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108th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES
 2d Session                                                     108-636

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



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

                                _______
                                

 September 7, 2004.--Committed to the Committee of the Whole House on 
            the State of the Union and ordered to be printed

                                _______
                                

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

                              R E P O R T

                             together with

                             MINORITY VIEWS

                        [To accompany H.R. 5006]

    The Committee on Appropriations submits the following 
report in explanation of the accompanying bill making 
appropriations for the Departments of Labor, Health and Human 
Services (except the Food and Drug Administration and the 
Indian Health Service), and Education, Armed Forces Retirement 
Home, Committee for Purchase from People Who are Blind or 
Severely Disabled, Corporation for National and Community 
Service, Corporation for Public Broadcasting, Federal Mediation 
and Conciliation Service, Federal Mine Safety and Health Review 
Commission, Institute of Museum and Library Services, Medicare 
Payment Advisory Commission, National Commission on Libraries 
and Information Science, National Council on Disability, 
National Labor Relations Board, National Mediation Board, 
Occupational Safety and Health Review Commission, Railroad 
Retirement Board, and the Social Security Administration for 
the fiscal year ending September 30, 2005, and for other 
purposes.

                        INDEX TO BILL AND REPORT

_______________________________________________________________________


                                                            Page number

                                                            Bill Report
                                                                 
                                                                       
Title I--Department of Labor:                                    
                                                                       
        Employment and Training Administration.............     2
                                                                      8
        Employee Benefits Security Administration..........     8
                                                                     15
        Pension Benefit Guaranty Corporation...............     8
                                                                     15
        Employment Standards Administration................     9
                                                                     15
        Occupational Safety and Health Administration......    14
                                                                     17
        Mine Safety and Health Administration..............    17
                                                                     18
        Bureau of Labor Statistics.........................    18
                                                                     18
        Office of Disability Employment Policy.............    19
                                                                     18
        Departmental Management............................    19
                                                                     19
        Veterans Employment and Training...................    21
                                                                     20
        Office of the Inspector General....................    21
                                                                     21
        General Provisions.................................    22
                                                                     21
Title II--Department of Health and Human Services:               
                                                                       
        Health Resources and Services Administration.......    23
                                                                     21
        Centers for Disease Control and Prevention.........    26
                                                                     43
        National Institutes of Health......................    28
                                                                     61
        Substance Abuse and Mental Health Services 
            Administration.................................    35
                                                                    116
        Agency for Healthcare Research and Quality.........    37
                                                                    121
        Centers for Medicare and Medicaid Services.........    37
                                                                    123
        Administration for Children and Families...........    40
                                                                    128
        Administration on Aging............................    49
                                                                    141
        Office of the Secretary............................    49
                                                                    144
        General Provisions.................................    54
                                                                    151
Title III--Department of Education:                              
                                                                       
        Education for the Disadvantaged....................    65
                                                                    153
        Impact Aid.........................................    66
                                                                    157
        School Improvement Programs........................    67
                                                                    158
        Indian Education...................................    69
                                                                    162
        Innovation and Improvement.........................    69
                                                                    163
        Safe Schools and Citizenship Education.............    70
                                                                    167
        English Language Acquisition.......................    70
                                                                    169
        Special Education..................................    70
                                                                    169
        Rehabilitation Services and Disability Research....    71
                                                                    171
        Special Institutions for Persons with Disabilities.    72
                                                                    175
        Vocational and Adult Education.....................    72
                                                                    175
        Student Financial Assistance.......................    74
                                                                    178
        Student Aid Administration.........................    75
                                                                    180
        Higher Education...................................    75
                                                                    180
        Howard University..................................    76
                                                                    186
        College Housing and Academic Facilities Loans......    77
                                                                    186
        Historically Black College and University Capital 
            Financing......................................    77
                                                                    186
        Institute of Education Sciences....................    77
                                                                    187
        Departmental Management............................    78
                                                                    189
        Office for Civil Rights............................    78
                                                                    190
        Office of the Inspector General....................    78
                                                                    190
        General Provisions.................................    78
                                                                    190
Title IV--Related Agencies:                                      
                                                                       
        Armed Forces Retirement Home.......................    80
                                                                    191
        Committee for Purchase from People Who Are Blind or 
            Severely Disabled..............................    80
                                                                    191
        Corporation for National and Community Service.....    80
                                                                    191
        Corporation for Public Broadcasting................    81
                                                                    193
        Federal Mediation and Conciliation Service.........    82
                                                                    193
        Federal Mine Safety and Health Review Commission...    84
                                                                    194
        Institute of Museum and Library Services...........    84
                                                                    194
        Medicare Payment Advisory Commission...............    84
                                                                    194
        National Commission on Libraries and Information 
            Science........................................    84
                                                                    195
        National Council on Disability.....................    85
                                                                    195
        National Labor Relations Board.....................    85
                                                                    195
        National Mediation Board...........................    86
                                                                    195
        Occupational Safety and Health Review Commission...    86
                                                                    195
        Railroad Retirement Board..........................    86
                                                                    196
        Social Security Administration.....................    88
                                                                    197
Title V--General Provisions:                                     
                                                                       
        House of Representatives Report Requirements.......    91
                                                                    198

                Summary of Estimates and Appropriations

    The following table compares on a summary basis the 
appropriations including trust funds for fiscal year 2005, the 
budget estimate for fiscal year 2005 and the Committee 
recommendation for fiscal year 2005 in the accompanying bill.

                                 2005 LABOR, HHS, EDUCATION APPROPRIATIONS BILL
                                            [In millions of dollars]
----------------------------------------------------------------------------------------------------------------
                                                             Fiscal year--               2005 committee compared
                                                ---------------------------------------           to--
                                                                                       -------------------------
                                                     2004     2005 budget      2005         2004
                                                  comparable                committee    comparable  2005 budget
----------------------------------------------------------------------------------------------------------------
Department of Labor............................      $15,278      $15,186      $14,906        -$372        -$280
    Advances...................................        2,545        2,551        2,551           +6            0
Department of Health and Human Services........      353,642      369,010      368,990      +15,348          -20
    Advances...................................       56,099       62,784       62,784       +6,685            0
Department of Education........................       58,236       59,975       60,317       +2,081         +342
    Advances...................................       15,011       15,022       15,022          +11            0
Related Agencies...............................       44,428       48,915       48,708       +4,280         -207
    Advances...................................       11,458       12,980       12,980       +1,522            0
Grand Total, current year......................      471,584      493,086      492,921      +21,337         -165
    Advances...................................       85,113       93,337       93,337       +8,224            0
Current year total using 302(b) scorekeeping...      471,288      492,125      492,327      +21,039         +202
    Mandatory..................................      331,864      349,801      349,801      +17,937            0
    Discretionary..............................      139,424      142,324      142,526       +3,102         +202
----------------------------------------------------------------------------------------------------------------


                                           PROGRAM LEVEL DISCRETIONARY
                                            [In millions of dollars]
----------------------------------------------------------------------------------------------------------------
                                                             Fiscal year--               2005 committee compared
                                                ---------------------------------------           to--
                                                                                       -------------------------
                                                     2004     2005 budget      2005         2004
                                                  comparable                committee    comparable  2005 budget
----------------------------------------------------------------------------------------------------------------
Department of Labor............................      $11,821      $12,003      $11,723         -$98        -$280
Department of Health and Human Services........       62,201       63,231       63,210        1,009          -21
Department of Education........................       55,662       57,339       57,681        2,019          342
Related Agencies...............................       10,070       10,712       10,505          435         -207
                                                ----------------------------------------------------------------
      Subtotal Program Level...................      139,754      143,285      143,119        3,365         -166
----------------------------------------------------------------------------------------------------------------

                      General Summary of the Bill

    Funding levels in the fiscal year 2005 appropriation bill 
for the Departments of Health and Human Services, and Education 
and Related Agencies reflect the Committee's attempt to 
establish priorities within the very stringent limitations. As 
in past years, the Committee has increased funding for programs 
that work for people and represent a core Federal 
responsibility.
    Bill total.--Total funding, including offsets, for fiscal 
year 2005 in the Departments of Health, and Human Services and 
Education and Related Agencies Appropriations Act, 2005 is 
$492,327,096,000.
    Discretionary Programs.--For Discretionary accounts for 
2005 the bill provides $142,526,000,000, including offsets. 
This is $3,101,931,000 above the fiscal year 2004 comparable 
level. After adjusting for fluctuations in advance 
appropriations, the comparable program increase is 
$3,366,085,000, or 2.41 percent, over fiscal year 2004.
    Mandatory programs.--The bill provides $349,801,096,000 for 
entitlement programs in fiscal year 2005. This is 
$17,937,264,000 above the fiscal year 2004 comparable level, or 
an increase of 5.4 percent. Over two thirds of the funding in 
the bill is for these mandatory costs. Funding requirements for 
entitlement programs are determined by the basic authorizing 
statutes. Mandatory programs include general fund support for 
the Medicare and Medicaid programs, Supplemental Security 
Income, Trade Adjustment Assistance and Black Lung payments. 
The following chart indicates the funding levels for the major 
mandatory programs in fiscal years 2004 and 2005 and the growth 
in these programs.

                                                    MANDATORY
                                             [Dollars in thousands]
----------------------------------------------------------------------------------------------------------------
                                                                 Fiscal Year      Fiscal Year
                           Program                                   2004             2004            Change
----------------------------------------------------------------------------------------------------------------
Department of Labor:
    Federal Unemployment Benefits and Allowances.............        1,338,200        1,057,300         -280,900
    Advances to the UI and other trust funds.................          467,000          517,000          +50,000
    Special Benefits.........................................          163,000          233,000          +70,000
    Special Benefits for Disabled Coal Miners................          299,991          188,000         -111,991
    Energy Employees Occupational Illness Compensation Fund..           51,651           40,821          -10,830
    Black Lung Disability Trust..............................        1,055,000        1,059,000           +4,000

Department of Health and Human Services:
    Vaccine Injury Compensation Trust fund...................           66,000           66,000                0
    Medicaid current law benefits............................      172,706,067      167,013,865       -5,692,202
    Medicaid State and Local Administration..................        9,067,320        9,318,602         +251,282
    CMS Vaccines for Children................................          980,196        1,208,296         +228,100
    Medicare Payments to Healthcare Trust Funds..............       95,084,100      114,608,900      +19,524,800
    Child Support Enforcement................................        4,361,674        4,398,698          +37,024
    Social Services Block Grant..............................        1,700,000        1,700,000                0
    Promoting Safe and Stable Families.......................          305,000          305,000                0
    Payments to States for Foster Care and Adoption..........        5,068,300        5,037,900          -30,400
    Medical Benefits for Commissioned Officers...............          321,763          330,636           +8,873

Department of Education:
    Vocaltional Rehabilitation...............................        2,584,162        2,635,845          +51,683
Related Agencies:                                                   34,336,000       38,181,929       +3,845,929
----------------------------------------------------------------------------------------------------------------

    Department of Labor.--The bill appropriates $11,723,237,000 
for the discretionary programs of the Labor Department.
    Employment and Training.--The Committee recommends 
$5,112,728,000 to carry out the provisions of the Workforce 
Investment Act of 1998. This is $32,736,000 below the fiscal 
year 2004 comparable level and $213,564,000 below the request. 
The Committee recommends an increase in funding over fiscal 
year 2004 for dislocated worker re-employment assistance of 
$25,000,000.
    Employee Benefits Security Administration.--The Committee 
recommends $132,345,000 for the EBSA to carry out their 
responsibilities to American workers and their families who are 
covered by private sector pension, health, and other employee 
benefit plans. This is $8,305,000 above the fiscal year 2004 
comparable level and the same as the request.
    Employment Standards Administration.--The Committee 
recommends $402,818,000 for ESA. This level is $10,802,000 
above the fiscal year 2004 comparable level and $6,476,000 
below the President's program level request for the Agency.
    Occupational Safety and Health Administration.--The 
Committee recommends funding for OSHA at $461,599,000, 
$4,058,000 above the fiscal year 2004 comparable level and the 
same as the request.
    Department of Health and Human Services.--The bill 
appropriates $63,210,324,000 for discretionary programs of the 
Department.
    Health Resources and Services Administration.--Funding for 
the Health Resources and Services Administration (HRSA) 
programs is $6,330,333,000, $287,970,000 below the fiscal year 
2004 comparable level and $282,500,000 above the request. 
Within HRSA, the community health centers funding is at 
$1,835,925,000, an increase of $218,544,000 above the fiscal 
year 2004 comparable level and the same as the request. Health 
professions training is funded at $416,365,000, $19,715,000 
below last year's comparable level and $258,582,000 above the 
request. Ryan White AIDS Care Act programs are funded at 
$2,099,861,000, $35,000,000 above last year's comparable level 
and $20,000,000 above the request. In addition, $542,649,000 is 
recommended for HRSA's bioterrorism preparedness and response 
activities. This is the same as the fiscal year 2004 comparable 
level and $39,000,000 above the request.
    Centers for Disease Control and Prevention.--The bill 
provides a total program level of $4,477,878,000 directly to 
the Centers for Disease Control and Prevention (CDC). This is 
$101,421,000 below the fiscal year 2004 comparable level and 
$15,244,000 above the request. In addition, $1,637,760,000 is 
available for CDC homeland security activities funded through 
the Public Health and Social Services Emergency Fund. CDC 
programs and activities include: Immunization; bioterrorism 
preparedness and response; chronic disease prevention; domestic 
and Global HIV/AIDS; surveillance, prevention, and control of 
infectious diseases, such as hepatitis, SARS, and the West Nile 
Virus.
    National Institutes of Health.--The Committee recommends 
$28,441,371,000 for the biomedical research activities of the 
National Institutes of Health (NIH). This is $782,238,000 above 
the fiscal year 2004 comparable level and the same as the 
request. The Committee continues to support strongly the 
research and training activities of the NIH. The Committee has 
maintained its policy of resisting disease specific earmarks in 
the bill and report, believing that decisions as to appropriate 
levels of funding and appropriate avenues of research are best 
left to the scientific managers at NIH. It is the view of the 
Committee that this is the best means available for advancing 
our understanding of human health and disease and improving the 
quality of life for affected individuals and families.
    Substance Abuse and Mental Health Services 
Administration.--The bill provides $3,270,360,000 for the 
Substance Abuse and Mental Health Services Administration 
(SAMHSA), an amount $36,452,000 above the fiscal year 2004 
level and $158,579,000 below the request.
    Agency for Healthcare Research and Quality.--The bill 
provides $303,695,000 for the Agency for Healthcare Research 
and Quality (AHRQ), an amount that is the same as the fiscal 
year 2004 comparable level and the request.
    Medicare and Medicaid.--The bill provides $177,540,763,000 
for Medicaid and $114,608,900,000 in Federal funds for the 
Government's share of payments to Medicare in fiscal year 2005.
    Low Income Home Energy Assistance.--The Committee provides 
$1,900,000,000 for the Low Income Home Energy Assistance 
Program formula grants to States in fiscal year 2005. This is 
$110,620,000 more than the fiscal year 2004 level and 
$99,500,000 more than the request. The Committee includes 
$100,000,000 in contingent emergency funding for heating and 
cooling emergencies, which is $590,000 more than last year's 
level and $100,000,000 less than the request.
    Child Care and Development Block Grant.--The Committee 
includes $2,099,729,000 for the Child Care and Development 
Block Grant for fiscal year 2005. This is $12,419,000 above the 
fiscal year 2004 level and the same as the request.
    Social Services Block Grant.--The Committee provides 
$1,700,000,000 for the Social Services Block Grant, the same as 
both the fiscal year 2004 level and the request.
    Head Start.--The bill includes $6,898,580,000 for Head 
Start, $123,732,000 above last year's level and $45,000,000 
below the request.
    Human Embryo Research.--The bill includes the same language 
included for the past several years to prohibit the use of 
federal funds for research involving human embryos. This 
language also has the effect of prohibiting the use of funds in 
the bill to support human cloning.
    Needle Exchange.--The bill includes a prohibition on the 
use of Federal funds for needle exchange programs, which is the 
same as last year.
    Title X Family Participation in Decisions of Minors to Seek 
Family Planning.--The bill includes language requiring 
recipients of title X funding, family planning funding, to 
certify that it encourages family participation in the decision 
of minors to seek family planning services and that it provides 
counseling to minors on how to resist attempts to coerce minors 
into engaging in sexual activities. This language has been 
included in the bill for several years.
    Title X Compliance With State Laws.--The bill includes a 
provision, continued from last year, requiring Title X clinics 
to comply with State laws relating to notification or reporting 
of child abuse, child molestation, sexual abuse, rape or 
incest.
    Department of Education.--The bill funds programmatic and 
support activities in the Department of Education at 
$57,681,171,000, an increase of $342,119,000 above the request 
and $2,018,710,000 above last year's comparable level (adjusted 
for advance appropriations in fiscal year 2004).
    Education for the Disadvantaged.--The bill provides 
$13,342,309,000, for grants to local education agencies under 
title I of the Elementary and Secondary Education Act. This 
level is $1,000,000,000 above the fiscal year 2004 amount and 
the same as the request level.
    Impact Aid.--The bill provides $1,250,893,000 for school 
districts that are impacted by Federal activities, such as 
military bases or Indian lands. This is an increase of 
$21,367,000 above the fiscal year 2004 level, and the 
President's request.
    School Improvement Programs.--The bill provides 
$5,641,401,000 for the school improvement programs. The bill 
includes $2,950,000,000 for state grants for improving teacher 
quality, $19,874,000 above last year's level and the request. 
The bill also includes $269,115,000 for math and science 
partnerships, an increase of $120,000,000 above last year's 
level and the same as the request.
    Innovation and Improvement.--The bill provides $669,936,000 
for innovation and improvement programs. Included within this 
account is $268,702,000 for charter schools, an increase of 
$12,721,000 above last year's levels.
    Special Education.--The Committee recommends an overall 
program funding level for special education programs of 
$12,176,101,000, $1,015,393,000 above last year's level and the 
same as the President's request. The bill provides a 
$1,000,000,000 increase for grants to states under part B of 
the Individuals with Disabilities Education Act.
    Vocational and Adult Education.--Vocational education state 
grants are funded at $1,215,008,000 and adult education state 
grants are funded at $574,372,000.
    Student Financial Assistance and Higher Education.-- For 
Student Financial Aid, the Committee provides $14,755,794,000, 
$748,498,000 above last year and $57,172,000 above the 
President. For Higher Education, the Committee provides 
$1,976,056,000. This level is $116,586,000 below last year and 
$972,000 below the request. The bill allows the maximum Pell 
grant to be maintained at $4,050--the highest in history.
    Institute of Education Sciences.--The Committee proposes 
$526,804,000 for education research and statistics. For on-
going activities, this level is $30,069,000 above last year and 
$77,183,000 above the request level.

                       TITLE IV--RELATED AGENCIES

    Institute of Museum and Library Services.--Funding for the 
Institute of Museum and Library Services is $261,743,000 
including $23,000,000 for a librarian recruitment initiative.
    Social Security Administrative Costs.--Funding provided for 
the cost of administering the Social Security programs is 
$8,798,100,000, $484,926,000 above the fiscal year 2004 level 
and $82,900,000 below the request.

                 Government Performance and Results Act

    The Committee commends the Departments and Agencies under 
its jurisdiction for the progress they have made toward the 
establishment of goals and other benchmarks as required by the 
Government Performance and Results Act. However, these 
Departments and Agencies remain a long way from meeting its 
overall intent. The Committee continues to feel that 
quantifiable and measurable individual performance indicators 
need to be developed for each program. Individual indicators 
need to be specific and measurable wherever possible, need to 
be consistent with other measures used in similar programs and 
need to be supported by systems that can provide annual 
information on the progress being made toward achieving the 
stated goals. There are still far too many programs with 
indicators using the terms ``increase,'' or ``decrease,'' or 
``improve'' rather than specific numerical goals.
    In addition, these indicators must increasingly focus on 
the improvements in employment and income, worker safety, 
health status, biomedical discoveries, the quality of life of 
various populations, educational achievement, and the many 
other goals that are the primary purpose of the programs funded 
by this bill. Again, the indicators are far too often related 
to the issuance of program guidance or focus on the number of 
individuals served.
    Finally, the Committee continues to urge the Departments 
and Agencies under its jurisdiction to manage themselves based 
on performance and outcomes. They should use outcome and 
performance measures as the primary management tool for 
resource allocation and the evaluation of programs and 
individuals. The Committee expects that each Department and 
office funded in the bill will be prepared to testify during 
the fiscal year 2005 cycle on how performance and outcome 
measures are being used to manage their programs, including:
    How outcome and performance goals are being established for 
individual offices within departments and how they are held 
accountable for the achievement of these goals;
    How such data is used to establish individual performance 
goals; and
    How actual performance is measured against these goals and 
the kinds of incentives, both positive and negative, that are 
in place to assure the achievement of overall goals.

                           Effect Statements

    The Committee directs the Departments and agencies 
identified in the report accompanying the fiscal year 1998 bill 
to continue to provide it with effects statements within 45 
days of enactment of this Act.

                      TITLE I--DEPARTMENT OF LABOR


                 Employment and Training Administration


                    TRAINING AND EMPLOYMENT SERVICES

                         (INCLUDING RESCISSION)

    The Committee recommends $5,112,728,000 for this account, 
which provides funding authorized primarily by the Workforce 
Investment Act of 1998 (WIA). This is $32,736,000 below the 
fiscal year 2004 level and $213,564,000 below the budget 
request.
    The Training and Employment Services account is comprised 
of programs that enhance the employment and earnings of those 
in need of such services, operated through a decentralized 
system of skill training and related services. The account is 
mostly forward-funded on a July to June cycle, with funds 
provided for fiscal year 2005 supporting the effort from July 
1, 2005 through June 30, 2006.
    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 
667.220 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 activities

    For adult employment and training activities, the Committee 
recommends $900,000,000. This is $1,109,000 above the fiscal 
year 2004 level and the same as the budget request. Of the 
amount recommended $712,000,000 will become available on 
October 1, 2005. This program is authorized by the Workforce 
Investment Act of 1998. The funds are allocated by formula 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, available to all adults with no eligibility 
requirements, and intensive services, for unemployed 
individuals who are not able to find jobs through core services 
alone.

Dislocated worker employment and training activities

    For dislocated worker employment and training activities, 
the Committee recommends $1,479,149,000. This is $25,000,000 
above the fiscal year 2004 level and $96,379,000 above the 
budget request. Of the amount recommended, $1,060,000,000 will 
become available on October 1, 2005. Of the total, 
$1,178,192,000 is designated for State formula grants that 
support core services, intensive services, training, and 
supportive services. In addition, States use these funds for 
rapid response assistance to help workers affected by mass 
layoffs and plant closures. The bill includes $301,227,000 for 
the National Reserve, which supports National Emergency Grants 
to respond to mass layoffs, plant and/or military base 
closings, and natural disasters across the country, which 
cannot be otherwise anticipated, as well as technical 
assistance and training and demonstration projects.
    Within funds available under the dislocated worker national 
reserve, the Secretary may use up to $50,000,000 to carry out 
the Community College/Community-Based Job Training Initiative. 
The Committee encourages the Secretary to ensure that funds 
used for Initiative strengthen partnerships between community 
colleges, employers, and local workforce investment boards. 
Within the total for the National Reserve, the Committee also 
intends that up to $30,000,000 shall be available to the 
Secretary of Labor to support health insurance coverage 
assistance authorized in the Trade Act of 2002.

Youth activities

    For youth activities, the Committee recommends 
$1,000,965,000. This is $5,906,000 above the fiscal year 2004 
level and the same as the budget request.
    The Workforce Investment Act of 1998 consolidated the 
Summer Youth Employment and Training Program and Youth Training 
Grants under the Job Training Partnership Act into a single 
youth training activity. The funds are allocated by formula to 
States and further distributed to local workforce investment 
boards.

Job Corps

    For Job Corps, the Committee recommends $1,542,321,000. 
This is $1,169,000 above the fiscal year 2004 level and 
$14,966,000 below the budget request. Of the amount 
recommended, $691,000,000 will become available on October 1, 
2004.
    The Job Corps, authorized by the Workforce Investment Act 
of 1998, 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 open 
to economically disadvantaged young people in the 16 to 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 supports the 
effort of the Workforce Investment Act of 1998 to more fully 
integrate Job Corps centers in their local communities.
    The Committee recognizes the significant impact of the home 
building industry on the economic recovery, and its efforts to 
house our nation's working families, notwithstanding an ongoing 
shortage of labor in the construction trades. The Committee 
recognizes the essential role of the National Training 
Contractors (NTCs) such as the Home Builders Institute (HBI), 
the workforce development arm of the National Association of 
Home Builders, in training Job Corps youth for careers in this 
high growth industry. The Committee commends HBI on its 30 
years of proven results in building our nation's workforce by 
providing at-risk youth with the skills training and employment 
opportunities they need to succeed. The Committee encourages 
the Department to identify existing and future sites for 
potential expansion of construction trades training by the NTCs 
to help alleviate the industry's worker shortages and to impel 
its continued prosperity.
    The Committee applauds Job Corps' proactive approach to 
protecting America's homeland security, including offering the 
security trade at many of the 118 Job Corps centers. The 
Committee believes that the Job Corps program is in an 
excellent position to provide a substantial human resource pool 
of certified entry-level screeners for the Transportation 
Security Administration (TSA). The Committee recognizes that 
Job Corps is training a quality workforce of entry-level 
employees with the skills in high demand by TSA for our 
nation's municipal, national, and international airports. The 
Committee directs the U.S. Department of Labor and the U.S. 
Department of Homeland Security to enter into a memorandum of 
understanding that establishes the parameters for Job Corps and 
TSA to: cost-effectively leverage resources, create customized 
training curriculum, and enhance the labor pool. These steps 
will enable TSA to locate and hire qualified entry-level 
airport screeners from Job Corps for local, national and 
international airports.
    The Committee commends the Job Corps program for 
establishing cost-effective national and local partnerships 
with the U.S. Army, Navy and Coast Guard to recruit high 
quality military personnel. Job Corps students' average scores 
on military entrance exams exceed the national average. Twenty-
eight centers are former military installations, and many of 
the program's basic training and residential practices are 
based on a military model. The residential component of Job 
Corps instills discipline, responsibility, and group cohesion, 
preparing students in a way that is conducive to military life. 
The Committee encourages the Department to establish Junior 
Reserve Officers Training Corps (JROTC) programs that would be 
located near existing military installations. Together, Job 
Corps and the JROTC program would offer training in leadership 
skills, organizational management, and physical fitness for 
students pursuing advanced military careers. Job Corps centers 
that have expressed interest in a JROTC program include Shriver 
(MA), Cassadaga (NY), New Haven (CT) and Atterbury (IN).
    The Committee commends the Job Corps for developing 
programs to help address the nation's shortfall of staff in 
health professions, including nursing, pharmacy, and lab 
technician trades. Private sector companies including HCR Manor 
Care, HCA, CVS, and Walgreens and others have formed 
partnerships with Job Corps to help fill nursing and other 
allied heath care vacancies (such as facilities maintenance and 
dietary management). The Committee supports training Job Corps 
students in the health sciences, including CNAs, LPNs, health 
records technicians, dieticians, pharmacy technicians, 
healthcare facilities maintenance, and medical billing. The 
Committee understands several Job Corps Centers have expressed 
interest in being designated health care magnet centers, 
including the Columbia Basin (WA), Keystone (PA), and the Miami 
(FL) Job Corps Centers.
    The Committee believes that Job Corps' partnerships with 
national non-profit faith founded organizations such as Joint 
Action in Community Services (JACS), Women in Community 
Services, and the YWCA are essential to the success of Job 
Corps. The Committee commends JACS and its national network of 
nearly 3,000 volunteers for their proven record in providing 
at-risk young adults supportive services as they transition 
from Job Corps back to their home communities and into the 
world of work. As such, the Committee encourages the Department 
to expand its Job Corps partnership with such national 
volunteer programs in order to ensure the continued 
availability to youth to transition services that are national 
in scope, yet local in focus.

Native Americans

    For Native Americans, the Committee recommends $54,675,000. 
This is the same as the fiscal year 2004 level and $325,000 
below the budget request. This program, authorized by the 
Workforce Investment Act of 1998, is designed to improve the 
economic well being of Native Americans (Indians, Eskimos, 
Aleuts, and Native Hawaiians) through the provision of 
training, work experience, and other employment-related 
services and opportunities that are intended to aid the 
participants to secure permanent, unsubsidized jobs. The 
Department of Labor allocates formula grants to Indian tribes 
and other Native American groups whose eligibility for such 
grants is established in accordance with Department 
regulations.

Migrant and seasonal farmworkers

    For Migrant and Seasonal Farmworkers, the Committee 
recommends $76,874,000. This is the same as the fiscal year 
2004 level. The budget request did not include funds for this 
program. The Committee recommendation includes bill language 
directing that $4,583,000 for migrant and seasonal farmworker 
housing grants. The bill language further directs that not less 
than 70 percent of this amount be used for permanent housing 
grants. The recommendation also provides that the remaining 
amount be used for State service area grants, including funding 
grantees in those States impacted by formula reductions at no 
less than eighty-five percent of the comparable 1998 levels for 
such States. Within the National Activities/Other line item, 
the Committee includes $504,000 to be used for Section 167 
training, technical assistance and related activities, 
including continuing funding for migrant rest center activities 
at the current level.
    This program, authorized by the Workforce Investment Act of 
1998, 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.

National programs

    This activity includes Workforce Investment Act authorized 
programs in support of the workforce system including technical 
assistance and incentive grants, evaluations, pilots, 
demonstrations and research.
    Pilots, Demonstrations and Research: The Committee 
recommends $48,474,000 for grants or contracts to conduct 
research, pilots or demonstrates that improve techniques or 
demonstrate the effectiveness of programs. This is $9,277,000 
below the fiscal year 2004 level and $18,474,000 above the 
budget request.
    Evaluation: The Committee recommends $8,000,000 to provide 
for the continuing evaluation of program conducted under the 
Workforce Investment Act of 1998, as well as of federally 
funded employment-related activities under other provisions of 
law. This is $986,000 below the fiscal year 2004 level and the 
same as the budget request.
    Responsible Reintegration of Youthful Offenders: The 
Committee does not include funding for the Responsible 
Reintegration of Youthful Offenders program. The fiscal year 
2004 level was $49,705,000 and the budget request is 
$50,000,000.
    Technical Assistance: The Committee recommends $2,000,000. 
The funds recommended support the development of performance 
management systems, the provision of quality services, and 
promoting accountability and collaboration. This is $1,486,000 
below the fiscal year 2004 level and the same as the budget 
request.
    The Committee has not included separate funding for new 
programs requested by the Administration. The Administration 
requested $50,000,000 for Personal Reemployment Accounts and 
$40,000,000 for the Prisoner Re-entry Initiative. The Committee 
has deferred action on these two new programs until after the 
passage of authorizing legislation. In addition, the 
Administration requested $250,000,000 for the Community College 
Initiative. The Committee has provided up to $50,000,000 of 
National Reserve funds for this purpose.
    Rescission: The Committee has included language rescinding 
$100,000,000 of the unobligated funds contained in the H1-B 
Nonimmigrant Petitioner Account. The Committee understands that 
the authorization for this program has expired and that the 
Administration does not intend to seek reauthorization of this 
program.

            COMMUNITY SERVICE EMPLOYMENT FOR OLDER AMERICANS

    The Committee recommends $440,200,000 for community service 
employment for older Americans. This is $1,550,000 above the 
fiscal year 2004 level and the same as the budget request.
    The community service employment for older Americans 
program provides grants to public and private nonprofit 
organizations that subsidize part-time work in community 
service activities for unemployed persons aged 55 and older, 
whose family's annual income does not exceed 125 percent of the 
poverty level.

              FEDERAL UNEMPLOYMENT BENEFITS AND ALLOWANCES

    The Committee recommends $1,057,300,000. This is 
$280,900,000 below the fiscal year 2004 level and the same as 
the budget request.
    The Trade Adjustment Assistance Program provides assistance 
to certified workers adversely affected by imports and trade 
with countries covered by the North America Free Trade 
Agreement. Funding will continue the implementation of the TAA 
program with an emphasis on integrating the program into the 
One-Stop System. The Trade Adjustment Assistance Reform Act of 
2002 increased the possibility of training and income support 
benefits.

     STATE UNEMPLOYMENT INSURANCE AND EMPLOYMENT SERVICE OPERATIONS

    The Committee recommends $3,582,848,000 for this account. 
This is $5,056,000 below the fiscal year 2004 level and 
$10,586,000 less than the budget request. Included in the total 
availability is $3,440,914,000 authorized to be drawn from the 
Employment Security Administration Account of the Unemployment 
Trust Fund and $141,934,000 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 
that administer Federal and State unemployment compensation 
laws and operate the public employment service.
    For Unemployment Insurance Services, the Committee 
recommends $2,701,214,000. This is $82,685,000 above the fiscal 
year 2004 level and $10,000,000 below the budget request. The 
total includes $2,690,714,000 for State Operations and 
$10,500,000 for national activities. Included in the amount 
provided for State Operations is up to $10,000,000 to station 
staff in One-Stop Centers to conduct Unemployment Insurance 
eligibility interviews.
    For the Employment Service, the Committee recommends 
$763,000,000, which includes $23,300,000 in general funds 
together with an authorization to spend $739,700,000 from the 
Employment Security Administration Account of the Unemployment 
Trust Fund. This is $87,995,000 below the fiscal year 2004 
level and the same as the budget request. Included in the bill 
for the Employment Service grants to States is $696,000,000, 
available for the program year of July 1, 2005 through June 30, 
2006. This is $90,887,000 below the fiscal year 2004 level and 
the same as the budget request.
    The Committee recommends $67,000,000 for ES national 
activities. This is $3,029,000 above the fiscal year 2004 level 
and the same as the budget request.
    The Committee recommends $98,764,000 for America's Labor 
Market Information System. This is the same as the fiscal year 
2004 level and $586,000 below the budget request. This funding 
supports core employment statistics, universal access for 
customers, improving efficiency in labor market transactions, 
and measuring and displaying WIA performance information.
    The Committee recommendation includes $19,870,000 for the 
Work Incentives Grants program, $117,000 above the fiscal year 
2004 level and the same as the budget request, 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

    The Committee recommends $517,000,000. This is $50,000,000 
above the fiscal year 2004 level and the same as the budget 
request. 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.

                         PROGRAM ADMINISTRATION

    The Committee recommends $170,354,000. This is $1,995,000 
below the fiscal year 2004 level and $10,664,000 below the 
budget request. This includes $111,375,000 in general funds and 
authority to expend $57,479,000 from the Employment Security 
Administration Account of the Unemployment Trust Fund. Within 
the amounts provided, the Committee has included $6,900,000 for 
Executive Direction. This is $1,500,000 below the fiscal year 
2004 comparable level and $1,818,000 below the request. General 
funds in this account provide the Federal staff to administer 
employment and training programs under the Workforce Investment 
Act of 1998, the Older Americans Act, the Trade Act, 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.

               Employee Benefits Security Administration


                         SALARIES AND EXPENSES

    The bill provides $132,345,000 for the Employee Benefits 
Security Administration, an increase of $8,305,000 over the 
fiscal year 2004 level and the same amount as the budget 
request.
    The Employee Benefits 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. This involves ERISA fiduciary and 
reporting/disclosure requirements. EBSA is also responsible for 
enforcement of sections 8477 and 8478 of the Federal Employees' 
Retirement Security Act of 1986. The agency was also given 
responsibilities under the Health Insurance Portability and 
Accountability Act of 1996.
    The Committee is interested in policy initiatives that 
enhance personal retirement readiness and security of the 
Nation's workforce. The Committee is aware of an innovative 
proposal of the International Foundation for Retirement 
Education to identify the real rate of retirement readiness of 
the workforce and the Committee encourages EBSA to consider 
supporting such a project.

                  Pension Benefit Guaranty Corporation

    The Corporation's budget for fiscal year 2004 is 
$266,330,000, which is $33,558,000 above the fiscal year 2004 
level and the same as the budget request.
    The Corporation is a wholly owned government corporation 
established by the Employee Retirement Income Security Act of 
1974 (ERISA). The law places it within the Department of Labor 
and makes the Secretary of Labor the chairperson of its board 
of directors. The Corporation receives its income from 
insurance premiums collected from covered pension plans, 
collections of employer liabilities imposed by ERISA, and 
investment earnings. It is also authorized to borrow up to 
$100,000,000 from the United States Treasury. The primary 
purpose of the Corporation is to guarantee the payment of 
pension plan benefits to participants if covered plans fail or 
go out of existence.
    The bill includes language permitting obligations in excess 
of the amount provided in the bill after approval by both the 
Office of Management and Budget as well as the Committee on 
Appropriations. The Committee has an interest in approving 
obligations that may change the total amount available to any 
agency.

                  Employment Standards Administration


                         SALARIES AND EXPENSES

    The bill includes $402,818,000 for this account. This is 
$10,802,000 above the budget request and $6,476,000 below the 
fiscal year 2004 comparable level. The bill includes 
$400,797,000 in general funds for this account and contains 
authority to expend $2,021,000 from the Special Fund 
established by the Longshore and Harbor Workers' Compensation 
Act.
    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, the Longshore and Harbor Workers' 
Compensation Act, and the Federal Mine Safety and Health Act 
(black lung). The agency also administers Executive Order 11246 
related to affirmative action by Federal contractors and the 
Labor-Management Reporting and Disclosure Act.
    The Committee requests the Department submit a report that 
details: (1) the specific changes that have been made to the 
wage determination process, the costs associated with those 
changes, and the effectiveness of those changes; (2) what 
additional changes are planned for the future and the proposed 
schedule for implementation; and (3) any recommendations for 
further changing the wage determination process.

                            SPECIAL BENEFITS

    The bill includes $233,000,000. This is the same 
$70,000,000 above the fiscal year 2004 appropriation and the 
same as the budget request. This appropriation primarily 
provides benefits under the Federal Employees' Compensation Act 
(FECA). The payments are required by law. In fiscal year 2004, 
an estimated 155,000 injured Federal workers or their survivors 
will file claims; 55,500 will receive long-term wage 
replacement benefits for job-related injuries, diseases, or 
deaths.
    The total amount to be available in fiscal year 2004 for 
FECA payments is expected to be $3,561,963,000, an increase of 
$113,202,000 over the fiscal year 2004 comparable level.

               SPECIAL BENEFITS FOR DISABLED COAL MINERS

    The Committee recommends an appropriation of $276,000,000 
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 2004, the same as 
the budget request. These funds are used to provide monthly 
benefits to coal miners disabled by black lung disease and to 
their widows and certain other dependents, as well as to pay 
related administrative costs.
    The Committee recommends an advance appropriation of 
$81,000,000 for the first quarter of fiscal year 2005, the same 
as the budget request. These funds will ensure uninterrupted 
benefit payments to coal miners, their widows, and dependents.
    The Black Lung Consolidation of Administrative 
Responsibility Act of 2002 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.

    ADMINISTRATIVE EXPENSES, ENERGY EMPLOYEES OCCUPATIONAL ILLNESS 
                           COMPENSATION FUND

    The bill includes $40,821,000 for the Energy Employees 
Occupational Illness Compensation Program authorized by Title 
XXXVI of the National Defense Authorization Act of 2001. This 
is $10,830,000 below the fiscal year 2004 level and the same as 
the budget request. Funds will be used to administer the 
program that provides compensation to employees or survivors of 
employees of the Department of Energy (DOE), its contractors 
and subcontractors, companies that provided beryllium to DOE, 
and atomic weapons employees who suffer from a radiation-
related cancer, beryllium-related disease, or chronic silicosis 
as a result of their work in producing or testing nuclear 
weapons, and uranium workers covered under the Radiation 
Exposure Compensation Act.

                    BLACK LUNG DISABILITY TRUST FUND

    The bill includes $1,058,644,000 for this account, of which 
$57,049,000 is definite budget authority and $1,001,951,000 is 
indefinite budget authority. The bill language provides such 
sums as may be necessary to pay for benefits.
    The Trust Fund pays all black lung compensation/medical and 
survivor benefit expenses when no responsible mine operator can 
be assigned liability for such benefits, or when coal mine 
employment ceased prior to 1970, as well as administrative 
costs which are incurred in administering the benefits program 
and operating the Trust Fund.
    The basic financing for the Trust Fund comes from a coal 
excise tax for underground and surface-mines coal. Additional 
funds come from reimbursement payments from mine operators for 
benefit payments made by the Trust Fund before the mine 
operator is found liable. 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

    The bill includes $461,599,000 for the Occupational Safety 
and Health Administration. This is $4,058,000 above the fiscal 
year 2004 level and the same as the budget request. This agency 
is responsible for enforcing the Occupational Safety and Health 
Act of 1970 in the Nation's workplaces.
    The Committee has included language prohibiting OSHA from 
obligating or expending any of these funds to enforce the 
annual fit test requirement of the General Industry Respiratory 
Protection Standard with respect to exposure to tuberculosis.
    The Committee commends OSHA, EPA and the private-sector 
participants who are supporting the Alliance on Identification 
and Management of Chemical Reactivity Hazards as an outstanding 
example of joint cooperative public/private efforts to improve 
health and safety in the workplace and community. The Committee 
directs the Director of the Occupational Safety and Health 
Administration to assure that sufficient resources will be made 
available to support this Alliance's objectives to develop and 
disseminate materials to assist in the identification and 
management of reactive chemical hazards, including electronic 
assistance resources (e.g., interactive software e-Tools, 
technology-based training), training and materials for OSHA 
staff, and the customization of these tools and resources for 
specific workplace sectors, such as small and medium 
enterprises.
    The Committee is disappointed by OSHA's decision to proceed 
with enforcement of the General Industry Respiratory Protection 
Standard as it applies to occupational exposure to tuberculosis 
(TB). The Committee strongly urges the agency to delay 
enforcement of the Respiratory Standard as it applies to TB. 
Personal respiratory protections have been in place in 
healthcare facilities for over 10 years, as recommended by the 
Centers for Disease Control and Prevention (CDC), and as 
enforced through OSHA's General Duty Clause. Additionally, the 
Committee strongly advises OSHA to take no further action with 
regard to occupational exposure to TB until such time as the 
CDC has completed the ongoing revisions of its TB guidelines. 
Subsequent actions should only be taken in accordance with the 
CDC's recommendations.
    The Committee continues to be concerned with the lack of 
progress on the agency's regulation concerning Employer Payment 
for Personal Protective Equipment, the public comment period 
for which ended over five years ago. The Committee is 
especially concerned because the rate of worker deaths and 
injuries, which has decreased in the last decade for all 
American workers, has increased during that same time among 
Hispanic workers, many of whom work in the nation's most 
dangerous professions, including the construction industry. The 
Committee urges the agency to move expeditiously toward the 
completion of this regulation.

                 Mine Safety and Health Administration


                         SALARIES AND EXPENSES

    The bill includes $275,567,000 for this agency. This is 
$6,710,000 above the fiscal year 2004 comparable level and the 
same as the budget request. This agency enforces the Federal 
Mine Safety and Health Act in underground and surface coal and 
metal and non-metal mines.

                       Bureau of Labor Statistics


                         SALARIES AND EXPENSES

    The total funding recommended by the Committee for the 
Bureau of Labor Statistics (BLS) is $533,518,000. This is 
$15,022,000 above the fiscal year 2004 comparable level and the 
same as the budget request. The bill includes $455,045,000 in 
general funds for this account and authority to spend 
$78,473,000 from the Employment Security Administration Account 
of the Unemployment Trust Fund. The BLS is the principal fact-
finding agency in the Federal government in the broad field of 
labor economics. Its principal surveys include the Consumer 
Price Index and the monthly unemployment series.

                 Office of Disability Employment Policy


                         SALARIES AND EXPENSES

    The bill includes $47,555,000 for the Office of Disability 
Employment Policy, which is $531,000 above the fiscal year 2004 
comparable level and the same as the budget request. The Office 
provides leadership to eliminate employment barriers to people 
with disabilities.

                        Departmental Management


                         SALARIES AND EXPENSES

    The bill includes $259,967,000 for Departmental Management 
activities. This is $90,352,000 below the fiscal year 2004 
level and $27,201,000 below the budget request. The bill 
includes $259,653,000 in general funds for this account along 
with authority to transfer $314,000 from the Employment 
Security Administration Account of the Unemployment Trust Fund.
    The Departmental Management appropriation finances staff is 
responsible for formulating and overseeing the implementation 
of Departmental policy and management activities. 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 level and 
$6,122,000 below the budget request.
    The bill provides $30,000,000 for the Department-wide 
information technology crosscut, which is $18,219,000 below the 
fiscal year 2004 comparable level and $3,565,000 below the 
budget request. The Committee commends the Department in 
streamlining its information technology infrastructure into a 
single, uniform system and encourages the Department in this 
effort.
    The bill provides $5,000,000 for the Departmental 
Management Crosscut. This is $35,000 above the fiscal year 2004 
level and $5,100,000 below the budget request.
    The bill includes $32,675,000 for the Administration and 
Management program that provides leadership and policy guidance 
for a number of Department-wide activities. This is $478,000 
above the fiscal year 2004 level and the same as the budget 
request.
    The bill includes $35,545,000 for the Bureau of 
International Labor Affairs (ILAB), which is $5,000,000 above 
the budget request and $74,317,000 below the fiscal year 2004 
comparable level. At the level in this bill, ILAB will continue 
to coordinate the Department's global responsibilities in 2004 
and to provide expert support for many of the Administration's 
international initiatives, including the promotion of core 
labor standards and the elimination of exploitative child 
labor.
    The Committee recognizes the importance of fostering 
economic growth in developing regions of the world and 
recommends that the International Labor Affairs Bureau ensure 
that the United States Government recognizes and promotes 
international standards of excellence, and encourages public-
private partnerships that focus on capacity building in 
priority areas such as labor standards and human rights, rule 
of law, trade facilitation, and workforce training and 
education. The Committee is aware of the work being performed 
by the Global Training Partnership (GTP) to promote capacity 
building for jobs and economic growth in developing regions 
globally. The Committee recommends that the agency expand the 
work of the Global Training Partnership to build regional 
capacity in Sub-Saharan Africa, Central America, the Caribbean 
and Andean regions, in order to maximize benefits from 
improvement of sound policies and practices conducive to 
economic growth, poverty reduction, and the rule of law.
    The Committee intends that the Women's Bureau increase 
funding for Women Work! training and technical assistance 
services for programs that assist women in transition to 
reenter the workforce. Women Work! has valuable experience, is 
uniquely qualified to deliver these services through its 
national network, and has demonstrated results through outcome 
assessments. An increase in funding is needed to meet the needs 
of more than 1,000 programs in the Women Work! Network.
    The Committee is aware of ongoing discussions concerning 
the mandatory expensing of stock options and believes that 
further information is needed about the possible consequences 
of such expensing for the high technology workforce. The 
Committee has provided $50,000 to initiate this study to 
examine the role of broad-based stock option plans in the 
recruitment and retention of skilled workers. The study shall 
be provided to the Committee on Appropriations by December 31, 
2004.

        ASSISTANT SECRETARY FOR VETERANS EMPLOYMENT AND TRAINING

    The Committee recommends $220,648,000 for veteran 
employment and training activities. This is $2,002,000 above 
the fiscal year 2004 level and the same as the budget request. 
Within this amount, the bill includes $194,098,000 to be 
expended from the Employment Security Administration account of 
the Unemployment Trust Fund for the traditional State and 
Federal administration of veterans' employment and training 
activities.
    For State grants the Committee recommends $162,415,000. 
This is $1,007,000 above the fiscal year 2004 level and the 
same as the budget request.
    For Federal administration, the Committee recommends 
$29,683,000. This is $826,000 above the fiscal year 2004 level 
and the same as the budget request. The Committee recommends 
$2,000,000 for the National Veterans Training Institute, the 
same as the budget request. The Committee recommends 
$19,000,000 for the homeless veterans reintegration program 
assisting homeless veterans to find jobs, the same as the 
budget request. The Committee recommends $7,550,000 for 
veterans workforce investment programs, the same as 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 services; a guide for assisting veterans 
service organizations and homeless veteran service providers in 
accessing workforce investment funds and 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.
    Individuals leaving the military are 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 Transition Assistance Program (TAP) has 
been established to ease the transition of separating service 
members to the civilian sector. The Committee instructs the 
Secretary of Labor to ensure that a module on homelessness 
prevention is added to the TAP 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.

                    OFFICE OF THE INSPECTOR GENERAL

    The bill includes $69,590,000 for the Office of the 
Inspector General (OIG). This is $4,251,000 above the fiscal 
year 2004 comparable level and the same as the budget request. 
This includes $64,029,000 in general funds for this account 
along with the authority to transfer $5,561,000 from the 
Employment Security Administration Account of the Unemployment 
Trust Fund.
    The 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 program of audits, 
investigations, and program evaluations, the OIG attempts to 
reduce the incidence of fraud, waste, abuse, and mismanagement, 
and to promote economy, efficiency, and effectiveness 
throughout the Department.

                          Working Capital Fund

    The Committee includes $10,000,000 for a new core 
accounting system for the Department of Labor, including 
hardware and software infrastructure.

                           General Provisions

    Sec. 101. The Committee continues a provision to prohibit 
the use of Job Corps funding for compensation of an individual 
at a rate in excess of Executive Level II.
    Sec. 102. The Committee includes a provision to permit 
transfers of up to one percent between appropriations, the same 
as the budget request.
    Sec. 103. The Committee includes a provision directing the 
Secretary to provide to the Department of Labor employees in 
the National Capital Region the full transit subsidy that they 
are eligible to receive.

           TITLE II--DEPARTMENT OF HEALTH AND HUMAN SERVICES


              Health Resources and Services Administration


                     HEALTH RESOURCES AND SERVICES

    The bill includes $6,266,982,000 for health resources and 
services programs, which is $326,321,000 below the fiscal year 
2004 comparable level for these activities and $244,149,000 
above the budget request. In addition, the Committee provides 
$542,649,000 in the Public Health and Social Services Emergency 
Fund for two programs administered by the Health Resources and 
Services Administration (HRSA)--$514,944,000 for hospital 
preparedness and $27,705,000 for education incentives for 
medical school curriculum.
    HRSA supports programs which provide health services to 
disadvantaged, medically undeserved, and special populations; 
improve infant mortality rates; direct the education, supply, 
and distribution of a wide range of health professionals; and 
provide technical assistance regarding the utilization of 
health resources and facilities.

Community health centers

    The Committee provides $1,835,925,000 for community health 
centers, which is $218,544,000 above the fiscal year 2004 
comparable level and the same as the budget request. These 
funds support programs which include community health centers, 
migrant health centers, health care for the homeless and public 
housing health service grants.
    The Committee includes bill language similar to previous 
years limiting the amount of funds available for the payment of 
claims under the Federal Tort Claims Act to $45,000,000, which 
is the same as the budget request and the limitation in the 
fiscal year 2004 bill. The Committee recognizes the value of 
this program for health centers and as additional health 
centers participate in the program, the number of claims 
submitted and paid also increases.
    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 million remains, of 
the $160 million appropriated in fiscal years 1997 and 1998, 
for loan guarantee authority for guarantees of both loan 
principal and interest.
    Although the Committee continues to support the expansion 
of the health center program to double the number of patients 
served, the Committee is concerned that current funding 
methodologies may not recognize the increased cost of providing 
services for current patients at existing health centers. The 
Committee urges HRSA to use a portion of the increased funding 
provided to increase support for existing health centers based 
on performance-related criteria in addition to site and service 
expansion applications.
    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 pleased with the success of the school-
based health center initiative, but 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.
    Community health centers are encouraged to make ultrasound 
services available to their patients.

Free clinics medical malpractice

    The Committee does not provide fiscal year 2005 funding for 
payments of claims under the Federal Tort Claims Act to be made 
available for volunteer free clinic health care professionals. 
$4,821,000 was provided for this purpose in fiscal year 2004 
and claims are not expected against the fund until at least 
fiscal year 2006. The program extends Federal Tort Claims Act 
coverage to health care professional 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 will be 
interested to learn how many health care professionals apply to 
be deemed for coverage under the program as it begins operation 
this year.

National Health Service Corps: Field placements

    The Committee provides $45,506,000 for field placements, 
which is the same as the fiscal year 2004 comparable level and 
$229,000 below the budget request. These funds are used to 
support the activities of National Health Service Corps (NHSC) 
obligors and volunteers in the field, including travel and 
transportation costs of assignees, training and education, 
recruitment of students, residents and clinicians and retention 
activities. Salary costs of most new assignees are paid by the 
employing entity.

National Health Service Corps: Recruitment

    The Committee provides $124,397,000 for recruitment 
activities, which is the same as the fiscal year 2004 
comparable level and $34,735,000 below the budget request. The 
program awards scholarships to health professions students and 
assists graduates in repaying their student loans. In return 
for every year of support, these individuals are obligated to 
provide a year of service in health professional shortage areas 
of greatest need. The minimum obligation is two years. The 
Committee does not include the bill language requested by the 
Administration to establish a flexible Commissioned Corps 
reserve within the NHSC and does not expect funds to be used 
for this purpose.
    The Committee is pleased by the increasing proportion of 
NHSC assignees being placed 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 has access to a sufficient level of 
health professionals through the NHSC.
    The Committee is concerned that the current HPSA scoring 
process used by HRSA may disadvantage some health centers 
located in medically underserved areas of the country. The 
Committee encourages HRSA to consider using alternative data to 
score Federally qualified health centers under the automatic 
designation process.

Health professions

    The Committee provides $416,365,000 for all health 
professions training programs, which is $19,715,000 below the 
fiscal year 2004 comparable level and $258,582,000 above the 
budget request. The Committee was unable to restore completely 
the $278,297,000 reduction in health professions funding 
proposed by the Administration, but intends to continue all the 
programs at manageable operating levels with the funds 
provided. The Committee felt it was especially important to 
support diversity and nurse training programs. The Bureau of 
Health Professions provides both policy leadership and support 
for health professions workforce enhancement and educational 
infrastructure development.
    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 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 is concerned that too few clinics and 
physicians are prepared to treat patients with rare diseases. 
Therefore, the Committee encourages HRSA to include ``treatment 
of patients with rare diseases'' and ``training of health 
professionals to recognize and treat patients with rare 
diseases'' as priority areas in its selection of health 
professions training grants.

Centers of excellence

    The Committee provides $33,882,000 for centers of 
excellence, which is the same as the fiscal year 2004 
comparable level. The Administration did not request funding 
for this program. The program is designed to strengthen the 
national capacity to educate underrepresented minority (URM) 
students in the health professions by offering special support 
to those institutions which train a significant number of URM 
individuals, including African-Americans, Hispanics and Native 
Americans. Funds are used for the recruitment and retention of 
students and faculty, information resources and curricula, 
faculty and student research, and the development of plans to 
achieve institutional improvements.
    The Committee is pleased that HRSA has re-focused the 
minority centers of excellence program on providing support to 
historically minority health professions institutions. The 
Committee recognizes the important role of this program in 
supporting faculty and other academic programs at minority 
institutions. The Committee encourages the program to consider 
applications that are responsive to allied health professions 
that 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, which is the same as the fiscal year 2004 
comparable level. The Administration did not request funding 
for this program. This program provides grants and contracts to 
eligible health professions schools for identifying, 
recruiting, and selecting individuals from the various racial 
and ethnic populations who are from disadvantaged backgrounds 
for education and training in a health profession and 
facilitating their entry into, retention and completion of 
their education at a health professions school.
    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. The Committee encourages the program to consider 
applications that are responsive to allied health professions 
that are experiencing shortages and high vacancy rates, such as 
laboratory personnel.

Faculty loan repayments

    The Committee provides $1,313,000 for loan repayments and 
fellowships regarding faculty positions, which is the same as 
the fiscal year 2004 comparable level. The Administration did 
not request funding for this program. The program provides for 
the repayment of educational loans of individuals from 
disadvantaged backgrounds who are health professions students 
or graduates, and who have agreed to serve for not less than 
two years as a faculty member of an eligible health professions 
school. The school matches the Federal contribution toward loan 
repayment. The program also supports fellowships for URM 
faculty members.

Scholarships for disadvantaged students

    The Committee provides $47,510,000 for scholarships for 
disadvantaged students, which is the same as the fiscal year 
2004 comparable level and $37,613,000 above the budget request. 
The program provides grants to eligible health professions and 
nursing schools to provide scholarships to eligible individuals 
from disadvantaged backgrounds, including students who are 
members of racial and ethnic minority groups. By statute, not 
less than 16 percent of the funds must go to schools of 
nursing.

Training in primary care medicine and dentistry

    The Committee provides $63,857,000 for training in primary 
care medicine and dentistry, which is $17,885,000 below the 
fiscal year 2004 comparable level. The Administration did not 
request funding for this program. The program is comprised of 
four elements: (1) family medicine programs; (2) general 
internal medicine and general pediatrics (GIM/GP) training; (3) 
physician assistants (PA) training; and (4) general or 
pediatric dentistry training. Family medicine grants and 
contracts promote the predoctoral training of medical students, 
support family medicine residency programs and their trainees, 
train physicians who plan to teach in family medicine programs, 
and assist in establishing or improving family medicine 
academic administrative units. GIM/GP grants and contracts are 
to plan and operate residency programs and to provide financial 
assistance for residents, meet the costs of training programs 
for physicians who plan to teach in GIM/GP, as well as to 
support the faculty trainees, and develop programs to support 
predoctoral activities. PA training grants and contracts are to 
plan, develop, and operate programs for the training of PAs and 
for the training of individuals who will teach in programs to 
provide such training. General or pediatric dentistry training 
grants and contracts are to meet the costs of planning, 
developing, or operating programs and to provide financial 
assistance to residents in such programs.
    The Committee recognizes the important role that HRSA 
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 recognizes there will be a major increase in 
the pediatric population through 2020 and an increased 
percentage of the children will be under-privileged. The 
roughly one of every six children living in poverty today has 
about five times the level of untreated dental disease compared 
to their more affluent peers. Pediatric dentistry residency 
programs provide both treatments for underprivileged children 
and training opportunities for pediatric dentists. In fact, 
two-thirds of the patients treated in these programs are 
Medicaid recipients. Recruitment and retention of pediatric 
dental educators is vital to pediatric dental residency 
programs. While pediatric dentists treat about 30 percent of 
the children in this country, they train 100 percent of the 
dentists who treat children. The Committee encourages HRSA to 
develop innovative programs, such as faculty development 
initiatives and a faculty loan repayment pilot program.

Area health education centers

    The Committee provides $29,206,000 for area health 
education centers (AHEC), which is the same as the fiscal year 
2004 comparable level. The Administration did not request 
funding for this program. The program links university health 
science centers with community health service delivery systems 
to provide community-based training sites for students, 
faculty, and practitioners. The program supports two types of 
projects: (1) basic/core AHEC cooperative agreement projects to 
plan and implement new and developing programs; and (2) model 
programs to extend AHEC cooperative agreement projects, with 
not less than 50 percent of the project costs supported by non-
Federal monetary contributions. The Committee encourages AHEC 
programs to coordinate with the rural health outreach program 
for the greater effectiveness of both programs.

Health education and training centers

    The Committee has provided $3,851,000 for health education 
and training centers, the same as fiscal year 2004. The 
Administration did not request funds for this program. The 
program funds schools of medicine and osteopathy to conduct 
training and education programs for health professions students 
to improve the access, diversity, and quality of health 
personnel along the border between the United States and 
Mexico, in the State of Florida, and in other urban and rural 
areas with populations with serious unmet health care needs. 
The program also provides educational support to health 
professionals, including nursing, practicing in the area.

Allied health and other disciplines

    The Committee provides $11,849,000 for allied health and 
other disciplines, which is the same as the fiscal year 2004 
comparable level. The Administration did not request funding 
for this program. The program is comprised of three elements: 
(1) allied health special projects; (2) podiatric primary care 
residency training; and (3) chiropractic demonstration 
projects. Allied health special projects assist entities in 
meeting the costs associated with expanding or establishing 
programs that will increase the number of individuals trained 
in allied health professions. Activities included are those 
that: (1) expand enrollments; (2) provide rapid transition and 
career advancement training programs; (3) establish community-
based training programs; (4) expand or establish 
interdisciplinary training programs, demonstration centers, and 
clinical training sites in medically underserved or rural 
communities; (5) provide traineeships to students; and (6) 
plan, develop, and operate or maintain graduate programs in 
behavioral and mental health practice. Podiatric primary care 
residency training grants and contracts are for planning and 
implementing projects in residency programs and providing 
traineeships to residents who plan to specialize in primary 
care. Chiropractic demonstration grants and contracts are 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 intends that the same amounts as in fiscal 
year 2004 be provided for the graduate psychology education 
program to train health service psychologists as well as the 
geropsychology training program. The Committee understands that 
this is the only federally funded psychology training program, 
and for this reason, considers its continuation a high 
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.
    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 laboratory personnel and 
urges HRSA to redouble efforts to address these shortages.

Geriatric programs

    The Committee provides $31,805,000 for geriatric programs, 
which is the same as the fiscal year 2004 comparable level. The 
Administration did not request funding for this program. The 
program provides grants and contracts to eligible entities to: 
(1) establish geriatric education centers to provide training 
for health care professionals who provide treatment and for 
training and retraining of faculty who teach geriatrics; (2) 
provide support for geriatric training projects to train 
physicians, dentists, and behavioral and mental health 
professionals who plan to teach geriatrics; and (3) establish a 
program to provide Geriatric Academic Career Awards to eligible 
individuals to promote the career development of such 
individuals as academic geriatricians.
    The Committee intends that the same amounts as in fiscal 
year 2004 be provided to geriatric education centers, geriatric 
training programs, and geriatric academic career awards. The 
Committee is concerned that there is an insufficient number of 
health care providers trained to address the health care needs 
of the growing older population. With only a small number of 
new physicians going into the field and those already in the 
field approaching retirement age, incentives are needed to 
increase the number of academic geriatricians to competently 
train health professionals from a variety of disciplines, 
including geriatric medicine. The Committee believes that to 
meet the needs of an aging population, HRSA needs to improve 
the training of all health professionals in geriatrics.

Quentin N. Burdick program for rural interdisciplinary training

    The Committee provides $2,255,000 for the Quentin N. 
Burdick program for rural interdisciplinary training, which is 
$3,871,000 below the fiscal year 2004 comparable level. The 
Administration did not request funding for this program. The 
program provides grants and contracts to entities for the 
purpose of funding interdisciplinary training projects that are 
designed to train, recruit, and retain teams of 
interdisciplinary professionals to work in underserved areas.

Health professions workforce information and analysis

    The Committee has not provided funding for health 
professions workforce information and analysis. The 
Administration requested $999,000 for this program, and the 
fiscal year 2004 comparable level is $722,000. The Department 
is encouraged to use policy evaluation funds to support this 
program. The program provides grants and contracts to eligible 
entities to provide for the collection and analysis of targeted 
information, research on high priority workforce questions, the 
development of a non-Federal analytic and research 
infrastructure, and the conduct of program evaluation and 
assessment.

Public health, preventive medicine and dental public health programs

    The Committee provides $6,970,000 for public health, 
preventive medicine and dental public health programs, which is 
$2,200,000 below the fiscal year 2004 comparable level. The 
Administration did not request funding for this program. The 
program is comprised of three elements: (1) public health 
training centers; (2) public health traineeships; and (3) 
preventive medicine and dental public health residencies. 
Grants or contracts for the operation of public health training 
centers are awarded to an accredited school of public health, 
or another public or nonprofit private institution accredited 
for the provision of graduate or specialized training in public 
health, that plans, develops, operates, and evaluates projects 
in the areas of preventive medicine, health promotion and 
disease prevention, or improving access to and quality of 
health services in medically underserved communities. Public 
health traineeship grants provide graduate or specialized 
public health training to individuals in the fields of 
epidemiology, environmental health, biostatistics, toxicology, 
nutrition, and maternal and child health. Preventive medicine 
and dental public health residency grants and contracts assist 
schools in developing new residency training programs or 
improving existing programs and in providing financial 
assistance to residency trainees.

Health administration programs

    The Committee provides $1,045,000 for health administration 
programs, which is $34,000 below the fiscal year 2004 
comparable level. The Administration did not request funds for 
this program. These programs provide grants to eligible 
entities with an accredited program in health administration, 
hospital administration, or health policy analysis and planning 
to provide traineeships to students and to assist accredited 
health administration programs in the development or 
improvement of programs to prepare students for employment with 
public or nonprofit private agencies.

Advanced education nursing

    The Committee provides $53,634,000 for advanced education 
nursing, which is $5,002,000 below the fiscal year 2004 
comparable level and $9,997,000 above the budget request. The 
program provides grants and contracts to eligible entities to 
meet the costs of: (1) projects that support the enhancement of 
advanced nursing education and practice; and (2) traineeships 
for individuals in advanced nursing education programs. The 
program prepares nurse practitioners, clinical nurse 
specialists, nurse midwives, nurse anesthetists, nurse 
educators, nurse administrators, public health nurses or other 
nurse specialists for advanced practice roles. Within the 
allocation, the Committee encourages HRSA to allocate funding 
at least at the fiscal year 2001 levels for nurse anesthetist 
education.

