[House Report 108-188]
[From the U.S. Government Publishing Office]



108th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES
 1st Session                                                    108-188

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



 
  DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND 
               RELATED AGENCIES APPROPRIATION BILL, 2004

                                _______
                                

  July 8, 2003.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

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

                              R E P O R T

                             together with

                            DISSENTING VIEWS

                        [To accompany H.R. 2660]

    The Committee on Appropriations submits the following 
report in explanation of the accompanying bill making 
appropriations for the Departments of Labor, Health and Human 
Services (except the Food and Drug Administration and the 
Indian Health Service), and Education, Armed Forces Retirement 
Home, Corporation for National and Community Service, 
Corporation for Public Broadcasting, Federal Mediation and 
Conciliation Service, Federal Mine Safety and Health Review 
Commission, Institute of Museum and Library Services, Medicare 
Payment Advisory Commission, National Commission on Libraries 
and Information Science, National Council on Disability, 
National Labor Relations Board, National Mediation Board, 
Occupational Safety and Health Review Commission, Railroad 
Retirement Board, Social Security Administration, and the 
United States Institute of Peace for the fiscal year ending 
September 30, 2004, and for other purposes.

                        INDEX TO BILL AND REPORT

_______________________________________________________________________


                                                            Page number

                                                            Bill Report
Title I--Department of Labor:
        Employment and Training Administration.............     2
                                                                      8
        Employee Benefits Security Administration..........     8
                                                                     15
        Pension Benefit Guaranty Corporation...............     8
                                                                     15
        Employment Standards Administration................     9
                                                                     16
        Occupational Safety and Health Administration......    14
                                                                     18
        Mine Safety and Health Administration..............    17
                                                                     19
        Bureau of Labor Statistics.........................    18
                                                                     19
        Office of Disability Employment Policy.............    18
                                                                     19
        Departmental Management............................    19
                                                                     19
        Veterans Employment and Training...................    20
                                                                     21
        Office of the Inspector General....................    21
                                                                     21
        General Provisions.................................    21
                                                                     22
Title II--Department of Health and Human Services:
        Health Resources and Services Administration.......    22
                                                                     22
        Centers for Disease Control and Prevention.........    26
                                                                     41
        National Institutes of Health......................    28
                                                                     55
        Substance Abuse and Mental Health Services 
            Administration.................................    34
                                                                     99
        Agency for Healthcare Research and Quality.........    34
                                                                    103
        Centers for Medicare and Medicaid Services.........    35
                                                                    105
        Administration for Children and Families...........    38
                                                                    110
        Administration on Aging............................    45
                                                                    121
        Office of the Secretary............................    45
                                                                    123
        General Provisions.................................    49
                                                                    130
Title III--Department of Education:
        Education for the Disadvantaged....................    59
                                                                    132
        Impact Aid.........................................    60
                                                                    135
        School Improvement Programs........................    61
                                                                    136
        Indian Education...................................    61
                                                                    140
        Innovation and Improvement.........................    62
                                                                    140
        Safe Schools and Citizenship Education.............    62
                                                                    144
        English Language Acquisition.......................    63
                                                                    147
        Special Education..................................    63
                                                                    147
        Rehabilitation Services and Disability Research....    64
                                                                    150
        Special Institutions for Persons with Disabilities.    64
                                                                    153
        Vocational and Adult Education.....................    65
                                                                    154
        Student Financial Assistance.......................    67
                                                                    156
        Student Aid Administration.........................    67
                                                                    158
        Higher Education...................................    67
                                                                    158
        Howard University..................................    69
                                                                    164
        College Housing and Academic Facilities Loans......    69
                                                                    164
        Historically Black College and University Capital 
            Financing......................................    69
                                                                    164
        Institute of Education Sciences....................    70
                                                                    165
        Departmental Management............................    70
                                                                    166
        Office for Civil Rights............................    70
                                                                    167
        Office of the Inspector General....................    70
                                                                    167
        General Provisions.................................    71
                                                                    167
Title IV--Related Agencies:
        Armed Forces Retirement Home.......................    72
                                                                    168
        Corporation for National and Community Service.....    73
                                                                    168
        Corporation for Public Broadcasting................    73
                                                                    170
        Federal Mediation and Conciliation Service.........    74
                                                                    170
        Federal Mine Safety and Health Review Commission...    76
                                                                    170
        Institute of Museum and Library Services...........    76
                                                                    170
        Medicare Payment Advisory Commission...............    76
                                                                    171
        National Commission on Libraries and Information 
            Science........................................    76
                                                                    171
        National Council on Disability.....................    77
                                                                    171
        National Labor Relations Board.....................    77
                                                                    171
        National Mediation Board...........................    78
                                                                    172
        Occupational Safety and Health Review Commission...    78
                                                                    172
        Railroad Retirement Board..........................    78
                                                                    172
        Social Security Administration.....................    80
                                                                    173
        United States Institute of Peace...................    83
                                                                    175
Title V--General Provisions................................    83
                                                                    175
House of Representatives Report Requirements...............
                                                                    176

                Summary of Estimates and Appropriations

    The following table compares on a summary basis the 
appropriations including trust funds for fiscal year 2004, the 
budget estimate for fiscal year 2004 and the Committee 
recommendation for fiscal year 2004 in the accompanying bill.

                                 2004 LABOR, HHS, EDUCATION APPROPRIATIONS BILL
                                            [In millions of dollars]
----------------------------------------------------------------------------------------------------------------
                                                             Fiscal year--               2004 committee compared
                                                ---------------------------------------           to--
                                                                                       -------------------------
                                                     2003     2004 budget      2004         2003
                                                  comparable                committee    comparable  2004 budget
----------------------------------------------------------------------------------------------------------------
Department of Labor............................      $14,983      $15,076      $15,136        +$153         +$60
    Advances...................................        2,560        2,551        2,551           -9            0
Department of Health and Human Services........      318,536      353,090      359,449      +40,913       +6,359
    Advances...................................       56,107       62,784       62,784       +6,677            0
Department of Education........................       55,646       55,808       57,964       +2,318       +2,156
    Advances...................................       17,255       15,011       15,011       -2,244            0
Related Agencies...............................       41,825       45,722       45,857       +4,032         +135
    Advances...................................       11,470       12,590       12,920       +1,450         +330
Grand Total, current year......................      430,990      469,696      478,406      +47,416       +8,710
    Advances...................................       87,392       92,936       93,266       +5,874         +330
Current year total using 302(b) scorekeeping...      423,137      463,938      470,011      +46,874       +6,073
    Mandatory..................................      290,781      325,948      331,975      +41,194       +6,027
    Discretionary..............................      132,356      137,990      138,036       +5,680          +46
----------------------------------------------------------------------------------------------------------------


                                           PROGRAM LEVEL DISCRETIONARY
                                            [In millions of dollars]
----------------------------------------------------------------------------------------------------------------
                                                             Fiscal year--               2004 committee compared
                                                ---------------------------------------           to--
                                                                                       -------------------------
                                                     2003     2004 budget      2004         2003
                                                  comparable                committee    comparable  2004 budget
----------------------------------------------------------------------------------------------------------------
Department of Labor............................      $11,848      $11,622      $11,682        -$166          $60
Department of Health and Human Services........       60,083       60,862       61,195        1,112          333
Department of Education........................       53,113       53,139       55,380        2,267        2,241
Related Agencies...............................        9,608       10,243       10,047          439         -196
                                                ----------------------------------------------------------------
      Subtotal Program Level...................      134,652      135,866      138,304        3,652        2,438
----------------------------------------------------------------------------------------------------------------

                         Highlights of the Bill

    Funding levels in the fiscal year 2004 appropriation bill 
for the Departments of Labor, Health and Human Services, and 
Education and Related Agencies reflect the Committee's attempt 
to establish priorities within the very stringent limitations. 
As in past years, the Committee has increased funding for 
programs that work for people and represent a core Federal 
responsibility.
    Bill total.--Total funding, including offsets, for fiscal 
year 2004 in the Departments of Labor, Health, and Human 
Services and Education and Related Agencies Appropriations Act, 
2004 is $478,406,936,000.
    Discretionary Programs.--For Discretionary accounts for 
2004 the bill provides $138,036,000,000, including offsets. 
This is $5,680,048,000 above the fiscal year 2003 comparable 
level. After adjusting for fluctuations in advance 
appropriations, the comparable program increase is 
$3,652,202,000, or 2.71 percent, over fiscal year 2003.
    Mandatory programs.--The bill provides $331,974,965,000 for 
entitlement programs in fiscal year 2004. This is 
$41,913,697,000 above the fiscal year 2003 comparable level, or 
an increase of 12.4 percent. Over two thirds of the funding in 
the bill is for these mandatory costs. Funding requirements for 
entitlement programs are determined by the basic authorizing 
statutes. Mandatory programs include general fund support for 
the Medicare and Medicaid programs, Supplemental Security 
Income, Trade Adjustment Assistance and Black Lung payments. 
The following chart indicates the funding levels for the major 
mandatory programs in fiscal years 2003 and 2004 and the growth 
in these programs.

                                                    MANDATORY
                                             [Dollars in Thousands]
----------------------------------------------------------------------------------------------------------------
                                                                 Fiscal year      Fiscal year
                           Program                                   2003             2004            Change
----------------------------------------------------------------------------------------------------------------
Department of Labor:
    Federal; Umemployment Benefits and Allowances............         $972,200       $1,338,200         $366,000
    Energy Employees Occupational Illness Compensation Fund..          104,867           55,074          -49,793
    Black Lung Disability Trust Fund.........................        1,035,000        1,043,000           +8,000
Department of Health and Human Services:
    Vaccine Injury Compensation Trust Fund...................           85,918           66,000          -19,918
    Medicaid current law benefits............................      148,726,168      172,706,067      +23,979,899
    CMS Vaccines for Children................................          823,938          980,196         +156,258
    Medicare Payments to Healthcare Trust Funds..............       81,462,700       95,084,100      +13,621,400
    Child Support Enforcement................................        2,936,800        3,425,270         +488,470
    Payments to States for Foster Care and Adoption..........        4,855,000        5,068,300         +213,300
    Medical Benefits for Commissioned Officers...............          310,017          329,868          +19,851
Department of Education:
    Vocational Rehabilitation................................        2,533,492        2,584,162          +50,670
Related Agencies:
    Supplemental Security Income.............................       31,879,392       34,328,000       +2,448,608
----------------------------------------------------------------------------------------------------------------

    Department of Labor.--The bill appropriates $11,682,034,000 
for the discretionary programs of the Labor Department.
    Employment and Training.--The Committee recommends 
$5,077,039,000 to carry out the provisions of the Workforce 
Investment Act of 1998. This is $123,122,000 below the fiscal 
year 2003 comparable level and $125,053,000 above the request. 
The Committee recommends an increase in funding over fiscal 
year 2003 for dislocated worker re-employment assistance of 
$78,105,000.
    Employee Benefits Security Administration.--The Committee 
recommends $128,605,000 for the EBSA to carry out their 
responsibilities to American workers and their families who are 
covered by private sector pension, health, and other employee 
benefit plans. This is $12,322,000 above the fiscal year 2003 
comparable level and the same as the request.
    Employment Standards Administration.--The Committee 
recommends $397,753,000 for ESA. This level is $16,640,000 
above the fiscal year 2003 comparable level and the same as the 
President's program level request for the Agency.
    Occupational Safety and Health Administration.--The 
Committee recommends funding for OSHA at $450,008,000, $302,000 
below the fiscal year 2003 comparable level and the same as the 
request.
    Department of Health and Human Services.--The bill 
appropriates $61,194,650,000 for discretionary programs of the 
Department.
    Health Resources and Services Administration.--Funding for 
the Health Resources and Services Administration (HRSA) 
programs is $6,252,256,000, $178,302,000 below the fiscal year 
2003 comparable level and $586,260,000 above the request. 
Within HRSA, the community health centers funding is at 
$1,627,164,000, an increase of $122,358,000 above the fiscal 
year 2003 comparable level and the same as the request. Health 
professions training is funded at $391,203,000, $30,000,000 
below last year's comparable level and $282,089,000 above the 
request. Ryan White AIDS Care Act programs are funded at 
$2,023,599,000, $30,634,000 above last year's comparable level 
and $14,050,000 above the request. In addition, $587,597,000 is 
recommended for HRSA's bioterrorism preparedness and response 
activities, $41,727,000 from HRSA's regular appropriation and 
$545,870,000 from within the Public Health and Social Services 
Emergency Fund. This is $38,581,000 below the fiscal year 2003 
comparable level and $30,576,000 below the request.
    Centers for Disease Control and Prevention.--The bill 
provides a total program level of $4,551,914,000 directly to 
the Centers for Disease Control and Prevention (CDC). This is 
$56,876,000 above the fiscal year 2003 comparable level and 
$232,603,000 above the request. In addition, $1,116,156,000 is 
available for CDC homeland security activities funded through 
the Public Health and Social Services Emergency Fund. CDC 
programs and activities include: Immunization; bioterrorism 
preparedness and response; chronic disease prevention; domestic 
and Global HIV/AIDS; surveillance, prevention, and control of 
infectious diseases, such as hepatitis, SARS, and the West Nile 
Virus.
    National Institutes of Health.--The Committee recommends 
$27,663,991,000 for the biomedical research activities of the 
National Institutes of Health (NIH). This is $681,387,000 above 
the fiscal year 2003 comparable level and the same as the 
request. The Committee continues to support strongly the 
research and training activities of the NIH. The Committee has 
maintained its policy of resisting disease specific earmarks in 
the bill and report, believing that decisions as to appropriate 
levels of funding and appropriate avenues of research are best 
left to the scientific managers at NIH. It is the view of the 
Committee that this is the best means available for advancing 
our understanding of human health and disease and improving the 
quality of life for affected individuals and families.
    Substance Abuse and Mental Health Services 
Administration.--The bill provides $3,345,000,000 for the 
Substance Abuse and Mental Health Services Administration 
(SAMHSA), an amount $133,260,000 above the fiscal year 2003 
comparable level and $64,315,000 below the request. The 
Committee has provided $2,191,816,000 for the Center for 
Substance Abuse Treatment, which is $182,806,000 above last 
year's comparable level and $150,000,000 below the request.
    Agency for Healthcare Research and Quality.--The bill 
provides $303,695,000 for the Agency for Healthcare Research 
and Quality (AHRQ), an amount that is the same as the fiscal 
year 2003 comparable level and $24,695,000 above the request.
    Medicare and Medicaid.--The bill provides $182,753,583,000 
for Medicaid and $95,084,100,000 in Federal funds for the 
Government's share of payments to Medicare.
    Low Income Home Energy Assistance.--The Committee provides 
$1,700,000,000 for the Low Income Home Energy Assistance 
Program formula grants to States in fiscal year 2004. This is 
$11,050,000 more than the fiscal year 2003 comparable level and 
the same as the request. The Committee includes $100,000,000 in 
contingent emergency funding for heating and cooling 
emergencies, which is $100,000,000 more than last year's 
comparable level and $200,000,000 less than the request.
    Child Care and Development Block Grant.--The Committee 
includes $2,099,729,000 for the Child Care and Development 
Block Grant for fiscal year 2004. This is $13,385,000 above the 
fiscal year 2003 comparable level and the same as the request.
    Social Services Block Grant.--The Committee provides 
$1,700,000,000 for the Social Services Block Grant, the same as 
both the fiscal year 2003 level and the request.
    Head Start.--The bill includes $6,815,570,000 for Head 
Start, $148,037,000 above last year's level and the same as the 
request.
    Human Embryo Research.--The bill includes the same language 
included for the past several years to prohibit the use of 
federal funds for research involving human embryos. This 
language also has the effect of prohibiting the use of funds in 
the bill to support human cloning.
    Needle Exchange.--The bill includes a prohibition on the 
use of Federal funds for needle exchange programs, which is the 
same as last year.
    Title X Family Participation in Decisions of Minors to Seek 
Family Planning.--The bill includes language requiring 
recipients of title X funding, family planning funding, to 
certify that it encourages family participation in the decision 
of minors to seek family planning services and that it provides 
counseling to minors on how to resist attempts to coerce minors 
into engaging in sexual activities. This language has been 
included in the bill for several years.
    Title X Compliance With State Laws.--The bill includes a 
provision, continued from last year, requiring Title X clinics 
to comply with State laws relating to notification or reporting 
of child abuse, child molestation, sexual abuse, rape or 
incest.
    Department of Education.--The bill funds programmatic and 
support activities in the Department of Education at 
$55,380,003,000, an increase of $2,240,800,000 above the 
request and $2,267,244,000 above last year's comparable level 
(adjusted for advance appropriations in fiscal year 2003).
    Education for the Disadvantaged.--The bill provides 
$14,507,000,000, for grants to local education agencies under 
title I of the Elementary and Secondary Education Act. This 
level is $768,727,000 above the fiscal year 2003 amount and 
$323,000,000 above the request level.
    Impact Aid.--The bill provides $1,238,324,000 for school 
districts that are impacted by Federal activities, such as 
military bases or Indian lands. This is an increase of 
$50,098,000 above the fiscal year 2003 level, and $222,824,000 
above the President's request.
    School Improvement Programs.--The bill provides 
$5,797,637,000 for the school improvement programs. The bill 
includes $2,930,825,000 for state grants for improving teacher 
quality, the same as year's level and $80,825,000 above the 
request. The bill also includes $150,000,000 for math and 
science partnerships, an increase of $49,656,000 above last 
year's level and $137,500,000 above the request.
    Innovation and Improvement.--The bill provides $814,959,000 
for innovation and improvement programs. Included within this 
account is $49,400,000 for the Transition to Teaching program, 
an increase of $7,673,000 above the fiscal year 2003 level and 
$220,000,000 for charter schools, an increase of $21,300,000 
above last year's levels.
    English Language Acquisition.--English language acquisition 
programs are funded at $685,515,000, the same as the fiscal 
year 2003 amount and $20,515,000 above the President's request.
    Special Education.--The Committee recommends an overall 
program funding level for special education programs of 
$11,049,790,000, $1,015,873,000 above last year's level and 
$359,686,000 above the President's request. The bill provides a 
$1,000,000,000 increase for grants to states under part B of 
the Individuals with Disabilities Education Act.
    Vocational and Adult Education.--Vocational education state 
grants are funded at $1,200,000,000 and adult education state 
grants are funded at $584,300,000.
    Student Financial Assistance and Higher Education.--The 
Committee places a high priority on direct assistance to 
students. For Student Financial Aid, the Committee provides 
$14,247,432,000, $884,360,000 above last year and $271,068,000 
below the President. For Higher Education, the Committee 
provides $1,985,991,000. This level is $107,460,000 below last 
year and $81,553,000 above the request. The bill allows the 
maximum Pell grant to be maintained at $4,050--the highest in 
history.
    Institute of Education Sciences.--The Committee propose 
$500,599,000 for education research and statistics. For on-
going activities, this level is $52,643,000 above last year and 
$124,684,000 above the request level.

                       TITLE IV--RELATED AGENCIES

    Institute of Museum and Library Services.--Funding for the 
Institute of Museum and Library Services is $238,126,000 
including $20,000,000 for a librarian recruitment initiative.
    Social Security Administrative Costs.--Funding for the cost 
of administering the Social Security programs is 
$8,361,800,000, $476,663,000 above the fiscal year 2003 
comparable level and $168,200,000 below the request.

                 Government Performance and Results Act

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

                           Effect Statements

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

                      TITLE I--DEPARTMENT OF LABOR


                 Employment and Training Administration


                    TRAINING AND EMPLOYMENT SERVICES

    The Committee recommends $5,077,039,000 for this account, 
which provides funding authorized primarily by the Workforce 
Investment Act of 1998 (WIA). This is $123,122,000 below the 
fiscal year 2003 level and $125,053,000 above the budget 
request.
    The Training and Employment Services account is comprised 
of programs that enhance the employment and earnings of those 
in need of such services, operated through a decentralized 
system of skill training and related services. The account is 
mostly forward-funded on a July to June cycle, with funds 
provided for fiscal year 2004 supporting the effort from July 
1, 2004 through June 30, 2005.

Adult employment and training activities

    For adult employment and training activities, the Committee 
recommends $900,000,000. This is $1,222,000 above the fiscal 
year 2003 and the same as the budget request. Of the amount 
recommended $712,000,000 will become available on October 1, 
2004. This program is authorized by the Workforce Investment 
Act of 1998. The funds are allocated by formula to States and 
further distributed to local workforce investment boards. 
Services for adults will be provided through the One-Stop 
system and most customers receiving training will use their 
individual training accounts to determine which programs and 
providers fit their needs. The Act authorizes core services, 
available to all adults with no eligibility requirements, and 
intensive services, for unemployed individuals who are not able 
to find jobs through core services alone.

Dislocated worker employment and training activities

    For dislocated worker employment and training activities, 
the Committee recommends $1,461,145,000. This is the same as 
the fiscal year 2003 level and $78,105,000 above the budget 
request. Of the amount recommended, $1,060,000,000 will become 
available on October 1, 2003. Of the total, $1,155,152,000 is 
designated for State formula grants that support core services, 
intensive services, training, and supportive services. In 
addition, States use these funds for rapid response assistance 
to help workers affected by mass layoffs and plant closures. 
The bill includes $305,993,000 for the National Reserve which 
supports National Emergency Grants to respond to mass layoffs, 
plant and/or military base closings, and natural disasters 
across the country, which cannot be otherwise anticipated, as 
well as technical assistance and training and demonstration 
projects. Within the total for the National Reserve the 
Committee expects that up to $3,000,000 shall be available to 
the Secretary to support health insurance coverage assistance 
authorized in the Trade Act of 2002.

Youth activities

    For youth activities, the Committee recommends 
$1,000,965,000. This is $6,506,000 below the fiscal year 2003 
level and the same as the budget request.
    The Workforce Investment Act of 1998 consolidated the 
Summer Youth Employment and Training Program and Youth Training 
Grants under the Job Training Partnership Act into a single 
youth training activity. The funds are allocated by formula to 
States and further distributed to local workforce investment 
boards.

Youth opportunity grants

    The Committee has not included funding for Youth 
Opportunity grants. The budget request did not include funds 
for Youth Opportunity grants. The fiscal year 2003 level was 
$44,211,000 to maintain the current projects administered in 
this program.

Job Corps

    For Job Corps, the Committee recommends $1,541,216,000. 
This is $28,045,000 above the fiscal year 2003 level and 
$24,667,000 below the budget request. Of the amount 
recommended, $691,000,000 will become available on October 1, 
2003.
    The Job Corps, authorized by the Workforce Investment Act 
of 1998, is a nationwide network of residential facilities 
chartered by Federal law to provide a comprehensive and 
intensive array of training, job placement and support services 
to at-risk young adults. The mission of Job Corps is to attract 
eligible young adults, teach them the skills they need to 
become employable and independent, and place them in meaningful 
jobs or further education. Participation in the program is open 
to economically disadvantaged young people in the 16 to 24 age 
range who are unemployed and out of school. Most Job Corps 
students come from disruptive or debilitating environments, and 
it is important that they be relocated to residential 
facilities where they can benefit from the highly structured 
and carefully integrated services provided by the Job Corps 
program. A limited number of opportunities are also available 
for non-residential participation. The Committee supports the 
effort of the Workforce Investment Act of 1998 to more fully 
integrate Job Corps centers in their local communities.
    The Committee believes that Job Corps' partnerships with 
National Training Contractors, such as the Home Builders 
Institute (HBI), the workforce development arm of the National 
Association of Home Builders, are essential to the success of 
Job Corps. The Committee commends HBI for its proven record in 
providing at-risk youth with the craft skills training and 
employment opportunities they need to succeed while helping the 
building industry meet its workforce needs. As such, the 
Committee encourages the Department to expand its Job Corps 
partnership with the building industry in order to ensure the 
continued availability of skilled workers for this thriving 
industry.
    The evaluation and overall goals of the Job Corps program 
and other job training programs at the Department of Labor are 
a concern to the Committee. The Committee is interested in the 
long-term effects of job-training programs at the Department of 
Labor. The department is encouraged to submit an assessment of 
previous studies of the long-term effectiveness of job training 
programs and a proposal on collecting data that will enhance 
the overall job-training program and more effectively identify 
deficiencies.
    The Committee commends the Job Corps program for 
establishing cost-effective national and local partnerships 
with the U.S. Army, Navy, and Coast Guard to recruit high 
quality military personnel. Job Corps students' average scores 
on military entrance exams exceed the national average. Last 
year, the Army recruited more than 2,000 Job Corps graduates. 
The Committee also recognizes that the Job Corps is training 
young people with skills that are in high demand by civilian 
support contractors who service the military, including 
computer technology, nursing, and welding. The Committee 
directs the Job Corps to explore further options to expand 
programs that provide all branches of the military with high 
quality recruits, and to assist contractors in filing their 
entry-level positions with qualified Job Corps graduates.
    The Committee commends the Job Corps for developing 
programs to help address the nation's shortfall of staff in 
health professions, including nurses, pharmacists, and lab 
technicians. Private sector companies including HCR Manor Care, 
HCA, CVS, Walgreens and others have formed partnerships with 
Job Corps to help fill vacancies with qualified, trained, entry 
level staff. Efforts such as the Nursing Career Ladder pilot 
program and CareCareers.net will help address the caregiver 
shortage. To build upon these initiatives, the Committee 
directs the Department to explore the possibility of 
establishing one or more Job Corps centers that are dedicated 
to training Job Corps students in the health sciences, 
including licensed practical nurses, health records 
technicians, certified nurse assistants, dieticians, pharmacy 
technicians, and healthcare facilities maintenance.

Native Americans

    For Native Americans, the Committee recommends $55,000,000. 
This is $636,000 below the fiscal year 2003 level and the same 
as the budget request. This program, authorized by the 
Workforce Investment Act of 1998, is designed to improve the 
economic well-being of Native Americans (Indians, Eskimos, 
Aleuts, and Native Hawaiians) through the provision of 
training, work experience, and other employment-related 
services and opportunities that are intended to aid the 
participants to secure permanent, unsubsidized jobs. The 
Department of Labor allocates formula grants to Indian tribes 
and other Native American groups whose eligibility for such 
grants is established in accordance with Department 
regulations.

Migrant and seasonal farmworkers

    For Migrant and Seasonal Farmworkers, the Committee 
recommends $60,000,000. This is $17,330,000 below the fiscal 
year 2003 level. The budget request did not include funds for 
this program. The Committee recommendation includes bill 
language directing that $3,600,000 of this amount be used for 
migrant and seasonal farmworker housing grants, including 
permanent housing. This recommendation also provides that the 
remaining amount be used for State service area grants, 
including funding grantees in those States impacted by formula 
reductions at no less than eighty-five percent of the 
comparable 1998 levels for such States. Within the National 
Activities/Other line item, the conference agreement includes 
$400,000 to be used for Section 167 training, technical 
assistance and related activities, including continuing funding 
for migrant rest center activities at the current level.
    This program, authorized by the Workforce Investment Act of 
1998, is designed to serve members of economically 
disadvantaged families whose principal livelihood is derived 
from migratory and other forms of seasonal farmwork, or 
fishing, or logging activities. Enrollees and their families 
are provided with employment training and related services 
intended to prepare them for stable, year-round employment 
within and outside of the agriculture industry.
    The Committee has also included bill language directing 
that migrant and seasonal farmworker funds appropriated in 
fiscal year 2003 be made available under the terms and 
conditions in effect June 30, 2002, the end of the performance 
period for which funds were last competed. For Fiscal 2003, for 
migrant and seasonal housing, the Committee believes that the 
Department pursued a program initiative that was inconsistent 
with the intent of Congress. Further, in fiscal year 2003 the 
Department neither requested funds for the Migrant and Seasonal 
Farmworker Program in its 2003 budget justification nor did the 
Department inform the Committee that it would be changing the 
focus of the housing program for farmworkers. Absent 
notification and approval regarding a refocus or redirection of 
a program or activity, the Committee expects that funds will 
continue to be used in the manner for which they had been 
previously requested and appropriated. It is the intent of the 
Committee that the Department restore the farmworker housing 
program to its longstanding principal emphasis: development of 
permanent housing and related facilities for migrant and 
seasonal farmworkers.

National programs

    This activity includes Workforce Investment Act authorized 
programs in support of the workforce system including technical 
assistance and incentive grants, evaluations, pilots, 
demonstrations and research.
    Pilots, Demonstrations and Research: The Committee 
recommends $46,615,000 for grants or contracts to conduct 
research, pilots or demonstrations that improve techniques or 
demonstrate the effectiveness of programs. This is $29,240,000 
below the fiscal year 2003 level and $11,615,000 above the 
budget request.
    The Committee points to the success rates and effectiveness 
of the YouthBuild Louisville public/private partnership in 
Louisville, Kentucky, and encourages the Department of Labor 
(DOL) to establish a demonstration evaluating the feasibility 
of expanding this program to include within the purvey of DOL. 
The purpose of this demonstration should be to evaluate the 
possibility of using this program as model for DOL youth 
employment initiatives.
    Evaluation: The Committee recommends $9,098,000 to provide 
for the continuing evaluation of program conducted under the 
Workforce Investment Act of 1998, as well as of federally-
funded employment-related activities under other provisions of 
law. This is $59,000 above the fiscal year 2003 level and the 
same as the budget request.
    Responsible Reintegration of Youthful Offenders: The 
Committee concurs with administration's request not to include 
funding for the Responsible Reintegration of Youthful 
Offenders. The fiscal year 2003 level was $54,642,000.
    Technical Assistance: The Committee recommends $3,000,000. 
The funds recommended support the development of performance 
management systems, the provision of quality services, and 
promoting accountability and collaboration.
    Women in Apprenticeship for Non-Traditional Occupations: 
The Committee concurs with the Administration's request not to 
include funding for this program. In fiscal year 2003, $993,000 
was provided.

            COMMUNITY SERVICE EMPLOYMENT FOR OLDER AMERICANS

    The Committee recommends $440,200,000 for community service 
employment for older Americans. This is $2,106,000 below the 
fiscal year 2003 level and the same as the budget request.
    The community service employment for older Americans 
program provides grants to public and private nonprofit 
organizations that subsidize part-time work in community 
service activities for unemployed persons aged 55 and older, 
whose family's annual income does not exceed 125 percent of the 
poverty level.
    The Committee commends the Department of Labor's action, 
consistent with the Older Americans Act Amendments of 2000, to 
open the national grants portion of the Senior Community 
Service Employment Program (SCSEP) to competition. Competing 
the SCSEP grants will spur innovation, improve services, and 
help more low-income, older workers achieve economic 
independence through this program. In addition, competition 
enables all qualified organizations to have the opportunity to 
participate and provide services to seniors in the most 
efficient and effective manner possible. The Committee is also 
encouraged by the Department's efforts to ensure that services 
to SCSEP participants are not disrupted and that these seniors 
retain the right to remain in the program no matter which 
grantee or subgrantee serves their geographic area. The 
Committee also urges the Department to encourage new national 
contractors to work closely with subgrantees of predecessor 
national contractors where appropriate to ensure that program 
participants will not be adversely affected by the change of 
national contractor status.

              FEDERAL UNEMPLOYMENT BENEFITS AND ALLOWANCES

    The Committee recommends $1,338,200,000. This is 
$366,000,000 above the fiscal year 2003 level and the same as 
the budget request.
    The Trade Adjustment Assistance Program provides assistance 
to certified workers adversely affected by imports and trade 
with countries covered by the North America Free Trade 
Agreement. Funding will continue the implementation of the TAA 
program with an emphasis on integrating the program into the 
One-Stop System. The Trade Adjustment Assistance Reform Act of 
2002 increased the possibility of training and income support 
benefits.

     STATE UNEMPLOYMENT INSURANCE AND EMPLOYMENT SERVICE OPERATIONS

    The Committee recommends $3,615,381,000 for this account. 
This is $20,000,000 above the fiscal year 2003 level and 
$31,402,000 less than the budget request. Included in the total 
availability is $3,472,861,000 authorized to be drawn from the 
Employment Security Administration Account of the Unemployment 
Trust Fund and $142,520,000 to be provided from the general 
fund of the Treasury. The funds in this account are used to 
provide administrative grants and assistance to State agencies 
that administer Federal and State unemployment compensation 
laws and operate the public employment service.
    For Unemployment Insurance Services, the Committee 
recommends $2,634,253,000. This total includes $2,624,318,000 
for State Operations and $9,935,000 for national activities. 
This is the same as the fiscal year 2003 level and $16,249,000 
below the budget request.
    For the Employment Service, the Committee recommends 
$861,908,000, which includes $23,300,000 in general funds 
together with an authorization to spend $838,608,000 from the 
Employment Security Administration Account of the Unemployment 
Trust Fund. This is $20,000,000 above the fiscal year 2003 
level and $13,373,000 below the budget request. Included in the 
bill for the Employment Service grants to States is 
$791,557,000, available for the program year of July 1, 2004 
through June 30, 2005. This is the same as the fiscal year 2003 
level and $5,178,000 below the budget request.
    The Committee recommends $70,351,000 for ES national 
activities. This is $20,000,000 above the fiscal year 2003 
level and $8,195,000 below the budget request. Funds provided 
support the Foreign Labor Certification Programs, the Work 
Opportunity Tax Credit and Welfare-to-Work tax credit programs, 
and capacity building and technical assistance focused on the 
integration of ES into the Workforce Investment Act delivery 
system.
    The Committee recommends $99,350,000 for America's Labor 
Market Information System. This is the same as the fiscal year 
2003 level and $1,650,000 below the budget request. This 
funding supports core employment statistics, universal access 
for customers, improving efficiency in labor market 
transactions, and measuring and displaying WIA performance 
information.
    The Committee recommendation includes $19,870,000 for the 
Work Incentives Grants program, the same as last year's level 
and $130,000 less than 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.

        ADVANCES TO THE UNEMPLOYMENT TRUST FUND AND OTHER FUNDS

    The Committee recommends $467,000,000. This is $4,000,000 
above the fiscal year 2003 level and the same as the budget 
request. The appropriation is available to provide advances to 
several accounts for purposes authorized under various Federal 
and State unemployment compensation laws and the Black Lung 
Disability Trust Fund, whenever balances in such accounts prove 
insufficient.

                         PROGRAM ADMINISTRATION

    The Committee recommends $172,327,000. This is $2,184,000 
below the fiscal year 2003 level and $11,038,000 below the 
budget request. This includes $115,824,000 in general funds and 
authority to expend $56,503,000 from the Employment Security 
Administration Account of the Unemployment Trust Fund. General 
funds in this account provide the Federal staff to administer 
employment and training programs under the Workforce Investment 
Act of 1998, the Older Americans Act, the welfare-to-work 
program, 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.
    The Committee acknowledges the important work of the New 
York Regional Employment and Training Office, which oversees 
employment and training activities in New York, New Jersey, 
Puerto Rico, and the Virgin Islands. The Department has not 
provided the Committee with requested information including a 
list of criteria, rationale, and cost benefit analysis. The 
Committee, therefore, directs the Department to maintain the 
current office structure of the New York City and Boston 
Employment and Training Administration Offices until the 
Committee has had sufficient time to review this proposal.

               Employee Benefits Security Administration


                         SALARIES AND EXPENSES

    The bill provides $128,605,000 for the Employee Benefits 
Security Administration (formerly known as the Pension and 
Welfare Benefits Administration), an increase of $12,322,000 
over the fiscal year 2003 level and the same amount as the 
budget request.
    The Employee Benefits Security Administration (EBSA) is 
responsible for the enforcement of Title I of the Employee 
Retirement Income Security Act of 1974 (ERISA) in both civil 
and criminal areas. This involves ERISA fiduciary and 
reporting/disclosure requirements. EBSA is also responsible for 
enforcement of sections 8477 and 8478 of the Federal Employees' 
Retirement Security Act of 1986. The agency was also given 
responsibilities under the Health Insurance Portability and 
Accountability Act of 1996.

                  Pension Benefit Guaranty Corporation

    The Corporation's budget for fiscal year 2003 is 
$228,772,000, which is $35,963,000 above the fiscal year 2003 
level and the same as the budget request. The previous amount 
in the administrative expense limitation was $12,965,000 and 
the comparable estimate for fiscal year 2004 scoring is 
$16,553,000.
    The Corporation is a wholly-owned government corporation 
established by the Employee Retirement Income Security Act of 
1974 (ERISA). The law places it within the Department of Labor 
and makes the Secretary of Labor the chairperson of its board 
of directors. The Corporation receives its income from 
insurance premiums collected from covered pension plans, 
collections of employer liabilities imposed by ERISA, and 
investment earnings. It is also authorized to borrow up to 
$100,000,000 from the United States Treasury. The primary 
purpose of the Corporation is to guarantee the payment of 
pension plan benefits to participants if covered plans fail or 
go out of existence.
    The bill does not include a limit on administrative 
expenses. However the Committee has included language 
permitting obligations in excess of the amount provided in the 
bill after approval by both the Office of Management and Budget 
as well as the Committee on Appropriations. The Committee has 
an interest in approving obligations that may change the total 
amount available to any agency. Further, the Committee remains 
concerned regarding actions taken by the Pension Benefit 
Guaranty Corporation (PBGC) on June 14, 2002 to terminate 
pension plans in advance of a plant shutdown in order to avoid 
paying ``shutdown'' benefits that had been negotiated between a 
company and its workers. This policy shift was made without 
advance notice to the parties involved. Furthermore, this 
policy adjustment is a significant change in the practice that 
the PBGC had engaged in over the past eight years. The action 
taken by the PBGC has resulted in disparate treatment of 
workers in similar situations, with workers in a plant that 
shutdown prior to June 14, 2002 receiving ``shutdown'' benefits 
and workers in a plant that shutdown after June 14, 2002 not 
receiving ``shutdown'' benefits.

                  Employment Standards Administration


                         SALARIES AND EXPENSES

    The bill includes $397,753,000 for this account. This is 
$16,640,000 above the budget request and the same as the fiscal 
year 2003 comparable level. The bill includes $395,697,000 in 
general funds for this account and contains authority to expend 
$2,056,000 from the Special Fund established by the Longshore 
and Harbor Workers' Compensation Act.
    The Committee did not include authority for the Department 
to impose a surcharge totaling $87,573,000 collected from 
Federal agencies for workers compensation for administration of 
the Federal Employees' Compensation Act program as requested in 
the Treasury, Postal and General Government Appropriations Act.
    The Employment Standards Administration is involved in the 
administration of numerous laws, including the Fair Labor 
Standards Act, the Immigration and Nationality Act, the Migrant 
and Seasonal Agricultural Workers' Protection Act, the Davis-
Bacon Act, the Family and Medical Leave Act, the Federal 
Employees' Compensation Act, the Longshore and Harbor Workers' 
Compensation Act, and the Federal Mine Safety and Health Act 
(black lung). The agency also administers Executive Order 11246 
related to affirmative action by Federal contractors and the 
Labor-Management Reporting and Disclosure Act.

                            SPECIAL BENEFITS

    The bill includes $163,000,000. This is the same as the 
fiscal year 2003 appropriation and the budget request. This 
appropriation primarily provides benefits under the Federal 
Employees' Compensation Act (FECA). The payments are required 
by law. In fiscal year 2004, an estimated 155,000 injured 
Federal workers or their survivors will file claims; 55,500 
will receive long-term wage replacement benefits for job-
related injuries, diseases, or deaths.
    The total amount to be available in fiscal year 2004 for 
FECA payments, including anticipated reimbursements from 
Federal agencies of $1,462,000,000, is expected to be 
$3,448,761,000, an increase of $100,000,000 over the fiscal 
year 2003 comparable level.
    The Committee recommends continuation of appropriation 
language to provide authority to deposit into the Special 
Benefits account 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 
also includes appropriation language to provide that up to 
$39,315,000 of the funds transferred from the ``fair share'' 
agencies to pay the costs of administration will be available 
to the Secretary of Labor to finance capital improvement 
projects meant to enhance fund oversight and control. The 
remaining balance of the administrative costs paid by the 
``fair share'' entities will revert to the United States 
Treasury as miscellaneous receipts.

               SPECIAL BENEFITS FOR DISABLED COAL MINERS

    The Committee recommends an appropriation of $300,000,000 
for special benefits for disabled coal miners. This is in 
addition to the $97,000,000 appropriated last year as an 
advance for the first quarter of fiscal year 2003, the same as 
the budget request. These funds are used to provide monthly 
benefits to coal miners disabled by black lung disease and to 
their widows and certain other dependents, as well as to pay 
related administrative costs.
    The Committee recommends an advance appropriation of 
$88,000,000 for the first quarter of fiscal year 2005, the same 
as the budget request. These funds will ensure uninterrupted 
benefit payments to coal miners, their widows, and dependents.
    The Black Lung Consolidation of Administrative 
Responsibility Act of 2002 amends the Black Lung Benefits Act 
to transfer part B black lung benefits responsibility from the 
Commissioner of Social Security to the Secretary of Labor. In 
fiscal year 2004 an estimated 56,000 beneficiaries will receive 
benefits.

    ADMINISTRATIVE EXPENSES, ENERGY EMPLOYEES OCCUPATIONAL ILLNESS 
                           COMPENSATION FUND

    The bill includes $55,074,000 for the Energy Employees 
Occupational Illness Compensation Program authorized by Title 
XXXVI of the National Defense Authorization Act of 2001. This 
is $49,793,000 below the fiscal year 2003 level and the same as 
the budget request. Funds will be used to administer the 
program that provides compensation to employees or survivors of 
employees of the Department of Energy (DOE), its contractors 
and subcontractors, companies that provided beryllium to DOE, 
and atomic weapons employees who suffer from a radiation-
related cancer, beryllium-related disease, or chronic silicosis 
as a result of their work in producing or testing nuclear 
weapons, and uranium workers covered under the Radiation 
Exposure Compensation Act. Benefit costs of $385,000,000 are 
anticipated in fiscal year 2004.

                    BLACK LUNG DISABILITY TRUST FUND

    The bill includes $1,043,000,000 for this account, of which 
$56,099,000 is definite budget authority and $986,901,000 is 
indefinite budget authority. The bill language provides such 
sums as may be necessary to pay for benefits. The amount 
available will provide $346,901,000 for benefit payments and 
$56,099,000 for administration expenses for the Department of 
Labor.
    The Trust Fund pays all black lung compensation/medical and 
survivor benefit expenses when no responsible mine operator can 
be assigned liability for such benefits, or when coal mine 
employment ceased prior to 1970, as well as administrative 
costs which are incurred in administering the benefits program 
and operating the Trust Fund.
    It is estimated that 44,500 people will be receiving black 
lung benefits financed from the Trust Fund in fiscal year 2004. 
This compares with an estimated 49,000 receiving benefits in 
2003.
    The basic financing for the Trust Fund comes from a coal 
excise tax for underground and surface-mines coal. Additional 
funds come from reimbursement payments from mine operators for 
benefit payments made by the Trust Fund before the mine 
operator is found liable. The advances to the Fund assure 
availability of necessary funds when liabilities may exceed 
other income. The Omnibus Budget Reconciliation Act of 1987 
continues the current tax structure until 2014.

             Occupational Safety and Health Administration


                         SALARIES AND EXPENSES

    The bill includes $450,008,000 for the Occupational Safety 
and Health Administration. This is the same as the budget 
request and $302,000 below the fiscal year 2003 comparable 
level. This agency is responsible for enforcing the 
Occupational Safety and Health Act of 1970 in the Nation's 
workplaces.
    The Committee is very pleased with OSHA's efforts in 
placing high priority on the Voluntary Protection Program (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. In fiscal year 2003, the Committee expects OSHA to 
continue to place priority on the VPP, making every effort to 
ensure 25-percent growth in participation by sites covered 
under Federal OSHA jurisdiction. Cooperative voluntary 
programs, especially the VPP, are important to an employer's 
ability to assure worker safety and health.
    The committee recognizes that needlestick injuries can 
expose nurses and doctors to dangerous and even deadly viruses 
such as Hepatitis C and HIV, and directs OSHA to undertake 
efforts to educate healthcare employers and clinicians about 
these threats, particularly with regard to needlestick 
protection and alternatives to the use of tape and suture to 
secure IV catheters. The committee notes the effectiveness of 
IV catheter securement devices, sometimes referred to as 
adhesive anchors or catheter fixation devices and directs OSHA 
to better inform clinicians of safety securement devices, and 
to encourage employers to consider these devices when compiling 
and updating the required annual Exposure Control Plan.
    The Committee is disappointed with the lack of progress on 
the agency's regulation concerning Employer Payment for 
Personal Protective Equipment, the public comment period for 
which ended over four years ago. The Committee is especially 
concerned because the rate of worker deaths and injuries, which 
has decreased in the last decade for all American workers, has 
increased among Hispanic workers during that same time because 
they take on a disproportionate number of jobs in the nation's 
most dangerous professions, including the construction 
industry. The Committee expects the agency to, report to the 
Committee on the status of this regulation.
    In the face of uncertain risk to their own health and that 
of their families, our country's doctors, nurses and other 
health care workers have courageously stepped forward to 
provide professional and compassionate care to patients with a 
variety of newly emerging, naturally occurring airborne 
infectious diseases such as SARS and monkeypox. With SARS, 
approximately half of all suspected and probable SARS cases in 
Canada are among health care workers who become infected while 
caring for their patients.
    With our country confronting these new airborne biological 
threats, we have asked our health care professionals to do more 
to protect all of us. These workers have responded. The 
Committee believes that the Congress now owes a debt of 
gratitude and has a responsibility to protect these same health 
care workers from the occupational hazards they face, so that 
they can focus on doing the best job possible in caring for, 
and treating their patients.
    To protect health care workers from newly emerging 
intentional and unintentional airborne infectious disease 
threats, the Committee urges OSHA to consider an airborne 
disease standard.

                 Mine Safety and Health Administration


                         SALARIES AND EXPENSES

    The bill includes $266,767,000 for this agency. This is 
$6,189,000 above the fiscal year 2003 comparable level and the 
same as the budget request. This agency enforces the Federal 
Mine Safety and Health Act in underground and surface coal and 
metal and non-metal mines.

                       Bureau of Labor Statistics


                         SALARIES AND EXPENSES

    The total funding recommended by the Committee for the 
Bureau of Labor Statistics (BLS) is $512,262,000. This is 
$20,029,000 above the fiscal year 2003 comparable level and the 
same as the budget request. The bill includes $437,152,000 in 
general funds for this account and authority to spend 
$75,110,000 from the Employment Security Administration Account 
of the Unemployment Trust Fund. The BLS is the principal fact-
finding agency in the Federal government in the broad field of 
labor economics. Its principal surveys include the Consumer 
Price Index and the monthly unemployment series.

