[House Report 108-727]
[From the U.S. Government Publishing Office]
108th Congress Rept. 108-727
HOUSE OF REPRESENTATIVES
2d Session Part 1
======================================================================
PATIENT NAVIGATOR OUTREACH AND CHRONIC DISEASE PREVENTION ACT OF 2004
_______
October 5, 2004.--Ordered to be printed
_______
Mr. Barton of Texas, from the Committee on Energy and Commerce,
submitted the following
R E P O R T
[To accompany H.R. 918]
[Including cost estimate of the Congressional Budget Office]
The Committee on Energy and Commerce, to whom was referred
the bill (H.R. 918) to authorize the Health Resources and
Services Administration, the National Cancer Institute, and the
Indian Health Service to make grants for model programs to
provide to individuals of health disparity populations
prevention, early detection, treatment, and appropriate follow-
up care services for cancer and chronic diseases, and to make
grants regarding patient navigators to assist individuals of
health disparity populations in receiving such services, having
considered the same, report favorably thereon with amendments
and recommend that the bill as amended do pass.
CONTENTS
Page
Amendment........................................................ 2
Purpose and Summary.............................................. 3
Background and Need for Legislation.............................. 4
Hearings......................................................... 4
Committee Consideration.......................................... 4
Committee Votes.................................................. 4
Committee Oversight Findings..................................... 4
Statement of General Performance Goals and Objectives............ 4
New Budget Authority, Entitlement Authority, and Tax Expenditures 4
Committee Cost Estimate.......................................... 5
Congressional Budget Office Estimate............................. 5
Federal Mandates Statement....................................... 6
Advisory Committee Statement..................................... 6
Constitutional Authority Statement............................... 6
Applicability to Legislative Branch.............................. 6
Section-by-Section Analysis of the Legislation................... 6
Changes in Existing Law Made by the Bill, as Reported............ 8
Amendment
The amendments are as follows:
Strike all after the enacting clause and insert the
following:
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Patient Navigator Outreach and Chronic
Disease Prevention Act of 2004''.
SEC. 2. PATIENT NAVIGATOR GRANTS.
Subpart V of part D of title III of the Public Health Service Act (42
U.S.C. 256) is amended by adding at the end the following:
``SEC. 340A. PATIENT NAVIGATOR GRANTS.
``(a) Grants.--The Secretary, acting through the Administrator of the
Health Resources and Services Administration, may make grants to
eligible entities for the development and operation of demonstration
programs to provide patient navigator services to improve health care
outcomes. The Secretary shall coordinate with, and ensure the
participation of, the Indian Health Service, the National Cancer
Institute, the Office of Rural Health Policy, and such other offices
and agencies as deemed appropriate by the Secretary, regarding the
design and evaluation of the demonstration programs.
``(b) Use of Funds.--A condition on the receipt of a grant under this
section is that the grantee agree to use the grant to recruit, assign,
train, and employ patient navigators who have direct knowledge of the
communities they serve to facilitate the care of individuals, including
by performing each of the following duties:
``(1) Acting as contacts, including by assisting in the
coordination of health care services and provider referrals,
for individuals who are seeking prevention or early detection
services for, or who following a screening or early detection
service are found to have a symptom, abnormal finding, or
diagnosis of, cancer or other chronic disease.
``(2) Facilitating the involvement of community organizations
providing assistance to individuals who are at risk for or who
have cancer or other chronic diseases to receive better access
to high-quality health care services (such as by creating
partnerships with patient advocacy groups, charities, health
care centers, community hospice centers, other health care
providers, or other organizations in the targeted community).
``(3) Notifying individuals of clinical trials and
facilitating enrollment in these trials if requested and
eligible.
``(4) Anticipating, identifying, and helping patients to
overcome barriers within the health care system to ensure
prompt diagnostic and treatment resolution of an abnormal
finding of cancer or other chronic disease.
``(5) Coordinating with the relevant health insurance
ombudsman programs to provide information to individuals who
are at risk for or who have cancer or other chronic diseases
about health coverage, including private insurance, health care
savings accounts, and other publicly funded programs (such as
Medicare, Medicaid, and the State children's health insurance
program).
