifestyles and nutrition, an increase of
$100,568,000 over the fiscal year 2004 appropriation. The
Committee urges agencies receiving funds for this purpose under
this bill to take special measures to coordinate their
activities.
Carol M. White Physical Education for Progress Program.--
Despite the well-publicized benefits of exercise, more than 50
percent of American adults do not get enough physical activity
to provide health benefits. This trend is not limited to
adults--nearly one-half of Americans ages 12 to 21 are not
vigorously active on a regular basis. Physical education
classes are important for ensuring that young people have a
minimal, regular amount of physical activity and for
establishing physical activity patterns that may be carried
into adulthood. Yet the Committee notes that daily enrollment
in physical education classes dropped from 42 percent to 25
percent among high school students between 1991 and 1995. To
help reverse this trend, the Committee recommendation includes
$75,000,000 for the Carol M. White Physical Education for
Progress program. This is an increase of $5,413,000 over the
fiscal year 2004 level. This program provides grants to local
educational agencies and community-based organizations to
initiate, expand, and improve physical education programs for
students in kindergarten through 12th grade.
Extramural Prevention Research.--The Committee commends CDC
for its efforts to support research in humans that examines
factors associated with preventing disease and promoting
health. The Committee has included $36,000,000 for public
health research at CDC, an increase of more than $5,000,000
over the fiscal year 2004 level. Public health research helps
to define the best strategies to motivate healthy lifestyles
and to communicate that information to communities. The
Committee has encouraged CDC to pay particular attention to
research that will evaluate the effectiveness of business based
wellness programs for employees and to develop and disseminate
best practices in this area.
Mental Health Surveillance.--The Committee has included
$2,000,000 for a new initiative designed to measure mental and
behavioral health needs in the Unites States. Despite the
significant levels of Federal, State, and local funding for
mental health services, there are currently no population-based
sources of data on the mental and behavioral health needs in
this country. Under this initiative, SAMHSA, in consultation
with CDC, will develop ways of monitoring the mental health
status of the population, the mental and behavioral health
risks facing the Nation, and the immediate and long-term impact
of emergencies on population mental health and behavior. The
Committee envisions that when these measures are implemented in
future years, the resulting data will be enormously useful to
policymakers in deciding how to allocate mental health
resources and reform the Nation's mental health care system.
Nutrition, Physical Activity, Obesity State Grants.--The
Committee has included $50,702,000 for the CDC State grant
program that addresses nutrition, physical activity and
obesity. This is an increase of $6,000,000. Currently, 23
States are utilizing this funding for capacity-building
activities including efforts to develop State nutrition and
physical activity plans, identify community resources and gaps,
implement small-scale interventions, and raise public awareness
of system changes needed to help State residents achieve and
maintain a healthy weight.
Obesity Research.--Overall, the Committee recommendation
includes $440,000,000 for research into the causes and cures
for obesity. This figure is an increase of $40,000,000 over
last year. This increase includes $22,000,000 for the
development of a Strategic Plan for NIH Obesity Research, which
will coordinate NIH obesity research across all of the
Institutes.
Pioneering Healthy Communities.--The Committee has included
$2,000,000 to support the YMCA of the USA for its work in
developing healthier communities through its Pioneering
Healthier Communities conference. These funds will be used to
support these healthy communities in the implementation of
their community action plans. This program will be a proactive
response to the surging epidemic of obesity and physical
inactivity by supporting community-based solutions to these
problems.
Prevention Centers.--The Committee has provided
$31,652,000, an increase of $5,000,000 for prevention research
centers, which are a network of academic centers, public health
agencies, and community partners conducting applied research
and practice in chronic disease prevention and control. Centers
design, test, and disseminate strategies that help build
evidence-based interventions for public health programs. These
centers are working with communities to evaluate programs meant
to encourage increased physical activity, reduce the prevalence
of smoking, and foster better eating habits.
School Mental Health Services.--The Committee has included
$10,548,000 for a new program to support the integration of
schools and mental health systems under the Department of
Education. This program, which was authorized in the No Child
Left Behind Act but has not yet been funded, is designed to
promote school-wide mental health strategies, provide training
to elementary school and secondary school personnel to
recognize early warning signs of mental illness, and increase
student access to high-quality mental health services. An
estimated 7 million to 10 million adolescents suffer from
mental health issues that can lead to academic difficulties and
poor life outcomes. Integrating mental health services in
schools will increase the likelihood that they will receive the
treatment they need.
On a related note, the Committee has for the first time
dedicated funding for the study of screening methods that are
intended to identify students who are at risk of suicide. Some
existing screening techniques show promise, but they require
further testing. More must also be learned about ways to link
at-risk students with appropriate treatment. The Committee has
set aside $4,500,000 for SAMHSA to award grants for these
purposes to school systems or nonprofit groups in conjunction
with schools.
STEPS to a Healthier U.S.--The Committee has provided
$43,700,000, an increase of $5,000,000 over the fiscal year
2004 level, to target obesity, diabetes, asthma, heart disease,
stroke, and cancer. Programs should develop and implement
comprehensive wellness programs that motivate and support
responsible health choices, reduce the risk factors and
complications of chronic disease, and encourage cooperation
between agencies, policy makers, and the public to prevent
diseases before they occur. Grants will be awarded to local and
State health agencies, and tribal entities that develop
community action plans which focus on community and school
interventions for both the specific diseases and the related
risk factors.
Tobacco Cessation Activities at CDC.--The Committee has
included $114,437,000 for tobacco control activities at CDC, an
increase of $15,000,000. Tobacco use is the single most
preventable cause of death and disease in our society. It
causes more than 400,000 deaths in the U.S. each year, and
costs the Nation $50,000,000,000 in medical expenses alone.
Children are especially hard hit by tobacco--90 percent of
adult smokers begin their habit as children. These funds are
intended to expand the capacity of all State and local health
departments, education agencies, and national organizations to
build comprehensive tobacco control programs and to develop and
begin implementation of a national public education campaign to
reduce access to and the appeal of tobacco products among young
people.
TITLE I--DEPARTMENT OF LABOR
Employment and Training Administration
TRAINING AND EMPLOYMENT SERVICES
Appropriations, 2004.................................... $5,142,595,000
Budget estimate, 2005................................... 5,323,203,000
Committee recommendation................................ 5,377,662,000
The Committee recommends $5,377,662,000 for this account in
2005 which provides funding primarily for activities under the
Workforce Investment Act [WIA]. This is $235,067,000 more than
the 2004 level, and $54,459,000 over the administration
request.
Training and employment services is comprised of programs
designed to enhance the employment and earnings of economically
disadvantaged and dislocated workers, operated through a
decentralized system of skill training and related services.
This appropriation is generally forward-funded on a July-to-
June cycle. Funds provided for fiscal year 2005 will support
the program from July 1, 2005 through June 30, 2006.
Beginning with the fiscal year 2000 appropriation, budget
constraints required that a portion of this account's funding
be advance appropriated, with obligations for a portion of
Adult and Dislocated Worker Employment and Training Activities
and Job Corps delayed until the following fiscal year. This
practice will continue in this year's appropriation.
Fiscal year 2000 was the first full year of operations
under the Workforce Investment Act, for the program year July
1, 2000 through June 30, 2001. This legislation significantly
enhanced employment and training services, consolidating,
coordinating, and improving programs utilizing a local level
one-stop delivery system.
The legislation is due for reauthorization for fiscal year
2005, and therefore, the Committee is acting on a current law
request, deferring without prejudice proposed legislative
language that should be addressed by the authorizing
committees. The Committee is deferring consideration of a
proposed program initiative for personal re-employment
accounts.
The Committee directs that Department take no action in
fiscal year 2005 to amend, through regulatory or other
administrative action, the definition established in 20 CFR
677.220 for functions and activities under title I of the
Workforce Investment Act until such time as legislation
reauthorizing the Act is enacted.
Adult Employment and Training.--For Adult Employment and
Training Activities, the Committee recommends $898,107,000, the
same as the fiscal year 2004 level. This program is formula-
funded to States and further distributed to local workforce
investment boards. Services for adults will be provided through
the One-Stop system and most customers receiving training will
use their individual training accounts to determine which
programs and providers fit their needs. The Act authorizes core
services, which will be available to all adults with no
eligibility requirements, and intensive services, for
unemployed individuals who are not able to find jobs through
core services alone.
Dislocated Worker Assistance.--For Dislocated Worker
Assistance, the Committee recommends $1,479,419,000, an
increase of $26,268,000 over the fiscal year 2004 level. Of the
total, $1,196,048,000 is designated for State formula grants.
This program is a State-operated effort which provides core
services, intensive services, training, and supportive services
to help permanently separated workers return to productive,
unsubsidized employment. In addition, States use these funds
for rapid response assistance to help workers affected by mass
layoffs and plant closures. The recommendation includes
$283,371,000 available to the Secretary for activities such as
responding to mass layoffs, plant and/or military base
closings, and natural disasters across the country, which
cannot be otherwise anticipated, as well as technical
assistance and training and demonstration projects, including
community college initiatives.
The Committee bill continues language authorizing the use
of funds under the dislocated workers program for projects that
provide assistance to new entrants in the workforce and
incumbent workers, as well as to provide assistance where there
have been dislocations across multiple sectors or local areas
of a State.
The Committee recommendation includes, as it has in past
years, funding for dislocated worker projects aimed at
assisting the long-term unemployed.
Due to economic reasons and family dysfunction, elderly
caregivers care for thousands of preschool Hawaiian and part-
Hawaiian children with little or no preparation. The Committee
urges the Department to expand funding to programs which work
to train and assist these caregivers and the children they
serve. The Committee was pleased to learn from the Secretary
that the administration has established an interagency effort
to address our Nation's nursing shortage. The shortage is
especially critical in rural America and within various ethnic
minority populations, such as native Hawaiians. The Department
is accordingly strongly urged to work with nursing programs
serving such populations, and in particular, to ensure that
summer employment opportunities exist for nursing students.
The Committee is aware of the ever changing agricultural
worker training needs in Hawaii and recommends continued
funding for a collaborative and adaptive effort involving the
Hawaiian Department of Labor and Industrial Relations and the
Hawaiian Cooperative Extension Service to provide
multiculturally-sensitive on-farm food safety training,
agribusiness training, and production training in support of a
rapidly expanding landscaping and grounds keeping industry.
The Committee continues to be troubled by the length of
time it takes for the Department to approve applications for
National Emergency Grants. The purpose of this program is to
provide emergency help to workers who have recently lost their
jobs get training to quickly find a new job. However, it
routinely takes the Department several months to respond to
emergency requests. The Committee requests that the Government
Accountability Office examine the administration of this
program, and make recommendations for improvement.
The Committee recommendation includes $250,000,000
requested by the administration to carry out the Community
College/Community-Based Job Training Grant initiative. Of this
amount, $125,000,000 is to be allocated from National Emergency
Grant funds available under section 132(a)(2)(A) of the
Workforce Investment Act. The Secretary is directed to
initially use resources from the National Emergency Grants
account for these awards that are designated for non-
emergencies under sections 171(d) and 170(b) of the Workforce
Investment Act. Community-Based Job Training Grant awards will
also be subject to the limitations of sections 171(c)(4)(A)
through 171(c)(4)(C) of the Workforce Investment Act to ensure
that these grants are awarded competitively. Funds used for
this initiative should strengthen partnerships between
workforce investment boards, community colleges, and employers,
to train workers for high growth, high demand industries in the
new economy.
Youth Training.--For Youth Training, the Committee
recommends $994,242,000, the same as the fiscal year 2004
level. The Committee recommendation does not address the
administration's legislative proposals for these activities.
The purpose of Youth Training is to provide eligible youth with
assistance in achieving academic and employment success through
improving educational and skill competencies and providing
connections to employers. Other activities include providing
mentoring opportunities, opportunities for training, supportive
services, summer employment opportunities that are directly
linked to academic and occupational learning, incentives for
recognition and achievement, and activities related to
leadership development, citizenship, and community service.
Job Corps.--For Job Corps, now entering its 40th year, the
Committee recommends $1,577,287,000. This is $20,000,000 more
than the budget request, and $36,135,000 more than the 2004
comparable level. The Committee applauds Job Corps for
establishing partnerships with national employers, and
encourages Job Corps to continue to work with both large
employers and small businesses to ensure that student training
meets current labor market needs. Job Corps is a nationwide
network of residential facilities chartered by Federal law to
provide a comprehensive and intensive array of training, job
placement and support services to at-risk young adults. The
mission of Job Corps is to attract eligible young adults, teach
them the skills they need to become employable and independent,
and place them in meaningful jobs or further education.
Participation in the program is voluntary and is open to
economically disadvantaged young people in the 16-24 age range
who are unemployed and out of school. Most Job Corps students
come from disruptive or debilitating environments, and it is
important that they be relocated to residential facilities
where they can benefit from the highly structured and carefully
integrated services provided by the Job Corps program. A
limited number of opportunities are also available for non-
residential participation.
The Committee recommendation includes additional funds to
begin the process of establishing up to four additional Job
Corps centers, following up on directions contained in the
conference report accompanying Public Law 108-199. In addition,
consideration should be given to designating two of the
proposed new Job Corps centers as ``High Growth Job Corps
Centers,'' with emphasis placed on training students for
industries facing labor shortages such as health care.
The Committee recommendation includes funding to support a
demonstration partnership with the Transportation Security
Administration [TSA] at multiple Job Corps sites so that the
Job Corps can help to fill unmet needs by providing TSA access
to an expanded pool of job applicants. This funding will pay
costs of both parties. The Department of Labor and the
Department of Homeland Security are encouraged to develop a
cooperative agreement that would help to leverage Federal
resources, to provide TSA with an expanded pool of potential
job applications and to utilize Job Corps facilities as
appropriate to support the needs of TSA, including those of
qualified private screening companies under contract to TSA.
The Committee recognizes Project CRAFT (Community,
Restitution, and Apprenticeship-Focused Training), a program of
the Home Builders Institute, the workforce development arm of
the National Association of Home Builders, as a modern
intervention technique in the rehabilitation and reduced
recidivism of adjudicated youth. The Committee also
acknowledges the importance of housing to our Nation's economy
and the role Project CRAFT plays in preparing young people to
join the residential construction industry's workforce. The
Committee therefore encourages the Department to replicate
Project CRAFT to bring its outcomes-oriented approach to
adjudicated juveniles throughout the country in order to help
them become members of this industry's workforce and spur the
Nation's economy.
The Committee encourages Job Corps to strengthen working
relationships with workforce development entities, including
employers, that will enhance services to students and increase
students' career opportunities. The Department is encouraged to
continue its efforts to meet industry standards in its
occupational offerings through a multi-year process to review,
upgrade, and modernize its vocational curricula, equipment, and
programs in order to create career opportunities for students
in appropriate growth industries. The Committee also continues
to urge the Employment and Training Administration to encourage
Job Corps centers to coordinate with community-based
organizations, such as substance abuse treatment centers, in
innovative ways.
Responsible Reintegration of Youthful Offenders.--The
Committee recommendation includes $50,000,000, the same as the
budget request, to continue funding for the current
Reintegration of Youthful Offenders Program. The Reintegration
of Youthful Offenders Program targets critical funding to help
prepare and assist young offenders to return to their
communities. The program also provides support, opportunities,
education and training to youth who are court-involved and on
probation, in aftercare, on parole, or who would benefit from
alternatives to incarceration or diversion from formal judicial
proceedings. The recommendation also includes the $40,000,000
budget request for the prisoner re-entry initiative, to extend
assistance to a broader population of ex-offenders.
Native Americans.--For Native Americans, the Committee
recommends $55,000,000. This is the same as the budget request
level. This program is designed to improve the economic well-
being of Native Americans (Indians, Eskimos, Aleuts, and Native
Hawaiians) through the provision of training, work experience,
and other employment-related services and opportunities that
are intended to aid the participants to secure permanent,
unsubsidized jobs.
Migrant and Seasonal Farmworkers.--For Migrant and Seasonal
Farmworkers, the Committee recommends $76,874,000. This is the
same as the 2004 comparable level. This program, authorized by
WIA, is designed to serve members of economically disadvantaged
families whose principal livelihood is derived from migratory
and other forms of seasonal farmwork, or fishing, or logging
activities. Enrollees and their families are provided with
employment training and related services intended to prepare
them for stable, year-round employment within and outside of
the agriculture industry.
There are at least 3 million hard-working migrant and
seasonal farmworkers in America whose annual incomes are below
$10,000. At a time when most State budgets are shrinking and
many of the basic services provided by State and local
governments are being cut back, the Committee recognizes the
importance of sustaining a national commitment, dating from
1964, to help alleviate the chronic seasonal unemployment and
underemployment that traps many farmworker families in a cycle
of poverty across generations and that deprives many farmworker
children of educational opportunities and real prospects for
better jobs at higher wages. The Committee also recognizes that
many State and local government officials will be reluctant to
fund this training and related assistance for this vulnerable
portion of our Nation's workforce who migrate through many
States every year, even though the work they perform is
essential to the economic well-being of our Nation's farmers,
growers, and small businesses.
The Committee recommendation of $76,874,000 for program
year 2005 activities authorized under Section 167 of the
Workforce Investment Act is reflected in two separate line
items on the table accompanying the Committee Report: ``Migrant
and Seasonal Farmworkers'' and ``National Activities/Other.''
Under the Migrant and Seasonal Farmworkers line item, the
Committee recommends $76,370,000. The Committee recommendation
includes bill language directing that $4,583,000 of this amount
be used for migrant and seasonal farmworker housing grants, of
which not less than 70 percent shall be for permanent housing.
The principal purpose of these funds is to continue the network
of local farmworker housing organizations working on permanent
housing solutions for migrant and seasonal farmworkers. The
recommendation also provides that the remaining amount of
$71,787,000 be used for State service area grants, including
funding grantees in those States impacted by formula reductions
at no less than 85 percent of the comparable 1998 levels for
such States. Within the National Activities/Other line item,
the Committee recommendation includes $504,000 to be used for
Section 167 training, technical assistance and related
activities, including funds for migrant rest center activities.
The Committee urges the Department to continue valuable
technical assistance services provided by the Association of
Farmworker Opportunity Programs. Finally, the Committee wishes
to again advise the Department regarding the requirements of
the Workforce Investment Act in selecting an eligible entity to
receive a State service area grant under Section 167. Such an
entity must have already demonstrated a capacity to administer
effectively a diversified program of workforce training and
related assistance for eligible migrant and seasonal
farmworkers.
National Programs.--This activity includes WIA-authorized
programs in support of the workforce system including technical
assistance and incentive grants, evaluations, pilots,
demonstrations and research, and the Women in Apprenticeship
Program.
Technical Assistance.--The Committee recommends $3,486,000
for the provision of technical assistance and staff
development, an increase of $1,486,000 over the budget request.
This includes $996,000 for technical assistance to employers
and unions to assist them in training, placing, and retraining
women in nontraditional jobs and occupations. As described in
the Migrant and Seasonal Farmworker section of this report, it
also includes $504,000 for WIA Section 167 activities.
Pilots, Demonstrations, and Research.--The Committee
recommends $62,751,000, an increase of $32,751,000 over the
budget request, for grants or contracts to conduct research,
pilots or demonstrations that improve techniques or demonstrate
the effectiveness of programs.
In addition, the Committee recommends $8,000,000, compared
to the current level of $4,970,000, for the Denali Commission
for job training in connection with infrastructure building
projects it funds in rural Alaska. Funding will allow
unemployed and underemployed rural Alaskans to train for high
paying jobs in their villages.
The Committee is deeply concerned about the ability of the
28 million Americans who are deaf or hard-of-hearing to be
informed of critical news and information in the post-9/11/01
environment. The Committee is aware that court reporting
schools may not be able to meet the ``unfunded mandate'' set by
the Telecommunications Act of 1996 to provide closed captioning
of 100 percent of broadcast programming by January 2006. These
compelling concerns justify continued Federal support to those
schools to increase their capability to attract and train more
real time writers and to work closely with the broadcasting
industry to significantly increase the amount of programming
that is closed captioned, that 100 million Americans utilize
closed captioning in some form and the shortage of providers
need to be addressed immediately.
Evaluation.--The Committee recommends $8,000,000 to provide
for the continuing evaluation of programs conducted under the
Workforce Investment Act, as well as of federally-funded
employment-related activities under other provisions of law.
Rescission.--This bill includes the cancellation of
$100,100,000, that remains unobligated for the H-1B Technical
Skills Grant program. This compares to the $100,000,000
rescission proposed in the President's budget. The authority to
impose fees that funded the program lapsed on September 30,
2003, and therefore the program is ending. The Committee has
utilized these savings to restore other job training programs
that the administration has recommended for reduction or
elimination.
COMMUNITY SERVICE EMPLOYMENT FOR OLDER AMERICANS
Appropriations, 2004.................................... $438,650,000
Budget estimate, 2005................................... 440,200,000
Committee recommendation................................ 440,200,000
The Committee recommends $440,200,000, the same as the
budget request and $1,550,000 over the program year 2004
comparable level for community service employment for older
Americans. This program, authorized by title V of the Older
Americans Act, provides part-time employment in community
service activities for unemployed, low-income persons aged 55
and over. It is forward-funded from July to June, and the 2005
appropriation will support the program from July 1, 2004,
through June 30, 2005. The Committee believes that within the
title V community service employment for older Americans,
special attention should be paid to providing community service
jobs for older Americans with poor employment prospects,
including individuals with a long-term detachment from the
labor force, older displaced homemakers, aged minorities,
limited English-speaking persons, and legal immigrants.
The program provides a direct, efficient, and quick means
to assist economically disadvantaged older workers because it
has a proven effective network in every State and in
practically every county. Administrative costs for the program
are low, and the vast majority of the money goes directly to
low-income seniors as wages and fringe benefits.
The program provides a wide range of vital community
services that would not otherwise be available, particularly in
low-income areas and in minority neighborhoods. Senior
enrollees provide necessary and valuable services at Head Start
centers, schools, hospitals, libraries, elderly nutrition
sites, senior center, and elsewhere in the community. These
services would not be available without the program.
A large proportion of senior enrollees use their work
experience and training to obtain employment in the private
sector. This not only increases our Nation's tax base, but it
also enables more low-income seniors to participate in the
program.
The Committee believes that the program should pay special
attention to providing community service jobs for older
Americans with poor employment prospects, including individuals
with a long-term detachment from the labor force, older
displaced homemakers, aged minorities, limited English-speaking
persons, and legal immigrants.
FEDERAL UNEMPLOYMENT BENEFITS AND ALLOWANCES
Appropriations, 2004.................................... $1,338,200,000
Budget estimate, 2005................................... 1,057,300,000
Committee recommendation................................ 1,057,300,000
The Committee recommends $1,057,300,000, the same as the
budget estimate for fiscal year 2005, a decrease of
$280,900,000 below the fiscal year 2004 appropriation for
Federal Unemployment Benefits and Allowances. However, new
obligations in fiscal year 2005 are estimated to be
$1,097,000,000, compared to $836,000,000 in fiscal year 2004
due to an estimated unobligated balances of $549,200,000 in
2004. Trade Readjustment Allowance [TRA] weekly benefits are
estimated to increase from $2,500,000 in fiscal year 2004 to
$4,200,000 in fiscal year 2005. Fiscal year 2005 will continue
the implementation and operation of the Trade Adjustment
Assistance program with an emphasis on melding the TAA program
into the workforce investment system. The Committee expects the
Department to provide funds to the State of Alaska to mitigate
negative effects on Alaskan fishermen and other Alaskan
displaced workers stemming from passage of Trade and Adjustment
Assistance Act legislation in 2002. Funds should be provided on
a flexible basis to cover costs of job training and placement
programs, among other uses.
The Trade Adjustment Assistance Reform Act of 2002 that
amended the Trade Act of 1974 was signed into law on August 6,
2002 (Public Law 107-210). This Act consolidated the previous
Trade Adjustment Assistance [TAA] and NAFTA Transitional
Adjustment Assistance [NAFTA-TAA] programs, into a single,
enhanced TAA program with expanded eligibility, services, and
benefits. While the amendments generally apply to workers
covered on or after November 4, 2002, the Act includes
provisions to continue eligibility for workers certified prior
to November 4 until their eligibility under the previous
legislation is exhausted. Therefore, the amounts appropriated
to the FUBA account are to provide for services and benefits to
workers certified under the amended program as well as the
predecessor programs. Additionally, the Act provides a program
of Alternative Trade Adjustment Assistance for Older Workers.
STATE UNEMPLOYMENT INSURANCE AND EMPLOYMENT SERVICE OPERATIONS
Appropriations, 2004.................................... $3,587,904,000
Budget estimate, 2005................................... 3,593,434,000
Committee recommendation................................ 3,636,235,000
The Committee recommends $3,636,235,000 for this account.
This is $42,801,000 above the budget request and $48,331,000
above the 2004 comparable level. Included in the total
availability is $3,494,438,000 authorized to be drawn from the
``Employment Security Administration'' account of the
unemployment trust fund, and $141,797,000 to be provided from
the general fund of the Treasury.
The funds in this account are used to provide
administrative grants and assistance to State agencies which
administer Federal and State unemployment compensation laws and
operate the public employment service.
For unemployment insurance [UI] services, the bill provides
$2,665,214,000. This includes $2,654,714,000 for State
Operations, and $10,500,000 for UI national activities, which
is directed to activities that benefit the State/Federal
unemployment insurance program. The bill provides for a
contingency reserve amount should the unemployment workload
exceed an average weekly insured claims volume of 3,227,000,
instead of 3,327,000 in the request. This contingency amount
would fund the administrative costs of unemployment insurance
workload over the level of 3,227,000 insured unemployed per
week at a rate of $28,600,000 per 100,000 insured unemployed,
with a pro rata amount granted for amounts of less than 100,000
insured unemployed.
For the Employment Service grants to States, the Committee
recommends $852,387,000 which includes $23,163,000 in general
funds together with an authorization to spend $829,224,000 from
the ``Employment Security Administration'' account of the
unemployment trust fund. These funds are available for the
program year of July 1, 2005 through June 30, 2006.
The recommendation includes $65,500,000 for national
activities, an increase of $1,529,000 over the fiscal year 2004
level. This recommendation provides increased funding of the
foreign labor certification program, but not the full amount
requested by the administration. The recommendation includes
$18,000,000, the budget request level, for the work opportunity
tax credit program.
The recommendation also includes $98,764,000, the 2004
level, for One-Stop Career Centers. The Committee
recommendation includes funding for America's Labor Market
Information System, including core employment statistics,
universal access for customers, improving efficiency in labor
market transactions, and measuring and displaying WIA
performance information.
The recommendation includes the budget request level of
$19,870,000 for the Work Incentives Grants program, to help
persons with disabilities find and retain jobs through the One-
Stop Career Center system mandated by the Workforce Investment
Act. Funding will support systems building grants intended to
ensure that One-Stop systems integrate and coordinate
mainstream employment and training programs with essential
employment-related services for persons with disabilities.
ADVANCES TO THE UNEMPLOYMENT TRUST FUND AND OTHER FUNDS
Appropriations, 2004.................................... $467,000,000
Budget estimate, 2005................................... 517,000,000
Committee recommendation................................ 517,000,000
The Committee recommends $517,000,000, the same as the
budget estimate for fiscal year 2005, an increase of
$50,000,000 over 2004. The appropriation is available to
provide advances to several accounts for purposes authorized
under various Federal and State unemployment compensation laws
and the Black Lung Disability Trust Fund, whenever balances in
such accounts prove insufficient. The bill anticipates that
fiscal year 2004 advances will be made to the Black Lung
Disability Trust Fund. The requested amount is required to
provide for loan interest payments on Black Lung Trust Fund
borrowed amounts.
The separate appropriations provided by the Committee for
all other accounts eligible to borrow from this account in
fiscal year 2005 are expected to be sufficient. Should the need
arise, due to unanticipated changes in the economic situation,
laws, or for other legitimate reasons, advances will be made to
the appropriate accounts to the extent funds are available.
Funds advanced to the Black Lung Disability Trust Fund are now
repayable with interest to the general fund of the Treasury.
PROGRAM ADMINISTRATION
Appropriations, 2004.................................... $172,349,000
Budget estimate, 2005................................... 181,018,000
Committee recommendation................................ 177,615,000
The Committee recommendation includes $117,576,000 in
general funds for this account, as well as authority to expend
$60,039,000 from the ``Employment Security Administration''
account of the unemployment trust fund, for a total of
$177,615,000. This level provides sufficient resources to cover
built-in cost increases.
General funds in this account provide the Federal staff to
administer employment and training programs under the Workforce
Investment Act, the Older Americans Act, the Trade Act of 1974,
and the National Apprenticeship Act. Trust funds provide for
the Federal administration of employment security functions
under title III of the Social Security Act and the Immigration
and Nationality Act, as amended. Federal staff costs related to
the Wagner-Peyser Act in this account are split 97 percent to 3
percent between unemployment trust funds and general revenue,
respectively.
The Committee believes that the public workforce system is
strengthened by the effective participation of all of the
stakeholders in the system and urges that the Department use a
portion of its discretionary funds to support that
participation through grants to intergovernmental, business,
labor, and community-based organizations dedicated to training
and technical assistance in support of Workforce Investment
Boards and their members. Specifically, the Committee intends
that the Employment and Training Administration renew grant
funding for the Working for America Institute, at no less than
the cost of the latest grant. In a hearing held July 22, 2004,
the Committee heard testimony strongly supporting the work of
the Institute, which has successfully administered Labor
Department awards for more than 35 years.
It has come to the attention of the Committee that the
Department of Labor has recently chosen not to renew a contract
with the Appalachian Council serving participants in the Job
Corps program. It is of concern to the Committee that the
Department has discontinued this important effort. In a hearing
held July 22, 2004, the Committee heard witnesses describe the
unique character of this organization that justifies its
continued eligibility for a sole-source contract award at the
national level. It is the Committee's intent that the
Employment and Training Administration renew funding for the
Appalachian Council to continue its nearly 40 years of service
to the employment needs of our Nation.
The Committee is concerned that there are limited
opportunities for Native Hawaiian administrators in health care
organizations and encourages effective training programs to
prepare Native Hawaiians with the expertise to excel in these
areas.
The Committee is aware that a study is urgently needed to
obtain a comprehensive and accurate understanding of the costs
of replacing workers who leave the Federal work force and to
evaluate the changes needed to attract and retain skilled older
workers and the costs of implementing such a program. The
Committee urges the Department of Labor to obtain such a study.
The Committee urges the Department of Labor to work with
leading national aging organizations with specialized expertise
concerning older workers to conduct a Conference on the Aging
Workforce. This Conference can be an appropriate forum to
assess how our Nation can continue to progress economically
when there will quite likely be a shortage of workers in a
variety of present and future occupations. It can also evaluate
the appropriate role that older workers can play in meeting
future national skill needs.
The Committee instructs that, for the purposes of the
temporary visa programs, the Department of Labor shall treat
loggers as agricultural workers and not as non-agricultural
workers. Presently, the Department classifies loggers as non-
agricultural; however, since June 1987, it has imposed upon
them the same worker protections and labor standards as H-2A
agricultural workers. Employers wishing to hire logger aliens
must already provide transportation, housing, and meals, and
must make the same benefits available to U.S. workers based on
Department policy that predates the 1986 immigration reforms.
The provision applies strictly to loggers, and shall not affect
any other H-2B workers.
Employee Benefit Security Administration
SALARIES AND EXPENSES
Appropriations, 2004.................................... $124,040,000
Budget estimate, 2005................................... 132,345,000
Committee recommendation................................ 132,345,000
The Committee recommendation provides $132,345,000 for this
account which is $8,305,000 above the 2004 comparable level.
This includes funding of a requested program increase to
enhance regional office enforcement activities.
The Employee Benefit Security Administration [EBSA] is
responsible for the enforcement of title I of the Employee
Retirement Income Security Act of 1974 [ERISA] in both civil
and criminal areas. ESBA is also responsible for enforcement of
sections 8477 and 8478 of the Federal Employees' Retirement
Security Act of 1986 [FERSA]. In accordance with the
requirements of FERSA, the Secretary of Labor has promulgated
regulations and prohibited transactions class exemptions under
the fiduciary responsibility and fiduciary bonding provisions
of the law governing the Thrift Savings Plan for Federal
employees. In addition, the Secretary of Labor has, pursuant to
the requirement of section 8477(g)(1) of FERSA, established a
program to carry out audits to determine the level of
compliance with the fiduciary responsibility provisions of
FERSA applicable to Thrift Savings Plan fiduciaries. ESBA
provides funding for the enforcement and compliance; policy,
regulation, and public services; and program oversight
activities.
Pension Benefit Guaranty Corporation
The Corporation's estimated obligations for fiscal year
2005 include single employer benefit payments of
$3,295,000,000, multiemployer financial assistance of
$39,000,000 and administrative expenses of $266,330,000.
Administrative expenses are comprised of three activities: (1)
pension insurance activities, $12,211,000; (2) operational
support, $84,380,000; and (3) pension plan terminations
expenses, $169,739,000. Such expenditures will be financed by
permanent authority.
The Pension Benefit Guaranty Corporation is a wholly owned
Government corporation established by the Employee Retirement
Income Security Act of 1974. The law places it within the
Department of Labor and makes the Secretary of Labor the Chair
of its Board of Directors. The Corporation receives its income
primarily from insurance premiums collected from covered
pension plans, assets of terminated pension plans, collection
of employer liabilities imposed by the act, and investment
earnings. It is also authorized to borrow up to $100,000,000
from the Treasury. The primary purpose of the Corporation is to
guarantee the payment of pension plan benefits to participants
if covered defined benefit plans fail or go out of existence.
The 2005 budget does not recommend a discretionary limit on
administrative expenditures [LAE] for PBGC. The PBGC's budget
will reflects--in a way that is more accountable to the
Committee--the level of administrative expenditures that the
Committee believes is appropriate to PBGC's changing
responsibilities to protect the pensions it insures. PBGC's
dollar benefit levels and workload change from year to year as
specific pension plans fail. Most of its workload involves
terminating failed pension plans, so that pension benefits can
be paid. The workload of plan termination especially fluctuates
from year to year as large plans (or a spate of small ones)
terminate, and then as the terminations are completed. The
language provides the PBGC the flexibility to respond when
dictated by increased workload and increased benefit payments,
while increasing accountability to the Committee by requiring
approval by the Office of Management and Budget and the
Committees on Appropriations.
The single-employer program protects about 34.5 million
participants in about 29,500 defined benefit pension plans. The
multi-employer insurance program protects about 9.7 million
participants in more than 1,600 plans.
Employment Standards Administration
SALARIES AND EXPENSES
Appropriations, 2004.................................... $392,016,000
Budget estimate, 2005................................... 409,294,000
Committee recommendation................................ 405,870,000
The Committee recommendation includes $405,870,000 for this
account. The bill contains authority to expend $2,058,000 from
the special fund established by the Longshore and Harbor
Workers' Compensation Act; the remainder of $403,812,000 are
general funds. In addition, an amount of $32,646,000 is
available by transfer from the black lung disability trust
fund.
This recommendation provides sufficient funding to offset
the impact of inflation, and includes resources for a portion
of requested program increases.
The Employment Standards Administration is involved in the
administration of numerous laws, including the Fair Labor
Standards Act, the Immigration and Nationality Act, the Migrant
and Seasonal Agricultural Workers' Protection Act, the Davis-
Bacon Act, the Family and Medical Leave Act, the Federal
Employees' Compensation Act [FECA], the Longshore and Harbor
Workers' Compensation Act, and the Federal Mine Safety and
Health Act (black lung).
SPECIAL BENEFITS
Appropriations, 2004.................................... $163,000,000
Budget estimate, 2005................................... 233,000,000
Committee recommendation................................ 233,000,000
The Committee recommends $233,000,000, the same as the
budget estimate for fiscal year 2005, and $70,000,000 more than
fiscal year 2004. This appropriation primarily provides
benefits under the Federal Employees' Compensation Act [FECA].
The payments are prescribed by law. In fiscal year 2005, an
estimated 170,000 injured Federal workers or their survivors
will file claims; 7,000 will receive long-term wage replacement
benefits for job-related injuries, diseases, or deaths.
The Committee recommends continuation of appropriation
language to provide authority to require disclosure of Social
Security account numbers by individuals filing claims under the
Federal Employees' Compensation Act or the Longshore and Harbor
Workers' Compensation Act and its extensions.
The Committee recommends continuation of appropriation
language that provides authority to use the FECA fund to
reimburse a new employer for a portion of the salary of a newly
reemployed injured Federal worker. The FECA funds will be used
to reimburse new employers during the first 3 years of
employment not to exceed 75 percent of salary in the worker's
first year, declining thereafter.
The Committee again includes appropriation language that
retains the drawdown date of August 15. The drawdown authority
enables the agency to meet any immediate shortage of funds
without requesting supplemental appropriations. The August 15
drawdown date allows flexibility for continuation of benefit
payments without interruption.
The Committee recommends continuation of appropriation
language to provide authority to deposit into the special
benefits account of the employees' compensation fund those
funds that the Postal Service, the Tennessee Valley Authority,
and other entities are required to pay to cover their fair
share of the costs of administering the claims filed by their
employees under FECA. The Committee concurs with requested bill
language to allow use of fair share collections to fund capital
investment projects and specific initiatives to strengthen
compensation fund control and oversight.
SPECIAL BENEFITS FOR DISABLED COAL MINERS
Appropriations, 2004.................................... $299,991,000
Appropriations, Advanced 2005........................... 88,000,000
Budget estimate, 2005................................... 276,000,000
Budget estimate, Advance 2006........................... 81,000,000
Committee recommendation, 2005.......................... 276,000,000
Committee recommendation, Advanced 2006................. 81,000,000
The Black Lung Consolidation of Administrative
Responsibility Act was enacted on November 2, 2002. The Act
amends the Black Lung Benefits Act to transfer part B black
lung benefits responsibility from the Commissioner of Social
Security to the Secretary of Labor, thus consolidating all
black lung benefit responsibility under the Secretary. Part B
benefits are based on claims filed on or before December 31,
1973. The Secretary of Labor is already responsible for the
part C claims filed after December 31, 1973. In fiscal year
2005, an estimated 46,100 beneficiaries (5,100 miners and
41,000 survivors) will receive benefits.
The Committee recommends an appropriation of $276,000,000
in fiscal year 2005 for special benefits for disabled coal
miners. This is in addition to the $88,000,000 appropriated
last year as an advance for the first quarter of fiscal year
2005. The recommendation is the same as the administration
request. These funds are used to provide monthly benefits to
coal miners disabled by black lung disease and to their widows
and certain other dependents, as well as to pay related
administrative costs.
By law, increases in black lung benefit payments are tied
directly to Federal pay increases. The year-to-year decrease in
this account reflects a declining beneficiary population.
The Committee recommends an advance appropriation of
$81,000,000 for the first quarter of fiscal year 2006, the same
as the administration request. These funds will ensure
uninterrupted benefit payments to coal miners, their widows,
and dependents.
ENERGY EMPLOYEES OCCUPATIONAL ILLNESS COMPENSATION PROGRAM
Appropriations, 2004.................................... $51,651,000
Budget estimate, 2005................................... 40,821,000
Committee recommendation................................ 40,821,000
The Committee recommends $40,821,000, the same as the
budget estimate for fiscal year 2005, and $10,830,000 below
2004.
The mission of the Energy Employees Occupational Illness
Compensation Program is to deliver benefits to eligible
employees and former employees of the Department of Energy, its
contractors and subcontractors or to certain survivors of such
individuals, as provided in the Energy Employees Occupational
Illness Compensation Program Act. The mission also includes
delivering benefits to certain beneficiaries of the Radiation
Exposure Compensation Act. Benefit costs of $221,000,000 are
anticipated in fiscal year 2005.
The Department of Labor's Office of Workers' Compensation
Programs within the Employment Standards Administration is
responsible for adjudicating and administering claims filed by
employees or former employees (or their survivors) under the
Act. The program went into effect on July 31, 2001.
BLACK LUNG DISABILITY TRUST FUND
Appropriations, 2004 (Definite)......................... $56,099,000
Appropriations, 2004 (Indefinite)....................... 998,901,000
Budget estimate, 2005 (Definite)........................ 57,049,000
Budget estimate, 2005 (Indefinite)...................... 1,001,951,000
Committee recommendation (Definite)..................... 57,049,000
Committee recommendation (Indefinite)................... 1,001,951,000
The Committee recommends $1,059,000,000 for this account in
2005, of which $57,049,000 is definite authority and
$1,001,951,000 is indefinite authority. The appropriation
language changed beginning in fiscal year 2003 for the Black
Lung Disability Trust Fund to provide such sums as may be
necessary to pay for benefits. This change eliminated the need
for drawdowns from the subsequent year appropriation in order
to meet current year compensation, interest, and other benefit
payments. The appropriation language will continue to provide
definite budget authority for the payment of administrative
expenses for the operation and administration of the trust
fund.
The total amount available for fiscal year 2005 will
provide $1,001,951,000 for benefits payments, and $56,693,000
for administrative expenses for the Department of Labor. Also,
included is $356,000 for interest payments on advances.
The trust fund pays all black lung compensation/medical and
survivor benefit expenses when no responsible mine operation
can be assigned liability for such benefits, or when coal mine
employment ceased prior to 1970, as well as all administrative
costs which are incurred in administering the benefits program
and operating the trust fund.
It is estimated that 41,400 people will be receiving black
lung benefits financed through the end of the fiscal year 2005,
compared to an estimated 44,500 receiving benefits in fiscal
year 2004.
The basic financing for the trust fund comes from a coal
excise tax for underground and surface-mined coal. Additional
funds come from reimbursement from the Advances to the
Unemployment Trust Fund and Other Funds as well as payments
from mine operators for benefit payments made by the trust fund
before the mine operator is found liable. The advances to the
fund assure availability of necessary funds when liabilities
may exceed other income. The Omnibus Budget Reconciliation Act
of 1987 continues the current tax structure until 2014.
Occupational Safety and Health Administration
SALARIES AND EXPENSES
Appropriations, 2004.................................... $457,541,000
Budget estimate, 2005................................... 461,599,000
Committee recommendation................................ 468,645,000
The Committee recommendation includes $468,645,000 for this
account. This is an increase of $7,046,000 over the budget
request and an increase of $11,104,000 above the 2004
comparable level. This agency is responsible for enforcing the
Occupational Safety and Health Act of 1970 in the Nation's
workplaces.
This recommendation provides sufficient funding to offset
the impact of inflation, as well as additional resources to
expand outreach to non-English speaking workers and small
businesses.
In addition, the Committee has included language to allow
OSHA to retain up to $750,000 per fiscal year of training
institute course tuition fees to be utilized for occupational
safety and health training and education grants in the private
sector.
The Committee retains language carried in last year's bill
effectively exempting farms employing 10 or fewer people from
the provisions of the act except those farms having a temporary
labor camp. The Committee also retains language exempting small
firms in industry classifications having a lost workday injury
rate less than the national average from general schedule
safety inspections. These provisions have been in the bill for
many years.
The Committee believes that OSHA's worker safety and health
training and education programs, including the grant program
that supports such training, are a critical part of a
comprehensive approach to worker protection. The Committee is
concerned that OSHA has again cut funding to help establish
ongoing worker safety and health training programs and has
provided $6,510,000 in additional funds to restore the Susan
Harwood training grant program to $10,510,000. Bill language
specifies that no less than $3,200,000 shall be used to
maintain the existing institutional competency building
training grants, provided that grantees demonstrate
satisfactory performance.
The Committee has provided $53,792,000, the budget request
level, for the State consultation grant program and expects
that this program will continue to be targeted to provide
compliance assistance to small businesses.
The Committee continues to be pleased with OSHA's efforts
in placing high priority on the voluntary protection programs
[VPP] and other voluntary cooperative programs. The Committee
expects OSHA to continue to place high priority on the VPP.
Cooperative voluntary programs, especially the VPP, are an
important part of OSHA's ability to assure worker safety and
health and should be administered in conjunction with an
effective strong enforcement program.
The Committee also intends that the Office of Regulatory
Analysis continue to be funded as close as possible to its
present level.
Mine Safety and Health Administration
SALARIES AND EXPENSES
Appropriations, 2004.................................... $268,857,000
Budget estimate, 2005................................... 275,567,000
Committee recommendation................................ 280,002,000
The Committee recommendation includes $280,002,000 for this
account, an increase of $4,435,000 over the budget request.
This recommendation provides sufficient funding to offset
the impact of inflation, as well as additional resources for
enforcement, compliance assistance, and the new office
providing technical assistance to small mine organizations. It
further includes funding to continue the Miner's Choice X-ray
Program.
The Committee recommendation also increases the requested
bill language amount for mine rescue and recovery activities
from up to $1,000,000 to up to $2,000,000, the same as the
fiscal year 2004 comparable level. It also retains the
provision allowing the Secretary of Labor to use any funds
available to the Department to provide for the costs of mine
rescue and survival operations in the event of a major
disaster.
This agency insures the safety and health of the Nation's
miners by conducting inspections and special investigations of
mine operations, promulgating mandatory safety and health
standards, cooperating with the States in developing effective
State programs, and improving training in conjunction with
States and the mining industry.
In addition, bill language is included to allow the
National Mine Health and Safety Academy to collect not to
exceed $750,000 for room, board, tuition, and the sale of
training materials to be available for mine safety and health
education and training activities. Bill language also allows
MSHA to retain up to $1,000,000 from fees collected for the
approval and certification of equipment, materials, and
explosives for use in mines, and may utilize such sums for such
activities.
Bureau of Labor Statistics
SALARIES AND EXPENSES
Appropriations, 2004.................................... $518,496,000
Budget estimate, 2005................................... 533,518,000
Committee recommendation................................ 533,518,000
The Committee includes $533,518,000 for this account,
$15,022,000 more than the 2004 comparable level. This includes
$78,473,000 from the ``Employment Security Administration''
account of the unemployment trust fund, and $455,045,000 in
Federal funds. This funding level will cover the agency's
built-in increases, and includes $5,000,000 to continue the
Mass Layoff Statistics Program.
The Bureau of Labor Statistics is the principal fact
finding agency in the Federal Government in the broad field of
labor economics.
Office of Disability Employment Policy
Appropriations, 2004.................................... $47,024,000
Budget estimate, 2005................................... 47,555,000
Committee recommendation................................ 47,555,000
The Committee recommends $47,555,000 for this account in
2005. This is the same as the President's request and $531,000
above 2004.
Congress created the Office of Disability Employment Policy
[ODEP] in the Department of Labor's fiscal year 2001
appropriation. Programs and staff of the former President's
Committee on Employment of People with Disabilities [PCEPD]
have been integrated into this office.
The ODEP mission, under the leadership of an Assistant
Secretary, is to bring a heightened and permanent long-term
focus to the goal of increasing employment of persons with
disabilities. This will be achieved through policy analysis,
technical assistance, and development of best practices, as
well as outreach, education, constituent services, and
promoting ODEP's mission among employers.
Within the funds provided for the Office of Disability
Employment Policy, the Committee has included $2,500,000 for
the telework feasibility program. These funds are to be used to
enable Government agencies to explore the feasibility of
employing home-based workers with significant disabilities.
The Committee recommends that the Office of Disability
Employment Policy continue the existing, structured, internship
program for undergraduate college students with disabilities,
at no less than current appropriation levels. The Committee
continues to believe that this innovative, structured
internship program will provide important opportunities for
undergraduate students with disabilities to pursue academic and
career development opportunities within the Department of Labor
and other Federal agencies.
Departmental Management
SALARIES AND EXPENSES
Appropriations, 2004.................................... $350,319,000
Budget estimate, 2005................................... 287,168,000
Committee recommendation................................ 357,050,000
The Committee recommendation includes $357,050,000 for this
account, which is $69,882,000 more than the budget request and
$6,731,000 more than the 2004 comparable level. In addition, an
amount of $23,705,000 is available by transfer from the black
lung disability trust fund, which is the same as the budget
request.
The primary goal of the Department of Labor is to protect
and promote the interests of American workers. The departmental
management appropriation finances staff responsible for
formulating and overseeing the implementation of departmental
policy and management activities in support of that goal. In
addition, this appropriation includes a variety of operating
programs and activities that are not involved in departmental
management functions, but for which other salaries and expenses
appropriations are not suitable.
The Committee recommendation includes $27,084,000 for
Executive Direction, the same as the fiscal year 2004
comparable level. Within this amount, which includes cost
savings in excess of $4,000,000, the Committee concurs with the
budget request of up to $5,000,000 to encourage greater use of
flex time and telework options to help ease the pressures faced
by workers and their families.
The Committee recommendation includes $9,554,000 for the
Women's Bureau. The Committee encourages the Women's Bureau to
support effective programs such as ``Women Work!'', to provide
technical assistance and training on programming for women in
transition to reenter the workforce.
The Committee is pleased with efforts to investigate the
impact of the nursing shortage on the overall health care labor
market across the country, particularly in rural areas, such as
Hawaii. The Committee urges the Department to work with HRSA in
creating solutions to remedy the ongoing shortage and report on
these efforts.
The University of Hawaii Center on the Family is dedicated
to understanding and promoting the factors that foster
resiliency in families facing personal, social, and financial
crises. The uniqueness of this program is the emphasis on the
psychological and behavioral processes, family resilience and
vulnerability, and includes Asians, Pacific Islanders and
Caucasians families. The State's diverse multicultural
population adds to the reliability of the research conclusions.
The Committee is disappointed that the Department of Labor
has once again put forward a budget for the coming year that
drastically reduces funding for the initiatives within the
International Labor Affairs Bureau [ILAB] working with the
International Labor Organization to combat abusive and
exploitative child labor.
Last December, a report on the economic impact of child
labor programs commissioned by the Department of Labor was
released. ``Investing In Every Child'' found that the average
economic benefit of eliminating child labor around the world
exceeds the cost of those efforts by a ratio of 6.7 to 1. Even
in the region of the world whose economic benefit is the
lowest, sub-Saharan Africa, the benefit is more than 5 to 1.
The study also found that each year of additional education
beyond the age of 14 yields an 11 percent increase in that
individual's earning power resulting in just over
$5,000,000,000,000 in global benefits.
The Committee is pleased to have definitive economic
analysis proving that eradicating child labor and investing in
education will contribute to increased economic prosperity for
developing nations. The Committee views the investment made by
the United States and the programs run by the Department of
Labor to eliminate child labor as a proven method for improving
the economic infrastructure of developing nations and providing
a market for U.S. goods. In addition, the Committee is pleased
to note that its investment in programs to eliminate child
labor has inspired matching funds from countries like India,
Cambodia, Lebanon, and Yemen, thus exponentially increasing the
reach of these valuable programs.
Given this new Department of Labor data on the value of
these programs in reducing the need for foreign economic
assistance, the amount needed to service debt for developing
countries and the clear impact of these programs for advancing
the ability of nations to form sound trade agreements, the
Committee is mystified by the Department's annual effort to
eliminate these programs, this year proposing an astounding 87
percent reduction.
Therefore, the Committee recommendation includes
$110,500,000 for the Bureau of International Labor Affairs. Of
this amount, the Committee's recommendation includes
$82,000,000 for international child labor prevention activities
including $45,000,000 for the U.S. contribution to sustain and
to extend to more countries in waiting the successful efforts
of the ILO's International Program for the Elimination of Child
Labor [IPEC]. The remaining $37,000,000 is for bilateral
assistance to expand upon the program initiated by the
Department in fiscal year 2001 to help ensure access to basic
education for the growing number of children removed from the
worst forms of child labor in impoverished nations where
abusive and exploitative child labor is most acute. The
Committee expects the Department of Labor to work with the
governments of host countries to eliminate school fees that
cause additional burdens to former exploited child laborers.
The Committee notes that in the fiscal year 2003, ILAB
contracted with two international aid organizations for
$8,000,000 to create employment centers in Iraq. During this
same fiscal year, Congress was presented with a request of
$87,000,000,000 for the general reconstruction of Iraq and
Afghanistan. Congress acted on this request and $87,000,000,000
in aid was approved on November 6, 2003. The Committee is
concerned that ILAB went outside the scope of congressional
approval by diverting funds from the multilateral and bi-
lateral technical assistance programs to gain additional
funding for the reconstruction of these two countries. The
Committee expects a detailed report by March 31, 2005 on the
use of the $8,000,000, including a timeline of when the funds
were requested, by whom, the process by which the two aid
organizations were selected, when the contracts were issued,
and what such contracts entailed. The Committee understands
that the contracts have changed drastically due to unforeseen
events in Iraq and expect that the report will also detail the
decision making process between the contractors, the CPA and
ILAB on the changes and a detailed table explaining how the
funds were eventually spent by the contractors.
The Committee deems it very important that ILAB deepen and
improve its permanent capacity to compile and report to the
Congress annually on the extent to which each foreign country
that has trade and investment agreements with the United States
enforces internationally-recognized worker rights. This report
is required under multiple U.S. laws and promotes core labor
standards as embodied in the ILO Declaration on Fundamental
Principles and Rights at Work as adopted and reaffirmed in
1998. The Committee is aware that currently this report only
tracks the progress of countries that are designated as
beneficiaries under the U.S. Generalized System of Preferences
[GSP]. The GSP program grants duty-free treatment to specified
products imported from developing countries and territories. As
the United States' negotiates separate Free Trade Agreements
with GSP beneficiaries, the DOL stops tracking their progress
in the elimination of abusive and exploitative child labor.
Therefore, the Committee directs the Secretary to include in
the 2005 report, all former GSP recipients that have negotiated
Free Trade Agreements with the United States over the last 2
years. The Committee has provided $5,000,000 for the
compilation of this report. The Committee further includes
$2,500,000 for bilateral and multilateral assistance, to be
used to promote the International Labor Organization's
Declaration of Fundamental Principles and Rights at Work.
The Committee recommends $10,000,000 for HIV/AIDS workplace
education, for the purpose of providing the ILO with assistance
to conduct global education and prevention programs. For other
ILAB programs, including 125 FTE for Federal Administration,
the Committee recommends $11,000,000.
The Committee expects that the administration's fiscal year
2006 Departmental Management budget justification material will
include detailed information on past year, current year, and
budget year spending and estimate for international travel
taken by Department of Labor employees and officials related to
ILAB activities, including amounts by appropriation account
throughout the Labor Department.
Acknowledging the need to upgrade the information
technology capability in the Department of Labor, the Committee
provides $33,565,000 for the information technology fund, and
$4,965,000 for management cross cut activities. The total
provided includes support for cross-cutting investments such as
common office automation suite implementation, architecture
requirements, equipment, software, and related needs, as well
as human resource management. In addition, $15,000,000 of the
requested $25,000,000 is recommended for a separate Working
Capital Fund appropriation, for implementation of a new core
accounting system for the Department of Labor.
The Committee retains bill language intended to ensure that
decisions on appeals of Longshore and Harborworker Compensation
Act claims are reached in a timely manner.
The Committee notes with approval the increased attention
being paid to the coordination of human services with
transportation. The Committee notes the recent executive order
issued by the President calling for a report on transportation
coordination within 1 year. The Committee expects the Labor
Department, as one of the lead agencies mentioned in the
executive order to report its findings to the Committee as soon
as the study is complete.
VETERANS EMPLOYMENT AND TRAINING
Appropriations, 2004.................................... $218,646,000
Budget estimate, 2005................................... 220,648,000
Committee recommendation................................ 226,781,000
The Committee recommendation includes $226,781,000 for this
account, including $32,683,000 in general revenue funding and
$194,098,000 to be expended from the ``Employment Security
Administration'' account of the unemployment trust fund. This
is $8,135,000 more than the 2004 comparable level.
For State grants the bill provides $162,415,000, which
includes funding for the Disabled Veterans Outreach Program and
the Local Veterans Employment Representative Program.
For Federal administration, the Committee recommends
$29,683,000, the same as the budget request. The Committee
supports the concept of the Transition Assistance Program
administered jointly with the Department of Defense which
assists soon-to-be-discharged service members in transitioning
into the civilian work force and includes funding to maintain
this effective program.
Individuals leaving the military may be at high risk of
homelessness due to a lack of job skills transferable to the
civilian sector, disrupted or dissolved family and social
support networks, and other risk factors that preceded their
military service. The Committee expects the Secretary of Labor
to ensure that a module on homelessness prevention is added to
the Transition Assistance Program curriculum. The module should
include a presentation on risk factors for homelessness, a
self-assessment of risk factors, and contact information for
preventative assistance associated with homelessness.
The Committee recommendation includes $2,000,000, the same
as the budget request, for the National Veterans Training
Institute [NVTI]. This Institute provides training to the
Federal and State staff involved in the direct delivery of
employment and training related services to veterans.
The Committee recommendation includes $23,000,000 for the
Homeless Veterans Program, an increase of $4,000,000 over the
budget request. Also included is $9,683,000 for the Veterans
Workforce Investment Program, an increase of $2,133,000 over
the budget request.
The Committee is interested in ensuring that qualified job
training programs of the Department of Labor fully extend
priority of service for veterans as required by the Jobs for
Veterans Act. Toward this effort, the Committee urges the
Secretary to develop a guide for veterans in accessing
workforce investment planning processes; and a guide to inform
workforce systems on the employment services needs of veterans
and the responsibility of such systems to prioritize veterans
for services and to collaborate with veterans organizations and
providers. The Committee urges the Secretary to instruct State
workforce agencies to increase their outstationing of disabled
veterans outreach program specialists and local veterans
employment representatives in locations where homeless veterans
congregate, including grantees under the homeless provider
grant and per diem program and the homeless veterans
reintegration program.
OFFICE OF THE INSPECTOR GENERAL
Appropriations, 2004.................................... $65,339,000
Budget estimate, 2005................................... 69,590,000
Committee recommendation................................ 69,590,000
The bill includes $69,590,000 for this account, $4,251,000
above the 2004 comparable level. The bill includes $64,029,000
in general funds and authority to transfer $5,561,000 from the
``Employment Security Administration'' account of the
unemployment trust fund. In addition, an amount of $342,000 is
available by transfer from the black lung disability trust
fund. This level provides sufficient resources to cover built-
in cost increases, as well as funding of requested program
increases.
The Office of the Inspector General [OIG] was created by
law to protect the integrity of departmental programs as well
as the welfare of beneficiaries served by those programs.
Through a comprehensive program of audits, investigations,
inspections, and program evaluations, the OIG attempts to
reduce the incidence of fraud, waste, abuse, and mismanagement,
and to promote economy, efficiency, and effectiveness.
General Provisions
General provision bill language is included to:
Prohibit the use of Job Corps funding for compensation of
an individual at a rate in excess of Executive Level II (sec.
101).
Limits reprogramming and transfers of appropriated funds
between programs, projects, and activities, and requires 15
days notification to both the House and Senate Appropriations
Committees (sec. 102).
Prohibit funding for the procurement of goods and services
utilizing forced or indentured child labor in industries and
host countries already identified by the Labor Department (sec.
103 in accordance with Executive Order 13126).
Authorize funds to be appropriated for job training for
workers involved in construction projects funded through the
Denali Commission (sec. 104).
Require the Secretary of Labor to issue a monthly transit
subsidy of not less than the amount each employee of the
National Capitol Region is eligible to receive, not to exceed a
maximum of $100 (sec. 105).
Require the Department of Labor to submit its fiscal year
2006 congressional budget justifications in the traditional
budget structure rather than in a ``performance'' budget
structure. The Department is directed to develop and present
the fiscal year 2006 budget justification delineated by
appropriation account, providing detailed information on the
prior year, current year, and requested budget year funding and
Federal staffing levels for each program, project, or activity
funded within each account; a detailed narrative description of
each program, project, or activity; and any proposed changes to
such program, project, or activity. Additional performance
budget and measurement information should be submitted as a
separate appendix in the budget justification material. The
Department is encouraged to continue using outcome and
performance measures as the primary management tool for
resource allocation and the evaluation of programs and
individuals (sec. 106).
Require that none of the funds provided in this Act may be
used by the Department of Labor to implement or administer any
changes to regulations regarding overtime compensation in
effect on July 14, 2004, except those changes in section
541.600 of the Department's final regulation specifying the
amount of salary required to qualify as an exempt employee.
This provision requires the immediate re-instatement and
enforcement of the old overtime regulations in effect on July
14, 2004, except for the new section 541.600 salary
requirements (secs. 107 and 108).
TITLE II--DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Resources and Services Administration
HEALTH RESOURCES AND SERVICES
Appropriations, 2004.................................... $6,618,303,000
Budget estimate, 2005................................... 6,047,833,000
Committee recommendation................................ 6,966,280,000
The Committee provides a program level of $6,966,280,000
for the Health Resources and Services Administration [HRSA].
The Committee recommendation includes $6,941,280,000 in budget
authority and an additional $25,000,000 via transfers available
under section 241 of the Public Health Services Act. The fiscal
year 2004 comparable program level was $6,618,303,000 and the
administration request program level was $6,047,833,000. The
Committee has also provided $503,649,000 in the Public Health
and Social Services Emergency Fund for programs administered by
HRSA. The HRSA portion of the Committee report has been
organized in a manner consistent with the organizational
structure of HRSA.
Health Resources and Services Administration activities
support programs to provide health care services for mothers
and infants; the underserved, elderly, homeless; migrant farm
workers; and disadvantaged minorities. This appropriation
supports cooperative programs in community health, AIDS care,
health provider training, and health care delivery systems and
facilities.
As emphasized in past years, the Committee strongly
supports the establishment of Centers of Excellence for
Indigenous Health and Healing at schools that serve native
peoples including American Indians, Alaska Natives and Pacific
Islanders. The incorporation of traditional medicine and
healing practices into the training of medical, nursing, social
work, psychology, pharmacy and public health students will not
only advance these disciplines but also enhance the health care
services delivered to these populations. The Committee
encourages HRSA to support these concepts in their awarding of
grants wherever native and indigenous people reside.
The Committee urges HRSA to consider waivers for rural or
isolated area demonstration projects when calculating
requirements such as population density in the State of Hawaii.
BUREAU OF PRIMARY HEALTH CARE
HEALTH CENTERS
The Committee provides $1,867,381,000 for the consolidated
health centers. The fiscal year 2004 comparable program level
was $1,617,381,000 and the administration request program level
was $1,835,925,000. This group of programs includes community
health centers, migrant health centers, health care for the
homeless, and public housing health service grants.
Within the amount provided, $31,000,000 is for base grant
adjustments for existing health centers. Funding should be used
to offset the rising cost of health care nationwide, and also
to resolve specific financial situations beyond the control of
the local health center, such as unusual increases in the
number of uninsured patients seeking care.
The Committee supports the long-standing HRSA policy of
approving specific qualified applications for future funding.
This process enables high-quality applicants to take steps to
develop and implement care delivery systems in their
communities instead of wasting scarce resources to reapply for
funding. However, HRSA should limit the use of this mechanism
in a manner consistent with expected Presidential requests.
The Committee is concerned that providers serving special
populations (including migrant, homeless, school-based and
frontier providers) have been largely unable to meet the
current funding criteria used to determine health center
funding, and encourages HRSA to establish distinct criteria and
funding methodologies that recognize the unique needs of these
communities and populations.
The Committee has limited the amount of funds available for
the payment of claims under the Federal Tort Claims Act to
$45,000,000. This is the same as the amount provided in fiscal
year 2004, and the same as the President's request. Bill
language has been included to indicate that this funding is
available until expended.
The Committee does not provide additional funds for loan
guarantee authority under section 330(d) of the Public Health
Service Act. The Committee notes that $121,000,000 in loan
guarantee authority from the $160,000,000 appropriated in
fiscal years 1997 and 1998 continues to remain available for
guarantees of both loan principal and interest.
Community Health Centers
Community health centers improve the health of Americans by
providing comprehensive primary and preventive health care
services to underserved populations in rural and urban areas,
regardless of ability to pay. Of the clients served by
community health centers, over 39 percent had no insurance, 64
percent were minorities, 47 percent lived in rural areas, and
28 percent were children under 12 years of age.
The Committee is concerned that Federal community health
center funds are often not available to small, remote
communities in Alaska, Hawaii and other similar States because
the population base is too small. Many of these communities
have no health service providers and residents are forced to
travel long distances by boat or plane even in emergency
situations. The Committee continues to support the
administration's effort to double community health center
funding to address the growing number of uninsured persons in
this country, but, without new approaches to providing health
services, many will not benefit from the proposed increases in
funding. The Committee recommends that HRSA examine its
regulations and applications procedures to ensure they are not
unduly burdensome and are appropriately flexible to meet the
needs of these communities. The Committee applauds the agency
for its initiatives such as the ``Alaska Frontier Health Plan''
and encourages the agency to continue and expand its efforts
with this program.
The Committee continues to believe that community health
centers are a critical source of care for the underserved in
remote rural areas. The Committee commends HRSA for its
continued efforts to visit and evaluate many rural and
underserved areas across the country. New and expanded health
centers in remote communities are critically needed. The
Committee understands that nurse practitioners could be
instrumental in expanding the services offered by new and
existing centers. The Committee understands that opportunities
exist for the increased use of nurses in rural community health
centers through collaboration with the National Institute of
Nursing Research. The Committee strongly urges such
collaborations. In addition, the Committee understands that
telemedicine technology is often used to maximize resources and
collaborative communication, and encourages increased use of
these technologies. The Committee applauds HRSA for the
continued work that has been done to reexamine regulations and
to create an on-line grant application process.
The Committee recognizes that Nurse-Managed Health Centers
[NMHCs] serve a dual function in strengthening the health care
safety net by providing health care to populations in
underserved areas and by providing the clinical experiences to
nursing students that are mandatory for professional
development. Recognizing that NMHCs are frequently the only
source of health care to their patients and that a lack of
clinical education sites for nurses is a contributing factor to
the nationwide nursing shortage, the Committee encourages HRSA
to provide alternative means to secure cost-based reimbursement
for NMHCs, by providing that reimbursement or by granting
university-based CHCs. In addition, the Committee urges HRSA to
research the effectiveness of nurse-managed health centers as a
national model to reduce health disparities.
The Committee appreciates the attention paid by the HRSA
Administrator to the special health care needs of Native
Hawaiians and the medically underserved, especially to those
living on the ``neighbor islands'' of Hawaii. The diverse,
rural and underserved Native Hawaiian populations of the island
of Molokai face challenges in obtaining comprehensive primary
care and prevention interventions. Drug abuse prevention among
youth is particularly difficult to obtain. The Committee urges
HRSA to provide technical assistance in the preparation and
submission of grants for new community health centers to the
community health leaders of Molokai, Lanai, and all other
underserved areas of the country. The Committee believes that
linking new centers to existing health care programs and
facilities is an efficient use of resources.
The Committee is pleased with efforts at our Nation's
community health centers to address the health disparities of
American Samoans.
Congress recognized the need to provide mental and
behavioral health services to the underserved through the
Federal Community Health Centers in the Safety Net Legislation
of 2001. The Committee encourages HRSA to expand its efforts to
provide mental and behavioral health services by increasing the
number of psychologists in Community Health Centers nationwide.
An estimated 80 million people have a potentially blinding
eye disease, 3 million have low vision, 1.1 million are legally
blind, and 200,000 are more severely visually impaired. While
it is believed that half of all blindness can be prevented, the
number of Americans who suffer vision loss continues to
increase. To address this growing problem, the Committee urges
the Administrator to strengthen the vision health services at
community health centers by establishing partnerships with
voluntary health organizations to improve the overall quality
of eye care, including comprehensive vision screenings and
appropriate follow up care.
The Committee recognizes that prenatal alcohol exposure is
the leading known cause of mental retardation in the United
States. It is associated with lifelong difficulties with
learning, memory, attention, and problem solving as well as
problems with mental health and social interactions. Each year,
approximately 40,000 children are born with Fetal Alcohol
Spectrum Disorders [FASD]. This amounts to almost 1 out of 100
live births, with a disproportionate impact on underserved
American Indian and African American populations. The Committee
has provided sufficient funding to coordinate, develop, and
begin implementation of a program in collaboration with a
national voluntary organization that incorporates sustainable
systems in community health center delivery sites around the
Nation focusing on the prevention, identification, and support
of individuals with FASD.
The Committee is concerned by the increasing disparity in
the amount of applications received and grants awarded to
States under section 330, in particular the Health Center
grants. Because of this disparity, many high need States and
local communities are not being benefited by a program
specifically designed to serve their needs. The Committee
acknowledges that this is a competitive grant program and not
all grant applications submitted are of the quality necessary
to receive funding. However, recent trends indicate that there
may be other factors contributing to this problem. Therefore,
the Committee requests that HRSA study this issue further and
within 90 days of enactment of this Act, prepare and submit a
report to the Committee that includes factors contributing to
the disparity and ways that HRSA hopes to remedy these factors.
School-Based Health Centers
This program provides grants for comprehensive primary and
preventive health care services and health education to at-risk
and medically underserved children and youth. Grants are
awarded to public or private, nonprofit, community-based health
care providers. Through agreements with a local school or
school system, the health care entity provides the services in
the school building or on school grounds.
The Committee is pleased with the success of the school-
based health center initiative, however is concerned that in
the last fiscal year only 3 of 43 applications were funded. The
Committee expects HRSA to continue to target funds for school-
based health centers operated by fully qualified organizations
and expresses concern that school-based health centers often
experience difficulty completing the complex application
process for community health center funding. The Committee
requests that HRSA establish a separate application process for
school-based health centers that recognizes the distinct
patient volume, productivity, scope of service, and staffing
requirements that are more appropriate to school-based delivery
systems.
Migrant Health Program
The program helps provide culturally sensitive
comprehensive primary care services to migrant and seasonal
farm workers and their families. Over 80 percent of the centers
also receive funds from the community health centers program.
Health Care for the Homeless
The program provides project grants for the delivery of
primary health care services, substance abuse services, and
mental health services to homeless adults and children. About
one-half of the projects are administered by community health
centers. The other one-half are administered by nonprofit
coalitions, inner-city hospitals, and local public health
departments.
Public Housing Health Service Grants
The program awards grants to community-based organizations
to provide case-managed ambulatory primary health and social
services in clinics at or in proximity to public housing. More
than 60 percent of the programs are operated by community
health centers.
Native Hawaiian Health Care
The Committee again includes the legal citation in the bill
for the Native Hawaiian Health Care Program. The Committee has
included sufficient funding so that health care activities
funded under the Native Hawaiian Health Care Program can be
supported under the broader community health centers line. The
Committee expects that not less than $15,000,000 be provided
for these activities in fiscal year 2005.
Free Clinics Medical Malpractice Coverage
The Committee provides $4,821,000 in funding for payments
of claims under the Federal Tort Claims Act to be made
available for free clinic health professionals as authorized by
U.S.C. Title 42, Section 233(o) of the Public Health Service
Act.
This appropriation continues to extend Federal Tort Claims
Act coverage to medical volunteers in free clinics in order to
expand access to health care services to low-income individuals
in medically underserved areas. According to Title 42, Section
233(o), a free clinic must apply, consistent with the
provisions applicable to community health centers, to have each
health care professional ``deemed'' an employee of the Public
Health Service Act, and therefore eligible for coverage under
the Federal Tort Claims Act. The Committee urges HRSA to create
a deeming process as quickly as possible to ensure that health
professionals treating patients at free clinics have access to
this coverage in a timely manner. HRSA should make every effort
to make the deeming process as efficient as possible and to
prevent the process from becoming a barrier to use of the
program.
Radiation and Exposure Screening and Education Program
The Committee provides $1,974,000 for the Radiation
Exposure Compensation Act. The fiscal year 2004 comparable
level was $1,974,000 and the administration request was
$1,974,000. This program provides grants for the education,
prevention, and early detection of radiogenic cancers and
diseases resulting from exposure to uranium during its mining
and milling at nuclear test sites.
Health Care Access for the Uninsured/Community Access Program
The Committee provides $88,674,000 for the Community Access
Program. The fiscal year 2004 comparable level was $83,674,000
and the administration requested $9,998,000 for a new version
of this program in fiscal year 2005. The Committee has provided
these funds to continue the Community Access Program in its
current form, which is designed to increase the capacity and
effectiveness of community health care institutions and
providers who serve patients, regardless of their ability to
pay. The Committee does not approve the new use of these funds
to create Health Center Networks. The Committee does approve
the use of up to $4,900,000 for additional Chronic Disease
Management activities provided by grantees of this program.
Community Health Centers have the potential to serve as a
valuable resource in biomedical and behavioral research aimed
at reducing health status disparities among minority and
medically underserved populations. The Committee continues to
encourage HRSA, through the Community Access Program, to
prioritize the establishment of demonstration projects between
Community Health Centers and minority health professions
schools for the purpose of health status disparities research
and data collection. Such demonstration projects were
authorized in the ``Health Care Safety Net Amendments of
2002.''
National Hansen's Disease Program
The Committee has included $17,413,000 for the National
Hansen's Disease Program. The fiscal year 2004 comparable level
was $17,413,000 and the administration request was $17,413,000
in fiscal year 2005. This program offers Hansen's Disease
treatment in Baton Rouge at the Center, at other contract
supported locations in Baton Rouge, and in grant supported
outpatient regional clinics. These programs provide treatment
to about 3,000 of the 6,000 Hansen's disease sufferers in the
United States.
National Hansen's Disease Program Buildings and Facilities
The Committee provides $249,000 for buildings and
facilities. The fiscal year 2004 comparable level was $249,000
and the administration request was $249,000. This funding
provides for the repair and maintenance of buildings at the
Gillis W. Long Hansen's Disease Center.
Payment to Hawaii for Hansen's Disease Treatment
The Committee provides $2,033,000 for Hansen's disease
services. The fiscal year 2004 comparable level was $2,033,000
and the administration requested $2,033,000.
Black Lung Clinics
The Committee provides $6,000,000 for black lung clinics.
The fiscal year 2004 comparable level was $5,963,000 and the
administration requested $5,963,000. This program funds clinics
that treat respiratory and pulmonary diseases of active and
retired coal miners. These clinics reduce the incidence of
high-cost inpatient treatment for these conditions.
BUREAU OF HEALTH PROFESSIONS
National Health Service Corps: Field Placements
The Committee provides $45,735,000 for field placement
activities. The fiscal year 2004 comparable level was
$45,506,000 and the administration request was $45,735,000. The
funds provided for this program are used to support the
activities of National Health Service Corps obligors and
volunteers in the field, including travel and transportation
costs of assignees, training and education, recruitment of
volunteers, and retention activities. Salary costs of most new
assignees are paid by the employing entity.
The Committee is pleased by the increasing percentage of
placements of NHSC assignees at Community, Migrant, Homeless,
and Public Housing Health Centers. The Committee encourages
HRSA to further expand this effort to ensure that the health
center expansion effort is sustainable and has access to a
sufficient level of health professionals.
The Committee is concerned by reports that the current HPSA
scoring process used by HRSA may be disadvantaging many health
centers located in medically underserved areas of the country.
The Committee urges HRSA to look into these reports and
reconsider requirements that might eliminate health centers
from eligibility for the placement of NHSC scholars, Ready
Responders, and HHS' J-1 Visa waiver program.
National Health Service Corps: Recruitment
The Committee provides $127,397,000 for recruitment
activities. The fiscal year 2004 comparable level was
$124,397,000 and the administration request was $159,132,000.
This program provides major benefits to students (full-cost
scholarships or sizable loan repayment) in exchange for an
agreement to serve as a primary care provider in a high
priority federally designated health professional shortage
area. These funds should support multi-year, rather than
single-year, commitments. The Committee has not included bill
language requested by the administration that would have
established a Commissioned Corps reserve within the National
Health Service Corps and the Committee does not intend for
funds to be used for this purpose.
Of this amount, $3,000,000 is designated for the
demonstration program which allows chiropractors to participate
in the National Health Service Corps student loan forgiveness
program, as authorized under section 338L of the Public Health
Service Act. The Committee is concerned that funding provided
for this demonstration in fiscal year 2003 resulted in only
eight chiropractic demonstrations nationwide. The purpose of
the demonstration program was to collect data on comprehensive
patient outcomes associated with community health centers that
provided chiropractic services. While the Committee is
comfortable with conclusions drawn from the data collected on
the 24 pharmacists in the demonstration program and looks
forward to that information in the coming year, the Committee
believes that eight chiropractors is not a statistically
significant figure and conclusions cannot safely be drawn from
this part of the demonstration. Therefore, the Committee
expects HRSA to use these funds to conduct another
demonstration on a cohort of exclusively chiropractors and
report to the Committee on the findings.
The Committee commends the National Health Service Corps
for its focus on ensuring a workforce for integrated,
comprehensive health care for the underserved that includes
mental and behavioral health services. The Committee urges the
NHSC to continue its efforts, increase the number of
psychologists in the Loan Repayment Program and begin, for the
first time, to support psychology students in the Scholarship
Program.
The national nursing shortage is pervasive throughout all
of the varied practice, educational and research settings. The
United States Public Health Commissioned Corps is a critical
aspect of our Nation's public health infrastructure and will be
relied upon to respond to a terrorist or bioterrorist event.
With the passage of the Nurse Reinvestment Act in 2002, a
National Nurse Corps grant program was established. Coupled
with the National Health Service Corps, the new National Nurse
Corps program may serve as a nurse recruiting pool for the
Commissioned Corps. The Committee urges HRSA to establish
mechanisms to encourage National Nurse Corps grant recipients
to enter the Public Health Service Commissioned Corps.
HEALTH PROFESSIONS
The Committee provides $465,357,000 for all HRSA health
professions programs. The fiscal year 2004 comparable level was
$436,080,000 and the administration requested $157,783,000 in
fiscal year 2005.
The Committee commends HRSA for its continuing efforts to
address the growing gap between the size of the Nation's aging
baby boom population and the number of pulmonary/critical care
physicians. The committee understands that HRSA is still
developing a report on the healthcare workforce shortage issue,
and that the portion of the report that will attempt to
identify the causes of, and potential responses to, the
critical care workforce shortage will be informed, in part, by
The Critical Care Medicine Crisis: A Call For Federal Action
prepared by the American College of Chest Physicians [ACCP] and
the members of the Critical Care Workforce Partnership. The
Committee continues to encourage HRSA to address the critical
care workforce shortage issue and use the pulmonary/critical
care specialty as a model for developing and testing policy
approaches to address workforce shortage issues.
The Committee previously asked HRSA to complete a national
study on the status of pediatric rheumatology in the United
States. The Committee urges HRSA to conclude its research in
this area in partnership with the Arthritis Foundation. As
provided in the Children's Health Act of 2000, this study
assesses the current pediatric services shortage and identifies
strategies for addressing this significant shortage for
children with arthritis.
Training for Diversity
Centers of Excellence
The Committee provides $33,882,000 for the Centers of
Excellence program. The fiscal year 2004 comparable level was
$33,882,000 and the administration did not request any funds
for this program in fiscal year 2005. This program was
established to fund institutions that train a significant
portion of the Nation's minority health professionals. Funds
are used for the recruitment and retention of students, faculty
training, and the development of plans to achieve institutional
improvements. The institutions that are designated as centers
of excellence are private institutions whose mission is to
train disadvantaged minority students for service in
underserved areas. Located in poor communities and usually with
little State funding, they serve the health care needs of their
patients often without remuneration.
The Committee is pleased that HRSA has re-focused the
Minority Centers of Excellence program on providing support to
historically minority health professions institutions. The
Committee recognizes the important role of this program in
supporting faculty and other academic programs at minority
institutions. The Committee continues to encourage the Centers
of Excellence program to consider applications that are
responsive to allied health professions which are experiencing
shortages and high vacancy rates, such as laboratory personnel.
Health Careers Opportunity Program
The Committee provides $35,935,000 for the Health Careers
Opportunity Program. The fiscal year 2004 comparable level was
$35,935,000 and the administration did not request any funds
for this program in fiscal year 2005. This program provides
funds to medical and other health professions schools for
recruitment of disadvantaged students and pre-professional
school preparations. The Committee continues to encourage the
H-COP program to consider applications that are responsive to
allied health professions which are experiencing shortages and
high vacancy rates, such as laboratory personnel.
The Committee is concerned about the reduced level of
support provided to minority health professions schools through
the H-COP program in fiscal year 2004. For fiscal year 2005,
the Committee encourages HRSA to give priority consideration to
awarding grants to those institutions with a historic mission
of training minorities in the health professions.
Faculty Loan Repayment
The Committee provides $1,313,000 for the Faculty Loan
Repayment program. The fiscal year 2004 comparable level was
$1,313,000 and the administration did not request any funds for
this program in fiscal year 2005. This program provides for the
repayment of education loans for individuals from disadvantaged
backgrounds who are health professions students or graduates,
and who have agreed to serve for not less than 2 years as a
faculty member of a health professions school.
Scholarships for Disadvantaged Students
The Committee provides $47,510,000 for the Scholarships for
Disadvantaged Students program. The fiscal year 2004 comparable
level was $47,510,000 and the administration requested
$9,897,000 for this program in fiscal year 2005. This program
provides grants to health professions schools for student
scholarships to individuals who are from disadvantaged
backgrounds and are enrolled as full-time students in such
schools. The Committee continues to intend that all health
professions disciplines made eligible by statute be able to
participate in the scholarships program.
Training in Primary Care Medicine and Dentistry
The Committee provides $90,742,000 for Training in Primary
Care Medicine and Dentistry programs. The fiscal year 2004
comparable level was $81,742,000 and the administration did not
request funding for this program in fiscal year 2005.
Family Medicine Training
Family medicine activities support grants for graduate
training in family medicine, grants for pre-doctoral training
in family medicine, grants for faculty development in family
medicine, and grants for the establishment of departments of
family medicine. The Committee reiterates its support for this
program and recognizes its importance in increasing the number
of primary care physicians in underserved areas.
General Internal Medicine and Pediatrics Training
This program provides funds to public and private nonprofit
hospitals and schools of medicine and osteopathic medicine to
support residencies in internal medicine and pediatrics. Grants
may also include support for faculty.
Physician Assistants
This program supports planning, development, and operation
of physician assistant training programs.
General Dentistry and Pediatric Dental Residencies
This program assists dental schools and postgraduate dental
training institutions to meet the costs of planning,
developing, and operating residency training and advanced
education programs in general practice of dentistry and funds
innovative models for postdoctoral general dentistry and
pediatric dentistry.
The Committee recognizes that these programs play a
critical role in meeting the oral health care needs of
Americans; especially those who require specialized or complex
care and represent vulnerable populations in underserved areas.
Additionally, rural States are disproportionately underserved
by pediatric dentists. The Committee notes that several States
have fewer than 10 pediatric dentists. This clearly is not
enough to address American children's needs. The Committee
intends that the Pediatric Dental Program be continued with at
least the fiscal year 2004 funding level.
Interdisciplinary, Community-based Linkages
Area Health Education Centers
The Committee provides $29,206,000 for the Area Health
Education Centers program. The fiscal year 2004 comparable
level was $29,206,000 and the administration did not request
any funds for this program in fiscal year 2005. This program
links university health science centers with community health
service delivery systems to provide training sites for
students, faculty, and practitioners. The program supports
three types of projects: Core grants to plan and implement
programs; special initiative funding for schools that have
previously received Area Health Education Centers [AHEC]
grants; and model programs to extend AHEC programs with 50
percent Federal funding.
Health Education and Training Centers
The Committee provides $3,851,000 for the Health Education
and Training Centers program. The fiscal year 2004 comparable
level was $3,851,000 and the administration did not request any
funds for this program in fiscal year 2005. These centers
provide training to improve the supply, distribution, and
quality of personnel providing health services in the State of
Florida or along the border between the United States and
Mexico and in other urban and rural areas with populations with
serious unmet health care needs.
Allied Health and Other Disciplines
The Committee provides $11,849,000 for the Allied Health
and Other Disciplines programs. The fiscal year 2004 comparable
level was $11,849,000 and the administration did not request
any funds for this program in fiscal year 2005. These programs
seek to improve access, diversity, and distribution of allied
health practitioners to areas of need. The program improves
access to comprehensive and culturally competent health care
services for underserved populations.
The Committee continues to encourage HRSA to give priority
consideration to projects for schools training allied health
professionals experiencing shortages, such as medical
technologists and cytotechnologists. The Committee is concerned
about high vacancy rates for these critical laboratory
personnel and urges HRSA to redouble efforts to address these
shortages.
The Committee understands the Graduate Psychology Education
Program is the only federally funded psychology training
program, and for this reason, considers its continuation a
priority. This competitive program will continue to provide
grant awards for work with underserved populations,
particularly in rural communities, including elderly, children,
the chronically ill, and victims of abuse or terror.
Geriatric Education Centers and Training
The Committee provides $31,805,000 for the Geriatrics
Education Centers and Training programs. The fiscal year 2004
comparable level was $31,805,000 and the administration did not
request any funds for this program in fiscal year 2005. This
program supports grants to health professions schools to
establish geriatric education centers and to support geriatric
training projects. These centers and geriatric training
programs play a vital role in enhancing the skill-base of
health care professionals to care for our Nation's growing
elderly population. The Committee is concerned about the
shortage of trained geriatricians and urges the agency to give
priority to building the workforce necessary to care for the
Nation's elderly.
Quentin N. Burdick Program for Rural Health
Interdisciplinary Training
The Committee provides $6,126,000 for these programs. The
fiscal year 2004 comparable level was $6,126,000 and the
administration did not request any funds for this program in
fiscal year 2005. This program addresses shortages of health
professionals in rural areas through interdisciplinary training
projects that prepare students from various disciplines to
practice together, and offers clinical training experiences in
rural health and mental health care settings to expose students
to rural practice.
This program continues to be an important mechanism for
addressing the shortages of health professionals in rural
areas. Particularly commendable is the focus on rural health
training projects that stimulate interdisciplinary practice and
expose students to the unique needs of rural populations. The
Committee encourages an emphasis on telemedicine technology to
maximize accessibility to resources. The Committee remains
concerned about the critical shortage of nurses and this should
continue to be addressed at every opportunity.
Podiatric Primary Care Training
This program provides grants to hospitals and schools of
podiatric medicine for residency training in primary care. In
addition to providing grants to hospitals and schools of
podiatric medicine for residency training in primary care, the
program also permits HRSA to study and explore ways to more
effectively administer postdoctoral training in an ever
changing health care environment.
Chiropractic Demonstration Grants
This program provides grants to colleges and universities
of chiropractic to carry out demonstration projects in which
chiropractors and physicians collaborate to identify and
provide effective treatment of spinal and lower back
conditions. The Committee continues to support the chiropractic
research and demonstration grant program, originally authorized
under Section 782 of Public Law 102-408, and funded by the
Committee in previous years. The Committee recommends that the
chiropractic-medical school demonstration grant program be
continued.
The Committee is aware that the initial authorization for
this program indicated that the funds were to go to colleges
and universities for the purpose of encouraging collaboration
between chiropractors and physicians on identifying and
providing effective treatment of spinal and lower back
conditions. It is the contention of this Committee that
interdisciplinary training programs are an integral component
of expanding the identification and treatment of these
conditions. The Committee is aware that a requirement of the
program is the participation of a school of medicine or a
school of osteopathic medicine. Given that the very purpose of
these entities is to train healthcare professionals, the
Committee concludes that training programs are well within the
eligible activities of this program.
Workforce Information and Analysis
The Committee provides $993,000 for these programs. The
fiscal year 2004 comparable level was $722,000 and the
administration requested $993,000.
Health Professions Data and Analysis
This program supports the collection and analysis of data
on the labor supply in various health professions and on future
workforce configurations.
Research on Certain Health Professions Issues
This program supports research on the extent to which debt
has a detrimental effect on students entering primary care
specialties; the effects of federally funded education programs
for minorities attending and completing health professions
schools; and the effectiveness of State investigations in
protecting the health of the public.
Public Health Workforce Development
With the continued need for public health training
throughout the country, the Committee believes these programs
serve an important role in maintaining the country's public
health infrastructure.
Public Health, Preventive Medicine, and Dental Public
Health Programs
The Committee provides $9,170,000 for these programs. The
fiscal year 2004 comparable level was $9,170,000 and the
administration did not request any funds for this program in
fiscal year 2005. This program supports awards to schools of
medicine, osteopathic medicine, public health, and dentistry
for support of residency training programs in preventive
medicine and dental public health; and for financial assistance
to trainees enrolled in such programs.
Health Administration Programs
The Committee provides $1,079,000 for the Health
Administration programs. The fiscal year 2004 comparable level
was $1,079,000 and the administration did not request any funds
for this program in fiscal year 2005. These programs provide
grants to public or nonprofit private educational entities,
including schools of social work, but not schools of public
health, to expand and improve graduate programs in health
administration, hospital administration, and health policy
analysis and planning; and assists educational institutions to
prepare students for employment with public or nonprofit
private agencies.
Nursing Workforce Development Programs
The Committee provides $161,890,000 for the Nursing
Workforce Development programs. The fiscal year 2004 comparable
level was $141,890,000 and the administration requested
$146,887,000 for this program in fiscal year 2005. The
Committee recognizes that the current nursing shortage has
reached a crisis state across America. The situation only
promises to worsen due to a lack of young nurses in the
profession, an aging existing workforce, and inadequate
availability of nursing faculty to prepare future nurses. The
Committee urges HRSA to support programs aimed at increasing
nursing faculty and encouraging a diverse population's entry
into nursing.