                 Office of Disability Employment Policy


                         SALARIES AND EXPENSES

    The bill includes $47,333,000 for the Office of Disability 
Employment Policy, which is $155,000 above the fiscal year 2003 
comparable level and the same as the budget request. The Office 
provides leadership to eliminate employment barriers to people 
with disabilities.

                        Departmental Management


                         SALARIES AND EXPENSES

    The bill includes $253,018,000 for Departmental Management 
activities. This is $134,823,000 below the fiscal year 2003 
level and $20,518,000 below the budget request. The bill 
includes $252,701,000 in general funds for this account along 
with authority to transfer $317,000 from the Employment 
Security Administration Account of the Unemployment Trust Fund. 
In addition, an amount of $23,401,000 is available by transfer 
from the Black Lung Disability Trust Fund.
    The Departmental Management appropriation finances staff is 
responsible for formulating and overseeing the implementation 
of Departmental policy and management activities. In addition, 
this appropriation includes a variety of operating programs and 
activities that are not involved in Departmental Management 
functions, but for which other salaries and expenses 
appropriations are not suitable.
    The Committee recommendation includes $28,260,000 for 
Executive Direction, $1,964,000 above the fiscal year 2003 
level and the same as the budget request.
    The bill provides the budget request for the Department-
wide information technology crosscut, which is $6,077,000 below 
the fiscal year 2003 comparable level. The Committee commends 
the Department in streamlining its information technology 
infrastructure into a single, uniform system and encourages the 
Department in this effort.
    The bill includes $34,391,000 for the Administration and 
Management program that provides leadership and policy guidance 
for a number of Department-wide activities. This is $718,000 
above the fiscal year 2003 level and $2,000,000 above the 
budget request. Funding provided above the budget request is 
intended to address the initiatives requested in the management 
crosscut.
    The bill includes $12,270,000 for the Bureau of 
International Labor Affairs (ILAB), which is the same as the 
budget request and $134,783,000 below the fiscal year 2003 
comparable level. The Committee continues to be concerned about 
the growth of ILAB's programs and funding in recent years. At 
the level in this bill, ILAB will continue to coordinate the 
Department's global responsibilities in 2004 and to provide 
expert support for many of the Administration's international 
initiatives, including the promotion of core labor standards 
and the elimination of exploitative child labor.
    The Committee intends that the Women's Bureau provide 
funding for Women Work! training and technical assistance 
services for programs that assist women in transition to enter/
reenter the workforce; Women Work! has valuable experience and 
is uniquely qualified to deliver these services through its 
national network. Women Work! has demonstrated results through 
outcome assessments and the Committee expects Women Work! to 
continue to refine measurable standards for training and 
technical assistance services in collaboration with the Women's 
Bureau.
    On June 18, 2002, the Department of Justice published final 
regulations regarding EO 13166. The committee remains concerned 
about the potential costs of implementation to the Department 
of Labor and DOL programs, state agencies, local workforce 
investment boards, and other grant recipients. Therefore, the 
department should prepare a report for submission to the 
committee and all interested Members which outlines: 
implementation of the new policy guidance as interpreted by the 
department including enforcement policies; costs to the 
department and all affected entities under the jurisdiction of 
the Department of Labor including State labor departments or 
agencies. In addition, the committee requests that the report 
also include what assistance the department will offer to 
assist grant recipients in complying with the revised policy 
guidance.
    The committee recognizes the growing crisis in recruiting 
and training quality direct support professionals to serve 
people with mental retardation and other developmental 
disabilities living in the community. The Department of Labor 
is encouraged to work with the Department of Health and Human 
Services to commission a joint national commission to examine 
recruitment and retention of direct support professionals that 
includes all relevant stake holders, from both for profit and 
not-for-profit providers, to study and make recommendations to 
address the critical shortage of this work force.
    The Committee encourages the Department to enhance personal 
retirement readiness and security of our nation's workforce and 
to work with the International Foundation for Retirement 
Education (InFRE), to identify the real rate of retirement 
readiness of our nation's workforce segmented by age, gender, 
income, education, employment, and ethnicity.

        ASSISTANT SECRETARY FOR VETERANS EMPLOYMENT AND TRAINING

    The Committee recommends $219,933,000 for veteran 
employment and training activities. This is $7,174,000 above 
the fiscal year 2003 level and the same as the budget request. 
Within this amount, the bill includes $193,443,000 to be 
expended from the Employment Security Administration account of 
the Unemployment Trust Fund for the traditional State and 
Federal administration of veterans employment and training 
activities.
    For State grants the Committee recommends $162,415,000. 
This is $2,593,000 above the fiscal year 2003 level and the 
same as the budget request.
    For Federal administration, the Committee recommends 
$29,028,000. This is $1,539,000 above the fiscal year 2003 
level and the same as the budget request. The Committee 
recommends $2,000,000 for the National Veterans Training 
Institute, the same as the budget request. The Committee 
recommends $19,000,000 for the homeless veterans reintegration 
program assisting homeless veterans to find jobs. This is 
$869,000 above the fiscal year 2003 level and the same as the 
budget request. The Committee recommends $7,550,000 for 
veterans workforce investment programs. This is $173,000 more 
than the fiscal year 2003 level and the same as the budget 
request.

                    OFFICE OF THE INSPECTOR GENERAL

    The bill includes $66,795,000 for the Office of the 
Inspector General (OIG). This is $4,943,000 above the fiscal 
year 2003 comparable level and the same as the budget request. 
This includes $60,896,000 in general funds for this account 
along with the authority to transfer $5,899,000 from the 
Employment Security Administration Account of the Unemployment 
Trust Fund. The Committee has included $2,500,000, as proposed 
in the budget request, for the Labor Racketeering initiative to 
combat such problems as pension plan corruption and organized 
crime affecting industries and unions.
    The OIG was created by law to protect the integrity of 
Departmental programs as well as the welfare of beneficiaries 
served by those programs. Through a program of audits, 
investigations, and program evaluations, the OIG attempts to 
reduce the incidence of fraud, waste, abuse, and mismanagement, 
and to promote economy, efficiency, and effectiveness 
throughout the Department.

                          Working Capital Fund

    The Committee includes $18,000,000 for a new core 
accounting system for the Department of Labor, including 
hardware and software infrastructure.

                           General Provisions

    Sec. 101. The Committee continues a provision to prohibit 
the use of Job Corps funding for compensation of an individual 
at a rate in excess of Executive Level II.
    Sec. 102. The Committee includes a provision to permit 
transfers of up to one percent between appropriations, the same 
as the budget request.

           TITLE II--DEPARTMENT OF HEALTH AND HUMAN SERVICES


              Health Resources and Services Administration


                     HEALTH RESOURCES AND SERVICES

    The bill includes $6,252,256,000 for health resources and 
services programs, which is $178,302,000 below the fiscal year 
2003 comparable level for these activities and $586,260,000 
above the budget request. In addition, the Committee provides 
$545,870,000 in the Public Health and Social Services Emergency 
Fund for two programs administered by the Health Resources and 
Services Administration (HRSA)--$518,000,000 for hospital 
preparedness and $27,870,000 for education incentives for 
medical school curriculum.
    HRSA supports programs which provide health services to 
disadvantaged, medically undeserved, and special populations; 
improve infant mortality rates; direct the education, supply, 
and distribution of a wide range of health professionals; and 
provide technical assistance regarding the utilization of 
health resources and facilities.

Community health centers

    The Committee provides $1,627,164,000 for community health 
centers, which is $122,358,000 above the fiscal year 2003 
comparable level and the same as the budget request. These 
funds support programs which include community health centers, 
migrant health centers, health care for the homeless and public 
housing health service grants.
    The Committee includes bill language similar to previous 
years limiting the amount of funds available for the payment of 
claims under the Federal Tort Claims Act to $45,000,000, which 
is the same as the Administration request and $5,000,000 higher 
than the limitation in the fiscal year 2003 bill. The Committee 
recognizes the value of this program for health centers and as 
additional health centers participate in the program, the 
number of claims submitted and paid also increases.
    The Committee does not provide additional funds for loan 
guarantee authority under section 330(d) of the Public Health 
Service Act. The Committee notes that $121 million remains, of 
the $160 million appropriated in fiscal years 1997 and 1998, 
for loan guarantee authority for guarantees of both loan 
principal and interest.
    Although the Committee continues to support the expansion 
of the health center program to double the number of patients 
served, the Committee is concerned that current funding 
methodologies may not recognize the increased cost of providing 
services for current patients at existing health centers. The 
Committee expects HRSA to use a portion of the increased 
funding provided to increase support for existing health 
centers based on performance-related criteria in addition to 
site and service expansion applications.
    The Committee recognizes that asthma is a growing problem 
nationwide, particularly among minorities and the underserved. 
The Committee encourages HRSA, through its Community Health 
Centers program, to enhance its efforts aimed at reducing the 
incidence of asthma among ethnic and racial minorities and 
other medically underserved populations.
    Community health centers are encouraged to make untrasound 
services available to their low income patients at no charge.

National Health Service Corps: Field placements

    The Committee provides $45,948,000 for field placements, 
which is the same as the fiscal year 2003 comparable level and 
the $643,000 above the budget request. These funds are used to 
support the activities of National Health Service Corps (NHSC) 
obligors and volunteers in the field, including travel and 
transportation costs of assignees, training and education, 
recruitment of students, residents and clinicians and retention 
activities. Salary costs of most new assignees are paid by the 
employing entity.

National Health Service Corps: Recruitment

    The Committee provides $125,140,000 for recruitment 
activities, which is the same as the fiscal year 2003 
comparable level and $42,402,000 below the budget request. The 
program awards scholarships to health professions students and 
assists graduates in repaying their student loans. In return 
for every year of support, these individuals are obligated to 
provide a year of service in health professional shortage areas 
of greatest need. The minimum obligation is two years.

Health professions

    The Committee provides $391,203,000 for all health 
professions training programs, which is $30,000,000 below the 
fiscal year 2003 comparable level and $282,089,000 above the 
budget request. The Committee was unable to restore completely 
the $312,089,000 reduction in health professions funding 
proposed by the Administration, but intends to continue all the 
programs at manageable operating levels with the funds 
provided. The Bureau of Health Professions provides both policy 
leadership and support for health professions workforce 
enhancement and educational infrastructure development.

Centers of excellence

    The Committee provides $29,718,000 for centers of 
excellence, which is $4,370,000 below the fiscal year 2003 
comparable level. The Administration did not request funding 
for this program. The program is designed to strengthen the 
national capacity to educate underrepresented minority (URM) 
students in the health professions by offering special support 
to those institutions which train a significant number of URM 
individuals, including African-Americans, Hispanics and Native 
Americans. Funds are used for the recruitment and retention of 
students and faculty, information resources and curricula, 
faculty and student research, and the development of plans to 
achieve institutional improvements.
    The Committee is pleased that HRSA has re-focused the 
minority centers of excellence program on providing support to 
historically minority health professions institutions. The 
Committee recognizes the important role of this program in 
supporting faculty and other academic programs at minority 
institutions. The Committee encourages the program to consider 
applications that are responsive to allied health professions 
that are experiencing shortages and high vacancy rates, such as 
laboratory personnel.

Health careers opportunity program

    The Committee provides $31,548,000 for the health careers 
opportunity program, which is $4,604,000 below the fiscal year 
2003 comparable level. The Administration did not request 
funding for this program. This program provides grants and 
contracts to eligible health professions schools for 
identifying, recruiting, and selecting individuals from the 
various racial and ethnic populations who are from 
disadvantaged backgrounds for education and training in a 
health profession and facilitating their entry into, retention 
and completion of their education at a health professions 
school.
    The Committee is pleased that HRSA has given priority 
consideration for health careers opportunities program grants 
to minority health professions institutions and recommends that 
grant review committees have adequate representation from these 
institutions. The Committee encourages the program to consider 
applications that are responsive to allied health professions 
that are experiencing shortages and high vacancy rates, such as 
laboratory personnel.

Faculty loan repayments

    The Committee provides $1,171,000 for loan repayments and 
fellowships regarding faculty positions, which is $150,000 
below the fiscal year 2003 comparable level. The Administration 
did not request funding for this program. The program provides 
for the repayment of educational loans of individuals from 
disadvantaged backgrounds who are health professions students 
or graduates, and who have agreed to serve for not less than 
two years as a faculty member of an eligible health professions 
school. The school matches the Federal contribution toward loan 
repayment. The program also supports fellowships for URM 
faculty members.

Scholarships for disadvantaged students

    The Committee provides $42,374,000 for scholarships for 
disadvantaged students, which is $5,421,000 below the fiscal 
year 2003 comparable level and $32,474,000 above the budget 
request. The program provides grants to eligible health 
professions and nursing schools to provide scholarships to 
eligible individuals from disadvantaged backgrounds, including 
students who are members of racial and ethnic minority groups. 
By statute, not less than 16 percent of the funds must go to 
schools of nursing.

Training in primary care medicine and dentistry

    The Committee provides $79,249,000 for training in primary 
care medicine and dentistry, which is $13,183,000 below the 
fiscal year 2003 comparable level. The Administration did not 
request funding for this program. The program is comprised of 
four elements: (1) family medicine programs; (2) general 
internal medicine and general pediatrics (GIM/GP) training; (3) 
physician assistants (PA) training; and (4) general or 
pediatric dentistry training. Family medicine grants and 
contracts promote the predoctoral training of medical students, 
support family medicine residency programs and their trainees, 
train physicians who plan to teach in family medicine programs, 
and assist in establishing or improving family medicine 
academic administrative units. GIM/GP grants and contracts are 
to plan and operate residency programs and to provide financial 
assistance for residents, meet the costs of training programs 
for physicians who plan to teach in GIM/GP, as well as to 
support the faculty trainees, and develop programs to support 
predoctoral activities. PA training grants and contracts are to 
plan, develop, and operate programs for the training of PAs and 
for the training of individuals who will teach in programs to 
provide such training. General or pediatric dentistry training 
grants and contracts are to meet the costs of planning, 
developing, or operating programs and to provide financial 
assistance to residents in such programs.

Area health education centers

    The Committee provides $29,382,000 for area health 
education centers (AHEC), which is $3,759,000 below the fiscal 
year 2003 comparable level. The Administration did not request 
funding for this program. The program links university health 
science centers with community health service delivery systems 
to provide community-based training sites for students, 
faculty, and practitioners. The program supports two types of 
projects: (1) basic/core AHEC cooperative agreement projects to 
plan and implement new and developing programs; and (2) model 
programs to extend AHEC cooperative agreement projects, with 
not less than 50 percent of the project costs supported by non-
Federal monetary contributions. The Committee encourages AHEC 
programs to coordinate with the rural health outreach program 
for the greater effectiveness of both programs.

Health education and training centers

    The Committee provides $3,875,000 for health education and 
training centers, which is $496,000 below the fiscal year 2003 
comparable level. The Administration did not request funding 
for this program. The program funds schools of medicine and 
osteopathy to conduct training and education programs for 
health professions students to improve the access, diversity, 
and quality of health personnel along the border between the 
United States and Mexico, in the State of Florida, and in other 
urban and rural areas with populations with serious unmet 
health care needs. The program also provides educational 
support to health professionals, including nursing, practicing 
in the area.

Allied health and other disciplines

    The Committee provides $11,922,000 for allied health and 
other disciplines, which is the same as the fiscal year 2003 
comparable level. The Administration did not request funding 
for this program. The program is comprised of three elements: 
(1) allied health special projects; (2) podiatric primary care 
residency training; and (3) chiropractic demonstration 
projects. Allied health special projects assist entities in 
meeting the costs associated with expanding or establishing 
programs that will increase the number of individuals trained 
in allied health professions. Activities included are those 
that: (1) expand enrollments; (2) provide rapid transition and 
career advancement training programs; (3) establish community-
based training programs; (4) expand or establish 
interdisciplinary training programs, demonstration centers, and 
clinical training sites in medically underserved or rural 
communities; (5) provide traineeships to students; and (6) 
plan, develop, and operate or maintain graduate programs in 
behavioral and mental health practice. Podiatric primary care 
residency training grants and contracts are for planning and 
implementing projects in residency programs and providing 
traineeships to residents who plan to specialize in primary 
care. Chiropractic demonstration grants and contracts are to 
carry out demonstration projects in which chiropractors and 
physicians collaborate to identify and provide effective 
treatment of spinal and lower-back conditions.
    Within the total provided, level funding is provided to 
continue the graduate psychology education program to train 
health service psychologists as well as the new geropsychology 
training program. 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. The 
Committee is concerned about high vacancy rates for these 
laboratory personnel and urges HRSA to redouble efforts to 
address these shortages.

Geriatric programs

    The Committee provides $32,000,000 for geriatric programs, 
which is $4,182,000 above the fiscal year 2003 comparable 
level. The Administration did not request funding for this 
program. The program provides grants and contracts to eligible 
entities to: (1) establish geriatric education centers to 
provide training for health care professionals who provide 
treatment and for training and retraining of faculty who teach 
geriatrics; (2) provide support for geriatric training projects 
to train physicians, dentists, and behavioral and mental health 
professionals who plan to teach geriatrics; and (3) establish a 
program to provide Geriatric Academic Career Awards to eligible 
individuals to promote the career development of such 
individuals as academic geriatricians.
    The Committee intends that $19,000,000 of the total be 
provided to geriatric education centers, $7,000,000 be 
allocated to geriatric training programs, and $6,000,000 be 
distributed to geriatric academic career awards. The Committee 
is concerned that there is an insufficient number of health 
care providers trained to address the health care needs of the 
growing older population. With only a small number of new 
physicians going into the field and those already in the field 
approaching retirement age, incentives are needed to increase 
the number of academic geriatricians to competently train 
health professionals from a variety of disciplines, including 
geriatric medicine. The Committee believes that to meet the 
needs of an aging population, HRSA needs to improve the 
training of all health professionals in geriatrics.

Quentin N. Burdick program for rural interdisciplinary training

    The Committee provides $6,165,000 for the Quentin N. 
Burdick program for rural interdisciplinary training, which is 
$789,000 below the fiscal year 2003 comparable level. The 
Administration did not request funding for this program. The 
program provides grants and contracts to entities for the 
purpose of funding interdisciplinary training projects that are 
designed to train, recruit, and retain teams of 
interdisciplinary professionals to work in underserved areas.

Health professions workforce information and analysis

    The Committee provides $726,000 for health professions 
workforce information and analysis, which is $93,000 below the 
fiscal year 2003 comparable level and $274,000 below the budget 
request. The program provides grants and contracts to eligible 
entities to provide for the collection and analysis of targeted 
information, research on high priority workforce questions, the 
development of a non-Federal analytic and research 
infrastructure, and the conduct of program evaluation and 
assessment.
    The Committee encourages HRSA to review the distribution 
and need for mental health service professionals who serve 
children and adolescents, disaggregated by state, including 
with respect to such information as specialty certifications, 
practice characteristics, professional licensure, practice 
types, locations, education, and training.
    The Committee commends HRSA for its efforts to address the 
gap between the size of the nation's aging baby boom population 
and the number of pulmonary/critical care physicians. The 
Committee understands that HRSA is presently developing a 
report on the workforce shortage issue and that a portion of 
this report will attempt to identify the causes of, and 
potential responses to, the critical care workforce shortage. 
The Committee hopes that HRSA will use the pulmonary/critical 
care specialty as a model for developing and testing policy 
options to address workforce shortage issues.

Public health, preventive medicine and dental public health programs

    The Committee provides $9,225,000 for public health, 
preventive medicine and dental public health programs, which is 
$1,180,000 below the fiscal year 2003 comparable level. The 
Administration did not request funding for this program. The 
program is comprised of three elements: (1) public health 
training centers; (2) public health traineeships; and (3) 
preventive medicine and dental public health residencies. 
Grants or contracts for the operation of public health training 
centers are awarded to an accredited school of public health, 
or another public or nonprofit private institution accredited 
for the provision of graduate or specialized training in public 
health, that plans, develops, operates, and evaluates projects 
in the areas of preventive medicine, health promotion and 
disease prevention, or improving access to and quality of 
health services in medically underserved communities. Public 
health traineeship grants provide graduate or specialized 
public health training to individuals in the fields of 
epidemiology, environmental health, biostatistics, toxicology, 
nutrition, and maternal and child health. Preventive medicine 
and dental public health residency grants and contracts assist 
schools in developing new residency training programs or 
improving existing programs and in providing financial 
assistance to residency trainees.

Health administration programs

    The Committee provides $1,085,000 for health administration 
programs, which is $137,000 below the fiscal year 2003 
comparable level. The Administration did not request funds for 
this program. These programs provide grants to eligible 
entities with an accredited program in health administration, 
hospital administration, or health policy analysis and planning 
to provide traineeships to students and to assist accredited 
health administration programs in the development or 
improvement of programs to prepare students for employment with 
public or nonprofit private agencies.

Advanced education nursing

    The Committee provides $50,174,000 for advanced education 
nursing, which is the same as the fiscal year 2003 comparable 
level and $23,626,000 above the budget request. The program 
provides grants and contracts to eligible entities to meet the 
costs of: (1) projects that support the enhancement of advanced 
nursing education and practice; and (2) traineeships for 
individuals in advanced nursing education programs. The program 
prepares nurse practitioners, clinical nurse specialists, nurse 
midwives, nurse anesthetists, nurse educators, nurse 
administrators, public health nurses or other nurse specialists 
for advanced practice roles. Within the allocation, the 
Committee encourages HRSA to allocate funding at least at the 
fiscal year 2001 levels for nurse anesthetist education.

Nurse education, practice and retention

    The Committee provides $26,824,000 for nurse education, 
practice and retention, which is the same as the fiscal year 
2003 comparable level and $2,622,000 above the budget request. 
As amended by the Nurse Reinvestment Act of 2002, the Nurse 
Education, Practice and Retention Program is a broad authority 
with targeted purposes under three priority areas--education, 
practice and retention--in response to the growing nursing 
shortage. Under this authority, purposes identified under the 
Education Priority Area include: (1) expanding enrollment in 
baccalaureate nursing programs to increase the number of 
registered nurses; (2) developing and implementing internship 
and residency programs with mentoring components designed to 
retain new nurses, bring nurses back into the workforce and 
support the development of specialties for experienced nurses; 
and (3) providing education in new technologies, including 
distance learning methodologies. Purposes identified under the 
Practice Priority Area include: (1) establishing or expanding 
nursing practice arrangements, commonly referred to as nurse 
managed centers, in noninstitutional settings to demonstrate 
methods to improve access to primary health care in medically 
underserved communities; (2) providing care for underserved 
populations and other high risk groups such as the elderly, 
individuals with HIV/AIDS, substance abusers, the homeless, and 
victims of domestic violence; (3) providing managed care, 
quality improvement, and other skills needed to practice in 
existing and emerging organized health care systems; and (4) 
developing cultural competencies among nurses. Purposes 
identified under the Retention Priority Area include: (1) 
career ladder programs to promote advancement in a variety of 
training settings and assisting individuals in obtaining 
education and training required to enter the nursing 
profession; and (2) projects to improve the retention of nurses 
and enhance patient care that is directly related to nursing 
activities.

Nursing workforce diversity

    The Committee provides $9,935,000 for nursing workforce 
diversity, which is the same as the fiscal year 2003 comparable 
level and $10,629,000 below the budget request. The program 
provides grants and contracts to schools of nursing and other 
eligible entities to meet the costs of special projects to 
increase nursing education opportunities for individuals who 
are from disadvantaged backgrounds, including racial and ethnic 
minorities, by providing student scholarships or stipends, pre-
entry preparation, and retention activities. The program also 
contributes to the basic preparation of disadvantaged and 
minority nurses for leadership positions within the nursing and 
health care community.

Loan repayment and scholarship program

    The Committee provides $19,870,000 for nurse loan repayment 
for shortage area service, which is the same as the fiscal year 
2003 comparable level and $7,030,000 below the budget request. 
This program offers student loan repayment to nurses in 
exchange for an agreement to serve not less than two years in 
an Indian Health Service health center, Native Hawaiian health 
center, public hospital, community or migrant health center, or 
rural health clinic.

Comprehensive geriatric education

    The committee provides $2,980,000 for comprehensive 
education, which is the same as the fiscal year 2003 comparable 
level. The Administration did not request funds for this 
program. The Comprehensive Geriatric Education Program supports 
grants to develop and implement, in coordination with programs 
under section 753 (Geriatric Education Programs), programs and 
initiatives to train and educate individuals providing care for 
the elderly. Funds are to be used for (1) providing training to 
individuals who will provide geriatric care for the elderly; 
(2) develop and disseminate curricula relating to the treatment 
of the health care problems of elderly individuals; (3) train 
faculty members in geriatrics; or (4) provide continuing 
education to individuals who provide geriatric care.

Nurse faculty loan program

    The Committee provides $2,980,000 for the nurse faculty 
loan program, which is the same as the fiscal year 2003 
comparable level. The Administration did not request funds for 
this program. The Nurse Faculty Loan Program addresses the 
problem of a growing shortage of nursing faculty. Both the 
National League for Nursing and the American Association of 
Colleges of Nursing have published data on the severity of the 
shortage and the implications. Potential nursing students are 
being turned away from nursing schools because faculty are not 
available. The Nurse Faculty Loan Program supports the 
development of a student loan fund in schools of nursing to 
increase the number of qualified nursing faculty. Students may 
receive loans up to $30,000 per year for a maximum of 5 years. 
The program has a cancellation provision for up to 85 percent 
of the loan for recipients working full-time as nursing faculty 
for a period of 4 years. Twenty percent of the principal and 
interest may be canceled for each of the first, second and 
third year, and 25 percent may be canceled for the fourth year 
of full-time employment as nursing faculty.

Hansen's disease services

    The Committee provides $17,570,000 for the Hansen's disease 
program, which is $454,000 below the fiscal year 2003 
comparable level and the same as the budget request. This 
program offers Hansen's disease treatment to about 40 long term 
residents who continue to receive care from the National 
Hansen's Disease Center and to others who receive care from 
grant-supported outpatient regional clinics. Other former long 
term residents have been offered and elected to receive a 
living allowance from the program and now live independently. 
These programs provide treatment to about 3,000 of the 6,000 
Hansen's disease sufferers in the continental United States.

Maternal and child health block grant

    The Committee provides $732,965,000 for the maternal and 
child health (MCH) block grant, which is $3,000,000 above the 
fiscal year 2003 comparable level and $17,866,000 below the 
budget request. The MCH block grant provides funds to States to 
meet a broad range of basic and enabling health services, 
including personal health services; general, population-wide 
health services, such as screening; family support services; 
and integrated systems of care. The authorizing statute 
provides that, up to a funding level of $600,000,000, 85 
percent of the funds are distributed to the States, with 15 
percent of the funds set aside for special projects of regional 
and national significance (SPRANS). When the appropriation 
exceeds $600,000,000, 12.75 percent of the amount over 
$600,000,000 is directed to the Community Integrated Service 
Systems set-aside program. The remaining 87.25 percent is 
distributed by the same 85/15 percent allocation as in the 
basic block grant formula.
    The Committee has included bill language identifying 
$117,831,000 for the SPRANS set-aside. Within that total, 
$5,000,000 is provided for the continuation of oral health 
programs in the States. These programs address reduction of 
early childhood caries and baby bottle tooth decay, community 
water fluoridation, and school-linked dental sealant programs. 
The Committee has also provided $4,000,000 within the SPRANS 
set-aside to support the continuation of the locally based 
newborn screening follow-up and community based sickle cell 
disease outreach and supportive service initiative. The 
Committee also provides $3,000,000 for development of an 
epilepsy demonstration program to improve access to health and 
other services regarding seizures and to encourage early 
detection and treatment in children and others residing in 
medically underserved areas, especially rural medically 
underserved areas such as the State of Mississippi. In 
addition, the Committee recommends the establishment of a 
public education and awareness campaign directed toward racial 
and ethnic populations to improve access to care by partnering 
with a national voluntary epilepsy agency in implementing this 
activity.
    The Committee continues to recognize the critical role of 
hemophilia treatment centers in the prevention and treatment of 
the complications of hemophilia and other bleeding and clotting 
disorders. The Committee urges HRSA to strengthen support for 
these centers and to improve services provided through the 
network to persons with hemophilia and other blood disorders, 
especially the underserved.
    The Committee commends HRSA for its support of the Sudden 
Infant Death Syndrome (SIDS) program support center and 
encourages the Maternal and Child Health Bureau to continue its 
efforts in this area of service. The Committee is pleased that 
the SIDS and Other Infant Death Support Center is collaborating 
with the National Institutes of Health to address the 
disproportionately high incidence of SIDS among African 
Americans.
    The Committee notes that HRSA has issued a program 
announcement that will extend support for comprehensive 
treatment centers for Cooley's anemia patients under SPRANS 
through FY2005. The Committee applauds HRSA's responsiveness to 
earlier expressions of interest in this program.
    Newborn screening is used for early identification of 
infants affected by certain genetic, metabolic, hormonal and or 
functional conditions for which there is effective treatment or 
intervention. Screening detects disorders in newborns that, 
left untreated, can cause death, disability, mental retardation 
and other serious illnesses. The Committee encourages HRSA to 
work with States to begin to implement the heritable disorders 
program authorized in 2000. This program is designed to 
strengthen states' newborn screening programs and improve 
states' ability to develop, evaluate, and acquire innovative 
testing technologies, and establish and improve programs to 
provide screening, counseling, testing and special services for 
newborns and children at risk for heritable disorders.

Abstinence education

    The Committee provides $65,000,000 for the Title V SPRANS 
abstinence education program, which is $10,358,000 above the 
fiscal year 2003 comparable level and $8,044,000 below the 
budget request. The program provides support to public and 
private entities for the development and implementation of 
community-based projects for abstinence education for 
adolescents aged 12 through 18. The entire focus of these 
programs is to educate young people and create an environment 
within communities that supports teen decisions to postpone 
sexual activity until marriage. There is no funding match 
requirement for these grants. The Committee intends that not 
more than five percent of these funds are to be used to provide 
technical assistance and capacity building support to grantees.
    The Committee reinforces the guidance from its report 
accompanying the fiscal year 2002 appropriation with respect to 
the abstinence messages given by the public health entities 
that are grantees in the abstinence education program and to 
the conduct of evaluation activities for the program.

Healthy Start

    The Committee provides $98,346,000 for Healthy Start, which 
is the same as the fiscal year 2003 comparable level and 
$383,000 below the budget request. Healthy Start provides 
grants to select communities with high rates of infant 
mortality to help them identify, plan, and implement a diverse 
range of community-driven strategies that can successfully and 
significantly reduce disparities in perinatal health that 
contribute to the Nation's high infant mortality rate.

Universal newborn hearing

    The Committee provides $9,935,000 for the universal newborn 
hearing screening program, which is the same as the fiscal year 
2003 comparable level. The Administration did not request 
funding for this program. The program provides competitive 
grants to States for the purpose of implementing a national 
program of universal newborn hearing screening by means of 
physiologic testing prior to hospital discharge, audiologic 
evaluation by three months of age, and entry into a program of 
early intervention by six months of age.

Organ transplantation

    The Committee provides $24,828,000 for organ 
transplantation activities, which is the same as the fiscal 
year 2003 comparable level and $96,000 below the budget 
request. The program supports a scientific registry of organ 
transplant recipients; the National Organ Procurement and 
Transplantation Network, which matches organ donors with 
potential recipients; and grants and contracts with public and 
private non-profit organizations to promote and improve organ 
donation.
    The Committee encourages HRSA to support demonstration 
projects to increase the number of annual organ donations and 
to disseminate ``best practices'' to States on programs that 
are the most successful in accomplishing this.
    The Committee is aware of reports that fewer than 2,000 
cadaver pancreata are available each year for transplantation 
and research purposes, far fewer than other organs. Clinical 
trials involving pancreatic beta cells to cure juvenile (Type 
1) diabetes have shown great promise, and approximately 80 
percent of patients who have received the transplants remain 
free from insulin injections. The Committee urges HRSA to 
implement policies to encourage retrieval of pancreata so that 
additional transplants can be conducted.
    The Committee notes that in the past year, while there were 
approximately 5,300 liver transplants performed, there were 
over 17,000 individuals on the waiting list for liver 
transplantations of which about 1,700 people died due to the 
lack of a donor liver. In view of this continuing shortage of 
organ donors, the Committee is encouraged by the growing number 
of transplants using living donors who contribute a portion of 
their liver to a recipient. Additionally, the Committee 
encourages HRSA to collect data on the outcome of all live-
donor liver transplantations for both recipients and donors.
    The Committee encourages the Division of Transplantation to 
enhance its partnership with the pulmonary hypertension 
community aimed at increasing awareness about the need for 
increased heart and lung donations.

Bone marrow program

    The Committee provides $22,891,000 for the bone marrow 
program, which is the $1,000,000 above the fiscal year 2003 
comparable level and $878,000 above the budget request. In 
addition to funding from HRSA in fiscal year 2003, the National 
Marrow Donor Program (NMDP) is expected to receive $22,000,000 
from the U.S. Navy. Funds are used for donor medical costs, 
donor centers, tissue typing, research, minority recruitment, 
and program administration. The registry is run by contract.
    The Committee encourages the National Marrow Donor Program 
to enhance its public health preparedness efforts in the area 
of nuclear and chemical threats to the nation. The NMDP is 
developing planning efforts to ensure an adequate supply of 
needed marrow and blood stem cells as part of a national 
emergency response plan. The Committee supports the NMDP 
efforts to develop relationships with national and state 
emergency response organizations and agencies, to adapt its 
current systems to prepare for large-scale attacks, and to 
increase the sources of hematopoetic stem cells.

Rural outreach grants

    The Committee provides $57,410,000 for rural outreach 
grants, which is $1,000,000 below the fiscal year 2003 
comparable level and $19,658,000 above the budget request. The 
program supports projects that provide health services to rural 
populations not currently receiving them and that enhance 
access to existing services.

Rural health research

    The Committee provides $8,000,000 for rural health 
research, which is $2,630,000 below the fiscal year 2003 
comparable level and $2,016,000 above the budget request. The 
activity supports several rural health research centers and the 
Office for Rural Health Policy's advisory committee.

Telehealth

    The Committee provides $27,686,000 for telehealth, which is 
the same as the fiscal year 2003 comparable level and 
$22,092,000 above the budget request. The telehealth program 
works with and supports communities in their efforts to develop 
cost-effective uses of telehealth technologies. These 
technologies bring health services to residents of the Nation 
who are isolated from health care, and health-related education 
to the practitioners who serve them.
    The Committee strongly supports HRSA's numerous rural 
telehealth initiatives and continues to encourage the agency to 
work in partnership with medical librarians, the National 
Library of Medicine, and other health information specialists 
in the development and implementation of its telehealth 
projects.

Rural hospital flexibility grants

    The Committee provides $39,740,00 for rural hospital 
flexibility grants, which is the same as the fiscal year 2003 
comparable level and $9,819,000 above the budget request. The 
program provides grants to States to help them improve access 
to health care services in rural communities by: (1) developing 
and implementing a State rural health plan; (2) assisting 
small, at risk rural hospitals that wish to convert to Critical 
Access Hospitals and receive cost-based payments from Medicare; 
and (3) supporting these hospitals and the communities they 
serve in developing networks of care that meet the requirements 
of the law and integrate Critical Access Hospitals with 
emergency services and other sources of health care in the 
communities.

Rural access to emergency devices

    The Committee provides $12,419,000 for rural access to 
emergency devices, which is the same as the fiscal year 2003 
comparable level and $10,410,000 above the budget request. This 
program provides grants to expand the placement of automatic 
external defibrillators (AED) to rural areas and to address AED 
training needs for first responders and emergency medical 
technicians in rural communities.

State offices of rural health

    The Committee provides $4,000,000 for State offices of 
rural health, which is $4,445,000 below the fiscal year 2003 
comparable level and $10,000 above the budget request. The 
State office of rural health program creates a focal point for 
rural health within each of the 50 States. In each State, the 
office collects and disseminates information on rural health, 
coordinates rural health resources and activities, provides 
technical assistance to rural providers and communities, and 
helps communities recruit and retain health professionals.

Denali Commission

    The Committee has not included funding for the Denali 
Commission, which is $27,321,000 below the fiscal year 2003 
comparable level and the same as the budget request.

Emergency medical services for children

    The Committee provides $19,373,000 for emergency medical 
services for children, which is the same as the fiscal year 
2003 comparable level. The Administration proposed funding this 
program in the Public Health and Social Services Emergency 
Fund. The program supports grants for the delivery of emergency 
medical services to acutely ill and seriously injured children.

Poison control centers

    The Committee provides $22,354,000 for poison control 
centers, which is the same as the fiscal year 2003 comparable 
level. The Administration proposed funding this program in the 
Public Health and Social Services Emergency Fund.
    These funds will support a grant program for poison control 
centers. In addition, funds will be used to maintain a national 
toll-free number and implement a media campaign to advertise 
that number, as well as to support the development of uniform 
patient management guidelines and the improvement of data 
collection.

Traumatic brain injury

    The Committee provides $9,438,000 for the traumatic brain 
injury (TBI) program, which is the same as the fiscal year 2003 
comparable level and $1,959,000 above the budget request. The 
TBI program funds the development and implementation of 
statewide systems to ensure access to care including 
prehospital care, emergency department care, hospital care, 
rehabilitation, transitional services, and long-term community 
support. Grants also go to State protection and advocacy 
systems.

Black lung clinics

    The Committee provides $5,961,000 for black lung clinics, 
which is the same as the fiscal year 2003 comparable level and 
$39,000 below the budget request. The program supports 14 
grantees that treat a declining population of coal miners with 
respiratory and pulmonary impairments. The clinics presently 
receive more than one-third of their funding from other 
sources, such as Medicaid and Medicare. Of the 15 grantees, 
five actually receive health center funding as well as black 
lung grants.

Trauma care

    The Committee provides $3,476,000 for trauma care, which is 
the same as the fiscal year 2003 comparable level. The 
Administration did not request funding for this program. The 
program supports the development and enhancement of the basic 
infrastructure of trauma systems within States and territories.

Payment to Hawaii for treatment of Hansen's disease

    The Committee provides $2,032,000 for the treatment of 
persons with Hansen's disease in the State of Hawaii, which is 
the same as the fiscal year 2003 comparable level and $13,000 
below the budget request. The program, which provides a partial 
matching payment to the State of Hawaii, dates to the period of 
Father Damien's facility for sufferers of Hansen's disease 
(leprosy). That facility now has only 43 residents who live 
there by choice, and the grounds have been converted to a 
historical site. Most patients diagnosed with Hansen's disease 
in Hawaii are now treated in the same manner as new patients on 
the mainland; their care is handled on an out-patient basis, 
with the program paying for about 300 active ambulatory 
Hansen's Disease cases.

Ryan White AIDS programs

    The Committee provides $2,023,599,000 for Ryan White AIDS 
programs, which is $30,634,000 above the fiscal year 2003 
comparable level and $14,050,000 above the budget request. The 
Committee's allocation among the various titles of the Ryan 
White program reflect the high priority the Committee places on 
providing resources for the AIDS drug assistance program. 
Within the total provided, the Committee expects that Ryan 
White AIDS activities that are targeted to address the growing 
HIV/AIDS epidemic and its disproportionate impact upon 
communities of color, including African Americans, Latinos, 
Native Americans, Asian Americans, Native Hawaiians, and 
Pacific Islanders will be supported at no less than last year's 
funding level.

Emergency assistance

    The Committee provides $618,693,000 for the Part A, 
emergency assistance program, which is the same as the fiscal 
year 2003 comparable level and $188,000 below the budget 
request. These funds provide grants to metropolitan areas with 
very high numbers of AIDS cases for outpatient and ambulatory 
health and social support services. Half of the amount 
appropriated is allocated by formula and half is allocated to 
eligible areas demonstrating additional need through a 
competitive grant process.

Comprehensive care programs

    The Committee provides $1,091,344,000 for Part B, 
comprehensive care programs, which is $37,951,000 above the 
fiscal year 2003 comparable level and $14,317,000 above the 
budget request. The funds provided support formula grants to 
States for the operation of HIV service delivery consortia in 
the localities most heavily affected, for the provision of home 
and community-based care, for continuation of health insurance 
coverage for infected persons, and for purchase of therapeutic 
drugs.
    The Committee has included bill language identifying 
$753,317,000 specifically to support State AIDS Drug Assistance 
Programs. In fiscal year 2003, $714,326,000 was designated for 
this purpose.

Early intervention program

    The Committee provides $193,981,000 for Part C, the early 
intervention program, which is $4,393,000 below the fiscal year 
2003 comparable level and the same as the budget request. Funds 
are used for discretionary grants to migrant and community 
health centers, health care for the homeless grantees, family 
planning grantees, hemophilia centers and other private non-
profit entities that provide comprehensive primary care 
services to populations with or at risk for HIV disease. The 
grantees provide testing, risk reduction counseling, 
transmission prevention, and clinical care; case management, 
outreach, and eligibility assistance are optional services.

Women, youth and families

    The Committee provides $70,917,000 for Part D, pediatric 
AIDS demonstrations, which is $2,634,000 below the fiscal year 
2003 comparable level and the same as the budget request. The 
program supports demonstration grants to foster collaboration 
between clinical research institutions and primary community-
based medical and social service providers for the target 
population of HIV-infected children, pregnant women and their 
families. The projects are intended to increase access to 
comprehensive care, as well as voluntary participation in NIH 
and other clinical trials.

AIDS dental services

    The Committee provides $13,405,000 for AIDS dental 
services, which is the same as the fiscal year 2003 comparable 
level and $79,000 below the budget request. The program 
provides reimbursements to dental schools and postdoctoral 
dental education programs to assist with the cost of providing 
unreimbursed oral health care to patients with human 
immunodeficiency virus disease. Dental students and residents 
participating in this program receive extensive training in the 
understanding and management of the oral health care needs of 
people living with HIV/AIDS.

Education and training centers

    The Committee provides $35,259,000 for AIDS education and 
training centers (AETCs), which is $290,000 below the fiscal 
year 2003 comparable level and the same as the budget request. 
The centers train health care personnel who care for AIDS 
patients and develop model education programs.

Family planning

    The Committee provides $273,350,000 for the family planning 
program, which is the same as the fiscal year 2003 comparable 
level and $8,542,000 above the budget request. The program 
provides grants to public and private non-profit agencies to 
support a range of family planning and reproductive services, 
as well as screening for ancillary health problems such as 
hypertension and diabetes. The program also supports training 
for providers, an information and education program, and a 
research program which focuses on family planning service 
delivery improvements.
    The bill repeats language from the 2003 appropriations bill 
making clear that these funds shall not be expended for 
abortions, that all pregnancy counseling shall be nondirective, 
and that these funds shall not be used to promote public 
opposition to or support of any legislative proposal or 
candidate for public office.
    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.

Children's hospitals graduate medical education program

    The Committee provides $305,000,000 for the children's 
hospitals graduate medical education program, which is 
$14,898,000 above the fiscal year 2003 comparable bill and 
$105,742,000 above the budget request. The program provides a 
more adequate level of support for health professions training 
in children's teaching hospitals that have a separate Medicare 
provider number (``free-standing'' children's hospitals). 
Children's hospitals are statutorily defined under Medicare as 
those whose inpatients are predominantly under the age of 18. 
The funding in this program is intended to make the level of 
Federal Graduate Medical Education support more consistent with 
other teaching hospitals, including children's hospitals which 
share provider numbers with other teaching hospitals. Payments 
are determined by formula, based on a national per-resident 
amount. Payments support training of resident physicians as 
defined by Medicare in both ambulatory and inpatient settings.

Health care facilities

    The Committee has not included funding for health care 
facilities. A total of $294,700,000 was provided for this 
purpose in fiscal year 2003; no funding was included in the 
budget request. This program provides funds to public and 
private nonprofit entities for construction or modernization of 
outpatient medical facilities.

Buildings and facilities

    The Committee provides $248,000 for buildings and 
facilities, which is the same as the fiscal year 2003 
comparable level and $2,000 below the budget request. These 
funds are used to finance the repair and upkeep of buildings at 
the Gillis W. Long Hansen's Disease Center at Carville, 
Louisiana.

Radiation exposure compensation act

    The Committee provides $1,987,000 for the radiation 
exposure compensation act, which is the same as the fiscal year 
2003 comparable level and $2,019,000 below the budget request. 
This program provides grants for the education, prevention and 
early detection of radiogenic cancers and diseases resulting 
from exposure to uranium during its mining and milling at 
nuclear test sites.

National practitioner data bank

    The Committee does not provide funding for the national 
practitioner data bank for fiscal year 2004, which is the same 
as both the fiscal year 2003 action on appropriations and the 
budget request. The Committee recommendation and the budget 
request assume that the data bank will be self-supporting, with 
collections of $19,500,000 in user fees. The national data bank 
receives, stores and disseminates information on paid medical 
malpractice judgments and settlements, sanctions taken by 
Boards of Medical Examiners, losses of membership in 
professional societies, and certain professional review actions 
taken by health care entities. Insurance companies, State 
licensure boards and authorities, and other health care 
entities and professional societies are required to report 
information to the data bank within 30 days of each action. The 
coverage of the data bank includes dentists and physicians, 
and, with respect to malpractice settlements and judgments, 
other categories of licensed health professionals. Hospitals 
are required to search the data bank when a health care 
provider applies for employment and once every two years 
thereafter. State licensing boards, other health care entities, 
licensing authorities, and professional societies also have 
access to the data bank. Traditional bill language is included 
to ensure that user fees are collected to cover the full costs 
of the data bank operations.

Health care integrity and protection data bank

    The Committee does not provide funding for the health care 
integrity and protection data bank (HIPDB) for fiscal year 
2004. The Committee recommendation and the budget request 
assume that the data bank will be self-supporting, with 
collections of $5,600,000 in user fees. HIPDB receives, stores, 
and disseminates information on final adverse actions taken 
against health care providers, suppliers, and practitioners. 
This information is collected from and made available to 
Government agencies and health plans. In addition, disclosure 
of the information is made available, upon request, to health 
care providers, suppliers, and practitioners who wish to self-
query.

Community access program

    The Committee provides $104,317,000 for the community 
access program, which is the same as the fiscal year 2003 
comparable level. The Administration did not request funding 
for this program. The program is designed to increase the 
capacity and effectiveness of the variety of community health 
care institutions and providers who serve patients regardless 
of their ability to pay through development of community 
consortia.

State planning grants for health care access

    The Committee provides $14,902,000 for the community access 
program, which is the same as the fiscal year 2003 comparable 
level. The Administration did not request funding for this 
program. The program provides one-year grants to States to 
develop plans for providing access to affordable health 
insurance coverage to all their citizens.