``(6) Conducting ongoing outreach to health disparity
populations, including the uninsured, rural populations, and
other medically underserved populations, in addition to
assisting other individuals who are at risk for or who have
cancer or other chronic diseases to seek preventative care.
``(c) Grant Period.--
``(1) In general.--Subject to paragraphs (2) and (3), the
Secretary may award grants under this section for periods of
not more than 3 years.
``(2) Extensions.--Subject to paragraph (3), the Secretary
may extend the period of a grant under this section, except
that--
``(A) each such extension shall be for a period of
not more than 1 year; and
``(B) the Secretary may make not more than 4 such
extensions with respect to any grant.
``(3) End of grant period.--In carrying out this section, the
Secretary may not authorize any grant period ending after
September 30, 2010.
``(d) Application.--
``(1) In general.--To seek a grant under this section, an
eligible entity shall submit an application to the Secretary in
such form, in such manner, and containing such information as
the Secretary may require.
``(2) Contents.--At a minimum, the Secretary shall require
each such application to outline how the eligible entity will
establish baseline measures and benchmarks that meet the
Secretary's requirements to evaluate program outcomes.
``(e) Uniform Baseline Measures.--The Secretary shall establish
uniform baseline measures in order to properly evaluate the impact of
the demonstration projects under this section.
``(f) Preference.--In making grants under this section, the Secretary
shall give preference to eligible entities that demonstrate in their
applications plans to utilize patient navigator services to overcome
significant barriers in order to improve health care outcomes in their
respective communities.
``(g) Coordination With Other Programs.--The Secretary shall ensure
coordination of the demonstration grant program under this section with
existing authorized programs in order to facilitate access to high-
quality health care services.
``(h) Study; Reports.--
``(1) Final report by secretary.--Not later than 6 months
after the completion of the demonstration grant program under
this section, the Secretary shall conduct a study of the
results of the program and submit to the Congress a report on
such results that includes the following:
``(A) An evaluation of the program outcomes,
including--
``(i) quantitative analysis of baseline and
benchmark measures; and
``(ii) aggregate information about the
patients served and program activities.
``(B) Recommendations on whether patient navigator
programs could be used to improve patient outcomes in
other public health areas.
``(2) Interim reports by secretary.--The Secretary may
provide interim reports to the Congress on the demonstration
grant program under this section at such intervals as the
Secretary determines to be appropriate.
``(3) Interim reports by grantees.--The Secretary may require
grant recipients under this section to submit interim reports
on grant program outcomes.
``(i) Rule of Construction.--This section shall not be construed to
authorize funding for the delivery of health care services (other than
the patient navigator duties listed in subsection (b)).
``(j) Definitions.--In this section:
``(1) The term `eligible entity' means a public or nonprofit
private health center (including a Federally qualified health
center (as that term is defined in section 1861(aa)(4) of the
Social Security Act)), a health facility operated by or
pursuant to a contract with the Indian Health Service, a
hospital, a cancer center, a rural health clinic, an academic
health center, or a nonprofit entity that enters into a
partnership or coordinates referrals with such a center,
clinic, facility, or hospital to provide patient navigator
services.
``(2) The term `health disparity population' means a
population that, as determined by the Secretary, has a
significant disparity in the overall rate of disease incidence,
prevalence, morbidity, mortality, or survival rates as compared
to the health status of the general population.
``(3) The term `patient navigator' means an individual who
has completed a training program approved by the Secretary to
perform the duties listed in subsection (b).
``(k) Authorization of Appropriations.--
``(1) In general.--To carry out this section, there are
authorized to be appropriated $2,000,000 for fiscal year 2006,
$5,000,000 for fiscal year 2007, $8,000,000 for fiscal year
2008, $6,500,000 for fiscal year 2009, and $3,500,000 for
fiscal year 2010.
``(2) Availability.--The amounts appropriated pursuant to
paragraph (1) shall remain available for obligation through the
end of fiscal year 2010.''.
Amend the title so as to read:
A bill to amend the Public Health Service Act to
authorize a demonstration grant program to provide patient
navigator services to reduce barriers and improve health care
outcomes, and for other purposes.
Purpose and Summary
The purpose of H.R. 918 is to authorize the Secretary of
the Department of Health and Human Services to conduct a
demonstration program to promote model ``patient navigator''
programs to improve health care outcomes for individuals with
cancer or other chronic diseases, with a specific emphasis on
health disparity populations.