The Committee is aware of the Labor Department's
partnership with the Council for Adult and Experimental
Learning [CAEL] to address the Nation's shortage of nurses. The
Committee encourages HRSA to consider extending and expanding
these, and other, successful nurse training partnerships.
Advanced Education Nursing
The Committee provides $58,636,000 for the Advanced
Education Nursing programs. The fiscal year 2004 comparable
level was $58,636,000 and the administration requested
$43,637,000 for this program in fiscal year 2005. This program
funds nursing schools to prepare nurses at the master's degree
or higher level for teaching, administration, or service in
other professional nursing specialties.
With spiraling health care costs and the shortage of
professionals, the need to prepare quality, cost effective
providers such as nurse practitioners and nurse mid-wives
continues to be acute. The Committee understands that Nurse
Practitioners have been shown to provide high quality, cost
effective care in whatever geographic environment they
practice. The Committee believes that it is important to
prepare enough of these providers to meet health needs within
the current national shortages. The Committee urges HRSA to
maximize advanced education traineeships for these two proven
critical specialties.
Nurse Education, Practice, and Retention
The Committee provides $41,765,000 for the Nurse Education,
Practice, and Retention Programs. The fiscal year 2004
comparable level was $31,768,000 and the administration
requested $41,765,000 for this program in fiscal year 2005. The
goal of this program is to improve the quality of nursing
practice. Activities under this program will initiate new
projects that will change the educational mix of the nursing
workforce and empower the workforce to meet the demands of the
current health care system.
Nursing Workforce Diversity
The Committee provides $21,399,000 for the Nursing
Workforce Diversity program. The fiscal year 2004 comparable
level was $16,402,000 and the administration requested
$21,399,000 for this program in fiscal year 2005. The goal of
this program is to improve the diversity of the nursing
workforce through increased educational opportunities for
individuals from disadvantaged backgrounds. The Committee urges
the Division of Nursing to develop and increase cultural
competence in nursing and to increase the number of
underrepresented racial and ethnic minorities in all areas of
nursing education and practice to enhance nurses' ability to
provide quality health care services to the increasingly
diverse community it serves.
Racial/ethnic minorities comprise about 12.3 percent of the
current Registered Nurse population, compared to about 28
percent in the U.S. population. While efforts to deliver
culturally competent care with our current nursing population
are considerable and somewhat successful, there remains a
unique and critical need for more minority registered nurses.
The Committee recognizes that recent layoffs have
disproportionately impacted minority workers, and that nursing
recruitment efforts may naturally find emphasis among this
population. The Committee believes that increasing the ethnic
and cultural competence of nursing and other health professions
groups is critical to decreasing the health disparities of this
Nation. The Committee encourages HRSA to partner with
professional nursing organizations to create diversity
leadership programming and training as well as recruiting,
retaining and mentoring minority nurses in both the nursing
profession and in leadership positions within the profession.
These partnerships should focus on the goal of providing more
culturally relevant health care so as to decrease the national
infant mortality rate.
Nurse Loan Repayment and Scholarship Program
The Committee provides $31,742,000 for the Nurse Loan
Repayment and Scholarship programs. The fiscal year 2004
comparable level was $26,736,000 and the administration
requested $31,738,000 for this program in fiscal year 2005.
This program offers student loan repayment to nurses in
exchange for an agreement to serve not less than 2 years in an
Indian Health Service health center, native Hawaiian health
center, public hospital, community or migrant health center, or
rural health clinic.
Nurse Faculty Loan Program
The Committee provides $4,870,000 for the Nursing Faculty
Loan program. The fiscal year 2004 comparable level was
$4,870,000 and the administration requested $4,870,000 for this
program in fiscal year 2005. This program supports the
development of a student loan fund in schools of nursing to
increase the number of qualified nursing faculty.
The Committee recognizes that a shortage of faculty in
schools of nursing is contributing to the nationwide shortage
of Registered Nurses [RNs]. The Committee understands that in
2003, nursing programs turned away more than 16,000 potential
students due to a lack of faculty, clinical sites, and
classroom space. The Committee cites the Bureau of Labor
Statistics projected need for 1.1 million new and replacement
RNs by the year 2012. With the growing demand for health
services and the care provided by an essential nursing
workforce, the Committee urges HRSA to focus funding and
efforts on resolving the growing shortage of faculty necessary
to educate the future nursing workforce.
Comprehensive Geriatric Education
The Committee provides $3,478,000 for Comprehensive
Geriatric Education grants. The fiscal year 2004 comparable
level was $3,478,000 and the administration requested
$3,478,000 for this program in fiscal year 2005. These grants
prepare nursing personnel to care for the aging population.
Children's Hospitals Graduate Medical Education Program
The Committee has provided $303,258,000 for the Children's
Hospitals Graduate Medical Education [GME] program. The fiscal
year 2004 comparable level was $303,170,000 and the
administration requested $303,258,000 for this program in
fiscal year 2005.
The program provides support for health professions
training in children's teaching hospitals that have a separate
Medicare provider number (``free-standing'' children's
hospitals). Children's hospitals are statutorily defined under
Medicare as those whose inpatients are predominantly under the
age of 18. The funds in this program are intended to make the
level of Federal Graduate Medical Education support more
consistent with other teaching hospitals, including children's
hospitals, which share provider numbers with other teaching
hospitals. Payments are determined by formula, based on a
national per-resident amount. Payments support training of
resident physicians as defined by Medicare in both ambulatory
and inpatient settings.
National Practitioner Data Bank
The Committee provides $15,700,000 for the national
practitioner data bank. The fiscal year 2004 comparable level
was $16,000,000 and the administration request was $15,700,000.
The Committee and the administration assume that full funding
will be provided entirely through the collection of user fees
and will cover the full cost of operating the data bank. Bill
language is included to ensure that user fees are collected to
cover all costs of processing requests and providing such
information to data bank users.
Health Care Integrity and Protection Data Bank
The Committee provides $4,000,000 for the health care
integrity and protection data bank. The fiscal year 2004
comparable level was $4,000,000 and the administration request
was $4,000,000. The Committee and the administration assume
that full funding will be provided entirely through the
collection of user fees and will cover the full cost of
operating the data bank. The data bank is intended to collect,
maintain, and report on certain actions taken against health
care providers, suppliers, and practitioners.
Maternal and Child Health Bureau
Maternal and Child Health Block Grant
The Committee provides $734,817,000 for the maternal and
child health [MCH] block grant. The fiscal year 2004 comparable
level was $729,817,000 and the administration request was
$729,817,000.
The Maternal and Child Health Block Grant program provides
a flexible source of funding that allows States to target their
most urgent maternal and child health needs through development
of community-based networks of preventive and primary care that
coordinate and integrate public and private sector resources
and programs for pregnant women, mothers, infants, children,
and adolescents. The program supports a broad range of
activities including prenatal care, well child services and
immunizations, reducing infant mortality, preventing injury and
violence, expanding access to oral health care, addressing
racial and ethnic disparities and providing comprehensive care
for children, adolescents, and families through clinics, home
visits and school-based health programs.
The MCH block grant funds are provided to States to support
health care for mothers and children. According to statute, 85
percent of appropriated funds up to $600,000,000 are
distributed to States and 15 percent are set aside for special
projects of regional and national significance [SPRANS]. Also
according to statute, 12.75 percent of funds over $600,000,000
are to be used for community-integrated service systems [CISS]
programs. The remaining funds over $600,000,000 are distributed
on the same 85/15 percent split as the basic block grant. The
Committee has provided $122,530,000 for SPRANS activities. This
is $17,000,000 more than would otherwise have been available
under the statutory formula.
The Committee intends that $4,000,000 of the SPRANS amount
will be used to continue the sickle cell newborn screening
program and its locally based outreach and counseling efforts.
In addition, $5,000,000 of the SPRANS amount is intended to
continue the oral health demonstration programs and activities
in the States. The Committee also intends that $3,000,000 of
the SPRANS amount will be used for mental health programs and
activities in the States, $3,000,000 of the SPRANS amount will
be used for epilepsy demonstration projects, and $2,000,000 of
the SPRANS amount will be used for newborn and child screening
for heritable disorders as authorized in title XXVI of the
Children's Health Act of 2000.
The Committee has again provided $5,000,000 more for SPRANS
activities than would otherwise be the case under the statutory
formula for the continuation of oral health programs in the
States. Through grants, cooperative agreements or contracts,
these funds may be used to increase access to dental care for
the most vulnerable low-income children, such as Medicaid,
SCHIP, and Head Start eligible children and to implement State
identified objectives for improving oral health. Anticipated
activities include those targeting the reduction of early
childhood caries, and strengthening school-linked dental
sealant programs.
The Committee also provides an additional $3,000,000 more
for SPRANS activities than would otherwise be the case under
the statutory formula for mental health programs and activities
in the States. The Committee expects that the programs will
include mental health grants for prevention and early
intervention services for children and youth ages 0 to 24 years
and for women's mental health as it relates to their role in
the family, particularly for women diagnosed with postpartum
depression [PPD]. One out of every ten new mothers suffers from
PPD, a treatable condition that presents a range of emotional
and physical changes. Unfortunately, half of these women never
get help. The Committee encourages the Bureau to utilize this
funding to focus on low-income women and mothers of children
with low birth weight. The Committee recommends that funding be
used on science-based programs or models such as the Starting
Early Starting Smart Program that was funded by the Substance
Abuse and Mental Health Service Administration [SAMHSA] and the
Casey Family Programs to specifically target early intervention
and prevention.
Newborn screening is a public health activity used for
early identification of infants affected by certain genetic,
metabolic, hormonal and or functional conditions for which
there are effective treatments or interventions. Screening
detects disorders in newborns that, left untreated, can cause
death, disability, mental retardation and other serious
illnesses. Biliary atresia, a pediatric liver disease which
affects 1 in 10,000 infants, is such a condition. If identified
and treated before the infant reaches the age of 60 days,
biliary atresia has a high cure rate. If left untreated, it
will result in liver failure.
The Committee again provides $2,000,000 within the SPRANS
amount for the heritable disorders program authorized in title
XXVI of the Children's Health Act. This program is designed to
strengthen States' newborn screening programs and improve
States' ability to develop, evaluate, and acquire innovative
testing technologies, and establish and improve programs to
provide screening, counseling, testing and special services for
newborns and children at risk for heritable disorders. The
Committee urges HRSA to include additional conditions, such as
biliary atresia, Fragile X, and abnormally elevated levels of
bilirubin, in this evaluation of testing programs with the goal
of implementing cost-effective public health screening programs
for these and other disorders. The Committee requests a report
by March 15, 2005 on the steps taken to validate a screening
tool for biliary atresia and to launch a screening program
across the country. Given the potential of Fragile X screening
as a viable prototype for newborn and infant screening, the
Committee encourages HRSA to allocate funding from the
heritable disorders screening program toward screening and
epidemiological research activities related to Fragile X.
The Committee is aware of the extreme disparities that
exist among State newborn screening programs for metabolic and
genetic disorders. Parents and healthcare providers responsible
for the care of newborns should be able to provide the best
chance at a healthy start on life. For this reason, the
Committee strongly urges HRSA to include as a requirement for
funding a provision that parents be informed in writing of the
availability of additional tests that may not be required under
State law.
The Committee continues to support the Maternal and Child
Health Bureau's support of comprehensive treatment centers for
thalassemia patients under the SPRANS program and notes that
the current funding is due to expire in fiscal year 2005. The
Committee strongly encourages HRSA to continue this program,
expand it to include additional centers around the country, and
to continue to coordinate its activities with those of the
Cooley's Anemia Foundation.
The Committee recognizes epilepsy, a chronic neurological
condition, as a significant public health concern affecting
over 2,500,000 persons in the United States. As 125,000 new
cases of epilepsy are diagnosed annually, delayed diagnosis,
along with inadequate seizure treatment, greatly increases the
risk of subsequent seizures, brain damage, disability, and
death. Therefore, timely, effective treatment is essential. The
Committee is supportive of the epilepsy public health program
as described by the Children's Health Act of 2000 and of the
current model demonstration programs and public awareness
campaigns funded last year that would improve access to health
and other services to encourage early detection and treatment
for children and others residing in rural, urban and otherwise
medically underserved areas. The Committee supports the
implementation of recommendations addressing access to
specialty care for underserved and minority populations made in
Living Well With Epilepsy II. The Committee is pleased that
HRSA has partnered with a national voluntary epilepsy
organization to carry out these activities and encourages HRSA
to continue this partnership, the public awareness campaigns,
and the demonstration programs.
The Committee recognizes that numerous and challenging
problems exist for native Hawaiian children and adolescent
populations. The Committee urges children and adolescent
focused initiatives be pursued to provide integrated services
to this high risk population.
The Committee commends the work of the Sudden Infant Death
Syndrome Program Support Center, and encourages the Maternal
and Child Health Bureau to continue its support of this
important center. The Committee is pleased with the
collaboration between the NIH and the SIDS and Other Infant
Death Program Support Center to address the disproportionately
high incidence of SIDS among African Americans.
The Committee recognizes the critical role of the national
network of hemophilia treatment centers in providing needed
comprehensive care for bleeding disorders. The Committee urges
HRSA to provide additional resources to ensure continued access
to this model disease management network.
Chronic Fatigue Syndrome [CFS] patients' most crucial need
is for effective, compassionate medical care. Through its
demonstration grants program, HRSA has experience in piloting
new, efficient ways of delivering health care services to those
with emerging illnesses. The Committee encourages HRSA to
develop model CFS clinical centers with the goal of delivering
effective, multidisciplinary clinical care to persons with CFS.
The Committee recognizes the critical role that Maternal
and Child Health Centers for Leadership in Pediatric Dentistry
Education provide in preparing dentists with dual training in
pediatric dentistry and dental public health. Dentists in the
three currently funded programs concentrate on working with
Federal, State and local programs that provide services for
vulnerable populations including low-income children and women
and children with special health care needs. Dentists trained
through these centers provide State and community leadership in
maternal and child oral health programs, and become future
faculty specializing in pediatric dentistry and maternal and
child health. The Committee encourages the Maternal and Child
Health Bureau to extend this program to all regions.
Traumatic Brain Injury Program
The Committee provides $9,375,000 for the traumatic brain
injury program. The fiscal year 2004 comparable level was
$9,375,000 and the administration requested $9,375,000. The
program supports implementation and planning grants to States
for coordination and improvement of services to individuals and
families with traumatic brain injuries as well as protection
and advocacy. Such services can include: pre-hospital care,
emergency department care, hospital care, rehabilitation,
transitional services, education, employment, and long-term
support. The Committee includes $3,000,000 for protection and
advocacy services, as authorized under section 1305 of Public
Law 106-310.
Healthy Start Initiative
The Committee provides $105,000,000 for the healthy start
infant mortality initiative. The fiscal year 2004 comparable
level was $97,751,000 and the administration request was
$97,751,000.
The healthy start initiative was developed to respond to
persistently high rates of infant mortality in this Nation. The
initiative was expanded in fiscal year 1994 by a special
projects program, which supported an additional seven urban and
rural communities to implement infant mortality reduction
strategies and interventions. The Children's Health Act of 2000
fully authorized this initiative as an independent program.
The Committee urges HRSA to give preference to current and
former grantees with expiring or recently expired project
periods. This should include grantees whose grant applications
were approved but not funded during fiscal year 2004.
Universal Newborn Hearing Screening and Early Intervention
The Committee provides $9,872,000 for universal newborn
hearing screening and early intervention activities. The fiscal
year 2004 comparable level was $9,872,000 and the
administration did not request funds for this program in fiscal
year 2005. The Committee again rejects the administration
proposal to consolidate this program into the Maternal and
Child Health Block Grant program.
The Committee expects HRSA to coordinate projects funded
with this appropriation with projects related to early hearing
detection and intervention by the National Center on Birth
Defects and Developmental Disabilities, the National Institute
on Deafness and Other Communication Disorders, the National
Institute on Disability and Rehabilitation Research, and the
Office of Special Education and Rehabilitative Services.
Emergency Medical Services for Children
The Committee provides $20,360,000 for emergency medical
services for children. The fiscal year 2004 comparable level
was $19,860,000 and the administration requested $19,860,000
for this program in fiscal year 2005. The program supports
demonstration grants for the delivery of emergency medical
services to acutely ill and seriously injured children.
The Committee continues to be pleased with the efforts made
for the emergency medical services for children program. The 10
year Institute of Medicine [IOM] report and study was extremely
helpful. The Committee is pleased and encouraged with the
progress being made toward a 20 year update to the IOM report.
Poison Control Centers
The Committee provides $24,000,000 for poison control
center activities. The fiscal year 2004 comparable level was
$23,696,000 and the administration requested $23,696,000 for
this program in fiscal year 2005. The funds provided support
activities authorized in the Poison Control Center Enforcement
and Enhancement Act as well as the development and assessment
of uniform patient management guidelines.
The Committee recognizes that poison control centers may
serve as the entry point for sickened individuals into the
public health system. Early detection of public health threats
is critical to limiting the consequences of a threat.
Therefore, the Committee strongly urges HRSA to work with the
CDC to find innovative ways to further incorporate the poison
control centers into the public health infrastructure,
including the new BioSense initiative. HRSA and CDC should
cooperate to improve real-time data collection and analysis
from the poison control centers to identify the presence of a
potential health threat, including chemical or biological
attack, as early as possible.
HIV/AIDS Bureau
ACQUIRED IMMUNE DEFICIENCY SYNDROME
Ryan White AIDS Programs
The Committee provides $2,079,861,000 for Ryan White AIDS
programs. The recommendation includes $25,000,000 in transfers
available under section 241 of the Public Health Service Act.
The fiscal year 2004 comparable level was $2,044,861,000 and
the administration request was $2,079,861,000.
Next to the Medicaid program, the Ryan White CARE Act (the
CARE Act) is the largest Federal investment in the care and
treatment of people living with HIV/AIDS in the United States.
The CARE Act provides a wide range of community based services,
including primary and home health care, case management,
substance abuse treatment, mental health services, and
nutritional services.
Within the total provided, the Committee intends that Ryan
White AIDS activities that are targeted to address the growing
HIV/ AIDS epidemic and its disproportionate impact upon
communities of color, including African Americans, Latinos,
Native Americans, Asian Americans, Native Hawaiians, and
Pacific Islanders continue with at least the level of funding
provided in fiscal year 2004.
Advances in diagnosis, treatment, and medical management of
HIV/AIDS has resulted in dramatic improvements in individual
health, lower death rates and transmission of HIV from mother
to infant. The Committee recognizes, however, that not all HIV-
infected persons have benefited from these medical advances and
expects that the Ryan White CARE Act programs provide social
and other support services with the specific intent of
obtaining and maintaining HIV-infected individuals in
comprehensive clinical care.
The Department is encouraged to identify obstacles
confronting people with HIV/AIDS in receiving medical care
funded through the Ryan White programs and to develop
strategies to address these problems in light of the changing
medical needs of a patient population that is living longer
with current therapies.
The Committee recognizes the recent advances in the
treatment and medical care of persons with HIV disease and the
need for early access to these interventions and services.
Furthermore, the Committee understands that disparities exist
in accessing and maintaining the benefits of these recent
advances among communities highly impacted by HIV and AIDS.
Emergency Assistance--Title I
The Committee provides $615,023,000 for emergency
assistance grants to eligible metropolitan areas
disproportionately affected by the HIV/AIDS epidemic. These
funds are provided to metropolitan areas meeting certain
criteria. Half of the funds are awarded by formula and the
other half are awarded through supplemental competitive grants.
Comprehensive Care Programs--Title II
The Committee provides $1,120,900,000 for HIV health care
and support services. These funds are awarded to States to
support HIV service delivery consortia, the provision of home
and community-based care services for individuals with HIV
disease, continuation of health insurance coverage for low-
income persons with HIV disease and support for State AIDS drug
assistance programs [ADAP].
The Committee continues to be encouraged by the progress of
anti-retroviral therapy in reducing the mortality rates
associated with HIV infection and in enhancing the quality of
life of patients on medication. The Committee has approved bill
language for $783,872,000 for AIDS medications.
Early Intervention Program--Title III-B
The Committee provides $197,170,000 for early intervention
grants. These funds are awarded competitively to primary health
care providers to enhance health care services available to
people at risk of HIV and AIDS. Funds are used for
comprehensive primary care, including counseling, testing,
diagnostic, and therapeutic services.
Women, Infants, Children, and Youth--Title IV
The Committee provides $73,108,000 for title IV pediatric
AIDS. Funds are awarded to community health centers, family
planning agencies, comprehensive hemophilia diagnostic and
treatment centers, federally qualified health centers under
section 1905(1)(2)(B) of the Social Security Act, county and
municipal health departments and other nonprofit community-
based programs that provide comprehensive primary health care
services to populations with or at risk for HIV disease.
Title IV of the CARE Act provides a program of grants for
coordinated services and access to research for women, infants,
children and youth. Title IV grantees may engage in a broad
range of activities to reduce mother-to-child transmission,
including voluntary testing of pregnant women and treatment to
reduce mother-to-child transmission. In addition, title IV
grantees are required to provide individuals with information
and education on opportunities to participate in HIV/AIDS
clinical research.
The Committee expects HRSA to maximize available funds
under this part to existing grantees. The Committee is
concerned that instructions to HRSA regarding the analysis of
data pertaining to administrative costs in title IV have not
been followed. The Committee strongly urges HRSA to collaborate
with grantees under this title to produce necessary tools for
the accurate collection of expense data. Unless HRSA can
produce data regarding administrative expenses with a precise
definition to ensure accuracy and comparability, the agency
will be unable to impose a limitation on such expenses without
harming the ability of grantees to provide services for women,
children, youth and families infected with HIV.
The Committee is aware of the efforts of title IV grantees
to care for youth infected with HIV and urges HRSA to
disseminate the effective practices and models of care
developed by title IV grantees across all Ryan White CARE Act
providers.
Technical assistance may be provided to title IV grantees
using up to 2 percent of the funds appropriated under this
section. Within this amount sufficient funds exist to maintain
the current activities of the national title IV grantee
membership organization and its ability to provide technical
assistance to title IV grantees and to conduct policy analysis
and research.
AIDS Education and Training Centers
The Committee provides $35,335,000 for the AIDS education
and training centers [AETC's]. AIDS education and training
centers train health care practitioners, faculty, and students
who care for AIDS patients outside of the traditional health
professions education venues, and support curriculum
development on diagnosis and treatment of HIV infection for
health professions schools and training organizations. The
targeted education efforts by AETC's are needed to ensure the
cost-effective use of the significant expenditures in Ryan
White programs and the AIDS drugs assistance program. The
agency is urged to fully utilize the AETC's to ensure the
quality of medical care and to ensure, as much as possible,
that no individual with HIV receives suboptimal therapy due to
the lack of health care provider information.
AIDS Dental Services
The Committee provides $13,325,000 for AIDS Dental
Services. This program provides grants to dental schools,
dental hygiene schools, and postdoctoral dental education
programs to assist with the cost of providing unreimbursed oral
health care to patients with HIV disease.
The Committee recognizes the importance of oral health care
providers in the diagnosis of HIV and in treating the painful
and debilitating oral manifestations of this disease. The
Committee supports this program as it improves access to oral
health services for low-income and uninsured people living with
HIV and AIDS by providing partial reimbursement to dental
education institutions for delivering care. The Committee
recognizes that these dental services are vital because they
are often the only services available to AIDS patients since
many State Medicaid programs do not cover adult dental
services.
Telehealth
The Committee provides $5,000,000 for telehealth
activities. The fiscal year 2004 comparable level was
$3,949,000 and the administration request was $3,949,000. The
telehealth program funded through the Office for the
Advancement of Telehealth promotes the effective use of
technologies to improve access to health services for people
who are isolated from healthcare and distance education for
health professionals.
Physician licensure is frequently identified as one of the
most critical barriers to the increased use of telemedicine.
There is a need to stimulate cooperation and communication
among licensing authorities to address these issues and to
facilitate multi-State practice, ensure public safety and
create an environment for advancing telehealth services. The
Committee has provided $1,000,000 above the fiscal year 2004
level to support incentive grants that would be used as
authorized in the Health Care Safety Net Act of 2002 to develop
and implement policies to reduce barriers to telehealth
services.
SPECIAL PROGRAMS BUREAU
Organ Donation and Transplantation
The Committee provides $24,632,000 for organ transplant
activities. The fiscal year 2004 comparable level was
$24,632,000 and the administration request was $24,632,000.
These funds support a scientific registry of organ transplant
recipients and the National Organ Procurement and
Transplantation Network to match donors and potential
recipients of organs. A portion of the appropriated funds may
be used for education of the public and health professionals
about organ donations and transplants, and to support agency
staff providing clearinghouse and technical assistance
functions.
The Committee is encouraged by the initial success of Organ
Donation Collaborative project and has included funds for its
continuation. This project is focused on the nation's largest
hospitals and has adopted the goal of assisting these hospitals
achieve organ donation rates of 75 percent or higher, which
will result in at least 6,000 additional organs available for
transplantation. The Committee also urges the agency to
facilitate the adoption of a national system of simultaneous
referrals of available organs as opposed to the current system
of sequential or serial referrals, as this will further
guarantee that all available organs are utilized.
The Committee also urges an increase in grants or contracts
to public and non-profit private entities for the purpose of
carrying out studies and demonstration projects to increase and
maximize organ donation and recovery rates, including living
donation.
The Committee commends HRSA for its leadership in promoting
increased organ and tissue donations across the nation and
encourages the Division of Transplantation to continue its
partnership with the pulmonary hypertension community in this
important area. Moreover, the Committee is aware that the Organ
Procurement and Transplantation Network/United Network for
Organ Sharing has issued a proposed rule governing the
allocation of lungs for transplantation. The Committee
encourages OPTN/UNOS to work with the pulmonary hypertension
community to address its concerns regarding the methodology
used to determine transplantation eligibility for pulmonary
hypertension patients.
National Cord Blood Stem Cell Bank Program
The Committee has provided $9,941,000 for the National Cord
Blood Stem Cell Bank Network. The fiscal year 2004 comparable
level was $9,941,000 and the administration request was
$9,941,000.
The Committee continues to be supportive of the effort to
build the Nation's supply of cord blood stem cells available
for therapy and research. The Committee is awaiting the
conclusions of the Institute of Medicine study required by
House Report 108-401 and expects fiscal year 2005 funds to be
used as described in that report.
National Bone Marrow Donor Program
The Committee provides $22,662,000 for the National Bone
Marrow Donor Registry. The fiscal year 2004 comparable level
was $22,662,000 and the administration request was $22,662,000.
The National Bone Marrow Donor Registry is a network, operated
under contract, which helps patients suffering from leukemia or
other blood diseases find matching volunteer unrelated bone
marrow donors for transplants. The program also conducts
research on the effectiveness of unrelated marrow transplants
and related treatments.
Trauma Care
The Committee provides $4,000,000 for trauma/emergency
medical services. The fiscal year 2004 comparable level was
$3,449,000 and the administration did not request funds for
this program in fiscal year 2005. This program is intended to
improve the Nation's overall emergency medical systems, which
are constantly activated to respond to a wide range of natural
and man-made disasters.
State Planning Grants for Health Care Access
The Committee provides $8,000,000 for State Planning Grants
for Health Care Access. The fiscal year 2004 comparable level
was $14,810,000 and the administration did not request funding
for this activity in fiscal year 2005.
RURAL HEALTH PROGRAMS
Rural Health Policy Development Program
The Committee provides $8,902,000 for the Rural Health
Policy Development Program. The fiscal year 2004 comparable
level was $8,902,000 and the administration request was
$8,902,000. The funds provide support for the Office of Rural
Health Policy to be the focal point for the Department's
efforts to improve the delivery of health services to rural
communities and populations. Funds are used for rural health
research centers, the National Advisory Committee on Rural
Health, and a reference and information service.
Rural Health Care Services Outreach Grants
The Committee provides $39,601,000 for health outreach
grants. The fiscal year 2004 comparable level was $39,601,000
and the administration request was $11,098,000. This program
supports projects that demonstrate new and innovative models of
outreach in rural areas such as integration and coordination of
health services.
The Committee understands that many primary care clinics in
isolated, remote locations are providing extended stay services
and are not staffed or eligible to receive reimbursement for
this service. The Committee encourages the agency to continue
its support for a demonstration project authorized in the
Medicare Modernization Act to evaluate the effectiveness of a
new type of provider, the ``Frontier Extended Stay Clinic,'' to
provide expanded services in remote and isolated primary care
clinics to meet the needs of seriously ill or injured patients
who cannot be transferred quickly to acute care referral
centers, and patients who require monitoring and observation
for a limited time without requiring costly medivacs.
Mississippi's Delta is a community in which residents
disproportionately experience disease risk factors and children
are significantly mentally and physically developmentally
behind. The Committee recognizes that communities such as this
show positive behavioral change when community based programs
and infrastructure are in place. The Committee believes that
collaborative programs offering health education, coordination
of health services and health-related research offer the best
hope for breaking the cycle of poor health in underprivileged
areas such as the Mississippi Delta. Therefore, the Committee
recommends the continued funding of these activities as already
initiated and undertaken by the coordinated efforts of the
Mississippi Delta Health Alliance, which is a collaboration
involving Delta State University, Mississippi State University,
the University of Mississippi Medical Center, and the
Mississippi State Department of Health.
Rural and Community Access to Emergency Devices
The Committee provides $10,933,000 for rural and community
access to emergency devices. The fiscal year 2004 comparable
level was $10,933,000 and the administration request was
$2,015,000. This includes $9,933,000 for the rural program
under section 413 of the Public Health Service Act and
$1,000,000 for the community access demonstration under section
313. These programs provide grants to expand placement of
automatic external defibrillators [AEDs] and to ensure that
first responders and emergency medical personnel are
appropriately trained.
Rural Hospital Flexibility Grants
The Committee provides $39,499,000 for rural hospital
flexibility grants. The fiscal year 2004 comparable level was
$39,499,000 and the administration request did not request
funds for this program.
Under this program, eligible rural hospitals may convert
themselves into limited service facilities termed Critical Care
Hospitals. Such entities are then eligible to receive cost-
based payments from Medicare. The grant component of the
program assists States with the development and implementation
of State rural health plans, conversion assistance, and
associated activities.
Of the amount provided, the Committee includes $15,000,000
to continue the Small Rural Hospital Improvement Grant Program,
as authorized by Section 1820(g)(3) of the Social Security Act
and Public Law 107-116 and outlined in House Report 107-342.
State Offices of Rural Health
The Committee provides $8,390,000 for the State Offices of
Rural Health. The fiscal year 2004 comparable level was
$8,390,000 and the administration request was $8,390,000. The
State Office of Rural Health program helps the States
strengthen rural heath care delivery systems by allowing them
to better coordinate care and improve support and outreach in
rural areas. The Committee believes that continued funds for
this purpose are critical to improving access and quality
health care services throughout rural communities.
Rural Emergency Medical Services
The Committee has provided $997,000 for the Rural EMS
Training and Assistance Grants program. The comparable fiscal
year 2004 level was $497,000 and the administration did not
request funding for this program in fiscal year 2005.
Native and Rural Alaskan Health Care
The Committee provides $41,794,000 for the Denali
Commission. The fiscal year 2004 comparable level was
$34,793,000 and the administration requested $22,000,000 for
this program in fiscal year 2005. These funds support
construction and renovation of health clinics, hospitals and
social service facilities in rural Alaska as authorized by
Public Law 106-113. Provision of the funding will help remote
communities in Alaska develop critically needed health and
social service infrastructure for which no other funding
sources are available. The Committee expects the Denali
Commission to continue its support of joint venture projects to
replace the aging hospitals in Nome and Barrow.
Family Planning
The Committee provides $308,283,000 for the title X family
planning program. The fiscal year 2004 comparable level was
$278,283,000 and the administration request was $278,283,000.
Title X grants support primary health care services at more
than 4,600 clinics nationwide. About 85 percent of family
planning clients are women at or below 150 percent of poverty
level. Title X of the Public Health Service Act, which
established the family planning program, authorizes the
provision of a broad range of acceptable and effective family
planning methods and preventive health services. This includes
FDA-approved methods of contraception.
The Committee has increased funding for clinics receiving
title X funds to address increasing financial pressures in
their effort to provide high-quality, subsidized family
planning services and preventive health care to 5 million women
each year, many of whom are low-income and uninsured. These
pressures include rising medical costs of newer and longer
lasting contraceptive methods, pharmaceuticals, and screening
and diagnostic technologies (as well as a rising uninsured
population). Due to these financial pressures, it will be
difficult for title X clinics to serve the current number of
patients, up 10 percent since 2000, without a significant
funding increase. The Committee also recognizes that the
increased availability of new contraceptive methods and
screening technologies will improve women's health and result
in a decrease in unintended pregnancies nationwide.
The Committee remains concerned that programs receiving
title X funds ought to have access to these resources as
quickly as possible. The Committee, therefore, again instructs
the Department to distribute to the regional offices all of the
funds available for family planning services no later than 60
days following enactment of this bill.
The Committee intends that at least 90 percent of funds
appropriated for title X activities be for clinical services
authorized under section 1001 of the Act. All such funds for
section 1001 activities are to be provided to the regional
offices to be awarded to grantees to provide family planning
methods and services as specified by the title X statute. The
Committee further expects the Office of Family Planning to
spend any remaining year-end funds in section 1001 activities.
Any increases in funding in fiscal year 2005 are intended to
address rising medical costs and must be spent on medical
services and supplies.
Community Based Abstinence Education Program
The Committee has provided funding for the Community Based
Abstinence Education and related programs in the Administration
for Children and Families and the Office of the Secretary as
proposed in the administration request.
Health Care-related Facilities and Activities
The Committee provides $371,536,000 for the construction
and renovation (including equipment) of health care-related
facilities and other health care-related activities. The fiscal
year 2004 comparable level was $371,536,000 and the
administration did not request funds for this program in fiscal
year 2005. This account makes funds available to public and
private entities for the construction and renovation of health
care-related facilities and other health care-related
activities.
Program Management
The Committee provides $148,533,000 for program management
activities for fiscal year 2005. The fiscal year 2004
comparable level was $148,533,000 and the administration
request was $151,317,000.
The Committee is pleased with the successful distribution
of compassionate payments through the Ricky Ray Hemophilia
Relief Fund to the many hemophilia victims who were infected
with HIV/AIDS through contaminated anti-hemophilia factor
concentrates. The Ricky Ray Hemophilia Relief Fund terminated
by law on November 12, 2003. The Committee has been advised of
cases in which only one-half of the compassionate payment has
been issued to the surviving parent. The Committee understands
that HRSA has made budgetary arrangements in anticipation of
potential additional payments. The Committee urges HRSA to work
with members of the hemophilia patient community to complete
this effort.
Section 340B of the Public Health Service Act created the
340B Drug Discount Program to lower drug prices for over 10,000
public health grantees including community health centers and
public hospitals. The Committee was disappointed to learn that
participating entities were being overcharged for drugs
purchased under the program. The Inspector General of Health
and Human Services found that entities participating in the
340B Program did not receive the correct discount for 31
percent of sampled drug purchases made by the Inspector General
in September of 2002 and estimated that grantees were
overcharged over $41,000,000 during that one month period. The
problem appears to be systemic. The Committee is concerned that
HRSA does not have the technology or personnel to properly
administer the program. In addition, HRSA does not supply
entities with accurate pricing information to verify the
charges made by the pharmaceutical industry.
The Committee urges HRSA to allocate the necessary
information technology and personnel resources needed to
properly oversee this program. The Committee requests a report
from HRSA no later than March 31, 2005 on how it plans to
respond to the problems detailed by the Inspector General in
its oversight of the 340(b) program.
MEDICAL FACILITIES GUARANTEE AND LOAN FUND
The Committee has not included funding for the Medical
Facilities and Guarantee and Loan Fund. This fund was
established in 1972 under the Medical Facilities Construction
Program in order to make funds available for construction of
medical facilities. The fund is established in the Treasury
without fiscal year limitation to pay interest subsidies, make
payments of principal and interest in the event of default on a
guaranteed loan, and repurchase, if necessary loans sold and
guaranteed. There are sufficient carryover funds from prior
years' appropriations to pay defaults and interest subsidy
payments; therefore, no appropriation is required to cover
these payments.
HEALTH EDUCATION ASSISTANCE LOANS
The Committee provides $4,000,000 to liquidate obligations
from loans guaranteed before 1992. The fiscal year 2004
comparable level was $25,000,000 and the administration request
was $4,000,000. For administration of the HEAL Program
including the Office of Default Reduction, the Committee
provides $3,270,000. The fiscal year 2004 comparable level was
$3,353,000 and the administration request was $3,270,000.
The HEAL Program insures loans to students in the health
professions. The Budget Enforcement Act of 1990, changed the
accounting of the HEAL Program. One account is used to pay
obligations arising from loans guaranteed prior to 1992. A
second account was created to pay obligations and collect
premiums on loans guaranteed in 1992 and after. Administration
of the HEAL Program is separate from administration of other
HRSA programs.
Vaccine Injury Compensation Trust Fund
Appropriations, 2004.................................... $69,190,000
Budget estimate, 2005................................... 69,176,000
Committee recommendation................................ 69,176,000
The Committee provides that $69,176,000 be released from
the vaccine injury compensation trust fund in fiscal year 2005,
of which $3,176,000 is for administrative costs. The total
fiscal year 2004 comparable level was $69,190,000 and the total
administration request was $69,176,000.
The National Vaccine Injury Compensation Program provides
compensation for individuals with vaccine-associated injuries
or deaths. Funds are awarded to reimburse medical expenses,
lost earnings, pain and suffering, legal expenses, and a death
benefit. The vaccine injury compensation trust fund is funded
by excise taxes on certain childhood vaccines.
Centers for Disease Control and Prevention
DISEASE CONTROL, RESEARCH, AND TRAINING
Appropriations, 2004.................................... $4,579,299,000
Budget estimate, 2005................................... 4,462,654,000
Committee recommendation................................ 4,807,692,000
The Committee provides a program level of $4,807,692,000
for the Centers for Disease Control and Prevention. The
Committee recommendation includes $4,538,592,000 in budget
authority and an additional $269,100,000 via transfers
available under section 241 of the Public Health Services Act.
The fiscal year 2004 comparable program level was
$4,579,299,000 and the administration request program level was
$4,462,654,000. The Committee has also provided $1,239,571,000
in the Public Health and Social Services Emergency Fund for
programs administered by CDC.
The activities of the CDC focus on several major
priorities: provide core public health functions; respond to
urgent health threats; monitor the Nation's health using sound
scientific methods; build the Nation's health infrastructure to
insure our national security against bioterrorist threats;
promote women's health; and provide leadership in the
implementation of nationwide prevention strategies to encourage
responsible behavior and adoption of lifestyles that are
conducive to good health.
The CDC portion of the Committee report has been organized
in a manner that is broadly consistent with the new structure
of CDC. To separate actual program costs from the
administration of those programs, the Committee has reallocated
all management and administrative costs (except those of the
National Institute for Occupational Safety and Health) to two
new accounts: Public Health Improvement and Leadership and
Business Services Support. This will enable CDC to more easily
interpret Congress' intent with funding increases meant for
either programs or administration of those programs. All
comparisons to fiscal year 2004 levels and the budget request
have been adjusted to reflect this reallocation.
INFECTIOUS DISEASES
The Committee recommends $1,688,594,000 for infectious
disease related programs at the CDC. The fiscal year 2004
comparable level was $1,654,394,000 and the administration
requested a comparable level of $1,656,393,000 for fiscal year
2005. The Committee recommendation includes $12,794,000 in
transfers available under section 241 of the Public Health
Services Act.
The Coordinating Center for Infectious Diseases includes
the National Center for Infectious Diseases, the National
Center for STD, TB, and HIV Prevention, and the National
Immunization Program.
Infectious Disease Control
Within the total provided, the following amounts are
provided for the specified activities above the comparable
amount for fiscal year 2004: $4,000,000 to expand west nile
virus control activities; $6,000,000 to expand all other
emerging infectious disease activities; and $1,000,000 to
expand prion disease surveillance activities. All other
activities are funded at the level of the administration's
request.
These activities focus on: national surveillance of
infectious disease; applied research to develop new or improved
diagnoses; prevention and control strategies; working with
State and local departments and private health care providers
to transfer application of infectious disease prevention
technologies; and strengthening the capability to respond to
outbreaks of new or reemerging disease.
Disease outbreaks endanger U.S. citizens at home and
abroad, threaten U.S. Armed Forces overseas, and exacerbate
social and political instability. Outbreaks can interfere with
the global marketplace, affecting tourism, trade, and foreign
investment. CDC's strategies to combat infectious diseases
invest in and build upon both the public health system that was
established over a century ago to increase the preparedness to
address the emergence of dangerous new threats.
Chronic Fatigue Syndrome.--The Committee commends the CDC
for building the leading CFS program in the Nation, supporting
crucial population studies, clinical and laboratory research
and education. The Committee directs CDC to provide sufficient
resources to maintain the high caliber of this program. The
Committee is very interested in CDC efforts to document the
economic impact of the illness, to identify biomarkers using
genomic and proteomics technology and to address health care
providers' inability to appropriately diagnose and treat CFS.
Further, the Committee encourages CDC to better inform the
public about this condition, its severity and magnitude and to
use heightened awareness to create a registry of CFS patients
to aid research in this field.
Hepatitis.--The Committee has included sufficient funding
for the National Hepatitis C Prevention Strategy, and urges
that this funding be focused on expanding the capability of
State health departments and national voluntary health
organizations to provide hepatitis C testing and counseling as
well as more aggressive outreach and medical referrals. The
Committee is concerned that the CDC has reduced the number of
hepatitis C prevention demonstration project sites from 15
sites to only 5 sites in fiscal year 2005. The Committee urges
CDC to reconsider the closing of these 10 sites, and encourages
CDC to begin implementation of a National Hepatitis C
Prevention and Control program.
The Committee is concerned that more than 75 percent of the
4 million HCV positive individuals are unaware of their
condition and therefore urges a campaign of public
announcements to urge appropriate screening and medical follow
up of target populations. The Committee urges the expansion of
cooperative agreement programs with national voluntary health
organizations to meet this and other public health goals of
CDC's Division of Viral Hepatitis. Finally the Committee is
concerned with increasing rates of adult infection with
hepatitis A and B, and urges that an expanded vaccination
program be launched in response to this health issue.
The Committee continues to be concerned about the
prevalence of hepatitis and urges CDC to work with voluntary
organizations and professional societies to promote liver
wellness with increased attention toward education and
prevention. In addition, the CDC is urged to continue to
support the activities of the National Viral Hepatitis
Roundtable.
Patient Safety.--The Committee encourages the CDC to
continue the National Health Care Safety Network, a national
electronic medical error/adverse events monitoring system. This
system will encompass a representative sample of U.S.
hospitals, managed care organizations, long-term care
facilities, and other healthcare venues linked to health
departments and CDC. The Committee also encourages the CDC to
enhance the capacity for detection and response to medical
errors and other adverse healthcare events at State and local
levels through active monitoring, improved epidemiologic/root
cause investigation, and onsite intervention to promote patient
safety and improve patient outcomes. These efforts will enable
the CDC to promote research on preventing medical errors and
adverse healthcare events through feedback on adverse outcomes.
Prevention Epicenter Program.--The Committee applauds CDC's
support for the Prevention Epicenter Program and encourages CDC
to continue and expand this program to address patient safety
issues.
Sepsis.--The Committee is aware that sepsis, an
overwhelming systemic response to infection that leads to organ
dysfunction and death, kills more that 215,000 Americans every
year. The Committee understands that new treatments have been
developed which significantly improve prognosis when sepsis is
diagnosed in a timely fashion. In addition, new guidelines have
been developed to aid health care professionals in identifying
the syndrome. Unfortunately, too few medical personnel know how
to properly diagnose sepsis. To improve patient outcomes, the
Committee encourages CDC to develop a sepsis education program
to train infectious disease physicians, emergency room doctors,
and critical care nurses in the proper identification of
sepsis.
HIV, STD, and TB Prevention
Recognizing the intersection among these diseases, and the
need for a focal point for leadership and accountability, CDC
combines HIV, STD, and TB activities to provide leadership in
preventing and controlling human immunodeficiency virus
infection, other sexually transmitted diseases [STDs], and
tuberculosis. CDC works in collaboration with partners at
community, State, national, and international levels, applying
multi-disciplinary programs of research, surveillance,
technical assistance and evaluation. These diseases are not yet
vaccine preventable and must be controlled and prevented
through identifying, diagnosing, and treating infected persons;
through provision of confidential, culturally competent
counseling to identify and reach those who have been exposed to
infection and who may not know it; and through individual and
population level health promotion to reduce high risk
behaviors.
HIV/AIDS Prevention.--CDC's HIV/AIDS prevention programs
are working in every State and territory to prevent new
infections, link people who are already infected to medical
care, and translate scientific research findings into practical
prevention programs available to every person at risk. CDC will
continue to adapt these prevention programs to meet new and
different needs.
The Committee is concerned by the high rates of HIV
infection among young men who have sex with men in the United
States. Data recently reported at the International AIDS
Conference in Barcelona indicate that infection rates are nine
times higher for gay men than for women and heterosexual men
and that African Americans and Latinos are at particularly high
risk. The Committee urges the CDC to develop and implement new
approaches to reach young men with life-saving HIV prevention
services.
Microbicides.--The Committee commends CDC for recognizing
the urgent public health need to develop new HIV prevention
options by supporting microbicide research and development, and
has provided sufficient funding to continue these activities.
CDC's role is particularly important in the clinical evaluation
of potential new products as set forth in CDC's HIV Prevention
Strategic Plan and its topical microbicide 5-year research
agenda.
Tuberculosis.--The Committee is pleased with the efforts of
the tuberculosis control program, which has reduced the number
of new tuberculosis cases for the past 10 years. However, the
number of new tuberculosis cases in foreign-born individuals in
the United States remains a concern. Although tuberculosis
rates have been falling, the Committee is aware that similar
low rates have been achieved in the past only to see a
reemergence of the disease due to inadequate control efforts.
In the end, any savings achieved during that period were more
than used to again gain control of the incidence of the
disease. The Committee has provided $3,200,000 over the fiscal
year 2004 level to expand tuberculosis control efforts to
prevent a similar reemergence. The Committee urges CDC to work
with the U.S. Citizenship and Immigration Services [USCIS] to
develop novel tuberculosis screening strategies for individuals
emigrating from high tuberculosis incidence countries. The
Committee encourages CDC to consider implementing screening
programs for high-risk individuals residing in the United
States for latent tuberculosis. The Committee also encourages
the CDC to expand efforts to reduce racial disparities in
tuberculosis incidence in the Southeastern United States.
African-Americans in the Southeast bear a disproportionate
burden of tuberculosis.
Tuberculosis is an enormous and deadly problem in the
developing world, killing millions of people in the prime of
their lives every year. Approximately 2 billion people (30
percent) have been infected with Mycobacterium tuberculosis,
the causative agent of TB. Tuberculosis is a leading cause of
death in HIV-infected individuals and in women of childbearing
age. Each year, TB takes the lives 2 million people and there
are 8 million new cases; another million die of the combination
of HIV and TB. Among infectious diseases, only HIV and
diarrheal diseases kill more people. The worldwide pandemic of
tuberculosis continues largely unabated in spite of increased
attention to the disease globally, the expansion of DOTS
(Directly Observed Therapy--Short course) therapeutic regimes,
and the widespread use of an existing vaccine against
tuberculosis. Clearly a better vaccine against tuberculosis is
urgently needed. Modeling studies show that a modestly
effective vaccine (50-70 percent efficacious) used in
combination with drug therapy could save tens of millions of
lives, and a highly effective vaccine could eventually control
the disease. The Committee encourages the CDC to continue the
TB vaccine research cooperative agreement in partnership with
the leading private foundation conducting clinical field site
trial work on tuberculosis vaccines. The Committee encourages
CDC to provide leadership and technical assistance on field
site development and surveillance.
The Committee is aware that the Centers for Disease Control
[CDC] has developed a new funding formula for the 2005 CDC
Tuberculosis [TB] Prevention and Control. This formula
calculation is a major step forward and the Committee
recognizes CDC for taking into account the burden of this
disease and the complexity of cases. The Committee also notes
that CDC intends to make 20 percent of these funds available on
a per-case basis in fiscal year 2005 and 35 percent of these
funds on a per-case basis by fiscal year 2008. The success of
TB control in the United States depends on the ability of
States to maintain past gains in TB control and move toward TB
elimination. The Committee encourages CDC to use all of the
increased funding provided to maximize the percentage of TB
control funds available on a per-case basis while ensuring that
no State receives less funding than it received in fiscal year
2004. The Committee further requests that CDC identify the
optimal percentage of funding that should be distributed on a
per-case basis.
Immunization
The Committee recommends $488,789,000 for the program
authorized under section 317 of the Public Health Service Act.
The fiscal year 2004 comparable level was $468,789,000 and the
administration requested $468,789,000 for fiscal year 2005. The
Committee recommendation includes $12,794,000 in transfers
available under section 241 of the Public Health Service Act.
The Omnibus Reconciliation Act [OBRA] of 1993 established a
vaccine purchase and distribution system that provides, free of
charge, all pediatric vaccines recommended for routine use by
the Advisory Committee on Immunization Practices to all
Medicaid-eligible children, uninsured children, underinsured,
and native Americans through program-registered providers.
Despite great success in lowering disease levels and
raising immunization coverage rates, much remains to be done to
ensure the protection of children and adults worldwide.
Approximately 1 million 2-year-old children in the United
States have not received one or more of the more established,
recommended vaccines. New vaccines, although greatly beneficial
to public health, complicate an already complex immunization
schedule and make it increasingly difficult to ensure complete
immunization. One of our Nation's greatest challenges is
extending our success in childhood immunization to the adult
population. The burden due to the occurrence of vaccine-
preventable diseases in adults in the United States is
staggering. As many as 50,000 U.S. adults die of influenza,
pneumococcal infections and hepatitis B. CDC is addressing
these obstacles to the greatest extent possible and continues
to provide leadership to reduce disability and death resulting
from diseases that can be prevented through vaccination.
The Committee encourages CDC to increase section 317 grant
support for infrastructure development and purchase of vaccines
for the State of Alaska's universal immunization program. It
has been brought to the Committee's attention that
infrastructure costs of delivering vaccines to children in
Alaska are substantially higher than in other areas of the
country, because of the many small, remote communities which
must be served primarily by air. The Committee encourages the
agency to give careful consideration to Alaska's request for
sufficient funding for the purchase of vaccines needed for 90
percent of Alaskan children and to provide infrastructure
support needed to deliver these vaccines at the community
level, including development of a statewide immunization
registry to ensure that all children in Alaska are immunized.
The Committee notes that failure to immunize children in remote
areas of Alaska results in deaths each year from exposure to
open sewage lagoons and contaminated water.
Vaccine Stockpiles.--The Committee is concerned that recent
interpretations of revenue recognition guidelines of the
Securities and Exchange Commission may jeopardize the three-
decade history of stockpiles and prevent the establishment and
continued maintenance of stockpiles managed by the Department
of Health and Human Services containing both childhood vaccines
and bio-defense medical countermeasures. The Committee requests
that the Secretary of Health and Human Services, after
consultation with the Securities and Exchange Commission and
other appropriate agencies, submit a report and recommendations
within 90 days to the Committee. The report should include what
administrative actions are being taken, solutions proposed, or
identify what legislative clarification may be necessary to
resolve this problem.
Vaccine Tracking.--The Committee is pleased by CDC's
development of the Surveillance, Preparedness, Awareness and
Response System and has included $5,000,000 to continue and
expand these efforts. In light of vaccine shortages that have
occurred over the past several flu seasons, the Committee
understands that this system could serve as a valuable
surveillance and tracking system for private and public sector
inventory levels of vaccine. Increases in funding should be
directed toward system expansion to include pharmaceuticals and
other products that would be necessary in the medical treatment
of disease and injury resulting from natural or manmade disease
outbreaks beyond that currently provided by the strategic
national stockpile.
HEALTH PROMOTION
The Coordinating Center for Health Promotion includes the
National Center for Chronic Disease Prevention and Health
Promotion and the National Center for Birth Defects and
Developmental Disabilities.
The Committee recommends $988,090,000 for Health Promotion
related activities at the CDC. The fiscal year 2004 comparable
level was $932,067,000 and the administration requested
$989,780,000.
CHRONIC DISEASE PREVENTION AND HEALTH PROMOTION
Within the total provided, the following amounts are
provided for the specified activities above the comparable
amount for fiscal year 2004: $5,000,000 to expand Heart Disease
and Stroke related activities; $5,000,000 to expand Diabetes
related activities; $24,300,000 to expand Cancer Prevention and
Control activities; $2,000,000 to establish an Alzheimer's
Disease component of the Healthy Aging program; $800,000 to
expand Inflammatory Bowel Disease related activities; $700,000
to initiate activities related to Interstitial Cystitis;
$15,000,000 to expand Tobacco related activities; $6,000,000 to
expand Nutrition, Physical Activity, and Obesity Programs;
$2,000,000 to establish the Pioneering Healthier Communities
Activities with the YMCA of the USA; $1,000,000 to expand the
Behavioral Risk Factor Surveillance System; $200,000 to expand
Mind-Body related activities; $1,000,000 to expand Glaucoma
Screening and Visual Screening Education programs; $600,000 to
expand oral health related activities; $5,000,000 to expand
Prevention Center activities; $5,000,000 to expand the Steps to
a Healthier U.S. program. All other activities are funded at
the level of the administration's request.
Chronic diseases have had a profound human and economic
toll on our Nation. Nearly 125 million Americans today are
living with some form of chronic condition, including cancer,
cardiovascular disease, diabetes, arthritis, and various
neurological conditions such as epilepsy. These and other
chronic diseases now account for nearly 70 percent of all
health care costs, as well as 70 percent of all deaths
annually. A few modifiable risk factors bring suffering and
early death to millions of Americans. Three such factors--
tobacco use, poor nutrition, and lack of physical activity--are
major contributors to our Nation's leading causes of death.
Behavioral Risk Factor Surveillance System.--The Committee
has provided $1,000,000 above the fiscal year 2004 level for
the Behavioral Risk Factor Surveillance System [BRFSS]. The
Committee notes that gathering, analyzing, and distributing
data on behavioral risk factors is key to addressing a host of
health problems, especially chronic diseases. The BRFSS program
collects behavior-related data so that scarce resources can be
directed efficiently to address chronic diseases, such as heart
disease, cancer, diabetes, obesity, and vascular diseases such
as stroke. The Committee believes the increase in BRFSS funding
should be used to increase infrastructure at the State and CDC
levels; improve the rates of response of survey questions;
increase the timeliness of data; improve CDC's web site to make
data more accessible for analysis; and create State
demonstration projects to examine and assess innovative methods
in chronic disease health tracking.
Cancer Prevention and Control.--The programs included in
the CDC's cancer line item have proven to be highly effective,
but are only a starting point if we are to reduce the mortality
from cancer. The Committee is strongly supportive of the CDC
cancer programs focused on awareness, education and early
detection and has included a significant increase for these
programs.
The significant growth of cancer prevention and control
programs within State health agencies has resulted in the
recognition that improved coordination of cancer control
activities is essential to maximizing resources and achieving
desired cancer prevention and control outcomes. The Committee
commends CDC for its work with health agencies to enhance the
number and quality of cancer-related programs that are
available to the U.S. population and to develop an integrated
and coordinated approach to reduce the cancer burden through
prevention, early detection, treatment, and rehabilitation.
Within the amounts provided, the following amounts are
provided for the specified activities above the comparable
amount for fiscal year 2004: $9,000,000 to expand breast and
cervical cancer related activities; $5,000,000 to expand cancer
registries; $2,000,000 to expand colorectal cancer activities;
$7,000,000 to expand comprehensive cancer activities; $100,000
to expand ovarian cancer activities; $100,000 to expand
prostate cancer activities; $100,000 to expand skin cancer
activities; and $1,000,000 to establish the Cancer Survivorship
Resource Center. All other activities are funded at the level
of the administration's request.
Breast and Cervical Cancer.--CDC's National Breast and
Cervical Cancer Early Detection Program has provided more than
3 million potentially life-saving screening tests for women.
Despite its success in screening these women, the program is
still only able to screen 15-20 percent of the eligible
population due to the difficulties in finding these hard to
reach women. Therefore, the Committee recommends that 50
percent of funds be used for actual provision of screening and
clinical services and the remaining 50 percent of funds be used
by States for outreach, effective management, public and
professional education, and quality assurance to ensure
enhancement of infrastructure development activities that will
provide screening and diagnostic services to eligible women.
The Committee's recommendation will enable more women to
receive these vital screening services.
Cancer Survivorship Resource Center.--The Committee
applauds the partnership between CDC and the Lance Armstrong
Foundation [LAF] to address the needs of the nearly 10 million
cancer survivors by expanding the agency's State-based
comprehensive cancer control program to include issues of
survivorship, as outlined in the recently released National
Action Plan for Cancer Survivorship. The Committee supports the
development and expansion of Live Strong to serve as a national
resource for cancer patients, survivors, and their family and
friends. Therefore, the Committee provides $1,000,000 to
enhance the Live Strong cancer survivorship resource center.
Colorectal Cancer.--Colorectal Cancer is the third most
commonly diagnosed cancer in both men and women in the United
States, and the second leading cause of cancer related deaths.
In 2003, approximately 147,000 new cases were diagnosed and
56,000 people died from the disease. When colorectal cancer is
detected and treated early, survival is greatly enhanced.
However, despite the availability of proven screening tests,
only 37 percent of colorectal cancers are diagnosed while the
disease is still in a localized stage. The Committee is pleased
with the leadership of CDC's National Colorectal Cancer
Roundtable in promoting the availability and advisability of
screening to both health care providers and the general public.
The Committee encourages the CDC to continue to expand its
partnerships with State health departments, professional and
patient organizations, and private industry to combat this
devastating disease.
Comprehensive Cancer Control.--The significant growth of
cancer prevention and control programs within State health
agencies has resulted in the recognition that improved
coordination of cancer control activities is essential to
maximizing resources and achieving desired cancer prevention
and control outcomes. The Committee commends CDC for its work
with health agencies to enhance the number and quality of
cancer-related programs that are available to the U.S.
population and to develop an integrated and coordinated
approach to reduce the cancer burden through prevention, early
detection, treatment, and rehabilitation. CDC is funding States
to develop comprehensive cancer control programs that help
build the foundation for a nationwide, comprehensive cancer
control program. Comprehensive cancer programs integrate the
full range of cancer prevention activities including research,
evaluation, health education and communication, program
development, public policy development, surveillance, and
clinical services. The Committee has provided increased funding
to expand the number of health agencies funded for
comprehensive cancer control and support research and cancer
tracking to develop, implement, and evaluate comprehensive
approaches to cancer prevention at the State and community
level.
Cooley's Anemia.--The Committee is pleased with the
progress that CDC has made with regard to the establishment of
a blood safety surveillance program for Cooley's anemia
patients, who are the largest consumers of red blood cells. The
program involves six treatment centers that handle the medical
aspects, and the Cooley's Anemia Foundation that provides
education and awareness, patient recruitment, and other
services, while CDC is creating an archive of tested and
analyzed blood samples. As the program moves forward and one
time costs are met, the Committee urges the CDC to direct an
increasing amount of the funds available to active patient
recruitment, education and awareness, and related services.
Delta Health Initiative.--The Mississippi Delta Region
experiences some of the Nation's highest rates of chronic
diseases, such as diabetes, hypertension, obesity, heart
disease and stroke. The Committee recognizes the efforts of the
Delta Health Alliance in health education, coordination of
health services and health-related research in the Mississippi
Delta. The Committee believes that such collaborative,
community-based programs offer the best hope for breaking the
cycle of poor health in underprivileged areas such as the
Mississippi Delta. The Committee recommends that the CDC
collaborate with the Delta Health Alliance in addressing the
chronic health issues of the Mississippi Delta.
Diabetes.--The Division of Diabetes Translation [DDT] is
charged with addressing diabetes public health issues across
the country. This is done primarily through funding State
Diabetes Prevention and Control Programs. The Committee
encourages CDC to fund as many States as possible at the basic
implementation level.
Today, approximately 16 million Americans have diabetes,
including 5.9 million who do not know they have the disease.
Diagnosed diabetes rose 49 percent nationally between 1990 and
2000. Type 2 diabetes, once considered an adult disease, is now
found in children. Recently released results from the largest-
ever clinical study on diabetes prevention confirmed that
diabetes can be prevented in high-risk adults. The NIH-led and
CDC-supported Diabetes Prevention Program demonstrated that
sustained lifestyle change, including modest weight loss and
physical activity, resulted in prevention of diabetes in those
diagnosed as ``pre-diabetic''. Sixteen million Americans are
``pre-diabetic''. The Committee has provided $5,000,000 over
the fiscal year 2004 funding level for diabetes-related
activities at the CDC. The Committee encourages CDC to work
with State Diabetes Control Programs to establish pilot
projects to test strategies that will become effective public
health interventions to prevent or significantly delay the
onset of diabetes in high-risk individuals and develop systems
to identify and monitor the number of people who are at highest
risk for developing diabetes.
Diabetes Education.--The Committee is concerned about the
over 18 million Americans currently living with diabetes, a
number that is increasing every year and is estimated to reach
almost 10 percent of the total U.S. population by the year
2025. In response to this public health crisis, the Committee
applauds CDC for its new cooperative agreement, which is
intended to ensure early diagnoses of people with diabetes and
the best treatment and care of those trying to manage the
disease. The Committee encourages CDC to work in partnership
with diabetes educators to identify strategies for evaluating
the effectiveness of diabetes education in improving the self-
care of people with diabetes and in reducing risk factors for
diabetes.
Epilepsy.--The Committee continues to strongly support the
CDC epilepsy program to make progress in research, epidemiology
and surveillance, early detection, improved treatment, public
education and expansion of interventions to support people with
epilepsy and their families in their communities. The Committee
understands that the ``Living Well II'' public health agenda
conference will take place again this year using these funds.
Food Marketing.--The Committee commends the CDC on the
initiation of a food marketing study as requested in the fiscal
year 2004 report and has included sufficient funding for the
continuation of those efforts.
Geraldine Ferraro Cancer Education Program.--In fiscal year
2004, Congress provided funding to initiate the Geraldine
Ferraro Cancer Education Program, as authorized by the
Hematological Cancer Research Investment and Education Act of
2002. The Committee is pleased that CDC has established a
cooperative agreement program with national health
organizations to develop strategies to provide information and
education for patients, their family members, friends, and
caregivers with respect to hematologic cancers. The Committee
expects CDC to increase efforts to address hematologic cancer
survivorship issues and improve quality of national hematologic
data. The Committee strongly encourages CDC to support
activities related to the development of interactive web based
education for health care providers on the signs, symptoms and
current treatment of blood cancer by comprehensive cancer
centers.
Glaucoma and Other Vision Disorders.--Age-related threats
to sight, including age-related macular degeneration, glaucoma,
cataracts and diabetes retinopathy are expected to nearly
double by the year 2030 with the aging of the baby-boomer
generation. Recognizing this emerging public health threat, the
Committee is aware of the demonstrated success of vision
screening programs in preventing blindness and vision
impairments among many of the more than 30 million adults that
suffer from eye-related disorders.
The Committee is encouraged by the CDC's exploration of
strategies to implement a national initiative to combat the
effects of eye-related disorders, especially glaucoma. The
Committee has included $300,000 above the fiscal year 2004
level for CDC to expand vision screening and education programs
in partnership with national voluntary health agencies and for
CDC to continue to develop a national surveillance system to
monitor trends over time and assess the economic costs of
vision loss especially related to glaucoma. In addition, the
Committee has included $700,000 above the fiscal year 2004
level to expand a model project that is testing and evaluating
the efficacy of glaucoma screening using mobile units.
Healthy Aging and Alzheimer's Disease.--Recent preliminary
studies suggest that some of the same strategies that preserve
overall health may also help prevent or delay Alzheimer's
disease and dementia. For example, epidemiological studies have
revealed that individuals taking anti-inflammatory drugs to
treat conditions such as arthritis appear to have a lower-than-
expected occurrence of Alzheimer's disease. Furthermore, a
growing body of evidence appears to link known risk factors for
diabetes, heart disease, including high blood pressure and high
cholesterol, and risk factors for Alzheimer's disease and
dementia. Additionally, evidence supports that maintaining
intellectual and physical activity and remaining socially
connected may also help stave off dementia. In light of this
information, the Committee strongly urges the CDC to work with
the Alzheimer's Association to design and launch an
Alzheimer's-specific segment of the Healthy Aging Program, to
aggressively educate the public and health professionals as to
ways to reduce the risks of developing Alzheimer's by
maintaining a healthy lifestyle. The Committee has provided
$2,000,000 for this initiative. CDC should also coordinate this
effort with the National Institute on Aging and the
Administration on Aging.
Heart Disease and Stroke.--The Committee commends the CDC
for convening national leaders across Federal and State
Governments and voluntary and professional organizations to
develop and release A Public Health Action Plan to Prevent
Heart Disease and Stroke. The Committee is concerned about the
more than 64 million Americans who live with the often
disabling consequences of heart disease, stroke and other
cardiovascular diseases. The Committee strongly urges the CDC
to expand, intensify and coordinate heart disease and stroke
prevention activities, such as enhancing both the State Heart
Disease and Stroke Prevention Program and the Paul Coverdell
National Acute Stroke Registry. The funds provided will allow
the CDC to initiate a health communications campaign about
heart attack and stroke signs and symptoms, and public and
health care provider education, and invest in standardized
methodology on lipid and other measurements. Concerned that the
CDC lacks a Division to address heart disease and stroke, the
Committee encourages the agency to consolidate and elevate its
efforts on these diseases by creating a Heart Disease and
Stroke Division. The Committee is aware that many States still
need a State-based heart disease and stroke prevention program.
The Committee strongly believes that each State should receive
funding for basic implementation of a State Heart Disease and
Stroke Prevention Program and has included additional funding
to move toward that goal. The Committee has provided $5,000,000
above the fiscal year 2004 level for heart disease and stroke-
related activities.
Inflammatory Bowel Disease.--It is estimated that up to 1
million people in the United States suffer from Crohn's disease
or ulcerative colitis, collectively known as inflammatory bowel
disease [IBD]. An epidemiological study of IBD is needed to
gain a better understanding of the prevalence of IBD in the
United States and the demographic characteristics of the IBD
patient population. Over the last 3 years, the Crohn's and
Colitis Foundation of American has provided the CDC with a
$750,000 to initiate this epidemiological study. Now that this
project has been established through an investment by the
patient community, the Committee has provided $800,000 to
continue this study.
Juvenile Diabetes.--The Committee appreciates the CDC's
participation and coordination with the National Institute of
Diabetes and Digestive and Kidney Diseases [NIDDK] on the
Genetics of Kidneys in Diabetes [GoKinD] Study. The GoKinD
Study collection provides a unique opportunity to study the
genetics of renal disease in a well-defined population. CDC and
NIDDK are charged with ensuring that the collection becomes
available to the research community, to accelerate progress in
the prevention and treatment of kidney disease in diabetes.
Interstitial Cystitis.--The Committee is aware that it
takes an average of 5 to 7 years for patients to obtain an
accurate diagnosis of interstitial cystitis [IC]. The Committee
has provided $700,000 to CDC to educate the public and medical
communities about interstitial cystitis. To implement this
initiative, CDC should partner with a voluntary patient
organization dedicated to assisting persons with IC to support
activities targeted at disseminating information regarding IC
identification, diagnosis and support services for both
families and health care providers.
Lung Cancer.--The Committee urges the CDC through its
Cancer Registries Program and in coordination with the
Comprehensive Cancer Control Program to conduct a study that
would analyze the current trends of lung cancer screening and
would evaluate the number of people currently screened for lung
cancer; how lung cancer screening is being promoted; which
screening methods are being promoted; how the benefits and
risks of screening are communicated by health professionals to
at risk populations; determine if shared decision making taking
place; and attempt to measure trends in the number of biopsies
being performed following screening exams and trends in the
stage of lung cancer diagnosis.
Oral Health.--The Committee recognizes that to effectively
reduce disparities in oral disease will require improvements at
the State and local levels. The Committee has provided
additional funding to States to strengthen their capacities to
assess the prevalence of oral diseases, to target
interventions, like additional water fluoridation and school-
linked sealant programs, and resources to the underserved, and
to evaluate changes in policies, programs and disease burden.
The Committee also expects the CDC to advance efforts to reduce
the disparities and the health burden from oral cancers and
oral diseases that are closely linked to chronic diseases like
diabetes and heart disease.
Nutrition, Physical Activity and Obesity.--Obesity is
rampant in the United States. Between 1980 and 1994, the
prevalence of obesity in the United States has increased by 100
percent in children and adolescents. More than 20 percent of
the adult population is 30 pounds or more overweight and 10 to
15 percent of children and adolescents are overweight. Risk
factors associated with obesity--physical inactivity and
unhealthy eating--account for at least 300,000 preventable
deaths each year and increase the risk for many chronic
diseases like diabetes, heart disease and cancer. The Committee
is aware that the CDC's own statistics show that Native
Americans, including Native Alaskans and Native Hawaiians
suffer higher rates of obesity than other Americans. The
Committee has included $6,000,000 over the fiscal year 2004
level for Nutrition, Physical Activity, and Obesity related
activities.
The significance of the rising epidemic of overweight and
obesity among our Nation's children has been widely
acknowledged. The current trajectory of its continuing increase
indicates grave consequences for our young people, as being
overweight in youth sets the stage for a lifetime of being
overweight. In the U.S., more than 6 million, or approximately
1 in 12, children are living in households headed by
grandparents or other relatives. And, in some locales, the rate
is as high as one in five. In many of these households,
grandparents and other relatives are the primary caregivers.
While some programs focusing on childhood overweight and
obesity include a component that involves parents, grandparents
and other caregivers often are overlooked. The Committee
encourages CDC to develop model programs that assist African
American and Hispanic grandparents in encouraging their
grandchildren to eat more healthfully and be more physically
active.
Pain Management.--Millions of Americans, the vast majority
of whom do not receive proper treatment, suffer from chronic
pain. The Committee encourages the CDC to develop physician
education and training programs related to optimal diagnosis
and treatment of chronic pain. CDC should establish a plan to
disseminate information to physicians and to educate patients
about treatment options available for the management of chronic
pain.
Paul Coverdell National Acute Stroke Registry.--Established
by Congress during the fiscal year 2001 appropriations process,
the Paul Coverdell National Acute Stroke Registry is designed
to track and improve the delivery of care to patients with
acute stroke. The CDC developed and conducted prototypes for
this Registry from 2001-2003 and plans to fund three State
Registries in 2004 to enable them to monitor and improve stroke
emergency transport response times, delivery of acute care, and
use of treatments to prevent recurrent strokes in their
communities. The Committee encourages the CDC to fund as many
additional State Registries as possible.
Pioneering Healthier Communities.--The Committee commends
the YMCA of the USA for its work toward developing healthier
communities through its Pioneering Healthier Communities
conference. The Committee has included $2,000,000 to support
these communities in the implementation of their community
action plans and to support the annual Pioneering Healthier
Communities conference to enable additional communities to
benefit from this effort.
Prader-Willi Syndrome.--Prader-Willi Syndrome is the most
common known genetic cause of life-threatening obesity in
children. The Committee encourages the CDC to initiate a study
of the incidence rate of Prader-Willi Syndrome and to provide a
system for tracking the complications from the syndrome
including causes of premature death. Additionally, early
diagnosis and treatment is crucial to the proper treatment of
Prader-Willi Syndrome and can significantly reduce the long
term care costs. The Committee encourages the CDC to develop
and disseminate educational materials to clinicians, educators,
and parents in collaboration with voluntary organizations.
Pregnancy Risk Assessment Monitoring System.--The Committee
encourages CDC to expand the Pregnancy Risk Assessment
Monitoring System [PRAMS] to enable CDC to make national
estimates on behavioral and demographic risk factors for
preterm birth. Data collected through PRAMS is used to increase
understanding of maternal behaviors and experiences and their
relationship to adverse pregnancy outcomes, to develop and
modify maternal and child health programs, and to help
incorporate the latest research findings in standards of
practice.
Prevention Research Centers.--The Committee has provided
$5,000,000 over the fiscal year 2004 funding level for
prevention research centers [PRCs], which are a network of
academic centers, public health agencies, and community
partners conducting applied research and practice in chronic
disease prevention and control. Partners design, test, and
disseminate strategies that help build evidence-based
interventions for public health programs. In this capacity,
PRCs serve a unique role to address the gaps that exist in
putting research findings and the translation of findings into
public health practice and policy change. Within the amount
provided, the Committee expects that CDC will be able to ensure
that all currently funded centers will continue to receive
funding.
Prostatitis.--The Committee understands that chronic
prostatitis affects 10 percent of the male population and may
act as a reservoir for bacterial resistance and contribute to
the spread of chronic disease in men and women by various
pathogens. The Committee urges the CDC to continue and expand
its investigation of the etiology of prostatitis.
Pulmonary Hypertension.--The Committee continues to be
interested in pulmonary hypertension [PH], a rare, progressive
and fatal disease that predominantly affects women, regardless
of age or race. PH causes deadly deterioration of the heart and
lungs and is a secondary condition in many other serious
disorders such as scleroderma and lupus. Because early
detection of PH is critical to a patient's survival and quality
of life, the Committee continues to encourage CDC to give
priority consideration to supporting a cooperative agreement
with the pulmonary hypertension community designed to foster
greater awareness of the disease.
School Health.--The Committee applauds CDC for establishing
effective coordinated school health programs in States and
local education agencies. The Committee has included sufficient
funding to continue addressing risk behaviors such as tobacco
use, unhealthy diets, and physical inactivity.
Sleep Disorders.--The Committee is concerned about the
prevalence of sleep disorders and recognizes the need for
enhanced public and professional awareness on sleep and sleep
disorders. The Committee urges CDC to work with other agencies
and voluntary health organizations to support the development
of a sleep education and public awareness initiative. Several
agencies have had success with this collaborative model.
Steps to a Healthier United States.--The Committee applauds
the Department's continued commitment to tackling the problems
of obesity, diabetes, and asthma. The Committee agrees that
these are three of the most critical chronic conditions
afflicting Americans. The Committee is concerned that existing
programs that address these problems have not yet been
implemented in all of the States. The Committee has increased
funding for this initiative and also increased existing
programs within CDC that are aimed at obesity, diabetes, and
asthma. The Committee strongly urges CDC to coordinate the
efforts of these programs such that the best possible outcome
is achieved using these funds.
Sudden Infant Death Syndrome.--The Committee notes the work
of CDC, the National Institute of Child Health and Human
Development and the Health Resources and Services
Administration in developing model guidelines for death scene
protocol for Sudden Infant Death Syndrome. The Committee
continues to encourage CDC to implement projects to demonstrate
the effectiveness of the death scene protocol in a variety of
locales (urban, suburban, and rural) throughout the Nation. The
Committee looks forward to reports of progress on this
initiative as was requested in the fiscal year 2004 Committee
report.
Tobacco Use.--In fiscal year 2004, the Committee approved a
reprogramming request by the Secretary to provide $15,000,000
in competitive grants to States that wanted to upgrade their
existing tobacco quitlines or initiate new ones. This
reprogramming was financed in fiscal year 2004 by reducing from
12 to 9 months the project period for ongoing tobacco control
grants to States. The Committee understood at that time that
this would have no impact on ongoing State operations, as CDC
would accelerate by 3 months the date that continuation grants
are issued in fiscal year 2005. The Committee has provided
$15,000,000 above the fiscal year 2004 level for tobacco-
related programs. This will ensure that both the tobacco
control grants and the tobacco quitline grants are able to
continue with at least the fiscal year 2004 funding levels.
WISEWOMAN Program.--The WISEWOMAN program builds on the
CDC's National Breast and Cervical Cancer Early Detection
Program to also screen women for heart disease, stroke and
other cardiovascular disease risk factors. The CDC also
provides lifestyle counseling and education to these women to
improve their health and to prevent cardiovascular diseases,
the leading cause of death of American women. Heart disease,
alone, is the No. 1 killer of American women and stroke is the
No. 3 killer. Since its inception in 1995, tens of thousands of
low-income and uninsured women ages 40-64 have been screened
for high blood pressure and elevated cholesterol and have
received lifestyle counseling and education. From 50 percent to
75 percent of these women were found to have either high blood
pressure or elevated cholesterol. With more than two-thirds of
the women returning for follow-up services, the program has
been effective in retaining participants and providing needed
services.
Worksite Health Promotion.--The Committee commends CDC for
its efforts to evaluate worksite health promotion programs
including the impact that such programs have on reducing health
risks, health insurance costs, and employee absenteeism. The
Committee encourages CDC to develop an employer wellness model
program based on the results of these studies and disseminate
that information to businesses.
Birth Defects, Developmental Disabilities, Disability and Health
Within the total provided, the following amounts are
provided for the specified activities above the comparable
amount for fiscal year 2004: $1,000,000 to expand autism
surveillance, awareness, and education activities; $250,000 to
expand activities related to Fetal Alcohol Syndrome; $1,000,000
to initiate activities related to Fragile X; $400,000 to expand
the National Spina Bifida Program; $1,000,000 to expand the
craniofacial malformation program; $1,000,000 to continue the
Fetal Death Prevention program; $600,000 to establish a Diamond
Blackfan Anemia public health outreach and surveillance
program; $500,000 to expand activities related to Tourette
Syndrome; $1,500,000 to expand surveillance and epidemiological
efforts of Duchenne and Becker muscular dystrophies; $1,500,000
to expand support for the Special Olympics Healthy Athletes
Initiative; $1,000,000 to expand Rehabilitation Treadmill
Therapy activities; and $250,000 to expand the work of the
Attention Deficit Resource Centers. All other activities are
funded at the level of the administration's request.
Attention Deficit Hyperactivity Disorder.--The Committee
understands that current estimates indicate that as many as 7
percent of school-age children have Attention-Deficit/
Hyperactivity-Disorder [AD/HD] and more than two-thirds of
these children will continue to experience symptoms through
adulthood. Only half of all children with AD/HD receive
necessary treatment with lower care rates among girls,
minorities and children in foster care. The Surgeon General has
reported a severe lack of professions trained to diagnose and
treat the condition effectively. The Committee continues to
support the National Resource Center on AD/HD and has provided
$250,000 above the fiscal year 2004 level to expand the
activities at the Center to respond to the overwhelming demand
for information and support services; to better reach special
populations in need; to develop on-line educational tools for
professionals; and, to enable CDC to expand its population-
based research and surveillance.
Autism.--The Committee acknowledges the importance of CDC's
work in the area of autism surveillance, research, and
awareness, and has provided $1,000,000 above the fiscal year
2004 level to continue and expand the autism-related programs.
Childhood Obesity Prevention in Children with Special
Health Care Needs.--As authorized under Title XXIV of the
Children's Health Act of 2000, the Committee encourages the CDC
to fund public health research, surveillance and educational
activities related to obesity among children with special
health care needs, with a special emphasis on children with
Prader-Willi Syndrome.
Craniofacial Malformation.--The Committee has included
$1,000,000 over the fiscal year 2004 level to build on its
initiative to help families of children with craniofacial
malformations. The Committee recommends that these funds be
used to work with one or more of CDC's Centers for Birth
Defects Research and Prevention to collect data on the
prevalence of these malformations, the ability of families to
access services, and the long-term outcomes associated with
craniofacial malformation. Funds are also available for CDC to
work with a national voluntary organization to analyze and
disseminate this information.
Diamond Blackfan Anemia.--The Committee has included
$600,000 to establish a public health outreach and surveillance
program for Diamond Blackfan anemia. These funds should be used
to (a) educate clinicians and blood disorder treatment centers
about DBA and how to diagnose it and (b) collaborate with a
Clinical Care Center, which already has significant experience
in treating DBA patients, to create a critical mass of DBA
expertise where DBA patients may be referred.
Disability and Health.--The Committee urges the CDC to
significantly expand and strengthen its investment in the
public health research, surveillance activities, and
dissemination of scientific and programmatic health promotion
and wellness information for children and adults with
disabilities.
Down Syndrome.--The Committee encourages the CDC to conduct
two epidemiological studies on Down syndrome to (1) obtain an
accurate estimate of the number of people in the United States
living with the disorder and to identify them by age and ethnic
group, and (2) to document the onset and course of secondary
and related developmental and mental disorders in individuals
with Down syndrome. The Committee commends the National Center
for Birth Defects and Developmental Disorders for planning and
initiating these studies in fiscal year 2004.
Fetal Alcohol Spectrum Disorders.--The Committee recognizes
that prenatal alcohol exposure is the leading known cause of
mental retardation in the United States. It is associated with
lifelong difficulties with learning, memory, attention, and
problem solving as well as problems with mental health and
social interactions. Each year, approximately 40,000 children
are born with Fetal Alcohol Spectrum Disorders [FASD]. This
amounts to almost 1 out of 100 live births, with a
disproportionate impact on underserved American Indian and
African American populations. The Committee has provided
$250,000 over the fiscal year 2004 level for FASD-related
programs and recommends that the CDC expand surveillance
efforts to document the magnitude of the problem and continue
to support the development of an information clearinghouse on
FASD and the dangers of drinking while pregnant.
Fetal Deaths.--CDC has reported that fetal deaths at 20
weeks gestation or greater account for nearly as many deaths as
those that occur to infants during the first year of life. The
Committee understands that prevention strategies must first
recognize fetal deaths as a public health problem, improve
fetal death surveillance and reporting, and conduct research to
understand the causes of fetal death. To that end, the
Committee has included $1,000,000 for a demonstration project
with several States to link existing birth defect surveillance
systems and fetal death registries and to use that data to help
develop strategies to reduce fetal deaths.
Fragile X.--The Committee believes that the CDC's focus on
maximizing prevention potential, minimizing impact on families
and promoting early intervention through developmental
screening should incorporate individuals affected by Fragile X.
To support this effort, CDC is encouraged to create a Fragile X
public health program to expand surveillance and
epidemiological study of Fragile X, as well as provide patient
and provider outreach on Fragile X and other developmental
disabilities in collaboration with voluntary organizations,
such as the National Fragile X Foundation. The Committee has
provided $1,000,000 to support these activities.
Muscular Dystrophies.--The Committee is concerned with the
pace of the development of the CDC Birth Defects Surveillance
program covering the muscular dystrophies and recommends that
the agency substantially increase the internal staff commitment
to the program. The Committee has provided $1,500,000 above the
fiscal year 2004 level to expand these activities. Within the
increase, the Committee has provided $500,000 to initiate a
coordinated education and outreach initiative in collaboration
with a volunteer organization, such as the Parent Project
Muscular Dystrophy.
Paralysis Resource Center.--More than 2 million Americans
live with paralysis, including spinal cord injury, stroke,
multiple sclerosis, cerebral palsy, spina bifida and, ALS.
Those living with paralysis have a desperate need for
information and support to improve their health and quality of
life. In 2000, Congress established the Christopher and Dana
Reeve Paralysis Resource Center to provide information and
support to individuals living with paralysis, their caregivers
and their families. To keep up with the exploding demand for
information and support services, the Committee has provided
sufficient funds to continue to support the Paralysis Resource
Center at no less than the fiscal year 2004 level.
Regional Centers for Birth Defects Research and
Prevention.--The Committee encourages CDC to expand research
activities conducted by the 10 regional Centers for Birth
Defects Research and Prevention. The centers are located in
Arkansas, California, Georgia, Iowa, Massachusetts, New Jersey,
New York, North Carolina, Texas, and Utah. These centers are
participating in the National Birth Defect Prevention Study,
the largest case-control study of birth defects ever conducted.
The Committee is deeply concerned that for the first time since
1958, infant mortality rates have increased, and therefore
encourages the expansion of studies on the causes of birth
defects, the leading cause of infant mortality.
Rehabilitation Treadmill Therapy.--The Committee provides
$1,000,000 over the fiscal year 2004 level to continue and
expand programs that translate clinical rehabilitation
treadmill therapy research to community based settings and to
train health care professionals to appropriately deliver this
promising therapy. Within the additional funding provided,
$500,000 is to continue and expand the existing demonstration
programs in collaboration with the Christopher Reeve Paralysis
Foundation. The remaining $500,000 is to be used by CDC to
evaluate the feasibility of widespread implementation of these
rehabilitation programs.
Spina Bifida.--The Committee recognizes that Spina Bifida
is the leading permanently disabling birth defect in the United
States. While Spina Bifida and related neural tube defects are
highly preventable through proper nutrition, including
appropriate folic acid consumption, and its secondary effects
can be mitigated through appropriate and proactive medical care
and management, such efforts have not been adequately supported
or coordinated to result in significant reductions in these
costly conditions. In an effort to improve the quality-of-life
for individuals affected by Spina Bifida and reduce and prevent
the occurrence of--and suffering from--this birth defect, the
Committee provides $400,000 above the budget request to expand
the the National Spina Bifida Program. Within the total
provided, $200,000 is to partner with a national voluntary
organization for the creation of a National Spina Bifida
Clearinghouse and Resource Center to meet the current and
growing demand for information and support services for
individuals and families affected by Spina Bifida.
Special Olympics Healthy Athletes Initiative.--To address
the unmet health needs among its athletes, Special Olympics
created the Healthy Athletes Program, which provides Special
Olympics athletes access to an array of health assessment,
education, preventive health services and supplies, and
referral for follow-up care where needed. These services are
provided to athletes without cost in conjunction with
competitions at local, State, national, and international
levels. The Committee has included $1,500,000 above the fiscal
year 2004 level for this program.
State Cooperative Agreements for Birth Defects
Surveillance.--The Committee encourages CDC to increase support
to States to develop, implement, and/or expand community-based
birth defects tracking systems, programs to prevent birth
defects, and activities to improve access to health services
for children with birth defects.
Thrombophilia.--The Committee understands that at least 1
in 15 Americans has thrombophilia, which increases their risk
of developing life threatening thrombosis (blood clots), and
60,000 deaths annually are directly attributable to blood
clots. Many more die from blood clot related complications. The
Committee is concerned that physicians and the public are
poorly informed about the risks of thrombosis and
thrombophilia. CDC has funded eight sites to begin gathering
information on the dimensions of this disease and related
thrombosis. The Committee encourages the CDC to expand the
number of sites to address the dimensions of this widespread
public health problem.
Tourette Syndrome.--The Committee encourages CDC to
establish public health education and research programs in
partnership with a national voluntary health association
dedicated to assisting parents and families of children with
Tourette Syndrome. The programs should be designed to reach
parents, educators, pediatricians, physicians, and other health
workers in a campaign consistent with the authority and
direction of the Children's Health Act of 2000, and to increase
scientific knowledge on the prevalence, risk factors and co-
morbidities of Tourette Syndrome. The Committee has provided
$500,000 above the fiscal year 2004 level to expand Tourette
Syndrome-related activities.
HEALTH INFORMATION AND SERVICE
The Coordinating Center for Health Information and
Services.--Includes the National Center for Health Statistics,
a new National Center for Health Marketing, and a new National
Center for Public Health Informatics.
The Committee recommends a program level of $235,658,000
for Health Information and Service related activities at the
CDC. This recommendation includes $139,209,000 in transfers
available under section 241 of the Public Health Service Act.
The fiscal year 2004 comparable program level was $216,692,000
and the administration requested $235,658,000.
Health Statistics
CDC's statistics give us context and perspective on which
we can base important public health decisions. By aggregating
the experience of individuals, we gain a collective
understanding of our health, our collective experience with the
health care system, and our problems and public health
challenges. NCHS data are used to create a basis for
comparisons between population groups or geographic areas, as
well as an understanding of how trends in health change and
develop over time.
The NCHS is the Nation's preeminent source of health
statistics and therefore provides the foundation for assessing
National health trends and developing sound programs and
policies to protect and enhance the Nation's health. The
Committee is concerned with the adequacy and overall
coordination of the various Federal programs that collect,
analyze, and report the health statistics necessary for policy
development and public health interventions. During this period
of rapid advance in health and welfare policy, medical
practice, and biomedical knowledge, the Committee is committed
to ensuring that timely and relevant health statistics are
available to guide policy decisions. The Committee has provided
additional funds for the NCHS to strengthen its data collection
infrastructure.
ENVIRONMENTAL HEALTH AND INJURY PREVENTION
As funded by the Committee, the Coordinating Center for
Environmental Health and Injury Prevention includes the
National Center for Environmental Health, the Agency for Toxic
Substances and Disease Registry, and the National Center for
Injury Prevention and Control.
The Committee recommends $290,126,000 for environmental
health and injury prevention related activities at the CDC. The
fiscal year 2004 comparable level was $282,926,000 and the
administration requested $282,926,000 for fiscal year 2005.
Environmental Health
Within the total provided, the following amounts are
provided for the specified activities above the comparable
amount for fiscal year 2004: $1,000,000 to expand the Health
Tracking Network; $1,000,000 to expand Primary Immune
Deficiency activities; and $500,000 to expand Asthma related
activities. All other activities are funded at the level of the
administration's request.