Nurse education, practice and retention

    The Committee provides $36,765,000 for nurse education, 
practice and retention, which is $4,997,000 above the fiscal 
year 2004 comparable level and $5,000,000 below the budget 
request. As amended by the Nurse Reinvestment Act of 2002, the 
nurse education, practice and retention program is a broad 
authority with targeted purposes under three priority areas--
education, practice and retention--in response to the growing 
nursing shortage. Under this authority, purposes identified 
under the Education Priority Area include: (1) expanding 
enrollment in baccalaureate nursing programs to increase the 
number of registered nurses; (2) developing and implementing 
internship and residency programs with mentoring components 
designed to retain new nurses, bring nurses back into the 
workforce and support the development of specialties for 
experienced nurses; and (3) providing education in new 
technologies, including distance learning methodologies. 
Purposes identified under the Practice Priority Area include: 
(1) establishing or expanding nursing practice arrangements, 
commonly referred to as nurse managed centers, in 
noninstitutional settings to demonstrate methods to improve 
access to primary health care in medically underserved 
communities; (2) providing care for underserved populations and 
other high risk groups such as the elderly, individuals with 
HIV/AIDS, substance abusers, the homeless, and victims of 
domestic violence; (3) providing managed care, quality 
improvement, and other skills needed to practice in existing 
and emerging organized health care systems; and (4) developing 
cultural competencies among nurses. Purposes identified under 
the Retention Priority Area include: (1) career ladder programs 
to promote advancement in a variety of training settings and 
assisting individuals in obtaining education and training 
required to enter the nursing profession; and (2) projects to 
improve the retention of nurses and enhance patient care that 
is directly related to nursing activities.

Nursing workforce diversity

    The Committee provides $16,402,000 for nursing workforce 
diversity, which is the same as the fiscal year 2004 comparable 
level and $4,997,000 below the budget request. The program 
provides grants and contracts to schools of nursing and other 
eligible entities to meet the costs of special projects to 
increase nursing education opportunities for individuals who 
are from disadvantaged backgrounds, including racial and ethnic 
minorities, by providing student scholarships or stipends, pre-
entry preparation, and retention activities. The program also 
contributes to the basic preparation of disadvantaged and 
minority nurses for leadership positions within the nursing and 
health care community.

Loan repayment and scholarship program

    The Committee provides $31,738,000 for nurse loan repayment 
for shortage area service, which is $5,002,000 above the fiscal 
year 2004 comparable level and the same as the budget request. 
This program offers student loan repayment to nurses in 
exchange for an agreement to serve not less than two years in 
an Indian Health Service health center, Native Hawaiian health 
center, public hospital, community or migrant health center, or 
rural health clinic.

Comprehensive geriatric education

    The committee provides $3,478,000 for comprehensive 
education, which is the same as the fiscal year 2004 comparable 
level and the Administration request. The comprehensive 
geriatric education program supports grants to develop and 
implement, in coordination with Title VII geriatric education 
programs, to train and educate individuals providing care for 
the elderly. Funds are to be used for (1) providing training to 
individuals who will provide geriatric care for the elderly; 
(2) develop and disseminate curricula relating to the treatment 
of the health care problems of elderly individuals; (3) train 
faculty members in geriatrics; or (4) provide continuing 
education to individuals who provide geriatric care.

Nurse faculty loan program

    The Committee provides $4,870,000 for the nurse faculty 
loan program, which is the same as the fiscal year 2004 
comparable level and the Administration request. The nurse 
faculty loan program addresses the problem of a growing 
shortage of nursing faculty. Both the National League for 
Nursing and the American Association of Colleges of Nursing 
have published data on the severity of the shortage and the 
implications. Potential nursing students are being turned away 
from nursing schools because faculty are not available. The 
nurse faculty loan program supports the development of a 
student loan fund in schools of nursing to increase the number 
of qualified nursing faculty. Students may receive loans up to 
$30,000 per year for a maximum of 5 years. The program has a 
cancellation provision for up to 85 percent of the loan for 
recipients working full-time as nursing faculty for a period of 
4 years. Twenty percent of the principal and interest may be 
canceled for each of the first, second and third year, and 25 
percent may be canceled for the fourth year of full-time 
employment as nursing faculty.

Hansen's disease services

    The Committee provides $17,413,000 for the Hansen's disease 
program, which is the same as the fiscal year 2004 comparable 
level and the budget request. This program offers Hansen's 
disease treatment to about 35 long term residents who continue 
to receive care from the National Hansen's Disease Center and 
to others who receive care from grant-supported outpatient 
regional clinics. Other former long term residents have been 
offered and elected to receive a living allowance from the 
program and now live independently. These programs provide 
treatment to about 3,000 of the 6,000 Hansen's disease 
sufferers in the continental United States.

Maternal and child health block grant

    The Committee provides $729,817,000 for the maternal and 
child health (MCH) block grant, which is the same as the fiscal 
year 2004 comparable level and the budget request. The MCH 
block grant provides funds to States to meet a broad range of 
basic and enabling health services, including personal health 
services; general, population-wide health services, such as 
screening; family support services; and integrated systems of 
care. The authorizing statute provides that, up to a funding 
level of $600,000,000, 85 percent of the funds are distributed 
to the States, with 15 percent of the funds set aside for 
special projects of regional and national significance 
(SPRANS). When the appropriation exceeds $600,000,000, 12.75 
percent of the amount over $600,000,000 is directed to the 
Community Integrated Service Systems set-aside program. The 
remaining 87.25 percent is distributed by the same 85/15 
percent allocation as in the basic block grant formula.
    The Committee has included bill language identifying 
$119,158,000 for the SPRANS set-aside. Within that total, 
$5,000,000 is provided 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 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 has also provided $4,000,000 
within the SPRANS set-aside to support the continuation of the 
locally based newborn screening follow-up and community based 
sickle cell disease outreach and supportive service initiative. 
The Committee also provides $3,000,000 for the continuation of 
model demonstration programs and public awareness campaigns on 
epilepsy. The Committee recognizes epilepsy, a chronic 
neurological condition, as a significant public health concern 
affecting over 2.5 million persons in the United States. 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 services 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 is pleased that HRSA has partnered with a national 
voluntary epilepsy agency to carry out these activities. In 
addition, the Committee provides $2,000,000 to continue the 
newborn screening for heritable disorders demonstrations begun 
last year. Newborn screening is used for early identification 
of infants affected by certain genetic, metabolic, hormonal and 
or functional conditions for which there is effective treatment 
or intervention. Screening detects disorders in newborns that, 
left untreated, can cause death, disability, mental retardation 
and other serious illnesses. The Committee is aware of the wide 
disparity that exists between state newborn screening programs 
that can result in children suffering irreversible injury or 
death versus children receiving successful diagnosis and 
treatment, depending upon whether their state tests for certain 
disorders. The Committee encourages HRSA to work with States to 
facilitate the development of educational materials that inform 
parents and health care providers of the benefits of newborn 
screening, about which conditions are screened for in their 
state, and about options to have babies screened for additional 
conditions that are not covered by their state programs. The 
Committee commends the department on the establishment of the 
Advisory Committee on Heritable Disorders and Genetic Diseases 
in Newborns and Children and the appointment by the Secretary 
of fifteen members. The Committee urges the advisory committee 
to work promptly in order to provide States with valuable 
guidance and recommendations regarding newborn screening.
    Biliary atresia is a pediatric liver disease which affects 
one in 10,000 infants. 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, 
a liver transplant or death. The Committee is aware that other 
nations, such as Japan, have instituted infant screening for 
biliary atresia. The Committee requests a report by March 15, 
2005 on the steps taken to validate a screening tool.
    It has come to the Committee's attention that NIH has 
developed a technology to screen newborns for severe combined 
immune deficiency disease (SCID). The Committee commends the 
work that the Advisory Committee on Heritable Disorders and 
Newborn Screening under HRSA is doing in developing a list of 
recommended diseases to be screened for at birth. Since SCID is 
a pediatric emergency that can now be detected at birth and 
successfully treated, and is fatal without immediate diagnosis 
and treatment, the Committee recommends that the Advisory 
Committee include SCID newborn screening in its list of 
recommended newborn screening tests.
    The Committee continues to recognize the critical role of 
the national network of hemophilia treatment centers in 
providing needed comprehensive care for bleeding disorders and 
urges HRSA to strengthen resources for the centers to ensure 
continued access to this model disease management network.
    The Committee commends HRSA for its support of the Sudden 
Infant Death Syndrome (SIDS) program support center and 
encourages the Maternal and Child Health Bureau to continue its 
efforts in this area of service. The Committee is pleased that 
the SIDS and Other Infant Death Support Center is collaborating 
with the National Institutes of Health to address the 
disproportionately high incidence of SIDS among African 
Americans.
    The Committee restates its long-standing interest in the 
support that MCHB has provided to comprehensive treatment 
centers for thalassemia patients under the SPRANS program and 
notes that the current funding is due to expire in FY05. The 
Committee encourages MCHB to continue this program and to 
coordinate its activities with relevant voluntary health 
organizations.
    The Committee recognizes the contributions of the long-
standing Provider's Partnership program. The Partnership 
includes a series of state-level projects initiated to address 
female psychosocial issues. The morbidity and mortality 
attributed to these issues such as a woman's depression, 
tobacco use, substance abuse and domestic violence are becoming 
increasingly apparent. Obstetrician-gynecologists can play a 
critical role in addressing these problems within their current 
practice, however because of their complexity, and the 
importance of promptly linking at-risk women with appropriate 
services, responsibility for full psychosocial assessment and 
treatment cannot fall solely to obstetrician-gynecologists. 
Partnerships between these women's health care providers and 
community programs are needed that allow for integration of 
medical care with psychosocial services. The Committee 
encourages continued funding of the Provider's Partnership 
program.
    Since 1990, the Maternal and Child Health Bureau has worked 
in cooperative agreement to run the National Fetal Infant 
Mortality Review (NFIMR) program. NFIMR provides training and 
assistance to enhance cooperative partnerships among local 
community health professionals, public health officers, 
community advocates and consumers to reduce infant mortality. 
The goal is to improve local services and resources for women, 
infants and families, to remove barriers to care, and to ensure 
culturally appropriate, family friendly services. Such efforts 
are crucial to understanding and addressing infant health 
disparities in communities at highest risk. The Committee 
encourages HRSA to continue to use Healthy Start funds to 
support the NFIMR project.
    The Committee encourages ACF's Head Start Bureau and the 
Maternal and Child Health Bureau to continue and expand their 
successful interagency agreement to jointly address dental 
disease, the number one 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.

Abstinence education

    The Committee does not provide funding for abstinence 
education within the Health Resources and Services 
Administration. As requested by the Administration, this 
account is now funded within the Administration for Children 
and Families.

Healthy Start

    The Committee provides $97,751,000 for Healthy Start, which 
is the same as the fiscal year 2004 comparable level and the 
budget request. Healthy Start provides grants to select 
communities with high rates of infant mortality to help them 
identify, plan, and implement a diverse range of community-
driven strategies that can successfully and significantly 
reduce disparities in perinatal health that contribute to the 
Nation's high infant mortality rate.

Universal newborn hearing

    The Committee provides $9,872,000 for the universal newborn 
hearing screening program, which is the same as the fiscal year 
2004 comparable level. The Administration did not request 
funding for this program. The program provides competitive 
grants to States for the purpose of implementing a national 
program of universal newborn hearing screening by means of 
physiologic testing prior to hospital discharge, audiologic 
evaluation by three months of age, and entry into a program of 
early intervention by six months of age.

Organ transplantation

    The Committee provides $24,632,000 for organ 
transplantation activities, which is the same as the fiscal 
year 2004 comparable level and the budget request. The program 
supports a scientific registry of organ transplant recipients; 
the National Organ Procurement and Transplantation Network, 
which matches organ donors with potential recipients; and 
grants and contracts with public and private non-profit 
organizations to promote and improve organ donation.
    The Committee is encouraged by the initial success of the 
organ donation collaborative project. 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% 
or higher, which will result in at least 6,000 additional 
organs available for transplantation. The Committee also 
encourages HRSA to consider adopting 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 encourages HRSA to continue to support 
studies and demonstration projects to increase and maximize 
organ donation and recovery rates, including living donation.
    The Committee encourages the Division of Transplantation to 
enhance its partnership with the pulmonary hypertension (PH) 
community aimed at increasing awareness about the need for 
increased heart and lung donations. 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 PH community to address 
its concerns regarding the methodology used to determine 
transplantation eligibility for PH patients.

Cord blood bank

    The Committee does not provide additional funding for the 
cord blood program pending the completion of the Institute of 
Medicine report on the structure and administration of such a 
program. $9,941,000 was provided for this purpose in fiscal 
year 2004 to remain available until expended and requested by 
the President's budget.

Bone marrow program

    The Committee provides $25,662,000 for the bone marrow 
program, which is $3,000,000 above the fiscal year 2004 
comparable level and the budget request. In addition to funding 
from HRSA in fiscal year 2004, the National Marrow Donor 
Program (NMDP) is expected to receive $17,350,000 from the U.S. 
Navy. Funds are used for donor medical costs, donor centers, 
tissue typing, research, minority recruitment, and program 
administration. The Committee recognizes the important life-
saving role of the Registry in the lives of thousands of 
Americans. The National Marrow Donor Program (NMDP), which 
operates the Registry through a contract with HRSA, anticipates 
facilitating its 20,000th transplant by November 2004. The 
Committee understands that the Registry lists three sources of 
blood forming non-embryonic stem cells used in transplantation: 
marrow and peripheral blood from adult donors, and umbilical 
cord blood units. The NMDP now lists 5,000,000 potential 
volunteer, adult donors of marrow and peripheral blood stem 
cells on the Registry. In addition, 16 of the 19 public cord 
banks are or have applied to become NMDP network members. The 
Committee urges the NMDP to continue innovative, technological, 
and scientific advances in non-embryonic cell therapies that 
have the potential to help some of the hundreds of thousands of 
Americans with leukemia or other life threatening blood 
diseases. The Committee also strongly encourages the NMDP to 
continue the enhancement of the Registry through its umbilical 
cord blood program. In addition, the Committee supports the 
NMDP's important role in conducting and supporting research to 
improve the availability, efficiency, safety, and cost of 
transplants and the effectiveness of Registry operations; 
maintaining and expanding its medical emergency contingency 
response capabilities for our nation's national security; and 
increasing donor and patient outreach programs, especially for 
minorities and medically underserved population groups.

Rural outreach grants

    The Committee provides $30,124,000 for rural outreach 
grants, which is $9,477,000 below the fiscal year 2004 
comparable level and $19,026,000 above the budget request. The 
program supports projects that provide health services to rural 
populations not currently receiving them and that enhance 
access to existing services.

Rural health research

    The Committee provides $8,902,000 for rural health 
research, which is the same as the fiscal year 2004 comparable 
level and the budget request. The activity supports several 
rural health research centers and the Secretary's rural health 
advisory committee as well as staffing for the Secretary's 
rural initiative.

Telehealth

    The Committee provides $3,949,000 for telehealth, which is 
the same as the fiscal year 2004 comparable level and the 
budget request. The telehealth program works with and supports 
communities in their efforts to develop cost-effective uses of 
telehealth technologies. These technologies bring health 
services to residents of the Nation who are isolated from 
health care, and health-related education to the practitioners 
who serve them.
    The Committee strongly supports HRSA's numerous rural 
telehealth initiatives and continues to encourage the agency to 
work in partnership with medical librarians, the National 
Library of Medicine, and other health information specialists 
in the development and implementation of its telehealth 
projects.

Rural hospital flexibility grants

    The Committee provides $32,500,000 for rural hospital 
flexibility grants, which is $6,999,000 below the fiscal year 
2004 comparable level and $32,500,000 above the budget request. 
The program is comprised of two parts: (1) flexibility grants 
to States to assist small, at risk rural hospitals that wish to 
convert to Critical Access Hospitals and receive cost-based 
payments from Medicare and (2) small hospital improvement 
grants that provide very modest amounts to hospitals to assist 
them in automation and compliance with confidentiality 
requirements. $25,000,000 is provided for the flexibility 
grants and $7,500,000 is provided for the small hospital 
improvement grants.

Rural and community access to emergency devices

    The Committee provides $5,000,000 for the public access 
defibrillation demonstration grant program, which is $5,933,000 
below the fiscal year 2004 comparable level and $2,985,000 
above the budget request. The program assists both urban and 
rural communities in increasing survivability from sudden 
cardiac arrest by providing funding for the purchase, 
placement, and training in the use of automated external 
defibrillators (AEDs). The Committee intends that $1,000,000 of 
this total should be allocated to the community program and 
$4,000,000 should be directed to the rural program.

Rural EMS

    The Committee does not provide funding for the new rural 
emergency training and equipment assistance program, which is 
$497,000 lower than the fiscal year 2004 comparable level and 
the same as the budget request. The Committee does not believe 
the program at its current level can provide adequate 
assistance nationwide and believes there are other emergency 
programs funded in the bill that can address some of these 
problems in rural areas.

State offices of rural health

    The Committee provides $8,390,000 for State offices of 
rural health, which is the same as the fiscal year 2004 
comparable level and the budget request. The State office of 
rural health program creates a focal point for rural health 
within each of the fifty States. In each State, the office 
collects and disseminates information on rural health, 
coordinates rural health resources and activities, provides 
technical assistance to rural providers and communities, and 
helps communities recruit and retain health professionals.

Denali Commission

    The Committee has not included funding for the Denali 
Commission, which is $34,793,000 below the fiscal year 2004 
comparable level and $22,000,000 below the budget request.

Emergency medical services for children

    The Committee provides $19,860,000 for emergency medical 
services for children, which is the same as the fiscal year 
2004 comparable level and the Administration request. The 
program supports grants for the delivery of emergency medical 
services to acutely ill and seriously injured children.

Poison control centers

    The Committee provides $23,696,000 for poison control 
centers, which is the same as the fiscal year 2004 comparable 
level and the Administration request. These funds support a 
grant program for poison control centers. In addition, funds 
are used to maintain a national toll-free number and implement 
a media campaign to advertise that number, as well as to 
support the development of uniform patient management 
guidelines and the improvement of data collection.

Traumatic brain injury

    The Committee provides $9,375,000 for the traumatic brain 
injury (TBI) program, which is the same as the fiscal year 2004 
comparable level and the budget request. The TBI program funds 
the development and implementation of statewide systems to 
ensure access to care including prehospital care, emergency 
department care, hospital care, rehabilitation, transitional 
services, and long-term community support. Grants also go to 
State protection and advocacy systems.

Black lung clinics

    The Committee provides $5,963,000 for black lung clinics, 
which is the same as the fiscal year 2004 comparable level and 
the budget request. The program supports fifteen grantees that 
treat a declining population of coal miners with respiratory 
and pulmonary impairments. The clinics presently receive more 
than one-third of their funding from other sources, such as 
Medicaid and Medicare. Of the fifteen grantees, seven actually 
receive health center funding as well as black lung grants.

Trauma care

    The Committee provides $3,449,000 for the trauma care 
program, which is the same as the fiscal year 2004 comparable 
level. The Administration did not request funds for this 
program. The program provides small grants to States to 
establish State offices to coordinate trauma systems within the 
States.

Payment to Hawaii for treatment of Hansen's disease

    The Committee provides $2,033,000 for the treatment of 
persons with Hansen's disease in the State of Hawaii, which is 
the same as the fiscal year 2004 comparable level and the 
Administration request. The program, which provides a partial 
matching payment to the State of Hawaii, dates to the period of 
Father Damien's facility for sufferers of Hansen's disease 
(leprosy). That facility now has only 43 residents who live 
there by choice, and the grounds have been converted to a 
historical site. Most patients diagnosed with Hansen's disease 
in Hawaii are now treated in the same manner as new patients on 
the mainland; their care is handled on an out-patient basis, 
with the program paying for about 300 active ambulatory 
Hansen's Disease cases.

Ryan White AIDS programs

    The Committee provides $2,074,861,000 for Ryan White AIDS 
programs, which is $35,000,000 above the fiscal year 2004 
comparable level and $20,000,000 above the budget request. The 
bill also makes available $25,000,000 in program evaluation 
funding under section 241 of the Public Health Service for 
special projects of national significance. The Committee's 
allocation among the various titles of the Ryan White program 
reflect the high priority the Committee places on providing 
resources for the AIDS drug assistance program. Within the 
total provided, the Committee expects 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 will 
be supported at no less than the fiscal year 2004 level.
    The Committee is aware that, for a number of eligible 
metropolitan areas, the amount of their supplemental grant 
under title I of the Ryan White CARE Act has fluctuated 
markedly from year to year, thereby disrupting ongoing programs 
and services. Accordingly, the Committee directs HRSA to review 
the processes it uses to evaluate applications and award 
supplemental grants and to take appropriate steps to reduce 
such fluctuations and disruptions.

Emergency assistance

    The Committee provides $615,023,000 for the Part A, 
emergency assistance program, which is the same as the fiscal 
year 2004 comparable level and the budget request. These funds 
provide grants to metropolitan areas with very high numbers of 
AIDS cases for outpatient and ambulatory health and social 
support services. Half of the amount appropriated is allocated 
by formula and half is allocated to eligible areas 
demonstrating additional need through a competitive grant 
process.

Comprehensive care programs

    The Committee provides $1,140,900,000 for Part B, 
comprehensive care programs, which is $35,000,000 above the 
fiscal year 2004 comparable level and $20,000,000 above the 
budget request. The funds provided support formula grants to 
States for the operation of HIV service delivery consortia in 
the localities most heavily affected, for the provision of home 
and community-based care, for continuation of health insurance 
coverage for infected persons, and for purchase of therapeutic 
drugs.
    The Committee has included bill language identifying 
$803,872,000 specifically to support State AIDS Drug Assistance 
Programs. In fiscal year 2004, $768,872,000 was designated for 
this purpose.

Early intervention program

    The Committee provides $197,170,000 for Part C, the early 
intervention program, which is the same as the fiscal year 2004 
comparable level and the budget request. Funds are used for 
discretionary grants to migrant and community health centers, 
health care for the homeless grantees, family planning 
grantees, hemophilia centers and other private non-profit 
entities that provide comprehensive primary care services to 
populations with or at risk for HIV disease. The grantees 
provide testing, risk reduction counseling, transmission 
prevention, and clinical care; case management, outreach, and 
eligibility assistance are optional services.

Pediatric HIV/AIDS

    The Committee provides $73,108,000 for Part D, pediatric 
AIDS demonstrations, which is the same as the fiscal year 2004 
comparable level and the budget request. The program supports 
demonstration grants to foster collaboration between clinical 
research institutions and primary community-based medical and 
social service providers for the target population of HIV-
infected children, pregnant women and their families. The 
projects are intended to increase access to comprehensive care, 
as well as voluntary participation in NIH and other clinical 
trials.

AIDS dental services

    The Committee provides $13,325,000 for AIDS dental 
services, which is the same as the fiscal year 2004 comparable 
level and the budget request. The program provides 
reimbursements to dental schools and postdoctoral dental 
education programs to assist with the cost of providing 
unreimbursed oral health care to patients with human 
immunodeficiency virus disease. Dental students and residents 
participating in this program receive extensive training in the 
understanding and management of the oral health care needs of 
people living with HIV/AIDS.

Education and training centers

    The Committee provides $35,335,000 for AIDS education and 
training centers (AETCs), which is the same as the fiscal year 
2004 comparable level and the budget request. The centers train 
health care personnel who care for AIDS patients and develop 
model education programs.

Family planning

    The Committee provides $278,283,000 for the family planning 
program, which is the same as the fiscal year 2004 comparable 
level and the budget request. The program provides grants to 
public and private non-profit agencies to support a range of 
family planning and reproductive services, as well as related 
preventive health services such as patient education and 
counseling, breast and cervical cancer examinations, STD and 
HIV prevention education, counseling and testing and referral, 
and pregnancy diagnosis and counseling. The program also 
supports training for providers, an information and education 
program, and a research program which focuses on family 
planning service delivery improvements. The Committee 
encourages HRSA to work with CDC to implement HIV/AIDS testing 
and counseling as a part of the services provided in family 
planning centers.
    The bill repeats language from the 2004 appropriations bill 
making clear that these funds shall not be expended for 
abortions, that all pregnancy counseling shall be nondirective, 
and that these funds shall not be used to promote public 
opposition to or support of any legislative proposal or 
candidate for public office.

Children's hospitals graduate medical education program

    The Committee provides $303,258,000 for the children's 
hospitals graduate medical education program, which is $88,000 
above the fiscal year 2004 comparable bill and the same as the 
budget request. The program provides a more adequate level of 
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 funding 
in this program is 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.

Health care facilities and other programs

    The Committee has not included funding for health care 
facilities. A total of $371,536,000 was provided for this 
purpose in fiscal year 2004; no funding was included in the 
budget request. This program provides funds to public and 
private nonprofit entities for construction or modernization of 
outpatient medical facilities.

Buildings and facilities

    The Committee provides $249,000 for buildings and 
facilities, which is the same as the fiscal year 2004 
comparable level and the budget request. These funds are used 
to finance the repair and upkeep of buildings at the Gillis W. 
Long Hansen's Disease Center at Carville, Louisiana.

Radiation exposure compensation act

    The Committee provides $1,974,000 for the radiation 
exposure compensation act, which is the same as the fiscal year 
2004 comparable level and the budget request. This program 
provides grants for the education, prevention and early 
detection of radiogenic cancers and diseases resulting from 
exposure to uranium during its mining and milling at nuclear 
test sites.

National practitioner data bank

    The Committee does not provide funding for the national 
practitioner data bank for fiscal year 2005, which is the same 
as both the fiscal year 2004 action on appropriations and the 
budget request. The Committee recommendation and the budget 
request assume that the data bank will be self-supporting, with 
collections of $15,700,000 in user fees. The national data bank 
receives, stores and disseminates information on paid medical 
malpractice judgments and settlements, sanctions taken by 
Boards of Medical Examiners, losses of membership in 
professional societies, and certain professional review actions 
taken by health care entities. Insurance companies, State 
licensure boards and authorities, and other health care 
entities and professional societies are required to report 
information to the data bank within 30 days of each action. The 
coverage of the data bank includes dentists and physicians, 
and, with respect to malpractice settlements and judgments, 
other categories of licensed health professionals. Hospitals 
are required to search the data bank when a health care 
provider applies for employment and once every two years 
thereafter. State licensing boards, other health care entities, 
licensing authorities, and professional societies also have 
access to the data bank. Traditional bill language is included 
to ensure that user fees are collected to cover the full costs 
of the data bank operations.

Health care integrity and protection data bank

    The Committee does not provide funding for the health care 
integrity and protection data bank (HIPDB) for fiscal year 
2005. The Committee recommendation and the budget request 
assume that the data bank will be self-supporting, with 
collections of $4,000,000 in user fees. HIPDB receives, stores, 
and disseminates information on final adverse actions taken 
against health care providers, suppliers, and practitioners. 
This information is collected from and made available to 
Government agencies and health plans. In addition, disclosure 
of the information is made available, upon request, to health 
care providers, suppliers, and practitioners who wish to self-
query.

Community access program

    The Committee does not provide funding for the community 
access program, which is $83,674,000 below the fiscal year 2004 
comparable level and $9,998,000 below the Administration 
request. The program is designed to increase the capacity and 
effectiveness of the variety of community health care 
institutions and providers who serve patients regardless of 
their ability to pay through development of community 
consortia.

State planning grants for health care

    The Committee provides $14,810,000 for state planning 
grants, which is the same as the fiscal year 2004 comparable 
level. The Administration did not request funding for this 
program. The program makes grants to states to gather and 
analyze information on problems of access to health insurance 
within the state and develop plans for providing access to 
affordable health insurance coverage to all their residents.
    The Committee intends that, as in fiscal year 2004, these 
funds will be used for contination grants to assist states in 
completing or expanding their research and planning activities, 
and for grants to support the design and planning for pilot 
projects to expand health insurance coverage to a significant 
uninsured population within the state, as well as for initial 
grants to any states that have not yet received funding and 
wish to participate.

Program management

    The Committee provides $151,317,000 for the cost of Federal 
staff and related activities to coordinate, direct and manage 
the programs of the Health Resources and Services 
Administration, which is $2,784,000 above the comparable 2004 
action and the same as the budget request. The Committee 
includes funding for new HRSA activities proposed by the 
Administration.
    The Committee requested a report last year from HRSA 
detailing HRSA's response to a January 2002 report submitted by 
HRSA regional dental consultants. That report identified the 
decline in oral health leadership and personnel. The report 
requested by the Committee was due by February 1, 2004. The 
Committee is very disappointed that it has not received this 
report. The Committee has received testimony from various 
organizations concerned about the lack of access to dental 
care, the increase in oral disease among vulnerable populations 
and the decrease in state dental programs. The Committee 
expects HRSA to submit this report without further delay.

               Medical Facilities Guarantee and Loan Fund


           FEDERAL INTEREST SUBSIDIES FOR MEDICAL FACILITIES

    The Committee does not provide funding for the Medical 
Facilities Guarantee and Loan Fund, which is the same as the 
budget request. Appropriations are used to pay interest 
subsidies on loans made or guaranteed prior to fiscal year 1977 
for hospital construction. 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 PROGRAM

    The Health Education Assistance Loans (HEAL) program 
insured loans provided by non-Federal lenders to students in 
health professions schools. Under the accounting rules 
established in the Budget Enforcement Act of 1990, one account 
is maintained to pay the obligations arising from loans 
guaranteed prior to fiscal year 1992. A second account pays 
obligations and collects income from premiums on loans 
guaranteed in fiscal year 1992 and beyond. Each annual cohort 
of loans is independently tracked in this account. The 
authority for this program expired in fiscal year 1999. Fiscal 
year 1998 was the last year in which loans were obligated to 
previous borrowers under the HEAL authority.
    The Committee provides $4,000,000 to liquidate obligations 
from loans guaranteed prior to 1992, which is $21,000,000 below 
the fiscal year 2004 level and the same as the budget request.
    The Committee provides $3,270,000 for HEAL program 
management, which is $83,000 below the fiscal year 2004 
comparable level and the same as the budget request.

              NATIONAL VACCINE INJURY COMPENSATION PROGRAM

    The Committee makes available the release of $66,000,000 
from the Vaccine Injury Compensation Trust Fund in fiscal year 
2004, which is the same as the fiscal year 2004 level and the 
budget request.
    The National Vaccine Injury Compensation Program provides a 
system of compensation for individuals with vaccine-associated 
injuries or deaths. Funds for claims from vaccines administered 
on or after October 1, 1988 are generated by a per-dose excise 
tax on the sale of selected prescribed vaccines. Revenues 
raised by this tax are maintained in a Vaccine Injury 
Compensation Trust Fund.
    Trust funds made available in the bill will support the 
liability costs of vaccines administered after September 30, 
1988. They will also support the $3,176,000 in costs incurred 
by the agency in the operation of the program, which is $14,000 
below fiscal year 2004 level and the same as the budget 
request.

                      Centers for Disease Control


                 DISEASE CONTROL, RESEARCH AND TRAINING

    The Committee provides a program level of $4,477,878 for 
the Centers for Disease Control and Prevention (CDC), which is 
$101,421,000 below the fiscal year 2004 comparable level and 
$15,224,000 above the request. Of the funds provided, 
$249,100,000 shall be derived from evaluation set-aside funds 
available under Section 241 of the Public Health Service Act, 
as proposed in the request.
    The CDC assists State and local health authorities and 
other health-related organizations to control and reduce 
disease and other health problems. The activities of CDC focus 
on several major priorities, including providing core public 
health functions, responding to urgent health threats, 
monitoring the Nation's health using scientific methods, 
building the Nation's health infrastructure to insure our 
national security against bioterrorist threats, promoting 
women's health, and providing leadership in the implementation 
of nationwide prevention strategies to encourage responsible 
behavior and adoption of lifestyles that are conducive to good 
health.
    The Committee considers the table accompanying this report 
to be determinative of the CDC budget. Funds should be 
apportioned and allocated consistent with the table, and any 
changes in funding are subject to the normal reprogramming and 
notification procedures.

Birth defects, developmental disabilities, disability and health

    The Committee provides $119,214,000 for birth defects, 
developmental disabilities, disability and health, which is 
$6,471,000 above the fiscal year 2004 comparable level and 
$6,242,000 above the request. This program collects, analyzes, 
and makes available data on the incidence and causes of birth 
defects and developmental disabilities.
    Within the total provided, $2,054,000 above the fiscal year 
2004 comparable level is to expand autism and developmental 
disabilities activities.
    Within the total provided, $1,500,000 above the fiscal year 
2004 comparable level is to expand surveillance, 
epidemiological and education efforts of Duchenne and Becker 
muscular dystrophy in the United States.
    Within the total provided, $907,000 above the fiscal year 
2004 comparable level is to support activities related to the 
National Spina Bifida Program.
    Within the total provided, not less than $1,000,000 is for 
studies involving Down Syndrome.
    Within the total provided, $2,000,000 is to continue and 
expand the public health education initiative related to 
Tourette Syndrome.
    Within the total provided, $500,000 above the fiscal year 
2004 comparable level is to enhance the national campaign to 
increase the number of women taking folic acid daily.
    Attention Deficit/Hyperactivity Disorder (AD/HD).--The 
Committee continues to support the National Resource Center on 
AD/HD and has provided sufficient funds to continue 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 is aware of the progress that has 
been made with the autism programs at the CDC. The Committee 
acknowledges the importance of this work in the area of autism 
surveillance and research and urges it to continue in a timely 
manner. Within the funds provided, $15,300,000 is for the 
autism epidemiology program, including the CADDRE and ADDM 
Network, and $2,700,000 is to build upon last year's launch of 
the Autism Awareness and Education Campaign.
    Diamond Blackfan Anemia.--The Committee encourages the CDC 
to establish a public health outreach and surveillance program 
for Diamond Blackfan Anemia as authorized under Title III of 
the Public Health Services Act.
    Down Syndrome.--The Committee understands that in FY2004 
the CDC initiated planning for two epidemiological studies on 
Down syndrome. The first study will obtain an accurate estimate 
of the number of people in the United States living with the 
disorder and identify them by age and ethnic group. The second 
study will document the onset and course of secondary and 
related developmental and mental disorders in individuals with 
Down syndrome. The Committee has included $1,000,000 above the 
request to initiate these studies in FY2005.
    Duchenne and Becker Muscular Dystrophy.--The Committee is 
concerned with the pace of the development of the CDC Birth 
Defects Surveillance program covering the muscular dystrophies 
and is aware that the agency has made the commitment to enhance 
the internal staff commitment to the program. The Committee is 
encouraged by that new commitment and expects that CDC dedicate 
its efforts to organize, coordinate and implement the agency's 
Duchenne MD surveillance program. In addition, within the 
$1,500,000 increase provided for fiscal year 2005, the 
Committee has provided $500,000 to initiate a coordinated 
education and outreach initiative through the Parent Project 
Muscular Dystrophy.
    Folic Acid.--The Committee is pleased to learn that severe 
brain and spinal defects have dropped 27 percent in the U.S. 
since certain food producers have been required to fortify 
their foods with folic acid. The Committee encourages CDC to 
work with producers of suitable ethnic foods, such as 
tortillas, so ethnic populations may also benefit from folic 
acid fortification.
    Fragile X.--The Committee supports the CDC's focus on 
maximizing prevention potential, minimizing impact on families 
and promoting early intervention through developmental 
screening and encourages CDC to incorporate individuals 
affected by fragile X. In addition, the Committee encourages 
the CDC to consider developing 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 syndrome and other developmental disabilities.
    Hemophilia.--The Committee urges CDC to continue working 
closely with voluntary health organizations, such as the 
National Hemophilia Foundation, concerned about carrying out 
disease management, prevention, outreach, and blood safety 
surveillance programs for persons with bleeding and clotting 
disorders. The Committee encourages the CDC to maintain its 
support for surveillance of the bleeding disorders community to 
address concerns about inhibitor development and prevention 
within this population.
    Early Hearing Detection and Intervention.--The Committee 
continues to support the work of the CDC related to the early 
detection of hearing loss in infants. The recommendation 
provides $7,361,000 to maintain support for the program and its 
activities in FY2005.
    Limb Loss Information Center.--The Committee recognizes 
that one of the greatest challenges facing individuals with 
limb loss is access to necessary health and rehabilitative 
services. The Committee urges CDC to work with the Amputee 
Coalition of America (ACA) to identify strategies to remove 
these barriers. The Committee applauds the partnerships 
developed between the ACA and the CDC, Walter Reed, and Johns 
Hopkins University to advance the quality of life through 
research and support programs for people living with limb loss. 
The Committee continues to support the CDC's resource and 
information center which assists individuals living with 
disabilities, and their families, in need of information on 
medical, physical, and emotional needs, and resources and 
support to reintegrate socially and economically into society.
    Spina Bifida.--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. 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, $907,000 
is provided above FY2004 for the CDC's National Spina Bifida 
Program. The Committee continues to support the partnership 
between CDC and the Spina Bifida Association of America (SBAA) 
and urges the CDC to establish a National Spina Bifida 
Clearinghouse and Resource Center at the SBAA to meet the 
current and growing demand for information and support services 
for individuals and families affected by Spina Bifida.
    Tourette Syndrome.--The Committee commends CDC for its 
partnership with the national Tourette Syndrome Association in 
developing a public health education and research program and 
has provided $2,000,000 in FY2005 to continue to educate 
parents, physicians, educators and other health care workers 
about the disorder and to expand on the scientific knowledge 
base on prevalence, risk factors and co-morbidities of Tourette 
Syndrome. The Committee intends that these resources be used to 
support the partnership between the TSA and CDC
    Vision Loss.--The Committee encourages the Director to 
consider the creation of a National Information Center on 
Vision Loss to address the need for appropriate public health 
information to prevent further impairment and disability among 
individuals who are blind or who have low vision. The Committee 
further encourages CDC to partner with a national non-profit 
organization that is recognized for leadership in providing 
information to persons who are blind or visually impaired, 
including published resource guides, directories of services 
for consumers in the field, scholarly journals on blindness and 
vision loss, assistive technology magazines, and talking books. 
Particular attention should be paid to entities that have 
successfully implemented interactive and accessible information 
resources or comprehensive libraries for persons who are blind 
or visually impaired.

Chronic disease prevention and health promotion

    The Committee provides $915,711,000 for chronic disease 
prevention and health promotion, which is $62,333,000 above the 
fiscal year 2004 comparable level and $286,000 and above the 
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, obesity and 
various neurological conditions such as epilepsy. Complications 
from these conditions include vision loss, kidney disease, limb 
loss, oral disease and paralysis.
    The National Center for Chronic Disease Prevention and 
Health Promotion at CDC implements research and programs to 
prevent the leading causes of death and disability (e.g., heart 
disease and stroke, cancer, diabetes, and arthritis) which are 
among the most prevalent, costly, and preventable of all health 
problems. CDC plays a leadership role in coordinating and 
catalyzing the efforts of numerous public and private partners, 
which allows CDC to substantially extend its effectiveness in 
reaching people at highest risk for chronic disease. The 
Committee recognizes the essential infrastructure that CDC has 
built in state health departments and encourages CDC to expand 
its state-based leadership in surveillance, public health 
education, communications and model programs and research.
    Within the total provided, the Committee has included the 
following amounts above the fiscal year 2004 comparable level:

Heart Disease and Stroke................................      $3,000,000
Diabetes................................................       4,000,000
Cancer Prevention and Control...........................      13,000,000
Arthritis and Other Chronic Diseases....................       1,300,000
Glaucoma/Visual Screening Education.....................         170,000
Childhood Obesity Prevention--Verb Campaign.............      29,238,000
Steps to a Healthier U.S................................      12,000,000
Oral Health.............................................       1,000,000
Safe Motherhood/Infant Health...........................         413,000

    Alzheimer's disease.--The Committee encourages the CDC to 
work with the NIH to further research and investigate links 
between a healthy lifestyle and the prevention of Alzheimer's 
disease in an effort to develop an Alzheimer's specific segment 
of the Healthy Aging Program. The ultimate goal of the 
Alzheimer's Program would be to aggressively educate the public 
and health professionals as to research-based ways to reduce 
the risks of developing Alzheimer's by maintaining a healthy 
lifestyle.
    Arthritis.--The National Arthritis Action Plan (NAAP) 
supports programs to improve the quality of life of persons 
affected by arthritis and to improve the availability of 
information and self-management programs nationwide for 
Americans affected by the disease. The Committee recommendation 
includes $15,564,000 to support and expand CDC arthritis 
program activities, an increase of $800,000 over FY2004.
    Breast and Cervical Cancer Screening.--Given the high 
vacancy rates of qualified laboratory personnel who prepare and 
interpret tissue and cell samples, the Committee encourages CDC 
to consider expanding its education component and develop a 
partnership with HRSA's Allied Health and Special Projects 
program. The Committee provides an increase of $10,000,000 for 
the National Breast and Cervical Cancer Early Detection 
Program.
    Childhood and Adolescent Obesity.--The Committee recognizes 
that childhood and adolescent obesity is a serious and growing 
health concern. It is linked to the recent rise in Type 2 
diabetes and exposes them to greater risk for 42 diseases as an 
adult, including coronary heart disease and some cancers. The 
Committee urges the CDC to undertake an epidemiological study 
of the long-term impact of childhood and adolescent obesity. 
The Committee also encourages the CDC to fund school and 
community pilot programs that will increase nutritional 
awareness and that emphasize the importance of limiting non-
nutritive carbohydrates.
    Colorectal Cancer.--The Committee is very pleased with the 
leadership of CDC's National Colorectal Cancer Roundtable in 
promoting the availability and advisability of screening to 
both health care providers and the general public. The 
Committee encourages the CDC to continue to expand its 
partnerships with state health departments, professional and 
patient organizations, and private industry to combat this 
devastating disease.
    Diabetes.--The Committee applauds CDC for its new 
cooperative agreement with the American Association of Diabetes 
Educators (AADE), 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 AADE 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.
    The Committee commends the CDC for its efforts to develop a 
standardization program to improve the measurement of portable 
blood glucose monitoring systems. The accuracy of these devices 
is crucial for assisting diabetic individuals to avoid acute 
episodes of dangerously low blood glucose levels and to reduce 
the risk of debilitating, long-term complications.
    Epilepsy.--The Committee acknowledges and applauds CDC's 
partnership with the Epilepsy Foundation in developing a 
strategic vision for epilepsy programs in Living Well With 
Epilepsy II. Funding has been provided to enhance CDC's 
epilepsy efforts in partnership with a leading non-profit and 
to begin to implement the recommendations from Living Well With 
Epilepsy II. The Committee recommendation includes $8,674,000 
for epilepsy activities, an increase of $500,000 over FY2004.
    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 recommendation includes 
funds above FY2004 for 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.
    Inflammatory Bowel Disease.--For the past five years, the 
Committee has encouraged CDC to work in partnership with the 
IBD community to establish a national IBD epidemiology program 
to further our understanding of these diseases. The Committee 
understands that the Crohn's and Colitis Foundation of America 
has provided financial support through the CDC Foundation to 
initiate this important program. Now that the project is 
established, the Committee encourages CDC to contribute to the 
project in order to expand the work in FY2005.
    Interstitial Cystitis.--The Committee is pleased that the 
CDC has been working closely with the interstitial cystitis 
(IC) patient community to develop a program to expand both the 
public's and professional community's understanding of IC. The 
Committee encourages the CDC to formalize its partnership with 
a national non-profit voluntary health association dedicated to 
assisting persons with IC. This would allow the CDC to develop 
a long term, sustainable awareness campaign that has a 
measurable impact on patients, physicians, researchers and the 
general public.
    Lung Cancer.--The Committee encourages the CDC through its 
Cancer Registries program and in coordination with the 
Comprehensive Cancer Control program to conduct a study, or 
studies, that would examine: the current trends of lung cancer 
screening and evaluate the number of people currently getting 
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; trends in the number of 
biopsies being performed following screening exams; and trends 
in the stage of lung cancer diagnosis.
    Lupus.--The Committee recommendation includes $993,000 
within Arthritis and Other Chronic Diseases to continue support 
for the National Lupus Patient Registry.
    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 
$13,428,000 to allow the States to target their capacities to 
assess the prevalence of oral diseases, to target 
interventions, like additional water fluoridation and school-
linked sealant programs, and resources to the underserved, and 
to evaluate changes in policies, programs and disease burden. 
The Committee also expects the Division to advance efforts to 
reduce the disparities and the health burden from oral cancers 
and oral diseases that are closely linked to chronic diseases 
like diabetes and heart disease.
    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. 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.
    Prevention of Preterm Birth.--The Committee encourages the 
CDC to expand research on the causes of preterm birth, the 
prevention of preterm delivery for women at risk and the social 
and environmental factors exacerbating higher rates of preterm 
delivery in African-American women.
    School Health.--The Committee urges the Centers for Disease 
Control and Prevention to prioritize abstinence education among 
adolescents served through the Divisions of Adolescent School 
Health. Abstinence Education is consistent with the strategic 
direction of CDC in providing greater holistic health 
protection for young people and should be prioritized in 
activities funded through grants, cooperative agreements and 
other partnerships with DASH.
    The Committee encourages the continued support of center 
activities aimed at improving the health and well being of 
adolescents. The Committee has learned of concerns that CDC 
decided not to continue funding the State Adolescent Health 
Coordinators Network (SAHCN) Annual Meeting. This meeting 
provides a focus on the unique needs and assets of the 
adolescent population, bringing together specific expertise on 
the health issues that face adolescents and on the special 
programmatic considerations for this population. The Committee 
urges CDC to consider renewing its support of this activity to 
promote adolescent health, providing that the meeting 
organizers provide the necessary assurances to be eligible for 
federal funding.
    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 encourages CDC to work with other 
agencies, such as the National Center on Sleep Disorders 
Research (NIH), and voluntary health organizations, such as the 
National Sleep Foundation, to support the development of a 
sleep education and public awareness initiative.
    Steps for a Healthier U.S.--The Committee commends CDC for 
its work on the Steps program, including its partnerships with 
national organizations, such as the YMCA, aimed at coordinating 
and delivering program models to additional communities across 
America, including rural and disadvantaged communities. In 
order to expand the reach and impact of the STEPS program, the 
Committee urges the CDC to continue and increase funding for 
these national partnerships. The Committee provides an increase 
of $12,000,000 to expand the Steps program in FY2005.
    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.
    VERB.--The Committee recommendation includes $65,000,000 
for the Childhood Obesity Prevention Program, known as VERB. 
The Committee understands that evaluation results from the 
first year of funding for VERB demonstrate that the campaign 
has directly resulted in improved physical activity among the 
targeted age group, 9-to-13 year-olds. Funds will be used to 
support the fourth year of this national campaign, including 
updating the campaign's creative positioning and messages as 
well as marketing strategies and tactics in order to keep up 
with the rapidly changing target audience. Funds also will be 
used to continue a rigorous evaluation of the campaign's 
effectiveness.
    Vision Screening and Education.--The Committee 
recommendation includes $3,000,000 to enhance the national 
vision screening and education program, and commends CDC for 
its partnership with Prevent Blindness America, a national 
voluntary health agency, in building a public health action 
plan for vision health. The Committee intends that CDC dedicate 
at least half of the funds provided to further expand this 
partnership through the existing cooperative agreement to 
jointly further develop public, patient and professional 
education, community programs, research and the necessary 
infrastructure to deliver vision screening and education.

Environmental health

    The Committee provides $186,113,000 for environmental 
health, which is $2,901,000 above the fiscal year 2004 
comparable level and $2,318,000 above the request.
    Within the total provided, the Committee provides the 
following amounts above the FY2004 comparable level:




Environmental Health Laboratory.......................        $2,000,000
Asthma................................................           901,000


    Alpha-1 Antitrypsin Deficiency.--The Committee is aware 
that Alpha-1 Antitrypsin Deficiency is a genetic disorder that 
can result in devastating and fatal lung and/or liver disease. 
Early detection allows individuals to engage in preventative 
health measures and receive appropriate therapies that 
significantly improve their health status. The Committee 
encourages CDC to consider supporting an Alpha-1 screening and 
detection program that utilizes public and professional 
education regarding lung disease, both genetic and tobacco 
related.
    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, such 
as the American Lung Association 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.
    Further, 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.
    Biomonitoring.--Limited information exists about chemical 
exposures in humans and how these chemicals affect people's 
health. Without this information, public health officials 
cannot effectively identify and prevent diseases that result 
from chemical exposures. With prior CDC funding, 36 state 
public health labs developed plans for increasing biomonitoring 
capacity--the testing of body fluids, hair and skin for 
chemical exposure. In 2004, CDC reports providing support for 
the implementation of those plans for three grantees. The 
Committee has provided $770,000 above the FY2004 level to 
enhance public health laboratory biomonitoring capacity and to 
provide adequate technical assistance and training to states in 
assessing exposure to chemicals.
    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.
    Lead poisoning among Hispanic children in the nation is a 
significant problem. Oklahoma and Texas have a unique outreach 
program to the Hispanic community to help identify at-risk 
children and educate their parents about the source of the lead 
poisoning. The CDC is encouraged to work with the State Public 
Health Departments in Oklahoma and Texas to further develop 
this pilot program.
    Environmental Health Laboratory.--The Committee recognizes 
the extraordinary services of CDC's Environmental Health 
Laboratory, and has provided an additional $2,000,000 above 
FY2004 to expand its work in preventing disease from toxic 
exposures, assessment of exposure to priority toxic chemicals, 
including mercury and arsenic, and to provide expanded and more 
effective laboratory response to toxic emergencies.
    Human Exposure to Environmental Chemicals.--The CDC's 
National Report on Human Exposure to Environmental Chemicals is 
a significant new exposure tool that provides invaluable 
information for setting research priorities and for tracking 
trends in human exposures over time. The Committee continues to 
support the CDC environmental health laboratories efforts to 
provide exposure information about environmental chemicals. 
However, as CDC has recognized, this information does not by 
itself provide information on causes for effects in humans and 
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.
    Primary Immunodeficiency Diseases.--In each of last three 
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 Committee 
understands that the Foundation has leveraged more than seven 
dollars from donors and the media for every federal dollar 
appropriated and is a model of public-private cooperation. The 
Committee encourages the CDC to expand the reach of the 
Foundation's campaign to underserved communities, including 
African-American and Hispanic populations, and has provided 
sufficient funding to reach that critical goal. The Committee 
also encourages CDC to expand its programmatic activity on 
primary immune deficiency diseases to include pilot programs 
focused on newborn screening and school wellness.
    Severe Combined Immune Deficiency.--The Committee 
understands that scientists working in the intramural program 
at the NHGRI have developed the technology to screen newborns 
for severe combined immune deficiency disease (SCID) or ``the 
bubble boy disease.'' The Committee commends the CDC for the 
work begun on the development of a newborn screening program 
for SCID. Further, the Committee encourages the CDC to complete 
the development of the program and work in collaboration with 
relevant voluntary health organizations in developing a 
treatment protocol for any newborns that test positive for 
SCID.

Epidemic services and response

    The Committee provides $91,776,000 for epidemic services 
and response, which is the same as the fiscal year 2004 
comparable level and $709,000 below the request.
    The objectives of the program include the prevention and 
control of epidemics, the maintenance of surveillance systems, 
the training of public health epidemiologists, and the 
operation of the quarantine program. The program supports the 
Epidemic Intelligence Service program, the publication of the 
Morbidity and Mortality Weekly Report, and a variety of infant 
and minority health programs.
    Landmine Survivor Network.--The Committee commends CDC for 
its partnership with the Landmine Survivor Network that has 
developed peer support networks for landmine survivors in six 
mine-affected countries around the world. The Committee 
recommendation assumes continued support for the Network at not 
less than the fiscal year 2004 level.

Health statistics

    The Committee provides a total of $149,600,000 for health 
statistics, which is $21,966,000 above the fiscal year 2004 
comparable level and the same as the request. All funds 
provided shall be derived from section 241 evaluation set-aside 
funds, as proposed in the request.
    The Health Statistics program is responsible for 
collecting, interpreting, and disseminating data on the health 
status of the U.S. population and the use of health services. 
Surveys include the National Vital Statistics System, the 
National Health Interview Survey, the National Survey of Family 
Growth, the National Health and Nutrition Examination Survey, 
and the National Health Care Survey.
    The Committee supports the efforts to strengthen health 
statistics programs. The Committee is aware that the data 
systems of the National Center for Health Statistics require 
additional investment in order to sustain ongoing operations as 
well as to make needed improvements in content and technology. 
The Committee recognizes that the data provided by the Center 
are important to the ability of the Congress to set health 
priorities, evaluate funding requests, and provide oversight to 
the performance of Federal health agencies. They are equally 
important to the day to day planning and management of health 
programs of CDC and to the biomedical research conducted by 
NIH. The Committee commends Secretary and Director for the 
increased request and encourages each to ensure that continued 
support of these data systems is provided and to make needed 
improvements in content and technology.

HIV/AIDS, STD and TB prevention

    The Committee provides $1,149,330,000 for HIV/AIDS, STD and 
TB prevention, which is $7,669,000 above the fiscal year 2004 
comparable level and $6,031,000 above the request. Of the 
amount provided, $837,725,000 is for the HIV/AIDS programs, of 
which $142,808,000 is for global HIV/AIDS programs; 
$172,935,000 is for the STD program; and $138,670,000 is for 
the TB program.
    The HIV/AIDS programs support HIV research, surveillance, 
epidemiologic and laboratory studies, and prevention 
activities. CDC provides funds to state and local health 
departments to develop and implement integrated community 
prevention plans. The STD program awards grants to state and 
local health departments and other nonprofit entities to 
support a wide variety of public health activities to prevent 
and treat STDs. CDC directly conducts special investigations, 
surveillance and epidemiologic research. The tuberculosis 
program provides grants to States and large cities for a broad 
range of tuberculosis control activities. In addition, the CDC 
supports state and local laboratories and conducts research, 
epidemiological investigations, and education and training 
seminars.
    Domestic HIV/AIDS Prevention.--The Committee applauds CDC's 
steps to emphasize HIV testing to identify infected persons who 
are not aware of their own infection and to get them into 
treatment and prevention services. The Committee encourages the 
CDC to work specifically with federal programs providing 
reproductive health services to women to implement HIV/AIDS 
testing and counseling as a part of the Advancing HIV 
Prevention Initiative.
    The Committee is concerned, however, that while support for 
HIV/AIDS has increased over the past decade, CDC estimates that 
there has been no decline in the incidence of HIV, leading to 
concerns about the effectiveness of these programs. The 
Committee is pleased that the Director has acknowledged the 
need for greater accountability and the establishment of 
methods of measuring the effectiveness of the programs that 
receive CDC funding.
    The Committee requests that the CDC prepare and submit a 
report to the Committee by June 1, 2005 outlining the steps CDC 
has taken, or plans to take, to ensure that the programs 
receiving CDC support are effective in preventing the spread of 
HIV. The Committee requests that the report: (1) demonstrate 
how the CDC will ensure that HIV-prevention program evaluations 
include verifiable data to demonstrate how the funded projects 
will prevent or reduce risk behaviors and disease transmission; 
(2) describe how the CDC will evaluate the impact of both the 
actual program and its advertising and promotion in eliminating 
risk taking behaviors; (3) describe how such programs will be 
evaluated in a scientifically sound method to ensure that these 
programs reduce the transmission rates for sexually transmitted 
disease (STDs) including HIV/AIDS; (4) describe how the CDC 
will collect and evaluate data to demonstrate that each funded 
program will lower HIV and STD rates; and (5) describe how the 
CDC will make available to the public, information on which 
program and approaches have demonstrated success or failure in 
preventing the spread of HIV and STDs.
    Mother and Child HIV/AIDS Prevention.--The Committee 
recommendation does not include funds for the Mother and Child 
HIV/AIDS prevention initiative. Funding for this initiative was 
requested within the Global AIDS Coordinator's Office at the 
Department of State.
    Minority HIV/AIDS Initiative.--Within the total provided, 
the Committee expects the CDC to allocate not less than the 
fiscal year 2004 level for activities that are targeted to 
address the growing HIV/AIDS epidemic and its disparate impact 
on communities of color, including African Americans, Latinos, 
Native Americans, Asian Americans, Native Hawaiians, and 
Pacific Islanders. The Committee expects CDC to follow the 
fiscal year 2002 report accompanying this bill regarding the 
disbursement of these funds.
    Infertility Prevention Program.--The Committee provides an 
increase of $5,000,000 above the FY2004 comparable level to 
expand the infertility prevention activities for uninsured and 
underinsured women. The Committee understands that in six 
regions, which represent the most highly populated areas, 
screening activities reach only 36 percent of women in need.
    Tuberculosis.--The Committee provides $138,670,000 for 
Tuberculosis (TB) prevention and control, $2,465,000 above the 
fiscal year 2004 comparable level and $2,269,000 above the 
request.
    The Committee is pleased with the efforts of the TB control 
program, which has reduced the number of new TB cases for the 
past ten years but is concerned with the number of new TB cases 
in foreign-born individuals in the U.S. The Committee urges CDC 
to work with the U.S. Citizenship and Immigration Services 
(USCIS) to develop novel TB screening strategies for 
individuals emigrating from high TB incidence countries. The 
Committee also encourages CDC to consider implementing 
screening programs for high-risk individuals residing in the 
U.S. for latent TB.
    The Committee also recognizes that despite 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 TB, TB 
continues to be a worldwide pandemic. The Committee is aware of 
modeling studies showing that a modestly effective vaccine 
(50%-70% 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 
urges the CDC to continue its support for the TB vaccine 
research cooperative agreement in partnership with the leading 
private foundation conducting clinical field site trial work on 
TB vaccines. The Committee expects CDC will provide leadership 
and technical assistance on field site development and 
surveillance.
    The Committee understands that State of Oklahoma has a 
unique program, based upon a program that was successful in 
Florida, of outreach through the Catholic Church community to 
undocumented workers to better prevent and control TB among 
foreign-born individuals. CDC is encouraged to work with the 
State of Oklahoma, and other states wishing to participate, to 
support these model programs aimed at preventing and 
controlling TB in the population. The CDC is also encouraged to 
work with the country of Mexico to help them eradicate this 
problem within their own country.

Immunization

    The Committee provides a program level of $654,070,000 for 
immunization, which is $10,726,000 over the fiscal year 2004 
comparable level and $10,000,000 above the request. Of the 
amount provided, $14,000,000 is to be derived from section 241 
evaluation set-aside funds, as proposed in the request. In 
addition, the Vaccines for Children (VFC) program is expected 
to provide $1,208,000,000 in vaccine purchases and distribution 
support in fiscal year 2005.
    Immunization project grants are awarded to States and local 
agencies for planning, developing, and conducting childhood 
immunization programs including enhancement of the vaccine 
delivery infrastructure. CDC directly maintains a stockpile of 
vaccines, supports consolidated purchase of vaccines for state 
and local health agencies, and conducts surveillance, 
investigations, and research into the safety and efficacy of 
new and presently used vaccines. The Committee notes that there 
are other Federal programs that provide immunizations to 
children, including the State Children's Health Insurance 
Program (SCHIP), the Maternal and Child Health Block Grant, and 
community health centers.
    Meningococcal disease.--The Committee is aware of recent 
CDC efforts to consider increasing information on meningococcal 
disease and ways to prevent it so that the general public will 
be better educated on the symptoms and prevention methods. The 
Committee recommends that CDC work to improve education and 
immunization programs and encourages the CDC to partner with 
the National Meningitis Association to ensure that all 
families, especially those with adolescents and young adults, 
are effectively educated on this disease, vaccine availability, 
and all methods of prevention.
    Vaccine Safety Datalink Sharing Program.--The Committee is 
aware of sensitivities about research involving the safety of 
childhood vaccines. CDC's Vaccine Safety Datalink Data Sharing 
Program allows external researchers to assess vaccine safety by 
analyzing data from managed care organizations. The Committee 
believes that it is essential that these data be available in a 
way that allows for independent review while at the same time 
protect confidentiality and comply with regulations for the 
protection of human subjects involved in research. The 
Committee urges the CDC to assure access to these data. The 
Committee is concerned that some of the restrictions placed on 
outside researchers preclude independent researcher from being 
able to independently validate internal research conducted by 
the CDC's VSD project team. The Committee urges the CDC to 
reexamine the restrictions placed on external researchers so 
that these researchers may be able to validate the internal 
researcher's findings. The Committee recognizes that validating 
research findings requires that external researchers also have 
access to original datasets, not simply final datasets, and it 
directs that the CDC make such datasets available to external 
researchers in such a way as to assure compliance with the 
privacy protections set forth in Title 45, Part 46, Code of 
Federal Regulations.

Infectious diseases control

    The Committee provides $398,439,000 for infectious diseases 
control, which is $28,954,000 above the fiscal year 2004 
comparable level and $2,340,000 below the request.
    The program supports national surveillance of infectious 
diseases, the development of new or improved prevention and 
control methods and techniques, the acceleration of the general 
application of accepted prevention technologies, and 
strengthening of the capability to respond to outbreaks of new 
and re-emerging infectious diseases.
    Within the total provided, not less than $4,000,000 above 
the fiscal year 2004 comparable level is to continue planned 
activities and expand efforts to prevent and control the West 
Nile virus.
    Antimicrobial Resistance.--The Committee encourages the CDC 
to expand support for training and education of medical and 
public health personnel related to antimicrobial resistance and 
public health emergencies, including training laboratory 
personnel in the recognition of resistance in pathogens.
    Chronic Fatigue Syndrome.--The Committee is pleased that 
CDC is restoring funds for CFS research and that these funds 
are being used in substantive areas. The Committee encourages 
CDC to continue the establishment of a national registry to 
examine such things as: studies of etiologic agents, diagnostic 
markers, natural history, and risk factors using specialized 
molecular epidemiology techniques and advanced surveillance 
methodologies.
    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. As 
the program moves forward and one time costs are met, the 
Committee expects CDC to direct an increasing amount of the 
funds available to active patient recruitment, education and 
awareness, and related services.
    Global Disease Detection.--The Committee commends the CDC 
for moving rapidly to improve the capacity for disease 
detection and outbreak response. The Committee believes that 
the CDC's work in expanding both domestic and international 
surveillance and response capabilities were critical factors in 
mitigating adverse health effects in this country and abroad 
from outbreaks, such as SARS and Monkeypox. The Committee 
recommendation provides an increase of $24,895,000 to further 
enhance CDC's global disease detection capacity as proposed in 
the request.
    Hepatitis.--The Committee encourages CDC fully implement 
the National Hepatitis C Prevention Strategy. This prevention 
strategy includes enhancing state and local health department 
and community-based organizations' efforts to provide 
counseling, testing, partner notification, health education and 
medical referral to persons at risk of or infected with 
hepatitis C, and to enable state health departments to 
establish surveillance systems to monitor the burden of 
disease. While most States have designated a state Hepatitis C 
Coordinator, the Committee is concerned that coordinators are 
still lacking in 6 states. CDC is urged to work with these 
States to ensure the availability of hepatitis C coordinators. 
The Committee also notes that hepatitis C counseling and 
testing programs are not universally available, and encourages 
that CDC address this gap. Further, the Committee is concerned 
about reports that the CDC may reduce the number of Hepatitis C 
prevention demonstration project sites from 15 to 5 in FY2005 
and urges the Director to continue support for all 15 sites. 
The Committee also encourages more aggressive HCV outreach 
linkages to care are available in all states to those seeking 
hepatitis C prevention services. Finally, the Committee is 
pleased that several States, in collaboration with community 
stakeholders, have developed State plans to address hepatitis, 
but understand that funding has not been made available to 
implement these plans. Funds have been included above the 
request to support and expand the abovementioned hepatitis C 
activities.
    In addition, the Committee is concerned with increasing 
rates of adult infection with hepatitis A and B, and urges that 
the CDC consider launching an expanded vaccination program in 
response to this health issue.
    Lyme Disease.--The Committee continues to be concerned 
about the increase in tick-borne illnesses, including Lyme 
disease and Southern Tick-Associated Rash Illnesses. The 
Committee urges the Director, in collaboration with other 
relevant Departmental Operating Divisions, to consider the 
establishment of a comprehensive, multi-agency, five-year plan 
that lays out a blueprint for making progress toward effective 
surveillance, prevention, and control of tick-borne illnesses.
    Sepsis.--The Committee understands that sepsis remains a 
leading cause of death, in part because too few medical 
personnel know how to diagnose and treat it properly. The 
Committee encourages the CDC to work with State health 
departments to expand surveillance efforts related to sepsis. 
Furthermore, the Committee encourages the CDC work with 
relevant voluntary health organizations to examine effective 
means of educating infectious disease physicians, emergency 
room doctors, and critical care nurses, especially those in 
rural and traditionally underserved areas, in use of the new 
guidelines to identify sepsis and improve patient outcomes.
    West Nile Virus.--The Committee supports the CDC's efforts 
to complete a national plan for West Nile virus response, 
including surveillance, prevention, and control of the virus 
nationwide. The Committee is aware of concerns that political 
subdivisions of states, such as local and county/parish 
governments have not had the necessary resources to combat 
outbreaks, even though they have a significant responsibility 
for response. The Committee urges the Director to factor in the 
needs of local governments in the allocation of West Nile 
response funds in FY2005.