Background and Need for Legislation
Improving health care outcomes for all Americans requires
substantial improvement in health disparity populations,
populations--not defined solely by race and ethinicity--that
have a significant disparity in the overall rate of disease
incidence, prevalence, morbidity, mortality, or survival rates
as compared to the health status of the general population.
Patient navigator programs provide outreach to communities to
seek preventative care and coordinate health care services for
individuals who are at risk for or who have a chronic disease.
For example, the Ralph Lauren Center for Cancer Care and
Prevention, a partnership between Memorial Sloan-Kettering and
North General Hospital in Harlem, New York, operates a patient
navigator program to help patients and family members deal with
the complexities of the health care system. By coordinating
health care services through a patient navigator, the patient
navigator programs strive to shorten the period of time when a
patient is screened for cancer or other chronic diseases and
further diagnosis and treatment, if needed.
H.R. 918 authorizes the Secretary of Health and Human
Services to conduct a demonstration program to evaluate the
impact of patient navigator programs on improving health care
outcomes.
Hearings
The Committee on Energy and Commerce has not held hearings
on the legislation.
Committee Consideration
On Thursday, September 30, 2004 the Full Committee met in
open markup session and ordered H.R. 918 favorably reported to
the House, as amended, by a voice vote, a quorum being present.
Committee Votes
There were no record votes taken in connection with
ordering H.R. 918 reported. A motion by Mr. Barton to order
H.R. 918 reported to the House, as amended, was agreed to by a
voice vote.
Committee Oversight Findings
Pursuant to clause 3(c)(1) of rule XIII of the Rules of the
House of Representatives, the Committee has not held oversight
or legislative hearings on this legislation.
Statement of General Performance Goals and Objectives
The goal of H.R. 918 is to establish a demonstration
program to evaluate the impact of ``patient navigator''
programs on improving health care outcomes for individuals with
cancer or other chronic diseases.
New Budget Authority, Entitlement Authority, and Tax Expenditures
In compliance with clause 3(c)(2) of rule XIII of the Rules
of the House of Representatives, the Committee finds that H.R.
918, the Patient Navigator Outreach and Chronic Disease
Prevention Act of 2004, would result in no new or increased
budget authority, entitlement authority, or tax expenditures or
revenues.
Committee Cost Estimate
The Committee adopts as its own the cost estimate prepared
by the Director of the Congressional Budget Office pursuant to
section 402 of the Congressional Budget Act of 1974.
Congressional Budget Office Estimate
Pursuant to clause 3(c)(3) of rule XIII of the Rules of the
House of Representatives, the following is the cost estimate
provided by the Congressional Budget Office pursuant to section
402 of the Congressional Budget Act of 1974:
U.S. Congress,
Congressional Budget Office,
Washington, DC, October 4, 2003.
Hon. Joe Barton,
Chairman, Committee on Energy and Commerce,
House of Representatives, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for H.R. 918, the Patient
Navigator Outreach and Chronic Disease Prevention Act of 2004.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Margaret
Nowak.
Sincerely,
Douglas Holtz-Eakin,
Director.
Enclosure.
H.R. 918--Patient Navigator Outreach and Chronic Disease Prevention Act
of 2004
H.R. 918 would amend the Public Health Service Act to
authorize the Secretary of Health and Human Services to make
grants for the development and operation of programs that
provide ``patient navigator'' services. Patient navigators
assist patients in overcoming obstacles to the prompt diagnosis
and treatment of health problems, in part by identifying
sources of care and insurance, coordinating referrals, and
facilitating enrollment in clinical trials. The bill also would
require the Secretary to conduct a study and report to the
Congress within six months of completion of the grant program.
The bill would authorize the appropriation of $2 million in
2006, $5 million in 2007, $8 million in 2008, $6.5 million in
2009, and $3.5 million in 2010. Based on spending patterns for
similar programs, and assuming appropriation of the authorized
amounts, CBO estimates that implementing H.R. 918 would cost
$18 million from 2005 through 2009. The legislation would not
affect direct spending or receipts.
H.R. 918 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act; state,
local, and tribal governments would be eligible to apply for
grants authorized by the bill.