Program management

    The Committee provides $155,974,000 for the cost of Federal 
staff and related activities to coordinate, direct and manage 
the programs of the Health Resources and Services 
Administration. This amount is the same as the fiscal year 2003 
comparable level and $4,859,000 above the budget request. The 
Committee includes funding for new HRSA activities proposed by 
the Administration.
    From the early 1980s to the present there has been a 
decline in oral health leadership and personnel within the 
agency. At the HRSA central and regional office level, the 
number of dental health professionals has declined from more 
than 100 to less than 20. Of the remaining 20, 33 percent will 
reach the 30-year mandatory retirement level for commissioned 
corps officers this year. The Committee is concerned about this 
situation, especially after hearing from public witnesses about 
the current decrease in state dental programs and an increase 
in dental disease and oral health disparities for the nation's 
most vulnerable populations. Therefore, the Committee requests 
that HRSA report by February 2004 on what actions it has taken 
to address this situation, including in the report HRSA's 
response to a January 2002 report submitted by HRSA Regional 
Dental consultants.
    HRSA is directed to conduct a review of the free clinics 
network that provides care to uninsured patients, identifying 
the number of clinics and health care providers, the major 
sources of their financial support, their geographic 
dispersion, the number of patients they serve, and the extent 
of their co-location with community health centers' service 
areas. The review should include an actuarial analysis of the 
liability likely to be incurred by free clinics from lawsuits 
filed against their practitioners, based on past legal records. 
This analysis should be compared to similar experiences with 
the Federal Tort Claims Act protection for community health 
centers. Such an analysis will be important for Committee 
consideration of any future funding for the liability 
protection for free clinics authorized under section 224 of the 
Public Health Service Act. The Committee requests this report 
by April 1, 2004.

               Medical Facilities Guarantee and Loan Fund


           FEDERAL INTEREST SUBSIDIES FOR MEDICAL FACILITIES

    The Committee does not provide funding for the Medical 
Facilities Guarantee and Loan Fund, which is the same as the 
budget request. Appropriations are used to pay interest 
subsidies on loans made or guaranteed prior to fiscal year 1977 
for hospital construction. There are sufficient carryover funds 
from prior years' appropriations to pay defaults and interest 
subsidy payments; therefore, no appropriation is required to 
cover these payments.

               HEALTH EDUCATION ASSISTANCE LOANS PROGRAM

    The Health Education Assistance Loans (HEAL) program 
insured loans provided by non-Federal lenders to students in 
health professions schools. Under the accounting rules 
established in the Budget Enforcement Act of 1990, one account 
is maintained to pay the obligations arising from loans 
guaranteed prior to fiscal year 1992. A second account pays 
obligations and collects income from premiums on loans 
guaranteed in fiscal year 1992 and beyond. Each annual cohort 
of loans is independently tracked in this account. The 
authority for this program expired in fiscal year 1999. Fiscal 
year 1998 was the last year in which loans were obligated to 
previous borrowers under the HEAL authority.
    The Committee provides $7,000,000 to liquidate obligations 
from loans guaranteed prior to 1992, which is the same as the 
fiscal year 2003 level and $3,000,000 above the budget request.
    The Committee provides $3,389,000 for HEAL program 
management, which is $300,000 below the fiscal year 2003 
comparable level and the same as the budget request.

              NATIONAL VACCINE INJURY COMPENSATION PROGRAM

    The Committee makes available the release of $66,000,000 
from the Vaccine Injury Compensation Trust Fund in fiscal year 
2003, which is $19,918,000 below the fiscal year 2003 level and 
the same as the budget request.
    The National Vaccine Injury Compensation Program provides a 
system of compensation for individuals with vaccine-associated 
injuries or deaths. Funds for claims from vaccines administered 
on or after October 1, 1988 are generated by a per-dose excise 
tax on the sale of selected prescribed vaccines. Revenues 
raised by this tax are maintained in a Vaccine Injury 
Compensation Trust Fund.
    Trust funds made available in the bill will support the 
liability costs of vaccines administered after September 30, 
1988. They will also support the $3,472,000 in costs incurred 
by the agency in the operation of the program, which is 
$500,000 above fiscal year 2003 level and $481,000 above the 
budget request.

                      Centers for Disease Control


                 DISEASE CONTROL, RESEARCH AND TRAINING

    The Committee provides $4,588,671,000 for the Centers for 
Disease Control and Prevention (CDC), which is $304,031,000 
above the fiscal year 2003 comparable level and $321,341,000 
above the request. In addition, the Committee provides 
$13,226,000 in funds made available under Section 241 of the 
Public Health Service Act and includes a general provision 
(Sec. 218) that provides for a reduction of $49,982,000 in 
administrative and information technology expenses. The net 
effect is to provide a program level for CDC activities in 
fiscal year 2004 of $4,551,915,000. This is $56,876,000 above 
fiscal year 2003 and $232,603,000 above the request.
    The CDC assists State and local health authorities and 
other health-related organizations to control and reduce 
disease and other health problems. The activities of CDC focus 
on several major priorities, including providing core public 
health functions, responding to urgent health threats, 
monitoring the Nation's health using scientific methods, 
building the Nation's health infrastructure to insure our 
national security against bioterrorist threats, promoting 
women's health, and providing leadership in the implementation 
of nationwide prevention strategies to encourage responsible 
behavior and adoption of lifestyles that are conducive to good 
health.
    The Committee considers the table accompanying this report 
to be determinative of the CDC budget. Funds should be 
apportioned and allocated consistent with the table, and any 
changes in funding are subject to the normal reprogramming and 
notification procedures.

Birth defects, developmental disabilities, disability and health

    The Committee provides $106,339,000 for birth defects, 
developmental disabilities, disability and health, which is 
$8,299,000 above the fiscal year 2003 comparable level and 
$18,877,000 above the request. This program collects, analyzes, 
and makes available data on the incidence and causes of birth 
defects and developmental disabilities.
    Within the total provided, $2,500,000 above the fiscal year 
2003 comparable level is to expand autism and developmental 
disabilities activities.
    Within the total provided, $2,000,000 above the fiscal year 
2003 comparable level is to expand surveillance and 
epidemiological efforts of Duchenne and Becker muscular 
dystrophy in the United States.
    Within the total provided, $500,000 above the fiscal year 
2003 comparable level is to support activities related to the 
National Spina Bifida Program.
    Within the total provided, $500,000 above the fiscal year 
2003 comparable level is to expand CDC's newborn infant hearing 
program.
    Within the total provided, $1,000,000 above the fiscal year 
2003 comparable level is to continue and expand the partnership 
between the CDC and the Christopher Reeve Paralysis Foundation.
    Within the total provided, $1,500,000 is to establish a 
public health education initiative related to Tourette 
Syndrome.
    Within the total provided, $300,000 above the fiscal year 
2003 comparable level is to enhance the national campaign to 
increase the number of women taking folic acid daily.
    Attention Deficit/Hyperactivity Disorder.--The Committee 
continues to support the National Resource Center on AD/HD and 
has provided sufficient funds to continue the activities at the 
Center to better reach special populations in need; to develop 
on-line educational tools for professionals; and, to enable CDC 
to expand its population-based research and surveillance.
    Autism.--The Committee is concerned that the data 
collection and analysis within this program is not progressing 
at the anticipated pace and urges the CDC to allocate the 
resources necessary to gather and release the data, and 
conclusions in a timely manner. The Committee expects a status 
report on autism data collection before February 1, 2004.
    The Committee is also interested in data demonstrating that 
early identification for children with autism can be valuable 
in identifying the appropriate services and treatments. Early 
intervention for children with autism has shown significant 
improvement in behavior and function of many children with 
autism. The Committee encourages the CDC to develop an early 
identification initiative for autism and other developmental 
disabilities.
    Christopher and Dana Reeve Paralysis Resource Center.--In 
fiscal year 2001, the CDC began support of the Christopher and 
Dana Reeve Paralysis Resource Center to provide information and 
support to individuals living with paralysis, their caregivers 
and their families. In order to keep up with the increasing 
demand for information and support services, the Committee has 
provided $1,000,000 to augment the CDC's support of the Center. 
The Committee intends that the full amount of the increase be 
awarded to the resource center.
    Down Syndrome.--The Committee received testimony during the 
fiscal year 2004 budget hearings regarding Down syndrome. 
Furthermore, the Committee is aware of proposals for CDC to 
conduct an epidemiological study on Down syndrome and to plan a 
multi-site population-based study to document the onset and 
course of secondary and related developmental disorders and 
health conditions in individuals with Down syndrome. The 
Committee encourages the CDC to give careful consideration to 
these two proposals and to be prepared to report to the 
Committee during the fiscal year 2005 budget hearings on the 
need, design, and costs of undertaking these proposals.
    Folic Acid Education Campaign.--Funds have been provided 
above the request to expand the national public and health 
professions education campaign designed to increase the number 
of women taking folic acid daily. With increased funds, and in 
collaboration with the National Spina Bifida Program, this 
campaign should be able to reach more women of childbearing age 
and their health care providers.
    Limb Loss Information Center.--The Committee is pleased by 
the partnership between the CDC and the Amputee Coalition of 
America (ACA) and the ongoing success of the National Limb Loss 
Information Center which provides comprehensive resources, peer 
support and education programs for persons with limb loss, as 
well as their families, friends and health care professionals. 
The Committee has provided sufficient funds to support these 
activities at not less then the fiscal year 2003 level. In 
addition, the Committee commends the CDC and its partner on the 
Limb Loss Research and Statistics Program that is enhancing the 
nation's understanding of the true burden of limb loss in 
America and has provided funding to expand its initial research 
efforts.
    Sudden Infant Death Syndrome.--The Committee notes the work 
of CDC, the National Institute of Child Health and Human 
Development and the Health Resources and Services 
Administration in developing model guidelines for death scene 
protocol for Sudden Infant Death Syndrome. The Committee 
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 2005 hearings.
    Tourette Syndrome.--The Committee is concerned that the 
public's misunderstanding of the neurological disorder known as 
Tourette Syndrome has resulted in severe stigma, ridicule and 
denied learning and employment opportunities for children and 
adults living with the condition. The Committee has provided 
$1,500,000 to establish a public health education and research 
programs in partnership with a national voluntary health 
association dedicated to assist parents and families of 
children with Tourette Syndrome. The programs should be 
designed consistent with the authority and direction in Section 
2301 of the Children's Health Act of 2000 (P.L. 106-310).

Chronic disease prevention and health promotion

    The Committee provides $862,011,000 for chronic disease 
prevention and health promotion, which is $72,039,000 above the 
fiscal year 2003 comparable level and $27,964,000 above the 
request.
    Chronic diseases have had a profound human and economic 
toll on our nation. Nearly 125 million Americans today are 
living with some form of chronic condition, including cancer, 
cardiovascular disease, diabetes, arthritis, obesity and 
various neurological conditions such as epilepsy. Complications 
from these conditions include vision loss, kidney disease, limb 
loss, oral disease and paralysis.
    The National Center for Chronic Disease Prevention and 
Health Promotion at CDC implements research and programs to 
prevent the leading causes of death and disability (e.g., heart 
disease and stroke, cancer, diabetes, and arthritis) which are 
among the most prevalent, costly, and preventable of all health 
problems. CDC plays a leadership role in coordinating and 
catalyzing the efforts of numerous public and private partners, 
which allows CDC to substantially extend its effectiveness in 
reaching people at highest risk for chronic disease. The 
Committee recognizes the essential infrastructure that CDC has 
built in state health departments and encourages CDC to expand 
its state-based leadership in surveillance, public health 
education, communications and model programs and research.
    Within the total provided, the Committee has included the 
following amounts above the fiscal year 2003 comparable level:

Heart Disease and Stroke................................      $4,000,000
Diabetes................................................       4,000,000
Cancer Prevention and Control...........................      16,000,000
Arthritis...............................................         500,000
Epilepsy................................................         500,000
BRFSS...................................................       1,300,000
Vision Screening and Education..........................       1,000,000
School Health...........................................       5,000,000
Oral Health.............................................         800,000
Steps to a Healthier U.S................................      40,000,000

    Arthritis.--Within the Arthritis and Other Chronic Disease, 
the Committee recommendation includes $500,000 over fiscal year 
2003 to ensure that the CDC arthritis program can expand 
efforts to confront the burden of arthritis. The amount 
includes funds to support state-based programs and the 
collaboration between the agency and relevant voluntary health 
organizations.
    Breast and Cervical Cancer.--Within the amount provided for 
Cancer Prevention and Control, the Committee provides 
$210,929,000 for the National Breast and Cervical Cancer Early 
Detection Program. This is $11,558,000 above the fiscal year 
2003 comparable level and the same as the request.
    Cancer Survivorship.--The Committee is aware of the need 
for additional information and support for cancer survivors, 
from time of diagnosis through treatment, recovery and long-
term care issues. The Committee has provided sufficient funds 
above the request for the CDC to develop a cancer survivorship 
resource center focused on post-treatment needs and long-term 
survivorship/quality of life issues. The Committee encourages 
the CDC to develop the resource center in partnership with the 
Lance Armstrong Foundation (LAF).
    Cardiovascular Health State Program.--The Committee is 
aware that many states do not have a state-based heart disease 
and stroke prevention program. The amount recommended by the 
Committee includes funds above fiscal year 2003 for the Heart 
Disease and Stroke Prevention Program to allow CDC to elevate 
additional states from planning to program implementation, 
continue to support the other currently funded states and to 
initiate critical public and health care provider education, 
prevention research and evaluation.
    Colorectal Cancer.--The Committee is pleased with the 
leadership of CDC's National Colorectal Cancer Roundtable in 
promoting the availability and advisability of screening to 
both health care providers and the general public. The 
Committee encourages CDC to continue to expand its partnerships 
with state health departments, professional and patient 
organizations, and private industry to combat this devastating 
disease.
    Diabetes.--The Committee recommendation includes funds 
above the request to enable the CDC to expand the number of 
state-based diabetes control programs with basic implementation 
grants.
    Division of Adolescent School Health.--The Committee 
requests that the Director emphasize collaboration with 
prevention programs so that messages of prevention are 
consistent with one another and that prevention efforts are 
appropriate for specific populations. The Committee notes that 
according to CDC's own data, more than half of all adolescents 
are sexually abstinent. Therefore, DASH programs, in 
particular, should accommodate approaches that emphasize risk 
avoidance, abstinence education, and should make every effort 
to provide accurate information on the efficacy of condoms, as 
per the 2000 report on condom efficacy from the National 
Institutes of Health, for all sexually transmitted diseases. 
The Committee urges that in promoting HIV prevention programs, 
DASH emphasize those programs and approaches that have been 
shown to delay sexual debut or have demonstrated positive 
changes in the knowledge, attitudes, beliefs, and intentions of 
adolescents regarding the initiation of sexual activity.
    Epilepsy.--The Committee recognizes epilepsy, a chronic 
neurological condition, as a serious health concern. 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. The Committee urges CDC to 
enhance its epilepsy efforts in partnership with a leading 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.
    Inflammatory Bowel Disease.--For the past four years, the 
Committee has encouraged CDC to work in partnership with the 
IBD community to establish a national IBD epidemiology program 
to further our understanding of these diseases. The Committee 
understands that CDC has entered into a partnership with the 
Crohn's and Colitis Foundation of America to initiate this 
important program. Now that this project has been established, 
the Committee encourages CDC to provide funding for this 
program in fiscal year 2004.
    Lupus.--Within the amount provided for Arthritis and Other 
Chronic Diseases, the Committee has provided $1,000,000 for the 
operation of the National Lupus Patient Registry.
    Oral Health.--The Committee recognizes that to effectively 
reduce disparities in oral disease will require improvements at 
the state and local levels. The Committee has provided 
additional funding to allow the Division to fully fund the 13 
state grants already awarded and to initiate new grants to 
states to strengthen their capacities to assess the prevalence 
of oral diseases, to target interventions, like additional 
water fluoridation and school-linked sealant programs, and 
resources to the underserved, and to evaluate changes in 
policies, programs and disease burden. The Committee also 
expects the Division to advance efforts to reduce the 
disparities and the health burden from oral cancers and oral 
diseases that are closely linked to chronic diseases like 
diabetes and heart disease.
    Pulmonary Hypertension.--The Committee continues to be 
interested in pulmonary hypertension, a rare, progressive and 
fatal disease that predominantly affects women, regardless of 
age and race. The Committee looks forward to reviewing a report 
(as requested in the FY03 omnibus appropriations bill) from the 
CDC outlining the progress that has been made in establishing a 
pulmonary hypertension awareness campaign focused on the 
general public and health care providers. Moreover, the 
Committee encourages CDC to give priority consideration to 
supporting a cooperative agreement with the pulmonary 
hypertension community designed to foster greater awareness of 
the disease.
    Verb--It's what you do.--The Committee includes $50,967,000 
for fourth year of the youth media campaign to promote positive 
activity, especially physical activity, among youth ages 9-13. 
This is the same as the fiscal year 2003 comparable amount. The 
request included $5,000,000.
    Vision Screening and Education.--Within the funds provided 
for Health Promotion, the recommendation includes an increase 
of $1,000,000 above fiscal year 2003 to enhance the national 
vision screening and education program, and commends CDC for 
its partnership with national voluntary health agencies and 
associations in developing a public health action plan for 
vision health. The Committee has provided the necessary 
resources to develop public, patient and professional 
education, community programs, research and the necessary 
infrastructure to deliver vision screening and education and 
encourages CDC to continue its partnership with the leading 
voluntary health association fighting blindness and saving 
sight, especially with regard to macular degeneration, 
glaucoma, cataracts and diabetic retinopathy.

Environmental health

    The Committee provides $184,829,000 for environmental 
health, which is $2,000,000 above the fiscal year 2003 
comparable level and $34,602,000 above the request.
    Asthma.--The Committee commends CDC's efforts to collect 
national and local data on the incidence and prevalence of 
asthma and to implement asthma prevention programs. The 
Committee encourages CDC to continue with these activities and 
expand its prevention programs into areas of high pediatric 
asthma incidence. To help facilitate this effort, CDC is urged 
to partner with voluntary health organizations, such as the 
American Lung Association, 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.--The Committee 
commends the CDC for its commitment to support the enhanced 
development of a portable, hand-held lead screening device that 
holds great promise for increasing childhood screening rates in 
underserved communities. Further development of this device 
will help ensure its application in community health settings.
    The Committee is aware that Oklahoma and Texas have unique 
outreach programs into Hispanic communities to help identify 
at-risk children and help educate their parents on the source 
of the lead poisoning. The CDC is encouraged to work with the 
State Public Health Departments in Oklahoma and Texas in 
further developing these pilot programs.
    Environmental Health Laboratory.--The Committee recognizes 
the important achievements in the biomonitoring of CDC's 
Environmental Health Laboratory that improve the detection, 
risk assessment, and prevention of chemical exposures that may 
be harmful to health. The Committee provides $2,000,000 above 
the fiscal year 2003 comparable level to expand the activities 
of the laboratory. The laboratory is commended for its 
extensive interaction with other government agencies and other 
organizations that have found its services invaluable during 
this time of national crisis.
    Health Tracking Network.--The Committee continues support 
for the effort to develop a Health Tracking Network at the 
fiscal year 2003 comparable level of $27,800,000. This Network 
seeks to integrate environmental hazards data with human 
exposure and health effects data. The Committee understands 
that CDC's Centers of Excellence can provide useful assistance 
to states in designing their health tracking initiatives, and 
recommends that CDC continue to ensure that the states work 
with the Centers to design programs and approaches that are 
grounded in a rigorous scientific approach and consistent with 
the objectives of the Information Quality Act. The Committee 
also reaffirms the importance of ensuring that the health 
tracking effort is made compatible and integrated with other 
CDC and government tracking systems that focus on other 
environmental factors that may be related to health effects, 
such as infectious agents, behavioral risks, ultraviolet 
radiation, tobacco smoke, food-borne illness, naturally 
occurring substances, natural disasters and temperature 
extremes.
    Primary Immunodeficiency Diseases.--In each of the last two 
years, Congress has made available funds for CDC to support the 
national physician education and public awareness campaign 
developed by the Jeffrey Modell Foundation. The Committee 
understands that the campaign has been a success to date, 
featuring physician symposia throughout the country, an 
advertising campaign under the auspices of the Ad Council, and 
development of new materials and mailings to physicians and 
other providers. The Committee recommendation includes 
sufficient funds to continue support of the campaign at the 
fiscal year 2003 level and encourages the CDC to broaden the 
campaign to include an international component.

Epidemic services and response

    The Committee provides $82,494,000 for epidemic services 
and response, which is $5,000,000 above the fiscal year 2003 
comparable level and $6,336,000 above the request.
    The objectives of the program include the prevention and 
control of epidemics, the maintenance of surveillance systems, 
the training of public health epidemiologists, and the 
operation of the quarantine program. The program supports the 
Epidemic Intelligence Service program, the publication of the 
Morbidity and Mortality Weekly Report, and a variety of infant 
and minority health programs.
    Global Disease Detection.--The Committee provides 
$5,000,000 above the fiscal year 2003 comparable level for 
epidemic services. The part of the redirection of resources at 
the Agency that results from savings in the areas of 
information technology and administrative management 
recommended in the request. The Committee intends that these 
funds support high priority scientific and programmatic 
activities to expand and improve global disease detection.
    Landmine Survivor Network.--The Committee commends CDC for 
its partnership with the Landmine Survivor Network that has 
developed peer support networks for landmine survivors in six 
mine-affected countries around the world. The Committee 
recommendation assumes continued support for the Network at not 
less than the fiscal year 2003 level.

Health statistics

    The Committee provides a total of $125,899,000 for health 
statistics, which is the same as the fiscal year 2003 
comparable level and $1,278,000 above the request. Of this 
amount, $112,673,000 is provided in general funds and 
$13,226,000 is derived from the one percent evaluation set-
aside.
    This program is responsible for collecting, interpreting, 
and disseminating data on the health status of the U.S. 
population and the use of health services. Surveys include the 
National Vital Statistics System, the National Health Interview 
Survey, the National Survey of Family Growth, the National 
Health and Nutrition Examination Survey, and the National 
Health Care Survey.
    Health Statistics.--The Committee recognizes the critical 
importance of health statistics in federal policy development 
and urges the Director to examine the adequacy and overall 
coordination of the various Federal programs that collect, 
analyze, and report the health statistics necessary for policy 
development and public health interventions. The Committee 
encourages the Director to consider contracting for a study 
with the Institute of Medicine to provide for a comprehensive 
review the adequacy of the programs, structure, and 
coordination of Federal programs necessary to provide for 
timely, accurate, and comprehensive health statistics.

HIV/AIDS, STD and TB prevention

    The Committee provides $1,247,388,000 for HIV/AIDS, STD and 
TB prevention, which is $61,000,000 above the fiscal year 2003 
comparable level and $33,788,000 below the request. Of the 
amount provided, $942,189,000 is for the HIV/AIDS programs, of 
which $242,569,000 is for global HIV/AIDS programs; 
$168,572,000 is for the STD program; and $136,627,000 is for 
the TB program.
    The HIV/AIDS programs support HIV research, surveillance, 
epidemiologic and laboratory studies, and prevention 
activities. CDC provides funds to state and local health 
departments to develop and implement integrated community 
prevention plans. The STD program awards grants to state and 
local health departments and other nonprofit entities to 
support a wide variety of public health activities to prevent 
and treat STDs. CDC directly conducts special investigations, 
surveillance and epidemiologic research. The tuberculosis 
program provides grants to States and large cities for a broad 
range of tuberculosis control activities. In addition, the CDC 
supports state and local laboratories and conducts research, 
epidemiological investigations, and education and training 
seminars.
    Domestic HIV/AIDS Prevention.--The Committee applauds CDC's 
steps to emphasize HIV testing to identify infected persons who 
are not aware of their own infection to get them into treatment 
and prevention services. This initiative seeks to incorporate 
HIV testing as a routine part of care in traditional medical 
settings; implement new models for diagnosing HIV infections 
outside medical settings; prevent new infections by working 
with people diagnosed with HIV and their partners; and further 
decrease mother-to-child HIV transmission.
    Mother and Child HIV/AIDS Prevention.--Within the amount 
provided for Global HIV/AIDS, not less than $100,000,000 is for 
the International Mother and Child HIV/AIDS Prevention 
Initiative.
    Minority HIV/AIDS Initiative.--Within the total provided, 
the Committee expects the CDC to allocate not less than the 
fiscal year 2003 level for activities that are targeted to 
address the growing HIV/AIDS epidemic and its disparate impact 
on communities of color, including African Americans, Latinos, 
Native Americans, Asian Americans, Native Hawaiians, and 
Pacific Islanders. The Committee expects CDC to follow the 
fiscal year 2002 report accompanying this bill regarding the 
disbursement of these funds.
    Included in the total funding for CDC's Minority HIV/AIDS 
Initiative, the Committee provides funds for the Directly 
Funded Minority Community Based Organization Program to fund 
grant applications from minority community based organizations 
with a history of providing services to communities of color to 
develop and expand HIV prevention interventions and services 
targeted to highly impacted minority men, women, youth and sub-
populations.
    Tuberculosis.--The Committee provides $136,627,000 for 
Tuberculosis (TB) prevention and control, an increase of 
$1,000,000 over the fiscal year 2003 comparable level and 
$5,250,000 above the request.
    The Committee commends CDC for its continued efforts to 
control TB in the U.S., as demonstrated by nearly a decade of 
declining TB trends reported. The Committee remains concerned 
that the overall decline conceals large gaps in two specific 
populations, U.S. born African Americans and the foreign born 
that accounts for two-thirds of the cases in the U.S.
    With respect to the foreign born cases of TB, until global 
control efforts are more effective and new treatments and 
vaccines are developed, the global crisis on TB will continue 
to directly impact the U.S. Therefore, the Committee urges CDC 
to continue working with domestic partners to maintain strong 
prevention and control programs and to work with international 
partners assuring the success of international control 
programs.
    The Committee is aware of unique programs in Oklahoma and 
Florida using faith-based organizations working with foreign-
born individuals to assist in prevention, and control of TB and 
urges the CDC to support these model programs.
    The Committee also recognizes the prevalence of TB 
infections in the U.S.-Mexico border territory and encourages 
the CDC to work with the government of Mexico to engage them on 
the prevention and control of TB.
    Finally, the Committee encourages the CDC to support the 
development of new TB treatments and the development of an 
effective TB vaccine and recommends CDC consider partnering 
with private foundations in order to further research in the 
areas of development of vaccines, therapeutics, diagnostic 
tests, and new drugs and to test the applicability of new 
tools, as outlined in the recent Institute of Medicine Report 
entitled, ``Ending Neglect: The Elimination of Tuberculosis in 
the United States''.

Immunization

    The Committee provides $650,586,000 for immunization, which 
is the same as the fiscal year 2003 comparable level after 
adjusting for the use of evaluation funds and $30,080,000 above 
the request. In addition, the Vaccines for Children (VFC) 
program is expected to provide $980,196,000 in vaccine 
purchases and distribution support in fiscal year 2003.
    Immunization project grants are awarded to States and local 
agencies for planning, developing, and conducting childhood 
immunization programs including enhancement of the vaccine 
delivery infrastructure. CDC directly maintains a stockpile of 
vaccines, supports consolidated purchase of vaccines for state 
and local health agencies, and conducts surveillance, 
investigations, and research into the safety and efficacy of 
new and presently used vaccines. The Committee notes that there 
are other Federal programs that provide immunizations to 
children, including the State Children's Health Insurance 
Program (SCHIP), the Maternal and Child Health Block Grant, and 
community health centers.

Infectious diseases control

    The Committee provides $382,226,000 for infectious diseases 
control, which is $23,000,000 above the fiscal year 2003 
comparable level and $50,586,000 above the request.
    The program supports national surveillance of infectious 
diseases, the development of new or improved prevention and 
control methods and techniques, the acceleration of the general 
application of accepted prevention technologies, and 
strengthening of the capability to respond to outbreaks of new 
and re-emerging infectious diseases.
    Within the total provided, $18,000,000 above the fiscal 
year 2003 comparable level is for the Director to allocate to 
areas of highest scientific and programmatic priority in 
preparing and responding to present and emerging infectious 
disease threats.
    Within the total provided, $1,000,000 above the fiscal year 
2003 comparable level is to continue expansion of the Center's 
prion disease surveillance, research, and prevention 
activities.
    Within the total provided, not less than $4,000,000 above 
the fiscal year 2003 comparable level is to continue planned 
activities and expand efforts to prevent and control the West 
Nile virus.
    Chronic Fatigue Syndrome.--The Committee is pleased that 
CDC is restoring funds for CFS research and that these funds 
are being used in substantive areas. The Committee encourages 
CDC to continue the establishment of a national registry to 
examine such things as: studies of etiologic agents, diagnostic 
markers, natural history, and risk factors using specialized 
molecular epidemiology techniques and advanced surveillance 
methodologies.
    Cooley's Anemia.--The Committee is pleased with the 
progress that CDC has made with regard to the establishment of 
a blood safety surveillance program for Cooley's anemia 
patients, who are the largest consumers of red blood cells. The 
program involves six treatment centers that handle the medical 
aspects, and the Cooley's Anemia Foundation that provides 
education and awareness, patient recruitment and other 
services, while CDC has established an archive of tested and 
analyzed blood samples. As the program moves forward and one 
time start-up costs are expended, the Committee encourages CDC 
to direct a growing percentage of the money to assure the 
highest quality services are available to the largest number of 
patients possible.
    Hemophilia.--The Committee urges the CDC to continue 
working closely with the National Hemophilia Foundation to 
strengthen its disease management, prevention, outreach, and 
blood safety surveillance programs for meeting the needs of 
persons with hemophilia, other bleeding and clotting disorders, 
and particularly, women with bleeding disorders.
    Hepatitis C.--The Committee is aware that the three year 
funding cycle for the several hepatitis C prevention 
demonstration projects expires at the end of fiscal year 2003 
and urges that priority be given to an analysis of these 
several demonstrations and the development and implementation 
of best practices.
    Monkeypox.--The Committee commends CDC for its response to 
the recent outbreak of monkeypox in several Midwestern states, 
and expects CDC to continue its efforts to analyze and contain 
that outbreak. In doing so, the Committee urges CDC to continue 
to work closely with the Agriculture Department's Animal and 
Plant Health Inspection Service (APHIS) to facilitate a 
comprehensive federal response to the outbreak.
    West Nile Virus.--The Committee is aware of the Centers for 
Disease Control and Prevention's efforts to complete a national 
plan for West Nile virus response, including surveillance, 
prevention, and control of the virus nationwide. Local health 
agencies and other parts of local governments play a 
significant role in combating outbreaks. Consequently the 
Committee urges that they be integrally involved in the 
development and implementation of a national plan. Further, the 
Committee directs CDC to submit a report within 90 days of 
enactment of this Act detailing the amounts of FY 2002 and FY 
2003 West Nile Virus funding that: (a) each State spent or 
plans to spend to directly benefit or improve local capacity 
and (b) the amount each State has directly granted to local 
agencies.

Injury prevention and control

    The Committee provides $152,414,000 for the injury control 
program, which is $4,000,000 above the fiscal year 2003 
comparable level and $7,618,000 above the request. The injury 
prevention and control program supports intramural research, 
injury control research centers, extramural research grants, 
and technical assistance to state and local health departments.
    Gun Control Advocacy.--The Committee recommendation 
maintains language carried in the fiscal year 2003 bill and 
prior years prohibiting federal funds from being used to lobby 
for or against the passage of specific federal, state or local 
legislation intended to advocate or promote gun control. The 
Committee understands that the CDC's responsibility in this 
area is primarily data collection and the dissemination of that 
information and expects that research in this area to be 
objective and grants to be awarded through an impartial, 
scientific peer review process.
    National Violent Death Reporting System.--The Committee is 
pleased with the progress that has been made towards 
implementation of a system of more timely, complete, objective 
and accurate information about violent deaths and injuries. The 
Committee encourages CDC to continue its implementation of this 
model plan.
    Prevention of Child Maltreatment.--The Committee 
recommendation includes $3,000,000 above fiscal year 2003 to 
support public health surveillance and research for child 
maltreatment prevention programs.
    Traumatic Brain Injury.--Within the funds provided, 
$1,000,000 above the fiscal year 2003 comparable level is for 
expanding the activities of the Traumatic Brain Injury program.

Occupational safety and health

    The Committee provides $273,385,000 for occupational safety 
and health, which is the same as the fiscal year 2003 
comparable level, after adjusting for evaluation funds, and 
$27,056,000 above the request.
    This program conducts applied research, develops criteria 
for occupational safety and health standards, and provides 
technical services to government, labor and industry, including 
training for the prevention of work-related diseases and 
injuries. This appropriation supports surveillance, health 
hazard evaluations, intramural and extramural research, 
instrument and methods development, dissemination, and training 
grants.
    National Occupational Research Agenda (NORA).--The 
Committee recommendation restores the reduction proposed in the 
request for research associated with NIOSH's NORA program.
    Personal Protective Equipment.--The Committee strongly 
supports NIOSH's efforts for program activities in domestic 
terrorism preparedness and their work to carry out the NIOSH 
CBRN respirator program. The Committee believes significant 
work must be done to continue to protect emergency responders 
from biological and chemical terrorism exposures, as well as 
industrial accidents. Fire fighters, emergency medical 
personnel, and other on-site workers need reliable personal 
protective equipment, principally protective masks and 
respirators, but also protective clothing and detection devices 
to be able to effectively help victims in case of exposure to 
biological or chemical terrorist agents.
    NIOSH has made significant progress in the past year and is 
to be commended for working closely with manufacturers and 
first-responder representatives to create equipment that will 
protect our nation's workers. The self-contained breathing 
apparatus (SCBAs) are now approved and on the market, and the 
upgrade kits for items in current service are being approved. 
From there, NIOSH is expected to look at escape hoods and other 
equipment needed to protect first responders and civilians in 
the event of a chemical or biological terrorist attack, as well 
as to protect them from industrial accidents.
    In addition, the Committee encourages NIOSH to investigate 
the feasibility of the use of the military masks about to be 
surplused as the US military moves to a new mask that NIOSH and 
Fort Detrick are cooperatively creating. The Committee expects 
NIOSH to be prepared report on its findings during the fiscal 
year 2005 budget hearings.
    Personal Dust Monitors.--The Committee understands that 
NIOSH currently is testing the next generation of monitors for 
measuring dust levels in mines. Within the funds provided for 
NIOSH, the Committee has included sufficient funds to purchase 
up to 25 additional personal dosymmetry monitors.

Preventive health and health services block grant

    The Committee provides $134,089,000 for the preventive 
health and health services block grant, which is the same as 
the fiscal year 2003 comparable level and $877,000 below the 
budget request. This program provides grants to States by 
formula for a wide range of public and preventive health 
activities.

Public health improvement

    The Committee provides $144,530,000 for public health 
improvement, which is $8,504,000 below the fiscal year 2003 
comparable level, after adjusting for evaluation funds, and 
$30,853,000 above the request.
    This program funds activities designed to close the 
Nation's gap in public health capacity and strengthen the 
practice of public health at the front lines, develop improved 
interventions and services, help racial and ethnic minority 
communities mobilize and organize their resources to support 
effective and sustainable programs that will contribute to the 
elimination of health disparities, and develop and implement 
national data standards for surveillance reporting.
    Health Tracking Network.--The Committee has not included 
funds for the development of a Health Tracking Network within 
Public Health Improvement as proposed in the request. Instead, 
funds have been included within funds available for 
Environmental Health as was provided for in fiscal year 2003.
    Extramural Prevention Research.--The Committee 
recommendation restores the proposed reduction in the request 
for extramural prevention research. The Committee is aware of 
the importance of the Prevention Research program. This program 
awards peer-reviewed grants to academic health centers in 
partnership with community-based organizations to demonstrate 
and measure the performance of promising prevention 
initiatives. It is one example of CDC's commitment to 
extramural research in support of evidence-based prevention 
programs.
    Global Disease Detection, Communications, and Public Health 
Research.--The Committee recommendation provides $30,000,000 
within Public Health Improvement for high priority scientific 
and programmatic activities. The amount, coupled with increases 
provided for Infectious Disease Control, roughly equals the 
amount of savings resulting from the Information Technology and 
Management reductions assumed in the request, and provided for 
in Sec. 218. The Committee intends that the additional funds be 
directed into the following scientific and programmatic 
activities: Public Health Research, Global Disease Detection, 
and Communications.

Buildings and facilities

    The Committee provides $206,000,000 for buildings and 
facilities, which is $60,258,000 below the fiscal year 2003 
comparable level and $92,000,000 above the request.
    These funds support construction and ongoing maintenance 
projects, as well as essential safety repairs and equipment 
purchases. The funds provided will support high priority work 
identified in the CDC's Buildings and Facilities Master Plan 
phased planning effort. Funds also will be used to support the 
2nd year costs of replacing the CDC's Vector Borne Infectious 
Diseases Laboratory in Ft. Collins, CO.
    The Committee recommendation includes bill language to 
allow the CDC to enter into a single contract or related 
contracts for the full scope of development and construction of 
facilities. It also carries language included in the 
Departments of Labor, Health and Human Services and Education, 
and Related Agencies Appropriations Act, 2003 to allow funds 
appropriated to the CDC to be used to enter into a long-term 
ground lease for construction on non-Federal land, in order to 
replace their laboratory in the Fort Collins, Colorado area.
    ``Data Security and Storage.--Within the amount provided 
$6,000,000 is for data center storage infrastructure hardware 
and software upgrades. This funding is to provide for the 
remote mirroring of information between CDC data centers and 
recovery sites, and to provide heterogeneous connectivity to 
existing systems in use at the CDC, in order to ensure the 
protection, recovery, and availability of critical resources; 
as well as to provide for enhanced security-specific 
technologies and services in concert with critical 
infrastructure protection requirements.''

Office of the Director

    The Committee provides $49,707,000 for the activities of 
the Office of the Director, which is $281,000 above the fiscal 
year 2003 comparable level and $10,000,000 below the request.
    The Committee intends this amount to be a ceiling. The 
Director may transfer these funds to non-administrative, 
programmatic activities at her discretion.
    Public Health Resarch/Global Disease Detection and 
Communications.--The Committee commends CDC for efforts to 
achieve efficiency savings in the areas of Information 
Technology and Administrative Management. The Committee 
recommendation includes a provision, Sec. 217 that reduces 
funds available for information technology and administrative 
management by $49,982,000, the same as the amount recommended 
in the request. The Committee intends that the Director have 
the flexibility to allocate these savings across the various 
activities in a manner that ensures that high priority 
scientific and programmatic activities are not compromised.

Bioterrorism

    The Committee provides $1,116,156,000 for CDC bioterrorism 
activities, within the Public Health and Social Services 
Emergency Fund. This is $119,268,000 below the fiscal year 2003 
comparable level and the same as the request.
    Within the total provided: $940,000,000 is for State and 
Local Preparedness; $151,161,000 is for Upgrading CDC Capacity; 
$18,040,000 is for Anthrax Vaccine Research; $4,968,000 is for 
Public Health Preparedness Centers; and $1,987,000 is for 
Independent Studies.
    Smallpox Vaccination Program.--The Committee recognizes 
that serious public concerns about side-effects of the vaccinia 
vaccine for protection against smallpox pose challenges to the 
program's successful implementation. The Committee encourages 
the CDC to explore the efficacy and feasibility of using modern 
pharmacogenomic technologies to identify individuals at risk 
for serious adverse reactions to a smallpox vaccination.

                     National Institutes of Health

    The Committee provides $27,663,991,000 for the twenty-six 
appropriations which together fund the programs of the National 
Institutes of Health (NIH). These include appropriations for 
the 19 research Institutes, the National Center for Research 
Resources, the John E. Fogarty International Center, the 
National Library of Medicine, the National Center for 
Complementary and Alternative Medicine, the National Center on 
Minority Health and Health Disparities, the Office of the 
Director, and Buildings and Facilities. The total in the bill 
is $681,387,000 above the fiscal year 2003 comparable level and 
the same as the budget request. The Committee notes that under 
the President's budget proposal, one-time costs from the fiscal 
year 2003 budget are converted to research costs in fiscal year 
2004, generating an effective real increase in NIH spending of 
more than six percent.
    Biodefense.--The Administration's FY04 budget for NIH 
includes $1,625,000,000 for bioterrorism activities. The 
Committee recognizes the importance of this research activity, 
but is concerned about the limited increases this budget makes 
available for important non-biodefense research. The Committee 
has not identified a specific funding level for biodefense 
research, choosing to give the Director of NIH flexibility in 
determining what share of NIH resources should be considered 
biodefense activities. If, during 2004, the Director determines 
that a different allocation of resources is possible to 
increase support for high priority non-biodefense activities, 
the Committee would look favorably upon that reallocation.
    Balance in the research portfolio.--The Committee 
reiterates its longstanding view that NIH should distribute 
funding on the basis of scientific opportunity. The Committee 
urges the Director and the Administration to continue to resist 
pressures to earmark, set aside and otherwise politicize these 
resources. To enhance NIH's flexibility to allocate funding 
based on scientific opportunity, the Committee has attempted to 
minimize the amount of direction provided in the report 
accompanying the bill. For example, there are no directives to 
fund particular research mechanisms, such as centers or 
requests for applications, or specific amounts of funding for 
particular diseases.
    In stating that scientific opportunity should be the basis 
for allocating research funding, the Committee understands that 
other factors also are relevant to NIH's decisions, including 
such considerations as the infectious nature of a disease, the 
number of cases and deaths associated with a particular 
disease, the Federal and other costs of treating a disease, the 
years of productive life lost due to a particular disease, and 
the estimated proximity to research breakthroughs. The 
Committee does not presume to judge which criteria should take 
precedence or carry the greatest weight in individual funding 
decisions, but urges NIH to consider the full array of relevant 
criteria as it constructs its research portfolio.
    AIDS funding.--Consistent with the philosophy outlined 
above, the Committee has chosen not to earmark a specific 
dollar amount for AIDS research. The Committee understands that 
it would be NIH's intent to allocate AIDS funding consistent 
with the Director's recommendations. The Committee understands 
that this allocation may change before the beginning of the 
fiscal year.
    The Committee intends that the funds allocated for AIDS 
should be spent in a manner fully consistent with the AIDS 
research plan developed by the Office of AIDS Research (OAR) 
and expects the Director of NIH to use the full authority of 
his office to ensure that this occurs. The Committee has 
provided the Director of OAR, jointly with the Director of NIH, 
transfer authority to reallocate up to three percent of funds 
designated for AIDS research among Institutes, subject to 
normal reprogramming procedures. The Committee encourages NIH 
to use this authority whenever it believes that an adjustment 
in the allocation of AIDS funding between Institutes is 
appropriate to achieve scientific objectives or to facilitate 
promising research efforts.
    The Committee continues to support OAR, its leadership, and 
its coordinated budget planning process and expects the 
individual institutes, centers and divisions to fully cooperate 
with OAR's work. The Committee has provided funding for the OAR 
within the Office of the Director and intends that the OAR will 
maintain its current structure and responsibilities, including 
the allocation of an emergency discretionary fund.

