[Senate Report 105-300]
[From the U.S. Government Publishing Office]



                                                       Calendar No. 539
105th Congress                                                   Report
                                 SENATE

  2d Session                                                    105-300
_______________________________________________________________________


 
  DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION AND 
               RELATED AGENCIES APPROPRIATION BILL, 1999

                                _______
                                

 September 8 (legislative day, August 31), 1998.--Ordered to be printed

_______________________________________________________________________


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

                              R E P O R T

                         [To accompany S. 2440]

    The Committee on Appropriations reports the bill (S. 2440) 
making appropriations for Departments of Labor, Health and 
Human Services, and Education and related agencies for the 
fiscal year ending September 30, 1999, and for other purposes, 
reports favorably thereon and recommends that the bill do pass.


Amount of budget authority

Total bill as reported to Senate........................$287,592,472,000
Amount of adjusted appropriations, 1998................. 262,257,417,000
Budget estimates, 1999.................................. 286,606,839,000
The bill as reported to the Senate:
    Over the adjusted appropriations for 1998...........  25,335,055,000
    Over the budget estimates for 1999..................     985,633,000


                            C O N T E N T S

                              ----------                              
                                                                   Page
Budget estimates.................................................     4
Title I--Department of Labor:
    Employment and Training Administration.......................    10
    Pension and Welfare Benefits Administration..................    27
    Pension Benefit Guaranty Corporation.........................    28
    Employment Standards Administration..........................    28
    Occupational Safety and Health Administration................    30
    Mine Safety and Health Administration........................    32
    Bureau of Labor Statistics...................................    33
    Departmental management......................................    34
    Assistant Secretary for Veterans' Employment and Training....    36
Title II--Department of Health and Human Services:
    Health Resources and Services Administration.................    38
    Centers for Disease Control and Prevention...................    61
    National Institutes of Health................................    84
    Substance Abuse and Mental Health Services Administration....   146
    Agency for Health Care Policy and Research...................   154
    Health Care Financing Administration.........................   157
    Administration for Children and Families.....................   170
    Administration on Aging......................................   183
    Office of the Secretary......................................   187
Title III--Department of Education:
    Education reform.............................................   201
    Education for the Disadvantaged..............................   209
    Impact aid...................................................   214
    School improvement programs..................................   216
    Child literacy initiative....................................   223
    Indian education.............................................   224
    Bilingual and immigrant education............................   224
    Special education............................................   226
    Rehabilitation services and disability research..............   229
    Special institutions for persons with disabilities:
        American Printing House for the Blind....................   234
        National Technical Institute for the Deaf................   234
        Gallaudet University.....................................   234
    Vocational and adult education...............................   235
    Student financial assistance.................................   237
    Federal family education loan program........................   238
    Higher education.............................................   239
    Howard University............................................   248
    College housing and academic facilities loans................   249
    Historically black college and university capital financing 
      program....................................................   249
    Education research, statistics, and improvement..............   249
    Departmental management......................................   258
    Office for Civil Rights......................................   258
    Office of the Inspector General..............................   259
Title IV--Related agencies:
    Armed Forces Retirement Home.................................   260
    Corporation for National and Community Service...............   260
    Corporation for Public Broadcasting..........................   262
    Federal Mediation and Conciliation Service...................   263
    Federal Mine Safety and Health Review Commission.............   263
    Institute of Museum and Library Services.....................   263
    Medicare Payment Advisory Commission.........................   265
    National Commission on Libraries and Information Science.....   266
    National Council on Disability...............................   266
    National Education Goals Panel...............................   266
    National Labor Relations Board...............................   266
    National Mediation Board.....................................   267
    Occupational Safety and Health Review Commission.............   267
    Railroad Retirement Board....................................   267
    Social Security Administration...............................   268
    U.S. Institute of Peace......................................   273
Title V--General provisions......................................   274
Title VI--Center for Complementary and Alternative Medicine......   275
Budgetary impact of bill.........................................   276
Compliance with paragraph 7, rule XVI of the standing rules of 
  the Senate.....................................................   276
Compliance with paragraph 7(C), rule XXVI of the standing rules 
  of the Senate..................................................   277
Compliance with paragraph 12, rule XXVI of the standing rules of 
  the Sen- ate...................................................   278
Comparative statement of new budget authority....................   282

       Summary of Budget Estimates and Committee Recommendations

    For fiscal year 1999, the Committee recommends total budget 
authority of $287,597,472,000 for the Department of Labor, 
Health and Human Services, and Education, and Related Agencies. 
Of this amount, which includes subsequent year advances, 
$82,744,000,000 is current year discretionary funding.

                           allocation ceiling

    Consistent with Congressional Budget Office scorekeeping, 
the recommendations result in full use of the $82,319,000,000 
in general purpose discretionary budget authority pursuant to 
section 302(b) of the Congressional Budget Act of 1974, as 
amended. In addition, the recommendations include $405,000,000 
in budget authority for the Social Security Administration to 
conduct continuing disability reviews provided consistent with 
Public Law 104-124 and Public Law 104-193 and $20,000,000 for 
adoption incentive programs conducted by the Administration on 
Children and Families, provided consistent with Public Law 95-
266.

                         Highlights of the Bill

    Youth employment and training.--The Committee bill provides 
$1,750,965,000 for programs to provide training and work 
experience to youths. This amount includes $871,000,000 for 
summer youth employment and training, $375,000,000 for youth 
opportunities for fiscal years 1999 and 2000, $129,965,000 for 
youth training, and $250,000,000 for school-to-work.
    Job Corps.--The Committee recommendation includes 
$1,300,572,000 for the Job Corps, an increase of $54,355,000 
over the 1998 level.
    Worker protection.--The Committee bill includes 
$1,249,000,000 to ensure the health and safety of workers, 
including $348,983,000 for the Occupational Safety and Health 
Administration and $211,165,000 for the Mine Safety 
Administration.
    National Institutes of Health.--A total of $15,622,386,000 
is recommended to fund biomedical research at the 24 
Institutes, centers, and divisions that comprise the NIH. This 
represents an increase of $2,000,000,000 over the fiscal year 
1998 level.
    AIDS.--The Committee bill includes an estimated 
$3,959,579,000 for AIDS research, prevention, and services. 
This includes $1,217,800,000 for Ryan White programs, an 
increase of $68,288,000, and $631,779,000 for AIDS prevention 
programs at the Centers for Disease Control and Prevention.
    Women's health.--The Committee bill provides $15,495,000 
for programs focused on the advancement of women's health 
initiatives, an increase of $3,000,000 from the 1998 funding 
level. The Committee recommends an additional $145,000,000 for 
breast and cervical cancer screening, an increase of $2,221,000 
over the 1998 level.
    Infectious diseases.--The Committee bill provides 
$115,215,000 within the Centers for Disease Control and 
Prevention to combat the growing threat of infectious disease. 
The amount recommended is an increase of $2,358,000 over the 
fiscal year 1998 amount.
    Bioterrorism initiative.--The Committee bill recommends 
$158,750,000 to fund efforts to address the troubling threat of 
bioterrorism. These funds will be made available if the 
President declares an emergency.
    Family planning.--The Committee bill recommends 
$215,000,000 for the family planning program, an increase of 
$12,097,000 over last year's appropriation. These funds support 
primary health care services at over 4,000 clinics nationwide.
    Child care and development block grant.--The Committee 
recommendation provides $1,182,672,000 for child care services, 
$182,672,000 more than last year's level. This is in addition 
to the $2,167,000,000 appropriated in welfare reform 
legislation for child care.
    Community services block grant.--The Committee bill 
includes $490,600,000, an increase of almost $1,000,000 over 
the 1998 level.
    Head Start.--The Committee recommendation includes 
$4,660,000,000 for the Head Start Program. This represents an 
increase of $312,567,000 over the 1998 enacted level.
    Low-income home energy assistance.--The Committee 
recommends $1,100,000,000 for heating and cooling assistance 
for low-income individuals and families as an advance 
appropriation for fiscal year 2000. Also included is bill 
language permitting up to $300,000,000 in funding to provide 
additional energy assistance during weather emergencies.
    Crime reduction.--The bill recommends $148,000,000 for 
violent crime reduction activities, including $88,800,000 for 
battered women's shelters.
    Drug abuse.--A total of $3,394,664,000 is included for drug 
abuse prevention, treatment, and research activities, including 
$381,000,000 for safe and drug free schools and communities.
    Grants for disadvantaged children.--The Committee bill 
provides $7,676,020,000 for grants to disadvantaged children, 
$300,788,000 more than the 1998 level.
    School violence initiative.--The Committee bill 
recommendation includes $151,000,000 for programs to combat the 
increasing instances of school violence. An additional 
$16,723,000 is provided for youth offender education grants, 
and $7,000,000 for at-risk youth substance abuse prevention 
grants.
    Student financial aid.--The Committee recommends 
$10,214,551,000 for student financial assistance, including 
$900,000,000 for the Federal Work Study Program. The amount 
provided for the Pell Grant Program will allow the maximum 
grant to be raised to $3,100, an increase of $100 over the 1998 
amount.
    Higher education initiatives.--The Committee bill provides 
$1,138,944,000 for initiatives to provide greater opportunities 
for higher education, including $75,000,000 for Connections 
grants, $10,000,000 for Learning Anytime Anywhere partnership 
grants, and $75,000,000 to improve teacher quality training.
    Education for individuals with disabilities.--The Committee 
bill provides $5,112,946,000 to ensure that all children have 
access to a free and appropriate education, and that all 
infants and toddlers with disabilities have access to early 
intervention services. This represents an increase of 
$512,300,000 over the 1998 level.
    Rehabilitation services.--The bill recommends 
$2,645,266,000 for rehabilitation services, an increase of 
$54,071,000 above the amount provided in 1998. These funds are 
essential for families with disabilities seeking employment.
    Services for older Americans.--For programs serving older 
Americans, the Committee recommendation totals $2,108,181,000 
including $440,200,000 for community service employment for 
older Americans, $300,319,000 for supportive services and 
centers, and $486,412,000 for senior nutrition programs. For 
the medical research activities of the National Institute on 
Aging, the Committee recommends $596,521,000, an increase of 
15.1 percent. The Committee recommendation includes 
$15,5000,000 for the Medicare insurance counseling program, and 
$6,000,000 for the Alzheimer's demonstration grants program.
    Public broadcasting.--The Committee bill provides 
$340,000,000 to support public radio and television, an 
increase of $40,000,000 over the previous year's appropriation. 
In addition, $15,000,000 is provided, contingent upon 
authorization, for public broadcasting's digitalization 
program.
    Social Security Administration.--The Committee bill 
recommends $6,462,000,000, an increase of $52,960,000 over the 
1998 level.

              reprogramming and initiation of new programs

    Reprogramming is the utilization of funds for purposes 
other than those contemplated at the time of appropriation 
enactment. Reprogramming actions do not represent requests for 
additional funds from the Congress, rather, the reapplication 
of resources already available.
    The Committee has a particular interest in approving 
reprogrammings which, although they may not change either the 
total amount available in an account or any of the purposes for 
which the appropriation is legally available, represent a 
significant departure from budget plans presented to the 
Committee in an agency's budget justification.
    Consequently, the Committee directs that the Departments 
and agencies funded through this bill make a written request to 
the chairman of the Committee prior to reprogramming of funds 
in excess of 10 percent, or $250,000, whichever is less, 
between programs, activities, or elements. The Committee 
desires to have the requests for reprogramming actions which 
involve less than the above-mentioned amounts if such actions 
would have the effect of changing an agency's funding 
requirements in future years, if programs or projects 
specifically cited in the Committee's reports are affected or 
if the action can be considered to be the initiation of a new 
program.
    The Committee directs that it be notified regarding 
reorganization of offices, programs, or activities prior to the 
planned implementation of such reorganizations.
    The Committee further directs that each agency under its 
jurisdiction submit to the Committee statements on the effect 
of this appropriation act within 60 days of final enactment of 
this act.

                           transfer authority

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

               addressing the year 2000 computer problem

    The Committee is concerned about the ability of the Federal 
Government to deliver uninterrupted program services into the 
21st century. To do so, each Department and Agency must ensure 
that its information technology systems are year 2000 
compliant. This means that at the beginning of the new 
millenium, computers and telecommunication systems that are 
date sensitive will correctly interpret 01/01/00 as January 1, 
2000, not January 1, 1900. The Committee is devoting sufficient 
resources so that all mission critical computer systems that 
are not year 2000 compliant will be repaired or replaced, and 
subsequently tested to demonstrate their readiness. The 
Committee notes that a Governmentwide year 2000 fund is being 
established to provide emergency resources should there be a 
need for additional funding.

                 government performance and results act

Department of Labor
    The Committee received the Labor Department's performance 
plans in a timely manner--at the same time as the fiscal year 
1999 budget justification. In general, the Labor Department's 
work is organized around three strategic goals: (1) A prepared 
work force--enhance opportunities for America's work force; (2) 
a secure work force--promote the economic security of workers 
and families; and (3) quality workplaces--foster quality 
workplaces that are safe, healthy, and fair.
    For each of the three strategic goals there are supporting 
outcome goals in the fiscal year 1999 performance plan that 
refine and further focus the strategic goals. For each outcome 
goal, there are supporting performance goals that set specific 
and measurable target levels of performance for the Labor 
Department's agency programs for the fiscal year. Linkage to 
the budget is provided in the Labor Department annual 
performance plan by cross-referencing Labor Department budget 
activities to the Department's three strategic goals. Specific 
linkages between individual agency performance measures and 
budget activities are provided in the individual agency 
performance plans.
    With regard to the means for measuring performance, the 
Committee believes that the Labor Department has made 
significant progress by including measures in their performance 
plans for key program activities in the budget. The Department 
will still need to analyze programs for representative measures 
of core work, test the measures, and establish reporting 
systems that capture the data in a timely and accurate manner. 
Once reporting systems are in place, the Committee expects that 
the Labor Department's plans will be valuable instruments for 
decisions on resource allocation.
Department of Health and Human Services
    The fiscal year 1999 annual performance plan for the 
Department of Health and Human Services contains valuable 
information about how HHS intends to accomplish its mission. 
However, many parts of the plan could better fulfill the 
Results Act's purpose of ensuring that Congress has the 
necessary information to assess whether HHS programs are 
achieving intended results. In particular, more HHS agencies 
could consistently set measurable performance goals, provide 
information about how they will coordinate with each other and 
other performance partners to achieve related goals, identify 
the resources they need to accomplish their goals, and discuss 
how they intend to address problems with their performance 
data.
    The HHS plan could better discuss how HHS will accomplish 
its performance goals. Only some of the agencies indicate what 
strategies they intend to use. Furthermore, HHS has missed the 
opportunity to address the HHS-wide management challenges that 
it acknowledged in its strategic plan. For example, the 
performance plan discusses neither HHS-wide information 
technology resources needed to improve performance, nor a 
comprehensive strategy for addressing the year 2000 problem.
    The plan could provide more assurance that the information 
used to measure HHS's performance will be credible. For 
example, both the strategic and performance plans point out 
that the absence of reliable data from HHS's performance 
partners is a critical problem. HHS's agencies vary in the 
extent to which they include required information on data 
verification and validation. Additionally, while HHS and many 
of its agencies include thoughtful discussions of data 
limitations, they often do not say how they will address data 
limitation problems.
Department of Education
    Overall, the Department of Education's GPRA fiscal year 
1999 annual performance plan is a useful document and includes 
the elements required by the Results Act. The plan could 
benefit from more information, clarity, and content in some of 
its components. Specifically, the plan should include an 
explanation of the relationship between the Department's long-
term goals and objectives and its annual performance goals. It 
should also contain a complete description and schedule of 
program evaluations. The plan could better address the 
Department's major statutory requirements, such as 
responsibilities for the Civil Rights Act.
    The Department's performance plan contains 4 strategic 
goals and 22 crosscutting strategic objectives with strategies 
and measures, plus objectives related to the individual agency 
program plans. However, the plan does not provide a complete 
picture of intended performance across the agencies, nor does 
it discuss the strategies and resources to be used to achieve 
the Department's annual performance goals. Although the plan 
adequately discusses how it plans to validate and verify 
performance information, the Committee is not confident that 
all the performance information is credible to accurately 
measure program outcomes.

                     social security administration

    The Social Security Administration's fiscal year 1999 
annual performance plan establishes performance goals for each 
of the agency's five strategic goals. However, the plan 
provides an incomplete picture of intended performance across 
the agency. The quality and clarity of the 67 performance goals 
vary widely. Some are objective and measurable, while others 
are not. As a result, in some cases it is difficult to see how 
SSA will assess its progress. Also, SSA does not show how its 
performance goals relate to the program activities in its 
budget structure.
    SSA's plan does not provide enough detail on how the 
agency's strategies and resources will help achieve its goals. 
As a result, it is difficult to tell whether SSA has adequately 
planned how it will achieve results, or whether its performance 
goals are reasonable given its resources. SSA's plan does not 
provide sufficient confidence that its performance information 
will be credible. The plan states that the agency will rely on 
its inspector general to review the data systems underlying its 
performance measures, but the plan does not provide information 
about the key steps the agency is taking to ensure data 
integrity.
    SSA's performance plan would be more useful if the 
performance goals noted key management challenges facing the 
agency. For example, for several years SSA's Supplemental 
Security Income Program has not received sufficient oversight. 
However, SSA's plan does not contain a set of comprehensive 
measures to improve the management of the program. In addition, 
SSA is uniquely positioned to inform Congress and the public 
about long-term Social Security financing issues; however, the 
plan's set of goals related to conducting effective policy 
development and research provides little insight into how the 
agency will meet the information needs of Congress.

                      TITLE I--DEPARTMENT OF LABOR

                 Employment and Training Administration

                    training and employment services

Appropriations, 1998....................................  $5,232,737,000
Budget estimate, 1999...................................   5,323,373,000
Committee recommendation................................   5,159,375,000

    The Committee recommends $5,159,375,000 for this account in 
1999 which provides funding authorized primarily by the Job 
Training Partnership Act [JTPA]. This is $73,362,000 less than 
the 1998 level. In addition, $250,000,000 is appropriated for 
fiscal year 2000 for youth opportunity grants, available April 
1, 2000, to June 30, 2001.
    Training and employment services is comprised of programs 
designed to enhance the employment and earnings of economically 
disadvantaged and dislocated workers, operated through a 
decentralized system of skill training and related services. 
This appropriation is generally forward-funded on a July-to-
June cycle. Funds provided for fiscal year 1999 will support 
the program from July 1, 1999, through June 30, 2000.
    The Committee recognizes that the enactment of the 
Workforce Investment Act of 1998 will significantly change how 
job training and employment programs are operated in the 
future, and will work closely with the administration to ensure 
that the new work force system function as intended--to 
consolidate, coordinate, and improve employment and training 
programs, utilizing a local level one-step delivery system. The 
Committee also recognizes that the new act is authorized for 
the program year starting July 1, 1999, the period covered by 
the fiscal year 1999 appropriations bill for the ``Training and 
Employment Services'' appropriation account. Although JTPA is 
not repealed until July 1, 2000, there may be several States 
which elect to implement and operate their job training and 
employment programs under the Workforce Investment Act. The 
Committee encourages the Secretary to help those States which 
are able to implement their programs under the new legislation 
effective July 1, 1999.
    The Committee expects the Secretary to allocate funds 
appropriate for titles II-A, II-B, II-C, and III to States in 
accordance with the provisions of the Job Training Partnership 
Act.
    The Workforce Investment Act will require the Department of 
Labor and States and localities to expend much time and energy 
to transition to the new system, and will also require the 
Department to recognize and align functions within the 
Department of Labor and within the Employment and Training 
Administration in order to carry out the duties and 
responsibilities required by the act. The Committee cannot 
provide additional funds for these purposes, but it has 
included reprogramming and transfer authority in the bill. The 
Committee will give serious consideration to reprogramming and 
transfer requests from the Department for these purposes.
    Adult training--title II-A.--For the Adult Training Program 
under title II-A of the JTPA, the Committee recommends 
$950,000,000. This is $5,000,000 less than the 1998 comparable 
level. The Adult Training Program is designed to prepare 
economically disadvantaged adults for participation in the 
labor force by increasing their occupational and educational 
skills, resulting in improved long-term employability, 
increased employment and earnings, and reduced welfare 
dependency. It is operated at the local level through service 
delivery areas designated by the Governor. Each area has a 
private industry council to provide guidance and oversight with 
respect to activities under that area's job training plan, in 
partnership with the unit or units of general local government 
in the areas. The private industry council includes 
representatives of the private sector, educational agencies, 
organized labor, and other groups in the area. All funds are 
allocated to the States by statutory formula.
    Youth training--title II-C.--For the Youth Training Program 
under title II-C of the act, the Committee recommends 
$129,965,000. This is the same as the budget request and the 
1998 comparable level. The title II-C Youth Training Program is 
designed for youth to improve their long-term employability, 
enhance their educational, occupational, and citizenship 
skills, encourage their school completion, increase their 
employment and earnings, and reduce welfare dependency. Like 
adult training, the program is administered by local service 
delivery areas, as directed by private industry councils.
    Summer youth employment and training--title II-B.--For the 
Summer Youth Program under title II-B of the act, the Committee 
recommends $871,000,000. This is the same as the budget request 
and the 1998 comparable level. The Summer Youth Program offers 
work experience, supportive services, and academic enrichment 
to economically disadvantaged youth, aged 14 to 21. 
Participants receive the minimum wage. Funds are allocated to 
the States by formula based on relative numbers of unemployed 
and economically disadvantaged individuals.
    Dislocated worker assistance.--The Committee recommends 
$1,405,510,000 for dislocated worker programs. This is 
$45,000,000 below the budget request and $55,000,000 over the 
1998 comparable level. The title III system provides for early 
identification of dislocated workers, the rapid provision of 
services to such workers, and quality training. Among the 
program's components are universal rapid response capabilities, 
early intervention activities, the availability of needs-
related payments to assist workers in training, and substate 
delivery systems. Funds are allocated to the States by 
statutory formula; 20 percent is retained by the Secretary for 
discretionary purposes.
    To promote greater flexibility in local decisionmaking, the 
Committee has once again included bill language that allows 
service delivery areas to transfer funds provided between the 
title II-A Adult Training Program and title III Dislocated 
Worker Assistance Program, if such transfer is approved by the 
Governor. The Committee is aware of concerns that work 
participation requirements under welfare reform could foster 
such transfers to the detriment of services available to 
dislocated workers. The Committee is also aware of concerns 
that national reserve account funds may be used to provide 
services that could have been provided with funds that had been 
transferred from title III to II-A. Because of these concerns, 
the Committee has chosen to limit the transfer authority to 20 
percent.
    The Committee urges the Department to continue to seek 
permanent cooperative relationships with private outplacement 
firms and to fully utilize the private, for-profit sector in 
service to workers through the title I program.
    The Committee is aware of the severe worker dislocation 
brought on by the closure of one of three sugarcane plantations 
on the Hawaiian Island of Kauai, and the likely closure of a 
second plantation. To provide assistance to this rural 
community, the Committee encourages full and fair consideration 
of a $200,000 proposal from the Hawaii Department of Labor and 
the Kauai Cooperative Extension Service to use community-based 
expertise to provide agricultural and business training to 
dislocated sugarcane workers.
    The Committee recommends $3,000,000 to initiate the 
development of an industry-led consortium in Pennsylvania. This 
industry-led regional organization will assist Pennsylvania 
companies' efficiency and efforts to provide the highest levels 
of quality in meeting the training needs of their workers in 
order to enhance productivity and national competitiveness 
within Pennsylvania industry. The funds will support the cost 
associated with developing the consortium and on a targeted, 
matching and demonstration basis will in some instances cover 
the actual training costs of incumbent workers. The vast 
majority of the cost associated with training incumbent workers 
by companies involved in the consortium would be fully paid for 
by the companies themselves.
    The Committee recommends $1,000,000 to continue the 
JOBLINKS Program administered by the Community Transportation 
Association of America. The JOBLINKS Program provides technical 
assistance to local communities in developing and implementing 
strategies to get low-income people living in economically 
distressed communities to centers of employment. In light of 
the new work requirements for individuals receiving public 
assistance and the obstacle that the lack of transportation is 
to gaining a job, the Committee believes that continuation of 
this important program is warranted. As originally intended, 
the Committee directs the Department of Labor to expand the 
activities of the JOBLINKS Program to include up to 10 
demonstration sites, including an evaluation component, and to 
establish a center for technical assistance on employment and 
transportation issues.
    The Committee is aware of the severe problem facing the 
manufacturing industry in preparing skilled workers such as 
machinists and engineers to replace those workers who have 
retired or will be retiring from the industry in the next 
several years. Expanding this manufacturing base is key in 
moving people from poverty into skilled professions where an 
increase in the standards of living will directly impact 
regional economies. With a shortfall of approximately 2,000 
skilled machinists in the greater southeastern Pennsylvania 
region, Philadelphia Interfaith Action and Philadelphia Area 
Accelerated Manufacturing Education, Inc. [PHAME], a not-for-
profit educational initiative, have partnered to provide a 
year-long intensive training program (60 hours per week) and an 
interim living stipend to take unemployed and unskilled minimum 
wage employees and produce skilled employees for area 
manufacturers. The Committee expects the Department to review 
this partnership process and to support efforts to provide 
funding to enhance the skilled labor market by moving people 
from poverty into the labor force.
    The Committee recognizes the past efforts of Lehigh 
University's Iacocca Institute. Because manufacturing remains a 
cornerstone of the economy, real wages and productivity are on 
the decline, and the need to improve skills is essential, the 
Committee recommends $1,000,000 based on demonstrated 
performance for the institute so it may continue its national 
manufacturing work force demonstration that provides job 
training to dislocated and at-risk youth workers. The program's 
curriculum has been developed by Lehigh University researchers. 
The additional funding is necessary to continue the efforts 
with the Philadelphia Advanced Manufacturing Enterprise and to 
begin a replication of the program in the Bethlehem, PA, area. 
The program goals include activities that will facilitate 
national expansion of the program.
    The Committee is aware that the York Skill Center, serving 
the Pennsylvania counties of York, Adams, and Cumberland, is 
seeking Federal assistance for a high-technology skill training 
center for workers in advanced manufacturing. The 
recommendation includes $1,000,000 for this effort, developed 
through local partnerships of industry, labor, education, 
community-based organizations, and economic development 
organizations, and designed to provide training for local skill 
shortage occupations, including welding, computerized numeric 
control metal machinery, printing, plastic assembly, and 
plastic injection.
    The Committee understands that technology centers have been 
very successful and helpful at providing technical assistance 
to businesses in a variety of areas, including plastics, 
pollution prevention, hydraulics, electrical maintenance worker 
training, or printing.
    The Committee strongly urges the Department to support with 
fiscal year 1998 funds the proposal to expand this program, 
using the existing infrastructure throughout the Midwest to 
train and retrain incumbent workers in such training programs 
as environmental standards/painting, printing and maintenance, 
and hydraulics and pneumatics.
    A partnership of labor, unions, employers, technology 
centers, and Government would provide both the support and the 
expertise to train and retrain workers and will be a driving 
force in the retention of workers, increase job security, and 
in improving wage rates for today's manufacturing workers. This 
partnership will help achieve worker outreach and recruitment, 
outreach and recruitment of firms, joint training, models and 
mentors for workers, and recruitment of a highly qualified pool 
of trainers to achieve the necessary level of proficiency for 
these workers.
    The Committee provides $5,000,000 from the JPTA dislocated 
worker program for use by the organizing committee for the 1999 
Special Olympics World games to enhance employment 
opportunities for individuals with mental disabilities.
    The Committee recommendation includes $1,000,000 for a 
high-technology training initiative on the Island of Maui with 
a focus on improving the representation of women in computer 
networking, telecommunications, and to develop training and 
curriculum models to meet the increasing need for workers in 
the telecommunications industry. The Committee expects the 
local business community, in conjunction with the community 
colleges, to develop an effective partnership with business and 
community colleges. The Committee expects that a similar effort 
will be developed in Alaska.
    The recommendation includes $1,000,000 for a demonstration 
project at the University of Texas, Brownsville to develop a 
model worker retraining program for employees dislocated by the 
recent pending plant closures of Hagar, Levi Strauss, and 
others. This project will serve as a demonstration for 
successful techniques for retraining these moderately skilled 
workers along the economically volatile United States/Mexico 
border region, with its unique cultural, educational, and 
vocational needs.
    Native Americans.--For native American programs, the bill 
provides $59,315,000. This is $5,500,000 more than the budget 
request and the 1998 comparable level. These programs are 
designed to improve the economic well-being of disadvantaged 
native Americans through vocational training, work experience, 
and other services aimed at getting participants into permanent 
unsubsidized jobs.
    The Committees recommendation includes $5,000,000 for the 
State of Hawaii to colocate Federal and State funded work force 
investment activities as authorized by section 166(j) of the 
Workforce Investment Act of 1998. There are approximately 
20,000 to 25,000 American Samoans residing in Hawaii. These 
indigenous people have a unique status as U.S. nationals and 
are the only Pacific islander people under the territorial 
protection of the United States possessing the right to travel 
freely throughout all U.S. States and territories.
    American Samoans transition from a highly rural, community 
oriented society, and thus face numerous acculturation 
difficulties, including language and cultural barriers, leaving 
behind their matai system and extended families. Their 
unemployment rate at 12 percent, is estimated to be three times 
that of the State's average; 26 to 30 percent of recognized 
gangs in Hawaii are Samoan.
    The center will be located in public housing at Kuhio Park 
Terrace/Kuhio Homes which has 706 living units; 94 percent of 
these homes are headed by females, 86 percent are single 
parents, and 69 percent are unemployed.
    Migrant and seasonal farmworkers.--For migrant and seasonal 
farmworker programs, the bill provides $71,517,000. This is 
$500,000 more than the budget request and the 1998 comparable 
level. This program is aimed at alleviating chronic 
unemployment and underemployment being experienced by 
farmworker families. Training and employability development 
services prepare farmworkers for stable, year-round employment, 
both in and outside the agricultural industry. Supportive 
services such as transportation, housing, health care, and day 
care are also provided.
    The Committee is aware of the role the Association of 
Farmworker Opportunity Programs [AFOP], a trade association 
whose membership comprises JTPA section 402 grantees, has 
played in supporting an effective partnership between grantees 
and the Department of Labor. Through this partnership, the 
Committee believes that the issues related to child labor in 
agriculture and the needs of out-of-school farmworker youth can 
be most effectively addressed. The Committee has recommended 
sufficient funds to maintain support of technical assistance 
efforts through AFOP and others targeted at increasing the 
capability of section 402 grantees to deal with these critical 
issues. Through direct support of the grantee service delivery 
system, the Committee believes the greatest benefit is accrued 
to the farmworkers and their families.
    The Committee is aware of the vocational needs of at-risk 
and out-of-school farmworker youth. The Committee believes the 
JTPA section 402 program is the logical vehicle for delivery of 
needed services to such farmworker youth and recommends the 
additional $5,000,000 the administration requested for this 
purpose in the ``Pilots and demonstrations'' account of JTPA. 
The Committee urges the Department to transfer these funds to 
the section 402 program, to be administered in conjunction with 
the adult program, for grants to section 402 grantees, 
requesting each grantee to design a vocational program to 
address the needs of local farmworker youth.
    The Committee notes that the Workforce Investment Act 
authorizes a migrant and seasonal farmworker program 
administered by a single organizational unit within the 
Department's national office. The Committee supports this view. 
The Committee is aware that the Department is currently 
developing a new allocation formula for this program. The 
formula should assure that funds for the migrant and seasonal 
farmworker program are allocated in a fair and reasonable 
proportion to the number of eligible migrant and seasonal 
farmworkers.
    The Committee again reminds the Department that applicants 
for funding under the JTPA section 402 program must demonstrate 
a prior existing capacity to specifically serve the employment 
and training needs of migrant and seasonal farmworkers, and 
further reminds the Department of applicable provisions of the 
current law that states that the Secretary shall provide 
services to farmworkers through public agencies and private 
nonprofit organizations with a previously demonstrated 
capability to administer effectively a diversified 
employability development program for migrant and seasonal 
farmworkers.
    The Committee recommends that the Department of Labor 
continue to fund farmworker housing grants at a level not less 
than $3,000,000 for program year 1999. There funds should be 
used to enable housing organizations across the Nation to 
support the planning, development, and management of housing 
for agricultural workers.
    Job Corps.--For the Job Corps, the Committee recommends 
$1,300,572,000 for program year 1999. This is a decrease of 
$7,047,000 below the budget request and an increase of 
$54,355,000 above the 1998 comparable level. The amount in the 
bill includes $1,150,000,000 for operations and $150,572,000 
for facility construction, rehabilitation, and maintenance.
    The Committee acknowledges the efforts being made by the 
Department to expedite the review process used to address the 
facility construction and rehabilitation needs of Job Corps 
centers and to investigate options such as design-build to meet 
these requirements. The Department should continue to make 
every effort to streamline this process to ensure each center's 
construction and rehabilitation needs are met in the most cost 
effective and expeditious manner.
    In order to help single parents enroll and succeed in Job 
Corps, the Committee urges the Department to pursue linkages 
and collaborative interagency agreements with the appropriate 
agencies with the Department of Health and Human Services, 
including Head Start. Through colocated child care services for 
Job Corps students and their children on Job Corps campuses, 
Job Corps can better serve single parents and agencies, such as 
Head Start, can reach a greater number of needy children.
    The Committee encourages Job Corps to establish effective 
working relationships with work force development entities, 
including employers, that will enhance services to students and 
increase students' career opportunities. The Department is 
encouraged to intensify its efforts to meet industry standards 
in its occupational offerings by developing a multiyear process 
to review, upgrade, and modernize its vocational curricula, 
equipment, and programs in order to create career opportunities 
for students in appropriate growth industries. The Committee 
also encourages the Department of Labor's Employment and 
Training Administration to encourage Job Corps centers to 
coordinate with community-based organizations, such as 
substance abuse treatment centers, in innovative ways.
    The United States will host the 1999 Women's World Cup 
Soccer Tournament, the largest women's sporting event in 
history. The Committee encourages the Department to provide for 
materials needed to allow Job Corps trainees to participate in 
the preparations for the World Cup games. This partnership 
would allow Job Corps trainees to apply their developing 
vocational skills in a professional setting as part of an 
international sporting event.
    Veterans employment.--The Committee recommends $7,300,000 
for special veterans employment programs. This is the same as 
the budget request and the 1998 comparable level. These funds 
provide special employment and training programs designed to 
meet the unique needs of disabled, Vietnam-era, and recently 
separated veterans.
    The Committee urges that full and fair consideration be 
given to funding the employment and training demonstration 
proposal developed by Clayton College and State University 
relating to improving military-to-civilian employment 
transition. The project would allow members of the Armed Forces 
with a pay grade of E-6 or below to receive job-specific 
training during their spare time, using portable computers and 
Internet connections. The training for the project would be 
developed in coordination with the business community in order 
to provide a seamless transition from military service to 
employment in existing jobs in the private sector.
    School-to-work.--The Committee recommends $125,000,000 for 
school-to-work. This is the same as the budget request and a 
decrease of $75,000,000 below the 1998 comparable level. The 
school-to-work program is intended to provide a national 
framework within which all States can create statewide systems 
to help youth acquire the knowledge, skills, abilities, and 
labor market information they need to make an effective 
transition from school-to-work, or to further education or 
training. It is jointly administered by the Departments of 
Labor and Education.
    National activities.--For national activities $114,196,000 
is provided. This is $57,049,000 more than the budget request 
and $16,283,000 more than the 1998 comparable level. The bill 
includes funding for research and evaluation, $8,196,000; 
pilots and demonstrations, $85,000,000; the National 
Occupational Information Coordinating Committee, $10,000,000; 
skill standards, $7,000,000; and women in apprenticeship, 
$1,000,000.
    For homeless veterans, $3,000,000, is provided for the 
homeless veterans reintegration project, to be administered by 
the Assistant Secretary for Veterans Employment and Training 
Services. The Stewart B. McKinney Homeless Assistance Act 
authorization for this program was extended by the Veterans 
Benefits Improvement Act of 1996. It is anticipated that these 
funds will be awarded through a competitive grant process.
    The Committee has included $4,000,000 to implement the 
Department's requested quality child care initiative. These 
funds will allow the Bureau of Apprenticeship and Training 
[BAT], to establish at least 10 individual State systems for 
education and certification of child care providers through the 
National Registered Apprenticeship System. This initiative 
builds on the highly successful model in operation in West 
Virginia since 1989.
    The amount of $10,000,000 is provided to cover basic NOICC 
and SOICC activities including the development and delivery of 
occupational and career information to students, job seekers, 
employers, education and employment, and training programs 
(especially one-stop centers), school-to-work transition 
systems, military transition and staffing initiatives, and 
welfare to work efforts. At least 75 percent of this amount 
will pass through to State SOICC's. Of the total, up to 
$2,000,000 will support continuation of national and State 
career development and related capacity building programs which 
train personnel in assisting students and adults to understand 
themselves in the context of their career development and 
career transition, to be aware of the world of work, to 
understand the linkage between academic skills and work-related 
skills, to understand the linkages among related occupations 
and their skill requirements, and to make more informed, 
effective career decisions. In addition, the Committee included 
language which allows NOICC to charge fees for publications, 
training and technical assistance.
    The Committee recommendation includes $3,000,000 for the 
continuation of the Samoan/Asian Pacific Island job training 
program in Hawaii. The funding will be used to conduct targeted 
outreach in the Samoan community through the Samoan Providers 
Association [SPA] and for two one-stop job help stores which 
will provide access to bilingual and vocational education, job 
training and placement services, and outreach/distribution 
services in predominantly immigrant communities. The Committee 
appreciates the Department's support of this program, which has 
been very beneficial.
    The Committee recommends $125,000,000 for 1999, and 
$250,000,000 in advance funding for 2000 for youth opportunity 
grants, under authority of the recently enacted Workforce 
Investment Act of 1998. However, the $250,000,000 for youth 
opportunity projects provided in fiscal year 1998 as an advance 
for fiscal year 1999 is rescinded, since authorizing 
legislation was not enacted by the July 1, 1998, deadline 
specified in Public Law 105-78.
    The youth opportunity grants are critical to provide 
venture capital to high poverty urban neighborhoods and rural 
areas to help them increase employment among out-of-school 
young people to a level of 80 percent as an alternative to 
welfare and crime. It provides an important jobs and skill 
development component to the economic development activities of 
empowerment zone and enterprise communities, and administers 
funds through the same local work force development system that 
will be used to administer other Federal job training and 
employment resources. The current youth opportunity pilot sites 
are testing key features of the approach. These projects 
leverage other resources within the community to eventually 
sustain these services directed to out-of-school youth.
    The Committee understands that the new work force 
investment authorizing legislation provides for establishing a 
role model academy for out-of-school youth. The Committee urges 
the Secretary to expedite funding of this entity.
    The Committee notes the acute need in the city of 
Philadelphia to create job opportunities for youth who are out 
of school and at risk. The Committee is aware of efforts by the 
city to develop a comprehensive approach to this problem and 
urges the Department of Labor to lend appropriate support to 
these efforts.
    Of the funding for youth opportunity area projects, the 
Committee recommends funding to expand the availability of 
juvenile day treatment centers in North Carolina. Two existing 
programs provide a cost-effective way to place restrictive 
sanctions on juveniles without removing them from their 
community and without using expensive residential programs. The 
Committee recognizes the problems facing out-of-school youth in 
communities with high poverty, juvenile crime, child abuse and 
neglect, school failure, and teen pregnancy, and believes that 
these programs can serve as an antidote to such problems.
    Also of the funding for youth opportunity area projects, 
the Committee recommends $1,300,000 for Halifax County, NC, for 
the Phoenix Center, a facility that will operate as both a day 
treatment and a secure residential facility. Each juvenile will 
receive an individual assessment for behavioral, educational, 
and psychological needs. Each juvenile will have an individual 
plan and their progress will be monitored as they move through 
the program. Juveniles assigned to the Phoenix program will 
continue their education while receiving vocational training 
and mental health services in a safe drug-free environment. The 
Committee feels that such a program will facilitate a reduction 
in juvenile crime and in the number of children committed to 
training schools. The Committee's recommended expansion will 
provide additional communities with the opportunity to improve 
the employment prospects of out-of-school youth.
    The Committee recommends continued funding, based on 
demonstrated performance, for special native Hawaiian 
vocational education demonstration initiatives that provide 
basic education skills and preemployment tutoring for high-risk 
youth residing in rural communities, with an emphasis on 
vocations that benefit these communities, such as child care 
workers and teachers.
    The Committee continues to recognize that, due to the 
geographical isolation associated with rural communities in the 
States of Alaska and Hawaii, disadvantaged populations residing 
in these areas lack access to skill training programs, 
education opportunities, and other self-development initiatives 
which has contributed to the high rates of poverty, 
unemployment, school dropouts, teen pregnancy, substance abuse, 
and mental illness.
    Expanding on the direction prescribed in previous years, 
the Committee recommends that $5,000,000 be provided in pilot 
and demonstration funds to support training, education 
employment, and entrepreneurial opportunities to improve the 
economic and social health and welfare for adults on the 
neighbor islands of Hawaii and in Alaska. In Hawaii, the 
Committee urges that community colleges be the focal point of 
these programs. In Alaska, the Committee urges that, of the 
funds provided, $1,250,000 be provided to Ilisagvik College in 
Barrow, AK; $250,000 be provided to Koahnic Broadcasting, Inc., 
in Anchorage, AK; and $1,000,000 be provided to Kawerak, Inc., 
in Nome, AK, for continuation or initiation of vocational job 
training programs for Alaska Natives.
    The Committee recommends $1,000,000 in pilot and 
demonstration funds for the Alaska Federation of Natives 
Foundation consistent with the goals of the AFN Foundation 
bylaws, section 13, to develop and train highly skilled Alaska 
native workers for year-round employment within the petroleum 
industry in Alaska. The Committee expects that the Department 
will make these funds available to match contributions under 
the 1995 Alaska Native Utilization Agreement and that such 
funds shall be expended with the advice and consent of the 
advisory board established under section 9 of the Alaska Native 
Utilization Agreement.
    The Committee encourages full and fair consideration of a 
proposal to design and implement a 3-year project that will 
prepare students for the technological needs of the 21st 
century work force. The first phase would include a survey of 
the work force demands of the northeastern and southwestern 
Pennsylvania regions. The second phase would allow for 
information dissemination and the final phase would implement a 
skills development program. The State should use State 
resources to leverage any Federal resources.
    The Committee encourage the full and fair consideration of 
a proposal by the Philadelphia High School Academies [PHSA] to 
expand curricula to establish a second academy for law, 
criminal justice, and public administration. The PHSA also 
would produce an academy start-up kit for schools wishing to 
open an academy. The Committee believes that this additional 
academy will meet the needs of the work force and fulfill its 
mission to enhance public school students academic and 
occupational skills and options through its partnerships with 
business and educational institutions.
    The Committee is aware that the Philadelphia Housing 
Authority is seeking funds to prepare public and assisted 
housing residents to pass State approved building trade skill 
apprenticeship program tests, and recommends $1,000,000 to 
assist with this effort. This preapprenticeship initiative will 
offer comprehensive services, including literacy skills, 
development of good work habits, on-the-job training augmented 
with classroom training, and placement services.
    The Committee is aware of the success of the Women's 
Association for Women's Alternatives, Inc. [WAWA], of 
Swarthmore, PA, in bringing the concept of self-sufficiency 
into the implementation of welfare reform in Pennsylvania. The 
Committee recommends $90,000 for WAWA to train welfare 
caseworkers and facilities to use the Pennsylvania self-
sufficiency standard so that households stay off welfare 
permanently and attain livable wages.
    The Committee notes that the Department has launched a 
pilot project with Green Thumb, Inc., to train low-income 
seniors for good jobs in the growing information technology 
[IT] industry. This pilot and its modest expansion to include 
additional disadvantaged populations and sites is also 
receiving financial and in-kind support from major IT 
companies. The Committee urges the Department to consider 
expanding this pilot effort.
    The Committee recognizes the Department of Labor's 
continued efforts to improve job training and employment 
services of homeless and other at-risk population groups. The 
Committee urges the Department to build on the experience of 
its job training demonstration program for the homeless and 
recommends expansion to help formerly homeless individuals who 
may be welfare recipients or drug addicted get and keep 
unsubsidized jobs in local or regional skill shortage areas. 
The Committee recommendation includes JTPA title IV pilot and 
demonstration funds and the Committee also encourages the 
Secretary to use some JTPA title III national reserve funds 
with these funds to test innovative ways to help these 
individuals join the existing work force. Thus, these formerly 
homeless individuals can acquire skills in occupational areas 
in local or regional demand. This innovation may include 
customized training and should include strong linkages to other 
public and private resources to ensure these individuals can 
access a comprehensive range of services so they can find and 
keep jobs that are in demand. Specifically, the Committee is 
aware that since the early 1990's the homeless population has 
tripled in the southwestern Pennsylvania area and that there is 
an immediate and urgent need to expand skills training and 
services. Therefore, the recommendation includes $675,000 for 
the Southwestern Pennsylvania Employment Plus Job Training 
Program, a training demonstration project which will give the 
formerly homeless and drug addicted population the necessary 
job skills and self-development initiatives to join the 
existing work force.
    The Committee encourages full and fair consideration by the 
Department of Labor of a proposal by the Corporation for 
Supportive Housing for $2,000,000 to demonstrate effective 
approaches to increase the employment of poor, primarily single 
adults living in supportive housing. The Committee is aware of 
the Corporation for Supportive Housing's interest in helping 
local groups implement effective employment interventions for 
unattached adults, building on a firm foundation of residential 
stability. Anticipated outcomes would include increased job 
placement, retention and earnings, and the documentation and 
dissemination of best practices. The Committee expects that any 
proposed effort would link local groups to local work force 
development systems and that Federal demonstration funds would 
be more than doubled by philanthropic funds and other public 
funds.
    The Committee has included funds to provide for a model 
regional work force development center that will demonstrate 
the use of technology to train highly skilled employees for 
careers in machine technology, information technology, 
hospitality and travel, financial services and food services. 
The Committee is aware of the efforts of the Springfield 
Workforce Development Center and urges the Department to give 
full and fair consideration to the center when funds are 
awarded for such a demonstration.
    The Committee encourages full and fair consideration of a 
proposal by the Doe Fund's Ready, Willing and Able, a 
residential work program for economically disadvantaged and 
homeless men and women in Harlem, NY. This program prepares 
economically disabled adults for participation in the labor 
force and increases their occupational skills, resulting in 
improved, long-term employability, increased earnings, and 
reduced welfare dependency.
    The Committee recommends funding of a proposal to support a 
collaboration between the Department of Labor and the State of 
Vermont to establish a model regional work force development 
network. The purpose of this project would be to support 
regional economic development strategies including the 
establishment of an effective assessment system, disseminate 
best practices pertaining to training strategies, provide 
professional development activities for members of the regional 
work force investment boards and adapt comprehensive work force 
education and training system performance measures.
    The Committee recommends $1,000,000 for a proposal from the 
State of Vermont for a high skills training consortia for the 
plastics and support tooling industries, including development 
of a statewide curriculum which will meet the training needs of 
Vermont companies and their future work force.
    The Committee is aware that employment-related skills 
development is an essential component of sustained recovery 
from addiction. The Committee encourages full and fair 
consideration of a proposal for $1,000,000 for a program which 
will provide employment-related skills services into its 
recovery programs. The purpose of this grant is to design and 
evaluate a curriculum which will prepare addicts to make the 
transition from addiction to employment. The Committee is aware 
of the interest of the Center Point program in Marin County, 
CA, in such a grant.
    The Committee is aware of the South Carolina work force 
development project undertaken by the nonprofit Economic 
Development Inc. This project will develop a replicable model 
for providing a comprehensive and indepth assessment of the gap 
between employer skill needs and current and prospective 
employee skills. This assessment will go beyond currently 
available assessments of the education and training credentials 
needed for specific jobs, and will lead to a strategy to 
address the identified training needs through an ongoing 
public-private partnership. The Committee urges full and fair 
consideration of funding in the amount of $500,000 for this 
project.
    The Committee is aware of the services provided by the 
Guadalupe Center to the Latino community located in Kansas 
City, MO. The center is continuing its efforts to provide the 
services needed as well as working toward creating self-
sustaining and revenue generating programs. To provide 
assistance and help the Guadalupe Center meet its goal of self-
sufficiency the Committee recommends $2,000,000 for training, 
education, and acquisition of educational materials for its 
culinary and cultural arts expansion.
    The Committee recommends that $250,000 be provided to fund 
a demonstration project to increase the capacity of Women Work! 
to recruit and train displaced homemakers for jobs in 
information technology, to work with the information technology 
industry employers, and improve the organization's 
technological capacity.
    Recognizing the need to successfully reintegrate adult 
prisoners into society, the Committee recommends $500,000 for 
Project Horizons for New Opportunities. This program has been 
designed by the Berkshire County Office of the Sheriff, in 
collaboration with the Berkshire Training and Employment 
Program, to assist the 280 inmates at the Berkshire County 
House of Correction in Massachusetts. The program will teach 
prisoners life skills, assess individual career interest and 
aptitude assessment, provide basic occupational education 
through state-of-the-art technology, and will enable inmates to 
gain valuable work experience in community service projects 
that are closely linked to their occupational and educational 
goals. This innovative effort will help prisoners overcome 
barriers to employment and will enhance their reintegration 
into the community.
    The Committee recommends $406,000 for Project Homeward 
Bound, headquartered at Eliada Homes in Asheville, NC. The 
project provides juveniles with vocational education, job 
training, and placement.
    The Committee has again included language to authorize the 
Secretary of Labor to waive requirements (with limited 
exceptions) of the Job Training Partnership Act and the Wagner-
Peyser Act to facilitate the implementation of State plans for 
improving work force development systems. This language allows 
the Secretary to waive requirements of JTPA and Wagner-Peyser 
that are determined to impede these efforts. In exchange for 
the greater flexibility provided by such waivers, the language 
requires that the State execute a memorandum of understanding 
with the Secretary of Labor identifying the outcomes the State 
intends to achieve and other measures that will ensure 
appropriate accountability for the use of Federal funds.
    In addition, the Committee has retained language included 
in the fiscal year 1998 bill for the ``Training and employment 
services'' account which authorizes the Secretary to establish 
a work-flex partnership demonstration program with six States. 
This language does not authorize an additional six States, but 
merely continues the authorization for the six States 
authorized in the fiscal year 1998 bill.

            community service employment for older americans

Appropriations, 1998....................................    $440,200,000
Budget estimate, 1999...................................     440,200,000
Committee recommendation................................     440,200,000

    The Committee recommends $440,200,000, the same as the 
budget request for community service employment for older 
Americans. The Committee recommends 78 percent of the funds for 
national sponsors and 22 percent for State sponsors; this is 
the same percentage distribution as current law. This program, 
authorized by title V of the Older Americans Act, provides 
part-time employment in community service activities for 
unemployed, low-income persons aged 55 and over. It is forward-
funded from July to June, and the 1999 appropriation will 
support the program from July 1, 1999, through June 30, 2000. 
These funds are to be distributed in the same manner as 
currently authorized under the Older Americans Act, unless this 
law is subsequently altered. Current law states that title V 
funds should be targeted to eligible individuals with the 
greatest economic need. The Committee believes that within the 
title V community service employment for older Americans, 
special attention should be paid to providing community service 
jobs for older Americans with poor employment prospects, 
including individuals with a long-term detachment from the 
labor force, older displaced homemakers, aged minorities, 
limited English-speaking persons, and legal immigrants. The 
Committee would expect the administration of this program would 
remain at the Department of Labor, unless subsequent 
authorizing legislation is enacted which transfers the program 
to the Department of Health and Human Services.
    The Committee is concerned about the impact of welfare 
reform on indigent elderly legal immigrants who face the loss 
of Supplemental Security Income [SSI]. Current law states that 
title V funds should be targeted to eligible individuals with 
the greatest economic need. The Committee believes that within 
the title V community service employment for older Americans, 
special attention should be paid to providing community service 
jobs for elderly legal immigrants where possible.

              federal unemployment benefits and allowances

Appropriations, 1998....................................    $349,000,000
Budget estimate, 1999...................................     360,700,000
Committee recommendation................................     360,700,000

    The Committee recommends $360,700,000, the same as the 
budget request and an increase of $11,700,000 above the 1998 
enacted level for Federal unemployment benefits and allowances. 
These are entitlement funds.
    The trade adjustment line item has two activities totaling 
$312,300,000 in fiscal year 1999.
    The first activity, trade adjustment assistance benefits, 
provides for special unemployment benefit payments to workers 
as authorized by the Trade Act of 1974, as amended. For this 
activity the Committee recommends $218,000,000. This is the 
same as the budget request and an increase of $10,000,000 above 
the 1998 comparable level. These funds will permit payment of 
benefits, averaging $215 per week, to 35,200 workers for 1999. 
Of these workers, 26,000 will participate in training programs, 
receiving benefits for an average of 28.8 weeks. The remaining 
9,200 workers receiving benefits will receive training waivers 
and collect benefits.
    The second activity, trade adjustment assistance training, 
provides training, job search, and job relocation allowances to 
workers adversely affected by imports. The funding for this 
activity is also authorized under the Trade Act of 1974, as 
amended. The Committee recommends $94,300,000 for this 
activity. This is the same as the budget request and a decrease 
of $2,400,000 below the 1998 comparable level. These funds will 
provide services for an estimated 26,000 workers.
    For NAFTA activities, $48,400,000 is provided, in two 
components.
    The first component, NAFTA transitional adjustment 
assistance benefits, provides for weekly benefit payments to 
workers affected by imports from Mexico and Canada. These 
payments are also authorized by the Trade Act of 1974, as 
amended as a result of the signing of the North American Free 
Trade Agreement [NAFTA]. The Committee recommends $26,000,000 
for this activity. This is the same as the budget request and 
an increase of $4,000,000 over the 1998 comparable level. These 
funds will provide 3,900 eligible workers an average of 30 
weeks of benefits each, at an average weekly amount of $223.
    The second component, NAFTA transitional adjustment 
assistance training, provides funds for training, job search 
and job relocation to workers affected by imports from Mexico 
and Canada. The funding for this activity is also authorized by 
the amendment to the Trade Act of 1974 resulting from the 
signing of the NAFTA. The Committee recommends $22,400,000 for 
this activity. This is the same as the budget request and an 
increase of $100,000 over the 1998 comparable level. These 
funds will provide training for an estimated 5,300 workers.

     state unemployment insurance and employment service operations

Appropriations, 1998....................................  $3,500,417,000
Budget estimate, 1999...................................   3,368,173,000
Committee recommendation................................   3,279,573,000

    The Committee recommends $3,279,573,000 for this account. 
This is $88,600,000 below the budget request and a decrease of 
$220,844,000 below the 1998 comparable level. Included in the 
total availability is $3,117,476,000 authorized to be drawn 
from the ``Employment Security Administration'' account of the 
unemployment trust fund, and $162,097,000 to be provided from 
the general fund of the Treasury.
    The funds in this account are used to provide 
administrative grants and assistance to State agencies which 
administer Federal and State unemployment compensation laws and 
operate the public employment service.
    For unemployment insurance [UI] services, the bill provides 
$2,311,458,000. This total includes a regular contingency 
amount of $186,333,000 which may be drawn from the ``Employment 
Security Administration'' account of the unemployment trust 
fund. In addition the bill further provides for a second 
contingency amount should the unemployment workload exceed an 
average weekly insured claims volume of 2,629,000. This second 
contingency amount would fund the administrative costs of 
unemployment insurance workload over the level of 2,629,000 
insured unemployed per week at a rate of $28,600,000 per 
100,000 insured unemployed, with a pro rata amount granted for 
amounts of less than 100,000 insured unemployed.
    The unemployment insurance service recommendation provides 
a decrease of $209,000,000 below the fiscal year 1998 level. 
The allowance includes $2,115,125,000 for State operations, a 
decrease of $99,000,000 below the budget request and $1,000,000 
above the 1998 comparable level.
    The Committee recommends rescission of the $40,000,000 
provided in fiscal year 1998 as an advance for fiscal year 1999 
for the purpose of assisting States to convert their automated 
State employment security agency systems to be year 2000 
compliant. Instead, these resources will be provided through an 
emergency fund being provided on a Governmentwide basis.
    For the employment service, the Committee recommends 
$821,615,000 which includes $23,452,000 in general funds 
together with an authorization to spend $798,163,000 from the 
``Employment security administration'' account of the 
unemployment trust fund. These amounts are $5,000,000 above the 
budget request and the 1998 comparable level.
    Included in the recommendation for the employment service 
[ES] is $761,735,000 for State grants, available for the 
program year of July 1, 1999, through June 30, 2000. This is 
the same as the budget request and the 1998 comparable level. 
Also included is $59,880,000 for national activities, an 
increase of $5,000,000 above the budget request and the 1998 
comparable level. This increase above the 1998 and 1999 request 
level of $31,300,000 is for processing of labor certification 
workload.
    The recommendation includes $146,500,000 for one-stop 
career centers, which is the same as the budget request and a 
decrease of $16,844,000 below the 1998 comparable level.
    The Committee is concerned about the current state of the 
permanent labor certification program. This program, which 
provides access to needed workers in those cases where a 
shortage of American workers can be shown, is suffering from a 
lack of adequate funding and a significant increase in 
applications received, which has led to problems in 
administering the program.
    A part of the labor certification process most affected by 
the lack of funding and the increased demand is the permanent 
labor certification program [PLC]. By law, the PLC is a 
necessary predicate for employers to sponsor would-be 
immigrants for permanent residence in the United States based 
on an offer of employment. The program requires employers to 
demonstrate, through Department of Labor [DOL] monitored 
processing, that no qualified U.S. worker is available to be 
employed in the occupation and geographic area where the 
foreign worker is being offered a job. The program provides for 
a limited number of foreign-born employees each year to obtain 
permanent residence in the United States. In fiscal year 1997, 
the total number of applications received was 66,699. That 
number had already been surpassed by midyear of fiscal year 
1998.
    Significant reductions in funding for the labor 
certification program, however, combined with the significant 
increase in applications, have led to serious delays in the 
process. Employers in large volume States such as California 
and New York now have to wait up to 3 years before their 
applications for permanent labor certification can be 
processed. The Committee notes that although the Labor 
Department has attempted to address the issue of slow 
processing time with the publication of general administration 
letter [GAL] 1-97 in October 1996, the benefits received by the 
processing concepts put forth in that GAL have been overwhelmed 
by the reduction of staff and increased applications. 
Accordingly, the subcommittee recommends that the funding for 
the program be increased by $5,000,000.
    The Committee urges the Department to fund a national 
performance measurement system for ES activities. Each State 
should not have to create a separate system funded with their 
operating funds. Rather, the Department should fund the 
development and implementation of a standard system that would 
help to maintain the national ES system. State ES agencies 
should be involved in the development of such a system.
    The Committee also encourages the Department to coordinate, 
as appropriate, the development and implementation of a 
performance measurement system for ES with the development of 
the work force development performance measures.
    The Committee recommends that the Department support needed 
changes in State ES automated hardware and systems to address 
the year 2000 [Y2K] problem. The Committee has included funds 
requested for the America Job and Talent Banks and its new 
component, America's Learning Exchange. This program is 
intended as an electronic marketplace that will link training 
providers and developers to individuals and companies needing 
to purchase training. This initiative will also help address 
the Nation's Y2K problem.
    The Committee agrees that the work opportunity tax credit 
[WOTC], and the welfare-to-work tax credit provide important 
resources to create new jobs, particularly for those Americans 
who would otherwise be dependent on welfare. Therefore, the 
Committee recommendation includes $20,000,000 for these 
initiatives, subject to reauthorization the same as the request 
and fiscal 1998 enacted level.

        advances to the unemployment trust fund and other funds

Appropriations, 1998....................................    $392,000,000
Budget estimate, 1999...................................     357,000,000
Committee recommendation................................     357,000,000

    The Committee recommends $357,000,000 the same as the 
budget request and a decrease of $35,000,000 below the 1998 
comparable level, for this account. The appropriation is 
available to provide advances to several accounts for purposes 
authorized under various Federal and State unemployment 
compensation laws and the black lung disability trust fund, 
whenever balances in such accounts prove insufficient. The bill 
anticipates that fiscal year 1998 advances will be made to the 
black lung disability trust fund.
    The separate appropriations provided by the Committee for 
all other accounts eligible to borrow from this account in 
fiscal year 1999 are expected to be sufficient. Should the need 
arise, due to unanticipated changes in the economic situation, 
laws, or for other legitimate reasons, advances will be made to 
the needy accounts to the extent funds are available. Funds 
advanced to the black lung disability trust fund are now 
repayable with interest to the general fund of the Treasury.

                           program operations

Appropriations, 1998....................................    $131,382,000
Budget estimate, 1999...................................     143,460,000
Committee recommendation................................     137,711,000

    The Committee recommendation includes $93,995,000 in 
general funds for this account, as well as authority to expend 
$43,716,000 from the ``Employment Security Administration'' 
account of the unemployment trust fund, for a total of 
$137,711,000. This is $5,749,000 less than the budget request 
and $6,329,000 more than the 1998 comparable level. The 
reduction from the request was necessary due to severe budget 
constraints facing the Committee in fiscal year 1999.
    General funds in this account provide the Federal staff to 
administer employment and training programs under the Job 
Training Partnership Act, the Older Americans Act, the Trade 
Act of 1974, and the National Apprenticeship Act. Trust funds 
provide for the Federal administration of employment security 
functions under title III of the Social Security Act and the 
Immigration and Nationality Act, as amended. Federal staff 
costs related to the Wagner-Peyser Act in this account are 
split 97 percent to 3 percent between unemployment trust funds 
and general revenue, respectively.

              Pension and Welfare Benefits Administration

                         SALARIES AND EXPENSES

Appropriations, 1998....................................     $82,056,000
Budget estimate, 1999...................................      90,974,000
Committee recommendation................................      88,076,000

    The Committee recommendation provides $88,076,000 for this 
account, which is $2,898,000 less than the budget request and 
an increase of $6,020,000 over the 1998 comparable level. The 
reduction from the request was necessary due to severe budget 
constraints facing the Committee in fiscal year 1999.
    The Pension and Welfare Benefits Administration [PWBA] is 
responsible for the enforcement of title I of the Employee 
Retirement Income Security Act of 1974 [ERISA] in both civil 
and criminal areas. PWBA is also responsible for enforcement of 
sections 8477 and 8478 of the Federal Employees' Retirement 
Security Act of 1986 [FERSA]. PWBA provides funding for the 
enforcement and compliance; policy, regulation, and public 
services; and program oversight activities.
    The Committee recommends funding for the implementation of 
a new system devoted to processing form 5500 series financial 
data required under the Employee Retirement Income Security 
Act. This project enables employees to submit annual benefit 
plan reports electronically, reducing the cost, paperwork 
burden, and enhancing protection of pension funds. The 
Committee intends for the Internal Revenue Service and the 
Department of Labor to continue to share the ongoing operating 
costs of the system in the same manner as under the current 
system.

                  Pension Benefit Guaranty Corporation

    The Corporation's estimate for fiscal year 1999 includes 
benefit payments of $977,380,000, multiemployer financial 
assistance of $14,250,000, administrative expenses limitation 
of $10,958,000, and services related to terminations expenses 
of $147,724,000.
    The Pension Benefit Guaranty Corporation is a wholly owned 
Government corporation established by the Employee Retirement 
Income Security Act of 1974. The law places it within the 
Department of Labor and makes the Secretary of Labor the Chair 
of its Board of Directors. The Corporation receives its income 
primarily from insurance premiums collected from covered 
pension plans, collections of employer liabilities imposed by 
the act, and investment earnings. It is also authorized to 
borrow up to $200,000,000 from the 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.

                  Employment Standards Administration

                         SALARIES AND EXPENSES

Appropriations, 1998....................................    $301,020,000
Budget estimate, 1999...................................     316,191,000
Committee recommendation................................     311,333,000

    The Committee recommendation includes $311,333,000 for this 
account. This is $4,858,000 less than the budget request and an 
increase of $10,313,000 above the 1998 comparable level. The 
reduction from the request was necessary due to severe budget 
constraints facing the Committee in fiscal year 1999. The bill 
contains authority to expend $1,924,000 from the special fund 
established by the Longshore and Harbor Workers' Compensation 
Act; the remainder are general funds. In addition, an amount of 
$30,191,000 is available by transfer from the black lung 
disability trust fund. This is the same as the request and 
$4,044,000 more than the 1998 comparable level. The Committee 
recommendation includes full funding of the budget request for 
expanded enforcement of domestic child labor laws.
    The Committee is deeply concerned about the rising 
instances of child labor in the United States. Although no 
official estimate exists, studies place the number of illegally 
employed children in the United States between 300,000 and 
800,000. Therefore, the Committee has included full funding for 
the President's initiative on domestic child labor. 
Furthermore, the Committee strongly believes that effective 
enforcement must be a part of any comprehensive strategy to 
eliminate illegal child labor.
    The Committee is concerned that the Fair Labor Standards 
Act could be interpreted to require that funeral homes pay 
enormous amounts of overtime compensation to licensed funeral 
directors, who are often oncall 24 hours a day. Such an 
interpretation could have a serious adverse impact on many 
small funeral homes, and may create the necessity to provide 
them with the flexibility to allow options for alternative 
compensation.

                            SPECIAL BENEFITS

Appropriations, 1998....................................    $201,000,000
Budget estimate, 1999...................................     179,000,000
Committee recommendation................................     179,000,000

    The Committee recommends continuation of appropriation 
language to provide authority to require disclosure of Social 
Security account numbers by individuals filing claims under the 
Federal Employees' Compensation Act or the Longshore and Harbor 
Workers' Compensation Act and its extensions.
    The bill includes $179,000,000, the same as the budget 
request and a decrease of $22,000,000 below the 1998 comparable 
level. This appropriation primarily provides benefits under the 
Federal Employees' Compensation Act [FECA]. The payments are 
prescribed by law.
    The total amount to be available in fiscal year 1999, 
including anticipated reimbursements from Federal agencies of 
$1,846,000,000 is $2,025,000,000, a decrease of $18,000,000 
below the 1998 comparable level.
    The Committee recommends continuation of appropriation 
language that provides authority to use the FECA fund to 
reimburse a new employer for a portion of the salary of a newly 
reemployed injured Federal worker. The FECA funds will be used 
to reimburse new employers during the first 3 years of 
employment not to exceed 75 percent of salary in the worker's 
first year, declining thereafter. Costs will be charged to the 
FECA fund.
    The Committee again includes appropriation language that 
retains the drawdown date of August 15. The drawdown authority 
enables the agency to meet any immediate shortage of funds 
without requesting supplemental appropriations. The August 15 
drawdown date allows maximum flexibility for continuation of 
benefit payments without interruption.
    The Committee recommends continuation of appropriation 
language to provide authority to deposit into the special 
benefits account of the employees' compensation fund those 
funds that the Postal Service, the Tennessee Valley Authority, 
and other entities are required to pay to cover their fair 
share of the costs of administering the claims filed by their 
employees under FECA. The Committee concurs with requested bill 
language to allow the Secretary to use fair share collections 
to fund capital investment projects and specific initiatives to 
strengthen compensation fund control and oversight.
    The Employment Standards Administration is involved in the 
administration of numerous laws, including the Fair Labor 
Standards Act, the Immigration and Nationality Act, the Migrant 
and Seasonal Agricultural Workers' Protection Act, the Davis-
Bacon Act, the Family and Medical Leave Act, the Federal 
Employees' Compensation Act [FECA], the Longshore and Harbor 
Workers' Compensation Act, and the Federal Mine Safety and 
Health Act (black lung).

                    black lung disability trust fund

Appropriations, 1998....................................  $1,007,000,000
Budget estimate, 1999...................................   1,021,000,000
Committee recommendation................................   1,021,000,000

    The bill includes authority to obligate $1,021,000,000 from 
the black lung disability trust fund in fiscal year 1999. This 
is an increase of $14,000,000 above the 1998 comparable level.
    The total amount available for fiscal year 1999 will 
provide $453,725,000 for benefit payments, and $51,275,000 for 
administrative expenses for the Department of Labor. Also 
included is $516,000,000 for interest payments on advances. In 
fiscal year 1998, comparable obligations for benefit payments 
are estimated to be $466,650,000 while administrative expenses 
for the Departments of Labor and Treasury, respectively, are 
$45,994,000 and $356,000.
    The Committee reiterates its directive to prevent the 
closing of and to ensure the staffing of black lung field 
offices.
    The trust fund pays all black lung compensation/medical and 
survivor benefit expenses when no responsible mine operation 
can be assigned liability for such benefits, or when coal mine 
employment ceased prior to 1970, as well as all administrative 
costs which are incurred in administering the benefits program 
and operating the trust fund.
    It is estimated that 68,500 people will be receiving black 
lung benefits financed from the trust fund by the end of fiscal 
year 1999. This compares with an estimated 72,500 receiving 
benefits in fiscal year 1998.
    The basic financing for the trust fund comes from a coal 
excise tax for underground and surface-mined 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, and advances. 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.
    The Department of Labor is encouraged to expeditiously 
complete the review process on its proposed changes to the 
black lung regulations. The Committee understands that any 
procedural errors which may have occurred during the initial 
proposal process are being addressed by the Department and that 
they will be in full compliance with reg-flex and SBREFA prior 
to finalization of the regulatory proposals.

             Occupational Safety and Health Administration

                         SALARIES AND EXPENSES

Appropriations, 1998....................................    $336,678,000
Budget estimate, 1999...................................     355,045,000
Committee recommendation................................     348,983,000

    The Committee recommendation includes $348,983,000 for this 
account. This is $6,062,000 less than the budget request and an 
increase of $12,305,000 above the 1998 comparable level. The 
reduction from the request was necessary due to severe budget 
constraints facing the Committee in fiscal year 1999. This 
agency is responsible for enforcing the Occupational Safety and 
Health Act of 1970 in the Nation's workplaces.
    In addition, the Committee has included language to allow 
OSHA to retain up to $750,000 per fiscal year of training 
institute course tuition fees to be utilized for occupational 
safety and health training and education grants in the private 
sector.
    The Committee supports the State of New Jersey's pending 
application for a Public Employee Occupational Safety and 
Health [PEOSH] Program, and strongly urges OSHA to include the 
necessary funding for this program in its fiscal year 2000 
budget request.
    The Committee retains language carried in last year's bill 
effectively exempting farms employing 10 or fewer people from 
the provisions of the act except those farms having a temporary 
labor camp. The Committee also retains language exempting small 
firms in industry classifications having a lost workday injury 
rate less than the national average from general schedule 
safety inspections. These provisions have been in the bill for 
many years.
    The Committee is very pleased with OSHA's efforts in 
placing high priority on the voluntary protection programs 
[VPP] and other voluntary cooperative programs. The agency's 
work in reducing the VPP application backlog and its commitment 
to eliminate this backlog is particularly noteworthy. The 
Committee expects OSHA to continue to place high priority on 
the VPP, assuring prompt review and processing of VPP 
applications from interested employers and employees. 
Cooperative voluntary programs, especially the VPP, are an 
important part of OSHA's ability to assure worker safety and 
health and should be administered in conjunction with an 
effective strong enforcement program.
    The Committee also intends that the Office of Regulatory 
Analysis continue to be funded as nearly as possible at its 
present level.
    Accidental injuries from contaminated needles and other 
sharps jeopardize the well-being of our Nation's health care 
workers and result in preventable transmission of devastating 
bloodborne illnesses, including HIV, hepatitis B, and hepatitis 
C. The Committee is concerned that the OSHA 200 log does not 
accurately reflect the occurrence of these injuries. The 
Committee understands that the reporting and record keeping 
standard (29 CFR 1904) requires the recording on the OSHA 200 
log of injuries from potentially contaminated needles and other 
sharps that result in: the recommendation or administration of 
medical treatment beyond first aid; death, restriction of work 
or motion; loss of consciousness; transfer to another job; or 
seroconversion in the worker. Accidental injuries with 
potentially contaminated needles or other sharps require 
treatment beyond first aid. Therefore, the Committee urges OSHA 
to require the recording on the OSHA 200 log of injuries from 
needles and other sharps potentially contaminated with 
bloodborne pathogens.
    It has been brought to the Committee's attention that many 
medical workers, most of whom work in hospital operating rooms, 
are experiencing unexplained illness and disability, possibly 
as a result of exposure to glutaraldehyde, a chemical used for 
x-ray processing and disinfection of medical equipment. The 
Committee believes that OSHA should take necessary steps to 
educate medical facilities about the risks of glutaraldehyde 
exposure in the workplace, and assist those employers in 
implementing appropriate safety precautions for at-risk 
workers.

                 Mine Safety and Health Administration

                         SALARIES AND EXPENSES

Appropriations, 1998....................................    $203,397,000
Budget estimate, 1999...................................     211,165,000
Committee recommendation................................     211,165,000

    The Committee recommendation includes $211,165,000 for this 
account. This is the same as the budget request and $7,768,000 
more than the 1998 comparable level.
    This agency insures the safety and health of the Nation's 
miners by conducting inspections and special investigations of 
mine operations, promulgating mandatory safety and health 
standards, cooperating with the States in developing effective 
State programs, and improving training in conjunction with 
States and the mining industry.
    The Committee is aware that the Mine Safety and Health 
Administration's programs, expertise, and resources are pivotal 
to the dramatic safety and health progress achieved by the 
American mining industry. The Committee encourages MSHA to 
actively engage in exchange of mine safety and health 
techniques, knowledge, and resources to enhance miners' safety 
throughout the world.
    The Committee has continued language carried in the bill 
since fiscal year 1980 prohibiting the use of funds to carry 
out the training provisions of the Mine Act with respect to 
shell dredging, or with respect to any sand, gravel, surface 
stone, surface day, colloidal phosphate, or surface limestone 
mine. The Committee recommends including this language for 
another year. However, the Committee finds the agency's data 
regarding the number of untrained workers in these industries 
who are exposed to the risks and hazards associated with the 
mining environment disturbing. Therefore, the Committee intends 
for fiscal year 1999 to be the last year this provision will be 
contained in the bill. We are encouraged by the agency's and 
industries' efforts to resolve the issues regarding safety and 
health training for miners. The Committee directs the agency to 
continue to expeditiously develop appropriate training 
regulations for the workers at these operations, and receive 
input from industry and labor. The Committee is aware of a 
recent Solicitor opinion which raises issues whether new 
regulations can be developed under the existing bill language. 
The Committee is committed to considering a technical amendment 
to the current bill language in conference if it is needed to 
assure that these regulations can be promulgated. During fiscal 
year 1999, the agency should develop final miner training 
regulations for the affected industries. The Committee expects 
the agency to submit a report prior to its appropriations 
hearing on the fiscal year 2000 budget outlining the progress 
that has been made by that time.
    The Committee understands that the Assistant Secretary for 
Mine Safety and Health announced the agency's intention to seek 
to have the Federal Mine Safety and Health Review Commission's 
decision in the National Gypsum case overturned. That decision 
defined significant and substantial violations of the Mine Act 
as violations that are reasonably likely to result in a 
reasonably serious injury or illness. The Committee notes with 
approval that by Federal Register notice of April 23, 1998, 
MSHA announced that it would suspend its February 5, 1998, 
interpretive bulletin and continue to accept comments on this 
issue. In cases before the Review Commission, there has been 
discussion of reversing or revising the 17 years of case law 
precedents. Some have stated that a new interpretation of the 
plain language, legislative history, and remedial purpose of 
the Mine Act supports rejecting this precedent or creating 
presumptions that avoid this precedent. The reasonable 
likelihood standard best reflects congressional intent and is 
consistent with the plain language, legislative history, and 
remedial purpose of the Mine Act. By focusing on serious 
hazards, the reasonable likelihood standard permits the 
Commission, the industry, the work force and MSHA to focus on 
serious risks and prevent them.
    The Committee commends MSHA for its proactive approach in 
seeking the root causes of and solutions to persistent problems 
affecting miners' safety and health. In particular, the 
Committee is pleased with the agency's work to eliminate black 
lung disease and silicosis. Miners continue to be diagnosed 
with these diseases and black lung alone costs the Federal 
Government more than $1,000,000,000 annually. Understanding 
that changes and improvements to the program to protect miners' 
health are necessary, the Committee strongly urges the agency 
to continue to implement the recommendations of the Advisory 
Committee on the Elimination of Pneumoconiosis Among Coal Mine 
Workers. To that end, the Committee fully funds the 
administration's request for expansion of the coal dust 
sampling program, a unanimous recommendation of the Advisory 
Committee.

                       Bureau of Labor Statistics

                         SALARIES AND EXPENSES

Appropriations, 1998....................................    $380,543,000
Budget estimate, 1999...................................     398,870,000
Committee recommendation................................     390,889,000

    The Committee includes $390,889,000 for this account, which 
is $7,981,000 less than the budget request and $10,346,000 more 
than the 1998 comparable level. This includes $53,718,000 from 
the ``Employment Security Administration'' account of the 
unemployment trust fund, and $337,171,000 in Federal funds. The 
reduction from the request was necessary due to severe budget 
constraints facing the Committee in fiscal year 1999.
    The Committee has included $11,159,000 for the Consumer 
Price Index revision; this effort should remain the highest 
priority for the Bureau.
    The Bureau of Labor Statistics is the principal fact 
finding agency in the Federal Government in the broad field of 
labor economics.

                        Departmental Management

                         SALARIES AND EXPENSES

Appropriations, 1998....................................    $152,930,000
Budget estimate, 1999...................................     189,060,000
Committee recommendation................................     188,762,000

    The Committee recommendation includes $188,762,000 for this 
account, which is $298,000 less than the budget request and 
$35,832,000 above the 1998 comparable level. This consists of 
$188,463,000 in general funds and authority to transfer 
$299,000 from the ``Employment Security Administration'' 
account of the unemployment trust fund. In addition, an amount 
of $20,422,000 is available by transfer from the black lung 
disability trust fund, which is the same as the budget request. 
The reduction from the request was necessary due to severe 
budget constraints facing the Committee in fiscal year 1999.
    The primary goal of the Department of Labor is to protect 
and promote the interests of American workers. The departmental 
management appropriation finances staff responsible for 
formulating and overseeing the implementation of departmental 
policy and management activities in support of that goal. In 
addition, this appropriation includes a variety of operating 
programs and activities that are not involved in departmental 
management functions, but for which other salaries and expenses 
appropriations are not suitable.
    The Committee intends that the Women's Bureau maintain 
support at the fiscal year 1997 level for technical assistance 
and training on displaced homemaker programming through 
effective programs such as the Women Work Program. This 
assistance is critical as State and local agencies develop and 
implement new models for work force development and welfare 
reform. The Committee recommends $7,802,000, an increase of 
$40,000 over the fiscal year 1998 level.
    The Committee urges the Women's Bureau to continue support 
at the fiscal year 1998 level for effective organizations such 
as Women Work! to provide technical assistance and training on 
displaced homemaker programming.
    The Committee has expressed its concern in recent years 
about the exploitation of child labor around the world. The 
Committee's concern has been mirrored in a number of other 
international initiatives, and as a result, the fight to reduce 
child exploitation has been placed onto the global agenda. In a 
report released in 1996, the International Labor Organization 
estimates the total number of child workers between the ages of 
5 and 14 to be 250 million worldwide--some 120 million working 
full time.
    The Committee notes the positive work being done by the 
ILO's International Programme for the Elimination of Child 
Labor [IPEC], including funds made available to the Secretary 
of Labor by this Committee. The Committee has provided an 
additional $28,290,000 from within funds for the Bureau of 
International Labor Affairs, to continue work on international 
child labor issues and funding for the IPEC program.
    The Committee recognizes the value of the reports completed 
by the Bureau of International Labor Affairs in recent years 
documenting the incidence of international child labor in 
various industries and countries, and some of the innovative 
approaches to reduce the use of abusive and exploitative child 
labor such as codes of conduct and labeling initiatives. While 
obstacles such as poverty and limited family income contribute 
to child labor, it is clear that child labor imposes large 
economic costs by continuing the cycle of poverty and denying 
educational opportunities to millions of children. 
Consequently, the Committee requests that the Bureau undertake 
a study on the economic benefits that could be realized from 
the elimination of abusive and exploitative child labor and the 
increased enrollment of these children in school. The study 
should look at the economic benefits to individual countries 
and to possible global benefits, in particular U.S. trade, that 
would result from the elimination of abusive and exploitative 
child labor. The analysis could include appropriate case or 
country studies, as appropriate. The study should be completed 
by July 15, 1999.
    In addition, the Committee is concerned by the large and 
growing problem of abusive treatment of workers around the 
world who produce apparel for export to the United States and 
the impact of that treatment on companies and workers in the 
United States. In an effort to obtain more detailed and 
accurate information, the Committee urges the Department to 
establish a methodology and format for reporting regularly on 
the use of sweatshops in the production of apparel for import 
into the United States. Because the Department's reporting 
capabilities are currently limited to violations by domestic 
producers only, the misleading impression that violations of 
law and substandard conditions in the industry are far more 
extensive within the United States than elsewhere is given. 
Development of new reporting methods should help to correct the 
existing imbalance in the Department's current reporting on 
this subject.
    Since Haiti's economic recovery has been negatively 
impacted by continuing concerns about working conditions in the 
assembly sector, the Committee has allocated $1,000,000 to 
support a cooperative initiative between the Haitian private 
sector and the International Labor Organization which will 
assure that working conditions meet international standards.
    The Committee is aware of the unique efforts to develop and 
implement public-private initiatives promoting employment 
opportunities for persons with disabilities. Recognizing that 
less than one-third of the Nation's disability population is 
currently employed, the Committee has provided additional funds 
to support the activities of the President's Committee on 
Employment of People With Disabilities, including the promotion 
of students with disabilities in technology careers, business 
leader involvement in developing job opportunities, 
entrepreneurial development and for technical assistance in 
advising businesses regarding job accommodations.
    The Committee recommends the full request of $2,400,000 for 
the President's Task Force on Employment of Persons With 
Disabilities, by providing $1,400,000 in this account for S&E 
and other related expenses of the task force and $1,000,000 in 
the ``Social Security Administration'' account for policy 
research to support the goals of the task force. The task force 
will consult with the Social Security Administration in the 
design and implementation of this policy research.
    The Committee retains bill language intended to ensure that 
decisions on appeals of Longshore and Harborworker Compensation 
Act claims are reached in a timely manner.

        Assistant Secretary for Veterans Employment and Training

Appropriations, 1998....................................    $181,979,000
Budget estimate, 1999...................................     182,719,000
Committee recommendation................................     182,719,000

    The Committee recommendation includes $182,719,000 to be 
expended from the ``Employment Security Administration'' 
account of the unemployment trust fund. This is the same as the 
budget request and $740,000 above the 1998 comparable level.
    For State grants the bill provides $80,040,000 for the 
Disabled Veterans Outreach Program and $77,078,000 for the 
Local Veterans Employment Representative Program.
    For Federal administration, the Committee recommends 
$25,601,000, an increase of $740,000 over the fiscal year 1998 
level. The Committee supports the concept of the Transition 
Assistance Program administered jointly with the Department of 
Defense which assists soon-to-be-discharged service members in 
transitioning into the civilian work force and includes funding 
to maintain an effective program. The Committee notes the 
budget request includes $2,000,000, the same as the fiscal 1998 
level, for the National Veterans Training Institute [NVTI]. 
This Institute provides training to the Federal and State staff 
involved in the direct delivery of employment and training 
related services to veterans. The Committee urged that funding 
for the Institute be maintained, to the extent possible, at the 
1998 level.
    The recommendation also authorizes the Department of Labor 
to permit the Veterans' Employment and Training Service [VETS] 
to also fund activities in support of the VETS' Federal 
Contractor Program [FTP] from funds currently made available to 
States for veterans' employment activities.

                    OFFICE OF THE INSPECTOR GENERAL

Appropriations, 1998....................................     $46,272,000
Budget estimate, 1999...................................      49,805,000
Committee recommendation................................      48,500,000

    The bill includes $48,500,000 for this account, a decrease 
of $1,305,000 below the budget request and $2,228,000 above the 
1998 comparable level. The bill includes $44,775,000 in general 
funds and authority to transfer $3,725,000 from the 
``Employment Security Administration'' account of the 
unemployment trust fund. In addition, an amount of $306,000 is 
available by transfer from the black lung disability trust 
fund. The reduction from the request was necessary due to 
severe budget constraints facing the Committee in fiscal year 
1999.
    The Office of the Inspector General [OIG] was created by 
law to protect the integrity of departmental programs as well 
as the welfare of beneficiaries served by those programs. 
Through a comprehensive program of audits, investigations, 
inspections, and program evaluations, the OIG attempts to 
reduce the incidence of fraud, waste, abuse, and mismanagement, 
and to promote economy, efficiency, and effectiveness 
throughout the Department.

                           GENERAL PROVISIONS

    General provisions bill language is included to: Rescind 
welfare-to-work formula grant funding not claimed by the States 
(sec. 101); permit transfers of up to 1 percent between 
appropriations (sec. 102); and permit contracting out of Job 
Corps civilian conservation centers that fail to meet 
performance standards (sec. 103).

           TITLE II--DEPARTMENT OF HEALTH AND HUMAN SERVICES

              Health Resources and Services Administration

                     health resources and services

Appropriations, 1998....................................  $3,611,395,000
Budget estimate, 1999...................................   3,772,968,000
Committee recommendation................................   3,885,900,000

    The Committee recommends an appropriation of $3,885,900,000 
for health resources and services. This is $112,932,000 above 
the administration request and $274,505,000 more than the 
fiscal year 1998 allowance.
    Health Resources and Services Administration [HRSA] 
activities support programs to provide health care services for 
mothers and infants; the underserved, elderly, homeless; 
migrant farm workers; and disadvantaged minorities. This 
appropriation supports cooperative programs in community 
health, AIDS care, health provider training, and health care 
delivery systems and facilities.

                      CONSOLIDATED HEALTH CENTERS

    The Committee has again provided funds for community health 
centers, migrant health centers, health care for the homeless, 
and public housing health service grants in a consolidated line 
rather than through separate lines. The Committee provides 
$925,000,000 for the consolidated health centers [CHC's], which 
is $100,117,000 above the 1998 level and $85,532,000 above the 
administration request for this group of programs.

Community health centers

    The community health centers provide comprehensive, case-
managed primary health care services to medically indigent and 
underserved populations in rural and urban areas. Of the 
clients served by community health centers, about 44 percent 
are children and 66 percent have incomes below the poverty 
line.
    The Committee understands that half of new patients served 
by health centers over the past 3 years have no health 
insurance. This increase in uninsured patients has driven 
demand for expanded services. The Committee expects that 
funding increases will be reasonably allocated to increase 
grant levels for existing grantees (particularly those serving 
greater numbers of uninsured persons) and to initiate new sites 
in underserved areas, particularly in rural regions.
    The Committee is concerned about the low number of centers 
in rural areas where shortages of health professionals are the 
greatest. The Committee strongly urges the agency to place the 
highest priority on applications for new centers on rural areas 
which fall within the service area of an existing center but 
where no satellite clinic has been established.
    The Committee repeats bill language from previous years 
limiting the amount of funds available for the payment of 
claims under the Federal Tort Claims Act to $5,000,000.
    The Committee notes that in each of fiscal years 1997 and 
1998, $6,000,000 was made available from the health center 
appropriation for guarantees of loans made to health centers 
for the costs of developing and operating managed care networks 
or plans and for facility improvements. Because there are 
sufficient funds available to meet needs for these loan 
guarantees at the present time, the Committee is not making 
available additional funds for these loan guarantees in fiscal 
year 1999. Instead, the Committee intends that $6,000,000 in 
fiscal year 1999 funds for community health centers be made 
available for grants under section 330(c)(1)(B) to assist 
health centers in meeting the necessary startup expenses for 
planning and organizing managed care networks and plans, which 
must be made before a health center can use the loan guarantee 
program. The Committee further intends that the use of fiscal 
year 1999 grants under section 330(c)(1)(B) will not result in 
the reduction of any other grant to an existing health center.
    The Committee understands the difficulties with which the 
loan guarantee program, established under section 330(d) of the 
Public Health Service Act, is being implemented and requests 
the administrator to provide a report by December 31, 1998, on 
the status of this initiative, including recommendations on how 
its implementation could be expedited.
    Within the increase provided for community health centers, 
the bureau is encouraged to demonstrate and evaluate the 
outcomes of linking community health centers and substance 
abuse treatment centers.
    The Committee reiterates its support for providing 
comprehensive primary and preventive health care services to 
persons without health insurance coverage and to those residing 
in isolated areas. The Committee encourages HRSA to establish 
new centers and to expand existing centers in communities in 
need. The Committee is supportive of the proposal by the Haines 
Health Center in Haines, AK, and considers addressing the 
health needs of the people in the catchment area to be of the 
highest priority; the Committee further urges the agency to 
give full and fair consideration to this proposal. The 
Committee is aware of proposals by Ozark Tri-County in 
Pineville, MO, Cross Trails Medical Center in Advance, MO, and 
the Family Health Center in Columbia, MO, and encourages full 
and fair consideration of the proposals from these 
organizations. The Committee is further aware of the plan by 
Samuel U. Rodgers Health Center and Cabot Westside Clinic in 
Kansas City, MO, to collaborate and integrate service delivery 
systems, and urges the agency to give this proposal full and 
fair consideration.
    The integrated service delivery network developed by the 
Iowa/Nebraska primary care association has served as a model to 
more effectively and efficiently provide access and quality 
care to underserved populations. The Committee encourages HRSA 
to give full and fair consideration to a proposal from this 
association to expand this network to other rural communities 
including Burlington and Ottumwa, IA.
    The Committee is concerned with the Department's delay in 
the publication of regulations to update and revise medically 
underserved areas [MUA] and health professions shortage areas 
[HPSA]. Many communities depend on MUA and HPSA designations 
for participation in vital programs which assist them in the 
delivery of health care services to the underserved. 
Furthermore, the Committee is concerned that current MUA and 
HPSA decisions are based on outdated and inaccurate data which 
results in communities losing MUA and HPSA status and, 
therefore, participation in several important programs. The 
Committee urges the Department to expedite publication of the 
revised MUA and HPSA regulations, currently under development. 
In addition, the Committee expects the Department to provide 
extensions for areas which would otherwise lose their MUA and 
HPSA designations under the current system to allow time to 
have their status reviewed under the new regulations.
    The Committee is aware that a significant number of 
uninsured families in the Nation reside in the South, a region 
that has a high number of underserved areas. It has been 
brought to the Committee's attention that the Robert Wood 
Johnson Foundation has initiated a program, the Southern Rural 
Access Program, that works with targeted States to increase 
access to care by developing community leadership and improving 
rural health care infrastructure. Housed at the Geisinger 
Health System of the Pennsylvania State University, the 
national program office for this initiative is positioned to 
provide ongoing technical assistance. Several States have 
elected to participate in the RWJF program but still lack the 
necessary resources for entry. The Committee strongly urges the 
Secretary to consider designating a portion amount of the funds 
appropriated to Community and Migrant Health Centers and 
School-Based Clinics as matching funds for centers 
participating in the program.
    It has been brought to the Committee's attention that 
environmental health burdens have fallen disproportionately 
upon low-income and minority communities. The agency is 
encouraged to develop more effective intervention and 
prevention strategies that address this area of need.
    The Committee is concerned that despite previous 
recommendations that the Hui program be funded, given Hawaii's 
pressing and unique needs and the administration's assurance of 
support, only a minimal amount of funding was made available. 
Accordingly, the Committee expects a significant increase be 
provided for this project to address the unique health care 
needs of Hawaii's underserved populations which include the 
unemployed, persons with drug addiction, alcoholism, and 
chronic illness. The Committee recommends that community health 
centers serve as a safety net for this program, utilizing nurse 
practitioners and psychologists as care providers for these 
underserved populations.
    Native Hawaiian indigenous populations continue to 
experience significant health problems, including asthma and 
diabetes. The Committee urges HRSA to implement a program under 
which the systematic utilization of native Hawaiian healing 
expertise may effectively impact the health status in these 
populations. The Committee further urges the continued use of 
community-based health centers as a foundation for traditional 
healing initiatives.
    The Committee is aware of HRSA's policy of disinvestment 
and is concerned that the agency is unduly penalizing community 
and rural health centers that operate efficiently and utilize 
sound budgeting. The Committee urges HRSA to reevaluate the 
disinvestment process.

Migrant health centers

    The program helps provide culturally sensitive 
comprehensive primary care services to migrant and seasonal 
farm workers and their families. Over 80 percent of the centers 
also receive funds from the community health centers program.
    The Committee is aware of a HRSA policy that may be 
penalizing those migrant health centers that are operating 
efficiently and utilizing sound budgeting. The Committee urges 
the agency to reevaluate the disinvestment process.

Health care for the homeless

    The program provides project grants for the delivery of 
primary health care services, substance abuse services, and 
mental health services to homeless adults and children. About 
one-half of the projects are administered by community health 
centers. The other one-half are administered by nonprofit 
coalitions, inner-city hospitals, and local public health 
departments.

Public housing health service grants

    The program awards grants to community-based organizations 
to provide case-managed ambulatory primary health and social 
services in clinics at or in proximity to public housing. More 
than 60 percent of the programs are operated by community 
health centers.

Native Hawaiian health care

    The Committee again includes the legal citation in the bill 
for the Native Hawaiian Health Care Program. The Committee has 
included funding for the consolidated health centers line so 
that health care activities funded under the Native Hawaiian 
Health Care Program can be supported under the broader 
community health centers line. The Committee expects that not 
less than $3,500,000 be provided for these activities in fiscal 
year 1999.
    The purpose of this activity is to improve the health 
status of native Hawaiians by making primary care, health 
promotion, and disease prevention services available through 
the support of native Hawaiian health systems. Services 
provided include health screening, nutrition programs, and 
contracting for basic primary care services. This activity also 
supports a health professions scholarship program for native 
Hawaiians.
    Pacific basin initiative.--The Committee appreciates the 
Institute of Medicine study of the Pacific basin health care 
delivery system, conducted in 1998. It is the Committee's 
understanding that the IOM cited alarming findings for all 
health indicators for the 500,000 people residing in the freely 
associated States, as being worse than those for mainland 
Americans because of health conditions such as tuberculosis, 
malnutrition, dental caries, fever, cholera, diabetes, cancer, 
and heart disease. The Committee, therefore, expects the 
Department to review the IOM findings and initiate 
implementation of its recommendations which include: 
jurisdictional coordination by the Pacific Islanders Health 
Officers Association [PIHOA]; use of Tripler Army Medical 
Center and Guam Naval Hospital for care coordination, with 
emphasis on telehealth assessment and management; development 
of and participation in a regional health information system 
for information tracking and storage; continuing education for 
all health providers; and increased involvement in health care, 
particularly women's health issues. The Committee expects an 
initial progress report from the Department on these 
initiatives by January 1, 1999.

National Health Service Corps: Field placements

    The Committee provides $37,244,000 for field placement 
activities, which is $31,000 above the 1998 level and $69,000 
above the administration request. The funds provided for this 
program are used to support the activities of National Health 
Service Corps obligors and volunteers in the field, including 
travel and transportation costs of assignees, training and 
education, recruitment of volunteers, and retention activities. 
Salary costs of most new assignees are paid by the employing 
entity.
    The Committee is concerned about the lack of dental 
participation in the NHSC Scholarship Program and few dental 
recipients of NHSC loan repayment awards, despite a significant 
increase in the number of dentists needed to service designated 
dental health professions shortage areas. The Committee 
strongly urges the NHSC to address this problem through 
increased dental participation.

National Health Service Corps: Recruitment

    The Committee provides $78,166,000 for recruitment 
activities, which is $309,000 above the 1998 level and $144,000 
above the administration request. This program provides major 
benefits to students (full-cost scholarships or sizable loan 
repayment) in exchange for an agreement to serve as a primary 
care provider in a high priority federally designated health 
professional shortage area. The Committee reiterates its 
intention that funds provided be used to support multiyear, 
rather than single-year, commitments.
    The Committee again intends that $3,000,000 of funds 
appropriated for this activity be used for State offices of 
rural health. The Committee continues to be concerned about 
possible overlap and duplication between primary care offices 
[PCO's] supported in every State through the health centers 
appropriation and State offices of rural health [SORH's] 
supported in each State through the National Health Service 
Corps appropriation. While some required activities are 
exclusive to one program or another, the majority are similar. 
These include assessment of need for health services and 
available resources, targeting areas of unmet need, site and 
community development, technical assistance, and training. The 
Committee reiterates its recommendation that HRSA encourage 
States to create agreements between each State's PCO and SORH 
delineating joint and separate activities and promoting 
collaboration to the satisfaction of program officials.
    Within the National Health Service Corps, the 
administration proposes to incorporate activities previously 
included under the health professions program: Grant to 
Communities and Nurse Loan Repayment. The grants to communities 
are intended to increase the availability of primary health 
care in urban and rural health professional shortage areas. The 
nurse loan repayment program offers repayment to nurses in 
exchange for an agreement to serve in an area with high 
disadvantaged populations.
    In view of the significant shortage of behavioral and 
mental health care providers in the 775 community health 
centers across the country and the high level of need for these 
services, the Committee strongly encourages NHSC to continue 
initiatives that will attract and support psychologists as care 
providers in community health centers.