Many of the public health successes that were achieved in
the 20th century can be traced to innovations in environmental
health practices. However, emerging pathogens and environmental
toxins continue to pose risks to our health and significant
challenges to public health. The task of protecting people's
health from hazards in their environment requires a broad set
of tools. First among these tools are surveillance and data
collection to determine which substances in the environment are
getting into people and to what degree. It also must be
determined whether or not these substances are harmful to
humans, and at what level of exposure. Many scientists estimate
that about two-thirds of all cancers result from environmental
exposure, but much better data are needed to improve this
estimate and determine which exposures cause cancer and other
diseases.
Asthma.--The Committee is pleased with the work that the
CDC has done to address the increasing prevalence of asthma.
However, the increase in asthma among children remains
alarming. The Committee urges CDC to expand its outreach aimed
at increasing public awareness of asthma control and prevention
strategies, particularly among at-risk populations in
underserved communities. To further facilitate this effort, CDC
is urged to partner with voluntary health organizations to
support program activity consistent with the CDC's efforts to
fund community-based interventions that apply effective
approaches demonstrated in research projects within the
scientific and public health community.
In addition, the Committee commends CDC's efforts to
collect national and local data on the incidence and prevalence
of asthma and to implement asthma prevention programs. The
Committee encourages CDC to continue with these activities and
expand its prevention programs into areas of high pediatric
asthma incidence.
Childhood Lead Poisoning Prevention.--The Committee
commends the CDC for its commitment to support the enhanced
development of a portable, hand-held lead screening device that
holds great promise for increasing childhood screening rates in
underserved communities. Further development of this device
will help ensure its application in community health settings.
Environmental Health Laboratory.--The CDC environmental
health laboratory performs assessments for State investigations
of diseases (such as cancer and birth defects) and
investigations of chemical exposures, such as dioxin,
pesticides, mercury and cadmium. CDC is also working with
States to improve public health laboratories that assess State
level biomonitoring needs. CDC works closely with academic
institutions, other Federal agencies, and other partners to
measure human exposure to toxic substances and the adverse
effects of that exposure.
The CDC's National Report on Human Exposure to
Environmental Chemicals is a significant new exposure tool that
provides information for setting research priorities and for
tracking trends in human exposures over time. However, as CDC
has recognized, this information does not by itself provide
information on causes for effects in humans. Therefore,
communicating these results in context is vitally important.
The Committee applauds the CDC's efforts in this regard and
encourages the agency to continue to do so.
Environmental Health Workforce.--The Committee encourages
the CDC to begin the enhancement and revitalization of
environmental health services at the National, State, and local
levels. A 1980 Health and Human Services report stated that
there were 235,000 individuals in the Nation's environmental
health work force and the report forecasted 137,000 additional
professionals would be needed over the following decade. In
2000, a Health and Human Services report estimated that the
size of our country's environmental health work force had
shrunk to 19,431. During this same period, the demand for
environmental health services had expanded to include external
and internal air quality, drinking water quality, food safety,
childhood lead poisoning, asthma control, rodent control, and
hazardous chemical control and management. In addition, city
and State environmental health personnel are responsible for
providing the initial response to acts of chemical and
radiological terrorism. In light of this increased demand and
our country's reduced capacity, the Committee is concerned
about the need to enhance and revitalize environmental health
services at the National, State, and local levels.
Health Tracking Network.--The Committee has provided
$1,000,000 over the fiscal year 2004 level to continue and
expand the development of a Health Tracking Network, which
seeks to develop a surveillance system that can integrate
environmental hazards data with human exposure and health
effects data that have possible links to the environment. With
health tracking, public health officials can better target
preventive services, health care providers can offer better
health care, and the public will be able to develop a clear
understanding of what is occurring in their communities and how
overall health can be improved.
The initial efforts to establish such a Network are now
being carried out through a series of State grants to develop
pilot initiatives and projects. The Committee understands that
a critical component of the nationwide tracking program is
assuring that communities are engaged in the process of
developing the State-based networks and informed of the
results. The Committee urges CDC and the State and local
programs to work with the citizens in local communities.
Perchlorate Contamination.--The Committee is concerned
about contamination due to perchlorate, which is primarily used
as an oxidizer for rocket fuel and munitions. Perchlorate
contamination has been discovered in 34 States and is known to
have adverse health affects on pregnant women, newborns, and
young children. The Committee strongly urges the CDC to conduct
surveys on the level of perchlorate in humans, to provide
information for assessments on a national level, and to address
regional concerns in areas most affected.
Primary Immunodeficiency Diseases.--In each of the last 3
years, Congress has made available funds for CDC to support the
national physician education and public awareness campaign
developed by the Jeffrey Modell Foundation. The Foundation has
leveraged more than $7 from donors and the media for every
Federal dollar appropriated and is a model of public-private
cooperation. The campaign has featured physician symposia,
publications, public service announcements, and the development
of website and educational materials, as well as mailings to
physicians, school nurses and others. This very successful
physician and public awareness campaign now must expand its
reach to underserved communities, including African-American
and Hispanic populations, and the Committee has provided
sufficient funding to reach that critical goal. In addition,
the Committee encourages CDC to expand it programmatic activity
on primary immune deficiency diseases to include pilot programs
focused on newborn screening and school wellness. The Committee
has provided $1,000,000 over the fiscal year 2004 level for
these purposes.
Severe Combined Immune Deficiency Disease.--It has come to
the Committee's attention that NIH has developed the technology
to screen newborns for severe combined immune deficiency
disease [SCID] or ``the bubble boy disease.'' The Committee
commends the Newborn Screening Branch at the National Center
for Environmental Health at CDC for their commitment to
developing a newborn screening program for SCID. The Committee
encourages the CDC to consider support for the development of a
newborn screening program for SCID.
Injury Prevention and Control
CDC is the lead Federal agency for injury prevention and
control. Programs are designed to prevent premature death and
disability and reduce human suffering and medical costs caused
by: fires and burns; poisoning; drowning; violence; lack of
bicycle helmet use; lack of seatbelt and proper baby seat use;
and other injuries. The national injury control program at CDC
encompasses non-occupational injury and applied research in
acute care and rehabilitation of the injured. Funds are
utilized for both intramural and extramural research as well as
assisting State and local health agencies in implementing
injury prevention programs. The Committee recognizes the vital
role CDC serves as a focal point for all Federal injury control
activities.
The Committee has provided additional funding to the
National Center for Injury Prevention and Control. In part,
these funds should be used to strengthen the capacity of State
and local health agencies to prevent injuries and support
extramural public health research to conduct and translate
science into practice. The increase would expand public health
support for injury prevention programs in States and ensure
provision of necessary tools for developing effective injury
prevention programs in our communities.
Sufficient funds have been included to continue support for
all existing Injury Control Research Centers.
Fire and Fall Injury Prevention.--CDC funds five States to
implement and evaluate Remembering When, a fire and fall injury
prevention program directed at older adults. Remembering When
was developed by the National Fire Protection Association, with
assistance from CDC, the Consumer Product Safety Commission and
others. CDC also funds 13 States to install 10-year lithium
powered smoke alarms and to provide fire-safety education in
homes in high-risk communities. High-risk communities are those
with fire death rates higher than State and national averages
and median household incomes below the poverty level. Homes
with children and older adults are especially targeted for
smoke alarm installation and education outreach. The Committee
encourages CDC to continue the implementation of this project.
National Violent Death Reporting System.--The Committee
provides an increase of $700,000 over the fiscal year 2004
level for the National Violent Death Reporting System [NVDRS]
to allow additional States to be funded to gather and share
State-level data about violent deaths. This State-based system
collects data from medical examiners, coroners, police, crime
labs, and death certificates to understand the circumstances
surrounding violent deaths. The information can be used to
develop, inform, and evaluate violence prevention programs.
Rape Prevention and Education.--The CDC provides one of the
only sources of funding for rape prevention and education. Most
other funding sources are focused on services to survivors and
the criminal justice system. The Committee urges CDC to ensure
that States receiving funds from the grants for assistance to
victims of sexual assault, as provided in the Violence Against
Women Act, support State sexual assault coalitions, community-
based rape crisis centers, and other non-profit entities whose
work is focused on ending sexual violence, operating hotlines
for victims of sexual violence and their families, and those
which provide crisis intervention, advocacy and support
services to victims. The Committee urges the CDC to ensure that
States work collaboratively with State sexual assault
coalitions in planning and funding activities. The Committee
has provided $2,000,000 over the fiscal year 2004 level for
these activities. The Committee recommends that a portion of
these additional funds be used to fund awareness activities and
materials in conjunction with Sexual Assault Awareness Month.
Through its technical assistance, training and
informational materials, the National Resource Center on Sexual
Assault has played an increasingly important role in bringing
direction, coordination and voice to a movement that was
previously dispersed and disconnected. The Committee has
provided sufficient resources to fund this Center at the
statutory maximum of $1,000,000.
Suicide Prevention.--The Committee encourages CDC to
conduct suicide prevention research and support demonstration
projects to identify promising and effective suicide prevention
strategies. Research will enhance the knowledge base about risk
and protective factors and the consequences of suicidal
behavior in order to develop more effective prevention
strategies.
Traumatic Brain Injury.--The Committee understands that a
National Information Center for Traumatic Brain Injury is
expanding as a pilot program providing persons with brain
injury, their families, and those who serve them with toll-free
information on State-specific resources and linkage to service.
The Committee encourages the CDC to be supportive of this
National Information Center. The Committee also encourages the
CDC to fulfill its duties under the TBI Act as part of the
Children's Health Act, such as monitoring the outcomes and
services of people who sustain injuries, including TBI, during
mass casualty events such as a terrorist attack; strengthen
support for State and local efforts to collect data on TBI;
increasing education and awareness efforts; conduct public
health research related to TBI and collecting annual incidence
and outcome data on ``mild'' TBI.
Violence Against Women.--The Committee urges the CDC to
increase research on the psychological consequences of violence
against women and expand research on special populations and
their risk for violence including adolescents, older women,
ethnic minorities, women with disabilities, and other affected
populations.
OCCUPATIONAL SAFETY AND HEALTH
The Committee recommends $294,587,000 for occupational
safety and health programs. The fiscal year 2004 comparable
level was $276,988,000 and the administration requested
$278,587,000 for fiscal year 2005. The Committee recommendation
includes $82,097,000 in transfers available under section 241
of the Public Health Service Act.
The CDC's National Institute for Occupational Safety and
Health [NIOSH] is the only Federal agency responsible for
conducting research and making recommendations for the
prevention of work-related illness and injury. The NIOSH
mission spans the spectrum of activities necessary for the
prevention of work-related illness, injury, disability, and
death by gathering information, conducting scientific
biomedical research (both applied and basic), and translating
the knowledge gained into products and services that impact
workers in settings from corporate offices to construction
sites to coal mines.
NIOSH has a unique legislative history that is distinct
from other components of CDC. NIOSH was created under the
Occupational Safety and Health Act of 1970, to be a separate
Institute within what is now the Department of Health and Human
Services. NIOSH was charged with carrying out the many
responsibilities given the Secretary under the authorizing
legislation, including conducting research, recommending
criteria for standards, providing information on toxic
substances and training occupational safety and health
professionals. Since that time Congress has significantly
expanded NIOSH's role to include carrying out responsibilities
given the Secretary of Health and Human Services under the Mine
Safety and Health Act and Energy Employees Occupational Illness
and Compensation Act. Today, NIOSH is responsible for a wide
range of programs and activities to enhance workers safety and
health. With its sister agencies, the Occupational Safety and
Health Administration [OSHA] and the Mine Safety and Health
Administration [MSHA], NIOSH has made significant contributions
to the major reduction in workplace injuries over the last
three decades.
Congress established NIOSH with the expressed intent ``to
provide occupational safety and health research with the
visibility and status it merits'' and ``to elevate the status
of occupational safety and health research'' (Legislative
History of the Occupational Safety and Health Act of 1970, S.
2193, Public Law 91-596). The Committee strongly supports these
principles. The Committee expects CDC to ensure that the
ongoing CDC reorganization does not impede nor diminish NIOSH's
ability to meet its statutory responsibilities to protect the
safety and health of America's workers. The Committee believes
that NIOSH must have the stature necessary to work effectively
with OSHA, the Department of Labor, and the Department of
Health and Human Services in the manner described by statute.
Therefore, the Committee directs the CDC to maintain the status
quo with respect to the direct reporting relationship of the
NIOSH director to the CDC director. The Committee further
directs the CDC to: (1) make no changes to NIOSH's current
operating procedures and organizational structure and (2)
ensure that no funds or personnel will be transferred from
NIOSH to other components of CDC by means other than
traditional reprogramming of funds.
Construction Safety and Health.--The Committee once again
is very pleased with the progress that NIOSH has made in its
program directed at occupational illnesses and injuries in the
building and construction industry. However, the Committee is
still concerned with the continued high fatality rate in the
industry, and encourages NIOSH to continue studying this
important issue.
Education and Research Centers.--The Committee recognizes
the important role Education and Research Centers [ERCs] play
in preventive health research and the training of occupational
safety and health professionals, and includes an increase of
$2,000,000 for ERCs over the amount appropriated for ERCs in
fiscal 2004.
Farm Health and Safety.--The Committee has included funding
to continue the farm health and safety initiative. This
important initiative, begun in fiscal year 1990, has a primary
focus of reducing the incidence of fatal and nonfatal injuries
and occupational diseases among the millions of agricultural
workers and their families in the United States. The Committee
is particularly pleased with the research being undertaken by
the Agricultural Research Centers.
Miners' Choice Health Screening Program.--The Committee has
been advised that NIOSH will begin solely administering the
Miners' Choice Health Screening Program in fiscal year 2005,
and that funds have been included in the administration's
request to support these activities. This program was initiated
to encourage all miners to obtain free and confidential chest
x-rays to obtain more data on the prevalence of Coal Workers'
Pneumonconiosis [CWP] in support of development of new
respirable coal dust rules. The Committee is strongly
supportive of these efforts and urges NIOSH to work to improve
this health screening program thereby helping to protect the
health and safety our Nation's miners.
Mining Research Program.--The Committee has provided
$6,000,000 over the fiscal year 2004 level for NIOSH's Mining
Research Program. The Committee recommends that $4,000,000 of
the additional funding be used to increase base funding of the
NIOSH in-house research programs to offset the effects of
inflation. The Committee recommends that $1,000,000 of the
additional funding be used to expand the extramural mining
research program, and that the remaining $1,000,000 be used to
respond to emerging issues.
National Occupational Research Agenda.--The Committee
recommendation includes an increase of $5,000,000 over the
fiscal year 2004 level for CDC's National Occupational Research
Agenda [NORA]. The Committee believes that NORA is a critical
scientific research program that protects employees and
employers from the high personal and financial costs of work
site health and safety losses. Industries such as agriculture,
construction, health care, and mining benefit from the
scientific research supported by NORA. The program's research
agenda focuses on prevention of disease and injury resulting
from infectious diseases, cancer, asthma, hearing loss,
musculoskeletal disorders, traumatic injuries, and allergic
reactions, among others. The Committee continues to strongly
support NORA and encourages expansion of its research program
to cover additional causes of work place health and safety
problems.
National Personal Protective Technologies Laboratory.--The
Committee provides $3,000,000 over the fiscal year 2004 level
for the NIOSH National Personal Protective Technologies
Laboratory to expedite research and development in, and
certification of, protective equipment, such as powered air
purifying respirators, and combined self-contained breathing
apparatus/escape sets.
Radiation Exposure.--The Committee strongly encourages
NIOSH to expedite decisions on petitions filed under the
Procedure for Designating Classes of Employees as Members of
the Special Exposure Cohorts (42 CFR Part 83). It was Congress'
intent in passing the Energy Employees Compensation Act of 2000
to provide for timely, uniform and adequate compensation for
employees made ill from exposure to radiation, beryllium and
silica, while employed at Department of Energy nuclear
facilities or while employed at beryllium vendors and atomic
weapons employer facilities. The Committee encourages the
Department to recognize that in situations where records
documenting internal or external radiation doses received by
workers at the specific facility are of poor quality or do not
exist that workers should promptly be placed in a special
exposure cohort.
Research to Practice Initiative.--The Committee is
supportive of NIOSH's Research to Practice Initiative to
develop and expand efforts to put research findings into
practice. The Committee encourages NIOSH to use this initiative
to translate useful research findings into best practices,
products, and technologies and to disseminate this information
to employers and employees to improve the health and safety of
workers.
GLOBAL HEALTH
The Committee recommends $305,239,000 for global health
related activities at the CDC in fiscal year 2005. The fiscal
year 2004 comparable level was $279,944,000 and the
administration requested $304,444,000 for fiscal year 2005. The
Office of Global Health will lead and coordinate CDC's global
programs to promote health and prevent disease in the United
States and abroad, including ensuring rapid detection and
response to emerging health threats.
Global HIV/AIDS.--CDC works with governments in 25
countries in Africa, Asia and Latin America and the Caribbean
focusing on primary prevention of HIV/AIDS; care and treatment
of tuberculosis and other opportunistic infections, palliative
care and appropriate use of antiretroviral medications; and
infrastructure and capacity development.
The Committee understands that little attention has been
given to the increased risk of HIV infection for individuals
with disabilities in some parts of the world, including sub-
Saharan Africa. Information, testing, and treatment are often
inaccessible and denied to individuals with disabilities. The
Committee encourages the CDC to investigate this issue and
report on the problem and efforts to address it. The Committee
also encourages the CDC to provide technical assistance to
grantees on how to develop inclusive and accessible public
awareness campaigns, educational materials, testing, treatment,
palliative and preventive care to ensure that people with
disabilities have equal access to services and supports for
HIV/AIDS.
The Committee encourages the CDC to assist African nations
in developing systems to ensure that blood supplies are
screened for HIV/AIDS and other communicable diseases.
The Committee notes that funding for continuation of the
International Mother and Child HIV Prevention Initiative [MTCT]
has been requested in the budget for the Department of State
under the jurisdiction of the Foreign Operations Appropriations
Subcommittee. Therefore, the Committee does not providing any
funding for the program in the CDC, however, the Committee
remains supportive of this critical program. The Committee
encourages CDC to ensure that funds provided to the MTCT
program, the CDC GAP initiative, and the Global Fund for HIV/
AIDS, Tuberculosis, and Malaria are used in a coordinated and
complementary fashion.
Global Disease Detection.--The Committee commends CDC for
its role in strengthening the capacity of the public health
community, both at home and abroad, to respond to global
threats, such as SARS, monkeypox, West Nile virus, pandemic flu
and bioterrorism. CDC's Global Disease Detection System is
integral to these efforts. This system is designed to provide
worldwide technical support to ensure rapid and accurate
diagnoses of emerging infectious disease events, and to provide
a secure link between clinicians and laboratories and CDC and
the World Health Organization to ensure real-time reporting of
emerging threats. The Global Disease Detection System also will
support sentinel sites in key regions around the globe to
ensure prompt disease detection and referral to a regional
laboratory service. These capacities are critical to mitigate
the consequences of a catastrophic public health event, whether
the cause is an intentional act of terrorism or the natural
emergence of a deadly infectious virus, like SARS. The
Committee has provided $24,500,000 over the fiscal year 2004
level for these efforts.
Global Immunization Activities.--The Committee includes
$557,000 above the fiscal year 2004 level for polio vaccine,
surveillance, and program operations for the highly successful,
yet unfinished polio eradication efforts; and $238,000 above
the fiscal year 2004 level for the purchase of measles vaccine
for measles mortality reduction and regional measles
elimination initiatives and to expand epidemiologic,
laboratory, and programmatic/operational support to WHO and its
member countries.
The Committee appreciates CDC's contribution to global
immunization efforts to eradicate polio and eliminate measles
worldwide. Federal dollars help leverage private dollars in
both the Polio Eradication Campaign and the Measles Initiative,
partnerships among international agencies, NGOs and CDC. Polio
eradication is close to completion; however, polio is still
endemic in six countries. Any ground lost in maintaining
``immunization days,'' surveillance and labs is disastrous.
Immunization is respected in these developing countries to the
point that they cause temporary ceasefires in countries at war.
PUBLIC HEALTH RESEARCH
Public Health Research and Prevention Research.--The
Committee has provided $35,000,000 in transfers available under
section 241 of the Public Health Service Act to fund the Public
Health Research and Extramural Prevention Research programs. In
fiscal year 2004, the combined funding for these programs was
$29,107,000 and the administration requested $15,000,000 for
these programs in fiscal year 2005. The Committee is strongly
supportive of public health and prevention research, which
bridge the gap between medical research discoveries and
behaviors that people adopt by identifying the best strategies
for detecting new diseases, assessing the health status of
populations, motivating healthy lifestyles, communicating
effective health promotion messages, and acquiring and
disseminating information in times of crisis.
The Committee recognizes the need to enhance the
recognition and understanding of mind/body medicine's role in
the practice of medicine. To foster and expand the uses of
mind/body interactions in healthcare and other appropriate
settings, the Committee encourages the Public Health Research
Program to provide support to research, test, and disseminate
the practices related to mind/body techniques. To receive
appropriate technical assistance, CDC is strongly encouraged to
consult experts in the mind/body field.
PUBLIC HEALTH IMPROVEMENT & LEADERSHIP
The Committee provides $261,858,000 for public health
improvement and leadership activities at the CDC. The fiscal
year 2004 comparable level was $232,687,000 and the
administration requested a comparable program level of
$200,537,000 for fiscal year 2005.
Leadership and Management
To more easily identify and quantify administrative,
management, and leadership costs at the CDC, the Committee has
provided the administrative funds for the agency and its
institutes, centers, and offices (except NIOSH) within this
account. The Committee provides $179,977,000 for leadership and
management costs at the CDC in fiscal year 2005. The fiscal
year 2004 comparable level was $170,780,000 and the
administration requested a comparable level of $180,444,000 for
fiscal year 2005.
Director's Discretionary Fund.--The Committee has provided
$18,000,000 for a Director's Discretionary Fund. This fund will
allow the Director to quickly respond to emerging public health
issues and threats not contemplated at the time of enactment of
the appropriations.
Epidemic Services and Response.--CDC's epidemic services
and response program provides resources and scientific
expertise for operating and evaluating surveillance systems;
developing and refining research methods and strategies to the
benefit of public health practice; training public health
professionals who are prepared to respond to public health
emergencies, outbreaks and other assistance requests; and
communicating with multi-faceted audiences accurate public
health information and effective messages. The Committee
recognizes that CDC maintains a keen appreciation for the fact
that local outbreaks of illness can develop rapidly into
epidemics, that previously unidentified health problems can
appear at any time, that contaminated food or defective
products may appear in the community without warning, and that
the threat of bioterrorism is present in many areas of the
world. When CDC participates in an investigation, all of the
resources of the agency are at the disposal of the affected
area, including its state-of-the-art laboratories.
Individual Learning Accounts.--The Committee commends CDC
for its commitment to workforce development, and supports the
use of Individual Learning Accounts to provide CDC employees
with flexible opportunities for continuing education. In a
recent assessment of the use of such accounts at 13 Federal
agencies, the Office of Personnel Management recommended their
implementation government-wide so as to enhance workforce
development opportunities for all Federal employees. The
Committee recommendation includes up to $30,000,000, within
current appropriations, to establish Individual Learning
Accounts for full-time equivalent employees at CDC.
Leadership and Management Savings.--The Committee strongly
believes that as large a portion as possible of CDC funding
should go to programs and initiatives that improve the health
and safety of Americans. To facilitate this goal, any savings
in leadership and management may be reallocated to the
Director's Discretionary Fund upon notification of the
Committee.
Transfer Authority.--The Committee has included authority
for the Director to transfer up to 1 percent of any CDC
program, project, or activity to any other CDC program,
project, or activity. No program, project, or activity may be
decreased by more than 1 percent and no program, project, or
activity may be increased by more than 3 percent.
PREVENTATIVE HEALTH & HEALTH SERVICES BLOCK GRANT
The Committee has provided $131,814,000 for the
Preventative Health & Health Services Block grant. The fiscal
year 2004 comparable level was $131,814,000 and the
administration requested a comparable level of $131,814,000 for
fiscal year 2005.
The block grant provides funding for primary prevention
activities and health services that address urgent health
problems in local communities. This flexible source of funding
can be used to target concerns where other funds do not exist
or where they are inadequate to address the extent of the
health problem. The grants are made to the 50 States, the
District of Columbia, two American Indian tribes, and eight
U.S. territories.
BUILDINGS AND FACILITIES
The Committee has provided $294,500,000 for the planning,
design, and construction of new facilities, repair and
renovation of existing CDC facilities, and data security and
storage. The fiscal year 2004 comparable level was $260,454,000
and the administration requested $81,500,000 for fiscal year
2005.
The Committee recommendation includes $250,000,000 for the
continuation of CDC's Buildings and Facilities Master Plan in
Atlanta, Georgia and $44,400,000 to complete construction of
CDC's Division of Vector Borne Infectious Diseases Laboratory
in Fort Collins, Colorado.
The Committee has again provided bill language to allow CDC
to enter into a single contract or related contracts for the
full scope of development and construction of facilities and
instructs CDC to utilize this authority, when necessary, in
constructing the Atlanta and Fort Collins facilities.
The Committee is aware that a number of small buildings
from the former U.S. Bureau of Mines now comprise the current
NIOSH National Personal Protective Technologies Laboratory. A
modern laboratory is needed to conduct certification tests and
related respiratory protection research. As CDC reviews its
CDC-wide Master Plan, the agency is urged to give priority
consideration to modernizing this laboratory space.
BUSINESS SERVICES SUPPORT
The Committee provides $282,226,000 for business services
support functions at the CDC. The fiscal year 2004 comparable
level was $282,226,000 and the administration requested a
comparable level of $286,015,000 for fiscal year 2005. These
funds will be used to support CDC-wide support functions.
The Committee strongly believes that as large a portion as
possible of CDC funding should go to programs and initiatives
that improve the health and safety of Americans. To facilitate
this goal, any savings in business services support may be
reallocated to the Director's Discretionary Fund upon
notification of the Committee.
NIH Preamble
As a Nation, we can take justifiable pride in our
achievements in the fields of science and medicine. The fruits
of medical research have made possible the drugs, surgical
techniques and prevention strategies that have virtually
conquered many of the leading killers of past generations of
Americans, such as tuberculosis, rheumatic fever, smallpox,
pneumonia and many others. Much of what has been accomplished
to help save lives and improve the quality of life can be
attributed, directly or indirectly, to the world's leading
medical research enterprise: the National Institutes of Health.
One accomplishment alone--the sequencing of the human genome--
has opened the way to heretofore unimagined opportunities to
explore human biology in both health and disease. Medical
genetics, once a tool for diagnosing a handful of rare
diseases, can now be used to predict a healthy person's risk of
diseases such as breast cancer and heart disease, provide new
tests for diagnosing illness and determine individual responses
to drugs and environmental agents. But the conquest of some
diseases, by increasing our life span, has made us more
vulnerable to others. As the baby boom generation moves past
age 50 at the rate of 10,000 per day, a large cohort of
Americans are entering the age of high risk for cancer,
cardiovascular disease, Alzheimer's, arthritis, diabetes and
oral disease. Emerging infectious agents such as SARS, West
Nile Virus and hepatitis C kindle new threats to health, while
with the menace of bioterrorism poses new challenges for rapid
detection, containment and treatment. And despite improvements
in the overall health of America, minority populations continue
to suffer an unequal burden of disease, disability and death.
This Committee has long recognized the role NIH can and
does play in transforming the health status of America. In
1998, the Committee embarked on a 5-year endeavor to double the
investment in NIH in an effort to quicken the pace and
intensity of this transformation. Although it is impossible to
predict what cures or new treatments will emerge as a result,
it is certain that the infusion of new funds during the
doubling process helped push back the frontiers of scientific
knowledge, while attracting the best and brightest minds to
careers in medical research. However, the accumulation of
fundamental knowledge for its own sake is of little value
unless it finds its way to hospitals and physicians, where it
can be put to use in promoting good health or diagnosing,
preventing and treating disease. For that to happen requires a
robust commitment of resources over a sustained period. The
Committee recommends $28,900,300,000 for the NIH. This amount
is $1,100,252,000 above the fiscal year 2004 appropriation and
$373,429,000 over the budget request.
Biomedical Research and Development Price Index.--The
Committee is disappointed that the budget request would require
NIH to break its funding commitments to existing grantees,
contradicting the principles of the agency's own 1992 Cost
Management Plan. Forcing grantees to reduce the scope of
research that is already underway would establish an
unfortunate precedent and could erode confidence in NIH.
Therefore, the Committee has included sufficient funding to
enable NIH to fully pay the committed levels on its grants. The
Committee is also disappointed that the budget request's
proposed average cost assumptions would keep NIH from buying
the same amount of research as in fiscal year 2004 with its new
research project grants [RPGs], when biomedical inflation, as
measured by the Department of Commerce's Biomedical Research
and Development Price Index [BRDPI], is taken into account. The
funding level recommended by the Committee will permit the
average cost of new and competing RPGs to rise by 2 percent
instead of the 1 percent increase proposed in the budget
request.
Consulting Fees.--The Committee was extremely disappointed
to learn the extent to which NIH scientists and administrators
have been receiving monetary compensation from pharmaceutical
and biotechnology companies. Some NIH employees have received
hundreds of thousands of dollars for their outside work, none
of which was publicly disclosed. Even more disturbing, some of
these employees did not disclose their outside work to agency
officials. These arrangements raise questions about potential
conflicts of interest, the influence that these monetary
compensations could have on the outcome of scientific research,
and whether these employees are more interested in procuring
lucrative consulting fees than in meeting the responsibilities
of their full-time, taxpayer-funded jobs. The Committee finds
it difficult to understand how the most prestigious biomedical
research institution in the world could allow these questions
to be raised. The Committee commends the NIH Director for
convening a Blue Ribbon Panel to review and make
recommendations regarding existing laws, regulations, policies
and procedures governing consulting fees. The Committee was
also pleased to learn that the NIH plans to implement new
regulations to ensure the integrity of its scientific research.
While the Committee strongly supports intramural and extramural
research at the NIH, it must be sure of the integrity of that
research; therefore, the Committee directs the NIH Director to
immediately put in place safeguards that will insure that no
conflicts of interest exist between scientists and
pharmaceutical and biotechnology companies, or any other
entity.
Human Embryonic Stem Cell Research.--The Committee is very
concerned that the current administration policy relating to
human embryonic stem cell research is extremely limiting and is
significantly slowing the pace of stem cell research. The
Committee strongly believes that embryonic stem cells have the
potential to be used to treat or cure the 100 million Americans
who are afflicted with diseases such as cancer, heart disease,
diabetes, Parkinson's, Alzheimer's, multiple sclerosis, spinal
cord injury, and many others. While it originally appeared that
78 embryonic stem cell lines would be available for research
under the Federal policy, now, more than 2 years after the
President's announcement on August 9, 2001, only 24 are
available to researchers. Moreover, scientists have told the
Committee that all available stem cell lines were grown with
mouse feeder cells, making their therapeutic use for humans
uncertain. The Committee strongly urges the administration to
modify the current embryonic stem cell policy so that it
provides this area of research the greatest opportunity to lead
to the treatments and cures for which we are all hoping.
The Committee is also deeply concerned with the slow pace
of implementation of the current policy. The Committee was
informed by NIH this year that anticipated spending on human
embryonic stem cell research is just $24,800,000.
NATIONAL CANCER INSTITUTE
Appropriations, 2004.................................... $4,739,255,000
Budget estimate, 2005................................... 4,870,025,000
Committee recommendation................................ 4,894,900,000
The Committee recommends an appropriation of $4,894,900,000
for the National Cancer Institute [NCI]. The budget request was
$4,870,025,000. The fiscal year 2004 appropriation was
$4,739,255,000. The comparable amounts for the budget estimate
include funds to be transferred from the Office of AIDS
Research.
Mission.--The NCI conducts and supports basic and applied
cancer research in prevention, early detection, diagnosis,
treatment, and rehabilitation. The Institute provides training
support for research scientists, clinicians, and educators, and
maintains a national network of cancer centers, clinical
cooperative groups, community clinical oncology programs,
cancer prevention and control initiatives, and outreach
programs to rapidly translate basic research findings into
clinical practice.
Anticancer compounds.--The Committee encourages the
National Cancer Institute to increase research in the area of
anticancer compounds. Sources of these compounds include marine
invertebrates, terrestrial plants, and microorganisms that may
be used to develop small molecule anticancer drugs. The
Committee further understands that little research is conducted
in this area and therefore urges the Institute to conduct
appropriate research in this area.
Behavioral Research.--The Committee recognizes the enormous
progress NCI has made in the quality and breadth of cancer
related behavioral science ranging from basic bio-behavioral
research to health communication research and tobacco control
research. Closing the gap between research and program delivery
is both a challenge and a necessity if we are to ensure that
all populations benefit from new scientific discoveries.
Behavioral science can contribute to survival, reduced
morbidity and increased quality of life, and the behavioral and
cognitive sciences can be highly applicable in answering
critical questions regarding patient care. The Committee sees
NCI's behavioral science research program as a model for other
institutes.
Bladder and Renal Cancer.--The Committee is concerned about
the poor implementation of the 2002 Progress Review Group
Report on Bladder and Renal Cancers. The incidence and
mortality of renal cancer has been steadily increasing over the
past several decades. Renal cancers are silent killers; for
many, renal cancers are not recognized until late in the
disease, when cancer has already spread beyond the kidney. NCI
is urged to expand studies to improve detection and diagnosis
of renal cancer. For patients with metastatic renal cancer,
survival is only 9 percent with a median survival time of 12
months. There are very few effective treatments. Metastatic
bladder cancer also responds poorly to treatment. The Committee
urges NCI to develop a novel treatment network to rapidly
identify and test for new therapies for renal and bladder
cancer in human patients and to expand studies on mechanisms of
metastasis in these patients.
Blood Cancers.--The Committee is pleased that important new
therapies have been developed for the blood cancers--leukemia,
lymphoma, and multiple myeloma. It has been brought to the
Committee's attention that the Leukemia, Lymphoma, and Myeloma
Progress Review Group, a blue ribbon advisory panel of NCI
recommended in May 2001 the establishment of new multi-
disciplinary and multi-institutional structures to shorten the
timeline for new blood cancer drug development. The Committee
encourages the NCI to develop new strategies to accelerate the
development of new blood cancer therapies, which might include,
among other options, public-private partnerships, multi-
disciplinary collaborations, and multi-institutional
initiatives. The Committee further urges the NCI to consider
flexible uses of current funding mechanisms in order to respond
to the key recommendation of the blood cancer Progress Review
Group.
Bone Metastasis.--The NCI is encouraged to develop an
integrated approach to study bone metastasis, leveraging the
expertise of cancer and bone biologists, clinical oncologists
and metastasis experts and representatives of the
pharmaceutical industry. Key issues to address include the
generation of novel models which mimic tumor/bone interaction
and which delineate mechanisms to determine why tumor cells
prefer bone for metastasis. It is clinically relevant to learn
how to use information to change the bone microenvironment so
that it is hostile to the invading tumor cells. The Committee
also urges NCI to expand research on osteosarcoma to improve
survival and quality of life and to prevent metastatic
osteosarcoma in children and teenagers who develop this cancer.
Brain Tumors.--The Committee is concerned that insufficient
attention is being given by NCI and NINDS to brain tumor
research. The Committee encourages NCI to fund at least five
Specialized Programs of Research Excellence in Brain Tumors
[SPORE] grants in the upcoming fiscal year, with particular
emphasis on those proposals which include both basic research
and clinical treatment applications.
Cancer Centers and Minorities.--The Committee commends NCI
on the success of its cancer centers program. Given that
minority populations suffer disproportionately from virtually
every form of cancer, the Committee encourages NCI to support
the establishment of a comprehensive center at a minority
institution focused on research, treatment, and prevention of
cancer in African American and other minority communities.
Cancer Genomics.--The Committee is pleased that the NCI has
focused considerable attention on building innovative public/
private partnerships to accelerate the development and
deployment of new technologies, which will facilitate the
Institute's ambitious goal of dramatically altering the
understanding and treatment of cancer by 2015. The Committee is
also aware of the enormous potential for improved understanding
and treatment of cancer presented by the use of microarray
technology in both basic research and clinical setting. The
Committee understands that the use of this technology can help
accelerate the development of effective cancer drugs, the
prediction of drug response, and ultimately the early detection
and improved treatment of cancer. The Committee recommends that
NCI continue to employ these enabling technologies to identify,
characterize, and validate the gene pathways that cause cancer
and that it continue to work cooperatively with public and
private sector entities to do so.
Cancer and Native Hawaiians.--The Committee remains
concerned about the high incidence of breast, colon, and lung
cancer among the native Hawaiian population. The Committee
anticipates an update on the Director's task force to explore
the continuing unique needs of the people of Hawaii and the
Pacific Basin region.
Chronic Lymphocytic Leukemia [CLL].--This incurable disease
is the most common form of adult leukemia in the United States.
The Committee once again urges the NCI to increase research
into CLL, including improved therapies and their rapid movement
from the laboratory to the bedside. The Committee is pleased to
learn that the unique multidisciplinary and multi-institutional
research consortium funded by the NCI for the past 5 years is
proceeding with a competing renewal of its initial grant to
permit coordinated continued study of CLL at the cellular and
clinical levels. The Committee strongly urges the NCI to give
favorable consideration to continuing and expanding the scope
of research activities funded through the the CLL Research
Consortium as it works to defeat this devastating blood
disorder.
Complementary and Alternative Cancer Therapies.--The
Committee expects NCI to expand its work and its collaborative
efforts with NCCAM to support research on promising
complementary and alternative cancer therapies as well as on
their integration with traditional therapies.
Diethylstilbestrol [DES].--The Committee continues to
strongly support increased efforts to study and educate the
public and health professionals about the impact of exposure to
the synthetic hormone diethylstilbestrol [DES]. The Committee
expects NCI to continue its support of research in this area,
and to continue to consult with organizations representing
individuals impacted by DES as they carry out DES research and
education efforts.
Gynecologic Cancers.--In the last 5 years, approximately
130,000 women in the United States have lost their lives to
gynecologic cancer. The Committee commends the NCI for creating
a cervical cancer and endometrial cancer SPORE, bringing the
total number of gynecologic cancers SPORES to six, and expects
that the NCI will expand the number of centers in the future.
Unfortunately, 70 percent of ovarian cancer patients continue
to be diagnosed in advanced stages when 5-year survival rates
remain less then 25 percent. The Committee encourages continued
research by the four ovarian SPORES that will lead to a better
understanding of prevention and the development of a screening
tool offering women earlier diagnosis when this cancer is more
curable. The Committee also supports the expansion of NCI's
collaboration with the NICHD for faculty development of
gynecologic oncologists.
Health Care Decision-making.--The Committee applauds NCI's
investment in staff and resources to help build the science of
health care decision-making. Such research will improve
understanding of human decision-making processes so that
individuals can make more informed choices about their health,
and so more useful decision support systems can be constructed.
Efforts to integrate basic behavioral and social research in
judgment and decision-making, and applied cancer decision
making will serve to harness the work of basic researchers, who
may not have previously applied their work to health settings.
Imaging Systems Technologies.--The Committee is encouraged
by progress made by the NCI following its August 1999
conference on biomedical imaging, and urges the NCI to continue
to take a leadership role with the Centers for Medicare and
Medicaid Services [CMS] and the Food and Drug Administration to
avoid duplicative reviews of new imaging technologies which may
prevent their benefits from reaching patients on a timely
basis. The Committee is aware of the great potential for
improved patient care and disease management represented by
molecular imaging technologies, especially positron emission
tomography [PET] through its ability to image the biology of
many kinds of cancer and other diseases. The Committee
continues to support the NCI's increased emphasis on examining
the molecular basis of disease through imaging technologies
such as PET and MicroPET. The Committee continues to encourage
the large-scale testing of women for breast cancer and men for
prostate cancer to demonstrate and quantify the increased
diagnostic and staging capabilities of PET relative to
conventional diagnostic and staging technologies, including
mammography.
Liver Cancer.--The Committee notes that in contrast to many
other cancers, the number of people who develop and die from
liver cancer has increased 24 percent since the year 2000. As
the symptoms of liver cancer often do not appear until the
disease is advanced, only a small number of liver cancer cases
are found in the early stages of the disease, when it can be
easily treated. The Committee is aware that the NCI, in
collaboration with NIDDK, convened an Experts Conference that
will help define the most urgent areas requiring additional
research, professional education and public awareness
initiatives. The Committee urges NCI to issue a Request for
Applications based on the findings of this conference.
Lung Cancer.--Lung cancer remains a major public health
issue and is the leading cause of cancer death among women and
minority populations. The death rate is expected to escalate as
the population ages. Treatment and research now require an
interdisciplinary approach and thoracic surgeons play an
important role in both. The Committee encourages the Institute
to work with the thoracic surgical community to identify
priority areas for new clinical and translational studies and
to ensure their participation in any interdisciplinary research
efforts. Thoracic surgeons should be included in all relevant
review and advisory committees and councils.
Molecular Cancer Diagnostics.--The Committee understands
that the NCI is aware of the potential for molecular cancer
diagnostics using circulating nucleic acids, including in
particular extracellular RNA in plasma. The Committee believes
that this technology could have enormous potential for the
early detection, monitoring, and selection of more effective
treatment of a broad array of cancers and therefore encourages
the NCI to explore the use and clinical application of this
technology.
Multidisciplinary Research.--NCI is commended for its
innovative support of multidisciplinary training programs to
enhance the scientific workforce. The Committee encourages NCI
to explore new opportunities with the Office of Behavioral and
Social Sciences Research to increase the number of scientists
who can bridge the realms of behavioral and social science
research and public health or biomedical research.
Myelodysplasia and Myeloproliferative Disorders.--The
Committee recognizes NCI's support for a new research
initiative in Myeloproliferative Disorders [MPDs), which
evolved from a recent conference involving the Institute and
NHLBI. MPDs and Myelodysplasia [MDS] are chronic diseases of
bone marrow cells that can develop into acute leukemia. The
Committee encourages NCI and NHLBI to bring together scientific
and clinical experts in these fields to explore collaborative
and crosscutting research mechanisms to further this research
agenda. The Committee also urges NCI to utilize the
Surveillance, Epidemiology, and End Results [SEER] Program to
collect data on the incidence and distribution of these
diseases.
Nanosystems Biology.--The Committee encourages NCI and the
Office of the NIH Director to support a collaborative effort to
bringing together nanotechnology, systems biology and molecular
imaging to examine the molecular basis of cancer. Initial
efforts have shown that cancers such as breast cancer are not a
single disease, but may encompass many different diseases, when
examined at the molecular level. Many clinical trials of new
drugs are now considered a failure if only 10 percent of
patients benefit, yet the 10 percent may represent a specific
type of the disease, where the drug may be 100 percent
effective. Bringing these three disciplines together may allow
researchers to identify specific sub-types of cancer and to
better target new interventions. Successful results of such an
effort could lead to a molecular classification of many types
of cancer and to targeted molecular treatments for molecular-
specific diseases.
Neurofibromatosis.--The Committee commends NCI for
conducting phase II clinical trials of NF1 patients with
plexiform neurofibromas. The Committee is concerned about
recent large drops in funding for NF research, and recognizing
NF's connection to many of the most common forms of human
cancer, the Committee encourages NCI to substantially increase
its NF research portfolio in such areas as further development
of animal models, natural history studies, therapeutic
experimentation, and clinical trials. The Committee is mindful
of NF's rapid movement toward clinical research and encourages
NCI to aggressively pursue clinical/translational research
while still maintaining a solid basic research portfolio.
Pancreatic Cancer.--The Committee remains concerned about
the lack of scientists researching pancreatic cancer, the
Nation's fourth-leading cause of cancer death. The NCI's recent
policy of offering a 50 percent extended payline for grants
that are 100 percent related to pancreatic cancer was viewed as
a critically important effort to encourage both young and
experienced investigators to develop careers in this research
field. Thus, the Committee is disappointed that the NCI plans
to weaken that policy and adopt a new strategy consisting of
identifying grants that are 50 percent directed to pancreatic
cancer and then bringing them to the attention of the NCI
Executive Committee. The Committee notes that this special
consideration will not necessarily result in actual funding.
Therefore, the Committee urges the NCI to maintain the 50
percent extended payline for 100 percent relevant pancreatic
cancer research grants as the best way to attract a critical
mass of scientists to this field.
Prostate Cancer.--The Committee commends the NCI for the
considerable investment in prostate cancer, the leading cause
of non-cutaneous cancer death among men, and encourages NCI to
continue to support research to improve the accuracy of
screening and early detection of prostate cancer.
Psychoneuroimmunology and Cancer.--The Committee is
interested in NCI's initiative to evaluate the complex
interrelationships among emotional, behavioral, neural and
immunological processes and how they may affect the etiology
and progression of cancer. NCI's BiMPED initiative is a good
example of leveraging the institute's resources to seed new
research across NIH on fundamental mechanisms and processes
that may affect multiple diseases and conditions.
Radio Waves.--It has been brought to the Committee's
attention that radio waves may prove promising in reducing
cancerous tumors. While current radio frequency ablation
requires placing electrodes directly into the tumor, this new
non-invasive technique would target only the cancer cells while
avoiding healthy tissue. The Committee urges the NCI to support
research using this non-invasive cancer-targeting technique.
Tuberous Sclerosis Complex.--Tuberous sclerosis complex, or
TSC, is a genetic disorder that triggers uncontrollable tumor
growth in multiple organs of the body, including the brain,
heart, kidneys, lungs, liver, eyes or skin. In light of its
similarities to the uncontrolled growth of cancer cells, many
scientists believe that determining the cause of tumor growth
in TSC could open the way for cures and treatments for cancer
as well. To those ends, the Committee strongly encourages NCI
to support programs examining the molecular and cellular basis
of TSC, and the role of TSC in tumor development.
NATIONAL HEART, LUNG, AND BLOOD INSTITUTE
Appropriations, 2004.................................... $2,878,691,000
Budget estimate, 2005................................... 2,963,953,000
Committee recommendation................................ 2,985,900,000
The Committee recommendation includes $2,985,900,000 for
the National Heart, Lung, and Blood Institute [NHLBI]. The
fiscal year 2004 appropriation was $2,878,691,000 and the
budget request was $2,963,953,000. The comparable amounts for
the budget estimate include funds to be transferred from the
Office of AIDS Research.
Mission.--The National Heart, Lung, and Blood Institute
provides leadership for a national research program in diseases
of the heart, blood vessels, lungs and blood, in transfusion
medicine, and in sleep disorders through support of basic,
clinical, population-based, and health education research.
Advanced Imaging Technology for Heart Disease and Stroke.--
The Committee is aware that heart perfusion PET scans using
Rubidium-82 are considered the ``gold standard'' for
determining the extent of muscle damage to the heart following
a heart attack. The Committee encourages the NHLBI to expand
its research efforts into the role of biological imaging and
PET in delivering more accurate information to determine
appropriate treatment for heart disease patients.
Allied Health Personnel.--Given the existing and growing
shortages of qualified allied health professions who serve as
laboratory personnel, NHLBI is encouraged to enhance program
activity at research institutions training these individuals,
as one step to alleviate this problem. This shortage is of
particular concern since laboratory personnel are critical to
identifying biological agents and, therefore, to any state or
national plan for combating bioterrorism.
American Indians and Alaskan Natives Community-Responsive
Interventions to Reduce Cardiovascular Risk.--The Committee is
aware that American Indian and Alaska Native communities bear a
heavy burden of heart disease, stroke and other cardiovascular
diseases. But, few preventive interventions have been tested.
Tribal leaders have urged that research in their communities
focus on finding solutions for the most serious issues these
populations face, including heart disease, stroke and other
cardiovascular diseases. To address the concerns of the tribal
leaders, the Committee strongly urges the NHLBI to start a
planned initiative to evaluate approaches to reducing
behavioral cardiovascular disease risk factors such as obesity,
diet, smoking, sleep restriction, stress, and sedentary
lifestyle in the American Indian and Alaskan Native
populations. A central part of this research will be the
development of interventions that can be incorporated into
community patient care programs or delivered through other
public health avenues in native communities.
Behavioral Research on Long-term Exercise Benefits.--The
Committee encourages NHLBI to continue its research program on
longterm behavior change, particularly as it concerns physical
activity. NHLBI-funded research showed that moderate-intensity
exercise was as effective in a long-term program as high-
intensity exercise in enabling patients to maintain weight loss
for over a year. NHLBI is encouraged to continue its focus on
the role of exercise in health, and factors that increase the
likelihood that sedentary adults and youth can initiate and
maintain programs of physical activity to prevent obesity.
Cardio-thoracic Surgery.--The Committee commends the
Institute for its efforts to increase research in the role of
cardio-thoracic surgery in the treatment and management of
heart and lung diseases. Reestablishing the cardio-thoracic
intramural program is an important component of this effort. To
support this renewed activity, the Committee encourages the
Institute to increase the representation of cardiovascular and
thoracic surgeons at all levels, including the advisory
council.
Cardiovascular Diseases.--The Committee continues to regard
research into the causes, cure, prevention and treatment of
heart disease, stroke and other cardiovascular diseases as a
major concern for our Nation and urges the NIH and the NHLBI to
make these diseases a top priority. Cardiovascular diseases
remain the leading cause of death in the United States and a
major cause of permanent disability. The Committee continues to
strongly support increased efforts to study heart disease,
stroke and other cardiovascular diseases. The Committee is very
concerned that funding over the years for cardiovascular
disease research has not kept pace with the scientific
opportunities, the number of Americans afflicted with
cardiovascular diseases and the economic toll these diseases
impose on our Nation. Concerned that cardiovascular disease
research still receives disproportionately low funding, the
Committee urges the Institute to aggressively expand its
research portfolio and dramatically increase its resources
dedicated to cardiovascular disease research through all
available mechanisms.
Cardiovascular Health Study.--The Committee is aware that
the Cardiovascular Health Study, initiated in 1987 to determine
risk factors for development and progression of heart disease,
stroke and other cardiovascular diseases in nearly 6,000
Americans age 65 and older, is scheduled to end in 2005. The
wide variety and complexity of data and samples collected in
the Cardiovascular Health Study represent an unique national
research resource. The Committee urges the NHLBI to initiate a
planned proposal to stimulate innovative use of Cardiovascular
Health Study data and material, provide opportunities for open,
efficient use of the information for the entire scientific
community, and continue follow-up of study participants.
Chronic Obstsructive Pulmonary Disease [COPD] Education and
Prevention Program.--The Committee urges the NHLBI to implement
an education and prevention program for Chronic Obstructive
Pulmonary Disease [COPD]. To enhance the proper diagnosis and
early detection of COPD, NHLBI is urged to launch an effort to
reach out to the more than 13.3 million Americans living with
COPD and the 24 million individuals yet to be diagnosed. In
developing such an education and prevention program, the NHLBI
is encouraged to work closely with patient and physician
organizations and existing coalitions to coordinate with on-
going activities in the community.
Early identification of those at-risk for or who have COPD
is essential in the effort to stem the growth of this segment
of population. The Committee encourages NHLBI to enhance its
efforts in this area, through all available mechanisms, as
appropriate, including working with national lung
organizations, such as the American Thoracic Society and the
American Lung Association to develop epidemiological studies of
patients who are at-risk for or who have this disease as well
on a national education campaign for providers and the public
about COPD.
Cooley's Anemia.--The Committee remains strongly supportive
of the focused research effort that is being undertaken by the
Thalassemia Clinical Research Network, which is comprised the
leading research institutions in the field of thalassemia, or
Cooley's anemia. The Committee believes that this network is
just beginning to meet its promise and urges the institute to
continue its support. In addition, the Committee believes that,
where appropriate, consideration should be given to including
patients with related hemoglobinopathies whenever such
inclusion will enhance the scientific validity of the research
being conducted.
Cystic Fibrosis.--The Committee understands that cystic
fibrosis researchers are evaluating a number of compounds as
possible therapies for CF. This will require the completion of
clinical trials enrolling a significant number of participants.
The Committee encourages NHLBI, which has a long and successful
record in supporting trials on therapies for chronic disease,
to expand its involvement in trials to demonstrate the
effective use of approved therapies in CF patients and
especially trials to examine the use of approved products in
pediatric patients with CF.
Diamond-Blackfan Anemia.--The Committee is pleased that
NHLBI is working to develop a comprehensive research initiative
to investigate the rare bone marrow deficiency disorder,
Diamond Blackfan Anemia [DBA]. The Committee understands that
breakthroughs in this disorder may lead to important strides in
research especially relating to blood cell formation (recovery
from cancer chemotherapy), cancer predisposition, gene
discovery, and the effectiveness of steroids and blood
transfusions as treatment options for all bone marrow failure
syndromes and that the detailed evaluation of DBA patients will
also serve as an important model for understanding the genetics
of birth defects. The Committee commends NHLBI for their
attention to this disorder.
Duchenne Muscular Dystrophy.--The Committee encourages
NHLBI, in collaboration with the Office of Rare Diseases, to
enhance the research and related activities surrounding
pulmonary and cardiac complications associated with Duchenne
muscular dystrophy. The NHLBI is expected to report to the
Committee on its approach to this issue not later than January
15, 2005.
Heart Failure Management.--The Committee is concerned that
heart failure is a major cause of hospitalization and
readmission. Medicare recipients represent about 65 percent of
repeat hospitalizations within 1 year. Yet, perhaps 50 percent
of these hospitalizations are avoidable. The Committee urges
NHLBI to initiate a planned multi-center, randomized trial to
evaluate management strategies for heart failure patients in
terms of their ability to prevent death or hospital
readmission. Costs, quality of life, physician compliance, and
patient adherence to prescribed treatment will also be
assessed. This clinical trial will identify and disseminate
useful and effective tools for translation of proven heart
failure therapies into patient care.
Hemophilia.--The Committee commends NHLBI for its
leadership in advancing research on bleeding disorders and the
complications of these disorders. The Committee applauds NHLBI
for its efforts, working with the National Hemophilia
Foundation, to support research on improved and novel therapies
for bleeding disorders.
Marfan Syndrome.--The Committee commends NHLBI for its
support of research opportunities to study this life-
threatening, degenerative genetic disorder. Marfan syndrome is
characterized by cardiovascular, skeletal and ocular
manifestations, and its cardiovascular complications result in
premature death. Insights gained from research in this area can
have implications for the understanding of other connective
tissue disorders, other genetically mediated diseases, and the
larger population of aging adults with thoracic aneurysms. The
Committee urges NHLBI to expand its collaborative efforts with
other institutes to support research, awareness of aortic
dissection and help reduce the number of premature
cardiovascular deaths resulting from undiagnosed genetic
conditions.
Minority Health.--The Committee notes lung disease
disproportionately affects many minority groups. The Committee
urges NHLBI to work with other Institutes and Centers to
develop an epidemiologic approach to determine the
disproportionate impact of airway disease on minority
populations.
Myelodysplasia and Myeloproliferative Disorders.--The
Committee commends NHLBI for its new research initiatives in
Myelodysplasia [MDS] and Myeloproliferative Disorders [MPDs),
which resulted from a recent conference involving the Institute
and NCI. MPDs and MDS are chronic diseases of bone marrow cells
that can develop into acute leukemia. The Committee encourages
NHLBI and NCI to bring together scientific and clinical experts
in this field to explore collaborative research and
crosscutting mechanisms to further this research agenda.
National Asthma Education and Prevention Program [NAEPP].--
The Committee commends the NAEPP for its leadership in helping
to educate physicians, asthma patients, their families, and the
general public regarding asthma and its management. The
Committee urges NAEPP to enhance the role that its advisory
committee plays in helping to coordinate asthma education
throughout the United States. The Children's Health Act of 2000
included provisions for NAEPP to develop, in conjunction with
other Federal agencies and voluntary and professional health
organizations, a Federal plan to respond to asthma. This plan
will include the roles and responsibilities of several Federal
agencies in combating asthma. The Committee would like to be
kept apprised on the progress of NAEPP's planning efforts, and
urges NHLBI to move forward as early as possible.
Neurofibromatosis.--Significant advances continue to be
made in research on NF's implications with heart disease and in
particular, its involvement with hypertension and congenital
heart disease which together affect over 50 million Americans.
The Committee applauds NHLBI for its involvement with NF
research and encourages it to continue to expand its NF
research portfolio.
Obstructive Sleep Apnea.--The Committee commends the
Institute for its work on obstructive sleep apnea, a disorder
that affects approximately 80 percent of the elderly, and which
if left untreated significantly increases risk for
hypertension, coronary artery disease, heart failure and
stroke. The Institute is encouraged to include surgical
treatments in its search for useful treatments for this
disorder.
Pediatric Asthma Network.--The Committee recognizes that
little is known about the optimal treatment for asthma in
infants and young children. The Committee urges NHLBI to use
the research amassed through the Pediatric Asthma Clinical
Research Network to provide clearer choices for childhood
asthma therapy, to encourage the development and dissemination
of new therapies, and to identify optimum asthma management
strategies for children.
Primary Immunodeficiency Diseases.--The Committee
understands that NHLBI has begun to work with the Jeffrey
Modell Foundation as part of its national physician education
and public awareness campaign for primary immunodeficiency
diseases, including co-sponsorship of physician conferences at
the NIH. The Committee encourages NHLBI to take further action
in this regard and to be an active participant in the
development of educational materials and future conferences, as
appropriate.
Pulmonary Hypertension.--Pulmonary Hypertension [PH] is a
rare, progressive and fatal disease that predominantly affects
women, regardless of age or race. PH causes deadly
deterioration of the heart and lungs and is a secondary
condition in many other serious disorders such as scleroderma
and lupus. The Committee continues to view research in this
area as a high priority and commends NHLBI's efforts to promote
PH related research. For fiscal year 2005, the Committee
encourages the Institute to increase funding for basic
research, gene therapy and clinical trials of promising
pharmaceuticals, and to take appropriate measures to ensure the
submission of high quality proposals in this area.
Scleroderma.--The Committee is encouraged by NHLBI's
growing interest in scleroderma, a chronic and progressive
disease that predominantly strikes women. Scleroderma is
disfiguring and can be life-threatening, affecting multiple
systems including the heart and lungs. More research is
critically needed in order to develop safe, effective
treatments and to identify the cause or causes of the
complications of scleroderma that include pulmonary fibrosis,
pulmonary hypertension, myocardial fibrosis, cardiac
arrhythmias, pericarditis, and Raynaud's Phenomenon.
Sleep Disorders.--The Committee commends the National
Center on Sleep Disorders Research for its progress and is
pleased that the Center has sponsored the translational
conference Frontiers of Knowledge in Sleep and Sleep Disorders.
The Committee urges the Center to partner with other Federal
agencies, such as the Centers for Disease Control and
Prevention, as well as voluntary health organizations such as
the National Sleep Foundation, to develop a sleep education and
public awareness initiative that will provide a forum for
dissemination of the outcomes of the sleep translational
conference, and serve as an ongoing, inclusive mechanism for
public and professional awareness on sleep and sleep disorders.
Several institutes and public health service agencies have had
success with these collaborative models.
Thrombosis and Thrombophilia.--The Committee is concerned
that too little is known about the basic science of thrombosis
and thrombophilia, major causes of death and disability in this
country. The Committee strongly urges the Institute to expand
its support for basic research into their underlying causes in
order to improve diagnosis and treatment for these conditions.
The Committee also strongly urges the Institute to use all
available mechanisms to support this research and urges
collaboration with the thrombophilia centers funded by CDC.
Tissue Engineered Blood Vessel Replacement and Repair.--The
Committee is aware that a need exists to develop alternatives
to natural blood vessels for the adults who endure heart artery
bypass surgery and for the children born with complex heart
defects who need multiple blood vessel grafts. The Committee
encourages the NHLBI to initiate a planned initiative to
complement existing tissue engineered research programs to
stimulate efforts to ``grow'' small-diameter, functional blood
vessels.
Tuberculosis and AIDS.--The Committee supports the
important research on the interaction of tuberculosis and AIDS
conducted by the NHLBI AIDS research program and encourages
NHLBI to strengthen its research in this important area.
Von Willebrand Disease.--The Committee encourages NHLBI to
establish a universal treatment algorithm (after consultation
with established medical associations such as the American
Society of Hematology) for the treatment of Von Willebrand
disease. At present there is no accepted treatment algorithm in
the United States for this condition. The Committee also
recognizes that Von Willebrand disease is an under-recognized
and under-diagnosed disease. The Committee believes that there
are instances where women who are suffering from idiopathic
menorrhagia are needlessly subjected to invasive procedures
such as hysterectomies. The Committee encourages NHLBI to
launch a pilot program among obstetricians and gynecologists
treating patients, especially young women, with idiopathic
menorrhagia to provide a blood test for Von Willebrand Disease.
Such a program would act to confirm if a link exists between
menorrhagia and Von Willebrand Disease in additional to
providing the benefits of early detection and treatment.
NATIONAL INSTITUTE OF DENTAL AND CRANIOFACIAL RESEARCH
Appropriations, 2004.................................... $383,282,000
Budget estimate, 2005................................... 394,080,000
Committee recommendation................................ 399,200,000
The Committee recommendation includes $399,200,000 for the
National Institute of Dental and Craniofacial Research [NIDCR].
The fiscal year 2004 appropriation was $383,282,000 and the
budget requested $394,080,000. The comparable amounts for the
budget estimate include funds to be transferred from the Office
of AIDS Research.
Mission.--The NIDCR supports research and research training
to improve the oral health of Americans. The Institute
emphasizes ways to prevent disease in high-risk groups,
including the elderly, minority populations, and individuals
with medical conditions and medications that compromise oral
health. The research agenda includes studies of craniofacial
genes and birth defects; bone and joint diseases; AIDS, other
infections, and immunity; oral cancer; chronic pain;
epidemiology; biomaterials; and diagnostic systems.
Saliva as a Diagnostic Tool.--In recent years dental
scientists have learned that the oral fluids in the mouth
contain a cornucopia of information about the condition of the
various systems of the body. Of particular interest is the
potential to develop a diagnostic test for early detection of
breast cancer. The Committee recognizes that considerable
clinical research must be done before a test can be approved
for use by health care professionals so that the women of this
country will have a simple non-invasive, inexpensive procedure
to alert them to the risk of breast cancer. The Committee urges
the Institute to advance the field of salivary diagnostics.
Scleroderma.--The Committee is encouraged by NIDCR's
interest in scleroderma, a chronic and progressive disease that
predominantly strikes women. Scleroderma is disfiguring and
life-threatening; and effective treatments are lacking.
Scleroderma is often associated with a number of dental and
craniofacial complications. The most major and common problems
are xerostomia and microstomia. Additional concerns are
increased frequency of caries, periodontal disease, fibrotic
changes, fungal infections, telangectasia and bone resorption
of the mandible. Additional research is needed to develop safe
and effective treatments and to identify the cause or causes of
the serious complications of scleroderma.
Skeletal Disorders.--The Committee encourages NIDCR to
continue to conduct research into the basic biology of bone
cells and bone matrix and their roles in bone turnover and
regeneration. The Committee also urges NIDCR to pursue research
into the role of genes and other agents in restoring skeletal
tissue, and skeletal disorders--including fibrous dysplasia and
dental abnormalities in Paget's disease patients.
Systemic Health Risks and Oral Health.--The association
between oral health and systemic health has been a topic of
NIDCR funded research projects for many years. Early results
from several studies indicate that there is a link between oral
bacterium and preterm births. Still another report has shown a
connection between gum disease and heart attacks, regardless of
whether the patient uses tobacco. The Committee encourages
further research to identify the connection between oral
disease and systemic disorders.
NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES
Appropriations, 2004.................................... $1,671,803,000
Budget estimate, 2005................................... 1,726,196,000
Committee recommendation................................ 1,739,100,000
The Committee recommends an appropriation of $1,739,100,000
for the National Institute of Diabetes and Digestive and Kidney
Diseases [NIDDK]. The fiscal year 2004 appropriation was
$1,671,803,000 and the administration's request is
$1,726,196,000. The comparable amounts for the budget estimates
include funds to be transferred from the Office of AIDS
Research.
Mission.--The NIDDK provides leadership for a national
program in three major disease categories: diabetes,
endocrinology, and metabolic diseases; digestive diseases and
nutrition; and kidney, urologic, and hematologic diseases. The
NIDDK plans, conducts, fosters, and supports a coordinated
program of fundamental and clinical research and demonstration
projects relating to the causes, prevention, diagnosis, and
treatment of diseases within these categories. The Institute
also supports efforts to transfer the knowledge gained from its
research program to health professionals, patients, and the
general public.
Acute Liver Failure.--The Committee is pleased that the
NIDDK has funded an Acute Liver Failure Study Group [ALFSG]
that will improve medical knowledge necessary to prevent and
treat acute liver failure. The Committee is pleased with the
progress of the ALFSG, but notes that funding for the pediatric
component of this initiative is limited. The Committee
therefore urges increased funding for the ALFSG, particularly
to permit a focus on pediatric issues.
Auto-Immune Liver Diseases.--These diseases are the primary
indication for liver transplantation in adolescents. The
Committee urges additional research to improve the prevention
and treatment of auto-immune liver diseases in children.
Behavioral Research.--The Committee encourages NIDDK's
initiative to expand research on childhood obesity,
particularly behavioral research on physical activity in
children in various site-specific settings (schools, after-
school care, or other community venues). The goal of such
research would be to explore methods in pediatric populations
for the prevention of inappropriate weight gain among those not
overweight; to prevent further weight gain among those already
overweight or obese; or treatment of overweight or obesity to
prevent the complications of associated co-morbidities. The
Committee applauds NIDDK's proposed long-term effort to address
the relative contributions of the environmental and behavioral
factors that lead to excessive weight gain and obesity among
children.
Cooley's Anemia.--The Committee continues to support the
high quality research being conducted by the NIDDK on such
issues as iron chelation, non-invasive iron measurement, fetal
hemoglobin, and other topics critical the improving the lives
of Cooley's anemia patients. The development of a less
burdensome means of iron chelation is urgently needed. In
addition, the Committee encourages NIDDK to continue to work
closely with NIBIB to develop and perfect non-invasive means of
iron measurement.
Cystic Fibrosis.--Over the last three decades, advances in
the treatment of cystic fibrosis have resulted in improvements
in the life expectancy of individuals with CF. However, much
more remains to be done to find new treatments for CF. One
promising area of research is proteomics, which is focused on
the CF Transmembrane conductance Regulator and its
abnormalities, the many proteins that interact with CFTR, and
the identification of novel targets for new CF drugs. The
Committee encourages NIDDK to expand its support for basic and
clinical CF research and to place a special emphasis on
proteomics in CF.
Diabetes in Native Hawaiians.--The Committee recommends
investigating the incidence of diabetes in Native American,
Hawaiian and Alaskan populations, as well as the Mississippi
Band of the Choctaw Indians and the Eastern Band of the
Cherokee Indians.
Digestive Diseases.--The Committee commends NIDDK on the
success of its Digestive Disease Centers program in addressing
a wide range of disorders that result in tremendous human
suffering and economic cost. The Committee continues to
encourage NIDDK to expand this important program with an
increased emphasis on irritable bowel syndrome.
Fatty Liver Disease.--The Committee notes that there is an
emerging obesity-related chronic liver disease, nonalcoholic
fatty liver disease, which may affect as many as 1 in every 4
adults over the age of 18. This diagnosis encompasses a
spectrum of severity with many cases evolving into non-
alcoholic steatohepatitis [NASH] and, ultimately, cirrhosis.
NASH-related liver disease has already become an important
indicator for liver transplantation, and, in the absence of
better treatments, the need for NASH-related liver
transplantation will increase significantly over time. The
Committee appreciates NIDDK's existing programs in this area
but urges expanded basic and clinical research focused both on
interventions needed to prevent the onset of NASH and improved
protocols for treatment of established cases. The Committee
also urges the Institute to review opportunities to expand
current clinical programs, where appropriate, to permit the
enrollment and follow up of larger numbers of patients.
Finally, the Committee urges a public awareness campaign with a
national voluntary health agency with State and local
affiliates to reverse this growing and preventable public
health epidemic linked to the broader issue of obesity.
Fragile X.--Fragile X mental retardation is one of the most
common single gene disorders, and yet there exists almost no
research on its effects outside the central nervous system.
Fragile X causes a broad range of symptoms including premature
ovarian failure, macroorchidism (large testicles), and
malformations in the urogenital track, digestive problems
including excessive vomiting and increased motility. The fact
that these diverse symptoms arise from one gene mutation offers
an invaluable opportunity to understand and develop treatments
for these disorders. The Committee urges NIDDK to expand its
research activities on Fragile X and to coordinate these
efforts with other Institutes working on related activities,
including NIMH and NICHD.
Glomerular Injury Research.--The Committee is pleased with
NIDDK's glomerular injury research initiatives, including a
clinical trial for patients with focal segmental
glomerulosclerosis. The Committee understands that in addition
to the clinical trial, the NIDDK is collaborating on a joint
research program with a voluntary foundation to include basic
and genetic studies. Further the Committee is pleased that
NIDDK is sponsoring a scientific conference on glomerular
injury research, and is hopeful that this important workshop
will lead to a broader scope of activities and initiatives on
glomerular disease research.
Hepatitis B Conference.--Hepatitis B remains a common cause
of acute hepatitis affecting 1,250,000 Americans. Among the
Asian and Pacific Island populations the rate of infection rate
is even higher, affecting up to 15 percent of individuals. In
order to address this health issue, the Committee urges NIDDK
to convene an Expert Conference in fiscal year 2005 to reach
consensus on the best treatment protocols.
Hepatitis C in Children.--The Committee is pleased that the
NIDDK has launched a pediatric hepatitis C trial that will
permit long-term follow up of children enrolled in treatment
protocols, particularly as these treatment regimens impact the
growth and development of the children. The Committee looks
forward to being informed on the progress of this trial during
the fiscal year 2006 appropriations hearings.
Incontinence.--Fecal incontinence, also called bowel
incontinence, affects people of all ages and is associated with
a wide variety of causes. The Committee encourages NIDDK to
develop a standardization of scales to measure incontinence
severity and quality of life, and to develop strategies for
primary prevention of fecal incontinence associated with
childbirth.
Inflammatory Bowel Disease.--The Committee has been
encouraged in recent years by the discoveries related to
Crohn's disease and ulcerative colitis, collectively known as
inflammatory bowel disease [IBD]. These extremely complex
disorders represent the major cause of morbidity from
intestinal illness. The Committee commends the NIDDK for its
strong leadership in this area and encourages the Institute to
increase funding for research focused on: the cellular,
molecular, and genetic structure of IBD; identification of the
genes that determine susceptibility or resistance to IBD in
various patient subgroups; and translation of basic research
findings into patient clinical trials as outlined in the
research agenda developed by the scientific community titled,
``Challenges in Inflammatory Bowel Disease''. The Committee
also encourages NIDDK to continue to strengthen its partnership
with the IBD community and increase funding for its successful
digestive disease centers program with an emphasis on IBD.
Interstitial Cystitis.--The Committee is pleased by recent
advances in the area of interstitial cystitis research,
particularly in the area of urinary markers. The Committee
urges the NIDDK to continue to aggressively support IC-specific
basic science initiatives, particularly through program
announcements. The Committee also encourages the NIDDK to work
closely with the IC patient community on developing and funding
an IC awareness campaign for both the public and professional
communities, and to host a consensus conference on the
definition of IC. The absence of a uniform definition that
accurately captures the condition and the affected population
is negatively impacting patients in terms of diagnosis and
treatment as well as researchers in terms of literature review
and their research activities. The Committee was very
encouraged by the progress reported at the 2003 NIDDK-sponsored
scientific symposium on IC, and it urges the NIDDK to further
this scientific momentum by hosting the next international
symposium on IC in 2005.
Irritable Bowel Syndrome.--The Committee encourages NIDDK
to provide adequate funding for irritable bowel syndrome/
functional bowel disorders research and to give priority
consideration to funding grants that will continue to increase
the IBS portfolio. The Committee requests that NIDDK actively
pursue the development of a strategic plan for IBS research.
Mucopolysaccharidosis [MPS].--The Committee recognizes the
efforts of the NIDDK to enhance research efforts to achieve a
greater understanding and pursue development of effective
therapies for MPS disorders. In addition to the general overall
support of broad based MPS research, the Committee supports
studying bone and joint disease in MPS disorders. Research into
the underlying pathophysiology of bone and joint lesions, the
gene mutations and substrates that are stored and potential
therapeutic approaches are of interest to the Committee. The
Committee encourages NIDDK's continued efforts to collaborate
with NIAMS on bone and joint research in Lysosomal Storage
Disorders and commends the NIDDK on its performance in
collaborating with NINDS, NICHD, NCRR, and ORD in advancing
MPS-related research.
Osteoporosis.--The Committee encourages NIDDK, in concert
with other NIH institutes, to increase research into disease-
related osteoporosis and/or bone disorders. This research
should include studies of the role of genetics, the effects of
these diseases on bone turnover and altered bone metabolism,
the impact of environmental and lifestyle factors, their
effects on bone quality and fracture incidence, the role of
bone marrow changes, the use of agents to increase bone mass,
and the therapeutic use of new technologies to combat
osteoporosis.
Pediatric Kidney Disease.--Chronic kidney disease is the
ninth leading cause of death and one of the costliest illnesses
in the U.S. Although significant strides have been made in
understanding kidney disease in adults, much less is known
about its manifestations in children. This breach has taken on
greater significance in recent years as the number of children
who are overweight and obese has skyrocketed, giving rise to an
increased incidence of type 2 diabetes, hypertension and
chronic kidney disease in this population. Given the long-term
implications of diabetes-related kidney problems initiating in
childhood, NIDDK is encouraged to undertake longitudinal
studies of the natural history, prevention and treatment of
kidney disease in type 2 diabetes and its antecedents in
children and adolescents. The Committee is pleased that NIDDK
has assigned priority to clinical studies related to the
treatment of FSGS, the most common acquired cause of kidney
disease in children, and to longitudinal epidemiological
studies of children. In both instances, NIDDK is encouraged to
support ancillary studies aimed at discovering new prevention
and treatment strategies for children.
Pediatric Liver Transplant National Database and
Registry.--The Committee is pleased that NIDDK has funded the
Studies in Pediatric Liver Transplantation Registry. This
database and registry follows the natural history of infants
and children who receive liver transplants until they are 18
years of age. This National Database and Registry will permit
more hypothesis testing and outcomes research to determine both
the health and financial impact of liver transplants on the
child and the child's family.
Pediatric Urology.--The Committee remains concerned with
the lack of research dedicated to pediatric urologic
conditions. According to the NIDDK Bladder Research Review
Group document ``Overcoming Bladder Disorders: A Strategic Plan
for Research,'' the gaps and requirements for pediatric disease
research remain substantial, particularly for conditions such
as vesicoureteral reflux and bladder dysfunction. The Committee
urges NIDDK to commit the necessary resources to expand
research on pediatric urologic conditions, which may in turn
provide additional insight into adult urologic problems.
Polycystic Kidney Disease [PKD].--Recent breakthroughs in
PKD research have culminated in the development of therapies to
potentially halt disease progression for the 600,000 Americans
who suffer from PKD. Key to such therapies is the discovery
that an existing drug controlling other abnormal fluid-
retention diseases in humans also retards the production of
cysts and disease progression in all forms of PKD in the
laboratory. Also, the NIDDK-funded CRISP study for PKD proves
the value of innovative imaging methods to measure disease
progression, thus reducing by forty-fold the number of patients
needed to adequately assess clinical research outcomes.
Moreover, the possibility that future PKD clinical trials can
be conducted simultaneously with other research protocols under
the NIDDK-funded Halt-PKD Interventional Trials infrastructure
is also encouraging. The Committee urges the NIDDK to pursue
clinical trials regarding these recent breakthroughs and to
expand its infrastructure for PKD clinical research, while
expeditiously implementing the new PKD Strategic Plan it
recently developed.
Prostate Diseases.--Prostate diseases are highly prevalent
and poorly understood. While progress has been made, the
Committee encourages the Institute to develop a comprehensive
initiative on basic prostate biology that can lead to improved
diagnosis and treatment of diseases such as prostatitis and
BPH. In particular, the current efforts to develop biomarkers
for benign prostate diseases should be expanded.
Prostatitis.--The Committee encourages the Institute to
provide more diverse medical specialties to supplement and
build upon the insufficient treatment options and the
background of basic information now available. The genetic and
molecular epidemiology, the management of pelvic pain, the
infectious origins and the symptoms of prostatitis that are
identical to symptoms of prostate cancer need special
attention.
Scleroderma.--The Committee encourages the NIDDK to support
scleroderma relevant research. Scleroderma is a chronic and
progressive disease that predominantly strikes women. It is
estimated that 90 percent of patients with systemic sclerosis
have gastrointestinal [GI] involvement and of that number 50
percent have clinically significant manifestations. GI
involvement can manifest as gastroesophageal reflux disease,
dysphagia, Barrett's esophagus, gastroparesis, ``watermelon
stomach'', malabsorption, and fibrosis of the small and large
intestines. Renal crisis affects 20 percent of those with
systemic sclerosis often within the first 5 years after
diagnosis. More research is urgently needed in order to develop
safe and effective treatments and to identify the cause or
causes of the complications of scleroderma.
Tuberous Sclerosis Complex.--Tuberous sclerosis complex, or
TSC, is a genetic disorder that triggers uncontrollable tumor
growth in multiple organs of the body including the kidneys,
where patients are at risk for polycystic kidney disease,
cancer or, most commonly, benign growths known as
angiomyolipoma that can result in kidney failure. The Committee
strongly urges NIDDK to support studies examining the molecular
and cellular basis of these manifestations of TSC as well as
pre-clinical and clinical studies.
Urogynecology Program.--The Committee is pleased that the
NIDDK has supported the Urinary Incontinence Treatment Network
and urges increased funding and expansion for this important
and productive clinical network. While recent studies have
yielded gains in understanding these conditions, the Committee
is equally concerned that more needs to be done with basic and
translational research in order to create better foundations
for clinical care. The Committee supports the NIDDK in the
creation of a team focused on urogynecology and encourages a
dedicated study section in this area.
Urology Research.--The Committee commends NIDDK's release
of the first report on the burden of urologic disease through
its ``Urologic Diseases in America'' project, with a final
compendium due out in 2006. The Committee urges NIDDK to
allocate resources to ensure that updated reports are sustained
in the future and to provide a report on the plan for this
activity. The Committee is pleased that NIDDK has recognized
the interconnection between obesity and diabetes and urologic
disorders as shown by the December 2003 NIDDK meeting
``Urologic Complications of Diabetes'' and the NIDDK Bladder
Research Review Group document ``Overcoming Bladder Disorders:
A Strategic Plan for Research'' that dedicated an entire
section to the urologic problems associated with diabetes and
obesity. The Review Group specifically addressed research goals
including programs to assess the effect of obesity on
genitourinary tract function and to clarify the biologic
mechanisms for bladder and urethral dysfunction in diabetes.
The Committee encourages NIDDK to ensure that the NIH Obesity
Research Task Force includes adequate resources for research
addressing often-overlooked urologic problems associated with
diabetes and obesity. In particular, the Committee recommends
that the Urinary Incontinence Treatment Network continue
observational and interventional trials in the area of
incontinence associated with obesity and diabetes.
The Committee urges the NIDDK to provide to the Committee
the reports for the urology Interagency Coordinating Committee
meetings for the past 5 years and the collaborative initiatives
that have resulted from these meetings, and to provide the plan
for the next year on collaborative Interagency and
Interinstitute urology research. In particular, treatment for
prostate cancer is associated with significant incidence of
urinary incontinence and erectile dysfunction that severely
affect quality of life. NIDDK is urged to cooperate with the
National Cancer Institute on studies of the cause, prevention,
and treatment of urinary incontinence and erectile dysfunction
after treatment for prostate cancers. Incidence of urologic
disorders increases with aging; for example, urinary
incontinence is one of the leading causes of admission to
nursing homes. NIDDK is urged to work with the National
Institute on Aging to develop a comprehensive cooperative
program to address these costly and pervasive urology health
issues related to aging. In this regard, the Committee is
pleased to learn that NIDDK leadership has taken steps to
enhance integration of urologic diseases in initiatives within
NIDDK and between and across the NIH, and urges continuation of
these activities. A recently-appointed NIDDK Senior Advisor for
Urology is working to coordinate urology research activities
across the NIH.
The Committee is impressed with the results produced by the
George M. O'Brien urology research centers that bring together
a critical mass of scientists who focus on urologic disease.
The Committee recommends that NIDDK ensure adequate support to
enhance the successes and to provide for collaboration among
these centers.
Prostate diseases are highly prevalent and poorly
understood. While progress has been made, the Committee
encourages the Institute to develop a comprehensive initiative
on basic prostate biology that can lead to improved diagnosis
and treatment of diseases such as prostatitis and BPH. In
particular, the current efforts to develop biomarkers for
benign prostate diseases should be expanded.
The Committee is concerned about the continuing world-wide
HIV epidemic. HIV is readily transmitted through sexual
contact, yet little work is being done to examine the specific
role of semen in this transmission. The Committee believes that
a better understanding of these fundamental issues will
contribute significantly to research for a vaccine and more
effective treatments, and is pleased with the NIDDK's recent
initiative to encourage basic and clinical research studies
that will elucidate the factors that determine HIV release in
the male genital tract. The Committee urges the Institute to
continue enhancing its grant portfolio on the role of semen in
HIV transmission.
The Committee remains concerned with the lack of research
dedicated to pediatric urologic conditions. According to the
NIDDK Bladder Research Review Group document ``Overcoming
Bladder Disorders: A Strategic Plan for Research,'' the gaps
and requirements for pediatric disease research remain
substantial, particularly for conditions such as vesicoureteral
reflux and bladder dysfunction. The Committee urges NIDDK to
commit the necessary resources to expand research on pediatric
urologic conditions, which may in turn provide additional
insight into adult urologic problems.
NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE
Appropriations, 2004.................................... $1,501,207,000
Budget estimate, 2005................................... 1,545,623,000
Committee recommendation................................ 1,569,100,000
The Committee recommends an appropriation of $1,569,100,000
for the National Institute of Neurological Disorders and Stroke
[NINDS]. The fiscal year 2004 appropriation was $1,501,207,000
and the budget request is $1,545,623,000. The comparable
amounts for the budget estimates include funds to be
transferred from the Office of AIDS Research.
Mission.--The NINDS conducts and supports a broad range of
research and research training on the normal function of the
brain, spinal cord, and peripheral nerves, and on neurological
and neuromuscular disorders. Neurological research includes
epidemiology studies to identify risk factors for disease;
laboratory studies to examine the structure and function of
nerve cells; and brain imaging studies to understand how the
brain is affected by disease and how it operates to carry out
tasks such as learning and memory. New approaches for the
diagnosis, treatment, and prevention of brain disorders are
evaluated in studies with patients and those at risk for brain
disorders.
Alzheimer's Disease.--NINDS continues to play an integral
role in widening the scientific base of knowledge about
Alzheimer's disease. One emerging theme in the study of
Alzheimer's disease and other neurodegenerative diseases such
as Parkinson's and Huntington's disease, is the overlap
researchers have observed in the pathology underlying these
conditions. Scientific reports are showing evidence that these
disorders may be caused by similar abnormalities in protein
folding and accumulation, making support for Alzheimer's
disease research more relevant than ever. On another front,
working with NIA in the area of immunotherapy for Alzheimer's
disease, NINDS has funded a collaborative group of Alzheimer's
disease centers that will investigate the differences which can
involve the production of antibodies that reduce the cellular
and behavioral effects of the disease. The Committee encourages
NINDS to continue to assign a high priority to its Alzheimer's
research portfolio, and to work closely with NIA and other
institutes. The Committee also encourages NINDS to conduct
large scale clinical trials that will identify therapies and
treatments capable of slowing or halting the onset and
progression of Alzheimer's.
Alzheimer's Disease and Early Diagnosis.--The Committee
urges the NINDS, in collaboration with the NIA and NIMH, to
expand its research into early diagnosis of Alzheimer's using
PET imaging of the brain, and to share its results with the
Centers for Medicare and Medicaid Services.
Ataxia Telangiectasia [A-T].--A-T is a genetic disease that
attacks in early childhood. It progressively affects
coordination and severely compromises the immune system.
Children with A-T are highly likely to develop cancer, and
rarely live beyond their teens. The Committee encourages the
NINDS to work with the NCI and other appropriate Institutes to
support research aimed at understanding the underlying causes
of A-T with the goal of translating this basic research into
treatments for the disease.
Batten Disease.--The Committee is once again disappointed
with the pace of research regarding Batten disease. The
Committee strongly urges the Institute to increase funding for
such research by actively soliciting grant applications for
Batten disease and taking aggressive steps to assure that a
vigorous research program is established. The Committee expects
to be informed of the steps taken to increase research on
Batten disease.
Behavioral Research and Measurement of Cognitive
Function.--The Committee applauds the efforts of NINDS to
understand the mechanisms of executive function and ways to
enhance cognitive rehabilitation for neurological disease. The
Committee commends NINDS for its leadership in research to
develop and validate neuropsychological test batteries and
other instruments needed to measure executive function,
including higher level cognitive processes such as working
memory, decision-making, anticipation, and planning. Such tests
are critical measurement tools for establishing the efficacy of
interventions in NINDS clinical trials.
Brain Tumors.--The Committee continues to be concerned that
not enough attention and resources are devoted to identifying
causes of and treatments for brain tumors and encourages NINDS
to continue working with NCI to carry out the recommendations
of the Report of the Brain Tumor Progress Review Group.
Charcot-Marie-Tooth Disorder.--Charcot-Marie-Tooth Disorder
[CMT] is one of the most common inherited neurological
disorders, affecting approximately 1 in 2,500 people in the
United States. The Committee is concerned abut the prevalence
of this disease and its effect on people across the age
spectrum and recognizes the value of CMT research for advancing
understanding into other neuromuscular disorders. The Committee
urges the Institutes to identify new research opportunities on
CMT that could lead to a relevant program announcement or
request for applications. The Committee requests a report on
NIH efforts and research on CMT and CMT-related disorders by
April 1, 2005.
Down Syndrome.--Recently Down syndrome research has begun
to focus more on understanding the effect the disorder has on
gene expression, cell function, neurons and neural systems. The
Committee strongly encourages NINDS to expand its research on
Down syndrome, particularly as it relates to gene expression in
the brain and the development of possible biomedical
interventions to improve cognition, memory, speech, behavior,
and prevent early dementia. The Committee further encourages
NINDS to assume a leadership role in coordinating this research
among the Institutes and to work closely with NICHD to address
the serious shortage of mice used for Down syndrome research.
Duchenne Muscular Dystrophy.--The Committee urges NINDS, in
collaboration with NIAMS and NICHD, to dedicate additional
resources to develop a standard of care and improve treatments,
accelerate clinical trials and translational research for
patients with DMD. The Committee strongly encourages the
funding of three additional Centers of Excellence and doubling
of the funding for existing Centers of Excellence by the end of
fiscal year 2005. In addition, the Committee notes that the NIH
Interagency Coordinating Committee for muscular dystrophy has
missed its 1-year deadline to submit a plan for conducting and
supporting research and education on muscular dystrophy through
NIH in accordance with the MD CARE Act of 2001. The Committee
strongly urges the Coordinating Committee to finalize and
submit this plan, as well as include representation from the
Department of Defense on the panel, as soon as possible.
The Committee was disappointed with the July 2004
``Muscular Dystrophy Research and Education Plan for the
National Institutes of Health''. The Plan developed by the MD
Interagency Coordinating Committee, provides a summary of
research goals, but lacks sufficient detail into baseline
research efforts, funding, and technical progress. In
compliance with the provision of the Muscular Dystrophy Care
Act of 2001 (Public Law 107-84, ``MD Care Act''), the report
from the Coordinating Committee should be sufficient to support
science and research objectives; thus providing an investment
strategy and technical roadmap. In addition, the Committee
notes that in accordance with the MD Care Act, the Department
of Health and Human Services was to establish an Interagency
Coordinating Committee whose responsibility was the development
a plan on research and education on Muscular Dystrophy. The
Committee is also disappointed with the speed at which the Act
is being implemented. The Act became law in 2001 and the
coordinating Committee did not convene until July 2003.
Therefore, the Committee requests that, not later than February
1, 2005, the NIH shall provide an submit an additional report
which should contain a plan which establishes research goals;
the Institute or Center responsible for that research, the
amount of funding spent in fiscal year 2000 through fiscal year
2004 and the amount of funds that NIH will devote to this
research in fiscal year 2005 and 2006; key technical risk
areas; integration efforts between NIH Institutes and Centers;
and all opportunities for transition of technology to industry;
translational research; major milestones and clinical trial
opportunities.
Duchene Muscular Dystrophy Translational Research.--The
Committee commends the Institute for its enhanced efficiency in
the grant review cycle to fund translational research for
Spinal Muscular Atrophy [SMA]. The Committee strongly endorses
this accelerated research approach and urges the Institute to
evaluate the merits of this review model to fund translational
research for Duchenne Muscular Dystrophy and report back to
Congress no later than April 2005. The Committee believes the
SMA model enhances the dialogue between reviewers and
scientists, facilitating modifications of grant proposals that
are in the best interest of the patients. In addition, the
Committee strongly urges the Institute to increase funding for
basic and translation DMD research by aggressively soliciting
grant applications. The Committee encourages the Institute to
employ existing mechanisms such as a standing program
announcement, websites, publications, workshops and conferences
to promote awareness of funding opportunities. In addition, the
Committee encourages the NIH to further develop opportunities
for upcoming clinical trials and to help make available all
ongoing patient care options. The NIH is encouraged to
collaborate with other Departments, Federal agencies and
Patient Groups to develop formal programs that increase public
and professional awareness of the disease. The Committee
requests that NIH report back to the Committee, no later than
April 2005 with a progress report on all aspects of DMD
translational research.