                       NATIONAL CANCER INSTITUTE

    The Committee provides $4,770,519,000 for the National 
Cancer Institute (NCI), which is $178,171,000 above the fiscal 
year 2003 comparable level and the same as the budget request.
    Mission.--The NCI conducts and supports basic and applied 
cancer research in early detection, diagnosis, prevention, 
treatment and rehabilitation. NCI provides training support for 
research scientists, clinicians and educators, and maintains a 
national network of cancer centers, clinical cooperative 
groups, and community clinical oncology programs, along with 
cancer prevention and control initiatives and outreach programs 
to rapidly translate basic research findings into clinical 
practice.
    Prostate cancer.--Cancer of the prostate is the most 
commonly diagnosed non-skin cancer in America and tends to 
disproportionately affect men who are members of minority 
groups. If detected early, it can be treated successfully with 
no negative impact on the cancer survivor's quality of life. 
However, existing forms of detection are insufficient, and 
available treatments frequently result in erectile dysfunction, 
urinary problems, or other disorders and disruptions that 
negatively impact the patient's quality of life. The Committee 
encourages NCI to place an increased priority on research 
through all available mechanisms, as appropriate, including 
clinical trials that result in earlier, more reliable detection 
methods and more effective and less disfiguring treatment 
regimes. The Committee encourages NCI to identify a budget 
strategy with specific prostate cancer funding opportunities 
and priority investments.
    Cancer centers.--The Committee is pleased with the 
substantial progress in cancer research and the many 
opportunities that have been created by the sustained 
investment in biomedical research and technology. One of the 
most successful investments by NCI is the Cancer Centers 
program, which has the potential to accelerate progress further 
by linking its state-of-the-art resources with the broader 
cancer community. In order to speed progress and promote 
greater collaboration among scientists, the Committee requests 
that NCI explore innovative and creative ways to share 
information throughout the cancer community, utilizing the 
infrastructure of the national cancer centers program.
    Given that minority populations suffer disproportionately 
from virtually every form of cancer, the Committee encourages 
NCI to give consideration to the establishment of a 
comprehensive center at a minority institution focused on 
research, treatment, and prevention of cancer in African 
American and other minority communities.
    Neurofibromatosis (NF).--The Committee is pleased that NCI 
is conducting phase II clinical trials of NF1 patients with 
plexiform neurofibromas. The Committee is concerned about 
recent declines in funding for NF research, recognizing NF's 
connection to many of the most common forms of human cancer. 
The Committee encourages NCI to substantially increase its 
efforts in NF research in further development of animal models, 
natural history studies, therapeutic experimentation, and 
clinical trials.
    Liver cancer.--The Committee is concerned that primary 
liver cancer continues to be one of the few forms of cancer for 
which incidence is growing. While progress is being made, much 
more needs to be done. NCI is planning a joint meeting with 
NIDDK for April 2004. The Committee hopes that this meeting 
will result in a strong plan for future research in liver 
cancer that will reverse the current increases.
    Lymphoma.--The Committee recommends that NCI increase its 
efforts to examine the issue of environmental and viral links 
to lymphoma. Although many studies have suggested an increased 
risk of lymphoma associated with environmental factors such as 
chemicals, pesticides and herbicides, other investigations have 
reported inconsistent results. However, many of these studies 
are weakened by limited sample sizes, flaws in study design, 
and imprecision in the measurement of environmental carcinogen 
exposures. The Committee recommends that NCI work to develop a 
well-constructed prospective study, using a multidisciplinary 
approach to examine environmental links to lymphoma.
    In a recent report, the Institute of Medicine concluded 
that there is moderate to strong biological evidence supporting 
a role of Simian Virus 40 in human cancer. Recent reports 
suggest that more than 40% of lymphomas tested were positive 
for this virus. Additional research studies have also found an 
association between other viruses, such as human herpes virus 8 
and hepatitis C, and lymphoma. As a result of these studies, it 
is possible that more than half of all lymphomas may be 
attributed to viruses. The Committee encourages NCI to increase 
its efforts to examine the viral etiology of lymphoma.
    Pancreatic cancer.--Pancreatic cancer is the fifth leading 
cause of cancer death, and 99 percent of those diagnosed with 
pancreatic cancer die within six months. The Committee 
encourages NCI to begin to implement the short- and medium-term 
strategies identified in the strategic plan to address the 
recommendations of the pancreatic cancer progress review group. 
NCI is encouraged to place particular emphasis on developing a 
critical mass of researchers in pancreatic cancer. The 
Committee requests a report in March, 2004 of the specific 
budgetary and programmatic actions planned to respond to the 
strategic plan.
    Hodgkin's and Non-Hodgkin's lymphoma--More than 61,000 
Americans will be diagnosed with Hodgkin's lymphoma and non-
Hodgkin's lymphoma (NHL) in 2003. The Committee notes that 
there have been significant advances in the treatment of 
Hodgkin's lymphoma over the last thirty years and some 
improvements in the treatment of NHL. However, NHL treatments 
are not adequate, and treatment improvements are critical for 
this group of cancer patients. The Committee encourages NCI to 
increase its investment in clinical research on lymphoma and 
strengthen its collaboration with industry to improve the 
efficiency and timeliness of the lymphoma drug development 
process. The Committee recommends that, in addition to 
initiatives to improve the lymphoma drug development process, 
NCI increase its investment in several other areas of research, 
including research on nonablative transplants, immunomodulatory 
regimens, central nervous system lymphoma, the late and long-
term effects of current lymphoma treatments, and lymphoma 
etiology and prevention. The Committee also encourages NCI to 
cooperate with private organizations in the development of a 
comprehensive lymphoma tissue bank.
    Myelodysplasia and myeloproliferative disorders.--The 
Committee is pleased with NCI's efforts to address the lack of 
basic knowledge about myelodysplasia and myeloproliferative 
disorders, two very different types of chronic diseases of bone 
marrow cells that can develop into acute leukemia. The 
Committee encourages NCI to carry out the recommendations of 
its recent conference of experts on these diseases and to 
advance new research initiatives into developing effective 
treatments.
    Brain tumors.--Each year, more than 100,000 new brain tumor 
cases are diagnosed, including tumors that arise in the brain 
and tumors that spread to the brain from other cancers such as 
breast and lung. Cancer is the second leading cause of death in 
children, and brain tumors are the second most common childhood 
cancer. The causes of brain tumors remain largely unknown, and 
there are virtually no means of prevention. Scientists have 
begun to develop better and less toxic treatments for brain 
tumors, which will produce longer survival and higher quality 
of life. The Committee encourages NCI, in cooperation with the 
National Institute of Neurological Disorders and Stroke, to 
more fully support brain tumor research, including the brain 
tumor specialized programs of research excellence (SPORE) 
grants. The Committee is aware of the ongoing need to develop 
brain tumor tissue banks and encourages NCI and NINDS to 
consider developing a plan to establish coordinated tumor banks 
that would bank not only tissue but also blood and 
cerebrospinal fluid from patients with all varieties of brain 
tumors. The Committee requests a copy of the plan within six 
months of enactment of this bill.
    Cancer genomics.--The Committee commends NCI for its 
commitment to understanding the role of genomics and genetics 
in the progression of cancer. Considerable effort must now be 
directed toward applying those findings to tumor classification 
and therapeutic choice, with a focus on breast, colorectal and 
lung cancer, as well as leukemia and lymphoma. An important 
component of this effort will be to build a public database of 
whole genome expression profiles from various tumor types, 
which includes clinical outcome information. The Committee 
encourages NCI to ensure that this data is available to health 
professionals to assist physicians and patients in choosing the 
best treatment options.
    American Russian Cancer Alliance.--The American Russian 
Cancer Alliance is established to implement long-term 
collaborative programs for clinical and research activities 
that ultimately benefit cancer patients worldwide. The 
Committee acknowledges and recognizes the significant effort of 
the American Russian Cancer Alliance in reducing mortality and 
morbidity of cancer globally. The Committee recommends that NCI 
promote, facilitate, and support the development of the 
Alliance in order to bolster cancer research and treatment 
opportunities in the United States Cancer Centers.
    Bone metastases.--The Committee urges NCI to continue its 
emphasis on studying the bone microenvironment and bone 
metastasis related to prostate cancer, breast cancer and 
multiple myeloma and to support research to delineate the 
mechanisms of reciprocal interactions between tumor cells and 
bone. NCI is also encouraged to establish a repository of human 
bone metastases for the scientific community and support 
research to generate three-dimensional in vitro and/or in vivo 
models that yield bone metastasis.
    Tobacco harm reduction.--The Committee is aware that NCI 
has established the Tobacco Control Research Branch, which is 
designed to reduce cancer incidence and mortality caused by 
tobacco use through a comprehensive research program, and 
applauds the establishment of a collaborative research effort 
between the NCI and the CDC related to the analysis of tobacco 
products and harm reduction. The Committee is aware of a 2001 
report from the Institute of Medicine entitled ``Clearing the 
Smoke, Assessing the Science Base for Tobacco Harm Reduction.'' 
This report notes that despite overwhelming evidence and 
widespread recognition that tobacco use poses a serious risk to 
health, some tobacco users cannot or will not quit, and raises 
the question of whether or not addicted tobacco users who do 
not quit could reduce the health risks of tobacco products. NCI 
should be prepared to report to the Committee during the fiscal 
year 2005 budget hearings regarding the findings of this 
collaboration with regard to the effectiveness of harm 
reduction for those tobacco users who are unable to quit.

               NATIONAL HEART, LUNG, AND BLOOD INSTITUTE

    The Committee provides $2,867,995,000 for the National 
Heart, Lung, and Blood Institute (NHLBI), which is $74,262,000 
above the fiscal year 2003 comparable level and the same as the 
budget request.
    Mission.--The National Heart, Lung, and Blood Institute 
provides leadership for a national research program in diseases 
of the heart, blood vessels, lungs, and blood, in transfusion 
medicine, and in sleep disorders through support of basic, 
clinical, and population-based and health education research.
    Cardiovascular diseases.--The Committee continues to regard 
research into the causes, cure, prevention and treatment of 
heart disease, stroke and other cardiovascular diseases as a 
top priority. Cardiovascular diseases remain a leading cause of 
death and permanent disability in the United States. The 
Committee continues to believe that an intensive research 
program in these areas is necessary.
    Tuberculosis and AIDS interaction.--The Committee supports 
the important research on the interaction of tuberculosis and 
AIDS conducted by the NHLBI AIDS research program and 
encourages NHLBI to strengthen its research in this important 
area.
    Chronic obstructive pulmonary disease (COPD).--The 
Committee is aware that chronic obstructive pulmonary disease 
(COPD) is a major cause of chronic morbidity and mortality 
throughout the world. The Committee congratulates the NHLBI for 
its collaborative effort with the World Health Organization 
(WHO) to release the report on the global burden of COPD. NHLBI 
is encouraged to utilize the report to increase awareness of 
COPD in the public and research community. The Committee 
encourages NHLBI to expand research to improve prevention, 
early diagnosis and management of COPD, especially on pediatric 
origins of COPD.
    Juvenile Diabetes.--Vascular complications including 
cardiovascular, peripheral vascular, and cerebrovascular are a 
major cause of mortality and morbidity in persons with 
diabetes--particularly in those with juvenile diabetes. NHLBI 
is urged to focus on initiatives specifically relating to 
individuals with juvenile diabetes, who experience accelerated 
and severe complications as a result of hyperglycemia, such as 
atherosclerosis, vascular inflammation, and microvascular 
disease.
    Scleroderma.--The Committee encourages NHLBI to undertake 
research to study the cause and treatment of scleroderma, a 
chronic and progressive disease that predominantly strikes 
women. Scleroderma is disfiguring and can be life-threatening, 
affecting multiple systems including the heart and lungs. More 
research is needed in order to develop safe, effective 
treatments and to identify the cause or causes of the 
complications of scleroderma that include pulmonary fibrosis, 
pulmonary hypertension, myocardial fibrosis, cardiac 
arrhythmias, pericarditis, and Raynaud's Phenomenon.
    Hemophilia.--The Committee commends NHLBI for its 
leadership in advancing research on bleeding disorders and the 
complications of these disorders, including inhibitor 
development and improved treatments such as gene therapy. The 
Committee encourages NHLBI to continue to partner with other 
NIH Institutes and voluntary associations in further expanding 
opportunities for hematologic research through clinical 
research networks. The Committee also requests a report by 
March 31, 2004 on the status of research on type 1 and 2 von 
Willebrand disease and how NHLBI plans to expand research in 
this important area.
    Transmissible spongiform encephalopathies.--The Committee 
encourages NHLBI to enhance its efforts to develop a diagnostic 
test for TSE that would be suitable for screening the blood 
supply. Currently, there is no suitable method for identifying 
TSE-infected blood. In addition, the Committee encourages NHLBI 
to seek new technologies and procedures for inactivating blood-
borne causative agents for human TSEs, further ensuring a safe 
blood supply. Human TSEs, for which there are no known 
treatments, include Creutzfeld-Jakob disease and new variant 
Creutzfeldt-Jakob disease.
    Lupus.--There are many more data on younger women with 
lupus having heart disease in their teens and twenties. The 
Committee encourages NHLBI to enhance its efforts to study the 
inflammatory mechanisms of atherosclerosis that are prominent 
in lupus and that can be found in the wider aging population.
    Cooley's anemia.--The Committee remains strongly supportive 
of the Institute's efforts in creating the Thalassemia Clinical 
Research Network, which is comprised of the country's leading 
research entities on thalassemia, or Cooley's anemia. The 
Committee believes that research into this disease has 
implications far beyond this patient population and that all 
reasonable steps should be taken to ensure that the Network 
reaches its maximum potential. In addition, the Committee 
encourages NHLBI to join with the Centers for Disease Control 
and Prevention and the Food and Drug Administration to enhance 
blood safety.
    Pulmonary hypertension.--Pulmonary hypertension (PH) is a 
rare, progressive and fatal disease that predominantly affects 
women, regardless of age or race. PH causes deadly 
deterioration of the heart and lungs and is a secondary 
condition in many other serious disorders such as scleroderma 
and lupus. The Committee views research in this area as a high 
priority and commends NHLBI's efforts to promote PH-related 
research. The Committee continues to urge the Institute to 
enhance basic research, gene therapy and clinical trials of 
promising pharmaceuticals, and to work with the research 
community to stimulate the submission of high quality proposals 
in this area.
    Neurofibromatosis (NF).--Significant advances continue to 
be made in research on NF's implications with heart disease and 
in particular its involvement with hypertension and congenital 
heart disease which together affect over fifty million 
Americans. Accordingly, the Committee urges NHLBI to enhance 
its NF research portfolio.
    Myelodysplasia and myeloproliferative disorders.--The 
Committee encourages NHLBI to fund research in myelodysplasia 
and myeloproliferative disorders, specifically into the 
vascular, thrombotic, and hemorrhagic abnormalities associated 
with myeloproliferative disorders, as well as the specific 
abnormalities in cell gene expression that are responsible for 
these diseases.
    Obstructive sleep apnea.--Symptomatic sleep apnea is common 
in middle-age adults, and far more frequent in the elderly. 
Moreover, asymptomatic sleep apnea is epidemic with as much as 
25 percent of middle-aged adults and up to 81 percent of the 
elderly afflicted. Untreated sleep apnea results in mortality, 
cardiovascular disease, and quality of life deficits. The 
Committee recommends that NHLBI in collaboration with the 
National Institute on Aging support research to define useful 
treatments--including surgical treatments--for the large 
segment of the general population that suffers from 
insufficiently treated obstructive sleep apnea.
    Marfan syndrome.--The Committee commends NHLBI for its past 
and ongoing support of research on aortic aneurysms, which are 
pathologically related to the Marfan syndrome. Marfan syndrome 
is a life-threatening, progressive and degenerative genetic 
disorder affecting the heart, lungs, skeleton and eyes. The 
Committee urges NHLBI to expand its aneurysm research efforts 
to include both basic and clinical research in the area of 
Marfan syndrome as was suggested at a recent NHLBI Working 
Group Meeting.
    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. The 
Committee therefore is pleased to note that NHLBI, in 
collaboration with the National Institute on Aging (NIA), is 
supporting cardiovascular health studies that are examining the 
natural history of the development of Alzheimer's and 
identifying individuals at high risk of developing the disease. 
Ancillary studies also are underway to determine the 
contribution of vascular factors to Alzheimer's. The Committee 
encourages NHLBI to continue to pursue this line of research 
and to work collaboratively with NIA.
    Diamond-blackfanse anemia (DBA).--The Committee is pleased 
that NHLBI has developed a comprehensive research strategy for 
DBA based on the NIH workshop held to evaluate the state of the 
science. The Committee encourages NHLBI to pursue research on 
DBA's genetic predispositions to cancer and birth defects as 
well as gene therapy and to strengthen the DBA national 
registry.
    Peripheral arterial disease (PAD).--The Committee is aware 
that an estimated 8 to 12 million Americans have PAD, a 
progressive disease that can lead to reduced mobility, 
amputation and death. Over the last decade a large body of 
evidence has established PAD as an important predictor of both 
heart disease and stroke. Risk factors for PAD include high 
blood pressure, high cholesterol levels, diabetes, smoking and 
obesity. Although PAD can be easily diagnosed with a simple, 
non-invasive test, the lack of awareness of PAD among doctors 
and patients leads to under-diagnosis and under-treatment. 
Furthermore, studies suggest that despite comparable rates of 
prevalence between women and men and minorities and Caucasians, 
women and minorities are less likely to be diagnosed with PAD 
and experience poorer outcomes than do white men. The Committee 
encourages NHLBI to develop research initiatives in the area of 
PAD, including studies to improve the diagnosis and treatment 
of women and minorities. The Committee also encourages NHLBI to 
support educational programs directed to health professionals, 
patients and the public to raise awareness of PAD as a risk 
factor for heart disease and stroke.

         NATIONAL INSTITUTE OF DENTAL AND CRANIOFACIAL RESEARCH

    The Committee provides $382,396,000 for the National 
Institute of Dental and Craniofacial Research (NIDCR), which is 
$10,760,000 above the fiscal year 2003 comparable level and the 
same as the budget request.
    Mission.--The NIDCR conducts and supports research and 
research training to improve craniofacial, oral and dental 
health. The Institute's programs reflect the genetic, 
behavioral and environmental factors that result in complex 
human disease and are clustered into the following areas: 
inherited disorders; infection and immunity; oral, pharyngeal 
and laryngeal cancers; chronic and disabling conditions such as 
bone and joint diseases and chronic pain; behavioral science, 
epidemiology and health promotion; and tissue engineering and 
biomimetics research to improve diagnostics and tissue repair 
and regeneration.
    Scleroderma.--The Committee is encouraged by NIDCR's 
interest in scleroderma, a chronic and progressive disease that 
predominantly strikes women. Scleroderma is disfiguring and 
life-threatening; and effective treatments are lacking. 
Scleroderma is often associated with a number of dental and 
craniofacial complications. The most major and common problems 
are xerostomia and microstomia. Additional concerns are 
increased frequency of caries, periodontal disease, fibrotic 
changes, fungal infections, telangectasia and bone resorption 
of the mandible. Additional research is needed to develop safe 
and effective treatments and to identify the cause or causes of 
the serious complications of scleroderma.
    Saliva.--The Committee is aware that research on saliva has 
progressed rapidly and holds the potential to be an inexpensive 
non-invasive diagnostic tool for early detection of breast 
cancer, osteoporosis, hepatitis, HIV, and Sjogren's disease. 
The Committee encourages NIDCR to work cooperatively with NCI 
and other appropriate institutes in pursuing research 
initiatives on the development of saliva as a diagnostic tool.
    Dental caries among native populations.--The Committee is 
concerned about the exceptionally high rate of severe dental 
caries suffered by American Indian and Alaska Native children. 
The Committee encourages NIDCR to consider the needs of these 
populations in its research agenda, especially focusing on the 
etiology and pathogenesis of dental caries in these 
populations.

    NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES

    The Committee provides $1,670,007,000 for the National 
Institute of Diabetes and Digestive and Kidney Diseases 
(NIDDK), which is $47,277,000 above the fiscal year 2003 
comparable level and the same as the budget request. In 
addition, $150,000,000 in mandatory funds are available for 
juvenile diabetes research.
    Mission.--The NIDDK supports research in three major 
disease categories: diabetes, endocrinology, and metabolic 
diseases; digestive diseases and nutrition; and kidney, 
urologic, and hematologic diseases. The NIDDK supports a 
coordinated program of fundamental and clinical research and 
demonstration projects relating to the causes, prevention, 
diagnosis, and treatment of diseases within these categories. 
The Institute also supports efforts to transfer the knowledge 
gained from its research program to health professionals, 
patients, and the general public.
    Juvenile diabetes.--The Committee applauds NIDDK for the 
launch of TrialNet. TrialNet establishes an infrastructure to 
coordinate and support clinical trials in diabetes dealing with 
the preservation of pancreatic beta cell function to prevent 
juvenile diabetes in high-risk individuals.
    Translational research.--The Committee commends NIDDK for 
its development of the platform technologies of genomics and 
proteomics to expand clinical research capability. The 
Committee urges NIDDK to continue the effort to remove the most 
common barriers between laboratory discoveries and clinical 
trials, including by making available on a competitive basis 
the resources for pre-clinical development of drugs and 
therapies.
    Digestive diseases.--Diseases of the digestive system 
continue to affect more than one-half of all Americans at some 
time in their lives. Serious disorders such as colorectal 
cancer, inflammatory bowel disease, irritable bowel syndrome, 
hemochromatosis, celiac disease, and hepatitis take a serious 
toll in terms of human suffering, mortality, and economic 
burden. The Committee commends NIDDK on the success of its 
Digestive Disease Centers program and continues to encourage 
NIDDK to enhance this important program with an increased 
emphasis on irritable bowel syndrome.
    Irritable bowel syndrome (IBS).--The Committee is pleased 
that NIDDK is considering the development of a strategic plan 
for IBS research. The Committee, however, remains concerned 
about the increasing frequency of IBS, a chronic complex of 
disorders that affect the digestive system. These common 
dysfunctions strike approximately sixty million Americans 
annually and result in significant human suffering and 
disability. The Committee encourages NIDDK to give priority 
consideration to funding grants that will increase the IBS 
portfolio.
    Inflammatory bowel disease.--The Committee has been 
encouraged in recent years by discoveries related to Crohn's 
disease and ulcerative colitis, collectively known as 
inflammatory bowel disease (IBD). These extremely complex 
disorders represent the major cause of morbidity and mortality 
from intestinal illness. The Committee commends NIDDK for its 
strong leadership in this area and encourages the Institute to 
continue to give priority consideration to the following areas 
of IBD research: (1) investigation into the cellular, molecular 
and genetic structure of IBD, (2) identification of the genes 
that determine susceptibility or resistance to IBD in various 
patient subgroups, and (3) translation of basic research 
findings into patient clinical trials as outlined in the 
research agenda developed by the scientific community entitled, 
``Challenges in Inflammatory Bowel Disease.'' Finally, the 
Committee also encourages NIDDK to continue to strengthen its 
partnership with the IBD community on innovative research 
projects.
    Urologic disorders.--Bladder diseases, such as interstitial 
cystitis, urinary tract infections and urinary incontinence, 
disproportionately affect women, and the Committee urges NIDDK 
to develop a comprehensive program to address these and other 
urological needs of women. The report of the Bladder Research 
Progress Review Group outlines a strategic plan for research in 
this area. The Committee encourages NIDDK to pursue promising 
leads on bladder epithelium, bladder afferent nerve cells, and 
urinary markers of IC patients. This report also identifies the 
considerable urologic complications of diabetes, which continue 
to worsen. Related to this problem is the issue of obesity and 
incontinence, which particularly affects minority women and 
should be given priority in the Institute's plans for the 
coming fiscal year.
    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 encouraged that 
the NIDDK has solicited proposals for a prospective cohort 
study of chronic kidney insufficiency in children and looks 
forward to the implementation of this study. Given the long-
term implications when children reach adulthood, the Committee 
continues to urge the NIDDK to undertake research into the 
history and treatment of cardiovascular problems in children 
suffering from chronic kidney disease, giving careful 
consideration to (1) 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. Funding for 
ancillary studies to determine the pathophysiology of these 
problems in children, including the ongoing clinical trial for 
focal segmental glomerulosclerosis, should be supported in 
order to develop new approaches to their treatment and 
prevention.
    Interstitial cystitis (IC).--The Committee was pleased to 
learn about NIDDK's recent investment in IC-focused basic 
science research, continuation of the IC Clinical Trials Group, 
and publication of the Bladder Research Review Group document 
entitled ``Overcoming Bladder Disorders; A Strategic Plan For 
Research.'' However, the Committee is concerned about the 
direction of the studies on IC currently being funded by NIDDK. 
In fiscal year 2000, the Committee urged NIDDK to undertake a 
comprehensive epidemiology study of IC, including 
scientifically valid statistics of the incidence of the 
disease, the demographics, occurrence in minority populations, 
and the health care costs. The Committee is concerned that the 
current studies may not adequately address these aims and 
requests that NIDDK address any shortcomings in the 
epidemiology effort. The Committee would like a report on the 
status of this initiative by the time of the FY 2005 hearings. 
The Committee also requests NIDDK to work with voluntary 
associations to undertake a national IC awareness campaign 
aimed at reducing the delay in diagnosing IC.
    Glomerular injury research.--The Committee is pleased with 
NIDDK's glomerular injury research initiatives, including a 
clinical trial for patients with focal segmental 
glomerulosclerosis. The Committee understands that in addition 
to the clinical trial, NIDDK is collaborating on a joint 
research program with a voluntary association to include basic 
and genetic studies. Further, the Committee continues to 
encourage NIDDK to consider initiating a scientific conference 
on glomerular injury research, and to explore support for 
gathering prevalence data on glomerular injury.
    Scleroderma.--The Committee encourages NIDDK to support 
scleroderma relevant research. Scleroderma is a chronic and 
progressive disease that predominantly strikes women. It is 
estimated that 90 percent of patients with systemic sclerosis 
have gastrointestinal (GI) involvement and of that number 50 
percent have clinically significant manifestations. GI 
involvement can manifest as gastroesophageal reflux disease, 
dysphagia, Barrette's esophagus, gastroparesis, ``watermelon 
stomach'', malabsorption, and fibrosis of the small and large 
intestines. Renal crisis affects 20 percent of those with 
systemic sclerosis often within the first five years after 
diagnosis. More research is urgently needed in order to develop 
safe and effective treatments and to identify the cause or 
causes of the complications of scleroderma.
    Cooley's anemia.--The Committee continues to support the 
outstanding work being done at 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, which currently involves a daily 
infusion of up to twelve hours, is urgently needed. In 
addition, NIDDK is urged to continue its collaboration with the 
National Institute of Biomedical Imaging and Bioengineering on 
imaging issues related to iron measurement.
    Living donor liver transplants.--The Committee is aware 
that more than 1,700 people died over the last year waiting for 
a liver transplant due to a lack of a donor liver. As of March, 
2003, there were almost 17,000 on the list waiting for a liver 
transplant. In view of the continuing shortage of livers 
available for transplantation, the Committee is pleased with 
the award in the past year of funding for a study of adult-to-
adult living donor transplants which will compare outcomes of 
living donor transplants to cadaver transplants. The Committee 
encourages additional research that would facilitate the 
success of living donor liver transplants and the number of 
livers available for transplantation.
    Pediatric liver disease database.--The Committee encourages 
NIDDK to consider supporting a pediatric liver disease national 
database and registry. Such a registry would permit hypothesis 
testing and outcomes research to determine the health and 
financial impact of liver transplants on a child and the 
child's family.
    Hepatitis C in children.--The Committee is aware that 
recent studies have indicated that one in every 200 children 
over the age of twelve is infected with the hepatitis C virus. 
The Committee urges NIDDK, with appropriate support from the 
National Institute of Child Health and Human Development 
(NICHD), to study the natural history of hepatitis C in 
infected children to help determine the optimal timing and 
medical regimen for treatment.
    Hepatitis C consensus development conference.--The 
Committee is aware that the conference, which met in June, 2002 
made seventeen specific recommendations to develop better 
treatments and a cure for hepatitis, including the creation of 
a clinical research network. The Committee requests a report by 
March 1, 2004 regarding the plans and progress to address the 
conference's recommendations.
    Lupus.--Because more than one-third of lupus patients have 
some form of kidney disease, a leading cause of death among the 
1.5 million Americans afflicted with lupus, the Committee 
encourages NIDDK to increase support for studies that will lead 
to better understanding of this dangerous manifestation of 
lupus.
    Polycystic kidney disease (PKD).--The Committee anticipates 
important scientific advances resulting from the recent NIDDK-
sponsored International PKD Strategic Planning Meeting. In 
addition, the Committee is pleased with the start of the ``Halt 
PKD Interventional Trials Network,'' designed to identify 
therapeutic strategies for retarding the progression of PKD. 
Recent discoveries bode well for developing drug therapies to 
decrease abnormal cell growth that occurs in PKD, a disease 
that causes pain, suffering and premature death for 600,000 
patients. The Committee encourages NIDDK to expeditiously 
implement the new PKD Strategic Plan and thus intensify its 
efforts to find a treatment and cure, and in so doing to 
consider establishing additional PKD Centers and issuing new 
RFAs in key areas of PKD science.
    Cystic fibrosis.--Advances have been achieved in the 
treatment of cystic fibrosis (CF), resulting in significant 
improvements in life expectancy for individuals with CF. This 
progress can be attributed to strong public and private sector 
investment in CF research, including clinical trials evaluating 
a wide range of possible new treatments. The Committee urges 
NIDDK to continue its support for CF researchers engaged in 
basic and clinical CF research.
    Mucopolysaccharidosis (MPS).--The Committee recognizes the 
efforts of the NIDDK to enhance research efforts to achieve a 
greater understanding and pursue development of effective 
therapies for MPS disorders. The Committee encourages continued 
investment in MPS-related research and enhanced collaborative 
efforts with the NINDS, NICHD and appropriate institutes and 
centers involved in this crucial research, including bone and 
joint involvement in MPS disorders and pathophysiology of brain 
damage as they relate to MPS disorders.

        NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE

    The Committee provides $1,468,926,000 for the National 
Institute of Neurological Disorders and Stroke (NINDS), which 
is $12,450,000 above the fiscal year 2003 comparable level and 
the same as the budget request.
    Mission.--The NINDS supports and conducts basic and 
clinical neurological research and research training to 
increase understanding of the brain and improve the prevention 
and treatment of neurological and neuromuscular disorders. The 
NINDS mission encompasses over 600 disorders, including stroke; 
head and spinal cord injury; epilepsy; multiple sclerosis; and 
neurodegenerative disorders such as Parkinson's disease.
    Epilepsy.--Epilepsy remains a major, unsolved public health 
problem affecting the lives of millions of Americans and their 
families. The Committee seeks intensified efforts by the 
Institute in the prevention, treatment, and eventual cure of 
epilepsy. The Committee applauds the development of benchmarks 
for epilepsy research resulting from the ``Curing Epilepsy: 
Focus on the Future'' conference held in March, 2000. The 
Committee encourages NINDS to address the research issues 
related to the impact of seizures on young women, children, the 
elderly and those with intractable or uncontrolled epilepsy. 
The Committee urges NINDS to develop specific research plans 
and goals for the anti-epileptic drug development program that 
has led to the discovery of many important anti-epileptic 
medications.
    Alzheimer's disease.--Research supported by NINDS continues 
to play an integral role in widening the scientific base of 
knowledge about Alzheimer's disease. NINDS is working closely 
with the National Institute on Aging (NIA) in the area of 
immunotherapy for Alzheimer's disease, which can involve the 
production of antibodies that reduce the cellular and 
behavioral effects of the disease. The Committee encourages 
NINDS to continue to assign a high priority to its Alzheimer's 
research portfolio, and to continue to work closely with NIA 
and other institutes.
    Amyotrophic lateral sclerosis (ALS).--ALS is one of a 
family of neurodegenerative diseases that plague millions of 
Americans. The Committee is pleased by the Institute's recent 
efforts to intensify its research into ALS, and commends NINDS 
on its multiple initiatives involving high throughput screening 
and assay development to identify compounds with activity in 
neurodegenerative disorders, including ALS. The Committee 
understands that the Institute has worked with voluntary 
associations as co-sponsors of some of these activities, and 
encourages NINDS to continue such productive partnerships to 
understand and develop treatments for ALS. These efforts may 
lead to possible prevention and treatment interventions for 
other degenerative disorders.
    The Committee is also pleased by the January 2003 
scientific workshop on ALS that NINDS held with the Department 
of Veteran Affairs (VA), as well as other entities. The 
Committee encourages the Institute's further collaboration with 
the VA in developing an initiative to address the scientific 
questions and gaps in the knowledge of ALS and motor neuron 
biology discussed at the workshop. The Committee also 
encourages the NINDS to coordinate, and collaborate on, ALS 
research with other appropriate NIH Institutes, particularly 
the NIEHS, and continue its partnership with other 
organizations, as appropriate, to advance ALS research.
    Transmissible spongiform encephalopathies (TSE).--The 
Committee recognizes the efforts of NINDS, in collaboration 
with NHLBI, to fund contracts for the development of a 
biological assay for TSE. The Committee requests that the 
Director of the Institute to be prepared to provide a report on 
the progress made toward the development of a TSE bioassay at 
the fiscal year 2005 appropriations hearing. The Committee is 
particularly interested in the success in detecting disease-
causing agents in blood, saliva, cerebrospinal fluid, and other 
bodily fluids, as well as lymphoid tissue, especially tonsils.
    Therapies for multiple sclerosis and other immune system 
diseases.--The Committee encourages NINDS and NIAID to continue 
collaborative efforts to investigate the role of neutralizing 
antibodies as described in the FY 2003 conference report. The 
Committee further encourages NIH to use all available 
mechanisms, including conducting a scientific workshop, to 
investigate the use of existing, approved pharmaceuticals, 
biologicals, and other therapies as platforms for combination 
therapies to address diseases of the immune system, such as 
multiple sclerosis, and other diseases.
    Dystonia.--The Committee continues to support the expansion 
of research on the neurological movement disorder dystonia, the 
third most common movement disorder. The Committee encourages 
NINDS to support additional research on both focal and 
generalized dystonia, and commends NINDS for its study of the 
DYT1 gene. The Committee encourages the Institute to continue 
its collaboration with the dystonia research community in 
supporting epidemiological studies on dystonia and in 
increasing public and professional awareness. The Committee 
commends NINDS for the recent release with other Institutes of 
the joint dystonia research program announcement. The Committee 
would like NINDS to be prepared to report on the dystonia 
research portfolio at the FY04 budget hearings.
    Spina bifida.--Spina bifida is the leading, permanently 
disabling birth defect in the U.S. The Committee urges NINDS to 
allocate resources to and prioritize research on primary and 
secondary prevention for spina bifida.
    Tuberous sclerosis.--Tuberous sclerosis complex (TSC) is a 
genetic disorder that affects many different organ systems. 
Genetic links provided by the TSC genes and research on TSC 
provide significant implications for scientific advancement 
benefiting other large patient populations suffering from 
epilepsy, lung disease, cancer, diabetes, autism, learning 
disabilities, and mental retardation. The Committee encourages 
NINDS to enhance research in this area, including consideration 
of the development of a comprehensive TSC patient registry, 
epidemiology studies on the natural history of TSC, and animal 
models/cell lines.
    Juvenile diabetes.--The Committee commends NINDS for its 
efforts to prevent and treat hypoglycemia and neuropathy, both 
of which are serious complications of diabetes and demonstrate 
accelerated development in individuals with juvenile diabetes. 
The Committee encourages NINDS to expand its research in 
neuropathy by considering the establishment of centers 
specifically for detection and prevention of this dangerous 
complication of diabetes.
    Neurofibromatosis (NF).--Advances in NF research have 
linked NF to cancer, brain tumors, learning disabilities and 
heart disease affecting over 150 million Americans. Because NF 
regulates both the RAS and cAMP pathways relating to cell 
growth and cognition, NF plays a pivotal role both in disorders 
of the brain and in cancer. The enormous promise of NF research 
is now reaching fruition in the testing of potential therapies. 
Therefore, the Committee encourages NINDS to enhance its NF 
clinical and basic research portfolios through clinical trials, 
RFAs, and other funding mechanisms to accelerate and exploit 
the substantial progress in NF research. The Committee commends 
NINDS for its leadership role in NF research and in 
coordinating efforts with other Institutes engaged in NF 
research.
    Reflex sympathetic dystrophy syndrome (RSD).--The Committee 
recognizes the substantial burden RSD imposes upon people and 
the lack of understanding and adequate treatment for this 
disease. The Committee commends the NINDS for holding the 
December, 2001 state of the science meeting on RSD and 
encourages NINDS to follow through on the meeting's 
recommendations, including efforts to develop standardized 
diagnostic criteria, to assess risk factors and incidence 
through epidemiology studies, to develop and validate animal 
models and to explore avenues for developing treatments.
    Spinal muscular atrophy (SMA).--SMA is the most common 
genetic killer of infants and toddlers and is the most 
prevalent genetic motor neuron disease. While there is 
currently no cure for the disease, the research outlook is 
promising. Researchers have already identified the genes 
involved in SMA as well as compounds that may lead to potential 
treatments. The Committee understands that the severity of the 
disease, its relatively high incidence, and the possibility of 
imminent treatments have led the NINDS to select SMA as a model 
for a new approach to funding translational research. The 
Committee encourages NINDS to sponsor and convene a scientific 
and clinical workshop on SMA with a focus on implementing SMA 
translational research, and to employ existing mechanisms such 
as websites, publications, and participation in conferences to 
promote awareness of funding opportunities. The Director is 
also encouraged to work with other Institutes and Federal 
agencies to develop formal programs that increase public and 
professional awareness of the disease. The Committee requests 
NINDS to submit a report by March, 2004 on progress on all 
aspects of SSMA translational research.
    Lupus.--Individuals with lupus commonly experience 
headaches, confusion, difficulty concentrating, and 
occasionally seizures, strokes, or other disorders of the 
nervous system. Stroke and seizures are a serious health effect 
of lupus. The Committee encourages NINDS to enhance efforts to 
study the neurological aspects of lupus.
    Down syndrome.--Down syndrome is caused by extra genetic 
material on the 21st chromosome. It is the leading genetic 
cause of mental retardation in humans. The Committee encourages 
NINDS to enhance its efforts on Down syndrome, particularly as 
it relates to cognitive enhancement.
    Mucolipidosis type IV (ML4).--Building on the 
identification of the gene that causes this debilitating 
genetic metabolic disorder, the Committee encourages NINDS to 
expand its efforts to support research leading to possible 
treatments and cures for those with ML4. In particular, NINDS 
is encouraged to support research involving other organisms 
which bear genes resembling the one whose mutation in humans 
causes ML4. This research should also offer insight into other 
genetic disorders.
    Mucopolysaccharidosis (MPS).--The Committee is encouraged 
by NINDS sponsorship of a scientific conference focusing on 
central nervous system issues and the barriers to and 
development of effective therapies for MPS disorders. The 
Committee urges NINDS to solicit and provide for investigator 
proposals resulting from the findings of this conference. The 
Committee encourages NINDS, in collaboration with NIDDK and 
NICHD, to support current MPS research and study of the blood 
brain barrier as an impediment to treatment, and to use all 
available mechanisms to further stimulate and enhance efforts 
to better understand and treat MPS disorders.

         NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES

    The Committee provides $4,335,255,000 for the National 
Institute of Allergy and Infectious Diseases (NIAID), which is 
$629,116,000 above the fiscal year 2003 comparable level and 
the same as the budget request. Bill language is repeated from 
last year that permits the transfer of $100,000,000 to the 
global AIDS, tuberculosis, and malaria fund.
    Mission.--The NIAID supports and conducts basic and 
clinical research and research training programs in infectious 
diseases caused by, or associated with, disorders of the immune 
system. NIAID supported research includes research on acquired 
immunodeficiency syndrome (AIDS), asthma and allergies, 
tuberculosis, sexually transmitted diseases, tropical diseases, 
and emerging microbes. The goals of NIAID research are to 
better understand disease pathogenesis, to improve disease 
diagnosis, to develop new and improved drugs to treat diseases, 
and to develop new and improved vaccines to prevent disease, 
many of which significantly affect public health.
    Tuberculosis.--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 NIAID for its aggressive program of tuberculosis 
research, and encourages greater emphasis on tuberculosis 
vaccine development, as noted by the NIAID-developed Blueprint 
for Tuberculosis Vaccine Development.
    Kidney and islet transplantation.--The Committee commends 
NIAID for its leadership role in the evaluation of strategies 
to achieve tolerance in the context of kidney and islet 
transplantation. These two areas of investigation hold the most 
promise for moving research into the clinical setting.
    Hemophilia.--The Committee supports NIAID's efforts with 
voluntary organizations to ensure access for persons with 
hemophilia to clinical trials for improving the treatment of 
HIV and complications of hemophilia, including hepatitis C. The 
Committee urges the Institute to continue its efforts related 
to research on liver disease progression and response to 
hepatitis C treatment among HIV infected persons with 
hemophilia.
    Hepatitis C vaccine.--The Committee notes the slow progress 
to date in developing a vaccine to prevent infection from the 
hepatitis C virus and encourages NIAID to redouble its efforts. 
The Committee requests a report by March 1, 2004 on progress 
made and the most promising avenues of research.
    Lupus.--Lupus is a prototypic polygenic, multi-organ 
disease of hyperactive immune function. Therefore, by 
unraveling the genetic disorders that lead to lupus, much could 
be learned about the structure and balance of interacting 
forces in the body's natural defenses against infections, 
allergies and cancer. The Committee encourages NIAID to enhance 
its research on this prototypical autoimmune disease.
    Primary immune deficiency diseases.--The Committee notes 
that more than 70 primary immune deficiency diseases have been 
identified to date. These diseases, which impair the body's 
immune system, strike most severely at children, many of whom 
do not survive beyond their teens or early twenties. Primary 
immune deficiencies afflict more than 50,000 Americans. The 
Committee commends NIAID for the establishment of its Primary 
Immunodeficiency Disease Research Consortium. As part of this 
new initiative, the Committee encourages the Institute to 
provide adequate support for primary immune deficiency 
research, clinical registries, and a repository for biomedical 
specimens. The Committee encourages NIAID to work closely with 
the patient community on this promising new program.
    Autoimmune disease prevention and treatment.--The Committee 
commends NIAID for implementing a new model for clinical 
research. The autoimmunity centers of excellence support an 
integrated basic and clinical research program focused on 
approaches for the treatment or prevention of immune-mediated 
diseases like Type 1 diabetes, rheumatoid arthritis, and 
multiple sclerosis. The involvement of clinical specialists in 
planning, conduct, and evaluation of trials and studies should 
lead to a more coordinated approach to development of new 
immune-based therapies for all autoimmune diseases as well as 
accelerate the translation of basic advances to the clinic.
    Inflammatory bowel disease.--The Committee continues to 
note with interest a scientific research agenda for Crohn's 
disease and ulcerative colitis (collectively known as 
inflammatory bowel disease) entitled ``Challenges to 
Inflammatory Bowel Disease (IBD).'' This report identifies 
strong linkages between the functions of the immune system and 
IBD. The Committee is aware of NIAID's research partnerships 
with the IBD community and 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.
    Adverse reactions to smallpox vaccine.--The Committee is 
pleased that NIAID has focused considerable attention on 
research efforts aimed at reducing adverse reactions to the 
smallpox vaccine. The Committee understands that the risk of 
adverse reactions is particularly high in individuals who have 
or have experienced atopic dermatitis. Given the high incidence 
of atopic dermatitis among those with asthma and allergies, and 
the potential for their adverse reactions to the smallpox 
vaccine, the Committee is pleased that NIAID has undertaken a 
major initiative in this area, the atopic dermatitis and 
vaccinia immunization network. NIAID is encouraged to take 
additional steps to encourage investigator-initiated research 
to complement this effort.
    Asthma research and severe acute respiratory syndrome 
(SARS).--The Committee encourages NIAID to continue its strong 
efforts in the area of asthma research. Research in this area 
is closely related to research on SARS. Therapies currently 
used to treat SARS are commonly used to treat complications of 
asthma. Therefore, the Committee encourages NIAID to engage the 
asthma research community in efforts related to SARS so that 
knowledge gained from studies of immune reaction to viruses in 
the lung among asthma patients can be applied.

             NATIONAL INSTITUTE OF GENERAL MEDICAL SCIENCES

    The Committee provides $1,923,133,000 for the National 
Institute of General Medical Sciences (NIGMS), which is 
$76,133,000 above the fiscal year 2003 comparable level and the 
same as the budget request.
    Mission.--The NIGMS supports research and research training 
in the basic biomedical sciences. Institute grantees, working 
in such fields as cell biology, biophysics, genetics, 
developmental biology, pharmacology, physiology, and biological 
chemistry, study normal biological processes to better 
understand what goes wrong when disease occurs. In this way, 
NIGMS supports the new knowledge, theories, and technologies 
that can then be applied to the disease-targeted studies 
supported by other NIH components. NIGMS-supported basic 
research advances also find applications in the biotechnology 
and pharmaceutical industries. The Institute's training 
programs help provide the scientists needed by industry and 
academia.
    Training programs.--The Committee continues to be pleased 
with the quality of NIGMS's training programs, particularly 
those that have a special focus on increasing the number of 
minority scientists, such as the Minority Access to Research 
Careers (MARC) and Minority Biomedical Research Support (MBRS) 
programs. The Committee expects NIGMS to continue to support 
these important initiatives, and is particularly pleased that 
NIGMS has supported biomedical research career opportunity 
programs for high school and undergraduate college students in 
conjunction with historically black health professions schools.

        NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT

    The Committee provides $1,245,371,000 for the National 
Institute of Child Health and Human Development (NICHD), which 
is $39,444,000 above the fiscal year 2003 comparable level and 
the same as the budget request.
    Mission.--The NICHD conducts and supports laboratory and 
clinical research on the reproductive, developmental, and 
behavioral processes that determine and maintain the health and 
well-being of children, adults, families and populations. In 
addition, research in medical rehabilitation is supported.
    Sudden infant death syndrome.--The Committee is pleased 
with NICHD's continued efforts to extend the reach of its 
extremely 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 five-year research plan. This third 
five-year plan will continue the efforts of the past two five-
year plans, which have been responsible for many of the 
research breakthroughs in the effort to reduce SIDS cases in 
the U.S. The Committee requests that this five year plan be re-
examined to determine the appropriateness and scientific 
validity of including research on stillbirth and miscarriage as 
components of the five-year plan.
    Neurofibromatosis (NF).--Learning disabilities occur with 
high frequency in children with NF. Enormous advances have been 
made in NF research in just the past year unlocking the 
mysteries of how the NF gene is related to learning 
disabilities, which significantly advances the prospects of 
finding a treatment for learning disabilities not only in 
children with NF but in the general population as well. The 
Committee encourages NICHD to enhance this promising NF 
research.
    Pre-term labor and delivery.--Pre-term labor and delivery 
is the leading cause of neonatal mortality, and many babies 
born prematurely have serious physical and mental disabilities, 
such as cerebral palsy, mental retardation, chronic lung 
disease, and vision and hearing loss. Rates of pre-term birth 
vary significantly by race and ethnicity. The Committee 
encourages NICHD to increase its efforts in researching the 
underlying causes of pre-term delivery, to identify prevention 
strategies and to improve the treatment and outcomes for 
infants born pre-term.
    Pediatric liver disease.--The Committee urges the Institute 
to more aggressively pursue opportunities to participate with 
NIDDK and other Institutes in pediatric liver disease research, 
particularly related to the optimal timing and medical 
treatment regimens for children infected with the hepatitis C 
virus.
    Spina bifida.--The Committee is pleased that NICHD co-
sponsored a spina bifida research conference in May 2003. The 
Institute is encouraged to pursue research recommendations 
generated by the conference to address the prevention and 
treatment of spina bifida and associated secondary conditions. 
The Institute should be prepared to testify on its efforts to 
advance these areas of research at the fiscal year 2005 
appropriations hearing.
    Primary immunodeficiencies (PI) diseases.--The Committee 
continues to be impressed with the commitment NICHD has shown 
to addressing PI. With the availability of cutting-edge 
microarray technologies, the Committee encourages NICHD to 
identify specific molecular biomarkers, improve diagnostic 
methodologies, and develop newborn screening procedures for PI.
    Juvenile diabetes.--The Committee encourages NICHD to work 
closely with NIDDK on the continued development of Trial Net, 
which is designed to coordinate and support clinical trials in 
diabetes with the ultimate goal of preventing juvenile diabetes 
in high risk individuals.
    Pediatric kidney disease.--Kidney disease remains a 
persistent and little-understood problem among infants, 
children, and adolescents. The NICHD is encouraged 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.
    Traumatic brain injury (TBI).--The Committee encourages 
NICHD to continue and enhance the cooperative multi-center 
traumatic brain injury clinical trials network in order to 
identify which intervention variables result in improvements in 
long-term outcomes for individuals with TBI.
    Bone density.--The Committee encourages NICHD to conduct 
research into quantification of bone mass and its biomechanical 
properties in children, and the relationship of diet and 
exercise to bone health. The Committee also encourages the 
expansion of osteogenesis imperfecta research in genetic 
therapies, drug treatment and rehabilitation.
    Bleeding disorders.--The Committee encourages the Institute 
to work collaboratively with voluntary associations to address 
issues related to neonatal intracranial hemorrhage and 
pediatric complications of bleeding disorders, including 
medical, psychosocial, and quality-of-life issues.
    Down syndrome.--About one in 800 babies born alive in the 
U.S. has Down syndrome, and approximately 350,000 people in the 
U.S. live with the disorder. The Committee encourages NICHD to 
place a high priority on researching the causes and treatment 
of Down syndrome, particularly in the areas of cognitive 
enhancement and the early onset of dementia. The Committee 
encourages NICHD to strengthen its support for the production 
of the Ts65Dn mouse, which is used extensively in the research 
of Down syndrome and Alzheimer's disease. Current production 
levels of this mouse strain are not adequate for planned 
research.
    Mucopolysaccharidosis (MPS).--The Committee encourages 
NICHD to enhance efforts to engage in collaborative research 
support with NINDS and NIDDK with respect to MPS disorders. The 
Committee also encourages NICHD to examine the issues 
pertaining to the loss of cognitive function in those affected 
by MPS disorders and barriers to delivery of effective 
therapies to the central nervous system.
    Maternal-fetal medicine network.--The Committee recognizes 
the important contributions of the Maternal-Fetal Medicine 
Network (MFMU) in addressing clinical questions related to the 
care andtreatment of high-risk and complicated pregnancies. By 
studying large numbers of patients, the network has demonstrated that 
it offers the most effective and cost-efficient way to study high-risk 
conditions. The Committee encourages NICHD to strengthen its support of 
the network so that it can continue to address these important research 
questions, with an emphasis on issues pertaining to preterm births and 
low birth weight deliveries.
    Limb loss.--The Committee is aware of the development of 
the Amputee Care Center at Walter Reed Army Medical Center to 
improve the level of care within military medicine for those 
who are injured and lose limbs. The Committee urges NICHD, 
working through the National Center for Medical Rehabilitation 
Research, to work in partnership with Walter Reed to support 
its efforts to conduct clinical research focused on developing 
new amputee-care metrics applicable to the rehabilitation of 
highly active persons with limb loss. Additional clinical 
research is also needed, however, to better understand the 
applicability of new technology to various segments of the 
limb-loss population, including older Americans who might not 
otherwise ambulate with traditional prosthetic technology. 
advances have recently been made by the private sector to 
develop breakthrough prosthetic limb technologies which have 
dramatically improved the functionality, stamina and psycho-
social well being of patients, in particular, the 
microprocessor-controlled hydraulic fluid swing and stance 
phase knee device technology. The Committee encourages NICHD to 
consider supporting this type of research, using all available 
mechanisms.
    Best pharmaceuticals for children.--The Committee 
recognizes the importance of ensuring that drugs are safe and 
effective for use by children. The Committee strongly supports 
the research being conducted by NIH to implement the Best 
Pharmaceuticals for Children Act of 2002. NICHD should 
coordinate its activities with other Institutes within NIH for 
which pediatric pharmacological drug research may have 
therapeutic relevance. The committee requests NIH to provide by 
March 30, 2004 information on the number of studies supported; 
the estimated cost of each study undertaken; the number of 
label changes resulting from completed studies; the patent 
status of the drugs studied; and the number of drugs remaining 
on the priority list.
    National children's study.--The Committee continues to 
support implementation of the national children's study, which 
aims to quantify the impacts of environmental influences, 
including physical, chemical, biological and social influences, 
on child health and development. The Committee encourages NICHD 
to continue to coordinate closely with the CDC, EPA, other 
institutes and agencies and non-Federal partners conducting 
research on children's environmental health and development so 
that this study can be completed within its original timeframe.