The CBO staff contact for this estimate is Margaret Nowak.
This estimate was approved by Peter H. Fontaine, Deputy
Assistant Director for Budget Analysis.
Federal Mandates Statement
The Committee adopts as its own the estimate of Federal
mandates prepared by the Director of the Congressional Budget
Office pursuant to section 423 of the Unfunded Mandates Reform
Act.
Advisory Committee Statement
No advisory committees within the meaning of section 5(b)
of the Federal Advisory Committee Act were created by this
legislation.
Constitutional Authority Statement
Pursuant to clause 3(d)(1) of rule XIII of the Rules of the
House of Representatives, the Committee finds that the
Constitutional authority for this legislation is provided in
Article I, section 8, clause 3, which grants Congress the power
to regulate commerce with foreign nations, among the several
States, and with the Indian tribes.
Applicability to Legislative Branch
The Committee finds that the legislation does not relate to
the terms and conditions of employment or access to public
services or accommodations within the meaning of section
102(b)(3) of the Congressional Accountability Act.
Section-by-Section Analysis of the Legislation
Section 1. Short title
This section provides the short title of the bill, the
``Patient Navigator Outreach and Chronic Disease Prevention Act
of 2004.''
Section 2. Patient navigator grants
Section 2 authorizes the Secretary of the Department of
Health and Human Services, acting through the Administrator of
the Health Resources and Services Administration (``HRSA''), to
make grants to eligible entities for the development and
operation of demonstration programs to provide patient
navigator services to improve health care outcomes. Eligible
entities include a public or nonprofit private health center, a
community health center, a health facility operated with the
Indian Health Services, a hospital, a cancer center, a rural
health clinic, an academic health center, or a nonprofit entity
that enters into a partnership or coordinates referrals with
such health care facilities. With respect to a nonprofit
entity, the Committee does not intend the term ``coordinates
referrals with'' to imply that a nonprofit entity must jointly
file a grant application with a health care facility. Instead,
the Committee fully expects the Administrator of HRSA to
evaluate nonprofit entity applications by the strength of the
nonprofit entity's ability to provide all of the requirements
of patient navigator services, including referrals to specific
facilities, as well as the ability of the nonprofit
organization to conduct outreach activities for prevention
services and treatment programs.
The Committee recognizes the challenges of some communities
in overcoming significant barriers to high quality health care
services, including geographic isolation, cultural and
linguistic barriers, limited transportation services, lack of
health insurance and information about health options, and
socioeconomic status. Therefore, section 2 requires the
Administrator of HRSA to give preference to grant applicants
who target populations in greatest need and utilize patient
navigators to help overcome these and other barriers in order
to reduce health care disparities and improve health care
outcomes.
Eligible entities may use the grant to recruit, assign,
train, and employ patient navigators who have a direct
knowledge of the communities they serve. The term ``patient
navigator'' is defined to mean an individual who has completed
a training program approved by the Secretary to perform the
duties outlined in the legislation. The Committee recognizes
that there will be grant applicants with varying levels of
experience in patient navigation. Some may have existing,
trained patient navigators who want to expand their services;
others may have no trained navigators but are well positioned
to begin providing patient navigator services with appropriate
training. An allowable use of part of the funds under this
grant would be to provide navigator training, a plan for which
should be included in the grant application.
Patient navigators must coordinate health care services and
provider referrals, facilitate the involvement of community
organizations to provide assistance to patients, facilitate
enrollment in clinical trials, anticipate barriers within the
health care system and help ensure prompt diagnostic care and
treatment, coordinate with appropriate health insurance
ombudsman programs, and conduct ongoing outreach to health
disparity populations and other individuals to seek
preventative care. Section 2 includes a rule of construction to
clarify that the bill does not authorize funding for the
delivery of health care services other than the patient
navigator duties outlined in the legislation. The Committee
fully expects that patient navigators will assist the uninsured
individuals in enrolling in appropriate health coverage
programs, including private insurance, publicly funded programs
like Medicaid, as well as health care savings accounts.