Dystonia.--The Committee continues to support the expansion
of research and treatment developments regarding the
neurological movement disorder dystonia, given that dystonia is
the third most common movement disorder after tremor and
Parkinson's disease. The Committee encouragaes NINDS to support
additional research on both focal and generalized dystonia, and
commends NINDS for its study of the DYT1 gene and encourages
expansion in this area of research. The Committee also commends
NINDS for the release of the joint dystonia research program
announcement with other NIH Institutes and requests a
comprehensive report on the results of this important mechanism
for the fiscal year 2006 hearings. The Committee encourages the
Institute to continue its collaboration with the dystonia
research community in supporting epidemiological studies on
dystonia and in increasing public and professional awareness of
this disorder.
Epilepsy.--The Committee strongly encourages the Institute
to expand its efforts to find breakthroughs in the prevention,
treatment, and eventual cure of epilepsy. The Committee
applauds the development of benchmarks for epilepsy research
resulting from the ``Curing Epilepsy: Focus on the Future''
conference held in March 2000. The Committee expects that NINDS
will continue to update Congress and the public on progress in
reaching these goals. The Committee further encourages the
Institute to address critical research issues raised at the
Living Well With Epilepsy II conference held in July 2003.
These investments in our Nation's health examine how epilepsy
begins, ways of identifying people at risk and how to develop
treatments that will prevent epilepsy in those people, as well
as continuing the search for new therapies, free of side
effects, to prevent seizures. In addition, the Committee urges
the NINDS to focus on the critical research issues relating to
the over 30 percent of patients with intractable epilepsy, to
the life-long impact of seizures on young children, and to the
growing incidence of epilepsy in the elderly. The Committee
encourages the Institute to continue its anti-epileptic drug
development program to discover therapies that may provide
answers for the large number of people who do not respond to
current treatments. The Institute is expected to update the
Committee on its plans to advance these critical areas of
research at the fiscal year 2006 appropriations hearing.
Fragile X.--Fragile X is a single-gene disorder, but both
its symptoms and its cellular mechanisms suggest involvement of
multiple genes and specific brain pathways which are associated
with other neurological disorders, such as autism and seizures.
Furthermore, recent research offers clear evidence for
disruption of fundamental brain circuitry in Fragile X.
Research on Fragile X has the potential to contribute to
understanding of multiple disorders. The Committee urges NINDS
to expand its research activities on Fragile X and to
coordinate these efforts with other Institutes working on
related activities, including NIMH and NICHD.
FXTAS.--Fragile X-associated tremor/ataxia syndrome, or
FXTAS, is a newly discovered, progressive neurological disorder
that affects older men who are carriers of a premutation in the
same gene that causes Fragile X syndrome, the most common cause
of inherited mental retardation. Nearly 1 in 800 men in the
general population carries this premutation in the Fragile X
gene, and as many as 30 percent of these carriers--roughly 1 in
3,000 men--may develop FXTAS later in life. NINDS, in
collaboration with the National Institute on Aging, is urged to
commit additional resources and expand research into FXTAS, as
identification of older male carriers will lead to a better
understanding of the true incidence of Fragile X syndrome and
afford at-risk families of child-bearing age the opportunity to
pursue genetic counseling.
Interdisciplinary Research.--The Committee encourages NINDS
to continue exploring novel pathways by which cognitive
neuroscientists and rehabilitation clinicians can apply new
findings of central nervous system plasticity towards optimal
treatment outcomes for patients with disorders of the brain
affecting higher thought processes. The Committee applauds
NINDS for promoting the establishment of multidisciplinary
teams of scientists including neurologists, cognitive
functional imaging experts and computational modelers in order
to accelerate progress in the field of cognitive
rehabilitation. By focusing on the limited set of neurological
conditions (stroke, traumatic brain injury, and brain tumor)
where these partnerships are likely to produce realistic gains
in higher level functioning, NINDS may provide a model for
interdisciplinary approaches to a range of conditions in which
residual capacity is more difficult to measure.
Juvenile Diabetes.--The Committee commends the NINDS for
its efforts to prevent and treat hypoglycemia and neuropathy,
both of which are serious complications of juvenile diabetes.
The Committee encourages the NINDS to continue to expand its
research into neuropathy and hypoglycemia unawareness and to
consider establishing centers focused specifically on diabetic
neuropathy. The Committee requests an update during the fiscal
year 2006 hearings on the current status of diabetes-related
research programs being carried out by the Institute and also
urges NINDS to organize a workshop focusing on diabetic
neuropathy. Such a workshop would provide the research
community with an opportunity to identify common goals toward
the development of novel clinical treatments for diabetic
peripheral and autonomic neuropathies.
Mucopolysaccharidosis [MPS].--The Committee is gratified at
the release of the August 2003 PAS titled ``Neuroprotective CNS
Barriers in Neurological Diseases'' and the stated interest in
Lysosomal Storage Disorders [LSD] research in this initiative.
The Committee is pleased to learn NINDS has chosen to work with
the National MPS Society and other LSD groups in implementation
of a new PAS initiative focused on therapeutic Central Nervous
System research in Lysosomal Storage Disorders. The Committee
continues to encourage NINDS to collaborate with all
appropriate Institutes and Centers to support current MPS
research, study the blood brain barrier as an impediment to
treatment, and use all available mechanisms to further
stimulate and enhance efforts to better understand and treat
MPS disorders.
Multiple Sclerosis [MS].--The Committee recognizes that
more than 350,000 people in the United States currently suffer
from multiple sclerosis and that approximately 200 new cases
are diagnosed each week. The cause of MS remains unknown and no
cure exists. The Committee urges NINDS to coordinate with
private organizations that are working to discover effective
treatment targets for MS.
Neurofibromatosis.--Advances in NF research have linked NF
to cancer, brain tumors, learning disabilities and heart
disease affecting over 150 million Americans. Because NF plays
a pivotal role both in disorders of the brain and in cancer and
the enormous promise of NF research is now reaching fruition in
the testing of potential therapies, the Committee encourages
NINDS to aggressively expand its NF clinical and basic research
portfolios. The Committee commends NINDS for its leadership
role in NF research and in coordinating efforts with other
Institutes engaged in NF research. The Committee applauds NINDS
and the Office of Rare Diseases for convening a major
conference on NF in December 2003. The Committee also applauds
NINDS on issuing major program announcements in fiscal year
2004, pursuing the creation of NF research centers and NF
translational research. The Committee encourages NINDS to
follow through with the creation of these centers.
Neuroprosthetics.--The Committee urges the Institute to
expand research on neuroprosthetics, such as the Brain Machine
Interface (or Human Assisted Neurological Device) project. This
research offers great promise in restoring movement in
individuals suffering from a variety of neurological disorders
including paralysis, stroke and wound-related trauma.
Parkinson's Disease.--The Committee urges NINDS, in
addition to pursuing all promising therapeutic avenues, such as
gene therapy, stem cells, surgical approaches, non-human
models, and biomarkers, to continue to identify and study
neuroprotectant compounds, such as Coenzyme Q10, creatine, and
minocycline.
Furthermore, the Committee encourages NINDS to work with
NIBIB to discover a biomarker (particularly a molecular one)
for Parkinson's. Investment by NIBIB in clinical trials could
greatly enhance the value of these trials, as imaging
technology facilitates a better understanding of the physical
effects of tested drugs.
Finally, the Committee commends NINDS for committing to set
aside funds within its budget to fund the Udall Centers. The
Morris K. Udall Parkinson's Disease Research Centers of
Excellence support additional research opportunities and
discoveries that will lead to improved diagnosis and treatment
of patients with Parkinson's disease. The Centers vary in their
basic and clinical objectives, but together they foster an
environment that enhances research effectiveness in a
multidisciplinary setting.
Pick's Disease.--The Committee requests the NINDS, in
conjunction with NIA and NIMH, to provide a report to the
Committee by March 31, 2005, on grant funding and research
expenditures for Pick's disease and other frontotemporal
dementias. The Committee further requests that the NINDS
conduct an epidemiology study of frontotemporal dementias and
hold a workshop for researchers, clinicians, and advocates to
assess the current state of frontotemporal dementia research,
treatment, and needs.
Peripheral Neuropathy.--The Committee is aware that an
estimated 20 million Americans suffer from peripheral
neuropathy, a neurological disorder that causes debilitating
pain, weakness in the arms and legs, and difficulty walking.
Peripheral neuropathy affects approximately one-third of
diabetics, or about 5.1 million persons. Other forms of
neuropathy are inherited; associated with cancer, kidney
disease or infections like hepatitis, HIV/AIDS or Lyme disease;
or caused by autoimmunity, traumatic injuries, poor nutrition,
toxins and certain medications. For most of its victims, the
only recourse is pain medication, physical therapy or assistive
devices to help maintain strength and improve mobility. In
light of the large number of individuals affected, and the
attendant costs of this disease to society, the Committee is
concerned that insufficient resources are being devoted to
finding ways to cure, prevent and more effectively treat
peripheral neuropathy. To that end, the Committee strongly
urges NINDS to (1) determine how much NIH is devoting to
research in this area, and (2) develop a research agenda that
is coordinated with work being done through other institutes.
The Committee expects to receive a report on this effort at
next year's hearings.
Spina Bifida.--The Committee strongly encourages NINDS to
enhance research to address issues relating the outcomes of the
conference and urges significant expansion of prevention and
treatment of Spina Bifida and associated secondary conditions.
The Director should be prepared to testify on efforts to
advance these areas of research at the fiscal year 2006
appropriations hearing.
Spinal Muscular Atrophy.--SMA is the leading genetic killer
of infants and toddlers. The Committee understands that the
severity of the disease, its relatively high incidence, and the
possibility of imminent treatments have led NINDS to initiate
the SMA Therapeutics Development Program. The Committee is
pleased that initial work has begun on the program and strongly
urges NIH/NINDS to commit the resources required to ensure a
timely completion of the project mission--a treatment for SMA
ready for clinical trails for current and future therapies. To
maximize program efficiency, it is also critical that NINDS
integrate Therapeutics Development efforts with the biotech and
pharmaceuticals industry, academic medical centers and
collaborations with voluntary health organizations. The
Committee encourages NINDS to aggressively expand its SMA
basic, translational and clinical research portfolio. The
Committee understands that the strategy for developing a
treatment for SMA will guide therapeutics development for other
diseases including: Duchenne Muscular Dystrophy, ALS,
Huntington's and Alzheimer's. The Committee strongly urges
NINDS to successfully and expeditiously execute the SMA
Therapeutics Development Program for the benefit of patients of
SMA and countless other diseases. The Committee requests that
NIH report back to the committee, no later than April 2005 with
a progress report on all aspects of SMA research.
Stroke.--The Committee continues to regard research into
the causes, cure, prevention, treatment and rehabilitation of
stroke as a major concern for our Nation and urges the NIH and
the NINDS to make stroke a top priority. Stroke remains
America's third most common killer, a major contributor to
late-life dementia, and a major cause of permanent disability.
The Committee continues to strongly support increased efforts
on stroke research. The Committee is very concerned that
funding for stroke research over the years has not kept pace
with the scientific opportunities, the number of Americans
afflicted with stroke, and the economic toll this disease
imposes on our Nation. The Committee urges the NINDS to
aggressively expand its research portfolio and dramatically
increase resources dedicated to stroke research through all
available mechanisms. The Institute is urged to expand its
stroke education program, to continue to implement the long-
range strategic plan for stroke research and to continue and
expand innovative approaches to improve stroke diagnosis,
treatment, rehabilitation, and prevention.
Stroke Professional Judgment Budget.--The Committee
commends the NINDS for convening a Stroke Progress Review Group
which subsequently developed and released a 2002 report
identifying critical gaps in stroke knowledge and outlining
research priorities and resource priorities. The Committee is
concerned that the report did not include a professional
judgment budget and therefore requests that the NINDS submit to
the Committee by April 2005 a professional judgment budget for
each year of the plan. The Committee encourages the Institute
to continue to implement and fully fund the priorities in the
Report and requests an implementation report by April 2005.
Tuberous Sclerosis Complex.--Tuberous sclerosis complex, or
TSC, is a genetic disorder that triggers uncontrollable tumor
growth in multiple organs of the body, including the brain,
heart, kidneys, lungs, liver, eyes or skin. Its victims--many
of whom are infants and young children--face a lifetime of
suffering with kidney failure, seizures, behavioral disorders,
autism and mental retardation. Because of the effects of TSC on
multiple organ systems, the Committee last year called upon the
NIH Director to formulate an NIH-wide research agenda. The
Committee understands that NINDS is assigned to implement and
coordinate that effort, and looks forward to a yearly report on
that effort. In the meantime, NINDS is strongly urged to
support research examining the molecular and cellular basis of
central nervous system manifestations in TSC, including studies
examining TSC-associated epilepsy and brain tumor formation,
and the effect of tubers and seizures on cognition and
behavior. The Committee also looks forward to a report on
NINDS's coordinating activities and progress towards
implementing the research agenda prior to the fiscal year 2006
hearings.
NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES
Appropriations, 2004.................................... $4,155,447,000
Budget estimate, 2005................................... 4,325,507,000
Committee recommendation................................ 4,307,185,000
The Committee recommends an appropriation of $4,307,185,000
for the National Institute of Allergy and Infectious Diseases
[NIAID]. The budget request was $4,325,507,000. The fiscal year
2004 appropriation was $4,155,447,000. Included in these funds
is $149,115,000 to be transferred to the Global Fund to Fight
HIV/AIDS, Malaria, and Tuberculosis. The comparable amounts for
the budget estimate include funds to be transferred from the
Office of AIDS Research.
Mission.--The NIAID is the lead NIH Institute charged with
developing vaccines and supporting research on allergies,
acquired immunodeficiency syndrome [AIDS], sexually transmitted
diseases, turberculosis, tropical diseases, and other
infectious diseases--including those likely to be used as
agents of bioterrorism. To accomplish this mission, the NIAID
supports and conducts basic and clinical research and research
training programs in infectious diseases, whether they are
naturally occurring or the result of a bioterrorist attack, and
in diseases caused by, or associated with, disorders of the
immune system.
Arthritis.--The Committee encourages the NIAID to
coordinate its research efforts with other NIH institutes to
find a cure for arthritis and related diseases.
Asthma.--The Committee is pleased with NIAID's leadership
regarding asthma research and management. The Committee urges
NIAID to continue to improve its focus and effort on asthma
management, especially as it relates to children. The Committee
also urges the NIAID to collaborate more aggressively with
voluntary health organizations to support asthma prevention,
treatment, and research activities. Additionally, recent
studies suggest that a variety of viral and bacterial agents,
including agents used for immunization may play a role in the
development of asthma. The Committee urges the Institute to
expand research into the role that infections and vaccines play
in the development of asthma.
Atopic Dermatitis.--Atopic dermatitis [AD] is one of the
most common skin disorders experienced by infants and children.
Patients with AD suffer with chronic skin inflammation and
itching that disrupt sleep and reduce quality of life. Of
additional concern, individuals who have active or dormant AD
are at high risk for serious adverse reaction to the smallpox
vaccine. The Committee encourages NIAID to work with NIAMS to
spearhead a multidisciplinary, multi-institute initiative to
encourage investigator-initiated research on AD as it relates
to smallpox vaccination as well as the progression to asthma
and other allergic diseases.
Genomics.--The Committee is pleased that the NIAID has
focused its attention on research efforts associated with
multiple categories of pathogens. The Committee understands
that commercially available research tools, such as microarray
technology, can enhance the progress of pathogen-related
research. The Committee urges the NIAID to utilize this
technology to further support an aggressive agenda of pathogen
research activities.
Hemophilia.--The Committee appreciates NIAID's efforts to
improve HIV and hepatitis C virus [HCV] treatment for persons
with hemophilia or other bleeding disorders. The Committee
encourages NIAID to work with the National Hemophilia
Foundation in strengthening its support for research on liver
disease progression to improve HIV and HCV treatment among
persons with bleeding disorders.
Hepatitis.--The Committee continues to be concerned about
the prevalence of hepatitis and urges NIAID to work with public
health organizations to promote liver wellness, education, and
prevention of hepatitis.
Hepatitis C Vaccine.--The Committee is encouraged to learn
that a small hepatitis C vaccine human trial has been launched
and urges the consideration of other creative approaches and
new paradigms including the development of DNA vaccines.
Inflammatory Bowel Disease.--Recent research identifies
strong linkages between Crohn's disease and ulcerative colitis
(collectively known as inflammatory bowel disease) and the
functions of the immune system. The Committee encourages the
Institute to expand its research partnerships with the IBD
community, and to increase funding for research focused on the
immunology of IBD and the interaction of genetics and
environmental factors in the development of the disease.
Juvenile Diabetes.--The Committee is encouraged by the
Institute's efforts regarding the Autoimmune Prevention
Centers, and it encourages the Institute to develop pilot
projects, initiated with the support of the Prevention Centers
of Autoimmunity, into full research proposals with special
emphasis on pre-clinical studies related to juvenile diabetes.
Nontuberculous Mycobacteria [NTM].--Mycobacteria are
environmental organisms found in both water and soil that can
cause significant respiratory damage. The Committee is aware of
the increasing incidence of nontuberculous mycobacteria [NTM]
pulmonary infections in women, particularly involving rapidly
growing mycobacteria, an inherently resistant subspecies. The
Committee encourages NIAID to advance diagnostic and treatment
protocols for patients suffering from NTM diseases.
Primary Immunodeficiency Diseases.--The Committee notes
that more than 150 primary immune deficiency diseases have been
identified to date. These diseases, which impair the body's
immune system, strike more severely in children, many of whom
do not survive beyond their teens or early twenties. Primary
immune deficiencies afflict more than 50,000 Americans,
regardless of age, race, or gender. The Committee believes that
NIAID should play a significant role in addressing this
seriously under-diagnosed class of diseases. Research is being
funded at many institutions, including several of the twelve
Jeffrey Modell Diagnostic and Research Centers, as part of a
consortium created to expand and enhance the research in this
group of diseases. However, that research only helps people if
physicians know to look for the disease; the public is aware of
it; and, patients are diagnosed early and accurately. For this
reason, the Committee encourages NIAID to increase its support
for the public outreach campaign principally funded by the CDC,
while maintaining its research portfolio. The Committee
commends NIAID for the establishment of its primary
immunodeficiency disease research consortium (USIDNet) in
partnership with the Immune Deficiency Foundation and
encourages continued support for this program.
Psoriasis.--Psoriasis is a chronic, immune-mediated disease
that affects more than 5 million Americans. A 1999 NIMH-
supported study found that patients with psoriasis reported
reduction in physical and mental functioning comparable to that
seen in cancer, arthritis, hypertension, heart disease,
diabetes, and depression. The Committee considers research on
psoriasis and psoriatic arthritis very important, and is
pleased that NIAMS helped create a psoriasis tissue bank from
which the first several psoriasis genes have been identified.
The Committee urges NIAMS to support additional research into
the identification of other genes expected to play a role in
psoriasis pathogenesis, and also to support additional clinical
research on current and potential therapies for psoriasis and
psoriatic arthritis.
Scleroderma.--The Committee encourages NIAID to undertake
research to study the cause and treatment of scleroderma, a
chronic progressive disease that predominantly strikes women.
Scleroderma is disfiguring and can be life-threatening,
affecting multiple systems. More research is critically needed
in order to develop safe, effective treatments and to identify
the cause or causes of scleroderma and its complications.
Therefore, the Committee urges NIAID to include scleroderma
research in the portfolio of the Autoimmune Centers of
Excellence.
Transplantation Research.--The Committee urges NIAID to
convene an expert conference during fiscal year 2005 to develop
a Transplantation Research Action Plan identifying the most
urgently needed research to facilitate an increase in the
success of organ transplantation. The Committee requests a
report on the results of this conference including a breakdown
of resources committed to this category of research.
Tuberculosis.--The World Health Organization estimates that
nearly 1 billion people will become infected with tuberculosis
[TB], 200 million will become sick, and 70 million will die
worldwide between now and 2020. The Committee is pleased with
NIAID's efforts to develop an effective TB vaccine and
encourages the Institute to continue its TB vaccine development
work and to expand efforts to develop new drugs to treat TB.
NATIONAL INSTITUTE OF GENERAL MEDICAL SCIENCES
Appropriations, 2004.................................... $1,904,838,000
Budget estimate, 2005................................... 1,959,810,000
Committee recommendation................................ 1,975,500,000
The Committee recommendation includes $1,975,500,000 for
the National Institute of General Medical Sciences [NIGMS]. The
fiscal year 2004 appropriation was $1,904,838,000 and the
administration's request is $1,959,810,000. The comparable
amounts for the budget estimate include funds to be transferred
from the Office of AIDS Research.
Mission.--NIGMS supports research and research training in
the basic biomedical sciences. Institute grantees, working in
such fields as cell biology, biophysics, genetics,
developmental biology, pharmacology, physiology, biological
chemistry, bioinformatics, and computational biology, study
normal biological processes to better understand what goes
wrong when disease occurs. In this way, NIGMS supplies the new
knowledge, theories, and technologies that can then be applied
to the disease-targeted studies supported by other NIH
components. NIGMS-supported basic research advances also
regularly find applications in the biotechnology and
pharmaceutical industries. The Institute's training programs
help provide the scientists needed by industry and academia to
maintain United States leadership in biomedical science.
Basic Behavioral Science.--The legislative mandate for
NIGMS specifically includes behavioral science research,
although NIGMS does not now support behavioral science research
or training. Given the wide range of fundamental behavioral
topics with relevance to a variety of diseases and health
conditions, the Committee encourages NIGMS to incorporate basic
behavioral research as part of its portfolio, especially in the
areas of cognition, behavioral neuroscience, behavioral
genetics, psychophysiology, methodology and evaluation, and
experimental psychology
Basic Research on Pre-Disease Pathways.--As the NIH
institute most concerned with basic research, NIGMS has
provided leadership in research on physiological and biological
structures and functions that may play roles in numerous health
conditions. The Committee encourages NIGMS to collaborate with
other institutes including NCI, NIMH and the Office of
Behavioral and Social Sciences Research to fund research to
integrate physiological knowledge of pre-disease pathways with
behavioral studies.
NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT
Appropriations, 2004.................................... $1,242,361,000
Budget estimate, 2005................................... 1,280,915,000
Committee recommendation................................ 1,288,900,000
The Committee recommends an appropriation of $1,288,900,000
for the National Institute of Child Health and Human
Development [NICHD]. The fiscal year 2004 appropriation was
$1,242,361,000 and the administration's request is
$1,280,915,000. The comparable amounts for the budget estimate
include funds to be transferred from the Office of AIDS
Research.
Mission.--The NICHD is that component of the NIH
responsible for conducting and supporting research on maternal
and child health, the population sciences, and medical
rehabilitation. Research encompassed by these areas targets
infant mortality; genetic diseases, including birth defects;
mental retardation; gynecological health and contraceptive
development and evaluation; pediatric, maternal, and adolescent
AIDS; developmental biology; vaccine development; demographic
and behavioral research; and restoration or enhancement of
function in individuals experiencing physical disability due to
injury, disease, or birth defect.
Behavioral Science.--The Committee emphasizes its strong
support for the broad portfolio of behavioral research at
NICHD, and supports NICHD's efforts to determine the
biological, behavioral, and social factors that affect
cognitive, social, and personality development of children in a
variety of settings. The Committee encourages research on
effective ways to promote and sustain healthy family formations
for low-income families, including families of color. The
Committee is particularly concerned about rising rates of
childhood obesity and supports continued initiatives to promote
healthy behaviors in children and adolescents and research to
prevent health risk behaviors.
Demographic Research.--The Committee commends NICHD for its
strong support of demographic research. This research has
consistently provided critical scientific knowledge on issues
of greatest consequence for American families: work-family
conflicts, family formation and structure, childcare,
adolescent health and wellness, and family and household
behavior. Recent findings have provided invaluable insights
into timely issues such as the role of maternal employment and
parental involvement on child development. The Committee
applauds NICHD for its ongoing support of the Fragile Families,
Three Cities Study of Welfare, and National Longitudinal Study
of Adolescent Health studies in particular. The Committee
encourages the Institute to ensure adequate funding for the
large databases such as these that make advances in population
research possible. Further, the Committee urges NICHD to
maintain stable funding for the Population Research
Infrastructure program. The recent retooling of this program
has enhanced its ability to support vital interdisciplinary
collaboration and innovation in population research at academic
and research institutions nationwide. The diverse exceptional
research supported by this program has yielded key findings in
areas such as fertility, health disparities, immigration and
migration trends, and family dynamics. Given the importance of
these issues to policymakers and the public, demographic
research at the NICHD must continue to thrive.
Down Syndrome.--The Committee encourages NICHD to increase
funding for Down syndrome research as relates to gene
expression of chromosome 21, the effects on cell function and
cognition, and possible medical treatments to eliminate or
reduce the cognitive abnormalities associated with the
disorder. The Committee is aware of a serious shortage of mice
used in the research of Down Syndrome and strongly encourages
NICHD to increase funding for greater production of the Ts65Dn
mouse model and for the research and development of other mouse
models. The Committee also urges NICHD to work closely with
NINDS, NIA, NIMH and NHGRI to establish a new, multi-year
research initiative to fund Down syndrome biomedical research
on cognition, behavior and early dementia.
Drug Safety for Children.--The Committee recognizes the
importance of ensuring that drugs are safe and effective for
use by children and are appropriately labeled for pediatric
use. The Committee strongly supports continued implementation
of the Research Fund within the National Institutes of Health,
as established in the Best Pharmaceuticals for Children Act of
2003 (Public Law 107-109) within section 409I of the Public
Health Service Act, which supports the pediatric testing of
off-patent drugs, as well as on-patent drugs not being studied
through existing mechanism. The Committee urges NICHD to act as
the coordinating Institute for other Institutes within NIH for
which pediatric pharmacological drug research may have
therapeutic relevance, and urges consultation with the Food and
Drug Administration to ensure that the studies conducted
through the Fund are designed to yield improved pediatric
labeling. The Committee expects an update prior to the fiscal
year 2006 hearings, including information on the number of
studies supported through the Research Fund; the estimated cost
of each study undertaken; the nature and type of studies
undertaken; the number of label changes resulting from
completed studies; the patent status of the drugs studied; and
the number of drugs remaining on the priority list established
through section 409I.
Fragile X.--Title II of the Children's Health Act of 2000
authorized the establishment of at least three Fragile X
research centers. The Committee is pleased that the NICHD has
funded three Centers on a first-year basis, and urges the NICHD
to issue an RFP with the goal of enhancing the Centers and
recruiting new researchers to the Fragile X field. The
Committee also encourages the NICHD to coordinate its Fragile X
research efforts internally, by partnering with others, and by
relating Fragile X research with that in other developmental
disorders, and with autism research.
Infertility and Contraceptive Research.--The Committee
continues to place high priority on research to combat
infertility and speed the development of improved
contraceptives. NICHD is urged to continue aggressive
activities in this area, including individual research grants
and those of the infertility and contraceptive research
centers.
Learning and School Readiness.--The Committee commends
NICHD on its commitment to research in reading, learning
disabilities, and math and science cognition. NICHD is
encouraged to support additional research on developing
comprehensive, culturally neutral and developmentally
appropriate assessments and instruments to measure cognitive,
social and emotional skills for pre-school-aged children that
are necessary for school readiness.
Maternal Fetal Medicine Units Network [MFMU].--The
Committee was extremely encouraged by the research results from
NICHD's Maternal Fetal Medicine Units Network on the
identification of a therapy, progesterone, that prevents
recurrent preterm birth in high-risk women. The Committee
understands that this is one of the first advances in this
area, despite extensive efforts over decades, and urges the
NICHD to build on this finding and to fully support the MFMU
Network.
National Children's Study.--The Committee strongly supports
full and timely implementation of the National Children's
Study. This study aims to quantify the impacts of a broad range
of environment influences, including physical, chemical,
biological and social influences, on child health and
development. The Committee urges the NICHD to coordinate the
involvement of the Department, the lead Federal partners--CDC,
EPA, and NIEHS--and other interested institutes, agencies, and
non-Federal partners conducting research on children's
environmental health and development, such that this study is
ready for the field no later than 2006.
The Committee is pleased that the National Children's Study
Advisory Committee is planning to utilize probability sampling
in its design and is undertaking a strategic planning process
that emphasizes collaboration between the biomedical and
behavioral sciences.
Neurofibromatosis.--Learning disabilities occur with high
frequency (30-65 percent) in children with NF and in
approximately 5 percent of the entire world's population.
Enormous advances have been made in NF research in just the
past year, regarding the mysteries of how the NF gene is
related to learning disabilities, raising hopes of finding a
treatment for learning disabilities not only in children with
NF but in the general population as well.
Obesity in Children.--The Committee strongly urges the
NICHD, in collaboration with other relevant Institutes, to
support the initiation of a study on the metabolic,
psychological, and genetic causes of obesity in children. The
Committee requests the Institute be prepared to report on the
progress being made in the development of such study during the
fiscal year 2006 appropriation hearings.
Pediatric AIDS.--The Committee urges the Institute to
increase support for AIDS research, especially pediatric HIV/
AIDS research. HIV/AIDS affects children differently than it
does adults, and it is essential to do specific research for
pediatric populations in order to continue making significant
strides in treating children with HIV/AIDS.
Pediatric Liver Disease.--The Committee urges the Institute
to aggressively pursue and fund ancillary studies associated
with the recently awarded NIDDK pediatric hepatitis C clinical
trial. This clinical trial will provide long term follow up for
children treated for hepatitis C, permitting growth and
development issues to be more fully explored. The Committee
also notes that the Institute has provided only limited support
for pediatric liver disease research and urges support to
expand ongoing efforts to study biliary atresia and to provide
expanded support for the Biliary Atresia Clinical Research
Consortium.
Prader-Willi Syndrome.--Prader-Willi Syndrome is the most
common known genetic cause of life threatening obesity in
children. The Committee strongly encourages the NICHD to place
a high priority on Prader-Willi Syndrome research to study
childhood obesity. Furthermore, the NICHD is urged to
incorporate Prader-Willi Syndrome into the planning process for
The National Children's Study.
Prematurity.--The Committee encourages NICHD to support a
major initiative in the area of prematurity. The rates of
premature birth have increased 29 percent since 1981 to over
480,000 babies in 2002. African-American infants are nearly
twice as likely as non-Hispanic white infants to be born
prematurely. Premature birth is the leading cause of death in
the first month of life and most recent data indicate the first
rise in infant mortality rates since 1958. Premature birth can
occur in any pregnancy; the causes of nearly half of all
preterm births are unknown. The Committee commends NICHD for
its work on preterm birth and strongly urges the allocation of
more funds to reveal the underlying cause of preterm delivery,
to identify prevention strategies and improve the treatment of
outcomes for infants born preterm.
In addition, the Committee is aware that genomic and
proteomic strategies are widely used and have had a major
impact on medicine. The Committee believes it is imperative
that these techniques also be used to understand prematurity,
and strongly encourages NICHD to support an initiative to
hasten a better understanding of the pathophsiology of
premature birth, discover novel diagnostic biomarkers, and
ultimately aid in formulating more effective interventional
strategies to prevent premature birth.
Primary Immunodeficiency Diseases.--The Committee continues
to be impressed with the dedication of financial and personnel
resources by NICHD to address the research and awareness issues
that surround this class of more than 100 diseases. The
Committee is particularly encouraged by the institute's
research commitment to develop newborn screening procedures for
PI through microarray technologies and urges the NICHD to press
ahead aggressively with this initiative.
Skeletal Development.--The Committee urges NICHD to focus
on the effects of a wide variety of drugs on the growing
skeleton and how to minimize these effects by working to ensure
that the impact on the growing skeleton is investigated for all
therapeutic agents in the implementation of the Better
Pharmaceuticals for Children Act. The Committee also encourages
NICHD to engage in trans-NIH research into other factors--
including genetic, diet and exercise--affecting the
determination of peak bone mass in children with and without
the metabolic bone diseases of osteoporosis and osteogenesis
imperfecta. In addition, the Committee urges support for basic
research on the pathophysiology, genetics and treatment of
osteopetrosis.
Spina Bifida.--The Committee is pleased that the Institute
cosponsored the Spina Bifida Research Conference in May 2003.
However the Committee has concerns that without adequate
follow-up the conference findings and recommendations will not
come to fruition. The Committee strongly encourages NICHD to
enhance research to address issues related to the outcome of
the conference and urges the Institute to significantly expand
its research efforts in the prevention and treatment of Spina
Bifida and associated secondary conditions. The Director should
be prepared to report on efforts to advance these areas of
research at the fiscal year 2006 appropriations hearing.
Spinal Muscular Atrophy [SMA].--SMA is the leading genetic
killer of infants and toddlers, and is the most prevalent
genetic motor neuron disease. The severity of the disease, its
relatively high incidence, and the possibility of imminent
treatments have led NINDS to initiate the SMA Project. The
Committee believes that the treatment of SMA, and the SMA
Project at NINDS, is strategically consistent with the mission
the NICHD. The Committee strongly urges the NICHD to work
closely with NINDS to develop collaborations and programs which
will support and expand the SMA Project. The Committee strongly
urges NICHD to expand the scope and level of SMA research by
aggressively soliciting grant applications on an expedited
basis. Lastly, the Committee strongly urges the NICHD to
develop formal programs that increase public and professional
awareness of SMA. The Committee requests that the NICHD report
back to the Committee during the fiscal year 2006
appropriations hearings.
Stillbirth.--The Committee applauds NICHD's efforts in
addressing stillbirth, a major public health issue with
morbidity equal to that of all infant deaths. The Committee
understands that NICHD has established a cooperative network of
clinical centers and a data center to address this issue with a
standard protocol, and strongly encourages the NICHD to fully
fund this effort.
Sudden Infant Death Syndrome.--The Committee is pleased
with NICHD's continued efforts to extend the reach of its
extremely successful ``Back to Sleep'' campaign to underserved
populations and daycare providers. Now that NICHD is focusing
more globally on infant mortality, the Committee urges the
Institute to transition from its successful SIDS 5-year
research plan to a more comprehensive plan focusing on SIDS,
stillbirth, and miscarriage. The Committee requests that NICHD
determine an appropriate means of including research on these
causes of infant mortality into one inclusive plan.
Urinary Incontinence.--Urinary incontinence is one of the
most prevalent chronic diseases in women affecting 30 percent
of females; these and other pelvic floor disorders serve as
obstructions to healthy living and contribute to depression and
obesity. The Committee commends the NICHD for establishing the
Pelvic Floor Disorder Network [PFDN] and expects additional
resources will enable the network to expand the quality and
integrity of clinical and basic scientific research in the
field of urogynecology. The Committee is pleased that the NICHD
continues to collaborate with the NIDDK in developing research
in urinary incontinence. Recent studies have yielded gains in
understanding these conditions but the Committee is equally
concerned that more needs to be done with basic, clinical and
translational research in order to create better foundations
for clinical care. The Committee encourages the Institute to
provide expanded research for investigator-initiated
applications to ensure a self-sustaining base of ongoing
research and encourages a dedicated study section in this area.
The Committee also encourages the NICHD to include the effects
of pregnancy on a woman's chance for incontinence and pelvic
floor disorders in the future National Children's Study.
Vulvodynia.--Millions of American women suffer from
vulvodynia, a painful and often debilitating disorder of the
female reproductive system. Despite its prevalence, inadequate
attention has been paid to the disorder by health professionals
or researchers. Since fiscal year 1998, the Committee has
called on the NICHD to support research on the prevalence,
causes and treatment of vulvodynia. While some initial steps
have been taken, more must be done. The Committee urges the
Institute to fund a collaborative research network to expedite
the collection of data on the efficacy of current and future
treatments. In addition, the Committee notes that, on average,
women with vulvodynia consult five physicians before receiving
a correct diagnosis. Therefore, the Committee urges the NICHD
to work with the National Vulvodynia Association to implement a
national education program for primary care health
professionals, patients and the general public to reduce this
delay.
NATIONAL EYE INSTITUTE
Appropriations, 2004.................................... $653,052,000
Budget estimate, 2005................................... 671,578,000
Committee recommendation................................ 680,300,000
The Committee recommends an appropriation of $680,300,000
for the National Eye Institute [NEI]. The budget request was
$671,578,000 and the fiscal year 2004 appropriation was
$653,052,000. The comparable amounts for the budget estimate
include funds to be transferred from the Office of AIDS
Research.
Mission.--The NEI is the Nation's Federal resource for the
conduct and support of laboratory and clinical research,
research training, and other programs with respect to blinding
eye diseases, visual disorders, mechanisms of visual function,
preservation of sight, and the special health problems and
needs of individuals who are visually impaired or blind. In
addition, the NEI is responsible for the dissemination of
information, specifically public and professional education
programs aimed at the prevention of blindness.
Diabetic Retinopathy.--The Committee commends NEI for
establishing the Diabetic Retinopathy Clinical Research
Network, which serves to expedite the evaluation of new
approaches to address vision-related complications of diabetes.
The Committee encourages NEI to continue to expand upon its
efforts to detect, prevent and treat diabetic retinopathy by
collaborating with NIBIB on the development and application of
scanning technologies that will be highly affordable and widely
accessible to allow for early detection.
Gene Therapy.--The Committee is aware of progress made in
demonstrating the effectiveness of gene therapy to reverse and
cure several retinal diseases, including diabetic retinopathy,
macular degeneration, and retinopathy of prematurity. diabetic
retinopathy and macular degeneration are leading causes of
blindness and visual disability in the United States, with an
additional 165,000 people losing their vision each year due to
these disorders. Additionally, each year more than 500 infants
are blinded by retinopathy of prematurity. Since gene therapy
intervention has been successfully demonstrated in laboratory
animals, the Committee urges the Institute to facilitate
clinical trials in primates and humans to further validate gene
therapy interventions to reverse and cure retinal diseases.
Juvenile Diabetes.--The Committee is aware of the serious
problem of retinopathy in individuals with juvenile diabetes,
and it encourages the NEI to continue to collaborate with other
institutes on efforts to identify the genes for diabetic
retinopathy by collecting and analyzing human samples and by
developing animal models of diabetic retinopathy.
NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES
Appropriations, 2004.................................... $632,392,000
Budget estimate, 2005................................... 650,027,000
Committee recommendation................................ 655,100,000
The Committee recommends an appropriation of $655,100,000
for the National Institute of Environmental Health Sciences
[NIEHS]. The budget request was $650,027,000 and the fiscal
year 2004 appropriation was $632,392,000. The comparable
amounts for the budget estimate include funds to be transferred
from the Office of AIDS Research.
Mission.--The mission of the NIEHS is to define how
environmental exposures affect health; how individuals differ
in their susceptibility to these effects; and how these
susceptibilities change with time. This knowledge, coupled with
prevention and communication programs, can lead to a reduction
in environmentally associated diseases and dysfunctions.
Breastfeeding and Toxins.--Recent reports on the presence
of flame retardants and other environmental toxins in human
breastmilk have given rise to concerns about the safety of
breastfeeding. Recognizing that these reports may offer mixed
messages about this public health concern, the Committee
reaffirms the goal of Healthy People 2010 of ``[I]ncreasing the
proportion of mothers who breastfeed their babies.'' The
Committee also strongly urges the National Institute of
Children's Health and Human Development, the National Institute
of Nursing Research, the National Institute of Environmental
Health Sciences, the Centers for Disease Control and
Prevention, Department of Health and Human Services' Office of
Women's Health to hold a consensus meeting with health
professionals, to include nursing and breastfeeding and
lactation professionals. The consensus meeting should focus on
environmental toxins and breastfeeding and appropriate public
risk communication.
Environmental Health and Nursing.--According to the final
report of the Nursing and Environmental Health Roundtable, held
in the fall of 2002, there is a significant need to build a
cadre of registered nurse researchers specializing in
environmental health. During the last decade, increased
emphasis has been placed on the impact of environment on human
health and the need for nurses to engage in research to advance
knowledge in this field. Several nurse researchers received
funding for environmental health projects focused on prevention
of lead exposures, environmental factors and asthma, pesticide
exposures among workers and their families, environmental
awareness, and occupational health. Despite these efforts,
significant needs still exist. Environmental health nurse
researchers bring knowledge in nursing research methods as well
as more traditional areas of environmental health research,
such as human disease manifestation, risk assessment, and risk
management. Many of the priority areas of environmental health
nursing research rely on methods of exposure assessment, risk
assessment, and risk communication. This Committee urges the
National Institute of Environmental Health Sciences to create
specific nurse research fellowships with the goal of increasing
the number of registered nurse researchers specializing in the
area of environmental health.
Pacific Center for Environmental Health.--The Committee
encourages NIEHS to establish a Pacific Center for
Environmental Health to further study the short-term and long-
term health effects of volcanic emissions as well as other
environmental issues. Such environmental concerns should
include food and waterborne illness, fish contamination by
pesticides and heavy metals, and pesticide residue in food and
water.
Parkinson's Disease.--The Committee urges NIEHS in
collaboration with NINDS to gain a greater understanding of the
environmental underpinnings of Parkinson's disease. The
Committee also strongly urges NIEHS to intensify its efforts in
the Collaborative Centers for Parkinson's Disease Research
Program--as this initiative facilitates significant
collaboration among genetics, clinical medicine, epidemiology,
and basic science so that the most promising leads may be
investigated more quickly in pursuit of a cure or to reduce the
incidence of harmful toxins.
NATIONAL INSTITUTE ON AGING
Appropriations, 2004.................................... $1,024,754,000
Budget estimate, 2005................................... 1,055,666,000
Committee recommendation................................ 1,094,500,000
The Committee recommendation includes $1,094,500,000 for
the National Institute on Aging [NIA]. The budget request was
$1,055,666,000 and the fiscal year 2004 appropriation was
$1,024,754,000. The comparable amounts for the budget estimate
include funds to be transferred from the Office of AIDS
Research.
Mission.--The NIA conducts biomedical, behavioral, and
social research related to the aging process to prevent disease
and other problems of the aged, and to maintain the health and
independence of older Americans. Research in aging over the
last two decades demonstrates that aging should not be equated
with inevitable decline and disease.
Alzheimer's Disease.--The number of Americans with
Alzheimer's--4.5 million today--will increase to between 11.2
million and 16 million by 2050. Within a decade, total annual
Medicare costs for people with Alzheimer's will increase by
almost 55 percent to nearly $50,000,000,000. Medicaid health
and long-term care expenditures will rise by 80 percent, to
$33,000,000,000 annually. Alzheimer's is also having a
corrosive effect in the private sector, costing U.S. businesses
$61,000,000,000 in 2002, an amount equivalent to the net
profits of the top 10 Fortune 500 companies. The Committee
notes, however, that rapid advances in basic science are
helping to identify multiple targets for therapies that may
help slow or halt the progression of Alzheimer's disease.
Before these promising advances can be put to use preventing or
treating the disease, they must be tested and validated in
controlled clinical trials. Given the tremendous toll
Alzheimer's disease exacts in human suffering, health care
costs and economic loss, the Committee strongly urges NIA to
launch simultaneous clinical trials on therapies it determines
to be most promising. The Committee also encourages NIA to work
collaboratively with other institutes and the CDC to educate
Americans about the ways they can maintain their brain as they
age.
Alzheimer's Research Caregiver, Education, and Training.--
The Committee recommends that the NIA establish cooperative
working relationships with non-profit organizations dedicated
to new approaches to care-giving for patients with Alzheimer's
disease, and to expand the level of resources made available
for Alzheimer's disease caregiver education, research, and
training.
Behavioral Research and Older Workers.--The Committee
encourages NIA to expand research on the needs of older
workers. Since more baby boomers will be working well beyond
the traditional age of retirement, more information is needed
about the ways in which workplaces and workplace technology can
be better designed to accommodate the needs of older workers.
Bone Diseases.--The Committee encourages NIA to increase
research into the pathophysiology of osteoporosis, Paget's
disease and osteogenesis imperfecta. This research should
include: genetics, the role of cell aging and altered
metabolism, environmental and lifestyle factors, bone
responsiveness to weight bearing, bone quality and fracture
incidence, bone marrow changes, new agents to increase bone
mass, the therapeutic use of new technology, and the
comorbidity of metabolic bone diseases with chronic diseases of
aging.
Claude D. Pepper Older American Independence Centers.--The
Committee continues to strongly support these successful
centers, which focus on developing innovative and cost-
effective ways to enhance the independence of older Americans.
The centers also play a critical role in developing top-level
experts in geriatrics. The Committee again urges NIA to make
all possible efforts to expand these centers to include a
school of nursing.
Cognitive Research.--The Committee has noted the results of
the NIA-funded clinical trial, ACTIV, in which interventions to
improve various aspects of cognition in older people were found
to be effective, but did not generalize to improved cognitive
performance overall. Understanding that changes in memory and
cognition are troubling to older people and threaten their
independence, the Committee encourages NIA to consider next
steps in research to develop cognition-enhancing interventions
and report back on additional efforts.
Demographic and Economic Research.--The Committee once
again commends the NIA for supporting demographic and economic
research and, in particular, the NIA Demography of Aging
Centers program. Since its inception 10 years ago, the program
has supported invaluable research to enhance knowledge about
the well being of older Americans--especially information about
their health and socioeconomic status, including their income,
savings, work, and retirement decisions. Researchers at these
Centers have initiated critical surveys, such as the Health and
Retirement Survey and the National Long-Term Care Survey, which
have, for example, identified social and economic consequences
of retirement and the decline in disability among older
Americans, respectively. After a decade, the Centers are poised
to make significant contributions on numerous policy issues
confronting an aging society. The Demography Centers are also
now in a unique position to collaborate with several of the NIA
Roybal Centers program to help translate findings into
interventions and improve quality of life for older people.
Therefore, the Committee urges NIA to continue its strong
support of the demography centers program.
Down Syndrome.--Research has shown that all persons with
Down syndrome develop the neuropathological findings of
Alzheimer's disease, and that many go on in later life to show
cognitive decline. The Committee strongly urges NIA to increase
funding to study the connection between Alzheimer's disease and
Down syndrome and to work closely with NINDS, NICHD, NIMH and
NHGRI to establish a new, multi-year research initiative to
fund Down syndrome research on improving cognition and
preventing early dementia through biomedical treatments.
Hematology Research.--The Committee remains interested in
advancing research opportunities into blood disorders in the
elderly population. The Committee is particularly concerned
that the incidence and prevalence of anemia increases with age;
after age 85, one quarter of the population is anemic. Research
is needed to better understand the basic biology and adverse
quality of life complications of anemia and other blood
diseases in the elderly. The Committee is supportive of the
ongoing collaboration between the American Society of
Hematology and NIA, with the participation of NHLBI, NCI, and
NIDDK, to develop a research agenda in this field.
Parkinson's Disease.--The Committee encourages NIA to
collaborate with NINDS to determine the overlap in benefits
that current research could provide to understanding both
Alzheimer's and Parkinson's disease. The Committee
congratulates the significant investment by NIA in
understanding the role of genes, including alpha-synuclein, in
the causation and manifestation of Parkinson's. Work of this
nature is critical for better comprehension of the disease
process, identification of potential pharmaceutical agents,
improved diagnostic ability--especially during the early stages
of the disease, and the development of accurate animal models.
NATIONAL INSTITUTE OF ARTHRITIS AND MUSCULOSKELETAL AND SKIN DISEASES
Appropriations, 2004.................................... $501,066,000
Budget estimate, 2005................................... 515,378,000
Committee recommendation................................ 520,900,000
The Committee recommends an appropriation of $520,900,000
for the National Institute of Arthritis and Musculoskeletal and
Skin Diseases [NIAMS]. The budget requested $515,378,000 and
the fiscal year 2004 appropriation was $501,066,000. The
comparable amounts for the budget estimate include funds to be
transferred from the Office of AIDS Research.
Mission.--NIAMS conducts and supports basic and clinical
research and research training, and the dissemination of health
information on the more than 100 forms of arthritis;
osteoporosis and other bone diseases; muscle biology and muscle
diseases; orthopedic disorders, such as back pain and sports
injuries; and numerous skin diseases. The research agenda of
NIAMS addresses many devastating and debilitating diseases that
afflict millions of Americans. These diseases of the joints,
muscles, bones, connective tissues, and skin, in the aggregate,
will affect nearly every American at some point in their lives,
causing tremendous human suffering and costing the Nation
billions of dollars in both health care expenditures and lost
productivity. The research activities of this Institute serve
the concerns of many different special populations, including
women, minorities, children, and the elderly.
Arthritis.--Arthritis is the leading cause of disability in
the United States, with 70 million Americans living with some
form of the disease of chronic joint symptoms. The NIAMS is a
leader in the field of arthritis research. The committee urges
NIAMS to collaborate with other NIH Institutes toward a cure
for arthritis and related diseases.
Bone and Cartilage Diseases.--The Committee urges NIAMS to
explore new avenues for cell and gene-based therapies for the
treatment of bone and cartilage diseases, such as osteoporosis,
Paget's disease, and osteogenesis imperfecta. Identifying new
targets for enhancing bone formation and blocking bone
destruction should be a major focus, with studies that
integrate basic and clinical approaches regarding bone forming
cell development.
Duchenne Muscular Dystrophy [DMD].--The Committee urges
NIAMS, in collaboration with NINDS, to dedicate additional
resources to improve treatments for patients with DMD.
Juvenile Arthritis.--The Committee urges the NIAMS, in
collaboration with NICHD and NIAID, to strengthen its
investment in, and commit additional resources to, basic,
clinical, and translational research efforts and related
activities specific to juvenile arthritis, as authorized by the
Children's Health Act. The Committee expects the NIH to provide
Congress with a report on efforts underway and progress made in
achieving this goal by February 2005.
Lupus.--The Committee is aware of the importance of lupus
susceptibility genes. Voluntary health organizations have
established a collaboration among many individual research
teams throughout the country to accelerate the search for these
genes. The Committee urges the Institute to pursue this
collaboration and to provide increased funding so that
sufficiently large patient cohorts can be developed that will
facilitate research in this area. Because lupus is disorder
that disproportionately affects women of African American,
Hispanic and Asian ancestry, appropriate numbers of samples
from these populations should be included in these cohorts. The
Committee also urges the Institute to consider the importance
of creating repositories that might aid research into the
genetic aspects of lupus.
Marfan Syndrome.--The Committee commends NIAMS and its
collaborative efforts with other institutes to provide vital
support for research on Marfan syndrome, a life-threatening,
progressive and degenerative genetic disorder. The Committee
urges NIAMS to focus on research opportunities that have the
potential to advance non-surgical treatment options, through
all available mechanisms, as appropriate.
Metabolic Bone Diseases.--The Committee urges NIAMS to
support trans-NIH research into all aspects of genetics and
gene therapies for the treatment of metabolic bone diseases,
the role of environmental and lifestyle factors in bone
disease, the effects of depression and cardiovascular disease
on bone disease, the impact of mechanical loading of bone,
translational research to bring the recent exciting basic
discoveries about bone in to clinical practice, and research on
bone health and osteoporosis in special groups, such as non-
Caucasian ethnic groups.
Mucopolysaccharidosis [MPS].--The Committee is aware of
recent efforts with NIDDK to facilitate communication between
MPS and Lysosomal Storage Disorder investigators with bone
pathology and connective tissue scientists to examine
problematic issues in this area of study. Research in the
underlying pathophysiology of bone and joint lesions, the gene
mutations and substrates that are stored and potential
therapeutic approaches are of interest to the Committee. The
Committee encourages NIAMS to enhance its efforts to directly
support and collaborate with NIDDK on bone and joint diseases
in MPS disorders.
Scleroderma.--The Committee is encouraged by NIAMS's
growing interest in scleroderma, a chronic and progressive
disease that predominantly strikes women. Scleroderma is
disfiguring and can be life-threatening and effective
treatments are lacking. The Committee encourages NIAMS to
collaborate with other institutes, including NHLBI, NIDDK,
NIAID, and NIDCR to generate additional research opportunities
for scleroderma to identify genetic risk factors and safe and
effective treatments.
Tuberous Sclerosis Complex.--Tuberous sclerosis complex, or
TSC, is a genetic disorder that triggers uncontrollable tumor
growth in multiple organs of the body, including the skin. The
Committee strongly encourages NIAMS to support programs
examining the molecular and cellular basis of dermatological
lesions in TSC as well as the development of non-surgical
treatments for skin manifestations.
NATIONAL INSTITUTE ON DEAFNESS AND OTHER COMMUNICATION DISORDERS
Appropriations, 2004.................................... $382,053,000
Budget estimate, 2005................................... 393,507,000
Committee recommendation................................ 399,000,000
The Committee recommends an appropriation of $399,000,000
for the National Institute on Deafness and Other Communication
Disorders [NIDCD]. The budget requested $393,507,000 and the
fiscal year 2004 appropriation was $382,053,000. The comparable
amounts for the budget estimate include funds to be transferred
from the Office of AIDS Research.
Mission.--The NIDCD funds and conducts research and
research training in the normal and disordered processes of
human communication, specifically in the areas of hearing,
balance, smell, taste, voice, speech, and language. The
Institute addresses the special biomedical and behavioral
problems of people who have communication impairments or
disorders; contributes to health promotion and disease
prevention; and supports efforts to create devices that
substitute for lost and impaired sensory and communication
functions.
Animal Models of Hearing Loss.--It is now clear that
peripheral hearing loss leads to profound changes in the
central nervous system, including cell death and loss of
synapse function. The Committee encourages research to focus on
animal models of conductive and senorineural hearing loss,
particularly the induced changes in brain physiology that
result from deafness during development. Understanding the
brain structure and function of deaf individuals is essential
to proper implementation of ameliorative strategies such as
hearing aid and cochlear implants.
Behavioral Research.--The Committee recognizes that many
behavioral problems afflict those who suffer from communication
disorders, and that NIDCD research in behavioral and
communication science is key to alleviating these conditions.
Unwanted behaviors, as a result of autism or other disorders,
can interfere with the development of communication skills, and
research has shown that highly structured behavioral programs
are effective in some cases. Research in cognitive processing
combines behavioral and biological approaches to help
understand the normal mechanisms of sensory processing,
cognition and perception. This is an excellent example of the
interdisciplinary research that should be supported at NIH.
Clinical Evaluation of Hearing Loss.--The Committee
encourages NIDCD to partner with other Institutes at NIH to
support the development of functional neuroimaging technology
with more precise spatial and temporal resolution, as well as
better molecular probes to monitor brain activity.
Deafness Research.--The Committee urges the NIDCD to
continue to support research in the areas of inner ear
protection, rescue, and regeneration, such as noise-induced
hearing loss, ototoxicity and hair cell regeneration, as well
as research on the central auditory system. In addition, NIDCD
should continue research on rehabilitative technologies and
strategies, leading to improved prevention, treatment and
management of hearing loss, tinnitus and dizziness. The
Committee strongly urges the NIDCD to continue to support the
translation of basic research discoveries into better clinical
diagnostic techniques and treatments.
Early Detection and Intervention.--It is now clear that
early treatment of hearing loss is essential for normal
language acquisition. However, the Committee notes that there
are many children with late onset and progressive hearing loss
who are not identified by Universal Neonatal Hearing Screening
[UNHS], so parents and clinicians should be made aware of this
in NIDCD newsletters and on the NIDCD website. The Committee
supports expanded research on the early detection, diagnosis,
and intervention of infants with deafness and other
communication disorders. This should include exploring the role
of intrauterine exposure to cytomegalovirus [CMV] in
progressive hearing impairment. It is also critical to
recognize that otitis media, or middle ear infection, is among
the most frequent reasons for a sick child to visit the doctor
within the first few years of life. The use of antibiotics to
treat this disorder is resulting in more strains of bacteria
that cause otitis media to be resistant to first and second
line antibiotics. The Committee encourages NIDCD to explore
alternative ways to either treat or prevent otitis media, which
exacts an estimated public health burden of about
$5,000,000,000 a year in the United States.
Environmentally-induced Hearing Loss.--The Committee
continues to be concerned by the number of Americans who suffer
from chemical-and noise-induced hearing loss. The NIDCD's Wise
Ears Campaign is making significant inroads towards educating
Americans of all ages, and the Committee strongly supports its
expansion to school-age children. The Committee also supports
expanded research on prosthetic and pharmacological therapies
for hearing loss from noise stress, ototoxic drugs and other
environmental traumas.
Hair Cell Regeneration.--The Committee urges NIDCD to
continue to assign a high priority to new and important
directions for inner ear hair cell regeneration in mammals,
specifically in the use of gene therapy to restore hair cells
in the cochlea with adenovirus vectors, and in the development
of stem cells to re-grow hair cells of the inner ear.
Hearing Devices.--The Committee encourages the NIDCD to
expand research that would improve the benefits of cochlear
prostheses and improve remediation of less-than-profound
hearing loss through hearing aids and/or new prostheses and
drug-delivery systems. Building on the successful clinical
implementation of the cochlear implant, the Committee
encourages NIDCD to explore the feasibility of electrical
stimulation applied to the vestibular system to treat balance
disorders.
Hereditary Hearing Loss.--The Committee applauds the
remarkable progress towards understanding the molecular basis
for hereditary hearing impairment. The Committee encourages a
sustained effort to screen for the single and multigenetic
bases of hearing loss through contemporary techniques,
including the development of diagnostic gene chips for auditory
dysfunction. The Committee also encourages the development of
animal models to better assess at the level of structure and
function how gene mutation results in impaired central auditory
function.
Language Acquisition.--The Committee encourages the NIDCD
to explore the biological bases of infant speech perception and
language acquisition. This should include studies on the impact
of partial or profound hearing loss.
Neurofibromatosis.--NF2 accounts for approximately 5
percent of genetic forms of deafness. Unlike other genetic
forms of deafness, NF2-associated deafness is potentially
preventable or curable if tumor growth is halted before damage
has been done to the adjacent nerve. Research is now being
conducted to cure deafness in NF2 mice through gene therapy,
with enormous implications for gene therapy in general and for
patients suffering from meningiomas and other tumors in
particular. The Committee therefore encourages NIDCD to expand
its NF2 research portfolio through all suitable mechanisms
including RFAs and clinical trials.
Presbycusis.--Presbycusis, the gradual loss of hearing from
aging, is the third leading chronic disease, following
hypertension and arthritis, in individuals over age 65. It will
become more common as the Nation's population grows older. The
Committee encourages research on the central and peripheral
mechanisms leading to presbycustic hearing loss and on
strategies that would prevent hearing loss in our senior
population. NIDCD is urged to undertake research on the
mechanism underlying the premature cell death that results in
many forms of presbycusis so as to develop prevention and cure
strategies.
Stuttering.--The Committee received testimony concerning
stuttering which affects approximately 3 million people in this
country. It was learned that healthy individuals who stutter
are often labeled as unintelligent, eccentric, mentally ill
and/or emotionally disturbed. NIDCD is encouraged to conduct a
workshop in fiscal year 2005 on stuttering, which will examine
the current state of the science as well as to identify future
research opportunities in the field of stuttering and to report
to the Committee on the plans for the workshop at next year's
hearings.
Tinnitus.--The Committee encourages the Institute to expand
its research into mechanisms underlying peripheral and central
tinnitus.
Translational Research.--The Committee encourages NIDCD to
support research activities aimed at accelerating the
translations of new findings from the laboratory bench to the
bedside. With the exciting new insights and findings of our
molecular and basic sciences in understanding the mechanisms of
cell death and disease processes, it is important to provide
support for those activities that will translate these findings
into new interventions and technologies to better prevent and
treat deafness and other communication disorders.
NATIONAL INSTITUTE OF NURSING RESEARCH
Appropriations, 2004.................................... $134,724,000
Budget estimate, 2005................................... 139,198,000
Committee recommendation................................ 140,200,000
The Committee recommends an appropriation of $140,200,000
for the National Institute of Nursing Research [NINR]. The
budget request was $139,198,000 and the fiscal year 2004
appropriation was $134,724,000. The comparable amounts for the
budget estimate include funds to be transferred from the Office
of AIDS Research.
Mission.--The National Institute of Nursing Research [NINR]
supports clinical and basic research on biological and
behavioral aspects of critical national health problems. The
Institute's programs have established a scientific basis for
research that seeks to reduce the burden of acute and chronic
illness and disability for individuals of all ages; improve the
quality of life by preventing and delaying the onset of disease
or slowing its progression; and establishing better approaches
to promoting health and preventing disease. The NINR supports
programs essential to improving clinical environments by
testing interventions which influence patient health outcomes
and reduce costs and demands for care.
Alzheimer's Disease.--The Committee is pleased that NINR
has stepped up its research both on Alzheimer's patients and
those who care for them. For example, a nursing research study
is now underway comparing four interventions designed for
families coping with the effects of Alzheimer's disease and
related disorders. Two home-based and two community-based
interventions are being assessed according to the physical and
psychological well-being of the caregiver and the cognitive/
behavioral functioning and well-being of the person receiving
the care. Future findings promise valuable information for
nursing, social work and other health disciplines about each
intervention's usefulness for particular situations.
Adolescent Risk Behavior.--The Committee commends NINR's
research in risk behavior. Increased understanding of factors
that facilitate healthy lifestyle behaviors, as well as the
modification of risky behaviors, will reduce the consequences
associated with these risks. Recognizing that many adolescent
risk behaviors are intertwined, the focus of NINR's initiative
is on developing interventions that target several risk
behaviors simultaneously. The Committee hopes this research
will continue to bear positive results.
End of Life Research.--The Committee continues to strongly
support NINR's leadership in coordinating end-of-life research
at NIH. Expansion of the NINR research portfolio to include
children at the end-of-life is a groundbreaking research
initiative in an area that has not received the attention that
it should. By focusing on such behavioral issues as stress and
decision-making, as well as end-of-life care for children, the
institute will continue to make strides that will alleviate the
burdens involved with caring for those with terminal
conditions.
Genetics.--The Committee is pleased with NINR's efforts in
genetics and emphasis on the integration of genetics into
nursing research, practice, and education. The NINR Summer
Genetics Institute, which provides an 8-week intensive genetics
research training program each year, is a key component of the
effort to increase genetics expertise within the nursing
knowledge base and healthcare practice.
Minority Health and Disparities.--The Committee commends
NINR for its support of research to reduce disparities in the
health of minority populations and is pleased that this will
receive continued emphasis. It is important to reduce low
birth-weight rates for minority women, which can be 50 percent
higher than for white women. NINR's focus on early
identification of risk factors and chronic diseases during
pregnancy and on health promotion for pregnant minority women
will be important to lower the unacceptably high number of low
birth-weight babies in the country. NINR is also urged to
continue its successful research in promoting the health of
minority men who have a reduced life expectancy compared to
women. Research of effective health promotion strategies such
as smoking cessation, nutrition, physical activity, and
increased management of stress are critical to improving and
extending the life cycle of minority men.
Nurse-managed Health Centers.--The Committee urges the NINR
to increase funding for nurse-managed health centers and
advanced practice nurses in research and demonstration
projects.
Nursing Shortage.--NINR is to be commended for its forward-
thinking investment in research training as a way to address
the nursing shortage. Training support for fast-track
baccalaureate-to-doctoral program participants is one important
initiative. The 17 recently funded Nursing Partnership Centers
to Reduce Health Disparities is another initiative that helps
produce an adequate number of nurse researchers. Not only will
these partnerships between research-intensive schools of
nursing and minority serving university schools of nursing
train more minority nurses, but they also expand health
disparities research.
Self-Management.--Increasingly, self-management is becoming
a significant approach to living with illness because it
enhances the ability to retain the highest quality of life
possible. The Committee is pleased that NINR is taking new
approaches in its research on self-management of chronic
illnesses that tailors interventions to diverse and vulnerable
populations. Results from studies of technological advances
that aid self-management, such as technologies that allow
monitoring indices of illness at home, are an important adjunct
to self-management strategies.
NATIONAL INSTITUTE ON ALCOHOL ABUSE AND ALCOHOLISM
Appropriations, 2004.................................... $428,669,000
Budget estimate, 2005................................... 441,911,000
Committee recommendation................................ 444,900,000
The Committee recommends an appropriation of $444,900,000
for the National Institute on Alcohol Abuse and Alcoholism
[NIAAA]. The budget request was $441,911,000 and the fiscal
year 2004 appropriation was $428,669,000. The comparable
amounts for the budget estimate include funds to be transferred
from the Office of AIDS Research.
Mission.--The NIAAA conducts biomedical and behavioral
research for improving prevention and treatment and reducing or
eliminating the associated health, economic, and social
consequences of alcohol abuse and alcoholism. NIAAA provides
leadership in the country's effort to combat these problems by
developing new knowledge that will decrease the incidence and
prevalence of alcohol abuse and alcoholism and associated
morbidity and mortality. NIAAA addresses these questions
through an integrated program of biomedical, behavioral, and
epidemiologic research on alcoholism, alcohol abuse, and
related problems. This broad-based program includes various
areas of special emphasis such as medications development,
fetal alcohol syndrome, genetics, neuroscience, and moderate
drinking.
Alcohol Policy Information System.--The Committee supports
the Alcohol Policy Information System [APIS]. This
clearinghouse provides users with access to the latest and most
comprehensive information to develop and implement effective
policies and practices to combat underage drinking and other
alcohol problems. The Committee strongly encourages the NIAAA
to increase funding in this area and to report on its efforts
to maintain the APIS, and to develop a plan to increase public
awareness and use of this information clearinghouse.
Alaska Alcohol and Substance Abuse.--The Committee is aware
of serious problems with alcohol and substance abuse in Alaska,
especially among its Alaska Native population and of the need
for translating research into clinical applications for this
population. The Committee urges NIAAA to sponsor a Research to
Practice Forum with the Substance Abuse and Mental Health
Services Administration to focus on bridging the gap between
researchers and practitioners and translating scientific
research into clinical applications, and encourages NIAAA to
support the implementation of any recommendations developed at
the forum.
Co-occuring Substance Abuse Disorders.--The Committee notes
that the Report to Congress on the Prevention and Treatment of
Co-occurring Substance Abuse Disorders and Mental Health
Disorders found that a ``significant lack of prevalence data on
co-occurring disorders exist.'' The Committee encourages NIMH,
NIAAA and NIDA to collaborate with States to develop more
recent and accurate data on persons with co-occurring mental
health and substance use disoders--with an emphasis on
individuals with mild to moderate mental health disorders.
Drinking as a Development Disorder.--The Committee
understand that new NIAAA research has shown serious drinking
problems previously associated with middle adulthood often
begin to emerge during adolescence and young adulthood. The
Committee encourages NIAAA to continue researching alcohol-
related problems in a developmental context and recognizes that
alcohol abuse and dependence are best characterized as
developmental disorders that become manifest throughout the
lifespan.
Knowledge Transfer.--The Committee urges NIAAA to redouble
its efforts to transfer new knowledge to communities and to
primary care health providers who can apply it to prevention
and treatment. Recognizing the developmental nature of alcohol-
related problems, NIAAA should continue to focus intensively on
the transition from childhood into adolescence, adolescence
itself, and the transition from adolescence into young
adulthood. The Committee looks forward to research findings
that will reduce the risk to future generations of Americans
and will spare countless additional parents from suffering the
consequences of problem drinking in their children.
Nonalcoholic Steatohepatitis [NASH].--The Committee notes
that the mechanisms that cause NASH and the treatment protocols
that are effective with regard to NASH also offer promise for
treating alcoholic liver disease [ALD]. The Committee urges
additional research focused on NASH and ALD to address both
these diseases as well as to further test the hypothesis that
the mechanisms causing these diseases are similar and new
research findings may address both diseases.
Underage Drinking.--The Committee acknowledges that alcohol
is, by far, the psychoactive substance most often used by
youth, leading to numerous problems for themselves such as
lower grades or school failure, social problems, physical
problems, such as hangovers or medical illnesses, unwanted or
unintended sexual activity, physical and sexual assault, memory
problems, increased risk for suicide and homicide, alcohol-
related car crashes and death from alcohol poisoning. The
Committee recognizes that alcohol consumption represents one of
the most important public health problems among youth today.
Using an Integrative Approach.--The Committee encourages
NIAAA to continued directing substantial effort and resources
toward the achievement of a more fully integrated and
comprehensive scientific understanding of the environmental,
behavioral, biological, and genetic factors that promote the
initiation, maintenance, and acceleration of alcohol use, and
that influence the transition into harmful alcohol use,
including abuse and dependence.
NATIONAL INSTITUTE ON DRUG ABUSE
Appropriations, 2004.................................... $990,953,000
Budget estimate, 2005................................... 1,019,060,000
Committee recommendation................................ 1,026,200,000
The Committee recommends an appropriation of $1,026,200,000
for the National Institute on Drug Abuse [NIDA]. The budget
request was $1,019,060,000. The fiscal year 2004 appropriation
was $990,953,000. The comparable numbers for the budget
estimate include funds to be transferred from the Office of
AIDS Research.
Mission.--Created in 1974, NIDA supports about 85 percent
of the world's biomedical research in the area of drug abuse
and addiction. The Committee commends NIDA for demonstrating
through research that drug use is a preventable behavior and
that addiction is a treatable disease. NIDA's basic research
plays a fundamental role in furthering knowledge about the ways
in which drugs act on the brain to produce dependence, and
contributes to understanding how the brain works. In addition,
NIDA research identifies the most effective pharmacological and
behavioral drug abuse treatments. NIDA conducts research on the
nature and extent of drug abuse in the United States and
monitors drug abuse trends nationwide to provide information
for planning both prevention and treatment services. An
important component of NIDA's mission is also to study the
outcomes, effectiveness, and cost benefits of drug abuse
services delivered in a variety of settings and to assure
dissemination of information with respect to prevention of drug
abuse and treatment of drug abusers.
Adolescent Drug Use.--The Committee is pleased with the
Institute's focus on adolescents. The Committee notes that if
drug use is to be reduced, there must be a better understanding
of the adolescent decision-making process so that more
effective prevention programs can be developed. NIDA is urged
to increase its research to better understand the mechanisms
underlying adolescent judgment, decision-making, impulsivity
and risk-taking.
Collaboration With SAMHSA.--The Committee commends NIDA for
its outreach and work with State substance abuse authorities to
reduce the current 15- to 20-year lag between the discovery of
an effective treatment of intervention and its availability at
the community. In particular, the Committee applauds NIDA for
working with SAMHSA on a recent RFA designed to strengthen
State agencies' capacity to support and engage in research that
will foster statewide adoption of meritorious science-based
policies and practices. The Committee also encourages NIDA to
continue collaborative work with States to ensure that research
findings are relevant and adaptable by State Substance Abuse
systems. In addition, the Committee encourages NIDA to work
with SAMHSA, NIAAA and NIMH to develop more recent and accurate
data on persons with co-occurring mental health and substance
use disorders, with an emphasis on individuals with mild to
moderate mental health disorders.
Co-morbidity.--Co-mortidity between drug abuse and mental
illness is common and may reflect common contributing factors.
The Committee urges NIDA to expand research efforts to better
understand the neurobiological underpinnings of these co-
occurring disorders; to elucidate risk and protective factors
for development of mental health and substance abuse problems;
and more specifically to explore the impact of stimulant
therapies for mental disorders such as ADHD on later drug use
disorders. The Committee also encourages NIDA to examine how
treatment services can best accommodate the co-morbid nature of
these disorders.
Drug Abuse and HIV/AIDS.--The Committee understands HIV/
AIDS continues to disproportionately affect vulnerable
populations in the United States (e.g. criminal justice
populations, pregnant women, minorities and youth) and that
drug abuse is often a factor in transmission of HIV/AIDS.
Therefore, the Committee urges NIDA to continue its support of
research that is focused on the development and testing of
drug-abuse related interventions designed to reduce the spread
of HIV/AIDS in these populations.
Emerging Drugs.--The Committee is concerned regarding the
abuse of over-the-counter medications, including
dextromethorphan [DMS] and steroids. Recognizing the
significant role that NIDA has played in monitoring drug trends
and responding to emerging drug problems like methamphetamine
and prescription drugs, the Institute is encouraged to continue
to increase its research and dissemination efforts on emerging
drug problems.
Long-Term Consequences of Marijuana Use.--The Committee is
concerned with the continuing widespread use of marijuana.
Research shows that marijuana can be detrimental to educational
attainment, work performance, and cognitive function. However,
more information is needed in order to assess the full impact
of long-term marijuana use. The Committee urges NIDA to support
increased efforts to assess the long-term consequences of
marijuana use on cognitive abilities, achievement, and mental
and physical health.
Medical Consequences.--The Committee recognizes that
addiction is a disorder that affects the course of other
diseases such as cancer, cardiovascular and infectious
diseases. Therefore, the Committee urges the NIDA to continue
to support research on the medical consequences associated with
drug abuse and addiction.
Medications Development.--The Committee applauds NIDA for
over a decade of leadership in working with private industry to
develop anti-addiction medications and is pleased this
collaboration has resulted in a new medication for opiate
addiction. The Committee encourages NIDA to continue its work
with the private sector to develop anti-addiction medications,
particularly for cocaine, methamphetamine, and marijuana.
Methamphetamine Abuse.--The Committee continues to be
concerned with the rate of methamphetamine abuse across the
Nation. The problem is especially acute in Midwestern States.
The Committee again urges NIDA to expand its research on
improved methods of prevention and treatment of methamphetamine
abuse.
Outreach.--The Committee commends NIDA for its outreach and
work with State substance abuse authorities to reduce the
current 10- to 20-year lag between the discovery of an
effective treatment of intervention and its availability at the
community level. The Committee is pleased with NIDA's
collaboration with SAMHSA on strengthening State agencies'
capacity to support and engage in research that will foster
statewide adoption of science-based policies and practices. The
Committee also encourages NIDA to continue collaborative work
with States to ensure that research findings are relevant and
adaptable by State Substance Abuse systems.
Primary Care Settings and Youth.--Primary care settings,
such as offices of pediatricians and general practitioners, are
potential key points of access to prevent and treat problem
drug use among young people; yet primary care and drug abuse
services are commonly delivered through separate systems. The
Committee encourages NIDA to expand support for health services
research on effective ways to educate primary care providers
about drug abuse; develop brief behavioral interventions for
preventing and treating drug use and related health problems,
particularly among adolescents; and develop methods to
integrate drug abuse screening, assessment, prevention and
treatment into primary health care settings.
NATIONAL INSTITUTE OF MENTAL HEALTH
Appropriations, 2004.................................... $1,381,774,000
Budget estimate, 2005................................... 1,420,609,000
Committee recommendation................................ 1,436,800,000
The Committee recommends an appropriation of $1,436,800,000
for the National Institute of Mental Health [NIMH]. The budget
request was $1,420,609,000 and the fiscal year 2004
appropriation was $1,381,774,000. The comparable amounts for
the budget estimate include funds to be transferred from the
Office of AIDS Research.
Mission.--The mission of the NIMH is to reduce the burden
of mental illness and behavioral disorders through research on
mind, brain, and behavior. At the same time, NIMH maintains a
clear focus on its ultimate goal: to pursue an understanding
that will enable it to prevent mental illness, or to develop
rational treatments that will actually cure them once they
occur.
As the leading Federal agency involved in research focused
on mental disorders, NIMH and the scientists it supports seek
to gain an understanding of the fundamental mechanisms
underlying thought, emotion, and behavior--and an understanding
of what goes wrong in the brain in mental illness. Equally
important are the Institute's strong efforts to translate this
basic knowledge into clinical research that will lead to better
treatments and ultimately be effective in diverse populations
and evolving health care systems.
Aging and Mental Health.--The Committee continues to be
concerned that NIMH has not provided substantial resources to
promote aging research or provide data on existing funds
targeted toward geriatric mental health research. Therefore,
the Committee encourages NIMH to significantly expand research
in this area extramurally through all available mechanisms to
advance the geriatric mental health research agenda.
Alzheimer's Disease.--Recently, NIMH launched a five-site
trial of antidepressant medications designed to help identify
the best medication regimen for treating the behavioral
problems that often occur in Alzheimer patients. Initial
results should be available in late 2004. In addition, NIMH
intramural researchers identified a promising new method for
early detection of Alzheimer's disease. Long-term studies now
underway will determine whether this biomarker can be used as a
predictive and diagnostic tool. The Committee encourages NIMH
to continue to place significant priority on studies of
Alzheimer's disease.
Behavioral Science.--The Committee is aware that NIMH is
reviewing its portfolio in basic behavioral science and
encourages NIMH to continue its commitment to strengthen
behavioral research that examines the basic psychological
functions that promote mental health or become disturbed in
mental disorders. The Committee further recognizes the
potential contribution of research on cognitive, personality,
emotional, and social processes that underlie behavioral
functioning and urges their inclusion in inter-disciplinary
research. The Committee is pleased that the National Mental
Health Advisory Council has established a basic science working
group and looks forward to receiving a report on the working
group's conclusions regarding research opportunities in basic
behavioral sciences relating to mental health.
Down Syndrome.--The Committee encourages NIMH to research
the mental health symptoms of persons with Down syndrome and to
investigate risk factors and possible treatments for autism,
obsessive-compulsive disorder, attention deficit disorder,
anxiety, and depression. The Committee urges NIMH to include
Down syndrome in its studies on related disorders and to
coordinate its work with the National Center on Birth Defects
and Developmental Disabilities at the Centers for Disease
Control and Prevention. The Committee further urges NIMH to
work closely with NINDS, NICHD, NIA and NHGRI to establish a
new, multi-year research initiative to fund Down syndrome
research relating to cognition and behavior through biomedical
interventions.
Fragile X.--Fragile X is the most common single-gene
neuropsychiatric disease known. It causes cognitive impairment,
mental disorders such as obsessive-compulsive disorder, and
extreme anxiety. The Committee commends NIMH for working with
FRAXA Research Foundation to spearhead three focused research
meetings devoted to identifying critical research needs, in
November 2001, January 2003, and a planned meeting in July
2004. The Committee urges NIMH to pursue the most critical
needs identified by the meeting panels. These include
controlled studies of existing and new pharmacological
treatments for Fragile X and identification of the key
molecular targets which are likely candidates for designing
drug treatments for Fragile X and related disorders such as
autism. The Committee also urges NIMH to include Fragile X in
its studies of related neuropsychiatric disorders and to work
with other Institutes such as NICHD and NINDS to develop
cooperative research support mechanisms in this area.
Frontier Mental Health Needs.--The Committee commends NIMH
on its outreach efforts to determine the differences in mental
health needs which may exist in remote frontier communities.
The Committee encourages NIMH to expand its research efforts
into these communities, which are often ignored in research
projects, but which continue to suffer from high incidences of
mental health problems including depression, suicide and co-
occurring disorders with substance abuse.
Major Depression and Bipolar Disorder.--The prevalence,
economic consequences, and systemic nature of major depression
is alarming. Depression is now recognized as a multisystem
disorder affecting not only the brain, but the entire body. It
has been associated with alterations in endocrine,
cardiovascular, and immune systems as well as changes in bone
metabolism. Researchers funded by NIMH found that the
prevalence for major depression for lifetime was 16.2 percent;
in any given year, more than 20 million children and adults in
the Nation are affected by major depression or bipolar
disorder. Depression has been shown to be a leading cause of
disability worldwide. The Committee urges the NIMH to continue
its efforts to understand depression, to develop new
treatments, to decrease the impact of depression on comorbid
illnesses, and--because depression and bipolar disorders are
prominently associated with suicide--to reduce suicide. The
Committee is pleased with NIMH's leadership in the public
education campaign entitled ``Real Men. Real Depression'' and
encourages the Institute to continue these education and
information dissemination efforts.
Outreach.--The Committee commends NIMH on its outreach
efforts to determine the differences in mental health needs
which may exist in remote rural communites. The Committee
encourages NIMH to expand its research efforts toward the
unique needs of the Native Hawaiian community.
Parkinson's Disease.--The Committee encourages NIMH to
increase its research on the role of depression in Parkinson's
disease. Particularly, depression may be a very early symptom
of Parkinson's, sometimes appearing before other traditional
symptoms. NIMH should also continue its ongoing research into
the proper treatment of depression and other serious mental
disorders that often co-occur with Parkinson's, such as
dementia and anxiety.
Portfolio Review.--The Committee is pleased with recent
NIMH efforts to set priorities with an eye toward achieving
maximum impact against mental disorders. A balanced NIMH
research portfolio ranges from the most basic molecular
research to complex clinical and health services research--all
of which contributes to the body of knowledge that will enable
science to develop targeted and highly effective treatment
interventions that can then be implemented through services
that reach every individual who is in need. In this regard, the
Committee understands that Working Groups of the National
Advisory Mental Health Council [NAMHC], convened by the NIMH
Director--including NAMHC members and outside scientific
experts--have scrutinized the current NIMH portfolio related to
clinical trials, to basic neurobiological research, and to
basic behavioral research. The Committee favors these efforts
at careful portfolio management, and looks forward to seeing
the resulting recommendations of the Workgroups as to how the
NIMH can best focus its efforts in areas that are relevant to
the tremendous public health burden of mental disorders while
at the same time promising the greatest opportunity for
scientific advancement.
Prader-Willi Syndrome.--The Committee commends the NIMH for
its efforts to further the understanding and description of the
mental health components of Prader-Willi Syndrome. The
Committee recommends that NIMH expand its programs to develop
practical treatment protocols, including pharmaceutical
options, for the severe anxiety, obsessive-compulsive disorder,
oppositional-defiant disorder and psychotic mental illness
aspects of Prader-Willi Syndrome.
Prevention Research.--The Committee places a high priority
on prevention research, particularly with respect to mental
disorders among children and adolescents, in identifying
protective factors against the negative impacts of stress among
young adults, and in developing strategies to strengthen the
family.
Psychological Impacts of Terrorism.--The Committee supports
NIMH research related to the psychological impact of both acute
and chronic exposure to threats of violence, including
terrorism and war, with particular emphasis on vulnerable
populations, such as trauma survivors, children and older
adults. The Committee encourages NIMH to expand its research
portfolio to include research related to factors that promote
detection or prediction, prevention, and post-exposure recovery
and resilience.
Research Progress.--Research has led to breakthroughs in
understanding the brain, how it is affected by environmental
conditions, and how this in turn works to influence behavior.
The Committee is pleased to see the success of research on the
genetics of mental illness supported by NIMH, and progress made
in identifying genes that increase one's risk of developing
schizophrenia, depression and bipolar disorder, and unraveling
how the genes work in the brain to influence vulnerability.
The Committee notes recent findings from the NIMH
intramural research program on brain development, particular
its study of normal brain development in youth ages 4 to 21.
These results have elucidated the processes involved in the
development of the normal brain, thus allowing more precise
interpretation of what goes awry in neurodevelopmental
disorders such as autism and schizophrenia. These developments
are a clear illustration of the critically important work that
is supported at NIH.
Schizophrenia.--The Committee supports NIMH's recent
innovative steps to hasten understanding of schizophrenia,
especially the emphasis on its highlight successful intramural
program relating to schizophrenia, and on developing
medications that will target cognitive symptoms associated with
psychotic disorders.
Post Traumatic Stress Disorder.--The Committee supports
NIMH's leadership in working to address urgent public health
problems. NIMH research has shown that, for some individuals,
exposure to violent or traumatic events can result in
significant mental health repercussions. For example, in the
area of fear, a great deal has been learned about the
neurobiology of ``extinction,'' which enables most individuals
to recover from a traumatic experience. Those not able to do
this develop Post Traumatic Stress Disorder [PTSD]. By studying
fear learning and extinction in non-human animals, scientists
now know that PTSD must involve a well-defined specific brain
circuit. This information can be important given the need to
address potential psychological repercussions of terrorism and
terrorist acts. The Committee is aware of NIMH's leadership in
seeking interagency coordination in addressing this urgent
issue.
Selective Serotonin Reuptake Inhibitors.--The Committee
urges the NIMH, in collaboration with the NICHD and other
appropriate Institutes, to develop and conduct studies to
examine the safety and efficacy of selective serotonin reuptake
inhibitors [SSRIs] in children and adolescents. SSRIs are
prescribed to millions of American children each year, and that
number continues to increase dramatically. Yet there is
conflicting information about the benefits and possible risks
of using SSRIs to treat youth suffering from depression.
Therefore, the Committee recommends that studies be designed to
conclusively answer questions about the safety and efficacy of
SSRIs in youth suffering from depression. The Committee further
recommends that these studies focus on original research to the
extent that existing data prove insufficient to answer such
questions.
Social Work.--The Committee commends the NIH Office of
Behavioral and Social Science Research for its leadership in
working together with NIH Institutes and centers, especially
NCI, NIAAA, NIA, NIDA, NIMH, NICHD, and social work
organizations and academics to implement recommendations from
the NIH Plan for Social Work Research, including expanded
technical assistance and outreach and a summer 2004 training
institute, and encourages continued implementation activities
including working with appropriate social work practice,
education, and research groups to host a trans-NIH conference
on social work research.
Suicide.--The Committee supports NIMH efforts to enhance
suicide awareness and prevention, and encourages the Institute
to continue its collaborative work with other NIH Institutes to
address this painful yet all-to-real topic. In 2000, 30,000
persons killed themselves in the United States. Suicide deaths
outnumber homicide deaths by 5 to 3, and suicide was the third
leading cause of death for 10- to 24-year-olds. The health
conditions most consistently associated with suicide are mental
illness and addictive disorders, affecting up to 90 percent of
all people who die by suicide. The Committee is pleased with
the program announcement sponsored by NIMH, NIAAA, NIDA, and
others asking for grant applications for research that will
reduce the burden of suicide. This multi-Institute initiative
is meant to intensify investigator-initiated research on
suicide and to attract new investigators to the field. This
work is critical, and the Committee applauds this trans-NIH
approach. Prescriptions for psychotropic medications for
children and youth have clearly been increasing. While many
children are immeasurably helped by these medications--so that
they can lead satisfying social lives, perform well in school--
recent reports of a possible link between use of these
medications and suicide have alarmed the Committee. NIMH is
addressing this important public health issue through its
support of the large-scale clinical trial to carefully evaluate
safety and effectiveness of treatments for adolescents with
depression. The Committee would like a brief report from NIMH
after publication of the trial results. The Committee notes
NIMH's web page essay on this topic, and urges NIMH to continue
its vital research on the effects of these medication on
children and on developing the brain when used long-term.
Translating Behavioral Research.--The Committee recognizes
and strongly supports NIMH's efforts to advance the application
of behavioral research and interventions in clinical settings
to address the public health burden of mental disorders. The
Committee strongly supports translational research in the
behavioral and social sciences to address how basic behavioral
processes, such as cognition, emotion, motivation, development
and social interaction, inform the diagnosis, treatment and
delivery of services for mental disorders. Behavioral
interventions are especially needed for children and
adolescents with mental disorders.
NATIONAL HUMAN GENOME RESEARCH INSTITUTE
Appropriations, 2004.................................... $479,073,000
Budget estimate, 2005................................... 492,670,000
Committee recommendation................................ 496,400,000
The Committee recommendation includes $496,400,000 for the
National Human Genome Research Institute [NHGRI]. The budget
requested $492,670,000 and the fiscal year 2004 appropriation
was $479,073,000. The comparable amounts for the budget
estimate include funds to be transferred from the Office of
AIDS Research.
Mission.--The Human Genome Project was an effort to
determine the location and sequence of the estimated 30,000
genes that constitute the human genome. This historic
achievement opens the genomic era of medicine. The Committee
commends the NHGRI for developing this vision for the future of
genomics.
The NHGRI coordinates extramural and intramural research as
well as research training in the area of genomics and genetics.
The Division of Extramural Research supports research on
genetic sequences of both human and non-human genomes, DNA
sequencing technology development, database management and
analysis, and studies of the ethical, legal, and social
implications of human genome research. The Division of
Intramural Research focuses on applying the tools and
technologies of the Human Genome Project to understanding the
genetic basis of disease and developing DNA-based diagnostics
and gene-based therapies. The intramural program has also
developed a strong clinical research program in collaboration
with several other NIH Institutes to study and better
understand rare and complex genetic diseases such as diabetes,
heart disease, breast cancer, colon cancer, and melanoma.
Behavioral Research.--The Committee acknowledges NHGRI's
leadership in establishing a social and behavioral intramural
research branch within its intramural program. The new branch
will work to translate the discoveries from the recently
completed Human Genome Project into interventions for health
promotion and disease prevention, and for counseling patients
and families dealing with the impact of devastating genetic
disorders. The SBRB also will investigate the complex social,
ethical and public policy impact of genomic research.
Gene-Environment Interactions.--NHGRI is commended for its
partnerships with other Institutes and the Office of Behavioral
and Social Sciences Research to push the frontier of genetics
research forward by examining gene-environment interactions.
Research on the environmental stimuli, such as behaviors,
experience of stress, or exposure to certain physical
conditions, that lead to the expression of genes is critical if
science is to reap the benefits of the mapped genome. NHGRI is
encouraged to work with OBSSR on multidisciplinary training
programs to increase the number of skilled scientists who can
bridge the behavioral and genetic realms.
