[Senate Report 107-216]
[From the U.S. Government Publishing Office]



                                                       Calendar No. 509
107th Congress                                                   Report
                                 SENATE
 2d Session                                                     107-216

======================================================================
 
  DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND 
               RELATED AGENCIES APPROPRIATION BILL, 2003
                                _______
                                

                 July 22, 2002.--Ordered to be printed

                                _______
                                

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

                              R E P O R T

                         [To accompany S. 2766]

    The Committee on Appropriations reports the bill (S. 2766) 
making appropriations for Departments of Labor, Health and 
Human Services, and Education and related agencies for the 
fiscal year ending September 30, 2003, and for other purposes, 
reports favorably thereon and recommends that the bill do pass.






Amount of budget authority

Total bill as reported to Senate........................$432,502,509,000
Amount of adjusted appropriations, 2002................. 411,276,875,000
Budget estimates, 2003.................................. 426,171,807,000
The bill as reported to the Senate:
    Over the adjusted appropriations for 2002........... +21,225,634,000
    Over the budget estimates for 2003..................  +6,330,702,000








                            C O N T E N T S

                              ----------                              
                                                                   Page
Summary of Budget Estimates and Committee Recommendations........     4
Overview and Bill Highlights.....................................     4
Highlights of the Bill...........................................     4
Accrual Funding of Retirement Costs and Post-Retirement Health 
  Benefits.......................................................    18
Title I--Department of Labor:
    Employment and Training Administration.......................    20
    Pension and Welfare Benefits Administration..................    30
    Pension Benefit Guaranty Corporation.........................    30
    Employment Standards Administration..........................    31
    Occupational Safety and Health Administration................    34
    Mine Safety and Health Administration........................    36
    Bureau of Labor Statistics...................................    36
    Office of Disability Policy..................................    37
    Departmental Management......................................    38
    Veterans Employment and Training.............................    41
    Office of the Inspector General..............................    42
Title II--Department of Health and Human Services:
    Health Resources and Services Administration.................    43
    Centers for Disease Control and Prevention...................    68
    National Institutes of Health................................    97
    Substance Abuse and Mental Health Services Administration....   158
    Agency for Healthcare Research and Quality...................   170
    Centers for Medicare and Medicaid Services...................   172
    Administration for Children and Families.....................   178
    Administration on Aging......................................   198
    Office of the Secretary......................................   203
Title III--Department of Education:
    Education for the disadvantaged..............................   215
    Impact aid...................................................   220
    School improvement programs..................................   221
    Indian education.............................................   232
    English language acquisiton..................................   232
    Special education............................................   233
    Rehabilitation services and disability research..............   235
    Special institutions for persons with disabilities:
        American Printing House for the Blind....................   243
        National Technical Institute for the Deaf................   243
        Gallaudet University.....................................   243
    Vocational and adult education...............................   244
    Vocational education.........................................   244
    Adult education..............................................   246
    State grants for incarcerated youth offenders................   247
    Student financial assistance.................................   247
    Higher education.............................................   250
    Howard University............................................   257
    College housing and academic facilities loans................   257
    Historically black college and university capital Financing 
      program....................................................   258
    Education research, statistics, and improvement..............   258
    Departmental management:
        Program administration...................................   260
        Office for Civil Rights..................................   260
        Office of the Inspector General..........................   261
    General provisions...........................................   261
Title IV--Related agencies:
    Armed Forces Retirement Home.................................   263
    Corporation for National and Community Service...............   263
    Corporation for Public Broadcasting..........................   265
    Federal Mediation and Conciliation Service...................   266
    Federal Mine Safety and Health Review Commission.............   266
    National Foundation of the Arts and the Humanities: Institute 
      of Museum and Library ServiceI60267........................
    Medicare Payment Advisory Commission.........................   268
    National Commission on Libraries and Information Science.....   269
    National Council on Disability...............................   269
    National Labor Relations Board...............................   269
    National Mediation Board.....................................   270
    Occupational Safety and Health Review Commission.............   270
    Railroad Retirement Board....................................   270
    Social Security Administration...............................   271
    U.S. Institute of Peace......................................   275
Title V--General provisions......................................   277
Budgetary impact of bill.........................................   278
Compliance with paragraph 7, rule XVI of the standing rules of 
  the Senate.....................................................   278
Compliance with paragraph 7(C), rule XXVI of the standing rules 
  of the Senate..................................................   279
Compliance with paragraph 12, rule XXVI of the standing rules of 
  the Sen- 
  ate............................................................   279
Comparative statement of new budget authority....................   281






       SUMMARY OF BUDGET ESTIMATES AND COMMITTEE RECOMMENDATIONS

    For fiscal year 2003, the Committee recommends total budget 
authority of $432,502,509,000 for the Departments of Labor, 
Health and Human Services, and Education, and Related Agencies. 
Of this amount, $134,132,000,000 is current year discretionary 
funding.

                           ALLOCATION CEILING

    Consistent with Congressional Budget Office scorekeeping, 
the recommendations result in full use of the $134,132,000,000 
in discretionary budget authority pursuant to section 302(b) of 
the Congressional Budget Act of 1974, as amended.

                      OVERVIEW AND BILL HIGHLIGHTS

    The Labor, HHS, and Education and Related Agencies bill 
constitutes the largest of the non-defense Federal 
appropriations bills being considered by Congress this year. It 
is the product of extensive deliberations, driven by the 
realization that no task before Congress is more important than 
safeguarding and improving the health and well-being of all 
Americans. This bill is made up of over 300 programs, spanning 
three Federal Departments and numerous related agencies. But 
the bill is more than its component parts. Virtually every 
element of this bill reflects the traditional ideal of 
democracy: that every citizen deserves the right to a basic 
education and job skills training; protection from illness and 
want; and an equal opportunity to reach one's highest 
potential.
    This bill at the same time provides a safety net of social 
protections for the needy while stimulating advances in human 
achievement and the life sciences. At its core, this bill 
embodies those defining principles by which any free society 
must be guided: compassion for the less fortunate; respect for 
family and loved ones; acceptance of personal responsibility 
for one's actions; character development; and the avoidance of 
destructive behavior.

                         HIGHLIGHTS OF THE BILL

    Physical Activity and Nutrition.--The Committee 
recommendation includes a total of $998,349,000 for programs to 
increase physical activity, improve nutrition, and reduce 
obesity and overweight.
    Job Training.--The Committee recommendation includes 
$5,633,364,000 for job training programs, an increase of 
$657,601,000 over the budget request.
    Worker protection.--The Committee bill includes 
$1,475,808,000 to ensure the health and safety of workers, 
including $469,604,000 for the Occupational Safety and Health 
Administration and $261,841,000 for the Mine Safety and Health 
Administration. The recommendation is an increase of 
$70,592,000 over the 2002 level.
    Child Labor.--The Committee bill includes $148,015,000 for 
activities designed to end abusive child labor. This is 
$93,441,000 above the budget request.
    Persons With Disabilities.--To promote independent living 
in home and community based settings, the Committee has 
included $6,984,298,000 for services to persons with 
disabilities. This includes $30,884,000 for programs authorized 
under the Assistive Technology Act. In addition, the 
recommendation includes $47,015,000 for the Office of 
Disability Policy at the Department of Labor, and $40,000,000 
for Real Choice Systems Change Grants through the Center for 
Medicaid and Medicare Services.
    National Institutes of Health.--A total of $27,192,926,000 
is recommended to fund biomedical research at the 27 Institutes 
and Centers that comprise the NIH. This represents an increase 
of $3,737,083,000 over the fiscal year 2002 level and 
$25,000,000 over the budget request. This appropriation 
completes the historic 5-year effort to double the funding for 
the NIH.
    AIDS.--The Committee bill includes $5,697,731,000 for AIDS 
research, prevention, and services. This includes 
$2,072,000,000 for Ryan White programs, an increase of 
$161,413,000 over the fiscal year 2002 level, and $860,293,000 
for AIDS prevention programs at the Centers for Disease Control 
and Prevention.
    Bioterrorism initiative.--The Committee bill includes 
$3,741,080,000 to fund efforts to address bioterrorism threats.
    Health Centers.--The recommendation includes $1,533,570,000 
for health centers, an increase of $75,706,000 over the budget 
request and $190,000,000 over the fiscal 2002 level.
    Centers for Disease Control.--The Committee bill provides 
$810,785,000 within the Centers for Disease Control and 
Prevention to combat chronic disease and promote health. The 
amount recommended is an increase of $63,563,000 over the 
fiscal year 2002 amount and $120,555,000 over the budget 
request.
    Substance abuse.--The Committee bill provides 
$2,307,000,000 for substance abuse prevention and treatment 
programs. This is an increase of $92,606,000 over the 2002 
enacted level. The recommendation restores proposed reductions 
to substance abuse prevention programs and supports an increase 
of $70,000,000 for the substance abuse prevention and treatment 
block grant.
    Head Start.--The Committee recommendation includes 
$6,870,000,000 for the Head Start Program. This represents an 
increase of $332,360,000 over the 2002 level and $202,467,000 
over the request. The recommendation will support the 
enrollment of an additional 20,000 children, bringing Head 
Start enrollment to more than 935,000.
    Low-income home energy assistance.--The Committee 
recommends $2,000,000,000 for heating and cooling assistance 
for low-income individuals and families, $300,000,000 more than 
the President's budget. Of this amount, $300,000,000 supports 
additional energy assistance during emergencies.
    Education for the Disadvantaged.--The Committee has 
provided $14,087,400,000 in grants to enhance educational 
opportunities for disadvantaged children. This includes an 
increase of $1,500,000,000 over the fiscal year 2002 amount for 
grants to local education agencies, bringing the total to 
$11,850,000,000.
    Teacher Quality.--The Committee recommends $3,100,000,000 
for State grants to improve teacher quality. This is an 
increase of $250,000,000 above both the fiscal year 2002 
appropriation and the budget request.
    English Language Acquisition.--The Committee recommends 
$740,000,000 for bilingual education, an increase of 
$75,000,000 over the administration request and the fiscal year 
2002 level.
    Student financial aid.--The Committee recommends 
$13,162,000,000 for student financial assistance, an increase 
of $876,500,000 over last year and $394,500,000 more than the 
President's budget. The amount provided for the Pell Grant 
Program will allow the maximum grant to be raised to $4,100, an 
increase of $100 over the 2002 amount and the budget request.
    Higher education initiatives.--The Committee bill provides 
$1,986,336,000 for initiatives to provide greater opportunities 
for higher education, including $832,500,000 for Federal TRIO 
programs.
    Education for individuals with disabilities.--The Committee 
bill provides $9,696,424,000 to help ensure that all children 
have access to a free and appropriate education, and that all 
infants and toddlers with disabilities have access to early 
intervention services. This represents an increase of 
$1,023,620,000 over the 2002 level. Included in this 
appropriation is an increase of $1,000,000,000 over last year's 
level for grants to States.
    Rehabilitation services.--The bill recommends 
$2,963,722,000 for rehabilitation services, an increase of 
$17,909,000 above the amount provided in 2002. These funds are 
essential for families with disabilities seeking employment. 
The Committee restored funding for several important programs 
proposed for elimination, such as Supported Employment State 
Grants, Projects with Industry, Recreational programs and 
programs for migrant and seasonal farmworkers.
    Services for older Americans.--For programs serving older 
Americans, the Committee recommendation totals $3,083,053,000, 
an increase of $176,855,000 over the fiscal year 2002. This 
recommendation includes $237,547,000 for senior volunteer 
programs, $450,000,000 for community service employment for 
older Americans, $364,500,000 for supportive services and 
centers, $160,500,000 for family caregiver support programs and 
$723,287,000 for senior nutrition programs. For the medical 
research activities of the National Institute on Aging, the 
Committee recommends $1,000,099,000. The Committee 
recommendation includes $12,500,000 for the Medicare insurance 
counseling program.
    Public broadcasting.--The Committee bill provides 
$50,000,000 for the conversion of public radio and television 
stations to digital broadcasting, double the previous year's 
appropriation.

               PHYSICAL ACTIVITY AND NUTRITION INITIATIVE

    Obesity has become our Nation's fastest rising public 
health threat. All available data show that the number of 
Americans who are obese or overweight have reached epidemic 
proportions. An estimated 120 million people--61 percent of 
American adults--are either overweight or obese. This puts them 
at increased risk for chronic and life-threatening diseases 
such as heart disease, stroke, cancer and diabetes. Chronic 
diseases account for 7 out of every 10 U.S. deaths, and more 
than 60 percent of medical care expenditures.
    Between 1980 and 1999 the number of obese American adults 
nearly doubled from approximately 15 percent to 27 percent. An 
estimated 300,000 premature deaths a year are associated with 
obesity and overweight, an amount second only to tobacco-
related deaths. The total direct and indirect costs attributed 
to overweight and obesity amounted to $117,000,000,000 in 2000. 
The problem is not limited to adults. Alarmingly, an increasing 
number of overweight youth in this country are at risk for 
chronic health problems or disabilities later in life. About 13 
percent of children and 14 percent of adolescents are obese. 
The increase in obesity and overweight among American youth 
over the past two decades has been dramatic, more than tripling 
in the past two decades. According to a recent study, hospital 
costs for diseases related to childhood obesity have increased 
threefold in the past 20 years. A recent study confirms that 
Americans are becoming obese at younger ages: approximately 27 
percent of U.S. adults are obese by the time they reach their 
mid-30s, about twice the rate in the early 1960s.
    This dramatic upsurge in obesity has been associated with a 
nationwide increase in diabetes. The prevalence of type 2 
diabetes, the most common form of the disease, has tripled in 
the last 30 years. At least 80 percent of patients with type 2 
diabetes are overweight or obese. Type 2 diabetes was commonly 
known in the past as ``adult onset'' diabetes. However, 
research is showing a dramatic escalation in the number of 
children diagnosed with type 2 diabetes. Whereas fewer than 4 
percent of childhood diabetes cases in 1990 were type 2, that 
number has risen to approximately 20 percent.
    Problems with obesity and diabetes also disproportionately 
affect minority communities. Thirty percent of African 
Americans are obese, compared to 21 percent of whites. Black 
women were nearly twice as likely as white women to be obese, 
and one quarter of Hispanic women are obese. According to the 
CDC, African American are considered to have the highest rates 
of both obesity and diabetes among all races and ethnic groups. 
Among all groups, however, Native Americans have some of the 
highest prevalence rates of overweight. Among the highest rates 
reported are for American Indians in Arizona at 80 percent for 
women and 67 percent for men.
    The good news is that many of the chronic diseases linked 
to obesity are preventable. Recent studies provide strong 
evidence that prevention efforts focusing on diet, exercise and 
other lifestyle changes can result in substantially reduced 
risk among high-risk groups. Last August a major clinical trial 
reported that Americans at high risk for type 2 diabetes can 
dramatically reduce their risk of getting the disease with 
improvements to their diet and exercise. In addition, exercise 
and nutrition can have health benefits for individuals of all 
ages and at all levels of fitness.
    The Committee strongly believes a commitment to improving 
physical activity and nutrition is imperative if we are to 
reduce chronic disease, premature deaths and related health 
care costs. For this reason, the Committee has included a total 
of $998,349,000 for programs designed to increase physical 
activity, healthy lifestyles and nutrition. This is an increase 
of $49,701,000 over last year's level.
    Recognizing the myriad physical activity promotion programs 
being undertaken by different Federal agencies, the Committee 
urges agencies receiving funds for this purpose under this bill 
to take special measures to coordinate their activities. In 
particular, the CDC's Center for Chronic Disease Prevention and 
Health Promotion in carrying out the Youth Media Campaign (YMC) 
and the Division of Nutrition and Physical Activity (DNPA) 
programs should develop mechanisms such as interagency 
committees to coordinate with the Department of Education in 
administering such as programs as the Carol M. White Physical 
Education for Progress in order to leverage resources at the 
local level. The Committee notes the recent establishment of a 
Memorandum of Understanding between the CDC, the Department of 
Interior and the Department of Agriculture in the area of 
promoting physical activity as a valuable model.
Nutrition and Physical Activity
    The Committee commends the substantial efforts that CDC is 
directing to stem the obesity epidemic across all life stages. 
CDC is coordinating national, State, and school-based programs 
to research and implement health promotion and public health 
education strategies and interventions to increase physical 
activity levels and good nutrition at all ages, to provide 
important health information, and to monitor health and healthy 
behaviors in the population. CDC currently funds 12 States to 
promote physical activity and good nutrition to prevent and 
control obesity. The Committee recommends $50,000,000 for 
primary prevention activities related to Nutrition, Physical 
Activity, and Obesity at CDC, an increase of $22,495,000 over 
fiscal year 2002.
    The Committee recognizes the potential to respond to this 
national problem through broad, population-based primary 
prevention strategies. The Committee encourages CDC to build on 
the successful CDC Guide to Community Preventive Services and 
the Guidelines for Comprehensive Programs to Promote Healthy 
Eating and Physical Activity, and to collect and disseminate 
information, evaluations, and planning guides that document a 
range of specific State and local policy and environmental 
interventions that provide practical, replicable approaches to 
improving nutrition and physical activity.The Committee 
recognizes coordination at the local level is critical, 
especially among community health and school-based efforts to 
promote physical activity and nutrition. The Committee 
recommends that the CDC urge its grantees to establish a 
position of statewide physical activity coordinator to oversee 
a comprehensive physical activity and nutrition program, in 
order to ensure resources are utilized to their optimum 
potential and to avoid duplicative efforts. This position could 
be funded through DNPA grants or elsewhere and could be located 
in the State Health Department, Governor's Council on Physical 
Fitness and Sports, or in the State Education Department.
Youth Media Campaign
    Our Nation's youth increasingly are inactive, overweight 
and engage in unhealthy behaviors. These unhealthy behaviors 
have proven to lead to heart disease later in life. At the same 
time, young people in our society rely heavily on the media. 
Children 8 and older spend an average of more than 47 hours a 
week--nearly 6.75 hours a day--consuming television, radio and 
the internet. The Committee believes that this statistic, while 
alarming, underscores the need to promote healthy lifestyles to 
our youth in a way they understand. For this reason the 
Committee provides $40,000,000 to CDC for a national multi-
media campaign to promote healthy lifestyles among young 
people. This funding restores the cut requested by the 
administration for this program. This campaign will use mass 
media, in-school media and a national events tour to reinforce 
messages and strategies promoting healthy activities. The 
Committee encourages coordination of the Youth Media Campaign 
with the State and local grantees of related nutrition, 
physical activity and school health programs.
Healthy Communities
    The Committee provides $20,000,000 to HRSA for the Healthy 
Communities Innovation Initiative, a new pilot program designed 
to prevent three of the most rapidly increasing chronic 
conditions in this country: diabetes, asthma, and obesity. The 
Committee is pleased that the Secretary has championed this 
program, which will develop coalitions between private and 
public organizations working in the areas of prevention, 
medical, social, educational, business, religious, and civic 
services. This program will encourage the development of 
innovative efforts in five communities to enhance access to 
services, encourage positive behavioral changes, and improve 
community health. The Committee further encourages the 
Secretary to stress the importance of weight reduction as a 
tool in preventing heart disease.
School Health
    Obesity rates were significantly reduced among girls in 
grades 6-8 who participated in a school-based intervention 
program. The Committee applauds CDC for establishing effective 
coordinated school health programs in 20 States and 2 local 
education agencies. The Committee urges CDC to expand its 
coordinated school health program. The Committee has provided 
$63,000,000 for coordinated school health to address risk 
behaviors such as tobacco use, unhealthy diets, and physical 
inactivity at CDC, an increase of $4,505,000 over fiscal year 
2002 funding. The Committee urges CDC and the Department of 
Education to coordinate activities relating to nutrition and 
physical activity which will help to reduce obesity and prevent 
heart disease.
Head Start
    The Committee commends the Department for its focus on 
prevention as a key to improving the overall health and well-
being of our Nation. The Committee also recognizes the 
importance of good nutrition and physical activity among young 
children for developing a fertile atmosphere for cognitive 
development and school readiness. According to the Nutrition 
Cognition National Advisory Committee at Tufts University in 
Massachusetts, children without an adequate diet may have 
trouble concentrating in school, participating in play, bonding 
with peers, and performing at their potential. Therefore, the 
Committee urges the Head Start Bureau to review the scope of 
good nutrition and physical activities which are presently 
being undertaken in response to the Head Start Performance 
Standards, as well as the current knowledge base on good 
nutrition and physical activities for young children. Further, 
the Committee urges the Head Start Bureau to review the 
activities presently being undertaken by local programs to 
promote healthy bodies as a prerequisite for strong minds and 
to identify best practices currently employed by local 
programs. As a follow up, the Committee encourages the Head 
Start Bureau, in collaboration with the National Head Start 
Association, to devise a plan for implementing a locally-
determined but coordinated effort to achieve the goals of a 
stronger, more vibrant and effective nutritional and physical 
activity component within Head Start programs. The Committee 
expects that the Head Start Bureau will enter into a 
cooperative agreement with the National Head Start Association 
to carry out these activities.
Physical Education
    Despite the well-publicized benefits of exercise, more than 
60 percent of American adults do not get enough physical 
activity to provide health benefits. This trend is not limited 
to adults: more than a third of young people in grades 9-12 do 
not regularly engage in physical activity. Nearly one-half of 
American youths aged 12-21 years are not vigorously active on a 
regular basis. Physical education (PE) classes are important 
for ensuring that young people have a minimal, regular amount 
of physical activity and for establishing physical activity 
patterns that may be carried into adulthood. Yet the Committee 
notes that daily enrollment in physical education classes 
dropped from 42 percent to 25 percent among high school 
students between 1991 and 1995. In order to help reverse this 
trend, the Committee recommendation includes $70,000,000 for 
the Carol M. White Physical Education for Progress program. 
This is an increase of $20,000,000 over the fiscal year 2002 
level and $70,000,000 over the request. This program provides 
grants to local educational agencies and community-based 
organization to initiate, expand and improve physical education 
program for students in kindergarten through 12th grade. The 
PEP program will help curb this Nation's increasing obesity 
problem, which will in turn reduce the risk of developing heart 
disease later in life.
National Youth Fitness Survey
    The Committee believes a national instrument to assess 
fitness levels of young people is needed to plan, execute and 
evaluate a comprehensive effort to address obesity and 
overweight. CDC conducted the National Children and Youth 
Fitness Survey (NCYFS) twice during the mid-1980's, funded 
under Departmental authority, but this survey was discontinued. 
The Committee believes NCYFS should be re-established. The 
NCYFS should include the same measures of fitness used 
previously, in order to allow for comparisons with past data, 
and should incorporate new measures, in order to reflect new 
understandings of appropriate fitness assessment. In addition, 
in developing a new NC fiscal years, consideration should be 
given to establishing measures relating the provision of 
physical activity programs (physical education, recess, and 
after-school) and academic performance. The Committee envisions 
NCYFS to be done on regular 5-year intervals in the future.

           PREVENTING AND REVERSING HEART DISEASE INITIATIVE

    Nearly 62 million Americans, young and old, live with the 
effects of cardiovascular disease. The Nation's number one 
killer, cardiovascular disease costs society an estimated 
$330,000,000,000 annually in medical costs and lost 
productivity. Challenges to combating this disease include 
persistent geographic, racial, and ethnic disparities, the 
increased prevalence of sedentary lifestyles, obesity rates, 
and deficiencies in the use of proven and effective treatments 
for those already afflicted with cardiovascular disease.
    On May 16, 2002, the Subcommittee on Labor, Health and 
Human Services and Education convened a hearing to more closely 
examine the factors contributing to cardiovascular disease, and 
to explore possible approaches to prevent, control, and reverse 
its effects. Testimony heard from a variety of top medical 
experts reflected a common theme: All agreed that stress 
management, in conjunction with diet modification, exercise, 
and pharmacological and/or surgical intervention, can 
significantly improve the quality of life for those confronted 
with cardiovascular disease. Witnesses confirmed that 
cardiovascular disease usually begins several years before 
symptoms appear. Due to the body's compensation mechanisms many 
individuals function normally for years in an asymptomatic 
state, unaware that the disease is taking hold. Once symptoms 
become apparent, a disproportionate amount of medical resources 
are devoted to dealing with those symptomatic events, rather 
than taking preventive measures at a much earlier stage. 
Integrating technology, behavioral and metabolic medicine, and 
lifestyle modifications at an early age would shift that focus 
from reactive medicine to preventive medicine. For example, 
relatively simple lifestyle modifications, including exercise, 
nutrition plans and learning a relaxation response to stress, 
such as yoga techniques, have led to successful outcomes for 
individuals who are otherwise at risk. Individuals who have 
adopted these changes have experienced positive results, 
including weight loss, lower blood pressure and cholesterol 
levels, improved clinical symptoms and reduction in 
psychological distress. For many years the National Heart, Lung 
and Blood Institute has supported a vigorous program of 
research on the behavioral and psychological impact of 
cardiovascular disease. Data obtained by NHLBI confirmed that 
mental stress could cause myocardial ischemia or reduced blood 
flow.
    Current evidence suggests that all individuals at risk for 
cardiovascular disease can benefit from stress reduction, but 
that general health and well-being are greatly improved if the 
first steps are taken during childhood. Among children, in 
fact, stress management programs have been shown to improve 
self-esteem, grade-point average and work habits while reducing 
violent behavior. To that end, the educational system in this 
country should be encouraged to incorporate stress management 
programs into school curriculum.
    To address the prevention and reversing heart disease 
initiative, the Committee has included $419,300,000 in addition 
to the amounts provided as part of the physical activity and 
nutrition initiative.
    Obesity and nutrition programs work hand in hand in 
preventing and reducing heart disease. The Committee encourages 
the Departments of Health and Human Services and Education to 
coordinate the above programs and activities to address both 
initiatives.
Fund for Innovative Education
    As part of the preventing and reversing heart disease 
initiative, the Committee has included $1,000,000 to design 
programs to teach school children and teachers coping skills to 
help ease both the short- and long-term effects of stress. The 
Committee directs the Department to implement this initiative 
as soon as possible. Programs such as these have been 
scientifically proven to improve students' self-esteem, self-
efficacy, control, grade point average, work habits, memory and 
cooperation.
National Institute of Heart, Lung and Blood
    The Committee encourages the NHLBI, in conjunction with 
Walter Reed Medical Center, to conduct a controlled, 
prospective, randomized trial to compare the outcomes of 
utilizing a demanding vegetarian diet versus a more liberal 
diet that would also utilize lipid-lowering drugs, as well as 
the impact of relaxation response-based stress management 
programs. Such a trial could take place over a long period of 
time to allow a long-term assessment of outcomes.
Centers for Medicare and Medicaid Service
    The Committee commends the Centers for Medicare and 
Medicaid Service (CMS) for their work on a lifestyle 
modification study comparing the efficacy and costs of two 
cardiac approaches to reversing heart disease.
Centers for Disease Control
    The Committee has provided $10,000,000 to increase CDC's 
cardiovascular programs as part of the Committee's initiative 
to prevent and reverse heart disease. The Committee urges the 
CDC to initiate research to examine strategies to prevent and 
reverse heart disease, including mind/body approaches to stress 
management, yoga, diet modifications, and exercise programs.

                       SAFE MOTHERHOOD INITIATIVE

    Over the last decade, the Committee has expressed its 
strong support for closing the gap in research on diseases and 
conditions specific to women and of including women and 
minorities in clinical research where they had previously been 
ignored. The Committee recognizes that much progress has been 
made to improve research and the quality of care for women. Yet 
over the past year, the Committee has grown increasingly 
concerned about the lack of progress that has been made in 
reducing the rates of maternal mortality and morbidity in the 
United States. The Committee notes that there has been no 
decline in pregnancy-related deaths or morbidity in 20 years. 
Although the Department of Health and Human Services set goals 
to reduce pregnancy-related deaths and illness set forth in 
Healthy People 2000 and again in Healthy People 2010, it has 
failed to do so.
    Today, the United States ranks 20th out of 49 developed 
countries in maternal mortality related deaths. About 1,000 
women a year--two to three every day--die from pregnancy-
related causes. African American women are four times more 
likely to die from pregnancy-related illness or conditions; and 
women over the age of 35 are two to three times more likely to 
experience a pregnancy-related death compared to women aged 20-
25. The rate of pre-term labor and delivery remains virtually 
unchanged as well.
    Pregnancy-related illness affect an even wider number of 
women: in the United States one out of three pregnant women 
experience a major medical complication at some point during 
their pregnancy. And women who are high-risk, who have a 
chronic condition face even more difficult pregnancies, 
deliveries, and risk to their long-term health.
    Despite the need for accurate information on prescription 
drug use by pregnant women, only 1 percent of FDA approved 
drugs have been shown in controlled studies to show no risk to 
pregnant women and their babies. And 80 percent of FDA approved 
drugs lack adequate scientific evidence about use in pregnancy. 
That means that pregnant women are left with little or no 
knowledge about the safety of medications, prescribed or over-
the-counter, and their impact on the fetus.
    The Committee believes it is time to live up to the 
commitments articulated in Healthy People 2000 and 2010 to 
reduce maternal mortality and morbidity and ensure a safe and 
healthy pregnancy for all women. In fact, a recent National 
Summit on Safe Motherhood held by the CDC, and cosponsored by a 
range of agencies and organizations, laid the cornerstones of a 
strategy to improve our Nation's commitments to healthy 
pregnancies, healthy mothers, and healthy infants. The 
Committee calls on the Secretary to put key elements of such a 
safe motherhood initiative in place and has developed this Safe 
Motherhood initiative to help achieve these goals, including:
Federal Research and Strategic Action Plan for Safe Motherhood
    The Committee provides $3,000,000 to the Office of the 
Secretary, acting through the Director of the Office of Women's 
Health, to establish an ``Interagency Coordinating Committee on 
Safe Motherhood,'' which shall include representatives of 
relevant Federal agencies and offices, community healthcare 
experts, relevant community health professionals, and leaders 
from the women's health community. The Interagency Committee, 
as part of its duties, shall evaluate existing research and 
health promotion programs and their success in serving pregnant 
women. The Interagency Committee shall also develop a 5-year 
Federal research and strategic action-plan, including 
professional funding recommendations, to reduce maternal 
morbidity and mortality.
    The plan shall include recommendations for the research in 
the following areas: pregnancy-related conditions, the impact 
of chronic conditions on pregnancy, complications that occur 
during pregnancy, post-partum conditions (depression, 
hemorrhage, and fever), racial and ethnic disparities in 
maternal morbidity and mortality, social and behavioral factors 
in pregnancy, as well as the safety of drugs, devices, 
cosmetics, and food with respect to pregnancy and on the impact 
of pregnancy in women 35 and older. The plan shall also include 
specific recommendations for establishing and implementing a 
national public education and health promotion campaign on safe 
motherhood. The ``Interagency Coordinating Committee'' shall 
prepare and submit the Federal research and strategic action 
plan'' no later than 18 months after enactment of this Act to 
the Secretary and the Committee.
Improving the Safety of Medications for Pregnant Women
    The Committee is very concerned about the lack of 
scientific data and studies on the safety and dosing of drugs 
for women who are pregnant. While drug testing in women raises 
important ethical considerations, the Committee believes that 
the NIH and FDA can develop appropriate protocols and 
mechanisms to improve the quality of information available to 
women and their health care providers about the safety and 
proper dosing of drugs and biologics taken during pregnancy. 
The Committee urges NIH to work with the FDA to improve the 
quality of information on drugs and biological products for 
women who are pregnant and lactating through grants, contract 
or other appropriate mechanisms to aid in promptly completing 
studies to determine the safety and dosing for marketed drugs 
and biologics that were not approved or licensed based on 
studies in pregnant women. The Director shall be prepared to 
report to the Committee at its annual review before the 
Committee on the progress and activities.
Improving National Data and Information related to Maternal Morbidity 
        and Mortality
    The Committee provides the CDC $7,000,000 to establish a 
demonstration program to improve data collection about 
pregnancy-related complications and maternal mortality. CDC 
shall award grants to at least four States for the development 
of surveillance systems that use standard definitions of 
maternal morbidity and mortality that have been developed by 
the CDC in collaboration with the grant recipients. The quality 
of data and information about maternal morbidity and mortality 
is poor and unreliable. States do not use standard definitions 
of maternal morbidity or mortality. When States do collect 
data, it is impossible to compare their data, know precisely 
what is happening within the State, or to identify emerging 
trends across States.
CDC Safe Motherhood Activities
    The committee commends CDC for its groundbreaking National 
Summit of Safe Motherhood and commends the agency for its work 
on its Safe Motherhood Initiative. The Summit succeeded in 
expanding our understanding of Safe Motherhood as a critical 
woman's health issue and identified the troubling lack of 
research and data on pregnancy-related issues. The Committee 
has provided an increase of $2,000,000 to CDC to further its 
work identified at the Summit and to continue to carry out 
their existing Safe Motherhood activities.
Research to Reduce Poor Pregnancy Outcomes--and Racial and Ethnic 
        Disparities
    The Committee provides CDC $2,000,000 to provide individual 
grants to community-based organizations, public and private 
research institutions and universities to conduct prevention 
and health promotion research to focus specifically on 
improving maternal outcomes in maternal morbidity and 
mortality, eliminating racial disparities in maternal morbidity 
and mortality, such as developing better health care models, 
population-based studies, prevention strategies, culturally 
sensitive and appropriate health care practice models, improved 
outreach and efforts and funding for minority organizations to 
provide technical assistance and outreach in minority 
communities. The research should take into consideration the 
role of stress, violence, discrimination, nutrition, obesity, 
and access to quality health care and health literacy.
Substance abuse treatment
    According to the National Institute of Drug Abuse, more 
than 5 percent of the 4,000,000 women who gave birth in the 
United States in 1992 used illegal drugs while pregnant, 
according to the first and only nationally representative 
survey of drug use among pregnant women. That is an estimated 
221,000 women gave birth that year while using illicit drugs 
during their pregnancy. The Committee notes that when a 
pregnant woman abuses drugs or alcohol, both she and her unborn 
child may suffer harm. In addition, substance abuse often 
creates or is accompanied by an array of social problems for 
the abuser and those around her, including violence, child 
abuse and neglect, and family dysfunction. Therefore, the 
Committee has provided SAMHSA with $3,000,000 for residential 
treatment programs for pregnant women which provide 
comprehensive treatment service strategies, including outreach, 
intake and assessment, provision of comprehensive services, and 
follow-up for women and their children in order to reduce the 
harm caused to mothers and their children.

                          EDUCATION INITIATIVE

    The No Child Left Behind Act, approved overwhelmingly by 
Congress last year and signed into law in January, includes the 
Nation's most sweeping education reforms in decades. It signals 
a new relationship between the Federal Government and public 
schools, one that is based on high expectations for every 
student--and strict accountability for success or failure. More 
than ever before, Federal dollars will be tied to academic 
achievement; States, districts, and schools must improve 
student performance, or face the consequences.
    Most importantly, the law presumes that all children--
regardless of race, ethnicity, disability, or proficiency in 
English--can succeed academically. That is a powerful notion, 
and it holds great potential to raise student performance 
across the Nation.
    But it is important that high expectations are backed up 
with enough resources to make them attainable. Hiring qualified 
teachers takes more than lofty goals and good intentions; it 
also takes money. So does replacing old textbooks, buying 
computers, fixing leaky roofs, providing professional 
development, implementing successful curricula, and numerous 
other measures that are critical to creating an environment 
where children can learn. Educators and parents need to believe 
their schools have a fighting chance to meet the new 
requirements. Without that trust, public opinion will quickly 
turn against the No Child Left Behind Act's reforms, and 
pressure could build to relax or ignore the high expectations. 
That would be a tragic result for the millions of today's 
students who are receiving an inadequate education. For those 
reasons, the Committee is deeply concerned that the budget 
request does not include enough funding for education. The 
Committee has responded by adding more than $4,200,000,000 for 
education over last year's appropriation. More than 
$2,300,000,000 of that amount is designated for programs 
authorized by the No Child Left Behind Act.
Title I grants to LEAs
    The Committee's top educational priority was to increase 
funding for Title I Grants to LEAs. Schools receiving Title I 
aid are at the greatest risk of failing to meet the academic 
standards required in the new law; they're also the schools 
upon which the most accountability measures have been placed. 
Therefore, the Committee has provided for this account a 
record-high $11,850,000,000, an increase of $1,500,000,000 over 
last year. The Committee allocated the bulk of this increase 
through the two funding formulas that are the most targeted to 
the poorest schools: targeted grants and education finance 
incentive grants.
    In addition, the Committee allocated $100,000,000 for a 
newly authorized Title I program designed specifically to help 
schools that are identified as needing improvement and can 
demonstrate that they have a plan to turn themselves around.
State grants for improving teacher quality
    The Committee's next priority for addressing the 
requirements of the No Child Left Behind Act was to increase 
funding for State grants for improving teacher quality, which 
can be used for a variety of measures, including teacher 
recruitment and retention, professional development, the reform 
of teacher certification requirements, and class-size 
reduction. The No Child Left Behind Act requires that all 
teachers must be ``highly qualified'' by the end of the 2005-06 
school year; in the near term, all Title I teachers hired after 
this September must also meet that definition. Therefore, the 
Committee has provided an increase of $250,000,000 for this 
account, for a total of $3,100,000,000.
English language acquisition
    The No Child Left Behind Act establishes several new 
accountability measures that specifically address limited-
English-proficient (LEP) students. States will be required to 
set annual yearly progress goals for the achievement of all 
children, including LEP students specifically. In addition, 
each State will be required to develop annual measurable 
objectives for LEP students; these objectives must track 
student progress in learning English and district progress in 
making adequate yearly progress for LEP students. The Committee 
recognizes that LEP students will face many unique challenges 
in trying to meet these goals; therefore, it has provided an 
increase of $75,000,000 for English language acquisition State 
grants, for a total of $740,000,000.
Other key education programs
    The Committee also directed additional funding to several 
other programs that will help States, districts, and schools 
meet the new education mandates. Among them:
  --The Committee has provided a $100,000,000 increase, as 
        requested by the administration, for the Reading First 
        program, for a total of $1,000,000,000. This program 
        provides State grants to improve reading instruction in 
        grades K-3.
  --The Committee has provided $175,000,000, an increase of 
        $12,500,000 over last year, for rural education 
        programs.
  --The Committee has provided $15,000,000, an increase of 
        $5,000,000 over last year, for dropout prevention 
        grants.
  --The Committee has provided $15,000,000, an increase of 
        $5,000,000, for school leadership programs to help 
        districts recruit and train principals.
  --The Committee has provided $35,000,000, an increase of 
        $10,000,000 over last year, for voluntary public school 
        choice programs; such programs help enable parents of 
        students in failing public schools to send their 
        children to better public schools.

              REPROGRAMMING AND INITIATION OF NEW PROGRAMS

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

                           TRANSFER AUTHORITY

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

ACCRUAL FUNDING OF RETIREMENT COSTS AND POST-RETIREMENT HEALTH BENEFITS

    The President's Budget included a legislative proposal 
under the jurisdiction of the Senate Committee on Governmental 
Affairs to charge to individual agencies, starting in fiscal 
year 2003, the fully accrued costs related to retirement 
benefits of Civil Service Retirement System employees and 
retiree health benefits for all civilian employees. The Budget 
also requested an additional dollar amount in each affected 
discretionary account to cover these accrued costs.
    The authorizing committee has not acted on this 
legislation, therefore the Senate Appropriations Committee has 
reduced the dollar amounts of the President's request shown in 
the ``Comparative Statement of New Budget Authority Request and 
Amounts Recommended in the Bill'', as well as in other tables 
in this report, to exclude the accrual funding proposal.
    The Committee further notes that administration proposals 
requiring legislative action by the authorizing committees of 
Congress are customarily submitted in the budget as separate 
schedules apart from the regular appropriations requests. 
Should such a proposal be enacted, a budget amendment formally 
modifying the President's appropriation request for 
discretionary funding is subsequently transmitted to the 
Congress.
    The Senate Appropriations Committee joins with the House 
Appropriations Committee in raising concern that this practice, 
which has always worked effectively for both Congress and past 
administrations, was not followed for the accrual funding 
proposal. In this case, the Office of Management and Budget 
(OMB) decided to include accrual amounts in the original 
discretionary appropriations language request. These amounts 
are based on legislation that has yet to be considered and 
approved by the appropriate committees of Congress. This led to 
numerous misunderstandings both inside and outside of Congress 
of what was the ``true'' President's budget request. The 
Committee believes that, in the future, OMB should follow long-
established procedures with respect to discretionary spending 
proposals that require legislative action.

                      TITLE I--DEPARTMENT OF LABOR

                 Employment and Training Administration

                    TRAINING AND EMPLOYMENT SERVICES

Appropriations, 2002....................................  $5,484,834,000
Budget estimate, 2003...................................   4,975,763,000
Committee recommendation................................   5,633,364,000

    The Committee recommends $5,633,364,000 for this account in 
2003 which provides funding authorized primarily by the 
Workforce Investment Act [WIA]. This is $148,530,000 more than 
the 2002 level, and $657,601,000 above the administration 
request.
    Training and employment services is comprised of programs 
designed to enhance the employment and earnings of economically 
disadvantaged and dislocated workers, operated through a 
decentralized system of skill training and related services. 
This appropriation is generally forward-funded on a July-to-
June cycle. Funds provided for fiscal year 2003 will support 
the program from July 1, 2003, through June 30, 2004.
    Beginning with the fiscal year 2000 appropriation, budget 
constraints required that a portion of this account's funding 
be advance appropriated, with obligations for a portion of 
Adult and Dislocated Worker Employment and Training Activities 
and Job Corps delayed until the following fiscal year. This 
practice will continue in this year's appropriation.
    Fiscal year 2000 was the first full year of operations 
under the new Workforce Investment Act, beginning July 1, 2000 
through June 30, 2001. The new legislation is significantly 
enhancing employment and training services, consolidating, 
coordinating, and improving programs utilizing a local level 
one-stop delivery system. The Committee recommendation rejects 
the cutbacks proposed in the President's budget, recognizing 
the vital role of the workforce system at a time of economic 
slowdown.
    Adult employment and training activities.--For Adult 
Employment and Training Activities, the Committee recommends 
$950,000,000. This is the same as the 2001 comparable level and 
$50,000,000 more than the budget request. This program is 
authorized by the Workforce Investment Act and is formula-
funded to States and further distributed to local workforce 
investment boards. Services for adults will be provided through 
the One-Stop system and most customers receiving training will 
use their individual training accounts to determine which 
programs and providers fit their needs. The Act authorizes core 
services, which will be available to all adults with no 
eligibility requirements, and intensive services, for 
unemployed individuals who are not able to find jobs through 
core services alone.
    Dislocated worker employment and training activities.--For 
Dislocated Worker Employment and Training Activities, the 
Committee recommends $1,549,000,000. This is an increase of 
$177,500,000 over the 2002 comparable level. Of this amount, 
$1,239,200,000 is designated for State formula grants, an 
increase of $110,000,000 over the 2002 enacted level. This 
program, authorized by WIA, is a State-operated effort which 
provides core services, intensive services, training, and 
supportive services to help permanently separated workers 
return to productive, unsubsidized employment. In addition, 
States use these funds for rapid response assistance to help 
workers affected by mass layoffs and plant closures. The 
recommendation includes $309,800,000 available to the Secretary 
for activities specified in WIA, primarily to respond to mass 
layoffs, plant and/or military base closings, and natural 
disasters across the country, which cannot be otherwise 
anticipated, as well as technical assistance and training and 
demonstration projects.
    The Committee bill continues language authorizing the use 
of funds under the dislocated workers program for projects that 
provide assistance to new entrants in the workforce and 
incumbent workers.
    The Committee recommendation includes, as it has in past 
years, funding for dislocated worker projects aimed at 
assisting the long-term unemployed.
    The Committee encourages efforts to make certain that 
dislocated workers in low pay, entry-level jobs can qualify for 
help under the Dislocated Worker Program and get a fair share 
of the funding.
    The Committee is aware of the substantial worker 
dislocation brought on by the closure of sugarcane plantations 
and the rapidly increasing demand for food safety training at 
all levels of food production. To meet these needs, the 
Committee reiterates its recommendation in last year's report 
to provide on-farm and off-farm food safety training for 
dislocated sugarcane workers employed in the agricultural and 
food sector. Due to economic reasons and family dysfunction, 
elderly caregivers care for thousands of preschool Hawaiian and 
part-Hawaiian children with little or no preparation. The 
Committee urges the Department to expand funding to programs 
which work to train and assist these caregivers and the 
children they serve. The Committee was pleased to learn from 
the Secretary that the administration has established an 
interagency effort to address our Nation's nursing shortage. 
The shortage is especially critical in rural America and within 
various ethnic minority populations, such as native Hawaiians. 
The Department is accordingly strongly urged to work with 
nursing programs serving such populations, and in particular, 
to ensure that summer employment opportunities exist for 
nursing students.
    Youth activities.--For Youth Activities, the Committee 
recommends $1,127,965,000, the same as the 2002 comparable 
level and $127,000,000 more than the budget request. Youth 
Activities, authorized by WIA, consolidates the Summer Youth 
Employment and Training Program under JTPA Title IIB, and Youth 
Training Grants under JTPA Title IIC. In addition to 
consolidating programs, WIA also requires Youth Activities to 
be connected to the One-Stop system as one way to link youth to 
all available community resources. The purpose of Youth 
Activities is to provide eligible youth with assistance in 
achieving academic and employment success through improving 
educational and skill competencies and providing connections to 
employers. Other activities include providing mentoring 
opportunities, opportunities for training, supportive services, 
summer employment opportunities that are directly linked to 
academic and occupational learning, incentives for recognition 
and achievement, and activities related to leadership 
development, citizenship, and community service.
    Youth opportunity grants.--For Youth Opportunity Grants, 
the Committee recommends $225,100,000, the same as the 2002 
comparable level. Youth Opportunity Grants are authorized in 
the Workforce Investment Act. These grants are aimed at 
increasing the long-term employment of youth who live in 
empowerment zones, enterprise communities, and other high-
poverty areas. Surveys conducted by the Department of Labor 
have found employment rates for out-of-school youth as low as 
24 percent in selected high-poverty neighborhoods. Youth 
Opportunity Grants will attempt to dramatically increase these 
employment rates, and thus improve all aspects of life for 
persons living in these communities.
    Job Corps.--For Job Corps, the Committee recommends 
$1,518,550,000. This is $13,610,000 less than the budget 
request, but $59,798,000 more than the 2002 comparable level. 
The Committee applauds Job Corps for establishing partnerships 
with national employers, and encourages Job Corps to continue 
to work with both large employers and small businesses to 
ensure that student training meets current labor market needs. 
Job Corps should continue its efforts to upgrade its vocational 
offerings and curricula to reflect industry standards and skill 
shortages. Job Corps, authorized by WIA, is a nationwide 
network of residential facilities chartered by Federal law to 
provide a comprehensive and intensive array of training, job 
placement and support services to at-risk young adults. The 
mission of Job Corps is to attract eligible young adults, teach 
them the skills they need to become employable and independent, 
and place them in meaningful jobs or further education. 
Participation in the program is voluntary and is open to 
economically disadvantaged young people in the 16-24 age range 
who are unemployed and out of school. Most Job Corps students 
come from disruptive or debilitating environments, and it is 
important that they be relocated to residential facilities 
where they can benefit from the highly structured and carefully 
integrated services provided by the Job Corps program. A 
limited number of opportunities are also available for non-
residential participation.
    The Committee encourages Job Corps to strengthen working 
relationships with work force development entities, including 
employers, that will enhance services to students and increase 
students' career opportunities. The Department is encouraged to 
continue its efforts to meet industry standards in its 
occupational offerings through a multi-year process to review, 
upgrade, and modernize its vocational curricula, equipment, and 
programs in order to create career opportunities for students 
in appropriate growth industries. The Committee also continues 
to encourage the Department of Labor's Employment and Training 
Administration to encourage Job Corps centers to coordinate 
with community-based organizations, such as substance abuse 
treatment centers, in innovative ways.
    The Committee supports the goal of the Workforce Investment 
Act of 1998 to integrate our Nation's many diverse job training 
programs, and its approach of retraining the national character 
of the Job Corps program within the new framework. The 
Committee encourages the Department to continue its work to 
develop national partnerships with major regional and national 
employers to increase employment opportunities for Job Corps 
graduates. The Department should also continue to establish 
connections between Job Corps and State workforce development 
programs, and between Job Corps and other national and 
community partners, to provide the most efficient, cost-
effective services possible.
    Responsible Reintegration for Young Offenders.--The 
Committee recommends $55,000,000 for Responsible Reintegration 
for Young Offenders, the same as the fiscal year 2002 level, to 
address youth offender issues. This large scale WIA Pilot and 
Demonstration initiative will link offenders under age 35 with 
essential services that can help make the difference in their 
choices in the future, such as education, training, job 
placement, drug counseling, drug demand reduction activities, 
and mentoring, in order to reintegrate them into the mainstream 
economy. Through local competitive grants, this program would 
establish partnerships between the criminal justice system and 
local workforce investment systems, complementing a similar 
program in the Department of Justice (DOJ). To maximize the 
impact of these initiatives, the DOL and DOJ funds will be 
targeted to the same communities and populations. An estimated 
10,400 youth will be served, and it is expected that 65 percent 
of program graduates will get jobs, re-enroll in high school, 
or be enrolled in post-secondary education or training.
    Native Americans.--For Native Americans, the Committee 
recommends $57,000,000. This is the same as the 2002 comparable 
level. This program, authorized by WIA, is designed to improve 
the economic well-being of Native Americans (Indians, Eskimos, 
Aleuts, and Native Hawaiians) through the provision of 
training, work experience, and other employment-related 
services and opportunities that are intended to aid the 
participants to secure permanent, unsubsidized jobs.
    Migrant and seasonal farmworkers.--For Migrant and Seasonal 
Farmworkers, the Committee recommends $80,770,000. This is the 
same as the 2002 comparable level. This program, authorized by 
WIA, is designed to serve members of economically disadvantaged 
families whose principal livelihood is derived from migratory 
and other forms of seasonal farmwork, or fishing, or logging 
activities. Enrollees and their families are provided with 
employment training and related services intended to prepare 
them for stable, year-round employment within and outside of 
the agriculture industry.
    There are at least 3 million hard-working migrant and 
seasonal farmworkers in America whose annual incomes are below 
$10,000. At a time when most State budgets are shrinking and 
many of the basic services provided by State and local 
governments are being cut back, the Committee recognizes the 
importance of sustaining a national commitment, dating from 
1964, to help alleviate the chronic seasonal unemployment and 
under-employment that traps many farmworker families in a cycle 
of poverty across generations and that deprives many farmworker 
children of educational opportunities and real prospects for 
better jobs at higher wages. The Committee also recognizes that 
many State and local government officials will be reluctant to 
fund this training and related assistance for this vulnerable 
portion of our Nation's workforce who migrate through many 
States every year, even though the work they perform is 
essential to the economic well-being of our Nation's farmers, 
growers, and small businesses.
    The Committee recommendation of $80,770,000 for activities 
authorized under Section 167 of the Workforce Investment Act is 
reflected in two separate line items on the table accompanying 
the Committee Report: ``Migrant and Seasonal Farmworkers'' and 
``National Activities/Other.'' Under the Migrant and Seasonal 
Farmworkers line item, the Committee recommends $79,751,000. 
The Committee recommendation includes bill language directing 
that $4,786,000 of this amount be used for migrant and seasonal 
farmworker housing grants. The Committee recommends that the 
remaining $74,965,000 be used for State service area grants. 
Within the National Activities/Other line item, the Committee 
recommendation includes $1,019,000 to be used for Section 167 
training, technical assistance and related activities, 
including funds for migrant rest center activities and to 
continue technical assistance services provided by the 
Association of Farmworker Opportunity Programs. Finally, the 
Committee wishes to again advise the Department regarding the 
requirements of the Workforce Investment Act in selecting an 
eligible entity to receive a State service area grant under 
Section 167. Such an entity must have already demonstrated a 
capacity to administer effectively a diversified program of 
workforce training and related assistance for eligible migrant 
and seasonal farmworkers.
    The Committee believes that the Association of Farmworkers 
Opportunity Programs provide valuable technical assistance and 
training to grantees and has distinguished itself as a 
tremendous resource. Its Children in the Fields Campaign 
provides information, education, and technical assistance 
related to child labor in agriculture. The Association also 
provides other assistance related to employment and training 
(including pesticide and other worker safety training for 
children and adults). The Department is encouraged to continue 
the services that the Association provides these areas.
    The Committee requests the Department undertake a study and 
submit a report to the Congress by July 1, 2003 with 
recommendations for eliminating the double standard embodied 
currently in the Fair Labor Standards Act (FLSA) and 
corresponding regulations whereby child farmworkers as young as 
10 years of age can work in large-scale, corporate agriculture 
in the United States at younger ages, for longer hours, and 
under more hazardous conditions than minors age 16 and over 
working in non-agricultural jobs.
    National programs.--This activity includes WIA-authorized 
programs in support of the workforce system including technical 
assistance and incentive grants, evaluations, pilots, 
demonstrations and research, and the Women in Apprenticeship 
Program.
    Technical Assistance/Incentive Grants.--The Committee 
recommends $15,000,000 for the provision of technical 
assistance, staff development, and replication of programs of 
demonstrated effectiveness; as well as incentive grants to each 
State that exceeds State adjusted levels of performance for WIA 
State programs.
    Pilots, Demonstrations, and Research.--The Committee 
recommends $44,881,000, which is $85,268,000 less than the 
fiscal year 2002 level, for grants or contracts to conduct 
research, pilots or demonstrations that improve techniques or 
demonstrate the effectiveness of programs. Within this amount, 
the Committee expects the Department of Labor to conduct a 
comprehensive study on the composition (including past and 
present numbers, as well as future projections) of the U.S. 
textile and apparel industry labor force, including the 
availability of training and textile-related engineering and 
manufacturing programs. The study should include a significant 
review of the impact of lay-offs on the industry, the workers, 
the local communities, and the States and regions involved. The 
Committee expects the Department of Labor to coordinate with 
the Department of Commerce in designing the preparation of this 
report. The Committee requests that the study be completed no 
later than May 1, 2003.
    The Committee is deeply concerned about the ability of the 
28 million Americans who are deaf or hard-of-hearing to be 
informed of critical news and information in the post-9/11/01 
environment. The Committee is aware that court reporting 
schools may not be able to meet the ``unfunded mandate'' set by 
the Telecommunications Act of 1996 to provide closed captioning 
of 100 percent of broadcast programming by January 2006. These 
compelling concerns justify continued Federal support to those 
schools to increase their capacity to attract and train more 
real time writers and to work closely with the broadcasting 
industry to significantly increase the amount of programming 
that is closed captioned.
    The Committee is concerned with the lack of information 
provided to the Committee regarding the performance and 
operation of the Workforce Investment Act (WIA). Further, the 
Committee is concerned that States and local workforce 
investment areas lack the technology to comply with the basic 
performance reporting and operational requirements of the WIA. 
This includes client case management, program performance and 
fiscal reporting and basic job match. The Committee recognizes 
that the private sector has developed and successfully 
implemented such technology on a limited basis on behalf of 
State and local workforce areas. However, the infrastructure 
cost restraints of the WIA have impeded widespread 
implementation. Therefore, the Committee recommends the 
Secretary provide States and local workforce investment areas 
funding to partner with the private sector to pilot such 
technology and determine its benefit to the WIA system.
    Evaluation.--The Committee recommends $9,098,000 to provide 
for the continuing evaluation of programs conducted under WIA, 
as well as of federally-funded employment-related activities 
under other provisions of law.
    Women in Apprenticeship.--The Committee recommends 
$1,000,000 to continue the current level of the Women in 
Apprenticeship and Nontraditional Occupations program. This 
activity provides technical assistance to employers and unions 
to assist them in training, placing, and retraining women in 
nontraditional jobs and occupations.
    National Skills Standards Advisory Board.--The Committee 
concurs with the administration's request not to provide 
additional funding for the Board, the authorization for which 
has expired. Fiscal year 2002 funding for the Board was 
$3,500,000, to remain available until expended.
    The Committee acknowledges the ongoing dialogue between the 
National Skill Standards Board (NSSB) and the Department of 
Labor concerning the future mission funding, and governance of 
the NSSB. If a plan satisfactory to the Labor Department can be 
developed, the Committee would entertain a request to provide 
funds through reprogramming.

            COMMUNITY SERVICE EMPLOYMENT FOR OLDER AMERICANS

Appropriations, 2002....................................    $445,100,000
Budget estimate, 2003...................................     440,200,000
Committee recommendation................................     450,000,000

    The Committee recommends $450,000,000, an increase of 
$9,800,000 over the budget request and $4,900,000 over the 
fiscal year 2002 appropriation for community service employment 
for older Americans. This program, authorized by title V of the 
Older Americans Act, provides part-time employment in community 
service activities for unemployed, low-income persons aged 55 
and over. It is forward-funded from July to June, and the 2003 
appropriation will support the program from July 1, 2003, 
through June 30, 2004. The Committee believes that within the 
title V community service employment for older Americans, 
special attention should be paid to providing community service 
jobs for older Americans with poor employment prospects, 
including individuals with a long-term detachment from the 
labor force, older displaced homemakers, aged minorities, 
limited English-speaking persons, and legal immigrants.
    The program provides a direct, efficient, and quick means 
to assist economically disadvantaged older workers because it 
has a proven effective network--currently operated jointly by 
10 national sponsors and the States--in every State and in 
practically every county. Administrative costs for the program 
are low, and the vast majority of the money goes directly to 
low-income seniors as wages and fringe benefits.
    The program provides a wide range of vital community 
services that would not otherwise be available, particularly in 
low-income areas and in minority neighborhoods. Senior 
enrollees provide necessary and valuable services at Head Start 
centers, schools, hospitals, libraries, elderly nutrition 
sites, senior center, and elsewhere in the community. These 
services would not be available without the program.
    A large proportion of senior enrollees use their work 
experience and training to obtain employment in the private 
sector. This not only increases our Nation's tax base, but it 
also enables more low-income seniors to participate in the 
program.
    The Committee directs the Department to implement the 
grantee responsibility tests under Section 514(d) of the Older 
Americans Act and to conduct a grant competition for only those 
national grantees that fail to be deemed responsible. The 
Committee further directs the Department to implement 
corrective action, as set forth in Section 514(e) of the Older 
Americans Act, for any national grantee failing to meet 
established performance measures. The Committee expects the 
Department will also implement performance measures and 
competition for States as authorized under Section 514(f) of 
the Act.
    The Committee is aware that the administration portion of 
the cost per authorized position in the Title V program has not 
been adjusted since 1981. The Committee therefore directs the 
Department to conduct, in consultation with national and State 
Title V grantees, an analysis to determine the appropriate cost 
per authorized position and to report back its finding and 
recommendations no later than July 1, 2003.
    Finally, the Committee reiterates the concern expressed in 
last year's report regarding balancing the community service 
and employment and training goals of this important program. 
The Committee again expresses its concern that any significant 
increase in job placement goals must be accompanied by 
assurances from the Department to the Committee that sufficient 
skills training resources under the Workforce Investment Act 
will be available to national and State Title V grantees to 
help meet such increased placement goals. The Committee has not 
yet received such assurances.
    The Committee is aware that, prior to enactment of the 
Workforce Investment Act (WIA), the Federal job-training 
program targeted funds specifically to older workers. 
Currently, WIA funds are not targeted for training older 
workers, at a time when the number of older workers is 
increasing significantly. To remain competitive in the labor 
market, older workers must acquire or update their job skills. 
While WIA is designed to meet the needs of all workers, the 
Committee is concerned that the One-Stop Career Centers, funded 
under WIA, may not be adequately meeting the training and 
education needs of older workers. The Committee therefore 
requests that the Department report within 180 days the 
measures it can undertake to ensure training and related 
services, appropriated under WIA, are available to older 
workers.

              FEDERAL UNEMPLOYMENT BENEFITS AND ALLOWANCES

Appropriations, 2002....................................    $415,650,000
Budget estimate, 2003...................................      13,000,000
Committee recommendation................................     415,650,000

    The Committee recommends $415,650,000, the same as the 
fiscal year 2002 level. This consists of $349,500,000 for trade 
adjustment assistance, and $66,150,000 for NAFTA activities. 
The Committee recommendation maintains funding at the current 
level, pending enactment of renewed authorizing legislation. 
Resources related to pending legislation will be considered 
upon its enactment for Federal unemployment benefits and 
allowances. These are entitlement funds.

     STATE UNEMPLOYMENT INSURANCE AND EMPLOYMENT SERVICE OPERATIONS

Appropriations, 2002....................................  $3,779,501,000
Budget estimate, 2003...................................   3,686,543,000
Committee recommendation................................   3,631,903,000

    The Committee recommends $3,631,903,000 for this account. 
This is $54,640,000 below the budget request and $147,598,000 
below the 2002 comparable level. Included in the total 
availability is $3,475,451,000 authorized to be drawn from the 
``Employment Security Administration'' account of the 
unemployment trust fund, and $156,452,000 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 
$2,651,488,000. This includes $2,641,488,000 for State 
Operations, which is $76,200,000 less than the President's 
request and $136,498,000 less than the fiscal year 2002 level. 
The Committee has deleted the request for $76,200,000 related 
to proposed legislation for temporary extended benefits, since 
this cost was previously enacted as part of Public Law 107-147. 
The Committee expects the Department to manage these resources 
to ensure equitable funding to States to handle total workload. 
The Committee recommendation includes $10,000,000 for UI 
national activities, the same as the fiscal year 2002 level and 
the President's request, which is directed to activities that 
benefit the State/Federal unemployment insurance program. The 
bill provides for a contingency reserve amount should the 
unemployment workload exceed an average weekly insured claims 
volume of 4,526,000. This contingency amount would fund the 
administrative costs of unemployment insurance workload over 
the level of 4,526,000 insured unemployed per week at a rate of 
$28,600,000 per 100,000 insured unemployed, with a pro rata 
amount granted for amounts of less than 100,000 insured 
unemployed.
    For the Employment Service grants to States, the Committee 
recommends $796,735,000 which includes $23,452,000 in general 
funds together with an authorization to spend $773,283,000 from 
the ``Employment Security Administration'' account of the 
unemployment trust fund. These funds are available for the 
program year of July 1, 2003, through June 30, 2004.
    The recommendation includes $50,680,000 for national 
activities, an increase of $21,560,000 over the budget request. 
This recommendation restores the $20,560,000 reduction proposed 
in direct funding of the foreign labor certification program, 
rejecting the proposal to finance a portion of this program by 
a direct transfer from H-1B fees. The recommendation also adds 
$1,000,000 over the request to restore the proposed cut in the 
work opportunity tax credit program.
    The recommendation also includes the budget request of 
$113,000,000 for One-Stop Career Centers. This Committee 
recommendation includes funding for America's Labor Market 
Information System, including core employment statistics, 
universal access for customers, improving efficiency in labor 
market transactions, and measuring and displaying WIA 
performance information.
    The recommendation includes $20,000,000 for the Work 
Incentives Grants program, the same as last year's level and 
the President's request, to help persons with disabilities find 
and retain jobs through the One-Stop Career Center system 
mandated by the Workforce Investment Act. Funding will support 
systems building grants intended to ensure that One-Stop 
systems integrate and coordinate mainstream employment and 
training programs with essential employment-related services 
for persons with disabilities.
    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 $21,000,000 for the 
administration of these initiatives, an increase of $1,000,000 
over the budget request, restoring the increased amount 
previously enacted.

        ADVANCES TO THE UNEMPLOYMENT TRUST FUND AND OTHER FUNDS

Appropriations, 2002....................................    $464,000,000
Budget estimate, 2003...................................     463,000,000
Committee recommendation................................     463,000,000

    The Committee recommends $463,000,000, a decrease of 
$1,000,000 below the 2002 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 2003 
advances will be made to the black lung disability trust fund. 
The requested amount is required to provide for loan interest 
payments on Black Lung Trust Fund borrowed amounts.
    The separate appropriations provided by the Committee for 
all other accounts eligible to borrow from this account in 
fiscal year 2003 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 ADMINISTRATION

Appropriations, 2002....................................    $161,276,000
Budget estimate, 2003...................................     172,061,000
Committee recommendation................................     177,642,000

    The Committee recommendation includes $121,032,000 in 
general funds for this account, as well as authority to expend 
$56,610,000 from the ``Employment Security Administration'' 
account of the unemployment trust fund, for a total of 
$177,642,000. This is $16,366,000 greater than the 2002 
comparable level.
    The Committee recommendation concurs with the $5,500,000 
requested increase to provide staff and contract resources for 
performance management and accountability functions. However, 
it recommends an increase of $2,000,000, instead of the 
requested $5,530,000, to administer an expanded national 
employment grants program. The recommendation restores proposed 
reductions in apprenticeship, Job Corps, and other youth 
services administrative activities. The recommendation also 
adds $6,000,000 to restore funding which the budget had assumed 
would come from enactment of authorizing legislation 
redirection H-1B fees for Federal administration expenses.
    General funds in this account provide the Federal staff to 
administer employment and training programs under the Workforce 
Investment Act, the Older Americans Act, the Trade Act of 1974, 
and the National Apprenticeship Act. Trust funds provide for 
the Federal administration of employment security functions 
under title III of the Social Security Act and the Immigration 
and Nationality Act, as amended. Federal staff costs related to 
the Wagner-Peyser Act in this account are split 97 percent to 3 
percent between unemployment trust funds and general revenue, 
respectively.

              Pension and Welfare Benefits Administration


                         SALARIES AND EXPENSES

Appropriations, 2002....................................    $110,932,000
Budget estimate, 2003...................................     117,044,000
Committee recommendation................................     114,044,000

    The Committee recommendation provides $114,044,000 for this 
account, which is $3,112,000 above the 2002 comparable level, 
and $3,000,000 less than the budget request.
    This recommendation provides sufficient funding to offset 
the impact of inflation, but it does not include resources for 
the requested increase for enforcement and compliance 
activities. Instead, $3,000,000 has been provided to the 
Departmental Management Salaries and Expenses account to 
establish a new Office of Pension Participant Advocacy thereby 
providing the President's request for this activity.
    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.

                  Pension Benefit Guaranty Corporation

    The Corporation's estimate for fiscal year 2003 includes 
benefit payments of $1,325,000,000, multiemployer financial 
assistance of $10,000,000, administrative expenses limitation 
of $13,050,000, and services related to terminations expenses 
of $179,844,000.
    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 $100,000,000 from the Treasury. The primary 
purpose of the Corporation is to guarantee the payment of 
pension plan benefits to participants if covered plans fail or 
go out of existence.

                  Employment Standards Administration


                         SALARIES AND EXPENSES

Appropriations, 2002....................................    $370,236,000
Budget estimate, 2003...................................     294,315,000
Committee recommendation................................     384,096,000

    The Committee recommendation includes $384,096,000 for this 
account. This is $13,860,000 above the 2002 comparable level 
and $89,781,000 above the budget request. The bill contains 
authority to expend $2,029,000 from the special fund 
established by the Longshore and Harbor Workers' Compensation 
Act; the remainder are general funds. In addition, an amount of 
$31,987,000 is available by transfer from the black lung 
disability trust fund. This is the same as the request and 
$610,000 above the 2002 comparable level.
    This recommendation provides sufficient funding to offset 
the impact of inflation, preventing the reduction in full-time 
equivalent staffing assumed in the budget request. It rejects 
the administration's proposed legislation that would have 
established a surcharge on the amount billed to Federal 
agencies for workers' compensation benefits to finance Labor 
Department administrative expenses of $86,442,000. It restores 
proposed program reductions, including the equal pay 
initiative, but does not include requested resources for a 
program increase under the Labor-Management Reporting and 
Disclosure Act.
    The Committee has been informed that the Department of 
Labor is considering changes in the longstanding annual 
financial reporting requirements imposed on labor unions under 
the Labor Management Reporting and Disclosure Act. These 
revisions would reportedly require large and small unions alike 
to collect and report detailed and minute information, much of 
which would duplicate information unions must already report to 
their members, the public, and the Government. The financial 
burden of collecting this duplicative information could divert 
members' dues and over burden many small local unions run by 
volunteers. The Committee directs the Secretary of Labor not to 
revise, amend, or change in any way, whether by rulemaking or 
otherwise, the reporting requirements imposed on labor 
organizations under the Labor Management Reporting and 
Disclosure Act. Further, the Committee expects the Secretary to 
provide the Committee her rationale for any reporting 
requirement changes being considered by the administration.
    The President's budget included a legislative proposal 
under the jurisdiction of the Senate Committee on Health, 
Education, Labor, and Pensions to charge individual agencies, 
starting in fiscal year 2003, the administrative cost of the 
Federal Employees' Compensation Act (FECA) program. Currently 
Federal agencies are budgeted for and billed each year for 
monetary and medical benefits that have been paid to their 
employees under FECA, while the program's discretionary 
administrative costs are financed in the Department of Labor 
(DOL). The authorizing committee has not acted on this 
legislation, therefore the Senate Appropriations Committee will 
continue to fund this administrative cost through this account.
    The Employment Standards Administration is involved in the 
administration of numerous laws, including the Fair Labor 
Standards Act, the Immigration and Nationality Act, the Migrant 
and Seasonal Agricultural Workers' Protection Act, the Davis-
Bacon Act, the Family and Medical Leave Act, the Federal 
Employees' Compensation Act [FECA], the Longshore and Harbor 
Workers' Compensation Act, and the Federal Mine Safety and 
Health Act (black lung).
    The Committee supports expansion of the equal pay 
initiative, which helps business improve the way they pay their 
employees, and assists in education about the importance of 
equal pay.

                            SPECIAL BENEFITS

Appropriations, 2002....................................    $121,000,000
Budget estimate, 2003...................................     163,000,000
Committee recommendation................................     163,000,000

    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 recommendation includes $163,000,000, the same as the 
budget request and an increase of $42,000,000 above the 2002 
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 2003 is 
$3,326,393,000, an increase of $108,000,000 above the 2002 
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 use fair share collections to fund capital 
investment projects and specific initiatives to strengthen 
compensation fund control and oversight.

       ENERGY EMPLOYEES OCCUPATIONAL ILLNESS COMPENSATION PROGRAM

Appropriations, 2002....................................    $135,665,000
Budget estimate, 2003...................................     104,867,000
Committee recommendation................................     104,867,000

    The Committee recommends $104,867,000 for this account in 
2003. This is the same as the President's request and 
$30,798,000 below 2002.
    The mission of the Energy Employees Occupational Illness 
Compensation Program is to deliver benefits to eligible 
employees and former employees of the Department of Energy, its 
contractors and subcontractors or to certain survivors of such 
individuals, as provided in the Energy Employees Occupational 
Illness Compensation Program Act. The mission also includes 
delivering benefits to certain beneficiaries of the Radiation 
Exposure Compensation Act. Benefit costs of $758,000,000 are 
anticipated in fiscal year 2003.
    The Energy Employees Occupational Illness Compensation 
Program provides benefits authorized by the Energy Employees 
Occupational Illness Compensation Program Act. The program went 
into effect on July 31, 2001. The Department of Labor's Office 
of Workers' Compensation Programs within the Employment 
Standards Administration is responsible for adjudicating and 
administering claims filed by employees or former employees (or 
their survivors) under the Act.

                    BLACK LUNG DISABILITY TRUST FUND

Appropriations, 2002 (Definite).........................  $1,036,115,000
Budget estimate, 2003:
    (Definite)..........................................      55,629,000
    (Indefinite)........................................     979,371,000
Committee recommendation:
    (Definite)..........................................      55,629,000
    (Indefinite)........................................     979,371,000

    The Committee recommends $1,035,000,000 for this account in 
2003, of which $55,629,000 is definite budget authority and 
$979,371,000 is indefinite budget authority. In total, this is 
a decrease of $934,000 below the 2002 comparable level and the 
same as the administration request. This represents a change in 
the appropriation language beginning in fiscal year 2002 for 
the Black Lung Disability Trust Fund. This change will 
eliminate the need for drawdowns from the subsequent year 
appropriation in order to meet current year compensation, 
interest, and other benefit payments. The appropriation 
language will continue to provide definite budget authority for 
the payment of administrative expenses for the operation and 
administration of the Trust Fund.
    The total amount available for fiscal year 2003 will 
provide $360,371,000 for benefit payments, and $55,629,000 for 
administrative expenses for the Department of Labor. Also 
included is $619,000,000 for interest payments on advances. In 
fiscal year 2002, comparable obligations for benefit payments 
are estimated to be $388,283,000 while administrative expenses 
are $54,651,000. In fiscal year 2002, the interest payments on 
advances is estimated to be $593,000,000.
    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 49,000 people will be receiving black 
lung benefits financed from the trust fund by the end of the 
fiscal year 2003. This compares with an estimated 53,250 
receiving benefits in fiscal year 2002.
    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.

             Occupational Safety and Health Administration


                         SALARIES AND EXPENSES

Appropriations, 2002....................................    $443,498,000
Budget estimate, 2003...................................     437,019,000
Committee recommendation................................     469,604,000

    The Committee recommendation includes $469,604,000 for this 
account. This is an increase of $32,585,000 over the budget 
request and an increase of $26,106,000 above the 2002 
comparable level. This agency is responsible for enforcing the 
Occupational Safety and Health Act of 1970 in the Nation's 
workplaces.
    This recommendation provides sufficient funding to offset 
the impact of inflation, preventing the reduction in full-time 
equivalent staffing assumed in the budget request.
    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.
    Within the amount for Safety and Health Standards, bill 
language specifies that $2,000,000 of the increased funding is 
only available to provide for the reissuance of a rule relating 
to ergonomics. It is the Committee's expectation that these 
funds expedite activities leading to reissuance of such a rule 
within the timeframe and according to the parameters specified 
in S. 2184.
    The Committee is concerned that OSHA has halted action on 
or delayed many important regulatory initiatives on major 
workplace hazards, including chemical safety regulations to 
prevent reactive chemical explosions which have killed 108 
workers over the past two decades, the extension of confined 
space entry requirements to the construction industry where 87 
workers were killed in confined space incidents during the 
1990's, and regulations to limit exposure to cancer causing 
chemicals perchoroetlylene, hexavalent chromium and 
metalworking fluids. At the same time, the administration has 
proposed to reduce funding for its standards activities and the 
Committee has been informed that the agency is proposing to 
redirect a quarter of its standard setting resources to 
voluntary initiatives. The Committee believes that the 
development and issuance of safety and health standards is one 
of the core responsibilities of OSHA, and has provided funding 
in the bill to maintain OSHA's current level of activity for 
safety and health standards (not including funds for the 
development of a new ergonomics standard) and language to 
ensure that funds for the setting of occupational safety and 
health standards are used for this purpose.
    The Committee retains language carried in last year's bill 
effectively exempting farms employing 10 or fewer people from 
the provisions of the act except those farms having a temporary 
labor camp. The Committee also retains language exempting small 
firms in industry classifications having a lost workday injury 
rate less than the national average from general schedule 
safety inspections. These provisions have been in the bill for 
many years.
    The Committee believes that OSHA's worker safety and health 
training and education programs, including the grant program 
that supports such training, are a critical part of a 
comprehensive approach to worker protection. The Committee is 
concerned that OSHA cut funding to help establish ongoing 
worker safety and health training programs and has provided 
$7,175,000 in additional funds to restore the Susan Harwood 
training grant program to $11,175,000. Bill language specifies 
that no less than $3,200,000 shall be used to maintain the 
existing institutional competency building training grants, 
provided that grantees demonstrate satisfactory performance.
    The Committee has provided funding to maintain the State 
consultation grant program and expects that this program will 
continue to be targeted to provide compliance assistance to 
small businesses.
    The Committee 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 expanding participation in the programs, and promoting 
prompt review and processing of applications is particularly 
noteworthy. The Committee expects OSHA to continue to place 
high priority on the VPP. Cooperative voluntary programs, 
especially the VPP, are an important part of OSHA's ability to 
assure worker safety and health and should be administered in 
conjunction with an effective strong enforcement program.
    The Committee also intends that the Office of Regulatory 
Analysis continued to be funded as close as possible to its 
present level.
    In last year's report, the Committee noted that OSHA had 
conducted a study on the effectiveness of the State 
consultation program--the first such evaluation of the program 
since it was initiated in 1977--and that a draft report had 
been prepared. The agency subsequently stated that it planned 
to revise and finalize the report for publication in March 
2002. However, the report still has not been received; 
therefore, OSHA is directed to submit this report to the 
Committee no later than September 18, 2002.

                 Mine Safety and Health Administration


                         SALARIES AND EXPENSES

Appropriations, 2002....................................    $253,932,000
Budget estimate, 2003...................................     254,323,000
Committee recommendation................................     261,841,000

    The Committee recommendation includes $261,841,000 for this 
account. This is $7,909,000 more than the 2002 comparable 
level, and $7,518,000 more than the budget request.
    This recommendation provides sufficient funding to offset 
the impact of inflation, preventing the reduction in full-time 
equivalent staffing assumed in the budget request.
    This agency insures the safety and health of the Nation's 
miners by conducting inspections and special investigations of 
mine operations, promulgating mandatory safety and health 
standards, cooperating with the States in developing effective 
State programs, and improving training in conjunction with 
States and the mining industry.
    In addition, bill language is included to allow the 
National Mine Health and Safety Academy to collect not to 
exceed $750,000 for room, board, tuition, and the sale of 
training materials to be available for mine safety and health 
education and training activities. Bill language also allows 
MSHA to retain up to $1,000,000 from fees collected for the 
approval and certification of equipment, materials, and 
explosives for use in mines, and may utilize such sums for such 
activities.
    The Committee is aware that in October 2001 the National 
Academy of Sciences (NAS) released a report on recommendations 
to improve the safety of coal waste impoundments. The Committee 
notes that the NAS report includes recommendations on actions 
that could be taken, primarily by the Mine Safety and Health 
Administration (MSHA) and the Office of Surface Mining (OSM) to 
improve the design process for coal slurry impoundments; to 
improve mapping of mines and the characterization of sites of 
existing and future impoundments; to improve the assessment of 
mitigation of risks associated with impoundments; and to assess 
alternative options for these impoundments. In recognizing the 
public safety and environmental threats that these impoundment 
failures pose, the Committee directs MSHA and OSM to provide 
the Committee with a study, no later than January 15, 2003, on 
specific actions the respective agencies are taking to 
implement the recommendations contained in the October 2001 NAS 
report, and on specific actions taken to address failures and 
potential failures which have occurred since October 11, 2000.

                       Bureau of Labor Statistics


                         SALARIES AND EXPENSES

Appropriations, 2002....................................    $475,431,000
Budget estimate, 2003...................................     498,164,000
Committee recommendation................................     498,164,000

    The Committee includes $498,164,000 for this account, the 
same as the budget request and $22,733,000 more than the 2002 
comparable level. This includes $72,029,000 from the 
``Employment Security Administration'' account of the 
unemployment trust fund, and $426,135,000 in Federal funds. 
Within this amount, the Committee recommendation includes 
$1,500,000 to conduct focused research on the causes and 
prevention of job-related injuries and illnesses. This funding 
level will cover the agency's built in increases.
    The Bureau of Labor Statistics is the principal fact 
finding agency in the Federal Government in the broad field of 
labor economics.
    In addition to the amounts above, the Committee has 
included bill language making $10,280,000 of the BLS allowance 
for Occupational Employment Statistics available on a program 
year basis. This action is taken in order to maintain the 
funding stream established in the ETA State Unemployment 
Insurance and Employment Service Operations account, through 
which the program was previously funded, thereby avoiding a 
programmatic disruption at the State level.

                      Office of Disability Policy

Appropriations, 2002....................................     $38,056,000
Budget estimate, 2003...................................      47,015,000
Committee recommendation................................      47,015,000

    The Committee recommends $47,015,000 for this account in 
2003. This is the same as the President's request and 
$8,959,000 above 2002.
    Congress created the Office of Disability Employment Policy 
(ODEP) in the Department of Labor's fiscal year 2001 
appropriation. Programs and staff of the former President's 
Committee on Employment of People with Disabilities (PCEPD) 
have been integrated into this new office.
    The ODEP mission, under the leadership of an Assistant 
Secretary, is to bring a heightened and permanent long-term 
focus to the goal of increasing employment of persons with 
disabilities. This will be achieved through policy analysis, 
technical assistance, and development of best practices, as 
well as outreach, education, constituent services, and 
promoting ODEP's mission among employers.
    The increase includes: an expansion of One-Stop 
accessability grants, to support the process of implementing 
the ``ticket to work'' through One-Stop Career Centers; 
expanding the provision of grants aimed at developing and 
implementing innovative programs for moving youth with 
disabilities from school to work; and funding an Olmstead grant 
program to assist persons with significant disabilities in 
making the transition from institutional settings to the 
community and employment.
    The Committee recommendation includes $500,000 for the 
establishment of a special, structured, internship program to 
support undergraduate students with disabilities in their 
efforts to pursue careers in public service. The program would 
be carried out under a partnership between the Secretary, the 
Congress and the Judiciary, groups representing citizens with 
disabilities and colleges and universities that would provide 
opportunities for their students to participate in this 
innovative program for undergraduate students with 
disabilities.

                        Departmental Management


                         SALARIES AND EXPENSES

Appropriations, 2002....................................    $385,601,000
Budget estimate, 2003...................................     317,934,000
Committee recommendation................................     396,623,000

    The Committee recommendation includes $396,623,000 for this 
account, which is $78,689,000 more than the budget request and 
$11,022,000 more than the 2002 comparable level. In addition, 
an amount of $22,952,000 is available by transfer from the 
black lung disability trust fund, which is the same as the 
budget request.
    The primary goal of the Department of Labor is to protect 
and promote the interests of American workers. The departmental 
management appropriation finances staff responsible for 
formulating and overseeing the implementation of departmental 
policy and management activities in support of that goal. In 
addition, this appropriation includes a variety of operating 
programs and activities that are not involved in departmental 
management functions, but for which other salaries and expenses 
appropriations are not suitable.
    The Committee recommendation reflects major Committee 
priorities, including international labor affairs, and pension 
participant advocacy.
    The Committee recommendation includes $26,468,000 for 
Executive Direction, the same as the budget request.
    The Committee recommends $10,973,000 for the Women's 
Bureau, an increase of $2,604,000 over the budget request and 
$808,000 above the fiscal year 2002 level. The Committee urges 
the Women's Bureau to provide increased support for effective 
programs such as ``Women Work!'', to provide technical 
assistance and training on programming for women in transition, 
as well as Pay Equity initiatives.
    Bill language specifies that not less than $3,000,000 is 
provided to establish an Office of Pension Participant Advocacy 
within the Office of the Secretary at the Department of Labor. 
The Committee believes that protecting and promoting the rights 
of workers in retirement plans is central to the mission of the 
Department of Labor. The Committee is concerned by the lack of 
protection for participants in private retirement plans that 
have been highlighted by recent financial failures. The 
Committee believes that it is necessary for there to be an 
office within the Federal Government to advise both Congress 
and the Administration on necessary changes in policies to 
correct problems that affect participants. In addition, there 
is a need to coordinate public and private efforts to assist 
participants and provide them with meaningful information. 
Although several Federal agencies have oversight of pension 
plans--the PBGC insures terminated defined benefit plans and 
the PWBA has traditionally focused on protecting the integrity 
of pension funds--none have traditionally sought to protect the 
retirement security interests of American workers. For this 
reason, the Committee has chosen to include funds for the 
express purpose of creating an office within this agency to 
identify needed changes in pension policies, and gaps in data 
on pension plans and their participants.
    The Committee recommends $148,015,000 for the Bureau of 
International Labor Affairs, the same level of funding as 
provided in fiscal year 2002.
    Of this amount, the Committee's recommendation includes 
$82,000,000 to sustain important U.S. commitments to restore 
hope and to improve the lives of more than 250 million 
defenseless child laborers at work in today's global economy. 
The United States was the third nation, to ratify ILO 
Convention #182 for the Elimination of the Worst Forms of Child 
Labor, just months after its unprecedented unanimous adoption 
in 1999. Having done so, the Committee recognizes an on-going 
obligation to provide supplementary resources to assist 
developing countries especially to remove children from the 
worst forms of child labor. $45,000,000 of that sub-total shall 
constitute the U.S. contribution to sustain and to extend to 
more countries in waiting the successful efforts of the ILO's 
International Program for the Elimination of Child Labor 
(IPEC). The remaining $37,000,000 is for bilateral assistance 
to expand upon the program initiated by the Department in 
fiscal year 2001 to help ensure access to basic education for 
the growing number of children removed from the worst forms of 
child labor in impoverished nations where abusive and 
exploitative child labor is most acute; however, the Secretary 
may transfer $14,000,000 of this sub-total to USAID's ``Basic 
Education and Policy Support Initiative'' for complementary 
projects. The Committee notes that the United States was a 
strong and active supporter of the Dakar Declaration of 2000, 
including the commitment therein to help achieve universal 
access to basic education for all of the world's children by 
2015. Accordingly, the Committee views this program to be a 
vital component for fulfilling this on-going commitment and 
firmly believes that affording access to basic education is 
also the single most effective means to curb the worst forms of 
child labor, wherever they exist. In programming these funds, 
the Committee directs the Department to consult with our 
country's labor attaches and labor reporting officers abroad, 
to coordinate and work more closely with USAID and IPEC 
officials, and to also make use of non-governmental 
organizations and trade unions, when appropriate, to promptly 
and economically steer these funds to where they benefit the 
most child laborers who are at the greatest risk.
    The Committee finds it to be inexcusable that ILAB has 
failed to provide the Congress with several overdue reports 
reaching as far back as fiscal year 1998. These failures leave 
the Department in violation of key provisions of the Trade and 
Development Act of 2000, for example, and cripple our Federal 
Government's capacity to ensure international compliance with 
the child labor requirements of that law. They also deprive the 
Committee as well as the Department of valuable and timely 
information with which to make more informed workers rights 
policy judgments ad funding decisions of this new era of rapid, 
global economic integration. The Committee directs the 
Secretary of Labor to take immediately action to ensure that 
the Department of Labor is more responsive to requests for 
reports from the Bureau of International Labor Affairs.
    The Committee recognizes that combating abusive children 
labor and promoting greater respect for other internationally-
recognized worker rights and core labor standards are crucial 
to spreading the benefits of trade and investment more broadly 
within as well as among all trading nations. Accordingly, the 
Committee further recommends $20,000,000 for multilateral 
technical assistance, and $17,000,000 for bilateral assistance 
to enable developing countries in particular to strengthen 
governmental capacity to enforce national labor laws and 
protect internationally-recognized worker rights, to implement 
core labor standards, and to develop policies to assist workers 
who are adversely affected by shifts in trade and investment 
flows, structural adjustments, and macroeconomic changes within 
national economies and the global economy respectively.
    The Committee also deems it very important that ILAB deepen 
and improve its permanent capacity to compile and report to the 
Congress annually on the extent to which each foreign country 
that has trade and investment agreements with the United States 
enforces internationally-recognized worker rights as required 
under multiple U.S. laws and promotes core labor standards as 
embodied in the ILO Declaration on Fundamental Principles and 
Rights at Work as adopted and reaffirmed in 1998. The Committee 
expects $5,000,000 to be spent for this purpose. The Committee 
recognizes that it may be necessary to build ILAB capacity over 
a period of 2 years and, for the Department to tap private 
sector expertise from knowledgeable employer, trade union, and 
non-governmental organizations with their own presence or in-
country partners on the ground in foreign countries.
    Finally, the Committee requests that ILAB undertake and 
complete a study and report to the Congress by September 30, 
2003 on government-wide implementation of Executive Order No. 
13126 prohibiting the acquisition and procurement of any 
products mined, produced, or manufactured with any forced or 
indentured child labor and compliance with this order by all 
civilian and military agencies. In prior studies ad reports to 
the Congress, the Department has identified and presented 
evidence of the use of forced or indentured child labor in the 
production of at least 45 products in at least 25 foreign 
countries and those findings have been further corroborated by 
the U.S. State Department in its annual human rights reports to 
the Congress. Nevertheless, the Department, in coordination 
with the General Services Administration, inexplicably only 
included 11 products in two foreign countries when the final 
list of tainted products was published in the Federal Register 
for the first time on January 18, 2001. This study should 
explain in detail why so few products and countries have been 
included on the current list of procurement prohibitions, given 
that the Labor Department, State Department, and Customs 
Service within the Treasury Department have identified 
collectively a much larger list of goods produced in many more 
foreign countries they have reason to believe were mined, 
produced, or manufactured using forced or indentured child 
labor. It should also include recommendations to improve 
government-wide compliance with Executive Order No. 13126, to 
include services within its scope where there is reason to 
believe thee is forced or indentured child labor involved, and 
to award Federal procurement preferences to reward companies 
and industries that do not do business with any foreign or 
domestic producers who use forced, indentured, or abusive child 
labor.
    The Committee concurs with the request to provide 
$10,000,000 for HIV/AIDS workplace education. The Committee 
expects the Department to work through the ILO to most 
effectively program the appropriated funds. The Committee 
previously directed that ILAB work through the ILO to 
effectively program funds provided in fiscal year 2002 to 
global workplace-based education and prevention programs. In 
fiscal year 2003, the Committee recommendation includes 
$10,000,000 solely for the purpose of providing the ILO with 
assistance to conduct global workplace-based HIV-AIDS education 
and prevention programs. For other ILAB programs, including 125 
FTE for Federal Administration, the Committee recommends 
$14,282,000.
    Acknowledging the need to upgrade the information 
technology capability in the Department of Labor, the Committee 
provides $55,000,000 for the information technology fund, and 
$5,884,000 for management cross cut activities. The total 
provided includes support for cross-cutting investments such as 
common office automation suite implementation, architecture 
requirements, and web services as well as human resource 
management.
    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.

                    Veterans Employment and Training

Appropriations, 2002....................................    $212,624,000
Budget estimate, 2003...................................     210,337,000
Committee recommendation................................     218,087,000

    The Committee recommendation includes $218,087,000 for this 
account, including $26,550,000 in general revenue funding and 
$191,537,000 to be expended from the ``Employment Security 
Administration'' account of the unemployment trust fund. This 
is $7,750,000 more than the budget request and $5,463,000 above 
the 2002 comparable level.
    For State grants the bill provides $83,615,000 for the 
Disabled Veterans Outreach Program and $79,253,000 for the 
Local Veterans Employment Representative Program. These amounts 
are each $2,000,000 above the budget request and the fiscal 
year 2002 enacted level.
    For Federal administration, the Committee recommends 
$28,669,000, an increase of $2,000,000 over the budget request 
and $713,000 more than the fiscal year 2002 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 recommendation 
includes $2,000,000, the same as the fiscal 2002 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 recommendation includes $19,000,000 for the 
Homeless Veterans Program, an increase of $1,500,000 over the 
budget request. Also included is $7,550,000 for the Veterans 
Workforce Investment Program, an increase of $250,000 above the 
budget request and the same as the fiscal year 2002 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. It does not 
authorize transfer of any activities to the Department of 
Veterans Affairs, as proposed in the budget request.

                    Office of the Inspector General

Appropriations, 2002....................................     $56,860,000
Budget estimate, 2003...................................      62,256,000
Committee recommendation................................      59,756,000

    The bill includes $59,756,000 for this account, $2,500,000 
less than the budget request and $2,896,000 above the 2002 
comparable level. This funding will cover the agency's built-in 
increases, as well its proposed unemployment insurance 
initiative. It does not include the requested $2,500,000 
increase which was to be used for expansion of the Office of 
Labor Racketeering. The bill includes $54,159,000 in general 
funds and authority to transfer $5,597,000 from the 
``Employment Security Administration'' account of the 
unemployment trust fund. In addition, an amount of $334,000 is 
available by transfer from the black lung disability trust 
fund.
    The Office of the Inspector General [OIG] was created by 
law to protect the integrity of departmental programs as well 
as the welfare of beneficiaries served by those programs. 
Through a comprehensive program of audits, investigations, 
inspections, and program evaluations, the OIG attempts to 
reduce the incidence of fraud, waste, abuse, and mismanagement, 
and to promote economy, efficiency, and effectiveness.