Injury prevention and control

    The Committee provides $155,591,000 for the injury control 
program, which is $2,000,000 above the fiscal year 2004 
comparable level and $1,712,000 above the request. The injury 
prevention and control program supports intramural research, 
injury control research centers, extramural research grants, 
and technical assistance to state and local health departments.
    Gun Control Advocacy.--The Committee recommendation 
maintains language carried in the fiscal year 2004 bill and 
prior years prohibiting federal funds from being used to lobby 
for or against the passage of specific federal, state or local 
legislation intended to advocate or promote gun control. The 
Committee understands that the CDC's responsibility in this 
area is primarily data collection and the dissemination of that 
information and expects that research in this area to be 
objective and grants to be awarded through an impartial, 
scientific peer review process. The Committee requests that the 
Director be prepared to report on the steps taken to ensure 
this restriction is followed during the FY2006 budget hearings.
    National Violent Death Reporting System.--The Committee 
commends the CDC for working with several academic institutions 
to develop and implement model population-based violent injury 
reporting systems, and to develop systems that link information 
from law enforcement agencies, medical examiners, and coroners, 
health providers, crime laboratories, and other agencies. The 
Committee is pleased with the progress that has been made 
towards implementation of a system of more timely, complete, 
objective and accurate information about violent deaths and 
injuries. The Committee encourages CDC to continue to work with 
both State and private partners in its implementation of this 
model plan.
    Prevention of Child Maltreatment.--The Committee 
recommendation includes sufficient funds to support public 
health surveillance and research for child maltreatment 
prevention programs at not less than the FY2004 level. The 
Committee provides $1,000,000 above the request for child 
maltreatment and other intentional injury activities.
    Traumatic Brain Injury.--Within the funds provided, 
$1,000,000 above the fiscal year 2004 comparable level is for 
expanding the activities of the Traumatic Brain Injury program.

Occupational safety and health

    The Committee provides a program level of $278,587,000 for 
occupational safety and health, which is the same as the 
request and $1,599,000 above the FY2004 comparable level. Of 
the amount provided, $41,900,000 is to be derived from section 
241 evaluation set-aside funds, as proposed in the request.
    This program conducts applied research, develops criteria 
for occupational safety and health standards, and provides 
technical services to government, labor and industry, including 
training for the prevention of work-related diseases and 
injuries. This appropriation supports surveillance, health 
hazard evaluations, intramural and extramural research, 
instrument and methods development, dissemination, and training 
grants.
    National Occupational Research Agenda (NORA).--The 
Committee recommendation continues support for research 
associated with NIOSH's NORA program at not less than the 
FY2004 level.
    Personal Protective Equipment.--The Committee strongly 
supports NIOSH's efforts for program activities in domestic 
terrorism preparedness. The Committee believes significant work 
must be done to continue to protect emergency responders from 
biological and chemical terrorism exposures, as well as 
industrial accidents. Firefighters, emergency medical 
personnel, and other on-site workers need reliable personal 
protective equipment, principally protective masks and 
respirators, but also protective clothing and detection devices 
to be able to effectively help victims in case of exposure to 
biological or chemical terrorist agents.
    NIOSH has made significant progress in the past year and is 
to be commended for working closely with manufacturers and 
first-responder representatives to create equipment that will 
protect our nation's workers. The self-contained breathing 
apparatus (SCBAs) are now approved and on the market, and the 
upgrade kits for items in current service are being approved. 
NIOSH should investigate the feasibility of the use of the 
military masks about to be surplused as the U.S. military moves 
to a new mask that NIOSH and Fort Detrick are cooperatively 
creating.

Preventive health and health services block grant

    The Committee provides $110,000,000 for the preventive 
health and health services block grant, which is $23,298,000 
below the fiscal year 2004 comparable level and the budget 
request. This program provides grants to States by formula for 
a wide range of public and preventive health activities.

Public health improvement

    The Committee provides a program level of $128,774,000 for 
public health improvement, which is $43,788,000 below the 
fiscal year 2004 comparable level, and $15,482,000 above the 
request. Of the amount provided, $43,600,000 is to be derived 
from section 241 evaluation set-aside funds, as proposed in the 
request.
    This program funds activities designed to close the 
Nation's gap in public health capacity and strengthen the 
practice of public health at the front lines, develop improved 
interventions and services, help racial and ethnic minority 
communities mobilize and organize their resources to support 
effective and sustainable programs that will contribute to the 
elimination of health disparities, and develop and implement 
national data standards for surveillance reporting.
    Extramural Prevention Research.--The Committee provides 
$483,000 for extramural prevention research. The Committee 
understands that no new grants will be funded through the 
program in FY2004 and that the grant periods for all but one of 
the 25 grants supported expire on September 30, 2004. As a 
result, $483,000 is provided for continuation requirements in 
FY2005.
    Public Health Research.--The Committee recommendation 
provides a total of $30,000,000 for public health research. Of 
this amount, $15,000,000 is to be derived from section 241 
evaluation set-aside funds as proposed in the request.

Buildings and facilities

    The Committee provides $81,500,000 for buildings and 
facilities, which is $178,954,000 below the fiscal year 2004 
comparable level and the same as the request.
    These funds support construction and ongoing maintenance 
projects, as well as essential safety repairs and equipment 
purchases. The funds provided will support high priority work 
identified in the CDC's Buildings and Facilities Master Plan 
phased planning effort. Funds also will be used to support the 
2nd year costs of replacing the CDC's Vector Borne Infectious 
Diseases Laboratory in Ft. Collins, CO.
    The Committee recommendation includes bill language to 
allow the CDC to enter into a single contract or related 
contracts for the full scope of development and construction of 
facilities. It also carries language included in the 
Departments of Labor, Health and Human Services and Education, 
and Related Agencies Appropriations Act, 2004 to allow funds 
appropriated to the CDC to be used to enter into a long-term 
ground lease for construction on non-Federal land, in order to 
replace their laboratory in the Fort Collins, Colorado area.
    Data Security and Storage.--Within the amount provided 
sufficient funds are available for data center storage 
infrastructure hardware and software upgrades. This funding is 
to provide further for the remote mirroring of information 
between CDC data centers and recovery sites, and to provide 
heterogeneous connectivity to existing systems in use at the 
CDC, in order to ensure the protection, recovery, and 
availability of critical resources; as well as to provide for 
enhanced security-specific technologies and services in concert 
with critical infrastructure protection requirements.

Office of the Director

    The Committee provides $59,173,000 for the activities of 
the Office of the Director, which is the same as the fiscal 
year 2004 comparable level and $500,000 below the request.
    The Committee intends this amount to be a ceiling. The 
Director may transfer these funds to non-administrative, 
programmatic activities at her discretion.
    The Committee recommendation includes a provision, sec. 220 
that reduces funds available for information technology and 
administrative management by $15,000,000. The Committee 
included this provision to partially offset funds provided 
within public health improvement to support high priority 
public health research. The Committee expects the Director to 
submit a report regarding the allocation by budget activity of 
the administrative and information technology savings across 
the CDC prior to the obligation of FY2005 public health 
research funds.
    Cooperative Agreements.--The Committee is concerned that 
CDC is considering altering the cooperative agreement that has 
effectively supported research, fellowships, training, 
preparedness and other activities at schools of public health 
over the past 23 years. The Schools of Public Health are an 
integral part of the public health infrastructure through 
preparation of future public health leaders and through key 
research and training activities. The Committee notes that the 
competitive, peer-reviewed projects funded through this 
mechanism are results-oriented and have positive evaluations. 
The Committee is aware that this cooperative agreement was one 
of the first such funding models at CDC that allow flexibility 
to meet unanticipated public health needs at the community 
level and rapidly respond to emerging situations while ensuring 
accountability and integrity. The Committee expects that CDC 
will not proceed with any modification to this arrangement 
without prior justification and consultation with the 
Committee.
    Futures Initiative.--The Committee understands that since 
June 2003, CDC has been engaged in a strategic planning process 
called the, ``Futures Initiative.'' The process has yielded a 
series of organizational recommendations to ensure that CDC 
will continue to have the capacity to effectively and 
efficiently protect and improve the health of the American 
people. The Committee understands that the organizational 
recommendations may require changes to the manner in which 
funds are appropriated to the CDC and will work to incorporate 
those changes before the funding recommendations for FY2005 are 
finalized.

Terrorism

    The Committee provides $1,637,760,000 for CDC terrorism 
preparedness and response activities within the Public Health 
and Social Services Emergency Fund (PHSSEF). This is 
$130,549,000 above the FY2004 comparable amount and 
$128,189,000 above the request.
    Within the total provided: $934,300,000 is for State and 
Local Capacity, including $871,900,000 to be provided to State 
and local health departments through grants and cooperative 
agreements; $142,160,000 is for Upgrading CDC Capacity; 
$11,300,000 for Anthrax; $100,000,000 for the Biosurveillance 
Initiative and $450,000,000 for the Strategic National 
Stockpile.
    Poison Control Centers.--For many years the Committee has 
recognized the importance of the national network of poison 
control centers in the early identification of potential public 
health incidents and domestic terrorist events. The centers, 
which operate around the clock, have developed a national, 
real-time data collection, analysis and surveillance 
capability. The Committee urges the CDC to continue to 
incorporate these unique capabilities and to provide sufficient 
support to enable the centers to participate fully in the 
BioSense program as it develops.

                     National Institutes of Health

    The Committee provides $28,526,871,000 for the twenty-six 
appropriations which together fund the programs of the National 
Institutes of Health (NIH). The total in the bill is 
$726,823,000 above the fiscal year 2004 comparable level and 
the same as the budget request. The bill also includes 
$47,400,000 in the Public Health and Social Services Emergency 
Fund as requested by the Administration for targeted research 
activities to develop radiological and nuclear threat 
countermeasures. NIH would manage and oversee this work.
    Roadmap.--The Committee endorses the Administration's 
proposal of supporting the NIH Roadmap for Biomedical Research 
at a funding level of $236,800,000, from funding contributed by 
the Institutes and Centers based on less than one percent of 
their budgets and out of the Director's Discretionary Fund. The 
Committee believes the Roadmap is an important step to moving 
biomedical research forward to the next level of discovery at a 
pace that hastens its delivery to patients. The Roadmap 
addresses common needs across all disease areas and should 
produce research advances that will benefit many diseases and 
conditions. The Committee expects to be to notified on a 
quarterly basis if the contribution from the Institutes and 
Centers or the allocation of funding by initiative changes from 
what is presented in the congressional justification.
    Biodefense.--The Administration's FY05 budget for NIH 
includes $1,694,200,000 for bioterrorism activities. The 
Committee has not identified a specific funding level for 
biodefense research, choosing to give the Director of NIH 
flexibility in determining what share of NIH resources should 
be considered biodefense activities.
    Balance in the research portfolio.--The Committee 
reiterates its longstanding view that NIH should distribute 
funding on the basis of scientific opportunity. The Committee 
urges the Director and the Administration to continue to resist 
pressures to earmark, set aside and otherwise politicize these 
resources. To enhance NIH's flexibility to allocate funding 
based on scientific opportunity, the Committee has attempted to 
minimize the amount of direction provided in the report 
accompanying the bill. For example, there are no directives to 
fund particular research mechanisms, such as centers or 
requests for applications, or specific amounts of funding for 
particular diseases.
    In stating that scientific opportunity should be the basis 
for allocating research funding, the Committee understands that 
other factors also are relevant to NIH's decisions, including 
such considerations as the infectious nature of a disease, the 
number of cases and deaths associated with a particular 
disease, the Federal and other costs of treating a disease, the 
years of productive life lost due to a particular disease, and 
the estimated proximity to research breakthroughs. The 
Committee does not presume to judge which criteria should take 
precedence or carry the greatest weight in individual funding 
decisions, but urges NIH to consider the full array of relevant 
criteria as it constructs its research portfolio.
    AIDS funding.--Consistent with the philosophy outlined 
above, the Committee has chosen not to earmark a specific 
dollar amount for AIDS research. The Committee understands that 
it would be NIH's intent to allocate AIDS funding consistent 
with the Director's recommendations. The Committee understands 
that this allocation may change before the beginning of the 
fiscal year.
    The Committee intends that the funds allocated for AIDS 
should be spent in a manner fully consistent with the AIDS 
research plan developed by the Office of AIDS Research (OAR) 
and expects the Director of NIH to use the full authority of 
his office to ensure that this occurs. The Committee has 
provided the Director of OAR, jointly with the Director of NIH, 
transfer authority to reallocate up to three percent of funds 
designated for AIDS research among Institutes, subject to 
normal reprogramming procedures. The Committee encourages NIH 
to use this authority whenever it believes that an adjustment 
in the allocation of AIDS funding between Institutes is 
appropriate to achieve scientific objectives or to facilitate 
promising research efforts.
    The Committee continues to support OAR, its leadership, and 
its coordinated budget planning process and expects the 
individual institutes, centers and divisions to fully cooperate 
with OAR's work. The Committee has provided funding for the OAR 
within the Office of the Director and intends that the OAR will 
maintain its current structure and responsibilities, including 
the allocation of an emergency discretionary fund.
    Conflict of Interest.--The integrity of NIH's scientists is 
of paramount importance. The Committee commends NIH for 
forthrightly addressing the issue and supports the NIH 
proposals announced at the June 22 hearing of the House Energy 
and Commerce Health Subcommittee. The proposals, several of 
which would require regulatory changes, would properly restrict 
some consulting and other outside arrangements while creating a 
rigorous management process for monitoring the remaining 
interactions with outside interests.

                       National Cancer Institute

    The Committee provides $4,870,025,000 for the National 
Cancer Institute (NCI), which is $130,770,000 above the fiscal 
year 2004 comparable level and the same as the budget request. 
The bill includes language requested by the Administration 
identifying up to $8,000,000 for repairs and improvements to 
the NCI intramural facility in Frederick, Maryland.
    Mission.--The NCI conducts and supports basic and applied 
cancer research in early detection, diagnosis, prevention, 
treatment and rehabilitation. NCI provides training support for 
research scientists, clinicians and educators, and maintains a 
national network of cancer centers, clinical cooperative 
groups, and community clinical oncology programs, along with 
cancer prevention and control initiatives and outreach programs 
to rapidly translate basic research findings into clinical 
practice.
    Prostate cancer.--The Committee recognizes NCI's commitment 
to prostate cancer research as laid forth in its ``Prostate 
Cancer Research Plan, FY 2003-FY 2008''. The Committee requests 
that NCI provide an annual update every January on its progress 
in prostate cancer research as it reflects the goals outlined 
in the plan for years FY04-FY08.
    Pediatric cancer.--To expedite the progress and further 
improvements in outcomes for children with cancer, the 
conferees encourage NCI to increase its support of dedicated 
translational research to accelerate the pace of pediatric 
cancer clinical trials. The conferees also urge NCI to place a 
significant focus on genomic and proteomic approaches to 
identifying and validating potential molecular targets for 
therapeutic exploitation and evaluation in a controlled 
clinical trial setting. The existing, NCI-supported national 
clinical trials infrastructure and network, the Children's 
Oncology Group, should be the dominant participant in this 
accelerated effort.
    Pancreatic cancer.--The Committee is concerned that there 
are too few scientists researching pancreatic cancer, which is 
the country's fourth leading cause of cancer deaths. 
Tragically, 99 percent of people diagnosed with this disease 
die within six months. The Committee compliments the NCI's past 
efforts for increasing the research field through its program 
of a 50 percent formalized extended payline for grants that 
were 100 percent relevant to pancreatic cancer, an initiative 
that was an important method for attracting both young and 
experienced investigators to develop careers in pancreatic 
cancer. The Committee understands that NCI is adjusting this 
policy for the current year and looks forward to learning 
whether this revised approach is even more successful in 
increasing the number of prostate cancer grants.
    Cancer centers.--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 give consideration to 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.
    Neurofibromatosis (NF).--The Committee is pleased that NCI 
is conducting phase II clinical trials of NF1 patients with 
plexiform neurofibromas. Recognizing NF's connection to many of 
the most common forms of human cancer, the Committee encourages 
NCI to increase its NF research portfolio in such areas as 
further development of animal models, natural history studies, 
therapeutic experimentation, and clinical trials. The Committee 
hopes that NCI will aggressively pursue clinical and 
translational research while still maintaining a solid basic 
research portfolio.
    Liver cancer.--The Committee notes with concern the number 
of people who develop and die from liver cancer. 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 they can be 
easily treated. The Committee is aware that NCI, in 
collaboration with NIDDK, convened an Experts Conference in 
April, 2004 to help define the most pressing areas requiring 
additional research, professional education and public 
awareness initiatives. The Committee encourages NCI to pursue 
the research initiatives that result from the Conference.
    Kidney cancer.--The Committee is concerned that the 
incidence of kidney cancer has increased significantly over the 
last decade. The Committee encourages NCI to develop a 
strategic plan to combat kidney cancer, including implementing 
the NCI Progress Review Group's (PRG) recommendations in order 
to bolster research efforts to fight this disease. The 
Committee requests that NCI report in March 2005 on its 
progress in developing a strategic plan.
    Lymphoma.--Hodgkin's lymphoma and non-Hodgkin's lymphoma 
(NHL) represent a serious health burden, because of their 
persistent high incidence and the inadequate improvement in 
survival rates. The Committee encourages NCI to strengthen its 
support for translational and clinical lymphoma research which 
can utilize laboratory discoveries in lymphoma biology 
specifically to develop new approaches in the clinic for 
patients. The Committee recommends that NCI evaluate its 
current investment in lymphoma clinical research and expand or 
initiate programs that would ensure support for translational 
and clinical research efforts.
    The Committee encourages NCI to enhance and expand its 
commitment to investigation of the etiology and prevention of 
lymphoma. In the past decade there has been a dramatic and 
unexplained increase in the incidence of the disease; this 
epidemic is particularly evident in young and middle-aged 
persons. Evidence suggests that these cancers develop from 
genetic damage caused by environmental factors such as 
chemicals, toxins and ultraviolet light, and infectious 
organisms such as hepatitis C, as well as immune dysfunction.
    Angiogenesis.--The Committee is pleased with the progress 
of angiogenesis research across the institute to involve both 
intramural and extramural researchers and encourages NCI to 
continue to pursue efforts to establish greater collaboration 
between angiogenesis researchers in the fields of cancer 
biology and diabetes. The trans-NIH angiogenesis workshop is an 
important step toward promoting multidisciplinary research on 
this important topic.
    Blood cancers.--The Committee is pleased that important new 
therapies have been developed for the blood cancers--leukemia, 
lymphoma, and multiple myeloma. Despite the introduction of 
these new therapies--including monoclonal antibody, 
radioimmunotherapies, and a proteasome inhibitor--far too many 
Americans still die from the blood cancers. The Leukemia, 
Lymphoma, and Myeloma Progress Review Group, a blue ribbon 
advisory panel of the National Cancer Institute (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 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. NCI should consider flexible uses of current 
funding mechanisms in order to respond to the key 
recommendation of the blood cancer Progress Review Group, which 
was to reduce dramatically the time required to develop new 
therapies.
    Myelodysplasia and myeloproliferative disorders research.--
The Committee recognizes NCI's support for a new research 
initiative in myeloproliferative disorders, which 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.
    Chronic lymphocytic leukemia (CLL).--This incurable disease 
is the most common form of adult leukemia in the U.S. The 
Committee encourages NCI to strengthen research efforts 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 Institute for the past five 
years is proceeding with a competing renewal of its initial 
grant to permit continued study of CLL at the cellular and 
clinical levels. The Committee encourages NCI to consider 
enhancing the scope of research activities funded through the 
CLL Research Consortium as it works to defeat this devastating 
blood disorder.
    Tuberous sclerosis complex.--Tuberous sclerosis complex 
(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. The Committee encourages NCI to support programs 
examining the molecular and cellular basis of TSC, and the role 
of TSC in tumor development.
    Cancer genomics.--The Committee is aware of the potential 
for improved understanding and treatment of cancer presented by 
the use of microarray technology in both basic research and the 
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 in this effort.
    American Russian Cancer Alliance.--The Committee recognizes 
the contribution of the American Russian Cancer Alliance (ARCA) 
in its pursuit of novel research activities that ultimately 
benefit cancer patients worldwide. The Alliance has brought 
together the scientific strengths, expertise, and particular 
resources of both nations for the benefit of humankind through 
its effort to diagnose, treat and prevent cancer. The Committee 
notes in particular the unique ARCA projects in molecular 
imaging and radionuclide therapy that capitalize on the 
exceptional scientific expertise and technical capabilities of 
the leading Russian nuclear research centers and American 
cancer centers. The Committee encourages NCI to establish a 
mechanism to support the continued development of this 
collaboration between the United States and Russian cancer 
researchers and to develop a plan to support the necessary 
infrastructure at U.S. institutions for the Alliance and its 
activities.
    Bone metastasis study.--The Committee encourages NCI to 
develop an integrated approach to study bone metastasis, 
leveraging the expertise of cancer and bone biologists, 
clinical oncologists and metastasis experts and representatives 
from 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. The Committee also urges NCI to 
expand research on osteosarcoma to improve survival and quality 
of life and to prevent metastatic osteosarcoma for children and 
teenagers who develop this cancer.
    Tobacco harm reduction.--The Committee continues to 
encourage research about tobacco products intended to reduce 
the harm caused by cigarette smoking and encourages NCI to 
expedite its research and review of existing literature 
regarding tobacco harm reduction. The Committee is particularly 
interested in what can be done from a public policy perspective 
to reduce tobacco related mortality and morbidity in that ten 
to fifteen percent of the adult population who cannot or will 
not quit smoking. The Committee encourages NCI to focus on the 
difference in harm caused by cigarettes versus potential 
reduced exposure tobacco products and how effective these 
products are or could be in smoking cessation efforts. NCI 
should consider exploring why Sweden has been so successful in 
reducing smoking and smoking related disease and what has been 
the impact of non-combustion products on smoking cessation in 
Sweden.
    Human embryonic stem cell research.--The Committee 
understands that NCI will soon begin implementing a human 
embryonic stem cell program. The Committee requests NCI to 
submit a report to the Committee by December 1, 2004 listing 
the human embryonic stem cell research grants that NCI has 
awarded, the requests for proposals on human embryonic stem 
cell research that have been developed by NCI, and a plan 
describing how NCI will further develop its human embryonic 
stem cell research program.

               NATIONAL HEART, LUNG, AND BLOOD INSTITUTE

    The Committee provides $2,963,953,000 for the National 
Heart, Lung, and Blood Institute (NHLBI), which is $85,262,000 
above the fiscal year 2004 comparable level and the same as the 
budget request.
    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, and population-based and health education research.
    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 
top priority. Cardiovascular diseases remain the leading cause 
of death and a major cause of permanent disability. The 
Committee continues to believe that an intensive research 
program in these areas is necessary.
    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 a unique national 
research resource. The Committee encourages NHLBI to initiate a 
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.
    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 one year. Yet, perhaps 50 
percent of these hospitalizations are avoidable. The Committee 
encourages NHLBI to consider initiating a randomized trial to 
evaluate management strategies for heart failure patients in 
terms of their ability to prevent death or hospital 
readmission.
    Cardiovascular risk in American Indians and Alaskan 
Natives.--The Committee is aware that American Indian and 
Alaska Native communities bear a heavy burden of heart disease, 
stroke and other cardiovascular diseases and few preventive 
interventions have been tested. The Committee encourages NHLBI 
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.
    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 NHLBI to begin an initiative to complement existing 
tissue engineered research programs to stimulate efforts to 
``grow'' small-diameter, functional blood vessels.
    Cooley's anemia.--The Committee remains supportive of the 
focused research effort that is being undertaken by the 
Thalassemia Clinical Research Network, which is comprised of 
the leading research institutions in the field of thalassemia, 
or Cooley's anemia. In addition, the Committee suggests that 
NHLBI should consider including patients with related 
hemoglobinopathies whenever such inclusion will enhance the 
scientific validity of the research being conducted.
    Hemophilia.--The Committee commends NHLBI for its 
leadership in advancing research on bleeding disorders and the 
complications of these disorders and applauds NHLBI for its 
efforts, working with private non-profit groups, to support 
research on improved and novel therapies for bleeding 
disorders.
    Tuberculosis and AIDS interaction.--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.
    COPD education and prevention program.--The Committee 
encourages NHLBI to implement an education and prevention 
program for chronic obstructive pulmonary disease (COPD). In 
developing such an education and prevention program, 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 the population with COPD. The Committee 
encourages NHLBI to enhance its efforts in this area, including 
epidemiological studies of patients who are at-risk for or who 
have this disease as well as a national education campaign for 
providers and the public about COPD.
    Coronary heart disease and diabetes.--The Committee is 
aware that more than 18 million Americans are currently living 
with diabetes, a chronic condition that can lead to life-
threatening illness. People with diabetes are two to four times 
more likely than others to develop heart disease and are more 
likely to die from heart attacks than people who do not have 
diabetes. Further, patients with diabetes may be asymptomatic 
or present with atypical symptoms of coronary heart disease, 
such as fatigue, indigestion, or shortness of breath. This may 
be due in part to the effects of diabetes on the heart, which 
may blunt the pain response to ischemia. Given the significant 
morbidity and mortality associated with coronary heart disease 
among patients with diabetes, the Committee recognizes the 
importance of diagnosing coronary heart disease in patients 
with diabetes whether or not these patients present with 
typical chest pain symptoms. The Committee encourages NHLBI to 
develop research initiatives to examine coronary artery disease 
in at-risk patients with diabetes, including studies of high 
diabetes incidence populations such as African-Americans, 
Hispanic Americans, and Native Americans. The Committee also 
encourages NHLBI to support educational programs directed to 
health professionals, patients, and the public to raise 
awareness of increased risk for heart disease and stroke for 
diabetics.
    Juvenile diabetes.--The Committee commends NHLBI and NIDDK 
for launching an initiative to stimulate research on the 
progression of cardiovascular disease, a significant long-term 
complication of juvenile diabetes.
    Angiogenesis.--The Committee is encouraged with the 
progress of angiogenesis research at the institute and 
encourages NHLBI to collaborate more closely with NCI in this 
area.
    Wound healing.--The Committee commends the institute for 
its research on the acceleration of vascular disease in type 1 
diabetes. The Committee also encourages the Institute to be a 
key player in initiatives to advance wound healing, with 
particular emphasis on wounds associated with juvenile 
diabetes.
    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 needed 
to develop safe, effective treatments and to identify the 
causes of the complications of scleroderma that include 
pulmonary fibrosis, pulmonary hypertension, myocardial 
fibrosis, cardiac arrhythmias, pericarditis, and Raynaud's 
Phenomenon.
    Transmissible spongiform encephalopathies.--The Committee 
encourages NHLBI to enhance its efforts to develop a diagnostic 
test for TSE that would be suitable for screening the blood 
supply. Currently, there is no suitable method for identifying 
TSE-infected blood. In addition, the Committee encourages NHLBI 
to seek new technologies and procedures for inactivating blood-
borne causative agents for human TSEs, further ensuring a safe 
blood supply. Human TSEs, for which there are no known 
treatments, include Creutzfeld-Jakob disease and new variant 
Creutzfeldt-Jakob disease.
    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. The Committee encourages the Institute to 
continue 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.
    Neurofibromatosis (NF).--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 fifty million 
Americans. Accordingly, the Committee urges NHLBI to enhance 
its NF research portfolio.
    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 disease 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.
    Obstructive sleep apnea.--The Committee commends the 
Institute for its work on obstructive sleep apnea. This 
disorder affects approximately 80 percent of the elderly and if 
left untreated it significantly increases risk for 
hypertension, coronary artery disease, heart failure and 
stroke. The Committee encourages the Institute to include 
surgical treatments in its work to define useful treatments for 
this disorder.
    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 encourages the National Center to 
partner with other Federal agencies, such as the Centers for 
Disease Control and Prevention, as well as voluntary 
organizations, to develop a sleep education and public 
awareness initiative that will provide a forum for 
dissemination of the outcomes of the sleep translational 
conferences.
    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 of a 
variety of causes which can lead to aortic dissection. The 
Committee urges NHLBI to expand its collaborative efforts with 
other institutes to support research in this area.
    Alpha-1 antitrypsin deficiency.--The Committee is aware 
that Alpha-1 antitrypsin deficiency is often misdiagnosed as 
asthma or Chronic Obstructive Pulmonary Disease (COPD). 
Individuals with Alpha-1 exhibit symptoms of advanced emphysema 
between 30 and 50 years of age, even in the absence of tobacco 
use. Alpha-1 is a major cause of transplantation in adults and 
a leading cause of liver transplantation in children. The 
Committee commends NHLBI for its plans to conduct a state-of-
the-science conference on Alpha-1 leading towards a five-year 
research agenda. NHLBI is also encouraged to collaborate with 
NIDDK and other institutes to enhance its research portfolio, 
encourage screening and detection, raise public awareness about 
Alpha-1 and provide appropriate information to health 
professionals.
    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 Committee requests that NHLBI report to 
the Committee on its approach to this issue not later than 
January 15, 2005.
    Primary immunodeficiency diseases.--The Committee 
understands that NHLBI has begun to work with a national 
voluntary organization as part of a national physician 
education and public awareness campaign for primary 
immunodeficiency diseases. 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.
    Lung repair.--Respiratory failure is often a result of 
irreversible lung injury. This may occur acutely in conditions 
such as acute respiratory distress syndrome (ARDS) or 
chronically with disorders such as COPD or pulmonary fibrosis. 
The Committee encourages NHLBI to promote the use of stem cells 
in animal models to study lung repair and organogenesis as a 
method to reverse respiratory failure.
    Allied health personnel.--Given the existing and growing 
shortages of qualified allied health professionals who serve as 
laboratory personnel, NHLBI is encouraged to enhance program 
activity at research institutions training these individuals, 
which contributes to the alleviation of this problem.
    Von Willebrand Disease.--The Committee encourages NHLBI to 
establish a universal treatment algorithm (after consultation 
with established medical associations) 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 
addition to providing the benefits of early detection and 
treatment.
    Heart disease and kidney disease.--There is a well-
established and significant link between heart disease, 
hypertension and kidney disease. With 41 million people having 
decreased kidney function, and in the face of an ever aging 
population, the need to develop better treatment and prevention 
strategies to address this linkage will only increase over the 
coming decade. The Committee encourages NHLBI to collaborate 
more fully with NIDDK to develop appropriate research 
initiatives that can be undertaken cooperatively, and 
encourages NHLBI to sponsor a workshop on hypertension as it 
relates to heart and kidney disease with input from the renal 
community to address these issues.

         NATIONAL INSTITUTE OF DENTAL AND CRANIOFACIAL RESEARCH

    The Committee provides $394,080,000 for the National 
Institute of Dental and Craniofacial Research (NIDCR), which is 
$10,798,000 above the fiscal year 2004 comparable level and the 
same as the budget request.
    Mission.--The NIDCR conducts and supports research and 
research training to improve craniofacial, oral and dental 
health. The Institute's programs reflect the genetic, 
behavioral and environmental factors that result in complex 
human disease and are clustered into the following areas: 
inherited disorders; infection and immunity; oral, pharyngeal 
and laryngeal cancers; chronic and disabling conditions such as 
bone and joint diseases and chronic pain; behavioral science, 
epidemiology and health promotion; and tissue engineering and 
biomimetics research to improve diagnostics and tissue repair 
and regeneration.
    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.
    Saliva.--The Committee is aware that research on saliva has 
progressed rapidly and holds the potential to be an inexpensive 
non-invasive diagnostic tool for early detection of breast 
cancer, osteoporosis, hepatitis, HIV, and Sjogren's disease. 
The Committee encourages NIDCR to work cooperatively with NCI 
and other appropriate institutes in pursuing research 
initiatives on the development of saliva as a diagnostic tool.
    Biology of bone.--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 causing skeletal disorders, including fibrous 
dysplasia and dental abnormalities in Paget's disease patients.
    Mucolipidosis Type IV.--The Committee urges NIDCR to 
continue its efforts to create a strain of mice which has the 
same genetic characteristics as that of humans with this 
debilitation genetic disorder. This research offers promise for 
the eventual development of treatments or cures for this and 
similar genetic disorders in humans.

    NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES

    The Committee provides $1,726,196,000 for the National 
Institute of Diabetes and Digestive and Kidney Diseases 
(NIDDK), which is $54,393,000 above the fiscal year 2004 
comparable level and the same as the budget request. In 
addition, $150,000,000 in mandatory funds are available for 
juvenile diabetes research.
    Mission.--The NIDDK supports research in three major 
disease categories: diabetes, endocrinology, and metabolic 
diseases; digestive diseases and nutrition; and kidney, 
urologic, and hematologic diseases. The NIDDK 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.
    Juvenile diabetes.--The Committee is pleased that the 
Immune Tolerance Network (ITN) and the TrialNet diabetes trial 
network have established a joint evaluation process, which 
allows the same proposals to be considered simultaneously by 
both networks. The Committee hopes that TrialNet will be able 
to use some of the expertise and structure already established 
at the ITN in the design/execution of the TrialNet trials, 
especially if any mechanistic studies are being performed. The 
Committee requests that TrialNet provides a report on the 
progress made by the network thus far, and comments on any 
plans for internal/external evaluation, which should promote 
the effective operation of the network. The Committee 
encourages TrialNet to expedite their proposal review and 
implementation processes. In addition, the Committee recommends 
that TrialNet consider funding of Phase I studies in order to 
fill in the scientific gap between basic discoveries and 
clinical trials to generate more extensive opportunities for 
translational research within the field of juvenile diabetes.
    Irritable bowel syndrome.--The Committee remains concerned 
about the increasing frequency of irritable bowel syndrome 
(IBS), a chronic complex of disorders that malign the digestive 
system. This common disorder strikes people from all walks of 
life affecting between 25 to 45 million Americans and results 
in significant human suffering and disability. The Committee 
encourages NIDDK to support 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, and would 
like to receive a report on the progress made by NIDDK to 
develop this plan in next year's hearings.
    Inflammatory bowel disease.--The Committee has been 
encouraged in recent years by discoveries related to Crohn's 
disease and ulcerative colitis, collectively known as 
inflammatory bowel disease (IBD). These extremely complex 
disorders represent the major cause of morbidity and mortality 
from intestinal illness. The Committee commends NIDDK for its 
strong leadership in this area and encourages the Institute to 
continue to give priority consideration to the following areas 
of IBD research: (1) investigation into the cellular, molecular 
and genetic structure of IBD, (2) identification of the genes 
that determine susceptibility or resistance to IBD in various 
patient subgroups, and (3) translation of basic research 
findings into patient clinical trials as outlined in the 
research agenda developed by the scientific community entitled, 
``Challenges in Inflammatory Bowel Disease.'' Finally, the 
Committee also encourages NIDDK to continue to strengthen its 
partnership with the IBD community on innovative research 
projects.
    Interstitial cystitis.--The Committee is pleased by the 
unprecedented scientific advances in the area of interstitial 
cystitis (IC) research, particularly in the area of urinary 
markers. The Committee understands that this progress is due in 
large part to investments in basic science research. Therefore, 
the Committee encourages NIDDK to continue to aggressively 
support IC-specific basic science initiatives, particularly 
through program announcements. The Committee also encourages 
NIDDK to work closely with the IC patient community on 
developing and funding an IC awareness campaign for both the 
public and professional community, as well as to host a 
consensus conference on the definition of IC. The absence of a 
uniform definition which 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 encourages 
NIDDK to further this scientific momentum by hosting the next 
international symposium on IC in 2005.
    Incontinence.--Many otherwise healthy, active individuals 
suffer from 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.
    Scleroderma.--The Committee encourages NIDDK to support 
scleroderma-relevant research. Scleroderma is a chronic and 
progressive disease that predominantly strikes women. It is 
estimated that ninety percent of patients with systemic 
sclerosis have gastrointestinal (GI) involvement and that of 
that number fifty 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 twenty percent 
of those with systemic sclerosis often within the first five 
years after diagnosis. More research is needed in order to 
develop safe and effective treatments and to identify the cause 
or causes of the complications of scleroderma.
    Acute liver failure.--The Committee is pleased that 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, and encourages increased attention to pediatric 
issues.
    Auto-immune liver diseases.--These diseases are the primary 
indication for liver transplantation in adolescents. The 
Committee encourages targeted research to improve the 
prevention and treatment of auto-immune liver diseases in 
children.
    Alpha-1 antitrypsin deficiency.--The Committee is aware 
that alpha-1 antitrypsin deficiency liver disease is a leading 
cause of pediatric transplantation and can manifest at any age. 
The Committee is encouraged that NIDDK has invested in research 
on this devastating disorder. The Committee encourages NIDDK to 
maintain its research funding and encourages NIDDK to 
collaborate with NHLBI and other institutes to enhance its 
research portfolio, encourage screening and detection, raise 
public awareness about alpha-1 and provide appropriate 
information to health professionals.
    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 one in every 
four adults over the age of eighteen. 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 encourages additional 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 suggests that the Institute review opportunities 
to expand current clinical programs, where appropriate, to 
permit the enrollment and follow up of larger numbers of 
patients. Finally, the Committee suggests a public awareness 
campaign with a voluntary health agency to address this growing 
and preventable public health problem.
    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 follow the natural history of infants and 
children who receive liver transplants until they are eighteen 
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.
    Hepatitis C in children.--The Committee is pleased that 
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 about the progress of this trial at 
upcoming appropriations hearings.
    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 encourages 
NIDDK to convene an expert panel in FY 2005 to reach consensus 
on the best treatment protocols.
    Kidney disease clinical research.--The Committee previously 
noted the problem in conducting kidney disease research due to 
lack of a permanent infrastructure, such as a Clinical Trials 
Cooperative Group. The Committee wishes to command NIDDK for 
its leadership in moving forward in this area, by holding an 
initial workshop and developing strategies that will strengthen 
kidney research. The Committee encourages NIDDK to work with 
the renal community to continue these efforts in important 
research areas such as hypertension, uremic toxicity, diabetic 
nephropathy and transplant--immunology.
    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 focal segmental glomerulosclerosis, 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.
    Polycystic kidney disease.--The Committee is pleased that a 
series of synergistic events in PKD research has 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 has encouraged public-private research partnerships, 
thus in this instance the collaborative efforts by the NIDDK, 
patient advocacy and industry organizations, are positive 
examples of how new strategies to energize clinical research 
enterprises has the potential to benefit PKD sufferers, save 
billions of Federal dollars otherwise paid by Medicare and 
Medicaid for renal replacement therapy and free-up several 
thousand spots on the kidney transplant waiting list. Given 
these exciting scientific developments, the Committee 
encourages NIDDK to aggressively 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.
    Glomerular injury research.--The Committee is pleased with 
NIDDK's glomerular injury research initiatives, including a 
clinical trial for patients with focal segmental 
glomerulosclerosis. The Committee understands that in addition 
to the clinical trial, NIDDK is collaborating on a joint 
research program with a voluntary foundation to include basic 
and genetic studies. Further, the Committee is aware 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.
    Tuberous sclerosis complex.--Tuberous sclerosis complex 
(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 
encourages NIDDK to support studies examining the molecular and 
cellular basis of these manifestations of TSC as well as pre-
clinical and clinical studies.
    Celiac disease.--The Committee commends NIDDK for 
recognizing the lack of understanding, and under-diagnosis of 
the genetic, autoimmune disorder, Celiac disease (CD), and for 
including CD in the NIH Consensus Development Program for 2004. 
Although readily diagnosed in European countries, it takes on 
average eleven years for Americans to be properly diagnosed. 
Delays in diagnosis place individuals at risk for osteoporosis, 
anemia, miscarriages, and small bowel cancer. Current evidence 
demonstrates that CD is the most common genetic disorder in the 
world, with a treatment--strict, gluten-free diet--that can be 
managed almost exclusively by the individual, or family. 
Education about CD is needed for health care professionals and 
patients. The Committee encourages NIDDK to coordinate 
informational and educational programs directed at health 
professionals, patients and the public to raise awareness and 
understanding about CD, and the need for early diagnosis.
    Osteoporosis.--The Committee encourages NIDDK, in concert 
with other NIH institutes, to increase research into disease-
related osteoporosis and/or bone disorders. NIDDK should 
consider supporting research on 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.
    Digestive diseases.--Diseases of the digestive system 
continue to affect more than one-half of all Americans at some 
time in their lives. Serious disorders such as colorectal 
cancer, inflammatory bowel disease, irritable bowel syndrome, 
hemochromatosis, celiac disease, and hepatitis take a 
tremendous toll in terms of human suffering, mortality, and 
economic burden. The Committee commends NIDDK on the success of 
its Digestive Disease Centers program in addressing a wide 
range of disorders. The Committee continues to encourage NIDDK 
to expand this important program, with an increased emphasis on 
irritable bowel syndrome.
    Cystic fibrosis.--Advances have been achieved in the 
treatment of cystic fibrosis (CF), resulting in significant 
improvements in life expectancy for individuals with CF. This 
progress can be attributed to strong public and private sector 
investment in CF research, including clinical trials evaluating 
a wide range of possible new treatments. The Committee 
encourages NIDDK to continue its support for CF researchers 
engaged in basic and clinical CF research.
    Mucopolysaccharidosis (MPS).--The Committee recognizes the 
efforts of NIDDK to enhance research efforts to achieve a 
greater understanding of 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 should also be studied. The Committee 
encourages NIDDK's continued efforts to collaborate with NIAMS 
on bone and joint research in lysosomal storage disorders.
    Gastroesophogeal reflux disease (GERD).--The Committee is 
aware of new research which indicates a controlled carbohydrate 
diet may dramatically reduce the incidence of gastroesophogeal 
reflux (heartburn). The Committee encourages NIDDK to support 
research into the effectiveness of this approach in treating 
GERD.
    Adhesion related disorder.--This little known condition 
commonly leads to abnormal attachments between the organs 
inside the abdomen. The adhesions generally are composed of 
scar tissue resulting from previous operations. Very little is 
known about why adhesions form more aggressively in some 
people. Diagnosis of the disease is typically difficult, and 
surgical correction is often unsuccessful. The Committee 
encourages NIDDK to investigate this disease, supporting 
research to find treaments and understand causation and to 
communicate these findings to broaden knowledge of the disease 
in the medical community.

        NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE

    The Committee provides $1,545,623,000 for the National 
Institute of Neurological Disorders and Stroke (NINDS), which 
is $44,416,000 above the fiscal year 2004 comparable level and 
the same as the budget request.
    Mission.--The NINDS supports and conducts basic and 
clinical neurological research and research training to 
increase understanding of the brain and improve the prevention 
and treatment of neurological and neuromuscular disorders. The 
NINDS mission encompasses over 600 disorders, including stroke; 
head and spinal cord injury; epilepsy; multiple sclerosis; and 
neurodegenerative disorders such as Parkinson's disease.
    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 NINDS to 
make stroke a top priority. The Committee commends NINDS for 
convening a Stroke Progress Review Group that subsequently 
developed and released a 2002 report identifying critical gaps 
in stroke knowledge and outlining research priorities and 
resource priorities.
    Epilepsy.--Epilepsy remains a major, unsolved public health 
problem affecting the lives of millions of Americans and their 
families. The Committee seeks intensified efforts by the 
Institute to produce 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 and encourages the Institute to 
address important research issues raised at the ``Living Well 
with Epilepsy II'' conference held in July, 2003. The Committee 
encourages NINDS to develop specific research plans and goals 
for the anti-epileptic drug development program. The Committee 
requests the Institute for an update on its plans to advance 
these areas of research at the fiscal year 2006 appropriations 
hearing.
    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. 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 may involve the 
production of antibodies that reduce the cellular and 
behavioral effects of the disease. The Committee encourages 
NINDS to continue to assign a high priority to its Alzheimer's 
research portfolio, and to continue to work closely with NIA 
and other institutes.
    Parkinson's disease.--The Committee encourages 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. Participation 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 funding the Morris K. Udall 
Parkinson's Disease Research Centers of Excellence. These 
centers 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.
    Transmissible spongiform encephalopathies (TSE).--The 
Committee recognizes the efforts of NINDS, in collaboration 
with NHLBI, to fund contracts for the development of a 
biological assay for TSE. The Committee requests that the 
Director of the Institute be prepared to provide a report on 
the progress made toward the development of a TSE bioassay at 
the fiscal year 2006 appropriations hearing. The Committee is 
particularly interested in the success in detecting disease-
causing agents in blood, saliva, cerebrospinal fluid, and other 
bodily fluids, as well as lymphoid tissue, especially tonsils.
    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. 
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 encourages NINDS to develop a neuropathy 
research agenda, coordinated with work being done through other 
institutes, and report how much funding NIH is devoting to 
research in this area. The Committee expects to receive a 
report on this effort at next year's hearings.
    Dystonia.--The Committee continues to support the expansion 
of research and treatment developments regarding the 
neurological movement disorder dystonia, the third most common 
movement disorder after tremor and Parkinson's disease. The 
Committee encourages NINDS to support research on both focal 
and generalized dystonia, and commends NINDS for its study of 
the DYT1 gene. The Committee commends NINDS for the release 
with other Institutes of the joint dystonia research program 
announcement. The Committee would like NINDS to be prepared to 
report on the dystonia research portfolio at the FY06 budget 
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.
    Spina bifida.--The Committee encourages NINDS to enhance 
research to address issues related to the outcome of the spina 
bifida conference held in May 2003 and to expand its research 
efforts in the prevention, and treatment of spina bifida and 
associated secondary conditions. The Director should be 
prepared to testify on NINDS efforts to advance these areas of 
research at the fiscal year 2006 appropriations hearing
    Tuberous sclerosis complex.--Tuberous sclerosis complex 
(TSC) is a genetic disorder that triggers uncontrollable tumor 
growth in multiple organs of the body. 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 has been assigned to implement 
and coordinate that effort. NINDS is encouraged 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 looks forward to a report on NINDS's 
coordinating activities and progress towards implementing the 
research agenda prior to the FY2006 hearings.
    Neurofibromatosis (NF).--Advances in NF research have 
linked NF to cancer, brain tumors, learning disabilities and 
heart disease. Because NF plays a pivotal role both in 
disorders of the brain and in cancer and because the promise of 
NF research is now being achieved in the testing of potential 
therapies, the Committee encourages NINDS to enhance 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 holding 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.
    Spinal muscular atrophy (SMA).--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 encourages NINDS to move forward with the mission to 
develop a treatment for SMA to be ready for clinical trials 
within four years. The Committee further encourages NINDS to 
develop a strategy for executing effective clinical trials for 
future therapies. The Committee encourages NINDS to integrate 
therapeutics development efforts with the biotech and 
pharmaceuticals industry, academic medical centers and 
collaborations with voluntary health organizations.
    Down syndrome.--Recently Down syndrome research has begun 
to focus increasingly 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 to 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.
    Mucolipidosis Type IV (ML4).--Since the gene causing this 
debilitating genetic metabolic disorder has been identified, 
the Committee encourages NINDS to support both extramural and 
intramural research which will lead to possible treatments and 
cures for those with ML4. In particular, NINDS is encouraged to 
conduct research involving other organisms which bear genes 
resembling the one whose mutation in humans causes ML4.
    Mucopolysaccharidosis (MPS).--The Committee encourages 
NINDS to collaborate with all appropriate Institutes and 
Centers to support mucopolysaccharidosis research, to study the 
blood brain barrier as an impediment to treatment, and to use 
all available mechanisms to further stimulate and enhance 
efforts to better understand and treat MPS disorders.
    Friedreich's ataxia.--The Committee commends NINDS efforts 
to translate research from bench to bedside, collaborating 
between its intramural and extramural programs and with patient 
advocacy groups to bring promising basic research into clinical 
applications so treatments can be developed. The Committee 
further notes that NINDS co-funded and co-hosted with a patient 
advocacy group this year an international scientific conference 
on Friedreich's ataxia, bringing together one hundred leading 
scientists from twelve countries to share insights and 
accelerate progress toward treatments for this disease. The 
Committee commends NINDS for these types of collaborative, 
translational efforts.
    Neuronal ceroid lipofuscinoses (NCLs).--The Committee 
encourages NINDS to support research projects on NCLs, focusing 
particularly on Batten Disease. The Committee is pleased by 
recent scientific conferences focusing on NCLs and encourages 
NINDS to continue to sponsor these gatherings.

         NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES

    The Committee provides $4,440,007,000 for the National 
Institute of Allergy and Infectious Diseases (NIAID), which is 
$135,445,000 above the fiscal year 2004 comparable level and 
the same as the budget request. $150,000,000 is provided as 
requested in the President's budget for the construction of 
extramural biodefense research facilities. No funds were 
provided for this purpose in fiscal year 2004. In addition, 
bill language is repeated from last year that permits the 
transfer of $100,000,000 to the global AIDS, tuberculosis, and 
malaria fund.
    Mission.--The NIAID supports and conducts basic and 
clinical research and research training programs in infectious 
diseases caused by, or associated with, disorders of the immune 
system. NIAID supported research includes research on acquired 
immunodeficiency syndrome (AIDS), asthma and allergies, 
tuberculosis, sexually transmitted diseases, tropical diseases, 
and emerging microbes. The goals of NIAID research are to 
better understand disease pathogenesis, to improve disease 
diagnosis, to develop new and improved drugs to treat diseases, 
and to develop new and improved vaccines to prevent disease, 
many of which significantly affect public health.
    Tuberculosis.--The World Health Organization estimates that 
nearly one billion people will become infected with 
tuberculosis (TB), 200 million will become sick, and 70 million 
will die worldwide between now and 2020 of this disease. The 
Committee is pleased with NIAID's efforts to develop an 
effective TB vaccine. The Committee encourages the Institute to 
continue its TB vaccine development work and to expand efforts 
to develop new drugs to treat TB.
    Hemophilia.--The Committee appreciates NIAID's efforts to 
improve HIV and hepatitis C virus (HCV) treatment for persons 
with hemophilia or other bleeding disorders and encourages 
NIAID to work with private non-profit groups to strengthen 
support for research on liver disease progression.
    Hepatitis C vaccine.--The Committee is encouraged to learn 
that a small hepatitis C vaccine human trial has been awarded 
and urges the consideration of other creative approaches and 
new paradigms, including the development of DNA vaccines.
    Primary immune deficiency diseases.--The Committee notes 
that more than one hundred primary immune deficiency diseases 
have been identified to date. These diseases, which impair the 
body's immune system, strike most severely at children, many of 
whom do not survive beyond their teens or early twenties. The 
Committee commends NIAID for the establishment of its primary 
immunodeficiency disease research consortium in partnership 
with a private foundation and encourages continued support for 
this program.
    Inflammatory bowel disease.--The Committee continues to 
note with interest a scientific research agenda for Crohn's 
disease and ulcerative colitis (collectively known as 
inflammatory bowel disease) entitled ``Challenges to 
Inflammatory Bowel Disease (IBD).'' This report identifies 
strong linkages between the functions of the immune system and 
IBD. The Committee encourages the Institute to enhance its 
support of research focused on the immunology of IBD, as well 
as the interaction of genetics and environmental factors in the 
development of the disease.
    Asthma.--The Committee is pleased with NIAID's leadership 
regarding asthma research and management. The Committee 
encourages NIAID to continue to improve its focus and effort on 
asthma management, especially as it relates to children. The 
Committee also encourages 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 may play a role in the development of 
asthma. The Committee suggests the Institute expand research 
into the role that infections and vaccines may play in the 
development of asthma.
    Transplantation research.--The Committee encourages NIAID 
to convene an expert conference to develop a transplantation 
research action plan identifying the most urgently needed 
research to facilitate an increase in the success of organ 
transplantation.
    Scleroderma.--The Committee encourages NIAID to conduct 
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 needed in order to 
develop safe, effective treatments and to identify the causes 
of scleroderma and its complications. NIAID is encouraged to 
consider including scleroderma as one of the diseases in the 
Autoimmune Centers of Excellence (ACE) program in order to 
address these important questions.
    Atopic dermatitis.--Atopic dermatitis (AD) is one of the 
most common skin disorders experienced in infants and children. 
Over 90% of cases are diagnosed before the age of five. 
Patients with AD suffer with chronic skin inflammation and 
itching that disrupt sleep and reduce quality of life. An 
estimated 17 percent of children in the United States have 
atopic dermatitis, a dramatic increase above the pre-1960s 
level of approximately 3 percent. The reason for this increase 
is unknown, but mirrors the increased rates of asthma and 
requires greater study. 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.
    Nasal aerosol and spray vaccine delivery systems.--Recent 
developments exploring new routes of immunization such as 
delivery of measles vaccine via aerosol and nasal spray may 
generate significant savings and result in fewer side effects 
than immunization by injection. The Committee encourages NIAID 
to support research in developing and testing these new 
approaches, building upon the testing already completed in 
older children, to investigate this delivery method in younger 
children.
    Meningococcal disease.--Although meningococcal disease is 
vaccine-preventable in most cases, approximately 30 percent of 
the deaths and disabilities from this bacterial infection are 
attributed to serogroup B, which is not vaccine-preventable. 
The Committee encourages NIAID to increase research efforts to 
develop an effective, low-cost vaccine against serogroup B that 
will help protect infants and adolescents.
    Genomics.--The Committee is pleased that NIAID has focused 
on research efforts associated with multiple categories of 
pathogens. The Committee understands that microarray technology 
has enhanced the progress of pathogen-related research. The 
Committee encourages NIAID to continue to use this technology 
to further support an aggressive agenda of pathogen research 
activities.
    Condom effectiveness.--The Committee recognizes the 
interest in the June 2000 NIH-STD Condom Report and the 
attention that this report calls to the epidemic of sexually 
transmitted diseases (STDs) that the nation is experiencing. 
The Committee encourages NIH to continue its practice of making 
advances in STD research available to the public and to health 
practitioners through web sites and other publications.

             NATIONAL INSTITUTE OF GENERAL MEDICAL SCIENCES

    The Committee provides $1,959,810,000 for the National 
Institute of General Medical Sciences (NIGMS), which is 
$54,972,000 above the fiscal year 2004 comparable level and the 
same as the budget request.
    Mission.--The NIGMS supports research and research training 
in the basic biomedical sciences. Institute grantees, working 
in such fields as cell biology, biophysics, genetics, 
developmental biology, pharmacology, physiology, and biological 
chemistry, study normal biological processes to better 
understand what goes wrong when disease occurs. In this way, 
NIGMS supports 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 find applications in the biotechnology 
and pharmaceutical industries. The Institute's training 
programs help provide the scientists needed by industry and 
academia.
    Training programs.--The Committee continues to be pleased 
with the quality of NIGMS's training programs, particularly 
those that have a special focus on increasing the number of 
minority scientists, such as the Minority Access to Research 
Careers (MARC) and Minority Biomedical Research Support (MBRS) 
programs. The Committee encourages NIGMS to continue to support 
these important initiatives, and is particularly pleased that 
NIGMS has supported biomedical research career opportunity 
programs for high school and undergraduate college students in 
conjunction with historically black health professions schools. 
The Committee encourages continued, long-term support of this 
program.

        NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT

    The Committee provides $1,280,915,000 for the National 
Institute of Child Health and Human Development (NICHD), which 
is $38,544,000 above the fiscal year 2004 comparable level and 
the same as the budget request.
    Mission.--The NICHD conducts and supports laboratory and 
clinical research on the reproductive, developmental, and 
behavioral processes that determine and maintain the health and 
well-being of children, adults, families and populations. In 
addition, research in medical rehabilitation is supported.
    Sudden infant death syndrome.--The Committee is pleased 
with NICHD's continued efforts to extend the reach of its 
``Back to Sleep'' campaign to underserved populations and 
daycare providers. The Committee encourages NICHD to transition 
from its SIDS five-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.
    Prematurity.--The Committee encourages NICHD to support 
genomic and proteomic research in the area of prematurity to 
hasten a better understanding of the pathophysiology of 
premature birth, discover novel diagnostic biomarkers, and 
ultimately aid in formulating more effective interventional 
strategies to prevent premature birth.
    Preterm labor and delivery.--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. 
Premature birth can happen to any pregnant woman and the causes 
of nearly half of all preterm births are unknown. The Committee 
commends NICHD for its work on preterm birth and encourages 
enhanced efforts to research the underlying causes of preterm 
delivery, to identify prevention strategies and improve the 
treatment and outcomes for infants born preterm.
    Maternal Fetal Medicine Units Network (MFMU).--The 
Committee was encouraged about the research results from NICHD' 
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. The Committee encourages NICHD to build on this 
finding through continued support of the MFMU Network.
    Stillbirth.--The Committee applauds NICHD 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. The Committee encourages NICHD to strongly 
support this effort.
    Pediatric liver disease.--The Committee urges the Institute 
to aggressively pursue opportunities to participate with NIDDK 
and other Institutes in pediatric liver disease research, 
particularly related to the optimal timing and medical 
treatment regimens for children infected with the hepatitis C 
virus. The Committee also encourages NICHD support of biliary 
atresia research.
    Spina bifida.--The Committee is pleased that NICHD 
cosponsored the spina bifida research conference in May 2003 
and urges adequate follow-up on the conference findings and 
recommendations. The Committee encourages NICHD to enhance 
research related to the outcome of the conference and to 
significantly expand its research efforts in the prevention and 
treatment of spina bifida and associated secondary conditions. 
The Director should be prepared to testify on the Institute's 
efforts to advance these areas of research at the fiscal year 
2006 appropriations hearing.
    Primary immunodeficiency diseases.--The Committee continues 
to be impressed with the dedication of resources by NICHD to 
address the research and awareness issues that surround this 
class of more than one hundred diseases. The Committee is 
particularly encouraged by the Institute's research commitment 
to develop newborn screening procedures for primary 
immunodeficiency through microarray technologies and encourages 
NICHD to press ahead with this initiative.
    Neurofibromatosis (NF).--Learning disabilities occur with 
high frequency in children with NF. Recent advances in NF 
research describe how the NF gene is related to learning 
disabilities, advancing the prospects of finding a treatment 
for learning disabilities not only in children with NF but in 
the general population as well. The Committee encourages NICHD 
to enhance this promising NF research.
    Down syndrome.--The Committee encourages NICHD to enhance 
funding for Down syndromes research as it 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 the shortage of mice used 
in the research of Down syndrome and encourages NICHD to 
strengthen its support for greater production of the Ts65Dn 
mouse model and for the research and development of other mouse 
models. The Committee also encourages NICHD to work closely 
with NINDS, NIA, NIH and NHGRI to establish a new, multi-year 
research initiative to fund Down syndrome biomedical research 
on cognition, behavior and early dementia.
    Limb loss.--The Committee is aware of the development of 
the Amputee Care Center at Walter Reed Army Medical Center to 
improve the level of care within military medicine for those 
who are injured and lose limbs. The Committee urges NICHD, 
working through the National Center for Medical Rehabilitation 
Research, to work in partnership with Walter Reed to support 
its efforts to conduct clinical research focused on developing 
new amputee-care metrics applicable to the rehabilitation of 
highly active persons with limb loss. Additional clinical 
research is also needed to better understand the applicability 
of new technology to various segments of the limb-loss 
population, ranging from highly functional military personnel 
who have been injured in Operation Iraqi Freedom to older 
Americans who might not otherwise ambulate with traditional 
prosthetic technology. Advances have recently been made by the 
private sector to develop breakthrough prosthetic limb 
technologies which have dramatically improved the 
functionality, stamina and psycho-social well being of 
patients, in particular, the microprocessor-controlled 
hydraulic fluid swing and stance phase knee device technology. 
The Committee encourages NICHD to consider supporting this type 
of research, using all appropriate mechanisms.
    Spinal muscular atrophy.-- Spinal muscular atrophy [SMA] is 
the leading genetic killer of infants and toddlers and is the 
most prevalent genetic motor neuron disease. Over 25,000 
Americans, mostly children, suffer from significant physical 
disability and impairment as a result of SMA. The Committee 
encourages NICHD to work closely with NINDS to develop 
collaborations which will support the SMA Therapeutics 
Development project, including an expansion of the scope and 
level of SMA research at NICHD. In addition, NICHD is 
encouraged to develop formal programs that increase public and 
professional awareness of SMA.
    National children's study.--The Committee remains 
interested in the national children's study, which aims to 
quantify the impacts of a broad range of environmental 
influences, including physical, chemical, biological and social 
influences, on child health and development. The Committee 
encourages NICHD to continue to coordinate closely with the 
CDC, EPA, other institutes and agencies and non-Federal 
partners conducting research on children's environmental health 
and development.
    Fragile X.--The Committee believes that the National Center 
on Birth Defects and Developmental Disabilities' 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, the Committee recommends that NICHD 
develop 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 syndrome and 
other developmental disabilities.
    Bone diseases.--The Committee encourages NICHD to support 
research on the effects of drugs on the growing skeleton and to 
work to ensure that the impact on the ongoing skeleton is 
investigated for all therapeutic agents. The Committee also 
encourages NICHD to participate in trans-NIH research about 
other factors--including genetics, diet and exercises--
affecting the determination of peak bone mass in children with 
and without the metabolic bone diseases of osteoporosis and 
osteogenesis imperfecta.
    Demographic research.--The Committee commends NICHD for its 
support of demographic research. This research has provided 
critical scientific knowledge on issues such as work-family 
conflicts, family formation and structure, childcare, 
adolescent health and wellness, family and household behavior, 
the role of maternal employment, and parental involvement on 
child development. The Committee encourages NICHD to continue 
support for the Population Research Infrastructure program. The 
diverse research supported by this program has yielded key 
findings in areas such as fertility, health disparities, 
immigration and migration trends, and family dynamics.

                         NATIONAL EYE INSTITUTE

    The Committee provides $671,578,000 for the National Eye 
Institute (NEI), which is $18,526,000 above the fiscal year 
2004 comparable level and the same as the budget request.
    Mission.--The NEI conducts and supports basic and clinical 
research, research training, and other programs with respect to 
blinding eye diseases, visual disorders, mechanisms of visual 
function, preservation of sight, and the special health 
problems and needs of individuals who are visually-impaired or 
blind. In addition, the NEI is responsible for the 
dissemination of information, specifically public and 
professional education programs aimed at the prevention of 
blindness.
    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. This gene therapy 
intervention has been successfully demonstrated in laboratory 
animals. The Committee encourages 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 encourages 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.
    Ocular albinism.--Ocular albinism is a hereditary, blinding 
disease that causes severely distorted vision in children. 
Victims, who are usually boys and receive the defective gene 
from their mother, experience nystagmus, photophobia, lack of 
stereoscopic vision, strabismus, and other symptoms which deny 
these children normal vision. In recent years, research has 
made great strides in the search for improved diagnostic tools 
and treatments. Recently, the OA1 gene, responsible for most 
cases of the disease, was identified, and a diagnostic 
screening test was created to help women determine if they are 
at risk of passing the disease on to their children. As 
researchers move closer to understanding how this disease works 
and developing potential treatments that could improve the 
vision of children with the condition, the Committee requests 
NEI to be prepared to report on advances in research on ocular 
albinism in the fiscal year 2006 hearing.
    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 enhance its efforts 
to detect, prevent and treat diabetic retinopathy by 
collaborating with NIBIB on the development and application of 
scanning technologies that will be affordable and accessible to 
allow for early detection.

          NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES

    The Committee provides $650,027,000 for the National 
Institute of Environmental Health Science (NIEHS), which is 
$17,635,000 above the fiscal year 2004 comparable level and the 
same as the budget request.
    Mission.--The NIEHS mission is to reduce the burden of 
environmentally related illness and dysfunction by 
understanding how environmental exposures affect health, how 
individuals differ in their susceptibility to these effects, 
and how these susceptibilities change over time. This mission 
is achieved through multidisciplinary biomedical research 
programs, prevention and intervention efforts, and 
communication strategies that encompass training, education, 
technology transfer, and community outreach.
    Environmental exposures and lung disease.--The Committee is 
pleased to note NIEHS's support of studies that establish 
epidemiological links between environmental exposures and the 
development of lung disease like asthma and COPD. The Committee 
encourages the Institute to enhance its research into how 
environmental stimuli interact with the lung to produce lung 
disease, with emphasis on cellular responses to inhaled 
pollutants and the subsequent cell signaling steps that lead to 
disease.
    Juvenile diabetes.--The Committee commends NIEHS efforts on 
the Environmental Genome Project (EGP), which seeks to 
understand how individuals differ in their susceptibility to 
environmental agents and how these susceptibilities change over 
time. This project may help to identify environmental triggers 
for diseases such as Type 1 diabetes. The Committee encourages 
enhanced efforts to interact and coordinate EGP with efforts 
like NIDDK's Environmental Determinants of Diabetes in the 
Young (TEDDY) Study, to investigate genetic and gene-
environment interactions in the development of prediabetic 
autoimmunity and Type 1 diabetes.
    Mercury.--In order to properly research gaps in the area of 
mercury exposure and brain chemistry, and given recent hearings 
on mercury exposure and relationships between autism and 
Alzheimer's disease and mercury exposure, NIEHS is encouraged 
to pursue studies of how inorganic mercury and organic mercury 
compounds (including ethyl, methyl, and other forms of mercury 
from all sources) are processed in the bodies of children and 
adults. NIEHS is also encouraged to support studies of the 
toxic effects of inorganic mercury and organic mercury 
compounds on the nervous systems of young children, adults, and 
the elderly and methods of properly removing mercury and 
mercury-containing compounds from the brains of affected 
humans.
    Toxic exposure and brain development.--Notwithstanding the 
Institute of Medicine May 2004 report on autism, the Committee 
believes it is important to develop a more complete 
understanding of the impact that toxic exposures may have on 
brain development. There is a convergence of findings from 
tissue culture studies, animal models, and clinical studies of 
immune dysfunction in children with autism that suggests a 
biological link between genetic sensitivity and damage to 
developing brains from certain toxins. It is important that NIH 
continue this research to better understand the impact that 
exposures to mercury (including thimerosal) and other toxins 
have on brain development. A more complete understanding of the 
impact of these exposures through research, including animal 
models, will help to develop more effective interventions.
    National Toxicology Program.--In order for the Interagency 
Coordinating Committee for the Validation of Alternative 
Methods (ICCVAM) to carry out its responsibilities under the 
ICCVAM Authorization Act, the Committee encourages NIEHS to 
strengthen the resources provided for ICCVAM activities in 
order to ensure that new and alternative test methods used or 
recommended for federal regulatory agencies, and those under 
consideration or planned for use within the National Toxicology 
Program's toxicity testing project, are validated prior to 
their use.
    Parkinson's disease.--The Committee encourages NIEHS in 
collaboration with NINDS to gain a greater understanding of the 
environmental underpinnings of Parkinson's disease. The 
Committee also encourages NIEHS to intensify its efforts in the 
Collaborative Centers for Parkinson's Disease Research Program. 
This initiative facilitates significant collaboration between 
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

    The Committee provides $1,055,666,000 for the National 
Institute on Aging (NIA), which is $30,912,000 above the fiscal 
year 2004 comparable level and the same as the budget request.
    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.
    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 billion. The Committee notes 
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. The Committee encourages 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.
    Down syndrome.--Research has shown that many people 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 encourages NIA to study the 
connection between Alzheimer's disease and Down syndrome and to 
work closely with NINDS, NICHD, NIMH and NHGRI to establish an 
initiative to support Down syndrome research on improving 
cognition and preventing early dementia through biomedical 
treatments.
    End-of-life/palliative care.--The Committee encourages NIA 
to expand research, implementation of insights in practice, and 
training programs, aiming to understand the mechanisms of 
disability and suffering in fatal chronic illness and to 
prevent and relieve that disability and suffering, particularly 
with respect to pain management.
    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 a voluntary organization and NIA, 
with the participation of NHLBI, NCI and NIDDK, to develop a 
research agenda in this field. The Committee requests a report 
on the priority research areas identified in anemia in the 
elderly that offer promising clinical opportunities and the 
steps to be taken to accelerate research in these areas.
    Bone diseases.--The Committee encourages NIA to strengthen 
support of research into the pathophysiology of osteoporosis, 
Paget's disease and osteogenesis imperfecta. Research is needed 
in the areas of 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.
    Parkinson's disease.--The Committee encourages NIA to 
collaborate with NINDS in developing a greater understanding of 
the overlap in benefits that current research could provide to 
understanding both Alzheimer's and Parkinson's disease. The 
Committee applauds 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 nearly 
stages of the disease, and the development of accurate animal 
models.
    Demographic and economic research.--The Committee commends 
NIA for supporting demographic and economic research and, in 
particular, the NIA Demography of Aging Centers program. This 
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. The Demography 
Centers are 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. The Committee encourages NIA to continue its 
support of the demography centers program.