Targeting Disease Prevention.--The Committee commends NHGRI
for creating the Encyclopedia of Data Elements [ENCODE]
project, which has a long term goal of identifying and locating
all protein-coding genes, non-protein coding genes and other
sequence-based functional elements contained in human DNA
sequence. However, other important research related to
unveiling the secrets of the human genome should also be
investigated. These include: the development of a comprehensive
catalogue of the functional components encoded in the human and
mouse genomes, a study of how microarray technology can play a
role in the screening of newborn infants in conjunction with
the NICHD, and the completion of the international haplotype
mapping [HAPMAP] project. In each of these areas, the Committee
recognizes that advances in the use of mircroarray technology
can enhance NHGRI's global leadership in meeting these goals.
NATIONAL INSTITUTE OF BIOMEDICAL IMAGING AND BIOENGINEERING
Appropriations, 2004.................................... $287,129,000
Budget estimate, 2005................................... 297,647,000
Committee recommendation................................ 300,800,000
The Committee recommends an appropriation of $300,800,000
for the National Institute of Biomedical Imaging and
Bioengineering [NIBIB]. The budget requested $297,647,000 and
the fiscal year 2004 appropriation was $287,129,000. The
comparable amounts for the budget estimate include funds to be
transferred from the Office of AIDS Research.
Mission.--The NIBIB improves health by promoting
fundamental discoveries, design and development, and
translation and assessment of technological capabilities in
biomedical imaging and bioengineering, enabled by relevant
areas of information science, physics, chemistry, mathematics,
materials science, and computer sciences. The Institute plans,
conducts, fosters, and supports an integrated and coordinated
program of research and research training that can be applied
to a broad spectrum of biological processes, disorders and
diseases and across organ systems. The Institute coordinates
with the biomedical imaging and bioengineering programs of
other agencies and NIH Institutes to support imaging and
engineering research with potential medical applications and
facilitates the transfer of such technologies to medical
applications.
Artificial Tissues.--The Committee encourages the Institute
to focus on improved tissue and organ imaging technologies and
on the growth of artificial tissues. Progress in these fields
will have multiple benefits including addressing issues such as
invasive diagnostics tests now required for liver diseases and
the need to address the shortage of livers and other organs
available for transplantation.
Cardio-vascular Surgery.--Cardio-vascular surgery depends
on the development of new materials and tools that can be used
in surgical management of heart and lung disease. The Committee
is encouraged that the Institute has recognized the importance
of this concept and implemented programs in advanced
biomaterials and tissue engineering that have a direct bearing
on these surgical fields.
Imaging Techniques.--The Committee urges NIBIB to make new
bone imaging techniques a primary focus, speeding the
development of new imaging modalities that better capture bone
quality, including bone micro- and macro-architecture,
quantification of bone mass and crystalline composition. This
is necessary to develop diagnostic and treatment therapies for
patients with metabolic bone diseases. The Committee urges
NIBIB to participate actively in trans-NIH initiatives that
address these priorities.
Pet MicroPET Scans.--The Committee continues to encourage
this new Institute to devote significant resources to molecular
imaging technologies such as positron emission tomography [PET]
and microPET to take advantage of the capacities of molecular
imaging to detect disease process at the molecular level and to
monitor the effectiveness of targeted gene therapies now under
development. The Committee also encourages the new Institute to
develop its research agenda in close collaboration with other,
disease-specific Institutes at NIH, so that new imaging
technologies are closely tied to the research projects being
undertaken by the various other Institutes of NIH.
NATIONAL CENTER FOR RESEARCH RESOURCES
Appropriations, 2004.................................... $1,179,058,000
Budget estimate, 2005................................... 1,094,141,000
Committee recommendation................................ 1,213,400,000
The Committee recommends an appropriation of $1,213,400,000
for the National Center for Research Resources [NCRR]. The
budget request was $1,094,141,000 and the fiscal year 2004
appropriation was $1,179,058,000. The comparable amounts for
the budget estimate include funds to be transferred from the
Office of AIDS Research.
Mission.--The NCRR develops and supports critical research
technologies and shared resources that underpin research to
maintain and improve the health of our Nation. The NCRR
programs develop a variety of research resources; provide
biomaterial and resources for complex biotechnologies, clinical
research, and specialized primate research; develop research
capacity in minority institutions; and enhance the science
education of pre-college students and the general public.
Animal Research.--The Committee encourages NCRR to support
research and development focused on improving methods for
recognizing, assessing, and alleviating pain and distress in
research animals.
Cystic Fibrosis.--The Committee commends NCRR for its
support of clinical trials networks, including cystic fibrosis
clinical trials networks. A number of research institutions and
private organizations are engaged in efforts to initiate or
provide ongoing support to biospecimen repositories or specimen
banks. The Committee recognizes that NCRR has supported
programs to provide biomaterials to researches and recommends
that NCRR continue such efforts, including collaborative
efforts with private sector entities. The Committee recommends
that NCRR support a cystic fibrosis biospecimen repository,
which would serve as an important resource to CF researchers
and function as a model for other diseases.
Extramural Construction.--The Committee has included bill
language identifying $119,220,000 for extramural biomedical
facility renovation and construction. This amount is the same
as the fiscal year 2004 appropriation. The fiscal year 2005
budget proposed to eliminate funding for the program. These
funds are to be awarded competitively, consistent with the
requirements of section 481A of the Public Health Service Act,
which allocates 25 percent of the total funding to institutions
of emerging excellence.
Extramural Facilities Construction at Minority
Institutions.--The Committee encourages NCRR to give priority
consideration to supporting extramural facilities construction
projects at historically minority institutions which have
developed a comprehensive plan to address the disproportionate
impact of cancer in minority communities.
General Clinical Research Centers.--The 79 NCRR-funded
General Clinical Research Centers across the country are
critical to NIH efforts to translate basic science discoveries
into vaccines, treatments, and cures for disease. Approximately
10,000 researchers use GCRCs each year for patient-oriented
research focused on a wide variety of diseases. A recent
publication by the members of the Institute of Medicine
Clinical Research Roundtable described the GCRCs as ``an
extraordinarily important model for how clinical research can
be done'' within academic health centers and recommended an
expansion of the program. To enhance the capacity of these
Centers to support patient-oriented research, the Committee has
provided $300,000,000 for GCRC Grants (M01), an increase of
$14,800,000 over fiscal year 2004. To clarify its intentions,
the Committee emphasizes that this funding should be allocated
directly to NCRR-funded GCRCs through or as a supplement to the
M01 mechanism to support clinical research infrastructure such
as inpatient and outpatient beds, laboratory services, research
nutrition services, and statistical support for publicly and
privately funded clinical investigators. The Committee asks to
be informed in advance of any new initiatives within the GCRC
program that entail expenditure or reallocation of funds.
The Committee encourages the NCRR to upgrade GCRC
facilities with the sophisticated technologies needed to apply
the mapping of the human genome to the study of human disease
and respond to the threat of bioterrorism; expand staffing as
recently mandated by NCRR to assure patient safety; and support
local GCRC pilot projects as approved by the NCRR Advisory
Council.
IDeA Grants.--The Committee has provided $224,000,000 for
the Institutional Development Award [IDeA] Program authorized
by section 402(g) of the Public Health Service Act. This is a
$10,000,000 increase over fiscal year 2004 and the same as the
fiscal year 2005 budget request. Within the total provided,
$81,000,000 is for Idea Networks of Biomedical Research
Excellence [INBRE] and $136,000,000 is for the Centers of
Biomedical Research Excellence [COBRE] initiative.
Positron Emission Tomography.--The Committee continues to
urge NCRR to support research resource centers for the
development and refinement of positron emission tomography
[PET] as a unique imaging technology to diagnose and stage
diseases of the brain, including Alzheimer's disease.
Plant-Based Medicinal Products.--The Committee continues
its interest in accelerating the development and
commercialization of plant-based medicinal products.
Prader-Willi Syndrome.--The Committee recognizes the
commitment to establish a Rare Diseases Clinical Research
Center as part of the Rare Diseases Clinical Research Network
for the study of Prader-Willi Syndrome and other rare
disorders. The Committee recommends that the RDCRC program be
expanded to increase the level of research being conducted.
Research Resource Centers.--The Committee continues to urge
NCRR to support research resource centers for the development
and refinement of positron emission tomography [PET] as a
unique imaging technology to diagnose and stage diseases of the
brain, including Alzheimer's disease.
NATIONAL CENTER FOR COMPLEMENTARY AND ALTERNATIVE MEDICINE [NCCAM]
Appropriations, 2004.................................... $116,978,000
Budget estimate, 2005................................... 121,116,000
Committee recommendation................................ 121,900,000
The Committee has included $121,900,000 for the National
Center for Complementary and Alternative Medicine. The budget
request was $121,116,000 and the fiscal year 2004 appropriation
was $116,978,000. The comparable amounts for the budget
estimate include funds to be transferred from the Office of
AIDS Research.
The Committee strongly supports the work of the National
Center for Complementary and Alternative Medicine. The Center
is charged with assuring that complementary and alternative
therapies be rigorously reviewed to provide consumers reliable
information.
The Committee expects that funding for existing and new
centers supported by NCCAM will be maintained. The Committee
further expects NCCAM to undertake field investigations and a
program for the collection and evaluation of outcome data on
promising alternative therapies. The Committee expects NCCAM to
expand its support of CDC's field investigations program and of
AHRQ's literature reviews and data-analysis efforts, and to
develop and disseminate a comprehensive set of fact sheets on
CAM therapies to inform the public and health professionals of
the state of scientific knowledge about these therapies.
The Committee once again calls upon NCCAM to increase the
number of research grants and centers awarded to CAM
institutions. The Committee believes that in order to assure an
adequate CAM research infrastructure and to encourage quality
research at these institutions, greater support and resources
from NCCAM to these institutions are needed.
Ameliorating Liver Disease.--The Committee notes that NIDDK
has completed efforts to synthesize and calibrate the
production of milk thistle, which will now make possible
clinical trials to demonstrate its value in slowing the
progression of nonalcoholic steatohepatitis and to reduce the
side effects of hepatitis C interferon treatments. The
Committee urges NCCAM to pursue research to demonstrate the
value of milk thistle to ameliorate liver disease.
Bone Health and Nutrition.--The Committee urges NCCAM to
conduct research on women in their 30s and 40s with respect to
bone health and nutrition, including the use of supplements and
nutraceuticals, in an effort to determine whether such
strategies can prevent osteoporosis and fractures later in
life. In addition the Committee urges support for research on
the effect of complementary and alternative medicine on bones
and pain management in people with metabolic bone diseases.
Native Hawaiian Healing.--The Committee encourages the
preservation and documentation of Native Hawaiian traditional
cultural healing practices.
Parkinson's Disease.--The Committee encourages NCCAM to
continue exploration of the neuroprotective qualities of B
vitamins and antioxidant phytochemicals in berries via animal
models. Research with animals has shown that diets containing
berry fruits, such as blueberries, in addition to B vitamins
may forestall and could reverse many of the neurological
changes associated with age-related neurodegenerative
conditions, such as Parkinson's and Alzheimer's disease.
NATIONAL CENTER ON MINORITY HEALTH AND HEALTH DISPARITIES
Appropriations, 2004.................................... $191,471,000
Budget estimate, 2005................................... 196,780,000
Committee recommendation................................ 197,900,000
The Committee has included $197,900,000 for the National
Center on Minority Health and Health Disparities. The budget
request was $196,780,000 and the fiscal year 2004 appropriation
was $191,471,000. The comparable amounts for the budget
estimate include funds to be transferred from the Office of
AIDS Research.
Mission.--The NCMHD advises the NIH Director and Institute
and Center [IC] directors on the development of NIH-wide policy
issues related to minority health disparities research,
research on other health disparities, and related research
training. Among other activities, the NCMHD develops, in
consultation with the NIH Director, IC directors, and the
advisory council, a comprehensive strategic plan that
identifies and establishes objectives, priorities, budgets, and
policy statements governing the conduct and support of all NIH
minority health disparities research, research on other health
disparities, and related research training activities. It also
administers funds for the support of minority health
disparities research and other health disparities research, by
awarding grants and leveraging the programs of the ICs.
Behavioral and Social Sciences Research.--The Committee is
pleased with NCMHD's efforts to reach out to and coordinate
with the Office of Behavioral and Social Sciences Research.
Cooperative efforts to spur research on socioeconomic status
and health, experience of racism, and effective health
communications are encouraged.
Community-Based Organization Partnership Prevention
Centers.--The Committee recommends expansion of community-based
partnerships to further respond to the Department's prevention
initiatives. Efforts should be concentrated on the development
of Community Prevention Partnership Centers whereby CBOs
partner with targeted institutions of higher education. These
institutions of higher education are HBCUs, HSIs, and API
Serving Institutions. In American Indian, Alaska Native and
Native Hawaiian communities, Tribal Colleges, Universities and
health centers would serve as community prevention centers. All
centers would provide cultural competent health promotion and
disease prevention services and activities to promote healthy
lifestyles and reduce risks for health problems ranging from
diabetes, to cardiovascular disease, to substance abuse.
Community Programs to Improve Minority Health Grants.--The
Committee recommends funding additional minority community-
based grant projects that integrate community-based screening
and outreach services, and include linkages for access and
treatment to minorities in high risk or low-income communities,
and address socio-cultural and linguistic barriers to health.
The Committee notes that a number of meritorious grant
applications in this important area are going unfunded.
Cultural and Linguistic Best Practices Studies.--The
Committee urges studies of best practices and effective
approaches implemented by health care providers in addressing
cultural and linguistic barriers that impact on diagnosis and
treatment regimens, patient health outcomes, patient
comprehension and compliance with care and treatment regimens,
and patient safety and medical errors reduction.
Hepatitis C.--The Committee notes that hepatitis C is twice
as common in African Americans as it is in European Americans
and standard hepatitis C treatments do not respond as well in
African American populations. The Committee therefore urges the
Center to initiate and participate with NIDDK in research
focused on the Hepatitis C disparities that exist among
minority populations.
Liver Disease.--The Committee remains concerned about the
disproportionate burden of liver disease among African
Americans, Hispanics, Asians and Native Americans. Among
younger Native Americans liver disease is the second major
cause of death, and the sixth leading cause of death among all
Native American age groups. Furthermore, among most Asian
populations hepatitis B is a major cause of death. The
Committee strongly encourages NCMHD, in collaboration with
NIDDK, to expand research to improve liver disease treatment
effectiveness among minority populations.
Racial and Ethnic Disparities.--The Committee believes that
implementation of recommendations stemming from the Institute
of Medicine [IOM] ``Unequal Treatment: Confronting Racial and
Ethnic Disparities in Health Care'', study offer significant
opportunities for improving health across communities of color.
NCMHD is urged to support minority organizations and minority
community-based efforts to disseminate research based health
information that highlights health disparities experienced by
different racial and ethnic groups. NCMHD is expected to engage
minority national organizations including minority community-
based organizations in educating diverse communities about
recommendations of the Institute of Medicine report in an
effort to improve health.
Scleroderma.--The Committee encourages the Center to
support research that furthers the understanding of causes and
consequences of scleroderma, a chronic, degenerative disease of
collagen production, prevalent among African Americans,
Hispanic and Native American men and women as well as other
populations. The Center is encouraged to establish
epidemiological studies to address the prevalence of
scleroderma among these populations, as statistics indicate
that African Americans have a slightly higher incidence of
scleroderma. This population is also likely to be diagnosed at
a younger age and tend to be diagnosed more often with the
diffuse form of scleroderma.
JOHN E. FOGARTY INTERNATIONAL CENTER FOR ADVANCED STUDY IN THE HEALTH
SCIENCES
Appropriations, 2004.................................... $65,382,000
Budget estimate, 2005................................... 67,182,000
Committee recommendation................................ 67,600,000
The Committee recommends an appropriation of $67,600,000
for the Fogarty International Center [FIC]. The budget request
was $67,182,000 and the fiscal year 2004 appropriation was
$65,382,000. The comparable amounts for the budget estimate
include funds to be transferred from the Office of AIDS
Research.
Mission.--Adapting research advances in biomedicine to
populations at home and abroad requires a continuing commitment
to basic science as well as rigorous clinical and applied
(epidemiological) studies. Examples are vaccines, anti-
infective agents, drugs, and more efficient diagnostic tools,
combinations of interventions, and health policies to reduce
the risk of disease and its associated human, social, and
economic consequences. These challenges will benefit from a
more coordinated and multi-disciplinary approach to global
health needs. It is the mission of the FIC to address these
challenges by forging collaborations with a range of domestic
and global partners in international research and training to
pursue three core objectives: first, to accelerate the pace of
discovery and its application by special projects enabling
scientists worldwide to share conceptual insights, analytic
methods, data sets, patient cohorts, or special environments;
second, to engage and assist young as well as more established
U.S. investigators to address scientific challenges related to
global health; and third, to help develop a cadre of highly
capable young foreign investigators positioned to cooperate
with U.S. scientists in areas of the world that, due to
geography, genetics, or disease burdens, provide unique
opportunities to understand disease pathogenesis, anticipate
disease trends, or develop interventions of relevance and
priority for both the United States and the collaborating
country.
Chronic Obstructive Pulmonary Disease.--The Committee notes
that Chronic Obstructive Pulmonary Disease [COPD] is the fourth
leading cause of death worldwide, and encourages the Fogarty
International Center to expand its COPD research and training
activities.
Tuberculosis Training.--The Committee is pleased with the
Fogarty International Center's efforts to supplement grants in
AIDS International Training and Research Program [AITRP] or
International Training and Research Program in Emerging
Infectious Diseases [ERID], which trains tuberculosis experts
in the developing world. Given the magnitude of global
tuberculosis, the Committee encourages FIC to develop a
specific free-standing TB training program.
National Library of Medicine
Appropriations, 2004.................................... $317,245,000
Budget estimate, 2005................................... 325,147,000
Committee recommendation................................ 325,100,000
The Committee recommends an appropriation of $325,100,000
for the National Library of Medicine [NLM]. The budget
requested $325,147,000 and the fiscal year 2004 appropriation
was $317,245,000. These amounts include $8,200,000 made
available from program evaluation funds. The recommendation
includes $4,000,000 for improvement of information systems. The
comparable amounts for the budget estimate include funds to be
transferred from the Office of AIDS Research.
Mission.--The National Library of Medicine is the Federal
institution that for more than 150 years has collected,
organized, preserved, and disseminated the world's output of
biomedical literature in all forms. As a result of this
activity NLM is the world's largest library of the health
sciences, its holdings numbering more than 5,000,000 items. The
NLM has pioneered innovative methods to disseminate
bibliographic information. Basic to the mission of the NLM is a
wide-ranging research program to improve how medical
information is communicated. This responsibility is aided by a
grants program and by specialized services in toxicology,
environmental health, and biotechnology.
Computational Science.--The Committee recognizes that
advances in computer science and technology, and applications
of those advances to biomedical research, underpin many of the
remarkable advances in the life sciences that have been
achieved during the last couple of decades. Biomedical research
now involves not only experiment, but also extensive
computation. Increasingly, shortcomings in the specific
biomedical computing environment limit the rate of progress in
biomedical research. Accordingly, the Committee believes that a
major effort must be undertaken to improve the ability of
computation to serve biomedical research. The Committee urges
that NIH develop a plan for the near, intermediate, and long
term, to improve the biomedical computing environment to the
point that inefficiencies in the use of computer power and
information technology no longer limit the rate of progress in
biomedical research. The Committee recognizes that expertise
relevant to the development and implementation of such a plan
resides in other agencies as well as the NIH, such as the
National Science Foundation, the Department of Energy, DARPA,
and others, and thus encourages the NIH work with all such
agencies in the development and implementation of such a plan.
Home Medical Consultations.--The Committee continues to
support an expansion of a model project on the use of state-of-
the-art telemedicine technology for home medical consultations.
This innovative approach holds great promise for improving the
care and lowering health care costs for home-bound individuals
who require frequent monitoring.
Native Hawaiian Healing.--The Committee encourages the
preservation and documentation of Native Hawaiian traditional
cultural healing practices.
NLM Research Facility.--The Committee was pleased to learn
that the design for the new research facility at the NLM has
been completed and urges the NIH to assign a high priority to
this construction project. The National Center for
Biotechnology Information is the leveraging resource for much
of the science that NIH supports. The information-handling
capabilities of the Center are being jeopardized by a lack of
adequate facilities, and for the good of biomedical research
this expansion of NLM is needed as soon as possible.
Senior Citizen Outreach.--The Committee is very pleased
with the excellent work by NLM to expand access to NLM's
databases by senior citizens, and it urges the Library to
continue this worthwhile effort.
OFFICE OF THE DIRECTOR
Appropriations, 2004.................................... $327,504,000
Budget estimate, 2005................................... 359,645,000
Committee recommendation................................ 364,100,000
The Committee recommends an appropriation of $364,100,000
for the Office of the Director [OD]. The budget request was
$359,645,000 and amount appropriated in fiscal year 2004 was
$327,504,000. The comparable amounts for the budget estimate
include funds to be transferred from the Office of AIDS
Research.
Mission.--The Office of the Director provides leadership
and direction to the NIH research community, and coordinates
and directs initiatives which crosscut the NIH. The Office of
the Director is responsible for the development and management
of intramural and extramural research and research training
policy, the review of program quality and effectiveness, the
coordination of selected NIH-wide program activities, and the
administration of centralized support activities essential to
operation of the NIH.
Amnion-derived Stem Cell [ASC].--The Committee understands
that ASC technologies offers the potential to develop and
produce an adequate supply of cells for therapeutic cellular
transplantation based upon isolation from placental tissue. The
Committee supports all avenues of stem cell research and
strongly urges the NIH to explore research in this area and
steps necessary for the clinical application of this
technology.
Autism Spectrum Disorders.--The Committee is encouraged by
the NIH's autism research matrix and urges NIH to devote
sufficient resources to this research agenda. The Committee
urges the NIH when implementing the autism research matrix to
coordinate with autism organizations already funding research
initiatives to ensure the most efficient use of it resources.
The Committee also notes the promise of particular areas cited
in the matrix, including genetic and behavioral
characterizations of the disorder and screening and early
diagnosis.
Autoimmune Diseases.--The Autoimmune Disease Coordinating
Committee, with representation from each NIH Institute, Centers
for Disease Control and Prevention, Food and Drug
Administration, Veterans Administration, and patient advocacy
organizations, has been effective in fostering collaborative,
integrated multi-Institute research on issues affecting the
entire genetically related family of autoimmune diseases, as
recommended in the Autoimmune Diseases Research Plan. This
collaboration has been a significant factor in achieving recent
advances in the understanding, diagnosis and treatment of
autoimmune diseases. Congress supports the committee's
continued efforts in implementing the Autoimmune Diseases
Research Plan.
Basic Behavioral Research.--The Committee notes with
interest that NIH has undertaken a review of basic behavioral
and social sciences research funded by the National Institutes
of Health. The working group, composed of outside scientists
and chaired by a member of the Advisory Council to the NIH
Director, is charged in part with reviewing NIH's portfolio and
identifying areas of opportunity in basic behavioral and social
sciences, consistent with NIH's mission, that NIH should
consider supporting. Basic research in these sciences is
fundamental to an understanding of the mechanisms of sensation
and perception, development, learning and memory, and group
dynamics and behavior, among other areas. The Committee
reiterates its support for NIH's history of investment in basic
behavioral and social sciences research and looks forward to
reviewing the report of the working group.
Center for Scientific Review [CSR].--The Committee
recognizes that the reorganization of CSR offers the
opportunity to enhance the quality of peer review for grant
applications in the areas of cardiovascular, congenital and
thoracic surgery. The Committee is encouraged by CSR's decision
to restructure the peer review of these applications and to
ensure that cardio-thoracic surgeons are full participants in
the peer review process. The Committee will monitor this
activity to ensure that proper support is given to the
development of new surgical knowledge. This is especially
important as biomedical research evolves into a more integrated
model that cuts across existing boundaries to incorporate the
expertise of different scientific disciplines including
surgery.
Childhood Obesity, Trans-NIH Obesity Research Initiative.--
The committee encourages the NIH to further expand the Trans-
NIH obesity research initiative to include a multi-center study
of the metabolic, psychological, and genetic precursors of
obesity in children.
Chronic Fatigue Syndrome [CFS].--The Committee is
disappointed that NIH funding for CFS has basically remained
flat in recent years, despite repeated congressional requests
for increases. In addition, several grants represented to be
for CFS research have limited direct relevance to CFS. The
Committee notes that the Office of Research on Women's Health,
through the Trans-NIH Working Group for Research on Chronic
Fatigue Syndrome, is working on a request for applications
[RFA] based on the findings of a June 2003 scientific workshop
on CFS. The Committee strongly urges the NIH to fund this RFA
as soon as possible. The Committee also urges the NIH to expand
the involvement of intramural researchers in the study of CFS.
Clinical Investigators.--The Committee commends the Office
of the Director for rapidly launching programs with loan
repayment and for training clinical investigators and
encourages NIH to maintain and expand these programs. These
programs will be crucial for establishing the clinically
trained work force that will translate the promising basic
discoveries supported by NIH into clinical application to cure
and prevent disease in American citizens.
Clinical Practice Networks.--The Director of NIH is
commended for his Roadmap efforts to re-engineer clinical
research as currently supported by NIH. The Committee
recognizes that it is essential that study results be rapidly
disseminated into clinical practice. Therefore, the Director is
encouraged to work directly with the medical community--
including the surgical community--in order to utilize existing
networks as a way to accelerate the transfer of information for
the treatment of patients. The Committee requests a report on
this effort prior to next year's Appropriations hearing.
Clinical Research.--The opportunities for substantial
dividends on the Nation's investment in medical research have
never been greater. The Human Genome Project is providing
remarkable insights into diseases and disorders that have
plagued society for centuries. Those insights, together with
the infusion of resources during the 5-year doubling of NIH,
are opening new pathways to discovery. Commensurately, public
expectations are growing with the hope that past investments
will hasten the translation of new scientific knowledge into
better health and more effective treatment and prevention
strategies. But clinical research, the staging ground that
deploys the results of research to hospitals and health care
providers, is increasingly emerging as a bottleneck in the
scientific continuum. At a time when a cohesive and coherent
national effort is vital, the academic health centers on whose
shoulders this work rests face unfunded regulatory mandates,
fragmented clinical research infrastructure, incompatible data
bases, and a severe and growing shortage of qualified clinical
investigators and willing participants. While the NIH Roadmap
initiative is intended to address some of these obstacles, more
must be done to help academic health centers defray the costs
associated with unfunded mandates; support infrastructure
grants to modernize information technology systems and
databases; and help modernize clinical research facilities. The
Committee requests a report on these and other steps taken to
improve the clinical research enterprise prior to the fiscal
year 2006 hearings.
Clinical Research Loan Repayment Program.--The Committee is
pleased that NIH has moved forward with the Clinical Research
Loan Repayment Program. As the program completes its third
year, the Committee would like to assess outcomes to date as
well as areas for potential improvement. It is the Committee's
understanding that the requirement that applicants have an
institutional guarantee of 2 years of research support has
proven an insurmountable hurdle for many potential applicants,
particularly those at the end of a training grant or career
award who have not yet obtained outside support for the next
stage of their careers. The Committee requests a report within
60 days after passage of this bill evaluating alternative
strategies for assuring that recipients of loan repayment
actually pursue careers in clinical research. Second, the
Committee requests a report profiling award recipients
including their training experience; degrees held; medical/
scientific disciplines; academic positions; and the funding
support by which they were eligible to apply.
Cystic Fibrosis.--The NIH Roadmap identifies the re-
engineering of the clinical research system as a top priority.
One of the strategies that the Roadmap recommends to enhance
clinical research is establishing clinical trials networks that
share informatics and other technologies. These networks also
should include a significant number of institutions, in order
to facilitate efficient recruitment and rapid enrollment of
trial participants. The Committee believes that there are
important opportunities for collaboration between NIH and this
existing clinical trials network and encourages NIH to pursue
this potential collaboration.
Digestive Disease Commission.--The Committee calls on the
Director, in collaboration with the Secretary, to establish a
national commission on digestive diseases composed of
distinguished scientists and physicians who are experts in
digestive diseases, digestive disease patient advocates and
representatives of Federal departments, agencies or institutes
providing support for research related to digestive diseases in
order to (1) study the incidence, duration, and mortality rates
of digestive diseases, as well as their social and economic
impacts; (2) evaluate public and private facilities and
resources, including trained personnel and research activities,
for the diagnosis, prevention, and treatment of such diseases;
(3) identify related disease management programs, including
biological, behavioral, nutritional, environmental, and social
programs; and (4) develop a long-range plan for the use and
organization of national resources to effectively deal with
digestive diseases.
Duchenne Muscular Dystrophy.--The Committee strongly
encourages the funding of three additional Centers of
Excellence and to double the funding for existing centers of
excellence by the end of fiscal year 2005. In addition, the
Committee notes that the NIH Interagency Coordinating Committee
for muscular dystrophy has missed its 1-year deadline to submit
a plan for conducting and supporting research and education on
muscular dystrophy through NIH in accordance with the MD CARE
Act of 2001. The Committee strongly urges the Coordinating
Committee to finalize and submit this plan, as well as include
representation from the Department of Defense on the panel, as
soon as possible.
In addition, the Committee strongly urges the NIH's to
devote additional resources to DMD translational research and
clinical trials. This funding is to be separate from the
Centers of Excellence program. Based on the severity of this
disorder, its high incidence in children, and the prospect of
important new treatments, the Committee strongly urges OD,
through NIAMS and NINDS, to follow the accelerated model for
funding DMD translational research that was used for motor
neuron diseases, including ALS and SMA. The Committee strongly
endorses that plan and urges the OD to equip the program and
the personnel charged with executing the plan with appropriate
authoritative and financial resources to maximize the chances
of success.
Finally, the Committee encourages the OD to further develop
opportunities for upcoming clinical trials and to help make
available all existing and emerging patient care options. The
Institutes are encouraged to work with other Federal agencies
to develop formal programs that increase public and
professional awareness of the disease.
Epilepsy.--The Committee recognizes that while the NINDS is
the primary Institute for addressing epilepsy, several other
Institutes are also involved in related research. They include
the NICHD, the NHGRI, the NIMH, and the NIA. The Committee
requests the Director to provide a report by April 1, 2005, on
the progress made in the coordination of research efforts in
epilepsy among these Institutes, and on the progress made in
implementing the NINDS research benchmarks resulting from the
March 2000 conference ``Curing Epilepsy: Focus on the Future.''
Fragile X.--The Committee notes that in fiscal year 2003,
75 grants were provided by 11 separate NIH Institutes, units,
and its National Center for Research Resources to find a
treatment and cure for Fragile X. In addition, privately-funded
Fragile X research is rapidly expanding, often in partnership
with NIH grants. The Committee commends the growing breadth and
diversity of this research but strongly urges the Director to
establish a coordinating mechanism to direct and coordinate
these efforts in regularly-scheduled meetings. The Committee
requests that the Director report to the Congress on the
progress during the fiscal year 2006 appropriations hearings.
Fragile X Pediatric Training.--The committee encourages the
Director to increase the number and size of institutional
training grants to institutions supporting pediatric training
and the number of grants for career development clinical
research.
Gender-Based Biology.--The Institute of Medicine [IOM] has
released a study that clearly demonstrates that all biological
research--from bench to bedside--must be cognizant of the
differences that result from the sex of the patient, tissue or
cell. One of the areas where such differences are most
pronounced is in the field of neuroscience. For this reason,
the Committee believes it is entirely appropriate that the
Director assure that the ten institutes involved in the trans-
institute initiative on brain research include gender-based
biology as an integral part of the research conducted and that
research results are analyzed and reported in this manner, when
appropriate. The Committee would like a report from the
Director on the progress of this effort prior to next year's
hearings.
General Clinical Research Centers.--The Committee has
supported expansion of the General Clinical Research Centers
program within the National Center for Research Resources.
Wherever possible, the Committee encourages the Director to
utilize the GCRCs as the foundation of NIH Roadmap activities
related to clinical research. Rather than establishing programs
in isolation, the Committee believes that it will be both
synergistic and cost-effective for NIH Roadmap clinical
research programs to be sited in the GCRCs as practicable.
Genomics.--The Committee recognizes that while the NHGRI is
the primary Institute for addressing the human genome sequence,
other Institutes should also identify the role genomics and
genetics play in the progression of specific diseases. For
example, the Committee urges the Director to encourage the
various Institutes, including the NIA, NIMH, and NINDS, to take
advantage of advances in microarray technology. Utilization of
this technology could lead to improved prevention and
therapeutic intervention strategies for Alzheimer's and
Parkinson's diseases, as well as autism, obsessive compulsive
and bi-polar disorder.
Graduate Training in Clinical Investigation Awards.--In an
effort to reverse the shortage of well-trained clinical
investigators, Congress authorized the Clinical Research
Curriculum Awards and the Graduate Training in Clinical
Investigation Awards. The Curriculum Awards were intended to
support institutional training programs in clinical research,
with the second award intended to provide tuition and stipend
support for enrolling students. For 3 consecutive years, this
Committee has expressed concern that NIH has not moved forward
with implementation of the Graduate Training in Clinical
Investigation Awards. The Committee believes that NIH is
compromising the effectiveness of the training programs that
have been established through the Curriculum Awards by failing
to fund the complementary student stipend/tuition awards. The
report of the General Accounting Office on NIH implementation
of the clinical research legislation substantiated the
Committee's concerns. The Committee urges the Director to
consider including these awards in the NIH Roadmap activities
related to enhancing the clinical research workforce and
provide sufficient funds to support 200 students in fiscal year
2005.
Heart Disease, Stroke and Other Cardiovascular Diseases.--
The Committee recognizes that the problems associated with
heart disease, stroke and other cardiovascular diseases involve
many institutes and centers, including NHLBI, NINDS, NIA,
NIDCR, and NCRR. The Committee strongly urges the Director to
expand its research portfolio and increase its resources and
better coordinate cross-cutting research on these diseases in
all institutes, centers and divisions, as appropriate, and
through all available mechanisms. The Committee requests the
Director to be prepared to report on initiatives on these
diseases begun in fiscal year 2004 or scheduled to begin in
fiscal year 2005 at the fiscal year 2006 appropriations
hearings.
Hepatitis B.--The Committee is aware that although there
has been tremendous success in the prevention and treatment of
hepatitis B, this disease remains a serious concern. The large
number of immigrants to the United States from countries where
hepatitis B is endemic will keep the disease in the forefront
of public health for years to come. The Director of NIH is
urged to make hepatitis B a priority and to stimulate research
to find complements for the current therapies; improvements in
prevention, detection and treatment; and develop new vaccines
and outreach programs.
High-Risk Research.--As the NIH enters into a period of
limited funding resources, the peer review system will
naturally tend to reward conservative research proposals rather
than bolder ideas that have a higher risk of succeeding. The
Committee strongly urges the NIH to beware of this tendency, in
terms of both the research grants that it awards and the types
of researchers who receive them. Relying solely on tried-and-
true approaches to medical research, conducted solely by
veteran, established researchers, will not result in quantum
leaps in discovery. Despite the current decline in the growth
rate of NIH's budget, the NIH must continue to fund high-risk
research and young investigators who have innovative ideas.
Hepatitis C Consensus Conference Implementation.--The
Committee notes that the Hepatitis C Consensus Development
Conference recommended the creation of a Hepatitis Clinical
Research Network [HCRN] and commends NIDDK and NIAID for
expanding Hepatitis C related clinical research studies. The
Committee requests a report by April 2005 to incorporate the
advice of NIH and biomedical community leaders to assess the
adequacy of this arrangement along with alternative approaches
to assure a complete response to the original recommendations
of the Hepatitis C Consensus Conference regarding the creation
of the Network.
Human Tissue Supply.--The Committee remains interested in
matching the increased needs of NIH grantees, intramural, and
university-based researchers who rely upon human tissues and
organs to study human diseases and search for cures, including
for those researchers dedicated to the study and cure of rare
diseases. The Committee is aware that one of the leaders in
this competitive field, the National Disease Research
Interchange [NDRI], is uniquely positioned to obtain this
valuable and effective alternative research resource. More than
500 peer-reviewed research advances made by NDRI-dependent
researchers have been published during the past 4 years
contributing to the research community's fund of knowledge. The
Committee is encouraged by NDRI's role in these research
advances and applauds the Director's expanded support for NDRI
by bringing NEI, NIDDK, NIAID, NIAMS, and the Office of Rare
Diseases into the multi-institute initiative. While this is
promising, more needs to be done to match the demand for the
use of human tissue in research. The Committee, therefore,
strongly urges the Director to increase the core support NDRI
receives from NCRR, and the Institute Directors to identify and
implement program-specific initiatives intended to expand
support for NDRI.
Interdisciplinary Research and Training.--The committee
notes OBSSR's efforts to develop new mechanisms for training
scientists in more than one academic discipline to create a
scientific workforce better prepared to research multi-faceted
problems. OBSSR is directed to report back to the committee on
interdisciplinary research issues such as cross-disciplinary
support for the new mechanisms, numbers of applicants, and any
barriers encountered in implementing the new program.
Irritable Bowel Syndrome.--The Committee is pleased with
the increased focus on irritable bowel syndrome [IBS] at the
NIH's Office of Research on Women's Health. It is estimated
that over 60,000,000 Americans, disproportionately women,
suffer from IBS.
Juvenile Arthritis.--The Committee urges the Director, in
collaboration with NIAMS, NICHD and NIAID, to strengthen its
investment in, and commit additional resources to, basic,
clinical, and translational research efforts and related
activities specific to juvenile arthritis as authorized by the
Children's Health Act. The Committee requests the NIH to
provide Congress with a report on efforts underway and progress
made in achieving this goal by April 2005.
Liver Disease and the Veterans Health Administration.--The
Committee believes that closer collaboration with the Veterans
Health Administration will significantly facilitate,
accelerate, and leverage research to develop more effective
treatments and cures for liver disease. The Committee notes
that the Veterans Health Administration [VHA] has developed a
significant database of veterans with hepatitis C that includes
demographic, diagnostic, laboratory, drug treatment and co-
morbidity population statistics that could be used to support a
large number of NIH funded research efforts. The Committee is
pleased that NIDDK, as the lead NIH Institute, has begun
efforts to develop a cooperative agreement with the Veterans
Health Administration as a vehicle for cost-sharing
collaborative efforts to facilitate liver disease research on a
trans-NIH basis. The Committee requests the Institute be
prepared to report at the fiscal year 2006 Appropriation the
progress and status of cooperative research efforts with the
VHA to address hepatitis C.
Lymphatic System Research.--Despite the central role of the
lymphatic system in human health and disease, this focus of
research and medical care has, until recently, been relatively
neglected. The lack of research has created barriers to
effective delivery of health care and limited the interest of
biomedical investigators to pursue prospective studies in this
area. Therefore, the Committee urges the Trans-NIH Coordinating
Committee for the Lymphatic System to work with its member ICs
to implement a comprehensive lymphatic research awareness
campaign that is designed to target academia, governmental
agencies, industry, scientific and medical professional
organizations, and the public at large.
The Committee also urges the OD to consider targeted
initiatives regarding the lymphatic system, such as: (a) the
development of suitable reagents, including monoclonal
antibodies, to facilitate lymphatic investigation in vitro and
in vivo; (b) the development of transgenic and knockout animal
models; (c) the functional imaging of the lymphatic system; (d)
academic career development; and (e) a national patient
registry and tissue bank for lymphatic diseases. Finally, the
Committee encourages the Coordinating Committee to work with
the Center for Scientific Review and ICs to ensure that experts
in the lymphatic system are adequately represented on peer
review panels.
Microbicides for the Prevention of HIV.--Microbicides, a
class of products that would be applied topically to prevent
HIV, represent a promising prevention strategy, with the
potential to be especially significant in preventing HIV in
women, who now account for more than half of the individuals
newly infected with HIV globally. Once developed, microbicides
and vaccines would serve as complementary HIV prevention
technologies.
NIH, principally through NIAID, spends the majority of
Federal dollars in this area. The Committee remains concerned
that microbicide research at NIH is currently conducted with no
single line of administrative accountability or specific
funding coordination. The Director of NIH, in consultation with
OAR and in coordination with NIAID, NICHD, NIDA, NIMH, and
ORWH, is urged to establish a microbicides branch or comparable
dedicated unit specifically for microbicides research and
development, with appropriate staff and funding.
Minority Health and Racial Disparities.--The Nation has
invested greatly in the NIH providing tremendous opportunities
for accelerated improvements in health and quality of life.
Research advances must be applied more expeditiously to ensure
greater improvements in health outcomes across all communities
of color and the general public. The Committee strongly urges
the NIH to improve, strengthen and expand its systems of
information dissemination and outreach to health care
providers, minority organizations, and the public. Knowing that
one-size does not fit all as it relates to the public,
communities, and the Institutes and Centers, the Committee
strongly urges the Director of NIH, and the director of each of
the Institutes and Centers to report on their respective
improved systems across these areas during next year's
appropriations hearings.
Nanosystems Biology.--The Committee encourages the
director, along with NCI, to support a collaborative effort to
bring nanotechnology, systems biology and molecular imaging
together to examine the molecular basis of cancer, consistent
with the Director's Roadmap Initiative.
Office of Dietary Supplements.--The Committee continues to
strongly support the important work of this Office. Use of
dietary supplements has increased significantly among Americans
who want to improve their health and prevent disease. There is
a great need for additional research to better inform consumers
of the health benefits of supplements. Accordingly, the
Committee has provided additional funds to expand this office's
efforts. In particular, the Committee expects the ODS to speed
up ongoing collaborative efforts to develop, validate and
disseminate analytical methods and reference materials for the
most commonly used botanicals and other dietary supplements.
The Committee also expects the ODS to contract with industry
non-profit associations or foundations which currently have and
maintain a database of dietary supplement labels to develop,
create, continually update, maintain and make available to
Government and research entities a database of all supplement
labels sold in the United States. The creation of this database
would allow ODS to have access for research purposes of all
known supplements manufactured in the United States and to
allow access by other Federal agencies for ensuring safety to
consumers, through the mandatory listing of ingredients in
these products on the label, who purchase supplements
manufactured and/or sold in the United States.
Office of Science Education.--The Committee is pleased with
the work of the Office of Science Education and encourages all
of the NIH Institutes to work with the Office to support
supplemental curricular and training project for K-12 science
education. The support from the NIH Institutes and centers
greatly enhance the capacity of this Office to provide the
critical investment in science literacy among young people
throughout the Nation.
Office of Research on Women's Health.--The Committee
recognizes the critical role played by the Specialized Centers
of Research on Sex and Gender Factors Affecting Women's Health
and encourages the Office to continue programmatic initiatives
to further this work. The Committee also supports the
development of an intramural women's health program at NIH.
Parkinson's Disease.--The Committee commends the Director
for his strong support and facilitation of collaboration with
patient advocacy groups, health non-profits, and international
organizations.
The Committee is also aware that the Parkinson's Disease
Research Agenda [PDRA] developed by NIH in 2000 included
professional judgments funding projections that totaled an
additional $1,000,000,000 over 5 years to achieve a cure. The
Committee strongly urges NIH to come as close as possible to
fulfilling that Agenda while maintaining the standards of peer
review. Furthermore, the Committee is also aware that the
Director has prepared his own ``matrix'' for Parkinson's which,
while laudable, falls short of the ambitious goal of the
Parkinson's Disease Research Agenda to find a cure for
Parkinson's by developing a roadmap and projections of the
resources needed to achieve that goal.
The Committee strongly urges the NIH to devote additional
resources to Parkinson's research, as recommended by the
Parkinson's disease Research Agenda, using all available
mechanisms, including RFAs.
The Committee expects the NIH to report to Congress by
April 2005, not only on the steps it is taking to fulfill the
Parkinson's disease Research Agenda, but also its progress
towards finding a cure for this devastating disease.
Additionally, as 5 years have elapsed since the last NIH
conference on Parkinson's disease, the Committee strongly urges
the Director to hold another conference, similar to the one
held in November 1999, to examine the path to a cure, working
with patient advocacy, scientific, and non-profit communities.
The results of the conference should produce a strategic plan
setting forth the research funding and programs required to
secure the earliest possible development of effective
therapies, prevention, and a cure for Parkinson's disease.
Pediatric Research Initiative.--The Committee urges the
Office of the Director to expand the Pediatric Research
Initiative, as authorized by the Children's Health Act of 2000.
The Committee strongly supports the growth of support for
pediatric research across Institutes and encourages activities
which stimulate new and promising areas of pediatric research.
Additionally, the Committee urges NIH to collaborate with the
CDC and HRSA in research areas related to heritable and genetic
disorders affecting children.
Population-Based Prevention Research.--The Committee
commends NIH for its efforts to support research in humans that
examines factors associated with preventing disease and
promoting health. The Committee urges the NIH to seek ways to
remove barriers that prevent research findings from being
translated into population-wide health improvements and to
expand its support for studies that include examination in
human populations of biological, behavioral and environmental
factors associated with disease and means to ameliorate them.
As part of these efforts, the Committee requests the NIH to
submit a report by April 1, 2005, that indicates total funding
by institute, and where applicable by disease, for prevention
research among human populations that reduces disease risk
through social, behavioral and environmental change.
Prader-Willi Syndrome.--The Committee commends the NIH for
creation of an Obesity Research Task Force and for NIH's
recognition of the need to prevent and treat obesity beginning
in childhood. However, the committee strongly urges the Task
Force to explicitly include, across the six proposed trans-NIH
obesity initiatives, investigations into the genetic causes of
obesity beginning with study of Prader-Willi Syndrome.
Furthermore, the Committee urges the Director of NIH to conduct
outreach to the Prader-Willi Syndrome community to participate
in research at the proposed ``Obesity Clinical Research
Center.'' The NIH should be prepared to report on the progress
made by the Obesity Research Task Force, and the trans-NIH
research efforts to appropriately incorporate both children and
genetics into the overall obesity research agenda during the
fiscal year 2006 appropriations hearings.
Public Health Relevance of Research Awards.--The Committee
is encouraged by steps the National Institutes of Health [NIH]
is taking to improve communications regarding the public health
relevance of its research awards. Specifically, the Committee
is pleased NIH has proposed a modification to its standard
grant application, PHS Form 398, requiring all grantees to
include a statement of public health significance. The
Committee urges the Department of Health and Human Services and
the Office of Management and Budget to approve the proposed
revision and support the agency in its efforts to implement
this important change in the grant application form.
Rare Liver Diseases.--The Committee is pleased that the
Office of Rare Diseases has provided significant co-funding,
along with NIDDK, for the Biliary Atresia Research Network. The
Committee urges ORD to continue to address rare liver diseases
including primary biliary cirrhosis, primary sclerosing
cholangitis, and auto-immune hepatitis.
Saliva Research.--The Committee has learned that saliva is
gaining value as a diagnostic tool and potential monitor of
disease progression in systemic disorders, including
Alzheimer's disease, Sjogren's syndrome, cystic fibrosis, and
diabetes; moreover, studies have uncovered the presence of a
cancer-related protein whose concentration increases in the
presence of breast cancer--thus, having the potential as a
diagnostic marker for the early detection of breast cancer. The
Director of NIH is urged, working with the NIDCR, to find ways
to expand and accelerate research in this area and report back
to the Committee prior to next year's hearing.
Sepsis.--The Committee is aware that sepsis kills more than
215,000 Americans each year. To improve health care provider
education in correctly diagnosing sepsis, the Committee urges
the Director to work with outside organizations to create and
implement a program to train infectious disease physicians,
emergency room doctors, critical care nurses, and oncologists,
especially those serving in rural and underserved areas, in the
use of new guidelines to identify sepsis to improve patient
outcomes. The Committee further encourages the Director to work
with the NIAID, NHLBI and NCI in these provider education
efforts.
Spina Bifida.--The Committee recognizes that Spina Bifida
is the leading permanently disabling birth defect in the United
States and has concerns that the NIH has not prioritized
research into primary and secondary prevention of this
condition. While Spina Bifida is highly preventable through
proper nutrition, including appropriate folic acid consumption,
too many pregnancies are still affected each year by this
devastating birth defect. The Committee also acknowledges that
prevention does not assist the more than 70,000 individuals
living with Spina Bifida and therefore urges the NIH/NINDS/
NICHD to allocate adequate and additional resources to
prioritize research into primary and secondary prevention for
Spina Bifida.
Spinal Muscular Atrophy.--The Committee strongly urges the
OD to ensure the success of the SMA Project by providing active
and ongoing support from the OD as well as from other related
Institute Directors, most notably NICHD. The OD is urged to
take all necessary steps to ensure that the NICHD is fully
engaged by expanding their scope and level of resources
dedicated to SMA.
Stroke in Women.--As the second leading cause of death
among women worldwide, stroke in women is a major health
problem. Stroke kills more than twice as many women as do
breast cancer and AIDS combined. Acute care of women stroke
victims is often delayed, and 62 percent of all stroke-related
deaths occur in women. Recognizing that women are the single
largest group at risk for death from stroke, the Committee
believes that special attention should be focused on better
understanding the gender-related differences in stroke. Some
aspects of the disease unique to women include strokes related
to pregnancy and the use of oral contraceptives. Stroke is
additionally a leading cause of serious disability among women
and may contribute to late-life cognitive decline. The
Committee supports the funding of new and continuing NIH
studies that investigate the impact of postmenopausal hormone
replacement therapy on stroke risk. Continued support of
clinical and basic research on hormone physiology in women is
necessary to understanding the impact of hormones on women's
vascular systems. The Committee urges NIH to increase research
in stroke among women of all ages, with specific attention to
gender-related differences in stroke risk, and to stroke
prevention interventions, acute stroke management, post-stroke
recovery, long-term outcomes, and quality of care. The
Committee further urges NIH to increase research into new
therapies for stroke in women as well as into ways of enhancing
the vascular health of all Americans.
The Committee also encourages and supports NIH's
initiatives toward advancing the organization of stroke care,
including post-stroke rehabilitation, and the identification of
stroke treatment and research centers that would provide rapid,
early, continuous 24-hour treatment to stroke victims,
including the use of the clot-buster t-PA, when appropriate.
Designated areas in medical facilities equipped with the
resources and personnel for treating stroke would also promote
the early evaluation of innovative stroke treatments.
Temporomandibular Joint [TMJ] Disorders.--The Committee
commends the NIH for holding a scientific meeting in May 2004
on the co-morbidities of TMJ. This meeting highlighted the
complexity of TMJ diseases and disorders, the research
opportunities available and the importance of inter-institute
collaborations to further the understanding, treatment, and
prevention of this condition. The Committee is disappointed,
however, that the NIH Temporomandibular Disorders Interagency
Working Group [TMJDIWG] has not yet developed a trans-NIH
research agenda on TMJ disorders, as discussed in the fiscal
year 2005 congressional budget justification. The Committee
strongly urges the Director to ensure that this plan is
completed as soon as possible. The plan should incorporate
input from patients and should include listings of the specific
research opportunities that have been identified by the
TMJDIWG. It should also include summaries from each Institute
in the working group regarding which research opportunities it
plans to pursue, with approximate timeframes. The Committee
requests a report on this plan by April 1, 2005. Finally, the
Committee urges the NIH to develop informational materials on
TMJ disorders for distribution to patients, the media, health
care organizations, and the public.
Tuberous Sclerosis Complex.--In its report accompanying the
fiscal year 2004 appropriations, the Committee called upon the
Office of the Director to formulate an NIH-wide research agenda
on tuberous sclerosis complex, and to report back to the
Committee on this effort. While a research agenda was
developed, the Committee is disappointed by the failure to act
upon it. The report to the Committee cited research studies
were carried out several years ago or which only generally
relate to TSC, and failed to establish a mechanism to
coordinate research activities across several Institutes. The
Committee strongly urges the OD to establish such coordinating
mechanism as soon as possible, and to undertake TSC-specific
research.
Vascular Biology.--The Committee recognizes the importance
of advancing research in the field of vascular biology, the
study of blood and blood vessels and their interactions. Not
only is the maintenance of the blood supply critical to the
functioning of all organs of the body, understanding the
mechanisms and treatment of diseases that interrupt the blood
supply is relevant to all organ systems and their disorders.
Research into vascular biology can provide the scientific basis
for new therapies to prevent thrombosis; therapies that are
important to the prevention and control of heart disease,
stroke, recurrent fetal loss, and complications associated with
sickle cell anemia and diabetes; and therapies related to the
interruption of the blood supply to tumors and cancers. Because
of the cross-cutting aspects of this research, the Committee
urges the NIH Director to develop a comprehensive NIH-wide
approach to identify and pursue research opportunities in this
field.
OFFICE OF AIDS RESEARCH
The Committee recommendation does not include a direct
appropriation for the Office of AIDS Research [OAR]. Instead,
funding for AIDS research is included within the appropriation
for each Institute, Center, and Division of the NIH. The
recommendation also includes a general provision which directs
that the funding for AIDS research, as determined by the
Director of the National Institutes of Health and the OAR, be
allocated directly to the OAR for distribution to the
Institutes consistent with the AIDS research plan. The
recommendation also includes a general provision permitting the
Director of the NIH and the OAR to shift up to 3 percent of
AIDS research funding among Institutes and Centers throughout
the year if needs change or unanticipated opportunities arise.
The Committee requests that the Director provide notification
to the Committee in the event the Directors exercise the 3
percent transfer authority.
The NIH Office of AIDS Research [OAR] coordinates the
scientific, budgetary, legislative, and policy elements of the
NIH AIDS research program. Congress provided new authorities to
the OAR to fulfill these responsibilities in the NIH
Revitalization Act Amendments of 1993. The law mandates the OAR
to develop an annual comprehensive plan and budget for all NIH
AIDS research and to prepare a Presidential bypass budget.
BUILDINGS AND FACILITIES
Appropriations, 2004.................................... $88,972,000
Budget estimate, 2005................................... 99,500,000
Committee recommendation................................ 114,500,000
The Committee recommends an appropriation of $114,500,000
for buildings and facilities [B&F]. The budget requested
$99,500,000 and the fiscal year 2004 appropriation was
$88,972,000.
Mission.--The buildings and facilities appropriation
provides for the NIH construction programs including design,
construction, and repair and improvement of the clinical and
laboratory buildings and supporting facilities necessary to the
mission of the NIH. This program maintains physical plants at
Bethesda, Poolesville, Baltimore, and Frederick, MD; Research
Triangle Park, NC; Hamilton, MT; Perrine, FL; New Iberia, LA;
and Sabana Seca, PR.
The Committee has included full-scope bill language within
this appropriation to give flexibility to the NIH to continue
work on the John E. Porter Neuroscience Research Center for
which $15,000,000 has been included. Funds have also been
included for the Animal Research Center, the Rocky Mountain
Laboratories Buffer Replacement Facility, asbestos abatement,
fire protection and health and safety compliance, air quality
improvement programs and to eliminate barriers to persons with
disabilities.
Substance Abuse and Mental Health Services Administration
Appropriations, 2004.................................... $3,350,958,000
Budget estimate, 2005................................... 3,550,242,000
Committee recommendation................................ 3,484,729,000
The Committee recommends $3,484,729,000 for the Substance
Abuse and Mental Health Services Administration [SAMHSA] for
fiscal year 2005. This amount is $133,771,000 above the
comparable fiscal year 2004 level and $65,513,000 below the
administration request. The recommendation includes
$123,303,000 in transfers available under section 241 of the
Public Health Service Act. SAMHSA is responsible for supporting
mental health programs and alcohol and other drug abuse
prevention and treatment services throughout the country,
primarily through categorical grants and block grants to
States.
The Committee has provided funding for programs of regional
and national significance under each of the three SAMHSA
centers: mental health services, substance abuse treatment and
substance abuse prevention. Separate funding is available for
the children's mental health services program, projects for
assistance in transition from homelessness, the protection and
advocacy program, data collection activities undertaken by the
Office of Applied Studies and the two block grant programs: the
community mental health services block grant and the substance
abuse prevention and treatment block grant.
The Committee strongly supports SAMHSA's Federal leadership
role to improve the quality and availability of empirically-
based prevention and treatment services in the areas of mental
health and substance abuse. The Committee commends SAMHSA for
its ongoing collaboration with the National Institutes of
Health, specifically with the National Institute of Mental
Health [NIMH], the National Institute on Drug Abuse [NIDA], and
the National Institute on Alcohol Abuse and Alcoholism [NIAAA].
As one example of this partnership, the Committee notes that
SAMHSA collaborated with NIDA on the recent NIH Request for
Applications [RFA] designed to strengthen the capacity of State
Alcohol and Drug Abuse Agencies to support and engage in
research that will foster adoption of science-based policies
and practices. The Committee urges that SAMHSA and NIH continue
its collaboration to reduce the current 15 to 20-year lag
between the discovery of an effective treatment or intervention
and its availability at the community level. The Committee is
particularly interested in recent brain imaging research being
conducted and supported by NIH. The Committee believes this
research will have a significant impact on the development of
new science-based treatment and prevention strategies for those
suffering from mental illness and substance abuse.
The Committee requests that SAMHSA work with the Centers
for Medicare and Medicaid Services to maximize reimbursement of
a more complete continuum of treatment and prevention services,
including recovery support services, through the Medicaid
program. Medicaid is an important but under-utilized funding
stream for drug and alcohol treatment and prevention services
that complements the funding provided through SAMHSA programs,
especially when evidence shows that when treatment is provided
other health care costs can be reduced by as much as 50
percent.
The Committee remains concerned by the disproportionate
presence of substance abuse in rural and native communities,
particularly for American Indian, Alaska Native and Native
Hawaiian communities. The Committee reiterates its belief that
funds for prevention and treatment programs should be targeted
to those persons and communities most in need of service.
Therefore, the Committee has provided sufficient funds to fund
projects to increase knowledge about effective ways to deliver
services to rural and native communities.
CENTER FOR MENTAL HEALTH SERVICES
Appropriations, 2004.................................... $862,220,000
Budget estimate, 2005................................... 912,502,000
Committee recommendation................................ 935,082,000
The Committee recommends $935,082,000 for mental health
services. This amount is $72,862,000 above the comparable level
for fiscal year 2004 and $22,580,000 above the administration
request. The recommendation includes $21,803,000 in transfers
available under section 241 of the Public Health Service Act.
Included in the recommendation is funding for programs of
regional and national significance, the mental health
performance partnership block grant to the States, children's
mental health services, projects for assistance in transition
from homelessness, and protection and advocacy services for
individuals with mental illnesses.
The Committee notes that that SAMHSA's 2002 ``Report to
Congress on the Prevention and Treatment of Co-occurring
Substance Abuse Disorders and Mental Health Disorders'' found
that a ``significant lack of prevalence data on co-occurring
disorders exist.'' The Committee encourages SAMHSA to work with
NIMH, NIAAA, and NIDA to collaborate with States to develop
more recent and accurate data on persons with co-occurring
mental health and substance use disorders, with an emphasis on
individuals with mild to moderate mental health disorders.
Programs of Regional and National Significance
The Committee recommends $303,128,000 for programs of
regional and national significance. This amount is $62,332,000
above the comparable level for fiscal year 2004 and $32,580,000
above the administration request. Programs of regional and
national significance address priority mental health needs
through developing and applying best practices, offering
training and technical assistance, providing targeted capacity
expansion grants, and changing the delivery system through
family, client-oriented and consumer-run activities.
The Committee is deeply concerned that between 5 percent to
9 percent of all children suffer from a mental, behavioral or
emotional disorder which, if undiagnosed and untreated, can
substantially interfere with academic achievement, or lead to
student drop-out, substance abuse, violent behavior, or
suicide. Because most youth aged 15 to 19 are in school, the
educational system is the best environment to identify those
youth at risk for suicide and to facilitate the services that
the individual needs. The Committee is aware that SAMHSA is
overseeing a pilot study in one school system, utilizing
evidence-based screening techniques and tools to screen and
identify teenagers who are at risk. Several promising screening
techniques to identify youth at risk exist but they need
further testing. There also is a need to develop evidence-based
interventions to work with students found to be at risk and
their families so as to facilitate treatment. The Committee has
included $4,500,000 for SAMHSA to make grants to local
educational systems or non-profit entities in conjunction with
local educational systems both to further test the use of the
screening mechanisms and to identify evidence-based practices
for facilitating treatment for youth at risk.
The Committee has included $3,000,000 to continue
supporting the National Suicide Prevention Resource Center.
This important initiative supports technical assistance in
developing, implementing and evaluating effective suicide
prevention programs. The Resource Center serves as a training
and field support and acts as a clearinghouse for all pertinent
best practices information regarding suicide prevention, and it
promotes evaluation of suicide prevention programs to ensure
that effective techniques, strategies, and recommended best
practices are made available to users. The Committee also
continues funding at last year's level for the Suicide
Prevention Hotline program.
The Committee continues to support funding for mental
health counselors for school-age children, as part of an effort
to reduce the incidence of youth violence. The Committee
intends that $95,000,000 be used for counseling services for
school-age youth. Among other things, the Committee believes
that mental health counseling for troubled youth can help
prevent violent acts, and therefore is providing continued
funding to help schools in that effort. It is again expected
that SAMHSA will collaborate with the Departments of Education
and Justice to continue a coordinated approach.
The Committee appreciates CMHS's commitment to improving
the quality, effectiveness and availability of therapeutic
services delivered to traumatized children and adolescents;
furthering the understanding of the individual, familial, and
community impact of child and adolescent traumatic stress and
the methods used to prevent its consequences; and reducing the
frequency and consequences of traumatic events on children and
adolescents. The Committee recommendation includes $30,000,000
to continue and build on the National Child Traumatic Stress
Initiative.
The Committee provides $2,000,000 to continue the current
level of funding for the consumer and consumer-supporter
national technical assistance centers. The Committee directs
CMHS to support multi-year grants to five such national
technical assistance centers.
The Committee recommendation includes $5,000,000 to
continue the elderly treatment and outreach program. The
administration did not request funding for this program. The
Committee notes that this is the only federally funded services
program dedicated specifically to the mental health care of
older adults. From 15 to 25 percent of elderly people in the
United States suffer from significant symptoms of mental
illness. In addition, the highest suicide rate in America is
among those aged 65 and older. This grant program will help
local communities establish the infrastructure necessary to
better serve the mental health needs of older adults.
The Committee supports $7,000,000 for the jail diversion
grant program. The Department of Justice estimates that 16
percent of all inmates in local and state jails suffer from a
mental illness. The Committee recognizes that as many as
700,000 persons suffering from a mental illness are jailed each
year. Recognizing these troubling statistics, the President's
New Freedom Commission on Mental Health called for the adoption
of diversion strategies to avoid unnecessary criminalization
and incarceration of non-violent offenders with mental illness.
The Committee urges SAMHSA to work with the Department of
Justice, the law enforcement community, the court system and
other appropriate agencies and associations to ensure that
funding is utilized to divert inappropriate incarcerations and
link individuals with mental illnesses with the support they
need to avoid future contact with the criminal justice system.
The Committee recommendation fully funds the administration
request for the new State Incentive Grants for Transformation
program. The Committee directs SAMHSA to ensure that State
mental health planning and advisory councils play a significant
role in the development of comprehensive State plans under this
new program. The Committee believes that the councils must play
a key role in the development of these new plans because the
councils represent the consumer and family voice in States
across the country.
The Committee recognizes the urgent need to train
increasing numbers of minority mental health professionals,
including Native Hawaiians, to provide competent, accessible
mental health and substance abuse services for diverse
populations. It encourages SAMHSA to provide additional
resources for the Minority Fellowship program.
The Committee recognizes the need to support grants to
community-based providers operating in traditional and non-
traditional settings who provide direct mental health services
to racial and ethnic minorities suffering from HIV/AIDS and
associated mental health problems. Individuals suffering from
HIV/AIDS and co-occurring disorders present unique and unmet
treatment needs necessitating specialized training for
providers. The Committee encourages SAMHSA to provide
additional funding for training mental health professionals to
provide integrated mental health and substance abuse services
for persons suffering from HIV/AIDS and co-occurring disorders.
Due to lack of authorizing legislation for the Samaritan
Initiative, the Committee has included $10,000,000 in this
account for grants to fund services in permanent supportive
housing to help end chronic homelessness. The Committee
encourages CMHS to award these grants to applicants that
operate permanent supportive housing funded by HUD's Homeless
Assistance Programs, section 8, or comparable programs
administered by States or local governments.
Mental Health Performance Partnership Block Grant
The Committee recommends $436,070,000 for the mental health
performance partnership block grant, which is $1,380,000 above
the comparable fiscal year 2004 amount and the same as the
administration's request. The recommendation includes
$21,803,000 in transfers available under section 241 of the
Public Health Service Act. States use these funds to support
the development and implementation of innovative community-
based services and maintain continuity of community programs.
Funds are allocated to States and territories by formula.
Children's Mental Health Services
The Committee recommends $106,013,000 for the children's
mental health services program. This amount is $3,659,000 above
the comparable fiscal year 2004 level and the same as the
administration's request. This program provides grants and
technical assistance to support community-based services for
children and adolescents with serious emotional, behavioral or
mental disorders. Grantees must provide matching funds, and
services must involve the educational, juvenile justice, and
health systems.
The Committee encourages SAMHSA to expand this program into
new States and localities. Such a financial investment is vital
given the increased number of young children diagnosed with
mental disorders, the rising teen suicide rate, incidents of
school violence, and the psychological consequences of
terrorism and war. These factors all indicate that our Nation's
children and youth need appropriate, quality mental health
services.
Projects for Assistance in Transition From Homelessness [PATH]
The Committee recommends $55,251,000 for the PATH Program.
This amount is $5,491,000 above the comparable fiscal year 2004
level and is the same as the administration's request.
PATH is a critical program which provides outreach, mental
health, and case management services and other community
support services to individuals with serious mental illness who
are homeless or at risk of becoming homeless. The PATH Program
makes a significant difference in the lives of homeless persons
with mental illnesses. PATH services eliminate the revolving
door of episodic inpatient and outpatient hospital care.
Multidisciplinary teams address client needs within a continuum
of services, providing needed stabilization so that mental
illnesses and co-occurring substance abuse and medical issues
can be addressed. Assistance is provided to enhance access to
housing, rehabilitation and training, and other needed
supports, assisting homeless people in returning to secure and
stable lives.
Protection and Advocacy
The Committee recommends $34,620,000 for the protection and
advocacy program, which is the same as the comparable fiscal
year 2004 level and the administration request. This program
helps ensure that the rights of mentally ill individuals are
protected while they are patients in treatment facilities, or
while they are living in the community, including their own
homes. Funds are allocated to States according to a formula
based on population and relative per capita income.
Samaritan Initiative
The Committee has not included funding for the Samaritan
Initiative due to lack of authorizing legislation. The
administration requested $10,000,000 for this new program,
which would provide the full range of services needed by
chronically homeless people, such as housing, health care,
mental health and substance abuse treatment, supportive and
other services. The Committee has included $10,000,000 in
funding for homeless programs within the Programs of Regional
and National Significance account. The Committee will
reconsider the administration's request for the Samaritan
Initiative once authorizing legislation is enacted.
CENTER FOR SUBSTANCE ABUSE TREATMENT
Appropriations, 2004.................................... $2,198,365,000
Budget estimate, 2005................................... 2,349,267,000
Committee recommendation................................ 2,256,252,000
The Committee recommends $2,256,252,000 for substance abuse
treatment programs. This amount is $57,887,000 above the
comparable fiscal year 2004 funding level and $93,015,000 below
the administration's request. The recommendation includes
$83,500,000 in transfers available under section 241 of the
Public Health Service Act. This amount funds substance abuse
treatment programs of regional and national significance and
the substance abuse prevention and treatment block grant to the
States.
The Committee remains concerned with the negative impact
substance abuse has on our country. The National Survey on Drug
Use and Health [NSDUH] estimated that 22 million Americans
suffered from substance dependence or abuse due to drugs,
alcohol or both in 2002. In contrast, studies conclude that
approximately 3 million receive care in any given year. As a
result, our Nation continues to face a severe ``treatment
gap''--those who need treatment but do not receive the services
necessary to address their problems. The Committee is concerned
that, according to SAMHSA, approximately 40 percent of those
not receiving treatment reported cost as the reason why they
did not receive appropriate services.
The Committee recognizes that the effectiveness of alcohol
and drug treatment programs and the sustained recovery of
individuals require an appropriately trained workforce. The
Committee encourages SAMHSA to prioritize the development and
implementation of a workforce action plan. This plan could
include recommendations, survey instruments, studies, training,
and technical assistance, and incentive programs that would
improve the recruitment, training and retention of the alcohol
and drug treatment workforce. The Committee requests that
SAMSHA consult closely with drug and alcohol programs, States,
drug and alcohol recovery organizations, other experts and
stakeholders in the development of its recommendations.
The Committee commends SAMHSA's recent efforts to develop
performance measures and further demonstrate the efficacy of
prevention and treatment programs in order to manage for
results and further improve the effectiveness of these critical
programs. The Committee requests that SAMHSA continue to
consult with States, drug and alcohol programs, drug and
alcohol recovery organizations, other stakeholders and experts
to develop and implement reasonable and meaningful performance
measures that can be applied by SAMHSA and State governments
consistently across programs. The Committee also requests that
States receiving SAMHSA funds consult with local alcohol and
drug programs, recovery organizations, stakeholders and experts
in order to improve the implementation of these performance
measures at the local level.
Programs of Regional and National Significance
The Committee recommends $424,017,000 for programs of
regional and national significance [PRNS]. The comparable
fiscal year 2004 level was $419,219,000 and the
administration's request was $517,032,000. The recommendation
includes $4,300,000 in transfers available under section 241 of
the Public Health Service Act.
Programs of regional and national significance include
three primary activities: best practice programs are used to
develop more information on how best to serve those most in
need; training and technical assistance supports dissemination
of information through knowledge development; and targeted
capacity expansion programs enable the agency to respond to
service needs in local communities.
The Committee recommendation includes $100,000,000 for the
Access to Recovery program.
The Committee commends SAMHSA for including States as
eligible applicants for all new Targeted Capacity Expansion
[TCE] grants. The Committee believes States must be eligible to
apply for all appropriate grants in order to assist States in
planning, coordinating, and implementing a comprehensive
Statewide service delivery system.
The Committee continues to be concerned about the incidence
of drug addiction among pregnant and parenting women. The
Committee believes that increased capacity is necessary for
treatment programs designed for pregnant and parenting women
and their families. Within the funds appropriated for CSAT, the
Committee recommends $10,000,000 for treatment programs for
pregnant, postpartum, and residential women and their children.
No less than last year's funding shall be used for the
Residential Treatment Program for Pregnant and Postpartum Women
[PPW], authorized under section 508 of the Public Health
Service Act.
Substance Abuse Prevention and Treatment Block Grant
The Committee recommends $1,832,235,000 for the substance
abuse prevention and treatment block grant. The recommendation
includes $79,200,000 in transfers available under section 241
of the Public Health Service Act. The recommendation is
$53,089,000 more than the comparable level for fiscal year 2004
and is the same as the administration request. The block grant
provides funds to States to support alcohol and drug abuse
prevention, treatment, and rehabilitation services. Funds are
allocated to the States according to formula. State plans must
be submitted and approved annually.
The Children's Health Act of 2000 made several changes in
SAMHSA, including transforming the current Block Grant to a
Performance Partnership Grant [PPG], in which States are
granted program flexibility and reduced reporting burden in
exchange for implementing a set of common performance measures.
The Committee is concerned that SAMHSA failed to issue a report
to Congress by the October 2002 deadline set in the Children's
Health Act outlining a suggested roadmap for the PPG
transition. The Committee once again strongly urges SAMHSA to
make the PPG implementation its number one priority for
substance abuse programming and to allocate commensurate
resources to support the transition to reflect this priority
status.
The Committee's recommendation reflects its continued
belief that the most effective and efficient way to support
substance abuse programs in every State and territory is to
direct the bulk of available new resources into the Block Grant
and the PPG. The Committee also continues to express its strong
support for preserving the current Block Grant and PPG as the
foundation of our publicly funded substance abuse system in
every State and territory in the United States. The Committee
remains very concerned with any effort that could erode the
strength of this vital funding stream.
CENTER FOR SUBSTANCE ABUSE PREVENTION
Appropriations, 2004.................................... $198,458,000
Budget estimate, 2005................................... 196,018,000
Committee recommendation................................ 198,940,000
The Committee recommends $198,940,000 for programs to
prevent substance abuse. The comparable fiscal year 2004 level
was $198,458,000 and the administration request was
$196,018,000. This amount funds substance abuse prevention
programs of regional and national significance.
The Committee notes that effective substance abuse
prevention efforts pay economic dividends--every dollar spent
on drug use prevention will save communities $4 to $5 in costs
for drug abuse treatment and counseling. Findings from the
Monitoring the Future study showed an 11 percent decrease in
illicit teen drug use between 2001 and 2003. Ecstasy use, which
soared between 1998 and 2001, fell by more than half among high
school students. These findings show that drug prevention
efforts are working. With drug use finally dropping among
school-aged youth after almost a decade of dramatic increases,
the Committee reiterates its support for prevention programs
and is pleased that the administration has requested a funding
level sufficient to continue CSAP's existing programs. The
Committee expects CSAP to focus its efforts on identifying and
diffusing comprehensive community-wide strategies to reduce
youth drug use, with an emphasis on increasing the age of first
use of alcohol and illicit drugs.
Programs of Regional and National Significance
The Committee has provided $198,940,000 for programs of
regional and national significance [PRNS]. The comparable
fiscal year 2004 level was $198,458,000 and the administration
request was $196,018,000. The Center for Substance Abuse
Prevention is the sole Federal organization with responsibility
for improving accessibility and quality of substance abuse
prevention services. Through the programs of regional and
national significance activity, CSAP supports: development of
new practice knowledge on substance abuse prevention;
identification of proven effective models; dissemination of
science-based intervention information; State and community
capacity-building for implementation of proven effective
substance abuse prevention programs; and programs addressing
new needs in the prevention system.
In implementing the Strategic Prevention Framework State
Incentive Grant program [SPFSIG], CSAP and the States should
give priority in the use of funds to support drug and alcohol
prevention community coalition efforts to plan and implement
comprehensive local strategies to address specific local needs.
The Committee expects States receiving funding under the SPFSIG
to give priority in the use of the 20 percent prevention set-
aside in the Substance Abuse Prevention and Treatment Block
Grant to funding the specific priorities identified in the
comprehensive community strategies developed by the communities
in their States.
The Committee notes that prenatal alcohol exposure is the
leading known cause of mental retardation and birth defects in
the United States. It is associated with lifelong difficulties
with learning, memory, attention, and problem solving as well
as problems with mental health and social interactions. A
recent study showed that 15 percent of pregnant women surveyed
as they waited in clinics for prenatal care indicated they had
drunk alcohol during pregnancy. At least 5,000 infants are born
each year with Fetal Alcohol Syndrome [FAS] and another 50,000
children show symptoms of Fetal Alcohol Effect [FAE]. The
Committee has provided $11,000,000 to strengthen system-wide
approaches to identify and serve women at risk of delivering
FAS/FAE children, with an emphasis on teen mothers.
PROGRAM MANAGEMENT
The Committee recommends $94,455,000 for program management
activities of the agency. The recommendation includes
$18,000,000 in transfers available under section 241 of the
Public Health Service Act. The recommendation is $2,540,000
above the comparable level for fiscal year 2004 and $2,000,000
above the budget request.
The program management activity includes resources for
coordinating, directing, and managing the agency's programs.
Program management funds support salaries, benefits, space,
supplies, equipment, travel, and departmental overhead required
to plan, supervise, and administer SAMHSA's programs.
The Committee has included $2,000,000 to establish
surveillance measures to address the mental and behavioral
health needs of the population of the United States. Despite
the significant levels of Federal, State, and local funding for
mental health services, and a growing consensus that the
Nation's mental health care system must be reformed, there are
currently no population-based sources of data on the mental and
behavioral health needs in this country. The Committee believes
that such data would help policymakers implement the
recommendations in the President's New Freedom Commission on
Mental Health report ``Achieving the Promise: Transforming
Mental Health Care in America.'' Therefore, the Committee urges
SAMHSA, in consultation with the Centers for Disease Control
and Prevention, to develop ways of monitoring the mental health
status of the population, the mental and behavioral health
risks facing the Nation, and the immediate and long-term impact
of emergencies on population mental health and behavior. Such
measures could include new survey instruments or enhancements
to existing public health surveillance systems that do not
currently address mental and behavioral health. The Committee
envisions that when these measures are implemented in future
years, they will allow SAMHSA and CDC to document the health
status of the population and of important subgroups; identify
disparities in health status and use of health care by race/
ethnicity, socio-economic status, region, and other population
characteristics; and monitor trends in health status, access,
and health care delivery.
The Committee remains concerned that SAMHSA has not yet
provided to Congress information detailing the resources each
State will need for data infrastructure and other needs
relating to the transition from the current Block Grant to the
emerging PPG. The Committee directs SAMHSA to work with the
States to assess the costs regarding data infrastructure needs
and report its findings to the Committee.
Agency for Healthcare Research and Quality
Appropriations, 2004.................................... $303,695,000
Budget estimate, 2005................................... 303,695,000
Committee recommendation................................ 318,695,000
The Committee recommends $318,695,000 for the Agency for
Healthcare Research and Quality [AHRQ]. This amount is
$15,000,000 above the administration request and the comparable
funding level for fiscal year 2004. The Committee has funded
AHRQ through transfers available under section 241 of the
Public Health Service Act.
The Agency for Healthcare Research and Quality was
established in 1990 to promote improvements in clinical
practice and patient outcomes, promote improvements in the
financing, organization, and delivery of health care services,
and increase access to quality care. AHRQ is the Federal agency
charged to produce and disseminate scientific and policy-
relevant information about the cost, quality, access, and
medical effectiveness of health care. AHRQ provides
policymakers, health care professionals, and the public with
the information necessary to improve cost effectiveness and
appropriateness of health care and to reduce the costs of
health care.
HEALTH COSTS, QUALITY, AND OUTCOMES
The Committee provides $260,695,000 for research on health
costs, quality and outcomes [HCQO]. The comparable amount for
fiscal year 2004 was $245,695,000. HCQO research activity is
focused upon improving clinical practice, improving the health
care system's capacity to deliver quality care, and tracking
progress toward health goals through monitoring and evaluation.
For fiscal year 2005, the Committee directs AHRQ to devote
$84,000,000 of the total amount provided for HCQO to
determining ways to reduce medical errors. This represents an
increase of $4,500,000 over the comparable fiscal year 2004
level.
The Committee also directs AHRQ to devote $15,000,000 of
the total amount provided for HCQO to research on outcomes,
comparative clinical effectiveness and appropriateness of
prescription drugs and other health care items as authorized in
Section 1013 of the Medicare Prescription Drug, Improvement and
Modernization Act of 2003.
Autoimmune Disease.--In support of continued HHS-wide
implementation of the HHS Autoimmune Diseases Research Plan,
the Committee encourages AHRQ to estimate the annual treatment
and societal costs of autoimmune diseases in the United States,
in order to project their future impact and burden on the
healthcare system.
Duchenne Muscular Dystrophy.--The Committee urges AHRQ to
study and develop recommendations on the need for standards of
care for individuals with Duchenne muscular dystrophy, allowing
for input from external entities including parent advocacy
programs. In addition, the Committee encourages AHRQ to conduct
a workshop on standards of care for the muscular dystrophies
and coordinate this activity with national advocacy
organizations dedicated to this condition.
Elderly Mental Health.--The Committee is seriously
concerned about the prevalence of undiagnosed and untreated
mental illness among older Americans. Affective disorders,
including depression, anxiety, dementia, and substance abuse
and dependence, are often misdiagnosed or not recognized at all
by primary and specialty care physicians in their elderly
patients. While effective treatments for these conditions are
available, there is an urgent need to translate advancements
from biomedical and behavioral research to clinical practice.
The Committee urges AHRQ to support evidence-based research
projects focused on the diagnosis and treatment of mental
illnesses in the geriatric population, and to disseminate
evidence-based reports to physicians and other health care
professionals.
Hospital-Based Patient Initiative.--The Committee
encourages AHRQ to work with multi-site academic medical
centers to identify and implement programs to improve patient
safety in a hospital setting. The Committee is interested in
patient safety improvements that are designed for rapid
turnaround and for developing practical and replicable projects
in the future.
Multiple Sclerosis.--The Committee is aware of an
increasing number of non-chemotherapy infused biologicals that
are under FDA review or are currently available for the
treatment of diseases such as multiple sclerosis. The Committee
urges AHRQ to conduct a study examining changes in the market
involving infused biologicals. The report should examine
changes in market demand for non-chemotherapy infused
therapies, whether health care providers have adequate capacity
to meet increased demand, the cost to providers for meeting
increased demand, as well as geographical and subspecialty
variations in access and demand.
Nurse-Managed Health Centers.--The Committee encourages
AHRQ to include nurse-managed health centers and advanced
practice nurses in research and demonstration projects
conducted by the agency.
Organ Donation.--The Committee recognizes that there is
presently no formal mechanism to scientifically evaluate the
efficacy of many new medications, devices, surgical techniques,
and technical innovations that are being developed to improve
organ preservation and maximize organ usage. The Committee
encourages AHRQ to study and develop scientific evidence in
support of efforts to increase organ donation and improve the
recovery, preservation, and transportation of organs.
Provider Level Data.--The Committee understands that
policies on databases and data elements are being developed in
many State and local jurisdictions. The Committee urges AHRQ to
conduct a study on the role and importance of provider level
data for patient safety, quality of care, electronic health
data interchange, and development of evidence-based practice
standards. The Committee believes that such a report could
serve as an important benchmark for jurisdictions developing
database policies both in the United States and abroad.
Unequal Treatment.--The Committee encourages the Agency to
carefully evaluate the analysis, findings, and recommendations
of the March 2002 Institute of Medicine report regarding the
disparities of medical care delivery to minorities. In
particular, the Agency should pursue creative ways to address
this serious finding and improve health care delivery for
African-Americans, those of Hispanic and Asian origin, Native-
Americans, Alaskans and Native Hawaiians.
MEDICAL EXPENDITURES PANEL SURVEYS
The Committee provides $55,300,000 for health insurance and
medical expenditures panel surveys [MEPS], which is the same as
the administration request and the comparable fiscal year 2004
level. MEPS is intended to obtain timely national estimates of
health care use and expenditures, private and public health
insurance coverage, and the availability, costs and scope of
private health insurance benefits. It also develops cost and
savings estimates of proposed changes in policy and identifies
impact of policy changes on payers, providers, and patients.
Program Support
The Committee recommends $2,700,000 for program support.
This amount is the same as the administration request and the
comparable fiscal year 2004 level. This activity supports the
overall management of the Agency.
Centers for Medicare and Medicaid Services
GRANTS TO STATES FOR MEDICAID
Appropriations, 2004....................................$130,892,197,000
Budget estimate, 2005................................... 119,124,488,000
Committee recommendation................................ 119,124,488,000
The Committee recommends $119,124,488,000 for Grants to
States for Medicaid. This amount is $11,767,709,000 less than
the fiscal year 2004 appropriation and the same as the
administration's request. This amount excludes $58,416,275,000
in fiscal year 2004 advance appropriations for fiscal year
2005. In addition, $58,517,290,000 is provided for the first
quarter of fiscal year 2006, as requested by the
administration.
The Medicaid program provides medical care for eligible
low-income individuals and families. It is administered by each
of the 50 States, the District of Columbia, Puerto Rico, and
the territories. Federal funds for medical assistance are made
available to the States according to a formula, which
determines the appropriate Federal matching rate for State
program costs. This matching rate is based upon the State's
average per capita income relative to the national average, and
shall be no less than 50 percent and no more than 83 percent.
PAYMENTS TO HEALTH CARE TRUST FUNDS
Appropriations, 2004.................................... $95,084,100,000
Budget estimate, 2005................................... 114,608,900,000
Committee recommendation................................ 114,608,900,000
The Committee recommends $114,608,900,000 for Federal
payments to health care trust funds. This amount is the same as
the administration's request and is an increase of
$19,524,800,000 from the fiscal year 2004 appropriation.
This entitlement account includes the general fund subsidy
to the Supplementary Medical Insurance Trust Fund (Medicare
Part B), plus other reimbursements to the Hospital Insurance
Trust Fund (Medicare Part A), for benefits and related
administrative costs that have not been financed by payroll
taxes or premium contributions.
The Committee has provided $114,002,000,000 for the Federal
payment to the Supplementary Medical Insurance Trust Fund. This
payment provides matching funds for premiums paid by Medicare
Part B enrollees. This amount is the same as the
administration's request and is $19,484,000,000 more than the
fiscal year 2004 amount. The increase includes $5,742,000,000
to cover an anticipated shortfall in the amount appropriated in
fiscal year 2004.
The recommendation also includes $87,000,000 for hospital
insurance for the uninsured. This amount is the same as the
administration's request and is $110,000,000 less than the 2004
amount.
The Committee also recommends $199,000,000 for Federal
uninsured benefit payment. This payment reimburses the Hospital
Insurance Trust Fund for the cost of benefits provided to
Federal annuitants who are eligible for Medicare. This amount
is the same as the administration's request and an increase of
$31,000,000 over the fiscal year 2004 level, reflecting an
increase on the number of covered individuals who are currently
enrolled. The recommendation also includes the budget estimate
of $105,900,000 for General Revenue for the Medicare
Prescription Drug account, a new funding requirement. This
account was established by Public Law 108-173; the Medicare
Prescription Drug, Improvement and Modernization Act of 2003.
The general fund will finance $105,900,000 in State low-income
determination activities through the Prescription Drug Account.
Requested bill language is also included to ensure prompt
payments of Medicare prescription drug benefits as provided
under section 1860 D-16 of the Social Security Act, of
$5,216,900,000 for fiscal year 2006.
The Committee recommendation includes $215,000,000 to be
transferred to the Hospital Insurance Trust Fund as the general
fund share of CMS's program management administrative expenses.
This amount is the same as the administration's request and is
$13,900,000 more than the fiscal year 2004 level.
PROGRAM MANAGEMENT
Appropriations, 2004.................................... $2,636,846,000
Budget estimate, 2005................................... 2,746,127,000
Committee recommendation................................ 2,756,644,000
The Committee recommends $2,756,644,000 for CMS program
management, which is $10,517,000 more than the amount requested
by the administration and $119,798,000 more than the fiscal
year 2004 enacted level.
Research, Demonstrations, and Evaluations
The Committee recommends $77,791,000 for research,
demonstrations, and evaluation activities. This amount is
$9,517,000 more than the budget request.
CMS research and demonstration activities facilitate
informed, rational Medicare and Medicaid policy choices and
decision making. These studies and evaluations include projects
to measure the impact of Medicare and Medicaid policy analysis
and decision making, to measure the impact of Medicare and
Medicaid on health care costs, to measure patient outcomes in a
variety of treatment settings, and to develop alternative
strategies for reimbursement, coverage, and program management.
The Committee has included $40,000,000 for Real Choice
Systems Change Grants to States to fund initiatives that
establish specific action steps and timetables to achieve
enduring system improvements and to provide long-term services
and supports, including community-based attendant care, to
eligible individuals in the most integrated setting
appropriate.
The Secretary shall report to Congress on measurable
outcomes for these grants and shall work in collaboration with
the technical assistance provider to do so. The Committee
further recommends that the technical assistance funding shall
be used solely to fund technical assistance for the systems
change grants, including ongoing technical assistance to ensure
continuous quality improvement and progress on measurable
outcomes. The Committee acknowledges the work of the consumer-
controlled consortium and recommends continued funding for
technical assistance for the State system change consumer task
forces.
The Committee recognizes the critical role of direct
service workers in the Nation's community-based long-term care
system and supports the administration's efforts to improve
recruitment, training and retention of direct service workers.
The Committee has included $3,000,000 more than the
administration requested for the national demonstration
designed to address workforce shortages of community service
direct care workers. The Committee is doing so in recognition
of the current shortage of direct service workers and the
predicted increase in the need for additional direct service
workers over the next 10 years. The Bureau of Labor Statistics
predicts a 39 percent growth in the need for direct service
workers in the next 10 years.
The funds should be used to improve recruitment, training,
supervision by managers and people with disabilities,
retention, health insurance and other benefits, career
development, education, working environments, and managers'
cultural competence. To the extent that funds are used for
direct service costs, those funds must be phased out by the end
of the grant period and the State must have a plan for
maintaining these supports that the grant made possible. CMS
should require States to involve people with disabilities and
direct service workers in the planning and implementation of
the projects funded under this initiative.
Medicare Operations
The Committee recommends $1,796,879,000 for Medicare
operations, which is the amount requested by the
administration, adjusted to reflect the $3,000,000 transfer of
BIPA section 522 funding to the Medicare Operations line from
the Federal Administration line. Based on current operations,
the Committee believes that both national and local coverage
determinations are more appropriately funded from the Medicare
Operations line. In addition, $720,000,000 is available for the
Medicare Integrity Program within the mandatory budget as part
of the health insurance reform legislation.
The Medicare operations line item covers a broad range of
activities including claims processing and program safeguard
activities performed by Medicare contractors. These contractors
also provide information, guidance, and technical support to
both providers and beneficiaries. In addition, this line item
includes a variety of projects that extend beyond the
traditional fee-for-service arena.