                           General Provisions

    General provision bill language is included to:
    Prohibit the use of Job Corps funding for compensation of 
an individual at a rate in excess of Executive Level II (sec. 
101).
    Permit transfers of up to 1 percent between appropriations 
(sec. 102).
    Prohibit funding for the procurement of goods and services 
utilizing forced or indentured child labor in industries and 
host countries already identified by the Labor Department (sec. 
103 in accordance with Executive Order 13126).
    Authorize funds to be appropriated for job training for 
workers involved in construction projects funded through the 
Denali Commission (sec. 104)..

           TITLE II--DEPARTMENT OF HEALTH AND HUMAN SERVICES

              Health Resources and Services Administration

                     HEALTH RESOURCES AND SERVICES

Appropriations, 2002....................................  $6,080,551,000
Budget estimate, 2003...................................   5,365,404,000
Committee recommendation................................   6,175,402,000

    The Committee provides an appropriation of $6,175,402,000 
for health resources and services. This is $809,998,000 more 
than the administration request and $94,851,000 more than 
fiscal year 2002.
    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.

                             HEALTH CENTERS

    The Committee provides $1,533,570,000 for the health 
centers, which is $190,000,000 more than fiscal year 2002 level 
and $75,706,000 above the administration request for this group 
of programs, which include community health centers, migrant 
health centers, health care for the homeless, and public 
housing health service grants.
    In fiscal year 2003, community, migrant, public housing and 
homeless Health Centers will provide primary health care 
services to more than 12,000,000 people. Health Centers serve 
indigent urban and underserved rural clients, including many 
uninsured patients. From 1999 to 2001, the number of uninsured 
seeking care at Health Centers increased by 500,000 for a total 
of 4.2 million or about 40 percent of the patient population in 
2001. In addition, millions of poor, minority, or isolated 
people, who have some health insurance coverage, continue to 
encounter serious difficulties in getting access to health care 
due to income or distance barriers. For many of these 
Americans, Health Centers are the only source of primary and 
preventive health care. Located in more than 3,500 rural and 
urban medically-underserved communities around the Nation, 
Health Centers have proven to be a cost-effective and efficient 
source of care for the underserved. By providing access to 
basic health services, Health Centers annually save the health 
care system billions of dollars in reduced use of costly 
emergency room, specialty, and hospital inpatient care.
    The Committee does not set aside any additional 
appropriations for loan guarantee authority under Section 
330(d) or Part A of Title XVI of the Public Health Service Act. 
The Committee intends that the $14,000,000 of subsidy authority 
appropriated in fiscal year 1997 and fiscal year 1998, making 
$160,000,000 available for loan guarantees, continue to be 
available for guarantees of both loan principal and interest in 
accordance with the original allocations.
    The Committee limits the amount available for payment of 
claims under the Federal Tort Claims Act to $50,000,000, which 
is $25,000,000 more than the administration request and 
$35,000,000 more than the amount provided for last year. The 
Committee recognizes the tremendous value of this program for 
health centers and as new health centers become covered, and 
past claims are settled, payments have risen accordingly.

Community health centers

    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 67 percent have incomes below the poverty 
line.
    The Committee is pleased with the process HRSA has used to 
fund new start applications and also the expeditious manner in 
which the first round of funding was allocated. Adequate 
funding is provided to ensure that at least 30 new starts, 60 
new sites, and 80 project expansions occur in 2003. However, 
the Committee expects HRSA to give priority to areas of the 
country that currently have few health centers and significant 
numbers of underserved populations not currently served by 
health centers, especially minority communities and rural and 
frontier areas.
    Although the Committee continues to support the expansion 
of the health centers program to double the number of patients 
served, the Committee is concerned that current funding 
methodologies may not recognize the increased cost of providing 
services for current patients at existing health centers. The 
Committee expects HRSA to use a portion of the increased 
funding provided to increase support for existing health 
centers based on performance-related criteria separate from the 
funding of new service site and service expansion applications.
    The Committee is concerned that Federal community health 
center funds are often not available to small, remote 
communities in Alaska, Hawaii and other similar States because 
the population base is too small. Many of these communities 
have no health service providers and are forced to travel long 
distances by boat or plane even in emergency situations. The 
Committee is aware that efforts are now underway to double 
community health center funding to address the growing number 
of uninsured persons in this country, but, without new 
approaches to providing health services, many will not benefit 
from the proposed increases in funding. The Committee applauds 
the agency for its initiatives such as the ``Alaska Frontier 
Health Plan,'' and encourages the agency to continue and expand 
its efforts with this program.
    The Committee is concerned by the small percentage of 
Illinois' medically-under-served population that presently have 
access to community or migrant health center services. The 
Committee expects HRSA to take steps to address this services 
deficit in fiscal year 2003.

School-based health centers

    This program provides grants for comprehensive primary and 
preventive health care services and health education to at-risk 
and medically underserved children and youth. Grants are 
awarded to public or private, nonprofit, community-based health 
care providers. Through agreements with a local school or 
school system, the health care entity provides the services in 
the school building or on school grounds.

Migrant health program

    The program helps provide culturally sensitive 
comprehensive primary care services to migrant and seasonal 
farm workers and their families. Over 80 percent of the centers 
also receive funds from the community health centers program.

Health care for the homeless

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

Public housing health service grants

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

Native Hawaiian health care

    The Committee again includes the legal citation in the bill 
for the Native Hawaiian Health Care Program. The Committee has 
included sufficient funding so that health care activities 
funded under the Native Hawaiian Health Care Program can be 
supported under the broader community health centers line. The 
Committee expects that not less than $9,000,000 be provided for 
these activities in fiscal year 2002.
    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.

Other Native Hawaiian and Pacific Islander health issues

    The Committee remains committed to the concept of a 
demonstration project for American Samoans in Hawaii at the 
Waimanalo Health Center that will integrate social services, 
include traditional health, prevention and disease management, 
and address the disparities in health status among native 
Hawaiians and other minority populations.
    In addition, as emphasized last year, the Committee 
strongly supports the establishment of a Center of Excellence 
for Indigenous Health and Healing at the University of Hawaii 
and other schools that serve native peoples including American 
Indians, Alaska Natives and Pacific Islanders. The 
incorporation of traditional medicine and healing practices 
into the training of medical, nursing, social work, psychology, 
pharmacy and public health students will not only advance these 
disciplines but also enhance the health care services delivered 
to these populations.
    The Committee believes that community health centers are a 
critical source of care for the underserved, particularly in 
remote rural areas in States such as Alaska and Hawaii. To 
facilitate the development of such centers in these and other 
States with low-income persons living in extremely remote 
areas, the Committee recommends that HRSA examine its 
regulations and applications procedures to ensure they are not 
unduly burdensome but are appropriately flexible to meet the 
needs of these communities. New health centers in remote 
communities are needed.
    Again, the Committee observes that the State of Hawaii and 
Pacific Basin Region are experiencing an acute shortage of 
doctorally prepared pharmacists, and there is no school of 
pharmacy in the State. Unique to Hawaii is the fact that much 
of its population comes from the pacific basin region and use 
health interventions that are unique to that part of the world. 
Therefore, the Committee again urges HRSA to develop a pharmacy 
program at the University of Hawaii/Hilo that includes in its 
curriculum a strong clinical focus on pacific basin region 
culture and traditional interventions.
    The Committee recognizes the important service done by the 
Molokai Health System on that remote island. This is an 
exemplary facility. Its environment provides opportunities to 
research outcomes of new interventions, evaluate culturally 
relevant health education, train providers on caring for ethnic 
populations and integrate non-Western health treatments. The 
leadership of Molokai has also encouraged the collaboration 
among diverse health professionals and the use of technological 
advances such as telehealth and telemedicine and video 
consultations. Given this history of success in meeting the 
needs of its unique community, the Committee strongly 
recommends that Molokai General Hospital be designated as a 
Center of Excellence on the provision of health care in rural 
areas.

National Health Service Corps: Field placements

    The Committee provides $46,498,000 for field placement 
activities, which is $8,000 less than the fiscal year 2002 
level and the same as 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.

National Health Service Corps: Recruitment

    The Committee provides $142,918,000 for recruitment 
activities, which is $43,929,000 more than the fiscal year 2002 
level and the same as 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 support multi-year, rather 
than single-year, commitments.
    The Committee applauds the President for building on the 
Committee's Rural Health Initiative from the previous fiscal 
year by proposing a needed increase for this program. The 
Committee is again increasing funding for field placements and 
recruitment to address growing concerns about primary care 
provider shortages in rural and underserved areas. The 
Committee strongly supports these programs because of their 
success in recruiting, training, and retaining well-trained 
providers in these areas. The Committee is aware that providers 
who train in rural and underserved areas are more likely to 
elect to practice in those areas.

                           HEALTH PROFESSIONS

    The Committee provides $160,000,000 for health professions 
programs under Title VII of the Public Health Services Act, 
which is $135,221,000 less than the fiscal year 2002 level and 
$149,000,000 more than the administration request for these 
programs.
    The Committee is disappointed in the administration's 
decision to eliminate or cut nearly every Health Profession 
program under Title VII of the Public Health Services Act. The 
Committee attempted to restore funding for these programs to 
the degree budget limitations allowed. However, despite these 
limitations, the Committee urges the administration to fund all 
Title VII rural programs at no less than the fiscal year 2002 
level.
    By enhancing the cultural competency and diversity of the 
health care workforce, the Title VII programs fill a unique 
role in the training of the health care providers who serve our 
neediest populations. The Committee believes that Title VII 
programs are valuable mechanisms for educating health 
professionals and for encouraging the delivery of care to the 
underserved in rural and underserved areas. However, this 
assumption needs to be validated to ensure ongoing reliable 
funding. The Committee therefore directs HRSA to study the 
effectiveness of each health professions program at meeting 
their intended purpose and report its findings to the Committee 
by June 1, 2003.
    The health professions under Title VII of the Public Health 
Service Act provide support to students, programs, departments, 
and institutions to improve the accessibility, quality, and 
racial and ethnic diversity of the health care workforce. In 
addition to providing unique and essential training and 
education opportunities, these programs help meet the health 
care delivery needs of the over 3,100 Health Professions 
Shortage Areas in this country, at times serving as the only 
source of health care in many rural and disadvantaged 
communities. Providers who were trained under Title VII funded 
programs are 3-5 times more likely to provide health care in 
rural and underserved areas. The organizations representing 
schools, programs, and institutions that benefit from this 
funding have determined that these programs needs strong 
funding to educate and train a health care workforce that meets 
the public's health care needs.
    The Committee includes sufficient funds for the creation of 
a partnership between the HRSA and the Arthritis Foundation for 
the purpose of conducting a national study on the status of 
pediatric rheumatology in the United States. As provided in the 
Children's Health Act of 2000, this study will asses this 
crisis and identify strategies for addressing the significant 
shortage of pediatric services for children with arthritis. The 
Secretary shall report the findings of the study to the 
Committee no later than June 1, 2003.
    The Committee remains concerned about the widening gap 
between the size of the Nation's aging baby boom population and 
the number of pulmonary/critical care physicians. Given the 
current funding trends for graduate medical education, we can 
expect a severe shortage of these specialists by 2007. The 
Committee therefore urges the Administrator to consult with the 
American College of Chest Physicians and the members of the 
Critical Care Workforce Partnership to develop a comprehensive 
action plan to address this pending crisis.
    The following clusters and their associated programs are 
included in this consolidated account:

A. Training for diversity

            Centers of excellence
    This program was established to fund institutions that 
train a significant portion of the Nation's minority health 
professionals. Funds are used for the recruitment and retention 
of students, faculty training, and the development of plans to 
achieve institutional improvements. The institutions that are 
designated as centers of excellence are private institutions 
whose mission is to train disadvantaged minority students for 
service in underserved areas. Located in poor communities and 
usually with little State funding, they serve the health care 
needs of their patients often without remuneration. The 
Committee is pleased that the agency has refocused the minority 
centers of excellence program on providing support to 
historically minority health professions institutions.
    The Committee is pleased that HRSA has re-focused the 
Minority Centers of Excellence program on providing support to 
historically minority health professions institutions.
            Health careers opportunity program
    This program provides funds to medical and other health 
professions schools for recruitment of disadvantaged students 
and pre-professional school preparations. The Committee is 
pleased that HRSA has given priority consideration for grants 
to minority health professions institutions, and recommends 
that grant review committees have proportionate representation 
from these institutions.
    The Committee is pleased that HRSA has given priority 
consideration for H-COP grants to minority health professions 
institutions, and recommends that grant review committees have 
proportionate representation from these institutions. The 
Committee continues to encourage the H-COP program to consider 
applications that are responsive to allied health professions 
which are experiencing shortages and high vacancy rates.
            Faculty loan repayment
    This program provides for the repayment of education loans 
for individuals from disadvantaged backgrounds who are health 
professions students or graduates, and who have agreed to serve 
for not less than 2 years as a faculty member of a health 
professions school.
            Scholarships for disadvantaged students
    This program provides grants to health professions schools 
for student scholarships to individuals who are from 
disadvantaged backgrounds and are enrolled as full-time 
students in such schools. The Committee continues to intend 
that all health professions disciplines made eligible by 
statute be able to participate in the scholarships program.

B. Training in primary care medicine and dentistry

            Family medicine training
    Family medicine activities support grants for graduate 
training in family medicine, grants for pre-doctoral training 
in family medicine, grants for faculty development in family 
medicine, and grants for the establishment of departments of 
family medicine. The Committee reiterates its support for this 
program and recognizes its importance in increasing the number 
of primary care physicians in underserved areas.
            General internal medicine and pediatrics training
    This program provides funds to public and private nonprofit 
hospitals and schools of medicine and osteopathic medicine to 
support residencies in internal medicine and pediatrics. Grants 
may also include support for faculty.
            Physician assistants
    This program supports planning, development, and operation 
of physician assistant training programs.
            General dentistry and pediatric dental residencies
    This program assists dental schools and postgraduate dental 
training institutions to meet the costs of planning, 
developing, and operating residency training and advanced 
education programs in general practice of dentistry and funds 
innovative models for postdoctoral general dentistry and 
pediatric dentistry.
    The Committee recognizes the need to increase the number of 
dentists in rural and underserved areas, and particularly 
increase the number of pediatric dentists in those areas. Rural 
States are disproportionately underserved by pediatric 
dentists.
    The Committee recognizes that these programs play a 
critical role in meeting the oral health care needs of 
Americans; especially those who require specialized or complex 
care and represent vulnerable populations in underserved areas. 
Additionally, the Committee realizes that several States have 
fewer than 10 pediatric dentists. This clearly is not enough to 
address American children's needs.

C. Interdisciplinary, community-based linkages

            Area health education centers
    This program links university health science centers with 
community health service delivery systems to provide training 
sites for students, faculty, and practitioners. The program 
supports three types of projects: Core grants to plan and 
implement programs; special initiative funding for schools that 
have previously received Area Health Education Centers (AHEC) 
grants; and model programs to extend AHEC programs with 50 
percent Federal funding. The Committee intends that adequate 
funding be provided to the area health education centers grant 
program since AHEC's are an important component of the Federal/
State partnership in addressing rural health issues.
            Health education and training centers
    These centers provide training to improve the supply, 
distribution, and quality of personnel providing health 
services in the State of Florida or along the border between 
the United States and Mexico and in other urban and rural areas 
with populations with serious unmet health care needs.
            Allied health and other disciplines
    These programs seek to improve access, diversity, and 
distribution of allied health practitioners to areas of need. 
The program improves access to comprehensive and culturally 
competent health care services for underserved populations.
    The Committee provides sufficient funds to continue the 
Graduate Psychology Education Program within the Bureau of 
Health Professions. The Committee understands that this is the 
only federally funded psychology-training program, and for this 
reason, considers its continuation a high priority. Within the 
funds provided, the Committee includes $3,000,000 for the 
establishment of a graduate training program in Geropsychology 
(GTG) to train health service psychologists to work with older 
Americans, especially in rural communities and other 
underserved people.
    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
    The Committee expects this program to continue to support 
grants to health professions schools to establish geriatric 
education centers and to support geriatric training projects. 
These centers and geriatric training programs play a vital role 
in enhancing the skill-base of health care professionals to 
care for our Nation's growing elderly population. The Committee 
is concerned about the shortage of trained geriatricians and 
urges the agency to give priority to building the work force 
necessary to care for the Nation's elderly.
            Quentin N. Burdick program for rural health 
                    interdisciplinary training
    This program addresses shortages of health professionals in 
rural areas through interdisciplinary training projects that 
prepare students from various disciplines to practice together, 
and offers clinical training experiences in rural health and 
mental health care settings to expose students to rural 
practice. The Committee continues to be concerned about the 
lack of providers in rural areas and expects funding to 
continue at least at the fiscal year 2003 level.
    The Committee supports addressing the issue of how the 
delivery of chiropractic health care can be enhanced in rural 
areas, and how more women and minorities can be recruited as 
chiropractic health care practitioners in rural areas. The 
Committee also expects the Bureau to expand its support for 
telecommunications and telehealth initiatives for providing 
distance education and training for nurses and allied health 
professionals serving rural areas.
            Podiatric primary care training
    This program provides grants to hospitals and schools of 
podiatric medicine for residency training in primary care. In 
addition to providing grants to hospitals and schools of 
podiatric medicine for residency training in primary care, the 
program also permits HRSA to study and explore ways to more 
effectively administer postdoctoral training in an ever 
changing health care environment.
            Chiropractic demonstration grants
    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 continues to strongly support the 
chiropractic research and demonstration grant program, 
originally authorized under Section 782 of Public Law 102-408, 
and funded by the Committee in previous years. The Committee 
recommends that the chiropractic-medical school demonstration 
grant program be continued and funded at no less than current 
levels.
    The Committee believes that demonstration projects that 
address treatment for spinal and lower-back conditions, as 
authorized under Section 755(b)(3) of Public Law 105-392, may 
include training initiatives as well as research collaborations 
between physicians, chiropractors and chiropractic colleges. 
Therefore, the Committee directs HRSA to provide funding for 
such training components of chiropractic demonstration grant 
proposals in fiscal year 2003 and beyond.

D. Workforce information and analysis

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

E. Public health workforce development

    With the continued need for public health training 
throughout the country, the Committee believes these programs 
serve an important role in maintaining the country's public 
health infrastructure.
            Public health, preventive medicine and dental public health 
                    programs
    This program supports awards to schools of medicine, 
osteopathic medicine, public health, and dentistry for support 
of residency training programs in preventive medicine and 
dental public health; and for financial assistance to trainees 
enrolled in such programs.
            Health administration programs
    This program provides grants to public or nonprofit private 
educational entities, including schools of social work, but not 
schools of public health, to expand and improve graduate 
programs in health administration, hospital administration, and 
health policy analysis and planning; and assists educational 
institutions to prepare students for employment with public or 
nonprofit private agencies.

F. Children's hospital graduate medical education program

    The Committee provides $290,000,000 for the Children's 
Hospital Graduate Medical Education (GME) program. This is 
$5,033,000 more than the fiscal year 2002 level and $90,000,000 
more than the administration request.
    The program provides support for health professions 
training in children's teaching hospitals that have a separate 
Medicare provider number (``free-standing'' children's 
hospitals). Children's hospitals are statutorily defined under 
Medicare as those whose inpatients are predominantly under the 
age of 18. The funds in this program are intended to make the 
level of Federal Graduate Medical Education support more 
consistent with other teaching hospitals, including children's 
hospitals, which share provider numbers with other teaching 
hospitals. Payments are determined by formula, based on a 
national per-resident amount. Payments support training of 
resident physicians as defined by Medicare in both ambulatory 
and inpatient settings.
    The Committee believes Federal support for GME for 
children's hospitals is a sound investment in children's 
health. Congress has enacted expansions in children's health 
coverage and increased support for health programs devoted to 
children and biomedical research. Equitable funding for 
children's hospitals GME is needed to sustain the pediatric 
workforce, including an adequate supply of future pediatric 
researchers, and our pediatric research enterprise.
    The Committee further recognizes that an inequity exists 
for GME funding for children's teaching hospitals because 
Medicare is the largest single payer of GME, and free-standing 
children's hospitals treat few Medicare patients. These funds 
provide essential, equitable support for the teaching 
contributions of these institutions.

G. Nursing education programs

    The Committee provides $88,002,000 for Nursing Education 
Programs under Title VIII of the Public Health Services Act 
which is $5,500,000 more than the fiscal year 2002 level and 
$4,500,000 more than the administration request.
    The Committee recognizes the current nursing shortage is 
creating a health care crisis in hospitals and skilled nursing 
facilities. The lack of young people in nursing has resulted in 
a steady and dramatic increase in the average age of U.S. 
nurses. Today, the average age of a working RN is 43 years old. 
According to recent surveys, one in five nurses plans to retire 
by 2006, exacerbating the shortage. In Senate Report 107-84, 
the Committee directed the Secretaries of Labor and Health and 
Human Services to convene a panel of national experts to study 
these issues. The Committee eagerly awaits the findings and 
recommendations from the panel, which should completed by the 
beginning of next year.
    Another factor contributing to the nursing shortage is the 
availability of nursing faculty. They, like nurses in 
healthcare delivery, are aging. Thus, for some schools, even if 
they could recruit more students, they may not have faculty to 
teach them. The Committee believes that this is an area that 
requires critical attention.
    One reason for this shortage is the inability of nursing 
schools to educate more nursing students, which is in turn 
largely the result of a lack of qualified nursing faculty. 
Since the average age of nurse educators today is 55, this 
shortage of educators will continue to accelerate. The 
Committee is further aware of the success of the Troops-to-
Teachers program at the Departments of Defense and Education in 
placing qualified military veterans into teaching positions in 
America's public schools through an expedited certification 
process. The Committee therefore encourages HRSA to establish a 
pilot program similar to the Troops-to-Teachers program to 
encourage qualified, active duty military nurses to become 
nurse educators in certified nursing school programs. The 
program should include career and placement assistance, 
transitional stipends for those who commit to teach in nursing 
schools, and cooperation with nursing schools to expedite the 
transition from the military to civilian teaching.
            Advanced education nursing
    The Committee provides $62,541,000 for Advanced Education 
Nursing programs, which is $2,500,000 more than the fiscal year 
2002 level and $1,500,000 more than the administration request. 
This program funds nursing schools to prepare nurses at the 
master's degree or higher level for teaching, administration, 
or service in other professional nursing specialties.
            Basic nurse education and practice
    The Committee provides $18,289,000 for Basic Nurse 
Education and Practice programs, which is $2,000,000 more than 
the fiscal year 2002 level and the administration request. 
Authorized by Public Law 105-392, the goal of this program is 
to improve the quality of nursing practice. Activities under 
this program will initiate new projects that will change the 
educational mix of the basic nursing workforce and empower the 
workforce to meet the demands of the current health care 
system.
            Nursing workforce diversity
    The Committee provides $7,172,000 for Nursing Workforce 
Diversity programs, which is $1,000,000 more than the fiscal 
year 2002 level and the administration request. The goal of 
this program is to improve the diversity of the nursing 
workforce through increased educational opportunities for 
individuals from disadvantaged backgrounds. The Committee urges 
the Division of Nursing to develop and increase cultural 
competence in nursing and to increase the number of 
underrepresented racial and ethnic minorities in all areas of 
nursing education and practice to enhance nursing's ability to 
provide quality health care services to the increasingly 
diverse community it serves.

                          OTHER HRSA PROGRAMS

Hansen's disease services

    The Committee has included $18,142,000 for the Hansen's 
Disease Program which is $303,000 more than fiscal year 2002 
and the same as the administration request. This program offers 
Hansen's Disease treatment in Baton Rouge at the Center, at 
other contract supported locations in Baton Rouge, and in grant 
supported outpatient regional clinics. These programs provide 
treatment to about 3,000 of the 6,000 Hansen's disease 
sufferers in the United States.
    With the exception of about 40 long-term residents who 
continue to reside at Carville, the program has completed the 
move to leased space in Baton Rouge. Other former long term 
residents have been offered and elected to receive a living 
allowance from the program and now live independently. The 
former Federal property at Carville has been transferred to the 
State of Louisiana.
    Over the next few years a long term facility will be 
developed in the Baton Rouge area and offered to the current 
long term residents remaining at the Carville location as an 
alternative to remaining at the historic facility.
    The program also conducts research focusing on the global 
elimination of Hansen's Disease in laboratory facilities at 
Louisiana State University in Baton Rouge. Research activities 
are directed toward the development of new anti-leprosy drugs 
and short-term more effective regimens; manufacture and 
distribution of lepromin skin tests reagents through the World 
Health Organization; identification of host resistant 
mechanisms for potential use in vaccines development; and 
application of state-of-the-art biotechnology to develop simple 
lab techniques for case detection and diagnosis of preclinical 
disease.
    The Committee was surprised to learn of the extent to which 
there has been an increase in the number of individuals 
afflicted with Hansen's Disease in Hawaii due to its 
geographical location and the influx of immigrants from the 
Pacific Basin region. Funds have been provided to assist the 
State in its screening efforts, which of necessity, must be 
targeted towards the unique immigration cultures.

Healthy communities innovation initiative

    The Committee has included $20,000,000 for the Healthy 
Communities Innovation Initiative. This new program is funded 
at the administration's request.
    The Healthy Communities Innovation Initiative is a new 
interdisciplinary services demonstration program which will 
concentrate on the prevention of three of the most rapidly 
increasing diseases in the United States; diabetes, asthma, and 
obesity. The purpose of this initiative is to encourage the 
development of innovative efforts within 5 communities in 
defined geographical areas, to enhance access to services, and 
change health outcomes.

Maternal and child health block grant

    The Committee provides $755,000,000 for the maternal and 
child health [MCH] block grant. This is $23,469,000 more than 
fiscal year 2002 and the administration request.
    The Maternal and Child Health Block Grant program provides 
a flexible source of funding that allows States to target their 
most urgent maternal and child health needs through development 
of community-based networks of preventive and primary care that 
coordinate and integrate public and private sector resources 
and programs for pregnant women, mothers, infants, children, 
and adolescents. The program supports a broad range of 
activities including prenatal care, well child services and 
immunizations, reducing infant mortality, preventing injury and 
violence, expanding access to oral health care, addressing 
racial and ethnic disparities and providing comprehensive care 
for children, adolescents, and families through clinics, home 
visits and school-based health programs.
    The MCH block grant funds are provided to States to support 
health care for mothers and children. According to statute, 
12.75 percent of funds over $600,000,000 are used for 
community-integrated service systems [CISS] programs. Of the 
remaining funds, 15 percent is used for special projects of 
regional or national significance [SPRANS] while 85 percent is 
distributed on the same percentage split as the basic block 
grant formula.
    The Committee provides $5,000,000 more for SPRANS 
activities than would otherwise be the case under the statutory 
formula for oral health demonstration programs and activities 
in the States. The Committee expects that the programs will 
include grants to reduce the incidence of early childhood 
caries and baby bottle tooth decay, community water 
fluoridation, school-linked dental sealant programs, and to 
implement State identified objectives for improving oral 
health.
    The Committee is aware of the joint activities between CMS 
and HRSA to improve access to medical and dental care for 
mothers and children in underserved populations. CMS and the 
Maternal and Child Health program at HRSA have worked together 
to assist States to reduce barriers to care for Medicaid and 
SCHIP populations for maternal and child health care including 
oral health care. The Committee urges these agencies to 
continue their partnership and expand support for State oral 
health systems grants and innovative demonstration projects for 
the prevention and early intervention of dental diseases in 
young children, State dental access summit meetings, and the 
National Maternal and Child Oral Health Resource Center. The 
Committee recognizes that such agency collaborations are 
instrumental for providing coordinated services that do not 
duplicate limited resources.
    It is the Committee's understanding that MCH has committed 
to retaining SPRANS funding for three thalassemia centers that 
provide comprehensive services to patients and families through 
fiscal year 2003. The Committee believes that these are 
critical programs and commends MCH for its support for them. 
The Committee further urges MCH to work closely with these 
three centers and with the Cooley's Anemia Foundation to assure 
that these centers continue to have a stable source of support 
that will allow them to function at or above current levels of 
service.
    The Committee commends HRSA's Maternal and Child Health 
Bureau for its support of the Sudden Infant Death Syndrome 
Program Support Center, and encourages the Bureau to continue 
its efforts in this important area of service. The Committee is 
pleased that the SIDS and Other Infant Death Support Center is 
collaborating with the NIH to address the disproportionately 
high incidence of SIDS among African Americans.
    The Committee recognizes that numerous and challenging 
problems confront our adolescent populations and that every 
effort should be made to encourage initiatives that promote the 
health and well being of whose who represent our future. In 
particular, we commend the Waimanalo Health Center in Hawaii 
and encourage all efforts to expand its programs for 
adolescents.
    The Committee recognizes that every year over 4 million 
infants are born and screened to detect conditions that 
threaten their life and long-term health. Newborn screening is 
a public health activity used for early identification of 
infants affected by certain genetic, metabolic, hormonal, and 
or functional conditions for which there may be an effective 
treatment or intervention. If left untreated, these disorders 
can cause death, disability, mental retardation, and other 
serious illnesses. Parents are often unaware that while nearly 
all babies born in the United States undergo newborn screening, 
the number and quality of these tests vary from State to State. 
The Committee supports efforts, including those authorized by 
the Children's Health Act of 2000, to eliminate the disparities 
that exist between the types of screening provided in the 
States. Ultimately, eliminating these disparities can be the 
difference between children suffering irreversible injury or 
death versus children receiving successful diagnosis and 
treatment.

Healthy start initiative

    The Committee provides $103,000,000 for the healthy start 
infant mortality initiative. This is $4,011,000 more than 
fiscal year 2002 and 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. The Children's Health Act of 2000 
fully authorized this initiative as an independent program.

Universal newborn hearing screening and early intervention

    The Committee provides $13,000,000 for universal newborn 
hearing screening and early intervention activities, which is 
$3,001,000 above the fiscal year 2002 level and $13,000,000 
more than the administration request. The Committee rejects the 
administration proposal to consolidate this program into the 
Maternal and Child Health Block Grant program.
    The Committee continues to strongly support the initiative 
it began 2 year's ago to provide grants to States to establish 
universal newborn hearing screening and early intervention 
programs. This initiative has been quite successful and the 
response from States has been substantial. The Committee is 
aware that HRSA received many more high quality applications 
for this program than it was able to fund. Numerous studies 
have demonstrated that newborn hearing screening followed by 
early intervention services can greatly improve health and 
educational outcomes for children.
    Currently, 44 States and 3 territories have received 
competitive grants for the purpose of implementing statewide 
early hearing detection intervention (EHDI) programs. Since 
these grants have only been operational for between 6 months to 
2 years, the Committee believes that a dedicated source of 
funding is critical at this time to ensure that State EHDI 
programs become fully operational and that screening programs 
are properly linked with diagnosis, early intervention, and the 
child's routine medical care (medical home).
    The Committee is concerned that only 67 percent of babies 
are now screened for hearing loss before 1 month of age. Of the 
babies screened, only 56 percent who needed diagnostic 
evaluations actually receive them by 3 months of age. Moreover, 
only 53 percent of those diagnosed with hearing loss are 
enrolled in early intervention programs by 6 months of age.
    The Committee has provided an increase to expand funding to 
States, increase the availability of qualified pediatric 
audiologists, educate health care providers and families about 
the importance of and procedures for EHDI, continue and expand 
the National Technical Assistance System which works with 
States to develop their programs, evaluate the impact of 
statewide EHDI programs, increase the capacity of States to 
screen children for progressive and late-onset hearing losses, 
as well as chronic middle ear infections, and to link 
identified children with medical, audiological, 
otolaryngological and early intervention services. To minimize 
the loss to follow-up, the Committee urges HRSA to ensure that 
all infants identified through the screening process are linked 
to a medical home.
    The Committee expects HRSA to coordinate projects funded 
with this appropriation with projects related to early hearing 
detection and intervention by the National Center on Birth 
Defects and Developmental Disabilities, the National Institute 
on Deafness and Other Communication Disorders, the National 
Institute on Disability and Rehabilitation Research, and the 
Office of Special Education and Rehabilitative Services.

Organ procurement and transplantation

    The Committee provides $24,990,000 for organ transplant 
activities. This is $5,000,000 more than fiscal year 2002 and 
the same as the administration request.
    These funds support a scientific registry of organ 
transplant recipients and the National Organ Procurement and 
Transplantation Network to match donors and potential 
recipients of organs. A portion of the appropriated funds may 
be used for education of the public and health professionals 
about organ donations and transplants, and to support agency 
staff providing clearinghouse and technical assistance 
functions. The Committee encourages the agency to establish 
linkages with State and Federal transportation officials to 
improve coordination of donation following vehicular accidents, 
through the establishment of donor registries.
    The Committee considers increasing the supply of organs, 
available from voluntary donations to be a top public health 
priority and expects that funds be committed to those 
activities having the greatest demonstrable impact on donation 
rate.

National bone marrow donor program

    The Committee provides $22,034,000 for the national bone 
marrow donor program. This is $37,000 more than fiscal year 
2002 and the same as the administration request. 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 provides $51,472,000 for health outreach 
grants. This amount is the same as the fiscal year 2002 level 
and $13,620,000 more 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.
    The Committee is aware that the population of the 
Mississippi Delta suffers from the worst health status in the 
United States. This predominately African-American population 
suffers from disproportionately high rates of heart disease, 
cancer, diabetes, sexually transmitted diseases, and other 
infectious and chronic diseases. The Committee recognizes the 
variety of factors including socioeconomic, heredity, 
educational and environmental conditions that result in this 
abnormally high incidence of disease and poor health status. As 
a result of this combination of factors, the Committee also 
understands the need for a sustained multi-faceted approach 
that includes research, education, and infrastructure, as well 
as surveillance, prevention and treatment strategies to combat 
this health crisis. Therefore, the Committee recommends the 
continued funding of these activities as already initiated and 
undertaken by the coordinated efforts of the Mississippi Delta 
Health Initiative. The Delta Health Initiative is a partnership 
between The University of Mississippi Medical Center, Delta 
State University, Mississippi Valley State University and the 
Mississippi Department of Health as well as Delta region health 
officials, agencies and providers.
    The Committee is deeply concerned about the increased 
incidence of prescription drug abuse in pockets of the country, 
particularly rural and frontier communities. Using existing 
authority under the Public Health Act, HRSA is urged to 
establish a program to raise awareness and promote 
comprehensive, community-focused, research-based approaches to 
reversing this trend, principally among our youth. Education 
and awareness on this critical issue will hopefully reduce the 
incidence of non-medical use of prescribed drugs and allow 
those patients who truly need these medicines to continue to 
have access to them.
    The Committee understands that many primary care clinics in 
isolated, remote locations are providing extended stay services 
and are not staffed or receiving appropriate compensation to 
provide this service. The Committee encourages the agency to 
undertake a demonstration project to evaluate the effectiveness 
of a new type of provider, the ``Extended Stay Primary Care 
Center,'' to provide expanded services in remote and isolated 
primary care clinics to meet the needs of seriously ill or 
injured patients who cannot be transferred quickly to acute 
care referral centers, and patients who require monitoring and 
observation for a limited time.

Rural health research

    The Committee provides $16,808,000 for the Rural Health 
Policy Development Program. This is the same as the fiscal year 
2002 level and $10,808,000 more than 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, the National Advisory 
Committee on Rural Health, and a reference and information 
service.

State offices of rural health

    The Committee provides $12,000,000 for the State Offices of 
Rural Health. This is $4,001,000 above the fiscal year 2002 
level and $8,000,000 more than the administration request. The 
State Office of Rural Health program helps the States 
strengthen rural heath care delivery systems. For the second 
consecutive year, Committee is significantly increasing funding 
for the offices of rural health to allow States to better 
coordinate care and improve support and outreach in rural 
areas. The Committee believes that increased funds for this 
purpose are critical to improving access and quality health 
care services throughout rural communities.

Telehealth

    The Committee provides $39,192,000 for telehealth 
activities. This is the same as the fiscal year 2002 level and 
$33,583,000 more the administration request.
    The telehealth program promotes the use of technologies to 
improve access to health services and distance education for 
health professionals. The Committee recognizes the tremendous 
potential that telehealth has for improving the delivery of 
quality health care to rural underserved areas and for 
providing distance education to health care professionals. The 
Committee supports HRSA's numerous rural telehealth initiatives 
and encourages the agency to work in partnership with medical 
librarians and other health information specialists in the 
development and implementation of its telehealth projects.

Native and rural Alaskan health care

    The Committee provides $30,000,000 for the Denali 
Commission, which is $10,000,000 more than the fiscal year 2002 
level and $30,000,000 more than the administration request. 
These funds support construction and renovation of health 
clinics, hospitals and social service facilities in rural 
Alaska as authorized by Public Law 106-113. Provision of this 
funding will help remote communities in Alaska develop 
critically needed health and social service infrastructure for 
which no other funding sources are available so that health and 
social services may be provided to Alaskans in remote rural 
communities as they are in other communities throughout the 
country.
    The Committee expects the Denali Commission to allocate 
funds to a mix of rural hospital, clinic, long-term care and 
social service facilities, rather than focusing exclusively on 
clinic funding.

Critical care programs

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

Emergency medical services for children

    The Committee provides $20,000,000 for emergency medical 
services for children. This is $1,009,000 more than the fiscal 
year 2002 level and $1,007,000 more than 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, 
and supports the efforts and purpose of the EMSC program to 
continue to work with States to improve the training and 
availability of emergency medical services personnel who 
effectively treat children. The Committee also urges the 
Department to focus on the development of prevention and 
treatment programs and education of emergency personnel in 
remote and rural areas throughout the country.

Poison control centers

    The Committee provides $25,600,000 for poison control 
center activities, which is $4,392,000 more than fiscal year 
2002 and $4,389,000 more than the administration request. The 
funds provided support activities authorized in the Poison 
Control Center Enforcement and Enhancement Act as well as the 
development and assessment of uniform patient management 
guidelines.

Traumatic brain injury program

    The Committee provides $10,000,000 for the traumatic brain 
injury program, which is $2,501,000 more than the fiscal year 
2002 level and the administration request. The program supports 
implementation and planning grants to States for coordination 
and improvement of services to individuals and families with 
traumatic brain injuries as well as protection and advocacy. 
Such services can include: pre-hospital care, emergency 
department care, hospital care, rehabilitation, transitional 
services, education, employment, and long-term support. The 
Committee includes $3,000,000 for protection and advocacy 
services, as authorized under section 1305 of Public Law 106-
310.

Black lung clinics

    The Committee provides $6,000,000 for black lung clinics. 
This is the same level as the fiscal year 2002 level and 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.

Trauma care

    The Committee provides $5,000,000 for trauma/emergency 
medical services. This is $1,500,000 more than the fiscal year 
2002 level and $5,000,000 more than the administration request. 
The Committee rejects the administration proposal to 
consolidate this program into the Maternal and Child Health 
Block Grant program. This program is intended to improve the 
Nation's overall emergency medical systems, which are 
constantly activated to respond to a wide range of natural and 
man-made disasters, such as: earthquakes; mass violence; riots; 
school shootings; motor vehicle crashes; and terrorist attacks.

Nurse loan repayment for shortage area service

    The Committee provides $15,000,000 for nurse loan payment 
for shortage area services. This is $4,761,000 more than fiscal 
year 2002 and the same as the administration request.
    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 Committee commends the administration 
for supporting and building on the commitment made in the Rural 
Health Initiative last year for this critical program. The 
Committee again intends that the majority of the increased 
funding be provided to increase the supply of qualified health 
care professionals in rural areas.

Payment to Hawaii, Hansen's disease treatment

    The Committee provides $2,045,000 for Hansen's disease 
services. This is the same as fiscal year 2002 and the 
administration request.
    Within the amount provided for Hansen's disease services, 
the Committee urges funding for the fiscal year 2003 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 Gillis W. Long National Hansen's 
Disease Center. This amount is the same as the administration 
request and the 2002 level.

                  ACQUIRED IMMUNE DEFICIENCY SYNDROME

Ryan White AIDS programs

    The Committee provides $2,072,000,000 for Ryan White AIDS 
programs. This is $161,413,000 more than fiscal year 2002 and 
$161,275,000 more than the administration request.
    Recent advances in diagnosis, treatment, and medical 
management of HIV disease has resulted in dramatic improvements 
in individual health, lower death rates and transmission of HIV 
from mother to infant. The Committee recognizes, however, that 
not all HIV infected persons have benefited from these medical 
advances and expects that the Ryan White CARE Act programs 
provide social and other support services with the specific 
intent of obtaining and maintaining HIV-infected individuals in 
comprehensive clinical care.
    The Department is encouraged to identify obstacles 
confronting people with HIV/AIDS in receiving medical care 
funded through the Ryan White programs and to develop 
strategies to address these problems in light of the changing 
medical needs of a patient population that is living longer 
with current therapies.
    The Committee recognizes the recent advances in the 
treatment and medical care of persons with HIV disease and the 
need for early access to these interventions and services. 
Furthermore, the Committee understands that disparities exist 
in accessing and maintaining the benefits of these recent 
advances among communities highly impacted by HIV and AIDS.

Emergency assistance--title I

    The Committee provides $640,000,000 for emergency 
assistance grants to eligible metropolitan areas 
disproportionately affected by the HIV/AIDS epidemic. This 
amount is $20,486,000 above the fiscal year 2002 and the 
administration request. These funds are provided to 
metropolitan areas meeting certain criteria. One-half of the 
funds are awarded by formula and one-half are awarded through 
supplemental competitive grants.
    The Committee encourages the Secretary, when awarding 
supplemental title I funds, to give priority as appropriate to 
EMA's whose applications increase services to women, 
adolescents, and children with AIDS/HIV infection.

Comprehensive care programs--title II

    The Committee provides $1,095,000,000 for HIV health care 
and support services. This amount is $117,627,000 above the 
fiscal year 2002 level and the administration request. These 
funds are awarded to States to support HIV service delivery 
consortia, the provision of home and community-based care 
services for individuals with HIV disease, continuation of 
health insurance coverage for low-income persons with HIV 
disease and support for State AIDS drug assistance programs 
[ADAP].
    The Committee continues to be encouraged by the progress of 
anti-retroviral therapy in reducing the mortality rates 
associated with HIV infection and in enhancing the quality of 
life of patients on medication. The Committee has approved bill 
language for $739,000,000 for AIDS medications, which is 
$100,000,000 more than the fiscal year 2002 level and the 
administration request.
    The Committee further urges HRSA to encourage States to 
utilize Federal ADAP funding in the most cost-effective manner 
to maximize access to HIV drug therapies and to eliminate cost-
shifting from Medicaid to the State ADAP programs. States with 
ADAP funding should be allowed the flexibility to purchase and 
maintain insurance policies for eligible clients including 
covering any costs associated with these policies, or continue 
to pay premiums on existing insurance policies that provide a 
full range of HIV treatments and access to comprehensive 
primary care services, as determined by a State. Funds should 
not be committed to purchase insurance deemed inadequate by a 
State in its provision of primary care or in its ability to 
secure adequate access to HIV treatments.

Early intervention program--title III-B

    The Committee provides $205,000,000 for early intervention 
grants. This is $11,083,000 more than the fiscal year 2002 
level and $10,945,000 more 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.
    The Committee encourages HRSA to fairly allocate the 
increase for title III-B between existing grantees and new 
providers. By providing additional funds to current grantees, 
the Committee intends to strengthen the HIV care infrastructure 
already established in title III-B clinics. The Committee also 
supports expansion of the number of communities receiving 
assistance from this title.
    Priority should be placed on funding existing and new 
projects in rural, medically underserved areas, and secondary 
cities outside of major metropolitan areas in order to build 
clinical capacity for the delivery of HIV care among clinicians 
serving high-risk populations, minorities, and those who are 
unable to access clinical HIV care for economic reasons. In 
building capacity, the goal is to develop knowledgeable 
clinicians to improve access to quality HIV treatment based 
upon the evolving HIV treatment guidelines of DHHS.

Women, infants, children, and youth--title IV

    The Committee provides $75,000,000 for title IV pediatric 
AIDS, which is $4,010,000 above the fiscal year 2002 level and 
the administration request. Funds are awarded to community 
health centers, family planning agencies, comprehensive 
hemophilia diagnostic and treatment centers, federally 
qualified health centers under section 1905(1)(2)(B) of the 
Social Security Act, county and municipal health departments 
and other nonprofit community-based programs that provide 
comprehensive primary health care services to populations with 
or at risk for HIV disease.
    The Committee intends that at least 90 percent of total 
title IV funding be provided to grantees. The Committee expects 
the agency to provide at least 75 percent of the funding 
increase to existing grantees to reflect the increases in the 
costs of providing comprehensive care, including the 
implementation of quality management programs. HRSA should use 
a significant portion of the remaining funds to expand 
comprehensive services for youth, both through existing and new 
grantees. The Committee expects the agency to expand efforts to 
facilitate ongoing communication with grantees on the 
administration of the Title IV program. These expanded efforts 
should include collaboration with grantees on the forthcoming 
determinations by the Secretary mandated in the Ryan White CARE 
Act Amendments of 2000 on administrative expenses and HIV-
related research access. The Committee also expects HRSA to 
collaborate with CDC to identify and eliminate barriers between 
HIV prevention and care.
    Some 5 percent of the funds appropriated under this section 
may be used to provide peer-based technical assistance. Within 
this amount, sufficient funds are available to maintain and 
expand work being done to create a national consumer and 
provider education center on the use of various strategies and 
planning in the care of children, youth, women and families 
infected with or affected by HIV and AIDS.

AIDS dental services

    The Committee provides $17,000,000 for AIDS dental 
services, which is $3,502,000 more than the fiscal year 2002 
level and the administration request. This program provides 
grants to dental schools, dental hygiene schools, and 
postdoctoral dental education programs to assist with the cost 
of providing unreimbursed oral health care to patients with HIV 
disease.
    The Committee recognizes the importance of oral health care 
providers in the diagnosis of HIV and in treating the painful 
and debilitating oral manifestations of this disease. The 
Committee supports this program as it improves access to oral 
health services for low-income and uninsured people living with 
HIV and AIDS by providing partial reimbursement to dental 
education institutions for delivering care. The Committee 
recognizes that these dental services are vital because they 
are often the only services available to AIDS patients since 
many State Medicaid programs do not cover adult dental 
services.

AIDS education and training centers

    The Committee provides $40,000,000 for the AIDS education 
and training centers [AETC's], which is $4,705,000 more than 
the fiscal year 2002 level and 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 provides $285,000,000 for the title X family 
planning program. This is $19,945,000 more than the fiscal year 
2002 level and $19,725,000 more than the administration 
request. Title X grants support primary health care services at 
more than 4,500 clinics nationwide. About 85 percent of family 
planning clients are women at or below 150 percent of poverty 
level. Title X of the Public Health Service Act, which 
established the family planning program, authorizes the 
provision of a broad range of acceptable and effective family 
planning methods and preventive health services. This includes 
FDA-approved methods of contraception.
    The Committee has increased funding for clinics receiving 
Title X funds to address increasing financial pressures in 
their effort to provide high-quality, subsidized family 
planning services and preventive health care to (4.4 million 
each year, many of whom are uninsured) low-income and uninsured 
women. These pressures include rising medical costs of newer 
and longer lasting contraceptive methods, pharmaceuticals, and 
screening and diagnostic technologies (as well as a rising 
uninsured population). The Committee recognizes that due to 
these financial pressures, it will be difficult for Title X 
clinics to serve the current number of patients without a 
significant funding increase. The Committee also recognizes 
that the increased availability of new contraceptive methods 
and screening technologies will improve women's health and 
result in a decrease in unintended pregnancies nationwide.
    The Committee remains concerned that programs receiving 
Title X funds ought to have access to these resources as 
quickly as possible. The Committee, therefore, again instructs 
the Department to distribute to the regional offices all of the 
funds available for family planning services no later than 60 
days following enactment of this bill.
    The Committee intends that at least 90 percent of funds 
appropriated for Title X activities be for clinical services 
authorized under section 1001 of the Act. All such funds for 
section 1001 activities are to be provided to the regional 
offices to be awarded to grantees to provide family planning 
methods and services as specified by the Title X statute. The 
Committee further expects the Office of Family Planning to 
spend any remaining year-end funds in section 1001 activities.

Community Based Abstinence Education Program

    The Committee provides $40,000,000 for this program, which 
provides support for the development and implementation of 
abstinence education programs for adolescents, ages 12 through 
18. This is the same as the fiscal year 2002 level and 
$32,979,000 less than the President's request. These funds, 
together with the $50,000,000 in mandatory funds provided 
through the Personal Responsibility and Work Opportunity 
Reconciliation Act of 1996, will make $90,000,000 available for 
abstinence education. These programs are unique in that their 
entire focus is to educate young people and create an 
environment within communities that support teen decisions to 
postpone sexual activity until marriage. The Committee intends 
that the Secretary fund grantees who are currently receiving 
section 510 funds, but whose project periods are expiring at 
the end of fiscal year 2002.

Health care facilities

    The Committee has provided no funding for health care 
facilities, which is $311,942,000 below the 2002 level and the 
same as the administration request. Funds are made available to 
public and private entities for construction and renovation of 
health care and other facilities. The reduction below last 
year's level is due to the funding of one-time projects.

Buildings and facilities

    The Committee provides $250,000 for buildings and 
facilities, which is the same as fiscal year 2002 level and the 
administration request.

Rural hospital flexibility grants

    The Committee provides $50,000,000 for rural hospital 
flexibility grants, which is $10,000,000 more than the fiscal 
year 2002 level and $25,000,000 more than the administration 
request.
    This program administers the Rural Health Flexibility 
Program previously administered by the Health Care Finance 
Administration. Under this program, eligible rural hospitals 
may convert themselves into limited service facilities termed 
Critical Care Hospitals. Such entities are then eligible to 
receive cost-based payments from Medicare. The grant component 
of the program assists States with the development and 
implementation of State rural health plans, conversion 
assistance, and associated activities.
    Of the amount provided, the Committee includes $20,000,000 
to continue the Small Rural Hospital Improvement Grant Program, 
as authorized by Section 1820 (g)(3) of the Social Security Act 
and Public Law 107-116 and outlined in House Report 107-342.

Rural access to emergency devices

    The Committee provides $12,500,000 for rural access to 
emergency devices, which is the same as the fiscal year 2002 
level and $10,500,000 more than the administration request. 
This program, which is to be administered through the Rural 
Health Outreach Office, provides grants to expand placement of 
automatic external defibrillators (AEDs) in rural areas and to 
ensure that first responders and emergency medical personnel 
are appropriately trained.

Radiogenic diseases

    The Committee provides $2,000,000 for the Radiation 
Exposure Compensation Act, which is $2,000,000 less than the 
fiscal year 2002 level and the administration request. This 
program provides grants for the education, prevention, and 
early detection of ragiogenic cancers and diseases resulting 
from exposure to uranium during its mining and milling at 
nuclear test sites.

National practitioner data bank

    The Committee provides $19,500,000 for the national 
practitioner data bank, which is $2,900,000 more than the 
fiscal year 2002 level and the same as the administration 
request. The Committee and the administration assume that full 
funding will be provided entirely through the collection of 
user fees and will cover the full cost of operating the data 
bank. Traditional bill language is included to ensure that user 
fees are collected to cover all costs of processing requests 
and providing such information to data bank users.

Health care integrity and protection data bank

    The Committee provides $5,600,000 for the health care 
integrity and protection data bank, which is $500,000 more than 
the fiscal year 2002 level and the same as the administration 
request. The Committee and the administration assume that full 
funding will be provided entirely through the collection of 
user fees and will cover the full cost of operating the data 
bank. The data bank is intended to collect, maintain, and 
report on certain actions taken against health care providers, 
suppliers, and practitioners.

Healthcare access for the uninsured/Community access program

    The Committee provides $120,027,000 for this activity, 
which is the same as the fiscal year 2002 level and 
$120,027,000 more than the administration's request. This 
program is designed to increase the capacity and effectiveness 
of community health care institutions and providers who serve 
patients, regardless of their ability to pay. These funds will 
enable public, private, and non-profit health entities to 
assist safety-net providers in developing and expanding 
integrated systems of care and address service gaps within such 
integrated systems.

Program management

    The Committee provides $143,354,000 for program management 
activities for fiscal year 2003. This is $5,783,000 less than 
the fiscal year 2002 level and $348,000 less than the 
administration request.

               MEDICAL FACILITIES GUARANTEE AND LOAN FUND

    The Committee has not included funding for the Medical 
Facilities and Guarantee and Loan Fund. This fund was 
established in 1972 under the Medical Facilities Construction 
Program in order to make funds available for construction of 
medical facilities. The fund is established in the Treasury 
without fiscal year limitation to pay interest subsidies, make 
payments of principal and interest in the event of default on a 
guaranteed loan, and repurchase, if necessary loans sold and 
guaranteed. There are sufficient carryover funds from prior 
years' appropriations to pay defaults and interest subsidy 
payments; therefore, no appropriation is required to cover 
these payments.

                   HEALTH EDUCATION ASSISTANCE LOANS

    The Committee provides no additional guarantee authority 
for new HEAL loans in fiscal year 2003, which is the same as 
the President's request.
    The Committee provides $7,000,000 to liquidate obligations 
from loans guaranteed before 1992, which is the same as the 
administration request and $3,000,000 less than the 2002 
appropriation.
    For administration of the HEAL Program including the Office 
of Default Reduction, the Committee provides $3,914,000, which 
is $123,000 above the 2002 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, 2002....................................     $84,696,000
Budget estimate, 2003...................................      88,909,000
Committee recommendation................................      88,909,000

    The Committee provides that $88,909,000 be released from 
the vaccine injury compensation trust fund in fiscal year 2003, 
of which $2,991,000 is for administrative costs. The total 
amount is $4,213,000 more than fiscal year 2002 and the same as 
the administration request.
    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, 2002....................................  $4,303,256,000
Budget estimate, 2003...................................   3,874,444,000
Committee recommendation................................   4,493,572,000

    The Committee provides $4,493,572,000 for the Centers for 
Disease Control and Prevention (CDC), which is $190,316,000 
below the fiscal year 2002 level and $619,128,000 above the 
budget request.
    The activities of the CDC focus on several major 
priorities: provide core public health functions; respond to 
urgent health threats; monitor the Nation's health using sound 
scientific methods; build the Nation's health infrastructure to 
insure our national security against bioterrorist threats; 
promote women's health; and provide leadership in the 
implementation of nationwide prevention strategies to encourage 
responsible behavior and adoption of lifestyles that are 
conducive to good health.
    The anthrax attacks of late last year set off an avalanche 
of false alarms that produced thousands of samples for testing. 
Each of these samples had to be handled as if contaminated with 
the deadly Bacillus anthracis bacterium. The Committee is aware 
of the sacrifices made to ensure the accurate processing and 
testing of thousands of samples for anthrax. The Committee 
commends the CDC, especially the National Center for Infectious 
Diseases, National Institute for Occupational Safety and 
Health, and National Center for Environmental Health, for their 
efforts during this time of uncertainty.

    BIRTH DEFECTS, DEVELOPMENTAL DISABILITIES, DISABILITY AND HEALTH

    The Committee recommends $99,823,000 for birth defects, 
developmental disabilities, disability and health which is 
$9,913,000 above the fiscal year 2002 level and $10,500,000 
above the administration request.
    Birth defects are the leading cause of infant death in the 
United States. More than 150,000 infants are born with birth 
defects each year in the United States. The Child Health Act of 
2000 created CDC's National Center on Birth Defects and 
Developmental Disabilities. The Committee recognizes CDC as the 
Nation's leader in assisting States in monitoring for birth 
defects and developmental disabilities and improving the health 
and wellness of people living with a disability. The birth 
defects and developmental disabilities monitoring programs 
collect, analyze, and make available data on the incidence and 
causes of birth defects and developmental disabilities.
    Autism.--Within the total provided, $2,000,000 above the 
budget request is to expand autism surveillance activities. The 
Committee is concerned about the lack of information available 
on the prevalence, cause or effective treatment of autism. 
Basic data collection and verification is integral to better 
understanding the incidence of autism, the factors that may be 
associated with a higher rate of incidence, and effective 
treatment.
    Childhood birth defects and developmental disorders.--The 
Committee recognizes the importance of helping children 
suffering from birth defects and developmental disorders. These 
include cleft lip, cleft palate, missing limbs and other facial 
deformities from hemanjiomas, hemifacial and microsomia to 
microtia, aural atresia, and craniosynostosis. The Committee, 
therefore, urges the National Center on Birth Defects and 
Developmental Disabilities to conduct research on the incidence 
of birth defects including abnormalities of structure, 
function, or body metabolism, the cost of appropriate medical 
treatment, availability of insurance coverage, and insurance 
coverage policies. The Committee urges the Center to work with 
the National Foundation for Facial Reconstruction and the 
American Society of Plastic Surgeons to develop an information 
clearinghouse for parents and physicians regarding appropriate 
medical treatment.
    Disabilities Prevention Programs.--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. Individuals living 
with disabilities and their families need information on 
medical, physical, and emotional needs, and resources and 
support to reintegrate socially and economically into society. 
The Committee is pleased by the partnerships between the CDC 
and the disability-related information and support centers in 
the areas of limb loss, paralysis and AD/HD and has included 
sufficient funding to allow CDC to continue these successful 
programs and partnerships at, at least, their current funding 
levels and with existing partners.
    In particular, the Committee commends CDC for its work with 
the Christopher Reeve Paralysis Foundation to establish an 
information and support center and to reduce secondary 
disabilities among people with paralysis.
    The Committee encourages the continued support of 
activities aimed at improving knowledge about the usefulness 
and effectiveness of health promotion programs for persons with 
disabilities.
    Duchenne muscular dystrophy.--The Committee has included 
$4,000,000 to expand the epidemiological program in Duchenne 
and Becker muscular dystrophy. The Center is expected to gather 
and analyze extensive data on these diseases, including a 
comparison of treatment approaches.
    Fetal Alcohol Syndrome.--Within the total provided, 
$1,500,000 above the budget request is to expand activities 
related to Fetal Alcohol Syndrome (FAS).
    The Committee supports CDC's efforts to reduce the rates of 
Fetal Alcohol Syndrome (FAS) through surveillance and 
prevention programs. FAS, the country's leading known cause of 
mental retardation and birth defects, devastates the lives of 
as many as 12,000 newborn children and their families each 
year, and is completely preventable. This increase will allow 
CDC to expand surveillance activities to document the magnitude 
of the problem and to develop and implement prevention 
strategies.
    Folic acid education campaign to prevent birth defects.--
Each year, an estimated 2,500 babies are born with neural tube 
defects (NTDs), birth defects of the brain and spinal cord, 
including anencephaly and spina bifida. CDC estimates that up 
to 70 percent of NTDs could be prevented if all women of 
childbearing age consume 400 micrograms of folic acid daily, 
beginning before pregnancy. The Committee commends CDC for its 
leadership in this area.
    Newborn Screening.--Title XXVI of the Children's Health Act 
of 2000 provides that the Secretary shall award grants to 
improve or expand the ability of State and local public health 
agencies to provide screening to newborns and children having 
or at risk for heritable disorders. The Committee supports 
further research and demonstration projects for the translation 
of new scientific knowledge into applied public health 
screening programs. The Committee urges CDC to coordinate with 
HRSA in translating the results of these efforts, particularly 
in the areas of Fragile X Syndrome and Cystic Fibrosis, into 
guidance for public health programs, including State newborn 
screening programs.
    The Committee commends CDC for its early hearing detection 
and intervention (EHDI) program for newborns, infants and young 
children with hearing loss. Thirty States have received 
cooperative agreement grants over the last 2 years (15 States 
in fiscal year 2000 and another 15 States in fiscal year 2001) 
to assist in developing strong surveillance and tracking 
systems. These grants ensure that infants referred from newborn 
hearing screening programs receive appropriate and timely 
diagnostic and early intervention services. The Committee is 
concerned that of babies who were screened, only 56 percent who 
needed diagnostic evaluations actually received them by 3 
months of age. Moreover, only 53 percent of those diagnosed 
with hearing loss were enrolled in early intervention programs 
by 6 months of age. The Committee believes that increased 
funding is required to ensure that States develop appropriate 
surveillance and tracking systems to provide timely and 
appropriate diagnostic and intervention services to infants and 
toddlers.
    The Committee encourages the National Center on Birth 
Defects and Developmental Disabilities to provide clarification 
and guidance to States regarding how EHDI surveillance, 
tracking, and data management programs are affected by the 
Health Insurance Portability and Accountability Act and the 
Family Education Rights and Privacy Act
    To avoid duplication and interference, the Committee 
expects CDC to coordinate projects funded with this 
appropriation with EHDI projects conducted by the Health 
Resources Services Administration, the National Institute on 
Deafness and Other Communication Disorders, the National 
Institute on Disability and Rehabilitation Research, and the 
Office of Special Education and Rehabilitative Services.
    Regional centers for birth defects research and 
prevention.--The Committee encourages CDC to increase support 
for research activities conducted by the eight regional Centers 
for Birth Defects Research and Prevention. These centers 
located in Arkansas, California, Georgia, Iowa, Massachusetts, 
New Jersey, New York, and Texas, conduct epidemiological 
research on the prevention of birth defects. For over 5 years, 
the Centers have identified cases and obtained data for 
inclusion in the National Birth Defect Prevention Study, the 
largest case-control study of birth defects ever conducted. 
Now, the centers can begin to use this data for studies that 
will lead to understanding the biological mechanisms of the 
nearly 80 percent of birth defects whose causes are unknown. An 
increase will allow these centers to expand and intensify the 
study of genetic and environmental causes of birth defects.
    Special Olympics Healthy Athletes Initiative.--The 
Committee continues to be concerned about the unmet health 
needs among persons with mental retardation. In March of 2001, 
this Committee held a field hearing in Anchorage Alaska, during 
the World Winter Special Olympics Games. At that hearing, 
numerous witnesses, including persons with mental retardation, 
expressed their frustration in securing needed health services 
and the severe consequences of not being able to obtain such 
services in a timely and appropriate way. Persons with mental 
retardation have more health challenges and poorer access to 
health care than the rest of the population. As a result, their 
lives are unnecessarily shortened and the quality of their 
lives is severely compromised.
    To address the unmet health needs among its athletes, 
Special Olympics created the Healthy Athletes Program, which 
provides Special Olympics athletes access to an array of health 
assessment, education, preventive health services and supplies, 
and referral for follow-up care where needed. These services 
are provided to athletes without cost in conjunction with 
competitions at local, State, national, and international 
levels. Last year, this Committee established a Special 
Olympics Healthy Athletes Initiative at CDC to support these 
efforts. Sufficient funds have been included this year to 
increase funding for that activity.
    Spina Bifida.--The Committee recognizes that Spina Bifida 
is the leading permanently disabling birth defect in the United 
States. While Spina Bifida and related neural tube defects are 
highly preventable through proper nutrition, including 
appropriate folic acid consumption, and its secondary effects 
can be mitigated through appropriate and proactive medical care 
and management, such efforts have not been adequately supported 
or coordinated to result in significant reductions in these 
costly conditions. In an effort to improve the quality-of-life 
for individuals affected by Spina Bifida and reduce and prevent 
the occurrence of and suffering from this birth defect, the 
Committee has provided $2,000,000 to support the establishment 
of a National Spina Bifida Program. This program should be 
established in coordination with a leading national voluntary 
health agency which exists to promote the prevention of spina 
bifida and to enhance the lives of all affected. Such a 
national program will lead the nation's efforts in addressing 
issues associated with this devastating birth defect.
    State cooperative agreements for birth defects 
surveillance.--The Committee encourages CDC to increase support 
to States to develop, implement, and/or expand community-based 
birth defects tracking systems, programs to prevent birth 
defects, and activities to improve access to health services 
for children with birth defects. CDC is now assisting twenty-
eight States with cooperative agreements.

Chronic Disease Prevention and Health Promotion

    The Committee recommends $810,785,000 for chronic disease 
prevention and health promotion, which is $63,563,000 above the 
fiscal year 2002 level and $120,555,000 above the 
administration's request.
    The unprecedented commitment to biomedical research in 
recent years represents a critical investment in the future 
health of our nation. The Committee recognizes, however, that 
the benefits of basic research alone cannot be fully realized 
unless results of this important work are effectively 
translated into public health interventions to address costly 
and prevalent conditions such as chronic diseases.
    Chronic diseases have had a profound human and economic 
toll on our nation. Nearly 125 million Americans today are 
living with some form of chronic condition, including cancer, 
cardiovascular disease, diabetes, arthritis and various 
neurological conditions such as epilepsy. These and other 
chronic diseases now account for nearly 70 percent of all 
health care costs, as well as 70 percent of all deaths 
annually. By the year 2020, the affected population is expected 
to reach 157 million Americans and represent $1,000,000,000,000 
in health care expenditures, equivalent to over 80 percent of 
all anticipated health care expenditures. Less than $1.25 per 
person, however, is directed towards public health 
interventions focused on preventing the debilitating effects 
traditionally associated with chronic conditions. A few 
modifiable risk factors bring suffering and early death to 
millions of Americans. Three such factors--tobacco use, poor 
nutrition, and lack of physical activity are major contributors 
to our Nation's leading causes of death.
    The Committee believes that the Federal investment in 
chronic disease prevention remains inadequate. Recognizing the 
need to establish chronic disease prevention as a national 
priority, the Committee therefore provides an increase of 
$55,193,000 over fiscal year 2002 levels to begin to more 
appropriately address this national crisis.
    Within the total provided, the following funding levels are 
for the specific program activities: heart disease and stroke, 
$47,218,000; cancer prevention and control, $290,526,000; 
arthritis, $14,896,000 health promotion, $27,875,000; diabetes, 
$66,500,000; tobacco, $100,623,000; nutrition, physical 
activity and obesity, $50,000,000; school health, $63,000,000; 
safe motherhood, $62,500,000; oral health, $11,791,000; 
prevention centers, $27,945,000; epilepsy, $7,434,000; iron 
overload, $477,000; and National Campaign to Change Children's 
Health Behavior, $40,000,000.
    Arthritis.--The Committee notes that Congress established 
the CDC arthritis program in 1999 following the development of 
the National Arthritis Action Plan (NAAP). The CDC activities 
form the backbone of a multi-pronged response to the Nation's 
leading cause of disability. Prior to this initiative, there 
was no coordinated public health strategy to prevent and 
appropriately treat the over 100 forms of this painful, 
debilitating disease. Grants to States are a core component of 
the CDC arthritis program. These partnerships promote the 
development of a State-based network of local activities to 
confront the burden of arthritis. This approach also encourages 
the formation of broadly-based coalitions with health care 
providers, community-based organizations, and other 
stakeholders to coordinate and leverage their resources. The 
Arthritis Foundation chapters across the country have led this 
external effort.
    Behavioral Risk Factor Surveillance System.--The Committee 
has provided $8,000,000 for the Behavioral Risk Factor 
Surveillance System (BRFSS). The Committee notes that 
gathering, analyzing, and distributing data on behavioral risk 
factors is key to addressing a host of health problems, 
especially chronic diseases. The BRFSS program collects 
behavior-related data so that scarce resources can be directed 
efficiently to address chronic diseases, such as heart disease, 
cancer, diabetes, obesity, and vascular diseases such as 
stroke. The Committee believes the increase in BRFSS funding 
should be used to increase infrastructure at the State and CDC 
levels; improve the rates of response of survey questions; 
increase the timeliness of data; improve CDC's web site to make 
data more accessible for analysis; and create State 
demonstration projects to examine and assess innovative methods 
in chronic disease health tracking.
    Cancer Prevention and Control.--The previous 5 years have 
seen a major increase in the nation's investment in medical 
research at the NIH, resulting in significant breakthroughs for 
cancer and other serious diseases. Testimony at the Committee's 
cancer hearing, in June, repeatedly referred to the vital 
importance of prevention and public education programs and the 
need to translate the increased research funding into programs 
that reach people who are affected by cancer. Specifically, 
there was discussion of the need for increased application 
research funding in the nation's cancer program, primarily 
housed at the CDC. The need to reach the public, particularly 
medically underserved populations, with the message of 
prevention and early detection of cancer cannot be overstated. 
The seven CDC programs--Comprehensive Cancer Control 
Initiative; National Cancer Registries Program; Colorectal 
Cancer Screening, Education and Outreach; Prostate Cancer 
Awareness Campaign; National Breast and Cervical Cancer Early 
Detection Program; Ovarian Cancer Program; Skin Cancer 
Program--included in the CDC's cancer line item have proven to 
be highly effective, but are only a starting point if we are to 
reduce the mortality from cancer. The Committee is strongly 
supportive of the CDC cancer programs focused on awareness, 
education and early detection and has included a significant 
increase for these programs.
    The significant growth of cancer prevention and control 
programs within State health agencies has resulted in the 
recognition that improved coordination of cancer control 
activities is essential to maximizing resources and achieving 
desired cancer prevention and control outcomes. The Committee 
commends CDC for its work with health agencies to enhance the 
number and quality of cancer-related programs that are 
available to the U.S. population and to develop an integrated 
and coordinated approach to reduce the cancer burden through 
prevention, early detection, treatment, and rehabilitation. In 
fiscal year 2002, CDC is funding 19 States and one Indian 
Health Board to develop comprehensive cancer control programs 
which help build the foundation for a nationwide, comprehensive 
cancer control program. Comprehensive cancer programs integrate 
the full range of cancer prevention activities including 
research, evaluation, health education and communication, 
program development, public policy development, surveillance, 
and clinical services.
    The Committee includes the President's request for 
increased funding for the Breast and Cervical Screening 
program. CDC's National Breast and Cervical Cancer Early 
Detection Program has provided more than 3 million potentially 
life-saving screening tests for women. Despite its success in 
screening these women, the program is still only able to screen 
15-20 percent of the eligible population due to the 
difficulties in finding these hard to reach women. Therefore, 
the Committee recommends that 50 percent of funds be used for 
actual provision of screening and clinical services and the 
remaining 50 percent of funds be used by States for outreach, 
effective management, public and professional education, and 
quality assurance to ensure enhancement of infrastructure 
development activities that will provide screening and 
diagnostic services to eligible women. The Committee's 
recommendation will enable more women to receive these vital 
screening services.
    Colorectal cancer is the third most commonly diagnosed 
cancer for both men and women in the United States, and the 
second leading cause of cancer related deaths. In 2001, 
approximately 148,000 new cases were diagnosed and 56,000 
people died from the disease. When colorectal cancer is 
detected and treated early, survival is greatly enhanced. 
However, despite the availability of proven screening tests, 
only 37 percent of colorectal cancers are diagnosed while the 
disease is still in a localized stage.
    The Committee is very pleased with the leadership of CDC's 
National Colorectal Cancer Roundtable in promoting the 
availability and advisability of screening to both health care 
providers and the general public. The Committee encourages CDC 
to continue to expand its partnerships with State health 
departments, professional and patient organizations, and 
private industry to combat this devastating disease.
    As pancreatic cancer is the country's fifth leading cause 
of cancer death, and 99 percent of people diagnosed with 
pancreatic cancer die within 6 months, the Committee urges the 
CDC to convene a series of meetings of CDC and other agency 
officials, leading advocacy organizations who provide 
information and education, and other key stakeholders, to 
define the public health role of educating medical 
professionals and the public about the risk factors, symptoms, 
treatment options and palliative care methods related to 
pancreatic cancer. These findings should be presented in a 
report due to the Committee no later than 30 days prior to the 
fiscal year 2004 Appropriations hearings. The report should 
include a budget and timeframe for implementing the 
recommendations derived from these meetings.
    The Committee applauds the partnership between CDC and the 
Lance Armstrong Foundation to address the needs of the over 9 
million Americans living with, through and beyond cancer by 
expanding the Agency's State-based comprehensive cancer program 
to include issues of survivorship, including late term effects 
and quality of life.
    Given the shortages and high vacancy rates of qualified 
health personnel who work in laboratories to prepare and 
analyze tissue and cell samples, the Committee urges CDC's 
Breast and Cervical Cancer Screening Program to develop a 
partnership with HRSA's Allied Health Special Projects Program 
to support programs at schools which contribute to solving the 
shortages.
    Chronic Fatigue Syndrome (CFS).--The Committee is pleased 
that CDC has branched into new and important areas of CFS 
research and medical education in the first 3 years of the 4-
year period in which $12,900,000 is being restored to the CFS 
program at CDC. Since approximately half the funds remain, the 
Committee instructs CDC to extend the payback period by 1 year, 
through fiscal year 2004. The Committee further expects that 
CDC will provide sufficient funding, including funds allocated 
through the payback program, to accelerate its CFS research 
plan to identify the causes, risk factors, diagnostic markers, 
natural history and economic impact of CFS; to create a CFS 
patient registry; and to educate health care providers about 
the detection, diagnosis and management of CFS.
    Cooley's Anemia and Thalassemia.--In fiscal year 2002, the 
Committee supplied funding for CDC to create a thalassemia-
based blood safety and surveillance program, modeled after the 
universal data collection program used for hemophilia. It is 
the Committee's intention that this program be continued in 
fiscal year 2003. In addition, the Committee believes that the 
program will benefit from expanded interaction between CDC and 
the Cooley's Anemia Foundation, particularly with regard to 
educating patients, families, health providers and the public 
about blood safety.
    Diabetes.--There is a diabetes epidemic in our nation. 
Today, approximately 16 million Americans have diabetes, 
including 5.9 million who do not know they have the disease. 
Diagnosed diabetes rose 49 percent nationally between 1990 and 
2000. Type 2 diabetes, once considered an adult disease, is now 
found in children. Recently released results from the largest-
ever clinical study on diabetes prevention confirmed that 
diabetes can be prevented in high-risk adults. The NIH-led and 
CDC-supported Diabetes Prevention Program (DPP) demonstrated 
that sustained lifestyle change, including modest weight loss 
and physical activity, resulted in prevention of diabetes in 
those diagnosed as ``pre-diabetic''. An additional 16 million 
Americans are ``pre-diabetic''. The Committee encourages CDC to 
work with State Diabetes Control Programs to establish pilot 
projects to test strategies that will become effective public 
health interventions to prevent or significantly delay the 
onset of diabetes in high-risk individuals and develop systems 
to identify and monitor the number of people who are at highest 
risk for developing diabetes.
    The high incidence of diabetes among Native Hawaiian 
populations persists, and the Committee is pleased with CDC's 
efforts to target this population, in particular to assist the 
leadership of Native Hawaiian and Pacific Basin Islander 
communities. It is important to incorporate traditional healing 
concepts and to develop partnerships with community centers, 
and the Committee encourages CDC to build on its historical 
efforts in this regard. Diabetes is also one of the most 
serious health challenges facing American Indians and Alaska 
Natives today. Some American Indian Tribes have the highest 
rates of diabetes in the world. Approximately half of American 
Indian adults have diabetes. On average, American Indians and 
Alaska Natives are 2.8 times as likely to have diagnosed 
diabetes as non-Hispanic whites of similar age.
    Available data often underestimates the true prevalence of 
diabetes in American Indians. The Navajo Health and Nutrition 
Survey, published in 1997, showed that 22.9 percent of Navajo 
adults age 20 and older had diabetes. Fourteen percent had a 
history of diabetes, but another 7 percent were found to have 
undiagnosed diabetes during the survey.
    In all 12 Indian Health Service Areas, diabetes is reported 
as one of the top ten major health problems. 15.1 percent of 
American Indians and Alaska Natives receiving care from IHS 
have diabetes. Until recently, type 2 diabetes was rarely 
diagnosed in children and adolescents. An alarming recent 
development is the occurrence of type 2 diabetes, once called 
``adult-onset'' diabetes, with much greater frequency among 
children, especially minority children including Native 
American youth.
    The Committee expects CDC to place continued priority on 
the prevention of diabetes among American Indians and Alaska 
Natives.
    Epilepsy.--The Committee recognizes epilepsy, a chronic 
neurological condition, as a significant public health concern 
affecting over 2.3 million persons in the United States 
including 300,000 American seniors over the age of 65. For a 
long time epilepsy has been seen as a condition that affects 
young people, often starting in early childhood; sometimes 
lasting throughout life. The U.S. population is aging and 
stroke, cardiovascular disease, brain tumors and Alzheimer's 
disease are all causes of epilepsy in the elderly. Further, the 
Committee acknowledges that CDC has worked diligently over the 
last couple of years to promote better public education and 
treatment of people with epilepsy. Therefore, the Committee has 
provided increased funding for the CDC to enhance its epilepsy 
efforts in partnership with a national non-profit that works on 
behalf of children and adults affected by seizures through 
research, education, advocacy and service, and should include 
activities addressing the relationship between older adults and 
epilepsy; maximizing public and provider health education 
programs in the schools, the public sector and in States; and 
supporting prevention research on stigma and self-esteem.
    Glaucoma and other Vision Disorders.--Age-related threats 
to sight, including age-related macular degeneration, glaucoma, 
cataracts and diabetes retinopathy are expected to nearly 
double by the year 2030 with the aging of the baby-boomer 
generation. Recognizing this emerging public health threat, the 
Committee is aware of the demonstrated success of vision 
screening programs in preventing blindness and vision 
impairments among many of the more than 30 million adults that 
suffer from eye-related disorders.
    The Committee is encouraged by the CDC's exploration of 
strategies to implement a national initiative to combat the 
effects of eye-related disorders, especially glaucoma. The 
Committee has included funds for CDC to establish vision 
screening and education programs in partnership with national 
voluntary health agencies and for CDC to develop a national 
surveillance system to monitor trends over time and assess the 
economic costs of vision loss especially related to glaucoma. 
In addition, the Committee concurs with the President's request 
that $2,800,000 should be used to continue or expand a model 
project that is testing and evaluating the efficacy of glaucoma 
screening using mobile units.
    Heart Disease and Stroke.--The Committee recommendation 
includes a $10,000,000 increase for the CDC cardiovascular 
programs as part of the Committee's initiative to prevent and 
reveres heart disease. The Committee urges the CDC to initiate 
research to examine strategies to prevent and reverse heart 
disease, including mind/body approaches to stress management, 
yoga, diet modifications and exercise programs.The Committee is 
aware that many States still need a State-based cardiovascular 
disease prevention and control program, but in the past funding 
has not been made available. In fiscal year 2001, only 28 
States received CDC funding to design and/or implement State-
specific programs to prevent and control heart disease, stroke 
and other cardiovascular diseases even though cardiovascular 
diseases remain the No. 1 killer of men and women across all 
racial and ethnic groups in the United States. The Committee 
strongly believes that since cardiovascular diseases remain the 
No. 1 killer in every State, each State should receive funding 
for a Cardiovascular Health State Program and, therefore, has 
increased funding for the Cardiovascular Health State Program, 
allowing CDC to increase the number of States supported by this 
program and to initiate research to examine the causes of the 
regional disparity of cardiovascular diseases.
    The Committee recommends an increase of $1,000,000 to 
expand the WISEWOMAN program. WISEWOMAN provides additional 
preventive services to low-income uninsured women screened in 
CDC's National Breast and Cervical Cancer Early Detection 
Program. CDC uses this established system to screen women for 
other chronic disease risk factors, to respond to women with 
risk factors (e.g. high blood pressure, high cholesterol) by 
providing dietary and physical activity counseling and 
programs. Since WISEWOMAN's inception approximately 10,000 low-
income and uninsured women have been screened for high blood 
pressure and cholesterol. In fiscal year 2002 CDC will fund 12 
WISEWOMAN programs.
    Stroke remains America's No. 3 killer, a major cause of 
permanent disability and a key contributor to late-life 
dementia. This year about 600,000 Americans will suffer a 
stroke and nearly 170,000 will die. The drug tPA is the only 
FDA-approved emergency treatment for clot-based stroke. Yet, 
less than 5 percent of those eligible for tPA receive it. 
Established by Congress during the fiscal year 2001 
appropriations process, the Paul Coverdell National Acute 
Stroke Registry is designed to track and improve the delivery 
of care to patients with acute stroke. In fiscal year 2002, the 
CDC will support activities to develop and test prototypes for 
this registry in 8 sites. The Committee urges CDC to continue 
to work with the National Institute of Neurological Disorders 
and Stroke, and the National Heart, Lung, and Blood Institute 
at the National Institutes of Health, the Brain Attack 
Coalition, and other pertinent professional organizations, 
including hospitals, universities, State and local health 
departments, and other appropriate partners experienced in the 
treatment of stroke to further implement this registry.
    Hemophilia.--The Committee expects CDC to continue working 
closely with the National Hemophilia Foundation in 
strengthening its disease management, prevention, outreach, and 
blood safety surveillance programs to meet the needs of persons 
with hemophilia, other bleeding and clotting disorders, and, 
particularly, women with bleeding disorders. The Committee 
requests a report by March, 2003 on CDCs efforts to establish a 
genetic data bank for persons with hemophilia and the resources 
required and steps to be taken to expeditiously genotype the 
hemophilia community.
    Juvenile Diabetes.--The Committee is aware that a 
surveillance system to track childhood diabetes has been 
initiated that is proving beneficial to research for the 
treatment and cure of the disease. The Committee encourages CDC 
to extend and expand the childhood diabetes surveillance system 
to track all American children suffering from the disease.
    Kidney disease.--The Committee recognizes that kidney 
disease is the ninth leading cause of death in the United 
States, costing the Medicare program $12,000,000,000 annually. 
Recent epidemiologic research indicates that more than 20 
million Americans have signs of kidney disease and that an 
additional 20 million individuals in this country are at 
increased risk of kidney disease. Moreover, most of these 
individuals are unaware of this danger to their health. The 
Committee believes there is a need for public health programs 
to identify and educate those who are threatened by kidney 
disease and thereby reduce morbidity and improve outcomes. 
Therefore, the Committee encourages CDC to develop a national 
kidney disease action plan and a public health strategy to 
combat kidney disease in this country.
    Micronutrients.--Deficiencies of micronutrients such as 
iron, iodine, and vitamin A, affect nearly one-third of the 
world's population, and result in reduced mental and physical 
development of children, poor pregnancy outcomes, diminished 
work capacity of adults, and increased morbidity and premature 
mortality among populations. Effective and inexpensive 
interventions such as dietary diversification, food 
fortification and supplementation have eliminated most 
micronutrient deficiencies in developed countries.
    The Committee has provided sufficient funding for CDC to 
continue its efforts to eliminate micronutrient malnutrition. 
The focus of these efforts is to support a number of national 
and international efforts to assess mirconutrient status of 
populations and to monitor and strengthen implementation of 
interventions as well as to assess the impact of the 
interventions over time. CDC has extensive expertise in 
epidemiology, monitoring and assessment, and laboratory 
science. These efforts reflect the unique contribution that CDC 
can make to eliminate micronutrient deficiencies.
    Nutrition, Physical Activity and Obesity.--Obesity is 
epidemic in the United States. Between 1980 and 1994, the 
prevalence of obesity in the United States has increased by 100 
percent in children and adolescents. More than 20 percent of 
the adult population is 30 pounds or more overweight and 10 to 
15 percent of children and adolescents are overweight. The cost 
of diseases associated with obesity is almost $100,000,000,000 
per year. Risk factors associated with obesity--physical 
inactivity and unhealthy eating--account for at least 300,000 
preventable deaths each year and increase the risk for many 
chronic diseases like diabetes, heart disease and cancer. The 
Committee is aware that the CDC's own statistics show that 
native Americans, including native Alaskans and native 
Hawaiians suffer higher rates of obesity than other Americans.
    The Committee commends the substantial, comprehensive 
efforts that CDC is directing to stem the obesity epidemic 
across all life stages. CDC is coordinating national, State and 
school-based programs to research and implement interventions 
to increase physical activity levels and good nutrition at all 
ages, to provide important health information, and to monitor 
health and healthy behaviors in the population. CDC currently 
funds 12 States to promote physical activity and good nutrition 
to prevent and control obesity. As part of its physical 
activity, nutrition and obesity prevention initiative, the 
Committee has included a significant increase for Nutrition, 
Physical Activity, and Obesity at CDC.
    Oral Health.--The Committee recognizes that to effectively 
reduce disparities in oral disease will require improvements at 
the State and local levels. The Committee is pleased that 
almost half of the States applied for grant funding from the 
Division of Oral Health to target prevention programs and 
resources to those at greatest risk. The Committee expects the 
Division to advance efforts to reduce the disparities and 
health burden from oral cancers that are closely linked to 
chronic diseases like diabetes and heart disease.
    Prevention Centers.--The prevention centers form a 
nationwide network of academic institutions that conduct 
applied research designed to develop and test innovative 
strategies for health promotion and disease prevention. The 
primary goals of the program are to identify risk factors, to 
identify barriers and facilitators to behavior change to 
demonstrate the effectiveness of prevention interventions, to 
increase collaboration among agencies and community partners, 
and to train public health professionals in creative ways for 
preventing chronic diseases and other health problems. The 
Committee has included sufficient funds to expand the number of 
prevention centers funded by CDC.
    The Committee continues to support within the prevention 
center program a Tobacco Prevention Research Network to 
increase the knowledge base on the most effective strategies 
for preventing and reducing youth tobacco use, as well as on 
the social, physiological and cultural reasons for tobacco use 
among children.
    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 recognizes the urgency to discover novel 
compounds to combat bioengineered (weapons-grade) bioterrorist 
threats. Many of these threats require antibiotics and 
antiviral agents with activity against drug resistant strains 
of these bioengineered bioterrorist weapons.
    Primary Immunodeficiencies Diseases.--In fiscal year 2002, 
the Committee appropriated funding for a national physician 
education and public awareness program related to primary 
immunodeficiency diseases. It is the Committee's intent that 
this program be continued in fiscal year 2003 and that CDC 
continue to work closely with the Jeffrey Modell Foundation to 
implement and continue the Foundation's plan for public 
awareness and physician education. The Committee is also 
pleased that CDC has recognized that these diseases constitute 
a major public health issue and intends to pursue appropriate 
public health interventions to address it with other available 
resources.
    Prostatitis.--Prostatitis affects 10 percent of the male 
population. It may be the trigger for both prostate enlargement 
and prostate cancer. Prostatitis may act as a reservoir for 
bacterial resistance and for the spread of chronic disease in 
women and men by various pathogens. The Committee encourages 
CDC to continue to investigate the etiology of prostatitis, 
begin disease surveillance, increase public awareness, and 
determine treatment and prevention.
    Safe Motherhood.--The Committee has increased funding for 
the Safe Motherhood program as part of its Safe Motherhood 
initiative. The purpose of this program is to improve the 
chances that a woman will have a safe and healthy pregnancy and 
delivery. Of the 4 million women who give birth in the United 
States each year, over one-third have a pregnancy-related 
complication before, during, or after delivery. These 
complications may cause long-term health problems or even 
death. Unfortunately, the causes and treatments of pregnancy-
related complications are largely unknown and understudied. If 
fact, the United States ranks only 20th in maternal mortality 
rates out of 49 developed countries. Every day, two to three 
women die from pregnancy related complications. And despite the 
fact that maternal mortality was targeted in 1987 as part of 
Healthy People 2000, the maternal mortality rate in this 
country has not decreased in 20 years.
    School Health.--The Committee notes that obesity rates were 
cut in half among girls in grades 6-8 who participated in a 
school-based intervention program. The Committee applauds CDC 
for establishing effective coordinated school health programs 
in 20 States and two local education agencies. As part of its 
physical activity, nutrition and obesity prevention initiative, 
the Committee has included sufficient funds for CDC to expand 
its coordinated school health program to address risk behaviors 
such as tobacco use, unhealthy diets, and physical inactivity.
    The Committee further recognizes the effectiveness of 
school health programs as demonstrated by the significant 
reductions in sexual risk behaviors among the nation's high 
school students over the past decade. However, the Committee is 
concerned that CDC's funding for the school health HIV program 
has not increased in 10 years. To compensate, some of the 
additional funding provided over last year's level is directed 
to the school health HIV program and the Committee urges CDC to 
use the funds to expand is prevention efforts aimed at youth.
    Sudden Infant Death Syndrome.--The Committee notes the work 
of CDC, the National Institute of Child Health and Human 
Development and HRSA in developing model guidelines for death 
scene protocol for Sudden Infant Death Syndrome. The Committee 
encourages CDC to implement projects to demonstrate the 
effectiveness of the death scene protocol in a variety of 
locales (urban, suburban, and rural) throughout the Nation. The 
Committee expects CDC to be prepared to report on progress on 
this initiative during the fiscal year 2004 budget hearings.
    Tobacco Use.--Tobacco use is the single most preventable 
cause of death and disease in our society. It causes more than 
400,000 deaths in the United States each year, and costs the 
nation $50,000,000,000 in medical expenses alone. Children are 
especially hard hit by tobacco. Ninety percent of adult smokers 
begin their habit as children. These funds are intended to 
expand the capacity of all State and local health departments, 
education agencies, and national organizations to build 
comprehensive tobacco control programs and to develop and begin 
implementation of a national public education campaign to 
reduce access to and the appeal of tobacco products among young 
people.
    Youth Media Campaign.--The Committee recommends $40,000,000 
for the Youth Media Campaign. The President's budget request 
did not request funding for this valuable program. The 
Committee believes that the need for this program, with its 
emphasis on encouraging physical activity in youth, is greater 
than ever. In any given week, 71 percent of adolescents do not 
participate in physical education. Nearly half of young people 
(ages 12-21) do not regularly engage in vigorous physical 
activity. ``Tweens'', the 9-13 year olds forming the target 
demographic group for the Youth Media Campaign, average 6 hours 
of television, radio, and internet every day. At the same time, 
because of increased time spent on television, radio, and 
internet, youth are exposed to greater amounts of media that 
often promote unhealthy behaviors, such as insufficient 
physical activity. As a result, the percentage of obese youth 
has more than doubled in the last 20 years. In contrast to the 
Committee's recommended funding level, millions of dollars are 
spent every year advertising to youths, often resulting in 
unhealthy behaviors.
    Research has shown that the first year of an advertising 
campaign serves to raise the awareness of an issue and that, in 
order to have an impact, it is critical that the campaign's 
messages reach the target audience frequently over an extended 
period of time in order to change behaviors. CDC has carefully 
researched and crafted an excellent campaign that will, if 
given sufficient time, have a positive impact on youth physical 
activity behaviors. In addition, being more physically active 
likely will, in turn, result in changing other unhealthy 
behaviors. The Committee commends CDC for its excellent work on 
the Youth Media Campaign.