The Administrator of HRSA must coordinate and ensure the
participation of the Indian Health Service, the National Cancer
Institute, the Office of Rural Health Policy, and other such
office and agencies deemed appropriate by the Secretary,
regarding the deign and evaluation of the demonstration
program. To facilitate the operation of the program, the
Committee has assigned primary responsibility to the
Administrator of HRSA. However, the Committee recognizes the
distinct role of each of these offices and agencies within the
Department of Health and Human Services, and therefore requires
close coordination to maximize the impact of the patient
navigator demonstration program. Section 2 also requires the
Secretary to ensure coordination of the demonstration program
with existing authorized programs in order to facilitate access
tohigh-quality health care services, for example, the Community
Access Program administered by HRSA and the breast and cervical cancer
screening programs administered by the Centers for Disease Control and
Prevention.
An eligible entity may receive a grant for a period of not
more than 3 years. The Secretary may, based on extenuating
circumstances, approve an extension of the grant period for up
to one-year. The demonstration program expires on September 30,
2010.
Grant recipients must establish baseline measures and
benchmarks to evaluate program outcomes. The Secretary may
require grant recipients to submit interim reports on grant
program outcomes, as well as provide Congress with interim
reports on the progress of the demonstration program. The
Secretary is required to conduct an evaluation of the results
of the program no later than 6 months after the completion of
the demonstration grant program. To effectively measure program
outcomes, the Committee recommends that the Secretary collect
and include the following data in the final report to Congress:
the patient's insurance status, income, education level,
gender, age, race and ethnicity, the number of patients
navigated, demographic coverage area, screening location and
date, type and stage of diagnosis, point at which the navigator
was brought into the process, type of navigator (lay or
professional), barriers the patient encountered and how they
were resolved, compliance rate for appointments and follow-up
exams, number of patients referred (e.g., to treatment,
pharmaceutical assistance programs, ombudsman programs/other
health insurance programs, community organizations) and follow-
up outcomes (e.g., number of uninsured who get health coverage,
etc.), time interval between diagnosis or referral and
resolution date, and the final outcome or result. For
applicants who are providing training for patient navigators,
the report should also include the plan for such training and
the outcomes.
Finally, section 2 authorizes to be appropriated $2 million
in fiscal year 2006, $5 million in fiscal year 2007, $8 million
in fiscal year 2008, $6.5 million in fiscal year 2009, and $3.5
million in fiscal year 2010 to carry out the patient navigator
demonstration program. Amounts appropriated will be available
through the end of fiscal year 2010.
Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (new matter is
printed in italic and existing law in which no change is
proposed is shown in roman):
PUBLIC HEALTH SERVICE ACT
* * * * * * *
TITLE III--GENERAL POWERS AND DUTIES OF PUBLIC HEALTH SERVICE
* * * * * * *
Part D--Primary Health Care
* * * * * * *
Subpart V--Healthy Communities Access Program
* * * * * * *
SEC. 340A. PATIENT NAVIGATOR GRANTS.
(a) Grants.--The Secretary, acting through the Administrator
of the Health Resources and Services Administration, may make
grants to eligible entities for the development and operation
of demonstration programs to provide patient navigator services
to improve health care outcomes. The Secretary shall coordinate
with, and ensure the participation of, the Indian Health
Service, the National Cancer Institute, the Office of Rural
Health Policy, and such other offices and agencies as deemed
appropriate by the Secretary, regarding the design and
evaluation of the demonstration programs.
(b) Use of Funds.--A condition on the receipt of a grant
under this section is that the grantee agree to use the grant
to recruit, assign, train, and employ patient navigators who
have direct knowledge of the communities they serve to
facilitate the care of individuals, including by performing
each of the following duties:
(1) Acting as contacts, including by assisting in the
coordination of health care services and provider
referrals, for individuals who are seeking prevention
or early detection services for, or who following a
screening or early detection service are found to have
a symptom, abnormal finding, or diagnosis of, cancer or
other chronic disease.
(2) Facilitating the involvement of community
organizations providing assistance to individuals who
are at risk for or who have cancer or other chronic
diseases to receive better access to high-quality
health care services (such as by creating partnerships
with patient advocacy groups, charities, health care
centers, community hospice centers, other health care
providers, or other organizations in the targeted
community).
(3) Notifying individuals of clinical trials and
facilitating enrollment in these trials if requested
and eligible.
(4) Anticipating, identifying, and helping patients
to overcome barriers within the health care system to
ensure prompt diagnostic and treatment resolution of an
abnormal finding of cancer or other chronic disease.