                         NATIONAL EYE INSTITUTE

    The Committee provides $648,299,000 for the National Eye 
Institute (NEI), which is $15,151,000 above the fiscal year 
2003 comparable level and the same as the budget request.
    Mission.--The NEI conducts and supports basic and clinical 
research, research training, and other programs with respect to 
blinding eye diseases, visual disorders, mechanisms of visual 
function, preservation of sight, and the special health 
problems and needs of individuals who are visually-impaired or 
blind. In addition, the NEI is responsible for the 
dissemination of information, specifically public and 
professional education programs aimed at the prevention of 
blindness.
    Genetics of retinopathy.--The Committee is aware of the 
serious problem of retinopathy in individuals with juvenile 
diabetes. The genetic basis of diabetic retinopathy is 
currently unknown. The Committee encourages NEI to collaborate 
with other Institutes on efforts to identify the genes for 
diabetic complications, including retinopathy, by collecting 
and analyzing human samples and by developing animal models of 
disease.
    Juvenile diabetes.--The Committee is aware of the 
importance of early detection to prevent and treat blindness 
due to retinopathy in individuals with juvenile diabetes and is 
concerned that many Americans with the disease do not have 
regular eye exams due to geographic location and/or economic 
status. The Committee encourages NEI to focus on the 
development and application of scanning technologies to detect 
retinopathy that will be highly affordable and widely 
accessible to primary care physicians so that all Americans 
with diabetes may benefit from technologies that will allow for 
early detection.
    Ocular albinism.--Ocular albinism is a hereditary, blinding 
disease that causes terribly distorted vision in children. 
Victims, who are usually boys and receive the defective gene 
from their mother, experience nystagmus, photophobia, lack of 
stereoscopic vision, strabismus, and other symptoms which deny 
these children the gift of normal vision. In recent years, 
research has made great strides in the search for improved 
diagnostic tools and treatments. Recently, the OA1 gene, 
responsible for most cases of the disease, was identified, and 
a diagnostic screening test was created to help women determine 
if they are at risk of passing the disease on to their 
children. As researchers move closer to understanding how this 
disease works and developing potential treatments that could 
improve the vision of children with the condition, the 
Committee asks NEI to be prepared to report on advances in 
research on ocular albinism in the fiscal year 2005 hearing.

          NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES

    The Committee provides $630,774,000 for the National 
Institute of Environmental Health Science (NIEHS), which is 
$16,535,000 above the fiscal year 2003 comparable level and the 
same as the budget request.
    Mission.--The NIEHS mission is to reduce the burden of 
environmentally related illness and dysfunction by 
understanding how environmental exposures affect health, how 
individuals differ in their susceptibility to these effects, 
and how these susceptibilities change over time. This mission 
is achieved through multidisciplinary biomedical research 
programs, prevention and intervention efforts, and 
communication strategies that encompass training, education, 
technology transfer, and community outreach.
    Lung disease.--The Committee is pleased to note NIEHS's 
support of studies that establish epidemiological links between 
environmental exposures and the development of lung disease 
like asthma and COPD. The Committee encourages the Institute to 
enhance its research into how environmental stimuli interact 
with the lung to produce lung disease, with emphasis on 
cellular responses to inhaled pollutants and the subsequent 
cell signaling steps that lead to disease.
    Asthma.--The Committee commends NIEHS for supporting 
research aimed at determining the relationship between 
environmental exposures and the development of asthma. The 
Committee encourages NIEHS to partner with other institutes to 
develop a multi-center longitudinal study to understand the 
environmental and genetic risk factors for asthma.
    Breast cancer.--The Committee commends NIEHS for its recent 
efforts to bolster research aimed at discovering the 
environmental influences on breast cancer. The Committee 
encourages the Institute to establish a group of breast cancer 
and environmental research advisers to make recommendations 
with regard to the support of the breast cancer and 
environmental research, and to include in the group 
representatives from the breast cancer community who have the 
disease. The Committee requests an update at the fiscal year 
2005 hearings on the progress in establishing an advisory 
group. The Committee encourages NIEHS to consider establishing 
centers to conduct multi-disciplinary and multi-institution 
research on environmental factors that may be related to breast 
cancer and to develop a national strategy to address this 
issue.
    Lupus.--In recent years, several clusters of lupus have 
been reported in which increased exposure to toxic chemicals 
has been blamed. While previous studies have been inconclusive, 
environmental factors are suspected of triggering lupus disease 
activity in people who may be genetically predisposed to 
developing lupus. The Committee urges NIEHS to enhance its 
efforts to study the relationship between lupus and 
environmental factors.
    Children's health.--The Committee is pleased that NIEHS, in 
collaboration with the Environmental Protection Agency, is 
supporting children's health centers focused on the role that 
environmental factors play in health issues such as learning 
disabilities, asthma, developmental deficits and autism. The 
Committee encourages NIEHS, in continued collaboration with 
EPA, to consider supporting additional centers of excellence 
with a focus on disease endpoints in children.
    Environmental factors and skin cancer.--Skin cancers are 
the most common and most curable malignancies, but despite the 
curability of skin cancer, it causes many deaths because people 
fail to obtain treatment. The Committee encourages NIEHS to 
conduct additional research into the development of the 
disease, in particular how exposure to various chemicals in the 
environment, such as cigarette smoke, influence its development 
and progression. Research is also needed that is focused on the 
various environmental agents that may protect against the 
development of skin cancers.
    Mercury.--In order to properly research gaps in the area of 
mercury exposure and brain chemistry, and given recent hearings 
on mercury exposure and relationships between autism and 
Alzheimer's disease and mercury exposure, NIEHS is encouraged 
to pursue studies of how inorganic mercury and organic mercury 
compounds (including ethyl, methyl, and other forms of mercury 
from both food, pharmaceutical and dental sources) are 
processed in the bodies of children and adults. NIEHS is also 
encouraged to support studies of the toxic effects of inorganic 
mercury and organic mercury compounds on the nervous systems of 
young children, adults, and the elderly and methods of properly 
removing mercury and mercury-containing compounds from the 
brains of affected humans.

                      NATIONAL INSTITUTE ON AGING

    The Committee provides $994,411,000 for the National 
Institute on Aging (NIA), which is $813,000 above the fiscal 
year 2003 comparable level and the same as the budget request.
    Mission.--The NIA conducts biomedical, behavioral, and 
social research related to the aging process to prevent disease 
and other problems of the aged, and to maintain the health and 
independence of older Americans.
    Alzheimer's disease.--An estimated 4.5 million Americans--
almost all of whom are Medicare beneficiaries--suffer from 
Alzheimer's disease. Their complex health and long-term care 
needs are driving Medicare and Medicaid costs to unsustainable 
levels--even though seventy percent of care is provided by 
families. Within 10 years, annual Medicare costs for 
beneficiaries with Alzheimer's will increase by 55 percent--to 
nearly $55 billion; Medicaid costs will go up 80% to nearly $33 
billion. That will happen just as baby boomers begin to enter 
the age of risk. By the middle of the century, as many as 16 
million Americans will have Alzheimer's. Science is now at the 
point where effective treatment and prevention of Alzheimer's 
are within reach. Scientists are focusing on catching the 
disease process early, in the ten to twenty years before 
clinical symptoms become apparent. The Committee encourages NIA 
to expand its investment in Alzheimer's disease research, 
including clinical trials for the rapid translation of 
laboratory findings to effective treatments and prevention, as 
well as new initiatives in imaging and genetics aimed at 
finding risk factors and surrogate markers.
    Bone diseases.--The Committee encourages NIA to enhance 
research into the pathophysiology of osteoporosis and Paget's 
disease and the role of environmental and lifestyle factors 
associated with these diseases, particularly in men and women 
of diverse races and ethnicities. The Committee also encourages 
NIA to coordinate research with the National Institute on 
Arthritis, Musculoskeletal and Skin Diseases (NIAMS) into 
treatment for aging-related osteogenesis imperfecta 
complications.
    Down syndrome.--Research has shown that people with Down 
syndrome have an increased risk of developing Alzheimer's 
disease. Approximately fifty percent of individuals with Down 
syndrome over the age of 35 will develop the clinical signs and 
symptoms of Alzheimer's type dementia. All persons with Down 
syndrome will develop the neuropathology of Alzheimer's 
disease, even if they do not demonstrate dementia. Research 
into the process by which Alzheimer's disease evolves in 
persons with Down syndrome affords the opportunity to 
understand an important link between development and aging in 
all individuals. The Committee encourages NIA to enhance its 
research into the connection between Down syndrome and 
Alzheimer's disease.
    End-of-life/palliative care.--The Committee encourages NIA 
to expand research, implementation of insights in practice, and 
training programs, aiming to understand the mechanisms of 
disability and suffering in fatal chronic illness and to 
prevent and relieve that disability and suffering, particularly 
with respect to pain management.
    Family caregivers.--Since the burdens and challenges of 
family caregiving are already substantial and are expected to 
become overwhelming as the ratio of elderly persons to children 
gets larger, the Committee urges NIA to intensify its research 
activities to support rapid improvements in understanding human 
resources, service delivery arrangements, technology, and 
financing that would be most useful in ensuring comfort and 
dignity for individuals with fatal chronic illness, and in 
relieving the burdens borne by family and professional 
caregivers.

 NATIONAL INSTITUTE OF ARTHRITIS AND MUSCULOSKELETAL AND SKIN DISEASES

    The Committee provides $502,778,000 for the National 
Institute of Arthritis and Musculoskeletal and Skin Diseases 
(NIAMS), which is $16,635,000 above the fiscal year 2003 
comparable level and the same as the budget request.
    Mission.--The NIAMS conducts and supports basic and 
clinical research and research training, and the dissemination 
of health information on the more than 100 forms of arthritis; 
osteoporosis and other bone diseases; muscle biology and muscle 
diseases; orthopaedic disorders, such as back pain and sports 
injuries; and numerous skin diseases.
    Lupus.--Lupus is an autoimmune disease in which the body's 
immune system, for unknown reasons, attacks healthy tissue and 
organs, causing inflammation that can lead to organ failure and 
death. Lupus is the prototypical autoimmune disease and affects 
mostly women, with the highest prevalence among women of color. 
There have been no new therapies approved by the U.S. Food and 
Drug Administration (FDA) in more than three decades. Current 
therapies can cause life-threatening health effects. The 
Committee encourages NIAMS to enhance its research efforts on 
lupus through all available means, as appropriate, to improve 
understanding of the disease and lead to advances in treatment. 
There are five areas in which research may yield important new 
insights, including susceptibility, pathogenesis, inflammation 
and damage, clinical assessment and therapy. In addition, the 
Committee encourages NIAMS to facilitate efforts to validate 
biomarkers for lupus. In recent years, the lupus research 
community has identified a number of biologic molecules that 
may serve as effective markers of disease risk, disease 
activity or severity, clinical features of the disease, or 
response to potential therapies. Collaborative approaches to 
research on biomarkers could lead to the development of 
promising new drugs, and ease the way to approval of these 
agents by the FDA.
    Bone diseases.--The Committee urges NIAMS to explore new 
avenues for cell- and gene-based therapies for the treatment of 
bone and cartilage diseases, such as osteoporosis, Paget's 
disease, and osteogenesis imperfecta, as well as identify new 
targets for enhancing bone formation and blocking bone 
destruction.
    Duchenne muscular dystrophy.--Duchenne is a degenerative 
and fatal form of muscular dystrophy that usually takes its 
victims in their late teens or early twenties. The only 
treatment is the long-term use of steroids, which delays the 
progression of the disease but has many unwanted side effects. 
The Committee considers this a very important area of research 
and urges NIAMS, along with NINDS and NICHD, to work to enhance 
the research efforts into Duchenne muscular dystrophy.
    Scleroderma.--The Committee is encouraged by NIAMS's 
growing interest in scleroderma, a chronic and progressive 
disease that predominantly strikes women. Scleroderma is 
disfiguring and can be life-threatening, and effective 
treatments are lacking. The Committees encourages NIAMS to 
collaborate with other institutes, including NHLBI, NIDDK, and 
NIDCR, to generate additional research opportunities for 
scleroderma to identify genetic risk factors and safe and 
effective treatments.
    Vitiligo treatments for children.--Vitiligo is an 
environmental and genetic auto-immune disease of unknown origin 
which affects about three to six million Americans. Almost 50 
percent develop the disease in childhood, with the median age 
of onset at four years of age. In its most severe forms, 
patients have milky white patches covering widespread areas of 
the body due to the loss of pigment in these areas. Especially 
for young children, the physical pain caused by severe burns 
from the harmful effects of sunlight and the emotional pain 
caused by people confusing vitiligo with an infectious disease 
diminishes the quality of a patient's life. There are no FDA-
approved treatments for children. The Committee urges NIAMS to 
enhance research efforts through all available mechanisms, as 
appropriate, to identify the causes of this disease and develop 
pediatric treatment options for vitiligo.
    Marfan syndrome.--The Committee commends NIAMS for its 
vital support of research on heritable disorders of connective 
tissue (HDCT), which includes Marfan syndrome. Marfan syndrome 
is a life-threatening, progressive and degenerative genetic 
disorder affecting several organ systems. The Committee 
encourages NIAMS to collaborate with other Institutes and 
patient foundations to develop a comprehensive analysis of 
research opportunities including a multi-institute research 
plan for Marfan syndrome and related disorders through all 
available mechanisms, as appropriate.
    Pemphigus registry.--The Committee encourages NIAMS to 
consider establishing a national pemphigus registry, which 
would be important to the scientific community and patients in 
identifying the epidemiology, improving the understanding of 
the potential causes, and assessing the value of therapies for 
this chronic and life-threatening autoimmune disease.
    Burden of skin diseases.--The Committee is pleased that 
NIAMS held a workshop last fall on the burden of skin diseases. 
The participants in the workshop recommended that skin disease-
specific measures be developed in order to generate data on the 
incidence, prevalence, economic burden and disability 
attributable to these diseases. The Committee encourages NIAMS 
to consider supporting the development of new tools to measure 
the burden of skin diseases and training researchers in this 
area.

    NATIONAL INSTITUTE ON DEAFNESS AND OTHER COMMUNICATION DISORDERS

    The Committee provides $380,377,000 for the National 
Institute on Deafness and Other Communication Disorders 
(NIDCD), which is $9,995,000 above the fiscal year 2003 
comparable level and the same as the budget request.
    Mission.--The NIDCD funds and conducts research in human 
communication. Included in its program areas are research and 
research training in the normal and disordered mechanisms of 
hearing, balance, smell, taste, voice, speech and language. The 
Institute addresses special biomedical and behavioral problems 
associated with people who have communication impairments or 
disorders. In addition, the NIDCD is actively involved in 
health promotion and disease prevention, dissemination of 
research results, and supports efforts to create devices that 
substitute for lost and impaired sensory and communication 
functions.
    Dysphonia.--The Committee continues to be pleased with 
NIDCD's expanding intramural research program with respect to 
dysphonia. The Committee commends NIDCD on the release of a 
joint program announcement with NINDS, which will lead to a 
more active extramural research effort on dysphonia, and 
collaboration with other NIH Institutes on this important 
disorder.
    Neurofibromatosis (NF).--NF accounts for approximately five 
percent of genetic forms of deafness and, unlike other genetic 
forms of deafness, NF-associated deafness is potentially 
preventable or curable if tumor growth is halted before damage 
has been done to the adjacent nerve. Research is now being 
conducted to cure deafness in NF mice through gene therapy, 
which could prove enormously beneficial for gene therapy in 
general and for patients suffering from meningiomas and other 
tumors. The Committee therefore encourages NIDCD to expand its 
NF research portfolio through all suitable mechanisms, 
including clinical trials and RFAs.

                 NATIONAL INSTITUTE OF NURSING RESEARCH

    The Committee provides $134,579,000 for the National 
Institute of Nursing Research (NINR), which is $3,995,000 above 
the fiscal year 2003 comparable level and the same as the 
budget request.
    Mission.--The NINR supports and conducts scientific 
research and research training to reduce the burden of illness 
and disability; improve health-related quality of life; and 
establish better approaches to promote health and prevent 
disease.
    Health disparities.--The Committee commends NINR for its 
longstanding support of research to reduce health disparities 
among minorities. The Committee notes that NINR plans to 
increase research to reduce the high rate of low birth weight 
babies. Emphasis on promoting the health of minority men is 
another important initiative. To extend these men's lives, 
research on effective health promotion strategies that reduce 
stress and risky behaviors, such as smoking and lack of 
exercise, is needed. The seventeen new nursing partnership 
centers to reduce health disparities are of special interest to 
the Committee. NINR's goal of bringing together research-
intensive schools of nursing and minority serving schools of 
nursing into partnerships to promote health disparities 
research and to expand the number of minority nurse researchers 
is commendable. The Committee looks forward to learning more 
about this creative approach.
    Nursing interventions for psychiatric populations.--The 
Committee commends the mentorship program established by NINR 
in collaboration with the National Institute of Mental Health 
(NIMH) to prepare mental health nurse scientists. The Committee 
urges NINR to continue to partner with NIMH and with 
psychiatric nursing to: (1) build the capacity to address 
research questions in treating psychiatric populations, and (2) 
stimulate research that develops and tests interventions for 
individuals with co-existing medical and mental illnesses. Such 
interventions are important given the high prevalence of mental 
illness, the burden of mental disorders on patients and their 
families, and the primary role assumed by nurses in providing 
psychiatric services in diverse settings and systems of care.
    Alzheimer's disease.--The Committee is pleased that NINR 
has increased its research both on Alzheimer patients and those 
who care for them. For example, a nursing research study is now 
underway comparing four interventions designed for families 
coping with the effects of Alzheimer's disease and related 
disorders. Two home-based and two community-based interventions 
are being assessed according to the physical and psychological 
well-being of the caregiver and the cognitive/behavioral 
functioning and well-being of the person receiving the care. 
Future findings promise valuable information for nursing, 
social work and other health disciplines about each 
intervention's usefulness for particular situations.
    Self-management.--The Committee encourages NINR to continue 
its strong focus on self-management for patients who live with 
chronic illness. Advancing knowledge of technological 
innovations that help people manage their own health and 
promote their quality of life is a key area for research.
    End-of-life care.--Dissatisfaction with care during the 
last stages of life has been widely reported by recent studies. 
The Committee applauds NINR's plans to focus on children during 
the end-of-life, especially since the Institute of Medicine 
recently identified this population as being overlooked by 
research.
    Nurse shortage.--The nursing shortage is of concern to the 
Committee, not only because of its effects on the health care 
system, but because it has reduced the number of nurse 
researchers and educators. NINR's activities to confront this 
issue by increasing support for training programs, such as 
fast-track baccalaureate-to-doctoral training and promotion of 
careers in patient-oriented research, are encouraging. These 
efforts will play an important role in ensuring an adequate 
number of nurse researchers and faculty for the future.
    Genetics.--Advances in genetics will revolutionize many 
aspects of health and healthcare. The Committee is pleased that 
NINR is integrating genetics into nursing research, practice, 
and education. NINR's annual eight-week Summer Genetics 
Institute increases expertise in genetics and conveys genetic 
knowledge that ranges from tailoring drugs according to 
genotype to providing genetic counseling for individuals and 
families.

           NATIONAL INSTITUTE ON ALCOHOL ABUSE AND ALCOHOLISM

    The Committee provides $430,121,000 for the National 
Institute on Alcohol Abuse and Alcoholism (NIAAA), which is 
$14,070,000 above the fiscal year 2003 comparable level and the 
same as the budget request.
    Mission.--The NIAAA supports research to generate new 
knowledge to answer crucial questions about why people drink; 
why some individuals are vulnerable to alcohol dependence or 
alcohol-related diseases and others are not; the relationship 
of genetic and environmental factors involved in alcoholism; 
the mechanisms whereby alcohol produces its disabling effects, 
including organ damage; how to prevent alcohol misuse and 
associated damage and how alcoholism treatment can be improved. 
NIAAA addresses these questions through a program of 
biomedical, behavioral, and epidemiologic research on 
alcoholism, alcohol abuse, and related problems. This program 
includes various areas of special emphasis such as medications 
development, fetal alcohol syndrome, genetics, and moderate 
drinking.
    Underage rural drinking.--The Committee understands that 
alcohol is the number one drug of choice among children and 
adolescents in this country. There are relatively few studies 
about the extent of the problem in rural and small urban areas, 
and the Committee would like to see more research in this area. 
The Committee commends NIAAA for being one of the scientific 
leaders in developing prevention/intervention programs for 
young people with alcohol and risky behavior problems. It 
encourages NIAAA to provide leadership in developing model 
longitudinal prevention/intervention community-based programs 
focusing on how individual families, school and community 
networks can help reduce high-risk behavior among nine- to 
fifteen-year olds in rural and small urban areas. These model 
programs should focus not only on reducing alcohol problems 
among people in this age group, but should also recognize other 
high-risk behaviors such as tobacco use, other illegal drug 
use, risky sexual behavior and psychological and parental risk 
factors for these problem behaviors. The Committee expects 
NIAAA to provide leadership by working collaboratively with the 
Substance Abuse and Mental Health Services Administration, the 
Department of Education, NIDA and NCI. The Committee encourages 
NIAAA to utilize the expertise of academic health centers in 
this effort. The Committee requests that NIAAA be prepared to 
report its progress in developing model prevention programs 
during the fiscal year 2005 appropriations hearings.

                    NATIONAL INSTITUTE ON DRUG ABUSE

    The Committee provides $995,614,000 for the National 
Institute on Drug Abuse (NIDA), which is $33,893,000 above the 
fiscal year 2003 comparable level and the same as the budget 
request.
    Mission.--NIDA-supported science addresses questions about 
drug abuse and addiction, which range from its causes and 
consequences to its prevention and treatment. NIDA research 
explores how drugs of abuse affect the brain and behavior and 
develops effective prevention and treatment strategies; the 
Institute works to ensure the transfer of scientific data to 
policy makers, practitioners, and the public.

                  NATIONAL INSTITUTE OF MENTAL HEALTH

    The Committee provides $1,382,114,000 for the National 
Institute of Mental Health (NIMH), which is $41,100,000 above 
the fiscal year 2003 comparable level and the same as the 
budget request.
    Mission.--The NIMH is responsible for research activities 
that seek to improve diagnosis, treatments, and overall quality 
of care for persons with mental illnesses. Disorders of high 
priority to NIMH include schizophrenia, depression and manic 
depressive illness, obsessive-compulsive disorder, anxiety 
disorders and other mental and behavioral disorders that occur 
across the lifespan; these include childhood mental disorders 
such as autism and attention-deficit/hyperactivity disorder; 
eating disorders; Alzheimer's disease; and other illnesses. 
NIMH supports and conducts fundamental research in 
neuroscience, genetics, and behavioral science. In addition to 
laboratory and controlled clinical studies, the NIMH supports 
research on the mental health needs of special populations and 
health services research.
    Alzheimer's disease.--NIMH continues to play an important 
part in efforts to develop effective treatment strategies for 
Alzheimer's disease. The Institute is currently recruiting 
Alzheimer patients to participate in a clinical trial designed 
to identify the best medication regimen for treating the 
behavioral problems that co-occur in Alzheimer's disease. The 
Committee is also pleased to note that through the efforts of 
its Aging Research Consortium and its collaboration with other 
NIH institutes including NIA, NIMH is continuing to expand 
efforts to develop effective treatments for reducing the 
burdens of Alzheimer's disease. The Committee encourages NIMH 
to enhance this Alzheimer's portfolio.
    Down syndrome.--Persons with Down syndrome have a greater 
risk of developing disorders such as autism, attention deficit 
disorder, obsessive-compulsive disorder, anxiety and 
depression. The Committee encourages NIMH to conduct research 
on the mental health symptoms of persons with Down syndrome and 
to investigate effective treatments. The Committee also 
encourages NIMH to include Down syndrome in its studies of 
related disorders.

                NATIONAL HUMAN GENOME RESEARCH INSTITUTE

    The Committee provides $478,072,000 for the National Human 
Genome Research Institute (NHGRI), which is $13,077,000 above 
the fiscal year 2003 comparable level and the same as the 
budget request.
    Mission.--The NHGRI coordinates extramural and intramural 
research as well as 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 3,000 
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.
    ENCODE.--The Committee commends NHGRI for creating the 
Encyclopedia of Data Elements (ENCODE) project, which has a 
long term goal of identifying and locating all protein-coding 
genes, non-protein coding genes and other sequence-based 
functional elements contained in human DNA sequence. This 
significant undertaking will help scientists mine and fully 
utilize the human sequence, gain a deeper understanding of 
human biology, predict potential disease risk and stimulate new 
strategies for the prevention and treatment of disease. The 
Committee would like to receive a report on the progress of 
this effort prior to next year's hearings.

      NATIONAL INSTITUTE OF BIOMEDICAL IMAGING AND BIOENGINEERING

    The Committee provides $282,109,000 for the National 
Institute of Biomedical Imaging and Bioengineering (NIBIB), 
which is $3,830,000 above the fiscal year 2003 comparable level 
and the same as the budget request.
    Mission.--The mission of the Institute is to improve health 
by promoting fundamental discoveries, design and development, 
and translation and assessment of technological capabilities in 
biomedical imaging and bioengineering, enabled by relevant 
areas of information science, physics, chemistry, mathematics, 
materials science, and computer sciences.

                 NATIONAL CENTER FOR RESEARCH RESOURCES

    The Committee provides $1,053,926,000 for the National 
Center for Research Resources (NCRR), which is $84,895,000 
below the fiscal year 2003 comparable level and the same as the 
budget request. The Committee does not include bill language 
identifying funding for extramural facility construction, which 
is the same as the Administration request. $120,000,000 was 
provided in fiscal year 2003 for extramural construction. The 
Committee notes that more than $68,000,000 was provided in 
fiscal year 2003 through the Health Resources and Services 
Administration for biomedical research facility construction 
and renovation.
    Mission.--The NCRR develops and supports critical research 
technologies and shared resources that underpin biomedical 
research. The NCRR programs develop a variety of research 
resources; provide resources for complex biotechnologies, 
clinical research and specialized primate research; develop 
research capacity in minority institutions; and enhance the 
science education of pre-college students and the general 
public.
    Institutional development awards (IDeA).--The Committee has 
identified $210,000,000 for this program, which is the same as 
the Administration request and the fiscal year 2003 level. The 
program is comprised of the Centers of Biomedical Research 
Excellence (COBRE) program and Biomedical Research 
Infrastructure Network (BRIN) program. The focus of IDeA should 
continue to be on improving the necessary infrastructure and 
strengthening the biomedical research capacity and capability 
of research institutions within the IDeA states.
    Clinical trials.--The Committee commends the National 
Center for Research Resources for its leadership in funding 
innovative clinical trials systems. The Committee encourages 
NCRR to evaluate clinical research partnerships with minority-
serving institutions and to expand its support for clinical 
trials networks for orphan diseases, such as the cystic 
fibrosis (CF) clinical trials network. This clinical trials 
system holds promise as a model for other orphan diseases, and 
the Committee encourages NCRR to consider strategies for the 
replication of this network for other orphan diseases.
    Animal resources at minority health professions schools.--
The Committee commends 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. These 
upgrades are necessary to assist these institutions in 
complying with federal regulations and attain accreditation by 
the appropriate scientific organizations. The Committee 
encourages NCRR to continue to work in partnership with the 
National Center on Minority Health and Health Disparities to 
support this important initiative.
    National primate research centers.--The Committee values 
the important role played by the eight national primate 
centers. In the past several years, there has been an extensive 
expansion of the breadth and volume of demands for primate 
center resources. The Committee encourages NCRR to increase the 
base support for these centers and to conduct a periodic 
assessment of primate center needs. The first of these 
assessments should be submitted at the time of the FY 2005 
budget request.
    Health disparities centers.--The Committee commends NCRR 
for its proposal to establish comprehensive centers for health 
disparities research and looks forward to learning more about 
this important new initiative during the FY05 hearing process.
    Research centers at minority institutions (RCMI).--The 
Committee continues to recognize the important role played by 
minority institutions at both the graduate and undergraduate 
level in addressing the health research and training needs of 
minority populations. These programs help facilitate the 
preparation of a new generation of scientists at these 
institutions. The Research Centers in Minority Institutions 
(RCMI) program continues to address these problems. The 
Committee encourages NCRR to strengthen participation from 
minority institutions and increase resources available in this 
area. The Committee also encourages NCRR to work with minority 
institutions with a track record of producing minority scholars 
in science and technology.
    General clinical research centers (GCRC).--The Committee 
recognizes that GCRCs across the country play an important role 
in NIH efforts to translate basic science discoveries into 
vaccines, treatments, and cures for disease. The Committee 
encourages NIH to upgrade GCRC facilities with the 
sophisticated technologies needed to apply the mapping of the 
human genome to the study of human disease and response to the 
threat of bioterrorism and to support local GCRC pilot projects 
as approved by the NCRR Advisory Council.
    Islet resource centers.--The Committee commends NCRR for 
establishing 10 sites for isolation, purification, and 
characterization of insulin-producing cells and encourages NCRR 
to consider expanding this effort. The Committee also 
encourages NCRR to facilitate this important research by 
isolating insulin-producing cells for both distribution to 
researchers and by improving methods to store and transport 
insulin-producing cells.

       NATIONAL CENTER FOR COMPLEMENTARY AND ALTERNATIVE MEDICINE

    The Committee provides $116,202,000 for the National Center 
for Complementary and Alternative Medicine (NCCAM), which is 
$2,795,000 above the fiscal year 2003 comparable level and the 
same as the budget request.
    Mission.--The Center was established to stimulate, develop, 
and support rigorous and relevant research of high quality and 
open, objective inquiry into the safety and effectiveness of 
complementary and alternative medicine practices in order to 
provide the American public with reliable information about 
these practices.
    Liver disease.--The Committee is aware of efforts to 
synthesize and calibrate the production of milk thistle for use 
in clinical trials to demonstrate its value to slow the 
progression of nonalcoholic steatohepatitis and to reduce the 
side effects of hepatitis C interferon treatments. The 
Committee encourages NCCAM to support research into milk 
thistle.

       NATIONAL CENTER ON MINORITY HEALTH AND HEALTH DISPARITIES

    The Committee provides $192,724,000 for the National Center 
on Minority Health and Health Disparities (NCMHD), which is 
$7,010,000 above the fiscal year 2003 comparable level and the 
same as the budget request.
    Mission.--The Center conducts and supports research, 
training, information dissemination and other programs aimed at 
reducing the disproportionately high incidence and prevalence 
of disease, burden of illness and mortality experienced by 
certain American populations, including racial and ethnic 
minorities and other groups, such as the urban and rural poor, 
with disparate health status.
    Cancer in minority communities.--The Committee commends 
NCMHD for its leadership in addressing the disproportionate 
impact of cancer in minority communities. The Committee 
encourages NCMHD to consider collaborating with NCRR and NCI in 
supporting the establishment of a cancer center at a 
historically minority institution focused on research, 
treatment and prevention of cancer in African American and 
other minority communities.
    Glomerular injury.--The Committee understands that 
glomerular injury, a group of diseases which affect the 
filtering mechanisms of the kidney, are more prevalent among 
African Americans than the general population. The Committee 
urges NCMHD to explore collaboration with NIDDK to conduct and 
support research activities related to glomerular injury.
    Lupus.--Lupus is an inflammatory autoimmune disease 
affecting 1,500,000 Americans and is two to three times more 
common among African Americans, Native Americans, Hispanics and 
Asians than among Caucasians. The Committee is concerned by a 
report from the U.S. Centers for Disease Control and Prevention 
which notes a significant rise in lupus mortality among older 
African American women over a twenty-year period, and that 
African Americans are three times more likely to die from lupus 
than Caucasians. The Committee encourages NCMHD to increase 
research on lupus to better understand why lupus is more common 
and more severe among people of different non-Caucasian racial 
and ethnic origins.
    Scleroderma.--The Committee encourages the Center to 
support research that furthers the understanding of causes and 
consequences of scleroderma, a chronic, degenerative disease of 
collagen production, present among African Americans, Hispanic 
and Native American men and women. The Center is encouraged to 
establish epidemiological studies to address the prevalence of 
scleroderma among these populations, as statistics indicate 
that African Americans have a slightly higher incidence of 
scleroderma. This population is also likely to be diagnosed at 
a younger age and tend to be diagnosed more often with the 
diffuse form of scleroderma.
    Research endowment.--The Committee commends NCMHD for its 
leadership in addressing the longstanding problem of health 
status disparities in minority and medically underserved 
populations. The Committee continues to encourage NCMHD to 
implement its successful research endowment program as an 
ongoing initiative.
    Hepatitis C.--The Committee remains concerned about the 
disproportionate burden of hepatitis C on African Americans and 
Hispanics. The incidence is high and the response to treatment 
is low. The Committee encourages NCMHD to work with NIDDK and 
NIAID to expand research to improve treatment effectiveness and 
safety, and to partner with CDC and nonprofit groups to 
implement a prevention and education campaign targeted at high-
risk populations.
    Project EXPORT.--The Committee commends NCMHD for its 
successful ``Project EXPORT'' initiative and urges continued 
support for this important program.
    Palliative care.--Palliative care relieves the suffering 
and improves the quality of life for persons with advanced and 
terminal illnesses and their families. The Committee is aware 
of evidence regarding the inadequacy of palliative care, 
particularly among minority populations. The Committee 
encourages NCMHD to support research aimed at identifying the 
reasons for these disparities and developing responsive 
interventions.

                  JOHN E. FOGARTY INTERNATIONAL CENTER

    The Committee provides $64,266,000 for the Fogarty 
International Center (FIC), which is $801,000 above the fiscal 
year 2003 comparable level and the same as the budget request.
    Mission.--The FIC was established to improve the health of 
the people of the United States and other nations through 
international cooperation in the biomedical sciences. In 
support of this mission, the FIC pursues the following four 
goals: mobilize international research efforts against global 
health threats; advance science through international 
cooperation; develop human resources to meet global research 
challenges; and provide leadership in international science 
policy and research strategies.

                      NATIONAL LIBRARY OF MEDICINE

    The Committee provides $316,040,000 for the National 
Library of Medicine (NLM), which is $15,905,000 above the 
fiscal year 2003 comparable level and the same as the budget 
request.
    Mission.--The National Library of Medicine collects, 
organizes, disseminates, and preserves biomedical literature in 
all forms, regardless of country of origin, language, or 
historical period. The Library's collection is widely 
available; it may be consulted at the NLM facility on the NIH 
campus; items may be requested on interlibrary loan; and the 
extensive NLM bibliographic databases may be searched online by 
health professionals around the world. NLM has a program of 
outreach to acquaint health professions with available NLM 
services. The Library also is mandated to conduct research into 
biomedical communications and biotechnology; to award grants in 
support of health science libraries and medical informatics 
research and training; and to create specialized information 
services in such areas as health services research, 
environmental health, AIDS, hazardous substances, and 
toxicology.
    Outreach.--The Committee encourages NLM to continue its 
outreach activities aimed at educating health care 
professionals and the general public about the library's 
products and services, in coordination with medical librarians 
and other health information specialists.
    PubMed Central.--The Committee commends NLM for its 
leadership in developing PubMed Central, an electronic online 
repository for life science articles. Because of the high level 
of expertise health information specialists have in the 
organization, collection, and dissemination of medical 
information, the Committee believes that health sciences 
librarians have a key role to play in the further development 
of PubMed Central. The Committee encourages NLM to work with 
the medical library community regarding issues related to 
copyright, fair use, peer-review and classification of 
information on PubMed Central.
    Minority health.--The Committee encourages NLM to enhance 
its support of annual conferences sponsored by the minority 
health professions community designed to foster increased 
interest among minority students in the fields of biomedical 
science and bio-informatics.
    Clinical vocabulary standards.--The Committee notes the 
contribution of NLM to the development of standardized clinical 
data vocabularies that play a key role in improving 
interoperability of medical information systems. The committee 
supports NLM's efforts to expand the Unified Medical Language 
System (UMLS) to enable it to serve as a major vehicle for 
facilitating the exchange of clinical health information. 
Through common standards, patient care will be improved, errors 
will be reduced, and the communication of health information 
among disparate health care systems will be greatly enhanced.
    Restrictions on access to research data.--The Committee is 
concerned by reports that there has been a significant change 
in the availability of research data internationally and a 
dramatic rise in medical research data subscription costs. NLM 
is encouraged to examine how the consolidation of for-profit 
biomedical research publishers, with their increased 
subscription charges, has restricted access to vital research 
information to not-for-profit libraries. The Committee would 
like a report by March 1, 2004, about potential remedies to 
ensure that taxpayer-funded research remains in the public 
domain and steps that can be taken to alleviate this 
restrictive trend in information technology.
    Bioethics literature.--As Congress and other Federal and 
state decision makers contemplate important policy decisions in 
the field of bioethics, the Committee commends NLM for its 
support of the National Reference Center for Bioethics 
Literature (NRCBL) and the Bioethics Information Retrieval 
(BIR) Project. The NRCBL and BIR Project have created 
comprehensive interdisciplinary information resources which 
serve as models for bioethics research centers worldwide. The 
Committee is aware that the NLM is undertaking a review of how 
it manages bioethics research materials. As that process moves 
forward, the Committee would like to be kept fully informed 
about that review.