Environmental Health

    The Committee recommends $189,489,000 for environmental 
health activities which is $36,058,000 above the fiscal year 
2002 level and $37,334,000 above the administration request.
    Within the total provided, the following funding levels are 
for specific funding activities: $36,826,000 is for the 
environmental health laboratory; $69,002,000 is for 
environmental health activities; $39,887,000 is for the asthma 
program; and $43,774,000 is for the childhood lead poisoning 
program.
    Many of the public health successes that were achieved in 
the 20th century can be traced to innovations in environmental 
health practices. However, emerging pathogens and environmental 
toxins continue to pose risks to our health and significant 
challenges to public health. The task of protecting people's 
health from hazards in their environment requires a broad set 
of tools. First among these tools are surveillance and data 
collection to determine which substances in the environment are 
getting into people and to what degree. It also must be 
determined whether or not these substances are harmful to 
humans, and at what level of exposure. Many scientists estimate 
that about two-thirds of all cancers result from environmental 
exposure, but much better data are needed to improve this 
estimate and determine which exposures cause cancer and other 
diseases.
    The Committee is aware of concerns raised within and 
outside Alaska about the safety of Alaskan wild foods. The 
Committee encourages CDC to give careful consideration to a 
State of Alaska program to monitor the safety of Alaskan wild 
foods, including field studies of the effects of environmental 
chemical contaminants and naturally occurring metals in Alaskan 
wild foods, measurement of PCB levels in remote arctic 
communities, documentation of mercury levels in ancient humans, 
documentation of incidence of childhood asthma, and development 
of public health recommendations on Alaskan wild food 
consumption by subsistence users and others.
    Asthma.--CDC's asthma activities focus on three areas: 
tracking the disease to improve the Nation's ability to 
determine asthma prevalence, severity, and management; assuring 
that interventions are based on science; and working to address 
this problem through partnerships including providing technical 
assistance to non-governmental organizations to carry out 
diverse community-based childhood asthma control programs.
    The Committee is pleased with the work that the CDC has 
done to address the increasing prevalence of asthma. However, 
the increase in asthma among children remains alarming. The 
Committee urges CDC to expand its outreach aimed at increasing 
public awareness of asthma control and prevention strategies, 
particularly among at-risk populations in underserved 
communities. To further facilitate this effort, CDC is urged to 
partner with voluntary health organizations, such as the 
American Lung Association's Asthma Clinical Research Centers, 
to support program activity consistent with CDC's efforts to 
fund community-based interventions that apply effective 
approaches demonstrated in research projects within the 
scientific and public health community.
    Childhood Lead Poisoning Prevention.--Since its inception 
in fiscal year 1990, the CDC program has expanded to 
approximately 40 project areas that encompass States, local 
areas, and numerous communities and screens an estimated 1.75 
million children annually. The program has developed its first 
Geographic Information System (GIS) website using U.S. Census 
data on income, race, and old housing to help State and local 
health departments identify high-risk geographic areas. The 
availability of such information will result in more efficient, 
targeted screening.
    The Committee is concerned the current approach to lead 
poisoning prevention cannot achieve the national goal of ending 
this disease by 2010. The Committee has provided an increase 
above the budget request to support more concerted, prevention-
oriented strategies. The Committee encourages CDC to target its 
grants to communities at high risk, promote wide adoption of 
lead-safe work practices, emphasize correction of identified 
lead hazards, make clearance dust testing routine, and support 
community-based efforts to assess and address health hazards in 
high-risk housing.
    Childhood Leukemia.--The Committee appreciates the CDC's 
continuing work on the cancer cluster investigation in Fallon, 
Nevada, and understands that preliminary results of that 
investigation are due within the next few months. The Committee 
strongly encourages the CDC to continue to devote resources to 
this investigation.
    Environmental Health Laboratory.--The CDC environmental 
health laboratory performs assessments for State investigations 
of diseases (such as cancer and birth defects) and 
investigations of chemical exposures, such as dioxin, 
pesticides, mercury and cadmium. CDC is also working with 
States to improve public health laboratories that assess State 
level biomonitoring needs. CDC works closely with academic 
institutions, other Federal agencies, and other partners to 
measure human exposure to toxic substances and the adverse 
effects of that exposure.
    The Committee recognizes CDC for its commendable work in 
analyzing toxic exposures throughout the United States. The 
Committee further recognizes that CDC's environmental 
laboratory is unprecedented in the world for measuring toxic 
exposures to humans and further commends CDC for publishing the 
National Report on Human Exposure to Environmental Chemicals, 
which provides information about the U.S. population's exposure 
to 27 toxic substances, including heavy metals and certain 
pesticides.
    The Committee supports the CDC biomonitoring program and 
study of environmental toxins and their relationship to chronic 
diseases, such as asthma, many birth defects, and cancer to 
increase our understanding of the cause of many chronic 
diseases and conditions and to facilitate the development of 
effective prevention strategies.
    Health Tracking Network.--The Committee has included 
$30,000,000 for the Health Tracking Network. In fiscal year 
2001, the Committee first requested that CDC develop a plan for 
a coordinated Nationwide Health Tracking Network. In fiscal 
year 2002, the Committee provided $17,500,000 to develop pilot 
programs in States as a first step in the development of the 
Network. The fiscal year 2003 funds will enable CDC to 
establish tracking networks in up to 15 additional States and 
create a Center of Excellence in public health at an 
appropriate research university. The Committee strongly urges 
CDC to assure that as States develop these systems they build 
on existing efforts where appropriate, including terrorism 
preparedness and other ongoing State tracking and monitoring 
initiatives. The Committee urges that all of the relevant 
centers, institutes, and offices within the CDC be included in 
the development, testing, and implementation of this nationwide 
project.
    The Committee further urges CDC to make every effort to 
support systems that are flexible in their data content, 
platform independent, and scalable to the entire Nation. The 
Committee understands that this is a long term project, and 
requests CDC to submit a vision statement for a Nationwide 
Health Tracking Network as well as a plan for achieving this 
vision.
    Rural Health.--The Committee is greatly concerned about the 
health status of the residents of rural communities. The 
Committee commends CDC for its efforts last year to conduct an 
assessment of rural health problems. Sufficient funds have been 
provided to continue this important effort.

Epidemic Services and Response

    The Committee recommends $78,001,000 for epidemic services 
and response which is $2,138,000 below the fiscal year 2002 
level and the same as the administration's request.
    CDC's epidemic services and response program provides 
resources and scientific expertise for operating and evaluating 
surveillance systems; developing and refining research methods 
and strategies to the benefit of public health practice; 
training public health professionals who are prepared to 
respond to public health emergencies, outbreaks and other 
assistance requests; and communicating with multi-faceted 
audiences accurate public health information and effective 
messages. The scientific basis of this program is applied 
epidemiology, in concert with other components of sound public 
health practice. Findings from these disciplines enable States, 
health organizations, foreign ministries of health, and others 
in the health field to make sound decisions and create 
effective policy. Information derived from epidemiologic data 
and scientific reasoning provide public health programs with an 
objective rationale to set priorities, apply interventions and 
policies, and evaluate public health programs. Within the 
epidemic services and response program, CDC carries out a 
variety of applied research and development activities. Areas 
of research include: social determinants of health; aberration 
detection; burden of disease; injury, and death; prevention 
effectiveness; and health care quality. The Committee 
recognizes that CDC maintains a keen appreciation for the fact 
that local outbreaks of illness can develop rapidly into 
epidemics, that previously unidentified health problems can 
appear at any time, that contaminated food or defective 
products may appear in the community without warning, and that 
the threat of bioterrorism is present in many areas of the 
world. When CDC participates in an investigation, all of the 
resources of the agency are at the disposal of the affected 
area, including its state-of-the-art laboratories.

Health Statistics

    The Committee recommends $125,899,000 which is $780,000 
below fiscal year 2002 and the same as the administration 
request.
    CDC's statistics give us context and perspective on which 
we can base important public health decisions. By aggregating 
the experience of individuals, we gain a collective 
understanding of our health, our collective experience with the 
health care system, and our problems and public health 
challenges. NCHS data are used to create a basis for 
comparisons between population groups or geographic areas, as 
well as an understanding of how trends in health change and 
develop over time.

HIV, STD, and TB Prevention

    The Committee recommends $1,168,532,000 for HIV, STD, and 
TB Prevention, which is $33,532,000 above the fiscal year 2002 
level and $33,532,000 above the administration request. Of the 
amount provided, $860,293,000 is for HIV/AIDS programs, of 
which $168,763,000 is for global HIV/AIDS programs; 
$170,450,000 is for the STD program; and $137,789,000 if for 
the Tuberculosis program.
    Recognizing the intersection among these diseases, and the 
need for a focal point for leadership and accountability, CDC 
combines HIV, STD, and TB activities to provide leadership in 
preventing and controlling human immunodeficiency virus 
infection, other sexually transmitted diseases (STDs), and 
tuberculosis. CDC works in collaboration with partners at 
community, State, national, and international levels, applying 
well-integrated, multi-disciplinary programs of research, 
surveillance, technical assistance and evaluation. These 
diseases are not vaccine preventable and must be controlled and 
prevented through identifying, diagnosing, and treating 
infected persons; through provision of confidential, culturally 
competent counseling to identify and reach those who have been 
exposed to infection and who may not know it; and through 
individual and population level health promotion to reduce high 
risk behaviors.
    HIV/AIDS Prevention.--CDC's HIV/AIDS prevention programs 
are working in every State and territory to prevent new 
infections, link people who are already infected to medical 
care and translate scientific research findings into practical 
prevention programs available to every person at risk. CDC will 
continue to adapt these prevention programs to meet new and 
different needs.
    According to the CDC, between 4 million and 5 million 
people in the United States are at continued behavioral risk 
for HIV infection. The Committee recognizes that this is a low 
estimate due to under-reporting by participants and the lack of 
inclusion of schools, prisons, and the military. Communities 
must be better equipped with local data to identify and direct 
resources to those most at risk. They must have an array of 
effective interventions available and the capacity to implement 
and evaluate them at the local level. They must also be able 
not only to address barriers and deter risky behavior but also 
to encourage health promotion behavior through a variety of 
individual and group interventions, community-level supports, 
and structural level changes. Because those at risk for or 
living with HIV infection are often also at risk for other 
health problems, HIV prevention must be integrated with other 
services such as STD and TB screening and treatment, 
reproductive health services, mental health services, and drug 
use prevention and treatment.
    The Committee recognizes the role of State and local health 
departments in providing comprehensive HIV prevention programs 
targeted locally to address the prevention needs of individual 
communities and in conducting surveillance activities designed 
to monitor the course of the epidemic.
    The Committee recognizes that CDC is currently developing a 
new program announcement to guide State and local HIV 
prevention efforts beginning in January 2004. The Committee 
encourages CDC to work with State and local health departments 
to streamline the application process and reduce the 
administrative burden on health departments.
    HIV prevention community planning is an important component 
of the comprehensive HIV prevention programs administered by 
State and local health departments nationwide. With nearly 10 
years of experience with community planning, the Committee 
urges the CDC to revise Federal guidance to be less 
prescriptive and to encourage greater flexibility for 
jurisdictions to implement models of community planning 
appropriate for their jurisdictions including multi-year 
planning and joint care and prevention planning.
    Global HIV/AIDS.--CDC works with governments in 25 
countries in Africa, Asia and Latin America and the Caribbean 
focusing on primary prevention of HIV/AIDS; care and treatment 
of tuberculosis and other opportunistic infections, palliative 
care and appropriate use of antiretroviral medications; and 
infrastructure and capacity development. The Committee 
recognizes that it is not feasible for CDC to establish 
programs in every country in need. The increase should support 
rapid response teams and regional programs to address the needs 
of countries that are not part of CDC's Global AIDS Program and 
to foster regional approaches to HIV/AIDS prevention, care and 
treatment.
    The Committee commends CDC for recognizing the urgent 
public health need to develop new HIV prevention options by 
increasing the funds available for microbicide research and 
development. The Committee urges CDC to continue to expand 
funding and staff for microbicide research and development 
within funds provided for global AIDS. These funds could 
support clinical trials of microbicides as set forth in CDC's 
HIV Prevention Strategic Plan and its topical microbicide 5-
year research agenda.
    Sexually transmitted diseases.--CDC's strategy for STD 
prevention is to provide national and international leadership 
through research, surveillance, policy development, and 
assistance to States, territories and local health departments 
in the delivery of services to prevent and control the 
transmission of STDs and their complications. The Committee 
recognizes that this year, more than 15 million Americans will 
contract a STD. National surveillance of syphillis, chlamydia, 
and gonorrhea is supported, and sentinel surveillance 
strategies are being developed for new viral STDs, 
specifically, human papillomavirus. Prevention research is 
conducted to improve methods and delivery of prevention 
services and to develop and refine interventions.
    The Committee has recommended increased funding for this 
program to address priorities of CDC's sexually transmitted 
disease program including infertility prevention and syphilis 
elimination. Funds would support expansion of chlamydia 
screening to reach more underserved women and enhanced rapid 
response and community partnerships to eliminate syphilis
    Turberculosis (TB).--The Committee recommendation includes 
increased funding for CDC's Tuberculosis program to begin to 
implement the recommendations of the recent Institute of 
Medicine Report entitled, ``Ending Neglect: The Elimination of 
Tuberculosis in the United States'' which was a call to triple 
research funding for TB to prevent and control the disease; to 
advance efforts to maintain control of TB in the United States 
by identifying and curing active TB; to speed the decline of TB 
through target testing and treatment of latent infection; and 
to advance global research and control efforts. As the report 
recommends, CDC should partner with private foundations on 
research, including the development of vaccines, diagnostic 
tests, and new drugs and to test the applicability of new 
tools, to achieve the recommendations.
    The Committee commends CDC for its continued efforts to 
control TB in the United States, as demonstrated by the 8 years 
of declining numbers of TB cases in this country. However, TB 
is the leading infectious disease killer in the world with more 
than 2 billion people--or one-third of the world's population--
infected with Mycobacterium tuberculosis, the causative agent 
of TB. In the next two decades, there are predicted to be 249 
million new active cases and 70 million resulting deaths from 
TB. Worldwide, TB is the leading killer of people who are HIV-
infected, accounting for one-third of AIDS deaths. While rates 
of TB in the United States have been on a steady decline, this 
global crisis will continue to directly impact this country 
until global control efforts are more effective. Soon, more 
than half of all cases of TB in the United States will be among 
foreign-born individuals. The Committee urges CDC to consider 
working with the Immigration and Naturalization Service to 
develop novel TB screening strategies for individuals 
emigrating from high TB incidence countries.

Immunization

    The Committee recommends $672,895,000 for the program 
authorized under section 317 of the Public Health Service Act 
which is $45,294,000 above the fiscal year 2002 level and 
$45,294,000 above the administration request.
    The Omnibus Reconciliation Act [OBRA] of 1993 established a 
new vaccine purchase and distribution system that provides, 
free of charge, all pediatric vaccines recommended for routine 
use by the Advisory Committee on Immunization Practices to all 
Medicaid-eligible children, uninsured children, underinsured, 
and native Americans through program-registered providers.
    Despite great success in lowering disease levels and 
raising immunization coverage rates, much remains to be done to 
ensure the protection of children and adults worldwide. 
Approximately 1 million 2-year-old children in the United 
States have not received one or more of the more established, 
recommended vaccines. New vaccines, although greatly beneficial 
to public health, complicate an already complex immunization 
schedule and make it increasingly difficult to ensure complete 
immunization. One of our Nation's greatest challenges is 
extending our success in childhood immunization to the adult 
population. The burden due to the occurrence of vaccine-
preventable diseases in adults in the United States is 
staggering. As many as 50,000 U.S. adults die of influenza, 
pneumococcal infections and hepatitis B. CDC is addressing 
these obstacles to the greatest extent possible and continues 
to provide leadership to reduce disability and death resulting 
from diseases that can be prevented through vaccination.
    The Committee has increased funding for the Section 317 
immunization program. It has been brought to the Committee's 
attention that costs of delivering vaccines to children in 
remote frontier areas are substantially higher than in other 
areas of the country because these communities are often only 
accessible via aircraft. The Committee encourages CDC to 
provide infrastructure support needed to deliver these vaccines 
at the community level, including development of a statewide 
immunization registry to ensure that all children in remote 
rural areas are immunized. The Committee notes that failure to 
immunize children in such areas results in deaths each year 
from exposure to open sewage lagoons and contaminated water.
    Global Immunization Activities.--The Committee includes 
$148,788,000 for global immunization activities which include 
$106,400,000 for polio vaccine, surveillance, and program 
operations for the highly successful, yet unfinished polio 
eradication efforts; and $42,388,000 for the purchase of 
measles vaccine for measles mortality reduction and regional 
measles elimination initiatives and to expand epidemiologic, 
laboratory, and programmatic/operational support to WHO and its 
member countries.
    While the United States has greatly reduced its burden of 
vaccine preventable diseases through childhood immunization, 
its children remain at risk due to widespread occurrence of 
these diseases in other countries. CDC supports a broad range 
of programmatic and research efforts to reduce the global 
burden of these diseases. A record low of 480 polio cases 
occurred worldwide in 2001, a decrease of more than 99.8 
percent since 1988 when the polio eradication initiative was 
launched. Endemic measles cases have been eliminated from all 
but two countries in the Americas; however, measles remains the 
largest single-cause of child vaccine preventable deaths 
globally, with approximately 800,000 measles-related deaths 
still occurring each year (450,000 in Africa). Each year, 
diseases that could be prevented with available vaccines kill 3 
million children worldwide. Vaccines that are now in late 
stages of development could prevent almost 2 million additional 
deaths. CDC Measles activities should build on global disease 
control and surveillance infrastructure developed for polio 
eradication.

Infectious Disease Control

    The Committee recommends $350,597,000 for infectious 
disease control, which is $6,151,000 above the fiscal year 2002 
level and $16,126,000 above the administration request.
    These activities focus on: national surveillance of 
infectious disease; applied research to develop new or improved 
diagnoses; prevention and control strategies; working with 
State and local departments and private health care providers 
to transfer application of infectious disease prevention 
technologies; and strengthening the capability to respond to 
outbreaks of new or reemerging disease.
    Infectious diseases are a leading cause of death worldwide, 
accounting for one-quarter to one-third of the estimated 54 
million deaths in 1998. Disease outbreaks endanger U.S. 
citizens at home and abroad, threaten U.S. Armed Forces 
overseas, and exacerbate social and political instability. 
Outbreaks can interfere with the global marketplace, affecting 
tourism, trade, and foreign investment. CDC's strategies to 
combat infectious diseases invest in and build upon both the 
public health system that was established over a century ago to 
increase the preparedness to address the emergence of dangerous 
new threats.
    The Committee is aware that in 1995, in partnership with 
Federal, State, and local agencies, universities, private 
industry, foreign governments, the World Health Organization 
(WHO), and many non-governmental organizations, CDC launched 
the first phase of a nationwide program to revitalize national 
capacity to protect the public from infectious disease threats. 
The second phase of CDC's effort, ``Preventing Emerging 
Infectious Diseases: A Strategy for the 21st Century'', 
published in 1998, continues these partnerships to build 
domestic and global capacity for recognizing and responding to 
infectious diseases.
    Anti-microbial resistance.--The Committee is concerned over 
the development of resistance in microbes to current 
antimicrobial therapies. Bacterial resistance to common 
antimicrobial agents has become one of the most serious 
emerging infectious disease threats facing communities and the 
health care system in the United States. Resistance to drug 
therapies leaves entire populations vulnerable to both simple 
infections and complex bioterrorism, as almost all microbes 
have become resistant to any commercially available product. To 
combat this national health threat, the Committee recognizes a 
need to discover and develop new pharmaceutical products to 
combat these drug resistant microbes. In recognition of the 
growing problem, the CDC's goal is to develop and evaluate new 
antimicrobial drugs. With the CDC's mission and expertise in 
world-wide surveillance, it is uniquely positioned to 
facilitate the global bio-prospecting and development of new 
pharmacologically active compounds in untapped ocean and land 
environments to combat the growing threat posed by drug 
resistant microbes.
    Recognizing that a greater effort is needed to confront 
this problem, the Committee encourages CDC to provide 
sufficient funds to begin to address several critical areas. 
These include (1) development and evaluation of compounds with 
antimicrobial activity against multidrug resistant strains of 
Staphylococcus aureus, enterococcus, gram-negative hospital 
acquired pathogens, and vancomycin-tolerant pneumococcus; (2) 
development of demonstration projects to combat antimicrobial 
resistance in the hospital and community, particularly in rural 
settings; (3) development of Centers of Excellence in Health 
Care Epidemiology, and (4) enhancement of capacity at the CDC 
to support these and other activities related to control of 
antimicrobial resistance.
    Antimicrobial Resistance Epicenter Program.--The Committee 
applauds CDC on its support for the Prevention Epicenter 
Program and recommends that CDC significantly expand and 
enhance this program to address patient safety issues.
    Food Safety.--CDC established PulseNet in 45 State health 
departments. PulseNet is a national network of public health 
laboratories that performs DNA ``fingerprinting'' on bacteria 
that may be foodborne. The PulseNet network has revolutionized 
foodborne disease surveillance by allowing near real-time 
comparison of these ``fingerprint'' patterns through an 
electronic database at CDC. Matching patterns can indicate 
possible nationwide outbreaks and provide an early warning for 
public health investigation and intervention. The Committee is 
pleased that CDC has developed and implemented a state-of-the-
art diagnostic and communications system to improve parasitic 
disease diagnoses in the United States. This system, known as 
DPDx, uses Internet communication to rapidly exchange 
diagnostic images of parasites digitally captured from 
microscopic slides. Using DPDx, public health laboratories can 
obtain diagnostic assistance in real time, allowing for rapid 
identification of possible outbreaks.
    Global Malaria Initiative.--The Committee continues to 
recognize the tremendous impact of malaria in the developing 
world, and notes malaria's increasing resistance to 
antimalarial drugs designed to counter its pervasive effects. 
New drugs must be developed, and the Committee urges the CDC to 
continue its efforts to lead in new compound discovery.
    Hepatitis C.--The Committee is pleased with the initial 
steps taken to implement the National Hepatitis C Prevention 
Strategy including the appointment of Hepatitis C coordinators 
in all 50 States plus the establishment of 15 large 
metropolitan area demonstrations. The Committee notes, however, 
based on the CDC report Implementation Plan for the National 
Hepatitis C Prevention Strategy that significant deficiencies 
exist in mounting a full national response to hepatitis C. The 
Committee recommends that CDC conduct a National Hepatitis 
Coordinators Conference to train coordinators to help States 
integrate hepatitis prevention in State public health programs. 
The Committee requests a report by January, 2003 which 
documents the treatment and pharmaceutical needs of individuals 
served by the large metropolitan demonstrations and the 
necessary funding mechanisms needed to meet these needs.
    The Committee urges CDC to work with voluntary health 
organizations and professional societies to promote liver 
wellness and prevention of hepatitis. CDC is urged to review 
options for a National Hepatitis Roundtable, similar to CDC's 
Colorectal Cancer Roundtable.
    Pandemic Influenza.--Pandemic influenza is a particularly 
virulent strain of influenza that arises spontaneously and 
periodically. Examples include the outbreak of Spanish flu in 
1918, that killed 500,000 people, and outbreaks in 1957 (Asian 
flu) and 1968 (Hong Kong flu). The Committee has included 
additional funds for pandemic influenza activities. These funds 
will allow CDC to strengthen global and domestic surveillance 
capabilities in order to increase the likelihood of early 
detection of an influenza pandemic and the effective tracking 
of its spread.
    Patient Safety.--The Committee recommends increased funding 
for patient safety activities. The Committee urges CDC to 
expand the National Health Care Safety Network, a national 
electronic medical error/adverse events monitoring system. This 
system will encompass a representative sample of hospitals in 
the United States, managed care organizations, long-term care 
facilities, and other healthcare venues linked to health 
departments and CDC. The funds can also be used to enhance 
capacity for detection and response to medical errors and other 
adverse healthcare events at State and local levels through 
active monitoring, improved epidemiologic/root cause 
investigation, and onsite intervention to promote patient 
safety and improve patient outcomes.
    West Nile virus.--The Committee is aware of CDC's effort to 
complete a national plan for West Nile virus response in the 
United States. That includes developing a computerized national 
surveillance system for West Nile virus and provides funds to 
53 health departments to build national capacity to develop and 
implement effective surveillance, prevention, and control of 
West Nile virus in the United States.

Injury Prevention and Control

    The Committee recommends $149,385,000 for injury prevention 
and control, which is $62,000 below the 2002 level and 
$4,621,000 above the administration request.
    CDC is the lead Federal agency for injury prevention and 
control. Programs are designed to prevent premature death and 
disability and reduce human suffering and medical costs caused 
by: fires and burns; poisoning; drowning; violence; lack of 
bicycle helmet use; lack of seatbelt and proper baby seat use; 
and other injuries. The national injury control program at CDC 
encompasses nonoccupational injury and applied research in 
acute care and rehabilitation of the injured. Funds are 
utilized for both intramural and extramural research as well as 
assisting State and local health agencies in implementing 
injury prevention programs. The Committee recognizes the vital 
role CDC serves as a focal point for all Federal injury control 
activities.
    The Committee's recommended increase over the amount 
proposed in the President's Budget for Injury Prevention and 
Control which will enable CDC to continue the widespread 
adoption of programs, policies, and practices that are 
successful in reducing injuries and deaths, as well as 
minimizing the adverse outcomes from injury. These funds will 
allow current activities in fiscal year 2002 to continue, 
including programs to support trauma information and education, 
activities in childhood injury and violence prevention and 
research and State programs to prevent injury and violence.
    In addition, sufficient funds have been included to 
continue support for all existing Injury Control Research 
Centers.
    Traumatic Brain Injury.--The Committee has provided an 
increase in the TBI Prevention Program to enable the program to 
implement its new authorities enacted in 2000 regarding TBI 
surveillance and registry, establish a One-Call information 
Center, and expand awareness programs with an emphasis on 
minority populations. This increase will assist in filling 
significant gaps in information available at State and Federal 
levels regarding the incidence and prevalence of TBI, the 
resources available to victims of TBI, and the nature of 
specific factors involving TBI in young children and in 
institutionalized individuals.
    National Violent Death Reporting System.--In fiscal year 
2002, Congress called on CDC to begin implementation of a plan 
for a system for timely, complete, objective and accurate 
information about violent deaths and injuries to inform and 
evaluate policy and program efforts. The Committee is pleased 
with the progress and has included $3,000,000 to extend 
implementation of this model plan for the establishment of a 
national violent death reporting system (NVDRS) from 20 to 22 
States. NVDRS will enable States to understand more about the 
violence problem in their States. The Committee urges CDC to 
continue to work with private health and education agencies as 
well as State agencies in the development and implementation of 
an injury reporting system.

Occupational Safety and Health

    The Committee recommends $274,899,000 for occupational 
safety and health programs, which is $1,181,000 below the 
fiscal year 2002 level and $27,581,000 above the administration 
budget.
    The CDC's National Institute for Occupational Safety and 
Health (NIOSH), is the only Federal agency responsible for 
conducting research and making recommendations for the 
prevention of work-related illness and injury. The NIOSH 
mission spans the spectrum of activities necessary for the 
prevention of work-related illness, injury, disability, and 
death by gathering information, conducting scientific 
biomedical research (both applied and basic), and translating 
the knowledge gained into products and services that impact 
workers in settings from corporate offices to constructions 
sites to coal mines.
    The Committee recommends $88,760,000 for CDC's National 
Occupational Research Agenda (NORA). This is the same funding 
level as fiscal year 2002 and restores the $25,581,000 cut 
proposed by the Administration. NORA is a critical scientific 
research program that projects employees and employers from the 
high personal and financial costs of work site health and 
safety losses. Industries such as agriculture, construction, 
health care, and mining benefit from the scientific research 
supported by NORA. The program's research agenda focuses on 
prevention of disease and injury resulting from infectious 
diseases, cancer, asthma, hearing loss, musculoskeletal 
disorders, traumatic injuries, and allergic reactions, among 
others. In fiscal year 2002, NORA is supporting more than 
$40,000,000 in extramural research conducted by universities 
and other research institutions. The Committee continues to 
strongly support NORA and encourages expansion of its research 
program to cover additional causes of work place health and 
safety problems.
    Construction Safety and Health.--The Committee once again 
is very pleased with the progress that NIOSH has made in its 
program directed at occupational illnesses and injuries in the 
building and construction industry. According to the Bureau of 
Labor Statistics, the rate of serious illnesses and injuries in 
construction has dropped 32 percent from 1992 to 1997. The 
Committee is also pleased by NIOSH's new focus on active 
intervention to prevent occupational injury and illness in the 
construction industry, and the National Occupational Research 
Agenda (NORA) for establishing research priorities. However, 
the Committee is concerned with the continued high fatality 
rate in the industry, and has included funds to continue the 
program at no less than current levels.
    Education and Research Centers.--The Committee commends the 
work of the 15 university-based Education and Research Centers 
(ERC's) and the smaller single discipline Training Project 
Grants (TPG's). These regional centers are integral to the 
Nation's efforts to improve the health and safety of working 
men and women, and important to the future efforts of NIOSH to 
implement the National Occupational Research Agenda (NORA). 
Recognizing the important role Education ERCs play in 
preventive health research and the training of occupational 
safety and health professionals, and includes an increase of 
$2,000,000 for ERCs.
    Farm Health and Safety.--The Committee has included funding 
to continue the farm health and safety initiative. This 
important initiative, begun in fiscal year 1990, has a primary 
focus of reducing the incidence of fatal and nonfatal injuries 
and occupational diseases among the millions of agricultural 
workers and their families in the United States. The Committee 
is particularly pleased with the research being undertaken by 
the Agricultural Research Centers.

Preventive Health and Health Services Block Grant

    The Committee recommends $134,966,000 for the preventive 
health and health services block grant, which is the same as 
the 2002 level and the administration's request.
    The Preventive Health and Health Services Block Grant 
provides States with funds for services to reduce preventable 
morbidity and mortality to improve the quality of life. The 
Block Grant is the primary source of funding to States for 
health education and risk reduction activities; cholesterol, 
hypertension, and cancer screening; and programs to prevent sex 
offenses. The strategy of the Block Grant is to provide States 
with flexibility to tailor prevention and health promotion 
programs to their health priority needs. Block Grant funding 
enables States to provide money for developing new programs; 
fund essential services that would otherwise go unfunded; and 
address urgent, rapidly developing health hazards such as 
disease outbreaks or environmental disasters.

Public Health Improvement

    The Committee recommends $117,743,000 for public health 
improvement, which is $30,457,000 below the fiscal year 2002 
level and $924,000 above the administration request.
    Our national public health system is the first line of 
defense against preventable disease, disability and 
bioterrorism. Virtually every health problem in our 
communities--infectious disease outbreaks, chemical hazards, 
chronic diseases, and injuries--is first recognized by local 
public health professionals, who must work in concert with 
State and national officials to control these threats, prevent 
spread, and save lives. Despite steady increases and shifts in 
the U.S. population there has been a decline in the number of 
public health workers per capita in the past decade. Schools of 
Public Health and Preventive Medicine report that the majority 
of graduates do not seek employment in public health agencies. 
Only an estimated 44 percent of the Nation's current 448,000 
public health practitioners have had formal training in public 
health. One-half of all public health nurses--the largest 
profession in public health--lack a baccalaureate nursing 
degree. The majority of public and private laboratory 
scientists lack access to continuing education and training 
essential to using the cascade of new, high-technology 
laboratory tests accurately and safely.
    Minority Health Disparities.--This program is intended to 
help racial and ethnic minority communities mobilize and 
organize their resources to support effective and sustainable 
programs that will contribute to the elimination of health 
disparities in the following six target health areas: infant 
mortality, breast and cervical cancer screening and management, 
cardiovascular disease, diabetes, HIV infection and AIDS, and 
child and adult immunizations. REACH 2010 is a two-phased, 5-
year demonstration project. Phase I is a 12-month planning 
phase to support planning and development of demonstration 
programs. Phase II is a 4-year implementation and evaluation 
phase. The Committee is pleased with CDC's commitment to the 
REACH 2010 Program. The planning (Phase I) communities 
currently are establishing infrastructure to support community-
level data collection, establishing collaborative partnerships, 
establishing linkages with other State and local agencies, and 
working with Federal agencies and other partners to identify 
promising prevention strategies that have the greatest 
potential for reducing the health disparities in the target 
populations.
    National Electronic Disease Surveillance System.--Accurate, 
timely health information is a critical component of all 
effective prevention and control efforts. Yet, only 55 percent 
of local health departments have high-speed, continuous 
Internet access for finding the most recent health guidelines 
and recommendations. Only 56 percent can successfully receive 
broadcast health alerts. Only 50 percent have access to 
community health information critical for setting priorities, 
taking effective actions, and tracking improvements in health 
status. The Committee is pleased with CDC's work to integrate 
disease detection and monitoring to ensure rapid reporting and 
follow-up.
    Prevention Research.--The Committee recommends $19,092,000 
for the extramural prevention research program. This is the 
same level of funding as in fiscal year 2002 and it reverses 
the virtual elimination of the program proposed in the 
President's request. The prevention research program translates 
biomedical research into practical public health actions by 
sponsoring peer-reviewed research conducted by academics who 
are linked with State and local health agencies to develop 
improved interventions. The anthrax attacks of last fall 
demonstrated dramatically the gaps in our Nation's knowledge of 
how best to address industrial exposure, risk factors, 
treatment, effective control measures, and environmental 
cleanup. These and many other urgent questions regarding 
infectious and chemical agents, mass trauma, and radiological 
exposures need to be answered through additional prevention 
research. The Committee supports this program strongly and 
encourages CDC to expand the program's research into additional 
areas of public health concern. There are many areas of 
research that can pay dividends in both improved health and 
reduced health care costs. The Committee expects some of these 
funds to be used to support research on ways to prevent disease 
and disability in rural areas and to better utilize nurses and 
allied health professionals in prevention and health promotion 
efforts.
    As more and more Americans use alternative and 
complementary therapies to maintain and improve their health, 
there is a growing need for better consumer information about 
these therapies. The Committee expects CDC to expand their 
effort in this area. Practice-based assessments and the 
identification and study of promising and heavily used 
complementary and alternative therapies and practices should be 
undertaken and results published. The Committee expects CDC to 
collaborate with the National Center for Complementary and 
Alternative Medicine to assure that its efforts are coordinated 
with efforts by this Center.
    The Committee is aware of research regarding saliva as a 
cost-effective, non-invasive diagnostic tool for early 
detection of breast cancer and encourages CDC to consider a 
``Saliva as a Diagnostic Tool'' research initiative.

Buildings and Facilities

    The Committee recommendation includes $322,000,000 for the 
planning, design, and construction of new facilities as well as 
the repair and renovation of existing CDC facilities. This is 
$72,000,000 above the fiscal year 2002 level and $322,000,000 
above the administration request.
    The Committee recommendation includes $250,000,000 for 
continuation of CDC's building program for its Atlanta 
facilities and $72,000,000 for construction and equipment for 
CDC's infectious disease laboratory in Fort Collins, Colorado. 
The Committee has long supported the rapid implementation of 
CDC's Buildings and Facilities Master Plan and is pleased with 
the progress made to date for the agency's Atlanta, Georgia 
facilities. The Committee notes that continuing to implement 
the Master Plan as quickly as possible is essential for the 
public health security of our Nation, particularly after the 
World Trade Center and anthrax terrorist attacks of last year. 
Like some of its remaining Atlanta, Georgia facilities, CDC's 
Fort Collins laboratory is antiquated, it poses a health and 
safety threat to employees, and it is inadequate for the job of 
responding to bioterrorist attacks and other public health 
threats. The facility suffers from severe overcrowding, 
significant infrastructure failings including fragile cooling, 
heating and air handling systems, lack of adequate fire alarms 
or intercom systems, lack of functional sprinkler systems, and 
a sinking foundation. The Committee urges replacement of the 
existing Fort Collins laboratory as quickly as possible. while 
others are in great need of complete renovation.
    The Committee has provided bill language to allow CDC to 
enter into a single contract or related contracts for the full 
scope of development and construction of facilities and 
instructs CDC to utilize this authority when constructing the 
Ft. Collins facility.

Office of the Director

    The Committee recommends $52,749,000 for the Office of the 
Director, which is $1,329,000 above the fiscal year 2002 level 
and $7,870,000 above the administration request.
    The Office of the Director (OD) manages and directs 
programs of the CDC. OD provides leadership, advises on policy 
matters, and develops and evaluates progress of goals and 
objectives related to disease prevention and control. OD 
provides direction and coordination to the epidemiologic 
activities of CDC and coordinates CDC's response to health 
emergencies. In addition, OD coordinates and manages programs 
on global health activities, minority health, and women's 
health relating to disease prevention and control.
    Energy Employees Occupational Illness Compensation 
Program.--The Committee commends CDC, and in particular, NIOSH 
for its efforts under the Energy Employees Occupational Illness 
Compensation Program Act (EEOICPA). The Committee is aware that 
the Department of Labor and NIOSH have already received a large 
number of cancer claims and expect more under this program. 
Most cancer claims will require dose reconstruction in order to 
determine probability of causation. The Committee is concerned 
that NIOSH may not have adequate staff to handle this workload 
and urges the Director of CDC to closely monitor the situation 
so that claims can be promptly evaluated.
    The Committee expects CDC to report to the Committee prior 
to next year's budget hearing on how it intends to address this 
backlog issue.
    Inflammatory Bowel Disease.--It is estimated that up to 1 
million people in the United States suffer from Crohn's disease 
or ulcerative colitis, collectively known as inflammatory bowel 
disease (IBD). For the past several years, the Committee has 
encouraged CDC to work in partnership with the IBD community to 
establish a national IBD epidemiological program to further our 
understanding of these diseases. The Committee continues to 
strongly urge the Center for Chronic Disease Prevention and 
Health Promotion, and the National Center for Infectious 
Diseases to collaborate with the IBD community on this high 
priority initiative.
    Moreover, the Committee requests that the Director of CDC 
provide to the Committee no later than July 1, 2003, a report 
detailing the progress that has been made in this important 
area during the previous 3 fiscal years.

                     National Institutes of Health

    With this year's appropriation, the Committee marks a 
historic event: Funding for one of our great national 
treasures, the National Institutes of Health, has been doubled 
in just 5 years.
    Through past investments in the NIH, countless lives have 
been saved; new vaccines, cures, diagnostics, and treatments 
have been developed; and a thriving biomedical research 
industry has been created. That extraordinary record of 
achievement inspired the Committee in 1998 to embark upon the 
ambitious goal of doubling the Nation's investment in 
biomedical research.
    This goal could not have been achieved without widespread 
support from scientists, who made a compelling case that the 
additional funds could be put to good use, and from the 
American people, millions of whom look to the NIH as their best 
hope for medical cures and treatments. They, more than anyone 
else, have reason to celebrate the completion of the doubling 
effort.
    By steadfastly keeping NIH funding on track to achieve this 
goal, the Committee has enabled the NIH to support far more 
promising research than it was ever able to before, and to 
advance into new areas of science, even as the doubling project 
was underway. For example:
  --The NIH now funds nearly 10,000 more research grants than 
        it did before the doubling began. That's 10,000 more 
        ideas that could lead to vaccines, cures, and 
        treatments, as well as fundamental scientific 
        breakthroughs that could open up new opportunities for 
        improving human health;
  --The NIH now funds 40 percent more research centers than it 
        did in 1998. Such centers can provide the catalyst for 
        researchers of many backgrounds--not just physicians, 
        but mathematicians, computer scientists, physicists, 
        social scientists, and chemists--to come together to 
        solve fundamental science problems or develop novel 
        cures. In the process, the doubling effort has helped 
        change the way research is conducted.
  --The NIH can now support the training of over 1,500 more 
        scientists each year than it could in 1998. This 
        investment will help ensure there are enough trained 
        professionals ready to turn today's research advances 
        into tomorrow's treatments, diagnostics, vaccines, and 
        cures.
  --NIH funding for clinical trials has doubled from 
        $1,400,000,000 in 1998 to $2,800,000,000 today. This 
        increase has enabled NIH-funded scientists to get basic 
        research results into medical practice that much 
        faster, and the Nation to benefit more quickly from its 
        investments in biomedical research.
    The Committee understands that the impact of the doubling 
effort will continue to be felt for many decades. But several 
advances during the past 5 years offer a sense of the benefits 
the Nation will reap in the future from today's investments. 
They include: the mapping of the human genome, which is 
revolutionizing biology and opening up entire new fields of 
research; the FDA approval of Gleevec, the first drug that 
directly turns off the signal of a protein known to cause a 
cancer; and rapid advances in embryonic and adult stem cell 
biology, areas of discovery that could lead to revolutionary 
treatments and cures.
    While the NIH continues to invest in basic research, it is 
also helping the Nation respond to new threats to the 
homeland--specifically, to the threat of bioterrorism. NIH-
funded scientists helped analyze the genetic code of the 
anthrax strains used in last fall's anthrax attacks, in an 
effort to catch the perpetrators, even as other NIH-supported 
researchers helped advance our knowledge about how to design 
new vaccines and cures for bioterrorist agents. The NIH is now 
initiating an important bioterrirosm research initiative to 
develop countermeasures to neutralize bioterrorist threats from 
micro-organisms such as smallpox, anthrax, tularemia, and 
plague.
    As the Committee marks the conclusion of the doubling 
effort, it notes that the job of investing in biomedical 
research is far from over. Heart disease, drug abuse, mental 
disorders, cancer, diabetes, Parkinson's, Alzheimer's, and 
other debilitating diseases and conditions continue to affect 
millions of Americans on a daily basis. The Nation must sustain 
the momentum of these investments, so future generations can 
continue to benefit from the improvements in human health that 
flow from the NIH.
    The Committee recommends $27,192,926,000 for the NIH. This 
amount is $3,737,083,000 above the fiscal year 2002 
appropriation and $25,000,000 above the budget request. For 
each Institute and Center below, figures for the fiscal year 
2002 appropriation and the budget request have been adjusted to 
reflect transfers to the NIBIB.

                       NATIONAL CANCER INSTITUTE

Appropriations, 2002....................................  $4,128,351,000
Budget estimate, 2003...................................   4,642,394,000
Committee recommendation................................   4,642,394,000

    The Committee recommends an appropriation of $4,642,394,000 
for the National Cancer Institute [NCI]. This is equal to the 
budget request and $514,043,000 more than the fiscal year 2002 
appropriation. The comparable amounts for the budget estimate 
include funds to be transferred from the Office of AIDS 
Research.
    Mission.--The NCI conducts and supports basic and applied 
cancer research in prevention, early detection, diagnosis, 
treatment, and rehabilitation. The Institute provides training 
support for research scientists, clinicians, and educators, and 
maintains a national network of cancer centers, clinical 
cooperative groups, community clinical oncology programs, 
cancer prevention and control initiatives, and outreach 
programs to rapidly translate basic research findings into 
clinical practice.
    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.
    Anti-cancer drugs.--The Committee is aware that the NCI is 
collaborating on the development of synthetic small molecule 
drugs that target both novel and known targets in cell cycle 
regulation. The Committee understands that these compounds 
leave normal, non-cancer cells unharmed while inducing cell-
suicide in cancer cells. The Committee encourages the NCI to 
continue to fund this unique research effort.
    Behavioral research.--The NCI is encouraged to continue its 
recent emphasis on the interactions of genetic, environmental, 
and lifestyle factors that affect cancer risk and the 
prevention, detection, and treatment of cancer. The Committee 
is particularly supportive of work on risk determination and 
better communication of that risk to the public and public 
health infrastructures. The NCI is uniquely positioned to 
develop and expand large collaborative human population studies 
that can help build the science base. The NCI is also 
encouraged to expand research efforts to define the biological, 
behavioral, and social bases of tobacco use and addiction, and 
to refine treatment options for specific groups (e.g. pregnant 
women or young smokers).
    Blood cancers.--The Committee urges the NCI to continue to 
implement the research priorities for leukemia, lymphoma, and 
multiple myeloma included in the May 2001 Progress Review Group 
Report.
    Bone metastases.--The Committee understands that bone 
metastases are common in a number of human cancers and 
contribute heavily to morbidity, most prominently in prostate 
cancer, breast cancer and multiple myeloma. Recognizing this, 
the NCI is encouraged to promote research to understand the 
underpinnings of tumor metastasis to the bone. The Institute is 
also encouraged to focus on understanding the interaction 
between tumor cells and a multitude of cells in the bone 
microenvironment, as well as the role of extra cellular matrix 
and a multitude of growth factors, cytokines and other proteins 
on tumor survival and growth in the bone microenvironment.
    Brain Tumor Progress Review Group.--The Committee is 
concerned that the NCI and NINDS have not proceeded with 
implementation of the Brain Tumor Progress Review Group's 
recommendations on advancing brain tumor research. The 
Committee strongly urges the NCI and NINDS to finalize their 
plan for implementing the recommendations and to provide 
additional funding for the NCI-NINDS Neuro-Oncology Program to 
ensure that the Federal research agency is a leader in brain 
tumor research. The two Institutes should also seek to expand 
their collaborative brain tumor research ventures, including 
interactive meetings involving scientists of different 
disciplines and interdisciplinary grant applications in brain 
tumor biology and etiology. The Committee requests that the NCI 
and NINDS report on their collaborative brain tumor research 
initiatives by December 31, 2003.
    Cancer and minorities.--The Committee remains concerned 
that cancer rates for Native Hawaiians and other Native 
American Pacific Islanders are disproportionately high. The 
Committee encourages the NCI to expand its research in this 
area.
    Cancer screening technologies.--The Committee recognizes 
the importance of novel technologies such as plasma K-RAS DNA 
in the NCI's efforts to develop non-invasive cancer screening 
technologies for clinical use.
    Cancer survivorship.--With the advances that have resulted 
from the ongoing commitment and investment in biomedical 
research, and the resultant advances in cancer treatment, 
cancer for many has become a chronic illness. Currently, there 
are over 9 million cancer survivors in the Nation, and this 
number is expected to grow dramatically. More must be done to 
improve the understanding of the growing cancer survivorship 
population, including determinations of physiological and 
psychological late effects, prevalence of secondary cancers, as 
well as further development of effective survivorship 
interventions. The Committee supports an aggressive expansion 
of the NCI Office of Cancer Survivorship activities, to include 
the convening of a consensus conference on cancer survivorship. 
The Committee requests the Director of NCI to submit a report, 
by April 1, 2003, outlining the activities the NCI is 
undertaking to enhance cancer survivorship research and to 
expand the Office on Cancer Survivorship.
    Chronic lymphocytic leukemia.--The Committee strongly 
encourages the NCI to increase the level of research aimed at 
determining the underlying cause and optimum therapies for CLL, 
the most common form of adult leukemia in the United States. 
The Committee is encouraged by the NCI's willingness to 
consider a supplementary application for research funding for 
the CLL Research Consortium. The Committee further urges the 
NCI to expand funding for the Consortium to speed up the 
progress in finding significant scientific breakthroughs.
    Chronic myeloproliferative disorders.--Polycythemia vera, 
idiopathic myelofibrosis and essential thrombocytosis are 
malignant diseases of the bone marrow that are underserved with 
respect to research funding, considering the number of people 
they strike. These disorders are chronic and can transform into 
acute leukemia. They offer great research promise with respect 
to insights into the behavior of blood cells, since the cells 
that they affect appear normal but behave abnormally. The major 
obstacle to research into the causes and the treatment of these 
disorders has been the lack of Federal funds designated for 
this purpose. The Committee strongly believes that the NCI 
should expand research into these disorders, and it expects the 
NCI to report to Congress by April 1, 2003, about existing 
efforts, as well as planned future efforts, to better 
understand these disorders.
    Complementary and alternative cancer therapies.--The 
Committee expects the NCI to expand its work and its 
collaborative efforts with NCCAM to support research on 
promising complementary and alternative cancer therapies as 
well as on their integration with traditional therapies. 
Thousands of Americans are turning to these therapies, and 
consumers will benefit from a rigorous scientific review of 
them.
    DES.--The Committee continues to strongly support increased 
efforts to study and educate the public and health 
professionals about the impact of exposure to the synthetic 
hormone diethylstilbestrol (DES). The Committee expects the NCI 
to continue its support of research in this area. In addition, 
the Committee urges the NCI to continue its agreement with the 
CDC to implement a national education program for consumers and 
health professionals. The Committee expects the NCI and these 
other agencies to continue to consult with organizations 
representing individuals impacted by DES as they carry out DES 
research and education efforts.
    Gynecologic cancers.--The Committee is concerned about the 
patterns of care for gynecological cancers, and it urges the 
NCI to expand CanCORS to gynecologic cancers. While the 
Committee commends the NCI for funding four ovarian cancer 
SPOREs and the one gynecologic cancer SPORE, it believes 
research into other gynecologic cancers needs to be enhanced. 
The Committee urges the NCI to continue funding ovarian cancer 
SPORES and to consider creating SPORES specifically for 
cervical and endometrial cancers.
    Imaging systems technologies.--The Committee is encouraged 
by progress made by the NCI following its August 1999 
conference on biomedical imaging, and it urges the NCI to 
continue to take a leadership role with the Centers for 
Medicare and Medicaid Services (CMS) and the Food and Drug 
Administration to avoid duplicative reviews of new imaging 
technologies which may prevent their benefits from reaching 
patients on a timely basis. The Committee is aware of the great 
potential for improved patient care and disease management 
represented by molecular imaging technologies, especially 
positron emission tomography (PET) through its ability to image 
the biology of many kinds of cancer and other diseases. The 
Committee continues to support the NCI's increased emphasis on 
examining the molecular basis of disease through imaging 
technologies such as PET and MicroPET. The Committee continues 
to encourage the large-scale testing of women for breast cancer 
and of men for prostate cancer to demonstrate and quantify the 
increased diagnostic and staging capabilities of PET relative 
to conventional diagnostic and staging technologies including 
mammography.
    Kidney and bladder cancers.--The Committee is concerned 
that funding for kidney and bladder cancer has not kept pace 
with that of other cancers. The Committee understands that the 
NCI has worked with the scientific community to develop an 
agenda for research into these cancers. The Committee 
encourages the NCI to implement this agenda for other urologic 
cancers in the coming fiscal year.
    Liver cancer.--The Committee encourages the NCI to work 
closely with the NIDDK to investigate prevention, diagnosis and 
therapy for hepatocellular carcinoma and other cancers of the 
liver.
    Neurofibromatosis (NF).--Neurofibromatosis research has 
significant potential for cancer patients since NF genes have 
been implicated in the signaling process that determines cell 
growth and cell differentiation. The Committee commends NCI for 
recognizing NF's connection to many of the most common forms of 
human cancers and commencing phase II clinical trials of NF1 
patients with plexiform neurofibromas. The Committee encourages 
the NCI to strengthen its NF research portfolio in such areas 
as further development of animal models, natural history 
studies, therapeutic experimentation and clinical trials.
    Pancreatic cancer.--The Committee is very concerned that 
funding increases for pancreatic cancer research have not risen 
at a rate commensurate with the severity of this disease or the 
increases afforded the NCI for the past 5 years. Pancreatic 
cancer is the Nation's fifth-leading cause of cancer death, and 
99 percent of people diagnosed with pancreatic cancer die 
within 6 months. Therefore, the Committee strongly urges the 
NCI to: (1) fully implement the recommendations outlined in the 
Progress Review Group on pancreatic cancer during fiscal year 
2003; (2) consider funding five pancreatic cancer SPOREs by 
fiscal year 2004; and (3) develop a plan to create a critical 
mass of pancreatic cancer researchers and grants over the next 
3 years. The Committee asks the NIH to address these 
recommendations in a report to Congress by March 30, 2003.
    The Committee also urges the NCI to explore new methods for 
identifying genetic and environmental factors and gene-
environment interactions that contribute to pancreatic cancer, 
and to develop and implement methods for rapid case 
ascertainment, which may include immediate electronic reporting 
from pathology, radiology, and laboratory departments.
    The Committee further notes the promise of utilizing 
proteomic analysis of blood samples to diagnose pancreatic 
cancer at its earliest stages. Proteomic analysis, which 
involves the identification of specific protein patterns in 
blood or other specimens that match known malignant patterns, 
is quicker than identifying separate proteins and the genes 
that create the proteins. This analysis was recently employed 
for the detection of ovarian neoplasms and is presently under 
study for the early detection of invasive prostate cancer. The 
Committee encourages the NCI to rapidly identify predictive 
proteomic patterns relevant to pancreatic cancer.
    Primary immunodeficiencies (PI).--Research has shown that 
patients suffering from primary immunodeficiencies have a 100-
200 times greater risk of developing cancer than persons not 
suffering from PI. This has been a particular problem in 
minority communities, where PI is often underdiagnosed. The 
Committee urges the NCI to fund an aggressive research agenda 
that will target methods of identifying undiagnosed patients 
and appropriate treatments as a means of preventing cancer. In 
addition, the Committee continues to urge NCI to play a 
meaningful role in the national physician education and public 
awareness campaign of the Jeffrey Modell Foundation.
    Prostate cancer.--Incidences of prostate cancer have been 
on the rise in recent decades. Evidence is growing that in 
addition to genetic disposition, numerous other factors--
including lifestyle, nutritional imbalances, chronic 
infections, and hormonal, psychological and environmental 
components--play a role in the development of prostate cancer. 
The Committee strongly urges the NIH to renew its commitment to 
prostate cancer research, with a special emphasis on 
accelerating new avenues for basic research, drug development, 
and clinical research.

               NATIONAL HEART, LUNG, AND BLOOD INSTITUTE

Appropriations, 2002....................................  $2,560,197,000
Budget estimate, 2003...................................   2,776,411,000
Committee recommendation................................   2,820,011,000

    The Committee recommendation includes $2,820,011,000 for 
the National Heart, Lung, and Blood Institute [NHLBI]. This is 
$43,600,000 more than the budget request and $259,814,000 more 
than the fiscal year 2002 appropriation. The comparable amounts 
for the budget estimate include funds to be transferred from 
the Office of AIDS Research.
    Mission.--The National Heart, Lung, and Blood Institute 
provides leadership for a national research program in diseases 
of the heart, blood vessels, lungs and blood, in transfusion 
medicine, and in sleep disorders through support of innovative 
basic, clinical, population-based, and health education 
research.
    Advanced imaging technology for heart disease and stroke.--
The Committee is aware that heart perfusion PET scans using 
Rubidium-82 are considered the ``gold standard'' for 
determining the extent of muscle damage to the heart following 
a heart attack. The Committee encourages the NHLBI to expand 
its research efforts into the role of biological imaging and 
PET in delivering more accurate information to determine 
appropriate treatment for heart disease patients.
    Behavioral research on positive health.--The Committee 
notes that the NHLBI has sponsored important research 
demonstrating the power of social connectedness to help speed 
recovery after heart attacks. The Committee is interested in 
research that helps reveal the pathways through which positive 
experiences and emotions may enhance health or protect against 
illness. The Committee encourages the NHLBI to continue its 
work in this area and to expand where possible any initiatives 
to increase basic behavioral research on the etiology of 
disease resistance. The Institute is also encouraged to examine 
initiatives that may be ready for field-testing in community 
populations.
    Blood disorders.--The Committee commends the NHLBI for its 
actions to establish a Transfusion Medicine/Hemostasis Clinical 
Research Network and for the enhancements being made to the 
existing network of sickle cell centers.
    Cardiovascular diseases.--The Committee continues to regard 
research into the causes, cure, prevention and treatment of 
heart attack, stroke and other cardiovascular diseases as one 
of the Nation's top priorities. Cardiovascular diseases remain 
the leading cause of death in the United States and a major 
cause of disability. The Committee is concerned that funding in 
constant dollars for NHLBI's extramural Heart Program has not 
kept pace with increases for the NIH at a time when promising 
breakthroughs are on the horizon. The Committee continues to 
believe that an intensive research program on heart attack, 
stroke and other cardiovascular diseases should be a top 
priority of the NHLBI and of the NIH. The Committee urges the 
Institute to place the highest priority on cardiovascular 
research and has included sufficient funds to allow the 
Institute to support existing heart and stroke-related research 
and to invest in promising research initiatives in this area.
    Cardiovascular diseases in women.--The Committee is aware 
that cardiovascular diseases remain a major cause of disability 
and the leading cause of death of American women. The clinical 
course of cardiovascular disease is different in men than in 
women, and current diagnostic capabilities are less accurate in 
women than in men. The Committee urges the NHLBI to expand 
cardiovascular disease research in women, including studies to 
develop safe, efficient and cost effective diagnostic 
approaches for women. In addition, the Committee encourages the 
NHLBI to create more informational and educational programs for 
women patients and health care providers on heart disease and 
stroke risk factors, as authorized under Public Law 105-340, 
the Women's Health Research and Prevention Amendments of 1998.
    Chronic obstructive pulmonary disease (COPD).--The 
Committee encourages the Institute to further research COPD and 
to expand research on the pediatric origins of COPD, the 
effects of environment on COPD, and the identification of 
biomarkers that might predict complications of COPD, including 
lung cancer.
    Cooley's anemia.--The Committee remains strongly supportive 
of the Institute's creation of the Thalassemia Clinical 
Research Network, which is composed of North America's leading 
research entities on thalassemia, the medical term for Cooley's 
anemia.
    Disease networks.--The Committee is pleased with the 
NHLBI's efforts to create disease networks in the areas of 
asthma, sarcoidosis, and ARDS. The Committee encourages the 
NHLBI to expand disease networks and to expand the network 
concept to include the creation of tissue banks for acquisition 
and distribution of tissue for asthma, COPD, and interstitial 
lung disease.
    Heart disease and kidney disease.--There is a well-
established and significant link between heart disease, 
hypertension, and kidney disease. The Committee encourages the 
NHLBI to increase its collaboration with the NIDDK to develop 
cooperative research initiatives in this area, and it urges the 
NHLBI to consider sponsoring a workshop on hypertension as it 
relates to heart and kidney disease.
    Hemophilia.--The Committee commends the NHLBI for its role 
in addressing hemophilia and for the Institute's strong support 
of hemophilia gene therapy research. The Committee notes the 
NHLBI program for women with bleeding disorders, and it 
encourages the NHLBI to convene a consensus conference to 
determine next steps for research. The Committee recognizes the 
Institute's efforts to address the shortage of trained 
hematology specialists through the establishment of a clinical 
research network, and it urges the NHLBI to expand support for 
strategies to ensure this critical issue is addressed.
    Lung repair.--Respiratory failure is often a result of 
irreversible lung injury. This may occur acutely in conditions 
such as the acute respiratory distress syndrome (ARDS) or 
chronically with disorders such as COPD or pulmonary fibrosis. 
The Committee encourages the NHLBI to promote the use of stem 
cells in animal models to study lung repair and organogenesis 
as a novel method to reverse respiratory failure.
    Marfan syndrome.--The Committee commends the NHLBI for its 
past and ongoing support of research on aortic aneurysms, which 
are pathologically related to Marfan syndrome. In particular, 
the Committee commends the Institute for providing funding 
support for the request for applications that was initiated by 
NIAMS for heritable disorders of connective tissue, which 
include Marfan syndrome. Marfan syndrome is a life-threatening 
genetic disorder that affects several organ systems and may 
result in rupture of the aorta without the proper intervention.
    Minority cardiovascular health research.--The Committee 
remains concerned that cardiovascular diseases 
disproportionately affect minorities. For example, compared 
with whites, blacks have a 1.3 times greater rate of nonfatal 
stroke, a 1.8 times greater rate of fatal stroke, and a 1.5 
times greater rate of heart disease death. The Committee 
encourages the NHLBI to support new partnerships between 
research-intensive medical centers and health care systems that 
serve minority populations. Such partnerships would facilitate 
the study of complex biological, behavioral, and societal 
factors that contribute to health disparities in cardiovascular 
disease; promote research within the health care systems to 
improve minority health and reduce health disparities; and 
provide training of investigators to study cardiovascular 
diseases in minorities. An important aspect of the programs 
would be the development of community involvement in the 
research and outreach strategies for patient recruitment and 
retention and emphasis on prompt and effective communication of 
research findings to health care practitioners.
    Minority health and lung disease.--The Committee is aware 
that lung diseases disproportionately affect many minority 
groups. The Committee encourages the NHLBI to work with other 
Institutes and Centers to develop an epidemiologic approach to 
determine the disproportionate impact of airway disease on 
minority populations.
    Myeloproliferative disorders and myelodysplasia.--The 
Committee urges the NHLBI to work with the NCI to develop new 
research initiatives into the causes and targeted therapies of 
myeloproliferative disorders and myelodysplastic syndromes. 
These disorders are characterized by an overgrowth of often 
abnormal cells in the bone marrow which may lead to leukemia.
    National Asthma Education and Prevention Program (NAEPP).--
The Committee commends the NAEPP, which is administered by the 
NHLBI, for its leadership in helping to educate physicians, 
asthma patients, their families, and the general public 
regarding asthma and its management. The Committee encourages 
the NAEPP to enhance the role that its advisory committee plays 
in helping to coordinate asthma education throughout the United 
States. In addition, the Children's Health Act of 2000 
legislation included provisions for the NAEPP to develop, in 
conjunction with other Federal agencies and voluntary and 
professional health organizations, a Federal plan to respond to 
asthma. This plan will include the roles and responsibilities 
of several Federal agencies in combatting asthma. The Committee 
encourages the NHLBI to move forward quickly on this effort.
    Obesity-associated cardiovascular diseases.--Obesity is a 
major risk factor for heart disease, stroke, and other 
cardiovascular diseases. An estimated 61 percent of American 
adults are overweight or obese, and excessive weight in 
children and adolescents is of increasing concern. The 
Committee encourages the NHLBI to support basic and clinical 
studies to explain how excessive body weight contributes to the 
development of cardiovascular diseases such as hardening of the 
arteries, enlarged hearts, heart failure and irregular heart 
beats. Major areas needing further research and clarification 
include the role of fatty tissue in inflammation, the effects 
of obesity on the growth of the heart, blood vessel, 
respiratory, hormone and metabolic systems; and the complex 
interactions between being overweight and conditions such as 
chronic sleep loss, high blood pressure and diabetes.
    Pediatric asthma.--The Committee recognizes that little is 
known about the optimal treatment for asthma in infants and 
young children. The Committee encourages NHLBI to use the 
research amassed through the Pediatric Asthma Clinical Research 
Network to provide clearer choices for childhood asthma 
therapy, to encourage the development and dissemination of new 
therapies, and to identify optimum asthma management strategies 
for children.
    Pulmonary hypertension.--Pulmonary hypertension (PH) is a 
rare, progressive and fatal disease that predominantly affects 
women. It causes deadly deterioration of the heart and lungs 
and is a secondary condition in many other serious disorders 
such as scleroderma and lupus. The Committee commends the 
NHLBI's efforts to promote PH-related research, and it 
encourages the Institute to increase funding for basic 
research, gene therapy, and clinical trials of promising 
pharmaceuticals.
    Scleroderma.--The Committee encourages the NHLBI to 
undertake research initiatives on the cause of and treatment 
options for scleroderma, a chronic and progressive disease that 
predominantly strikes young women. Scleroderma can result in 
complications that include pulmonary fibrosis, pulmonary 
hypertension, myocardial fibrosis, cardiac arrhythmias, 
pericarditis, and Raynaud's phenomenon.
    Sleep medicine.--The Committee commends the Institute and 
its National Center for Sleep Disorders Research for the 
progress being made to advance research into the relationship 
between obstructive sleep apnea and obesity, hypertension, 
cardiovascular diseases, and mortality. The Committee 
encourages the Institute to accelerate these efforts and to 
consider conducting multi-site clinical studies that will 
assess effective treatments for patients with sleep apnea and 
identify the functions of sleep for health, aging, and 
prevention of disease.
    Temporomandibular joint disorders (TMJ).--The Committee 
applauds the NHLBI for taking the initiative to investigate 
research opportunities related to the cardiovascular and sleep-
related consequences of temporomandibular disorders, and it 
encourages the Institute to act upon the recommendations that 
ensued from an NHLBI workshop related to these issues.
    Tuberculosis and AIDS interaction.--The Committee supports 
the important research on the interaction of tuberculosis and 
AIDS conducted by the NHLBI AIDS research program, and it 
encourages NHLBI to strengthen its research in this important 
area.
    Vascular disease and Alzheimer's.--There is a growing body 
of evidence that cerebrovascular disease may be a key mechanism 
in triggering the manifestation of Alzheimer's disease. Autopsy 
data reveal that individuals whose brains showed the plaques 
and tangles that are the hallmark of Alzheimer's disease were 
much more likely to develop dementia if they had also suffered 
a series of small strokes. Data from longitudinal studies also 
suggest that high cholesterol and hypertension may be 
significant risk factors in Alzheimer's disease. The 
implications of these discoveries are enormous, particularly 
for racial and ethnic groups that are disproportionately 
affected by vascular disease. Preliminary studies indicate that 
cholesterol-lowering drugs and anti-hypertensive medications 
may also protect against cognitive impairment and Alzheimer's 
disease. The Committee urges the NHLBI to pursue this line of 
research and to work collaboratively with the NIA.

         NATIONAL INSTITUTE OF DENTAL AND CRANIOFACIAL RESEARCH

Appropriations, 2002....................................    $343,149,000
Budget estimate, 2003...................................     372,167,000
Committee recommendation................................     374,067,000

    The Committee recommendation includes $374,067,000 for the 
National Institute of Dental and Craniofacial Research [NIDCR]. 
This is $1,900,000 more than the budget request and $30,918,000 
more than the fiscal year 2002 appropriation. The comparable 
amounts for the budget estimate include funds to be transferred 
from the Office of AIDS Research.
    Mission.--The NIDCR supports research and research training 
to improve the oral health of the American people. The 
Institute emphasizes ways to prevent disease in high-risk 
groups, including the elderly, minority populations, and 
individuals with medical conditions and medications that 
compromise oral health. The research agenda includes studies of 
craniofacial genes and birth defects; bone and joint diseases; 
AIDS, other infections, and immunity; oral cancer; chronic 
pain; epidemiology; biomaterials; and diagnostic systems.
    Dental complications of Paget's disease.--The Committee 
encourages NIDCR to support research on bone surrounding teeth, 
oral and dental complications of Paget's disease, new animal 
models of dentinogenesis imperfecta, orthodontic manipulation 
in people with osteogenesis imperfecta and biomarkers related 
to saliva. The Committee also encourages NIDCR to continue its 
research on fibrous dysplasia.
    Temporomandibular joint disorders (TMJ).--The Committee is 
aware that the Institute intends to broaden its scientific base 
for TMJ research beyond studies on the psychological and 
behavioral factors in the etiology or chronicity of TMJ 
diseases and disorders that have long dominated the research 
portfolio. The Committee urges investment in studies of normal 
and abnormal structural and functional features of the joint 
and related structures, using the tools of cell and molecular 
biology as well as advanced imaging techniques. The Committee 
asks that the NIDCR and other Institutes follow up with 
research initiatives resulting from the spring 2002 TMJ 
Association's meeting on joint and muscle dysfunction of the 
TMJ.

    NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES

Appropriations, 2002....................................  $1,466,380,000
Budget estimate, 2003...................................   1,604,647,000
Committee recommendation................................   1,637,347,000

    The Committee recommends an appropriation of $1,637,347,000 
for the National Institute of Diabetes and Digestive and Kidney 
Diseases [NIDDK]. This is $32,700,000 more than the 
administration's request and $170,967,000 more than the fiscal 
year 2002 appropriation. The comparable amounts 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.
    Behavioral research.--The Committee encourages the NIDDK to 
continue a research emphasis on the links between depression 
and diabetes. Diabetics who have co-occurring depressive 
symptoms have less success managing their illnesses. Depression 
has been linked to poorer adherence to medical and behavioral 
regimens and lower rates of exercise. The Committee also notes 
that a recent NIDDK clinical trial on diabetes, the Diabetes 
Prevention Program, demonstrated that diet and exercise could 
be more successful than medication in preventing the 
development of diabetes in groups that faced a high risk of 
diabetes. The NIDDK is strongly encouraged to build on its 
investment in behavioral research, particularly in areas that 
would add to the science base on the maintenance of positive 
behavior change.
    Bladder disease research.--Bladder diseases have a 
significant negative impact on the U.S. population. The 
Committee urges the Institute to increase funds for the urology 
program and other areas critical to bladder disease.
    Children and adolescent urological diseases.--While 
research urologic diseases has led to advances in the care and 
management of some urologic diseases affecting adults, these 
diseases persist as a major cause of illness among the most 
vulnerable population, children and adolescents. The NIDDK 
should develop and implement an interagency plan for pediatric 
urologic disease research. The Committee requests the NIDDK to 
submit a status report prior to the fiscal year 2004 
appropriations hearings that outlines the steps it is taking to 
address the specific research needs of children and adolescents 
suffering from urologic diseases and conditions.
    Chronic prostatitis.--The Committee requests that the NIDDK 
increase funding for the Chronic Prostatitis Collaborative 
Research Network. The Institute is also encouraged to stimulate 
new and diverse research in chronic prostatitis by convening a 
scientific and clinical workshop to be held in fiscal year 2003 
which will disseminate the findings of the CPCRN and develop a 
strategic research plan.
    Cooley's anemia.--The Committee commends the outstanding 
work being done at the NIDDK on such issues as iron chelation, 
non-invasive iron measurement, fetal hemoglobin and other 
topics that are critical to the health and well-being of 
Cooley's anemia patients. The development of a less burdensome 
method of iron chelation, in particular, is a critical priority 
as these patients currently must infuse themselves with a drug 
pumped into their bodies up to 12 hours per night. Research 
directed at reducing this burden is urgently needed.
    Diabetes in Native Hawaiians.--The Committee encourages the 
NIDDK to investigate the incidence of diabetes in Native 
American, Hawaiian, and Alaskan populations, as well as the 
Mississippi Band of the Choctaw Indians and the Eastern Band of 
the Cherokee Indians.
    Digestive diseases.--Diseases of the digestive system, such 
as colorectal cancer, inflammatory bowel disease, irritable 
bowel syndrome, hemochromatosis, celiac disease, and hepatitis, 
affect more than one-half of all Americans at some time in 
their lives. The Committee commends the NIDDK on the success of 
its Digestive Disease Centers program in addressing a wide 
range of disorders that result in tremendous human suffering 
and economic cost. The Committee encourages the Institute to 
expand this program.
    Glomerular injury research.--The Committee is pleased with 
the NIDDK's glomerular injury research initiatives, including a 
clinical trial for patients with focal segmental 
glomerulosclerosis. Further, the Committee continues to 
encourage the NIDDK to consider initiating a scientific 
conference on glomerular injury research, and to explore 
support for gathering prevalence data on glomerular injury.
    Hematology.--The Committee is aware of the high-quality 
hematology research in iron metabolism, gene regulation, and 
stem cell plasticity currently funded by the Institute, and it 
encourages the NIDDK to plan the next steps in setting 
priorities for future research in these and other areas that 
significantly impact a broad array of blood disorders.
    Hepatitis C.--The Committee remains concerned about the 
disproportionate impact of hepatitis C among minorities. The 
Committee encourages the NIDDK to expand research on better 
treatment options for minorities, and to partner with the CDC 
and voluntary health organizations to facilitate a prevention 
and education campaign targeted at high-risk populations.
    Inflammatory bowel disease.--The Committee has been 
encouraged in recent years by discoveries related to Crohn's 
disease and ulcerative colitis, collectively known as 
inflammatory bowel disease (IBD). These extremely complex 
disorders represent the major cause of morbidity and mortality 
from intestinal illness. The Committee commends NIDDK for its 
strong leadership in this area and encourages the Institute to 
continue to give priority consideration to the following areas 
of IBD research; (1) investigation into the cellular, molecular 
and genetic structure of IBD, (2) identification of the genes 
that determine susceptibility or resistance to IBD in various 
patient subgroups, and (3) coordination and integration of 
basic investigations designed to clarify mechanisms of action 
and disease pathogenesis into clinical trials.
    Interstitial cystitis.--The Committee is very concerned by 
the direction of interstitial cystitis (IC) research at the 
NIDDK in the last two budget cycles. Despite strong 
congressional interest in expanding such research, the NIDDK 
did not invest in new IC-specific research grants during fiscal 
year 2002 and has thus far not committed to doing so in fiscal 
year 2003. The Committee urges the NIDDK to reverse this trend 
and aggressively support research that will enhance the basic 
science knowledge of IC through IC-specific research.
    The Committee is pleased that NIDDK has pledged continued 
support and expansion of the IC Clinical Trials Group. The 
Committee is aware that the group is making good progress on 
the evaluation of BCG for the treatment of IC. Ancillary 
studies, including urinary marker studies, are being done 
concurrently, and will help provide an understanding of the 
differences between responders and non-responders. The 
Committee feels strongly that funding for ancillary studies 
should be included in the recompetition of the RFA for the 
ICCTG clinical centers. This will ensure peer review, and at 
the same time, avoid possible significant delays in funding of 
the ancillary studies should they be offered through a 
different mechanism.
    The Committee is also pleased that the NIDDK completed a 
draft of the recommendations put forth by the Bladder Research 
Review Group and will issue its final report in 2002. The 
Committee urges that the strategic plan's recommendations 
regarding IC be implemented and fully funded as soon as 
possible. The Committee requests a full update on this and all 
IC-related research activities as part of the NIDDK's written 
testimony for the fiscal year 2004 Senate appropriations 
hearing.
    Irritable bowel syndrome.--The Committee remains concerned 
about the increasing frequency of irritable bowel syndrome 
(IBS), and it encourages NIDDK to partner with other Institutes 
and Centers to enhance research on this disorder, including 
studies on its prevalence.
    Islet cell transplantation.--The Committee is pleased with 
NIH-supported research involving the transplantation of 
insulin-producing islet cells into individuals with juvenile 
diabetes. The Committee encourages the NIDDK to work closely 
with the NIAID on initiatives to create and maintain immune 
tolerance to transplanted islet cells. In addition, the 
Committee encourages the NIDDK to vigorously pursue all avenues 
of research that could lead to alternative supplies of insulin-
producing cells, including stem cell technology.
    Juvenile diabetes.--The Committee urges the NIDDK to 
continue development of a vaccine to prevent juvenile diabetes, 
and to collaborate with other Institutes on this project. In 
addition, the Committee commends the NIDDK for its efforts to 
determine the genetic origins of juvenile diabetes, including 
the development of a Type 1 Diabetes Genetics Consortium, which 
will collect and share valuable DNA information from juvenile 
diabetes patients from studies around the world. The Committee 
encourages the NIDDK to continue and expand this effort to 
determine the genetics of the complications of diabetes, such 
as retinopathy, kidney disease and neuropathy. The Committee 
also remains concerned about reports of a shortage of pediatric 
endocrinologists, and it urges the NIDDK to enhance efforts to 
address this serious problem.
    Kidney disease and end-stage renal disease.--Diabetes is 
the leading cause of kidney failure and end-stage renal 
disease. The Committee urges the NIDDK to expand research into 
early prevention and therapeutic intervention of kidney disease 
to prevent end-stage renal failure. The Committee also 
encourages the NIDDK to consider launching a permanent kidney 
disease clinical research mechanism. Finally, the Institute is 
urged to address an anticipated workplace shortage in 
nephrology by launching new training initiatives and workshops 
to foster interest in the field.
    Kidney disease clinical research.--The Committee previously 
noted the current inherent problems in conducting kidney 
disease research due to the lack of a permanent infrastructure, 
such as a clinical trials cooperative group. The Committee 
commends the NIDDK for its leadership in moving forward in this 
area, by holding an initial workshop to develop strategies that 
will strengthen kidney research and enhance researchers' 
abilities to translate research findings to the bedside, 
facilitate clinical trials, and recruit patients for studies. 
The Committee urges the NIDDK to continue with these efforts, 
and to make the necessary funds available in this fiscal year 
to launch a permanent kidney disease clinical research 
mechanism.
    Live-donor liver transplantations.--More than 1,300 people 
died over the past year because of the lack of a donor liver, 
and there were almost 18,750 individuals on the list waiting 
for liver transplantations. In view of this continuing shortage 
of organ donors, the Committee is pleased that an award has 
been made for the establishment of six clinical centers and a 
data coordinating center to focus research on the need to 
improve the outcome of both donors and recipients involved in 
such transplants.
    Mucopolysaccharidosis (MPS).--The Committee is pleased with 
the efforts made by the NIDDK to enhance research efforts in 
the area of MPS, both to achieve a greater understanding of 
these disorders and to pursue the development of effective 
therapies. The Committee encourages the NIDDK to continue its 
strong investment in MPS-related research, including bone and 
joint involvement and pathophysiology of brain damage as they 
relate to MPS disorders. The NIDDK is further encouraged to 
build on collaborative efforts with the NINDS, NICHD and 
appropriate Institutes and Centers involved in this research.
    Non-alcoholic Steatohepatitis.--The Committee is pleased 
that the Institute has provided funding for six clinical 
centers and one data coordinating center to focus additional 
research on non-alcoholic steatohepatitis (NASH), which is the 
second most common cause of liver disease after hepatitis C. In 
view of the fact that NASH is increasing rapidly in children, 
the Institute is encouraged to collaborate with the NICHD to 
expand this award to include a more significant focus on 
children.
    Osteoporosis.--The Committee encourages the NIDDK to 
collaborate with the NIAMS to conduct large-scale trials to 
determine the most effective and least costly way to combine 
treatments for osteoporosis, both to prevent bone breakdown and 
build new bone. The Committee also urges the NIDDK to consider 
co-funding grants with NCCAM and the Office of Dietary 
Supplements regarding the nutritional and hormonal influences 
of calcium on bones, as well as the bioavailability of various 
calcium supplements.
    Pediatric kidney disease.--Although significant strides 
have been made in understanding kidney disease in adults, much 
less is known about its complications in children, including 
obstacles to full growth potential and neurocognitive 
development. For this reason, the Committee is disappointed 
that children were not included in a prospective cohort study 
of chronic renal insufficiency, particularly in light of recent 
initiatives calling for greater participation of children in 
studies of this nature. Given the long-term implications when 
children reach adulthood, the Committee strongly urges the 
NIDDK to undertake research into the history and treatment of 
(1) cardiovascular problems in children suffering from chronic 
kidney disease, giving careful consideration to the role of 
hypertension, lipid abnormalities, obesity, cardiovascular 
calcification and cardiac arrhythmia, and (2) neurocognitive 
and developmental deficits including learning disabilities, 
with related issues of chronic neurological, intellectual and 
emotional impairment; poor linear growth; and abnormal bone 
formation.
    Pediatric liver disease.--The Committee is pleased that the 
NIDDK has taken steps to increase research on biliary atresia, 
the most common cause of liver transplantation in children. The 
Committee notes that metabolic causes of liver disease and non-
alcoholic steatohepatitis (NASH) are also significant causes of 
liver disease in children. Therefore, it urges additional 
research focused on these diseases and other forms of pediatric 
liver disease.
    Polycystic kidney disease (PKD).--The Committee is pleased 
that the NIDDK has implemented most of the PKD Strategic Plan 
as established in early fiscal year 1999, and that has 
sponsored another PKD Strategic Planning Meeting to chart the 
next 3- to 5-year course for this promising field of study. 
Likewise, the Committee is encouraged to know that the NIDDK 
will launch the PKD Interventional Trials Network this year and 
will partner with the private sector to increase the quality of 
this project. The Committee is pleased to note that both the 
ARPKD gene discovery (for infantile PKD) and the Intracellular 
Calcium Channel breakthrough for ADPKD in February 2002 were 
discovered by NIH-funded scientists. The Committee strongly 
urges NIDDK to take advantage of this unprecedented PKD 
research momentum and accelerate its research efforts toward 
creating effective clinical interventions for the 600,000 
Americans afflicted with PKD.
    Training grants.--The Committee is very concerned that so 
few investigators have focused their careers on diseases of the 
pancreas and pancreatic cancer. The Committee urges the NIDDK 
to increase the number of training grants, fellowship and 
career development programs, and seed grants that are 
specifically aimed at increasing the number of researchers, 
including young investigators, to pancreatic diseases.
    Urinary incontinence.--Urinary incontinence afflicts 
approximately 13 million adults in the United States, 85 
percent of whom are women. The Committee urges the NIDDK to 
enhance its support of urinary incontinence research following 
the recommendations of the Bladder Research Progress Review 
Group. In addition, the Committee encourages the NIDDK to 
increase the number of clinical sites in the Urinary 
Incontinence Treatment Network Initiative.
    Urological diseases.--Urological diseases have a 
significant impact on men, women and children in this country 
and represent a major public health issue that will increase as 
the population ages. The Committee has previously expressed its 
concern over the adequacy of the urology basic science research 
effort. The Committee therefore strongly encourages the NIDDK 
to make the investments in urology research needed to achieve 
significant improvement in the ability of physicians to 
diagnose and treat these diseases and to relieve the human 
suffering they cause.
    Urologist shortage.--The Committee is aware of the shortage 
of urologists entering research careers. It encourages the 
NIDDK to initiate career development awards appropriate for 
urologists and other surgeons, taking into account the specific 
requirements for training and experience that urology residency 
and fellowship training programs must meet. The NIDDK should 
consider modifying the current research time requirements and 
develop alternative career pathways suitable for urologic 
fellowship training programs.
    Urology Interagency Coordinating Committee.--Several 
Federal agencies, including the Department of Defense and the 
Veterans Administration, have a role in urology research. In 
order to strengthen trans-institutional research, the Committee 
encourages the NIDDK to provide funds to the Urology 
Interagency Coordinating Committee to foster such research.
    Urology research centers.--The Committee is impressed with 
the results produced by the O'Brien urology research centers, 
which bring together a critical mass of scientists who focus on 
a particular aspect of urologic disease. The Committee urges 
the NIDDK to increase the number and funding of these centers 
and ensure that there is focus on pediatric urology; prostate 
growth and disease; female urology, including incontinence, 
infection, interstitial cystitis, and bladder function and 
development; and tissue engineering and genetics. These centers 
should also be able to develop exploratory projects and provide 
support for resident and fellow research opportunities.
    Women's urological health.--The Committee is concerned with 
the lack of progress at NIDDK in developing a women's 
urological health initiative. The conference held 4 years ago 
identified important research issues and needs, but there has 
been little subsequent action. The Committee strongly urges the 
Institute to implement the conference recommendations in the 
coming fiscal year and address the management problems that 
caused this delay in action.

        NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE

Appropriations, 2002....................................  $1,312,780,000
Budget estimate, 2003...................................   1,424,405,000
Committee recommendation................................   1,466,005,000

    The Committee recommends an appropriation of $1,466,005,000 
for the National Institute of Neurological Disorders and Stroke 
[NINDS]. This is $41,600,000 more than the budget request and 
$153,225,000 more than the fiscal year 2002 appropriation. The 
comparable amounts 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 NINDS continues to play an 
integral role in widening the scientific base of knowledge 
about Alzheimer's disease. For example, scientists have 
developed an antisense molecule that, when introduced 
intravenously, reversed learning and memory deficits in mice 
with an Alzheimer's-like disease. The Committee believes that 
the potential of antisense therapy for Alzheimer's and related 
disorders is promising. The Committee urges the NINDS to 
continue to assign a high priority to its Alzheimer's research 
portfolio. In addition, the Committee urges the NINDS, in 
collaboration with the NIA and NIMH, to expand its research 
into early diagnosis of Alzheimer's using PET imaging of the 
brain.
    Ataxia telangiectasia (A-T).--A-T is a genetic disease that 
attacks in early childhood. It progressively affects 
coordination and severely compromises the immune system. 
Children with A-T are highly likely to develop cancer, and 
rarely live beyond their teens. The Committee encourages the 
NINDS to work with the NCI and other appropriate Institutes to 
support research aimed at understanding the underlying causes 
of A-T with the goal of translating this basic research into 
treatments for the disease.
    Batten disease.--The Committee is disappointed with the 
pace of research regarding Batten disease. The Committee 
strongly urges the Institute to increase funding for such 
research by actively soliciting grant applications for Batten 
disease and taking aggressive steps to assure that a vigorous 
research program is established.
    Brain tumors.--The Committee encourages the NINDS to 
continue working with the NCI to carry out the recommendations 
of the recently issued Report of the Brain Tumor Progress 
Review Group.
    Duchenne muscular dystrophy.--The Committee continues to 
strongly urge the NINDS to establish centers of excellence for 
basic and applied research in the muscular dystrophies. The 
Committee also urges the NINDS to coordinate with the NIAMS and 
the Centers for Disease Control and Prevention to develop 
strategic research priorities for the centers.
    Dystonia.--The Committee continues to support the expansion 
of research and treatment developments regarding the 
neurological movement disorder dystonia, which is the third 
most common movement disorder after tremor and Parkinson's 
disease. The Committee encourages the NINDS to support 
additional research on both focal and generalized dystonia, and 
it commends the Institute for its study of the DYT1 gene and 
encourages expansion in this research area. Furthermore, the 
Institute is encouraged to support epidemiological studies on 
dystonia and to increase public and professional awareness of 
this disorder.
    Epilepsy.--Epilepsy remains a major, unsolved public health 
problem affecting the lives of over 2.5 million Americans and 
their families. The Committee applauds the development of 
benchmarks for epilepsy research resulting from the ``Curing 
Epilepsy: Focus on the Future'' conference held in March 2000, 
and it encourages the NINDS to expand research into the 
prevention, treatment, and eventual cure of epilepsy. In 
addition, the Committee urges the NINDS to address critical 
research issues related to the impact of seizures on young 
children, women, the elderly and those with intractable or 
uncontrolled epilepsy. The Committee commends the Institute on 
the anti-epileptic drug development program that has led to the 
discovery of many important anti-epileptic medications, and it 
encourages the Institute to further develop this program with 
specific research plans and goals.
    Fragile X.--Fraglie X is a single-gene neurological disease 
resulting in mental disorders, cognitive impairment and 
seizures. The Committee urges the NINDS to enhance its research 
activities on Fragile X and to include Fragile X patients in 
its studies of related disorders. The Committee also urges the 
NINDS to coordinate these efforts with other Institutes working 
on related activities, including the NIMH and the NICHD.
    Mucoploysaccharidosis (MPS).--The Committee commends the 
NINDS for sponsoring a scientific conference focusing on 
central nervous system issues and the barriers to and 
development of effective therapies for MPS disordersm, and 
urges the NINDS to solicit investigator proposals resulting 
from the findings of the conference. The Committee also 
encourages the NINDS, in collaboration with the NIDDK and the 
NICHD, to support current MPS research and use all available 
mechanisms to further stimulate and enhance efforts to better 
understand and treat MPS disorders.
    Neurofibromatosis.--Neurofibromatosis (NF) is a genetic 
disorder of the nervous system that causes tumors to grow along 
nerves anywhere on or in the body. The Committee is aware that 
recent advances in research have linked NF to cancer, brain 
tumors, learning disabilities and heart disease, and it urges 
the NINDS to expand its NF basic and clinical research 
portfolio.
    Stroke.--The Committee continues to regard research into 
the causes, cure, prevention, treatment and rehabilitation of 
stroke as one of the Nation's top priorities. The Committee 
commends the NINDS for convening a Stroke Progress Review 
Group, consisting of researchers, clinicians, pertinent 
organizations and advocacy groups. This Group crafted a report 
that will serve as a blueprint for a long-range strategic plan 
on stroke research.
    The Committee is concerned that funding for stroke research 
over the years may not have kept pace with the scientific 
opportunities and the number of Americans afflicted with 
stroke. The Committee encourages the NINDS to dedicate more 
resources to stroke research and to expand its stroke education 
program. The Committee also encourages the NINDS to expand its 
research efforts into the utility of PET scans of the brains of 
stroke victims to determine whether brain tissue damage from 
stroke may be reversible.
    Temporomandibular joint disorders (TMJ).--The Committee 
commends the Institute for its initiative in conducting a 
workshop on Neurobiology of Craniofacial/Deep Tissue Persistent 
Pain, designed to attract neuroscience investigators to explore 
these little-understood areas of acute and chronic pain. The 
Committee expects a report on initiatives and research growing 
out of the workshop and urges, in addition, that research be 
conducted in collaboration with the NHLBI and other pertinent 
institutes on other aspects of sensory-motor dysfunction 
associated with TMJ diseases and disorders, including autonomic 
nervous system involvement, dysphagia, alterations in 
proprioception, and a range of speech, breathing, and sleep 
problems.
    Traumatic brain injury (TBI).--There are at least 1.5 
million people who sustain a traumatic brain injury (TBI) 
annually, and at least 5.3 million people who live with a 
disability as a result of TBI. The Committee urges the NINDS to 
expand bench science research on the mechanisms of this 
disorder and to begin translational research into clinical 
settings.

         NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES

Appropriations, 2002....................................  $2,534,539,000
Budget estimate, 2003...................................   3,990,473,000
Committee recommendation................................   3,727,473,000

    The Committee recommends an appropriation of $3,727,473,000 
for the National Institute of Allergy and Infectious Diseases 
[NIAID]. This is $263,000,000 less than the budget request and 
$1,192,934,000 more than the fiscal year 2002 appropriation. 
Included in these funds is $100,000,000 to be transferred to 
the Global Fund to Fight HIV/AIDS, Malaria, and Tuberculosis. 
The comparable amounts for the budget estimate include funds to 
be transferred from the Office of AIDS Research.
    The Committee recommendation includes bill language that 
allows the NIAID to spend up to $150,000,000 on extramural 
facilities construction.
    Mission.--The NIAID is the lead NIH Institute charged with 
developing vaccines and supporting research on allergies, 
acquired immunodeficiency syndrome (AIDS), sexually transmitted 
diseases, turberculosis, tropical diseases, and other 
infectious diseases--including those likely to be used as 
agents of bioterrorism. To accomplish this mission, the NIAID 
supports and conducts basic and clinical research and research 
training programs in infectious diseases, whether they are 
naturally occurring or the result of a bioterrorist attack, and 
in diseases caused by, or associated with, disorders of the 
immune system.
    Advanced vaccine/device combination.--The Committee is 
aware of new vaccine/device delivery systems that could 
increase vaccine efficacy, use far less vaccine, and require 
fewer doses. The U.S. Army Medical Research Institute of 
Infectious Diseases (USAMRIID) is currently conducting research 
and development on vaccine/device combinations to improve the 
performance of vaccines against weaponized organisms, including 
anthrax, plague, and staphylococcus enterotoxin B. The 
Committee encourages NIAID to work with USAMRIID on this 
effort.
    Asthma, allergic diseases, and drug allergy.--The Committee 
encourages the NIAID to continue its efforts on asthma and 
expand its research into the area of drug allergy. Penicillin 
allergy alone causes 400 deaths each year in this country. The 
Committee encourages the NIAID, in collaboration with other 
Institutes as appropriate, to implement a program that will 
begin to address this need.
    Asthma research and management.--The Committee is very 
pleased with the NIAID's leadership regarding asthma research 
and management. The Committee recognizes the role the Institute 
has played in the Inner City Asthma Study and the importance of 
this effort concerning morbidity and mortality among 
underserved populations, particularly children. The Committee 
encourages the NIAID to continue to improve its focus and 
effort on asthma management, especially as it relates to 
children. The Committee also encourages the NIAID to 
collaborate more aggressively with voluntary health 
organizations to support asthma prevention, treatment, and 
research activities. Additionally, recent studies suggest that 
a variety of viral and bacterial agents, including agents used 
for immunization, may play a role in the development of asthma. 
The Committee encourages the Institute to expand research into 
the role that infections and vaccines may play in the 
development of asthma.
    Eye diseases.--The Committee encourages the Institute to 
collaborate with the NEI on research involving eye-related 
viruses and infectious diseases.
    Food allergy.--An estimated 7 million individuals suffer 
from food allergies in the United States, with up to 6 percent 
of all children under the age of 3 experiencing these 
potentially life-threatening allergies. The Committee urges the 
NIAID to implement a program to stimulate more research in this 
area.
    Hemophilia.--The Committee supports the NIAID's efforts to 
ensure access for persons with hemophilia to clinical trials 
for improving treatment of HIV and complications of hemophilia, 
including hepatitis C (HCV). The Committee, in particular, is 
encouraged by the NIAID's leadership in supporting research 
related to liver disease progression and response to HCV 
treatment among HIV/HCV co-infected persons with hemophilia, 
and it urges the Institute to continue its efforts in this 
area.
    Hepatitis C.--The Committee encourages the NIAID to support 
the virology and immunology portions of the NIDDK's HALT-C 
clinical trial. The HALT-C trial is a multi-center, randomized, 
controlled study designed to determine if using interferon over 
several years will suppress the hepatitis C virus, prevent 
progression to cirrhosis, prevent liver cancer, and reduce the 
need for liver transplantation. In addition, the Committee 
understands that limited clinical trials in Europe have 
partially validated the premise that the most effective way to 
eliminate the hepatitis C virus is to initiate an aggressive 
treatment at the inception of the virus. The Institute is 
encouraged to collaborate with the NIDDK and the Centers for 
Disease Control and Prevention to establish and validate 
treatment guidelines for use with individuals with acute 
hepatitis C at its inception.
    Inflammatory bowel disease.--The Committee continues to 
note with interest a scientific research agenda for Crohn's 
disease and ulcerative colitis (collectively known as 
inflammatory bowel disease) titled ``Challenges to Inflammatory 
Bowel Disease (IBD).'' This report identifies strong linkages 
between the functions of the immune system and IBD. The 
Committee is aware of the NIAID's research partnerships with 
the IBD community, and it encourages the Institute to expand 
its support of research focused on the immunology of IBD as 
well as the interaction of genetics and environmental factors 
in the development of the disease.
    Juvenile diabetes.--The Committee is aware that the Immune 
Tolerance Network is investigating methods to create and 
maintain tolerance to transplanted insulin-producing islet 
cells in recipients with juvenile diabetes. The Committee 
understands that the goal of this investigation is to eliminate 
the need for patients to undergo long-term immunosuppressive 
therapy after transplantation. The Committee encourages the 
NIAID to continue and expand this area of research, including 
developing additional protocols focused on islet cell 
transplantation into individuals with juvenile diabetes.
    Primary immune deficiency diseases.--The Committee is 
concerned that the primary immune deficiency community would be 
at significant risk for contracting smallpox if the Nation were 
to initiate a large-scale smallpox vaccination campaign. 
Therefore, the Committee encourages the NIAID to give priority 
consideration under its accelerated bioterrorism research 
program to a study of the potential benefits of immune globulin 
intravenous (IGIV) in the fight against smallpox. The Committee 
also understands that the NIAID intends to establish a 
cooperative consortium of investigators to address clinical and 
pre-clinical research questions on PI, including the molecular 
and cellular characterization of patients with novel 
phenotypes, and the development of new models, novel 
diagnostics, and new treatment approaches, such as gene 
therapy. The Committee urges the NIAID to move ahead 
aggressively with this initiative. In addition, the Committee 
would like to see the NIAID's current research project that is 
testing a new screening method for underserved populations 
replicated in other urban centers. Finally, the Committee 
continues to support greater involvement by the NIAID in the 
Jeffrey Modell Foundation's national campaign for physician 
education and public awareness of these diseases.
    Temporomandibular joint disorders (TMJ).--The Committee 
urges NIAID to incorporate the autoimmune and inflammatory 
processes involved in temporomandibular diseases and disorders 
into its research portfolio. The collection of tissue samples 
from TMJ patients and people without TMJ disease has been 
suggested as part of a patient registry, to determine whether 
inflammatory mediators, growth factors, cytokines and other 
cell and molecular factors affecting immunity may differ 
between people with and without TMJ disease.
    Transplantation.--The Committee is aware of the wide gap 
between the supply of and demand for transplanted organs. The 
Institute is encouraged to expand research on organ 
transplantation, including the development of artificial 
organs, hepatocyte transplantation, xenotransplantation, live-
donor liver transplantation, split liver transplantation, and 
other research focuses as appropriate.
    Tuberculosis.--Tuberculosis continues to account for more 
deaths worldwide than any other infectious disease and for over 
a quarter of all preventable adult deaths. The Committee 
commends the NIAID for its aggressive program of tuberculosis 
research, and it encourages a greater emphasis on the 
development of a vaccine, as noted by the NIAID's ``Blueprint 
for Tuberculosis Vaccine Development.''