                           HEALTH PROFESSIONS

    For all HRSA health professions programs, the bill includes 
$208,000,000, which is $84,518,000 less than the fiscal year 
1998 appropriation and $82,595,000 less than the overall 
administration request for these programs.
    The Committee recommends consolidated funding for programs 
authorized under titles III, VII, and VIII programs.
    The following programs are included in this consolidated 
account:

Grants to communities for scholarships

    This program provides grants to States to provide financing 
for community organizations located in health professions 
shortage areas to make scholarship awards to health professions 
students in exchange for a service obligation in the community. 
Sixty percent of the costs of scholarships are paid by the 
States and sponsoring community organizations. The 
administration proposes to incorporate this activity in the 
National Health Service Corps Program, and has not requested 
funds for this activity in fiscal year 1999.

Health professions data and analysis

    This program supports the collection and analysis of data 
on the labor supply in various health professions and on future 
work force configurations.

Research on certain health professions issues

    This program supports research on the extent to which debt 
has a detrimental effect on students entering primary care 
specialties; the effects of federally funded education programs 
for minorities attending and completing health professions 
schools; and the effectiveness of State investigations in 
protecting the health of the public. The Committee reiterates 
its support for the three centers for health professions 
research that are current grantees.

Centers of excellence

    This program was established to fund institutions that 
train a significant portion of the Nation's minority health 
professionals. Funds are used for the recruitment and retention 
of students, faculty training, and the development of plans to 
achieve institutional improvements. The institutions that are 
designated as centers of excellence are private institutions 
whose mission is to train disadvantaged minority students for 
service in underserved areas. Located in poor communities and 
usually with little State funding, they serve the health care 
needs of their patients often without remuneration.

Health careers opportunity program

    This program provides funds to medical and other health 
professions schools for recruitment of disadvantaged students 
and preprofessional school preparations. The Committee is 
pleased that HRSA has given priority consideration for grants 
to minority health professions institutions, and recommends 
that grant review committees have proportionate representation 
from these institutions.

Exceptional financial need scholarships

    This program provides scholarship assistance to 
exceptionally needy students enrolled in schools of medicine, 
osteopathic medicine, or dentistry who agree to practice 
primary care for 5 years after completing training.

Faculty loan repayment

    This program provides for the repayment of education loans 
for individuals from disadvantaged backgrounds who are health 
professions students or graduates, and who have agreed to serve 
for not less than 2 years as a faculty member of a health 
professions school.

Financial assistance for disadvantaged health professions students

    This program provides financial assistance to disadvantaged 
students at medical, osteopathic, or dental schools who agree 
to practice primary health care for 5 years after completing 
training.
    The Committee has been supportive of this program's 
critical role in improving the health status of minority and 
disadvantaged citizens by increasing available opportunities 
for those individuals seeking a health professions career. The 
Committee understands that minority providers are more likely 
to serve in underserved areas. The program has recognized the 
contribution of historically minority health professions 
schools, and have supported those institutions which have made 
the greatest contribution to increasing the number of 
minorities in health professions careers.

Scholarships for disadvantaged students

    This program provides grants to health professions schools 
for student scholarships to individuals who are from 
disadvantaged backgrounds and are enrolled as full-time 
students in such schools. The Committee continues to intend 
that all health professions disciplines made eligible by 
statute be able to participate in the scholarships program.
    The Committee continues to recognize the importance of 
training greater numbers of psychologists and other health 
professionals from disadvantaged backgrounds to participate on 
interdisciplinary primary care teams addressing a range of 
behavioral and mental health needs.

Family medicine training

    Family medicine activities support grants for graduate 
training in family medicine, grants for predoctoral training in 
family medicine, grants for faculty development in family 
medicine, and grants for the establishment of departments of 
family medicine. The Committee reiterates its support for this 
program and recognizes its importance in increasing the number 
of primary care physicians in underserved areas.

General internal medicine and pediatrics training

    This program provides funds to public and private nonprofit 
hospitals and schools of medicine and osteopathic medicine to 
support residencies in internal medicine and pediatrics. Grants 
may also include support for faculty.

Physician assistants

    This program supports planning, development, and operation 
of physician assistant training programs.

Public health and preventive medicine

    This program supports awards to schools of medicine, 
osteopathic medicine, public health, and dentistry for support 
of residency training programs in preventive medicine and 
dental public health; and for financial assistance to trainees 
enrolled in such programs.
    The Committee encourages the increase of residency training 
opportunities in dental public health so that Federal, State, 
and community-based programs have the leadership capabilities 
to prevent dental disease, promote oral health, and improve 
treatment outcomes.

Health administration traineeships and special projects

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

Area health education centers

    This program links university health science centers with 
community health service delivery systems to provide training 
sites for students, faculty, and practitioners. The program 
supports three types of projects: Core grants to plan and 
implement programs; special initiative funding for schools that 
have previously received AHEC grants; and model programs to 
extend AHEC programs with 50 percent Federal funding. The 
Committee intends that adequate funding be provided to the area 
health education centers [AHEC] grant program since AHEC's are 
an important component of the Federal/State partnership in 
addressing rural health issues.
    The Committee encourages the development of a training 
curriculum on chronic fatigue and associated illnesses for 
health care providers in practice and in training. Such a 
curriculum holds significant potential in improving the 
detection, diagnosis, treatment, and management of CFIDS 
patients.
    The Committee continues to support the WAMI medical 
educational consortium for eligible residents of the States of 
Washington, Alaska, Montana, and Idaho. The program seeks to 
establish rural training programs for medical students and 
telecommunication links between participating centers. The 
Committee expects the agency and the AHEC program to work with 
the consortium and to grant full and fair consideration for the 
concepts advanced by WAMI.

Border health training centers

    These centers provide training to improve the supply, 
distribution, and quality of personnel providing health 
services in the State of Florida or along the border between 
the United States and Mexico and in other urban and rural areas 
with populations with serious unmet health care needs.

General dentistry residencies

    This program assists dental schools and postgraduate dental 
training institutions to meet the costs of planning, 
developing, and operating residency training and advanced 
education programs in general practice of dentistry and funds 
innovative models for postdoctoral general dentistry.

Allied health advanced training and special projects

    This program provides funds to assist schools or programs 
with projects designed to plan, develop, or expand 
postbaccalaureate programs for the advanced training of allied 
health professions; and provide traineeships or fellowships to 
postbaccalaureate students who are participating in the program 
and who commit to teaching in the allied health profession 
involved. This program also provides funds to expand existing 
training programs or develop new ones, recruit individuals into 
allied professions with the most severe shortages or whose 
services are most needed by the elderly, and increase faculty 
recruitment and education, and research.
    The Committee continues to encourage HRSA to give priority 
consideration to those projects for schools training allied 
health professionals experiencing shortages, such as medical 
technologists and cytotechnologists.

Geriatric education centers and training

    This program supports grants to health professions schools 
to establish geriatric education centers and to support 
geriatric training projects. The administration requested 
funding in a consolidated program cluster. These centers and 
geriatric training programs play a vital role in enhancing the 
skill-base of health care professionals to care for our 
Nation's growing elderly population. The Committee is concerned 
about the shortage of trained geriatricians and urges the 
agency to give priority to building the work force necessary to 
care for the Nation's elderly.

Rural health interdisciplinary training

    This program addresses shortages of health professionals in 
rural areas through interdisciplinary training projects that 
prepare students from various disciplines to practice together, 
and offers clinical training experiences in rural health and 
mental health care settings to expose students to rural 
practice. The Committee encourages this program to continue 
addressing the issue of how the delivery of chiropractic health 
care can be enhanced in rural areas, and how more women and 
minorities can be recruited as chiropractic health care 
practitioners in rural areas. The Committee expects this 
program to be continued to be funded at current levels. The 
Committee also urges the bureau to consider implementation of 
telecommunications and telehealth initiatives for providing 
distance education and training for nurses and other health 
professionals serving in rural areas.

Podiatric primary care training

    The program provides grants to hospitals and schools of 
podiatric medicine for residency training in primary care. In 
addition to providing grants to hospitals and schools of 
podiatric medicine for residency training in primary care, the 
program also permits HRSA to study and explore ways to more 
effectively administer postdoctoral training in an ever 
changing health care environment.

Chiropractic demonstration grants

    The program provides grants to colleges and universities of 
chiropractic to carry out demonstration projects in which 
chiropractors and physicians collaborate to identify and 
provide effective treatment of spinal and lower back 
conditions. The Committee recommends that the program be 
continued and funded at current levels.

Advanced nurse education

    This program funds nursing schools to prepare nurses at the 
master's degree or higher level for teaching, administration, 
or service in other professional nursing specialties.

Nurse practitioner/nurse midwife education

    This program supports programs preparing nurse 
practitioners and nurse midwives to effectively provide primary 
health care in settings such as the home, ambulatory, and long-
term care facilities, and other health institutions. These 
professionals are in especially short supply in rural and 
underserved urban areas.

Nursing special projects

    This program supports projects to increase the supply of 
nurses meeting the health needs of underserved areas; 
demonstrate methods to improve access to nursing services in 
nontraditional settings; and demonstrate innovative nursing 
practices.
    The Committee is aware of the new interstate nurse 
licensure compact approved by the National Council of State 
Boards of Nursing. Several States will need to convert their 
current system to the new system, which will improve specific 
administrative functions, allow for better coordination and 
cooperation among participating States, and enable better 
tracking of investigations and disciplinary actions. The bureau 
is encouraged to lend its assistance in identifying steps and 
resources that could accelerate the States' transition to the 
new system.

Nurse disadvantaged assistance

    This program provides grants and contracts to qualified 
schools and education programs to recruit individuals from 
minority and disadvantaged backgrounds, and to assist them with 
their nursing education by providing training, counseling, and 
stipends.

Professional nurse traineeships

    Traineeships fund registered nurses in programs of advanced 
nursing education, including preparation for teaching, 
administration, supervision, clinical specialization, research, 
and nurse practitioner and nurse midwife training.

Nurse anesthetist traineeships

    Grants are awarded to eligible institutions to provide 
traineeships for licensed registered nurses to become certified 
registered nurse anesthetists [CRNA]. The program also supports 
fellowships to enable CRNA faculty members to obtain advanced 
education.

Nurse loan repayment for shortage area service

    This program offers student loan repayment to nurses in 
exchange for an agreement to serve not less than 2 years in an 
Indian health service health center, native Hawaiian health 
center, public hospital, community or migrant health center, or 
rural health clinic. The administration proposes to incorporate 
this function within the National Health Service Corps Program, 
and has not requested separate funding for this function for 
fiscal year 1999.

                          other hrsa programs

Hansen's disease services

    The Committee has included $18,670,000 for the Hansen's 
Disease Program, which is $1,576,000 above the 1998 level and 
$1,650,000 above the administration request. The fiscal year 
1998 appropriations bill included legislation authorizing the 
transfer of the Carville facility to the State of Louisiana, 
the moving of the center to another location within Louisiana, 
the payment of a yearly stipend to those residents who choose 
to live independently, and certain personnel provisions for 
existing staff. The agency proposes to develop a plan to 
restructure its Hansen's Disease operations at its new 
location. The Committee has provided funding for the payment to 
Hawaii as a separate line item. The increase has been provided 
to cover additional expenses associated with the payment of 
stipends to eligible patients who choose to leave the center.

Maternal and child health block grant

    The Committee recommends $683,000,000 for the maternal and 
child health [MCH] block grant. This is $1,921,000 over the 
fiscal year 1998 level and $1,260,000 over the administration 
request.
    The MCH block grant funds are provided to States to support 
health care for mothers and children. According to statute, 
12.75 percent of funds over $600,000,000 are used for 
community-integrated service systems [CISS] programs. Of the 
remaining funds, 15 percent is used for special projects of 
regional or national significance [SPRANS] while 85 percent is 
distributed on the same percentage split as the basic block 
grant formula.
    The Committee includes bill language designating up to 
$105,863,000 of the maternal and child health block grant for 
special projects of regional and national significance 
[SPRANS]. This designation will provide $5,000,000 more for 
SPRANS activities than would otherwise be the case under the 
statutory formula. The Committee intends that this amount be 
used for the traumatic brain injury State demonstration 
projects authorized under title XII of the Public Health 
Service Act.
    The Committee urges the bureau to utilize SPRANS funds to 
support the proposal, family initiatives in children's health 
centers, to be administered by families for children with 
special health care needs, affiliated with a family-run 
national technical assistance center and three regional 
technical assistance centers, to provide health care 
information and education for families of children with special 
health care needs to assure that families receive timely and 
accurate information to make informed decisions about their 
children's unique health care needs. Under this proposal, the 
national center will collect information from the family-run 
centers to monitor health access, delivery, and financing for 
children with special health care needs and act as an 
information clearinghouse for the State-based centers.
    Within the funds provided, the Committee encourages the 
availability and accessibility of newborn screening services to 
apply public health recommendations for expansion of effective 
strategies. HRSA, in collaboration with the Centers for Disease 
Control and Prevention [CDC] and the National Institutes of 
Health [NIH], is encouraged to develop and implement a strategy 
for evaluating and expanding newborn screening programs, pilot 
demonstration projects, and the use of contemporary public 
health recommendations on specific conditions, such as cystic 
fibrosis and the fragile X syndrome. If implemented, the 
Committee directs that tangible steps be taken to protect 
patient privacy and to avert discrimination based upon 
information derived from the screenings.
    Within the funds provided, HRSA is encouraged to consider a 
service demonstration to develop a targeted initiative for 
prenatal providers to better screen at-risk alcohol-using 
pregnant women in order to reduce their alcohol use during 
pregnancy and to refer them to alcohol treatment services.
    The Committee has been pleased with the Bureau's efforts in 
responding to the joint effort with the NIH's Child Health 
Institute in the Back to Sleep Campaign for sudden infant death 
syndrome, and by continuing to focus on outreach to underserved 
populations. The MCH Bureau is also commended for establishing 
the SIDS program support center as recommended by the 
nationwide survey of sudden infant death services in 
conjunction with the Sudden Infant Death Syndrome Alliance and 
encouraged to continue the research and data collection this 
center has begun.
    The Committee is pleased with the overall progress of the 
Office of Adolescent Health in its efforts to address the needs 
of adolescents at risk for poor health outcomes. The Committee 
recognizes that psychosocial issues represent the chief causes 
of morbidity and mortality among the adolescent population and 
that comprehensive approaches employed by the Office of 
Adolescent Health have the best chance for success in meeting 
adolescents' multiple needs. The Committee urges the Office of 
Adolescent Health to move forward with its integrated 
approaches to physical and mental healthcare and substance 
abuse services for teenagers.
    The Committee reiterates its support for childhood vision 
screening as a cost-effective public health activity. Within 
the allocation, the Committee encourages the agency to provide 
$200,000 to initiate implementation of screening efforts, 
including grants to States.
    Dental caries (tooth decay) is one of the most common 
health problems among children, and fluoridation has proven to 
be the single most cost-effective preventive measure. It is 
estimated that Medicaid spends significantly more per child to 
care for a child's teeth in nonfluoridated areas compared to 
districts whose water supply is fluoridated. The Committee 
reiterates its support for implementation of enhanced 
fluoridation efforts, particularly in underutilized areas of 
the country, and intends that an amount no less than that 
expended last year by the agency be used for those States with 
fluoridation levels below 25 percent to allow them to develop 
implementation plans for increased fluoridation.
    It has been brought to the Committee's attention that 
millions of infants are not receiving screening for hearing 
loss. Such screening can be performed at minimal cost and can 
prevent significant health and education costs for children. 
Recent advancements have been made on screening and the 
National Institutes of Health is concluding a major study of 
the most effective forms of screening. The Committee continues 
to believe that screening would be a judicious use of block 
grant funds and again recommends that HRSA provide States with 
the results of the NIH study.
    The Committee continues to support the concept of malama. 
This innovative, culturally sensitive community partnership 
program addresses the prenatal needs of minorities in rural 
Hawaii. The Committee encourages the HRSA to support the 
replication of this project to include teen pregnancies. The 
ever increasing epidemic of teen pregnancy makes the maximum 
utilization of effective strategies a necessity.
    The Committee recognizes the important role of hemophilia 
treatment centers in the prevention and treatment of the 
complications of hemophilia. Funds are available to maintain 
support for these centers in order to sustain their treatment 
outreach to persons with hemophilia and ensure their 
participation with CDC and FDA on blood safety surveillance and 
patient notification efforts.
    The Committee is aware of the efforts of the Therapeutic 
Education Treatment Center at KidsPeace, the National Center 
for Kids Overcoming Crisis, to promote expressive therapy 
treatment activities and development of crisis and special 
education centers, and encourages the agency to consider its 
proposal.

Healthy start initiative

    The Committee recommends $105,000,000 for the healthy start 
infant mortality initiative. This amount is $9,474,000 over the 
fiscal year 1998 amount and $9,195,000 over the administration 
request.
    The healthy start initiative was developed to respond to 
persistently high rates of infant mortality in this Nation. The 
initiative was expanded in fiscal year 1994 by a special 
projects program, which supported an additional seven urban and 
rural communities to implement infant mortality reduction 
strategies and interventions.
    While these projects have made substantial progress in the 
reduction of infant mortality, there remain significant 
challenges to sustain the gains already attained. Abrupt 
termination of the program will likely result in increases in 
infant mortality in the targeted project areas. While the 
Committee is aware of the original timeframe of the program, it 
places its highest priority toward averting and reducing infant 
mortality through sustainable means in areas with continued 
critical needs.
    The Committee is pleased with the success of and supports 
expansion of the healthy schools, healthy communities 
initiative which has been particularly effective in providing 
comprehensive school-based, school-linked, family centered, 
community-based primary care to approximately 24,000 children. 
The Committee encourages HRSA to continue this program which 
enhances a child's ability to learn and grow to his or her full 
potential.

Organ procurement and transplantation

    The Committee provides $10,000,000 for organ transplant 
activities. This is $5,889,000 over the administration request 
and $7,222,000 more than the fiscal year 1998 appropriation.
    The Committee considers increasing the supply of organs, 
particularly livers, available for voluntary donation to be a 
top public health priority. The Committee notes that there has 
been considerable debate for the past 2 years on the method of 
distribution of scarce organs; however, no solution is complete 
without a concerted effort to increase the availability of 
organs from potential donors. The wide State-by-State 
disparities in waiting times for a donated liver, for example, 
are indicative of the need for improved donation rates. The 
Committee has added $5,889,000 above the request to accelerate 
nationwide efforts to increase the rate of donation. The 
Committee further expects that the additional funds be 
committed to those activities having the greatest demonstrable 
impact on donation rates and expects an operational plan from 
the agency within 60 days of enactment of this bill.
    These funds support a scientific registry of organ 
transplant recipients and kidney dialysis patients, and the 
National Organ Procurement and Transplantation Network to match 
donors and potential recipients of organs. A portion of the 
appropriated funds may be used for education of the public and 
health professionals about organ donations and transplants, and 
to support agency staff providing clearinghouse and technical 
assistance functions. The Committee is concerned that while 
approximately 10 people die each day waiting for an organ 
transplant, the rate of organ donation has remained flat for 
the last 8 years. In order to increase the rate of organ 
donation, the Committee urges increased behavioral research to 
better target and increase the effectiveness of public 
awareness campaigns.

Health teaching facilities interest subsidies

    The Committee recommends $150,000 for interest subsidies 
for three health professions teaching facilities. This is the 
same as the administration request and $74,000 less than the 
fiscal year 1998 appropriation. This program continues support 
of interest subsidies and loan guarantees for three loans for 
construction of health professions teaching facilities under a 
now discontinued Public Health Service Act authority. The 
remaining Federal commitment on these loans will expire in the 
year 2004.

National bone marrow donor program

    The Committee has included $15,270,000 for the national 
bone marrow donor program. This is the same as the 
administration request and the fiscal year 1998 level. The 
National Bone Marrow Donor Registry is a network, operated 
under contract, that helps patients suffering from leukemia or 
other blood diseases find matching volunteer unrelated bone 
marrow donors for transplants. The program also conducts 
research on the effectiveness of unrelated marrow transplants 
and related treatments.

Rural health outreach grants

    The Committee recommends $32,592,000 for health outreach 
grants. This amount is $156,000 higher than the fiscal year 
1998 level and $60,000 higher than the administration request. 
This program supports projects that demonstrate new and 
innovative models of outreach in rural areas such as 
integration and coordination of health services and rural 
telemedicine projects. The Health Care Consolidation Act of 
1996 authorized a new rural network development program 
intended to develop integrated organizational capabilities 
among three or more rural health provider entities.
    The Committee commends the efforts of the Office of Rural 
Health Policy to expand the use of telehealth services to 
increase access and improve care to individuals in underserved 
areas. However, the Committee is concerned that present efforts 
do not adequately encompass the discipline of nursing and other 
allied health professionals' contributions in this field. The 
utilization of nursing telehealth interventions in the home 
health care arena offers great potential for improved services 
to patients. Additionally, the Committee urges consideration of 
the unique needs of the rehabilitation community and the 
Rehabilitation Hospital of the Pacific, as potential 
beneficiaries of telehealth activities.
    The Committee remains supportive of the effort by Southwest 
Alabama Network for Education and Telemedicine to build a 
telemedicine project dedicated to serving rural, poor, and 
medically underserved communities through a high-speed, 
community-access telecommunication network. The Committee has 
included sufficient funds within this account to continue its 
work at last year's level.
    The Committee is aware of the proposal by the children's 
health fund to implement a rural health initiative that would 
expand the availability and accessibility of comprehensive 
primary pediatric care to underserved rural communities, 
especially in rural areas of Mississippi, West Virginia, south 
Florida, and Arkansas. The Committee has included $500,000 
within this account to initiate this activity.
    The Committee urges HRSA to provide technical assistance to 
Marshall University of Huntington, WV, in developing an 
innovative plan to improve health care access and outcomes for 
the following underserved rural populations: infants and young 
children; pregnant women; patients with chronic cardiac or lung 
disease; patients with diabetes; and isolated rural elders. 
Sufficient funds have been included for this activity.
    The Committee is aware of the efforts of Low Country Health 
Care Systems, a five-county vertically integrated network in 
South Carolina comprised of community health centers, rural 
community hospitals, rural health clinics, State health 
departments, and other public and private health providers. The 
consortium seeks to provide quality, low-cost health care for 
people living in a medically underserved health professions 
shortage area. The Committee encourages the agency to consider 
allocating up to $250,000 for this project.
    The Committee is supportive of the Community Voices Program 
of the Moore Regional Hospital in Pinehurst, NC, that seeks to 
strengthen the ability of underserved and at-risk rural 
individuals to interact more effectively with the health care 
system and care providers.

Emergency medical care for children

    The Committee provides $15,000,000 for emergency medical 
services for children. This is $2,059,000 above the 1998 level 
and $4,024,000 above the administration request. The program 
supports demonstration grants for the delivery of emergency 
medical services to acutely ill and seriously injured children. 
The Committee urges HRSA to consider EMSC a high priority, 
focusing on the development of prevention and treatment 
programs and education of emergency personnel in remote and 
rural areas such as Alaska and Hawaii, using telemedicine 
technology. For example, a collaborative effort with Tripler 
Army Medical Center, using the telemedicine technology already 
available would enhance the development of the EMSC 
initiatives.

Black lung clinics

    The Committee includes $5,000,000 for black lung clinics. 
This is $24,000 above the fiscal year 1998 amount and the same 
as the administration request. This program funds clinics which 
treat respiratory and pulmonary diseases of active and retired 
coal miners. These clinics reduce the incidence of high-cost 
inpatient treatment for these conditions.

Alzheimer's disease demonstration grants

    The Committee recommends $6,000,000 for Alzheimer's 
demonstration grants, which is $30,000 higher than the 1998 
level. The administration requested transfer of funding and 
program operations to the Administration on Aging.
    Alzheimer's State demonstration grants.--The Committee is 
pleased to learn that this program is proving to be an 
effective catalyst by encouraging an estimated 147 State and 
local agencies to strengthen and coordinate community services 
for Alzheimer families. By leveraging State matching funds, 
projects in 15 States have provided outreach to an estimated 
4.5 million persons, many of whom live in rural and inner-city 
communities. The President's budget proposes to transfer this 
program to the Administration on Aging, however, the Committee 
has deferred action at this time pending assurances from the 
Secretary that current projects will be permitted to complete 
their 2-year cycle of funding without disruption.

Payment to Hawaii, Hansen's disease treatment

    Within the amount provided for Hansen's disease services, 
the Committee has provided $2,045,000 for the 1999 payment to 
the State of Hawaii for the medical care and treatment in its 
hospital and clinic facilities of persons with Hansen's disease 
at a per diem rate not greater than the comparable per diem 
operating cost per patient at the Gillis W. Long National 
Hansen's Disease Center in Carville, LA. This amount is the 
same as the administration request and the 1998 level.

                  acquired immune deficiency syndrome

                        Ryan White AIDS programs

    The Committee provides $1,367,800,000 for Ryan White AIDS 
programs. This is $54,818,000 above the administration request 
and $218,288,000 above the 1998 level.
    Recent advances in diagnosis, treatment, and medical 
management of HIV disease has resulted in dramatic improvements 
in individual health, lower death rates and transmission of HIV 
from mother to infant. The Committee recognizes, however, that 
not all HIV infected persons have benefited from these medical 
advances and expects that the Ryan White CARE Act programs 
provide social and other support services with the specific 
intent of obtaining and maintaining HIV-infected individuals in 
comprehensive clinical care.

Emergency assistance--title I

    The Committee recommends $478,000,000 for emergency 
assistance grants to eligible metropolitan areas 
disproportionately affected by the HIV/AIDS epidemic. This 
amount is $13,264,000 above the fiscal year 1998 amount and 
$10,974,000 below the administration request. These funds are 
provided to metropolitan areas with a cumulative total of more 
than 2,000 cases of AIDS or a per capita incidence of 0.0025 
for cases prior to fiscal year 1995. One-half of the funds are 
awarded by formula and one-half are awarded through 
supplemental competitive grants.
    The Committee is concerned about the limited AIDS therapy 
options for children and pregnant women, and encourages the 
Secretary, when awarding supplemental title I funds, to give 
priority as appropriate to EMA's whose applications increase 
services to women and children with AIDS/HIV infection.

Comprehensive care programs--title II

    The Committee has provided $738,000,000 for HIV health care 
and support services which includes advance funding of 
$150,000,000. This amount is $69,130,000 above the 
administration request and $195,217,000 above the 1998 level. 
These funds are awarded to States to support HIV service 
delivery consortia, the provision of home and community-based 
care services for individuals with HIV disease, continuation of 
health insurance coverage for low-income persons with HIV 
disease and support for State AIDS drug assistance programs 
[ADAP].
    The Committee continues to be encouraged by the progress of 
protease inhibitor therapy in reducing the mortality rates 
associated with HIV infection and in enhancing the quality of 
life of patients on medication. The Committee has approved bill 
language for $461,000,000 for AIDS medications, compared to 
$285,500,000 provided for this purpose in fiscal year 1998. The 
amount provided includes advance funding of $150,000,000 to be 
made available for obligation from October 1, 1999, through 
September 30, 2000. The Committee further urges HRSA to 
encourage States to utilize Federal ADAP funding in the most 
cost-effective manner to maximize access to HIV drug therapies 
and to eliminate cost-shifting from Medicaid to the State ADAP 
programs. States with ADAP funding should be allowed the 
flexibility to purchase and maintain insurance policies for 
eligible clients including covering any costs associated with 
these policies, or continue to pay premiums on existing 
insurance policies that provide a full range of HIV treatments 
and access to comprehensive primary care services, as 
determined by a State. Funds should not be committed to 
purchase insurance deemed inadequate by a State in its 
provision of primary care or in its ability to secure adequate 
access to HIV treatments.

Early intervention program--title III-B

    The Committee recommends $82,000,000 for early intervention 
grants. This is $5,789,000 above the 1998 level and $4,154,000 
less than the administration request. These funds are awarded 
competitively to primary health care providers to enhance 
health care services available to people at risk of HIV and 
AIDS. Funds are used for comprehensive primary care, including 
counseling, testing, diagnostic, and therapeutic services.
    To the extent practicable, the Committee encourages HRSA to 
fairly allocate the increase for title III-B between existing 
grantees and new providers. The Committee understands that 
existing grantees have been level-funded throughout the history 
of the CARE Act. By providing additional funds to current 
grantees, the Committee intends to undergird the HIV care 
infrastructure already established in title III-B clinics. The 
Committee also supports expansion of the number of communities 
receiving assistance from this title. The Committee understands 
that HRSA is conducting a grant-review process expected to 
identify qualified new grantees in underserved rural and urban 
areas.
    The Committee is aware that the FDA recently approved at-
home telemedicine diagnostic testing methods which may offer 
important fiscal, privacy, and public health advantages. The 
Committee understands that a CDC study indicates a significant 
percentage of individuals using public clinics for onsite HIV 
testing do not return for their results, and that HRSA data 
indicates the average cost for onsite testing, counseling, and 
referral services is about $160 per person, compared with the 
$40 cost for at-home telemedicine testing. The Committee 
requests HRSA to evaluate and report on the benefits and costs 
of varying testing methods, including at-home telemedicine, and 
to implement program changes as they are deemed warranted and 
practical.

Pediatric AIDS demonstrations--title IV

    The Committee recommends $44,000,000 for title IV pediatric 
AIDS, which is $74,000 higher than the administration request 
and $3,197,000 above the 1998 amount. This program supports 
demonstration grants to develop innovative models that foster 
collaboration between clinical research institutions and 
primary/community-based medical and social service providers 
for underserved children, youth, pregnant women, and their 
families.
    Some 5 percent of the funds appropriated under this section 
may be used to provide peer-based training and technical 
assistance through national organizations that collaborate with 
projects to ensure development of innovative models of family 
centered and youth-centered care; advanced provider training 
for pediatric, adolescent, and family HIV providers; health 
care financing, outcome measures, and policy analysis; and 
coordination with research programs.
    The Committee is aware that the Ryan White CARE Act 
Amendments of 1996 requires significant enrollment of title IV 
patients in NIH research programs. The Committee is further 
aware that funding for the pediatric AIDS clinical trial group 
has been reduced by the NIH Office of AIDS Research, and urges 
HRSA to consider this reduction in funding as well as research 
protocol requirements when evaluating the ability of title IV 
projects to enroll significant numbers of patients in research 
programs.
    The Committee is aware of the efforts of the National 
Pediatric and Family HIV Resource Center to increase the 
quality of care for children and youth living with HIV 
infection and urges the agency to continue its support of this 
activity.
    Transmission of HIV to newborns can be reduced by over 90 
percent if pregnant women are aware they are HIV positive and 
are effectively treated with drugs prior to birth. To improve 
testing of pregnant women and reduce the incidence of HIV 
births, the Committee encourages consideration of demonstration 
projects involving at-home diagnostic testing with telemedicine 
support. The Committee believes the use of at-home telemedicine 
services for HIV testing may hold promise as an outreach tool 
for pregnant women in high HIV prevalence States.

AIDS dental services

    The Committee provides $7,800,000 for AIDS dental services, 
which is $13,000 above the administration request and $37,000 
above the 1998 level. This program provides grants to dental 
schools and postdoctoral dental education programs to assist 
with the cost of providing unreimbursed oral health care to 
patients with HIV disease.

AIDS education and training centers

    The Committee recommends $18,000,000 for the AIDS education 
and training centers [AETC's]. This amount is $784,000 above 
the 1998 level and $729,000 above the administration request. 
AIDS education and training centers train health care 
practitioners, faculty, and students who care for AIDS patients 
outside of the traditional health professions education venues, 
and support curriculum development on diagnosis and treatment 
of HIV infection for health professions schools and training 
organizations. The targeted education efforts by AETC's are 
needed to ensure the cost-effective use of the significant 
expenditures in Ryan White programs and the AIDS drugs 
assistance program. The agency is urged to fully utilize the 
AETC's to ensure the quality of medical care and to ensure, as 
much as possible, that no individual with HIV receives 
suboptimal therapy due to the lack of health care provider 
information.

Family planning

    The Committee recommends $215,000,000 for the title X 
family planning program. This is $3,077,000 below the 
administration request and $12,097,000 above the 1998 level. 
Title X grants support primary health care services at more 
than 4,000 clinics nationwide. About 85 percent of family 
planning clients are women at or below 150 percent of poverty 
level.
    Title X of the Public Health Service Act, which established 
the family planning program, authorizes the use of a broad 
range of acceptable and effective family planning methods and 
services. The Committee believes this includes oral, 
injectable, and other preventive modalities.
    The Committee remains concerned that programs receiving 
title X funds ought to have access to these resources as 
quickly as possible. The Committee, therefore, again instructs 
the Department to distribute to the regional offices all of the 
funds available for family planning services no later than 60 
days following enactment of this bill.
    The Committee is pleased with recent data indicating a 
reduction in the rate of teenage pregnancy in the United 
States. In order to assure that all low-income women have 
access to comprehensive family planning services, the Committee 
expects that no less than 90 percent of the total title X 
appropriation must be allocated to the regional offices to be 
awarded to grantees who provide clinical family planning 
services as defined by law.

Rural health research

    The Committee recommends $11,713,000 for the Office of 
Rural Health Policy. This is $57,000 more than the fiscal year 
1998 level and $22,000 above the administration request. The 
funds provide support for the Office as the focal point for the 
Department's efforts to improve the delivery of health services 
to rural communities and populations. Funds are used for rural 
health research centers, grants to telemedicine projects, the 
National Advisory Committee on Rural Health, and a reference 
and information service.

Health care facilities

    The Committee provides $30,000,000 for health care 
facilities, which is $2,043,000 above the 1998 level and 
$30,000,000 above the administration request. Funds are made 
available to public and private entities for construction and 
renovation of health care and other facilities.
    Sufficient funds are available to contribute to the 
construction of a pediatric dental facility serving medically 
underserved inner city neighborhoods. The Committee is aware 
that the University of Pennsylvania School of Dental Medicine 
has many meritorious characteristics that make it well-suited 
for this important task, and urges the full and fair 
consideration of its proposal.
    Funds are also available to contribute to the upgrade of 
existing facilities dedicated to women's health that emphasize 
support of homeless and medically underserved women. The 
Committee is aware that Magee-Womens Hospital of Pittsburgh, 
PA, is one of a few specialty hospitals in the country 
providing services exclusively for women and infants, and urges 
that its proposal receive full and fair consideration.
    Funds are available to contribute to the upgrading of an 
osteopathic facility dedicated to medically underserved areas 
in an inner city area. The Committee is supportive of the 
efforts of the Philadelphia College of Osteopathic Medicine and 
urges its proposal receive high priority in funding.
    Funds are available to contribute to the modernization and 
upgrade of a medium-sized medical facility that coordinates 
health services within a county. The Committee is supportive of 
the proposal by the Fulton County Medical Center in 
Pennsylvania and urges the bureau to grant its full and fair 
consideration of the project.
    The Committee has included funds that would enable the 
Mercy Health System of Philadelphia to initiate their proposal 
for new approaches in health programs in urban low-income 
settings.
    The Committee is aware of the proposal by Heflin Human 
Genetics Center of Alabama to establish a research facility 
dedicated to human genetics, and has included sufficient funds 
to contribute to the construction of this facility.
    Funds are available to continue the construction of the 
ethics conference center at Tuskegee University in Alabama.
    Funds are available to contribute to the construction of a 
pediatric health facility serving inner city children, infants, 
and youth. The Committee understands that the Montefiore 
Hospital in the Bronx of New York City has a proposal with many 
meritorious characteristics and urges the agency grant it full 
and fair consideration.
    Funds are available to initiate and maintain a facility 
that would enable comprehensive care and services for diabetics 
among a native American population. The Committee is aware of 
the extensive prevalence of diabetes among the Eastern Band of 
Cherokee Indians in North Carolina, and urges the agency to 
grant full and fair consideration of the tribe's proposal.
    The Committee provides sufficient funds to contribute to 
the initial construction of a clinical center and life sciences 
facility that integrates research efforts in biomedical, 
agricultural, and veterinary sciences for the treatment of the 
elderly and other at-risk populations. The Committee is aware 
of the distinct capabilities of the University of Missouri-
Columbia to conduct this effort and urges full and fair 
consideration of its proposal.
    Funds are available for the upgrade and modernization of 
facilities at a major urban medical center. The Committee is 
aware of the special needs of the University of Colorado Health 
Sciences Center in Denver, CO, and urges the agency to grant 
its full and fair consideration of its proposal.
    Sufficient funds are provided to initiate the renovation of 
health facilities serving an economically disadvantaged 
population. The Committee is aware of the proposal by Delta 
Health Center of Mound Bayou, MS, and urges the agency to grant 
its full and fair consideration.
    Additional funds are available for the renovation, 
modernization, and expansion of a current medical facility 
serving a medically underserved population. The Committee is 
aware of the proposal by the Jackson-Hinds Comprehensive Health 
Center of Jackson, MS, and recommends that it receive high 
priority for funding.
    Funds are available to initiate the construction of a new 
clinic and educational facility that would serve medically 
underserved populations in a large rural catchment area. The 
Committee is aware of the meritorious proposal by the Alaska 
Family Practice Residency Program and urges the agency to grant 
its full and fair consideration.
    Sufficient funds are provided to support health facilities 
located in Iowa dedicated to assisting low-income and 
underserved populations.
    The Committee has included funds that would initiate a 
women's health outreach program serving a growing population 
with unique health care needs. The Committee is aware of the 
proposal by the Oregon Health Sciences University that would 
develop a center for women's health in the North Macadam 
District in Portland, OR, and urges the agency grant its full 
and fair consideration to this proposal.
    Funds are available to complete construction of the Lawton 
and Rhea Chiles Center for Healthy Mothers and Babies at the 
University of South Florida in Tampa. The Committee urges the 
project receive high priority for funding.
    The Committee encourages full and fair consideration for 
design, planning, and construction of an expansion of the 
Medical University of South Carolina's cancer research center. 
The Committee is aware of the need to expand this facility to 
address the high incidence of cancer in this region and to 
translate basic biomarker research to direct application.

Buildings and facilities

    The Committee recommends $250,000 for buildings and 
facilities, the same as the administration request and 
$2,248,000 below the fiscal year 1998 amount.

National practitioner data bank

    The Committee has not provided Federal funding for the 
national practitioner data bank, which is the same as the 
administration request. The Committee and the administration 
assume that $12,000,000 will be provided entirely through the 
collection of user fees and will cover the full cost of 
operating the data bank, an amount that is $4,000,000 higher 
than what was authorized to be collected in fiscal year 1998. 
Traditional bill language is included to ensure that user fees 
are collected to cover all costs of processing requests and 
providing such information to data bank users.

Program management

    The Committee recommends $120,000,000 for program 
management activities for fiscal year 1999. This is $5,941,000 
higher than the administration request and the 1998 level.
    The Committee encourages the agency to provide $2,000,000 
to continue the efforts of the AFNA national education and 
research fund of Philadelphia, a nonprofit organization that 
operates a program aimed at encouraging and preparing minority 
students for health professions careers and other associated 
activities.

               medical facilities guarantee and loan fund

Appropriations, 1998....................................      $6,000,000
Budget estimate, 1999...................................       1,000,000
Committee recommendation................................       1,000,000

    The Committee recommends $1,000,000 for the medical 
facilities guarantee and loan fund. This is the same as the 
administration request and $5,000,000 less than the fiscal year 
1998 appropriation. These funds are used to comply with the 
obligation of the Federal Government to pay interest subsidies 
on federally guaranteed loans throughout the life of the loans. 
These loans were used for hospital modernization, construction, 
and conversion. The bill includes language, as in prior years, 
which prohibits commitments for new loans or loan guarantees in 
fiscal year 1999.

                   health education assistance loans

    The Committee recommends no additional guarantee authority 
for new HEAL loans in fiscal year 1999, which is the same as 
the President's request and $1,020,000 below the fiscal year 
1998 level.
    The Committee recommends $37,000,000 to liquidate 1999 
obligations from loans guaranteed before 1992, which is the 
same as the administration request and $7,434,000 above the 
1998 appropriation.
    For administration of the HEAL Program including the Office 
of Default Reduction, the Committee recommends $3,688,000, 
which is $13,000 above the 1998 appropriation and the same as 
the administration request.
    The HEAL Program insures loans to students in the health 
professions and helps to ensure graduate student access to 
health professions education, especially among minority, 
disadvantaged students, and those from behavioral and mental 
health fields. The Budget Enforcement Act of 1990, changed the 
accounting of the HEAL Program. One account is used to pay 
obligations arising from loans guaranteed prior to 1992. A 
second account was created to pay obligations and collect 
premiums on loans guaranteed in 1992 and after. Administration 
of the HEAL Program is separate from administration of other 
HRSA programs.

                 vaccine injury compensation trust fund

Appropriations, 1998....................................     $45,600,000
Budget estimate, 1999...................................      54,600,000
Committee recommendation................................      54,600,000

    The Committee recommends that $54,600,000 be released from 
the vaccine injury compensation trust fund in 1999, of which 
$3,000,000 is for administrative costs. This amount is the same 
as the budget request and is $9,000,000 higher than the fiscal 
year 1998 amount. In addition, $100,000,000 in general funds 
are appropriated for compensation of vaccine-related injuries 
associated with vaccines administered before fiscal year 1989. 
This is $100,000,000 above the administration request and the 
fiscal year 1998 year amount. Information has been brought to 
the Committee's attention that prior estimates were based on 
historical compensation rates for the pre-1988 program, 26.8 
percent. Over the past year, compensation rates for pre-1988 
claims has risen to approximately 48.3 percent. The increased 
rate has been deemed sufficiently consistent enough to be the 
more appropriate rate at which to project pre-1988 
expenditures.
    The National Vaccine Injury Compensation Program provides 
compensation for individuals with vaccine-associated injuries 
or deaths. Funds are awarded to reimburse medical expenses, 
lost earnings, pain and suffering, legal expenses, and a death 
benefit. The vaccine injury compensation trust fund is funded 
by excise taxes on certain childhood vaccines.

               Centers for Disease Control and Prevention

                disease control, research, and training

Appropriations, 1998....................................  $2,383,638,000
Budget estimate, 1999...................................   2,497,397,000
Committee recommendation................................   2,366,644,000

    For the Centers for Disease Control and Prevention [CDC], 
the Committee provides $2,366,644,000, which is $16,994,000 
below the 1998 level and $130,753,000 below the budget request.
    The Committee has provided an additional $228,400,000 for 
CDC activities within the Public Health and Social Services 
emergency fund and $25,000,000 in expected interagency 
transfers, which, along with the regular appropriation, would 
provide a total of $2,620,044,000 for the agency.
    The activities of the CDC focus on four major priorities: 
provide core public health functions; respond to urgent health 
threats; promote women's health; and provide leadership in the 
implementation of nationwide prevention strategies to encourage 
responsible behavior and adoption of lifestyles that are 
conducive to good health. While Americans today enjoy the 
longest life expectancy of any time in our Nation's history, 
preventable diseases and conditions still cause death, and 
disability, and still compromise the quality of life for 
millions of Americans. Public health experts estimate that 
about one-half of the deaths which occur in the United States 
every year are considered preventable, as are many of the 
illnesses.
    The Committee has not chosen to break out administrative 
expenses as proposed by the House and understands that 
administrative expenses as displayed by the House include 
salary and benefits of program personnel, travel for epidemics 
and program site visits, contracts for scientific studies, 
supplies for laboratories, and other expenses integral to the 
program operation of the agency. Nevertheless, the Committee 
fully expects the agency to closely monitor these intramural 
program costs and reserves the right to concur with the House 
table should circumstances warrant such action.
    The Committee is further concerned about reports of 
significant overhead costs being imposed upon programs and 
certain grantees. While it is understood that these costs 
support operating expenses for the agency such as procurement, 
personnel, computers, rent, utilities, and other items, and 
traditionally that these costs have been less than 5 percent of 
the total appropriation when the Office of the Director is 
excluded, the Committee directs CDC to monitor these costs 
closely and to minimize them to the extent possible.
    In particular, the Committee is concerned that the CDC has 
allocated a disproportionate share of available funds to 
administrative activities by limiting the amount of funding 
available to State and local service providers. Annual 
fluctuations in administrative costs and delays in the release 
of HIV prevention funding have adversely affected community HIV 
prevention planning. The Committee expects the agency to 
minimize administrative overhead and to expedite the release of 
community prevention grants.
    The Committee has provided additional funds for 
bioterrorism and related public health infrastructure 
activities at CDC within the public health and social services 
emergency fund.

Preventive health and health services block grant

    The Committee recommends $120,000,000 for the preventive 
health and health services block grant, $27,362,000 less than 
the budget request and $26,566,000 less than the 1998 
appropriation. The Committee recommendation includes an 
additional $37,000,000 from the violent crime reduction trust 
fund for rape prevention and education activities authorized by 
the Violence Against Women Act to be carried out through the 
preventive health and health services block grant. This amount 
is $8,000,000 less than the 1998 appropriation and is the full 
amount authorized by the act for fiscal year 1999.
    The preventive health and health services block grant 
provides States with funds for services to reduce preventable 
morbidity and mortality and improve the quality of life. The 
grants give States flexibility in deciding how available 
funding can be used to meet State preventive health priorities. 
Programs eligible for funding include screening, laboratory 
services, health education, and outreach programs for such 
conditions as high blood pressure and cholesterol, and breast 
and uterine cancer.

Prevention centers

    The Committee recommends $9,080,000 for prevention centers. 
This is $1,208,000 over the budget request and $1,350,000 over 
the fiscal year 1998 appropriation.
    CDC's prevention centers program provides grants to 
academic programs to support applied research designed to yield 
tangible results in health promotion, disease prevention, and 
injury control. This network of collaborating prevention 
centers works to fill the knowledge gaps that block achievement 
of prevention goals. The centers work with State and local 
health departments and other organizations to increase the 
implementation of research findings. The Committee has included 
sufficient funds to continue existing prevention centers, such 
as West Virginia University and St. Louis University's 
prevention centers.
    The Committee encourages the continued support of Center 
activities aimed at improving knowledge about the usefulness 
and effectiveness of health promotion programs for persons with 
disabilities.
    The Committee has included $1,000,000 to establish within 
the CDC prevention center program a tobacco prevention research 
network to increase the knowledge base on the most effective 
strategies for preventing and reducing youth tobacco use, as 
well as on the social, physiological, and cultural reasons for 
tobacco use among children.
    Prevention marketing and health behavior change.--The 
Committee encourages the CDC to consider establishing a focus 
on prevention marketing and behavior change strategies for 
enhancing health in disadvantaged communities.
    Cardiovascular disease prevention.--The Committee is 
encouraged by the agency's work with numerous health 
organizations to develop an integrated and comprehensive 
national cardiovascular disease program. CDC should identify 
additional States and localities for future expanded efforts in 
cardiovascular disease risk reduction, surveillance, and 
laboratory capacity. Priority should continue to be given to 
those States with the highest age-adjusted death rates due to 
cardiovascular diseases.

Sexually transmitted diseases

    The Committee recommends $113,671,000 for sexually 
transmitted disease prevention and control, $7,910,000 less 
than the budget request and $1,554,000 more than the fiscal 
year 1998 appropriation.
    The mission of the STD program is to survey, prevent, and 
control the transmission of STD's by providing national 
leadership for: prevention and control programs; monitoring 
disease trends; behavioral and clinical research; education and 
training; building partnerships for STD prevention; the STD 
accelerated prevention campaign; and infertility. Grants are 
awarded to State and local health departments and other 
nonprofit entities to support primary prevention activities, 
surveillance systems, screening programs, partner notification 
and counseling, outbreak control, and clinical skills training.
    The Committee urges the CDC to continue to work with 
community-based organizations such as the Swope Parkway 
Community Health Center in Kansas City, MO, to control the 
spread of HIV through the treatment of other sexually 
transmitted diseases.
    The Committee remains concerned about the extent of 
sexually transmitted diseases within the United States, which 
according to the Institute of Medicine, remain exceptionally 
high for an industrialized nation. With STD's contributing to 
the spread of HIV and with women and children 
disproportionately impacted, the Committee recommends that the 
agency intensify its efforts in those States with the highest 
STD rates.
    The Committee is heartened by the progress CDC has made in 
combating syphilis in the United States. The Committee 
recognizes that for this effort to be successful, community-
based partnerships, especially within racial and ethnic 
minorities, need to be formed. The Committee recommends that 
CDC use funds as needed to create community-based coalitions to 
work in partnership with the local health authority to provide 
services and program evaluation.
    The Committee is pleased with efforts to reduce rates of 
infertility through the national chlamydia program. The 
effectiveness of these projects in Federal regions X and III 
are encouraging. The Committee expects the agency to continue 
expansion of this programs to all regions of the country.

Immunization

    The Committee recommends $405,900,000 for immunization 
activities in fiscal year 1999 authorized under section 317 of 
the Public Health Service Act, $6,332,000 more than the budget 
request and $4,258,000 below the fiscal year 1998 level.
    The Omnibus Reconciliation Act [OBRA] of 1993 established a 
new vaccine purchase and distribution system that provides, 
free of charge, all pediatric vaccines recommended for routine 
use by the Advisory Committee on Immunization Practices to all 
Medicaid-eligible children, uninsured children, underinsured, 
and native Americans through program-registered providers. 
Included in the Medicaid estimate for fiscal year 1999 is 
$566,278,000 for the purchase and distribution of vaccines for 
a total immunization recommendation of $972,178,000 in the 
bill.
    The administration of safe and effective vaccines remains 
the most cost-effective method of preventing human suffering 
and reducing economic costs associated with vaccine-preventable 
diseases. Through the immunization program, the CDC provides 
leadership and support for national and international efforts 
to prevent and/or control vaccine-preventable diseases.
    Within the amounts appropriated, sufficient funds are 
provided for the purchase of vaccine under the 317 program. As 
in previous years, the Director has discretion to make 
transfers from among funds provided for 317 vaccine purchase 
and infrastructure grants based upon the program requirements. 
This will ensure that States receive up to their maximum 
estimates for vaccine purchases and provide CDC with sufficient 
flexibility to reallocate vaccine purchase dollars if States' 
needs prove lower than the amount provided. The Committee 
requests that the CDC provide notification of the amount of any 
transfer, the latest State carryover balance estimates, and the 
justification for the transfer.
    The Committee is concerned about plans of the Department to 
require States to purchase vaccines for the Vaccines for 
Children Program with section 317 discretionary funds. All VFC 
vaccines should be purchased with mandatory funding provided in 
the Omnibus Budget Reconciliation Act of 1993 for that purpose. 
It is also the Committee's view that the cost cap applies to 
all vaccines purchased under the CDC-administered childhood 
immunization programs without regard for whether the funding is 
mandatory or discretionary.
    The Committee notes that childhood immunization coverage 
rates have remained high and disease rates have remained low 
over the past 5 years. The Committee acknowledges the high 
quality of work done by the CDC and the State immunization 
programs to achieve this success. The Committee is concerned 
about future funding for immunization activities and is 
interested in evaluating the relationship between funding 
levels over the past 5 years, and corresponding coverage and 
disease rates. Of particular concern are the manner in which 
immunization program funds are distributed among States and the 
degree to which funds within States are targeted at high-risk 
populations. Since 1994, over $2,300,000,000 in discretionary 
funds has been provided to the CDC for immunization activities, 
with a significant proportion of those funds allocated to State 
immunization programs. The Committee has expressed concern 
during that time about large carryover balances of State grant 
funds. The Committee understands that the 1997 carryover 
balance of $33,000,000 was the lowest level reported since 
1994.
    The Committee urges CDC to contract with the Institute of 
Medicine to conduct a study of the immunization program and to 
report its findings by May 1999. Specifically, such a study 
should focus upon the following questions: (1) To what extent 
has increased Federal spending during the 1994-98 period 
affected the immunization coverage rates; (2) how were new 
funds spent by the States and to what extent did States 
maintain their own level of effort over the past 5 years; (3) 
what are current and future funding requirements for childhood 
immunization activities and how can those requirements be met 
through a combination of State funding, Federal immunization 
funding, and funding available through the Childrens' Health 
Insurance Program; (4) how should Federal grant funds be 
distributed among the States; and (5) how should funds be 
targeted within States to reach high-risk populations without 
diminishing high levels of coverage in the overall population.
    The Committee urges CDC and the States using section 317 
funds to provide timely and appropriate immunizations for 
inmates of State prisons, as recommended by the CDC Advisory 
Council on Immunization Practices. The Committee understands 
that, on average, for every 100,000 inmates in State correction 
institutions, $329,000,000 will be spent treating the 
consequences of hepatitis B infections alone. Public health 
security would be further advanced if all inmates were 
vaccinated against major infectious diseases. Such efforts 
would likely play a central role in averting disease outbreaks 
in prisons, reduce spending on treatment, and inhibit the 
spread of infectious diseases to criminal justice workers, 
health care professionals, and the general public.
    The Committee recommends that the CDC continue to ensure 
that all grantees receiving IAP funds reserve 10 percent of 
those funds for the purpose of funding immunization assessment 
and referral services in WIC sites in 1998. CDC should ensure 
that all of these funds are used in each State for WIC 
immunization activities unless CDC can document that assessment 
and referral in a State's WIC sites are taking place without 
the need for specific funds. CDC should collaborate with the 
National Association of WIC Directors and with State 
immunization directors in setting the criteria for assessment, 
referral, and annual reporting of WIC coverage.
    As in previous years, the Committee also recommends that 
the CDC require that all States receiving IAP funds continue to 
conduct annual provider site assessments in all public clinics, 
using CDC-approved methodology. In the event that States lack 
sufficient resources to conduct such assessments, the Committee 
requests that the CDC provide technical assistance to the 
States for this purpose.
    The Committee recommendation assumes the continuation of 
the bonus program to improve immunization rates. Using State-
specific immunization coverage data, CDC provides payments to 
States for 2-year-olds who have been fully immunized. CDC will 
provide to the States: $50 per child in excess of 65 percent 
and less than 75 percent; $75 per child in excess of 75 percent 
and less than 85 percent; and $100 per child in excess of 85 
percent.
    The recommendation includes the funds requested for polio 
eradication in order to support CDC's capacity to meet the goal 
of global eradication of polio by the year 2000. The Committee 
is aware of the progress that has been made in eradicating 
polio, and the real prospect of eliminating this disease by the 
year 2000. The Committee again commends the CDC for its active 
leadership in the effort.
    Hepatitis B vaccination program for adolescents.--The 
Committee notes that, while the hepatitis B vaccination has 
been available nationwide for several years, only 12 States 
currently have laws requiring HBV vaccinations as a requirement 
for middle school admission. To accelerate this process and 
address the public health threat, the CDC is urged to support 
adolescent health coordinators in each State to work with 
physicians, nurses, public health care providers, schools, 
State legislators, and others to increase the rate of 
compliance with the HBV vaccination program.
    The recommendation includes sufficient funds for the CDC, 
as part of their global polio eradication efforts, to provide 
measles vaccine for supplemental measles immunization campaigns 
and to expand epidemiologic, laboratory, and programmatic/
operational support to the WHO and its member countries. Such 
support should build on the global disease control and 
surveillance infrastructure developed for polio eradication in 
a manner that does not compromise ongoing global polio 
eradication activities. The Committee also encourages the 
Director to provide sufficient staff support for this 
accelerated international measles control effort.
    The Committee continues to be supportive of the research 
exploring the promise of plant-delivered oral vaccines being 
undertaken by the Thomas Jefferson Center for Biomedical 
Research in collaboration with the Delaware Valley College. 
Through the use of genetically engineered plants, this research 
continues to show promise as a means of oral vaccine production 
for both animals and humans, especially in the area of the 
diagnosis and treatment of the hepatitis B and C viruses 
involving glycoprocessing inhibitors. The Committee continues 
to encourage the agency to accelerate this effort and notes 
that sufficient resources are available for this endeavor.

Infectious diseases

    The Committee's recommendation includes $115,215,000 for 
infectious disease activities, $47,300,000 below the budget 
request and $2,358,000 over the 1998 appropriation. Additional 
funds for this activity is available within the Public Health 
and Social Services emergency fund.
    These activities focus on: national surveillance of 
infectious diseases; applied research to develop new or 
improved diagnoses; prevention and control strategies; working 
with State and local departments and private health care 
providers, to transfer application of infectious diseases 
prevention technologies; and strengthening the capability to 
respond to outbreaks of new or reemerging disease.
    The Committee is concerned by the disease prevalence and 
projected increasing mortality rates of hepatitis C, which 
presently afflicts 4 million Americans, but nontheless is going 
largely unrecognized by health care providers and our national 
disease surveillance efforts. The Committee encourages the CDC 
to require reporting of chronic hepatitis C to generate 
information on both populations at risk of infection as well as 
modes of disease transmission to establish a systematic 
national approach to control the spread of hepatitis C.
    The Committee is supportive of the Secretary's lookback 
initiatives regarding screening and counseling for people who 
may have been infected with hepatitis C through blood 
transfusions conducted prior to 1992. The Committee encourages 
CDC to develop a centralized national screening program 
supported by a toll-free telephone number-based operation, 
involving risk assessment, convenient screening, and 
counseling. Under this program, persons receiving lookback 
notification letters would be advised of the hotline service 
that provides education and telephone counseling and 
coordinates convenient testing.
    The Committee encourages the National Center for Infectious 
Diseases to continue its field research programs, including 
behavioral, entomological, epidemiological and immunological 
studies, and particularly those research activities at its 
Kenya field station.
    The Committee is concerned over the global extent and 
proliferation of malaria, especially multidrug resistant forms. 
The Committee is aware of the multilateral initiative on 
malaria that is a partnership between the countries of North 
America, Africa, and Europe and is conducted by NIH. The U.S. 
health agencies, including CDC, are encouraged to participate, 
to the extent that is practical and cost efficient, in the 
initiative.
    The Committee commends CDC for working with the National 
Hemophilia Foundation in moving forward with expanding blood 
surveillance and patient outreach activities. An early warning 
blood safety system is critical in protecting the public, 
particularly persons with hemophilia and other bleeding 
disorders. Within the amount provided, funds are available to 
ensure wider implementation of the blood safety program as well 
as the prevention activities aimed at reducing the risk of 
complications resulting from hemophilia, von Willibrands, and 
other bleeding disorders. The Committee expects CDC to work 
collaboratively with FDA to fully investigate instances of 
viral or pathogenic contamination of blood and blood products.
    HCV Consensus Development Conference.--The Committee is 
aware of the research recommendations made by the March 1997 
Hepatitis C [HCV] Consensus Development Conference impact on 
the program responsibilities of the CDC. These recommendations 
include: (1) continued monitoring of the epidemiology of acute 
and chronic HCV is necessary, particularly studies of the 
specific mode of transmission in minority groups, low 
socioeconomic groups, institutionalized individuals, and 
injection and intranasal drug users are needed as well as more 
information on sexual, household, occupational, nosocomial, and 
perinatal transmission; and (2) strategies need to be developed 
to educate at-risk groups concerning transmission of the 
disease, as well as provide access to diagnosis and treatment. 
The Committee urges the Hepatitis Council of the American Liver 
Foundation and the CDC to work together is developing these 
research initiatives.
    Accidental needle stick injuries.--The Committee is 
concerned about the availability of data on the occurrence of 
needle stick injuries in health care settings such as hospitals 
and clinics. The Committee expects CDC and NIOSH to inform the 
Committee of the relative occurrence of accidental needle 
sticks in facilities using needles which incorporate a safety 
feature as compared to facilities utilizing conventional 
needles. Such information should also include the impact of 
worker training and education materials on the incidence of 
accidental needle sticks, and an assessment of the reporting 
requirements of health care facilities regarding accidental 
needle sticks. The Committee further urges the agency to 
consider revision of its infection control manual 
recommendations to take into account any new findings.
    The Committee is aware of a proposal to establish an 
International Center for Public Health in Newark, NJ. The 
proposed center would advance infectious disease research and 
treatment through a collaboration between the University of 
Medicine and Dentistry of New Jersey's National Tuberculosis 
Center and the Public Health Research Institute. The Committee 
encourages the agency to grant full and fair consideration of 
this proposal.
    The Committee is aware of the recent outbreak of the 
hantavirus in the four corners area of the Southwestern United 
States, which is the nexus of Colorado, New Mexico, Utah, and 
Arizona. The Committee believes that prevention, surveillance, 
and research continue to be necessary in reducing this public 
health threat. The Committee encourages CDC to continue to 
prioritize the prevention and containment of the hantavirus in 
Colorado and the four corners area.

Tuberculosis elimination

    The Committee's recommendation provides $119,236,000 for 
CDC's activities to prevent or control tuberculosis. This is 
$1,586,000 above the budget request and $1,265,000 above the 
fiscal year 1998 appropriation.
    CDC provides support for the control and elimination of TB. 
This is accomplished in large part through awarding cooperative 
agreements to State, territorial, and large city health 
departments to strengthen their control and elimination 
programs.
    The Committee is pleased that the focus on tuberculosis 
control has had a positive impact on tuberculosis rates in the 
United States and commends the CDC and its State and local 
partners for the fifth year of decline in reported cases of TB. 
Clearly, CDC's public health intervention strategies, such as 
directly observed therapy have been effective in reversing the 
alarming increases in TB during the preceding decade. The 
Committee continues to be concerned about the increasing number 
of foreign-born TB cases, the need for improved surveillance 
and new diagnostic and preventive tools, such as a vaccine, and 
multidrug resistant TB. The Committee encourages CDC's 
continued efforts outlined in the national plan for the 
elimination of multidrug resistant tuberculosis, and is pleased 
that CDC intends to update its strategic plan for the 
elimination of tuberculosis.
    The Committee notes the number of cases in the United 
States and globally among the foreign born. The Committee 
commends CDC for working with the U.S. Agency for International 
Development to develop a joint plan for collaboration among 
both agencies that outlines specific initiatives that could 
take place to combat TB globally, and further recommends that 
CDC work with the USAID to encourage the expansion of their 
effort beyond the three foreign countries that contribute most 
heavily to the cases of foreign born TB in the United States.

Chronic and environmental disease prevention

    The Committee's recommendation includes $258,568,000 for 
chronic and environmental disease prevention activities. This 
is $5,000,000 below the budget request and $46,591,000 above 
the 1998 appropriation. With $25,000,000 in funds to be 
transferred from the National Cancer Institute, the total 
amount available to this account would be $283,568,000.
    In many instances, premature death, avoidable illness, and 
disability are caused by personal behavior, exposure to toxic 
substances, and/or natural disasters. Prevention of the 
occurrence and progression of chronic diseases, therefore, is 
based on reducing or eliminating behavioral risk factors, 
increasing the prevalence of health promoting practices, 
detecting disease early to avoid complications, assessing human 
risks from environmental exposures, and reducing or eliminating 
exposures to environmental hazards. The focus of the programs 
in this activity includes diabetes, cardiovascular diseases, 
developmental disabilities, tobacco use, comprehensive school 
health, teen pregnancy, birth defects, fetal alcohol syndrome, 
spina bifida, chronic fatigue syndrome, prostate cancer, 
women's health, cancer registries, oral health, skin cancer, 
arthritis, and epilepsy.
    Arthritis.--The Committee is concerned about the extensive 
prevalence of arthritis and the social and economic costs 
associated with the care and support of those afflicted with 
the disease. The Committee is aware of a proposal, the national 
arthritis action plan, to greatly expand the scope and depth of 
CDC's activities on arthritis, including: providing assistance 
to States, supporting prevention research and surveillance 
activity, and targeting interventions with voluntary, nonprofit 
organizations. The Committee has provided sufficient funds to 
initiate elements of the national arthritis action plan and 
considers this effort to be a top priority.
    Diabetes.--The incidence of diabetes affects more than 16 
million persons in America. Research has demonstrated that 
controlling blood sugar levels prevents diabetes-related 
complications. While the CDC supports local diabetes prevention 
and control programs in all States, additional support could 
further reduce the number of diabetes complications. The 
Committee supports this work and has included sufficient funds 
to enable the CDC to expand its diabetes prevention effort. 
Funds are provided as proposed in the request to: establish 
comprehensive State diabetes prevention programs; implement the 
public health components of the National Diabetes Education 
Prevention Program; develop and implement public health 
surveillance systems; and conduct applied prevention research.
    The Committee remains acutely concerned that the high 
incidence of diabetes within the native American, Native 
Alaskan, and native Hawaiian populations. The Committee urges 
the CDC to continue to develop a targeted prevention and 
treatment program for these culturally unique yet similar 
groups. In addition, the Committee urges the CDC to work with 
native Americans, native Hawaiians, and developing partnerships 
with community centers as a safety net during program 
development.
    The Committee urges that CDC undertake a comprehensive 
evaluation of the effectiveness of intensive diet and exercise 
intervention in reducing the risk of complications among rural, 
elderly people with diabetes.
    The Committee has provided sufficient funds to continue the 
community-based diabetes intervention program for the Navajo 
and other native Americans located at the Indian Diabetes 
Center in Gallup, NM.
    Traditional healing.--Native Hawaii's indigenous 
populations continue to experience significant health problems, 
to include phenomenally high incidences of diabetes and asthma. 
The Committee appreciates the leadership of the CDC in 
examining how the systematic utilization of native Hawaiian 
healing expertise might effectively impact their health status 
with diseases such as diabetes and asthma. The Committee also 
urges the use of community-based health centers as a foundation 
for this initiative.
    Volcanic emissions.--The Committee remains quite concerned 
about the public health hazard posed by volcanic emissions in 
Hawaii and, therefore, encourages CDC to continue work with the 
NINR and NIEHS in determining the environmental, physical, and 
mental effects of volcanic emission that might result in 
increased levels of cancer, asthma, and other serious 
illnesses. The Committee is pleased with the progress made thus 
far in examining this environmental hazard on native Hawaiian 
health.
    Liver disease surveillance.--The Committee is aware that 
there is currently no surveillance system in the United States 
to determine trends in chronic liver disease. This information 
is needed to assist the CDC, NIH, and other public health 
agencies to better target their research and other public 
health efforts. The Committee urges that the CDC give priority 
to developing the necessary epidemiological information 
regarding trends in chronic liver disease. The Committee is 
also pleased that the CDC has entered into a cooperative 
agreement for further support and expanded efforts of a private 
nonprofit national voluntary health organization to meet the 
need for public information on hepatitis and other liver 
diseases. The Committee urges the continuation and expansion of 
support for this effort.
    Teenage smoking.--The Committee is aware of the 
collaborative efforts between the University of Pennsylvania 
and the University of Hawaii schools of social work to develop 
models for curtailing teenage smoking as a mechanism for 
decreasing the number of teens in the juvenile justice system. 
The Committee urges full and fair consideration be given for 
proposals submitted by these schools.
    Chronic fatigue and immune dysfunction syndrome.--The 
Committee is aware that enhancing laboratory studies, including 
serial analysis of genomic expression studies, and surveillance 
projects, would significantly strengthen outreach to 
populations not formerly recognized as being affected by CFIDS, 
namely minority populations and children and adolescents. The 
Committee is also concerned about delays at the CDC in adding a 
neuroendocrinologist to its CFS research group as encouraged by 
this Committee, and reiterates its support for this addition to 
enable expansion of research. The Committee remains concerned 
about CDC's accounting of CFIDS research funds and expects the 
agency to provide a clear, accurate, and timely accounting of 
all expenses related to its CFIDS research program for fiscal 
year 1996 and fiscal year 1997.
    Cancer.--Prostate cancer, and its disproportionate impact 
on minority males, continues to be a major concern of the 
Committee. The Committee continues to encourage the CDC to 
enhance its prostate cancer awareness/outreach program targeted 
at high-risk populations through collaborations with public and 
private nonprofit organizations with expertise in cancer 
education.
    The Committee has provided sufficient funds to continue the 
Cancer Registries Program. The information gleaned from these 
registries are important for planning, implementation, and 
evaluation of public health practices in cancer prevention and 
control at the State and national levels.
    Safe drinking water.--The Committee recommendation includes 
funds to enhance CDC supported evaluations and interventions 
regarding the health effects from inadequate provision of safe 
drinking water in remote arctic communities. The Committee 
recommends the CDC consider building upon existing cooperative 
agreements with State departments of health in the region when 
undertaking this initiative.
    Sudden infant death syndrome.--The Committee notes the work 
of the CDC, the National Institute of Child Health and Human 
Development, and the Health Resources and Services 
Administration in developing a model guideline for death scene 
protocol for sudden infant death syndrome in a variety of 
locales. The Committee encourages continued development and 
publication of these guidelines.
    Birth defects.--The Committee recognizes that birth defects 
are the leading cause of infant mortality in the United States 
and are also the leading cause of childhood disability. The 
Committee has provided funds for the CDC to expand its efforts 
to research, survey, and prevent birth defects. The Committee 
is especially interested in CDC's efforts to prevent spina 
bifida and anencephaly through the promotion of increased 
consumption of folic acid among women of reproductive age. The 
agency is further encouraged to establish an information 
clearinghouse that would assemble, analyze, and disseminate 
national data on birth defects.
    Tobacco.--The Committee supports CDC's Office of Smoking 
and Health, and encourages continued public health prevention 
and cessation activities. Sufficient funds are available to 
fully meet the administration request for this activity. The 
Committee continues to strongly support efforts to reduce youth 
tobacco use and is very concerned about reports of increasing 
use. For a number of years, the Committee has included funding 
within the Office for counteradvertising. The Committee 
believes that more should be done in this area.
    The Committee is aware that tobacco use is the single most 
preventable cause of death and disease in the country. It is 
estimated that tobacco contributes to more than 400,000 deaths 
in the United States annually, and costs the Nation 
$50,000,000,000 in medical expenses. It is further estimated 
that 90 percent of adult smokers begin their habit as children. 
The Committee believes that a significantly increased effort to 
curtail youth tobacco use is needed and has included additional 
funding for tobacco control within the amounts provided. These 
funds are intended to expand the capacity of State and local 
health departments, education agencies, and national 
organizations to build comprehensive tobacco control programs 
and to develop and begin implementation of a national public 
education campaign to reduce access to and the appeal of 
tobacco products among young people. The Committee further 
encourages CDC to develop community-based public awareness 
programs aimed at the prevention and cessation of smoking 
during pregnancy and to inform the public about the potential 
consequences of smoking during and after pregnancy.
    The Committee approves the transfer of the American Stop 
Smoking Intervention Study [ASSIST] from the National Cancer 
Institute to the CDC in fiscal year 1999. Sufficient funds, 
$25,000,000, have been appropriated to the NCI and the 
Committee expects NCI to transfer these funds to CDC 
expeditiously. The Committee encourages the CDC to increase 
funding for the current IMPACT States over the next several 
years to a level comparable to that of the ASSIST States. The 
Committee further urges that tobacco control funding be awarded 
to public health entities directly responsible for tobacco 
control and urges that minorities be appropriately targeted for 
smoking reduction efforts.
    Disabilities prevention.--The Committee continues to 
strongly support the CDC disabilities prevention program which 
provides support to States and academic centers to reduce the 
incidence and severity of disabilities, especially 
developmental and secondary disabilities.
    Cardiovascular diseases.--The Committee remains concerned 
that cardiovascular diseases, including heart disease and 
stroke, remain the No. 1 killer in the United States. The 
Committee has included funding to expand its heart disease and 
health promotion activities and assist States in the prevention 
of risk factors associated with cardiovascular diseases, such 
as, tobacco use, physical inactivity, and poor nutrition.
    The Committee remains supportive of the directive in the 
fiscal year 1998 report directing the CDC to establish a 
national cardiovascular disease program to provide assistance 
to States, to provide greater support for research, 
surveillance and laboratory capacity and to reduce risk factors 
for cardiovascular disease by promoting healthy behaviors. The 
Committee is aware of the program at the Hematology and 
Oncology Center at the Walt Disney Memorial Cancer Institute in 
Orlando, FL, and would encourage the CDC to consider entering 
into a partnership with that center.
    Limb loss.--The Committee recommendation includes 
sufficient funds for the CDC to continue support for 
development of a National Limb Loss Information Center.
    Asthma.--The Committee recognizes that asthma is estimated 
to affect between 14 and 15 million people, and is the most 
common chronic disease of childhood--affecting 5 million 
children under the age of 18. In addition, the Committee is 
aware that there have been significant scientific advances in 
the management of asthma and that there are many promising 
environmental interventions that have been shown to reduce the 
frequency and severity of asthma exacerbations.
    In this regard, the Committee further encourages the 
National Center for Chronic Disease Prevention and Health 
Promotion, and the National Center for Environmental Health, to 
consider undertaking a collaborative effort to foster more 
effective communication between physicians and consumers on 
asthma and an effective means of controlling and preventing the 
disease. The Committee further encourages CDC to work in 
conjunction with State and local health departments to collect 
locality specific data on pediatric and adult asthma.
    Lymphoma.--The Committee commends the CDC for its current 
research into the potential environmental factors responsible 
for lymphoma, and encourages continued and expanded 
collaboration with the National Institutes of Health in further 
examination of this issue.
    Immune deficiency outreach.--The Committee notes that 70 
primary immune deficiency diseases have been diagnosed in 
500,000 persons, mostly children, and remain undiagnosed in 
500,000 more. Because early intervention and effective 
treatment can greatly improve the quality of life of children 
with these chronic diseases, the Committee urges CDC to work 
closely with the National Institute of Child Health and Human 
Development in its efforts to educate physicians and initiate 
national awareness campaigns directed at parents and other 
health professionals.
    Prevention, marketing, and health behavior change.--The 
Committee encourages the CDC to establish a center within a 
school of public health to focus on prevention, marketing, and 
behavior change strategies for enhancing health in 
disadvantaged communities.
    Fetal alcohol syndrome.--The Committee encourages the CDC 
to develop effective strategies for preventing alcohol-exposed 
pregnancies among women in high-risk setting and to improve 
State-based surveillance of fetal alcohol syndrome.
    Cerebral palsy.--The Committee recognizes the substantial 
health and related costs associated with cerebral palsy, and 
believes there is considerable merit to focus national 
scientific attention on this growing problem and to disseminate 
research findings rapidly to the research and patient advocate 
community.
    Obesity and nutrition.--The Committee is very encouraged by 
the work by CDC's National Center for Chronic Disease 
Prevention and Health Promotion, on nutrition and obesity. 
Improving the diet of Americans and their physical activity 
would dramatically reduce the occurrence of major, chronic 
disease, including cardiovascular disease, cancer and diabetes. 
The Committee urges the CDC to expand its efforts in the links 
between nutrition and obesity, including collaboration with 
NIH. The Committee is particularly interested in efforts to 
determine the most effective methods of changing behavior 
related to weight control, including the best methods of 
fostering healthy behavior. Additional work is also needed to 
support professional education programs to improve management 
of patients with nutritional and weight disorders.
    Chronic liver diseases.--The Committee is pleased that the 
CDC has entered into a cooperative agreement to further support 
the efforts of a national voluntary health organization to meet 
the need for public information on hepatitis and other liver 
diseases. The Committee encourages the continuation and 
expansion of this collaboration and further urges the agency to 
give priority to developing the necessary epidemiological 
information regarding trends in chronic liver disease.
    Colorectal cancer.--The Committee is aware that colorectal 
cancer is the third most commonly diagnosed cancer for both men 
and women in the United States, and the second leading cause of 
cancer-related deaths. In 1998, 56,500 Americans will die from 
colorectal cancer; approximately 131,600 new cases will be 
diagnosed. When colorectal cancer is detected and treated 
early, survival is greatly enhanced. Yet, only a minority of 
colorectal cancers are diagnosed while the disease is still in 
a localized stage. The Committee recommends that the agency 
develop and implement a national colorectal cancer screening 
program with State health departments, including building 
coalitions, public and professional education, quality 
assurance, surveillance, and evaluation.
    Epilepsy.--The Committee is aware of the Living Well With 
Epilepsy Conference and the steps taken by the CDC to implement 
the conference recommendations. The Committee urges the agency 
to continue to work with the public and professional epilepsy 
organizations to develop a national outreach and education 
campaign directed at school-age, early childhood, and at-risk 
populations, to promote patient-centered treatment and 
management of epilepsy under managed care and Medicaid plans.
    Ischemia research and education.--The Committee reiterates 
its support for the development of a comprehensive 
cardiovascular program that emphasizes risk-factor reduction 
and healthy behavior promotion. The Committee is aware of the 
efforts of the Ischemia Research and Education Foundation of 
San Francisco to bring its expertise into collaboration with 
that of the CDC cardiovascular disease efforts. The Committee 
expects CDC to work more closely with groups, such as the IREF, 
that hold unique resources and knowledge in this field.
    Oral health.--The Committee is aware of the extent of the 
need for oral health services. Much of the health and economic 
burden associated with oral diseases and conditions are 
preventable. Funds are available to further enhance oral health 
activities at CDC, including targeted efforts in collaboration 
with public and private partners, implementation of proven 
prevention programs to reduce dental decay and expand community 
fluoridation, sealant programs, and oral health surveillance.
    Autism epidemiology and training.--Autism ranks as one of 
the leading causes of childhood developmental disability. The 
Committee understands that there is a paucity of domestic 
epidemiologic data on autism and urges the CDC to consider 
upgrading the national capability to track and evaluate the 
prevalence of the disability.
    The Committee is encouraged by the work being done by 
Marshall University's Autism Training Center and has included 
sufficient funding to continue the program at an increased 
level of $400,000 to expand services to families with autism.
    Health information center.--The Committee is aware that CDC 
has funded an external evaluation of the C. Everett Koop 
Community Health Information Center and that preliminary 
results of this evaluation are encouraging. Within the amount 
provided, funds are available to implement the recommendations 
of the evaluation, to strengthen the center, and to disseminate 
the results of its evaluation to professional medical societies 
throughout the country.
    Newborn screening.--Recent advances in genetic screening 
for newborn infants allow identification at birth of underlying 
conditions which can cause or contribute to disease, 
disabilities, and death. Funds are available for policy 
development and for research and development efforts to 
facilitate the translation of scientific advances into newborn 
screening programs. Fragile X syndrome and cystic fibrosis are 
among those diseases that ought to receive a high priority. The 
Committee urges the agency to coordinate with the Health 
Resources and Services Administration in translating the 
results of these efforts into guidance for public health 
programs, including State newborn screening programs.
    Iron overload illnesses.--Hereditary hemochromatosis is 
among the most common genetic disorders, which results in 
excess iron accumulation, tissue damage, and systemic organ 
failure. Funds are available to further study and to implement 
strategies for the prevention of this disease.
    Radioactive iodide study.--The Committee has included 
sufficient funds to continue the followup study of the Utah 
cohort exposed to fallout from the Nevada Nuclear Weapons Test 
Site. The Committee further expects that administrative costs 
charged to this project be minimized.

Lead poisoning

    The Committee recommendation includes $38,205,000 for lead 
poisoning prevention activities, $341,000 above the 1998 
appropriation and $307,000 above the President's request.
    Since its inception in fiscal year 1990, the CDC program 
has expanded to about 40 project areas that encompass States, 
local areas, and numerous communities and screens an estimated 
1,750,000 children annually.
    The Committee was pleased to learn that, with CDC's support 
and participation, the Food and Drug Administration had given 
final approval to a portable lead screening device. The 
Committee believes that this device holds great promise for 
increasing childhood screening rates in many underserved urban 
communities in the United States and throughout the world.

Breast and cervical cancer mortality prevention

    The Committee's recommendation includes $145,000,000 for 
breast and cervical cancer mortality prevention activities, 
$1,515,000 above the request and $2,221,000 more than the 1998 
appropriation.
    While some progress has been made recently in reducing 
deaths from breast cancer, many women who develop these cancers 
and who are at highest risk for premature death from cancers of 
the breast and cervix are minorities and/or the economically 
disadvantaged. These populations of women still have not showed 
reductions in deaths from breast cancer, in large measure due 
to not having access to preventive services such as screening 
mammograms and pap smears.
    In fiscal year 1998, 65 States, territories, and American 
Indian tribal organizations will receive resources for 
comprehensive programs. Funds provided for fiscal year 1998 
will help improve access for all women to preventive services, 
and assist State programs in: informing women of the value of 
early detection; educating physicians about recommended 
screening guidelines; ensuring the quality of screening 
mammography and pap tests; and monitoring program effectiveness 
through appropriate surveillance and evaluation activities.
    The Committee commends the CDC for utilizing funding for 
the breast and cervical screening program to continue to build 
programs nationwide, and to develop programs consistently from 
State to State that include minimum standards for participating 
States. Continued priority for breast cancer screening should 
be given to postmenopausal, low-income, underinsured and 
uninsured women.
    The Committee commends CDC for the development and 
expansion of the national breast and cervical cancer early 
detection program. This program, now active in every State, has 
provided life-saving mammography and Pap smear screenings to 
over 1 million low-income women. In addition, the program 
coordinates with State/local health departments and other 
health care providers to ensure that women with abnormal 
screening results receive appropriate followup care.
    The Committee also continues to be pleased with the 
progress of CDC's Wisewoman Program. This demonstration program 
provides low-income women participating in the national breast 
and cervical cancer early detection program with additional 
preventive screenings and medical referrals. The Committee 
encourages CDC to continue its planned expansion of the 
Wisewoman initiative.
    The Committee is concerned with the disproportionately high 
prevalence of cancer among disadvantaged and minority 
populations, particularly higher mortality rates among African-
American women from breast and cervical cancer. Within this 
amount, funding is available for early screening and treatment 
programs specifically designed to address the needs of this 
population. The Committee encourages CDC to work with 
community-based organizations such as Swope Parkway Health 
Center in Kansas City, MO, in reaching and treating this 
population.

Injury control

    The recommendation by the Committee includes $50,765,000 
for injury control efforts. This is $1,429,000 above the 
President's request and $1,001,000 more than the fiscal year 
1998 appropriation. The recommendation includes an additional 
$6,000,000 from the violent crime reduction trust fund for 
domestic violence activities authorized by the Violence Against 
Women Act. This is the same level as the 1998 appropriation. 
These funds will continue to support community program 
demonstrations on domestic violence.
    The Center is the lead Federal agency for injury prevention 
and control. Programs are designed to prevent premature death 
and disability and reduce human suffering and medical costs 
caused by: fires and burns; poisoning; drowning; violence; lack 
of bicycle helmets, seatbelts, and baby seats; and other 
injuries. The national injury control program encompasses 
nonoccupational injury and applied research in acute care and 
rehabilitation of the injured. Funds are utilized both for 
intramural and extramural research as well as for assisting 
State and local health agencies in implementing injury 
prevention programs. The Committee recognizes the important 
role that CDC provides as a focal point for all Federal injury 
control activities.
    The Committee recognizes the outstanding achievements of 
the injury control research centers [ICRC's]. Based at 
universities across the Nation, the ICRC's have excelled in 
discovering what prevention and treatment measures work and in 
disseminating these measures to State and community injury 
prevention programs.
    Each year, approximately 300 bicyclists 17 years and 
younger are fatally injured, and over 150,000 are treated in 
hospital emergency rooms for bicycle-related head injuries. 
Research has shown that 85 percent of these head injuries can 
be prevented by the use of helmets. Despite this fact, and the 
successful effort in many communities to promote bicycle helmet 
usage, it is estimated that less than 15 percent of American 
children wear them. The Committee encourages the Center to 
organize a national campaign to promote bicycle helmet usage. 
Such efforts should involve private and public partners, and 
include organizations interested in child health, safety, brain 
injury prevention, and cycling.
    Sufficient funds have been provided to enable the Center to 
support and expand effective prevention programs for traumatic 
brain injury consistent with the Traumatic Brain Injury Act. 
The Committee is supportive of a science-based process that 
identifies the most practical and effective steps communities 
can undertake to prevent suicide in high-risk populations.
    Suicide and suicidal behavior is a major public health 
risk, particularly for the elderly, adolescents, and young 
adults. The Committee recommendation includes funds for the 
Center to sustain suicide prevention research and intervention.
    The Committee recognizes CDC's contribution to national 
efforts to reduce violence and prevent domestic violence. With 
over 1 million children a year the victims of abuse and 
neglect, the Committee again recommends the Center give 
consideration to extending its focus on violence by supporting 
an initiative directed to the prevention of physical and 
emotional injuries associated with child maltreatment and 
neglect. The Committee encourages the NCIPC to collaborate with 
relevant national organizations and with academic institutions, 
including schools of social work, in the development and 
implementation of this initiative.
    The Committee recommendation maintains the proviso included 
in the House bill prohibiting the use of funds to advocate or 
promote gun control.
    The Committee is pleased with the efforts of the National 
Program for Playground Safety and the level of public interest 
which has been generated by this program. The Committee 
recognizes that implementation of the plan requires additional 
resources and encourages an increase in funding for this 
project, and in particular for the development of a model 
playground to serve the needs of children below the age of 3.
    The Committee reiterates its concern over child sexual 
abuse. CDC is strongly encouraged to consider the working ideas 
offered by nongovernmental entities that show promise in 
reducing the contributing factors for child sexual abuse. The 
Committee is aware of the Stop It Now Program and urges the 
agency's full and careful consideration of its ideas and 
proposal for collaboration with CDC.
    The Committee understands that efforts to ensure children 
sit with proper restraining equipment in the rear seats of 
motor vehicles significantly reduces injuries and deaths 
arising from motor vehicle accidents. The Committee urges CDC 
to consider developing research and community-based 
intervention trials to promote the positioning of children in 
rear seats of the vehicles in which they are riding.
    The Committee is aware of a proposed study to determine the 
cost effectiveness of trauma care by comparing the functional 
outcomes of patients provided care by trauma center and 
nontrauma center facilities. The Committee urges CDC to 
consider initiating this activity and encourages it to consider 
a cooperatively determined methodology from the managed care 
industry, the American Trauma Society, and participating 
agencies, including the Institute of Medicine.
    The Committee is supportive of efforts by CDC to establish 
a nationwide 1-800 number for the ``Mr. Yuk'' poison control 
effort which would link current poison control centers to a 
nationwide data bank. A tollfree number would enable parents to 
access real time information and medical assistance in cases in 
which children accidentally ingest a potentially toxic 
substance.

Occupational safety and health

    The Committee's recommendation includes $200,000,000 for 
the National Institute for Occupational Safety and Health 
[NIOSH], $14,436,000 above the budget request and $12,787,000 
more than the 1998 appropriation.
    The National Institute for Occupational Safety and Health 
[NIOSH] in CDC is charged with conducting a national program of 
occupational safety and health research and information 
dissemination to ensure safe and healthful working conditions 
for American working men and women. Occupational injuries occur 
at twice the rate of injuries in the home or in public places. 
Severe occupational trauma is second only to motor vehicle 
incidents as a cause of unintentional death in the United 
States. The majority of all of these deaths and injuries are 
preventable.
    To prevent work-related hazards, NIOSH conducts applied 
research with a corps of occupational safety and health 
professionals operating in multidisciplinary teams comprised of 
engineers, epidemiologists, industrial hygienists, physicians, 
and toxicologists. Intramural efforts are complemented by 
grants, contracts, and cooperative agreements to form a 
comprehensive and integrated program consisting of four 
components: Identification of hazards; research on causes and 
prevention of occupational injuries and illnesses, 
dissemination of research findings and recommendations; and 
training of those involved in preventing disease and injury at 
work.
    Sufficient funding is provided to continue the farm health 
and safety initiative. This important initiative, begun in 
1990, has a primary focus of reducing the incidence of fatal 
and nonfatal injuries and occupational diseases among the 
millions of agricultural workers and their families in the 
United States. The Committee is particularly pleased with the 
research being undertaken by the agricultural research centers 
and expects that this program will continue at no less than the 
level of funding provided in fiscal year 1998.
    The Committee is pleased that the number of injuries in the 
building and construction trades has declined by nearly one-
third since 1990, and is encouraged by the progress that has 
been made on construction safety and health during the past 5 
years. Funding has been included to continue this initiative.
    The Committee is aware of recent evidence that excessive 
ultraviolet radiation exposure [UVR] from sunlight, both in 
recreational and occupational settings, generates an increased 
risk for skin cancer, which is preventable. The Committee is 
further aware that no governmental standards exist concerning 
exposure protection for outdoor workers. The Committee urges 
the Director to give consideration to supporting this area of 
research.
    The Committee commends the work of the 15 university-based 
education and research centers [ERC's] and the smaller single 
discipline training project grants [TPG's]. These regional 
centers are integral to efforts to improve the health and 
safety of working men and women, and important to the future 
efforts of NIOSH to implement the national occupational 
research agenda [NORA]. The Committee supports the research and 
training roles of the ERC's and TPG's, and has included 
additional funding to expand these efforts.
    The Committee is encouraged with the progress by NIOSH on 
implementing the National Occupational Research Agenda [NORA]. 
The Committee is supportive of NIOSH's efforts to further its 
partnerships with the occupational safety and health community 
and the broader public and private public health research 
community, and believes these partnerships will be important in 
the implementation phase. The Committee urges NIOSH to work 
with its partners to augment resources available to the 
Institute for NORA research. In particular, the Committee 
strongly encourages NIOSH to continue partnering with the 
National Institutes of Health to cosponsor and fund extramural 
research in relevant NORA priority areas.
    The Committee has included sufficient funds to meet the 
request for intramural research and staffing on work-related 
diseases at the new laboratory in Morgantown, WV.
    The recommendation includes consolidated funds for the 
former U.S. Bureau of Mines mine safety and health research 
activities. In fiscal year 1996 these activities were 
transferred from the U.S. Bureau of Mines to NIOSH. The former 
Bureau of Mines research activities address a broad spectrum of 
issues which target worker safety, disaster prevention, and 
health in the mining industry.
    While NIOSH has had responsibility for occupational safety 
and health research aimed at industry in general, the Committee 
understands that many mine safety and health research needs are 
either unique to mining or require mining-specific emphasis. 
The Committee, therefore, expects the NIOSH to continue to 
preserve the integrity of the mine safety and health research 
unit of the Bureau so that the collective experience and 
expertise of that group can be maintained within NIOSH.
    The Committee is supportive of the concept of establishing 
NIOSH regional surveillance centers, based upon the successful 
Alaska model, and notes that Hawaii and the Pacific basin 
region would be an ideal region for such a center. The 
Committee understands that in 1987, the Institute of Medicine 
reported that occupational illness and injury surveillance 
systems have been inadequate. By developing the regional center 
concept, NIOSH would be able to include relevant local and 
unique data in its efforts to evaluate and compare various 
health risks and hazards.
    The Committee has included $1,000,000 within this account 
to augment activities of the Colorado School of Mines.

Epidemic services

    The Committee's recommendation includes $69,844,000 for 
epidemic services, $25,072,000 less than the request and 
$2,499,000 over the 1998 appropriation. Additional funds for 
this activity are available within the Public Health and Social 
Services emergency fund.
    The objectives of the epidemic services activity are to: 
provide for the investigation, prevention, or control of 
epidemics, develop, operate, and maintain surveillance systems, 
analyze data, and respond to public health problems when 
indicated; train public health epidemiologists [EIS]; carryout 
quarantine regulations; reduce the importation of disease from 
developing countries; publish the morbidity and mortality 
weekly report; develop, coordinate, and provide efficacious, 
effective, and economic prevention strategies; and assist in 
the improvement of State infrastructure.
    The Committee is concerned about the high numbers of 
childbirth complications; it has been estimated that one in 
four women who deliver a baby in the United States each year 
will experience a serious complication during labor, including 
bleeding, high blood pressure, or infection. The Committee 
notes the need for enhanced tools to effectively monitor, 
research, and prevent maternal deaths and strongly encourages 
CDC to develop means of replicating the pregnancy risk 
assessment monitoring system [PRAMS] to additional States.
    The Committee encourages the agency to support the 
development of a rapid toxic screen to measure human exposure 
to a wide variety of toxic substances.

Health statistics

    The recommendation of the Committee includes $84,573,000 to 
be provided from PHS 1 percent evaluation and set-aside funds. 
This is the same as the request and the fiscal year 1998 level.
    CDC's National Center for Health Statistics [NCHS] is the 
Nation's principal health statistics agency, whose mission is 
to provide statistical information that will guide actions and 
policies to improve the health of the American people.
    The increase provided is for the national health and 
nutrition examination survey [NHANES]. This is the same as the 
request and will provide for full funding of this important 
component of the Nation's health information strategy. When 
fully implemented, NHANES provides unique information from 
direct physical examinations, biochemical measures, interviews, 
and nutritional analysis from a large, representative sample of 
persons. This survey is the only national source of objectively 
measured health status data, and is essential to interpreting 
information from other survey components.
    Sarcoidosis.--The Committee encourages the National Center 
for Health Statistics to collect data on the prevalence of 
sarcoidosis by making sarcoidosis a reportable disease and by 
establishing a national sarcoidosis patient registry, in 
collaboration with NHLBI, NIAID, and the Sarcoidosis National 
Network.

Human immunodeficiency virus

    The Committee recommendation includes $631,779,000 for HIV/
AIDS activities, $6,835,000 more than the fiscal year 1998 
appropriation and $9,555,000 more than the request.
    The Committee continues to support CDC's strategy to 
develop community planning to direct resources to where the 
most critical needs are.
    The Committee is very supportive of the hemophilia 
consumer-based patient involvement programs that have been 
successful in HIV/AIDS risk reduction and in the prevention of 
the complications of hemophilia. The Committee has included 
funds to maintain and strengthen hemophilia and other 
hematologic program activities focused on preventing and 
reducing the crippling, debilitating complications, and death 
caused by such bleeding disorders.
    The Committee is aware that racial and ethnic minorities 
continue to be disproportionately affected by HIV disease. The 
Committee expects the CDC to target and include racial and 
ethnic minority communities in HIV prevention efforts through 
the existing community prevention planning process. 
Furthermore, the Committee recommends that any additional 
resources for HIV prevention activities be prioritized for 
State and local health department cooperative agreement grants 
to address these health disparities. The Committee stresses the 
need for close collaboration between State and local public 
health departments and the CDC in devising and implementing HIV 
prevention measures to systematically address disparities in 
racial and ethnic populations.
    The Committee recommends that $1,000,000 of the funds 
provided for HIV prevention be used to support demonstration 
projects to achieve HIV, STD, and reproductive health 
integration. These efforts should include integration of 
planning, service delivery, and evaluation at the State and 
local level. It is anticipated that these projects will focus 
on minority communities, low-income women, and adolescents who 
are disproportionately affected by these three issues.

Building and facilities

    The Committee recommendation includes $6,800,000 for repair 
and renovation of CDC facilities, $8,000 over the request and 
$34,704,000 below the fiscal year 1998 appropriation. Funds are 
provided for the most needed repair and improvement projects as 
facilities age and programs change.

Prevention research

    For this activity, the Committee has provided no funding. 
The administration proposed $24,969,000 for extramural research 
programs, information systems and laboratory activities.

Office of the Director

    For the Office of the Director, the Committee recommends 
$23,020,000, which is $8,000,000 below the President's request 
and $10,641,000 below the fiscal year 1998 appropriation. This 
line item includes amounts previously attributed to program 
management activities.
    The ``Program management'' account primarily supports the 
activities of the Office of the Director of the CDC. The vast 
majority of administrative costs are captured throughout the 
program accounts within the CDC.
    The recommendation includes bill language providing the 
Director with authority to transfer funds available from the 
sale of surplus vaccine from the vaccine stockpile to other 
activities within the jurisdiction of the Centers for Disease 
Control and Prevention. In the event the Director exercises 
this transfer authority, the Committee is to be notified 
immediately.
    The Committee continues to be pleased with CDC's program 
activity and commitment to improving the health status of 
minority and disadvantaged individuals, and urges continued 
expansion of these efforts, including the coordination of 
preventative care with substance abuse centers.
    The Committee understands that under the Clinical 
Laboratory Improvement Act [CLIA], the FDA was given the 
responsibility to categorize the complexity of new invitro 
diagnostic [IVD] devices. The Committee continues to be 
concerned that this dual responsibility has resulted in a 
process that causes confusion, unnecessary conflict, and 
duplication of effort. The Committee continues to encourage 
discussions between FDA and CDC on returning to FDA the role of 
categorizing CLIA complexity evaluations and expects to be 
informed regarding the efficiencies to be gained from such a 
transfer, the ways in which FDA review can result in waived 
status for certain technologies, and any impediments to FDA 
reasserting to its role.

Health disparities demonstration

    The Committee has included $10,000,000 for the new 
demonstration projects to address racial health disparities. 
This amount is $19,963,000 less than the President's request 
and $10,000,000 over the fiscal year 1998 appropriation. These 
funds will support research demonstration projects which 
address six identified areas of health disparities--infant 
mortality, cancer, heart disease, diabetes, HIV infections, and 
child and adult immunizations.