 NATIONAL INSTITUTE OF ARTHRITIS AND MUSCULOSKELETAL AND SKIN DISEASES

    The Committee provides $515,378,000 for the National 
Institute of Arthritis and Musculoskeletal and Skin Diseases 
(NIAMS), which is $14,312,000 above the fiscal year 2004 
comparable level and the same as the budget request.
    Mission.--The NIAMS conducts and supports basic and 
clinical research and research training, and the dissemination 
of health information on the more than 100 forms of arthritis; 
osteoporosis and other bone diseases; muscle biology and muscle 
diseases; orthopaedic disorders, such as back pain and sports 
injuries; and numerous skin diseases.
    Bone diseases.--The Committee encourages 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, and on bone 
health and osteoporosis in special groups, such as non-
Caucasian ethnic groups.
    Scoliosis.--The Committee encourages NIAMS, in coordination 
with other institutes, to enhance research relevant to 
scoliosis to identify bio-mechanical causes and to develop 
genetic strategies to prevent the condition.
    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 Committees encourages NIAMS to 
collaborate with other institutes, including NHLBI, NIAID, 
NIDDK, and NIDCR, to generate additional research opportunities 
for scleroderma to identify genetic risk factors and safe and 
effective treatments.
    Vitiligo treatments for children.--Vitiligo is an 
environmental and genetic auto-immune disease of unknown origin 
which affects about three to six million Americans. Almost 
fifty percent develop the disease in childhood, with the median 
age of onset at four years of age. In its most severe forms, 
patients have milky white patches covering widespread areas of 
the body due to the loss of pigment in these areas. Especially 
for young children, the physical pain caused by severe burns 
from the harmful effects of sunlight and the emotional pain 
caused by people confusing vitiligo with an infectious disease 
diminishes the quality of a patient's life. There are no FDA-
approved treatments for children. The Committee urges NIAMS to 
enhance research efforts through all available mechanisms, as 
appropriate, to identify the causes of this disease and develop 
pediatric treatment options for vitiligo.
    Marfan syndrome.--The Committee commends NIAMS for its 
collaboration with other institutes to support research on 
Marfan syndrome, a life-threatening, progressive and 
degenerative genetic disorder. Marfan syndrome is characterized 
by cardiovascular, skeletal and ocular manifestations and its 
cardiovascular complications can result in premature death. 
Insights gained from research in this area may have 
implications for the understanding of other connective tissue 
disorders, other genetically mediated diseases, and the larger 
population of aging adults with thoracic aneurysms from a 
variety of causes. The Committee encourages NIAMS to focus on 
research opportunities which have the potential to advance non-
surgical treatment options, through all appropriate mechanisms.
    Pemphigus registry.--The Committee encourages NIAMS to 
consider establishing a national pemphigus registry, which 
would be important to the scientific community and patients in 
identifying the epidemiology, improving the understanding of 
the potential causes, and assessing the value of therapies for 
this chronic and life-threatening autoimmune disease. The 
Committee requests a report from NIAMS about whether such a 
registry will be established and under what timeframe.
    Tuberous sclerosis complex.--Tuberous sclerosis complex 
(TSC) is a genetic disorder that triggers uncontrollable tumor 
growth in multiple organs of the body, including the skin. The 
Committee 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.
    Atopic dermatitis.--Atopic dermatitis (AD) is one of the 
most common skin disorders experienced by infants and children. 
Over 90 percent of cases are diagnosed before the age of five. 
Patients with AD suffer with chronic skin inflammation and 
itching that disrupt sleep and reduce quality of life. An 
estimated 17 percent of children in the United States have 
atopic dermatitis, a dramatic increase above pre-1960s levels. 
The reason for this increase is unknown, but mirrors the 
increased rates of asthma and requires greater study. 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 NIAMS to work with NIAID to 
spearhead an 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.
    Burden of skin diseases.--The Committee commends NIAMS for 
conducting a workshop on the burden of skin diseases. The 
participants in the workshop recommended that skin disease-
specific measures be developed in order to generate data on the 
incidence, prevalence, economic burden and disability 
attributable to these diseases. The Committee encourages NIAMS 
to continue to work with the scientific community to implement 
the recommendations of the workshop participants.
    Psoriasis.--Psoriasis is a chronic, immune-mediated disease 
that affects more than five 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 important, and is pleased 
that NIAMS helped create a psoriasis tissue bank from which the 
first several psoriasis genes have been identified. The 
Committee encourages NIAMS to support additional research into 
the identification of other genes expected to play a role in 
psoriasis pathogenesis and to strengthen clinical research on 
potential therapies for psoriasis and psoriatic arthritis.
    Mucolipidosis Type IV (ML4).--The Committee commends NIMH 
for its efforts to create a strain of mice which replicates the 
genetic mutation which in humans causes this debilitating 
genetic metabolic disorder, and encourages NIMH to complete 
this work. Now that the gene which causes this disorder has 
been identified, research on such organisms is crucial to the 
eventual development of treatments or cures for this and 
similar genetic disorders.
    Mucopolysaccharidosis (MPS).--The Committee is aware of 
NIAMS's 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. The Committee 
encourages NIAMS to enhance its efforts to directly support and 
collaborate with NIDDK on bone and joint diseases in MPS 
disorders.

    NATIONAL INSTITUTE ON DEAFNESS AND OTHER COMMUNICATION DISORDERS

    The Committee provides $393,507,000 for the National 
Institute on Deafness and Other Communication Disorders 
(NIDCD), which is $11,454,000 above the fiscal year 2004 
comparable level and the same as the budget request.
    Mission.--The NIDCD funds and conducts research in human 
communication. Included in its program areas are research and 
research training in the normal and disordered mechanisms of 
hearing, balance, smell, taste, voice, speech and language. The 
Institute addresses special biomedical and behavioral problems 
associated with people who have communication impairments or 
disorders. In addition, the NIDCD is actively involved in 
health promotion and disease prevention, dissemination of 
research results, and supports efforts to create devices that 
substitute for lost and impaired sensory and communication 
functions.
    Dysphonia.--The Committee continues to be pleased with 
NIDCD's expanding intramural research program with respect to 
dysphonia. The Committee commends NIDCD on the release of a 
joint program announcement with NINDS, which will lead to a 
more active extramural research effort on dysphonia, and 
collaboration with other NIH Institutes on this important 
disorder. The Committee requests a report on the number of 
dysphonia grant proposals received and funded as a result of 
the joint program announcement.
    Inner ear protection, rescue and regeneration.--The 
Committee encourages 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 is encouraged to continue research 
on rehabilitative technologies and strategies, leading to 
improved prevention, treatment and management of hearing loss, 
tinnitus and dizziness.
    Stuttering.--The Committee received testimony concerning 
stuttering which affects approximately three 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 consensus conference to examine the current state of 
science as well as to identify future research opportunities in 
the field of stuttering and to report to the Committee on the 
outcome of this conference prior to next year's hearings.
    Neurofibromatosis (NF).--NF accounts for approximately five 
percent of genetic forms of deafness and, 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 NF mice through gene therapy, 
which could prove beneficial for gene therapy in general and 
for patients suffering from meningiomas and other tumors. The 
Committee encourages NIDCD to enhance its NF research portfolio 
through all suitable mechanisms, including clinical trials and 
RFAs.

                 NATIONAL INSTITUTE OF NURSING RESEARCH

    The Committee provides $139,198,000 for the National 
Institute of Nursing Research (NINR), which is $4,474,000 above 
the fiscal year 2004 comparable level and the same as the 
budget request.
    Mission.--The NINR supports and conducts scientific 
research and research training to reduce the burden of illness 
and disability; improve health-related quality of life; and 
establish better approaches to promote health and prevent 
disease.
    Nurse management of chronic illness.--The Committee is 
aware of the increasing role nurses play in patient education 
and management of chronic diseases like asthma and chronic 
obstructive pulmonary disease (COPD). The Committee encourages 
NINR to partner with other institutes to develop effective 
patient education and management models for nurses to use in 
the care and management of asthma and COPD.
    Health disparities.--The Committee commends NINR for its 
longstanding support of research to reduce health disparities 
among minorities. Along with research in promoting the health 
of minority men, NINR has focused past efforts on identifying 
risk factors and strategies to reduce the high rates of low 
birth-weight babies born to minority women. The Committee 
encourages NINR to expand these efforts to study other women's 
health issues and to measure health indicators such as 
physiological, socioeconomic, emotional, environmental, 
cultural, and genetic factors.
    The seventeen recently-initiated Nursing Partnership 
Centers to Reduce Health Disparities are of special interest to 
the Committee. NINR's goal of bringing together research-
intensive schools of nursing and minority-serving schools of 
nursing into partnerships to promote health disparities 
research and expand the number of minority nurse researchers is 
commendable. The Committee looks forward to learning more about 
this creative approach.
    Self-management.--The Committee encourages NINR to continue 
its strong focus on self-management for patients who live with 
chronic illness. Advancing knowledge of technological 
innovations that help people manage their own health and 
promote their quality of life is a key area for research.
    End-of-life care.--Dissatisfaction with care during the 
last stages of life has been widely reported by recent studies. 
The Committee applauds NINR's plans to focus on children during 
the end-of-life, especially since the Institute of Medicine 
recently identified this population as being overlooked by 
research.
    Nurse shortage.--The nursing shortage is of serious concern 
to the Committee, not only because of its effects on the health 
care system, but because it has reduced the number of nurse 
researchers and educators. NINR's activities to confront this 
issue by increasing support for training programs, such as 
fast-track baccalaureate-to-doctoral training and promotion of 
careers in patient-oriented research, are encouraging. These 
efforts will play an important role in ensuring an adequate 
number of nurse researchers and faculty for the future.
    Genetics.--Advances in genetics will revolutionize many 
aspects of health and healthcare. The Committee is pleased that 
NINR is integrating genetics into nursing research, practice, 
and education. NINR's annual eight-week Summer Genetics 
Institute increases expertise in genetics and conveys genetic 
knowledge that ranges from tailoring drugs according to 
genotype to providing genetic counseling for individuals and 
families.

           NATIONAL INSTITUTE ON ALCOHOL ABUSE AND ALCOHOLISM

    The Committee provides $441,911,000 for the National 
Institute on Alcohol Abuse and Alcoholism (NIAAA), which is 
$13,242,000 above the fiscal year 2004 comparable level and the 
same as the budget request.
    Mission.--The NIAAA supports research to generate new 
knowledge to answer crucial questions about why people drink; 
why some individuals are vulnerable to alcohol dependence or 
alcohol-related diseases and others are not; the relationship 
of genetic and environmental factors involved in alcoholism; 
the mechanisms whereby alcohol produces its disabling effects, 
including organ damage; how to prevent alcohol misuse and 
associated damage and how alcoholism treatment can be improved. 
NIAAA addresses these questions through a program of 
biomedical, behavioral, and epidemiologic research on 
alcoholism, alcohol abuse, and related problems. This program 
includes various areas of special emphasis such as medications 
development, fetal alcohol syndrome, genetics, and moderate 
drinking.
    Asian American and Pacific Islander (AAPI) populations.--
The Committee suggests that NIAAA take further steps to meet 
the research needs of the rapidly growing AAPI populations in 
the fifty states and the six Pacific Island jurisdictions. 
NIAAA should consider creating an NIAAA Asian American and 
Pacific Islander Workgroup to develop an AAPI research agenda 
and implementation plan for alcohol and alcohol abuse issues.
    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 
encourages 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.
    Underage rural drinking.--The Committee understands that 
alcohol is the number one drug of choice among children and 
adolescents in this country. The Committee commends NIAAA for 
being one of the scientific leaders in developing prevention/
intervention programs for young people with alcohol and risky 
behavior problems. It encourages NIAAA to continue to provide 
leadership in developing model longitudinal prevention/
intervention community-based programs focusing on how 
individual families, school and community networks can help 
reduce high-risk behavior among nine- to fifteen-year olds in 
rural and small urban areas. The Committee encourages NIAAA to 
continue to utilize the expertise of academic health centers in 
this effort.

                    NATIONAL INSTITUTE ON DRUG ABUSE

    The Committee provides $1,012,760,000 for the National 
Institute on Drug Abuse (NIDA), which is $21,807,000 above the 
fiscal year 2004 comparable level and the same as the budget 
request. In addition, $6,300,000 is made available as requested 
by the Administration from program evaluation funds to carry 
out surveys of drug abuse.
    Mission.--NIDA-supported science addresses questions about 
drug abuse and addiction, which range from its causes and 
consequences to its prevention and treatment. NIDA research 
explores how drugs of abuse affect the brain and behavior and 
develops effective prevention and treatment strategies; the 
Institute works to ensure the transfer of scientific data to 
policy makers, practitioners, and the public.
    Asian American and Pacific Islander (AAPI) populations.--
The Committee suggests that NIDA take further steps to meet the 
research needs of the rapidly growing AAPI populations in the 
fifty states and the six Pacific Island jurisdictions. In 
particular, AAPI research with respect to substance abuse 
prevention, treatment, services and training is needed to help 
address the public health needs of these populations. The NIDA 
AAPI Workgroup has provided important recommendations to NIDA 
critical to developing the needed body of scientific knowledge 
regarding AAPIs, and the Committee encourages NIDA to consider 
carefully these recommendations and take action where 
warranted.

                  NATIONAL INSTITUTE OF MENTAL HEALTH

    The Committee provides $1,420,609,000 for the National 
Institute of Mental Health (NIMH), which is $38,835,000 above 
the fiscal year 2004 comparable level and the same as the 
budget request.
    Mission.--The NIMH is responsible for research activities 
that seek to improve diagnosis, treatments, and overall quality 
of care for persons with mental illnesses. Disorders of high 
priority to NIMH include schizophrenia, depression and manic 
depressive illness, obsessive-compulsive disorder, anxiety 
disorders and other mental and behavioral disorders that occur 
across the lifespan; these include childhood mental disorders 
such as autism and attention-deficit/hyperactivity disorder; 
eating disorders; Alzheimer's disease; and other illnesses. 
NIMH supports and conducts fundamental research in 
neuroscience, genetics, and behavioral science. In addition to 
laboratory and controlled clinical studies, the NIMH supports 
research on the mental health needs of special populations and 
health services research.
    Mental health research and the aging.--The Committee is 
aware that demographics will demand a greatly increased focus 
on mental disorders in older persons, and consequently the 
Committee continues to be interested in supporting funding for 
late-life mental health research at NIMH. The committee 
encourages NIMH to strengthen the resources supporting aging 
research and to provide data on existing funds targeted toward 
geriatric mental health research.
    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 encourages NIMH to work 
closely with NINDS, NICHD, NIA and NHGRI to establish a 
research initiative to fund Down syndrome research relating to 
cognition and behavior through biomedical interventions.
    Alzheimer's disease.--Recently, NIMH launched a trial of 
antidepressant medications designed identify the best 
medication regimen of 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.
    Parkinson's disease.--The Committee encourages NIMH to 
enhance its research on the role of depression in Parkinson's 
disease. 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.

                NATIONAL HUMAN GENOME RESEARCH INSTITUTE

    The Committee provides $492,670,000 for the National Human 
Genome Research Institute (NHGRI), which is $13,597,000 above 
the fiscal year 2004 comparable level and the same as the 
budget request.
    Mission.--NHGRI coordinates extramural and intramural 
research, as well as research training, in the areas 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 research on 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.
    Targeting disease prevention.--The Committee commends NHGRI 
for creating the Encyclopedia of DNA Elements (ENCODE) project, 
which has a long-term goal of creating a comprehensive 
catalogue of the functional components encoded in the human 
genome. This project will help scientists mine and fully 
utilize the human sequence, gain a deeper understanding of 
human biology, predict potential disease risk, and stimulate 
the development of new genome technologies as well as 
strategies for the prevention and treatment of disease. The 
Committee is also pleased with the progress of the 
international haplotype mapping (HapMap) project and looks 
forward to its completion in 2005. In each of these areas, the 
Committee recognizes that advances in the use of new genomic 
technologies, including different types of microarrays, can 
enhance NHGRI's global leadership in meeting these goals.
    Neurogenomics and neuroinformatics.--The Committee 
encourages NHGRI to assist private efforts to collect and 
integrate the various repositories of neuroscience information, 
including brain imaging, with genome information and cross-
referencing this with human disease to advance knowledge along 
a broad front of neurologic, psychiatric and neurodegenerative 
diseases, their causes and cures.

      NATIONAL INSTITUTE OF BIOMEDICAL IMAGING AND BIOENGINEERING

    The Committee provides $297,647,000 for the National 
Institute of Biomedical Imaging and Bioengineering (NIBIB), 
which is $10,518,000 above the fiscal year 2004 comparable 
level and the same as the budget request.
    Mission.--The mission of the Institute is to improve 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.
    NIBIB growth.--The Committee recognizes the important role 
of new imaging and engineering techniques and technologies both 
in improving health care delivery and enabling progress in 
biomedical research. The Committee believes that NIBIB has 
worked effectively with the extramural community to identify 
important research opportunities and challenges. Through 
workshops and conferences NIBIB has produced an ambitious 
research agenda that will produce new technologies with 
clinical applications to a broad spectrum of biological 
processes, disorders, and diseases and across organ systems as 
well as facilitate advanced research in virtually all other NIH 
institutes. The NIH leadership has recognized the central role 
of imaging by including the development of molecular imaging 
and molecular libraries as an initiative in the NIH Roadmap for 
Medical Research. The important innovations envisioned in the 
imaging and biomedical engineering agenda are unlikely to be 
achieved in the foreseeable future, however, unless additional 
resources are available to NIBIB. Because NIBIB was created at 
the end of the congressional effort to double the NIH budget 
over five years, it faces special challenges as funding growth 
slows. The Committee urges the Director of NIH to give NIBIB 
special attention so that it can achieve its potential. For 
that reason, the Committee requests NIH to develop a five-year 
professional judgment budget that would enable NIBIB to grow at 
an appropriate rate. The Committee expects to receive the 
report by May 1, 2005.
    Bone imaging.--The Committee encourages 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, which 
are necessary to develop diagnostic and treatment therapies for 
patients with metabolic bone diseases. The Committee encourages 
NIBIB to participate actively in trans-NIH initiatives that 
address these priorities.
    Organ imaging.--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 diagnostic tests now required for liver diseases and 
the need to address the shortage of livers and other organs 
available for transplantation.
    Diabetic retinopathy.--The Committee encourages NIBIB to 
collaborate with NEI on the development and application of 
scanning technologies that will be affordable and accessible to 
allow for early detection of diabetic retinopathy.

                 NATIONAL CENTER FOR RESEARCH RESOURCES

    The Committee provides $1,094,141,000 for the National 
Center for Research Resources (NCRR), which is $84,917,000 
below the fiscal year 2004 comparable level and the same as the 
budget request. The Committee does not include bill language 
identifying funding for extramural facility construction, which 
is the same as the Administration request. $118,497,000 was 
provided in fiscal year 2004 for extramural construction.
    Mission.--The NCRR develops and supports critical research 
technologies and shared resources that underpin biomedical 
research. The NCRR programs develop a variety of research 
resources; provide 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.
    Institutional development awards (IDeA).--The Committee has 
identified $222,000,000 for this program, which is the same as 
the Administration request and $8,000,000 above the fiscal year 
2004 level. The program is comprised of the Centers of 
Biomedical Research Excellence (COBRE) program and Biomedical 
Research Infrastructure Network (BRIN) program. The focus of 
IDeA should continue to be on improving the necessary 
infrastructure and strengthening the biomedical research 
capacity and capability of research institutions within the 
IDeA states.
    National primate research centers.--The Committee values 
the important role played by the eight national primate 
centers. In the past several years, there has been an extensive 
expansion of the breadth and volume of demands for primate 
center resources. The Committee encourages NCRR to strengthen 
the base support for these centers and to conduct an assessment 
of primate center resource needs. This assessment should be 
submitted to the Committee at the time of the FY 2006 budget 
request.
    Health disparities centers.--The Committee commends NCRR 
for its proposal to establish comprehensive centers for health 
disparities research and looks forward to learning more about 
this important new initiative.
    Research centers at minority institutions (RCMI).--The 
Committee continues to recognize the important role played by 
minority institutions at both the graduate and undergraduate 
level in addressing the health research and training needs of 
minority populations. These programs help facilitate the 
preparation of a new generation of scientists at these 
institutions. The RCMI program continues to address these 
problems. The Committee encourages NCRR to strengthen 
participation from minority institutions. The Committee also 
encourages NCRR to work with minority institutions with a track 
record of producing minority scholars in science and 
technology.
    General clinical research centers (GCRCs).--The 79 NCRR-
funded general clinical research centers across the country are 
important 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. The Committee 
is concerned that NCRR has in the past included activities not 
related to GCRCs in NCRR-reported funding totals for the GCRCs. 
In the future, the Committee expects NCRR to restrict its 
reporting to funds that go directly to GCRCs instead of 
including general clinical research activities in those totals.
    Islet resource centers.--The Committee encourages NCRR to 
accelerate the efforts of the islet cell resource centers to 
improve the quality and yield of islets, to improve the storage 
and transportability of islets to enhance regional distribution 
of these cells, and to serve as national resource centers to 
support national efforts in islet transplantation by providing 
human islets for both basic research and clinical islet 
transplantation.
    Cystic fibrosis.--NCRR has played a leadership role in 
providing clinical researchers with the tools they need to 
conduct their research and to undertake and complete clinical 
trials efficiently. NCRR has supported the development of 
shared resources for clinical researchers, an activity that has 
strengthened the nation's clinical research capabilities. The 
Committee commends NCRR for its support of clinical trials 
networks, including the cystic fibrosis clinical trials 
network. The Committee suggests that NCRR consider supporting a 
cystic fibrosis biospecimen repository, which would serve as an 
important resource to CF researchers and function as a model 
for other diseases.

       NATIONAL CENTER FOR COMPLEMENTARY AND ALTERNATIVE MEDICINE

    The Committee provides $121,116,000 for the National Center 
for Complementary and Alternative Medicine (NCCAM), which is 
$4,138,000 above the fiscal year 2004 comparable level and the 
same as the budget request.
    Mission.--The Center was established to stimulate, develop, 
and support rigorous and relevant research of high quality and 
open, objective inquiry into the safety and effectiveness of 
complementary and alternative medicine practices in order to 
provide the American public with reliable information about 
these practices.
    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.
    Osteoporosis.--The Committee encourages NCCAM to conduct 
research on women in their thirties and forties 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 in later 
life. In addition, the Committee encourages support for 
research on the effects of complementary and alternative 
medicine on bones and pain management in people with metabolic 
bone diseases.
    Chromium nutrition and diabetes.--Recent research has 
demonstrated that chromium picolinate can restore normal 
glucose metabolism by enhancing insulin sensitivity. Impaired 
insulin sensitivity is a major factor leading to the 
development of type 2 diabetes and cardiovascular disease. In 
clinical studies in people with type 2 diabetes, chromium 
supplementation has been shown to significantly reduce elevated 
blood sugar levels and improve long-term blood sugar control. 
The beneficial effects were predominantly seen in populations 
who were overweight and insulin resistant. Since it has been 
shown that many Native Americans have severely impaired insulin 
sensitivity and are overweight, a strong case can be made to 
support the hypothesis that chromium supplementation can 
significantly help Native American populations. In addition to 
potential treatment benefits, chromium supplementation in 
overweight pediatric populations may restore normal glucose 
metabolism, and thereby reduce or delay the onset of diabetes. 
Therefore, NCCAM is encouraged to expand upon these early 
findings to support research on chromium supplementation as a 
safe, effective, low cost nutritional therapy for type 2 
diabetes.
    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 
can forestall and perhaps 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

    The Committee provides $196,780,000 for the National Center 
on Minority Health and Health Disparities (NCMHD), which is 
$5,309,000 above the fiscal year 2004 comparable level and the 
same as the budget request.
    Mission.--The Center conducts and supports research, 
training, information dissemination and other programs aimed at 
reducing the disproportionately high incidence and prevalence 
of disease, burden of illness and mortality experienced by 
certain American populations, including racial and ethnic 
minorities and other groups, such as the urban and rural poor, 
with disparate health status.
    Cancer in minority communities.--The Committee commends 
NCMHD for its leadership in addressing the disproportionate 
impact of cancer in minority communities. The Committee 
encourages NCMHD to consider collaborating with NCRR and NCI in 
supporting the establishment of a cancer center at a 
historically minority institution focused on research, 
treatment and prevention of cancer in African American and 
other minority communities.
    Glomerular injury.--The Committee understands that 
glomerular injury, a group of diseases which affect the 
filtering mechanisms of the kidney, is more prevalent among 
African Americans than the general population. The Committee 
encourages NCMHD to collaborate with NIDDK to conduct and 
support research activities related to glomerular injury.
    Latinos.--The Committee recognizes that Latinos are the 
fastest-growing ethnic group in the United States and 
encourages NCMHD to increase its training of bilingual and 
bicultural researchers. The Committee encourages NCMHD to focus 
on research benefiting the diverse subgroups of the Latino 
population.
    Scleroderma.--The Committee encourages NCMHD to support 
research that furthers the understanding of causes and 
consequences of scleroderma, a chronic, degenerative disease of 
collagen production, present among African Americans, Hispanic 
and Native American men and women. NCMHD 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 tends to be diagnosed more often with the 
diffuse form of scleroderma.
    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 encourages NCMHD, in collaboration with NIDDK, to 
enhance research to improve liver disease treatment 
effectiveness among minority populations.
    Research endowment.--The Committee commends NCMHD for its 
leadership in addressing the longstanding problem of health 
status disparities in minority and medically underserved 
populations. The Committee continues to encourage NCMHD to 
implement its successful research endowment program as an 
ongoing initiative.
    Project EXPORT.--The Committee commends NCMHD for its 
successful ``Project EXPORT'' initiative and urges continued 
support for this important program.

                  JOHN E. FOGARTY INTERNATIONAL CENTER

    The Committee provides $67,182,000 for the Fogarty 
International Center (FIC), which is $1,800,000 above the 
fiscal year 2004 comparable level and the same as the budget 
request.
    Mission.--The FIC was established to improve the health of 
the people of the United States and other nations through 
international cooperation in the biomedical sciences. In 
support of this mission, the FIC pursues the following four 
goals: mobilize international research efforts against global 
health threats; advance science through international 
cooperation; develop human resources to meet global research 
challenges; and provide leadership in international science 
policy and research strategies.
    Chronic obstructive pulmonary disease (COPD).--The 
Committee notes that COPD is the fourth leading cause of death 
worldwide, and encourages the Fogarty International Center to 
strengthen its COPD research and training activities.
    Tuberculosis training.--The Committee is pleased with the 
Fogarty International Center's efforts to supplement grants in 
the 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 consider 
developing a specific free-standing TB training program.

                      NATIONAL LIBRARY OF MEDICINE

    The Committee provides $316,947,000 for the National 
Library of Medicine (NLM), which is $7,902,000 above the fiscal 
year 2004 comparable level and the same as the budget request. 
In addition, $8,200,000 is made available from program 
evaluation funds as requested by the Administration to support 
the National Center on Health Services Research. The same 
amount was provided last year.
    Mission.--The National Library of Medicine collects, 
organizes, disseminates, and preserves biomedical literature in 
all forms, regardless of country of origin, language, or 
historical period. The Library's collection is widely 
available; it may be consulted at the NLM facility on the NIH 
campus; items may be requested on interlibrary loan; and the 
extensive NLM bibliographic databases may be searched online by 
health professionals around the world. NLM has a program of 
outreach to acquaint health professions with available NLM 
services. The Library also is mandated to conduct research into 
biomedical communications and biotechnology; to award grants in 
support of health science libraries and medical informatics 
research and training; and to create specialized information 
services in such areas as health services research, 
environmental health, AIDS, hazardous substances, and 
toxicology.
    Outreach.--The Committee encourages NLM to continue its 
outreach activities aimed at educating health care 
professionals and the general public about the Library's 
products and services, in coordination with medical librarians 
and other health information specialists.
    PubMed Central.--The Committee commends NLM for its 
leadership in developing PubMed Central, an electronic online 
repository for life science articles. Because of the high level 
of expertise health information specialists have in the 
organization, collection, and dissemination of medical 
information, the Committee believes that health sciences 
librarians have a key role to play in the further development 
of PubMed Central. The Committee encourages NLM to work with 
the medical library community regarding issues related to 
copyright, fair use, peer-review and classification of 
information on PubMed Central.
    Minority health.--The Committee encourages NLM to enhance 
its support of annual conferences sponsored by the minority 
health professions community designed to foster increased 
interest among minority students in the fields of biomedical 
science and bio-informatics.
    Access to research results.--The Committee is very 
concerned that there is insufficient public access to reports 
and data resulting from NIH-funded research. This situation, 
which has been exacerbated by the dramatic rise in scientific 
journal subscription prices, is contrary to the best interests 
of the U.S. taxpayers who paid for this research. The Committee 
is aware of a proposal to make the complete text of articles 
and supplemental materials generated by NIH-funded research 
available on PubMed Central (PMC), the digital library 
maintained by the National Library of Medicine (NLM). The 
Committee supports this proposal and recommends that NIH 
develop a policy, to apply from FY 2005 forward, requiring that 
a complete electronic copy of any manuscript reporting work 
supported by NIH grants or contracts be provided to PMC upon 
acceptance of the manuscript for publication in any scientific 
journal listed in the NLM's PubMed directory. Under this 
proposal, NLM would commence making these reports, together 
with supplemental materials, freely and continuously available 
six months after publication, or immediately in cases in which 
some or all of the publication costs are paid with NIH grant 
funds. For this purpose, ``publication costs'' would include 
fees charged by a publisher, such as color and page charges, or 
fees for digital distribution. NIH is instructed to submit a 
report to the Committee by December 1, 2004 about how it 
intends to implement this policy, including how it will ensure 
the reservation of rights by the NIH grantee, if required, to 
permit placement of the article in PMC and to allow appropriate 
public uses of this literature.

                         OFFICE OF THE DIRECTOR

    The Committee provides $359,645,000 for the Office of the 
Director (OD), which is $32,141,000 above the fiscal year 2004 
comparable level and the same as the budget request. The bill 
repeats language included in prior years authorizing the 
collection of third party payments for the cost of clinical 
services, providing the Director of NIH with one percent 
transfer authority, and allocating up to $500,000 of funds 
within the Office of the Director appropriation for the 
Foundation for the National Institutes of Health.
    The Committee provides $70,000,000 within the Office of the 
Director for the Director's Discretionary Fund (DDF), which is 
the same as the Administration request and $25,763,000 above 
the fiscal year 2004 comparable level. $60,000,000 of this 
funding is intended to be used for Roadmap initiatives. The 
Committee has repeated last year's bill language making up to 
$7,500,000 of this total available through the flexible 
research authority provided in section 217 of the Act.
    The Committee includes bill language identifying the 
maximum funding that may be used for Roadmap activities and the 
method of calculating each Institute or Center's contribution.
    The Committee has not approved the Administration proposal 
to give NIH authority to fund the multi-year cost of grants in 
the first year of their award and has not included the proposed 
general provision authorizing this action. In a budget with 
modest increases for Institutes, multi-year funding of the 
awards that are made would have an unacceptable impact on the 
volume of awards. The Committee suggests that the 
Administration not propose this approach without the funding 
increases necessary to stabilize the number of new grants 
awarded. Multi-year funding should not be expanded to grants 
beyond the limited number of small grants that historically are 
multi-year funded.
    Mission.--The Office of the Director provides leadership to 
the NIH research enterprise and coordinates and directs 
initiatives which cross-cut the NIH. The OD 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 operations of the NIH.
    Office of Research on Women's Health.--The Office of 
Research on Women's Health (ORWH) works in collaboration with 
the Institutes and Centers of NIH to promote and foster efforts 
to address gaps in knowledge related to women's health through 
the enhancement and expansion of funded research and/or the 
initiation of new investigative studies. The ORWH is 
responsible for ensuring the inclusion of women in clinical 
research funded by NIH, including the development of a 
computerized tracking system and the implementation of 
guidelines on such inclusion. This Office is also involved in 
promoting programs to increase the number of women in 
biomedical science careers, and in the development of women's 
health and sex and gender factors in biology as a focus of 
medical/scientific research.
    The Committee is pleased with the increased focus on 
irritable bowel syndrome (IBS) at the ORWH. It is estimated 
that between 25 and 45 million Americans, disproportionately 
women, suffer from IBS.
    Twenty to thirty percent of women in the U.S. of 
reproductive age suffer from uterine fibroids, a benign tumor 
that affects their reproductive health. Research on treatment 
has been limited, and often women have unnecessary 
hysterectomies when less costly and invasive treatments may be 
possible. In conjunction with NICHD, NIEHS, and NCMHD, ORWH is 
encouraged to intensify and coordinate programs to support 
research on uterine fibroids.
    Office of AIDS Research.--The Office of AIDS Research (OAR) 
is responsible for coordination of the scientific, budgetary, 
legislative, and policy elements of the NIH AIDS research 
program. The OAR develops a comprehensive plan for NIH AIDS-
related research activities which is updated annually. The plan 
is the basis for the President's budget distribution of AIDS-
related funds to the Institutes, and centers within NIH. The 
Committee expects the Director of NIH to use this plan and the 
budget developed by OAR to guide his decisions on the 
allocation of AIDS funding among the Institutes. The Director 
of NIH also should use the full authority of his office to 
ensure that the Institutes and Centers spend their AIDS 
research dollars in a manner consistent with the plan. In 
addition, the OAR allocates an emergency AIDS discretionary 
fund to support research that was not anticipated when budget 
allocations were made.
    The Committee has included the same general provisions in 
bill language that were contained in the 2004 appropriations 
bill. This language permits the Director of OAR, jointly with 
the Director of NIH, to transfer between Institutes and Centers 
up to three percent of the funding determined by NIH to be 
related to AIDS research. This authority could be exercised 
throughout the fiscal year subject to normal reprogramming 
procedures, and is intended to give NIH flexibility to adjust 
the AIDS allocations among Institutes if research opportunities 
and needs should change. The Committee also repeats language 
from last year's bill making the research funds identified by 
NIH as being AIDS related available to the OAR account for 
transfer to the Institutes. This provision permits the flow of 
funds through the OAR in the spirit of the authorization 
legislation without requiring the Congress to earmark a 
specific dollar amount for AIDS research.
    The Committee encourages OAR to strengthen science-based 
HIV prevention research for African Americans, Latinos, Native 
Americans, Asian Americans, Native Hawaiians, and Pacific 
Islanders. The Office is also encouraged to focus on existing 
and developing areas of culturally appropriate research that 
seeks to reduce the risk of contracting HIV through high-risk 
behaviors and the transmission of HIV infection in the targeted 
minority populations.
    Office of Dietary Supplements.--The Office of Dietary 
Supplements (ODS) was established in recognition that dietary 
supplements can have an important impact on the prevention and 
management of disease and on the maintenance of health. ODS is 
charged with promoting, conducting, and coordinating scientific 
research within NIH relating to dietary supplements.
    Office of Behavioral and Social Sciences Research.--The 
Office of Behavioral and Social Sciences Research (OBSSR) 
provides leadership and direction for the development of a 
trans-NIH plan to increase the scope of and support for 
behavioral and social science research and in defining an 
overall strategy for the integration of these disciplines 
across NIH institutes and centers; develops initiatives to 
stimulate research in the behavioral and social sciences arena 
and integrate a biobehavioral perspective across the research 
areas of NIH; and promotes studies to evaluate the 
contributions of behavioral, social and lifestyle determinants 
in the development, course, treatment, and prevention of 
illness and related public health problems.
    Office of Rare Disease Research.--The Office of Rare 
Disease Research (ORD) was established in recognition of the 
need to provide a focal point of attention and coordination at 
NIH for research on rare diseases. ORD works with Federal and 
non-Federal national and international organizations concerned 
with rare disease research and orphan products development; 
develops a centralized database on rare diseases research; and 
stimulates rare diseases research by supporting scientific 
workshops and symposia to identify research opportunities.
    The Committee commends the Director of NIH and ORD for the 
rapid progress over the past eighteen months since the office 
was created in statute and given additional responsibilities. 
The Committee appreciates the initiation of the rare disease 
clinical research network, and encourages research aimed at the 
development of interventions for orphan diseases, including 
cystic fibrosis. The Committee also encourages NIH to pursue 
exploratory grants and proof of concept studies for the 
development of new therapeutics in the treatment of rare 
diseases and to intensify support of the training of clinical 
research investigators in rare diseases.
    The Committee is concerned about the development of 
diagnostic tests for rare diseases and requests that ORD 
evaluate this situation and report to the Committee on what 
steps have been taken to increase NIH involvement in this area.
    The Committee is pleased with the ORD support of the 
biliary atresia research network. The Committee encourages ORD 
to continue to address rare liver diseases, including primary 
biliary cirrhosis, primary sclerosing cholangitis, and auto-
immune hepatitis.
    Amyloidosis.--The Committee encourages NIH to expand its 
research efforts into the amyloidoses--a group of rare diseases 
characterized by abnormally folded protein deposits in tissues. 
These diseases are often fatal and there is no known cure. 
Treatment involving large-dose intravenous chemotherapy 
followed by stem cell replacement or rescue is effective for 
many patients, but this procedure is risky, unsuitable for many 
patients, and not a cure. The Committee is aware that NIH has 
recently created a Trans-NIH Working Group on Rare Diseases 
Research. Accordingly the Committee urges NIH to consider 
holding a conference led by the Office of Rare Diseases with 
support from NIH institutes and centers with a research focus 
on amyloidosis and related diseases, to assess the current 
state of the science and to determine the next steps to 
increase the understanding, prevention, and treatment of this 
devastating group of diseases. Results and recommendations from 
this conference should be sent to the Committee before October 
1, 2005.
    Public health relevance of awards.--The Committee is 
encouraged by steps 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 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.
    Cooperation with the Veterans Health Administration.--The 
Committee believes that closer collaboration with the Veterans 
Health Administration (VHA) will significantly facilitate, 
accelerate, and leverage research to develop more effective 
treatments and cures for liver disease. The Committee notes 
that the 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 NIH-funded research 
efforts. The Committee is pleased that NIDDK has begun efforts 
to develop a cooperative agreement with the VHA as a vehicle 
for collaborative efforts to facilitate liver disease research 
on a trans-NIH basis.
    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 for expanding 
Hepatitis C-related clinical research studies. The Committee 
requests a report by April 28, 2005 identifying NIH's response 
to the original recommendations of the Hepatitis C consensus 
conference.
    NIH roadmap and clinical practice.--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. 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.
    Best pharmaceuticals for children.--The Committee 
recognizes the importance of ensuring that drugs are safe and 
effective for use by children. The Committee supports continued 
implementation by NIH of the Best Pharmaceuticals for Children 
Act of 2002 to support the pediatric testing of off-patent 
drugs, as well as on-patent drugs not being studied through 
existing mechanisms. In implementing this responsibility, NICHD 
should act as coordinator for all other institutes within NIH 
for which pediatric pharmacological drug research may have 
therapeutic relevance. NICHD is also encouraged to consult with 
the Food and Drug Administration to ensure that the studies 
conducted are designed to yield improved pediatric labeling. 
The Committee requests NIH to provide an update during its 
annual appropriations testimony on the number of studies 
supported; the estimated cost of each study 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. NICHD should focus its 
resources on encouraging the study of drugs where there is a 
medical necessity to conduct clinical pediatric studies, 
consistent with ethical concerns. The Committee also urges 
NICHD to give full consideration to existing information that 
supports the safe use of drugs in children and use of 
conditions contained in the Pediatric Research Equity Act to 
identify drugs for study and to determine the scope and 
magnitude of those studies.
    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. 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. The report should also include an evaluation 
of alternative strategies for assuring that recipients of loan 
repayment actually pursue careers in clinical research.
    Graduate training in clinical investigation awards.--In an 
effort to reverse the shortage of well-trained clinical 
investigators, the Committee encourages NIH to continue and 
strengthen support for K12 mentored clinical scientist 
development awards which provide tuition and stipend support 
for students.
    Duchenne/Becker muscular dystrophy.--The Committee notes 
that Duchenne muscular dystrophy (DMD) and its milder form, 
Becker muscular dystrophy (BMD), are the most common, lethal 
genetic childhood disorders known. The Committee urges NINDS, 
in collaboration with NIAMS, to enhance resources to improve 
treatments for patients with muscular dystrophy. The conferees 
strongly encourage NIH to consider funding additional centers 
of excellence and to strengthen the funding for existing 
centers of excellence. In addition, the Committee notes that 
the NIH interagency coordinating committee for muscular 
dystrophy has missed its one-year deadline to submit a plan for 
conducting and supporting research and education on muscular 
dystrophy. The Committee 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 encourages NIH to increase its 
commitment to DMD translational research and clinical trials, 
separate from support in 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 encourages NIH, through NINDS and NIAMS, to follow 
the accelerated model for funding DMD translational research 
that was used for motor neuron diseases, including ALS and SMA.
    Finally, the Committee encourages the institutes to further 
develop opportunities for clinical trials and to help make 
available all existing and emerging patient care options. The 
institutes are encouraged to work with other institutes and 
Federal agencies to develop formal programs that increase 
public and professional awareness of the disease. The Committee 
requests that NIH report back to the Committee by April, 2005 
with a progress report on all aspects of DMD translational and 
clinical research.
    Autism spectrum disorders.--The Committee is pleased with 
NIH's autism research matrix and encourages NIH to devote 
sufficient resources to this research agenda. When implementing 
the autism research matrix, the Committee encourages NIH to 
coordinate with autism organizations already funding research 
initiatives to ensure the most efficient use of resources. The 
Committee also notes the promise of particular areas cited in 
the matrix, including genetic and behavioral characterization 
of the disorder, screening and early diagnosis.
    Autism and vaccine.--The Committee continues to be aware of 
concerns about reports of a possible association between the 
measles component of the measles-mumps-rubella (MMR) vaccine 
and a subset of autism termed autistic entercolitis. The 
Committee continues its interest in this issue and encourages 
the Interagency Coordinating Committee to continue to give 
serious attention to these reports. The Committee is aware that 
research is underway, supported by NIH, and encourages NIH to 
avoid delays in this research.
    The Committee is also concerned that there is some evidence 
that infant exposures to thimerosal in the 1990s may be related 
to the epidemic of neurodevelopmental disorders in children. 
CDC's most extensive review of Vaccine Safety Datalink data 
concluded that more research needs to be conducted in this 
arena to answer these questions with certainty and the 
Committee concurs with the need for this continued research.
    The Committee encourages NIH to dedicate significant 
resources to pursue the recommended research initiatives 
outlined in the Institute of Medicine's (IOM) Immunization 
Review. These reports have identified the research needed to 
better understand why a number of children suffer severe 
adverse reactions to childhood vaccines. Continuation of this 
research to develop a better understanding of biological 
mechanisms is critical for knowing with certainty whether or 
not thimerosal and other vaccines exposures might cause 
increased risks for some children.
    Microbicides.--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. The Committee is 
concerned that microbicide research at NIH is currently 
conducted with no single line of administrative accountability 
or specific funding coordination. The Committee urges NIH to 
consider establishing a lead office to coordinate research 
among institutes and with other Federal agencies.
    Autoimmune diseases.--The Committee appreciates the NIH 
Autoimmune Diseases Coordinating Committee (ADCC) and the 
comprehensive Autoimmune Diseases Research Plan it prepared. 
The Autoimmune Diseases 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. The ADCC's effectiveness 
in promoting inter-Institute collaboration on high priority 
cross-cutting research identified in the Autoimmune Diseases 
Research Plan has been a significant factor in achieving recent 
advances in the understanding, diagnosis and treatment of the 
autoimmune family of diseases. The Committee hopes that NIH 
will target the high-priority cross-cutting research identified 
in the Autoimmune Diseases Research Plan research.
    Research infrastructure at minority health professions 
institutions.--The Committee continues to be pleased with the 
NIH Director's implementation of various programs focused on 
developing research infrastructure at minority health 
professions institutions. The Committee encourages the NIH 
Director to work closely with the Director of the NCMHD to 
ensure coordination among these various mechanisms to partner 
with minority health professions schools to address their 
infrastructure needs.
    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 urges the Director of NIH to 
intensify his coordination of cross-cutting research on these 
diseases in all institutes and centers as appropriate and 
requests that the Director be prepared to report to the 
Committee on these initiatives in the FY2006 budget hearings.
    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. The 
Committee encourages the NIH director, working with the 
individual institutes and relevant voluntary health 
organizations, to develop a comprehensive NIH-wide approach to 
identify and pursue research opportunities in this field.
    Parkinson's disease.--The Committee is interested in the 
development of NIH's Parkinson's disease ``matrix.'' The 
Committee encourages NIH to extend the matrix to include 
concrete steps toward better treatments and a cure. Since five 
years have elapsed since the last NIH conference on Parkinson's 
disease, the Committee encourages the Director to hold another 
conference, similar to the one held in November of 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 
programs required to secure the earliest possible development 
of effective therapies, prevention, and a cure for Parkinson's 
disease.
    Lupus.--Lupus is a disabling and life-threatening 
autoimmune disease which affects more than 1.5 million 
Americans, 90 percent of whom are women. It causes the immune 
system to attack the body's own cells and organs, including the 
kidneys, heart, lungs, brain, blood and skin. Lupus is two to 
three times more common among African Americans, Native 
Americans, Hispanics, and Asians, than among Caucasians. Lupus 
is a disease of rampant, uncontrolled inflammation caused by 
multiple genes. Scientists know some of the specific proteins 
that trigger lupus and are approaching a time when new 
strategies in molecular medicine can be applied to improve the 
function of these proteins and prevent lupus flares. Because 
lupus is a multifaceted disease, the Committee encourages the 
Director to ensure that all relevant institutes work closely 
and collaboratively to maximize the output of our national 
investment in lupus research. To ensure that progress is 
maximized, the Committee requests NIH to develop a five-year 
trans-NIH research plan for the full spectrum of lupus 
research. Among the institutes to be involved should be NIAMS, 
NHLBI, NIDDK, NINDS, NIAID, NIEHS, and NCMHD.
    Spina bifida.--The Committee recognizes that spina bifida 
is the leading permanently disabling birth defect in the U.S. 
and encourages NIH to put a higher priority on research into 
primary and secondary prevention of this condition. While 
through research we have learned that 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 
NIH, particularly through NINDS and NICHD, to focus research 
into secondary prevention for spina bifida.
    Tuberous sclerosis complex.--The Committee is aware that 
NIH released a strategic plan for tuberous sclerosis complex 
(TSC) last summer. The Committee encourages NIH to expand the 
scope of this effort to broaden the research to multiple 
institutes beyond NINDS and to emphasize research efforts that 
are specific to TSC.
    Obesity.--Obesity is epidemic in America today, adding an 
estimated $117 billion to our nation's health care costs. To 
combat this epidemic, the Committee strongly supports providing 
Americans with safe and effective alternatives for controlling 
their weight. NIH has conducted research on the controlled 
carbohydrate nutritional approach in the short-term. The 
Committee commends the collaborative efforts of NIH to 
undertake a more, definitive long-term study of the safety and 
effectiveness of controlled carbohydrate nutrition. The study, 
funded by NCCAM, NIDDK and NHLBI, is a multi-site, randomized 
controlled long-term study of low- versus higher-carbohydrate 
diet. The Committee looks forward to learning the results of 
this study when completed.
    Rett syndrome.--Rett syndrome is a genetically inherited 
neurological disorder seen almost exclusively in females and 
found in many racial and ethnic groups worldwide. It is 
believed that Rett syndrome affects approximately one in ten 
thousand live births per year, although recent discoveries 
about the underlying genetic cause of this disorder may reveal 
significantly more affected people than previously diagnosed. 
The Committee is very encouraged by the most recent advances 
that have taken place in Rett syndrome research. Important 
breakthroughs in methods to detect previously undetected 
genetic variations and, most importantly, critical new 
discoveries in understanding the genetics of Rett syndrome are 
likely to catapult treatments not only for Rett syndrome but 
pave the way for greater understanding of other neurological 
impairments ranging from autism to schizophrenia. The Committee 
applauds the excellent program area developed by the NIH and 
encourages NIH to continue to target its research efforts to 
ascertain how the genes involved in Rett syndrome and the 
associated proteins affect other genes and tissues during the 
development of the nervous system. Furthermore, NIH is 
encouraged to support the development of animal models, as well 
as genotype and phenotype investigations of Rett syndrome that 
could hasten progress in eliminating this and other 
neurologically based disorders The Committee notes there is 
also need for expanded research on the daily problems that 
affect children with Rett syndrome, including autonomic 
disorders, such as respiratory, gastrointestinal, circulatory 
and cardiac disorders, seizures, and scoliosis. Additionally, 
the Committee recognizes that research in applied areas such as 
interventions and technological aids for improved literacy and 
communication will improve the quality of life for Rett 
syndrome patients and those with other communicative disorders. 
Since Rett syndrome is a multi-faceted disorder, the Committee 
encourages NIH to partner with existing advocacy groups and to 
continue to work to promote continuity across Institutes in 
their Rett syndrome research.
    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 are 
envisioned to include a significant number of institutions, in 
order to facilitate efficient recruitment and rapid enrollment 
of trial participants. An existing clinical trials network for 
testing therapies for cystic fibrosis (CF) includes many of the 
elements that have been cited in the Roadmap as critical for 
any model clinical trials system. The CF system includes: (1) 
centralized data management and analysis capability, (2) 
centralized data safety monitoring, and (3) the participation 
of eighteen institutions, which ensures rapid accrual to 
trials. The Committee believes that there are important 
opportunities for collaboration between NIH and this clinical 
trials network and encourages NIH to pursue this potential 
collaboration. One benefit of this collaboration would be the 
ability for NIH to evaluate the impact and benefits of this 
clinical trials network, its cost efficiencies, and the 
application of its core features to other diseases and in other 
settings.
    Charcot-Marie-Tooth disorder.--Charcot-Marie-Tooth disorder 
(CMT) is one of the most common inherited neurological 
disorders, affecting approximately one in 3,500 people in the 
United States. The Committee is concerned about 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 
encourages NIH 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 on CMT and CMT-related disorders by March, 2005.
    Traumatic brain injury.--The Committee encourages NIH to 
build upon its work in brain injury rehabilitation at the 
National Center on Medical Rehabilitation and Research and to 
continue conducting basic research and translational clinical 
research on traumatic brain injury through NINDS.
    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 Committee believes that scientists and clinical 
educators should be alerted to the scientific opportunities and 
resources that exist to undertake basic and clinical 
investigation into the role of the lymphatic system in human 
health and disease. Therefore, the Committee encourages the 
Trans-NIH Coordinating Committee for the Lymphatic System, in 
collaboration with the OD Office of Communications and relevant 
institute offices of communications, to implement a 
comprehensive lymphatic research awareness campaign to inform 
academia, governmental agencies, industry and scientific and 
medical professional organizations and to create a heightened 
comprehension of the central role occupied by the lymphatic 
system in the maintenance of human health.
    Lymphangioleiomyomatosis (LAM).--The Committee remains very 
interested in efforts to find a cure for LAM, a progressive and 
often fatal lung disease of women with no effective treatment. 
The Committee understands that very recent scientific findings 
have presented new treatment approaches for clinical testing, 
and that experimental trials with the drug sirolimus have 
begun. The Committee encourages NCI, ORD, NINDS and NHLBI to 
explore opportunities for funding clinical treatment trials 
through both intramural and extramural means and to use all 
available mechanisms as appropriate, including support of 
state-of-the-science symposia and facilitating access to human 
tissues, to stimulate a broad range of clinical and basic LAM 
research. The Committee also commends NCRR and ORD for their 
roles in supporting the Rare Lung Disease Consortium.
    Cost-effectiveness research.--Another round of cost 
increases threatens the healthcare delivery system, and many 
health care experts predict nine percent increases for the 
foreseeable future. Unfortunately, the same new biomedical 
research discoveries that provide new remedies for health 
problems may in some cases contribute to higher health care 
costs. The Committee recognizes the need to ensure that 
increased investment in biomedical research does not price 
quality health care out of the reach of many Americans. 
Providers, patients, and health care payers need objective, 
scientific information to understand which new interventions 
are more effective than existing practices, which groups of 
patients are most likely to benefit, the degree of improvement 
compared to the cost, and the relative risks for the patient of 
alternative interventions. The Director is encouraged to make 
this type of research a higher priority across each of the 
institutes and centers and report to the Committee at the end 
of fiscal year 2005 a summary of grants awarded with a focus on 
findings related to reducing the cost of health care.
    Hyperbaric oxygen therapy (HBOT).--HBOT is currently in 
widespread use in medical practice. NIH is encouraged to 
support meritorious research in this area, especially in basic 
science, in order to gather evidence regarding the efficacy of 
HBOT. In particular, studies should consider HBOT as a 
treatment for various manifestations of reperfusion injury, 
hemorrhagic shock, trauma injury, surgery patients, stroke and 
dementia. When appropriate, clinical studies to test the safety 
and efficacy of this treatment for a variety of conditions 
should include adult and pediatric populations. NIH is also 
encouraged to work with professional organizations interested 
in HBOT as this research moves forward.
    Sepsis.--The Committee is aware that sepsis, an 
overwhelming systemic response to infection that leads to organ 
dysfunction and death, kills more than 215,000 Americans every 
year, with direct annual medical costs estimated to exceed $17 
billion. Septicemia, a form of sepsis that infects the blood, 
has been identified by the Centers for Disease Control as the 
tenth leading cause of death in the United States; sepsis 
resulting from pneumonia and chemotherapy causes tens of 
thousands of additional deaths annually. Until recently, 
therapies proved ineffective. New treatments have been 
developed which significantly improve prognosis when sepsis is 
diagnosed in a timely fashion, and new guidelines have been 
developed to aid health care professionals in identifying the 
syndrome. Sepsis remains a leading cause of death, however, 
because too few medical personnel know how to identify and 
diagnose it. To improve recognition of sepsis among health care 
providers, the Committee encourages the Office of the Director 
to work with a national alliance that is focused on sepsis 
education to create and implement a program to train infectious 
disease physicians, emergency room doctors, critical care 
nurses, and oncologists, especially those in rural and 
traditionally underserved areas, in the use of the new 
guidelines to identify sepsis and improve patient outcomes. In 
particular, the Committee requests the support of NIAID, NHLBI 
and NCI in these provider education efforts.
    Ataxia-telangiectasia (A-T).--A-T is a rare, fatal genetic 
disease that affects children, causing progressive loss of 
muscle control, immune system problems, and a high rate of 
cancer. Recent advances show that A-T research is important not 
just for patients with A-T, but also for more prevalent 
diseases including cancer and neurodegenerative diseases such 
as Alzheimer's and Parkinson's. The Committee supports the 
development of an inter-institute coordinating committee for 
research on A-T comprised of representatives from all the 
institutes relevant to A-T, including but not limited to NINDS, 
NICHD, NCI, NHGRI, NEI, NIA and NHLBI. The Committee encourages 
the inter-institute coordinating committee on A-T to conduct 
workshops with members of the scientific and medical 
communities to identify important, unanswered scientific 
question about A-T and to develop and regularly revise an 
inter-institute NIH research plan for A-T.
    Sex-based biology.--The Institute of Medicine has released 
a study demonstrating that all biological research 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 encourages the 
institutes involved in brain research to include sex-based 
biology as a part of the research conducted and to analyze and 
report research results in this manner, when appropriate. The 
Committee would like a report from the Director on the progress 
of this effort in next year's hearings.
    Disease collections.--The Committee is aware that NIH has 
now published on its web site spending levels for its entire 
disease collection. The Committee commends the agency for 
making this information available and believes it will be of 
benefit to many advocacy groups and individuals with an 
interest in NIH's research portfolio.

                        BUILDINGS AND FACILITIES

    The Committee provides $99,500,000 for buildings and 
facilities, which is $10,528,000 above the fiscal year 2004 
comparable level and the same as the Administration request.
    Mission.--The Buildings and Facilities appropriation 
provides for the design, construction, improvement, and major 
repair of clinical, laboratory, and office buildings and 
supporting facilities essential to the mission of the National 
Institutes of Health. The funds in this appropriation support 
the 77 buildings on the main NIH campus in Bethesda, Maryland; 
the Animal Center in Poolesville, Maryland; the National 
Institute of Environmental Health Sciences facility in Research 
Triangle Park, North Carolina; and other smaller facilities 
throughout the United States.

       Substance Abuse and Mental Health Services Administration


               SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES

    The Committee provides a program level of $3,391,663,000 
for the Substance Abuse and Mental Health Services 
Administration (SAMHSA), which is $40,705,000 above the fiscal 
year 2004 comparable level and $158,579,000 below the budget 
request. Within the total, $121,303,000 is provided through the 
evaluation set-aside as requested.
    SAMHSA is responsible for supporting mental health and 
alcohol and drug abuse prevention and treatment services 
nationwide through discretionary targeted capacity expansion 
and knowledge application grants, formula block grants to the 
States and associated technical assistance efforts. The agency 
consists of three principal centers: the Center for Mental 
Health Services, the Center for Substance Abuse Treatment, and 
the Center for Substance Abuse Prevention. The Office of the 
Administrator is responsible for overall agency management.
    The Committee expects that no less than the amounts 
allocated in fiscal year 2004 will be spent in fiscal year 2005 
for activities throughout SAMHSA that are targeted to address 
the growing HIV/AIDS epidemic and its disparate impact on 
communities of color, including African Americans, Latinos, 
Native Americans, Asian Americans, Native Hawaiians, and 
Pacific Islanders. These activities include treatment of mental 
health disorders related to HIV disease and expansion of 
service capacity of substance abuse treatment and prevention 
programs that provide services to high-risk communities of 
color.
    The Committee recommends that SAMHSA address the lack of 
culturally competent substance abuse prevention, education, and 
treatment services, including co-occurring disorders, for the 
over 12 million Asian American and Pacific Islander (AAPI) 
populations in the 50 States and the six Pacific Islander 
jurisdictions by developing a comprehensive strategic plan with 
input from an AAPI Workgroup. The majority of the AAPI 
populations are immigrant, refugee, or indigenous Pacific 
Islanders with limited access to culturally competent substance 
abuse services. This SAMHSA strategic plan should implement a 
special AAPI substance abuse initiative to collect data and 
document underserved populations, facilitate the development of 
culturally competent services, including replication of 
evidence-based programs whenever AAPI populations are 
underserved, and to develop a cadre of AAPI substance abuse 
professionals. In carrying out the strategic plan, SAMHSA 
should form partnerships with other appropriate HHS agencies as 
well as the Department of Justice and other agencies with 
knowledge of or experience with substance abuse.

Center for Mental Health Services

    The Committee provides a program level total of 
$890,754,000 for the Center for Mental Health Services (CMHS), 
which is $28,534,000 above the fiscal year 2004 comparable 
level and $21,748,000 below the budget request. Within the 
total, $21,803,000 is provided through the evaluation set-aside 
as requested.
            Programs of regional and national significance
    The Committee provides $257,420,000 for mental health 
programs of regional and national significance, which is 
$16,624,000 above the fiscal year 2004 comparable level and 
$13,128,000 below the budget request. The program includes 
studies that identify the most effective service delivery 
practices, knowledge synthesis activities that translate 
program findings into useful products for the field, and 
knowledge application projects that support adoption of 
exemplary service approaches throughout the country.
    The Committee provides $20,000,000 for the State incentive 
grants for transformation, which is $23,732,000 below the 
budget request. The Committee supports the recommendations made 
in the July 2003 New Freedom Commission on Mental Health's 
report on transforming mental health care in America. These 
grants will support the development of comprehensive State 
mental health plans that will enhance services and supports to 
persons with mental illnesses.
    Within funds provided, the Committee has included 
$30,000,000 for the National Child Traumatic Stress Initiative. 
This program has established 54 treatment development and 
community service centers to treat children who have 
experienced trauma. It is estimated that up to 40,000 
traumatized children and their families will directly benefit 
from services delivered as a result of this initiative.
    The mental health needs of our Nation's seniors are largely 
ignored within our mental health system. Outreach to elderly 
persons conducted in places frequented by seniors, such as 
senior centers, meals sites, primary care settings and others 
is needed. The Committee recommends that no less than the level 
provided in fiscal year 2004 be allocated to continue and 
expand the work that SAMHSA began in prior fiscal years to 
provide evidence-based mental health outreach and treatment 
services to the elderly.
    Within funds provided, the Committee recommends that no 
less than level allocated in fiscal year 2004 be provided for 
grants for jail diversion programs. This program provides 
grants to States or localities, Indian tribes, and tribal 
organizations, acting directly or through agreements with other 
public or nonprofit entities, to develop and implement programs 
to divert individuals with a mental illness from the criminal 
justice system to community-based services.
    The Committee notes that while minorities represent 30 
percent of the population and are projected to increase to 40 
percent of the population by 2025, they are significantly 
underrepresented in the field of psychology and other 
professional mental health disciplines. The President's New 
Freedom Commission on Mental Health stated that the mental 
health system should be ``making strong efforts to recruit, 
retain, and enhance an ethnically, culturally, and 
linguistically competent mental health workforce throughout the 
country.'' Within the funds provided, the Committee has 
included $5,320,000 for the Minority Fellowship Program.
    The Committee recognizes the need to continue 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, including dementia 
and depression, and the chronic, progressive neurological 
disabilities that often accompany HIV/AIDS. Individuals 
suffering from HIV/AIDS and co-occurring disorders present 
unique and unmet treatment needs necessitating specialized 
training for providers. Therefore, within the level provided, 
the Committee has included 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.
    The Committee is deeply concerned that 5% to 9% 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 dropout, substance abuse, violent behavior, or suicide. 
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 can 
provide a link to appropriate services. The report also cited 
examples of evidence-based screening techniques and tools 
already being utilized by some schools. The Committee is aware 
that SAMHSA is overseeing a very promising pilot study 
utilizing evidence-based screening techniques and tools to 
screen and identify teenagers who are at risk. The Committee 
urges SAMHSA to evaluate the effectiveness of that pilot study 
and, if proven successful, expand to additional sites. The 
Committee expects SAMSHA to work in collaboration with the 
Office of Safe and Drug-free Schools, and to report on concrete 
steps being taken to promote early screening and detection 
programs available in schools prior to the fiscal year 2006 
appropriations hearings.
            Mental health block grants
    The Committee provides a program level total of 
$436,070,000 for mental health block grants, which is 
$1,380,000 above the fiscal year 2004 comparable level and the 
same as the budget request. The block grants provide funds to 
States to support mental health prevention, treatment, and 
rehabilitation services. Funds are allocated according to 
statutory formula among the States that have submitted approved 
annual plans. The Committee notes that the mental health block 
grant funding represents less than 2 percent of total State 
mental health funding and less than 3 percent of State 
community-based mental health services. Within the total, 
$21,803,000 is provided through the evaluation set-aside as 
requested.
            Children's mental health
    The Committee provides $106,013,000 for the grant program 
for comprehensive community mental health services for children 
with serious emotional disturbance, which is $3,659,000 above 
the fiscal year 2004 comparable level and the same as the 
budget request. Funding for this program supports grants and 
technical assistance for community-based services for children 
and adolescents up to age 22 with serious emotional, 
behavioral, or mental disorders. The program assists States and 
local jurisdictions in developing integrated systems of 
community care. Each individual served receives an individual 
service plan developed with the participation of the family and 
the child. Grantees are required to provide increasing levels 
of matching funds over the six-year grant period.
            Grants to states for the homeless (PATH)
    The Committee provides $55,251,000 for the grants to States 
for the homeless (PATH) program, which is $5,491,000 above the 
fiscal year 2004 comparable level and the same as the budget 
request. PATH grants to States provide assistance to 
individuals suffering from severe mental illness and/or 
substance abuse disorders and who are homeless or at imminent 
risk of becoming homeless. Grants may be used for outreach, 
screening and diagnostic treatment services, rehabilitation 
services, community mental health services, alcohol or drug 
treatment services, training, case management services, 
supportive and supervisory services in residential settings, 
and a limited set of housing services.
            Samaritan initiative
    The Committee does not provide funding for the Samaritan 
Initiative. The budget request is $10,000,000. Legislation 
authorizing this program is pending Congressional action.
            Protection and advocacy
    The Committee provides $36,000,000 for the protection and 
advocacy program, which is $1,380,000 above the budget request 
and the fiscal year 2004 comparable level. This funding is 
distributed to States according to a formula based on 
population and income to assist State-designated independent 
advocates to provide legal assistance to mentally ill 
individuals during their residence in State-operated facilities 
and for 90 days following their discharge.