The Committee recommends that not less than $31,700,000 be
made available for the State Health Insurance Counseling
Program, which has expanded responsibilities related to
providing assistance to services concerning prescription drug
benefits. Of this amount, at least $14,100,000 would come from
this Program Management account, with additional amounts from
Medicare Modernization Act funding.
State Survey and Certification
The Committee recommends $270,392,000 for Medicare State
survey and certification activities, which is $19,140,000 more
than the fiscal year 2004 level.
Survey and certification activities ensure that
institutions and agencies providing care to Medicare and
Medicaid beneficiaries meet Federal health, safety, and program
standards. On-site surveys are conducted by State survey
agencies, with a pool of Federal surveyors performing random
monitoring surveys.
Federal Administration
The Committee recommends $587,182,000 for Federal
administration costs, which is an increase of $10,036,000, over
the fiscal year 2004 level and reflects the shift of $3,000,000
requested for BIPA section 522 funding to the Medicare
Operations activity. This funding level allows for fixed cost
increases associated with the current staffing level of 4,398
full-time equivalent positions. An additional $1,000,000 over
the request is included for the cost of an Institute of
Medicine study and report described under general provision
language in section 221, pertaining to the Medicare 75 percent
rule.
The Committee recommends continuing the current level of
$13,000,000 for the Healthy Start, Grow Smart program. The
Healthy Start, Grow Smart program develops, prints, and
disseminates a series of 13 informational brochures in English
and Spanish to new Medicaid-eligible mothers. These brochures
are distributed at the time of birth, an then monthly over the
first year of each child's life. Each publication focuses on
activities that stimulate infant brain development and build
the skills these children need to be successful in school. In
addition to these educational suggestions, each Healthy Start
pamphlet includes vital health and safety information for new
parents. Content for each brochure is tied to the developmental
stage of the child at the time it is sent.
The Committee is pleased with the demonstration project at
participating sites licensed by the Program for Reversing Heart
Disease and encourages its continuation. The Committee further
urges CMS to continue with the demonstration project being
conducted at the Mind Body Institute of Boston, Massachusetts.
The Committee is aware of the importance of providing
vision rehabilitation services and is interested in ensuring
that vision rehabilitation services are available on a
nationwide basis, and that they may be provided by vision
rehabilitation professionals acting under a physician's general
supervision. The Secretary of the Department of Health and
Human Services, with funding included in this bill, is urged to
continue the nationwide 5-year outpatient vision rehabilitation
services demonstration project authorized in the fiscal year
2004 omnibus report, under which vision rehabilitation
professionals may deliver services in the home under the
general supervision of a qualified physician.
The Committee first addressed the issue of proper coding
within the Medicare outpatient Ambulatory Procedure
Classification system for cobalt\60\ stereotactic neurosurgery
in its fiscal year 2000 report. The Committee is pleased that
CMS subsequently separated stereotactic radiosurgery by
industry segment. However, in doing so CMS has changed the
clinical definition of one segment--cobalt\60\ stereotactic
neurosurgery--and its acceptable coding has been divided and
positioned with radiation therapy and not neurosurgery. This
has resulted in significant reimbursement issues between
insurers and the hospitals providing the surgery since early
2002, including development of secondary ``in-house'' coding
systems, and the delay and/or denials of patient treatments.
The Committee strongly urges CMS to reinstate one neurosurgical
billing code for cobalt\60\ outpatient stereotactic
neurosurgery, beginning as soon as possible, to alleviate the
hospital burden in this area and to represent the way hospitals
are set up and staffed to provide this neurosurgical procedure.
The Committee again encourages CMS to work with the
International Radiosurgery Association which represents
hospitals, professionals and patients, and the neurosurgical
community before designating, defining or changing coding for
cobalt\60\ stereotactic neurosurgery. CMS is also urged to
consult these groups when making changes or additions to
radiosurgery coding in the future.
The Committee understands the CMS Ambulatory Procedure
Classification [APC] system is a method to provide proper
coding and reimbursement to hospitals for outpatient Medicare
treatments. The Committee also understands that at this time,
the APC panel is primarily composed of physicians and
representatives of physician associations who are not subject
to hospital coding. These members may have self interests in
coding that is in conflict with and not in the best interests
of hospitals. The Committee urges CMS to add hospital and
hospital trade association representatives to the APC panel as
vacancies arise. The Committee is concerned that CMS work with
hospitals and their representatives and that the APC panel be
responsive to hospital issues when a hospital industry segment
is bringing issues before the panel.
The Committee notes that when hospitals are routinely
performing procedures in the outpatient setting, CMS may
restrict reimbursement to the inpatient setting. This penalizes
hospitals for reducing costs and avoiding overnight hospital
stays. The Committee encourages CMS through its APC panel to
allow coding in the setting that hospitals are providing the
treatment procedures and to use established clinical
definitions for the coding.
The Committee recommendation includes funding to study the
cost-effectiveness of innovative State dental Medicaid programs
for children. The study should focus on those programs that
reported improvements in access to care through innovative
designs that have attracted adequate numbers of dentists and
assured improved access for patients.
The Committee is very pleased with the efforts of CMS to
address the extraordinary adverse health status of Native
Hawaiians in Waimanalo, Hawaii. The Committee continues to urge
additional focus upon American Samoan residents in that
geographical area utilizing the expertise of the Waimanalo
Health Center.
The Committee urges the Centers for Medicare and Medicaid
Services to consider waivers for rural or isolated area
demonstration projects when calculating such requirements as
population density in the State of Hawaii.
The Committee has been informed about recent CMS data which
shows that less than one-third of Medicare beneficiaries
eligible for diabetes self-managed training are receiving the
care they need. To identify the primary barriers to access in
urban and rural settings, the Committee recommends that CMS
conduct demonstrations in partnership with an association that
has expertise in providing diabetes self-management training to
determine the effectiveness of diabetes self-management
training and the various obstacles to access.
The Committee is aware of changes being developed by CMS to
alter the Medicare coverage policy for power mobility devices
including power wheelchairs. The Committee strongly encourages
CMS to use its resources toward development of a coverage
policy firmly based on a functional standard of nonambulatory.
The Committee believes beneficiaries who cannot perform their
basic acts of daily living, toileting, food preparation and
emergency egress, are nonambulatory and must have access to
this mobility benefit to function independently. The committee
supports controlling fraud and abuse through requirements that
ensure proper substantiation of medical need for this equipment
but does not support narrowing the definition of nonambulatory
to exclude the elderly and disabled dependent on these devices
to function in the home. The Committee believes that the
medically necessary application of this mobility benefit can
save Medicare money through cost-avoidance associated with
expensive institutional care or hospitalization resulting from
falls by the growing elderly population.
The Committee encourages CMS to examine the unintended
consequences current reimbursement policies have on restricting
access and utilization of oral anticancer therapies through the
Part B drug payment policies. CMS is encouraged to evaluate
reimbursement policies for such oral therapies.
The Committee is concerned that the current Medicare
payment cap for federally-qualified health centers [FQHC] has
had a detrimental impact on the financial stability of these
safety net providers that jeopardizes access to care in
underserved areas. The Committee understands that the payment
cap has not been adjusted in more than 10 years, the data used
to initially create the cap was not based on FQHC data,
increases in health centers costs have not been accounted for,
and more than one half of all health centers are now negatively
impacted. The Committee urges the Secretary to recalculate the
payment cap for FQHCs to take into account these issues.
The Committee urges CMS to provide for reimbursement for
services rendered to Native Hawaiians in federally qualified
health centers in the same manner that it currently does for
American Indians and Alaskan Natives. Further, the Committee
requests a report on this matter by next year's budget
hearings.
The Committee remains extremely concerned over CMS'
continuing failure to articulate clear guidelines and to set
expeditious timetables for consideration of new technologies,
procedures and products for Medicare coverage. However, the
Committee applauds CMS' decision to expand Medicare coverage of
Positron Emission Tomography [PET] in cases of suspected
Alzheimer's disease, when a specific diagnosis remains
uncertain despite a thorough clinical evaluation, and in cases
where patients with early dementia or unexpected memory loss
are enrolled in clinical trials containing certain patient
safeguards. The Committee is also pleased to note that CMS will
collaborate with the National Institutes of Health and the Food
and Drug Administration to develop needed evidence on the role
of PET scans in guiding the diagnosis and treatment of, and
predicting the course of, Alzheimer's disease. In choosing
panels to develop criteria and evaluate use of PET scans for
Alzheimer's disease, the Committee expects the agencies
involved to name members familiar with PET technology and its
uses. The Committee does not expect that the Agency for
Healthcare Research and Quality will direct or be involved in
this effort. The Committee firmly believes that these steps
will increase Medicare beneficiaries' access to innovative
technologies and will ultimately lead to improved health
outcomes.
The Committee expects CMS to continue to gather pertinent
information relative to model practices of quality chronic care
management by implementing Section 721 of the Medicare
Prescription Drug, Improvement, and Modernization Act of 2003.
The Committee recommends that CMS support independently
financed demonstration projects for serious illnesses and
coordinated care.
The Committee is aware of innovative information technology
that promises substantial advances such as more fully informing
and educating patients and numerous potential applications. The
Committee encourages a demonstration of the ways in which this
technology may improve the health care system.
The Committee is aware that a recent study by the General
Accountability Office has revealed that Medicare Call Centers
need to improve responses to policy-oriented questions from
providers. According to the study, only 4 percent of the
responses received from GAO test calls were correct and
complete. The Committee understands that CMS generally agrees
with the GAO's findings, and urges that it expedite efforts to
implement the recommendations, including: a process to route
policy inquiries to staff with appropriate expertise; clear and
easily accessible policy-oriented material to assist customer
service representatives; and an effective monitoring program
for call centers. The Committee expects CMS to provide a report
on its actions to improve responses to policy-oriented
inquiries from providers as part of its fiscal year 2006
congressional budget justification material.
The Committee believes that in the Medicare continuum of
care there is a vital role for long-term acute care hospitals
[LTACHs], including hospitals set up in other hospitals to
provide that care. On August 2, 2004 CMS promulgated a rule
which, over 4 years, establishes a patient quota rule setting
limits on the percentage of patients which can go into an LTACH
from the host facility. The Committee believes that the
decision as to which patients should go into a LTACH should be
made by physicians based on well-defined patient and hospital
admissions criteria--not on an arbitrary quota and therefore,
that this rule should be replaced with a rule developed on
clinically-based criteria. The Committee recommends that CMS
commission a comprehensive study on what patient and hospital
admissibility criteria should be put in place to assure the
responsible growth and development of this important part of
medical services for the elderly.
The Committee commends CMS for removing barriers to
reimbursement for treatment of obesity. CMS is encouraged to
work with the Centers for Disease Control and Prevention in
reviewing scientific evidence in order to determine coverage of
obesity treatment and prevention, and also in establishing a
national public health action plan on obesity. The Committee
also recommends that CMS work with State health educators and
health promotion directors to assure that people receive
relevant information to their life-stage on how obesity should
be treated and prevented.
Reducing Medicare Mispayments.--The Committee is pleased
with recent improvements in the rate of mispayments by the
Medicare program. Additional resources and efforts have begun
to make a difference. However, the Committee remains very
concerned with the amount of money that continues to be lost to
fraud, waste, and abuse in the Medicare program. The Committee
has held many hearings and taken other corrective actions over
a 15 year period to expose and reduce these losses. The
Committee held a hearing on overpayments for certain medical
supplies in June of last year. At that time the Administrator
of CMS promised to move forward with implementation of enhanced
inherent reasonableness authority. Yet, to date no action has
been taken. The Committee calls upon the Administrator to
promptly utilize the IR authority granted to the Secretary and
request a briefing as to his timeline for action by December 1,
2004. By March 1, 2005, the Committee would like to receive a
progress report and future work plan for all Departmental
efforts to reduce fraud, waste and abuse in Medicare.
Revitalization Plan
The Committee recommends the budget request of $24,400,000,
as the second-year investment in CMS's efforts to make
significant improvements to key aspects of managing the agency
and the Medicare program. First-year funding is fiscal year
2004 was $29,619,000. Funding in fiscal year 2005 will target
system-related improvements.
HMO Loan and Loan Guarantee Fund
The Committee concurs with requested bill language making
receipts of this fund available for payment of obligations, but
prohibiting the issuance of additional direct loans or loan
guarantees to health maintenance organizations from this fund.
Administration for Children and Families
PAYMENTS TO STATES FOR CHILD SUPPORT ENFORCEMENT AND FAMILY SUPPORT
PROGRAMS
Appropriations, 2004.................................... $3,312,970,000
Budget estimate, 2005................................... 2,825,802,000
Committee recommendation................................ 2,873,802,000
The Committee recommends $2,873,802,000 be made available
in fiscal year 2005 for payments to States for child support
enforcement and family support programs. The comparable funding
level for fiscal year 2004 is $2,825,802,000 and the budget
request includes $2,873,802,000 for this program. The Committee
recommendation provides the full amount requested under current
law. The budget request includes net savings of $48,000,000
based on proposed legislation.
These payments support the States' efforts to promote the
self-sufficiency and economic security of low-income families.
These funds also support efforts to locate non-custodial
parents, determine paternity when necessary, and establish and
enforce orders of support. The appropriation, when combined
with the $1,200,000,000 in advance funding provided in last
year's bill and an estimated $194,800,000 from offsetting
collections, supports a program level of $4,268,602,000.
The Committee also has provided $1,200,000,000 in advance
funding for the first quarter of fiscal year 2006 for the child
support enforcement program, the same as the budget request.
LOW-INCOME HOME ENERGY ASSISTANCE PROGRAM
Appropriations, 2004.................................... $1,888,790,000
Budget estimate, 2005................................... 2,000,500,000
Committee recommendation................................ 2,000,500,000
The Committee recommends $2,000,500,000 for fiscal year
2005 for LIHEAP. The comparable funding level for fiscal year
2004 is $1,888,790,000 and the budget request includes
$2,000,500,000 for this program. LIHEAP is made up of two
components: the State grant program and the contingency fund.
The Committee recommendation includes $1,901,090,000 for
fiscal year 2005 for the State grant program. The comparable
funding level for fiscal year 2004 is $1,789,380,000 and the
budget request includes $1,800,500,000 for this program. Within
the funds provided, the Committee recommends $500,000 for
evaluation purposes, as requested by the administration. LIHEAP
grants are awarded to States, territories, Indian tribes, and
tribal organizations to assist low-income households in meeting
the costs of home energy. States receive great flexibility in
how they provide assistance, including direct payments to
individuals and vendors and direct provision of fuel. These
resources are distributed by formula to these entities as
defined by statute, based in part on each State's share of home
energy expenditures by low-income households.
The Committee recommends $99,410,000 for fiscal year 2005
for the contingency fund. The comparable funding level for
fiscal year 2004 is $99,410,000 and the budget request includes
$200,000,000 designated as non-emergency funding for this
program. The contingency fund may be used to provide assistance
to one or more States adversely affected by extreme heat or
cold, significant price increases, or other causes of energy-
related emergencies. The Committee is committed to ensuring
that sufficient resources are available in the fund, to provide
additional assistance to households with energy burdens not met
by the regular program, and to meet the objectives of the
authorizing statute. The Committee intends to monitor household
energy burdens that might require action in future
appropriations bills.
The Committee intends that up to $27,500,000 of the amount
recommended for LIHEAP for fiscal year 2005 be used for the
leveraging incentive fund. The fund will provide a percentage
match to States for private or non-Federal public resources
allocated to low-income home energy benefits.
REFUGEE AND ENTRANT ASSISTANCE
Appropriations, 2004.................................... $447,598,000
Budget estimate, 2005................................... 473,239,000
Committee recommendation................................ 477,239,000
The Committee recommends $477,239,000 for fiscal year 2005
for refugee and entrant assistance. The comparable funding
level for fiscal year 2004 is $447,598,000 and the budget
request includes $473,239,000 for this program.
The Refugee and Entrant Assistance Program is designed to
assist States in their efforts to assimilate refugees, asylees,
Cuban and Haitian entrants, and adults and minors who are
trafficking victims, into American society as quickly and
effectively as possible. The program funds State-administered
transitional and medical assistance, the voluntary agency
matching grant program, programs for victims of trafficking and
torture, employment and social services, targeted assistance,
and preventive health.
Based on an estimated refugee admission ceiling of 70,000,
this appropriation, together with prior-year funds available
for fiscal year 2005 expenses, will enable States to continue
to provide at least 8 months of cash and medical assistance to
eligible refugees and entrants, a variety of social and
educational services, as well as foster care for refugee and
entrant unaccompanied minors.
In order to carry out the refugee and entrant assistance
program, the Committee recommends $193,577,000 for transitional
and medical assistance, including State administration and the
voluntary agency program; $10,000,000 for victims of
trafficking; $155,121,000 for social services; $4,835,000 for
preventive health; and $49,477,000 for targeted assistance.
The Committee has included $19,000,000 within the funds
provided for social services for increased support to
communities with large concentrations of refugees whose
cultural differences make assimilation especially difficult
justifying a more intense level and longer duration of Federal
assistance.
The Committee is aware that the State Department has made
arrangements for 15,000 Hmong refugees to enter the United
States starting in 2004 and carrying over into 2005. The
Committee is concerned that unlike prior groups of Hmong
refugees, which were made up of military and political leaders
with the means and education to succeed in America, these
immigrants have spent their lives in a refugee camp. Few, if
any, speak English. Most are under 18 and have little
schooling. Even with the greater level of education and skills
possessed by prior refugees, current statistics indicate that
about 38 percent of current Hmong-Americans live in poverty. In
addition, the Committee has become aware of efforts by the
State Department to admit a significant number of Bantu
refugees from camps along the Somali-Kenya border. A persecuted
minority in Somalia, the Bantus were barred from school and so
are largely illiterate. The Committee is concerned that the
Bantus only recently began arriving in the United States, thus
there is no currently existing Bantu population in the United
States to welcome the newcomers. In addition, the Bantus
represent the largest cohesive refugee group presented for
resettlement screening since the mid-1990s. For these reasons,
the Committee has set aside $8,000,000 within the ORR
appropriation for the resettlement of unanticipated arrivals.
The Committee recommends $54,229,000 for unaccompanied
children pursuant to section 462 of the Homeland Security Act
of 2002. Funds are provided for the care and placement of
unaccompanied alien minors in the Office of Refugee
Resettlement. Approximately 5,000 unaccompanied alien children
are apprehended each year in the United States by INS/Homeland
Security agents, Border Patrol officers, or other law
enforcement agencies and taken into care pending resolution of
their claims for relief under U.S. immigration law, released to
an adult family member, or released to a responsible adult
guardian.
The Committee is encouraged by steps taken by the Office of
Refugee Resettlement to improve access to legal representation
for children served through this program, as called for by
Congress in the statement of the managers accompanying the
Department of Health and Human Services Appropriations Act,
2004. The Committee encourages the Office to continue efforts
in this area, in particular focusing on developing an
infrastructure for identifying, assigning, coordinating and
tracking competent pro bono counsel in addition to independent
guardians ad litem for all such children. Furthermore, the
Committee strongly encourages the Office of Refugee
Resettlement to give high priority to the location of
immigration courts and services when electing ORR contracted
facilities. The Committee requests a full discussion of efforts
taken in this area to be included in the 2006 congressional
justification.
The Committee also recommends $10,000,000 to treat and
assist victims of torture. These funds may also be used to
provide training to healthcare providers to enable them to
treat the physical and psychological effects of torture. The
Committee acknowledges that well-established treatment centers,
such as the Center for Victims of Torture, have developed the
knowledge base that has fostered growth of treatment facilities
around the country and strengthened treatment services
generally. This positive trend may continue if leading centers
are able to expand their staffs to create more trainers and
improve evaluation and research needed to guide and develop new
programs. The Committee urges the Office of Refugee
Resettlement to place a priority on continued and sufficient
grant support for services provided by existing centers before
using funds to expand communities served through this program.
Section 412(a)(7) of title IV of the Immigration and
Nationality Act authorizes the use of funds appropriated under
this account to be used to carry out monitoring, evaluation,
and data collection activities to determine the effectiveness
of funded programs and to monitor the performance of States and
other grantees.
CHILD CARE AND DEVELOPMENT BLOCK GRANT
Appropriations, 2004.................................... $2,087,310,000
Budget estimate, 2005................................... 2,099,729,000
Committee recommendation................................ 2,099,729,000
The Committee recommends $2,099,729,000 for fiscal year
2005 for child care and development block grant. The comparable
funding level for fiscal year 2004 is $2,087,310,000 and the
budget request includes $2,099,729,000 for this program.
The child care and development block grant supports grants
to States to provide low-income families with financial
assistance for child care; for improving the quality and
availability of child care; and for establishing or expanding
child development programs. The funds are used to both expand
the services provided to individuals who need child care in
order to work, or attend job training or education, and to
allow States to continue funding the activities previously
provided under the consolidated programs.
The Committee recommendation continues specific earmarks in
appropriations language, also included in the budget request,
that provide targeted resources to specific policy priorities
including $19,120,000 for the purposes of supporting before and
afterschool services, as well as resource and referral
programs. This represents the Federal commitment to the
activities previously funded under the dependent care block
grant. The Committee expects that these funds will not supplant
current funding dedicated to resource and referral and school
age activities provided by the child care and development block
grant. The Committee strongly encourages States to continue to
address the matters of before and afterschool care and the
establishment of resource and referral programs with the funds
provided in this program.
The Committee recommendation includes an additional
$272,672,000 for child care quality activities, and sets aside
$100,000,000 specifically for an infant care quality
initiative. These funds are recommended in addition to the 4
percent quality earmark established in the authorizing
legislation. The Committee has provided these additional
quality funds because of the considerable research that
demonstrates the importance of serving children in high quality
child care settings which include nurturing providers who are
educated in child development and adequately compensated. While
considerable progress has been made, the Committee believes
States should continue to invest in education and training
linked to compensation of the child care workforce in order to
improve the overall quality of child care.
The Committee recommendation also provides $10,000,000 for
child care research, demonstration and evaluation activities.
The Committee recommendation for resource and referral
activities also includes $1,000,000 to continue support for the
National Association of Child Care Resource and Referral
Agencies' information service, Child Care Aware, and the
national toll-free information hotline which links families to
local child care services and programs.
SOCIAL SERVICES BLOCK GRANT
Appropriations, 2004.................................... $1,700,000,000
Budget estimate, 2005................................... 1,700,000,000
Committee recommendation................................ 1,700,000,000
The Committee recommends $1,700,000,000 for fiscal year
2005 for the social services block grant. The comparable
funding level for fiscal year 2004 is $1,700,000,000 and the
budget request includes $1,700,000,000 for this program. The
Committee has included bill language that allows States to
transfer up to 10 percent of their TANF allotment to the social
services block grant.
CHILDREN AND FAMILIES SERVICES PROGRAMS
Appropriations, 2004.................................... $8,833,371,000
Budget estimate, 2005................................... 9,097,897,000
Committee recommendation................................ 9,094,146,000
The Committee recommends $9,094,146,000 for fiscal year
2005 for children and families services programs. The
comparable funding level for fiscal year 2004 is $8,833,371,000
and the budget request includes $9,097,897,000 for this
program. In addition, $10,500,000 in transfers are available
under section 241 of the Public Health Service Act.
This appropriation provides funding for programs for
children, youth, and families, the developmentally disabled,
and Native Americans, as well as Federal administrative costs.
Head Start
The Committee recommends $6,935,452,000 for fiscal year
2005 for Head Start. The comparable funding level for fiscal
year 2004 is $6,774,980,000 and the budget request includes
$6,935,452,000 for this program. The Committee recommendation
includes $1,400,000,000 in advance funding that will become
available on October 1, 2005. The Committee recommendation does
not include the $45,000,000 requested in the budget for the
grant program for those States that directly administer the
Head Start program.
The Committee is aware that studies on early childhood that
provide clear evidence that the brain undergoes its most
dramatic development during the first 3 years of life, when
children acquire the ability to think, speak, learn, and
reason. Disparities in children's cognitive and social
abilities become evident well before they enter Head Start or
pre-kindergarten programs at age 4. Early Head Start minimizes
these disparities so that children are ready to enter school
and learn. The National Evaluation of Early Head Start
concluded that Early Head Start is making a positive difference
in areas associated with children's success in school, family
self-sufficiency, and parental support of child development.
Currently only 3 percent of estimated eligible infants and
toddlers are enrolled in Early Head Start. Over the past 5
years, the Committee has significantly increased funding for
Early Head Start, to provide more low-income infants and
toddlers with the positive experiences they need for later
school and life successes. The Committee intends to continue
this important investment.
Given the recent changes in the overall Head Start training
and technical assistance system and the special training and
technical assistance needs of programs working with infants,
toddlers, and their families, the Committee is concerned about
the maintenance of the Early Head Start Training and Technical
Assistance System. In particular, the Committee is concerned
that long distance, technology-based technical assistance is
taking the place of providing programs with support from
qualified on-site people. The Committee believes that in order
to sustain the positive outcomes generated by the program,
Early Head Start programs and staff need to continue to receive
ongoing training opportunities and technical assistance from
organizations with specialized expertise relating to infants,
toddlers and families and the demonstrated capacity needed to
provide direction and support to the Head Start national
training and technical assistance system.
Head Start provides comprehensive development services for
low-income children and families, emphasizing cognitive and
language development, socioemotional development, physical and
mental health, and parent involvement to enable each child to
develop and function at his or her highest potential. At least
10 percent of enrollment opportunities in each State are made
available to children with disabilities.
The Committee understands the serious need for additional
and expanded Head Start facilities among Native American
populations and in rural areas. The Committee believes that the
Department could help serve these needy communities by
providing minor construction funding, as authorized, in remote
Native American communities.
Tribal colleges and universities [TCUs) play a central role
in strengthening education, economic development, and self-
sufficiency to American Indian communities. The Committee
recognizes the success of the Head Start-TCU partnership formed
in 1999 to foster educational, health, nutritional, and social
services for Indian children, and recommends that this program
be continued and expanded. The Committee supports the
Department's commitment to continue to award 5-year grants to
tribal colleges and universities.
While current law requires that 50 percent of Head Start
teachers in center-based Head Start programs have not less than
an associate degree in early childhood education or a related
field, American Indian Head Start programs are generally
located in areas that are isolated from mainstream colleges
where such degrees can be earned. This program provides
accessible, high-quality, and accredited education
opportunities to American Indian Head Start agency staff,
enabling them to better deliver services that enhances the
social and cognitive development of low income American Indian
children.
The Committee strongly supports the effort to strengthen
the qualifications of Head Start teachers. The Committee
encourages Head Start to continue to work toward the goal of
having all of their teachers in center-based Head Start
programs have an associate, baccalaureate, or advanced degree
in early childhood education, or a degree in a related field
with experience in teaching preschool children. The Committee
expects the Department to focus staff development efforts on
increasing the educational level of Head Start teachers in
order to meet this goal.
The Committee is aware that the Department's ``Descriptive
Study of Seasonal Farmworker Families'' published in September
2001 revealed that just 19 percent of eligible children of
migrant and seasonal farmworkers are served by Migrant Head
Start programs. The study also concluded ``that Migrant Head
Start agencies greatly improve the lives of migrant and
seasonal farmworker families, and in doing so, help to
strengthen local agricultural economies.'' The Committee urges
the Head Start Bureau to examine this issue and develop a plan
to ensure that sufficient funds are provided for Migrant Head
Start programs.
The Head Start Bureau shall provide the Committee with the
number and cost of buses purchased, by region, in fiscal years
2002, 2003, and the first half of 2004 with Head Start funds no
later than March 31, 2005.
The Committee is conscious of efforts currently being
undertaken to improve pre-literacy skills in Head Start
children and lauds the administration for its commitment to
this effort. However, the Committee continues to caution
against anything that would detract from the comprehensive
nature of the program in delivering early childhood development
and family services. While school readiness is front and center
in the goals of Head Start, the elements necessary to achieve
that readiness range from adequate nutrition and health
screening, to social and emotional development and family
building, as well as the cognitive growth of young children.
The Committee encourages ACF's Head Start Bureau and HRSA's
Maternal and Child Health Bureau to continue and expand their
successful interagency agreement to jointly address dental
disease, a significant unmet health need of Head Start
children. This partnership has brought together Head Start and
the dental community at the national, State and local levels to
seek solutions to improve access to oral health care for these
children through the public and private sectors.
The Committee recognizes that assessing the effectiveness
of Head Start nationwide is an important goal and that by
sponsoring the development of the National Reporting System
[NRS] the U.S. Department of Health and Human Services hopes to
aggregate and report data nationally. The Committee commends
the efforts of the Administration for Children and Families
[ACF] to measure the effectiveness of Head Start and to assess
progress among Head Start children. In order to ensure that the
National Reporting System is effectively meeting its objective,
the Committee urges ACF to utilize an independent organization
to review the test's validity and its impact on instruction.
The Committee acknowledges Head Start's effort to test both
English and Spanish language speakers. Currently, the
determining factor for which language version will be
administered is the child's repeated failure to comprehend
questions posed in English. The Committee urges ACF to review
this policy in order to minimize any potential unintended
consequences for children and the teacher-child relationship.
The Committee intends that no Head Start agency, Head Start
center, or Early Head Start center receiving financial
assistance available through this Act shall provide
compensation for any of its employees (including program
directors) in excess of the salary of the Secretary of the
Department of Health and Human Services and that each Head
Start agency, Head Start center, or Early Head Start center
receiving financial assistance available through this Act shall
maintain and annually submit to the Secretary, a complete
accounting of its administrative expenses, including expenses
for salaries and compensation funded under this subchapter
disaggregated by employee.
It has come to the Committee's attention that one Head
Start grantee did not adequately obtain parental consent before
performing a health screening on Head Start students which
included intrusive physical examinations. The Committee
believes that Head Start agencies receiving financial
assistance available through this Act should obtain written
parental consent before administration of, or referral for, any
health care service provided or arranged to be provided,
including any non-emergency intrusive physical examination of a
child in connection with participation in a Head Start program.
This should not in any way be interpreted to prohibit agencies
from using established methods for handing cases of suspected
or known child abuse and neglect that are in compliance with
applicable Federal, State, or tribal law.
The Committee is interested meeting the goal of this
important program through the efficient and effective
expenditure of Head Start program funds. With respect to
training activities of Head Start agencies and providers, the
Committee is concerned that funds provided under this section
shall not be used for long-distance travel expenses for
training activities that are substantially similar to training
activities that are locally or regionally available. The
Committee would like to note that this is not intended to
automatically prevent attendance in National Conferences within
the 50 United States.
Consolidated Runaway and Homeless Youth Program
The Committee recommends $95,000,000 for fiscal year 2005
for the consolidated runaway and homeless youth program. The
comparable funding level for fiscal year 2004 is $89,431,000
and the budget request includes $89,447,000 for this program.
The Committee recommends $49,181,000 for basic centers and
$46,819,000 for transitional living programs.
This program addresses the crisis needs of runaway and
homeless youth and their families through support to local and
State governments and private agencies. Basic centers and
transitional living programs help address the needs of some of
the estimated 500,000 to 1.5 million and homeless youth, many
of whom are running away from unsafe or unhealthy living
environments. These programs have been proven effective at
supporting positive youth development, securing stable and safe
living arrangements and providing the skills required to engage
in positive relationships with caring adults and contribute to
society.
Under current law the Runaway and Homeless Youth Act
requires that not less than 90 percent of the funds be
allocated to States for the purpose of establishing and
operating community-based runaway and homeless youth centers,
as authorized under Parts A and B of the Act. Funds are
distributed on the basis of the State youth population under 18
years of age in proportion to the national total. The remaining
10 percent funds networking and research and demonstration
activities including the National Toll-Free Communications
Center.
Grants are used to develop or strengthen community-based
programs which assist homeless youth in making a smooth
transition to productive adulthood and social self-sufficiency;
and to provide technical assistance to transitional living
programs for the acquisition and maintenance of resources and
services.
The basic centers program, authorized under Part A of the
Act, supports grants to community-based public and private
agencies for the provision of outreach, crisis intervention,
temporary shelter, counseling, family unification and aftercare
services to runaway and homeless youth and their families.
The transitional living program [TLP] provides grants to
local public and private organizations to address shelter and
service needs of homeless youth, ages 16-21. The program's
goals are to have youth safe at home or in appropriate
alternative settings and to help them develop into independent,
contributing members of society.
A homeless youth accepted into the program is eligible to
receive shelter and services continuously for up to 540 days.
The services include counseling; life skills training, such as
money management and housekeeping; interpersonal skill
building, such as decision-making and priority setting;
educational advancement; job preparation attainment; and mental
and physical health care.
Under the new authorization, the maximum age limit for
youth seeking shelter is reduced from 21 to 18, however there
is an exception that allows youth in the program who have not
reached age 18 to remain in the program after 540 days. Centers
are now able to exceed the 20 youth capacity limit if the State
requires a higher limit in order to be licensed under the Basic
Center program. Finally, the allotment for Transitional Living
Programs is increased to 45 percent and, under warranted
conditions, to 55 percent.
The Committee recommendation does not include the
$10,000,000 requested in the budget for a separate maternity
group homes program. The Committee is aware of the need for and
shares the administration's interest in funding residential
services for young mothers and their children who are unable to
live with their own families because of abuse, neglect, or
other circumstances. The Committee notes that pregnant and
parenting youth are currently eligible for and served through
the TLP.
The Committee also recognizes the need for and value of
expanding transitional living opportunities for all homeless
youth. Therefore, the Committee seeks to preserve the
flexibility afforded in current law to respond to the needs of
the young people who are most at-risk and in greatest need of
transitional living opportunities in their communities by
providing additional resources to the existing portfolio of
consolidated Runaway and Homeless Youth Act programs.
It is the Committee's expectation that current and future
TLP grantees will continue to provide transitional living
opportunities and support to pregnant and parenting homeless
youth, as is their current practice. To further ensure that
pregnant and parenting homeless youth are able to access
transitional living opportunities and support in their
communities, the Committee encourages the Secretary, acting
through the network of federally-funded runaway and homeless
youth training and technical assistance providers, to offer
guidance to grantees and others on the programmatic
modifications required to address the unique needs of pregnant
and parenting youth and on the various sources of funding
available for residential services to this population.
Maternity Group Homes
The Committee recommendation does not include the
$10,000,000 requested in the budget for the maternity group
homes program. Under this proposed program, the ACF would
provide targeted funding for community-based, adult-supervised
group homes for young mothers and their children. These homes
would provide safe, stable, nurturing environments for mothers
who cannot live safely with their own families and assist them
in moving forward with their lives by providing support so they
can finish school, acquire job skills, and learn to be good
parents.
The Committee expects the Family and Youth Services Bureau
to continue to provide the technical assistance needed to
enable TLP grantees and their community partners to address the
unique needs of young mothers and their children, as well as
helping interested entities in identifying sources of funding
currently available to provide residential services to this
population.
Runaway Youth Prevention Program
The Committee recommends $15,802,000 for fiscal year 2005
for the runaway youth prevention program. The comparable
funding level for fiscal year 2004 is $15,302,000 and the
budget request includes $15,302,000 for this program. This is a
discretionary grant program open to private nonprofit agencies
for the provision of services to runaway, homeless, and street
youth. Funds may be used for street-based outreach and
education, including treatment, counseling, provision of
information, and referrals for these youths, many of whom have
been subjected to, or are at risk of being subjected to, sexual
abuse. The goal of this program is to help young people leave
the streets.
Child Abuse Prevention Programs
The Committee recommends $61,886,000 for fiscal year 2005
for child abuse prevention programs. The comparable funding
level for fiscal year 2004 is $56,269,000 and the budget
request includes $68,279,000 for this program. The
recommendation includes $27,500,000 for State grants and
$34,386,000 for discretionary activities.
These programs seek to improve and increase activities at
all levels of government which identify, prevent, and treat
child abuse and neglect through State grants, technical
assistance, research, demonstration, and service improvement.
Abandoned Infants Assistance
The Committee recommends $12,052,000 for fiscal year 2005
for abandoned infants assistance. The comparable funding level
for fiscal year 2004 is $12,052,000 and the budget request
includes $12,086,000 for this program.
This program provides financial support to public and
private entities to develop, implement, and operate
demonstration projects that will prevent the abandonment of
infants and young children. Grants provide additional services
such as identifying and addressing the needs of abandoned
infants, especially those who are drug exposed or HIV positive;
providing respite care for families and care givers; and
assisting abandoned infants and children to reside with their
natural families or in foster care.
Child Welfare Services
The Committee recommends $291,986,000 for fiscal year 2005
for child welfare services. The comparable funding level for
fiscal year 2004 is $289,320,000 and the budget request
includes $291,986,000 for this program.
This program helps State public welfare agencies improve
their child welfare services with the goal of keeping families
together. State services include: preventive intervention, so
that, if possible, children will not have to be removed from
their homes; reunification so that children can return home;
and development of alternative placements like foster care or
adoption if children cannot remain at home. These services are
provided without regard to income.
Child Welfare Training
The Committee recommends $7,470,000 for fiscal year 2005
for child welfare training. The comparable funding level for
fiscal year 2004 is $7,411,000 and the budget request includes
$7,470,000 for this program.
Under section 426, title IV-B of the Social Security Act,
discretionary grants are awarded to public and private
nonprofit institutions of higher learning to develop and
improve education/training programs and resources for child
welfare service providers. These grants upgrade the skills and
qualifications of child welfare workers.
Adoption Opportunities
The Committee recommends $27,343,000 for fiscal year 2005
for adoption opportunities. The comparable funding level for
fiscal year 2004 is $27,103,000 and the budget request includes
$27,343,000 for this program.
This program eliminates barriers to adoption and helps find
permanent homes for children who would benefit by adoption,
particularly children with special needs.
Adoption Incentives
The Committee recommends $32,103,000 for fiscal year 2005
for adoption incentives. The comparable funding level for
fiscal year 2004 is $7,456,000 and the budget request includes
$32,103,000 for this program.
The purpose of this program is to provide incentive funds
to States to encourage an increase in the number of adoptions
of children from the public foster care system. These funds are
used to pay States bonuses for increasing their number of
adoptions. The appropriation allows incentive payments to be
made for adoptions completed prior to September 30, 2005.
Adoption Awareness
The Committee recommends $12,906,000 for fiscal year 2005
for adoption awareness. The comparable funding level for fiscal
year 2004 is $12,785,000 and the budget request includes
$12,906,000 for this program.
This program was authorized in the Children's Health Act of
2000. The program consists of two activities: the Infant
Adoption Awareness Training Program and the Special Needs
Awareness Campaign. The Infant Adoption Awareness Training
Program provides grants to support adoption organizations in
the training of designated health staff, in eligible health
centers that provide health services to pregnant women, to
inform them about adoption and make referrals on request on an
equal basis with all other courses of action. Within the
Committee recommendation, $9,906,000 is available for this
purpose.
The Special Needs Adoption Campaign supports grants to
carry out a national campaign to inform the public about the
adoption of children with special needs. The Committee
recommendation includes $3,000,000 to continue this important
activity.
Compassion Capital Fund
The Committee recommends $47,702,000 for fiscal year 2005
for the compassion capital fund. The comparable funding level
for fiscal year 2004 is $47,702,000 and the budget request
includes $100,000,000 for this program.
The Committee expects funds made available through this
program to supplement and not supplant private resources and
encourages the Secretary to require private resources to match
grant funding provided to public/private partnerships.
Funds available will support grants to charitable
organizations to emulate model social service programs and to
encourage research on the best practices of social service
organizations.
Social Services Research
The Committee recommends $19,168,000 for fiscal year 2005
for the social services research. The comparable funding level
for fiscal year 2004 is $19,168,000 and the budget request
includes $5,982,000 for this program.
The Committee has funded $6,000,000 of this program through
transfers available under section 241 of the Public Health
Service Act. These funds support cutting-edge research and
evaluation projects in areas of critical national interest.
Research includes determining services that are more cost-
effective and alternative ways to increase the economic
independence of American families.
The Committee notes ACF's efforts to assist States with
meeting the extensive record-keeping, reporting, and tracking
requirements of the TANF program. Working through the state
information technology consortium, ACF is providing States with
the tools necessary to strengthen and improve the complex IT
systems required to support TANF. Similarly, on behalf of Child
Support Enforcement, the consortium is helping to expand data
exchange capabilities between the courts and State child
support enforcement agencies as well as increase collection
efficiency in States and tribal organizations. The Committee
recommends that both collaborative efforts with the state
information technology consortium be continued at their current
levels.
Community-Based Resource Centers
The Committee recommends $43,205,000 for fiscal year 2005
for community-based resource centers. The comparable funding
level for fiscal year 2004 is $33,205,000 and the budget
request includes $65,002,000 for this program.
These resources support two purposes: assisting each State
in developing, operating, expanding, and enhancing a network of
community-based, prevention-focused, family resource and
support programs and supporting activities that foster an
understanding, appreciation, and knowledge of diverse
populations in order to be effective in preventing and treating
child abuse and neglect.
Abstinence Education
The Committee recommends $154,500,000 for fiscal year 2005
for community based abstinence education. The comparable
funding level for fiscal year 2004 is $124,549,000 and the
budget request includes $236,426,000 for this program. Within
the funds provided, $100,000,000 is provided for community-
based abstinence education, $4,500,000 is provided through an
evaluation set-aside as requested by the administration, and
$50,000,000 is provided as pre-appropriated mandatory funds.
This program provides support for the development and
implementation of abstinence education programs for
adolescents, ages 12 through 18. These programs are unique in
that their entire focus is to educate young people and create
an environment within communities that supports teen decisions
to postpone sexual activity until marriage.
Developmental Disabilities
The Committee recommends $171,438,000 for fiscal year 2005
for programs administered by the Administration on
Developmental Disabilities. The comparable funding level for
fiscal year 2004 is $164,772,000 and the budget request
includes $164,854,000 for these programs. Within the funds
provided, $156,526,000 is for carrying out the Developmental
Disability Act, and $14,912,000 is for carrying out the Help
America Vote Act of 2002.
The Administration on Developmental Disabilities supports
community-based delivery of services which promote the rights
of persons of all ages with developmental disabilities.
Developmental disability is defined as severe, chronic
disability attributed to mental or physical impairments
manifested before age 22, which causes substantial limitations
in major life activities. The ADD also administers monies for
election assistance for individuals with disabilities. This
program is for individuals with any type of disability.
Of the funds provided, the Committee recommends $73,081,000
for State councils. These councils assist each State in
promoting the development of a comprehensive, statewide,
consumer and family-centered system which provides a
coordinated array of culturally-competent services, and other
assistance for individuals with development disabilities. State
councils undertake a range of activities including
demonstration of new approaches, program and policy analysis,
interagency collaboration and coordination, outreach and
training.
The Committee recommends $40,000,000 for protection and
advocacy grants. This formula grant program provides funds to
States to establish protection and advocacy systems to protect
the legal and human rights of persons with developmental
disabilities who are receiving treatment, services, or
rehabilitation within the State.
The Committee recommends $11,642,000 for projects of
national significance to assist persons with developmental
disabilities. This program funds grants and contracts providing
nationwide impact by developing new technologies and applying
and demonstrating innovative methods to support the
independence, productivity, and integration into the community
of persons with developmental disabilities. The Committee
recognizes the potential benefits that assistive technology can
have for individuals with developmental disabilities. Of these
funds, $4,000,000 is available to expand activities of the
Family Support Program. The Committee's placement of funds for
family support within the Projects of National Significance
account does not provide ACF with discretion on this definition
of family support as defined in Title II of the Developmental
Disability Act. The Committee makes a crucial distinction
between support services designed for families of children with
disabilities and support services designed for an individual
with a disability. The Committee intends that these funds be
used for the support and assistance of families of children
with disabilities, in accordance with the statute.
The Committee recommends $31,803,000 for university-
affiliated programs. This program consists of a network of
centers that are interdisciplinary education, research and
public service units of a university system, or are public or
non-profit entities associated with universities. These centers
conduct research, develop evidence based practices and teach
thousands of parents, professionals, students, and people with
disabilities about critical disability areas such as early
intervention, health care, community-based services, inclusive
and meaningful education, transition from school to work,
employment, housing, assistive technology, aging with a
disability and transportation. The centers serve as the major
vehicle to translate disability related research into community
practice and service systems and to train the next cohort of
future professionals who will provide services and supports to
an increasingly diverse population of people with disabilities.
The increase provided in the bill will allow funding for
existing centers to reach the authorized level, support new
center grants in five States that currently have unserved or
underserved populations, and establish four new centers that
specialize in minority health disparities and education issues.
The Committee recommends $14,912,000 for disabled voter
services. Of these funds, $10,000,000 is to promote disabled
voter access, and the remaining $4,912,000 is for disabled
voters protection and advocacy systems. The election assistance
for individuals with disabilities program was authorized in the
Help America Vote Act of 2002. The program enables an applicant
to establish, expand, and improve access to, and participation
by, any individual with a disability in the election process.
Native American Programs
The Committee recommends $45,157,000 for fiscal year 2005
for Native American programs. The comparable funding level for
fiscal year 2004 is $45,157,000 and the budget request includes
$45,155,000 for this program.
The Administration for Native Americans [ANA] assists
Indian tribes and Native American organizations in planning and
implementing long-term strategies for social and economic
development through the funding of direct grants for individual
projects, training and technical assistance, and research and
demonstration programs.
The Committee continues its significant interest in the
revitalization of native languages through education. The
Committee encourages ANA to allocate additional resources to
support the Native American Languages program and urges the ANA
to make schools a part of this effort, consistent with the
policy expressed in the Native American Languages Act.
Community Services
The Committee recommends $727,650,000 for fiscal year 2005
for the community services programs. The comparable funding
level for fiscal year 2004 is $731,284,000 and the budget
request includes $552,350,000 for this program.
Within the funds provided, the Committee recommends
$650,000,000 for the community services block grant [CSBG].
These funds are used to make formula grants to States and
Indian tribes to provide a wide range of services and
activities to alleviate causes of poverty in communities and to
assist low-income individuals in becoming self-sufficient.
The Committee rejects the administration's recommendation
to cut the community services block grant funding. Although a
restrictive Committee allocation prevented CSBG funding from
being substantially increased this year, the Committee
continues to recognize the importance of CSBG and the Community
Action Agencies it funds in helping meet the extraordinary
challenges facing low-income communities.
The Nation's Community Action Agency network relies on CSBG
funding to help initiate and administer programs designed to
alleviate poverty. The universal characteristic of these CSBG-
funded programs is that they provide people with the resources
and the tools to become self-sufficient. The Committee
understands that the Department of Health and Human Services,
and its Office of Community Services in particular, could
better use this network in developing future policy
initiatives. The Committee notes that in a number of States,
including Iowa and Pennsylvania, CAA-initiated family
development and self-sufficiency programs are a integral
component of welfare reform efforts. The administration is
encouraged to look for further nationwide linkages between
those individuals seeking to leave the welfare system and
become self-sufficient and the many family development and
self-sufficiency strategies operated by Community Action
Agencies.
The Committee expects the Office of Community Services to
release funding to States in the most timely manner. The
Committee also expects States to make funds available promptly.
The Committee is aware that the Office of Community Services
and some States have been extraordinarily delinquent in
providing funds to local eligible entities.
In addition, the Committee again expects the Office of
Community Services to inform the State CSBG grantees of any
policy changes affecting carryover CSBG funds within a
reasonable time after the beginning of the Federal fiscal year.
Several discretionary programs are funded from this
account. Funding for these programs is recommended at the
following levels for fiscal year 2005: community economic
development, $38,000,000, of which $2,000,000 is for
neighborhood innovation projects; individual development
accounts, $24,912,000; rural community facilities, $7,500,000;
and community food and nutrition, $7,238,000. The Committee did
not provide funds for the national youth sports program.
The Committee continues to support strongly the Community
Economic Development program because of the substantial record
of achievement that Community Development Corporations have
complied in working in distressed urban and rural communities.
The Committee, in particular, notes that Federal funds leverage
substantial non-Federal resources in meeting the objectives of
this program. Therefore, it is the Committee's intent that
appropriated funds should be allocated to the maximum extent
possible in the form of grants to qualified Community
Development Corporations in order to maximize the leveraging
power of the Federal investment and the number and amount of
set-asides should be reduced to the most minimal levels.
Community economic development grants are made to private,
nonprofit community development corporations, which in turn
provide technical and financial assistance to business and
economic development projects that target job and business
opportunities for low income citizens. The Committee has
included bill language clarifying that Federal funds made
available through this program may be used for financing for
construction and rehabilitation and loans or investments in
private business enterprises owned by Community Development
Corporations.
The Committee recognizes that manufacturing is an important
part of the economic base in urban communities and rural areas.
The Committee notes that recent research indicates that very
little venture or equity capital makes it into this sector and
this is particularly the case for manufacturing businesses
located in economically distressed communities. The Committee
is aware that a number of community development corporations
[CDCs] have provided financing to manufacturing businesses in
low income areas.
A principal source of capital for CDCs is Community
Economic Development Grants. The Committee recommendation
includes an additional $3,500,000 above the budget request for
the purpose of providing technical and financial assistance to
manufacturing enterprises. The Committee intends that these
funds be made available to experienced CDCs with a record of
lending or investing in manufacturing. Further, the Committee
intends these funds to be used for providing technical
assistance and financial assistance--including loans and
investments for plants, equipment and working capital--to
manufacturing businesses. Of the total provided, the Committee
has included $5,481,000 for the Job Creation Demonstration
authorized under the Family Support Act to target community
development activities to create jobs for people on public
assistance. This demonstration program provides grants on a
competitive basis to non-profit organizations to create new
employment and business opportunities for TANF recipients and
other low-income individuals. Funding also supports technical
and financial assistance for private employers that will result
in the creation of full-time permanent jobs for eligible
individuals. The Committee recognizes that continued funding of
the Job Creation Demonstration program would provide
opportunities for more low-income individuals. As in the past,
the Committee expects that a priority for grants under this
program go to experienced community development corporations.
Within the funds provided, the Committee has also included
$2,000,000 for neighborhood innovation projects (42 USC
9921(a)(4)) to enable the Office of Community Services to
participate with the Department of Housing and Urban
Development, foundations, and financial institutions.
Most of the drinking water and wastewater systems in the
country that are not in compliance with Federal standards are
in communities of 3,000 or fewer. Rural Community Assistance
Programs [RCAPs] use funds available from the Rural Community
Facilities Program to assist a number of communities in gaining
access to adequate community facilities, gaining financing for
new or improved water and wastewater systems and in complying
with Federal standards.
The Committee has included bill language allocating funding
to the Office of Community Services for Rural Community
Facilities Technical Assistance as authorized under section
680(3)(B) of the Community Services Block Grant Act. In
providing this funding, the Committee expects that it be used
solely for the purpose of improving water and wastewater
facilities in poor, rural communities. As in the past, these
funds should be allocated to regional, rural community
assistance programs.
The Committee is concerned that many small and very small
community water and wastewater treatment systems might be most
vulnerable to terrorist attack, and yet least prepared to deal
with the issue. The Committee urges OCS to continue to support
RCAP Small Community Infrastructure Safety and Security
Training and Technical Assistance project, which provides
State, regional and national infrastructure safety and security
training workshops and on-site technical assistance targeted to
small and very small community water and wastewater treatment
systems. The goal of the project is to improve the capacity of
small systems to better prepare for emergencies, develop
emergency preparedness training manuals for small water
systems, identify appropriate technologies to secure such
systems, and provide technical assistance to small communities
struggling to deal with these issues.
Domestic Violence Hotline
The Committee recommends $3,500,000 for fiscal year 2005
for the national domestic violence hotline. The comparable
funding level for fiscal year 2004 is $2,982,000 and the budget
request includes $3,000,000 for this program.
This is a cooperative agreement which funds the operation
of a national, toll-free, 24-hours-a-day telephone hotline to
provide information and assistance to victims of domestic
violence.
Battered Women's Shelters
The Committee recommends $128,000,000 for fiscal year 2005
for battered women's shelters program. The comparable funding
level for fiscal year 2004 is $125,648,000 and the budget
request includes $125,648,000 for this program.
This is a formula grant program to support community-based
projects which operate shelters and provide related assistance
for victims of domestic violence and their dependents. Emphasis
is given to projects which provide counseling, advocacy, and
self-help services to victims and their children.
Early Learning Opportunities Program
The Committee recommends $36,000,000 for fiscal year 2005
for early learning opportunities program. The comparable
funding level for fiscal year 2004 is $33,580,000 and the
budget request did not include funds for this program.
This program supports grants to local community councils
comprised of representatives from agencies involved in early
learning programs, parent organizations and key community
leaders. Funds are used to increase the capacity of local
organizations to facilitate development of cognitive skills,
language comprehension and learning readiness; enhance
childhood literacy; improve the quality of early learning
programs through professional development and training; and
remove barriers to early learning programs.
Faith-Based Center
The Committee recommends $1,386,000 for fiscal year 2005
for the operation of the Department's Center for Faith-Based
and Community Initiatives. The comparable funding level for
fiscal year 2004 is $1,386,000 and the budget request includes
$1,400,000 for this program.
Mentoring Children of Prisoners
The Committee recommends $50,000,000 for fiscal year 2005
for mentoring children of prisoners. The comparable funding
level for fiscal year 2004 is $49,701,000 and the budget
request includes $50,000,000 for this program.
The mentoring children of prisoners program was authorized
in 2001 under section 439 of the Social Security Act. The
purpose of this program is to help children while their parents
are imprisoned and includes activities that keep children
connected to a parent in prison in order to increase the
chances that the family will come together successfully when
the parent is released. As a group, children of prisoners are
less likely than their peers to succeed in school and more
likely to become engaged in delinquent behavior.
Independent Living Training Vouchers
The Committee recommends $44,734,000 for fiscal year 2005
for independent living training vouchers. The comparable
funding level for fiscal year 2004 is $44,734,000 and the
budget request includes $60,000,000 for this program.
These funds will support vouchers of up to $5,000 for
college tuition, or vocational training for individuals who age
out of the foster care system so they can be better prepared to
live independently and contribute productively to society.
Studies have shown that 25,000 youth leave foster care each
year at age 18 and just 50 percent will have graduated high
school, 52 percent will be unemployed and 25 percent will be
homeless for one or more nights.
Promotion of Responsible Fatherhood and Healthy Marriage
The Committee does not provide funds for fiscal year 2005
for promotion of responsible fatherhood and healthy marriage.
The budget request includes $50,000,000 for this new program
designed to promote responsible fatherhood and responsible
marriage. The purpose of this proposed program, for which
authorizing legislation is pending, is to spur approaches at
State and community levels to assist fathers to be more
actively and productively involved in the lives of their
children.
Program Administration
The Committee recommends $190,206,000 for fiscal year 2005
for program administration. The comparable funding level for
fiscal year 2004 is $177,894,000 and the budget request
includes $190,206,000 for this program.
The Committee urges ACF to continue to make progress in
improving its Annual Performance Plan and Annual Performance
Report. The Committee notes that many programs proposed for
funding do not have solid data for baselines or performance
outcome measures. This lack of objective data makes more
difficult the Committee's decisions regarding the allocation of
limited resources. The Committee believes that the Agency
should work with program grantees and relevant associations to
identify the most objective ways in which to evaluate the
effectiveness of ACF programs and establish a timeline for
producing meaningful data by which programs can be assessed.
The Committee urges that steps be taken to improve this
situation and expects information regarding such actions to be
included in the fiscal year 2006 congressional justification.
The Committee continues its interest in the Department's
Child and Family Services reviews. These reviews are an
effective method for monitoring the progress States are making
in assuring the safety, health, and permanency for children in
child welfare and foster care as required in the Adoption and
Safe Families Act. The Committee encourages the Department to
make available sufficient resources to ensure full
implementation of the new collaborative monitoring system.
PROMOTING SAFE AND STABLE FAMILIES
Appropriations, 2004.................................... $404,383,000
Budget estimate, 2005................................... 505,000,000
Committee recommendation................................ 404,383,000
The Committee recommends $404,383,000 for fiscal year 2005
for promoting safe and stable families. The comparable funding
level for fiscal year 2004 is $404,383,000 and the budget
request includes $505,000,000 for this program.
Funding available provides grants to States in support of:
(1) family preservation services; (2) time-limited family
reunification services; (3) community-based family support
services; and, (4) adoption promotion and support services. The
Committee notes that most of the Federal funding related to
child welfare is provided for the removal and placement of
children outside of their own homes. Funds available through
the Promoting Safe and Stable Families program are focused on
supporting those activities that can prevent family crises from
emerging which might require the temporary or permanent removal
of a child from his or her own home.
The Promoting Safe and Stable Families program is comprised
of $305,000,000 in capped entitlement funds authorized by the
Social Security Act and $99,383,000 in discretionary
appropriations.
PAYMENTS TO STATES FOR FOSTER CARE AND ADOPTION ASSISTANCE
Appropriations, 2004.................................... $5,068,300,000
Budget estimate, 2005................................... 5,037,900,000
Committee recommendation................................ 5,037,900,000
The Committee recommends $5,037,900,000 for fiscal year
2005 for payments to States for foster care and adoption
assistance. The comparable funding level for fiscal year 2004
is $5,068,300,000 and the budget request includes
$5,037,900,000 for this program. In addition, the Committee
recommendation concurs with the administration's request of
$1,767,200,000 for an advance appropriation for the first
quarter of fiscal year 2006.
The Foster Care Program provides Federal reimbursement to
States for: maintenance payments to families and institutions
caring for eligible foster children, matched at the Federal
medical assistance percentage [FMAP] rate for each State; and
administration and training costs to pay for the efficient
administration of the Foster Care Program, and for training of
foster care workers and parents.
The Adoption Assistance Program provides funds to States
for maintenance costs and the nonrecurring costs of adoption
for children with special needs. The goal of this program is to
facilitate the placement of hard-to-place children in permanent
adoptive homes, and thus prevent long, inappropriate stays in
foster care. As in the Foster Care Program, State
administrative and training costs are reimbursed under this
program.
The Independent Living Program provides services to foster
children under 18 and foster youth ages 18-21 to help them make
the transition to independent living by engaging in a variety
of services including educational assistance, life skills
training, health services and room and board. States are
awarded grants from the annual appropriation proportionate to
their share of the number of children in foster care, subject
to a matching requirement.
Administration on Aging
Appropriations, 2004.................................... $1,373,917,000
Budget estimate, 2005................................... 1,376,527,000
Committee recommendation................................ 1,395,117,000
The Committee recommends an appropriation of $1,395,117,000
for aging programs. This amount is $21,200,000 above the
comparable fiscal year 2004 level and $18,590,000 above the
administration request.
Supportive Services and Senior Centers
The Committee recommends an appropriation of $357,000,000
for supportive services and senior centers, which is $3,111,000
above the comparable fiscal year 2004 level and the same as the
administration request. This State formula grant program funds
a wide range of social services for the elderly, including
multipurpose senior centers, adult day care and ombudsman
activities. State agencies on aging award funds to designated
area agencies on aging who in turn make awards to local
services providers. All individuals age 60 and over are
eligible for services, although, by law, priority is given to
serving those who are in the greatest economic and social need,
with particular attention to low-income minority older
individuals and those residing in rural areas. Under the basic
law, States have the option to transfer up to 30 percent of
funds appropriated between the senior centers program and the
nutrition programs, which allows the State to determine where
the resources are most needed.
Preventive Health Services
The Committee recommends $21,919,000 for preventive health
services, which is the same as the administration request. The
comparable fiscal year 2004 level was $21,790,000. Funds
appropriated for this activity are part of the comprehensive
and coordinated service systems targeted to those elderly most
in need. Preventive health services include nutritional
counseling and education, exercise programs, health screening
and assessments, and prevention of depression.
The Committee is pleased that the budget request includes
$5,500,000 to expand medication management, screening and
education activities, including the use of new medication
management devices, to prevent incorrect medication and adverse
drug reactions among the elderly.
Protection of Vulnerable Older Americans
The Committee recommends $20,474,000 for grants to States
for protection of vulnerable older Americans. This is
$1,030,000 above the comparable fiscal year 2004 level and
$1,915,000 above the administration request. Within the
Committee recommendation, $15,276,000, an increase of
$1,000,000 over the fiscal year 2004 level, is for the
ombudsman services program and $5,198,000 is for the prevention
of elder abuse program. Both programs provide formula grants to
States to prevent the abuse, neglect, and exploitation of older
individuals. The ombudsman program focuses on the needs of
residents of nursing homes and board and care facilities, while
elder abuse prevention targets its message to the elderly
community at large.
The Committee encourages the Administration on Aging to
fund a demonstration grant program in support of the activities
authorized under Title VII, Subtitle B of the Older Americans
Act for programs directed to preventing abuse, neglect, and
exploitation of older individuals in Indian Country. Funds
should be used for education programs directed toward
increasing awareness of elder abuse in Indian Country and on
developing enforceable codes at the tribal level.
National Family Caregiver Support Program
The Committee recommends $157,000,000 for the national
family caregiver support program, which is $4,262,000 above the
comparable fiscal year 2004 level and $1,488,000 above the
administration request. Funds appropriated for this activity
established a multifaceted support system in each State for
family caregivers. All States are expected to implement the
following five components into their program: individualized
referral information services; assistance to caregivers in
locating services from a variety of private and voluntary
agencies; caregiver counseling, training and peer support;
respite care provided in the home, an adult day care center or
other residential setting located in an assisted living
facility; and limited supplemental services that fill remaining
service gaps.
Native American Caregiver Support Program
The Committee recommendation includes $6,355,000 to carry
out the Native American Caregiver Support Program, which is the
same as the administration request. The comparable fiscal year
2004 level was $6,318,000. The program will assist tribes in
providing multifaceted systems of support services for family
caregivers and for grandparents or older individuals who are
relative caregivers. In fiscal year 2004, funds were used to
provide both discretionary and formula grants to support the
goals of this program.
Congregate and Home-delivered Nutrition Services
For congregate nutrition services, the Committee recommends
an appropriation of $388,646,000, which is $2,293,000 above the
comparable fiscal year 2004 level and the same as the
administration request. For home-delivered meals, the Committee
recommends $180,985,000, which is $1,068,000 above the
comparable fiscal year 2004 level and the same as the
administration request. These programs address the nutritional
need of older individuals. Projects funded must make home-
delivered and congregate meals available at least once a day, 5
days a week, and each meal must meet one-third of the minimum
daily dietary requirements. While States receive separate
allotments of funds for congregate and home-delivered nutrition
services and support services, they are permitted to transfer
up to 40 percent of funds between these programs.
Nutrition Services Incentives Program
The Committee recommendation includes $149,183,000 for the
nutrition services incentives program, the same as the
administration request. The comparable fiscal year 2004 funding
level was $148,191,000. This program, which was transferred
from the Department of Agriculture in fiscal year 2003,
augments funding for congregate and home-delivered meals
provided to older adults. Funds provided under this program are
dedicated exclusively to the provision of meals. NSIP rewards
effective performance by States and Tribal organizations in the
efficient delivery of nutritious meals to older individuals
through the use of cash or commodities.
Aging Grants to Indian Tribes and Native Hawaiian Organizations
The Committee recommends $26,612,000 for grants to native
Americans, which is $159,000 above the fiscal year 2004
comparable level and the same as the administration request.
Under this program awards are made to tribal and Alaskan Native
organizations and to public or nonprofit private organizations
serving native Hawaiians which represent at least 50 percent
Indians or Alaskan Natives 60 years of age or older to provide
a broad range of supportive services and assure that nutrition
services and information and assistance are available.
The Committee recognizes that this program is the primary
vehicle for providing nutrition and other supportive services
to Indian, Alaska Native, and Native Hawaiian elders. The
Committee urges the Administration on Aging to devote its
attention toward this purpose.
Training, Research and Discretionary Projects
The Committee recommends $37,647,000 for training,
research, and discretionary projects. The comparable fiscal
year 2004 level was $33,509,000. These funds support activities
designed to expand public understanding of aging and the aging
process, apply social research and analysis to improve access
to and delivery of services for older individuals, test
innovative ideas and programs to serve older individuals, and
provide technical assistance to agencies that administer the
Older Americans Act. Given the enormous demands on Alzheimer's
family caregivers, the Committee has included $1,000,000 to
support an Alzheimer's family contact center for round-the-
clock help to Alzheimer's families in crisis.
The Committee continues to support funding at no less than
last year's level for national programs scheduled to be
refunded in fiscal year 2005 that address a variety of issues,
including elder abuse, native American issues and legal
services.
The Committee is aware of the high incidence of chronic
diseases among elders in Indian Country. The Committee
encourages the agency to carry out a demonstration program
directed at decreasing health disparities through prevention
and wellness outreach. The Committee also recommends that the
agency continue and expand programs that focus on improving
access to social services by elders in Indian Country.
The Committee encourages the Administration on Aging to
facilitate the expansion of demonstration projects gauging the
efficiency of nurse-managed Geriatric Wellness Centers.
The Committee is concerned about the prevalence of
undiagnosed and untreated mental illness among older Americans.
Disorders such as anxiety, depression, and dementia are common
in older patients, but often go undetected. The Committee urges
the Administration on Aging to study the benefits of
integrating mental health treatment for older adults with
primary medical treatment, commonly referred to as
collaborative care.
The Committee expects the Administration on Aging to
continue to fund the national program of statewide senior legal
services hotlines (also called legal helplines) at their
current levels and ideally to provide an increase in the number
of States served by these legal hotlines.
Aging Network Support Activities
The Committee recommends $13,373,000 for aging network
support activities, the same as the administration request. The
comparable amount for fiscal year 2004 was $13,294,000. The
Committee recommendation includes $1,199,000 for the Eldercare
Locator and $1,180,000 for the pension information and
counseling projects.
The Eldercare Locator, a toll-free, nationwide directory
assistance service for older Americans and their caregivers, is
operated by the National Association of Area Agencies on Aging.
Since 1991, the service has linked more than 700,000 callers to
an extensive network of resources for aging Americans and their
caregivers.
Pension counseling projects provide information, advice,
and assistance to workers and retirees about pension plans,
benefits, and how to pursue claims when pension problems arise.
The information dissemination and outreach activities of the
pension counseling projects have served over 25,000 people and
has helped obtain more than $50,000,000 in retirement benefits
for older individuals.
The Committee has provided funding at the administration
request level for the National Long Term Care Ombudsman
Resource Center, the National Center on Elder Abuse and the
Health Care Anti-Fraud, Waste and Abuse Program.
Alzheimer's Disease Demonstration Grants to States
As a result of the aging of the baby boom generation, the
number of individuals affected by Alzheimer's disease will
double in the next 20 years. The Committee recommends a funding
level of $12,883,000 for Alzheimer's disease demonstration
grants to States. This is $1,000,000 above the comparable
fiscal year 2004 level and $1,383,000 above the administration
request.
Currently, an estimated 70 percent of individuals with
Alzheimer's disease live at home, where families provide the
preponderance of care. For these families, caregiving comes at
enormous physical, emotional and financial sacrifice. The
Alzheimer's disease demonstration grant program currently
provides matching grants to 37 States to stimulate and better
coordinate services for families coping with Alzheimer's. With
a relatively small amount of Federal support to provide the
stimulus, States have found innovative ways to adapt existing
health, long-term care, and community services to reach
previously underserved populations, particularly minorities and
those living in rural communities.
White House Conference on Aging
The Committee recommends $4,558,000 for the White House
Conference on Aging, which is the same level as the
administration request. These funds are available until
September 30, 2007. Funds will be used for start up costs for
the Conference, which will be held prior to December 31, 2005
and is required by the Older Americans Act Amendments of 2000.
Program Administration
The Committee recommends $18,482,000 to support Federal
staff that administer the programs in the Administration on
Aging, which is the same as the administration request. These
funds provide administrative and management support for
programs administered by the agency.
Office of the Secretary
GENERAL DEPARTMENTAL MANAGEMENT
Appropriations, 2004.................................... $360,069,000
Budget estimate, 2005................................... 437,822,000
Committee recommendation................................ 382,555,000
The Committee recommends $382,555,000 for general
departmental management [GDM]. The comparable level for fiscal
year 2004 was $360,069,000 and the administration request was
$437,822,000. The Committee recommendation includes the
transfer of $5,851,000 from Medicare trust funds, which is the
same as the administration request.
The Committee directs that specific information requests
from the chairman and ranking member of the Subcommittee on
Labor, Health and Human Services, and Education, and Related
Agencies, on scientific research or any other matter, shall be
transmitted to the Committee on Appropriations in a prompt
professional manner and within the time frame specified in the
request. The Committee further directs that scientific
information requested by the Committees on Appropriations and
prepared by Government researchers and scientists be
transmitted to the Committee on Appropriations, uncensored and
without delay.
This appropriation supports those activities that are
associated with the Secretary's role as policy officer and
general manager of the Department. It supports certain health
activities performed by the Office of Public Health and
Science, including the Office of the Surgeon General. GDM funds
also support the Department's centralized services carried out
by several Office of the Secretary staff divisions, including
personnel management, administrative and management services,
information resources management, intergovernmental relations,
legal services, planning and evaluation, finance and
accounting, and external affairs.
The Office of the Surgeon General, in addition to its other
responsibilities, provides leadership and management oversight
for the PHS Commissioned Corps, including the involvement of
the Corps in departmental emergency preparedness and response
activities.
The Committee has provided $3,634,000 to support the
activities of the United States-Mexico Border Health Commission
as authorized by Public Law 103-400. The Commission is
authorized to assess and resolve current and potential health
problems that affect the general population of the United
States-Mexico border area.
The Committee understands that there are nearly 400,000
frozen embryos in fertility clinics in the United States and
only approximately 2 percent of these are donated to other
couples in order to bear children. The Committee continues to
believe that increasing public awareness of embryo donation and
adoption remains an important goal and therefore directs the
Department to continue its embryo adoption awareness campaign.
The Committee has provided $1,000,000 for this purpose.
The Committee recommendation includes $3,000,000 for the
Secretary to establish a Citizens' Health Care Working Group as
authorized in Section 1014 of the Medicare Prescription Drug,
Improvement and Modernization Act of 2003.
Childhood Drinking.--The Committee understands that new
research from the National Institute on Alcohol Abuse and
Alcoholism shows that serious drinking problems previously
associated with adulthood actually begin to emerge during
childhood and adolescence. In this context, alcohol abuse and
dependence are best characterized as developmental disorders
that begin during ages that are a critical time for cognitive
and physiological growth. These findings underscore the public
health challenge of preventing childhood drinking, as well as
raising the age of first use of alcohol.
The Committee commends the Secretary for establishing the
Interagency Coordinating Committee on the Prevention of
Underage Drinking [ICCPUD] and applauds the SAMHSA
Administrator for taking a strong leadership role. The ICCPUD's
interim report describes the steps involved in developing a
coordinated plan for combating underage drinking and lists the
related current and planned activities by the numerous Federal
agencies involved in this effort. The Committee was
disappointed to see that the Surgeon General is not engaged in
any activities specifically intended to reduce underage
drinking, nor does he plan any such activities in the near
future. The Committee notes that the Surgeon General has a
unique role that involves advocating for effective disease
prevention and health promotion programs, as well as providing
a highly recognized symbol of national commitment to combating
public health threats. The Surgeon General, as the Nation's top
doctor, has issued Reports and Calls to Action in the past to
focus National attention on important public health issues such
as suicide prevention, youth violence and obesity. The
Committee believes that the Surgeon General must be fully
engaged in the effort to combat childhood drinking. Therefore,
the Committee strongly urges the Surgeon General, in
coordination with SAMHSA, to issue a Call to Action on the
health crisis of underage drinking.
Diabetes.--The Committee is aware and very supportive of
the Secretary's recently announced Diabetes Detection
Initiative, but is concerned about meeting the treatment needs
of all the newly diagnosed patients with diabetes. The
Committee is aware of the valuable services that certified
diabetes educators provide to newly diagnosed patients--
teaching them the necessary skills they need to self-manage the
disease throughout their life including nutrition, exercise,
blood sugar monitoring and medication management. The Committee
urges the Secretary to dedicate appropriate resources to
conduct demonstrations to measure the effectiveness of diabetes
self-management training in preventing diabetes and the
complications it causes.
HIV1-2 Rapid Testing.--The Committee is aware that wide-
scale deployment of new oral fluid testing for AIDS is a
significant step towards helping citizens, throughout the
United States and around the world, to know their HIV status.
The Committee urges the Secretary to significantly increase the
use of bulk purchasing and wide-scale deployment of FDA-
approved oral fluid HIV1-2 rapid tests for domestic and
international programs.
National Children's Study.--The Committee strongly supports
full and timely implementation of the National Children's
Study, which aims to quantify the impacts of a broad range of
environmental influences on child health and development. The
Committee urges the Department to coordinate the involvement of
the CDC and the NICHD, and to work closely with the EPA and
other interested institutes, agencies and non-Federal partners
conducting research on children's environmental health and
development so that this study is ready for the field by no
later than 2006.
Pharmacy Services.--The Committee encourages the Department
to begin a study on comprehensive pharmacy services in light of
changes in technology, distance and distributive learning
models, the aging of the population and the Department's study
on the severe pharmacist shortage in order to analyze how they
may influence the nature of pharmaceutical education and
interventions in healthcare.
Public Health Training.--The Committee is aware that public
health physicians play an important role in the Federal, State
and local public health infrastructure and are critical for
public health preparedness. However, currently there is not a
generally agreed upon model for training physicians for public
health careers. Therefore, the Committee has included $500,000
for a study by the Institute of Medicine to determine what
knowledge and skills are needed by public health physicians;
what type of training program would prepare physicians for
public health careers; how many training programs are needed to
maintain an adequate public health physician workforce; and how
these training programs should be funded.
Transportation Coordination.--The Committee notes with
approval the increased attention being paid to the coordination
of human services with transportation. The Committee notes the
recent executive order issued by the President calling for a
report on transportation coordination within 1 year. The
Committee expects the Department, as a lead agency mentioned in
the executive order, to report its finding to the Committee as
soon as the study is finished.
Vision Screening.--The Committee is concerned that many
children in the United States have uncorrected vision problems,
such as amblyopia, that can lead to difficulty in school and
permanent vision loss. Amblyopia, also known as ``lazy eye,''
is the leading cause of vision loss in young Americans, yet
many children do not receive timely diagnosis or treatment for
the condition. The Committee encourages the Secretary to
examine ways to increase the number of children that receive an
eye exam from an eye doctor in order to reduce vision loss in
children.
Adolescent Family Life
The Committee has provided $37,500,000 for the Adolescent
Family Life Program [AFL], which is $6,554,000 above the
comparable fiscal year 2004 level. The administration request
was $54,349,000.
AFL is the only Federal program focused directly on the
issue of adolescent sexuality, pregnancy, and parenting.
Through demonstration grants and contracts, AFL focuses on a
comprehensive range of health, educational, and social services
needed to improve the health of adolescents, including the
complex issues of early adolescent sexuality, pregnancy, and
parenting.
Within the total provided, the Committee has included
$2,500,000 for the development of a National Abstinence
Education Campaign. This campaign will help parents communicate
with their children about the health risks associated with
premarital activity.
Minority Health
The Committee recommends $53,351,000 for the Office of
Minority Health. The comparable level for fiscal year 2004 was
$55,190,000 and the administration request was $47,236,000.
The Office of Minority Health [OMH] focuses on strategies
designed to decrease the disparities and to improve the health
status of racial and ethnic minority populations in the United
States. OMH establishes goals, and coordinates all departmental
activity related to improving health outcomes for disadvantaged
and minority individuals. OMH supports several demonstration
projects, including the Minority Community Health Coalition,
the Bilingual/Bicultural Service, the Center for Linguistic and
Cultural Competency in Health Care, and the Family and
Community Violence Prevention Program.
The Committee continues to support the National Minority
Male Health Project and urges the Office of Minority Health to
fund a consortium of historically black colleges and
universities [HBCUs] to plan for the implementation of this
project. The Committee understands that Bowie State University,
Lincoln University, Morehouse College, Morgan State University
and Wilberforce University will be part of the initial group of
demonstration institutions. The Committee urges OMH to dedicate
adequate funds to expand support to the existing HBCUs and to
add other minority-serving institutions.
The Committee commends the OMH for establishing in 2003 a
public and private partnership to address the protective and
risk factors identified in the Aberdeen Area Infant Mortality
Study. In 2004 the Committee included $1,000,000 to reduce SIDS
disparity rates and provide risk reduction education to African
American and American Indian populations in the United States.
The Committee was pleased that the Deputy Secretary chose to
supplement the Committee's effort, resulting in an $8,650,000
infant mortality reduction initiative. However the Committee is
disappointed to note the lack of any notification about the
change in scope and direction of the $1,000,000 provided by the
Committee, nor of the diversion of funds from other maternal
and child health programs. In addition, the Committee is
concerned that the fiscal year 2005 budget justifications
include no information about the future of this initiative. The
Committee directs the Secretary to report on the progress of
the Deputy Secretary's infant mortality initiative and
specifically on the SIDS portion of that initiative no later
than July 1, 2005, and to include adequate information
pertaining to the initiative in the Department's fiscal year
2006 budget request.
Office on Women's Health
The Committee recommends $29,103,000 for the Office on
Women's Health, the same as the administration request. The
comparable level for fiscal year 2004 was $28,915,000.
The PHS Office on Women's Health [OWH] develops,
stimulates, and coordinates women's health research, health
care services, and public and health professional education and
training across HHS agencies. It advances important
crosscutting initiatives and develops public-private
partnerships, providing leadership and policy direction, and
initiating and synthesizing program activities to redress the
disparities in women's health.
The Committee remains strongly supportive of the work done
by the Office on Women's Health in the Office of the Secretary.
In addition to its own work advancing women's health, it
provides critical coordinating services with offices located in
NIH, CDC, HRSA, FDA, SAMHSA, AHRQ, and CMS. In totality, these
offices assure that issues related to research, treatment,
services, training, and education efforts by HHS reflect the
distinct needs of women. The Secretary should notify the
Committee in advance of any changes planned for the status,
location, or reporting structure of this office or any of the
offices enumerated above.
HIV/AIDS in Minority Communities
To address high-priority HIV prevention and treatment needs
of minority communities heavily impacted by HIV/AIDS, the
Committee recommends $52,838,000. This amount is $3,294,000
above the comparable fiscal year 2004 level and the same as the
administration request. These funds are available to key
operating divisions of the Department with capability and
expertise in HIV/AIDS services to assist minority communities
with education, community linkages, and technical assistance.
OFFICE OF INSPECTOR GENERAL
Appropriations, 2004.................................... $39,094,000
Budget estimate, 2005................................... 40,323,000
Committee recommendation................................ 40,323,000
The Committee recommends an appropriation of $40,323,000
for the Office of Inspector General, which is the same as the
administration request. The fiscal year 2004 comparable level
was $39,094,000. In addition to discretionary funds, the Health
Insurance Portability and Accountability Act of 1996 provides
$160,000,000 in mandatory funds for the Office of Inspector
General in fiscal year 2005; the total funds provided to the
Office by this bill and the authorizing bill would be
$200,323,000 in fiscal year 2005.
The Office of Inspector General conducts audits,
investigations, inspections, and evaluations of the operating
divisions within the Department of Health and Human Services.
The OIG functions with the goal of reducing the incidence of
waste, abuse, and fraud. It also pursues examples of
mismanagement toward the goal of promoting economy and
efficiency throughout the Department.
OFFICE FOR CIVIL RIGHTS
Appropriations, 2004.................................... $33,901,000
Budget estimate, 2005................................... 35,357,000
Committee recommendation................................ 35,357,000
The Committee recommends $35,357,000 for the Office for
Civil Rights. This is the same as the administration request.
The comparable fiscal year 2004 level was $33,901,000. The
recommendation includes the transfer of $3,314,000 from the
Medicare trust funds.
The Office for Civil Rights is responsible for enforcing
civil rights-related statutes in health care and human services
programs. To enforce these statutes, OCR investigates
complaints of discrimination, conducts program reviews to
correct discriminatory practices, and implements programs to
generate voluntary compliance among providers and constituency
groups of health and human services.
POLICY RESEARCH
Appropriations, 2004.................................... $20,750,000
Budget estimate, 2005................................... 28,750,000
Committee recommendation................................ 28,750,000
The Committee recommends $28,750,000 for policy research
funded through transfers available under section 241 of the
Public Health Service Act. The comparable program level for
fiscal year 2004 was $20,750,000. The increase in funding in
fiscal year 2005 will provide support for the National
Electronic Health Information Initiative and the Current
Population Survey.
Funds appropriated under this title provide resources for
research programs that examine broad issues which cut across
agency and subject lines, as well as new policy approaches
outside the context of existing programs. This research can be
categorized into three major areas: health policy, human
services policy, and disability, aging and long-term care
policy.
RETIREMENT PAY AND MEDICAL BENEFITS FOR COMMISSIONED OFFICERS
Appropriations, 2004.................................... $321,763,000
Budget estimate, 2005................................... 330,636,000
Committee recommendation................................ 330,636,000
The Committee provides an estimated $330,636,000 for
retirement pay and medical benefits for commissioned officers
of the U.S. Public Health Service, the same as the
administration request. The comparable level for fiscal year
2004 was $321,763,000.
This account provides for: retirement payments to U.S.
Public Health Service officers who are retired for age,
disability, or length of service; payments to survivors of
deceased officers; medical care to active duty and retired
members and dependents and beneficiaries; and for payments to
the Social Security Administration for military service
credits.
PUBLIC HEALTH AND SOCIAL SERVICES EMERGENCY FUND
Appropriations, 2004.................................... $2,164,003,000
Budget estimate, 2005................................... 2,225,058,000
Committee recommendation................................ 2,330,058,000
The Committee recommends $2,330,058,000 for the Public
Health and Social Services Emergency Fund, which is
$105,000,000 above the administration request and $166,055,000
above the comparable level for fiscal year 2004.
The Committee provides $934,454,000 to CDC for upgrading
State and local capacity. This amount is $105,106,000 above the
administration request and the same as the comparable level for
fiscal year 2004. The Committee continues to recognize that
bioterrorism events will occur at the local level and will
require local capacity, preparedness and initial response. It
is the Committee's intent that significant funding for State
and local public health infrastructure be used to improve local
public health capacity and meet the needs determined by local
public health agencies. The Committee's intent remains firm.
Because it is essential to the Nation's public health readiness
that bioterrorism funding be made available at the local level,
the Committee urges the CDC and the Department to ensure that
monies appropriated for State and local capacity building be
spent to improve local public health readiness in a manner with
which local public health officials concur. It is expected that
local public health agencies are and will continue to be full
partners in developing State plans.
Within the total for State and local capacity, the
Committee has included at least the same amount as last year
for the Health Alert Network [HAN]. To ensure that these funds
continue to be used to improve local capacity for electronic
communications and data exchange, the Committee encourages CDC
to provide adequate funding to improve public health capacity
for electronic communication and data exchange at the local
level in a manner consistent with the Public Health Information
Network and with which local public health officials concur.
This will enable enhanced local capacity that has resulted from
HAN funding to continue.
The Committee intended that one function of HAN was to
assure that essential, time-sensitive public health information
become available to both State and local public health agencies
in a timely manner. The Committee is concerned about reports
from localities, including large cities, participating in HAN
that they are not receiving all CDC-generated messages promptly
because such messages are going only to their State agencies.
Recognizing that both timeliness and redundancy in
communications are important in addressing urgent public health
concerns, the Committee strongly urges CDC to ensure that all
local public health agencies receive CDC information on the
same timely basis as do States.
Of the total amount provided, the Committee recommends
$400,000,000 for the Strategic National Stockpile, $157,183,000
for upgrading CDC capacity, $17,934,000 for anthrax vaccine
research, and $130,000,000 for biosurveillance activities.
The Committee remains concerned about the emergence of new
infectious diseases and the increasing zoonotic disease
transmission between animals and humans. As noted in last
year's report, some thirty previously unheard of infectious
diseases have been discovered in the last 30 years. Increases
in human and animal air travel and global commerce provide more
opportunities for infectious diseases like SARS, monkey pox and
avian flu to spread. The Committee notes that wild animal
veterinarians, often located at zoos in populated urban areas,
are sometimes the first to see these diseases and can
contribute significantly to the detection and understanding of
these diseases. The Committee commends the CDC's efforts to
merge surveillance systems of State diagnostic labs, veterinary
labs, wildlife health agencies and zoos, and urge the CDC to
consider the usefulness of including institutions with live
animal collections in the new biosurveillance initiative.
The Committee has again included bill language to exempt
employees of the CDC or the Public Health Service, detailed as
field assignees for purposes related to homeland security, from
full-time equivalent [FTE] employment limitations,
administrative ceilings, or targets. The effect of the bill
language is to furnish States, municipalities, and other
organizations with a sufficient number of field assignees to
implement important public health programs related to homeland
security.
The Committee's recommendation includes $64,438,000 for the
Office of the Secretary and $75,000,000 for activities to
ensure an adequate supply of vaccine in the event of an
influenza pandemic.
The Committee provides $503,649,000 to HRSA for
bioterrorism activities. Of this amount, $27,705,000 is for
curriculum development and training, and $475,944,000 is for
hospital preparedness and infrastructure improvements related
to bioterrorism. The Committee intends that States use these
funds to develop hospital preparedness in a manner that is
consistent with State and local bioterrorism preparedness
plans. The Committee expects the Department will ensure that
hospitals receiving funds have consulted with the local public
health agency (or State agency where no local agency exists)
and that the hospitals' uses of these funds are fully
coordinated with local, regional and State bioterrorism
preparedness plans.
The Committee recognizes the role community health centers
play in bioterrorism preparedness and response for millions of
underserved individuals, and therefore continues to support the
inclusion of both health centers and State and regional primary
care associations in bioterrorism preparedness and response
funding at the Federal, State and local levels.
The Committee's recommendation includes $47,400,000 for the
National Institutes of Health. These funds will be used for
research into the development of nuclear and radiological
countermeasures.
General Provisions, Department of Health and Human Services
The Committee recommendation includes language placing a
$50,000 ceiling on official representation expenses (sec. 201).
The Committee recommendation includes language carried in
fiscal year 2003 which limits the assignment of certain public
health personnel (sec. 202).
The Committee recommendation retains language regarding
set-asides in the authorizing statute of the National
Institutes of Health (sec. 203).
The Committee recommendation retains a provision carried in
fiscal year 2003 and 2004 to limit the use of grant funds to
pay individuals no more than an annual rate of Executive Level
I (sec. 204).
The Committee recommendation retains language carried in
fiscal year 2003 restricting the Secretary's use of taps for
program evaluation activities unless he submits a report to the
Appropriations Committees on the proposed use of funds (sec.
205).
The Committee recommendation includes language authorizing
the transfer of up to 2.5 percent of Public Health Service
funds for evaluation activities (sec. 206).
The Committee recommendation contains language restricting
transfers or reprogramming of appropriated funds between
programs, projects, and activities, and requires 15 day
notification to both the House and Senate Appropriations
Committees (sec. 207).
The Committee recommendation retains language carried in
fiscal year 2003 permitting the transfer of up to 3 percent of
AIDS funds among Institutes and Centers by the Director of NIH
and the Director of the Office of AIDS Research at NIH (sec.
208).
The Committee recommendation retains language which
requires that the use of AIDS research funds be determined
jointly by the Director of the National Institutes of Health
and the Director of the Office of AIDS Research and that those
funds be allocated directly to the Office of AIDS Research for
distribution to the Institutes and Centers consistent with the
AIDS research plan (sec. 209).
The Committee recommendation retains language carried in
fiscal year 2003 regarding requirements for family planning
applicants (sec. 210).
The Committee recommendation retains language which
restricts the use of funds to carry out the MedicareChoice
Program if the Secretary denies participation to an otherwise
eligible entity (sec. 211).
The Committee recommendation retains language which States
that no provider services under Title X of the PHS Act may be
exempt from State laws regarding child abuse (sec. 212).
The Committee recommendation retains language carried in
fiscal year 2004 extending the refugee status of persecuted
religious groups (sec. 213).
The Committee recommendation retains language which
prohibits the Secretary from withholding substance abuse
treatment funds (sec. 214).
The Committee recommendation includes language carried in
fiscal year 2003 which facilitates the expenditure of funds for
international AIDS activities (sec. 215).
The Committee recommendation includes a provision allowing
the Division of Federal Occupational Health to use personal
services contracting to employ professional, administrative,
and occupational health professionals (sec. 216).
The Committee recommendation includes bill language
allowing use of funds to continue operating the Council on
Graduate Medical Education (sec. 217).
The Committee recommendation retains a provision carried in
fiscal year 2004 authorizing the Director of the National
Institutes of Health to enter into certain transactions to
carry out research in support of the NIH Roadmap Initiative of
the Director (sec. 218).
The Committee recommendation includes a provision that
$10,000 of the amount provided under the Public Health Services
but may be used for official representation expenses under
sections 399 and 499 of that Act (sec. 219).
The Committee recommendation rescinds $199,900,000 of the
unobligated balance of funds appropriated by section 1016 of
the Medicare Modernization Act for a facilities loan fund. The
Committee recommendation includes funding for such activities
directly in appropriations accounts, rather than through
authorizing Committee action (sec. 220).