Violent crime reduction trust fund

    The Committee recommendation includes $43,000,000 from the 
violent crime reduction trust fund which is $8,000,000 below 
the fiscal year 1998 level and $62,000 above the budget request 
for activities authorized by the Violence Against Women Act in 
the crime bill. Included is $37,000,000 to augment rape 
prevention services supported by the States through the 
preventive health and health services block grant and 
$6,000,000 for grants to public and private nonprofit 
organizations to support community programs to prevent domestic 
violence. The Committee further provides $8,000,000 in regular 
appropriations, for a total of $45,000,000, to sustain current 
rape prevention activities.
    The funds for rape prevention and services will be used by 
States to expand support for rape crisis centers and State 
coalitions, to support rape crisis hotlines, victim counseling, 
professional training of police officers and investigators, and 
education programs in colleges and secondary schools.
    The Committee is concerned with the distribution of funds 
for rape prevention and education that are provided with funds 
from the violent crime reduction trust fund and sent to the 
States through the preventative health and health services 
block grant. States should comply with the statutory language 
and congressional recommendations accompanying the use of these 
funds. Funds should be used to supplement rape crisis centers 
and State sexual assault coalition's rape prevention and 
education efforts and not to supplant funds from other sources.
    It is the Committee's expectation that the Centers for 
Disease Control and Prevention take the lead in a collaborative 
effort between CDC and the Department of Justice in researching 
the behavioral and psychosocial factors relating to violence 
against women.
    The Committee urges CDC to ensure that States receiving 
funds from the grants for assistance to victims of sexual 
assault support State sexual assault coalitions and community-
based rape crisis centers whose work is focused on ending 
sexual violence, operating hotlines for victims of sexual 
violence and their families, and those who provide crisis 
intervention, advocacy, and self-help services to victims. The 
Committee also urges that similar nongovernmental nonprofit 
agencies show a demonstrated effectiveness in carrying out the 
work achieving these goals in order to receive funds. The 
Committee further encourages CDC work to have States devote 
adequate resources from their allocation for rape prevention 
and education for middle, junior, and high school youth in both 
school and nonschool settings.

                     National Institutes of Health

    Few of the Federal Government's actions affect the lives, 
well-being, and security of as many Americans as its investment 
in medical research. Similarly, few Federal investments have 
such far-reaching effects on this Nation's academic and 
economic standing throughout the world. The National Institutes 
of Health have often been referred to as the crown jewel of 
this country's research infrastructure and the world's 
preeminent medical research enterprise. It is those things and 
more. For millions of cancer and heart disease survivors it is 
the taproot of new drugs and surgical techniques that have 
added new years to life. It is the font of vaccines that save 
the lives of children who would have been considered hopeless 
cases only a few decades ago. And for the million of baby 
boomers who are shouldering their way into old age, it offers 
the only source of hope against the ruinous effects of 
Alzheimer's disease, stroke, arthritis, and Parkinson's.
    But past success is not self-sustaining; nor can tomorrow's 
challenges be left to chance. Scientific advances are 
cumulative and often slow to bear fruit. More likely than not, 
today's cure or treatment is likely to be the product of 
investigation begun years ago. Future life-saving breakthroughs 
depend on what this Nation is willing to invest today.
    This Committee views its decisions with regard to the 
National Institutes of Health as a significant responsibility. 
But responsibility falls as well on the various research 
Institutes and on the research community as a whole to balance 
the most promising scientific opportunities and the most 
pressing public health needs. The Committee generally has 
limited the amount of specific directives given in this report. 
However, this should in no way be construed to mean that the 
Committee has abandoned its prerogatives with respect to 
setting overall direction and guidance. To be sure, NIH must 
weigh a variety of factors when assigning research priorities, 
not the least of which are the desires of those who ultimately 
finance Federal research activities--the taxpayer. The 
Committee will continue to monitor this situation closely but 
in the meantime encourages NIH to consider carefully the 
recommendations set forth in the Institute of Medicine's report 
entitled, ``Scientific Opportunities and Public Needs,'' 
particularly those calling for greater public input.
    The Committee recommendation includes $15,622,386,000 for 
the National Institutes of Health. This is $819,073,000 more 
than the budget request and $2,000,000,000 more than the fiscal 
year 1998 appropriation.

                       NATIONAL CANCER INSTITUTE

Appropriations, 1998....................................  $2,542,559,000
Budget estimate, 1999...................................   2,768,635,000
Committee recommendation................................   2,927,187,000

    The Committee recommends an appropriation of $2,927,187,000 
for the National Cancer Institute [NCI]. This is $158,552,000 
more than the budget request and $384,628,000 more than the 
fiscal year 1998 appropriation. The comparable numbers for the 
budget estimate include funds to be transferred from the Office 
of AIDS Research.
    Mission.--The NCI conducts and supports basic and applied 
cancer research in prevention, early detection, diagnosis, 
treatment, and rehabilitation. NCI provides training support 
for research scientists, clinicians, and educators, and 
maintains a national network of cancer centers, clinical 
cooperative groups, community clinical oncology programs, 
cancer prevention and control initiatives, and outreach 
programs to rapidly translate basic research findings into 
clinical practice.
    The Committee continues to regard scientific investigation 
into the cause, cure, prevention, and treatment of cancer as 
one of the Nation's top priorities. Research offers the only 
hope for putting a stop to a disease that wastes precious human 
resources and contributes to spiraling health care costs. The 
Committee was pleased to learn of recent studies documenting a 
reduction in death rates and improved rates of cancer morbidity 
and mortality as a result of smoking cessation. While a 
testament to past investments in research, those findings 
should not be taken as a sign that the problem is solved. In 
fact, the incidence of many types of cancer continues to rise, 
and progress has not been seen across all populations, such as 
African-Americans.
    Breast cancer.--While recent data continues to show a drop 
in deaths from breast cancer, this disease still is expected to 
strike over 180,000 women in 1997. The Committee continues to 
believe that an intensive research program on breast cancer 
should be among the top priorities of the NCI and the NIH. More 
research is needed to better understand the underlying 
mechanisms of this disease, and to improve the ability to 
detect, diagnose, and treat breast cancer. Research also is 
needed to develop new prevention strategies with respect to 
this form of cancer. The Committee urges the NCI to strengthen 
its funding commitment to breast cancer research. The Committee 
also encourages the NCI to expand research into the 
occupational causes of breast cancer, tumor biology, 
immunology, molecular medicine, and development of new 
treatment methods. Research is also needed to develop better 
prevention and detection strategies.
    The Committee notes that breast cancer incidence and 
mortality are higher than the national average in several 
States in the Northeast. The Committee encourages the Institute 
to provide increased funding for regional breast cancer centers 
that would target areas of the country where the morbidity and 
mortality rates of breast cancer are higher than the national 
average.
    The Committee notes the need for a comprehensive initiative 
designed to assist in minority cancer control, prevention, and 
treatment. The Early Detection Breast Cancer Program consortium 
in south Florida is currently addressing the needs of the 
minority population with a concentrated and coordinated 
research and treatment effort.
    The Committee encourages the Institute to provide increased 
funding for a breast cancer research initiative designed to 
assist in minority cancer control, prevention, and treatment, 
particularly among Asian-American women.
    Cancer coordination.--The Committee encourages NCI to 
continue its leadership role as coordinator of the National 
Cancer Program. As the facilitator of the Nation's fight 
against cancer, the NCI specifically is encouraged to continue 
to work in collaboration with private/voluntary sector 
organizations, the CDC, and other Federal agencies to address 
the coordination challenges outlined in the National Cancer 
Advisory Board's report entitled ``Cancer at a Crossroads.''
    Cancer information service.--The Committee commends NCI for 
their creation of the toll-free cancer information services; 
however, it is aware of a May 1998 report issued by the HHS 
Inspector General which concluded that nearly one-third of 
those who call the toll-free number have failed to reach a 
cancer information specialist. The Committee notes that 
residences of Florida had the highest busy rate, with more than 
one-half the callers getting busy signals. The Committee 
further notes the report concludes that resources were not 
equitably allocated among the 19 regions. The Committee 
requests that the Director of NCI to issue a report to the 
Congress not later than May 1, 1999, which provides specific 
initiatives to address the concerns raised in the report of the 
HHS Inspector General.
    Clinical trials.--The high cost of clinical trials and lack 
of third-party insurance coverage for any treatment considered 
experimental in nature has made this critical bedside research 
arduous and difficult. The Committee encourages NCI to place a 
greater emphasis on funding clinical trials, and to continue 
its efforts to establish mechanisms to ensure that the basic 
research conducted through NCI is translated to clinical 
benefit when appropriate.
    Digital mammography.--Digital mammography technology is 
currently undergoing testing for FDA approval to demonstrate 
the safety and efficacy. However, large-scale testing of 
approximately 100,000 women is necessary to quantify its 
increased detection success relative to conventional film 
mammography. The Committee believes the National Cancer 
Institute should provide the Congress with a plan to manage 
such a large-scale trial in its fiscal year 2000 hearings.
    Bone diseases.--The Committee is extremely pleased with the 
important strides that have been made in research connecting 
osteoporosis and breast cancer, and encourages further 
investigation to determine how these insights may be used in 
the prevention of breast cancer. The Institute is also 
encouraged to further intensify and expand its research to 
determine the basis for skeletal metastasis of those 
malignancies with high preference for growth in bone, such as 
myeloma, breast cancer, and prostate cancer. The Committee 
further encourages the development of therapies directed at the 
bone that would prevent or ameliorate metastatic disease.
    Hepatitis C.--The Committee is aware that several of the 
significant new research recommendations of the NIH-sponsored 
Hepatitis C [HCV] Consensus Development Conference impacts 
directly on the research portfolio of the NCI. This research 
includes the NCI recommendation that studies are needed 
regarding the mechanism of development of hepatocellular 
carcinoma in patients with HCV. The Committee encourages the 
NCI to initiate research in a manner fully responsive to 
professional judgment recommendations.
    Lymphoma.--The Committee recognizes that lymphoma is one of 
the fastest growing cancers, striking more than 85,000 
Americans each year, resulting in a 50-percent mortality rate. 
The Committee further recognizes that approximately 600,000 
Americans today are living with lymphoid malignancies. 
Accordingly, the Committee encourages the NCI to increase 
funding for lymphoma research through use of all available 
mechanisms, including program announcements and requests for 
applications; convening a scientific workshop to examine the 
current state of lymphoma research and identify opportunities 
for further study; and expanding its current research into 
potential environmental factors responsible for lymphoma.
    Neurofibromatosis.--Enormous advances continue to be made 
in research on neurofibromatosis [NF] since the discovery of 
the NF1 and NF2 gene, including the recent discovery that NF is 
involved with the c-AMP pathway affecting learning disabilities 
in addition to its cancer-fighting tumor suppressor functions. 
The Committee encourages NCI to strengthen its NF research 
portfolio in such areas as continued development of animal 
models, natural history studies, and therapeutic 
experimentation and clinical trials. The Committee further 
encourages the following funding mechanisms, as appropriate: 
requests for applications; program announcements; the national 
cooperative drug discovery group program; and small business 
innovation research grants. The Committee requests that the 
Institute continue to coordinate its efforts with NINDS and be 
prepared to discuss the status of the NF research program, 
including progress in implementing these recommendations, at 
its hearings on the fiscal year 2000 budget.
    Translational research.--The Committee has been made aware 
of the extraordinary explosion of scientific advances in cancer 
biology, immunology, and molecular biology and genetics that 
have occurred in recent years as a result of previous 
investments in basic research. These advances provide 
unprecedented opportunities to develop new therapies, early 
detection technologies, and prevention strategies. The 
Committee is concerned that the translation of these promising 
discoveries into practice is not keeping pace with the 
opportunities that exist due to changes in the health care 
marketplace and weakness in the infrastructure for 
translational research. The Committee requests that the NCI 
evaluate the barriers and impediments that inhibit clinical 
testing of new technologies such as vaccines, gene therapies, 
monoclonal antibodies, and be prepared to discuss the steps 
needed to remove these barriers at next year's appropriations 
hearing.
    Pancreatic, prostate, and colon cancer.--The Committee 
supports increased efforts in the areas of pancreatic, 
prostatic, and colon cancer. Pancreatic cancer afflicts 30,000 
new patients per year and leads to 29,800 deaths. Prostate 
cancer afflicts 185,000 Americans yearly and causes 39,000 
deaths. Colon cancer afflicts 60,000 Americans yearly and 
causes 40,000 deaths. A portion of the amount provided should 
be devoted to research programs in these areas, particularly 
programs that utilize the newly discovered CaSm gene for gene 
therapy of pancreatic cancer; the newly implicated ETS2 gene 
for prostatic cancer; and the well described DRA gene for colon 
cancer. Antisense and gene therapy, and immunotherapy 
approaches can be supported to utilize these genes for the 
control of the indicated diseases.
    The Committee continues to be very concerned about the high 
rates of incidence and mortality related to prostate cancer, 
particularly among African-American males. Prostate cancer is 
the second leading cause of cancer death in men, and African-
American males are 66 percent more likely to be stricken with 
the disease. The Committee is encouraged by NCI's 
collaborations with the Department of Defense in combating this 
devastating disease and urges NCI to continue to strengthen and 
expand its prostate cancer research portfolio.
    The Committee encourages NCI to explore the feasibility of 
developing a national model research, education, training, and 
treatment center focusing on early diagnosis, prevention, and 
treatment of prostate cancer.
    The Committee also requests that the Director of the 
National Institutes of Health, together with the Director of 
the NCI, submit a report to the Appropriations Committees, no 
later than April 1, 1999, outlining the activities NIH is 
undertaking to enhance prostate cancer research programs.
    Smoking intervention study.--Consistent with the budget 
request, the Committee agrees that the American stop smoking 
intervention study [ASSIST], be moved to CDC. The Committee 
expects the NCI to transfer the $25,000,000 expended in fiscal 
year 1998 for ASSIST to the CDC to continue this program. The 
Committee continues to believe that NCI has a critical role to 
play in preventing and reducing tobacco use and its adverse 
health consequences. Tobacco use is responsible for at least 
one-third of all cancers and NCI resources should better 
reflect this. The Committee believes that NCI must expand its 
existing tobacco-related research portfolio with a greater 
emphasis on behavioral, community, and State intervention 
research.
    Outreach and public education.--The Committee commends the 
NCI's dedication to the National 5-A-Day Campaign. This 
campaign is an important facet of NIH's overall commitment to 
the prevention of nutrition-related disease. The practical 
value of research is dependent on the translation of that 
research into practice by the public. The Committee recognizes 
that a diet including a minimum of five servings of fresh 
fruits and vegetables is a critical factor in reducing cancer 
risk. The Committee encourages NCI to consider increasing its 
communications and communications research for the 5-A-Day 
Program from its previous levels and increase its research in 
fruits and vegetables nutrition.
    Gene therapy.--The Committee notes the outstanding progress 
being made by organizations studying the use of gene therapy in 
finding a cure for several forms of cancer. The Committee is 
impressed by the progress being made by the Human Gene Therapy 
Research Institute at the Iowa Methodist Medical Center in Des 
Moines, IA, in finding a cure for breast cancer. The Committee 
encourages the Institute to support organizations like this 
conducting breast cancer research utilizing autogolous bone 
marrow transplantation and gene therapy methods.
    Primary immune deficiency diseases.--These genetic 
disorders, which affect as many as 1 million Americans, most of 
whom are children, are characterized by unusually high 
incidences of several forms of cancer. The relationship between 
the genetics of the immune system and the genetics of cancer is 
an area ripe for scientific endeavor. For this reason, the 
Committee urges NCI to establish a transinstitute initiative 
with NIAID, NICHD, and NHGRI by sponsoring a symposium of 
leading experts in cancer, immunodeficiencies, pediatrics, and 
genetics to explore the most promising areas of research and 
develop a comprehensive agenda for future research initiatives.
    Urological cancers.--Urological cancers such as kidney, 
bladder, and prostate cancer afflict thousands of people each 
year. Research funding for such cancers has not kept pace with 
other diseases. Therefore, the Committee strongly urges NCI to 
significantly expand its research programs for these urologic 
cancers.
    Nutrition and cancer.--The Committee continues to be 
extremely supportive of the Cancer Prevention Program, 
particularly the nutrition research component. Recent 
developments highlight the significance of diet in relation to 
prostate cancer and breast cancer. The Committee hopes that the 
Cancer Prevention Program and nutrition research will have 
added significance in the new organizational structure recently 
implemented at NCI. The Committee is particularly concerned 
that NCI utilize existing clinical nutrition research units and 
general clinical research centers to carry out investigation 
regarding the role of nutrition in cancer prevention.
    Imaging systems technologies.--The Committee is aware of 
the striking advances in high-resolution imaging technologies 
of magnetic resonance imaging and spectroscopy and position 
emission tomography, and optical coherence tomography for 
detecting small abnormalities in tissues and for determining 
the structure of important cellular mollicules. Given the 
recent data showing a high rate of false-positive diagnoses of 
breast cancer from current mammographic technologies, the 
Committee believes that there is a critical need to bring 
important new technologies to full development so that the 
breast cancer can be detected at earlier stages than currently 
exists. Therefore, the Committee encourages the NCI to 
accelerate development and implementation of these advanced 
imaging systems.
    Ovarian cancer.--In 1998, 25,400 women will be diagnosed 
with ovarian cancer and over 14,500 women will die from the 
disease. The Committee understands that more than 70 percent of 
women with ovarian cancer are diagnosed by their physicians for 
the first time when the disease is in its advanced stages, 
apparently because only vague symptons appear in its early 
stages. As survival rates for women with ovarian cancer 
increase dramatically if the cancer is found in its earliest 
stages the Committee encourages the NCI to support expanded 
research into improved methods for early detection, diagnosis, 
and staging of ovarian cancer and also encourages the Institute 
to set up a specialized program of research excellence for 
ovarian cancer.
    Diethylstilbestrol.--The Committee continues to strongly 
support increased efforts to study and educate the public and 
health professionals about the impact of exposure to the 
synthetic hormone diethylstilbestrol [DES]. NCI and other 
Institutes, along with the Office of Women's Health, have 
developed a plan for expanded research activities in this area. 
The Committee has included sufficient funds to carry out this 
plan. In addition, educational materials for consumers and 
health professionals have been developed as a result of a 
demonstration project funded by the Committee in previous 
years. The Committee has included sufficient funds for NCI to 
contract with CDC to undertake educational efforts targeting 
consumers and health professionals on a national basis. The 
Committee expects NCI and other agencies to continue to consult 
with organizations representing individuals impacted by DES as 
DES research and education efforts are carried out.
    Complementary and alternative cancer therapies.--The 
Committee expects NCI to work collaboratively with the Office 
of Alternative Medicine to support expanded research on 
promising complementary and alternative cancer therapies, and 
on their integration with traditional therapies. Thousands of 
Americans are turning to these therapies and consumers will 
benefit from the results of rigorous scientific review. The 
Committee expects to be briefed on the progress of the 
Institute's efforts prior to the next appropriations cycle.
    Cancer in minorities.--The Committee remains concerned over 
recent statistics citing higher incidences of cancer among the 
native Hawaiian population. In comparison to other ethnic and 
racial groups, native Hawaiians have the highest incidence of 
the most common forms of cancer such as breast, colon, and lung 
cancer. The Committee encourages continued research in the 
areas of prevention and detection, utilizing nurse 
practitioners in community-based centers for screening and 
education for the underserved populations.
    Heat shock problems.--The Committee is aware of the 
development of a new technology that employs heat shock 
proteins to provide a genetic fingerprint of cells that allows 
for the identification of irregularities in cells. This 
technology could lead to the development of vaccines based on 
irregularities found in particular cells. The Committee 
encourages NCI to support further investigation into this area.
    Behavioral science research.--The Committee is pleased to 
learn that cancer rates have dropped significantly, much of 
this due to the adoption of healthy behaviors. The Committee 
urges NCI to increase its investigations into the underlying 
factors that promote the adoption of healthy behaviors as well 
as those mitrigate against obstruct such behaviors.

               NATIONAL HEART, LUNG, AND BLOOD INSTITUTE

Appropriations, 1998....................................  $1,582,924,000
Budget estimate, 1999...................................   1,709,534,000
Committee recommendation................................   1,793,697,000

    The Committee recommendation includes $1,793,697,000 for 
the National Heart, Lung, and Blood Institute [NHLBI]. This is 
$84,163,000 more than the budget request and $210,773,000 more 
than the fiscal year 1998 appropriation. The comparable numbers 
for the budget estimate include funds to be transferred from 
the Office of AIDS Research.
    Mission.--The National Heart, Lung, and Blood Institute 
provides leadership for a national research program in diseases 
of the heart, blood vessels, lungs, and blood, in transfusion 
medicine, and in sleep disorders through support of innovative 
basic, clinical, population-based, and health education 
research.
    Asthma research, education, and prevention.--The Committee 
is pleased with the early efforts of the Asthma Clinical 
Network to determine the effectiveness of asthma drugs and to 
identify better asthma management practices. During its first 4 
years, the network has completed and published the results of 
two clinical trials of medication usage in patients with mild 
and moderate asthma. Two ongoing studies are evaluating the 
effects of asthma medications in altering clinical outcomes and 
airway inflammation in moderate and severe asthma. Another 
study, to establish doses of different inhaled corticosteroids, 
is expected to be completed in the near future.
    The Committee recognizes the strong commitment of the NHLBI 
to learn more about asthma in minority populations, and is 
pleased at recent efforts by the Institute to extend its 
educational programs for these groups. In particular, the 
Committee has learned that the NHLBI plans to modify existing 
educational materials on asthma management to produce 
documents, audiovisual materials, and information packages for 
general dissemination and for targeted groups of patients, 
families, and health care providers at the community level, 
based on sociodemographic and cultural considerations.
    The Committee was pleased to learn that the National Asthma 
Education and Prevention Program [NAEPP] has published updated 
asthma management guidelines. The Committee was also encouraged 
to hear that the NAEPP is working with national and local 
organizations to increase guideline use. The NAEPP has 
published a summary of asthma self-management approaches for 
use by local asthma coalitions. Professionals will be 
encouraged to use the materials to support patient education 
efforts.
    Cooley's anemia.--The Committee is pleased that the 
Institute has included sufficient funding in its fiscal year 
1999 budget for the development of a network of collaborative 
clinical centers that will facilitate research into Cooley's 
anemia and possibly other diseases, as recommended by several 
special emphasis panels. The Committee looks forward to 
receiving a report from the Institute on the status of this 
network, and the expected areas of research on which it will 
concentrate, prior to next year's hearings.
    Sarcoidosis.--Ongoing NHLBI sarcoidosis research includes 
studies to identify the cause(s) of the disease; to determine 
the pattern of inheritance in African-Americans and the role 
for major and minor genes in disease development; and to 
examine the immunological and inflammatory processes that occur 
in pulmonary sarcoidosis. Research findings are expected to 
improve understanding of sarcoidosis and lead to better 
treatment and perhaps to a cure. The Committee strongly 
supports these efforts.
    Comprehensive sickle cell centers.--The Committee 
recognizes the terrible toll that sickle cell disease continues 
to take on African-Americans and strongly encourages NIH to 
accelerate the search for a cure for this devastating disease. 
The Committee urges NHLBI to increase the number of 
comprehensive sickle cell centers by awarding four additional 
grants on a competitive basis, targeting regions with a 
significant African-American population not already served by 
such a center.
    Cardiovascular disease.--The Committee recognizes the 
seriousness of heart attack, stroke, and other cardiovascular 
diseases and is concerned that cardiovascular disease continues 
to remain America's No. 1 killer and a major cause of 
disability. The Committee encourages the Institute to increase 
funding for the extramural heart program to support increased 
heart- and stroke-related research programs and to invest in 
promising heart- and stroke-related initiatives.
    Abnormal heart rhythms.--Abnormal heart rhythms, or 
arrhythmias, can make the heart beat too fast, too slow or 
irregularly, and decrease the heart's ability to pump blood 
effectively. Ventricular arrhythmias cause most of the 250,000 
sudden cardiac deaths each year, while atrial fibrillation, 
which occurs in about 2 million Americans, causes 90,000 
strokes yearly. The Committee urges the Institute to expand 
research that may lead to new treatments for arrhythmias, 
improved preventive measures for Americans at risk of 
arrhythmic death, and reduce stroke as a complication of 
cardiac arrhythmias.
    Origins of atherosclerosis.--Atherosclerosis (hardening of 
the arteries) causes blockages which lead to heart attacks and 
stroke. The Committee encourages the Institute to expand and 
initiate research using techniques of vascular biology, gene 
therapy and noninvasive, nonradioactive imaging that could lead 
to the identification and treatment of high-risk individuals 
before heart attack or stroke strikes. The Committee further 
encourages expansion of research into the role that bacteria 
and viruses might play in causing inflammation of the artery, 
research that could lead to the development of effective 
prevention strategies.
    Congestive heart failure.--Heart attacks, high blood 
pressure, and congenital heart defects can result in a damaged 
heart muscle and can cause congestive heart failure. It is 
estimated that over 5 million Americans are afflicted with this 
disorder. The Committee encourages the Institute to explore 
promising new treatment options such as removal of 
nonfunctioning heart muscle, mechanical assist devices, animal 
hearts for transplant, transplantation of healthy heart cells, 
and the role of programmed cell death in the development of 
congestive heart failure. The Committee further encourages the 
Institute to support research on cardiomyopathy, a heart muscle 
disease afflicting about 50,000 Americans who are also prone to 
congestive heart failure.
    Congenital heart defects and specialized centers of 
research.--Congenital heart defects remain America's most 
common birth defect, and are the major cause of birth defect-
related infant deaths and a significant cause of childhood 
disability. The Committee encourages the Institute to continue 
and expand research in emerging areas such as the use of new 
genetic tools to identify genes that control heart development, 
and improved diagnosis, treatment and prevention methods.
    Congenital heart defects affect 32,000 newborns in the 
United States each year, killing about 2,300 children in their 
first year of life. Scientists often do not know why these 
defects occur. The Committee encourages NHLBI to support an 
additional three specialized centers of research in pediatric 
cardiovascular diseases and to continue research in emerging 
areas such as the use of new generic tools to identify genes 
that control heart development.
    High blood pressure.--The Committee is pleased to learn 
that the National High Blood Pressure Education Program has 
released the sixth guideline for primary care clinicians on 
prevention and management of hypertension. Hypertension, an 
important public health problem, exists in all sectors of 
society, but is more prevalent in African-Americans and older 
Americans. The Committee recognizes the work of the National 
High Blood Pressure Education Program.
    Prevention of heart disease and stroke.--The Committee 
supports NHLBI research to prevent heart disease and stroke and 
encourages expansion of this effort, particularly with respect 
to thrombosis, or blood clot formation. Blood clots are 
responsible for a host of life-threatening events, including 
heart attack and stroke. Research on the genetics of 
thrombosis, coupled with use of highly sensitive imaging 
techniques, may someday enable physicians to identify persons 
at risk for heart attack and stroke and intervention to prevent 
the occurrence of these deadly events.
    A healthful lifestyle.--Success in translating awareness of 
heart attack, stroke, and other cardiovascular disease risk 
factors into behavior modification has been limited. Millions 
of Americans still smoke, are physically inactive and obese, 
and have unhealthful diets, high cholesterol, and elevated 
blood pressure. The Committee encourages the Institute to 
expand and initiate research into behavior modification in 
order to create public health interventions that help promote 
healthful behaviors. The Committee further encourages the 
Institute to expand research into the causes of and treatment 
for obesity, especially in children and young adults.
    Thirty to forty percent of coronary heart disease deaths 
can be attributed to obesity, high blood pressure and high 
cholesterol; one-half of adult Americans have cholesterol 
levels above the desired level. The Committee continues to 
support the initiatives taken by NHLBI in the nutrition and 
obesity area, particularly clinical research in nutrition and 
obesity.
    The Committee further encourages the Institute to work in 
collaboration with NCI, NIDDK, and other Institutes in this 
effort.
    Primary pulmonary hypertension.--The Committee was pleased 
to learn that the NHLBI is expanding its research program in 
primary pulmonary hypertension. The Institute recently released 
a program announcement to encourage new investigations into 
cellular and molecular events underlying the disease and 
cosponsored a conference on mechanisms for eliminating vascular 
diseases. The Committee strongly urges NIH to actively pursue 
and increase funding for opportunities for fixture research, 
expanded studies at the cellular and molecular level; mapping 
the locus of familial PPH and screening for genetic mutations 
in and new treatment modalities; and developing animal models 
to investigate how prostacyclin may achieve a regression of 
vascular disease.
    Hemophilia.--The Committee remains supportive of NHLBI's 
hemophilia gene therapy research program and encourages 
expanded research emphasis in this critical area. In light of 
the research opportunities in hemophilia gene therapy, the 
Committee urges NHLBI to develop a collaborative research plan 
with NIDDK, the National Human Genome Research Institute, and 
the hemophilia scientific and medical community for the 
development of promising hemophilia gene therapy technologies. 
The Committee requests a report on the steps taken by March 31, 
1999.
    Acute respiratory distress syndrome [ARDS].--ARDS, a 
devastating and incurable form of respiratory failure, remains 
a significant health threat for many seriously ill people. The 
ARDS Network, consisting of 10 critical care treatment groups, 
has been established by the NHLBI to identify effective 
therapies through prospective, randomized multicenter clinical 
trials. The Committee is pleased to learn that the ARDS Network 
will be used to evaluate a promising investigational toxicity 
modifier. The Committee believes that these types of innovative 
public/private collaborations, will serve to rapidly translate 
research into practice. The Committee looks forward to hearing 
about this important initiative at next year's hearing.
    Alternative research resources.--The Committee is very 
interested in matching the increased needs of researchers who 
rely upon human tissues and organs, a very valuable and 
effective alternative research resource, to study human 
diseases and to search for cures. The Committee is aware that 
the National Disease Research Interchange [NDRI], dedicated to 
providing the research community with this valuable and 
effective alternative research resource, has supplied thousands 
of human tissues and organs, and therby contributed to a number 
of recent significant research advances. The Committee, being 
greatly encouraged by NDRI's role in these research advances, 
expects the Director to participate in a multi-institute 
initiative to expand support for NDRI.
    National Cholesterol Education Program.--The Committee 
encourages the National Heart Lung and Blood Institute to 
continue its efforts to persuade the National Committee for 
Quality Assurance to accredit health plans based on their 
ability to reach treatment goals established by the National 
Cholesterol Education Program in treating patients with 
hypercholesterolemia.

         NATIONAL INSTITUTE OF DENTAL and craniofacial RESEARCH

Appropriations, 1998....................................    $209,026,000
Budget estimate, 1999...................................     228,811,000
Committee recommendation................................     233,588,000

    The Committee recommendation includes $233,588,000 for the 
National Institute of Dental and Craniofacial Research [NIDCR]. 
This is $4,777,000 more than the budget request and $24,562,000 
more than the fiscal year 1998 appropriation. The comparable 
numbers for the budget estimate include funds to be transferred 
from the Office of AIDS Research.
    Mission.--The NIDCR supports research and research training 
to improve the oral health of the American people. The 
Institute emphasizes ways to prevent disease in high-risk 
groups, including the elderly, minority populations, and people 
with medical conditions and medications that compromise oral 
health. The research agenda includes studies of craniofacial 
genes and birth defects; bone and joint diseases; AIDS, other 
infections, and immunity; oral cancer; chronic pain; 
epidemiology; biomaterials; and diagnostic systems.
    Early childhood caries.--The Committee is aware of the 
findings of the Early Childhood Caries Conference that dental 
caries has reached epidemic proportions in many low 
socioeconomic preschool children in the United States. The 
Committee encourages the NIDCR to expand its research on this 
problem and, to the extent possible, collaborate with the 
Agency for Health Care Policy and Research to identify 
effective means of preventing and treating early childhood 
caries.
    Periodontal disease.--The Committee is aware of the 
impressive work being done in periodontal disease at many of 
this Nation's research institutions. The Committee encourages 
the NIDCR to support research that focuses on the biofilm 
etiology of periodontal disease. This type of research could 
show promise for future treatments.
    Bone disease.--The Committee notes the growth of research 
in osteoporosis, Paget's disease, and osteogenesis imperfecta 
and encourages the Institute to provide additional funds in 
this area in order to further expand and intensify the research 
programs on bone disease.
    Temporomandibular joint disorders [TMJ].--The Committee 
remains interested in research on temporomandibular joint 
disorders [TMJ]. Last year, NIDCR convened a Technology 
Assessment Conference on the Management of TMJ. The Committee 
urges the Institute to expand its efforts to implement this 
agenda. The Committee again calls on NIDCR to form an 
interinstitute committee along with representatives of the 
Office on Women's Health, AHCPR, and CDC to develop a short- 
and long-term research agenda. Further, a study of TMJ patients 
who are suffering craniofacial and systemic problems as a 
result of dental implants is recommended.

    NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES

Appropriations, 1998....................................    $872,231,000
Budget estimate, 1999...................................     941,544,000
Committee recommendation................................     994,218,000

    The Committee recommends an appropriation of $994,218,000 
for the National Institute of Diabetes and Digestive and Kidney 
Diseases [NIDDK]. This is $52,674,000 more than the 
administration's request and $121,987,000 more than the fiscal 
year 1998 appropriation. The comparable numbers for the budget 
estimate include funds to be transferred from the Office of 
AIDS Research.
    Mission.--The NIDDK provides leadership for a national 
program in three major disease categories: diabetes, 
endocrinology, and metabolic diseases; digestive diseases and 
nutrition; and kidney, urologic, and hematologic diseases. The 
NIDDK plans, conducts, fosters, and supports a coordinated 
program of fundamental and clinical research and demonstration 
projects relating to the causes, prevention, diagnosis, and 
treatment of diseases within these categories. The Institute 
also supports efforts to transfer the knowledge gained from its 
research program to health professionals, patients, and the 
general public.
    Polycystic kidney disease.--Polycystic kidney disease [PKD] 
is a life-threatening genetic disease. The Committee 
understands that PKD science has progressed rapidly over the 
past several years and for that reason, the Committee has 
consistently recommended substantial increases in this area. 
The Committee further understands that a number of scientists 
are now predicting new therapies will emerge in the near 
future. The Committee, therefore, strongly recommends that 
NIDDK accelerate its research effort on PKD, including the 
creation of four PKD interdisciplinary centers. At least two of 
these centers should be broadly based to allow a wide range of 
skills and experience to be brought to bear in the development 
of therapies for PKD.
    Interstitial cystitis.--Interstitial cystitis [IC] is a 
serious and debilitating bladder disorder that primarily 
affects women. The Committee is pleased that in fiscal year 
1998 the NIDDK continued to fund IC clinical research and 
initiated the second phase of the IC data base, consisting of 
clinical centers to develop and test treatment protocols. The 
Committee encourages the Institute to continue and expand 
research and investigators on IC and to pursue proposals 
through a series of request for applications for individual 
research grants and pilot studies to investigate promising new 
strategies for IC symptom relief, epidemiology, and further 
understanding the basic science of IC. The Committee requests 
that the NIDDK be prepared to report to the Committee during 
the fiscal year 2000 hearings on ongoing research studies and 
areas for research solicitations, demonstrating where advances 
can be made in the effective treatment and prevention of IC.
    Oxalosis.--The Committee is encouraged to learn that the 
Institute will hold a workshop on oxalosis, a pediatric disease 
that crosses disciplines in genetics, urology, metabolic, 
kidney, liver, and transplants.
    Benign prostatic hypertrophy [BPH].--The incidence of 
benign prostatic hypertrophy [BPH] is staggering, affecting 
more than 12 million men over age 50. The Committee urges NIDDK 
to increase its research into prostate growth factors and 
related issues. Further, the Committee encourages a 
collaborative program with the Agency for Health Care Policy 
Research to better define the clinical and pathological 
spectrum of BPH, and to determine the most effective medical 
and surgical treatments for the various categories and stages 
of this disease.
    Women's urological health.--The Committee is pleased that 
NIDDK has responded to its recommendation for a women's 
urological health initiative by hosting a conference to 
identify research issues. The Committee strongly encourages the 
Institute to implement the conference recommendations and 
provide increased funding in this area.
    Urology research.--The Committee remains concerned that no 
research support is targeted on several critical areas in 
urology, including male infertility and impotence, congenital 
anomalies of the genitourinary tract, and kidney stone disease. 
The Institute should be prepared to report on the state of 
urology research with recommendations for new programmatic 
activities during the fiscal year 2000 hearings.
    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 colon cancer, 
inflammatory bowel disease, irritable bowel syndrome, and viral 
hepatitis take a significant toll in terms of human suffering, 
mortality, and economic burden. The Committee encourages NIDDK 
to enhance its efforts to strike an appropriate balance between 
conducting basic studies on digestive diseases and bringing 
those research findings to the bedside in the form of improved 
patient care.
    Inflammatory bowel disease.--The Committee is encouraged by 
recent discoveries related to inflammatory bowel disease [IBD], 
Crohn's disease, and ulcerative colitis. These extremely 
complex disorders represent the major cause of morbidity and 
mortality from intestinal illness. The Committee encourages 
NIDDK to give priority consideration to the following areas of 
IBD research: investigation into the cellular, molecular, and 
genetic structure of IBD; identification of the genes that 
determine susceptibility or resistance to IBD in various 
patient subgroups; coordination and integration of basic 
investigations designed to clarify mechanisms of action and 
disease pathogenesis into clinical trials; and IBS education 
and scientific symposiums.
    Irritable bowel syndrome [IBS].--The Committee remains 
concerned about the increasing frequency of irritable bowel 
syndrome [IBS], a chronic complex of disorders that malign the 
digestive system. These common dysfunctions strike people from 
all walks of life and result in tremendous human suffering and 
disability. The Committee encourages the NIDDK to provide 
adequate funding for irritable bowel syndrome/functional bowel 
disorders research.
    Alternative research resources.--The Committee is very 
interested in matching the increased needs of researchers who 
rely upon human tissues and organs, a very valuable and 
effective alternative research resource, to study human 
diseases and to search for cures. The Committee is aware that 
the National Disease Research Interchange [NDRI], dedicated to 
providing the research community with this valuable and 
effective alternative research, has supplied thousands of human 
tissues and organs, and thereby contributed to a number of 
recent significant research advances. The Committee, being 
greatly encouraged by NDRI's role in these research advances, 
expects the Director to participate in a multi-institute 
initiative to expand support for NDRI.
    Prostatitis.--The Committee is pleased that the NIDDK has 
begun to address the public health issues of prostatitis. It 
has been brought to the Committee's attention that a number of 
reports suggest that there is a strong familial occurrence of 
the disease and that chronic prostatitis is a precursor to both 
benign prostatic hyperplasia [BPH] and prostate cancer. The 
Committee encourages the Institute to increase research to 
explore the genetics and molecular epidemiology of the disease, 
and the relationship between chronic prostatitis and other 
diseases of the prostate.
    Pediatric kidney disease.--Despite medical advances in the 
care and treatment of children and adolescents, kidney diseases 
continue to be a significant cause of illness and death among 
this vulnerable population. It is estimated that 150,000 young 
people suffer from kidney diseases for which there is no cure 
or effective treatments. As many as 10,000 suffer from chronic 
kidney failure, require kidney dialysis treatment, or have had 
a kidney transplant. Thousands more will fall victim to urinary 
tract infections that permanently damage kidney tissue, develop 
the early signs of progressive kidney disease, or be stricken 
with diabetes and eventually require dialysis or a kidney 
transplant.
    In its fiscal year 1998 report, the Committee urged NIDDK 
to develop and implement an interagency action plan for adult 
and pediatric kidney disease research. The Committee made that 
distinction because young people are especially vulnerable to 
problems not encountered by adults, involving growth and 
development, a higher potential for learning disabilities, and 
the effectiveness of immunosuppressive drugs. The Committee, 
therefore, urges NIDDK to submit a status report prior to next 
year's hearings, outlining specific actions taken to address 
the special research needs of children and adolescents 
suffering from kidney disease.
    Digestive disease centers.--The Committee notes that the 
digestive disease centers program has been highly successful in 
addressing a wide range of maladies that cost the economy an 
estimated $56,000,000,000 per year. Nevertheless, there remain 
many areas that could benefit from additional attention through 
this program. Included among them are pancreatic disease, 
genetic disease (hemochromatosis) and gene therapy, pediatric 
GI disease, hepatitis C, IBS, and IBD, H. pylori, inflammatory 
cytokines, and food safety. The Committee supports the 
expansion of the digestive disease centers program to create up 
to six additional categorical centers in these important areas 
in the next 3 to 5 years.
    Bone diseases.--The Committee is pleased with the growth of 
research on osteoporosis, Paget's disease, and related bone 
diseases and encourages the Institute to further expand and 
intensify its research programs on these bone diseases.
    Nutrition research and prevention.--Nearly one-third of 
adult Americans are overweight. Poor diet and lack of physical 
activity are associated with over 300,000 deaths per year. 
Obesity is a major risk factor for type 2 diabetes, stroke, and 
hypertension. The Committee encourages the Institute, working 
in collaboration with NCI, NHLBI, and other Institutes, to 
expand research in the basic and clinical areas and to develop 
nutrition interventions to manage obesity. The Committee 
further directs the NIDDK to foster development of 
collaborative clinical research programs in nutrition and 
obesity between clinical nutrition research units, obesity 
research centers, and general clinical research centers.
    Hemophilia.--The Committee encourages NIDDK to work with 
NIDDK, NHLBI, and NHGRI to expand research on effective 
hepatitis treatments for persons with hemophilia and to advance 
research on gene therapy technologies for hemophilia and other 
genetic disorders.
    Hepatitis C.--The Committee is aware that many of the 
significant new research recommendations of the NIH-sponsored 
Hepatitis C [HCV] Consensus Development Conference relate 
directly to the research portfolio of the NIDDK. These 
recommendations include: initiation of large-scale, long-term 
studies to better define the natural history of hepatitis, 
especially to identify factors associated with disease 
progression to cirrhosis; studies of the pathogenesis and 
mechanism of liver cell injury by HCV; the development of 
better diagnostic tests for hepatitis C; and the development of 
a hepatitis clinical trial group with laboratory support to 
identify optimal treatment regimens. The Committee urges NIDDK 
to initiate this research in a manner fully responsive to 
professional judgment recommendations and, as the NIH Institute 
with lead responsibility on liver disease, to facilitate the 
transinstitute research required to fully address the HCV 
threat.
    Liver and biliary disease.--The Committee is aware that 25 
million Americans--or 1 of every 10 individuals--are or have 
been afflicted with liver, bile duct, or gallbladder diseases. 
The Committee urges a high priority on research to prevent, 
cure, and better treat liver diseases. The Committee is pleased 
with the development of the liver and biliary disease strategic 
plan and urges the NIDDK to coordinate its liver disease 
research efforts with the other institutes identified in the 
strategic plan.
    Cooley's anemia.--The Committee has long supported research 
in the area of Cooley's anemia. Due to the numerous red blood 
cell transfusions that Cooley's anemia patients must undergo, 
iron accumulates in the major organs. The effective removal of 
this iron by chelating drugs requires an accurate assessment of 
iron levels in the patient. Accuracy is impeded, however, by 
the lack of a quality, noninvasive test to measure iron 
overload. The Committee, therefore, encourages NIDDK to move 
forward in an effort to develop an accurate noninvasive test to 
measure iron overload in patients with Cooley's anemia as well 
as other conditions. Treatment could be further enhanced by the 
development of an iron chelator drug that can be taken orally.
    Diabetes.--Diabetes affects 16 million Americans and is a 
leading cause of blindness, kidney disease, heart disease, and 
amputations. Given the enormous human and economic costs of 
diabetes, the Committee urges the Director to expand current 
research efforts in this area. The Committee further encourages 
increased research into the causes and treatments of juvenile 
diabetes.
    Diabetes in native American, Hawaiian, and Alaskan 
populations.--The Committee recognizes the Institute's interest 
in studying the incidence of diabetes in native American, 
Hawaiian, and Alaskan populations, and encourages the NIH to 
include native Hawaiian and Alaskan populations, the 
Mississippi Band of the Choctaw Indians, and the Eastern Band 
of the Cherokee Indians in diabetes studies.
    Biomaterials.--Promising research is now underway in the 
development of biomaterials that offer more effective 
alternatives for tissue repair and replacement. The Committee 
encourages NIDDK to expand support for this effort.

        NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE

Appropriations, 1998....................................    $779,257,000
Budget estimate, 1999...................................     841,828,000
Committee recommendation................................     903,278,000

    The Committee recommends an appropriation of $903,278,000 
for the National Institute of Neurological Disorders and Stroke 
[NINDS]. This is $61,450,000 more than the budget request and 
$124,021,000 more than the fiscal year 1998 appropriation. The 
comparable numbers for the budget estimate include funds to be 
transferred from the Office of AIDS Research.
    Mission.--The NINDS conducts and supports a broad range of 
research and research training on the normal function of the 
brain, spinal cord, and peripheral nerves, and on neurological 
and neuromuscular disorders. Neurological research includes 
epidemiology studies to identify risk factors for disease; 
laboratory studies to examine the structure and function of 
nerve cells; and brain imaging studies to understand how the 
brain is affected by disease and how it operates to carry out 
tasks such as learning and memory. New approaches for the 
diagnosis, treatment, and prevention of brain disorders are 
evaluated in studies with patients and those at risk for brain 
disorders.
    Alzheimer's disease.--The Committee is pleased to note that 
NINDS has been one of the leaders in the support of research on 
Alzheimer's disease and related disorders. Through research 
supported by NINDS and others, scientists have learned that 
Alzheimer's disease begins to attack brain cells several years 
before outward symptoms appear. By that time, it is too late to 
reverse the disease process. The Committee encourages NINDS, in 
collaboration with the National Institute on Aging, the 
National Institute of Mental Health, and other Institutes, to 
launch a prevention initiative aimed at identifying those 
therapies that hold the greatest potential for delaying or 
preventing the onset of Alzheimer's disease.
    Parkinson's disease.--The Committee is encouraged by 
continuing discoveries in the genetics, pathophysiology, and 
treatment of Parkinson's disease, and continues to seek 
intensified efforts by NINDS to speed the development of 
effective therapies for this devastating disorder. The 
Committee also recognizes the benefits of research 
breakthroughs in this area on other disorders within the 
Institute's scope.
    The Committee acknowledges the 1997 enactment of the Udall 
Parkinson's Research Act as a timely recognition of the huge 
potential in this field. The Committee is encouraged by initial 
efforts to implement the act's authorization of expanded 
Parkinson's-focused research. The Committee has provided 
sufficient funds to increase such initiatives, in coordination 
with NIA and other relevant Institutes, in order to carry out 
the full intent of the act and fully fund its authorization for 
research focused on Parkinson's disease.
    Autism.--The Committee urges the NINDS to explore the link 
between seizure activity and autism. Additionally, the 
Committee recommends the Institute, along with the NIMH, 
explore more effective neural imaging strategies for young 
children.
    Multiple sclerosis [MS].--The Committee continues its 
strong interest in an aggressive research program on MS. The 
Committee is aware of recent progress in treating MS patients 
with recurrent/remissive forms of the disease and urges the 
Institute to continue and expand its support for basic and 
applied research on MS.
    Spinal cord injury [SC].--The Committee encourages the 
Institute to provide additional funds to continue and expand 
research regarding SC. Over 250,000 Americans are living with 
the consequences of SC and more than 10,000 new cases will 
occur each year. The Committee is aware of the extensive work 
that the Department of Veterans Affairs has developed in the 
research and treatment of SC. The Committee encourages the NIH 
and the Veterans Administration to work together on a 
collaborative research effort to marry the strengths of these 
two agencies to lead to a more effective coordinated Federal 
research effort.
    Epilepsy.--The Committee seeks intensified and expanded 
efforts by the Institute to create breakthroughs in the 
prevention, treatment, and eventual cure of epilepsy. The 
Committee urges the Institute to maintain the crucial 
antiepileptic drug development program which has led to the 
discovery of many important antiepileptic medications. The 
Committee further encourages the Institute to consider 
additional resources directed specifically to intractable or 
uncontrolled epilepsy, which affects approximately 750,000 of 
the nearly 3 million individuals with epilepsy. This 
devastating disorder, which most often begins in childhood, is 
strongly associated with cognitive dysfunction, apparently 
because of the impact of uncontrolled seizures on the 
developing brain in its pediatric victims. The Committee is 
also interested in the progress being made in understanding the 
critical issues affecting women with epilepsy, in particular 
the relationship between women's seizures and the hormonal 
cycles. During the fiscal year 2000 appropriations hearings, 
NINDS should be prepared to present specific plans for 
advancing research in these important areas.
    Neurofibromatosis [NF].--Recent advances in NF research 
have linked NF to cancer, brain tumors, and learning 
disabilities. Researchers have demonstrated that the protein 
made by the NF gene is part of a pathway which is known to 
control learning and memory, while at the same time being 
implicated with NF's cancer fighting tumor suppressor 
functions. This discovery has created new opportunities for 
drug and genetic therapies for NF patients. The Committee 
encourages NINDS to continue to increase its NF basic and 
clinical research portfolio though the use of: requests for 
applications; program announcements; the national cooperative 
drug discovery group program; and small business innovation 
research grants. The Committee also urges the Institute to 
continue to coordinate its efforts with NCI and be prepared to 
report on the status of the NF research program, including 
progress in implementing these recommendations, at its hearings 
on the fiscal 2000 budget.
    Amyotrophic lateral sclerosis [ALS].--ALS, more commonly 
known as Lou Gehrig's disease, is a progressive, fatal 
neurological disorder for which no cure exists. The Committee 
understands that recent developments in the use of animal 
models that are genetically identical to humans, for the first 
time, enabled researchers to study the biological basis of ALS. 
These animal models may help researchers learn what causes 
motor neurons to die; what the diagnostic markers are for this 
disease; and lead to the development of early diagnostic tests. 
The Committees encourages the Institute to expand and intensify 
research into the causes and cures of ALS.
    Alternative research resources.--The Committee is very 
interested in matching the increased need of researchers who 
rely upon human tissues and organs, a very valuable and 
effective alternative research resource, to study human 
diseases and to search for cures. The Committee is aware that 
the National Disease Research Interchange [NDRI], dedicated to 
providing the research community with this valuable and 
effective alternative research resource, has supplied thousands 
of human tissues and organs, and thereby contributed to a 
number of recent significant research advances. The Committee, 
being greatly encouraged by NDRI's role in these research 
advances, expects the Director to participate in a multi-
institute initiative to expand support for NDRI.
    Neurodegenerative disorders.--The Committee strongly 
supports the increased emphasis placed on the study of 
neurodegenerative disorders within NINDS and across NIH. The 
Committee encourages the NIH to continue to support research 
which investigates the role of neurotransmitters in 
neurodegenerative disorders.
    Dystonia.--The Committee supports efforts to encourage 
extramural initiatives in dystonia-specific research, and 
encourages NINDS to work closely with other organizations 
having an interest in dystonia research. This includes 
collaboration on joint research programs encouraging 
investigators to study dystonia, particularly in light of the 
recent discovery of the gene for early onset dystonia, which 
has prompted many new dystonia-related research options. The 
Committee also supports the establishment of an epidemiological 
study on dystonia.
    Batten's disease.--The Committee continues to be concerned 
with the slow pace of research on Batten's disease. The 
Committee encourages the Institute to actively solicit grant 
applications for Batten's disease, and take the steps necessary 
to mount a vigorous research program. The Committee understands 
that there have been four significant breakthroughs with regard 
to gene localization in Batten's disease, including the 
identification of the single protein that is absent in late 
infantile Batten's disease.
    Restless leg syndrome.--The Committee encourages the NINDS 
to follow up on recent scientific publications highlighting the 
public health significance of restless legs syndrome [RLS] and 
periodic limb movement disorder [PLMD]. The Committee also 
encourages the Institute to conduct studies to investigate the 
relation of RLS and PLMD to pregnancy, diabetes, renal disease, 
fibromyalgia, spinal cord injuries, neuropathies and attention 
deficit hyperactivity disorder.
    Systemic lupus erythematosus (lupus).--The Committee 
encourages the Institute to expand research into the area of 
central nervous system [CNS] involvement in lupus. CNS 
involvement in lupus patients is one of the least understood 
clinical manifestation of this disease. CNS lupus is diffuse 
and reversible yet it constitutes one of the major causes of 
death among lupus patients. Research in this area could improve 
significantly with the development of new techniques to assess 
organ involvement and new animal models to explore the 
pathogenesis of the disease. The committee also urges 
collaboration between NIAMS and the NINDS.
    Stroke.--Stroke remains America's third leading killer, the 
leading cause of permanent disability and a major contributor 
to late-life dementia. Stroke survivors often face years of 
debilitating physical and mental impairment, emotional distress 
and overwhelming medical costs. Now, opportunities to improve 
prevention and to treat stroke in progress have never been 
greater. The Committee encourages the NINDS to expand its 
stroke education program and initiate and continue innovative 
approaches to improve stroke diagnosis, treatment, 
rehabilitation and prevention.
    Ataxia-telangiectasia.--The Committee encourages the NINDS 
to continue and expand clinical research efforts aimed at 
understanding and treating the pediatric neurodegenerative 
disorder known as ataxia-telangiectasia.
    Spinal muscular atrophy [SMA].--SMA is a neuromuscular 
disease affecting voluntary movement and is the No. 1 genetic 
killer of children under the age of 2. The Committee urges the 
Institute to intensify its efforts to develop methods of 
treatment and cure for this devastating disease. The Committee 
further urges that NINDS utilize all available mechanisms as 
appropriate, including requests for applications and the 
exploration of areas of promising research identified in the 
1998 International Workshop Sponsored by Families of SMA.
    Fascioscapulahumeral-dystrophy [FSHD].--The Committee 
encourages the Institute to continue and expand research 
efforts focused on aiding in the diagnosis and treatment of 
FSHD.
    Tourette syndrome.--Tourette syndrome is a disorder that 
begins in childhood, often with simple tics, and progresses to 
multiple, complex movements including respiratory and vocal 
tics. The Committee urges the NINDS to expand its research 
efforts into this disorder and initiate innovative approaches 
to improve diagnosis and treatment.

         NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES

Appropriations, 1998....................................  $1,349,135,000
Budget estimate, 1999...................................   1,466,144,000
Committee recommendation................................   1,540,102,000

    The Committee recommends an appropriation of $1,540,102,000 
for the National Institute of Allergy and Infectious Diseases 
[NIAID]. This is $73,958,000 more than the budget request and 
$190,967,000 more than the fiscal year 1998 appropriation. The 
comparable numbers for the budget estimate include funds to be 
transferred from the Office of AIDS Research.
    Mission.--The NIAID supports and conducts basic and 
clinical research and research training programs in infectious 
diseases, including AIDS, and diseases caused by, or associated 
with, disorders of the immune system. The NIAID is the lead NIH 
Institute charged with developing new and improved vaccines and 
supporting research on acquired immunodeficiency syndrome, 
tuberculosis, sexually transmitted diseases, and tropical 
diseases. The NIAID's research goal is to improve the health 
and quality of life of people by improving diagnosis, 
treatment, and prevention of diseases.
    Tuberculosis.--The Committee encourages the NIAID to 
continue its support for tuberculosis [TB] research. This 
support is critical in developing improved diagnostic tests and 
treatments in response to the reemergence of TB in the United 
States. The Committee understands that NIAID-supported 
researchers have begun to understand multidrug resistant TB 
[MDR TB] and hope to develop methods to quickly determine which 
drug therapy is appropriate for MDR TB strains so patients can 
begin an appropriate treatment therapy immediately, thus 
reducing the risk of transmitting the disease to others. The 
Committee recognizes NIAID's cooperation with the Fogarty 
International Center [FIC] and the U.S. Agency for 
International Development [USAID] in coordinating U.S. domestic 
and international TB control efforts and encourages continued 
cooperation.
    Asthma.--The Committee notes that the number of asthma 
patients and asthma-related deaths have increased dramatically 
in the past decade. In particular, the morbidity and mortality 
rates among minority and inner-city populations continue to be 
disproportionately high. The prevalence of asthma is higher in 
African-American children than in white children. The Committee 
urges NIAID to strengthen research in this area.
    The Committee recognizes the leadership role the Institute 
has played in the inner-city asthma study where results have 
shown that home-based interventions coupled with a counselor-
based intervention program have led to a reduction in asthma 
symptoms for children with severe asthma. The Committee 
commends the Institute for research into these community-based 
intervention strategies for treating and managing asthma.
    Alternative research resources.--The Committee is very 
interested in matching the increased need, of the hundreds of 
researchers who rely upon human tissues and organs to study 
human diseases and to search for cures. The Committee is aware 
that the National Disease Research Interchange [NDRI], 
dedicated to providing the research community with this 
valuable and effective alternative research resource for nearly 
20 years, has supplied thousands of human tissues and organs 
necessary to produce a number of recent significant research 
advances. The Committee, being greatly encouraged by NDRI's 
role in these research advances, expects the Director to 
participate in a multi-institute initiative to expand support 
for NDRI.
    Hemophilia.--Last year the Committee encouraged NIAID, 
working with national hemophilia organizations, to determine 
further research steps to address the complications of 
hemophilia, including treatment for vimi hepatitis. The 
Committee urges NIAID to develop a research action plan, 
working with the hemophilia scientific and medical community 
that fully addresses the complications of hemophilia and other 
bleeding disorders. The Committee further urges that in 
developing the plan, NIAID should work collaboratively with 
NIDDK on how to improve hepatitis treatment options for persons 
with hemophilia. The Committee requests a report by March 31, 
1999, on the status of these efforts.
    Hepatitis C.--The Committee is aware that several of the 
significant new research recommendations of the NIH-sponsored 
Hepatitis C [HCV] Consensus Development Conference impact 
directly on the research portfolio of the NIAID. These 
recommendations include: initiation of large-scale, long-term 
studies to better define the natural history of hepatitis, 
studies on the recovery from and persistence of viral 
infections as well as the pathogenesis and mechanism of liver 
cell injury by HCV; development of tissue cultures and small 
animal models; the development of better diagnostic tests for 
HCV; the development of a hepatitis clinical trial group with 
laboratory support to identify optimal treatment regimens; and 
the development of a vaccine for HCV. The Committee urges 
initiation of this research.
    The Committee understands that additional treatment options 
for hepatitis C have been approved by the FDA since the NIH 
Consensus Development Conference held in March 1997. The 
Committee urges NIAID, in collaboration with NIDDK, to 
undertake the necessary efforts to expand upon the consensus 
conference's treatment recommendations to include these new 
FDA-approved options.
    Organ transplantation.--The Committee is aware that NIAID 
is the leading NIH institute for organ transplantation research 
and is pleased that NIAID has funded behavioral research to 
focus on the issue of organ donation. The Committee urges 
additional research in this area as well as in basic and 
clinical transplantation immunology. The Committee hopes that 
this research will further our understanding of the immunologic 
mechanisms of transplantation tolerance, acute and chronic 
transplant rejection, and the mechanism of immunosuppression in 
experimental and clinical transplantation. The Committee 
encourages the NIAID to continue to sponsor workshops for the 
development of research questions in these areas. In addition, 
the Committee commends the NIAID for their continued leadership 
in facilitating cooperative clinical trials in pediatric renal 
transplantation, and for their efforts to promote industry and 
academic cooperation in basic research and clinical trials.
    Malaria.--Malaria continues to be one of the most 
devastating infectious diseases. The Committee applauds NIH and 
NIAID for their leadership at home and abroad in advancing the 
international collaborative research project, and for 
implementing NIAID's research plan for malaria vaccine 
development. The Committee urges NIAID to continue to expand an 
aggressive malaria research program.
    The Committee strongly encourages NIAID to establish at 
least one tropical disease research unit that would focus on 
multidisciplinary approaches to the study of this disease 
including medical entomology, molecular biology, biology of 
parasites and immunology, and the development of a vaccine or 
new drugs that can neutralize malarial infection. The Committee 
further encourages the Institute to include collaboration with 
scientists in countries with endemic malaria.
    Tropical disease research.--The Committee encourages NIAID 
to continue and expand research programs on global health 
including international collaborations in infectious disease 
research, tropical disease research units, and tropical 
medicine research centers. NIAID's support for international 
tropical disease research is critical for the advancement of 
the scientific understanding of emerging, reemerging, and other 
tropical diseases.
    Allergic diseases.--Allergic diseases describes a myriad of 
medical conditions such as asthma, allergic rhinitis, atopic 
dermatitis, food allergies, and anaphylaxis. The Committee 
understands that one of the most effective research mechanisms 
to address asthma is the asthma, allergic, and immunologic 
diseases cooperative research centers, which provide an 
infrastructure and collaborative environment to study the 
complex problems associated with these diseases. The Committee 
encourages the Institute to continue basic and clinical 
research initiatives through these centers to improve the 
diagnosis, prevention, and treatment of these diseases.
    Pediatric immune deficiency disease.--These 70 diseases, of 
which there are 500,000 diagnosed cases and another 500,000 
that have not been diagnosed, strike most severely at children. 
The Committee urges NIAID to maintain and expand its research 
focus on these disorders. In particular, the Committee believes 
that the Centers of Excellence in Immunology that the Institute 
will create in fiscal year 1999 represents an ideal vehicle for 
high-quality, peer-reviewed research into these genetic 
diseases and is pleased that the Institute's plans include a 
concentration on this category of diseases. The Committee also 
believes that collaboration with existing immunodeficiency 
research centers provides the most rapid means of addressing 
these needs. In addition, the Committee strongly encourages the 
Institute to expand and enhance its role in educating 
physicians, raising public awareness, and rapidly translating 
basic research findings into clinical practice.
    The Committee encourages NIAID to maintain its research 
focus on these devastating disorders and is pleased that NIAID 
recently expanded its clinical research registry for primary 
immune deficiencies.
    Sarcoidosis.--The Committee recognizes NIAID's past support 
of the sarcoidosis national network, a national network of 
sarcoidosis patients, their family members, and the public 
health community. The Committee encourages NIAID's continued 
support of this effort, and urges NIAID to continue its 
examination of the infectious disease component of sarcoidosis.
    Postpolio syndrome.--The Committee encourages the Institute 
to continue and expand research into postpolio syndrome, 
including providing rehabilitation alternatives for postpolio 
patients.
    Women and HIV/AIDS.--The Committee contends that HIV-
related prevention, treatment and care needs of women, 
particularly minority women in underserved areas, should be a 
top priority in defining the HIV research agenda. The Committee 
encourages NIAID to continue to work in collaboration with 
NICHD, using nurse practitioners to educate women in the 
utilization of female controlled barrier methods of HIV 
prevention and treatment and use of psychologists to educate 
women about the mental health aspects of HIV/AIDS prevention 
and awareness.
    Chronic fatigue.--The Committee understands that chronic 
fatigue syndrome [CFS] represents an extremely disabling 
illness that is undiagnosed in millions of Americans. The 
Committee urges the Institute to examine this illness, 
addressing a comprehensive variety of care needs which include 
educating providers in assessment, diagnosis and treatment, 
case management, rehabilitative efforts and the establishment 
of chronic fatigue assessment and treatment centers.
    Inflammatory bowel disease.--The Committee notes with 
interest a recent scientific research agenda entitled: 
``challenges in inflammatory bowel disease [IBD] that 
identifies strong linkages between the immune system and IBD. 
The Committee encourages the Institute to aggressively support 
research in this important area.
    Microbicides.--Given the disproportionate impact of STD's 
and the increase of HIV infection among women, the Committee 
encourages the Institute to support enhanced research into the 
basic, behavioral, and biomedical aspects of microbicides.
    Foodborne disease.--The Committee is concerned about the 
significant impact, in both human and economic terms, of 
foodborne disease. A 1996 report by the U.S. Department of 
Agriculture identified staphylococcal food poisoning as the No. 
1 cause of economic loss due to foodborne illness in the United 
States, with more than 12 million Americans effected each year, 
with approximately 100,000 fatalities.
    The bacterium E. coli 0157 causes an estimated 10,000 to 
20,000 cases of human illness a year, with about 250 deaths. 
Economic losses are estimated at more than $200,000,000 a year, 
which typically include the necessary destruction of millions 
of pounds of otherwise nutritious food. However, E. coli is 
considered an emerging pathogen and, absent an aggressive 
response, losses are expected to increase in future years.
    Also of serious concern is the emergence of multiple-drug-
resistant staphylococci and other diseases, such as toxic shock 
syndrome.
    The Committee notes that the University of Idaho is a 
leader in such critical food safety research, including efforts 
on staphylococcal food poisoning, strains of E. coli, 
salmonella species, and listeria monocytogenes. Research on 
vaccine-like treatments is a promising area of future research, 
and may also have applications in enhancing immune responses 
and treating cancer. The Committee encourages the Institute to 
continue and expand its research efforts in the area of 
foodborne disease.

             NATIONAL INSTITUTE OF GENERAL MEDICAL SCIENCES

Appropriations, 1998....................................  $1,063,959,000
Budget estimate, 1999...................................   1,142,086,000
Committee recommendation................................   1,197,825,000

    The Committee recommendation includes $1,197,825,000 for 
the National Institute of General Medical Sciences [NIGMS]. 
This is $55,739,000 more than the budget request and 
$133,866,000 more than the fiscal year 1998 appropriation. The 
comparable numbers for the budget estimate include funds to be 
transferred from the Office of AIDS Research.
    Mission.--NIGMS supports research and research training in 
the basic biomedical sciences. Institute grantees, working in 
such fields as cell biology, biophysics, genetics, 
developmental biology, pharmacology, physiology, and biological 
chemistry, study normal biological processes to better 
understand what goes wrong when disease occurs. In this way, 
NIGMS supplies the new knowledge, theories, and technologies 
that can then be applied to the disease-targeted studies 
supported by other NIH components. NIGMS-supported basic 
research advances also regularly find applications in the 
biotechnology and pharmaceutical industries. The Institute's 
training programs help provide the scientists needed by 
industry and academia to maintain U.S. leadership in biomedical 
science.
    Trauma.--The Committee recognizes that injury is the 
leading cause of death for Americans age 1 through 44, the 
leading cause of lost work productivity and, at a cost of 
$200,000,000,000 each year, is also one of the Nation's most 
costly public health problems. The Committee also recognizes, 
as reported in 1994 by the National Institutes of Health Trauma 
Research Task Force, that less than 1 percent of NIH funding is 
allocated to trauma-related research.
    The Committee urges the Director of the NIH to develop a 
coordination process focused on trauma and burn care research 
with the appropriate Institute Directors, including the NIGMS, 
NINDS, NIAMS, NICHD, NIA, and the National Center for 
Rehabilitation Research. The Institute Directors should be 
charged by the NIH Director with a goal of realizing the 
opportunities presented by basic science research by applying 
that knowledge to clinical research in trauma and burn care in 
order to significantly ameliorate the enormous impact of injury 
on both the patient and society.
    Training.--The Committee encourages NIGMS to support 
behavioral research training as part of its mandate to support 
basic research training in all areas of health related 
research.

        NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT

Appropriations, 1998....................................    $673,509,000
Budget estimate, 1999...................................     725,006,000
Committee recommendation................................     748,482,000

    The Committee recommends an appropriation of $748,482,000 
for the National Institute of Child Health and Human 
Development [NICHD]. This is $23,476,000 more than the budget 
request and $74,973,000 more than the fiscal year 1998 
appropriation. The comparable numbers for the budget estimate 
include funds to be transferred from the Office of AIDS 
Research.
    Mission.--NICHD is that component of the National 
Institutes of Health which is responsible for conducting and 
supporting research on maternal and child health, the 
population sciences, and medical rehabilitation. Research 
encompassed by these areas targets infant mortality; genetic 
diseases, including birth defects; mental retardation; 
contraceptive development and evaluation; pediatric, maternal, 
and adolescent AIDS; developmental biology; vaccine 
development; demographic and behavioral research; and 
restoration or enhancement of function in individuals 
experiencing physical disability due to injury, disease, or 
birth defect.
    Demographic research.--The Committee commends NICHD for its 
continued support of demographic research, which provides 
objective, policy-relevant scientific information about 
population trends. The Committee supports NICHD's initiative to 
conduct important demographic studies such as those of poor 
families and neighborhoods, adolescent health, welfare-to-work 
transitions, and child care. The Institute's leadership in 
research and developing new data on fatherhood will help to 
fill a serious gap in understanding of family formation, family 
strengths, and the development and well-being of children. The 
Committee applauds NICHD's successful coordination with other 
Federal units in developing and supporting these studies, and 
encourages NICHD to assure that sufficient funds are provided 
for training the next generation of demographic scientists to 
carry on this important research.
    Sudden infant death syndrome [SIDS].--The Committee 
commends NICHD for its aggressive efforts to reduce SIDS death 
through the national collaborative back to sleep campaign. This 
campaign has facilitated a 30-percent reduction in SIDS rates, 
the highest reduction in infant mortality rates in 20 years. To 
continue this progress, the Committee encourages the Institute 
to continue supporting the SIDS 5-year research plan. The 
Committee also recommends that NICHD review the progress of the 
last two 5-year plans to determine if a third plan is needed. 
The Committee encourages the Institute to continue to provide 
outreach to underserved populations, minorities, and to day-
care providers.
    Fetal alcohol syndrome.--The Committee encourages the 
Institute to continue to develop effective interventions for 
the treatment of children with fetal alcohol syndrome. The 
Committee also encourages support of demographic research for 
understanding alcohol consumption and related high-risk 
behaviors in women of childbearing age.
    Juvenile arthritis.--The Committee encourages NICHD to work 
in collaboration with NIAMS on arthritis-related research. 
NIAMS would prove to be an important partner, particularly for 
collaboration on such issues as clinical trials in juvenile 
arthritis, bone metabolism in children, and long-term effects 
of immunosuppression in children.
    Diet and nutrition.--The Committee is concerned about the 
large number of girls who are engaged in restrictive dieting 
and the consequences of dieting on their health and 
development. The Committee urges NICHD to further investigate 
behavioral, social, and cultural factors that affect adolescent 
girls' eating habits, with the goal of learning how to prevent 
and treat eating disorders.
    Alternative research resources.--The Committee is very 
interested in matching the increased needs of researchers who 
rely upon human tissues and organs, a very valuable and 
effective alternative research resource, to study human 
diseases and to search for cures. The Committee is aware that 
the National Disease Research Interchange [NDRI], dedicated to 
providing the research community with this valuable and 
effective alternative research resource, has supplied thousands 
of human tissues and organs, and thereby contributed to a 
number of recent significant research advances. The Committee, 
being greatly encouraged by NDRI's role in these research 
advances, expects the Director to participate in a multi-
institute initiative to expand support for NDRI.
    Osteogenesis imperfecta.--NICHD is to be commended for its 
research on the mapping of gene markers associated with several 
diseases, including osteogenesis imperfecta [OI]. OI is a 
genetic disorder characterized by bones that break easily from 
little or no apparent cause. The Committee encourages the 
Institute to further expand and intensify its research efforts 
on OI.
    Learning disabilities.--The Committee is pleased that NICHD 
has placed a high priority on learning disabilities research. 
The Committee has been impressed with the recent 
accomplishments reported from the research program on reading 
development and disability, and looks forward to learning the 
results of the new research program on mathematics. In 
addition, the Committee encourages NICHD to take the lead in 
coordinating this research effort with NINDS, NIMH, and NIDCD. 
The Committee also urges research on the outcome and 
effectiveness of primary and preventive health care for mothers 
to prevent learning disabilities in infants and children. The 
Committee is also pleased with the significant Medicaid fee for 
service, and early school health data available at the 
perinatal data center that will facilitate this research.
    Primary immune deficiency diseases.--The Committee is 
pleased with the establishment of peer-reviewed, collaborative 
research projects between the Institute and the Jeffrey Modell 
Foundation and urges the Institute to continue these efforts. 
In addition, the Committee notes that the NICHD has played the 
leading governmental role in supporting efforts to educate 
physicians and initiate national awareness campaigns concerning 
the early diagnosis and effective treatment of these diseases. 
The Committee urges NICHD to build on its past success in 
translating basic research to clinical research and then to 
clinical application through education and awareness programs, 
in conjunction with nonprofit foundations.
    Pelvic floor dysfunction and incontinence in women.--The 
Committee understands that the NICHD is moving forward with 
plans to hold a workshop in the area of pelvic floor 
dysfunction (including prolapse) and incontinence in women to 
determine future directions for research. The Committee is 
pleased with these efforts and encourages continued 
collaboration among NICHD, NIDDK, the NIA, and the Office of 
Research on Women's Health.
    Fragile X.--The Committee commends the NICHD for its 
continuing support for Fragile X research, and includes funds 
necessary for the Institute to further expand and strengthen 
its research activities on this disorder. Fragile X is the most 
common inherited cause of mental retardation. It is unique 
among developmental disorders because NICHD-funded research has 
identified the cause: the failure of a single gene to produce a 
specific protein. Although the protein can be produced 
synthetically, no cure or effective specific treatment has been 
found. The Committee urges the Institute to increase its 
efforts to find a cure for Fragile X, and to expand our 
understanding of the role of the Fragile X protein in brain 
function. The Committee is pleased that the NICHD is 
cosponsoring with the FRAXA Foundation an international Fragile 
X conference in December 1998. The Committee looks forward to 
receiving a report on the recommendations and goals set at the 
conference. An important portion of the conference will address 
increased research efforts to develop effective treatments for 
individuals with Fragile X, including testing of existing 
medications and development of new psychopharmacologic 
medications that are safe and effective. The Committee is 
pleased that NICHD has added Fragile X patients to its expanded 
program of autism research, and urges the Institute to include 
Fragile X patients in the pediatric psychopharmacology clinical 
trials being conducted by autism investigators as another 
effort to develop safe and effective medications for 
individuals with Fragile X.
    Autism.--Autism is a developmental disability that usually 
appears during the first 3 years of life. At present, there is 
no prevention, treatment, or cure for this disorder. The 
Committee commends the NIH for the research efforts focused on 
the neurobiology and genetics of autism and encourages 
continued research.
    The Committee commends the work of the Inter-Agency Autism 
Coordinating Committee and encourages the coordinating 
committee to meet regularly, to make those meetings open to the 
public, and to report to Congress on the goals set and progress 
made prior to the fiscal year 2000 hearings. The Committee is 
encouraged by the current program announcement for research on 
autism spectrum disorder and urges the Institute to intensify 
its investment in autism-focused research. The Committee 
further encourages that centers of excellence be selected to 
speed the pace of progress in autism research and an awareness 
program be started to regard the advances in the diagnosis and 
treatment of autism to educate doctors and other health 
professionals so that children can be diagnosed as early as 
possible.
    Chromosome 18.--The Committee recommends that the Institute 
expand and intensify research into the treatment of mental 
retardation caused by chromosome abnormalities, especially the 
syndromes of chromosome 18.
    Vulvodynia.--Hundreds of thousands of women suffer from 
vulvodynia, a painful and often debilitating disorder of the 
female reproductive system. Despite its prevalence, very little 
attention has been paid to the disorder by health professionals 
or researchers. In April 1997, NIH convened an international 
symposium to exchange information and develop a research agenda 
to address this problem. Last year, the Committee and the 
conference committee called on the NICHD to support research on 
the prevalence, causes, and treatment of vulvodynia. To date, 
no RFA has been issued. While the Committee supports the NICHD 
initiative on pelvic floor disorders, it expects NICHD to fund 
research on vulvodynia prior to the end of fiscal year 1998. 
Also, the Committee encourages that additional funds be 
provided above the budget request in fiscal year 1999 for 
research on vulvodynia and expects NICHD to issue a RFA within 
the first quarter of fiscal year 1999.
    Infertility and contraceptive research.--The Committee 
continues to place high priority on research to combat 
infertility and speed the development of improved 
contraceptives. NICHD is urged to continue aggressive 
activities in this area, including individual research grants 
and those of the infertility and contraceptive research 
centers.
    Behavioral and social sciences.--The Committee recognizes 
the NICHD's mission to study issues related not only to 
individuals but to families and distinct population groups 
within the United States. In furtherance of this mission, the 
Committee encourages NICHD to support projects that investigate 
family functioning and child rearing practices and their 
effects on child well-being and success among cultural minority 
groups. The Committee is particularly interested in the 
University of Hawaii Center on the Family's study on 
differential family and parental practices among Asian and 
Pacific Islanders. While they are among the fastest growing 
cultural groups in the United States, little research has been 
conducted in this area.
    The Committee commends NICHD for building an infrastructure 
to enhance research on child development and behavior. The 
Committee supports new initiatives to identify how behavioral 
roots of chronic diseases are established, and to help mediate 
critical behaviors that can lead to life threatening events 
such as automobile accidents, AIDS, and lung cancer. These 
include initiatives to prevent health risk behaviors and 
promote healthy behaviors in middle childhood.
    The Committee understands that NICHD has undertaken several 
steps to further strengthen its commitment to behavioral 
research and training, to include an initiative entitled: 
``Progress and Promise in Behavioral Sciences'' and a 
reorganization of the Institute's behavioral research programs 
into a new Child Development and Behavior Branch. The Committee 
commends these actions and urges NICHD to develop a plan and a 
timetable for implementing the findings of the progress and 
promise initiative.
    In many respects, a decaying urban environment can have 
enormous implications on human growth and development. The 
Committee encourages NICHD to support research on the 
biological and chemical effects on childhood as well as the 
effects of behavioral and societal influences.
    Child care.--Over the past 5 years, over $22,000,000,000 in 
public funds, most of which are Federal, have been invested in 
child care subsidies. Over 1 million children are affected each 
year as a result. The Committee strongly reiterates its request 
that the Institute determine the quality of care provided by 
federally funded child care programs. The purpose of this study 
is to determine the extent that recent research on the brain 
development of young children is being applied in federally 
supported child care programs and to make recommendations to 
improve quality in these settings.

                         NATIONAL EYE INSTITUTE

Appropriations, 1998....................................    $355,026,000
Budget estimate, 1999...................................     383,174,000
Committee recommendation................................     395,261,000

    The Committee recommends an appropriation of $395,261,000 
for the National Eye Institute [NEI]. This is $12,087,000 more 
than the budget request and $40,235,000 more than the fiscal 
year 1998 appropriation. The comparable numbers for the budget 
estimate include funds to be transferred from the Office of 
AIDS Research.
    Mission.--The NEI is the Nation's Federal resource for the 
conduct and support of 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.
    Clinical research.--The Committee was pleased to hear about 
the increase in mentored clinical research development awards 
at the NEI. The Committee encourages the Institute to continue 
to support investigators in their efforts toward translating 
the results of research into future cures and treatments for 
the millions affected by eye disease and blindness.
    Health services research.--The Committee is pleased that 
the Institute is conducting health services and epidemiologic 
research aimed at improving the delivery of vision services by 
eye care professionals. The NEI is urged to continue to expand 
upon these health services and epidemiologic research projects 
to study the effect of ocular disease on quality of life, 
utilization of eye care services, and to determine the cost-
benefit and utility of eye care services.
    Underserved populations.--The Committee is also pleased 
that the Institute is supporting studies on the eye care 
problems of minority populations in the United States. These 
specific projects will help provide the basis for directing 
manpower and resources appropriately toward the major eye 
health needs in traditionally underserved populations.
    Myopia.--The Committee encourages the Institute to continue 
the clinical research projects it is conducting on possible 
treatments for myopia, which is estimated to affect 25 percent 
of the adult population in the United States. These studies 
have great potential in filling in gaps in scientific knowledge 
about the eye health needs of all Americans.
    Glaucoma.--The NEI reported upon the commercial impact its 
research has had in the area of glaucoma drug development. NEI-
supported laboratory research led to the discovery of two new 
drugs and an almost fourfold increase in vision-related 
patents. The NEI is urged to continue to foster this productive 
relationship with the visioncare industry in order to hasten 
the availability of cost-effective new products to improve the 
vision care of the American people.
    Alternative research resources.--The Committee is very 
interested in matching the increased need, of researchers who 
rely upon human tissues and organs, a very valuable and 
effective alternative research resource, to study human 
diseases and to search for their cures. The Committee is aware 
that the National Disease Research Interchange [NDRI], 
dedicated to providing the research community with this 
valuable and effective alternative research resource has 
supplied thousands of human tissues and organs, and thereby 
contributed to a number of recent significant research 
advances. The Committee, being greatly encouraged by NDRI's 
role in these research advances, expects the Director to 
participate in a multi-institute initiative to expand support 
for NDRI.

          NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES

Appropriations, 1998....................................    $329,492,000
Budget estimate, 1999...................................     353,792,000
Committee recommendation................................     375,743,000

    The Committee recommends an appropriation of $375,743,000 
for the National Institute of Environmental Health Sciences 
[NIEHS]. This is $21,951,000 more than the budget request and 
$46,251,000 more than the fiscal year 1998 appropriation. The 
comparable numbers for the budget estimate include funds to be 
transferred from the Office of AIDS Research.
    Mission.--The mission of the NIEHS is to define how 
environmental exposures affect our health; how individuals 
differ in their susceptibility to these effects; and how these 
susceptibilities change with time. This knowledge, coupled with 
prevention and communication programs, can lead to a reduction 
in environmentally associated diseases and dysfunctions.
    Endocrine disruptors.--Endocrine disruptors are compounds 
in our environment which may have an impact on thyroid and 
reproductive function and development. The Committee encourages 
additional research in this area to determine the nature and 
extent to which endocrine disruptors affect humans and urges 
NIEHS to continue to support research in this area, especially 
as it relates to certain anabolic steroids.
    Lymphoma.--The Committee recognizes that lymphoma is one of 
the fastest growing cancers, striking upward of 85,000 
Americans each year with a 50-percent mortality rate. The 
Committee further understands that environmental factors may 
contribute to the growing incidence of lymphoma. Accordingly, 
the Committee encourages the NIEHS to expand its current 
research into potentially environmental factors responsible for 
lymphoma and to continue and expand its collaboration with the 
National Cancer Institute in exploring this issue.
    Marine and freshwater biomedical science centers.--The 
Committee commends the research NIEHS is supporting relating to 
the diagnosis, treatment, and prevention of human diseases and 
disorders caused by environmental chemicals and other factors. 
The Committee encourages NIEHS to support research in the field 
of ecotoxicology as it relates to human health.
    Cockroach allergens.--The Committee recognizes the 
collaborative effort between NIEHS and the NIAID that led to 
the identification of cockroach allergens as a major cause of 
asthma in inner-city children. The Committee urges NIEHS and 
NIAID to continue this cooperation by supporting the 
prevention/intervention phase of the project designed to reduce 
exposure to these allergens. The study will determine how 
reducing exposures to cockroaches, dust mites, and animal 
dander will decrease morbidity associated with this chronic 
inflammatory disease. There has been an increased recognition 
in the scientific and public health communities that minority 
and disadvantaged populations are disproportionately exposed to 
a variety of health hazards including air pollution. The 
Committee encourages NIEHS to continue research on the causes 
of asthma and other pulmonary disorders related to 
environmental exposures with special attention given to 
populations with high exposures.
    Harmful algal blooms.--The Committee is pleased that NIEHS 
has played an early leadership role in addressing the emerging 
issue of Pfiesteria and other algal blooms. The Committee 
supports the NIEHS' efforts to study the impact of algal 
blooms, especially Pfiesteria, on human health, including 
neurocognitive studies, molecular genetics studies, basic 
neurotoxicology mechanisms, toxin purification and 
characterization, and regulation of toxin production. The 
Committee supports the Institute's ongoing connections with 
Middle Atlantic States health and environment agencies, as well 
as other Federal agencies, in order to provide expert technical 
assistance in the design of appropriate detection, research, 
and prevention strategies to address public health concerns 
related to harmful algal blooms. The Committee encourages NIEHS 
to continue its research efforts related to these organisms.
    Environmentally sound research facilities.--The Committee 
has learned from otolaryngologists that NIEHS is leading an 
effort to help make the medical research field more 
environmentally sound, by working with both intramural and 
extramural laboratories. The Committee strongly supports this 
activity as it recognizes that virtually every environmental or 
pollution problem is, or will become, a medical or public 
health problem.
    Environmental health sciences centers.--The Committee 
continues to strongly support the environmental health sciences 
centers program and believes that a fully funded centers 
program is critical to carrying out the expanding mission of 
NIEHS. The Committee encourages the Institute to utilize funds 
provided above the request to fund centers at peer-reviewed 
levels.
    Parkinson's disease.--The Committee remains interested in 
the role of environmental exposures in the cause and 
pathogenesis of Parkinson's disease, given the significant and 
growing body of data linking the two. The Committee 
recommendation provides sufficient funds to increase the 
Institute's initiatives in this area, as part of the 
coordinated expansion of Parkinson's research pursuant to the 
1997 Morris K. Udall Parkinson's Disease Research Act.
    Volcanic emissions.--The Committee continues to be 
concerned about the public health aspects of volcanic emissions 
[VOG] in Hawaii and urges the Institute to collaborate with 
NINR in developing a multidisciplinary approach to this 
problem.
    Waste treatment management.--The Committee urges NIEHS to 
study the issue of waste treatment management by indigenous 
native Hawaiians, and to explore the public health implications 
with organizations such as Partners in Development which is 
implementing the living machines approach to waste management
    Mercury study and public awareness campaign.--The Committee 
is aware that, while there is a growing body of information on 
sources of mercury and its deposition, recent research efforts 
have not quantified the effects of mercury on high-risk 
populations such as pregnant women and their fetuses, women of 
child-bearing age, children, and individuals who subsist 
primarily on fish. In addition, despite the known health risks 
associated with mercury, there have been an increasing number 
of incidents involving children bringing mercury into schools, 
endangering themselves and others. The Committee encourages 
NIEHS to fund a national effort to characterize and quantify 
the potential mercury-related health effects on high-risk 
populations and to conduct a public awareness and prevention 
campaign targeted on schoolchildren and other populations most 
at risk from exposure to mercury.
    Study of deformities.--The Committee is concerned about the 
increasing number of findings of deformities in frogs 
throughout the Nation. The Committee urges NIEHS to provide 
sufficient funds to conduct detailed analytical work to help 
determine the cause of these abnormalities.
    Glutaraldehyde.--The Committee is aware that many medical 
workers, most of whom work in hospital operating rooms, are 
experiencing unexplained illness and disability, possibly as a 
result of exposure to glutaraldehyde, a chemical used for x-ray 
processing and disinfection of medical equipment. The 
Committee, therefore, encourages NIEHS to conduct research into 
the short-term and long-term effects of human exposure to 
glutaraldehyde.
    Green links.--The Committee encourages the Institute to 
give consideration to supporting the green links environmental 
research and development network. This 5-year program is 
expected to demonstrate a cost-effective transfer methodology 
to assure that the results of millions of dollars expended by 
the U.S. Government on research, new technology development, 
and innovative programming reaches our communities and our 
small- and medium-sized businesses.

                      NATIONAL INSTITUTE ON AGING

Appropriations, 1998....................................    $518,312,000
Budget estimate, 1999...................................     556,364,000
Committee recommendation................................     596,521,000

    The Committee recommendation includes $596,521,000 for the 
National Institute on Aging [NIA]. This is $40,157,000 more 
than the budget request and $78,209,000 more than the fiscal 
year 1998 appropriation. The comparable numbers for the budget 
estimate include funds to be transferred from the Office of 
AIDS Research.
    Mission.--The NIA conducts biomedical, behavioral, and 
social research related to the aging process to prevent disease 
and other problems of the aged, and to maintain the health and 
independence of older Americans. Research in aging over the 
last two decades demonstrates that aging should not be equated 
with inevitable decline and disease.
    Alzheimer's disease.--An estimated 4 million Americans have 
been stricken with Alzheimer's disease and, by the time the 
baby boom generation reaches the age of greatest risk, as many 
as 14 million persons and their families will suffer the 
consequences of this disease. The Committee recognizes that 
while research to learn how best to treat those already 
suffering with Alzheimer's disease must be accelerated, the 
only way to avoid a catastrophic rise in Alzheimer victims is 
by determining how to prevent or delay the onset of the 
disease. The Committee believes that the magnitude of this 
fast-approaching epidemic warrants a concerted and sustained 
research effort on the part of NIH. While the Committee 
encourages the Institute to continue the research on 
understanding the basic mechanisms of Alzheimer's disease, 
there is a pressing need to find a way to stop the disease in 
those who may not exhibit symptoms for another decade or more. 
The Committee encourages the Institute to initiate a full-scale 
prevention initiative that encompasses: multisite clinical 
trials in healthy people to determine which therapies can delay 
or prevent onset; identification of risk factors, biological 
markers, and reliable tests to identify those persons most at 
risk; development of laboratory models to learn how the disease 
progresses and test promising therapies; and a search for more 
cost-effective methods of care and treatment.
    Pancreatic, prostate, and colon cancer.--The Committee 
supports increased efforts in the areas of pancreatic, 
prostatic, and colon cancer. Pancreatic cancer afflicts 30,000 
new patients per year and leads to 29,800 deaths. Prostate 
cancer afflicts 185,000 Americans yearly and causes 39,000 
deaths. Colon cancer afflicts 60,000 Americans yearly and 
causes 40,000 deaths. A portion of the amount provided should 
be devoted to research programs in these areas, particularly 
programs that utilize the newly discovered CaSm gene for gene 
therapy of pancreatic cancer; the newly implicated ETS2 gene 
for prostatic cancer; and the well-described DRA gene for colon 
cancer. Antisense and gene therapy, and immunotherapy 
approaches can be supported to utilize these genes for the 
control of the indicated diseases.
    Arthritis in the elderly.--Given the high impact of some 
forms of arthritis on the elderly population, and the 
anticipated increase in the size of this population in the near 
future, increased involvement by the NIA is an appropriate 
avenue for support of arthritis research. The Committee 
encourages the Institute to consider research on the 
epidemiology of osteoarthritis, disability from arthritis in 
the elderly, and investigations related to two conditions 
predominant in elderly patients: temporal arteritis and 
polymyalgia rheumatica.
    Demographic research.--The Committee continues its strong 
support for the demographic research being carried out at the 
NIA. Of particular interest is the research being conducted on 
disability trends, and the findings from the health and 
retirement study and the implications for Medicare and Social 
Security. The Committee encourages the NIA to develop NIH-wide 
activities on population models of disease processes, and to 
develop innovative approaches to building leadership within 
diverse research communities. Special attention should be 
placed on training and career development, as well as on the 
aging centers program, so that such research can continue to 
flourish.
    Cardiovascular aging research.--Heart attack, congestive 
heart failure, stroke, and other cardiovascular diseases remain 
America's No. 1 killer of older men and women and a main cause 
of disability. The Committee encourages the Institute to make 
cardiovascular research a top priority and to expand ongoing 
studies and innovative extramural and intramural cardiovascular 
research programs.
    Claude D. Pepper Older American Independence Centers.--The 
Committee continues to strongly support these successful 
centers, which focus on developing innovative and cost-
effective ways to enhance the independence of older Americans. 
The centers also play the critical role of developing top level 
experts in geriatrics. The Committee urges NIA to expand these 
centers and to assure that the special needs of Alzheimer's 
disease victims are addressed by center activities.
    Gingko biloba.--There have been a number of preliminary 
studies indicating the potential role gingko biloba may play in 
combating dementia and Alzheimer's. Therefore, the Committee 
urges NIA to collaborate with the Office of Alternative 
Medicine in supporting clinical trials on this low-cost natural 
product, as part of the prevention initiative discussed above.
    Roybal Centers for Research on Applied Gerontology.--The 
Committee encourages NIA to continue to place a high priority 
on funding for the Roybal centers. The Roybal centers are 
designed to improve the quality of life of older adults by 
translating the results from behavioral and social research on 
aging into practical outcomes that will benefit the lives of 
older people.
    Cognitive aging.--The Committee is pleased that NIA is 
examining its portfolio in cognitive psychology and related 
behavioral aspects of aging. Understanding the effects of aging 
on such cognitive functions as memory, language, attention, and 
communication is critically important in addressing many of the 
serious health concerns of the elderly population, particularly 
in underserved and rural areas. The Committee strongly 
encourages NIA efforts in this area.
    Parkinson's disease.--The Committee recognizes that 
Parkinson's disease continues to exact a costly toll on the 
Nation, both in human and financial terms. With the average age 
of diagnosis of 57 years, the demographic surge known as the 
baby boomers will vastly increase this problem. The 
consequences will include not only incalculable human suffering 
but a further strain on Federal entitlement programs. The 
Committee is encouraged, however, by continued discoveries in 
the genetics, pathophysiology, and treatment of Parkinson's 
disease, and by growing opportunities for collaboration with 
Alzheimer's disease.
    Given the aging-related impact and the tremendous potential 
for development of more effective treatments, the Committee has 
provided sufficient funds for the Institute to develop programs 
to implement the 1997 Parkinson's Disease Research Act for 
increases in Parkinson's-focused research, in coordination with 
the Neurology Institute and other relevant Institutes.
    Alternative research resources.--The Committee is very 
interested in matching the increased needs of researchers who 
rely upon human tissues and organs, a very valuable and 
effective alternative research resource, to study human 
diseases and to search for cures. The Committee is aware that 
the National Disease Research Interchange [NDRI], dedicated to 
providing the research community with this valuable and 
effective alternative research resource, has supplied thousands 
of human tissues and organs, and thereby contributed to a 
number of recent significant research advances. The Committee, 
being greatly encouraged by NDRI's role in these research 
advances, expects the Director to participate in a multi-
institute initiative to expand support for NDRI.

 NATIONAL INSTITUTE OF ARTHRITIS AND MUSCULOSKELETAL AND SKIN DISEASES

Appropriations, 1998....................................    $274,248,000
Budget estimate, 1999...................................     294,700,000
Committee recommendation................................     304,320,000

    The Committee recommends an appropriation of $304,320,000 
for the National Institute of Arthritis and Musculoskeletal and 
Skin Diseases [NIAMS]. This is $9,620,000 more than the budget 
request and $30,072,000 more than the fiscal year 1998 
appropriation. The comparable numbers for the budget estimate 
include funds to be transferred from the Office of AIDS 
Research.
    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; orthopedic disorders, such as back pain and sports 
injuries; and numerous skin diseases. The research agenda of 
the NIAMS addresses many devastating and debilitating diseases 
that afflict millions of Americans. These diseases of the 
joints, muscles, bones, connective tissues, and skin, in the 
aggregate, will affect nearly every American at some point in 
their lives, causing tremendous human suffering and costing the 
Nation billions of dollars in both health care and lost 
productivity. The research activities of this Institute serve 
the concerns of many different special populations, including 
women, minorities, children, and the elderly.
    Skin diseases.--The skin is now viewed as a complex organ 
that is intimately responsive to the body's immune system. The 
Committee has learned of the efforts by skin disease 
researchers and patient advocate organizations to develop a 
comprehensive analysis of research opportunities and a plan for 
future activities aimed at finding cures and improving care for 
patients with skin diseases. The Committee applauds this 
initiative and encourages the NIAMS to publicize and support 
widespread use of this comprehensive analysis.
    Arthritis.--Millions of Americans suffer from some form of 
arthritis. There are more than 100 diseases that cause this 
condition. These diseases are typically chronic--causing pain 
and disability in individuals of all ages. The Committee 
encourages the Institute to increase patient-based research in 
arthritis, with a special emphasis in areas of disease 
mechanisms in humans. The Committee further encourages the 
Institute to expand clinical trials and explore the role that 
genetic factors play in arthritis.
    Bone diseases.--The Committee is pleased with the important 
strides that have been made with the establishment of an 
osteoporosis and related bone disease national resource center. 
The Committee urges the NIAMS to expand support for the 
resource center's activities to broaden its information 
services. The Committee also notes the growth of research on 
osteoporosis, Paget's disease, and osteogenesis imperfecta and 
encourages the Institute to further expand and intensify its 
research programs on these bone diseases.
    Women's sports injuries.--The Committee has been informed 
that as more women participate in recreational and organized 
sports, knee injuries, such as anterior cruciate ligament 
injuries, are having a dreadful impact on women athletes and 
have been found to affect women in greater numbers than men. 
With the steady increase in the number of sports activities 
available to women, the Committee encourages the Institute to 
pursue research into the prevention, causes, and treatment of 
athletically related musculoskeletal injuries that are unique 
to women and to coordinate efforts with the Office of Research 
on Women's Health.
    Growth plate injuries.--The Committee is pleased with the 
steps the Institute has taken to bring together basic and 
clinical investigators to address the current knowledge in the 
field of growth plate injuries in children and to identify 
promising future research directions. The Committee encourages 
the Institute to continue to expand research in this area and 
to keep the Committee informed of its progress.
    Quality of life.--The Committee is concerned that chronic 
disabling disorders will become a greater burden to the 
American people as our country ages, diminishing quality of 
life and threatening the financial solvency of the Medicare 
Program. The Committee urges the NIAMS to increase research in 
the area of skeletal deformities, musculoskeletal disorders, 
connective tissue disease, skin diseases, and other 
developmental abnormalities that begin in childhood and persist 
into adulthood.
    Scleroderma.--Scleroderma is a chronic, degenerative 
disease which causes the overproduction of collagen in the 
body's connective tissue. It affects between 300,000 to 500,000 
Americans and is often life-threatening, yet it remains 
relatively unknown and underfunded. The Committee urges NIAMS 
to work collaboratively with the Scleroderma Research 
Foundation to perform basic scientific work aimed at 
capitalizing on recent breakthroughs in understanding the 
fibrotic and vascular problems in scleroderma. The Committee 
further recommends that NIAMS establish a national patient data 
base and tissue registry in scleroderma.
    Fibromyalgia.--Fibromyalgia syndrome [FMS] is a clinically 
diagnosed disorder which is poorly understood, difficult to 
treat, and the cause of debilitating, chronic, and widespread 
pain and fatigue. The Committee encourages the NIH to take 
appropriate steps to increase the research on this disease.
    Chronic fatigue and immune dysfunction syndrome [CFIDS].--
Despite overall increases in NIH funding and the Committee's 
report language directing NIH to provide additional resources 
for CFIDS research, it appears that funding for CFIDS research 
has been underfunded. The Committee encourages the Institute to 
expand efforts in the area of extramural grants focused on 
promising areas of CFIDS research, particularly those 
investigations which will define the pathophysiology of the 
illness and identify diagnostic markers. The Committee strongly 
urges NIH to issue a special program announcement dedicated to 
the study of all facets of pediatric CFIDS.
    Facioscapulohumeral disease.--The Committee was pleased 
with the Institute's response to last year's request which 
encouraged NIH to stimulate research in the area of 
facioscapulohumeral disease [FSHD]. However, the Committee 
notes that NIAMS has not responded in developing a plan for 
enhancing FSHD research, and has not addressed the question of 
whether an intramural program in this area would be beneficial. 
Therefore, the Committee urges NIAMS to conduct a research 
planning conference in the near future in order explore 
scientific opportunities in FSHD research, both intramurally 
and extramurally.