Center for Substance Abuse Treatment

    The Committee provides a program level total of 
$2,208,454,000 for the Center for Substance Abuse Treatment 
(CSAT), which is $10,089,000 above the fiscal year 2004 
comparable level and $140,813,000 below the budget request. 
Within the total, $83,500,000 is provided through the 
evaluation set-aside as requested.
            Programs of regional and national significance
    The Committee provides a program level total of 
$419,219,000 for substance abuse treatment programs of regional 
and national significance, which is the same as the fiscal year 
2004 comparable level and $97,813,000 below the budget request. 
Within the total, $4,300,000 is provided through the evaluation 
set-aside as requested. The program supports activities to 
improve the accountability, capacity and effectiveness of 
substance abuse treatment services and services delivery. These 
activities include targeted capacity expansion initiatives to 
help communities respond to serious, emerging and unmet 
treatment needs and best practices initiatives to translate 
science into services through monitoring and accreditation of 
treatment programs, training, dissemination and knowledge 
application activities. The program promotes the adoption of 
science- and evidence-based treatment practices by developing 
and field-testing new treatment models in order to facilitate 
the provision of quality treatment services and service 
delivery. These activities are undertaken in actual service 
settings rather than laboratories and results are disseminated 
to State agencies and community treatment providers. The goal 
is to promote continuous, positive treatment service delivery 
change for those people who use and abuse alcohol and drugs.
    The Committee provides $100,000,000 for the Access to 
Recovery (ATR) substance abuse treatment voucher initiative; 
this is $590,000 more than the fiscal year 2004 level and 
$100,000,000 below the budget request. The Committee supports 
the Administration's commitment to increase substance abuse 
treatment capacity, consumer choice, and comprehensive 
treatment options and looks forward to hearing from SAMHSA 
about the various State programs once they have been 
established. While this is the second year of funding for this 
program, due to the funding cycle, first year grants have not 
yet gone out to States. To the extent that data become 
available, the Committee encourages SAMHSA to report to the 
Committee regularly on the status of the programs in those 
States that receive ATR funding.
            Substance abuse block grants
    The Committee provides a program level total of 
$1,789,235,000 for the substance abuse block grants, which is 
$10,089,000 above the fiscal year 2004 comparable level and 
$43,000,000 less than the budget request. Within the total, 
$79,200,000 is provided through the evaluation set-aside as 
requested. The substance abuse block grants provide funds to 
States to support alcohol and drug abuse prevention, treatment, 
and rehabilitation services. Funds are allocated among the 
States according to a statutory formula. State applications 
including comprehensive State Plans must be approved annually 
by SAMHSA as a condition of receiving funds.

Center for Substance Abuse Prevention

            Programs of regional and national significance
    The Committee provides $200,000,000 for the substance abuse 
prevention programs of regional and national significance, 
which is $3,982,000 above the budget request and $1,542,000 
above the fiscal year 2004 comparable level. The program 
identifies and disseminates science-based substance abuse 
prevention approaches.

Program management and buildings and facilities

    The Committee provides a program level total of $92,455,000 
for program management and buildings and facilities, of which 
$16,000,000 is provided through the evaluation set-aside as 
requested. The fiscal year 2005 level is $540,000 above the 
fiscal year 2004 comparable level and the same as the budget 
request. The appropriation provides funding to coordinate, 
direct, and manage the agency's programs. Funds are used for 
salaries, benefits, space, supplies, equipment, travel and 
overhead.

               Agency for Healthcare Research and Quality

    The Committee provides a total of $303,695,000 for the 
Agency for Healthcare Research and Quality (AHRQ), which is the 
same as the fiscal year 2004 comparable level and the budget 
request. This amount is funded from one percent evaluation 
funding.
    The mission of the Agency is to generate and disseminate 
information that improves the delivery of health care. Its 
research goals are to determine what works best in clinical 
practice; improve the cost-effective use of health care 
resources; help consumers make more informed choices; and 
measure and improve the quality of care.
    The Committee provides $245,695,000 for research on health 
costs, quality, and outcomes, which is the same as the fiscal 
year 2004 comparable level and the budget request. This program 
identifies the most effective and efficient approaches to 
organize, deliver, finance, and reimburse health care services; 
determines how the structure of the delivery system, financial 
incentives, market forces, and better information affects the 
use, quality, and cost of health services; and facilitates the 
translation of research findings for providers, patients, 
plans, purchasers, and policymakers. It also funds research 
that determines what works best in increasing the cost 
effectiveness and appropriateness of clinical practice; 
supports the development of tools to measure and evaluate 
health outcomes, quality of care, and consumer satisfaction 
with health care system performance; and facilitates the 
translation of information into practical uses through the 
development and dissemination of research databases.
    Within the total for research on health costs, quality, and 
outcomes, the Committee provides $84,000,000 for patient safety 
activities, which is $4,500,000 above the fiscal year 2004 
comparable level and the same as the budget request. This 
amount includes funding for the patient safety hospital 
information technology initiative. As part of its patient 
safety activity, the Committee encourages AHRQ to conduct pilot 
projects to demonstrate the feasibility and value of standards-
based electronic health care data interchange.
    The Committee commends AHRQ for its collaborative efforts 
with relevant Federal agencies and with public-private sector 
partnership groups, and urges AHRQ to continue its cooperative 
efforts to accelerate the adoption and use of standards and 
technology to support quality and safety.
    The Committee encourages AHRQ to continue and strengthen 
its efforts in comparative clinical effectiveness research, as 
authorized by the Medicare Modernization Act of 2003.
    The cost of health care delivery continues to rise with 
many health care experts predicting double digit increases for 
the foreseeable future. There is some concern that new 
biomedical research discoveries that provide new remedies for 
health problems may also contribute to higher health care costs 
when they are used inappropriately. The Committee recognizes 
the need to ensure that increased investment in biomedical 
research does not price quality health care out of reach of 
many Americans. Providers, patients and health care payers need 
objective, scientific information to understand which new 
interventions are more effective than existing practices, which 
groups of patients are most likely to benefit, the degree of 
improvement compared to the cost, and the relative risks for 
the patient of alternative interventions. The Committee 
suggests that AHRQ expand its efforts to support research and 
clinical effectiveness trials that will develop scientific 
evidence regarding the relative effectiveness, outcomes, risks 
and costs of promising new interventions in comparison with 
existing practices, especially those that have the potential to 
reduce health care costs without reducing quality.
    The Committee encourages 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 recommends that AHRQ 
conduct a workshop on standards of care for the muscular 
dystrophies and coordinate this activity with national advocacy 
organizations dedicated to this condition.
    The Committee encourages AHRQ to evaluate the outcomes, 
relevant patient care and financial impact of alternative 
methodologies of utilization and reimbursement of certified 
surgical assistances (CSAs) as recommended by the Government 
Accounting Office and report such outcomes to the Committee.
    The Committee is aware of a significant gap in information 
that is available to expectant mothers regarding umbilical cord 
blood donation. Cord blood transplants are used to treat a 
number of conditions, especially diseases of the blood and 
lymph system such as leukemia and lymphoma. The Committee 
encourages AHRQ to study and recommend the appropriate point in 
maternity care at which to provide full information on all cord 
blood donation options.
    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 encourages AHRQ to conduct a 
study examining changes in the market involving infused 
biologicals. The report should examine issues such as 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 
demands, geographical variations in access and meeting demand 
(including availability, capacity, barriers and variations in 
cost to rural providers). In addition, the Committee requests 
that the report examine demand for infused therapies by 
subspecialty including but not limited to neurology, hematology 
and rheumatology.
    The Committee provides $55,300,000 for the Medical 
Expenditures Panel Surveys (MEPS), which is the same as the 
fiscal year 2004 comparable level and the budget request. The 
MEPS provide data for 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. This activity also provides data for 
analysis of changes in behavior as a result of market forces or 
policy changes on health care use, expenditures, and insurance 
coverage; develops cost/savings estimates of proposed changes 
in policy; and identifies the impact of changes in policy for 
subgroups of the population.
    For program support, the Committee provides $2,700,000 
which is the the same as fiscal year 2004 level and the budget 
request. This activity supports the overall direction and 
management of the agency.

               Centers for Medicare and Medicaid Services


                     GRANTS TO STATES FOR MEDICAID

    The Committee provides $119,124,488,000 for the Federal 
share of current law State Medicaid costs, which is 
$11,767,709,000 below the fiscal year 2004 comparable level and 
the same as the budget request. This amount does not include 
$58,416,275,000, which was advance funded in the fiscal year 
2004 appropriation. In addition, the Committee provides an 
advance appropriation of $58,517,290,000 for program costs in 
the first quarter of fiscal year 2006. The Committee has also 
included indefinite budget authority for unanticipated costs in 
fiscal year 2005.
    Federal Medicaid grants reimburse States for 50 to 83 
percent (depending on per capita income) of their expenditures 
in providing health care for individuals whose income and 
resources fall below specified levels. Subject to certain 
minimum requirements, States have broad authority within the 
law to set eligibility, coverage, and payment levels. Over 43 
million low-income individuals will receive health care 
services in 2005 under the Medicaid program. State costs of 
administering the program are matched at rates that generally 
range from 50 to 90 percent, depending upon the type of cost. 
Total funding for Medicaid includes $1,208,296,000 for the 
entitlement Vaccines for Children program. These funds, which 
are transferred to the Centers for Disease Control and 
Prevention for administration, support the costs of 
immunization for children who are on Medicaid, uninsured or 
underinsured and receiving immunizations at Federally qualified 
health centers or rural health clinics.

Payments to health care trust funds

    The Committee provides $114,608,900,000 for the Payments to 
the Health Care Trust Funds account, which is $19,524,800,000 
above the fiscal year 2004 comparable level and the same as the 
budget request. In addition, as proposed by the Administration, 
the Committee provides a new advance mandatory appropriation of 
$5,216,900,000 to support the first-year costs of the Medicare 
prescription drug program.
    This entitlement account includes the general fund subsidy 
to the Federal Supplementary Medical Insurance Trust Fund for 
Medicare Part B benefits and for Medicare drug benefits and 
administration as well as other reimbursements to the Federal 
Hospital Insurance Trust Fund for benefits and related 
administrative costs which have not been financed by payroll 
taxes or premium contributions. The amount provided includes 
$215,000,000 for program management administrative 
expenditures, which is $13,900,000 above the fiscal year 2004 
estimate of the general fund share of CMS program management 
expenses. This general fund share will be transferred to the 
Federal Hospital Insurance Trust Fund to reimburse for the 
funds advanced by the trust fund in fiscal year 2005 to finance 
the general fund portion of Program Management.

Program management

    The Committee makes available $2,746,253,000 in trust funds 
for Federal administration of the Medicare and Medicaid 
programs, which is $109,407,000 above the fiscal year 2004 
comparable level and $126,000 above the budget request.

            Research, demonstration, and evaluation

    The Committee provides $68,400,000 for research, 
demonstration and evaluation, which is $9,391,000 below the 
fiscal year 2004 comparable level and $126,000 above the budget 
request. These funds support a variety of studies and 
demonstrations in such areas as monitoring and evaluating 
health system performance; improving health care financing and 
delivery mechanisms; modernization of the Medicare program; the 
needs of vulnerable populations in the areas of health care 
access, delivery systems, and financing; and information to 
improve consumer choice and health status. The reduction below 
last year's level is primarily due to the funding of one-time 
projects.
    The Committee is supportive of the clinical investigation 
of pancreatic islet cell transplantation to be implemented as 
directed by the Medicare Modernization Act of 2003. The 
Committee encourages CMS and NIH to establish and maintain a 
close collaboration that will ensure the success of this 
important initiative as it is launched in October, 2004. The 
Committee encourages CMS, in working with NIH, to ensure that a 
sufficient number of Medicare beneficiaries participate in the 
clinical investigation so that the results are applicable to 
the Medicare population with Type 1 diabetes and Medicare is 
able to make an informed decision regarding broader coverage of 
pancreatic islet transplantation.
    The Committee is concerned about recent CMS data which show 
that less than one-third of Medicare beneficiaries eligible for 
diabetes self-management training are receiving the care they 
need. To identify the primary barriers to access in urban and 
rural settings, the Committee encourages CMS to conduct 
demonstrations to determine the effectiveness of diabetes self-
management training and the various obstacles to access.
    The Committee urges CMS to study the cost-effectiveness of 
innovative state dental Medicaid programs for children. The 
study should focus on those programs that have reported 
improvements in access to care through innovative designs that 
have attracted adequate numbers of dentists and assured 
improved access for patients.

            Medicare operations

    The Committee provides $1,793,879,000 to support Medicare 
claims processing contracts, which is $92,841,000 above the 
fiscal year 2004 comparable level and the same as the budget 
request. The bill includes a general provision implementing the 
Administration's proposal to assess user fees to providers that 
submit incomplete or duplicate claims. The funds made available 
for Medicare operations will be reduced by $155,000,000 upon 
enactment of this provision. $129,000,000 is included within 
this account to begin implementation of reforms to the Medicare 
appeals process, of which $50,000,000 will be transferred to 
the Social Security Administration to conduct Medicare appeals 
hearings.
    Medicare contractors are responsible for paying Medicare 
providers promptly and accurately. In addition to processing 
claims, contractors also identify and recover Medicare 
overpayments, as well as review claims for questionable 
utilization patterns and medical necessity. Contractors also 
provide information and technical support both to providers and 
beneficiaries regarding the administration of the Medicare 
program. In 2005, contractors are expected to process over 
billion claims.
    The Committee understands that CMS has waived the five 
percent cap on transferring funds among functions as part of a 
pilot with three contractors. The Committee recommends that the 
waiver be extended to all contractors so they have greater 
flexibility to manage their resources in a manner that best 
matches programmatic needs and address mid-year addenda to 
budget instructions, new performance requirements and 
unanticipated increases in workload. The Committee requests CMS 
to report on its plans to extend the waiver to all contractors 
in its fiscal year 2006 congressional justification.

            Revitalization plan

    The Committee provides $24,400,000, to remain available for 
two years, as the second year of investment in CMS's efforts to 
make significant improvements to key aspects of managing both 
the agency and the Medicare program. This amount is the same as 
the budget request and $5,219,000 below the fiscal year 2004 
comparable level. Funding will target systems-related 
improvements.

            State survey and certification

    The Committee provides $270,392,000 for State inspections 
of facilities serving Medicare and Medicaid beneficiaries, 
which is $19,140,000 above the fiscal year 2004 comparable 
level and the same as the budget request.
    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. Almost 76,000 surveys and complaint 
investigations will be performed in fiscal year 2005.

            Federal administration

    The Committee provides $589,182,000 to support Federal 
administrative activities related to the Medicare and Medicaid 
programs, which is $12,036,000 above the fiscal year 2004 
comparable level and the same as the budget request. This 
amount includes $13,000,000 for the Healthy Start, Grow Smart 
program as requested by the Administration. The Committee 
repeats language from last year's enacted bill to identify 
$78,300,000 for the contract costs of the Health-care 
Integrated General Ledger Accounting System. The Medicare 
Modernization Act provided an additional $1,000,000,000 to CMS 
for administration of the new programs created.
    The Medicare, Medicaid, and Children's Health Insurance 
programs ensure the health care security of approximately 84 
million beneficiaries. The Federal Administration budget 
provides funds for the staff and operations of CMS to 
administer these programs.
    The Committee is concerned that CMS has failed to address a 
substantive inequity over current doctor reimbursement levels 
in the California counties of Santa Cruz, Sonoma, Santa Barbara 
and San Diego. CMS continues to assign these counties to 
geographic adjustment factor Locality 99 despite growing 
evidence that the geographic practice cost index of these 
counties exceeds the regulatory parameters for Locality 99 
designation. The Committee requests CMS to report to the 
Committee by January 1, 2005 a plan to correct this discrepancy 
via action at the Federal level.
    The Committee recognizes the importance of the State 
Medicare Carrier Advisory Committees (CACs) in the formation of 
local coverage policies issued by Medicare Part B Carriers. The 
Committee is concerned about the inconsistency of policies 
issued by Medicare Part B carriers in relation to 
interventional pain management services, and the lack of 
representation by interventional pain physicians. Given the 
growing concern over interventional pain management, the 
Committee believes it is important for the CACs to have the 
information necessary to develop appropriate policies to ensure 
access to pain management interventions that can make a 
difference in the quality of life for those who suffer from 
persistent pain. The Committee urges CMS to expand the number 
of required specialities to include interventional pain 
management representation on the state CACs.
    The Committee is concerned that Medicare patients with rare 
diseases may have difficulties accessing care that involves 
orphan drugs. The Committee encourages CMS to carefully 
consider the impact on this population in proposing 
regulations. The Committee encourages the Administrator to 
solicit the views of the FDA Office of Orphan Products 
Development and the NIH Office of Rare Diseases, as well as 
stakeholder groups, before determining whether an access 
problem exists or would be made worse by proposed regulations.
    The Committee is concerned about the reimbursement levels 
that the Medicare program provides for immunizations. Many 
States apply these rates to the immunizations for their 
Medicaid programs, which may affect the availability of 
childhood immunizations. The Committee encourages CMS to review 
its Medicare immunization rate policy and consider whether 
reimbursements should be tied more specifically to the number 
of immunizations administered in a single office visit.
    The Committee supports the proposed Hospital CAHPS patient 
satisfaction survey, which is intended to create comparable 
public reporting of hospitals' patient perspectives on consumer 
choice and hospital accountability. The Committee is aware that 
the survey may create time and cost burdens for hospitals and 
encourages CMS to be sensitive to these issues as it continues 
the development of the survey.
    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 was disturbed 
earlier this year by the examples of claims for this benefit 
being denied by CMS contractors based on an excessively narrow 
interpretation of what constitutes ``nonambulatory.'' 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 anti-cancer therapies through 
the Part B drug payment policies. Oral anti-cancer medications 
can offer clinical equivalency if not superiority to infusion 
therapies while providing broader benefits to patients, 
providers and payers. In providing effective cancer treatment, 
oral anti-cancer drugs benefit patients from greater 
convenience, flexibility and less adverse side effects compared 
to conventional infusion treatment. Payers benefit from an 
overall cost savings to the health system and providers can 
make appropriate treatment decisions without the deterrence of 
economic barriers. Availability of oral anti-cancer therapies 
may be important in rural areas where patients who are 
appropriate candidates as determined by their physicians may 
benefit from such care. Therefore, CMS is encouraged to 
evaluate reimbursement policies in order to ensure parity for 
such oral therapies.
    The Committee encourages CMS to develop policies to permit 
independent billing and payments to Certified Paramedic 
Intercept Providers delivering medically necessary and 
requested advanced life support (ALS). Such a policy would 
apply to services in ambulance transportation operated by 
public, non-profit or volunteer ambulance entities that 
qualified under Title XVIII of the Social Security Act and that 
offer only ``basic life support services.'' The Certified 
Paramedic Intercept Provider would not have to bill via the 
ambulance transportation entity, and the ambulance 
transportation entity could not bill, at the same time, for the 
advance life support intercept.

                Administration for Children and Families


  PAYMENTS TO STATES FOR CHILD SUPPORT ENFORCEMENT AND FAMILY SUPPORT 
                                PROGRAMS

    The Committee provides $2,873,802,000 for the Child Support 
Enforcement program, the same as the budget request. The bill 
also provides $1,200,000,000 in advance funding for the first 
quarter of fiscal year 2006 to ensure timely payments for the 
child support enforcement program, the same as the request. The 
bill continues to provide estimated funding of $23,000,000 for 
Payments to Territories, the same as the fiscal year 2004 level 
and the budget request. The bill provides $1,000,000 for the 
repatriation program, the same as the fiscal year 2004 level 
and the budget request.

                   LOW-INCOME HOME ENERGY ASSISTANCE

    The Committee provides an appropriation of $2,227,000,000 
for Low-Income Home Energy Assistance. This is $111,044,000 
more than the fiscal year 2004 comparable level and $64,700,000 
below the budget request. The Committee provides $1,900,000,000 
of these funds through the regular formula program and 
$100,000,000 in contingent emergency funding through the 
Department of Health and Human Services and $227,000,000 for 
weatherization assistance grants through the Department of 
Energy. The budget request included $1,800,500,000 in formula 
grants, $200,000,000 in contingent emergency funding, and 
$291,200,000 in weatherization assistance.
    Within the funds provided, $227,000,000 is provided for the 
weatherization assistance program to be transferred to the 
Department of Energy. This program increases the energy 
efficiency of dwellings owned or occupied by low-income persons 
to reduce their overall total residential energy expenditures. 
This program had been previously funded through the Interior 
Subcommittee Appropriations Act, but was transferred to the 
jurisdiction of the Labor, HHS, and Education Subcommittee in 
June of 2004.
    The weatherization assistance program has not been 
evaluated fully in over 10 years. The Committee was pleased by 
the last evaluation, performed by Oak Ridge National Laboratory 
(ORNL), and encourages the Department of Energy to contract 
with ORNL for an up-to-date assessment.
    The low-income home energy assistance program (LIHEAP), 
administered by the Department of Health and Human Services, 
provides assistance to low-income households to help pay the 
costs of home energy. Funds are provided through grants to 
States, Indian Tribes and territories, and are used for summer 
cooling and winter heating/crisis assistance programs.

                     REFUGEE AND ENTRANT ASSISTANCE

    The Committee provides $491,336,000 for refugee assistance 
programs. This is $43,738,000 more than the fiscal year 2004 
level and $18,097,000 more than the budget request.
    In addition, the bill provides the Office of Refugee 
Resettlement (ORR) the authority to carry over unexpended funds 
from fiscal year 2005 to reimburse the costs of services 
provided through September 30, 2007 for all programs within 
ORR's jurisdiction.

Transitional and medical services

    The Committee provides $193,577,000 for transitional and 
medical services. This is $24,602,000 more than the fiscal year 
2004 comparable level and the same as the budget request. The 
transitional and medical services program provides funding for 
the State-administered cash and medical assistance program that 
assists refugees who are not categorically eligible for TANF or 
Medicaid, the unaccompanied minors program that reimburses 
States for the cost of foster care, and the voluntary agency 
grant program in which participating National refugee 
resettlement agencies provide resettlement assistance with a 
combination of Federal and matched funds.

Victims of trafficking

    The Committee provides up to $10,000,000 for the victims of 
trafficking program. This is $91,000 more than the fiscal year 
2004 comparable level and the same as the budget request. The 
funds will ensure continued administration of a National 
network for identification, tracking and certification of 
trafficking victims.

Social services

    The Committee provides $166,218,000 for social services. 
This is $15,097,000 more than the budget request and 
$14,000,000 more than the fiscal year 2004 level. Funds are 
distributed by formula as well as through the discretionary 
grant making process for special projects. The Committee 
intends that funds provided above the request shall be used for 
Refugee School Impact Grants and for additional assistance in 
resettling and meeting the needs of the Hmong refugees expected 
to arrive during 2004 and 2005.
    Within the funds provided, the Committee has included 
$19,000,000 for increased support to communities with large 
concentrations of Cuban and Haitian refugees of varying ages 
whose cultural differences make assimilation especially 
difficult, justifying a more intense level and longer duration 
of Federal assistance for healthcare and education.

Preventive health

    The Committee provides $4,835,000 for preventive health 
services. This is $43,000 more than the fiscal year 2004 
comparable level and the same as the budget request. These 
funds are awarded to the States to ensure adequate health 
assessment activities for refugees.

Targeted assistance

    The Committee provides $49,477,000 for the targeted 
assistance program. This is $452,000 more than the fiscal year 
2004 comparable level and the same as the budget request. These 
grants provide assistance to areas with high concentrations of 
refugees.

Unaccompanied minors

    The Committee provides $54,229,000 for the unaccompanied 
minors program. This is $1,459,000 more than the fiscal year 
2004 comparable level and the same as the budget request. Funds 
were transferred to the Office of Refugee Resettlement (ORR) in 
fiscal year 2003 from the Immigration and Naturalization 
Service pursuant to section 462 of the Homeland Security Act. 
The program is designed to provide for the care and placement 
of unaccompanied alien minors who are apprehended in the U.S. 
pending resolution of their claims for relief under U.S. 
immigration law or released to an adult family member or 
responsible adult guardian.
    The Committee is pleased with the progress that ORR has 
made in taking responsibility for this important program, 
especially the significant improvements in the treatment of 
unaccompanied alien children, including improvements in their 
placements and in the healthcare provided to them. The 
Committee intends that the funds provided by this appropriation 
be used, in part, to increase the number of juvenile 
coordinators in the program and to continue improvements in the 
provision of healthcare, including mental health care, to 
children in the program.
    The Committee is concerned about some aspects of the 
transition of unaccompanied alien children functions from the 
INS to ORR, especially reports that not all unaccompanied alien 
children are making their way into the custody of ORR as was 
intended when Congress enacted the Homeland Security Act of 
2002. The Committee directs ORR, in consultation with all 
appropriate Federal agencies, to report to the Committee within 
90 days of the date of enactment of this Act, instances since 
March 1, 2003, in which Federal agencies have not promptly 
notified ORR that it has unaccompanied alien children in their 
custody and have not made arrangements for the prompt transfer 
of such children to ORR's care.
    The Committee is also aware of reports that the Department 
of Homeland Security (DHS) is not fully cooperating with ORR on 
release decisions and directs ORR, in cooperation with DHS, to 
report to this Committee on its formal arrangements with DHS on 
release decisions.

Victims of torture

    The Committee provides $13,000,000 to provide a 
comprehensive program of support for domestic centers and 
programs for victims of torture. This is $3,091,000 more the 
fiscal year 2004 level and $3,000,000 more than the budget 
request.
    The Committee expects that the Office of Refugee 
Resettlement should give priority to specialized treatment 
programs that provide services for the rehabilitation of 
victims of torture, including treatment of the physical and 
psychological effects of torture. To meet the need of the over 
400,000 victims of torture living in the United States, it is 
critical to invest in specialized treatment programs which, in 
turn, can offer essential training to general health care 
programs throughout the country.

                 CHILD CARE AND DEVELOPMENT BLOCK GRANT

    The bill includes $2,099,729,000 for the Child Care and 
Development Block Grant program, an increase of $12,419,000 
above the fiscal year 2004 comparable level and the same as the 
budget request.
    The Child Care and Development Block Grant program was 
originally enacted in the Omnibus Budget Reconciliation Act of 
1990 to increase the availability, affordability and quality of 
child care by providing funds to States, Territories and Indian 
Tribes for child care services for low-income families. The 
authorization for mandatory appropriations for childcare in the 
amount of $2,717,000,000 is also requested for fiscal year 
2005.

                      SOCIAL SERVICES BLOCK GRANT

    The Committee provides $1,700,000,000 for the social 
services block grant (SSBG). This is the same as the fiscal 
year 2004 level and the budget request.
    SSBGs are designed to encourage States to furnish a variety 
of social services to needy individuals to prevent and reduce 
dependency, help individuals achieve and maintain self-
sufficiency, prevent or reduce inappropriate institutional 
care, secure admission or referral for institutional care when 
other forms of care are not appropriate, and prevent neglect, 
abuse and exploitation of children and adults.
    Funds are distributed to the territories in the same ratio 
such funds were allocated in fiscal year 1981. The remainder of 
the appropriation is distributed to the States and the District 
of Columbia according to population.
    The bill includes a provision that modifies the percentage 
of funds that a State may transfer between the Social Services 
Block Grant and the Temporary Assistance to Needy Families 
programs to 4.5%.

                 CHILDREN AND FAMILY SERVICES PROGRAMS

    The Committee provides a program level total of 
$8,996,145,000 for children and family services programs. This 
is $144,146,000 more than the fiscal year 2004 comparable level 
and $114,380,000 less than the budget request. Within the total 
provided, $10,482,000 is provided through the evaluation set-
aside. This account finances a number of programs aimed at 
enhancing the well-being of the Nation's children and families, 
particularly those who are disadvantaged or troubled.

Head Start

    The bill includes $6,898,580,000 for the Head Start program 
for fiscal year 2005, an increase of $123,732,000 over the 
fiscal year 2004 amount and $45,000,000 below the budget 
request. Of this total, the Committee continues the policy of 
advancing $1,400,000,000 of this account into fiscal year 2006.
    Head Start provides comprehensive development services for 
children and their families. Intended for preschoolers from 
low-income families, the program seeks to foster the 
development of children and enable them to deal more 
effectively with both their present environment and later 
responsibilities in school and community life. Head Start 
programs emphasize cognitive and language development, 
emotional development, physical and mental health, and parent 
involvement to enable each child to develop and function at his 
or her highest potential. At least ten percent of enrollment 
opportunities in each State are made available to handicapped 
children.
    Grants to carry out Head Start programs are awarded to 
public and private non-profit agencies. Grantees must 
contribute 20 percent of the total cost of the program; this is 
usually an in-kind contribution. The Head Start Act does not 
include a formula for the allotment of funds to local grantees; 
however, it does require that 87 percent of the appropriation 
be distributed among States based on a statutory formula. In 
addition, grants, cooperative agreements and contracts are 
awarded in the areas of research, demonstration, technical 
assistance and evaluation from the remaining 13 percent.
    The Committee has learned that while most local grantees 
are working to ensure federal Head Start funds are spent 
directly on preparing disadvantaged children for kindergarten, 
others appear to be billing Head Start for lavish salary and 
compensation packages for their top executives. In response to 
this information, the Committee has included a general 
provision limiting the compensation of an individual working in 
Head Start to the Federal Executive Level II salary. The 
Committee routinely includes similar language with respect to 
Job Corps and NIH executives.
    The Committee is aware that only 19% of the children 
eligible for Migrant and Seasonal Head Start (MSHS) are able to 
access services due to limited funding in contrast to Regional 
Head Start programs that are able to serve 60% of their 
eligible children. Existing MSHS programs maintain significant 
wait lists and, in many areas of the country, there are not 
MSHS programs to provide services to migrant farmworker 
children when they move into a state. The Committee directs the 
department, within 90 days of enactment of the bill, to provide 
a plan to the Committee describing how it intends to serve a 
greater percentage of migrant children.
    The Committee recognizes that there is concern among the 
educational and Head Start community about the administration 
of a standardized test for 4- and 5-year olds. The Committee 
directs the Department of Health and Human Services to submit 
the report from the independent panel appointed in March of 
2004 assessing the effectiveness of the National Reporting 
System no later than November 30, 2004.
    The Committee notes that the current Head Start Act 
includes the provision of training and technical assistance in 
the area of family literacy services--a provision that is 
retained in both House and Senate versions of Head Start 
reauthorization legislation. Absent the enactment of 
reauthorization legislation, the Committee encourages the 
Secretary to ensure the continuity of the important services 
that are being provided through the Head Start Family Literacy 
Project.
    The Committee encourages the Head Start Bureau and the 
Maternal and Child Health Bureau to continue and expand their 
successful interagency agreement to jointly address dental 
disease.

Consolidated runaway and homeless youth program

    The Committee provides $89,447,000 for runaway and homeless 
youth activities, an increase of $16,000 more than the fiscal 
year 2004 comparable level and the same as the budget request. 
The Runaway, Homeless, and Missing Children Protection Act of 
2003 reauthorized the runaway and homeless youth programs and 
established a statutory formula distribution between the Basic 
Center Program and the Transitional Living Program.
    The runaway and homeless youth programs provide grants to 
local public and private organizations to establish and operate 
runaway and homeless youth shelters to address the crisis needs 
of runaway and homeless youth and their families. Grants are 
used to develop or strengthen community-based shelters, which 
are outside the law enforcement, juvenile justice, child 
welfare, and mental health systems.
    It is the Committee's expectation that current transitional 
living program grantees will continue to provide transitional 
living opportunities and supports 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 supports 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 has not included funding for this new 
program. The budget request is $10,000,000.
    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 
Transitional Living Program.

Prevention grants to reduce abuse of runaway youth

    The Committee provides $15,302,000 for prevention grants to 
reduce abuse of runaway youth. This is the same as the fiscal 
year 2004 level and the budget request. This program is 
designed to reduce the sexual abuse of runaway youth by 
providing grants to support street-based outreach and education 
to runaway, homeless, and street youth who have been sexually 
abused or who are at-risk of sexual abuse, in order to connect 
these young people with services so that they have a chance for 
a safe and healthy future. The street outreach program ensures 
rapid engagement with young people in an effort to prevent the 
most terrible situations that take place when they are 
subjected to life on the streets--physical and sexual abuse, 
assault, commercial sexual exploitation, disease, long-term 
homelessness, and even death.

Child abuse State grants and discretionary activities

    For child abuse State grants and discretionary activities, 
the Committee provides $54,570,000. This is $1,519,000 less 
than the fiscal year 2004 level and $13,529,000 less than the 
budget request. Within this total, the recommendation includes 
$28,484,000 for State grants, which is $6,601,000 more than the 
fiscal year 2004 level and $13,529,000 less than the budget 
request and $26,266,000 for child abuse discretionary 
activities which is the same as the budget request.

Community-based child abuse prevention

    The Committee provides $43,205,000 for community-based 
child abuse prevention. This is $10,000,000 more than the 
fiscal year 2004 comparable level and $21,797,000 less than the 
budget request. The Keeping Children and Families Safe Act of 
2003 reauthorized and renamed this program and added voluntary 
home visiting programs as a core local service. Funds are 
provided to lead State agencies and are used to develop, 
operate, expand, and enhance community-based efforts to 
strengthen and support families in order to prevent child abuse 
and neglect.

Abandoned infants assistance

    The Committee provides $12,086,000 for the Abandoned 
Infants Assistance Act. This is $34,000 more than the fiscal 
year 2004 comparable level and the same as the budget request. 
The purpose of this program is to provide financial support to 
public and private community and faith-based entities to 
develop, implement, and operate demonstration projects that 
will prevent the abandonment of infants and young children 
exposed to HIV/AIDS and drugs; identify and address their 
needs; assist such children to reside with their natural 
families or in foster care; recruit, train and retain foster 
parents as well as health and social services personnel; 
provide respite care for families and foster families; and 
prevent the abandonment of infants and young children.

Child welfare services and training

    The Committee provides $291,986,000 for child welfare 
services. This is $2,666,000 more than the fiscal year 2004 
comparable level and the same as the budget request. This 
program, authorized by title IV B of the Social Security Act, 
provides grants to States to assist public welfare agencies to 
improve child welfare services. State services include 
preventive intervention in order for children to stay in their 
homes, alternative placement like foster care or adoption if it 
is not possible for children to remain at home, and 
reunification programs so that, if appropriate, children can 
return home.
    The Committee provides $7,470,000 for child welfare 
training. This is $59,000 more than the fiscal year 2004 level 
and the same as the budget request. The Committee recognizes 
the need for trained, skilled and qualified child welfare 
service workers. This program provides grants to institutions 
of higher education to develop and improve education and 
training programs and resources for child welfare service 
providers as well as students seeking degrees in social work.

Adoption opportunities

    The Committee provides $27,343,000 for adoption 
opportunities. This is $240,000 more than the fiscal year 2004 
level and the same as the budget request. The Adoption 
Opportunities Program provides funding specifically targeted to 
improving the adoption of children, particularly those with 
special needs, and for providing for innovative services that 
support families involved in adoption.
    Minority and low-income foster children are the largest 
population of foster children nationwide and the hardest to 
place in homes. The Committee recognizes the positive impact of 
faith-based adoption organizations, such as One Church One 
Child, who specifically target minority populations in 
underserved communities. By providing adoption services and 
education to minority church communities to be paired with 
foster children, organizations such as One Church One Child 
bring together families and children who may not otherwise have 
access to adoption services.
    The Committee encourages the Department of Health and Human 
Services to expand funding opportunities for faith-based 
adoption programs such as One Church One Child to enhance their 
capacity to provide community-based counseling and mentoring 
programs to minority and low-income foster children and provide 
case management and wraparound support services to adoptive and 
foster children and their families to promote positive child, 
youth and family development.

Adoption incentives

    The Committee provides $32,103,000 for the adoption 
incentives program. This is $24,647,000 more than the fiscal 
year 2004 appropriated level and the same as the budget 
request. The Adoption Promotion Act of 2003 reauthorized this 
program and now targets incentives specifically for older 
children. Funds are awarded to States using three baselines: 
one for the total number of children adopted, one for children 
with special needs under the age of nine, and one for children 
aged nine and older. The goal of this program is to increase 
the number of adoptions nationwide.

Adoption awareness

    The Committee provides $12,906,000 for the adoption 
awareness program. This is the $121,000 more than the fiscal 
year 2004 comparable level and the same as the budget request. 
This program was authorized in the Children's Health Act of 
2000. The adoption awareness program provides training to 
designated staff of eligible health centers in providing 
adoption information and referrals to pregnant women on an 
equal basis with all other courses of action included in non-
directive counseling to pregnant women.

Compassion capital fund

    The Committee provides $55,000,000 for the compassion 
capital fund. This is $7,298,000 more than the fiscal year 2004 
comparable level and $45,000,000 less than the budget request. 
This program supports the creation of grants to public/private 
partnerships to support charitable organizations in expanding 
or emulating model social services agencies and provides 
capacity-building funds directly to faith- and community-based 
organizations.

Social services and income maintenance research

    The Committee provides $5,982,000 for social services and 
income maintenance research through the evaluation set-aside. 
This is the same level as the budget request and $13,186,000 
less than the fiscal year 2004 comparable level. The budget 
request provided this funding through direct appropriation. 
These funds support research, demonstration, evaluation and 
dissemination activities. Areas covered include welfare reform, 
childcare, and child welfare.

Developmental disabilities

    For programs authorized by the Developmental Disabilities 
Assistance and Bill of Rights Act of 2000 as well as by the 
Help America Vote Act, the Committee provides $164,942,000. 
This is $170,000 more than the fiscal year 2004 level and 
$88,000 more than the budget request. The account total 
includes $73,081,000 for allotments to the States to fund State 
Councils, the same as the budget request and the fiscal year 
2004 level. These Councils engage in such activities as 
planning, policy analysis, demonstrations, training, outreach, 
interagency coordination, and public education. They do not 
provide direct services to the developmentally disabled 
population.
    In addition, $38,416,000 will be available to the States to 
be used for operating a protection and advocacy system to 
protect the legal and human rights of the developmentally 
disabled. This is the same as the budget request and the fiscal 
year 2004 level.
    The Committee provides $15,000,000 for Disabled Voter 
programs. This is $89,000 more than the fiscal year 2004 level 
and $88,000 more than the budget request. Within the funds 
provided, $10,000,000 is available for payments to States to 
promote access for voters with disabilities and $5,000,000 is 
available for State protection and advocacy systems. The 
Disabled Voter programs are intended to make polling places 
accessible and provide equal access and participation for 
individuals with disabilities. The protection and advocacy 
program will ensure that individuals can fully participate in 
the electoral process, including registering to vote, accessing 
polling places, and casting a vote.
    The Committee provides $11,642,000 for developmental 
disabilities projects of National significance. This is $81,000 
more than the fiscal year 2004 funding level and the same as 
the budget request.
    The Committee provides a total of $26,803,000 for 
university centers for excellence in developmental 
disabilities. This is the same as the fiscal year 2004 level 
and the budget request. These are discretionary grants to 
public or not-for-profit entities associated with universities. 
These grants provide basic operational and administrative core 
support for these agencies. In addition, these funds support 
interdisciplinary training, community services, research and 
technical assistance and information dissemination.

Native American programs

    The Committee provides $45,155,000. This is the same as the 
budget request and $2,000 less than the fiscal year 2004 level. 
The Native American program assists Tribal and Village 
governments, Native American institutions and organizations to 
support and develop stable, diversified local economies. In 
promoting social and economic self-sufficiency, this 
organization provides financial assistance through direct 
grants for individual projects, training and technical 
assistance, and research and demonstration programs.

Community Services

    The Committee provides $710,088,000 for Community Services 
activities. This is $157,738,000 more than the budget request 
and $21,196,000 less than the fiscal year 2004 level.
            State block grant
    For the State Block Grant, the Committee provides 
$627,500,000. This is $132,554,000 more than the budget request 
and $14,435,000 less than the fiscal year 2004 comparable 
level. This program provides grants to States, territories and 
Indian Tribes for services to meet employment, housing, 
nutrition, energy, emergency services, and health needs of low-
income people. By law, 90 percent of these funds are passed 
directly through to local community action agencies that have 
previously received block grant funds.
    The Committee directs the Secretary to prepare a 3-year 
strategic plan for the Office of Community Services use of 
Training and Technical Assistance funds in the fiscal years 
2005-2008. The plan should be developed with the guidance of 
entities experienced in providing effective research and 
training support to the Community Services Block Grant agency 
network and should be provided to the Community by no later 
than June 15, 2005. The Committee further encourages Training 
and Technical Assistance funding appropriated for fiscal year 
2005 to be used for activities to carry out corrective action 
and monitoring activities (including the development of 
reporting systems and electronic data systems) to assist States 
in continuing to improve their local programs.

            Community economic development

    The Committee provides $32,492,000 for community economic 
development grants. This is $154,000 more than the fiscal year 
2004 level and the same as the budget request. These activities 
provide assistance to private, locally-initiated community 
development corporations that sponsor enterprises providing 
employment, training and business development opportunities for 
low-income residents in poor communities. Within the total, 
$5,481,000 is provided for the Job Opportunities for Low-Income 
Individuals program, which provides competitive grant to non-
profit organizations to create new employment and business 
opportunities for TANF recipients and other low-income 
individuals.
    It has come to the attention of the Committee that the 
Department has established a number of set-asides within the 
community economic development program. Given the limited 
amount of funds available, it is the Committee's view that the 
number of set-asides should be substantially reduced. Further, 
the Committee reminds the Department that the principal purpose 
of the program is making grants of qualified community 
development with a record of achievement in working in 
distressed urban and rural communities. The Committee believes 
that special emphasis should be placed on providing financial 
and technical assistance to local businesses and start-ups. 
Finally, the Committee directs that of funds allocated for Job 
Creation Demonstration, not more than $500,000 be set-aside for 
program support and technical assistance.

            Individual development account

    The Committee provides $24,912,000 for individual 
development accounts. This is $217,000 more than the fiscal 
year 2004 level and the same as the budget request. Individual 
development accounts are dedicated savings accounts that can be 
used by families with limited means for purchasing a first 
home, paying for postsecondary education or capitalizing a 
business. The intent of the program is to encourage 
participants to develop and reinforce strong habits for saving 
money. 501(c)(3) organizations are eligible to apply for the 
funds and applicants must match Federal funds with non-Federal 
funds.

            Rural community facilities

    The Committee provides $7,184,000 for the rural community 
facilities program. This is the same as the fiscal year 2004 
amount. No funding was requested for this program. The 
Committee includes these funds to 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.

            National youth sports program

    The Committee provides $18,000,000 for the National Youth 
Sports program. This is $106,000 more than the fiscal year 2004 
level. No funds were requested for this program. These funds 
are made available to a private, non-profit organization to 
provide recreational activities for low-income youth, primarily 
in the summer months. College and university athletic 
facilities are employed in the program.

            Community food and nutrition

    The Committee concurs with the budget request not to 
include funding for the Community Food and Nutrition program. 
The fiscal year 2004 funding level for this program is 
$7,238,000. This program provides grants to public and private 
agencies to coordinate existing food assistance programs, to 
identify sponsors of child nutrition programs and attempt to 
initiate new programs and to do advocacy work at the State and 
local levels.

Violent crime reduction programs

    The Committee provides $125,648,000 for family violence 
prevention and services and battered women's shelters. This is 
the same as the budget request and the fiscal year 2004 level. 
This program is designed to assist States and Indian Tribes in 
efforts to prevent family violence and to provide immediate 
shelter and related assistance for victims of family violence 
and their dependents, and to provide for technical assistance 
and training relating to family violence programs to State and 
local public agencies (including law enforcement agencies), 
nonprofit private organizations, and persons seeking such 
assistance.
    The Committee also includes $3,000,000 to continue funding 
the National Domestic Violence Hotline. This is $18,000 more 
than the fiscal year 2004 level and the same as the budget 
request.

Early Learning Fund

    The Committee concurs with the budget request and does not 
provide funding for the Early Learning Fund. The fiscal year 
2004 level for this program is $33,580,000. This program was 
begun in fiscal year 2001 to help facilitate the development of 
learning readiness in young children.

Faith-based center

    The Committee provides $1,400,000 for the faith-based 
center. This is the same as the budget request and $14,000 more 
than the fiscal year 2004 level. The center will support 
implementation of faith-based and community initiatives in 
accordance with the President's executive order.

Mentoring children of prisoners

    The Committee provides $50,000,000 for the mentoring 
children of prisoners program. This is $299,000 above the 
fiscal year 2004 level and the same as the budget request. This 
program supports competitively awarded grants to States and 
local governments, Indian tribes and consortia, and faith- and 
community-based organizations to mentor children of prisoners 
and those recently released from prison.

Independent living training vouchers

    The Committee provides $50,000,000 for independent living 
training vouchers. This is $5,266,000 more than the fiscal year 
2004 level and $10,000,000 less than the budget request. These 
funds support vouchers 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.

Promotion of responsible fatherhood and healthy marriages

    The Committee does not include funding for the promotion of 
responsible fatherhood and healthy marriages program. The 
budget request is $50,000,000. Legislation authorizing this 
program is pending Congressional action.

Abstinence education

    The Committee provides a program level total of 
$109,546,000 for the community-based abstinence education 
program, which is $34,997,000 above the fiscal year 2004 
comparable level and $76,880,000 below the budget request. 
Within the total, $4,500,000 is provided through the evaluation 
set-aside as requested. The program provides support to public 
and private entities for implementation of community-based 
abstinence education programs for adolescents aged 12 through 
18. The entire focus of these programs is to educate young 
people and create an environment within communities that 
supports teen decisions to postpone sexual activity until 
marriage. There is no funding match requirement for these 
grants. The Committee intends that up to five percent of these 
funds be used to provide technical assistance and capacity-
building support to grantees.
    Within the total for abstinence education, $10,000,000 may 
be used to carry out a National Abstinence Education Campaign. 
Funds were requested for this initiative within the Office of 
the Secretary. The campaign is entitled the ``Responsible 
Choices Campaign'' and it will help parents communicate with 
their children about the health risks associated with 
premarital sexual activity. This new initiative will also 
increase awareness on the importance of parental involvement 
and will develop strategies on strengthening families through 
effective communication.
    The Committee supports abstinence education (as defined in 
sections (A) through (H) of Title 5, section 510(b)(2) of the 
Social Security Act) for adolescents ages 12 through 18, and 
supports expansion of efforts to present this abstinence 
message to America's youth. Results from these programs are 
promising. It is important, however, to ensure that America's 
youth do not receive mixed messages, or medically inaccurate 
information. Abstinence messages to a group of youth by a 
grantee must not be diluted by any instructor or materials from 
the same grantee. Nothing in the legislation is intended to 
prevent these adolescents from seeking health information or 
services. Nothing shall preclude entities that have a public 
health mandate from discussing other forms of sexual conduct or 
providing services, as long as this is conducted in a different 
setting than where and when the abstinence-only course is being 
conducted. In allocating grant funds, priority should be given 
to those organizations that have a strong record of support of 
abstinence education as defined in sections (A) through (H) of 
Title 5, section 510(b)(2) of the Social Security Act.
    The Committee is committed to studying the effectiveness of 
abstinence education. In order to track the long-term effects 
of these programs properly, it is necessary to conduct 
longitudinal studies that, for a number of years, follow groups 
of individual adolescents who receive a particular curriculum. 
Therefore, the Committee provides $4,500,000 of funding under 
Public Health Service evaluation funds to study, track, and 
evaluate youth who receive such education. If possible, these 
cohorts should be large enough to provide statistically 
significant results in all major population segments of 
American society, including African-Americans, Asians, 
Caucasians, Hispanics and Native Americans. They should also be 
able to track socio-economic variables as well. All appropriate 
parental consent, age-appropriateness and privacy guidelines 
should be followed. Criteria for success should include: 
prevention and reduction of adolescent pregnancies and sexually 
transmitted disease infection, including both viral and 
bacterial; age at first sexual-activity and intercourse; 
frequency of sexual activity and intercourse; and numbers who 
postpone sexual activity or intercourse through adolescence. 
Progress reports should be submitted to Congress annually.

Program direction

    The Committee provides $190,206,000 for program direction 
expenses for the Administration for Children and Families. This 
is $12,312,000 more than the fiscal year 2004 level and the 
same as the budget request.

                   PROMOTING SAFE AND STABLE FAMILIES

    The Committee provides $410,000,000 for the promoting safe 
and stable families program. This is $5,617,000 more than the 
fiscal year 2004 level and $95,000,000 less than the budget 
request.

           PAYMENTS TO STATES FOR FOSTER CARE AND ASSISTANCE

    The Committee provides $5,037,900,000 for payments to 
States for foster care and adoption assistance. This is 
$30,400,000 less than the fiscal year 2004 level and the same 
as the budget request. The bill also includes an advance 
appropriation of $1,767,200,000 for the first quarter of fiscal 
year 2006 to ensure timely completion of first quarter grant 
awards.
    Of the total appropriation, including the advance 
appropriation from the prior year, the Committee provides 
$4,895,500,000 for the foster care program to provide 
maintenance payments to States on behalf of children who must 
live outside their homes. This is the same as the budget 
request and $78,700,000 less than the fiscal year 2004 level.
    Within the total appropriation, the Committee provides 
$1,770,100,000 for adoption assistance. This is $70,400,000 
more than the fiscal year 2004 level and the same as the budget 
request. This program provides training for parents and State 
administrative staff as well as payments on behalf of 
categorically eligible children considered difficult to adopt. 
This annually appropriated entitlement is designed to provide 
alternatives to long, inappropriate stays in foster care by 
developing permanent placements with families.
    Within the total appropriation for this account, the 
Committee provides $140,000,000 for the independent living 
program. This is the same as the fiscal year 2004 level and the 
budget request. The program is designed to assist foster 
children age 16 or older to make successful transitions to 
independence. Funds assist children to earn high school 
diplomas, receive vocational training, and obtain training in 
daily living skills. Funds are awarded to States on the basis 
of the number of children on behalf of whom Federal foster care 
payments are received.

                        Administration on Aging


                        AGING SERVICES PROGRAMS

    For programs administered by the Administration on Aging, 
the Committee provides a total of $1,403,479,000. This is 
$29,562,000 more than the fiscal year 2004 level and 
$26,952,000 more than the budget request. This account finances 
all programs under the Older Americans Act in this bill, with 
the exception of the Community Services Employment Program, 
which is administered by the Department of Labor.

Supportive services and centers

    The Committee provides $357,000,000 for supportive services 
and centers. This is $3,111,000 more than the fiscal year 2004 
level and the same as the budget request. Funds for supportive 
services and centers are awarded to States and territories for 
in-home and community-based services for frail elderly persons 
who are at risk of losing their self-sufficiency due to 
physical or mental impairments. The funds contained in the bill 
will support a variety of activities including transportation 
services, information and assistance, and personal care 
services.

Preventive health

    The Committee provides $21,919,000 for preventive health 
services authorized under part F of title III of the Act. This 
is $129,000 more than the fiscal year 2004 level and the same 
as the budget request. These funds are awarded to States and 
territories to support activities that educate older adults 
about the importance of healthy lifestyles and promote healthy 
behaviors that can prevent or delay chronic disease and 
disability.

Protection of Vulnerable Older Americans

    The Committee provides $18,559,000 for the protection of 
vulnerable older Americans, authorized by title VII of the 
Older Americans Act. This is the same as the budget request and 
$885,000 less than the fiscal year 2004 level. Funding is 
provided for both the long-term care ombudsman program, which 
protects the rights and interests of residents in nursing 
homes, board and care homes, assisted living facilities and 
similar adult care facilities, as well as for the prevention of 
elder abuse, neglect, and exploitation program, which trains 
law enforcement and medical professionals in how to recognize 
and respond to elder abuse.

National Family Caregiver Support Program

    The Committee provides $157,000,000 for the family 
caregivers program. This is $4,262,000 more than the fiscal 
year 2004 level and $1,488,000 more than the budget request. 
The family caregiver program provides formula grants to States 
to provide a support system in each State for family 
caregivers. All States are expected to put in place five basic 
system components, including: individualized information on 
available resources; assistance to families in locating 
services from private and voluntary agencies; caregiver 
counseling, training and peer support; respite care; and other 
supplemental services.

Native American Caregiver Support Program

    The Committee provides $6,355,000 for the Native American 
Caregiver Support Program. This is $37,000 more than the fiscal 
year 2004 level and the same as the budget request. The program 
assists Tribes in providing multifaceted systems of support 
services for family caregivers as well as for grandparents 
caring for grandchildren.

Nutrition programs

    For congregate and home delivered meals, as well as the 
nutrition services incentive program, the Committee provides 
$730,178,000. This is $15,717,000 more than the fiscal year 
2004 level and $11,364,000 more than the budget request. These 
programs are intended to address some of the difficulties 
confronting older individuals, namely nutrition deficiencies 
due to inadequate income, lack of adequate facilities to 
prepare food, and social isolation.

Grants for Native Americans

    The Committee provides $26,612,000 for grants for Native 
Americans. This is $159,000 more than the fiscal year 2004 
level and the same as the budget request. Grants are 
distributed to tribal organizations to be used to help Native 
American elders remain healthy and independent by providing 
transportation, nutrition, health screening and other services.

Program innovations

    The Committee provides $37,943,000 for program innovations. 
This is $14,100,000 more than the budget request and $4,434,000 
more than the fiscal year 2004 funding level. Funds under this 
program are used for competitive grants and contracts to 
support projects that develop new and promising practices to 
serve older adults and their families.
    The Committee provides $3,000,000 for social research into 
Alzheimer's disease care options, best practices and other 
Alzheimer's research priorities that include research into 
cause, cure and care, as well as respite care, assisted living, 
the impact of intervention by social service agencies on 
victims, and related needs. The Committee recommends this 
research utilize and give discretion to Area Agencies on Aging 
and their non-profit divisions in municipalities with aged 
populations (over the age of 60) of over 1 million, with 
preference given to the largest population. The Committee also 
recommends that unique partnerships to affect this research be 
considered for the selected Area Agency on Aging.

Aging network support activities

    The Committee provides $13,373,000 for aging network 
support activities, which include five ongoing programs: the 
Eldercare Locator, Pension Counseling, Senior Medicare Patrols, 
the National Long-Term Care Ombudsman Resource Center, and the 
National Center on Elder Abuse. This is $79,000 more than the 
fiscal year 2004 level and the same as the budget request. 
These established programs, which began as demonstration 
projects, provide critical support for the National aging 
services network.

Alzheimer's disease demonstration grants

    The Committee provides $11,500,000 for Alzheimer's disease 
demonstration grants. This is the same as the budget request 
and $383,000 less than the fiscal year 2004 level. The program 
provides competitive grants to States to help them plan and 
establish programs to provide models of care to individuals 
with Alzheimer's disease. Funds are used for respite care and 
supportive services, clearinghouses, training, and 
administrative costs for State offices.

White House conference on aging

    The Committee provides $4,558,000 for the White House 
conference on aging. This is $1,774,000 more than the fiscal 
year 2004 level and the same as the budget request. The 
Conference is required to take place no later than December 31, 
2005 and will be the first such conference of the 21st Century 
and the fifth in our Nation's history. Past White House 
conferences on aging have prompted the development of many of 
the programs that represent America's commitment to the 
elderly.

Program administration

    The Committee provides $18,482,000 for program 
administration expenses for the Administration on Aging (AoA). 
This is $1,158,000 more than the fiscal year 2004 level and the 
same as the budget request. This activity provides 
administrative and management support for all Older Americans 
Act programs administered by AoA.

                        Office of the Secretary


                    GENERAL DEPARTMENTAL MANAGEMENT

    The Committee provides $386,149,000 for general 
departmental management, which is $26,080,000 above the fiscal 
year 2004 comparable level and $51,673,000 below the budget 
request. Included in this amount is authority to spend 
$5,851,000 from the Medicare trust funds. In addition, the 
Office of the Secretary has access to $21,552,000 of policy 
evaluation funding.
    This appropriation supports those activities that are 
associated with the Secretary's roles as policy officer and 
general manager of the Department. The Office of the Secretary 
also implements Administration and Congressional directives, 
and provides assistance, direction and coordination to the 
headquarters, regions and field organizations of the 
Department. This account also supports several small health 
promotion and disease prevention activities that are centrally 
administered.
    The Committee includes $5,000,000 as requested by the 
Administration for the joint Department of Defense and HHS 
initiative to improve the largest women's hospital in Kabul, 
Afghanistan and to create four satellite teaching clinics. Bill 
language is included identifying the amount of assistance and 
citing as authority the Afghanistan Freedom Support Act of 
2002.
    Men's health.--The Committee understands that there is no 
entity in the Department responsible for the coordination and 
oversight of activities across the agency concerning men's 
health. The Committee is aware of reports that men are 25 
percent less likely than women to receive regular health 
screenings, and that one of the top problems facing men's 
health is that men are not likely to visit a doctor when they 
notice a problem. The Committee encourages the Secretary to 
expand departmental disease prevention and health promotion 
activities among men and to give consideration to establishing 
an office for men's health, similar to the HHS Office of 
Women's Health. The Committee expects the Secretary to report 
during the fiscal year 2006 hearings activities that have been 
undertaken with regard to men's health.
    Digestive diseases.--The Committee encourages the Secretary 
to consider establishing a national commission on digestive 
diseases composed of scientists and physicians, patient 
advocates and representatives of federal agencies to (1) study 
the incidence, duration, and mortality rates of digestive 
diseases, as well as their economic impact; (2) evaluate 
facilities and resources for the diagnosis, prevention, and 
treatment of such diseases; and (3) develop a long-range plan 
for the use and organization of national resources to 
effectively deal with digestive diseases.
    Privacy regulations.--The Committee believes that the 
Health Insurance Portability and Accountability Act (HIPAA) is 
a valuable tool in protecting individual's medical privacy. The 
Committee is also aware of concerns that overly broad 
interpretations and misinterpretations of HIPAA have deprived 
communities of information that affects their well-being and 
limits their ability to take informed action in response to 
local health and safety conditions. The Committee urges the 
Secretary of Health and Human Services to provide additional 
written guidance within 120 days on how covered and non-covered 
entities can best apply HIPAA so as to permit journalists to 
report on newsworthy events to the fullest possible extent.
    Amblyopia.--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 who receive a 
comprehensive eye examination from a licensed optometrist or 
ophthalmologist in order to reduce vision loss in children.
    Underage drinking.--The Committee commends the 
establishment of the Interagency Coordinating Committee on the 
Prevention of Underage Drinking (ICCPUD) and the issuance of 
the interim report in development of a coordinated plan for 
combating underage drinking. The Committee strongly encourages 
the Secretary to go forward with these and other related 
efforts, including work currently underway at SAMHSA on a 
National media campaign to combat underage drinking.
    Memory impairment screening.--The Committee requests a 
report by March, 2005 on the effectiveness and accuracy of 
existing screening tools to detect early stage memory 
impairment, along with recommendations to expand access to 
screening in the public and private sectors.
    Disease spending.--The Department is instructed to provide 
the Committee with a table detailing total spending by HHS, 
PHS, and NIH in fiscal years 1997 through the present on the 
following diseases: acute respiratory distress syndrome, 
arthritis, cancer, chronic obstructive pulmonary disease, 
depression, diabetes, heart disease, HIV/AIDS, kidney disease, 
liver disease, pneumonia and influenza, septicemia, and stroke. 
A functional breakdown of each showing the amount spent on 
research, prevention/education, and treatment should also be 
included for each of the diseases in the table. This table 
should also detail spending in both Medicaid and Medicare, as 
well as approximations for spending by insurance in the private 
sector, and private expenditures by individuals afflicted with 
these diseases. The Committee requests the table be completed 
no later than the end of February 2005.
    NIH Library of Medicine infrastructure.--The Committee 
continues to strongly support the work of the National Library 
of Medicine, the largest medical library in the world and the 
leader in digitized medical information resources. Previously, 
the Committee has taken steps to ensure that adequate funding 
was available for the architectural planning and design of a 
new NLM building to house the National Center for Biotechnology 
Information and other activities related to digital information 
development. With the preliminary work complete, the Committee 
urges the Secretary to consider the commitment of necessary 
resources to begin construction of new physical facilities for 
the NLM to enable it to keep pace with the rapid increase in 
medical publishing and biotechnology information research and 
development.
    Interactive patient education.--The Committee is aware of 
interactive, web-based, user-friendly computer programs that 
have promise in making patients active participants and 
partners in decision affecting their health and healthcare. 
Such innovative use of information technology promises 
substantial advances in more fully informing and educating 
patients and has applications to informed consent for surgery 
and for clinical trials. In addition, it has potential 
applications to chronic disease management, organ donation, and 
end-of-life care decisions. The Committee encourages the 
Department through CMS and AHRQ to demonstrate ways in which 
this technology may improve the health care system.
    Reglatory burden.--A major reason for the skyrocketing cost 
of health care is the regulatory burden that government is 
placing on the health care system, often without regard to the 
costs of that regulation. Thirty different federal agencies 
regulate hospitals and medical care, in addition to many other 
regulations created by local and State governments and private-
sector accrediting bodies. There are at least 132,000 pages of 
regulation in CMS alone, compared to only 93,000 pages of 
regulation for the tax code. A study by Duke University has 
estimated that at least $128 billion per year is wasted by this 
regulatory burden. These costs are unnecessarily being borne by 
employers and employees through increased health care premiums, 
as well as by taxpayers through higher program expenditures.
    The Committee intends that $2,0000,000 of the policy 
evaluation funds available to the Office of the Assistant 
Secretary for Planning and Evaluation be used to establish an 
interagency committee, to be coordinated by HHS and overseen by 
the Office of Management and Budget. The committee's role will 
be to examine the major regulations governing the health care 
industry, making suggestions regarding where they could be 
coordinated and simplified to reduce costs and burdens and 
improve translation of biomedical research into medical 
practice, while continuing to protect patients. The examination 
should include an economic analysis of the major regulations to 
determine transactional costs of complying with regulations. 
The committee should look at what immediate steps can be taken 
to reduce this costly burden and examine longer-term proposals 
for reducing the regulatory burden. The committee's findings 
should be provided to the Appropriations Committee one year 
from the date of the enactment of this Act. The Assistant 
Secretary for Planning and Evaluation is requested to notify 
the Committee fifteen days before committing funds for the 
study.
    In addition to representatives from the various Federal 
agencies, the committee should include representatives from 
throughout the health care industry, including institutional 
and individual providers, the clinical research sector, 
academia, and public health. It should also include experts in 
health care economics, hospital administration, and insurance 
billing practices.

Office of Minority Health

    The Committee provides $47,236,000 for the Office of 
Minority Health, which is $7,954,000 below the fiscal year 2004 
comparable amount and the same as the budget request. The 
Office of Minority Health works with Public Health Service 
agencies and other agencies of the Department in a leadership 
and policy development role to establish goals and coordinate 
other activities in the Department regarding disease 
prevention, health promotion, service delivery and research 
relating to disadvantaged and minority individuals; concludes 
interagency agreements to stimulate and undertake innovative 
projects; supports research, demonstration, and evaluation 
projects; and coordinates efforts to promote minority health 
programs and policies in the voluntary and corporate sectors. 
The reduction in fiscal year 2005 funding compared to the 
previous year is due to the funding of one-time projects in 
2004.
    Health professions.--The Committee continues to recognize 
the need to recruit and train more minorities in the health 
professions. The Committee encourages the Office of Minority 
Health to support annual conferences that have a proven record 
of increasing the number of under-represented minorities 
entering the health professions.
    Meharry Medical College.--The Committee encourages OMH to 
continue its successful cooperative agreement with Meharry 
Medical College aimed at meeting the challenges of academic 
opportunity for disadvantaged students and improving health 
care services in underserved communities.
    Morehouse School of Medicine.--The Committee encourages OMH 
to consider supporting strategic planning and development 
activities at the Morehouse School of Medicine.
    Charles R. Drew University.--The Committee is concerned 
about issues facing the residency training program at Charles 
R. Drew University and encourages the implementation of a broad 
HHS effort focused on faculty support to address this problem.
    American Indians/Alaskan Natives.--The Committee commends 
the Department's participation in the Washington Semester 
American Indian Program (WINS) and encourages HHS to increase 
the placement of WINS interns in its operating divisions.