             NATIONAL INSTITUTE OF GENERAL MEDICAL SCIENCES

Appropriations, 2002....................................  $1,700,139,000
Budget estimate, 2003...................................   1,854,984,000
Committee recommendation................................   1,853,584,000

    The Committee recommendation includes $1,853,584,000 for 
the National Institute of General Medical Sciences [NIGMS]. 
This is $1,400,000 less than the budget request and 
$153,445,000 more than the fiscal year 2002 appropriation. The 
comparable amounts for the budget estimate include funds to be 
transferred from the Office of AIDS Research.
    Mission.--NIGMS supports research and research training in 
the basic biomedical sciences. Institute grantees, working in 
such fields as cell biology, biophysics, genetics, 
developmental biology, pharmacology, physiology, biological 
chemistry, bioinformatics, and computational biology, study 
normal biological processes to better understand what goes 
wrong when disease occurs. In this way, NIGMS supplies the new 
knowledge, theories, and technologies that can then be applied 
to the disease-targeted studies supported by other NIH 
components. NIGMS-supported basic research advances also 
regularly find applications in the biotechnology and 
pharmaceutical industries. The Institute's training programs 
help provide the scientists needed by industry and academia to 
maintain United States leadership in biomedical science.
    Behavioral science research and training.--As the NIH 
Institute most concerned with basic research, the NIGMS has 
provided leadership in basic research on physiological and 
biological structures and functions that may play roles in 
numerous health conditions. The Committee encourages the NIGMS 
to develop collaborations with other Institutes, such as the 
NCI and NIMH, and the Office of Behavioral and Social Sciences 
Research to fund basic research to integrate physiological 
knowledge of predisease pathways with behavioral studies.
    Medical Scientist Training Program (MSTP).--The Committee 
understands that translating the human genome into cures and 
therapies is the next great challenge for modern medicine. To 
meet that challenge, a new generation of scientists must be 
trained. The MSTP is a highly competitive program that trains 
physicians for careers in biomedical research by supporting 
them as they earn both M.D. and Ph.D. degrees. The Committee 
strongly urges the NIGMS to provide additional funds to 
increase the number of promising physicians it trains through 
this program.
    Minority scientist training programs.--The Committee 
commends the NIGMS for its training programs that have a 
special focus on increasing the number of minority scientists, 
such as the Minority Access to Research Careers (MARC) and 
Minority Biomedical Research Support (MBRS) programs.

        NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT

Appropriations, 2002....................................  $1,113,087,000
Budget estimate, 2003...................................   1,213,817,000
Committee recommendation................................   1,213,817,000

    The Committee recommends an appropriation of $1,213,817,000 
for the National Institute of Child Health and Human 
Development [NICHD]. This is equal to the budget request and 
$100,730,000 more than the fiscal year 2002 appropriation. The 
comparable amounts for the budget estimate include funds to be 
transferred from the Office of AIDS Research.
    Mission.--The NICHD is that component of the NIH which is 
responsible for conducting and supporting research on maternal 
and child health, the population sciences, and medical 
rehabilitation. Research encompassed by these areas targets 
infant mortality; genetic diseases, including birth defects; 
mental retardation; gynecological health and contraceptive 
development and evaluation; pediatric, maternal, and adolescent 
AIDS; developmental biology; vaccine development; demographic 
and behavioral research; and restoration or enhancement of 
function in individuals experiencing physical disability due to 
injury, disease, or birth defect.
    Autism.--The Committee commends the NICHD for maintaining 
funding levels for the NIH centers of excellence in autism, and 
it urges the Institute to continue to do so. In addition, the 
Committee urges the NICHD to find ways to expand the pool of 
autism researchers.
    Demographic research.--The Committee is pleased with the 
development of a long-range plan for demographic research 
supported by the NICHD, and the continued active collaboration 
with other Federal offices and agencies in carrying out its 
mission. Contributions of the NICHD program to increasing 
knowledge of fatherhood, marriage, immigration, and the 
implications of increasing racial and ethnic diversity are of 
high importance. The Committee encourages the NICHD to continue 
focusing attention on family and community factors in examining 
the health and development of poor children. The Committee 
further encourages the Institute to continue its attention to 
data and training needs for policy-relevant demographic 
research.
    Duchenne muscular dystrophy.--The Committee commends the 
NICHD's interest in participating in the intramural muscular 
research initiative, and it encourages the NICHD to focus on 
childhood-specific muscular dystrophies. The Committee further 
encourages the NICHD to develop collaborative partnerships with 
the NINDS and NIAMS to advance basic, clinical, and 
translational research into treatment for Duchenne muscular 
dystrophy.
    Environmental effects on child health and development.--The 
Committee applauds the NICHD on its efforts to work 
collaboratively with the Environmental Protection Agency and 
the Centers for Disease Control and Prevention on developing 
the Longitudinal Cohort Study on Environmental Effects on Child 
Health and Development, which is now called the National 
Children's Study. This study aims to quantify the effects of 
environmental exposures plus the biological and social factors 
on child health and development. The Committee is pleased that 
the NICHD is undertaking a strategic planning process that 
strongly emphasizes a collaborative process between the 
biomedical and behavioral sciences and reaffirms its commitment 
to this entire effort.
    Fragile X.--Fragile X, the most common inherited cause of 
mental retardation, results from the failure of a single gene 
to produce a specific protein. Researchers at the NICHD have 
made great strides in understanding the mechanism by which this 
genetic defect causes mental retardation, seizures, aggressive 
outbursts and severe anxiety. Fragile X has the potential to be 
a powerful research model for other forms of X-linked mental 
retardation, as well as neuropsychiatric disorders, including 
autism, schizophrenia, mood disorders, and pervasive 
developmental disorder. The Committee is gratified that the 
NICHD has enhanced its research efforts on Fragile X 
internally, in cooperation with other Institutes, and by 
partnering with the FRAXA Research Foundation in the issuance 
and funding of a Request for Applications to research 
scientists. The Committee notes that the Children's Health Act 
of 2000 calls for the establishment of at least three Fragile X 
research centers. The Committee is pleased that the NICHD has 
issued a Request for Applications to implement this in fiscal 
year 2003. The Committee strongly urges the NICHD to allocate 
sufficient funds for expediting, expanding, and enhancing the 
work of these centers.
    Infertility and contraceptive research.--The Committee 
continues to place a high priority on research to combat 
infertility and speed the development of improved 
contraceptives. The NICHD is urged to continue aggressive 
activities in this area, including individual research grants 
and those of the infertility and contraceptive research 
centers.
    Juvenile diabetes.--The Committee encourages the NICHD to 
expand research using newborn screening tests, specifically to 
determine the causes of juvenile diabetes and to develop 
methods to prevent the disease. In addition, the Committee is 
aware of efforts to develop a vaccine to prevent juvenile 
diabetes and is encouraged by the early promise of this 
research. The Committee urges the NICHD to collaborate with the 
NIDDK in this important research initiative and with the CDC on 
the creation of a national surveillance system to track 
individuals with juvenile diabetes.
    Maternal-fetal medicine.--The Committee is pleased with the 
progress of the Maternal Fetal Medicine Units (MFMU) Network. 
The Committee urges the NICHD to continue and expand its 
support of the Network to enable researchers to continue to 
collect data and more efficiently study complicated pregnancies 
with a focus on pre-term birth and maternal complications. In 
addition, the Committee urges the NICHD to increase research in 
the area of pregnancy-related complications, with a special 
emphasis on issues related to minority health disparities.
    Osteogenesis imperfecta.--The Committee encourages the 
Institute to increase its research on osteogenesis imperfecta, 
especially genetic therapies, animal models, drug treatment, 
and rehabilitation.
    Pediatric kidney disease.--Kidney disease remains a 
persistent and little-understood problem among infants, 
children, and adolescents. The NICHD is strongly urged to 
undertake research to identify factors responsible for poor 
linear growth, abnormal bone formation and cognitive deficits 
in children; epidemiological studies designed to quantify the 
magnitude of the problem and identify which kidney diseases 
present the highest risk; and initiatives aimed at maximizing 
the academic potential of children with kidney disease.
    Pediatric liver disease.--The Committee urges the Institute 
to pursue opportunities to participate with the NIDDK and other 
Institutes on pediatric liver disease research, particularly in 
the areas of biliary atresia and non-alcoholic steatohepatitis.
    Primary immunodeficiencies (PI).--The Committee continues 
to be impressed by the comprehensive commitment that the NICHD 
has shown in addressing PI, particularly with regard to the 
Institute's partnership with the Jeffrey Modell Foundation, the 
NCI, the NIAID, and the CDC on a national physician education 
and public awareness campaign. The Committee encourages the 
NICHD to continue and expand its involvement in this campaign.
    Skeletal growth.--The committee encourages the NICHD to 
support research in abnormal and normal skeletal growth and 
development, including rickets and chronic under-nutrition, use 
of oral contraceptives and anabolic steroids, lactation, and 
pregnancy.
    Specialized centers for research.--The Committee commends 
the NICHD for its innovative program of specialized centers for 
research in reproductive medicine at minority institutions.
    Sudden Infant Death Syndrome.--The Committee is pleased 
with NICHD's continued efforts to extend the reach of its 
successful ``Back to Sleep'' campaign to underserved 
populations and daycare providers. The Committee also commends 
NICHD's attempts to further its progress in SIDS research by 
initiating a third SIDS 5-year research plan.
    Traumatic brain injury (TBI).--The Committee commends the 
NICHD and the National Center for Medical Rehabilitation 
Research for their efforts in establishing a TBI clinical 
trials network to investigate the efficacy of rehabilitation 
services for TBI victims. The Committee supports further 
research by the Center to investigate methods of improving 
decision-making functions and related cognitive skills of TBI 
victims.
    Urogynecology program.--The Committee is encouraged by the 
NICHD's accomplishments to date in establishing a research 
portfolio on pelvic floor disorders and urinary incontinence. 
The Committee encourages the Institute to fund grant 
applications for tissue structure, epidemiological studies, 
urinary incontinence, and clinical trials intervention 
programs. The Committee also encourages the NICHD to include 
the effects of pregnancy on a woman's chance for later 
urogynecologic problems in the future ``National Children's 
Study.''
    Vulvodynia.--Research indicates that millions of American 
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. Since fiscal year 1998, 
the Committee has called on the NICHD to support research on 
the prevalence, causes, and treatment of vulvodynia. While some 
initial steps have been taken, the Committee continues to be 
very concerned with the lack of research progress made in this 
important area and the lack of priority placed on it by the 
NICHD. The Committee expects the Institute to provide a 
significant increase in funding for research on vulvodynia.

                         NATIONAL EYE INSTITUTE

Appropriations, 2002....................................    $581,191,000
Budget estimate, 2003...................................     629,990,000
Committee recommendation................................     634,290,000

    The Committee recommends an appropriation of $634,290,000 
for the National Eye Institute [NEI]. This is $4,300,000 more 
than the budget request and $53,099,000 more than the fiscal 
year 2002 appropriation. The comparable amounts for the budget 
estimate include funds to be transferred from the Office of 
AIDS Research.
    Mission.--The NEI is the Nation's Federal resource for the 
conduct and support of laboratory and clinical research, 
research training, and other programs with respect to blinding 
eye diseases, visual disorders, mechanisms of visual function, 
preservation of sight, and the special health problems and 
needs of individuals who are visually impaired or blind. In 
addition, the NEI is responsible for the dissemination of 
information, specifically public and professional education 
programs aimed at the prevention of blindness.
    The Committee is pleased that vision impairment is a 
priority area in the national Healthy People 2010 initiative. 
The Institute is urged to develop the data on the extent of the 
problem of eye disease, especially among the aging population, 
and the economic consequences of eye disease so progress in 
these areas can be measured.
    Age-related macular degeneration.--Age-related macular 
degeneration (AMD) is the most common form of irreversible 
blindness for persons over the age of 65. More than 1.6 million 
Americans over age 50 suffer from AMD, and this number is 
expected to triple by the year 2020. NEI-supported research has 
demonstrated that early detection and treatment can slow the 
onset of this sight-threatening disease, thereby maintaining 
the independence and quality of life of the elderly. Therefore, 
the Committee encourages the NEI, through the National Eye 
Health Education Program (NEHEP), to launch an education and 
outreach program relating to AMD to increase public awareness 
about the need for early detection and diagnosis, recognition 
of symptoms, and treatments for the disease. The Committee 
likewise encourages the NEI to expand its intramural research 
efforts on this disease.
    Bioengineering.--The Committee commends the NEI for its 
longstanding support for new technologies specifically aimed at 
improving the understanding of ocular and visual systems. The 
Committee encourages the NEI to continue its research in these 
critical areas and to expand its research in tissue 
bioengineering related to artificial corneas, adult stem cell 
research aimed at replacing or regenerating cornea tissue, and 
other applications of innovative technologies that will enhance 
or restore vision.
    Diabetic eye diseases.--The Committee is pleased with the 
NEI's initiative to develop and evaluate more rapidly new 
treatments for macular edema through a new multicenter clinical 
trials network. The Committee is aware that diabetic 
retinopathy is the leading cause of new cases of blindness in 
this country. Diabetic macular edema, secondary to diabetic 
retinopathy, is a major cause of vision loss due to the leakage 
of fluids and other materials from damaged blood vessels. The 
Committee encourages the NEI to continue to implement the 
recommendations of the Diabetes Research Working Group related 
to diabetic eye disease.
    Health disparities.--NEI-supported researchers have found 
that the prevalence of non-insulin-dependent diabetes mellitus 
(NIDDM) is two to three times higher in Hispanics than in non-
Hispanic whites. The Committee is pleased with the NEI's 
progress in implementing its Spanish language education program 
``Ojo con su vision,'' and it encourages the NEI to continue 
its targeted health education activities and messages to 
increase awareness of diabetes and its complications in the 
Hispanic population.
    National Eye Health Education Program.--The National Eye 
Health Education Program (NEHEP) is coordinated by the NEI in 
partnership with over 60 national organizations that conduct 
eye health education programs. The Committee commends the NEI 
for its development of the Low Vision Education Program to 
increase awareness of low vision and its impact on the quality 
of life, particularly among African-American and Hispanic 
populations that are at increased risk of vision loss from 
sight-threatening diseases. The Committee is particularly 
pleased with ``The Eye Site,'' an award-winning traveling 
exhibit directed toward people with low vision, their families 
and friends, and health care and service professionals.
    Neurodegenerative eye diseases.--The Committee is pleased 
to learn of the significant advances made in research on 
neurodegeneration across a range of eye diseases, including 
retinitis pigmentosa, ocular albinism, macular degeneration, 
and glaucoma. In light of these developments, the Committee 
urges the NEI to increase its support and conduct of research 
on these neurodegenerative eye diseases, including support for 
genomic and proteomic resources and for collaborative 
multidisciplinary research.
    Sjogren's syndrome.--The Committee commends the NEI for 
supporting grants in dry eye and Sjogren's-related research and 
encourages continued investigation into improved therapeutics 
for dry eye. An important initial step in dry eye research and 
Sjogren's is obtaining epidemiology data, and the Committee 
encourages the NEI to pursue this research.

          NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES

Appropriations, 2002....................................    $566,118,000
Budget estimate, 2003...................................     614,258,000
Committee recommendation................................     617,258,000

    The Committee recommends an appropriation of $617,258,000 
for the National Institute of Environmental Health Sciences 
[NIEHS]. This is $3,000,000 more than the budget request and 
$51,140,000 more than the fiscal year 2002 appropriation. The 
comparable amounts for the budget estimate include funds to be 
transferred from the Office of AIDS Research.
    Mission.--The mission of the NIEHS is to define how 
environmental exposures affect health; how individuals differ 
in their susceptibility to these effects; and how these 
susceptibilities change with time. This knowledge, coupled with 
prevention and communication programs, can lead to a reduction 
in environmentally associated diseases and dysfunctions.
    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 
the NIEHS. The Committee strongly urges the Institute to 
maintain the centers' current funding levels.
    Hormone-disrupting chemicals.--The Committee encourages the 
NIEHS to enhance research on the health effects of exposure to 
hormone-disrupting chemicals. The committee also encourages the 
NIEHS to collaborate with the Centers for Disease Control and 
Prevention, the United States Geological Survey, the 
Environmental Protection Agency, and other appropriate agencies 
in this effort. This collaboration will contribute to a better 
understanding of how hormone-disrupting chemicals lead to the 
development of reproductive, nervous, and immune system 
disorders, and cancer, particularly as a consequence of pre-
natal exposures.
    Volcanic emissions.--The Committee continues to be 
concerned about the public health aspects of volcanic emissions 
in Hawaii. Such emissions present significant acute and long-
term health problems, and the Committee urges the development 
of a multidisciplinary approach to this problem.

                      NATIONAL INSTITUTE ON AGING

Appropriations, 2002....................................    $893,130,000
Budget estimate, 2003...................................     968,699,000
Committee recommendation................................   1,000,099,000

    The Committee recommendation includes $1,000,099,000 for 
the National Institute on Aging [NIA]. This is $31,400,000 more 
than the budget request and $106,969,000 more than the fiscal 
year 2002 appropriation. The comparable amounts for the budget 
estimate include funds to be transferred from the Office of 
AIDS Research.
    Mission.--The NIA conducts biomedical, behavioral, and 
social research related to the aging process to prevent disease 
and other problems of the aged, and to maintain the health and 
independence of older Americans. Research in aging over the 
last two decades demonstrates that aging should not be equated 
with inevitable decline and disease.
    Age-related bone diseases.--The committee encourages the 
NIA to coordinate research with NIAMS into age-related changes 
in bone and the skeleton, including osteoporosis, osteogenesis 
imperfecta, and Paget's disease.
    Alzheimer's disease.--An estimated 4 million Americans now 
suffer from Alzheimer's disease, a degenerative brain disorder 
that robs its victims of the ability to care for themselves; 
places enormous physical, emotional and financial burdens on 
family caregivers; and each year drains $100,000,000,000 from 
our economy. Left unchecked, an estimated 14 million 
individuals will be stricken over the next few decades, while 
the annual cost of caring for Alzheimer's victims will soar to 
$375,000,000,000. The Committee 3 years ago challenged the NIH 
and the scientific community to launch a full-scale assault on 
Alzheimer's disease that focuses on preventing or delaying its 
onset. The NIA responded by embarking on a multi-Institute 
prevention initiative that encompassed basic, epidemiological, 
behavioral and clinical research. As a result of these efforts, 
science is now at the point where effective treatment and 
prevention of the disabling effects of Alzheimer's are within 
reach. In light of the dramatic strides that have already been 
made in understanding Alzheimer's disease, scientists believe 
that an investment of $1,000,000,000 as soon as possible will 
produce the answers necessary to conquer Alzheimer's. The 
Committee urges the NIA to expand its investment in Alzheimer's 
disease research, focusing especially on its pathology, the 
identification of risk factors, more effective treatments, and 
large-scale clinical trials. In addition, advances in genetics 
and imaging now make it possible to study Alzheimer's in ways 
that were never before possible. The Committee encourages the 
NIA to apply this new knowledge to ongoing longitudinal 
studies.
    The Committee also urges the NIA to focus on early 
detection of Alzheimer's disease so that clinical interventions 
to slow or stop the progression of the disease may be 
undertaken. The Committee notes that positron emission 
tomography (PET) may identify Alzheimer's disease at an early 
stage and encourages the NIA, in collaboration with the NINDS 
and the NIMH, to expand its research efforts into early 
diagnosis of Alzheimer's using PET and other brain imaging 
methods.
    Behavioral research.--The Committee recognizes the NIA's 
efforts to spur research on aging and cognitive function, and 
it urges the Institute to focus on the many difficult questions 
involved in long-term maintenance of positive behavior change. 
The Committee applauds efforts in the Behavioral and Social 
Research branch to encourage multidisciplinary and 
interdisciplinary behavioral economics research that may 
address questions of savings and resource allocation in the 
pre- and post-retirement populations.
    Cardiovascular aging research.--Cardiovascular diseases 
remain America's leading causes of death of older men and women 
and a significant cause of disability. The Committee urges the 
NIA to make cardiovascular research a priority.
    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 strongly urges the NIA to 
make all possible efforts to expand these centers to include a 
school of nursing.
    Demographic and economic research.--The Committee commends 
the NIA for its demography and economic research. It is 
impressed by the importance of the findings from the Health and 
Retirement Study and the National Long Term Care Survey 
regarding the continuing decline in physical and cognitive 
disability. The Committee urges the NIA to expand funding for 
these studies and to explore the economic and social impact of 
the decline for families and society. The Committee also 
encourages the NIA to assess the role of health as a factor in 
premature retirement.
    Older Americans with mental illness.--The Committee is 
concerned about the growing population of older Americans who 
suffer from mental illness. This is often an underserved 
population, particularly in rural areas. The Committee 
encourages the NIA to target funds to study and identify 
vulnerable older adults who are at risk for such mental 
illnesses as depression, anxiety, and psychoses. Because 
advanced practice psychiatric nurses work in a variety of 
settings, the Committee believes they may be in a unique 
position to be a critical component of research related to the 
assessment and treatment of older adults with these disorders.

  NATIONAL INSTITUTE OF ARTHRITIS AND MUSCULOSKELETAL AND SKIN DISEASES

Appropriations, 2002....................................    $448,699,000
Budget estimate, 2003...................................     486,624,000
Committee recommendation................................     489,324,000

    The Committee recommends an appropriation of $489,324,000 
for the National Institute of Arthritis and Musculoskeletal and 
Skin Diseases [NIAMS]. This is $2,700,000 more than the budget 
request and $40,625,000 more than the fiscal year 2002 
appropriation. The comparable amounts for the budget estimate 
include funds to be transferred from the Office of AIDS 
Research.
    Mission.--NIAMS conducts and supports basic and clinical 
research and research training, and the dissemination of health 
information on the more than 100 forms of arthritis; 
osteoporosis and other bone diseases; muscle biology and muscle 
diseases; orthopedic disorders, such as back pain and sports 
injuries; and numerous skin diseases. The research agenda of 
NIAMS addresses many devastating and debilitating diseases that 
afflict millions of Americans. These diseases of the joints, 
muscles, bones, connective tissues, and skin, in the aggregate, 
will affect nearly every American at some point in their lives, 
causing tremendous human suffering and costing the Nation 
billions of dollars in both health care and lost productivity. 
The research activities of this Institute serve the concerns of 
many different special populations, including women, 
minorities, children, and the elderly.
    Duchenne muscular dystrophy.--The Committee urges NIAMS to 
intensify its research into the muscular dystrophies, and to 
continue working closely with the NINDS to identify 
collaborative opportunities to advance basic, clinical, and 
translational research into treatment for Duchenne muscular 
dystrophy. In addition, the Committee encourages NIAMS to 
coordinate with the NINDS and the Centers for Disease Control 
and Prevention to develop strategic research priorities for 
basic and applied research in the Duchenne and Becker muscular 
dystrophies.
    Gender differences in musculoskeletal biology.--Recent 
scientific advances have begun to make it possible to 
understand underlying gender-dependent differences that 
contribute to differences in disease incidence and severity 
between males and females. Osteoarthritis, rheumatoid 
arthritis, and osteoporosis are expressed to a greater extent 
in females. The Committee encourages NIAMS to work to identify 
the extent of these gender differences in musculoskeletal 
disorders and develop a plan for addressing the questions that 
require further research.
    Marfan syndrome.--Marfan syndrome is a life-threatening 
genetic disorder affecting several organ systems including 
musculoskeletal, cardiovascular and ophthalmologic systems. To 
further boost research in this area, the Committee encourages 
NIAMS to consider all available mechanisms of funding for 
research on Marfan syndrome. The Committee commends NIAMS for 
taking the lead role in the vital support of research on 
heritable disorders of connective tissue, which include Marfan 
syndrome. The Committee is pleased to note that NIAMS has 
issued a Request for Applications for heritable disorders of 
connective tissue.
    Metabolic bone diseases.--The Committee urges NIAMS to 
enhance its research into all metabolic bone diseases, to 
support research that applies new developments in genomics and 
proteomics to osteoporosis and related bone diseases, and to 
conduct large-scale clinical trials to determine whether agents 
that prevent bone loss reduce fracture risk in women with low 
bone mass.
    Osteogenesis imperfecta.--The Committee encourages the 
Institute to pursue new osteogenesis imperfecta (OI) research 
opportunities arising out of the 2002 scientific workshop on 
OI, including life-threatening respiratory and cardiovascular 
problems related to osteogenesis imperfecta.
    Scleroderma.--The Committee is encouraged by the NIAMS's 
growing interest in scleroderma, a chronic and progressive 
disease that predominantly strikes young women. More research 
is critically needed to identify the genetic risk factors for 
scleroderma and to develop safe and effective treatments. The 
Committee encourages the NIAMS to collaborate with other 
Institutes, including the NHLBI, NIDDK, and NIDCR, to generate 
more comprehensive research opportunities for scleroderma.
    Skeletal repair.--The Committee encourages NIAMS to explore 
the stimulation of skeletal repair by biophysical agents 
including mechanical strain, ultrasound, and electrical energy. 
This research would be valuable to interdisciplinary interests 
including trauma, aging, rehabilitation and exercise 
physiology, and tissue engineering.
    Temporomandibular joint disorders (TMJ).--The Institute is 
urged to initiate research on the unique features of the 
temporomandibular joint as well as explore to what extent 
temporomandibular diseases and disorders share common 
pathogenic mechanisms with osteoarthritis in other joints and 
musculoskeletal pain. The recommendations from the recent TMJ 
Association meeting on joint and muscle dysfunction of the TMJ, 
which NIAMS co-sponsored, can serve as guidance for the NIAMS 
TMJ research agenda.
    Tissue reengineering.--There is growing interest in the 
possibility that tissue engineering will provide a biological 
solution to the critical clinical need for organs and tissues. 
The Committee encourages NIAMS to consider holding a workshop 
to help educate clinicians, who can apply the advances to 
patients, about this new field.

    NATIONAL INSTITUTE ON DEAFNESS AND OTHER COMMUNICATION DISORDERS

Appropriations, 2002....................................    $341,965,000
Budget estimate, 2003...................................     370,805,000
Committee recommendation................................     372,805,000

    The Committee recommends an appropriation of $372,805,000 
for the National Institute on Deafness and Other Communication 
Disorders [NIDCD]. This is $2,000,000 more than the budget 
request and $30,840,000 more than the fiscal year 2002 
appropriation. The comparable amounts for the budget estimate 
include funds to be transferred from the Office of AIDS 
Research.
    Mission.--The NIDCD funds and conducts research and 
research training in the normal and disordered processes of 
human communication, specifically in the areas of hearing, 
balance, smell, taste, voice, speech, and language. The 
Institute addresses the special biomedical and behavioral 
problems of people who have communication impairments or 
disorders; contributes to health promotion and disease 
prevention; and supports efforts to create devices that 
substitute for lost and impaired sensory and communication 
functions.
    Dysphonia.--The Committee continues to be pleased with the 
NIDCD's expanding intramural research program with respect to 
dysphonia. The Committee encourages the NIDCD to explore 
possibilities for a more active extramural research effort on 
dysphonia, and collaboration with other NIH Institutes on this 
important disorder.
    Early detection and intervention.--The Committee supports 
expanded research on the early detection, diagnosis, and 
intervention of infants with deafness and other communication 
disorders, as well as on new intervention strategies to prevent 
otitis media and other childhood causes of hearing loss.
    Genetic deafness.--The Committee encourages the NIDCD to 
conduct research into the genetic basis for normal and 
disordered communication, especially auditory system 
proteomics, and into interventions that prevent or treat 
genetic deafness.
    Hair cell regeneration.--The Committee urges NIDCD to give 
a high priority to new and important directions for inner ear 
hair cell regeneration.
    Hearing devices.--The Committee encourages the NIDCD to 
expand research that would improve the benefits of cochlear 
prostheses and improve remediation of less-than-profound 
hearing loss through hearing aids and/or new prostheses and 
drug-delivery systems.
    Language acquisition.--The Committee encourages the NIDCD 
to explore the biological bases and genetics of language, as 
well as infant speech perception and language acquisition. It 
also encourages the Institute to develop clinical applications 
such as genetic screening for all communication disorders.
    Noise-induced hearing loss.--The Committee continues to be 
concerned by the number of Americans who suffer from noise-
induced hearing loss. The NIDCD's Wise Ears! campaign has the 
potential to make significant inroads towards educating 
Americans of all ages, and the Committee strongly supports its 
expansion.
    Presbycusis.--Presbycusis, the gradual loss of hearing from 
aging, will become more common as the Nation's population grows 
older. The Committee encourages research on the central and 
peripheral mechanisms leading to presbycustic hearing loss and 
on strategies that would prevent hearing loss in our senior 
population.
    Preventing hearing loss.--The Committee supports expanded 
research on prosthetic and pharmacological therapies for 
hearing loss from noise stress, ototoxic drugs and other 
traumas.
    Tinnitus.--The Committee encourages the Institute to expand 
its research into mechanisms underlying peripheral and central 
tinnitus.

                 NATIONAL INSTITUTE OF NURSING RESEARCH

Appropriations, 2002....................................    $120,428,000
Budget estimate, 2003...................................     130,438,000
Committee recommendation................................     131,438,000

    The Committee recommends an appropriation of $131,438,000 
for the National Institute of Nursing Research [NINR]. This is 
$1,000,000 more than the budget request and $11,010,000 more 
than the fiscal year 2002 appropriation. The comparable amounts 
for the budget estimate include funds to be transferred from 
the Office of AIDS Research.
    Mission.--The National Institute of Nursing Research [NINR] 
supports clinical and basic research on biological and 
behavioral aspects of critical national health problems. The 
Institute's programs have established a scientific basis for 
research that seeks to reduce the burden of acute and chronic 
illness and disability for individuals of all ages; improve the 
quality of life by preventing and delaying the onset of disease 
or slowing its progression; and establishing better approaches 
to promoting health and preventing disease. The NINR supports 
programs essential to improving clinical environments by 
testing interventions which influence patient health outcomes 
and reduce costs and demands for care.
    Adolescent research intervention.--Adolescents are prone to 
risky behaviors that endanger their present and future health, 
such as smoking, eating unhealthy foods, excessive drinking of 
alcohol, and physical inactivity. The Committee supports the 
NINR's research interventions that address multiple risks 
across adolescent populations and settings, such as school, 
work, and the community, to reduce youthful risk-taking and its 
consequences.
    Alzheimer's disease.--The Committee is pleased that the 
NINR plans to expand research on long-term care recipients' 
health care needs and interventions. Working in collaboration 
with the NIA and other Institutes, the NINR is playing a 
critical role in improving care for individuals with 
Alzheimer's disease through research aimed at maintaining 
functional mobility and preventing complications from co-
occurring illnesses, excess disability, and premature decline.
    Collaboration with NIMH.--The Committee acknowledges the 
long-term mentorship program established by NINR in 
collaboration with the National Institute of Mental Health to 
prepare mental health nurses with the skill sets required for 
competitive research proposals to the NIH. The Committee 
recommends continued collaboration with NIMH to generate 
initiatives.
    Health disparities.--The Committee commends the NINR for 
its active role in research to abolish health disparities and 
urges continued emphasis, particularly in light of findings 
that the health care of minorities, even those who are insured, 
is lower in quality. The NINR's efforts to build community 
partnerships for research on key health issues that are 
identified by the minority community members themselves are an 
important step in the right direction.
    Family caregivers.--The Committee commends the NINR for its 
research to assist the Nation's estimated 24 million to 27 
million family caregivers, who provide an average of 18 hours 
of unpaid care a week to their ill relatives. The Committee is 
encouraged by findings showing that nursing interventions can 
improve caregiver skill levels, morale, and quality of life, 
and it supports enhanced research in this area. The Committee 
is also pleased that the NINR is expanding caregiver research 
directed at professional caregivers who serve those residing in 
nursing homes and in assisted living facilities.
    Juvenile diabetes.--The Committee is aware of reports of 
adolescents with juvenile diabetes engaging in behavior that 
will accelerate damaging complications, such as neglecting to 
take insulin for purposes of weight loss. The Committee 
encourages the NINR to increase its attention to adolescents 
with juvenile diabetes, specifically regarding consequences of 
the disease's psychological impact. In addition, the Committee 
is aware of the important role that Ph.D. nurses play in 
research to find cures for diseases such as juvenile diabetes. 
The Committee encourages the Institute to expand measures to 
increase the numbers of Ph.D. nurses.
    Nursing shortage.--The Committee is very concerned about 
the shortage of nurses. The NINR's efforts to build nursing 
research capacity are essential to ensure a sufficient supply 
of well-prepared investigators to address the health needs of 
tomorrow. The Committee encourages the NINR to implement 
programs that bring students into the research stream at a 
younger age and to diversify research and training 
opportunities in reaching out to minorities.
    Palliative care.--The Committee commends the NINR for its 
efforts to advance the science of end-of-life/palliative care, 
and it encourages continued emphasis and expansion.

           NATIONAL INSTITUTE ON ALCOHOL ABUSE AND ALCOHOLISM

Appropriations, 2002....................................    $384,071,000
Budget estimate, 2003...................................     416,773,000
Committee recommendation................................     418,773,000

    The Committee recommends an appropriation of $418,773,000 
for the National Institute on Alcohol Abuse and Alcoholism 
[NIAAA]. This is $2,000,000 more than the budget request and 
$34,702,000 more than the fiscal year 2002 appropriation. The 
comparable amounts for the budget estimate include funds to be 
transferred from the Office of AIDS Research.
    Mission.--The NIAAA conducts biomedical and behavioral 
research for improving prevention and treatment and reducing or 
eliminating the associated health, economic, and social 
consequences of alcohol abuse and alcoholism. NIAAA provides 
leadership in the country's effort to combat these problems by 
developing new knowledge that will decrease the incidence and 
prevalence of alcohol abuse and alcoholism and associated 
morbidity and mortality. NIAAA addresses these questions 
through an integrated program of biomedical, behavioral, and 
epidemiologic research on alcoholism, alcohol abuse, and 
related problems. This broad-based program includes various 
areas of special emphasis such as medications development, 
fetal alcohol syndrome, genetics, neuroscience and moderate 
drinking.
    Alcohol treatment services.--Given the rapid growth of 
managed behavioral health care, the Committee is concerned that 
more needs to be known about how alcohol treatment services are 
delivered under managed care arrangements and the specific 
characteristics of behavioral health components of health 
insurance plans and managed care organizations. The Committee 
continues its support of the NIAAA Advisory Council's 
comprehensive plan for health services, particularly its 
recommendation to prioritize research to understand the effects 
of managed care on treatment services. The Committee 
acknowledges the NIAAA's progress in implementing this 
recommendation, and it encourages the Institute to consider 
supporting additional research in this area.
    Alcoholic liver disease.--Alcoholic liver disease remains a 
major cause of morbidity and mortality in the United States. 
The Committee notes that recent research suggests that free 
radicals are a principal vehicle through which alcohol damages 
the liver, and that antioxidants look increasingly promising as 
a potential treatment. The Committee encourages the Institute 
to expand its research on alcoholic liver disease, particularly 
regarding the interaction between hepatitis C and alcohol in 
liver disease.
    Brain mapping and organ imaging in alcoholism.--The 
Committee notes the rapid progress made through advanced 
imaging technology in mapping the brain pathways that are 
involved in alcohol addiction and alcohol-related brain damage. 
The Committee urges the Institute to expand research on brain 
mapping in alcoholics. Where possible, the Institute should 
collaborate with the NIBIB and other NIH Insitutes and agencies 
on the development of advanced instrumentation to further the 
understanding of alcohol dependence and alcohol-related medical 
disorders.
    College drinking.--The Committee applauds the NIAAA Task 
Force Report on College Drinking--``A Call To Action: Changing 
the Culture of Drinking at U.S. Colleges''--especially its goal 
of providing university and college presidents, policymakers, 
and researchers with information and recommendations on the 
effectiveness of current interventions and encouraging them to 
embrace rigorous research-based solutions. The Committee is 
pleased that the NIAAA website Collegedrinkingprevention.gov 
has over 2 million hits and has received over 15 awards since 
it appeared in April, reflecting the concern and interest in 
this national public health problem. The Committee believes the 
Task Force's proposed research-based recommendations should be 
implemented in as many colleges and universities as soon as 
possible.
    Health disparities.--Evidence suggests that alcohol affects 
genders and subpopulations differently, and that some groups 
suffer more adverse effects than others. The Committee 
encourages the Institute to work collaboratively with the NCMHD 
to study the role of gender, ethnicity, socioeconomic status, 
and other variables in determining the effects of alcohol use 
and abuse.
    Identification of molecular targets of alcohol in the 
brain.--The Committee notes the success of NIAAA-funded 
investigators in identifying molecular targets of alcohol in 
the brain. The characterization of these targets may lead to 
the discovery of compounds that block specific effects of 
alcohol. The Committee is pleased to learn that this strategy 
has led to the prevention of alcohol-related birth defects in 
mice, and it encourages the Institute to stimulate additional 
research on the molecular basis for the actions of alcohol.
    Longitudinal studies.--The Committee encourages the 
Institute to undertake longitudinal studies that recruit 
subjects in early adolescence to examine gene-environment 
interactions impacting alcohol abuse and alcoholism during the 
course of an individual's life. The Institute is encouraged to 
partner with other institutes, agencies and organizations 
deemed appropriate, including the NICHD and SAMHSA.
    Medications development for alcoholism treatment.--The 
Committee is aware of advances in the understanding of how 
genetics and environment influence the response to alcohol. The 
Committee urges the Institute to encourage studies on the 
influence of psychological and social factors on the success of 
treatment, and develop new medications for the treatment of 
alcoholism and alcohol-related disorders.
    Multidisciplinary research on fetal alcohol syndrome.--The 
Committee recognizes that fetal alcohol syndrome is among the 
most common preventable cause of mental impairment. The 
Committee supports the Institute's efforts to understand the 
biological mechanisms through which alcohol causes damage to 
the developing fetus. The Committee also urges the Institute to 
aggressively pursue research that will lead to effective 
strategies for the prevention and treatment of fetal alcohol 
syndrome.
    Native Alaskans.--The Committee is aware of serious 
problems with alcohol and substance abuse among Native Alaskans 
and of the need for translating research into clinical 
applications for this population. The Committee urges the NIAAA 
to sponsor a Research to Practice Forum to focus on bridging 
the gap between researchers and practitioners and translating 
scientific research into clinical applications, and to support 
the implementation of any recommendations developed at the 
forum.
    Prevention of alcohol abuse in adolescents.--The Committee 
is very concerned about the increasing number of alcohol-
related deaths on college campuses and increasing alcohol use 
among elementary and secondary school-aged children. The 
Committee urges the Institute to pursue collaborations with 
other Institutes, such as the NICHD and NIMH, to study the 
causes of alcohol abuse among this age group and to devise 
strategies for effective prevention and intervention.

                    NATIONAL INSTITUTE ON DRUG ABUSE

Appropriations, 2002....................................    $887,733,000
Budget estimate, 2003...................................     964,613,000
Committee recommendation................................     968,013,000

    The Committee recommends an appropriation of $968,013,000 
for the National Institute on Drug Abuse [NIDA]. This is 
$3,400,000 more than the budget request and $80,280,000 more 
than the fiscal year 2002 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 
that addiction is a treatable disease. NIDA's basic research 
plays a fundamental role in furthering knowledge about the ways 
in which drugs act on the brain to produce dependence, and 
contributes to understanding how the brain works. In addition, 
NIDA research identifies the most effective pharmacological and 
behavioral drug abuse treatments. NIDA conducts research on the 
nature and extent of drug abuse in the United States and 
monitors drug abuse trends nationwide to provide information 
for planning both prevention and treatment services. An 
important component of NIDA's mission is also to study the 
outcomes, effectiveness, and cost benefits of drug abuse 
services delivered in a variety of settings and to assure 
dissemination of information with respect to prevention of drug 
abuse and treatment of drug abusers.
    Collaboration with SAMHSA and other agencies.--The 
Committee encourages NIDA to continue to collaborate with 
SAMHSA and other agencies to bridge the existing gap between 
research and practice. The Committee is pleased that NIDA plans 
to support CSAT's Addiction Technology Transfer Centers. The 
Committee believes that this collaborative effort will have a 
significant impact on how communities receive and develop the 
skills, systems, and necessary support to implement new 
research findings.
    Community-friendly behavioral therapies.--Research-based 
behavioral treatments are often criticized as too lengthy, 
costly, complex, or difficult for treatment providers to 
integrate with more traditional methods of care. The Committee 
applauds NIDA's efforts to remedy this situation by developing 
and bringing behavioral therapies to community treatment 
centers. NIDA is urged to encourage researchers to make 
behavioral treatments more ``community friendly,'' while still 
maintaining their effectiveness. The Committee is pleased that 
NIDA has expanded the scope of its research beyond testing new 
treatments to include studies on financing and organizational 
adaptation and change. The Committee encourages NIDA to 
continue testing new treatments in clinical trials and 
supporting research on how to move effective treatments into 
health care systems.
    Hepatitis C treatment.--The Committee notes the high 
incidence of hepatitis C among the U.S. population that uses 
drugs. Research into the efficacy of treating such individuals 
for hepatitis C concurrently with drug dependency protocols 
such as methadone is highly recommended.
    Information dissemination.--The Committee urges NIDA to use 
both the existing National Drug Abuse Treatment Clinical Trials 
Network infrastructure and the new prevention infrastructures 
that are currently being established as part of NIDA's new 
Prevention Research Initiative to ensure that findings are put 
into practice in communities across the country.
    Methamphetamine.--The Committee continues to be concerned 
about methamphetamine abuse across the Nation, especially in 
the Midwest. The Committee again urges NIDA to expand its 
research on improved methods of prevention and treatment of 
methamphetamine abuse.
    Nicotine.--The Committee applauds NIDA's efforts to support 
a comprehensive research portfolio that has indisputably 
demonstrated the addictive nature of nicotine. The Committee 
encourages NIDA to work independently and, where possible, 
collaborate with other Institutes and organizations to identify 
and develop targets for new treatments. The Committee 
recognizes that treating addiction to nicotine remains among 
the most cost-effective approaches to reducing cancer risk.
    Prevention research.--The Committee is pleased that NIDA 
has launched a multi-component National Prevention Research 
Initiative that will involve partners at the State and local 
levels. The Committee urges NIDA to expand this initiative to 
test the effectiveness of new and existing science-based 
prevention approaches in different communities, while also 
studying how best to adapt the programs for local needs.
    Stress and substance abuse.--Stress plays a major role in 
the initiation and continuation of drug use, and in relapse to 
addiction. The Committee encourages the NIDA to increase its 
research portfolio on this topic as well as on post-traumatic 
stress disorder and substance abuse.
    Translating basic research.--NIDA's strong basic research 
foundation has provided great insight into the addiction 
process and has helped identify molecular targets for the 
development of medications as well as new behavioral treatment 
strategies as well. The Committee urges NIDA to use 
translational research to continue to rapidly bring knowledge 
from the lab into clinical practice.

                  NATIONAL INSTITUTE OF MENTAL HEALTH

Appropriations, 2002....................................  $1,238,093,000
Budget estimate, 2003...................................   1,343,088,000
Committee recommendation................................   1,350,788,000

    The Committee recommends an appropriation of $1,350,788,000 
for the National Institute of Mental Health [NIMH]. This is 
$7,700,000 more than the budget request and $112,695,000 more 
than the fiscal year 2002 appropriation. The comparable amounts 
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, according to 
a report recently issued by the Surgeon General of the United 
States, afflict more than one in five American adults. 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 to the Nation's well-being.
    Alzheimer's disease.--The NIMH continues to play an 
important part in efforts to develop effective treatment 
strategies for Alzheimer's disease. Already underway is a 
large-scale, multi-site study to identify the best medication 
treatment strategies for the behavioral problems that co-occur 
in Alzheimer's. In addition, the NIMH's newly formed Aging 
Workgroup has undertaken an exhaustive review of its current 
aging-related research portfolio, with a view toward enhancing 
coordination and collaboration with other NIH institutes. The 
Committee is pleased with the steps the NIMH has already taken, 
and it encourages the Institute to continue its efforts to 
reduce the psychiatric burden of Alzheimer's disease, including 
research into the relationship between Alzheimer's and 
depression.
    Autism.--The Committee notes that, that under the 
leadership of the NIMH, the NIH has quickly carried out the 
provisions of the Children's Health Act with respect to 
establishing autism centers of excellence and the Interagency 
Autism Coordinating Committee. The Committee is also encouraged 
by grants from the NIMH to investigate treatment options, 
including pharmaceutical research targeting the unique needs of 
the autism community in both children and adults. The Committee 
urges the NIMH to continue to fund behavioral and clinical 
research as well as other promising areas of research related 
to autism spectrum disorders.
    Borderline personality disorder (BPD).--The Committee 
understands that failure to recognize and adequately treat BPD 
can have devastating consequences such as substance abuse, 
domestic violence, and even suicide. The Committee urges the 
NIMH to expand its research on this disease.
    Elderly mental health.--The Committee is concerned that 
despite substantial funding increases for the NIMH in recent 
years, the Institute's sponsorship of extramural research on 
the mental health of the elderly has not kept pace with its 
funding of research for other populations. Therefore, the 
Committee urges the NIMH to expand research in this area 
through all available mechanisms.
    Fragile X.--Fragile X causes cognitive impairment, mental 
disorders such as obsessive-compulsive disorder, and extreme 
anxiety. The Committee urges the NIMH to conduct research on 
the neurobiological basis of Fragile X, characterize the mental 
health symptoms of Fragile X, and investigate effective 
treatments and promising new psychopharmacologic interventions 
that target those symptoms. The Committee also urges the NIMH 
to include Fragile X in its studies of related neuropsychiatric 
disorders and to work with other Institutes such as the NICHD 
and the NINDS to develop cooperative research support 
mechanisms in this area.
    Frontier mental health needs.--The Committee commends the 
NIMH on its outreach efforts to determine the differences in 
mental health needs which may exist in remote frontier 
communities. The Committee encourages the NIMH to expand its 
research efforts into these communities, which are often 
ignored in research projects but which continue to suffer from 
high incidences of mental health problems.
    Health disparities.--The Committee is encouraged by the 
NIMH's efforts to determine the causes for the disproportionate 
impact of mental disorders on racial and ethnic minority groups 
and to investigate methods of addressing and alleviating health 
disparities based on race and ethnicity. The Committee urges 
the NIMH to act on its strategic goals to achieve a more ethnic 
and racially diverse pool of mental health investigators 
through minority-focused training and career development 
mechanisms; to ensure inclusion of minority groups in clinical 
trials funded by the NIMH; to obtain an accurate measurement of 
the extent of mental health disparities across communities of 
color; and to use basic behavioral science to determine 
cultural differences in stress, coping and resilience.
    Major Depression and Bipolar Disorder.--More than 20 
million children and adults in the Nation are affected by major 
depression or bipolar disorder, and depression has been shown 
to be a leading cause of disability worldwide. Depression and 
bipolar disorders are also prominently associated with suicide. 
The Committee is aware that the NIMH has developed ``Breaking 
Ground, Breaking Through: The Strategic Plan for Mood Disorders 
Research'' in consultation with nationally recognized 
scientific experts, members of the National Advisory Mental 
Health Council, and representatives of consumer groups. This 
plan summarizes the current state of the science on major 
depression and bipolar disorder across the life span, provides 
a vision of achievable scientific goals, and recommends 
research priorities. It also addresses the causes, diagnosis, 
and improvement of interventions at the level of individual 
patients and service systems, as well as prevention. The 
Committee encourages the NIMH to continue its efforts to 
understand, treat, and prevent these illnesses.
    Native Hawaiians.--The Committee remains concerned that 
Native Hawaiians and other Native American Pacific Islanders 
continue to suffer disproportionately from mental health 
problems. The NIMH is encouraged to continue its efforts to 
address this area.
    Portfolio balance.--The Committee commends the NIMH for a 
balanced approach to research that includes basic neuroscience, 
behavioral science, health services research and clinical 
research. The Committee applauds, for example, the NIMH's 
leadership in working quickly to address urgent public health 
problems. NIMH research has shown that, for some individuals, 
exposure to violent or traumatic events can result in very 
significant mental health repercussions. Recent school violence 
and the events of September 11, 2001, have proven that this 
information is crucial and directly applicable. The Committee 
supports the NIMH's determination to speed the translation of 
research results into practical societal benefits, including 
improved mental health services for those who need them.
    Translating behavioral and social sciences research.--The 
Committee supports translational research in the behavioral and 
social sciences to address how basic behavioral processes 
inform the diagnosis, treatment, and delivery of services for 
patients, particularly for young people, with mental disorders. 
To further the translation of research knowledge into practice, 
the Committee encourages ongoing collaboration between the NIMH 
and the Substance Abuse and Mental Health Services 
Administration to reduce the current lag time between the 
discovery of an effective treatment or intervention and its 
availability at the community level. The Committee also 
promotes the establishment of translational behavioral research 
as a priority funding area for the NIMH.

                NATIONAL HUMAN GENOME RESEARCH INSTITUTE

Appropriations, 2002....................................    $429,312,000
Budget estimate, 2003...................................     465,137,000
Committee recommendation................................     468,037,000

    The Committee recommendation includes $468,037,000 for the 
National Human Genome Research Institute [NHGRI]. This is 
$2,900,000 more than the budget request and $38,725,000 more 
than the fiscal year 2002 appropriation. The comparable amounts 
for the budget estimate include funds to be transferred from 
the Office of AIDS Research.
    Mission.--The NHGRI coordinates extramural and intramural 
research as well as research training for the NIH component of 
the Human Genome Project, an effort to determine the location 
and sequence of the estimated 30,000 to 40,000 genes which 
constitute the human genome. The Division of Extramural 
Research supports research on genetic sequences of both human 
and non-human genomes, DNA sequencing technology development, 
database management and analysis, and studies of the ethical, 
legal, and social implications of human genome research. The 
Division of Intramural Research focuses on applying the tools 
and technologies of the Human Genome Project to understanding 
the genetic basis of disease and developing DNA-based 
diagnostics and gene-based therapies. Since its establishment, 
the intramural program has developed a strong research program 
in collaboration with several other NIH Institutes to study and 
better understand rare and complex genetic diseases such as 
diabetes, heart disease, breast cancer, colon cancer, and 
melanoma.
    The Committee notes that during fiscal year 2003, the field 
of genetics will observe a major anniversary, and the National 
Human Genome Research Institute (NHGRI) will reach an 
unprecedented accomplishment. Fifty years ago, in April of 
1953, Drs. James D. Watson and Francis Crick reported the 
discovery of the double helix structure of DNA, a landmark 
achievement in the annals of scientific research. In 2003 the 
Human Genome Project expects to complete the final DNA sequence 
of the human genome, in time for the 50th anniversary of the 
Watson-Crick paper. The Committee commends the NHGRI for 
completing the Human Genome Project both years ahead of 
schedule and under budget. While we have now entered the era in 
which science begins to unravel the great mystery of the human 
genome in order to understand the function of each of our 
genes, completely understanding that mystery will clearly take 
many more years of discovery.
    The Committee is pleased that even as it completes the 
sequence of the human genome, the NHGRI is planning for the 
future of genomic science and of the institute. The Committee 
encourages consultation with outside experts in such fields as 
genetics, genomics, medicine, biotechnology, the law, social 
policy and ethics as a way to prepare for the future. The 
development of a specific and bold new research plan for the 
NHGRI will certainly ensure continued scientific advances and 
greatly assist the Congress as it sets funding priorities in 
the coming years.
    Behavioral research.--Recent research has revealed that 
different genes can be turned on or turned off at different 
points in a person's life. Understanding what events or 
behaviors influence gene expression is an important frontier of 
scientific knowledge. The Committee encourages the NHGRI to 
develop collaborations with other Institutes and the Office of 
Behavioral and Social Sciences Research to support integrative 
research aimed at understanding the role of environmentally 
induced gene expression in the course of disease and in the 
promotion of health.
    Epilepsy.--The Committee encourages the Institute to 
continue to intensify its efforts to identify epilepsy genes 
for the more than 40 different types of epilepsy, and to assist 
the NINDS in the search for a genetic fingerprint diagnostic 
test aimed at improving drug therapy for epilepsy. The 
Committee further encourages the Institute to coordinate 
efforts with the NINDS to create a national consortium to 
identify new epilepsy susceptibility genes through a large-
scale genotype: phenotype screen. The Committee urges the 
Institute to continue to make epilepsy research a priority and 
to coordinate research efforts with other Institutes through 
the Interagency Epilepsy Coordinating Committee.
    Haplotype map.--The Committee supports the development of a 
``haplotype map'' of the human genome, if possible through a 
public-private partnership. This comprehensive resource for 
human biomedical research will capture the complete catalogue 
of the common genome ancestral segments (``haplotype blocks'') 
observed in human populations. This map will provide a new tool 
for scientists to scan the entire genome and identify more 
rapidly and effectively those genetic variations associated 
with disease risk and drug response in the human population. 
That, in turn, will help researchers develop an understanding 
of the complex biological processes that give rise to disease 
and assist scientists in discovering preventive measures, 
treatments and cures for these illnesses. The haplotype map and 
similar tools will help genomic science bridge the gap from 
basic science to applications for human health.
    Non-human genomes.--The Committee endorses the rigorous 
scientific process that the NHGRI has developed for selection 
of non-human genomes to sequence using NHGRI-supported 
sequencing capacity. This peer review process, whereby 
investigator- or community-initiated proposals are submitted 
for consideration by the NHGRI, ensures that organisms for 
genomic sequencing will be selected on the basis of specific, 
well-defined scientific goals, taking advantage of the rigor, 
robustness and fairness provided by scientific discussion and 
peer evaluation.
    The Committee is pleased that the NHGRI has indicated its 
interest in sequencing the cow and chicken genomes. The 
Committee encourages the Institute's efforts to expand genome 
sequencing to other mammalian and avian genomes, and to ensure 
that sequence information of these species is made publicly 
available to all without restriction.
    Privacy.--The Committee remains concerned about the proper 
use of genetic information and encourages the NHGRI's ongoing 
efforts, though its ELSI program, to examine the privacy and 
fair use of genetic information. Other important issues related 
to human genetics research and its consequences should also be 
studied, including: the appropriate use of genetic tests; the 
protection of human subjects who participate in genetic 
research; the development of policies to guide research into 
genetic variation; and complex social issues, such as how 
genetics informs concepts of race and ethnicity.
    Type 1 Diabetes Genetics Consortium.--The Committee is 
aware of the development of a Type 1 Diabetes Genetics 
Consortium, which will collect and share valuable DNA 
information from juvenile diabetes patients from studies around 
the world. The Committee encourages the NHGRI to collaborate 
with the NIDDK in efforts to determine the genetic origins of 
juvenile diabetes by directing resources towards this important 
initiative.

      NATIONAL INSTITUTE OF BIOMEDICAL IMAGING AND BIOENGINEERING

Appropriations, 2002....................................    $261,951,000
Budget estimate, 2003...................................     271,200,000
Committee recommendation................................     283,100,000

    The Committee recommends an appropriation of $283,100,000 
for the National Institute of Biomedical Imaging and 
Bioengineering [NIBIB]. This is $11,900,000 more than the 
budget request and $21,149,000 more than the fiscal year 2002 
appropriation. The comparable amounts for the budget estimate 
include funds to be transferred from the Office of AIDS 
Research.
    Mission.--The NIBIB improves health by promoting 
fundamental discoveries, design and development, and 
translation and assessment of technological capabilities in 
biomedical imaging and bioengineering, enabled by relevant 
areas of information science, physics, chemistry, mathematics, 
materials science, and computer sciences. The Institute plans, 
conducts, fosters, and supports an integrated and coordinated 
program of research and research training that can be applied 
to a broad spectrum of biological processes, disorders and 
diseases and across organ systems. The Institute coordinates 
with the biomedical imaging and bioengineering programs of 
other agencies and NIH Institutes to support imaging and 
engineering research with potential medical applications and 
facilitates the transfer of such technologies to medical 
applications.
    The Committee recognizes the contribution bioengineering 
brings to medicine. Bioengineering improves the quality of life 
through its contribution to advances in science and technology 
related to health. The Committee understands that this newly 
created Institute must have adequate resources to begin its 
important task of supporting high-quality research.
    Juvenile diabetes.--The Committee is aware that imaging and 
bioengineering technologies could have widespread applications 
for the treatment and prevention of diseases and conditions 
such as juvenile diabetes. The Committee encourages the NIBIB 
to collaborate with the NIDDK on the development and 
application of imaging technologies to evaluate and track the 
progress of biologic events non-invasively, specifically the 
investigation and monitoring of beta cell destruction during 
the onset of juvenile diabetes and indications of graft 
rejection following the transplantation of whole organs, 
tissue, or cells. The Committee also encourages the Institute 
to collaborate with the NIDDK to develop non-invasive metabolic 
sensor technologies for the monitoring of glucose and 
metabolism in individuals with juvenile diabetes.
    Molecular imaging technologies.--The Committee encourages 
the Institute to provide increased funding for molecular 
imaging technologies such as positron emission tomography (PET) 
and microPET to take advantage of the capacities of molecular 
imaging to detect disease process at the molecular level and to 
monitor the effectiveness of targeted gene therapies now under 
development. The Committee also encourages the Institute to 
develop its research agenda in close collaboration with other, 
disease-specific Institutes at NIH, so that new imaging 
technologies are closely tied to the research projects being 
supported by the NIH.
    Temporomandibular joint disorders (TMJ).--The Committee is 
mindful of the dismal history of failures in the case of 
plastic and other materials used in implants to replace parts 
of the temporomandibular joint. The Committee urges the 
Institute to make studies of the TM joint and related 
structures a high priority.

                 NATIONAL CENTER FOR RESEARCH RESOURCES

Appropriations, 2002....................................    $986,505,000
Budget estimate, 2003...................................   1,065,272,000
Committee recommendation................................   1,161,272,000

    The Committee recommends an appropriation of $1,161,272,000 
for the National Center for Research Resources [NCRR]. This is 
$96,000,000 more than the budget request and $174,767,000 more 
than the fiscal year 2002 appropriation. The comparable amounts 
for the budget estimate include funds to be transferred from 
the Office of AIDS Research.
    Mission.--The NCRR develops and supports critical research 
technologies and shared resources that underpin research to 
maintain and improve the health of our Nation. The NCRR 
programs develop a variety of research resources; provide 
biomaterial and resources for complex biotechnologies, clinical 
research, and specialized primate research; develop research 
capacity in minority institutions; and enhance the science 
education of pre-college students and the general public.
    Extramural construction.--The Committee has included bill 
language identifying $125,000,000 for extramural biomedical 
facility renovation and construction. This is an increase of 
$15,000,000 over the fiscal year 2002 appropriation and 
$48,000,000 over the budget request. These funds are to be 
awarded competitively, consistent with the requirements of 
section 481A of the Public Health Service Act, which allocates 
25 percent of the total funding to institutions of emerging 
excellence.
    Federal loan guarantee program.--The Committee understands 
that the Administration has been considering a program that 
would guarantee loans for construction of research facilities 
at institutions conducting NIH-supported biomedical research. 
The Committee is very interested in a Federal loan guarantee 
program, which has the potential to address the huge 
requirement for new and upgraded research facilities that has 
been generated by the doubling of the NIH budget. The Committee 
requests a report, to be submitted by June 1, 2003, describing 
how such a program would work, the potential benefits and costs 
both to the Federal Government and to the institution, and how 
a loan guarantee program would be integrated with the current 
grant program.
    General Clinical Research Centers.--In fiscal year 2002, 
the NCRR supported more than 80 General Clinical Research 
Centers (GCRCs) to provide people across the country with local 
access to clinical research programs focused on a wide range of 
diseases and disorders. GCRCs are also directly involved in 
translating basic science discoveries to improvements in 
patient care. For fiscal year 2003, the Committee has provided 
$312,000,000, an increase of $40,000,000 over the fiscal year 
2002 level, for the GCRC program as authorized by Section 481C 
of the Public Health Service Act. The Committee intends that 
this increase should be used to provide the resources necessary 
to upgrade GCRC facilities with the sophisticated technologies 
needed to apply the mapping of the human genome to the study of 
human disease and respond to the threat of bioterrorism; expand 
clinical research training efforts, including the recently 
announced Mentored Clinical Research Scholar Program Award; 
expand staffing as recently mandated by NCRR to assure patient 
safety and maximum compliance with new regulatory requirements; 
and support local GCRC pilot projects as approved by the NCRR 
Advisory Council.
    Health disparities research.--The Committee commends the 
NCRR for its proposal to establish comprehensive centers for 
health disparities research and looks forward to learning more 
about this important new initiative.
    IDeA grants.--The Committee has provided $220,000,000 for 
the Institutional Development Award (IDeA) Program authorized 
by section 402(g) of the Public Health Service Act. This is a 
$60,000,000 increase over fiscal year 2002. Within the total 
provided, $90,000,000 is for the Biomedical Research 
Infrastructure Network (BRIN) initiative and $130,000,000 is 
for the Centers of Biomedical Research Excellence (COBRE) 
initiative.
    The Committee strongly supports the IDeA program, and urges 
the NCRR to further expand these initiatives. The Committee 
understands that the NCRR intends to review and evaluate the 
BRIN mechanism this year, and awaits the results of this 
critical evaluation. The focus of IDeA should continue to be 
improving the necessary infrastructure at research institutions 
within the IDeA States, so that they may develop a critical 
mass of competitive biomedical researchers that will enhance 
our nation's overall biological research capacity.
    Institutional animal resources.--The Committee commends the 
NCRR for its support of recent efforts to upgrade animal 
research facilities at minority health professions schools 
including the recent competitive supplement to Research Centers 
in Minority Institutions (RCMI) for developing and improving 
institutional animal resources. The Committee encourages the 
NCRR to continue to work in partnership with the National 
Center on Minority Health and Health Disparities to support 
this initiative.
    National Primate Research Centers.--The Committee values 
the critical role played by the eight National Primate Research 
Centers (NPRCs). These centers conduct specialized basic and 
applied biomedical research and offer essential and valuable 
services to other researchers across the United States. The 
Committee urges the NCRR to engage with the NPRCs in an 
assessment process to identify NPRC and NPRC-user needs, and to 
provide the Committee with a summary of the findings.
    Plant-based medicinal products.--The Committee remains 
interested in efforts to develop plant-based medicinal 
products, and it encourages the NCRR to collaborate with plant 
scientists, particularly in rural America, in developing novel 
useful products.
    Positron emission tomography.--The Committee continues to 
urge the NCRR to support research resource centers for the 
development and refinement of positron emission tomography 
(PET) as a unique imaging technology to diagnose and stage 
diseases of the brain, including Alzheimer's disease.
    Research Centers in Minority Institutions.--The Committee 
continues to recognize the critical role played by minority 
institutions at both the graduate and undergraduate level in 
addressing the health research and training needs of minority 
populations. These programs help facilitate the preparation of 
a new generation of scientists at these institutions. The 
Committee urges the NCRR to contitute to support the Research 
Centers in Minority Institutions program.

   NATIONAL CENTER FOR COMPLEMENTARY AND ALTERNATIVE MEDICINE [CCAM]

Appropriations, 2002....................................    $104,592,000
Budget estimate, 2003...................................     113,249,000
Committee recommendation................................     114,149,000

    The Committee has included $114,149,000 for the National 
Center for Complementary and Alternative Medicine, an increase 
of $900,000 above the budget request and $9,557,000 over the 
fiscal year 2002 appropriation. The comparable amounts for the 
budget estimate include funds to be transferred from the Office 
of AIDS Research.
    The Committee strongly supports the work of the National 
Center for Complementary and Alternative Medicine. The Center 
is charged with ensuring that complementary and alternative 
therapies be rigorously reviewed to provide consumers with 
reliable information.
    The Committee expects that funding for existing and new 
Centers supported by NCCAM will be maintained and directs the 
Center to undertake field investigations and a program for the 
collection and evaluation of outcome data on promising 
alternative therapies. The Committee expects NCCAM to expand 
its support of CDC's field investigations program and of AHRQ 
literature reviews and data-analysis efforts. The Committee 
also expects the Center to allocate sufficient funds to develop 
and disseminate a comprehensive set of fact sheets on CAM 
therapies to inform the public and health professionals of the 
state of scientific knowledge about these therapies.
    The Committee has included sufficient funds for NCCAM to 
increase support for the chiropractic research center.

       NATIONAL CENTER ON MINORITY HEALTH AND HEALTH DISPARITIES

Appropriations, 2002....................................    $157,742,000
Budget estimate, 2003...................................     186,929,000
Committee recommendation................................     186,929,000

    The Committee has included $186,929,000 for the National 
Center on Minority Health and Health Disparities, the same as 
the budget request and $29,187,000 over the fiscal year 2002 
appropriation. The comparable amounts for the budget estimate 
include funds to be transferred from the Office of AIDS 
Research.
    Mission.--The NCMHD advises the NIH Director and Institute 
and Center (IC) directors on the development of NIH-wide policy 
issues related to minority health disparities research, 
research on other health disparities, and related research 
training. Among other activities, the NCMHD develops, in 
consultation with the NIH Director, IC directors, and the 
advisory council, a comprehensive strategic plan that 
identifies and establishes objectives, priorities, budgets, and 
policy statements governing the conduct and support of all NIH 
minority health disparities research, research on other health 
disparities, and related research training activities. It also 
administers funds for the support of minority health 
disparities research and other health disparities research, by 
awarding grants and leveraging the programs of the ICs.
    The Committee is encouraged by the opportunities that exist 
for the NCMHD to help further advances in improving the health 
of minorities and eliminating health disparities through the 
expanded conduct and support of research, research training, 
community outreach, and accelerated dissemination of research 
findings in cancer, heart disease, asthma, stroke, sickle cell 
disease, obesity, diabetes, substance abuse, mental health, 
infant mortality, HIV/AIDS, and chronic pulmonary diseases. 
Considerable opportunities are at hand for improving clinical 
outcomes in the short- and long-term. The NCMHD is encouraged 
to capitalize on opportunities provided by recent advances in 
biomedical, clinical and behavioral research by strengthening 
its focus on efforts to unravel the genomic analysis of 
diseases that disproportionately affect minorities including 
the ethical, legal and social implications of this research; 
applying advanced knowledge from prevention, behavioral, 
translational, clinical and basic research to developing and 
implementing effective innovative approaches that address 
obesity and diabetes across communities of color; ensuring the 
integration of advances in health care, practice, and self-
management in clinicians' guides and health care delivery; 
applying knowledge that has been learned with respect to stress 
and diet response mechanisms, and environmental risk factors 
for cancer, heart disease, asthma and stroke; applying advances 
stemming from unraveling the physiology and genetics of 
diabetes; furthering implementation of recommendations stemming 
from the various IOM studies on improving minority health; 
developing innovative strategies for improving the health 
status and health outcomes of minority adolescents, young 
adults and elderly; furthering the understanding of the dietary 
link in arthritic diseases; strengthening and expanding the 
involvement and participation of minority organizations 
including minority community-based organizations in research, 
outreach, awareness and prevention activities.
    Glomerular injury.--The Committee understands that 
glomerular injury, a group of diseases which effect the 
filtering mechanisms of the kidney, are more prevalent among 
African Americans than the general population. The Committee 
urges the NCMHD to explore collaboration with the NIDDK to 
conduct and support research activities related to glomerular 
injury.
    Lung diseases.--The Committee is concerned with the 
disproportionate impact of lung diseases affecting minorities. 
The Committee encourages the Center to partner with other 
agencies to develop an epidemiologic approach to determine the 
disproportionate impact of airway disease on minority 
populations.
    Strategic plan.--The Committee commends the NCMHD for its 
leadership in addressing the longstanding problem of health 
status disparities in minority populations. The Committee looks 
forward to reviewing the strategic plan for health disparities 
research currently being developed by the NCMHD. The Committee 
continues to encourage the NCMHD to implement its successful 
research endowment program as an ongoing initiative, and to 
establish the centers of excellence program. Finally, the 
Committee encourages the Director of the NCMHD to coordinate 
with the NIH Director and the NCRR in support of extramural 
facility construction and the development of other research 
infrastructure at minority health professions schools.

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

Appropriations, 2002....................................     $56,918,000
Budget estimate, 2003...................................      63,380,000
Committee recommendation................................      60,880,000

    The Committee recommends an appropriation of $60,880,000 
for the Fogarty International Center [FIC]. This is $2,500,000 
less than the budget request and $3,962,000 more than the 
fiscal year 2002 appropriation. The comparable amounts for the 
budget estimate include funds to be transferred from the Office 
of AIDS Research.
    Mission.--Adapting research advances in biomedicine to 
populations at home and abroad requires a continuing commitment 
to basic science as well as rigorous clinical and applied 
(epidemiological) studies. Examples are vaccines, anti-
infective agents, drugs, and more efficient diagnostic tools, 
combinations of interventions, and health policies to reduce 
the risk of disease and its associated human, social and 
economic consequences. These challenges will benefit from a 
more coordinated and multi-disciplinary approach to global 
health needs. It is the mission of the FIC to address these 
challenges by forging collaborations with a range of domestic 
and global partners in international research and training to 
pursue three core objectives: first, to accelerate the pace of 
discovery and its application by special projects enabling 
scientists worldwide to share conceptual insights, analytic 
methods, data sets, patient cohorts, or special environments; 
second, to engage and assist young as well as more established 
U.S. investigators to address scientific challenges related to 
global health; and third, to help develop a cadre of highly 
capable young foreign investigators positioned to cooperate 
with U.S. scientists in areas of the world that, due to 
geography, genetics, or disease burdens, provide unique 
opportunities to understand disease pathogenesis, anticipate 
disease trends, or develop interventions of relevance and 
priority for both the United States and the collaborating 
country.
    Chronic obstructive pulmonary disease.--The Committee notes 
that chronic obstructive pulmonary disease (COPD) is the 
fourth-leading cause of death worldwide, and it encourages the 
FIC to expand its COPD research and training activities.
    Tuberculosis.--The Committee recognizes the growing value 
of international research and surveillance programs with 
respect to infectious diseases such as tuberculosis (TB). The 
Committee is pleased by the Center's research collaboration 
with international organizations and governments on multi-drug-
resistant TB, and it encourages the Center to continue these 
important studies. The Committee is aware that the FIC offers 
TB supplemental training grants to recipients of AIDS 
International Training and Research Program (AITRP) or 
International Training and Research Program in Emerging 
Infectious Diseases (ERID) grants. The Committee encourages the 
FIC to develop a specific, freestanding TB training program.

                      NATIONAL LIBRARY OF MEDICINE

Appropriations, 2002....................................    $277,273,000
Budget estimate, 2003...................................     310,299,000
Committee recommendation................................     310,299,000

    The Committee recommends an appropriation of $310,299,000 
for the National Library of Medicine [NLM]. This is equal to 
the budget request and $33,026,000 more than the fiscal year 
2002 appropriation. Included is $4,000,000 for improvement of 
information systems. The comparable amounts for the budget 
estimate include funds to be transferred from the Office of 
AIDS Research.
    Mission.--The National Library of Medicine is the Federal 
institution that for more than 150 years has collected, 
organized, preserved, and disseminated the world's output of 
biomedical literature in all forms. As a result of this 
activity NLM is the world's largest library of the health 
sciences, its holdings numbering more than 5 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.
    Home medical consultations.--The Committee continues to 
support demonstration projects to test the use of state-of-the-
art telemedicine technology for home medical consultations. 
This innovative approach holds great promise for improving the 
care and lowering health care costs for home-bound individuals 
who require frequent monitoring.
    Internet connection grant program.--The Committee continues 
to be concerned about limitations on access to health 
information in rural and other medically underserved areas. It 
supports the NLM's efforts to address this issue through the 
Library's Internet Connection Grant program, which partners 
with regional libraries to provide hardware, set-up, training 
and access to the Internet at locations in medically 
underserved areas.
    Minority health professions.--The Committee encourages the 
NLM to strengthen information technology infrastructure at 
minority health professions schools that focus their research 
activities on health disparities and the education of health 
professionals who serve in medically underserved communities.
    New facility.--Many of the most serious diseases have a 
molecular basis. The NLM's National Center for Biotechnology 
Information is an integral player in this research process, for 
it organizes and analyzes the vast volume of genomic 
information uncovered in the last decade. The Congress believes 
that if this Center is to make its maximum contribution to our 
fight against disease, it must very soon have expanded 
facilities to meet the growing demands being placed on it. The 
Committee provided funds necessary for the design of such 
facilities, and it desires that such design, when completed, be 
rapidly moved into the construction phase. The Committee, 
therefore, requests a report from the NIH by April 1, 2003, 
that delineates the features of this new facility, its size and 
its expected cost, based upon a fast-track schedule.
    Outreach.--The Committee continues to note the success of 
the NLM's MEDLINE and MEDLINEplus databases. The Committee 
encourages NLM to continue its outreach activities aimed at 
educating health care professionals and the general public 
about the Library's products and services, in coordination with 
medical librarians and other health information specialists.
    Public mandate.--The NLM has legislatively mandated 
outreach activities to publicize its information services to 
health professionals and the public. Because the Library has 
developed an extensive set of authoritative and easily 
accessible (electronic and print) health information services 
for the public, the Committee encourages the NLM to continue 
these efforts and also to target specifically certain 
underserved parts of the U.S. population, particularly ethnic 
minorities, the elderly, non-English-speaking individuals, and 
Americans living in rural areas.
    PubMed Central.--The Committee commends the NLM for its 
continued management and development of PubMed Central, an 
electronic online repository for life science articles.
    Senior citizen outreach.--The Committee continues to 
support the NLM's efforts to provide senior citizens with 
expanded access to NLM's databases, through such means as 
including Internet access at senior centers and congregate meal 
sites.

                         OFFICE OF THE DIRECTOR

Appropriations, 2002....................................    $235,400,000
Budget estimate, 2003...................................     255,074,000
Committee recommendation................................     257,974,000

    The Committee recommends an appropriation of $257,974,000 
for the Office of the Director [OD]. This is $2,900,000 more 
than the budget request and $22,574,000 more than the fiscal 
year 2002 appropriation. The comparable amounts for the budget 
estimate include funds to be transferred from the Office of 
AIDS Research.
    Mission.--The Office of the Director provides leadership 
and direction to the NIH research community, and coordinates 
and directs initiatives which crosscut the NIH. The Office of 
the Director is responsible for the development and management 
of intramural and extramural research and research training 
policy, the review of program quality and effectiveness, the 
coordination of selected NIH-wide program activities, and the 
administration of centralized support activities essential to 
operation of the NIH.
    The Committee directs the Director of NIH to make a written 
request to the chairman of the Committee prior to any 
reprogramming of $1,000,000 or more, between programs, 
projects, activities, institutes, divisions and centers. The 
Committee desires to have the requests for reprogramming 
actions which involve less than the above-mentioned amounts if 
such actions would have the effect of changing funding 
requirements in future years, if programs or projects 
specifically cited in the Committee's reports are affected, or 
if the action can be considered to be the initiation of a new 
program.
    Alpha-1 antitrypsin deficiency.--Alpha-1 antitrypsin 
deficiency, a genetic disorder often misdiagnosed as asthma or 
chronic obstructive pulmonary disease (COPD), is a major cause 
of lung transplants in adults and liver transplants in 
children. The Committee encourages the NIH to enhance its 
clinical research portfolio for alpha-1 and to consider 
conducting a state-of-the-science conference on the disorder. 
The NIH is also encouraged to raise public awareness about 
alpha-1 and provide appropriate information to health 
professionals.
    Autoimmune diseases.--The Committee awaits the imminent 
release of the NIH's Autoimmune Diseases Research Plan, which 
was requested in the Children's Health Act of 2000. More than 
80 autoimmune diseases affect up to 22 million Americans, 
mostly women. The Committee believes that the planned research 
has the potential to generate improved prevention measures, 
diagnostic tools, and treatment regimens, resulting in reduced 
treatment costs and a significant alleviation of human 
suffering.
    Chronic fatigue syndrome.--The Committee is pleased that 
the NIH released its long-awaited CFS program announcement in 
December 2001, and it hopes that this initiative will reverse 7 
years of declining CFS funding at NIH. To foster response to 
this program announcement, the Committee urges the NIH to put a 
priority on efforts to understand the cause and progression of 
CFS, identify diagnostic markers, and better understand 
pediatric CFS.
    Clinical research.--Research supported by the National 
Institutes of Health has produced a wealth of knowledge about 
the fundamentals of human health and disease. But the 
accumulation of fundamental knowledge for its own sake is of 
little value unless it finds its way into hospitals and 
physicians, where it can be put to use in promoting good health 
or diagnosing, preventing and treating disease. Whether the 
dividends from basic research are fully realized will depend on 
the extent to which the clinical research enterprise is 
encouraged and nurtured, including health services and 
epidemiological studies. To that end, the Committee encourages 
the NIH Director to re-institute the advisory panel on clinical 
research and to consider creating an office of clinical 
research to oversee and coordinate activities across the NIH. 
In addition, the Committee strongly urges the NIH to accelerate 
its ongoing clinical research training program. The Committee 
requests a report by April 1, 2003, outlining the status of 
clinical research activities currently underway as well as 
plans for the future.
    Clinical research loan repayment.--In 2000, the Congress 
authorized a loan repayment program for clinical researchers as 
part of the Clinical Research Enhancement Act. The Committee is 
pleased that the NIH initiated the program last year, but was 
concerned that NIH established an initial policy that excluded 
clinical investigators who did not have NIH funding. The 
Committee understands that NIH plans to change this policy in 
the second year of the program, and it urges the NIH to include 
as eligible applicants students and trainees enrolled in peer-
reviewed clinical research training programs supported by the 
NIH or private sources. The Committee requests data on the 
number of applications submitted as well as the number and size 
of awards made as of April 1, 2003. The Committee also requests 
demographic information on the applicants and recipients of the 
awards, including the status of their career development.
    Department of Defense transfers.--The Committee has not 
approved the transfer of $49,000,000 requested in the budget to 
fund Department of Defense medical free electronic laser 
research, HIV clinical trial research and radiation exposure 
research. The Committee recommends that funding for defense-
related science and technology initiatives should be handled by 
the Defense Department.
    Distribution of resources.--Following the Institute of 
Medicine (IOM) study of the organization of the NIH, the 
Committee encourages NIH to contract with IOM to study the 
distribution of research resources across the agency's 
Institutes and Centers. An objective analysis may help inform 
the committee on the wisest distribution of new funds as they 
become available.
    Epilepsy.--The Committee recognizes that while the NINDS is 
the primary Institute for addressing epilepsy, several other 
Institutes are also involved in related research. As 75 percent 
of epilepsy cases begin in childhood, the NICHD has an 
important role to play in studying this disease. So, too, does 
the NHGRI, which is urged to assist the NINDS in the search for 
a genetic fingerprint diagnostic test aimed at improving drug 
therapy for epilepsy. The NIMH is encouraged to explore a 
potential link between epilepsy and mood disorders, both of 
which are often treated with anti-convulsant medications. 
Finally, the NIA is encouraged to examine epilepsy in patients 
over age 65. The Committee urges the Director to continue an 
Interagency Epilepsy Coordinating Committee that includes 
agency scientists and industry and patient representatives. It 
requests the Director to provide a report to Congress by April 
1, 2003, on the progress made in the coordination of research 
efforts in epilepsy among these Institutes, and on the progress 
made to implement the NINDS research benchmarks resulting from 
the March 2000 conference ``Curing Epilepsy: Focus on the 
Future.''
    Fibromyalgia.--Fibromyalgia is a chronic disorder 
characterized by widespread musculoskeletal pain, fatigue, 
multiple tender points, and other debilitating symptoms. 
Because the symptoms manifest themselves most notably in the 
muscles, NIH research in fibromyalgia has been concentrated in 
the NIAMS. While the Committee commends the NIAMS for its 
interest in this condition, research increasingly indicates 
that fibromyalgia is not primarily a disease of the muscles, 
but rather a condition caused by malfunctions in the brain and 
central nervous system. Therefore, the Committee strongly urges 
the NIAMS and the NINDS to work together in addressing the 
challenge of fibromyalgia, and to expand their research into 
this disorder. In addition, the Committee notes that there are 
no FDA-approved drugs for fibromyalgia. While the NIAMS 
Strategic Plan for 2000-2004 specifically cites the need for 
NIAMS-supported investigators to test the efficacy of new drugs 
and biologicals for arthritis and related diseases, the 
Institute has announced no plans to include fibromyalgia in 
that effort. The Committee urges the NIAMS to do so.
    Graduate Training in Clinical Investigation Awards.--The 
Committee understands that the translation of basic research to 
general medical practice is slowed by a shortage of well-
trained clinical investigators. The Committee is concerned that 
the NIH has not moved forward with implementation of the 
Graduate Training in Clinical Investigation Awards authorized 
by the Clinical Research Enhancement Act, which was intended to 
address this shortage. While the Committee is pleased that the 
NIH has initiated the Clinical Research Curriculum Awards to 
improve the quality of training in clinical research, a 
shortcoming of this program is the absence of support for 
tuition and stipends for the individual students. The Committee 
believes that the Graduate Training in Clinical Investigation 
Awards may be necessary to replenish the supply of well-trained 
clinical investigators.
    Human tissue supply.--The Committee continues to be very 
interested in supporting the needs of researchers, particularly 
NIH grantees, as well as intramural and university-based 
researchers, who rely upon human tissues and organs to study 
human diseases and to search for cures. The Committee is aware 
that one of the leaders in this competitive field, the National 
Disease Research Interchange (NDRI), is positioned to serve 
such researchers who find it difficult to obtain these valuable 
and effective research resources. More than 500 peer-reviewed 
research advances have been published by the NDRI-supported 
researchers during the past 4 years, documenting the NDRI's 
contribution to our fund of knowledge. The Committee is greatly 
encouraged by these research advances and applauds the 
Director's expanded support for the NDRI by bringing the NEI, 
NIDDK, NIAID, NIAMS, and the Office of Rare Diseases into the 
multi-institute initiative. While this is promising, more needs 
to be done to match the expanding and unmet demand for the use 
of human tissue in research. The Committee, therefore, suggests 
that the Director advise the Director of the NCRR to consider 
an increase of its core support for NDRI, and to continue to 
encourage the Institute Directors NIH-wide to identify and 
implement program-specific initiatives that utilize NDRI 
resources.
    Laboratory Animals.--The Committee is concerned about 
allegations that several institutions receiving NIH funding may 
not be in full compliance with the Public Health Service policy 
on humane Care and Use of Laboratory Animals. The Committee 
encourages NIH to determine the extent and scope of any such 
allegations and notify the Committee of its findings.
    Lymphatic diseases and lymphedema.--The Committee commends 
the NIH for co-sponsoring The Lymphatic Continuum conference in 
May 2002 and for establishing a trans-NIH coordinating 
committee to focus on the lymphatic system, with particular 
emphasis on lymphedema and related lymphatic disorders. Since 
basic and translational research for lymphatic research and 
diseases of the lymphatic system crosses most Institutes and 
Centers, broad committee representation is strongly encouraged. 
Research and medical care for lymphatic diseases has long been 
neglected; therefore, the Committee strongly urges the NIH to 
stimulate and support intramural and extramural programs for 
basic and translational research relating to lymphatic 
diseases, including but not limited to: insufficiency of 
lymphatic circulatory function (to include all forms of 
lymphedema, both primary and secondary); lymphatic vascular 
valvular insufficiencies; complex congenital vascular 
proliferative diseases of the lymphatic vasculature, including 
but not limited to, so-called lymphangioma, cystic hygroma, 
lymphangiosarcoma, lymphangioleio-myomatosis; and developmental 
disorders of the lymphatic system, including but not limited to 
lymphangiectasia, chylous reflux and complex vascular 
malformations, such as Klippel-Trenauny Syndrome.
    The Committee requests the Director to provide a report by 
April 1, 2003, outlining both short- and long-term plans to 
stimulate and support basic and translational research for 
lymphatic diseases. Furthermore, the Committee urges the NIH to 
examine whether experts on lymphatic research are adequately 
represented on CSR peer review panels and relevant Institute 
study sections.
    Microbicides.--There is an urgent need to expand the range 
of preventive interventions for HIV transmission. Microbicides, 
which are antimicrobial products that can be applied topically 
for the prevention of sexually transmitted diseases, may offer 
one of the most promising approaches to preventing HIV. The 
Committee commends the NIH for increasing the funds available 
for microbicide research and development, and it supports 
additional increases in funding for this area through OAR, 
NIAID, NICHD, NIMH, NIDA, and ORWH. The Committee remains 
concerned, however, that microbicide research at the NIH is 
currently conducted with no single line of administrative 
accountability or specific funding coordination. The Committee 
also notes that the Centers for Disease Control and the U.S. 
Agency for International Development have recently expanded 
their microbicide portfolios, which means that without overall 
Federal coordination, costly inefficiencies may result. 
Therefore, the Committee urges the NIH both to continue 
implementation of its strategic plan for microbicide research 
and development, and to accelerate and strengthen efforts to 
coordinate research among Institutes and with other Federal 
agencies. The Committee requests a report by March 31, 2003, on 
the status of its microbicide program, including research 
efforts, funding, and implementation of the strategic plan.
    Minority health professions infrastructure.--The Committee 
continues to be pleased with the NIH Director's implementation 
of various programs focused on developing research 
infrastructure at minority health professions institutions, 
including Research Centers at Minority Institutions, Extramural 
Biomedical Research Facilities, and the National Center for 
Minority Health and Health Disparities. Because there are a 
number of new competitive mechanisms for the NIH to work with 
these research institutions, the Committee recommends that the 
NIH Director work closely with the Director of the National 
Center on Minority Health and Health Disparities to coordinate 
these various mechanisms.
    National Institutes of Health/Department of Energy Medical 
Technology Partnership.--The Committee expects the NIH to 
continue to collaborate with the Department of Energy (DOE) to 
evaluate the technologies developed within the nuclear weapons 
program and other DOE programs in terms of their potential to 
enhance health sciences, with the goal of achieving clinical 
applications and improved national health care.
    Neurofibromatosis (NF).--The Committee has included 
specific report language on NF under the NCI and NINDS, but it 
recognizes that NF research involves many other Institutes and 
Centers as well, including the NHLBI, NEI, NIDCD, NICHD, and 
NIAMS. The Committee urges the Director to identify new 
research opportunities regarding NF that cuts across all these 
Institutes and Centers.
    Office of Behavioral and Social Sciences Research.--The 
Committee encourages the OBSSR to foster the NIH's behavioral 
research portfolio by planning and sponsoring interdisciplinary 
initiatives that further the public health missions of multiple 
Institutes and Centers. In particular, the OBSSR's efforts to 
encourage research on new methodologies in the behavioral and 
social sciences are appreciated. The Office is urged to follow 
up on its conferences on sociocultural research and health 
disparities by developing initiatives with the National Center 
for Minority Health and Health Disparities and the NIH 
Institutes and Centers. The Committee encourages the OBSSR to 
push forward on planned initiatives to increase scientific 
understanding of the elements of education and the workplace 
that most affect health, and to follow up on its successful 
program of grants on behavior change by focusing on the 
challenge of maintaining behavior change.
    Office of Dietary Supplements.--The use of dietary 
supplements has increased significantly among Americans who 
want to improve their health and prevent disease, and there is 
a great need for additional research to better inform consumers 
of the benefits of these supplements. The Committee expects the 
ODS to allocate sufficient funds to continue an initiative--
begun at the Committee's urging in last year's bill--to speed 
up ongoing collaborative efforts to develop, validate, and 
disseminate analytical methods and reference materials for the 
most commonly used botanicals and other dietary supplements.
    The Committee is pleased that the ODS has followed through 
on its recommendation to begin a major research initiative on 
the safety and efficacy of products containing ephedra, and it 
urges the Office to assure that the work is reviewed in an 
unbiased manner before it is finalized. The results of this 
research should be evaluated by the FDA to assure that any 
regulatory action taken on products containing ephedrine 
alkaloids is based on sound science.
    The Committee is also pleased that the ODS has begun an 
evidence-based review of the research concerning the health 
benefits of omega-3 fatty acids. Given the significant human 
and financial costs associated with heart disease, the 
Committee expects the Office to provide sufficient funds to 
promptly complete this initial review and provide 
recommendations for further major clinical trials.
    Office of Research on Women's Health.--The Office of 
Research on Women's Health (ORWH) works in collaboration with 
the Institutes and Centers (ICs) of the NIH to promote and 
foster efforts to address gaps in knowledge related to women's 
health through the enhancement and expansion of funded research 
and the initiation of new investigative studies. The ORWH is 
responsible for ensuring the inclusion of women in clinical 
research funded by the NIH, including the development and 
implementation of a computerized tracking system and the 
implementation of guidelines on such inclusion. The Office is 
also involved in promoting programs to increase the number of 
women in biomedical science careers, and in developing women's 
health and sex and gender factors in biology as a focus of 
medical/scientific research.
    The Committee recognizes the critical role played by the 
specialized centers of research on sex and gender factors 
affecting women's health, and it encourages the Office to 
continue programmatic initiatives to further this work. The 
Committee also continues to support the Building 
Interdisciplinary Research Careers in Women's Health programs.
    Parkinson's disease.--The Committee is aware that the 
Parkinson's Disease Research Agenda developed by the NIH in 
2000 included professional judgment funding projections that 
totaled an additional $1,000,000,000 over 5 years. It is the 
clear intent of the Committee that the NIH, which has received 
substantial funding increases in recent years, come as close as 
possible to fulfilling that Agenda while maintaining the 
standards of peer review.
    The Committee was extremely disappointed, therefore, to 
learn that during fiscal years 2001 and 2002--the first 2 years 
of the Parkinson's Disease Research Agenda--NIH funding 
increases for Parkinson's failed to keep pace with funding 
increases for NIH overall. In addition, the NIH's projected 
Parkinson's budget for fiscal year 2003 falls $138,200,000 
short of the $353,300,000 professional judgment budget estimate 
cited by the Agenda for that year. As a consequence, the NIH 
would fall even further behind on implementing the Agenda, and 
this highly promising field of research would not move ahead as 
speedily as the Congress intended.
    The Committee strongly urges the NIH to devote additional 
resources to Parkinson's research using all available 
mechanisms, including RFAs and further support of NIEHS 
initiatives.
    The Committee expects the NIH to report to Congress by 
April 1, 2003, on the steps it is taking to fulfill the 
Parkinson's Disease Research Agenda.
    Pediatric drug studies.--The Committee is aware that many 
generic drugs have not been studied for use in pediatric 
patients. Therefore, the Committee encourages the NIH to take 
actions necessary to fully implement the new section 409I of 
the Public Health Service Act to study the safety and efficacy 
of off-patent/off-exclusivity drugs in pediatric patients. The 
Committee requests a report by February 1, 2004, which includes 
information on the number of pediatric drug studies supported; 
the estimated cost of each study undertaken; the nature and 
type of studies undertaken; the number of label changes that 
occurred due to the studies completed; the patent status of the 
drugs studied; and the number of drugs remaining on the 
priority list established through section 409I of the Best 
Pharmaceuticals for Children Act.
    Pediatric research initiative.--The Committee is pleased 
that the Office of the Director is implementing its Pediatric 
Research Initiative, as authorized by the Child Health Act of 
2000. The Committee strongly supports the intent of the 
initiative, to provide additional funds to encourage the growth 
of support for pediatric research across Institutes and to 
stimulate new and promising areas of pediatric research.
    Pediatric research loan repayment.--The Children's Health 
Act of 2000 established the Pediatric Research Loan Repayment 
Program to ensure the future supply of researchers dedicated to 
the care and research needs of children. The Committee is 
pleased with the expeditious initial implementation of this 
program, and it urges the NIH to expand it, particularly in the 
areas of Duchenne muscular dystrophy and Fragile X. The 
Committee requests that the Director prepare a report by April 
1, 2003, detailing the progress of this program.
    Physical inactivity.--Physical inactivity, as a 
contributing factor to disease, represents the third leading 
cause of death in the United States and is a major contributor 
to obesity, the second leading cause of death. The Committee 
encourages the NIH to conduct public outreach efforts with the 
goal of encouraging researchers to bring their research 
expertise and skills to bear on this field.
    Postpartum depression.--Each year, over 400,000 women 
suffer from postpartum mood changes, with ``baby blues'' 
afflicting up to 80 percent of new mothers; postpartum mood and 
anxiety disorders impairing around 10-20 percent of new 
mothers; and postpartum psychosis striking 1 in 1,000 new 
mothers. However, little systematic research has been done to 
uncover the underlying causes and to develop effective 
treatments. Therefore, the Committee encourages the Institutes 
to expand, intensify and coordinate research on postpartum 
depression and psychosis. In addition, the Committee encourages 
the NIH to convene a national research conference to develop a 
national research plan for postpartum depression and psychosis.
    Racial and ethnic disparities.--The Committee was disturbed 
by the conclusions of the Institute of Medicine's March 2002 
report titled ``Unequal Treatment: Confronting Racial and 
Ethnic Disparities in Health Care.'' The Committee strongly 
urges the NIH to take all steps necessary to reduce and 
eventually eliminate racial and ethnic health disparities. On a 
related matter, the Committee is pleased with the leadership 
that NIH has shown, through its Projecto Ciencia initiative, to 
provide state-of-the-art health material to Hispanic consumers 
and information to Hispanic health professionals on NIH 
research opportunities. The NIH is encouraged to increase 
funding for this initiative with expanded emphasis on outreach 
to Hispanic consumers, Hispanic participation in clinical 
trials, and NIH training and research opportunities, especially 
as principal investigators.
    Scleroderma.--The Committee has included specific report 
language on scleroderma under NIAMS and the NHLBI, but it 
recognizes that scleroderma research involves many other 
Institutes and Centers as well. The NIDDK is encouraged to 
support such research because of scleroderma's links to 
gastrointestinal involvment and renal crisis; the NIDCR, 
because scleroderma may be associated with a number of 
potential dental and craniofacial complications; and the Office 
of Research on Women's Health, because scleroderma mainly 
strikes young women.
    Sjogren's syndrome.--Sjogren's syndrome is one of the most 
prevalent autoimmune diseases, yet little is known about the 
cause or effective treatments. The Committee is pleased by the 
research that the NIDCR has conducted on Sjogren's, but 
recognizes that because this disease may affect all organs, it 
falls within the mission of many Institutes. For this reason, 
the Committee urges the NIH Autoimmune Diseases Coordinating 
Committee, as it implements the NIH Autoimmune Diseases 
Research Plan, to emphasize increased research on Sjogren's 
syndrome across the Institutes. In particular, the Committee 
encourages the NIAMS and NIAID to expand their research on 
musculoskeletal and immunological manifestations of the 
disease. The Committee also notes that Sjogren's syndrome is an 
excellent model for lymphoproliferation and transformation to 
malignancies; therefore, the NCI is encouraged to explore the 
increased progression in Sjogren's from a benign autoimmune 
process to malignancy.
    Social work research.--The Committee commends the NIMH, 
NIDA, NCI, and the Office of Behavioral and Social Science 
Research for their recognition of social work research's 
important contribution to our Nation's health. The Committee 
urges the NIH to develop a social work research plan that 
outlines research priorities, as well as a research agenda, 
across NIH Institutes and Centers to be reported to the 
Committee by April 1, 2003.
    Stem cell research.--The Committee is encouraged by the 
promise of both adult and embryonic stem cell research to 
improve the lives of individuals suffering from devastating 
diseases and conditions. However, the Committee also recognizes 
that basic stem cell research must be accomplished before 
therapies can be produced. In last year's report, the Committee 
encouraged NIH to move forward expeditiously to implement the 
President's policy concerning support of scientifically 
meritorious stem cell research. The Committee also commended 
NIH for moving quickly to negotiate material transfer 
agreements with holders of existing embryonic cell lines. 
However, since then, the Committee has learned that very few 
stem cell lines are being shared with researchers. The 
Committee is also concerned that few grant applications have 
been funded in this area. The Committee requests that the 
Department of Health and Human Services send the subcommittee a 
report explaining how it plans to encourage more grant 
applications and what specific steps it plans to take to make 
more stem cell lines available.
    The Committee also commends NIH for the development of the 
online human embryonic stem cell registry and encourages NIH to 
expand the registry to make it more useful to researchers by 
providing additional documentation regarding the stem cell 
lines, such as conditions of derivation, characteristics of the 
cell lines (i.e. cell-surface markers present or absent, growth 
conditions, and requirements for maintenance in long-term 
culture), and publications that reference the cell lines. 
Furthermore, the Committee encourages NIH to seriously consider 
developing a stem cell repository.
    In addition, the Committee is aware of the exciting new 
developments in the field of umbilical cord stem cells. But 
more research needs to be undertaken to explore these issues, 
including the possible use of these cells to treat cancers, 
genetic diseases, muscular dystrophy, neurological disorders, 
and diabetes. The Committee urges the NCI, NHLBI, NIAMS, NIDDK, 
and the NINDS to actively pursue research in these areas in a 
manner consistent with the NIH tradition of strong peer 
reviewed science.
    Stroke in women.--As the second-leading cause of death 
among women worldwide, stroke in women is a major health 
problem. The Committee believes that special attention should 
be focused on better understanding the gender differences in 
stroke and cerebrovascular disease, as well as in the medical 
care of stroke patients. Some aspects of the disease unique to 
women include strokes related to pregnancy and the use of oral 
contraceptives; stroke in younger women therefore should not be 
underestimated. Stroke is additionally a leading cause of 
serious disability among women and may contribute to late-life 
cognitive decline. The Committee supports the funding of new 
and continuing NIH studies that investigate the impact of 
postmenopausal hormone replacement therapy on stroke risk. The 
Committee urges the NIH to increase research in stroke among 
women of all ages, with a focus on stroke prevention, acute 
stroke management, post-stroke recovery, long-term outcomes, 
and quality of life.
    In addition, the Committee supports the NIH's initiatives 
toward advancing the organization of stroke care and the 
identification of stroke treatment and research centers that 
would provide rapid, early, continuous 24-hour treatment to 
stroke victims, including the use of the clot-buster t-PA when 
appropriate. The Committee believes that designated areas in 
medical facilities equipped with the resources and personnel 
for treating stroke would also promote the early evaluation of 
innovative stroke treatments.
    Temporomandibular joint disorders (TMJ).--The Committee 
recognizes that the problems associated with temporomandibular 
diseases and disorders involve many Institutes and Centers, 
including the NIDCR, NIAMS, NIAID, and NIBIB. The Committee 
calls on the Office of the Director to coordinate cross-cutting 
research by the various Institutes and Centers and provide a 
report directly to the Committee by April 1, 2003, on TMJ 
initiatives begun in fiscal year 2002 or scheduled to begin in 
fiscal year 2003. The Committee commends the Office of Research 
on Women's Health for its consistent support of workshops and 
other activities to further TMJ research, in recognition that 
women in the child-bearing years appear to be more susceptible 
than men to TMJ problems. The Office is urged to continue its 
support of TMJ initiatives.
    Training award stipends.--The Committee concurs with the 
policy adopted by the NIH in March 2001 which provides for 10 
percent increases in research training award stipends until 
appropriate stipend levels are achieved. The Committee strongly 
encourages the NIH to apply this policy to the fiscal year 2003 
appropriation, just as it did with the training stipends funded 
by the fiscal year 2002 appropriation.