    NATIONAL INSTITUTE ON DEAFNESS AND OTHER COMMUNICATION DISORDERS

Appropriations, 1998....................................    $200,321,000
Budget estimate, 1999...................................     215,084,000
Committee recommendation................................     229,887,000

    The Committee recommends an appropriation of $229,887,000 
for the National Institute on Deafness and Other Communication 
Disorders [NIDCD]. This is $14,803,00 more than the budget 
request and $29,566,000 more than the fiscal year 1998 
appropriation. The comparable numbers for the budget estimate 
include funds to be transferred from the Office of AIDS 
Research.
    Mission.--The NIDCD funds and conducts research and 
research training in the normal and disordered processes of 
human communication, specifically in the areas of hearing, 
balance, smell, taste, voice, speech, and language. The 
Institute addresses the special biomedical and behavioral 
problems of people who have communication impairments or 
disorders; is actively involved in health promotion and disease 
prevention; and supports efforts to create devices that 
substitute for lost and impaired sensory and communication 
functions.
    Human communication.--The Committee is pleased to learn of 
the Institute's work with sensory imaging to study human 
communication, specifically the manipulation and production of 
language. The Committee looks forward to learning what these 
imaging tools will reveal about learning disabilities which 
affect one's ability to speak.
    Regeneration of hair cells.--The most common form of 
hearing loss is the loss of hair cells within the inner ear. 
The Committee encourages the Institute to aggressively pursue 
research exploring methods to enhance hair cell regeneration in 
mammals.
    Dysphonia.--Spasmodic dysphonia is a voice disorder that 
affects women predominantly, and usually renders a person 
difficult to understand because of uncontrolled voice and pitch 
breaks. The Committee is pleased with NIDCD intramural and 
extramural study into spasmodic dysphonia and encourages 
continued efforts in this area of research.
    Alternative research resources.--The Committee is very 
interested in matching the increased need, of researchers who 
rely upon human tissues and organs, a very valuable and 
effective alternative research resource, to study human 
diseases and to search for cures. The Committee is aware that 
the National Disease Research Interchange [NDRI], dedicated to 
providing the research community with this valuable and 
effective alternative research resource has supplied thousands 
of human tissues and organs, and thereby contributed to a 
number of recent significant research advances. The Committee, 
being greatly encouraged by NDRI's role in these research 
advances, expects the Director to participate in a multi-
institute initiative to expand support for NDRI.
    Meniere's disease and otitis media.--The Committee 
encourages the Institute to continue to support randomized 
clinical trials and especially endorses the continuation of the 
ongoing clinical trials of autoimmune inner ear disease and 
Meniere's disease. The Committee further encourages that 
current research findings on otitis media be disseminated to 
health care professions.
    Economic and social realities of communications 
disorders.--The Committee is pleased to learn that the 
Institute, as requested by this Committee, held a conference on 
the economic and social realities of the communication 
differences and disabilities, in cooperation with the 
Department of Education and the Department of Labor. The 
conference focused on those disorders and differences of 
hearing, voice, speech, and language that frequently underlie 
social and economic disadvantage. Actions can be taken now to 
prevent, alleviate, or cure many communications disorders and 
disease, resulting in an improved quality of life, improved job 
opportunity and productivity, and contributing greatly to the 
social well-being and economy of the Nation.
    Research opportunities.--It is clear from testimony that 
there is an abundance of research opportunities available. The 
Committee urges the Institute to seize the opportunity to 
determine the genetic bases for disorders of human 
communication. Also, an unprecedented opportunity is available 
to protect the ear from the principal causes of acquired 
deafness: noise and drugs. Further research should be 
encouraged to preserve the auditory nerve in the sensory 
impaired ear, and research to develop the techniques of gene 
therapy to prevent and treat sensorineural hearing loss should 
be increased. The Committee also encourages the Institute to 
support research and preclinical trials into the causes of 
acquired deafness and the effects of noise and drugs on 
hearing.
    Imaging.--The Committee is pleased that NIDCD has supported 
the use of imaging in communication disorders and urges it to 
continue studies in this field.
    Screening for newborns.--As universal newborn hearing 
screening is implemented throughout the Nation, intervention 
services for varying degrees of hearing impairment, from mild 
to profound, are needed for infants. The NIDCD is encouraged to 
pursue research on these intervention strategies.

                 NATIONAL INSTITUTE OF NURSING RESEARCH

Appropriations, 1998....................................     $63,478,000
Budget estimate, 1999...................................      68,149,000
Committee recommendation................................      69,834,000

    The Committee recommends an appropriation of $69,834,000 
for the National Institute of Nursing Research [NINR]. This is 
$1,685,000 more than the budget request and $6,356,000 more 
than the fiscal year 1998 appropriation. The comparable numbers 
for the budget estimate include funds to be transferred from 
the Office of AIDS Research.
    Mission.--The National Institute of Nursing Research [NINR] 
supports clinical and basic research on biological and 
behavioral aspects of critical national health problems. The 
Institute's programs have established a scientific basis for 
research that seeks to reduce the burden of acute and chronic 
illness and disability for individuals of all ages; improve the 
quality of life by preventing and delaying the onset of disease 
or slowing its progression; and establishing better approaches 
to promoting health and preventing disease. The NINR supports 
programs essential to improving clinical environments by 
testing interventions which influence patient health outcomes 
and reduce costs and demands for care.
    Culturally sensitive approaches to health care.--The NINR 
efforts to understand and reduce the burden of health problems 
in multiple socioeconomic, race, and age groups are 
particularly responsive to society's present needs. The 
Committee recommends that NINR's efforts in ethnic, rural, and 
other special populations be expanded, to include Native 
Alaskan and native Hawaiian populations. The Committee also 
calls attention to Malama, an innovative, culturally sensitive 
community partnerships program which addresses the prenatal 
care needs of minorities in Hawaii.
    Behavioral changes and interventions.--The Committee agrees 
that research is needed to understand the complex relationship 
between behavior and the immune system. An area of importance 
in this initiative is the prevention of low birthweight infants 
in undeserved areas, such as rural areas of Alaska and Hawaii. 
The Committee strongly supports research initiatives by NINR to 
study modulation of immune functions by behavioral 
interventions.
    Telehealth.--The Committee encourages the Institute to 
explore the relationship among telehealth, nursing, and 
increased access to care for prevention and treatment, 
particularly in underserved areas of the State of Hawaii. The 
Committee is aware that there is limited data on the efficacy 
of telehealth nursing interventions and encourages the NINR to 
partner with Tripler Army Medical Center in examining 
telehealth and nursing research issues.
    End-of-life issues.--The Committee understands that NINR 
has been designated as the lead Institute in a new NIH 
initiative that addresses health issues at the end of life. The 
NINR initiative emphasizes improved treatment for pain and 
improved diagnosis and treatment of behavioral symptoms such as 
cognitive problems, delirium, and depression. With its research 
in symptom management, decisionmaking for patients, care 
giving, and optimal environments for critically ill patients, 
the Committee feels that NINR brings impressive experience to 
this research effort and commends the Institute for its 
leadership in this area.
    Nurse scientists.--The Committee notes that NIH has 
established several innovative mechanisms to provide training 
in health research careers. The Committee strongly encourages 
collaboration between NINR and other Federal nursing agencies 
in developing innovative training opportunities for enhancing 
nursing research at the doctoral and postdoctoral level.
    Nursing research centers.--The Committee notes that the 
development of a strong field of nursing research depends on 
continued support of trainees and provision of research 
resources. The Committee agrees with the emphasis placed by the 
NINR on renewing its core centers program in 1999, and 
encourages the development of an additional center focused on 
the problems of rural populations, such as those residing in 
Alaska and Hawaii.
    Nurse managed clinics.--The Committee encourages NINR to 
explore a collaborative relationship with the University of 
Hawaii School of Nursing for developing research projects that 
focus on the use of nurse practitioners and psychologists as 
primary care providers in nurse-managed community-based centers 
serving rural native Hawaiian populations.

           National Institute on Alcohol Abuse and Alcoholism

Appropriations, 1998....................................    $226,752,000
Budget estimate, 1999...................................     245,037,000
Committee recommendation................................     259,747,000

    The Committee recommends an appropriation of $259,747,000 
for the National Institute on Alcohol Abuse and Alcoholism 
[NIAAA]. This is $14,710,000 more than the budget request and 
$32,995,000 more than the fiscal year 1998 appropriation. The 
comparable numbers for the budget estimate include funds to be 
transferred from the Office of AIDS Research.
    Mission.--The NIAAA conducts biomedical and behavioral 
research for improving prevention and treatment and reducing or 
eliminating the associated health, economic, and social 
consequences of alcohol abuse and alcoholism. NIAAA provides 
leadership in the country's effort to combat these problems by 
developing new knowledge that will decrease the incidence and 
prevalence of alcohol abuse and alcoholism and associated 
morbidity and mortality. NIAAA addresses these questions 
through an integrated program of biomedical, behavioral, and 
epidemiologic research on alcoholism, alcohol abuse, and 
related problems. This broad-based program includes various 
areas of special emphasis such as medications development, 
fetal alcohol syndrome [FAS], genetics, and moderate drinking.
    Alcohol and hepatitis C.--Nearly 4 million Americans are 
infected with the hepatitis C virus, resulting in 8,000 to 
10,000 deaths per year. Nearly 20 percent of these deaths are 
due to the interaction between alcohol and hepatitis C. The 
Committee encourages NIAAA to study the mechanisms whereby 
alcohol accelerates the course of viral hepatitis, suppresses 
the immune system, and reduces the efficacy of interferon 
therapy for chronic hepatitis C infection.
    Hepatitis.--The Committee is aware that several significant 
new research recommendations of the NIH-sponsored Hepatitis C 
[HCV] Consensus Development Conference impacts directly on the 
research portfolio of the NIAAA. These recommendations include 
studies of the interaction between HCV and obesity, diabetes 
mellitus, iron, and medications. The Committee encourages the 
Institute to pursue research in this area.
    Fetal alcohol syndrome [FAS].--The Committee recognizes 
that FAS is a leading cause of mental retardation in the United 
States and the most preventable cause of birth defects. The 
Committee supports the work of NIAAA in creating an Interagency 
Coordinating Committee on Fetal Alcohol Syndrome [ICCFAS], and 
is pleased with the plans of the ICCFAS to focus on prevention, 
basic research, early childhood diagnosis of neurological 
defects, surveillance, epidemiology, and the state-of-the-art 
of treatment and research on children with FAS. The Committee 
requests that the ICCFAS prepare a report within 120 days of 
enactment of this act, describing: the plans for the upcoming 
fiscal year, including recommended priorities, coordination 
with patients, professional, and academic groups; and how the 
ICCFAS will partner with national patient groups to disseminate 
materials to educate the general population and academic health 
centers on the prevention of FAS. The Committee further 
encourages the Institute to conduct and evaluate community-
based research on preventing women from drinking during 
pregnancy.
    Epidemiology.--The Committee encourages the Institute to 
continue work on the epidemiology of alcohol use and abuse in 
the general population. Additional understanding of the factors 
that affect the incidence and prevalence of drinking and the 
prevalence of drinking problems by gender, race, and 
socioeconomic status are important factors in understanding 
both the causes and the means of prevention of alcohol abuse 
and dependence.
    Neuroscience.--The Committee understands that unlike other 
drugs of abuse, alcohol interacts with a variety of different 
brain receptors to produce its effects. These diverse molecular 
interactions greatly complicate efforts to learn how alcohol 
produces intoxication, tolerance, and dependence. The Committee 
encourages the Institute to continue research into defining 
specific molecular targets of alcohol, the molecular biological 
techniques to learn how alcohol interacts with specific regions 
of brain receptors, and to support the design of potent new 
medications for the treatment of alcoholism. The Committee 
further encourages the Institute to pursue large-scale clinical 
trials of medications to treat alcohol addiction to determine 
their side effects, optimal use, and long-term benefits.
    Behavioral science.--The Committee commends NIAAA for its 
support of behavior research on alcohol abuse and alcoholism. 
An increased commitment in research about the social, 
environmental, and cultural factors influencing changes in 
youth drinking behaviors and the targeting of preventive 
interventions is now needed.
    Behavioral research on alcoholism.--The Committee 
understands that NIAAA is expanding its behavioral science 
research activities with new initiatives in the social 
psychology of group identification; behavioral genetics to 
understand the biological and environmental factors in 
vulnerability to alcoholism; the psychophysiology of 
alcoholism; and basic behavioral research on craving and on the 
effects of alcohol abuse on memory and cognition. The Committee 
strongly encourages the Institute to continue this expansion 
and looks forward to hearing about progress in these areas.
    Training.--The Committee strongly encourages NIAAA to adopt 
the B/START (behavioral science track awards for rapid 
transfusion) mechanism for training new behavioral science 
researchers to enhance efforts to expand its basic behavioral 
research portfolio.
    Health services research plan.--The Committee understands 
that the National Advisory Council on Alcohol Abuse and 
Alcoholism has developed a comprehensive plan for health 
services research, improving the delivery of alcohol treatment 
and prevention services. The Committee views health services 
research as an essential part of alcohol treatment and 
prevention, and would like the Institute to report on its 
progress in implementing this plan during the next round of 
appropriations hearings.
    Moderate alcohol consumption.--The Committee encourages the 
Institute to support studies of the benefits and risks of 
moderate alcohol consumption. The Committee furthers encourage 
research into the health effects of alcohol on atherosclerosis, 
osteoporosis, cerebrovascular diseases, women's health, and 
effects of alcohol and medications.
    The Committee is pleased to see a joint research project 
between NIAAA and SAMHSA on the effects of alcohol advertising 
on drinking behavior, especially the effect on the age of 
initiation of drinking by youth. The Committee urges NIAAA and 
SAMHSA to place a high priority on the continuation of this 
important research project.
    Drug development and biology of addiction.--New methods of 
molecular modeling are emerging which may permit scientists the 
ability to identify the manner in which alcohol changes the 
function of brain receptors. Developing models of alcohol's 
binding sites with brain receptors may lead to the development 
of drugs that would block alcohol's effects. Similarly, animal 
and human studies are producing an improved understanding of 
the biology of alcohol addiction. NIAAA is currently pursuing 
large-scale clinical trials aimed at determining the side 
effects, optimal use, and long-term benefits of three 
medications. The Committee encourages NIAAA to expand research 
into the design and development of new medications for the 
treatment of alcoholism, and to explore new therapeutic agents 
that prevent alcohol-induced liver damage, cardiomyopathy, and 
other tissue damage.
    Study of drunk driving enforcement and treatment 
programs.--The Committee is concerned about the problem of 
underage drinking and driving. For instance in the State of 
Vermont recent studies show that 68 percent of teens that died 
on highways were victims of alcohol-related crashes. The 
Committee urges NIAAA to support research to examine risk 
factors for alcohol abuse among teens, and the effectiveness of 
enforcement and treatment programs currently in place to combat 
this problem especially in areas with a high incidence of 
alcohol-related teen deaths.

                    NATIONAL INSTITUTE ON DRUG ABUSE

Appropriations, 1998....................................    $526,192,000
Budget estimate, 1999...................................     575,110,000
Committee recommendation................................     603,274,000

    The Committee recommends an appropriation of $603,274,000 
for the National Institute on Drug Abuse [NIDA]. This is 
$28,164,000 more than the budget request and $77,082,000 more 
than the fiscal year 1998 appropriation. The comparable numbers 
for the budget estimate include funds to be transferred from 
the Office of AIDS Research.
    Mission.--Created in 1974, NIDA supports about 85 percent 
of the world's biomedical research in the area of drug abuse 
and addiction. The Committee commends NIDA for demonstrating 
through research that drug use is a preventable behavior and 
addiction is a treatable disease. NIDA's basic research plays a 
fundamental role in furthering knowledge about the ways in 
which drugs act on the brain to produce dependence, and 
contributes to understanding how the brain works. In addition, 
NIDA research identifies the most effective pharmacological and 
behavioral drug abuse treatments. NIDA conducts research on the 
nature and extent of drug abuse in the United States and 
monitors drug abuse trends nationwide to provide information 
for planning both prevention and treatment services. An 
important component of NIDA's mission is also to study the 
outcomes, effectiveness, and cost benefits of drug abuse 
services delivered in a variety of settings.
    Nicotine research.--The Committee encourages NIDA to expand 
its support for basic research on the biological, 
pharmacological, and behavioral bases of nicotine addiction. 
The Committee further urges NIDA to conduct research targeting 
children and adolescents, to improve strategies to prevent 
smoking initiation, and to increase support for research that 
will lead to more effective long-term smoking cessation, by 
developing medications in combination with behavioral 
strategies.
    Clinical trials.--The Committee commends NIDA for having 
launched a major treatment initiative and encourages NIDA to 
develop a clinical trials infrastructure, and to move rapidly 
to test the efficacy of promising pharmacological, behavioral, 
and psychosocial treatments through large-scale, multisite 
clinical trials.
    Children and adolescents.--The Committee urges NIDA to 
continue research on preventing or diminishing the health and 
developmental consequences associated with drug abuse and 
addiction, looking particularly at prenatally exposed children 
to understand the long-term consequences of drug exposure in 
later childhood and adolescence.
    Methamphetamine.--NIDA research has shown that 
methamphetamine is a powerfully addictive stimulant associated 
with many physical and behavioral changes. The Committee 
encourages NIDA to study the development of antimethamphetamine 
medications, to clarify the long-term neurological and 
behavioral consequences of the use of these drugs, and to 
continue to study the epidemiological trends of methamphetamine 
use.
    The Committee is disturbed by the explosion in 
methamphetamine abuse across the Nation. The problem is 
especially acute in Iowa and other Midwestern States. The 
Committee is pleased that NIDA plans a conference in Des 
Moines, IA, to focus attention and expand understanding of this 
growing problem. The Committee urges NIDA to expand its 
research on improved methods of prevention and treatment of 
methamphetamine abuse.
    Drug abuse treatment.--The Committee commends NIDA for the 
progress in neuroscience research, and encourages NIDA to 
continue its efforts to develop pharmacological and behavioral 
drug abuse treatments.
    Social work research.--The Committee commends NIDA for 
supporting social work research and for dissemination on 
behavioral and psychosocial treatment and prevention related to 
drug abuse, addictions, and HIV/AIDS. The Committee also 
applauds NIDA's efforts to support the development of research 
capacity within graduate schools of social work to carry out 
drug abuse treatment and health services research.
    Sobriety programs.--The Committee remains acutely concerned 
with the high incidence of alcoholism and alcohol abuse among 
children and adolescents of Native Alaskan and native Hawaiian 
descent. The Committee urges the NIDA to work with existing 
native American and native Hawaiian organizations to assess and 
increase their effectiveness.
    Behavioral science research.--The Committee understands 
that in many cases behavioral intervention is the only 
available treatment for drug addiction, and that even in 
instances where medications are available, behavioral 
intervention is required. Recent NIDA research shows that the 
effectiveness of newly developed medication for cocaine 
addiction is contingent on having a behavioral intervention 
first. This example underscores the important role of behavior 
intervention in addressing and preventing drug abuse and 
addiction. The Committee continues to support NIDA's expansion 
of its behavioral science portfolio and views NIDA as a model 
of how to approach its behavioral science and public health 
responsibilities.

                  NATIONAL INSTITUTE OF MENTAL HEALTH

Appropriations, 1998....................................    $748,841,000
Budget estimate, 1999...................................     807,582,000
Committee recommendation................................     861,208,000

    The Committee recommends an appropriation of $861,208,000 
for the National Institute of Mental Health [NIMH]. This is 
$53,626,000 more than the budget request and $112,367,000 more 
than the fiscal year 1998 appropriation. The comparable numbers 
for the budget estimate include funds to be transferred from 
the Office of AIDS Research.
    Mission.--The research programs of the Institute lead the 
Federal effort to identify the causes of--and the most 
effective treatments for--mental illnesses, which afflict more 
than one in five Americans. Severe mental illnesses affect 2.8 
percent of the U.S. adult population annually, or approximately 
5 million people. These individuals suffer from disorders such 
as schizophrenia, manic-depressive illness, major depression, 
panic disorder, and obsessive-compulsive disorder. One result 
of the Federal research investment has been a growing awareness 
that undiagnosed and untreated mental illness, in all its forms 
and with all of its consequences, is as damaging as physical 
illness is to the Nation's well-being.
    A recent study from the World Bank, WHO, and Harvard 
University found that mental disorders currently account for 4 
out of 10 leading causes of disability in the United States for 
individuals above the age of 5. These alarming statistics make 
it clear that mental disabilities have a profound social and 
economic impact.
    Research has provided clear evidence that mental illnesses 
are diagnosable, treatable, and real diseases affecting the 
brain. The Committee has recently received from the National 
Advisory Mental Health Council [NAMHC] the report requested in 
its fiscal year 1998 appropriations report and notes the impact 
of managed care on keeping costs of parity at a low level. The 
Committee requests that the NAMHC prepare an additional report 
on its findings from emerging health services research data 
from both the private and public sectors, and submit it under 
provisions of section 406(g) of the Public Health Service Act. 
Where possible, the report should address both employer direct 
costs, and the impact of indirect cost savings from successful 
treatment of employees. This report should, to the extent 
possible, also consider the costs and quality of coverage for 
children, and the development of outcome measures of quality 
for all mental health coverage.
    Neuroscience.--NIMH's recent conference on the science of 
emotion, held with the Library of Congress, served to point out 
progress in understanding the neural mechanisms of human 
emotion and behavior. These types of accomplishments have been 
achieved through NIMH's support of basic neuroscience. The 
Committee encourages NIMH to continue to support this research, 
which provides the foundation of scientific knowledge that will 
combat the stigmatization of mental illness and will lead to 
novel treatments.
    Genetics.--Studies of mental disorders have conclusively 
demonstrated a significant genetic component for major mental 
illnesses. The Committee encourages NIMH in its emphasis on 
this area of research and urges collaboration with other 
Institutes at NIH. The Committee also endorses the B-MAP 
project, a collaborative effort with the National Institute of 
Neurological Disorders and Stroke, aimed at understanding 
patterns of gene expression in the brain.
    Alzheimer's disease.--The Committee is pleased to note that 
NIMH has played an integral role in advancing sciences' 
understanding of Alzheimer's disease. NIMH-supported 
researchers, for example, found that a particular gene product, 
APO E-4, is associated with increased behavioral disturbances 
in Alzheimer's disease. Further information about APO may prove 
to have implications for tailoring pharmacologic treatments to 
slow or halt the progression of Alzheimer's disease. Given the 
projected increase in the number of Americans who will be 
stricken with Alzheimer's disease, the Committee urges NIMH, in 
collaboration with the National Institute on Aging and the 
National Institute of Neurological Disorders and Stroke, to 
launch a prevention initiative whose goal is to discover 
therapies that delay or prevent the onset of Alzheimer's 
disease.
    Mental disorders in children.--The Committee is distressed 
to learn that as many as 10 million children in the United 
States suffer from mental disorders, such as depression, 
anxiety, attention deficit-hyperactivity disorder, and autism. 
All of these are sufficiently severe to compromise a child's 
ability to function optimally. The Committee wishes to commend 
NIMH for placing high priority on children's disorders and 
encourages the Institute to support scientific studies into the 
development of the brain and behavior that will provide 
insights to guide clinical researchers in understanding how 
brain disorders and disabling emotional states arise, 
eventually leading to effective treatment methods for specific 
disorders.
    Behavioral science.--The Committee notes the efforts of the 
NIMH to advance behavioral science and to train more behavioral 
researchers. The Committee encourages the NIMH to continue to 
make behavioral science more relevant to the public health and 
to create linkages to advances in the brain sciences.
    Clinical trials.--The Committee encourages NIMH to expand 
its clinical trials of treatments for mental illnesses, 
especially in the area of psychotherapeutic drugs for children 
and the elderly. The Committee also encourages trials of new 
medications and their effectiveness on severe mental disorders 
such as schizophrenia and manic-depressive illness.
    Eating disorders.--The Committee urges additional funding 
be provided for prevention research on eating disorders 
(anorexia nervosa, bulimia, and binge eating disorder). The 
Committee defines prevention research as the development of 
psychosocial and behavioral interventions and strategies aimed 
at reducing the incidence of these disorders.
    Rural mental health.--The Committee is aware that the 
Office of Rural Mental Health has explored collaboration with 
the USDA Extension Services as a vehicle for the delivery of 
behavioral and mental health services in rural and underserved 
areas. The Committee encourages the Institute to pursue 
research in these areas.
    Learning disabilities.--The Committee commends NIMH for 
collaborating with NICHD in the area of learning disabilities 
research and encourages NIMH to continue this productive 
relationship to explore these neurological disorders.
    Basic behavioral research.--For several years, the 
Committee has urged NIMH to strengthen its portfolio in basic 
behavioral research and prevention. The Committee continues to 
see basic behavioral research and prevention as two of NIMH's 
core responsibilities and urges the Institute to establish, in 
consultation with leading experts from the field, specific 
research and training initiatives to develop the base of 
theoretical knowledge on behavioral aspects of mental health, 
mental illness and prevention as a means of improving the 
connections between basic and clinical research.
    Violence against women.--The Committee encourages the 
National Institute of Mental Health to focus more attention on 
research into prevention, treatment, and intervention and 
subsequently to pursue large-scale clinical trials of violence 
against women, including behavioral and psychosocial factors.
    Social work research development centers.--The Committee 
commends NIMH for funding its seventh social work research 
development center, and urges NIMH to give consideration to 
expanding the number of centers.
    Human brain project.--The Committee supports NIMH's efforts 
to support functional brain imaging technologies and knowledge 
of behavior and neural circuits to pinpoint abnormalities in 
mental disorders. The Committee also remains very interested in 
the trans-NIH and transagency initiative called the human brain 
project, which supports research and development of tools to 
better analyze and understand data from brain research. The 
Committee requests that NIMH provide an update of the project 
before the fiscal year 1999 hearings.
    Autism.--The Committee recognizes that research into the 
genetics of autism is being supported by several Institutes at 
the NIH. Given the difficulty of recruiting multiplex families, 
the Committee requests that researchers be strongly encouraged 
to collaborate and share this important resource. To that end, 
the Committee recommends the NIMH consider supporting a 
collaborative autism gene bank and notes that one is already in 
existence, the autism genetic resource exchange.
    The Committee commends the work of the Inter-Agency Autism 
Coordinating Committee and encourages the coordinating 
committee to meet regularly, to make those meetings open to the 
public, and to report to Congress on the goals set and progress 
made prior to the fiscal year 2000 hearings. The Committee is 
encouraged by the current program announcement for research on 
autism spectrum disorder and urges the Institute to intensify 
its investment in autism-focused research. The Committee 
further encourages that centers of excellence be selected to 
speed the pace of progress in autism research and an awareness 
program be started to regard the advances in the diagnosis and 
treatment of autism to educate doctors and other health 
professionals so that children can be diagnosed as early as 
possible.

                NATIONAL HUMAN GENOME RESEARCH INSTITUTE

Appropriations, 1998....................................    $217,297,000
Budget estimate, 1999...................................     239,421,000
Committee recommendation................................     249,891,000

    The Committee recommendation includes $249,891,000 for the 
National Human Genome Research Institute [NHGRI]. This is 
$13,608,000 more than the budget request and $32,594,000 more 
than the fiscal year 1998 appropriation. The comparable numbers 
for the budget estimate include funds to be transferred from 
the Office of AIDS Research.
    Mission.--The NHGRI coordinates extramural research and 
research training for the NIH component of the human genome 
project, an international effort to determine the location and 
sequence of the estimated 100,000 genes which constitute the 
human genome. The division of extramural research supports 
research in genetic and physical mapping, DNA sequencing and 
technology development, data base management and analysis, and 
studies of the ethical, legal, and social implications of human 
genome research. The division of intramural research [DIR] 
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 therapies. Since 
its establishment in 1993, the intramural program has developed 
a strong research program and forged collaborative ties with 
several of the NIH research institutes to unravel the 
complexities of genetic diseases such as diabetes, breast and 
colon cancer, and melanoma.
    Human genome project.--The Committee commends the NHGRI for 
its leadership in research and policy development related to 
the ethical, legal, and social implications [ELSI] of the human 
genome project. The early commitment to devote 5 percent of the 
Institute's extramural research budget to study the ethical, 
legal, and social implications of genome research has generated 
important information and recommendations regarding research 
and public policy. The Committee is particularly pleased with 
the Institute's attention to protecting the genetic information 
of individuals from misuse in health insurance and employment 
and its development of concise policy recommendations in both 
areas. The Committee supports the NHGRI's ongoing efforts to 
examine the privacy and fair use of genetic information in 
these settings and the many other important issues related to 
human genetics research and its consequences, including: the 
appropriate use of genetic tests; the protection of human 
subjects who participate in genetic research; the development 
of policies with regard to research into genetic variation; and 
the attention to complex issues, such as concepts of race and 
ethnicity and behavioral genetics.
    The Committee also commends the NHGRI for its collaboration 
with the American Medical Association and the American Nurses 
Association in founding the National Coalition for Health 
Professional Education in Genetics. The Committee supports the 
work of the coalition to ensure that our Nation's health care 
providers have the knowledge, skills, and resources to 
integrate powerful new genetic knowledge into health care 
rapidly and responsibly.
    The Committee is aware of the recent announcement by two 
private sector companies of their intent to form a new company 
to produce a draft of the human genome within 3 years. The 
Committee is pleased to learn of the interest in the private 
sector in human sequencing. This reaffirms the enormous value 
of human genome project [HGP] products and the wisdom of this 
Committee's investment in the HGP over the last 9 years. The 
Committee continues to support the public project's central aim 
to produce a highly accurate, publicly available 
characterization of the complete set of human genetic 
instructions, as well as to pursue a vigorous agenda of other 
genome initiatives that will make this profoundly important 
information more interpretable. The Committee understands that 
the success and role of the announced private sector initiative 
will not be known for at least 12 to 18 months and looks 
forward to discussing the HGP and the private sector efforts 
during the fiscal year 2000 budget hearings.
    Bleeding disorders.--The Committee encourages NHGRI to 
explore collaborative ties with other NIH Institutes to 
encourage the development of promising gene therapy 
technologies for persons with bleeding disorders.

                 NATIONAL CENTER FOR RESEARCH RESOURCES

Appropriations, 1998....................................    $453,035,000
Budget estimate, 1999...................................     513,570,000
Committee recommendation................................     554,819,000

    The Committee recommends an appropriation of $554,819,000 
for the National Center for Research Resources [NCRR]. This is 
$41,249,000 more than the budget request and $101,784,000 more 
than the fiscal year 1998 appropriation. The comparable numbers 
for the budget estimate include funds to be transferred from 
the Office of AIDS Research.
    Mission.--The NCRR develops and supports critical research 
technologies and shared resources that underpin research to 
maintain and improve the health of our Nation. The NCRR 
programs develop a variety of research resources; provide 
biomaterial and resources for complex biotechnologies, clinical 
research, and specialized primate research; develop research 
capacity in minority institutions; and enhance the science 
education of precollege students and the general public.
    Extramural facilities.--The Committee has included 
$30,000,000 for extramural biomedical facility renovation and 
construction, $10,000,000 above the amount requested by the 
administration. These funds are to be awarded on a competitive 
basis consistent with section 481(A) of the Public Health 
Service Act.
    The Committee directs the Director to cap extramural 
facility awards at 25 percent of project costs, or a 3-to-1 
match, on any new awards made in fiscal year 1999. The 
Committee further requests that the Director review the need 
for extramural facilities, the impact of increasing 
construction funds on expanding the base of scientific 
knowledge, and how best to distribute these funds to the 
neediest institutions. The Committee further requests that the 
Director report on the amount of indirect costs currently being 
used from research grants for renovation and construction of 
research facilities.
    The Committee encourages that every appropriate 
consideration be given to supporting the Children's Hospital 
and Medical Center of Seattle. The medical center is in need of 
large medical laboratory equipment for NIH funded research at 
eight laboratories within the hospital and at the new pediatric 
clinical research center.
    It has been brought to the Committee's attention that 
biomedical research is positioned to make substantial advances 
based on large-scale application of high-performance computing 
and communication technologies. The Pittsburgh Supercomputing 
Center has provided the bulk of the access to high-performance 
computing for the Nation's biomedical researchers with the 
support of the National Science Foundation Supercomputing 
Program. The Committee understands that without the access to 
the PSC's resources that the computational needs of researches 
could be severely hampered. The Committee encourages that every 
consideration be given to support the Pittsburgh Supercomputing 
Center.
    It has come to the Committee's attention that the existing 
animal research facility at the University of North Dakota 
School of Medicine, the only medical school located in the 
State, needs to be updated. The medical school lacks procedure 
rooms, adequate pathogen and biohazard protection, the 
ventilation is inadequate and there is no facility to produce 
transgenic animals. The Committee encourages that every 
consideration be given to support the project outlined above.
    It has come to the Committee's attention that the existing 
animal research facility at the University of South Dakota 
School of Medicine, the only medical school in the State, needs 
to be renovated and expanded. The current facility lacks a 
quarantine room and does not have adequate space to fulfill the 
animal housing needs of the faculty researchers. The Committee 
encourages full and fair consideration to the University of 
South Dakota School of Medicine to support the project outlined 
above.
    The Committee strongly urges that full consideration be 
given to a proposal from the University of Nebraska Medical 
Center to develop two centers of excellence specializing in: 
(1) neurovirology and neurodegenerative research; and (2) stem 
cell biology. These centers will provide an interdisciplinary 
environment for furthering research in geriatric neurology and 
virological research and solid organ stem cell biology, 
embryonic stem cell biology, hematopoeitic stem cell biology, 
and immunobiology.
    The Committee is aware of the Robert Wood Johnson Medical 
School's Child Health Research Institute and encourages that 
every consideration be given to this project.
    The Committee encourages consideration be given a proposal 
from the Center for Research in Human Nutrition and Chronic 
Disease Prevention at the Wake Forest University School of 
Medicine.
    IDeA grants.--The Committee has provided $10,000,000 for 
the Institutional Development Award [IDeA] Program authorized 
by section 402(g) of the Public Health Service Act. This is 
$4,800,000 over both fiscal year 1998 and the budget request. 
The program is intended to broaden the geographic distribution 
of NIH funding of biomedical research by enhancing the 
competitiveness of biomedical and behavioral research 
institutions which historically have had low rates of success 
in obtaining funding. The Committee intends that the increase 
will be used in eligible States to cofund high quality 
applications for shared instrumentation and RO-1 proposals to 
those who would otherwise not receive support under the normal 
peer-review cycle. The Committee believes that the existing 
Shannon Awards Program can serve as the model for deciding 
which grants should be selected by NCRR for funding under the 
expanded IdeA Program.
    Cystic fibrosis data monitoring center.--The Committee 
strongly endorses efforts to speed the development of new 
therapies for rare diseases, such as NCRR's work to establish a 
pilot data monitoring center at a general clinical research 
center [GCRC]. This pilot, which is jointly supported by the 
Cystic Fibrosis Foundation, is designed to expedite the 
collection, manipulation, and evaluation of data gathered 
across multicenter trials on cystic fibrosis. Should this 
approach prove successful, the Committee urges NCRR to develop 
similar partnerships with rare disorder organizations to 
provide referral networks and data management resources across 
GCRC's.
    General clinical research centers.--As the Nation's 
academic medical centers have come under financial pressure, 
they have been forced to eliminate expenditures for the 
personnel and infrastructure required for clinical research. 
These institutions now rely almost exclusively on NCRR General 
Clinical Research Center grants to provide the facilities 
essential to the conduct of clinical research. In the past 
three decades, NIH spending for GCRC's has declined. This shift 
in resources has caused the NCRR to fund GCRC's at well below 
the Advisory Council approved budgets. The Committee believes 
that the NCRR must reverse this trend and has provided 
$20,000,000 above the President's requested level of 
$180,500,000 to fund existing centers, start new centers, and 
expand the Clinical Associate Physician Program.
    The Committee is encouraged by the efforts of the NCRR to 
collaborate with other NIH Institutes and agencies regarding 
clinical studies and GCRC's. The Committee urges the NCRR to 
expand this activity and, in particular, to foster the 
development of collaborative clinical research in the area of 
nutrition and obesity between NIDDK nutrition and obesity 
centers and GCRC's.
    The Committee encourages the Institute to consider 
establishing pediatric research units devoted to 
neurobehavioral analysis, with a special emphasis on rare brain 
disorders. These units could manage acute medical problems 
while accommodating pediatric patients with visual, auditory, 
communication, and behavioral disorders.
    Research centers in minority institutions.--The Committee 
recognizes the critical role to be played by minority 
institutions at both the graduate and undergraduate level in 
addressing the health research and training needs of our 
minority populations. These programs help facilitate the 
preparation of a new generation of scientists at these 
institutions. The Research Centers in Minority Institutions 
[RCMI] Program continues to impact significantly on these 
problems. The Committee encourages NIH to strengthen 
participation from minority institutions and increase resources 
available in this area.
    The Committee encourages NIH to work with minority 
institutions with a track record of producing minority scholars 
in science and technology.
    The Committee recognizes the health research and training 
needs of Alaska Natives and Aleuts and requests that the 
National Center for Research Resources recognize the University 
of Alaska as a minority school for purposes of qualifying for 
support under its Research Centers in Minority Institutions 
Program.
    Biomedical research support grants.--The Committee 
recognizes the value of maintaining research facilities and 
equipment and providing initial support for young investigators 
and bridge support for established researchers. In the past, 
the NIH utilized the biomedical research grants program to 
provide flexible funds to strengthen and stabilize NIH-
supported researchers, research programs, and academic health 
centers. In fiscal year 1999, however, no funds have been 
requested for the BRSG program. The Committee has heard 
testimony from the extramural research community that the 
transformation of the health care system to a market-driven, 
managed-care system, has placed enormous pressure on research 
programs at academic medical centers. The Committee requests 
that the NIH address the feasibility of reestablishing a 
revised biomedical research support grants program or creating 
an alternative mechanism to address with unmet needs in this 
area. The Committee expects that funds would be provided for 
direct costs only, would be rigorously peer-reviewed at the 
institutional level, and would be administered with full 
accountability.
    Research equipment.--The Committee is aware of the critical 
need for shared instrumentation grants, including standard and 
digital mammography, MRI and PET scan equipment, ultrasound, 
and stereotactic biopsy devices for breast cancer research. The 
Committee encourages additional funding for these grants.
    Alternative research resources.--The Committee is very 
interested in matching the increased need of researchers who 
rely upon human tissues and organs to study human diseases and 
to search for cures. The Committee is aware that the national 
disease research interchange [NDRI], dedicated to providing the 
research community with this valuable and effective alternative 
research resource has supplied thousands of human tissues and 
organs, and thereby contributed to a number of recent 
significant research advances. The Committee is encouraged by 
NDRI's role in these research advances and expects the Director 
to participate in a multi-institute initiative to expand 
support for NDRI.
    Clinical laboratories.--The committee encourages the NIH to 
place a greater emphasis on clinical laboratories and increase 
the investment in research infrastructure.

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

Appropriations, 1998....................................     $28,236,000
Budget estimate, 1999...................................      30,353,000
Committee recommendation................................      35,426,000

    The Committee recommends an appropriation of $35,426,000 
for the Fogarty International Center [FIC]. This is $5,073,000 
more than the budget request and $7,190,000 more than the 
fiscal year 1998 appropriation. The comparable numbers for the 
budget estimate include funds to be transferred from the Office 
of AIDS Research.
    Mission.--The primary function of the FIC is 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.
    Global health priorities.--The Committee commends the FIC 
for its efforts to create an international training network to 
build capacity on research, prevention, and control of emerging 
and reemerging infectious diseases, including tuberculosis and 
malaria, and encourages the FIC to expand its efforts in this 
vital area. In this regard, the Committee notes the importance 
of sharing skills and knowledge directed toward the prevention 
of the proliferation of biological warfare agents. In 
consultation with other NIH Institutes, the FIC is encouraged 
to expand its international training efforts to improve 
international preparedness to develop and deploy such critical 
tools as antimicrobial drugs, diagnostic agents, and vaccines. 
The Committee also encourages FIC to collaborate, where 
appropriate, with the NIAID and CDC to address the issue of 
emerging infectious diseases.
    The Committee notes that tuberculosis [TB] continues to be 
a global public health concern, and is concerned with the 
development of multidrug resistant TB in the United States and 
internationally. The Committee recognizes FIC's increased 
efforts to train experts in TB surveillance and treatment 
programs, and encourages FIC to continue its collaborative 
efforts with governmental and nongovernmental organizations to 
support training of professionals for TB control.
    The pace of international research in infectious disease 
and other disease priorities is accelerated through the use of 
state-of-the-art communications and computing technologies. FIC 
has provided a valuable programmatic resource to NIH 
investigators through its international initiative in medical 
informatics training. The Committee encourages FIC to expand 
this initiative in sub-Saharan Africa and, if possible, to 
extend this to other regions of the world where the 
establishment of Internet linkages and other information 
technologies would augment collaborative research programs.
    Scientific opportunities for women.--Medical research 
depends on talented groups of individuals from diverse cultures 
working toward the same objective, and the Committee is pleased 
that FIC fosters broad participation in the scientific 
enterprise through its existing programs. The Committee 
encourages FIC to strengthen these efforts, in particular to 
increase opportunities for women scientists from the United 
States and abroad to participate in international research and 
training, including mentoring activities.
    In view of the Committee's strong support for these FIC 
initiatives, additional funds have been provided above the 
President's fiscal year 1999 request for FIC.

                      NATIONAL LIBRARY OF MEDICINE

Appropriations, 1998....................................    $160,885,000
Budget estimate, 1999...................................     174,210,000
Committee recommendation................................     181,309,000

    The Committee recommends an appropriation of $181,309,000 
for the National Library of Medicine [NLM]. This is $7,099,000 
more than the budget request and $20,424,000 more than the 1998 
appropriation. The comparable numbers for the budget estimate 
include funds to be transferred from the Office of AIDS 
Research.
    Mission.--The National Library of Medicine is the Federal 
institution that for more than 150 years has collected, 
organized, preserved, and disseminated the world's output of 
biomedical literature in all forms. As a result of this 
activity NLM is the world's largest library of the health 
sciences, its holdings numbering more than 5 million items. The 
NLM has pioneered innovative methods to disseminate 
bibliographic information. Basic to the mission of the NLM is a 
wide-ranging research program to improve how medical 
information is communicated. This responsibility is aided by a 
grants program and by specialized services in toxicology, 
environmental health, and biotechnology.
    Outreach.--The Committee is pleased that NLM has made its 
MEDLINE data base available free via the World Wide Web. The 
Committee encourages NLM to continue its outreach activities 
aimed at educating health care professionals, health 
information specialists, and the general public about the 
Library's products and services. To continue its success in 
this area, the Committee encourages NLM to coordinate its 
outreach efforts with medical librarians and other health care 
professionals.
    The Committee notes that senior citizens would benefit 
greatly from expanded access to NLM's data bases and has, 
therefore, included funds for a demonstration of different 
means to this end, including Internet access at senior centers 
and congregate meal sites.
    Telemedicine.--The Committee is pleased with the success of 
NLM's numerous telemedicine sites and recognizes the positive 
impact that these programs are having on the delivery of health 
care in underserved communities. The Committee encourages NLM 
to continue the expansion of its research and development 
efforts in the areas of telemedicine and the next generation 
Internet [NGI].
    The Committee further encourages the Department to improve 
access to and quality of cost effective interactive 
telemedicine systems in the area of pediatric health care for 
patients in medically underserved rural and native American 
areas and encourages NLM to give every consideration to a 
proposal to serve the WWAMI region.
    Next generation Internet.--The Committee continues to be 
pleased with the innovative efforts NLM has fostered related to 
health applications of the next generation Internet. The 
Committee fully supports NLM's continuing efforts to assure 
that the unique needs of medicine and health are accounted for 
in the development of the next generation Internet. An 
especially important aspect of the next generation Internet is 
that relating to molecular biology information and the NIH 
human genome program. The tremendous growth in the size and use 
of NLM's GenBank data base of sequence information demonstrates 
the need for the increased capabilities of the NGI. Because of 
the needs for the transmission of medical information to be 
highly reliable and the highest integrity, the Committee 
endorsees NLM's efforts in this area and urges that additional 
resources be made available for these efforts.
    Information for the consumer.--The Committee is pleased 
with the Library's response to its outreach mandate to 
publicize its products and services, and supports NLM's recent 
accomplishments in making its information widely available, and 
free of charge, to health professionals and the public alike. 
The Committee urges NLM to publicize its services even more 
widely by disseminating its annual reports, planning documents, 
catalogues of its exhibitions, and other appropriate materials.

                         OFFICE OF THE DIRECTOR

Appropriations, 1998....................................    $241,101,000
Budget estimate, 1999...................................     264,060,000
Committee recommendation................................     302,947,000

    The Committee recommends an appropriation of $302,947,000 
for the Office of the Director [OD]. This is $38,887,000 more 
than the budget request and $61,846,000 more than the fiscal 
year 1998 appropriation. The comparable numbers for the budget 
estimate include funds to be transferred from the Office of 
AIDS Research. The recommendation also includes $43,493,000 
within the Office of the Director to support the activities of 
the OAR as proposed in the budget request.
    Mission.--The Office of the Director provides leadership 
and direction to the NIH research community, and coordinates 
and directs initiatives which crosscut the NIH. The Office of 
the Director is responsible for the development and management 
of intramural and extramural research and research training 
policy, the review of program quality and effectiveness, the 
coordination of selected NIH-wide program activities, and the 
administration of centralized support activities essential to 
operation of the NIH.
    Urological research.--The Committee remains concerned with 
the adequacy of the peer review system for reviewing urologic 
research grant applications. While the Institute has responded 
by creating a special emphasis panel to review urology grant 
applications, the Committee believes the NIH Director should 
consider further steps to provide more input from the 
urological research community. The Committee requests the 
Director be prepared to discuss on what further steps should be 
taken to rectify this at the fiscal year 2000 appropriation 
hearing.
    Pediatric research.--The Committee encourages the NIH to 
expand pediatric research to strengthen its portfolio of basic, 
behavioral, and clinical research for children. The Committee 
requests that the Office of the Director provide, by May 1999, 
an update on the amount of funding devoted to extramural 
pediatric research by Institute and by age bracket. The 
Committee is also pleased to learn that NIH will implement, 
effective October 1, a new policy to increase the participation 
of children in NIH-supported clinical research trials.
    Assistive technology.--The Committee encourages that funds 
be used to expand the research and development efforts of 
assistive technology. This technology can improve the lives of 
over 50 million Americans with physical or mental disabilities.
    Recombinant DNA Advisory Committee [RAC].--The Committee 
commends the NIH Director for his continued support of the 
Recombinant DNA Advisory Committee and strongly encourages the 
Director to restore the RAC's mandate to approve or disapprove 
human gene therapy protocols. The RAC provides a valuable 
service relevant to information gathering, and public 
discussion far in advance of the review of novel applications 
with possible societal implications. The Committee urges the 
Director to consider expanding the RAC's responsibilities into 
the areas of xenotransplantation and germ-line gene transfer.
    Chronic fatigue and immune dysfunction syndrome.--The 
Committee encourages the NIH to provide additional funds for 
grants which focus on promising CFIDS research, particularly 
those investigations which will define the pathophysiology of 
the illness and identify diagnostic markers. The Committee 
strongly urges NIH to issue a special program announcement 
dedicated to the study of all facets of pediatric CFIDS. 
Finally, the Committee urges NIH officials to identify 
appropriate NIH advisory committees for CFIDS representation 
and ensure appointment of qualified individuals to these 
committees.
    Cardiovascular diseases and stroke.--Advances have been 
made in the identification and treatment of risk factors for 
heart attack, stroke, and other cardiovascular diseases. The 
Committee encourages the Director to convene a transagency 
National Conference on Cardiovascular Diseases and Stroke to 
assess progress and opportunities and to develop a 
comprehensive research and prevention agenda for the 21st 
century in the battle against heart attack, stroke, and other 
cardiovascular diseases. Participants should include 
representatives from all Federal agencies involved in heart 
disease and stroke prevention and research, including the NIH, 
CDC, AHCPR, and pertinent voluntary nonprofit organizations, 
foundations, and experts in the field.
    Nutrition and obesity.--The Committee encourages the 
Director to expand clinical research programs in nutrition and 
obesity. These collaborative programs will develop existing 
clinical nutrition research units, obesity research centers, 
and general clinical research centers, with an emphasis on the 
integration of molecular genetics and clinical studies. The 
Committee encourages NIH to work collaboratively with the CDC 
to aid the development of a CDC prevention initiative on 
nutrition and obesity.
    Child abuse and neglect research.--The Committee recognizes 
the magnitude and significance of the problem of child abuse 
and neglect. The Committee is pleased that the NIH, under the 
leadership of NIMH, convened a working group of its component 
organizations to facilitate collaborative and cooperative 
efforts on child abuse and neglect research. The Committee 
urges the continuation of the working group and the 
implementation of the recommendations. The Committee further 
encourages the working group to hold a conference on child 
abuse and neglect to assess the state-of-the-art science and 
make recommendations for a research agenda in this field. The 
Committee requests that NIH be prepared to report on current 
and proposed NIH efforts in this area at the fiscal year 2000 
hearings.
    Alzheimer's disease.--NIH documents submitted to the 
Committee indicate that approximately $350,000,000 will be 
allocated to Alzheimer's disease research in fiscal year 1999. 
As noted elsewhere in this report, the Committee believes that 
the projected increase in the number of Americans who will be 
stricken with Alzheimer's--to as many as 14 million persons--
warrants special priority. The Committee, therefore, encourages 
that additional funds be used over the budget request for the 
National Institute on Aging, National Institute of Neurological 
Disorders and Stroke, and the National Institute of Mental 
Health to launch an Alzheimer's disease prevention initiative. 
Given the potentially ruinous efforts Alzheimer's disease could 
have on the Medicare and Medicaid programs, the Committee 
believes that the Health Care Financing Administration also has 
an important stake in the effort. The Committee strongly urges 
the NIH to develop a plan for undertaking a prevention 
initiative and reporting on its progress during the fiscal year 
2000 hearings.
    Office of Women's Health.--The Committee encourages the 
Director to provide funds to the Office of Women's Health to 
enter into a contract with the Institute of Medicine to conduct 
a study to validate the concept of sex and gender comparisons 
and analyses in basic biological research. This study should 
utilize the information and findings in the report of the task 
force on the NIH women's health research agenda for the 21st 
century. The IOM study should augment the findings of that 
report and seek to determine the continuing need for basic sex 
and gender studies in both Federal and private sector research, 
and address how to accomplish these desired goals. This study 
would have implications for research, clinical practice, 
disease prevention, medical education, health services 
research, and health care policy.
    Director's discretionary fund.--The Committee has 
recommended no funding for this activity.
    Trauma and burn care research.--The Committee recognizes 
that injury is the leading cause of death for Americans from 
age 44 and under, and the leading cause of lost work 
productivity. The Committee urges the Director of the NIH to 
develop a coordination process focused on trauma and burn care 
research with the appropriate Institute Directors, including 
NIGMS, NINDS, NIAMS, NICHD, NIA, and within it the National 
Center for Rehabilitation Research. This collaborative effort 
should focus on the goal of realizing the opportunities 
presented by basic science research by applying that knowledge 
to clinical research in trauma and burn care in order to 
significantly ameliorate the enormous impact of injury on both 
the patient and society.
    Center for Complementary and Alternative Medicine.--The 
Committee strongly supports the work of the Office of 
Alternative Medicine [OAM] and has included $50,000,000 to 
support its activities to investigate, evaluate, and validate 
alternative therapies. The Committee directed NIH to establish 
this office in 1991 with the intent of assuring that 
alternative therapies be rigorously reviewed to provide 
consumers reliable information. However, it is now clear that 
without greater authority and independence--including the 
initiation of research projects and development of its own peer 
review panels--alternative therapies will not be adequately 
reviewed and inefficiencies will remain. Currently, scarce time 
and resources are wasted because the Office must work through 
an Institute in order to carry out research projects. To 
address these shortcomings, the Committee has included bill 
language creating a Center for Complementary and Alternative 
Medicine [CCAM].
    The Committee expects that support for the centers 
supported by CCAM will be expanded significantly. The Committee 
directs CCAM to undertake field investigations and a program 
for the collection and evaluation of outcome data on promising 
alternative therapies, including new clinical trials of herbal 
natural products and other CAM therapies. The Committee also 
expects CCAM to continue and expand its work with CDC on field 
investigations and with AHCPR on literature reviews. Finally, 
the Committee continues to be concerned with the lack of 
adequate staff resources dedicated to this Center. The 
Committee notes that this Center has only eight FTE's while 
other NIH entities with comparable budgets have considerably 
larger professional staffs. Therefore, the Committee expects 
that the CCAM will be provided sufficient FTE's.
    The Committee believes that Federal policy in a number of 
areas is failing to keep up with the increased use of 
complementary and alternative therapies. An amount of 
$1,000,000 has been provided to support the establishment and 
operation of a White House Commission on Complementary and 
Alternative Medicine Policy to study and make recommendations 
to the Congress on appropriate policies regarding research, 
training, insurance coverage, licensing, and other pressing 
issues in this area.
    The Committee notes the growing popularity of natural 
medicines and the relative paucity of research focusing on 
these promising treatments. This research gap creates consumer 
safety issues and prevents the Nation from realizing the full 
potential of natural medicines. The Committee, therefore, 
strongly encourages NIH, working through its Center for 
Complementary and Alternative Medicine, to increase funding 
support for the development and evaluation of natural 
medicines. The Committee is aware of a collaborative effort by 
the National Center for the Development of Natural Products 
[NCDNP] at the University of Mississippi, Georgetown 
University's Center for Drug Development Science [CDDS], and 
the presentation health system in South Dakota to identify and 
develop natural products with potentially efficacious medical 
uses, perform the clinical testing of these products, and 
evaluate the data to determine their safety and efficacy. Full 
and fair consideration should be given to the project described 
above.
    Office of Dietary Supplements.--The Committee continues to 
strongly support the important work of this Office. Use of 
dietary supplements has increased significantly among Americans 
who want to improve their health and prevent disease. There is 
a great need for additional research to better inform consumers 
of the health benefits of supplements. The President's 
Commission on Dietary Supplements recently recommended that ODS 
be funded at its fully authorized level to meet this need. The 
Committee has included $2,000,000 in additional funds for the 
Office to expand its efforts and to develop a botanical 
research centers initiative with major research institutions 
across the Nation.
    The Committee also notes that 1999 marks the 30th 
anniversary of the landmark White House Conference on Food, 
Nutrition, and Health which lead to many major advancements in 
nutrition and health policy. The Committee encourages the 
Institute to plan and convene a conference to develop human 
nutrition policy recommendations for the next century. This 
conference should be developed in cooperation with the 
Agriculture Department and ensure full and appropriate private 
sector involvement.
    Training.--The Committee received the Director's response 
to the 1994 National Academy of Sciences recommendations on 
training needs for health research. The Committee appreciates 
NIH's decision to increase stipends as recommended, but is 
concerned that the NAS recommendations for increasing the 
number of awards in behavioral science, health services 
research, oral health, and nursing research were not included 
in this decision. The Academy articulated compelling national 
needs for increased training in these areas and its 
recommendations were developed with every awareness of the cost 
implications. Given the importance of a stable supply of high-
quality scientists in the areas specified in the NAS report, 
the Committee urges NIH to revisit the NAS recommendations. The 
Committee would like to receive a report on NIH's system for 
considering the NAS recommendations and establishing training 
policies in general.
    Office of Behavioral and Social Sciences.--The Committee 
has included $12,853,000 for the Office of Behavioral and 
Social Sciences. The Committee understands that behavioral 
science is an area of exceptional promise for understanding and 
ameliorating some of the Nation's most serious health concerns, 
many of which are due to behavior, and commends OBSSR for it's 
efforts to increase the visibility of behavioral science at 
NIH. The Committee recognizes that OBSSR's budget is extremely 
limited, and urges the Director to examine OBSSR's budget in 
order to increase the number of cross-NIH behavioral research 
and training initiatives.
    The Committee recognizes that stress contributes to a host 
of medical conditions confronted by health care practitioners, 
and current pharmaceutical and surgical approaches cannot 
adequately treat stress-related illnesses. Mind/body 
approaches, particularly those of the relaxation response and 
those related to utilizing the beliefs of the patients, have 
been used successfully to treat these disorders. The Committee 
is aware that the Mind/Body Medical Institute at the Harvard 
Medical School is at the forefront of research on mind/body 
interactions and their clinical applications. The Committee is 
encouraged by the results of this research and the health and 
cost benefits of mind/body approaches. The Committee encourages 
OBSSR to establish pilot mind/body medical centers to make more 
visible the benefits of mind/body medicine; to expand its 
scientific base; and to teach and train health care 
professionals in these approaches. The Committee further 
encourages the Director to establish 10 mind/body centers 
around the Nation, and report to the Committee prior to the 
consideration of next year's request on the status of the 
establishment of these centers.
    Peer review reorganization.--The Committee notes with 
interest that NIH is in the process of reorganizing its systems 
for reviewing research grant proposals. This reorganization was 
triggered by the integration of systems of NIMH, NIDA, and 
NIAA, which is adding considerably more neuroscience and 
behavioral research as an opportunity for NIH to significantly 
strengthen its behavioral science infrastructure. Because of 
the enormous budgetary and public health implications of NIH 
grant review, the Committee will continue to monitor this 
reorganization, including a plan for evaluating the changes by 
September 30, 1998.
    Hepatitis C [HCV].--The Committee notes that the March 1997 
Hepatitis C Consensus Development Conference made significant 
new research recommendations that impact several NIH 
Institutes, most particularly NIDDK, NIAID, NCI, NHLBI, NIDA, 
and NIAAA. The Committee urges that priority consideration be 
given to continuing and expanding this research. In addition, 
the Committee recently received the requested report which 
provides a strategic research plan for addressing liver and 
biliary diseases. The Committee requests that the Director 
implement and coordinate the plan to assure the new 
transinstitute research opportunities respond most effectively 
to the HCV epidemic and other liver diseases as detailed in the 
Consensus Development Conference and the livery and biliary 
strategic plan.
    Grant opportunities.--The Committee has been impressed with 
the efforts of the NIH to apply the technology of the Internet 
and specifically its weekly electronic mail service announcing 
grant opportunities. The Committee encourages the Department 
and those components that make funds available through grants 
and cooperative agreements to supplement the publication in the 
Federal Register with a weekly listserv to all interested 
parties, that links back to the full document. In addition, the 
Department should announce such availability in the Federal 
Register and at each of the Department's component pages. The 
Committee expects that this will improve the flow to all 
potential applicants concurrently in urban as well as in 
isolated communities, for example, Hawaii, Alaska, the western 
Pacific, and rural America that must now rely on the Federal 
Register to arrive in a timely manner to obtain the knowledge 
to apply for grant programs.
    Brain molecular anatomy project.--The Committee recognizes 
the brain molecular anatomy project, an NIH-wide collaboration 
lead by NIMH and NINDS, which holds the promise of identifying 
all of the genes that direct brain development and function, 
mapping them in the brain, and developing public data bases. 
The Committee encourages NIH to continue to expand research in 
these areas so that the combined tools of molecular genetics 
and neuroscience and fundamental new insights into brain 
development, disease, and behavior can be achieved.
    Breast implants.--Silicone breast implants are currently 
available only to women receiving reconstructive surgery after 
mastectomy, who have birth defects of the breast, or who need 
replacement of such implants due to leakage or rupture. The 
Committee encourages the Director to expand and intensify 
research regarding silicone implants, particularly clinical 
research, to increase understanding of the effects of implants 
on women's health.
    Parkinson's disease.--In fiscal year 1998, the Labor, 
Health and Human Services, and Education Appropriations Act, 
included the Morris K. Udall Parkinson's Disease Research Act, 
which authorized appropriations for research focused on 
Parkinson's disease. The Committee encourages the Director to 
provide a level of funding for Parkinson's focused research, 
and award 10 core center grants consistent with the Morris K. 
Udall Parkinson's Disease Research Act. The Committee further 
encourages the Director to provide funding for other provisions 
of the Udall Act, such as the scientists training program, the 
national data system of Parkinson's patient population, a 
clearinghouse, and a national education program. The Committee 
further encourages the Director to form a coordinating 
committee to direct both intramural and extramural Parkinson's 
research, and to include, as a part of this committee, all of 
the Institutes currently conducting Parkinson's research. The 
Committee requests that the NIH report to the Appropriations 
Committees within 120 days of enactment of this act on its 
plans for implementation of the recommendations outlined above.
    Extramural Associates Program [EA].--To provide increased 
opportunities for women and underrepresented minorities to 
participate in and contribute to biomedical and behavioral 
research, the Committee encourages the Director to provide 
additional funds for the EA program.
    The Committee is pleased that the NIH Director has moved 
forward with initial efforts to address the training and career 
development of clinical investigators. However, because of 
delays in responding to the clinical research crisis, the 
Committee encourages the NIH to provide additional funds to 
launch a substantial initiative at this time. The Committee 
urges the NIH to fund significantly more mentored patient-
oriented research career development awards and mid-career 
investigator in patient-oriented research awards proposed by 
NIH for fiscal year 1999. The Committee further encourages the 
NIH to move forward with grants to fund advanced degree 
training in clinical investigation as well as a loan repayment 
program for extramural clinical researchers. In addition, the 
Committee requests that the Director be prepared to discuss the 
feasibility of bonus supplemental support for investigators who 
add a patient-oriented or translational research component to 
their research project grants at the fiscal year 2000 hearings. 
Finally, the Committee commends the diligence of the NIH 
Director's advisory panel on clinical research and urges the 
NIH Director to actively involve the panel in the 
implementation of its recommendations.
    High technology surgical display.--The Committee is aware 
of the project proposal by Virtual Vision of Redmond, WA, to 
develop a head mounted surgical display that would enhance the 
operational ability of surgeons. The Committee encourages NIH 
to investigate this technology for potential clinical 
applications.
    Nutrition intervention for chronic illnesses.--The 
Committee encourages the Director to evaluate the use and 
effectiveness of nutrition intervention to reduce the level of 
prescription medications for patients with chronic diseases 
such as high blood pressure, renal disease, diabetes, and 
cardiovascular conditions. The Committee further encourages 
that the Director consult with health researchers and clinical 
practitioners with expertise in nutrition, including registered 
dietitians, and the American Dietetic Association.

                        BUILDINGS AND FACILITIES

Appropriations, 1998....................................    $206,570,000
Budget estimate, 1999...................................     258,227,000
Committee recommendation................................     263,822,000

    The Committee recommends an appropriation of $263,822,000 
for buildings and facilities [B&F]. Included in this amount is 
$40,000,000 for fiscal year 2000. The amount recommended is 
$5,595,000 more than the budget request and $57,252,000 more 
than the fiscal year 1998 appropriation.
    Mission.--The buildings and facilities appropriation 
provides for the NIH construction programs including design, 
construction, and repair and improvement of the clinical and 
laboratory buildings and supporting facilities necessary to the 
mission of the NIH. This program maintains physical plants at 
Bethesda, Poolesville, Baltimore, and Frederick, MD; Research 
Triangle Park, NC; Hamilton, MT; Perrine, FL; New Iberia, LA; 
and Sabana Seca, PR.
    Clinical research center.--The recommendation includes 
$90,000,000 in fiscal year 1999 for the fourth year of funding 
for the new Mark O. Hatfield Clinical Research Center. The 
recommendation includes the advance appropriation request 
totaling $40,000,000 as proposed in the budget request. This 
Center will replace the aging research hospital and related 
clinical laboratory facility and serve as the heart of the NIH 
intramural research program. To date, the design of the project 
has been substantially developed and site preparation is 
underway. The Committee requests that the Director provide 
notification of any revised project cost estimate that exceeds 
the current projected cost of the project.
    Vaccine lab building.--The recommendation includes funding 
to construct a laboratory to house the newly established 
Vaccine Research Center at the NIH. The Center, which will be a 
joint venture of the National Cancer Institute and the National 
Institute of Allergy and Infectious Diseases, will begin by 
incorporating a core of NIH scientists with interest and 
expertise in immunology, virology, and HIV vaccine research. 
The primary focus for the Center will be to stimulate 
multidisciplinary research from basic and clinical immunology 
and virology through to vaccine design. Construction of this 
state-of-the-art facility will help in both the recruitment of 
accomplished scientists from outside the NIH ranks and in 
accelerating progress in developing a safe and effective AIDS 
vaccine.

                        OFFICE OF AIDS RESEARCH

Appropriations, 1998....................................................
Budget estimate, 1999...................................  $1,725,588,000
Committee recommendation................................................

    The Committee recommendation does not include a direct 
appropriation for the Office of AIDS Research [OAR] as proposed 
in the budget request. Instead, funding for AIDS research is 
included within the appropriation for each Institute, Center, 
and Division of the NIH. The recommendation also includes a 
general provision which directs that the funding for AIDS 
research, as determined by the Directors of the National 
Institutes of Health and the OAR, be allocated directly to the 
OAR for distribution to the Institutes consistent with the AIDS 
research plan. The recommendation also includes a general 
provision permitting the Directors of the NIH and the OAR to 
shift up to 3 percent of AIDS research funding between 
Institutes and Centers throughout the year if needs change or 
unanticipated opportunities arise. These modifications to the 
budget recommendation are consistent with the manner in which 
funding for AIDS research was provided in fiscal year 1998. The 
Committee requests that the Director report on the fiscal year 
1999 allocation plans for AIDS research within 60 days of 
enactment and provide notification to the Committee in the 
event the Directors exercise their 3 percent transfer 
authority.
    The NIH Office of AIDS Research [OAR] coordinates the 
scientific, budgetary, legislative, and policy elements of the 
NIH AIDS research program. Congress provided new authorities to 
the OAR to fulfill these responsibilities in the NIH 
Revitalization Act Amendments of 1993. The law mandates the OAR 
to develop an annual comprehensive plan and budget for all NIH 
AIDS research and to prepare a Presidential bypass budget.
    Prevention science working group.--The Committee commends 
the Office of AIDS Research for establishing the prevention 
science working group, one of the major recommendations of the 
1996 comprehensive NIH AIDS review and evaluation report. The 
Committee urges the Office of AIDS research to broaden the 
scope of AIDS prevention by exploring research initiatives that 
link behavioral and biomedical approaches. The Committee is 
particularly interested in expanding research to identify 
distinctive patterns of behaviors and social conditions of 
women that determine their risk of infection and determine how 
women protect themselves against the spread of infection with 
partners who are infected or potentially infected with the 
disease.

       Substance Abuse and Mental Health Services Administration

Appropriations, 1998....................................  $2,147,156,000
Budget estimate, 1999...................................   2,274,643,000
Committee recommendation................................   2,151,643,000

    The Committee recommends $2,151,643,000 for the Substance 
Abuse and Mental Health Services Administration [SAMHSA] for 
fiscal year 1999, $4,487,000 more than the fiscal year 1998 
level and $123,000,000 below the administration request. SAMHSA 
is responsible for supporting mental health, alcohol abuse, and 
other drug abuse prevention and treatment services throughout 
the country, primarily through categorical grants and block 
grants to States. The Committee has provided funding for the 
Knowledge, Development, and Application Program to each of 
three authorities: mental health, substance abuse treatment, 
and substance abuse prevention. Separate funding is provided 
for the Children's Mental Health Program, the PATH formula 
grant, the Protection and Advocacy Formula Grant Program, and 
for the two block grant programs.
    The Committee has included bill language that retains the 
formula used in fiscal year 1998 for fiscal year 1999 
calculations of State allotments of the substance abuse 
performance partnership block grant and the mental health 
performance partnership block grant. States would receive an 
allotment in fiscal year 1999 proportional to what they 
received in fiscal year 1998. This provision has been included 
to allow sufficient time for the authorizing committees of 
Congress to consider legislation to reauthorize the programs of 
the Substance Abuse and Mental Health Services Administration, 
including any revisions to the existing formula.
    The Committee remains concerned by the disproportionate 
presence of substance abuse in rural and native communities, 
particularly for American Indian and Alaska Native communities. 
The Committee reiterates its belief that funds for prevention 
and treatment programs should be targeted to those persons and 
communities most in need of service. Therefore, the Committee 
has provided sufficient funds to fund projects to increase 
knowledge about effective ways to deliver services to rural and 
native communities. Within the funds reserved for rural 
programs, the Committee intends that $4,000,000 be reserved for 
CSAP grants, and $6,000,000 be reserved for CSAT grants.
    Knowledge developed and implemented through the CSAP and 
CSAT KDA grant systems should be coordinated to the fullest 
practical extent with the public alcohol and drug prevention 
and treatment system administered by the State alcohol and drug 
agencies. The Committee urges the agency to establish stronger 
linkages between KDA programs and the State network through 
regular consultation and coordination of effort with the State 
agencies and through other appropriate steps.

                   CENTER FOR MENTAL HEALTH SERVICES

Mental health, knowledge, development, and application

    The Committee recommends $57,964,000 for the mental health, 
knowledge, development, and application program [KDA], the same 
as the comparable fiscal year 1998 amount and the 
administration's request. The following programs are included 
in the mental health center KDA: Community Support Program 
[CSP]; homeless and AIDS demonstrations; and training and AIDS 
training programs.
    The Committee again restates its belief that mental health 
and substance abuse services are essential elements of primary 
care, and its concern about the impact of managed care on 
access to mental health services, and supports training of 
behavioral and mental health professionals for work in managed 
care settings, particularly in rural and underserved 
communities. The Committee urges the development of standards 
and guidelines for the delivery of such services in managed 
care entities, including curricula design and training models. 
The Committee further encourages CMHS to collaborate with the 
Health Resources and Services Administration [HRSA] on the 
development of training protocols for mental health 
professionals in primary care settings.
    The Committee has included sufficient funds to continue and 
expand the Farm Resource Center which provides outreach and 
counseling services in rural areas to displaced coal miners, 
farmworkers, and their families.
    The Committee is pleased with the successful collaboration 
between the Center for Mental Health Services and the Bureau of 
Health Professions in HRSA to fund interdisciplinary health 
professions training projects, including training of behavioral 
and mental health professionals, for practice in managed care/
primary care settings and urges that this joint effort be 
continued. The Committee encourages both agencies to develop 
technical assistance for use in health professions training 
programs for the purpose of enhancing primary care 
interdisciplinary models of practice. These efforts should be 
focused upon rural native populations that are at-risk for the 
problems most encountered by these health professionals.
    The Committee notes that survivors of torture from abroad 
represent a significant element in many of our communities. For 
many survivors, the psychological effects of torture can be 
crippling, but with treatment, they can become contributing 
members of their communities. For these reasons, the Committee 
recommends that the Center for Mental Health Services provide 
funding for research, training, and proper treatment for 
victims of torture.
    The Committee recognizes the need for comprehensive 
services for persons suffering from co-occurring disorders. An 
estimated 10 million persons in the United States have at least 
one mental disorder and at least one substance-related disorder 
in any given year. The Committee urges the Department to give 
priority to funding for treatment capacity programs that 
provide both mental health and substance abuse treatment 
services. Of the amounts provided, $3,000,000 is available from 
the Center for Mental Health Services and $2,000,000 from the 
Center for Substance Abuse Treatment for a joint award to fund 
the development of such an integrated service delivery system 
by the State of Alaska.
    The Committee supports the work of the agency in 
effectively treating individuals with mental and addictive 
disorders. In order to provide the best possible care, the 
Committee encourages the agency to create an evidence-based 
methodology developed by a national medical organization in a 
scientifically rigorous manner and based on information from 
patients and providers. This methodology will allow the agency 
to assess the quality of care while reflecting the full range 
of clinical complexity, setting, and financing and delivery 
issues that may influence that care.

Clinical and AIDS training

    The Committee is aware of the need for more trained health 
providers, including allied health professionals and social 
workers, to work with people suffering from HIV/AIDS. To the 
extent that funds are available, the Committee encourages 
SAMHSA to continue funding existing grants and contracts 
approved by SAMHSA under the current AIDS Training Program.
    The Clinical Training Program trains mental health 
personnel to deliver services to designated underserved 
populations in exchange for a repayment through service to 
underserved or priority populations, including severely 
mentally ill adults, children, and adolescents with serious 
emotional disorders, and the elderly. The AIDS Training Program 
provides training for mental health providers to address the 
neuropsychiatric aspects of HIV spectrum infection.
    The Committee recognizes that clinical training programs 
such as the Minority Fellowship Program have proven valuable in 
developing and disseminating new knowledge regarding mental 
health service delivery to SAMHSA's priority populations. 
Additionally, it remains a Federal priority to lead knowledge 
development and dissemination in this area, both for providers 
in need of inservice training, as well as for preservice 
trainees. The Committee urges the agency to fund training 
projects that foster cultural competencies, a diverse work 
force, collaboration among disciplines, and the use of 
interdisciplinary service delivery models, especially in rural 
areas such as Hawaii, where the cultural diversity factors 
predominate.

AIDS demonstrations

    This program provides 4 year grants to public and nonprofit 
private organizations to provide innovative mental health 
services to individuals who are experiencing severe 
psychological distress and other psychological sequelae as a 
result of infection with HIV. One coordinating center is 
supported to independently evaluate the quality and 
effectiveness of these services. The Committee commends the 
Center for Mental Health Services for its commitment in 
disseminating knowledge gained from these demonstration 
projects. The Committee urges the center to maintain its 
support for projects that provide direct mental health services 
while at the same time using the findings from previous 
projects to develop new knowledge in this area. The Committee 
again commends CMS for its leadership in working cooperatively 
in demonstrating the efficacy of delivering mental health 
services to individuals affected by and living with HIV/AIDS. 
The Committee encourages the Secretary to maintain these 
agencies' support for this program.

Mental health block grant

    The Committee recommends $275,420,000 for the mental health 
block grant, the same as the fiscal year 1998 amount and the 
President's request. States use these funds to support the 
development and implementation of innovative community-based 
services and maintain continuity of community programs. Funds 
are allocated to States by formula.

Children's mental health

    The Committee recommends $72,927,000 for the Children's 
Mental Health Program, the same as the fiscal year 1998 level 
and the administration's request. This program provides grants 
and technical assistance to support community-based services 
for children and adolescents with serious emotional, behavioral 
or mental disorders. States must provide matching funds, and 
services must involve the educational, juvenile justice, and 
health systems.

Projects for assistance in transition from homelessness [PATH]

    The Committee recommends $25,000,000 for the PATH Program, 
$2,000,000 more than the fiscal year 1998 amount and the 
administration's request.
    PATH is a critical program which provides outreach, mental 
health, and case management services and other assistance to 
persons who are homeless and have serious mental illnesses. The 
PATH Program makes a significant difference in the lives of 
homeless persons with mental illnesses. PATH services eliminate 
the revolving door of episodic inpatient and outpatient 
hospital care. Multidisciplinary teams address client needs 
within a continuum of services, providing needed stabilization 
so that mental illnesses and co-occurring substance abuse and 
medical issues can be addressed. Assistance is provided to 
enhance access to housing, rehabilitation and training, and 
other needed supports, assisting homeless people in returning 
to secure and stable lives.

Protection and advocacy

    The Committee recommends $22,957,000 for protection and 
advocacy, $1,000,000 more than the fiscal year 1998 amount and 
the administration's request. This program helps ensure that 
the rights of mentally ill individuals are protected while they 
are patients in treatment facilities and for 90 days following 
their discharge. Funds are allocated to States according to a 
formula based on population and relative per capita income.

                  CENTER FOR SUBSTANCE ABUSE TREATMENT

Substance abuse treatment knowledge, development, and application

    The Committee recommends $155,868,000 for the substance 
abuse treatment knowledge, development, and application program 
[KDA]. This amount is $40,441,000 more than the 
administration's request and the same as the comparable fiscal 
year 1998 amount.
    The Committee has provided sufficient funds to continue all 
existing residential women and children grants. The Committee 
has provided funds to continue the supplemental demonstration 
and evaluation of enhanced children's services as part of the 
Center for Substance Abuse and Mental Health Centers' 
Residential Women and Children and Pregnant and Postpartum 
Women Programs.
    The Committee reiterates its concern about the 
disproportionate impact of substance abuse in rural and native 
communities, and has included $6,000,000 for rural CSAT 
programs. The Committee again acknowledges the severe shortage 
of services in the State of Alaska, the pressing need to 
continue support of Alaska programs, and the need to develop 
knowledge about effective techniques for treating and 
preventing substance abuse in native populations. The 
Committee, therefore, expects that the increase provided will 
be reasonably allocated between expanding existing programs and 
initiating new programs, especially in Alaska.
    The Committee supports CSAT's efforts to assist women with 
substance abuse problems and their children in residential 
settings. Of the funds provided, the Committee has included 
$1,000,000 to provide assistance to rural areas in Alaska to 
support the expansion of services for women and children as 
part of the Targeted Capacity Expansion Program.
    The Committee recognizes the success of the Mental Health 
Association of Colorado [MHAC] as a leading educator and 
advocate on mental health and mental illness issues in the 
Rocky Mountain region and notes that sufficient funds are 
available to assist MHAC's efforts.
    The Committee again recognizes the work of the model 
initiative in San Francisco for its comprehensive and 
community-based treatment on demand and substance abuse 
prevention. The Committee has provided sufficient funds to 
continue planning, implementation, and evaluation of this 5-
year demonstration initiative. The Committee requests a report 
from SAMHSA by March 31, 1999, on the progress made from the 
first year of funding for this initiative.
    The Committee is concerned that substance abuse among the 
Nation's homeless population remains a serious problem that 
receives limited attention. The Committee encourages the 
Department to address the unique needs and life circumstances 
of homeless people through a targeted treatment program.
    The Committee is aware of the work of the Center Point 
Program in Marin County, CA, which provides comprehensive, 
affordable substance abuse, and related services to high-risk 
families and individuals. The Committee urges the agency to 
give full and fair consideration to a proposal from the program 
to design and evaluate an employment-related skills curriculum 
to prepare people battling addiction to make the transition to 
employment.
    The Committee is concerned about the growing problem of 
substance abuse among children and teenagers. The Committee 
encourages the Department to develop and disseminate new 
treatment models for adolescents. These efforts should include 
a focus on effective school-based intervention.
    In addition, the Committee recognizes that substance 
abusing youth are at a high risk for involvement in the 
juvenile justice system. Therefore, the Committee encourages 
the Department to support the development of models that foster 
linkages between school-based and juvenile justice 
interventions. Some promising approaches that warrant further 
testing include juvenile assessment centers, truancy 
interventions, mentoring, family empowerment, and juvenile drug 
courts.
    The Committee is aware of the work of Home/Life Services, 
Inc., of New York in providing social services to single women 
and their young children in the Bronx. The Committee urges the 
agency to give full and fair consideration to a proposal by 
Home/Life Services to treat 170 drug abusers with the HIV/AIDS 
virus in order to enable these individuals to become self-
sufficient.
    The Committee is aware of efforts by the National 
Association of Alcoholism and Drug Abuse Counselors to document 
the history of the addiction counseling profession. The 
Committee commends the profession for its work in fighting 
alcoholism and drug addiction and applauds the association for 
its efforts to document this important work.
    The Committee understands that methamphetamine abuse has 
become a major problem in many areas of the country, in 
particular, the South and Midwest. The State of Iowa has 
experienced a particularly high incidence of methamphetamine 
abuse. The Committee has included sufficient funding for a 
demonstration project in Iowa targeting both the treatment and 
the prevention of methamphetamine abuse in Iowa by both 
expanding treatment capacity and strengthening prevention 
activities.
    The Committee notes that the Department should strengthen 
the linkages between the block grant and the KDA grants to 
assure maximum leverage of Federal dollars. Linkages between 
the KDA's and the State grants will allow for the integration 
of KDA knowledge into the practice of substance abuse 
prevention and treatment on an individual State and nationwide 
basis.

Substance abuse block grant

    The Committee recommends $1,310,107,000 for the substance 
abuse block grant, the same as the comparable fiscal year 1998 
level and $195,000,000 less than the administration's request.
    The substance abuse block grant provides funds to States to 
support alcohol and drug abuse prevention, treatment, and 
rehabilitation services. Funds are allocated to the States 
according to formula. State plans must be submitted and 
approved annually. Each State's allotment for fiscal year 1999 
will be determined using the statutory formula for distribution 
as applied in fiscal year 1998.

                 CENTER FOR SUBSTANCE ABUSE PREVENTION

Substance abuse prevention, knowledge, development, and application

    The Committee has provided $151,000,000 for the substance 
abuse prevention, knowledge, development, and application 
program, the same as the comparable fiscal year 1998 amount and 
$33,559,000 more than the administration's request.
    The Committee also provides $7,000,000 for the purpose of 
making grants to public and nonprofit private entities for 
projects to demonstrate effective models for the prevention, 
treatment, and rehabilitation of drug abuse and alcohol abuse 
among high risk youth, as authorized by section 517 of the 
Public Health Service Act as amended. The Committee is highly 
concerned about the extent of substance abuse among high risk 
youth. This population is vulnerable to initiating criminal 
activity against people and property, especially following the 
acute and chronic use of illicit substances and the abuse of 
alcohol. These grants are intended to strengthen local 
capabilities in confronting the complex interrelationships 
between substance and alcohol abuse and other activities that 
may predispose young individuals toward criminal, self-
destructive, or antisocial behavior.
    In implementing the State Incentive Grant Program, CSAP and 
the States should give priority in the use of available funds 
to work with new and existing community coalitions; use these 
coalitions to plan and implement cost-effective strategies; and 
fill the service gaps identified through community level 
strategic planning and needs assessments.
    The Committee expects that States receiving funding under 
the State Incentive Grant Program will give priority in the use 
of the 20 percent prevention set-aside in the block grant to: 
(1) working with community coalitions to develop communitywide 
strategic plans and needs assessments; and (2) filling program 
and service gaps identified by these community plans.
    The Committee reiterates its concern about the 
disproportionate impact of substance abuse in rural and native 
communities, and has included $4,000,000 for CSAP programs 
which serve rural communities. The Committee intends this 
increase to be reasonably allocated between expanding existing 
programs and initiating new programs, especially in Alaska.
    The Committee supports CSAP's efforts in reducing drug use 
among teenage girls and recognizes the importance of such 
activities in improving the long-term quality of life for 
teenagers by reducing teenage pregnancy.
    The Committee believes that prevention programs need to 
start when children are young, and need to continue to help 
children make successful transitions. The Committee has 
included sufficient funds for evaluations of established 
school-based early prevention and transition programs and 
continues to be supportive of the efforts of the Corporate 
Alliance for Drug Education [CADE] which has been operating a 
program providing education and prevention services to 120,000 
elementary school-aged children in Philadelphia.
    The Committee is aware of a drug- and alcohol-free 
leadership training initiative being conducted by Green 
Mountain Prevention Programs in Vermont. Building teen-based 
support for activities that do not involve alcohol and drug use 
is an important way to prevent substance abuse and addiction. 
The Committee urges the Department to provide full and fair 
consideration to a $200,000 proposal from Green Mountain 
Prevention Programs for this purpose.
    The Committee commends CSAP for recognizing problems 
created by past use of the phrase, ``Alcohol and Other Drugs'' 
[AOD]; however, many constituencies which rely on CSAP for 
leadership and funding are not aware of the agency's important 
policy change. The Committee urges CSAP to fully implement its 
move away from AOD terminology, through direct communications 
to other Government agencies including the Department of 
Education, nonprofit organizations, and other CSAP 
constituencies, without prescribing specific speech to 
grantees.
    The Committee has included sufficient funds to continue the 
two new Iowa community schools projects first funded in fiscal 
year 1997.
    Within the funds available, the Committee urges CSAP to 
continue the national effort to provide alcohol and substance 
abuse prevention and education to children of native Americans 
with alcoholism.

                           PROGRAM MANAGEMENT

    The Committee recommends $55,400,000 for program management 
activities of the agency, $2,000,000 more than the President's 
request and $487,000 more than the 1998 level.
    The program management activity includes resources for 
coordinating, directing, and managing the agency's programs. 
Program management funds support salaries, benefits, space, 
supplies, equipment, travel, and departmental overhead required 
to plan, supervise, and administer the programs.
    The Committee is aware of the administration's proposal to 
begin the process of sealing off and preservation of the 
buildings of St. Elizabeth's Hospital, to bring the complex 
closer toward the standard of care expected of its designation 
as a national historic landmark. The Committee further expects 
any additional funds for preservation to be derived from 
carryover balances from amounts previously appropriated for 
buildings and facilities.

                            DATA COLLECTION

    The administration requested $22,000,000 to expand the 
national household survey on substance abuse to facilitate the 
development of State-level estimates of substance abuse and the 
impact of youth prevention programs. The Committee has 
recommended $18,000,000 for this activity, which is the same as 
the 1998 level.

     RETIREMENT PAY AND MEDICAL BENEFITS FOR COMMISSIONED OFFICERS

Appropriations, 1998....................................    $190,739,000
Budget estimate, 1999...................................     201,635,000
Committee recommendation................................     201,635,000

    The Committee provides an estimated $201,635,000 for 
retirement pay and medical benefits for commissioned officers 
of the U.S. Public Health Service. This is the same as the 
administration request and is $10,896,000 over the estimated 
payments for fiscal year 1998.
    This account provides for: retirement payments to U.S. 
Public Health Service officers who are retired for age, 
disability, or length of service; payments to survivors of 
deceased officers; medical care to active duty and retired 
members and dependents and beneficiaries; and for payments to 
the Social Security Administration for military service 
credits.

               Agency for Health Care Policy and Research

Appropriations, 1998....................................    $146,510,000
Budget estimate, 1999...................................     171,055,000
Committee recommendation................................     171,055,000

    The Committee recommends $50,000,000 in Federal funds for 
the Agency for Health Care Policy and Research [AHCPR]. In 
addition, the Committee provides transfers of $121,055,000 from 
funds available under section 241 of the Public Health Service 
Act. Total funding provided for the Agency is $171,055,000, 
which is $24,545,000 over the fiscal year 1998 funding and the 
same as the administration's request.
    The Agency for Health Care Policy and Research was 
established in 1990 to promote improvements in clinical 
practice and patient outcomes, promote improvements in the 
financing, organization, and delivery of health care services, 
and increase access to quality care. AHCPR is the Federal 
agency charged to produce and disseminate scientific and 
policy-relevant information about the cost, quality, access, 
and medical effectiveness of health care. AHCPR provides 
policymakers, health care professionals, and the public with 
the information necessary to improve cost effectiveness and 
appropriateness of health care and to reduce the costs of 
health care.

                  Health Costs, Quality, and Outcomes

    The Committee provides $140,914,000 for research on health 
costs, quality and outcomes [HCQO]. Of the amount provided, 
$93,255,000 is derived from section 241, 1-percent evaluation 
set-aside funds. This is a new budget activity; within this 
account the Administration proposes to incorporate activities 
previously identified as research on health care systems cost 
and access and as research on health care outcomes and quality. 
The combined expenditure of these two previously separate 
categories totaled $107,980,000 in fiscal year 1998, of which 
$19,906,000 was derived from section 241, 1-percent evaluation 
set-aside funds. HCQO research activity is focused upon 
improving clinical practice, improving the health care system's 
capacity to deliver quality care, and tracking progress toward 
health goals through monitoring and evaluation.
    Improving women's health and the diagnosis of gynecologic 
cancers.--Information has been brought to the Committee's 
attention that of the more than the estimated 50 million pelvic 
examinations performed annually to detect gynecologic 
pathology, a significant fraction yield inconclusive results 
that often require expensive retesting and invasive medical 
procedures. The Committee is aware of the development of highly 
mobile and miniaturized digital ultrasound technology that 
holds the promise of higher efficiency, lower costs, and higher 
quality of care. The Committee encourages the agency to conduct 
outcomes research that would incorporate the use of ultrasound 
as a standard of care for women's health services.
    Rural managed care program.--The Committee has included 
sufficient funds to continue rural managed care demonstration 
projects.
    The Committee is aware of the rural cardiovascular managed 
care demonstration being planned by the Catherine and Charles 
B. Owen Cardiovascular Research Institute located in Asheville, 
NC, and encourages the agency to review its merits.
    Collaboration with managed care organizations.--The 
Committee is aware of efforts by the agency to develop 
collaborative agreements with private managed care 
organizations, especially the Academic Medicine and Managed 
Care Forum. The Committee understands that a collaboration 
between Government, academia, and the managed care industry may 
yield useful findings, particularly in the area of health 
services research designed to demonstrate how managed care 
principles can be applied to produce quality outcomes. The 
agency is encouraged to pursue such a collaboration.
    Pharmaceutical outcomes research.--The Committee is aware 
of potential adverse reactions from prescribed medications. 
While development testing provides important information on 
potential adverse reactions, there remains inadequate national 
research capability to reduce the risks of prescription 
medications once they enter the market. Within the funds 
provided, the Committee encourages the agency to enhance 
research in this area and to consult widely with the Food and 
Drug Administration, consumer groups, and academic centers to 
develop a prospective plan to abate these risks.
    Maternal and child health care systems research.--The 
Committee is concerned that significant cultural, 
organizational, and financial barriers to managed care 
providers access exist for Medicaid clients. The Committee is 
further concerned that significant numbers of undereducated and 
underemployed mothers and their infants and children are, 
therefore, not receiving adequate care and urges systems 
research on ways to assure high levels of access and promotion 
of preventative care and measurement of outcomes quality for 
this segment of the population.
    Children's health.--The Committee is supportive of the 
Agency's efforts to establish a children's health services 
agenda. The Committee continues to encourage AHCPR to work with 
schools of nursing to identify the high risk areas requiring 
research to provide better direction in caring for this 
vulnerable group and to continue work with the Emergency 
Medical Services for Children Program at the Health Resources 
Services Administration to evaluate the potential impact of 
managed care on children's access to emergency medical care.
    Minority and underserved populations.--The Committee 
remains very supportive of the Agency working with the State of 
Hawaii, its unique health insurance plan, and its culturally 
diverse population and encourages continued support of 
initiative.
    Employee perspectives.--The Committee is supportive of 
efforts to solicit the perspectives of nonphysician health care 
professionals on enhancing quality of care and reducing costs. 
The Committee encourages research on contributing factors that 
enable employees to become effective contributors to care 
delivery, and urges the agency to consider developing a 
methodology to include health care employee perspectives on 
their role in health care delivery.
    Childhood caries.--The Committee is aware that the Early 
Childhood Caries [ECC] Conference, which was held at the NIH in 
October 1997, found that the prevalence, seriousness, and 
societal costs of ECC have not diminished despite the worldwide 
declining rates of caries among school-aged children. Early 
detection and appropriate referral of at-risk children appear 
to be important, unresolved issues. The agency is encouraged to 
identify the extent of dental health services research 
currently being supported across the Federal Government.

            health insurance and expenditures panel surveys

    The Committee provides $27,800,000 for health insurance and 
expenditures panel surveys [MEPS], which is the same as the 
administration request and $8,500,000 below the 1998 level. The 
entire amount provided is derived from 1 percent evaluation 
set-aside funds. Within this category of activity, the 
Administration proposes to include activities previously 
designated as research on health insurance and expenditure 
surveys. MEPS is intended to obtain timely national estimates 
of health care use and expenditures, private and public health 
insurance coverage, and the availability, costs and scope of 
private health insurance benefits. It also develops cost and 
savings estimates of proposed changes in policy and identifies 
impact of policy changes on payers, providers, and patients.

Program support

    The Committee recommends $2,341,000 for program support. 
This amount is the same as the administration request and is 
$111,000 higher than the 1998 level. This activity supports the 
overall management of the Agency.

                  Health Care Financing Administration

                     GRANTS TO STATES FOR MEDICAID

Appropriations, 1998.................................... $66,080,207,000
Budget estimate, 1999...................................  74,593,733,000
Committee recommendation................................  74,593,733,000

    The Committee recommends $74,593,733,000 for grants to 
States for Medicaid. This amount is $8,513,526,000 more than 
the fiscal year 1998 appropriation and the same as the 
administration's request. This amount excludes $27,800,689,000 
in fiscal year 1998 advance appropriations for fiscal year 
1999. In addition, $28,733,605 is provided for the first 
quarter of fiscal year 2000, as requested by the 
administration.
    The Medicaid Program provides medical care for eligible 
low-income individuals and families. It is administered by each 
of the 50 States, the District of Columbia, Puerto Rico, and 
the territories. Federal funds for medical assistance are made 
available to the States according to a formula which determines 
the appropriate Federal matching rate for State program costs. 
This matching rate, which may range from 50 to 90 percent, is 
based upon the State's average per capita income relative to 
the national average.
    The Committee commends the Department for releasing a 
letter on July 29, 1998, to State Medicaid directors clarifying 
that the Americans with Disabilities Act obligates States to 
offer appropriate community-based services. The Committee 
expects that HCFA will adopt policies and procedures for 
ensuring that States take necessary steps to come into 
compliance with the policy set out in the letter. The Committee 
expects that these steps will include developing additional 
technical assistance materials and ensuring that the ADA 
compliance issues are a component of ongoing monitoring of 
State programs. The Committee directs HCFA to report back to 
the Committee within 6 months regarding the steps taken to 
ensure that the policy set out in the letter is implemented by 
the States.
    The Committee is also concerned that there is insufficient 
oversight of current ICF/MR and home- and community-based 
waiver programs. The Committee strongly encourages the Health 
Care Financing Administration to commit appropriate resources 
to ensure the provision of ongoing training, technical 
assistance, and quality assurance support to regional and State 
personnel who are responsible for implementation and review of 
ICF/MR and waiver programs.
    The Committee is concerned by GAO's recent findings of 
widespread noncompliance in screening children served by 
Medicaid for lead poisoning and requests the Department to 
submit a report by February 1, 1999, on the policy, program, 
oversight, enforcement, and education steps it is taking to 
dramatically increase blood lead screening of children served 
by Medicaid, a population known to be at high risk.
    The Balanced Budget Act of 1997 requires HCFA to conduct a 
study of the impact that Medicaid managed care will have on 
special health care populations. This study is very important 
because States are serving these individuals, in ever 
increasing numbers, in capitated settings. The Committee 
strongly urges HCFA to initiate this study as soon as possible 
and asks that the Secretary update the Committee on the status 
of this report no later than December 31, 1998.

                  PAYMENTS TO HEALTH CARE TRUST FUNDS

Appropriations, 1998.................................... $60,904,000,000
Budget estimate, 1999...................................  62,953,000,000
Committee recommendation................................  62,953,000,000

    The Committee recommends $62,953,000,000 for Federal 
payments to the Medicare trust funds. This amount is the same 
as the administration's request and is an increase of 
$2,049,000,000 from the fiscal year 1998 appropriation.
    This entitlement account includes the general fund subsidy 
to the supplementary medical insurance trust fund (Medicare 
part B), plus other reimbursements to the hospital insurance 
trust fund (Medicare part A), for benefits and related 
administrative costs which have not been financed by payroll 
taxes or premium contributions.
    The Committee has provided $62,171,000,000 for the Federal 
payment to the supplementary medical insurance trust fund. This 
payment provides matching funds for premiums paid by Medicare 
part B enrollees. This amount is the same as the administration 
request, and is $1,432,000,000 more than the fiscal year 1998 
amount.
    The recommendation also includes $555,000,000 for hospital 
insurance for the uninsured. This amount is the same as the 
administration's request and is $607,000,000 more than the 1998 
amount.
    The Committee also recommends $97,000,000 for the Federal 
uninsured benefit payment. This payment reimburses the hospital 
insurance trust fund for the cost of benefits provided to 
Federal annuitants who are eligible for Medicare. This amount 
is the same as the administration's request and is $11,000,000 
more than the fiscal year 1998 appropriation.
    The Committee recommendation includes $130,000,000 to be 
transferred to the hospital insurance trust fund as the general 
fund share of HCFA's program management administrative 
expenses. This amount is the same as the administration's 
request and is $1,000,000 less than the fiscal year 1998 level.

                           PROGRAM MANAGEMENT

Appropriations, 1998....................................  $1,788,907,000
Budget estimate, 1999...................................   1,942,500,000
Committee recommendation................................   1,685,550,000

    The Committee recommends $1,685,550,000 for HCFA program 
management. This is $256,950,000 less than the budget request 
and $103,357,000 less than the fiscal year 1998 enacted level.