Office on Women's Health

    The Committee provides $29,103,000 for the Office on 
Women's Health, which is $188,000 above the fiscal year 2004 
comparable level and the same as the budget request. The Office 
on Women's Health advises the Secretary and provides 
Department-wide coordination of programs focusing specifically 
on women's health.
    Uterine fibroids.--The Committee encourages the Secretary 
to coordinate an effort among the PHS agencies to disseminate 
information to educate women and health care providers about 
the impact of uterine fibroids and available treatment options.

HIV/AIDS in minority communities

    The Committee provides $52,838,000 to be available to the 
Secretary to transfer to the Department's operating agencies 
for specific program activities to address the high-priority 
HIV prevention and treatment needs of minority communities. 
This is $3,294,000 above the fiscal year 2004 comparable level 
and the same as the budget request. These funds are to address 
the growing HIV/AIDS epidemic and its disparate impact on 
communities of color, including African Americans, Latinos, 
Native Americans, Asian Americans, Native Hawaiians, and 
Pacific Islanders.
    Within the total provided, the Committee expects that 
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 will 
be supported at no less than last year's funding level.

Adolescent Family Life

    The Committee provides $31,229,000 for the Adolescent 
Family Life program, which is $283,000 above the comparable 
2004 level and $23,120,000 below the budget request. The 
Committee has provided the requested $23,120,000 increase as 
part of the abstinence education program within the 
Administration for Children and Families. The Committee 
includes bill language requested by the Administration 
allocating all funds for prevention demonstrations to be 
available for abstinence education activities under section 
510(b)(2) of the Social Security Act. The program provides 
comprehensive and integrated approaches to the delivery of care 
services for pregnant and parenting adolescents, and prevention 
services that promote abstinence from sexual activity among 
non-parenting teens.

Health care information technology

    the Committee provides $25,000,000 for the new health care 
information technology program, which is $25,000,000 below the 
budget request. This program is planned to fund investments in 
the development and utilization of modern information 
technology in both health care and public health. Funds will be 
available to State and local organizations to provide the 
infrastructure necessary for the exchange of a patient's health 
information within that area, and with other such organizations 
nationally. The Committee urges the Secretary to mesh these 
activities with the AHRQ demonstrations presently underway.

Information technology security and innovation fund

    The Committee provides $14,847,000 for the information 
technology security and innovation fund, which is the same as 
the fiscal year 2004 comparable level and $3,553,000 less than 
the budget request. This fund supports HHS enterprise-wide 
investments in such areas as common IT infrastructure services, 
and security and infrastructure to enable common administrative 
systems.

                    OFFICE OF THE INSPECTOR GENERAL

    The Committee provides $40,323,000 for the Office of the 
Inspector General (OIG), which is $1,229,000 above the fiscal 
year 2004 level and the same as the budget request. A permanent 
appropriation for this office is contained in the Health 
Insurance Portability and Accountability Act of 1996. Total 
funds provided between this bill and the permanent 
appropriation would be $200,323,000 in fiscal year 2005.
    The Office of the Inspector General was created by law to 
protect the integrity of Departmental programs as well as the 
health and 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 throughout the 
Department.

                        OFFICE FOR CIVIL RIGHTS

    The Committee provides $35,357,000 for the Office of Civil 
Rights (OCR), which is $1,456,000 above the fiscal year 2004 
level and the same as the budget request. This includes 
authority to transfer $3,314,000 from the Medicare trust funds.
    The Office for Civil Rights is responsible for enforcing 
civil rights statutes that prohibit discrimination in health 
and human services programs. OCR implements the civil rights 
laws through a compliance program designed to generate 
voluntary compliance among all HHS recipients.

                            POLICY RESEARCH

    The Committee provides $20,750,000 for policy research 
through section 241 evaluation funding authority, which is the 
same as the comparable 2004 level and $8,000,000 below the 
Administration request. The Policy Research account, authorized 
by section 1110 of the Social Security Act, is the Department's 
principal source of policy-relevant data and research on the 
income sources of low-income populations; the impact, 
effectiveness, and distribution of benefits under existing and 
proposed programs; and other issues that cut across agency 
lines.

               MEDICAL BENEFITS FOR COMMISSIONED OFFICERS

    The Committee provides an estimated $330,636,000 for 
medical benefits for commissioned officers of the U.S. Public 
Health Service. This is the same as the Administration request 
and $8,873,000 above the fiscal year 2004 comparable amount.
    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 for active duty and retired 
members and dependents and beneficiaries; and for payments to 
the Social Security Administration for military service 
credits.
    The Committee repeats language from the fiscal year 2004 
appropriations bill clarifying that this account should be used 
to support the retirement medical cost payments for 
commissioned corps officers rather than the appropriations of 
the agencies to whom the officers are assigned.

            PUBLIC HEALTH AND SOCIAL SERVICES EMERGENCY FUND

    The Committee provides $2,292,247,000 for the public health 
and social services emergency fund for homeland security 
related activities. In addition, $60,000,000 is provided for 
activities to ensure year-round production capacity of 
influenza vaccine, bringing the total in the Fund to 
$2,352,247,000. This is $188,244,000 above the fiscal year 2004 
comparable level and $127,189,000 above the request.
    Within the amount provided for homeland security related 
activities, the funds are distributed as follows:

HRSA....................................................    $542,649,000
CDC.....................................................   1,637,760,000
Office of the Secretary.................................      64,438,000
NIH.....................................................      47,400,000

    Within the funds provided for HRSA, $27,705,000 is to 
support the interdisciplinary health professions training 
program and $514,944,000 is for the National Bioterrorism 
Hospital Preparedness Program. The Committee does not agree 
with the reduction in funds for hospital preparedness proposed 
in the request.
    Within the funds provided for the CDC, $934,300,000 is for 
State and Local Capacity, including $871,900,000 to be provided 
to State and local health departments through grants and 
cooperative agreements; $142,160,000 is for Upgrading CDC 
Capacity; $11,300,000 is for Anthrax; and $100,000,000 is for 
the Biosurveillance Initiative. The Committee does not agree 
with the reduction in State and Local Preparedness funds 
proposed in the request.
    In addition, $450,000,000 is provided for the Strategic 
National Stockpile. This is $52,400,000 above the FY2004 
comparable level and $50,000,000 above the request. The 
Committee does not provide authority to increase funds 
available to the Stockpile up $70,000,000 from funds otherwise 
available for use by the CDC as proposed in the request.
    Academic Health Centers.--The Committee continues to 
believe that significant expertise, capability, and resources 
exist in academic health centers and that, in large measure, 
these Centers have not been participants in state and local 
preparedness and response planning. The Committee urges the 
Secretary to examine ways of encouraging recipients of State 
and Local Preparedness funds to ensure that academic health 
centers are included in the planning process, and in making 
assessments of the capabilities and roles that academic health 
centers can have in enhancing preparedness.
    Anti-infective agents.--The Committee has maintained funds 
provided in fiscal year 2004 to support research into the 
discovery, development, and translation of anti-infective 
agents to combat emerging infectious diseases.
    Community Health Centers.--The Committee recognizes the 
important role community health centers play in terrorism 
preparedness and response. The Committee is concerned that 
despite their inclusion in the Department's state plan 
guidance, community health centers and regional primary care 
associations have not been fully included in the state and 
local decision-making process and in the allocation of 
preparedness resources. The Committee urges the Secretary to 
examine ways of ensuring that recipients of State and Local 
Preparedness funds include community health centers and their 
associated regional organizations are included in both 
preparedness planning and in resource allocation decisions.
    Physician Contact Database.--The Committee understands the 
urgent need to contact, inform and mobilize physicians in 
public health emergencies and with threats of bioterrorism. The 
Committee is also aware that CDC is in discussions with the 
Federation of State Medical Boards to develop an automated data 
system of physician contact information to be used for these 
purposes. Within the funding provided, the Committee encourages 
the Secretary to initiate a pilot project in five states. The 
Committee requests that the Secretary be prepared to report on 
plans for the project during the hearings on the FY2006 budget 
request.

                           General Provisions

    Sec. 201. The Committee continues a provision to limit the 
amount available for official reception and representation 
expenses.
    Sec. 202. The Committee continues a provision to limit the 
number of Public Health Service employees assigned to assist in 
child survival activities and to work in AIDS programs through 
and with funds provided by the Agency for International 
Development, the United Nations International Children's 
Emergency Fund or the World Health Organization.
    Sec. 203. The Committee continues a provision to prohibit 
the use of funds to implement section 399F(b) of the Public 
Health Service Act or section 1503 of the NIH Revitalization 
Act of 1993.
    Sec. 204. The Committee continues a provision to limit the 
salary of an individual through an NIH, AHRQ, or SAMHSA grant 
or other extramural mechanism to not more than the rate of 
Executive Level I.
    Sec. 205. The Committee includes a provision limiting the 
compensation of an individual working in Head Start to the 
Federal Executive Level II salary.
    Sec. 206. The Committee continues a provision to prohibit 
the Secretary from using evaluation set-aside funds until the 
Committee receives a report detailing the planned use of such 
funds.
    Sec. 207. The Committee continues a provision, although 
changes the percentage provided in the fiscal year 2004 bill, 
permitting the Secretary to use up to 2.3 percent of funds 
authorized under the PHS Act for the evaluation of programs.

                          (TRANSFER OF FUNDS)

    Sec. 208. The Committee continues a provision permitting 
the Secretary of HHS to transfer up to one percent of any 
discretionary appropriation from an account, with an additional 
two percent subject to the approval of the Appropriations 
Committees, but prohibiting any appropriation to increase by 
more than three percent by such transfer.
    Sec. 209. The Committee continues a provision to provide 
the Director of NIH, jointly with the Director of the Office of 
AIDS Research, the authority to transfer up to three percent of 
human immunodeficiency virus funds.
    Sec. 210. The Committee continues a provision to make NIH 
funds available for human immunodeficiency virus research 
available to the Office of AIDS Research.
    Sec. 211. The Committee continues a provision to prohibit 
the use of Title X funds unless the applicant for the award 
certifies to the Secretary that it encourages family 
participation in the decision of minors to seek family planning 
services and that it provides counseling to minors on how to 
resist attempts to coerce minors into engaging in sexual 
activities.
    Sec. 212. The Committee continues a provision related to 
the Medicare+Choice program.
    Sec. 213. The Committee continues a provision stating that 
no provider of services under title X shall be exempt from any 
State law requiring notification or the reporting of child 
abuse, child molestation, sexual abuse, rape, or incest.
    Sec. 214. The Committee continues a provision to exempt 
States from Synar provisions if certain funding criteria are 
met.
    Sec. 215. The Committee continues a provision to allow CDC 
international HIV/AIDS and other infectious disease, chronic 
and environmental disease, and other health activities abroad 
to be spent under the State Department Basic Authorities Act of 
1956.
    Sec. 216. The Committee continues a provision to permit the 
Division of Federal Occupational Health to use personal 
services contracting to employ professional management/
administrative and occupational health professionals.
    Sec. 217. The Committee includes a provision granting 
authority to the Office of the Director of the National 
Institutes of Health (NIH) to enter directly into transactions 
in order to implement the NIH Roadmap and permitting the 
Director to utilize peer review procedures, as appropriate, to 
obtain assessments of scientific and technical merit.
    Sec. 218. The Committee includes a provision rescinding an 
appropriation provided in the Medicare Modernization Act for a 
facilities loan fund. The Committee provides funding for these 
types of activities as part of its regular mission and objects 
to actions taken by the authorizing committees that cross this 
jurisdictional boundary.
    Sec. 219. The Committee includes a provision to permit the 
Centers for Medicare and Medicaid Services to charge providers 
who forward duplicate or unprocessable Medicare claims $5.00 
per claim and makes a corresponding $155,000,000 reduction in 
the CMS Program Management Account.
    Sec. 220. The Committee includes a general provision to 
reduce amounts available to the CDC for administrative and 
related information technology expenses by $15,000,000.
    Sec. 221. The Committee includes a provision prohibiting 
funds from being used to implement CMS inpatient rehabilitation 
facility reimbursement rules (commonly referred to as the 75 
percent rule) until after an Institute of Medicine study on 
medical criteria is completed. Funding for the CMS Program 
Management account is reduced by $9,000,000 to cover the costs 
of the study and the moratorium.
    Sec. 222. The Committee includes a provision prohibiting 
the use of funds appropriated to HHS for the purpose of 
impeding the exchange of information between the CMS actuary 
and the U.S. Congress.

                   TITLE III--DEPARTMENT OF EDUCATION

    The Committee's recommendations for the Department of 
Education for fiscal year 2005 will bring total departmental 
funding to $57,681,171,000, the highest level in the agency's 
history. The Committee notes that, although the federal 
government contributes only about eight percent of all K-12 
education spending in the United States, the role the federal 
government plays with regard to providing equal opportunity to 
education for all people in our society is an important one. 
Therefore, the Committee has focused its funding 
recommendations for K-12 education around the following 
principles: a quality teacher in every classroom; closing the 
achievement gap for poor and minority children by insisting on 
results; empowering parents; ensuring all third-grade children 
can read; more education, less paperwork; and spending for 
results. With the understanding that the Committee has focused 
its funding recommendations for K-12 education around the 
stated principles, which include a quality teacher in every 
classroom and spending for results, the Committee encourages 
the Department to establish an on-line reporting system to 
allow school districts receiving funds under this Act to submit 
to the Department by means of the Internet, on a voluntary 
basis, not later than April 30, 2005, a report on the school 
district's progress toward the following: placing quality 
teachers in every classroom; rigorous academic standards and 
curricula; small class sizes; high-quality facilities and 
libraries; up-to-date textbooks and computer technology; and 
quality guidance counselors. For higher education programs, the 
Committee has focused its recommendations on funding proven 
programs that help provide all Americans with the opportunity 
to further their studies and training and become competitive in 
the global marketplace.
    The Committee continues to emphasize the importance of 
developing clear, measurable outcomes for programs within the 
Department of Education as outlined in the Government 
Performance and Results Act. It is vital that the Committee be 
provided with information on the actual results achieved by the 
programs, not simply the number of students affected by the 
program or the quantity of materials distributed. Program 
outcomes should, to the extent possible, focus on the 
achievement improvements that result to students and teachers 
in the classroom as a result of the Federal investment. 
Programs that are able to demonstrate these results over time 
will be considered higher funding priorities than programs that 
are unable to clearly demonstrate their value to the American 
public.

                    EDUCATION FOR THE DISADVANTAGED

    The bill includes $15,535,735,000 for the disadvantaged 
programs. This amount is $330,567,000 more than the budget 
request and $1,089,392,000 above the fiscal year 2004 
appropriation. Of the total amount available, $7,849,390,000 is 
appropriated for fiscal year 2005 for obligation after July 1, 
2005 and $7,383,301,000 is appropriated for fiscal year 2006 
for obligation on or after October 1, 2005. This appropriation 
account includes compensatory education programs authorized 
under title I of the Elementary and Secondary Education Act of 
1965; and title VIII of the Higher Education Act.

Grants to local educational agencies

    Of the amounts provided for Title I programs, 
$7,037,592,000 is available for basic grants to local education 
agencies. This amount is the same as last year's level and the 
request. The Committee rejects the inclusion of any 100% hold 
harmless provision because it unfairly penalizes 
underprivileged and immigrant children in states with growing 
populations.
    Funding for concentration grants, which targets funds to 
Local Educational Agencies in counties with high levels of 
disadvantaged children, is $1,365,031,000, the same as last 
year and the request level. The bill includes $2,469,843,000 
for targeted grants, an increase of $500,000,000 above last 
year and $1,676,344,000 below the request. A total of 
$2,469,843,000 is also included for education finance incentive 
grants, $1,676,344,000 above the request and $500,000,000 above 
last year's level.
    Financial assistance flows to school districts by formula, 
based in part on the number of school-aged children from low-
income families. Within districts, local school officials 
target funds on school attendance areas with the greatest 
number or percentage of children from poor families. Local 
school districts develop and implement their own programs to 
meet the needs of disadvantaged students.
    Funds under this account will also be used to pay the 
Federal share of State administrative costs for title I 
programs. The maximum State administration grant is equal to 1 
percent of title I local educational agency plus State agency 
grants to the State, or $400,000, whichever is greater. These 
funds are included in the grants to local educational agencies 
account, rather than being a separate line item.
    Recent studies have demonstrated that comprehensive school-
improvement models, when well implemented, boost student 
achievement to a greater extent than other interventions 
designed to serve similar student populations. The Committee 
believes that comprehensive school reform provides an exemplary 
approach to raising academic achievement, particularly for 
schools that do not make adequate yearly progress under the No 
Child Left Behind Act. The Committee believes that States 
should utilize their four percent school improvement set aside 
funds, estimated at $520,000,000 in fiscal year 2005, to 
support implementation of CSR models with demonstrated success. 
Further, the Committee intends that the Secretary shall notify 
States that schools currently receiving CSR subgrants shall 
receive priority for targeted grants and/or technical 
assistance under section 1003(a) of ESEA.
    In addition, the Committee is concerned that in some cases, 
States have distributed the funds set aside within the title I 
program for school improvement purposes equally to each school 
identified in need of improvement. The Committee believes that 
this is resulting in allocations for each school that may be 
too small to effectively leverage needed reforms. The Committee 
strongly urges States to examine methods for distributing 
school improvement funds that will result in awards of 
sufficient size and scope to support the initial costs of 
comprehensive school reforms and to limit funding to programs 
that include each of the reform components described in section 
1606(a) of the No Child Left Behind Act of 2001 and have the 
capacity to improve the academic achievement of all students in 
core academic subjects within participating schools.

Even Start

    The Committee provides $246,910,000 for Even Start, the 
same as last year and $246,910,000 above the request. Even 
Start provides grants for programs focusing on the education of 
disadvantaged children, aged 1-7 years, who live in title I 
target school attendance areas, plus their parents who are 
eligible to be served under the Adult Education Act. These 
parents are not in school, are above the State's compulsory 
school attendance age limit, and have not earned a high school 
diploma (or equivalent). Even Start funds are allocated to the 
States, generally in proportion to title I basic grants.

Reading First State Grants

    The bill provides $1,125,000,000 for Reading First State 
grants, the same as the budget request and $101,077,000 above 
the fiscal year 2004 level. This program provides assistance to 
states and school districts in establishing scientific 
research-based reading programs for children in kindergarten 
through grade three. The program also provides for professional 
development and other supports to ensure that teachers can 
identify children at-risk for reading failure and provide the 
most effective early instruction to overcome specific barriers 
to reading proficiency.

Early Reading First

    The bill provides $132,000,000 for Early Reading First, the 
same as the budget request and an increase of $37,561,000 above 
the fiscal year 2004 level. This is a competitive grant program 
targeted toward children ages three through five, and would 
support the development of verbal skills, phonemic awareness, 
pre-reading development and assistance for professional 
development for teachers in evidence-based strategies of 
instruction.

Striving Readers

    The bill provides $100,000,000 for Striving Readers, the 
same as the budget request and $100,000,000 above last year's 
level. Striving Readers will make competitive grants to 
develop, implement and evaluate reading interventions for 
middle- or high-school students who are reading significantly 
below grade level.

Literacy through school libraries

    The bill provides $19,842,000 for literacy through school 
libraries, the same as the budget request and the fiscal year 
2004 level. This program helps school districts provide 
students with increased access to up-to-date school library 
materials, a well-equipped, technologically advanced school 
library media center, and well-trained, and professionally 
certified school library media specialists. At appropriations 
of less than $100,000,000 the Department makes competitive 
awards to districts with a child poverty rate of at least 20 
percent.

State agency programs: migrant

    The bill includes $393,577,000 for the migrant education 
program, the same as the budget request and the fiscal year 
2004 appropriation. This program supports formula grants to 
State agencies for the support of special educational and 
related services to children of migratory agricultural workers 
and fishermen. The purpose of this program is to provide 
supplementary academic education, remedial or compensatory 
instruction, English for limited English proficient students, 
testing, plus guidance and counseling.

State agency programs: neglected and delinquent

    For the State agency program for neglected and delinquent 
children, the bill includes $48,395,000, the same as the budget 
request and the fiscal year 2004 appropriation. This formula 
grant program provides services to participants in institutions 
for juvenile delinquents, adult correctional institutions, or 
institutions for the neglected.

Evaluation

    The Committee provides $9,500,000 for evaluation, $710,000 
above the 2004 appropriation and the same as the budget 
request. Title I evaluation supports large scale national 
evaluations that examine how title I is contributing to 
improved student performance at the State, local education 
agency, and school levels. It also supports short-term studies 
that document promising models and other activities to help 
States and local education agencies implement requirements in 
the title I statute.

Comprehensive school reform

    The bill includes $80,000,000 for the Comprehensive School 
Reform (CSR) Program, $80,000,000 above the request and 
$153,613,000 below last year's level, due to budget 
constraints. The CSR program authorizes incentive grants of at 
least $50,000 per year, for 3 years, for schools to implement 
effective, research-driven strategies for schoolwide reform. 
Recent studies have demonstrated that comprehensive school-
improvement models, when well implemented, boost student 
achievement to a greater extent than other interventions 
designed to serve similar student populations. The Committee 
believes that comprehensive school reform provides an exemplary 
approach to raising academic achievement, particularly for 
schools that do not make adequate yearly progress under the No 
Child Left Behind Act. The Committee believes that States 
should utilize their four percent school improvement set aside 
funds, estimated at $520,000,000 in fiscal year 2005, to 
support implementation of CSR models with demonstrated success. 
Further, the Committee intends that the Secretary shall notify 
States that schools currently receiving CSR subgrants shall 
receive priority for targeted grants and/or technical 
assistance under section 1003(a) of ESEA.
    In addition, the Committee is concerned that in some cases, 
States have merely divided the funds for school improvement 
purposes by the number of schools identified in need of 
improvement and that this is resulting in allocations for each 
school that may be too small to effectively leverage needed 
reforms. The Committee strongly urges States to examine methods 
for distributing school improvement funds that will result in 
awards of sufficient size and scope to support the initial 
costs of comprehensive school reforms and to limit funding to 
programs that include each of the reform components described 
in section 1606(a) of the No Child Left Behind Act of 2001 and 
have the capacity to improve the academic achievement of all 
students in core academic subjects within participating 
schools.

Migrant education, high school equivalency program

    The bill includes $22,545,000 for the high school 
equivalency program. This amount is $3,657,000 above the budget 
request and the fiscal year 2004 level. The high school 
equivalency program recruits migrant students aged 16 and over 
and provides academic and support services to help those 
students obtain a high school equivalency certificate and 
subsequently to gain employment or admission to a postsecondary 
institution or training program.

College assistance migrant programs

    The bill includes $15,657,000 for the college assistance 
migrant programs. This amount is the same as the fiscal year 
2004 level and the budget request. The college assistance 
migrant program (CAMP) provides tutoring and counseling 
services to first-year, undergraduate migrant students and 
assists those students in obtaining student financial aid for 
their remaining undergraduate years.

                               IMPACT AID

    The bill provides $1,250,893,000 for Federal impact aid 
programs in fiscal year 2005, an increase of $21,366,000 above 
the fiscal year 2004 appropriation and the budget request. This 
account supports payments to school districts affected by 
Federal activities. Impact Aid represents a federal 
responsibility to local schools educating children whose 
families are connected with the military or who live on Indian 
land.
    The bill also includes language ensuring that schools 
serving the children of military personnel continue to receive 
Impact Aid funds when the military parents who live on-base are 
deployed and the child continues to attend the same school and 
in cases in which an on-base military parent is killed while on 
active duty and the child continues to attend the same school.

Basic support payments

    The bill includes $1,083,687,000 for basic support payments 
to local educational agencies, an increase of $20,000,000 above 
the fiscal year 2004 appropriation and the budget request. 
Basic support payments compensate school districts for lost tax 
revenue and are made on behalf of Federally-connected children 
such as children of members of the uniformed services who live 
on Federal property.

Payments for children with disabilities

    The Committee recommends $50,369,000 for payments on behalf 
of Federally-connected children with disabilities, the same as 
the budget request and the fiscal year 2004 appropriation. 
These payments compensate school districts for the increased 
costs of serving Federally-connected children with 
disabilities.

Facilities maintenance

    The Committee recommends $7,901,000 for facilities 
maintenance, the same as the fiscal year 2004 amount and the 
budget request. These capital payments are authorized for 
maintenance of certain facilities owned by the Department of 
Education.

Construction

    The Committee recommends $45,936,000 for the construction 
program, the same as the budget request and the fiscal year 
2004 level. This program provides formula and competitive 
grants to eligible locally owned school districts for building 
and renovating school facilities.

Payments for Federal property

    The bill provides $63,000,000 for payments related to 
Federal property, an increase of $1,366,000 above the fiscal 
year 2004 appropriation and the budget request. Funds are 
awarded to school districts to compensate for lost tax revenue 
as the result of Federal acquisition of real property since 
1938.

                      SCHOOL IMPROVEMENT PROGRAMS

    The bill includes $5,641,401,000 for school improvement 
programs. This amount is $216,377,000 less than the comparable 
fiscal year 2004 appropriation and $299,092,000 below the 
budget request for comparable programs. This appropriation 
account includes programs authorized under titles II, IV, V, 
VI, and VII of the Elementary and Secondary Education Act; the 
McKinney-Vento Homeless Assistance Act, title IV-A of the Civil 
Rights Act, and section 105 of the Compact of Free Association 
Amendments Act of 2003.

State grants for improving teacher quality

    The bill includes $2,950,000,000 for state grants for 
improving teacher quality, which is $19,874,000 above the 
budget request and the fiscal year 2004 level. This program 
gives states and districts a flexible source of funding with 
which to meet their particular needs in strengthening the 
skills and knowledge of teachers and administrators to enable 
them to improve student achievement. States are authorized to 
retain 2.5 percent of funds for state activities, including 
reforming teacher certification, re-certification or licensure 
requirements; expanding, establishing or improving alternative 
routes to state certification; carrying out programs that 
include support during the initial teaching and leadership 
experience, such as mentoring programs; assisting school 
districts in effectively recruiting and retaining highly 
qualified and effective teachers and principals; reforming 
tenure systems; and developing professional development 
programs for principals.
    States send funding to the local level by formula and by 
competitive grant. Among other things, local uses of funds 
include initiatives to assist recruitment of principals and 
fully qualified teachers; initiatives to promote retention of 
highly qualified teachers and principals; programs designed to 
improve the quality of the teacher force; teacher opportunity 
payments; professional development activities; teacher 
advancement initiatives and hiring fully qualified teachers in 
order to reduce class size.
    The Committee is aware of a report by the Teaching 
Commission which examines current teaching programs and 
practices in the United States and makes several 
recommendations for areas of improvement. Specifically, the 
report addresses performance-based compensation, teacher 
preparation, teacher licensure and certification and leadership 
and support. The Committee urges the Department to share the 
ideas contained within this report to all states receiving 
grants under the teacher quality program and to provide 
technical assistance to states that have an interest in 
implementing the Commission's recommendations.
    The Committee has also been impressed with multivariate, 
longitudinal value-added analysis of student performance data 
that is being used in some states and school districts and 
urges all states and districts receiving federal funding to 
examine such models and consider their adoption.
    The Committee is aware that funding under the teacher 
quality program can be used for professional development and 
support for principals as well as teachers. The Committee 
recognizes the unique role that the principal plays as the 
instructional leader and CEO of a school, and strongly 
encourages states and school districts to devote a significant 
portion of professional development funds to providing high-
quality, ongoing professional development opportunities to 
principals. Particularly recommended is professional 
development to enhance principals' ability to work productively 
with families, provide staff development to teachers and other 
professionals, and to utilize data in decision-making. The 
Committee also encourages states and school districts to 
develop principals' professional development that is based on 
sound research on the most current models of leadership.

Early childhood educator professional development

    The bill includes $14,814,000 for early childhood educator 
professional development, the same as the budget request and 
the fiscal year 2004 level. This program provides competitive 
grants to partnerships to improve the knowledge and skills of 
early childhood educators and caregivers who work in 
communities that have high concentrations of children living in 
poverty.

Mathematics and science partnerships

    The bill includes $269,115,000 for mathematics and science 
partnerships, the same as the budget request and $120,000,000 
above the fiscal year 2004 level. This program promotes strong 
math and science teaching skills for elementary and secondary 
school teachers. Grantees may use program funds to develop 
rigorous math and science curricula, establish distance 
learning programs, and recruit math, science and engineering 
majors into the teaching profession. They may also provide 
professional development opportunities. Grants are made to 
States by formula based on the number of children aged 5 to 17 
who are from families with incomes below the poverty line, and 
States then award the funds competitively to partnerships which 
must include the State agency, and engineering, math or science 
department of an institution of higher education, and a high-
need school district. Other partners may also be involved.

Innovative Education Program Strategies State Grants

    The bill does not include funding for State grants under 
Innovative Education Program Strategies, a decrease of 
$296,549,000 below the budget request and the fiscal year 2004 
level. This program provides funding to State and local 
educational agencies for obtaining technology and training in 
technology related to the implementation of school based 
reform; acquiring and using educational materials; improving 
educational services for disadvantaged students; combating 
illiteracy among children and adults; addressing the 
educational needs of gifted and talented children; and 
implementing school improvement and parental involvement 
activities under ESEA Title I.

Education technology

    The bill includes $600,000,000 for Education Technology 
State Grants. This amount is $91,841,000 below the budget 
request and the comparable fiscal year 2004 level. Under this 
program, states are required to direct ninety-five percent of 
the funds to school districts for increasing access to 
technology, especially for high-need schools; improving and 
expanding teacher professional development in technology; and 
promoting innovative state and local initiatives using 
technology to increase academic achievement.
    The Secretary of Education is encouraged to examine in 
detail and assist the advancement of the rapidly-growing use of 
hand-held computer technology and to spread the penetration of 
the one-to-one (computer-to-student) computing it offers in a 
school environment, rather than the one-to-many model that 
prevails in most schools, where computers must be shared, thus 
limiting the advantages to students. Handheld personal 
computing is rapidly becoming more affordable, enhancing the 
cost effectiveness of this approach, especially when coupled 
with wireless technology.

Supplemental education grants

    The bill provides $12,230,000 for supplemental education 
grants to the Federated States of Micronesia and $6,100,000 for 
supplemental education grants to the Republic of the Marshall 
Islands. The Compact of Free Association Amendments Act of 2003 
(P.L. 108-188) discontinued, beginning in fiscal year 2005, 
most domestic formula grant programs funded by the Departments 
of Labor, Health and Human Services, and Education for the 
Federated States of Micronesia and the Republic of the Marshall 
Islands. In their place, P.L. 108-188 authorized $12,230,000 
and $6,100,000 for these two nations, respectively, for 
Supplemental Education Grants programs, which will provide both 
countries with the flexibility required to address the unique 
educational needs of their populations. P.L. 108-188 also 
authorizes both countries to request technical assistance from 
relevant U.S. Cabinet agencies for the purpose of transitioning 
to their own administration of programs.
    The budget request included language transferring fiscal 
year 2005 funds from the Departments of Labor, Health and Human 
Services and Education to the Federated States of Micronesia 
and the Republic of the Marshall Islands in amounts equal to 
amounts made available to them in fiscal year 2004 for these 
same activities. The funds provided by the Committee in this 
bill are expected to equal this total. The bill also includes 
language allowing the Federated States of Micronesia and the 
Republic of the Marshall Islands to reserve up to five percent 
of their supplemental education grants for technical 
assistance, administration and oversight purposes.

21st century community learning centers

    The bill provides $999,070,000 for 21st century community 
learning centers, the same as the budget request and the fiscal 
year 2004 level. This program is a formula grant to states. 
Ninety-five percent of funds are distributed on a competitive 
basis from the state to local school districts, community-based 
organizations and other public entities and private 
organizations. Grantees must target students who attend low-
performing schools. Funds may be used for before and after 
school activities that advance student academic achievement 
including remedial education and academic enrichment 
activities; math, science, arts, music, entrepreneurial and 
technology education; tutoring and mentoring; recreational 
activities; and expanded library service hours.

State assessments

    The bill includes $410,000,000 for state assessments, the 
same as the budget request and $20,000,000 above the fiscal 
year 2004 level. This program provides states with funding to 
develop annual assessments and to carry out activities related 
to ensuring accountability for results in the state's schools 
and school districts.

Javits gifted and talented education

    The bill includes $11,111,000 for gifted and talented 
education, the same as the fiscal year 2004 amount. The 
President's budget did not propose funding for this program. 
This program supports grants to build and enhance the ability 
of elementary and secondary schools to meet the needs of gifted 
and talented students. Competitive grants are awarded to states 
and school districts, institutions or higher education and 
other public and private entities.

Foreign language assistance grants

    The bill does not include funding for foreign language 
assistance grants, the same as the budget request. The program 
was funded at $16,546,000 in fiscal year 2004. The program 
supports competitive grants to school districts and states to 
increase the quality and quantity of elementary and secondary-
level foreign language instruction in the United States.

Education for homeless children and youth

    For the education of homeless children and youth program, 
the Committee recommends $70,000,000. This level is $10,354,000 
above the budget request and the fiscal year 2004 
appropriation. Grants are allocated to States in proportion to 
the total that each State receives under the title I program. 
For local grants, at least 50 percent must be used for direct 
services to homeless children and youth, including tutoring or 
remedial or other educational services.

Training and advisory services

    The bill includes $7,243,000 for training and advisory 
services authorized by title IV-A of the Civil Rights Act. This 
amount is the same as the budget request and the same as the 
fiscal year 2004 amount. Title IV-A authorizes technical 
assistance and training services for local educational agencies 
to address problems associated with desegregation on the basis 
of race, sex, or national origin. The Department awards 3-year 
grants to regional equity assistance centers (EACs) located in 
each of the 10 Department of Education regions. The EACs 
provide services to school districts upon request. Typical 
activities include disseminating information on successful 
education practices and legal requirements related to 
nondiscrimination on the basis of race, sex, and national 
origin in educational programs; training designed to develop 
educators' skills in specific areas, such as the identification 
of race and sex bias in instructional materials; increasing the 
skills of educational personnel in dealing with race-based 
confrontations such as hate crimes; and providing technical 
assistance in the identification and selection of appropriate 
educational programs to meet the needs of limited English 
proficient students.

Education for Native Hawaiians

    The Committee recommends $33,302,000 for education for 
Native Hawaiians, the same as the budget request and the fiscal 
year 2004 amount. A number of programs limited to Native 
Hawaiians are supported with these funds, including a model 
curriculum project, family-based education centers, 
postsecondary education fellowships, gifted and talented 
education projects, and special education projects for disabled 
pupils.

Alaska native education equity

    The Committee recommends $33,302,000 for the Alaska native 
education equity program, the same as the budget request and 
the fiscal year 2004 amount. These funds are used to develop 
supplemental educational programs to benefit Alaska natives.

Rural Education

    The bill includes $167,831,000 for rural education 
programs, the same as the fiscal year 2004 level and the budget 
request. This fund includes two programs to assist rural school 
districts to improve teaching and learning in their schools. 
The small, rural schools achievement program provides funds to 
rural districts that serve a small number of students; the 
rural and low-income schools program provides funds to rural 
districts that serve concentrations of poor students, 
regardless of the number of students served by the district.

Comprehensive Centers

    The bill includes $57,283,000 for comprehensive centers, 
the same as the fiscal year 2004 level and $29,629,000 above 
the budget request. The Committee intends these funds to be 
used for the new comprehensive centers that will provide 
training, technical assistance, and professional development in 
reading, mathematics, and technology, particularly to schools 
that fail to meet their State's definition of adequate yearly 
progress. The Committee intends that the Department proceed 
quickly with the competition and awarding of these centers so 
that there will be no service disruption to schools through the 
process of transitioning to the new centers. The Committee 
expects that the new centers will focus heavily on assisting 
school superintendents, principals and teachers to be good 
consumers of research information and particularly help them 
determine which interventions are based on sound research and 
are likely to be most effective in their schools.

                            INDIAN EDUCATION

    The bill includes $120,856,000 for Indian education. This 
amount is the same as the fiscal year 2004 appropriation and 
the budget request. This account supports programs authorized 
by part A of Title VII of the Elementary and Secondary 
Education Act and section 215 of the Department of Education 
Organization Act.

Grants to local educational agencies

    The bill provides $95,933,000 for grants to local education 
agencies, the same as the budget request and the fiscal year 
2004 amount. This program provides assistance through formula 
grants to school districts and schools supported or operated by 
the Bureau of Indian Affairs. The purpose of this program is to 
reform elementary and secondary school programs that serve 
Indian students, including preschool children. Grantees must 
develop a comprehensive plan and assure that the programs they 
carry out will help Indian students reach the same challenging 
standards that apply to all students. This program supplements 
the regular school program to help Indian children sharpen 
their academic skills, bolster their self-confidence, and 
participate in enrichment activities that would otherwise be 
unavailable.

Special programs for Indian children

    The Committee recommends $19,753,000 for special programs 
for Indian children, the same as fiscal year 2004 and the 
budget request. These programs make competitive awards to 
improve the quality of education for Indian students. This 
program also funds a new Indian Teacher Corps, which hopes to 
train over 1,000 Indian teachers over a five-year period to 
take positions in schools that serve concentrations of Indian 
children.

National activities

    The bill provides $5,170,000 for national activities, the 
same as fiscal year 2004 and the budget request. Funds under 
this authority support research, evaluation and data collection 
to provide information on the status of education for the 
Indian population and on the effectiveness of Indian education 
programs.

                       INNOVATION AND IMPROVEMENT

    The bill includes $669,936,000 for innovation and 
improvement programs. This amount is $432,690,000 less than the 
comparable fiscal year 2004 appropriation and $215,245,000 
below the budget request for comparable programs. This 
appropriation account includes programs authorized under part G 
of title I and portions of titles II and V of the Elementary 
and Secondary Education Act.

Troops to teachers

    The bill includes $14,912,000 for troops to teachers, the 
same as the budget request and the fiscal year 2004 level. This 
program is designed to assist eligible members of the armed 
forces to obtain certification or licensure as elementary and 
secondary school teachers, or vocational or technical teachers. 
The transition to teachers program is based on the model of the 
troops to teachers program and would address the need of high-
need school districts for highly qualified teachers.

Transition to teaching

    The bill includes $45,295,000 for transition to teaching, 
the same as the budget request and the fiscal year 2004 level. 
Transition to teaching is designed to help mitigate the 
shortage of qualified licensed or certified teachers in many of 
our Nation's schools. The program provides grants to help 
support efforts to recruit, train and place talented 
individuals into teaching positions and to support them during 
their first years in the classroom. In particular, the program 
focuses on mid-career professionals with substantial career 
experience, and recent college graduates. Grants are made on a 
competitive basis.

National writing project

    The bill provides $17,894,000 for the National Writing 
Project, the same as the fiscal year 2004 level. The 
President's budget did not request funding for this program. 
Funds are provided to the National Writing Project, a nonprofit 
educational organization that supports teacher training 
programs in the effective teaching of writing, and supports 
classroom-level research on teaching writing that documents 
effectiveness in terms of student performance. To provide these 
services, the National Writing Project contracts with numerous 
institutions of higher education and nonprofit education 
providers to operate small teacher training programs. Federal 
funds support 50 percent of the costs of these programs, and 
recipients must contribute an equal amount.

Teaching of traditional American history

    The bill does not include funding for the teaching of 
traditional American history, $119,292,000 below the budget 
request and the fiscal year 2004 level. This program supports 
competitive grants to school districts to promote the teaching 
of American history in elementary and secondary schools as a 
separate academic subject.

School leadership

    The bill includes $15,000,000 for school leadership 
activities, $2,654,000 above the fiscal year 2004 level. The 
President's budget did not propose funding for this program. 
The program provides competitive grants to assist high-need 
school districts with recruiting, training, and retaining 
principals and assistant principals.

Advanced credentialing

    The bill includes $18,391,000 for advanced credentialing, 
the same as the fiscal year 2004 level and $11,391,000 above 
the budget request. The program authorizes competitive grants 
to states, school districts, the National Board for 
Professional Teaching Standards (NBPTS) working with a district 
or states, the American Board for the Certification of Teacher 
Excellence working with a district or state, or another 
certification or credentialing organization working with a 
district or state. The program supports activities to encourage 
and support teachers seeking advanced certification or 
credentialing.
    The Committee has included funding to continue the 
evaluation described in the fiscal year 2004 conference 
agreement relating to the National Board for Professional 
Teaching Standards. The Committee further intends that 
$10,000,000 of the funds be awarded to the National Board for 
Professional Teaching Standards and that $7,000,000 be awarded 
to the American Board for the Certification of Teacher 
Excellence.

Charter schools

    The Committee recommends $218,702,000 for support of 
charter schools, the same as the budget request and the fiscal 
year 2004 amount. Charter schools are developed and 
administered by individuals or groups of individuals, which may 
include teachers, administrators, and parents. These groups 
enter into charters for operation of their schools, which must 
be granted exemptions from State and local rules that limit 
flexibility in school operation and management. Under this 
program, grants are made to State educational agencies in 
States that have charter school laws; the State educational 
agencies will in turn make sub-grants to authorized public 
chartering agencies in partnerships with developers of charter 
schools.

Credit enhancement for charter school facilities

    The bill includes $50,000,000 for credit enhancement for 
charter school facilities, $50,000,000 below the budget request 
and $12,721,000 above fiscal year 2004. This program helps 
charter schools meet their facility needs by providing funding 
on a competitive basis to leverage other funds and help charter 
schools obtain school facilities by means such as purchase, 
lease and donation. Charter schools are more likely than 
traditional schools to have problems obtaining adequate 
facilities because they are perceived as more financially risky 
than other schools, and unlike traditional school districts, 
charter schools generally lack the ability to issue general 
obligation bonds backed by property taxes.

Voluntary public school choice

    The bill includes $26,757,000 for voluntary public school 
choice, the same as the budget request and the fiscal year 2004 
level. This program supports efforts to establish intradistrict 
and interdistrict public school choice programs to provide 
parents with greater choice for their children's education. 
Funds are used to make competitive awards to states, school 
districts or partnerships.

Magnet schools assistance

    The bill includes $108,640,000 for the magnet schools 
assistance program, the same as the budget request and the 
fiscal year 2004 level. The magnet schools assistance program 
awards competitive grants to local educational agencies for use 
in establishing or operating magnet schools that are part of a 
desegregation plan approved by a court or by the Department of 
Education's Office for Civil Rights. A magnet school is defined 
by the statute as ``a school or education center that offers a 
special curriculum capable of attracting substantial numbers of 
students of different racial backgrounds.'' A funding priority 
is given to local educational agencies that did not receive a 
grant in the preceding fiscal year.
    The Committee is aware that three applications submitted 
for competition in the spring of 2004 were determined to be 
ineligible for consideration. The Committee urges the Secretary 
to reconsider means by which these applications could be 
considered for funding in fiscal year 2004.

Fund for the improvement of education

    The bill includes $100,000,000 for the fund for the 
improvement of education, $330,270,000 below the fiscal year 
2004 level and $70,185,000 below the budget request. The fund 
for the improvement of education has a broad portfolio of 
activities. Under the fund, the Secretary of Education supports 
activities that identify and disseminate innovative educational 
approaches. Several separate program authorities are included 
in this line item. Within the total, the committee has included 
$50,000,000 for the following activities:
    All Kinds of Minds, for start-up, expansion and research 
for the Schools Attuned teacher training program; American Film 
Institute, for a hands-on learning method; Battelle for Kids, 
for a multi-state effort to evaluate and learn the most 
effective ways for accelerating student academic growth; 
Carnegie Hall, for K-12 curriculum development; College Summit, 
for increasing the college enrollment rate of low-income youth; 
EARTH University Foundation, for student scholarships; 
Education Leaders Council, for expansion of the Following the 
Leaders program; Foundations for Learning Grants authorized by 
section 5542 of the No Child Left Behind Act of 2001, 
$1,000,000; Girl Scouts of America, for a Math and Science 
program; Institute of Heart Math, for a national demonstration 
on student standardized testing; Knowledge Is Power Program 
(KIPP), for support for training, instruction and 
organizational leadership; the Mesorah Heritage Foundation, for 
translation of classic texts; the Milken Family Foundation, for 
expansion of the Teacher Advancement Program into five 
additional states; Reach Out and Read, for expansion on an 
early literacy program; Special Olympics, to promote access to 
physical education for mentally disabled people worldwide; 
Starr Commonwealth Foundation, for expansion of the No 
Disposable Kids initiative; and Teach for America, for 
expansion of recruitment and training of new teachers to low-
income areas.
    The Committee has included additional funding for other 
teacher training and reading activities authorized by part D of 
title V of the No Child Left Behind Act of 2001.

Ready to Learn Television

    The bill includes $22,864,000 for the Ready to Learn 
Television program, the same as the budget request and the 
fiscal year 2004 level. Ready to Learn supports the development 
and distribution of educational video programming for preschool 
children, elementary school children and their parents. Only 
public telecommunications entities are eligible to receive 
awards.

Dropout prevention programs

    The bill does not include funding for the dropout 
prevention program, the same as the budget request. This 
program was funded at $4,970,000 in fiscal year 2004. The 
dropout prevention program provides assistance to help schools 
implement effective school dropout prevention and reentry 
programs. This program has only been funded for two years, and 
has made only about two dozen awards. The Committee notes that 
districts desiring to implement dropout prevention programs can 
use funds under title I for innovative programs to support such 
efforts; hence there is no need for a separately funded line-
item to accomplish this purpose.

Ellender fellowships/Close-Up

    The bill includes $1,481,000 for Ellender fellowships, the 
same as the fiscal year 2004 level. The budget did not propose 
funding for this program. The Ellender fellowship program makes 
an award to the Close-Up Foundation of Washington D.C. This 
organization provides fellowships to students from low income 
families and their teachers to enable them to participate with 
other students and teachers for a week of seminars on 
government and meetings with representatives of the three 
branches of the Federal government.

Advanced placement test fee program

    The Committee recommends $30,000,000 for advanced placement 
fees. This recommendation is $21,534,000 below the budget 
request and $6,466,000 above the fiscal year 2004 amount. The 
advanced placement test fee program awards grants to States to 
enable them to cover part or all of the cost of advanced 
placement test fees of low-income students who are enrolled in 
advanced placement classes and plan to take the advanced 
placement test. This program also supports competitive grants 
to states, school districts and national nonprofit educational 
agencies for programs that encourage greater participation by 
low-income students in advanced placement courses.

                 SAFE SCHOOLS AND CITIZENSHIP EDUCATION

    The bill includes $801,369,000 for school improvement 
programs. This amount is $54,405,000 less than the comparable 
fiscal year 2004 appropriation and $37,528,000 below the budget 
request for comparable programs. This appropriation account 
includes programs authorized under parts of titles II, IV, and 
V of the Elementary and Secondary Education Act.

Safe and drug-free schools and communities: State grants

    The Committee bill includes $440,908,000 for the State 
grants program, the same as the budget request and the fiscal 
year 2004 level. The program supports State formula grants for 
comprehensive, integrated approaches to drug and violence 
prevention. Local educational agencies must use their funds to 
implement a drug and violence prevention program for students 
and employees.
    The Committee is interested in the degree to which school 
districts are making use of their authority to transfer up to 
50 percent of their Safe and Drug Free Schools money to the 
Title I program. The Committee urges the Secretary to encourage 
school districts to report these transfers so the resulting 
funding levels for both programs can be determined and so that 
local practices across the nation can be better understood.
    The Committee is deeply concerned that between 5% to 9% 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. 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 
FY2004 report, 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.

Safe and drug-free schools and communities: national programs

    For the national programs under the Safe and Drug-Free 
Schools and Communities Act, the bill provides $153,767,000, 
the same as the fiscal year 2004 amount and $21,302,000 below 
the budget request. Under this program, the Secretary of 
Education administers a variety of activities to prevent the 
illegal use of drugs and violence among, and promote safety and 
discipline for, students at all educational levels, preschool 
through postsecondary. Within the amount provided, the 
Committee intends that the student drug testing pilot program 
be funded at a level of at least $10,000,000.

Alcohol abuse reduction

    The bill does not include funding for grants to reduce 
alcohol abuse, the same as the budget request and $29,823,000 
below the fiscal year 2004 level. This program awards 
competitive grants to districts to develop and implement 
innovative and effective programs to reduce alcohol abuse in 
secondary schools.

Mentoring programs

    The bill includes $49,705,000 for mentoring programs which 
provide competitive grants to school districts and community-
based organizations to promote mentoring programs for children 
with the greatest need. This is $50,295,000 below the budget 
request and the same as the fiscal year 2004 level.

Character education

    The bill includes $24,961,000 for character education, an 
increase of $270,000 over the fiscal year 2004 level and the 
budget request. This program provides support for the design 
and implementation of character education programs in 
elementary and secondary schools. Grantees may select the 
elements of character that will be taught, and must consider 
the views of parents and students to be served by the program.

Elementary and secondary school counseling

    The bill includes $33,799,000 for elementary and secondary 
school counseling, the same as the fiscal year 2004 level. The 
budget did not propose funding for this program. This program 
provides grants to school districts to enable them to establish 
or expand elementary school and secondary school counseling 
programs.

Physical education for progress

    The bill includes $69,587,000 for the physical education 
for progress program, the same as the budget request and the 
fiscal year 2004 level. The Committee expects that funds will 
be used to develop programs that can provide information to 
states, school districts and other youth organizations on the 
most effective methods for encouraging all students--not simply 
those who are already participating in competitive sports--to 
develop positive attitudes about fitness and increased levels 
of personal fitness.

Civic education

    The bill includes $28,642,000 for civic education, the same 
as the fiscal year 2004 level and the budget request. Program 
funds support the ``We the People'' and the Cooperative 
Education Exchange programs. ``We the People'' seeks to promote 
civic competence and responsibility among students. Cooperative 
Education Exchange provides support for education exchange 
activities in civics and economics between the United States 
and eligible countries in Central and Eastern Europe, the 
Commonwealth of Independent States, any country that was 
formerly a republic of the Soviet Union, the Republic of 
Ireland, the province of Northern Ireland and developing 
countries with a democratic form of government.

State grants for incarcerated youth offenders

    The bill does not include funding for state grants for 
incarcerated youth offenders, the same as the budget request 
and $24,852,000 below the fiscal year 2004 level. This program 
makes grants to state correctional agencies to assist and 
encourage incarcerated youths to acquire functional literacy 
skills and life and job skills.

                      ENGLISH LANGUAGE ACQUISITION

    The bill includes $681,215,000 for English language 
acquisition programs. This amount is the same as the budget 
request and the comparable fiscal year 2004 appropriation 
level.
    This program provides formula grants to states to serve 
limited English proficient students. Grants are based on each 
state's share of the Nation's limited English proficient and 
recent immigrant student population. Funds under this account 
also support professional development to increase the pool of 
teachers prepared to serve limited English proficient students 
and evaluation activities.

                           SPECIAL EDUCATION

    The bill includes $12,176,101,000 for programs for children 
with disabilities authorized under the Individuals with 
Disabilities Education Act (IDEA). This funding level is the 
same as the budget request and $1,015,393,000 above the 
comparable fiscal year 2004 appropriation.

State Grants: Grants to States for special education

    The bill provides $11,068,106,000 for grants to States, 
which is the same as the budget request and $1,000,000,000 
above the fiscal year 2004 level. Out of the total made 
available for school year 2005-2006, $5,655,106,000 is 
appropriated for fiscal year 2005 for obligation after July 1, 
2005 and 5,413,000,000 is appropriated for fiscal year 2006 for 
obligation on, or after, October 1, 2005.
    This program provides formula grants to assist the States 
in meeting the excess costs of providing special education and 
related services to children with disabilities. In order to be 
eligible for funds, States must make free appropriate public 
education available to all children with disabilities. Funds 
are distributed based on the amount that each State received 
from the fiscal year 1999 appropriation, and the numbers of 
children in the general population and who live in poverty in 
the age range for which each State mandates free appropriate 
public education for children with disabilities.

State grants: Preschool grants

    The bill provides $387,699,000 for preschool grants, the 
same as the fiscal year 2004 level and the budget request. This 
program provides grants to States on the basis of their 
proportionate share of the total number of children in the 3 
through 5 age range and the number of these children living in 
poverty. These funds are provided in order to assist States to 
make a free appropriate public education available to all 
children with disabilities in the 3 through 5 age range.

State Grants: Grants for infants and families

    The bill provides $466,581,000 for grants for infants and 
families, $22,218,000 above the fiscal year 2004 level and the 
same as the budget request. This formula grant program assists 
States in developing and implementing statewide systems of 
coordinated, comprehensive, multidisciplinary, interagency 
programs to make available early intervention services to all 
children with disabilities, aged birth through 2, and their 
families.

IDEA National Activities: State improvement

    The bill includes $51,061,000 for State improvement, the 
same as the budget request and the fiscal year 2004 
appropriation. This program supports competitive grants to 
State educational agencies to assist them, in partnership with 
parents, teachers, institutions of higher education, interest 
groups, and others, to improve results for children with 
disabilities by reforming and improving their educational, 
early intervention, and transitional service systems. Among 
these systems are those for professional development, technical 
assistance, and dissemination of knowledge about best 
practices. Awards are based on State improvement plans 
developed by the States.

IDEA National Activities: Technical assistance and dissemination

    The bill includes $52,819,000 for technical assistance and 
dissemination, the same as the budget request and the fiscal 
year 2004 appropriation. This program provides technical 
assistance and information through competitive awards that 
support institutes, regional resource centers, clearinghouses, 
and efforts to build State and local capacity to make systemic 
changes and improve results for children with disabilities.

IDEA National Activities: Personnel preparation

    The bill includes $91,357,000 for personnel preparation, 
which is the same as the budget request and the fiscal year 
2004 appropriation. This program supports competitive awards to 
help address State-identified needs for qualified personnel to 
work with children with disabilities, and to ensure that those 
personnel have the skills and knowledge they need to serve 
those children. Awards focus on addressing the need for 
personnel to serve low-incidence populations and high-incidence 
populations, leadership personnel, and projects of national 
significance.

IDEA National Activities: Parent information centers

    The bill includes $26,173,000 for parent information 
centers, the same as the fiscal year 2004 level and the budget 
request. This program makes awards to parent organizations to 
support parent training and information centers, including 
community parent resource centers. These centers provide 
training and information to meet the needs of parents of 
children with disabilities living in the areas served by the 
centers, particularly underserved parents and parents of 
children who may be inappropriately identified. Technical 
assistance is also provided under this program for developing, 
assisting and coordinating centers receiving assistance under 
this program.

IDEA National Activities: Technology and media services

    The bill includes $32,305,000 for technology and media 
services, which is $6,824,000 below the fiscal year 2004 
appropriation and the same as the budget request. This program 
makes competitive awards to support the development, 
demonstration, and use of technology and educational media 
activities of educational value to children with disabilities.
    The bill includes $11,400,000 for Recording for the Blind 
and Dyslexic Inc. These funds support continued production and 
circulation of recorded textbooks, increased outreach 
activities to print-disabled students and their teachers and 
accelerated use of digital technology. The Committee believes 
that the funds recommended will enable RFB&D; to significantly 
expand its service to students with print disabilities and to 
continue the digital production and use of its extensive 
library of educational materials.
    The Committee continues to recognize the importance of very 
small businesses in increasing the quality and cost 
effectiveness of the television-captioning program. As this 
program transitions into a mandated program as authorized by 
the Telecommunications Act, the Department shall give full and 
fair consideration to the applications for very small 
businesses. The Committee directs the Department to submit a 
report to Congress regarding its treatment of small and very 
small businesses no later than April 2005.

            REHABILITATION SERVICES AND DISABILITY RESEARCH

    The bill includes $3,054,587,000 for rehabilitation 
services and disability research. This amount is $7,390,000 
above the budget request and $43,317,000 above the fiscal year 
2004 appropriation. The programs in this account are authorized 
by the Rehabilitation Act of 1973, the Helen Keller National 
Center Act, and the Assistive Technology Act of 1998.

Vocational rehabilitation grants to States

    For vocational rehabilitation State grants, the bill 
includes $2,635,845,000, $51,683,000 above fiscal year 2004. 
This program supports basic vocational rehabilitation services 
through formula grants to the States. These grants support a 
wide range of services designed to help persons with physical 
and mental disabilities prepare for and engage in gainful 
employment to the extent of their capabilities. Emphasis is 
placed on providing vocational rehabilitation services to 
persons with the most significant disabilities.

Client assistance

    The bill includes $11,997,000 for the client assistance 
program, the same as the budget request and the fiscal year 
2004 amount. A client assistance program is required in each 
State as a condition of receipt of a basic State grant. State 
formula grants are used to help persons with disabilities 
overcome problems with the service delivery system and improve 
their understanding of services available to them under the 
Rehabilitation Act.

Training

    For training personnel to provide rehabilitation services 
to persons with disabilities, the bill includes $39,139,000, 
the same as the budget request and the fiscal year 2004 amount. 
The program supports long-term and short-term training, in-
service personnel training, and training of interpreters for 
deaf persons. Projects in a broad array of disciplines are 
funded to ensure that skilled personnel are available to serve 
the vocational needs of persons with disabilities.

Demonstration and training programs

    The bill includes $18,784,000 for demonstration and 
training programs, the same as the budget request and 
$5,502,000 below the fiscal year 2004 level. These programs 
authorize discretionary awards on a competitive basis to public 
and private organizations to support demonstrations, direct 
services, and related activities for persons with disabilities.

Migrant and seasonal farmworkers

    For programs serving migrant and seasonal farmworkers, the 
bill provides $2,321,000, which is the same as the fiscal year 
2004 amount and $2,321,000 above the budget request. This 
program provides discretionary grants to make comprehensive 
vocational rehabilitation services available to migrant and 
seasonal farmworkers with vocational disabilities. Projects 
emphasize outreach activities, specialized bilingual 
rehabilitation counseling, and coordination of vocational 
rehabilitation services with services from other sources.

Recreational programs

    For recreational programs, the bill provides $2,564,000, 
the same as the fiscal year 2004 amount and $2,564,000 above 
the budget request. This program provides individuals with 
recreation and related activities to aid in their employment, 
mobility, independence, socialization, and community 
integration. Discretionary grants are made on a competitive 
basis to States, public agencies, and nonprofit private 
organizations, including institutions of higher education.

Protection and advocacy of individual rights

    For protection and advocacy for persons with disabilities, 
the bill provides $16,790,000, $2,780,000 below the budget 
request and the same as the fiscal year 2004 level. Grants are 
awarded to entities that have the authority to pursue legal, 
administrative, and other appropriate remedies needed to 
protect and advocate the rights of persons with disabilities.

Projects with industry

    For projects with industry, the bill provides $21,799,000, 
the same as the fiscal year 2004 amount and $21,799,000 above 
the budget request. This program is the primary Federal vehicle 
for promoting greater participation of business and industry in 
the rehabilitation process. The program provides training and 
experience in realistic work settings to persons with 
disabilities to prepare them for employment in the competitive 
labor market. Awards are made to a variety of agencies and 
organizations, including business and industrial corporations, 
rehabilitation facilities, labor organizations, trade 
associations, and foundations.

Supported employment State grants

    For supported employment State grants, the bill includes 
$37,680,000, which is the same as the fiscal year 2004 amount 
and $37,680,000 above the budget request. These formula grants 
assist States in developing collaborative programs with public 
agencies and nonprofit agencies for training and post-
employment services leading to supported employment. In 
supported employment programs, persons with significant 
disabilities are given special supervision and assistance to 
enable them to work in an integrated setting.

Independent living: State grants

    For State grants for independent living, the bill includes 
$25,000,000. This amount is $2,980,000 above the budget request 
and the fiscal year 2004 level. This program supports formula 
grants to the States to provide services for independent living 
for persons with significant disabilities.

Independent living: centers

    For centers for independent living, the bill provides 
$75,000,000, which is $1,437,000 above the budget request and 
the fiscal year 2004 level. Discretionary grants support a 
network of consumer-controlled, nonresidential, community-based 
private nonprofit centers that provide a wide range of services 
to help persons with significant disabilities live more 
independently in family and community settings. Centers provide 
information and referral services, independent living skills 
training, peer counseling, and individual and systems advocacy. 
Discretionary grants are made to private nonprofit 
organizations.

Independent living: services for older blind persons

    For independent living services for older blind 
individuals, the bill provides $35,000,000. This amount is 
$3,189,000 above the fiscal year 2004 amount and the budget 
request. Discretionary grants support services for persons 55 
years old or over whose severe visual impairment makes gainful 
employment extremely difficult to obtain, but for whom 
independent living goals are feasible.

Program improvement

    For program improvement activities, the bill provides 
$850,000, which is $39,000 below the fiscal year 2004 level and 
the same as the budget request. The program: (1) provides 
technical assistance and consultative services to public and 
non-profit private agencies and organizations; (2) provides 
short-term training and technical instruction; (3) conducts 
special demonstrations; (4) collects, prepares, publishes and 
disseminates educational or informational materials; and (5) 
carries out monitoring and conducts evaluations.

Evaluation

    The bill includes $1,500,000 for program evaluation, the 
same as the budget request and $512,000 above the fiscal year 
2004 level. These funds are used to evaluate the impact and 
effectiveness of individual programs authorized under the 
Rehabilitation Act. Contracts are awarded on an annual basis 
for studies to be conducted by persons not immediately involved 
in the administration of the programs authorized by the Act.

Helen Keller National Center

    For the Helen Keller National Center for Deaf-Blind Youth 
and Adults, the bill includes $8,666,000, the same as the 
fiscal year 2004 amount and the budget request. These funds are 
used for the operation of the national center for intensive 
services for deaf-blind individuals and their families at Sands 
Point, New York and a network of 10 regional offices for 
referral and counseling and technical assistance.

National Institute on Disability and Rehabilitation Research

    The bill includes $106,652,000 for the National Institute 
on Disability and Rehabilitation Research, the same as the 
budget request and the fiscal year 2004 level. The Institute 
supports research, demonstration and training activities that 
are designed to maximize the employment and integration into 
society of individuals with disabilities of all ages.

Assistive technology

    For assistive technology activities, the bill provides 
$15,000,000, $10,943,000 below the fiscal year 2004 amount and 
the same as the budget request. Technology assistance 
activities are authorized under the Assistive Technology Act of 
1998. This Act authorizes the following activities: 
discretionary grants to the States to assist them in developing 
statewide programs to facilitate the provision of devices for, 
and services to, persons with disabilities; protection and 
advocacy services related to assistive technology; 
discretionary grants to the states for alternative financing 
programs; and technical assistance activities.

           Special Institutions for Persons With Disabilities


                 AMERICAN PRINTING HOUSE FOR THE BLIND

    The bill provides $17,000,000 for the American Printing 
House for the Blind, an increase of $597,000 above the fiscal 
year 2004 appropriation and the budget request. This 
appropriation subsidizes the production of educational 
materials for legally blind persons enrolled in pre-college 
programs. The Printing House, which is chartered by the State 
of Kentucky, manufactures and maintains an inventory of special 
materials that is distributed free of charge to schools and 
States based on the number of blind students in each State. The 
Printing House also conducts research and field activities to 
inform educators about the availability of materials and how to 
use them.

               NATIONAL TECHNICAL INSTITUTE FOR THE DEAF

    The bill provides $55,790,000 for the National Technical 
Institute for the Deaf (NTID), an increase of $2,307,000 above 
the comparable fiscal year 2004 amount and $1,987,000 above the 
request. Within the total, $1,685,000 is specified for 
construction. The NTID was established by Congress in 1965 to 
provide a residential facility for postsecondary technical 
training and education for deaf persons with the purpose of 
promoting the employment of deaf individuals. The Institute 
also conducts applied research and provides training in various 
aspects of deafness. The Secretary of Education administers 
these activities through a contract with the Rochester 
Institute of Technology in Rochester, New York.

                          GALLAUDET UNIVERSITY

    The bill provides $104,000,000 for Gallaudet University, an 
increase of $3,795,000 above the fiscal year 2004 appropriation 
and the budget request. Gallaudet is a private, non-profit 
educational institution Federally-chartered in 1864 providing 
elementary, secondary, undergraduate, and continuing education 
for deaf persons. In addition, the University offers graduate 
programs in fields related to deafness for deaf and hearing 
students, conducts various research on deafness, and provides 
public service programs for deaf persons.

                     VOCATIONAL AND ADULT EDUCATION

    The bill includes $2,025,456,000 for vocational and adult 
education programs. This amount is $76,531,000 below the fiscal 
year 2004 appropriation and $423,223,000 above the budget 
request. This appropriation account includes vocational 
education programs authorized by the Carl D. Perkins Vocational 
and Applied Technology Education Act. The account also includes 
adult education programs originally authorized by the Adult 
Education Act and reauthorized under the Workforce Investment 
Act of 1998.