                         OFFICE OF THE DIRECTOR

    The Committee provides $317,983,000 for the Office of the 
Director (OD), which is $51,751,000 above the fiscal year 2003 
comparable level and the same as the budget request. The bill 
repeats language included in prior years authorizing the 
collection of third party payments for the cost of clinical 
services, providing the Director of NIH with one percent 
transfer authority, and allocating up to $500,000 of funds 
within the Office of the Director appropriation for the 
Foundation for the National Institutes of Health.
    The Committee provides $45,000,000 within the Office of the 
Director for the Director's Discretionary Fund (DDF), which is 
the same as the Administration request and $25,130,000 above 
the fiscal year 2003 comparable level. The Director is 
encouraged to maximize the use of the fund to implement the 
``roadmap'' being developed by NIH to structure its future 
research portfolio. Within the ``roadmap'' research supported 
by the DDF, the Committee urges the Director to emphasize 
translational and clinical research designed to expedite 
delivery of new treatments with therapeutic promise and cures 
to patients with serious and degenerative illnesses. The 
Committee also encourages the Director to use the one percent 
transfer authority that is provided in the bill to allocate 
additional resources to clinical and translational research 
identified in the roadmap.
    The Committee has not approved the Administration proposal 
to give NIH authority to fund the multi-year cost of grants in 
the first year of their award and has not included the proposed 
general provision authorizing this action. In a budget with 
smaller than average increases for most Institutes, multi-year 
funding of the awards that are made would have an unacceptable 
impact on the volume of awards. The Committee suggests that the 
Administration not propose this approach without the funding 
increases necessary to stabilize the number of new grants 
awarded. Multi-year funding should not be expanded to grants 
beyond the limited number of small grants that historically are 
multi-year funded.
    Mission.--The Office of the Director provides leadership to 
the NIH research enterprise and coordinates and directs 
initiatives which cross-cut the NIH. The OD is responsible for 
the development and management of intramural and extramural 
research and research training policy, the review of program 
quality and effectiveness, the coordination of selected NIH-
wide program activities, and the administration of centralized 
support activities essential to operations of the NIH.
    Office of Research on Women's Health.--The Office of 
Research on Women's Health (ORWH) works in collaboration with 
the Institutes and Centers of NIH to promote and foster efforts 
to address gaps in knowledge related to women's health through 
the enhancement and expansion of funded research and/or the 
initiation of new investigative studies. The ORWH is 
responsible for ensuring the inclusion of women in clinical 
research funded by NIH, including the development of a 
computerized tracking system and the implementation of 
guidelines on such inclusion. This Office is also involved in 
promoting programs to increase the number of women in 
biomedical science careers, and in the development of women's 
health and sex and gender factors in biology as a focus of 
medical/scientific research.
    The Committee remains strongly supportive of the work done 
by the Office of Research on Women's Health. In recent years, 
the office (working with various institutes) created the BIRCWH 
training program (Building Interdisciplinary Research Careers 
in Women's Health) and the SCOR (Specialized Centers of 
Research on Sex and Gender Factors Affecting Women's Health) 
program. These have been major steps forward in women's health 
research. The Committee encourages the Director to provide 
adequate funding for ORWH so that it will be able to offer a 
second round of SCOR grants in FY04 and to expand the BIRCWH 
program.
    Scleroderma.--The Committee strongly supports the 
development of new research initiatives to support 
interdisciplinary research centers that will focus on 
scleroderma, a chronic, degenerative disease of collagen 
production, that strikes mainly women and effects multiple 
systems including digestive, kidney, heart, lung and skin often 
leading to premature death.
    Irritable bowel syndrome.--The Committee is pleased with 
the increased focus on irritable bowel syndrome (IBS) at the 
ORWH. It is estimated that over 60 million Americans, 
disproportionately women, suffer from IBS.
    Uterine fibroids.--Twenty to thirty percent of women in the 
U.S. of reproductive age suffer from uterine fibroids, a benign 
tumor that affects their reproductive health. Research on 
treatment has been limited, and often women have unnecessary 
hysterectomies when less costly and invasive treatments may be 
possible. In conjunction with NICHD, NIEHS, and NCMHD, ORWH is 
encouraged to intensify and coordinate programs to support 
research on uterine fibroids.
    Office of AIDS Research.--The Office of AIDS Research (OAR) 
is responsible for coordination of the scientific, budgetary, 
legislative, and policy elements of the NIH AIDS research 
program. The OAR develops a comprehensive plan for NIH AIDS-
related research activities which is updated annually. The plan 
is the basis for the President's budget distribution of AIDS-
related funds to the Institutes, and centers within NIH. The 
Committee expects the Director of NIH to use this plan and the 
budget developed by OAR to guide his decisions on the 
allocation of AIDS funding among the Institutes. The Director 
of NIH also should use the full authority of his office to 
ensure that the Institutes and Centers spend their AIDS 
research dollars in a manner consistent with the plan. In 
addition, the OAR allocates an emergency AIDS discretionary 
fund to support research that was not anticipated when budget 
allocations were made.
    The Committee has included the same general provisions in 
bill language that were contained in the 2003 appropriations 
bill. This language permits the Director of OAR, jointly with 
the Director of NIH, to transfer between Institutes and Centers 
up to three percent of the funding determined by NIH to be 
related to AIDS research. This authority could be exercised 
throughout the fiscal year subject to normal reprogramming 
procedures, and is intended to give NIH flexibility to adjust 
the AIDS allocations among Institutes if research opportunities 
and needs should change. The Committee also repeats language 
from last year's bill making the research funds identified by 
NIH as being AIDS related available to the OAR account for 
transfer to the Institutes. This provision permits the flow of 
funds through the OAR in the spirit of the authorization 
legislation without requiring the Congress to earmark a 
specific dollar amount for AIDS research.
    Office of Dietary Supplements.--The Office of Dietary 
Supplements (ODS) was established in recognition that dietary 
supplements can have an important impact on the prevention and 
management of disease and on the maintenance of health. ODS is 
charged with promoting, conducting, and coordinating scientific 
research within NIH relating to dietary supplements.
    Office of Behavioral and Social Sciences Research.--The 
Office of Behavioral and Social Sciences Research (OBSSR) 
provides leadership and direction for the development of a 
trans-NIH plan to increase the scope of and support for 
behavioral and social science research and in defining an 
overall strategy for the integration of these disciplines 
across NIH institutes and centers; develops initiatives to 
stimulate research in the behavioral and social sciences arena 
and integrate a biobehavioral perspective across the research 
areas of NIH; and promotes studies to evaluate the 
contributions of behavioral, social and lifestyle determinants 
in the development, course, treatment, and prevention of 
illness and related public health problems.
    Office of Rare Disease Research.--The Office of Rare 
Disease Research (ORD) was established in recognition of the 
need to provide a focal point of attention and coordination at 
NIH for research on rare diseases. ORD works with Federal and 
non-Federal national and international organizations concerned 
with rare disease research and orphan products development; 
develops a centralized database on rare diseases research; and 
stimulates rare diseases research by supporting scientific 
workshops and symposia to identify research opportunities. The 
Committee applauds ORD for its efforts to support the 
translation of basic research findings into improved treatments 
for orphan diseases. The Committee encourages the Office to 
increase its support for demonstration or pilot projects aimed 
at the development of interventions for orphan diseases, 
including cystic fibrosis. There is a pressing need for 
enhanced federal involvement in such programs, which are 
consistent with Congressional intent in passing the Rare 
Diseases Act of 2001.
    The Committee notes the significant number of rare liver 
diseases including primary biliary cirrhosis, primary 
sclerosing cholangitis and autoimmune hepatitis. The Committee 
encourages ORD to work closely with NIDDK to develop an 
appropriate response to address these significant diseases and 
to work toward a comprehensive research agenda.
    Clinical research.--The promise of medical research is 
greater now than ever before. Strong and sustained investments 
of taxpayer dollars in basic biomedical research over the past 
five decades have generated a wealth of knowledge about the 
fundamental mechanisms of human health and disease. To reap the 
full harvest of these discoveries, the public now requires 
careful attention to and investment in the translation of these 
fundamental scientific advances into improved patient care, a 
task carried out in large part through clinical research 
conducted by the nation's academic health centers. The 
Committee notes, however, that an increasing number of 
impediments to the translation of these remarkable research 
discoveries into practice, including rising costs, unfunded 
regulatory mandates, fragmented clinical research 
infrastructure, incompatible data bases, and a severe and 
growing shortage of qualified clinical investigators and 
willing participants. The Committee commends the NIH leadership 
for their efforts to critically examine and to re-engineer the 
clinical research enterprise to more efficiently translate 
clinical research advances into new treatments and improved 
medical care. The Committee recommends that as part of the 
``roadmap'' initiative, the Director develop recommendations 
for addressing these impediments, with special consideration 
given to: providing clinical research infrastructure support 
grants to eligible institutions; support and/or restructuring 
of the institutional review board system; and the harmonization 
and streamlining of NIH, FDA, NSF and DoD regulations governing 
clinical research. The Committee would like to hear NIH's 
response to these recommendations in the fiscal year 2005 
hearings.
    Practice-based clinical research networks.--Clinical 
research is more important now than ever before to translate 
advances in basic science into better diagnosis, prevention, 
treatment, and cure of disease and to provide high-quality 
evidence of diagnosis and treatment effectiveness to fully 
integrate into daily practice decisions. Placing clinical 
studies at the community practice level will ensure adequate 
representation of patients from all age, sex, and cultural 
groups in clinical studies, and will also increase the number 
of practicing clinicians who are trained to undertake clinical 
research. A model for such networks has been established by the 
Agency for Healthcare Research and Quality (AHRQ). The 
Committee encourages the Director of the NIH to consider 
incorporating the AHRQ practice-based networks into NIH-
supported clinical trials in order to include specialty 
practitioners who care for the most common health problems of 
the American people.
    Graduate training in clinical investigation awards.--The 
Committee is concerned that NIH has not implemented the 
graduate training in clinical investigation awards program. 
This program was authorized in the Clinical Research 
Enhancement Act to provide tuition and stipend support for 
students seeking advanced degrees in clinical research. The 
awards were intended to complement the NIH clinical research 
curriculum awards, a major NIH initiative aimed at establishing 
training programs to reverse the shortage of well-trained 
clinical investigators. While the Committee is pleased that 
numerous curriculum awards have been provided across the 
country, it is concerned that these awards do not include 
student stipend/tuition awards. The Committee encourages NIH to 
implement training in clinical investigation awards in 2004 or 
to report to the Committee by March 1, 2004 why it has chosen 
not to do so.
    Physical sciences.--The Committee recognizes that 
breakthroughs in the physical sciences underpin many of the 
remarkable advances in the life sciences that have been 
achieved during the last century. Biomedical research now 
involves not only molecular biologists but also chemists, 
bioengineers, bio-imaging experts, physicists, mathematicians, 
computer scientists, and other professionals. Increasingly, the 
boundaries between the life sciences and the physical sciences 
are being blurred, as capacities and talents bridging the 
disciplines are essential for modern experimentation and 
discovery. Accordingly, the Committee believes that a major 
effort must be undertaken to promote the advancement of 
research at the interface between the life sciences and the 
physical sciences. This interface occurs in many agencies 
including NIH, HSF, Office of Science, Department of Energy, 
DARPA, NASA, NOAA, and others. The Committee suggests that NIH 
work with all such agencies to convene a conference to discuss 
what needs to be done to encourage progress in the physical 
sciences that will provide support and underpinning in the 
future for advances in the life sciences.
    Autism.--The Committee encourages NIH to expand the 
research portfolios (basic and applied) at the Centers for 
Excellence in Autism as well as the Collaborative Programs for 
Excellence in Autism. The Committee strongly encourages NIH 
leadership, as well as individual institutes such as NICHD and 
NIMH, to coordinate a tissue bank program that will synchronize 
autism spectrum disorder brain banking and data management, and 
track research among all participants in the tissue collection 
program. The Committee further encourages NIH to work closely 
with the Interagency Autism Coordinating Committee in 
developing and implementing the matrix it is developing for 
autism spectrum disorder research. The Committee also 
encourages NIH to look at collaborative opportunities for joint 
projects and conferences with national autism organizations 
that will foster greater participation in research activities 
by investigators entering the field.
    The Committee continues to be aware of concerns about 
reports of a possible association between the measles component 
of the measles-mumps-rubella (MMR) vaccine and a subset of 
autism termed autistic entercolitis. The Committee continues 
its interest in this issue and urges the Interagency 
Coordinating Committee to continue to give serious attention to 
these reports. The Committee also urges NIH to continue to 
pursue appropriate research that will permit scientific 
analysis and evaluation of the concerns that have been raised 
through all available mechanisms, as appropriate, including an 
attempt to replicate the molecular evidence of persistent 
measles virus infection in children with autistic entercolitis. 
The research should be pursued in a way that does not cause 
undue harm to the Nation's efforts to protect children against 
vaccine-preventable diseases.
    The Committee encourages NIH to pursue the recommended 
research initiatives outlined in the Institute of Medicine's 
(IOM) Immunization Review Committee reports. These reports have 
identified the research needed to better understand why a small 
number of children suffer severe adverse reactions to childhood 
vaccines. This research is important for developing better 
screening capabilities and enhancing the public confidence in 
the national immunization programs.
    Genomics.--The Committee recognizes the important role that 
genomics and genetics plays in the progression of disease and 
believes that every institute has a key role to play in moving 
genomics to the clinical setting through the use of next 
generation technologies. The Committee urges the Director to 
continue to ensure that the institutes and centers are pursuing 
every available opportunity to advance this critical research.
    Scleroderma.--The Committee strongly supports the 
development of new research initiatives to support 
interdisciplinary research mechanisms that will focus on 
scleroderma, a chronic, degenerative disease of collagen 
production, that strikes mainly women and effects multiple 
systems including digestive, kidney, heart, lung and skin often 
leading to premature death.
    Microbicide research.--HIV is a serious and growing women's 
health issue. As of the end of 2002, half of the world's HIV/
AIDS-infected people were women. This trend devastates families 
and puts children at risk. Consensus has emerged across the 
public health, biomedical, and behavioral research communities 
that the range of preventive interventions for HIV transmission 
must be expanded, with particular focus on options women can 
control, such as microbicides. More than sixty potential 
microbicides are in various stages of development at public and 
private research entities around the globe. Designed for 
maximum safety and effectiveness, these products are also being 
designed to be inexpensive, readily available, and widely 
acceptable. Microbicides are critical until a range of HIV-
preventive vaccines become available, and would be a necessary 
and complementary preventive technology thereafter as well. The 
Committee is supportive of additional support for this area 
through OAR, NIAID, NICHD, NIMH, NIDA, and ORWH. The Committee 
is concerned that microbicide research at NIH is conducted 
under several institutes, with no single line of administrative 
accountability and no specific funding coordination. The 
Committee urges NIH to continue implementation of the 5-year 
strategic plan for microbicide research and development, and to 
accelerate and strengthen efforts to coordinate research among 
institutes and with other Federal agencies. To accelerate 
implementation of the strategic plan, the Committee encourages 
NIH to consider establishing a lead office to support 
implementation and coordination of the work encompassed by the 
plan. The Committee requests a report by March 31, 2004 on the 
status of its microbicide program, including research efforts, 
anticipated funding and staffing levels and implementation of 
the strategic plan.
    Physical inactivity and disease.--The Committee encourages 
NIH to integrate current research concerned with the impact of 
physical inactivity on human health, as well as the molecular 
mechanisms underlying disease prevention and treatment by 
exercise/activity, into a coordinated NIH-wide strategic 
research plan that confronts physical inactivity as a major 
cause of chronic health disorders. Physical inactivity, as a 
major catalyst of disease, represents a leading cause of death 
in the U.S. and is a major contributor to obesity and Type 2 
diabetes, other important predictors of morbidity and 
mortality. The Committee encourages NIH to stimulate research 
investigators to bring their research expertise to bear on 
physical inactivity and disease.
    Research infrastructure at minority health professions 
institutions.--The Committee continues to be pleased with the 
NIH Director's implementation of various programs focused on 
developing research infrastructure at minority health 
professions institutions. The Committee recommends that the NIH 
Director work closely with the Director of the NCMHD to ensure 
coordination among these various mechanisms to partner with 
minority health professions schools to address their 
infrastructure needs.
    Lupus.--Lupus is an inflammatory autoimmune disease which 
affects more than 1.5 million Americans, 90% of whom are women. 
Lupus causes the immune system to attack the body's own cells 
and organs, including the kidneys, heart, lungs, brain, blood 
and skin. Lupus is two to three times more common among African 
Americans, Native Americans, Hispanics, and Asians, than among 
Caucasians. Lupus is a disease of rampant, uncontrolled 
inflammation caused by multiple genes. It already is known that 
genes which regulate how immune system cells recognize foreign 
invaders in the body, and genes that modify the immune 
response, are involved in lupus. Therefore, scientists know 
some of the specific proteins that trigger lupus. New 
strategies in molecular medicine can now be applied to improve 
the function of these proteins and prevent lupus flares. 
Because lupus is a multifaceted disease, the Committee 
encourages the Director to ensure that all relevant institutes 
are working closely and collaboratively to maximize the output 
of their investment in lupus research.
    Tuberous sclerosis.--Tuberous sclerosis complex (TSC) is a 
genetic disorder that attacks many of the body's vital organs 
including brain, heart, kidneys, lungs, eyes and skin. TSC is 
characterized by tumor growth and lesions of the central 
nervous system that can result in seizures, autism, mental 
retardation and kidney failure. An estimated 50,000 Americans 
are thought to suffer from TSC, but because it is not widely 
known by the general public, nor commonly recognized by medical 
professionals, the number of individuals with TSC could be far 
greater. Because of the effects of TSC on multiple organ 
systems, the Committee urges the NIH Director to formulate an 
NIH-wide research agenda and report on this effort during the 
FY2005 hearings.
    Lymphangioleiomyomatosis (LAM).--The Committee remains very 
interested in efforts to find a cure for LAM, a progressive and 
often fatal lung disease with no effective treatment. The 
Committee understands that very recent scientific findings have 
presented new treatment approaches for clinical testing. The 
Committee urges the FDA, NCI, ORD and NHLBI to explore 
opportunities for funding clinical treatment trials through 
both intramural and extramural means and to use all available 
mechanisms, as appropriate, including support state-of-the-
science symposia and facilitating access to human tissues, to 
stimulate a broad range of clinical and basic LAM research.
    Asian-Pacific Islanders.--According to the HHS report 
Healthy People 2010, the rapidly growing and diverse Asian 
American and Pacific Islander (AAPI) populations on the US 
mainland, Hawaii, and Pacific Regions, reflect a number of 
health disparities, including in substance abuse. There is not 
adequate research data to address the increased incidence of 
substance use and abuse among AAPI youth and adults. The 
Committee encourages NIH to increase its efforts to address the 
need for substance abuse research among Asian American and 
Pacific Islander populations.
    Cooperation with the Department of Veterans Affairs.--The 
Committee applauds the increasing research collaboration 
between NIH and the Department of Veterans Affairs and notes 
that the DVA system of 173 hospitals and 771 clinics represents 
a significant resource to facilitate and accelerate clinical 
research. In particular, the Committee encourages NIH to 
increase its cooperative efforts with the DVA to diagnose and 
manage the medical issues associated with hepatitis C and liver 
cancer.
    Hepatitis C clinical trial research network.--The Committee 
notes that the hepatitis C consensus development conference 
recommended the creation of a clinical trial research network 
focused on hepatitis C but also intended to be useful to 
advancing an understanding of hepatitis C co-infection with HIV 
and hepatitis B. Since this research affects several 
institutes, the Committee encourages the Director of NIH to 
monitor that such a network be broadly representative across 
NIH research portfolios.
    Parkinson's disease.--The Committee supports the Director 
of NIH in his commitment to develop and implement a thorough 
plan for Parkinson's research. The Committee encourages NIH to 
devote resources to implement the plan developed using all 
available mechanisms and to consider including Parkinson's 
disease as a key part of the Director's clinical and 
translational research ``roadmap'' supported with the 
Director's discretionary fund.
    Rett syndrome.--Rett syndrome is a genetically inherited 
neurological disorder seen almost exclusively in females and 
found in many racial and ethnic groups worldwide. Rett syndrome 
affects approximately one in ten thousand live births per year. 
The Committee is encouraged by the advances that have taken 
place in Rett syndrome research, in particular the discovery of 
the MECP2 gene as the main cause of this devastating disorder, 
the discovery of which may hasten the search for treatment and 
potentially shed light on other neurologically based 
communicative disorders. The Committee encourages NIH to target 
its research efforts to ascertain how the MECP2 and its protein 
affect other genes and tissues during the development of the 
nervous system and to develop animal models, as well as 
genotype and phenotype investigations of Rett syndrome. The 
Committee notes there is a need for expanded research on the 
daily problems that affect children with Rett syndrome, 
including autonomic disorders, such as respiratory, 
gastrointestinal, circulatory and cardiac disorders, seizures, 
and scoliosis. Additionally, the Committee recognizes that 
research in applied areas such as interventions and 
technological aids for improved literacy and communication will 
improve the quality of life for Rett syndrome patients and 
those with other communicative disorders. Since Rett syndrome 
is a multi-faceted disorder, the Committee encourages NIH to 
promote continuity across Institutes in their Rett syndrome 
research.
    Research training.--The Committee recognizes the continuing 
need for young investigators and clinical scientists, and 
encourages NIH to increase its support for research training 
and loan repayment programs. The Committee is aware that the 
National Academy of Sciences is currently conducting its 
Congressionally-authorized study of research personnel needs 
with regard to the National Research Training Awards. This 
Committee has expressed interest in this study in the past, and 
is looking forward to receiving NAS's recommendations with 
regard to health research training priorities.
    Prevention research and training.--The Committee recognizes 
that NIH has a broad portfolio of prevention research programs 
and encourages the Director to continue collaborating with CDC 
in order to maximize health returns for the American public.
    Pseudo-xanthoma elasticum.--Pseudo-xanthoma elasticum is a 
rare inherited skin disease that is often not visible in early 
life, but in more severe cases may manifest in childhood. The 
disorder involves the elastic tissue in the skin, but also can 
result in macular degeneneration and hardening of the arteries. 
The Committee encourages NIH, through NIAMS, NEI and NHLBI, to 
support research regarding treatments and cures for pseudo-
xanthoma elasticum.
    Cost-effectiveness research.--Another round of cost 
increases threatens the healthcare delivery system, and many 
health care experts predict nine percent increases for the 
foreseeable future. Unfortunately, the same new biomedical 
research discoveries that provide new remedies for health 
problems may in some case contribute to higher health care 
costs. The Committee recognizes the need to ensure that 
increased investment in biomedical research does not price 
quality health care out of the reach of many Americans. 
Providers, patients, and health care payers need objective, 
scientific information to understand which new interventions 
are more effective than existing practices, which groups of 
patients are most likely to benefit, the degree of improvement 
compared to the cost, and the relative risks for the patient of 
alternative interventions. The Director is encouraged to make 
this type of research a higher priority across each of the 
institutes and centers and report to the Committee at the end 
of fiscal year 2004 a summary of grants awarded with a focus on 
findings related to reducing the cost of health care.
    Hyperbaric oxygen.--Based on anecdotal evidence collected 
by clinicians in the field of hyperbaric medicine, hyperbaric 
oxygen therapy (HBOT) is currently in widespread use in medical 
practice. NIH is encouraged to support meritorious research in 
this area, especially in basic science, in order to gather 
evidence regarding the efficacy of HBOT. When appropriate, 
clinical studies to test the safety and efficacy of this 
treatment for a variety of conditions, such as organ 
transplantation, limb reattachment, and before and after 
surgical procedures involving tourniqueting of extremities, as 
well as for treatment of hermorrhagic shock, brain injury, 
multiple trauma injury and multiple trauma crash injury, should 
be conducted. These studies should include adult and pediatric 
populations when possible. NIH is also encouraged to work with 
professional organizations interested in HBOT as this research 
moves forward to understand which new interventions are more 
effective than existing practices, which groups of patients are 
most likely to benefit, the degree of improvement compared to 
the cost, and the relative risks for the patient of alternative 
interventions. The Director is encouraged to make this type of 
research a higher priority across each of the Institutes and 
centers and report to the Committee at the end of fiscal year 
2003 a summary of grants awarded.

                        BUILDINGS AND FACILITIES

    The Committee provides $80,000,000 for buildings and 
facilities, which is $546,687,000 below the fiscal year 2003 
comparable level and the same as the Administration request. 
The fiscal year 2003 appropriation included more than $500 
million in one-time facilities costs.
    Mission.--The Buildings and Facilities appropriation 
provides for the design, construction, improvement, and major 
repair of clinical, laboratory, and office buildings and 
supporting facilities essential to the mission of the National 
Institutes of Health. The funds in this appropriation support 
the 77 buildings on the main NIH campus in Bethesda, Maryland; 
the Animal Center in Poolesville, Maryland; the National 
Institute of Environmental Health Sciences facility in Research 
Triangle Park, North Carolina; and other smaller facilities 
throughout the United States.

       Substance Abuse and Mental Health Services Administration


               SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES

    The Committee provides a program level of $3,345,000,000 
for the Substance Abuse and Mental Health Services 
Administration (SAMHSA), which is $133,260,000 above the fiscal 
year 2003 comparable level and $64,315,000 below the budget 
request.
    SAMHSA is responsible for supporting mental health and 
alcohol and drug abuse prevention and treatment services 
nationwide through discretionary targeted capacity expansion 
and knowledge application grants, formula block grants to the 
States and associated technical assistance efforts. The agency 
consists of three principal centers: the Center for Mental 
Health Services, the Center for Substance Abuse Treatment, and 
the Center for Substance Abuse Prevention. The Office of the 
Administrator is responsible for overall agency management.
    The provision of a seamless system of services for the 
chronically homeless represents a pressing problem facing 
providers in the overlapping jurisdictions of Housing and Urban 
Development and the Departments of Health and Human Services 
and Veterans Affairs. The Committee supports the budget request 
for the Samaritan Initiative, a supportive housing and services 
program designed to end the problem of chronic homelessness, 
within the Center for Mental Health Services and the Center for 
Substance Abuse Treatment.
    The Committee expects that no less than the amounts 
allocated in fiscal year 2003 will be spent in fiscal year 2004 
for activities throughout SAMHSA that are targeted to address 
the growing HIV/AIDS epidemic and its disparate impact on 
communities of color, including African Americans, Latinos, 
Native Americans, Asian Americans, Native Hawaiians, and 
Pacific Islanders. These activities include treatment of mental 
health disorders related to HIV disease and expansion of 
service capacity of substance abuse treatment and prevention 
programs that provide services to high-risk communities of 
color.

Center for Mental Health Services

    The Committee provides a total of $863,925,000 for the 
Center for Mental Health Services (CMHS), which is $29,919,000 
above the budget request and $7,438,000 above the fiscal year 
2003 comparable level.
            Programs of regional and national significance
    The Committee provides $237,000,000 for mental health 
programs of regional and national significance, which is 
$25,243,000 above the budget request and $7,443,000 below the 
fiscal year 2003 comparable level. The program includes studies 
that identify the most effective service delivery practices, 
knowledge synthesis activities that translate program findings 
into useful products for the field, and knowledge application 
projects that support adoption of exemplary service approaches 
throughout the country.
    The Committee expects that no less than the funds allocated 
in fiscal year 2003 will be allocated in fiscal year 2004 for 
the post-traumatic stress disorder program.
    The mental health needs of our Nation's seniors are largely 
ignored within our mental health system. Outreach to elderly 
persons conducted in places frequented by seniors, such as 
senior centers, meals sites, primary care settings and others 
is needed. The Committee recommends that no less than 
$5,000,000 be allocated to continue and expand the work that 
SAMHSA began in prior fiscal years to provide evidence-based 
mental health outreach and treatment services to the elderly.
    Within funds provided, the Committee recommends that no 
less than $7,000,000 be provided for grants for jail diversion 
programs. This program provides grants to States or localities, 
Indian tribes, and tribal organizations, acting directly or 
through agreements with other public or nonprofit entities, to 
develop and implement programs to divert individuals with a 
mental illness from the criminal justice system to community-
based services.
    Suicide continues to be the third leading cause of death 
for teens, but only one-third of youth with mental illness, one 
of the major risk factors for suicide, are identified and are 
in treatment. Evidence-based screening tools to detect at-risk 
youth are available. Some school districts have taken advantage 
of this and offer students a voluntary, school-based mental 
health check-up. Such screening should occur with parental and 
youth consent, and with a commitment to make treatment 
available for those found to be at-risk. The Committee urges 
SAMHSA to make these efforts more widely known and to 
collaborate with other Federal agencies, specifically the 
Department of Education and the Department of Justice, as well 
as public and private entities, to provide voluntary mental 
health check-ups to all school-aged youth. The Committee 
directs SAMHSA to report on steps being taken to promote this 
effort prior to the fiscal year 2005 appropriations hearings.
            Mental health block grants
    The Committee provides $435,000,000 for mental health block 
grants, which is $2,000,000 above the budget request and 
$2,140,000 below the fiscal year 2003 comparable level. The 
block grants provide funds to States to support mental health 
prevention, treatment, and rehabilitation services. Funds are 
allocated according to statutory formula among the States that 
have submitted approved annual plans. The Committee notes that 
the mental health block grant funding represents less than 2 
percent of total State mental health funding and less than 5 
percent of State community-based mental health services.
            Children's mental health
    The Committee provides $108,000,000 for the grant program 
for comprehensive community mental health services for children 
with serious emotional disturbance, which is $9,948,000 above 
the fiscal year 2003 comparable level and $1,306,000 above the 
budget request. Funding for this program supports grants and 
technical assistance for community-based services for children 
and adolescents up to age 22 with serious emotional, 
behavioral, or mental disorders. The program assists States and 
local jurisdictions in developing integrated systems of 
community care. Each individual served receives an individual 
service plan developed with the participation of the family and 
the child. Grantees are required to provide increasing levels 
of matching funds over the six-year grant period.
            Grants to states for the homeless (PATH)
    The Committee provides $50,055,000 for the grants to States 
for the homeless (PATH) program, which is $6,982,000 above the 
fiscal year 2003 comparable level and the same as the budget 
request. PATH grants to States provide assistance to 
individuals suffering from severe mental illness and/or 
substance abuse disorders and who are homeless or at imminent 
risk of becoming homeless. Grants may be used for outreach, 
screening and diagnostic treatment services, rehabilitation 
services, community mental health services, alcohol or drug 
treatment services, training, case management services, 
supportive and supervisory services in residential settings, 
and a limited set of housing services.
            Protection and advocacy
    The Committee provides $33,870,000 for the protection and 
advocacy program, which is $1,370,000 above the budget request 
and $91,000 above the fiscal year 2003 comparable level. This 
funding is distributed to States according to a formula based 
on population and income to assist State-designated independent 
advocates to provide legal assistance to mentally ill 
individuals during their residence in State-operated facilities 
and for 90 days following their discharge.

Center for Substance Abuse Treatment

    The Committee provides a total of $2,191,816,000 for the 
Center for Substance Abuse Treatment (CSAT), which is 
$182,806,000 above the fiscal year 2003 comparable level and 
$150,000,000 below the budget request.
    The Committee emphasizes the importance of the development 
and implementation of performance measures and expects that 
performance measurement will be an integral part of all 
substance abuse treatment programs. The Committee is pleased 
that SAMHSA is developing the new treatment voucher program 
with performance as an important component. It is the 
Committee's expectation that SAMHSA will begin integrating 
performance measurement into the Substance Abuse Prevention and 
Treatment Block Grant in fiscal year 2004 as States prepare to 
move to the Performance Partnership Grant program. As data 
become available on the development of performance guidelines 
and of the actual performance of these programs, the Committee 
strongly urges SAMHSA to provide the Congress periodic updates. 
SAMHSA should be prepared to testify on the performance of 
these programs at the fiscal year 2005 appropriations hearing.
            Programs of regional and national significance
    The Committee provides $417,278,000 for substance abuse 
treatment programs of regional and national significance, which 
is $100,000,000 above the fiscal year 2003 comparable level and 
$139,538,000 below the budget request. The program supports 
activities to improve the accountability, capacity and 
effectiveness of substance abuse treatment services and 
services delivery. These activities include targeted capacity 
expansion initiatives to help communities respond to serious, 
emerging and unmet treatment needs and best practices 
initiatives to translate science into services through 
monitoring and accreditation of treatment programs, training, 
dissemination and knowledge application activities. The program 
promotes the adoption of science- and evidence-based treatment 
practices by developing and field testing new treatment models 
in order to facilitate the provision of quality treatment 
services and service delivery. These activities are undertaken 
in actual service settings rather than laboratories and results 
are disseminated to State agencies and community treatment 
providers. The goal is to promote continuous, positive 
treatment service delivery change for those people who use and 
abuse alcohol and drugs.
    The Committee provides $100,000,000 for the ``Access to 
Recovery'' substance abuse treatment voucher initiative rather 
than $200,000,000 as requested. The Committee supports the 
Administration's commitment to increase substance abuse 
treatment capacity, consumer choice, and comprehensive 
treatment options. The Committee is concerned, however, that 
SAMHSA has not previously piloted the program on a smaller 
scale and recommends that the funding provided be used to 
establish the program in States that have the necessary 
infrastructure to administer this new and innovative program. 
To the extent that data are available, the Committee encourages 
SAMHSA to report to the Committee regularly on the status and 
continued design and enhancement of the program.
    According to Healthy People 2010, the rapidly growing and 
diverse Asian American and Pacific Islander (AAPI) populations 
on the U.S. mainland, Hawaii, and Pacific Regions, are 
experiencing a number of critical health disparities. The 
increased incidence of substance use and abuse among AAPI youth 
and adults has gone unaddressed due to the lack of relevant 
data and research, culturally competent service programs, and 
the lack of awareness among constituent communities. The 
Committee urges SAMHSA to increase its work with the network of 
AAPI community-based organizations, constituents, and other 
community members to create greater awareness about substance 
abuse and to improve substance abuse services for the AAPI 
communities.
            Substance abuse block grants
    The Committee provides $1,774,538,000 for the substance 
abuse block grants, which is $20,606,000 above the fiscal year 
2003 comparable level and $10,462,000 less than the budget 
request. The substance abuse block grants provide funds to 
States to support alcohol and drug abuse prevention, treatment, 
and rehabilitation services. Funds are allocated among the 
States according to a statutory formula. State applications 
including comprehensive State Plans must be approved annually 
by SAMHSA as a condition of receiving funds.
    The Committee is very interested in the innovative 
treatment voucher initiative and understands that the State of 
Maine has been implementing a voucher program with their State 
funds for five years. As the voucher system is developed, the 
Committee urges SAMHSA to examine ways in which to promote this 
funding option and to encourage States to incorporate vouchers 
into their State plans.

Center for Substance Abuse Prevention

            Programs of regional and national significance
    The Committee provides $198,000,000 for the substance abuse 
prevention programs of regional and national significance, 
which is $49,814,000 above the budget request and $889,000 
above the fiscal year 2003 comparable level. The program 
identifies and disseminates science-based substance abuse 
prevention approaches.
            Program management
    The Committee provides $91,259,000 for program management 
activities, of which $16,000,000 is provided through the 
evaluation set-aside as requested. The fiscal year 2004 level 
is $5,952,000 above the budget request and $4,327,000 above the 
fiscal year 2003 comparable level. The appropriation provides 
funding to coordinate, direct, and manage the agency's 
programs. Funds are used for salaries, benefits, space, 
supplies, equipment, travel and overhead.

               Agency for Healthcare Research and Quality

    The Committee provides a total of $303,695,000 for the 
Agency for Healthcare Research and Quality (AHRQ), which is the 
same as the fiscal year 2003 comparable level and $24,695,000 
above the budget request. This amount is funded from one 
percent evaluation funding.
    The mission of the Agency is to generate and disseminate 
information that improves the delivery of health care. Its 
research goals are to determine what works best in clinical 
practice; improve the cost-effective use of health care 
resources; help consumers make more informed choices; and 
measure and improve the quality of care.
    The Committee provides $245,695,000 for research on health 
costs, quality, and outcomes, which is $2,000,000 below the 
fiscal year 2003 comparable level and $24,695,000 above the 
budget request. This program identifies the most effective and 
efficient approaches to organize, deliver, finance, and 
reimburse health care services; determines how the structure of 
the delivery system, financial incentives, market forces, and 
better information affects the use, quality, and cost of health 
services; and facilitates the translation of research findings 
for providers, patients, plans, purchasers, and policymakers. 
It also funds research that determines what works best in 
increasing the cost effectiveness and appropriateness of 
clinical practice; supports the development of tools to measure 
and evaluate health outcomes, quality of care, and consumer 
satisfaction with health care system performance; and 
facilitates the translation of information into practical uses 
through the development and dissemination of research 
databases.
    The Committee does not approve the Administration's 
proposal to shift $10,000,000 from AHRQ to the Department of 
Commerce for the Current Population Survey (CPS) and does not 
intend for AHRQ funds to be used for that purpose. While the 
Committee supports improvements to the CPS, it does not believe 
that AHRQ's modest budget should be the source of the funding. 
Instead, the Committee intends that these funds be invested in 
non-patient safety health costs, quality and outcomes research.
    Within the total for research on health costs, quality, and 
outcomes, the Committee provides $75,000,000 for patient safety 
activities, which is $20,000,000 above the fiscal year 2003 
comparable level and $9,000,000 below the budget request. This 
amount includes funding for the patient safety hospital 
information technology initiative. As part of its patient 
safety activity, the Committee encourages AHRQ to conduct pilot 
projects to demonstrate the feasibility and value of standards-
based electronic health care data interchange.
    The Committee encourages AHRQ to support the acceleration 
of the adoption and use of standards and technology to support 
quality and safety, working with public-private sector 
partnerships such as the Foundation for eHealth Initiative to 
conduct pilot projects that demonstrate both the feasibility 
and value of standards-based electronic health care data 
interchange, to address patient safety.
    Health care costs.--The cost of health care delivery 
continues to rise with many health care experts predicting 
double digit increases for the foreseeable future. There is 
some concern that new biomedical research discoveries that 
provide new remedies for health problems may also contribute to 
higher health care costs when they are used inappropriately. 
The Committee recognizes the need to ensure that increased 
investment in biomedical research does not price quality health 
care out of reach of many Americans. Providers, patients and 
health care payers need objective, scientific information to 
understand which new interventions are more effective than 
existing practices, which groups of patients are most likely to 
benefit, the degree of improvement compared to the cost, and 
the relative risks for the patient of alternative 
interventions. The Committee suggests that AHRQ expand its 
efforts to support research and clinical effectiveness trials 
that will develop scientific evidence regarding the relative 
effectiveness, outcomes, risks and costs of promising new 
interventions in comparison with existing practices, especially 
those that have the potential to reduce health care costs 
without reducing quality. The agency is also encouraged to 
support an initiative to identify and make easily accessible 
the findings of existing, scientifically sound, cost-
effectiveness studies of new clinical interventions and 
technologies.
    Primary immunodeficiency diseases (PI).--The Committee 
remains concerned with the underdiagnosis of this class of 
diseases. Research has shown that screening of health records 
in a hospital emergency department can result in significant 
increases in the identification of these patients. The 
Committee encourages AHRQ to support evidence-based research 
projects focused on the diagnosis of PI in large urban health 
care systems and to disseminate evidence-based reports to 
physicians and other health care professionals.
    Treatment of chronic rhinosinusitis.--The National Health 
Interview Survey indicates that sinusitis is the most common 
chronic health complaint in the United States. An estimated 31 
million Americans experience rhinosinusitis each year, 
accounting for 18 million annual visits to primary care 
physicians at an estimated direct healthcare cost of almost $6 
billion. The Committee encourages AHRQ to support studies of 
overall clinical effectiveness of the treatment of chronic 
rhinosinusitis, comparing the effectiveness of medical and 
surgical treatment options, and assessing the impact of co-
morbid diseases such as asthma, allergy and immunodeficiency on 
treatment effectiveness.
    The Committee provides $55,300,000 for the Medical 
Expenditures Panel Surveys (MEPS), which is $2,000,000 above 
the fiscal year 2003 comparable level and the same as the 
budget request. The MEPS provide data for timely national 
estimates of health care use and expenditures, private and 
public health insurance coverage, and the availability, costs, 
and scope of private health insurance benefits. This activity 
also provides data for analysis of changes in behavior as a 
result of market forces or policy changes on health care use, 
expenditures, and insurance coverage; develops cost/savings 
estimates of proposed changes in policy; and identifies the 
impact of changes in policy for subgroups of the population.
    For program support, the Committee provides $2,700,000 
which is the same as the fiscal year 2003 level and the budget 
request. This activity supports the overall direction and 
management of the agency.

               Centers for Medicare and Medicaid Services


                     GRANTS TO STATES FOR MEDICAID

    The Committee provides $130,892,197,000 for the Federal 
share of current law State Medicaid costs, which is 
$18,801,979,000 above the fiscal year 2003 comparable level and 
$6,000,000,000 above the budget request. This amount does not 
include $51,861,386,000, which was advance funded in the fiscal 
year 2003 appropriation. In addition, the Committee provides an 
advance appropriation of $58,416,275,000 for program costs in 
the first quarter of fiscal year 2005. The Committee has 
included $6,000,000,000 for the temporary increase in the 
Federal match rate provided in Public Law 108-27. The Committee 
has also included indefinite budget authority for unanticipated 
costs in fiscal year 2004.
    Federal Medicaid grants reimburse States for 50 to 83 
percent (depending on per capita income) of their expenditures 
in providing health care for individuals whose income and 
resources fall below specified levels. Subject to certain 
minimum requirements, States have broad authority within the 
law to set eligibility, coverage, and payment levels. It is 
estimated that 43 million low-income individuals will receive 
health care services in 2004 under the Medicaid program. State 
costs of administering the program are matched at rates that 
generally range from 50 to 90 percent, depending upon the type 
of cost. Total funding for Medicaid includes $980,196,000 for 
the entitlement Vaccines for Children program. These funds, 
which are transferred to the Centers for Disease Control and 
Prevention for administration, support the costs of 
immunization for children who are on Medicaid, uninsured or 
underinsured and receiving immunizations at Federally qualified 
health centers or rural health clinics. Indefinite authority is 
provided by statute for the Vaccines for Children programs in 
the event that the current estimate is inadequate.

Payments to health care trust funds

    The Committee provides $95,084,100,000 for the Payments to 
the Health Care Trust Funds account, which is $13,621,400,000 
above the fiscal year 2003 comparable level and the same as the 
budget request.
    This entitlement account includes the general fund subsidy 
to the Medicare Part B trust fund as well as other 
reimbursements to the Part A trust fund for benefits and 
related administrative costs which have not been financed by 
payroll taxes or premium contributions. The amount provided 
includes $201,100,000 for program management administrative 
expenditures, which is $36,400,000 above the fiscal year 2003 
estimate of the general fund share of CMS program management 
expenses. This general fund share will be transferred to the 
Federal Hospital Insurance Trust Fund to reimburse for the 
funds advanced by the trust fund in fiscal year 2004 to finance 
the general fund portion of Program Management.

Program management

    The Committee makes available $2,698,025,000 in trust funds 
for Federal administration of the Medicare and Medicaid 
programs, which is $133,134,000 above the fiscal year 2003 
comparable level and $35,482,000 below the budget request.
            Research, demonstration, and evaluation
    The Committee provides $27,918,000 for research, 
demonstration and evaluation, which is $45,794,000 below the 
fiscal year 2003 comparable level and $35,482,000 below the 
budget request. These funds support a variety of studies and 
demonstrations in such areas as monitoring and evaluating 
health system performance; improving health care financing and 
delivery mechanisms; modernization of the Medicare program; the 
needs of vulnerable populations in the areas of health care 
access, delivery systems, and financing; and information to 
improve consumer choice and health status. The reduction below 
last year's level is primarily due to the funding of one-time 
projects.
    The Committee is encouraged by the L.A. Care Health Plan's 
development of a one-stop, on-line eligibility screening tool, 
which was funded, in part, by CMS. The screening tool expedites 
enrollment in public and private health care options for both 
individuals and families and provides instant information on 
health care options, eligibility, and referrals in English and 
Spanish. The Committee understands that field testing at 
various sites, including faith-based, school, community, 
provider, and employer-based sites, is currently underway. The 
Committee requests that CMS report by March, 2004 on the 
results of the filed testing that has been completed, the 
appropriateness of this screening tool for use in other 
localities and States, how the screening tool could be 
improved, and what additional resources would be needed to 
implement this screening tool on a nationwide basis.
    The Committee is pleased with CMS's proposal to provide 
demonstration grants to states to test innovative asthma 
disease management techniques for children enrolled in 
Medicaid. The Committee encourages CMS to provide this program 
with the necessary funding to carry out this initiative.
            Medicare operations
    The Committee provides $1,776,889,000 to support Medicare 
claims processing contracts, which is $110,209,000 above the 
fiscal year 2003 comparable level and the same as the budget 
request. The bill includes a general provision implementing the 
Administration's proposal to assess user fees to providers that 
submit incomplete or duplicate claims. The funds made available 
for Medicare operations will be reduced by $98,000,000 upon 
enactment of this provision. $126,000,000 is included within 
this account to begin implementation of the reforms to the 
Medicare appeals process mandated in the Benefits Improvement 
and Protection Act of 2000 and to begin to conduct Medicare 
hearings currently conducted by the Social Security 
Administration. An additional $3,000,000 is included for those 
activities in Federal administration.
    Medicare contractors are responsible for paying Medicare 
providers promptly and accurately. In addition to processing 
claims, contractors also identify and recover Medicare 
overpayments, as well as review claims for questionable 
utilization patterns and medical necessity. Contractors also 
provide information and technical support both to providers and 
beneficiaries regarding the administration of the Medicare 
program. In 2004, contractors are expected to process 1.1 
billion claims.
    The Committee understands that CMS has waived the five 
percent cap on transferring funds among functions as part of a 
pilot with three contractors. The Committee recommends that the 
waiver be extended to all contractors so they have greater 
flexibility to manage their resources in a manner that best 
matches programmatic needs and address mid-year addenda to 
budget instructions, new performance requirements and 
unanticipated increases in workload. The Committee requests CMS 
to report on the initial pilot and its plans to extend the 
waiver to all contractors in its fiscal year 2005 congressional 
justification.
            Revitalization plan
    The Committee provides $65,000,000, to remain available for 
two years, as the first year investment in CMS's efforts to 
make significant improvements to key aspects of managing both 
the agency and the Medicare program. Funding in fiscal year 
2004, the first year this funding was requested by the 
Administration, will target systems-related improvements.
            State survey and certification
    The Committee provides $247,647,000 for State inspections 
of facilities serving Medicare and Medicaid beneficiaries, 
which is $5,096,000 below the fiscal year 2003 comparable level 
and the same as the budget request.
    Survey and certification activities ensure that 
institutions and agencies providing care to Medicare and 
Medicaid beneficiaries meet Federal health, safety and program 
standards. On-site surveys are conducted by State survey 
agencies, with a pool of Federal surveyors performing random 
monitoring surveys. Over 71,000 surveys and complaint 
investigations will be performed in fiscal year 2004.
            Federal administration
    The Committee provides $580,571,000 to support Federal 
administrative activities related to the Medicare and Medicaid 
programs, which is $8,815,000 above the fiscal year 2003 
comparable level and the same as the budget request. This 
amount includes $13,000,000 for the Healthy Start, Grow Smart 
program as requested by the Administration. $3,000,000 is 
included within this account to begin implementation of the 
reforms to the Medicare appeals process mandated in the 
Benefits Improvement and Protection Act of 2000. The Committee 
repeats language from last year's enacted bill to identify 
$56,991,000 for the contract costs of the Health-care 
Integrated General Ledger Accounting System.
    The Medicare, Medicaid, and Children's Health Insurance 
programs ensure the health care security of over 82 million 
beneficiaries. The Federal Administration budget provides funds 
for the staff and operations of CMS to administer these 
programs.
    The Committee is aware that a proposed rule to revise the 
Medicare hospital conditions of participation was issued in 
December, 1997, and has never been finalized. Among other 
things, the proposed rule would have removed many of the overly 
prescriptive requirements in current regulations regarding the 
types of practitioners who may perform particular functions in 
a hospital, deferring instead to applicable State law. One such 
requirement is that only a doctor of medicine or osteopathy (or 
in certain cases, an oromaxillofacial surgeon) may provide a 
physical examination and take a medical history for a hospital 
inpatient. The omission of doctors of podiatric medicine from 
this list has resulted in situations in which an inpatient, who 
is under the care of a podiatrist, must be seen by a doctor of 
medicine or osteopathy for a history and physical, thereby 
resulting in unnecessary and wasteful expenditure of program 
funds. The Committee views this limitation as outdated because 
of evidence that the curricula of colleges of podiatric 
medicine fully prepare podiatrists to perform this function. 
The Committee encourages CMS to issue a final regulation adding 
doctors of podiatric medicine to the list of those who may 
provide a history and physical for patients admitted to a 
hospital if permitted by State law.
    The Committee commends CMS for issuing a program memorandum 
to clarify that Medicare beneficiaries who are blind or 
visually impaired are eligible for physician-prescribed 
rehabilitation services on the same basis as beneficiaries with 
other medical conditions. The Committee notes the impact of 
vision loss on beneficiaries' ability to function normally, and 
believes that vision rehabilitation services provided in a 
clinical setting may be enhanced by a brief course of 
additional vision rehabilitation in the home. The Committee 
encourages CMS to direct carriers and intermediaries to 
recognize the delivery of additional vision rehabilitation 
services in the home that are included in a clinical care plan.
    The Committee is concerned about patient access to care 
with plasma-derived and recombinant protein therapies 
(collectively, ``plasma therapies''). There are protein 
replacement or augmentation treatments used to treat diseases, 
such as Alpha-1 Antitrypsin Deficiency, primary 
immunodeficiencies and those with bleeding disorders. The 
Committee encourages CMS to amend the definition of blood and 
blood products for hospital outpatients to reflect the need to 
provide continuing access to plasma therapies used to treat 
chronic, life-threatening conditions and diseases.
    The Committee is concerned about the reimbursement levels 
that the Medicare program provides for immunizations. Many 
States apply these rates to the immunizations for their 
Medicaid programs, which may affect the availability of 
childhood immunizations. The Committee encourages CMS to review 
its Medicare immunization rate policy and consider whether 
reimbursements should be tied more specifically to the number 
of immunizations administered in a single office visit.
    The Committee has great concern about a May 19th proposed 
rule issued by CMS that effectively would eliminate graduate 
medical education payments to hospitals for non-hospital based 
residency training programs, including dental training, 
contrary to the provisions included in the Balanced Budget Act 
of 1997. It is the Committee's understanding that such action 
could result nationally in the loss of more than five hundred 
dental residencies and more than three hundred thousand dental 
patient visits, many of which are in medically underserved 
areas. The Committee urges CMS to reconsider the proposed 
policy change in light of the number of residency and faculty 
positions that would be eliminated, the additional costs that 
would accrue to States, and the resulting significant loss of 
medical and oral health services to all patient populations, 
but especially to uninsured and underserved populations.
    The Committee notes that the Kaiser Commission recently 
reported that approximately 5 million older Americans are 
missing out on hundreds of federal and State pharmacy benefits, 
discount cards and other assistance programs. The Committee is 
aware that the National Council on the Aging has developed an 
Internet-based prescription drug data base that provides 
information on approximately 260 public and private programs to 
assist seniors in determining what help is available to pay for 
prescription drugs. The Committee encourages CMS to consider 
supporting this data base to help maintain free access for 
seniors to this information. This data base is a useful interim 
tool as Congress works towards the creation and implementation 
of a new prescription benefit under Medicare.

                Administration for Children and Families


  PAYMENTS TO STATES FOR CHILD SUPPORT ENFORCEMENT AND FAMILY SUPPORT 
                                PROGRAMS

    The Committee provides $3,292,970,000 for the Child Support 
Enforcement program, the same as the budget request. The bill 
also provides $1,200,000,000 in advance funding for the first 
quarter of fiscal year 2005 to ensure timely payments for the 
child support enforcement program, the same as the request. The 
bill continues to provide estimated funding of $23,000,000 for 
Payments to Territories, the same as the fiscal year 2003 level 
and the budget request. The bill provides $1,000,000 for the 
repatriation program, the same as the fiscal year 2003 level 
and the budget request.

                   LOW-INCOME HOME ENERGY ASSISTANCE

    The Committee provides an appropriation of $1,800,000,000 
for the Low Income Home Energy Assistance Program (LIHEAP). 
This is $111,050,000 more than the fiscal year 2003 comparable 
level and $200,000,000 below the budget request. The Committee 
provides $1,700,000,000 of these funds through the regular 
formula program and $100,000,000 in contingent emergency 
funding. The budget request included $300,000,000 in contingent 
emergency funding.
    The LIHEAP program provides assistance to low-income 
households to help pay the costs of home energy. Funds are 
provided through grants to States, Indian Tribes and 
territories, and are used for summer cooling and winter 
heating/crisis assistance programs.

                     REFUGEE AND ENTRANT ASSISTANCE

    The Committee provides $461,853,000 for refugee assistance 
programs. This is $227,000 more than the budget request and 
$16,195,000 than the fiscal year 2003 comparable level.
    In addition, the bill provides the Office of Refugee 
Resettlement (ORR) the authority to carry over unexpended funds 
from fiscal year 2004 to reimburse the costs of services 
provided through September 30, 2006.
    It is estimated that approximately $23,800,000 will be 
available in fiscal year 2004 from carryover funds, and the 
Committee intends that these funds be used under social 
services to increase educational support to schools with a 
significant proportion of refugee children for the development 
of alternative cash assistance programs that involve case 
management approaches to improve resettlement outcomes. Such 
support should include intensive English language training and 
cultural assimilation programs.