Research, demonstrations, and evaluation

    The Committee recommends $75,000,000 for research, 
demonstration, and evaluation activities. This amount is 
$25,000,000 more than the budget request and $23,500,000 more 
than the amount provided in fiscal year 1998.
    HCFA research and demonstration activities facilitate 
informed, rational Medicare and Medicaid policy choices and 
decisionmaking. These studies and evaluations include projects 
to measure the impact of Medicare and Medicaid policy analysis 
and decisionmaking, to measure the impact of Medicare and 
Medicaid on health care costs, to measure patient outcomes in a 
variety of treatment settings, and to develop alternative 
strategies for reimbursement, coverage, and program management.
    The recommended funding level for the research and 
demonstration program will provide for continuation of current 
activities including telemedicine demonstration projects, which 
should remain a high priority. Priority areas for HCFA research 
include access to high-quality health care, health service 
delivery systems, and provider payment systems. In addition, 
within the funds provided, the Committee has included 
$25,000,000 to fully fund the Medicare rural hospital 
flexibility grants program authorized in the Balanced Budget 
Act of 1997.
    The Committee strongly supports continued funding for the 
Temple University Hospital Ventilator Rehabilitation Unit. 
Demonstration authority for this highly successful project, 
rated outstanding in the Nation by an independent audit, 
expired June 30, 1998. The Committee expects, therefore, that 
the HCFA project with respect to chronic ventilator-dependent 
units in hospitals, be extended for 3 years for the ventilator-
dependent unit at Temple University Hospital.
    The Committee is aware that individuals who require long-
term care services often require the assistance of an attendant 
in nursing homes and other institutions. However, under 
Medicaid law, these individuals are not guaranteed the right to 
remain in their own homes and communities while receiving this 
assistance. In order to test the potential application of 
community-based assistance programs nationwide and to determine 
the actual cost of attendant care services, the Committee 
recommendation includes $2,000,000 of the amount available for 
research, demonstration, and evaluation activities to continue 
carrying out demonstration projects on Medicaid coverage of 
community-based attendant care services for people with 
disabilities which ensure maximum control by the consumer to 
select and manage their attendant care services.
    The Committee recommendation includes $500,000 for a study 
by the Institute of Medicine of the National Academy of 
Sciences on the payments under part B of title XVIII of the 
Social Security Act for clinical laboratory tests. The 
Committee urges HCFA to initiate this critically important 
study immediately.
    The Committee understands that malnutrition can lead to an 
increased susceptibility to many illnesses and that elderly 
Americans are at a higher risk of malnutrition due to many 
physiological and environmental changes associated with aging. 
Studies have indicated that medical nutrition therapy by 
registered dietitians may improve health and lower treatment 
costs for patients with diabetes, cancer, pressure ulcers, 
cardiovascular disease, kidney disease, and other health 
problems that disproportionately afflict the elderly. Last year 
the Committee urged the Secretary of Health and Human Services 
to conduct a 2-year demonstration project on coverage of 
medical nutrition therapy by registered dietitians in the part 
B portion of Medicare to investigate its impact on program 
costs, savings and beneficiary health, and quality of life. The 
Committee is concerned that no progress has been made on this 
demonstration and expects the Secretary to proceed with this 
project and provide a report on its status by December 31, 
1998. In addition, the Secretary is urged to give strong 
consideration to the views of the American Dietetic Association 
and registered dietitians in developing and implementing this 
documentation.
    The Committee is aware of the efforts at the University of 
Missouri's Sinclair School of Nursing regarding health care 
quality and access for the vulnerable, frail elderly. The 
Committee included language in the fiscal year 1998 report 
regarding care for the frail elderly and continues to believe 
that HCFA should focus on this type of activity in fiscal year 
1999. The Committee recommendation includes $2,000,000 to 
support research conducted at the Sinclair School's Tiger 
Place, to develop a comprehensive elderly health care delivery 
model evaluation.
    The Committee urges the agency to grant full and fair 
consideration to a $100,000 research and demonstration effort 
by the Littleton Regional Hospital in Littleton, NH, for rural 
health, wellness, and education projects. Sufficient funds are 
available to address the high levels of unmet needs in rural 
areas, and the Committee believes that expanding patient care 
capabilities through wellness and education programs, clinical 
data base networks to assess rural community health needs, 
telemedicine and trauma care development for pediatrics, and 
environmental emergencies such as hypothermia are noteworthy 
projects.
    The Committee encourages HCFA to include the concept of 
nurse-run clinics and the utilization of advanced practice 
nurses as primary care providers in its research and 
demonstration activities. As Medicare and Medicaid move into 
the managed care arena, it is important that the most effective 
health care delivery systems be identified and utilized. Health 
promotion and prevention initiatives which are integral 
functions of nursing will play a significant role in the future 
of health care of our aging population.
    The Committee recommendation includes $1,000,000 to conduct 
a pilot program for optical memory cards to be used for the 
recording and keeping of medical records. The Committee 
recommends that this pilot program, with Medicare patients on a 
volunteer basis, be conducted with 8 to 12 hospitals and/or 
nursing homes in the New Jersey/eastern Pennsylvania area. The 
Committee recognizes that there are concerns about the security 
of such a system. A person's medical history is an extremely 
private matter. Only a patient, a doctor, and those who the 
patient wishes to take into their confidence should have access 
to a patient's medical record. Therefore, the Committee urges 
that this demonstration program carefully address privacy 
concerns, including the development of a security code that 
will ensure that only the patient will have access to his or 
her records.
    The Committee remains fully committed to HCFA's 
telemedicine demonstration projects. In fiscal year 1998, the 
Committee provided additional funds for the administrative and 
evaluation costs at these sites in order to ensure that they 
would be able to continue operating through the full period 
associated with HCFA's pilot reimbursement waiver program. This 
year's recommendation includes funds for these costs in fiscal 
year 1999. The Committee recommends that the participating 
projects be charged with expanding the distribution of these 
administrative funds to cover as many of those sites which are 
eligible under the Medicare reimbursement waived as 
practicable. Finally, the Committee reiterates its 
recommendation that HCFA fund and evaluate, store, and forward 
applications, telemental health, and emergency care services as 
part of these demonstrations.
    The Committee has been informed that Medicare patients 
receiving hospital treatment for chronic conditions who 
concurrently receive hospital based psychological services have 
improved health outcomes at lower overall cost. These 
additional psychological services are only provided at a few 
teaching hospitals around the country. For example, at the 
University of Florida, clinical psychologists working in Shands 
Teaching Hospital treat a variety of individuals with medical 
and psychological disorders. The Committee, therefore, urges a 
3-year demonstration, at appropriate university teaching 
hospitals, to demonstrate the cost and health outcome of 
psychological counseling services for Medicare patients 
receiving hospital based treatment and care for chronic 
conditions.
    The Committee is aware of the interest of the Community 
Development Commission of the county of Los Angeles and the 
Charles R. Drew University of Medicine and Science to expand 
the Nation's first urban telemedicine demonstration program, 
and urges full and fair consideration of a proposal from this 
organization. This demonstration project, which serves people 
living in public housing, will provide a model for using 
telemedicine technology in health care delivery to underserved 
inner-city communities, broadening the use of telemedicine 
beyond the more common rural use. Since the program's inception 
in November 1996, it has shown the cost-effective potential of 
disease surveillance and early screening afforded by 
telemedicine at public housing sites.
    The Committee encourages HCFA to provide medical education 
coverage for a dental school-based demonstration project in 
which postgraduate dental students provide dental care in 
school facilities and remote sites that result in improved 
access to primary dental services. The Committee notes that the 
University of Pennsylvania School of Dental Medicine is well 
qualified to provide such services.

Medicare contractors

    The Committee recommends a program level of $1,269,700,000 
for Medicare contractors, which is the same as the 
administration's request and $53,559,000 more than the 
comparable fiscal year 1998 appropriation. This figure reflects 
$165,500,000 in user fees proposed by the administration, to 
charge Medicare providers for processing paper claims and 
duplicate or unprocessable claims and for initial and continued 
enrollment in the Medicare Program. The Committee, however, has 
not included legislative language for the user fees, since 
authorization of such fees is within the jurisdiction of the 
Finance Committee but has, like the administration, included 
the fees in the program level totals. If such legislation is 
not enacted, the Committee intends to review this matter in the 
conference with the House. In addition, $560,000,000 is 
available for the Medicare Integrity Program within the 
mandatory budget as part of the recently enacted health 
insurance reform legislation.
    The Committee bill includes direct funding of 
$1,081,700,000 for Medicare contractor activities. This request 
excludes the administration's user fee proposal, and also 
reflects a $22,500,000 reduction from the amount requested for 
year 2000 activities, for which funding is being provided on a 
Governmentwide basis.
    Medicare contractors, who are usually insurance companies, 
are responsible for reimbursing Medicare beneficiaries and 
providers in a timely fashion and a fiscally responsible 
manner. These contractors also provide information, guidance, 
and technical support to both providers and beneficiaries.
    The Committee agrees that contracts with States for health 
advisory services programs for Medicare beneficiaries is an 
allowable activity under the Medicare contractor beneficiary 
services budget, and recommends $15,500,000 for this activity 
in fiscal year 1999. These contracts would provide assistance, 
counseling, and information activities relating to Medicare 
matters as well as Medicare supplemental policies, long-term 
care insurance, and other health insurance benefit information.
    The Committee is pleased that HCFA has drafted a 
comprehensive plan to guide their efforts to reduce Medicare 
losses to fraud, waste, and abuse. This report demonstrates the 
agency's increased focus on the problem. The Committee asks the 
agency to further strengthen the report by outlining in more 
specific detail planned actions and timelines for 
implementation. The Committee strongly believes that medical 
reviews, cost report audits, and fraud reviews must be 
significantly increased and better targeted and urges the 
agency to take steps in this direction. The Committee also 
urges the agency and its contractors to place greater emphasis 
on prepayment reviews to prevent mispayments in the first 
place. Finally, the Committee urges the agency to promptly 
develop and implement stronger program integrity performance 
criteria for its contractors as a part of this plan.
    The Health Insurance Portability and Accountability Act of 
1996 authorized separate payment integrity contractors for the 
Medicare program. The Committee urges HCFA to move promptly to 
begin testing three to five models of such contractors by early 
1999. The test should compare contractors with experience 
combating health care fraud and abuse in the private sector and 
current Medicare contractors. The Committee is aware, for 
example, that a number of companies have demonstrated capacity 
in this area while working on property and automobile insurance 
and should be carefully considered. In addition, for the test 
to be meaningful, the test areas should be geographically 
distributed, include rural and urban areas, and include at 
least one area with a high proportion of teaching hospitals and 
research institutions.
    The Committee is aware that HCFA recently completed tests 
of commercial off-the-shelf computer software designed to 
reduce Medicare mispayments and found that significant savings 
could be achieved by employing edits from the tested software. 
The Committee urges HCFA to promptly incorporate these edits 
and to test other commercial software for other edits that 
could be used to further increase savings while maintaining 
current Medicare regulations.
    The Committee recognizes the challenge that HCFA faces in 
providing Medicare beneficiaries with access to the newest 
medical technologies whose costs are justified by improvements 
in health outcomes, while limiting access to technologies of 
lesser or unknown value. However, the Committee is concerned 
that HCFA's failure to develop an open and accountable process 
for coverage determinations for technology and procedures with 
clear standard and criteria has created an unnecessary barrier 
to access to new technologies for Medicare beneficiaries. On 
January 13, 1998, GAO concluded that one element of HCFA's 
process, the Technical Advisory Committee, was in violation of 
the Federal Advisory Committee Act.
    The Committee understands that HCFA is aware of this 
problem and is in the process of developing a Federal Register 
notice that will document the process for making coverage 
determinations. This process should involve representatives 
from patient advocacy organizations, physician groups, medical 
research institutions, and the medical technology industry. The 
Committee expects that the process will be open to the public, 
include the full participation of interested stakeholders, 
establish clear standards and criteria, offer flexible coverage 
options, clarify when national and local decisionmaking is 
appropriate, include collaboration with NIH and other research 
institutions, as well as an appeals mechanism.

State survey and certification

    Survey and certification activities ensure that 
institutions and agencies providing care to Medicare and 
Medicaid beneficiaries meet Federal health, safety, and program 
standards. Onsite surveys are conducted by State survey 
agencies, with a pool of Federal surveyors performing random 
monitoring surveys.
    The Committee recommends $124,700,000 for Medicare State 
survey and certification activities. The administration has 
proposed a user fee to cover the cost of a Medicare initial 
certification survey and to cover one-third of the cost of 
recertification surveys. The administration estimates that the 
income from these fees will total $62,300,000 in fiscal year 
1999. The Committee has not included legislative language for 
the user fee since authorization of such a fee is within the 
jurisdiction of the Finance Committee, but if the fee is 
authorized, $187,000,000 will be available for State survey and 
certification activities, $20,000,000 more than the 
administration's request. If such legislation is not enacted, 
the Committee intends to review this matter in the conference 
with the House.
    The Committee is committed to insuring that nursing home 
residents receive the quality of care required by the Nursing 
Home Reform Act of 1987 [NHRA]. An indepth investigation by the 
General Accounting Office into the quality of care in 
California nursing homes found that far too many of these homes 
provide chronically substandard care. Such quality of care 
problems persist at least in part because HCFA has followed a 
permissive approach to nursing home compliance with the NHRA. 
The GAO made a number of recommendations to improve the survey 
and certification and enforcement process. Furthermore, the 
President, in July 1998, made proposals to improve survey and 
certification and enforcement procedures based on a HCFA study 
concluding that these procedures should be substantially 
strengthened. The Committee intends that HCFA use this increase 
in funding to achieve immediate improvements in the survey and 
certification and enforcement process including prompt 
implementation of the GAO recommendations and the President's 
initiatives.

Federal administration

    The Committee recommends a program level of $455,800 for 
Federal administrative costs. This is the same as the 
administration's request. This figure reflects the user fee, 
proposed by the administration, to assess a fee on managed care 
plans participating in Medicare to cover the cost of processing 
initial applications and annual renewal of contracts. The 
administration estimates that the income from this fee will 
total $36,700,000 in fiscal year 1999. The Committee has not 
included legislative language for the user fees, since 
authorization of such fees is within the jurisdiction of the 
Finance Committee but has, like the administration, included 
the fees in the program level totals. If such legislation is 
not enacted, the Committee intends to review this matter in the 
conference with the House.
    The Committee bill includes $406,084,000 for Federal 
administrative costs. This is $15,000,000 less than the 
administration's request. The $15,000,000 represents the 
portion of the administration's request that is for year 2000 
activities, for which funding is being provided on a 
Governmentwide basis.
    The Committee remains extremely concerned with the amount 
of money lost every year to fraud, waste, and abuse in the 
Medicare program. The Committee has held many hearings and 
taken other corrective actions over a 10-year period to expose 
and reduce these losses. The Balanced Budget Act contains a 
number of important reforms derived from Committee hearings. 
The Committee urges HCFA to promptly utilize these new 
authorities for competitive bidding and improved beneficiary 
information so that savings to Medicare will accrue as quickly 
as possible. Because the Veterans Administration has 
successfully operated competitive bidding programs for medical 
supplies for years, the Committee urges HCFA to contract with 
the VA to carry out a competitive bidding demonstration.
    There is strong evidence, through reports by the General 
Accounting Office, the Department and others that Medicare is 
significantly overpaying for many medical supplies. Therefore, 
the Committee strongly urges prompt use of the Secretary's 
enhanced inherent reasonableness authority on a national basis.
    The Committee has been made aware of a flaw in the 
calculation of the county-by-county per capita Medicare cost 
estimates for counties impacted by large numbers of military 
retirees. The Committee encourages the Secretary of Health and 
Human Services to work with the Secretary of Veterans Affairs 
and the Secretary of Defense in a timely manner to identify the 
costs incurred by these agencies in providing Medicare health 
care services to Medicare-eligible individuals by the 
Department of Veterans Affairs and at military treatment 
facilities and uniformed services treatment facilities.
    The Committee urges HCFA to ensure that all health 
professions are recognized in the allocations for graduate 
medical education.
    The Committee is aware that the inspector general has 
issued reports identifying a direct correlation between 
supplier training in the fabrication, fitting, and delivery of 
orthotic devices and consistent, appropriate billing for 
orthotics to Medicare. Medicare could realize significant 
savings through improved billing practices and the development 
of utilization criteria establishing required minimum supplier 
qualifications, including provider training and expertise, to 
receive Medicare payment for orthotic and prosthetic care. 
Therefore, the Committee urges HCFA to implement the OIG 
recommendations in report OEI-02-95-00380 to undertake a 
demonstration of the savings achievable through the 
establishment of minimum supplier qualifications to utilize 
HCPCS codes for customized orthotic and prosthetic devices. The 
Committee expects to receive a report from HCFA on its progress 
on this recommendation by January 1.
    The Committee has raised its concerns about HCFA and its 
contractors' plans for assuring year 2000 compliance. Without 
appropriate corrective action, Medicare payments could be 
significantly delayed and could result in significant loss of 
confidence among beneficiaries and a reduction of providers 
willing to accept Medicare patients. The Committee is pleased 
with the increased attention the Administrator has placed on 
solving this problem and expects to be briefed quarterly on 
progress to compliance. The Committee encourages the 
Administrator to devote sufficient personnel resources to this 
effort.
    The Committee encourages the administration to carefully 
review the HHS Office of Inspector General proposed rule to 
assure that the extension of its exclusion authority to include 
indirect providers, such as manufacturers of medical devices 
and pharmaceutical companies, is fair and equitable.
    The Committee strongly urges HCFA to extend the comment 
period for the proposed Medicare spending interim policy for 
the coverage of supplies, issued by the durable medical 
equipment regional carriers on July 15, 1998, to December 1, 
1998, and to extend the effective date to January 1, 1999.
    The Committee is pleased with the collaboration of HCFA and 
HRSA in implementing the Children's Health Insurance Program 
and urges expanded partnership of Medicaid and child health 
programs at the Federal and State level, particularly 
concerning outreach and systems development issues, to assure 
effective, efficacious and efficient use of title V, title XIX, 
and title XXI funds.
    It is the sense of the Committee that in the final PPS rule 
related to the Medicare wage index for fiscal year 1999, HCFA 
should include contract labor costs for part A physician 
services, as is currently proposed. The Committee understands 
that HCFA has worked to refine the wage index to make sure it 
accounts for all labor costs, including fringe benefits, home 
office salaries, nonphysician contract labor costs, as well as 
wages and salaries, that hospitals incur in caring for 
patients. HCFA proposes to add contract physician costs to the 
wage index to eliminate the inequity between hospitals that 
employ physicians for part A services and those that contract 
for such services. Inclusion of contract physician costs is the 
most straightforward approach to address the wage index equity 
issue as it relates to the inequity for hospitals in States 
which prohibit employment of physicians as well as for any 
hospital which chooses to contract for such services.
    The Committee urges the Secretary to base retaining or 
changing the current requirement of physician supervision of 
anesthesia services in Medicare on scientifically valid 
outcomes data. There has been serious concern expressed 
regarding HCFA's proposed elimination of this requirement which 
has been in effect since the inception of the Medicare Program. 
The Committee further suggests that the Secretary urge AHCPR to 
work with HCFA in a design and implementation of an outcome 
approach that would examine, utilizing existing Medicare data, 
mortality and failure-to-rescue rates by different anesthesia 
providers, adjusted to patient acuity, and other relevant 
scientific variables. This methodology should be developed 
after consultation with the relevant national professional 
organizations.
    The Committee believes that access of women and minorities 
and other Medicare patients to innovative, potentially life 
saving drug therapies continues to be restricted because of the 
past failure of Medicare's inpatient hospital payment system to 
separately track the costs of these therapies. In the Balanced 
Budget Act of 1997, Congress tried to rectify this by asking 
the Health Care Financing Administration [HCFA] to revise how 
it accounts for the cost of such drug therapies for hospital 
inpatients. However, the Committee has been informed that HCFA 
has not appropriately classified inpatient procedures using 
these innovative therapies and may be inhibiting the access of 
such Medicare beneficiaries to life saving clinical treatments. 
The Committee believes that ensuring equal access to drug 
therapies will reduce overall Medicare outlays by reducing the 
number of subsequent hospital admissions for coronary surgical 
procedures, for example.
    The Committee is concerned that HCFA went beyond the intent 
of Congress in its regulations implementing the home health 
surety bond requirement of the Balanced Budget Act of 1997. The 
surety bonds required by HCFA's regulations were not limited to 
the financial risks posed to the Medicare and Medicaid programs 
through fraud and abuse, as intended by Congress. The Committee 
is aware that HCFA's distortion of congressional intent has 
increased the costs of the bonds as well as the collateral and 
personal indemnification requirements, potentially driving 
quality home health providers out of business and forcing 
thousands of Medicare home health beneficiaries to search for 
new sources of care.
    Serious concerns have also been brought to the Committee's 
attention about HCFA's failure to comply with the 
Administrative Procedures Act [APA] as well as the Regulatory 
Flexibility Act [RFA] when promulgating this rule. The 
Committee has been informed that the Small Business 
Administration Office of Advocacy, in a written response, 
detailed HCFA's failure to comply with the APA and the RFA. The 
Committee, therefore, strongly urges HCFA to adhere to 
congressional intent and to the APA and the RFA, and to work 
with affected providers and the Committee to address these 
grave problems.
    The Committee strongly encourages HCFA not to seek to 
recover on those bonds already secured, and to announce 
publicly that it will not seek to recover on such bonds.
    The Committee is concerned that HCFA's implementation of 
the interim payment system [IPS] requirement of the Balanced 
Budget Act of 1997 is having a devastating impact on the 
Medicare home health industry and those who benefit from 
essential home health services. The Committee strongly urges 
HCFA to work cooperatively with affected parties to address 
these concerns, and to move expeditiously in implementing a 
prospective payment system to comply with the October 1, 1999, 
deadline contained in the Balanced Budget Act of 1997.
    The Committee urges HCFA to comply with the requirements of 
section 1932(a)(2)(A) of title XIX of the Social Security Act. 
The section prohibits the mandatory enrollment of children with 
special health care needs in managed care programs when States 
integrate managed care programs within their State plan. In 
doing so, Congress expressed its concern that it lacked the 
experience and knowledge needed to permit the mandatory 
enrollment of this vulnerable population of children. Congress 
continued to allow States to seek Federal waivers of this 
prohibition in order to conduct time-limited demonstration 
projects and other mandatory enrollment programs for these 
children under greater Federal scrutiny. The clear intent of 
Congress in allowing for such waivers was to assure that States 
could develop more experience and data on managed care for 
children with special health care needs, while maintaining 
Federal scrutiny over these children's access to appropriate 
care.
    The Committee notes that HCFA has not established standards 
for reviewing applications, nor developed a model waiver 
application for States seeking to establish managed care 
programs for special needs children under waiver authority. The 
Committee is concerned that such waivers may be granted without 
adequate assurances of the prevision of appropriate care for 
these children and without any requirements for data 
collection, the design of health services, or the establishment 
of capitation rates specific to their needs. This is expressly 
not in keeping with congressional intent to prohibit the 
mandatory enrollment of children with special health care needs 
in Medicaid managed care until such time as it can reasonably 
assure special needs children's access to appropriate care.
    In this report, the Committee has requested the Social 
Security Administration to carry out a multistate demonstration 
testing the feasibility of providing one-stop shopping for 
health care benefits to low-income Medicare beneficiaries, by 
allowing Medicare beneficiaries to apply for qualified Medicare 
beneficiary and specified low-income Medicare beneficiary 
benefits at Social Security offices. The Committee expects that 
HCFA will cooperate fully with the Social Security 
Administration in implementing this demonstration.
    The Committee is concerned that the current Medicare DRG 
payment system may not adequately cover the costs of a 
significant new technology to assist quadriplegics. The 
freehand system allows quadriplegics to regain functional hand 
motion, thus increasing independence. The Committee urges HCFA 
to examine the adequacy of its payment for the implantation of 
this new technology and make adjustments, such as a new DRG, as 
appropriate to assure patient access.
    The Committee has heard concerns regarding the equity of 
the new Medicare SNF prospective payment system as it relates 
to nontherapy ancillaries. The demonstration upon which the new 
system was based did not include this class of items and 
services. Due to the lack of sufficient data to make these 
changes, the new system may provide a windfall for some 
providers while seriously impairing the ability of others to 
treat patients requiring more intensive care. Therefore, the 
Committee urges HCFA to reexamine this policy an make budget-
neutral changes this year to assure continued access to 
services for high cost patients pending the gathering of 
sufficient data on which to base permanent reforms.
    The Committee has been informed that new Medicare payment 
policies for hospital-based psychiatric units have created 
financial problems for rural hospitals providing mental health 
services to elderly patients. Their patients tend to be older, 
have complicating medical conditions, and long lengths of stay. 
Beneficiaries receiving mental health services in units in 
urban and suburban hospitals are younger and have shorter 
stays. Thus the cost of care in the rural hospital is higher; 
however, the new payment formula is weighted to the lower costs 
of the urban and suburban institutions. The Committee is aware 
of concerns that rural hospitals will no longer be able to 
provide psychiatric care to their elderly patients and 
recommends that HCFA consider taking steps to develop a 
separate payment rate for rural hospitals that better reflects 
their true costs of providing mental health care to elderly 
beneficiaries. HCFA should report back to the Committee by 
February 1, 1999, on its actions with respect to this matter.
    The Committee is concerned that in developing a prospective 
payment system [PPS] for hospitals certified to participate in 
the Medicare program as long-term care hospitals under section 
1886(d) of the act, that HCFA may be developing a payment 
system based on resource utilization groups [RUG's] used to 
make Medicare payments to skilled nursing facilities.
    The skilled nursing payment system was not developed as a 
patient severity measurement and related payment system for 
hospital level patients. Additionally, the Committee is 
informed that a RUG's-based system can only make payment on a 
per patient, per day basis and, therefore, may provide 
inappropriate economic incentives for overutilization of 
hospital services and also may result in the premature 
exhaustion of Medicare beneficiaries limited hospital day 
benefit. It is recommended that in developing a long-term 
hospital PPS, under section 4422 of the BBA, that HCFA consider 
a long-term hospital site specific system which adjusts the 
current diagnosis-related groupings [DRG's] used to make 
payments to short-term hospitals under section 1886(d), to 
reflect resources used by Medicare beneficiaries admitted to 
long-term care hospitals.
    The Committee urges HCFA to recognize the integral role 
that Laguna Honda Hospital serves in meeting the needs of the 
elderly and disabled in San Francisco, and suggests that HCFA 
continue to allow the hospital to participate in the federally 
funded health programs as allowed under previous waivers. The 
Committee also urges officials from HCFA and other appropriate 
officials at the Department to work with the city and county of 
San Francisco to explore and develop alternatives to finance 
the construction of a replacement facility.
    The Committee recommends that the Secretary give strong 
consideration to establishing a new category of PPS-exempt 
hospitals. Nonresearch cancer hospitals like Calvary Hospital 
in New York, that the Secretary classified as PPS-exempt 
between 1991 and 1995, may qualify under the new designation 
and continue to be classified as PPS-exempt for purposes of 
Medicare hospital reimbursement.
    The Committee is concerned about the effect of changes to 
the Medicare home health benefit as they relate to venipuncture 
and urges the Secretary to conduct a study on the provision of 
home health services consisting of venipuncture, to be provided 
to the Committee no later than August 31, 1999. This study 
should assess, using the most recent data available and taking 
into account the increase in costs attributed to fraud and 
abuse under the Medicare program, the number of beneficiaries 
who receive home health services as well as the number who have 
lost venipuncture services, and make a determination of the 
number of beneficiaries who have been affected by the benefit 
change. Further, the study should contain a comparison of the 
utilization and costs of venipuncture services among all 
Medicare home health beneficiaries, regardless of the patient's 
qualifying service. The Secretary should also examine the 
effects of how such a benefit change would impact States in 
increased use of personal care services and nursing home care, 
and the extent to which rural Medicare beneficiaries' access to 
home health services would be impeded.

Medicare choice

    The Committee has included bill language giving HCFA the 
authority to collect $95,000,000 in user fees for the costs of 
beneficiary enrollment and dissemination of information for the 
managed care activities now permitted under the Medicare 
Program.
    As HCFA begins it outreach effort to Medicare beneficiaries 
to introduce them to the new options and choices enacted in the 
1997 Balanced Budget Act, the Committee recommends inclusion of 
education and outreach efforts to the Asian/Pacific Islanders 
population. Materials and education efforts must be offered in 
English, Spanish, and Asian dialects. The Committee encourages 
HCFA to work with the Asian community to ensure that Asian-
Americans are fully aware of the new choices and options 
available to Medicare beneficiaries.
    The Committee recognizes that the enrollment and 
information activities required are new ground for HCFA. The 
Committee also recognizes the value of any data and reporting 
on this and other programs which are designed to improve the 
quality of care and contain costs for Medicare beneficiaries. 
Therefore, the Committee believes HCFA should provide a 
quarterly report to Congress detailing the substance and 
implementation of information being provided to beneficiaries 
and an accounting of its expenditures under section 1857(e)(2) 
as soon as they become available.

                Administration for Children and Families

                   FAMILY SUPPORT PAYMENTS TO STATES

Appropriations, 1998....................................................
Budget estimate, 1999...................................  $1,989,000,000
Committee recommendation................................   1,989,000,000

    The Committee recommends that $1,989,000,000 be made 
available in fiscal year 1999 for family support payments to 
States, the same as the administration request. These payments 
support the States' efforts to promote the self-sufficiency and 
economic security of low-income families. In fiscal year 1999, 
these payments will also pay for prior-year claims in five 
discontinued programs related to AFDC.
    The Committee recommendation also provides $750,000,000 in 
advance funding for the first quarter of fiscal year 2000 for 
the child support enforcement program. These funds support 
efforts to locate noncustodial parents, determine paternity 
when necessary, and establish and enforce orders of support.

               low-income home energy assistance program

Appropriations, 1998....................................  $1,100,000,000
Budget estimate, 1999...................................   1,100,000,000
Committee recommendation................................   1,100,000,000

    The Committee recommendation includes a $1,100,000,000 
advance appropriation for fiscal year 2000, the same as the 
budget request. The advance appropriation, as authorized by 
law, gives States greater opportunity for effective program 
planning, including sound allocation of resources among the 
various components of the program.
    LIHEAP grants are awarded to the States, territories, and 
Indian tribes to assist low-income households in meeting the 
costs of home energy. States receive great flexibility in how 
they provide assistance, including direct payments to 
individuals and vendors and direct provision of fuel. LIHEAP 
grants are distributed by a formula defined by statute, based 
in part on each State's share of home energy expenditures by 
low-income households nationwide.
    The Committee recommendation includes an emergency 
allocation of up to $300,000,000 to be made available, only 
upon submission of a formal request designating the need for 
the funds as an emergency as defined by the Balanced Budget and 
Emergency Deficit Control Act. This is the same level as the 
emergency allocation available in fiscal year 1998.
    The Committee recommends that the Office of Community 
Services enhance its existing contract with the National Center 
for Appropriate Technology in Butte, MT, to undertake a 
national program of information collection and dissemination 
regarding the effects of energy industry deregulation and 
restructuring on low-income energy consumers. Such information 
should be made available through NCAT to LIHEAP agencies, 
community action groups, and other State and local 
organizations interested in addressing the needs of low-income 
families and individuals.
    The Committee intends that up to $27,500,000 of the amounts 
appropriated for LIHEAP for fiscal year 1999 be used for the 
leveraging incentive fund, which will provide a percentage 
match to States for private or non-Federal public resources 
allocated to low-income energy benefits. Of the fiscal year 
2000 advance appropriation, up to $27,500,000 is recommended 
for the leveraging fund.

                     refugee and entrant assistance

Appropriations, 1998....................................    $415,000,000
Budget estimate, 1999...................................     415,000,000
Committee recommendation................................     415,000,000

    The Committee recommends $415,000,000 for refugee and 
entrant assistance, the same as the level appropriated for 
fiscal year 1998 and the budget request.
    Based on an estimated refugee admission ceiling of 95,000, 
compared to 110,000, 3 years earlier, this appropriation, 
together with bill language allowing prior-year funds to be 
available for 1999 costs, will enable States to continue to 
provide at least 8 months of cash and medical assistance to 
needy refugees.
    The Refugee Assistance Program is designed to assist States 
in their efforts to assimilate refugees into American society 
as quickly and effectively as possible. The program funds 
State-administered cash and medical assistance, the voluntary 
agency matching grant program, employment services, targeted 
assistance, and preventive health.
    In order to carry out the program, the Committee recommends 
$230,698,000 for transitional and medical assistance, including 
State administration and the voluntary agency program; 
$129,990,000 for social services; $4,835,000 for preventive 
health; and $49,477,000 for targeted assistance.
    The Committee provides $19,000,000 to serve communities 
affected by the Cuban and Haitian entrants and refugees, the 
same as the amount contained in last year's appropriation. In 
addition, the Committee recommends $14,000,000 to address the 
needs of refugees and communities affected by recent changes in 
Federal assistance programs, and $16,000,000 to assist 
communities with large concentrations of refugees whose 
cultural differences make assimilation difficult. These funds 
are included in the social services line item.
    The Committee is aware of the valuable work the Voluntary 
Agency Assistance Program is doing to resettle immigrants, 
especially Russian Jews, in the United States. The Committee 
expects $39,000,000 will be used to support grants for the 
Voluntary Agency Grant Program.
    Section 412(a)(7) of title IV of the Immigration and 
Nationality Act authorizes the use of funds appropriated under 
this account to be used to carry out monitoring, evaluation, 
and data collection activities to determine the effectiveness 
of funded programs and to monitor the performance of States and 
other grantees.

                 child care and development block grant

Appropriations, 1998....................................  $1,000,000,000
Budget estimate, 1999...................................   1,182,672,000
Committee recommendation................................   1,182,672,000

    The Committee recommends an appropriation of $1,182,672,000 
for the advance for the child care and development block grant 
for fiscal year 2000. This is an increase of $182,672,000 over 
the fiscal year 1998 level and the same as the administration 
request.
    These funds provide grants to States to provide low-income 
families with financial assistance for child care; for 
improving the quality and availability of child care; and for 
establishing or expanding child development programs. The funds 
are used to both expand the services provided to individuals 
who need child care in order to work or attend job training or 
education and allow States to continue funding the activities 
previously provided under the consolidated programs. In 
addition, the Committee notes that child care entitlement 
funding under welfare reform legislation will provide 
$2,167,000,000 in fiscal year 1999, an increase of $100,000,000 
over the fiscal year 1998 enacted level.
    The bill provides that $19,120,000 of the amount 
appropriated shall be for the purposes of supporting resource 
and referral programs and before and afterschool services. This 
represents the Federal commitment to the activities previously 
funded under the dependent care block grant. The Committee 
further expects that these funds will not supplant current 
funding dedicated to resource and referral and school age 
activities provided by the child care and development block 
grant. The Committee strongly encourages States to address the 
matters of before and afterschool care and the establishment of 
resource and referral programs with the funds provided in this 
program. The Committee recommendation includes $50,000,000 for 
each of fiscal years 1999 and 2000 for an infant care quality 
initiative, the same amount provided in fiscal year 1998.
    As the Committee continues to expand the availability and 
affordability of child care in the country, the Committee urges 
the agency to provide the States with sufficient flexibility 
and discretion to administer these funds. The agency should 
work to ensure that there are no increased administrative 
burdens or costs for States and no concomitant reduction in the 
resources available for child care and in the ability of States 
to fully respond to their unique circumstances and needs. The 
Committee urges the agency to consider the removal of certain 
administrative burdens, including the requirement that the 
discretionary portion of the child care development fund [CCDF] 
be reported under a different code of Federal domestic 
assistance number than the other portions of the CCDF.

                      social services block grant

Appropriations, 1998....................................  $2,299,000,000
Budget estimate, 1999...................................   1,909,000,000
Committee recommendation................................   1,909,000,000

    The Committee recommends an appropriation of $1,909,000,000 
for the social services block grant. The recommendation is the 
same as the budget request and $390,000,000 below the 1998 
enacted level.
    Social services block grant funds are distributed to and 
used by States and territories to fund a wide variety of social 
services for the purpose of preventing or reducing dependency, 
and assisting individuals to achieve self-sufficiency. 
Activities include child and adult day care, child and adult 
abuse and neglect prevention, home-based services, and 
independent living services. Many of these activities are 
funded by separate appropriations elsewhere in the bill.

                children and families services programs

Appropriations, 1998....................................  $5,676,059,000
Budget estimate, 1999...................................   5,942,180,000
Committee recommendation................................   6,008,784,000

    The Committee recommends an appropriation of $6,008,784,000 
for the ``Children and families services programs'' account, 
which is $66,604,000 more than the administration request and 
$332,725,000 more than the fiscal year 1998 appropriation.
    This appropriation consists of programs for children, 
youth, and families, the developmentally disabled, and Native 
Americans, as well as Federal administrative costs.

Head Start

    Head Start provides comprehensive development services for 
low-income children and families, emphasizing cognitive and 
language development, socioemotional development, physical and 
mental health, and parent involvement to enable each child to 
develop and function at his or her highest potential. At least 
10 percent of enrollment opportunities in each State are made 
available to children with disabilities.
    The Committee recommends $4,660,000,000 for the Head Start 
Program, an increase of $312,567,000 above the 1998 level and 
the same as the budget request. This figure includes an advance 
appropriation of $1,365,000,000. The Committee took this action 
because of the severe budget constraints.
    The Committee recommendation includes funding for the 
expansion of the Head Start Program in an amount consistent 
with the bipartisan balanced budget agreement. The expansion 
funds shall be used in a manner which is responsive to the 
needs of each community, as identified in individual needs 
assessments.
    To address the needs of families returning to work under 
welfare reform, the Committee expects the Department to focus 
program expansion efforts on providing full-day, full-year 
services to children and families in need who are presently 
enrolled in the Head Start Program. Care provided beyond the 
traditional 9 to 5, Monday through Friday workday is essential 
in moving welfare recipients into the work force. Pocono 
Services for Families and Children in Monroe County, PA, is 
especially suited for such expansion services. PSFC was able to 
serve only 6 percent of the children deemed eligible by the 
County Assistance Office in 1996-97, and increasing its ability 
to serve needy children and their families is essential.
    The Committee is aware of the problems faced by the Wapato 
Head Start Center, which was ordered to be shut down in 1997 
due to the presence of asbestos. This center, which served 50 
to 60 children, is in need of a new facility and the Committee 
urges the administration to give full and fair consideration to 
a grant proposal by the Wapato Head Start Center.
    The Committee recommendation includes $200,000 for the 
development of the Wellston Developmental Child Care Center in 
Wellston, MO. The Committee is aware of the extreme child care 
and early childhood development needs of this economically 
distressed area where the average household income is 
approximately $12,000.
    The Committee is concerned that local Head Start 
organizations are maintaining their own transportation systems 
in many areas where lower cost alternatives are available. High 
transportation costs reduce amounts available for actual Head 
Start services. The Committee notes that the use of funds to 
directly buy and operate vehicles should only occur where 
alternatives are unavailable or impractical. The Committee 
strongly urges local Head Start organizations to contract with 
local transit authorities. The Committee expects the Secretary 
to report to the Committee by June 30, 1999, on the amount of 
Head Start funds allocated to transportation costs, as well as 
actions taken by Head Start to lower those costs.
    The Committee is concerned that funding for migrant Head 
Start programs has not kept pace with other elements of Head 
Start. The Committee, therefore, urges the Department of Health 
and Human Services to take steps to increase funding for 
migrant Head Start programs and improve the status of children 
of farmworkers in being able to gain access to Head Start 
services.

Runaway and homeless youth

    The Committee recommends $59,602,000 for this program, an 
increase of $1,106,000 above the fiscal year 1998 level and 
$1,000,000 above the administration request. The Committee has 
also provided an additional $15,000,000 from the violent crime 
reduction program.
    This program addresses the crisis needs of runaway and 
homeless youth and their families through support to local and 
State governments and private agencies. The Runaway and 
Homeless Youth Act requires that 90 percent of the funds be 
allocated to States for the purpose of establishing and 
operating community-based runaway and homeless youth centers, 
on the basis of the State youth population under 18 years of 
age in proportion to the national total. The remaining 10 
percent funds networking and research and demonstration 
activities including the National Toll-Free Communications 
Center. Consolidated within this line item is the transitional 
living for homeless youth program, which awards grants to 
public and private nonprofit entities to address the shelter 
and service needs of homeless youth. Grants are used to develop 
or strengthen community-based programs which assist homeless 
youth in making a smooth transition to productive adulthood and 
social self-sufficiency; and to provide technical assistance to 
transitional living programs for the acquisition and 
maintenance of resources and services.
    The Committee notes that there are a few model projects 
that provide coordinated substance abuse treatment, job 
training, transitional housing, and independent living to 
homeless youth who are pregnant or have small children and are 
recovering from substance abuse problems. One such model 
project is the House of Mercy in Des Moines, IA, and priority 
should be placed on supporting it.
    The Committee recommendation includes sufficient resources 
to fund the Center County Youth Services of State College and 
Three Rivers Youth of Pittsburgh at the fiscal year 1998 
funding level.

Child abuse prevention programs

    The Committee has included $35,180,000 for child abuse and 
neglect prevention and treatment activities, including 
$21,026,000 for State grants and $14,154,000 for discretionary 
activities. This is $64,000 above the fiscal year 1998 level. 
These programs seek to improve and increase activities at all 
levels of government which identify, prevent, and treat child 
abuse and neglect through State grants, technical assistance, 
research, demonstration, and service improvement.
    The Committee understands that the city of Newark, NJ, is 
working to establish a pilot project to assist children 
affected by domestic violence by putting these victims in touch 
with proper resources to address abusive behaviors, sexual or 
emotional assault, and drug or alcohol abuse in their home 
lives. The program will ensure that treatment and staff 
training are sensitive to cultural norms while working to 
enhance family cohesiveness. The Committee urges the 
administration to give full and fair consideration to a grant 
proposal by the city of Newark to create such a pilot program.
    The Committee has previously recommended that the 
Department utilize CAPTA resources for community-based child 
abuse prevention through Parents Anonymous, Inc. The 
authorizing committee included in the reauthorization of the 
Child Abuse Prevention and Treatment Act both bill language 
(section 105(a)(2) of CAPTA) and report language urging the 
Secretary to award a grant to a nonprofit organization such as 
Parents Anonymous to assist in the maintenance of a national 
network of mutual support and self-help programs to strengthen 
families and their communities in the fight against child 
abuse. The Committee again strongly urges the Department to 
implement this recommendation. To clarify its intent, the 
Committee has included bill language specifically citing 
appropriations authority under section 105(a)(2) of CAPTA.
    The Committee reiterates its support for the work of Family 
Place in Kentucky, the only agency in the region to provide 
intensive, family based treatment for intrafamilial child 
sexual abuse. The Committee urges the administration to provide 
funding for Family Place in their efforts to support a 4-year 
research project to fully test its treatment protocols.
    The Committee recommendation includes sufficient funds for 
the Vermont Parent Leadership Alliance to implement a model 
parent leadership training program that will assist regional 
partnerships in their struggle to provide parent training, 
strengthen parent involvement in the education of their 
children, and expand parent involvement in community education 
and human services planning.
    The Committee again recognizes the work of the Institute 
for Responsible Fatherhood and Family Revitalization, building 
bridges between the generations, and creating environments that 
are father friendly, children friendly, and family friendly. 
The Committee recommendation includes $300,000 to replicate the 
Institute's successful model program started in Cleveland, to 
other cities in the United States, and urges full and fair 
consideration of a proposal from this organization.
    The Committee is aware of the Team Parenting Program run by 
Goodwill Industries of southeastern Wisconsin that seeks to 
reengage noncustodial parents in the lives of their children 
and help them meet their child support commitments. Within the 
funds provided, the Committee recommendation includes 
sufficient funds to expand the Team Parenting Program to 
Milwaukee County, WI, and establish the Wisconsin Resource 
Center on Fragile Families.

Abandoned infants assistance

    The Committee concurs with the budget request in 
recommending an appropriation of $12,251,000 for abandoned 
infants assistance, an increase of $22,000 over the 1998 level. 
This program provides financial support to public and private 
entities to develop, implement, and operate demonstration 
projects that will prevent the abandonment of infants and young 
children. Grants provide additional services such as 
identifying and addressing the needs of abandoned infants, 
especially those who are drug exposed or HIV positive; 
providing respite care for families and care givers; and 
assisting abandoned infants and children to reside with their 
natural families or in foster care.

Child welfare

    The Committee recommends an appropriation of $291,989,000 
for child welfare services, the same as the administration 
request and $531,000 above the 1998 level. This program helps 
State public welfare agencies improve their child welfare 
services with the goal of keeping families together. State 
services include: preventive intervention, so that, if 
possible, children will not have to be removed from their 
homes; reunification so that children can return home if at all 
possible; and development of alternative placements like foster 
care or adoption if children cannot remain at home.
    For child welfare training, the Committee recommends 
$8,000,000, an increase of $2,011,000 over the fiscal year 1998 
level. Under section 426, title IV-B discretionary grants are 
awarded to public and private nonprofit institutions of higher 
learning to develop and improve education/training programs and 
resources for child welfare service providers. These grants 
upgrade the skills and qualifications of child welfare workers.
    The Committee again recommends that of the amounts 
appropriated, $130,000 be made available to colleges and 
universities that have enrolled American Indian and/or Alaska 
Natives in masters degree programs in social work for purposes 
of providing 20 field practicum placements of masters degree 
candidates in Indian reservation and rural Indian community 
settings.

Adoption opportunities

    The Committee recommends $25,000,000 for adoption 
opportunities, an increase of $2,042,000 above the fiscal year 
1998 level and $2,363,000 below the administration request. 
This program eliminates barriers to adoption and helps find 
permanent homes for children who would benefit by adoption, 
particularly children with special needs. Since the Committee 
recommendation exceeds $5,000,000, grants for placement of 
minority children and postlegal adoption services, as well as 
grants for improving State efforts to increase placement of 
foster children legally free for adoption, should be made, as 
required by law. This program also funds the national adoption 
clearinghouse, a national adoption information exchange system. 
Funding is not recommended for a new adoption initiative 
recommended by the administration, as the Committee intends to 
concentrate scarce resources on existing activities.

Adoption incentives

    The Committee recommends $20,000,000, the budget request, 
for adoption incentives. These funds are used to pay States 
bonuses for increasing their number of adoptions. The purpose 
of this program is to double the number of children adopted or 
permanently placed out of public child welfare systems by the 
year 2002, providing permanent homes to at least 54,000 
children.

Social services research

    The Committee recommends $21,000,000 for social services 
and income maintenance research, $11,000,000 above the 
administration request. This represents a decrease of 
$4,953,000 below the fiscal year 1998 level. A number of the 
projects for which funds were provided in 1998 were one-time 
only, reducing the amount needed in 1999. Remaining funds are 
for grants and contracts for a national random sample study of 
child welfare, and for research, evaluations, and national 
studies.
    The Committee is providing sufficient funds to support the 
University of Hawaii's Center on the Family's study to 
investigate family coping techniques in the face of economic 
distress and social change. The Committee is particularly 
interested in identifying positive family dynamics that 
contribute to the containment of social program costs.
    The Committee urges the administration to provide funds for 
family support centers in Allegheny County, PA, to continue its 
efforts to provide community-based family strength development 
services. Allegheny County has formed partnerships with local 
school districts, neighborhood leaders, and community-based 
organizations to provide children and families with 
comprehensive support services that will enable active parental 
participation in child development, community leadership, and 
create a positive sense of community for program participants.
    The Committee has provided $1,000,000 for a pilot study to 
(1) examine current Federal data collection and reporting 
requirements to determine how each can be best satisfied 
through State information systems, and whether more cost-
effective alternatives exist, and (2) evaluate and disseminate 
lessons learned from various State initiatives. Because it is a 
nonprofit consortium of State information technology officials, 
the State information technology consortium would be well-
suited to assist in this demonstration program.
    The Committee is providing $10,000,000 to fund a 5-year 
assets for independence demonstration program. These funds will 
establish individual development accounts [IDA's], which are 
special savings accounts that encourage low-income families and 
individuals to acquire productive assets. IDA's use matching 
funds to promote economic self-sufficiency by encouraging 
savings for investments in small businesses, homes, and 
education. The demonstration program will test the social, 
civic, psychological, and economic effects of IDA's on low-
income individuals and families. The Committee recommends that 
the Department use up to 2 percent of the funds provided to 
evaluate the IDA program.

Family violence prevention programs

    For programs authorized by the Family Violence Prevention 
and Treatment Act, the Committee concurs with the budget 
request to delete line item funding. Instead, increased 
resources are concentrated under violent crime reduction 
programs, as described later in this report.

Community-based resource centers

    The Committee recommends $32,835,000, the budget request, 
for community-based resource centers. This amount, the same as 
the administration request, funds a consolidation of the 
community-based family resource program and the temporary child 
care and crisis nurseries program. This program is intended to 
assist States in implementing and enhancing a statewide system 
of community-based, family-centered, family resource programs, 
and child abuse and neglect prevention through innovative 
funding mechanisms and broad collaboration with educational, 
vocational, rehabilitation, health, mental health, employment 
and training, child welfare, and other social services within 
the State. The temporary child care and crisis nurseries serve 
thousands of families with children who have a disability or 
serious illness, and families that are under stress, including 
families affected by HIV/AIDS, homelessness, violence, family 
crisis, and drugs and alcohol.
    The Committee is aware that the Southeastern region of the 
United States has traditionally lagged the rest of the Nation 
in all categories of measurable family success indices. To help 
strengthen families and provide early intervention assistance, 
the Committee is providing $3,000,000 to fund a pilot 
Southeastern regional community-based resource center. The 
pilot will be coordinated by the children's trust fund of 
Alabama, the lead State agency for the prevention of child 
abuse and neglect.

Developmental disabilities

    The Committee recommends $120,232,000 for developmental 
disabilities programs, which is $1,420,000 more than the 
request and $6,208,000 more than the fiscal year 1998 
appropriation. The Administration on Developmental Disabilities 
supports community-based delivery of services which promote the 
rights of persons of all ages with developmental disabilities. 
Developmental disability is defined as severe, chronic 
disability attributed to mental or physical impairments 
manifested before age 22, which causes substantial limitations 
in major life activities.

State councils

    For State councils, the Committee recommends $64,803,000, 
the same as the 1998 level and $228,000 above the 
administration request. In 1987, the Developmental Disabilities 
Act changed the focus of State councils from services provision 
and demonstration to planning and services coordination 
directed to effecting systems change. Since that time, the 
States have been shifting away from their original role of 
services provision to their current mission to effect system 
change on behalf of persons with developmental disabilities.

Protection and advocacy grants

    For protection and advocacy grants, the Committee 
recommends $26,718,000, which is the same as the fiscal year 
1998 level and $94,000 above the administration request. This 
formula grant program provides funds to States to establish 
protection and advocacy systems to protect the legal and human 
rights of persons with developmental disabilities who are 
receiving treatment, services, or rehabilitation within the 
State.

Special projects

    The Committee recommends $5,250,000, which is $18,000 above 
the administration request and $208,000 above the fiscal year 
1998 appropriation. This program funds grants and contracts 
providing nationwide impact by developing new technologies and 
applying and demonstrating innovative methods to support the 
independence, productivity, and integration into the community 
of persons with developmental disabilities.

University-affiliated programs

    For university-affiliated programs, the Committee 
recommends $17,461,000, which is the same as the 1998 level and 
$62,000 above the administration request. This program provides 
operational and administrative support for a national network 
of university-affiliated programs and satellite centers. Grants 
are made annually to university-affiliated programs and 
satellite centers for interdisciplinary training, exemplary 
services, technical assistance, and information dissemination 
activities.

State support system

    The Committee recommends $6,000,000 for a State support 
system for families of children with disabilities, $1,018,000 
more than the administration request. This program will provide 
competitive grants to States to develop, implement, expand, and 
enhance a statewide system of family support for families with 
disabilities. The Committee recommendation includes $1,000,000 
for Community Legal Services, Inc., of Philadelphia, PA, to 
continue existing activities providing legal services for the 
poor.

Native American programs

    The Committee concurs with the budget request in 
recommending $34,933,000 for native American programs, $64,000 
above the 1998 level. The Administration for Native Americans 
[ANA] assists Indian tribes and native American organizations 
in planning and implementing long-term strategies for social 
and economic development through the funding of direct grants 
for individual projects, training and technical assistance, and 
research and demonstration programs.
    The Committee notes the sharp increase in efforts to 
preserve native American languages through the native American 
languages program, which provides funds to tribes and native 
organizations. Accordingly, the Committee urges increased 
funding for the native American languages program. The 
Committee further recommends continued funding of the native 
Hawaiian revolving loan program.

Community services

    The Committee recommends an appropriation of $544,165,000 
for the community services programs. This is $2,985,000 above 
the fiscal year 1998 level and $55,065,000 higher than the 
administration request.
    Within the funds provided, the Committee recommends 
$490,600,000 for the community services block grant [CSBG]. 
These funds are used to make formula grants to States and 
Indian tribes to provide a wide range of services and 
activities to alleviate causes of poverty in communities and to 
assist low-income individuals in becoming self-sufficient. The 
Committee recommendation recognizes the increased demand by the 
low-income population for services provided by CSBG-funded 
community action agencies.
    The Committee bill again contains a provision requiring 
that carryover CSBG funds remain with the local grantee. This 
is the same language that was contained in the fiscal year 1998 
appropriations bill.
    The Committee again expects fiscal year 1999 CSBG funding 
to be allocated to the States in a timely manner. In addition, 
the Committee again expects the Office of Community Services to 
inform the State CSBG grantees of any policy changes affecting 
carryover CSBG funds within a reasonable time after the 
beginning of the Federal fiscal year.
    Several discretionary programs are funded from this 
account. Funding for these discretionary programs is 
recommended at the following levels for fiscal year 1999: 
community economic development, $30,065,000; rural community 
facilities, $3,500,000; national youth sports, $14,000,000; and 
community food and nutrition, $6,000,000. The Committee 
reiterates its expectation that national youth sports funds to 
be awarded competitively. The Committee has again included 
$5,500,000 from within this account for the job creation 
demonstration authorized under section 505 of the Family 
Support Act of 1988. This program has been very successful in 
moving people off welfare and into work. As in past years, the 
Committee expects that this program will be administered by the 
Office of Community Services and that a priority be given to 
community development corporations.

Program administration

    The Committee recommends $143,597,000 for program 
administration, the same as the fiscal year 1998 appropriation 
and $1,518,000 below the administration request. This reduction 
reflects the increased availability of mandatory appropriations 
available for administrative activities, under terms of 
recently enacted welfare reform legislation.
    This ``Program administration'' account funds Federal 
administration costs for the Administration for Children and 
Families [ACF]. The Committee is mindful of the many changes 
taking place among the programs administered by the 
Administration for Children and Families. The Committee has 
included what it believes are sufficient funds to permit ACF to 
carry out its important mission of improving the lives of 
America's children and families. The Committee recognizes that 
ACF will have to reallocate administrative resources within its 
budget to accommodate its changing workload and program mix. In 
particular, the Committee encourages ACF to utilize resources 
no longer needed to administer programs which the Congress has 
reduced, eliminated, or reformed to carry out its increased 
responsibilities in other important programmatic areas, such as 
child support enforcement, and in expanded activities to ensure 
program accountability, promote effective practices, and 
measure the effectiveness of new approaches to assisting 
families in need.

Rescissions

    The Committee has included bill language rescinding a total 
of $21,000,000 made available in welfare reform legislation for 
surveys and research activities. These are activities that have 
been historically funded in appropriations bills, not through 
authorizing legislation. Funds for social services research 
activities are included elsewhere in this account.

Crime reduction programs

    The Committee recommends $105,000,000 for violent crime 
reduction programs, $12,169,000 above the fiscal year 1998 
appropriation and the same as the administration request. The 
Committee notes that an additional $43,000,000 for crime bill 
activities is provided under the Centers for Disease Control 
and Prevention, which is $8,000,000 below the 1998 level and 
the same as the budget request.
    For the community schools youth services and supervision 
program, the Committee recommends no funding.
    For the runaway youth prevention program, the Committee 
recommends $15,000,000, which is $4,000,000 below the fiscal 
year 1998 appropriation and the same as the administration 
request. This is a discretionary grant program open to private 
nonprofit agencies for the provision of services to runaway, 
homeless, and street youth. Funds may be used for street-based 
outreach and education, including treatment, counseling, 
provision of information, and referrals for runaway, homeless, 
and street youth who have been subjected to or are at risk of 
being subjected to sexual abuse.
    For the national domestic violence hotline, the Committee 
recommends $1,200,000, which is the same as the administration 
request. This is a cooperative agreement which funds the 
operation of a national, toll-free, 24-hours-a-day telephone 
hotline to provide information and assistance to victims of 
domestic violence.
    The Committee recommends $88,800,000 for the grants for 
battered women's shelters program, $12,140,000 above the fiscal 
year 1998 program level and the same as the administration 
request. This is a formula grant program to support community-
based projects which operate shelters for victims of domestic 
violence. Emphasis is given to projects which provide 
counseling, advocacy, and self-help services to victims and 
their children.
    The Committee recognizes the economic barriers that victims 
of domestic violence face as they attempt to achieve economic 
security. They cannot meet requirements for assistance under 
the temporary assistance for needy families, they cannot find 
adequate housing as they are unable to afford the necessary 
security deposits or do not have established credit required by 
many landlords. The Committee recognizes the urgency in 
providing resources to these victims to escape violence and 
prevent the return to a violent situation.

                    family support and preservation

Appropriations, 1998....................................    $255,000,000
Budget estimate, 1999...................................     275,000,000
Committee recommendation................................     275,000,000

    The Committee recommends $275,000,000 for fiscal year 1999, 
the same as the amount requested by the administration and 
$20,000,000 above the fiscal year 1998 level. These funds will 
support: (1) community-based family support services to assist 
families before a crisis arises; and (2) innovative child 
welfare services such as family preservation, family 
reunification, and other services for families in crisis. These 
funds include resources to help with the operation of shelters 
for abused and neglected children, giving them a safe haven, 
and providing a centralized location for counseling.

       payments to states for foster care and adoption assistance

Appropriations, 1998....................................  $4,311,000,000
Budget estimate, 1999...................................   5,141,500,000
Committee recommendation................................   5,121,500,000

    The Committee recommends $5,121,500,000 for this account, 
which is $20,000,000 less than the budget request and 
$810,500,000 more than the 1998 comparable level. Also included 
is the administration's request of $1,355,000,000 for an 
advance appropriation for the first quarter of fiscal year 2000 
as requested by the administration. The Foster Care Program 
provides Federal reimbursement to States for: maintenance 
payments to families and institutions caring for eligible 
foster children, matched at the Federal medical assistance 
percentage [FMAP] rate for each State; and administration and 
training costs to pay for the efficient administration of the 
Foster Care Program, and for training of foster care workers 
and parents.
    The Adoption Assistance Program provides funds to States 
for maintenance costs, and the nonrecurring costs of adoption, 
for children with special needs. The goal of this program is to 
facilitate the placement of hard-to-place children in permanent 
adoptive homes, and thus prevent long, inappropriate stays in 
foster care. As in the Foster Care Program, State 
administrative and training costs are reimbursed under this 
program.

                        Administration on Aging

Appropriations, 1998....................................    $865,050,000
Budget estimate, 1999...................................     865,050,000
Committee recommendation................................     876,050,000

    The Committee recommends an appropriation of $876,050,000 
for aging programs, $11,000,000 above the 1998 appropriation 
and the administration request.
    The Committee recommends a legislative provision which 
would prevent any State from having its administrative costs 
under title III of the Older Americans Act reduced by more than 
5 percent below the fiscal year 1995 level. This provision has 
been included in the appropriations bill since fiscal year 
1996.

Supportive services and senior centers

    The Committee recommends an appropriation of $300,319,000 
for supportive services and senior centers, the same amount as 
requested by the administration and $9,181,000 less than the 
amount appropriated in fiscal year 1998. This State formula 
grant program funds a wide range of social services for the 
elderly, including multipurpose senior centers and ombudsman 
activities. State agencies on aging award funds to designated 
area agencies on aging who in turn make awards to local 
services providers. All individuals age 60 and over are 
eligible for services, although, by law, priority is given to 
serving those who are in the greatest economic and social need, 
with particular attention to low-income minority older 
individuals. Under the basic law, States have the option to 
transfer up to 20 percent of funds appropriated between the 
senior centers program and the nutrition programs which allows 
the State to determine where the resources are most needed.

Ombudsman/elder abuse

    The Committee recommends $7,449,000 for the ombudsman 
services program and $4,732,000 for the prevention of elder 
abuse program. The amount recommended for the ombudsman 
services program is $3,000,000 more than the fiscal year 1998 
level. The amount recommended for the elder abuse prevention 
program is the same as the fiscal year 1998 level. Both 
programs provide formula grants to States to prevent the abuse, 
neglect, and exploitation of older individuals. The ombudsman 
program focuses on the needs of residents of nursing homes and 
board and care facilities, while elder abuse prevention targets 
its message to the elderly community at large.
    The Committee supports continued and additional funding for 
the long-term care ombudsman resource center and its training 
and clearinghouse functions, which provide information, 
technical assistance, programmatic, and other support for State 
and regional long-term care ombudsmen.

Preventive health services

    The Committee recommends $16,123,000 for preventive health 
services, the same amount as the budget request and the amount 
appropriated in fiscal year 1998. Funds appropriated for this 
activity are part of the comprehensive and coordinated service 
systems targeted to those elderly most in need. Preventive 
health services include nutritional counseling and education, 
exercise programs, health screening and assessments, and 
prevention of depression.

Congregate and home-delivered nutrition services

    For congregate nutrition services, the Committee recommends 
an appropriation of $374,412,000, the same amount as the budget 
request and the amount appropriated in fiscal year 1998. For 
home-delivered meals, the Committee recommends $112,000,000, 
the same amount recommended by the administration and the 
amount appropriated in fiscal year 1998. These programs address 
the nutritional need of older individuals. Projects funded must 
make home-delivered and congregate meals available at least 
once a day, 5 days a week, and each meal must meet one-third of 
the minimum daily dietary requirements. While States receive 
separate allotments of funds for congregate and home-delivered 
nutrition services and support services, they are permitted to 
transfer up to 30 percent of funds between these programs.
    The Committee has included a provision carried in last 
year's bill which requires the Assistant Secretary to provide 
the maximum flexibility to applicants who seek to take into 
account subsistence, local customs, and other characteristics 
that are appropriate to the unique cultural, regional, and 
geographic needs. The provision clarifies that applicants who 
serve American Indian, native Hawaiian, and Alaska Native 
recipients in highly rural and geographically isolated areas 
are permitted to continue to tailor nutrition services that are 
appropriate to the circumstances associated with the served 
population. In addition, in an effort to meet the needs of the 
native Hawaiian elderly population sufficiently, the Committee 
urges the native Hawaiian grantee to coordinate with the 
Lunalilo Home, the only care facility for aged native 
Hawaiians.

In-home services for frail older individuals

    The Committee recommends $9,763,000 for in-home services 
for the frail elderly, the same as the fiscal year 1998 enacted 
level and the budget request. In-home services include 
homemaker and home health aides, visiting and telephone 
reassurance, chore maintenance, in-home respite care for 
families, and minor home modifications.

Aging grants to Indian tribes and native Hawaiian organizations

    The Committee recommends $18,457,000 for grants to Indian 
tribes, the same amount as the budget request and the amount 
appropriated in fiscal year 1998. Under this program awards are 
made to tribal and Alaskan Native organizations and to public 
or nonprofit private organizations serving native Hawaiians 
which represent at least 50 percent Indians or Alaskan Natives 
60 years of age or older to provide a broad range of services 
and assure that nutrition services and information and 
assistance services are available.
    The Committee encourages the agency to provide training, 
technical assistance, and capacity building activities to 
increase the efficiency and effectiveness of the program.

Aging research and training

    The Committee recommends $18,000,000 for aging research, 
training, and discretionary programs, $8,000,000 more than the 
fiscal year 1998 enacted level and the budget request. These 
funds support activities designed to expand public 
understanding of aging and the aging process, test innovative 
ideas and programs to serve older individuals, and provide 
technical assistance to agencies who administer the Older 
Americans Act. The Committee has included $5,000,000 to fund a 
national program of statewide senior legal services hotlines 
and related elder rights projects and $1,000,000 to continue 
and expand the Family Friends Program. Family Friends Program 
funds may also be used for the National Council on Aging to 
continue providing technical assistance and training to local 
sites and to examine new ways in which the Family Friends model 
can be replicated locally.
    The recommendation includes an additional $5,000,000 to 
continue the initiative begun 2 years ago, with funds 
transferred from the Health Care Financing Administration, to 
test different models designed to train retirees in local 
communities in detection and reporting of Medicare waste and 
abuse. The Commissioner is expected to continue consultation 
with other affected agencies, including the Office of Inspector 
General and the General Accounting Office. The Committee 
expects that the agency will use the funds to make grants and 
will minimize administrative costs.
    The Committee has included $750,000 for a project to 
monitor and report incidents of abuse and neglect of the 
elderly. The Committee recognizes the value of such oversight 
and encourages that funds be used to develop integrated 
reporting systems so that agencies that deliver programs to the 
elderly can share and cross-check incidents of neglect and 
abuse. Pennsylvania's elder abuse reporting system would be 
especially suited for such funding since it would allow the 
three agencies that assist the elderly to share information and 
thus expedite assistance to elderly victims.
    Within the funds provided, the Committee has included 
sufficient funds for the National Asian Pacific Center on Aging 
to continue an existing grant directed to developing, 
strengthening, and expanding linkages of a rapidly growing 
Asian Pacific aging community with local, State, and national 
community service providers and organizations.
    The Committee recognizes the value of using existing 
telemedicine and video conferencing technology to improve the 
health status of aging Americans residing in underserved rural 
areas and to educate physicians and health care professionals 
in those areas. The Committee has provided $1,000,000 for these 
purposes and urges the Department to fund such a project to 
address these needs. The Northwest Area Center for Studies on 
Aging would be particularly well-suited for such funding since 
it would specifically address the health care problems 
associated with aging and would provide these services in a 
region where there are no programs currently available.
    Within the amount provided for the National Indian Council 
on Aging, the Committee has included sufficient funds to 
continue an existing grant to increase Indian elder awareness 
and participation in the public policy issues that directly 
impact all of Indian country.
    The Committee recognizes the success of the National 
Hispanic Council on Aging's efforts in improving the quality 
and effectiveness of services for the elderly. Within the funds 
provided, the Committee has included sufficient funds to 
continue an existing grant for these services. In addition, the 
Committee notes that the council would be especially well 
suited for funding to expand its demonstration programs so that 
more elderly Hispanic individuals can be served.
    The Committee is aware of Nutrition 2030, an outcome-
oriented initiative of the National Policy and Resource Center 
on Nutrition and Aging at Florida International University. The 
Committee recognizes the Center's efforts to combat 
malnutrition among the elderly and urges the Department to give 
full and fair consideration for continued funding of Nutrition 
2030.
    The Committee recognizes the work of the Setting Priorities 
for Retirement Years [SPRY] Foundation in providing senior 
citizens increased access to health care information. Since 
SPRY is currently providing this service, it would be 
especially suited to expand these services to other regions. 
The Committee urges the Department to give full and fair 
consideration to a proposal from SPRY for this purpose.
    The Committee recognizes the contributions of the Sinai 
Family Health Centers' Senior Outreach Program in addressing 
the medical problems facing the inner-city elderly. The 
Committee urges the Department to give full and fair 
consideration to a proposal to enhance and expand the Outreach 
Program's efforts so that more inner-city seniors can be 
served.
    Within the funds provided, the Committee has included 
sufficient funds for the continuation of the elder care locator 
program, a toll-free telephone service for information about 
home and community-based services for older Americans and their 
caregivers. The Committee notes that the National Association 
of Area Agencies on Aging is currently providing this service 
and would be especially well-suited to continue it.
    The Committee recommendation includes sufficient funds for 
the pension information and counseling demonstration program, 
authorized under title IV of the Older Americans Act, to 
continue the existing demonstration projects, technical 
assistance and training projects, and any new model projects 
that were created in other regions of the country during fiscal 
year 1998. Pension counseling projects provide information, 
advice, and assistance to workers and retirees about pension 
plans, benefits, and pursuing claims when pension problems 
arise. Also included are funds for a study to examine the 
feasibility of implementing a financing mechanism that would 
allow the pension counseling program to become self-sustaining.

Program administration

    The Committee recommends $14,795,000 to support Federal 
staff that administer the programs in the Administration on 
Aging, the same amount as the budget request and the 1998 
appropriation. These funds provide administrative and 
management support for programs administered by the Department. 
The Committee has deferred consideration of the proposed 
transfer of the Alzehimer's State demonstration grants program 
from HRSA, pending assurances from the Secretary that current 
projects will be permitted to complete their 2-year cycle of 
funding without disruption.

                        Office of the Secretary

                    GENERAL DEPARTMENTAL MANAGEMENT

Appropriations, 1998....................................    $177,119,000
Budget estimate, 1999...................................     217,943,000
Committee recommendation................................     174,160,000

    The Committee recommends $174,160,000 for general 
departmental management [GDM]. This is $43,783,000 below the 
administration request and $2,959,000 below the fiscal year 
1998 level. Within this amount, the Committee includes the 
transfer of $5,851,000 from Medicare trust funds, which is the 
same as the administration request and the fiscal year 1998 
level.
    Within the funds requested by the administration, 
$70,000,000 is included for antiterrorism activities; the 
Committee has included funding under the Public Health Service 
emergency fund.
    This appropriation supports those activities that are 
associated with the Secretary's role as policy officer and 
general manager of the Department. It supports certain health 
activities performed by the Office of Public Health Science, 
including the Office of the Surgeon General. GDM funds also 
support the Department's centralized services carried out by 
several Office of the Secretary staff divisions, including 
personnel management, administrative and management services, 
information resources management, intergovernmental relations, 
legal services, planning and evaluation, finance and 
accounting, and external affairs.
    The Office of the Surgeon General, in addition to its other 
responsibilities, provides leadership and management oversight 
for the PHS Commissioned Corps, including the involvement of 
the Corps in departmental emergency preparedness and response 
activities. The Committee commends the Department for its 
report on the status of the Commissioned Corps of the U.S. 
Public Health Service. The Committee supports the Corps as a 
unique and flexible resource, available for immediate 
deployment in times of public health emergencies. Corps members 
have been vital contributors to research, health services, food 
and drug safety, and many other public health functions. The 
Committee is supportive of efforts to further enhance the 
effectiveness and ready capacity of the Corps and encourages 
the department to establish an Office of Reserve Coordination.
    The Committee has provided $200,000 to support the 
activities of the United States-Mexico Border Health Commission 
as authorized by Public Law 103-400. The Commission is 
authorized to assess and resolve current and potential health 
problems that affect the general population of the United 
States-Mexico border area. The Committee is aware of Baylor 
College of Dentistry's health outreach initiative to study, 
diagnose, and treat craniofacial deformities along the United 
States-Mexico border. This effort could serve as an initial 
demonstration, combining well-planned academic, clinical, and 
educational elements. The Commission is urged to grant full and 
fair consideration to this proposal.
    The Committee has included $700,000 for the Human Services 
Transportation Technical Assistance Program, which is $200,000 
higher than last year's amount. As in previous years, this 
program is to be administered by a national membership 
organization with expertise in working with local transit 
organizations. The program provides technical assistance and 
training to organizations that provide transportation services 
to the elderly, people with physical and developmental 
disabilities, and the economically disadvantaged. With these 
funds, the Committee expects a continued emphasis on assisting 
communities with transportation issues related to welfare 
reform since in many rural communities the largest obstacle in 
gaining employment is transportation to work sites. The 
Committee further expects the technical assistance to be 
provided include developing strategies for cost-effective 
transportation under Medicaid.
    The Committee also expects this program to initiate a new 
activity. States are increasingly looking for new and 
innovative approaches to provide nonemergency transportation 
through the Medicaid Program. As more medical services are 
being provided through managed care, States are also looking at 
means to contain transportation costs. The Committee expects 
the Department to work with the Community Transportation 
Association of America to develop a program of assistance for 
local communities find efficient ways to provide medical 
transportation services. The Committee also notes that the 
technical assistance provided by the Community Transportation 
Association of America is vital to the success of this project.
    The Committee reiterates its support of the Chronic Fatigue 
Syndrome Coordinating Committee [DHHS CFSCC]. The Committee 
urges the DHHS CFSCC to coordinate CFIDS research across the 
Public Health Service by defining priorities and creating a 
yearly action plan and recommends that the chartered committee 
conduct oversight into DHHS and SSA programs, evaluate program 
performance, review budget allocations, and identify priorities 
in CFS research and education. The Committee supports the 
renewal of the CFSCC's charter beyond its scheduled expiration 
in 1998.
    The Committee urges the development of a national media 
campaign targeting, but not limited to, adolescent girls and 
women, to educate them about healthy eating behaviors, positive 
body image, and self-esteem. The Secretary should consult 
widely among those agencies of the Public Health Service that 
could contribute content to the effort. The program should also 
educate the public about the risks of restrictive dieting and 
the prevention of eating disorders. Such programs may include 
development of a toll-free number and information clearinghouse 
on eating disorders.
    The Committee is aware of the high number of accidental 
needle-stick injuries that occur primarily to health care 
workers. These injuries are major risk factors for the 
transmission of HIV, hepatitis B, and hepatitis C. The 
Committee urges the Centers for Disease Control and Prevention, 
the National Institute for Occupational Safety and Health, the 
Food and Drug Administration, and the Occupational Safety and 
Health Administration of the Department of Labor to make 
reduction of accidental needle sticks a priority by increasing 
cooperation among these agencies and taking all necessary 
actions to address this serious public health problem.
    The Committee supports the efforts of the task force on 
environmental health risks and safety risks to children. The 
Committee encourages an expansion of the Office of the Surgeon 
General's programs on children's health to include outreach and 
technical support to communities. The Committee further 
encourages the Department to assist communities in identifying 
and ranking children's health and safety problems and in 
devising measurement systems to monitor whether community 
efforts are effective in improving children's health and 
safety. The Committee recommends a comprehensive approach in 
which the Department coordinates with the community outreach 
activities of other governmental agencies and existing health 
care systems to assist community leaders and parents in keeping 
children safe and healthy.
    The Committee encourages the National Heart, Lung, and 
Blood Institute to continue its efforts to persuade the 
National Committee for Quality Assurance to accredit health 
plans based on their ability to reach treatment goals 
established by the National Cholesterol Education Program in 
treating patients with hypercholesterolemia. Further, the 
Committee expects the Health Care Financing Administration to 
encourage health care plans that treat cholesterol patients 
enrolled in the Medicaid and Medicare programs to pursue 
vigorous management of the disease resulting in the attainment 
of the treatment goals established by the National Cholesterol 
Education Program.
    The Committee continues to be supportive of the HELP DESK 
interactive initiative based in Jackson, MS, that is designed 
to enhance Federal outreach and technical assistance to 
communities. The Committee notes that sufficient funds are 
available to continue this project.
    The Committee is supportive of efforts to coordinate a 
strategy to reduce the incidence of fetal alcohol syndrome 
[FAS] and fetal alcohol effects [FAE]. The Department is 
encouraged to identify resources among the agencies to initiate 
a national task force on FAS and FAE.
    The Committee remains concerned about the disproportionate 
environmental and human health burdens in low-income and 
minority communities, and about the insufficient resources 
being targeted to community health centers to conduct research 
and to develop effective intervention and prevention 
strategies. The Committee urges the Department to identify 
potential interagency resources and cooperation with community 
health centers. The Committee expects to be informed within 6 
months on what steps have been taken to address this 
recommendation.
    Commission on Background Screening for Long-Term Care 
Facilities.--The Committee is aware of increasing numbers of 
reports of people with abusive and criminal backgrounds finding 
work in direct patient care in Medicare and Medicaid long-term 
care facilities. Reports indicate that known abusers can travel 
between States and between facilities and continue to attack 
vulnerable patients. The Committee believes that a national 
system should be considered to screen potential employees at 
long-term care facilities to ensure that they do not have an 
abusive or criminal background and to ensure they do not work 
with patients.
    The Committee, therefore, strongly urges the Secretary to 
convene a commission to study and report within 1 year how a 
national background screening system might be developed and 
integrated into the Medicare and Medicaid programs. The 
commission should include representatives from the Department, 
State government, Federal and State law enforcement, nursing 
home and home health industries, long-term care employee 
advocates, and patient and consumer advocates. The system under 
consideration should include a national registry of long-term 
care workers with problematic records, including all confirmed 
abuse findings from State nurse aide registries.
    The commission should consider existing data bases within 
the Department that a national registry could administer. 
Policies should be developed to exclude workers with abusive or 
criminal histories, according to criteria developed by 
commission. The commission should also include in its report: 
information about estimated costs of administering a national 
background checking system; recommendations on the equitable 
division of costs between Medicare, Medicaid, and participating 
facilities; operational policies; and other systematic and 
technical details.

Adolescent family life

    The Committee has provided $16,709,000 for the Adolescent 
Family Life Program [AFL]. This is $12,000,000 more than the 
administration request and is $38,000 above the fiscal year 
1998 appropriation.
    AFL is the only Federal program focused directly on the 
issue of adolescent sexuality, pregnancy, and parenting. 
Through demonstration grants and contracts, AFL focuses on a 
comprehensive range of health, educational, and social services 
needed to improve the health of adolescents, including the 
complex issues of early adolescent sexuality, pregnancy, and 
parenting.
    Within the total provided, the Committee continues the 
prevention projects begun in fiscal year 1998, as well as new 
prevention projects. The Committee again expects the Department 
to fund new prevention projects which enable smaller 
communities to begin the organization and implementation of 
coalitions to implement abstinence-based education programs. 
The Committee again expects the Department, when announcing 
grant competitions, to provide a reasonable length of time for 
applicants to complete application packages, provide extensive 
technical assistance to applicants, with special assistance 
given to new applicants, and revise the terminology and 
instructions in grant applications to assure that the 
information being requested is as clear as possible.

Physical fitness and sports

    The Committee recommends $1,005,000 for the Federal staff 
which supports the President's Council on Physical Fitness and 
Sports. This is the same as the administration request and 
$9,000 more than the fiscal year 1998 appropriation.
    The President's Council on Physical Fitness and Sports 
serves as a catalyst for promoting increased physical activity/
fitness and sports participation for Americans of all ages and 
abilities, in accordance with Executive Order 12345, as 
amended. The programs sponsored by PCPFS are supported largely 
through private sector partnerships.

Minority health

    The Committee recommends $24,500,000 for the Office of 
Minority Health. This is $4,534,000 less than the fiscal year 
1998 appropriation and $1,400,000 above the administration 
request.
    The Office of Minority Health [OMH] focuses on strategies 
designed to decrease the disparities and to improve the health 
status of racial and ethnic minority populations in the United 
States. OMH establishes goals, and coordinates all departmental 
activity related to improving health outcomes for disadvantaged 
and minority individuals. OMH supports several demonstration 
projects, including the Minority Community Health Coalition, 
the Bilingual/Bicultural Service, the Center for Linguistic and 
Cultural Competency in Health Care, and the Family and 
Community Violence Prevention Program.
    The Committee recognizes the need to encourage minority 
development of family practice physicians and encourages the 
Office to assist programs designed for the purpose of direct 
and indirect support of family practice residency programs 
which focus on training, recruitment, and retention of 
minorities, including American Indian and Alaska Natives, as 
family practice physicians.
    The Committee is aware of a meritorious proposal by the 
Philadelphia City Wide Improvement and Planning Agency that 
would help inner city youth confront challenges at school, 
work, and home through an existing coalition of service 
providers and community groups. The Committee urges full and 
fair consideration of City Wide's application and has included 
$300,000 in support of their proposal.
    The Committee recognizes the efforts of the Scott County 
cooperative cardiovascular project in Iowa which has focused 
its efforts on trying to make screening, education, risk factor 
modification, and access to care more available to minorities 
in Scott County by bringing these modalities to people where 
they live and work. The Committee encourages the Department and 
the Office of Minority Health to work with the project to 
increase the access to health care for Scott County residents.
    The Committee is aware of the proposal by Stillman College 
in Tuscaloosa, AL, to develop a facility to serve the health, 
educational, and community development needs of the college and 
surrounding area. The Committee has included $500,000 in 
support of their proposal.
    The Committee is further aware of the joint proposal by 
Thomas Jefferson University of Philadelphia and the New York 
University Downtown Hospital in New York City to establish a 
community partnership to enhance the health status of Chinese- 
and Asian-American communities, and has included $500,000 in 
support of their proposal.
    The Committee is aware of the proposal by the CORE Center, 
a joint effort by Cook County and Rush Hospital of Chicago, to 
initiate a demonstration project for supervised intervention of 
health care professionals, nonspecialists, and community-based 
providers of HIV/AIDS care. The Committee urges the Office to 
grant full and fair consideration to its proposal.

Office on Women's Health

    The Committee recommends $15,495,000 for the Office on 
Women's Health. This is $2,978,000 more than the administration 
request, $3,028,000 more than the fiscal year 1998 
appropriation and the House level.
    The PHS Office on Women's Health [OWH] develops, 
stimulates, and coordinates women's health research, health 
care services, and public and health professional education and 
training across HHS agencies. It advances important 
crosscutting initiatives and develops public-private 
partnerships, providing leadership and policy direction, and 
initiating and synthesizing program activities to redress the 
disparities in women's health.
    Moreover, in view of the disparities in women's health 
research, services, and education and training, the Committee 
believes that one mechanism through which these inequities can 
be resolved is through providing support through various 
mechanisms to academic, consumer, health care professional, and 
community groups in this important area. To that end, the 
Committee urges that the PHS OWH develop and support programs 
to support crosscutting research, services, innovative 
partnerships, and demonstrations that will advance women's 
health. The Committee commends the PHS OWH for its leadership 
in developing new initiatives to improve women's health.
    Within the amount provided, the Committee has included 
sufficient funds to support continued implementation of the 
National Women's Health Information Center. This Center in 
partnership with the Department of Defense, provides a single 
access point to Federal information on women's health through a 
toll-free telephone number and the Internet, and links to over 
1,000 private sector resources as well. Consumers, researchers, 
health professionals, women's health advocates and the media 
will have access to the wide variety of information and 
resources on women's health that has been created by the 
various agencies of the Department of Health and Human 
Services, in partnership with the Department of Defense and all 
other agencies in the Federal Government.
    The National Centers of Excellence in Women's Health 
Program, established in fiscal year 1996 by the PHS OWH, 
through contracts to six academic health centers around the 
Nation, is developing model health care services, 
multidisciplinary research, public and health care professional 
education on women's health, and fostering leadership 
opportunities for women's health care professionals. Six new 
centers are expected to be awarded in fiscal year 1997, along 
with up to four minority women's health centers of excellence. 
The Committee has provided $5,000,000 to continue funding the 
existing centers established in 1996 and to support additional 
new centers.
    The Committee has also included funds for women's health 
coordinators. Regional coordinators have been established in 
the 10 Public Health Service regions around the Nation and link 
together all of the resources available from the Department of 
Health and Human Services and coordinate and stimulate women's 
health activities. They also work with women's groups and 
health care professionals at the regional, State, and local 
levels. These additional funds will be used to develop regional 
women's health activities in each of the 50 States.
    The Committee is concerned that cardiovascular diseases, 
including heart disease and stroke, remain the No. 1 killer of 
women. Twice as many women die from heart disease and stroke as 
those who die from breast, ovarian, and all other cancers. 
Although cardiovascular disease is commonly assumed to be a 
disease primarily of men, over one-half of all deaths caused by 
cardiovascular disease occur among women. The Committee is also 
concerned that women, especially older women are not properly 
screened for heart disease and stroke and there is little focus 
on prevention. The Committee is also concerned that 
traditionally women have not been the focus in prevention and 
treatment research. As a result, the survival rate for women 
following heart attack is less than for men. The Committee 
urges the PHS OWH to undertake a comprehensive review of the 
impact of heart disease and stroke on women.
    Osteoporosis is today a major health problem that the World 
Health Organization has characterized as epidemic. Osteoporosis 
effects 28 million Americans who either have or are at risk of 
the disease. The direct medical costs amount to $13,800,000,000 
annually and are expected to increase dramatically as the 
population ages. A task force convened by the Office of Public 
Health and Science on Women's Health, in conjunction with the 
National Osteoporosis Foundation has determined that a public 
education campaign is needed. In its first stage, the campaign 
will target teenage women, ages 13 to 18, to help them develop 
positive health behaviors, (for example, diet, exercise, 
calcium intake) that can have a significant effect on bone 
strength that can last a lifetime. Within the amount 
recommended the Committee has included $3,000,000 in funds to 
implement this campaign.
    The Committee commends the national action plan on breast 
cancer for its many accomplishments. This important public/
private partnership, which catalyzes breast cancer activities 
across the Federal Government and the private sector, has 
accomplished a great deal in the war against breast cancer. The 
Committee has provided sufficient funds within the budget of 
the National Cancer Institute to support the ongoing activities 
of the NAPBC.
    The Committee recommends $350,000 for the Office of Women's 
Health to enter into a contract with the Institute of Medicine 
to conduct a study to validate the concept of sex and gender 
based research. The study should identify, review, and assess 
the available research that examines the basic biologic and 
physiologic differences between men and women and supportive 
basic research with animal models; review current initiatives 
and programs of research; and make recommendations for 
advancing and implementing a research agenda, including the 
identification of research priorities and the programmatic 
implications of exploring these research opportunities.
    The study should use the findings of the Office of Research 
on Women's Health Beyond Hunt Valley meetings as a primer and 
integrate them as appropriate. The study should examine the 
entire Federal research establishment and private sector 
research. The findings of the study should have implications 
for both the public and private sectors.

Office of Emergency Preparedness

    The Committee has provided $9,600,000, which is $377,000 
less than last year's level and $60,400,000 less than the 
President's amended request, for activities to counter the 
adverse health and medical consequences from major terrorist 
events. Within this amount, sufficient funds are provided for 
the Office of Emergency Preparedness to staff and administer 
this program, as well as the other OEP activities specified in 
the administration's request. The amount provided by the 
Committee is intended to continue the formation of new 
metropolitan medical strike teams in key uncovered urban areas 
of the country. The Committee has provided additional funding 
for bioterrorism within the public health and social services 
emergency fund.
    The Department has lead responsibility for health, medical, 
and health-related support under the Federal response plan to 
catastrophic disasters. On behalf of the Department, the Office 
of Emergency Preparedness assesses the potential health and 
medical consequences of a terrorist incident and to formulate 
necessary responses. The funds provided would support 
activities to build local, State, and Federal capacity to 
respond to terrorist acts with public health implications. Such 
activities would include assisting local emergency managers 
through the MMST system to build an enhanced capability to 
detect and identify biologic and chemical agents.

                      OFFICE OF INSPECTOR GENERAL

Appropriations, 1998....................................     $31,855,000
Budget estimate, 1999...................................      29,000,000
Committee recommendation................................      29,000,000

    The Committee recommends an appropriation of $29,000,000 
for the Office of Inspector General. This is the same as the 
administration request and $2,855,000 less than the fiscal year 
1998 level. In addition to discretionary funds, the Health 
Insurance Portability and Accountability Act of 1996 provides 
no less than $90,000,000 and no more than $100,000,000 in 
mandatory funds for the Office of the Inspector General in 
fiscal year 1999; the total funds provided to the Office by 
this bill and the authorizing bill would be between 
$111,000,000 and $129,000,000 in fiscal year 1999.
    The Office of Inspector General conducts audits, 
investigations, inspections, and evaluations of the operating 
divisions within the Department of Health and Human Services. 
The OIG functions with the goal of reducing the incidence of 
waste, abuse, and fraud. It also pursues examples of 
mismanagement toward the goal of promoting economy and 
efficiency throughout the Department.
    The Committee commends the HHS Office of Inspector General 
for their continued efforts to reduce waste, fraud, and abuse 
in Department programs. The second OIG CFO Medicare audit again 
revealed significant shortcomings in the Department's efforts 
to prevent mispayments. The Committee urges the OIG to do 
further analysis of the results of this audit so that it can 
provide the Committee with a specific set of recommendations 
for reform. The Committee expects to hold hearings on the third 
annual CFO report. Furthermore, the Committee expects the OIG 
to continue to provide technical advise and expertise to the 
Administration on Aging's senior volunteer anti-Medicare fraud 
project. As a top priority, the Committee intends to assure 
that seniors calling into the toll-free telephone line to 
report Medicare fraud get a prompt and complete response. 
Therefore, the Committee urges the OIG to expand its staffing 
of their hotline.

                        OFFICE FOR CIVIL RIGHTS

Appropriations, 1998....................................     $19,659,000
Budget estimate, 1999...................................      20,659,000
Committee recommendation................................      20,659,000

    The Committee recommends $20,659,000 for the Office for 
Civil Rights. This is the same as the administration request 
and $1,000,000 more than the the fiscal year 1998 level.
    This recommendation includes the transfer of $3,314,000 
from the Medicare trust funds, which is the same as the 
administration request and the fiscal year 1998 level.
    The Office for Civil Rights is responsible for enforcing 
civil rights-related statutes in health care and human services 
programs. To enforce these statutes, OCR investigates 
complaints of discrimination, conducts program reviews to 
correct discriminatory practices, and implements programs to 
generate voluntary compliance among providers and constituency 
groups of health and human services.

                            POLICY RESEARCH

Appropriations, 1998....................................     $13,974,000
Budget estimate, 1999...................................      14,000,000
Committee recommendation................................      14,000,000

    The Committee recommends an appropriation of $14,000,000 
for policy research. This is the same as the administration 
request and $26,000 more than the fiscal year 1998 amount.
    Funds appropriated under this title provide resources for 
research programs that examine broad issues which cut across 
agency and subject lines, as well as new policy approaches 
outside the context of existing programs. This research can be 
categorized into three major areas: health policy, human 
services policy, and disability, aging and long-term care 
policy.
    The Committee recognizes the need for obtaining State level 
data regarding the impacts of welfare reform and includes 
sufficient funds to continue the longitudinal study on the 
outcomes of welfare reform. The Personal Responsibility and 
Work Opportunity Reconciliation Act of 1996 directed the Census 
Bureau to conduct the survey of program dynamics [SPD] on the 
national level; however, there is no mechanism in place to 
provide State-based or multistate information, particularly in 
less densely populated areas. Iowa State University has been 
working with the Census Bureau to develop an approach for State 
level surveys that are relevant for local welfare program 
design, implementation, and evaluation and can be integrated 
into the SPD. The Committee has provided sufficient funds 
within this account to support continued development of this 
model.

            PUBLIC HEALTH AND SOCIAL SERVICES EMERGENCY FUND

    The Committee recommendation includes an emergency 
allocation of $300,000,000 within the public health and social 
services emergency fund, to be made available only upon 
submission of a formal request designating the need for the 
funds as an emergency as defined by the Budget Enforcement Act. 
This year the Committee has reinstated this account to address 
the administration request regarding bioterrorism as well as 
other critical public health infrastructure needs. The 
administration submitted an amended budget request of 
$120,000,000 for activities intended to counter bioterrorism 
threats. Of the amount requested by the administration, 
$10,000,000 is allocated for vaccine development activities at 
the National Institutes of Health. The Committee has included 
sufficient funds within the regular NIH account to initiate the 
NIH portion of the bioterrorism request, leaving $110,000,000 
of the overall amended request to be further considered by the 
Committee.
    Bioterrorism initiative.--Should funds be released by a 
Presidential emergency declaration, the Committee directs 
$81,000,000 in funding for the following activities at the 
Centers for Disease Control and Prevention: $1,000,000 for the 
development of an overall preparedness plan; $1,000,000 to 
enhance technical capabilities to identify certain biological 
agents; $5,000,000 to develop new sources and methods for 
surveillance; $2,000,000 to assist States in developing 
emergency preparedness and response plans; $7,000,000 to 
strengthen State and local epidemiological and surveillance 
capacity; $2,000,000 to expand the CDC Epidemic Intelligence 
Service; $5,000,000 to better identify potential biological and 
chemical terrorism agents; $13,000,000 for regional 
laboratories for detecting and measuring biological and 
chemical agents; $5,000,000 to develop rapid toxic screening; 
and $40,000,000 to develop a national health surveillance and 
alert network. The Committee further allocates $3,600,000 for 
studies and evaluation projects on bioterrorism and nuclear 
weapons testing. In addition, the Committee has allocated 
$3,000,000 to upgrade and support antibioterrorism training at 
Fort McClellan's Noble Army Hospital in Alabama.
    Regional laboratories.--Sufficient funds have been provided 
to accelerate regional capabilities in detecting compounds and 
agents of potential use in bioterrorism. The Committee is aware 
of the proposals by the University of North Carolina School of 
Public Health to develop modern laboratories dedicated to 
emerging infectious diseases, and urges CDC to grant full and 
fair consideration to this proposal.
    National health surveillance and alert network.--The 
Committee is concerned about the lack of a national, 
coordinated system that would link local, regional, and 
national health authorities in the event of a major public 
health emergency. The Committee understands that many local 
health departments are lacking even basic equipment such as 
computers. Funds have been provided to establish such a network 
and the Committee expects that a significant proportion of 
these funds be directly available to local and State health 
authorities. Accordingly, the Committee expects the Department 
to develop criteria enabling such direct transfers, either 
through grant or contracting mechanisms.
    Independent assessments and evaluations.--The Committee 
believes that considerable work remains in conducting a full, 
independent, and reasoned threat assessment in the field of 
biological weapons, particularly with regard to establishing 
civilian defenses such as vaccine and pharmaceutical 
stockpiling. The Committee has provided $750,000 to the 
Chemical and Biological Arms Control Institute, an independent 
non-Government entity, to examine current assumptions 
underlying the initiative, identify other potential threats in 
this field, and to make tangible recommendations that would 
further enhance national security against biological threats. 
The Committee expects a report within 1 year of enactment.
    The Committee is supportive of efforts to integrate basic 
science with the independent strategic assessment of threats to 
civilian populations. The Committee is aware of the proposal by 
Johns Hopkins University to establish a Center for Civilian 
Biodefense Studies that would provide expertise for strategic 
planning and would develop a educational and research agenda. 
The Committee has included $1,000,000 to initiate this 
activity.
    The Committee has allocated $1,850,000 within the emergency 
fund for a study of the health consequences to the American 
population of nuclear weapons tests conducted by the United 
States and other nations. The Committee expects the Centers for 
Disease Control and Prevention to be the lead agency on the 
study, with the support of the National Cancer Institute. The 
Department should conduct an initial assessment of the 
feasibility and public health implications of such a study. The 
assessment ought to address major issues such as: radiation 
dose estimation and risk assessment, appropriate epidemiologic 
investigations, and health communication strategies for 
promoting better understanding of the research by the general 
public. In developing the assessment, design, and conduct of 
the study, the Department is expected to include input from the 
public and the Advisory Committee on Energy-Related 
Epidemiologic Research. In conducting the study, the Department 
ought to give high priority to examining the health 
consequences of exposure among both the general and high-risk 
populations to the full range of radionuclides produced by a 
nuclear weapons test. The Committee expects to be informed of 
the study's progress on a regular basis and expects to receive 
a final report by July 1, 2000.
    Office of the Secretary.--Within the bioterrorism 
initiative, the Committee further directs $65,000,000 in 
funding for activities at the Office of the Secretary, 
Department of Health and Human Services: $51,000,000 for the 
Office of Emergency Preparedness to establish a pharmaceutical 
stockpile for civilian populations; $9,000,000 for the Office 
of Emergency Preparedness for operational support and for the 
expansion of metropolitan medical response systems and national 
medical response teams; and $5,000,000 for the ``General 
departmental management'' account for the Department's support 
of bioterrorism and associated activities. The Committee 
further understands that OEP will receive a reimbursement of 
$9,000,000 from the Department of Justice for metropolitan 
medical response system activities. In developing plans for 
bioterrorism countermeasures, the Committee notes the standing 
personnel and reserves of the Public Health Service 
Commissioned Corps are a valuable resource that ought to be 
well-integrated.
    Emerging infectious diseases.--Within this emergency fund, 
the Committee directs $147,400,000 for the following activities 
at the Centers for Disease Control and Prevention: $47,300,000 
for CDC's infectious disease program; $25,100,000 for CDC's 
epidemic services program; $20,000,000 for CDC's polio 
eradication program; $8,000,000 for CDC's measles eradication 
program; $8,000,000 for CDC's sexually transmitted disease 
program; $33,000,000 for CDC's infectious disease laboratory; 
and $6,000,000 for the CDC Office of the Director.
    Polio eradication.--The Committee has provided $20,000,000 
to be allocated to the polio eradication activity of the 
National Immunization Program, an amount necessary to meet the 
goal of global eradication of polio by the year 2000. The 
Committee is aware of the progress that has been made in 
eradicating polio and is heartened by the prospect of 
eliminating this disease. Funding will enable CDC to accelerate 
its programs thereby decreasing the overall global disease 
burden caused by polio.
    Measles control/eradication.--The Committee has provided 
$8,000,000 to be allocated to the measles control and 
eradication activity of the National Immunization Program, 
which will enable CDC to provide measles vaccine for 
supplemental measles immunization campaigns and to expand 
epidemiologic, laboratory, and programmatic/operational support 
to the World Health Organization and its member countries for 
the measles elimination initiative in the Americas region and 
for accelerated measles control efforts worldwide. These 
efforts will be a crucial step toward the eventual global 
eradication of measles. Such support should build upon the 
disease control and surveillance infrastructure developed for 
polio eradication in a manner that does not compromise ongoing 
global polio eradication activities.