The Committee recommendations includes a requirement that
none of the funds provided in this Act may be expended to apply
the criteria, commonly known as the Medicare ``75 percent
rule'', that are used to determine whether a hospital or unit
of a hospital is an inpatient rehabilitation facility. The
Committee is concerned that this new rule has severe
consequences for access to inpatient services. The Committee
directs the Secretary of Health and Human Services to contract
with the Institute of Medicine of the National Academy of
Sciences to study and make recommendations on a clinical
consensus on how to modernize the Medicare criteria used to
distinguish an inpatient rehabilitation facility from an acute
care hospital and other providers of intensive medical
rehabilitation, and the appropriate medical necessity criteria
for determining clinical appropriateness of inpatient
rehabilitation facility admissions. Under the contract, the
Institute is expected to use a panel that includes a multi-
disciplinary group of expert researchers and clinicians in the
field of medical rehabilitation, and report its recommendations
to the Secretary and Congress not later than October 1, 2005
(sec. 221).
The Committee recommendation includes language authorizing
the Secretary of Health and Human Services to make
demonstration grants to accredited universities and/or
community colleges to establish summer health career
introductory programs for middle school and high school
students (sec. 222).
The Committee recommendation includes a provision
transferring $35,000,000 from the $1,000,000,000 appropriated
to HHS under the Medicare Modernization Act to the Office of
the Inspector General for work related to the oversight of that
Act (sec. 223).
TITLE III--DEPARTMENT OF EDUCATION
Education for the Disadvantaged
Appropriations, 2004.................................... $14,443,641,000
Budget estimate, 2005................................... 15,202,466,000
Committee recommendation................................ 15,500,684,000
The Committee recommends an appropriation of
$15,500,684,000 for education for the disadvantaged. The
comparable funding level for fiscal year 2004 is
$14,443,641,000 and the budget request includes $15,202,466,000
for this account.
The programs in the education for the disadvantaged account
help ensure that poor and low-achieving children are not left
behind in the Nation's effort to raise the academic performance
of all children and youth. That goal is more pressing than ever
since the passage of the No Child Left Behind Act, which
incorporates numerous accountability measures into Title I
programs, especially part A grants to local educational
agencies--the largest Federal elementary and secondary
education program.
In particular, the new law strengthens Title I
accountability by requiring States to implement statewide
accountability systems covering all public schools and
students. These systems must be based on challenging State
standards in reading and mathematics, annual statewide progress
objectives ensuring that all groups of students reach
proficiency in reading and math by the end of the 2013-14
school year, and annual testing for all students in grades 3-8.
State progress objectives and assessment results must be broken
out by poverty, race and ethnicity, disability, and limited
English proficiency. States, school districts, and schools must
report annually on their progress toward statewide proficiency
goals. Districts and schools that fail to make adequate yearly
progress [AYP] toward these goals will, over time, be subject
to increasingly rigorous improvement, corrective action, and
restructuring measures aimed at getting them back on course to
meet State standards. Students attending schools that fail to
meet annual State AYP objectives for 2 consecutive years will
be permitted to transfer to a better public school or, if the
school continues to fail to meet AYP for 3 years or more, to
use Title I funds to obtain educational services from a public-
or private-sector provider selected by their parents.
Funds appropriated in this account primarily support
activities in the 2005-2006 school year.
Grants to Local Educational Agencies
Title I Grants to Local Educational Agencies [LEAs] provide
supplemental education funding, especially in high-poverty
areas, for local programs that provide extra academic support
to help raise the achievement of eligible students or, in the
case of schoolwide programs, help all students in high-poverty
schools to meet challenging State academic standards. The
program serves more than 15 million students in nearly all
school districts and more than half of all public schools--
including two-thirds of the Nation's elementary schools.
Title I schools help students reach challenging State
standards through one of two models: ``targeted assistance''
that supplements the regular education program of individual
children deemed most in need of special assistance, or a
``schoolwide'' approach that allows schools to use Title I
funds--in combination with other Federal, State, and local
funds--to improve the overall instructional program for all
children in a school.
Starting with the fiscal year 2004 appropriation, States
are required to reserve 4 percent of their allocation under
this program for school improvement activities, double the
requirement in fiscal year 2003. States must distribute 95
percent of these reserved funds to local educational agencies
for schools identified for improvement, corrective action, or
restructuring. At the level of the Committee recommendation,
this set-aside will generate more than $520,000,000 for school
improvement activities.
More than any other Federal program, Title I grants to LEAs
are critical to the success of the No Child Left Behind Act.
The Committee recommends $13,457,607,000 for this program. The
comparable funding level for fiscal year 2004 is
$12,339,607,000 and the budget request includes $13,339,607,000
for Title I grants to LEAs. The Committee recommendation
proposes an increase of 54 percent over the amount provided
prior to passage of the No Child Left Behind Act. These Federal
resources represent the significant commitment this Committee
has made to provide the resources necessary to help all
children succeed in school.
The budget request includes bill language that authorizes
the use of $10,000,000 of Title I grants to LEAs by the
Secretary to support National Leadership activities, including
identifying and disseminating best practices undertaken by
school districts for closing the achievement gap and for
ensuring and supporting compliance with the No Child Left
Behind Act. The Committee bill does not include the requested
language.
Title I grants are distributed through four formulas:
basic, concentration, targeted, and education finance incentive
grant [EFIG].
For Title I basic grants, including the amount transferred
to the Census Bureau for poverty updates, the Committee
recommends an appropriation of $7,104,447,000. The comparable
funding level for fiscal year 2004 and the budget request are
both $7,034,890,000 for the basic grants funding stream. Basic
grants are awarded to school districts with at least 10 poor
children who make up more than 2 percent of enrollment.
The Committee bill includes language which provides
$71,557,000 from the amount made available under basic grants
to those States scheduled to receive, in aggregate, less funds
under the title I grants program for the 2004-2005 school year
than they received for the 2003-2004 school year. These funds
supplement funds previously appropriated for the 2004-2005
school year. The Committee has taken this action because of the
statutorily required change from bi-annual to annual updates
for poverty estimates that occurred this year and the
significant shifts that resulted from that statuary change.
These additional funds will allow affected States to allocate
funds for the 2004-2005 school year to offset partially reduced
allocations to many LEAs under Title I formulas.
For concentration grants, the Committee recommends an
appropriation of $1,365,031,000. The comparable funding level
for fiscal year 2004 and the budget request are both
$1,365,031,000. Funds under this program are distributed
according to the basic grants formula, except that they go only
to LEAs where the number of poor children exceeds 6,500 or 15
percent of the total school-aged population.
Last year, Congress provided all of the additional funding
for Title I grants to LEAs above the fiscal year 2003 level
through the EFIG and targeted formulas. The Committee
recommends allocating all of the increase proposed this year in
a similar manner. The Committee notes that analysis conducted
by the Congressional Research Service has demonstrated that
these formulas deliver a larger share of Title I funds to high-
poverty school districts than any other Title I formula. In
addition, the EFIG formula uses State-level ``equity'' and
``effort'' factors to make allocations to States that are
intended to encourage States to spend more on education and to
improve the equity of State funding systems. Once State
allocations are determined, suballocations to the LEA level are
based on a modified version of the targeted grants formula,
described below.
The targeted grants formula weights child counts to make
higher payments to school districts with high numbers or
percentages of poor students. For these grants, the Committee
recommends an appropriation of $2,231,954,000. The comparable
funding level for fiscal year 2004 is $1,969,843,000 and the
budget request includes $4,146,187,000 for this funding stream.
The Committee recommends an appropriation of $2,756,175,000
for education finance incentive grants. The comparable funding
level for fiscal year 2004 is $1,969,843,000 and the budget
request includes $793,499,000 for the EFIG funding stream.
William F. Goodling Even Start Family Literacy Program
The Committee does not recommend any funding in fiscal year
2005 for the Even Start program. The comparable funding level
for fiscal year 2004 is $246,910,000 and the budget request
does not include any funds for this program.
The Even Start program provides grants for family literacy
programs that serve disadvantaged families with children under
8 years of age and adults eligible for services under the Adult
Education and Family Literacy Act. Programs combine early
childhood education, adult literacy, and parenting education.
Reading First State Grants
The Committee recommends $1,062,000,000 for the Reading
First State Grants program. The comparable funding level for
fiscal year 2004 is $1,023,923,000 and the budget request
includes $1,125,000,000 for the Reading First State Grants
program. The Committee remains very supportive of the
President's goal of providing $5,000,000,000 over a 5-year
period for the Reading First program. The Committee
recommendation, in addition to amounts previously appropriated
for this program, brings the 4-year total up to $3,979,423,000.
Since President Bush took office, Federal funding for reading
programs has grown by more than 290 percent.
Reading First is a comprehensive effort to provide States
and LEAs with funds to implement comprehensive reading
instruction for children in grades K-3. The purpose of the
program is to help ensure that every child can read by the end
of third grade. LEAs and schools that receive funds under this
program should use the money to provide professional
development in reading instruction for teachers and
administrators, adopt and use reading diagnostics for students
in grades K-3 to determine where they need help, implement
reading curricula that are based on scientific research, and
provide reading interventions for children who are not reading
at grade level.
Early Reading First
The Committee recommends $110,000,000 for the Early Reading
First program. The comparable funding level for fiscal year
2004 is $94,439,000 and the budget request includes
$132,000,000 for Early Reading First.
Early Reading First complements Reading First State Grants
by providing competitive grants to school districts and
nonprofit groups to support activities in existing preschool
programs that are designed to enhance the verbal skills,
phonological awareness, letter knowledge, pre-reading skills,
and early language development of children ages 3 through 5.
Funds are targeted to communities with high numbers of low-
income families.
Striving Readers
The Committee recommends $25,000,000 for the Striving
Readers initiative. The budget request includes $100,000,000
for a new program intended to improve the reading skills of
secondary school students. This new initiative would help
develop, implement, and evaluate reading interventions for
middle- or high-school students reading significantly below
grade level. To carry out this proposed initiative, awards will
be made to partnership including institutions of higher
education, eligible nonprofit or for-profit organization and
school districts with one or more high or middle schools that
include a significant number or students reading below grade
level.
Improving Literacy Through School Libraries
The Committee recommends $22,842,000 for the Improving
Literacy Through School Libraries program. The comparable
funding level for fiscal year 2004 and the budget request both
are $19,842,000 for the Improving Literacy Through School
Libraries program.
This program provides funds for urgently needed, up-to-date
school library books and training for school library media
specialists in order to support the scientifically based
reading programs authorized by the Reading First initiative.
LEAs with a child-poverty rate of at least 20 percent are
eligible for the competitive awards. Funds may be used to
acquire school library media resources, including books and
advanced technology; facilitate resource-sharing networks among
schools and school libraries; provide professional development
for school library media specialists; and provide students with
access to school libraries during non-school hours.
Migrant Education Program
The Committee recommends $393,577,000 for the Migrant
Education program. The comparable fiscal year 2004 funding
level and the budget request are both $393,577,000 for the
Migrant Education program.
The Title I Migrant Education program authorizes grants to
State educational agencies for programs to meet the special
educational needs of the children of migrant agricultural
workers and fishermen. Funds are allocated to the States
through a statutory formula based on each State's average per-
pupil expenditure for education and actual counts of migratory
children ages 3 through 21 residing within the States in the
previous year. Only migratory children who have moved within
the last 3 years are generally eligible to be counted and
served by the program.
This appropriation also supports activities to improve
interstate and intrastate coordination of migrant education
programs, as well as identifying and improving services to the
migrant student population.
Neglected and Delinquent
The Committee recommends $52,000,000 for the Title I
neglected and delinquent program. The comparable funding level
for fiscal year 2004 and the budget request both are
$48,395,000 for the neglected and delinquent program.
This program provides financial assistance to State
educational agencies for education services to neglected and
delinquent children and youth in State-run institutions and for
juveniles in adult correctional institutions. Funds are
allocated to individual States through a formula based on the
number of children in State-operated institutions and per-pupil
education expenditures for the State.
States are authorized to set aside at least 15 percent, but
not more than 30 percent, of their neglected and delinquent
funds to help students in State-operated institutions make the
transition into locally operated programs and to support the
successful reentry of youth offenders, who are age 20 or
younger and have received a secondary school diploma or its
recognized equivalent. Reentry activities may include
strategies designed to expose the youth to, and prepare the
youth for, postsecondary education, or vocational and technical
training programs. The Committee urges the Secretary to provide
appropriate technical assistance to States in identifying and
implementing best practices for effectively utilizing funds
available for transition services and other activities.
Under the No Child Left Behind Act, the Congress provided
the Secretary with the authority to reserve up to 2.5 percent
of the appropriation for national activities. The Committee
urges the Secretary to fully utilize this authority to support
capacity building in and dissemination of best practices to
State agency programs and to develop a uniform model for
evaluating State performance under this program.
Evaluation
The Committee recommends $9,500,000 for evaluation of Title
I programs. The comparable funding level for fiscal year 2004
is $8,790,000 and the budget request includes $9,500,000 for
such activities.
Evaluation funds are used to support large-scale national
surveys that examine how the Title I programs are contributing
to student academic achievement. Funds also are used to
evaluate State assessment and accountability systems and
analyze the effectiveness of educational programs supported
with Title I funds.
The Committee bill includes language that provides the
Secretary with authority to use funds for technical assistance
to State and local educational agencies. The Committee
encourages the Secretary to focus these funds on disseminating
best practices through school leadership, supporting
professional development, and identifying and disseminating
exceptional methods used to communicate with parents.
Assistance for Local School Improvement
The Committee recommendation includes $100,000,000 for the
Assistance for Local School Improvement program. This program
has not been funded previously and the budget request did not
include any funds for this purpose.
The Assistance for Local School Improvement program was
authorized by the No Child Left Behind Act. This program
authorizes the Secretary to make grants to States for
additional assistance to school districts identified for
improvement. Funds may be used to support the implementation of
school improvement plans, public school choice, supplemental
services or other activities related to schools identified for
improvement.
Together with more than $520,000,000 available through the
school improvement set aside required from State Title I
allocations, these funds will provide a record level of Federal
support for assisting schools identified for improvement and
supporting public school choice and supplemental services for
students in low performing schools.
Comprehensive School Reform Demonstration
The Committee recommends $233,613,000 for the comprehensive
school reform demonstration program. The comparable funding
level for fiscal year 2004 is $233,613,000 and the budget
request did not include any funds for the comprehensive school
reform program.
This program provides schools with funding to develop or
adopt, and implement, comprehensive school reforms that will
enable children in participating schools to meet State
standards. The Department allocates funds to States based on
their relative shares of the previous year's Title I basic
grants funds.
High School Equivalency Program
The Committee recommends $18,888,000 for the high school
equivalency program [HEP]. The comparable funding level for
fiscal year 2004 and the budget request both are $18,888,000
for the HEP.
This program provides 5-year grants to institutions of
higher education and other nonprofit organizations to recruit
migrant students ages 16 and over and provide the academic and
support services needed to help them obtain a high school
equivalency certificate and subsequently gain employment, win
admission to a postsecondary institution or a job-training
program, or join the military. Projects provide counseling,
health services, stipends, and placement assistance. At the
budget request, HEP will serve roughly 5,500 migrants.
College Assistance Migrant Program
For the College Assistance Migrant Program [CAMP], the
Committee recommends $15,657,000. The comparable funding level
for fiscal year 2004 and the budget request both are
$15,657,000 for the CAMP.
Funds provide 5-year grants to institutions of higher
education and nonprofit organizations for projects that provide
tutoring, counseling, and financial assistance to migrant
students during their first year of postsecondary education.
Projects also may use up to 10 percent of their grants for
follow-up services after students have completed their first
year of college, including assistance in obtaining student
financial aid.
Impact Aid
Appropriations, 2004.................................... $1,229,527,000
Budget estimate, 2005................................... 1,229,527,000
Committee recommendation................................ 1,229,527,000
The Committee recommends an appropriation of $1,229,527,000
for impact aid for the Department of Education. The comparable
funding level for fiscal year 2004 and the budget request both
are $1,229,527,000 for the impact aid account.
Impact aid provides financial assistance to school
districts for the costs of educating children when enrollments
and the availability of revenues from local sources have been
adversely affected by the presence of Federal activities.
Children who reside on Federal or Indian lands generally
constitute a financial burden on local school systems because
these lands do not generate property taxes--a major revenue
source for elementary and secondary education in most
communities. In addition, realignments of U.S. military forces
at bases across the country often lead to influxes of children
into school districts without producing the new revenues
required to maintain an appropriate level of education.
The Committee notes that the administration is working to
develop an ``analysis plan'' to measure the performance of the
Impact Aid program. The Committee is committed to utilizing
performance outcome information to assess the effectiveness of
Federal programs and to determine their appropriate funding
levels. Therefore, the Committee requests a copy of the
``analysis plan'' as soon as it is available, and also expects
appropriate discussion of activities related to the plan to be
included in the fiscal year 2006 Justifications of
Appropriation Estimates to the Congress.
Basic Support Payments.--The Committee recommends
$1,063,687,000 for basic support payments. The comparable
funding level for fiscal year 2004 and the budget request both
are $1,063,687,000. Under this statutory formula, payments are
made on behalf of all categories of federally connected
children, with a priority placed on making payments first to
heavily impacted school districts and providing any remaining
funds for regular Basic Support Payments.
Payments for Children with Disabilities.--Under this
program, additional payments are made for certain federally
connected children eligible for services under the Individuals
with Disabilities Education Act. The Committee bill includes
$50,369,000 for this purpose. The comparable funding level and
the budget request both are $50,369,000.
Facilities Maintenance.--This activity provides funding for
emergency repairs and comprehensive capital improvements to
certain school facilities owned by the Department of Education
and used by local educational agencies to serve federally
connected military dependent students. The Committee recommends
$7,901,000. The comparable funding level for fiscal year 2004
and the budget request both are $7,901,000 for this purpose.
Funds appropriated for this purpose are available until
expended.
Construction.--Formula and competitive grants are awarded
to eligible LEAs for emergency repairs and modernization of
school facilities. The Committee recommends $45,936,000 for
this program. Funds appropriated for the construction activity
are available for obligation for a period of 2 years. The
comparable fiscal year 2004 funding level and the budget
request both are $45,936,000 for construction activities.
Payments for Federal Property.--These payments compensate
local educational agencies in part for revenue lost due to the
removal of Federal property from local tax rolls. Payments are
made to LEAs that have a loss of tax base of at least 10
percent of assessed value due to the acquisition since 1938 of
real property by the U.S. Government. The Committee recommends
$61,634,000 for this activity. The comparable funding level for
fiscal year 2004 and the budget request both are $61,634,000
for this program.
School Improvement Programs
Appropriations, 2004.................................... $5,872,847,000
Budget estimate, 2005................................... 5,955,561,000
Committee recommendation................................ 5,770,632,000
The Committee recommends an appropriation of $5,770,632,000
for school improvement programs. The comparable funding level
in fiscal year 2004 for this account is $5,872,846,000 and the
budget request includes $5,955,561,000.
State Grants for Improving Teacher Quality
The No Child Left Behind Act requires States to ensure that
all teachers teaching in core academic subjects are ``highly
qualified'' by the end of the 2005-2006 school year. The
Committee recommends $2,975,126,000 for State grants for
improving teacher quality. The comparable funding level for
fiscal year 2004 and the budget request both are
$2,930,126,000.
Under the Committee recommendation, funding for programs
that specifically support high-quality professional development
for teachers and school leadership will have increased by 43
percent since passage of the No Child Left Behind Act. The
Committee recommendation for fiscal year 2005 includes
$3,640,034,000 for such activities in recognition of the
critical role that these individuals occupy in educating the
Nation's children and the significant academic benefit that
students may derive from the presence of a highly qualified
teacher in their classroom. In addition, State and local
educational agencies have considerable flexibility to use funds
from their Title I grants to LEAs allocations, as well as other
State grant program dollars in support of high-quality
professional development opportunities.
States and LEAs may use the funds for a range of activities
related to the certification, recruitment, professional
development, and support of teachers and administrators.
Activities may include reforming teacher certification and
licensure requirements, addressing alternative routes to State
certification of teachers, recruiting teachers and principals,
and implementing teacher mentoring systems, teacher testing,
merit pay, and merit-based performance systems.
These funds may also be used by districts to hire teachers
to reduce class sizes. The Committee recognizes that smaller
classes, particularly in the early grades, can have a positive
impact on students by improving classroom discipline, providing
students with more individualized attention, and allowing
parents and teachers to work more closely together. Funds
within the teacher quality State grants program may be used to
continue this commitment to our Nation's students, parents, and
teachers, without taking away from other efforts to invest in
professional development.
Early Childhood Educator Professional Development
The Committee recommends $14,814,000 to support
professional development activities for early childhood
educators and caregivers in high-poverty communities. The
comparable funding level for fiscal year 2004 and the budget
request are both $14,814,000 for this program. From this
appropriation, the Secretary makes competitive grants to
partnerships of early childhood and family literacy caregivers
and educators in order to provide high quality, sustained and
intensive professional development for early childhood
educators to help them provide developmentally appropriate
school-readiness services for preschool-age children.
Mathematics and Science Partnerships
The Committee recommends $200,000,000 for the mathematics
and science partnerships program. The comparable funding level
for fiscal year 2004 is $149,115,000 and the budget request
includes $269,115,000 for this purpose. These funds will be
used to improve the performance of students in the areas of
math and science by bringing math and science teachers in
elementary and secondary schools together with scientists,
mathematicians, and engineers to increase the teachers'
subject-matter knowledge and improve their teaching skills.
When the appropriation for this program is $100,000,000 or
greater, the Secretary is authorized to award grants to States
by a formula which includes consideration of the number of
children aged 5 to 17 below the poverty line. States then are
required to make grants competitively to eligible partnerships
to enable the entities to pay the Federal share of the costs of
developing or redesigning more rigorous mathematics and science
curricula that are aligned with State and local standards;
creating opportunities for enhanced professional development
that improves the subject-matter knowledge of math and science
teachers; recruiting math and science majors; and improving and
expanding training of math and science teachers, including the
effective integration of technology into curricula and
instruction.
The budget request includes a legislative proposal to allow
the Secretary to use $120,000,000 in appropriated funds to make
competitive awards to projects designed to improve the
mathematics learning of secondary students. The Committee has
not provided this requested authority.
Innovative Education Program Strategies State Grants
The Committee does not recommend any funding for innovative
education program strategies State grants. The comparable
funding level for fiscal year 2004 and the budget request both
are $296,549,000 for this purpose. The Committee recommendation
does not provide an appropriation for this source of funding
due to the significantly enhanced flexibility authorized under
No Child Left Behind, the lack of evidence of effectiveness in
contributing to improved student learning and the importance of
investments in other areas where a system for measuring program
performance is in place.
The innovative education program is a flexible source of
Federal funds that provides support to States and LEAs in
developing education reform initiatives that will improve the
performance of students, schools, and teachers.
The Committee notes that States and LEAs may transfer funds
into this State grant program for authorized activities
described in Part A of Title V of the Elementary and Secondary
Education Act, even though no funding is provided in this
fiscal year 2005 appropriations bill. The Committee encourages
States and LEAs to transfer funds from one of the eligible
State grant programs if they believe Federal funds can be
better utilized under this authority to improve the academic
achievement of all students.
Educational Technology State Grants
The Committee recommends $691,841,000 for educational
technology State grants. The comparable funding level for
fiscal year 2004 and the budget request both are $691,841,000
for this program.
The educational technology State grants program supports
efforts to integrate technology into curricula to improve
student learning. Funds flow by formula to States and may be
used for the purchase of hardware and software, teacher
training on integrating technology into the curriculum, and
efforts to use technology to improve communication with
parents, among other related purposes. An LEA must use at least
25 percent of its formula allocation for professional
development in the integration of technology into the curricula
unless it can demonstrate that it already provides such high-
quality professional development.
21st Century Community Learning Centers
The Committee recommends an appropriation of $1,007,000,000
for the 21st Century Community Learning Centers program. The
comparable funding level for fiscal year 2004 and the budget
request both are $999,070,000 for this program.
Funds are allocated to States by formula, which in turn,
award at least 95 percent of their allocations to local
educational agencies, community-based organizations and other
public and private entities. Grantees use these resources to
establish or expand community learning centers that provide
activities offering significant extended learning
opportunities, such as before- and after-school programs,
recreational activities, drug and violence prevention and
family literacy programs for students and related services to
their families. Centers must target their services on students
who attend schools that are eligible to operate a schoolwide
program under Title I of the Elementary and Secondary Education
Act or serve high percentages of students from low-income
families.
State Assessments and Enhanced Assessment Instruments
The Committee recommends $420,000,000 for State
assessments. The comparable funding level for fiscal year 2004
is $390,000,000 and the budget request includes $410,000,000
for such activities.
A key accountability measure in the No Child Left Behind
Act requires annual State assessments in reading and
mathematics for all students in grades 3-8 beginning in the
2005-2006 school year. The new assessments will be used to
determine whether States, LEAs, and schools are making adequate
yearly progress toward the goal of helping all students attain
proficiency within 12 years of the 2001-2002 school year.
This program has two components. The first provides formula
grants to States to pay the cost of developing standards and
assessments required by the new law. The statute includes
funding ``trigger amounts'' for fiscal years 2002-2007; States
may defer the new assessments if the appropriation falls below
the trigger level. The trigger for fiscal year 2004 is
$390,000,000 and it rises to $400,000,000 in fiscal year 2005.
The Committee recommendation includes $400,000,000 for this
purpose.
Under the second component of State assessments--Grants for
Enhanced Assessment Instruments--appropriations in excess of
the trigger level are used for a competitive grant program
designed to support efforts by States to improve the quality
and fairness of their assessment systems. The Committee
recommendation for the second component is $20,000,000. The
budget request included $10,000,000 for enhanced assessment
instruments. No funds were appropriated for this purpose in
fiscal year 2004.
The Committee is concerned that many schools are unable to
properly assess the performance of students with disabilities
and students with limited English proficiency. Therefore, the
Committee urges the Department to place a high priority on
grant applications that aim to improve the quality of State
assessments for these two groups of students and to ensure the
most accurate means of measuring their performance on these
assessments.
The Committee recommends that grants should be used for
such activities as developing alternate assessments for
students with disabilities and for students with limited
English proficiency; developing appropriate accommodations to
ensure the full participation of these two groups of students
in State assessments; and developing universally designed
assessments that are accessible and valid for the widest
possible range of students, including students with
disabilities and students with limited English proficiency.
The Committee also recommends that States that receive
grants should submit a report to the Secretary regarding the
participation of students with disabilities and/or students
with limited English proficiency in State assessment programs
and changes, if any, in these students' achievement levels as a
result of more accurate assessments.
Statewide Data Systems
The Committee recommendation includes $40,000,000 for
Statewide Data Systems. This program was not funded previously
and the budget request did not include any funds for this
purpose.
The Educational Technical Assistance Act authorized a
competitive grant program to State Educational Agencies to
enable such agencies to design, develop, and implement
statewide, longitudinal data systems to manage, analyze,
disaggregate, and use individual student data. The Committee
believes these funds are necessary to help States measure
individual student performance, particularly as it relates to
adequate yearly progress goals, more efficiently and
accurately. The Committee urges the Department to establish a
priority for those States that currently have the most limited
ability to collect, analyze and report student achievement data
when considering applications for funds available through this
program.
Javits Gifted and Talented Education
The Committee recommends $12,111,000 for the Javits Gifted
and Talented Students Education Program. The comparable fiscal
year 2004 funding level is $11,111,000 and the President's
budget proposes to eliminate funding for this program. Funds
are used for awards to State and local education agencies,
institutions of higher education, and other public and private
agencies for research, demonstration, and training activities
designed to enhance the capability of elementary and secondary
schools to meet the special educational needs of gifted and
talented students.
Foreign Language Assistance
The Committee recommends $19,000,000 for the Foreign
Language Assistance program. The comparable funding level for
fiscal year 2004 is $16,546,000 and the budget request proposes
eliminating funds for foreign language assistance activities.
Funds from this program support competitive grants to
increase the quality and quantity of foreign language
instruction. At least 75 percent of the appropriation must be
used to expand foreign language education in the elementary
grades. The Committee intends that none of the Foreign Language
Assistance program funds shall be used for the Foreign Language
Incentive program. The Committee is concerned that this
program, which is the only Federal program designed to help
schools meet the need for foreign language instruction, is
unavailable to the poorest schools because grant recipients
must provide a 50 percent match from non-Federal sources. The
Committee, therefore, encourages the Secretary to use his
ability to waive the matching requirement for qualifying
schools and to increase awareness of this accommodation among
the affected school population.
Education for Homeless Children and Youth
For carrying out education activities authorized by Title
VII, subtitle B of the Stewart B. McKinney Homeless Assistance
Act, the Committee recommends $62,000,000. The comparable
fiscal year 2004 funding level and the budget request both are
$59,646,000.
This program provides assistance to each State to support
an office of the coordinator of education for homeless children
and youth, to develop and implement State plans for educating
homeless children, and to make subgrants to LEAs to support the
education of those children. Grants are made to States based on
the total that each State receives in Title I grants to LEAs.
Under the McKinney-Vento Homeless Children and Youths
Program, State educational agencies [SEAs] must ensure that
homeless children and youth have equal access to the same free
public education, including a public preschool education, as is
provided to other children and youth. States must review and
undertake steps to revise any laws, regulations, practices, or
policies that may act as barriers to the enrollment,
attendance, or success in school of homeless children and
youth.
Training and Advisory Services
For training and advisory services authorized by Title IV
of the Civil Rights Act, the Committee recommends $7,243,000.
The comparable fiscal year 2004 funding level and the budget
request both are $7,243,000 for these services.
The funds provided will support a new competition for
awards to operate the 10 regional equity assistance centers
[EACs]. Each EAC provides services to school districts upon
request. Activities include disseminating information on
successful practices and legal requirements related to
nondiscrimination on the basis of race, color, sex, or national
origin in education programs.
Education for Native Hawaiians
For programs for the education of Native Hawaiians, the
Committee bill includes $36,000,000. The comparable fiscal year
2004 funding level and the budget request are both $33,302,000
for these programs.
The Committee bill includes language allowing funds to be
used for construction and renovation of Native Hawaiian
educational facilities.
The Committee recognizes the important role that the Native
Hawaiian Education Council plays in coordinating services,
conducting needs assessments, and providing direction and
guidance on educational and related services available to
Native Hawaiians, including the activities assisted under this
program. The Committee urges the Secretary to continue working
with the Council to help it meet its congressionally-mandated
mission, and, in particular, focus on helping create an
appropriate mechanism for prioritizing activities within the
Council's jurisdiction.
The Committee encourages opportunities and educational
programs be provided to restore cultural pride and stimulate
the development of leadership skills by celebrating the Native
Hawaiian heritage and seafaring traditions as long distance
voyagers and ocean navigators.
Of all the indigenous languages of the United States, the
Hawaiian language has the most extensive written resources
preserved. It has come to the attention of the Committee that a
number of Hawaiian academic, cultural, and educational
organizations have joined together to preserve and develop
these written resources for contemporary use. Many of these
traditional perspectives and practices could have practical
application in resolving environmental management, medical and
natural resource challenges. The Committee urges attention in
this area.
The Committee is interested in the preservation and
recording of Hawaiian history through storytelling and
encourages support for efforts underway in Hawaii to perpetuate
these collections. The Committee also encourages efforts toward
the preservation and documentation of Native Hawaiian
traditional cultural healing practices.
Fathering Programs.--In 1997, a Department of Education
study found that children realize greater educational success
when fathers are involved in their child's education. The
Committee urges the Secretary devote special attention to this
subject through this grant program, as there are no competitive
grants for fathering programs. The Committee realizes great
value in fathering programs as they seek to improve the lives
of children by inspiring and equipping men to be more
effectively engaged in the lives of children.
Native Hawaiian Law Center of Excellence.--The Committee is
very pleased with the efforts underway to establish a Center of
Excellence in Native Hawaiian Law.
Prisoner Education.--Native Hawaiians continue to represent
a major, if not the largest, ethnic group in the State's prison
system. The Committee recognizes the importance of
reintegrating Native Hawaiian youth into school settings or
onto a career path and job placement through comprehensive,
culturally sensitive individual and family counseling;
educational skills training; and employment training/job
placement. Significant progress has resulted over the past
several years. Efforts should target Native Hawaiian youth in
districts with high percentages of school dropouts and youth
offenders.
The numbers of Hawaiian language immersion schools and
Hawaiian charter schools continue to increase as more families
are opting to more closely integrate culture, language and
education. The Committee is interested in greater development
of curriculum especially at the early education and secondary
levels, increasing the number of teachers certified in Hawaiian
language, and disseminating best practices to this growing
community of schools from pre-K through 12th grade.
Alaska Native Educational Equity
The Committee recommends $36,000,000 for the Alaska Native
educational equity assistance program. The comparable fiscal
year 2004 funding level and the budget request both are
$33,302,000 for this purpose.
These funds address the severe educational handicaps of
Alaska Native schoolchildren. Funds are used for the
development of supplemental educational programs to benefit
Alaska Natives. The Committee bill includes language which
allows funding provided by this program to be used for
construction. The Committee expects the Department to use some
of these funds to address the construction needs of rural
schools.
Rural Education
The Committee recommends $175,000,000 for rural education
programs. The comparable fiscal year 2004 funding level and
budget request both are $167,831,000 for these programs.
The Committee strongly supports the continued use of
Federal funding specifically for rural education. Rural schools
face difficult challenges in meeting the mandates in the No
Child Left Behind Act, particularly in the areas of attracting
highly qualified teachers and adapting to new assessment
requirements and reporting expectations. The rural education
programs are intended to help level the playing field for small
and high-poverty rural school systems that typically receive
less Federal formula funding than their urban and suburban
counterparts, and are frequently unable to compete for
competitive grants. In addition to providing more total funding
for such districts, the program also allows these districts to
combine funds from four categorical programs and use the money
to address their highest priorities, such as recruiting
teachers, purchasing technology, or upgrading curricula.
The Committee expects that rural education funding will be
equally divided between the Small, Rural Schools Achievement
Program, which provides funds to LEAs that serve a small number
of students, and the Low-Income and Rural Schools Program,
which provides funds to LEAs that serve concentrations of poor
students, regardless of the number of students served.
Comprehensive Centers
The Committee recommends $57,283,000 for the comprehensive
centers program. The comparable fiscal year 2004 funding level
and budget request are both $27,654,000 for such activities.
The budget request would support a new comprehensive
centers program, which would be comprised of not less than 20
centers with at least one in each of the 10 regions of the
United States. The centers, which would be operated by research
organizations, agencies, institutions of higher education or
partnerships thereof, would provide training and technical
assistance to States, LEAs, and schools as identified through
needs assessments undertaken in each region.
The new comprehensive centers program, as authorized by the
Educational Technical Assistance Act of 2002, would replace the
comprehensive regional assistance centers, the Eisenhower
regional mathematics and science consortia, the Eisenhower
National Clearinghouse for Mathematics and Science Education,
and the regional technology in education consortia which are no
longer authorized activities. The comprehensive regional
assistance centers provide technical assistance and training
through a network of 15 university-based or non-profit centers.
The Eisenhower regional mathematics and science consortia
program supports 10 regional centers that disseminate
information about exemplary mathematics and science
instructional materials, provide technical assistance on
teaching methods and assessment tools and build networks of
mathematics and science resources. The Mathematics and Science
Clearinghouse is a resource for mathematics and science
educators. The regional technology in education consortia
program supports 10 regional centers that disseminate
information and resources and provide training to States,
school districts, and schools with a large number of
disadvantaged students with limited access to technology.
Fiscal year 2005 funds will be used to continue funding for
existing grantees and support grants to carry out the new
comprehensive centers program. The Committee believes it is
important that training and technical assistance continue to be
of high-quality and accessible to school districts during this
transition year.
Supplemental Education Grants
The Committee recommendation includes $17,214,000 for the
supplemental education grants program. The comparable funding
level for fiscal year 2004 and the budget request both are
$15,068,000. This grant program was authorized by the Compact
of Free Association Amendments Act of 2003. The Act
discontinued the eligibility of Republic of Marshall Islands
and the Federated States of Micronesia for funding available
from Adult, Dislocated Worker and Youth Workforce Investment
Act programs, Head Start, Title I Grants to LEAs, Adult and
Vocational Education State Grants, Federal Work-Study and
Federal Supplemental Educational Opportunities Grants. In place
of funding from these sources, the Act provided a separate
supplemental education grant program that provides these
entities with a more flexible source of funds that can be
tailored to local needs. These funds will be transferred from
the Department of Education to the Secretary of Interior for
grants to these entities, and up to 10 percent may be used for
oversight and technical assistance, which may include
reimbursement of the Departments of Labor, Health and Human
Services and Education for such services. Of the funds
appropriated, $11,717,000 is for the Federated States of
Micronesia and $5,497,000 is for the Republic of the Marshall
Islands.
The Committee also has included bill language to clarify
the intent of section 105(f)(1)(B)(ix) of the Compact of Free
Association Amendments Act that the government, institutions,
and people of Palau shall continue to be eligible, and to
receive assistance in fiscal year 2005, as they have up to and
including fiscal year 2004.
Indian Education
Appropriations, 2004.................................... $120,856,000
Budget estimate, 2005................................... 120,856,000
Committee recommendation................................ 120,856,000
The Committee recommends $120,856,000 for Indian Education
programs. The comparable fiscal year 2004 funding level and the
budget request both are $120,856,000 for such activities.
Grants to Local Education Agencies
For grants to local education agencies, the Committee
recommends $95,933,000. The comparable fiscal year 2004 funding
level and the budget both are $95,933,000.
These funds provide financial support to elementary and
secondary school programs that serve Indian students, including
preschool children. Funds are awarded on a formula basis to
local educational agencies, schools supported and operated by
the Bureau of Indian Affairs and in some cases directly to
Indian Tribes.
Special Programs for Indian Children
The Committee recommends $19,753,000 for special programs
for Indian children. The comparable fiscal year 2004 funding
level and the budget request both are $19,753,000.
Funds are used for demonstration grants to improve Indian
student achievement through early childhood education and
college preparation programs, and for professional development
grants for training Indians who are preparing to begin careers
in teaching and school administration.
National Activities
The Committee recommends $5,170,000 for national
activities. The comparable fiscal year 2004 amount and the
budget request both are $5,170,000 for authorized activities.
Funds will be used to expand efforts to improve research,
evaluation, and data collection on the status and effectiveness
of Indian education programs.
Innovation and Improvement
Appropriations, 2004.................................... $1,102,627,000
Budget estimate, 2005................................... 885,181,000
Committee recommendation................................ 1,144,346,000
The Committee recommends an appropriation of $1,144,346,000
for programs within the innovation and improvement account. The
comparable fiscal year 2004 funding level for these programs is
$1,102,627,000 and the budget request includes $885,181,000 for
this account.
Troops-to-Teachers
The Committee recommends an appropriation of $14,912,000
for the Troops-to-Teachers program. The comparable funding
level for fiscal year 2004 and the budget request both are
$14,912,000 for this program.
This program supports the Defense Department's Troops to
Teachers program, which helps recruit and prepare retiring and
former military personnel to become highly qualified teachers
serving in high-poverty school districts. The Secretary of
Education transfers program funds to the Department of Defense
for the Defense Activity for Non-Traditional Education Support
to provide assistance, including stipends of up to $5,000 and
bonuses of up to $10,000, to eligible members of the Armed
Forces so that they can obtain teacher certification or
licensing. In addition, the program helps these individuals
find employment in a school.
Transition to Teaching
The Committee recommends $45,295,000 for the transition to
teaching program. The comparable fiscal year 2004 funding level
and the budget request both are $45,295,000 for this program.
This program provides grants to help support efforts to
recruit, train, and place nontraditional teaching candidates
into teaching positions and to support them during their first
years in the classroom. In particular, this program is intended
to attract mid-career professionals and recent college
graduates. Program participants are placed in high-need schools
in high-need LEAs.
National Writing Project
The Committee recommends $24,000,000 for the national
writing project. The comparable funding level for fiscal year
2004 is $17,894,000 and the budget request proposes to
eliminate Federal funding for this program.
These funds are awarded to the National Writing Project, a
nonprofit organization that supports and promotes K-16 teacher
training programs in the effective teaching of writing. From
the funds provided by the fiscal year 2005 appropriation, the
Committee intends that $500,000 shall be used to continue
support for the pilot program on the integration of technology
training in the NWP program.
Teaching of Traditional American History
The Committee recommends $120,000,000 for the teaching of
traditional American history program. The comparable fiscal
year 2004 funding level and the budget request are both
$119,292,000 for this activity. This program supports
competitive grants to LEAs, and funds may be used only to
undertake activities that are related to American history, and
cannot be used for social studies coursework. Grant awards are
designed to augment the quality of American history instruction
and to provide professional development activities and teacher
education in the area of American history. The Committee
directs the Department to continue its current policy of
awarding 3-year grants.
School Leadership
The Committee recommends $16,000,000 for the school
leadership program. The comparable fiscal year 2004 funding
level is $12,346,000 and the budget request proposes to
eliminate funding for this program. This program provides
competitive grants to assist high-need LEAs to recruit and
train principals and assistant principals through activities
such as professional development and training programs. The
Committee continues to recognize the critical role that
principals and assistant principals play in creating an
environment that fosters effective teaching and high academic
achievement.
Advanced Credentialing
The Committee recommends $17,000,000 for the advanced
credentialing program. The comparable fiscal year 2004 funding
level is $18,391,000 and the budget request includes $7,000,000
for one component of the authorized program.
The Committee recommendation includes $10,000,000 for the
National Board for Professional Teaching Standards [NBPTS]. The
comparable fiscal year 2004 funding level is $9,941,000 and the
budget request proposes to eliminate funding for the National
Board. Funds available assist the Board's work in providing
financial support to States for teachers applying for
certification, increasing the number of minority teachers
seeking certification and developing outreach programs about
the advanced certification program. The fiscal year 2005
appropriation will support a new grant for the National Board
for Professional Teaching Standards.
The Committee notes that a new independent study, in part
funded by the U.S. Department of Education and released in
March 2004, found that the NBPTS assessment process is
effectively identifying those teachers who contribute to
relatively larger student learning gains, particularly in the
early grades and among the poorest of students. The Committee
continues its strong support for the NBPTS due to its proven
success in identifying teachers who make significant gains in
student learning and achievement, which has been established
through a higher standard of research and validation than any
other professional board in the United States. Federal funds
are a critical supplement to the 50 States and more than 500
school districts across the nation that have implemented
policies, regulations and financial incentives to recruit,
reward and retain National Board Certified Teachers.
The Committee recommendation also includes $7,000,000 for
the American Board for the Certification of Teacher Excellence
[ABCTE] to continue development of its Initial Certification
and Master Certification programs. Fiscal year 2005 funding
represents the third year of a 5-year grant to the ABCTE. The
Committee expects the Department to continue to prepare for an
independent evaluation of the activities undertaken by the
ABCTE. The Committee expects the Department to include
information in the 2006 Congressional Justification about
actions taken to evaluate ABCTE's activities.
Charter Schools Grants
The Committee recommends $218,702,000 for the support of
charter schools. The comparable fiscal year 2004 funding level
and the budget request both are $218,702,000 for this program.
This program supports the planning, development, and
initial implementation of charter schools, which are public
schools that receive exemption from many statutory and
regulatory requirements in exchange for promising to meet
agreed-upon accountability measures. State educational agencies
that have the authority under State law to approve charter
schools are eligible to compete for grants. If an eligible SEA
does not participate, charter schools from the State may apply
directly to the Secretary. The authorizing statute requires
that amounts appropriated in excess of $200,000,000 and less
than $300,000,000 be used for 5-year competitive grants to
States that operate per-pupil facilities aid programs for
charters schools. Federal funds are used to match State funded
programs in order to provide charter schools with additional
resources for charter school facilities financing.
Credit Enhancement for Charter School Facilities
The Committee recommends $37,279,000 to assist charter
schools with their facility needs. The comparable funding level
for fiscal year 2004 is $37,279,000 and the budget request
includes $100,000,000 for this purpose. The Committee notes
that the authorization for this program expires during fiscal
year 2004.
This program provides assistance to help charter schools
meet their facility needs. Funds are provided on a competitive
basis to public and non-profit entitities, to leverage non-
Federal funds that help charter schools obtain school
facilities through purchase, lease, renovation and
construction.
Voluntary Public School Choice
The Committee recommends $26,757,000 for the voluntary
public school choice program. The comparable funding level for
fiscal year 2004 and the budget request both are $26,757,000
for this purpose.
This program supports efforts by States and school
districts to establish or expand State-or district-wide public
school choice programs, especially for parents whose children
attend low-performing public schools.
Magnet Schools Assistance
The Committee recommends $108,640,000 for the magnet
schools assistance program. The comparable fiscal year 2004
funding level and the budget request are both $108,640,000 for
this purpose.
This program supports grants to local educational agencies
to establish and operate magnet schools that are part of a
court-ordered or federally approved voluntary desegregation
plan. Magnet schools are designed to attract substantial
numbers of students from different social, economic, ethnic,
and racial backgrounds. Grantees may use funds for planning and
promotional materials, teacher salaries, purchase of computers,
and other educational materials and equipment.
Choice Incentive Fund
The Committee does not recommend any funding for this
proposed program, which is not specifically authorized. The
budget request includes $50,000,000 for this purpose. Through
this proposed program, funds would be used to award competitive
grants to establish or expand public or private school choice
opportunities.
Fund for the Improvement of Education
The Committee recommends an appropriation of $446,746,000
for the Fund for the Improvement of Education [FIE]. The
comparable funding level for fiscal year 2004 is $430,270,000
and the budget request includes $120,185,000 for comparable
activities.
The Committee recommendation includes $700,000 for the
National Institute of Building Sciences to continue operation
of the National Clearinghouse for Educational Facilities, the
Nation's sole source for comprehensive information about school
planning, design, financing, construction and maintenance. The
Committee recommends an additional $300,000 for this purpose
within Safe and Drug-Free Schools and Communities National
Programs to address issues related to school safety and healthy
school buildings.
The Committee recommends $27,000,000 to award a contract to
Reading Is Fundamental, Inc. [RIF] to provide reading-
motivation activities. The comparable funding level for fiscal
year 2004 and the budget request both are $25,185,000 for this
purpose. RIF, a private nonprofit organization, helps prepare
young children and motivate older children to read, through
activities including the distribution of books. Federal funds
provide up to 75 percent of the costs of books, except for
migrant and seasonal farmworker programs which may receive up
to 100 percent of the costs of books.
The administration proposes $10,000,000 for a military
families initiative under the fund for the improvement of
education program. Under this new categorical grant program,
the Department of Education would make competitive grants to
consortia of States, local educational agencies, and other
public and non-profit organizations, to address the challenges
faced by students from military families and ease their
transitions to new schools. Due to budget constraints, the
Committee recommendation does not include funds for this
purpose.
The administration proposes $40,000,000 for a new adjunct
teacher corps initiative. Through this new categorical grant
program, the Department of Education would make competitive
grants to partnerships of school districts and public and
private institutions to create opportunities for professionals
to teach secondary-school courses in the core academic
subjects, particularly math and science. Due to budget
constraints, the Committee recommendation does not include
funds for this purpose.
The administration recommended eliminating funding for
activities listed below.
The Committee recommends $24,000,000 for the Star Schools
program. The comparable funding level for fiscal year 2004 is
$20,362,000. The Star Schools program is designed to improve
instruction in math, science, foreign languages, and other
areas such as vocational education, to underserved populations
by means of telecommunications technologies.
The Committee recommends $14,500,000 for the Ready to Teach
program. The comparable funding level for fiscal year 2004 is
$14,321,000. Ready to Teach is the successor to the Public
Broadcasting Service's Mathline program, which was one of the
first to provide online professional development and continuing
education for teachers. Ready to Teach was reauthorized by the
No Child Left Behind Act of 2001 and continues to evolve to
enhance teacher quality and meet the goals of that Act. Ready
to Teach encompasses funding for PBS TeacherLine and one or
more nonprofit entities, for the purpose of continuing to
develop telecommunications-based programs to improve teacher
quality in core areas. It also includes digital educational
programming grants, which encourages community partnerships
among local public television stations, State and local
educational agencies, and other institutions to develop and
distribute digital instructional content based on State and
local standards.
The Committee recommendation for FIE includes $10,000,000
for the Education through Cultural and Historical Organizations
[ECHO] Act of 2001, as authorized by Public Law 107-110.
Activities authorized under ECHO provide a broad range of
educational, cultural and job training opportunities for
students from communities across the Nation, including Alaska,
Hawaii, and Massachusetts. The comparable funding level for
fiscal year 2004 is $8,450,000.
The Committee has included $40,500,000 for arts in
education. The comparable funding level for fiscal year 2004 is
$35,071,000. Within the total, $6,420,000 is for the John F.
Kennedy Center for the Performing Arts; $7,500,000 is for VSA
arts; $14,100,000 is for the competitive art education model
grant program for the development of model projects that
effectively strengthen and integrate arts and cultural
partnerships into the core curriculum, of which not less than
$3,500,000 shall be for new awards under a grant competition
conducted during fiscal year 2005; $8,000,000 is for grants for
professional development for music, dance, drama, and visual
arts educators to be administered by the U.S. Department of
Education; $500,000 is for the evaluation and national
dissemination of information regarding model programs and
professional development projects funded through the Arts in
Education section, including dissemination of information
regarding projects which received awards in fiscal year 2001,
fiscal year 2002, and subsequent years. Such information should
include resources regarding effective self-evaluation methods
for model arts programs; and $3,980,000 is for cultural
partnerships for at-risk youth.
The Committee again recommends additional funding for
evaluation and national dissemination activities as specified
in the previous paragraph. The Committee urges the Department
to focus first on dissemination activities related to model
programs before using these resources for other purposes. The
Committee directs that such information include resources
regarding effective self-evaluation methods for model arts
programs.
The Committee recommends $41,975,000 for Parental
Information and Resource Centers, which provide training,
information, and support to parents, State and local education
agencies, and other organizations that carry out parent
education and family involvement programs. The comparable
funding level for fiscal year 2004 is $41,975,000. The
Committee notes that research overwhelmingly demonstrates that
parent involvement in children's learning is positively related
to student achievement.
The Committee also notes that the No Child Left Behind Act
requires grantees to use at least 30 percent of their awards to
establish, expand, or operate Parents as Teachers, Home
Instruction Program for Preschool Youngsters, or other early
childhood parent education programs.
The Committee includes $3,000,000 for the women's
educational equity program. The comparable funding level for
fiscal year 2004 is $2,962,000. This program supports projects
that assist in the local implementation of gender equity
policies and practices.
The Committee recommendation also includes resources for
the following activities: $9,517,000 to support teacher quality
initiatives; $74,073,000 for comprehensive school reform
demonstration grants; $10,000,000 requested by the
administration to continue support for Reach Out and Read;
$1,500,000 for activities authorized by the Excellence in
Economics Education Act; and $13,260,000 for discretionary
grants and associated expenses, including voter participation
programs authorized under the Fund for the Improvement of
Education.
The Committee strongly believes that parental involvement
is a key to the success of No Child Left Behind Act. The
Committee urges the Department, in carrying out discretionary
parental involvement initiatives, to engage groups that are
committed to improving public schools and are experienced in
carrying out grassroots efforts with parents in local school
districts.
Ready to Learn Television
The Committee recommends an appropriation of $24,000,000
for the Ready to Learn Television program. The comparable
funding level for fiscal year 2004 and the budget request both
are $22,864,000 for this purpose.
Ready to Learn Television supports the development and
distribution of educational television programming designed to
improve the readiness of preschool children to enter
kindergarten and elementary school. The program also supports
the development, production, and dissemination of educational
materials designed to help parents, children, and caregivers
obtain the maximum advantage from educational programming.
The Committee continues to strongly support the educational
and outreach objectives of the ``Ready to Learn'' television
program. The Committee is especially pleased that television
programs such as ``Dragon Tales'' and ``Between the Lions''
developed with funding from Ready to Learn have been recognized
with national parent and television production awards. The
Committee reiterates the unique mission of Ready to Learn,
which is to use the television medium to help prepare pre-
school age children for school. The television programs that
must fulfill this mission are to be specifically designed for
this purpose, with the highest attention to production quality
and validity of research-based educational objectives, content,
and materials. Therefore, the Committee expects that the grant
competition administered for a new award under this program
will emphasize the importance of investing Ready to Learn
resources in those programs that have proven to fulfill this
mission, acquiring new programs with scrutiny, and
distinguishing Ready to Learn programs from content easily
available on commercial and cable television.
Dropout Prevention
The Committee recommendation includes $10,000,000 for the
dropout prevention program. The comparable funding level for
fiscal year 2004 is $4,970,000 and the budget request did not
include any funding for the dropout prevention program. These
funds are used to help schools implement effective school
dropout prevention and re-entry programs.
In addition, the Committee notes that in fiscal year 2003,
States reserved roughly $96,000,000 from their Title I, Part A
allocations to operate State-administered projects in LEAs with
the highest dropout rates and in areas serving a large number
of children in local correctional facilities, as is required by
law.
Under the No Child Left Behind Act, each State agency and
local educational agency that conducts dropout prevent and
reentry programs under Part D of Title I is required to submit
evaluation results to the State educational agency and the
Secretary and use the results of such evaluations to plan and
improve subsequent programs for participating children and
youth. The Committee strongly urges the Department to utilize
required evaluation reports in providing technical assistance
and support to State and local educational agencies to ensure
that these reserved funds are targeted to and effectively used
in preventing school dropout and promoting successful reentry.
The Committee requests that the Department provide a letter
report to the Committee on actions it has taken and developed
for addressing this issue, which also was raised in the fiscal
year 2004 Committee report. The Committee expects to receive
this report not later than March 1, 2005.
Close Up Fellowships
The Committee recommendation includes $1,481,000. The
comparable funding level for fiscal year 2004 is $1,481,000 and
the budget request did not include any funds for this purpose.
The Close Up Fellowships, formerly called Ellender, which is
administered by the Close Up Foundation of Washington, DC,
provides fellowships to students from low-income families and
their teachers to enable them to attend 1 week in Washington
attending seminars and meeting with representatives of the
three branches of the Federal Government.
In response to congressional interest, the Committee is
aware that the Close Up Foundation has undertaken actions to
identify and develop non-Federal sources of funding for
sustaining its operations. The Committee notes that, according
to the Department of Education, the amount of funding allocated
for teachers and economically disadvantaged students available
from non-Federal sources increased more than 10 percent
annually in each year 1999-2002.
The Committee also notes that the Close Up Foundation, in
collaboration with the Secretary of Education, is required to
develop and implement procedures for measuring the efficacy of
the Foundation's authorized programs, including the extent to
which the programs are providing young people with an increased
understanding of the Federal Government; heightening a sense of
civic responsibility among young people; and enhancing the
skills of educators in teaching young people about civic
responsibility, the Federal Government, and attaining
citizenship competencies. The Committee expects to see a more
complete discussion of the actions taken to meet this statutory
requirement, as well as program performance information, in the
fiscal year 2006 congressional justification.
Advanced Placement
The Committee recommends $33,534,000 for Advanced
Placement. The comparable funding level for fiscal year 2004 is
$23,534,000 and the budget request includes $51,534,000 for the
Advanced Placement program.
The first priority of the program is to subsidize test fees
for low-income students who are enrolled in an Advanced
Placement class and plan to take an Advanced Placement test.
The balance of the funds are allocated for Advanced Placement
Incentive Program grants, which are used to expand access for
low-income individuals to Advanced Placement programs. Eligible
activities include teacher training and participation in online
Advanced Placement courses, among other related purposes.
Safe Schools and Citizenship Education
Appropriations, 2004.................................... $855,775,000
Budget estimate, 2005................................... 838,897,000
Committee recommendation................................ 902,008,000
Safe and Drug-Free Schools and Communities
The Committee recommends a total of $902,008,000 for
activities to promote Safe Schools and Citizenship Education.
The comparable fiscal year 2004 funding level is $855,775,000
and the budget request includes $838,897,000 for these
activities.
State Grant Program.--The Committee recommends $440,908,000
for the safe and drug-free schools and communities State grant
program. The comparable fiscal year 2004 funding level and
budget request are both $440,908,000. The State grant program
is the backbone of youth drug prevention efforts in the United
States. This formula-based State grant program provides
resources to Governors, State educational agencies and local
educational agencies for developing and implementing activities
that help create and maintain safe and drug-free learning
environments in and around schools.
National Programs.--The Committee has included $156,219,000
for the national programs portion of the safe and drug-free
schools program. The comparable funding level for fiscal year
2004 is $153,767,000 and the budget request includes
$175,069,000 for these programs. The Committee does not
recommend additional funding for Project SERV (School Emergency
Response to Violence), which provides education-related
services to LEAs in which the learning environment has been
disrupted due to a violent or traumatic crisis. The budget
request included $5,000,000 for Project SERV. However, the
Committee notes that the Department currently has roughly
$8,000,000 available for this purpose. These funds are
available until expended. The Committee will monitor the
availability of funding and consider action in subsequent
appropriations bills.
The Committee continues to be concerned about the
increasing problem of alcohol and drug abuse on college
campuses. The Committee has included bill language requiring
the Department to spend $850,000 on this program under the
guidelines in section 120(f) of Public Law 105-244. This
program identifies and provides models of alcohol and drug
abuse prevention and education programs in higher education.
The Committee expects that the Department will provide
$300,000 for the continued operation of the National
Clearinghouse for Educational Facilities. These funds will be
used to address issues related to school safety and healthy
school buildings. The Committee has included additional funds
for the Clearinghouse through the Fund for the Improvement of
Education.
The Committee recommendation includes $10,000,000 for
school-based drug testing programs for students. This amount is
$8,012,000 more than the comparable funding level for fiscal
year 2004 and $15,000,000 less than the budget request. The
Committee expects that funding should be awarded only to LEAs
or other entities that require the written consent of the
student and his or her parent or guardian. In addition,
students who do not consent to random drug testing should not
be prohibited from participating in school or extracurricular
activities. Participating school districts should be prohibited
from disclosing drug test results to law enforcement officials,
and all results relating to drug testing of a student should be
destroyed when the student graduates or otherwise leaves the
LEA or private school involved. Finally, the testing agency in
programs that receive Federal drug testing funds should be
prohibited from disclosing to school officials any information
about legal medications that the students may be taking.
The Committee is deeply concerned that between 5 percent to
9 percent of all children suffer from a mental, behavioral or
emotional disorder which, if undiagnosed and untreated, can
substantially interfere with academic achievement, or lead to
student drop-out, substance abuse, violent behavior, or
suicide. The Committee notes that, in its July 2003 report, the
President's New Freedom Commission on Mental Health concluded
that greater reliance on early detection, assessment and links
with adequate treatment and support systems can help avoid or
ameliorate these outcomes. The report concluded that schools
are in a unique position to identify mental health problems in
their early stages, and to provide a link to appropriate
services, citing examples of evidence-based screening
techniques and tools already being utilized by some schools.
The Committee reiterates language contained in the fiscal year
2004 Committee report with respect to this issue, and calls
upon the Office of Safe and Drug-Free Schools to work with the
Substance Abuse and Mental Health Services Administration to
take concrete steps to promote and help implement early
detection and assessment programs in our Nation's schools.
Integration of Schools and Mental Health Systems
The Committee has included $10,548,000 for the integration
of schools and mental health systems, a program that was
authorized in the No Child Left Behind Act but has not yet been
funded. This is a competitive grant program designed to promote
school-wide mental health strategies, provide training to
elementary school and secondary school personnel to recognize
early warning signs of mental illness, and increase student
access to high-quality mental health services. Research has
found that early detection, assessment, and linkage with
treatment and supports can prevent mental health problems and
encourage high-risk children to develop into good students,
workers, and members of their families and communities.
Unfortunately, many children and their families do not know
where to turn for services. Integrating mental health services
in schools would increase the likelihood that they will receive
the treatment they need. Schools are encouraged to work with
community health systems as well as institutions of higher
learning and/or other relevant entities. The Committee urges
the Department to give preference to applicants that intend to
use evidence-based or promising early interventions.
Alcohol Abuse Reduction
The Committee recommends $35,000,000 for grants to LEAs to
develop and implement programs to reduce underage drinking in
secondary schools. The comparable funding level for fiscal year
2004 is $29,823,000 and the budget request did not include any
funds for this purpose. The Committee directs the Department
and the Substance Abuse and Mental Health Services
Administration [SAMHSA] in the Department of Health and Human
Services to work together on this effort.
Mentoring
The Committee recommends $65,000,000 to support mentoring
programs and activities for children who are at risk of failing
academically, dropping out of school, getting involved in
criminal or delinquent activities, or who lack strong positive
role models. The comparable fiscal year 2004 funding level is
$49,705,000 and the budget request includes $100,000,000 for
this purpose.
Character Education
The Committee recommends $24,691,000 to provide support for
the design and implementation of character education programs.
The comparable funding level for fiscal year 2004 and the
budget request both are $24,691,000 for this purpose.
Elementary and Secondary School Counseling
The Committee recommends $36,000,000 to establish or expand
counseling programs in elementary schools. The comparable
fiscal year 2004 funding level is $33,799,000 and the
President's budget proposes to eliminate funding for this
program. As authorized by the No Child Left Behind Act, all
amounts appropriated up to $40,000,000 are used only for
elementary school counseling programs.
The No Child Left Behind Act [NCLBA] requires the Secretary
to produce a report on school counseling programs ``not later
than 2 years after assistance is made available to local
educational agencies.'' The Committee is disappointed that this
deadline has not been met, and it urges the Secretary to
fulfill this requirement as soon as possible. As described in
the NCLBA, the report should evaluate the counseling programs
that receive funds and contain information from LEAs regarding
the ratios of students to school counselors, school social
workers, and school psychologists. The Committee also
encourages the Department to include questions in the Schools
and Staffing Survey that would allow the collection and
publication of accurate and timely data about the ratios of
students to each of the following: school counselors, school
social workers, and school psychologists.
Carol M. White Physical Education for Progress Program
The Committee recommends $75,000,000 to help LEAs and
community-based organizations initiate, expand and improve
physical education programs for students in grades K-12. The
comparable funding level for fiscal year 2004 and the budget
request both are $69,587,000 for this program. The Carol M.
White Physical Education for Progress Program, authorized by
the NCLB Act, established funding for physical education
programs for students in grades K-12. Provision of this funding
will help schools and communities nationwide improve their
structured physical education programs for students and help
children develop healthy lifestyles to combat the epidemic of
obesity in the Nation.
The budget request also includes bill language earmarking
$2,000,000 to support Special Olympics' mission of promoting
access to physical education for mentally disabled persons
through sports training and competition, health initiatives,
and other services. The Committee supports this request. This
funding should be used for the Special Olympics National Summer
Games, to be held in 2006. This will be the first event of its
kind in the United States, and it represents a unique physical
education opportunity for young people with disabilities across
the Nation.
The Committee notes that in the past 15 years, obesity has
increased by over 50 percent among adults and in the past 20
years, obesity has increased by 100 percent among children and
adolescents. A recent analysis by the National Institute of
Child Health and Human Development [NICHD] Study of Early Child
Care and Youth Development found that third grade children in
the study received an average of 25 minutes per week in school
of moderate to vigorous activity, while experts in the United
States have recommended that young people should
participate in physical activity of at least moderate intensity
for 30 to 60 minutes each day. While not nationally
represented, this information is consistent with the 2002 Youth
Risk Behavior Surveillance System which found that only roughly
one-half of all students report attending a physical education
class one or more time a week. The Committee believes Federal
funding is critical to the effort to reducing these trends and
helping improve the health of the American public.
Civic Education
The Committee recommends $30,642,000 for grants to improve
the quality of civics and government education, to foster civic
competence and responsibility, and to improve the quality of
civic and economic education through exchange programs with
emerging democracies. The comparable fiscal year 2004 funding
level and the budget request both are $28,642,000 for this
purpose.
Civic Education program funds support both the We the
People programs and the Cooperative Education Exchange. The
Committee recommends $17,970,000 for the nonprofit Center for
Civic Education to support the We the People programs. We the
People has two primary components: the Citizen and the
Constitution which provides teacher training, curriculum
materials, and classroom instruction for upper elementary,
middle and high school students; and Project Citizen, a program
for middle school students that focuses on the role of State
and local governments in the American Federal system.
Within the amount for the We the People program, the
Committee recommends the following: that $3,170,000 be reserved
to continue the comprehensive program to improve public
knowledge, understanding, and support of American democratic
institutions which is a cooperative project among the Center
for Civic Education, the Center on Congress at Indiana
University, and the Trust for Representative Democracy at the
National Conference of State Legislatures; and that $1,585,000
be used for continuation and expansion of the school violence
prevention demonstration program including the Native American
program.
The Committee recommends $12,672,000 for the Cooperative
Education Exchange program. Within this amount, the Committee
has included $4,752,000 for the Center for Civic Education and
$4,752,000 for the National Council on Economic Education. The
remaining $3,168,000 should be used for a competitive grant
program for civics and government education, and for economic
education.
State Grants for Incarcerated Youth Offenders
The Committee has included $28,000,000 for education and
training for incarcerated youth offenders. The comparable
funding level for fiscal year 2004 is $24,853,000. The
administration, once again, proposes to eliminate funding for
these activities. This program provides grants to State
correctional education agencies to assist and encourage
incarcerated youth to acquire functional literacy, life and job
skills, through the pursuit of a postsecondary education
certificate or an associate of arts or bachelor's degree.
Grants also assist correction agencies in providing employment
counseling and other related services that start during
incarceration and continue through prerelease and while on
parole. Each student is eligible for a grant of not more than
$1,500 annually for tuition, books, and essential materials,
and not more than $300 annually for related services such as
career development, substance abuse counseling, parenting
skills training, and health education. In order to participate
in a program, a student must be no more than 25 years of age
and be eligible to be released from prison within 5 years.
Youth offender grants are for a period not to exceed 5 years, 1
year of which may be devoted to study in remedial or graduate
education.
The Committee notes that State performance information
derived from annual performance reports indicate that the
percentage of students obtaining vocational skill certificates
in 2001 was 60 percent and that less than 10 percent of program
participants returned to prison within 1 year of release.
According to the Bureau of Justice Statistics, most former
State prisoners were rearrested shortly after getting out of
prison: 30 percent within 6 months, 44 percent within 1 year,
59 percent within 2 years and 67 percent by the end of 3 years.
This important program not only helps make the Nation's streets
safer for all Americans, but it reduces pressure on taxpayers
as fewer contacts are made with the more expensive criminal
justice system and former prisoners become employed, tax-paying
and productive members of society.
The Committee encourages the Department to continue to work
toward developing a more consistent and reliable system for
collecting performance outcome data. The Committee believes
that additional training and technical assistance for States
would help improve the collection by which the effectiveness of
this program can be measured. The Committee is disappointed by
the lack of a sufficient response to language included in last
year's Committee report regarding the actions planned and taken
by the Department to meet this goal. The Committee requests a
letter report, not later than March 1, 2005, from the
Department which includes a detailed discussion of actions
planned and taken by the Department to meet this goal.
Within the appropriation for State grants for incarcerated
youth offenders, the Committee includes $5,000,000 to continue
the prisoner literacy initiative. The Committee notes that the
extremely high rates of illiteracy or marginal reading skills
among inmates is a national problem and therefore encourages
the development of a uniform model to evaluate such literacy
programs across the country.
English Language Acquisition
Appropriations, 2004.................................... $681,215,000
Budget estimate, 2005................................... 681,215,000
Committee recommendation................................ 700,000,000
The Committee recommends an appropriation of $700,000,000
for English language acquisition. The comparable funding level
for fiscal year 2004 and the budget request both are
$681,215,000 for authorized activities. The Department makes
formula grants to States based on each State's share of the
Nation's limited-English-proficient and recent immigrant
student population. The program is designed to increase the
capacity of States and school districts to address the needs of
these students. The No Child Left Behind Act also requires that
6.5 percent of the appropriation be used to support national
activities, which include professional development activities
designed to increase the number of highly qualified teachers
serving limited English proficient students; a National
Clearinghouse for English Language Acquisition and Language
Instructional Programs; and evaluation activities.
At the level of the Committee recommendation, the State
grant portion of this account will increase by more than
$56,000,000, as funding for expiring projects is redirected to
the State grant program. These additional funds will help
States improve the educational outcomes for limited English
proficient students.
Special Education
Appropriations, 2004.................................... $11,160,707,000
Budget estimate, 2005................................... 12,176,101,000
Committee recommendation................................ 12,406,516,000
The Committee recommends $12,406,516,000 for special
education programs authorized by the Individuals with
Disabilities Education Act [IDEA]. The comparable fiscal year
2004 funding level is $11,160,707,000 and the budget request
includes $12,176,101,000 for such programs.
The Committee recognizes that Fetal Alcohol Spectrum
Disorders [FASD], the most common known cause of mental
retardation, result from maternal alcohol consumption during
pregnancy. Affected children have a lifelong disability of
mental impairments, behavioral problems, and developmental
delays that reduce their ability to respond to the educational
system. The burden to society is estimated at $5,400,000,000
from Fetal Alcohol Syndrome, one type of FASD alone, in 2003.
The Committee is pleased with the efforts of the Office of
Special Education and Rehabilitative Services to collaborate
with other Federal agencies represented on the Interagency
Coordinating Committee on Fetal Alcohol Syndrome, especially
with respect to the involvement of educational psychologists
and other educational and childcare professionals in developing
awareness about FASD. The Committee encourages the Department
of Education to expand activities related to FASD, specifically
the early identification and care plan development of affected
children.
Grants to States
The Committee recommends $11,228,981,000 for special
education grants to States, as authorized under part B of the
IDEA. The comparable fiscal year 2004 funding level is
$10,068,106,000 and the budget request includes
$11,068,106,000. This program provides formula grants to assist
States in meeting the costs of providing special education and
related services for children with disabilities.
The Committee's recommended funding level represents more
than 20 percent of the average per-pupil expenditure, compared
with almost 19 percent under the fiscal year 2004
appropriation. Since fiscal year 2000, increasing
appropriations have raised the Federal share of average per
pupil expenditures from 12 percent to an estimated 20 percent
in fiscal year 2005--half way to the 40 percent maximum
established in the IDEA.
Preschool Grants
The Committee recommends $390,000,000 for preschool grants.
The comparable fiscal year 2004 funding level and the budget
request both are $387,699,000. The preschool grants program
provides formula grants to States to make available special
education and related services for children with disabilities
aged 3 through 5.
Grants for Infants and Families
The Committee recommends $444,363,000 for grants for the
infants and families program under part C of the IDEA. The
comparable fiscal year 2004 funding level is $444,363,000 and
the budget request includes $466,581,000 for this activity.
This program provides formula grants to States to implement
statewide systems of coordinated, comprehensive,
multidisciplinary interagency programs to make available early
intervention services to all children with disabilities, ages 2
and under, and their families.
State Program Improvement
The Committee recommends $51,061,000 for State program
improvement grants. The comparable fiscal year 2004 funding
level and the budget request both are $51,061,000 for these
grants. This program provides competitive grants to State
educational agencies to assist them, in partnership with
parents, teachers, institutions of higher education, interest
groups, and others, to improve results for children with
disabilities by reforming and improving their educational
systems.
Research and Innovation in Special Education
The Committee recommends $78,125,000 for research and
innovation in special education. The comparable funding level
for fiscal year 2004 and the budget request both are
$78,125,000 for this purpose. This program supports competitive
awards to produce and advance the use of knowledge to improve
services and results for children with disabilities.
Technical Assistance and Dissemination
The Committee recommends $54,000,000 for technical
assistance and dissemination. The comparable fiscal year 2004
funding level and the budget request both are $52,819,000 for
these activities. Awards support institutes, regional resource
centers, clearinghouses, and other efforts to build State and
local capacity to make systemic changes and improve results for
children with disabilities.
Personnel Preparation
The Committee recommends $93,357,000 for the personnel
preparation program. The comparable fiscal year 2004 funding
level and the budget request both are $91,357,000 for this
program. Funds support competitive awards to help address
State-identified needs for personnel who are qualified to work
with children with disabilities, including special education
teachers and related services personnel.
The Committee continues to be particularly concerned about
the shortages of qualified special education teachers and of
higher education faculty to train those teachers. It intends
that these funds be used to address both shortages.
Parent Information Centers
The Committee recommends $27,500,000 for parent information
centers. The comparable fiscal year 2004 funding level and the
budget request both are $26,173,000 for authorized activities.
This program makes awards to parent organizations to support
parent training and information centers, including community
parent resource centers. These centers provide training and
information to meet the needs of parents of children with
disabilities living in the areas served by the centers,
particularly underserved parents, and parents of children who
may be inappropriately identified.
Technology and Media Services
The Committee recommends $39,129,000 for technology and
media services. The comparable fiscal year 2004 funding level
is $39,129,000 and the budget request includes $32,305,000 for
such activities. This program makes competitive awards to
support the development, demonstration, and use of technology,
and educational media activities of value to children with
disabilities.
The Committee recommendation includes $11,400,000 for
Recording for the Blind and Dyslexic, Inc. (RFB&D). These funds
support the continued production and circulation of recorded
textbooks, increased outreach activities to print-disabled
students and their teachers, and accelerated use of digital
technology. The administration proposed eliminating support of
RFB&D for these activities.
The Committee also recommends $1,500,000 to continue
support of the Reading Rockets program. Last year, this program
received $1,491,000. The administration proposed eliminating
support for this program.
This activity is authorized by section 687(b)(2)(G) of the
Individuals with Disabilities Education Act, as amended. The
Committee recognizes the progress of the Reading Rockets
program, which is developing a wide range of media resources to
disseminate research conducted by the National Institutes of
Health, as well as other research concerning effective teaching
strategies, early diagnosis of, and intervention for, young
children with reading disabilities. These resources include an
extensive web site, videos, and programming for television and
radio broadcast. The Committee includes funding for the
continued development and distribution of media resources to
reach the parents and teachers of children with reading
disabilities.
Rehabilitation Services and Disability Research
Appropriations, 2004.................................... $3,011,270,000
Budget estimate, 2005................................... 3,047,197,000
Committee recommendation................................ 3,077,328,000
The Committee recommends $3,077,328,000 for rehabilitation
services and disability research. The comparable fiscal year
2004 funding level is $3,011,270,000 and the budget request
includes $3,047,197,000 for programs in this account.
Vocational Rehabilitation State Grants
The Committee provides $2,635,845,000 for vocational
rehabilitation grants to States. The Committee recommendation
provides the full amount authorized by the Rehabilitation Act
of 1973. The comparable funding level for fiscal year 2004 is
$2,584,162,000. The budget request proposes to eliminate
separate funding of several categorical programs and redirect
these resources to the State grant program. The Committee
rejects this approach and believes changes of this nature
should be considered during reauthorization of the Act.
Basic State grant funds assist States in providing a range
of services to help persons with physical and mental
disabilities prepare for and engage in meaningful employment.
Authorizing legislation requires States to give priority to
persons with significant disabilities. Funds are allotted to
States based on a formula that takes into account population
and per capita income. States must provide a 21.3 percent match
of Federal funds, except the State's share is 50 percent for
the cost of construction of a facility for community
rehabilitation program purposes.
The Rehabilitation Act requires that no less than 1 percent
and not more than 1.5 percent of the appropriation in fiscal
year 2004 for vocational rehabilitation State grants be set
aside for grants for Indians. Service grants are awarded to
Indian tribes on a competitive basis to help tribes develop the
capacity to provide vocational rehabilitation services to
American Indians with disabilities living on or near
reservations.
Client Assistance
The Committee recommends $13,000,000 for the client
assistance program. The comparable fiscal year 2004 funding
level and the budget request both are $11,997,000 for
authorized activities.
The client assistance program funds State formula grants to
assist vocational rehabilitation clients or client applicants
in understanding the benefits available to them and in their
relationships with service providers. Funds are distributed to
States according to a population-based formula, except that
increases in minimum grants are guaranteed to each of the 50
States, the District of Columbia, and Puerto Rico, and
guaranteed to each of the outlying areas, by a percentage not
to exceed the percentage increase in the appropriation. States
must operate client assistance programs in order to receive
vocational rehabilitation State grant funds.
Training
The Committee recommends $39,139,000 for training
rehabilitation personnel. The comparable fiscal year 2004
funding level and the budget request both are $39,139,000 for
training activities.
The purpose of this program is to ensure that skilled
personnel are available to serve the rehabilitation needs of
individuals with disabilities. It supports training,
traineeships, and related activities designed to increase the
numbers of qualified personnel providing rehabilitation
services. The program awards grants and contracts to States and
public or nonprofit agencies and organizations, including
institutions of higher education, to pay all or part of the
cost of conducting training programs. Long-term, in-service,
short-term, experimental and innovative, and continuing
education programs are funded, as well as special training
programs and programs to train interpreters for persons who are
deaf, hard of hearing and deaf-blind.
The Committee remains concerned over the reduction in
funding for rehabilitation long-term training programs, and in
particular those that require orthotic and prosthetic care.
Therefore, the Committee urges RSA to utilize available funds
to support not less than four university orthotics and
prosthetics programs.
Demonstration and Training Programs
The Committee bill includes $24,286,000 for demonstration
and training programs for persons with disabilities. The
comparable fiscal year 2004 funding level is $24,286,000 and
the budget request includes $18,784,000 for authorized
activities. This program awards grants to States and nonprofit
agencies and organizations to develop innovative methods and
comprehensive services to help individuals with disabilities
achieve satisfactory vocational outcomes. Demonstration
programs support projects for individuals with a wide array of
disabilities. Within the Committee recommendation, $1,000,000
supports continuation of activities designed to establish an
applied research agenda, improve the quality of applied
orthotic and prosthetic research and help meet the increasing
demand for provider services. Funds are to be used to further
develop the orthotic and prosthetic awareness campaign, which
includes an educational outreach initiative designed to recruit
and retain professionals and develop a series of consensus
conferences and disseminate the resulting best practices to the
field.
Migrant and Seasonal Farmworkers
The Committee recommends $2,500,000 for migrant and
seasonal farmworkers. The comparable fiscal year 2004 funding
level is $2,321,000. The Department proposes eliminating
separate funding for this program.
This program provide grants limited to 90 percent of the
costs of the projects providing comprehensive rehabilitation
services to migrant and seasonal farm workers with disabilities
and their families. Projects also develop innovative methods
for reaching and serving this population. The program
emphasizes outreach, specialized bilingual rehabilitation
counseling, and coordination of vocational rehabilitation
services with services from other sources.
Recreational Programs
The Committee provides $2,750,000 for recreational
Programs. The comparable fiscal year 2004 funding level is
$2,564,000 and the budget request does not include funding for
this program.
Recreational programs help finance activities such as
sports, music, dancing, handicrafts, and art to aid in the
employment, mobility, and socialization of individuals with
disabilities. Grants are awarded to States, public agencies,
and nonprofit private organizations, including institutions of
higher education. Grants are awarded for a 3-year period with
the Federal share at 100 percent for the first year, 75 percent
for the second year, and 50 percent for the third year.
Programs must maintain the same level of services over the 3-
year period.
Protection and Advocacy of Individual Rights
The Committee recommends $18,000,000 for protection and
advocacy of individual rights. The comparable fiscal year 2004
funding level is $16,790,000 and the budget request includes
$19,570,000. However, included in the budget request is
$2,780,000 to continue funding for the Protection and Advocacy
for Assistive Technology program. This amount is less than the
$4,419,000 for such activities provided in fiscal year 2004.
This program provides grants to agencies to protect and
advocate for the legal and human rights of persons with
disabilities who are not eligible for protection and advocacy
services available through the Developmental Disabilities
Assistance and Bill of Rights Act or the Protection and
Advocacy for Individuals with Mental Illness Act.
Projects with Industry
The Committee recommends $22,000,000 for projects with
Industry. The comparable fiscal year 2004 funding level is
$21,799,000 and the administration proposes eliminating
separate funding for this program.
The projects with industry [PWI] program promotes greater
participation of business and industry in the rehabilitation
process. PWI provides training and experience in realistic work
settings to prepare individuals with disabilities for
employment in the competitive job market. Postemployment
support services are also provided. The program makes grants to
a variety of agencies and organizations, including
corporations, community rehabilitation programs, labor and
trade associations, and foundations.
Supported Employment State Grants
The Committee's bill includes $38,000,000 for the supported
employment State grant program. The comparable fiscal year 2004
funding level is $37,680,000 and the administration proposes
eliminating separate funding for this program.
This program assists persons who may have been considered
too severely disabled to benefit from vocational rehabilitation
services by providing the ongoing support needed to obtain
competitive employment. Short-term vocational rehabilitation
services are augmented with extended services provided by State
and local organizations. Federal funds are distributed on the
basis of population.
Independent Living State Grants
The Committee recommends $23,000,000 for independent living
State grants. The comparable funding level for fiscal year 2004
and the budget request both are $22,020,000 for authorized
activities.
The independent living State formula grants program
provides funding to improve independent living services,
support the operation of centers for independent living,
conduct studies and analysis, and provide training and
outreach.
Independent Living Centers
The Committee recommends $75,000,000 for independent living
centers. The comparable fiscal year 2004 funding level and the
budget request both are $73,563,000 for the centers.
These funds support consumer-controlled, cross-disability,
nonresidential, community-based centers that are designed and
operated within local communities by individuals with
disabilities. These centers provide an array of independent
living services.
Independent Living Services for Older Blind Individuals
The Committee provides $31,811,000 for independent living
services to older blind individuals. The comparable fiscal year
2004 funding level and the budget request both are $31,811,000
for these activities. Through this program, assistance is
provided to persons aged 55 or older to adjust to their
blindness, continue living independently and avoid societal
costs associated with dependent care. Services may include the
provision of eyeglasses and other visual aids, mobility
training, braille instruction and other communication services,
community integration, and information and referral. These
services help older individuals age with dignity, continue to
live independently and avoid significant societal costs
associated with dependent care. The services most commonly
provided by this program are daily living skills training,
counseling, the provision of low-vision devices community
integration, information and referral, communication devices,
and low-vision screening.
The Committee notes that there are 5 million Americans in
this country age 55 and older who are experiencing vision loss
and that the number of Americans in this category is expected
to double in the next 30 years. The Committee recognizes the
very important and cost-effective work carried out through this
program. By allowing older individuals to remain in their homes
and communities, substantial savings are achieved.
Program Improvement Activities
The Committee recommends $850,000 for program improvement
activities. The comparable fiscal year 2004 funding level is
$889,000 and the budget request includes $850,000. In fiscal
year 2005, funds for these activities will continue to support
technical assistance efforts to improve the efficiency and
effectiveness of the vocational rehabilitation program and
improve accountability efforts. The funds provided are
sufficient to support ongoing program improvement activities
and to support ongoing dissemination and performance
measurement activities.
Evaluation
The Committee recommends $1,500,000 for evaluation
activities. The comparable fiscal year 2004 funding level is
$988,000 and the budget request includes $1,500,000 for such
activities.
These funds support evaluations of the impact and
effectiveness of programs authorized by the Rehabilitation Act.
The Committee recommendation provides the requested increase
for the initiation of a new longitudinal study of the State
Vocational Rehabilitation Services program. The Department
awards competitive contracts for studies to be conducted by
persons not directly involved with the administration of
Rehabilitation Act programs.
Helen Keller National Center
The Committee recommends $9,000,000 for the Helen Keller
National Center for Deaf-Blind Youth and Adults. The comparable
fiscal year 2004 funding level and the budget request both are
$8,666,000 for this purpose.
The Helen Keller National Center consists of a national
headquarters in Sands Point, NY, with a residential training
and rehabilitation facility where deaf-blind persons receive
intensive specialized services; a network of 10 regional field
offices which provide referral and counseling assistance to
deaf-blind persons; and an affiliate network of agencies. At
the recommended level, the center would serve more than 110
persons with deaf-blindness at its headquarters facility and
provide field services to approximately 2,150 individuals and
families and more than 1,000 organizations.
National Institute on Disability and Rehabilitation Research
The Committee recommends $109,152,000 for the National
Institute on Disability and Rehabilitation Research [NIDRR].
The comparable fiscal year 2004 funding level and the budget
request both are $106,652,000 for authorized activities.
NIDRR develops and implements a comprehensive and
coordinated approach to the conduct of research, demonstration
projects, and related activities that enable persons with
disabilities to better function at work and in the community,
including the training of persons who provide rehabilitation
services or who conduct rehabilitation research. The Institute
awards competitive grants to support research in federally
designated priority areas, including rehabilitation research
and training centers, rehabilitation engineering research
centers, research and demonstration projects, and dissemination
and utilization projects. NIDRR also supports field-initiated
research projects, research training, and fellowships.
The Committee recommendation includes $2,500,000 above the
budget request to support NIDRR's model spinal cord injury
centers program. These funds, in addition to the $7,200,000
available within the budget request, will support $8,500,000 in
new awards in fiscal year 2005. The Committee intends that
these funds should be used to support investments that would
facilitate multi-center research and encourages NIDRR to
continue its collaboration with other Federal agencies in order
to leverage Federal investments in this area.
The Committee acknowledges that physical rehabilitation
services are essential to the functional status and
independence of individuals, particularly those dealing with
musculoskeletal conditions. The Committee directs the
Interagency Committee on Disability Research to report on the
existing, agency-wide research activities relating to physical
rehabilitation, opportunities for future physical
rehabilitation research, and recommendations on how physical
rehabilitation research can be enhanced within the departments
and agencies, including suggestions for those areas that need
to be addressed through statutory changes.
Assistive Technology
The Committee recommends $31,495,000 for assistive
technology. The comparable fiscal year 2004 funding level is
$25,943,000 and the budget request includes $15,000,000 for the
alternative financing program, but does not request funding for
title I State tech act projects or protection and advocacy for
assistive technology. However, under the PAIR program, the
administration proposes to fund protection and advocacy
activities previously funded through this program at
$2,780,000.
The Assistive Technology Program is designed to improve
occupational and educational opportunities and the quality of
life for people of all ages with disabilities through increased
access to assistive technology services and devices. It
provides grants to States to develop comprehensive, consumer-
responsive statewide programs that increase access to, and the
availability of, assistive technology devices and services. The
National Institute on Disability and Rehabilitation Research
administers the program.
The Committee recommendation includes $26,000,000 for
activities authorized under title I of the Assistive Technology
Act [AT Act]. The Committee has included bill language which
allows all State projects funded currently under title I of the
AT Act to receive not less than the amount they received in
fiscal year 2004 and supports continued funding under this
program for protection and advocacy for assistive technology.
The Committee expects funds to be allocated under title I,
consistent with the way in which they were allocated during
implementation of the fiscal year 2004 bill.
The Committee recommendation also includes $5,495,000 for
the alternative financing program. The Committee recommendation
includes bill language requested by the administration designed
to encourage States to support alternative financing programs.
These changes allow States to receive less than $500,000 for an
award, requires a match of 25 percent and enables States to
receive more than one grant. The Committee urges the Department
to ensure that grantees design and operate their programs in a
consumer-directed fashion.
Special Institutions for Persons With Disabilities
AMERICAN PRINTING HOUSE FOR THE BLIND
Appropriations, 2004.................................... $16,403,000
Budget estimate, 2005................................... 16,403,000
Committee recommendation................................ 17,000,000
The Committee recommends $17,000,000 for the American
Printing House for the Blind [APH]. The comparable fiscal year
2004 funding level and the budget request both are $16,403,000
for this purpose.
This appropriation helps support the American Printing
House for the Blind, which provides educational materials to
students who are legally blind and enrolled in programs below
the college level. The Federal subsidy provides almost 60
percent of APH's total sales income. Materials are distributed
free of charge to schools and States through per capita
allotments based on the total number of students who are blind.
Materials provided include textbooks and other educational aids
in braille, large type, and recorded form and microcomputer
applications. Appropriated funds may be used for staff salaries
and expenses, as well as equipment purchase and acquisition
consistent with the purpose of the Act to Promote the Education
of the Blind.
NATIONAL TECHNICAL INSTITUTE FOR THE DEAF
Appropriations, 2004.................................... $53,483,000
Budget estimate, 2005................................... 53,803,000
Committee recommendation................................ 55,790,000
The Committee recommends $55,790,000 for the National
Technical Institute for the Deaf [NTID]. The comparable fiscal
year 2004 funding level is $53,483,000 and the budget request
includes $53,803,000 for this purpose.
The Institute, located on the campus of the Rochester
Institute of Technology, was created by Congress in 1965 to
provide a residential facility for postsecondary technical
training and education for persons who are deaf. NTID also
provides support services for students who are deaf, trains
professionals in the field of deafness, and conducts applied
research. Within the amount provided, $1,685,000 is for
construction. The Committee recommendation includes $1,000,000
more than the budget request to provide partial support for the
new Student Development Center. The Committee is aware that
NTID plans to leverage this Federal support with approximately
$3,000,000 from private sources in order to complete this
important construction project. At the discretion of the
Institute, funds may be used for the Endowment Grant program.
GALLAUDET UNIVERSITY
Appropriations, 2004.................................... $100,205,000
Budget estimate, 2005................................... 100,205,000
Committee recommendation................................ 105,400,000
The Committee recommends $105,400,000 for Gallaudet
University. The comparable fiscal year 2004 funding level and
the budget request are both $100,205,000 for the university.