Transitional and medical services

    The Committee provides $200,193,000 for transitional and 
medical services. This is the same level as the budget request 
and $19,660,000 less than the fiscal year 2003 comparable 
level. The bill continues the policy of providing eight months 
of assistance to new arrivals. The transitional and medical 
services program provides funding for the State-administered 
cash and medical assistance program that assists refugees who 
are not categorically eligible for TANF or Medicaid, the 
unaccompanied minors program that reimburses States for the 
cost of foster care, and the voluntary agency grant program in 
which participating national refugee resettlement agencies 
provide resettlement assistance with a combination of Federal 
and matched funds.

Victims of trafficking

    The Committee provides up to $10,000,000 for the victims of 
trafficking program. This is $65,000 more than the fiscal year 
2003 comparable level and the same as the budget request. The 
funds will ensure continued administration of a national 
network for identification, tracking and certification of 
trafficking victims.

Social services

    The Committee provides $153,121,000 for social services. 
This is $2,982,000 more than the fiscal year 2003 comparable 
level and the same as the budget request. Funds are distributed 
by formula as well as through the discretionary grant making 
process for special projects.

Preventive health

    The Committee provides $4,835,000 for preventive health 
services. This is $31,000 more than the fiscal year 2003 
comparable level and the same as the budget request. These 
funds are awarded to the States to ensure adequate health 
assessment activities for refugees.

Targeted assistance

    The Committee provides $49,477,000 for the targeted 
assistance program. This is $322,000 more than the fiscal year 
2003 comparable level and the same as the budget request. These 
grants provide assistance to areas with high concentrations of 
refugees.

Unaccompanied minors

    The Committee provides $34,227,000 for the unaccompanied 
minors program. This is $227,000 more than the budget request 
and the same as the fiscal year 2003 comparable level. Funds 
were transferred to the Office of Refugee Resettlement in 
fiscal year 2003 from the Immigration and Naturalization 
Service pursuant to section 462 of the Homeland Security Act. 
The program is designed to provide for the care and placement 
of unaccompanied alien minors.

Victims of torture

    The Committee provides $10,000,000 to provide a 
comprehensive program of support for domestic centers and 
programs for victims of torture. This is $65,000 more the 
fiscal year 2003 comparable level and the same as the budget 
request.

                 CHILD CARE AND DEVELOPMENT BLOCK GRANT

    The bill includes $2,099,729,000 for the Child Care and 
Development Block Grant program, an increase of $13,385,000 
above the fiscal year 2003 comparable level and the same as the 
budget request.
    The Child Care and Development Block Grant program was 
originally enacted in the Omnibus Budget Reconciliation Act of 
1990 to increase the availability, affordability and quality of 
child care by providing funds to States, Territories and Indian 
Tribes for child care services for low-income families. The 
authorization for mandatory appropriations for child care in 
the amount of $2,717,000,000 is also requested for fiscal year 
2004.

                      SOCIAL SERVICES BLOCK GRANT

    The Committee provides $1,700,000,000 for the social 
services block grant (SSBG). This is the same as the fiscal 
year 2003 level and the budget request.
    SSBGs are designed to encourage States to furnish a variety 
of social services to needy individuals to prevent and reduce 
dependency, help individuals achieve and maintain self-
sufficiency, prevent or reduce inappropriate institutional 
care, secure admission or referral for institutional care when 
other forms of care are not appropriate, and prevent neglect, 
abuse and exploitation of children and adults.
    Funds are distributed to the territories in the same ratio 
such funds were allocated in fiscal year 1981. The remainder of 
the appropriation is distributed to the States and the District 
of Columbia according to population.
    The bill includes a provision that modifies the percentage 
of funds that a State may transfer between the Social Services 
Block Grant and the Temporary Assistance to Needy Families 
programs to 5.5%.

                        DISABLED VOTER PROGRAMS

    The Committee provides $15,000,000 for Disabled Voter 
programs. This is the same as the fiscal year 2003 level. No 
funding was requested for this program. Within the funds 
provided, $13,000,000 is available for State access grants and 
$2,000,000 is available for State protection and advocacy 
systems.
    The Disabled Voter programs are intended to make polling 
places accessible and provide equal access and participation 
for individuals with disabilities and for other voters, such as 
older Americans. The protection and advocacy program will 
ensure that individuals can fully participate in the electoral 
process, including registering to vote, accessing polling 
places, and casting a vote.

                 CHILDREN AND FAMILY SERVICES PROGRAMS

    The Committee provides $8,599,670,000 for children and 
family services programs. This is $30,606,000 less than the 
fiscal year 2003 comparable level and $87,712,000 less than the 
budget request. This account finances a number of programs 
aimed at enhancing the well-being of the Nation's children and 
families, particularly those who are disadvantaged or troubled.

Head Start

    The bill includes $6,815,570,000 for the Head Start program 
for fiscal year 2004, an increase of $148,037,000 over the 
fiscal year 2003 amount and the same as the budget request. Of 
this total, the Committee continues the policy of advancing 
$1,400,000,000 of this account into fiscal year 2005.
    Head Start provides comprehensive development services for 
children and their families. Intended for preschoolers from 
low-income families, the program seeks to foster the 
development of children and enable them to deal more 
effectively with both their present environment and later 
responsibilities in school and community life. Head Start 
programs emphasize cognitive and language development, 
emotional development, physical and mental health, and parent 
involvement to enable each child to develop and function at his 
or her highest potential. At least ten percent of enrollment 
opportunities in each State are made available to handicapped 
children.
    Grants to carry out Head Start programs are awarded to 
public and private non-profit agencies. Grantees must 
contribute 20 percent of the total cost of the program; this is 
usually an in-kind contribution. The Head Start Act does not 
include a formula for the allotment of funds to local grantees; 
however, it does require that 87 percent of the appropriation 
be distributed among States based on a statutory formula. In 
addition, grants, cooperative agreements and contracts are 
awarded in the areas of research, demonstration, technical 
assistance and evaluation from the remaining 13 percent.
    The Committee believes that the Head Start program holds 
great potential for closing the achievement gap between low-
income children and their more-advantaged peers. However, the 
Committee also believes that, as scientific research increases 
our understanding of how the brain develops and the importance 
of early linguistic stimulation in young children, Head Start 
should be able to do more to develop pre-literacy skills in the 
children it serves so that every Head Start child enters 
kindergarten ready to read and learn. To that end, the 
Committee encourages Head Start programs to place a greater 
focus on literacy-rich activities during the Head Start day. 
The Committee supports the efforts of the Administration in 
this regard.
    The Committee also believes that a greater link needs to be 
made between Head Start centers and the school systems which 
will eventually serve these children. The Committee is aware 
that such links frequently do occur, and that in many cases a 
school system also serves as the Head Start center grantee. 
However, the Committee continues to be concerned that not 
enough emphasis is placed upon the transition from pre-school 
to regular school for these children and that gains made in 
Head Start are sometimes lost once the child enters the regular 
school system. Therefore, the Committee encourages Head Start 
centers and school districts to develop stronger partnerships 
to ensure a smooth transition between Head Start and 
kindergarten. Specifically, the Committee encourages 
collaboration between Head Start and school districts in the 
approval of curriculum and professional development for the 
school readiness portion of the program, and recognizes the 
importance of partnerships in the approval and performance of 
professional development of the teachers in the program.

Consolidated runaway and homeless youth program

    The Committee provides $88,043,000 for runaway and homeless 
youth activities, a decrease of $1,935,000 less than the fiscal 
year 2003 comparable level and the same as the budget request. 
Within the funds provided, $61,630,000 is available for the 
basic center program and $26,413,000 is available for the 
transitional living program.
    The Runaway and Homeless Youth Program provides grants to 
local public and private organizations to establish and operate 
local runaway and homeless youth centers to address the crisis 
needs of runaway and homeless youth and their families. Grants 
are used to develop or strengthen community-based centers, 
which are outside the law enforcement, juvenile justice, child 
welfare, and mental health systems.
    It is the Committee's expectation that current and future 
transitional living program grantees will continue to provide 
transitional living opportunities and supports to pregnant and 
parenting homeless youth, as is their current practice. To 
further ensure that pregnant and parenting homeless youth are 
able to access transitional living opportunities and supports 
in their communities, the Committee encourages the Secretary, 
acting through the network of federally-funded runaway and 
homeless youth training and technical assistance providers, to 
offer guidance to grantees and others on the programmatic 
modifications required to address the unique needs of pregnant 
and parenting youth and on the various sources of funding 
available for residential services to this population.

Maternity group homes

    The Committee has not included funding for this new 
program. The budget request is $10,000,000.
    The Committee is aware of the need for and shares the 
Administration's interest in funding residential services for 
young mothers and their children who are unable to live with 
their own families because of abuse, neglect, or other 
circumstances. The Committee notes that pregnant and parenting 
youth are currently eligible for and served through the 
Transitional Living Program.

Prevention grants to reduce abuse of runaway youth

    The Committee provides $14,999,000 for prevention grants to 
reduce abuse of runaway youth. This is the same as the budget 
request and $400,000 less than the fiscal year 2003 comparable 
level. This program is designed to reduce the sexual abuse of 
runaway youth.
    This program provides grants to support street-based 
outreach and education to runaway, homeless, and street youth 
who have been sexually abused or are at-risk of sexual abuse, 
in order to connect these young people with services and a 
chance for a safe and healthy future. The street outreach 
program ensures rapid engagement with young people in an effort 
to prevent the most terrible situations that take place when 
they are subjected to life on the streets--physical and sexual 
abuse, assault, commercial sexual exploitation, disease, long-
term homelessness, and even death.

Child abuse

    For child abuse prevention and treatment, the Committee 
provides $48,314,000. This is same as the budget request and 
$7,401,000 less than the fiscal year 2003 comparable level. The 
recommendation includes $22,013,000 for State grants. This is 
$143,000 more than the fiscal year 2003 level and the same as 
the budget request.

Abandoned infants assistance

    The Committee provides $12,086,000 for the Abandoned 
Infants Assistance Act. This is same as the budget request and 
$40,000 less than the fiscal year 2003 comparable level. The 
purpose of this program is to provide financial support to 
public and non-profit private entities to develop, implement, 
and operate demonstration projects that will prevent the 
abandonment of infants and young children; identify and address 
their needs, especially those infected with HIV; assist such 
children to reside with their natural families or in foster 
care, as appropriate; provide respite care for families and 
caregivers; and recruit and train caregivers. Grantees must 
establish a care plan and case review system for each child.

Child welfare services and training

    The Committee provides $291,986,000 for child welfare 
services. This is $1,898,000 more than the fiscal year 2003 
comparable amount and the same as the budget request. This 
program authorized by title IV B of the Social Security Act 
provides grants to States to assist public welfare agencies to 
establish, extend, and strengthen child welfare services in 
order to enable children to remain in their homes under the 
care of their parents, or, where that is not possible, to 
provide alternative permanent homes for them.
    The Committee provides $7,470,000 for child welfare 
training. This is $21,000 more than the fiscal year 2003 
comparable level and the same as the budget request. The 
Committee recognizes the need for trained, skilled and 
qualified child welfare protection personnel. This program 
provides teaching and traineeship grants to schools of social 
work to train social workers in the specialty of child welfare.
    The Committee continues to be concerned about the crisis 
existing in child welfare agencies across the country. As 
States work to improve their child welfare workforce through 
targeted training, it is vital that an independent evaluation 
of the effectiveness of those training programs be conducted. 
The Committee is aware of the work of the National Resource 
Center on Child Welfare Training and Evaluation at the 
University of Louisville and urges the Administration for 
Children and Families to continue to partner with them as we 
seek to improve the effectiveness of child welfare workers.

Adoption opportunities

    The Committee provides $27,343,000 for adoption 
opportunities. This is $116,000 more than the fiscal year 2003 
comparable level and the same as the budget request. The 
Adoption Opportunities Program provides funding specifically 
targeted to improving the adoption of children with special 
needs and minority children and for providing for innovative 
services that support families involved in adoption.

Adoption incentives

    The Committee provides $43,000,000 for the adoption 
incentives program. This is $280,000 more than the fiscal year 
2003 comparable level and the same as the budget request. This 
program was authorized in the Adoption and Safe Families Act of 
1997. These funds are used to pay bonuses to States that 
increase their number of adoptions from the public foster care 
system. This should make adoption a higher priority at the 
State level.

Adoption awareness

    The Committee provides $12,906,000 for the adoption 
awareness program. This is the $84,000 more than the fiscal 
year 2003 comparable level and the same as the budget request. 
This program was authorized in the Child Health Act of 2000. 
The adoption awareness program provides training to designated 
staff of eligible health centers in providing adoption 
information and referrals to pregnant women on an equal basis 
with all other courses of action included in non-directive 
counseling to pregnant women.

Compassion capital fund

    The Committee provides $50,000,000 for the compassion 
capital fund. This is $15,228,000 more than the fiscal year 
2003 comparable level and $50,000,000 less than the budget 
request. This program supports the creation of grants to 
public/private partnerships to support charitable organizations 
in expanding or emulating model social services agencies.

Social services and income maintenance research

    The Committee provides $5,982,000 for social services and 
income maintenance research. This is the same level as the 
budget request and $22,767,000 less than the fiscal year 2003 
comparable level. These funds support research, demonstration, 
evaluation and dissemination activities. Areas covered include 
welfare reform, child care, and child welfare.
    The Committee is pleased with the results of the 
Administration for Children and Families' (ACF) work with the 
State information technology consortium, an effort that is 
helping States with the difficult task of streamlining service 
delivery, while also meeting Temporary Assistance for Needy 
Families (TANF) record-keeping and reporting requirements. As a 
result of this collaborative effort, States and ACF are now 
able to share systems information on TANF, child support 
enforcement, child welfare and childcare activities. The 
Committee is also pleased with the Child Support Enforcement 
program's work with the consortium, an effort that is improving 
the child support collection process by using web-based 
technologies to speed the flow of information between relevant 
agencies and the court system. The Committee recommends that 
both collaborative efforts with the State information 
technology consortium be continued at their current levels.

Community-based resource centers

    The Committee provides $33,403,000 for community-based 
resource centers. This is $203,000 more than the fiscal year 
2003 comparable level and the same as the budget request. The 
purpose of the program is to assist each State in developing 
and operating a network of community-based, prevention-focused 
family resource and support programs that coordinate resources 
among a broad range of human service organizations.

Developmental disabilities

    For programs authorized by the Developmental Disabilities 
Assistance Act, the Committee provides $145,500,000. This is 
$5,058,000 more than the budget request and $737,000 more than 
the fiscal year 2003 comparable level. The account total 
includes $71,500,000 for allotments to the States to fund State 
Councils, $1,700,000 more than the budget request and $365,000 
more than the fiscal year 2003 comparable level. These Councils 
engage in such activities as planning, policy analysis, 
demonstrations, training, outreach, interagency coordination, 
and public education. They do not provide direct services to 
the developmentally-disabled population.
    In addition, $36,500,000 will be available to the States to 
be used for operating an advocacy program to protect the rights 
of the developmentally disabled. This is $1,500,000 more than 
the budget request and $237,000 more than the fiscal year 2003 
comparable level.
    The Committee provides $12,500,000 for special 
discretionary projects for training, technical assistance and 
demonstration. This is $858,000 more than the budget request 
and $97,000 more than the fiscal year 2003 comparable funding 
level.
    The Committee provides a total of $25,000,000 for grants to 
university affiliated facilities and satellite centers to 
support the cost of administering and operating demonstration 
facilities and interdisciplinary training programs. This is 
$1,000,000 more than the budget request and $38,000 more than 
the fiscal year 2003 comparable level. These are discretionary 
grants to public and private non-profit agencies affiliated 
with a university. These grants provide basic operational and 
administrative core support for these agencies. In addition, 
these funds support interdisciplinary training, community 
services, technical assistance to State agencies and 
information dissemination.
    The Committee recognizes the growing crisis in recruiting 
and training quality direct support professionals to serve 
people with mental retardation and other developmental 
disabilities living in the community. The Department of Health 
and Human Services is encouraged to work with the Department of 
Labor to establish a joint commission to examine recruitment 
and retention of direct support professionals that includes all 
relevant stakeholders, from both for profit and not-for-profit 
providers, and to make recommendations to address the critical 
shortage of this workforce.

Native American programs

    The Committee provides $45,119,000. This is the same as the 
budget request and $338,000 less than the fiscal year 2003 
comparable level. The Administration for Native Americans 
assists Indian Tribes and Native American organizations in 
planning and implementing their own long-term strategies for 
social and economic development. In promoting social and 
economic self-sufficiency, this organization provides financial 
assistance through direct grants for individual projects, 
training and technical assistance, and research and 
demonstration programs.

Community Services

    The Committee provides $577,562,000 for Community Services 
activities. This is $25,250,000 more than the budget request 
and $156,947,000 less than the fiscal year 2003 comparable 
level.
            State block grant
    For the State Block Grant, the Committee provides 
$494,964,000. This is the same as the budget request and 
$150,798,000 less than the fiscal year 2003 comparable level. 
This program provides grants to States for services to meet 
employment, housing, nutrition, energy, emergency services, and 
health needs of low-income people. By law, 90 percent of these 
funds are passed directly through to local community action 
agencies that have previously received block grant funds. The 
Committee believes that this program provides the kind of 
flexibility at the local level necessary to assist people who 
are in temporary need of government assistance to get back on 
their feet.
            Community economic development
    The Committee provides $32,436,000 for community economic 
development grants. This is the same as the budget request and 
$110,000 less than the fiscal year 2003 comparable level. These 
activities provide assistance to private, locally-initiated 
community development corporations that sponsor enterprises 
providing employment, training and business development 
opportunities for low-income residents in poor communities. In 
certain instances, projects that have been awarded funding may 
not be able to go forward because of changed circumstances. The 
Secretary may approve the use of the funds for another project 
sponsored by the same community development corporation if the 
project meets the requirements of the law and the goals and 
objectives of the original project for which the grant was 
made.
            Individual development account
    The Committee provides $24,912,000 for individual 
development accounts. This is $84,000 more than the fiscal year 
2003 comparable level and the same as the budget request. 
Individual development accounts are dedicated savings accounts 
that can be used by families with limited means for purchasing 
a first home, paying for postsecondary education or 
capitalizing a business. The intent of the program is to 
encourage participants to develop and reinforce strong habits 
for saving money. 501(c)(3) organizations are eligible to apply 
for the funds and applicants must match federal funds with non-
federal funds.
            Rural community facilities
    The Committee provides $7,250,000 for the rural community 
facilities program. This is $47,000 more than the fiscal year 
2003 comparable amount. No funding was requested for this 
program. The Committee includes these funds to 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.
            National youth sports program
    The Committee provides $18,000,000 for the National Youth 
Sports program. This is $1,111,000 more than the fiscal year 
2003 comparable level. No funds were requested for this 
program. These funds are made available to a private, non-
profit organization to provide recreational activities for low-
income youth, primarily in the summer months. College and 
university athletic facilities are employed in the program.
            Community food and nutrition
    The Committee concurs with the budget request not to 
include funding for the Community Food and Nutrition program. 
The fiscal year 2003 comparable funding level for this program 
is $7,203,000. This program provides grants to public and 
private agencies to coordinate existing food assistance 
programs, to identify sponsors of child nutrition programs and 
attempt to initiate new programs and to do advocacy work at the 
State and local levels.

Violent crime reduction programs

    The Committee provides $126,403,000 for family violence 
prevention and services and battered women's shelters. This is 
$1,980,000 more than the budget request and the same as the 
fiscal year 2003 comparable level. This program is designed to 
assist States in efforts to prevent family violence and to 
provide immediate shelter and related assistance for victims of 
family violence and their dependents, and to provide for 
technical assistance and training relating to family violence 
programs to State and local public agencies (including law 
enforcement agencies), nonprofit private organizations, and 
persons seeking such assistance.
    The bill also includes $3,000,000 to continue funding the 
National Domestic Violence Hotline. This is $438,000 more than 
the fiscal year 2003 comparable level and the same as the 
budget request.

Early Learning Fund

    The Committee does not provide funding for the Early 
Learning Fund. The fiscal year 2003 comparable level for this 
program is $33,779,000. The budget did not request funding for 
this program. This program was begun in fiscal year 2001 to 
help facilitate the development of learning readiness in young 
children.

Faith-based center

    The Committee provides $1,400,000 for the faith-based 
center. This is the same as the budget request and $90,000 less 
than the fiscal year 2003 comparable level. The center will 
support implementation of faith-based and community initiatives 
in accordance with the President's executive order.

Mentoring children of prisoners

    The Committee provides $25,000,000 for the mentoring 
children of prisoners program. This is $15,065,000 above the 
fiscal year 2003 comparable level and $25,000,000 below the 
budget request. This program supports competitively awarded 
grants to States and local governments, Indian tribes and 
consortia, and faith and community-based organizations to 
mentor children of prisoners and those recently released from 
prison.

Independent living training vouchers

    The Committee provides $45,000,000 for independent living 
training vouchers. This is $3,273,000 more than the fiscal year 
2003 comparable level and $15,000,000 less than the budget 
request. These funds support vouchers for college tuition or 
vocational training for individuals who age out of the foster 
care system, so they can be better prepared to live 
independently.

Promotion of responsible fatherhood and healthy marriages

    The Committee does not include funding for the promotion of 
responsible fatherhood and healthy marriages program. The 
budget request is $20,000,000. Legislation authorizing this 
program is pending Congressional action.

Program direction

    The Committee has approved $179,584,000 for program 
direction expenses of the Administration for Children and 
Families. This is $7,771,000 more than the fiscal year 2003 
comparable level and the same as the budget request.

                   PROMOTING SAFE AND STABLE FAMILIES

    The Committee provides $405,000,000 for the promoting safe 
and stable families program. This is $650,000 more than the 
fiscal year 2003 comparable level and $99,978,000 less than the 
budget request.

           PAYMENTS TO STATES FOR FOSTER CARE AND ASSISTANCE

    The Committee provides $5,068,300,000 for payments to 
States for foster care and adoption assistance. This is 
$213,300,000 more than the fiscal year 2003 level and the same 
as the budget request. The bill also includes an advance 
appropriation of $1,767,700,000 for the first quarter of fiscal 
year 2005 to ensure timely completion of first quarter grant 
awards.
    Of the total appropriation, including the advance 
appropriation from the prior year, the Committee provides 
$4,974,200,000 for the foster care program to provide 
maintenance payments to States on behalf of children who must 
live outside their homes. This is $89,700,000 more than the 
fiscal year 2003 level and the same as the budget request.
    Within the total appropriation, the Committee provides 
$1,699,700,000 for adoption assistance. This is $115,200,000 
more than the fiscal year 2003 level and the same as the budget 
request. This program provides training for parents and State 
administrative staff as well as payments on behalf of 
categorically eligible children considered difficult to adopt. 
This annually appropriated entitlement is designed to provide 
alternatives to long, inappropriate stays in foster care by 
developing permanent placements with families.
    Within the total appropriation for this account, the 
Committee provides $140,000,000 for the independent living 
program. This is the same as the fiscal year 2003 level and the 
budget request. The program is designed to assist foster 
children age 16 or older to make successful transitions to 
independence. Funds assist children to earn high school 
diplomas, receive vocational training, and obtain training in 
daily living skills. Funds are awarded to States on the basis 
of the number of children on behalf of whom Federal foster care 
payments are received.

                        Administration on Aging


                        AGING SERVICES PROGRAMS

    For programs administered by the Administration on Aging, 
the Committee provides a total of $1,377,421,000. This is 
$33,720,000 more than the budget request and $10,364,000 more 
than the fiscal year 2003 comparable level. This account 
finances all programs under the Older Americans Act in this 
bill, with the exception of the Community Services Employment 
Program under title V, which is administered by the Department 
of Labor.
    The Committee intends that the funds appropriated for 
programs authorized by the Older Americans Act (OAA) be 
disbursed to States to support local Areas on Aging (AAA). 
These agencies provide vital services to our Nation's most 
vulnerable older citizens, and their funds should not be 
withheld if a State fails to pass its own annual budget in a 
timely manner.

Supportive services and centers

    The Committee provides $357,000,000 for supportive services 
and centers. This is $1,372,000 more than the fiscal year 2003 
comparable level and the same as the budget request. This 
includes funding for in-home services for frail elderly persons 
who are at risk of losing their self-sufficiency due to 
physical or mental impairments. Funds for supportive services 
and centers are awarded to each State with an approved State 
plan. The formula under title III of the Older Americans Act 
mandates that no State be allotted less than the total amount 
allotted to it in fiscal year 2000. The funds contained in the 
bill will support coordinated, comprehensive service delivery 
systems at the local level.

Preventive health

    The Committee provides $21,919,000 for preventive health 
services authorized under part F of title III of the Act. This 
is $357,000 more than the budget request and the same as the 
fiscal year 2003 comparable level. These funds are awarded to 
States by formula to allow States and communities the 
flexibility to meet the health promotion and disease prevention 
needs of older people.

Ombudsman/elder abuse

    The Committee provides $18,559,000 for the State long-term 
care ombudsman activities, the elder abuse prevention program, 
State elder rights and outreach and counseling authorized by 
title VII of the Older Americans Act. This is $878,000 more 
than the budget request and the same as the fiscal year 2003 
comparable level. This program provides the assistance needed 
by vulnerable older Americans to protect themselves from abuse 
and exploitation, to exercise control over their environment, 
and to locate the resources they need for care and daily 
living.

National Family Caregiver Support Program

    The Committee provides $162,000,000 for the family 
caregivers program. This is $20,500,000 more than the budget 
request and $12,975,000 more than the fiscal year 2003 
comparable level. The family caregiver program provides formula 
grants, competitive grants, research and national activities to 
provide a support system in each State for family caregivers. 
All States are expected to put in place five basic system 
components, including individualized information on available 
resources; assistance to families in locating services from 
private and voluntary agencies; caregiver counseling, training 
and peer support; respite care; and limited supplemental 
services.

Native American Caregiver Support Program

    The Committee provides $6,500,000 for the Native American 
Caregiver Support Program. This is $291,000 more than the 
fiscal year 2003 comparable level. The program assists Tribes 
in providing multifaceted systems of support service for family 
caregivers and for grandparents or older individuals who are 
relative caregivers.

Nutrition programs

    For congregate and home delivered meals, as well as the 
nutrition services incentive program, the Committee provides 
$720,655,000. This is $6,381,000 more than the fiscal year 2003 
comparable level and $2,485,000 more than the budget request. 
These programs are intended to address some of the difficulties 
confronting older individuals, namely nutrition deficiencies 
due to inadequate income, lack of adequate facilities to 
prepare food, and social isolation.

Grants to Indian tribes

    The Committee provides $25,729,000 for grants to Indian 
tribes. This is the same as the budget request and $1,766,000 
less than the fiscal year 2003 comparable level. Funds under 
this program are awarded to tribal organizations to be used to 
promote opportunities for older Indians, to secure and maintain 
independence and self-sufficiency, and to provide 
transportation, nutrition, health screening and other services 
to help meet the needs of this population.

Research, training and special projects

    The Committee provides $30,837,000 for research, training 
and special projects under title IV of the Older Americans Act. 
This is $3,000,000 more than the budget request and $9,421,000 
below the fiscal year 2003 comparable funding level. Funds 
under this program are used to support education and training 
activities for personnel working in the field of aging and to 
finance research, development, and demonstration projects.
    The Committee provides $3,000,000 for social research into 
Alzheimer's disease care options, best practices and other 
Alzheimer's research priorities that include research into 
cause, cure and care, as well as respite care, assisted living, 
the impact of intervention by social service agencies on 
victims, and related needs. The Committee recommends this 
research utilize and give discretion to Area Agencies on Aging 
and their non-profit divisions in municipalities with aged 
populations (over the age of 60) of over 1 million, with 
preference given to the largest population. The Committee also 
recommends that unique partnerships to affect this research be 
considered for the selected Area Agency on Aging.

Alzheimer's demonstration grants

    The Committee provides $11,500,000 for Alzheimer's 
demonstration grants. This is the same as the budget request 
and $1,912,000 less than the fiscal year 2003 comparable level. 
The program provides grants to States to help them plan and 
establish programs to provide health care services to 
individuals with Alzheimer's disease. Funds are used for 
respite care and supportive services, clearinghouses, training, 
and administrative costs for State offices. By law, States are 
required to match the Federal funding at 45 percent of the cost 
of the program by the third year of the grant.

White House conference on aging

    The Committee provides $2,842,000 for the White House 
conference on aging. This is the same level as the budget 
request. Funds were not required for this program in fiscal 
year 2003. The Conference is required to take place prior to 
December 31, 2005 and will be the first such conference of the 
21st Century and the fifth in our Nation's history. Past White 
House conferences on aging have prompted the development of 
many of the programs that represent America's commitment to the 
elderly.

Program administration

    The Committee provides $17,501,000 for program 
administration expenses of the Administration on Aging. This is 
the same as the budget request and $368,000 less than the 
fiscal year 2003 comparable level. This activity provides 
administrative and management support for all Older Americans 
Act programs administered by the Department.

                        Office of the Secretary


                    GENERAL DEPARTMENTAL MANAGEMENT

    The Committee provides $349,097,000 for general 
departmental management, which is $1,876,000 below the fiscal 
year 2003 comparable level and $4,854,000 below the budget 
request. Included in this amount is authority to spend 
$5,813,000 from the Medicare trust funds.
    This appropriation supports those activities that are 
associated with the Secretary's roles as policy officer and 
general manager of the Department. The Office of the Secretary 
also implements Administration and Congressional directives, 
and provides assistance, direction and coordination to the 
headquarters, regions and field organizations of the 
Department. This account also supports several small health 
promotion and disease prevention activities that are centrally 
administered.
    The Committee provides $8,235,000 for the immediate Office 
of the Secretary, $4,100,000 for the Office of the Assistant 
Secretary for Public Affairs, $3,200,000 for the Office of the 
Assistant Secretary for Legislation, $7,000,000 for the Office 
of Assistant Secretary for Planning and Evaluation, $20,588,000 
for the Office of the Assistant Secretary for Budget, 
Technology, and Finance, and $16,500,000 for the Office of the 
Assistant Secretary for Administration and Management.
    The Committee includes $5,000,000 as requested by the 
Administration for the joint Department of Defense and HHS 
initiative to improve the largest women's hospital in Kabul, 
Afghanistan and to create four satellite teaching clinics. Bill 
language is included identifying the amount of assistance and 
citing as authority the Afghanistan Freedom Support Act of 
2002. The Committee provides funding for Commissioned Corps 
revitalization in the Public Health and Social Services 
Emergency Fund.
    Health disparities.--It has been well documented that 
disparities in access to and quality of healthcare exist across 
ethnic and racial populations in the United States. However, 
there is no systematic way to assess disparities in care 
because race and ethnicity data collection is neither 
standardized nor widely performed. The Committee encourages the 
Secretary to promote standardized classification and collection 
of race and ethnicity data in healthcare settings, as an 
important step in addressing disparities in healthcare for 
minority populations. Further, the Committee suggests that the 
Secretary work with the Census Department and the Office of 
Management and Budget to standardize race and ethnicity data 
collection for federal purposes.
    Limited English proficiency.--The Committee believes that 
the Department's revised Limited English Proficiency (LEP) 
guidance should be implemented in a cost effective manner. The 
Committee therefore requests the Department of HHS to provide 
information to the Committee by December 1, 2003 on 
implementation of the revised guidance; HHS funding for 
services provided to implement the guidance, including 
publications, web site construction costs, and language line 
contracts; and the availability of existing data from States 
and localities relating to the cost of implementing the 
guidance.
    Chronic fatigue.--The Committee is pleased that HHS has 
chartered the Chronic Fatigue Syndrome (CFS) Advisory Committee 
and called for nominations. The Committee expects that the 
Department will move rapidly to install members and hold one 
meeting, both prior to the end of fiscal year 2003. It is the 
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 advisory committee's predecessor, the Chronic Fatigue 
Syndrome Coordinating Committee. The Committee anticipates that 
the new advisory committee will further advance the efforts of 
the Department and its public health service agencies to 
address the scientific questions about CFS and the social 
service needs of persons with CFS.
    Bioterrorism.--The Committee remains very concerned about 
the threat of bioterrorism, with its potential for serious 
consequences on the health and safety of the American public. 
The commissioned corps of the U.S. Public Health Service and 
its reserve component provide unique competencies that have 
responded to recent bioterrorist attacks. The ability of the 
commissioned corps and its reserve component to respond to a 
bioterrorist attack needs to strengthened. The lack of a 
formalized inactive reserve program and the inflexibility of 
full-time equivalent ceilings need to be addressed to help the 
corps respond in times of national emergency. The Committee 
intends that any public health service reserve personnel called 
to active duty for assignment of six months or less not be 
subject to FTE requirements.
    Men's health.--The Committee understands that there is no 
entity in the Department responsible for the coordination and 
oversight of activities across the agency concerning men's 
health. The Committee is aware of reports that men are 25 
percent less likely than women to receive regular health 
screenings, and that one of the top problems facing men's 
health is that men are not likely to visit a doctor when they 
notice a problem. The Committee encourages the Secretary to 
expand departmental disease prevention and health promotion 
activities among men and to give consideration to establishing 
an office for men's health, similar to the HHS Office of 
Women's Health. The Committee expects the Secretary to report 
during the fiscal year 2004 hearings activities that have been 
undertaken with regard to men's health. The Committee also 
encourages the Department to host a national town hall meeting 
on prostate cancer.
    Disease spending.-- The Department is instructed to provide 
the Committee with a table detailing total spending by HHS, 
PHS, and NIH in fiscal years 1997 through the present on the 
following diseases: acute respiratory distress syndrome, 
arthritis, cancer, chronic obstructive pulmonary disease, 
depression, diabetes, heart disease, HIV/AIDS, kidney disease, 
liver disease, pneumonia and influenza, speticemia, and stroke. 
A functional breakdown of each showing the amount spent on 
research, prevention/education, and treatment should also be 
included for each of the disease in the table. This table 
should also detail spending in both Medicaid and Medicare, as 
well as approximations for spending by insurance in the private 
sector, and private expenditures by individuals afflicted with 
these diseases. The Committee requests the table be completed 
and sent to the committee no later than the end of February 
2004.
    Office of HIV/AIDS policy.--The Committee is concerned 
about the lack of a permanent director for the Office of HIV/
AIDS Policy under the Office of Public Health and Science 
(OPHS). The Office of HIV/AIDS Policy serves an important role 
acting as the principal adviser to the Assistant Secretary for 
Health and Surgeon General on HIV/AIDS issues. This includes 
providing input on policies, priorities, and implementation of 
HIV/AIDS programs across the HHS agencies. The Committee 
strongly encourages the Secretary to identify a permanent 
Director.
    Title X Grantees.--The Committee directs that within 90 
days of enactment of this Act the Secretary develop and 
maintain a list of federally funded family planning grantees, 
delegates, and clinics (funded under Title X of the Public 
Health Service Act) that provide any abortion. The committee 
further directs the Secretary to submit a report on the 
findings to the Committees on Appropriations within the same 
time period.

Office of Minority Health

    The Committee provides $48,329,000 for the Office of 
Minority Health, which is $7,895,000 below the fiscal year 2003 
comparable amount and $1,319,000 above the budget request. The 
Office of Minority Health works with Public Health Service 
agencies and other agencies of the Department in a leadership 
and policy development role to establish goals and coordinate 
other activities in the Department regarding disease 
prevention, health promotion, service delivery and research 
relating to disadvantaged and minority individuals; concludes 
interagency agreements to stimulate and undertake innovative 
projects; supports research, demonstration, and evaluation 
projects; and coordinates efforts to promote minority health 
programs and policies in the voluntary and corporate sectors. 
The reduction in fiscal year 2004 funding compared to the 
previous year is due to the funding of one-time projects in 
2003.
    Health professions.--The Committee continues to recognize 
the need to recruit and train more minorities in the health 
professions. The Committee encourages the Office of Minority 
Health to support annual conferences that have a proven record 
of increasing the number of under-represented minorities 
entering the health professions.
    Racial and ethnic disparities.--The Committee encourages 
the Secretary to take steps toward implementing the 
recommendations contained in the Institute of Medicine's 
``Unequal Treatment: Confronting Racial and Ethnic Disparities 
in Health Care'' study. The recommendations offer significant 
guidelines and opportunities for eliminating disparities and 
improving health.
    Meharry Medical College.--The Committee encourages OMH to 
continue its successful cooperative agreement with Meharry 
Medical College aimed at meeting the challenges of academic 
opportunity for disadvantaged students and improving health 
care services in underserved communities.
    Morehouse School of Medicine.--The Committee encourages OMH 
to consider partnering with the Morehouse School of Medicine in 
an effort to facilitate its continued strategic growth and 
development.
    American Indians/Alaskan Natives.--The Committee commends 
the Department's participation in the Washington Semester 
American Indian Program (WINS) and encourages HHS to increase 
the placement of WINS interns in its operating divisions.

Office on Women's Health

    The Committee provides $28,658,000 for the Office on 
Women's Health, which is the same as the fiscal year 2003 
comparable level and $250,000 below the budget request. The 
Office on Women's Health advises the Secretary and provides 
Department-wide coordination of programs focusing specifically 
on women's health.
    The Committee remains strongly supportive of the work done 
by the Office of Women's Health in the Office of the Secretary. 
In addition to its own work advancing women's health, it 
provides important coordinating services for offices located in 
NIH, CDC, FDA, SAMHSA, AHRQ and CMS. Together, these entities 
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.
    Lupus.--The Committee is concerned that public and 
professional understanding of lupus remains low and this lack 
of knowledge is contributing to increases in lupus-related 
mortality. According to a recent survey, more than half of the 
people with lupus suffered four or more years and visited three 
or more doctors before obtaining a diagnosis of lupus. The 
Committee encourages the Office on Women's Health to continue 
to fund the National Lupus Education Campaign aimed at reaching 
health care professionals and the general public.

HIV/AIDS in minority communities

    The Committee provides $49,675,000 to be available to the 
Secretary to transfer to the Department's operating agencies 
for specific program activities to address the high-priority 
HIV prevention and treatment needs of minority communities. 
This is the same as the fiscal year 2003 comparable level and 
$325,000 below the budget request. These funds are to address 
the growing HIV/AIDS epidemic and its disparate impact on 
communities of color, including African Americans, Latinos, 
Native Americans, Asian Americans, Native Hawaiians, and 
Pacific Islanders.
    Within the total provided, the Committee expects that 
activities that are targeted to address the growing HIV/AIDS 
epidemic and its disproportionate impact upon communities of 
color, including African Americans, Latinos, Native Americans, 
Asian Americans, Native Hawaiians, and Pacific Islanders will 
be supported at no less than last year's funding level.

Adolescent Family Life

    The Committee provides $30,922,000 for the Adolescent 
Family Life program, which is the same as the comparable 2003 
level and $319,000 below the budget request. The program 
provides comprehensive and integrated approaches to the 
delivery of care services for pregnant and parenting 
adolescents, and prevention services that promote abstinence 
from sexual activity among non-parenting teens.

                    OFFICE OF THE INSPECTOR GENERAL

    The Committee provides $39,497,000 for the Office of the 
Inspector General (OIG), which is $2,689,000 above the fiscal 
year 2003 comparable level and the same as the budget request. 
A large permanent appropriation for this office is contained in 
the Health Insurance Portability and Accountability Act of 
1996. Total funds provided between this bill and the permanent 
appropriation would be $199,497,000 in fiscal year 2004.
    The Office of the Inspector General was created by law to 
protect the integrity of Departmental programs as well as the 
health and welfare of beneficiaries served by those programs. 
Through a comprehensive program of audits, investigations, 
inspections and program evaluations, the OIG attempts to reduce 
the incidence of fraud, waste, abuse and mismanagement, and to 
promote economy, efficiency and effectiveness throughout the 
Department.

                        OFFICE FOR CIVIL RIGHTS

    The Committee provides $34,250,000, which is $827,000 above 
the fiscal year 2003 comparable level and the same as the 
budget request. This includes authority to transfer $3,314,000 
from the Medicare trust funds.
    The Office for Civil Rights is responsible for enforcing 
civil rights statutes that prohibit discrimination in health 
and human services programs. OCR implements the civil rights 
laws through a compliance program designed to generate 
voluntary compliance among all HHS recipients.

                            POLICY RESEARCH

    The Committee provides $2,483,000, which is the same as the 
amount appropriated in fiscal year 2003 and $16,000 below the 
Administration request. The Committee also provides $18,000,000 
for policy research through section 241 evaluation funding 
authority, which is the same as the comparable 2003 level and 
$3,000,000 below the Administration request. The Policy 
Research account, authorized by section 1110 of the Social 
Security Act, is the Department's principal source of policy-
relevant data and research on the income sources of low-income 
populations; the impact, effectiveness, and distribution of 
benefits under existing and proposed programs; and other issues 
that cut across agency lines.
    The Committee urges the Office of Planning and Evaluation 
to support the initiative on national electronic health 
information systems described in the Administration's fiscal 
year 2004 request. The initiative will accelerate the 
development and adoption of the technology and national 
standards necessary for electronic health record information 
systems and their use by health care providers and the public 
health surveillance and response systems.

               MEDICAL BENEFITS FOR COMMISSIONED OFFICERS

    The Committee provides an estimated $329,868,000 for 
medical benefits for commissioned officers of the U.S. Public 
Health Service. This is $13,503,000 above the Administration 
request and $19,851,000 above the fiscal year 2003 comparable 
amount.
    This account provides for retirement payments to U.S. 
Public Health Service officers who are retired for age, 
disability or length of service; payments to survivors of 
deceased officers; medical care for active duty and retired 
members and dependents and beneficiaries; and for payments to 
the Social Security Administration for military service 
credits.
    The Committee repeats language from the fiscal year 2003 
appropriations bill clarifying that this account should be used 
to support the retirement medical cost payments for 
commissioned corps officers rather than the appropriations of 
the agencies to whom the officers are assigned.

            PUBLIC HEALTH AND SOCIAL SERVICES EMERGENCY FUND

    The Committee provides $1,726,846,000 for the public health 
and social services emergency fund for homeland security 
related activities. In addition, $50,000,000 is provided for 
activities to ensure year-round production capacity of 
influenza vaccine, bringing the total in the Fund to 
$1,776,846,000. This is $110,401,000 the fiscal year 2003 
comparable level and $119,303,000 below the request.
    Two programs that the request proposed to be supported by 
the Fund are instead retained in the HRSA account--$19,373,000 
for emergency medical services for children and $22,354,000 for 
poison control.
    Within the amount provided for homeland security related 
activities, the funds are distributed as follows:

HRSA....................................................    $545,870,000
CDC.....................................................   1,116,156,000
Office of the Secretary.................................      64,820,000

    The Committee supports the interdisciplinary health 
professions training program proposed to be financed in this 
Fund at a level of $27,870,000, rather than the $60,000,000 
proposed in the request. The recommendation also provides 
$3,000,000 to the Office of Secretary for activities related to 
the transformation and modernization of the Public Health 
Service Commissioned Corps. This is $1,013,000 above the fiscal 
year 2003 comparable level. The request proposed $5,000,000 for 
this activity within General Departmental Management.
    Academic Health Centers.--The Committee received testimony 
during the fiscal year 2004 hearings regarding the significant 
capability and resources of academic health centers. 
Furthermore, it learned that in large measure, these Centers 
have not been participants in state and local preparedness and 
response planning. The Committee urges the Secretary to 
strengthen the guidance provided to the recipients of State and 
Local Preparedness Funds to ensure that State and local 
planners are including academic health centers in their 
planning process, and making assessments of the capabilities 
and roles their academic health centers can have in enhancing 
preparedness.
    Anti-infective agents.--The Committee has maintained funds 
provided in fiscal year 2003 to support research into the 
discovery, development, and translation of anti-infective 
agents to combat emerging infectious diseases.
    Emergency Air Transport.--The Committee is aware that the 
CDC's ability to respond during a public health emergency in an 
appropriate and timely manner to investigate and contain the 
threat often is dependent upon the availability of appropriate 
transport. The Committee is troubled by the difficulty CDC 
experienced in transporting specimens and CDC personnel via 
commercial aircraft from Asia to CDC's Atlanta-based 
headquarters during the recent global outbreak of SARS. The 
Committee is concerned that CDC currently lacks an effective 
means of safely and efficiently transporting personnel with 
highly communicable infections to locations that can provide 
appropriate care. Experience over the past several months calls 
into question whether CDC can rely on commercial companies or 
other federal agencies to transport infectious specimens or to 
move highly contagious patients. The Committee urges CDC to 
give consideration to securing the ability to deploy a 
dedicated aircraft during public health emergencies with a 
capability to retrieve specimens rapidly, deploy key CDC 
personnel, or evacuate CDC personnel in the field.
    Geriatric Populations and Preparedness.--The Committee is 
concerned that the program guidance for potential grantees 
applying for health professions curriculum development and 
training for emergency preparedness and response does not 
specifically identify the need for a geriatric component. 
Current curriculum and training is noticeably lacking in 
information on how to adequately provide for the unique needs 
of older persons, particular those with physical or mental 
impairments, in the case of an emergency. The Committee urges 
HRSA to incorporate a geriatric component into its program 
guidance and encourages collaboration with existing Geriatric 
Education Centers (GECs), which already provide training to 
undergraduate, graduate and continuing education for health 
professionals and understand the special needs of older 
persons.
    Pediatric Preparedness.--The ``Public Health Security and 
Bioterrorism Preparedness and Response Act,'' enacted in 2003, 
directs that specific attention to the needs of children in 
building the nation's capacity to respond to bioterrorism and 
public health emergencies. To date, federal efforts to develop 
our nation's disaster readiness plans have necessarily focused 
on encompassing the public health needs of the most broadly 
defined population. According to children's hospitals and 
pediatric experts, national and state bioterrorism preparedness 
efforts have done little to address the unique risks and needs 
of children. The Committee urges HRSA develop and implement a 
plan that encourages States expand pediatric preparedness 
efforts and consider directing States to use a portion of their 
preparedness funds to establish a pediatric network on 
bioterrorism and public health emergency preparedness.
    Physician Data System.--The Committee understands the CDC 
is working with the Federation of State Medical Boards to 
develop an automated data system of physician contact 
information to be used in public health emergencies. The 
Committee encourages the CDC to accelerate this work in order 
to ensure a nationwide system is in place at the earliest date.
    State and Local Preparedness.--The Committee is concerned 
over reports that some federal state and local preparedness 
dollars awarded by CDC and/or HRSA have been used to supplant 
state and local funding for public health. The intent of the 
Congress has always been clear--funding for bioterrorism 
efforts is to supplement, not supplant state and funding of 
public health programs. During this crucial time, bioterrorism 
funding has been made available to build public health capacity 
at both state and local levels. Therefore, Committee urges the 
Secretary to ensure that the funds appropriated for state and 
local preparedness are being used to supplement existing State 
and local funds.