                           General Provisions

    The Committee recommendation includes language placing a 
$37,000 ceiling on official representation expenses (sec. 201), 
the same as existing law.
    The Committee recommendation includes language included in 
fiscal year 1998 which limits assignment of certain public 
health personnel (sec. 202).
    The Committee recommendation retains language carried in 
fiscal year 1998 regarding set-asides in the authorizing 
statute of the National Institutes of Health (sec. 203).
    The Committee recommendation retains a provision carried in 
fiscal year 1998 to limit use of grant funds to pay individuals 
more than an annual rate of $125,000 (sec. 204).
    The Committee recommendation retains language from fiscal 
year 1998 restricting the use of taps (sec. 205) for program 
evaluation activities by the Secretary prior to submitting a 
report on the proposed use of the funds to the Appropriations 
Committee. Section 241 of the Public Health Service Act 
authorizes the Secretary to redirect up to 1 percent of the 
appropriations provided for programs authorized under the act 
for evaluation activities. The Committee further expects that 
the report include a detailed itemization of the proposed use 
of evaluation funds for the Committee's review and approval.
    The Committee recommendation retains language prohibiting 
the use of funds for the Federal Council on Aging and the 
Advisory Board on Child Abuse and Neglect (sec. 206).
    The Committee recommendation retains language included in 
fiscal year 1998 restricting transfers of appropriated funds 
among accounts and requiring a 15-day notification of both 
Appropriations Committees prior to any transfer (sec. 207).
    The Committee recommendation includes language included in 
fiscal year 1998 permitting the transfer of up to 3 percent of 
AIDS funds among Institutes and Centers (sec. 208) by the 
Director of NIH and the Director of the Office of AIDS Research 
of NIH. The recommendation also includes language included in 
fiscal year 1998 which directs that the funding for AIDS 
research as determined by the Directors of the National 
Institutes of Health and the Office of AIDS Research be 
allocated directly to the OAR for distribution to the 
Institutes and Centers consistent with the AIDS research plan 
(sec. 209).
    The Committee recommendation includes a new provision to 
permit funds to be used for the National Institutes of Health 
to provide transit subsidies in amounts consistent with the 
transportation subsidy programs authorized under section 629 of 
the Public Law 101-509 to non-FTE bearing positions, including 
trainees, visiting fellows, and volunteers (sec. 210).
    The Committee bill includes a new provision which 
permanently changes the name of the National Institute of 
Dental Research to the National Institute of Dental and 
Craniofacial Research (sec. 211).
    The Committee recommendation includes a new provision which 
adjusts the fiscal year 1998 authorization level for the Social 
Services Block Grant Program (sec. 212).
    The Committee recommendation includes a new provision which 
restricts the use of funds to carry out the Medicare+Choice 
Program if the Secretary denies participation to an otherwise 
eligible entity (sec. 213).
    The Committee bill includes language naming the new NIH 
vaccine facility (sec. 214).
    The Committee bill includes language regarding prostate 
cancer (sec. 215).

                   TITLE III--DEPARTMENT OF EDUCATION

                            education reform

Appropriations, 1998....................................  $1,275,035,000
Budget estimate, 1999...................................   1,347,000,000
Committee recommendation................................   1,244,500,000

    The Committee has provided $1,244,500,000 in this account 
for education reform initiatives. The recommendation includes 
$496,000,000 for education reform activities authorized by the 
Goals 2000: Educate America Act, $125,000,000 to continue 
implementation of school-to-work transition systems authorized 
by the School-to-Work Opportunities Act, and $623,500,000 for 
education technology authorized by the Elementary and Secondary 
Education Act.

Goals 2000: State and local education systemic improvement grants

    The Committee recommends $466,000,000 for State and local 
systemic education improvement grants authorized by title III 
of the Goals 2000: Educate America Act. This amount is the same 
as the fiscal year 1998 appropriation and $10,000,000 below the 
administration request.
    Goals 2000 funds provide incentives for States to devise 
their own strategies for comprehensive reform of elementary and 
secondary education. Grants are distributed to States through a 
formula based on relative shares each State received in the 
previous year under titles I and VI of the Elementary and 
Secondary Education Act. By law, 1 percent is reserved for the 
outlying areas, schools supported by the Bureau of Indian 
Affairs and the Alaska Federation of Natives.

Parental assistance

    The Committee recommends $30,000,000 for title IV of the 
Goals 2000: Educate America Act, which authorizes a variety of 
activities designed to improve parenting skills and strengthen 
the partnership between parents and professionals in meeting 
the education needs of their children, including those aged 
birth through 5. The recommendation is $5,000,000 more than the 
administration request and the fiscal year 1998 amount. The 
funds provided will continue support for 52 centers.
    The Committee reiterates its concern that many of the 
grantees currently receiving funding under this program are 
making only minimal efforts to implement Parents as Teachers 
[PAT] or Home Instruction for Preschool Youngsters [HIPPY] 
Programs. The Committee, therefore, strongly urges the 
Department to stipulate that at least 50 percent of each grant 
award shall be used only for PAT or HIPPY Programs.

School-to-work opportunities

    The Committee supports funds for the School-to-Work 
Opportunities Act, and has recommended $125,000,000 for the 
Department of Education's share of program funding. The amount 
recommended is $75,000,000 less than the 1998 appropriation and 
the same as the administration request. Fiscal years 1997-98 
were the peak years for Federal support. The decrease 
recommended in fiscal year 1999 reflects the decline planned in 
Federal support as States assume increased responsibility for 
implementing their school-to-work systems. This amount, 
together with $125,000,000 recommended for the Labor 
Department, will provide a total of $250,000,000 in direct 
funding to help States implement their plans for creating 
systems to improve the transition from school to work.
    Local school-to-work programs include a combination of 
work-based learning involving job training and school-based 
learning tied to both occupational skill standards and the 
voluntary academic standards States establish under Goals 2000. 
Students who complete a school-to-work program will receive a 
high school diploma, a certificate recognizing 1 or 2 years of 
postsecondary education, if appropriate, and a portable, 
industry-recognized skill certificate.

Technology literacy challenge fund and regional technology consortia

    The Committee recommends $425,000,000 for the technology 
literacy challenge fund authorized by section 3132 of the 
Elementary and Secondary Education Act, the same as the fiscal 
year 1998 appropriation and a decrease of $50,000,000 below the 
budget request.
    The fund helps States put into practice strategies to 
enable schools to integrate technology into school curricula. 
Funds are used to enhance students' critical thinking skills, 
support training for teachers, connect classrooms to the 
information superhighway, and purchase computers and software. 
Funds are distributed according to each State's share of title 
I, part A moneys. To be eligible for funds, States must submit 
a statewide technology plan describing long-term strategies for 
financing technology education in the State, including private-
sector participation and targeting funds to school districts 
with the greatest need.

Technology innovation challenge grants

    The Committee recommends $136,000,000 for two of the 
technology programs authorized as part A of title III of the 
ESEA, an increase of $20,000,000 more than the budget request 
and the amount appropriated in fiscal year 1998.
    Technology innovation challenge grants support partnerships 
among educators, business and industry, and other organizations 
in the community to develop innovative new applications of 
technology and community plans for fully integrating technology 
into schools.
    It has been brought to the Committee's attention that 
grants issued since this program's creation in fiscal year 
1995, appear to be made disproportionately to States with high 
access to technology, high levels of private funding, and high 
concentrations of disadvantaged students, while the 
applications from predominantly rural States have been turned 
down, citing a lack of community resource contributions and low 
numbers of children benefiting from the proposals. The 
Committee encourages the Department to reexamine the criteria 
by which review panels score applications to ensure that the 
community resource contribution effort is taken into account, 
that true innovation, such as new applications of software and 
state-of-the-art professional training programs and multicounty 
and multistate consortia affecting underprivileged children in 
technologically underserved areas and rural demographic 
limitations, for example in Mississippi, are also considered.
    Within the amount recommended, the Committee has also 
included $10,000,000 to continue the regional technology in 
education consortia, the same amount appropriated in fiscal 
year 1998 and recommended by the administration. These 
consortia assist States and local educational agencies in the 
identification and procurement of resources necessary to 
implement technology plans; develop training resources for both 
elementary and secondary and adult education; provide referrals 
to sources of technical assistance and professional 
development; and assist institutions of higher education to 
establish preservice training programs in the appropriate use 
of educational technology.
    The Committee is encouraged by the number of public-private 
partnerships that have been launched around the Nation to 
increase technical education opportunities for high school 
students. The Committee urges the Department of Education to 
provide $2,500,000 for a demonstration project that would 
provide high technology training for students leading to 
certification, postsecondary education and employment 
opportunities for high-skill and high-wage technology-related 
careers for the 21st century; provide a positive alternative 
for youth for after-school hours; and support the local 
business community with an emerging well-trained work force 
pool for the growing high-technology market sector. The Memphis 
regional information technology education and training 
initiative would be especially suited to carry out an 
initiative such as the one described.
    The Committee encourages the Department of Education to 
provide $1,000,000 for a demonstration program to increase 
access to computer technology so as to help equip inner-city 
parents, children, and teachers with the computer skills needed 
for today's work force. Programs that target educationally 
disadvantaged adolescent populations, especially students with 
limited writing and reading skills, parents moving from 
welfare-to-work, and dropouts or those who are at risk of 
dropping out could benefit greatly from such a program. The 
Oakland Unified School District would be especially suited to 
conduct a demonstration program in this area.
    The Committee encourages the Department of Education to 
provided $2,000,000 to conduct a demonstration project that 
provides students and community members with the opportunity to 
enhance learning through state-of-the-art information 
technology systems. An information technology learning center 
for the public, equipped with high-technology instructional 
labs including networked computer work stations, overhead 
projection systems, and video-audio links to other sites would 
provide employers, employees, residents, and K-12 students and 
teachers the opportunity to increase their technological 
skills. Mansfield University in Pennsylvania would be 
especially suited to conduct a demonstration in this area.
    The Committee encourages the Department to provide 
$2,500,000 for a demonstration to establish a comprehensive, 
integrated voice-video-data communications network which will 
permit easy access to computer networks from both on- and off-
campus locations including local education agencies. The 
project should include statewide access to the faculty, 
research, and library resources for elementary and secondary 
education, participants in continuous and distance learning 
programs, and other educational institutions across the State. 
In addition, there should be a significant non-Federal level of 
financial participation. Rutgers, the State University of New 
Jersey, would be especially suited to carry out a demonstration 
project as described above.
    It has been brought to the Committee's attention that a 
successful computer learning program can improve the 
educational attainment of at-risk youth. The Beaufort County 
schools have been participating in the Learning with Laptops 
Program, which provides laptop computers for home use, and has 
shown great success in bringing new opportunities to students 
and their families. The Committee encourages the Department to 
provide $1,000,000 for a demonstration program such as the one 
described above.
    The Committee has been impressed with an innovative program 
developed in conjunction with the Krell Institute in Ames, IA, 
which integrates mathematics, science, and technology into a 
comprehensive curriculum using a learner-centered problem-based 
approach to learning. Through professional development summer 
programs for teachers, this program helps secondary school 
students develop the skills necessary to compete in a 
technology-based work environment. To help meet the need for a 
technology-capable work force in Alabama, Colorado, Iowa, New 
Mexico, and Tennessee, the Committee urges the Department to 
include $2,000,000 for a demonstration project such as the one 
described above.
    Community colleges are a valuable technical assistance 
resource to primary schools, especially those serving 
disadvantaged children. The Committee strongly urges the 
Secretary to place a high priority on new projects which link 
the technology resources of community colleges in Iowa with 
elementary, middle, and secondary schools in low-income 
communities.
    The Committee encourages the Department to use $1,200,000 
to conduct a demonstration that would provide user-friendly 
online services that help teachers apply technology in their 
classrooms. A program using Internet technologies to deliver 
learning resources to students from kindergarten through high 
school to increase student achievement, enhance teacher 
proficiencies, and foster community participation in the 
educational process will enable teachers to access resources 
and services at any time from any place in the State. The 
program can provide a model of how technology can enhance 
education for the Nation. LEARN North Carolina, in conjunction 
with the University of North Carolina at Chapel Hill, is 
currently developing such a program and would be especially 
suited to carry out a demonstration in this area.
    The Committee urges the Secretary to provide $2,000,000 for 
a traveling museum technology exposition that will showcase the 
latest computer hardware and software technologies and 
materials. Instructional programs and seminars by local museum 
curators and educators on how best to integrate new and 
existing technologies into museum exhibits and the classroom 
would also be highlighted. The Museums and Universities 
Supporting Educational Enrichment, Inc., in Philadelphia, PA, 
would be especially suited to carry out such a program.
    The Committee is aware of a unique opportunity to advance 
this Nation's knowledge of the Constitution and the role that 
technology can play in developing programs to expand the 
research and teaching of constitutionalism and democracy. 
Programs which foster cooperative efforts to develop strategic 
linkages with scholars and public officials, both in the United 
States and around the world; collaboration in the development 
of a state-of-the-art web site; academic programming, 
conferences, and symposia; and the creation of programs on 
contemporary and historical constitutional issues would make a 
direct contribution toward such an effort. Therefore, the 
Committee directs the Department to include $10,000,000 for 
development of a program which will use technological advances 
to engage all citizens in understanding the Constitution and 
its history. The National Constitution Center in partnership 
with the University of Pennsylvania would be the entities best 
suited to carry out a project such as the one described above.
    The Committee encourages the Department to include $850,000 
to develop and implement a series of professional development 
courses for elementary and secondary school teachers through 
the Internet. An Internet-based curriculum could provide 
training to teachers in remote and isolated areas, such as 
villages in Alaska, who could not otherwise take advantage of 
training opportunities. The State of Alaska's Department of 
Education would be especially suited to carry out a project 
such as the one described above.
    The Committee urges the Secretary, when awarding 
educational technology grants, to give full and fair 
consideration to the application for a grant award submitted by 
the Sedro-Woolley School District, in consortia with the 
Woodring College of Education; Western Washington University; 
Educational Service District No. 189; Anacortes School District 
No. 103; Burlington School District No. 100; Concrete School 
District No. 11; La Conner School District No. 311; and Mount 
Vernon School District No. 320.
    The Committee continues its concern regarding the growing 
need for the use of online resources in education, and the 
increasing importance of access to computer technology for all 
educational institutions. Increasing computer connectivity, 
joint storage, and data mining capabilities at the regional 
level have the potential to vastly improve the quality of 
primary and secondary schools as well as colleges, 
universities, and the private sector. The Committee, therefore, 
encourages the Department to provide $2,000,000 for a 
demonstration project to develop a supercomputing 
infrastructure with broad-based networking applications for 
elementary and secondary schools, colleges, and universities. 
The model should also include access to science and medical 
technology. The HUBS project in the Delaware Valley region of 
Pennsylvania is currently providing mail, Internet access, and 
automated library systems and would be especially suited to 
conduct a demonstration in this area.
    The Committee urges the Secretary, when awarding 
educational technology grants, to give consideration to school 
districts around the country, such as the Houston Independent 
School District, that encompass high concentrations of at-risk 
youth, empowerment zones, and enhanced enterprise communities.
    Technology has been proven to be an effective learning tool 
for students and an important teaching aid for teachers. 
However, a great need exists for a technology component for 
teacher certification. A program which emphasizes technology as 
a learning tool and one that will lead to preservice competency 
in distance learning, instructional television, and web-based 
and multimedia instruction would be especially useful. The 
Committee encourages the Department to provide $2,000,000 for 
such a technology program. The Utah Education Network would be 
in position to carry out such a project.
    The Committee urges the Department to provide $1,000,000 in 
funds for a project to train teachers in the effective use of 
instructional technology and its integration into classrooms. A 
public-private partnership of school districts, parents and 
teachers, universities and colleges, businesses, and community 
organizations would provide the structure for such an 
initiative. The technology for learning initiative located in 
Los Angeles, CA, would be especially suited for such a project.
    The Committee encourages the Department to provide 
$1,000,000 for a state-of-the-art science and technology center 
that will develop programs to foster collaboration between 
science and nonscience faculties and increase educational 
achievement. The Lieutenant Joseph P. Kennedy, Jr. Center for 
Collaboration in Science and Technology would be especially 
suited.
    The Committee encourages the Department to provide 
$2,000,000 for a pilot program to ensure that low-income 
students have access to computer technology. A program that 
would link schools, classrooms, and libraries through local and 
wide area networks would provide students with expanded 
opportunities for learning. The Newport News public schools 
technology plan would be especially suited for such a 
demonstration.
    The Committee is aware of an innovative project to assist 
parents in technology-based instruction. The Alhambra School 
District is currently operating such a program and would serve 
as a good model to supply parents with another educational 
tool.

National activities

    The Committee recommends no funds for the educational 
technology national activities. The administration requested 
$87,000,000 for this program authorized by title III, part A of 
the ESEA. No funds were provided for this purpose in fiscal 
year 1998. This activity supports Federal leadership activities 
that promote the use of technology in education. Funds may be 
used for teacher training technology, community-based 
technology, and technology leadership activities.

Star schools

    For the star schools program, the Committee recommends 
$46,500,000, an increase of $12,500,000 over the administration 
request and the 1998 appropriation.
    This program is designed to improve instruction in math, 
science, foreign languages, and other subjects such as 
vocational education, primarily by means of telecommunications 
technologies and to serve underserved populations. The program 
supports eligible telecommunications partnerships to develop 
and acquire telecommunications facilities and equipment, 
instructional programming teacher training programs and 
technical assistance.
    The Committee is aware of the benefits learning programs 
are having in enhancing education access, resource sharing, and 
communication among rural communities. The Committee urges the 
Department of Education to provide $2,000,000 for a 
demonstration project to develop a technology enhancement 
initiative that would offer access to higher education courses, 
library resources, and teacher technology education at a 
variety of community sites via distance learning to underserved 
counties. Elmira College is currently providing enhanced 
distance education and teacher technology training activities 
in the southern tier of New York and the northern tier of 
Pennsylvania, and would be especially suited to conduct a 
demonstration in this area.
    The Committee encourages the Department to provide $800,000 
for a demonstration project to enhance the distance delivery of 
natural resources management courses including soils and 
forestry to students in rural areas. The project could focus on 
the unique geographical obstacles that prevent or hamper 
traditional outreach activities. Special emphasis could be 
placed on providing instruction in computer application and 
geographical information systems for resource managers through 
formal education or informal workshops and short courses. The 
School of Agriculture and Land Resources Management at the 
University of Alaska, Fairbanks would be especially suited to 
carry out a project such as the one described above.
    The Committee strongly urges the Secretary to continue the 
Iowa statewide project at current funding levels. This will be 
the final year of funding.
    The Committee urges the Department to provide $1,500,000 to 
boost educational opportunities through distance learning 
programs. Programs that provide courses through classroom 
networks will help provide students with affordable access to 
postsecondary education and training. The Ivy Tech State 
College, located in Indiana, would be especially suited for 
such a project.
    The Committee encourages the Department to provide 
$1,000,000 to conduct a demonstration project that would 
promote the development of integrated information technologies 
in rural communities. Such a program would work with 
communities to build compatible technology infrastructure 
plans, provide instruction on hardware and software solutions, 
and help community libraries, government agencies, health care 
providers, and businesses utilize the Internet and other 
digital networks. The Digital Technology Partnerships for Rural 
Communities Program is a collaborative effort with the Montana 
State University, the local government center, Renne Library, 
and the Colleges of Agriculture, Business, and Engineering and 
would be especially suited to serve as a prototype for such a 
project.
    The Committee encourages the Department to provide 
$1,200,000 to conduct a demonstration project which would 
enable preservice teachers to practice and share their lessons 
with teachers and students in isolated rural areas. This unique 
delivery of teacher education would increase education 
achievement for all students. The multimedia classrooms and 
laboratories of the Rural Education Technology Center at the 
Western Montana College would be especially suited to carry out 
such a demonstration.
    The Committee encourages the Department to provide 
$2,000,000 for a demonstration project to construct a network 
of fiber-optic communication among universities, technical 
colleges, schools of art, and public libraries. This program 
could serve as a model for partnerships among these entities 
and demonstrate educational resource sharing through advanced 
telecommunications technology. The Committee notes that 
Winston-Net, located in Forsythe County, NC, would be 
especially suited to serve as a model for this project.

Ready to learn television

    The Committee recommends an appropriation of $11,000,000 
for the ready to learn television program, an increase of 
$4,000,000 over the amount appropriated in fiscal year 1998 and 
requested by the administration.
    This program supports the development and distribution of 
educational television programming designed to improve the 
readiness of preschool children to enter kindergarten and 
elementary school, consistent with the first national education 
goal that all children should start school ready to learn. The 
program also supports the development, production, and 
dissemination of educational materials designed to help 
parents, children, and caregivers obtain the maximum advantage 
from educational programming.

Telecommunications demonstration project for mathematics

    The Committee recommends $5,000,000 for the continuation of 
this PBS initiative called Mathline, $3,000,000 more than the 
amount recommended by the administration and $2,965,000 more 
than the fiscal year 1998 appropriation. Funds are used to 
carry out a national telecommunication-based demonstration 
project designed to train elementary and secondary school 
teachers in preparing all students for achieving State content 
standards in mathematics.
    This is a highly effective program which provides state-of-
the-art training for math teachers through video, print, and 
online, leader-led, group discussions. The Committee is pleased 
with the responses to the project and with the reaction of PBS 
to participant evaluations which suggested changes in 
accessibility and interactive discussions through the Internet. 
The project has laid the groundwork for technology driven 
network-based teacher training. The additional funding is 
intended to allow expansion of the program for preservice, as 
well as inservice teacher training in technology and science 
through the existing PBS satellite links at colleges and 
schools across the country. The Committee is encouraged by the 
effectiveness of the program and with the ability to reach most 
of our Nation's current teachers, as well as those still in 
colleges and universities.

                    Education for the Disadvantaged

Appropriations, 1998....................................  $8,021,827,000
Budget estimate, 1999...................................   8,495,892,000
Committee recommendation................................   8,334,781,000

    The Committee recommends an appropriation of $8,334,781,000 
for education for the disadvantaged. This is $312,594,000 more 
than the fiscal year 1998 appropriation and $161,111,000 less 
than the administration request. In fiscal year 1998, 
$1,448,386,000 was made available for this account in fiscal 
year 1999 funds. This year, the Committee recommendation 
forward funds $2,500,000,000 for fiscal year 2000. The 
Committee took this action because of the severe budget 
constraints facing the Committee in fiscal year 1999.
    Programs financed under this account are authorized under 
title I of the Elementary and Secondary Education Act [ESEA] 
and section 418A of the Higher Education Act. ESEA title I 
programs provide financial assistance to State and local 
educational agencies [LEA's] to meet the special educational 
needs of educationally disadvantaged children, migrant 
children, neglected and delinquent children in State 
institutions, and juveniles in adult correctional institutions. 
In addition, the Even Start Program supports projects that 
integrate early childhood education with parenting and adult 
literacy training. Funds for most of these programs are 
allocated through formulas that include the number of eligible 
children and each State's average per-pupil expenditure. Even 
Start funds are allocated according to each State's proportion 
of title I grants to LEA's.

Grants to local educational agencies

    Title I grants to local educational agencies provide 
supplemental education funding to LEA's and schools, especially 
in high-poverty areas, to help low-income, low-achieving 
students learn to the same high standards as other children. 
The program currently provides services to more than 10 million 
children. The formula for basic grants is based on the number 
of children from low-income families in each county, weighted 
by per-pupil expenditures for education in the State. States in 
turn make suballocations from the county to the LEA level using 
the best data available on the number of poor children. States 
are also required to reserve funds generated by counts of 
children in correctional institutions to make awards to LEA's 
for dropout prevention programs involving youth from 
correctional facilities and other at-risk children. By law, 1 
percent of the total LEA grant appropriation is set aside for 
the Bureau of Indian Affairs and the outlying areas.
    For title I basic grants, including the amount transferred 
to the Census Bureau for poverty updates, the Committee 
recommends an appropriation of $6,574,000,000. This amount is 
$300,788,000 more than appropriated in fiscal year 1998 and 
$300,000,000 more than the budget request.
    The Committee has provided no funding for the targeted 
grants program. The administration requested $293,000,000 for 
this program which distributes funds in a manner that provides 
higher per-children amounts for counties with the highest 
percentage of poor children.
    The Committee recommends $1,102,020,000 for concentration 
grants, the same amount appropriated in fiscal year 1998 and 
$97,980,000 less than the budget request. Funds under this 
program are distributed according to the basic grants formula, 
except that they only go to counties and LEA's where the number 
of poor children equals at least 6,500, or 15 percent, of the 
total school-aged population. Approximately 66 percent of 
counties nationally receive funds.
    The Committee has again included bill language providing 
that no local educational agency receive an allocation under 
title I, part A that is less than its allocation of the 
previous year. For fiscal year 1999, the Department will, for 
the first time, make allocations directly to local educational 
agencies if the Census Bureau can produce LEA-level data that 
the Secretaries of Education and Commerce determine, with the 
advice of the National Academy of Sciences, are valid and 
appropriate for that purpose. If the Bureau cannot produce such 
data, the Department will make allocations using newly updated 
county-level data. In either case, a 100-percent hold-harmless 
requirement will protect the allocations to school districts 
and States during a time of transition to new data. The 
Committee will continue to consider additional steps that can 
be taken to target title I aid on States and local educational 
agencies in greatest need. The Committee added additional funds 
to accommodate the hold-harmless provision.
    The Committee supports national efforts to help school 
districts improve class size and teacher quality, especially 
for disadvantaged students. Research shows that class size 
reduction leads to educational improvement in areas such as 
reading and mathematics for all students, but especially for 
disadvantaged students. The benefits of smaller classes are 
greatest for lower achieving, minority, poor, and inner-city 
children. One study found that urban fourth-graders in smaller-
than-average classes were three-fourths of a school year ahead 
of their counterparts in larger-than-average classes.
    Teachers in small classes can provide students with more 
individualized attention, spend more time on instruction and 
less on other tasks, cover more material more effectively, and 
are better able to work with parents to further their 
childrens' education. Smaller classes allow teachers to 
identify and work more effectively with students who have 
learning disabilities and, potentially, can reduce those 
students' need for special education services in the later 
grades. Students in smaller classes are able to become more 
actively engaged in learning than their peers in large classes.
    The quality of teacher training and education also drives 
the quality of student achievement. Efforts to improve teacher 
training and teacher quality must be part of any effort to 
reduce class size, with efforts to be determined by the local 
educational agency.
    Efforts available to local educational agencies should 
include: (a) training teachers in effective reading 
instructional practices (including practices for teaching 
students who experience initial difficulty in learning to read) 
and in effective instructional practices in small classes; (b) 
paying the costs for uncertified or unlicensed teachers hired 
to teach grades one through three, to obtain full certification 
or licensure within 3 years of such hiring; (c) providing 
mentors or other support for teachers in grades one through 
three; (d) improving recruitment of teachers for schools that 
have a particularly difficult time hiring certified or licensed 
teachers; and (e) providing scholarships or other aid for 
education and education-related expenses to paraprofessionals 
or undergraduate students in order to expand the pool of well-
prepared, and certified or licensed, teachers.
    The Committee strongly urges the Department of Education to 
expand demonstration projects under title I to be permitted to 
be used for the purposes of reducing class size and improving 
teacher quality. Title I funds could be used by local 
educational agencies to hire and retain well-qualified, well-
trained teachers to reduce class size in grades K-3, and to 
improve the quality of their teaching pool. Quality improvement 
options such as those listed above would qualify for funding.

Comprehensive school reform

    The Committee recommends $120,000,000 for the comprehensive 
school reform program which was created through the fiscal year 
1998 appropriations act and funded under the title I 
demonstration authority. This program received first time 
funding in fiscal year 1998 at the same level recommended in 
fiscal year 1999. The administration requested $150,000,000 for 
this purpose in fiscal year 1999. This program provides schools 
with funding to develop or adopt, and implement, comprehensive 
school reforms based on reliable research and effective 
teaching practices.

Capital expenses for private school students

    The Committee recommends $35,000,000 for the capital 
expenses program, a decrease of $6,119,000 below the 1998 
appropriation and $25,000,000 above the budget request.
    The Supreme Court's 1985 Aguilar v. Felton decision 
prohibited districts from sending public schoolteachers or 
other employees to private sectarian schools for the purpose of 
providing title I services. The capital expenses program has 
helped districts comply with Felton by paying a portion of the 
additional capital costs associated with serving religious 
school students outside school premises. Funds are used by 
districts for noninstructional goods and services such as 
renting classroom space in neutral sites, renting or purchasing 
mobile vans for title I instruction, or transporting private 
schoolchildren to the place of title I instruction.
    On June 23, 1997, the Court reversed its earlier ruling, 
and districts may now provide title I instruction in private 
schools. However, many school districts will continue, over the 
short term, to incur costs as a result of the original 1985 
decision. For example, some may have entered into multiyear 
leases for vans, portable classrooms, or other neutral 
instructional sites. The Committee, therefore, has recommended 
continuation of this program until an assessment has been made 
as to what the final costs are for Felton compliance.
    Funds are allocated to States according to the proportion 
of nonpublic school students served under the title I LEA 
grants program in the most recent year for which satisfactory 
data are available.

Even Start

    For the Even Start program, the Committee recommends 
$124,000,000, the same as the fiscal year 1998 appropriation 
and an increase of $9,008,000 above the budget request.
    The Even Start program provides grants for family literacy 
programs that serve disadvantaged families with children under 
8 years of age and adults eligible for services under the Adult 
Education Act. Programs combine early childhood education, 
adult literacy, and parenting education.
    States receive funds on the basis of their proportion of 
title I LEA grant allocations and make competitive 4-year 
grants to partnerships of local educational agencies and 
community-based organizations. Grant funds must be equitably 
distributed among urban and rural areas and the local share of 
program costs increases from 10 percent in the first year to 40 
percent in the fourth year.

Migrant

    For the State agency migrant program, the Committee 
recommends $320,473,000, an increase of $15,000,000 above the 
amount appropriated in fiscal year 1998. The administration 
requested $354,689,000 for this program.
    The title I migrant program authorizes grants to State 
educational agencies for programs to meet the special 
educational needs of the children of migrant agricultural 
workers and fishermen. Funds are allocated to the States 
through a statutory formula based on each State's average per-
pupil expenditure for education and counts of migratory 
children aged 3 through 21 residing within the States. Only 
migratory children who have moved within the last 3 years are 
generally eligible to be counted and served by the program. 
Currently, this program serves approximately 624,000 migrant 
students.
    This appropriation also supports activities to improve 
interstate and intrastate coordination of migrant education 
programs.

Neglected and delinquent

    The Committee recommends $40,311,000 for the title I 
neglected and delinquent program, the same amount appropriated 
in 1998 and the amount recommended by the administration.
    This program provides financial assistance to State 
educational agencies for education services to neglected and 
delinquent children and youth in State-run institutions and for 
juveniles in adult correctional institutions.
    Funds are allocated to individual States through a formula 
based on the number of children in State-operated institutions 
and per-pupil education expenditures for the State.
    States are authorized to set aside up to 10 percent of 
their neglected and delinquent funds to help students in State-
operated institutions to make the transition into locally 
operated programs. Transition activities are designed to 
address the high failure and dropout rate of institutionalized 
students and may include alternative classes, counseling and 
supervisory services, or educational activities in State-
supported group homes.

Evaluation

    The Committee bill includes $6,977,000 for title I 
evaluation activities, the same amount appropriated in fiscal 
year 1998. The amount recommended is a decrease of $1,923,000 
below the budget request.
    Evaluation funds are used to support large-scale national 
surveys that examine how the title I program is contributing to 
student performance. The recommended amount will provide 
sufficient funds to design, implement, and produce multiyear 
evaluations that will assess the effects of the changes made in 
the reauthorization of the title I program.

Transition to school demonstrations

    The Committee recommends no funds for the transition to 
school demonstrations. No specific authorization for this 
program currently exists. The administration requested 
$35,000,000 for this purpose. No funds were provided in fiscal 
year 1998. The Department planned to use funds to demonstrate 
effective practices that provide continuity among preschoool 
programs, kindergarten, and the early primary grades.

High school equivalency program

    The Committee bill includes $8,000,000 for the high school 
equivalency program [HEP]. This amount is an increase of 
$366,000 above the amount appropriated in fiscal year 1998 and 
$2,000,000 below the amount requested by the administration.
    This program provides 5-year grants to institutions of 
higher education and other nonprofit organizations to recruit 
migrant students aged 16 and over and provide the academic and 
support services needed to help them obtain a high school 
equivalency certificate and subsequently gain employment, win 
admission to a postsecondary institution or a job-training 
program, or join the military. Projects provide counseling, 
health services, stipends, and placement assistance. HEP will 
serve about 3,600 migrants in 1998.

College assistance migrant program

    For the college assistance migrant program [CAMP], the 
Committee recommends $4,000,000, an increase of $1,919,000 
above the fiscal year 1998 appropriation and $1,000,000 below 
the amount requested by the administration.
    Funds provide 5-year grants to institutions of higher 
education and nonprofit organizations for projects that provide 
tutoring, counseling, and financial assistance to migrant 
students during their first year of postsecondary education. 
Projects also may use up to 10 percent of their grants for 
followup services after students have completed their first 
year of college, including assistance in obtaining student 
financial aid. CAMP will serve about 375 students in 1998.

                               impact aid

Appropriations, 1998....................................    $808,000,000
Budget estimate, 1999...................................     696,000,000
Committee recommendation................................     810,000,000

    The Committee recommends an appropriation of $810,000,000 
for impact aid for the Department of Education. This amount is 
$2,000,000 above the 1998 appropriation and $114,000,000 above 
the administration request.
    Impact aid provides financial assistance to school 
districts for the costs of educating children when enrollments 
and the availability of revenues from local sources have been 
adversely affected by the presence of Federal activities. 
Children who reside on Federal or Indian lands generally 
constitute a financial burden on local school systems because 
these lands do not generate property taxes--a major revenue 
source for elementary and secondary education in most 
communities. In addition, realignments of U.S. military forces 
at bases across the country often lead to influxes of children 
into school districts without producing the new revenues 
required to maintain an appropriate level of education. During 
the current school year, approximately 2,000 school districts 
will receive payments on behalf of 1.2 million eligible 
children.
    The Committee has turned down the administration's language 
as follows: Language specifying that payments shall be made 
only for children living on Indian lands and children of 
members of the uniformed services living on Federal property; 
language overriding the eligibility requirements under section 
8003; language specifying the maximum basic support payment for 
which an LEA is eligible; language overriding the learning 
opportunity threshold and language overriding the hold-harmless 
provision of the statute so that all payments would be 
distributed by formula.
    It has been brought to the Committee's attention that the 
Hatboro-Horsham School District, in Horsham, PA, is responsible 
for educating children who are classified as civilian B and 
military A children, but currently does not meet the guidelines 
for reimbursement by the Department of Education. The Committee 
requests that the Department review its actions with regard to 
payments made to the Hatboro-Horsham School District and take 
steps to ensure that the school district be given adequate 
payment to meet the educational needs of the district's 
children.
    The Committee continues its concern regarding the financial 
problems that the Centennial School District in Warminster, PA, 
is experiencing due to the closure of the Warminster Naval Air 
Warfare Center. The district is responsible for educating 
children whose parents reside in naval housing, but are 
assigned to the Naval Air Station Joint Reserves in Willow 
Grove, located in a neighboring school district. The Committee 
requests that the Department review its actions with regard to 
payments made to the Centennial School District and take steps 
to ensure that adequate funding is available to provide a 
quality education for the district's children.
    It has been brought to the Committee's attention that 
Randolph Elementary School in Texas has been experiencing 
severe overcrowding conditions. Classroom facilities are also 
causing safety concerns and threaten the academic achievement 
of students at the school. The Committee requests that the 
Department work with the Randolph Field Independent School 
District to rectify the problem.
    The Committee is concerned that when impact aid funds are 
transferred to designated local banks, oftentimes neither the 
school district nor the county is aware of the deposit, and the 
deposit may not immediately enter into the proper account. It 
can take several days for the county to receive the payment 
notice, and several more days for the district to be notified. 
As a result, both the bank and the county earn interest that 
would otherwise be earned by the district if the payment were 
deposited directly into the proper account. The Committee 
recommends that the Department coordinate the transfer of funds 
with the payment notice to expedite the deposit of those funds 
into the districts' accounts, and consider notifying a district 
in advance of the date on which the transfer of funds will 
occur.
    It has been brought to the Committee's attention that the 
Box Elder public schools located on the Rocky Boy Indian 
Reservation have had an increase in their enrollment from 210 
to 375 students. This is primarily due to the construction of 
150 new homes in the area. Severe overcrowding has forced 
administrators to use recreation buildings as classrooms. The 
makeshift school facilities are without a working sewer, and 
the classrooms in the basement are without windows or 
ventilation. The Committee requests that the Department work 
with the Box Elder public schools to rectify the problem.
    The Committee is aware of the severe overcrowding 
conditions which exist at the public school on the Fort Peck 
Indian Reservation. The school is utilizing two modular units, 
one of which houses the fifth grade and the other the seventh 
and eighth grades. The Committee requests that the Department 
review the situation at the Brockton, MT, public schools and 
work with the school district to rectify the problem.
    It has been brought to the Committee's attention that the 
Navajo Mountain community, located on the Navajo Reservation, 
is in need of a school facility which would be large enough to 
accommodate the Arizona and Utah students who reside in the 
community. Children living on the Arizona border, live 75 miles 
away from the nearest Arizona high school. The San Juan School 
District, located in Utah, is currently constructing a new high 
school; however, the school will not be large enough to 
accommodate the Arizona students. Additional funds are needed 
for this expansion project. The Committee requests that the 
Department of Education review the situation and take steps to 
rectify the problem.
    It has come to the Committee's attention that the North 
Hanover Township public schools, located in New Jersey, have 
been adversely affected by the Department's interpretation of 
the definition of available revenues. The Committee understands 
that New Jersey State law prohibits school districts from 
paying for supplies, materials, and other expenses until a 
contract is completed for supplies and materials, thus fund 
balances often include obligated funds that have not been 
expended. The Committee urges the Department to work with the 
district to rectify this problem.
    The Committee is aware of the problem which exists in Day 
County, SD, involving the Webster school district. The county 
has experienced severe chronic flooding over the past 5 years 
which has resulted in a decrease in property tax receipts. The 
school district is having difficulty proving eligibility for 
section 8002 because a fire destroyed tax records. The 
Committee requests that the Department review the problems 
facing the schools in Day County, and work with the school to 
rectify the problem.
    Basic support payments.--The Committee recommends 
$662,000,000 for basic support payments, the same amount 
appropriated in fiscal year 1998 and $36,000,000 above the 
amount recommended by the administration. Under statutory 
formula, payments are made on behalf of all categories of 
federally connected children.
    Payments for children with disabilities.--Under this 
program additional payments are made for certain federally 
connected children eligible for services under the Individuals 
with Disabilities Education Act. The Committee bill includes 
$50,000,000 for this purpose, the same as the 1998 level and 
$10,000,000 above the administration request. The Committee has 
included this increase due to the rising costs of providing 
educational services to special needs children.
    Payments for heavily impacted districts.--These payments 
provide additional assistance to certain local educational 
agencies that enroll large numbers or proportions of federally 
connected children. The Committee recommends $62,000,000, the 
same amount appropriated in fiscal year 1998 and an increase of 
$42,000,000 over the amount requested by the administration.
    Facilities maintenance.--This activity provides funding for 
maintaining certain school facilities owned by the Department 
of Education. The Committee recommends $5,000,000 for this 
purpose in fiscal year 1999, a decrease of $5,000,000 below the 
budget request and an increase of $2,000,000 above the amount 
appropriated in fiscal year 1998.
    Construction.--Payments are made to eligible LEA's to be 
used for construction and renovation of school facilities, or 
for debt service related to the construction of school 
facilities. The Committee recommends $7,000,000 for this 
program, the same amount appropriated in fiscal year 1998. The 
administration requested no funds for this program.
    Payments for Federal property.--These payments compensate 
local educational agencies in part for revenue lost due to the 
removal of Federal property from local tax rolls. Payments are 
made to LEA's that have a loss of tax base of at least 10 
percent of assessed value due to the acquisition since 1938 of 
real property by the U.S. Government. The Committee recommends 
$24,000,000 for this activity in 1999, the same as the fiscal 
year 1998 amount. No funds were requested by the administration 
for this activity.

                      school improvement programs

Appropriations, 1998....................................  $1,541,188,000
Budget estimate, 1999...................................   1,475,800,000
Committee recommendation................................   1,655,188,000

    The Committee recommends an appropriation of $1,655,188,000 
for school improvement programs. This amount is $114,000,000 
more than the 1998 appropriation and $179,388,000 more than the 
administration's request.
    Eisenhower professional development State grants.--The 
Committee recommends $335,000,000 for Eisenhower professional 
development State grants, the same as the fiscal year 1998 
appropriation and the same amount requested by the 
administration. This program provides formula grants to States 
to support sustained and intensive high-quality professional 
development activities in the core academic subjects at the 
State and local levels.
    Innovative education program strategies State grants.--The 
Committee recommends $350,000,000 for innovative education 
program strategies State grants, the same as the fiscal year 
1998 appropriation. The administration proposed to eliminate 
funding for this program. This program makes grants to State 
and local educational agencies for activities intended to help 
meet the national education goals and assist in their reform of 
elementary and secondary education. Funds are awarded to States 
by a formula based on school-aged population and then to local 
districts under a State-determined formula. State and local 
funds may be used for acquisition of instructional materials 
such as library books, curricular materials, and computer 
software and hardware; improving educational services to 
disadvantaged children and dropout prevention; combating 
illiteracy among children and adults; programs for gifted and 
talented children; and reform activities consistent with Goals 
2000. Teacher training and other related activities in support 
of any of these purposes is also authorized.

Safe and drug free schools and communities

    State grant program.--The Committee bill provides 
$381,000,000 for the safe and drug free schools and communities 
State grant program. The amount recommended is $150,000,000 
below the fiscal year 1998 appropriation and $145,000,000 below 
the budget request.
    National programs.--The Committee has included $175,000,000 
for the national programs portion of the safe and drug free 
schools program, an increase of $145,000,000 above the amount 
requested by the administration and $150,000,000 above the 
fiscal year 1998 appropriation.

School violence initiative

    The Committee is extremely concerned about the increasingly 
frequent occurrence of violence in our Nation's schools. 
Therefore, the Committee directs the Secretary to use 
$150,000,000 of the amount provided for safe and drug free 
schools and communities national programs to support activities 
that promote safe learning environments for students. Such 
activities should include targeted assistance, through 
competitive grants, to local educational agencies for 
communitywide approaches to creating safe and drug free 
schools; providing alternative education settings for students 
who are expelled for bringing a gun to school or for other 
disciplinary reasons; improving the assessment of student 
behavior as part of the disciplinary process, and enhancing the 
capacity of schools to provide mental health services to 
troubled youth; and provide training for teachers and school 
security officers to help them identify students who exhibit 
early signs that are predictors of violent behavior, and 
respond to disruptive and violent behavior by students. The 
Committee also encourages the Department to coordinate efforts 
with children's mental health programs.
    The North Carolina Center for Prevention of School Violence 
has been running a successful program which has shown to reduce 
the incidence of violence.
    The Committee is aware of the increasing problem of alcohol 
abuse on college campuses and, therefore, encourages the 
Department to provide $750,000 for a demonstration project to 
identify and provide models of alcohol and drug abuse 
prevention and education programs in higher education at the 
college level. The Committee encourages the Secretary to make 
10 national recognition awards to institutions of higher 
education that have developed and implemented effective alcohol 
and drug abuse prevention and education programs.
    The Committee recognizes the need to develop and make 
available alternative programs capable of meeting the 
objectives of the Safe and Drug Free Schools and Communities 
Act. Accordingly, the Committee encourages the Department to 
review established comprehensive programs which might be used 
as an effective alternative to DARE by local education 
authorities.

Coordinator initiative

    The Committee recommends no funds for the coordinator 
initiative. No specific authorization for this program 
currently exists. The administration requested $50,000,000 for 
this purpose. No funds were provided in fiscal year 1998. The 
Department planned to use funds for drug and violence 
prevention program coordinators in middle schools. These 
coordinators would be responsible for developing, conducting, 
and analyzing assessments of their schools' drug and crime 
problems, and identify promising research-based drug and 
violence prevention strategies and programs to address these 
problems.

Inexpensive book distribution

    For the inexpensive book distribution program, the 
Committee provides $14,000,000, an increase of $2,000,000 over 
the 1998 appropriation and $1,000,000 above the amount 
recommended by the administration. This program is operated by 
Reading Is Fundamental [RIF], a private nonprofit organization 
associated with the Smithsonian Institution. RIF supports over 
4,500 projects at over 15,000 sites to distribute books to 
children from low-income families to help motivate them to 
read. In 1998, an estimated 7.2 million books will be 
distributed to 2.3 million children. This program has been 
successful in motivating children to read, increasing the use 
of libraries, increasing parental involvement in schools, and 
contributing to improved reading achievement.

Arts in education

    For the arts in education program, the Committee recommends 
$10,500,000, the same as the 1998 appropriation and the 
administration request. The amount recommended will support two 
awards: $5,246,000 for a grant to very special arts [VSA], 
which supports the development of programs to integrate the 
arts into the lives of children and adults with disabilities; 
and $4,254,000 for a grant to the John F. Kennedy Center for 
the Performing Arts, which supports a variety of activities 
through its education department that promote the arts 
throughout the Nation.

Magnet schools assistance

    For the magnet schools assistance program, the Committee 
bill provides $104,000,000, an increase of $3,000,000 over the 
amount recommended by the administration and the 1998 
appropriation.
    This program supports grants to local educational agencies 
to establish and operate magnet schools that are part of an 
approved desegregation plan and are designed to attract 
substantial numbers of students of different social, economic, 
ethnic, and racial backgrounds. Grantees may use funds for 
teacher salaries, purchase of computers, and other educational 
materials and equipment.
    Within the amounts provided, the Committee has included 
$6,000,000 for innovative programs, $3,000,000 more than the 
budget request and the fiscal year 1998 appropriation.
    It has been brought to the Committee's attention that many 
urban schools are experiencing difficulty maintaining 
compliance with desegregation plans because of the perception 
that the educational programs in these schools are inferior to 
those in the magnet school system. The Committee urges the 
Department of Education to provide $3,000,000 for schools of 
special emphasis to demonstrate that urban school systems can 
remain in compliance with desegregation plans when students 
have access to high quality, creative, challenging educational 
opportunities. The Pittsburgh School District would be 
especially suited to carry out such a demonstration.
    It has been brought to the Committee's attention that a new 
international program for students in K-12 is currently being 
developed to serve as a foundation for systemic reform 
involving the business community in educating students about 
trade, enhancement of language development, and overall 
academic excellence. The Seattle School District will be 
submitting a grant application to the Department of Education 
for funding a program such as the one described above and the 
Committee urges that full and fair consideration be given to 
this request.

Education for homeless children and youth

    For carrying out education activities authorized by part B, 
subtitle B of the Stewart B. McKinney Homeless Assistance Act, 
the Committee recommends $28,800,000, the same as the fiscal 
year 1998 amount and $1,200,000 below the budget request.
    This program provides assistance to each State to support 
an office of the coordinator of education for homeless children 
and youth, to develop and implement State plans for educating 
homeless children, and to carry out other activities to ensure 
that all homeless children and youth in the State have access 
to the same free, appropriate public education, including a 
public preschool education, as provided to other children and 
youth. Grants are made to States based on the total that each 
State receives under the title I program.

Women's educational equity

    The Committee recommends $3,000,000 for the women's 
educational equity program, the same as the fiscal year 1998 
appropriation and the same as the amount requested by the 
administration. The program supports projects that assist in 
the local implementation of gender equity policies and 
practices.

Training and advisory services

    For training and advisory services authorized by title IV 
of the Civil Rights Act, the Committee recommends $7,334,000, 
the same as the fiscal year 1998 appropriation and $966,000 
below the administration's request.
    The funds provided will continue the 10 regional equity 
assistance centers [EAC's] formerly known as regional 
desegregation assistance centers. Each EAC's provides services 
to school districts upon request. Activities include 
disseminating information on successful practices and legal 
requirements related to nondiscrimination on the basis of race, 
color, sex, or national origin in education programs. No funds 
are included for civil rights units in State education 
agencies.

Ellender fellowships

    For Ellender fellowships, the Committee bill includes 
$1,500,000, the same as the 1998 appropriation. The 
administration recommended no funding for this program. The 
Ellender fellowship program makes an award to the Close Up 
Foundation of Washington, DC, to provide fellowships to 
students from low-income families and their teachers to enable 
them to participate with other students and teachers for 1 week 
of seminars on Government and meetings with representatives of 
the three branches of the Federal Government.

Education for native Hawaiians

    For programs for the education of native Hawaiians, the 
Committee bill includes $22,000,000, which is $4,000,000 above 
the 1998 appropriation and the administration request.
    The Committee urges the Department when allocating these 
funds to provide the following: $5,500,000 for curricula 
development, teacher training, and recruitment programs, 
including native language revitalization and encourages 
priority be given to the University of Hawaii at Hilo Native 
Language College, acquaculture, prisoner education initiatives, 
waste management, computer literacy, big island astronomy, and 
indigenous health programs; $1,000,000 for the community based 
learning centers; $2,700,000 for the Hawaii higher education 
program; $2,000,000 for the gifted and talented programs; 
$2,000,000 for the special education programs; $300,000 for the 
native Hawaiian education councils; and $8,500,000 for the 
family based education centers, including preschool education 
for native Hawaiian children.
    Native Hawaiian agriculture partnership.--The Committee is 
aware of the dismal economic and social conditions in the rural 
areas of Hawaii resulting from the closure of several sugar 
cane plantations that formerly provided infrastructure for 
these communities. The Committee favors and continues to 
support the expansion of the partnerships between community-
based agricultural businesses and cooperating high schools, 
where agricultural and business practices are integrated into 
the curriculum and products that are ultimately purchased by 
the cooperating businesses.
    Waste management innovation.--Preservation of the 
environment is an important underpinning of Hawaiian culture, 
however, little is known of the historical practices used by 
the Hawaiian people to manage waste and guard against 
overexploitation. The Committee urges the continued study and 
documentation of traditional Hawaiian practices of sustainable 
waste management and to prepare teaching materials for 
educational purposes through a consortium involving Partners in 
Development (a Hawaiian nonprofit corporation) and the Bishop 
Museum.
    Computer literacy and access for Hawaiian and part-Hawaiian 
children.--The importance of literacy for success in school has 
been clearly demonstrated. Disadvantaged native Hawaiian and 
part-Hawaiian children struggle for opportunities. The 
Committee is pleased that a nonprofit organization is proposing 
a collaborative effort with several community-based study help 
programs staffed by volunteers and serving children in the 
Hawaiian community. The Committee urges that students 
interested in becoming elementary and high school teachers be 
strongly encouraged to pursue these fields of study.
    Prisoner education.--Native Hawaiians continue to represent 
the largest ethnic group in that State's prison system. The 
Committee urges the Department to support a demonstration 
project with a goal of reintegration of native Hawaiian youth 
into school settings or onto a career path and job placement 
through comprehensive, culturally sensitive individual and 
family counseling; educational skills training; and employment 
training/job placement. This project should target native 
Hawaiian youth in districts with high percentages of school 
dropouts and youth offenders.
    Big Island astronomy project.--Mauna Kea is internationally 
known for optical, infrared, and millimeter astronomy; is home 
to all four of the new generation telescopes; and is a cultural 
site of great importance to native Hawaiians. Given that very 
few Hawaiians are employed by these programs, the Committee 
urges the Department to set aside funding for development of 
educational programs to encourage native Hawaiians to enter the 
field of astronomy, with emphasis on astronomy as a profession; 
operation of astronomical and observatory equipment; or 
scientific and cultural expertise.
    Indigenous health.--The Native Hawaiian Health Care 
Improvement Act provides authority for inclusion of native 
Hawaiian traditional healers in the comprehensive health care 
delivery system. There is similar recognition of traditional 
healing within the Indian Health Service health care delivery 
system. Because of a lack of available instruction in 
traditional medicine, this knowledge is being lost for younger 
generations of native Americans and native Hawaiians. The 
Committee, therefore, recommends funding for the education of 
health care practitioners in traditional medicines and 
techniques in native Indian and native Hawaiian communities.

Alaska Native educational equity

    The Committee recommends $12,000,000 for the Alaska Native 
educational equity assistance program, authorized under title 
IX, part C, of the Elementary and Secondary Education Act. This 
amount is $4,000,000 over the 1998 appropriation and the budget 
request. These funds address the severe educational handicaps 
of Alaska Native schoolchildren. Funds are used for development 
of supplemental educational programs to benefit Alaska Natives. 
The Committee directs the Department to consult with the Alaska 
Federation of Natives [AFN] in developing criteria for grant 
proposals and consult with AFN in developing criteria for 
evaluating projects.
    It has been brought to the Committee's attention that in 
urban areas, 60 percent of Alaska Natives entering high school 
do not graduate, and the Alaska Natives test scores are on 
average 40 percent lower than those of other students. In some 
districts, none of the Alaska Native elementary students and 40 
percent of Native high school students are performing at their 
grade levels. The funds provided under the Alaska Native 
educational equity assistance program will help to address some 
of the barriers faced by Native Alaskan children and develop 
programs tailored to the unique needs of these children to 
improve performance levels.

Charter schools

    The Committee recommends $80,000,000 for support of charter 
schools, which is the same as the 1998 appropriation and 
$20,000,000 below the budget request.
    This program, authorized under title X, part C of the 
Elementary and Secondary Act of 1965, as amended, provides 
funds to the Secretary to make awards to State educational 
agencies, which, in turn, make subgrants to partnerships of 
developers and local education agencies or other public 
entities that can authorize or approve a charter school. Grants 
are limited to 3 years in duration, of which not more than 18 
months may be used for planning and program design, and not 
more than 2 years for the initial implementation of a charter 
school.
    Unlike traditional public schools, charter schools operate 
under charters or contracts with school districts, State 
education agencies, or other public institutions. They are 
designed by groups of parents, teachers, school administrators, 
other members of the community, and private corporations and 
are held accountable for student performance under the terms of 
their contracts. Also, charter schools can operate with 
considerable autonomy from external controls such as district, 
State, and union requirements.

Comprehensive regional assistance centers

    The Committee recommends $27,054,000 for the comprehensive 
regional technical assistance centers. This recommendation is 
the same as the fiscal year 1998 level. The administration 
recommended $40,000,000 for this program. This program supports 
15 regional centers that provide support, training, and 
technical assistance to Department of Education grantees. Of 
the amount recommended, approximately $135,000 is for an 
evaluation to collect performance indicator data that would 
improve the delivery of technical assistance centers.

Advanced placement test fees

    The Committee recommends $4,000,000 for the advanced 
placement test fees program, an increase of $1,000,000 above 
the amount requested by the administration and the amount 
appropriated in fiscal year 1998. This program awards grants to 
States to enable them to cover part or all of the cost of 
advanced placement test fees of low-income individuals who are 
enrolled in an advanced placement class and plan to take an 
advanced placement test.

Education opportunity zones

    The Committee recommends no funds for the Educational 
Opportunity Zones Program. No authorization currently exists 
for this program. The administration requested $200,000,000 for 
this purpose. No funds were appropriated in fiscal year 1998. 
The Department planned to use these funds to award competitive 
grants to local educational agencies that set challenging 
academic standards for all students; hold students, teachers, 
and administrators accountable for results; expand public 
school choice; and prepare to intervene in failing schools.

Education infrastructure

    The Committee recommends $100,000,000 for this new program 
authorized by title XII of the Elementary and Secondary 
Education Act, that would provide Federal grant funding for the 
repair, renovation, alteration, and construction of public 
elementary and secondary school libraries, media centers, and 
facilities used for academic or vocational instruction.
    Infrastructure grants would be made to urban and rural 
school districts that serve large numbers or percentages of 
disadvantaged students and that have urgent infrastructure 
needs. The statute requires the Secretary to give priority to 
applicants lacking the fiscal resources to undertake the 
project without Federal support and to projects needed to 
address conditions that compromise learning, health, or safety.
    Grants may be used for the inspection, repair, and upgrade 
of academic and library facilities; to meet the requirements of 
section 504 of the Rehabilitation Act of 1973 and the Americans 
With Disabilities Act of 1990; to remove or contain severely 
hazardous materials such as asbestos, lead and radon; and to 
comply with Federal, State, or local building codes.

                       child literacy initiative

Appropriations, 1998....................................................
Budget estimate, 1999...................................    $260,000,000
Committee recommendation................................................

    The Committee recommends no funding for a child literacy 
initiative. The administration requested $260,000,000 to begin 
the new America reads challenge program which would train 
30,000 reading specialists and coordinators to mobilize 1 
million volunteer reading tutors over the next 5 years. The 
fiscal year 1998 funds were provided only if authorized by 
subsequent legislation enacted by July 1, 1998. Because the 
authorizing legislation was not enacted by that date, the funds 
will be used for the Individuals With Disabilities Basic Grant 
Program in fiscal year 1999.

                            indian education

Appropriations, 1998....................................     $59,750,000
Budget estimate, 1999...................................      66,000,000
Committee recommendation................................      66,000,000

    The Committee recommends $66,000,000 for Indian education 
programs, an increase of $6,250,000 above the fiscal year 1998 
appropriation and the same as the budget request.

Grants to local education agencies

    For grants to local education agencies, the Committee 
recommends $62,000,000, an increase of $2,250,000 above the 
1998 appropriation and the same as the budget request. These 
funds provide financial support to reform elementary and 
secondary school programs that serve Indian students, including 
pre-school children. Funds are awarded on a formula basis to 
local educational agencies, the Bureau of Indian Affairs [BIA]-
supported schools and BIA operated schools.

Special programs for Indian children

    The Committee recommends $3,265,000 for special programs 
for Indian children, the same as the budget request. No funds 
were provided for this purpose in fiscal year 1998. Funds will 
be used for demonstration grants to improve Indian student 
achievement through early childhood and preschool education 
programs, and professional development grants for training 
Indians who are preparing to begin careers in teaching and 
school administration.

National activities

    The Committee recommends $735,000 for national activities, 
the same as the budget request. No funds were provided for this 
purpose in fiscal year 1998. Funds are used for research, 
evaluation, and data collection to provide information on the 
educational status for the Indian population and on the 
effectiveness of Indian education programs.

                   bilingual and immigrant education

Appropriations, 1998....................................    $354,000,000
Budget estimate, 1999...................................     387,000,000
Committee recommendation................................     354,000,000

    The Committee recommends an appropriation of $354,000,000 
for bilingual and immigrant education. This is the same as the 
1998 appropriation and $33,000,000 below the administration's 
request.
    The bilingual programs authorized by title VII of ESEA are 
designed to increase the capacity of States and school 
districts to provide special instruction to limited-English 
proficient students.

Instructional services

    The Committee bill includes $160,000,000 for bilingual 
instructional programs, the same as the 1998 level and 
$8,000,000 below the President's request.
    This activity provides competitive grants, primarily to 
school districts, to improve the quality of instructional 
programs for limited-English proficient students. Schools are 
permitted to select the instructional approach best suited to 
their students, except that no more than 25 percent of program 
funds may be used to support instruction that does not make use 
of the students' native language. Funds may also be used to 
provide services for preschool children and parents to assist 
in the education of their children.

Support services

    The Committee has included $14,000,000 for support 
services, the same as the fiscal year 1998 appropriation and 
the administration's request. This program provides 
discretionary grants and contracts in four specific areas: 
research and evaluation; dissemination of effective 
instructional models; data collection and technical assistance; 
and a national clearinghouse to support the collection, 
analysis, and dissemination of information about programs for 
limited-English proficient students.

Professional development

    The Committee recommends $25,000,000 for professional 
development, a decrease of $25,000,000 below the budget request 
and the same as the fiscal year 1998 appropriation.
    These funds support the training and retraining of 
bilingual education teachers and teacher aides, graduate 
fellowships related to the field of bilingual education, and 
grants to institutions of higher education to improve bilingual 
teacher training programs.

Immigrant education

    The Committee recommends $150,000,000 for immigrant 
education, the same as the administration request and the 
fiscal year 1998 appropriation.
    The Immigrant Education Program provides financial support 
to offset the additional costs of educating recently arrived 
immigrant students who often lack proficiency in English and 
need special services to make the transition to the American 
educational system. Federal dollars flow through State 
educational agencies to school districts enrolling a minimum of 
500 eligible immigrant students or where eligible immigrant 
children represent at least 3 percent of the enrollment. The 
Committee agrees with the administration and has included bill 
language to permit States to allocate all or any part of the 
funds to LEA's on a discretionary basis.

Foreign language assistance

    The Committee recommends $5,000,000 for competitive foreign 
language assistance grants, the same amount appropriated in 
fiscal year 1998 and requested by the administration. This 
activity provides grants to increase the quantity and quality 
of instruction in foreign languages.

                           Special education

Appropriations, 1998....................................  $4,810,646,000
Budget estimate, 1999...................................   4,845,646,000
Committee recommendation................................   5,322,946,000

    The Committee recommends a program level of $5,322,946,000 
for special education. This is $512,000,000 more than the 1998 
appropriation and $477,300,000 above the administration 
request. This amount includes $210,000,000 advance funded in 
fiscal year 1998.
    These programs, which are authorized by the Individuals 
with Disabilities Education Act [IDEA], provide assistance to 
ensure that all children with disabilities have access to a 
free, appropriate public education, and that all infants and 
toddlers with disabilities have access to early intervention 
services. This assistance is provided through State grants that 
offset a portion of the costs incurred by States and local 
educational agencies in educating children with disabilities 
and in developing and implementing statewide systems of early 
intervention services, and through six new programs that will 
provide a streamlined structure to help States improve 
educational and early intervention results for children with 
disabilities.

Grants to States

    The Committee bill provides $4,300,000,000, including the 
$210,000,000 fiscal year 1998 advance, for special education 
grants to States, an increase of $499,000,000 more than the 
fiscal year 1998 appropriation and $489,300,000 above the 
budget request. This program supports formula grants to States 
to finance a portion of the cost of providing special education 
and related services for children with disabilities.
    The Committee's recommended funding level represents 
approximately 11 percent of the estimated average per-pupil 
expenditure and 9 percent of excess costs, and would provide an 
estimated Federal share of $688 per child for the 6.2 million 
children expected to receive special education.

Preschool grants

    The Committee recommends $373,985,000 for preschool grants, 
the same as the fiscal year 1998 appropriation and the same as 
the budget request. The preschool grant program provides 
formula grants to States based on the amount of funding 
received in fiscal year 1997, the number of preschool children 
aged 3 through 5 years, and the number of preschool children 
living in poverty.
    The amount provided by the Committee is approximately $634 
per child for the 590,200 preschoolers expected to receive 
special education and related services in the next school year.
    States may retain an amount equal to 25 percent of their 
1997 allocation, cumulatively adjusted upward by the lesser of 
inflation or the percentage increase in the States allocation, 
of which 20 percent may be used for administration. These funds 
may be used for direct and support services for 3- through 5-
year-olds; and, at a State's discretion, to serve 2-year-olds 
with disabilities who will turn age 3 during the school year; 
and for other purposes. The remaining funds must be distributed 
to local educational agencies.

Grants for infants and families

    The Committee bill provides $370,000,000 for the part C 
grants for infants and families program, an increase of 
$20,000,000 above the fiscal year 1998 appropriation and the 
same as the budget request. This program provides formula 
grants to States to implement statewide systems of coordinated, 
comprehensive, multidisciplinary interagency programs to make 
available early intervention services to all children with 
disabilities, ages birth through 2, and their families.

State improvement

    For State improvement, the bill provides $35,200,000, the 
same as the fiscal year 1998 appropriation and $10,000,000 
below the budget request. 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 systems. The funds provided include continuation 
costs for severe disabilities and secondary and transitional 
service programs, which have now expired.

Research and innovation

    The Committee has included $64,508,000 for research and 
innovation, the same as the fiscal year 1998 appropriations 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 Committee continues to be concerned about unmet needs 
among children with disabilities in rural areas, particularly 
the Mississippi River Delta, and the lack of adequate support 
in these areas for parents, schools, child care, and health 
providers to make effective use of local resources. The 
Committee urges the Department of Education to provide 
$1,200,000 for the purpose of continuing a project, begun in 
fiscal year 1998, to provide early intervention and early 
childhood services to children with disabilities ages birth 
through 12 years, to assist parents, and to build local 
capacity to provide and coordinate such services.
    The Committee encourages the Department to provide 
$1,500,000 to support a symposium on the special education 
needs of children with disabilities. These funds would be used 
in connection with the 1999 Special Olympics World Games.

Technical assistance and dissemination

    The Committee bill provides $44,556,000, the same as the 
fiscal year 1998 level and the budget request. These funds 
provide 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.

Personnel preparation

    The Committee recommends $82,139,000 for the personnel 
preparation program. The amount recommended is the same as the 
fiscal year 1998 appropriation and the budget request. Funds 
support competitive awards to help address State-identified 
needs for qualified personnel to work with children with 
disabilities, and to ensure that these personnel have the 
skills and knowledge they need to serve these children.
    The appropriation includes funds to provide personnel 
preparation grants to high incidence disabilities including 
grants for graduate support to ensure a proper balance among 
all authorized grant categories.

Parent information centers

    The Committee bill provides $18,535,000 for parent 
information centers, the same as the fiscal year 1998 
appropriation and $2,000,000 below 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.

Technology and media services

    The Committee recommends $32,523,000 for technology and 
media services, the same as the fiscal year 1998 appropriation 
and $1,500,000 below 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.
    It has been brought to the Committee's attention that audio 
description and captioned theater are essential instructional 
tools in the arts education of visually and hearing-impaired 
children. The Committee urges the Department to conduct a 
demonstration designed to support statewide access to audio 
description and captioned theater programming for schools and 
the disabled community, and to coordinate the public 
distribution of information on accessibility services. The 
Kentucky Center for the Arts' accessibility initiative for 
disabled children is specially suited for this demonstration.
    Included in the amount recommended is $6,500,000 for 
recordings for the blind and dyslexic, an increase of $500,000 
over both the amounts requested by the President and the fiscal 
year 1998 amount. The fiscal year 1999 amount is to be awarded 
in a single grant to continue and expand activities of RFB&D 
approved in fiscal year 1998. These activities include 
production and circulation of recorded textbooks, increased 
outreach activities to print disabled students and their 
teachers, and accelerated use of digital technology for RFB&D 
products and services. This investment will allow the 
organization to continue efforts to expand the number of 
students served and to provide materials based on the latest 
user friendly technologies.

Readline

    The Committee recommends $1,500,000 for the Readline 
Program. The amount recommended is the same as the fiscal year 
1998 appropriation. The administration requested no funds for 
this purpose authorized by section 687 (b)(2)(G) of the 
Individuals With Disabilities Education Act, as amended, that 
would disseminate research conducted by the National Institutes 
of Health, as well as other research concerning effective 
teaching strategies, early diagnosis of, and intervention for, 
young children with reading disabilities.

            rehabilitation services and disability research

Appropriations, 1998....................................  $2,591,195,000
Budget estimate, 1999...................................   2,645,266,000
Committee recommendation................................   2,645,266,000

    The Committee recommends $2,645,266,000 for rehabilitation 
services and disability research, $54,071,000 more than the 
1998 appropriation and the same as the administration request.

Vocational rehabilitation State grants

    The Committee provides $2,298,467,000 for vocational 
rehabilitation grants to States, which is $51,579,000 more than 
the fiscal year 1998 appropriation and $5,944,000 less than the 
budget request.
    Basic State grant funds assist States in providing a range 
of services to help persons with physical and mental 
disabilities prepare for and engage in meaningful employment. 
Authorizing legislation requires States to give priority to 
persons with the most severe disabilities. Funds are allotted 
to States based on a formula that takes into account population 
and per capita income, and States must provide a 21.3-percent 
match of Federal funds, except the States share is 50 percent 
for the cost of construction of a facility for community 
rehabilitation program purposes.
    The Rehabilitation Act requires that no less than 0.75 
percent and not more than 1.5 percent of the appropriation in 
fiscal year 1999 for vocational rehabilitation State grants be 
set aside for grants for Indians. Service grants are awarded to 
Indian tribes on a competitive basis to help tribes develop the 
capacity to provide vocational rehabilitation services to 
American Indians with disabilities living on reservations.

Client assistance

    The Committee bill recommends $10,928,000 for the client 
assistance program, an increase of $214,000 more than the 
fiscal year 1998 appropriation and the same amount recommended 
by the administration request.
    The client assistance program funds State formula grants to 
assist vocational rehabilitation clients or client applicants 
in understanding benefits available to them and in their 
relationships with service providers. Funds are distributed to 
States according to a population-based formula, except each 
State is guaranteed a minimum grant of $100,000 if the 
appropriation exceeds $7,500,000. States must operate client 
assistance programs in order to receive vocational 
rehabilitation State grant funds.

Training

    The Committee provides $39,629,000 for training 
rehabilitation personnel, the same as the 1998 appropriation 
and $5,944,000 above the administration request.
    The purpose of this program is to ensure that skilled 
personnel are available to serve the rehabilitation needs of 
individuals with disabilities. It supports training, 
traineeships, and related activities designed to increase the 
numbers of qualified personnel providing rehabilitation 
services. The program awards grants and contracts to States and 
public or nonprofit agencies and organizations, including 
institutions of higher education, to pay all or part of the 
cost of conducting training programs. Long-term, in-service, 
short-term, experimental, and innovative and continuing 
education programs are funded, as well as special training 
programs and programs to train interpreters for persons who are 
deaf and deaf-blind.

Special demonstration programs

    The Committee bill includes $18,942,000 for special 
demonstration programs for persons with disabilities, an 
increase of $3,000,000 above the fiscal year 1998 appropriation 
and the same as the administration request.
    This program awards grants to States and nonprofit agencies 
and organizations to develop innovative methods and 
comprehensive services to help individuals with disabilities 
achieve satisfactory vocational outcomes. Special demonstration 
programs support projects for individuals with a wide array of 
disabilities.

Migratory workers

    The Committee recommends $2,350,000 for migratory workers, 
the same as the 1998 appropriation and the same level as the 
budget request.
    This program provides a 90-percent Federal match for 
comprehensive rehabilitation services to migrant and seasonal 
farm workers with disabilities and their families. Projects 
also develop innovative methods for reaching and serving this 
population. The program emphasizes outreach, specialized 
bilingual rehabilitation counseling, and coordination of 
vocational rehabilitation services with services from other 
sources.

Recreational programs

    The Committee provides $2,596,000 for recreational 
programs, the same as the 1998 appropriation and the 
administration request.
    Recreational programs help finance activities such as 
sports, music, dancing, handicrafts, and art to aid in the 
employment mobility, and socialization of individuals with 
disabilities. Grants are awarded to States, public agencies, 
and nonprofit private organizations, including institutions of 
higher education. Grants are awarded for a 3-year period with 
the Federal share at 100 percent for the first year, 75 percent 
for the second year, and 50 percent for the third year. 
Programs must maintain the same level of services over the 3-
year period.

Protection and advocacy of individual rights

    The Committee recommends $9,894,000 for protection and 
advocacy of individual rights, the same as the 1998 
appropriation and the same as the budget request.
    This program provides grants to agencies to protect and 
advocate for the legal and human rights of persons with 
disabilities.

Projects with industry

    The Committee bill includes $22,071,000 for projects with 
industry, the same as the 1998 appropriation and the 
administration request.
    The projects with industry [PWI] program is the primary 
Federal vehicle for promoting greater participation of business 
and industry in the rehabilitation process. PWI provides 
training and experience in realistic work settings to prepare 
individuals with disabilities for employment in the competitive 
job market. Postemployment support services are also provided. 
The program makes grants to a variety of agencies and 
organizations, including corporations, community rehabilitation 
programs, labor and trade associations, and foundations.

Supported employment State grants

    The Committee's bill includes $38,152,000 for the supported 
employment State grant program, the same as the 1998 
appropriation and the budget request.
    This program assists persons who may have been considered 
too severely disabled to benefit from vocational rehabilitation 
services by providing the ongoing support needed to obtain 
competitive employment. Short-term vocational rehabilitation 
services are augmented with extended services provided by State 
and local organizations. Federal funds are distributed on the 
basis of population. In 1998 an estimated 38,600 individuals 
will receive services and it is estimated that approximately 
11,550 will achieve an employment outcome.

Independent living State grants

    The Committee recommends $22,296,000 for independent living 
State grants, which is $437,000 more than the amount 
appropriated in 1998 and the same as the budget request.
    The independent living State formula grants program 
provides funding to improve independent living services, 
support the operation of centers for independent living, 
conduct studies and analysis, and provide training and 
outreach.

Independent living centers

    For independent living centers, the Committee bill includes 
$46,109,000, which is the same as the budget request and 
$904,000 over the 1998 appropriation.
    These funds support consumer-controlled, cross-disability, 
nonresidential, community-based centers that are designed and 
operated within local communities by individuals with 
disabilities. These centers provide an array of independent 
living services.

Independent living services for older blind individuals

    The Committee provides $11,169,000 for independent living 
services to older blind individuals, an increase of $219,000 
above the 1998 appropriation and the same as the administration 
request.
    This program provides discretionary grants on a competitive 
basis to State vocational rehabilitation agencies to assist 
persons aged 55 or older to adjust to their blindness by 
increasing their ability to care for their individual needs. 
Services may include the provision of eyeglasses or other 
visual aids, mobility training, braille instruction, guide 
services, reader services, and transportation.

Program improvement activities

    For program improvement activities, the Committee provides 
$1,900,000, the same as the budget request and $1,000,000 below 
the 1998 appropriation. In fiscal year 1999, funds for these 
activities will continue to support technical assistance 
efforts to improve the efficiency and effectiveness of the 
vocational rehabilitation program and improve accountability 
efforts and performance measures. The funds provided are 
sufficient to support ongoing program improvement activities 
and to support a national conference on the findings of the 
longitudinal study of the vocational rehabilitation program.

Evaluation

    The Committee recommends $1,587,000 for evaluation 
activities, the same as the 1998 appropriation and the 
administration request.
    These funds support evaluations of the impact and 
effectiveness of programs authorized by the Rehabilitation Act. 
The Department awards competitive contracts for studies to be 
conducted by persons not directly involved with the 
administration of Rehabilitation Act programs.

Helen Keller National Center

    The Committee bill includes $8,176,000 for the Helen Keller 
National Center for Deaf-Blind Youth and Adults, an increase of 
$627,000 over the 1998 appropriation and the same as the budget 
request.
    The Helen Keller National Center consists of a national 
headquarters in Sands Point, NY, with a residential training 
and rehabilitation facility where deaf-blind persons receive 
intensive specialized services; a network of 10 regional field 
offices which provide referral and counseling assistance to 
deaf-blind persons; and an affiliate network of 45 agencies. At 
the recommended level, the center would serve approximately 90 
persons with deaf-blindness at its headquarters facility and 
provide field services to approximately 1,750 persons.

National Institute on Disability and Rehabilitation Research

    The Committee recommends $81,000,000 for the National 
Institute on Disability and Rehabilitation Research [NIDRR], an 
increase of $4,200,000 over the amount appropriated in 1998 and 
the same as the budget request.
    NIDRR develops and implements a comprehensive and 
coordinated approach to the conduct of research, demonstration 
projects, and related activities enabling persons with 
disabilities to better function at work and in the community, 
including the training of persons who provide rehabilitation 
services or who conduct rehabilitation research. The Institute 
awards competitive grants to support research in federally 
designated priority areas, including rehabilitation research 
and training centers, rehabilitation engineering research 
centers, research and demonstration projects, and dissemination 
and utilization projects. NIDRR also supports field-initiated 
research projects, research training, and fellowships.
    The Committee encourages the Department to provide 
$1,000,000 to fund research on postpolio syndrome. 
Specifically, this research should focus on improved symptom 
assessment of postpolio patients; identification of 
rehabilitation alternatives for postpolio syndrome patients; 
and application to other muscular disorders. The Albert 
Einstein Memorial Hospital in Philadelphia, PA, is currently 
conducting research in this area, and the Committee requests 
that full and fair consideration be given to their application.
    The Committee encourages the Department to provide 
$1,000,000 to establish a center to evaluate medical, 
manipulative, and other techniques used for health problems 
that result in disability, focusing on research, prevention and 
treatment of disability. Such a center could promote primary 
and secondary wellness through lifestyle and behavioral 
modifications to reduce the morbidity, mortality and disability 
associated with chronic disease. The Institute for Disability 
Prevention and Wellness at the New Jersey School of Osteopathic 
Medicine would be especially suited to carry out such a 
demonstration.

Assistive technology

    The Committee bill provides $30,000,000 for assistive 
technology, the same as the budget request and $6,109,000 below 
the fiscal year 1998 appropriation.
    The Assistive Technology Program is designed to improve 
occupational and educational opportunities and the quality of 
life for people of all ages with disabilities through increased 
access to assistive technology services and devices. It 
provides grants to States to develop comprehensive, consumer 
responsive statewide programs that increase access to, and the 
availability of, assistive technology devices and services. The 
National Institute on Disability and Rehabilitation Research 
administers the program.
    The Committee is aware of the financial hardships that 
persons with disabilities face in acquiring assistive 
technology. Assistive technology provides a disabled individual 
the means to function better in the workplace and at home. This 
technology, which aids the millions of Americans with physical 
or mental disabilities, improves the users' quality of life as 
well as renders a means for acquiring a job. Recognizing the 
implications of improved access to assistive technology, the 
Committee encourages the Department to provide sufficient funds 
to implement a microloan demonstration program to assist 
disabled persons to purchase assistive technology.

           Special Institutions for Persons With Disabilities

                 American printing house for the blind

Appropriations, 1998....................................      $8,186,000
Budget estimate, 1999...................................       8,256,000
Committee recommendation................................       8,661,000

    The Committee recommends $8,661,000 for the American 
Printing House for the Blind [APH], $405,000 above the budget 
request and an increase of $475,000 above the 1998 
appropriation.
    This appropriation helps support the American Printing 
House for the Blind, which provides educational materials to 
students who are legally blind and enrolled in programs below 
the college level. The Federal subsidy provides about 40 
percent of APH's total sales income. Materials are distributed 
free of charge to schools and States through per capita 
allotments based on the total number of students who are blind. 
Materials provided include textbooks and other educational aids 
in braille, large type, and recorded form and microcomputer 
applications.

               national technical institute for the deaf

Appropriations, 1998....................................     $44,141,000
Budget estimate, 1999...................................      44,791,000
Committee recommendation................................      45,500,000

    The Committee recommends an appropriation of $45,500,000 
for the National Technical Institute for the Deaf [NTID], an 
increase of $1,359,000 over the 1998 appropriation and $709,000 
above the budget request.
    The Institute, located on the campus of the Rochester 
Institute of Technology, was created by Congress in 1965 to 
provide a residential facility for postsecondary technical 
training and education for persons who are deaf. NTID also 
provides support services for students who are deaf, trains 
professionals in the field of deafness, and conducts applied 
research.
    The increase included would provide sufficient funds for a 
detailed engineering design study of NTID's dormitories in 
preparation for the first renovation of these facilities since 
their construction nearly 25 years ago. In addition, the 
Committee recommends increases over the administration's 
request to support the creation of a communication and language 
center, and to develop and install a computerized management 
and scheduling information system.

                          gallaudet university

Appropriations, 1998....................................     $81,000,000
Budget estimate, 1999...................................      83,480,000
Committee recommendation................................      83,480,000

    The Committee recommends $83,480,000 for Gallaudet 
University, an increase of $2,480,000 above the amount 
appropriated in 1998 and the same as the administration 
request.
    Gallaudet University is a private, nonprofit institution 
offering college preparatory, undergraduate, and continuing 
education programs for students who are deaf, as well as 
graduate programs in fields related to deafness for students 
who are hearing-impaired. The university conducts basic and 
applied research related to hearing impairments and provides 
public service programs for the deaf community.
    The Committee is pleased by the progress made by Gallaudet 
with the doctoral training program for clinical psychologists, 
and requests a followup report on the progress of these health 
professionals postgraduation.
    The Model Secondary School for the Deaf serves as a 
laboratory for educational experimentation and development, 
disseminates models of instruction for students who are deaf, 
and prepares adolescents who are deaf for postsecondary 
academic or vocational education. The Kendall Demonstration 
Elementary School develops and provides instruction for 
children from infancy through age 15.

                     VOCATIONAL AND ADULT EDUCATION

Appropriations, 1998....................................  $1,507,698,000
Budget estimate, 1999...................................   1,544,147,000
Committee recommendation................................   1,502,478,000

    The Committee recommendation includes a total of 
$1,502,478,000 for vocational and adult education, consisting 
of $1,146,650,000 for vocational education and $355,828,000 for 
adult education.

                          Vocational education

    The Committee recommendation of $1,146,650,000 for 
vocational education is $3,497,000 less than the 
administration's request and $497,000 below the fiscal year 
1998 amount.
    Basic grants.--The Committee has included $1,027,550,000 
for basic grants, the same as the 1998 appropriation and 
$3,100,000 less than the administration request.
    Funds provided under the State grant program assist States, 
localities, and outlying areas to expand and improve their 
programs of vocational education and provide equal access to 
vocational education for populations with special needs. 
Persons assisted range from secondary students in prevocational 
courses through adults who need retraining to adapt to changing 
technological and labor market conditions. Funds are 
distributed according to a formula based on State population 
and State per capita income.
    Under the Indian and Hawaiian natives programs, competitive 
grants are awarded to federally recognized Indian tribes or 
tribal organizations and to organizations primarily serving and 
representing Hawaiian natives for services that are in addition 
to services such groups are eligible to receive under other 
provisions of the Perkins Act.
    Tech-prep education.--The Committee recommends $103,000,000 
for tech-prep programs. This is the same as the 1998 
appropriation and $3,000,000 less than the administration 
request. This program is designed to link academic and 
vocational learning and to provide a structured link between 
secondary schools and postsecondary education institutions. 
Funds are distributed to the States through the same formula as 
the basic State grant program. States then make planning and 
demonstration grants to consortia of local educational agencies 
and postsecondary institutions to develop and operate model 4-
year programs that begin in high school and provide students 
with the mathematical, science, communication, and 
technological skills needed to earn a 2-year associate degree 
or 2-year certificate in a given occupational field.
    Tribally controlled postsecondary vocational 
institutions.--The Committee has provided $4,100,000 on a 
current-funded basis for tribally controlled postsecondary 
vocational institutions. This is an increase of $1,000,000 over 
the fiscal year 1998 appropriation. The administration 
requested no funds for this program. This program provides 
grants for the operation and improvement of tribally controlled 
postsecondary vocational institutions to ensure continued and 
expanded educational opportunities for Indian students. Grantee 
institutions may use the funds for costs connected with 
training teachers, providing instructional services, purchasing 
equipment, administration, and operating and maintaining the 
institution.
    National programs, research.--The Committee recommends 
$12,000,000 for national research programs, a decrease of 
$1,497,000 below the 1998 appropriation and the administration 
request.
    The National Center for Research in Vocational Education is 
the only federally funded center charged with the 
responsibility to conduct research and provide technical 
assistance to vocational educators. The results of the applied 
research done by the Center are converted into technical 
assistance to reform and improve vocational education 
instruction in our schools and colleges. The Committee believes 
that the work of the Center is critically important to the 
provision of state-of-the-art job-related instruction that, in 
turn, will strengthen our Nation's economy.

                            Adult Education

    The Committee has included $355,828,000 for adult 
education, $38,172,000 less than the administration request and 
$4,723,000 less than the 1998 appropriation.
    Adult education State programs.--For adult education State 
programs, the Committee recommends $345,339,000, which is 
$15,661,000 less than the administration request and the same 
as the 1998 appropriation. These funds are used by States for 
programs to enable economically disadvantaged adults to acquire 
basic literacy skills, to enable those who so desire to 
complete a secondary education, and to make available to adults 
the means to become more employable, productive, and 
responsible citizens.
    Leadership activities.--The Committee has included 
$4,998,000, the same as the 1998 appropriation and a decrease 
of $22,002,000 below the administration request.
    National Institute for Literacy.--The Committee recommends 
$5,491,000 for the National Institute for Literacy, authorized 
under section 242 of the Adult Education and Family Literacy 
Act, the same amount appropriated in 1998 for this purpose and 
$509,000 less than the budget request. The Institute provides 
leadership and coordination for the national literacy effort by 
conducting research and demonstrations on literacy, providing 
technical assistance through a State capacity building grant 
program, establishing and maintaining a national center for 
adult literacy and learning disabilities, and awarding 
fellowships to outstanding individuals in the field to conduct 
research activities under the auspices of the Institute.
    Literacy programs for prisoners.--The Committee provides no 
funding for literacy programs for prisoners since the 
authorizing legislation repeals funding for this activity.

                      STUDENT FINANCIAL ASSISTANCE

Appropriations, 1998....................................  $8,978,934,000
Budget estimate, 1999...................................   9,203,000,000
Committee recommendation................................  10,172,551,000

    The Committee recommends an appropriation of 
$10,172,551,000 for student financial assistance, an increase 
of $1,193,617,000 over the fiscal year 1998 appropriation and 
$969,551,000 over the administration request.

Federal Pell Grant Program

    For Pell grant awards in the 1999-2000 academic year, the 
Committee recommends $8,527,551,000, $933,551,000 above the 
administration request.
    Pell grants provide need-based financial assistance that 
helps low- and middle-income undergraduate students and their 
families pay the costs of postsecondary education and 
vocational training. Awards are determined according to a 
statutory need analysis formula that takes into account a 
student's family income and assets, household size, and the 
number of family members attending postsecondary institutions. 
Pell grants are considered the foundation of Federal 
postsecondary student aid.
    The amount recommended is sufficient to raise the maximum 
Pell grant to $3,100 the highest level in the program's history 
and an increase of $100 over the maximum grant for the 1998-99 
academic year.

Federal supplemental educational opportunity grants

    The Committee recommends $619,000,000 for Federal 
supplemental educational opportunity grants [SEOG], an increase 
of $5,000,000 above the 1998 appropriation level and the same 
as the budget request.
    This program provides funds to postsecondary institutions 
for need-based grants to undergraduate students. Institutions 
must contribute 25 percent of SEOG awards, which are subject to 
a maximum grant level of $4,000. School financial aid officers 
have flexibility to determine student awards, though they must 
give priority to Pell grant recipients.

Federal work-study programs

    The Committee bill provides $900,000,000 for the Federal 
Work-Study Program, an increase of $70,000,000 above the 1998 
level and the same as the administration request. This program 
provides grants to approximately 3,400 institutions to help 
1,017,000 undergraduate, graduate, and professional students 
meet the costs of postsecondary education through part-time 
employment. Work-study jobs must pay at least the Federal 
minimum wage and institutions must provide at least 25 percent 
of student earnings. Institutions also must use at least 5 
percent of their grants for community-service jobs.
    The Committee supports continuing funding for the work 
colleges authorized in section 448 of the Higher Education Act. 
These funds help support comprehensive work-service-learning 
programs at qualifying institutions around the Nation. The 
Committee has included $2,000,000 to continue and expand the 
work colleges program.

Federal Perkins loans

    The Committee bill includes $60,000,000 for Federal Perkins 
loans capital contributions, which is $75,000,000 less than the 
1998 appropriation and the same as the budget request. The 
amount recommended when combined with the estimated $40,000,000 
available from the Perkins loan revolving fund, would maintain 
the 1999 loan volume at the current estimated level of 
$1,100,000,000. At this funding level an estimated 788,000 
loans would be made, the same number awarded in fiscal year 
1998.
    The Federal Perkins Loan Program supports student loan 
revolving funds built up with capital contributions to about 
2,130 participating institutions. Institutions use these 
revolving funds, which also include a 25-percent institutional 
contribution and student repayments, to provide low-interest (5 
percent) loans that help financially needy students pay the 
costs of postsecondary education. The Committee has included 
the amount necessary to maintain the current loan volume level.
    The Committee bill also includes $30,000,000 for loan 
cancellations, the same as the 1998 level and the amount 
requested by the administration. These funds reimburse 
institutional revolving funds on behalf of borrowers who 
perform statutorily specified types of public or military 
service, such as working in a Head Start Program, serving in 
the Peace Corps or VISTA, or teaching in a low-income school.

State student incentive grants

    For the State Student Incentive Grant Program [SSIG], the 
Committee includes $36,000,000, the same as the 1998 
appropriation. The administration recommended no funding for 
this program. This program provides a dollar-for-dollar Federal 
match to States as an incentive for providing need-based grant 
and work-study assistance to eligible students.

                 FEDERAL FAMILY EDUCATION LOAN PROGRAM

Appropriations, 1998....................................     $46,482,000
Budget estimate, 1999...................................      48,482,000
Committee recommendation................................      46,482,000

    The Committee recommends $46,482,000 for discretionary 
Federal administrative expenses related to the Federal Family 
Education Loan [FFEL] Program, formerly known as the Guaranteed 
Student Loan Program. The amount recommended is $2,000,000 
below the budget request and the same appropriated in fiscal 
year 1998.
    Funds appropriated for Federal administrative expenses will 
partially cover the fiscal year 1999 salaries and benefits, 
travel, printing, contracts, and other expenses associated with 
the program, including payment and claims processing, reducing 
loan default costs, and program monitoring. This discretionary 
administrative funding is included in the ``Federal family 
education loans'' appropriation account rather than under the 
Department's ``Salaries and expenses'' account pursuant to a 
requirement of the Federal Credit Reform Act of 1990.
    The FFEL Program is administered through State and private 
nonprofit guarantee agencies that insure loans directly, 
collect defaulted loans, and provide various services to 
lenders. The Federal Government supports the guarantee agencies 
by providing loan advances and reinsurance payments for 
borrower default, death, disability, and bankruptcy. The 
Federal Government also pays administrative cost allowances to 
guaranty agencies under section 458 of the Higher Education 
Act.
    The Federal Government also pays an interest subsidy to 
lenders, based on the borrower's interest rate, on behalf of 
Stafford loan student borrowers while they are in school and 
during certain grace and deferment periods. To be eligible for 
this subsidy, students must demonstrate financial need, be 
enrolled at least half time, and not be incarcerated. Federal 
Stafford loans may be borrowed by eligible students, regardless 
of their school year or dependency status. Borrowing limits are 
tied to the extent of need, for the cost of attendance minus an 
expected family contribution, and other aid as determined by a 
statutory need analysis system.
    Under the HEA reauthorization of 1992, a new unsubsidized 
Stafford Loan Program for middle-income borrowers provides 
federally reinsured loans to borrowers who do not qualify for 
Federal interest subsidy payments under the need-based Stafford 
Loan Program. Except for the interest benefit and certain loan 
limits, all other terms and conditions of the Federal Stafford 
Loan Program apply to the unsubsidized Stafford loans.
    Federal PLUS loans are made to parents of dependent 
undergraduate students. Interest rates for PLUS loans are 
usually higher than those for Federal Stafford loans, and the 
Federal Government does not pay the interest during in-school, 
grace, and deferment periods. No need analysis is required, but 
borrowing cannot exceed cost of attendance minus other aid.

                            HIGHER EDUCATION

Appropriations, 1998....................................    $943,738,000
Budget estimate, 1999...................................   1,288,405,000
Committee recommendation................................   1,138,944,000

    The Committee recommends an appropriation of $1,138,944,000 
for higher education programs, $195,206,000 more than the 1998 
amount and $149,461,000 below the budget request.

Aid for institutional development

    The Committee recommends $224,945,000 for aid for 
institutional development authorized by title III of the Higher 
Education Act, $14,000,000 above the 1998 appropriation and 
$27,555,000 below the budget request.
    Strengthening institutions.--The Committee bill includes 
$55,450,000 for the part A strengthening institutions program, 
the same as the 1998 level and $4,550,000 below the budget 
request. The part A program supports competitive, 5-year 
development grants for institutions with a significant 
percentage of financially needy students and low educational 
and general expenditures per student in comparison with similar 
institutions. Applicants may use part A funds to develop 
faculty, strengthen academic programs, improve institutional 
management, and expand student services.
    Hispanic-serving institutions [HSI].--The Committee 
recommends $17,000,000 for the section 316 set-aside for 
institutions at which Hispanic students make up at least 25 
percent of enrollment, $5,000,000 above the 1998 level and 
$11,000,000 below the administration request. The Committee has 
included bill language which, consistent with the budget 
request, overrides the current law requirement that funds be 
appropriated for the HSI program only when appropriations for 
the regular strengthening institutions program equal or exceed 
$80,000,000. Institutions applying for section 316 funds must 
meet the regular part A requirements and show: (1) that at 
least one-half of their Hispanic students are low-income, 
first-generation college students, and (2) that another one-
quarter of their Hispanic enrollments are either low-income or 
first-generation college students. In addition to the regular 
part A purposes, funds may be used for acquisition of 
scientific or laboratory equipment, renovation of instructional 
facilities, and purchase of educational materials. Section 316 
recipients are not eligible for other awards provided under 
part A.
    Strengthening historically black colleges and 
universities.--The Committee provides $122,495,000 for part B 
grants, $4,000,000 above the 1998 level and $12,005,000 below 
the administration request. The part B strengthening 
historically black colleges and universities [HBCU] program 
makes formula grants to HBCU's that may be used to purchase 
equipment, construct and renovate facilities, develop faculty, 
support academic programs, strengthen institutional management, 
enhance fundraising activities, provide tutoring and counseling 
services to students, and conduct outreach to elementary and 
secondary school students. The minimum allotment is $500,000 
for each eligible institution. Part B recipients are not 
eligible for awards under part A.
    Strengthening historically black graduate institutions.--
The Committee bill includes $30,000,000 for the part B, section 
326 program, $5,000,000 above the 1998 level and the 
administration request. The section 326 program provides 5-year 
grants to strengthen historically black graduate institutions 
[HBGI's]. The Higher Education Amendments of 1992 increased the 
number of recipients to 16 named institutions, but reserved the 
first $12,000,000 appropriated each year to the first 5 
institutions included in the original authorization. Grants may 
be used for any part B purpose and to establish an endowment.

Strengthening tribal colleges and universities

    The Committee recommends no funds for strengthening tribal 
colleges and universities. No authorization currently exists 
for this program. The administration requested $5,000,000 for 
this purpose. No funds were provided in fiscal year 1998. Funds 
would be used to improve the academic quality, technical 
capacity, institutional management, and fiscal stability of 
eligible tribal colleges and universities to strengthen their 
ability to make a substantial contribution to higher education.