(5) Coordinating with the relevant health insurance
ombudsman programs to provide information to
individuals who are at risk for or who have cancer or
other chronic diseases about health coverage, including
private insurance, health care savings accounts, and
other publicly funded programs (such as Medicare,
Medicaid, and the State children's health insurance
program).
(6) Conducting ongoing outreach to health disparity
populations, including the uninsured, rural
populations, and other medically underserved
populations, in addition to assisting other individuals
who are at risk for or who have cancer or other chronic
diseases to seek preventative care.
(c) Grant Period.--
(1) In general.--Subject to paragraphs (2) and (3),
the Secretary may award grants under this section for
periods of not more than 3 years.
(2) Extensions.--Subject to paragraph (3), the
Secretary may extend the period of a grant under this
section, except that--
(A) each such extension shall be for a period
of not more than 1 year; and
(B) the Secretary may make not more than 4
such extensions with respect to any grant.
(3) End of grant period.--In carrying out this
section, the Secretary may not authorize any grant
period ending after September 30, 2010.
(d) Application.--
(1) In general.--To seek a grant under this section,
an eligible entity shall submit an application to the
Secretary in such form, in such manner, and containing
such information as the Secretary may require.
(2) Contents.--At a minimum, the Secretary shall
require each such application to outline how the
eligible entity will establish baseline measures and
benchmarks that meet the Secretary's requirements to
evaluate program outcomes.
(e) Uniform Baseline Measures.--The Secretary shall establish
uniform baseline measures in order to properly evaluate the
impact of the demonstration projects under this section.
(f) Preference.--In making grants under this section, the
Secretary shall give preference to eligible entities that
demonstrate in their applications plans to utilize patient
navigator services to overcome significant barriers in order to
improve health care outcomes in their respective communities.
(g) Coordination With Other Programs.--The Secretary shall
ensure coordination of the demonstration grant program under
this section with existing authorized programs in order to
facilitate access to high-quality health care services.
(h) Study; Reports.--
(1) Final report by secretary.--Not later than 6
months after the completion of the demonstration grant
program under this section, the Secretary shall conduct
a study of the results of the program and submit to the
Congress a report on such results that includes the
following:
(A) An evaluation of the program outcomes,
including--
(i) quantitative analysis of baseline
and benchmark measures; and
(ii) aggregate information about the
patients served and program activities.
(B) Recommendations on whether patient
navigator programs could be used to improve
patient outcomes in other public health areas.
(2) Interim reports by secretary.--The Secretary may
provide interim reports to the Congress on the
demonstration grant program under this section at such
intervals as the Secretary determines to be
appropriate.
(3) Interim reports by grantees.--The Secretary may
require grant recipients under this section to submit
interim reports on grant program outcomes.
(i) Rule of Construction.--This section shall not be
construed to authorize funding for the delivery of health care
services (other than the patient navigator duties listed in
subsection (b)).
(j) Definitions.--In this section:
(1) The term ``eligible entity'' means a public or
nonprofit private health center (including a Federally
qualified health center (as that term is defined in
section 1861(aa)(4) of the Social Security Act)), a
health facility operated by or pursuant to a contract
with the Indian Health Service, a hospital, a cancer
center, a rural health clinic, an academic health
center, or a nonprofit entity that enters into a
partnership or coordinates referrals with such a
center, clinic, facility, or hospital to provide
patient navigator services.
(2) The term ``health disparity population'' means a
population that, as determined by the Secretary, has a
significant disparity in the overall rate of disease
incidence, prevalence, morbidity, mortality, or
survival rates as compared to the health status of the
general population.
(3) The term ``patient navigator'' means an
individual who has completed a training program
approved by the Secretary to perform the duties listed
in subsection (b).
(k) Authorization of Appropriations.--
(1) In general.--To carry out this section, there are
authorized to be appropriated $2,000,000 for fiscal
year 2006, $5,000,000 for fiscal year 2007, $8,000,000
for fiscal year 2008, $6,500,000 for fiscal year 2009,
and $3,500,000 for fiscal year 2010.
(2) Availability.--The amounts appropriated pursuant
to paragraph (1) shall remain available for obligation
through the end of fiscal year 2010.
* * * * * * *