                        BUILDINGS AND FACILITIES

Appropriations, 2002....................................    $326,100,000
Budget estimate, 2003...................................     632,800,000
Committee recommendation................................     632,800,000

    The Committee recommends an appropriation of $632,800,000 
for buildings and facilities [B&F]. The amount recommended is 
the same as the budget request and $306,700,000 more than the 
fiscal year 2002 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.
    Neuroscience Research Center and Clinical Research 
Center.--The Committee recommendation provides sufficient 
amounts for the NIH to continue support for high-priority 
construction projects previously approved and endorsed by the 
Congress. The Congress provided full-scope contract authority 
in the fiscal year 2002 appropriation for both phases of the 
John Edward Porter Neuroscience Research Center; that authority 
is continued for fiscal year 2003. The Committee expects the 
NIH to keep to the original schedule for completing this 
project. However, the Committee is extremely concerned about 
the cost of completing the Mark O. Hatfield Clinical Research 
Center. The Committee understands that small cost overruns are 
expected in most large construction projects. However, in this 
situation, $144,500,000 in unanticipated costs is totally 
unacceptable. Therefore, the Committee directs the NIH, prior 
to requesting any further construction dollars, to do a 
thorough investigation of why the cost overrun occurred, and 
what steps the NIH intends to take to ensure that future 
projects are better managed.
    The Committee has included full-scope bill language within 
this appropriation to give flexibility to the NIH to address 
the cost overrun situation. The Committee has taken this action 
to ensure that the new clinical center will be completed as 
soon as possible because of the critical role the center will 
play in the advancement of medical science. The Committee 
directs the NIH to report within 30 days of the enactment of 
this bill on how it will use the full-scope authority to 
maintain progress on these two projects. This report should 
also identify how other projects, if any, have been affected to 
maintain this progress.

                        OFFICE OF AIDS RESEARCH

Appropriations, 2002....................................................
Budget estimate, 2003...................................................
Committee recommendation................................................

    The Committee recommendation does not include a direct 
appropriation for the Office of AIDS Research [OAR]. Instead, 
funding for AIDS research is included within the appropriation 
for each Institute, Center, and Division of the NIH. The 
recommendation also includes a general provision which directs 
that the funding for AIDS research, as determined by the 
Director of the National Institutes of Health and the OAR, be 
allocated directly to the OAR for distribution to the 
Institutes consistent with the AIDS research plan. The 
recommendation also includes a general provision permitting the 
Director of the NIH and the OAR to shift up to 3 percent of 
AIDS research funding among Institutes and Centers throughout 
the year if needs change or unanticipated opportunities arise. 
These modifications to the budget recommendation are consistent 
with the manner in which funding for AIDS research was provided 
in fiscal year 2001. The Committee requests that the Director 
report on the fiscal year 2001 allocation plans for AIDS 
research within 60 days of enactment and provide notification 
to the Committee in the event the Directors exercise the 3 
percent transfer authority.
    The NIH Office of AIDS Research [OAR] coordinates the 
scientific, budgetary, legislative, and policy elements of the 
NIH AIDS research program. Congress provided new authorities to 
the OAR to fulfill these responsibilities in the NIH 
Revitalization Act Amendments of 1993. The law mandates the OAR 
to develop an annual comprehensive plan and budget for all NIH 
AIDS research and to prepare a Presidential bypass budget.

       Substance Abuse and Mental Health Services Administration

Appropriations, 2002....................................  $3,137,690,000
Budget estimate, 2003...................................   3,193,086,000
Committee recommendation................................   3,237,538,000

    The Committee recommends $3,237,538,000 for the Substance 
Abuse and Mental Health Services Administration [SAMHSA] for 
fiscal year 2003, an increase of $99,848,000 more than the 
comparable fiscal year 2002 level and $44,452,000 more than the 
administration request. SAMHSA is responsible for supporting 
mental health programs and alcohol and other drug abuse 
prevention and treatment services throughout the country, 
primarily through categorical grants and block grants to 
States.
    The Committee has provided funding for programs of regional 
and national significance under each of the three SAMHSA 
centers: mental health services, substance abuse treatment and 
substance abuse prevention. Separate funding is available for 
the children's mental health services program, projects for 
assistance in transition from homelessness, the protection and 
advocacy program, data collection activities undertaken by the 
Office of Applied Studies and the two block grant programs: the 
community mental health services block grant and the substance 
abuse prevention and treatment block grant.
    The Committee commends SAMHSA for proposing additional 
funding to address the treatment gap, but is concerned that 
these resources come at the expense of reductions in substance 
abuse prevention activities as well as best practice programs 
authorized under CMHS, CSAP and CSAT. The Committee notes that 
the Public Health Service Act authorizes SAMHSA to: ``conduct 
programs, and assure the coordination of such programs with 
activities of the National Institutes of Health and the Agency 
for Healthcare Research and Quality, as appropriate, to 
evaluate the process, outcomes and community impact of 
treatment and prevention services and systems of care in order 
to identify the manner in which such services can most 
effectively be provided.'' The Committee believes that it is 
important for SAMHSA to continue to have sufficient resources 
to fund best practices service research activities that support 
the development of the most effective prevention and treatment 
programs to address substance abuse and mental health issues.
    The Committee strongly supports SAMHSA's Federal leadership 
role to improve the quality and availability of empirically 
based prevention and treatment services in the areas of mental 
health and substance abuse. To further the translation of 
research knowledge into practice, the Committee encourages 
ongoing collaboration between SAMHSA and the National 
Institutes of Health (specifically with the National Institute 
of Mental Health, the National Institute of Drug Abuse, and the 
National Institute on Alcohol Abuse and Alcoholism.) The 
Committee believes concerted efforts should be undertaken to 
reduce the current 15- to 20-year lag between the discovery of 
an effective treatment or intervention and its availability at 
the community level.
    The Committee remains concerned by the disproportionate 
presence of substance abuse in rural and native communities, 
particularly for American Indian, Alaska Native and Native 
Hawaiian communities. The Committee reiterates its belief that 
funds for prevention and treatment programs should be targeted 
to those persons and communities most in need of service. 
Therefore, the Committee has provided sufficient funds within 
CSAP and CSAT to continue supporting projects that increase 
knowledge about effective ways to deliver services to rural and 
native communities. The Committee believes that Community 
Health Centers should be utilized in this effort.

                   CENTER FOR MENTAL HEALTH SERVICES

Appropriations, 2002....................................    $831,904,000
Budget estimate, 2003...................................     822,116,000
Committee recommendation................................     843,116,000

    The Committee recommends $843,116,000 for mental health 
services, $11,212,000 more than last year's level and 
$21,000,000 more than the budget request. Included in this 
amount is funding for programs of regional and national 
significance, the mental health performance partnership block 
grant to the States, children's mental health services, 
projects for assistance in transition from homelessness, and 
protection and advocacy services for individuals with mental 
illnesses.
    The Committee believes that CMHS should promote the model 
of permanent supportive housing for people who have been 
homeless for long periods of time. The Committee directs CMHS 
to work with providers and States to collect information on the 
amount of block grant funding being used by States for 
treatment in permanent supportive housing for people who have 
been homeless for long periods of time. This information should 
be included in future budget submissions beginning with fiscal 
year 2005. The Committee also encourages CMHS to monitor the 
extent to which homeless people assisted with PATH funds enter 
permanent housing. The Committee intends that funding for PATH 
help meet the goal of ending chronic homelessness.

Programs of regional and national significance

    The Committee recommends $231,067,000 for programs of 
regional and national significance, $1,149,000 more than the 
fiscal year 2002 amount and $18,000,000 more than the 
administration's request. Programs of regional and national 
significance address priority mental health needs through 
developing and applying best practices, offering training and 
technical assistance, providing targeted capacity expansion 
grants, and changing the delivery system through family, 
client-oriented and consumer-run activities.
    The Committee continues to support funding for mental 
health counselors for school-age children, as part of an effort 
to reduce the incidence of youth violence. The Committee 
intends that $95,000,000 be used for counseling services for 
school-age youth. Among other things, the Committee believes 
that mental health counseling for troubled youth can help 
prevent violent acts, and therefore is providing continued 
funding to help schools in that effort. It is again expected 
that SAMHSA will collaborate with the Departments of Education 
and Justice to continue a coordinated approach.
    The Committee notes that suicide continues to claim almost 
30,000 lives each year, making it one of the top 15 causes of 
death in the United States. For 15- to 24-year-olds and 
children ages 10-14, suicide is the third leading cause of 
death. The Committee continues to support State and local 
efforts to reduce the occurrence of this premature and 
unfortunate loss of life. The Committee has included $3,000,000 
to continue supporting the National Suicide Prevention Resource 
Center. This important initiative supports technical assistance 
in developing, implementing and evaluating effective suicide 
prevention programs. The Resource Center serves as a training 
and field support and acts as a clearinghouse for all pertinent 
best practices information regarding suicide prevention, and it 
promotes evaluation of suicide prevention programs to ensure 
that effective techniques, strategies, and recommended best 
practices are made available to users. The Committee also 
continues support for the Suicide Prevention Hotline program.
    The Committee appreciates CMHS's commitment to improving 
the quality, effectiveness and availability of therapeutic 
services delivered to traumatized children and adolescents; 
furthering the understanding of the individual, familial, and 
community impact of child and adolescent traumatic stress and 
the methods used to prevent its consequences; and reducing the 
frequency and consequences of traumatic events on children and 
adolescents. The Committee recommendation includes $30,000,000 
to continue and build on the National Child Traumatic Stress 
Initiative. Of the amount provided, $10,000,000 is available in 
the Public Health and Social Services Emergency Fund.
    The Committee remains concerned about the ongoing problems 
of post-traumatic stress disorder present in the refugee 
immigrant population in Hawaii. Because these immigrants 
represent diverse cultures and often have limited mastery of 
English, the Committee urges vigorous attention to the mental 
health problems of these future citizens.
    The Committee recommendation includes funding for the Safe 
Schools/Healthy Students Program, which supports the 
Departments of Health and Human Services, Justice, and 
Education, working together to develop empirically supported 
programs to prevent youth violence and to intervene with 
families, schools, and communities where violence has already 
occurred. The Committee urges the use of community health 
centers as part of this effort. The Committee also expects to 
receive comprehensive evaluation information from wave one 
grantees not later than October 1, 2002 and encourages CMHS to 
accelerate their national evaluation of this important program.
    The Surgeon General's report, ``Mental Health: Culture, 
Race, Ethnicity,'' clearly identifies the existence of racial 
and ethnic disparities in the mental health system. A major 
recommendation in the Surgeon General's earlier report ``Report 
on Mental Health'' is to increase funding for training minority 
mental health professionals. Although minorities currently 
represent 30 percent of our Nation's population and are 
projected to account for 40 percent in 2025, only 7.2 percent 
of doctorates awarded in psychology since 1978 have been to 
people of color. The Committee recognizes the urgency of 
training additional minority mental health professionals, to 
include Native Hawaiians, and encourages SAMHSA to provide 
additional resources to the Minority Fellowship Program.
    The Committee continues to recognize the importance of 
consumer/peer-run programs that help people with mental 
illnesses live successfully in the community. These low-cost 
services have an impressive record of assisting people with 
mental disorders to decrease their dependence on expensive 
social services and avoid psychiatric hospitalization. Having 
proved effective, they have been replicated in numerous 
communities with State and local funding. The Center for Mental 
Health Services has funded five consumer and consumer-supporter 
national technical assistance centers that provide training and 
information to help these groups grow. The Committee has 
included $2,000,000 above the budget request to continue the 
current level of funding for the consumer and consumer-
supporter national technical assistance centers. The Committee 
directs CMHS to support grants to fund five such national 
technical assistance centers for a period of no less than 5 
years.
    The Committee is concerned about the prevalence of 
pregnancy related mental health conditions suffered by women 
today. The Committee is concerned specifically about the high 
prevalence of postpartum depression and psychosis suffered by 
pregnant women today in the United States. Each year, over 
400,000 women suffer from postpartum mood changes, with ``baby 
blues'' afflicting up to 80 percent of new mothers; postpartum 
mood and anxiety disorders impairing around 10-20 percent of 
new mothers; and postpartum psychosis striking 1 in 1,000 new 
mothers. Therefore, the Committee recommends that resources be 
expended for the treatment of women and their families 
suffering from such pregnancy-related mental health conditions.
    The Committee recommendation includes $5,000,000 to 
continue the elderly treatment and outreach program. 
Demographic projections show that by the year 2010, there will 
be approximately 40 million Americans over the age of 65. The 
Committee notes that more than one in five will experience 
mental disorders. This grant program will help local 
communities establish the infrastructure necessary to better 
serve the mental health needs of older adults.
    The Committee supports $5,000,000 for the jail diversion 
grant program, an increase of $1,000,000 over last year. The 
Committee recognizes that up to 1 million individuals with 
mental illnesses will either spend time in jail or prison 
during the current year. This is a most unfortunate statistic, 
when individuals could be more appropriately treated in a 
community health setting. Therefore, the Committee urges SAMHSA 
to work with the Department of Justice, the law enforcement 
community, the court system and other appropriate agencies and 
associations to ensure that funding is utilized to divert 
inappropriate incarcerations and link individuals with mental 
illnesses with the support they need to avoid future contact 
with the criminal justice system.
    The Committee recommendation includes $6,000,000 to 
continue support for new awards under the community action 
grant program. This program helps communities implement 
evidence-based exemplary practices that serve adults with 
serious mental illness and children and adolescents with 
serious emotional disorders. The Committee notes that this 
program has met or exceeded performance measures in fiscal year 
2000 and fiscal year 2001.

Mental health performance partnership block grant

    The Committee recommends $433,000,000 for the mental health 
performance partnership block grant, the same amount as the 
fiscal year 2002 appropriation and the budget 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 and 
territories by formula.
    The Children's Health Act of 2000 made several changes to 
the authority for the mental health block grant, including the 
development of a performance partnership framework in which 
States are granted program flexibility for achieving a common 
set of performance measures. The Committee expects SAMHSA to 
provide detailed information in its fiscal year 2004 
congressional justification about the transition to the 
performance partnership grant framework and funding requested 
to support this transition.
    The Committee recognizes the vital importance of services 
supported by mental health block grant funds. From fiscal year 
1999 to 2002, the Committee has increased the appropriation by 
50 percent to help move care for adults with serious mental 
illness and children with serious emotional disturbance from 
inpatient care settings to treatment and supports available in 
the community. Unfortunately, due to tight budget constraints 
this year, the Committee must concur with the President's 
budget request for the mental health block grant.

Children's mental health services

    The Committee recommends $96,694,000 for the children's 
mental health services program, an increase of $63,000 more 
than the comparable fiscal year 2002 level and the same as the 
administration's request. This program provides grants and 
technical assistance to support community-based services for 
children and adolescents with serious emotional, behavioral or 
mental disorders. Grantees must provide matching funds, and 
services must involve the educational, juvenile justice, and 
health systems.
    The Committee notes the positive findings that program 
evaluations have generated to date. For example, cross-agency 
treatment planning has increased from 40 percent in 1997 to 
more than 62 percent in 2001, which illustrates the extent to 
which this program helps local program providers--from 
education and juvenile justice to child welfare--collaborate to 
support access to quality mental health treatment and services. 
Further, GPRA outcome measures indicate that targets were 
exceeded or met for sustained improvements in clinical 
outcomes, stability of living arrangements and decreases in 
contacts with law enforcement. The Committee expects that 
SAMHSA will disseminate widely information about the ways in 
which local communities can develop comprehensive systems of 
care that meet the needs of children with serious emotional 
disorders and their families, as well as support technical 
assistance for grantees to continue to improve local 
collaboration.

Projects for assistance in transition from homelessness [PATH]

    The Committee recommends $46,855,000 for the PATH Program, 
an increase of $7,000,000 more than the fiscal year 2002 amount 
and the same amount as the administration's request.
    PATH is a critical program which provides outreach, mental 
health, and case management services and other community 
support services to individuals with serious mental illness who 
are homeless or at risk of becoming homeless. The PATH Program 
makes a significant difference in the lives of homeless persons 
with mental illnesses. PATH services eliminate the revolving 
door of episodic inpatient and outpatient hospital care. 
Multidisciplinary teams address client needs within a continuum 
of services, providing needed stabilization so that mental 
illnesses and co-occurring substance abuse and medical issues 
can be addressed. Assistance is provided to enhance access to 
housing, rehabilitation and training, and other needed 
supports, assisting homeless people in returning to secure and 
stable lives.
    The Committee is aware that approximately 600,000 Americans 
are homeless on any given night. Of that number, an estimated 
one-third have serious mental illnesses, and more than one-half 
also have an alcohol and/or drug problem. A recent evaluation 
of the PATH program found that increasing outreach activities 
was an effective means of linking homeless persons to the 
services they need, which helps to stabilize their living 
situations and secure the additional support they need to live 
a healthy and self-sufficient life.

Protection and advocacy

    The Committee recommends $35,500,000 for the protection and 
advocacy program, an increase of $3,000,000 over the fiscal 
year 2002 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, or 
while they are living in the community, including their own 
homes. Funds are allocated to States according to a formula 
based on population and relative per capita income.
    The Committee has provided additional resources to support 
the efforts of the protection and advocacy system. Additional 
funding has enabled State P&A programs to increase the number 
of clients served, the amount of public awareness and education 
conducted and the number of training activities delivered. The 
Committee notes that the P&A programs have exceeded their GPRA 
performance targets in all of these areas. The Committee 
recognizes that additional investments are needed to support 
State P&A programs as they seek to meet their growing 
responsibilities. State P&A programs continue to support the 
needs of individuals with mental illness through advocacy and 
investigation related to incidents involving restraints and 
seclusion in care or treatment facilities and employment, 
housing and other supports provided in the community.

                  CENTER FOR SUBSTANCE ABUSE TREATMENT

Appropriations, 2002....................................  $2,016,383,000
Budget estimate, 2003...................................   2,142,994,000
Committee recommendation................................   2,105,000,000

    The Committee recommends $2,105,000,000 for substance abuse 
treatment programs, an increase of $88,617,000 over last year's 
funding and $37,994,000 less than the budget request. This 
amount funds substance abuse treatment programs of regional and 
national significance and the substance abuse prevention and 
treatment block grant to the States.
    The Committee remains concerned about the treatment gap 
that continues to exist for those Americans in need of 
substance abuse treatment services. The Committee commends 
SAMHSA for proposing additional funding to address the 
treatment gap, but is concerned that these resources come at 
the expense of reductions in substance abuse prevention 
activities as well as best practice programs authorized under 
CMHS, CSAP and CSAT. The latest estimates indicate that 
millions of Americans with serious substance abuse treatment go 
untreated each year, adding billions in monetary costs to our 
society and immeasurable emotional pain and suffering for 
millions of families. Studies have shown that substance abuse 
treatment is effective at reducing primary drug use by nearly 
50 percent, criminal activity by 80 percent and alcohol- and 
drug-related medical visits by 50 percent while increasing 
individual financial self-sufficiency. Further, the Committee 
is aware that studies have shown that addiction treatment is as 
effective as the treatment for other chronic medical 
conditions. The Committee commends CSAT for initiating its 
National Treatment Plan Initiative (NTP), and believes that 
additional resources need to be devoted to the NTP and to 
reducing, and eventually eliminating, the treatment gap.
    The Committee believes that CSAT should promote permanent 
supportive housing as a highly effective model for ending 
chronic homelessness. The Committee directs CSAT to collect 
information about the amount of block grant funds devoted to 
treatment for people who have been homeless for long periods of 
time and have moved into permanent supportive housing. This 
information should be included in future budget submissions 
beginning with fiscal year 2005.
    The Committee requests that CSAT provide it with a report 
of fiscal year 2003 funding available for treatment services 
for Native Americans.

Programs of regional and national significance

    The Committee recommends $310,000,000 for programs of 
regional and national significance [PRNS]. This amount is 
$18,617,000 above the fiscal year 2002 amount and $47,994,000 
less than the budget request.
    Programs of regional and national significance include 
three primary activities: best practice programs are used to 
develop more information on how best to serve those most in 
need; training and technical assistance supports dissemination 
of information through knowledge development; and targeted 
capacity expansion programs enable the agency to respond to 
service needs in local communities.
    The Committee supports CSAT's proposed expansion of 
clinically based treatment and related services for adult, 
juvenile and family drug courts and individuals returning from 
the community who are on probation, parole, or unsupervised 
release. The Committee is aware of the rapid increases in the 
use of drug courts throughout the country as an alternative to 
the traditional court system. These courts make substance abuse 
treatment available, when appropriate, as an alternative to 
incarceration, and are considered a cost-effective approach to 
helping drug users regain control of their lives.
    The Committee continues its strong support of the grants 
for homeless individuals program, a collaboration between CSAT 
and CMHS addressing the substance abuse and mental health 
treatment needs of homeless individuals. The Committee notes 
that as many as half of homeless adults have histories of 
alcohol abuse or dependence, one-third have histories of drug 
abuse and one-quarter have lifetime histories of serious mental 
illness. The Committee encourages these Centers to devote as 
much additional funding as possible for new awards.
    Programs of regional and national significance include 
critical support for substance abuse treatment services for the 
Nation's homeless population. The homeless have unique needs 
and life circumstances that have received inadequate attention 
in terms of substance abuse treatment. Therefore, the Committee 
continues to advocate coordinated and seamless service delivery 
for the homeless that includes mental health, primary care, and 
other social services that will support positive treatment 
outcomes. The Committee recommendation includes additional 
resources to continue to make progress in this area.
    The Committee understands that methamphetamine abuse 
continues to be a major problem in many areas of the country, 
in particular the South and the Midwest. The State of Iowa is 
experiencing a particularly high incidence of methamphetamine 
abuse, as well as other emerging drug issues. The Committee 
recommendation includes sufficient funding to support 
prevention and treatment demonstration projects in Iowa and 
other parts of the Midwest and South. School-based prevention 
demonstration projects would teach the dangers of 
methamphetamine abuse and addiction as well as other emerging 
drug issues, using methods that are effective and evidence-
based and include initiatives that give students the 
responsibility to create their own anti-drug abuse education 
programs for their schools. Treatment demonstrations would 
carry out planning, establishing, or administering evidence-
based treatment programs that are designed to assist 
individuals to quit their use of methamphetamine or other 
emerging drugs and remain drug-free.
    The Committee encourages CSAT to continue to focus new 
resources on targeting specific treatment approaches for 
adolescents. The Committee is aware of the lack of available 
treatment programs specifically designed to address the needs 
of adolescents. The Committee believes that adolescents would 
respond more favorably to treatment services offered in such a 
manner.
    The Committee remains concerned about the incidence of drug 
addiction among pregnant women and has provided funding within 
the Committee recommendation for the Residential Treatment 
Program for Pregnant and Postpartum Women (PPW), authorized 
under section 508 of the Public Health Service Act. Within the 
funds appropriated for CSAT, $3,000,000 shall be used for the 
PPW program. The Committee is particularly concerned about the 
increased incidence of methamphetamine use and urges the 
Secretary to fund a certain number of PPW programs in areas of 
high methamphetamine use.

Substance abuse prevention and treatment block grant

    The Committee recommends $1,795,000,000 for the substance 
abuse prevention and treatment block grant, $70,000,000 more 
than the fiscal year 2002 level and $10,000,000 more than the 
administration's request.
    The block grant provides funds to States to support alcohol 
and drug abuse prevention, treatment, and rehabilitation 
services. Funds are allocated to the States according to 
formula. State plans must be submitted and approved annually.
    The Committee recommendation includes an additional 
$70,000,000 for the block grant to reduce the treatment gap.
    The Children's Health Act of 2000 made several changes to 
the authority for the substance abuse prevention and treatment 
block grant, including the development of a performance 
partnership framework in which States are granted program 
flexibility for achieving a common set of performance measures. 
The Committee expects SAMHSA to provide detailed information in 
its fiscal year 2004 congressional justification about the 
transition to the performance partnership grant framework and 
proposed funding that will support this transition.

                 CENTER FOR SUBSTANCE ABUSE PREVENTION

Appropriations, 2002....................................    $198,011,000
Budget estimate, 2003...................................     152,815,000
Committee recommendation................................     202,000,000

    The Committee recommends $202,000,000 for programs to 
prevent substance abuse, an increase of $3,989,000 above last 
year's level and $49,185,000 more than the budget request. This 
amount funds substance abuse prevention programs of regional 
and national significance.
    The Committee is very concerned about the administration's 
request to significantly reduce funding for prevention 
activities. The Committee notes that prevention is a key 
partner in the effort to reduce the treatment gap. The 
Committee is aware that the National Drug Control Strategy has 
established 2-year goals of reducing current use by 10 percent 
for 12- to 17-year-olds and individuals 18 years and older. 
States and communities will be challenged to develop the 
capacity to deliver effective substance abuse prevention 
programs without additional resources, especially given the 
demographic surge in youth aged 15-20 expected during the 
current decade. The Committee recognizes that this cohort 
exhibits the highest rates of substance abuse initiation. If 
current rates hold steady during the current decade, this 
cohort of individuals would cause a significant increase in the 
treatment gap.
    The Committee is aware that CSAP's science-based model 
programs show that prevention investments have the potential to 
reduce substance abuse rates by 25 percent. Further, delaying 
the age of first use can slow the progression of abuse, 
dependency and the need for treatment. The Committee also notes 
that prevention programs reduce the risk factors that are 
associated with later use and increase the protective factors 
that help individuals avoid use, thus producing a downward 
pressure on the treatment gap over the long term. The Committee 
also is aware that prevention programs are cost-effective. The 
Office of National Drug Control Policy has shown a direct 
correlation between increases in drug prevention investments 
and decreases in the prevalence of drug use. Prevention 
programs show cost-benefit ratios in the range of 8:1 to 15:1 
for reduced costs in crime, school and work absenteeism, as 
well as reduced need for and costs of substance abuse 
treatment. Therefore, the Committee has provided $49,185,000 
over the budget request to continue investments in the Nation's 
substance use prevention infrastructure including the following 
programs: Starting Early, Starting Smart, Community-Initiated 
Prevention Intervention, FAS/FAE, Ecstasy and National 
Clearinghouse for Alcohol and Drug Information.

Programs of regional and national significance

    The Committee has provided $202,000,000 for programs of 
regional and national significance [PRNS], $3,989,000 more than 
the fiscal year 2002 amount and $49,185,000 more than the 
administration's request. The Center for Substance Abuse 
Prevention is the sole Federal organization with responsibility 
for improving accessibility and quality of substance abuse 
prevention services. Through the programs of regional and 
national significance activity, CSAP supports: development of 
new practice knowledge on substance abuse prevention; 
identification of proven effective models; dissemination of 
science-based intervention information; State and community 
capacity-building for implementation of proven effective 
substance abuse prevention programs; and programs addressing 
new needs in the prevention system.
    The Committee notes the alarming increase in use and 
availability of ecstasy and other club drugs among our Nation's 
youth. For 2 consecutive years, ecstasy use reported by 10th 
and 12th grade students has increased. According to SAMHSA's 
Drug Abuse Warning Network, ecstasy-related emergency room 
admissions in the United States increased significantly from 
253 in 1994 to 4,511 in 2000. The Committee urges SAMHSA to pay 
close attention to this and other emerging drug use issues and 
has included $5,000,000 to continue and expand on the program 
funded last year.
    The Committee is aware of the need to strengthen fetal 
alcohol syndrome (FAS) prevention efforts and improve service 
delivery by ensuring that professionals in key fields are 
knowledgeable about FAS and related birth defects, particularly 
in high-prevalence regions. The Committee has therefore 
included sufficient funding to support training on FAS and 
related birth defects for professionals and students in health 
care, education, social work, foster care, criminal justice, 
and other relevant fields.
    The Committee notes the insufficient number of effective 
fetal alcohol syndrome and fetal alcohol effects (FAS/FAE) 
programs in communities affected by this problem. The Committee 
has provided $12,500,000 to expand efforts to identify, 
disseminate and implement effective FAS/FAE prevention and 
treatment programs.
    The Committee is troubled by the recent findings of the 
NIAAA Task Force on College Drinking. The study reveals that 
drinking by college students age 18-24 contributes to an 
estimated 1,400 student deaths, 500,000 injuries, and 70,000 
cases of sexual assault or date rape each year. It also 
estimates that more than one-fourth of college students that 
age have driven in the past year while under the influence of 
alcohol. The Committee commends CSAP for funding programs 
designed to prevent alcohol problems among college students. 
The Committee encourages CSAP to continue to enhance its work 
in this area and to disseminate information about 
scientifically based prevention programs that can be utilized 
in appropriate settings. The Committee notes that two related 
programs were added this year to the National Registry of 
Effective Prevention Programs.
    The Committee is aware that alcohol abuse, though common on 
many campuses, does not run rampant among all college and 
university students, and also notes that one of the challenges 
to reducing alcohol abuse among this population is the 
perceived norm that everyone is doing it. Previous studies have 
shown that most students drink moderately or abstain. The 
Committee recognizes that the proportion of nondrinkers on 
college campuses increased from 15 to 19 percent between 1993 
and 1999.
    The Committee strongly supports the information 
dissemination activities of the National Clearinghouse for 
Alcohol and Drug Information (NCADI). Last year, the NCADI 
website received more than 86 million hits; its radio messages 
reached almost 52 million listeners; and it provided critical 
support to individuals in the prevention and treatment field. 
The Committee understands that NCADI exceeded its GPRA 
performance targets for both the number of information requests 
received, as well as the level of customer satisfaction 
achieved. Therefore, the Committee continues to support NCADI 
at no less than last year's level of funding, so it can 
continue to serve as a one-stop source for comprehensive, 
customer-oriented information regarding substance use 
prevention, intervention and treatment.

                           PROGRAM MANAGEMENT

    The Committee recommends $86,467,000 for program management 
activities of the agency, $4,925,000 less than the fiscal year 
2002 level and $11,306,000 more than the President's request.
    The program management activity includes resources for 
coordinating, directing, and managing the agency's programs. 
Program management funds support salaries, benefits, space, 
supplies, equipment, travel, and departmental overhead required 
to plan, supervise, and administer SAMHSA's programs.
    Last year, the Committee provided $9,000,000 requested in 
the SAMHSA budget for data collection initiatives. These 
additional resources were requested and provided to make much-
needed improvements in the Drug Abuse Warning Network (DAWN) 
and the Drug and Alcohol Services Information System (DASIS.) 
The Committee notes that the DAWN captures information from 
hospital emergency departments as a means of tracking current 
trends in illicit and licit drug abuse. The DASIS is the only 
source of national data on services available for substance 
abuse treatment and the characteristics of individuals admitted 
for treatment. The Committee is disappointed that funds 
required to sustain these improvements were eliminated from the 
SAMHSA budget.
    The Committee notes that only 36 percent of targets for 
fiscal year 2001 had reported data upon release of the Final 
Fiscal Year 2003 GPRA Annual Performance Plan and fiscal year 
2001 Annual Performance Report. The Committee expects that 
SAMHSA will continue to improve the quality and timeliness of 
data required for compliance with GPRA.
    The Committee has recommended additional resources for the 
program management account above the budget request, to 
continue support for critical investments in data collection 
activities, to support technical assistance to States as the 
block grants are transitioned to performance partnerships and 
to restore excessive reductions proposed in staff and 
associated expenses.
    The Committee also recommends $955,000 for Federally owned 
facilities at St. Elizabeths Hospital. The budget request did 
not include funds for this purpose. The funds will pay for day-
to-day protection and maintenance, environmental remediation, 
historic and archaeological studies, and cemetery clock tower 
maintenance. These activities are necessary to prepare the 
facilities for transfer to the General Services Administration 
as excess property.

               Agency For Healthcare Research and Quality

Appropriations, 2002....................................    $298,745,000
Budget estimate, 2003...................................     250,000,000
Committee recommendation................................     308,645,000

    The Committee recommends $308,645,000 for the Agency for 
Healthcare Research and Quality [AHRQ]. This is $58,645,000 
more than the administration request and $9,900,000 more than 
the fiscal year 2002 level. Included in this amount is 
$106,000,000 in transfers available under section 241 of the 
Public Health Service Act.
    The Agency for Healthcare Research and Quality was 
established in 1990 to promote improvements in clinical 
practice and patient outcomes, promote improvements in the 
financing, organization, and delivery of health care services, 
and increase access to quality care. AHRQ is the Federal agency 
charged to produce and disseminate scientific and policy-
relevant information about the cost, quality, access, and 
medical effectiveness of health care. AHRQ provides 
policymakers, health care professionals, and the public with 
the information necessary to improve cost effectiveness and 
appropriateness of health care and to reduce the costs of 
health care.

                  HEALTH COSTS, QUALITY, AND OUTCOMES

    The Committee provides $252,645,000 for research on health 
costs, quality and outcomes [HCQO], which is $58,645,000 more 
than the administration request and $5,000,000 above the fiscal 
year 2002 level. HCQO research activity is focused upon 
improving clinical practice, improving the health care system's 
capacity to deliver quality care, and tracking progress toward 
health goals through monitoring and evaluation.
    The Committee is disappointed that the administration's 
request for AHRQ reflected a cut of 16 percent, or almost 
$49,000,000. This proposed cut would prevent the agency from 
issuing any new grants or contracts, and would require current, 
non-patient safety grants to be cut in half. AHRQ's research 
provides crucial information to policymakers regarding key 
health issues, such as how to improve the quality of care, 
reduce costs, eliminate health disparities, and translate the 
medical discoveries made at the National Institutes of Health 
into improved health care services for all Americans. Examples 
of research supported by the Agency include studies showing 
that patients who take beta blockers prior to bypass surgery 
have improved survival rates, that newer antidepressants are 
equally as effective as older medication in the treatment of 
depression, and that African-American Medicare beneficiaries 
are far less likely than white beneficiaries to receive flu 
shots. The Committee believes that the health systems research 
sponsored by AHRQ is an important complement to the biomedical 
research performed at NIH, and is committed to ensuring that 
sufficient funding exists for this type of research.
    The Committee is also concerned that the administration has 
proposed transferring $10,000,000 from AHRQ to the Department 
of Commerce for the Current Population Survey. While the 
Committee supports improvements to the CPS, it is displeased 
that the administration has chosen to fund this activity from 
an agency with such a small budget. The Committee does not 
approve the administration's proposal to shift funds to the 
Department of Commerce, and directs that none of AHRQ's funds 
be used or transferred for this purpose.
    The Committee notes that, as a result of funds it provided 
3 years ago, the Agency has funded valuable research relating 
to bioterrorism. The Committee is aware that AHRQ has sponsored 
a web site to help primary care physicians learn how to 
diagnose and treat bioterrorist agents such as smallpox and 
anthrax. AHRQ also funded a ``real time'' early warning system 
for infectious disease outbreaks developed at Carnegie Mellon 
University, which was highlighted by President Bush in 
February. The Committee believes that this research is an 
integral part of efforts to ensure that our health care system 
is prepared for a bioterrorism attack. For this reason the 
Committee has provided AHRQ with an additional $5,000,000 for 
bioterrorism research within the Public Health and Social 
Services Emergency Fund.
    The Committee continues to be very concerned about the 
enormous personal and economic cost of medical errors. More 
people die annually from medical errors than from automobile 
accidents, breast cancer, or AIDS. During the past 2 years the 
Committee has provided funding for initiating research into the 
causes of medical errors in the hope of dramatically improving 
the safety of health care services in this country. For fiscal 
year 2003, the Committee directs AHRQ to devote $60,000,000 of 
the total amount provided for HCQO to determining ways to 
reduce medical errors. This represents an increase of 
$5,000,000 over the amount provided last year. The Committee 
understands that these funds will be used to provide challenge 
grants to health facilities to implement local safety 
interventions, and to develop a program to train patient safety 
experts.
    Childhood birth defects and developmental disorders.--The 
Committee recognizes the importance of helping children 
suffering from birth defects and developmental disorders. These 
include cleft lip, cleft palate, missing limbs and other facial 
deformities from hemanjiomas, hemifacial and microsomia to 
microtia, aural atresia, and craniosynostosis. The Committee, 
therefore, urges the Agency to identify surgical procedures and 
treatment protocols for congenital deformities that would 
clearly differentiate reconstructive surgery from cosmetic 
surgery. Also, the Committee urges the Agency to commission one 
of its Centers for Evidence-based Practice to conduct research 
for the development of standards for the treatment of 
congenital deformities.
    Health disparities.--The Committee encourages the Agency to 
carefully evaluate the analysis, findings, and recommendations 
of the March 2002 Institute of Medicine report regarding the 
disparities of medical care delivery to minorities. In 
particular, the Agency should pursue creative ways to address 
this serious finding and improve health care delivery for 
African-Americans, those of Hispanic and Asian origin, Native-
Americans, Alaskans and Hawaiians.
    Mental Illness and Older Americans.--The Committee is 
seriously concerned about the prevalence of undiagnosed and 
untreated mental illness among older Americans. Affective 
disorders, including depression, anxiety, dementia, and 
substance abuse and dependence, are often misdiagnosed or not 
recognized by primary and specialty care physicians in their 
elderly patients. While effective treatments for these 
conditions are available, there is an urgent need to translate 
advancements from biomedical and behavioral research to 
clinical practice. The Committee urges AHRQ to support 
evidence-based research projects focused on the diagnosis and 
treatment of mental illnesses in the geriatric population, and 
to disseminate evidence-based reports to physicians and other 
health care professionals.

                   MEDICAL EXPENDITURES PANEL SURVEYS

    The Committee provides $53,300,000 for health insurance and 
medical expenditures panel surveys [MEPS], which is the same as 
the administration request and $4,800,000 above the fiscal year 
2002 level. MEPS is intended to obtain timely national 
estimates of health care use and expenditures, private and 
public health insurance coverage, and the availability, costs 
and scope of private health insurance benefits. It also 
develops cost and savings estimates of proposed changes in 
policy and identifies impact of policy changes on payers, 
providers, and patients.

Program support

    The Committee recommends $2,700,000 for program support. 
This amount is the same as the administration request and is 
$100,000 more than the fiscal year 2002 level. This activity 
supports the overall management of the Agency.

               Centers for Medicare and Medicaid Services


                     GRANTS TO STATES FOR MEDICAID

Appropriations, 2002....................................$107,119,398,000
Budget estimate, 2003................................... 112,090,218,000
Committee recommendation................................ 112,090,218,000

    The Committee recommends $112,090,218,000 for Grants to 
States for Medicaid. This amount is $4,970,820,000 more than 
the fiscal year 2002 appropriation and the same as the 
administration's request. This amount excludes $46,601,937,000 
in fiscal year 2002 advance appropriations for fiscal year 
2003. In addition, $51,861,386,000 is provided for the first 
quarter of fiscal year 2004, as requested by the 
administration.
    The Medicaid program provides medical care for eligible 
low-income individuals and families. It is administered by each 
of the 50 States, the District of Columbia, Puerto Rico, and 
the territories. Federal funds for medical assistance are made 
available to the States according to a formula, which 
determines the appropriate Federal matching rate for State 
program costs. This matching rate is based upon the State's 
average per capita income relative to the national average, and 
shall be no less than 50 percent and no more than 83 percent.

                  PAYMENTS TO HEALTH CARE TRUST FUNDS

Appropriations, 2002.................................... $81,979,200,000
Budget estimate, 2003...................................  81,462,700,000
Committee recommendation................................  81,462,700,000

    The Committee recommends $81,462,700,000 for Federal 
payments to health care trust funds. This amount is the same as 
the administration's request and is a decrease of $516,500,000 
from the fiscal year 2002 appropriation.
    This entitlement account includes the general fund subsidy 
to the Supplementary Medical Insurance Trust Fund (Medicare 
Part B), plus other reimbursements to the Hospital Insurance 
Trust Fund (Medicare Part A), for benefits and related 
administrative costs that have not been financed by payroll 
taxes or premium contributions.
    The Committee has provided $80,905,000,000 for the Federal 
payment to the Supplementary Medical Insurance Trust Fund. This 
payment provides matching funds for premiums paid by Medicare 
Part B enrollees. This amount is the same as the 
administration's request and $427,000,000 less than the fiscal 
year 2002 amount.
    The recommendation also includes $225,000,000 for hospital 
insurance for the uninsured. This amount is the same as the 
administration's request and is $67,000,000 less than the 2002 
amount.
    The Committee also recommends $168,000,000 for Federal 
uninsured benefit payment. This payment reimburses the Hospital 
Insurance Trust Fund for the cost of benefits provided to 
Federal annuitants who are eligible for Medicare. This amount 
is the same as the administration's request and is $18,000,000 
more than the fiscal year 2002 appropriation.
    The Committee recommendation includes $164,700,000 to be 
transferred to the Hospital Insurance Trust Fund as the general 
fund share of CMS's program management administrative expenses.

                           PROGRAM MANAGEMENT

Appropriations, 2002....................................  $2,437,083,000
Budget estimate, 2003...................................   2,507,914,000
Committee recommendation................................   2,570,981,000

    The Committee recommends $2,570,981,000 for CMS program 
management. This is $63,067,000 more than the administration's 
request and $133,898,000 more than the fiscal year 2002 enacted 
level.

Research, demonstrations, and evaluations

    The Committee recommends $68,400,000 for research, 
demonstration, and evaluation activities. This amount is 
$48,801,000 less than the amount provided in fiscal year 2002 
and $40,000,000 more than the administration request.
    CMS research and demonstration activities facilitate 
informed, rational Medicare and Medicaid policy choices and 
decision making. These studies and evaluations include projects 
to measure the impact of Medicare and Medicaid policy analysis 
and decision making, to measure the impact of Medicare and 
Medicaid on health care costs, to measure patient outcomes in a 
variety of treatment settings, and to develop alternative 
strategies for reimbursement, coverage, and program management.
    The Committee has included $40,000,000 for Real Choice 
Systems Change Grants to States to fund initiatives that 
establish specific actions steps and timetables to achieve 
enduring system improvements and to provide long term services 
and supports, including community-based attendant care, to 
eligible individuals in the most integrated setting 
appropriate. Grant applications should be developed jointly by 
the State and Consumer Task Force. The Task Force should be 
composed of individuals with disabilities, consumers of long-
term care services and supports, and those who advocate on 
behalf of such individuals. Grant funded activities should 
focus on the following areas of need as determined by the 
States and the Task Force: community-integrated personal 
assistance services, building quality infrastructures for 
community-based long term care systems, enabling integrated 
long term support services to follow the individual across 
settings in a manner that permits as much participant direction 
as possible, developing innovative methods to address direct 
service worker shortages such as affordable health coverage and 
providing respite for caregivers of adults or children. These 
Real Choice Systems Change grants funds shall remain available 
until expended. To assure the sufficient time to promote 
enduring systems change, grantees will be allowed to utilize 
the funds over a 3-year period.
    The recommended funding level for the research and 
demonstration program will provide for continuation of current 
activities. Priority areas for CMS research include access to 
high-quality health care, health service delivery systems, and 
provider payment systems.

Medicare operations

    The Committee recommends $1,680,084,000 for Medicare 
operations (formerly know as Medicare contractors), which is 
$5,000,000 more than the budget request and $146,084,000 more 
than the fiscal year 2002 appropriation. In addition, 
$720,000,000 is available for the Medicare Integrity Program 
within the mandatory budget as part of the health insurance 
reform legislation.
    The Medicare operations line item covers a broad range of 
activities including claims processing and program safeguard 
activities performed by Medicare contractors. These contractors 
also provide information, guidance, and technical support to 
both providers and beneficiaries. In addition, this line item 
includes a variety of projects that extend beyond the 
traditional fee-for-service arena.
    The Committee recommends no less than $12,500,000 to 
support grants for State Health Insurance Counseling and 
Assistance programs (SHIPs). SHIPS provide information, 
counseling and decision support to people with Medicare.
    Medicare contractors partner with the Federal Government to 
administer the Medicare fee-for-service program. Contractors 
pay claims, provide beneficiary and provider customer service 
and education, and combat Medicare waste, fraud and abuse. The 
Committee believes that it is critical for Medicare contractors 
to be adequately funded. It is for this reason that the 
Committee has continued to increase Medicare contractor funding 
over the years. However, the Committee is concerned that the 
funding appropriated for Medicare contractor activities is not 
being appropriately distributed by CMS to its Medicare 
contractors. The Committee expects CMS to manage these 
resources so that Medicare contractors have the funding needed 
to handle total workloads, which are steadily increasing. The 
Committee also expects funding to be provided to Medicare 
contractors in a timely manner. Further, the Committee strongly 
recommends CMS eliminate the 5 percent cap on transferring 
funds among functions so that contractors have greater 
flexibility to manage their resources in a manner that best 
matches programmatic needs. The Committee expects CMS to 
include, within its fiscal year 2004 congressional 
justification, a report on how fiscal year 2003 resources were 
allocated to Medicare contractors.

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. On-site surveys are conducted by State survey 
agencies, with a pool of Federal surveyors performing random 
monitoring surveys.
    The Committee recommends $260,000,000 for Medicare State 
survey and certification activities, an increase of $12,353,000 
over the budget request and $5,603,000 more than the fiscal 
year 2002 level. The Committee understands that this level of 
effort will be supplemented by support contracts funded by the 
Quality Improvement Organization (formerly the Peer Review 
Organization) activity; this will bring the program level for 
survey and certification activities to $276,900,000 for fiscal 
year 2003.

Federal administration

    The Committee recommends $562,497,000 for Federal 
administration costs, $5,714,000 more than the administration's 
request. The Committee recommendation is $31,012,000 more than 
the fiscal year 2002 level.
    This funding level will support 4,539 full-time equivalent 
positions, a decrease of 93 from the fiscal year 2002 request. 
Most of the increase is for fixed expenses of personnel 
compensation and benefits.
    The Committee has been very pleased with the efforts of CMS 
under its demonstration authority to address the extraordinary 
adverse health status of Native Hawaiians in Waimanalo, Hawaii. 
The Committee urges an additional focus upon American Samoan 
residents in that geographical area utilizing the expertise of 
the Waimanalo Health Center and its Mauli Ola program.
    The Committee continues to support and invest in the 
enhanced quality of care for seniors. The Committee strongly 
urges the Secretary of Health and Human Services to implement 
the MedPAC's recommendation to assess contemporary models for 
pharmacists' services to ensure that seniors have access to 
this important patient care. The Committee urges the Secretary 
to consult with various national organizations representing 
pharmacists and pharmacies and to report back to Congress 
within this fiscal year.
    The Committee remains extremely concerned over CMS' 
continuing failure to articulate clear guidelines and to set 
expeditious timetables for consideration of new technologies, 
procedures and products for Medicare coverage. A particularly 
troubling example is CMS' lengthy delays and failure to 
articulate clear standards regarding Medicare coverage of 
positron emission tomography (PET). The effect of these delays 
in instituting Medicare coverage is to continue to deny the 
benefits to these technologies and procedures to Medicare 
patients. The Committee also remains concerned that CMS appears 
to be requiring some new technologies to repeat clinical trials 
and testing that have already gained FDA approval. The 
Committee is also concerned that CMS appears to be requiring 
substantially different levels of evidence to approve various 
new products for Medicare coverage. For example, very little 
documentation is required for approval of magnetic resonance 
angiography (MRA), while voluminous amounts of data are 
required to make a coverage decision on PET. The Committee 
remains concerned that the 120-person Medicare Coverage 
Advisory Committee may be further delaying coverage decisions 
and creating unnecessary costs for the Medicare program. These 
include the commissioning of studies that are not based on 
sound, established scientific principles. Because of the 
possible duplication of efforts among HHS agencies and related 
unnecessary costs to the Medicare program and the Department, 
the Committee again asks that the Secretary take a leadership 
role in resolving this matter expeditiously.
    The Committee is aware of the joint activities of CMS and 
HRSA to improve access to medical and dental care for mothers 
and children in underserved populations. CMS and the Maternal 
and Child Health program at HRSA, have worked together to 
assist States to reduce barriers to care for Medicaid and SCHIP 
populations for maternal and child health care including oral 
health care. The Committee urges these agencies to continue 
their partnership and expand support for State oral health 
systems grants and innovative demonstration projects for the 
prevention and early intervention of dental diseases in young 
children, State dental access summit meetings, and the National 
Maternal and Child Oral Health Resource Center. The Committee 
recognizes that such agency collaborations are instrumental for 
providing coordinated services that do not duplicate limited 
resources.
    The Committee is concerned that CMS has not updated its 
state guidance document on dental care for Medicaid-eligible 
children in over 20 years. The Committee is aware that CMS has 
commissioned and received an update of The Early and Periodic 
Screening, Diagnostic and Treatment (EPSDT) guide from the 
American Academy of Pediatric Dentistry. This document is vital 
to ensuring that the states correctly implement EPSDT dental 
requirements and provide full coverage for all eligible 
children. Furthermore, the guidance will help states improve 
access to dental care by providing a better understanding of 
the dental workforce and financing system. The Committee 
strongly urges CMS to release a revised state guidance manual 
on dental care under the Medicaid/EPSDT program before January 
1, 2003.
    The Committee expects the Secretary to issue ``L'' Codes 
based on fair and reasonable reimbursement levels to cover 
Total Body Orthotic Management for Non-Ambulatory severely 
disabled nursing home residents. Such treatment will be a 
medically prescribed device consisting of custom fitted 
individual braces with adjustable joints designed to improve 
function, retard progression of musculoskeletal deformity, or 
to restrict, eliminate or assist in the functioning of lower 
and upper extremities, pelvic, spinal, and cervical regions of 
the body. Such device will consist of individually adjustable 
braces that are attached to a frame which is an integral 
component of the device, and for which the individual braces 
cannot function or be used apart from the frame. This responds 
to a long-standing Committee concern about an unintended 
consequence of HCFA Ruling 96-1. While designed to crack down 
on fraud and abuse in the DME market on Part B Medicare 
reimbursement, this ruling also denied a highly specialized 
whole body orthotic treatment that dramatically improves the 
medical condition and quality of life for some severely 
disabled Medicare beneficiaries under full time care in nursing 
facilities. The Committee notes the May 2002, congressionally 
authorized GAO report entitled ``Orthotics Ruling Has 
Implications for Beneficiary Access and Federal and State 
Costs'' that identifies a substantial nursing home population 
that has been denied this care as a result of 96-1, but 
recommends that a restoration of such care be accompanied by 
appropriate controls, consistent with those established for 
existing ``L'' codes, that protect the integrity of the 
Medicare Program. The committee recognizes the need for these 
controls, but at the same time notes that beneficiaries have 
been without this treatment for over 5 years and urges CMS to 
expeditiously re-establish reimbursement measures for these 
services.
    The Committee directs the Secretary of Health and Human 
Services to review the Medicare Geographic Classification 
Review Board's criteria for reclassification determinations 
with respect to making payments to hospitals. The Committee 
requests the review to include a detailed analysis of 
disparities among hospital's reimbursement rates for hospitals 
in metropolitan statistical areas that border on areas that 
have a higher wage indices; the difficulty hospitals face in 
losing skilled medical personnel to neighboring areas with 
urban classifications and higher wage and salary structures; 
geographic and environmental impediments to traditional 
community routes; the base costs on which the wage index is 
applied; and the affect lower wage indices have on the quality 
of care. The Committee directs the Secretary to report to the 
Committee no later than January 15, 2003.

                Administration for Children and Families


  PAYMENTS TO STATES FOR CHILD SUPPORT ENFORCEMENT AND FAMILY SUPPORT 
                                PROGRAMS

Appropriations, 2002....................................  $2,536,313,000
Budget estimate, 2003...................................   2,416,800,000
Committee recommendation................................   2,475,800,000

    The Committee recommends that $2,475,800,000 be made 
available in fiscal year 2003 for payments to States for child 
support enforcement and family support programs. The Committee 
recommendation provides the full amount requested under current 
law. The budget request includes savings of $59,000,000 based 
on proposed legislation. These payments support the States' 
efforts to promote the self-sufficiency and economic security 
of low-income families. These funds support efforts to locate 
noncustodial parents, determine paternity when necessary, and 
establish and enforce orders of support. The appropriation, 
when combined with the $1,100,000,000 in advance funding 
provided in last year's bill and an estimated $461,000,000 from 
offsetting collections, supports a program level of 
$4,036,800,000.
    The Committee also has provided $1,100,000,000 in advance 
funding for the first quarter of fiscal year 2004 for the child 
support enforcement program, the same as the budget request.

               LOW-INCOME HOME ENERGY ASSISTANCE PROGRAM

Appropriations, 2002....................................  $2,000,000,000
Budget estimate, 2003...................................   1,700,000,000
Committee recommendation................................   2,000,000,000

    The Committee recommendation for LIHEAP is $2,000,000,000. 
The recommended amount is $300,000,000 more than the 
administration request and the same amount as last year.
    LIHEAP grants are awarded to States, territories, Indian 
tribes and tribal organizations to assist low-income households 
in meeting the costs of home energy. States receive great 
flexibility in how they provide assistance, including direct 
payments to individuals and vendors and direct provision of 
fuel.
    The Committee recommendation includes $1,700,000,000 for 
the State grant program, the same amount as last year's funding 
level and $300,000,000 more than the amount requested by the 
administration. These resources are distributed by formula to 
States, territories, Indian tribes and tribal organizations 
defined by statute, based in part on each State's share of home 
energy expenditures by low-income households nationwide.
    The Committee recommendation includes $300,000,000 in 
additional resources for the contingency fund, the same as the 
budget request. These resources are available until expended 
and can be released 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. The 
administration did not request resources for the contingency 
fund subject to this emergency requirement. The contingency 
fund may be used to provide assistance to one or more States 
adversely affected by extreme heat or cold, significant price 
increases or other causes of energy-related emergencies.
    The Committee is disappointed by the unwillingness of the 
administration to release any or all of the $600,000,000 in 
contingency funding currently available. The Committee notes 
that in both the Statement of the Managers accompanying the 
Supplemental Appropriations Act, 2001 (Public Law 107-20) and 
the Statement of the Managers accompanying the Department of 
Health and Human Services Appropriations Act, 2002 (Public Law 
107-116), the conferees encouraged the administration to 
release contingency funds provided by these Acts due to the 
pressing additional energy assistance needs of millions of 
eligible families. The Committee again notes that the 
authorizing statute states that the contingency fund was 
authorized to meet the additional home energy assistance needs 
of one or more States arising from a natural disaster or other 
emergency, as defined in section 2603(1)(A-G), which includes 
six other factors not related to weather or natural disasters.
    The Committee is aware of data that has been reported over 
the past 12 months that show the definition of emergency has 
been met in many States. The Committee directs the Department 
to provide a report within 60 days after the enactment of this 
bill identifying the sources of data used for considering 
release of contingency funds for each of the parts of the 
emergency definition.
    The Committee encourages the Department to work with 
appropriate agencies and associations to make sure data is 
available to administer this program, and in particular, make 
decisions about release of contingency funding.
    The Committee intends that up to $27,500,000 of the amount 
recommended for LIHEAP for fiscal year 2003 be used for the 
leveraging incentive fund. The fund will provide a percentage 
match to States for private or non-Federal public resources 
allocated to low-income home energy benefits.

                     REFUGEE AND ENTRANT ASSISTANCE

Appropriations, 2002....................................    $460,195,000
Budget estimate, 2003...................................     452,724,000
Committee recommendation................................     452,724,000

    The Committee recommends $452,724,000 for refugee and 
entrant assistance, $7,471,000 less than the fiscal year 2002 
level and the same amount as the budget request.
    Based on an estimated refugee admission ceiling of 75,000, 
this appropriation, together with prior-year funds available 
for fiscal year 2003 expenses, will enable States to continue 
to provide at least 8 months of cash and medical assistance to 
eligible refugees and entrants, a variety of social and 
educational services, as well as foster care for refugee and 
entrant unaccompanied minors.
    The Refugee and Entrant Assistance Program is designed to 
assist States in their efforts to assimilate refugees, asylees, 
Cuban and Haitian entrants, and adults and minors who are 
trafficking victims, into American society as quickly and 
effectively as possible. The program funds State-administered 
transitional and medical assistance, the voluntary agency 
matching grant program, programs for victims of trafficking and 
torture, employment and social services, targeted assistance, 
and preventive health.
    In order to carry out the refugee and entrant assistance 
program, the Committee recommends $227,291,000 for transitional 
and medical assistance, including State administration and the 
voluntary agency program; $10,000,000 for victims of 
trafficking; $151,121,000 for social services; $4,835,000 for 
preventive health; and $49,477,000 for targeted assistance.
    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.
    The Committee recommends $10,000,000 to treat and assist 
victims of torture. These funds may also be used to provide 
training to healthcare providers to enable them to treat the 
physical and psychological effects of torture. The Committee 
acknowledges that well-established treatment centers, such as 
the Center for Victims of Torture, have developed the knowledge 
base that has fostered growth of treatment facilities around 
the country and strengthened treatment services generally. This 
positive trend may continue if leading centers are able to 
expand their staffs to create more trainers and improve 
evaluation and research needed to guide and develop new 
programs.

                 CHILD CARE AND DEVELOPMENT BLOCK GRANT

Appropriations, 2002....................................  $2,099,976,000
Budget estimate, 2003...................................   2,099,994,000
Committee recommendation................................   2,099,994,000

    The Committee recommendation provides $2,099,994,000 for 
the child care and development block grant, $18,000 more than 
last year and the same as the budget request.
    The child care and development block grant supports grants 
to States to provide low-income families with financial 
assistance for child care; for improving the quality and 
availability of child care; and for establishing or expanding 
child development programs. The funds are used to both expand 
the services provided to individuals who need child care in 
order to work or attend job training or education and allow 
States to continue funding the activities previously provided 
under the consolidated programs.
    The Committee is aware that the authorization for the child 
care and development block grant program expires on September 
30, 2002. The block grant was last reauthorized in 1996 as part 
of the Personal Responsibility and Work Opportunity 
Reconciliation Act. The Act established the child care and 
development fund, which consists of mandatory funding provided 
under the Social Security Act and discretionary funding 
supported by annual appropriations under the child care and 
development block grant program.
    The Committee believes that significant increases in 
mandatory funding for child care should be supported by the 
reauthorization of the Welfare Reform law to pay for additional 
work requirements and to respond to the needs of low income, 
working poor families. The Welfare Reform law established 
policies that have resulted in a significant increase in the 
working Americans. Work requirements have decreased the welfare 
casesload by 1.8 million families from 1996-1999, many of whom 
are not earning a living wage and are in need of assistance. 
The share of families working or participating in work-related 
activities while receiving TANF also grew significantly; by 
fiscal year 1999, nearly 900,000 TANF parents were employed or 
engaged in work activities. Also, there has been a large 
increase in labor force participation by low income single 
parents, which includes many families not previously connected 
to the labor force; between 1996 and 1999, the number of 
employed single mothers grew from 1.8 million to 2.7 million.
    The Committee recommendation continues specific earmarks in 
appropriations language, also included in the budget request, 
that provide targeted resources to specific policy priorities 
including $19,120,000 for the purposes of supporting 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 
expects that these funds will not supplant current funding 
dedicated to resource and referral and school age activities 
provided by the child care and development block grant. The 
Committee strongly encourages States to address the matters of 
before and afterschool care and the establishment of resource 
and referral programs with the funds provided in this program.
    The Committee recommendation includes an additional 
$272,672,000 for child care quality activities, and sets aside 
$100,000,000 specifically for an infant care quality 
initiative. These funds are recommended in addition to the 4 
percent quality earmark established in the authorizing 
legislation. The Committee has provided these additional 
quality funds because of the considerable research that 
demonstrates the importance of serving children in high quality 
child care settings which include nurturing providers who are 
educated in child development and adequately compensated. While 
considerable progress has been made, the Committee believes 
States should continue to invest in education and training 
linked to compensation of the child care workforce in order to 
improve the overall quality of child care.
    The Committee recommendation also provides $10,000,000 for 
child care research, demonstration and evaluation activities.
    The Committee recommendation for resource and referral 
activities also includes $1,000,000 to continue support for the 
National Association of Child Care Resource and Referral 
Agencies' information service, Child Care Aware, the national 
toll-free information hotline which links families to local 
child care services and programs. Funds also were requested in 
the budget request for this purpose.

                      SOCIAL SERVICES BLOCK GRANT

Appropriations, 2002....................................  $1,700,000,000
Budget estimate, 2003...................................   1,700,000,000
Committee recommendation................................   1,700,000,000

    The Committee recommends an appropriation of $1,700,000,000 
for the social services block grant. The recommendation is the 
same amount as the budget request and 2002 enacted level.
    The Committee has included bill language that allows States 
to transfer up to 10 percent of their annual allocations under 
the Temporary Assistance for Needy Families to the Social 
Services Block Grant program. Under the budget request, States 
would be limited to transfers of up to 4.25 percent for fiscal 
year 2003. The Committee recognizes that the block grant is a 
vital source of support for many vulnerable children and 
families, the elderly and single adults and continues to 
support this important State flexibility.

                CHILDREN AND FAMILIES SERVICES PROGRAMS

Appropriations, 2002....................................  $8,428,574,000
Budget estimate, 2003...................................   8,593,364,000
Committee recommendation................................   8,864,054,000

    The Committee recommends an appropriation of $8,864,054,000 
for children and families services programs. This is 
$435,480,000 more than the comparable fiscal year 2002 funding 
level and $270,690,000 more than the budget request.
    This appropriation provides funding for programs for 
children, youth, and families, the developmentally disabled, 
and Native Americans, as well as Federal administrative costs.

Head Start

    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 $6,870,000,000 for the Head Start 
Program, an increase of $332,360,000 more than the comparable 
fiscal year 2002 level and $202,467,000 more than the budget 
request. The Committee recommendations includes $1,400,000,000 
in advance funding that will become available on October 1, 
2003.
    The Committee is aware that the Department's recently-
released 7-year national evaluation of the Federal Early Head 
Start program found that 3-year-old children completing the 
program performed better in cognitive and language development 
than children not participating in the program. Further, the 
study found that children completing Early Head Start achieved 
gains on standardized tests of cognitive and language 
development, may need fewer special learning interventions 
later on, and performed better on critical social-emotional 
tasks, such as relating to their parents, paying attention and 
behaving appropriately. The study also found that Early Head 
Start parents were more likely to read to their children, be 
emotionally supportive, help with language development and show 
positive parenting behavior. Early Head Start parents also 
participated more in education and employment-related 
activities. These findings justify the Committee's efforts to 
increase substantially funding for the Early Head Start 
program, to ensure that more eligible children participate in 
this important and effective program.
    The Committee is impressed by the most recent Family and 
Child Experience Survey (FACES) data released last month. The 
Committee notes that the findings reveal that as they had in 
1997-1998, Head Start children showed significant gains in 
vocabulary skills in 2000-2001 against national norms; Head 
Start children showed modestly larger gains in letter 
recognition skills in 2000-2001 than they had in 1997-1998; 
Head Start graduates showed gains in social skills, including 
improvements in interaction and complex play and Head Start 
classroom quality remained in the ``Good'' range in the Early 
Childhood Education Rating Scale and Assessment Profiles in 
2000, as they were in 1997. These findings support the 
significant investments that the Committee has supported for 
the Head Start program.
    However, the Committee is concerned that the 
congressionally-mandated National Impact Study of Head Start 
has not been completed and encourages the ACF to move forward 
and complete this important study. The National Impact Study 
was mandated by Congress to be completed by 2003.
    The Committee understands the serious need for additional 
and expanded Head Start facilities among native American 
populations and in rural areas. The Committee believes that the 
Department could help serve these needy communities by 
providing minor construction funding, as authorized, in remote 
native American communities.
    The Committee is aware of the unique circumstances rural 
areas face in designing Early Head Start programs to meet the 
needs of families. Rural areas experience higher costs per 
child, either due to the higher cost of transporting infants 
and children to Early Head Start Centers, or because of higher 
rents due to the lack of adequate and licensable facilities in 
rural areas. In selecting new grantees under this program, the 
Committee believes the Department should give consideration to 
applicants serving rural areas that meet or exceed all 
performance criteria even though they may propose a higher cost 
per child due to these factors.
    The Committee is aware that, in fiscal year 2002, 
approximately $40,000,000 in quality improvement Head Start 
funding was available to improve staff salaries and support 
professional development. This commitment of funding has helped 
increase both teacher compensation and retention rates among 
Head Start staff. The Committee expects the Department to 
continue to focus quality improvement efforts on improving Head 
Start teacher compensation such that teacher salaries more 
equitably reflect educational level and experience.
    The Committee strongly supports the effort to strengthen 
the qualifications of Head Start teachers. At least 50 percent 
of teachers in center-based Head Start programs must have an 
associate, baccalaureate, or advanced degree in early childhood 
education or a degree in a related field, with experience in 
teaching preschool children, by September 30, 2003. The 
Committee expects the Department to focus staff development 
efforts on increasing the educational level of Head Start 
teachers in order to meet this goal.
    The Head Start Act contemplates services to low-income 
children and their families. The law does not, however, 
prescribe age requirements for Head Start participation, short 
of limiting enrollment to children ``who have not yet reached 
the age of compulsory school attendance.'' Despite this fact, 
Head Start has traditionally served children in their years 
immediately prior to their entering into kindergarten. With 
States and localities increasing their investments in preschool 
services, local Head Start programs have been presented with 
not only an opportunity, but a need to serve infants and 
toddlers in their years proven to be the most formative in 
recently publicized brain research developmental studies.
    Accordingly, the Committee encourages the Department of 
Health and Human Services to support efforts by local Head 
Start programs to use grant funds to deliver quality services 
to the infant and toddler population where a community 
assessment evidences a need for such services and the local 
program has the capacity to meet that need. The Committee 
supports this expansion in response to changing local community 
needs, separate and apart from the new grant process under the 
Early Head Start program created as part of the 1994 Head Start 
reauthorization. When combined with the new grant authority for 
Early Head Start which flows from increased appropriations 
annually, expansion of existing preschool programs to serve 
infants and toddlers is particularly responsive to research 
emphasizing the developmental needs of our youngest children--
needs which can be ably addressed through the Head Start model 
of comprehensive services.
    The Committee commends the Department for its focus on 
prevention as a key to improving the overall health and well-
being of our Nation. The Committee also recognizes the 
importance of good nutrition and physical activity among young 
children for developing a fertile atmosphere for cognitive 
development and school readiness. According to the Nutrition 
Cognition National Advisory Committee at Tufts University in 
Massachusetts, children without an adequate diet may have 
trouble concentrating in school, participating in play, bonding 
with peers, and performing at their potential.
    Therefore, the Committee urges the Head Start Bureau to 
review the scope of good nutrition and physical activities 
which are presently being undertaken in response to the Head 
Start Performance Standards, as well as the current knowledge 
base on good nutrition and physical activities for young 
children. Further, the Committee urges the Head Start Bureau to 
review the activities presently being undertaken by local 
programs to promote healthy bodies as a prerequisite for strong 
minds and to identify best practices currently employed by 
local programs. As a follow up, the Committee encourages the 
Head Start Bureau, in collaboration with the National Head 
Start Association, to devise a plan for implementing a locally-
determined but coordinated effort to achieve the goals of a 
stronger, more vibrant and effective nutritional and physical 
activity component within Head Start programs. The Committee 
expects that the Head Start Bureau will enter into a 
cooperative agreement with the National Head Start Association 
to carry out these activities.
    The Senate is currently considering the reauthorization of 
the Personal Responsibility and Work Opportunities Act, in 
order to assist individuals to secure gainful employment and 
help families to gain self-sufficiency in the new economy. As a 
result of the 1996 enactment of welfare reform, families 
previously eligible for Head Start services based on their low-
income status have found themselves marginally exceeding those 
income limitations and, therefore, losing access to Head Start 
services for their children. The Committee recognizes that Head 
Start does not serve all income-eligible children and their 
families in the country. Nonetheless, while eligibility for 
other programs is sensitive to regional disparities in income, 
Head Start eligibility is not. It is clear that an inner-city 
family's expenses with respect to food, housing and medical 
needs are different from those of a rural family, while a rural 
family's transportation needs, for one, may well outpace 
similar needs for their urban neighbors. Eligibility 
requirements should reflect this difference. Current law gives 
the Secretary of Health and Human Services authority to permit 
the enrollment of a ``reasonable number'' of over-income 
families in Head Start. In a welfare-reformed era, families may 
find their income marginally exceeding national poverty 
guidelines, while their need for quality early childhood 
programming is even more pronounced. The Committee encourages 
the Secretary to permit local programs to best address local 
community needs in these changing times, but encourages 
flexibility which does not deny services to the neediest of the 
needy. The Committee encourages the Secretary to exercise his 
authority, as appropriate, to permit the enrollment of over-
income children and their families in up to 25 percent of 
program placements, so long as services are not denied to 
income-eligible children and families as a result of this 
flexibility.
    The Committee is aware that the Department's ``Descriptive 
Study of Seasonal Farmworker Families'' published in September 
2001 revealed that just 19 percent of eligible children of 
migrant and seasonal farmworkers are served by Migrant Head 
Start programs. The study also concluded ``that Migrant Head 
Start agencies greatly improve the lives of migrant and 
seasonal farmworker families, and in doing so, help to 
strengthen local agricultural economies.'' The Committee urges 
the Head Start Bureau to provide an increase in funding for 
Migrant Head Start programs proportionate to the overall 
increase in the Head Start appropriation.
    The Committee is aware of efforts currently being 
undertaken to improve pre-literacy skills in Head Start 
children and lauds the administration for its commitment to 
this effort. However, the Committee cautions against anything 
that would detract from the comprehensive nature of the program 
in delivering early childhood development and family services. 
While school readiness is front and center in the goals of Head 
Start, the elements necessary to achieve that readiness range 
from adequate nutrition and health screening to social and 
emotional development and family building as well as the 
cognitive growth of young children.
    The Committee encourages the Department to ensure that in 
securing pre-literacy training and technical assistance for 
Head Start grantees, every reasonable effort is made to use 
competitive procedures in securing private sector service 
providers to assist in completing the Head Start mission.
    The Committee is aware that the goal of the Head Start 
program is to ensure the social competence and school readiness 
of children upon completion of the program. The Committee 
expects the Department to continue to promote learning and 
brain development to accelerate and improve the cognitive 
development of Head Start children. The Committee expects the 
Department to monitor Head Start programs to ensure that a 
majority of children participating in Head Start programs meet 
the minimum educational performance measures and standards upon 
completion of the program as outlined in the Head Start Act, as 
amended in 1998.
    The TCU/Head Start partnership has made a lasting 
investment in our Indian communities by creating associate 
degree programs in Early Childhood Development and related 
fields. New graduates of these programs can help meet the 
Congressional mandate that 50 percent of all program teachers 
earn an Associate Degree in Early Childhood Development or a 
related discipline by 2003. One clear impediment to the on-
going success of this partnership program is the decrease in 
discretionary funding being targeted for the TCU/Head Start 
partnership. The Committee urges the Head Start Bureau to 
direct sufficient funding to allow current grantees to extend 
their programs for two additional years and to ensure that this 
vital program can continue and be expanded to serve all tribal 
college communities.

Consolidated runaway and homeless youth program

    The Committee recommends $93,000,000 for this program, an 
increase of $4,898,000 more than the fiscal year 2002 level and 
$4,867,000 more than the administration request. The Committee 
recommends not less than $41,800,000 for transitional living 
programs, and not less than $51,200,000 for basic centers.
    This program addresses the crisis needs of runaway and 
homeless youth and their families through support to local and 
State governments and private agencies. Basic centers and 
transitional living programs help address the needs of some of 
the estimated 300,000 homeless youth, many of whom are running 
away from unsafe or unhealthy living environments. These 
programs have been proven effective at supporting positive 
youth development, securing stable and safe living arrangements 
and providing the skills required to engage in positive 
relationships with caring adults and contribute to society. The 
Committee looks forward to the release of performance outcome 
data available through the new management information system.
    The Runaway and Homeless Youth Act requires that not less 
than 90 percent of the funds be allocated to States for the 
purpose of establishing and operating community-based runaway 
and homeless youth centers, as authorized under Parts A and B 
of the Act. Funds are distributed on the basis of the State 
youth population under 18 years of age in proportion to the 
national total. The remaining 10 percent funds networking and 
research and demonstration activities including the National 
Toll-Free Communications Center.
    Grants are used to develop or strengthen community-based 
programs which assist homeless youth in making a smooth 
transition to productive adulthood and social self-sufficiency; 
and to provide technical assistance to transitional living 
programs for the acquisition and maintenance of resources and 
services.
    The basic centers program, authorized under Part A of the 
Act, supports grants to community-based public and private 
agencies for the provision of outreach, crisis intervention, 
temporary shelter, counseling, family unification and aftercare 
services to runaway and homeless youth and their families.
    The transitional grant program (TLP) provides grants to 
local public and private organizations to address shelter and 
service needs of homeless youth, ages 16-21. The program's 
goals are to have youth safe at home or in appropriate 
alternative settings and to help them develop into independent, 
contributing members of society.
    A homeless youth accepted into the program is eligible to 
receive shelter and services continuously for up to 540 days. 
The services include counseling; life skills training, such as 
money management and housekeeping; interpersonal skill 
building, such as decision-making and priority setting; 
educational advancement; job preparation attainment; and mental 
and physical health care.
    The administration has proposed $10,000,000 for a separate 
maternity group home program. The Committee is aware of the 
need for and shares the administration's interest in funding 
residential services for young mothers and their children who 
are unable to live with their own families because of abuse, 
neglect, or other circumstances. The Committee notes that 
pregnant and parenting youth are currently eligible for and 
served through the TLP. The Committee commends the 
administration for placing special emphasis on pregnant and 
parenting youth in its fiscal year 2002 runaway and homeless 
youth program announcement. The Committee also compliments the 
administration for its special efforts to make the maternity 
group home community aware of the fiscal year 2002 program 
announcement.
    The Committee also recognizes the need for and value of 
expanding transitional living opportunities for all homeless 
youth. Therefore, the Committee seeks to preserve the 
flexibility afforded in current law to respond to the needs of 
the young people who are most at-risk and in greatest need of 
transitional living opportunities in their communities by 
providing additional resources to the existing portfolio of 
consolidated runaway and homeless youth act programs.
    It is the Committee's expectation that current and future 
TLP grantees will continue to provide transitional living 
opportunities and supports to pregnant and parenting homeless 
youth, as is their current practice. To further ensure that 
pregnant and parenting homeless youth are able to access 
transitional living opportunities and supports in their 
communities, the Committee encourages the Secretary, acting 
through the network of Federally-funded runaway and homeless 
youth training and technical assistance providers, to offer 
guidance to grantees and others on the programmatic 
modifications required to address the unique needs of pregnant 
and parenting youth and on the various sources of funding 
available for residential services to this population.

Maternity group homes

    The Committee recommendation does not include $10,000,000 
requested in the budget for the maternity group homes program. 
The Committee has deferred action on this program pending the 
enactment of authorizing language. Under this proposed program, 
the ACF would provide targeted funding for community-based, 
adult-supervised group homes for young mothers and their 
children. These homes would provide safe, stable, nurturing 
environments for mothers who cannot live safely with their own 
families and assist them in moving forward with their lives by 
providing support so they can finish school, acquire job 
skills, and learn to be good parents.
    The Committee provided a $19,000,000 increase in funding 
last year under the transitional living program to strengthen 
our Nation's support system for all youth in need of stable, 
safe living accommodations and services. The Committee expects 
the Family and Youth Services Bureau to continue to provide the 
technical assistance needed to enable TLP grantees and their 
community partners to address the unique needs of young mothers 
and their children, as well as helping interested entities in 
identifying sources of funding currently available to provide 
residential services to this population.

Child abuse prevention programs

    The Committee recommends $48,364,000 for child abuse and 
neglect prevention and treatment activities. The recommendation 
includes $22,013,000 for State grants, the same as last year 
and the budget request. The recommendation also includes 
$26,351,000 for discretionary activities, an increase of 
$201,000 more than last year and the same as the budget 
request. These programs seek to improve and increase activities 
at all levels of government which identify, prevent, and treat 
child abuse and neglect through State grants, technical 
assistance, research, demonstration, and service improvement.

Abandoned infants assistance

    The Committee recommendation includes $12,205,000 for 
abandoned infants assistance, an increase of $3,000 more than 
2002 level and the same amount as the budget request. This 
program provides financial support to public and private 
entities to develop, implement, and operate demonstration 
projects that will prevent the abandonment of infants and young 
children. Grants provide additional services such as 
identifying and addressing the needs of abandoned infants, 
especially those who are drug exposed or HIV positive; 
providing respite care for families and care givers; and 
assisting abandoned infants and children to reside with their 
natural families or in foster care.

Child welfare services

    The Committee recommends an appropriation of $291,986,000 
for child welfare services, the same as the fiscal year 2002 
level and the administration request. This program helps State 
public welfare agencies improve their child welfare services 
with the goal of keeping families together. State services 
include: preventive intervention, so that, if possible, 
children will not have to be removed from their homes; 
reunification so that children can return home and development 
of alternative placements like foster care or adoption if 
children cannot remain at home. These services are provided 
without regard to income.

Child welfare training

    The Committee recommends $7,498,000, an increase of $3,000 
over the comparable fiscal year 2002 level and the same amount 
as the administration request. Under section 426, title IV-B of 
the Social Security Act, discretionary grants are awarded to 
public and private nonprofit institutions of higher learning to 
develop and improve education/training programs and resources 
for child welfare service providers. These grants upgrade the 
skills and qualifications of child welfare workers.

Adoption opportunities

    The Committee recommends $27,405,000 for adoption 
opportunities, an increase of $20,000 more than the fiscal year 
2002 level and the same amount as 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. The Committee notes 
the progress that has been made in increasing adoptions of 
children within 2 years of their placement in the public foster 
care system, as well as the increase in family reunification 
within 1 year of placement.

Adoption incentives

    The Committee recommends $43,000,000 for adoption 
incentives, the same amount as the comparable fiscal year 2002 
appropriation and the budget request. The purpose of this 
program is to provide incentive funds to States to encourage an 
increase in the number of adoptions of children from the public 
foster care system. These funds are used to pay States bonuses 
for increasing their number of adoptions. The appropriation 
allows incentive payments to be made for adoptions completed in 
fiscal years 2001 and 2002.

Adoption awareness

    The Committee recommendation includes $12,906,000 for the 
adoption awareness program, the same amount as the fiscal year 
2002 level and the administration request. This program was 
authorized in the Children's Health Act of 2000. The program 
consists of two activities: the Infant Adoption Awareness 
Training Program and the Special Needs Awareness Campaign. The 
Infant Adoption Awareness Training Program provides grants to 
support adoption organizations in the training of designated 
health staff in eligible health centers that provide health 
services to pregnant women to inform them about adoption and 
make referrals on request on an equal basis with all other 
course of action. Within the Committee recommendation, 
$9,906,000 is available for this purpose.
    The Special Needs Adoption Campaign supports grants to 
carry out a national campaign to inform the public about the 
adoption of children with special needs. The Committee 
recommendation includes $3,000,000 to continue this important 
activity.

Compassion capital fund

    The Committee recommendation includes $45,000,000 for the 
compassion capital fund, $15,000,000 more than last year and 
$55,000,000 less than the budget request. Funds available will 
support grants to charitable organizations to emulate model 
social service programs and to encourage research on the best 
practices of social service organizations.
    The Committee expects funds made available through this 
program to supplement and not supplant private resources and 
encourages the Secretary to require private resources to match 
grant funding provided to public/private partnerships.

Social services research

    The Committee recommends $6,000,000 for social services and 
income maintenance research, the same amount the administration 
request for discretionary funding. Mandatory funding also is 
available for this purpose in the Welfare Reform legislation 
and the administration budget request assures $25,158,000 is 
available from this source. Last year, $31,158,000 was 
available for this program. These funds support cutting-edge 
research and evaluation projects in areas of critical national 
interest. Research includes determining services that are more 
cost-effective and alternative ways to increase the economic 
independence of American families.
    The Committee 4 years ago encouraged ACF to work with the 
State information technology consortium in an effort to help 
States with the difficult task of streamlining service 
delivery, while also meeting TANF record-keeping and reporting 
requirements. The Committee is pleased to learn that this 
effort is progressing and that States and ACF are now able to 
share systems information on TANF, child support enforcement, 
child welfare and child care activities. The Committee 
understands that plans are now underway to put in place web-
based technology that permits communications and interface 
within States, across State borders, and between ACF and 
States. Accordingly, the Committee urges ACF to expand its 
efforts with the State information technology consortium in 
fiscal year 2003. Similarly, The Committee is pleased to note 
that child support collections on behalf of families continue 
to grow. When combined with other income, child support 
collections passed through to TANF families can provide the 
boost needed to help a family attain self-sufficiency. To aid 
in this objective, the Committee urges CSE to implement the 
next phase of an effort launched last year in conjunction with 
the State information technology consortium. The Committee 
remains convinced that States are in a position to best 
determine how to remove current barriers to child support 
collections and to improve the flow of information between 
agencies and the court system.

Community-based resource centers

    The Committee recommends $33,417,000 for community-based 
resource centers, an increase of $1,000 more than the fiscal 
year 2002 level and the same amount as the administration 
request. These resources support two purposes: assisting each 
State in developing, operating, expanding and enhancing a 
network of community-based, prevention-focused, family resource 
and support programs and supporting activities that foster an 
understanding, appreciation, and knowledge of diverse 
populations in order to be effective in preventing and treating 
child abuse and neglect.

Developmental disabilities programs

    The Committee recommends $149,534,000 for developmental 
disabilities programs, an increase of $9,014,000 more than the 
comparable fiscal year 2002 amount and $9,000,000 more than the 
budget request. 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 $73,300,000. 
The State Councils on Developmental Disabilities program 
assists each State in promoting the development of a 
comprehensive, statewide, consumer and family-centered system 
which provides a coordinated array of culturally-competent 
services, and other assistance for individuals with development 
disabilities. State councils undertake a range of activities 
including demonstration of new approaches, program and policy 
analysis, interagency collaboration and coordination, outreach 
and training.