Fund for the improvement of postsecondary education

    The Committee recommends $22,500,000 for the fund for the 
improvement of postsecondary education [FIPSE], which is 
$2,700,000 less than the 1998 appropriation and the same as the 
administration request. FIPSE stimulates improvements in 
education beyond high school by supporting exemplary, locally 
developed projects that have potential for addressing problems 
and recommending improvements in postsecondary education. The 
fund is administered by an independent board that provides 
small, competitive grants and contracts to a variety of 
postsecondary institutions and agencies, including 2- and 4-
year colleges and universities, State education agencies, 
community-based organizations, and other institutions and 
organizations concerned with education beyond high school.
    The Committee encourages the Department to use $1,000,000 
to conduct a demonstration program to encourage 
underrepresented groups, such as women and minorities, to enter 
careers in fields of technology and business. Many business and 
industrial communities have established relationships with 
postsecondary institutions to provide the type of career-
oriented technical education programs described above. The 
Committee further encourages the Department to give priority to 
institutions which offer programs such as management, adult 
retraining, college preparation, distance learning, 
professional development, and academic courses to meet the 
technical education needs of the business communities and 
foster relationships with these communities. The Center for the 
Development of Urban Entrepreneurs at Pierce College would be 
especially suited to provide career-oriented technical 
education programs such as the one described above.
    It has been brought to the Committee's attention that the 
University of Hawaii, Leeward Community College has developed a 
network of educational institutions dedicated to improving the 
scientific expertise and interest of undergraduate students. 
The State of Hawaii has unique attributes, such as active 
volcanoes, a rain forest, and ongoing oceanography and 
aquaculture programs which could contribute to such efforts. 
The Committee urges the Department to give such full and fair 
consideration to funding a project of interinstitutional 
efforts.
    The Committee commends the innovative higher education 
initiative, the Metropolitan Scholars Program, launched by the 
University of Louisville with its public and private partners. 
The Metropolitan Scholars Program is specifically tailored to 
the needs of students with part-time employment with a goal of 
fully preparing participants for the skilled job opportunities 
of the future. For assistance with critical infrastructure 
needs to support this program such as fiberoptic cabling, 
hardware and communications equipment, and classroom 
renovations, the Committee encourages the Department to provide 
$1,500,000 to the University of Louisville in support of this 
program.
    The Committee encourages the Department to include 
$2,000,000 for a demonstration project to expand the successful 
college student preparation and retention programs for 
academically at-risk students. The Prairie View A&M University 
would be especially suited to carry out such a project.
    The Committee encourages the Department to provide 
$1,000,000 to carry out a demonstration to support a 
university-based advanced mathematics teacher-student training 
program. This initiative could provide minority students with 
hands-on mathematics skills training during summer math 
institute camps and train teachers to enhance their skills in 
these critical subject areas. The Southwest Texas State 
University would be especially suited for such a project.
    The Committee encourages the Department to provide 
$1,000,000 for a project that would establish off-campus and 
community-based delivery of educational programs and services 
to improve rural access. A program that permits students to 
register for a course, obtain counseling on academic options, 
financial aid services, and participate in a range of credit 
courses would serve as an ideal model. The Vermont State 
College is currently conducting such a project, and would be 
uniquely qualified.
    The Committee encourages the Department to provide $500,000 
for a program to develop, refine, and disseminate a national 
model of adaptive technologies to include students with 
disabilities alongside their peers in the general education 
settings. The National Institute of Technology for Inclusive 
Education located at the University of Northern Iowa would be 
especially suited for such a project.
    The Committee urges the Department to provide $500,000 for 
a project to improve the skills of physical science teachers. 
The program could build upon existing models that have 
developed a rigorous science sequence for teaching candidates. 
This approach could lead to a much-improved curriculum for new 
physical science teachers. The University of New Mexico-Sandia 
Laboratories would be especially qualified for such a project.
    The Committee urges the Department to provide $1,000,000 
for an inter- and intravideo conferencing project. A program 
that builds on new technology could become a viable entity in 
the distance learning arena. The Center for Minorities in 
Science, Engineering and Technology operating at Southern 
University, located in Louisiana, would be especially suited 
for such a project.
    The Committee urges the Department to provide $250,000 for 
a demonstration that promotes cooperative educational 
activities among faculty, students, community-based 
organizations, social service agencies, health care providers, 
and government. The Center for Urban Research and Learning at 
Loyola University in Chicago would be especially suited for 
such a project.
    The Committee encourages the Department to provide $750,000 
for a demonstration project that establishes a center for 
technical education to serve young people who do not intend to 
go on to college. A center, such as the Newport Regional 
Technical Education Center, that builds upon the current base 
of vocational training by providing high-technology resources, 
support of the local community, schools, and area businesses 
would be especially suited for such a project.
    The Committee urges the Department to provide $750,000 to 
support innovative approaches to connecting community colleges 
to 4-year institutions through a cooperative curriculum, shared 
student services, and faculty collaborations. The Portland 
State University would be especially suited to carry out such a 
project.
    The Committee notes that Appalachian State University in 
Boone, NC, and Western Carolina University in Cullowhee, NC, 
have developed educational programs to train students for 
careers in the hospitality and tourism industry. The Committee 
encourages the Department to give full and fair consideration 
to grant applications in this area.
    The Committee encourages the Department to provide 
$2,000,000 for a demonstration project that shows how effective 
the latest high-technology equipment can be in increasing 
educational achievement, a project that includes state-of-the-
art, multimedia, active-learning classrooms and technology-
assisted classrooms, new student computer workstations in 
student computer laboratories, upgrade of faculty computer 
access, and the required upgrade to the campus computer system. 
The technology-assisted learning campus located in New 
Rochelle, NY, could serve as a national model for the 
improvement of education in general, and postsecondary 
education in particular, and would be suited to carry out such 
a demonstration.

Minority teacher recruitment program

    The Committee recommends $2,212,000 for the minority 
teacher recruitment program, which is the same as the 1998 
appropriation and $64,788,000 below the budget request. This 
program, first authorized in the Higher Education Amendments of 
1992, is designed to increase the numbers of African-Americans, 
Hispanics, native Americans, and other minorities in the 
teaching profession. Partnership projects identify students 
with an interest in entering the teaching profession and 
provide support services such as scholarship funds, tutoring, 
and academic counseling. Teacher placement projects prepare 
minority students to become elementary and secondary 
schoolteachers and help place these students in schools with at 
least 50 percent minority enrollment.

Minority science improvement

    The Committee recommends $5,255,000 for the minority 
science improvement program [MSIP], the same as the 1998 level 
and $2,245,000 below the administration request. This program 
provides discretionary grants to institutions with minority 
enrollments greater than 50 percent to purchase equipment, 
develop curricula, and support advanced faculty training. 
Grants are intended to improve science education programs and 
increase the number of minority students in the fields of 
science, mathematics, and engineering.

International education and foreign language studies

    The bill includes a total of $61,117,000 for international 
education programs, $766,000 above the 1998 level and the same 
as the budget request.
    Domestic programs.--The Committee recommends $53,581,000 
for domestic program activities related to international 
education and foreign language studies, including international 
business education, under title VI of the HEA. This is the same 
as the 1998 appropriation and the administration request. 
Domestic programs include national resource centers, 
undergraduate international studies and foreign language 
programs, international studies and research projects, 
international business education projects and centers, American 
overseas research centers, language resource centers, and 
foreign language and area studies fellowships.
    Overseas programs.--The bill includes $6,536,000 for 
overseas programs authorized under the Mutual Educational and 
Cultural Exchange Act of 1961, popularly known as the 
Fulbright-Hays Act. This is $766,000 above the 1998 level and 
the same as the budget request. Under these overseas programs, 
grants are provided for group and faculty research projects 
abroad, doctoral dissertation research abroad, and special 
bilateral projects. Unlike other programs authorized by the 
Fulbright-Hays Act and administered by the U.S. Information 
Agency, these Department of Education programs focus on 
training American instructors and students in order to improve 
foreign language and area studies education in the United 
States.
    Institute for International Public Policy.--The Committee 
bill recommends $1,000,000 for the Institute for International 
Public Policy, the same as the 1998 appropriation and the 
budget request. This program is designed to increase the number 
of minority individuals in foreign service and related careers 
by providing a grant to a consortium of institutions for 
undergraduate and graduate level foreign language and 
international studies. An institutional match of 25 percent is 
required.

Urban community service

    The Committee recommends $4,637,000 for the urban community 
service program. The fiscal year 1998 appropriation was 
$4,900,000. The budget requested no funding for this purpose. 
This program provides grants to urban universities to encourage 
community involvement in solving the social and economic 
problems of the urban area which they serve. Other programs 
within the Department of Education, the Department of Health 
and Human Services and the Department of Housing and Urban 
Development carry out a variety of community development 
activities to help urban areas solve local community problems. 
The funds provided will be sufficient to complete the last year 
of the programs grantees.

Interest subsidy grants

    The Committee recommends $13,000,000 for interest subsidy 
grants, the same as the administration request and $700,000 
less than the 1998 level. This appropriation is required to 
meet the Federal commitment to pay interest subsidies on 
approximately 241 loans made in past years for constructing, 
renovating, and equipping postsecondary academic facilities. No 
new interest subsidy commitments have been entered into since 
1973 but subsidy payments on existing loans are expected to 
continue until the year 2013.

Bethune Memorial Fine Arts Center

    The Committee recommends no funding for the Bethune 
Memorial Fine Arts Center. The 1998 appropriation was 
$6,620,000 and completed the construction of the auditorium and 
conference facility, the final phase of the project. The 
administration requested no funds for this purpose.

Federal TRIO programs

    The Committee bill includes $554,667,000 for Federal TRIO 
programs, a decrease of $28,333,000 below the amount requested 
by the administration and $25,000,000 above the fiscal year 
1998 appropriation.
    TRIO programs provide a variety of services to improve 
postsecondary education opportunities for low-income 
individuals and first-generation college students: Upward Bound 
offers disadvantaged high school students academic services to 
develop the skills and motivation needed to continue their 
education; student support services provides remedial 
instruction and counseling to disadvantaged college students to 
help them complete their postsecondary education; talent search 
identifies and counsels individuals between ages 12 and 27 
regarding opportunities for completing high school and 
enrolling in postsecondary education; educational opportunity 
centers provide information and counseling on available 
financial and academic assistance to adults who are low-income 
and first-generation college students; and the Ronald E. McNair 
Postbaccalaureate Achievement Program supports research 
internships, seminars, tutoring, and other activities to 
encourage disadvantaged college students to enroll in graduate 
programs.
    The Committee notes that the recent study of the Student 
Support Services Program commissioned by the Department of 
Education indicated that students served by the TRIO Program 
had higher retention rates in colleges, and earned better 
grades and more academic credits; and that these successes were 
most evident where the intensity of services were highest. A 
similar study of the Upward Bound Program found that 
participating students completed a much more intensive academic 
program in high school.

National early intervention scholarships and partnerships

    The Committee bill includes $3,600,000 for this program of 
grants to States for projects that provide mentoring, outreach, 
counseling, and academic support for at risk students. This is 
the same as the 1998 appropriation. The administration 
requested no funds for this purpose. This program is intended 
to provide incentives for States to combine TRIO-type outreach 
activities with a State guarantee of college tuition assistance 
that will encourage low-income elementary and secondary school 
students to stay in school, earn their high school diplomas, 
and pursue postsecondary education.

Connections

    The Committee recommends $75,000,000 for the connections 
program, contingent upon enactment of authorizing legislation. 
No authorization currently exists for this program. The 
administration requested $140,000,000 for this purpose. No 
funds were provided in fiscal year 1998. Under this program 
funds would be used to assist middle schools serving a high 
percentage of low-income students and the high schools that 
these students would later attend. Services would provide 
students to prepare for and pursue a postsecondary education.

Byrd honors scholarships

    The Committee recommends $39,288,000 for the Byrd honors 
scholarship program, the amount recommended by the 
administration and the same as the 1998 appropriation.
    The Byrd honors scholarship program is designed to promote 
student excellence and achievement and to recognize 
exceptionally able students who show promise of continued 
excellence. Funds are allocated to State education agencies 
based on each State's school-aged population. The State 
education agencies select the recipients of the scholarships in 
consultation with school administrators, teachers, counselors, 
and parents. The funds provided will support a new cohort of 
first-year students in 1999, and continue support for the 1996, 
1997, and 1998 cohorts of students in their fourth, third and 
second years of study, respectively. The amount recommended 
will provide scholarships of $1,500 to 26,192 students.

Graduate assistance in areas of national need [GAANN]

    The Committee recommends $31,000,000 for graduate 
assistance in areas of national need, $1,000,000 more than the 
1998 level. The budget requested no funds for this program, and 
instead sought funds for a new national need graduate 
fellowships program. This program awards competitive grants to 
graduate academic departments and programs for fellowship 
support in areas of national need as determined by the 
Secretary. The program is currently supporting study in 
mathematics, physics, biology, chemistry, engineering, and 
computer and information sciences. Recipients must demonstrate 
financial need and academic excellence, seek the highest degree 
in their fields, and plan teaching or research careers.
    The Committee provides $6,588,000 to fund the Javits 
fellowships under the GAANN program. The Javits program is of 
particular importance as a mechanism for supporting America's 
next generation of leaders in the arts, humanities, and social 
sciences. The Committee has consolidated funding within the 
GAANN to streamline programs.
    It has been brought to the Committee's attention that 
fellowships awarded under the Javits program have in many cases 
been awarded too late for students to plan for funding for the 
upcoming academic year. The Committee, therefore, directs the 
Department to announce the competition for Javits fellowships 
in a timely manner so that funds may be awarded by April 1, 
1999.

National need graduate fellowships

    The Committee recommends no funding for the national need 
graduate fellowships program. No authorization currently exists 
for this program. The administration requested $37,500,000 for 
this purpose. No funds were provided in fiscal year 1998. The 
administration proposes to consolidate the graduate assistance 
in areas of national need program, Patricia Roberts Harris 
program, and the Jacob K. Javits fellowship program. The new 
program would be used to promote high-quality, postsecondary 
teaching and research in areas of national need, and to 
encourage women, and minorities, and individuals with 
disabilities to prepare for postsecondary education in fields 
which they are currently underrepresented.

State grants for incarcerated youth offenders

    The Committee has included $16,723,000 for a program 
authorized by part E of title X of the Higher Education Act, 
$4,723,000 above the amount appropriated in fiscal year 1998. 
The administration requested no funds for this program. This 
program provides grants to State correctional education 
agencies to assist and encourage incarcerated youth to acquire 
functional literacy, life and job skills, through the pursuit 
of a postsecondary education certificate or an associate of 
arts or bachelor's degree. Grants will also assist correction 
agencies in providing employment counseling and other related 
services that start during incarceration and continue through 
prerelease and while on parole. Each student is eligible for a 
grant of not more than $1,500 annually for tuition, books, and 
essential materials, and not more than $300 annually for 
related services such as career development, substance abuse 
counseling, parenting skills training, and health education. In 
order to participate in a program, a student must be no more 
than 25 years of age and be eligible to be released from prison 
within 5 years. Youth offender grants are for a period not to 
exceed 5 years, 1 year of which may be devoted to study in 
remedial or graduate education.
    The Committee also has included bill language providing 
$4,723,000 to continue the prison literacy program.
    The Committee notes the value of vocational training 
programs to reduce recidivism of inmates and promote their 
reintegration into society, and recognizes the county of Lake, 
CA, as especially suited to address this issue.

Early awareness information

    The Committee recommends no funds for the Early Awareness 
Information Program. The administration requested $15,000,000 
for this purpose. Funds would be used to educate students, 
parents, and adults who want to return to school, on the steps 
necessary to attend college.

Learning anytime anywhere partnerships

    The Committee recommends $10,000,000 for the learning 
anytime anywhere partnerships, contingent upon enactment of 
authorizing legislation. The administration requested 
$30,000,000 for this program. Funds would be used to support 
pilot projects using technology and other innovations to 
enhance the delivery of postsecondary education and lifelong 
learning opportunities.

Access and retention innovations

    The Committee recommends no funding for the Access and 
Retention Innovations Program. The administration requested 
$20,000,000 for this purpose. Funds would be used to support 
large-scale experimental design research projects in student 
aid packaging.

Teacher quality enhancement grants

    The Committee recommends $37,500,000 for the teacher 
quality enhancement grants. The higher education amendments of 
1998 provide for grants to be awarded to States to support 
statewide initiatives that best meet their specific teacher 
preparation and recruitment needs. Funds may be used for a 
variety of State-level reforms, including more rigorous teacher 
certification and licensure requirements; provision of high-
quality alternative routes to certification; development of 
systems to reward high-performing teachers and principals; and 
development of efforts to reduce the shortage of qualified 
teachers in high-poverty areas.

Teacher training partnership grants

    The Committee recommends $37,500,000 for the teacher 
training partnership grants. The higher education amendments of 
1998 also provide for grants to be awarded to local 
partnerships comprised of at least one school of arts and 
science, school or program of education, a local education 
agency, and a K-12 school. Partnerships may involve other 
entities, with those involving businesses receiving priority 
consideration. Partnerships are eligible to receive a one-time-
only grant to encourage reform and improvement at the local 
level. Funds may be used for a variety of activities designed 
to improve teacher preparation and performance, including 
efforts to provide increased academic study in a proposed 
teaching specialty area; to prepare teachers to use technology 
effectively in the classroom; to provide preservice clinical 
experiences; and to integrate reliable research-based teaching 
methods into the curriculum.

                           howard university

Appropriations, 1998....................................    $210,000,000
Budget estimate, 1999...................................     210,000,000
Committee recommendation................................     210,000,000

    The Committee recommends an appropriation of $210,000,000 
for Howard University, which is the same as the 1998 
appropriation and the budget request. Howard University is 
located in the District of Columbia and offers undergraduate, 
graduate, and professional degrees through 12 schools and 
colleges. The university also administers the Howard University 
Hospital, which provides both inpatient and outpatient care, as 
well as training in the health professions. Federal funds from 
this account support about 50 percent of the university's 
projected educational and general expenditures, excluding the 
hospital. The Committee agrees with the administration and 
recommends, within the funds provided, $3,530,000 for the 
endowment program.
    The Committee is supportive of the several initiatives that 
the university wishes to undertake. These improvements would 
include a facility to house an interdisciplinary science 
center; programs to improve basic science and mathematics and 
provide a foundation for substantive research in emerging 
fields; and the creation of a national HBCU information 
technology network to foster educational and economic 
opportunity through American-African partnerships in sub-
Saharan Africa.
    Howard University Hospital.--Within the funds provided, the 
Committee recommends $29,489,000 for the Howard University 
Hospital, the same as the 1998 level and the budget request. 
The hospital serves as a major acute and ambulatory care center 
for the District of Columbia and functions as a major teaching 
facility attached to the university that trains physicians in 
17 specialty areas. The Federal appropriation provides partial 
funding for the hospital's operations.

             college housing and academic facilities loans

Appropriations, 1998....................................        $698,000
Budget estimate, 1999...................................         698,000
Committee recommendation................................         698,000

    Federal administration.--The Committee bill includes 
$698,000 for Federal administration of the CHAFL program, the 
same as the 1998 level and the administration request.
    These funds will be used to reimburse the Department for 
expenses incurred in managing the existing CHAFL loan portfolio 
during fiscal year 1999. These expenses include salaries and 
benefits, travel, printing, contracts (including contracted 
loan servicing activities), and other expenses directly related 
to the administration of the CHAFL Program.

  historically black college and university capital financing program

Appropriations, 1998....................................        $104,000
Budget estimate, 1999...................................          96,000
Committee recommendation................................          96,000

    Federal administration.--The Committee recommends $96,000 
for Federal administration of the Historically Black College 
and University [HBCU] Capital Financing Program, the same as 
the administration request and a decrease of $8,000 below the 
1998 level.
    The HBCU Capital Financing Program makes capital available 
to HBCU's for construction, renovation, and repair of academic 
facilities by providing a Federal guarantee for private sector 
construction bonds. Construction loans will be made from the 
proceeds of the sale of the bonds.

            education research, statistics, and improvement

Appropriations, 1998....................................    $431,438,000
Budget estimate, 1999...................................     689,367,000
Committee recommendation................................     479,338,000

    The bill includes $479,338,000 for educational research, 
statistics, assessment, and improvement programs. This amount 
is $47,900,000 above the 1998 appropriation and $210,029,000 
below the administration request. This account supports 
education research, statistics, and assessment activities, as 
well as a variety of other discretionary programs for 
educational improvement.

Research, development, and dissemination

    The Committee recommends $72,567,000 for educational 
research and national dissemination activities, the same as the 
budget request and the 1998 appropriation level. The Committee 
has also included $56,000,000 for regional educational 
laboratories, the same as the administration request and the 
1998 appropriation. These activities are administered by the 
Office of Educational Research and Improvement [OERI], which 
was reauthorized by the Educational Research, Development, 
Dissemination, and Improvement Act of 1994.
    These funds support research, development, dissemination, 
and technical assistance activities which 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.

Interagency research initiative

    The Committee has included no funds for the proposed 
interagency research initiative for which the administration 
requested $50,000,000.

Statistics

    The Committee recommends $59,000,000 for data gathering and 
statistical analysis activities of the National Center for 
Education Statistics [NCES], the same as the fiscal year 1998 
appropriation and a decrease of $9,000,000 below the 
administration request.
    NCES collects, analyzes, and reports statistics on 
education in the United States. Activities are carried out 
directly and through grants and contracts. The Center collects 
data on educational institutions at all levels, longitudinal 
data on student progress, and data relevant to public policy. 
Technical assistance to State and local education agencies and 
postsecondary institutions is also provided by the Center.

Assessment

    The Committee recommends $32,000,000 for assessment, the 
same amount appropriated in fiscal year 1998 and $4,000,000 
below the administration request.
    The National Center for Education Statistics uses these 
funds to administer the national assessment of educational 
progress [NAEP], a 20-year-old congressionally mandated 
assessment created to measure the educational achievement of 
American students. The primary goal of NAEP is to determine and 
report the status and trends over time in educational 
achievement, subject by subject. NAEP has been expanded in 
recent years to include State representative assessments as 
well.
    Also included is $3,471,000 for the National Assessment 
Governing Board, the same amount as the fiscal year 1998 
appropriation and $529,000 less than requested by the 
administration.

Fund for the improvement of education

    The Committee bill provides $115,000,000 for the fund for 
the improvement of education [FIE], which is $6,900,000 more 
than the 1998 appropriation and $10,000,000 more than the 
administration request. This program provides the Secretary 
with broad authority to support nationally significant programs 
and projects to improve the quality of education, help all 
students meet high academic standards, and contribute to the 
achievement of the national education goals. The statute also 
authorizes support for specific activities, such as counseling 
and mentoring, comprehensive health education, and 
environmental education.
    Within the amount recommended, the Committee has included 
$10,000,000 for character education partnership grants, the 
same amount requested by the administration.
    Also within the amount recommended, the Committee has 
included $800,000 and urges the Department to use these funds 
for scholar-athlete competitions.
    It has been brought to the Committee's attention that there 
is a need for programs that help guide educators, clinicians, 
therapists, and caregivers in enhancing the educational 
outcomes of handicapped children. Funds would support 
innovative programming which increases the overall functioning 
of special children and contributes to higher educational 
achievement. The Committee encourages the Department to provide 
$1,500,000 to conduct a demonstration in this area. The Hebrew 
Academy for Special Children has been operating a residential 
program to help improve cognitive and communication skills of 
handicapped individuals and has been working with colleges in a 
collaborative effort to reduce the gap between research and 
practice. The academy would be especially suited to carry out a 
program such as the one described above.
    The Committee has included $1,000,000 to expand and 
replicate a large-scale project connecting young people with 
caring adult role models at school who serve as mentors, 
tutors, and literacy volunteers. Connecting caring adults with 
young people at school has proven particularly effective in 
improving attendance, enhancing academic performance, and 
lessening peer pressure. The greater Kansas City Area Youth 
Friends is operating an inititative such as the one described 
above and the Committee encourages full and fair consideration 
of their proposal.
    The Committee is aware of a tutoring program designed to 
improve the reading fluency and comprehension skills of second 
grade students. This program enlists the help of fifth grade 
students, who tutor the second graders using materials 
developed from reading research literature. The program 
utilizes a structured instructional framework, and a well 
developed support system which focuses on assisting second 
graders to become successful, independent readers, and 
proficient learners. As tutors, fifth graders develop skills in 
leadership, organization, and human relations. The Committee 
encourages the Department to provide $750,000 to conduct a 
demonstration program such as the one outlined above. The 
Reading Together USA Program would be especially suited to 
carry out such a demonstration.
    The Committee urges the Department to include $2,000,000 
for a multidistrict high-tech demonstration project to assist 
students in acquiring the skills necessary to take advantage of 
the abundance of excellent employment opportunities available 
in the growing high-tech industry in certain regions of the 
country. The Puget Sound region would be especially suited to 
carry out a demonstration project in this area.
    It has come to the Committee's attention that a national 
education demonstration project to integrate educational reform 
and educational technology would be useful in helping to 
increase student learning and achievement. The Committee urges 
the Department to provide $3,000,000 for a demonstration 
project in this area. State educational agencies of Arkansas, 
Illinois, and Washington, and participants from California and 
Pennsylvania have formed a consortium for a multistate 
technology project that would be especially suited to carry out 
a national demonstration.
    The Committee urges the Department to provide $2,000,000 
for the development and support of interactive exhibits 
designed to give students a unique opportunity to study science 
in an exciting, hands-on way. A project which partners teachers 
to directly interrelate to science education programs taught in 
our public schools with marine science museums would add an on-
the-water science discovery experience. The Naval Undersea 
Museum's science educational alliance project, located in 
Keyport, WA, would be especially suited to carry out a project 
such as the one described above.
    The Committee urges the Department to provide $1,000,000 to 
conduct a project designed to help teachers find new approaches 
to incorporating the arts into curriculum. The Heckscher Museum 
of Art, located on Long Island, NY, would be especially suited 
to carry out a project such as the one outlined above.
    The Committee urges the Department to include $2,000,000 to 
build upon programs within communities to make new books 
available to local literacy programs to support community based 
solutions to illiteracy and related problems. These programs 
should build upon national strategic partnerships to strengthen 
efforts of local tutoring and mentoring and reach out to 
children with the most need. The First Book Program, which 
distributed over 1 million books in 1997, would be especially 
suited to carry out a program in this area.
    The Committee encourages the Department to use $2,000,000 
for a demonstration project to improve learning among students 
at all levels of education. The demonstration would provide 
intensive faculty development in integrating information 
technology into the curriculum, with a special emphasis on 
creating materials and training for K-12 teachers and providing 
work force development activities designed to meet the need for 
technologically skilled workers. The Southeastern Pennsylvania 
Consortium of Higher Education would be especially suited to 
carry out a demonstration such as the one described above.
    The Committee encourages the Department to provide 
$3,000,000 for a demonstration project to advance the teaching 
of science education by using the arts as an entry point to 
study the physical and natural sciences. The project should 
provide interactive models of the Earth in the solar system; 
ocean basin formation; computer programs on global weather; and 
the Earth's history. These activities would serve as effective 
teaching tools for educators and their students. The Whitaker 
Center for Science and the Arts would be especially suited to 
carry out such a program.
    The Committee encourages the Department to provide 
$1,000,000 for a demonstration project which would promote 
learning skills through the performance and broadcasting of 
music, supplemented by an educational curriculum. The Young 
Performance Series would be especially suited for such a 
project.
    The Committee urges the Department to provide $1,000,000 
for a demonstration project designed to facilitate a statewide 
community-based curriculum development initiative to promote 
responsible, nonviolent behavior in schools and communities. 
The Committee understands that the School of Education at the 
University of Montana and the Montana Board of Crime Control 
are developing such a program and urges the Department to give 
it full consideration.
    The Committee encourages the Department to provide 
$2,000,000 for a project which encourages technology-based 
learning in schools, particularly in rural and low-income 
areas. A program which uses old computers donated by the 
private sector, would be used to instruct students on how to 
retool these computers. Students could then earn an A+ 
certificate enabling them to become certified computer 
technicians. The Explornet Program would be especially suited 
to carry out a project such as the one described above.
    The Committee encourages the Department to provide 
$2,000,000 to continue a project to further student knowledge 
of space science. A program designed to develop critical 
thinking skills, encourages problem-solving through teaming, 
and the teach mastry in cutting-edge technologies and distance 
learning initiatives. The Altoona, PA, Science and Technology 
Research Academy would be especially suited to continue a 
program such as the one outlined above.
    The Committee encourages the Department to provide 
$2,000,000 for a multisite demonstration project that will work 
with selected community organizations to identify, train, and 
support a team of parent leaders to work with parents in the 
community to improve parent-teacher communication and increase 
parent involvement within the schools; access community 
resources for children and their families; and enhance their 
child rearing skills. Such a project would include a component 
for parents of high-risk children and children with 
disabilities. The Parentcorps program under development at the 
Child Center at New York University and expansion of the 
project to other sites such as the University of Washington in 
Seattle, WA, would be especially suited for this important 
activity.
    The Committee notes the substantial ongoing investment of 
Federal funds in technology in education and urges the 
Department to assess the impact of Federal funding for 
telecommunications technologies in a sample of public schools 
throughout the United States, with the specific purpose of 
determining the ability of Federal funding to initiate and 
sustain educational reform strategies and methods. The 
Committee encourages the Department to include in the study the 
types of telecommunications projects underway (teacher-to-
teacher; teacher-to-student, that is, distance learning; 
student-to-student), the technologies used (Internet-based, 
satellite-based, videoconferencing), and whether the projects 
are achieving significant educational results. The Committee 
understands that Montana State University and the Center for 
Occupational Research and Development would be suited to 
conduct such a study.
    The Committee encourages the Department to provide 
$1,000,000 for a demonstration program to help assist schools 
across the country in connecting K-12 classrooms to the 
Internet. A program that encourages volunteers, develops 
outreach and implementation efforts to underserved communities 
would be especially suited. The NetDay organization has been 
developing such a program and would be qualified for such a 
demonstration.
    The Committee urges the Department to provide $1,100,000 
for a demonstration project for the training of new and current 
mathematics and science teachers in rural areas. The project 
will use technology and other means to extend such learning and 
related resource-sharing throughout a multicounty region. The 
Glenn T. Seaborg Science Complex, with its Center for Teaching 
and Learning Science and Mathematics at Northern Michigan 
University, has developed such a program and would be 
especially suited to conduct such a demonstration.
    The Committee encourages the Department to provide $500,000 
for an arts-in-education program that uses the visual and 
performing arts to spark learning in the school classroom. The 
Committee is aware that the PARTNERS (Partners In Arts and 
Education Revitalizing Schools) Program at the Bushnell Theater 
in Hartford, CT, has initiated such a program, and would be 
qualified to conduct such a demonstration.
    The Committee encourages the Department to provide $150,000 
for an after school program in areas with extremely high 
concentrations of violent crimes, assaults, and child abuse. A 
program to provide after school services and academic support, 
guidance, tutoring and counseling, as well as enrichment 
activities and computer training would be very beneficial. The 
Orange Public Elementary School, located in Franklin County, 
MA, would be especially suited for such a program.
    The Committee encourages the Department of Education to 
allow $750,000 for the development of an early childhood 
research center. The Committee is aware of the work of the 
University of Louisville in establishing such an 
interdisciplinary program that will engage in the development 
of educational theory and practice. The Committee believes the 
approaches envisioned by the university could serve as a model 
for the Nation in the development of research programs for the 
education and development of young children. The Committee 
encourages the Department to provide support to the university 
for this important initiative.
    The Committee recognizes the need for assistance for at-
risk children. Accordingly, the Committee recommends $750,000 
for the Thornberry Center for Youth and Families in Kansas 
City, MO; the center houses the Genesis School and the Boys and 
Girls Club. These funds may be used for the expansion of the 
academic component of the existing programs.
    The Committee has included $1,000,000 for a demonstration 
project to implement a resource-sharing video conferencing 
network. The Pennsylvania Telecommunications Exchange Network 
is currently carrying out such a project and the Committee 
urges the Department to give full and fair consideration to the 
network when funds are awarded for such a demonstration.
    The Committee encourages the Department to provide 
$2,000,000 for a demonstration to help disadvantaged students 
overcome the barriers to learning by providing health and 
social services programs, colocated within local public 
schools. Proposals by public schools, community organizations, 
parents, and the private sector, which have assessed the needs 
of these disadvantaged children could enhance educational 
outcomes. Counties such as Charles County, MD, Westchester 
County, NY, Cranston, RI, and Skagit County, WA, would be 
ideally suited to carry out such a demonstration.
    The Committee encourages the Department to establish a 
resource center with a nonprofit organization specializing in 
curriculum and materials for young children from infancy 
through grade three. The materials designed for multicultural 
use, age, and developmentally appropriate could assure all 
young children would have access to quality curriculum and 
materials, and that teachers would have more time to devote 
individual attention to students' needs. Ellensburg, WA, in 
partnership with I-DEAS Gateway would be especially suited for 
such a center.
    The Committee encourages the Department to provide $350,000 
to a demonstration project to promote reading and writing 
proficiency among children from a wide range of socioeconomic 
levels, including at-risk, low-income children, children who 
speak English as a second language, and children who speak 
nonstandard English. The project should use long-range 
strategies of ongoing professional development and parent 
education that improves the understanding of child literacy 
development among the adults who care for, and teach infants, 
toddlers, and preschoolers, including school personnel, child 
caregivers, and family members, and should include evaluation 
and national dissemination of a replicable model to meet these 
goals. The partners for literacy project in Columbia, SC, would 
be especially suited to carry out a demonstration such as the 
one outlined above. Also included is $250,000 for the student 
mock election.

International education exchange

    The Committee has provided $7,000,000 for the International 
Education Exchange Program authorized by section 601(c) of 
Public Law 103-227. These funds are $2,000,000 above the amount 
recommended by the administration and appropriated in fiscal 
year 1998. The program provides funds to support democracy and 
free market economies in Eastern Europe, the Commonwealth of 
Independent States, and other countries that formerly were part 
of the Soviet Union, by providing educators and other leaders 
from those countries curricula and teacher training programs in 
civic and economic education, as well as the opportunity to 
exchange ideas and experiences with teachers in the United 
States and other participating countries.
    Included within this amount is $1,000,000 to implement a 
cooperative education program in both the Republic of Ireland 
and Northern Ireland and $500,000 to increase support already 
underway in Bosnia-Herzegovina.

Civic education

    The Committee recommends $7,500,000 for the Center for 
Civic Education, $2,000,000 more than in fiscal year 1998 and 
$1,200,000 more than the administration request. This program 
provides a course of instruction at the elementary and 
secondary level on the basic principles of our constitutional 
democracy and the history of the Constitution and the Bill of 
Rights. Funds also may be used to provide advanced training for 
teachers concerning the Constitution and the Bill of Rights.
    Within the amounts provided the Committee has included 
$1,000,000 for a new violence prevention initiative. The 
Committee encourages that funds be used to conduct a five State 
violence prevention demonstration program on public and private 
elementary, middle, and secondary schools involving students, 
parents, community leaders, volunteers, and public and private 
sector agencies, such as law enforcement, courts, bar 
associations, and community based organizations.

Eisenhower professional development Federal activities

    The Committee recommends $23,300,000 for the Eisenhower 
Professional Development Federal Activities Program, 
$26,700,000 below the budget request and the same as the 1998 
appropriation.
    This program supports activities of national significance 
contributing to the development and implementation of high-
quality professional development in the core academic subjects. 
Projects may include development of teacher training programs, 
or dissemination of information about exemplary programs of 
professional development.
    The Committee has included $18,500,000 for the National 
Board for Professional Teaching Standards, the same as the 
fiscal year 1998 appropriation and $2,500,000 below the 
administration request.
    The Committee has included $4,691,000 for the National 
Clearinghouse for Mathematics and Science Education, the same 
amount provided for this purpose in 1998. The clearinghouse 
maintains a permanent repository of mathematics and science 
education instructional materials and programs for elementary 
and secondary schools; disseminates information, programs, and 
instructional materials to the public, information networks, 
and regional consortiums; and coordinates with existing data 
bases containing mathematics and science curriculum and 
instructional materials.

Eisenhower regional mathematics and science education consortia

    The Committee has included $15,000,000 for the Eisenhower 
regional mathematics and science education consortia, the same 
amount appropriated in fiscal year 1998 and $10,000,000 below 
the amount recommended by the administration. This program 
supports grants to establish and operate regional consortia to 
disseminate exemplary mathematics and science instructional 
materials and provide technical assistance in the use of 
improved teaching methods and assessment tools to benefit 
elementary and secondary school students, teachers, and 
administrators.

21st century community learning centers

    The Committee has included $75,000,000 for the 21st century 
community learning centers, an increase of $35,000,000 over the 
amount appropriated in fiscal year 1998. The administration 
requested $200,000,000 for this program and proposed that the 
funds be used for competitive grants to centers in high-need 
areas to stay open before and after school hours. The 
administration also proposes changes in the authorizing 
legislation to require a 1-for-1 match and to allow the grants 
to be awarded for 5 years. The Committee has deferred action on 
this request, until the authorizing legislation has been 
enacted. This program supports grants to rural and inner-city 
public elementary or secondary schools, or consortia of such 
schools, to enable them to plan, implement, or expand projects 
that benefit the educational, health, social service, cultural, 
and recreational needs of a rural or inner-city community.
    As outlined, in the President's budget, sufficient funds 
are included to continue the cityscape program in Barre, VT. 
This program is designed to increase the educational attainment 
in math, science, and social studies in rural middle-school 
children.

Javits gifted and talented students education

    The Committee has included $6,500,000 for the Javits Gifted 
and Talented Students Education Program, the same amount 
recommended by the administration and the same amount as the 
fiscal year 1998 appropriation.
    This program authorizes awards to State and local education 
agencies, institutions of higher education, and public and 
private agencies for research, demonstration, and training 
activities designed to enhance the capability of elementary and 
secondary schools to meet the special educational needs of 
gifted and talented students. Priority is given to projects 
that identify and serve gifted and talented students who may 
not be identified and served through traditional assessment 
methods, including those who are economically disadvantaged or 
limited English proficient, or have disabilities. Some funds 
are set aside for a national center for research and 
development in the education of gifted and talented children 
and youth, which researches methods and techniques for 
identifying and teaching gifted and talented students.

National writing project

    The Committee bill provides $7,000,000 for the national 
writing project, an increase of $2,000,000 above the 1998 
appropriation and the administration request.
    These funds are awarded to the national writing project in 
Berkeley, CA, which in turn funds projects in 45 States to 
train teachers of all subjects how to teach effective writing.
    The writing project is the only federally funded program 
for the teaching and writing skills at all grade levels. In 
fiscal year 1997 the program successfully trained more than 
100,000 teachers for less than 90 cents per participant-hour. 
The additional funds provided will expand the sites from 160 to 
over 200, creating the ability to reach almost every teacher in 
the Nation. The Committee is pleased with the continued success 
of this program, and for its ability to leverage up to seven 
times its Federal appropriation from State, local, and private 
funds. The Committee encourages the Department to continue its 
close association with this project, and to use it as a model 
for teacher training initiatives in other disciplines, taking 
advantage of the infrastructure and network of facilities and 
personnel in place.

                        Departmental Management

                         program administration

Appropriations, 1998....................................    $343,914,000
Budget estimate, 1999...................................     362,000,000
Committee recommendation................................     362,000,000

    The Committee recommends $362,000,000 for program 
administration, an increase of $18,086,000 above the 1998 
appropriation and the same as the budget request.
    Funds support personnel compensation and benefits, travel, 
rent, communications, utilities, printing, equipment and 
supplies, automated data processing, and other services 
required to award, administer, and monitor approximately 170 
Federal education programs. Support for program evaluation and 
studies and advisory councils is also provided under this 
activity. Within the funds provided, the Committee encourages 
the Department to provide at least $200,000 for the National 
Advisory Council on Indian Education.

                        office for civil rights

Appropriations, 1998....................................     $61,500,000
Budget estimate, 1999...................................      68,000,000
Committee recommendation................................      63,500,000

    The Committee bill includes $63,500,000 for the Office for 
Civil Rights [OCR], $2,000,000 above the 1998 appropriation and 
$4,500,000 below the budget request.
    The Office for Civil Rights is responsible for the 
enforcement of laws that prohibit discrimination on the basis 
of race, color, national origin, sex, disability, and age in 
all programs and institutions funded by the Department of 
Education. To carry out this responsibility, OCR investigates 
and resolves discrimination complaints, monitors desegregation 
and equal educational opportunity plans, reviews possible 
discriminatory practices by recipients of Federal education 
funds, and provides technical assistance to recipients of funds 
to help them meet civil rights requirements.
    The Committee is concerned about the Department's 
interpretation and application of title IX of the 1972 
Education Amendments Act with regard to same gender education 
programs. The Committee, therefore, urges the Department to 
review its regulations and policies to ensure that if funds are 
used for students to participate in any education reform 
projects that provide same gender schools or classrooms, 
comparable educational opportunities are offered for students 
of both sexes. The Committee further directs the Department to 
report to Congress within 90 days of enactment of this act on 
the actions taken on this issue.

                    office of the inspector general

Appropriations, 1998....................................     $30,242,000
Budget estimate, 1999...................................      31,242,000
Committee recommendation................................      31,242,000

    The Committee recommends $31,242,000 for the Office of the 
Inspector General, $1,000,000 above the 1998 appropriation and 
the same as the administration request.
    The Office of the Inspector General has the authority to 
investigate all departmental programs and administrative 
activities, including those under contract or grant, to prevent 
and detect fraud and abuse, and to ensure the quality and 
integrity of those programs. The Office investigates alleged 
misuse of Federal funds, and conducts audits to determine 
compliance with laws and regulations, efficiency of operations, 
and effectiveness in achieving program goals.

                           General Provisions

    The Committee bill contains language which has been 
included in the bill since 1974, prohibiting the use of funds 
for the transportation of students or teachers in order to 
overcome racial imbalance (sec. 301).
    The Committee bill contains language included in the bill 
since 1977, prohibiting the transportation of students other 
than to the school nearest to the student's home (sec. 302).
    The Committee bill contains language which has been 
included in the bill since 1980, prohibiting the use of funds 
to prevent the implementation of programs of voluntary prayer 
and meditation in public schools (sec. 303).
    The Committee bill includes a provision giving the 
Secretary of Education authority to transfer up to 1 percent of 
any discretionary funds between appropriations (sec. 304).
    The Committee bill includes language prohibiting the use of 
funds to field test, implement, or administer any federally 
sponsored national test (sec. 305).
    The Committee bill includes language requiring institutions 
of higher education to include in applications to the Secretary 
regarding funds to be used for endowment challenge grants (sec. 
306).
    The Committee bill includes language regarding the 
enforcement of certain provisions of the Higher Education Act 
with respect to lender loan portfolios that is equal to or less 
than $5,000,000 (sec. 307).

                       TITLE IV--RELATED AGENCIES

                      Armed Forces Retirement Home

Appropriations, 1998....................................     $68,669,000
Budget estimate, 1999...................................      70,745,000
Committee recommendation................................      70,745,000

    The Committee recommends authority to expend $70,745,000 
from the Armed Forces Retirement Home trust fund for operation 
and construction activities at the U.S. Soldiers' and Airmen's 
Home and the U.S. Naval Home, $2,076,000 more than the 1998 
appropriation and the same as the budget request.

Operation and maintenance

    The Committee recommends $55,028,000 for the operation and 
maintenance of the Soldiers' and Airmen's Home and the U.S. 
Naval Home, $424,000 less than the fiscal year 1998 
appropriation and the same as the budget request.

Capital outlay

    The Committee recommends $15,717,000 for capital activities 
at the Soldiers' and Airmen's Home and the U.S. Naval Home, 
$2,500,000 more than the 1998 appropriation and the same as the 
budget request.

             Corporation for National and Community Service

                  domestic volunteer service programs

Appropriations, 1998....................................    $256,604,000
Budget estimate, 1999...................................     278,422,000
Committee recommendation................................     275,039,000

    The Committee recommends an appropriation of $275,039,000 
for the domestic volunteer service programs of the Corporation 
for National and Community Service, $18,435,000 above the 1998 
appropriation and $3,383,000 less than the budget request.

VISTA

    The Committee bill provides $73,000,000 for the Volunteers 
in Service to America [VISTA] Program, $7,765,000 above the 
fiscal year 1998 level and the same as the budget request.
    VISTA is a 30-year-old program which provides capacity 
building for small community-based organizations. VISTA 
volunteers raise resources for local projects, recruit and 
organize volunteers, and establish and expand local community-
based programs in housing, employment, health, and economic 
development activities.

National Senior Volunteer Corps

    The Committee bill provides $173,910,000 for the National 
Senior Volunteer Corps programs, $10,670,000 above the fiscal 
year 1998 level and the same as the budget request.
    The Committee has included $1,080,000 for senior 
demonstration programs.
    In accordance with the Domestic Volunteer Service Act, 
sufficient funds (one-third of the increase over fiscal year 
1998 funding levels) have been included to expand existing 
Foster Grandparent [FGP] and Retired and Senior Volunteer 
programs [RSVP] to address unmet needs in the community through 
programs of national significance grants. Furthermore, funds 
are available within the FGP and RSVP allocations for 
administrative cost increases of 3 percent. Funds remaining 
should be used to begin new FGP and RSVP programs in geographic 
areas currently underserved. The Committee expects that the use 
of the funding increases in FGP and RSVP may not be restricted 
to America Reads activities.
    The Committee directs that, of the amounts appropriated to 
FGP, SCP, and RSVP, no funds will be made available for 
demonstration activities without the prior submission of a 
reprogramming request for the Committee's approval.
    The Committee has reserved judgment of America Reads 
activities within this account until such time when authorizing 
legislation has been enacted into law.

Foster Grandparent Program

    The Committee recommends $94,162,000 for the Foster 
Grandparent Program, $6,569,000 above the fiscal year 1998 
appropriations level and the same as the budget request.
    This program provides volunteer opportunities to seniors 
age 60 and over who serve at-risk youth. This program involves 
seniors in their communities and provides a host of services to 
children.

Senior Companion Program

    For the Senior Companion Program, the Committee bill 
includes $35,368,000, the same as the fiscal year 1998 
appropriations level and the same as the budget request.
    This program enables senior citizens to provide personal 
assistance and companionship to adults with physical, mental, 
or emotional difficulties. Senior companions provide vital in-
home services to elderly Americans who would otherwise have to 
enter nursing homes. The volunteers also provide respite care 
to relieve care givers.

Retired and Senior Volunteer Program

    The Committee bill provides $43,300,000 for the Retired and 
Senior Volunteer Program [RSVP], $3,021,000 above the fiscal 
year 1998 level and the same as the budget request.
    This program involves persons age 55 and over in volunteer 
opportunities in their communities.

Program support

    The Committee bill includes $28,129,000 for program 
support, the same as the fiscal year 1998 appropriations level 
and $3,383,000 less than the budget request.

                  Corporation for Public Broadcasting

Appropriations, 1999....................................    $300,000,000
Appropriations, 2000....................................     300,000,000
Budget estimate, 2001...................................     340,000,000
Committee recommendation................................     340,000,000

    The Committee recommends an appropriation of $340,000,000 
for the Corporation for Public Broadcasting [CPB], an advance 
appropriation for fiscal year 2001. This amount is $40,000,000 
more than the fiscal year 2000 appropriation and the same as 
the budget request.
    The Committee intends that CPB foster services for unserved 
or underserved audiences focusing on entities whose primary 
services are directed at audiences in rural areas and native 
American audiences. The committee is concerned about the 
erosion of grants for radio stations serving these communities.
    The Committee recognizes that stations serving rural and 
underserved audiences have limited local potential for 
fundraising because of sparse populations serviced, limited 
number of local businesses, and low-income level. In rural 
areas, while many stations receive per capita local support far 
greater than that contributed in urban areas, they receive 
relatively few matching dollars because the populations served 
are small.
    The Committee directs CPB to explore new methodologies for 
distribution of Federal matching dollars which take into 
account measures such as per capita support and other factors 
that would serve to level the playing field between urban and 
rural stations in the distribution of matching funds.
    The FCC has established a timeline during which public and 
commercial television broadcasters are required to begin 
transmitting signals in digital. While a Federal timeline has 
not yet been established for public radio stations, they are 
expected to face a similar conversion process soon. The 
Committee is aware that digital technology will revolutionize 
both the quantity and quality of public television, allowing 
computer-like data to accompany programs, expanding the 
broadcast capabilities of individual stations, and providing 
sharper images and sounds. Such services will undoubtedly 
enhance the educational value of public broadcasting.
    This required conversion will impose enormous costs on both 
individual stations and the public broadcasting system as a 
whole. Because television and radio broadcast infrastructures 
are closely linked, the conversion of television to digital 
will create immediate costs not only for television, but also 
for public radio stations. Therefore, the Committee has 
included $15,000,000 to assist radio stations and television 
stations in the conversion to digitalization. The Committee has 
provided these funds contingent upon authorizing legislation 
being enacted by April 1, 1999.

               Federal Mediation and Conciliation Service

Appropriations, 1998....................................     $33,481,000
Budget estimate, 1999...................................      34,620,000
Committee recommendation................................      34,620,000

    The Committee recommends an appropriation of $34,620,000 
for the Federal Mediation and Conciliation Service [FMCS] 
$1,139,000 above the fiscal year 1998 appropriation and the 
same as the budget request.
    The FMCS was established by Congress in 1947 to provide 
mediation, conciliation, and arbitration services to labor and 
management. FMCS is authorized to provide dispute resolution 
consultation and training to all Federal agencies.

            Federal Mine Safety and Health Review Commission

Appropriations, 1998....................................      $6,060,000
Budget estimate, 1999...................................       6,060,000
Committee recommendation................................       6,060,000

    The Committee recommends an appropriation of $6,060,000 for 
the Federal Mine Safety and Health Review Commission. The same 
as the fiscal year 1998 appropriation and the same as the 
budget request.
    The Federal Mine Safety and Health Review Commission 
provides administrative trial and appellate review of legal 
disputes under the Federal Mine Safety and Health Act of 1977. 
The five-member Commission provides administrative appellate 
review of the Commission's administrative law judge decisions.

                Institute of Museum and Library Services

Appropriations, 1998....................................    $146,340,000
Budget estimate, 1999...................................     146,340,000
Committee recommendation................................     156,340,000

    The Committee recommends an appropriation of $156,340,000 
for the Institute of Museum and Library Services. This is 
$10,000,000 more than the 1998 level and the administration 
request.

Office of Library Services State Grants

    The Committee recommends $135,391,000 for State grants. 
Funds are provided to States by formula to carry out 5-year 
State plans. These plans must set goals and priorities for the 
State consistent with the purpose of the act, describe 
activities to meet the goals and priorities and describe the 
methods by which progress toward the goals and priorities and 
the success of activities will be evaluated. States may 
apportion their funds between two activities, technology and 
targeted services. For technology, States may use funds for 
electronic linkages among libraries, linkages to educational, 
social and information services, accessing information through 
electronic networks, or link different types of libraries or 
share resources among libraries. For targeted services, States 
may direct library and information services to persons having 
difficulty using a library, underserved urban and rural 
communities, and children from low income families. Within the 
total recommended, $2,561,000 has been provided for services to 
Indian tribes.

National leadership projects

    The Committee recommends $15,488,000 for national 
leadership projects. These funds support activities of national 
significance to enhance the quality of library services 
nationwide and to provide coordination between libraries and 
museums. Activities are carried out through grants and 
contracts awarded on a competitive basis to libraries, 
agencies, institutions of higher education and museums. 
Priority is given to projects that focus on education and 
training of library personnel, research and development for the 
improvement of libraries, preservation, digitalization of 
library materials, partnerships between libraries and museums 
and other activities that enhance the quality of library 
services nationwide.
    It has been brought to the Committee's attention that there 
is a crucial need in rural communities and State agencies for 
geospatial digital and numerical data that can only be met 
through the establishment of a data library. The Committee 
urges the Director to provide $750,000 for a demonstration 
project such as the one described above. The Digital Geospatial 
and Numerical Data Library at the University of Idaho would be 
especially suited to carry out a demonstration of such a 
project.
    The Committee urges the Director to provide $1,000,000 for 
a demonstration project that would expand library services that 
integrate faculty and student research needs with model 
regional telecommunications capabilities. The University of 
South Carolina at Spartanburg would be especially suited to 
carry out such a project.
    The Committee urges the Director to provide $1,500,000 for 
a demonstration project to maintain and enhance the oldest 
scientific journal in the United States; manage an extensive 
international program; and provide an innovative science 
education program in the library setting. The Franklin 
Institute, located in Philadelphia, PA, would be especially 
suited to carry out such a project.
    The Committee is aware of an innovative historical project 
designed to document the treatment of Italian-Americans during 
World War II. This unique project would research and document 
the persecution and relocation of Italian-Americans during this 
period. The Committee urges the Director to provide $750,000 
for such a project.
    The Committee encourages the Director to provide $2,000,000 
to enhance digitalization efforts to improve online access to 
library collections. The New York Public Library is currently 
undertaking such a project and would be especially suited for 
such a demonstration.
    Many young people and adults in the inner cities of this 
Nation lack access to information and learning opportunities. A 
community-library collaborative which links underserved 
communities with educational and informational resources, 
promotes community ownership and demonstrates the potential of 
the library as an information and services hub could contribute 
to individual and community development. The Committee 
encourages the Director to provide $500,000 for such a project. 
The Libraries for the Future Program, operating in Washington, 
DC, would be especially suited to build a national network of 
community-library information collaboratives.
    It has been brought to the Committee's attention that the 
Milwaukee Public Museum has been operating a unique educational 
program which features an interactive, multimedia gallery of 
the Earth's biological diversity, as well as World Wide Web 
link to serve as a national educational tool. This project 
serves as a unique educational opportunity for inner-city youth 
ages 10 to 17. The Committee encourages the Director to provide 
$1,500,000 for a demonstration project such as the one 
described.
    The Committee encourages the Director to provide $1,000,000 
for a project that would preserve, restore, and consolidate the 
largest collection of Cuban materials in existence outside of 
Cuba. Funds would be used for improved format conversion, 
materials preservation, expanded acquisition, and access 
activities. The University of Miami Library would be especially 
suited for such a project.
    The Committee urges the Director to provide $300,000 to 
complete transcription, indexing, cataloging, and microfilming 
of approximately 1,200 oral history interviews relating to Iowa 
labor and unions and to process and catalog approximately 800 
shelf feet of labor history archival material in order to make 
the entire collection accessible to researchers. The Committee 
understands that the documents are now with the State 
Historical Society of Iowa but there are not funds available to 
catalog and prepare the materials so that they are available to 
the public.

Administration

    The Committee recommends $2,900,000 for program 
administration, the same as the budget request. Funds support 
personnel compensation and benefits, travel, rent, 
communications, utilities, printing, equipment and supplies, 
automated data processing, and other services.

                  Medicare Payment Advisory Commission

Appropriations, 1998....................................      $7,015,000
Budget estimate, 1999...................................       7,015,000
Committee recommendation................................       7,015,000

    The Committee recommends an appropriation of $7,015,000 for 
the Medicare Payment Advisory Commission, the same as the 
fiscal year 1998 appropriations and the same as the budget 
request.
    The Medicare Payment Advisory Commission [MedPAC] was 
established by Congress as part of the Balanced Budget Act of 
1997 (Public Law 105-33). Congress merged the Physician Payment 
Review Commission with the Prospective Payment Assessment 
Commission to create MedPAC.
    The Medicare Payment Assessment Commission plays an 
influential role in the formulation and evaluation of Medicare 
and Medicaid payment policy. To ensure the Commission assesses 
the impact of these policies in a fair and comprehensive 
manner, taking into account the diversity that characterizes 
the American health care system, it is critically important 
that the General Accounting Office draw from both rural and 
urban areas when identifying new members. To ensure adequate 
representation from both rural and urban settings, the 
Committee believes the Commission should include at least two 
individuals involved in rural health care whose background and 
experience reflects a strong rural health care orientation.

        National Commission on Libraries and Information Science

Appropriations, 1998....................................      $1,000,000
Budget estimate, 1999...................................       1,000,000
Committee recommendation................................       1,000,000

    The Committee recommends an appropriation of $1,000,000 for 
the National Commission on Libraries and Information Science, 
the same as the fiscal year 1998 appropriation and the same as 
the budget request.
    The Commission determines the need for, and makes 
recommendations on, library and information services, and 
advises the President and Congress on the development and 
implementation of national policy in the library and 
information field.

                     National Council on Disability

Appropriations, 1998....................................      $1,793,000
Budget estimate, 1999...................................       2,344,000
Committee recommendation................................       2,344,000

    The Committee recommends an appropriation of $2,344,000 for 
the National Council on Disability, $551,000 above the fiscal 
year 1998 appropriation and the same as the budget request.
    The Council is mandated to make recommendations to the 
President, the Congress, the Rehabilitation Services 
Administration, and the National Institute on Disability and 
Rehabilitation Research, on the public issues of concern to 
individuals with disabilities. The Council gathers information 
on the implementation, effectiveness, and impact of the 
Americans With Disabilities Act and looks at emerging policy 
issues as they affect persons with disabilities and their 
ability to enter or reenter the Nation's work force and to live 
independently.

                     National Education Goals Panel

Appropriations, 1998....................................      $2,000,000
Budget estimate, 1999...................................       2,100,000
Committee recommendation................................       2,100,000

    The Committee recommends $2,100,000 for the national 
education goals panel, $100,000 above the 1998 appropriation 
and the same as the budget request.
    Following the 1989 education summit in Charlottesville, the 
Governors and President Bush agreed on education goals for the 
Nation and created the National Education Goals Panel as an 
accountability mechanism to monitor and report on the Nation's 
progress toward reaching the goals. To date, the goals panel 
has issued four annual reports delineating National and State 
progress toward the national education goals.

                     National Labor Relations Board

Appropriations, 1998....................................    $174,661,000
Budget estimate, 1999...................................     184,451,000
Committee recommendation................................     184,451,000

    The Committee recommends an appropriation of $184,451,000 
for the National Labor Relations Board [NLRB], $9,790,000 more 
than the fiscal year 1998 appropriation and the same as the 
budget request.
    While the bulk of this increase is intended to meet built-
in costs such as mandatory cost-of-living adjustments, it 
includes the requested increase for field operations, as well 
as $1,300,000 to strengthen operations at the National Board 
level. The Committee recommendation also assumes that of the 
$10,046,000 included in the budget request for information 
technology activities, $1,300,000 for year 2000 activities will 
be derived from funding being provided on a Governmentwide 
basis.
    The NLRB is a law enforcement agency which adjudicates 
disputes under the National Labor Relations Act.

                        National Mediation Board

Appropriations, 1998....................................      $8,600,000
Budget estimate, 1999...................................       8,400,000
Committee recommendation................................       8,400,000

    The Committee recommends an appropriation of $8,400,000 for 
the National Mediation Board, $200,000 less than the fiscal 
year 1998 appropriation and the same as the budget request.
    The National Mediation Board protects interstate commerce 
as it mediates labor-management relations in the railroad and 
airline industries under the Railway Labor Act. The Board 
mediates collective bargaining disputes, determines the choice 
of employee bargaining representatives through elections, and 
administers arbitration of employee grievances.

            Occupational Safety and Health Review Commission

Appropriations, 1998....................................      $7,900,000
Budget estimate, 1999...................................       8,050,000
Committee recommendation................................       8,100,000

    The Committee recommends an appropriation of $8,100,000 for 
the Occupational Safety and Health Review Commission, $200,000 
above the fiscal year 1998 appropriation and $50,000 above the 
budget request.
    The Commission serves as a court to justly and 
expeditiously resolve disputes between the Occupational Safety 
and Health Administration [OSHA] and employers charged with 
violations of health and safety standards enforced by OSHA.

                       Railroad Retirement Board

                     dual benefits payments account

Appropriations, 1998....................................    $205,500,000
Budget estimate, 1999...................................     191,000,000
Committee recommendation................................     189,000,000

    The Committee has provided a total of $189,000,000 for dual 
benefits, including $11,000,000 in income tax receipts on dual 
benefits as authorized by law. The Committee recommendation is 
$2,000,000 below the original budget request.
    This appropriation provides for vested dual benefit 
payments authorized by the Railroad Retirement Act of 1974, as 
amended by the Omnibus Reconciliation Act of 1981. This 
separate account, established for the payment of dual benefits, 
is funded by general fund appropriations and income tax 
receipts of vested dual benefits.

          Federal payments to the railroad retirement account

Appropriations, 1998....................................         $50,000
Budget estimate, 1999...................................         150,000
Committee recommendation................................         150,000

    The Committee recommends $150,000 for interest earned on 
unnegotiated checks. This is $100,000 above the fiscal year 
1998 appropriation and the same as the budget request.

                      limitation on administration

Appropriations, 1998....................................     $87,228,000
Budget estimate, 1999...................................      86,000,000
Committee recommendation................................      90,000,000

    The Committee recommends an appropriation of $90,000,000 
for the administration of railroad retirement/survivor benefit 
programs. This amount is $2,772,000 above the fiscal year 1998 
appropriation, and $4,000,000 above the budget request.
    The Board administers comprehensive retirement-survivor and 
unemployment-sickness insurance benefit programs for the 
Nation's railroad workers and their families. This account 
limits the amount of funds in the railroad retirement and 
railroad unemployment insurance trust funds which may be used 
by the Board for administrative expenses.

           limitation on the office of the inspector general

Appropriations, 1998....................................      $5,794,000
Budget estimate, 1999...................................       5,400,000
Committee recommendation................................       5,600,000

    The Committee recommends $5,600,000 for the Office of the 
Inspector General, $194,000 below the 1998 appropriation and 
$200,000 above the budget request.

                     Social Security Administration

                PAYMENTS TO SOCIAL SECURITY TRUST FUNDS

Appropriations, 1998....................................     $20,308,000
Budget estimate, 1999...................................      19,689,000
Committee recommendation................................      19,689,000

    The Committee recommends an appropriation of $19,689,000 
for payments to Social Security trust funds, the same as the 
administration request. This amount reimburses the old age and 
survivors and disability insurance trust funds for special 
payments to certain uninsured persons, costs incurred 
administering pension reform activities, and the value of the 
interest for benefit checks issued but not negotiated. This 
appropriation restores the trust funds to the same financial 
position they would have been in had they not borne these 
costs, properly charged to the general funds. The fiscal year 
1999 request for these mandatory payments decreases primarily 
because special payments for certain uninsured persons decrease 
due to a declining beneficiary population.

               SPECIAL BENEFITS FOR DISABLED COAL MINERS

Appropriations, 1998....................................    $426,090,000
Budget estimate, 1999...................................     382,803,000
Committee recommendation................................     382,803,000

    The Committee recommends an appropriation of $382,803,000 
for special benefits for disabled coal miners. This is in 
addition to the $160,000,000 appropriated last year as an 
advance for the first quarter of fiscal year 1999. The 
recommendation is the same as the administration request. These 
funds are used to provide monthly benefits to coal miners 
disabled by black lung disease and to their widows and certain 
other dependents, as well as to pay related administrative 
costs.
    The Social Security Administration holds primary 
responsibility for claims filed before July 1973, with the 
Department of Labor responsible for claims filed after that. By 
law, increases in black lung benefit payments are tied directly 
to Federal pay increases. The year-to-year decrease in this 
account reflects a declining beneficiary population.
    The Committee recommends an advance appropriation of 
$141,000,000 for the first quarter of fiscal year 2000, the 
same as the administration request. These funds will ensure 
uninterrupted benefit payments to coal miners, their widows, 
and dependents.

                      SUPPLEMENTAL SECURITY INCOME

Appropriations, 1998.................................... $16,370,000,000
Budget estimate, 1999...................................  21,797,000,000
Committee recommendation, 1999..........................  21,840,000,000

    The Committee recommends an appropriation of 
$21,840,000,000 for supplemental security income. This is in 
addition to the $8,680,000,000 appropriated last year as an 
advance for the first quarter of fiscal year 1999 and includes 
funds for continuing disability reviews. The recommendation is 
$43,000,000 more than the administration's request and 
$5,470,000,000 more than the fiscal year 1998 level. The 
Committee also recommends an advance appropriation of 
$9,550,000,000 for the first quarter of fiscal year 2000 to 
ensure uninterrupted benefits payments.
    These funds are used to pay benefits under the SSI Program, 
which was established to ensure a Federal minimum monthly 
benefit for aged, blind, and disabled individuals, enabling 
them to meet basic needs. It is estimated that approximately 
6.3 million persons will receive SSI benefits each month during 
fiscal year 1999. In many cases, SSI benefits supplement income 
from other sources, including Social Security benefits. The 
funds are also used to reimburse the Social Security trust 
funds for the administrative costs for the program with a final 
settlement by the end of the subsequent fiscal year as required 
by law, and to reimburse vocational rehabilitation agencies for 
costs incurred in successfully rehabilitating SSI recipients.

Beneficiary services

    The Committee recommendation includes $61,000,000 for 
beneficiary services, which is the same as the administration 
request and $15,000,000 above the fiscal year 1998 level. This 
amount is available for reimbursement of State vocational 
rehabilitation agencies and alternate public or private 
providers. In 1994 SSA published a regulation permitting direct 
reimbursement of alternate public and private providers to 
provide vocational rehabilitation services. Vocational 
rehabilitation services are now more readily available to a 
larger number of people with disabilities, since the regulation 
allows SSA to use an alternate public or private sector 
provider, if a State vocational rehabilitation agency has not 
accepted an SSA-referred person for services or extended 
evaluation.

Research and demonstration projects

    The Committee recommendation includes $37,000,000 for 
research and demonstration projects conducted under sections 
1110 and 1115 of the Social Security Act. This is $20,300,000 
above the fiscal year 1998 level and $7,000,000 above the 
administration request. This amount will support SSA's efforts, 
as an independent agency, to focus on research on long-range 
solvency issues, the impact of demographics changes on future 
workloads, and development of effective return-to-work 
strategies for disabled beneficiaries.
    Sufficient funds are provided to carry out a multistate 
demonstration testing the feasibility and efficacy of providing 
one-stop shopping for health care benefits to low-income 
Medicare beneficiaries. In the five pilot States, low-income 
seniors would apply for Medicare and Medicaid qualified 
Medicare beneficiary and specified low income Medicare 
beneficiary benefits at Social Security offices. Currently, 
only about one-half of the poor elderly that qualify for these 
Medicaid benefits receive them. This demonstration will show 
whether a single application process can lower these barriers 
to affordable health care for the most vulnerable senior 
citizens.
    In addition, the Committee has included funds to conduct a 
demonstration that would identify potential Medicare buy-in 
eligibles during the recalculation of benefits for widowed 
spouses, and provide the appropriate State agencies with 
periodic listings of potential eligibles for their followup. 
This demonstration seeks to improve State responsiveness to 
critical shifts in the economic resources of aging Social 
Security beneficiaries.
    The Committee has provided funds for research in the 
following substantive areas: Whether the loss of public health 
insurance presents a barrier to employment and strategies to 
address health care coverage for this population, the 
implications of State mental health/mental retardation systems 
and worker compensation programs for national disability 
programs, barriers to employment of persons with disabilities 
presented by the unemployment insurance program and the effect 
of private health and disability insurance practices on the 
employment of persons with disabilities. In addition, these 
funds will permit the establishment and dissemination of a data 
base on disability and employment which will include 
information on public subsidies, employment discrimination and 
rates of return to work for persons with disabilities.
    The Committee encourages SSA to establish cooperative 
research and development agreements with universities proximate 
to the SSA Headquarters, such as the University of Maryland, 
Baltimore County [UMBC], in order to enhance administrative 
productivity, improve program efficiencies, and provide 
critical analyses on implementation. The Committee also urges 
SSA to draw upon library resources, conference facilities, 
technical support, training capability, and the policy sciences 
expertise at UMBC to support the development of the proposed 
retirement research centers.

Administration

    The Committee recommendation includes $2,100,000,000 for 
payment to the Social Security trust funds for the SSI 
Program's share of SSA's base administrative expenses. This is 
$73,000,000 above the fiscal year 1998 level and $36,000,000 
more than the administration request.

Continuing disability reviews

    The recommendation includes $227,000,000 for payments to 
the Social Security trust fund to process continuing reviews 
and redeterminations of the disability and nondisability 
eligibility factors of entitlement for individuals receiving 
supplemental security income on the basis of their disability.
    The Committee is aware of the unique problems that Chronic 
Fatigue and Immune Dysfunctions Syndrome [CFIDS] patients 
encounter in the process of applying for benefits. The 
Committee urges the agency to develop and implement appropriate 
training agendas and materials for employees. Further, the 
Committee urges the agency to expedite efforts to investigate 
obstacles to benefits for persons with CFIDS and to keep 
medical information updated throughout all levels of the 
application and review process.

                 LIMITATION ON ADMINISTRATIVE EXPENSES

Appropriations, 1998....................................  $6,409,040,000
Budget estimate, 1999...................................   6,448,000,000
Committee recommendation, 1999..........................   6,462,000,000

    The Committee recommends a program funding level of 
$6,462,000,000 for the limitation on administrative expenses, 
which is $14,000,000 more than the administration request and 
$52,960,000 higher than the fiscal year 1998 level.
    This account provides resources from the Social Security 
trust funds to administer the Social Security retirement and 
survivors and disability insurance programs, and certain Social 
Security health insurance functions. As authorized by law, it 
also provides resources from the trust funds for certain 
nontrust fund administrative costs, which are reimbursed from 
the general funds. These include administration of the 
supplemental security income program for the aged, blind and 
disabled; work associated with the Pension Reform Act of 1984; 
and the portion of the annual wage reporting work done by the 
Social Security Administration for the benefit of the Internal 
Revenue Service. The dollars provided also support automated 
data processing activities and fund the State disability 
determination services which make initial and continuing 
disability determinations on behalf of the Social Security 
Administration. Additionally, the limitation provides funding 
for computer support, and other administrative costs. In 1999 
about 51.1 million people will receive a Social Security or 
supplemental security income checks each month. Cash payments 
are expected to be about $417,000,000,000 during fiscal year 
1999.
    The limitation includes $5,982,000,000 for routine 
operating expenses of the agency, which is $33,000,000 more 
than the amount requested by the President and $87,960,000 over 
the 1998 comparable amount. These funds, as well as those 
derived from an increase in the user fees which are discussed 
below, cover the mandatory costs of maintaining equipment and 
facilities, as well as staffing. The Committee supports SSA's 
unique cooperative training program with the Association of 
Administrative Law Judges, Inc., which is recognized by State 
bar associations for continuing legal education credits. The 
Committee believes this will improve SSA's ability to meet its 
performance goals and encourages SSA to continue and expand its 
support of this program and to increase ALJ participation.
    The Committee recognizes that many victims of domestic 
violence find it necessary to relocate and establish new lives 
in order to avoid further instances of abuse. The Committee 
urges the Administrator to consider ways to more expeditiously 
respond to the requests of victims of domestic violence to 
change their Social Security numbers so that victims can 
establish new identities.

User fees

    In addition to other amounts provided, the Committee 
recommends $75,000,000 for administrative activities funded 
from user fees that were authorized in fiscal year 1998. This 
is the same as the administration's request and an increase of 
$40,000,000 over the fiscal year 1998 level.

Social Security Advisory Board

    The Committee has included $1,600,000 within the limitation 
on administrative expenses account for the Social Security 
Advisory Board for fiscal year 1999, the same level as for 
fiscal year 1998 and the administration request.

Automation initiative

    Fiscal year 1998 marked the final year of the 5-year 
automation investment fund which has enabled SSA to invest for 
efficiencies. The Committee expects that unobligated funds at 
the end of fiscal year 1999, not needed for fiscal year 1999, 
will be made available for investment in the Social Security 
Administration's computing network.

Continuing disability reviews

    The Committee has provided an additional $405,000,000 to 
the limitation on administrative expenses account for 
continuing disability reviews of individuals receiving Social 
Security disability benefits and continuing disability reviews 
and redeterminations of the disability and nondisability 
eligibility factors of entitlement for individuals receiving 
supplemental security income on the basis of disability.

                    OFFICE OF THE INSPECTOR GENERAL

Appropriations, 1998....................................     $48,424,000
Budget estimate, 1999...................................      52,000,000
Committee recommendation, 1999..........................      50,212,000

    The Committee recommends $50,212,000 for activities for the 
Office of the Inspector General, $1,788,000 more than fiscal 
year 1998 and $1,788,000 less than the administration request. 
This includes a general fund appropriation of $11,082,000 
together with an obligation limitation of $39,130,000 from the 
Federal old-age and survivors insurance trust fund and the 
Federal disability insurance trust fund.

                        U.S. Institute of Peace

Appropriations, 1998....................................     $11,160,000
Budget estimate, 1999...................................      11,495,000
Committee recommendation................................      11,495,000

    The Committee recommends an appropriation of $11,495,000 
for the U.S. Institute of Peace, $335,000 above the fiscal year 
1998 appropriation and the same as the budget request.
    The Institute was established by the U.S. Institute of 
Peace Act (Public Law 98-525) in 1984. The Institute is an 
independent, nonprofit, national organization whose primary 
mission is to promote, through scholarship and education, 
international peace, and the resolution of conflicts without 
recourse to violence.

                      TITLE V--GENERAL PROVISIONS

    The Committee recommendation retains provisions which: 
authorize transfers of unexpended balances (sec. 501); limit 
funding to 1 year availability unless otherwise specified (sec. 
502); limit lobbying and related activities (sec. 503); limit 
official representation expenses (sec. 504); prohibit funding 
of any program to carry out distribution of sterile needles for 
the hypodermic injection of any illegal drug unless the 
Secretary of HHS determines such programs are effective in 
preventing the spread of HIV and do not encourage the use of 
illegal drugs (sec. 505); state the sense of Congress about 
purchase of American-made equipment and products (sec. 506); 
clarify Federal funding as a component of State and local grant 
funds (sec. 507); and limit use of funds for abortion (secs. 
508 and 509).
    The Committee recommendation also retains provisions 
carried in last year's bill relating to transfer authority, 
obligation and expenditure of appropriations, and detail of 
employees (sec. 510).
    The Committee recommendation retains language on human 
embryo research (sec. 511).
    The Committee recommendation retains the limitation on use 
of funds for promotion of legalization of controlled substances 
included last year (sec. 512).
    The Committee recommendation retains the bill language 
limitation on use of funds to enter into or review contracts 
with entities subject to the requirement in section 4212(d) of 
title 38, United States Code, if the report required by that 
section has not been submitted (sec. 513).
    The Committee bill includes language regarding the 
individual health identifier (sec. 514).
    The Committee recommendation includes an across-the-board 
administrative cost reduction (sec. 515).

  TITLE VI--NATIONAL CENTER FOR COMPLEMENTARY AND ALTERNATIVE MEDICINE

    As the number of Americans using complementary and 
alternative medicine practices has substantially increased, the 
Committee believes that additional authority is required to 
assure that the NIH appropriately review these practices. 
Accordingly, title VI authorizes the Office of Alternative 
Medicine within NIH to become a Center for Complementary and 
Alternative Medicine [CCAM]. The Committee believes this change 
will enable rigorous investigation, evaluation and validation 
of complementary and alternative treatments, practices and 
products. This Center will study appropriate and efficacious 
integration of complementary and alternative medicine with 
conventional practices that is based on evidence, ensuring 
state-of-the-art, rigorous scientific review. To facilitate and 
enhance knowledge and understanding of complementary and 
alternative practices and products throughout the world, CCAM 
also will establish and continue to update a comprehensive 
bibliographic system of complementary and alternative medicine 
practices. The Committee expects NIH to move promptly to effect 
this change and to ensure a smooth and efficient transition of 
the Office to Center status.


                                            BUDGETARY IMPACT OF BILL                                            
  PREPARED IN CONSULTATION WITH THE CONGRESSIONAL BUDGET OFFICE PURSUANT TO SEC. 308(a), PUBLIC LAW 93-344, AS  
                                                     AMENDED                                                    
                                            [In millions of dollars]                                            
----------------------------------------------------------------------------------------------------------------
                                                                  Budget authority               Outlays        
                                                             ---------------------------------------------------
                                                               Committee    Amount  of   Committee    Amount  of
                                                               allocation      bill      allocation      bill   
----------------------------------------------------------------------------------------------------------------
Comparison of amounts in the bill with Committee allocations                                                    
 to its subcommittees of amounts for 1999: Subcommittee on                                                      
 Labor, Health and Human Services, Education, and Related                                                       
 Agencies:                                                                                                      
    Defense discretionary...................................  ...........  ...........  ...........  ...........
    Nondefense discretionary................................       82,175       82,600       80,300   \1\ 80,677
    Violent crime reduction fund............................          144          144          136          136
    Mandatory...............................................      220,740      220,740      221,661      221,661
Projections of outlays associated with the recommendation:                                                      
    1999....................................................  ...........  ...........  ...........  \2\ 195,085
    2000....................................................  ...........  ...........  ...........       40,971
    2001....................................................  ...........  ...........  ...........        9,137
    2002....................................................  ...........  ...........  ...........        2,990
    2003 and future year....................................  ...........  ...........  ...........          155
Financial assistance to State and local governments for 1999                                                    
 in bill....................................................           NA      118,688           NA      119,153
----------------------------------------------------------------------------------------------------------------
\1\ Includes outlays from prior-year budget authority.                                                          
\2\ Excludes outlays from prior-year budget authority.                                                          
                                                                                                                
NA: Not applicable.                                                                                             
                                                                                                                
Note.--Consistent with the funding recommended in the bill for continuing disability reviews and in accordance  
  with Public Laws 104-124 and 104-193, the Committee anticipates that the Budget Committee will file a revised 
  section 302(a) allocation for the Committee on Appropriations reflecting an upward adjustment of $425,000,000 
  in budget authority and $377,000,000 in outlays.                                                              

  COMPLIANCE WITH PARAGRAPH 7, RULE XVI, OF THE STANDING RULES OF THE 
                                 SENATE

    Paragraph 7 of rule XVI requires that Committee report on 
general appropriations bills identify each Committee amendment 
to the House bill ``which proposes an item of appropriation 
which is not made to carry out the provisions of an existing 
law, a treaty stipulation, or an act or resolution previously 
passed by the Senate during that session.''

    The following items are identified pursuant to this 
requirement:
          Community service employment for older Americans, 
        $440,200,000;
          National Health Service Corps recruitment, 
        $78,166,000;
          Consolidated health professions, $210,000,000;
          Emergency medical services for children, $15,000,000;
          Organ transplantation, $4,116,000;
          Health teaching facilities interest subsidies, 
        $150,000;
          Bone Marrow Program, $15,270,000;
          Centers for Disease Control and Prevention, 
        $2,797,058,000;
          Substance Abuse and Mental Health Services 
        Administration, $1,703,411,000;
          Head Start, $4,660,000,000;
          Community services block grant, $490,600,000;
          Runaway and Homeless Youth Program, $44,653,000;
          North American programs, $34,933,000;
          National Youth Sports Program, $14,000,000;
          Community food and nutrition, $6,000,000;
          Community initiative program, $33,565,000;
          Transitional living for homeless youth, $14,949,000;
          Adolescent family life, $16,709,000;
          Aging service programs, $870,050,000;
          Office of Minority Health, $23,100,000;
          Rehabilitation services and disability research, 
        $2,615,266,000; and
          Vocational and adult education, $1,507,201,000.

COMPLIANCE WITH PARAGRAPH 7(C), RULE XXVI OF THE STANDING RULES OF THE 
                                 SENATE

    Pursuant to paragraph 7(c) of rule XXVI, the accompanying 
bill was ordered reported from the Committee, subject to 
amendment and subject to the section 302(b) allocation, by 
recorded vote of 28-0 a quorum being present.
    The vote was as follows:
        Yeas                          Nays
Chairman Stevens
Mr. Cochran
Mr. Specter
Mr. Domenici
Mr. Bond
Mr. Gorton
Mr. McConnell
Mr. Burns
Mr. Shelby
Mr. Gregg
Mr. Bennett
Mr. Campbell
Mr. Craig
Mr. Faircloth
Mrs. Hutchison
Mr. Byrd
Mr. Inouye
Mr. Hollings
Mr. Leahy
Mr. Bumpers
Mr. Lautenberg
Mr. Harkin
Ms. Mikulski
Mr. Reid
Mr. Kohl
Mrs. Murray
Mr. Dorgan
Mrs. Boxer

 COMPLIANCE WITH PARAGRAPH 12, RULE XXVI OF THE STANDING RULES OF THE 
                                 SENATE

    Paragraph 12 of rule XXVI requires that Committee reports 
on a bill or a joint resolution repealing or amending any 
statute include ``(a) the text of the statute or part thereof 
which is proposed to be repealed; and (b) a comparative print 
of that part of the bill or joint resolution making the 
amendment and of the statute or part thereof proposed to be 
amended, showing by stricken through type and italics, parallel 
columns, or other appropriate typographical devices the 
omissions and insertions which would be made by the bill or 
joint resolution if enacted in the form recommended by the 
committee.''
    In compliance with this rule, the following changes in 
existing law proposed to be made by the bill are shown as 
follows: existing law to be omitted is enclosed in black 
brackets; new matter is printed in italic; and existing law in 
which no change is proposed is shown in roman.

                       Public Health Service Act

                 TITLE IV--NATIONAL RESEARCH INSTITUTES

                 Part A--National Institutes of Health

           organization of the national institutes of health

  Sec. 401. * * *

           *       *       *       *       *       *       *


                    [office of alternative medicine

  [Sec. 404E. (a) There is established within the Office of the 
Director of NIH an office to be known as the Office of 
Alternative Medicine (in this section referred to as the 
``Office''), which shall be headed by a director appointed by 
the Director of NIH.
  [(b) The purpose of the Office is to facilitate the 
evaluation of alternative medical treatment modalities, 
including acupuncture and Oriental medicine, homeopathic 
medicine, and physical manipulation therapies.
  [(c) The Secretary shall establish an advisory council for 
the purpose of providing advice to the Director of the Office 
on carrying out this section. Section 222 applies to such 
council to the same extent and in the same manner as such 
section applies to committees or councils established under 
such section.
  [(d) In carrying out subsection (b), the Director of the 
Office shall--
          [(1) establish an information clearinghouse to 
        exchange information with the public about alternative 
        medicine;
          [(2) support research training--
                  [(A) for which fellowship support is not 
                provided under section 487; and
                  [(B) that is not residency training of 
                physicians or other health professionals; and
          [(3)(A) prepare biennial reports on the activities 
        carried out or to be carried out by the Office; and
          [(B) submit each such report to the Director of NIH 
        for inclusion in the biennial report under section 
        403.]

           *       *       *       *       *       *       *


                     Part E--Other Agencies of NIH

Subpart 1--National Center for Research Resources

           *       *       *       *       *       *       *


                Subpart 4--Office of Dietary Supplements

SEC. 485C. DIETARY SUPPLEMENTS.

           *       *       *       *       *       *       *


 Subpart 5--National Center for Complementary and Alternative Medicine

SEC. 485D. PURPOSE OF CENTER.

  (a) In General.--The general purposes of the National Center 
for Complementary and Alternative Medicine (in this subpart 
referred to as the ``Center'') are the conduct and support of 
basic and applied research (including both intramural and 
extramural research), research training, the dissemination of 
health information, and other programs with respect to 
identifying, investigating, and validating complementary and 
alternative treatment, diagnostic and prevention modalities, 
disciplines and systems. The Center shall be headed by a 
director, who shall be appointed by the Secretary. The Director 
of the Center shall report directly to the Director of NIH.
  (b) Advisory Council.--The Secretary shall establish an 
advisory council for the Center in accordance with section 406, 
except that at least half of the members of the advisory 
council who are not ex officio members shall include 
practitioners licensed in one or more of the major systems with 
which the Center is concerned, and at least 3 individuals 
representing the interests of individual consumers of 
complementary and alternative medicine.
  (c) Complement to Conventional Medicine.--In carrying out 
subsection (a), the Director of the Center shall, as 
appropriate, study the integration of alternative treatment, 
diagnostic and prevention systems, modalities, and disciplines 
with the practice of conventional medicine as a complement to 
such medicine and into health care delivery systems in the 
United States.
  (d) Appropriate Scientific Expertise and Coordination With 
Institutes and Federal Agencies.--The Director of the Center, 
after consultation with the advisory council for the Center and 
the division of research grants, shall ensure that scientists 
with appropriate expertise in research on complementary and 
alternative medicine are incorporated into the review, 
oversight, and management processes of all research projects 
and other activities funded by the Center. In carrying out this 
subsection, the Director of the Center, as necessary, may 
establish review groups with appropriate scientific expertise. 
The Director of the Center shall coordinate efforts with other 
Institutes and Federal agencies to ensure appropriate 
scientific input and management.
  (e) Evaluation of Various Disciplines and Systems.--In 
carrying out subsection (a), the Director of the Center shall 
identify and evaluate alternative and complementary medical 
treatment, diagnostic and prevention modalities in each of the 
disciplines and systems with which the Center is concerned, 
including each discipline and system in which accreditation, 
national certification, or a State license is available.
  (f) Ensuring High Quality, Rigorous Scientific Review.--In 
order to ensure high quality, rigorous scientific review of 
complementary and alternative, diagnostic and prevention 
modalities, disciplines and systems, the Director of the Center 
shall conduct or support the following activities:
          (1) Outcomes research and investigations.
          (2) Epidemiological studies.
          (3) Health services research.
          (4) Basic science research.
          (5) Clinical trials.
          (6) Other appropriate research and investigational 
        activities.
The Director of NIH, in coordination with the Director of the 
Center, shall designate specific personnel in each Institute to 
serve as full-time liaisons with the Center in facilitating 
appropriate coordination and scientific input.
  (g) Data System; Information Clearinghouse.--
          (1) Data system.--The Director of the Center shall 
        establish a bibliographic system for the collection, 
        storage, and retrieval of worldwide research relating 
        to complementary and alternative treatment, diagnostic 
        and prevention modalities, disciplines and systems. 
        Such a system shall be regularly updated and publicly 
        accessible.
          (2) Clearinghouse.--The Director of the Center shall 
        establish an information clearinghouse to facilitate 
        and enhance, through the effective dissemination of 
        information, knowledge and understanding of alternative 
        medical treatment, diagnostic and prevention practices 
        by health professionals, patients, industry, and the 
        public.
  (h) Research Centers.--The Director of the Center, after 
consultation with the advisory council for the Center, shall 
provide support for the development and operation of 
multipurpose centers to conduct research and other activities 
described in subsection (a) with respect to complementary and 
alternative treatment, diagnostic and prevention modalities, 
disciplines and systems. The provision of support for the 
development and operation of such centers shall include 
accredited complementary and alternative medicine research and 
education facilities.
  (i) Availability of Resources.--After consultation with the 
Director of the Center, the Director of NIH shall ensure that 
resources of the National Institutes of Health, including 
laboratory and clinical facilities, fellowships (including 
research training fellowship and junior and senior clinical 
fellowships), and other resources are sufficiently available to 
enable the Center to appropriately and effectively carry out 
its duties as described in subsection (a). The Director of NIH, 
in coordination with the Director of the Center, shall 
designate specific personnel in each Institute to serve as 
full-time liaisons with the Center in facilitating appropriate 
coordination and scientific input.
  (j) Availability of Appropriations.--Amounts appropriated to 
carry out this section for fiscal year 1999 are available for 
obligation through September 30, 2001. Amounts appropriated to 
carry out this section for fiscal year 2000 are available for 
obligation through September 30, 2001.

           *       *       *       *       *       *       *


                          Social Security Act

SEC. 403. GRANTS TO STATES.

  (a) Grants.--
          (1) Family assistance grant.--

           *       *       *       *       *       *       *

          (5) Welfare-to-work grants.--
                  (A) Formula grants.--
                          (i) Entitlement.--* * *

           *       *       *       *       *       *       *

                          (ix) Reversion of Unallotted Formula 
                        Funds.--If at the end of any fiscal 
                        year any funds available under this 
                        subparagraph have not been allotted due 
                        to a determination by the Secretary 
                        that any State has not met the 
                        requirements of clause (ii), such funds 
                        shall be transferred to the General 
                        Fund of the Treasury of the United 
                        States.

              DEFINITION OF PROGRAM, PROJECT, AND ACTIVITY

    During fiscal year 1999 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. For the purposes of this bill, or funding under a 
continuing resolution in lieu of a regular bill, 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 1998, the accompanying House and 
Senate Committee reports, the conference report and 
accompanying joint explanatory statement of the managers of the 
committee of conference. In the event of funding under a 
formula-based continuing resolution, agencies should fund each 
project or activity according to the formula, and if this 
process results in a funding level above what the account total 
would be if the formula were applied to it alone, an across-
the-board reduction in each project or activity in the account 
would be required to bring the account total within the 
formula.

  COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 1998 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL FOR FISCAL 
                                                                        YEAR 1999                                                                       
                                                                [In thousands of dollars]                                                               
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                                        Senate Committee recommendation 
                                                                                                                            compared with (+ or -)      
                             Item                                     1998         Budget estimate      Committee    -----------------------------------
                                                                  appropriation                      recommendation         1998                        
                                                                                                                        appropriation    Budget estimate
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                                                                        
                 TITLE I--DEPARTMENT OF LABOR                                                                                                           
                                                                                                                                                        
            EMPLOYMENT AND TRAINING ADMINISTRATION                                                                                                      
                                                                                                                                                        
             TRAINING AND EMPLOYMENT SERVICES \1\                                                                                                       
Grants to States:                                                                                                                                       
    Adult Training............................................          955,000         1,000,000           950,000            -5,000           -50,000 
    Youth Training............................................          129,965           129,965           129,965   ................  ................
    Summer Youth Program \2\..................................          871,000           871,000           871,000   ................  ................
    Dislocated Worker Assistance..............................        1,350,510         1,450,510         1,405,510           +55,000           -45,000 
Federally administered programs:                                                                                                                        
    Native Americans..........................................           53,815            53,815            59,315            +5,500            +5,500 
    Migrant and Seasonal Farmworkers..........................           71,017            71,017            71,517              +500              +500 
    Job Corps:                                                                                                                                          
        Operations............................................        1,127,726         1,157,047         1,150,000           +22,274            -7,047 
        Construction and Renovation \3\.......................          118,491           150,572           150,572           +32,081   ................
                                                               -----------------------------------------------------------------------------------------
          Subtotal, Job Corps.................................        1,246,217         1,307,619         1,300,572           +54,355            -7,047 
                                                               =========================================================================================
    Veterans' employment......................................            7,300             7,300             7,300   ................  ................
    National activities:                                                                                                                                
        Pilots and Demonstrations.............................           65,717            32,000            85,000           +19,283           +53,000 
        Research, Demos, evaluation...........................            8,196            10,000             8,196   ................           -1,804 
        Opportunity Areas for Youth:                                                                                                                    
            Advance from prior year (NA)......................  ................         (250,000)         (250,000)        (+250,000)  ................
            Adjustment........................................  ................  ................         -125,000          -125,000          -125,000 
            Advance for subsequent year.......................          250,000           250,000           250,000   ................  ................
        Other.................................................           12,000             5,000            10,000            -2,000            +5,000 
                                                               -----------------------------------------------------------------------------------------
          Subtotal, National activities.......................          335,913           297,000           228,196          -107,717           -68,804 
              Current Year: Fiscal year 1998/99...............          (85,913)          (47,000)         (-21,804)        (-107,717)         (-68,804)
              Fiscal year 1999/2000...........................         (250,000)         (250,000)         (250,000)  ................  ................
                                                               =========================================================================================
          Subtotal, Federal activities........................        1,714,262         1,736,751         1,666,900           -47,362           -69,851 
              Current Year: Fiscal year 1998/99...............       (1,464,262)       (1,486,751)       (1,416,900)         (-47,362)         (-69,851)
              Fiscal year 1999/2000...........................         (250,000)         (250,000)         (250,000)  ................  ................
                                                               =========================================================================================
          Total, Job Training Partnership Act.................        5,020,737         5,188,226         5,023,375            +2,638          -164,851 
              Current Year: Fiscal year 1998/99...............       (4,770,737)       (4,938,226)       (4,773,375)          (+2,638)        (-164,851)
              Fiscal year 1999/2000...........................         (250,000)         (250,000)         (250,000)  ................  ................
                                                               =========================================================================================
    Women in Apprenticeship \2\...............................            1,000               647             1,000   ................             +353 
    Skills Standards..........................................            8,000             7,000             7,000            -1,000   ................
                                                               -----------------------------------------------------------------------------------------
      Subtotal, National activities, TES......................          344,913           304,647           236,196          -108,717           -68,451 
          Current Year: Fiscal year 1998/99...................           (9,000)           (7,647)           (8,000)          (-1,000)            (+353)
          Fiscal year 1999/2000...............................         (250,000)         (250,000)         (250,000)  ................  ................
    School-to-Work \4\........................................          200,000           125,000           125,000           -75,000   ................
    Homeless Veterans \2\.....................................            3,000             2,500             3,000   ................             +500 
                                                               =========================================================================================
      Total, Training and Employment Services.................        5,232,737         5,323,373         5,159,375           -73,362          -163,998 
          Current Year: Fiscal year 1998/99...................       (4,982,737)       (5,073,373)       (4,909,375)         (-73,362)        (-163,998)
          Fiscal year 1999/2000...............................         (250,000)         (250,000)         (250,000)  ................  ................
    Welfare-to-work rescission................................  ................  ................         -137,000          -137,000          -137,000 
COMMUNITY SERVICE EMPLOYMENT OLDER AMERICANS \5\..............          440,200           440,200           440,200   ................  ................
                                                                                                                                                        
         FEDERAL UNEMPLOYMENT BENEFITS AND ALLOWANCES                                                                                                   
                                                                                                                                                        
Trade Adjustment..............................................          304,700           312,300           312,300            +7,600   ................
NAFTA Activities..............................................           44,300            48,400            48,400            +4,100   ................
Proposed Legislation NAFTA....................................  ................         (138,300)         (138,300)        (+138,300)  ................
                                                               -----------------------------------------------------------------------------------------
      Total...................................................          349,000           360,700           360,700           +11,700   ................
                                                               =========================================================================================
STATE UNEMPLOYMENT INSURANCE AND EMPLOYMENT SERVICE OPERATIONS                                                                                          
                                                                                                                                                        
Unemployment Compensation (Trust Funds):                                                                                                                
    State Operations..........................................       (2,114,125)       (2,214,125)       (2,115,125)          (+1,000)         (-99,000)
    National Activities.......................................          (10,000)          (10,000)          (10,000)  ................  ................
    Year 2000 Computer conversion:                                                                                                                      
        Advance from prior year...............................  ................          (40,000)          (40,000)         (+40,000)  ................
        Rescission............................................  ................  ................         (-40,000)         (-40,000)         (-40,000)
        Adjustment............................................         (160,000)  ................  ................        (-160,000)  ................
                                                               -----------------------------------------------------------------------------------------
          Subtotal, current year..............................         (160,000)          (40,000)  ................        (-160,000)         (-40,000)
        Advance (Fiscal year 1999/2000).......................          (40,000)  ................  ................         (-40,000)  ................
    Contingency...............................................         (196,333)         (180,933)         (186,333)         (-10,000)          (+5,400)
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Unemployment Comp (trust funds)...............       (2,520,458)       (2,405,058)       (2,271,458)        (-249,000)        (-133,600)
          Current Year: Fiscal year 1998/99...................       (2,480,458)       (2,405,058)       (2,271,458)        (-209,000)        (-133,600)
          Fiscal year 1999/2000...............................          (40,000)  ................  ................         (-40,000)  ................
Employment Service:                                                                                                                                     
    Allotments to States:                                                                                                                               
        Federal Funds.........................................           23,452            23,452            23,452   ................  ................
        Trust Funds...........................................         (738,283)         (738,283)         (738,283)  ................  ................
                                                               -----------------------------------------------------------------------------------------
          Subtotal............................................          761,735           761,735           761,735   ................  ................
    National Activities: Trust Funds \6\......................          (54,880)          (54,880)          (59,880)          (+5,000)          (+5,000)
                                                               =========================================================================================
          Subtotal, Employment Service........................          816,615           816,615           821,615            +5,000            +5,000 
              Federal funds...................................           23,452            23,452            23,452   ................  ................
              Trust funds.....................................         (793,163)         (793,163)         (798,163)          (+5,000)          (+5,000)
One Stop Career Centers:                                                                                                                                
    Federal Funds.............................................          163,344           138,645           138,645           -24,699   ................
        Trust Funds...........................................  ................           (7,855)           (7,855)          (+7,855)  ................
                                                               -----------------------------------------------------------------------------------------
          Total, One stop centers.............................          163,344           146,500           146,500           -16,844   ................
                                                               =========================================================================================
          Total, State Unemployment...........................        3,500,417         3,368,173         3,239,573          -260,844          -128,600 
              Federal Funds...................................          186,796           162,097           162,097           -24,699   ................
              Trust Funds.....................................       (3,313,621)       (3,206,076)       (3,077,476)        (-236,145)        (-128,600)
                  Current year................................       (3,273,621)       (3,206,076)       (3,077,476)        (-196,145)        (-128,600)
                  Fiscal year 1999/2000.......................          (40,000)  ................  ................         (-40,000)  ................
Advances to the UI and Other Trust Funds \7\..................          392,000           357,000           357,000           -35,000   ................
                                                               =========================================================================================
                    PROGRAM ADMINISTRATION                                                                                                              
                                                                                                                                                        
Adult Employment and Training.................................           26,121            28,103            27,688            +1,567              -415 
    Trust Funds...............................................           (2,259)           (3,129)           (2,395)            (+136)            (-734)
Youth Employment and Training.................................           29,925            32,854            31,721            +1,796            -1,133 
Employment Security...........................................            6,174             4,718             4,718            -1,456   ................
    Trust Funds...............................................          (37,697)          (41,704)          (39,956)          (+2,259)          (-1,748)
Apprenticeship Services.......................................           16,448            18,365            17,435              +987              -930 
Executive Direction...........................................            5,729             6,822             6,073              +344              -749 
    Trust Funds...............................................           (1,329)           (1,365)           (1,365)             (+36)  ................
Welfare to Work \8\...........................................            5,700             6,400             6,360              +660               -40 
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Program Administration........................          131,382           143,460           137,711            +6,329            -5,749 
          Federal funds.......................................           90,097            97,262            93,995            +3,898            -3,267 
          Trust funds.........................................          (41,285)          (46,198)          (43,716)          (+2,431)          (-2,482)
                                                               =========================================================================================
      Subtotal, Employment and Training Administration........       10,045,736         9,992,906         9,557,559          -488,177          -435,347 
          Federal funds.......................................        6,690,830         6,740,632         6,436,367          -254,463          -304,265 
              Current Year: Fiscal year 1998/99...............       (6,440,830)       (6,490,632)       (6,186,367)        (-254,463)        (-304,265)
              Fiscal year 1999/2000...........................         (250,000)         (250,000)         (250,000)  ................  ................
          Trust funds.........................................       (3,354,906)       (3,252,274)       (3,121,192)        (-233,714)        (-131,082)
              Current Year: Fiscal year 1998/99...............       (3,314,906)       (3,252,274)       (3,121,192)        (-193,714)        (-131,082)
              Fiscal year 1999/2000...........................          (40,000)  ................  ................         (-40,000)  ................
                                                                                                                                                        
          PENSION AND WELFARE BENEFITS ADMINISTRATION                                                                                                   
                                                                                                                                                        
                     SALARIES AND EXPENSES                                                                                                              
                                                                                                                                                        
Enforcement and Compliance....................................           66,146            71,660            69,840            +3,694            -1,820 
Policy, Regulation and Public Service.........................           12,289            15,555            14,477            +2,188            -1,078 
Program Oversight.............................................            3,621             3,759             3,759              +138   ................
                                                               -----------------------------------------------------------------------------------------
      Subtotal, PWBA..........................................           82,056            90,974            88,076            +6,020            -2,898 
                                                                                                                                                        
             PENSION BENEFIT GUARANTY CORPORATION                                                                                                       
                                                                                                                                                        
Program Administration subject to limitation (TF).............          (10,433)          (10,958)          (10,958)            (+525)  ................
Termination services not subject to limitation (NA)...........         (137,376)         (147,724)         (147,724)         (+10,348)  ................
                                                               -----------------------------------------------------------------------------------------
      Subtotal, PBGC new BA...................................          (10,433)          (10,958)          (10,958)            (+525)  ................
      Subtotal, PBGC (Program level)..........................         (147,809)         (158,682)         (158,682)         (+10,873)  ................
                                                                                                                                                        
              EMPLOYMENT STANDARDS ADMINISTRATION                                                                                                       
                                                                                                                                                        
                     SALARIES AND EXPENSES                                                                                                              
                                                                                                                                                        
Enforcement of Wage and Hour Standards........................          121,347           129,897           127,414            +6,067            -2,483 
Office of Labor-Management Standards..........................           26,735            27,648            27,648              +913   ................
Federal Contractor EEO Standards Enforcement..................           62,344            67,836            65,461            +3,117            -2,375 
Federal Programs for Workers' Compensation....................           77,906            76,759            76,759            -1,147   ................
    Trust Funds...............................................             (993)           (1,924)           (1,924)            (+931)  ................
Program Direction and Support.................................           11,695            12,127            12,127              +432   ................
                                                               -----------------------------------------------------------------------------------------
      Subtotal, ESA salaries and expenses.....................          301,020           316,191           311,333           +10,313            -4,858 
          Federal funds.......................................          300,027           314,267           309,409            +9,382            -4,858 
          Trust funds.........................................             (993)           (1,924)           (1,924)            (+931)  ................
                                                                                                                                                        
                     SPECIAL BENEFITS \9\                                                                                                               
Federal employees compensation benefits.......................          197,000           175,000           175,000           -22,000   ................
Longshore and harbor workers' benefits........................            4,000             4,000             4,000   ................  ................
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Special Benefits..............................          201,000           179,000           179,000           -22,000   ................
                                                                                                                                                        
             BLACK LUNG DISABILITY TRUST FUND \10\                                                                                                      
Benefit payments and interest on advances.....................          960,650           969,725           969,725            +9,075   ................
Employment Standards Adm. S&E.................................           26,147            30,191            30,191            +4,044   ................
Departmental Management S&E...................................           19,551            20,422            20,422              +871   ................
Departmental Management, Inspector General....................              296               306               306               +10   ................
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Black Lung Disablty. Trust Fund, apprn........        1,006,644         1,020,644         1,020,644           +14,000   ................
Treasury Adm. Costs (Indefinite)..............................              356               356               356   ................  ................
                                                               -----------------------------------------------------------------------------------------
      Total, Black Lung Disability Trust Fund.................        1,007,000         1,021,000         1,021,000           +14,000   ................
                                                               =========================================================================================
      Total, Employment Standards Administration..............        1,509,020         1,516,191         1,511,333            +2,313            -4,858 
          Federal funds.......................................        1,508,027         1,514,267         1,509,409            +1,382            -4,858 
          Trust funds.........................................             (993)           (1,924)           (1,924)            (+931)  ................
                                                               =========================================================================================
         OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION                                                                                                  
                                                                                                                                                        
                     SALARIES AND EXPENSES                                                                                                              
                                                                                                                                                        
Safety and Health Standards...................................           12,091            12,437            12,323              +232              -114 
Federal Enforcement...........................................          128,886           135,298           133,182            +4,296            -2,116 
State Programs................................................           77,941            81,140            80,084            +2,143            -1,056 
Technical Support.............................................           17,591            18,504            18,203              +612              -301 
Compliance Assistance:                                                                                                                                  
    Federal Assistance........................................           43,927            46,529            45,670            +1,743              -859 
    State Consultation Grants.................................           35,373            38,757            37,640            +2,267            -1,117 
Safety and Health Statistics..................................           14,283            15,610            15,172              +889              -438 
Executive Direction and Administration........................            6,586             6,770             6,709              +123               -61 
                                                               -----------------------------------------------------------------------------------------
      Total, OSHA.............................................          336,678           355,045           348,983           +12,305            -6,062 
                                                               =========================================================================================
             MINE SAFETY AND HEALTH ADMINISTRATION                                                                                                      
                                                                                                                                                        
                     SALARIES AND EXPENSES                                                                                                              
                                                                                                                                                        
Coal Enforcement..............................................          107,452           109,851           109,851            +2,399   ................
Metal/Non-Metal Enforcement...................................           43,695            44,550            44,550              +855   ................
Standards Development.........................................            1,290             1,509             1,509              +219   ................
Assessments...................................................            3,556             3,896             3,896              +340   ................
Educational Policy and Development............................           14,839            15,838            15,838              +999   ................
Technical Support.............................................           23,747            25,312            25,312            +1,565   ................
Program Administration........................................            8,818            10,209            10,209            +1,391   ................
                                                               -----------------------------------------------------------------------------------------
      Total, Mine Safety and Health Administration............          203,397           211,165           211,165            +7,768   ................
                                                               =========================================================================================
                  BUREAU OF LABOR STATISTICS                                                                                                            
                                                                                                                                                        
                     SALARIES AND EXPENSES                                                                                                              
                                                                                                                                                        
Employment and Unemployment Statistics........................          110,975           115,828           114,227            +3,252            -1,601 
Labor Market Information (Trust Funds)........................          (52,848)          (54,146)          (53,718)            (+870)            (-428)
Prices and Cost of Living.....................................          107,059           120,179           115,849            +8,790            -4,330 
Compensation and Working Conditions...........................           58,934            61,029            60,337            +1,403              -692 
Productivity and Technology...................................            7,251             7,526             7,435              +184               -91 
Economic Growth and Employment Projections....................            4,729             4,905             4,847              +118               -58 
Executive Direction and Staff Services........................           23,317            24,098            23,317   ................             -781 
Consumer Price Index Revision \7\.............................           15,430            11,159            11,159            -4,271   ................
                                                               -----------------------------------------------------------------------------------------
      Total, Bureau of Labor Statistics.......................          380,543           398,870           390,889           +10,346            -7,981 
          Federal Funds.......................................          327,695           344,724           337,171            +9,476            -7,553 
          Trust Funds.........................................          (52,848)          (54,146)          (53,718)            (+870)            (-428)
                                                               =========================================================================================
                    DEPARTMENTAL MANAGEMENT                                                                                                             
                                                                                                                                                        
                     SALARIES AND EXPENSES                                                                                                              
                                                                                                                                                        
Executive Direction...........................................           18,004            20,193            20,193            +2,189   ................
Legal Services................................................           65,147            66,219            66,219            +1,072   ................
    Trust Funds...............................................             (282)             (299)             (299)             (+17)  ................
International Labor Affairs...................................           12,095            39,385            40,385           +28,290            +1,000 
Administration and Management.................................           15,151            15,774            15,774              +623   ................
Adjudication..................................................           20,688            21,842            21,842            +1,154   ................
Promoting Employment of People with Disabilities..............            4,421             4,679             4,750              +329               +71 
Women's Bureau................................................            7,762             7,802             7,802               +40   ................
Civil Rights Activities.......................................            4,580             4,929             4,929              +349   ................
Chief Financial Officer.......................................            4,800             5,538             5,169              +369              -369 
Task Force/Employment people w/disabilities...................  ................            2,400             1,400            +1,400            -1,000 
                                                               -----------------------------------------------------------------------------------------
      Total, Salaries and expenses............................          152,930           189,060           188,762           +35,832              -298 
          Federal funds.......................................          152,648           188,761           188,463           +35,815              -298 
          Trust funds.........................................             (282)             (299)             (299)             (+17)  ................
                                                               =========================================================================================
               VETERANS EMPLOYMENT AND TRAINING                                                                                                         
                                                                                                                                                        
State Administration:                                                                                                                                   
    Disabled Veterans Outreach Program........................          (80,040)          (80,040)          (80,040)  ................  ................
    Local Veterans Employment Program.........................          (77,078)          (77,078)          (77,078)  ................  ................
                                                               -----------------------------------------------------------------------------------------
      Subtotal, State Administration..........................         (157,118)         (157,118)         (157,118)  ................  ................
Federal Administration........................................          (24,861)          (25,601)          (25,601)            (+740)  ................
                                                               -----------------------------------------------------------------------------------------
      Total, Veterans Employment and Training (TF)............         (181,979)         (182,719)         (182,719)            (+740)  ................
                                                               =========================================================================================
                OFFICE OF THE INSPECTOR GENERAL                                                                                                         
                                                                                                                                                        
Program Activities............................................           36,854            40,043            39,185            +2,331              -858 
    Trust Funds...............................................           (3,645)           (3,772)           (3,725)             (+80)             (-47)
Executive Direction and Management............................            5,773             5,990             5,590              -183              -400 
                                                               -----------------------------------------------------------------------------------------
      Total, Office of the Inspector General..................           46,272            49,805            48,500            +2,228            -1,305 
          Federal funds.......................................           42,627            46,033            44,775            +2,148            -1,258 
          Trust funds.........................................           (3,645)           (3,772)           (3,725)             (+80)             (-47)
                                                               =========================================================================================
      Total, Departmental Management..........................          381,181           421,584           419,981           +38,800            -1,603 
          Federal funds.......................................          195,275           234,794           233,238           +37,963            -1,556 
          Trust funds.........................................         (185,906)         (186,790)         (186,743)            (+837)             (-47)
                                                               =========================================================================================
      Total, Labor Department.................................       12,949,044        12,997,693        12,538,944          -410,100          -458,749 
          Federal funds.......................................        9,343,958         9,491,601         9,164,409          -179,549          -327,192 
              Current Year: Fiscal year 1998/99...............       (9,093,958)       (9,241,601)       (8,914,409)        (-179,549)        (-327,192)
              Fiscal year 1999/2000...........................         (250,000)         (250,000)         (250,000)  ................  ................
          Trust funds.........................................       (3,605,086)       (3,506,092)       (3,374,535)        (-230,551)        (-131,557)
              Current Year: Fiscal year 1998/99...............       (3,565,086)       (3,506,092)       (3,374,535)        (-190,551)        (-131,557)
              Fiscal year 1999/2000...........................          (40,000)  ................  ................         (-40,000)  ................
                                                               =========================================================================================
       TITLE II--DEPARTMENT OF HEALTH AND HUMAN SERVICES                                                                                                
                                                                                                                                                        
         HEALTH RESOURCES AND SERVICES ADMINISTRATION                                                                                                   
                                                                                                                                                        
                 HEALTH RESOURCES AND SERVICES                                                                                                          
                                                                                                                                                        
Consolidated health centers...................................          824,883           839,468           925,000          +100,117           +85,532 
National Health Service Corps:                                                                                                                          
    Field placements..........................................           37,213            37,175            37,244               +31               +69 
    Recruitment...............................................           77,857            78,022            78,166              +309              +144 
                                                               -----------------------------------------------------------------------------------------
      Subtotal, National Health Service Corps.................          115,070           115,197           115,410              +340              +213 
                                                                                                                                                        
                      Health Professions                                                                                                                
                                                                                                                                                        
Grants to Communities for Scholarships........................              531   ................  ................             -531   ................
Health Professions data systems...............................              236               237   ................             -236              -237 
Research on Health Professions Issues.........................              450               451   ................             -450              -451 
Nurse loan repayment for shortage area service................            2,199   ................  ................           -2,199   ................
Centers of excellence.........................................           24,679            24,757   ................          -24,679           -24,757 
Health careers opportunity program............................           26,742            26,825   ................          -26,742           -26,825 
Exceptional financial need scholarships.......................           11,371            11,352   ................          -11,371           -11,352 
Faculty loan repayment........................................            1,060             1,063   ................           -1,060            -1,063 
Fin. Assistance for disadvantaged HP students.................            6,741             6,730   ................           -6,741            -6,730 
Scholarships for disadvantaged students.......................           18,647   ................  ................          -18,647   ................
Family medicine training/departments..........................           49,194            49,342   ................          -49,194           -49,342 
General internal medicine and pediatrics......................           17,597            17,649   ................          -17,597           -17,649 
Physician assistants..........................................            6,368             6,387   ................           -6,368            -6,387 
Public health and preventive medicine.........................            7,986             8,012   ................           -7,986            -8,012 
Health administration traineeships/projects...................            1,094             1,097   ................           -1,094            -1,097 
Area health education centers.................................           28,451            28,539   ................          -28,451           -28,539 
Border health training centers................................            3,747             3,759   ................           -3,747            -3,759 
General dentistry residencies.................................            3,780             3,792   ................           -3,780            -3,792 
Allied health special projects................................            3,505             3,839   ................           -3,505            -3,839 
Geriatric education centers and training......................            8,869             8,896   ................           -8,869            -8,896 
Rural interdisciplinary traineeships..........................            4,470             4,160   ................           -4,470            -4,160 
Podiatric Medicine............................................              675               678   ................             -675              -678 
Chiropractic demonstration grants.............................            1,024             1,027   ................           -1,024            -1,027 
Advanced Nurse Education......................................           12,450            12,489   ................          -12,450           -12,489 
Nurse practitioners/nurse midwives............................           17,564            17,617   ................          -17,564           -17,617 
Special projects..............................................           10,549            10,582   ................          -10,549           -10,582 
Nurse disadvantaged assistance................................            3,860             3,872   ................           -3,860            -3,872 
Professional nurse traineeships...............................           15,918            15,968   ................          -15,918           -15,968 
Nurse anesthetists............................................            2,761             2,769   ................           -2,761            -2,769 
Loans for Disadvantaged Students..............................  ................           18,706   ................  ................          -18,706 
Consolidated health professions...............................  ................  ................          208,000          +208,000          +208,000 
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Health professions............................          292,518           290,595           208,000           -84,518           -82,595 
Other HRSA Programs:                                                                                                                                    
    Hansen's Disease Services \11\............................           17,094            17,020            18,670            +1,576            +1,650 
    Maternal and Child Health Block Grant.....................          681,079           681,740           683,000            +1,921            +1,260 
    Healthy Start.............................................           95,526            95,805           105,000            +9,474            +9,195 
    Organ Transplantation.....................................            2,778             4,111            10,000            +7,222            +5,889 
    Health Teaching Facilities Interest Subsidies.............              224               150               150               -74   ................
    Bone Marrow Program.......................................           15,270            15,270            15,270   ................  ................
    Rural outreach grants.....................................           32,436            32,532            32,592              +156               +60 
    Emergency medical services for children...................           12,941            10,976            15,000            +2,059            +4,024 
    Black lung clinics........................................            4,976             5,000             5,000               +24   ................
    Alzheimer's demonstration grants \12\.....................            5,970             6,000             6,000               +30   ................
    Payment to Hawaii, treatment of Hansen's..................            2,045             2,045             2,045   ................  ................
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Other HRSA programs...........................          870,339           870,649           892,727           +22,388           +22,078 
Ryan White AIDS Programs:                                                                                                                               
    Emergency Assistance......................................          464,736           488,974           478,000           +13,264           -10,974 
    Comprehensive Care Programs...............................          542,783           668,870           588,000           +45,217           -80,870 
        Drug Assistance Program (ADAP) (NA)...................         (285,500)         (385,500)         (311,000)         (+25,500)         (-74,500)
        ADAP Advance funding (fiscal year 1999/2000)..........  ................  ................          150,000          +150,000          +150,000 
                                                               -----------------------------------------------------------------------------------------
          Subtotal, ADAP......................................          285,500           385,500           461,000          +175,500           +75,500 
    Early Intervention Program................................           76,211            86,154            82,000            +5,789            -4,154 
    Pediatric Demonstrations..................................           40,803            43,926            44,000            +3,197               +74 
    AIDS Dental Services......................................            7,763             7,787             7,800               +37               +13 
    Education and Training Centers............................           17,216            17,271            18,000              +784              +729 
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Ryan White AIDS programs......................        1,149,512         1,312,982         1,367,800          +218,288           +54,818 
Family Planning...............................................          202,903           218,077           215,000           +12,097            -3,077 
Rural Health Research.........................................           11,656            11,691            11,713               +57               +22 
Health Care and Other Facilities..............................           27,957   ................           30,000            +2,043           +30,000 
Buildings and Facilities......................................            2,498               250               250            -2,248   ................
National Practitioner Data Bank...............................            8,000            12,000            12,000            +4,000   ................
    User Fees.................................................           -8,000           -12,000           -12,000            -4,000   ................
Program Management............................................          114,059           114,059           120,000            +5,941            +5,941 
                                                               -----------------------------------------------------------------------------------------
      Total, Health resources and services....................        3,611,395         3,772,968         3,885,900          +274,505          +112,932 
                                                               =========================================================================================
MEDICAL FACILITIES GUARANTEE AND LOAN FUND: Interest subsidy                                                                                            
 program......................................................            6,000             1,000             1,000            -5,000   ................
HEALTH EDUCATION ASSISTANCE LOANS PROGRAM (HEAL):                                                                                                       
    New loan subsidies........................................            1,020   ................  ................           -1,020   ................
    Liquidating account (NA)..................................          (29,566)          (37,000)          (37,000)          (+7,434)  ................
    HEAL loan limitation (NA).................................          (85,000)  ................  ................         (-85,000)  ................
    Program management \13\...................................            3,675             3,688             3,688               +13   ................
                                                               -----------------------------------------------------------------------------------------
      Total, HEAL.............................................            4,695             3,688             3,688            -1,007   ................
                                                               =========================================================================================
VACCINE INJURY COMPENSATION PROGRAM TRUST FUND:                                                                                                         
    Post-fiscal year 1988 claims (TF).........................           42,600            51,600            51,600            +9,000   ................
    HRSA administration (TF)..................................            3,000             3,000             3,000   ................  ................
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Vaccine injury compensation trust fund........           45,600            54,600            54,600            +9,000   ................
VACCINE INJURY COMPENSATION: Pre-fiscal year 1989 claims                                                                                                
 (appropriations).............................................  ................  ................          100,000          +100,000          +100,000 
                                                               -----------------------------------------------------------------------------------------
      Total, Vaccine inquiry..................................           45,600            54,600           154,600          +109,000          +100,000 
                                                               =========================================================================================
      Total, Health Resources and Services Admin..............        3,667,690         3,832,256         4,045,188          +377,498          +212,932 
                                                               =========================================================================================
          CENTERS FOR DISEASE CONTROL AND PREVENTION                                                                                                    
                                                                                                                                                        
            DISEASE CONTROL, RESEARCH AND TRAINING                                                                                                      
                                                                                                                                                        
Preventive Health Services Block Grant:                                                                                                                 
    Program...................................................          147,362           146,566           120,000           -27,362           -26,566 
    Administration............................................            1,730             2,247   ................           -1,730            -2,247 
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Preventive Health Services Block Grant........          149,092           148,813           120,000           -29,092           -28,813 
Prevention Centers:                                                                                                                                     
    Program...................................................            7,730             7,872             9,080            +1,350            +1,208 
    Administration............................................              321               164   ................             -321              -164 
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Prevention Centers............................            8,051             8,036             9,080            +1,029            +1,044 
Bioterrorism Stockpile........................................  ................  ................  ................  ................  ................
CDC/HCFA vaccine program:                                                                                                                               
    Childhood immunization:                                                                                                                             
        Program...............................................          361,983           350,659           405,900           +43,917           +55,241 
        Administration........................................           48,175            48,909   ................          -48,175           -48,909 
                                                               -----------------------------------------------------------------------------------------
          Subtotal, Childhood immunization....................          410,158           399,568           405,900            -4,258            +6,332 
    HCFA vaccine purchase (NA)................................          437,104           566,278           566,278          +129,174   ................
                                                               -----------------------------------------------------------------------------------------
      Subtotal, CDC/HCFA vaccine program level................          847,262           965,846           972,178          +124,916            +6,332 
Communicable Diseases:                                                                                                                                  
    AIDS:                                                                                                                                               
        Program...............................................          505,080           497,497           631,779          +126,699          +134,282 
        Administration........................................          119,864           124,727   ................         -119,864          -124,727 
                                                               -----------------------------------------------------------------------------------------
          Subtotal, HIV/AIDS..................................          624,944           622,224           631,779            +6,835            +9,555 
    Tuberculosis:                                                                                                                                       
        Program...............................................          113,316           112,912           119,236            +5,920            +6,324 
        Administration........................................            4,655             4,738   ................           -4,655            -4,738 
                                                               -----------------------------------------------------------------------------------------
          Subtotal, Tuberculosis..............................          117,971           117,650           119,236            +1,265            +1,586 
    Sexually Transmitted Diseases:                                                                                                                      
        Program...............................................           99,694           108,904           113,671           +13,977            +4,767 
        Administration........................................           12,423            12,677   ................          -12,423           -12,677 
                                                               -----------------------------------------------------------------------------------------
          Subtotal, Sexually Transmitted Diseases.............          112,117           121,581           113,671            +1,554            -7,910 
Chronic Diseases:                                                                                                                                       
    Chronic and Environmental Disease Prevention:                                                                                                       
        Program...............................................          160,249           211,694           258,568           +98,319           +46,874 
        Administration........................................           51,728            51,874   ................          -51,728           -51,874 
                                                               -----------------------------------------------------------------------------------------
          Subtotal, Chronic and Environmental Disease.........          211,977           263,568           258,568           +46,591            -5,000 
    Breast and Cervical Cancer Screening:                                                                                                               
        Program...............................................          135,306           135,064           145,000            +9,694            +9,936 
        Administration........................................            7,473             8,421   ................           -7,473            -8,421 
                                                               -----------------------------------------------------------------------------------------
          Subtotal, Breast and Cervical Cancer Screening......          142,779           143,485           145,000            +2,221            +1,515 
Infectious Diseases:                                                                                                                                    
    Program...................................................           54,742            95,179           115,215           +60,473           +20,036 
    Administration............................................           58,115            67,336   ................          -58,115           -67,336 
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Infectious diseases...........................          112,857           162,515           115,215            +2,358           -47,300 
Lead Poisoning Prevention:                                                                                                                              
    Program...................................................           31,324            31,212            38,205            +6,881            +6,993 
    Administration............................................            6,540             6,686   ................           -6,540            -6,686 
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Lead Poisoning Prevention.....................           37,864            37,898            38,205              +341              +307 
Injury Control:                                                                                                                                         
    Program...................................................           36,994            33,711            50,765           +13,771           +17,054 
    Administration............................................           12,770            15,625   ................          -12,770           -15,625 
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Injury Control................................           49,764            49,336            50,765            +1,001            +1,429 
Occupational Safety and Health (NIOSH): \14\                                                                                                            
    Program...................................................           72,823            65,610           200,000          +127,177          +134,390 
    Administration............................................          114,390           119,954   ................         -114,390          -119,954 
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Occupational Safety and Health................          187,213           185,564           200,000           +12,787           +14,436 
Epidemic Services:                                                                                                                                      
    Program...................................................           14,767            39,432            69,844           +55,077           +30,412 
    Administration............................................           52,578            55,484   ................          -52,578           -55,484 
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Epidemic Services.............................           67,345            94,916            69,844            +2,499           -25,072 
Office of the Director:                                                                                                                                 
    Budget Authority..........................................           32,964            29,581            21,581           -11,383            -8,000 
    1 percent Set Aside.......................................             (697)           (1,439)           (1,439)            (+742)  ................
                                                               -----------------------------------------------------------------------------------------
      Office of the Director, program level...................          (33,661)          (31,020)          (23,020)         (-10,641)          (-8,000)
National Center for Health Statistics:                                                                                                                  
    Program Operations:                                                                                                                                 
        Budget Authority......................................           10,020   ................  ................          -10,020   ................
        1 percent Set Aside...................................  ................           (9,323)  ................  ................          (-9,323)
    Administration:                                                                                                                                     
        Budget Authority......................................           16,018   ................  ................          -16,018   ................
        1 percent evaluation funds (NA).......................          (58,535)          (75,250)          (84,573)         (+26,038)          (+9,323)
                                                               -----------------------------------------------------------------------------------------
          Subtotal, Health Statistics program level...........          (84,573)          (84,573)          (84,573)  ................  ................
Buildings and Facilities......................................           41,504             6,792             6,800           -34,704                +8 
Prevention research...........................................  ................           24,969   ................  ................          -24,969 
Health disparities demonstration..............................  ................           29,963            10,000           +10,000           -19,963 
    Crime activities not funded from Crime Trust Fund.........  ................            8,000   ................  ................           -8,000 
                                                               =========================================================================================
      Subtotal, Centers for Disease Control...................        2,332,638         2,454,459         2,315,644           -16,994          -138,815 
Crime Bill Activities:                                                                                                                                  
    Crime Trust Fund:                                                                                                                                   
        Rape Prevention and Education.........................           45,000            36,945            37,000            -8,000               +55 
        Domestic Violence Community Demonstrations............            6,000             5,993             6,000   ................               +7 
                                                               -----------------------------------------------------------------------------------------
          Subtotal, Crime bill activities.....................           51,000            42,938            43,000            -8,000               +62 
                                                               =========================================================================================
        Rape Prevention--General Revenues.....................  ................  ................            8,000            +8,000            +8,000 
                                                               -----------------------------------------------------------------------------------------
          Subtotal, rape prevention...........................           45,000            36,945            45,000   ................           +8,055 
                                                               =========================================================================================
          Total, Crime activities incl general revenue........           51,000            50,938            51,000   ................              +62 
                                                               =========================================================================================
          Total, Disease Control..............................        2,383,638         2,497,397         2,366,644           -16,994          -130,753 
                                                               =========================================================================================
                 NATIONAL INSTITUTES OF HEALTH                                                                                                          
                                                                                                                                                        
National Cancer Institute.....................................        2,542,559         2,528,429         2,927,187          +384,628          +398,758 
    AIDS (NA).................................................  ................         (240,206)  ................  ................        (-240,206)
                                                               -----------------------------------------------------------------------------------------
      Subtotal, NCI...........................................       (2,542,559)       (2,768,635)       (2,927,187)        (+384,628)        (+158,552)
National Heart, Lung, and Blood Institute.....................        1,582,924         1,641,524         1,793,697          +210,773          +152,173 
    AIDS (NA).................................................  ................          (68,010)  ................  ................         (-68,010)
                                                               -----------------------------------------------------------------------------------------
      Subtotal, NHLBI.........................................       (1,582,924)       (1,709,534)       (1,793,697)        (+210,773)         (+84,163)
National Institute of Dental Research and Craniofacial........          209,026           213,913           233,588           +24,562           +19,675 
    AIDS (NA).................................................  ................          (14,898)  ................  ................         (-14,898)
                                                               -----------------------------------------------------------------------------------------
      Subtotal, NIDR..........................................         (209,026)         (228,811)         (233,588)         (+24,562)          (+4,777)
National Institute of Diabetes and Digestive and Kidney                                                                                                 
 Diseases.....................................................          872,231           924,701           994,218          +121,987           +69,517 
    AIDS (NA).................................................  ................          (16,843)  ................  ................         (-16,843)
                                                               -----------------------------------------------------------------------------------------
      Subtotal, NIDDK.........................................         (872,231)         (941,544)         (994,218)        (+121,987)         (+52,674)
National Institute of Neurological Disorders and Stroke.......          779,257           813,195           903,278          +124,021           +90,083 
    AIDS (NA).................................................  ................          (28,633)  ................  ................         (-28,633)
                                                               -----------------------------------------------------------------------------------------
      Subtotal, NINDS.........................................         (779,257)         (841,828)         (903,278)        (+124,021)         (+61,450)
National Institute of Allergy and Infectious Diseases.........        1,349,135           699,927         1,540,102          +190,967          +840,175 
    AIDS (NA).................................................  ................         (766,217)  ................  ................        (-766,217)
                                                               -----------------------------------------------------------------------------------------
      Subtotal, NIAID.........................................       (1,349,135)       (1,466,144)       (1,540,102)        (+190,967)         (+73,958)
National Institute of General Medical Sciences................        1,063,959         1,111,531         1,197,825          +133,866           +86,294 
    AIDS (NA).................................................  ................          (30,555)  ................  ................         (-30,555)
                                                               -----------------------------------------------------------------------------------------
      Subtotal, NIGMS.........................................       (1,063,959)       (1,142,086)       (1,197,825)        (+133,866)         (+55,739)
National Institute of Child Health and Human Development......          673,509           652,746           748,482           +74,973           +95,736 
    AIDS (NA).................................................  ................          (72,260)  ................  ................         (-72,260)
                                                               -----------------------------------------------------------------------------------------
      Subtotal, NICHD.........................................         (673,509)         (725,006)         (748,482)         (+74,973)         (+23,476)
National Eye Institute........................................          355,026           373,229           395,261           +40,235           +22,032 
    AIDS (NA).................................................  ................           (9,945)  ................  ................          (-9,945)
                                                               -----------------------------------------------------------------------------------------
      Subtotal, NEI...........................................         (355,026)         (383,174)         (395,261)         (+40,235)         (+12,087)
National Institute of Environmental Health Sciences...........          329,492           347,043           375,743           +46,251           +28,700 
    AIDS (NA).................................................  ................           (6,749)  ................  ................          (-6,749)
                                                               -----------------------------------------------------------------------------------------
      Subtotal, NIEHS.........................................         (329,492)         (353,792)         (375,743)         (+46,251)         (+21,951)
National Institute on Aging...................................          518,312           554,397           596,521           +78,209           +42,124 
    AIDS (NA).................................................  ................           (1,967)  ................  ................          (-1,967)
                                                               -----------------------------------------------------------------------------------------
      Subtotal, NIA...........................................         (518,312)         (556,364)         (596,521)         (+78,209)         (+40,157)
National Institute of Arthritis and Musculoskeletal and Skin                                                                                            
 Diseases.....................................................          274,248           290,177           304,320           +30,072           +14,143 
    AIDS (NA).................................................  ................           (4,523)  ................  ................          (-4,523)
                                                               -----------------------------------------------------------------------------------------
      Subtotal, NIAMS.........................................         (274,248)         (294,700)         (304,320)         (+30,072)          (+9,620)
National Institute on Deafness and Other Communication                                                                                                  
 Disorders....................................................          200,321           213,191           229,887           +29,566           +16,696 
    AIDS (NA).................................................  ................           (1,893)  ................  ................          (-1,893)
                                                               -----------------------------------------------------------------------------------------
      Subtotal, NIDCD.........................................         (200,321)         (215,084)         (229,887)         (+29,566)         (+14,803)
National Institute of Nursing Research........................           63,478            62,228            69,834            +6,356            +7,606 
    AIDS (NA).................................................  ................           (5,921)  ................  ................          (-5,921)
                                                               -----------------------------------------------------------------------------------------
      Subtotal, NINR..........................................          (63,478)          (68,149)          (69,834)          (+6,356)          (+1,685)
National Institute on Alcohol Abuse and Alcoholism............          226,752           229,550           259,747           +32,995           +30,197 
    AIDS (NA).................................................  ................          (15,487)  ................  ................         (-15,487)
                                                               -----------------------------------------------------------------------------------------
      Subtotal, NIAAA.........................................         (226,752)         (245,037)         (259,747)         (+32,995)         (+14,710)
National Institute on Drug Abuse..............................          526,192           393,940           603,274           +77,082          +209,334 
    AIDS (NA).................................................  ................         (181,170)  ................  ................        (-181,170)
                                                               -----------------------------------------------------------------------------------------
      Subtotal, NIDA..........................................         (526,192)         (575,110)         (603,274)         (+77,082)         (+28,164)
National Institute of Mental Health...........................          748,841           699,678           861,208          +112,367          +161,530 
    AIDS (NA).................................................  ................         (107,904)  ................  ................        (-107,904)
                                                               -----------------------------------------------------------------------------------------
      Subtotal, NIMH..........................................         (748,841)         (807,582)         (861,208)        (+112,367)         (+53,626)
National Human Genome Research Institute......................          217,297           236,283           249,891           +32,594           +13,608 
    AIDS (NA).................................................  ................           (3,138)  ................  ................          (-3,138)
                                                               -----------------------------------------------------------------------------------------
      Subtotal, NHGRI.........................................         (217,297)         (239,421)         (249,891)         (+32,594)         (+10,470)
National Center for Research Resources........................          453,035           421,722           554,819          +101,784          +133,097 
    AIDS (NA).................................................  ................          (91,848)  ................  ................         (-91,848)
                                                               -----------------------------------------------------------------------------------------
      Subtotal, NCRR..........................................         (453,035)         (513,570)         (554,819)        (+101,784)         (+41,249)
John Fogarty International Center.............................           28,236            19,048            35,426            +7,190           +16,378 
    AIDS (NA).................................................  ................          (11,305)  ................  ................         (-11,305)
                                                               -----------------------------------------------------------------------------------------
      Subtotal, FIC...........................................          (28,236)          (30,353)          (35,426)          (+7,190)          (+5,073)
National Library of Medicine..................................          160,885           170,738           181,309           +20,424           +10,571 
    AIDS (NA).................................................  ................           (3,472)  ................  ................          (-3,472)
                                                               -----------------------------------------------------------------------------------------
      Subtotal, NLM...........................................         (160,885)         (174,210)         (181,309)         (+20,424)          (+7,099)
Office of the Director........................................          241,101           222,308           302,947           +61,846           +80,639 
    AIDS (NA).................................................  ................          (41,752)  ................  ................         (-41,752)
                                                               -----------------------------------------------------------------------------------------
      Subtotal, OD............................................         (241,101)         (264,060)         (302,947)         (+61,846)         (+38,887)
Buildings and facilities:                                                                                                                               
    Current year..............................................          206,570           218,227           223,822           +17,252            +5,595 
    Advance...................................................  ................           40,000            40,000           +40,000   ................
Office of AIDS Research.......................................  ................        1,725,588   ................  ................       -1,725,588 
                                                               =========================================================================================
      Total NIH:                                                                                                                                        
          Current Year: Fiscal year 1998/99...................       13,622,386        14,763,313        15,582,386        +1,960,000          +819,073 
          Fiscal year 1999/2000...............................  ................           40,000            40,000           +40,000   ................
                                                               =========================================================================================
   SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION                                                                                            
                                                                                                                                                        
Mental Health:                                                                                                                                          
    Knowledge development and application.....................           57,964            57,964            57,964   ................  ................
    Mental Health Performance Partnership.....................          275,420           275,420           275,420   ................  ................
    Children's Mental Health..................................           72,927            72,927            72,927   ................  ................
    Grants to States for the Homeless (PATH)..................           23,000            23,000            25,000            +2,000            +2,000 
    Protection and Advocacy...................................           21,957            21,957            22,957            +1,000            +1,000 
                                                               -----------------------------------------------------------------------------------------
      Subtotal, mental health.................................          451,268           451,268           454,268            +3,000            +3,000 
Substance Abuse Treatment:                                                                                                                              
    Knowledge Development and Application.....................          155,868           115,427           155,868   ................          +40,441 
    Substance Abuse Performance Partnership...................        1,310,107         1,505,107         1,310,107   ................         -195,000 
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Substance Abuse Treatment (BA)................        1,465,975         1,620,534         1,465,975   ................         -154,559 
Substance Abuse Prevention:                                                                                                                             
    Knowledge Development and Application.....................          151,000           117,441           151,000   ................          +33,559 
    High Risk Youth Grants....................................            6,000            10,000             7,000            +1,000            -3,000 
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Substance abuse prevention....................          157,000           127,441           158,000            +1,000           +30,559 
Program Management and Buildings and Facilities...............           54,913            53,400            55,400              +487            +2,000 
Data Collection...............................................           18,000            22,000            18,000   ................           -4,000 
                                                               =========================================================================================
      Total, Substance Abuse and Mental Health................        2,147,156         2,274,643         2,151,643            +4,487          -123,000 
                                                               =========================================================================================
 RETIREMENT PAY AND MEDICAL BENEFITS FOR COMMISSIONED OFFICERS                                                                                          
                                                                                                                                                        
Retirement payments...........................................          149,217           159,251           159,251           +10,034   ................
Survivors benefits............................................           11,643            11,531            11,531              -112   ................
Dependents' medical care......................................           27,470            28,541            28,541            +1,071   ................
Military services credits.....................................            2,409             2,312             2,312               -97   ................
                                                               -----------------------------------------------------------------------------------------
      Total, Retirement pay and medical benefits..............          190,739           201,635           201,635           +10,896   ................
                                                               =========================================================================================
          AGENCY FOR HEALTH CARE POLICY AND RESEARCH                                                                                                    
                                                                                                                                                        
Research on Health Care Systems Cost and Access:                                                                                                        
    Federal Funds.............................................           88,074            98,067            47,659           -40,415           -50,408 
    1 percent evaluation funding (NA).........................          (19,906)          (42,847)          (93,255)         (+73,349)         (+50,408)
                                                               -----------------------------------------------------------------------------------------
      Subtotal................................................         (107,980)         (140,914)         (140,914)         (+32,934)  ................
Health insurance and expenditure surveys: 1 percent evaluation                                                                                          
 funding (NA).................................................          (36,300)          (27,800)          (27,800)          (-8,500)  ................
Program Support...............................................            2,230             2,341             2,341              +111   ................
                                                               =========================================================================================
      Total, AHCPR............................................          146,510           171,055           171,055           +24,545   ................
          Federal Funds.......................................           90,304           100,408            50,000           -40,304           -50,408 
          1 percent evaluation funding (non-add)..............          (56,206)          (70,647)         (121,055)         (+64,849)         (+50,408)
                                                               =========================================================================================
      Total, Public Health Service............................       22,101,913        23,709,652        24,437,496        +2,335,583          +727,844 
          Current Year: Fiscal year 1998/99...................      (22,101,913)      (23,669,652)      (24,247,496)      (+2,145,583)        (+577,844)
          Fiscal year 1999/2000...............................  ................          (40,000)         (190,000)        (+190,000)        (+150,000)
                                                               =========================================================================================
             HEALTH CARE FINANCING ADMINISTRATION                                                                                                       
                                                                                                                                                        
                 GRANTS TO STATES FOR MEDICAID                                                                                                          
                                                                                                                                                        
Medicaid current law benefits.................................       95,263,000       101,710,700       101,710,700        +6,447,700   ................
State and local administration................................        5,209,314         5,639,666         5,639,666          +430,352   ................
Vaccines for Children.........................................          487,245           566,278           566,278           +79,033   ................
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Medicaid program level, fiscal year 1998/99...      100,959,559       107,916,644       107,916,644        +6,957,085   ................
      Carryover balance.......................................       -6,890,359        -5,522,222        -5,522,222        +1,368,137   ................
      Less funds advanced in prior year.......................      -27,988,993       -27,800,689       -27,800,689          +188,304   ................
                                                               =========================================================================================
      Total, request, fiscal year 1998/99.....................       66,080,207        74,593,733        74,593,733        +8,513,526   ................
          New advance 1st quarter, fiscal year 1999/2000......       27,800,689        28,733,605        28,733,605          +932,916   ................
                                                               =========================================================================================
              PAYMENTS TO HEALTH CARE TRUST FUNDS                                                                                                       
                                                                                                                                                        
Supplemental medical insurance................................       60,739,000        62,171,000        62,171,000        +1,432,000   ................
Hospital insurance for the uninsured..........................          -52,000           555,000           555,000          +607,000   ................
Federal uninsured payment.....................................           86,000            97,000            97,000           +11,000   ................
Program management............................................          131,000           130,000           130,000            -1,000   ................
                                                               -----------------------------------------------------------------------------------------
      Total, Payments to Trust Funds, current law.............       60,904,000        62,953,000        62,953,000        +2,049,000   ................
                                                               =========================================================================================
                      PROGRAM MANAGEMENT                                                                                                                
                                                                                                                                                        
Research, demonstration, and evaluation: Regular Program......          (51,500)          (50,000)          (75,000)         (+23,500)         (+25,000)
Medicare Contractors..........................................       (1,216,141)       (1,104,200)       (1,081,700)        (-134,441)         (-22,500)
    (Year 2000 conversion)....................................  ................  ................          (22,500)         (+22,500)         (+22,500)
    User Fee legislative proposal.............................  ................          165,500   ................  ................         -165,500 
    H.R. 3103 funding (NA)....................................         (500,000)         (560,000)         (560,000)         (+60,000)  ................
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Medicare Contractors limit'n on new BA........       (1,216,141)       (1,269,700)       (1,081,700)        (-134,441)        (-188,000)
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Contractors program level.....................       (1,716,141)       (1,829,700)       (1,664,200)         (-51,941)        (-165,500)
State Survey and Certification................................         (154,000)         (104,700)         (124,700)         (-29,300)         (+20,000)
User fee legislative proposal.................................  ................          (62,300)  ................  ................         (-62,300)
Federal Administration:                                                                                                                                 
    Federal Administration....................................         (369,200)         (421,084)         (406,084)         (+36,884)         (-15,000)
    (Year 2000 conversion)....................................  ................  ................          (15,000)         (+15,000)         (+15,000)
    User Fees.................................................          (-1,934)          (-1,984)          (-1,934)  ................             (+50)
    User fee legislative proposal.............................  ................          (36,700)  ................  ................         (-36,700)
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Federal Administration........................         (367,266)         (455,800)         (404,150)         (+36,884)         (-51,650)
                                                               =========================================================================================
      Total, Program management...............................       (1,788,907)       (1,942,500)       (1,685,550)        (-103,357)        (-256,950)
          Total, current law..................................       (1,788,907)       (1,942,500)       (1,685,550)        (-103,357)        (-256,950)
          Total, user fee legislative proposals...............         (500,000)         (560,000)         (597,500)         (+97,500)         (+37,500)
      Total, Program Management limitation on new BA..........       (2,288,907)       (2,502,500)       (2,283,050)          (-5,857)        (-219,450)
                                                               =========================================================================================
Medicare Trust Fund Activity:                                                                                                                           
    Hospital Insurance TF \15\................................      (-7,700,000)      (-6,800,000)      (-6,800,000)        (+900,000)  ................
    Supplemental Medical Ins. TF \16\.........................      (-2,000,000)        (-300,000)        (-300,000)      (+1,700,000)  ................
                                                               =========================================================================================
      Total, Health Care Financing Administration.............      156,573,803       168,222,838       167,965,888       +11,392,085          -256,950 
          Federal funds.......................................      154,784,896       166,280,338       166,280,338       +11,495,442   ................
              Current year, fiscal year 1998/99...............     (126,984,207)     (137,546,733)     (137,546,733)     (+10,562,526)  ................
              New advance, 1st quarter, fiscal year 1999/2000.      (27,800,689)      (28,733,605)      (28,733,605)        (+932,916)  ................
          Trust funds.........................................       (1,788,907)       (1,942,500)       (1,685,550)        (-103,357)        (-256,950)
                                                               =========================================================================================
           ADMINISTRATION FOR CHILDREN AND FAMILIES                                                                                                     
                                                                                                                                                        
               FAMILY SUPPORT PAYMENTS TO STATES                                                                                                        
                                                                                                                                                        
Aid to Families with Dependent Children (AFDC)................  ................           35,000            35,000           +35,000   ................
Quality control liabilities...................................  ................          -25,000           -25,000           -25,000   ................
Payments to territories.......................................  ................           21,000            21,000           +21,000   ................
Emergency assistance..........................................  ................           65,000            65,000           +65,000   ................
Repatriation..................................................  ................            1,000             1,000            +1,000   ................
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Welfare payments..............................  ................           97,000            97,000           +97,000   ................
Child Support Enforcement:                                                                                                                              
    State and local administration............................  ................        2,073,000         2,073,000        +2,073,000   ................
    Federal incentive payments................................  ................          469,000           469,000          +469,000   ................
    Access and visitation.....................................  ................           10,000            10,000           +10,000   ................
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Welfare payments..............................  ................        2,552,000         2,552,000        +2,552,000   ................
                                                               =========================================================================================
      Total, Payments, fiscal year 1998/99 program level......  ................        2,649,000         2,649,000        +2,649,000   ................
          Less funds advanced in previous years...............  ................         -660,000          -660,000          -660,000   ................
                                                               -----------------------------------------------------------------------------------------
          Total, payments, current request, fiscal year 1998/                                                                                           
           99.................................................  ................        1,989,000         1,989,000        +1,989,000   ................
          New advance, 1st quarter, fiscal year 1999/2000.....          660,000           750,000           750,000           +90,000   ................
                                                               =========================================================================================
               LOW INCOME HOME ENERGY ASSISTANCE                                                                                                        
                                                                                                                                                        
Advance from prior year (NA)..................................       (1,000,000)       (1,100,000)       (1,100,000)        (+100,000)  ................
Adjustment....................................................  ................  ................  ................  ................  ................
                                                               -----------------------------------------------------------------------------------------
      Fiscal year 1998/99 program level.......................       (1,000,000)       (1,100,000)       (1,100,000)        (+100,000)  ................
New Emergency Allocation (NA).................................         (300,000)         (300,000)         (300,000)  ................  ................
Advance funding (fiscal year 1999/2000).......................        1,100,000         1,087,000         1,100,000   ................          +13,000 
                                                                                                                                                        
              REFUGEE AND ENTRANT ASSISTANCE \17\                                                                                                       
                                                                                                                                                        
Transitional and Medical Services.............................          230,698           230,698           230,698   ................  ................
Social Services...............................................          129,990           129,990           129,990   ................  ................
Preventive Health.............................................            4,835             4,835             4,835   ................  ................
Targeted Assistance...........................................           49,477            49,477            49,477   ................  ................
                                                               -----------------------------------------------------------------------------------------
      Total, Refugee and entrant assistance (BA)..............          415,000           415,000           415,000   ................  ................
                                                               =========================================================================================
CHILD CARE AND DEVELOPMENT BLOCK GRANT:                                                                                                                 
    Advance funding from prior year (NA)......................         (937,000)       (1,000,000)       (1,000,000)         (+63,000)  ................
    Adjustment (current funding) \18\.........................           65,672           176,672   ................          -65,672          -176,672 
                                                               -----------------------------------------------------------------------------------------
        Current year program level (fiscal year 1998/99)......       (1,002,672)       (1,176,672)       (1,000,000)          (-2,672)        (-176,672)
    Advance funding fiscal year 1999/2000.....................        1,000,000         1,182,672         1,182,672          +182,672   ................
Social Services Block Grant (Title XX)........................        2,299,000         1,909,000         1,909,000          -390,000   ................
                                                                                                                                                        
            CHILDREN AND FAMILIES SERVICES PROGRAMS                                                                                                     
                                                                                                                                                        
Programs for Children, Youth, and Families:                                                                                                             
    Head Start................................................        4,347,433         4,660,000         3,295,000        -1,052,433        -1,365,000 
    Advance funding (fiscal year 1999/2000)...................  ................  ................        1,365,000        +1,365,000        +1,365,000 
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Head start....................................        4,347,433         4,660,000         4,660,000          +312,567   ................
    Runaway and Homeless Youth................................           43,574            43,653            44,653            +1,079            +1,000 
    Runaway Youth--Transitional Living........................           14,922            14,949            14,949               +27   ................
                                                               -----------------------------------------------------------------------------------------
      Subtotal, runaway.......................................           58,496            58,602            59,602            +1,106            +1,000 
    Child Abuse State Grants..................................           20,988            21,026            21,026               +38   ................
    Child Abuse Discretionary Activities......................           14,128            14,154            14,154               +26   ................
    Abandoned Infants Assistance..............................           12,229            12,251            12,251               +22   ................
    Child Welfare Services....................................          291,458           291,989           291,989              +531   ................
    Child Welfare Training....................................            5,989             6,000             8,000            +2,011            +2,000 
    Adoption Opportunities....................................           22,958            27,363            25,000            +2,042            -2,363 
Adoption Incentive............................................  ................           20,000            20,000           +20,000   ................
Family Violence...............................................            9,982   ................  ................           -9,982   ................
Social Services and Income Maintenance Research...............           25,953            10,000            21,000            -4,953           +11,000 
Community Based Resource Centers..............................           32,775            32,835            32,835               +60   ................
Developmental disabilities program:                                                                                                                     
    State Councils............................................           64,803            64,575            64,803   ................             +228 
    Protection and Advocacy...................................           26,718            26,624            26,718   ................              +94 
    Developmental Disabilities Special Projects...............            5,042             5,232             5,250              +208               +18 
    Developmental Disabilities University Affiliated..........           17,461            17,399            17,461   ................              +62 
    State support system......................................  ................            4,982             6,000            +6,000            +1,018 
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Developmental disabilities....................          114,024           118,812           120,232            +6,208            +1,420 
Native American Programs......................................           34,869            34,933            34,933               +64   ................
Community services:                                                                                                                                     
    Grants to States for Community Services...................          489,685           489,100           490,600              +915            +1,500 
    Community initiative program:                                                                                                                       
        Economic Development..................................           30,009   ................           30,065               +56           +30,065 
        Rural Community Facilities............................            3,493   ................            3,500                +7            +3,500 
                                                               -----------------------------------------------------------------------------------------
          Subtotal, discretionary funds.......................           33,502   ................           33,565               +63           +33,565 
    National Youth Sports.....................................           14,000   ................           14,000   ................          +14,000 
    Community Food and Nutrition..............................            3,993   ................            6,000            +2,007            +6,000 
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Community services............................          541,180           489,100           544,165            +2,985           +55,065 
Program Direction.............................................          143,597           145,115           143,597   ................           -1,518 
                                                               =========================================================================================
      Total, Children and Families Services Programs..........        5,676,059         5,942,180         6,008,784          +332,725           +66,604 
                                                               =========================================================================================
VIOLENT CRIME REDUCTION PROGRAMS:                                                                                                                       
    Crime Trust Funds:                                                                                                                                  
        Runaway Youth Prevention..............................           14,973            11,000            11,000            -3,973   ................
        Domestic Violence Hotline.............................            1,198             1,200             1,200                +2   ................
        Battered Women's Shelters.............................           76,660            88,800            88,800           +12,140   ................
                                                               -----------------------------------------------------------------------------------------
          Total: Crime Trust Fund.............................           92,831           101,000           101,000            +8,169   ................
                                                               =========================================================================================
    Runaway Youth Prevention--General Revenues................  ................            4,000             4,000            +4,000   ................
                                                               -----------------------------------------------------------------------------------------
      Total, Violent crime reduction programs.................           92,831           105,000           105,000           +12,169   ................
                                                               =========================================================================================
Rescission of permanent appropriations........................          -21,000   ................          -21,000   ................          -21,000 
FAMILY SUPPORT AND PRESERVATION...............................          255,000           275,000           275,000           +20,000   ................
                                                               =========================================================================================
  PAYMENTS TO STATES FOR FOSTER CARE AND ADOPTION ASSISTANCE                                                                                            
                                                                                                                                                        
Foster Care...................................................        3,540,300         3,982,700         3,982,700          +442,400   ................
Adoption Assistance...........................................          700,700           868,800           868,800          +168,100   ................
Independent living............................................           70,000            70,000            70,000   ................  ................
Unspecified request \19\......................................  ................           20,000   ................  ................          -20,000 
Adoption Assistance proposal..................................  ................          200,000           200,000          +200,000   ................
                                                               -----------------------------------------------------------------------------------------
      Total, Program level: Payments to States................        4,311,000         5,141,500         5,121,500          +810,500           -20,000 
      Less Advances from Prior Year...........................       -1,111,000        -1,157,500        -1,157,500           -46,500   ................
                                                               =========================================================================================
      Total, request, fiscal year 1998/99.....................        3,200,000         3,984,000         3,964,000          +764,000           -20,000 
      New Advance, 1st quarter, fiscal year 1999/2000.........        1,157,500         1,355,000         1,355,000          +197,500   ................
                                                               =========================================================================================
      Total, Administration for Children and Families.........       15,900,062        19,170,524        19,032,456        +3,132,394          -138,068 
          Current year, fiscal year 1998/99...................      (11,982,562)      (14,795,852)      (13,279,784)      (+1,297,222)      (-1,516,068)
          Fiscal year 1999/2000...............................       (3,917,500)       (4,374,672)       (5,752,672)      (+1,835,172)      (+1,378,000)
                                                               =========================================================================================
                    ADMINISTRATION ON AGING                                                                                                             
                                                                                                                                                        
Grants to States:                                                                                                                                       
    Supportive Services and Centers...........................          309,500           300,319           300,319            -9,181   ................
    Preventive Health.........................................           16,123            16,123            16,123   ................  ................
        Title VII/ombudsman...................................  ................            9,181            12,181           +12,181            +3,000 
    Nutrition:                                                                                                                                          
        Congregate Meals......................................          374,412           374,412           374,412   ................  ................
        Home Delivered Meals..................................          112,000           112,000           112,000   ................  ................
Frail Elderly In-Home Services................................            9,763             9,763             9,763   ................  ................
Grants to Indians.............................................           18,457            18,457            18,457   ................  ................
Aging Research, Training and Special Projects.................           10,000            10,000            18,000            +8,000            +8,000 
Program Administration........................................           14,795            14,795            14,795   ................  ................
                                                               -----------------------------------------------------------------------------------------
      Total, Administration on Aging..........................          865,050           865,050           876,050           +11,000           +11,000 
                                                               =========================================================================================
                    OFFICE OF THE SECRETARY                                                                                                             
                                                                                                                                                        
GENERAL DEPARTMENTAL MANAGEMENT:                                                                                                                        
    Federal Funds.............................................          102,123           100,761           101,000            -1,123              +239 
        Trust Funds...........................................           (5,851)           (5,851)           (5,851)  ................  ................
    1 percent Evaluation funds (ASPE) (NA)....................          (20,552)          (20,552)          (20,552)  ................  ................
                                                               -----------------------------------------------------------------------------------------
      Subtotal................................................         (128,526)         (127,164)         (127,403)          (-1,123)            (+239)
    Adolescent Family Life (Title XX).........................           16,671             4,709            16,709               +38           +12,000 
    Physical Fitness and Sports...............................              996             1,005             1,005                +9   ................
    Minority health...........................................           29,034            23,100            24,500            -4,534            +1,400 
    Office of Women's Health..................................           12,467            12,517            15,495            +3,028            +2,978 
    Anti-Terrorism............................................            9,977            70,000             9,600              -377           -60,400 
                                                               -----------------------------------------------------------------------------------------
      Total, General Departmental Management..................          177,119           217,943           174,160            -2,959           -43,783 
          Federal funds.......................................          171,268           212,092           168,309            -2,959           -43,783 
          Trust funds.........................................           (5,851)           (5,851)           (5,851)  ................  ................
                                                               =========================================================================================
OFFICE OF THE INSPECTOR GENERAL:                                                                                                                        
    Federal Funds.............................................           31,855            29,000            29,000            -2,855   ................
    H.R. 3103 funding (NA)....................................          (84,650)          (97,350)          (97,350)         (+12,700)  ................
                                                               -----------------------------------------------------------------------------------------
      Total, Inspector General (BA)...........................           31,855            29,000            29,000            -2,855   ................
      Total, Inspector General program level..................         (116,505)         (126,350)         (126,350)          (+9,845)  ................
                                                               =========================================================================================
OFFICE FOR CIVIL RIGHTS:                                                                                                                                
    Federal Funds.............................................           16,345            17,345            17,345            +1,000   ................
    Trust Funds...............................................           (3,314)           (3,314)           (3,314)  ................  ................
                                                               -----------------------------------------------------------------------------------------
      Total, Office for Civil Rights..........................           19,659            20,659            20,659            +1,000   ................
          Federal funds.......................................           16,345            17,345            17,345            +1,000   ................
          Trust funds.........................................           (3,314)           (3,314)           (3,314)  ................  ................
                                                               =========================================================================================
POLICY RESEARCH...............................................           13,974            14,000            14,000               +26   ................
Public Health and Social Service and Emergency fund...........  ................  ................         (300,000)        (+300,000)        (+300,000)
                                                               =========================================================================================
      Total, Office of the Secretary..........................          242,607           281,602           237,819            -4,788           -43,783 
          Federal funds.......................................          233,442           272,437           228,654            -4,788           -43,783 
          Trust funds.........................................           (9,165)           (9,165)           (9,165)  ................  ................
                                                               =========================================================================================
      Total, Department of Health and Human Services..........      195,683,435       212,249,666       212,549,709       +16,866,274          +300,043 
          Federal Funds.......................................      193,885,363       210,298,001       210,854,994       +16,969,631          +556,993 
              Current year, fiscal year 1998/99...............     (162,167,174)     (177,149,724)     (176,178,717)     (+14,011,543)        (-971,007)
              Fiscal year 1999/2000...........................      (31,718,189)      (33,148,277)      (34,676,277)      (+2,958,088)      (+1,528,000)
          Trust funds.........................................       (1,798,072)       (1,951,665)       (1,694,715)        (-103,357)        (-256,950)
                                                               =========================================================================================
            TITLE III--DEPARTMENT OF EDUCATION \20\                                                                                                     
                                                                                                                                                        
                     EDUCATION REFORM \1\                                                                                                               
                                                                                                                                                        
Goals 2000: Educate America Act:                                                                                                                        
    State Grants forward funded...............................          464,500           474,000           464,500   ................           -9,500 
    State Grants current funded...............................            1,500             2,000             1,500   ................             -500 
    Parental Assistance \2\...................................           25,000            25,000            30,000            +5,000            +5,000 
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Goals 2000....................................          491,000           501,000           496,000            +5,000            -5,000 
School-to-Work Opportunities..................................          200,000           125,000           125,000           -75,000   ................
Education Technology: \2\                                                                                                                               
    Technology for Education..................................          541,000           591,000           561,000           +20,000           -30,000 
    National Activities:                                                                                                                                
        Technology Leadership Activities......................  ................            2,000   ................  ................           -2,000 
        Preservice Teacher Training...........................  ................           75,000   ................  ................          -75,000 
        Community-Based Technology............................  ................           10,000   ................  ................          -10,000 
                                                               -----------------------------------------------------------------------------------------
          Subtotal............................................          541,000           678,000           561,000           +20,000          -117,000 
        Star Schools..........................................           34,000            34,000            46,500           +12,500           +12,500 
        Ready to Learn Television.............................            7,000             7,000            11,000            +4,000            +4,000 
        Telcom Demo Project for Mathematics...................            2,035             2,000             5,000            +2,965            +3,000 
                                                               -----------------------------------------------------------------------------------------
          Subtotal, Education technology......................          584,035           721,000           623,500           +39,465           -97,500 
                                                               =========================================================================================
          Total...............................................        1,275,035         1,347,000         1,244,500           -30,535          -102,500 
          Subtotal, Forward funded............................         (664,500)         (599,000)         (589,500)         (-75,000)          (-9,500)
                                                               =========================================================================================
              EDUCATION FOR THE DISADVANTAGED \1\                                                                                                       
                                                                                                                                                        
Grants to Local Education Agencies (LEAs):                                                                                                              
    Basic Grants:                                                                                                                                       
        Advance from prior year...............................       (1,298,386)       (1,448,386)       (1,448,386)        (+150,000)  ................
        Forward funded........................................        4,821,326         4,822,114         4,070,500          -750,826          -751,614 
        Current funded........................................            3,500             3,500             3,500   ................  ................
                                                               -----------------------------------------------------------------------------------------
          Subtotal, Basic grants..............................        6,123,212         6,274,000         5,522,386          -600,826          -751,614 
          Advance fiscal year 1999/2000.......................        1,448,386         1,448,386         2,500,000        +1,051,614        +1,051,614 
                                                               -----------------------------------------------------------------------------------------
          Total, Program level................................        6,273,212         6,274,000         6,574,000          +300,788          +300,000 
                                                               =========================================================================================
    Concentration Grants......................................        1,102,020         1,200,000         1,102,020   ................          -97,980 
    Targeted Grants...........................................  ................          293,000   ................  ................         -293,000 
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Grants to LEAs................................        7,375,232         7,767,000         7,676,020          +300,788           -90,980 
Capital Expenses for Private School Children..................           41,119            10,000            35,000            -6,119           +25,000 
Even Start....................................................          124,000           114,992           124,000   ................           +9,008 
State agency programs:                                                                                                                                  
    Migrant...................................................          305,473           354,689           320,473           +15,000           -34,216 
    Neglected and Delinquent/High Risk Youth..................           39,311            40,311            40,311            +1,000   ................
Evaluation \2\................................................            6,977             8,900             6,977   ................           -1,923 
    Comprehensive School Reform...............................          120,000           150,000           120,000   ................          -30,000 
Transition to School Demonstrations \2\.......................  ................           35,000   ................  ................          -35,000 
                                                               =========================================================================================
      Total, ESEA.............................................        8,012,112         8,480,892         8,322,781          +310,669          -158,111 
                                                               =========================================================================================
Migrant education:                                                                                                                                      
    High School Equivalency Program \1\.......................            7,634            10,000             8,000              +366            -2,000 
    College Assistance Migrant Program \1\....................            2,081             5,000             4,000            +1,919            -1,000 
                                                               -----------------------------------------------------------------------------------------
      Subtotal, migrant education.............................            9,715            15,000            12,000            +2,285            -3,000 
                                                               =========================================================================================
      Total, Compensatory education programs..................        8,021,827         8,495,892         8,334,781          +312,954          -161,111 
          Current Year fiscal year 1998/99....................          (20,192)          (62,400)          (22,477)          (+2,285)         (-39,923)
          Fiscal year 1999/2000...............................       (1,448,386)       (1,448,386)       (2,500,000)      (+1,051,614)      (+1,051,614)
      Subtotal, forward funded................................       (6,553,249)       (6,985,106)       (5,812,304)        (-740,945)      (-1,172,802)
                                                               =========================================================================================
                          IMPACT AID                                                                                                                    
                                                                                                                                                        
Basic Support Payments........................................          662,000           626,000           662,000   ................          +36,000 
Payments for Children with Disabilities.......................           50,000            40,000            50,000   ................          +10,000 
Payments for Heavily Impacted Districts (Sec. f)..............           62,000            20,000            62,000   ................          +42,000 
                                                               -----------------------------------------------------------------------------------------
      Subtotal................................................          774,000           686,000           774,000   ................          +88,000 
Facilities Maintenance (Sec. 8008)............................            3,000            10,000             5,000            +2,000            -5,000 
Construction (Sec. 8007)......................................            7,000   ................            7,000   ................           +7,000 
Payments for Federal Property (Sec. 8002).....................           24,000   ................           24,000   ................          +24,000 
                                                               =========================================================================================
      Total, Impact aid.......................................          808,000           696,000           810,000            +2,000          +114,000 
                                                               =========================================================================================
                  SCHOOL IMPROVEMENT PROGRAMS                                                                                                           
                                                                                                                                                        
Professional development \21\.................................          335,000           335,000           335,000   ................  ................
Program innovation \21\.......................................          350,000   ................          350,000   ................         +350,000 
Safe and drug-free schools:                                                                                                                             
    State Grants \21\.........................................          531,000           526,000           381,000          -150,000          -145,000 
    National Programs.........................................           25,000            30,000           175,000          +150,000          +145,000 
    Coordinator Initiative....................................  ................           50,000   ................  ................          -50,000 
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Safe and drug-free schools....................          556,000           606,000           556,000   ................          -50,000 
Inexpensive Book Distribution (RIF)...........................           12,000            13,000            14,000            +2,000            +1,000 
Arts in Education.............................................           10,500            10,500            10,500   ................  ................
Other school improvement programs:                                                                                                                      
    Magnet Schools Assistance.................................          101,000           101,000           104,000            +3,000            +3,000 
    Education for Homeless Children and Youth \21\............           28,800            30,000            28,800   ................           -1,200 
    Women's Education Equity..................................            3,000             3,000             3,000   ................  ................
    Training and Advisory Services (Civil Rights).............            7,334             8,300             7,334   ................             -966 
    Ellender Fellowships/Close Up \21\........................            1,500   ................            1,500   ................           +1,500 
    Education for Native Hawaiians............................           18,000            18,000            22,000            +4,000            +4,000 
    Alaska Native Education Equity............................            8,000             8,000            12,000            +4,000            +4,000 
    Charter Schools...........................................           80,000           100,000            80,000   ................          -20,000 
                                                               -----------------------------------------------------------------------------------------
      Subtotal, other school improvement programs.............          247,634           268,300           258,634           +11,000            -9,666 
Comprehensive Regional Assistance Centers.....................           27,054            40,000            27,054   ................          -12,946 
Advanced Placement Fees.......................................            3,000             3,000             4,000            +1,000            +1,000 
Education Opportunity Zones (proposed legislation)............  ................          200,000   ................  ................         -200,000 
Construction..................................................  ................  ................          100,000          +100,000          +100,000 
                                                               =========================================================================================
      Total, School improvement programs......................        1,541,188         1,475,800         1,655,188          +114,000          +179,388 
      Subtotal, forward funded................................       (1,246,300)         (891,000)       (1,096,300)        (-150,000)        (+205,300)
                                                               =========================================================================================
                   LITERACY INITIATIVE \22\                                                                                                             
                                                                                                                                                        
Advance from prior year.......................................  ................         (210,000)  ................  ................        (-210,000)
Adjustment....................................................  ................           50,000   ................  ................          -50,000 
                                                               -----------------------------------------------------------------------------------------
      Total, current year.....................................  ................          260,000   ................  ................         -260,000 
                                                               =========================================================================================
                       INDIAN EDUCATION                                                                                                                 
                                                                                                                                                        
Grants to Local Educational Agencies..........................           59,750            62,000            62,000            +2,250   ................
Special Programs for Indian Children..........................  ................            3,265             3,265            +3,265   ................
National Activities...........................................  ................              735               735              +735   ................
                                                               -----------------------------------------------------------------------------------------
      Total, Indian Education.................................           59,750            66,000            66,000            +6,250   ................
                                                               =========================================================================================
               BILINGUAL AND IMMIGRANT EDUCATION                                                                                                        
                                                                                                                                                        
Bilingual education:                                                                                                                                    
    Instructional Services....................................          160,000           168,000           160,000   ................           -8,000 
    Support Services..........................................           14,000            14,000            14,000   ................  ................
    Professional Development..................................           25,000            50,000            25,000   ................          -25,000 
Immigrant Education...........................................          150,000           150,000           150,000   ................  ................
Foreign Language Assistance...................................            5,000             5,000             5,000   ................  ................
                                                               -----------------------------------------------------------------------------------------
      Total, Bilingual and Immigrant Education................          354,000           387,000           354,000   ................          -33,000 
                                                               =========================================================================================
                       SPECIAL EDUCATION                                                                                                                
                                                                                                                                                        
State grants: \1\                                                                                                                                       
    Advance from prior year...................................  ................  ................         (210,000)        (+210,000)        (+210,000)
    Grants to States Part B...................................        3,801,000         3,810,700         4,090,000          +289,000          +279,300 
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Part B........................................       (3,801,000)       (3,810,700)       (4,300,000)        (+499,000)        (+489,300)
    Preschool Grants..........................................          373,985           373,985           373,985   ................  ................
    Grants for Infants and Families...........................          350,000           370,000           370,000           +20,000   ................
    Evaluation forward funded.................................            5,000   ................  ................           -5,000   ................
    Evaluation current funded.................................            1,700   ................  ................           -1,700   ................
                                                               -----------------------------------------------------------------------------------------
      Subtotal, State grants..................................        4,531,685         4,554,685         4,833,985          +302,300          +279,300 
IDEA National Programs (Public Law 105-17):                                                                                                             
    State Program Improvement Grants \1\......................           35,200            45,200            35,200   ................          -10,000 
    Research and Innovation to Improve Services...............           64,508            64,508            64,508   ................  ................
    Technical Assistance and Dissemination....................           44,556            44,556            44,556   ................  ................
    Personnel Preparation.....................................           82,139            82,139            82,139   ................  ................
    Parent Information Centers................................           18,535            20,535            18,535   ................           -2,000 
    Technology and Media Services.............................           32,523            34,023            32,523   ................           -1,500 
    Public Telecom Info/Training Dissemination................            1,500   ................            1,500   ................           +1,500 
                                                               -----------------------------------------------------------------------------------------
      Subtotal, IDEA special programs reauthorization.........          278,961           290,961           278,961   ................          -12,000 
                                                               =========================================================================================
      Total, Special education................................        4,810,646         4,845,646         5,112,946          +302,300          +267,300 
      Subtotal, Forward funded................................       (4,565,185)       (4,599,885)       (4,869,185)        (+304,000)        (+269,300)
          Program level.......................................        4,810,646         4,845,646         5,322,946          +512,300          +477,300 
                                                               =========================================================================================
        REHABILITATION SERVICES AND DISABILITY RESEARCH                                                                                                 
                                                                                                                                                        
Vocational Rehabilitation State Grants........................        2,246,888         2,304,411         2,298,467           +51,579            -5,944 
Tech assistance to States.....................................  ................  ................  ................  ................  ................
Client Assistance State grants................................           10,714            10,928            10,928              +214   ................
Training......................................................           39,629            33,685            39,629   ................           +5,944 
Special demonstration programs................................           15,942            18,942            18,942            +3,000   ................
Migratory workers.............................................            2,350             2,350             2,350   ................  ................
Recreational programs.........................................            2,596             2,596             2,596   ................  ................
Protection and advocacy of individual rights (PAIR)...........            9,894             9,894             9,894   ................  ................
Projects with industry........................................           22,071            22,071            22,071   ................  ................
Supported employment State grants.............................           38,152            38,152            38,152   ................  ................
Independent living:                                                                                                                                     
    State grants..............................................           21,859            22,296            22,296              +437   ................
    Centers...................................................           45,205            46,109            46,109              +904   ................
    Services for older blind individuals......................           10,950            11,169            11,169              +219   ................
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Independent living............................           78,014            79,574            79,574            +1,560   ................
Program Improvement...........................................            2,900             1,900             1,900            -1,000   ................
Evaluation....................................................            1,587             1,587             1,587   ................  ................
Helen Keller National Center for Deaf-Blind Youths and Adults.            7,549             8,176             8,176              +627   ................
National Institute for Disability and Rehabilitation Research                                                                                           
 (NIDRR)......................................................           76,800            81,000            81,000            +4,200   ................
                                                               =========================================================================================
      Subtotal, mandatory programs............................        2,555,086         2,615,266         2,615,266           +60,180   ................
Assistive Technology..........................................           36,109            30,000            30,000            -6,109   ................
                                                               =========================================================================================
      Total, Rehabilitation services..........................        2,591,195         2,645,266         2,645,266           +54,071   ................
                                                               =========================================================================================
      SPECIAL INSTITUTIONS FOR PERSONS WITH DISABILITIES                                                                                                
                                                                                                                                                        
AMERICAN PRINTING HOUSE FOR THE BLIND.........................            8,186             8,256             8,661              +475              +405 
NATIONAL TECHNICAL INSTITUTE FOR THE DEAF.....................           44,141            44,791            45,500            +1,359              +709 
GALLAUDET UNIVERSITY..........................................           81,000            83,480            83,480            +2,480   ................
                                                               -----------------------------------------------------------------------------------------
      Total, Special Inst for Persons with Disabilities.......          133,327           136,527           137,641            +4,314            +1,114 
                                                               =========================================================================================
              VOCATIONAL AND ADULT EDUCATION \1\                                                                                                        
                                                                                                                                                        
Vocational education:                                                                                                                                   
    Basic State Grants........................................        1,027,550         1,030,650         1,027,550   ................           -3,100 
    Tech-Prep Education.......................................          103,000           106,000           103,000   ................           -3,000 
    Tribally Controlled Postsecondary Vocational Institutions                                                                                           
     \2\......................................................            3,100   ................            4,100            +1,000            +4,100 
    National Programs: Research...............................           13,497            13,497            12,000            -1,497            -1,497 
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Vocational education..........................        1,147,147         1,150,147         1,146,650              -497            -3,497 
Adult education:                                                                                                                                        
    State Programs............................................          345,339           361,000           345,339   ................          -15,661 
    National programs:                                                                                                                                  
        National Leadership activities........................            4,998            27,000             4,998   ................          -22,002 
        National Institute for Literacy.......................            5,491             6,000             5,491   ................             -509 
                                                               -----------------------------------------------------------------------------------------
          Subtotal, National programs.........................           10,489            33,000            10,489   ................          -22,511 
    Literacy Programs for Prisoners...........................            4,723   ................  ................           -4,723   ................
                                                               -----------------------------------------------------------------------------------------
      Subtotal, adult education...............................          360,551           394,000           355,828            -4,723           -38,172 
                                                               =========================================================================================
      Total, Vocational and adult education...................        1,507,698         1,544,147         1,502,478            -5,220           -41,669 
      Subtotal, forward funded................................       (1,504,598)       (1,544,147)       (1,498,378)          (-6,220)         (-45,769)
                                                               =========================================================================================
                 STUDENT FINANCIAL ASSISTANCE                                                                                                           
                                                                                                                                                        
Pell Grant--maximum grant (NA)................................           (3,000)           (3,100)           (3,100)            (+100)  ................
Pell Grants--Regular Program..................................        7,344,934         7,594,000         8,527,551        +1,182,617          +933,551 
Federal Supplemental Educational Opportunity Grants...........          614,000           619,000           619,000            +5,000   ................
Federal Work Study............................................          830,000           900,000           900,000           +70,000   ................
Federal Perkins loans:                                                                                                                                  
    Capital Contributions.....................................          135,000            60,000            60,000           -75,000   ................
    Loan Cancellations........................................           30,000            30,000            30,000   ................  ................
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Federal Perkins loans.........................          165,000            90,000            90,000           -75,000   ................
State Student Incentive Grants................................           25,000   ................           36,000           +11,000           +36,000 
                                                               =========================================================================================
      Total, Student financial assistance.....................        8,978,934         9,203,000        10,172,551        +1,193,617          +969,551 
                                                               =========================================================================================
             FEDERAL FAMILY EDUCATION LOAN PROGRAM                                                                                                      
                                                                                                                                                        
Federal Administration........................................           46,482            48,482            46,482   ................           -2,000 
                                                                                                                                                        
                       HIGHER EDUCATION                                                                                                                 
                                                                                                                                                        
Aid for institutional development:                                                                                                                      
    Strengthening Institutions................................           55,450            60,000            55,450   ................           -4,550 
    Hispanic Serving Institutions.............................           12,000            28,000            17,000            +5,000           -11,000 
    Strengthening Historically Black Colleges (HBCUs).........          118,495           134,500           122,495            +4,000           -12,005 
    Strengthening historically black graduate insts...........           25,000            25,000            30,000            +5,000            +5,000 
    Strengthening Tribal Colleges \23\........................  ................            5,000   ................  ................           -5,000 
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Institutional development.....................          210,945           252,500           224,945           +14,000           -27,555 
Program development:                                                                                                                                    
    Fund for the Improvement of Postsec. Ed. (FIPSE)..........           25,200            22,500            22,500            -2,700   ................
    Minority Teacher Recruitment \24\.........................            2,212            67,000             2,212   ................          -64,788 
    Minority Science Improvement..............................            5,255             7,500             5,255   ................           -2,245 
    International educ and foreign language studies:                                                                                                    
        Domestic Programs.....................................           53,581            53,581            53,581   ................  ................
        Overseas Programs.....................................            5,770             6,536             6,536              +766   ................
        Institute for International Public Policy.............            1,000             1,000             1,000   ................  ................
                                                               -----------------------------------------------------------------------------------------
          Subtotal, International education...................           60,351            61,117            61,117              +766   ................
    Urban Community Service...................................            4,900   ................            4,637              -263            +4,637 
                                                               =========================================================================================
      Subtotal, Program development...........................           97,918           158,117            95,721            -2,197           -62,396 
Interest Subsidy Grants for Prior Year Construction...........           13,700            13,000            13,000              -700   ................
Special grants:                                                                                                                                         
    Mary McLeod Bethune Memorial Fine Arts Center.............            6,620   ................  ................           -6,620   ................
    Federal TRIO Programs.....................................          529,667           583,000           554,667           +25,000           -28,333 
    National Early Intervention Scholarships and Partn........            3,600   ................            3,600   ................           +3,600 
    Connections...............................................  ................          140,000            75,000           +75,000           -65,000 
Scholarships: Byrd Honors Scholarships........................           39,288            39,288            39,288   ................  ................
Graduate fellowships: Graduate Assistance in Areas of National                                                                                          
 Need.........................................................           30,000            37,500            31,000            +1,000            -6,500 
Youth Offender Grants.........................................           12,000   ................           16,723            +4,723           +16,723 
Early Awareness Information...................................  ................           15,000   ................  ................          -15,000 
Learning anytime anywhere partnerships........................  ................           30,000            10,000           +10,000           -20,000 
Access and Retention Innovation...............................  ................           20,000   ................  ................          -20,000 
Improving Teacher Quality:                                                                                                                              
    Teacher quality enhancement grants........................  ................  ................           37,500           +37,500           +37,500 
    Teacher training partnership grants.......................  ................  ................           37,500           +37,500           +37,500 
                                                               =========================================================================================
      Total, Higher education.................................          943,738         1,288,405         1,138,944          +195,206          -149,461 
                                                               =========================================================================================
                       HOWARD UNIVERSITY                                                                                                                
                                                                                                                                                        
Academic Program..............................................          180,511           176,981           176,981            -3,530   ................
Endowment Program.............................................  ................            3,530             3,530            +3,530   ................
Howard University Hospital....................................           29,489            29,489            29,489   ................  ................
                                                               -----------------------------------------------------------------------------------------
      Total, Howard University................................          210,000           210,000           210,000   ................  ................
                                                               =========================================================================================
COLLEGE HOUSING AND ACADEMIC FACILITIES LOANS PROGRAM: Federal                                                                                          
 Administration...............................................              698               698               698   ................  ................
                                                                                                                                                        
  HISTORICALLY BLACK COLLEGE AND UNIVERSITY CAPITAL FINANCING                                                                                           
                            PROGRAM                                                                                                                     
                                                                                                                                                        
Federal Administration........................................              104                96                96                -8   ................
                                                                                                                                                        
        EDUCATION RESEARCH, STATISTICS, AND IMPROVEMENT                                                                                                 
                                                                                                                                                        
Research and statistics:                                                                                                                                
    Research..................................................           72,567            72,567            72,567   ................  ................
    Regional Education Laboratories...........................           56,000            56,000            56,000   ................  ................
    Statistics................................................           59,000            68,000            59,000   ................           -9,000 
    Interagency Research Initiative...........................  ................           50,000   ................  ................          -50,000 
    Assessment:                                                                                                                                         
        National Assessment...................................           32,000            36,000            32,000   ................           -4,000 
        National Assessment Governing Board...................            3,471             4,000             3,471   ................             -529 
                                                               -----------------------------------------------------------------------------------------
          Subtotal, Assessment................................           35,471            40,000            35,471   ................           -4,529 
                                                               =========================================================================================
          Subtotal, Research and statistics...................          223,038           286,567           223,038   ................          -63,529 
Fund for the Improvement of Education.........................          108,100           105,000           115,000            +6,900           +10,000 
International Education Exchange..............................            5,000             5,000             7,000            +2,000             2,000 
21st Century Community Learning Centers.......................           40,000           200,000            75,000           +35,000          -125,000 
Civics Education..............................................            5,500             6,300             7,500            +2,000            +1,200 
Eisenhower Professional Dvp. National Activities..............           23,300            50,000            23,300   ................          -26,700 
Eisenhower Regional Math and Science Ed. Consortia............           15,000            25,000            15,000   ................          -10,000 
Javits Gifted and Talented Education..........................            6,500             6,500             6,500   ................  ................
National Writing Project......................................            5,000             5,000             7,000            +2,000            +2,000 
                                                               =========================================================================================
      Total, ERSI.............................................          431,438           689,367           479,338           +47,900          -210,029 
                                                               =========================================================================================
                    DEPARTMENTAL MANAGEMENT                                                                                                             
                                                                                                                                                        
PROGRAM ADMINISTRATION........................................          343,914           362,000           362,000           +18,086   ................
OFFICE FOR CIVIL RIGHTS.......................................           61,500            68,000            63,500            +2,000            -4,500 
OFFICE OF THE INSPECTOR GENERAL...............................           30,242            31,242            31,242            +1,000   ................
                                                               -----------------------------------------------------------------------------------------
      Total, Departmental management..........................          435,656           461,242           456,742           +21,086            -4,500 
                                                               =========================================================================================
                         STUDENT LOANS                                                                                                                  
                                                                                                                                                        
New Annual Loan Volume (Excluding consolidation):                                                                                                       
    Federal Family Education Loans (FFEL).....................      (20,461,000)      (21,932,000)      (21,932,000)      (+1,471,000)  ................
    Federal Direct Student Loans (FDSL).......................      (11,204,000)      (12,002,000)      (12,002,000)        (+798,000)  ................
Total Outstanding Loan Volume:                                                                                                                          
    Federal Family Education Loans (FFEL).....................     (119,189,182)     (126,602,699)     (126,602,699)      (+7,413,517)  ................
    Federal Direct Student Loans (FDSL).......................      (33,565,504)      (45,363,630)      (45,363,630)     (+11,798,126)  ................
                                                               =========================================================================================
      Total, Department of Education..........................       32,149,716        33,590,568        34,367,651        +2,217,935          +777,083 
          Current year fiscal year 1998/99....................      (30,701,330)      (32,142,182)      (31,867,651)      (+1,166,321)        (-274,531)
          Fiscal year 1999/fiscal year 2000...................       (1,448,386)       (1,448,386)       (2,500,000)      (+1,051,614)      (+1,051,614)
                                                               =========================================================================================
                  TITLE IV--RELATED AGENCIES                                                                                                            
                                                                                                                                                        
                 ARMED FORCES RETIREMENT HOME                                                                                                           
                                                                                                                                                        
Operations and Maintenance: TF................................           55,452            55,028            55,028              -424   ................
Capital Program: TF...........................................           13,217            15,717            15,717            +2,500   ................
                                                               -----------------------------------------------------------------------------------------
      Total, AFRH.............................................           68,669            70,745            70,745            +2,076   ................
                                                               =========================================================================================
      CORPORATION FOR NATIONAL AND COMMUNITY SERVICE \25\                                                                                               
                                                                                                                                                        
Domestic Volunteer Service Programs:                                                                                                                    
    Volunteers in Service to America (VISTA)..................           65,235            73,000            73,000            +7,765   ................
    National Senior Volunteer Corps:                                                                                                                    
        Foster Grandparents Program...........................           87,593            94,162            94,162            +6,569   ................
        Senior Companion Program..............................           35,368            35,368            35,368   ................  ................
        Retired Senior Volunteer Program......................           40,279            43,300            43,300            +3,021   ................
        Senior Demonstration Program..........................  ................            1,080             1,080            +1,080   ................
                                                               -----------------------------------------------------------------------------------------
          Subtotal, Senior Volunteers.........................          163,240           173,910           173,910           +10,670   ................
    Program Administration....................................           28,129            31,512            28,129   ................           -3,383 
                                                               =========================================================================================
      Total, Domestic Volunteer Service Programs..............          256,604           278,422           275,039           +18,435            -3,383 
                                                               =========================================================================================
Corporation for Public Broadcasting:                                                                                                                    
    Fiscal year 2001 (current request) with fiscal year 2000                                                                                            
     comparable...............................................          300,000           340,000           340,000           +40,000   ................
    Fiscal year 2000 advance with fiscal year 1999 comparable                                                                                           
     (NA).....................................................         (250,000)         (300,000)         (300,000)         (+50,000)  ................
    Fiscal year 1999 advance with fiscal year 1998 comparable                                                                                           
     (NA).....................................................         (250,000)         (250,000)         (250,000)  ................  ................
Digitalization program........................................  ................           50,000            15,000           +15,000           -35,000 
                                                               -----------------------------------------------------------------------------------------
      Subtotal, fiscal year 1999 appropriation................          250,000           300,000           265,000           +15,000           -35,000 
Federal Mediation and Conciliation Service....................           33,481            34,620            34,620            +1,139   ................
Federal Mine Safety and Health Review Commission..............            6,060             6,060             6,060   ................  ................
Institute of Museum and Library Services \26\.................          146,340           146,340           156,340           +10,000           +10,000 
Medicare Payment Advisory Commission (TF).....................           (7,015)           (7,015)           (7,015)  ................  ................
National Commission on Libraries and Info Science.............            1,000             1,000             1,000   ................  ................
National Council on Disability................................            1,793             2,344             2,344              +551   ................
National Education Goals Panel................................            2,000             2,100             2,100              +100   ................
National Labor Relations Board................................          174,661           184,451           184,451            +9,790   ................
National Mediation Board......................................            8,600             8,400             8,400              -200   ................
Occupational Safety and Health Review Commission..............            7,900             8,050             8,100              +200               +50 
                                                                                                                                                        
                   RAILROAD RETIREMENT BOARD                                                                                                            
                                                                                                                                                        
Dual Benefits Payments Account................................          205,500           191,000           189,000           -16,500            -2,000 
Less Income Tax Receipts on Dual Benefits.....................          -12,000           -11,000           -11,000            +1,000   ................
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Dual Benefits.................................          193,500           180,000           178,000           -15,500            -2,000 
Federal Payment to the RR Retirement Account..................               50               150               150              +100   ................
Limitation on administration:                                                                                                                           
    Consolidated Account......................................          (87,228)          (86,000)          (90,000)          (+2,772)          (+4,000)
    Inspector General.........................................           (5,794)           (5,400)           (5,600)            (-194)            (+200)
                                                                                                                                                        
                SOCIAL SECURITY ADMINISTRATION                                                                                                          
                                                                                                                                                        
Payments to Social Security Trust Funds.......................           20,308            19,689            19,689              -619   ................
                                                                                                                                                        
           SPECIAL BENEFITS FOR DISABLED COAL MINERS                                                                                                    
                                                                                                                                                        
Benefit payments..............................................          581,470           538,183           538,183           -43,287   ................
Administration................................................            4,620             4,620             4,620   ................  ................
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Black Lung, fiscal year 1998/99 program level.          586,090           542,803           542,803           -43,287   ................
      Less funds advanced in prior year.......................         -160,000          -160,000          -160,000   ................  ................
                                                               -----------------------------------------------------------------------------------------
      Total, Black Lung, current request, fiscal year 1998/99.          426,090           382,803           382,803           -43,287   ................
          New advances, 1st quarter fiscal year 1999/2000.....          160,000           141,000           141,000           -19,000   ................
                                                               =========================================================================================
                 SUPPLEMENTAL SECURITY INCOME                                                                                                           
                                                                                                                                                        
Federal benefit payments......................................       23,710,300        28,020,000        28,020,000        +4,309,700   ................
Beneficiary services..........................................           46,000            61,000            61,000           +15,000   ................
Research and demonstration....................................           16,700            30,000            37,000           +20,300            +7,000 
Administration................................................        2,027,000         2,064,000         2,100,000           +73,000           +36,000 
Automation investment initiative..............................           50,000   ................  ................          -50,000   ................
                                                               -----------------------------------------------------------------------------------------
      Subtotal, SSI fiscal year 1998/99 program level.........       25,850,000        30,175,000        30,218,000        +4,368,000           +43,000 
      Less funds advanced in prior year.......................       -9,690,000        -8,680,000        -8,680,000        +1,010,000   ................
                                                               =========================================================================================
      Subtotal, regular SSI current year, fiscal year 1998/99.       16,160,000        21,495,000        21,538,000        +5,378,000           +43,000 
          Additional CDR funding \7\..........................           75,000           177,000           227,000          +152,000           +50,000 
          User Fee Activities.................................           35,000            75,000            75,000           +40,000   ................
          Non-disability redeterminations \7\.................  ................           50,000   ................  ................          -50,000 
          SSI reforms (welfare) \7\...........................          100,000   ................  ................         -100,000   ................
                                                               -----------------------------------------------------------------------------------------
      Total, SSI, current request, fiscal year 1998/99........       16,370,000        21,797,000        21,840,000        +5,470,000           +43,000 
          New advance, 1st quarter, fiscal year 1999/2000.....        8,680,000         9,550,000         9,550,000          +870,000   ................
                                                               =========================================================================================
             LIMITATION ON ADMINISTRATIVE EXPENSES                                                                                                      
                                                                                                                                                        
OASDI Trust Funds.............................................       (2,900,440)       (2,931,400)       (2,928,400)         (+27,960)          (-3,000)
HI/SMI Trust Funds............................................         (965,000)         (952,000)         (952,000)         (-13,000)  ................
Social Security Advisory Board................................           (1,600)           (1,600)           (1,600)  ................  ................
SSI...........................................................       (2,027,000)       (2,064,000)       (2,100,000)         (+73,000)         (+36,000)
                                                               -----------------------------------------------------------------------------------------
      Subtotal, regular LAE...................................       (5,894,040)       (5,949,000)       (5,982,000)         (+87,960)         (+33,000)
User Fee Activities...........................................          (35,000)          (75,000)          (75,000)         (+40,000)  ................
SSI non-disability redeterminations \7\.......................  ................          (50,000)  ................  ................         (-50,000)
Claimant representative payments..............................  ................          (19,000)  ................  ................         (-19,000)
    Automation Initiative: \7\                                                                                                                          
        OASDI Automation......................................         (140,000)  ................  ................        (-140,000)  ................
        SSI Automation........................................          (50,000)  ................  ................         (-50,000)  ................
                                                               -----------------------------------------------------------------------------------------
          Subtotal, automation initiative.....................         (190,000)  ................  ................        (-190,000)  ................
                                                               =========================================================================================
      TOTAL, REGULAR LAE......................................       (6,119,040)       (6,093,000)       (6,057,000)         (-62,040)         (-36,000)
          Additional CDR funding: \7\                                                                                                                   
              OASDI...........................................         (115,000)         (178,000)         (178,000)         (+63,000)  ................
              SSI.............................................          (75,000)         (177,000)         (227,000)        (+152,000)         (+50,000)
                                                               -----------------------------------------------------------------------------------------
                Subtotal, CDR funding.........................         (190,000)         (355,000)         (405,000)        (+215,000)         (+50,000)
          SSI reforms (welfare) \7\...........................         (100,000)  ................  ................        (-100,000)  ................
                                                               =========================================================================================
      Total, LAE..............................................       (6,409,040)       (6,448,000)       (6,462,000)         (+52,960)         (+14,000)
                                                               =========================================================================================
                  OFFICE OF INSPECTOR GENERAL                                                                                                           
                                                                                                                                                        
Federal Funds.................................................           10,164            12,000            11,082              +918              -918 
Trust Funds...................................................          (38,260)          (40,000)          (39,130)            (+870)            (-870)
                                                               -----------------------------------------------------------------------------------------
      Total, Office of the Inspector General..................           48,424            52,000            50,212            +1,788            -1,788 
                                                               =========================================================================================
      Total, Social Security Administration...................       29,826,862        36,024,492        36,043,704        +6,216,842           +19,212 
          Federal funds.......................................       25,666,562        31,902,492        31,944,574        +6,278,012           +42,082 
              Current year fiscal year 1998/99................      (16,826,562)      (22,211,492)      (22,253,574)      (+5,427,012)         (+42,082)
              New advances, 1st quarter fiscal year 1999/2000.       (8,840,000)       (9,691,000)       (9,691,000)        (+851,000)  ................
          Trust funds.........................................       (4,160,300)       (4,122,000)       (4,099,130)         (-61,170)         (-22,870)
                                                               =========================================================================================
United States Institute of Peace..............................           11,160            11,495            11,495              +335   ................
                                                               =========================================================================================
      Total, Title IV, Related Agencies.......................       31,138,717        37,447,084        37,440,163        +6,301,446            -6,921 
          Federal Funds (all years)...........................       26,878,380        33,226,669        33,238,418        +6,360,038           +11,749 
              Current year, fiscal year 1998/99...............      (17,738,380)      (23,195,669)      (23,207,418)      (+5,469,038)         (+11,749)
              Fiscal year 1999/2000...........................       (8,840,000)       (9,691,000)       (9,691,000)        (+851,000)  ................
              Fiscal year 2000/01.............................         (300,000)         (340,000)         (340,000)         (+40,000)  ................
          Trust funds.........................................       (4,260,337)       (4,220,415)       (4,201,745)         (-58,592)         (-18,670)
                                                               =========================================================================================
                            SUMMARY                                                                                                                     
                                                                                                                                                        
Title I--Department of Labor:                                                                                                                           
    Federal Funds.............................................        9,343,958         9,491,601         9,164,409          -179,549          -327,192 
        Current year..........................................       (9,093,958)       (9,241,601)       (8,914,409)        (-179,549)        (-327,192)
        2000 advance..........................................         (250,000)         (250,000)         (250,000)  ................  ................
    Trust Funds...............................................       (3,605,086)       (3,506,092)       (3,374,535)        (-230,551)        (-131,557)
        Current year..........................................       (3,565,086)       (3,506,092)       (3,374,535)        (-190,551)        (-131,557)
        2000 advance..........................................          (40,000)  ................  ................         (-40,000)  ................
Title II--Department of Health and Human Services:                                                                                                      
    Federal Funds.............................................      193,885,363       210,298,001       210,854,994       +16,969,631          +556,993 
        Current year..........................................     (162,167,174)     (177,149,724)     (176,178,717)     (+14,011,543)        (-971,007)
        2000 advance..........................................      (31,718,189)      (33,148,277)      (34,676,277)      (+2,958,088)      (+1,528,000)
    Trust Funds...............................................       (1,798,072)       (1,951,665)       (1,694,715)        (-103,357)        (-256,950)
Title III--Department of Education:                                                                                                                     
    Federal Funds.............................................       32,149,716        33,590,568        34,367,651        +2,217,935          +777,083 
        Current year..........................................      (30,701,330)      (32,142,182)      (31,867,651)      (+1,166,321)        (-274,531)
        2000 advance..........................................       (1,448,386)       (1,448,386)       (2,500,000)      (+1,051,614)      (+1,051,614)
Title IV--Related Agencies:                                                                                                                             
    Federal Funds.............................................       26,878,380        33,226,669        33,238,418        +6,360,038           +11,749 
        Current year..........................................      (17,738,380)      (23,195,669)      (23,207,418)      (+5,469,038)         (+11,749)
        2000 advance..........................................       (8,840,000)       (9,691,000)       (9,691,000)        (+851,000)                  
        2001 advance..........................................         (300,000)         (340,000)         (340,000)         (+40,000)                  
    Trust Funds...............................................       (4,260,337)       (4,220,415)       (4,201,745)         (-58,592)         (-18,670)
Administration offset, LHHS-Ed sec. 519.......................  ................  ................          -33,000           -33,000           -33,000 
                                                               =========================================================================================
Total, all titles:                                                                                                                                      
    Federal Funds.............................................      262,257,417       286,606,839       287,592,472       +25,335,055          +985,633 
        Current year..........................................     (219,700,842)     (241,729,176)     (240,135,195)     (+20,434,353)      (-1,593,981)
        2000 advance..........................................      (42,256,575)      (44,537,663)      (47,117,277)      (+4,860,702)      (+2,579,614)
        2001 advance..........................................         (300,000)         (340,000)         (340,000)         (+40,000)                  
    Trust Funds...............................................       (9,663,495)       (9,678,172)       (9,270,995)        (-392,500)        (-407,177)
        Current year..........................................       (9,623,495)       (9,678,172)       (9,270,995)        (-352,500)        (-407,177)
        2000 advance..........................................          (40,000)  ................  ................         (-40,000)  ................
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ Forward funded except where noted.                                                                                                                  
\2\ Current funded.                                                                                                                                     
\3\ Three year forward funded availability.                                                                                                             
\4\ 15-month forward funded availability.                                                                                                               
\5\ The request earmarks $91 million for integrity activities.                                                                                          
\6\ Figures include $20 million related to the Work Opportunity Tax Credit which is unauthorized for fiscal year 1998 and fiscal year 1999.             
\7\ Two year availability.                                                                                                                              
\8\ Tax credit is unauthorized.                                                                                                                         
\9\ The request and the bill include four earmarks totalling $40.5 million.                                                                             
\10\ The request proposes an indefinite appropriation for this account.                                                                                 
\11\ Proposed for consolidation.                                                                                                                        
\12\ Proposed for transfer to AoA; House bill shifts funding to AoA.                                                                                    
\13\ The fiscal year 1998 APT displayed an appropriation for this appropriation of $2.688 million and a $1 million scorekeeping adjustment.             
\14\ Includes Mine Safety and Health.                                                                                                                   
\15\ Intermediate estimates: Page 40 of the 1998 Annual Report of the Board of Trustees of the Federal Hospital Insurance Trust Fund.                   
\16\ Intermediate estimates: Page 39 of the 1998 Annual Report of the Board of Trustees of the Federal Supplementary Medical Insurance Trust Fund.      
\17\ The request does not include traditional bill language permitting the use of carryover funds in fiscal year 1998 and fiscal year 1999.             
\18\ The request includes a $180 million legislative proposal for later transmittal.                                                                    
\19\ The budget justification indicates a request of $3,964,000,000. The President's actual budget request is $3,984,000,000 (see p. 428 Appendix).     
\20\ Fiscal year 1998 library funding was provided through the Department of Education. Comparable figures are now displayed in the Institute for Museum
  and Library Services account.                                                                                                                         
\21\ Forward funded.                                                                                                                                    
\22\ Reflects contingent transfer of $210 million to Special Education enacted in the fiscal year 1998 bill. The President proposes to retain the       
  funding in this account.                                                                                                                              
\23\ This program has never been authorized in law.                                                                                                     
\24\ The purposes for which the additional funding is requested for this program have never been specifically authorized in law.                        
\25\ The request earmarks $59.573 million for America Reads. Appropriations for Americorps are provided in HUD-VA bill.                                 
\26\ Fiscal year 1998 library funding was provided in the Department of Education. Comparable figures are displayed here for purposes of comparison.    