Vocational education basic grants

    This bill includes $1,215,008,000 for basic grants to 
States under the Carl D. Perkins Vocational and Technical 
Education Act of 1998, which is $20,000,000 above the fiscal 
year 2004 amount and $203,008,000 above the comparable budget 
request. Out of the total made available for school year 2004-
2005, $424,008,000 is appropriated for fiscal year 2005 for 
obligation after July 1, 2005 and $791,000,000 is appropriated 
for fiscal year 2006 for obligation on, or after, October 1, 
2005.
    State grants support a variety of vocational education 
programs developed in accordance with the State plan. The Act 
concentrates federal resources on institutions with high 
concentrations of low-income students. The populations assisted 
by Basic Grants range from secondary students in pre-vocational 
courses to adults who need retraining to adapt to changing 
technological and labor markets.

Tech-prep

    The bill includes $106,665,000 for tech-prep, the same as 
fiscal year 2004. The budget request did not propose separate 
line item funding for this program. This appropriation includes 
activities under title II of the Carl D. Perkins Vocational and 
Technical Education Act of 1998. The tech-prep education 
program provides planning and demonstration grants to consortia 
of local educational agencies and postsecondary institutions to 
develop and operate model technical education programs. These 
programs begin in high school and provide students with the 
mathematical, science, communications and technological skills 
needed to enter a 2-year associate degree or 2-year certificate 
program in a given occupational field, and to make a successful 
transition into further postsecondary education or begin their 
careers. The purpose of tech-prep is to develop structural 
links between secondary and postsecondary institutions that 
integrate academic and vocational education and better prepares 
students to make the transition from school to careers.

National programs

    For national programs, the Committee provides $11,852,000, 
which is the same as the fiscal year 2004 amount. The budget 
did not request separate funding for this program. This 
authority supports the conduct and dissemination of research in 
vocational education, and includes support for the National 
Centers for Research and Dissemination in Career and Technical 
Education, five regional curriculum coordination centers, and 
other discretionary research.

Tech-Prep Education Demonstration

    The bill does not include funding for the Tech-Prep 
Education Demonstration. The President's budget did not request 
funding for it. Last year this program was funded at 
$4,939,000. The program makes competitive grants to consortia 
to establish Tech-prep programs in secondary schools located on 
the sites of community colleges.

Occupational and Employment Information Program

    The bill does not include funding for the Occupational and 
Employment Information Program. The President's budget did not 
request funding for it. Last year this program was funded at 
$9,382,000. The program provides career information and 
guidance services to students and adults through a network of 
state agencies.

State programs for adult education

    For state grants, the Committee recommends $574,372,000, 
which is the same as the fiscal year 2004 amount, and the same 
as the comparable budget request. State formula grants support 
programs to enable all 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.
    Grants are provided on a formula basis to States under the 
new Adult Education and Family Literacy Act. The formula 
provides an initial allotment of $25,000 for each state and 
$100,000 to each outlying area, with additional allotments 
distributed on the basis of population aged 16 through 60 who 
are without a high school diploma or equivalent who are not 
enrolled in secondary school.
    States may use 12.5 percent of their allotments for state 
leadership activities and may use an additional 5 percent or 
$65,000 for state administration. States and localities must 
give priority to adult education and literacy activities that 
are built on a strong foundation of research on effective 
practices and that effectively employ technology. Funds are 
provided on a forward-funded basis.
    The Committee notes that over 40 percent of new adult 
education entrants are seeking English as-a-second language 
(ESL) services and that ESL accounts for 51 percent of all 
adults receiving adult education services and 76 percent of the 
hours of instruction received. The Committee expects that the 
funds provided in this program will be used by states with 
large concentrations of students who seek English language 
proficiency training to meet the needs of those individuals. 
The Committee bill retains language similar to that contained 
in last year's bill that guarantees a portion of the funds will 
be used to provide civics education services to new immigrants.

National Programs--National Leadership Activities

    The Committee provides $9,169,000 for national leadership 
activities. This amount is the same as the fiscal year 2004 
level and the budget request. Through applied research, 
development, dissemination, evaluation, and program improvement 
activities, this program assists State efforts to improve the 
quality of adult education. The funds support such projects as 
evaluations on the status and effectiveness of adult education 
programs, national and international adult literacy surveys, 
and technical assistance on using technology to improve 
instruction and administration that show promise of 
contributing to the improvement and expansion of adult 
education.

National Institute for Literacy

    For the National Institute for Literacy, the bill provides 
$6,692,000, which is the same as the fiscal year 2004 amount 
and the budget request. The Institute supports research and 
development projects, tracks progress made toward national 
literacy goals, supports research fellowships, disseminates 
information through a national clearinghouse, and coordinates 
literacy information data from national and State sources.

Smaller learning communities

    The bill includes $101,698,000 for the smaller learning 
program, $72,269,000 below fiscal year 2004. The Administration 
did not request funding for this program. The Committee 
reiterates its strong support for the smaller learning 
communities program but was unable to provide additional 
resources due to budget constraints. As in past years, the bill 
specifies that these funds shall be used only for activities 
related to the redesign of large high schools enrolling 1,000 
or more students.
    The Committee requests that the Department fully consult 
with the Appropriations Committees prior to the release of the 
fiscal year 2004 and fiscal year 2005 program guidance for the 
smaller learning communities program. The Committee believes 
the Department must improve its leadership, outreach and 
technical assistance for smaller learning communities. 
Therefore, the Committee requests the Secretary to develop an 
aggressive plan to ensure that school districts have clear and 
timely guidance, adequate time to apply for federal assistance 
and to receive such assistance well in advance of the start of 
the school year, sufficient time and resources to accomplish 
the complex task of restructuring high schools, access to 
technical assistance providers with experience in establishing 
smaller learning communities, and a support network to share 
best practices. This plan shall also describe in detail the 
planned allocation of the five percent set aside for national 
activities for fiscal year 2004 and fiscal year 2005. The 
Secretary shall submit a letter report to the Committee 
describing this plan not later than January 1, 2005.

Community technology centers

    The bill does not include funding for community technology 
centers, $9,941,000 below the fiscal year 2004 level and the 
same as the request. The program provides competitive grants to 
create and expand community technology centers that offer 
disadvantaged residents of economically distressed urban and 
rural communities access to information technology and related 
training. Other Federal programs also exist that fund 
communities that want to establish and operate technology 
centers.

                      STUDENT FINANCIAL ASSISTANCE

    The bill provides $14,755,794,000 for student financial 
assistance programs, an increase of $748,498,000 over the 
comparable fiscal year 2004 appropriation and $57,172,000 above 
the budget request.

Pell grants

    The bill maintains the maximum Pell Grant at $4,050, the 
same as the budget request and the comparable fiscal year 2004 
amount. The bill provides $12,830,000,000 in new budget 
authority for the Pell Grant program, the same as the request 
and $823,262,000 above the comparable fiscal year 2004 amount. 
Pell Grants provide portable education vouchers to 
postsecondary students who may use them at any of over 6,000 
eligible schools. The bill does not include funding for 
enhanced Pell grants for state scholars, which the 
administration requested at $33,000,000. The Committee notes 
that this program has not been authorized.

Federal Supplemental Educational Opportunity Grants

    The bill provides $794,455,000 for federal supplemental 
educational opportunity grants, $24,000,000 above the request 
and the fiscal year 2004 level. The SEOG program provides 
grants through postsecondary institutions to qualified students 
who demonstrate exceptional financial need. Institutions have 
broad flexibility within the eligibility criteria for awarding 
these grants with the exception that priority must be given to 
Pell Grant recipients.

Work-study

    The bill provides $998,502,000 for the work-study program, 
the same as the comparable fiscal year 2004 appropriation and 
the budget request. Funding for this program is provided 
through institutions to students who work part-time to meet the 
cost of education. Institutions receive funding according to a 
statutory formula and may allocate it for job location and job 
development centers.

Perkins loans capital contributions

    The bill does not include funding for new capital 
contributions to federal Perkins revolving loan funds, the same 
as the budget request. This program received $98,764,000 in 
fiscal year 2004. The committee is aware that the Perkins 
program currently has over $1,000,000,000 in its revolving fund 
that can be used to make new awards to students. In addition, 
the Committee believes that the combination of a low interest 
rate environment and the availability of the Federal Family 
Education Loan Program and the Federal Direct Student Loan 
Program make additional capital contributions unnecessary this 
year.

Perkins loans cancellations

    The bill provides $66,665,000 for federal Perkins loans 
cancellations, the same as the budget request and the fiscal 
year 2004 amount. The Federal Government reimburses 
institutional Perkins revolving loan funds for loan 
cancellations permitted under Federal law. Loans may be 
canceled when the borrower pursues a career in one of 12 
statutorily-designated professions including corrections, 
medical technical work, and peace corps or VISTA service.

Leveraging educational assistance partnership

    The bill includes $66,172,000 for the leveraging 
educational assistance partnership (LEAP) program, the same as 
the fiscal year 2004 level and $66,172,000 above the budget 
request. LEAP provides dollar-for-dollar matching funds to 
States as an incentive for providing need-based grant and work 
study assistance to eligible postsecondary students. Federally 
supported grants and job earnings are limited to $5,000 per 
award year for full-time students. By law, each State's 
allocation is based on its relative share of the total national 
population of students eligible to participate in the programs, 
except that no state is to receive less than it received in 
1979. If LEAP amounts are below this level, each State is 
allocated an amount proportional to the amount of funds it 
received in 1979. If a state does not use all of its 
allocation, the excess funds are distributed to other States in 
the same proportion as the original distribution. States must, 
at a minimum, match LEAP grants dollar for dollar with state 
funds provided through direct state appropriations for this 
purpose.

                       STUDENT AID ADMINISTRATION

    The bill includes $120,247,000 in discretionary resources 
for the Student Aid Administration account. The Committee 
recommendation is $3,520,000 more than the comparable fiscal 
year 2004 funding level and $19,392,000 below the request, when 
adjusted for discretionary-scored spending. Funds appropriated 
to 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 Federal Student Aid Office and the 
Office of Postsecondary Education have primary responsibility 
for administering Federal student financial assistance 
programs. The Committee bill does not include the 
Administration's legislative proposal to fund this new account 
solely through annual appropriations.

                            HIGHER EDUCATION

    The bill provides $1,976,056,000 for higher education 
programs, a decrease of $116,586,000 below the fiscal year 2004 
appropriation and $972,000 below the budget request.

Strengthening institutions

    The bill provides $80,986,000 for the regular strengthening 
institutions program, the same as the budget request and the 
fiscal year 2004 level. This program provides general operating 
subsidies to institutions with low average educational and 
general expenditures per student and significant percentages of 
low-income students. Awards may be used for faculty and 
academic program development, management, joint use of 
libraries and laboratories, acquisition of equipment, and 
student services.

Hispanic serving institutions

    The bill provides $95,873,000 for the Hispanic serving 
institutions program, the same as the budget request and 
$1,880,000 above the fiscal year 2004 level. The HSI program 
provides operating subsidies to schools that serve at least 25 
percent Hispanic students of whom at least half are low-income 
students.

Strengthening historically black colleges and universities

    The bill provides $240,500,000 for strengthening 
historically black colleges and universities (HBCUs), 
$17,736,000 above the fiscal year 2004 appropriation and the 
same as the budget request.
    This program provides operating subsidies to accredited, 
legally authorized HBCUs established prior to 1964 whose 
principal mission is the education of black Americans. Funds 
may be used to support both programs and management and are 
distributed through a formula grant based on the enrollment of 
Pell Grant recipients, number of graduates, and the number of 
graduates entering graduate or professional schools in which 
blacks are underrepresented. The minimum grant is $500,000.

Strengthening historically black graduate institutions

    The bill provides $58,500,000 for the strengthening 
historically black graduate institutions program, the same as 
the budget request and $5,400,000 above the fiscal year 2004 
appropriation.
    The program provides 5-year grants to the following 18 
post-secondary institutions that are specified in section 
326(e)(1) of the Higher Education Act: Morehouse School of 
Medicine, Meharry Medical School, Charles R. Drew Postgraduate 
Medical School, Clark-Atlanta University, Tuskegee University 
School of Veterinary Medicine, Xavier University School of 
Pharmacy, Southern University School of Law, Texas Southern 
University Schools of Law and Pharmacy, Florida A&M; University 
School of Pharmaceutical Sciences, North Carolina Central 
University School of Law, Morgan State University qualified 
graduate program, Hampton University qualified graduate 
program, Alabama A&M; qualified graduate program, North Carolina 
A&T; State University qualified graduate program, University of 
Maryland Eastern Shore qualified graduate program, Jackson 
State qualified graduate program, Norfolk State University and 
Tennessee State University. Of the amount appropriated, the 
first $26,600,000 is used to make grants to the first 16 
institutions listed above. Any amount appropriated in excess of 
$26,600,000 but less than $28,600,000 is used to make grants to 
Norfolk State University and Tennessee State University and any 
remaining appropriation is made available to each of the 18 
institutions based on a formula. Awards may be used for 
building endowments as well as the same purposes for which the 
strengthening HBCU grants may be used.

Strengthening Alaska Native and Native Hawaiian-serving institutions

    The Committee recommends $10,935,000 for strengthening 
Alaska Native and Native Hawaiian-serving institutions, the 
same as the fiscal year 2004 level and $4,798,000 above the 
budget request.

Strengthening tribally controlled colleges and universities

    The Committee recommends $23,753,000 for the strengthening 
tribally controlled colleges and universities program, the same 
as the budget request and $466,000 above the fiscal year 2004 
level.

International education and foreign languages studies

            Domestic programs

    The bill provides $93,211,000 for the domestic activities 
of the international education and foreign languages studies 
programs, $4,000,000 above the fiscal year 2004 appropriation 
and the budget request. The program assists graduate and 
undergraduate foreign language and area studies programs and 
students at institutions of postsecondary education. Programs 
include national resource centers, foreign language and area 
studies fellowships, undergraduate international studies and 
foreign language programs, international research and studies 
projects, business and international education projects, 
international business education centers, language resource 
centers, American overseas research centers, and technological 
innovation and cooperation for foreign information access. In 
general, the Secretary has discretion to allocate funding among 
these various activities.
    The Committee finds that globalization and the war on 
terrorism have increased America's need for international 
experts as well as for citizens with foreign language skills 
and global understanding. The bill includes $1,500,000 of which 
$500,000 shall be derived from the one percent set aside for 
Title VI national activities, to support a contract with the 
National Research Council (NRC) of the National Academies, 
through its Division of Behavioral and Social Sciences and 
Education (DBASSE), for an independent review of the Title VI 
international education and foreign language studies and 
section 102(b)(6) Fulbright-Hays programs.
    The Committee requests that the NRC review the adequacy and 
effectiveness of Title VI and Fulbright-Hays in addressing 
their statutory missions and in building the nation's 
international and foreign language expertise--particularly as 
needed for economic, foreign affairs and national security 
purposes. The study should include, but not be limited to, 
evaluating the performance of these programs in: (1) supporting 
research, education and training in foreign languages and 
international studies, including opportunities for such 
research, education and training overseas; (2) reducing 
shortages of foreign language and area experts; (3) infusing a 
foreign language and area studies dimension throughout the 
educational system and across relevant disciplines including 
professional education; (4) producing relevant instructional 
materials that meet accepted scholarly standards; (5) advancing 
uses of new technology in foreign language and international 
studies; (6) addressing business needs for international 
knowledge and foreign language skills; (7) increasing the 
numbers of underrepresented minorities in international 
service; and (8) conducting public outreach/dissemination to K-
12 and higher education, media, government, business, and the 
general public. The study should convene experts and scholars 
widely accepted in the scholarly community with expertise in 
foreign language and international studies, including 
international business education. The study may commission the 
collection of new data and conduct appropriate, rigorous 
analyses of such data. The Committee requests that the NRC 
submit its final report to the Secretary of Education and the 
Congress not later than two years after date of enactment of 
this bill, with an interim report to be submitted after 15 
months.

            Overseas programs

    The bill provides $12,840,000 for the overseas programs in 
international education and foreign language studies authorized 
under the Mutual Educational and Cultural Exchange Act of 1961, 
popularly known as the Fulbright-Hays Act. The appropriation is 
the same as the budget request and the fiscal year 2004 
appropriation. Funding for these programs support group 
projects abroad, faculty research abroad, special bilateral 
projects, and doctoral dissertation research abroad.

Institute for International Public Policy

    The bill provides $1,629,000 for the Institute for 
International Public Policy, the same as the budget request and 
the fiscal year 2004 appropriation. This program provides a 
grant to an eligible recipient to operate the Institute through 
sub-grantees chosen among minority serving institutions.

Fund for the improvement of postsecondary education

    The Committee recommends $32,011,000 for the fund for the 
improvement of postsecondary education (FIPSE), the same as the 
budget request and $125,689,000 below the fiscal year 2004 
amount. FIPSE awards grants and contracts to a variety of 
postsecondary institutions and other organizations to improve 
the quality and delivery of postsecondary education.

Minority science and engineering improvement

    The bill provides $8,889,000 for the minority science and 
engineering improvement program (MSEIP), the same as the fiscal 
year 2004 appropriation and the budget request.
    The MSEIP program awards grants to improve mathematics, 
science, and engineering programs at institutions serving 
primarily minority students and to increase the number of 
minority students who pursue advanced degrees and careers in 
those fields.

Interest subsidy grants

    The bill provides $1,500,000 for interest subsidy grants 
authorized under section 121 of the Higher Education Act, the 
same amount requested in the budget and $488,000 below the 
fiscal year 2004 appropriation. This program provides loan 
subsidies to higher education institutions for facilities 
acquisition, construction and renovation loans taken prior to 
1974. All loans will terminate by the fiscal year 2013. The 
authority to initiate new loan subsidy commitments was repealed 
in the 1992 amendments to the Higher Education Act. Interest 
subsidies provide institutions the difference between the 
interest they pay on commercially-obtained loans and 3 percent 
of the loan balance. The bill provides funding sufficient to 
meet the Federal Government's commitments on the loans expected 
to be in repayment status in fiscal year 2005.

Tribally controlled postsecondary vocational and technical institutions

    The bill includes $7,185,000 for grants for tribally 
controlled postsecondary vocational and technical institutions, 
the same as the budget request and the fiscal year 2004 amount. 
This program provides grants for the operation and improvement 
of training programs to ensure continuation and expansion of 
vocational training opportunities for Indian youth.

TRIO

    The bill provides $842,559,000 for the TRIO programs, 
$10,000,000 above the budget request and the fiscal year 2004 
appropriation. The TRIO programs provide a variety of outreach 
and support services to encourage low-income, potential first-
generation college students to enter and complete college. 
Discretionary grants of up to four or five years are awarded 
competitively to institutions of higher education and other 
agencies. At least two-thirds of the eligible participants in 
TRIO must be low-income, first-generation college students.

GEAR UP

    The bill includes $318,230,000 for the GEAR UP program, 
$20,000,000 above last year's level and the budget request. 
GEAR UP provides grants to states and partnerships of low-
income middle and high schools, institutions of higher 
education and community organizations to target entire grades 
of students and give them the skills and encouragement to 
successfully pursue postsecondary education. The Committee bill 
provides a sixth and final year award to grantees first funded 
in 2000, while continuing all other funded projects. The 
Committee also intends that these funds be available to 
eligible 1999 grantees that opt to apply for new grant awards 
upon completion of the original award. The Committee believes 
that grants should be awarded on an annual basis and expects 
the Department to consult with the Committee on Appropriations 
of both the House and the Senate prior to the announcement of 
any new grant competition.

Byrd scholarships

    The bill does not include funding for the Byrd scholarships 
program, $40,758,000 below the budget request and the fiscal 
year 2004 appropriation. The Byrd scholarship program provides 
formula grants to States to award $1,500 scholarships to 
students who demonstrate academic excellence in high school.

Javits fellowships

    The Committee recommends $9,876,000 for the Javits 
fellowship program, the same as the budget request and the 
fiscal year 2004 appropriation. Under the Javits program, 
institutions receive Federal support to make fellowship awards 
to students pursuing doctoral study in the arts, humanities, 
and social sciences.

Graduate assistance in areas of national need program

    The Committee recommends $30,616,000 for the graduate 
assistance in areas of national need (GAANN) program, the same 
as the budget request and the fiscal year 2004 appropriation. 
The GAANN program awards grants to institutions of higher 
education to provide fellowships to economically disadvantaged 
students who have demonstrated academic excellence and who are 
pursuing graduate education in designated areas of national 
need.

Teacher quality enhancement grants

    The Committee recommends $88,888,000 for teacher quality 
enhancement grants, the same as the budget request and the 
fiscal year 2004 appropriation. Teacher quality enhancement 
grants have three components: state grants, partnership grants 
and recruitment grants. By statute, state and partnership 
grants each receive 45 percent of the appropriation, and 
recruitment grants receive 10 percent.
    Under the state grant component, states apply to receive up 
to three years of funding to improve the quality of their 
teaching force through promoting reform activities such as 
teacher licensing and certification, accountability for high 
quality teacher preparation and professional development and 
recruiting teachers for high-need schools. States must match 50 
percent of the federal award.
    Under the partnership component, partnerships apply to 
receive a five-year grant to strengthen the capacity of K-12 
educators in designing and implementing effective teacher 
education programs, and by increasing collaboration among these 
practitioners and departments of arts and sciences and schools 
of education at institutions of higher education. Partnerships 
must match 25 percent of the federal grant in the first year, 
35 percent in the second year, and 50 percent for the remaining 
years.
    The recruitment component supports the efforts to reduce 
shortages of qualified teachers in high-need school districts. 
States or partnerships may apply to receive these grants.
    The Committee believes that colleges of education play a 
key role in improving teacher quality. The Committee urges 
colleges receiving teacher quality enhancement grants to 
consider the recommendations made by the Teaching Commission, 
including recruiting stronger students from all major fields of 
study, requiring education majors to receive at least a minor 
in an academic subject in addition to education, using 
research-based practices and pedagogy and offering 
opportunities to learn and observe in a real world setting.

Child care access means parents in school

    The Committee recommends $16,099,000 for child care access 
means parents in school program, the same as the budget request 
and the fiscal year 2004 appropriation. Under this program, 
institutions may receive discretionary grants of up to four 
years to support or establish a campus-based childcare program 
primarily serving the needs of low-income students enrolled at 
the institution. Priority is given to childcare programs that 
leverage significant local or institutional resources and 
utilize a sliding fee scale. Grants can only be used to 
supplement childcare services or start new programs.

Demonstration projects to ensure quality higher education for students 
        with disabilities

    The Committee does not recommend funding for demonstration 
projects in disabilities, the same as the budget request. The 
program was funded at $6,913,000 in fiscal year 2004.
    This program provides discretionary grants for three years 
to support model demonstration projects that provide technical 
assistance and professional development activities for faculty 
and administrators in institutions of higher education in order 
to provide students with disabilities a high-quality 
postsecondary education. A number of models have now been 
developed and are being disseminated to other institutions.

Underground railroad program

    The Committee does not recommend funding for the 
underground railroad program, which is the same as the budget 
request. This program was funded at $2,222,000 in fiscal year 
2004. The underground railroad program provides grants to non-
profit institutions to research, display, interpret and collect 
artifacts relating to the history of the underground railroad.

GPRA data/HEA program evaluation

    The Committee recommends $988,000 for program evaluation 
and development of data required under the Government 
Performance and Results Act for Higher Education programs 
administered by the Department. This is the same as the fiscal 
year 2004 appropriation and the budget request.
    The Committee understands that for many higher education 
programs, baseline and performance indicator data are sparse, 
nonexistent or difficult to collect. Funding under this 
activity will support the Department in developing high-quality 
data as required under the Government Performance and Results 
Act.

Olympic Scholarships

    The bill includes $988,000 for Olympic Scholarships, the 
same as the fiscal year 2004 level. The budget did not request 
funding for this program. This program provides financial 
assistance to athletes who are training at the U.S. Olympic 
Education Center or one of the U.S. Olympic Training Centers 
and who are pursuing a postsecondary education at an 
institution of higher education.

                           HOWARD UNIVERSITY

    The bill provides $243,893,000 for Howard University, 
$5,130,000 above the budget request and the fiscal year 2004 
appropriation. The bill includes a minimum of $3,552,000 for 
the endowment, which is the same as the current level.
    Howard University is a ``Research I'' university located in 
the District of Columbia. Direct appropriations for Howard 
University are authorized by 20 U.S.C. 123, originally enacted 
in 1867. Howard University provides undergraduate liberal arts, 
graduate and professional instruction to approximately 11,000 
students from all 50 States. Masters degrees are offered in 
over 55 fields and Doctor of Philosophy degrees in 26 fields.

         COLLEGE HOUSING AND ACADEMIC FACILITIES LOANS PROGRAM

    The bill provides $578,000 for the Federal administration 
of the college housing and academic facilities loan (CHAFL) 
program, the Higher Educational Facilities Loans program and 
the College Housing Loans program, the same as the budget 
request and $191,000 below the fiscal year 2004 appropriation.

HISTORICALLY BLACK COLLEGE AND UNIVERSITY CAPITAL AND FINANCING PROGRAM

Federal administration

    The bill provides $212,000 for the administration of the 
historically black college and university capital financing 
program authorized under part D of title III of the Higher 
Education Act, $3,000 above the fiscal year 2004 appropriation 
and the same as the budget request. The program is intended to 
make capital available for repair and renovation of facilities 
at historically black colleges and universities. In exceptional 
circumstances, capital provided under the program can be used 
for construction or acquisition of facilities.

Bond subsidies

    Under the HBCU capital program, a private, for-profit 
``designated bonding authority'' issues construction bonds to 
raise capital for loans to historically black colleges and 
universities for construction projects. The Department provides 
insurance for these bonds, guaranteeing full payment of 
principal and interest to bond holders. Federally insured bonds 
and unpaid interest are limited by statute to $375,000,000. The 
letter of credit limitation establishes the total amount of 
bonds which can be issued by the designated bonding authority. 
The credit limitation must be explicitly stated in an 
appropriation Act according to the authorizing legislation.

                    INSTITUTE OF EDUCATION SCIENCES

    The bill includes $526,804,000 for the Institute of 
Education Sciences. This amount is $77,183,000 above the budget 
request, and $30,069,000 above the fiscal year 2004 level. This 
account supports education research, statistics, and assessment 
activities.

Research

    This bill includes $165,518,000 for educational research, 
the same as the fiscal year 2004 level and $19,482,000 below 
the budget request. The Institute of Education Sciences 
supports research, development and national 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 is concerned that the research and 
development centers required by the Education Sciences Reform 
Act of 2002 (ESRA) be able to fulfill their statutory mission 
to ``carry out specific, long-term research activities that are 
consistent with the priorities and mission of the Institute, 
and are approved by the Director'' (20 USC 9533) concerning the 
topics of critical national interest on which each center is 
focused. In particular, the Committee believes that the funding 
levels announced for the center competitions completed in 2004 
may, in some cases, be insufficient. The Committee directs the 
Director of the Institute of Education Sciences (IES) to 
consider means at his disposal to increase the funding of 
centers when additional funding would enhance their 
contributions to the mission of IES. This includes providing 
grant supplements to expand projects or to launch new projects 
within the scope of center's grant, and working actively with 
centers to encourage their application for funds for research 
grants available through other research competitions held by 
IES.

Statistics

    This bill includes $91,664,000 for the activities of the 
National Center for Education Statistics, exclusive of the 
National Assessment of Educational Progress. This amount is the 
same as the budget request and the fiscal year 2004 level.
    Statistics activities are authorized under the Education 
Sciences Reform Act of 2002, title I of P.L. 107-279. The 
Center collects, analyzes, and reports statistics on all levels 
of education in the United States. Activities are carried out 
directly and through grants and contracts. Major publications 
include ``The Condition of Education'' and ``Digest of 
Education Statistics.'' Other products include projections of 
enrollments, teacher supply and demand, and educational 
expenditures. Technical assistance to state and local education 
agencies and postsecondary institutions is provided. 
International comparisons are authorized.

Regional educational laboratories

    The Committee has included $66,665,000 for the regional 
educational laboratories. This amount is the same as the fiscal 
year 2004 level. The budget request did not include funding for 
this program. The Committee believes that the regional 
educational laboratories can play a key role in supporting the 
achievement of all children by focusing and aligning their work 
to help states and education practitioners implement the 
requirements contained in the No Child Left Behind Act (NCLB). 
This assistance should include product development, applied 
research, technical assistance and professional development. 
The Committee intends that each regional educational laboratory 
identify priority NCLB issues in their designated region and 
provide assistance with the implementation of NCLB. Particular 
focus should be placed on helping states and schools implement 
the provisions contained in the Highly Qualified Teacher 
regulations.

IDEA National Activities: Research and innovation

    The bill includes $78,125,000 for research and innovation, 
the same as the fiscal year 2004 level and the budget request. 
This program supports competitive awards to produce and advance 
the use of knowledge to improve services and results for 
children with disabilities. The program focuses on producing 
new knowledge, integrating research and practice and improving 
the use of knowledge.

Statewide data systems

    The bill includes $30,000,000 for a program to award 
grants, on a competitive basis, to State educational agencies 
to enable such agencies to design, develop, and implement 
statewide, longitudinal data systems to efficiently and 
accurately manage, analyze, disaggregate, and use individual 
student data, consistent with the No Child Left Behind Act. The 
budget did not request funding for this program and it was not 
funded in fiscal year 2004.

Assessment

    This bill includes $94,832,000 for the National Assessment 
of Educational Progress, the same as the budget request, and 
$69,000 above the fiscal year 2004 level. The Assessment is 
authorized under section 303 of the National Assessment of 
Educational Progress Authorization Act, and is the only 
nationally representative survey of educational ability and 
achievement of American students. The primary goal of the 
Assessment is to determine and report the status and trends of 
the knowledge and skills of students, subject by subject. 
Subject areas assessed in the past have included reading, 
writing, mathematics, science, and history, as well as 
citizenship, literature, art, and music. The Assessment is 
operated by contractors through competitive awards made by the 
National Center for Education Statistics; a National Assessment 
Governing Board formulates the policy guidelines for the 
program. Within the amounts provided, $5,129,000 is for the 
National Assessment Governing Board.

                        DEPARTMENTAL MANAGEMENT

    The bill includes $559,093,000 for departmental management 
(salaries and expenses) at the Department of Education. This 
amount is $3,785,000 above the fiscal year 2004 appropriation 
and $14,062,000 below the budget request. These activities are 
authorized by the Department of Education Organization Act, 
P.L. 96-88, and include costs associated with the management 
and operations of the Department as well as separate costs 
associated with the Office for Civil Rights and the Office of 
the Inspector General.
    The Committee continues to be pleased with the emphasis the 
Department's senior management team has placed on complying 
with the Government Performance and Results Act. The Committee 
expects the Department to continue to develop and refine GPRA 
measures for all programs, focusing particularly on student 
achievement outcomes.
    The Committee is aware that regional offices of the 
Department of Education are conducting ongoing audits of 
various institutions of higher education. The Committee is 
interested in the outcomes of past audits and therefore directs 
the Secretary to provide a report to the Committee on 
Appropriations of both the House and the Senate no later than 
six weeks after the date of enactment of this Act with the 
following information: a list of every institution placed on 
reimbursement since 1995 by the Dallas or Chicago regional 
student financial aid offices, along with the date on which the 
school went on reimbursement and the date on which the matter 
was resolved and the reason it was resolved. The report should 
include how many schools were required to do a 100% audit of 
any school year and how many of those schools went on to be 
placed on reimbursement. The report should also note if a 
school put on reimbursement was subsequently closed and the 
date on which that occurred.
    Executive Order 13270 directed federal agencies to take 
steps to enhance access to federal opportunities and resources 
for American Indian/Alaska Native students from tribal colleges 
and other postsecondary schools. The Committee believes that 
the Washington Semester American Indian Program (WINS) is an 
excellent way to advance the goals of Executive Order 13270, 
and strongly urges the Secretary to maximize the number of 
agencies that participate in the WINS program.

Program administration

    The bill includes $421,055,000 for program administration. 
This amount is $676,000 above the fiscal year 2004 
appropriation and $8,723,000 below the budget request. These 
funds support the staff and other costs of administering 
programs and activities at the Department. Items include 
personnel compensation and health, retirement and other 
benefits as well as travel, rent, telephones, utilities, 
postage fees, data processing, printing, equipment, supplies, 
technology training, consultants and other contractual 
services.

Office for Civil Rights

    The bill includes $90,248,000 for the salaries and expenses 
of the Office for Civil Rights. This amount is $1,943,000 above 
the fiscal year 2004 appropriation and $2,553,000 below the 
budget request. This Office is responsible for enforcing laws 
that prohibit discrimination on the basis of race, color, 
national origin, sex, disability, membership in a patriotic 
society, and age in all programs and institutions that receive 
funds from the Department. These laws extend to 50 State 
educational agencies, 16,000 local educational agencies, 3,500 
institutions of higher education, as well as to proprietary 
schools, State rehabilitation agencies, libraries, and other 
institutions receiving Federal funds.

Office of the Inspector General

    The bill includes $47,790,000 for the Office of the 
Inspector General. This amount is $1,166,000 above the fiscal 
year 2004 appropriation and $2,786,000 below the budget 
request. This Office has authority to inquire into all program 
and administrative activities of the Department as well as into 
related activities of grant and contract recipients. It 
conducts audits and investigations to determine compliance with 
applicable laws and regulations, to check alleged fraud and 
abuse, efficiency of operations, and effectiveness of results.

                           General Provisions

    Sec. 301. The Committee continues a provision which 
prohibits funds under this Act from being used for the 
transportation of students or teachers in order to overcome 
racial imbalances or to carry out a plan of racial 
desegregation.
    Sec. 302. The Committee continues a provision which 
prohibits funds under this Act from being used to require the 
transportation of any student to a school other than the school 
which is nearest the student's home in order to comply with 
title VI of the Civil Rights Act of 1964.
    Sec. 303. The Committee continues a provision which 
prohibits funds under this Act from being used to prevent the 
implementation of programs of voluntary prayer and meditation 
in public schools.
    Sec. 304. The Committee continues a provision which allows 
up to 1 percent of any discretionary funds appropriated for the 
Department of Education to be transferred between 
appropriations accounts, provided that no appropriation is 
increased by more than 3 percent by any such transfer. This 
provision requires the Secretary to notify the Appropriations 
Committees of both Houses of Congress at least 15 days in 
advance of a transfer.
    Sec. 305. The Committee includes a provision making a 
technical change to the Impact Aid Program to extend the 
application deadline for applying for section 8002 federal 
property payments from FY 2005 to FY 2007.
    Sec. 306. The Committee recently became aware of a policy 
change implemented by the Department of Education regarding 
consolidation loans. The Committee believes that the proper 
forum for any such change is within the reauthorization of the 
Higher Education Act of 1965. The Committee therefore directs 
the Secretary to make no change to these policies while the 
Committee on Education and the Workforce is in the process of 
this reauthorization. Further, the Committee directs the 
Secretary to withdraw the Secretary's dear colleague letter 
dated April 29, 2004, regarding consolidation loans and to 
remove any restriction on the Department's servicer in the 
processing of loan verification certificates.

                       TITLE IV--RELATED AGENCIES


                      Armed Forces Retirement Home

    The bill provides authority to expend $61,195,000 from the 
Armed Forces Retirement Home Trust Fund for operations and 
capital activities at the United States Soldiers' and Airmen's 
Home and the United States Naval Home, a decrease of $3,699,000 
below the comparable fiscal year 2004 appropriation and the 
same as the budget request.

Operations

    The bill provides authority to expend $57,195,000 from the 
Armed Forces Retirement Home Trust Fund for operations of the 
United States Soldiers' and Airmen's Home and the United States 
Naval Home, a decrease of $5,728,000 above the comparable 
fiscal year 2004 appropriation and the same as the budget 
request.

Capital outlay

    The bill provides authority to expend $4,000,000 from the 
Armed Forces Retirement Home Trust Fund for capital activities 
at the Soldiers' and Airmen's Home and the United States Naval 
Home, an increase of $2,029,000 above the comparable fiscal 
year 2004 appropriation and the same as the budget request.

 Committee for Purchase From People Who Are Blind or Severely Disabled

    The bill provides $4,672,000 for the Committee for Purchase 
From People Who Are Blind or Severely Disabled, a decrease of 
$53,000 below the comparable fiscal year 2004 appropriation and 
the same as the budget request.
    The Committee for Purchase From People Who Are Blind or 
Severely Disabled was established by the Wagner-O'Day Act of 
1938 as amended. Its primary objective is to increase the 
employment opportunities for people who are blind or have other 
severe disabilities and, whenever possible, to prepare them to 
engage in competitive employment.

             Corporation for National and Community Service


                  DOMESTIC VOLUNTEER SERVICE PROGRAMS

    The bill provides $353,197,000 for the Domestic Volunteer 
Service Programs that are administered by the Corporation for 
National and Community Service. The recommended amount is 
$1,143,000 below the fiscal year 2004 appropriation and 
$22,138,000 below the budget request. Appropriations for these 
programs are not authorized in law for fiscal year 2005. 
Funding for the Americorps program that is also administered by 
the Corporation for National and Community Service is provided 
in the VA/HUD and Independent Agencies appropriations bill.
    The Committee emphasizes the importance of developing 
clear, measurable outcomes for programs within the purview of 
the Corporation as outlined in the Government Performance and 
Results Act. It is vital that the Committee be provided with 
information on the actual results achieved by the programs, not 
simply the number of volunteers participating in the program or 
the number of hours served. Program outcomes should, to the 
extent possible, focus on the actual improvements in the 
health, safety, education, and quality of life of individuals 
in the community as a result of the Federal investment. 
Programs that are able to demonstrate these results over time 
will be considered higher funding priorities than programs that 
are unable to clearly demonstrate their value to the American 
public.

VISTA

    The bill provides $93,731,000 for the Volunteers in Service 
to America (VISTA) program, the same as the fiscal year 2004 
level and $2,697,000 below the budget request. The VISTA 
program supports individuals who recruit volunteers and 
organize community volunteer activities but who do not provide 
direct volunteer services.

Special Volunteer Programs

    The bill includes $5,000,000 for special volunteer programs 
authorized under section 122 part C of title I of the Domestic 
Volunteer Service Act of 1973, $4,876,000 below the fiscal year 
2004 level and $10,000,000 below the budget request.
    These funds are to be used to place volunteers in community 
activities that are targeted specifically at contributing to 
homeland defense. Grants will be made to states and community 
organizations on a competitive basis and will support public 
and nonprofit agencies' efforts in the areas of public safety, 
public health, and disaster relief and preparedness. The 
Committee intends that these funds be used to support volunteer 
efforts across the population, and not simply focus on 
recruiting seniors.

National Senior Volunteer Corps

    The bill provides a total of $216,466,000 for the National 
Senior Volunteer Corps, $2,202,000 above the fiscal year 2004 
level and $8,078,000 below the budget request.
    The bill provides $112,323,000 for the Foster Grandparents 
program, $2,202,000 above the fiscal year 2004 levels and 
$5,623,000 above the budget request. This program provides 
volunteer service opportunities for low-income people aged 60 
and over.
    The bill provides $45,987,000 for the Senior Companion 
program, the same as the fiscal year 2004 appropriation and 
$576,000 below the budget request. The program provides project 
grants to private, non-profit organizations and State and local 
public agencies to offer volunteer service opportunities to 
low-income individuals aged 60 and over. These volunteers 
assist older adults with physical, mental or emotional 
impairments that put them at risk for institutionalization.
    The bill provides $58,156,000 for the Retired Senior 
Volunteer Program (RSVP), the same as the fiscal year 2004 
appropriation and $11,728,000 below the budget request. This 
program provides part-time volunteer service opportunities for 
low-income individuals aged 55 and over to recruit volunteers 
and organize volunteer activities relating to a variety of 
social needs.
    The bill does not include funding for senior demonstration 
programs, the same as the fiscal year 2004 level and $1,397,000 
above the budget request.

Program administration

    The bill provides $38,000,000 for program administration, 
$1,531,000 above the fiscal year 2004 appropriation and 
$1,363,000 below the budget request.

                  Corporation for Public Broadcasting

    The Committee has provided $400,000,000 in advance funding 
for fiscal year 2007 for the Corporation for Public 
Broadcasting (CPB). The Administration did not request any 
advance funding.
    The Committee has included authority for CPB to spend up to 
$20,000,000 in fiscal year 2005 funds for CPB digital 
conversion activities. The Committee has also included 
authority for CPB to spend up to $60,000,000 on the Satellite 
Interconnection system.
    The Committee commends the Independent Television Service 
(ITVS), through its collaboration with the Corporation for 
Public Broadcasting (CPB), for its continuing success in 
diversifying programming on public television. The Committee 
was pleased that the last contract between ITVS and CPB was a 
multi-year one and contained increases to ITVS in line with 
historic funding percentages. The Committee urges that the next 
contract again be made on a multi-year basis and contain 
appropriate increases for the ITVS basic production grant and 
for costs associated with producing the series, Independent 
Lens.

               Federal Mediation and Conciliation Service

    The bill provides $43,964,000 for the Federal Mediation and 
Conciliation Service (FMCS), an increase of $835,000 above the 
comparable fiscal year 2004 appropriation the same as the 
budget request.
    The FMCS attempts to prevent and minimize labor-management 
disputes having a significant impact on interstate commerce or 
national defense, except in the railroad and airline 
industries. The agency convenes boards of inquiry appointed by 
the President in emergency disputes and conducts dispute 
mediation, preventive mediation, and arbitration. In addition, 
the Service offers alternative dispute resolution services and 
training to other Federal agencies to reduce litigation costs 
and speed Federal administrative proceedings.
    The bill also includes provisions first enacted in the 
fiscal year 1996 Appropriations Act granting the agency the 
authority to accept gifts and to charge fees for certain 
services. The Committee understands that the Youth Violence 
Prevention and Conflict Resolution Program under the Federal 
Mediation and Conciliation Service (FMCS) has received $500,000 
for the past two years for on-going expenses related to 
partnerships with local schools and universities to provide 
youth violence education and awareness services. Specifically, 
the Committee recognizes the success that this program has had 
in providing schools, after school programs, universities with 
computer technology to gather information designed to identify 
factors for school conflict and youth violence within their 
community. Through this program, schools are able to partner 
with FMCS to develop solutions to address the problems that 
affect their specific youth population. The Committee believes 
that this program should be evaluated for future funding 
increases to be able to offer these services to more than the 
12 locations nationwide currently participating.

            Federal Mine Safety and Health Review Commission

    The bill provides $7,813,000 for the Federal Mine Safety 
and Health Review Commission, $85,000 above the fiscal year 
2004 level and the same as the budget request. The Commission 
is responsible for reviewing the enforcement activities of the 
Secretary of Labor under the Federal Mine Safety and Health 
Act. The Commission's administrative law judges hear and decide 
cases initiated by the Secretary of Labor, mine operators, or 
miners. The five-member Commission hears appeals from 
administrative law judge decisions, rules on petitions for 
discretionary review, and may direct, of its own initiative, 
review of cases that present unusual questions of law.

                Institute of Museum and Library Services

    The Committee recommends $261,743,000 for the Institute of 
Museum and Library Services. This is $497,000 below the fiscal 
year 2004 level and the same as the budget request. The 
Institute makes state formula grants for library services and 
discretionary national grants for joint library and museum 
projects.
    For Library Services, the Committee recommends $169,958,000 
for State grants and $3,675,000 for library services to Native 
Americans and Native Hawaiians. The Committee recommends 
$16,500,000 for national leadership grants. The Committee 
continues to support and commend the 21st Century Librarian 
Initiative that recruits and educates librarians and has 
included the full amount requested, $23,000,000 for this 
purpose.
    For Museum Services, the Committee recommends $20,700,000 
for the museums for America program, $450,000 for museum 
assessment programs; $3,630,000 for Conservation programs; 
$12,000,000 for National Leadership projects; and $644,000 for 
Native American Museum Services.
    The Committee recommends $11,186,000 for program 
administration, the same as the budget request.

                  Medicare Payment Advisory Commission

    The Committee recommends $9,905,000 for the Medicare 
Payment Advisory Commission, an increase of $660,000 above the 
comparable fiscal year 2004 appropriation and the budget 
request. The Commission advises Congress on matters of 
physician and hospital reimbursement under the Medicare and 
Medicaid programs.

        National Commission on Libraries and Information Science

    The Committee recommends $1,000,000 for the National 
Commission on Libraries and Information Science. This is $6,000 
above the fiscal year 2004 level and the same as the budget 
request.

                     National Council on Disability

    The bill provides $2,873,000 for the National Council on 
Disability (NCD), a decrease of $148,000 below the comparable 
fiscal year 2004 level appropriation and the same as the budget 
request. The Council monitors implementation of the Americans 
with Disabilities Act and makes recommendations to the 
President, the Congress, the Rehabilitation Services 
Administration, and the National Institute on Disability and 
Rehabilitation Research on public policy issues of concern to 
individuals with disabilities.

                     National Labor Relations Board

    The bill provides $248,785,000 for the National Labor 
Relations Board (NLRB). This is $6,152,000 above the fiscal 
year 2004 level and the same as the budget request. The NLRB 
receives, investigates, and prosecutes unfair labor practice 
charges filed by businesses, labor unions, and individuals. It 
also schedules and conducts representation elections. The five-
member Board considers cases in which an administrative law 
judge decisions are appealed.
    In 1959, Congress passed a law to give the NLRB 
jurisdiction over businesses to settle labor disputes between 
unions and management based on gross receipts. Once a business' 
gross receipts pass a certain threshold, it is subject to NLRB 
intervention. Businesses below the threshold are subject to 
actions under State laws, instead of the NLRB.
    The Committee is aware of concerns over the backlog of 
cases before the NLRB. The Committee requests that the Board 
investigate the causes of this backlog, and report on options 
for reducing the backlog, including raising the jurisdictional 
thresholds of the Board.

                        National Mediation Board

    The bill provides $11,635,000 for the National Mediation 
Board (NMB), $281,000 above the comparable fiscal year 2004 
appropriation and the same as the budget request. The NMB 
mediates labor disputes between employees and railroad and 
airline carriers subject to the Railway Labor Act. The Board 
also resolves representation disputes involving labor 
organizations seeking to represent railroad or airline 
employees.

            Occupational Safety and Health Review Commission

    The bill provides $10,516,000 for the Occupational Safety 
and Health Review Commission, $711,000 above the fiscal year 
2004 level and the same as the budget request. The Commission 
adjudicates contested citations issues by the Occupational 
Safety and Health Administration against employers for 
violations of safety and health standards. The Commission's 
administrative law judges settle and decide cases at the 
initial level of review. The agency's three appointed 
Commissioners also review cases, issue rulings on complicated 
issues, and may direct review of any decision by an 
administrative law judge.

                       Railroad Retirement Board


                         DUAL BENEFITS ACCOUNT

    The bill provides $108,000,000 for dual benefits, a 
decrease of $10,298,000 below the comparable fiscal year 2004 
appropriation and the same as the budget request. These funds 
are used to pay dual benefits to those retirees receiving both 
railroad retirement and social security benefits. The bill 
includes a provision permitting a portion of these funds to be 
derived from income tax receipts on dual benefits as authorized 
by law. The Railroad Retirement Board estimates that 
approximately $8,000,000 may be derived in this manner.

           FEDERAL PAYMENT TO THE RAILROAD RETIREMENT ACCOUNT

    The bill provides $150,000 for the interest earned on 
unnegotiated checks, the same as the budget request and the 
comparable amount provided for fiscal year 2004.

                      LIMITATION ON ADMINISTRATION

    The bill provides a consolidated limitation of $102,202,000 
on the expenditure of railroad retirement and railroad 
unemployment trust funds for administrative expenses of the 
Railroad Retirement Board, the same as the comparable fiscal 
year 2004 appropriation and a decrease of $398,000 below the 
budget request. The bill includes a provision from the fiscal 
year 1999 Appropriations Act prohibiting the transfer of 
resources formerly identified in a Memorandum of Understanding 
from the RRB to the Inspector General.
    The Railroad Retirement Board (RRB) administers 
comprehensive retirement-survivor and unemployment-sickness 
insurance benefit programs for railroad workers and their 
families. This account limits the amount of funds in the 
railroad retirement and railroad unemployment insurance trust 
funds that may be used by the RRB for administrative expenses. 
The Committee prohibits 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.
    The bill includes language (Sec. 517) limiting the 
availability of funds to the Railroad Retirement Board to enter 
into an arrangement with a nongovernmental financial 
institution to serve as disbursing agent for benefits payable 
under the Railroad Retirement Act of 1974.
    The Committee is pleased with the management of the Board 
and reiterates its interest in quickly and comprehensively 
implementing the Government Performance and Results Act.

             LIMITATION ON THE OFFICE OF INSPECTOR GENERAL

    The bill provides authority to expend $6,561,000 from the 
railroad retirement and railroad unemployment insurance trust 
funds for the Office of Inspector General, the same as the 
comparable fiscal year 2004 appropriation and a decrease of 
$639,000 below the budget request. This account provides 
funding for the Inspector General to conduct and supervise 
audits and investigations of programs and operations of the 
Board.
    The Committee compliments the work of the Office of the 
Inspector General of the Railroad Retirement Board for their 
work in obtaining information on actual collections, offsets, 
and funds put to better use as required in House Report 105-
635. This information is of great use to the Committee and the 
Committee understands the difficulty encountered by the OIG in 
obtaining it. The Committee expects that the Office of 
Inspector General will continue to report the information to 
it.

                     Social Security Administration


                PAYMENTS TO SOCIAL SECURITY TRUST FUNDS

    The Committee provides $20,454,000 for mandatory payments 
necessary to compensate the Old Age and Survivors Insurance 
(OASI) and Disability Insurance (DI) Trust Funds for special 
payments to certain uninsured persons (for which no payroll tax 
is received), costs incurred for administration of pension 
reform activities and interest lost on the value of benefit 
checks issued but not negotiated. This appropriation restores 
the trust funds to the position they would have been in had 
they not borne these costs properly charged to the general 
funds.

                  SUPPLEMENTAL SECURITY INCOME PROGRAM

    The Committee provides $28,578,829,000 for the Supplemental 
Security Income (SSI) program. The Committee also provides 
$10,930,000,000 in advance funding for the first quarter of 
fiscal year 2006.

Beneficiary services

    In addition to Federal benefits, the Social Security 
Administration (SSA) administers a program of supplementary 
State benefits for those States that choose to participate. The 
funds are also used to reimburse the trust funds for the 
administrative costs of the program. The Committee provides 
$45,929,000 for beneficiary services, the same as the budget 
request, with the total appropriations for SSI. This funding 
reimburses State vocational rehabilitation services agencies 
for successful rehabilitation of SSI recipients.

Research and demonstration

    Within the appropriation for SSI, the Committee provides 
$27,000,000 for research and demonstration activities conducted 
under section 1110 of the Social Security Act.

Administration

    Within the appropriation for SSI, the Committee provides 
$2,986,900,000 for payment to the Social Security trust funds 
for the SSI Program's share of SSA's base administrative 
expenses.

                 LIMITATION ON ADMINISTRATIVE EXPENSES

    The bill provides a limitation on administrative expenses 
for the Social Security Administration (SSA) of $8,674,100,000 
to be funded from the Social Security and Medicare trust funds. 
This is $480,926,000 more than the fiscal year 2004 level and 
$82,900,000 less than the budget request. The Committee does 
not provide the contingency reserve from the HI/SMI trust funds 
as requested.
    The Committee notes the success of the third party verifier 
pilot program, designed to detect identity fraud and false 
Social Security Number (SSN) usage. Over 7% of the SSNs 
processed through the current program have come back as a ``no 
match,'' meaning that the program has been successful in 
discovering identity fraud, as intended. The Committee 
encourages SSA to continue the pilot program and requests that 
SSA notify the Committee 180 days prior to any possible 
elimination of this program.
    The Committee is pleased with the initiative the Social 
Security Administration has started in examining the population 
with limb loss who could return to work with proper prosthetic 
and orthotics care. The Committee encourages the Ticket-to-Work 
initiative to continue to pursue this vital area.

                     Social Security Advisory Board

    The bill provides that not less than $2,000,000 within the 
limitation on administrative expenses shall be available for 
the Social Security Advisory Board, $200,000 more than the 
fiscal year 2004 level and the same as the budget request.

User fees

    In addition to other amounts provided in the bill, the 
Committee provides an additional limitation of $124,000,000 for 
administrative activities funded from user fees. This is 
$4,000,000 more than the fiscal year 2004 level and the same as 
the request.

                      OFFICE OF INSPECTOR GENERAL

    The bill provides $91,107,000 for the Office of the 
Inspector General (OIG), $3,428,000 more than the fiscal year 
2004 level and $893,000 less than the budget request. The bill 
also provides authority to expend $65,359,000 from the Social 
Security trust funds for activities conducted by the Inspector 
General, $2,035,000 more than the fiscal year 2004 level and 
$641,000 less than the budget request.

                      TITLE V--GENERAL PROVISIONS

    Sec. 501. The Committee continues a provision to allow the 
Secretaries of Labor, Health and Human Services, and Education 
to transfer unexpended balances of prior appropriations to 
accounts corresponding to current appropriations to be used for 
the same purpose and for the same periods of time for which 
they were originally appropriated.
    Sec. 502. The Committee continues a provision to prohibit 
the obligation of funds beyond the current fiscal year unless 
expressly so provided.
    Sec. 503. The Committee continues a provision to prohibit 
appropriated funds to be used to support or defeat legislation 
pending before the Congress or any State legislature, except in 
presentation to the Congress or any State legislature itself.
    Sec. 504. The Committee continues a provision to limit the 
amount available for official reception and representation 
expenses for the Secretaries of Labor and Education, the 
Director of the Federal Mediation and Conciliation Service, and 
the Chairman of the National Mediation Board.
    Sec. 505. The Committee continues a provision to prohibit 
funds to be used to carry out a needle distribution program.
    Sec. 506. The Committee continues a Sense of the Congress 
provision related to buy American-made products.
    Sec. 507. The Committee continues a provision to require 
grantees receiving Federal funds to clearly state the 
percentage of the total cost of the program or project that 
will be financed with Federal money.
    Sec. 508. The Committee continues a provision to prohibit 
appropriated funds to be used for any abortion.
    Sec. 509. The Committee continues a provision to provide 
exceptions for Sec. 508 and adds a limitation prohibiting funds 
from the bill to be made available to a Federal, State or local 
government or program if they discriminate against 
institutional or individual health care entities if they do not 
provide, pay for, or refer for abortions.
    Sec. 510. The Committee continues a provision to prohibit 
the use of funds in the Act concerning research involving human 
embryos. However, this language should not be construed to 
limit federal support for research involving human embryonic 
stem cells listed on an NIH registry and carried out in 
accordance with policy outlined by the President.
    Sec. 511. The Committee continues a provision to prohibit 
the use of funds for any activity that promotes the 
legalization of any drug or substance included in schedule I of 
the schedules of controlled substances.
    Sec. 512. The Committee continues a provision related to 
annual reports to the Secretary of Labor.
    Sec. 513. The Committee continues a provision to prohibit 
the use of funds to promulgate or adopt any final standard 
providing for a unique health identifier until legislation is 
enacted specifically approving the standard.
    Sec. 514. The Committee continues a provision that 
prohibits the transfer of funds from this Act except by 
authority provided in this Act or another appropriation Act.
    Sec. 515. The Committee includes a provision to limit funds 
in the bill for public libraries to those libraries that comply 
with the requirements of the Children's Internet Protection 
Act.
    Sec. 516. The Committee includes a provision to limit 
technology funds in the bill for elementary and secondary 
schools to those schools that comply with the requirements of 
the Children's Internet Protection Act.
    Sec. 517. The Committee includes language limiting the 
availability of funds to the Railroad Retirement Board to enter 
into an arrangement with a nongovernmental financial 
institution to serve as disbursing agent for benefits payable 
under the Railroad Retirement Act of 1974.
    Sec. 518. The Committee includes a new provision clarifying 
the procedures for reprogramming of funds. The Committee notes 
that reprogramming procedures had heretofore been included in 
the Report. However, adherence to the reprogramming procedures 
by Agencies funded in this Act has varied widely, including one 
recent example where the Committee was notified of a 
reprogramming through a press release. The Committee also notes 
that this provision is consistent with reprogramming language 
included in other bills within the Committee's jurisdiction.

                        CONSTITUTIONAL AUTHORITY

    Clause 3(d)(1) of rule XIII of the Rules of the House of 
Representatives states that:
    Each report of a committee on a public bill or public joint 
resolution shall contain the following:
    (1) A statement citing the specific powers granted to 
Congress in the Constitution to enact the law proposed by the 
bill or joint resolution.
    The Committee on Appropriations bases its authority to 
report this legislation on Clause 7 of Section 9 of Article I 
of the Constitution of the United States of America which 
states:
    No money shall be drawn from the Treasury but in 
consequence of Appropriations made by law * * *.
    Appropriations contained in this Act are made pursuant to 
this specific power granted by the Constitution.

                   COMPARISON WITH BUDGET RESOLUTION

    Clause 3(c)(2) of rule XIII of the Rules of the House of 
Representatives requires an explanation of compliance with 
section 308(a)(1)(A) of the Congressional Budget Act of 1974 
(Public Law 93-344), as amended, which requires that the report 
accompanying a bill providing new budget authority contain a 
statement detailing how the authority compares with the report 
submitted under section 302 of the Act for the most recently 
agreed to concurrent resolution on the budget for the fiscal 
year. This information follows:

                                            [In millions of dollars]
----------------------------------------------------------------------------------------------------------------
                                                   302(b) allocation                       This bill
                                         -----------------------------------------------------------------------
                                          Budget authority       Outlays      Budget authority       Outlays
----------------------------------------------------------------------------------------------------------------
Discretionary...........................           142,526           141,117           142,526           141,117
Mandatory...............................           342,503           342,402           342,503           342,402
----------------------------------------------------------------------------------------------------------------

    In accordance with the Congressional Budget Act of 1974 
(Public Law 93-344), as amended, the following information was 
provided to the Committee by the Congressional Budget Office:

                         FIVE-YEAR PROJECTIONS

    In compliance with section 308(a)(1)(B) of the 
Congressional Budget Act of 1974 (Public Law 93-344), as 
amended, the following table contains five-year projections 
associated with the budget authority provided in the 
accompanying bill:

                        [In millions of dollars]



Budget authority......................................           399,114
Outlays:
    2005 \1\..........................................           317,066
    2006..............................................            60,666
    2007..............................................            16,788
    2008..............................................             3,825
    2009 and future years.............................               602


\1\ Excludes outlays from prior year budget authority.

          FINANCIAL ASSISTANCE TO STATE AND LOCAL GOVERNMENTS

    In accordance with section 308(a)(1)(C) of the 
Congressional Budget Act of 1974 (Public Law 93-344), as 
amended, the financial assistance to State and local 
governments is as follows:

                        [In millions of dollars]



Budget authority......................................           185,515
Outlays...............................................            14,710


                           TRANSFER OF FUNDS

    Pursuant to clause 3(f)(2), rule XIII of the Rules of the 
House of Representatives, the following table is submitted 
describing the transfers of funds provided in the accompanying 
bill.
    The table shows, by Department and agency, the 
appropriations affected by such transfers.

                                 APPROPRIATION TRANSFERS RECOMMENDED IN THE BILL
----------------------------------------------------------------------------------------------------------------
                                                                  Account from which transfer is
        Account to which transfer is made            Amount                    made                    Amount
----------------------------------------------------------------------------------------------------------------
Department of Labor:                                            Department of Labor:
    Special Benefits............................         (\1\)    Postal Service..................         (\1\)
    Various Agencies \1\........................  ............    Energy Employees Occupational     ............
                                                                   Illness Compensation Fund \1\.
    Employment Standards Administration--          $32,646,000    Black Lung Disability Trust Fund   $32,646,000
     Salaries and Expenses.
    Departmental Management--Salaries and           23,705,000    Black Lung Disability Trust Fund    23,705,000
     Expenses.
    Office of Inspector General.................       342,000    Black Lung Disability Trust Fund       342,000
Department of Health and Human Services:                        International Assistance Programs:
 National Institutes of Health:
    National Institute of Allergy and Infectious   100,000,000    Global Fund to Fight HIV/AIDS,     100,000,000
     Disease.                                                      Malaria, and Tuberculosis.
Department of Energy:                                           Department of Health and Human
                                                                 Services: Administration for
                                                                 Children and Families:
    Weatherization Assistance Program...........   227,000,000    Low-Income Home Energy             227,000,000
                                                                   Assistance.
Related Agencies:
    Social Security Administration:
        Office of Inspector General.............    65,359,000  Federal Old-Age and Survivors         65,359,000
                                                                 Insurance Trust Fund and Federal
                                                                 Disability Insurance Trust Fund.
                                                                Department of Health and Human
                                                                 Services: Centers for Medicare
                                                                 and Medicaid Services:
        Office of Hearings and Appeals..........    50,000,000    Program Management..............    50,000,000
----------------------------------------------------------------------------------------------------------------
\1\ Such sums.

                              RESCISSIONS

    Pursuant to clause 3(f)(2), rule XIII of the Rules of the 
House of Representatives, the following table is submitted 
describing the rescissions recommended in the accompanying 
bill.

          Compliance With Rule XIII, Cl. 3(e) (Ramseyer Rule)

    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 (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italic, existing law in which no change is 
proposed is shown in roman):

           *       *       *       *       *       *       *


                 Changes in Application of Existing Law

    Pursuant to clause 3, rule XIII of the Rules of the House 
of Representatives, the following statements are submitted 
describing the effect of provisions in the accompanying bill 
which may directly or indirectly change the application of 
existing law.
    In some instances the bill includes appropriations for 
certain ongoing programs which are not yet authorized for 
fiscal year 2004.
    The bill provides that appropriations shall remain 
available for more than one year for some programs for which 
the basic authorizing legislation does not presently authorize 
such extended availability.
    In various places in the bill, the Committee has earmarked 
funds within appropriation accounts in order to fund specific 
sections of a law. Whether these actions constitute a change in 
the application of existing law is subject to individual 
interpretation, but the Committee felt that this fact should be 
mentioned.
    In several instances, the bill provides advance 
appropriations for fiscal year 2006 for programs for which such 
advances are not authorized by law.

                      TITLE I--DEPARTMENT OF LABOR


                    Training and Employment Services

    Language prohibiting the use of funds from any other 
appropriation to provide meal services at or for Job Corps 
centers.

     State Unemployment Insurance and Employment Service Operations

    Language allowing the use of funds for amortization 
payments to States which had independent retirement plans in 
their State employment service agencies prior to 1980.
    Language allowing the Labor Department to withhold from 
State allotments funds available for penalty mail under the 
Wagner-Peyser Act.
    Language providing that funds in this Act for one-stop 
career centers and unemployment insurance national activities 
may be used for contracts, grants or agreements with non-State 
entities.
    Language providing that funds in this Act may be used by 
the States for integrated Employment Service and Unemployment 
Insurance automation efforts.

                  Employment Standards Administration


                         SALARIES AND EXPENSES

    Language authorizing the Secretary of Labor to accept and 
spend all sums of money ordered to be paid to the Secretary, in 
accordance with the terms of a Consent Judgment in U.S. 
District Court for the Northern Mariana Islands.
    Language authorizing the Secretary of Labor to collect user 
fees for processing certain applications and issuing certain 
certificates and registrations under the Fair Labor Standards 
Act and the Migrant and Seasonal Agricultural Worker Protection 
Act.

                            SPECIAL BENEFITS

    Language providing funds may be used under the Federal 
Employees' Compensation Act in which the Secretary of Labor may 
reimburse an employer, who is not the employer at the time of 
injury, for portions of the salary of a reemployed, disabled 
beneficiary.
    Language allowing the Secretary of Labor to transfer 
certain administrative funds from the Postal Service fund and 
certain other government corporations and agencies related to 
the administration of the Federal Employees' Compensation Act.
    Language allowing the Secretary of Labor to require any 
person filing a claim for benefits under the Federal Employees' 
Compensation Act or the Longshore and Harbor Workers' 
Compensation Act to provide such identifying information as the 
Secretary may require, including a Social Security number.

             Occupational Safety and Health Administration


                         SALARIES AND EXPENSES

    Language establishing a maximum amount available for grants 
to States under the Occupational Safety and Health Act, which 
grants shall be no less than 50 percent of the costs of State 
programs required to be incurred under plans approved by the 
Secretary under section 18 of the Act.
    Language authorizing the Occupational Safety and Health 
Administration to retain and spend up to $750,000 of training 
institute course tuition fees for training and education 
grants.
    Language allowing the Secretary of Labor to collect and 
retain fees for services provided to Nationally Recognized 
Testing Laboratories.
    Language prohibiting OSHA from obligating or expending any 
of these funds to enforce the annual fit test requirement of 
the General Industry Respiratory Protection Standard with 
respect to exposure to tuberculosis.

                 Mine Safety and Health Administration


                         SALARIES AND EXPENSES

    Language allowing the Mine Safety and Health Administration 
to collect up to $750,000 at the National Mine Health and 
Safety Academy for room, board, tuition, and the sale of 
training materials, otherwise authorized by law to be 
collected, to be available for mine safety and health education 
and training activities, notwithstanding 31 U.S.C. 3302.
    Language allowing the Mine Safety and Health Administration 
to accept land, buildings, equipment, and other contributions 
from public and private sources; to prosecute projects in 
cooperation with other agencies, Federal, State, or private; 
and to promote health and safety education and training in the 
mining community through cooperative programs with States, 
industry, and safety associations.
    Language 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 major disasters.