Gallaudet University is a private, nonprofit institution
offering undergraduate, and continuing education programs for
students who are deaf, as well as graduate programs in fields
related to deafness for students who are hearing-impaired and
who are deaf. The university conducts basic and applied
research related to hearing impairments and provides public
service programs for the deaf community.
The Model Secondary School for the Deaf serves as a
laboratory for educational experimentation and development,
disseminates models of instruction for students who are deaf,
and prepares adolescents who are deaf for postsecondary
academic or vocational education. The Kendall Demonstration
Elementary School develops and provides instruction for
children from infancy through age 15.
The Committee recommendation includes funding to enable
Gallaudet University to continue to offer competitive pay
increase for faculty and staff, strengthen the training of
social workers and other clinical service providers in order to
increase the educational achievement of deaf and hard of
hearing students in the school setting, provide for expanded
training and information dissemination programs and support
other program improvements. Funds also are available, at the
discretion of the university, for the Endowment Grant program.
Vocational and Adult Education
Appropriations, 2004.................................... $2,101,027,000
Budget estimate, 2005................................... 1,601,273,000
Committee recommendation................................ 2,102,086,000
The Committee recommendation includes a total of
$2,102,086,000 for vocational and adult education, consisting
of $1,326,992,000 for vocational education, $590,137,000 for
adult education and $184,967,000 for other activities. The
comparable funding level in fiscal year 2004 is $2,101,027,000
and the budget request includes $1,601,273,000 for this
account.
VOCATIONAL EDUCATION
The Committee recommends $1,326,992,000 for vocational
education. The comparable fiscal year 2004 funding level is
$1,326,992,000 and the budget request is $1,011,146,000 for
these activities.
Basic Grants.--The Committee recommends $1,194,295,000 for
basic grants. The comparable fiscal year 2004 funding level is
$1,194,295,000 and the budget request includes $1,011,146,000
for this purpose.
Funds provided under the State grant program assist States,
localities, and outlying areas to expand and improve their
programs of vocational education and provide equal access to
vocational education for populations with special needs.
Persons assisted range from secondary students in prevocational
courses through adults who need retraining to adapt to changing
technological and labor market conditions. Funds are
distributed according to a formula based on State population
and State per capita income.
Under the Indian and Hawaiian Natives programs, competitive
grants are awarded to federally recognized Indian tribes or
tribal organizations and to organizations primarily serving and
representing Hawaiian Natives for services that are in addition
to services such groups are eligible to receive under other
provisions of the Perkins Act.
Tech-Prep Education.--The Committee recommends $106,665,000
for tech-prep programs. The comparable fiscal year 2004 funding
level is $106,665,000 and the budget request proposes to
eliminate funding for this program. This program is designed to
link academic and vocational learning and to provide a
structured link between secondary schools and postsecondary
education institutions. Funds are distributed to the States
through the same formula as the basic State grant program.
States then make planning and demonstration grants to consortia
of local educational agencies and postsecondary institutions to
develop and operate model 4-year programs that begin in high
school and provide students with the mathematical, science,
communication, and technological skills needed to earn a 2-year
associate degree or 2-year certificate in a given occupational
field.
National Programs, Research.--The Committee recommends
$11,852,000 for national research programs and other national
activities. The comparable fiscal year 2004 funding level is
$11,852,000 and the budget request proposes to eliminate
separate funding for this program. The National Research Center
for Career and Technical Education and the National
Dissemination Center for Career and Technical Education are the
only federally funded centers charged with the responsibility
to conduct research and provide technical assistance to
vocational educators. The results of the applied research done
by these Centers inform technical assistance to reform and
improve vocational education instruction in schools and
colleges. Resources made available through this program also
are used to support a variety of activities to identify and
promote effective research-based programs and practice in
vocational education.
Tech-Prep Education Demonstration Program.--The Committee
recommendation includes $4,939,000 for this program. The
comparable fiscal year 2004 funding level is $4,939,000 and the
budget request proposes to eliminate funding for this program.
Under this demonstration authority, the Secretary awards grants
competitively to consortia that involve a business as a member,
locate a secondary school on the site of a community college,
and seek voluntary participation of secondary school students
enrolled such a high school. The purpose of the demonstration
program is to support development of the ``middle college''
model of high school, which promotes higher student achievement
and postsecondary enrollment. Funds may be used for curriculum,
professional development, equipment, and other start-up and
operational costs.
Occupational and Employment Information Program.--The
Committee recommends $9,241,000 to continue activities
authorized by section 118 of the Carl Perkins Act. The
comparable fiscal year 2004 funding level is $9,241,000 and the
budget request proposes to eliminate this program. The Act
requires that at least 85 percent of the amount be provided
directly to State entities to develop and deliver occupational
and career information to students, job seekers, employers,
education, employment and training programs.
ADULT EDUCATION
The Committee recommends $590,127,000 for adult education.
The comparable fiscal year 2004 funding level and the budget
request both are $590,127,000 for this purpose.
Adult Education State Programs.--For adult education State
programs, the Committee recommends $574,266,000. The comparable
fiscal year 2004 funding level and the budget request both are
$574,266,000 for authorized activities. These funds are used by
States for programs to enable economically disadvantaged adults
to acquire basic literacy skills, to enable those who so desire
to complete a secondary education, and to make available to
adults the means to become more employable, productive, and
responsible citizens.
The Committee recommendation continues the English literacy
and civics education State grants set aside within the Adult
Education State grant appropriation. Within the total,
$69,135,000 is available to help States or localities affected
significantly by immigration and large limited-English
populations to implement programs that help immigrants acquire
English literacy skills, gain knowledge about the rights and
responsibilities of citizenship and develop skills that will
enable them to navigate key institutions of American life.
National Activities.--The Committee recommends $9,169,000
for national leadership activities. The comparable funding
level for fiscal year 2004 and the budget request both are
$9,169,000 for this purpose. The Department supports applied
research, development, dissemination, evaluation and program
improvement activities to assist States in their efforts to
improve the quality of adult education programs.
National Institute for Literacy.--The Committee recommends
$6,692,000 for the National Institute for Literacy, authorized
under section 242 of the Adult Education and Family Literacy
Act. The comparable fiscal year 2004 funding level and the
budget request both are $6,692,000 for this purpose. The
Institute provides leadership and coordination for national
literacy efforts by conducting research and demonstrations on
literacy, establishing and maintaining a national center for
adult literacy and learning disabilities, and awarding
fellowships to outstanding individuals in the field to conduct
research activities under the auspices of the Institute.
Smaller Learning Communities
The Committee recommends $173,967,000 for smaller learning
communities. The comparable fiscal year 2004 funding level is
$173,967,000 and the budget request does not include any funds
for this purpose. This program supports competitive grants to
local educational agencies to enable them to create smaller
learning communities in large schools. Funds may be used to
study, research, develop and implement strategies for creating
smaller learning communities, as well as professional
development for staff. Two types of grants are made under this
program: 1-year planning grants, which help LEAs plan smaller
learning communities and 3-year implementation grants, which
help create or expand such learning environments. The Committee
bill includes language which makes these funds available on
July 1, 2005, except for up to 5 percent which will become
available on October 1, 2004 and may be used for technical
assistance, program outreach, evaluation, school networking,
and peer review of applications.
Community Technology Centers
The Committee recommends $11,000,000 for community
technology centers. The comparable funding level for fiscal
year 2004 is $9,941,000 and the budget request proposes to
eliminate funding for this program. Community technology
centers provide disadvantaged residents of economically
distressed urban and rural communities with access to
information technology and related training. They can provide,
among other things, preschool and after-school programs, adult
education and literacy, and workforce development and training.
The Committee directs the Secretary to work with the
Department of Commerce's Technology Opportunities Program, the
Department of Housing and Urban Development's Neighborhood
Networks programs, and other Federal agencies to share the
tools, research, best practices, and other outcomes generated
by program grants with community-based organizations that are
working to ensure equitable access to information and
communications technology tools and the skills and
opportunities to use them for all Americans.
Student Financial Assistance
Appropriations, 2004.................................... $14,006,887,000
Budget estimate, 2005................................... 14,698,213,000
Committee recommendation................................ 14,859,694,000
The Committee recommends an appropriation of
$14,859,694,000 for student financial assistance. The
comparable fiscal year 2004 funding level is $14,006,887,000
and the budget request includes $14,698,213,000 for this
purpose.
Federal Pell Grant Program
For Pell grant awards in the 2005-2006 academic year, the
Committee recommends $12,830,000,000 to maintain the record
maximum Pell Grant award level of $4,050.
Pell grants provide need-based financial assistance that
helps low-and middle-income undergraduate students and their
families pay the costs of postsecondary education and
vocational training. Awards are determined according to a
statutory need analysis formula that takes into account a
student's family income and assets, household size, and the
number of family members, excluding parents, attending
postsecondary institutions. Pell grants are considered the
foundation of Federal postsecondary student aid.
The Committee has made significant gains in supporting
increases in funding for the Pell Grant program. Since fiscal
year 2000, the maximum Pell grant has been increased from
$3,300 to the current recommendation of $4,050. Also, the
number of students receiving Pell grant awards will have
increased by more than one million over the past 4 years.
The Committee has deferred action on the proposed enhanced
Pell grants for State scholars program. This program is not
currently authorized. The budget request includes $33,000,000
to provide additional Pell grant support to students completing
specific challenging coursework while in secondary school.
Federal Supplemental Educational Opportunity Grants
The Committee recommends $799,850,000 for Federal
supplemental educational opportunity grants [SEOG]. The
comparable fiscal year 2004 funding level and the budget
request both are $770,305,000 for this purpose. This program
provides funds to postsecondary institutions for need-based
grants to undergraduate students. Institutions must contribute
25 percent of SEOG awards, which are subject to a maximum grant
level of $4,000. School financial aid officers have flexibility
to determine student awards, though they must give priority to
Pell grant recipients.
Federal Work-Study Programs
The Committee bill provides $998,243,000 for the Federal
work-study program. The comparable fiscal year 2004 funding
level and the budget request both are $998,243,000 for
authorized activities. This program provides grants to more
than 3,300 institutions to help an estimated 1,000,000
undergraduate, graduate, and professional students meet the
costs of postsecondary education through part-time employment.
Work-study jobs must pay at least the Federal minimum wage and
institutions must provide at least 25 percent of student
earnings. Institutions also must use at least 7 percent of
their grants for community-service jobs.
The Committee strongly supports continued funding for the
work colleges program authorized in section 448 of the Higher
Education Act of 1965. These funds help support comprehensive
work-service learning programs at seven work colleges, and
cooperative efforts among the work colleges to expose other
institutions of higher education to the work college concept.
Of the amount recommended by the Committee, $6,000,000 is
available for this program.
Federal Perkins Loans
The Committee bill includes $98,764,000 for Federal Perkins
loans capital contributions. The comparable fiscal year 2004
funding level is $98,764,000 and the budget request does not
include any funds for this purpose. The amount recommended,
when combined with institutional revolving funds, would
maintain the 2005 loan volume at the current estimated level of
$1,200,000,000. At this funding level more than 600,000 loans
would be made.
The Federal Perkins loan program supports student loan
revolving funds built up with capital contributions to about
2,000 participating institutions. Institutions use these
revolving funds, which also include Federal capital
contributions [FCC], institutional contributions equal to one-
third of the FCC, and student repayments, to provide low-
interest (5 percent) loans that help financially needy students
pay the costs of postsecondary education. The Committee has
included the amount necessary to maintain the current loan
volume level.
The Committee also recommends $66,665,000 for loan
cancellations. The comparable funding level for fiscal year
2004 and the budget request both are $66,665,000 for this
activity. These funds reimburse institutional revolving funds
on behalf of borrowers whose loans are cancelled in exchange
for statutorily specified types of public or military service,
such as teaching in a qualified low-income school, working in a
Head Start Program, serving in the Peace Corps or VISTA, or
nurses and medical technicians providing health care services.
Leveraging Educational Assistance Partnership Program
For the leveraging educational assistance partnership
[LEAP] program, the Committee recommends $66,172,000. The
comparable funding level for fiscal year 2004 is $66,172,000
and the budget proposes to eliminate funding for this program.
The leveraging educational assistance partnership program
provides a Federal match to States as an incentive for
providing need-based grant and work-study assistance to
eligible postsecondary students. When the appropriation exceeds
$30,000,000, amounts above this threshold must be matched by
States on a 2:1 basis. Federally supported grants and job
earnings are limited to $5,000 per award year for full-time
students.
The Committee recognizes the important role that the LEAP
program plays in maintaining a Federal-State partnership for
ensuring that postsecondary education is available to all
academically-qualified Americans. The Committee notes that a
recent Advisory Committee on Student Financial Aid report
recommended that Federal policy should encourage a far more
substantial State and institutional commitment to need-based
grant aid. The Committee notes that this important program
leverages almost $1,000,000,000 in State spending for need-
based student grant programs. Therefore, it is the Committee's
intent to continue this important program.
Student Aid Administration
Appropriations, 2004.................................... $116,727,000
Budget estimate, 2005................................... 934,639,000
Committee recommendation................................ 121,000,000
The Committee recommends $121,000,000 in discretionary
resources for the Student Aid Administration account. The
comparable fiscal year 2004 discretionary funding level is
$116,727,000 and the budget request includes $934,639,000 in
such funding. However, the budget request assumes enactment of
the proposal to rescind $795,000,000 in mandatory budget
authority available in Section 458 of the Higher Education Act
and to provide these funds through discretionary
appropriations.
Funds appropriated for the Student Aid Administration
account, in addition to mandatory funding available through
Section 458 of the Higher Education Act, will support the
Department's student aid management expenses. The Office of
Federal Student Aid and Office of Postsecondary Education have
primary responsibility for administering Federal student
financial assistance programs.
The Committee does not agree with the administration's
legislative proposal to fund this new account solely through
annual appropriations. The Committee notes the Higher Education
Act is up for reauthorization and a change of this magnitude
should be considered during that process.
Higher Education
Appropriations, 2004.................................... $2,092,644,000
Budget estimate, 2005................................... 1,977,028,000
Committee recommendation................................ 2,148,458,000
The Committee recommends an appropriation of $2,148,458,000
for higher education programs. The comparable fiscal year 2004
funding level is $2,092,644,000 and the budget request includes
$1,977,028,000 for such activities.
Aid for Institutional Development
The Committee recommends $522,000,000 for aid for
institutional development authorized by titles III and V of the
Higher Education Act. The comparable funding level for fiscal
year 2004 is $485,065,000 and the budget request includes
$505,749,000 for authorized activities.
The Committee encourages the Department to provide
technical assistance and conduct research on issues germane to
predominately and Historically Black Colleges and Universities
[HBCUs] and other institutions of higher education that have
large minority student populations, including disseminating
best practices information on the most efficient and cost-
effective uses of title III funding, reducing student loan
default rates, increasing graduation rates, and grant writing
training.
Strengthening Institutions.--The Committee bill includes
$85,000,000 for the part A strengthening institutions program.
The comparable fiscal year 2004 funding level and the budget
request both are $80,986,000 for this activity. The part A
program supports competitive, 1-year planning and 5-year
development grants for institutions with a significant
percentage of financially needy students and low educational
and general expenditures per student in comparison with similar
institutions. Applicants may use part A funds to develop
faculty, strengthen academic programs, improve institutional
management, and expand student services. Institutions awarded
funding under this program are not eligible to receive grants
under other sections of part A or part B.
Hispanic-Serving Institutions [HSI].--The Committee
recommends $100,000,000 for institutions at which Hispanic
students make up at least 25 percent of enrollment. The
comparable fiscal year 2004 funding level is $93,993,000 and
the budget request includes $95,873,000 for these institutions.
Institutions applying for title V funds must meet the regular
part A requirements and show that at least one-half of their
Hispanic students are low-income college students. Funds may be
used for acquisition, rental or lease of scientific or
laboratory equipment, renovation of instructional facilities,
development of faculty, support for academic programs,
institutional management, and purchase of educational
materials. Title V recipients are not eligible for other awards
provided under title III, parts A and B.
Strengthening Historically Black Colleges and
Universities.--The Committee recommends $240,500,000 for part B
grants. The comparable fiscal year 2004 funding level is
$222,764,000 and the budget request includes $240,500,000 for
authorized activities. The part B strengthening historically
black colleges and universities [HBCU] program makes formula
grants to HBCUs that may be used to purchase equipment,
construct and renovate facilities, develop faculty, support
academic programs, strengthen institutional management, enhance
fundraising activities, provide tutoring and counseling
services to students, and conduct outreach to elementary and
secondary school students. The minimum allotment is $500,000
for each eligible institution. Part B recipients are not
eligible for awards under part A.
Strengthening Historically Black Graduate Institutions.--
The Committee recommends $58,500,000 for the part B, section
326 program. The comparable fiscal year 2004 funding level is
$53,100,000 and the budget request includes $58,500,000 for
such activities. The section 326 program provides 5-year grants
to strengthen historically black graduate institutions [HBGIs].
The Higher Education Amendments of 1998 increased the number of
recipients to 18 named institutions, but reserved the first
$26,600,000 appropriated each year to the 16 institutions
included in the previous authorization. Grants may be used for
any part B purpose and to establish an endowment.
Strengthening Alaska Native and Native Hawaiian-Serving
Institutions.--The Committee recommends $13,000,000 for this
program. The comparable funding level for fiscal year 2004 is
$10,935,000 and the budget request includes $6,137,000 for
authorized activities. The purpose of this program is to
improve and expand the capacity of institutions serving Alaska
Native and Native Hawaiian students. Funds may be used to plan,
develop, and implement activities that encourage: faculty and
curriculum development; better fund and administrative
management; renovation and improvement of educational
facilities; student services; and the purchase of library and
other educational materials. As initial funding cycles expire,
the Committee encourages the Department to use simplified
application forms to permit participating institutions to
obtain continuation funding for successful programs funded
under this program.
Strengthening Tribally Controlled Colleges and
Universities.--The Committee recommends $25,000,000 for
strengthening tribal colleges and universities [TCUs]. The
comparable funding level for fiscal year 2004 is $23,287,000
and the budget request includes $23,753,000 for this program.
Tribal colleges and universities rely on a portion of the funds
provided to address developmental needs, including faculty
development, curriculum and student services.
For the past 4 years, the Committee has supported a
competitive grant program to assist institutions in addressing
long overdue and high-priority infrastructure and facilities
requirements. The funds provided are to be used to support
continuation of existing basic grants and new planning or
implementation grant awards. The remaining funds shall be
available for grants for renovation and construction of
facilities to continue to address urgently needed facilities
repair and expansion.
International Education and Foreign Language Studies
The bill includes a total of $103,680,000 for international
education and foreign language programs. The comparable fiscal
year 2004 funding level and the budget request both are
$103,680,000 for such activities.
Domestic Programs.--The Committee recommends $89,211,000
for domestic program activities related to international
education and foreign language studies, including international
business education, under title VI of the HEA. The comparable
fiscal year 2004 funding level and the budget request both are
$89,211,000 for authorized activities. Domestic programs
include national resource centers, undergraduate international
studies and foreign language programs, international research
and studies projects, international business education projects
and centers, American overseas research centers, language
resource centers, foreign language and area studies
fellowships, and technological innovation and cooperation for
foreign information access.
Overseas Programs.--The bill includes $12,840,000 for
overseas programs authorized under the Mutual Educational and
Cultural Exchange Act of 1961, popularly known as the
Fulbright-Hays Act. The comparable fiscal year 2004 funding
level and the budget request both are $12,840,000 for these
programs. Under these overseas programs, grants are provided
for group and faculty research projects abroad, doctoral
dissertation research abroad, and special bilateral projects.
Unlike other programs authorized by the Fulbright-Hays Act and
administered by the Department of State, these Department of
Education programs focus on training American instructors and
students in order to improve foreign language and area studies
education in the United States.
Institute for International Public Policy.--The Committee
bill recommends $1,629,000 for the Institute for International
Public Policy. The comparable funding level for fiscal year
2004 and the budget request both are $1,629,000 for authorized
activities. This program is designed to increase the number of
minority individuals in foreign service and related careers by
providing a grant to a consortium of institutions for
undergraduate and graduate level foreign language and
international studies. An institutional match of 50 percent is
required.
Fund for the Improvement of Postsecondary Education
The Committee recommends $157,700,000 for the Fund for the
Improvement of Postsecondary Education [FIPSE], the same as the
comparable fiscal year 2004 funding level. The budget request
is $32,011,000. FIPSE stimulates improvements in education
beyond high school by supporting exemplary, locally developed
projects that have potential for addressing problems and
recommending improvements in postsecondary education. The fund
is administered by an independent board that provides small,
competitive grants and contracts to a variety of postsecondary
institutions and agencies, including 2- and 4-year colleges and
universities, State education agencies, community-based
organizations, and other non-profit institutions and
organizations concerned with education beyond high school.
The Committee recommendation includes $24,881,000, the full
amount requested for the comprehensive program.
Minority Science and Engineering Improvement
The Committee recommends $8,889,000 for the Minority
Science and Engineering Improvement program [MSEIP]. The
comparable fiscal year 2004 funding level and the budget
request both are $8,889,000 for this program. Funds are used to
provide discretionary grants to institutions with minority
enrollments greater than 50 percent to purchase equipment,
develop curricula, and support advanced faculty training.
Grants are intended to improve science and engineering
education programs and increase the number of minority students
in the fields of science, mathematics, and engineering.
Interest Subsidy Grants
The Committee recommends $1,500,000 for interest subsidy
grants. The comparable fiscal year 2004 funding level is
$1,988,000 and the budget request includes $1,500,000 for these
grants. This appropriation is required to meet the Federal
commitment to pay interest subsidies on 32 loans made in past
years for constructing, renovating, and equipping postsecondary
academic facilities. No new interest subsidy commitments have
been entered into since 1973 but subsidy payments on existing
loans are expected to continue until the year 2013.
Tribally Controlled Postsecondary Vocational Institutions
The Committee recommends $8,000,000 on a current-funded
basis for tribally controlled postsecondary vocational
institutions. The comparable fiscal year 2004 funding level and
the budget request both are $7,185,000 for this purpose. This
program provides grants for the operation and improvement of
two tribally controlled postsecondary vocational institutions
to ensure continued and expanding opportunities for Indian
students: United Tribes Technical College in Bismarck, North
Dakota, and Crownpoint Institute of Technology in Crownpoint,
New Mexico.
Federal TRIO Programs
The Committee recommends $844,500,000 for Federal TRIO
Programs. The comparable fiscal year 2004 funding level and the
budget request both are $832,559,000 for authorized activities.
TRIO programs provide a variety of services to improve
postsecondary education opportunities for low-income
individuals and first-generation college students: Upward Bound
offers disadvantaged high school students academic services to
develop the skills and motivation needed to continue their
education; Student Support Services provides remedial
instruction, counseling, summer programs and grant aid to
disadvantaged college students to help them complete their
postsecondary education; Talent Search identifies and counsels
individuals between ages 11 and 27 regarding opportunities for
completing high school and enrolling in postsecondary
education; Educational Opportunity Centers provide information
and counseling on available financial and academic assistance
to low-income adults who are first-generation college students;
and the Ronald E. McNair Postbaccalaureate Achievement Program
supports research internships, seminars, tutoring, and other
activities to encourage disadvantaged college students to
enroll in graduate programs.
The Committee urges the Department to use a funding
allocation strategy in making awards under TRIO that balances
the need to fund a larger number of grantees with the need for
projects to improve the quality of student services and expand
to serve all eligible students.
Gaining Early Awareness and Readiness for Undergraduate Programs
[GEARUP]
The Committee recommends $302,500,000 for GEAR UP. The
comparable fiscal year 2004 funding level and the budget
request both are $298,230,000 for this purpose. Under this
program funds are used by States and partnerships of colleges,
middle and high schools, and community organizations to assist
middle and high schools serving a high percentage of low-income
students. Services provided help students prepare for and
pursue a postsecondary education. Funds will support a sixth
and final year award to grantees first funded in 2000, while
continuing all other projects.
The Committee has provided funds above the fiscal year 2004
level and the budget request for the Department to fund a new
grant competition under the GEAR UP program. The Committee
believes that grants should not be fully-funded, but instead
should be awarded on an annual basis from the fiscal year 2004
and subsequent appropriations during the period of the grant,
contingent upon grantee performance. The Committee notes that
grants were awarded using this approach during the first 2
years of the program. The Committee expects the Department to
consult with it prior to the announcement of this new grant
competition.
Byrd Honors Scholarships
The Committee recommends $41,000,000 for the Byrd honors
scholarship program. The comparable fiscal year 2004 funding
level and the budget request both are $40,758,000 for this
program.
The Byrd honors scholarship program is designed to promote
student excellence and achievement and to recognize
exceptionally able students who show promise of continued
excellence. Funds are allocated to State education agencies
based on each State's school-aged population. The State
education agencies select the recipients of the scholarships in
consultation with school administrators, teachers, counselors,
and parents. The funds provided will support a new cohort of
first-year students in 2005, and continue support for the 2002,
2003, and 2004 cohorts of students in their fourth, third and
second years of study, respectively. The amount recommended
will provide scholarships of $1,500 to 27,333 students.
Javits Fellowships
The Committee recommends $9,876,000 for the Javits
Fellowships program. The comparable fiscal year 2004 funding
level and the budget request both are $9,876,000 for this
program.
The Javits Fellowships program provides fellowships of up
to 4 years to students of superior ability who are pursuing
doctoral degrees in the arts, humanities, and social sciences
at any institution of their choice. Each fellowship consists of
a student stipend to cover living costs, and an institutional
payment to cover each fellow's tuition and other expenses.
Funds provided in the fiscal year 2005 appropriation support
fellowships for the 2006-2007 academic year.
Graduate Assistance in Areas of National Need [GAANN]
The Committee recommends $30,616,000 for graduate
assistance in areas of national need. The comparable fiscal
year 2004 funding level and the budget request both are
$30,616,000 for GAANN. This program awards competitive grants
to graduate academic departments and programs for fellowship
support in areas of national need as determined by the
Secretary. In fiscal year 2002, the Secretary designated the
following areas of national need: biology, chemistry, computer
and information sciences, engineering, geological and related
sciences, mathematics and physics. Recipients must demonstrate
financial need and academic excellence, and seek the highest
degree in their fields.
Teacher Quality Enhancement Grants
The Committee recommends $88,888,000 for the teacher
quality enhancement grants program. The comparable fiscal year
2004 funding level and the budget request both are $88,888,000.
The program was established to support initiatives that best
meet specific teacher preparation and recruitment needs.
Further, the Act provides and designates funding for the
program in three focus areas: 45 percent of resources support a
State grant program, 45 percent of funds are used for a
partnership program, and 10 percent are designated for a
recruitment grant program.
The budget request includes bill language that would allow
the Department to fund awards under the three program areas at
the discretion of the Department, instead of as mandated by the
Higher Education Act. The Committee has not provided the
requested authority.
Under the State grant program, funds may be used for a
variety of State-level reforms, including more rigorous teacher
certification and licensure requirements; provision of high-
quality alternative routes to certification; development of
systems to reward high-performing teachers and principals; and
development of efforts to reduce the shortage of qualified
teachers in high-poverty areas.
Teacher training partnership grants, which are awarded to
local partnerships comprised of at least one school of arts and
science, one school or program of education, a local education
agency, and a K-12 school, may be used for a variety of
activities designed to improve teacher preparation and
performance, including efforts to provide increased academic
study in a proposed teaching specialty area; to prepare
teachers to use technology effectively in the classroom; to
provide preservice clinical experiences; and to integrate
reliable research-based teaching methods into the curriculum.
Partnerships may work with other entities, with those involving
businesses receiving priority consideration. Partnerships are
eligible to receive a one-time-only grant to encourage reform
and improvement at the local level.
The recruitment grant program supports efforts to reduce
shortages of qualified teachers in high-need school districts
as well as provide assistance for high-quality teacher
preparation and induction programs to meet the specific
educational needs of the local area.
Child Care Access Means Parents in Schools
The Committee recommends an appropriation of $16,099,000
for the Child Care Access Means Parents in School [CCAMPIS]
program. The comparable fiscal year 2004 funding level and the
budget request both are $16,099,000 for this program. CCAMPIS
was established in the Higher Education Amendments of 1998 to
support the efforts of a growing number of non-traditional
students who are struggling to complete their college degrees
at the same time that they take care of their children.
Discretionary grants of up to 4 years are made to institutions
of higher education to support or establish a campus-based
childcare program primarily serving the needs of low-income
students enrolled at the institution.
Demonstration Projects to Ensure Quality Higher Education for Students
With Disabilities
The Committee recommends $7,000,000 for this program. The
comparable fiscal year 2004 funding level is $6,913,000. The
budget proposes no funding for this program. This program's
purpose is to ensure that students with disabilities receive a
high-quality postsecondary education. Grants are made to
support model demonstration projects that provide technical
assistance and professional development activities for faculty
and administrators in institutions of higher education.
Underground Railroad Program
The Committee recommendation includes $2,222,000 for the
Underground Railroad program. The comparable fiscal year 2004
funding level is $2,222,000 and the administration proposes to
eliminate funding for this activity. The program was authorized
by the Higher Education Amendments of 1998 and was funded for
the first time in fiscal year 1999. Grants are provided to
research, display, interpret, and collect artifacts relating to
the history of the underground railroad. Educational
organizations receiving funds must demonstrate substantial
private support through a public-private partnership, create an
endowment fund that provides for ongoing operation of the
facility, and establish a network of satellite centers
throughout the United States to share information and teach
people about the significance of the Underground Railroad in
American history.
GPRA/Higher Education Act Program Evaluation
The Committee recommends $988,000 for data collection
associated with the Government Performance and Results Act data
collection and to evaluate programs authorized by the Higher
Education Act. The comparable fiscal year 2004 funding level
and the budget request both are $988,000 for these activities.
These funds are used to comply with the Government Performance
and Results Act, which requires the collection of data and
evaluation of Higher Education programs and the performance of
recipients of Higher Education funds.
B.J. Stupak Olympic Scholarships
The Committee recommendation does not include funding for
this program. The comparable fiscal year 2004 funding level is
$988,000 and the budget request did not include funds for this
activity. Funds appropriated in fiscal year 2004 will be used
to provide financial assistance to athletes who are training at
the United States Olympic Education Center or one of the United
States Olympic Training Centers and who are pursuing a
postsecondary education at an institution of higher education.
Unlike most other Federal student aid programs, scholarships
are provided without consideration of expected family
contributions.
Thurgood Marshall Legal Educational Opportunity Program
The Committee recommendation includes $3,000,000 for the
Thurgood Marshall Legal Educational Opportunity Program.
Funding for this program was not available in fiscal year 2004
and the budget request did not include any funds for this
purpose. According to the U.S. Department of Education, the
Council for Legal Educational Opportunity still has available
balances from appropriations provided in fiscal years 2001,
2002 and 2003.
Under this program, funds help low-income, minority or
disadvantaged college students with the information,
preparation and financial assistance to enter and complete law
school study. The Higher Education Act stipulates that the
Secretary make an award to or contract with the Council on
Legal Education Opportunity to carry out authorized activities.
Howard University
Appropriations, 2004.................................... $238,763,000
Budget estimate, 2005................................... 238,763,000
Committee recommendation................................ 239,763,000
The Committee recommends an appropriation of $239,763,000
for Howard University. The comparable fiscal year 2004 funding
level and the budget request both are $238,763,000 for this
purpose. Howard University is located in the District of
Columbia and offers undergraduate, graduate, and professional
degrees through 12 schools and colleges. The university also
administers the Howard University Hospital, which provides both
inpatient and outpatient care, as well as training in the
health professions. Federal funds from this account support
more than 50 percent of the university's projected educational
and general expenditures, excluding the hospital. The Committee
recommends, within the funds provided, not less than $3,600,000
shall be for the endowment program.
Howard University Hospital.--Within the funds provided, the
Committee recommends $29,999,000 for the Howard University
Hospital. The comparable fiscal year 2004 funding level and the
budget request both are $29,999,000 for this purpose. The
hospital serves as a major acute and ambulatory care center for
the District of Columbia and functions as a major teaching
facility attached to the university. The Federal appropriation
provides partial funding for the hospital's operations.
College Housing and Academic Facilities Loans
Appropriations, 2004.................................... $769,000
Budget estimate, 2005................................... 578,000
Committee recommendation................................ 578,000
Federal Administration.--The Committee bill includes
$578,000 for Federal administration of the CHAFL program. The
comparable fiscal year 2004 funding level is $769,000 and the
budget request includes $578,000 for such expenses.
These funds will be used to reimburse the Department for
expenses incurred in managing the existing CHAFL loan portfolio
during fiscal year 2005. These expenses include salaries and
benefits, travel, printing, contracts (including contracted
loan servicing activities), and other expenses directly related
to the administration of the CHAFL Program.
Historically Black College and University Capital Financing Program
Appropriations, 2004.................................... $209,000
Budget estimate, 2005................................... 212,000
Committee recommendation................................ 212,000
Federal Administration.--The Committee recommends $212,000
for Federal administration of the Historically Black College
and University [HBCU] Capital Financing Program. The comparable
fiscal year 2004 funding level is $209,000 and the budget
request includes $212,000 for this activity.
The HBCU Capital Financing Program makes capital available
to HBCUs for construction, renovation, and repair of academic
facilities by providing a Federal guarantee for private sector
construction bonds. Construction loans will be made from the
proceeds of the sale of the bonds.
Institute of Education Science
Appropriations, 2004.................................... $496,735,000
Budget estimate, 2005................................... 449,621,000
Committee recommendation................................ 418,679,000
The bill includes $418,679,000 for the Institute of
Education Sciences. The comparable fiscal year 2004 funding
level is $496,735,000 and the budget request includes
$449,621,000 for comparable activities. This account supports
education research, data collection and analysis activities,
and the assessment of student progress.
Research, Development and Dissemination
The Committee recommends $165,518,000 for education
research, development and national dissemination activities.
The comparable fiscal year 2004 amount is $165,518,000 and the
budget request includes $185,000,000 for these activities.
Funds are available for obligation for 2 fiscal years. These
funds support research, development, and dissemination
activities that are aimed at expanding fundamental knowledge of
education and promoting the use of research and development
findings in the design of efforts to improve education.
The Committee strongly supports the premise that
developing, identifying and implementing scientifically based
research is critical to the success of the No Child Left Behind
Act [NCLB] and to the increased effectiveness generally of
education programs and interventions. The Committee recognizes
the current scarcity of educational interventions that have
been proven effective in research that meets the rigorous
standards set out in the NCLB. In particular, the Committee
believes that a greater focus must be placed on the use of
randomized controlled trials, longitudinal studies, and other
research that meets the standards set by the National Research
Council.
The Committee recognizes the critical role that IES plays
in achieving the important goals set by the No Child Left
Behind Act and encourages IES to continue its progress in
translating scientifically based research findings into
classroom practice. The Committee is interested in support for
programs that bring advances in cognitive, developmental,
educational science and neuroscience into the classroom by
informing curriculum development in schools and in graduate
schools of education. Research that focuses on the key
processes of attention, memory, and reasoning are essential for
learning and are likely to produce substantial gains in
academic achievement. The Committee also supports the
Institute's research investments in reading comprehension,
teacher quality, English language learners, and educational
interventions in mathematics, science and reading.
The Committee is concerned that the Department plans to
underfund the National Research and Development Centers
program. The Committee notes that the three existing centers
that are slated to receive continuation funding in fiscal year
2005 will each receive at least $3,600,000. Under the
Department's new request for center proposals, published in
February 2004, centers will be funded at just $1,000,000 to
$2,000,000 per year. The Committee questions whether these
funding levels will be of ``sufficient size and scope to be
effective,'' as mandated in section 133(c)(4) of the Education
Sciences Reform Act of 2002. The Committee believes that the
centers must have sufficient funding to enable them to fulfill
their missions to support long-term programs of research that
address the topics of critical national interest on which each
center is focused. The Committee also believes it is essential
that the centers not be restricted to researching limited
issues that are not broadly applicable.
The Committee urges the Department to fund each center in
the next round of competition at levels that are comparable to
those of existing centers. It also urges the Department to
reexamine the current level of funding offered for the four
centers being competed in 2004 to consider whether they might
be more effective if funded at this higher level and with a
broader mandate.
Statistics
The Committee recommends $91,664,000 for data-gathering and
statistical-analysis activities of the National Center for
Education Statistics [NCES]. The comparable fiscal year 2004
funding level and the budget request both are $91,664,000 for
this purpose.
The NCES collects, analyzes, and reports statistics on
education in the United States. Activities are carried out
directly and through grants and contracts. The Center collects
data on educational institutions at all levels, longitudinal
data on student progress, and data relevant to public policy.
The NCES also provides technical assistance to State and local
education agencies and postsecondary institutions.
Regional Educational Laboratories
The Committee recommends $66,665,000 to continue support
for the regional educational laboratories. The comparable
fiscal year 2004 funding level is $66,665,000 and the budget
request proposes to eliminate funding for this purpose. Program
funds support a network of 10 laboratories that are responsible
for promoting the use of broad-based systemic strategies to
improve student achievement.
Assessment
The Committee recommends $94,832,000 for assessment. The
comparable fiscal year 2004 funding level and the budget
request both are $94,832,000 for authorized activities.
These funds provide support for the National Assessment of
Educational Progress [NAEP], a congressionally mandated
assessment created to measure the educational achievement of
American students. The primary goal of NAEP is to determine and
report the status and trends over time in educational
achievement, subject by subject. Beginning in 2002, the
Department will pay for State participation in biennial reading
and mathematics assessments in grades 4 and 8.
Within the funds appropriated, the Committee recommends
$5,129,000 for the National Assessment Governing Board [NAGB],
which is responsible for formulating policy for NAEP. The
comparable fiscal year 2004 amount is $5,060,000 and the budget
request includes $5,129,000 for NAGB.
Departmental Management
PROGRAM ADMINISTRATION
Appropriations, 2004.................................... $420,379,000
Budget estimate, 2005................................... 429,778,000
Committee recommendation................................ 420,379,000
The Committee recommends $420,379,000 for program
administration. The comparable fiscal year 2004 funding level
is $420,379,000 and the budget request includes $429,778,000
for this purpose.
Funds support personnel compensation and benefits, travel,
rent, communications, utilities, printing, equipment and
supplies, automated data processing, and other services
required to award, administer, and monitor approximately 180
Federal education programs. Support for program evaluation and
studies and advisory councils is also provided under this
activity.
The Committee notes with approval the increased attention
being paid to the coordination of human services with
transportation. The Committee notes the recent Executive Order
issued by the President calling for a report on transportation
coordination within 1 year. The Committee expects the
Department, as a key agency mentioned in the Executive Order,
to report the findings to the Committee as soon as the study is
complete. The Committee understands that the Interagency
Transportation Coordinating Council on Access and Mobility,
housed in the Department of Transportation, will produce the
report called for in the executive order.
The Committee acknowledges that although the Committee
included language prohibiting the use of updated tax tables in
awarding Pell Grants for the 2005-2006 award year, that the
issue of the best methodology for Federal need analysis remains
in question. Therefore, the Committee looks forward to
reviewing the recommendations of the Advisory Committee on
Student Financial Assistance regarding the efficiency,
effectiveness and fairness of the current procedures for
determining a family's available income and assets. The
Committee intends that the needs analysis for Pell Grants
accurately represents the relative distribution of eligible
students across the Nation.
OFFICE FOR CIVIL RIGHTS
Appropriations, 2004.................................... $88,305,000
Budget estimate, 2005................................... 92,801,000
Committee recommendation................................ 92,801,000
The Committee bill includes $92,801,000 for the Office for
Civil Rights [OCR]. The comparable fiscal year 2004 amount is
$88,305,000 and the budget request includes $92,801,000 for
this purpose.
The Office for Civil Rights is responsible for the
enforcement of laws that prohibit discrimination on the basis
of race, color, national origin, sex, disability, and age in
all programs and institutions funded by the Department of
Education. To carry out this responsibility, OCR investigates
and resolves discrimination complaints, monitors desegregation
and equal educational opportunity plans, reviews possible
discriminatory practices by recipients of Federal education
funds, and provides technical assistance to recipients of funds
to help them meet civil rights requirements.
OFFICE OF THE INSPECTOR GENERAL
Appropriations, 2004.................................... $46,624,000
Budget estimate, 2005................................... 50,576,000
Committee recommendation................................ 50,576,000
The Committee recommends $50,576,000 for the Office of the
Inspector General. The comparable fiscal year 2004 amount is
$46,624,000 and the budget request includes $50,576,000 for
authorized activities.
The Office of the Inspector General has the authority to
investigate all departmental programs and administrative
activities, including those under contract or grant, to prevent
and detect fraud and abuse, and to ensure the quality and
integrity of those programs. The Office investigates alleged
misuse of Federal funds, and conducts audits to determine
compliance with laws and regulations, efficiency of operations,
and effectiveness in achieving program goals.
General Provisions
The Committee bill contains language which has been
included in the bill since 1974, prohibiting the use of funds
for the transportation of students or teachers in order to
overcome racial imbalance (sec. 301).
The Committee bill contains language included in the bill
since 1977, prohibiting the transportation of students other
than to the school nearest to the student's home (sec. 302).
The Committee bill contains language which has been
included in the bill since 1980, prohibiting the use of funds
to prevent the implementation of programs of voluntary prayer
and meditation in public schools (sec. 303).
The Committee bill includes a provision giving the
Secretary of Education authority to transfer up to 1 percent of
any discretionary funds between appropriations (sec. 304).
The Committee bill includes a provision, also contained in
the fiscal year 2004 Act, that prevents the Secretary from
using updated State and other tax information in the Federal
needs analysis methodology (sec. 305).
TITLE IV--RELATED AGENCIES
Armed Forces Retirement Home
Appropriations, 2004.................................... $64,894,000
Budget estimate, 2005................................... 61,195,000
Committee recommendation................................ 61,195,000
The Committee recommends authority to expend $61,195,000
from the Armed Forces Home Trust Fund to operate and maintain
the Armed Forces Retirement Home--Washington, and the Armed
Forces Retirement Home--Gulfport. This amount is equal to the
budget request. (8=5)
Corporation for National and Community Service
DOMESTIC VOLUNTEER SERVICE PROGRAMS
Appropriations, 2004.................................... $354,340,000
Budget estimate, 2005................................... 375,335,000
Committee recommendation................................ 357,814,000
The Committee recommends $357,814,000 for fiscal year 2005
for the domestic volunteer service programs of the Corporation
for National and Community Service. The comparable funding
level for fiscal year 2004 is $354,340,000 and the budget
request includes $375,335,000 for this program.
The Committee is concerned by the apparent inconsistencies
in the Corporation's budget justification. The Corporation is
right to be concerned about unobligated funds, however the
Committee notes that the Corporation already possesses the
flexibility to redirect unused funds to grantees with
additional capacity. For that reason, the Committee has
rejected the cuts proposed by the Corporation and directs the
CEO to utilize existing flexibility to resolve any volunteer
retention issues.
VISTA
The Committee recommends $96,428,000 for fiscal year 2005
for the Volunteers in Service to America [VISTA] Program. The
comparable funding level for fiscal year 2004 is $93,731,000
and the budget request includes $96,428,000 for this program.
VISTA, created in 1964 by the Johnson Administration under
the Economic Opportunity Act, is a program which provides
capacity building for small community-based organizations.
VISTA volunteers raise resources for local projects, recruit
and organize volunteers, and establish and expand local
community-based programs in housing, employment, health, and
economic development activities.
The Committee is anxious that the funding provided for
training and technical assistance be utilized to support
training that can enhance the effectiveness of VISTA members
with respect to their mission to build the capacity of local
communities to support the projects that they develop. VISTA
members are increasingly called upon to write grant
applications and do fundraising as a way of making their
service projects self-sufficient, requiring knowledge of grant
writing that cannot be gained in the local organization, as
well as training in the general field in which they are slated
to serve. For that reason, the Committee urges the Corporation
to integrate grant writing and issue specific presentations
into the training sessions currently given to all new VISTA
members. The Committee directs the Corporation to report in the
fiscal year 2006 budget justification on the percentage of
training funds and percentage of training time spent on each of
the following categories: organizational training, grant
writing and fundraising training, and issue specific training
(i.e. early childhood education, environment, disaster
assistance, etc).
Special Volunteer Programs
The Committee recommends $5,000,000 for fiscal year 2005
for the Special Volunteer programs. The comparable funding
level for fiscal year 2004 is $9,876,000 and the budget request
includes $15,000,000 for this program.
These funds will be used to carry out Part C of Title I of
the Domestic Volunteer Service Act of 1973, which authorizes
grants to volunteer organizations to encourage and enable
persons from all age groups to perform volunteer service in
agencies, institutions, and situations of need. Grants are
awarded to organizations that strengthen and support volunteer
efforts, with a particular emphasis on anti-poverty efforts.
The Committee commends the CNCS for its stated goal of
recruiting new Senior Corps volunteers and strongly supports
this effort. The Committee is aware that one of the most
important factors in the decision to continue volunteering is
the quality of the first volunteer experience and the ongoing
presence of the volunteer organization. For this reason, the
Committee urges the Corporation to coordinate this program with
the Senior Corps direct service programs. The budget request
did not include funding for the Parent Drug Corps, and the
Committee concurred.
National Senior Volunteer Corps
The Committee recommends $218,886,000 for fiscal year 2005
for the National Senior Volunteer Corps programs. The
comparable funding level for fiscal year 2004 is $214,264,000
and the budget request includes $224,544,000 for this program.
The Committee recognizes the valuable contributions of
seniors participating in the Foster Grandparent [FGP], Retired
and Senior Volunteer Program [RSVP], and Senior Companion
Programs [SCP]. In accordance with the Domestic Volunteer
Service Act [DVSA], the Committee intends that at least one-
third of each program's increase over the fiscal year 2001
level shall be used to fund Programs of National Significance
[PNS] expansion grants to allow existing FGP, RSVP, and SCP
programs to expand the number of volunteers serving in areas of
critical need as identified by Congress in the DVSA. Remaining
funds should be used to begin new FGP, RSVP, and SCP programs
in geographic areas currently underserved. The Committee
expects these projects to be awarded via a nationwide
competition among potential community-based sponsors. No funds
have been included for senior demonstration programs.
Foster Grandparent Program
The Committee recommends $112,323,000 for fiscal year 2005
for the Foster Grandparent Program. The comparable funding
level for fiscal year 2004 is $110,121,000 and the budget
request includes $106,700,000 for this program.
This program provides volunteer opportunities to seniors
age 60 and over who serve at-risk youth. This program not only
involves seniors in their communities, but it also provides a
host of services to children.
Senior Companion Program
The Committee recommends $46,563,000 for fiscal year 2005
for the Senior Companion Program. The comparable funding level
for fiscal year 2004 is $45,987,000 and the budget request
includes $46,563,000 for this program.
This program enables senior citizens to provide personal
assistance and companionship to adults with physical, mental,
or emotional difficulties. Senior companions provide vital in-
home services to elderly Americans who would otherwise have to
enter nursing homes. The volunteers also provide respite care
to relieve care givers.
Retired and Senior Volunteer Program
The Committee recommends $60,000,000 for fiscal year 2005
for the Retired and Senior Volunteer Program. The comparable
funding level for fiscal year 2004 is $58,156,000 and the
budget request includes $69,884,000 for this program.
This program involves persons age 55 and over in volunteer
opportunities in their communities such as tutoring youth,
responding to natural disasters, teaching parenting skills to
teen parents, and mentoring troubled youth.
Program Administration
The Committee recommends $37,500,000 for fiscal year 2005
for program support administration. The comparable funding
level for fiscal year 2004 is $36,469,000 and the budget
request includes $39,363,000 for this program.
The Committee is pleased with action the Corporation has
taken to reverse the consolidation of State Offices as directed
in the fiscal year 2004 Appropriations bill. However, the
Committee is troubled that the Corporation did not provide the
requested 5-year plan in the fiscal year 2005 budget
justification detailing the number, location of State offices,
and staffing plans of each. The Committee expects the
Corporation to provide this information no later than 6 weeks
after enactment of the fiscal year 2005 appropriation.
Corporation for Public Broadcasting
Appropriations, 2005.................................... $390,000,000
Appropriations, 2006.................................... 400,000,000
Budget estimate, 2007...................................................
Committee recommendation................................ 400,000,000
The Committee recommends $400,000,000 be made available for
the Corporation for Public Broadcasting [CPB], an advance
appropriation for fiscal year 2007. The comparable funding
level provided last year was $400,000,000 for fiscal year 2004.
The budget request does not include advance funds for this
program.
In addition, the Committee recommends $49,705,000 be made
available in fiscal year 2005 for the conversion to digital
broadcasting. The comparable funding level for fiscal year 2004
is the same amount. The budget request included no funding for
this purpose.
In addition, the Committee recommends $50,000,000 be made
available in fiscal year 2005 for the replacement project of
the interconnection system. In fiscal year 2004, $9,941,000 was
appropriated for this purpose.
The current interconnection system is entirely satellite
based. This satellite is currently nearing the end of its
useful life, and while satellite technology is currently the
most cost-effective method for distribution in a point-to-
multipoint system, terrestrial technology is far more
economical when data is distributed between single points. The
Next Generation Interconnection System will utilize a
combination of satellite and terrestrial technologies for a
more flexible system. In addition, a portion of the provided
funds will be used to upgrade existing ground station and
transmit/receive equipment to be compatible with the new
system.
The Committee is disturbed by the recent GAO report
detailing the Corporation's use of appropriated funds for the
Television Future Fund, which provides funding to project-
specific grants that have a system-wide benefit. The
Corporation's authorizing statute requires that 75 percent of
funds be distributed to local stations through Community
Service Grants [CSG] and 25 percent of funds be used to support
the creation of national programming. While the Committee is
not prepared to evaluate the possible need for such a fund, the
Committee feels strongly that the statute does not currently
permit the use of appropriated funds for this type of grant
program. For that reason, the Committee has included bill
language prohibiting funding in fiscal years 2005, 2006, and
2007 from being used for the Television Future Fund or any
similar activity until such time as a specific authorization is
enacted to allow it.
Federal Mediation and Conciliation Service
Appropriations, 2004.................................... $43,129,000
Budget estimate, 2005................................... 43,964,000
Committee recommendation................................ 44,464,000
The Committee recommends $44,464,000 for fiscal year 2005
for the Federal Mediation and Conciliation Service [FMCS]. The
comparable funding level for fiscal year 2004 is $43,129,000
and the budget request includes $43,964,000 for this program.
The FMCS was established by Congress in 1947 to provide
mediation, conciliation, and arbitration services to labor and
management. FMCS is authorized to provide dispute resolution
consultation and training to all Federal agencies.
The Committee continues to support the FMCS program to
prevent youth violence and is especially pleased with the
initiative to train educators in conflict resolution. The
Committee is also impressed with the development of a CD-ROM
that will address conflict resolution among preschool and
elementary age children. The Committee has included $500,000
for the continuation of these innovative programs for youth
violence prevention.
Federal Mine Safety and Health Review Commission
Appropriations, 2004.................................... $7,728,000
Budget estimate, 2005................................... 7,813,000
Committee recommendation................................ 7,813,000
The Committee recommends $7,813,000 for fiscal year 2005
for the Federal Mine Safety and Health Review Commission. The
comparable funding level for fiscal year 2004 is $7,728,000 and
the budget request includes $7,813,000 for this program.
The Federal Mine Safety and Health Review Commission
provides administrative trial and appellate review of legal
disputes under the Federal Mine Safety and Health Act of 1977.
The five-member Commission provides review of the Commission's
administrative law judge decisions.
Institute of Museum and Library Services
Appropriations, 2004.................................... $262,240,000
Budget estimate, 2005................................... 261,743,000
Committee recommendation................................ 262,240,000
The Committee recommends $262,240,000 for fiscal year 2005
for the Institute of Museum and Library Services. The
comparable funding level for fiscal year 2004 is $262,240,000
and the budget request includes $261,743,000 for this program.
Office of Museum Services Operations Grants
The Committee recommends $19,724,000 for operations grants.
These funds support grants to museums for building increased
public access, expanding educational services, reaching
families and children, and using technology more effectively in
support of these goals. In addition, non-competitive grants are
awarded for technical assistance in four types of assessments:
Institutional, Collections Management, Public Dimension, and
Governance. In addition to the total recommended, $1,000,000
has been provided for Native American Museum service grants.
Museum Conservation Programs
The Committee recommends $3,630,000 for Conservation
programs. These funds support grants to allow museums to survey
collections, perform training, research, treatment and
environmental improvements. In addition, grantees may receive
additional funds to develop an education component that relates
to their conservation project. In addition, non-competitive
grants are awarded for technical assistance in conservation
efforts.
Museum National Leadership Projects
The Committee recommends $10,000,000 for National
Leadership projects. The National Leadership Grants encourage
innovation in meeting community needs, widespread and creative
use of new technologies, greater public access to museum
collections, and an extended impact of Federal dollars through
collaborative projects.
Office of Library Services State Grants
The Committee recommends $172,900,000 for State grants.
Funds are provided to States by formula to carry out 5-year
State plans. These plans must set goals and priorities for the
State consistent with the purpose of the act, describe
activities to meet the goals and priorities and describe the
methods by which progress toward the goals and priorities and
the success of activities will be evaluated. States may
apportion their funds between two activities, technology and
targeted services. For technology, States may use funds for
electronic linkages among libraries, linkages to educational,
social and information services, accessing information through
electronic networks, or link different types of libraries or
share resources among libraries. For targeted services, States
may direct library and information services to persons having
difficulty using a library, underserved urban and rural
communities, and children from low income families. In addition
to the total recommended, $3,800,000 has been provided for
library services to Native Americans and Native Hawaiians. The
Committee is aware that many traditional healers are aging and
the world may soon lose the knowledge that they possess. For
that reason, the Committee encourages IMLS to work for the
preservation and documentation of Native Hawaiian traditional
cultural healing practices. It is essential that these
practices be documented in creative media formats due to the
variety and complexity of the practices and the healers.
Library National Leadership Projects
The Committee recommends $20,000,000 for national
leadership projects. These funds support activities of national
significance to enhance the quality of library services
nationwide and to provide coordination between libraries and
museums. Activities are carried out through grants and
contracts awarded on a competitive basis to libraries,
agencies, institutions of higher education and museums.
Priority is given to projects that focus on education and
training of library personnel, research and development for the
improvement of libraries, preservation, digitization of library
materials, partnerships between libraries and museums and other
activities that enhance the quality of library services
nationwide.
The Committee commends the administration for proposing an
Initiative to Recruit and Educate Librarians and has included
$20,000,000 for this purpose. The Nation is facing an impending
retirement wave of librarians. The Bureau of Labor Statistics
reports that 57 percent of current librarians are 45 and older
and 50 percent of librarians are expected to leave the
profession in the next 10 years. In addition, current
librarians are being asked to take on expanded duties as
information technology advances and our society experiences an
ever-increasing need for the dissemination of public safety and
public health data.
Museum and Library Services Administration
The Committee recommends $11,186,000 for program
administration, the same as the budget request. Funds support
personnel compensation and benefits, travel, rent,
communications, utilities, printing, equipment and supplies,
automated data processing, and other services.
Medicare Payment Advisory Commission
Appropriations, 2004.................................... $9,245,000
Budget estimate, 2005................................... 9,905,000
Committee recommendation................................ 9,905,000
The Committee recommends $9,905,000 for fiscal year 2005
for the Medicare Payment Advisory Commission. The comparable
funding level for fiscal year 2004 is $9,245,000 and the budget
request includes $9,905,000 for this program.
The Medicare Payment Advisory Commission [MedPAC] was
established by Congress as part of the Balanced Budget Act of
1997 (Public Law 105-33). Congress merged the Physician Payment
Review Commission with the Prospective Payment Assessment
Commission to create MedPAC.
National Commission on Libraries and Information Science
Appropriations, 2004.................................... $994,000
Budget estimate, 2005................................... 1,000,000
Committee recommendation................................ 994,000
The Committee recommends $994,000 for fiscal year 2005 for
the National Commission on Libraries and Information Science.
The comparable funding level for fiscal year 2004 is $994,000
and the budget request includes $1,000,000 for this program.
The Commission determines the need for, and makes
recommendations on, library and information services, and
advises the President and Congress on the development and
implementation of national policy in library and information
sciences.
National Council on Disability
Appropriations, 2004.................................... $3,021,000
Budget estimate, 2005................................... 2,873,000
Committee recommendation................................ 3,371,000
The Committee recommends $3,371,000 for fiscal year 2005
for the National Council on Disability. The comparable funding
level for fiscal year 2004 is $3,021,000 and the budget request
includes $2,873,000 for this program.
The Council is mandated to make recommendations to the
President, the Congress, the Rehabilitation Services
Administration, and the National Institute on Disability and
Rehabilitation Research, on the public issues of concern to
individuals with disabilities. The Council gathers information
on the implementation, effectiveness, and impact of the
Americans with Disabilities Act and looks at emerging policy
issues as they affect persons with disabilities and their
ability to enter or reenter the Nation's work force and to live
independently.
The Committee strongly supports the Americans with
Disabilities Act and appreciates the effort that the Council
has undertaken to gather input on the ADA from stakeholders
across the country. For this reason, the Committee has included
additional resources to allow the Council to continue to hold
forums, survey stakeholders, develop approaches to address the
current state of the Act and to ensure that people with
disabilities are adequately protected from discrimination.
National Labor Relations Board
Appropriations, 2004.................................... $242,633,000
Budget estimate, 2005................................... 248,785,000
Committee recommendation................................ 250,000,000
The Committee recommends $250,000,000 for fiscal year 2005
for the National Labor Relations Board [NLRB]. The comparable
funding level for fiscal year 2004 is $242,633,000 and the
budget request includes $248,633,000 for this program.
The NLRB is a law enforcement agency which adjudicates
disputes under the National Labor Relations Act.
The Committee is disappointed that, for the past 2 years,
the administration has repeatedly underestimated the funding
necessary to process the increase in case intakes occurring as
a result of the economic downturn. The Committee has repeatedly
included additional funds to reduce the backlog but progress on
that front has been stymied by the increase in cases. The
backlog at the end of fiscal year 2002 was 1,046 cases and grew
to 1,193 cases by the end of fiscal year 2003. It is estimated
that the backlog will be 1,436 cases by the end of fiscal year
2004. The Committee is concerned about the impact this backlog
has on workplace conditions. The Committee has again included
additional funds to address this serious situation, however,
the Committee encourages the administration to develop more
accurate estimates on which to base their request.
The Committee is disappointed by the NLRB's plan to
restructure its regional offices. Current consolidation
proposals will slow the decision making process in some regions
and hurt workers access to a fair and timely hearing. The
Committee specifically opposes the elimination of Region 30 and
the subsequent downgrading of the Region 30 Office to sub-
regional status. Downgrading this office will force interested
parties to travel long distances while increasing the backlog
of cases in Region 18.
National Mediation Board
Appropriations, 2004.................................... $11,354,000
Budget estimate, 2005................................... 11,635,000
Committee recommendation................................ 11,635,000
The Committee recommends $11,635,000 for fiscal year 2005
for the National Mediation Board. The comparable funding level
for fiscal year 2004 is $11,354,000 and the budget request
includes $11,635,000 for this program.
The National Mediation Board protects interstate commerce
as it mediates labor-management relations in the railroad and
airline industries under the Railway Labor Act. The Board
mediates collective bargaining disputes, determines the choice
of employee bargaining representatives through elections, and
administers arbitration of employee grievances.
Occupational Safety and Health Review Commission
Appropriations, 2004.................................... $9,805,000
Budget estimate, 2005................................... 10,516,000
Committee recommendation................................ 10,516,000
The Committee recommends $10,516,000 for fiscal year 2005
for the Occupational Safety and Health Review Commission. The
comparable funding level for fiscal year 2004 is $9,805,000 and
the budget request includes $10,516,000 for this program.
The Commission serves as a court to justly and
expeditiously resolve disputes between the Occupational Safety
and Health Administration [OSHA] and employers charged with
violations of health and safety standards enforced by OSHA.
Railroad Retirement Board
DUAL BENEFITS PAYMENTS ACCOUNT
Appropriations, 2004.................................... $110,345,000
Budget estimate, 2005................................... 100,000,000
Committee recommendation................................ 100,000,000
The Committee recommends $100,000,000 for fiscal year 2005
for the Dual Benefits Payments Account. The comparable funding
level for fiscal year 2004 is $110,345,000 and the budget
request includes $100,000,000 for this program.
This appropriation provides for vested dual benefit
payments authorized by the Railroad Retirement Act of 1974, as
amended by the Omnibus Reconciliation Act of 1981. This
separate account, established for the payment of dual benefits,
is funded by general fund appropriations and income tax
receipts of vested dual benefits.
FEDERAL PAYMENTS TO THE RAILROAD RETIREMENT ACCOUNT
Appropriations, 2004.................................... $150,000
Budget estimate, 2005................................... 150,000
Committee recommendation................................ 150,000
The Committee recommends $150,000 for fiscal year 2005 for
interest earned on unnegotiated checks. The comparable funding
level for fiscal year 2004 is $150,000 and the budget request
includes $150,000 for this program.
LIMITATION ON ADMINISTRATION
Appropriations, 2004.................................... $100,702,000
Budget estimate, 2005................................... 102,600,000
Committee recommendation................................ 102,600,000
The Committee recommends $102,600,000 for fiscal year 2005
for the administration of railroad retirement/survivor benefit
programs. The comparable funding level for fiscal year 2004 is
$100,702,000 and the budget request includes $102,600,000 for
this program.
The Board administers comprehensive retirement-survivor and
unemployment-sickness insurance benefit programs for the
Nation's railroad workers and their families. This account
limits the amount of funds in the railroad retirement and
railroad unemployment insurance trust funds which may be used
by the Board for administrative expenses.
The Committee has included language to prohibit funds from
the railroad retirement trust fund from being spent on any
charges over and above the actual cost of administering the
trust fund, including commercial rental rates.
LIMITATION ON THE OFFICE OF THE INSPECTOR GENERAL
Appropriations, 2004.................................... $6,561,000
Budget estimate, 2005................................... 7,200,000
Committee recommendation................................ 7,200,000
The Committee recommends $7,200,000 for fiscal year 2005
for the Office of the Inspector General. The comparable funding
level for fiscal year 2004 is $6,561,000 and the budget request
includes $7,200,000 for this program.
The Committee has included bill language to allow the
Office of the Inspector General to use funds to conduct audits,
investigations, and reviews of the Medicare program. The
Committee finds that as long as the RRB has the authority to
negotiate and administer the separate Medicare contract, the
RRB Inspector General should not be prohibited from using funds
to review, audit, or investigate the Railroad Retirement
Board's separate Medicare contract.
Social Security Administration
PAYMENTS TO SOCIAL SECURITY TRUST FUNDS
Appropriations, 2004.................................... $21,658,000
Budget estimate, 2005................................... 20,454,000
Committee recommendation................................ 20,454,000
The Committee recommends an appropriation of $20,454,000
for payments to Social Security trust funds. The comparable
fiscal year 2004 funding level is $21,658,000 and the budget
request includes $20,454,000 for this purpose. This amount
reimburses the old age and survivors and disability insurance
trust funds for special payments to certain uninsured persons,
costs incurred administering pension reform activities, and the
value of the interest for benefit checks issued but not
negotiated. This appropriation restores the trust funds to the
same financial position they would have been in had they not
borne these costs, properly charged to the general funds.
SUPPLEMENTAL SECURITY INCOME
Appropriations, 2004.................................... $26,229,300,000
Budget estimate, 2005................................... 28,608,929,000
Committee recommendation................................ 25,327,949,000
The Committee recommends an appropriation of
$25,327,949,000 for supplemental security income. This is in
addition to the $12,590,000,000 appropriated last year as an
advance for the first quarter of fiscal year 2005. The
comparable fiscal year 2004 funding level is $26,229,300,000
and the budget request includes $28,608,929,000. The Committee
also recommends an advance appropriation of $14,130,000,000 for
the first quarter of fiscal year 2006 to ensure uninterrupted
benefits payments. The program level supported by the Committee
recommendation is $39,457,949,000, compared to the total
program level requested in the budget of $39,538,929,000. The
Committee recommendation also includes bill language which
adjusts the timing of the October 2005 SSI benefit payment.
These funds are used to pay benefits under the SSI Program,
which was established to ensure a Federal minimum monthly
benefit for aged, blind, and disabled individuals, enabling
them to meet basic needs. It is estimated that approximately
6,900,000 persons will receive SSI benefits each month during
fiscal year 2005. In many cases, SSI benefits supplement income
from other sources, including Social Security benefits. The
funds are also used to reimburse the Social Security trust
funds for the administrative costs for the program with a final
settlement by the end of the subsequent fiscal year as required
by law, to reimburse vocational rehabilitation agencies for
costs incurred in successfully rehabilitating SSI recipients
and for research and demonstration projects.
Beneficiary Services
The Committee recommendation includes $45,929,000 for
beneficiary services. The comparable funding level in fiscal
year 2004 is $100,000,000 and the budget request includes
$45,929,000 for these services. This amount is available for
payments to Employment Networks for successful outcomes or
milestone payments under the Ticket to Work program and for
reimbursement of State vocational rehabilitation agencies and
alternate public or private providers. The decrease in budget
authority requested and concurred in by the Committee is due to
the availability of resources from prior years.
Research and Demonstration Projects
The Committee recommendation includes $35,000,000 for
research and demonstration projects conducted under sections
1110 and 1115 of the Social Security Act. The comparable fiscal
year 2004 funding level is $38,000,000 and the budget request
includes $27,000,000 for authorized activities.
This amount will support SSA's efforts to strengthen its
policy evaluation capability and focus on research of: program
issues, the impact of demographic changes on future workloads
and effective return-to-work strategies for disabled
beneficiaries.
The Committee commends the administration on their stated
goal of preventing and ending homelessness for people with
disabilities within 10 years. The Committee believes that
increasing the Social Security Administration's outreach and
application assistance to homeless people as well as others who
are economically disadvantaged is an important part of this
effort. The Committee is aware that SSA operated an effective
outreach program in the early 1990's, where grants were awarded
to local non-profits to provide SSI outreach and application
assistance. In light of the ongoing need for SSI outreach and
application assistance, the Committee has included an
additional $8,000,000 to continue the demonstration grants
demonstration program targeted toward providing outreach and
application assistance to homeless persons and other
underserved populations.
Administration
The Committee recommendation includes $2,928,020,000 for
payment to the Social Security trust funds for the SSI
Program's share of SSA's base administrative expenses. The
comparable fiscal year 2004 amount is $2,973,300,000 and the
budget request includes $3,017,000,000 for such activities.
LIMITATION ON ADMINISTRATIVE EXPENSES
Appropriations, 2004.................................... $8,313,174,000
Budget estimate, 2005................................... 8,881,000,000
Committee recommendation................................ 8,622,818,000
The Committee recommends a program funding level of
$8,622,818,000 for the limitation on administrative expenses.
The comparable fiscal year 2004 funding level is $8,313,174,000
and the budget request includes $8,881,000,000 for this
purpose. The budget request also includes $100,000,000 for a
contingency reserve fund to support additional administrative
costs associated with the Medicare Prescription Drug,
Improvement, and Modernization Act of 2003. Due to the current
availability of funds for this purpose, the Committee
recommendation does not include the requested contingency
reserve.
This account provides resources from the Social Security
trust funds to administer the Social Security retirement and
survivors and disability insurance programs, and certain Social
Security health insurance functions. As authorized by law, it
also provides resources from the trust funds for certain
nontrust fund administrative costs, which are reimbursed from
the general funds. These include administration of the
supplemental security income program for the aged, blind and
disabled; work associated with the Pension Reform Act of 1984;
and the portion of the annual wage reporting work done by the
Social Security Administration for the benefit of the Internal
Revenue Service. The dollars provided also support automated
data processing activities and fund the State disability
determination services which make initial and continuing
disability determinations on behalf of the Social Security
Administration. Additionally, the limitation provides funding
for computer support, and other administrative costs.
The Committee recommendation includes $8,498,818,000 for
routine operating expenses of the agency, as well as the
resources derived from the user fees which are discussed below.
The budget request includes bill language earmarking not
less than $561,000,000 of funds available within this account
for program integrity activities, including continuing
disability reviews, SSI non-disability redeterminations of
eligibility and overpayment workloads. The Committee bill does
not include such an earmark.
The Committee recommendation supports an increase of more
than 3.7 percent over the comparable fiscal year 2004 level for
the administrative expenses of the Social Security
Administration. However, due to budget constraints, the
Committee recommendation does not provide the full budget
request for SSA's administrative expenses. The substantial
investment in SSA is recommended to continue addressing the
significant challenges the agency faces in improving the
disability claims process and eliminating the backlog in this
workload; efficiently processing increasing claims volumes,
including special workloads; enhancing service quality, options
and program stewardship; and investing in staff. The Committee
commends SSA for its continued progress related to increasing
agency productivity and addressing these challenges, even
though available resources have been less than amounts
requested by the Commissioner.
The Committee continues to encourage SSA officials to
educate adjudicators at all levels about the functional impact
of CFS and the application of the April 1999 CFS ruling (99-2p)
to ensure that adjudicators remain up-to-date on the evaluation
of disability imposed by this condition. The Committee
encourages SSA to continue examining obstacles to benefits for
persons with CFS, to assess the impact of the ruling on
disabled CFS patients' access to benefits, and to keep medical
information updated throughout all levels of the application
and review process.
Social Security Advisory Board
The Committee has included not less than $2,000,000 within
the limitation on administrative expenses account for the
Social Security Advisory Board for fiscal year 2005.
User Fees
In addition to other amounts provided, the Committee
recommends $124,000,000 for administrative activities funded
from user fees that were authorized in fiscal year 1998.
OFFICE OF THE INSPECTOR GENERAL
Appropriations, 2004.................................... $87,679,000
Budget estimate, 2005................................... 92,000,000
Committee recommendation................................ 92,000,000
The Committee recommends $92,000,000 for activities for the
Office of the Inspector General. The comparable fiscal year
2004 funding level is $87,679,000 and the budget request
includes $92,000,000 for this office. This includes a general
fund appropriation of $26,000,000 together with an obligation
limitation of $66,000,000 from the Federal old-age and
survivors insurance trust fund and the Federal disability
insurance trust fund.
The Committee continues to be very concerned with the many
challenges to protecting the privacy of individuals' Social
Security Numbers [SSNs]. The number of complaints of identity
theft and other abuses due to the inappropriate sale or misuse
of SSNs has risen dramatically. The Committee encourages the
SSA IG to expand its efforts to stop the inappropriate sale and
misuse of SSNs.
U.S. Institute of Peace
Appropriations, 2004.................................... $27,099,000
Budget estimate, 2005................................... 22,099,000
Committee recommendation................................ 22,099,000
The Committee recommends $22,099,000 for fiscal year 2005
for the U.S. Institute of Peace. The comparable funding level
for fiscal year 2004 is $27,099,000 which includes a one-time
appropriation of $10,000,000 for programs in Iraq and
Afghanistan. The budget request includes $22,099,000 for this
program.
The Institute was established by the U.S. Institute of
Peace Act (Public Law 98-525) in 1984. The Institute is an
independent, nonprofit, national organization whose primary
mission is to promote, through scholarship and education,
international peace, and the resolution of conflicts without
recourse to violence.
TITLE V--GENERAL PROVISIONS
The Committee recommendation retains provisions which:
authorize transfers of unexpended balances (sec. 501); limit
funding to 1 year availability unless otherwise specified (sec.
502); limit lobbying and related activities (sec. 503); limit
official representation expenses (sec. 504); prohibit funding
of any program to carry out distribution of sterile needles for
the hypodermic injection of any illegal drug (sec. 505); state
the sense of Congress about purchase of American-made equipment
and products (sec. 506); clarify Federal funding as a component
of State and local grant funds (sec. 507); limit use of funds
for abortion (sec. 508 and sec. 509); restrict human embryo
research (sec. 510); limit the use of funds for promotion of
legalization of controlled substances included last year (sec.
511); limits use of funds to enter into or review contracts
with entities subject to the requirement in section 4212(d) of
title 38, United States Code, if the report required by that
section has not been submitted (sec. 512); prohibits the use of
funds to promulgate regulations regarding the individual health
identifier (sec. 513); prohibits transfer of funds made
available in this Act to any department, agency, or
instrumentality of the U.S. Government, except as otherwise
provided by this or any other Act (sec. 514); prohibits funds
for the Railroad Retirement Board from being used for a non-
governmental disbursing agent (sec. 515); relates to the Native
Americans status of Native Hawaiians (sec. 516); and allows
Southcentral Foundation in Anchorage, Alaska to sell an
outdated Head Start facility and use the proceeds to acquire a
new, updated facility that would better serve its children
(sec. 517).
BUDGETARY IMPACT OF BILL
PREPARED IN CONSULTATION WITH THE CONGRESSIONAL BUDGET OFFICE PURSUANT TO SEC. 308(a), PUBLIC LAW 93-344, AS
AMENDED
[In millions of dollars]
----------------------------------------------------------------------------------------------------------------
Budget authority Outlays
---------------------------------------------------
Committee Amount of Committee Amount of
allocation bill allocation bill
----------------------------------------------------------------------------------------------------------------
Comparison of amounts in the bill with Committee allocations
to its subcommittees of amounts in the Budget Resolution
for 2005: Subcommittee on Labor-HHS-Education.
Discretionary........................................... 142,317 142,317 140,936 \1\ 138,896
Mandatory............................................... 342,503 342,503 342,402 \1\ 342,402
Projection of outlays associated with the recommendation:
2005.................................................... ........... ........... ........... \2\ 311,741
2006.................................................... ........... ........... ........... 62,532
2007.................................................... ........... ........... ........... 16,245
2008.................................................... ........... ........... ........... 3,918
2009 and future years................................... ........... ........... ........... 607
Financial assistance to State and local governments for NA 187,415 NA 147,761
2005.......................................................
----------------------------------------------------------------------------------------------------------------
\1\ Includes outlays from prior-year budget authority.
\2\ Excludes outlays from prior-year budget authority.
NA: Not applicable.
COMPLIANCE WITH PARAGRAPH 7, RULE XVI, OF THE STANDING RULES OF THE
SENATE
Paragraph 7 of rule XVI requires that Committee report on
general appropriations bills identify each Committee amendment
to the House bill ``which proposes an item of appropriation
which is not made to carry out the provisions of an existing
law, a treaty stipulation, or an act or resolution previously
passed by the Senate during that session.''
The following items are identified pursuant to this
requirement: Workforce Investment Act, $5,252,662,000; Title
VII and Title VIII of the Public Health Services Act,
$466,080,000; National Cord Blood Stem Cell Bank Program,
$9,941,000; Universal Newborn Hearing Screening, $9,872,000;
Organ Transplantation, $24,632,000; Rural Hospital Flexibility
Grants, $39,499,000; Denali Commission, $41,794,000; Family
Planning, $308,283,000; State Offices of Rural Health,
$8,390,000; Rural and Community Access to Emergency Devices,
$10,933,000; Trauma/EMS, $4,000,000; Infectious Diseases,
$1,688,594,000; Health Promotion, $864,195,000; Health
Information and Services, $235,657,000; Environmental Health
and Injury, $290,126,000; Occupational Safety and Health,
$294,587,000; Global Health, $305,239,000; Public Health
Research, $35,000,000; Public Health Improvement and
Leadership, $261,858,000; Preventive Health and Health Services
Block Grant, $131,814,000; CDC Business Services, $282,226,000;
Title V of the Public Health Services Act, $3,356,426,000;
Adolescent Family Life, $37,500,000; Office of Minority Health,
$53,351,000; Office of Disease Prevention and Health Promotion,
$7,698,000; Child Care and Development Block Grant,
$2,099,729,000; Head Start, $6,935,452,000; Native American
Programs, $45,157,000; Refugee and Entrant Assistance Programs,
$477,239,000; Community Services $727,650,000; Alzheimer's
Disease Demonstration Grants to States, $11,883,000; Volunteers
in Service to America, $96,428,000; Special Volunteer Programs,
$5,000,000; National Senior Volunteer Corps, $216,684,000; High
School Equivalency program, $18,888,000; College assistance
migrant program, $15,657,000; Credit enhancement for charter
school facilities, $32,279,000; State grants for incarcerated
youth offenders, $28,000,000; Rehabilitation Services and
Disability Research, except Title III of the Assistive
Technology Program, $3,071,833,000; National Technical
Institute for the Deaf, $55,790,000; Gallaudet University,
$105,400,000; Vocational Education, $1,326,992,000; Adult
Education, $590,127,000; Higher Education, $2,148,458,000.
COMPLIANCE WITH PARAGRAPH 7(C), RULE XXVI OF THE STANDING RULES OF THE
SENATE
Pursuant to paragraph 7(c) of rule XXVI, on September 15,
2004, the Committee ordered reported en bloc S. 2809, an
original bill making appropriations for Departments of
Commerce, Justice, and State, the Judiciary, and related
agencies for the fiscal year ending September 30, 2005, an
original bill making appropriations for the Foreign Operations,
Export Financing, and related programs for the fiscal year
ending September 30, 2005; and S. 2810, an original bill making
appropriations for the Departments of Labor, Health and Human
Services, and Education, and related agencies for the fiscal
year ending September 30, 2005, each subject to amendment and
each subject to the budget allocations, by a recorded vote of
29-0, a quorum being present. The vote was as follows:
Yeas Nays
Chairman Stevens
Mr. Cochran
Mr. Specter
Mr. Domenici
Mr. Bond
Mr. McConnell
Mr. Burns
Mr. Shelby
Mr. Gregg
Mr. Bennett
Mr. Campbell
Mr. Craig
Mrs. Hutchison
Mr. DeWine
Mr. Brownback
Mr. Byrd
Mr. Inouye
Mr. Hollings
Mr. Leahy
Mr. Harkin
Ms. Mikulski
Mr. Reid
Mr. Kohl
Mrs. Murray
Mr. Dorgan
Mrs. Feinstein
Mr. Durbin
Mr. Johnson
Ms. Landrieu
COMPLIANCE WITH PARAGRAPH 12, RULE XXVI OF THE STANDING RULES OF THE
SENATE
Paragraph 12 of rule XXVI requires that Committee reports
on a bill or a joint resolution repealing or amending any
statute include ``(a) the text of the statute or part thereof
which is proposed to be repealed; and (b) a comparative print
of that part of the bill or joint resolution making the
amendment and of the statute or part thereof proposed to be
amended, showing by stricken through type and italics, parallel
columns, or other appropriate typographical devices the
omissions and insertions which would be made by the bill or
joint resolution if enacted in the form recommended by the
committee.''
With respect to this bill, it is the opinion of the
Committee that it is necessary to dispense with these
requirements in order to expedite the business of the Senate.
COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2004 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL FOR FISCAL
YEAR 2005
[In thousands of dollars]
--------------------------------------------------------------------------------------------------------------------------------------------------------
Senate Committee recommendation compared with (+
or -)
Item 2004 comparable Budget House allowance Committee ----------------------------------------------------
estimate deg. recommendation Budget House
2004 comparable estimate allowance
------------------------------------------------------------------------------------------------------------------------- -----------------------------------
TITLE I
DEPARTMENT OF LABOR
EMPLOYMENT AND TRAINING
ADMINISTRATION
TRAINING AND EMPLOYMENT SERVICES
Grants to States:
Adult Training, current year.. 186,107 187,153 186,107 ............... -1,046
Advance from prior year... (707,799) (712,000) (712,000) (+4,201) ...............
Fiscal year 2006.......... 712,000 712,000 712,000 ............... ...............
---------------------------------------------------------------------------------------------------------------------
Adult Training.......... 898,107 899,153 898,107 ............... -1,046
Youth Training................ 994,242 1,000,025 994,242 ............... -5,783
Dislocated Worker Assistance, 328,924 250,367 348,048 +19,124 +97,681
current year.................
Advance from prior year... (842,997) (848,000) (848,000) (+5,003) ...............
Fiscal year 2006.......... 848,000 848,000 848,000 ............... ...............
---------------------------------------------------------------------------------------------------------------------
Dislocated Worker 1,176,924 1,098,367 1,196,048 +19,124 +97,681
Assistance.............
Federally Administered Programs:
Dislocated Worker Assistance
National Reserve:
Current year.............. 64,227 71,371 71,371 +7,144 ...............
Advance from prior year... (210,749) (212,000) (212,000) (+1,251) ...............
Fiscal year 2006.......... 212,000 212,000 212,000 ............... ...............
---------------------------------------------------------------------------------------------------------------------
Dislocated Worker 276,227 283,371 283,371 +7,144 ...............
Assistance Nat'l
Reserve................
---------------------------------------------------------------------------------------------------------------------
Total, Dislocated Worker 1,453,151 1,381,738 1,479,419 +26,268 +97,681
Assistance.............
Native Americans.............. 54,675 55,000 55,000 +325 ...............
Migrant and Seasonal 76,370 ................. 76,370 ............... +76,370
Farmworkers..................
Job Corps:
Operations................ 820,114 859,966 859,966 +39,852 ...............
Advance from prior (587,513) (591,000) (591,000) (+3,487) ...............
year.................
Fiscal year 2006...... 591,000 591,000 591,000 ............... ...............
Construction and 30,038 6,321 26,321 -3,717 +20,000
Renovation...............
Advance from prior (99,410) (100,000) (100,000) (+590) ...............
year.................
Fiscal year 2006...... 100,000 100,000 100,000 ............... ...............
---------------------------------------------------------------------------------------------------------------------
Subtotal, Job Corps, 1,541,152 1,557,287 1,577,287 +36,135 +20,000
program level......
National Activities:
Pilots, Demonstrations and 57,751 30,000 62,751 +5,000 +32,751
Research.................
Responsible Reintegration 49,705 50,000 50,000 +295 ...............
of Youthful Offender.....
Evaluation................ 8,986 8,000 8,000 -986 ...............
Prisoner Re-entry......... ............... 40,000 40,000 +40,000 ...............
Community College ............... 250,000 125,000 +125,000 -125,000
initiative...............
Program level (NA)........ ............... (250,000) (250,000) (+250,000) ...............
Personal reemployment ............... 50,000 ............... ............... -50,000
accounts.................
Denali Commission......... 4,970 ................. 8,000 +3,030 +8,000
Other..................... 3,486 2,000 3,486 ............... +1,486
---------------------------------------------------------------------------------------------------------------------
Subtotal, National 124,898 430,000 297,237 +172,339 -132,763
activities.............
=====================================================================================================================
Subtotal, Federal 2,073,322 2,325,658 2,289,265 +215,943 -36,393
activities.............
Current Year........ 1,170,322 1,422,658 1,386,265 +215,943 -36,393
Fiscal year 2006.... 903,000 903,000 903,000 ............... ...............
---------------------------------------------------------------------------------------------------------------------
Total, Workforce 5,142,595 5,323,203 5,377,662 +235,067 +54,459
Investment Act.........
Current Year........ 2,679,595 2,860,203 2,914,662 +235,067 +54,459
Fiscal year 2006.... 2,463,000 2,463,000 2,463,000 ............... ...............
---------------------------------------------------------------------------------------------------------------------
Subtotal, National 124,898 430,000 297,237 +172,339 -132,763
activities, TES........
=====================================================================================================================
Total, Training and 5,142,595 5,323,203 5,377,662 +235,067 +54,459
Employment Services....
Current Year........ (2,679,595) (2,860,203) (2,914,662) (+235,067) (+54,459)
Fiscal year 2006.... (2,463,000) (2,463,000) (2,463,000) ............... ...............
COMMUNITY SERVICE EMPLOYMENT FOR 438,650 440,200 440,200 +1,550 ...............
OLDER AMERICANS..................
FEDERAL UNEMPLOYMENT BENEFITS AND 1,338,200 1,057,300 1,057,300 -280,900 ...............
ALLOWANCES.......................
STATE UNEMPLOYMENT INSURANCE AND
EMPLOYMENT SERVICE OPERATIONS
Unemployment Compensation:
State Operations.............. 2,608,653 2,700,714 2,654,714 +46,061 -46,000
National Activities........... 9,876 10,500 10,500 +624 ...............
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Subtotal, Unemployment 2,618,529 2,711,214 2,665,214 +46,685 -46,000
Compensation...............
Employment Service:
Allotments to States:
Federal Funds............. 23,163 23,300 23,163 ............... -137
Trust Funds............... 763,724 672,700 763,724 ............... +91,024
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Subtotal................ 786,887 696,000 786,887 ............... +90,887
ES National Activities........ 63,971 67,000 65,500 +1,529 -1,500
=====================================================================================================================
Subtotal, Employment Service 850,858 763,000 852,387 +1,529 +89,387
Federal Funds........... 23,163 23,300 23,163 ............... -137
Trust Funds............. 827,695 739,700 829,224 +1,529 +89,524
One-Stop Career Centers/Labor 98,764 99,350 98,764 ............... -586
Market Information...............
Work Incentives Grants............ 19,753 19,870 19,870 +117 ...............
=====================================================================================================================
Total, State Unemployment & 3,587,904 3,593,434 3,636,235 +48,331 +42,801
Employment Srvcs...........
Federal Funds........... 141,680 142,520 141,797 +117 -723
Trust Funds............. 3,446,224 3,450,914 3,494,438 +48,214 +43,524
ADVANCES TO THE UI AND OTHER TRUST 467,000 517,000 517,000 +50,000 ...............
FUNDS \1\........................
PROGRAM ADMINISTRATION
Adult Employment and Training..... 38,382 39,380 39,187 +805 -193
Trust Funds................... 6,814 6,980 6,957 +143 -23
Youth Employment and Training..... 39,009 40,133 39,947 +938 -186
Employment Security............... 5,948 6,146 6,094 +146 -52
Trust Funds................... 48,624 55,722 51,000 +2,376 -4,722
Apprenticeship Services........... 20,760 21,405 21,306 +546 -99
Executive Direction............... 8,400 8,718 8,568 +168 -150
Trust Funds................... 2,041 2,158 2,082 +41 -76
Welfare to Work................... 2,371 376 2,474 +103 +2,098
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Total, Program 172,349 181,018 177,615 +5,266 -3,403
Administration.............
Federal Funds........... 114,870 116,158 117,576 +2,706 +1,418
Trust Funds............. 57,479 64,860 60,039 +2,560 -4,821
=====================================================================================================================
Total, Employment and 11,146,698 11,112,155 11,206,012 +59,314 +93,857
Training Administration....
Federal Funds........... 7,642,995 7,596,381 7,651,535 +8,540 +55,154
Current Year........ (5,179,995) (5,133,381) (5,188,535) (+8,540) (+55,154)
Fiscal year 2006.... (2,463,000) (2,463,000) (2,463,000) ............... ...............
Trust Funds............. 3,503,703 3,515,774 3,554,477 +50,774 +38,703
EMPLOYEE BENEFITS SECURITY
ADMINISTRATION
Enforcement and Participant 102,730 110,330 110,330 +7,600 ...............
Assistance.......................
Policy and Compliance Assistance.. 16,907 17,497 17,497 +590 ...............
Program Oversight and 4,403 4,518 4,518 +115 ...............
Administration...................
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Total, EBSA................. 124,040 132,345 132,345 +8,305 ...............
PENSION BENEFIT GUARANTY
CORPORATION
Pension insurance activities...... (17,821) (12,211) (12,211) (-5,610) ...............
Pension plan termination.......... (170,504) (169,739) (169,739) (-765) ...............
Operational support............... (83,547) (84,380) (84,380) (+833) ...............
Program Adm. subject to limitation ............... ................. ............... ............... ...............
(TF).............................
Termination services not subject ............... ................. ............... ............... ...............
to limitation (NA)...............
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Total, PBGC................. ............... ................. ............... ............... ...............
Total, PBGC (Program level). (271,872) (266,330) (266,330) (-5,542) ...............
EMPLOYMENT STANDARDS
ADMINISTRATION
SALARIES AND EXPENSES
Enforcement of Wage and Hour 160,096 165,933 165,933 +5,837 ...............
Standards........................
Office of Labor-Management 38,580 43,545 40,646 +2,066 -2,899
Standards........................
Federal Contractor EEO Standards 79,442 82,078 82,078 +2,636 ...............
Enforcement......................
Federal Programs for Workers' 96,754 99,528 99,528 +2,774 ...............
Compensation.....................
Trust Funds................... 2,021 2,058 2,058 +37 ...............
Program Direction and Support..... 15,123 16,152 15,627 +504 -525
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Total, ESA salaries and 392,016 409,294 405,870 +13,854 -3,424
expenses...................
Federal Funds........... 389,995 407,236 403,812 +13,817 -3,424
Trust Funds............. 2,021 2,058 2,058 +37 ...............
SPECIAL BENEFITS
Federal employees compensation 160,000 230,000 230,000 +70,000 ...............
benefits.........................
Longshore and harbor workers' 3,000 3,000 3,000 ............... ...............
benefits.........................
---------------------------------------------------------------------------------------------------------------------
Total, Special Benefits..... 163,000 233,000 233,000 +70,000 ...............
SPECIAL BENEFITS FOR DISABLED COAL
MINERS
Benefit payments.................. 390,848 358,806 358,806 -32,042