Protection and advocacy grants

    For protection and advocacy grants, the Committee 
recommends $37,000,000. This formula grant program provides 
funds to States to establish protection and advocacy systems to 
protect the legal and human rights of persons with 
developmental disabilities who are receiving treatment, 
services, or rehabilitation within the State.

Projects of national significance

    The Committee recommends $12,734,000 for projects of 
national significance to assist persons with developmental 
disabilities. This program funds grants and contracts providing 
nationwide impact by developing new technologies and applying 
and demonstrating innovative methods to support the 
independence, productivity, and integration into the community 
of persons with developmental disabilities.
    The Committee recognizes the potential benefits that 
assistive technology can have for individuals with 
developmental disabilities.
    Within the Committee recommendation, $4,000,000 is 
available to expand activities of the Family Support Program. 
The increase over the budget request for programs of national 
significance has been provided for this purpose.

University-affiliated programs

    For university-affiliated programs, the Committee 
recommends $26,500,000. This program provides operational and 
administrative support for a national network of university-
affiliated programs and satellite centers. Grants are made 
annually to university-affiliated programs and satellite 
centers for interdisciplinary training, exemplary services, 
technical assistance, and information dissemination activities.

Native American programs

    The Committee recommends $45,912,000 for Native American 
programs, the same amount as the 2002 level and $716,000 more 
than the budget request. The Administration for Native 
Americans [ANA] assists Indian tribes and native American 
organizations in planning and implementing long-term strategies 
for social and economic development through the funding of 
direct grants for individual projects, training and technical 
assistance, and research and demonstration programs.
    The Committee continues its significant interest in the 
revitalization of native languages through education. The 
Committee encourages ANA to allocate additional resources to 
support the Native American Languages program and urges the ANA 
to make schools a part of this effort, consistent with the 
policy expressed in the Native American Languages Act.

Community services

    The Committee recommends an appropriation of $743,990,000 
for the community services programs. This is $5,205,000 more 
than the fiscal year 2002 level and $103,665,000 higher than 
the administration request.
    Within the funds provided, the Committee recommends 
$650,000,000 for the community services block grant [CSBG]. 
These funds are used to make formula grants to States and 
Indian tribes to provide a wide range of services and 
activities to alleviate causes of poverty in communities and to 
assist low-income individuals in becoming self-sufficient.
    The Committee rejects the administration's recommendation 
to cut the Community Services Block Grant funding. Although a 
restrictive Committee allocation prevented CSBG funding from 
being substantially increased this year, the Committee 
continues to recognize the importance of CSBG and the Community 
Action Agencies it funds in helping meet the extraordinary 
challenges facing low-income communities.
    The Committee recognizes that many small rural communities 
have little if any capacity to plan for and undertake community 
development projects. Often times, this lack of capacity 
results in higher unemployment and a general deterioration of 
the communities' infrastructure.
    The Committee has provided bill language that instructs the 
Office of Community Services (OCS) to work with statewide 
associations of Community Action Agencies and individual 
Community Action Agencies that have experience in serving rural 
populations to implement a Rural Comprehensive Community 
Development Technical Assistance program in the States of West 
Virginia, Ohio, Kentucky, Iowa, Michigan, Wisconsin and 
Indiana. The Committee recognizes that there is an established 
network serving these particular States that is uniquely 
qualified to meet the needs of rural communities. As additional 
funds become available, the Office of Community Services is 
urged to consider the economic development technical assistance 
needs of rural communities in other States. The Committee 
recommendation includes $2,500,000 for OCS to carry out this 
program.
    The Nation's Community Action Agency network relies on CSBG 
funding to help initiate and administer programs designed to 
alleviate poverty. The universal characteristic of these CSBG-
funded programs is that they provide people with the resources 
and the tools to become self-sufficient. The Committee 
understands that the Department of Health and Human Services, 
and its Office of Community Services in particular, could 
better use this network in developing future policy 
initiatives. The Committee notes that in a number of States, 
including Iowa and Pennsylvania, CAA-initiated family 
development and self-sufficiency programs are a integral 
component of welfare reform efforts. The administration is 
encouraged to look for further nationwide linkages between 
those individuals seeking to leave the welfare system and 
become self-sufficient and the many family development and 
self-sufficiency strategies operated by Community Action 
Agencies.
    In addition, the Committee believes that the Office of 
Community Services should be more agressive in ensuring proper 
oversight of some State CSBG State expenditure of CSBG 
allocations that are intended to fund local eligible 
activities. The Committee expects the Office of Community 
Services to better evaluate and enforce each State's 
expenditure of CSBG funds. The Committee is also concerned that 
some State audits of the previous years' expenditures of CSBG 
funds are not adequately reviewed and acted upon.
    The Committee expects the Office of Community Services to 
release funding to the States in the most timely manner. The 
Committee also expects the States to makes funds available 
promptly. The Committee is aware that the Office of Community 
Services and some States have been extraordinarily delinquent 
in providing funds to local eligible entities.
    In addition, the Committee again expects the Office of 
Community Services to inform the State CSBG grantees of any 
policy changes affecting carryover CSBG funds within a 
reasonable time after the beginning of the Federal fiscal year.
    Several discretionary programs are funded from this 
account. Funding for these programs is recommended at the 
following levels for fiscal year 2003: community economic 
development, $34,000,000; individual development accounts, 
$24,990,000; rural community facilities, $7,500,000; national 
youth sports, $17,000,000; and community food and nutrition, 
$8,000,000.
    Community economic development grants are made to private, 
nonprofit community development corporations, which in turn 
provide technical and financial assistance to business and 
economic development projects that target job and business 
opportunities for low income citizens. The Committee has 
included bill language clarifying that Federal funds made 
available through this program may be used for financing for 
construction and rehabilitation and loans or investments in 
private business enterprises owned by Community Development 
Corporations. Of the total provided, the Committee has included 
$5,500,000 for the Job Creation Demonstration authorized under 
the Family Support Act to target community development 
activities to create jobs for people on public assistance. As 
in the past, the Committee expects that a priority for grants 
under this program go to experienced community development 
corporations.
    The Committee continues to support the Job Creation 
Demonstration program, authorized by the Family Support Act. 
This demonstration program provides grants on a competitive 
basis to non-profit organizations to create new employment and 
business opportunities for TANF recipients and other low income 
individuals. Funding also supports technical and financial 
assistance for private employers that will result in the 
creation of full-time permanent jobs for eligible individuals. 
The Committee recognizes that continued funding of the Job 
Creation Demonstration program would provide opportunities for 
more low-income individuals.
    Most of the drinking water and waste water systems in the 
country that are not in compliance with Federal standards are 
in communities of 3,000 or fewer. Rural Community Assistance 
Programs [RCAPs] use funds available from the Rural Community 
Facilities Program to assist a number of communities in gaining 
access to adequate community facilities, gaining financing for 
new or improved water and waste water systems and in complying 
with Federal standards.
    The Committee has included bill language allocating funding 
to the Office of Community Services for Rural Community 
Facilities Technical Assistance as authorized under section 
680(3)(B) of the Community Services Block Grant Act. In 
providing this funding, the Committee directs that it be used 
solely for the purpose of improving water and waste water 
facilities in poor, rural communities. As in the past these 
funds should be allocated to regional, rural community 
assistance programs.
    The Committee is concerned that many small and very small 
community water and wastewater treatment systems might be most 
vulnerable to terrorist attack, yet least prepared to deal with 
the issue. The Committee urges OCS to support a RCAP Small 
Community Infrastructure Safety and Security Training and 
Technical Assistance project, which will provide State, 
regional and national infrastructure safety and security 
training workshops and on-site technical assistance targeted to 
small and very small community water and wastewater treatment 
systems. The goal of the project is to improve the capacity of 
small systems to better prepare for emergencies, develop 
emergency preparedness training manuals for small water 
systems, identify appropriate technologies to secure such 
systems, and provide technical assistance to small communities 
struggling to deal with these issues.

Family violence prevention and services

    The Committee recommends $149,000,000 for family violence 
prevention and services programs, an increase of $7,385,000 
over the fiscal year 2002 appropriation and the budget request.
    For the runaway youth prevention program, the Committee 
recommends $16,000,000, which is $1,001,000 more than the 
fiscal year 2002 appropriation and 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 these youths, many of whom have 
been subjected to or are at risk of being subjected to sexual 
abuse. The goal of this program is to help young people leave 
the streets.
    For the national domestic violence hotline, the Committee 
recommends $3,000,000, which is $843,000 more than the fiscal 
year 2002 comparable level and 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 has recommended additional funding for 
the hotline because of the 19 percent growth in call volume 
that occurred last year and the associated increased in the 
caller abandonment rate of the hotline. The Committee is aware 
that employees of the parent agency even voluntarily reduced 
their pay to stay within budget constraints, rather than reduce 
hotline staff and service to those in need.
    The Committee recommends $130,000,000 for the grants for 
battered women's shelters program, $5,541,000 above the fiscal 
year 2002 program level and the administration request. This is 
a formula grant program to support community-based projects 
which operate shelters and provide related assistance for 
victims of domestic violence and their dependents. Emphasis is 
given to projects which provide counseling, advocacy, and self-
help services to victims and their children.

Early learning opportunities program

    The Committee recommendation includes $38,000,000 for the 
early learning opportunities program, an increase of 
$13,003,000 more than the comparable fiscal year 2002 funding 
level. The administration proposed eliminating this program. 
This program supports grants to local community councils 
comprised of representatives from agencies involved in early 
learning programs, parent organizations and key community 
leaders. Funds are used to increase the capacity of local 
organizations to facilitate development of cognitive skills, 
language comprehension and learning readiness; enhance 
childhood literacy; improve the quality of early learning 
programs through professional development and training; and 
remove barriers to early learning programs.

Faith-based center

    The Committee recommendation includes $1,500,000 to 
continue staff support for the operation of the Department's 
Center for Faith-Based and Community Initiatives, the same as 
the fiscal year 2002 level and the budget request.

Promotion of responsible fatherhood and healthy marriage

    The Committee recommendation does not include $20,000,000 
included in the budget request for a new program designed to 
promote responsible fatherhood and responsible marriage. 
Legislation has not been enacted that would create this new 
program. The purpose of this proposed program was to spur State 
and community level approaches to assist fathers to be more 
actively and productively involved in the lives of their 
children.

Mentoring children of prisoners

    The Committee recommendation includes $12,500,000 for this 
new program. The administration requested $25,000,000. The 
mentoring children of prisoners program was authorized last 
year under section 439 of the Social Security Act. The purpose 
of this program is to help children while their parents are 
imprisoned, which includes activities that keep children 
connected to a parent in prison in order to increase the 
chances that the family will come together successfully when 
the parent is released. As a group, children of prisoners are 
less likely than their peers to succeed in school and more 
likely to engaged delinquent behavior.

Independent Living Training Vouchers

    The Committee recommendation includes $60,000,000 for the 
new independent living program, the same as the budget request. 
These funds will support vouchers of up to $5,000 for college 
tuition or vocational training for individuals who age out of 
the foster care system, so they can be better prepared to live 
independently and contribute productively to society. Studies 
have shown that 25,000 youth leave foster care each year at age 
18 and just 50 percent will have graduated high school, 52 
percent will be unemployed and 25 percent will be homeless for 
one or more nights.

Program administration

    The Committee recommends $172,837,000 for program 
administration, $1,045,000 more than the comparable fiscal year 
2002 level and $2,090,000 more than the administration request.
    The Committee urges ACF to continue to make progress in 
improving its Annual Performance Plan and Annual Performance 
Report. The Committee notes that many programs proposed for 
funding do not have solid data for baselines or performance 
outcome measures. This lack of objective data makes more 
difficult the Committee's decisions regarding the allocation of 
limited resources. The Committee believes that the agency 
should work with program grantees and relevant associations to 
identify the most objective ways in which to evaluate the 
effectiveness of ACF programs and establish a timeline for 
producing meaningful data by which programs can be assessed.
    The Committee continues its interest in the Department's 
Child and Family Services reviews. These reviews are an 
effective method for monitoring the progress States are making 
in assuring the safety, health and permanency for children in 
child welfare and foster care as required in the Adoption and 
Safe Families Act. The Committee encourages the Department to 
make available sufficient resources to ensure full 
implementation of the new collaborative monitoring system. The 
Committee understands that the remaining States will be 
reviewed during fiscal year 2003. The Committee requests that 
ACF prepare a report on compliance and other implementation 
issues identified during these reviews and provide it to the 
Committee not later than 90 days after the last review.
    In establishing its Technical Assistance Centers for 
Children and Families initiative, the Committee urges the 
Administration to give consideration to establishing a Pacific 
Basin focus given the unique needs, geographical isolation, 
cultural complexities, and Federal responsibilities for the 
residents of that region.

                   PROMOTING SAFE AND STABLE FAMILIES

Appropriations, 2002....................................    $375,000,000
Budget estimate, 2003...................................     505,000,000
Committee recommendation................................     505,000,000

    The Committee recommends $505,000,000 for fiscal year 2003, 
an increase of $130,000,000 more than the fiscal year 2002 
amount and the same as the budget request. Funding available 
provides grants to States in support of: (1) family 
preservation services; (2) time-limited family reunification 
services (3) community-based family support services and (4) 
adoption promotion and support services. The Committee notes 
that most of the Federal funding related to child welfare is 
provided for the removal and placement of children outside of 
their own homes. Funds available through the Promoting Safe and 
Stable Families program are focused on supporting those 
activities that can prevent family crises from emerging that 
might require the temporary or permanent removal of a child 
from his or her own home.
    The Promoting Safe and Stable Families program is comprised 
of $305,000,000 in capped entitlement funds authorized by the 
Social Security Act and $200,000,000 in discretionary 
appropriations.

       PAYMENTS TO STATES FOR FOSTER CARE AND ADOPTION ASSISTANCE

Appropriations, 2002....................................  $4,855,600,000
Budget estimate, 2003...................................   4,855,000,000
Committee recommendation................................   4,855,000,000

    The Committee recommends $4,855,000,000 for this account, 
which is $30,600,000 less than the 2002 comparable level and 
the same as the budget request. In addition, the Committee 
recommendation concurs with the administration's request of 
$1,745,600,000 for an advance appropriation for the first 
quarter of fiscal year 2004. The Committee also has included 
bill language, proposed in the budget, that will improve 
program operations and the flow of funds to States. The Foster 
Care Program provides Federal reimbursement to States for: 
maintenance payments to families and institutions caring for 
eligible foster children, matched at the Federal medical 
assistance percentage [FMAP] rate for each State; and 
administration and training costs to pay for the efficient 
administration of the Foster Care Program, and for training of 
foster care workers and parents.
    The Adoption Assistance Program provides funds to States 
for maintenance costs and the nonrecurring costs of adoption 
for children with special needs. The goal of this program is to 
facilitate the placement of hard-to-place children in permanent 
adoptive homes, and thus prevent long, inappropriate stays in 
foster care. As in the Foster Care Program, State 
administrative and training costs are reimbursed under this 
program.
    The Independent Living Program provides services to foster 
children under 18 and foster youth ages 18-21 to help them make 
the transition to independent living by engaging in a variety 
of services including educational assistance, life skills 
training, health services and room and board. States are 
awarded grants from the annual appropriation proportionate to 
their share of the number of children in foster care, subject 
to a matching requirement.

                        Administration on Aging

Appropriations, 2002....................................  $1,349,089,000
Budget estimate, 2003...................................   1,340,986,000
Committee recommendation................................   1,383,907,000

    The Committee recommends an appropriation of $1,383,907,000 
for aging programs, $34,818,000 more than the fiscal year 2002 
comparable funding level and $42,921,000 more than the budget 
request.

Supportive services and senior centers

    The Committee recommends an appropriation of $364,500,000 
for supportive services and senior centers, $7,506,000 more 
than the comparable fiscal year 2002 level and $7,500,000 more 
than the administration request. This State formula grant 
program funds a wide range of social services for the elderly, 
including multipurpose senior centers, adult day care and 
ombudsman activities. State agencies on aging award funds to 
designated area agencies on aging who in turn make awards to 
local services providers. All individuals age 60 and over are 
eligible for services, although, by law, priority is given to 
serving those who are in the greatest economic and social need, 
with particular attention to low-income minority older 
individuals and those residing in rural areas. Under the basic 
law, States have the option to transfer up to 30 percent of 
funds appropriated between the senior centers program and the 
nutrition programs, which allows the State to determine where 
the resources are most needed.

Preventive health services

    The Committee recommends $24,062,000 for preventive health 
services, an increase of $2,939,000 more than the comparable 
fiscal year 2002 amount and $2,500,000 more than the budget 
request. Funds appropriated for this activity are part of the 
comprehensive and coordinated service systems targeted to those 
elderly most in need. Preventive health services include 
nutritional counseling and education, exercise programs, health 
screening and assessments, and prevention of depression.
    Within the appropriation for this program, the Committee 
recommends that $7,500,000 be provided to expand medication 
management, screening and education activities to prevent 
incorrect medication and adverse drug reactions among the 
elderly. These activities will help older adults learn more 
about managing medications safely and help reduce unnecessary 
hospitalizations and illnesses. The Committee notes that 
individuals aged 65 years and older take the greatest number 
and quantity of medications, which increases the health risks 
associated with adverse drug interactions and misuse. Studies 
have found that up to 28 percent of hospitalizations of older 
people are due to noncompliance with drug therapy and adverse 
events. These additional funds will help reduce the incidence 
of adverse effects of drug interaction and misuse.

Protection of vulnerable older Americans

    The Committee recommends $20,681,000 for grants to States 
for protection of vulnerable older Americans. Within the 
Committee recommendation, $15,449,000 is for the ombudsman 
services program and $5,232,000 is for the prevention of elder 
abuse program. The amount recommended for the ombudsman 
services program is $3,000,000 more than the fiscal year 2002 
level and the administration request. The amount recommended 
for the elder abuse prevention program is the same as the 
fiscal year 2002 level and budget request. 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 recognizes the importance of the Long-Term 
Care Ombudsman Program in assisting residents of nursing homes 
and board and care facilities resolve abuse and neglect 
complaints. The Committee is aware of the Institute of 
Medicine's 1995 study which recommended a ratio of 1 ombudsman 
for every 2,000 nursing home beds to meet the needs of long-
term care residents, as well as the DHHS Office of Inspector 
General's 1999 report recommending additional funding for the 
program. Therefore, the Committee has provided an increase of 
$3,000,000 for the Long-Term Ombudsman Program, which will 
allow the program to hire additional ombudsman staff, expand 
public information and education campaigns, and upgrade 
technology.
    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.

National family caregiver support program

    The Committee recommends $153,500,000 for the national 
family caregiver support program, an increase of $17,500,000 
more than the comparable fiscal year 2002 level and the budget 
request. Funds appropriated for this activity established a 
multifaceted support system in each State for family 
caregivers. All States are expected to implement the following 
five components into their program: individualized referral 
information services; assistance to caregivers in locating 
services from a variety of private and voluntary agencies; 
caregiver counseling, training and peer support; respite care 
provided in the home, an adult day care center or other 
residential setting located in an assisted living facility; and 
limited supplemental services that fill remaining service gaps.
    The Committee continues to make investment in our Nation's 
family caregiver support system, in recognition of the critical 
role and essential care that millions of informal and family 
caregivers provide. Research has shown that half of all 
caregivers of older persons are 65 years of age or older, many 
of whom are themselves in fair to poor health. Further, one-
third of caregivers are employed full-time and have to take 
unpaid leave or rearrange their work schedules to care for a 
loved one. The family caregiver support program provides 
respite care, caregiving training and counseling and other 
support services that support the efforts of the caregiver.

Native American Caregiver Support Program

    The Committee recommendation includes $7,000,000 to carry 
out the Native American Caregiver Support Program, an increase 
of $1,500,000 more than last year and the budget request. The 
program will assist Tribes in providing multifaceted systems of 
support services for family caregivers and for grandparents or 
older individuals who are relative caregivers. In fiscal year 
2002, funds were used to provide both discretionary and formula 
grants to support the goals of this program.

Congregate and home-delivered nutrition services

    For congregate nutrition services, the Committee recommends 
an appropriation of $390,000,000, the same amount as the 
comparable fiscal year 2002 level and the budget request. For 
home-delivered meals, the Committee recommends $183,617,000, an 
increase of $7,475,000 more than the comparable fiscal year 
2002 funding level and $5,475,000 more than the administration 
request. These programs address the nutritional need of older 
individuals. Projects funded must make home-delivered and 
congregate meals available at least once a day, 5 days a week, 
and each meal must meet one-third of the minimum daily dietary 
requirements. While States receive separate allotments of funds 
for congregate and home-delivered nutrition services and 
support services, they are permitted to transfer up to 40 
percent of funds between these programs.
    The Committee celebrates the 30th anniversary of the Older 
Americans Act Nutrition Program. Over the past 30 years, the 
program has supported almost 6 billion meals for older 
Americans. A national evaluation of the nutrition program found 
that it successfully reaches older individuals who are older, 
poorer, more likely to live in rural areas, more functionally 
impaired and at higher nutritional risk than the population 
generally. Individuals who were served realized higher nutrient 
intake, decreased food insecurity, increased social interaction 
and an improved quality of life. The Committee also recognizes 
the significant role that the program plays beyond the 
provision of meals. Nutrition screening, education and 
counseling services are critical to maintaining good health and 
independence for older adults.

Nutrition Services Incentives Program

    The Committee recommendation includes $149,670,000 for the 
nutrition services incentives program, the same as the 
comparable fiscal year 2002 funding level and the budget 
request.
    The Committee agrees with the administration's request to 
shift funding for the Nutrition Services Incentive Program 
(NSIP) from the Food and Nutrition Service within USDA to the 
Administration on Aging within the Department of Health and 
Human Services (DHHS). It is the Committee's belief, however, 
that it is critically important for several aspects of NSIP to 
remain intact, as the program is shifted into DHHS. This 
includes the allocation of NSIP funds on the basis of the 
number of meals served in a State in the previous year, as 
opposed to the number of seniors that reside in that State. 
Further, NSIP funds are not currently, and should not become, 
subject to transfer, expenditure for administrative costs, or 
match requirements, and States should continue to have the 
option of receiving benefits in the form of cash or 
commodities. The Committee directs the Under Secretary of the 
Food and Nutrition Service to work with the Assistant Secretary 
for Aging within DHHS to ensure this transfer of funding and 
responsibilities is carried out in a manner that in no way 
disrupts the delivery of services provided by NSIP. The 
Committee has maintained access to commodities within USDA 
because the agency has both the infrastructure and the 
expertise to conduct this activity that is not available in AoA 
and HHS.

Aging grants to Indian tribes and native Hawaiian organizations

    The Committee recommends $27,675,000 for grants to native 
Americans, $1,946,000 more than the comparable fiscal year 2002 
amount and the administration request. Under this program 
awards are made to tribal and Alaskan Native organizations and 
to public or nonprofit private organizations serving native 
Hawaiians which represent at least 50 percent Indians or 
Alaskan Natives 60 years of age or older to provide a broad 
range of supportive services and assure that nutrition services 
and information and assistance are available.

Training, research and discretionary projects

    The Committee recommends $27,837,000 for training, 
research, and discretionary projects, $10,436,000 less than the 
fiscal year 2002 comparable level and the same as the budget 
request. These funds support activities designed to expand 
public understanding of aging and the aging process, apply 
social research and analysis to improve access to and delivery 
of services for older individuals, test innovative ideas and 
programs to serve older individuals, and provide technical 
assistance to agencies that administer the Older Americans Act.
    The Committee has provided support at last year's level to 
continue the pilot project to test the best ways of using the 
skills of retired nurses, doctors, accountants and other 
professionals to train other seniors and to serve as expert 
resources to detect and stop Medicare fraud, waste and abuse. 
The Committee expects that these funds will be used to make 
grants and that administrative costs will be minimized. In 
addition, the Committee expects that an improved system will be 
developed and implemented in coordination with CMS and the OIG 
to track cases referred by this initiative.Insert 216A
    The Committee is aware that the Centers for Disease Control 
and Prevention (CDC) reported that more than 10,000 seniors 
died in 1999 from fall-related injuries. CDC estimates that the 
direct costs to Medicare and Medicaid for falls-related care 
will exceed $32,000,000,000 in 2020. Given the unnecessary and 
premature loss of life and public expense associated with elder 
falls, the Committee encourages the Administration on Aging to 
oversee and support a national education campaign to reduce the 
risk of elder falls and prevent repeat falls. The campaign 
should be directed to elders, their families, and health care 
providers.
    The Committee continues to support funding at no less than 
last year's level for national programs scheduled to be 
refunded in fiscal year 2003 that address a variety of issues, 
including elder abuse, native American issues and legal 
services.

Aging network support activities

    The Committee recommends $2,379,000 for aging network 
support activities, the same as the comparable fiscal year 2002 
amount and the budget request. The Committee recommendation 
includes $1,199,000 for Eldercare Locator. The Committee 
recommendation provides $1,180,000 for the pension information 
and counseling projects, the same as the comparable fiscal year 
2002 level.
    The Eldercare Locator, a toll-free, nationwide directory 
assistance service for older Americans and their caregivers, is 
operated by the National Association of Area Agencies on Aging. 
Since 1991, the service has linked more than 700,000 callers to 
an extensive network of resources for aging Americans and their 
caregivers. The Committee provided an increase of almost 
$340,000 to support expansion to the Internet of this 
information and referral service.
    Pension counseling projects provide information, advice, 
and assistance to workers and retirees about pension plans, 
benefits, and how to pursue claims when pension problems arise. 
The information dissemination and outreach activities of the 
pension counseling projects have reached nearly 50,000 
individuals. In addition, individualized counseling to more 
than 7,000 individuals has helped recoup more than $30,000,000 
on behalf of older individuals.

Alzheimer's Disease Demonstration Grants to States

    As a result of the aging of the baby boom generation, the 
number of individuals affected by Alzheimer's disease will 
double in the next 20 years. The Committee recommends a funding 
level of $15,000,000, an increase of $3,504,000 more than the 
comparable fiscal year 2002 level and $3,500,000 more than the 
administration's request, for Alzheimer's disease demonstration 
grants to States.
    Currently, an estimated 70 percent of individuals with 
Alzheimer's disease live at home, where families provide the 
preponderance of care. For these families, caregiving comes at 
enormous physical, emotional and financial sacrifice. The 
Alzheimer's disease demonstration grant program currently 
provides matching grants to 32 States to stimulate and better 
coordinate services for families coping with Alzheimer's. With 
a relatively small amount of Federal support to provide the 
stimulus, States have found innovative ways to adapt existing 
health, long-term care, and community services to reach 
previously underserved populations, particularly minorities and 
those living in rural communities. Given the program's proven 
record of success, the Committee recommends an increase of 
$2,504,000 more than the comparable 2002 appropriation to 
expand the program to additional States. Given the enormous 
demands on Alzheimer's family caregivers, the Committee has 
included $1,000,000 to support an Alzheimer's family contact 
center for round-the-clock help to Alzheimer's families in 
crisis.

Program administration

    The Committee recommends $17,986,000 to support Federal 
staff that administer the programs in the Administration on 
Aging, $116,000 less than the comparable 2002 level and the 
same amount as the budget request. These funds provide 
administrative and management support for programs administered 
by the agency.

                        Office of the Secretary


                    GENERAL DEPARTMENTAL MANAGEMENT

Appropriations, 2002....................................    $347,052,000
Budget estimate, 2003...................................     384,395,000
Committee recommendation................................     377,386,000

    The Committee recommends $377,386,000 for general 
departmental management [GDM]. This is $7,009,000 below the 
administration request and $30,334,000 above the fiscal year 
2002 level. The Committee does not agree to the proposed 
consolidation of Public Affairs and Legislative Affairs 
functions in the Office of the Secretary. For this reason the 
Committee's recommendation does not include the $27,793,000 
requested to transfer staff from the operating divisions to the 
Office of the Secretary. In addition, the Committee has denied 
the fiscal year 2003 bill language request, proposed in the 
budget, to transfer funds from accounts of the National 
Institutes of Health and the Agency for Healthcare Research and 
Quality within the Department for the purpose of consolidating 
all of HHS legislative and public affairs activities within the 
Office of the Secretary. The Committee has taken this action 
because of the concern that information necessary to make 
timely decisions by the Congress and requests for information 
by the public may be delayed by this consolidation.
    The Committee recommendation includes $21,552,000 in 
appropriated funds which in previous years were provided 
through program evaluation funds. On a comparable basis, the 
Committee's recommendation reflects a decrease of $768,000 
below the administration request. The Committee recommendation 
includes the transfer of $5,851,000 from Medicare trust funds, 
which is the same as the administration request and the fiscal 
year 2002 level.
    The Committee directs that specific information requests 
from the chairman and ranking member of the Subcommittee on 
Labor, Health and Human Services, and Education, and Related 
Agencies, on scientific research or any other matter, shall be 
transmitted to the Committee on Appropriations in a prompt 
professional manner and within the time frame specified in the 
request. The Committee further directs that scientific 
information requested by the Committees on Appropriations and 
prepared by Government researchers and scientists be 
transmitted to the Committee on Appropriations, uncensored and 
without delay.
    This appropriation supports those activities that are 
associated with the Secretary's role as policy officer and 
general manager of the Department. It supports certain health 
activities performed by the Office of Public Health and 
Science, including the Office of the Surgeon General. GDM funds 
also support the Department's centralized services carried out 
by several Office of the Secretary staff divisions, including 
personnel management, administrative and management services, 
information resources management, intergovernmental relations, 
legal services, planning and evaluation, finance and 
accounting, and external affairs.
    The Office of the Surgeon General, in addition to its other 
responsibilities, provides leadership and management oversight 
for the PHS Commissioned Corps, including the involvement of 
the Corps in departmental emergency preparedness and response 
activities.
    The Committee has provided $4,000,000 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.
    Chronic Fatigue.--The Committee is disappointed that the 
establishment of the Department's Chronic Fatigue Syndrome 
advisory committee, announced in January 2001, has been delayed 
and that the advisory committee's predecessor, the Chronic 
Fatigue Syndrome Coordinating Committee has not met since 
January 2001. These delays have jeopardized momentum and 
important partnerships between the member agencies and the CFS 
community. The Committee urges the Department to approve the 
CFS Advisory Committee Charter, publish a call for nominations, 
install members and hold one meeting, all prior to the end of 
calendar year 2002. It is this Committee's expectation that the 
new advisory committee will not diminish the full partnership 
of involved agencies or the collaborative relationships among 
Federal agencies, scientists, and CFS advocates that have 
developed over recent years through the CFS Coordinating 
Committee. The Committee anticipates that the new advisory 
committee will further advance the efforts of the Department 
and the public health service agencies to address the 
scientific questions about CFS and the social service needs of 
persons with CFS.
    Complementary and Alternative Medicine Policy.--The 
Committee is pleased with the strong work and final report of 
the White House Commission on Complementary and Alternative 
Medicine Policy. The Committee expects the Secretary to provide 
sufficient funds to establish an interagency coordinating unit 
to assist with the implementation of the Commission's 
recommendations and expects to receive a briefing on the 
Department's progress in this area by March 30, 2003.
    Data Collection.--The Committee urges the Secretary to 
strengthen the Department's collection and reporting of data on 
health care enrollment, access and utilization by patients' 
race, ethnicity, primary language and socioeconomic status by 
all agencies engaged in, or receiving Federal funds for health-
related activities. It is expected that all Federal, State, and 
other entities receiving Federal funds shall collect and report 
disaggregated data; that racial and ethnic data shall be 
reported by federally-defined categories, and by subpopulation 
groups. Measures of racial and ethnic disparities should be 
used in performance measurement and in monitoring the progress 
of federally-funded activities for the elimination of health 
disparities. As the Nation's leading health enterprise, the 
Department is expected to play a leadership role in assuring 
the collection and reporting of racial, ethnic and primary 
health-related data through written policy and sustained action 
and resources. The Secretary is urged to designate a central 
authority within the Department to oversee its policies in this 
area, as well as dissemination, implementation and compliance 
activities.
    The Secretary must ensure that Federal datasets meet at 
least the minimum standards set by the Office of Management and 
Budget in 1997 and subsequent standards for maintaining, 
collecting, and presenting Federal data on race and ethnicity. 
Also, the Committee reminds the Secretary of OMB's requirement 
that the standards be adopted as soon as possible, but not 
later than January 1, 2003, for use in household surveys, 
administrative forms and records, and other data collections 
purposes.
    Homelessness.--The Committee supports the administration's 
goal of ending chronic homelessness. The Committee encourages 
the various agencies within the Department to re-examine their 
program delivery mechanisms to ensure that resources, both 
targeted and mainstream, are reaching people who have been 
homeless for long periods of time.
    The Committee also supports efforts to address chronic 
homelessness more effectively through better coordination of 
housing and support services at both the national policy and 
local service delivery levels. The Committee encourages the 
Department to seek opportunities to partner with the Department 
of Housing and Urban Development in providing service enriched 
supportive housing. The development of permanent supportive 
housing, that is, housing coupled with mental health, substance 
abuse and primary care supportive services, has been shown to 
be a highly effective model for addressing the needs of the 
chronically homeless. The Committee encourages Departmental 
program offices, including the Community Health Centers Program 
in HRSA, and the Centers for Mental Health Services, Substance 
Abuse Treatment, and Substance Abuse Prevention in SAMHSA to 
work with their grantees to identify opportunities for 
collaborating with local housing providers to develop permanent 
supportive housing.
    The Committee urges the Department to study whether 
additional policies and protocols may be needed to ensure that 
persons being discharged from systems of care including mental 
health and substance abuse treatment programs and foster care 
have housing options to prevent such discharge from immediately 
resulting in homelessness.
    Racial and Ethnic Disparities.--The Committee is deeply 
concerned about the results of a study released in March 2002 
from the Institute of Medicine: Unequal Treatment: Confronting 
Racial and Ethnic Disparities in Health Care. The Committee is 
committed to ensuring the overall improved health of the 
American people, and strongly urges the Secretary to take the 
steps necessary to implement the study's recommendations, which 
offer significant guidelines and opportunities for eliminating 
health disparities and improving health. Specifically, all 
institutes and agencies are strongly encouraged to increase the 
representation of racial and ethnic minorities among health 
professionals, advance equity of care through the use of 
evidence-based guidelines, and promote the concept of multi-
disciplinary treatment teams and community health workers who 
can help patients navigate through the health care system. The 
Committee expects the Secretary to report on the progress of 
this action during next year's appropriations hearings, and to 
include a progress update in the Department's Budget 
Justification.
    Tick-Borne Disease.--The Committee urges the Secretary to 
consult with the biomedical community, community-based 
clinicians, voluntary organizations, patients and appropriate 
governmental agency officials to ensure coordination and 
communication regarding tick-borne diseases. These 
consultations may provide knowledge and support to the 
Secretary on matters of program oversight, performance, and 
priority setting for agencies that impact tick borne diseases.

Adolescent family life

    The Committee has provided $31,124,000 for the Adolescent 
Family Life Program [AFL]. This is $2,198,000 more than the 
fiscal year 2002 appropriation and same as the administration 
request.
    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 $1,223,000 for the Federal staff 
which supports the President's Council on Physical Fitness and 
Sports. This is the same as the budget request and $86,000 more 
than the fiscal year 2002 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 13265, as 
amended. The programs sponsored by PCPFS are supported largely 
through private sector partnerships.
    The Committee has provided additional resources in this 
bill for a physical activity and nutrition initiative. The 
President's Council is urged to take a look at the Committee's 
recommendations and offer suggestions regarding how to 
coordinate between programs receiving funds for this purpose 
and how to build upon this initiative next year.

Minority health

    The Committee recommends $46,329,000 for the Office of 
Minority Health. This is the same as the budget request and 
$3,228,000 less than the fiscal year 2002 appropriation.
    The Office of Minority Health [OMH] focuses on strategies 
designed to decrease the disparities and to improve the health 
status of racial and ethnic minority populations in the United 
States. OMH establishes goals, and coordinates all departmental 
activity related to improving health outcomes for disadvantaged 
and minority individuals. OMH supports several demonstration 
projects, including the Minority Community Health Coalition, 
the Bilingual/Bicultural Service, the Center for Linguistic and 
Cultural Competency in Health Care, and the Family and 
Community Violence Prevention Program.
    The Committee continues to recognize the need to recruit 
and train more minorities in the health professions. The 
Committee encourages the Office of Minority Health to support 
established programs that have a proven record of increasing 
the number of under-represented minorities entering the health 
professions.
    Health Disparities.--The Committee commends the Secretary 
for designating the elimination of health disparities as a 
major priority for the Department, and is encouraged that the 
agencies within the Department are moving forward in this area 
as they develop, implement, and evaluate strategic plans for 
eliminating health disparities. The Committee expects the 
Office of Minority Health, along with the National Center for 
Minority Health and Health Disparities at the National 
Institutes of Health, to coordinate and monitor the 
implementation of the Department's elimination of health 
disparities strategic plans. The Committee expects the 
Secretary to report to Congress on the progress and 
implementation of the strategic plans during next year's 
appropriations hearings, and to include a progress update in 
the Department's Budget Justification.
    National Minority Male Health Project.--The Committee 
continues to support this effort and urges the Office of 
Minority Health to fund a consortium of historically black 
colleges and universities (HBCUs) to plan for the 
implementation of this project. The Committee understands that 
Bowie State University, Lincoln University, Morehouse College, 
Morgan State University, and Wilberforce will all be part of 
the initial group of demonstration institutions. The Committee 
urges that OMH dedicate adequate funds to expand this effort to 
include at least five additional HBCUs as demonstration 
institutions.
    Provider education.--The Committee encourages the Secretary 
to provide funding for HIPAA provider education geared 
specifically to home care and hospice providers. These funds 
should be used to assist providers in complying with HIPAA 
privacy and administrative simplification requirements.

Office on Women's Health

    The Committee recommends $31,795,000 for the Office on 
Women's Health. This is $3,000,000 above the administration 
request and $5,034,000 more than the fiscal year 2002 
appropriation.
    The PHS Office on Women's Health [OWH] develops, 
stimulates, and coordinates women's health research, health 
care services, and public and health professional education and 
training across HHS agencies. It advances important 
crosscutting initiatives and develops public-private 
partnerships, providing leadership and policy direction, and 
initiating and synthesizing program activities to redress the 
disparities in women's health.
    The Committee remains strongly supportive of the work done 
by the Office on Women's Health in the Office of the Secretary. 
In addition to its own work advancing women's health, it 
provides critical coordinating services with offices located in 
NIH, CDC, HRSA, FDA, SAMHSA, AHRQ, and CMS. In totality, these 
offices assure that issues related to research, treatment, 
services, training, and education efforts by HHS reflect the 
distinct needs of women. The Secretary should notify the 
Committee in advance of any changes planned for the status, 
location, or reporting structure of this office or any of the 
offices enumerated above.
    The Committee is concerned that little progress has been 
made at reducing maternal mortality or morbidity over the past 
20 years. The Committee therefore has provided $3,000,000 to 
the Office on Women's Health to establish an ``Interagency 
Coordinating Committee on Safe Motherhood,'' which shall 
include representatives of relevant Federal agencies and 
offices, community healthcare experts, relevant community 
health professionals, and leaders from the women's health 
community. The Interagency Committee, as part of its duties, 
shall evaluate existing research and health promotion programs 
and their success in serving pregnant women. The Interagency 
Committee shall also develop a 5-year Federal research and 
strategic action plan, including professional funding 
recommendations, to reduce maternal morbidity and mortality.
    The plan shall include recommendations for the research in 
the following areas: pregnancy-related conditions, the impact 
of chronic conditions on pregnancy, complications that occur 
during pregnancy, post-partum conditions (depression, 
hemorrhage, and fever), racial and ethnic disparities in 
maternal morbidity and mortality, social and behavioral factors 
in pregnancy, as well as the safety of drugs, devices, 
cosmetics, and food with respect to pregnancy and on the impact 
of pregnancy in women 35 and older. The plan shall also include 
specific recommendations for establishing and implementing a 
national public education and health promotion campaign on safe 
motherhood. The ``Interagency Coordinating Committee'' shall 
prepare and submit the Federal research and strategic action 
plan no later than 18 months after enactment of this Act to the 
Secretary and the Committee.

Office of Emergency Preparedness

    The Committee has provided $15,247,000, which is the same 
as the budget request and $1,076,000 more than last year, 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 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.

HIV/AIDS in minority communities

    To address high-priority HIV prevention and treatment needs 
of minority communities heavily impacted by HIV/AIDS, the 
Committee recommends $50,000,000. These funds are available to 
key operating divisions of the Department with capability and 
expertise in HIV/AIDS services to assist minority communities 
with education, community linkages, and technical assistance.

                      OFFICE OF INSPECTOR GENERAL

Appropriations, 2002....................................     $35,727,000
Budget estimate, 2003...................................      39,747,000
Committee recommendation................................      39,747,000

    The Committee recommends an appropriation of $39,747,000 
for the Office of Inspector General. This is the same as the 
administration request and $4,020,000 higher than the fiscal 
year 2002 level. In addition to discretionary funds, the Health 
Insurance Portability and Accountability Act of 1996 provides 
$160,000,000 in mandatory funds for the Office of the Inspector 
General in fiscal year 2003; the total funds provided to the 
Office by this bill and the authorizing bill would be 
$199,747,000 in fiscal year 2003.
    The Office of Inspector General conducts audits, 
investigations, inspections, and evaluations of the operating 
divisions within the Department of Health and Human Services. 
The OIG functions with the goal of reducing the incidence of 
waste, abuse, and fraud. It also pursues examples of 
mismanagement toward the goal of promoting economy and 
efficiency throughout the Department.
    The Committee commends the Office of Inspector General for 
their continued good work to reduce waste, fraud and abuse in 
Department programs. The Committee expects efforts to reduce 
Medicare mispayments will be continued and expanded. The 
Committee also wants to assure that seniors calling into the 
toll-free telephone line to report Medicare mispayments get a 
prompt and complete response.

                        OFFICE FOR CIVIL RIGHTS

Appropriations, 2002....................................     $31,955,000
Budget estimate, 2003...................................      33,642,000
Committee recommendation................................      33,642,000

    The Committee recommends $33,642,000 for the Office for 
Civil Rights. This is the same as the administration request 
and $1,687,000 more than the fiscal year 2002 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 2002 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, 2002....................................      $2,500,000
Budget estimate, 2003...................................       2,499,000
Committee recommendation................................       2,499,000

    The Committee recommends $2,499,000 for policy research, 
which is the same as the administration request and $1,000 less 
than the fiscal year 2002 amount. The Committee also provides 
$18,000,000 in program evaluation funds, which will yield a 
program level of $20,499,000 in fiscal year 2003.
    Funds appropriated under this title provide resources for 
research programs that examine broad issues which cut across 
agency and subject lines, as well as new policy approaches 
outside the context of existing programs. This research can be 
categorized into three major areas: health policy, human 
services policy, and disability, aging and long-term care 
policy.

     RETIREMENT PAY AND MEDICAL BENEFITS FOR COMMISSIONED OFFICERS

Appropriations, 2002....................................    $262,075,000
Budget estimate, 2003...................................     251,039,000
Committee recommendation................................     251,039,000

    The Committee provides an estimated $251,039,000 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 $11,036,000 below the estimated 
payments for fiscal year 2002.
    This account provides for: retirement payments to U.S. 
Public Health Service officers who are retired for age, 
disability, or length of service; payments to survivors of 
deceased officers; medical care to active duty and retired 
members and dependents and beneficiaries; and for payments to 
the Social Security Administration for military service 
credits.
    The Committee notes that, according to the budget request, 
the various agencies and operating divisions across the 
Department are expected to absorb $27,702,000 in retirement 
medical cost payments for Commissioned Corps Officers. Medical 
cost payments have traditionally been funded by this account. 
While the Committee understands that the transfer of 
responsibility is mandated in the Department of Defense 
Reauthorization Act of fiscal year 2002, the Committee is 
disturbed that the corresponding funds were not transferred to 
the operating divisions to cover these costs. Therefore, the 
Committee has included bill language mandating that the 
Retirement Pay and Medical Benefits for Commissioned Officers 
account continue to cover these costs in fiscal year 2003 as it 
has done in the past. The Committee expects that any future 
proposals by the administration for the operating divisions to 
pay these costs will include the funding required to do so.

           HEALTH FACILITIES CONSTRUCTION AND MANAGEMENT FUND

Appropriations, 2002....................................................
Budget estimate, 2003...................................    $184,000,000
Committee recommendation................................................

    The Committee recommendation does not include funding for 
this account. The administration proposed consolidating into 
this account the management of buildings and construction 
across the Department. Instead the Committee has included 
$322,000,000 for buildings and facilities in the CDC 
appropriation and $20,000,000 for CDC security in the PHSSEF 
appropriation.

            PUBLIC HEALTH AND SOCIAL SERVICES EMERGENCY FUND

Appropriations, 2002....................................  $2,707,263,000
Budget estimate, 2003...................................   2,295,184,000
Committee recommendation................................   2,255,980,000

    The Committee recommends $2,255,980,000 for the Public 
Health and Social Services Emergency Fund. This is $39,204,000 
below the administration request and $451,283,000 below the 
fiscal year 2002 level. The Committee has provided funding for 
Poison Control and Emergency Medical Services for Children in 
HRSA instead of in this account as proposed by the 
administration. The Committee has fully funded the 
administration request when these amounts are included.
    The Committee provides $940,000,000 to CDC for upgrading 
State and local capacity. This amount maintains funding at the 
level provided last year. The Committee has included 
$40,000,000 for the Health Alert Network. The Health Alert 
Network was established to provide ongoing communications, 
technology, information systems support and education and 
training to local public health agencies. The Committee 
recognizes the important role that HAN played during and after 
the events of September 11. The Committee is also aware that 
the broad public health infrastructure required is the same for 
bioterrorism preparedness as for other public health threats. 
The Committee also recognizes that ongoing support for 
communications, technology and information systems is necessary 
to ensure that broad-based public health capacity is improved 
and maintained. Given the investment made in the development of 
HAN, the Committee expects that CDC will move forward with the 
next logical phase of the network, which is to provide 
workforce training and education, support for organizational 
capacity building in local public health agencies and the 
creation of knowledge management systems required by public 
health practitioners.
    The Committee directs CDC and the Department to assure that 
State HAN grantees spend no less than 85 percent of these funds 
at the local level for local public health improvement. 
Further, CDC and the Department are directed to ensure that any 
funds provided for training, communications and technology for 
bioterrorism be coordinated and used in collaboration with HAN 
where appropriate.
    Of the total amount, the Committee recommends $158,700,000 
for upgrading CDC capacity, which is an increase of $21,995,000 
over the fiscal year 2002 level. The Committee recommends an 
additional $5,000,000 to CDC for public health preparedness 
centers in order to provide public health preparedness training 
to contiguous States. The Committee has also provided the 
following amounts for CDC: $300,000,000 for the National 
Pharmaceutical Stockpile, $100,000,0000 for the smallpox 
vaccine, $18,040,000 for evaluation and research of the anthrax 
vaccine, and $20,000,000 for security at CDC's facilities in 
Atlanta, including information technology security.
    The Committee notes that these funds provided to CDC can be 
used to give assistance to States who want to use technology 
which allows for more rapid administration of vaccines on a 
massive scale in case of bioterrorism attack.
    The Committee's recommendation includes $152,240,000 for 
the Office of the Secretary, an increase of $35,396,000 over 
fiscal year 2002. The Committee has provided $2,000,000 within 
this amount to the Office of Public Health and Science for 
activities related to the transformation and modernization of 
the Public Health Service (PHS) Commissioned Corps. Such a 
transformation will entail the following: (1) establishment of 
an integrated command and control structure, to provide the 
Secretary with the capacity to field proportional responses to 
emergencies while simultaneously strengthening the nation's 
public health infrastructure; and (2) modernization of the 
Corps to ensure that it is rapidly deployable and adaptable, 
capable of responding effectively to emergencies of varying 
intensities, able to integrate resources from various partner 
agencies into a unified response system, and directed via an 
integrated management and administration structure in the 
Department. These funds will allow an increase in recruitment 
for Corps health professionals, expand and enhance the 
Commissioned Corps Readiness Force, provide medical readiness 
education and training to Corps personnel, and establish a PHS 
Auxiliary system to provide locally-grouped professionals who 
can be deployed along with Corps teams.
    The Committee also provides $547,000,000 to HRSA for 
bioterrorism activities. Of this amount, $492,000,000 is for 
hospital preparedness and infrastructure improvements related 
to bioterrorism. This is an increase of $357,000,000 over last 
year's level. The Committee provides $55,000,000 for curriculum 
development and training on the detection and treatment of 
diseases caused by bioterrorism. The Committee recommendation 
also includes $10,000,000 for SAMHSA and $5,000,000 for 
bioterrorism research at AHRQ.
    The Committee directs the Secretary to use the $10,000,000 
for SAMHSA to supplement the $20,000,000 available for the 
National Child Traumatic Stress Initiative within Programs of 
Regional and National Significance under the Center for Mental 
Health Services. With a total program level of $30,000,000 
($10,000,000 more than last year, excluding $10,000,000 in 
grants supported by Public Law 107-38), the Committee expects 
that SAMHSA will be able to increase the number of children and 
families served through the direct services provided by this 
program. In addition, the additional funding will promote 
improvements in treatment, training opportunities and public 
information efforts.
    In addition to the funds provided in the PHSSEF, the 
Committee has provided $1,485,100,000 to NIH for bioterrorism-
related activities. The aggregate amount provided in this bill 
for bioterrorism is $3,741,080,000.
    The Committee notes that a bioterrorism event will occur at 
the local level and will require local capacity, preparedness 
and initial response. For this reason it was the intent of 
Congress that a significant amount of the funding provided in 
the Emergency Supplemental Act of 2002 (Public Law 107-117) be 
used to improve local public health capacity and meet the needs 
determined by local public health agencies. The Committee 
believes it is essential that local public health agencies are 
full partners in developing State plans and that a significant 
level of funding be made available to build local capacity and 
meet the needs as determined by local public health officials.
    Therefore, the Committee directs the Department to report 
on steps it is taking to ensure that: (1) substantial funding 
reaches local public health agencies, and such funds are used 
to build local public health capacity in ways with which local 
public health officials concur; and (2) local public health 
agencies are fully participating partners in developing State 
preparedness plans. The Department is directed to report to the 
Committee on the amounts of fiscal year 2002 funding that each 
State has spent or plans to spend to directly benefit or 
improve local public health capacity, and the amount each State 
has directly granted to local public health agencies. The 
Committee expects this report to be submitted 90 days after the 
enactment of this bill.

      General Provisions, Department of Health and Human Services

    The Committee recommendation includes language placing a 
$50,000 ceiling on official representation expenses, which is 
$13,000 more than existing law (sec. 201).
    The Committee recommendation includes language carried in 
fiscal year 2002 which limits the assignment of certain public 
health personnel (sec. 202).
    The Committee recommendation retains language regarding 
set-asides in the authorizing statute of the National 
Institutes of Health (sec. 203).
    The Committee recommendation retains a provision carried in 
fiscal year 2002 to limit the use of grant funds to pay 
individuals no more than an annual rate of Executive Level I 
(sec. 204).
    The Committee recommendation retains language carried in 
fiscal year 2002 restricting the Secretary's use of taps for 
program evaluation activities unless he submits a report to the 
Appropriations Committees on the proposed use of funds (sec. 
205).
    The Committee recommendation includes language authorizing 
the transfer of up to 1.25 percent of Public Health Service 
funds for evaluation activities (sec. 206).
    The Committee recommendation retains language restricting 
transfers of appropriated funds among accounts and requiring 15 
day notification to both the House and Senate Appropriations 
Committees (sec. 207).
    The Committee recommendation retains language carried in 
fiscal year 2002 permitting the transfer of up to 3 percent of 
AIDS funds among Institutes and Centers by the Director of NIH 
and the Director of the Office of AIDS Research at NIH (sec. 
208).
    The Committee recommendation retains language which 
requires that the use of AIDS research funds be determined 
jointly by the Director of the National Institutes of Health 
and the Director of the Office of AIDS Research and that those 
funds be allocated directly to the Office of AIDS Research for 
distribution to the Institutes and Centers consistent with the 
AIDS research plan (sec. 209).
    The Committee recommendation retains language carried in 
fiscal year 2002 regarding requirements for family planning 
applicants (sec. 210).
    The Committee recommendation retains language which 
restricts the use of funds to carry out the Medicare+Choice 
Program if the Secretary denies participation to an otherwise 
eligible entity (sec. 211).
    The Committee recommendation retains language which States 
that no provider services under Title X of the PHS Act may be 
exempt from State laws regarding child abuse (sec. 212).
    The Committee recommendation retains language carried in 
fiscal year 2002 extending the refugee status of persecuted 
religious groups (sec. 213).
    The Committee recommendation retains language which 
prohibits the Secretary from withholding substance abuse 
treatment funds (sec. 214).
    The Committee recommendation retains language carried in 
fiscal year 2002 which facilitates the expenditure of funds for 
international AIDS activities (sec. 215).
    The Committee recommendation includes a new provision 
allowing the Division of Federal Occupational Health to use 
personal services contracting to employ professional, 
administrative, and occupational health professionals (sec. 
216).
    The Committee recommendation includes bill language which 
permits transfer of the Nutrition Services Incentives Program 
from USDA to AOA (sec. 217).
    The Committee recommendation includes bill language that 
allows the NIH to expand the number of Morris K. Udall 
Parkinson's Disease Centers (sec. 218).

                   TITLE III--DEPARTMENT OF EDUCATION

                    EDUCATION FOR THE DISADVANTAGED

Appropriations, 2002.................................... $12,346,900,000
Budget estimate, 2003...................................  13,385,400,000
Committee recommendation................................  14,087,400,000

    The Committee recommends an appropriation of 
$14,087,400,000 for education for the disadvantaged. This 
amount is $1,740,500,000 more than the fiscal year 2002 
appropriation and $702,000,000 more than the budget request.
    The programs in the Education for the Disadvantaged account 
help ensure that poor and low-achieving children are not left 
behind in the Nation's effort to raise the academic performance 
of all children and youth. That goal is more pressing than ever 
since the passage of the No Child Left Behind Act, which 
incorporates numerous accountability measures into Title I 
programs, especially part A grants to local educational 
agencies--the largest Federal elementary and secondary 
education program.
    In particular, the new law strengthens Title I 
accountability by requiring States to implement statewide 
accountability systems covering all public schools and 
students. These systems must be based on challenging State 
standards in reading and mathematics, annual statewide progress 
objectives ensuring that all groups of students reach 
proficiency in reading and math within 12 years, and annual 
testing for all students in grades 3-8. State progress 
objectives and assessment results must be broken out by 
poverty, race and ethnicity, disability, and limited English 
proficiency. States, school districts, and schools must report 
annually on their progress toward statewide proficiency goals. 
Districts and schools that fail to make adequate yearly 
progress (AYP) toward these goals will, over time, be subject 
to increasingly rigorous improvement, corrective action, and 
restructuring measures aimed at getting them back on course to 
meet State standards. Students attending schools that fail to 
meet annual State AYP objectives for 2 consecutive years will 
be permitted to transfer to a better public school or, if the 
school continues to fail to meet AYP for 3 years or more, to 
use Title I funds to obtain educational services from a public- 
or private-sector provider selected by their parents.
    While these accountability measures hold promise for 
improved student achievement, the Committee is deeply concerned 
that the budget request would not provide enough resources to 
enable States and LEAs to meet the high standards required in 
the new law. Therefore, the Committee has made an increase in 
funding for Title I programs its top educational priority.

Grants to local educational agencies

    Title I Grants to Local Educational Agencies (LEAs) provide 
supplemental education funding, especially in high-poverty 
areas, for local programs that provide extra academic support 
to help raise the achievement of eligible students or, in the 
case of schoolwide programs, help all students in high-poverty 
schools to meet challenging State academic standards. The 
program serves more than 15 million students in nearly all 
school districts and more than half of all public schools--
including two-thirds of the Nation's elementary schools.
    Title I schools help students reach challenging State 
standards through one of two models: ``targeted assistance'' 
that supplements the regular education program of individual 
children deemed most in need of special assistance, or a 
``schoolwide'' approach that allows schools to use Title I 
funds--in combination with other Federal, State, and local 
funds--to improve the overall instructional program for all 
children in a school.
    More than any other Federal program, Title I grants to LEAs 
are critical to the success of the No Child Left Behind Act. 
That is why the Committee recommends for this program an 
increase of $1,500,000,000--the largest increase of any 
Department program--for a total of $11,850,000,000.
    The grants are distributed through four formulas: basic, 
concentration, targeted, and education finance incentive grant 
(EFIG).
    For Title I basic grants, including the amount transferred 
to the Census Bureau for poverty updates, the Committee 
recommends an appropriation of $7,172,971,000, the same as the 
fiscal year 2002 appropriation and the budget request. Basic 
grants are awarded to school districts with at least 10 poor 
children who make up more than 2 percent of enrollment.
    For concentration grants, the Committee recommends an 
appropriation of $1,365,031,000, the same as the fiscal year 
2002 appropriation and the budget request. Funds under this 
program are distributed according to the basic grants formula, 
except that they go only to LEAs where the number of poor 
children exceeds 6,500 or 15 percent of the total school-aged 
population.
    Last year, for the first time, Congress appropriated Title 
I funds through the EFIG and targeted formulas. This year, the 
Committee recommends allocating all of the increase through 
those two formulas.
    The EFIG formula delivers a larger share of Title I funds 
to high-poverty school districts--those with child poverty 
rates in excess of 30 percent--than any other Title I formula, 
followed closely by the targeted grants formula. In addition, 
the EFIG formula uses State-level ``equity'' and ``effort'' 
factors to make allocations to States that are intended to 
encourage States to spend more on education and to improve the 
equity of State funding systems. Once State allocations are 
determined, suballocations to the LEA level are based on a 
modified version of the targeted grants formula, described 
below.
    The Committee recommends an appropriation of $1,655,999,000 
for education finance incentive grants. This amount is 
$862,500,000 more than the fiscal year 2002 appropriation and 
the budget request.
    The targeted grants formula weights child counts to make 
higher payments to school districts with high numbers or 
percentages of poor students. For these grants, the Committee 
recommends an appropriation of $1,655,999,000, which is 
$637,500,000 more than the fiscal year 2002 appropriation and 
$362,500,000 less than the budget request.

School improvement grants

    The Committee recommends $100,000,000 for a new program to 
assist struggling schools that are committed to raising 
academic achievement. The budget request did not include funds 
for this program, which was authorized by the No Child Left 
Behind Act but has not yet been funded.
    As more and more schools are determined to require 
improvement under the Act's accountability measures, States and 
districts will face increasing pressure to turn them around. 
Under Title I grants to LEAs, States are required to reserve 2 
percent of their Part A allocations for school improvement 
purposes. The Committee proposes to add another $100,000,000 
for that effort through this separately authorized school 
improvement program.
    The Department would make grants to States based on the 
share of funds each State receives under parts A, C, and D of 
Title I. States would be required to describe how they would 
allocate funds to LEAs. States must give priority to LEAs with 
the lowest-achieving schools that demonstrate the greatest need 
for such funds and the strongest commitment to making adequate 
yearly progress. Each LEA that applies for an award must 
describe how it will provide assistance to the lowest-achieving 
schools.

William F. Goodling Even Start Family Literacy Program

    For the Even Start program, the Committee recommends 
$250,000,000, which is the same as the fiscal year 2002 
appropriation and $50,000,000 more than 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 and Family Literacy Act. Programs combine early 
childhood education, adult literacy, and parenting education.
    States receive funds on the basis of their proportion of 
Title I LEA grant allocations and make competitive 4-year 
grants to partnerships of local educational agencies and 
community-based organizations. Grant funds must be equitably 
distributed among urban and rural areas. The local share of 
program costs must increase from 10 percent in the first year 
to 40 percent in the 4th year, 50 percent in years 5 through 8, 
and 65 percent after 8 years.

Reading First State Grants

    The Committee recommends $1,000,000,000, the same as the 
budget request and $100,000,000 more than the fiscal year 2002 
appropriation, for the Reading First State Grants program.
    Reading First is a comprehensive effort to provide States 
and LEAs with funds to implement comprehensive reading 
instruction for children in grades K-3. The purpose of the 
program is to help ensure that every child can read by third 
grade. LEAs and schools that receive funds under this program 
should use the money to provide professional development in 
reading instruction for teachers and administrators, adopt and 
use reading diagnostics for students in grades K-3 to determine 
where they need help, implement reading curricula that are 
based on scientific research, and provide reading interventions 
for children who are not reading at grade level.

Early Reading First

    The Committee recommends $75,000,000, the same as the 
budget request and the fiscal year 2002 appropriation, for 
Early Reading First. Early Reading First complements Reading 
First State Grants by providing competitive grants to school 
districts and nonprofit groups to support activities in 
existing preschool programs that are designed to enhance the 
verbal skills, phonological awareness, letter knowledge, pre-
reading skills, and early language development of children ages 
3 through 5. Funds are be targeted to communities with high 
numbers of low-income families.

Improving Literacy Through School Libraries

    The Committee recommends $25,000,000 for the Improving 
Literacy Through School Libraries program. This amount is 
$12,500,000 more than the budget request and the fiscal year 
2002 appropriation.
    This program provides funds for urgently needed, up-to-date 
school library books and training for school library media 
specialists in order to support the scientifically based 
reading programs authorized by the Reading First initiative. 
LEAs with a child-poverty rate of at least 20 percent are 
eligible for the competitive awards. Funds may be used to 
acquire school library media resources, including books and 
advanced technology; facilitate resource-sharing networks among 
schools and school libraries; provide professional development 
for school library media specialists; and provide students with 
access to school libraries during non-school hours.

Migrant

    For the State agency migrant program, the Committee 
recommends $410,000,000, which is $14,000,000 more than the 
budget request and the fiscal year 2002 appropriation.
    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 ages 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.
    This appropriation also supports activities to improve 
interstate and intrastate coordination of migrant education 
programs.

Neglected and delinquent

    The Committee recommends $52,000,000 for the Title I 
neglected and delinquent program. This amount is $4,000,000 
more than the budget request and the fiscal year 2002 
appropriation.
    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 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 $8,900,000, the same as the 
budget request and the fiscal year 2002 appropriation, for 
Title I evaluation activities. Evaluation funds are used to 
support large-scale national surveys that examine how the Title 
I program is contributing to student performance.

Comprehensive school reform

    The Committee recommends $235,000,000, the same as the 
budget request and the fiscal year 2002 appropriation, for the 
Comprehensive School Reform program under Title I. Additional 
funds are provided under the Fund for the Improvement of 
Education.
    This program provides schools with funding to develop or 
adopt, and implement, comprehensive school reforms that will 
enable children in participating schools to meet State 
standards. The Department allocates funds to States based on 
their relative shares of the previous year's Title I basic 
grants funds.

Dropout prevention

    The Committee recommends $15,000,000 to help schools 
implement effective school dropout prevention and re-entry 
programs. This amount is $5,000,000 more than the fiscal year 
2002 appropriation. The administration requested no funds for 
this purpose.

Close Up Fellowships

    For Close Up Fellowships, formerly called Ellender 
Fellowships, the Committee bill includes $1,500,000, the same 
as the fiscal year 2002 appropriation. The administration 
proposed eliminating this program, which is administered by the 
Close Up Foundation of Washington, D.C. The program provides 
fellowships to students from low-income families and their 
teachers to enable them to attend 1 week in Washington 
attending seminars and meeting with representatives of the 
three branches of the Federal Government.

Advanced Placement

    The Committee recommends $25,000,000 for Advanced 
Placement. This amount is $3,000,000 more than the budget 
request and the fiscal year 2002 appropriation. The first 
priority of the program is to subsidize test fees for low-
income students who are enrolled in an Advanced Placement class 
and plan to take an Advanced Placement test. The balance of the 
funds are allocated for Advanced Placement Incentive Program 
grants, which are used to expand access for low-income 
individuals to Advanced Placement programs. Eligible activities 
include teacher training and participation in online Advanced 
Placement courses, among other related purposes.

High school equivalency program

    The Committee bill includes $24,000,000 for the high school 
equivalency program (HEP). This amount is $1,000,000 more than 
the budget request and the fiscal year 2002 appropriation.
    This program provides 5-year grants to institutions of 
higher education and other nonprofit organizations to recruit 
migrant students ages 16 and over and provide the academic and 
support services needed to help them obtain a high school 
equivalency certificate and subsequently gain employment, win 
admission to a postsecondary institution or a job-training 
program, or join the military. Projects provide counseling, 
health services, stipends, and placement assistance. HEP serves 
about 8,000 migrants.

College Assistance Migrant Program

    For the College Assistance Migrant Program (CAMP), the 
Committee recommends $16,000,000, which is $1,000,000 more than 
the budget request and the fiscal year 2002 appropriation.
    Funds provide 5-year grants to institutions of higher 
education and nonprofit organizations for projects that provide 
tutoring, counseling, and financial assistance to migrant 
students during their first year of postsecondary education. 
Projects also may use up to 10 percent of their grants for 
follow-up services after students have completed their first 
year of college, including assistance in obtaining student 
financial aid.

                               IMPACT AID

Appropriations, 2002....................................  $1,143,500,000
Budget estimate, 2003...................................   1,140,500,000
Committee recommendation................................   1,200,500,000

    The Committee recommends an appropriation of $1,200,500,000 
for impact aid for the Department of Education. This amount is 
$60,000,000 more than the budget request and $57,000,000 more 
than the fiscal year 2002 appropriation.
    Impact aid provides financial assistance to school 
districts for the costs of educating children when enrollments 
and the availability of revenues from local sources have been 
adversely affected by the presence of Federal activities. 
Children who reside on Federal or Indian lands generally 
constitute a financial burden on local school systems because 
these lands do not generate property taxes--a major revenue 
source for elementary and secondary education in most 
communities. In addition, realignments of U.S. military forces 
at bases across the country often lead to influxes of children 
into school districts without producing the new revenues 
required to maintain an appropriate level of education.
    Basic support payments.--The Committee recommends 
$1,032,500,000 for basic support payments. This amount is 
$50,000,000 more than the budget request and the fiscal year 
2002 appropriation. 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 
$52,000,000 for this purpose. This amount is $2,000,000 more 
than the fiscal year 2002 level and the budget request.
    Facilities maintenance.--This activity provides funding for 
maintaining certain school facilities owned by the Department 
of Education. The Committee recommends $8,000,000, the same as 
the budget request and the fiscal year 2002 level, for this 
purpose.
    Construction.--Payments are made to eligible LEAs to be 
used for construction and renovation of school facilities, or 
for debt service related to the construction of school 
facilities. The Committee recommends $50,000,000 for this 
program. This amount is $5,000,000 more than the budget request 
and $2,000,000 more than the fiscal year 2002 appropriation.
    Payments for Federal property.--These payments compensate 
local educational agencies in part for revenue lost due to the 
removal of Federal property from local tax rolls. Payments are 
made to LEAs that have a loss of tax base of at least 10 
percent of assessed value due to the acquisition since 1938 of 
real property by the U.S. Government. The Committee recommends 
$58,000,000 for this activity. This amount is $3,000,000 more 
than the budget request and the fiscal year 2002 appropriation.

                      SCHOOL IMPROVEMENT PROGRAMS

Appropriations, 2002....................................  $7,837,473,000
Budget estimate, 2003...................................   6,784,484,000
Committee recommendation................................   8,303,834,000

    The Committee recommends an appropriation of $8,303,834,000 
for school improvement programs. This is $1,519,350,000 more 
than the budget request and $466,361,000 more than the fiscal 
year 2002 appropriation.

State grants for improving teacher quality

    The No Child Left Behind Act requires States to ensure that 
all teachers teaching in core academic subjects are ``highly 
qualified'' by the end of the 2005-2006 school year. The 
Committee is concerned that States will have difficulty meeting 
this requirement, given the number of new teachers who will 
have to be hired before then to replace those who are retiring 
and to accommodate growing student enrollments. Therefore, the 
Committee recommends a $250,000,000 increase over the budget 
request and the fiscal year 2002 appropriation for the 
Improving Teacher Quality State Grants program, for a total of 
$3,100,000,000.
    States and LEAs may use the funds for a range of activities 
related to the certification, recruitment, professional 
development and support of teachers. Activities may include 
reforming teacher certification and licensure requirements, 
addressing alternative routes to State certification of 
teachers, recruiting teachers and principals, and implementing 
teacher mentoring systems, teacher testing, merit pay and 
merit-based performance systems.
    These funds may also be used by districts to hire teachers 
to reduce class sizes. The Committee recognizes that smaller 
classes, particularly in the early grades, can have a positive 
impact on students by improving classroom discipline, providing 
students with more individualized attention, and allowing 
parents and teachers to work more closely together. Funds 
within the teacher quality State grants program may be used to 
continue this commitment to our Nation's students, parents and 
teachers, without taking away from other efforts to invest in 
professional development.

Improving teacher quality: National activities

    The Committee recommends $40,000,000 for professional 
development national activities. This amount is $5,000,000 more 
than the fiscal year 2002 appropriation and $25,000,000 more 
than the budget request. Within those funds, $15,000,000 is 
included for professional development activities for early 
childhood educators and caregivers in high-poverty communities. 
This amount is the same as the fiscal year 2002 appropriation 
and the budget request. In addition, $10,000,000, the same as 
the fiscal year 2002 appropriation, is included for the 
National Board for Professional Teaching Standards. The 
administration requested no funds for this purpose. Finally, 
the Committee recognizes the critical role that principals play 
in creating an environment that fosters good teaching and high 
academic achievement. Therefore, the Committee recommends 
$15,000,000 for the school leadership program, which provides 
competitive grants to assist high-need LEAs to recruit and 
train principals and assistant principals through activities 
such as professional development and training programs. This 
amount is $5,000,000 more than the fiscal year 2002 
appropriation; the administration requested no funds for this 
purpose.

Mathematics and science partnerships

    For mathematics and science partnerships, the Committee 
recommends $25,000,000, which is $12,500,000 more than the 
fiscal year 2002 appropriation and the budget request. These 
funds will be used to improve the performance of students in 
the areas of math and science by bringing math and science 
teachers in elementary and secondary schools together with 
scientists, mathematicians, and engineers to increase the 
teachers' subject-matter knowledge and improve their teaching 
skills. The Secretary is authorized to award grants, on a 
competitive basis, to eligible partnerships to enable the 
entities to pay the Federal share of the costs of developing or 
redesigning more rigorous mathematics and science curricula 
that are aligned with State and local standards; creating 
opportunities for enhanced professional development that 
improves the subject-matter knowledge of math and science 
teachers; recruiting math and science majors; and improving and 
expanding training of math and science teachers, including the 
effective integration of technology into curricula and 
instruction.

Troops-to-Teachers

    This program supports the Defense Department's Troops to 
Teachers program, which helps prepare retiring military 
personnel to teach in high-poverty school districts. The 
Secretary of Education transfers program funds to the 
Department of Defense for the Defense Activity for Non-
Traditional Education Support to provide assistance, including 
stipends of up to $5,000, to eligible members of the armed 
forces so that they can obtain teacher certification or 
licensing. In addition, the program helps these individuals 
find employment in a school. The Committee recommends 
$20,000,000, the same as the budget request, for this program. 
This amount is $2,000,000 more than the fiscal year 2002 
appropriation.

Transition to teaching

    This program provides grants to help support efforts to 
recruit, train, and place nontraditional teaching candidates 
into teaching positions and to support them during their first 
years in the classroom. In particular, this program is intended 
to attract mid-career professionals and recent college 
graduates. Program participants are placed in high-need schools 
in high-need LEAs. The Committee recommends $39,400,000, the 
same as the budget request, for the Transition to Teaching 
program. This amount is $4,400,000 more than the fiscal year 
2002 appropriation.

Innovative education program strategies State grants

    The Committee recommends $385,000,000 for innovative 
education program strategies State grants. This amount is the 
same as the fiscal year 2002 appropriation and the budget 
request.
    The innovative education program provides support to States 
and LEAs in developing education reform initiatives that will 
improve the performance of students, schools and teachers.

Educational technology state grants

    The Committee recommends $700,500,000 for educational 
technology State grants. This amount is the same as the budget 
request and the fiscal year 2002 appropriation.
    This program supports efforts to integrate technology into 
curricula to improve student learning. Funds flow by formula to 
States and may be used for the purchase of hardware and 
software, teacher training on integrating technology into the 
curriculum, and efforts to use technology to use technology to 
improve communication with parents, among other related 
purposes. An LEA must use at least 25 percent of its formula 
allocation for professional development in the integration of 
technology into the curricula unless it can demonstrate that it 
already provides such professional development.

Ready to Learn Television

    The Committee recommends an appropriation of $24,000,000 
for the Ready to Learn Television program. This amount is 
$2,000,000 more than the budget request and the fiscal year 
2002 appropriation.
    Ready to Learn Television supports the development and 
distribution of educational television programming designed to 
improve the readiness of preschool children to enter 
kindergarten and elementary school. The program also supports 
the development, production, and dissemination of educational 
materials designed to help parents, children, and caregivers 
obtain the maximum advantage from educational programming.

Preparing Tomorrow's Teachers to Use Technology

    The Committee recommends $67,500,000, which is $5,000,000 
above the fiscal year 2002 appropriation, for the Preparing 
Tomorrow's Teachers to Use Technology (PT3) program. The 
administration requested no funds for this purpose.
    The Committee strongly believes that this program should be 
preserved. Teacher preparation is critical to ensuring that the 
Nation's substantial investment in education technology is used 
effectively. Too often, however, it is mistakenly assumed that 
just because prospective teachers may know how to use 
technology in their daily lives, they automatically understand 
how to integrate it into curricula. Without a program 
designated specifically to promote high-quality teacher 
preparation in technology, the Committee fears that States are 
unlikely to devote adequate funds for this purpose from larger 
block programs that they rely on to address a myriad of other 
pressing needs, from recruiting teachers and reducing class 
sizes to buying new hardware and upgrading distance learning 
capabilities.
    Funds are used to assist consortia of private and public 
entities to prepare prospective teachers to use technology 
effectively in the classroom. Consortia consist of at least one 
institution of higher education, one State or local educational 
agency, and one other entity. Of the amount appropriated, the 
Committee urges the Department to allocate all funds that are 
not used for continuation costs for the purpose of issuing a 
new, multi-year grant competition.

21st Century Community Learning Centers

    The Committee recommends an appropriation of $1,090,000,000 
for the 21st Century Community Learning Centers program. This 
amount is $90,000,000 above the budget request and the fiscal 
year 2002 appropriation.
    This program enables communities to establish or expand 
community learning centers that provide activities offering 
significant extended learning opportunities, such as before-and 
after-school programs, for students and related services to 
their families. Centers must target their services on students 
who attend schools that are eligible to operate a schoolwide 
program under Title I of the Elementary and Secondary Education 
Act or serve high percentages of students from low-income 
families.

Safe and drug-free schools and communities

    The Committee recommends a total of $654,250,000 for 
activities to promote safe and drug-free schools and 
communities. This amount is the same as the fiscal year 2002 
appropriation and $10,000,000 more than the budget request.
    State grant program.--The Committee bill provides 
$485,017,000 for the safe and drug-free schools and communities 
State grant program. This amount is $13,000,000 more than the 
fiscal year 2002 appropriation and the budget request.
    National programs.--The Committee has included $169,233,000 
for the national programs portion of the safe and drug-free 
schools program. This amount is $13,000,000 less than the 
fiscal year 2002 appropriation and $3,000,000 less than the 
budget request. The Committee intends that $7,000,000 of these 
funds be used for Project SERV (School Emergency Response to 
Violence), which provides education-related services to LEAs in 
which the learning environment has been disrupted due to a 
violent or traumatic crisis. This amount is $3,000,000 less 
than the budget request. Congress provided $10,000,000 for 
Project SERV in the December 2001 emergency supplemental 
appropriations bill. That funding is available until expended; 
only $5,000,000 has been used so far.
    The Committee is aware of the increasing problem of alcohol 
and drug abuse on college campuses. Therefore, it has included 
$850,000 to continue the National Recognition Awards program 
under the same guidelines outlined by Section 120(f) of Public 
Law 105-244. This program identifies and provides models of 
alcohol and drug abuse prevention and education programs in 
higher education. The Committee is disappointed that the 
Department did not fund this program last year, as requested in 
Senate report language. The Committee strongly urges the 
Department to resume funding in fiscal year 2003.
    Modifications made to the Safe and Drug Free Schools 
Program in Section 4114(a)(1) of the No Child Left Behind Act 
may have created dramatic changes in funding for some LEAs. The 
Committee understands that no data have been compiled to show 
the nationwide breakdown of these funding changes at the LEA 
level. Therefore, the Committee requests that the Department 
gather this information and report back to Congress no later 
than May 1, 2004, with its findings.

Magnet schools assistance

    For the magnet schools assistance program, the Committee 
bill provides $110,000,000, the same as the budget request and 
the fiscal year 2002 appropriation.
    This program supports grants to local educational agencies 
to establish and operate magnet schools that are part of a 
court-ordered or federally approved voluntary desegregation 
plan. Magnet schools are designed to attract substantial 
numbers of students from different social, economic, ethnic, 
and racial backgrounds. Grantees may use funds for teacher 
salaries, purchase of computers, and other educational 
materials and equipment.

Charter schools

    The Committee recommends $200,000,000 for the support of 
charter schools. This amount is the same as the budget request 
and the fiscal year 2002 appropriation.
    This program supports the planning, development, and 
initial implementation of charter schools, which are public 
schools that receive exemption from many statutory and 
regulatory requirements in exchange for promising to meet 
agreed-upon accountability measures. State educational agencies 
that have the authority under State law to approve charter 
schools are eligible to compete for grants. If an eligible SEA 
does not participate, charter schools from the State may apply 
directly to the Secretary.

Voluntary public school choice

    The Committee recommends $35,000,000, which is $10,000,000 
above the budget request and the fiscal year 2002 
appropriation, for efforts to establish or expand State-or 
district-wide public school choice programs, especially for 
parents whose children attend low-performing public schools.

State assessments and enhanced assessment instruments

    A key accountability measure in the No Child Left Behind 
Act requires annual State assessments in reading and 
mathematics for all students in grades 3-8 beginning in the 
2005-2006 school year. The new assessments will be used to 
determine whether States, LEAs, and schools are making adequate 
yearly progress toward the goal of helping all students attain 
proficiency within 12 years of the 2001-2002 school year.
    This program has two components. The first provides formula 
grants to States to pay the cost of developing standards and 
assessments required by the new law. The statute includes 
funding ``trigger amounts'' for fiscal years 2002-2007; States 
may defer the new assessments if the appropriation falls below 
the trigger level. The trigger was $370,000,000 for fiscal year 
2002 and rises to $387,000,000 in fiscal year 2003. Under the 
second component, appropriations in excess of the trigger level 
are used for the Grants for Enhanced Assessment Instruments 
program. This competitive grant program supports efforts by 
States to improve the quality and fairness of their assessment 
systems.
    Congress appropriated a total of $387,000,000 for the two 
programs in fiscal year 2002--$370,000,000 for State 
assessments and $17,000,000 for enhanced assessment 
instruments. The administration has requested the same total 
for fiscal year 2003, with $380,000,000 dedicated to State 
assessments and $7,000,000 to enhanced assessment instruments. 
The Committee recommends an appropriation of $397,000,000, 
which is $10,000,000 more than the budget request and the 
fiscal year 2002 appropriation, in order to maintain the 
$17,000,000 funding level for the enhanced assessment program.

Education for homeless children and youth

    For carrying out education activities authorized by Title 
VII, subtitle B of the Stewart B. McKinney Homeless Assistance 
Act, the Committee recommends $52,000,000, which is $2,000,000 
more than the budget request and the fiscal year 2002 
appropriation.
    This program provides assistance to each State to support 
an office of the coordinator of education for homeless children 
and youth, to develop and implement State plans for educating 
homeless children, and to make subgrants to LEAs to support the 
education of those children. Grants are made to States based on 
the total that each State receives in Title I grants to LEAs.

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 budget request and the fiscal year 2002 
appropriation.
    The funds provided will continue operation of the 10 
regional equity assistance centers (EACs). Each EAC provides 
services to school districts upon request. Activities include 
disseminating information on successful practices and legal 
requirements related to nondiscrimination on the basis of race, 
color, sex, or national origin in education programs.

Education for Native Hawaiians

    For programs for the education of Native Hawaiians, the 
Committee bill includes $32,500,000, which is $14,200,000 more 
than the budget request and $2,000,000 more than the fiscal 
year 2002 appropriation. The Committee urges the Department to 
continue its eight programmatic funding level allocations of 
last year and, further, to provide $2,000,000 for early 
childhood education. The Committee remains supportive of the 
funding for construction/co-location activities within those 
public schools heavily impacted by a high proportion of Native 
Hawaiian students.
    The Committee includes bill language making a minor change 
in the Native Hawaiian section of the No Child Left Behind Act 
to reflect a provision included by the Senate in its version of 
the legislation.
    Prisoner education.--Native Hawaiians continue to represent 
a major, if not the largest, ethnic group in the State's prison 
system. The Committee recognizes the importance of 
reintegrating Native Hawaiian youth into school settings or 
onto a career path and job placement through comprehensive, 
culturally sensitive individual and family counseling; 
educational skills training; and employment training/job 
placement. Over the past several years, efforts in this area 
have shown significant progress. Efforts should target Native 
Hawaiian youth in districts with high percentages of school 
dropouts and youth offenders.

Alaska Native educational equity

    The Committee recommends $32,500,000 for the Alaska Native 
educational equity assistance program. This amount is 
$18,300,000 more than the budget request and $8,500,000 more 
than the fiscal year 2002 appropriation.
    These funds address the severe educational handicaps of 
Alaska Native schoolchildren. Funds are used for the 
development of supplemental educational programs to benefit 
Alaska Natives.
    The Committee has included bill language making minor 
corrections in the Alaska Native section of Public Law 107-110.

Rural education

    The Committee recommends $175,000,000, an increase of 
$12,500,000 over the fiscal year 2002 appropriation, for rural 
education programs. The administration requested no funds for 
this purpose.
    The Committee strongly supports the continued use of 
Federal funding specifically for rural education. Rural schools 
face difficult challenges in meeting the mandates in the No 
Child Left Behind Act, particularly in the areas of attracting 
highly qualified teachers and adapting to new assessment 
requirements and reporting expectations. The rural education 
programs that were funded for the first time last year are 
intended to help level the playing field for small and high-
poverty rural school systems that typically receive less 
Federal formula funding than their urban and suburban 
counterparts, and are frequently unable to compete for 
competitive grants. In addition to providing more total funding 
for such districts, the program also allows the districts to 
combine funds from four categorical programs and use the money 
to address their highest priorities, such as recruiting 
teachers, purchasing technology, or upgrading curricula.
    Rural education funding should be equally divided between 
the Small, Rural Schools Achievement Program, which provides 
funds to LEAs that serve a small number of students, and the 
Low-Income and Rural Schools Program, which provides funds to 
LEAs that serve concentrations of poor students, regardless of 
the number of students served.

Mentoring

    The Committee recommends $17,500,000 to support mentoring 
programs and activities for children who are at risk of failing 
academically, dropping out of school, or getting involved in 
criminal or delinquent activities, or who lack strong positive 
role models. This amount is the same as the fiscal year 2002 
appropriation; the administration requested no funds for this 
program.

Fund for the Improvement of Education

    The Committee recommends an appropriation of $876,350,000 
for the Fund for the Improvement of Education (FIE). This 
amount is $43,461,000 more than the fiscal year 2002 
appropriation and $792,350,000 more than the budget request.
    Programs of national significance: Within the amount 
recommended, the Committee includes $375,416,000 for programs 
of national significance. This amount is $8,539,000 below the 
fiscal year 2002 appropriation and $340,416,000 more than the 
budget request. This amount includes $75,000,000, the same as 
the fiscal year 2002 appropriation, to continue support for 
comprehensive school reform demonstrations. The administration 
requested no funds for this purpose. The Comprehensive School 
Reform Demonstration program aims to raise student achievement 
by helping public schools implement successful, comprehensive 
school reforms. The program is primarily supported with Title I 
funds. Funding under the FIE account funding is distributed to 
States based on their population of students aged 5 to 17, and 
it permits the inclusion of non-Title I schools in the program 
activity.
    Also within programs of national significance, the 
Committee has included $1,000,000--as part of its preventing 
and reversing heart disease initiative--for programs to teach 
school children and teachers coping skills to help ease the 
short- and long-term effects of stress. Programs such as these 
have been scientifically proven to improve students' self-
esteem, self-efficacy, control, grade point average, work 
habits, memory and cooperation.
    Character education: The Committee recommends $25,000,000 
to provide support for the design and implementation of 
character education programs. This amount is the same as the 
budget request and the fiscal year 2002 appropriation.
    Reading Is Fundamental/Inexpensive book distribution: The 
Committee recommends $27,000,000 to award a contract to Reading 
Is Fundamental, Inc. (RIF) to provide reading-motivation 
activities. This amount is $3,000,000 more than the budget 
request and the fiscal year 2002 appropriation. RIF, a private 
nonprofit organization, encourages reading both inside and 
outside school by allowing youngsters to select books to keep 
at home. Federal funds provide up to 75 percent of the costs of 
books.
    The administration recommended eliminating the 12 programs 
below. The Committee has rejected that recommendation.
    Elementary school counseling: The Committee includes 
$32,500,000 to establish or expand counseling programs in 
elementary schools. This amount is the same as the fiscal year 
2002 appropriation.
    Smaller learning communities: The Committee recommends 
$142,189,000 for activities related to the redesign of large 
high schools enrolling 1,000 or more students. This amount is 
the same as the fiscal year 2002 appropriation. Five percent of 
the funding is current funded with 2-year availability, and the 
rest is forward funded.
    Javits gifted and talented education: The Committee has 
included $13,250,000 for the Javits Gifted and Talented 
Students Education Program. This amount is $2,000,000 more than 
the fiscal year 2002 appropriation. This program authorizes 
awards to State and local education agencies, institutions of 
higher education, and other public and private agencies for 
research, demonstration, and training activities designed to 
enhance the capability of elementary and secondary schools to 
meet the special educational needs of gifted and talented 
students.
    Star Schools: The Committee recommends $27,520,000 for the 
Star Schools program. This amount is the same as the fiscal 
year 2002 appropriation. The Star Schools program is designed 
to improve instruction in math, science, foreign languages, and 
other subjects such as vocational education, to underserved 
populations by means of telecommunications technologies.
    Ready to Teach: The Committee recommends $17,000,000 for 
two Ready to Teach programs. This amount is $5,000,000 more 
than the fiscal year 2002 appropriation. The Committee includes 
$12,000,000 for Teacherline and one or more other nonprofit 
entities, for the purpose of developing national 
telecommunications-based programs to improve teaching in core 
curricular areas, and $5,000,000 for digital educational 
programming grants, which allow local public television 
stations, in partnership with State and local educational 
agencies, institutions of higher education, nonprofit groups, 
and businesses to develop digital instructional materials for 
classroom use.
    Foreign language assistance: The Committee recommends 
$20,000,000, which is $6,000,000 more than the fiscal year 2002 
appropriation, for competitive grants to increase the quality 
and quantity of foreign language instruction. The Committee 
intends that none of the Foreign Language Assistance program 
funds should be used for the Foreign Language Incentive 
program.
    Carol M. White Physical Education for Progress: The 
Committee recommends $70,000,000 to help LEAs and community-
based organizations initiate, expand and improve physical 
education programs for students in grades K-12. This amount is 
$20,000,000 more than the fiscal year 2002 appropriation.
    Community technology centers: The Committee recommends 
$32,475,000, the same amount as the fiscal year 2002 
appropriation, for community technology centers. Community 
technology centers provide disadvantaged residents of 
economically distressed urban and rural communities with access 
to information technology and related training. They can 
provide, among other things, preschool and after-school 
programs, adult education and literacy, and workforce 
development and training.
    Exchanges with historic whaling and trading partners: The 
Committee recommends $10,000,000 to provide educational, 
cultural, apprenticeship, and exchange programs for Alaska 
Natives, Native Hawaiians and their historical whaling and 
trading partners in Massachusetts. This amount is $5,000,000 
more than the fiscal year 2002 appropriation.
    Arts in education: The Committee has included $36,000,000 
for arts in education. This amount is $6,000,000 more than the 
fiscal year 2002 appropriation. Within the total, $6,000,000 is 
for the John F. Kennedy Center for the Performing Arts; 
$7,000,000 is for VSA arts; $10,000,000 is for the competitive 
art education model grant program for the development and model 
projects that effectively strengthen and integrate the arts and 
cultural partnerships into the core curriculum; $7,000,000 is 
for grants for professional development for music, dance, drama 
and visual arts educators to be administered by the U.S. 
Department of Education; $2,000,000 is for national evaluation 
and dissemination of information regarding funded model 
programs and professional development projects; $1,000,000 is 
for media literacy projects focused on violence prevention; and 
$3,000,000 is for cultural partnerships for at-risk youth. When 
awarding grants for professional development of music 
educators, the Department is urged to put a priority on 
preparing and retaining teachers in underserved rural and urban 
areas, including music teachers who enter the profession 
through alternative certification.
    Parental assistance: The Committee recommends $45,000,000 
for Parental Information and Resource Centers, which provide 
training, information, and support to parents, State and local 
education agencies, and other organizations that carry out 
parent education and family involvement programs. This amount 
is $5,000,000 above the fiscal year 2002 appropriation.
    Women's educational equity: The Committee includes 
$3,000,000, the same as the fiscal year 2002 appropriation, for 
the women's educational equity program. This program supports 
projects that assist in the local implementation of gender 
equity policies and practices.

Community service for expelled or suspended students

    The Committee recommends $50,000,000, the same as the 
fiscal year 2002 appropriation, for formula grants to States to 
carry out programs under which students who are expelled or 
suspended from school are required to perform community 
service. The administration requested no funds for this 
purpose.

Alcohol abuse reduction

    The Committee recommends $25,000,000, the same as the 
fiscal year 2002 appropriation, for grants to LEAs to develop 
and implement programs to reduce underage drinking in secondary 
schools. The administration requested no funds for this 
purpose. The Committee directs the Department and the Substance 
Abuse and Mental Health Services Administration (SAMHSA) in the 
Department of Health and Human Services to work together on 
this effort.

Teaching of traditional American history

    The Committee recommends $100,000,000, the same as the 
fiscal year 2002 appropriation, for the instruction of American 
history in elementary and secondary education. This amount is 
$50,000,000 more than the budget request. Grants are limited to 
activities that are related to American history, and cannot be 
used for social studies coursework. Grant awards are designed 
to augment the quality of American history instruction and to 
provide professional development activities and teacher 
education in the area of American history. The Committee 
directs the Department to continue its current policy of 
awarding 3-year grants.

Civic education

    The Committee recommends $30,000,000, which is $3,000,000 
more than the fiscal year 2002 appropriation, for grants to 
improve the quality of civics and government education, to 
foster civic competence and responsibility, and to improve the 
quality of civic and economic education through exchange 
programs with emerging democracies. The administration 
requested no funds for this purpose.
    Program funds support the Cooperative Education Exchange 
and We the People programs. The Committee recommends 
$12,000,000, which is $1,200,000 more than the fiscal year 2002 
appropriation, for the Cooperative Education Exchange program, 
formerly called the International Education Exchange program.
    Of these funds, the Committee has included $4,500,000 for 
the Center for Civic Education and $4,500,000 for the National 
Council on Economic Education. The remaining $3,000,000 should 
be used for a competitive grant program for civics and 
government education, and for economic education.
    The Committee recommends $18,000,000, which is $1,800,000 
more than the fiscal year 2002 appropriation, for the nonprofit 
Center for Civic Education to support the We the People 
program. We the People has two components: the Citizen and the 
Constitution, which provides teacher training and curriculum 
materials for upper elementary, middle, and high school 
students; and Project Citizen, a program for middle school that 
focuses on the role of State and local governments in the 
American Federal system.