                        Departmental Management


                         SALARIES AND EXPENSES

    Language providing that no funds made available by this Act 
may be used by the Solicitor of Labor to participate in a 
review in any United States court of appeals of any decision 
made by the Benefits Review Board under section 21 of the 
Longshore and Harbor Workers' Compensation Act where such 
participation is precluded by the decision of the Supreme Court 
in Director, Office of Workers' Compensation Programs v. 
Newport News Shipbuilding, 115 S. Ct. 1278 (1995), 
notwithstanding any provisions to the contrary contained in 
Rule 15 of the Federal Rules of Appellate Procedure.
    Language providing that any decision under the Longshore 
Act pending before the Benefits Review Board for more than one 
year shall be considered affirmed by the Board and shall be 
considered the final order of the Board.

           TITLE II--DEPARTMENT OF HEALTH AND HUMAN SERVICES


              Health Resources and Services Administration


                     HEALTH RESOURCES AND SERVICES

    Language providing that $39,740,000 from general revenues, 
not-withstanding section 1820(j) of the Social Security Act, 
shall be available for carrying out the Medicare rural hospital 
flexibility grants program under section 1820 of such Act.
    Language providing that in addition to fees authorized by 
section 427(b) of the Health Care Quality Improvement Act of 
1986, fees shall be collected for the full disclosure of 
information under the Act sufficient to recover the full costs 
of operating the National Practitioner Data Bank, and shall 
remain available until expended to carry out that Act.
    Language providing that fees collected under the Health 
Care Fraud and Abuse Data Collection Program shall be 
sufficient to recover the full costs of operating the program, 
and shall remain available until expended to carry out that 
Act.
    Language providing that all pregnancy counseling under the 
family planning program shall be nondirective.
    Language making $25,000,000 available under section 241 of 
the Public Health Service Act to fund special programs for the 
care and treatment of individuals with HIV disease.
    Funds are set aside for special projects of regional and 
national significance under section 501(a)(2) of the Social 
Security Act which shall not be counted toward compliance with 
the allocation required in section 502(a)(1) of the Act and 
which shall be used only for making competitive grants to 
provide abstinence education.

               Centers for Disease Control and Prevention


    Language permitting the Centers for Disease Control and 
Prevention to purchase and insure official motor vehicles in 
foreign countries.
    Language providing the Centers for Disease Control and 
Prevention to purchase, hire, maintain and operate aircraft.
    Language providing that $81,500,000 is available until 
expended for equipment and construction and renovation of 
facilities.
    Language providing that $142,808,000 is available until 
September 30, 2006 for International HIV/AIDS.
    Language providing that collections from user fees may be 
credited to the Centers for Disease Control and Prevention 
appropriation.
    Language making specific amounts under section 241 of the 
Public Health Service Act available to carry out: National 
Immunization Surveys; National Center for health Statistics 
surveys; information systems standards development and 
architecture and applications-based research used at local 
public health levels; Public Health Research; and the National 
Occupational Research Agenda.
    Language allowing the Director of the Centers for Disease 
Control and Prevention to redirect certain funds appropriated 
under Public Law 101-502.
    Language providing that not to exceed $12,500,000 may be 
made available for grants under section 1509 of the Public 
Health Service Act to not more than 15 States, tribes, or 
tribal organizations.
    Language permitting the Centers for Disease Control and 
Prevention to proceed with property acquisition, including a 
long-term ground lease for construction on non-federal land, 
for construction of a replacement laboratory in the Ft. 
Collins, Colorado area.
    Language permitting the Centers for Disease Control and 
Prevention to enter into a single contract or related contracts 
for the full scope of development and construction of 
facilities, subject to available appropriations.

                     National Institutes of Health

    Language allowing the transfer of $100,000,000 to 
International Assistance Programs, ``Global Fund to Fight HIV/
AIDS, Malaria, and Tuberculosis,'' to remain available until 
expended.

                    National Institute on Drug Abuse

    Language making $6,300,000 available under section 241 of 
the Public Health Service Act to carry out national surveys on 
drug abuse and related analysis.

                      NATIONAL LIBRARY OF MEDICINE

    Language providing that the National Library of Medicine 
may enter into certain personal services contracts.
    Language making $8,200,000 available under section 241 of 
the Public Health Service Act to carry out National Information 
Center on Health Services Research and Health Care Technology 
and related health services.

                         OFFICE OF THE DIRECTOR

    Language providing that the National Institutes of Health 
is authorized to collect third party payments for the cost of 
the clinical services that are incurred in NIH research 
facilities and that such payments shall be credited to the NIH 
Management Fund and shall remain available for one fiscal year 
after they are deposited.
    Language providing the Director of NIH authority to 
transfer funds between appropriation accounts in this or any 
other Act.

       Substance Abuse and Mental Health Services Administration


               SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES

    Language making specific amounts available under section 
241 of the Public Health Service Act to fund technical 
assistance, National data, data collection and evaluation 
activities; $16,000,000 to carry out national surveys on drug 
abuse; and, $4,300,000 for substance abuse treatment programs.

               Agency for Healthcare Research and Quality

    Language is included to permit the Agency for Healthcare 
Research and Quality to retain and expend amounts received from 
Freedom of Information Act fees, reimbursable and interagency 
agreements and the sale of data tapes.
    Language making amounts under section 241 of the Public 
Health Service Act available to carry out agency activities.

               Centers for Medicare and Medicaid Services


                     GRANTS TO STATES FOR MEDICAID

    A provision that in the administration of title XIX of the 
Social Security Act, payments to a state for any quarter may be 
made with respect to a State plan or plan amendment in effect 
during any such quarter, if submitted in, or prior to, such 
quarter and approved in that or any such subsequent quarter.

                           PROGRAM MANAGEMENT

    A provision that all funds collected in accordance with 
section 353 of the Public Health Service Act, together with 
such sums as may be collected from authorized user fees, 
administrative fees collected relative to Medicare overpayment 
recovery activities, and the sale of data, shall be available 
for expenditure by the Center for Medicare and Medicaid 
Services.
    Language allowing fees charged in accordance with 31 U.S.C. 
9701 to be credited to the Centers for Medicare and Medicaid 
Services administrative account.

                Administration for Children and Families


  PAYMENTS TO STATES FOR CHILD SUPPORT ENFORCEMENT AND FAMILY SUPPORT 
                                PROGRAMS

    Language providing that the sum of the amounts available to 
a State with respect to expenditures under title IV-A of the 
Social Security Act in fiscal year 1997 under this 
appropriation and under such title IV-A as amended by the 
Personal Responsibility and Work Opportunity Reconciliation Act 
of 1996 shall not exceed the limitations under section 116(b) 
of such Act.

                      SOCIAL SERVICES BLOCK GRANT

    Language providing that States may transfer up to 10 
percent of Temporary Assistance for Needy Family funds to the 
Social Services Block Grant.

                CHILDREN AND FAMILIES SERVICES PROGRAMS

    Language making $5,982,000 available under section 241 of 
the Public Health Service Act to carry out provisions of 
section 1110 of the Social Security Act.
    Language providing that unexpended Community Services Block 
Grant funds may be carried over to the next fiscal year by 
local grantees.
    Language making $4,500,000 available under section 241 of 
the Public Health Service Act to carry out evaluations of 
adolescent pregnancy prevention approaches.

                            POLICY RESEARCH

    Language making amounts under section 241 of the Public 
Health Service Act available to carry out agency activities.

            PUBLIC HEALTH AND SOCIAL SERVICES EMERGENCY FUND

    Language permitting the Centers for Disease Control and 
Prevention to exempt from any personnel ceiling applicable to 
the Agency both civilian and Commissioned Officers detailed to 
the States, municipalities, or other organizations under 
authority of section 214 of the Public Health Service Act for 
purposes related to homeland security during the period of 
detail or assignment.
    Language transferring to the Secretary of Health and Human 
Services the functions, assets, unexpended balances, and 
liabilities of the Strategic National Stockpile, including the 
functions of the Secretary of Homeland Security relating 
thereto, while retaining the right of both Secretaries to 
deploy the Stockpile when deemed appropriate.

                   TITLE III--DEPARTMENT OF EDUCATION


                               IMPACT AID

    Language ensuring that schools serving the children of 
military personnel continue to receive Impact Aid funds when 
the military parents who live on-base are deployed and the 
child continues to attend the same school and in cases in which 
an on-base military parent is killed while on active duty and 
the child continues to attend the same school.

                      SCHOOL IMPROVEMENT PROGRAMS

    Language allowing the Republic of the Marshall Islands and 
the Federated States of Micronesia to reserve up to five 
percent of their supplemental education grants for technical 
assistance, administration and oversight purposes.

                     VOCATIONAL AND ADULT EDUCATION

    Language stating that a portion of the amount provided for 
Adult Education State Grants shall be for integrated English 
literacy and civics education services to immigrants and other 
limited English proficient populations, and specifying the 
distribution of such funds.

                      STUDENT FINANCIAL ASSISTANCE

    Language providing that the maximum Pell grant a student 
may receive in the 2004-2005 academic year shall be $4,050.

                            HIGHER EDUCATION

    Language providing that funds are available to fund 
fellowships for academic year 2005-2006 under part A, subpart 1 
of title VII of the Higher Education Act of 1965, under the 
terms and conditions of part A, subpart 1.
    Language providing that notwithstanding any other provision 
of law, funds made available to carry out title VI of the 
Higher Education Act and section 102(b)(6) of the Mutual 
Educational and Cultural Exchange Act of 1961 may be used to 
support visits and study in foreign countries by individuals 
who are participating in advanced foreign language training and 
international studies in areas that are vital to United States 
national security and who plan to apply their language skills 
and knowledge of these countries in the fields of government, 
the professions, or international development.

                           HOWARD UNIVERSITY

    Language providing that Howard University shall use not 
less than $3,600,000 for the endowment program pursuant to the 
Howard University Endowment Act.

                       TITLE IV--RELATED AGENCIES


             Corporation for National and Community Service

    Language specifying that none of the funds for activities 
authorized by section 122 and part C of title I and part E of 
title II of the Domestic Volunteer Service Act of 1973 shall be 
used to provide stipends or other monetary incentives to 
volunteers or volunteer leaders whose incomes exceed 125 
percent of the national poverty level.

               Federal Mediation and Conciliation Service


                         SALARIES AND EXPENSES

    The bill includes language specifying that notwithstanding 
31 U.S.C. 3302, fees charged by the Federal Mediation and 
Conciliation Service, up to full-cost recovery, for special 
training activities and for arbitration services shall be 
credited to and merged with its administrative account, and 
shall remain available until expended; that fees for 
arbitration services shall be available only for education, 
training, and professional development of the agency workforce; 
and that the Director of the Service is authorized to accept on 
behalf of the United States gifts of services and real, 
personal, or other property in the aid of any projects or 
functions within the Director's jurisdiction.

                     National Labor Relations Board


                         SALARIES AND EXPENSES

    The bill includes a provision requiring that appropriations 
to the NLRB shall not be available to organize or assist in 
organizing agricultural laborers or used in connection with 
investigations, hearings, directives, or orders concerning 
bargaining units composed of agricultural laborers as referred 
to in 2(3) of the Act of July 5, 1935 (29 U.S.C. 152), and as 
amended by the Labor-Management Relations Act, 1947, as 
amended, and as defined in 3(f) of the Act of June 25, 1938 (29 
U.S.C. 203), and including in said definition employees engaged 
in the maintenance and operation of ditches, canals, 
reservoirs, and waterways, when maintained or operated on a 
mutual non-profit basis and at least 95 per centum of the water 
stored or supplied thereby is used for farming purposes.

                       Railroad Retirement Board


                     DUAL BENEFITS PAYMENTS ACCOUNT

    The bill includes language providing that the total amount 
provided for railroad retirement dual benefits shall be 
credited to the Dual Benefits Payments Account in 12 
approximately equal amounts on the first day of each month in 
the fiscal year.

                      LIMITATION ON ADMINISTRATION

    The bill includes language providing that the Railroad 
Retirement Board shall determine the allocation of its 
administrative budget between the railroad retirement accounts 
and the railroad unemployment insurance administration fund.

                     Social Security Administration


                 LIMITATION ON ADMINISTRATIVE EXPENSES

    Language providing that unobligated balances at the end of 
fiscal year 2005 shall remain available until expended for the 
agency's information technology and telecommunications hardware 
and software infrastructure, including related equipment and 
non-payroll administrative expenses associated solely with this 
information technology and telecommunications infrastructure; 
language authorizing the use of up to $15,000 for official 
reception and representation expenses; and language providing 
that reimbursement to the trust funds under this heading for 
expenditures for official time for employees of the Social 
Security Administration pursuant to section 7131 of title 5, 
United States Code, and for facilities or support services for 
labor organizations pursuant to policies, regulations, or 
procedures referred to in 7135(b) of such title shall be made 
by the Secretary of the Treasury, with interest, from amounts 
in the general fund not otherwise appropriated, as soon as 
possible after such expenditures are made.
    Language providing that funds may be derived from 
administration fees collected pursuant to 1616(d) of the Social 
Security Act or 212(b)(3) of Public Law 93-66 and that, to the 
extent that the amounts collected pursuant to such sections in 
fiscal year 2005 exceed $124,000,000, the amounts shall be 
available in fiscal year 2006 only to the extent provided in 
advance in appropriations Acts.
    Language providing that unobligated funds previously 
appropriated for Federal-State partnerships shall be 
transferred to the Supplemental Security Income Program and 
remain available until expended.

                      OFFICE OF INSPECTOR GENERAL

    Language permitting the transfer of a certain amount of 
funds into this account from the SSA administrative account 
provided that the Appropriations Committees are promptly 
notified.

                           General Provisions

    Sections 102, 201, 202, 203, 204, 205, 206, 207, 208, 209, 
210, 211, 212, 213, 214, 215, 216, 217, 221, 222, 301, 302, 
303, 304, 501, 504, 507, 508, 509, 510, 511, 512, 513, 514, 516 
and 517 of the bill are general provisions, most of which have 
been carried in previous appropriations acts, which place 
limitations on the use of funds in the bill or authorize or 
require certain activities, and which might, under some 
circumstances, be construed as changing the application of 
existing law.

              DEFINITION OF PROGRAM, PROJECT, AND ACTIVITY

    During fiscal year 2005 for purposes of the Balanced Budget 
and Emergency Deficit Control Act of 1985 (Public Law 99-177), 
as amended, the following information provides the definition 
of the term ``program, project, and activity'' for departments 
and agencies under the jurisdiction of the Labor, Health and 
Human Services, and Education and Related Agencies 
Subcommittee. The term ``program, project, and activity'' shall 
include the most specific level of budget items identified in 
the Departments of Labor, Health and Human Services, and 
Education, and Related Agencies Appropriations Act, 2005, the 
accompanying House and Senate Committee reports, the conference 
report and accompanying joint explanatory statement of the 
managers of the committee of conference.

         Statement of General Performance Goals and Objectives

    Pursuant to clause 3(c)(4) of rule XIII of the Rules of the 
House of Representatives, the following is a statement of 
general performance goals and objectives for which this measure 
authorizes funding:
    The Committee on Appropriations considers program 
performance, including a program's success in developing and 
attaining outcome-related goals and objectives, in developing 
funding recommendations.

                  Appropriations Not Authorized by Law

    Pursuant to clause 3 of rule XIII of the Rules of the House 
of Representatives, the following table lists the 
appropriations in the accompanying bill which are not 
authorized by law:

----------------------------------------------------------------------------------------------------------------
                                                                            Appropriations in
         Agency/program               Last year of     Authorization level     last year of    Appropriations in
                                     authorization                            authorization        this bill
----------------------------------------------------------------------------------------------------------------
       DEPARTMENT OF LABOR

Employment and Training           2003...............  Such Sums..........     $5,217,070,000     $5,112,728,000
 Administration--Training and
 Employment Services.

 DEPARTMENT OF HEALTH AND HUMAN
            SERVICES

HRSA:
    Health Professions, except    2002...............  Such Sums..........         295,11,000        269,478,000
     certain nursing programs.
    Universal Newborn Screening.  2002...............  Such Sums..........          9,995,000          9,872,000
    Organ Transplantation.......  1993...............  Such Sums..........         24,990,000         24,632,000
    Rural and Community Access    2003...............  $25,000,000........         12,500,000          5,000,000
     to Emergency Devices.
    State Offices of Rural        2002...............  Such Sums..........          7,996,000          8,390,000
     Health.
    Trauma Care.................  2002...............  Such Sums..........          3,499,000          3,449,000
    Family Planning.............  1985...............  $158,400,000.......        142,500,000        278,283,000
    State Planning Grants for     NA.................  NA.................                 NA             14,810
     Health Care Access.
CDC:
    Birth Defects...............  2002...............  Such Sums..........         98,040,000        119,214,000
    Cancer Registeries..........  2003...............  Such Sums..........         45,649,000         49,669,000
    Prostate Cancer.............  2004...............  Such Sums..........         15,452,000         15,452,000
    Breast and Cervical Cancer    2003...............  Such Sums..........        199,371,000        219,533,000
     Prevention.
    Wisewoman...................  2003...............  Such Sums..........         12,500,000         12,500,000
    Prevention Centers..........  2003...............  Such Sums..........         26,830,000         26,652,000
    Health statistics...........  2003...............  Such Sums..........         25,899,000        149,600,000
    Preventive Health Services    1998...............  Such Sums..........        149,092,000        110,000,000
     Block Grant.
    Sexually Transmitted          1998...............  Such Sums..........        112,117,000        172,935,000
     Diseases Grants.
    Tuberculosis Grants.........  2002...............  Such Sums..........        132,689,000        138,670,000
    Loan Repayment..............  2002...............  $500,000...........            500,000            500,000
NIH:
    National Institutes of        1996...............  Such Sums..........        416,992,000        763,899,000
     Health--Research Training.
    National Cancer Institute...  1996...............  Such Sums..........      2,248,000,000      4,870,025,000
    National Heart, Lung, and     1996...............  Such Sums..........      1,354,945,000      2,963,953,000
     Blood Institute.
    National Institute on Aging.  1996...............  Such Sums..........        453,541,000      1,055,666,000
    National Institute on         1994...............  Such Sums..........        185,538,000        441,911,000
     alcohol abuse and
     Alcoholism.
    National Institute on Drug    1994...............  Such Sums..........        424,315,000      1,012,760,000
     Abuse.
    National Institute of Mental  1994...............  Such Sums..........        613,352,000      1,420,609,000
     Health.
    National Institute of         2003...............  Such Sums..........        280,100,000        297,647,000
     Biomedical Imaging and
     Bioengineering.
    National Library of Medicine  1996...............  Such Sums..........        140,936,000        316,947,000
SAMHSA:
    Substance Abuse and Mental    FY 2003............  Such Sums..........      3,158,068,000      3,391,663,000
     Health Services
     Administration programs.
ACF:
    Office of Refugee             FY 2002............  Such Sums..........        439,894,000        414,107,000
     Resettlement, except:
     Unaccompanied Alien
     Children, Victims of
     Torture, and Victims of
     Trafficking.
    Child Care Development Block  FY 2002............  $1,000,000,000.....      2,099,994,000      2,099,729,000
     Grant.
    Head Start..................  FY 2003............  Such Sums..........      6,815,570,000      6,898,580,000
    Native American programs....  FY 2002............  Such Sums..........         45,946,000         45,155,000
    Community Services Block      FY 2003............  Such Sums..........        739,315,000        710,088,000
     Grant programs.
    Office of the Secretary       1985...............  $30,000,000........         14,716,000         31,229,000
     Adolescent Family Life
     (Title XX).

     DEPARTMENT OF EDUCATION

Education for the Disadvantaged-- FY 2003............  Such Sums..........         34,750,000         38,202,000
 Migrant Education.
Innovation and Improvement--      FY 2003............  Such Sums..........         24,838,000         50,000,000
 Credit Enhancement for Charter
 School Facilities.
Special Education:
    Grants to States Part B.....  FY 2002............  Such Sums..........          7,528,533     11,068,106,000
    Preschool Grants............  FY 2002............  Such Sums..........        390,000,000        387,699,000
    Grants for Infants and        FY 2002............  Such Sums..........        417,000,000        466,581,000
     Families.
    IDEA National Activities....  FY 2002............  Such Sums..........        337,271,000        253,715,000
Rehabilitation Services and       FY 2003............  Such Sums..........      3,013,305,000      3,054,587,000
 Disability Research.
Special Institutions for Persons
 with Disabilities:
    National Technical Institute  FY 2003............  Such Sums..........         53,800,000         55,790,000
     for the Deaf.
    Gallaudet University........  FY 2003............  Such Sums..........        100,800,000        104,000,000
Vocational and Adult Education..  FY 2003............  Such Sums..........      2,121,690,000      2,025,456,000
Student Financial Assistance....  FY 2004............  Such Sums..........     14,007,296,000     14,755,794,000
Student Aid Administration......  FY 2004............  Such Sums..........        116,727,000        120,247,000
Higher Education:
    Aid for Institutional         FY 2004............  Such Sums..........        485,065,000        510,547,000
     Development.
    International Education and   FY 2004............  Such Sums..........        103,680,000        107,680,000
     Foreign Language.
        Domestic Programs.......  FY 2004............  Such Sums..........         89,211,000         93,211,000
        Institute for             FY 2004............  Such Sums..........          1,629,000          1,629,000
         International Public
         Policy.
    Fund for Improvement of Post  FY 2004............  Such Sums..........        157,700,000         32,011,000
     Secondary Education.
    Minority Science and          FY 2004............  Such Sums..........          8,889,000          8,889,000
     Engineering Improvement.
    Interest Subsidy Grants.....  FY 2004............  Such Sums..........          1,988,000          1,500,000
    Tribally Controlled Post-     FY 2004............  $4,000,000.........          7,185,000          7,185,000
     Secondary vocational and
     Technical Institutions.
    Federal TRIO Programs.......  FY 2004............  Such Sums..........        832,559,000        842,559,000
    GEAR UP.....................  FY 2004............  Such Sums..........        298,230,000        318,230,000
    Javits Fellowships..........  FY 2004............  Such Sums..........          9,876,000          9,876,000
    Graduate Assistance in Areas  FY 2004............  Such Sums..........         30,616,000         30,616,000
     of National Need.
    Teacher Quality Enhancement   FY 2004............  Such Sums..........         88,887,000         88,888,000
     Grants.
    Child Care Access Means       FY 2004............  Such Sums..........         16,098,000         16,099,000
     Parents in School.
    GPRA Data/HEA program         FY 2004............  Such Sums..........            988,000            988,000
     evaluation.
    B.J. Stupak Olympic           FY 2004............  Such Sums..........            988,000            988,000
     Scholarships.
Howard University--Endowment      FY 1985............  $2,000,000.........          2,000,000          3,552,000
 Program.
Institute of Education Sciences-- FY 2002............  Such Sums..........         78,380,000         78,125,000
 Research and Innovation in
 Special Education.
        RELATED AGENCIES

Corporation for National and      FY 1996............  Such Sums..........        198,393,000        353,197,000
 Community Service--Domestic
 Volunteer Service Programs.
Corporation for Public            FY 1993............  $200,000,000.......         65,327,000         60,000,000
 Broadcasting--FY2005,
 Interconnection.
Corporation for Public            FY 2001............  $20,000,000........         20,000,000         20,000,000
 Broadcasting--FY2005
 Digitization.
National Council on Disability..  FY 2003............  Such Sums..........          2,858,000          2,873,000
----------------------------------------------------------------------------------------------------------------

          Compliance With Rule XIII, Cl. 3(e) (Ramseyer Rule)

  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 (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italics, existing law in which no change 
is proposed is shown in roman):

   SECTION 8002 OF THE ELEMENTARY AND SECONDARY EDUCATION ACT OF 1965

SEC. 8002. PAYMENTS RELATING TO FEDERAL ACQUISITION OF REAL PROPERTY.

  (a) * * *

           *       *       *       *       *       *       *

  (m) Eligibility.--
          (1) Old federal property.--Except as provided in 
        paragraph (2), a local educational agency that is 
        eligible to receive a payment under this section for 
        Federal property acquired by the Federal Government, 
        before the date of the enactment of the Impact Aid 
        Reauthorization Act of 2000, shall be eligible to 
        receive the payment only if the local educational 
        agency submits an application for a payment under this 
        section not later than [5] 7 years after the date of 
        the enactment of such Act.
          (2) Combined federal property.--A local educational 
        agency that is eligible to receive a payment under this 
        section for Federal property acquired by the Federal 
        Government before the date of the enactment of the 
        Impact Aid Reauthorization Act of 2000 shall be 
        eligible to receive the payment if--
                  (A) * * *
                  (B) the local educational agency submits an 
                application for a payment under this section 
                not later than [5] 7 years after the date of 
                acquisition of the Federal property acquired 
                after the date of the enactment of such Act.
          (3) New federal property.--A local educational agency 
        that is eligible to receive a payment under this 
        section for Federal property acquired by the Federal 
        Government after the date of the enactment of the 
        Impact Aid Reauthorization Act of 2000 shall be 
        eligible to receive the payment only if the local 
        educational agency submits an application for a payment 
        under this section not later than [5] 7 years after the 
        date of acquisition.

           *       *       *       *       *       *       *


                          Full Committee Votes

    Pursuant to the provisions of clause 3(b) of rule XII of 
the House of Representatives, the results of each rollcall vote 
on an amendment or on the motion to report, together with the 
names of those voting for and those voting against, are printed 
below:
                             ROLLCALL NO. 1

    Date: July 14, 2004.
    Measure: Departments of Labor, Health and Human Services, 
and Education, and Related Agencies Appropiations Bill, FY 
2005.
    Motion by: Mr. Obey.
    Description of motion: To increase various Labor, Health 
and Human Services, and Education programs above amounts 
recommended in the underlying bill; increases are offset by a 
reduction to tax cuts for certain income groups.
    Results: Rejected--yeas 25; nays 31.

        Members Voting Yea            Members Voting Nay

Mr. Berry                           Mr. Aderholt
Mr. Bishop                          Mr. Bonilla
Mr. Boyd                            Mr. Crenshaw
Mr. Clyburn                         Mr. Culberson
Mr. Cramer                          Mr. Cunningham
Mr. DeLauro                         Mr. Doolittle
Mr. Edwards                         Mr. Emerson
Mr. Farr                            Mr. Frelinghuysen
Mr. Hinchey                         Mr. Goode
Mr. Hoyer                           Mr. Granger
Mr. Jackson                         Mr. Hobson
Mr. Kennedy                         Mr. Istook
Mr. Kilpatrick                      Mr. Kirk
Mr. Lowey                           Mr. Kolbe
Mr. Mollohan                        Mr. LaHood
Mr. Moran                           Mr. Lewis
Mr. Murtha                          Mr. Nethercutt
Mr. Obey                            Mr. Northup
Mr. Olver                           Mr. Peterson
Mr. Pastor                          Mr. Regula
Mr. Price                           Mr. Rogers
Mr. Roybal-Allard                   Mr. Sherwood
Mr. Sabo                            Mr. Simpson
Mr. Serrano                         Mr. Taylor
Mr. Visclosky                       Mr. Tiahrt
                                    Mr. Vitter
                                    Mr. Walsh
                                    Dr. Weldon
                                    Mr. Wicker
                                    Mr. Wolf
                                    Mr. Young
                             ROLLCALL NO. 2

    Date: July 14, 2004.
    Measure: Departments of Labor, Health and Human Services, 
and Education, and Related Agencies Appropriations Bill, FY 
2005.
    Motion by: Mr. Obey.
    Description of motion: To add language prohibiting the use 
of funds by the Department of Labor to implement or administer 
any change to regulations regarding overtime compensation.
    Results: Rejected--yeas 29; Nays 31.

        Members Voting Yea            Members Voting Nay

Mr. Berry                           Mr. Aderholt
Mr. Bishop                          Mr. Bonilla
Mr. Boyd                            Mr. Crenshaw
Mr. Clyburn                         Mr. Culberson
Mr. Cramer                          Mr. Cunningham
Ms. DeLauro                         Mr. Frelinghuysen
Mr. Dicks                           Mr. Goode
Mr. Edwards                         Ms. Granger
Mr. Farr                            Mr. Hobson
Mr. Fattah                          Mr. Istook
Mr. Hinchey                         Mr. Kingston
Mr. Hoyer                           Mr. Knollenberg
Mr. Jackson                         Mr. Kolbe
Ms. Kaptur                          Mr. LaHood
Mr. Kennedy                         Mr. Latham
Ms. Kilpatrick                      Mr. Lewis
Mrs. Lowey                          Mr. Nethercutt
Mr. Mollohan                        Mrs. Northup
Mr. Moran                           Mr. Peterson
Mr. Murtha                          Mr. Regula
Mr. Obey                            Mr. Rogers
Mr. Olver                           Mr. Sherwood
Mr. Pastor                          Mr. Simpson
Mr. Price                           Mr. Taylor
Mr. Rothman                         Mr. Tiahrt
Ms. Roybal-Allard                   Mr. Vitter
Mr. Sabo                            Mr. Walsh
Mr. Serrano                         Dr. Weldon
Mr. Visclosky                       Mr. Wicker
                                    Mr. Wolf
                                    Mr. Young

                             ROLLCALL NO. 3

    Date: July 14, 2004.
    Measure: Departments of Labor, Health and Human Services, 
and Education, and Related Agencies Appropriations Bill, FY 
2005.
    Motion by: Mr. Wicker.
    Description of motion: To add language prohibiting the 
obligation or expenditure of funds to administer or enforce the 
provisions of the General Industry Respiratory Protection 
Standard to the extent that such provisions require annual fit 
testing of respirators of occupational exposure to 
tuberculosis.
    Results: Adopted--yeas 35; nays 27.

        Members Voting Yea            Members Voting Nay

Mr. Aderhold                        Mr. Berry
Mr. Bonilla                         Mr. Bishop
Mr. Crenshaw                        Mr. Boyd
Mr. Culberson                       Ms. DeLauro
Mr. Cunningham                      Mr. Dicks
Mr. Doolittle                       Mr. Edwards
Mrs. Emerson                        Mr. Farr
Mr. Frelinghuysen                   Mr. Fattah
Mr. Goode                           Mr. Hinchey
Ms. Granger                         Mr. Hoyer
Mr. Hobson                          Mr. Jackson
Mr. Istook                          Ms. Kapture
Mr. Kingston                        Mr. Kennedy
Mr. Kirk                            Ms. Kilpatrick
Mr. Knollenberg                     Mrs. Lowery
Mr. Kolbe                           Mr. Mollohan
Mr. LaHood                          Mr. Moran
Mr. Latham                          Mr. Murtha
Mr. Lewis                           Mr. Obey
Mr. Nethercutt                      Mr. Olver
Mr. Northup                         Mr. Pastor
Mr. Peterson                        Mr. Price
Mr. Regula                          Mr. Rothman
Mr. Rogers                          Ms. Roybal-Allard
Mr. Sherwood                        Mr. Sabo
Mr. Simpson                         Mr. Serrano
Mr. Sweeney                         Mr. Visclosky
Mr. Taylor
Mr. Tiahrt
Mr. Vitter
Mr. Wamp
Dr. Weldon
Mr. Wicker
Mr. Wolf
Mr. Young

                             ROLLCALL NO. 4

    Date: July 14, 2004.
    Measure: Departments of Labor, Health and Human Services, 
and Education, and Related Agencies Appropriations Bill, FY 
2005.
    Motion by: Mr. Goode.
    Description of motion: To add language prohibiting the use 
of funds by the Commissioner of Social Security to implement 
the agreement establishing totalization arrangements between 
the social security system established by title II of the 
Social Security Act and the social security system of Mexico.
    Results: Rejected--yeas 20; nays 36.

        Members Voting Yea            Members Voting Nay

Mr. Culberson                       Mr. Bishop
Mr. Doolittle                       Mr. Bonilla
Mrs. Emerson                        Mr. Boyd
Mr. Goode                           Mr. Clyburn
Mr. Istook                          Mr. Crenshaw
Mr. Kingston                        Ms. DeLauro
Mr. Kolbe                           Mr. Dicks
Mr. LaHood                          Mr. Edwards
Mr. Peterson                        Mr. Farr
Mr. Rogers                          Mr. Frelinghuysen
Mr. Sherwood                        Ms. Granger
Mr. Simpson                         Mr. Hinchey
Mr. Sweeney                         Mr. Hobson
Mr. Taylor                          Mr. Hoyer
Mr. Tiahrt                          Mr. Jackson
Mr. Vitter                          Mr. Kennedy
Mr. Wamp                            Ms. Kilpatrick
Dr. Weldon                          Mr. Knollenberg
Mr. Wolf                            Mr. Latham
Mr. Young                           Mrs. Lowey
                                    Mr. Mollohan
                                    Mr. Moran
                                    Mr. Nethercutt
                                    Mrs. Northup
                                    Mr. Obey
                                    Mr. Olver
                                    Mr. Pastor
                                    Mr. Price
                                    Mr. Regula
                                    Mr. Rothman
                                    Ms. Roybal-Allard
                                    Mr. Sabo
                                    Mr. Serrano
                                    Mr. Visclosky
                                    Mr. Walsh
                                    Mr. Wicker

                                    
                                    

 MINORITY VIEWS OF THE HONORABLE DAVID OBEY, STENY HOYER, NITA LOWEY, 
 ROSA DeLAURO, JESSE JACKSON, JR., PATRICK KENNEDY, AND LUCILLE ROYBAL-
                                 ALLARD

    While this bill is a modest improvement over the 
President's budget request, it fails to meet America's needs in 
education, health care, medical research, and human services. 
The bill's inadequacies, however, are not the fault of the 
Committee or Chairman Regula. This bill's shortcomings are the 
direct and foreseeable result of the Majority's reckless FY 
2005 budget resolution which, as with each of the budgets the 
Majority produced over the past three years, abandons fiscal 
discipline, mortgages our nation's future, and makes impossible 
critical investments that benefit all Americans. It is the 
product of the skewed priorities of the Majority, who value 
super-sized tax cuts for our wealthiest and most privileged 
citizens over honoring our commitments and protecting our most 
vulnerable citizens.
    Even when provided with an opportunity to change course, 
the Majority held rigidly to its failed budget blueprint. 
Earlier this year, the Majority rejected a Democratic 
alternative to the FY 2005 budget that was fiscally responsible 
and allowed a greater investment in education, health care, and 
many other critical priorities. Then, on June 24, the Majority 
defeated a Democratic resolution to revise the budget 
resolution that would have made a greater investment in 
education, training, and health by modestly scaling back tax 
cuts for those with annual incomes of $1 million or more.
    Given the Majority Party's misguided budgetary choices, 
shortfalls in appropriations are inevitable. In fact, the 
Labor-HHS-Education Subcommittee received a relatively good 
share of an inadequate total, allowing an increase of about $3 
billion above the current year. That increase was largely 
allocated to a few areas: providing $1 billion increases for 
two high-priority education programs, keeping up with rising 
costs in the Pell Grant program, partially covering increased 
research costs at NIH, and funding the administrative expenses 
of the Social Security Administration.
    After doing these things, the subcommittee had more than 
exhausted the additional funds it was allocated above the FY 
2004 level. Consequently, other priorities in the bill had to 
be cut.

                 EDUCATION--NOT AT THE TOP OF THE CLASS

    Next year, K-12 and higher education enrollments will again 
reach record levels. Nearly 55 million students will attend the 
nation's elementary and secondary schools--4 million more 
students than in 1995. Full-time college enrollment will reach 
16.7 million students--14 percent more than a decade ago.
    At the same time that schools are serving more students, 
the stakes are raised higher by the mandates of the No Child 
Left Behind Act (NCLB). During the 2005 school year, schools 
must actually test each student in grades 3-8 in reading and 
math or face federal sanctions. Student achievement must 
improve. And, every teacher of a core academic subject must 
become ``highly qualified.''
    Against the backdrop of record school enrollments, 
unprecedented Federal education accountability requirements, 
and rising demand for college assistance, the Committee bill 
fails to match these growing demands with sufficient resources. 
The bill provides a $2.0 billion (3.6 percent) increase over FY 
2004 for the Department of Education's discretionary programs, 
continuing a downward slide in new discretionary education 
investments under the Bush Administration.



No Child Left Behind

    While all 50 states and 15,500 school districts are 
striving to address NCLB's worthy goals, money remains short in 
many schools. Nonetheless, the Committee bill actually cuts 
NCLB funding $120 million below the Administration's request, 
while providing only $328 million(1.3 percent) more than FY 
2004. In total, the bill provides $9.5 billion less than the funding 
promised in NCLB.
    Fully funding Title 1--which serves low-income children in 
schools with the greatest educational challenges--is the 
centerpiece of federal education reform efforts. Title 1 grants 
to school districts receive a $1 billion (8.1 percent) increase 
in the Committee bill, the same amount as the President's 
request. Despite this needed increase, Title 1 appropriations 
in FY 2005 would still fall $7.2 billion short of the NCLB 
funding promise--accounting for most of the total $9.5 billion 
NCLB shortfall in the Committee bill.
    A key concept in NCLB is that students who are falling 
behind are able to receive tutoring and a broad array of 
enrichment services in school and community-based after school 
centers. Yet the Committee bill freezes funding for 21st 
Century Community Learning Centers at $999 million--only half 
of the $2.0 billion authorized by NCLB. At the $2.0 billion 
level, an additional 1.3 million children could be served in 
such communities as Davenport, Iowa, Columbus, Ohio, 
Greenville, South Carolina, and Salt Lake City, Utah, all of 
which are struggling to keep existing after school centers open 
to serve children in working families.
    The Committee bill freezes funding at last year's levels 
for several programs that are important to the success of NCLB. 
For example, English language learning assistance for more than 
5 million children who must learn to read and speak English is 
frozen at $681 million, the second year in a row--even while 
these children must meet the same rigorous academic standards 
as all other children. About 6,500 rural school districts will 
see their Rural Educational Achievement Program grants level 
funded at $168 million, in the aggregate; despite the 
difficulty they face in recruiting and retaining teachers. In 
addition, investments in school violence prevention, substance 
abuse prevention and school safety activities are frozen at 
$595 million, nearly 10 percent less than the safe and drug-
free schools funding level three years ago.
    The Committee bill makes only modest investments in a few 
areas. For example, it provides a $63 million net increase for 
teacher training in math and science instruction (after 
accounting for an offsetting reduction in NSF support). It 
provides 1,300 school districts located on or near military 
bases and other federal facilities a $21 million (1.7 percent) 
increase under the Impact Aid program. Further, it rejects the 
Administration's proposal to cut vocational and career 
education by $316 million and, instead, provides an increase to 
offset inflation.
    These modest increases, however, are offset by deep 
reductions in other education initiatives, including the 
outright elimination of 22 programs. For example, the Committee 
bill wipes out the Title VI education block grant, although the 
Administration proposed to continue its flexible funding of 
nearly $300 million to help the nation's school districts pay 
for locally identified needs, such as up-to-date instructional 
materials, counseling services, and parental involvement 
activities. Moreover, arts education, teacher training to 
improve American history instruction, drop out prevention, K-12 
foreign language assistance, and community technology centers 
to bridge the digital divide in low-income communities--all 
priority activities reauthorized in NCLB--are terminated. 
Because of budget constraints, the bill even denies over $100 
million in education initiatives requested by the President.

Special education

    President Bush's Commission on Excellence in Special 
Education concluded, ``children with disabilities remain those 
most at risk of being left behind.'' The Committee bill makes 
progress in fulfilling federal commitments in special education 
by providing a $1 billion (9.9 percent) increase over FY 2004 
for IDEA Part B State Grants, the same amount as the 
President's request. Under the Committee bill, the federal 
contribution toward special education costs incurred by the 
nation's schools will increase from 18.7 percent in FY 2004 to 
19.8 percent in FY 2005. Nonetheless, the Committee bill falls 
$2.5 billion short of the $13.6 billion promised last year by 
the Majority party when it passed H.R. 1350, the IDEA 
reauthorization bill.

College assistance

    In today's increasingly technological society, a college 
education is essential for a good-paying job. For low- and 
moderate-income families, however, the task of sending a child 
to college--which has never been easy--is now a daunting 
challenge, given an average 26 percent tuition increase in the 
last two years at 4-year public colleges and universities.
    The Committee bill, however, makes little progress in 
making college more affordable for disadvantaged students. The 
bill freezes the maximum Pell Grant for low-income college 
students at $4,050 for the second year in a row, freezes 
College Work Study assistance, and cuts Perkins Loans by $99 
million below last year's level.
    College students will receive help with dramatically rising 
tuition bills only through a $24 million (3.1 percent) increase 
for Supplemental Educational Opportunity Grants (SEOGs), and a 
restoration of the $66million LEAP grants for state need-based 
student financial assistance programs, which the Administration sought 
to eliminate.

                INVESTING LESS IN AMERICA'S LABOR FORCE

    For the Department of Labor's employment and training 
assistance programs for unemployed Americans, the Committee 
bill invests $236 million less than the Administration's 
request and $40 million less than last year, despite a loss of 
1.8 million private sector jobs since President Bush took 
office.
    While the Committee bill provides a $25 million (1.7 
percent) increase over FY 2004 to assist dislocated workers 
affected by mass layoffs, it denies 80 percent of the 
Administration's $250 million request for the Community College 
technical training initiative and eliminates the $90 million 
prisoner re-entry initiative due to budget constraints. The 
bill shaves the Administration's proposed 2.8 percent increase 
for salaries and other operating costs for Job Corps, the 
highly successful initiative that helps hard-core disadvantaged 
and unemployed youth, to a 1.8 percent increase over FY 2004.
    Unemployment remains unacceptably high with 8.0 million 
Americans out of work; however, the Committee bill actually 
cuts assistance for individuals seeking jobs through the 
Employment Service, a building block for the nation's one-stop 
employment services delivery system. State Employment Service 
funding is cut to $696 million, a 10 percent reduction below FY 
2004 and the lowest level in more than 10 years. The Committee 
bill also rescinds $100 million in prior funding, as requested 
by the Administration, for the H-1B training grants that help 
train Americans in high-skill, high-wage jobs and reduce the 
nation's reliance on foreign workers.
    Further, funding to promote international labor standards 
and combat abusive child labor will be eviscerated with a 68 
percent cut in the Committee bill, which adds only $5 million 
to the Administration's request. The $35.5 million provided in 
the bill includes only $16 million for child labor projects 
compared with the $82 million allocated in FY 2004.

       FALLING SHORT OF THE PROMISE OF A SAFE AND HEALTHY NATION

    For the health-related programs of the Department of HHS, 
the Committee's bill falls short of what is needed to maintain 
the health care safety net, protect the public health, and 
advance medical research.
    The measure does substantially increase funding for 
Community Health Centers, expand a Global Disease Detection 
initiative at CDC, and provide modest increases for AIDS drug 
assistance and chronic disease prevention programs. In some 
respects it is an improvement over the President's budget--it 
rejects the Administration's proposal to cut bio-terrorism 
preparedness assistance to health departments and hospitals, 
and reduces the President's proposed cuts in rural health and 
health professions programs.
    However, a number of health programs are still cut below 
the current-year level by the Committee bill. Examples include 
the Healthy Communities Access Program, several rural health 
programs, some health professions training programs (especially 
those related to primary care and public health), and block 
grants for public health services. A large number of other 
programs have their funding frozen, often for the second or 
third year in a row. These freezes, while health care costs and 
the number of people needing assistance are continuing to 
increase, mean real erosion in the health care safety net and 
public health protection.
     The Committee bill terminates the Healthy 
Communities Access Program (HCAP), which makes grants to local 
consortia of hospitals, health centers, and other providers to 
build better integrated systems of care for the uninsured. This 
means that roughly 70 communities will lose their existing 
three-year grants and about 35 new grants will not be made.
     Rural Health Outreach Grants--which support 
primary health care, dental health, mental health, and 
telemedicine projects--are cut by 24 percent. Grants to improve 
small rural hospitals are cut in half, funding to help rural 
communities acquire the defibrillators that can save the lives 
of heart attack victims are cut by more than half, and a small 
new program to help improve emergency medical services in rural 
areas is eliminated.
     Apart from grants to Health Centers, the bill 
continues to slow erosion of most other health care programs. 
The Maternal and Child Health Block Grant is funded slightly 
below its level of three years earlier, with no increase for 
rising health care costs, population or anything else. These 
grants help support prenatal care and health and dental 
services for low-income children, and assist children with 
disabilities and other special health care needs. The National 
Health Service Corps--which helps bring doctors and dentists 
into under-served areas--receives a bit less than in FY 2003. 
The Ryan White AIDS Care programs (other thandrug assistance) 
is also slightly under its FY 2003 level (while the number of AIDS 
patients has been rising by about 7 percent per year), and the Title X 
family planning program is just 1.8 percent above FY 2003.
     Support for training in primary care medicine and 
dentisty--which is targeted to increasing the number of doctors 
and dentists in rural and other underserved areas--is cut 22 
percent below the current year by the bill. Support for 
training in public health and preventive medicine is cut 24 
percent, despite the difficulties that public health 
departments are having recruiting and retaining qualified 
professionals.
     The Committee bill does include a small, $5 
million (3.5 percent) increase for nurse education and training 
programs. While a step in the right direction, it pales in 
comparison to the national commitment envisioned under the 
Nurse Reinvestment Act, which was aimed at stemming the looming 
nursing shortage.
     CDC's childhood immunization program receives a 
small but welcome $11 million increase in the Committee bill. 
However, the bill's FY 2005 level is just 3.4 percent above FY 
2002 while the cost to immunize a child with all recommended 
vaccines will have increased 18.5 percent.
     Also in CDC, although the bill roughly doubles an 
important Global Disease Detection initiative, funding for 
ongoing domestic activities to control and respond to 
infectious diseases like West Nile Virus, SARS and the flu are 
increased by just 1.1 percent.
     The Committee bill makes a 17.5 percent cut in 
basic support to state and local health departments through the 
Preventive Health and Health Services Block Grant. This funding 
is used for a range of priorities, from health screening to 
immunization to control of chronic diseases like diabetes and 
asthma to basic epidemiological investigations and public 
health laboratory operations.
    For the National Institutes of Health, the Committee bill 
is identical to the Administration's budget request. It 
provides an increase of 2.6 percent--which is the smallest in 
19 years and significantly less than the 3.5 percent needed to 
cover estimated inflation in biomedical research costs. 
Although the Administration says that its budget (and hence the 
Committee bill) would produce a small increase in the number of 
new and re-competing research project grants--reversing a 
decrease that is occurring in FY 2004--it achieves that result 
only by assuming unusually tight limits on the average size of 
research grants, including cuts to ongoing research projects 
below previously committed levels. If grant amounts were 
instead allowed to increase at normal rates, the number of new 
grants would decrease for the second year in a row. Many 
Members have been circulating letters to the Committee urging 
additional funding to accelerate research into diseases like 
Parkinson's or Alzheimer's or cancer. Many of the Members of 
Congress who have signed such letters in fact voted for the 
Republican budget resolution which has made it impossible for 
the committee to provide funding levels requested in such 
letters. At the funding level in the Committee bill, such 
increases simply are not possible.

               HELPING AMERICA'S MOST VULNERABLE CITIZENS

    For the human services side of the Department of HHS, the 
Committee bill includes increases for Low-Income Home Energy 
Assistance (LIHEAP), Refugee Assistance, Head Start, 
Abstinence-only Sex Education, and some programs of the 
Administration on Aging. It also rejects most (but not all) of 
the cut in the Community Services Block Grant proposed by the 
President. On the whole, however, the bill's human services 
appropriations fall short of what is needed.
    For LIHEAP, the Committee added $111 million above FY 2004, 
as proposed by the President. However, this barely does more 
than reverse a decrease that occurred last year. Sharply higher 
energy prices combined with cold winters have increased the 
need for LIHEAP. These same conditions have also led to growing 
need for the Energy Department's Weatherization Assistance 
Program (which was recently transferred to the Labor-HHS bill). 
However, the bill includes no increase at all for 
Weatherization, rejecting the $64 million addition proposed by 
the President.
    The Child Care Block Grant has its funding essentially 
frozen for the third year in a row under the Committee's bill, 
meaning a real reduction in help for working families. 
Appropriations for Head Start are $45 million less than the 
amount proposed by the President. Overall funding for the 
Administration on Aging is up by 2.2 percent. However, this 
follows two years of even smaller increases, leaving the FY 
2005 figure just 4.0 percent above its level three years 
earlier.

                       The Democratic Alternative

    The demands of the war on terrorism, the conflict in Iraq, 
homeland security needs, and a sluggish economy require a 
pragmatic and responsible approach to America's budget. Yet, 
even with all these competing needs and challenges, this bill's 
shortcomings were not fated.
    The budget alternatives that Democrats offered earlier this 
year--including the package of budget resolution revisions that 
the House considered on June 24--would have allowed this 
Committee to make a greater investment in education, health 
care, medical research, and other pressing needs. Our budget 
alternatives were also fiscally responsible; they would have 
provided for these national needs and reduced the deficit by 
modestly reducing tax cuts for those with annual incomes above 
$1 million.
    When this bill was considered by subcommittee and by the 
full Appropriations Committee, amendments were offered 
mirroring the Labor-HHS-Education portion of the Democratic 
budget proposal. These amendments would have added $7.4 billion 
to the bill, paid for by 30 percent reduction in the 2005 tax 
cuts for people with incomes over $1 million. Instead of tax 
cuts averaging about $127,000, this top-income group would have 
their tax cuts reduced to an average of $89,000. Regrettably, 
these amendments were defeated on party line votes. Had they 
been adopted, we could:
           Invest $1.5 billion more in Title I 
        instruction to help an additional 500,000 low-income 
        and minority children in the poorest communities 
        succeed in school;
           Invest $200 million more in after school 
        centers so that an additional 267,000 children, who are 
        responsible for taking care of themselves after school 
        each day, have a safe and nurturing place to go after 
        school;
           Invest $1.2 billion more to subsidize the 
        high costs of educating 6.9 million children with 
        disabilities;
           Provide a $450 increase in the maximum Pell 
        Grant for students with the greatest financial need, 
        and begin to restore its purchasing power for more than 
        5 million low-income students;
           Assist an additional 51,000 teachers improve 
        their instructional skills to become highly qualified 
        under NCLB; and
           Ensure that 2,500 low-performing schools 
        receive the assistance they were promised to implement 
        effective, comprehensive reforms to raise their 
        academic performance.
    In the area of workforce training, the Democratic amendment 
would have provided an additional $200 million to support 
training and job placement services for more jobless Americans. 
And, it would have fully restored funding to combat child labor 
and promote workers' rights around the world, which in turn 
would have helped workers here at home.
    On the health and human services side, the Democratic 
amendment would have allowed us to provide more help to the 45 
million people without health care, maintain momentum in 
biomedical research, and restore some of the lost purchasing 
power in key human services programs. For example, the 
amendment would do the following:
     Maintain the Healthy Communities Access Program, 
rather than terminating it as under the Committee bill, and add 
some funds to make up for lost ground in programs like the 
Maternal and Child Health Block Grant, Family Planning, and 
Community Mental Health Block Grant.
     Avoid any cuts in health professions training 
programs, add $20 million to the National Health Service Corps 
to get more doctors and dentists into underserved rural and 
inner city areas, and add $35 million to Nurse Reinvestment Act 
programs to help stem the nursing shortage by providing more 
scholarships for nursing students and more support for nursing 
schools.
     Eliminate the proposed cuts in rural health 
programs, and add an additional $19 million to better support 
rural health clinics, hospitals and emergency services.
     Provide $50 million to help meet some of the most 
urgent unmet needs for dental care, through grants for rural 
dental clinics, scholarships and student loan repayment 
arrangements for dentists who locate in underserved areas, and 
grants and low-interest loans to help dentists who agree to 
participate in Medicaid establish and expand practices in areas 
with dental shortages.
     Add $500 million to the budget of the National 
Institutes of Health--enough to provide a full inflation 
adjustment, renew all ongoing research grants, and restore the 
number of new grants to the FY 2003 level. This would help 
maintain momentum in research tofind better treatments for 
diseases like cancer, Parkinson's disease, and Alzheimer's.
     Provide $50 million more for child immunization, 
to help catch up with rising vaccine costs, and also add $50 
million to other infectious disease control efforts at CDC 
(including those aimed at HIV/AIDS, tuberculosis, and sexually 
transmitted diseases).
     Add $200 million to the Low-Income Home Energy 
Assistance Program to help keep up with rising needs. Between 
the 2002 and 2004 winter heating seasons, average home heating 
costs rose 50 percent for natural gas users and 54 percent for 
users of fuel oil. As energy prices rise and the economy 
remains weak, the number of households seeking assistance is 
rising, but the program still serves only about 14 percent of 
the eligible population.
    Provide an additional $70 million for senior citizens' 
programs of the Administration on Aging, including Meals on 
Wheels and other nutrition programs.
    Budgets are as much about America's values are they are 
about dollars and cents. By prioritizing massive tax cuts for 
the wealthiest among us, House Republicans have once again 
rejected traditional American values of shared sacrifice in 
difficult times and equal opportunity for all Americans. The 
Majority's priorities will mean less opportunity through 
education and job training, decreased access to health care in 
rural and other underserved areas, and a nation that is less 
caring toward its most vulnerable children, families, and 
senior citizens.
    The decisions that have led to this unhappy situation have, 
in fact, already been made by the Republican majority members 
who have voted for the Republican budget resolution and against 
our efforts to modify it. This bill is the inevitable unhappy 
result of those decisions. The only way to achieve a more 
favorable final outcome is for this bill to move to conference 
with the Senate and be greatly altered to produce a more 
responsible result.

                                   David Obey.
                                   Steny Hoyer.
                                   Nita Lowey.
                                   Rosa L. DeLauro.
                                   Jesse L. Jackson, Jr.
                                   Patrick J. Kennedy.
                                   Lucille Roybal-Allard.
                                   
                                   

 MINORITY VIEWS OF THE HONORABLE DAVID OBEY, STENY HOYER, NITA LOWEY, 
 ROSA DeLAURO, JESSE JACKSON, JR., PATRICK KENNEDY, AND LUCILLE ROYBAL-
           ALLARD ON THE ADMINISTRATION'S OVERTIME REGULATION

    The Administration is poised--in a few short weeks--to 
implement the most sweeping, anti-worker revision of the Fair 
Labor Standards Act (FLSA) since its inception in 1938. The 
overtime pay requirements of the FLSA, which guarantee for most 
workers ``time and a half'' pay for hours worked beyond a 
standard 40-hour work week, are one of the nation's bedrock 
worker protections. The FLSA's overtime provisions cover 
approximately 115 million workers--about 85 percent of the 
nation's workforce.
    On August 23rd, 2004, the Department of Labor's final 
overtime regulations (redefining who is considered a 
professional, administrative, or executive employee and thereby 
exempt from overtime pay) are slated to go into effect, giving 
employers a huge windfall taken right out of employees' 
paychecks. On the eve of Labor Day, more than 6 million 
Americans soon will be getting less pay for their labors 
courtesy of the Bush Administration.
    This anti-worker regulation is just the latest attack on 
America's workers by this Administration. Since President Bush 
entered office, 1.8 million private sector jobs have been lost. 
Despite modest job creation in the last few months, some 8.2 
million Americans remain unemployed--2.3 million (38 percent) 
more than when President Bush entered office. Further, more 
unemployed individuals are out of work for longer periods of 
time. In June 2004, 1.7 million individuals had been unemployed 
for over 6 months--nearly triple the number of long-term 
unemployed at the start of the Administration.
    For families who received overtime pay in 2000, overtime 
earnings accounted for about 25 percent of their income or 
about $8,400 a year. Overtime compensation is essential to 
their ability to pay mortgages, medical bills, and make ends 
meet. Yet, despite the urgent need to halt the Administration's 
assault on these workers, the House Appropriations Committee 
rejected, by a party line vote of 29 to 31, a Democratic 
amendment that would have prevented the Administration from 
rolling back the 40-hour workweek.
    Last year, both the House and the Senate voted to stop the 
Administration from taking away workers' rights to overtime 
when theDepartment of Labor issued its initial proposal to 
strip overtime protections away from 8 million workers. The Senate 
twice adopted amendments offered by Senator Tom Harkin to prohibit the 
Administration from taking away overtime pay. Last October, the House 
voted to adopt the Obey-Miller Motion to Instruct by a vote of 221 to 
203.
    Both the Harkin Amendment and the Obey-Miller Motion to 
Instruct would have restricted the Administration's ability to 
disqualify anyone from overtime protection, while retaining 
virtually the only positive change in the initial regulation--a 
long overdue and non-controversial increase in the protective 
salary threshold to guarantee overtime rights for low-income 
workers. Democrats support extending overtime protections to 
more low-income workers, even though the Administration's 
proposal fails to provide a true inflationary adjustment to the 
salary threshold. (Moreover, we now know that that far fewer 
workers would actually benefit from this change than claimed by 
the Department of Labor.)
    Yet, despite passage of these measures in the Senate and 
the House--in opposition to all the traditions of the 
Congress--the Republican leadership stripped the Harkin 
language from the final fiscal year 2004 omnibus appropriations 
bill, allowing the Department of Labor to proceed with its 
anti-worker regulation.
    On July 14, the Committee on Appropriations had an 
opportunity to preserve the hard-earned overtime rights for 
working Americans by adopting the Democratic amendment. The 
Democratic amendment was identical, in effect, to the earlier 
measures approved by both the House and the Senate. It would 
have prohibited the Department of Labor from implementing the 
final rule to disqualify workers from overtime coverage. At the 
same time, it would have allowed the expansion of overtime 
rights for low-income workers earning up to $23,660 a year, 
precisely as proposed by the Department of Labor in its final 
regulation.
    The Democratic amendment would protect more than 6 million 
workers in a broad range of occupations now at risk of losing 
their overtime rights according to estimates made by the 
Economic Policy Institute (EPI).\1\ Indeed, an even larger 
number of workers are likely to be harmed by the Administration 
rule because EPI examined only 10 of the hundreds of 
occupational categories covered by the Bush anti-worker 
regulation.
---------------------------------------------------------------------------
    \1\ Ross Eisenbrey, Economic Policy Institute, ``Longer Hours, Less 
Pay'', July 14, 2004.
---------------------------------------------------------------------------
    The Democratic amendment would protect:
           2.3 million workers who lead teams of other 
        employees assigned to major projects--even if these 
        team leaders have no direct supervisory 
        responsibilities for other employees on the team. About 
        40 percent of employers with 50 or more employees 
        routinely use work teams. Under the Department of 
        Labor's final regulation, however, we can expect even 
        more employers to take advantage of this new exemption 
        with enormous negative consequences for employees;
           Nearly 2 million low-level working 
        supervisors in fast food restaurants, lodging and 
        retail stores. Under the Department of Labor's final 
        regulation, these employees could lose 100 percent of 
        their overtime eligibility even though only a small 
        percentage of their time is spent on managerial work. 
        For example, low-paid Burger King assistant manager who 
        spends nearly all of his or her time cooking hamburgers 
        and serving customers, with no authority to hire or 
        fire subordinates, could lose all of his or her 
        overtime pay. Moreover, it will not be easier for 
        employers to evade the rules by converting hourly 
        employees to exempt salaried employees;
           More than 1 million employees without a 
        college or graduate degree. These employees will now be 
        exempt from overtime pay as professional employees 
        because employers will be able to substitute work 
        experience for a degree under the Department of Labor's 
        final regulation.
    Moreover, the Department of Labor has not resolved the 
question of whether training in the military can be considered 
substitute work experience. Thus, despite Labor Department 
denials, many veterans employed in engineering, accounting, and 
technical occupations could lose overtime pay. For example, the 
Boeing corporation observed, ``* * * many of its most skilled 
technical workers received a significant portion of their 
knowledge and training outside of the university classroom, 
typically in a branch of the military service * * *''\2\;
---------------------------------------------------------------------------
    \2\ Cheryl A. Russell, Boeing's director of federal affairs as 
quoted in The Washington Post, January 29, 2004.
---------------------------------------------------------------------------
           30,000 nursery school and Head Start 
        teachers. These already low-paid employees, who 
        currently receive overtime pay because their jobs do 
        not require them to exercise sufficient discretion and 
        judgment to be considered professional employees, will 
        lose the right to extra pay under the Department of 
        Labor's final regulation;
           160,000 mortgage loan officers and hundreds 
        of thousands of additional workers in the financial 
        services industry. These employees will lose their 
        overtime rights because of a blanket industry exemption 
        in the Department of Labor final regulation for 
        financial service employees who work at such duties as 
        collecting customer financial information, providing 
        information and advice about financial products, or 
        marketing financial products;
           Nearly 90,000 computer employees, funeral 
        directors and licensed embalmers. These employees will 
        become exempt and lose their right to pay under the 
        Department of Labor's final regulation; and
           Nearly 400,000 workers earning more than 
        $100,000 annually. Under the Department of Labor final 
        regulation, these highly compensated employees will 
        lose overtime pay under a new blanket exemption if they 
        perform only a single exempt task ``customarily or 
        regularly'', such as suggesting discipline, promotion 
        or assignment of other employees perhaps as 
        infrequently as twice a year. Over time, as incomes 
        grow, the number of employees bumped into this new 
        exclusion from overtime pay will increase.
    The Department of Labor failed to hold a single public 
hearing on one of the most controversial regulations in the 
history of the Department, despite receiving 75,280 comments on 
its proposals. Indeed, the Department of Labor even provided 
information to employers in its initial regulation on how to 
escape overtime pay requirements as part of a concerted 
campaign to give employers dozens of new ways--both obvious and 
subtle--to reclassify workers to cut costs.

          Affected employers would have four choices concerning 
        potential payroll costs: (1) Adhering to a 40 hour work 
        week; (2) paying statutory overtime premiums for 
        affected workers' hours worked beyond 40 per week; (3) 
        raising employees' salaries to levels required for 
        exempt status by the proposed rule; or (4) converting 
        salaried employees' basis of pay to an hourly rate (no 
        less than the federal minimum wage) that results in 
        virtually no (or only a minimal) changes to the total 
        compensation paid to those workers. Employers could 
        also change the duties of currently exempt and 
        nonexempt workers to comply with the proposed rule.\3\
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    \3\ Federal Register, Vol. 68, No. 61, March 31, 2003, page 15576.

    The Administration claims that its overtime regulation will 
strengthen and expand overtime protections. The facts say 
different. Even the Republican-led Senate voted 99 to 0 in 
favor of the amendmentoffered by Senator Judd Gregg to protect 
overtime rights in 55 job classifications--including blue-collar 
workers, registered nurses, police officers, and firefighters--because 
they had no confidence in the Administration's claims.
    The Administration claims that its overtime regulation will 
reduce costly and lengthy litigation. However, three experts 
who formerly administered the FLSA in the Department of Labor 
during both Republican and Democratic administration reached 
exactly the opposite conclusion,

          Further, in our view, the Department has written 
        rules that are vague and internally inconsistent, and 
        that will likely result in a profusion of confusion and 
        court litigation--outcomes that the Department 
        explicitly sought to avoid. \4\
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    \4\ John Fraser, Monica Gallagher, and Gail Coleman, ``Observations 
on the Department of Labor's Final Regulations Defining and Delimiting 
the [Minimum Wage and Overtime] Exemptions for Executive, 
Administrative, Professional, Outside Sales and Computer Employees'', 
July 2004.

     For example, the former Department of Labor officials 
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observed that,

          The team leader provision in new Sec. 541.203(3) is 
        an entirely new regulatory concept that is also fraught 
        with ambiguity. This provision is not based on case 
        law, but is purportedly an attempt to reflect modern 
        workplace practices. . . . Furthermore, the regulations 
        do not address the very real possibility that team 
        leaders may be working on a number of different short- 
        or long-term projects, simultaneously or in succession, 
        some of which would be major and directly related to 
        the performance of management or general business 
        operations and some of which would not. Evaluating the 
        team leader's primary duty in that instance will be 
        very difficult at best. Would the employee, for 
        example, move in and out of exempt status from one week 
        to the next? How this provision will operate in 
        practice can only be imagined, but one can surmise that 
        employers will seek to apply this provision to large 
        numbers of employees to whom the exemption was never 
        intended to apply.\5\
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    \5\ Ibid.

    Rather than providing more clarity to protect more workers, 
the Administration's overtime regulation constituents an open 
invitation to dispute. The Department of Labor deliberately has 
replaced longstanding, objective criteria by which employers 
and employees could clearly understand who qualifies for 
overtime pay and who does not with ambiguous concepts and 
criteria. These changes will require subjective judgments by 
employers that no doubt will be made based on the employers' 
economic interests to the detriment of workers. Practically the 
only instances in which the Labor Department ``clarified'' the 
rules are by declaring virtually entire classes of workers--for 
example, financial services workers, insurance claims 
adjusters, athletic trainers, funeral directors and embalmers, 
and employees earning more than $100,000--ineligible for 
overtime pay.
    At a time when millions of families feel lucky just to have 
a job, this Committee should have rejected the Administration's 
proposed pay cut for 6 million American families. By failing to 
adopt the Democratic amendment, the Committee failed to uphold 
the values of working and middle class Americans who simply 
want a fair day's pay for a hard day's work.

                                   David Obey.
                                   Steny Hoyer.
                                   Nita Lowey.
                                   Rosa L. DeLauro.
                                   Jesse L. Jackson, Jr.
                                   Patrick J. Kennedy.
                                   Lucille Roybal-Allard.