National Writing Project

    The Committee recommends $18,000,000, which is $4,000,000 
more than the fiscal year 2002 appropriation, for the National 
Writing Project. The administration recommended eliminating 
this program.
    These funds are awarded to the National Writing Project, a 
nonprofit organization that supports and promotes K-16 teacher 
training programs in the effective teaching of writing.

                            INDIAN EDUCATION

Appropriations, 2002....................................    $120,368,000
Budget estimate, 2003...................................     122,368,000
Committee recommendation................................     122,368,000

    The Committee recommends $122,368,000, the same as the 
budget request, for Indian education programs. This amount is 
$2,000,000 more than the fiscal year 2002 appropriation.

Grants to local education agencies

    For grants to local education agencies, the Committee 
recommends $97,133,000, the same as the budget request and the 
fiscal year 2002 appropriation. These funds provide financial 
support to reform elementary and secondary school programs that 
serve Indian students, including preschool children. Funds are 
awarded on a formula basis to local educational agencies and 
schools supported and operated by the Bureau of Indian Affairs.

Special programs for Indian children

    The Committee recommends $20,000,000 for special programs 
for Indian children. This amount is the same as the budget 
request and the fiscal year 2002 appropriation. Funds are used 
for demonstration grants to improve Indian student achievement 
through early childhood and preschool education programs, and 
for professional development grants for training Indians who 
are preparing to begin careers in teaching and school 
administration.

National activities

    The Committee recommends $5,235,000, the same as the budget 
request, for national activities. This amount is $2,000,000 
more than the fiscal year 2002 appropriation. The increased 
funds will be used to expand efforts to improve research, 
evaluation, and data collection on the status and effectiveness 
of Indian education programs.

                      ENGLISH LANGUAGE ACQUISITION

Appropriations, 2002....................................    $665,000,000
Budget estimate, 2003...................................     665,000,000
Committee recommendation................................     740,000,000

    The Committee recommends an appropriation of $740,000,000 
for English language acquisition. That amount is $75,000,000 
more than the budget request and the fiscal year 2002 
appropriation. The Department makes formula grants to States 
based on each State's share of the Nation's limited-English-
proficient and recent immigrant student population. The program 
is designed to increase the capacity of States and school 
districts to address the needs of these students.

                           SPECIAL EDUCATION

Appropriations, 2002....................................  $8,672,804,000
Budget estimate, 2003...................................   9,687,804,000
Committee recommendation................................   9,696,424,000

    The Committee strongly supports legislative measures that 
would fulfill the Federal Government's responsibility for 
paying its share of special education costs, as described in 
the Individuals with Disabilities Education Act (IDEA). The 
Committee notes that the Senate Budget Committee included in 
its budget resolution a measure to pay for increases in special 
education grants to States using mandatory funding, rather than 
discretionary funding.
    In the meantime, the Committee recommends $9,696,424,000 
for special education programs authorized by the IDEA. This 
amount is $1,023,620,000 more than the fiscal year 2002 
appropriation and $8,620,000 more than the budget request.

Grants to states

    The Committee recommends $8,528,533,000 for special 
education grants to States, as authorized under part B of the 
IDEA. The amount recommended is $1,000,000,000 more than the 
fiscal year 2002 appropriation and the same as the budget 
request. This program provides formula grants to assist States 
in meeting the costs of providing special education and related 
services for children with disabilities.
    The Committee's recommended funding level represents 
approximately 18 percent of the average per-pupil expenditure, 
compared with 17 percent under the fiscal year 2002 
appropriation.

Preschool grants

    The Committee recommends $390,000,000 for preschool grants. 
This amount is the same as the fiscal year 2002 appropriation 
and the budget request. The preschool grants program provides 
formula grants to States to make available special education 
and related services for children with disabilities aged 3 
through 5.

Grants for infants and families

    The Committee bill provides $437,000,000, the same as the 
budget request, for grants for the infants and families program 
under part C of the IDEA. This amount is $20,000,000 more than 
the fiscal year 2002 appropriation. This program provides 
formula grants to States to implement statewide systems of 
coordinated, comprehensive, multidisciplinary interagency 
programs to make available early intervention services to all 
children with disabilities, ages 2 and under, and their 
families.

State improvement

    For State improvement grants, the bill provides 
$51,700,000, the same as the fiscal year 2002 appropriation and 
the budget request. This program provides competitive grants to 
State educational agencies to assist them, in partnership with 
parents, teachers, institutions of higher education, interest 
groups, and others, to improve results for children with 
disabilities by reforming and improving their educational 
systems.

Research and innovation

    The Committee has included $70,000,000, which is $8,380,000 
below the budget request and the fiscal year 2002 
appropriation, for research and innovation. This program 
supports competitive awards to produce and advance the use of 
knowledge to improve services and results for children with 
disabilities.
    The Committee's recommendation does not include any funding 
for the research agenda of the President's Commission on 
Excellence in Special Education. The Committee believes that 
funding for that purpose should be considered following the 
IDEA reauthorization, along with measures to fully fund the 
part B State grants program.

Technical assistance and dissemination

    The Committee recommends $53,481,000, the same as the 
fiscal year 2002 level and the budget request, for technical 
assistance and dissemination. Awards support institutes, 
regional resource centers, clearinghouses, and other efforts to 
build State and local capacity to make systemic changes and 
improve results for children with disabilities.

Personnel preparation

    The Committee recommends $100,000,000 for the personnel 
preparation program. This amount is $10,000,000 more than the 
fiscal year 2002 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 Committee is particularly concerned about the shortage 
of qualified special education teachers and higher education 
faculty. Therefore, it has provided sufficient resources in 
this account to ensure an increase in funding for leadership 
personnel over the fiscal year 2002 level. The Committee also 
urges the Department to use a portion of the increased 
appropriation for the preparation of personnel who serve 
children with low-incidence disabilities, particularly those 
with sensory disabilities such as low vision, blindness, and 
deafness.

Parent information centers

    The Committee bill provides $28,000,000 for parent 
information centers. This amount is $2,000,000 more than the 
fiscal year 2002 appropriation and the budget request. This 
program makes awards to parent organizations to support parent 
training and information centers, including community parent 
resource centers. These centers provide training and 
information to meet the needs of parents of children with 
disabilities living in the areas served by the centers, 
particularly underserved parents, and parents of children who 
may be inappropriately identified.

Technology and media services

    The Committee recommends $37,710,000 for technology and 
media services. This amount is $5,000,000 more than the budget 
request and the same as the fiscal year 2002 appropriation. 
This program makes competitive awards to support the 
development, demonstration, and use of technology, and 
educational media activities of value to children with 
disabilities.
    The Committee recommendation includes $9,500,000 for 
Recording for the Blind and Dyslexic, Inc. This is the same 
amount as the fiscal year 2002 level and $3,500,000 more than 
the budget request. These funds support the continued 
production and circulation of recorded textbooks, increased 
outreach activities to print-disabled students and their 
teachers, and accelerated use of digital technology.
    The Committee also recommends $1,500,000 for the Readline 
Program. The amount recommended is the same as the fiscal year 
2002 appropriation for this activity. The administration 
proposed eliminating this program.
    This activity is authorized by section 687(b)(2)(G) of the 
Individuals with Disabilities Education Act, as amended. The 
Committee recognizes the progress of the Readline Program, 
which is developing a wide range of media resources to 
disseminate research conducted by the National Institutes of 
Health, as well as other research concerning effective teaching 
strategies, early diagnosis of, and intervention for, young 
children with reading disabilities. These resources include an 
extensive Web site, videos, and programming for television and 
radio broadcast. The Committee includes funding for the 
continued development and distribution of media resources to 
reach the parents and teachers of children with reading 
disabilities.

            REHABILITATION SERVICES AND DISABILITY RESEARCH

Appropriations, 2002....................................  $2,945,813,000
Budget estimate, 2003...................................   3,001,840,000
Committee recommendation................................   2,963,722,000

    The Committee recommends $2,963,722,000 for rehabilitation 
services and disability research, $17,909,000 more than the 
comparable fiscal year 2002 funding level and $38,118,000 less 
than the administration request.

Vocational rehabilitation State grants

    The Committee provides $2,533,492,000 for vocational 
rehabilitation grants to States, which is $52,109,000 more than 
the comparable fiscal year 2002 funding level. The Committee 
recommendation provides the full amount authorized by the 
authorizing statute. The budget request proposed to eliminate 
several categorical programs, redirected $62,573,000 in funding 
to the State grant program and provided an additional increase 
of $20,260,000. The Committee rejected this approach and 
believes changes of this nature should be considered during 
reauthorization.
    Basic State grant funds assist States in providing a range 
of services to help persons with physical and mental 
disabilities prepare for and engage in meaningful employment. 
Authorizing legislation requires States to give priority to 
persons with significant disabilities. Funds are allotted to 
States based on a formula that takes into account population 
and per capita income. States must provide a 21.3 percent match 
of Federal funds, except the State's share is 50 percent for 
the cost of construction of a facility for community 
rehabilitation program purposes.
    The Rehabilitation Act requires that no less than 1 percent 
and not more than 1.5 percent of the appropriation in fiscal 
year 2003 for vocational rehabilitation State grants be set 
aside for grants for Indians. Service grants are awarded to 
Indian tribes on a competitive basis to help tribes develop the 
capacity to provide vocational rehabilitation services to 
American Indians with disabilities living on or near 
reservations.

Vocational Rehabilitation Incentive Grants

    The Committee recommendation does not include $30,000,000 
proposed in the budget request for the new Vocational 
Rehabilitation Incentive Grants program. This proposed program 
is not authorized. Under this new program, grants would be 
awarded to State VR agencies based on their performance in 
helping individuals with disabilities obtain competitive jobs.

Client assistance

    The Committee bill recommends $12,397,000 for the client 
assistance program, an increase of $500,000 more than the 
fiscal year 2002 appropriation and the administration request.
    The client assistance program funds State formula grants to 
assist vocational rehabilitation clients or client applicants 
in understanding the benefits available to them and in their 
relationships with service providers. Funds are distributed to 
States according to a population-based formula, except that 
increases in minimum grants are guaranteed to each of the 50 
States, the District of Columbia, and Puerto Rico, and 
guaranteed to each of the outlying areas, by a percentage not 
to exceed the percentage increase in the appropriation. States 
must operate client assistance programs in order to receive 
vocational rehabilitation State grant funds.

Training

    The Committee provides $42,629,000 for training 
rehabilitation personnel, an increase of $3,000,000 more than 
the fiscal year 2002 appropriation and same as 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, hard of hearing and deaf-blind.
    The Committee is concerned over the reduction in funding 
for rehabilitation long-term training programs, and in 
particular those that require orthotic and prosthetic care, and 
urges RSA to fund no fewer than four university O+P programs at 
$250,000 each.

Demonstration and training programs

    The Committee bill includes $21,238,000 for demonstration 
and training programs for persons with disabilities, the same 
amount as the comparable fiscal year 2002 appropriation and 
$3,746,000 more than 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. Demonstration programs 
support projects for individuals with a wide array of 
disabilities.

Migrant and seasonal farmworkers

    The Committee recommends $2,350,000 for migrant and 
seasonal farmworkers, the same as the fiscal year 2002 
appropriation. The Department proposed eliminating funding for 
this program.
    This program provide grants limited to 90 percent of the 
costs of the projects providing comprehensive rehabilitation 
services to migrant and seasonal farm workers with disabilities 
and their families. Projects also develop innovative methods 
for reaching and serving this population. The program 
emphasizes outreach, specialized bilingual rehabilitation 
counseling, and coordination of vocational rehabilitation 
services with services from other sources.

Recreational programs

    The Committee provides $2,596,000 for recreational 
programs, the same amount as the fiscal year 2002 
appropriation. The budget request did not include funding for 
this program.
    Recreational programs help finance activities such as 
sports, music, dancing, handicrafts, and art to aid in the 
employment, mobility, and socialization of individuals with 
disabilities. Grants are awarded to States, public agencies, 
and nonprofit private organizations, including institutions of 
higher education. Grants are awarded for a 3-year period with 
the Federal share at 100 percent for the first year, 75 percent 
for the second year, and 50 percent for the third year. 
Programs must maintain the same level of services over the 3-
year period.
    The Committee notes that the primary purpose of this 
program is to initiate recreational and related activities for 
individuals with disabilities. These programs are designed to 
aid individuals with disabilities in employment, mobility, 
independence and community integration. The Committee notes 
that almost three out of four programs whose last year of 
Federal funding ended in fiscal years 1998 through 2000 are 
still in operation and continue to meet the recreational needs 
of individuals with disabilities. These results show that this 
limited investment is having a national impact, as each new 
grant supports seed money for recreational programs throughout 
the United States.

Protection and advocacy of individual rights

    The Committee recommends $17,500,000 for protection and 
advocacy of individual rights, an increase of $2,300,000 more 
than the fiscal year 2002 appropriation and the budget request.
    This program provides grants to agencies to protect and 
advocate for the legal and human rights of persons with 
disabilities who are not eligible for protection and advocacy 
services available through the Developmental Disabilities 
Assistance and Bill of Rights Act or the Protection and 
Advocacy for Individuals with Mental Illness Act.
    The Committee notes that a recent evaluation of the PAIR 
program found that more than 98 percent of cases closed by a 
sample of PAIR programs were resolved through counseling, 
negotiation/mediation and supervised referrals. The evaluation 
also found that many of the programs had considerable 
difficulties attempting to serve the significant number of 
persons eligible for the program. Therefore, the Committee has 
recommended additional resources to continue to expand the 
availability of PAIR services to eligible individuals.

Projects with industry

    The Committee bill includes $22,071,000 for projects with 
industry, the same as the 2002 appropriation. The 
administration proposed eliminating funding for this program.
    The projects with industry [PWI] program promotes greater 
participation of business and industry in the rehabilitation 
process. PWI provides training and experience in realistic work 
settings to prepare individuals with disabilities for 
employment in the competitive job market. Postemployment 
support services are also provided. The program makes grants to 
a variety of agencies and organizations, including 
corporations, community rehabilitation programs, labor and 
trade associations, and foundations.
    The Committee notes that according to the Department's 2001 
Annual Performance Report, the Projects with Industry program 
has exceeded performance measures in all three areas by which 
the program is measured. More than 3 out of 5 PWI clients were 
placed in competitive employment in 2001; Projects With 
Industry projects will report that participants placed in 
competitive employment increase earnings by an average of at 
least $236 per week; and 67.2 percent of previously unemployed 
persons were placed in competitive employment. These 
significant achievements warrant continued funding, especially 
in light of the new Ticket to Work program and the role that 
PWI projects can play in assisting Social Security disability 
beneficiaries and SSI recipients in securing employment and 
exiting the disability roles.

Supported employment State grants

    The Committee's bill includes $38,152,000 for the supported 
employment State grant program, the same as the 2002 
appropriation. The administration proposed eliminating funding 
for this program.
    This program assists persons who may have been considered 
too severely disabled to benefit from vocational rehabilitation 
services by providing the ongoing support needed to obtain 
competitive employment. Short-term vocational rehabilitation 
services are augmented with extended services provided by State 
and local organizations. Federal funds are distributed on the 
basis of population.

Independent living State grants

    The Committee recommends $22,296,000 for independent living 
State grants, which is the same as the amount appropriated in 
2002 and 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 recommends 
$69,500,000, an increase of $7,000,000 over the 2002 
appropriation and the same amount as the budget request.
    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 $28,000,000 for independent living 
services to older blind individuals, an increase of $3,000,000 
more than the 2002 appropriation and the administration 
request.
    States participating in the program must match every $9 of 
Federal funds with not less than $1 in non-Federal resources. 
Assistance is provided to persons aged 55 or older to adjust to 
their blindness, continue living independently and avoid 
societal costs associated with dependent care. Services may 
include the provision of eyeglasses and other visual aids, 
mobility training, braille instruction and other communication 
services, community integration, and information and referral. 
These services help older individuals age with dignity, 
continue to live independently and avoid significant societal 
costs associated with dependent care. The services most 
commonly provided by this program are daily living skills 
training, counseling, the provision of low-vision devices 
community integration, information and referral, communication 
devices, and low-vision screening.
    The Committee notes that there are 5,000,000 Americans in 
this country age 55 and older who are experiencing vision loss 
and that the number of Americans in this category is expected 
to double in the next 30 years. The Committee recognizes the 
very important and cost-effective work carried out through this 
program. By allowing older individuals to remain in their homes 
and communities, substantial savings are achieved. The 
Committee is informed that the yearly savings to society for 
just 10 percent of the clients now receiving independent living 
services is $56,000,000.

Program improvement activities

    For program improvement activities, the Committee provides 
$900,000, the same amount as the 2002 appropriation and the 
budget request. In fiscal year 2003, funds for these activities 
will continue to support technical assistance efforts to 
improve the efficiency and effectiveness of the vocational 
rehabilitation program and improve accountability efforts. The 
funds provided are sufficient to support ongoing program 
improvement activities and to support ongoing dissemination and 
performance measurement activities.

Evaluation

    The Committee recommends $1,000,000 for evaluation 
activities, the same as the 2002 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 $8,717,000 for the Helen Keller 
National Center for Deaf-Blind Youth and Adults, the same as 
the 2002 appropriation and 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 48 agencies. At 
the recommended level, the center would serve approximately 102 
persons with deaf-blindness at its headquarters facility and 
provide field services to approximately 1,850 individuals and 
families.

National Institute on Disability and Rehabilitation Research

    The Committee recommends $110,000,000 for the National 
Institute on Disability and Rehabilitation Research [NIDRR], 
the same as the amount appropriated in fiscal year 2002 and the 
budget request.
    NIDRR develops and implements a comprehensive and 
coordinated approach to the conduct of research, demonstration 
projects, and related activities that enable persons with 
disabilities to better function at work and in the community, 
including the training of persons who provide rehabilitation 
services or who conduct rehabilitation research. The Institute 
awards competitive grants to support research in Federally 
designated priority areas, including rehabilitation research 
and training centers, rehabilitation engineering research 
centers, research and demonstration projects, and dissemination 
and utilization projects. NIDRR also supports field-initiated 
research projects, research training, and fellowships.
    The Committee urges the NIDRR to focus on activities to 
enhance access to assistive technology for people with 
disabilities, including technology-based activities, such as 
technology transfer.
    The Committee strongly encourages NIDDR to give priority in 
awarding grants to establish new rehabilitation and research 
engineering centers which will aid in the implementation of the 
Executive Order related to the Supreme Court Decision in L.C. 
v. Olmstead.
    The Committee encourges NIDRR to provide increased funding 
for the Interagency Committee on Disability Research (ICDR) and 
notes that the primary purpose of the ICDR is to promote 
cooperation across various government agencies in the 
development and execution of disability and rehabilitation and 
research activities. The Committee strongly encourages the ICDR 
to enter into cooperative agreements with other ICDR members to 
identify Federally funded technological and scientific research 
that could be applied to promote the independence of people 
with disabilities and the elderly. The same Federal agencies 
shall work in partnership with the private sector to develop a 
plan to bring the applied technologies to the private 
marketplace. The Committee commends ICDR for expansion of its 
website/database for the coordination of research by various 
agencies.
    The Committee strongly urges NIDRR to use resources 
appropriated for the Assistive Technology Development Fund to 
develop new assistive technology, bring technology that has 
already been developed to market and expand the availability of 
existing assistive technology to people with disabilities. The 
Committee believes that priority for grants should be given to 
the development of technology that has a limited number of 
users, or orphan technology. In addition, a portion of these 
funds should be used to further the development of assistive 
technology for children and students and reach the goals of 
projects that were previously funded through the small business 
innovation research activity of OSER's technology and media 
services program.

Assistive technology

    The Committee bill provides $30,884,000 for assistive 
technology, a reduction of $30,000,000 from the fiscal year 
2002 appropriation and the same as the budget request.
    The Assistive Technology Program is designed to improve 
occupational and educational opportunities and the quality of 
life for people of all ages with disabilities through increased 
access to assistive technology services and devices. It 
provides grants to States to develop comprehensive, consumer-
responsive statewide programs that increase access to, and the 
availability of, assistive technology devices and services. The 
National Institute on Disability and Rehabilitation Research 
administers the program.
    The Committee recommendation includes $26,971,484 for 
activities authorized under title I of the Assistive Technology 
Act (AT Act). The Committee has included bill language which 
allows all State projects funded currently under title I of the 
AT Act to receive not less than the amount they received in 
fiscal year 2002. The bill language also provides minimum 
grants of $100,000 for State protection and advocacy systems, 
$30,000 for systems in the outlying areas. In fiscal year 2003, 
the AT Act would require 23 States to lose Federal financial 
support provided by title I, at a time when States are 
operating in a new policy landscape that includes the Olmstead 
decision, final section 508 standards and the Ticket to Work 
and Work Incentives Improvement Act.
    The Committee recommendation includes $3,912,516 to support 
grants to States and technical assistance activities, 
authorized under title III of the AT Act, to establish or 
maintain alternative loan financing programs. The Committee has 
increased significantly funding for alternative financing 
programs authorized under title III of the AT Act. In fiscal 
year 2000, the Committee provided $4,028,000 in first year 
funding. Last year, the Committee provided $36,552,000, and 
allowed these funds to be available for 2 years. The Committee 
will review the program funding level in the fiscal year 2004 
budget and ensure that sufficient resources are available to 
continue this important program. Currently, major service 
programs such as Medicaid, Medicare, special education, and 
vocational rehabilitation cannot meet the growing demand for 
assistive technology. Loan programs offer individuals with 
disabilities attractive options that significantly enhance 
their ability to purchase assistive technology devices and 
services.
    The Committee recommendation concurs with the 
administration request to make technical changes to the 
alternative financing program authorized under title III of the 
AT Act. The changes will eliminate the minimum grant amount and 
formula allocation requirements, allow States to receive more 
than 1 year of funding and enable States to be awarded more 
than one grant. These changes will ensure that States are able 
to take full advantage of the opportunities presented by this 
program and are the same as enacted in the Department of 
Education Appropriations Act, 2002. The Committee believes that 
States should be allowed to utilize non-Federal resources from 
any source in order to meet the match required to receive an 
award to operate alternative loan programs.

Access to telework fund

    The Committee does not recommend additional resources for 
the access to telework fund, the same amount requested by the 
administration. The Committee provided $20,000,000 for this new 
program last year, and notes that the grant competition has not 
been announced as of yet. Funding provided last year is 
available to the Department for 2 years. The Committee will 
review the funding needed in fiscal year 2004 to maintain and 
expand this program.
    The access to telework fund is designed to increase 
employment opportunities for individuals with disabilities by 
providing greater access to computers and other equipment 
individuals need if they decide to work from home. The fund 
would provide matching funds to States to enable them to 
provide loans for individuals with disabilities to purchase 
computers and other equipment so that they can telework from 
home.
    The Committee encourages the Department of Education to 
design the access to telework loan program in a manner which 
creates the maximum incentives for people with disabilities to 
participate. The Committee recognizes that the decision to 
attempt to work involves a high level of risk for a person with 
a disability, including the potential loss of health care 
coverage and income subsidies, and that the design of the 
program should take this fact into account (including the 
possibility of loan forgiveness should the person's attempt to 
work fail). Finally, the Committee encourages the Department to 
allow States flexibility in implementation of the program to 
encourage participation, including the use of any non-Federal 
resources to meet the match requirement.

           Special Institutions for Persons With Disabilities


                 AMERICAN PRINTING HOUSE FOR THE BLIND

Appropriations, 2002....................................     $14,000,000
Budget estimate, 2003...................................      14,000,000
Committee recommendation................................      15,500,000

    The Committee recommends $15,500,000 for the American 
Printing House for the Blind [APH], $1,500,000 more than the 
2002 appropriation and the budget request.
    This appropriation helps support the American Printing 
House for the Blind, which provides educational materials to 
students who are legally blind and enrolled in programs below 
the college level. The Federal subsidy provides almost 51 
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, 2002....................................     $55,376,000
Budget estimate, 2003...................................      52,014,000
Committee recommendation................................      54,600,000

    The Committee recommends an appropriation of $54,600,000 
for the National Technical Institute for the Deaf [NTID], a 
decrease of $776,000 from the fiscal year 2002 appropriation 
and $2,586,000 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. Within the amount provided, $1,600,000 is for 
construction and funds, at the discretion of the Institute are 
available for the Endowment Grant program.

                          GALLAUDET UNIVERSITY

Appropriations, 2002....................................     $96,938,000
Budget estimate, 2003...................................      94,446,000
Committee recommendation................................      98,438,000

    The Committee recommends $98,438,000 for Gallaudet 
University, an increase of $1,500,000 above the amount 
appropriated in 2002 and $3,992,000 more than the budget 
request.
    Gallaudet University is a private, nonprofit institution 
offering undergraduate, and continuing education programs for 
students who are deaf, as well as graduate programs in fields 
related to deafness for students who are hearing-impaired and 
who are deaf. The university conducts basic and applied 
research related to hearing impairments and provides public 
service programs for the deaf community.
    The Model Secondary School for the Deaf serves as a 
laboratory for educational experimentation and development, 
disseminates models of instruction for students who are deaf, 
and prepares adolescents who are deaf for postsecondary 
academic or vocational education. The Kendall Demonstration 
Elementary School develops and provides instruction for 
children from infancy through age 15.
    The Committee recommendation includes funding to enable 
Gallaudet University to maintain and enhance its technological 
base, continue investments in faculty and staff, continue to 
enhance developmental and honors programs and support 
improvements in physical facilities, including campus security. 
Funds also are available, at the discretion of the University, 
for the Endowment Grant program.

                     VOCATIONAL AND ADULT EDUCATION

Appropriations, 2002....................................  $1,934,060,000
Budget estimate, 2003...................................   1,897,560,000
Committee recommendation................................   1,938,060,000

    The Committee recommendation includes a total of 
$1,938,060,000 for vocational and adult education, consisting 
of $1,322,000 for vocational education and $591,060,000 for 
adult education, and $25,000,000 for State grants for 
incarcerated youth offenders.

                          VOCATIONAL EDUCATION

    The Committee recommendation of $1,322,000 for vocational 
education is $1,000,000 more than the fiscal year 2002 amount 
and $15,500,000 more than the administration's request.
    Basic grants.--The Committee has included $1,180,000,000 
for basic grants, the same as the fiscal year 2002 
appropriation and 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 $108,000,000 
for tech-prep programs. This is the same as the 2002 
appropriation and 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 $7,000,000 on a 
current-funded basis for tribally controlled postsecondary 
vocational institutions, an increase of $500,000 over the 
fiscal year 2002 level and the budget request. This program 
provides grants for the operation and improvement of two 
tribally controlled postsecondary vocational institutions to 
ensure continued and expanding opportunities for Indian 
students: United Tribes Technical College in Bismarck, North 
Dakota, and Crownpoint Institute of Technology in Crownpoint, 
New Mexico.
    National programs, research.--The Committee recommends 
$12,000,000 for national research programs and other national 
activities, the same amount as the 2002 appropriation and the 
administration request. The National Research Center for Career 
and Technical Education and the National Dissemination Center 
for Career and Technical Education are the only federally 
funded centers charged with the responsibility to conduct 
research and provide technical assistance to vocational 
educators. The results of the applied research done by these 
Centers inform technical assistance to reform and improve 
vocational education instruction in schools and colleges. 
Resources made available through this program also are used to 
support a variety of activities to identify and promote 
effective research-based programs and practice in vocational 
education.
    Vocational training tied to real economic opportunities and 
rooted in endangered traditional crafts is a significant need 
in rural Hawaiian and part-Hawaiian communities. The Committee 
urges the Department to fund programs that support the 
development of mentoring programs pairing secondary students 
with individuals who have succeeded in commercially developing 
traditional Hawaiian arts and crafts. These mentoring programs 
can provide young Hawaiian and Part-Hawaiian students with 
training in important crafts while also teaching them how to 
successfully turn these skills into economic gain.
    Tech-prep education demonstration program.--The Committee 
recommendation includes $5,000,000 for this program, the same 
amount as provided in fiscal year 2002. The administration did 
not request funding for this program. Under this demonstration 
authority, the Secretary awards grants competitively to 
consortia that involve a business as a member, locate a 
secondary school on the site of a community college, and seek 
voluntary participation of secondary school students enrolled 
such a high school. The purpose of the demonstration program is 
to support development of the ``middle college'' model of high 
school, which promotes higher student achievement and 
postsecondary enrollment. Funds may be used for curriculum, 
professional development, equipment, and other start-up and 
operational costs.
    Occupational and employment information program.--The 
amount of $10,000,000 has been provided to continue activities 
authorized by section 118 of the Carl Perkins Act, $500,000 
more than last year. The administration proposed the 
elimination of this program. The Act requires that at least 85 
percent of the amount be provided directly to State entities to 
develop and deliver occupational and career information to 
students, job seekers, employers, education, employment and 
training programs.

                            ADULT EDUCATION

    The Committee has included $591,060,000 for adult 
education, the same amount as the 2002 appropriation and the 
administration request.
    Adult education State programs.--For adult education State 
programs, the Committee recommends $575,000,000, the same 
amount as the fiscal year 2002 appropriation and the 
administration request. These funds are used by States for 
programs to enable economically disadvantaged adults to acquire 
basic literacy skills, to enable those who so desire to 
complete a secondary education, and to make available to adults 
the means to become more employable, productive, and 
responsible citizens.
    The Committee recommendation continues the English literacy 
and civics education State grants set aside within the Adult 
Education State grant appropriation. Within the total, 
$70,000,000 is available to help States or localities affected 
significantly by immigration and large limited-English 
populations to implement programs that help immigrants acquire 
English literacy skills, gain knowledge about the rights and 
responsibilities of citizenship and develop skills that will 
enable them to navigate key institutions of American life. The 
amount recommended is the same as the fiscal year 2002 level 
and the budget request.
    National activities.--The Committee has included 
$9,500,000, the same as the 2002 appropriation and the 
administration request. The Department supports applied 
research, development, dissemination, evaluation and program 
improvement activities to assist States in their efforts to 
improve the quality of adult education programs.
    National Institute for Literacy.--The Committee recommends 
$6,560,000 for the National Institute for Literacy, authorized 
under section 242 of the Adult Education and Family Literacy 
Act, the same amount as available currently and the budget 
request. The Institute provides leadership and coordination for 
national literacy efforts 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.
    The Committee recognizes and supports the unique mandate of 
the National Institute for Literacy to serve as a national 
resource for adult education and literacy programs. The 
Committee is aware that the President has nominated 10 new 
advisory board members to oversee the work of the Institute. 
The Committee urges this new advisory board to assist the 
Institute in maintaining its unique focus on adult literacy 
through its programs, such as the Bridges to Practice 
initiative that informs and trains adult educators on proper 
assessments and interventions for low literate adults who have 
learning disabilities, and the Equipped for the Future 
initiative that works to improve the quality and results of 
adult learning programs by focusing instruction and assessment 
on the skills and knowledge adults need to accomplish their 
goals as citizens, parents, and workers.

             STATE GRANTS FOR INCARCERATED YOUTH OFFENDERS

    The Committee has included $25,000,000 for a program 
authorized by part D of title VIII of the Higher Education Act, 
an increase of $3,000,000 more than the amount appropriated in 
fiscal year 2002. The Department proposed eliminating 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 also assist 
correction agencies in providing employment counseling and 
other related services that start during incarceration and 
continue through prerelease and while on parole. Each student 
is eligible for a grant of not more than $1,500 annually for 
tuition, books, and essential materials, and not more than $300 
annually for related services such as career development, 
substance abuse counseling, parenting skills training, and 
health education. In order to participate in a program, a 
student must be no more than 25 years of age and be eligible to 
be released from prison within 5 years. Youth offender grants 
are for a period not to exceed 5 years, 1 year of which may be 
devoted to study in remedial or graduate education.
    The Committee notes the positive findings from a recent 
evaluation of programs funded in three States. The Three State 
Recidivism Study found that re-arrest, reconviction, and re-
incarceration rates were significantly lower for the prison 
population who had participated in correctional education than 
for non-participants. The study found the re-arrest rate of 
correctional education participants was 48 percent, compared to 
57 percent for the non-participants; re-conviction rate was 27 
percent for correctional educational participants, compared to 
35 percent for non-participants; and re-incarceration rate was 
21 percent, compared to 31 percent for non-participants. This 
important program not only helps make the Nation's streets 
safer for all Americans, but it saves public money as fewer 
contacts are made with the more expensive criminal justice 
system and former prisoners become employed, contributing 
members of society.
    Within the appropriation for State grants for incarcerated 
youth offenders, the Committee includes $5,000,000 to continue 
the prisoner literacy initiative. The Committee notes that the 
extremely high rates of illiteracy or marginal reading skills 
among inmates is a national problem and therefore encourages 
the development of a uniform model to evaluate literacy 
programs across the country.

                      STUDENT FINANCIAL ASSISTANCE

Appropriations, 2002.................................... $12,285,500,000
Budget estimate, 2003...................................  12,767,500,000
Committee recommendation................................  13,162,000,000

    The Committee recommends an appropriation of 
$13,162,000,000 for student financial assistance, an increase 
of $876,500,000 more than the comparable fiscal year 2002 
appropriation and $394,500,000 more than the administration 
request.

Federal Pell Grant Program

    For Pell grant awards in the 2003-2004 academic year, the 
Committee recommends $11,180,000,000. The Committee 
recommendation is $317,000,000 more than requested by the 
administration.
    Pell grants provide need-based financial assistance that 
helps low-and middle-income undergraduate students and their 
families pay the costs of postsecondary education and 
vocational training. Awards are determined according to a 
statutory need analysis formula that takes into account a 
student's family income and assets, household size, and the 
number of family members, excluding parents, attending 
postsecondary institutions. Pell grants are considered the 
foundation of Federal postsecondary student aid.
    The amount recommended is sufficient to raise the maximum 
Pell grant to $4,100, the highest level in the program's 
history and an increase of $100 over the maximum grant for the 
2002-2003 academic year. The Pell grant maximum award supported 
by the Committee recommendation is at least $100 more than that 
requested by the administration.
    The Committee has made significant gains in supporting 
increases in funding for the Pell Grant Program. Since fiscal 
year 2000, the maximum Pell grant has been increased from 
$3,300 to the current recommendation of $4,100, an increase of 
almost 25 percent in 3 years. With the Committee recommendation 
for this year, program funding will have increased by 50 
percent over this period. Also, the number of students 
receiving Pell grant awards will have increased by more than 
500,000 over the past 3 years. While the Committee would have 
liked to increase the maximum grant by a larger amount, budget 
constraints would not accommodate investments greater than the 
Committee recommendation.
    The Committee has not included bill language requested by 
the administration that would allow the Secretary to establish 
the Pell grant maximum award after enactment of the 
appropriations bill.

Federal supplemental educational opportunity grants

    The Committee recommends $725,000,000 for Federal 
supplemental educational opportunity grants [SEOG], the same 
amount as the 2002 appropriation level and 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 $1,011,000,000 for the Federal 
Work-Study Program, the same as the 2002 level and the 
administration request. This program provides grants to more 
than 3,300 institutions to help an estimated 1 million 
undergraduate, graduate, and professional students meet the 
costs of postsecondary education through part-time employment. 
Work-study jobs must pay at least the Federal minimum wage and 
institutions must provide at least 25 percent of student 
earnings. Institutions also must use at least 7 percent of 
their grants for community-service jobs.
    The Committee strongly supports continued funding for the 
work colleges program authorized in section 448 of the Higher 
Education Act of 1965. These funds help support comprehensive 
work-service learning programs at seven work colleges, and 
cooperative efforts among the work colleges to expose other 
institutions of higher education to the work college concept. 
Of the amount recommended by the Committee, $4,000,000 is 
available for this program.

Federal Perkins loans

    The Committee bill includes $100,000,000 for Federal 
Perkins loans capital contributions, which is the same as the 
2002 appropriation and the budget request. The amount 
recommended, when combined with institutional revolving funds, 
would maintain the 2003 loan volume at the current estimated 
level of $1,200,000,000. At this funding level more than 
700,000 loans would be made.
    The Federal Perkins Loan Program supports student loan 
revolving funds built up with capital contributions to about 
2,000 participating institutions. Institutions use these 
revolving funds, which also include Federal capital 
contributions (FCC), institutional contributions equal to one-
third of the FCC, and student repayments, to provide low-
interest (5 percent) loans that help financially needy students 
pay the costs of postsecondary education. The Committee has 
included the amount necessary to maintain the current loan 
volume level.
    The Committee bill also includes $72,500,000 for loan 
cancellations, an increase of $5,000,000 over the 2002 level 
and amount requested by the administration. These funds 
reimburse institutional revolving funds on behalf of borrowers 
whose loans are cancelled in exchange for statutorily specified 
types of public or military service, such as teaching in a 
qualified low-income school, working in a Head Start Program, 
serving in the Peace Corps or VISTA, or nurses and medical 
technicians providing health care services.

Leveraging educational assistance partnership program

    For the leveraging educational assistance partnership 
[LEAP] program, the Committee includes $72,500,000, an increase 
of $5,500,000 over the 2002 appropriation. The administration 
proposed eliminating this program.
    The leveraging educational assistance partnership program 
provides a Federal match to States as an incentive for 
providing need-based grant and work-study assistance to 
eligible postsecondary students. When the appropriation exceeds 
$30,000,000, amounts above this threshold must be matched by 
States on a 2:1 basis. Federally supported grants and job 
earnings are limited to $5,000 per award year for full-time 
students.
    The Committee recognizes the important role that the LEAP 
program plays in maintaining a Federal-State partnership for 
ensuring that postsecondary education is available to all 
academically-qualified Americans. The Committee notes that a 
recent Advisory Committee on Student Financial Aid report 
recommended that Federal policy should encourage a far more 
substantial State and institutional commitment to need-based 
grant aid. The Committee notes that this important program 
leverages almost $1,000,000,000 in State spending for need-
based student grant programs. Therefore, it is the Committee's 
intent to continue to build on this important program.

Loan forgiveness for child care providers

    The Committee recommends $1,000,000 for this demonstration 
program, the same as the fiscal year 2002 appropriation and the 
budget request. Under this demonstration program, Stafford and 
Unsubsidized Stafford Loan borrowers under the Federal Family 
Education Loan Program and the William D. Ford Direct Loan 
program who have earned a degree in early childhood education 
and work for 2 full years as a child care provider in a low-
income community may have a portion of their loan obligation 
forgiven.
    The Committee encourages the Department to prepare the 
required final evaluation report of this important program as 
soon as possible. The Committee looks forward to receiving this 
report, so further actions and investments can be made that 
support improvements in the education level and compensation of 
the early childcare profession.

                            HIGHER EDUCATION

Appropriations, 2002....................................  $2,031,048,000
Budget estimate, 2003...................................   1,883,053,000
Committee recommendation................................   1,986,336,000

    The Committee recommends an appropriation of $1,986,336,000 
for higher education programs, $44,712,000 less than the fiscal 
year 2002 amount and $103,283,000 more than the budget request.

Aid for institutional development

    The Committee recommends $465,413,000 for aid for 
institutional development authorized by titles III and V of the 
Higher Education Act, $26,788,000 above the 2002 appropriation 
and $10,999,000 more than the budget request.
    The Committee encourages the Department to provide 
technical assistance and conduct research on issues germane to 
predominately and Historically Black Colleges and Universities 
(HBCUs) and other institutions of higher education that have 
large minority student populations, including disseminating 
best practices information on the most efficient and cost-
effective uses of title III funding, reducing student loan 
default rates, increasing graduation rates, and grant writing 
training.
    Strengthening institutions.--The Committee bill includes 
$80,000,000 for the part A strengthening institutions program, 
an increase of $6,375,000 over the fiscal year 2002 level and 
$3,725,000 more than the budget request. The part A program 
supports competitive, 1-year planning and 5-year development 
grants for institutions with a significant percentage of 
financially needy students and low educational and general 
expenditures per student in comparison with similar 
institutions. Applicants may use part A funds to develop 
faculty, strengthen academic programs, improve institutional 
management, and expand student services. Institutions awarded 
funding under this program are not eligible to receive grants 
under other sections of part A or part B.
    Hispanic-serving institutions [HSI].--The Committee 
recommends $91,000,000 for institutions at which Hispanic 
students make up at least 25 percent of enrollment, $5,000,000 
more than the fiscal year 2002 level and $1,904,000 more than 
the administration request. Institutions applying for title V 
funds must meet the regular part A requirements and show that 
at least one-half of their Hispanic students are low-income 
college students. Funds may be used for acquisition, rental or 
lease of scientific or laboratory equipment, renovation of 
instructional facilities, development of faculty, support for 
academic programs, institutional management, and purchase of 
educational materials. Title V recipients are not eligible for 
other awards provided under title III, parts A and B.
    Strengthening historically black colleges and 
universities.--The Committee provides $213,415,000 for part B 
grants, $7,415,000 more than the fiscal year 2002 level and the 
same as the administration request. The part B strengthening 
historically black colleges and universities [HBCU] program 
makes formula grants to HBCUs that may be used to purchase 
equipment, construct and renovate facilities, develop faculty, 
support academic programs, strengthen institutional management, 
enhance fundraising activities, provide tutoring and counseling 
services to students, and conduct outreach to elementary and 
secondary school students. The minimum allotment is $500,000 
for each eligible institution. Part B recipients are not 
eligible for awards under part A.
    Strengthening historically black graduate institutions.--
The Committee bill includes $50,764,000 for the part B, section 
326 program, $1,764,000 more than the fiscal year 2002 level 
and the same amount as the administration request. The section 
326 program provides 5-year grants to strengthen historically 
black graduate institutions [HBGIs]. The Higher Education 
Amendments of 1998 increased the number of recipients to 18 
named institutions, but reserved the first $26,600,000 
appropriated each year to the 16 institutions included in the 
previous authorization. Grants may be used for any part B 
purpose and to establish an endowment.

Strengthening Alaska Native and Native Hawaiian-serving institutions

    The Committee recommends $7,234,000 for this program, an 
increase of $734,000 over the fiscal year 2002 appropriation 
and $500,000 more than budget request. The purpose of this 
program is to improve and expand the capacity of institutions 
serving Alaska Native and Native Hawaiian students. Funds may 
be used to plan, develop, and implement activities that 
encourage: faculty and curriculum development, better fund and 
administrative management, renovation and improvement of 
instructional facilities, student services, and the purchase of 
library books and other educational materials.

Strengthening tribally controlled colleges and universities

    The Committee recommends $23,000,000 for strengthening 
tribal colleges and universities (TCUs), an increase of 
$5,500,000 over the fiscal year 2002 level and $4,870,000 more 
than the budget request. Still in their early stages, TCUs rely 
on a portion of these funds to address developmental needs, 
including faculty development, curriculum and student services. 
In addition, the Committee in fiscal year 2001 helped launch a 
competitive grant program to assist institutions in addressing 
long overdue and high-priority infrastructure and facilities 
requirements. The funds provided shall be used to support 
continuation of existing basic grants and new planning or 
implementation grant awards. The remaining funds shall be 
available for grants for renovation and construction of 
facilities to help address urgently needed facilities repair 
and expansion.

International education and foreign language studies

    The bill includes a total of $102,500,000 for international 
education programs, an increase of $4,000,000 over the fiscal 
year 2002 level and the same as the budget request.
    Domestic programs.--The Committee recommends $88,000,000 
for domestic program activities related to international 
education and foreign language studies, including international 
business education, under title VI of the HEA, an increase of 
$2,800,000 above the fiscal year 2002 appropriation and the 
same as the administration request. Domestic programs include 
national resource centers, undergraduate international studies 
and foreign language programs, international research and 
studies projects, international business education projects and 
centers, American overseas research centers, language resource 
centers, foreign language and area studies fellowships, and 
technological innovation and cooperation for foreign 
information access.
    Overseas programs.--The bill includes $13,000,000 for 
overseas programs authorized under the Mutual Educational and 
Cultural Exchange Act of 1961, popularly known as the 
Fulbright-Hays Act. The recommendation is an increase of 
$1,200,000 more than the fiscal year 2002 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 Department of State, these 
Department of Education programs focus on training American 
instructors and students in order to improve foreign language 
and area studies education in the United States.
    Institute for International Public Policy.--The Committee 
bill recommends $1,500,000 for the Institute for International 
Public Policy. This is the same amount as the fiscal year 2002 
level 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 
50 percent is required.

Fund for the improvement of postsecondary education

    The Committee recommends $75,922,000 for the Fund for the 
Improvement of Postsecondary Education [FIPSE], which is 
$105,000,000 less than the 2002 appropriation and $36,784,000 
more than 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 non-profit institutions and organizations concerned with 
education beyond high school.
    The Committee recommendation includes $25,810,000, the full 
amount requested for the comprehensive program. The Committee 
rejects the budget request to consolidate the Demonstration 
Projects to Ensure Quality Higher Education for Students with 
Disabilities program within the FIPSE program.

Minority science and engineering improvement

    The Committee recommends $8,500,000 for the Minority 
Science and Engineering Improvement program [MSEIP], the same 
as the fiscal year 2002 level and 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 and 
engineering education programs and increase the number of 
minority students in the fields of science, mathematics, and 
engineering.

Interest subsidy grants

    The Committee recommends $3,000,000 for interest subsidy 
grants, $2,000,000 less than the fiscal year 2002 level and the 
same as the administration request. This appropriation is 
required to meet the Federal commitment to pay interest 
subsidies on 73 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.

Federal TRIO programs

    The Committee bill includes $832,500,000 for Federal TRIO 
programs, an increase of $30,000,000 above the fiscal year 2002 
appropriation and the administration request.
    TRIO programs provide a variety of services to improve 
postsecondary education opportunities for low-income 
individuals and first-generation college students: Upward Bound 
offers disadvantaged high school students academic services to 
develop the skills and motivation needed to continue their 
education; Student Support Services provides remedial 
instruction, counseling, summer programs and grant aid to 
disadvantaged college students to help them complete their 
postsecondary education; Talent Search identifies and counsels 
individuals between ages 11 and 27 regarding opportunities for 
completing high school and enrolling in postsecondary 
education; Educational Opportunity Centers provide information 
and counseling on available financial and academic assistance 
to low-income adults who are first-generation college students; 
and the Ronald E. McNair Postbaccalaureate Achievement Program 
supports research internships, seminars, tutoring, and other 
activities to encourage disadvantaged college students to 
enroll in graduate programs.
    The Committee urges the Department to use a funding 
allocation strategy in making awards under TRIO that balances 
the need to fund a larger number of grantees with the need for 
projects to improve the quality of student services and expand 
to serve all eligible students. The Committee notes that, at 
the budget request level, $5,365,000 has not been allocated to 
any particular TRIO program.

Gaining early awareness and readiness for undergraduate programs [GEAR 
        UP]

    The Committee recommends $295,000,000, an increase of 
$10,000,000 over the amount provided in fiscal year 2002 and 
the budget request. Under this program funds are used by States 
and partnerships of colleges, middle and high schools, and 
community organizations to assist middle and high schools 
serving a high percentage of low-income students. Services 
provided help students prepare for and pursue a postsecondary 
education.

Byrd honors scholarships

    The Committee recommends $41,001,000 for the Byrd honors 
scholarship program, the same amount as the fiscal year 2002 
appropriation and the budget request.
    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 2003, and continue support for the 2000, 
2001, and 2002 cohorts of students in their fourth, third and 
second years of study, respectively. The amount recommended 
will provide scholarships of $1,500 to 27,334 students.

Javits fellowships

    The Committee recommends $12,000,000 for the Javits 
Fellowships program, an increase of $2,000,000 above the fiscal 
year 2002 amount and the budget request.
    The Javits Fellowships program provides fellowships of up 
to 4 years to students of superior ability who are pursuing 
doctoral degrees in the arts, humanities, and social sciences 
at any institution of their choice. Each fellowship consists of 
a student stipend to cover living costs, and an institutional 
payment to cover each fellow's tuition and other expenses. 
Funds provided in the fiscal year 2003 appropriation support 
fellowships for the 2004-2005 academic year.

Graduate assistance in areas of national need [GAANN]

    The Committee recommends $31,000,000 for graduate 
assistance in areas of national need, the same as the fiscal 
year 2002 level and the budget request. This program awards 
competitive grants to graduate academic departments and 
programs for fellowship support in areas of national need as 
determined by the Secretary. In fiscal year 2001, the Secretary 
designated the following areas of national need: biology, 
chemistry, computer and information sciences, engineering, 
geological and related sciences, mathematics and physics. 
Recipients must demonstrate financial need and academic 
excellence, and seek the highest degree in their fields.

Teacher quality enhancement grants

    The Committee recommends $90,000,000 for the teacher 
quality enhancement grants program, the same amount as the 
fiscal year 2002 level and the budget request. The program was 
established to support statewide initiatives that best meet 
their specific teacher preparation and recruitment needs. 
Further, the Act provides and designates funding for the 
program in three focus areas: 45 percent of resources support a 
State grant program, 45 percent of funds are used for a 
partnership program, and 10 percent are designated for a 
recruitment grant program.
    Under the State grant program, funds may be used for a 
variety of State-level reforms, including more rigorous teacher 
certification and licensure requirements; provision of high-
quality alternative routes to certification; development of 
systems to reward high-performing teachers and principals; and 
development of efforts to reduce the shortage of qualified 
teachers in high-poverty areas.
    Teacher training partnership grants, which are awarded to 
local partnerships comprised of at least one school of arts and 
science, one school or program of education, a local education 
agency, and a K-12 school, may be used for a variety of 
activities designed to improve teacher preparation and 
performance, including efforts to provide increased academic 
study in a proposed teaching specialty area; to prepare 
teachers to use technology effectively in the classroom; to 
provide preservice clinical experiences; and to integrate 
reliable research-based teaching methods into the curriculum. 
Partnerships may work with other entities, with those involving 
businesses receiving priority consideration. Partnerships are 
eligible to receive a one-time-only grant to encourage reform 
and improvement at the local level.
    The recruitment grant program supports efforts to reduce 
shortages of qualified teachers in high-need school districts 
as well as provide assistance for high-quality teacher 
preparation and induction programs to meet the specific 
educational needs of the local area.

Child care means parents in schools

    The Committee recommends an appropriation of $15,000,000 
for the Child Care Access Means Parents in School (CAMPUS) 
program, $10,000,000 less than the 2002 appropriation and the 
same as the budget request. The Committee takes this action 
because of the $8,700,000 lapsed in fiscal year 2001 and the 
Department's expectation that additional funds will lapse in 
fiscal year 2002. This program was established in the Higher 
Education Amendments of 1998 to support the efforts of a 
growing number of non-traditional students who are struggling 
to complete their college degrees at the same time that they 
take care of their children. Discretionary grants of up to 4 
years are made to institutions of higher education to support 
or establish a campus-based childcare program primarily serving 
the needs of low-income students enrolled at the institution.
    The Committee expects the Department to continue to 
publicize the availability of these funds, provide appropriate 
technical assistance and offer pre-application workshops to 
ensure that eligible entities are able to access funding made 
available through this program.

Demonstration projects to ensure quality higher education for students 
        with disabilities

    The Committee recommends $7,000,000 for this program, the 
same amount appropriated in fiscal year 2002. The Department 
proposed eliminating funding for this program. This program's 
purpose is to ensure that students with disabilities receive a 
high-quality postsecondary education. Grants are made to 
support model demonstration projects that provide technical 
assistance and professional development activities for faculty 
and administrators in institutions of higher education.

Underground railroad program

    The Committee recommendation includes $2,500,000 for the 
Underground Railroad program, an increase of $500,000 over the 
fiscal year 2002 amount. The administration did not request any 
resources for this program. The program was newly authorized by 
the Higher Education Amendments of 1998 and was funded for the 
first time in fiscal year 1999. Grants are provided to 
research, display, interpret, and collect artifacts relating to 
the history of the underground railroad. Educational 
organizations receiving funds must demonstrate substantial 
private support through a public-private partnership, create an 
endowment fund that provides for ongoing operation of the 
facility, and establish a network of satellite centers 
throughout the United States to share information and teach 
people about the significance of the underground railroad in 
American history.

GPRA/Higher Education Act Program Evaluation

    The Committee recommends $1,000,000 for the Government 
Performance and Results Act data collection and for the Higher 
Education Act Program Evaluation program, the same amount as 
the fiscal year 2002 appropriation and the budget request. The 
administration requested these funds to comply with the 
Government Performance and Results Act, which requires the 
collection of data and evaluation of Higher Education programs 
and the performance of recipients of Higher Education funds.

Thurgood Marshall legal educational opportunity program

    The Committee recommends $4,000,000 for this program, the 
same as the fiscal year 2002 appropriation. The Department did 
not request funding for this program. Resources will be used to 
provide minority, low-income or disadvantaged college students 
with the information, preparation, and financial assistance 
needed to gain access to and complete law school study.

B.J. Stupak Olympic scholarships

    The Committee recommendation does not include funding for 
this program, the same as the budget request. The $1,000,000 
appropriated for fiscal year 2002 will be used to provide 
financial assistance to athletes who are training at the United 
States Olympic Education Center or one of the United States 
Olympic Training Centers and who are pursuing a postsecondary 
education at an institution of higher education.

                           HOWARD UNIVERSITY

Appropriations, 2002....................................    $237,474,000
Budget estimate, 2003...................................     237,474,000
Committee recommendation................................     237,474,000

    The Committee recommends an appropriation of $237,474,000 
for Howard University, which is the same as the fiscal year 
2002 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 53 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, $3,600,000 for the 
endowment program.
    Howard University Hospital.--Within the funds provided, the 
Committee recommends $30,374,000 for the Howard University 
Hospital, the same as the fiscal year 2002 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. The Federal 
appropriation provides partial funding for the hospital's 
operations.

             COLLEGE HOUSING AND ACADEMIC FACILITIES LOANS

Appropriations, 2002....................................        $762,000
Budget estimate, 2003...................................         762,000
Committee recommendation................................         762,000

    Federal administration.--The Committee bill includes 
$762,000 for Federal administration of the CHAFL program, the 
same as the 2002 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 2003. 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, 2002....................................        $208,000
Budget estimate, 2003...................................         208,000
Committee recommendation................................         208,000

    Federal administration.--The Committee recommends $208,000 
for Federal administration of the Historically Black College 
and University [HBCU] Capital Financing Program, the same as 
the fiscal year 2002 level and the administration request.
    The HBCU Capital Financing Program makes capital available 
to HBCUs for construction, renovation, and repair of academic 
facilities by providing a Federal guarantee for private sector 
construction bonds. Construction loans will be made from the 
proceeds of the sale of the bonds.

             EDUCATION RESEARCH, STATISTICS, AND ASSESSMENT

Appropriations, 2002....................................    $443,870,000
Budget estimate, 2003...................................     432,887,000
Committee recommendation................................     445,887,000

    The bill includes $445,887,000 for educational research, 
statistics, and assessment programs. This amount is $2,017,000 
more than the fiscal year 2002 appropriation and $13,000,000 
more than the budget request. This account supports education 
research, data collection and analysis activities, and the 
assessment of student progress.

Research and dissemination

    The Committee recommends $140,000,000 for educational 
research and national dissemination activities. This amount is 
$18,183,000 more than the fiscal year 2002 appropriation and 
$35,000,000 less than the budget request. These funds support 
research, development, and dissemination activities that are 
aimed at expanding fundamental knowledge of education and 
promoting the use of research and development findings in the 
design of efforts to improve education.
    The Committee recognizes the important role of research as 
a key component of educational reform. However, it notes that 
the budget request presumed that Congress would succeed in 
passing legislation to reorganize education research in the 
Department of Education. Until such legislation is approved, 
the Committee believes it would be premature to increase 
funding in this account to the level requested by the 
administration.

Regional educational laboratories

    The Committee recommends $67,500,000, the same amount as 
the budget request and the fiscal 2002 appropriation, for 
regional educational laboratories. Funding supports a network 
of 10 laboratories that are responsible for promoting the use 
of broad-based systemic strategies to improve student 
achievement.

Statistics

    The Committee recommends $90,000,000 for data-gathering and 
statistical-analysis activities of the National Center for 
Education Statistics (NCES). This amount is $5,000,000 more 
than the fiscal year 2002 appropriation and $5,000,000 less 
than the budget request.
    The NCES collects, analyzes, and reports statistics on 
education in the United States. Activities are carried out 
directly and through grants and contracts. The Center collects 
data on educational institutions at all levels, longitudinal 
data on student progress, and data relevant to public policy. 
The NCES also provides technical assistance to State and local 
education agencies and postsecondary institutions.

Assessment

    The Committee recommends $95,387,000, the same as the 
budget request, for assessment. This amount is $16,166,000 less 
than the fiscal year 2002 appropriation.
    These funds provide support for the National Assessment of 
Educational Progress (NAEP), a congressionally mandated 
assessment created to measure the educational achievement of 
American students. The primary goal of NAEP is to determine and 
report the status and trends over time in educational 
achievement, subject by subject. Beginning in 2002, the 
Department will pay for State participation in biennial reading 
and mathematics assessments in grades 4 and 8.
    Within the funds appropriated, the Committee recommends 
$4,562,000 for the National Assessment Governing Board (NAGB), 
which is responsible for formulating policy for NAEP. The 
amount is the same as the budget request and $509,000 more than 
the fiscal year 2002 appropriation.

Multi-year grants and contracts

    The Committee recommends $53,000,000 to continue multi-year 
grants and contracts to comprehensive regional assistance 
centers, Eisenhower regional mathematics and science consortia, 
and regional technology in education consortia (R*TECs). This 
amount is $5,000,000 below the fiscal year 2002 appropriation. 
The administration requested no funds for this purpose.
    Within the funds appropriated, the Committee recommends: 
$28,000,000 for the comprehensive regional assistance centers 
program, which funds 15 university-based or nonprofit centers 
that offer technical assistance to States, school districts, 
and schools on a variety of topics; $15,000,000 for Eisenhower 
regional mathematics and science consortia, which disseminate 
exemplary mathematics and science education instruction 
materials and provide technical assistance for the 
implementation of teaching methods and assessment tools; and 
$10,000,000 for R*TECs, which are regional centers that help 
States, local educational agencies, teachers, school library 
and media personnel, administrators, and other education 
entities successfully integrate technologies into K-12 
classrooms, library media centers, and other educational 
settings, including adult literacy centers.

                        Departmental Management


                         PROGRAM ADMINISTRATION

Appropriations, 2002....................................    $364,761,000
Budget estimate, 2003...................................     411,795,000
Committee recommendation................................     412,093,000

    The Committee recommends $412,093,000 for program 
administration, $47,332,000 more than the comparable fiscal 
year 2002 funding level and $298,000 more than 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.
    The Committee is concerned about the delay applicants are 
experiencing in receiving awards under grant programs. The 
Committee is aware of grant competitions that have taken more 
than 1 year from the announcement of the competition to the 
official notification of awards. The Committee understands that 
the events of September 11th and late enactment of the bill 
caused some delay in the process. However, it is the 
Committee's strong belief that every action should be taken to 
reduce the time it takes for applicants to learn whether their 
program has been renewed or whether they have been funded for 
the first time, while still maintaining a strong peer and grant 
review framework. The Committee requests that the Department 
provide a report within 60 days of enactment of this bill on 
the steps that it can take to reduce the delay in administering 
grant competitions.
    The Committee has included $750,000 to provide to all Title 
IV institutions, that are eligible for funding under the higher 
education, a handbook providing detailed instructions on 
compliance with section 485(f) of the Higher Education Act of 
1965. The Committee expects that these handbooks will be 
distributed no later than August 1, 2003.
    The Committee has provided the authority for the Department 
to lease from non-Federal sources one additional passenger 
motor vehicle as requested in the budget.
    The Committee has included $12,795,000, requested by the 
administration, to support costs associated with the renovation 
and modernization of the Mary E. Switzer building. These funds 
are available until expended. The Committee expects the 
Department to include a detailed explanation and justification 
of the funding required to complete this project in its fiscal 
year 2004 budget justification.

                        OFFICE FOR CIVIL RIGHTS

Appropriations, 2002....................................     $79,934,000
Budget estimate, 2003...................................      86,276,000
Committee recommendation................................      86,276,000

    The Committee bill includes $86,276,000 for the Office for 
Civil Rights [OCR], $6,342,000 more than the comparable fiscal 
year 2002 appropriation and the same as 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.

                    OFFICE OF THE INSPECTOR GENERAL

Appropriations, 2002....................................     $38,720,000
Budget estimate, 2003...................................      41,000,000
Committee recommendation................................      41,000,000

    The Committee recommends $41,000,000 for the Office of the 
Inspector General, $2,280,000 more than the fiscal year 2002 
appropriation and the same as the budget 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.

                       STUDENT AID ADMINISTRATION

Appropriations, 2002....................................    $107,484,000
Budget estimate, 2003...................................     105,388,000
Committee recommendation................................     105,388,000

    The Committee recommends $105,388,000 in discretionary 
resources for the new Student Aid Administration account. The 
Committee recommendation is $2,096,000 less than the comparable 
fiscal year 2002 funding level and the same as the request.
    Fiscal year 2002 funding for activities funded in this new 
account was provided by the the FFEL Federal Administration 
account and program administration account.
    Funds appropriated for the Student Aid Administration 
account, in addition to mandatory funding available through 
Section 458 of the Higher Education Act, will support the 
Department's student aid management expenses. The Office of 
Student Financial Assistance and Office of Postsecondary 
Education have primary responsibility for administering Federal 
student financial assistance programs.
    The Committee rejects the Administration's legislative 
proposal to fund this new account solely through annual 
appropriations.

                           General Provisions

    The Committee bill contains language which has been 
included in the bill since 1974, prohibiting the use of funds 
for the transportation of students or teachers in order to 
overcome racial imbalance (sec. 301).
    The Committee bill contains language included in the bill 
since 1977, prohibiting the transportation of students other 
than to the school nearest to the student's home (sec. 302).
    The Committee bill contains language which has been 
included in the bill since 1980, prohibiting the use of funds 
to prevent the implementation of programs of voluntary prayer 
and meditation in public schools (sec. 303).
    The Committee bill includes a provision giving the 
Secretary of Education authority to transfer up to 1 percent of 
any discretionary funds between appropriations (sec. 304).
    The Committee bill includes a provision mandating the 
certain funds for reading activities not be used to supplant 
non-Federal funds (sec. 305).
    The Committee bill includes a provision regarding 
allocation of Title I funds in New York City (sec. 306).
    The Committee bill includes language making minor 
corrections in the Alaska native section of Public Law 107-110 
(sec. 307).
    The Committee includes language making a minor correction 
in the Native Hawaiian section of Public Law 107-110 (sec. 
308).

                       TITLE IV--RELATED AGENCIES

                   Armed Forces Retirement Home Board

Appropriations, 2002....................................     $71,440,000
Budget estimate, 2003...................................      67,340,000
Committee recommendation................................      67,340,000

    The Committee recommends authority to expend $67,340,000 
from the Armed Forces Home Trust Fund to operate and maintain 
the Armed Forces Retirement Home--Washington and the Armed 
Forces Retirement Home--Gulfport. This amount is equal to the 
budget request.

             Corporation for National and Community Service


                  DOMESTIC VOLUNTEER SERVICE PROGRAMS

Appropriations, 2002....................................    $328,895,000
Budget estimate, 2003...................................     396,063,000
Committee recommendation................................     381,063,000

    The Committee recommends an appropriation of $381,063,000 
for the domestic volunteer service programs of the Corporation 
for National and Community Service. The Committee 
recommendation is $52,168,000 above the fiscal year 2002 
comparable level, and $15,000,000 less than the budget request.

VISTA

    The Committee bill provides $99,287,000 for the Volunteers 
in Service to America (VISTA) Program, $14,000,000 above the 
fiscal year 2002 level and $5,000,000 above the budget request.
    VISTA is a 36-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.

Special Volunteer Programs

    The Committee recommends $10,000,000 for the Special 
Volunteer Programs, double the fiscal year 2002 level and 
$45,000,000 below the budget request.
    These funds will be used to carry out Part C of Title I of 
the Domestic Volunteer Service Act of 1973, which authorizes 
grants to volunteer organizations to encourage and enable 
persons from all age groups to perform volunteer service in 
agencies, institutions and situations of need. Grants are 
awarded to organizations that strengthen and support volunteer 
efforts, with a particular emphasis on anti-poverty efforts.
    The Committee commends the CNS for its stated goal of 
recruiting 100,000 new Senior Corps volunteers and strongly 
supports this effort. The Committee is aware that one of the 
most important factors in the decision to continue volunteering 
is the quality of the first volunteer experience and the 
ongoing presence of the volunteer organization. For this 
reason, the Committee has chosen to double this newly funded 
program and simultaneously expand the Corporation's direct 
service programs to better sustain these newly recruited 
volunteers. No funds have been included for the proposed Parent 
Drug Corps.

National Senior Volunteer Corps

    The Committee bill provides $237,547,000 for the National 
Senior Volunteer Corps programs, $31,168,000 above the fiscal 
year 2002 level and $25,000,000 above the budget request.
    The Committee recognizes the valuable contributions of 
seniors participating in the Foster Grandparent (FGP), Retired 
and Senior Volunteer (RSVP) and Senior Companion Programs 
(SCP). In accordance with the Domestic Volunteer Service Act 
(DVSA), the Committee intends that at least one-third of each 
program's increase over the fiscal year 2001 level shall be 
used to fund Program of National Significance (PNS) expansion 
grants to allow existing FGP, RSVP and SCP programs to expand 
the number of volunteers serving in areas of critical need as 
identified by Congress in the DVSA. Within the appropriation, 
sufficient funding has been included to provide adequate 
resources for administrative cost increases realized by all 
current grantees in each DVSA program. Remaining funds should 
be used to begin new FGP, RSVP and SCP programs in geographic 
areas currently underserved. The Committee expects these 
projects to be awarded via a nationwide competition among 
potential community-based sponsors.
    The Committee is concerned that 1,474 service years under 
the Senior Corps programs went unfilled in fiscal year 2001. 
These unfilled slots resulted in over $5,000,000 of unexpended 
funds. Since the early 1990's, the Corporation has maintained a 
15 percent allowance for health care costs above the income 
guidelines. Over the same period of time, health care costs 
have risen exponentially. Data from the Centers for Medicare 
and Medicaid Services (CMS) indicates that seniors under 125 
percent of poverty (those eligible for Senior Corps) spend an 
average of 35 percent of their out-of-pocket income on 
prescription drugs alone--more than twice the Corporations' 
allowance for all healthcare costs. In addition, seniors just 
above the Senior Corps eligibility, between 135 percent and 150 
percent of poverty, spend an average of 30 percent of their 
income on prescription drugs. The Committee urges the 
Corporation to examine the potential for a more appropriate 
health care allowance that would allow the Senior Corps to tap 
into these potential volunteers and engage more of the 
President's projected new volunteers into sustained volunteer 
opportunities.
    The Committee has included $5,400,000 for senior 
demonstration programs, $5,000,000 above the fiscal year 2002 
appropriation and the budget request.
    As a result of the G.I. Bill and expanded opportunities for 
women, more retirees now hold college degrees than any 
generation before them. In addition, life expectancy has 
increased by 27 years since 1900. The last few decades have 
also seen a steady decline in the number of disabilities and 
other impairments among the elderly population due to 
improvements in medical research. At the age of 65, the average 
American is more well-educated than their predecessors, more 
physically able and can now expect to live another 17 years. 
The Committee believes that this population of retirees holds a 
great deal of promise for our nation, in the form of experience 
and wisdom to solve the problems of their communities. 
Unfortunately, traditional volunteer opportunities offer few 
creative outlets for seniors to share their unique skills. The 
Committee is encouraged by examples like retired doctors 
opening clinics and retired teachers designing tutoring 
programs. The Committee urges the Corporation to develop 
demonstration programs to engage retired seniors in creative 
ways of sharing their professional expertise to address 
problems in their communities.

Foster Grandparent Program

    The Committee recommends $106,700,000 for the Foster 
Grandparent Program, equal to the fiscal year 2002 
appropriations level and 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 $56,563,000, an increase of $12,168,000 over the 
fiscal year 2002 appropriations level and $10,000,000 over 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 $68,884,000 for the Retired and 
Senior Volunteer Program (RSVP), $14,000,000 above the fiscal 
year 2002 level and $10,000,000 above the budget request.
    This program involves persons age 55 and over in volunteer 
opportunities in their communities.

Program support

    The Committee bill includes $34,229,000 for program 
support, $2,000,000 above the fiscal year 2002 appropriation 
and equal to the budget request.

                  Corporation for Public Broadcasting

Appropriations, 2003....................................    $365,000,000
Appropriations, 2004....................................     380,000,000
Budget estimate, 2005...................................     395,000,000
Committee recommendation................................     395,000,000

    The Committee recommends an appropriation of $395,000,000 
for the Corporation for Public Broadcasting (CPB), an advance 
appropriation for fiscal year 2005. This amount is $15,000,000 
more than the fiscal year 2004 appropriation and equal to the 
budget request.
    In addition, the Committee recommends $50,000,000 for the 
conversion to digital broadcasting. The recommendation is 
$25,000,000 above last year's appropriation and the 
administration request.
    The Committee notes that since the passage of the 1996 
Telecommunications Act, only 76 of the Nation's 356 public 
television stations have converted to digital. The remaining 
280 stations are facing a May 2003 deadline by which to 
complete conversion or risk losing their licenses. To date, 
Federal funding for this conversion totals $158,000,000 out of 
the total estimated cost of $1,700,000,000. The estimated 
Federal share of this cost is $610,000,000. Stations have 
raised over $750,000,000 from State and private sources and are 
generally expected to cover more than half of the costs of 
conversion. The Committee is concerned that the 
Administration's request is not sufficient to meet the Federal 
mandate and to cover the Federal share of conversion. 
Therefore, the Committee has doubled the funding for this 
important program.

               Federal Mediation and Conciliation Service

Appropriations, 2002....................................     $39,982,000
Budget estimate, 2003...................................      40,718,000
Committee recommendation................................      41,218,000

    The Committee recommends an appropriation of $41,218,000 
for the Federal Mediation and Conciliation Service (FMCS), 
$1,236,000 above the fiscal year 2002 appropriation and 
$500,000 more than 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.
    The Committee continues to support the FMCS program to 
prevent youth violence and has included second-year funding for 
this effort. The Committee is especially pleased with the 
initiative to train educators in conflict resolution and 
strongly urges the FMCS to invest more resources in this 
effort.

            Federal Mine Safety and Health Review Commission

Appropriations, 2002....................................      $6,939,000
Budget estimate, 2003...................................       7,127,000
Committee recommendation................................       7,127,000

    The Committee recommends an appropriation of $7,127,000 for 
the Federal Mine Safety and Health Review Commission, an 
increase of $188,000 over the fiscal year 2002 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.

             National Foundation on the Arts and Humanities


                INSTITUTE OF MUSEUM AND LIBRARY SERVICE

Appropriations, 2002....................................    $224,501,000
Budget estimate, 2003...................................     210,000,000
Committee recommendation................................     214,000,000

    The Committee recommends an appropriation of $214,000,000 
for the Institute of Museum and Library Services. This is 
$10,501,000 less than the 2002 level and $4,000,000 more than 
the administration request.

Office of Museum Services Operations Grants

    The Committee recommends $15,932,000 for operations grants. 
These funds support grants to museums for building increased 
public access, expanding educational services, reaching 
families and children, and using technology more effectively in 
support of these goals. In addition, non-competitive grants are 
awarded for technical assistance in four types of assessments: 
Institutional, Collections Management, Public Dimension, and 
governance.

Museum Conservation Programs

    The Committee recommends $3,630,000 for Conservation 
programs. These funds support grants to allow museums to survey 
collections, perform training, research, treatment and 
environmental improvements. In addition, grantees may receive 
additional funds to develop an education component that relates 
to their conservation project. In addition, non-competitive 
grants are awarded for technical assistance in conservation 
efforts.

Museum National Leadership Projects

    The Committee recommends $5,700,000 for National Leadership 
projects. The National Leadership Grants encourage innovation 
in meeting community needs, widespread and creative use of new 
technologies, greater public access to museum collections, and 
an extended impact of Federal dollars through collaborative 
projects.

Office of Museum Services Administration

    The Committee recommends $3,760,000 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.

Office of Library Services State Grants

    The Committee recommends $158,494,000 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, $3,075,000 has been provided for library 
services to Native Americans and Native Hawaiians.

Library National leadership projects

    The Committee recommends $21,081,000 for national 
leadership projects. These funds support activities of national 
significance to enhance the quality of library services 
nationwide and to provide coordination between libraries and 
museums. Activities are carried out through grants and 
contracts awarded on a competitive basis to libraries, 
agencies, institutions of higher education and museums. 
Priority is given to projects that focus on education and 
training of library personnel, research and development for the 
improvement of libraries, preservation, digitization of library 
materials, partnerships between libraries and museums and other 
activities that enhance the quality of library services 
nationwide.
    The Committee commends the administration for proposing an 
Initiative to Recruit and Educate Librarians and has included 
$10,000,000 for this purpose. The nation is facing an impending 
retirement wave of librarians. The Bureau of Labor Statistics 
reports that 57 percent of current librarians are 45 and older 
and 50 percent of librarians are expected to leave the 
profession in the next 10 years. In addition, current 
librarians are being asked to take on expanded duties as 
information technology advances and our society experiences an 
ever-increasing need for the dissemination of public safety and 
public health data.

Office of Library Services Administration

    The Committee recommends $6,145,000 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, 2002....................................      $8,250,000
Budget estimate, 2003...................................       8,250,000
Committee recommendation................................       9,050,000

    The Committee recommends an appropriation of $9,050,000 for 
the Medicare Payment Advisory Commission, $800,000 more than 
the fiscal year 2002 appropriation and 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.

        National Commission on Libraries and Information Science

Appropriations, 2002....................................      $1,000,000
Budget estimate, 2003...................................................
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 2002 appropriation and $1,000,000 
more than 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 library and information 
sciences.
    The Committee notes that legislation exists to create a 
joint Museum and Library Advisory Board to advise Congress and 
the Administration on the development of national policy 
relating to libraries.

                     National Council on Disability

Appropriations, 2002....................................      $2,830,000
Budget estimate, 2003...................................       2,830,000
Committee recommendation................................       2,830,000

    The Committee recommends an appropriation of $2,830,000 for 
the National Council on Disability, equal to the fiscal year 
2002 appropriation and 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 Labor Relations Board

Appropriations, 2002....................................    $226,618,000
Budget estimate, 2003...................................     233,223,000
Committee recommendation................................     243,223,000

    The Committee recommends an appropriation of $243,223,000 
for the National Labor Relations Board (NLRB), $16,605,000 more 
than the fiscal year 2002 comparable level and $10,000,000 more 
than the budget request.
    The NLRB is a law enforcement agency which adjudicates 
disputes under the National Labor Relations Act.
    The Committee is disappointed to note that the progress 
made by the NLRB reducing the backlog of unfair labor practice 
cases has been stymied by an increase in case intakes. The 
backlog at the end of fiscal year 2001 was approximately 970 
cases and is expected to grow to 1,700 cases by the end of 
fiscal year 2002. The Committee is concerned about the impact 
this backlog has on workplace conditions. To that end, the 
Committee has included additional funds to continue the effort 
to reduce backlogged cases.

                        National Mediation Board

Appropriations, 2002....................................     $10,635,000
Budget estimate, 2003...................................      11,203,000
Committee recommendation................................      11,203,000

    The Committee recommends an appropriation of $11,203,000 
for the National Mediation Board, $568,000 more than the fiscal 
year 2002 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, 2002....................................      $8,964,000
Budget estimate, 2003...................................       9,577,000
Committee recommendation................................       9,577,000

    The Committee recommends an appropriation of $9,577,000 for 
the Occupational Safety and Health Review Commission, $613,000 
above the fiscal year 2002 appropriation and the same as 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, 2002....................................    $137,000,000
Budget estimate, 2003...................................     124,000,000
Committee recommendation................................     124,000,000

    The Committee has provided a total of $124,000,000 for dual 
benefits, including $8,000,000 in income tax receipts on dual 
benefits as authorized by law. The Committee recommendation is 
$13,000,000 less than the fiscal year 2002 level and the same 
as the 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, 2002....................................        $150,000
Budget estimate, 2003...................................         150,000
Committee recommendation................................         150,000

    The Committee recommends $150,000 for interest earned on 
unnegotiated checks. This is the same as the fiscal year 2002 
appropriation and budget request.

                      LIMITATION ON ADMINISTRATION

Appropriations, 2002....................................     $97,700,000
Budget estimate, 2003...................................      97,720,000
Committee recommendation................................      97,720,000

    The Committee recommends an appropriation of $97,720,000 
for the administration of railroad retirement/survivor benefit 
programs. This amount is $20,000 more than the fiscal year 2002 
comparable level, and the same as 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.
    The Committee is concerned by the administration's lack of 
a consistent policy on the payment of commercial rent by trust 
fund agencies. The Committee requests that the Office of 
Management and Budget clarify its policy in the fiscal year 
2004 budget. In the meantime, the Committee has included 
language to prohibit funds from the railroad retirement trust 
fund from being spent on any charges over and above the actual 
cost of administering the trust fund, including commercial 
rental rates.

           LIMITATION ON THE OFFICE OF THE INSPECTOR GENERAL

Appropriations, 2002....................................      $6,261,000
Budget estimate, 2003...................................       6,300,000
Committee recommendation................................       6,300,000

    The Committee recommends $6,300,000 for the Office of the 
Inspector General, $39,000 above the 2002 appropriation and the 
same as the budget request.
    The Committee has included bill language to allow the 
Office of the Inspector General to use funds to conduct audits, 
investigations, and reviews of the Medicare program. The 
Committee finds that as long as the RRB has the authority to 
negotiate and administer the separate Medicare contract, the 
RRB Inspector General should not be prohibited from using funds 
to review, audit, or investigate the RRB's separate Medicare 
contract.

                     Social Security Administration


                PAYMENTS TO SOCIAL SECURITY TRUST FUNDS

Appropriations, 2002....................................    $434,400,000
Budget estimate, 2003...................................      20,400,000
Committee recommendation................................      20,400,000

    The Committee recommends an appropriation of $20,400,000 
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 decrease in appropriation is a result of the inclusion 
of $414,000,000 in last year's appropriation for the 
quinquennial adjustment to reimburse the OASI trust funds for 
the costs of granting noncontributory wage credits for military 
service.

               SPECIAL BENEFITS FOR DISABLED COAL MINERS

Appropriations, 2002....................................    $332,840,000
Budget estimate, 2003...................................     300,177,000
Committee recommendation................................     300,177,000

    The Committee recommends an appropriation of $300,177,000 
for special benefits for disabled coal miners. This is in 
addition to the $108,000,000 appropriated last year as an 
advance for the first quarter of fiscal year 2003. 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 
$97,000,000 for the first quarter of fiscal year 2004, the same 
as the administration request. These funds will ensure 
uninterrupted benefit payments to coal miners, their widows, 
and dependents.

                      SUPPLEMENTAL SECURITY INCOME

Appropriations, 2002.................................... $21,577,412,000
Budget estimate, 2003...................................  24,017,392,000
Committee recommendation................................  24,025,392,000

    The Committee recommends an appropriation of 
$24,025,392,000 for supplemental security income. This is in 
addition to the $10,790,000,000 appropriated last year as an 
advance for the first quarter of fiscal year 2003 and includes 
funds for continuing disability reviews. The recommendation is 
$2,447,980,000 more than the fiscal year 2002 level and 
$8,000,000 more than the administration's request. The 
Committee also recommends an advance appropriation of 
$11,080,000,000 for the first quarter of fiscal year 2004 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 
6.5 million persons will receive SSI benefits each month during 
fiscal year 2003. In many cases, SSI benefits supplement income 
from other sources, including Social Security benefits. The 
funds are also used to reimburse the Social Security trust 
funds for the administrative costs for the program with a final 
settlement by the end of the subsequent fiscal year as required 
by law, to reimburse vocational rehabilitation agencies for 
costs incurred in successfully rehabilitating SSI recipients 
and for research and demonstration projects.
    The Committee is concerned about backlogs in the amount of 
time that many applicants for Social Security disability 
benefits must wait before they finally receive disability 
benefits to which they are entitled. In fiscal year 2002, the 
Committee provided funding to reduce this backlog, as well as 
the funding to address a special caseload of beneficiaries who 
have received Supplemental Security Income disability benefits, 
but are entitled to Social Security disability benefits as 
well. In May 2002, the Social Security Administration 
discovered that this special caseload was more extensive than 
originally believed, potentially including more than 500,000 
individuals. The Committee understands that the Commissioner is 
in the process of undertaking a thorough review of this issue 
to determine the number of affected individuals and the cost of 
processing this caseload. These complex cases must be re-
examined by specially trained SSA staff so that these SSI 
beneficiaries can receive Social Security disability benefits 
to which they are entitled, some from as far back as the 
1970's. The Committee is also concerned that re-examining these 
cases and calculating past due benefits will lengthen the 
already-unacceptable waiting periods facing disabled Americans. 
The Committee directs the SSA Commissioner to submit a report 
to the Committee by December 31, 2002 detailing the amount of 
funds necessary to complete the training of staff and 
processing of this special caseload, as well as a plan for 
eliminating the backlog of disability applications and appeals 
and the amount of funding necessary to execute that plan.

Beneficiary services

    The Committee recommendation includes $45,728,000 for 
beneficiary services, which is the same as the administration 
request and $8,316,000 more than the fiscal year 2002 level. 
This appropriation added to an estimated $39,300,000 in 
carryover funding will bring the fiscal year 2003 program 
funding level to approximately $85,000,000. This amount is 
available for payments to Employment Networks for successful 
outcomes or milestone payments under the Ticket to Work program 
and for reimbursement of State vocational rehabilitation 
agencies and alternate public or private providers.

Research and demonstration projects

    The Committee recommendation includes $38,000,000 for 
research and demonstration projects conducted under sections 
1110 and 1115 of the Social Security Act. This is $1,000,000 
more than the fiscal year 2002 level and $8,000,000 more than 
the administration request.
    This amount will support SSA's efforts to strengthen its 
policy evaluation capability and focus on research of: program 
issues, the impact of demographic changes on future workloads 
and effective return-to-work strategies for disabled 
beneficiaries.
    The Committee commends the Administration on their stated 
goal of preventing and ending homelessness for people with 
disabilities, within 10 years. The Committee believes that 
increasing the Social Security Administration's outreach and 
application assistance to homeless people as well as others who 
are economically disadvantaged is an important part of this 
effort. The Committee is aware that SSA operated an effective 
outreach program in the early 1990's, where grants were awarded 
to local non-profits to provide SSI outreach and application 
assistance. In light of the ongoing need for SSI outreach and 
application assistance, the Committee has included an 
additional $8,000,000 to provide and to administer a 
competitive demonstration grants demonstration program, 
targeted toward providing outreach and application assistance 
to homeless persons and other underserved populations.

Administration

    The Committee recommendation includes $2,824,000,000 for 
payment to the Social Security trust funds for the SSI 
Program's share of SSA's base administrative expenses. This is 
$197,000,000 above the fiscal year 2002 level and equal to the 
administration request.

                 LIMITATION ON ADMINISTRATIVE EXPENSES

Appropriations, 2002....................................  $7,575,500,000
Budget estimate, 2003...................................   7,936,000,000
Committee recommendation................................   7,936,000,000

    The Committee recommends a program funding level of 
$7,936,000,000 for the limitation on administrative expenses, 
which is equal to the administration request and $360,500,000 
higher than the fiscal year 2002 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.
    The limitation includes $7,825,000,000 for routine 
operating expenses of the agency, which is equal to the amount 
requested by the President and $782,500,000 over the 2002 
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 commends SSA for monitoring and assessing the 
impact of Social Security Ruling (SSR) 99-2p regarding Chronic 
Fatigue Syndrome. The Committee is pleased that SSA officials 
have continued to educate adjudicators at all levels of the SSA 
process about the April 1999 Chronic Fatigue Syndrome ruling 
(99-2p). The Committee encourages SSA to continue these 
educational efforts, as many SSA employees remain unfamiliar 
with or misinformed about CFS and the functional limitations it 
imposes. Finally, the Committee encourages SSA to continue 
examining obstacles to benefits for persons with CFS. The 
Committee also encourages SSA to examine the impact of the 
ruling on CFS patients' access to benefits, and to keep medical 
information updated throughout all levels of the application 
and review process.

Social Security Advisory Board

    The Committee has included $1,800,000 within the limitation 
on administrative expenses account for the Social Security 
Advisory Board for fiscal year 2003, the same level as the 
administration request and the same as the fiscal year 2002 
level.

User fees

    In addition to other amounts provided, the Committee 
recommends $111,000,000 for administrative activities funded 
from user fees that were authorized in fiscal year 1998. This 
is equal to the administration's request and an increase of 
$11,000,000 over the fiscal year 2002 level.

                    OFFICE OF THE INSPECTOR GENERAL

Appropriations, 2002....................................     $75,000,000
Budget estimate, 2003...................................      83,000,000
Committee recommendation................................      83,000,000

    The Committee recommends $83,000,000 for activities for the 
Office of the Inspector General, $8,000,000 more than fiscal 
year 2002 and equal to the administration request. This 
includes a general fund appropriation of $21,000,000 together 
with an obligation limitation of $62,000,000 from the Federal 
old-age and survivors insurance trust fund and the Federal 
disability insurance trust fund.

                        U.S. Institute of Peace

Appropriations, 2002....................................     $15,104,000
Budget estimate, 2003...................................      16,200,000
Committee recommendation................................      17,200,000

    The Committee recommends an appropriation of $17,200,000 
for the U.S. Institute of Peace, $2,096,000 more than the 
fiscal year 2002 appropriation and $1,000,000 above 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.
    The Committee supports the multi-faceted work of the USIP 
and recommends a modest increase in fiscal year 2003 funding to 
be used primarily for increasing understanding of the origins 
of international terrorism, identifying long-term, non-violent 
options for dissipating it, and enhancing the Institute's 
education and training programs. The Committee commends the 
USIP for the practical research it has undertaken to develop 
degree-awarding courses of study in peace-making and encourages 
the USIP to make use of distance-learning capabilities whenever 
possible. These courses are meant to prepare students for 
professional careers in governmental agencies and non-
governmental organizations engaged in problem-solving and 
conflict resolution. The Committee urges the USIP to consult 
with a cross-section of public and private sector practitioners 
in the development and implementation of these courses.

                      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 (amended) (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); limit use of funds for abortion (sec. 508 and 
sec. 509); restrict human embryo research (sec. 510); limit the 
use of funds for promotion of legalization of controlled 
substances included last year (sec. 511); limits use of funds 
to enter into or review contracts with entities subject to the 
requirement in section 4212(d) of title 38, United States Code, 
if the report required by that section has not been submitted 
(sec. 512); and prohibits the use of funds to promulgate 
regulations regarding the individual health identifier (sec. 
513).
    The Committee recommendation includes a new provision 
regarding the Institute of Peace (sec. 514).


                                            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 \1\      bill     allocation \1\      bill
----------------------------------------------------------------------------------------------------------------
Comparison of amounts in the bill with Committee
 allocations to its subcommittees, fiscal year 2003:
 Subcommittee on Labor, Health and Human Services,
 Education, and Related Agencies:
    Discretionary.....................................        134,132       134,132        127,131   \2\ 126,299
    Mandatory.........................................             NA       286,551             NA       286,497
Projections of outlays associated with the
 recommendation:
    2003..............................................  ..............  ...........  ..............  \3\ 272,095
    2004..............................................  ..............  ...........  ..............       55,080
    2005..............................................  ..............  ...........  ..............       14,823
    2006..............................................  ..............  ...........  ..............        1,434
    2007 and future years.............................  ..............  ...........  ..............          275
Financial assistance to State and local governments                NA       171,330             NA       168,940
 for  2003............................................
----------------------------------------------------------------------------------------------------------------
\1\ Levels approved by the Committee on June 27, 2002.
\2\ Includes outlays from prior-year budget authority.
\3\ Excludes outlays from prior-year budget authority.
NA: Not applicable.

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

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

    The following items are identified pursuant to this 
requirement:
    Nursing Loan Repayment, $15,000,000; Title VII of the 
Public Health Services Act, $160,000,000; Title VIII of the 
Public Health Services Act, $88,002,000; Universal Newborn 
Hearing Screening, $13,000,000; Trauma Care, $5,000,000; 
Abstinence Education, $40,000,000; Organ Transplantation, 
$24,990,000; Rural Hospital Flex Grants, $50,000,000; Denali 
Project, $30,000,000; Family Planning, $285,000,000; State 
Offices of Rural Health, $12,000,000; Health statistics, 
$125,899,000; Injury, $149,385,000; Birth defects and 
developmental disabilities, $99,823,000; Adolescent Family 
Life, $31,124,000; Office of Minority Health, $46,329,000; 
Office of Disease Prevention and Health Promotion, $7,589,000; 
Child Care and Development Block Grant, $2,099,994,000; Child 
Abuse Prevention and Treatment Act, $109,186,000; Abandoned 
Infants Assistance Act, $12,205,000; Native American Programs, 
$45,912,000; Refugee and Entrant Assistance Programs, 
$442,724,000; Alzheimer's Disease Demonstration Grants to 
States, $15,000,000; Volunteers in Service to America, 
$99,287,000; Special Volunteer Programs, $10,000,000; National 
Senior Volunteer Corps, $237,547,000; Institute of Museum and 
Library Services, $214,000,000; United States Institute of 
Peace, $17,200,000;

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

    Pursuant to paragraph 7(c) of rule XXVI, on July 18, 2002, 
the Committee ordered S. 2766, an original Labor, Health and 
Human Services, Education Appropriations bill, 2003, subject to 
amendment and each subject to the budget allocations, by a 
recorded vote of 29-0, a quorum being present. The vote was as 
follows:
        Yeas                          Nays
Chairman Byrd
Mr. Inouye
Mr. Hollings
Mr. Leahy
Mr. Harkin
Ms. Mikulski
Mr. Reid
Mr. Kohl
Mrs. Murray
Mr. Dorgan
Mrs. Feinstein
Mr. Durbin
Mr. Johnson
Ms. Landrieu
Mr. Reed
Mr. Stevens
Mr. Cochran
Mr. Specter
Mr. Domenici
Mr. Bond
Mr. McConnell
Mr. Burns
Mr. Shelby
Mr. Gregg
Mr. Bennett
Mr. Campbell
Mr. Craig
Mrs. Hutchison
Mr. DeWine

 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.
    With respect to this bill, it is the opinion of the 
Committee that it is necessary to dispense with these 
requirements in order to expedite the business of the Senate.

  COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2002 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL FOR FISCAL
                                                                        YEAR 2003
                                                                [In thousands of dollars]
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                                         Senate Committee recommendation
                                                                                                          Committee          compared with (+ or -)
                                Item                                 2002 comparable  Budget estimate   recommendation ---------------------------------
                                                                                                                        2002 comparable  Budget estimate
--------------------------------------------------------------------------------------------------------------------------------------------------------
                    TITLE I--DEPARTMENT OF LABOR
               EMPLOYMENT AND TRAINING ADMINISTRATION
                  TRAINING AND EMPLOYMENT SERVICES
Grants to States:
    Adult Training, current year...................................         238,000          188,000          238,000   ...............         +50,000
        Advance from prior year....................................        (712,000)        (712,000)        (712,000)  ...............  ...............
        Fiscal year 2004...........................................         712,000          712,000          712,000   ...............  ...............
                                                                    ------------------------------------------------------------------------------------
          Adult Training...........................................         950,000          900,000          950,000   ...............         +50,000

    Youth Training.................................................       1,127,965        1,000,965        1,127,965   ...............        +127,000
    Dislocated Worker Assistance...................................         281,200          258,432          391,200         +110,000         +132,768
        Advance from prior year....................................        (848,000)        (848,000)        (848,000)  ...............  ...............
        Fiscal year 2004...........................................         848,000          848,000          848,000   ...............  ...............
                                                                    ------------------------------------------------------------------------------------
          Dislocated Worker Assistance.............................       1,129,200        1,106,432        1,239,200         +110,000         +132,768
Federally Administered Programs:
    Dislocated Worker Assistance...................................          30,300           64,608           97,800          +67,500          +33,192
        Advance from prior year....................................        (212,000)        (212,000)        (212,000)  ...............  ...............
        Fiscal year 2004...........................................         212,000          212,000          212,000   ...............  ...............
                                                                    ------------------------------------------------------------------------------------
          Dislocated Worker Assistance.............................         242,300          276,608          309,800          +67,500          +33,192
                                                                    ------------------------------------------------------------------------------------
          Total, Dislocated Workers................................       1,371,500        1,383,040        1,549,000         +177,500         +165,960


    Native Americans...............................................          57,000           55,000           57,000   ...............          +2,000
    Migrant and Seasonal Farmworkers...............................          79,751   ...............          79,751   ...............         +79,751
    Job Corps:
        Operations.................................................         737,377          813,610          800,000          +62,623          -13,610
            Advance from prior year................................        (591,000)        (591,000)        (591,000)  ...............  ...............
            Fiscal year 2004.......................................         591,000          591,000          591,000   ...............  ...............
        Construction and Renovation................................          30,375           27,550           27,550           -2,825   ...............
            Advance from prior year................................        (100,000)        (100,000)        (100,000)  ...............  ...............
            Fiscal year 2004.......................................         100,000          100,000          100,000   ...............  ...............
                                                                    ------------------------------------------------------------------------------------
              Subtotal, Job Corps, program level...................       1,458,752        1,532,160        1,518,550          +59,798          -13,610
    National activities:
        Pilots, Demonstrations and Research........................         130,149           35,000           44,881          -85,268           +9,881
        Responsible Reintegrat'n of Youthful Offenders.............          55,000   ...............          55,000   ...............         +55,000
        Evaluation.................................................           9,098            9,098            9,098   ...............  ...............
        Youth Opportunity Grants...................................         225,100           44,500          225,100   ...............        +180,600
        Other......................................................          16,019           15,000           16,019   ...............          +1,019
                                                                    ------------------------------------------------------------------------------------
          Subtotal, National activities............................         435,366          103,598          350,098          -85,268         +246,500
                                                                    ====================================================================================
          Subtotal, Federal activities.............................       2,273,169        1,967,366        2,315,199          +42,030         +347,833
                                                                    ====================================================================================
          Total, Workforce Investment Act..........................       5,480,334        4,974,763        5,632,364         +152,030         +657,601
    Women in Apprenticeship........................................           1,000            1,000            1,000   ...............  ...............
    Skill Standards................................................           3,500   ...............  ...............          -3,500   ...............
                                                                    ------------------------------------------------------------------------------------
      Subtotal, National activities, TES...........................         439,866          104,598          351,098          -88,768         +246,500
                                                                    ------------------------------------------------------------------------------------
      Subtotal, Training and Employment Services...................       5,484,834        4,975,763        5,633,364         +148,530         +657,601
          Current Year.............................................      (3,021,834)      (2,512,763)      (3,170,364)       (+148,530)       (+657,601)
          Fiscal year 2004.........................................      (2,463,000)      (2,463,000)      (2,463,000)  ...............  ...............


COMMUNITY SERVICE EMPLOYMENT FOR OLDER AMERICANS...................         445,100          440,200          450,000           +4,900           +9,800
WORKERS COMPENSATION PROGRAMS......................................         175,000   ...............  ...............        -175,000   ...............


            FEDERAL UNEMPLOYMENT BENEFITS AND ALLOWANCES
Trade Adjustment...................................................         349,500           13,000          349,500   ...............        +336,500
NAFTA Activities...................................................          66,150   ...............          66,150   ...............         +66,150
                                                                    ------------------------------------------------------------------------------------
      Total........................................................         415,650           13,000          415,650   ...............        +402,650
            STATE UNEMPLOYMENT INSURANCE AND EMPLOYMENT
                         SERVICE OPERATIONS
Unemployment Compensation:
    State Operations \1\...........................................       2,777,986        2,717,688        2,641,488         -136,498          -76,200
    National Activities............................................          10,000           10,000           10,000   ...............  ...............
    Emergency Response Funds.......................................           4,100   ...............  ...............          -4,100   ...............
                                                                    ------------------------------------------------------------------------------------
      Subtotal, Unemployment Compensation..........................       2,792,086        2,727,688        2,651,488         -140,598          -76,200
Employment Service:
    Allotments to States:
        Federal Funds..............................................          23,452           23,452           23,452   ...............  ...............
        Trust Funds................................................         773,283          773,283          773,283   ...............  ...............
                                                                    ------------------------------------------------------------------------------------
          Subtotal.................................................         796,735          796,735          796,735   ...............  ...............
    ES National Activities.........................................          50,680           29,120           50,680   ...............         +21,560
                                                                    ====================================================================================
      Subtotal, Employment Service.................................         847,415          825,855          847,415   ...............         +21,560
          Federal Funds............................................          23,452           23,452           23,452   ...............  ...............
          Trust Funds..............................................         823,963          802,403          823,963   ...............         +21,560
One Stop Career Centers/Labor Market Information...................         120,000          113,000          113,000           -7,000   ...............
Work Incentives Grants.............................................          20,000           20,000           20,000   ...............  ...............
                                                                    ====================================================================================
      Total, State Unemployment....................................       3,779,501        3,686,543        3,631,903         -147,598          -54,640
        Federal Funds..............................................         167,552          156,452          156,452          -11,100   ...............
        Trust Funds................................................       3,611,949        3,530,091        3,475,451         -136,498          -54,640
ADVANCES TO THE UI AND OTHER TRUST FUNDS \1\.......................         464,000          463,000          463,000           -1,000   ...............
                       PROGRAM ADMINISTRATION
Adult Employment and Training......................................          34,076           42,620           39,090           +5,014           -3,530
    Trust Funds....................................................           2,887            2,973            2,973              +86   ...............
Youth Employment and Training......................................          37,603           38,947           40,858           +3,255           +1,911
Employment Security................................................           5,867            6,051            6,051             +184   ...............
    Trust Funds....................................................          44,216           45,586           51,586           +7,370           +6,000
Apprenticeship Services............................................          21,406           20,836           22,036             +630           +1,200
Executive Direction................................................           7,914            8,286            8,286             +372   ...............
    Trust Funds....................................................           1,404            2,051            2,051             +647   ...............
Welfare to Work....................................................           5,903            4,711            4,711           -1,192   ...............
                                                                    ------------------------------------------------------------------------------------
      Subtotal, Program Administration.............................         161,276          172,061          177,642          +16,366           +5,581
          Federal Funds............................................         112,769          121,451          121,032           +8,263             -419
          Trust Funds..............................................          48,507           50,610           56,610           +8,103           +6,000
                                                                    ====================================================================================
      Total, Employment and Training Administration................      10,925,361        9,750,567       10,771,559         -153,802       +1,020,992
          Federal Funds............................................       7,264,905        6,169,866        7,239,498          -25,407       +1,069,632
              Current Year.........................................      (4,801,905)      (3,706,866)      (4,776,498)        (-25,407)     (+1,069,632)
              Fiscal year 2003.....................................      (2,463,000)      (2,463,000)      (2,463,000)  ...............  ...............
          Trust Funds..............................................       3,660,456        3,580,701        3,532,061         -128,395          -48,640
            PENSION AND WELFARE BENEFITS ADMINISTRATION
Enforcement and Compliance.........................................          85,502           92,125           89,125           +3,623           -3,000
Policy, Regulation and Public Service..............................          19,694           20,575           20,575             +881   ...............
Program Oversight..................................................           5,736            4,344            4,344           -1,392   ...............
                                                                    ------------------------------------------------------------------------------------
      Total, PWBA..................................................         110,932          117,044          114,044           +3,112           -3,000
                PENSION BENEFIT GUARANTY CORPORATION
Program Administration subject to limitation (TF)..................          11,567           13,050           13,050           +1,483   ...............
Termination services not subject to limitation (NA)................        (178,924)        (179,844)        (179,844)           (+920)  ...............
                                                                    ------------------------------------------------------------------------------------
      Total, PBGC (Program level)..................................        (190,491)        (192,894)        (192,894)         (+2,403)  ...............
                EMPLOYMENT STANDARDS ADMINISTRATION
                       SALARIES AND EXPENSES
Enforcement of Wage and Hour Standards.............................         155,580          155,387          159,387           +3,807           +4,000
Office of Labor-Management Standards...............................          30,622           34,503           31,142             +520           -3,361
Federal Contractor EEO Standards Enforcement.......................          77,678           77,544           79,544           +1,866           +2,000
Federal Programs for Workers' Compensation.........................          91,327           96,975           97,675           +6,348             +700
    FECA Fees......................................................  ...............         -86,442   ...............  ...............         +86,442
    Trust Funds....................................................           1,975            2,029            2,029              +54   ...............
Program Direction and Support......................................          13,054           14,319           14,319           +1,265   ...............
                                                                    ------------------------------------------------------------------------------------
      Total, ESA salaries and expenses.............................         370,236          294,315          384,096          +13,860          +89,781
          Federal Funds............................................         368,261          292,286          382,067          +13,806          +89,781
          Trust Funds..............................................           1,975            2,029            2,029              +54   ...............
                          SPECIAL BENEFITS
Federal employees compensation benefits............................         118,000          160,000          160,000          +42,000   ...............
Longshore and harbor workers' benefits.............................           3,000            3,000            3,000   ...............  ...............
                                                                    ------------------------------------------------------------------------------------
      Total, Special Benefits......................................         121,000          163,000          163,000          +42,000   ...............
               ENERGY EMPLOYEES OCCUPATIONAL ILLNESS
                         COMPENSATION FUND
Program Benefits...................................................        (769,000)        (758,000)        (758,000)        (-11,000)  ...............
Administrative Expenses............................................         135,665          104,867          104,867          -30,798   ...............
                  BLACK LUNG DISABILITY TRUST FUND
Benefit payments and interest on advances..........................         981,283          979,371          979,371           -1,912   ...............
Employment Standards Adm. S&E......................................          31,377           31,987           31,987             +610   ...............
Departmental Management S&E........................................          22,590           22,952           22,952             +362   ...............
Departmental Management, Inspector General.........................             328              334              334               +6   ...............
                                                                    ------------------------------------------------------------------------------------
      Subtotal, Black Lung Disablty................................       1,035,578        1,034,644        1,034,644             -934   ...............
Treasury Administrative Costs......................................             356              356              356   ...............  ...............
                                                                    ------------------------------------------------------------------------------------
      Total, Black Lung Disability Trust Fund......................       1,035,934        1,035,000        1,035,000             -934   ...............
                                                                    ====================================================================================
      Total, Employment Standards Administration...................       1,662,835        1,597,182        1,686,963          +24,128          +89,781
          Federal Funds............................................       1,660,860        1,595,153        1,684,934          +24,074          +89,781
          Trust Funds..............................................           1,975            2,029            2,029              +54   ...............
           OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION
                       SALARIES AND EXPENSES
Safety and Health Standards........................................          15,567           14,237           18,000           +2,433           +3,763
Federal Enforcement................................................         161,998          161,080          171,080           +9,082          +10,000
State Programs.....................................................          89,747           89,747           93,747           +4,000           +4,000
Technical Support..................................................          19,612           20,234           20,234             +622   ...............
Compliance Assistance:
    Federal Assistance.............................................          59,104           60,248           64,248           +5,144           +4,000
    State Consultation Grants......................................          51,021           52,521           55,521           +4,500           +3,000
    Training Grants................................................          11,175            4,000           11,175   ...............          +7,175
                                                                    ------------------------------------------------------------------------------------
      Subtotal, Compliance Assistance..............................         121,300          116,769          130,944           +9,644          +14,175
Safety and Health Statistics.......................................          26,257           25,739           26,386             +129             +647
Executive Direction and Administration.............................           9,017            9,213            9,213             +196   ...............
                                                                    ====================================================================================
      Total, OSHA..................................................         443,498          437,019          469,604          +26,106          +32,585
               MINE SAFETY AND HEALTH ADMINISTRATION
                       SALARIES AND EXPENSES
Coal Enforcement...................................................         117,049          112,337          119,655           +2,606           +7,318
Metal/Non-Metal Enforcement........................................          61,099           63,910           63,910           +2,811   ...............
Standards Development..............................................           2,357            2,328            2,428              +71             +100
Assessments........................................................           4,807            4,836            4,936             +129             +100
Educational Policy and Development.................................          27,984           27,914           27,914              -70   ...............
Technical Support..................................................          28,085           28,675           28,675             +590   ...............
Program Administration.............................................          12,551           14,323           14,323           +1,772   ...............
                                                                    ------------------------------------------------------------------------------------
      Total, Mine Safety and Health Administration.................         253,932          254,323          261,841           +7,909           +7,518
                     BUREAU OF LABOR STATISTICS
                       SALARIES AND EXPENSES
Employment and Unemployment Statistics.............................         146,889          151,004          151,004           +4,115   ...............
Labor Market Information (Trust Funds).............................          69,132           72,029           72,029           +2,897   ...............
Prices and Cost of Living..........................................         148,494          160,716          160,716          +12,222   ...............
Compensation and Working Conditions................................          74,221           76,422           76,422           +2,201   ...............
Productivity and Technology........................................           9,605            9,925            9,925             +320   ...............
Executive Direction and Staff Services.............................          27,090           28,068           28,068             +978   ...............
                                                                    ------------------------------------------------------------------------------------
      Total, Bureau of Labor Statistics............................         475,431          498,164          498,164          +22,733   ...............
          Federal Funds............................................         406,299          426,135          426,135          +19,836   ...............
          Trust Funds..............................................          69,132           72,029           72,029           +2,897   ...............
               OFFICE OF DISABILITY EMPLOYMENT POLICY
Office of Disability Employment Policy.............................          35,416           47,015           47,015          +11,599   ...............
Task Force on Employment of Adults with Disabilities...............           2,640   ...............  ...............          -2,640   ...............
                                                                    ------------------------------------------------------------------------------------
      Total, Office of Disability Employment Policy................          38,056           47,015           47,015           +8,959   ...............
                      DEPARTMENTAL MANAGEMENT
                       SALARIES AND EXPENSES
Executive Direction................................................          27,054           26,468           26,468             -586   ...............
Departmental IT Crosscut...........................................          50,000           74,000           55,000           +5,000          -19,000
Departmental Management Crosscut...................................             884            7,000            5,884           +5,000           -1,116
Legal Services.....................................................          77,104           77,680           77,680             +576   ...............
    Trust Funds....................................................             310              310              310   ...............  ...............
International Labor Affairs........................................         148,015           54,574          148,015   ...............         +93,441
Administration and Management......................................          35,553           30,191           30,191           -5,362   ...............
Adjudication.......................................................          24,632           25,472           25,232             +600             -240
Women's Bureau.....................................................          10,165            8,369           10,973             +808           +2,604
Civil Rights Activities............................................           5,635            5,969            5,969             +334   ...............
Chief Financial Officer............................................           6,249            7,901            7,901           +1,652   ...............
Office of Pension Participant Advocacy.............................  ...............  ...............           3,000           +3,000           +3,000
                                                                    ------------------------------------------------------------------------------------
      Total, Salaries and expenses.................................         385,601          317,934          396,623          +11,022          +78,689
          Federal Funds............................................         385,291          317,624          396,313          +11,022          +78,689
          Trust Funds..............................................             310              310              310   ...............  ...............
                  VETERANS EMPLOYMENT AND TRAINING
State Administration:
    Disabled Veterans Outreach Program.............................          81,615           81,615           83,615           +2,000           +2,000
    Local Veterans Employment Program..............................          77,253           77,253           79,253           +2,000           +2,000
                                                                    ------------------------------------------------------------------------------------
      Subtotal, State Administration...............................         158,868          158,868          162,868           +4,000           +4,000
Federal Administration.............................................          27,956           26,669           28,669             +713           +2,000
Homeless Veterans Program..........................................          18,250           17,500           19,000             +750           +1,500
Veterans Workforce Investment Programs.............................           7,550            7,300            7,550   ...............            +250
                                                                    ------------------------------------------------------------------------------------
      Total, Veterans Employment and Training......................         212,624          210,337          218,087           +5,463           +7,750
          Federal Funds............................................          25,800           24,800           26,550             +750           +1,750
          Trust Funds..............................................         186,824          185,537          191,537           +4,713           +6,000
                  OFFICE OF THE INSPECTOR GENERAL
Program Activities.................................................          51,909           56,659           54,159           +2,250           -2,500
    Trust Funds....................................................           4,951            5,597            5,597             +646   ...............
Executive Direction and Management.................................  ...............  ...............  ...............  ...............  ...............
                                                                    ------------------------------------------------------------------------------------
      Total, Office of the Inspector General.......................          56,860           62,256           59,756           +2,896           -2,500
          Federal funds............................................          51,909           56,659           54,159           +2,250           -2,500
          Trust funds..............................................           4,951            5,597            5,597             +646   ...............
                                                                    ====================================================================================
      Total, Departmental Management...............................         655,085          590,527          674,466          +19,381          +83,939
          Federal Funds............................................         463,000          399,083          477,022          +14,022          +77,939
          Trust Funds..............................................         192,085          191,444          197,444           +5,359           +6,000
                                                                    ====================================================================================
      Total, Labor Department......................................      14,576,697       13,304,891       14,536,706          -39,991       +1,231,815
          Federal Funds............................................      10,641,482        9,445,638       10,720,093          +78,611       +1,274,455
              Current Year.........................................      (8,178,482)      (6,982,638)      (8,257,093)        (+78,611)     (+1,274,455)
              Fiscal year 2004.....................................      (2,463,000)      (2,463,000)      (2,463,000)  ...............  ...............
          Trust Funds..............................................       3,935,215        3,859,253        3,816,613         -118,602          -42,640
         TITLE II--DEPARTMENT OF HEALTH AND HUMAN SERVICES
            HEALTH RESOURCES AND SERVICES ADMINISTRATION
                   HEALTH RESOURCES AND SERVICES
Community health centers...........................................       1,343,570        1,457,864        1,533,570         +190,000          +75,706
National Health Service Corps:
    Field placements...............................................          46,506           46,498           46,498               -8   ...............
    Recruitment....................................................          98,989          142,918          142,918          +43,929   ...............
                                                                    ------------------------------------------------------------------------------------
      Subtotal, National Health Service Corps......................         145,495          189,416          189,416          +43,921   ...............
                         HEALTH PROFESSIONS
Consolidated Title VII Health Professions..........................  ...............  ...............         160,000         +160,000         +160,000
Training for Diversity:
    Centers of excellence..........................................          32,633   ...............  ...............         -32,633   ...............
    Health careers opportunity program.............................          34,791   ...............  ...............         -34,791   ...............
    Faculty loan repayment.........................................           1,330   ...............  ...............          -1,330   ...............
    Scholarships for disadvantaged students........................          46,233           10,000   ...............         -46,233          -10,000
                                                                    ------------------------------------------------------------------------------------
      Subtotal, Training for Diversity.............................         114,987           10,000   ...............        -114,987          -10,000
Training in Primary Care Medicine and Dentistry....................          93,037   ...............  ...............         -93,037   ...............
Interdisciplinary Community-Based Linkages:
    Area health education centers..................................          33,358   ...............  ...............         -33,358   ...............
    Health education and training centers..........................           4,402   ...............  ...............          -4,402   ...............
    Allied health and other disciplines............................           9,499   ...............  ...............          -9,499   ...............
    Geriatric programs.............................................          20,408   ...............  ...............         -20,408   ...............
    Quentin N. Burdick program for rural training..................           6,999   ...............  ...............          -6,999   ...............
                                                                    ------------------------------------------------------------------------------------
      Subtotal, Interdisciplinary Comm. Linkages...................          74,666   ...............  ...............         -74,666   ...............
Health Professions Workforce Info & Analysis.......................             824            1,000   ...............            -824           -1,000
Public Health Workforce Development:
    Public health, preventive med. & dental pgms...................          10,477   ...............  ...............         -10,477   ...............
    Health administration programs.................................           1,230   ...............  ...............          -1,230   ...............
                                                                    ------------------------------------------------------------------------------------
      Subtotal, Public Health Workforce Development................          11,707   ...............  ...............         -11,707   ...............
                                                                    ------------------------------------------------------------------------------------
      Subtotal, Title VII Health Professions.......................         295,221           11,000          160,000         -135,221         +149,000
Children's Hospitals Graduate Medical Educ.........................         284,967          200,000          290,000           +5,033          +90,000
Advanced Education Nursing.........................................          60,041           61,041           62,541           +2,500           +1,500
Basic nurse education and practice.................................          16,289           16,289           18,289           +2,000           +2,000
Nursing workforce diversity........................................           6,172            6,172            7,172           +1,000           +1,000
                                                                    ====================================================================================
      Subtotal, Health Professions.................................         662,690          294,502          538,002         -124,688         +243,500
Other HRSA Programs:
    Hansen's Disease Services......................................          17,839           18,142           18,142             +303   ...............
    Healthy Communities Innovation Initiative......................  ...............          20,000           20,000          +20,000   ...............
    Maternal & Child Health Block Grant............................         731,531          731,531          755,000          +23,469          +23,469
    Abstinence Education:
        Advance from prior year....................................         (30,000)  ...............  ...............        (-30,000)  ...............
        Current Year...............................................          10,000           72,979           40,000          +30,000          -32,979
    Healthy Start..................................................          98,989           98,989          103,000           +4,011           +4,011
    Universal Newborn Hearing......................................           9,999   ...............          13,000           +3,001          +13,000
    Organ Transplantation..........................................          19,990           24,990           24,990           +5,000   ...............
    Bone Marrow Program............................................          21,997           22,034           22,034              +37   ...............
    Rural outreach grants..........................................          51,472           37,852           51,472   ...............         +13,620
    Rural Health Research..........................................          16,808            6,000           16,808   ...............         +10,808
    Telehealth.....................................................          39,192            5,609           39,192   ...............         +33,583
    State offices of rural health..................................           7,999            4,000           12,000           +4,001           +8,000
    Denali Commission..............................................          20,000   ...............          30,000          +10,000          +30,000
    Critical Care Programs:
        Emergency medical services for children \2\................          18,991   ...............          20,000           +1,009          +20,000
        Poison control \2\.........................................          21,208   ...............          25,600           +4,392          +25,600
        Traumatic Brain Injury.....................................           7,499            7,499           10,000           +2,501           +2,501
                                                                    ------------------------------------------------------------------------------------
          Subtotal, Critical Care Programs.........................          47,698            7,499           55,600           +7,902          +48,101
    Black lung clinics.............................................           6,000            6,000            6,000   ...............  ...............
    Trauma Care....................................................           3,500   ...............           5,000           +1,500           +5,000
    Nursing loan repayment for shortage area service...............          10,239           15,000           15,000           +4,761   ...............
    Payment to Hawaii, treatment of Hansen's.......................           2,045            2,045            2,045   ...............  ...............
                                                                    ====================================================================================
      Other HRSA programs--Current Year............................       1,115,298        1,072,670        1,229,283         +113,985         +156,613
Ryan White AIDS Programs:
    Emergency Assistance...........................................         619,514          619,514          640,000          +20,486          +20,486
    Comprehensive Care Programs....................................         977,373          977,373        1,095,000         +117,627         +117,627
        AIDS Drug Assistance Program (ADAP) (NA)...................        (639,000)        (639,000)        (739,000)       (+100,000)       (+100,000)
    Early Intervention Program.....................................         193,917          194,055          205,000          +11,083          +10,945
    Pediatric HIV/AIDS.............................................          70,990           70,990           75,000           +4,010           +4,010
    AIDS Dental Services...........................................          13,498           13,498           17,000           +3,502           +3,502
    Education and Training Centers.................................          35,295           35,295           40,000           +4,705           +4,705
                                                                    ------------------------------------------------------------------------------------
      Subtotal, Ryan White AIDS programs...........................       1,910,587        1,910,725        2,072,000         +161,413         +161,275
Family Planning....................................................         265,055          265,275          285,000          +19,945          +19,725
Health Care and Other Facilities...................................         311,942   ...............  ...............        -311,942   ...............
Buildings and Facilities...........................................             250              250              250   ...............  ...............
Rural Hospital Flexibility Grants..................................          40,000           25,000           50,000          +10,000          +25,000
Rural Access to Emergency Devices..................................          12,500            2,000           12,500   ...............         +10,500
Radiation Exposure Compensation Act................................           4,000            4,000            2,000           -2,000           -2,000
National Practitioner Data Bank....................................          16,600           19,500           19,500           +2,900   ...............
    User Fees......................................................         -16,600          -19,500          -19,500           -2,900   ...............
Health Care Integrity and Protection Data Bank.....................           5,100            5,600            5,600             +500   ...............
    User Fees......................................................          -5,100           -5,600           -5,600             -500   ...............
Community Access Program...........................................         120,027   ...............         120,027   ...............        +120,027
Program Management.................................................         149,137          143,702          143,354           -5,783             -348
                                                                    ====================================================================================
      Total, Health resources and services.........................       6,080,551        5,365,404        6,175,402          +94,851         +809,998
HEALTH EDUCATION ASSISTANCE LOANS PROGRAM:
    Liquidating account............................................         (10,000)          (7,000)          (7,000)         (-3,000)  ...............
    Program management.............................................           3,791            3,914            3,914             +123   ...............
                                                                    ------------------------------------------------------------------------------------
      Total, HEAL..................................................           3,791            3,914            3,914             +123   ...............
VACCINE INJURY COMPENSATION PROGRAM TRUST FUND:
    Post-fiscal year 1988 claims...................................          81,704           85,918           85,918           +4,214   ...............
    HRSA administration............................................           2,992            2,991            2,991               -1   ...............
                                                                    ------------------------------------------------------------------------------------
      Total, Vaccine Injury Compensation Trust Fund................          84,696           88,909           88,909           +4,213   ...............
                                                                    ====================================================================================
      Total, Health Resources and Services Admin...................       6,169,038        5,458,227        6,268,225          +99,187         +809,998
                    CENTERS FOR DISEASE CONTROL
Birth Defects/Developmental Disabilities/Disability and Health.....          89,910           89,323           99,823           +9,913          +10,500
Chronic Disease Prevention and Health Promotion....................         747,222          690,230          810,785          +63,563         +120,555
Environmental Health...............................................         153,431          152,155          189,489          +36,058          +37,334
Epidemic Services and Response.....................................          80,139           78,001           78,001           -2,138   ...............
Health Statistics..................................................         103,393           78,917           71,708          -31,685           -7,209
    Evaluation Tap Funding.........................................         (23,286)         (46,982)         (54,191)        (+30,905)         (+7,209)
HIV/AIDS, STD and TB Prevention....................................       1,135,000        1,135,000        1,168,532          +33,532          +33,532
Immunization.......................................................         627,601          627,601          672,895          +45,294          +45,294
Infectious Disease Control.........................................         344,446          334,471          350,597           +6,151          +16,126
Injury Prevention and Control......................................         149,447          144,764          149,385              -62           +4,621
Occupational Safety and Health \3\.................................         276,080          247,318          274,899           -1,181          +27,581
Preventive Health and Health Services Block Grant..................         134,967          134,966          134,966               -1   ...............
Public Health Improvement..........................................         148,200          116,819          117,743          -30,457             +924
Buildings and Facilities...........................................         250,000   ...............         322,000          +72,000         +322,000
Office of the Director.............................................          51,420           44,879           52,749           +1,329           +7,870
Emergency Response and Recovery....................................          12,000   ...............  ...............         -12,000   ...............
ATSDR \4\..........................................................         (78,235)         (77,388)         (77,388)           (-847)  ...............
                                                                    ------------------------------------------------------------------------------------
      Total, Disease Control.......................................       4,303,256        3,874,444        4,493,572         +190,316         +619,128
                   NATIONAL INSTITUTES OF HEALTH
National Cancer Institute..........................................       4,128,351        4,642,394        4,642,394         +514,043   ...............
National Heart, Lung, and Blood Institute..........................       2,560,197        2,776,411        2,820,011         +259,814          +43,600
National Institute of Dental & Craniofacial Research...............         343,149          372,167          374,067          +30,918           +1,900
National Institute of Diabetes and Digestive and Kidney Diseases...       1,466,380        1,604,647        1,637,347         +170,967          +32,700
National Institute of Neurological Disorders & Stroke..............       1,312,780        1,424,405        1,466,005         +153,225          +41,600
National Institute of Allergy and Infectious Diseases..............       2,509,539        3,890,473        3,627,473       +1,117,934         -263,000
    Global HIV/AIDS Fund Transfer..................................          25,000          100,000          100,000          +75,000   ...............
                                                                    ------------------------------------------------------------------------------------
      Subtotal.....................................................       2,534,539        3,990,473        3,727,473       +1,192,934         -263,000
National Institute of General Medical Sciences.....................       1,700,139        1,854,984        1,853,584         +153,445           -1,400
National Institute of Child Health & Human Development.............       1,113,087        1,213,817        1,213,817         +100,730   ...............
National Eye Institute.............................................         581,191          629,990          634,290          +53,099           +4,300
National Institute of Environmental Health Sciences................         566,118          614,258          617,258          +51,140           +3,000
    NIEHS/Superfund (NA) \5\.......................................         (76,074)         (76,074)         (76,074)  ...............  ...............
National Institute on Aging........................................         893,130          968,699        1,000,099         +106,969          +31,400
National Institute of Arthritis and Musculoskeletal and Skin                448,699          486,624          489,324          +40,625           +2,700
 Diseases..........................................................
National Institute on Deafness and Other Communication Disorders...         341,965          370,805          372,805          +30,840           +2,000
National Institute of Nursing Research.............................         120,428          130,438          131,438          +11,010           +1,000
National Institute on Alcohol Abuse and Alcoholism.................         384,071          416,773          418,773          +34,702           +2,000
National Institute on Drug Abuse...................................         887,733          964,613          968,013          +80,280           +3,400
National Institute of Mental Health................................       1,238,093        1,343,088        1,350,788         +112,695           +7,700
National Human Genome Research Institute...........................         429,312          465,137          468,037          +38,725           +2,900
National Institute of Biomedical Imaging and Bioengineering........         261,951          271,200          283,100          +21,149          +11,900
National Center for Research Resources.............................         986,505        1,065,272        1,161,272         +174,767          +96,000
National Center for Complementary and Alternative Medicine.........         104,592          113,249          114,149           +9,557             +900
National Center on Minority Health and Health Disparities..........         157,742          186,929          186,929          +29,187   ...............
John E. Fogarty International Center...............................          56,918           63,380           60,880           +3,962           -2,500
National Library of Medicine.......................................         277,273          310,299          310,299          +33,026   ...............
Office of the Director.............................................         235,400          255,074          257,974          +22,574           +2,900
Buildings and Facilities...........................................         251,100          632,800          632,800         +381,700   ...............
    Global HIV/AIDS Fund Transfer..................................          75,000   ...............  ...............         -75,000   ...............
                                                                    ------------------------------------------------------------------------------------
      Subtotal, Buildings and Facilities...........................         326,100          632,800          632,800         +306,700   ...............
                                                                    ====================================================================================
      Total, N.I.H. appropriations.................................      23,455,843       27,167,926       27,192,926       +3,737,083          +25,000
          Global HIV/AIDS Fund Transfer............................        -100,000         -100,000         -100,000   ...............  ...............
                                                                    ------------------------------------------------------------------------------------
      Total, N.I.H., Program Level.................................     (23,355,843)     (27,067,926)     (27,092,926)     (+3,737,083)        (+25,000)
             SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES
Mental Health:
    Programs of Regional and National Significance.................         229,918          213,067          231,067           +1,149          +18,000
    Mental Health Performance Partnership..........................         433,000          433,000          433,000   ...............  ...............
    Children's Mental Health.......................................          96,631           96,694           96,694              +63   ...............
    Grants to States for the Homeless (PATH).......................          39,855           46,855           46,855           +7,000   ...............
    Protection and Advocacy........................................          32,500           32,500           35,500           +3,000           +3,000
                                                                    ------------------------------------------------------------------------------------
      Subtotal, Mental Health......................................         831,904          822,116          843,116          +11,212          +21,000
Substance Abuse Treatment:
    Programs of Regional and National Significance.................         291,383          357,994          310,000          +18,617          -47,994
    Substance Abuse Performance Partnership........................       1,725,000        1,785,000        1,795,000          +70,000          +10,000
                                                                    ------------------------------------------------------------------------------------
      Subtotal, Substance Abuse Treatment..........................       2,016,383        2,142,994        2,105,000          +88,617          -37,994
Substance Abuse Prevention:
    Programs of Regional and National Significance.................         198,011          152,815          202,000           +3,989          +49,185
Program Management and Buildings and Facilities....................          91,392           75,161           86,467           -4,925          +11,306
St. Elizabeth's....................................................  ...............  ...............             955             +955             +955
                                                                    ====================================================================================
      Total, Substance Abuse and Mental Health.....................       3,137,690        3,193,086        3,237,538          +99,848          +44,452
             AGENCY FOR HEALTHCARE RESEARCH AND QUALITY
Research on Health Costs, Quality, and Outcomes:
    Federal Funds..................................................  ...............  ...............         146,645         +146,645         +146,645
    Evaluation Tap funding (NA)....................................        (247,645)        (194,000)        (106,000)       (-141,645)        (-88,000)
        Health Coverage Data Improvement (CPS).....................  ...............         (10,000)  ...............  ...............        (-10,000)
        Portion for reducing medical errors (non-add)..............         (55,000)         (60,000)         (60,000)         (+5,000)  ...............
                                                                    ------------------------------------------------------------------------------------
          Subtotal including Evaluation Tap funds..................  ...............  ...............        (146,645)       (+146,645)       (+146,645)
Health insurance and expenditure surveys:
    Federal Funds..................................................  ...............  ...............          53,300          +53,300          +53,300
    Evaluation Tap funding (NA)....................................         (48,500)         (53,300)  ...............        (-48,500)        (-53,300)
Program Support....................................................           2,600   ...............           2,700             +100           +2,700
    Evaluation Tap funding (NA)....................................  ...............          (2,700)  ...............  ...............         (-2,700)
        Federal Funds..............................................           2,600   ...............         202,645         +200,045         +202,645
        Evaluation Tap funding (NA)................................        (296,145)        (250,000)        (106,000)       (-190,145)       (-144,000)
                                                                    ------------------------------------------------------------------------------------
          Total, AHRQ..............................................        (298,745)        (250,000)        (308,645)         (+9,900)        (+58,645)
                                                                    ====================================================================================
          Total, Public Health Service.............................      37,068,427       39,693,683       41,394,906       +4,326,479       +1,701,223
             CENTER FOR MEDICARE AND MEDICAID SERVICES
                   GRANTS TO STATES FOR MEDICAID
Medicaid current law benefits......................................     134,308,100      148,726,168      148,726,168      +14,418,068   ...............
State and local administration.....................................       8,293,316        9,142,049        9,142,049         +848,733   ...............
Vaccines for Children..............................................         795,533          823,938          823,938          +28,405   ...............
                                                                    ------------------------------------------------------------------------------------
      Subtotal, Medicaid program level.............................     143,396,949      158,692,155      158,692,155      +15,295,206   ...............
          Less Medicare Transfer (Public Law 105-33)...............         -70,000   ...............  ...............         +70,000   ...............
          Less funds advanced in prior year........................     -36,207,551      -46,601,937      -46,601,937      -10,394,386   ...............
                                                                    ------------------------------------------------------------------------------------
            Total, request.........................................     107,119,398      112,090,218      112,090,218       +4,970,820   ...............
            New advance, 1st quarter...............................      46,601,937       51,861,386       51,861,386       +5,259,449   ...............
                PAYMENTS TO HEALTH CARE TRUST FUNDS
Supplemental medical insurance.....................................      81,332,000       80,905,000       80,905,000         -427,000   ...............
Hospital insurance for the uninsured...............................         292,000          225,000          225,000          -67,000   ...............
Federal uninsured payment..........................................         150,000          168,000          168,000          +18,000   ...............
Program management.................................................         205,200          164,700          164,700          -40,500   ...............
                                                                    ------------------------------------------------------------------------------------
      Total, Payments to Trust Funds, current law..................      81,979,200       81,462,700       81,462,700         -516,500   ...............
                         PROGRAM MANAGEMENT
Research, Demonstration, and Evaluation:
    Regular Program................................................         117,201           28,400           68,400          -48,801          +40,000
Medicare Operations................................................       1,482,000        1,675,084        1,680,084         +198,084           +5,000
    H.R. 3103 funding (NA).........................................        (700,000)        (720,000)        (720,000)        (+20,000)  ...............
    Medicare Plus Choice...........................................          52,000   ...............  ...............         -52,000   ...............
                                                                    ------------------------------------------------------------------------------------
      Subtotal, Medicare Operations limit'n on new BA..............       1,534,000        1,675,084        1,680,084         +146,084           +5,000
                                                                    ------------------------------------------------------------------------------------
      Subtotal, Operations program level...........................      (2,234,000)      (2,395,084)      (2,400,084)       (+166,084)         (+5,000)
State Survey and Certification.....................................         254,397          247,647          260,000           +5,603          +12,353
Federal Administration:
    Federal Administration.........................................         533,603          556,783          562,497          +28,894           +5,714
    User Fees......................................................          -2,118   ...............  ...............          +2,118   ...............
                                                                    ------------------------------------------------------------------------------------
      Subtotal, Federal Administration.............................         531,485          556,783          562,497          +31,012           +5,714
                                                                    ====================================================================================
      Total, Program management....................................       2,437,083        2,507,914        2,570,981         +133,898          +63,067
      Total, Program management, program level.....................      (3,137,083)      (3,227,914)      (3,290,981)       (+153,898)        (+63,067)
                                                                    ====================================================================================
      Total, Center for Medicare and Medicaid Services.............     238,137,618      247,922,218      247,985,285       +9,847,667          +63,067
          Federal funds............................................     235,700,535      245,414,304      245,414,304       +9,713,769   ...............
              Current year.........................................    (189,098,598)    (193,552,918)    (193,552,918)     (+4,454,320)  ...............
              New advance, 1st quarter, fiscal year 2004...........     (46,601,937)     (51,861,386)     (51,861,386)     (+5,259,449)  ...............
          Trust Funds..............................................       2,437,083        2,507,914        2,570,981         +133,898          +63,067
              ADMINISTRATION FOR CHILDREN AND FAMILIES
                 FAMILY SUPPORT PAYMENTS TO STATES
Prior year AFDC and related payments...............................          50,000   ...............  ...............         -50,000   ...............
Payments to territories............................................          23,000           23,000           23,000   ...............  ...............
Repatriation.......................................................           1,000            1,000            1,000   ...............  ...............
                                                                    ------------------------------------------------------------------------------------
      Subtotal, Other payments.....................................          74,000           24,000           24,000          -50,000   ...............
Child Support Enforcement:
    State and local administration.................................       3,452,313        3,482,800        3,541,800          +89,487          +59,000
    Federal incentive payments.....................................         450,000          461,000          461,000          +11,000   ...............
    Hold Harmless payments.........................................          10,000   ...............  ...............         -10,000   ...............
    Access and visitation..........................................          10,000           10,000           10,000   ...............  ...............
                                                                    ------------------------------------------------------------------------------------
      Subtotal, Child Support Enforcement..........................       3,922,313        3,953,800        4,012,800          +90,487          +59,000
                                                                    ====================================================================================
      Total, Payments, fiscal year 2003 program level..............       3,996,313        3,977,800        4,036,800          +40,487          +59,000
          Less funds advanced in previous years....................      -1,000,000       -1,100,000       -1,100,000         -100,000   ...............
                                                                    ------------------------------------------------------------------------------------
            Total, payments, current request.......................       2,996,313        2,877,800        2,936,800          -59,513          +59,000
            New advance, 1st quarter, fiscal year 2004.............       1,100,000        1,100,000        1,100,000   ...............  ...............
                 LOW INCOME HOME ENERGY ASSISTANCE
Current Year.......................................................       1,700,000        1,400,000        1,700,000   ...............        +300,000
    Non-emergency funding..........................................         300,000          300,000   ...............        -300,000         -300,000
    Emergency allocation...........................................  ...............  ...............         300,000         +300,000         +300,000
                   REFUGEE AND ENTRANT ASSISTANCE
Transitional and Medical Services..................................         227,283          227,291          227,291               +8   ...............
Victims of Trafficking.............................................          10,000           10,000           10,000   ...............  ...............
Social Services....................................................         158,600          151,121          151,121           -7,479   ...............
Preventive Health..................................................           4,835            4,835            4,835   ...............  ...............
Targeted Assistance................................................          49,477           49,477           49,477   ...............  ...............
Victims of Torture.................................................          10,000           10,000           10,000   ...............  ...............
                                                                    ------------------------------------------------------------------------------------
      Total, Refugee and entrant assistance........................         460,195          452,724          452,724           -7,471   ...............
CHILD CARE AND DEVELOPMENT BLOCK GRANT.............................       2,099,976        2,099,994        2,099,994              +18   ...............
SOCIAL SERVICES BLOCK GRANT (TITLE XX).............................       1,700,000        1,700,000        1,700,000   ...............  ...............
              CHILDREN AND FAMILIES SERVICES PROGRAMS
Programs for Children, Youth, and Families:
    Head Start, current funded.....................................       5,137,640        5,267,533        5,470,000         +332,360         +202,467
        Advance from prior year....................................      (1,400,000)      (1,400,000)      (1,400,000)  ...............  ...............
        Fiscal year 2004...........................................       1,400,000        1,400,000        1,400,000   ...............  ...............
                                                                    ------------------------------------------------------------------------------------
          Subtotal, Head Start, program level......................       6,537,640        6,667,533        6,870,000         +332,360         +202,467
    Consolidated Runaway, Homeless Youth Prog......................          88,102           88,133           93,000           +4,898           +4,867
    Maternity Group Homes..........................................  ...............          10,000   ...............  ...............         -10,000
    Child Abuse State Grants.......................................          22,013           22,013           22,013   ...............  ...............
    Child Abuse Discretionary Activities...........................          26,150           26,351           26,351             +201   ...............
    Abandoned Infants Assistance...................................          12,202           12,205           12,205               +3   ...............
    Child Welfare Services.........................................         291,986          291,986          291,986   ...............  ...............
    Child Welfare Training.........................................           7,495            7,498            7,498               +3   ...............
    Adoption Opportunities.........................................          27,385           27,405           27,405              +20   ...............
    Adoption Incentive.............................................          20,000           43,000           43,000          +23,000   ...............
    Adoption Incentive (no cap adjustment).........................          23,000   ...............  ...............         -23,000   ...............
    Adoption Awareness.............................................          12,906           12,906           12,906   ...............  ...............
    Compassion Capital Fund........................................          30,000          100,000           45,000          +15,000          -55,000
Social Services and Income Maintenance Research....................          31,158            6,000            6,000          -25,158   ...............
Community Based Resource Centers...................................          33,416           33,417           33,417               +1   ...............
Developmental Disabilities Program:
    State Councils.................................................          69,800           69,800           73,300           +3,500           +3,500
    Protection and Advocacy........................................          35,000           35,000           37,000           +2,000           +2,000
    Developmental Disabilities Special Projects....................          11,720           11,734           12,734           +1,014           +1,000
    Developmental Disabilities University Affiliated...............          24,000           24,000           26,500           +2,500           +2,500
                                                                    ------------------------------------------------------------------------------------
      Subtotal, Developmental disabilities.........................         140,520          140,534          149,534           +9,014           +9,000
Native American Programs...........................................          45,912           45,196           45,912   ...............            +716
Community Services:
    Grants to States for Community Services........................         649,987          570,000          652,500           +2,513          +82,500
    Community Initiative Program:
        Economic Development.......................................          32,509           32,517           34,000           +1,491           +1,483
        Individual Development Account Initiative..................          24,976           24,990           24,990              +14   ...............
        Rural Community Facilities.................................           7,000            6,161            7,500             +500           +1,339
                                                                    ------------------------------------------------------------------------------------
          Subtotal, Community Initiative Program...................          64,485           63,668           66,490           +2,005           +2,822
    National Youth Sports..........................................          17,000   ...............          17,000   ...............         +17,000
    Community Food and Nutrition...................................           7,313            6,657            8,000             +687           +1,343
                                                                    ------------------------------------------------------------------------------------
      Subtotal, Community Services.................................         738,785          640,325          743,990           +5,205         +103,665
Runaway Youth Prevention...........................................          14,999           14,999           16,000           +1,001           +1,001
Domestic Violence Hotline..........................................           2,157            2,157            3,000             +843             +843
Battered Women's Shelters..........................................         124,459          124,459          130,000           +5,541           +5,541
Early Learning Fund................................................          24,997   ...............          38,000          +13,003          +38,000
Faith-Based Center.................................................           1,500            1,500            1,500   ...............  ...............
Promotion of Responsible Fatherhood & Healthy Marriage.............  ...............          20,000   ...............  ...............         -20,000
Mentoring Children of Prisoners....................................  ...............          25,000           12,500          +12,500          -12,500
Independent Living Training Vouchers...............................  ...............          60,000           60,000          +60,000   ...............
Program Direction..................................................         171,792          170,747          172,837           +1,045           +2,090
                                                                    ====================================================================================
      Total, Children and Families Services Programs...............       8,428,574        8,593,364        8,864,054         +435,480         +270,690
          Current Year.............................................      (7,028,574)      (7,193,364)      (7,464,054)       (+435,480)       (+270,690)
          Fiscal year 2004.........................................      (1,400,000)      (1,400,000)      (1,400,000)  ...............  ...............
Rescission of permanent appropriations.............................         -21,000   ...............  ...............         +21,000   ...............
PROMOTING SAFE AND STABLE FAMILIES.................................         305,000          305,000          305,000   ...............  ...............
    Discretionary Funds............................................          70,000          200,000          200,000         +130,000   ...............
          PAYMENTS TO STATES FOR FOSTER CARE AND ADOPTION
Foster Care........................................................       5,055,500        4,884,500        4,884,500         -171,000   ...............
Adoption Assistance................................................       1,426,000        1,584,500        1,584,500         +158,500   ...............
Independent living.................................................         140,000          140,000          140,000   ...............  ...............
                                                                    ------------------------------------------------------------------------------------
      Total, Program level, Payments to States.....................       6,621,500        6,609,000        6,609,000          -12,500   ...............
          Less Advances from Prior Year............................      -1,735,900       -1,754,000       -1,754,000          -18,100   ...............
                                                                    ------------------------------------------------------------------------------------
            Total, payments, current request.......................       4,885,600        4,855,000        4,855,000          -30,600   ...............
            New Advance, 1st quarter...............................       1,754,000        1,745,600        1,745,600           -8,400   ...............
                                                                    ====================================================================================
            Total, Administration for Children & Families..........      25,778,658       25,629,482       26,259,172         +480,514         +629,690
                Current year.......................................     (21,524,658)     (21,383,882)     (22,013,572)       (+488,914)       (+629,690)
                Fiscal year 204....................................      (4,254,000)      (4,245,600)      (4,245,600)         (-8,400)  ...............
                      ADMINISTRATION ON AGING
Grants to States:
    Supportive Services and Centers................................         356,994          357,000          364,500           +7,506           +7,500
    Preventive Health..............................................          21,123           21,562           24,062           +2,939           +2,500
    Title VII......................................................          17,681           17,681           20,681           +3,000           +3,000
    Family Caregivers..............................................         136,000          136,000          153,500          +17,500          +17,500
    Native American Caregivers Support.............................           5,500            5,500            7,000           +1,500           +1,500
                                                                    ------------------------------------------------------------------------------------
      Subtotal, Caregivers.........................................         141,500          141,500          160,500          +19,000          +19,000
    Nutrition:
        Congregate Meals...........................................         390,000          390,000          390,000   ...............  ...............
        Home Delivered Meals.......................................         176,142          178,142          183,617           +7,475           +5,475
        Nutrition Services Incentive program.......................         149,670          149,670          149,670   ...............  ...............
Grants to Indians..................................................          25,729           25,729           27,675           +1,946           +1,946
Aging Research, Training and Special Projects......................          38,273           27,837           27,837          -10,436   ...............
Aging Network Support Activities...................................           2,379            2,379            2,379   ...............  ...............
Alzheimer's Initiative.............................................          11,496           11,500           15,000           +3,504           +3,500
Program Administration.............................................          18,102           17,986           17,986             -116   ...............
                                                                    ------------------------------------------------------------------------------------
      Total, Administration on Aging...............................       1,349,089        1,340,986        1,383,907          +34,818          +42,921
                      OFFICE OF THE SECRETARY
GENERAL DEPARTMENTAL MANAGEMENT:
    Federal Funds..................................................         140,178          177,272          168,263          +28,085           -9,009
        NAS study..................................................             499   ...............  ...............            -499   ...............
    Trust Funds....................................................           5,851            5,851            5,851   ...............  ...............
    1 percent Evaluation funds (ASPE) (NA).........................         (21,552)         (21,552)  ...............        (-21,552)        (-21,552)
                                                                    ------------------------------------------------------------------------------------
      Subtotal.....................................................        (168,080)        (204,675)        (174,114)         (+6,034)        (-30,561)
    Adolescent Family Life (Title XX)..............................          28,926           31,124           31,124           +2,198   ...............
    Physical Fitness and Sports....................................           1,137            1,223            1,223              +86   ...............
    Minority health................................................          49,557           46,329           46,329           -3,228   ...............
    Office of women's health.......................................          26,761           28,795           31,795           +5,034           +3,000
    U.S. Surgeon General violence initiative.......................           1,000            1,000   ...............          -1,000           -1,000
    Office of Emergency Preparedness...............................          14,171           15,247           15,247           +1,076   ...............
    Office of Human Research Protection............................           7,021            7,554            7,554             +533   ...............
    Bioterrorism (PHSSEF) \6\......................................  ...............  ...............  ...............  ...............  ...............
    Minority HIV/AIDS..............................................          49,991           50,000           50,000               +9   ...............
    IT Security and Innovation Fund................................          21,960           20,000           20,000           -1,960   ...............
                                                                    ------------------------------------------------------------------------------------
      Total, General Departmental Management.......................         347,052          384,395          377,386          +30,334           -7,009
          Federal Funds............................................         341,201          378,544          371,535          +30,334           -7,009
          Trust Funds..............................................           5,851            5,851            5,851   ...............  ...............
OFFICE OF THE INSPECTOR GENERAL:
    Federal Funds..................................................          35,727           39,747           39,747           +4,020   ...............
    HIPAA funding (NA).............................................        (150,000)        (160,000)        (160,000)        (+10,000)  ...............
                                                                    ------------------------------------------------------------------------------------
      Total, Inspector General program level.......................        (185,727)        (199,747)        (199,747)        (+14,020)  ...............
OFFICE FOR CIVIL RIGHTS:
    Federal Funds..................................................          28,641           30,328           30,328           +1,687   ...............
    Trust Funds....................................................           3,314            3,314            3,314   ...............  ...............
                                                                    ------------------------------------------------------------------------------------
      Total, Office for Civil Rights...............................          31,955           33,642           33,642           +1,687   ...............
POLICY RESEARCH....................................................           2,500            2,499            2,499               -1   ...............
RETIREMENT PAY AND MEDICAL BENEFITS FOR COMMISSIONED:
    Retirement payments............................................         207,887          222,058          222,058          +14,171   ...............
    Survivors benefits.............................................          12,115           12,904           12,904             +789   ...............
    Dependents' medical care.......................................          40,780           14,668           14,668          -26,112   ...............
    Military services credits......................................           1,293            1,409            1,409             +116   ...............
                                                                    ------------------------------------------------------------------------------------
      Total, Retirement pay and medical benefits...................         262,075          251,039          251,039          -11,036   ...............
HEALTH FACILITIES CONSTRUCTION AND MANAGEMENT FUND.................  ...............         184,000   ...............  ...............        -184,000
          PUBLIC HEALTH AND SOCIAL SERVICE EMERGENCY FUND
Public Health/Social Service Emergency (Public Law 107-38).........       2,464,314   ...............  ...............      -2,464,314   ...............
    Public Health/Social Service Fund \7\..........................         242,949        2,295,184        2,255,980       +2,013,031          -39,204
                                                                    ====================================================================================
      Total, Office of the Secretary...............................       3,386,572        3,190,506        2,960,293         -426,279         -230,213
          Federal Funds............................................       3,377,407        3,181,341        2,951,128         -426,279         -230,213
          Trust Funds..............................................           9,165            9,165            9,165   ...............  ...............
                                                                    ====================================================================================
      Total, Department of Health and Human Services...............     305,720,364      317,776,875      319,983,563      +14,263,199       +2,206,688
          Federal Funds............................................     303,274,116      315,259,796      317,403,417      +14,129,301       +2,143,621
              Current year.........................................    (252,418,179)    (259,152,810)    (261,296,431)     (+8,878,252)     (+2,143,621)
              Fiscal year 204......................................     (50,855,937)     (56,106,986)     (56,106,986)     (+5,251,049)  ...............
          Trust Funds..............................................       2,446,248        2,517,079        2,580,146         +133,898          +63,067
                 TITLE III--DEPARTMENT OF EDUCATION
                   EDUCATION FOR THE DISADVANTAGED
Grants to Local Education Agencies (LEAs):
    Basic Grants:
        Advance from prior year....................................      (5,394,300)      (4,011,272)      (4,011,272)     (-1,383,028)  ...............
        Forward funded.............................................       3,158,199        4,158,199        3,414,199         +256,000         -744,000
        Current funded.............................................           3,500            3,500            3,500   ...............  ...............
                                                                    ------------------------------------------------------------------------------------
          Subtotal, Basic grants current year approp...............       3,161,699        4,161,699        3,417,699         +256,000         -744,000
          Subtotal, Basic grants total funds available.............      (8,555,999)      (8,172,971)      (7,428,971)     (-1,127,028)       (-744,000)
        Basic Grants fiscal year 2004 Advance......................       4,011,272        3,011,272        3,755,272         -256,000         +744,000
                                                                    ------------------------------------------------------------------------------------
          Subtotal, Basic grants, program level....................       7,172,971        7,172,971        7,172,971   ...............  ...............
    Concentration Grants:
        Advance from prior year....................................      (1,364,000)      (1,365,031)      (1,365,031)         (+1,031)  ...............
        Fiscal year 2004 advance...................................       1,365,031        1,365,031        1,365,031   ...............  ...............
                                                                    ------------------------------------------------------------------------------------
          Subtotal, Concentration Grants program level.............       1,365,031        1,365,031        1,365,031   ...............  ...............
    Targeted Grants:
        Advance from prior year....................................  ...............      (1,018,499)      (1,018,499)     (+1,018,499)  ...............
        Fiscal year 2004 advance...................................       1,018,499        2,018,499        1,655,999         +637,500         -362,500
                                                                    ------------------------------------------------------------------------------------
          Subtotal, Targeted Grants program level..................       1,018,499        2,018,499        1,655,999         +637,500         -362,500
    Education Finance Incentive Grants:
        Advance from prior year....................................  ...............        (793,499)        (793,499)       (+793,499)  ...............
        Fiscal year 2004 advance...................................         793,499          793,499        1,655,999         +862,500         +862,500
                                                                    ------------------------------------------------------------------------------------
          Subtotal, Education Finance Incentive Grants.............         793,499          793,499        1,655,999         +862,500         +862,500
                                                                    ====================================================================================
          Subtotal, Grants to LEAs (program level).................      10,350,000       11,350,000       11,850,000       +1,500,000         +500,000
School Improvement.................................................  ...............  ...............         100,000         +100,000         +100,000
Even Start.........................................................         250,000          200,000          250,000   ...............         +50,000
Reading First
    State Grants (forward funded)..................................         690,000          790,000          790,000         +100,000   ...............
    State Grants (current funded)..................................          15,000           15,000           15,000   ...............  ...............
        Advance from prior year....................................  ...............        (195,000)        (195,000)       (+195,000)  ...............
        Fiscal year 2004 advance...................................         195,000          195,000          195,000   ...............  ...............
                                                                    ------------------------------------------------------------------------------------
          Subtotal, Reading First, program level...................         900,000        1,000,000        1,000,000         +100,000   ...............
    Early Reading First............................................          75,000           75,000           75,000   ...............  ...............
Literacy through School Libraries..................................          12,500           12,500           25,000          +12,500          +12,500
State agency programs:
    Migrant........................................................         396,000          396,000          410,000          +14,000          +14,000
    Neglected and Delinquent/High Risk Youth.......................          48,000           48,000           52,000           +4,000           +4,000
Evaluation.........................................................           8,900            8,900            8,900   ...............  ...............
Comprehensive School Reform Demonstration..........................         235,000          235,000          235,000   ...............  ...............
Dropout Prevention Programs........................................          10,000   ...............          15,000           +5,000          +15,000
Ellender Fellowships/Close Up......................................           1,500   ...............           1,500   ...............          +1,500
Advanced Placement Fees............................................          22,000           22,000           25,000           +3,000           +3,000
Migrant Education:
    High School Equivalency Program................................          23,000           23,000           24,000           +1,000           +1,000
    College Assistance Migrant Program.............................          15,000           15,000           16,000           +1,000           +1,000
                                                                    ------------------------------------------------------------------------------------
      Subtotal, Migrant Education..................................          38,000           38,000           40,000           +2,000           +2,000
                                                                    ====================================================================================
      Total, Education for the disadvantaged.......................      12,346,900       13,385,400       14,087,400       +1,740,500         +702,000
          Current Year.............................................      (4,963,599)      (6,002,099)      (5,460,099)       (+496,500)       (-542,000)
          Fiscal year 2004.........................................      (7,383,301)      (7,383,301)      (8,627,301)     (+1,244,000)     (+1,244,000)
                                                                    ------------------------------------------------------------------------------------
      Subtotal, forward funded.....................................      (4,777,199)      (5,827,199)      (5,151,199)       (+374,000)       (-676,000)
                             IMPACT AID
Basic Support Payments.............................................         982,500          982,500        1,032,500          +50,000          +50,000
Payments for Children with Disabilities............................          50,000           50,000           52,000          ++2,000
Facilities Maintenance (Sec. 8008).................................           8,000            8,000            8,000   ...............  ...............
Construction (Sec. 8007)...........................................          48,000           45,000           50,000           +2,000           +5,000
Payments for Federal Property (Sec. 8002)..........................          55,000           55,000           58,000           +3,000           +3,000
                                                                    ------------------------------------------------------------------------------------
      Total, Impact aid............................................       1,143,500        1,140,500        1,200,500          +57,000          +60,000
                    SCHOOL IMPROVEMENT PROGRAMS
State Grants for Improving Teacher Quality.........................       1,700,000        1,700,000        1,950,000         +250,000         +250,000
    Advance from prior year........................................      (1,150,000)      (1,150,000)      (1,150,000)  ...............  ...............
    Fiscal year 2004 advance.......................................       1,150,000        1,150,000        1,150,000   ...............  ...............
                                                                    ------------------------------------------------------------------------------------
      State Grants for Improving Teacher Quality, program level....       2,850,000        2,850,000        3,100,000         +250,000         +250,000
National Activities:
    School Leadership..............................................          10,000   ...............          15,000           +5,000          +15,000
    Advanced Credentialing.........................................          10,000   ...............          10,000   ...............         +10,000
    Early Childhood Educator Professional Development..............          15,000           15,000           15,000   ...............  ...............
                                                                    ------------------------------------------------------------------------------------
      Subtotal, National Activities................................          35,000           15,000           40,000           +5,000          +25,000
Mathematics and Science Partnerships...............................          12,500           12,500           25,000          +12,500          +12,500
Troops-to-Teachers.................................................          18,000           20,000           20,000           +2,000   ...............
Transition to Teaching.............................................          35,000           39,400           39,400           +4,400   ...............
State Grants for Innovative Education (Education Block Grant)......         100,000          100,000          100,000   ...............  ...............
    Advance from prior year........................................        (285,000)        (285,000)        (285,000)  ...............  ...............
    Fiscal year 2004...............................................         285,000          285,000          285,000   ...............  ...............
                                                                    ------------------------------------------------------------------------------------
      Education Block Grant, program level.........................         385,000          385,000          385,000   ...............  ...............
Educational Technology:
    Educational Technology State Grants............................         700,500          700,500          700,500   ...............  ...............
    Ready to Learn.................................................          22,000           22,000           24,000           +2,000           +2,000
    Preparing Tomorrow's Teachers to Use Technology................          62,500   ...............          67,500           +5,000          +67,500
                                                                    ------------------------------------------------------------------------------------
      Subtotal, Educational Technology.............................         785,000          722,500          792,000           +7,000          +69,500
21st Century Community Learning Centers............................       1,000,000        1,000,000        1,090,000          +90,000          +90,000
Safe and Drug Free Schools:
    State Grants, current funded...................................         142,017          142,017          155,017          +13,000          +13,000
        Advance from prior year....................................        (330,000)        (330,000)        (330,000)  ...............  ...............
        Fiscal year 2004...........................................         330,000          330,000          330,000   ...............  ...............
                                                                    ------------------------------------------------------------------------------------
          State Grants, program level..............................         472,017          472,017          485,017          +13,000          +13,000
    National Programs..............................................         182,233          172,233          169,233          -13,000           -3,000
                                                                    ------------------------------------------------------------------------------------
      Subtotal, Safe and Drug Free Schools.........................         654,250          644,250          654,250   ...............         +10,000
    Magnet Schools Assistance......................................         110,000          110,000          110,000   ...............  ...............
    Charter Schools Grants.........................................         200,000          200,000          200,000   ...............  ...............
    Credit Enhancement for Charter School Facilities...............  ...............         100,000   ...............  ...............        -100,000
    Voluntary Public School Choice.................................          25,000           25,000           35,000          +10,000          +10,000
    Choice Demonstration Fund......................................  ...............          50,000   ...............  ...............         -50,000
    State Assessments/Enhanced Assessment Instruments..............         387,000          387,000          397,000          +10,000          +10,000
    Education for Homeless Children & Youth........................          50,000           50,000           52,000           +2,000           +2,000
    Training and Advisory Services (Civil Rights)..................           7,334            7,334            7,334   ...............  ...............
    Education for Native Hawaiians.................................          30,500           18,300           32,500           +2,000          +14,200
    Alaska Native Education Equity.................................          24,000           14,200           32,500           +8,500          +18,300
    Rural Education................................................         162,500   ...............         175,000          +12,500         +175,000
    Mentoring Programs.............................................          17,500   ...............          17,500   ...............         +17,500
    Fund for the Improvement of Education (FIE):
        Programs of National Significance, Current funded..........         308,955           35,000          300,416           -8,539         +265,416
        Programs of National Signifiance, Forward funded...........          75,000   ...............          75,000   ...............         +75,000
                                                                    ====================================================================================
          Subtotal, Programs of National Significance..............         383,955           35,000          375,416           -8,539         +340,416
    Character Education............................................          25,000           25,000           25,000   ...............  ...............
    Reading is Fundamental/Inexpensive Book Dist...................          24,000           24,000           27,000           +3,000           +3,000
    School Counseling..............................................          32,500   ...............          32,500   ...............         +32,500
    Smaller Learning Communities...................................
        Current funded.............................................           7,109   ...............           7,109   ...............          +7,109
        Forward funded.............................................         135,080   ...............         135,080   ...............        +135,080
                                                                    ------------------------------------------------------------------------------------
          Subtotal, Smaller Learning Communities...................         142,189   ...............         142,189   ...............        +142,189
    Javits Gifted and Talented.....................................          11,250   ...............          13,250           +2,000          +13,250
    Star Schools...................................................          27,520   ...............          27,520   ...............         +27,520
    Ready to Teach.................................................          12,000   ...............          17,000           +5,000          +17,000
    Foreign Language Assistance....................................          14,000   ...............          20,000           +6,000          +20,000
    Carol M. White Physical Education for Progress.................          50,000   ...............          70,000          +20,000          +70,000
    Community Technology Centers...................................          32,475   ...............          32,475   ...............         +32,475
    Exchanges with Historic Whaling&Trading Partners...............           5,000   ...............          10,000           +5,000          +10,000
    Arts in Education..............................................          30,000   ...............          36,000           +6,000          +36,000
    Parental Assistance Information Centers........................          40,000   ...............          45,000           +5,000          +45,000
    Women's Education Equity.......................................           3,000   ...............           3,000   ...............          +3,000
                                                                    ------------------------------------------------------------------------------------
      Subtotal, Fund for the Improvement of Education..............         832,889           84,000          876,350          +43,461         +792,350
    Community Service for Expelled or Susp'd Students..............          50,000   ...............          50,000   ...............         +50,000
    Alcohol Abuse Reduction........................................          25,000   ...............          25,000   ...............         +25,000
    Teaching of Traditional American History.......................         100,000           50,000          100,000   ...............         +50,000
    Civic Education................................................  ...............  ...............  ...............  ...............  ...............
        Cooperative Education Exchanges............................          10,800   ...............          12,000           +1,200          +12,000
        We the People..............................................          16,200   ...............          18,000           +1,800          +18,000
    National Writing Project.......................................          14,000   ...............          18,000           +4,000          +18,000
                                                                    ====================================================================================
      Total, School improvement programs...........................       7,837,473        6,784,484        8,303,834         +466,361       +1,519,350
          Current Year.............................................      (6,072,473)      (5,019,484)      (6,538,834)       (+466,361)     (+1,519,350)
          Fiscal year 2004.........................................      (1,765,000)      (1,765,000)      (1,765,000)  ...............  ...............
                                                                    ------------------------------------------------------------------------------------
      Subtotal, forward funded.....................................      (2,801,597)      (2,379,017)      (3,089,097)       (+287,500)       (+710,080)
Reading Excellence Act.............................................  ...............  ...............  ...............  ...............  ...............
    Advance from prior year........................................        (195,000)  ...............  ...............       (-195,000)  ...............
    Fiscal year 2004...............................................  ...............  ...............  ...............  ...............  ...............
                                                                    ------------------------------------------------------------------------------------
      Reading Excellence, program level............................  ...............  ...............  ...............  ...............  ...............
                          INDIAN EDUCATION
Grants to Local Educational Agencies...............................          97,133           97,133           97,133   ...............  ...............
Federal Programs:
    Special Programs for Indian Children...........................          20,000           20,000           20,000   ...............  ...............
    National Activities............................................           3,235            5,235            5,235           +2,000   ...............
                                                                    ------------------------------------------------------------------------------------
      Subtotal.....................................................          23,235           25,235           25,235           +2,000   ...............
                                                                    ====================================================================================
      Total, Indian Education......................................         120,368          122,368          122,368           +2,000   ...............
                    ENGLISH LANGUAGE ACQUISITION
Current funded.....................................................         250,000          196,000          196,000          -54,000   ...............
Forward funded.....................................................         415,000          469,000          544,000         +129,000          +75,000
                                                                    ------------------------------------------------------------------------------------
      Total, English Language Acquisition..........................         665,000          665,000          740,000          +75,000          +75,000
                         SPECIAL EDUCATION
State grants:
    Grants to States Part B advance funded.........................       5,072,000        5,072,000        6,072,000       +1,000,000       +1,000,000
        Part B advance from prior year.............................      (5,072,000)      (5,072,000)      (5,072,000)  ...............  ...............
    Grants to States Part B current year...........................       2,456,533        3,456,533        2,456,533   ...............      -1,000,000
                                                                    ------------------------------------------------------------------------------------
      Grants to States, program level..............................       7,528,533        8,528,533        8,528,533       +1,000,000   ...............
    Preschool Grants...............................................         390,000          390,000          390,000   ...............  ...............
    Grants for Infants and Families................................         417,000          437,000          437,000          +20,000   ...............
                                                                    ------------------------------------------------------------------------------------
      Subtotal, State grants, program level........................       8,335,533        9,355,533        9,355,533       +1,020,000   ...............
IDEA National Activities (current funded):
    State Program Improvement Grants...............................          51,700           51,700           51,700   ...............  ...............
    Research and Innovation........................................          78,380           78,380           70,000           -8,380           -8,380
    Technical Assistance and Dissemination.........................          53,481           53,481           53,481   ...............  ...............
    Personnel Preparation..........................................          90,000           90,000          100,000          +10,000          +10,000
    Parent Information Centers.....................................          26,000           26,000           28,000           +2,000           +2,000
    Technology and Media Services..................................          37,710           32,710           37,710   ...............          +5,000
                                                                    ------------------------------------------------------------------------------------
      Subtotal, IDEA special programs..............................         337,271          332,271          340,891           +3,620           +8,620
                                                                    ====================================================================================
      Total, Special education.....................................       8,672,804        9,687,804        9,696,424       +1,023,620           +8,620
          Current Year.............................................      (3,600,804)      (4,615,804)      (3,624,424)        (+23,620)       (-991,380)
          Fiscal year 2004.........................................      (5,072,000)      (5,072,000)      (6,072,000)     (+1,000,000)     (+1,000,000)
                                                                    ------------------------------------------------------------------------------------
      Subtotal, Forward funded.....................................      (3,315,233)      (4,335,233)      (3,335,233)        (+20,000)     (-1,000,000)
          REHABILITATION SERVICES AND DISABILITY RESEARCH
Vocational Rehabilitation State Grants.............................       2,481,383        2,533,492        2,533,492          +52,109   ...............
Discretionary Supplement to Voc. Rehab. State Grants...............  ...............          82,833   ...............  ...............         -82,833
Vocational Rehabilitation Incentive Grants.........................  ...............          30,000   ...............  ...............         -30,000
Client Assistance State grants.....................................          11,897           11,897           12,397             +500             +500
Training...........................................................          39,629           42,629           42,629           +3,000   ...............
Demonstration and training programs................................          21,238           17,492           21,238   ...............          +3,746
Migrant and seasonal farmworkers...................................           2,350   ...............           2,350   ...............          +2,350
Recreational programs..............................................           2,596   ...............           2,596   ...............          +2,596
Protection and advocacy of individual rights (PAIR)................          15,200           15,200           17,500           +2,300           +2,300
Projects with industry.............................................          22,071   ...............          22,071   ...............         +22,071
Supported employment State grants..................................          38,152   ...............          38,152   ...............         +38,152
Independent living:
    State grants...................................................          22,296           22,296           22,296   ...............  ...............
    Centers........................................................          62,500           69,500           69,500           +7,000   ...............
    Services for older blind individuals...........................          25,000           25,000           28,000           +3,000           +3,000
                                                                    ------------------------------------------------------------------------------------
      Subtotal, Independent living.................................         109,796          116,796          119,796          +10,000           +3,000
Program Improvement................................................             900              900              900   ...............  ...............
Evaluation.........................................................           1,000            1,000            1,000   ...............  ...............
Helen Keller National Center for Deaf/Blind........................           8,717            8,717            8,717   ...............  ...............
National Inst. Disability and Rehab Research (NIDRR)...............         110,000          110,000          110,000   ...............  ...............
Assistive Technology...............................................          60,884           30,884           30,884          -30,000   ...............
Access to Telework Fund............................................          20,000   ...............  ...............         -20,000   ...............
                                                                    ------------------------------------------------------------------------------------
      Subtotal, discretionary programs.............................         464,430          468,348          430,230          -34,200          -38,118
                                                                    ====================================================================================
      Total, Rehabilitation services...............................       2,945,813        3,001,840        2,963,722          +17,909          -38,118
         SPECIAL INSTITUTIONS FOR PERSONS WITH DISABILITIES
AMERICAN PRINTING HOUSE FOR THE BLIND..............................          14,000           14,000           15,500           +1,500           +1,500
NATIONAL TECHNICAL INSTITUTE FOR THE DEAF:
    Operations.....................................................          50,000           49,414           53,000           +3,000           +3,586
    Endowment......................................................  ...............           1,000   ...............  ...............          -1,000
    Construction...................................................           5,376            1,600            1,600           -3,776   ...............
                                                                    ------------------------------------------------------------------------------------
      Total........................................................          55,376           52,014           54,600             -776           +2,586
GALLAUDET UNIVERSITY:
    Operations.....................................................          96,938           93,446           98,438           +1,500           +4,992
    Endowment......................................................  ...............           1,000   ...............  ...............          -1,000
                                                                    ------------------------------------------------------------------------------------
      Total........................................................          96,938           94,446           98,438           +1,500           +3,992
                                                                    ====================================================================================
      Total, Special Institutions for Persons with Disabilities....         166,314          160,460          168,538           +2,224           +8,078
                   VOCATIONAL AND ADULT EDUCATION
Vocational Education:
    Basic State Grants, current funded.............................         389,000          389,000          389,000   ...............  ...............
        Advance from prior year....................................        (791,000)        (791,000)        (791,000)  ...............  ...............
        Fiscal year 2004...........................................         791,000          791,000          791,000   ...............  ...............
                                                                    ------------------------------------------------------------------------------------
          Basic State Grants, program level........................       1,180,000        1,180,000        1,180,000   ...............  ...............
    Tech-Prep Education State Grants...............................         108,000          108,000          108,000   ...............  ...............
    Tribally Controlled Postsec Vocational & Tech Inst.............           6,500            6,500            7,000             +500             +500
    National Programs..............................................          12,000           12,000           12,000   ...............  ...............
    Tech-Prep Education Demonstration..............................           5,000   ...............           5,000   ...............          +5,000
    Occupational and Employment Information Program................           9,500   ...............          10,000             +500          +10,000
                                                                    ------------------------------------------------------------------------------------
    Subtotal, Vocational Education.................................       1,321,000        1,306,500        1,322,000           +1,000          +15,500
Adult education:
    State Grants, current funded...................................         575,000          575,000          575,000   ...............  ...............
    National Programs:
        National Leadership Activities.............................           9,500            9,500            9,500   ...............  ...............
        National Institute for Literacy............................           6,560            6,560            6,560   ...............  ...............
                                                                    ------------------------------------------------------------------------------------
          Subtotal, National programs..............................          16,060           16,060           16,060   ...............  ...............
                                                                    ====================================================================================
          Subtotal, Adult education................................         591,060          591,060          591,060   ...............  ...............
State Grants for Incarcerated Youth Offenders......................          22,000   ...............          25,000           +3,000          +25,000
                                                                    ====================================================================================
      Total, Vocational and adult education........................       1,934,060        1,897,560        1,938,060           +4,000          +40,500
          Current Year.............................................      (1,143,060)      (1,106,560)      (1,147,060)         (+4,000)        (+40,500)
          Fiscal year 2004.........................................        (791,000)        (791,000)        (791,000)  ...............  ...............
                                                                    ------------------------------------------------------------------------------------
      Subtotal, forward funded.....................................      (1,136,560)      (1,100,060)      (1,140,060)         (+3,500)        (+40,000)
                    STUDENT FINANCIAL ASSISTANCE
Pell Grants--maximum grant (NA)....................................          (4,000)          (4,000)          (4,100)           (+100)           (+100)
Pell Grants--Regular Program.......................................      10,314,000       10,863,000       11,180,000         +866,000         +317,000
Federal Supplemental Educational Opportunity Grants................         725,000          725,000          725,000   ...............  ...............
Federal Work Study.................................................       1,011,000        1,011,000        1,011,000   ...............  ...............
Federal Perkins loans:
    Capital Contributions..........................................         100,000          100,000          100,000   ...............  ...............
    Loan Cancellations.............................................          67,500           67,500           72,500           +5,000           +5,000
                                                                    ------------------------------------------------------------------------------------
      Subtotal, Federal Perkins loans..............................         167,500          167,500          172,500           +5,000           +5,000
LEAP program.......................................................          67,000   ...............          72,500           +5,500          +72,500
Loan Forgiveness for Child Care....................................           1,000            1,000            1,000   ...............  ...............
                                                                    ====================================================================================
      Total, Student Financial Assistance..........................      12,285,500       12,767,500       13,162,000         +876,500         +394,500
                          HIGHER EDUCATION
Aid for institutional development:
    Strengthening Institutions.....................................          73,625           76,275           80,000           +6,375           +3,725
    Hispanic Serving Institutions..................................          86,000           89,096           91,000           +5,000           +1,904
    Strengthening Historically Black Colleges (HBCUs)..............         206,000          213,415          213,415           +7,415   ...............
    Strengthening historically black graduate insts................          49,000           50,764           50,764           +1,764   ...............
    Strengthening Alaska/Native Hawaiian-Serving Inst..............           6,500            6,734            7,234             +734             +500
    Strengthening Tribal Colleges..................................          17,500           18,130           23,000           +5,500           +4,870
                                                                    ------------------------------------------------------------------------------------
    Subtotal, Aid for Institutional development....................         438,625          454,414          465,413          +26,788          +10,999
    International education & foreign language:
        Domestic Programs..........................................          85,200           88,000           88,000           +2,800   ...............
        Overseas Programs..........................................          11,800           13,000           13,000           +1,200   ...............
        Institute for International Public Policy..................           1,500            1,500            1,500   ...............  ...............
                                                                    ------------------------------------------------------------------------------------
          Subtotal, International Ed & Foreign Lang................          98,500          102,500          102,500           +4,000   ...............
Fund for the Improvement of Postsec. Ed. (FIPSE)...................         180,922           39,138           75,922         -105,000          +36,784
Minority Science and Engineering Improvement.......................           8,500            8,500            8,500   ...............  ...............
Interest Subsidy Grants............................................           5,000            3,000            3,000           -2,000   ...............
Federal TRIO Programs..............................................         802,500          802,500          832,500          +30,000          +30,000
GEAR UP............................................................         285,000          285,000          295,000          +10,000          +10,000
Byrd Honors Scholarships...........................................          41,001           41,001           41,001   ...............  ...............
Javits Fellowships.................................................          10,000           10,000           12,000           +2,000           +2,000
Graduate Assistance in Areas of National Need......................          31,000           31,000           31,000   ...............  ...............
Teacher Quality Enhancement Grants.................................          90,000           90,000           90,000   ...............  ...............
Child Care Access Means Parents in School..........................          25,000           15,000           15,000          -10,000   ...............
Demonstration in Disabilities/Higher Education.....................           7,000   ...............           7,000   ...............          +7,000
Underground Railroad Program.......................................           2,000   ...............           2,500             +500           +2,500
GPRA data/HEA program evaluation...................................           1,000            1,000            1,000   ...............  ...............
Thurgood Marshall Scholarships.....................................           4,000   ...............           4,000   ...............          +4,000
B.J. Stupak Olympic Scholarships...................................           1,000   ...............  ...............          -1,000   ...............
                                                                    ====================================================================================
      Total, Higher education......................................       2,031,048        1,883,053        1,986,336          -44,712         +103,283
                         HOWARD UNIVERSITY
Academic Program...................................................         203,500          203,500          203,500   ...............  ...............
Endowment Program..................................................           3,600            3,600            3,600   ...............  ...............
Howard University Hospital.........................................          30,374           30,374           30,374   ...............  ...............
                                                                    ------------------------------------------------------------------------------------
      Total, Howard University.....................................         237,474          237,474          237,474   ...............  ...............
College Housing and Academic Facilities Loans Program: CHAFL)......             762              762              762   ...............  ...............
HBCU Capital Financing Program: Federal Administration.............             208              208              208   ...............  ...............
          EDUCATION RESEARCH, STATISTICS, AND IMPROVEMENT
Research and statistics:
    Research.......................................................         121,817          175,000          140,000          +18,183          -35,000
    Regional Educational Laboratories..............................          67,500           67,500           67,500   ...............  ...............
    Statistics.....................................................          85,000           95,000           90,000           +5,000           -5,000
    Assessment:
        National Assessment........................................         107,500           90,825           90,825          -16,675   ...............
        National Assessment Governing Board........................           4,053            4,562            4,562             +509   ...............
                                                                    ------------------------------------------------------------------------------------
          Subtotal, Assessment.....................................         111,553           95,387           95,387          -16,166   ...............
                                                                    ====================================================================================
          Subtotal, Research and statistics........................         385,870          432,887          392,887           +7,017          -40,000
Multi-year Grants and Contracts....................................          58,000   ...............          53,000           -5,000          +53,000
                                                                    ------------------------------------------------------------------------------------
      Total, ERSI..................................................         443,870          432,887          445,887           +2,017          +13,000
                      DEPARTMENTAL MANAGEMENT
PROGRAM ADMINISTRATION.............................................         364,761          411,795          412,093          +47,332             +298
OFFICE FOR CIVIL RIGHTS............................................          79,934           86,276           86,276           +6,342   ...............
OFFICE OF THE INSPECTOR GENERAL....................................          38,720           41,000           41,000           +2,280   ...............
                                                                    ------------------------------------------------------------------------------------
      Total, Departmental management...............................         483,415          539,071          539,369          +55,954             +298
                     STUDENT AID ADMINISTRATION
Administrative Costs...............................................         107,484          932,000          105,388           -2,096         -826,612
Federal Direct Student Loan Reclassification (Leg pro).............  ...............        -797,000   ...............  ...............        +797,000
                                                                    ------------------------------------------------------------------------------------
      Total: Elementary and Secondary Education Act programs.......      22,222,794       22,133,139       24,537,489       +2,314,695       +2,404,350
                                                                    ====================================================================================
      Total, Department of Education...............................      51,421,993       52,841,371       55,698,270       +4,276,277       +2,856,899
          Current Year.............................................     (36,410,692)     (37,830,070)     (38,442,969)     (+2,032,277)       (+612,899)
          Fiscal year 2004.........................................     (15,011,301)     (15,011,301)     (17,255,301)     (+2,244,000)     (+2,244,000)
                     TITLE IV--RELATED AGENCIES
                    ARMED FORCES RETIREMENT HOME
Operations and Maintenance.........................................          61,628           61,628           61,628   ...............  ...............
Capital Program....................................................           9,812            5,712            5,712           -4,100   ...............
                                                                    ------------------------------------------------------------------------------------
      Total, AFRH..................................................          71,440           67,340           67,340           -4,100   ...............
         CORPORATION FOR NATIONAL AND COMMUNITY SERVICE \8\
Volunteers in Service to America (VISTA)...........................          85,287           94,287           99,287          +14,000           +5,000
Special Volunteer Programs.........................................           5,000           55,000           10,000           +5,000          -45,000
National Senior Volunteer Corps:
    Foster Grandparents Program....................................         106,700          106,700          106,700   ...............  ...............
    Senior Companion Program.......................................          44,395           46,563           56,563          +12,168          +10,000
    Retired Senior Volunteer Program...............................          54,884           58,884           68,884          +14,000          +10,000
    Senior Demonstration Program...................................             400              400            5,400           +5,000           +5,000
                                                                    ------------------------------------------------------------------------------------
      Subtotal, Senior Volunteers..................................         206,379          212,547          237,547          +31,168          +25,000
Program Administration.............................................          32,229           34,229           34,229           +2,000   ...............
                                                                    ====================================================================================
      Total, Domestic Volunteer Service Programs...................         328,895          396,063          381,063          +52,168          -15,000
CORPORATION FOR PUBLIC BROADCASTING:
    Fiscal year 2005 (current request) with fiscal year 2004                380,000          395,000          395,000          +15,000   ...............
     comparable....................................................
    Fiscal year 2004 advance with fiscal year 2003 comparable (NA).        (365,000)        (380,000)        (380,000)        (+15,000)  ...............
    Fiscal year 2003 advance with fiscal year 2002 comparable (NA).        (350,000)        (365,000)        (365,000)        (+15,000)  ...............
    Digitalization program \9\.....................................          25,000           25,000           50,000          +25,000          +25,000
                                                                    ------------------------------------------------------------------------------------
      Subtotal, fiscal year 2003 appropriation.....................          25,000           25,000           50,000          +25,000          +25,000
FEDERAL MEDIATION AND CONCILIATION SERVICE.........................          39,982           40,718           41,218           +1,236             +500
FEDERAL MINE SAFETY AND HEALTH REVIEW COMMISSION...................           6,939            7,127            7,127             +188   ...............
INSTITUTE OF MUSEUM AND LIBRARY SERVICES \10\......................         224,501          210,000          214,000          -10,501           +4,000
MEDICARE PAYMENT ADVISORY COMMISSION...............................           8,250            8,250            9,050             +800             +800
NATIONAL COMMISSION ON LIBRARIES AND INFO SCIENCE..................           1,000   ...............           1,000   ...............          +1,000
NATIONAL COUNCIL ON DISABILITY.....................................           2,830            2,830            2,830   ...............  ...............
NATIONAL EDUCATION GOALS PANEL.....................................             400   ...............  ...............            -400   ...............
NATIONAL LABOR RELATIONS BOARD.....................................         226,618          233,223          243,223          +16,605          +10,000
NATIONAL MEDIATION BOARD...........................................          10,635           11,203           11,203             +568   ...............
OCCUPATIONAL SAFETY AND HEALTH REVIEW COMMISSION...................           8,964            9,577            9,577             +613   ...............
                     RAILROAD RETIREMENT BOARD
Dual Benefits Payments Account.....................................         146,000          132,000          132,000          -14,000   ...............
Less Income Tax Receipts on Dual Benefits..........................          -9,000           -8,000           -8,000           +1,000   ...............
                                                                    ------------------------------------------------------------------------------------
      Subtotal, Dual Benefits......................................         137,000          124,000          124,000          -13,000   ...............
Federal Payment to the RR Retirement Account.......................             150              150              150   ...............  ...............
Limitation on administration.......................................          97,700           97,720           97,720              +20   ...............
    Inspector General..............................................           6,261            6,300            6,300              +39   ...............
                   SOCIAL SECURITY ADMINISTRATION
Payments to Social Security Trust Funds............................         434,400           20,400           20,400         -414,000   ...............
             SPECIAL BENEFITS FOR DISABLED COAL MINERS
Benefit payments...................................................         440,931          402,089          402,089          -38,842   ...............
Administration.....................................................           5,909            6,088            6,088             +179   ...............
                                                                    ------------------------------------------------------------------------------------
      Subtotal, Black Lung, fiscal year 2004 program level.........         446,840          408,177          408,177          -38,663   ...............
          Less funds advanced in prior year........................        -114,000         -108,000         -108,000           +6,000   ...............
            Total, Black Lung, current request, fiscal year 2004...         332,840          300,177          300,177          -32,663   ...............
            New advances, 1st quarter fiscal year 2004.............         108,000           97,000           97,000          -11,000   ...............
                    SUPPLEMENTAL SECURITY INCOME
Federal benefit payments...........................................      29,046,000       31,795,664       31,795,664       +2,749,664   ...............
Beneficiary services...............................................          37,412           45,728           45,728           +8,316   ...............
Research and demonstration.........................................          37,000           30,000           38,000           +1,000           +8,000
Administration.....................................................       2,627,000        2,825,000        2,825,000         +198,000   ...............
                                                                    ------------------------------------------------------------------------------------
      Subtotal, SSI program level..................................      31,747,412       34,696,392       34,704,392       +2,956,980           +8,000
          Less funds advanced in prior year........................     -10,470,000      -10,790,000      -10,790,000         -320,000   ...............
                                                                    ------------------------------------------------------------------------------------
            Subtotal, regular SSI current year.....................      21,277,412       23,906,392       23,914,392       +2,636,980           +8,000
                Additional CDR funding \1\.........................         200,000   ...............  ...............        -200,000   ...............
                User Fee Activities................................         100,000          111,000          111,000          +11,000   ...............
                                                                    ------------------------------------------------------------------------------------
            Total, SSI, current request............................      21,577,412       24,017,392       24,025,392       +2,447,980           +8,000
                New advance, 1st quarter, fiscal eyar 2004.........      10,790,000       11,080,000       11,080,000         +290,000   ...............
               LIMITATION ON ADMINISTRATIVE EXPENSES
OASDI Trust Funds..................................................       3,219,700        3,775,200        3,775,200         +555,500   ...............
HI/SMI Trust Funds.................................................       1,194,000        1,223,000        1,223,000          +29,000   ...............
Social Security Advisory Board.....................................           1,800            1,800            1,800   ...............  ...............
SSI................................................................       2,627,000        2,825,000        2,825,000         +198,000   ...............
                                                                    ------------------------------------------------------------------------------------
      Subtotal, regular LAE........................................       7,042,500        7,825,000        7,825,000         +782,500   ...............
User Fee Activities (SSI)..........................................         100,000          111,000          111,000          +11,000   ...............
                                                                    ====================================================================================
      Total, REGULAR LAE...........................................       7,142,500        7,936,000        7,936,000         +793,500   ...............
          Additional CDR funding \1\...............................
              OASDI................................................         233,000   ...............  ...............        -233,000   ...............
              SSI..................................................         200,000   ...............  ...............        -200,000   ...............
                                                                    ------------------------------------------------------------------------------------
                Subtotal, CDR funding..............................         433,000   ...............  ...............        -433,000   ...............
                                                                    ====================================================================================
      Total, LAE...................................................       7,575,500        7,936,000        7,936,000         +360,500   ...............
                    OFFICE OF INSPECTOR GENERAL
Federal Funds......................................................          19,000           21,000           21,000           +2,000   ...............
Trust Funds........................................................          56,000           62,000           62,000           +6,000   ...............
                                                                    ------------------------------------------------------------------------------------
      Total, Office of the Inspector General.......................          75,000           83,000           83,000           +8,000   ...............
Adjustment: Trust fund transfers from general revenues.............      -2,927,000       -2,936,000       -2,936,000           -9,000   ...............
                                                                    ====================================================================================
      Total, Social Security Administration........................      37,966,152       40,597,969       40,605,969       +2,639,817           +8,000
          Federal funds............................................      33,261,652       35,535,969       35,543,969       +2,282,317           +8,000
              Current year.........................................     (22,363,652)     (24,358,969)     (24,366,969)     (+2,003,317)         (+8,000)
              New advances, 1st quarter............................     (10,898,000)     (11,177,000)     (11,177,000)       (+279,000)  ...............
          Trust funds..............................................       4,704,500        5,062,000        5,062,000         +357,500   ...............
UNITED STATES INSTITUTE OF PEACE...................................          15,104           16,200           17,200           +2,096           +1,000
                                                                    ====================================================================================
      Total, Title IV, Related Agencies............................      39,557,821       42,248,670       42,283,970       +2,726,149          +35,300
          Federal Funds............................................      34,741,110       37,074,400       37,108,900       +2,367,790          +34,500
              Current Year.........................................     (23,463,110)     (25,502,400)     (25,536,900)     (+2,073,790)        (+34,500)
              Fiscal year 2004.....................................     (10,898,000)     (11,177,000)     (11,177,000)       (+279,000)  ...............
              Fiscal year 2005.....................................        (380,000)        (395,000)        (395,000)        (+15,000)  ...............
          Trust Funds..............................................       4,816,711        5,174,270        5,175,070         +358,359             +800
                              SUMMARY
Federal Funds......................................................     400,078,701      414,621,205      420,930,680      +20,851,979       +6,309,475
    Current year...................................................    (320,470,463)    (329,467,918)    (333,533,393)    (+13,062,930)     (+4,065,475)
    2004 advance...................................................     (79,228,238)     (84,758,287)     (87,002,287)     (+7,774,049)     (+2,244,000)
    2005 advance...................................................        (380,000)        (395,000)        (395,000)        (+15,000)  ...............
Trust Funds........................................................      11,198,174       11,550,602       11,571,829         +373,655          +21,227
                                                                    ------------------------------------------------------------------------------------
      Grand Total..................................................     411,276,875      426,171,807      432,502,509      +21,225,634       +6,330,702
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ Two year availability.
\2\ Requested in the Public Health and Human Services Emergency Fund.
\3\ Includes Mine Safety and Health.
\4\ Funded in VA/HUD Bill.
\5\ Superfund dollars are appropriated in the VA/HUD Bill.
\6\ Funds are provided in the Public Health and Social Service Emergency Fund.
\7\ Funding transferred from Office of the Secretary and CDC to the PHSSEF.
\8\ Appropriations for Americorps are provided in the VA-HUD bill.
\9\ Current Funded.
\10\ Fiscal year 2002 & fiscal year 2003 includes both Interior & LHHS portions.



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