                           General Provisions

    Sec. 201. The Committee continues a provision to limit the 
amount available for official reception and representation 
expenses.
    Sec. 202. The Committee continues a provision to limit the 
number of Public Health Service employees assigned to assist in 
child survival activities and to work in AIDS programs through 
and with funds provided by the Agency for International 
Development, the United Nations International Children's 
Emergency Fund or the World Health Organization.
    Sec. 203. The Committee continues a provision to prohibit 
the use of funds to implement section 399F(b) of the Public 
Health Service Act or section 1503 of the NIH Revitalization 
Act of 1993.
    Sec. 204. The Committee repeats a provision included in 
last year's bill to limit the salary of an individual through 
an NIH or SAMHSA grant or other extramural mechanism to not 
more than Executive Level I.
    Sec. 205. The Committee continues a provision to prohibit 
the Secretary from using evaluation set-aside funds until the 
Committee receives a report detailing the planned use of such 
funds.
    Sec. 206. The Committee continues a provision included in 
last year's bill to permit the Secretary to use up to 1.25 
percent of funds authorized under the PHS Act for the 
evaluation of programs.

                          (TRANSFER OF FUNDS)

    Sec. 207. The Committee continues a provision included in 
last year's bill permitting the Secretary of HHS to transfer up 
to one percent of any discretionary appropriation from an 
account, with an additional 2 percent subject to the approval 
of the Appropriations Committees, but no appropriation may be 
increased by more than 3 percent by such transfer.
    Sec. 208. The Committee continues a provision to provide 
the Director of NIH, jointly with the Director of the Office of 
AIDS Research, the authority to transfer up to three percent of 
human immunodeficiency virus funds.
    Sec. 209. The Committee continues a provision to make NIH 
funds available for human immunodeficiency virus research 
available to the Office of AIDS Research.
    Sec. 210. The Committee continues a provision to prohibit 
the use of Title X funds unless the applicant for the award 
certifies to the Secretary that it encourages family 
participation in the decision of minors to seek family planning 
services and that it provides counseling to minors on how to 
resist attempts to coerce minors into engaging in sexual 
activities.
    Sec. 211. The Committee continues a provision related to 
the Medicare+Choice program.
    Sec. 212. The Committee continues a provision stating that 
no provider of services under title X shall be exempt from any 
State law requiring notification or the reporting of child 
abuse, child molestation, sexual abuse, rape, or incest.
    Sec. 213. The Committee continues a provision to exempt 
States from Synar provisions if certain funding criteria are 
met.
    Sec. 214 and Sec. 215. The Committee continues two 
provisions to allow CDC international HIV/AIDS and other 
infectious disease, chronic and environmental disease, and 
other health activities abroad to be spent under the State 
Department Basic Authorities Act of 1956.
    Sec. 216. The Committee continues a provision to permit the 
Division of Federal Occupational Health to use personal 
services contracting to employ professional management/
administrative and occupational health professionals.
    Sec. 217. The Committee includes a provision requested by 
the Administration to permit the Center for Medicare and 
Medicaid Services to charge providers who forward duplicate or 
unprocessable Medicare claims $2.50 per claim.
    Sec. 218. The Committee recommendation includes a new 
general provision that reduces funds made for available for 
information technology and administration by $49,982,000. This 
is the same as the amount recommended in the request. The 
Committee intends that the Director of the Centers for Disease 
Control and Prevention have the flexibility to allocate these 
savings across the various activities in a manner that ensures 
that high priority scientific and programmatic activities are 
not compromised.

                   TITLE III--DEPARTMENT OF EDUCATION

    The Committee's recommendations for the Department of 
Education for fiscal year 2004 will bring total departmental 
funding to $55,380,003,000, the highest level in the agency's 
history. The Committee notes that, although the federal 
government contributes only about eight percent of all K-12 
education spending in the United States, the role the federal 
government plays with regard to providing equal opportunity to 
education for all people in our society is an important one. 
Therefore, the Committee has focused its funding 
recommendations for K-12 education around the following 
principles: a quality teacher in every classroom; closing the 
achievement gap for poor and minority children by insisting on 
results; empowering parents; ensuring all third-grade children 
can read; more education, less paperwork; and spending for 
results. For higher education programs, the Committee has 
focused its recommendations on funding proven programs that 
help provide all Americans with the opportunity to further 
their studies and training and become competitive in the global 
marketplace.
    The Committee continues to emphasize the importance of 
developing clear, measurable outcomes for programs within the 
Department of Education as outlined in the Government 
Performance and Results Act. It is vital that the Committee be 
provided with information on the actual results achieved by the 
programs, not simply the number of students affected by the 
program or the quantity of materials distributed. Program 
outcomes should, to the extent possible, focus on the 
achievement improvements that result to students and teachers 
in the classroom as a result of the Federal investment. 
Programs that are able to demonstrate these results over time 
will be considered higher funding priorities than programs that 
are unable to clearly demonstrate their value to the American 
public.

                    EDUCATION FOR THE DISADVANTAGED

    The bill includes $14,507,000,000 for the disadvantaged 
programs. This amount is $323,000,000 more than the budget 
request and $768,727,000 above the fiscal year 2003 
appropriation. Of the total amount available, $6,943,199,000 is 
appropriated for fiscal year 2004 for obligation after July 1, 
2004 and $7,383,301,000 is appropriated for fiscal year 2005 
for obligation on or after October 1, 2004. This appropriation 
account includes compensatory education programs authorized 
under title I of the Elementary and Secondary Education Act of 
1965; and title VIII of the Higher Education Act.

Grants to local educational agencies

    Of the amounts provided for Title I programs, 
$7,172,971,000 is available for basic grants to local education 
agencies and State administration. This amount is the same as 
the 2003-2004 school year and the request. The Committee 
rejects the inclusion of any 100% hold harmless provision 
because it unfairly penalizes underprivileged and immigrant 
children in states with growing populations.
    Funding for concentration grants, which targets funds to 
Local Educational Agencies in counties with high levels of 
disadvantaged children, is $1,365,031,000, the same as last 
year and the request level. The bill includes $3,018,499,000 
for targeted grants, an increase of $1,348,260,000 above last 
year and the same as the request. A total of $793,499,000 is 
also included for education finance incentive grants, the same 
as the request and $748,260,000 below last year's level.
    Financial assistance flows to school districts by formula, 
based in part on the number of school-aged children from low-
income families. Within districts, local school officials 
target funds on school attendance areas with the greatest 
number or percentage of children from poor families. Local 
school districts develop and implement their own programs to 
meet the needs of disadvantaged students.
    Funds under this account will also be used to pay the 
Federal share of State administrative costs for title I 
programs. The maximum State administration grant is equal to 1 
percent of title I local educational agency plus State agency 
grants to the State, or $400,000, whichever is greater. These 
funds are included in the grants to local educational agencies 
account, rather than being a separate line item.

Even Start

    The Committee provides $250,000,000 for Even Start, 
$1,625,000 above last year and $75,000,000 above the request. 
Even Start provides grants for programs focusing on the 
education of disadvantaged children, aged 1-7 years, who live 
in title I target school attendance areas, plus their parents 
who are eligible to be served under the Adult Education Act. 
These parents are not in school, are above the State's 
compulsory school attendance age limit, and have not earned a 
high school diploma (or equivalent). Even Start funds are 
allocated to the States, generally in proportion to title I 
basic grants.

Reading First State Grants

    The bill provides $1,050,000,000 for Reading First State 
grants, the same as the budget request and $56,500,000 above 
the fiscal year 2003 level. This program provides assistance to 
states and school districts in establishing scientific 
research-based reading programs for children in kindergarten 
through grade three. The program also provides for professional 
development and other supports to ensure that teachers can 
identify children at-risk for reading failure and provide the 
most effective early instruction to overcome specific barriers 
to reading proficiency.

Early Reading First

    The bill provides $100,000,000 for Early Reading First, the 
same as the budget request and an increase of $25,488,000 above 
the fiscal year 2003 level. This is a competitive grant program 
targeted toward children ages three through five, and would 
support the development of verbal skills, phonemic awareness, 
pre-reading development and assistance for professional 
development for teachers in evidence-based strategies of 
instruction.

Literacy through school libraries

    The bill provides $27,500,000 for literacy through school 
libraries, the same as the budget request and $15,081,000 above 
the fiscal year 2003 level. This program helps school districts 
provide students with increased access to up-to-date school 
library materials, a well-equipped, technologically advanced 
school library media center, and well-trained, and 
professionally certified school library media specialists. At 
appropriations of less than $100,000,000 the Department makes 
competitive awards to districts with a child poverty rate of at 
least 20 percent.

State agency programs: migrant

    The bill includes $396,000,000 for the migrant education 
program, the same as the budget request and $587,000 above the 
fiscal year 2003 appropriation. This program supports formula 
grants to State agencies for the support of special educational 
and related services to children of migratory agricultural 
workers and fishermen. The purpose of this program is to 
provide supplementary academic education, remedial or 
compensatory instruction, English for limited English 
proficient students, testing, plus guidance and counseling.

State agency programs: neglected and delinquent

    For the State agency program for neglected and delinquent 
children, the bill includes $49,000,000; this level is 
$1,000,000 above the budget request and $318,000 above the 
fiscal year 2003 appropriation. This formula grant program 
provides services to participants in institutions for juvenile 
delinquents, adult correctional institutions, or institutions 
for the neglected.

Evaluation

    The Committee provides $9,500,000 for evaluation, $658,000 
above the 2003 appropriation and the same as the budget 
request. Title I evaluation supports large scale national 
evaluations that examine how title I is contributing to 
improved student performance at the State, local education 
agency, and school levels. It also supports short-term studies 
that document promising models and other activities to help 
States and local education agencies implement requirements in 
the title I statute.

Comprehensive school reform

    The bill includes $235,000,000 for demonstrations of 
comprehensive school reform. This is $1,527,000 above the 
fiscal year 2003 level. The President's budget did not request 
funding for it. This program provides schools with funds to 
develop and implement school reforms based on reliable research 
that will enable children to meet State academic standards.

Migrant education, high school equivalency program

    The bill includes $24,000,000 for the high school 
equivalency program. This amount is $11,000,000 above the 
budget request and $653,000 above the fiscal year 2003 level. 
The high school equivalency program recruits migrant students 
aged 16 and over and provides academic and support services to 
help those students obtain a high school equivalency 
certificate and subsequently to gain employment or admission to 
a postsecondary institution or training program.

College assistance migrant programs

    The bill includes $16,000,000 for the college assistance 
migrant programs. This amount is $601,000 above the fiscal year 
2003 level and $1,000,000 above the budget request. The college 
assistance migrant program (CAMP) provides tutoring and 
counseling services to first-year, undergraduate migrant 
students and assists those students in obtaining student 
financial aid for their remaining undergraduate years.

                               IMPACT AID

    The bill provides $1,238,324,000 for Federal impact aid 
programs in fiscal year 2004, an increase of $50,098,000 above 
the fiscal year 2003 appropriation and $222,824,000 above the 
budget request. This account supports payments to school 
districts affected by Federal activities. Impact Aid represents 
a federal responsibility to local schools educating children 
whose families are connected with the military or who live on 
Indian land.

Basic support payments

    The bill includes $1,073,000,000 for basic support payments 
to local educational agencies, an increase of $47,708,000 above 
the fiscal year 2003 appropriation and $205,500,000 above the 
budget request. Basic support payments compensate school 
districts for lost tax revenue and are made on behalf of 
Federally-connected children such as children of members of the 
uniformed services who live on Federal property.

Payments for children with disabilities

    The Committee recommends $50,668,000 for payments on behalf 
of Federally-connected children with disabilities, $10,668,000 
above the budget request and the same as the fiscal year 2003 
appropriation. These payments compensate school districts for 
the increased costs of serving Federally-connected children 
with disabilities.

Facilities maintenance

    The Committee recommends $7,948,000 for facilities 
maintenance, the same as the fiscal year 2003 amount and 
$52,000 below the budget request. These capital payments are 
authorized for maintenance of certain facilities owned by the 
Department of Education.

Construction

    The Committee recommends $44,708,000 for the construction 
program, a decrease of $292,000 below the budget request and 
the same as the fiscal year 2003 level. This program provides 
formula grants to eligible locally owned school districts for 
building and renovating school facilities.

Payments for Federal property

    The bill provides $62,000,000 for payments related to 
Federal property, an increase of $2,390,000 above the fiscal 
year 2003 appropriation and $7,000,000 above the budget 
request. Funds are awarded to school districts to compensate 
for lost tax revenue as the result of Federal acquisition of 
real property since 1938.

                      SCHOOL IMPROVEMENT PROGRAMS

    The bill includes $5,797,637,000 for school improvement 
programs. This amount is $85,455,000 more than the comparable 
fiscal year 2003 appropriation and $754,803,000 above the 
budget request for comparable programs. This appropriation 
account includes programs authorized under titles II, IV, V, 
VI, and VII of the Elementary and Secondary Education Act; the 
McKinney-Vento Homeless Assistance Act, and title IV-A of the 
Civil Rights Act.

State grants for improving teacher quality

    The bill includes $2,930,825,000 for state grants for 
improving teacher quality, which is $80,825,000 above the 
budget request and the same as the fiscal year 2003 level. This 
program gives states and districts a flexible source of funding 
with which to meet their particular needs in strengthening the 
skills and knowledge of teachers and administrators to enable 
them to improve student achievement. States are authorized to 
retain 2.5 percent of funds for state activities, including 
reforming teacher certification, re-certification or licensure 
requirements; expanding, establish or improving alternative 
routes to state certification; carrying out programs that 
include support during the initial teaching and leadership 
experience, such as mentoring programs; assisting school 
districts in effectively recruiting and retaining highly 
qualified and effective teachers and principals; reforming 
tenure systems; and developing professional development 
programs for principals.
    States send funding to the local level by formula and by 
competitive grant. Among other things, local uses of funds 
include initiatives to assist recruitment of principals and 
fully qualified teachers; initiatives to promote retention of 
highly qualified teachers and principals; programs designed to 
improve the quality of the teacher force; teacher opportunity 
payments; professional development activities; teacher 
advancement initiatives and hiring fully qualified teachers in 
order to reduce class size.

Early childhood educator professional development

    The bill includes $14,902,000 for early childhood educator 
professional development, $98,000 below the budget request and 
the same as the fiscal year 2003 level. This program provides 
competitive grants to partnerships to improve the knowledge and 
skills of early childhood educators and caregivers who work in 
communities that have high concentrations of children living in 
poverty.

Mathematics and science partnerships

    The bill includes $150,000,000 for mathematics and science 
partnerships, an increase of $137,500,000 above the budget 
request and $49,656,000 above the fiscal year 2003 level. This 
program promotes strong math and science teaching skills for 
elementary and secondary school teachers. Grantees may use 
program funds to develop rigorous math and science curricula, 
establish distance learning programs, and recruit math, science 
and engineering majors into the teaching profession. They may 
also provide professional development opportunities. Grants are 
made to States by formula based on the number of children aged 
5 to 17 who are from families with incomes below the poverty 
line, and States then award the funds competitively to 
partnerships which must include the State agency, and 
engineering, math or science department of an institution of 
higher education, and a high-need school district. Other 
partners may also be involved.

Innovative Education Program Strategies State Grants

    The Committee recommends $335,000,000 for State grants 
under Innovative Education Program Strategies, a decrease of 
$50,000,000 below the budget request and $47,498,000 below the 
fiscal year 2003 level. This program provides funding to State 
and local educational agencies for obtaining technology and 
training in technology related to the implementation of school 
based reform; acquiring and using educational materials; 
improving educational services for disadvantaged students; 
combating illiteracy among children and adults; addressing the 
educational needs of gifted and talented children; and 
implementing school improvement and parental involvement 
activities under ESEA Title I.

Education technology

    The bill includes $695,947,000 for Education Technology 
State Grants. This amount is $4,553,000 below the budget 
request and the same as the comparable fiscal year 2003 level. 
Under this program, states are required to direct ninety-five 
percent of the funds to school districts for increasing access 
to technology, especially for high-need schools; improving and 
expanding teacher professional development in technology; and 
promoting innovative state and local initiatives using 
technology to increase academic achievement. The bill does not 
include funding for Preparing Tomorrow's Teachers to Use 
Technology, which was funded at $62,094,000 in fiscal year 
2003. The Committee notes that the State Grants for Improving 
Teacher Quality provides a flexible source of funds that can be 
used for this purpose.
    The Secretary of Education is encouraged to examine the 
rapidly-growing use of hand-held computer technology. Handheld 
computing is rapidly becoming more affordable, enhancing the 
cost effectiveness of this approach, especially when coupled 
with wireless technology.

21st century community learning centers

    The bill provides $1,000,000,000 for 21st century community 
learning centers, $400,000,000 above the budget request and 
$6,500,000 above the fiscal year 2003 level. This program is a 
formula grant to states. Ninety-five percent of funds are 
distributed on a competitive basis from the state to local 
school districts, community-based organizations and other 
public entities and private organizations. Grantees must target 
students who attend low-performing schools. Funds may be used 
for before and after school activities that advance student 
academic achievement including remedial education and academic 
enrichment activities; math, science, arts, music, 
entrepreneurial and technology education; tutoring and 
mentoring; recreational activities; and expanded library 
service hours.
    The Committee is aware that many schools and community-
based organizations that desire to operate an after school 
program lack a central point of guidance in how to go about 
developing a high-quality program. The Committee therefore 
encourages the Department to develop a ``one-stop shopping'' 
website that can be used as a resource to schools and other 
entities that would provide comprehensive information about how 
to develop and operate a high-quality after school program.
    The findings from a recent study of the 21st Century 
Community Learning Centers program underscore the importance of 
increasing student participation, improving content, and 
enhancing accountability within after school programs. 
Specifically, the No Child Left Behind Act directs States to 
develop performance indicators by which an after school program 
can be evaluated. However, the Committee is aware that many 
States have not yet developed such indicators or use vague 
standards and need some additional guidance. To that end, the 
Committee urges the Department to work in collaboration with 
the after-school community to develop standards by which a 
successful after school program can be evaluated.
    The Committee is also aware that some research has shown 
that certain after-school programs, including those that engage 
young people in community service, can help to reduce teen 
pregnancy and other risky behaviors. The Committee encourages 
21st Century Community Learning Center grantees to build on the 
connection between after-school programs and reducing risky 
behaviors.

State assessments

    The bill includes $390,000,000 for state assessments, the 
same as the budget request and $5,516,000 above the fiscal year 
2003 level. This program provides states with funding to 
develop annual assessments and to carry out activities related 
to ensuring accountability for results in the state's schools 
and school districts.

Javits gifted and talented education

    The bill includes $11,177,000 for gifted and talented 
education, the same as the fiscal year 2003 amount. The 
President's budget did not propose funding for this program. 
This program supports grants to build and enhance the ability 
of elementary and secondary schools to meet the needs of gifted 
and talented students. Competitive grants are awarded to states 
and school districts, institutions or higher education and 
other public and private entities.

Foreign language assistance grants

    The bill does not include funding for foreign language 
assistance grants, the same as the budget request. The program 
was funded at $16,144,000 in fiscal year 2003. The program 
supports competitive grants to school districts and states to 
increase the quality and quantity of elementary and secondary-
level foreign language instruction in the United States.

Education for homeless children and youth

    For the education of homeless children and youth program, 
the Committee recommends $60,000,000. This level is $10,000,000 
above the budget request and $5,358,000 above the fiscal year 
2003 appropriation. Grants are allocated to States in 
proportion to the total that each State receives under the 
title I program. For local grants, at least 50 percent must be 
used for direct services to homeless children and youth, 
including tutoring or remedial or other educational services.

Training and advisory services

    The bill includes $7,286,000 for training and advisory 
services authorized by title IV-A of the Civil Rights Act. This 
amount is $48,000 below the budget request and the same as the 
fiscal year 2003 amount. Title IV-A authorizes technical 
assistance and training services for local educational agencies 
to address problems associated with desegregation on the basis 
of race, sex, or national origin. The Department awards 3-year 
grants to regional equity assistance centers (EACs) located in 
each of the 10 Department of Education regions. The EACs 
provide services to school districts upon request. Typical 
activities include disseminating information on successful 
education practices and legal requirements related to 
nondiscrimination on the basis of race, sex, and national 
origin in educational programs; training designed to develop 
educators' skills in specific areas, such as the identification 
of race and sex bias in instructional materials; increasing the 
skills of educational personnel in dealing with race-based 
confrontations such as hate crimes; and providing technical 
assistance in the identification and selection of appropriate 
educational programs to meet the needs of limited English 
proficient students.

Education for Native Hawaiians

    The Committee recommends $18,300,000 for education for 
Native Hawaiians, the same as the budget request and 
$12,498,000 below the fiscal year 2003 amount. A number of 
programs limited to Native Hawaiians are supported with these 
funds, including a model curriculum project, family-based 
education centers, postsecondary education fellowships, gifted 
and talented education projects, and special education projects 
for disabled pupils.

Alaska native education equity

    The Committee recommends $14,200,000 for the Alaska native 
education equity program, the same as the budget request and 
$16,598,000 below the fiscal year 2003 amount. These funds are 
used to develop supplemental educational programs to benefit 
Alaska natives.

Rural Education

    The bill includes $170,000,000 for rural education 
programs, $2,347,000 above the fiscal year 2003 level and 
$170,000,000 above the budget request. This fund includes two 
programs to assist rural school districts to improve teaching 
and learning in their schools. The small, rural schools 
achievement program provides funds to rural districts that 
serve a small number of students; the rural and low-income 
schools program provides funds to rural districts that serve 
concentrations of poor students, regardless of the number of 
students served by the district.

                            INDIAN EDUCATION

    The bill includes $121,573,000 for Indian education. This 
amount is the same as the fiscal year 2003 appropriation and 
$795,000 below the budget request. This account supports 
programs authorized by part A of Title VII of the Elementary 
and Secondary Education Act and section 215 of the Department 
of Education Organization Act.

Grants to local educational agencies

    The bill provides $96,502,000 for grants to local education 
agencies, $631,000 below the budget request and the same as the 
fiscal year 2003 amount. This program provides assistance 
through formula grants to school districts and schools 
supported or operated by the Bureau of Indian Affairs. The 
purpose of this program is to reform elementary and secondary 
school programs that serve Indian students, including preschool 
children. Grantees must develop a comprehensive plan and assure 
that the programs they carry out will help Indian students 
reach the same challenging standards that apply to all 
students. This program supplements the regular school program 
to help Indian children sharpen their academic skills, bolster 
their self-confidence, and participate in enrichment activities 
that would otherwise be unavailable.

Special programs for Indian children

    The Committee recommends $19,870,000 for special programs 
for Indian children, the same as fiscal year 2003 and $130,000 
below the budget request. These programs make competitive 
awards to improve the quality of education for Indian students. 
This program also funds a new Indian Teacher Corps, which hopes 
to train over 1,000 Indian teachers over a five-year period to 
take positions in schools that serve concentrations of Indian 
children.

National activities

    The bill provides $5,201,000 for national activities, the 
same as fiscal year 2003 and $34,000 below the budget request. 
Funds under this authority support research, evaluation and 
data collection to provide information on the status of 
education for the Indian population and on the effectiveness of 
Indian education programs.

                       INNOVATION AND IMPROVEMENT

    The bill includes $807,959,000 for innovation and 
improvement programs. This amount is $291,090,000 less than the 
comparable fiscal year 2003 appropriation and $559,000 above 
the budget request for comparable programs. This appropriation 
account includes programs authorized under part G of title I 
and portions of titles II and V of the Elementary and Secondary 
Education Act.

Troops to teachers

    The bill includes $20,000,000 for troops to teachers, 
$5,000,000 below the budget request and $8,812,000 below the 
fiscal year 2003 level. The Committee notes that funding is 
reduced because of a moratorium placed on military retirements 
during the conflict in Iraq. Extended availability was provided 
in the fiscal year 2003 Supplemental Appropriations Bill to 
allow carryover funding from fiscal year 2003 to be used in 
fiscal year 2004.
    This program is designed to assist eligible members of the 
armed forces to obtain certification or licensure as elementary 
and secondary school teachers, or vocational or technical 
teachers. The transition to teachers program is based on the 
model of the troops to teachers program and would address the 
need of high-need school districts for highly qualified 
teachers.

Transition to teaching

    The bill includes $49,400,000 for transition to teaching, 
the same as the budget request and $7,673,000 above the fiscal 
year 2003 level. Transition to teaching is designed to help 
mitigate the shortage of qualified licensed or certified 
teachers in many of our Nation's schools. The program provides 
grants to help support efforts to recruit, train and place 
talented individuals into teaching positions and to support 
them during their first years in the classroom. In particular, 
the program focuses on mid-career professionals with 
substantial career experience, and recent college graduates. 
Grants are made on a competitive basis.

National writing project

    The bill provides $16,890,000 for the National Writing 
Project, the same as the fiscal year 2003 level. The 
President's budget did not request funding for this program. 
Funds are provided to the National Writing Project, a nonprofit 
educational organization that supports teacher training 
programs in the effective teaching of writing, and supports 
classroom-level research on teaching writing that documents 
effectiveness in terms of student performance. To provide these 
services, the National Writing Project contracts with numerous 
institutions of higher education and nonprofit education 
providers to operate small teacher training programs. Federal 
funds support 50 percent of the costs of these programs, and 
recipients must contribute an equal amount.

Teaching of traditional American history

    The bill includes $50,000,000 for the teaching of 
traditional American history, $50,000,000 below the budget 
request and $49,350,000 below the fiscal year 2003 level. This 
program supports competitive grants to school districts to 
promote the teaching of American history in elementary and 
secondary schools as a separate academic subject.

School leadership

    The bill includes $12,419,000 for school leadership 
activities, the same as the fiscal year 2003 level. The 
President's budget did not propose funding for this program. 
The program provides competitive grants to assist high-need 
school districts with recruiting, training, and retaining 
principals and assistant principals.

Advanced credentialing

    The bill includes $16,500,000 for advanced credentialing, 
an increase of $6,565,000 above the fiscal year 2003 level and 
$16,500,000 above the budget request. The program authorizes 
competitive grants to states, school districts, the National 
Board for Professional Teaching Standards (NBPTS) working with 
a district or states, the National Council on Teacher Quality 
working with a district or state, or another certification or 
credentialing organization working with a district or state. 
The program supports activities to encourage and support 
teachers seeking advanced certification or credentialing.
    The Committee intends that $10,000,000 of the funds 
provided under this authority be used to complete the last year 
of a five-year grant to the National Board for Professional 
Teaching Standards. The Committee is extremely interested in 
reviewing the results that the NBPTS has achieved with the 
considerable federal investment made over the past several 
years. The Committee therefore directs the Department to 
conduct an evaluation of the outcomes of teachers who achieved 
NBPTS certification versus teachers who did not complete 
certification and teachers who did not participate in or apply 
for the program. The Committee is particularly interested in an 
examination of 1) whether the NBPTS certification model is a 
cost effective method of improving teacher quality, and 2) the 
extent to which certification makes a difference in student 
academic achievement.

Charter schools

    The Committee recommends $220,000,000 for support of 
charter schools, the same as the budget request and $21,300,000 
above the fiscal year 2003 amount. Charter schools are 
developed and administered by individuals or groups of 
individuals, which may include teachers, administrators, and 
parents. These groups enter into charters for operation of 
their schools, which must be granted exemptions from State and 
local rules that limit flexibility in school operation and 
management. Under this program, grants are made to State 
educational agencies in States that have charter school laws; 
the State educational agencies will in turn make sub-grants to 
authorized public chartering agencies in partnerships with 
developers of charter schools.

Credit enhancement for charter school facilities

    The bill includes $75,000,000 for credit enhancement for 
charter school facilities, $25,000,000 below the budget request 
and $50,162,000 above fiscal year 2003. This program helps 
charter schools meet their facility needs by providing funding 
on a competitive basis to leverage other funds and help charter 
schools obtain school facilities by means such as purchase, 
lease and donation. Charter schools are more likely than 
traditional schools to have problems obtaining adequate 
facilities because they are perceived as more financially risky 
than other schools, and unlike traditional school districts, 
charter schools generally lack the ability to issue general 
obligation bonds backed by property taxes.

Voluntary public school choice

    The bill includes $25,831,000 for voluntary public school 
choice, $831,000 above the budget request and the same as the 
fiscal year 2003 level. This program supports efforts to 
establish intradistrict and interdistrict public school choice 
programs to provide parents with greater choice for their 
children's education. Funds are used to make competitive awards 
to states, school districts or partnerships.

Magnet schools assistance

    The bill includes $109,285,000 for the magnet schools 
assistance program, $715,000 below the budget request and the 
same as the fiscal year 2003 level. The magnet schools 
assistance program awards competitive grants to local 
educational agencies for use in establishing or operating 
magnet schools that are part of a desegregation plan approved 
by a court or by the Department of Education's Office for Civil 
Rights. A magnet school is defined by the statute as ``a school 
or education center that offers a special curriculum capable of 
attracting substantial numbers of students of different racial 
backgrounds.'' A funding priority is given to local educational 
agencies that did not receive a grant in the preceding fiscal 
year.

Choice Incentive Fund

    The bill does not include funding for the choice 
demonstration program. The Administration requested $75,000,000 
for this program, which has not been funded in the past. The 
funds would support research projects that develop, implement 
and evaluate innovative approaches to providing parents with 
expanded school choice options.

Fund for the improvement of education

    The bill includes $165,797,000 for the fund for the 
improvement of education, $306,849,000 below the fiscal year 
2003 level and $106,797,000 above the budget request. The fund 
for the improvement of education has a broad portfolio of 
activities. Under the fund, the Secretary of Education supports 
activities that identify and disseminate innovative educational 
approaches. Several separate program authorities are included 
in this line item. Within the total, the Committee has provided 
$74,513,000 to support the comprehensive school reform 
demonstration program. The Committee notes that funding for 
other authorities can be provided at the Secretary's discretion 
pursuant to the provisions of the No Child Left Behind Act of 
2001.
    The Committee is interested in professional development 
programs that prepare school personnel to use a 
neurodevelopment framework to recognize, understand and manage 
students who struggle to find school success because of 
differences in learning. The Committee particularly supports 
research that could determine the impact of professional 
development programs on student outcomes; economic benefits to 
special education service delivery through more effective pre-
referral services and teacher recruitment and retention.

Ready to Learn Television

    The bill includes $22,000,000 for the Ready to Learn 
Television program, the same as the budget request and $850,000 
below the fiscal year 2003 level. Ready to Learn supports the 
development and distribution of educational video programming 
for preschool children, elementary school children and their 
parents. Only public telecommunications entities are eligible 
to receive awards. The Committee intends that a portion of the 
funding be used to ensure that the children's television 
program, ``Reading Rainbow'' continues to be aired on public 
television.

Dropout prevention programs

    The bill does not include funding for the dropout 
prevention program, the same as the budget request. This 
program was funded at $10,929,000 in fiscal year 2003. The 
dropout prevention program provides assistance to help schools 
implement effective school dropout prevention and reentry 
programs. This program has only been funded for two years, and 
has made only about two dozen awards. The Committee notes that 
districts desiring to implement dropout prevention programs can 
use funds under title I, comprehensive school reform, or state 
grants for innovative programs to support such efforts. In 
addition, states will reserve about $80,000,000 in fiscal year 
2004 to support dropout prevention programs; hence there is no 
need for a separately funded line-item to accomplish this 
purpose.

Ellender fellowships/Close-Up

    The bill provides $1,490,000 for Ellender fellowships, the 
same as the fiscal year 2003 level and $1,490,000 above the 
budget request. The Ellender fellowship program makes an award 
to the Close-Up Foundation of Washington D.C. This organization 
provides fellowships to students from low income families and 
their teachers to enable them to participate with other 
students and teachers for a week of seminars on government and 
meetings with representatives of the three branches of the 
Federal government.

Advanced placement test fee program

    The Committee recommends $23,347,000 for advanced placement 
fees. This recommendation is $1,347,000 above the budget 
request and the same as the fiscal year 2003 amount. The 
advanced placement test fee program awards grants to States to 
enable them to cover part or all of the cost of advanced 
placement test fees of low-income students who are enrolled in 
advanced placement classes and plan to take the advanced 
placement test. This program also supports competitive grants 
to states, school districts and national nonprofit educational 
agencies for programs that encourage greater participation by 
low-income students in advanced placement courses.

                 SAFE SCHOOLS AND CITIZENSHIP EDUCATION

    The bill includes $820,068,000 for school improvement 
programs. This amount is $64,857,000 less than the comparable 
fiscal year 2003 appropriation and $63,818,000 above the budget 
request for comparable programs. This appropriation account 
includes programs authorized under parts of titles II, IV, and 
V of the Elementary and Secondary Education Act.

Safe and drug-free schools and communities: State grants

    The Committee bill includes $468,949,000 for the State 
grants program, $46,932,000 above the budget request and the 
same as the fiscal year 2003 level. The program supports State 
formula grants for comprehensive, integrated approaches to drug 
and violence prevention. Local educational agencies must use 
their funds to implement a drug and violence prevention program 
for students and employees.
    The Committee expects that the Uniform Management 
Information and Reporting System, required by the No Child Left 
Behind Act, will be developed and implemented so that data and 
other pertinent information is collected in a uniform manner 
both within a particular State and across all States, and that 
it be reported by every State to the Secretary of Education so 
that data can be compared both within and across States.
    The Committee reiterates that funding for local programs 
under this line item is not restricted to programs appearing on 
a list of ``promising and exemplary'' models of safe and drug 
free schools programs that was compiled by the Department of 
Education and published on January 18, 2001. The Committee is 
aware that other Federal agencies, such as the Center for 
Substance Abuse Prevention, have expertise in this field and 
have also initiated work to identify promising, effective and 
model prevention programs, strategies and activities. 
Consistent with the ``principles of effectiveness'' included in 
the No Child Left Behind Act, the Committee encourages States 
and school districts receiving these funds to examine the 
information and results available from all sources, conduct 
needs assessments and choose programs, strategies and 
activities that best fit particular local needs.

Safe and drug-free schools and communities: national programs

    For the national programs under the Safe and Drug-Free 
Schools and Communities Act, the bill provides $155,180,000, 
the same as the fiscal year 2003 amount and $17,053,000 below 
the budget request. Under this program, the Secretary of 
Education administers a variety of activities to prevent the 
illegal use of drugs and violence among, and promote safety and 
discipline for, students at all educational levels, preschool 
through postsecondary.

Community service for expelled or suspended students

    The bill does not include funding for community service for 
expelled or suspended students, the same as the budget request 
and $49,675,000 below the fiscal year 2003 level. This program 
authorizes formula grants to state to carry out programs under 
which students expelled or suspended from school are required 
to perform community service.

Alcohol abuse reduction

    The bill does not include funding for grants to reduce 
alcohol abuse, the same as the budget request and $24,838,000 
below the fiscal year 2003 level. This program awards 
competitive grants to districts to develop and implement 
innovative and effective programs to reduce alcohol abuse in 
secondary schools.

Mentoring programs

    The bill includes $50,000,000 for mentoring programs which 
provide competitive grants to school districts and community-
based organizations to promote mentoring programs for children 
with the greatest need. This is $50,000,000 below the budget 
request and $32,614,000 above the fiscal year 2003 level.

Character education

    The bill includes $24,838,000 for character education, the 
same as the fiscal year 2003 level and $162,000 below the 
budget request. This program provides support for the design 
and implementation of character education programs in 
elementary and secondary schools. Grantees may select the 
elements of character that will be taught, and must consider 
the views of parents and students to be served by the program.

Elementary and secondary school counseling

    The bill includes $32,289,000 for elementary and secondary 
school counseling, the same as the fiscal year 2003 level. The 
President's budget did not propose funding for this program. 
This program provides grants to school districts to enable them 
to establish or expand elementary school and secondary school 
counseling programs.
    The Committee is aware that some school districts have 
employed the use of screening tools to detect depression, the 
risk of suicide, and other mental disorders in school aged 
youth. The Committee urges the Secretary to make the 
availability of such screening tools more widely known, and to 
encourage school districts, juvenile justice facilities and 
community-based organizations to screen youth for such 
problems. The Committee expects the Department to be prepared 
to report on this activity in the FY 2005 appropriations 
hearings.

Physical education for progress

    The bill includes $60,000,000 for the physical education 
for progress program, an increase of $390,000 above the fiscal 
year 2003 level. The President's budget did not request funding 
for this program, but did request $10,000,000 for a separate, 
new physical education initiative which has not been funded by 
the Committee.
    The Committee agrees with the goals set forth by the 
Administration in proposing a physical education initiative to 
help encourage exercise and healthy weight among youth. The 
Committee has heard compelling testimony from the Centers for 
Disease Control and Prevention that many of the chronic health 
problems facing the country today such as diabetes, heart 
disease and some cancers are preventable, and attributable to a 
few behaviors including poor nutrition, tobacco use and 
insufficient physical activity.
    To that end, the Committee has included funding for this 
line item but directs the Department to use such funds to 
demonstrate high-quality, research-based approaches for 
incorporating regular physical activity into students' everyday 
lives and promoting lifelong personal fitness activities and 
healthy habits. The Committee is concerned that the current-
funded physical education program is primarily being used to 
purchase sports equipment for regular school sports and 
physical education programs and to train school faculty in the 
use of such equipment. This is not the intent of these funds. 
The Committee expects that funds will be used to develop 
programs that can provide information to states, school 
districts and other youth organizations on the most effective 
methods for encouraging all students--not simply those who are 
already participating in competitive sports--to develop 
positive attitudes about fitness and increased levels of 
personal fitness. The Committee is aware that some schools have 
begun to use heart rate monitors in physical education classes 
toward that end and the Committee encourages the Department to 
examine this model.
    The Committee also encourages grantees to include in their 
proposals how they will address the dietary aspects of physical 
fitness in addition to the exercise components.

Civic education

    The bill includes $28,812,000 for civic education, the same 
as the fiscal year 2003 level and $1,812,000 above the budget 
request. Program funds support the ``We the People'' and the 
Cooperative Education Exchange programs. ``We the People'' 
seeks to promote civic competence and responsibility among 
students. Cooperative Education Exchange provides support for 
education exchange activities in civics and economics between 
the United States and eligible countries in Central and Eastern 
Europe, the Commonwealth of Independent States, any country 
that was formerly a republic of the Soviet Union the Republic 
of Ireland, the province of Northern Ireland and developing 
countries with a democratic form of government.

State grants for incarcerated youth offenders

    The bill does not include funding for state grants for 
incarcerated youth offenders, the same as the budget request 
and $23,348,000 below the fiscal year 2003 level. This program 
makes grants to state correctional agencies to assist and 
encourage incarcerated youths to acquire functional literacy 
skills and life and job skills.

                      ENGLISH LANGUAGE ACQUISITION

    The bill includes $685,515,000 for English language 
acquisition programs. This amount is $20,515,000 above the 
budget request and the same as the comparable fiscal year 2003 
appropriation level.
    This program provides formula grants to states to serve 
limited English proficient students. Grants are based on each 
state's share of the Nation's limited English proficient and 
recent immigrant student population. Funds under this account 
also support professional development to increase the pool of 
teachers prepared to serve limited English proficient students 
and evaluation activities.

                           SPECIAL EDUCATION

    The bill includes $11,049,790,000 for programs for children 
with disabilities authorized under the Individuals with 
Disabilities Education Act (IDEA). This funding level is 
$359,686,000 above the budget request and $1,015,873,000 above 
the fiscal year 2003 appropriation.

State Grants: Grants to States for special education

    The bill provides $9,874,398,000 for grants to States, 
which is $345,865,000 above the budget request and 
$1,000,000,000 above the fiscal year 2003 level. Out of the 
total made available for school year 2004-2005, $4,802,398,000 
is appropriated for fiscal year 2004 for obligation after July 
1, 2004 and $5,072,000,000 is appropriated for fiscal year 2005 
for obligation on, or after, October 1, 2004.
    This program provides formula grants to assist the States 
in meeting the excess costs of providing special education and 
related services to children with disabilities. In order to be 
eligible for funds, States must make free appropriate public 
education available to all children with disabilities. Funds 
are distributed based on the amount that each State received 
from the fiscal year 1999 appropriation, and the numbers of 
children in the general population and who live in poverty in 
the age range for which each States mandates free appropriate 
public education for children with disabilities.

State grants: Preschool grants

    The bill provides $390,000,000 for preschool grants, 
$2,535,000 above the fiscal year 2003 level and the same as the 
budget request. This program provides grants to States on the 
basis of their proportionate share of the total number of 
children in the 3 through 5 age range and the number of these 
children living in poverty. These funds are provided in order 
to assist States to make a free appropriate public education 
available to all children with disabilities in the 3 through 5 
age range.

State Grants: Grants for infants and families

    The bill provides $447,000,000 for grants for infants and 
families, $12,841,000 above the fiscal year 2003 level and the 
same as the budget request. This formula grant program assists 
States in developing and implementing statewide systems of 
coordinated, comprehensive, multidisciplinary, interagency 
programs to make available early intervention services to all 
children with disabilities, aged birth through 2, and their 
families.

IDEA National Activities: State improvement

    The bill includes $51,364,000 for State improvement, 
$7,364,000 above the budget request and the same as the fiscal 
year 2003 appropriation. This program supports competitive 
grants to State educational agencies to assist them, in 
partnership with parents, teachers, institutions of higher 
education, interest groups, and others, to improve results for 
children with disabilities by reforming and improving their 
educational, early intervention, and transitional service 
systems. Among these systems are those for professional 
development, technical assistance, and dissemination of 
knowledge about best practices. Awards are based on State 
improvement plans developed by the States.

IDEA National Activities: Research and innovation

    The bill includes $77,210,000 for research and innovation, 
the same as the fiscal year 2003 level and $1,170,000 below the 
budget request. This program supports competitive awards to 
produce and advance the use of knowledge to improve services 
and results for children with disabilities. The program focuses 
on producing new knowledge, integrating research and practice 
and improving the use of knowledge.

IDEA National Activities: Technical assistance and dissemination

    The bill includes $53,481,000 for technical assistance and 
dissemination, the same as the budget request and $348,000 
above the fiscal year 2003 appropriation. This program provides 
technical assistance and information through competitive awards 
that support institutes, regional resource centers, 
clearinghouses, and efforts to build State and local capacity 
to make systemic changes and improve results for children with 
disabilities.

IDEA National Activities: Personnel preparation

    The bill includes $91,899,000 for personnel preparation, 
which is the $1,899,000 above the budget request and the same 
as the fiscal year 2003 appropriation. This program supports 
competitive awards to help address State-identified needs for 
qualified personnel to work with children with disabilities, 
and to ensure that those personnel have the skills and 
knowledge they need to serve those children. Awards focus on 
addressing the need for personnel to serve low incidence 
populations and high incidence populations, leadership 
personnel, and projects of national significance.

IDEA National Activities: Parent information centers

    The bill includes $26,328,000 for parent information 
centers, the same as the fiscal year 2003 level and $328,000 
above the budget request. This program makes awards to parent 
organizations to support parent training and information 
centers, including community parent resource centers. These 
centers provide training and information to meet the needs of 
parents of children with disabilities living in the areas 
served by the centers, particularly underserved parents and 
parents of children who may be inappropriately identified. 
Technical assistance is also provided under this program for 
developing, assisting and coordinating centers receiving 
assistance under this program.

IDEA National Activities: Technology and media services

    The bill includes $38,110,000 for technology and media 
services, which is $149,000 above the fiscal year 2003 
appropriation and $5,400,000 above the budget request. This 
program makes competitive awards to support the development, 
demonstration, and use of technology and educational media 
activities of educational value to children with disabilities.
    The bill includes $11,400,000 for Recording for the Blind 
and Dyslexic. These funds support continued production and 
circulation of recorded textbooks and increased outreach 
activities to print-disabled students and their teachers. The 
Committee has been supportive of RFB&D's efforts on the 
development and application of digital audio technology as a 
tool to improve the usefulness of its recorded books for 
students. The Committee is aware of a proposal to distribute 
specially designed digital compact disc players and reader 
software that will enable users to employ the new digital audio 
technology. The Committee directs the Department to report by 
December 1, 2003 on the technology involved and its readiness 
for the field, the proposed numbers of intended users, 
associated costs and plans for distribution of the devices.
    The Committee continues to recognize the importance of very 
small businesses in increasing the quality and cost-
effectiveness of the television captioning program. As 
captioning becomes mandatory under the Telecommunications Act, 
the Committee urges the Department to give full and fair 
consideration to the applications of very small businesses.

            REHABILITATION SERVICES AND DISABILITY RESEARCH

    The bill includes $2,999,165,000 for rehabilitation 
services and disability research. This amount is $3,748,000 
below the budget request and $45,532,000 above the fiscal year 
2003 appropriation. The programs in this account are authorized 
by the Rehabilitation Act of 1973, the Helen Keller National 
Center Act, and the Assistive Technology Act of 1998.

Vocational rehabilitation grants to States

    For vocational rehabilitation State grants, the bill 
includes $2,584,162,000, $50,670,000 above fiscal year 2003. 
This program supports basic vocational rehabilitation services 
through formula grants to the States. These grants support a 
wide range of services designed to help persons with physical 
and mental disabilities prepare for and engage in gainful 
employment to the extent of their capabilities. Emphasis is 
placed on providing vocational rehabilitation services to 
persons with the most significant disabilities.

Client assistance

    The bill includes $12,068,000 for the client assistance 
program, $171,000 above the budget request and the fiscal year 
2003 amount. A client assistance program is required in each 
State as a condition of receipt of a basic State grant. State 
formula grants are used to help persons with disabilities 
overcome problems with the service delivery system and improve 
their understanding of services available to them under the 
Rehabilitation Act.

Training

    For training personnel to provide rehabilitation services 
to persons with disabilities, the bill includes $39,371,000, 
$3,258,000 below the budget request and the same as the fiscal 
year 2003 amount. The program supports long-term and short-term 
training, in-service personnel training, and training of 
interpreters for deaf persons. Projects in a broad array of 
disciplines are funded to ensure that skilled personnel are 
available to serve the vocational needs of persons with 
disabilities.
    The Committee is also concerned about the funding for 
rehabilitation long-term training programs, particularly 
orthotic and prosthetic programs, and urges the Department to 
provide sufficient funding to continue such activities. The 
Committee expects the Department to be prepared to report on 
these activities in the fiscal year 2005 budget hearings.

Demonstration and training programs

    The bill includes $20,895,000 for demonstration and 
training programs, the same as the fiscal year 2003 level and 
$3,597,000 below the budget request. These programs authorize 
discretionary awards on a competitive basis to public and 
private organizations to support demonstrations, direct 
services, and related activities for persons with disabilities.

Migrant and seasonal farmworkers

    For programs serving migrant and seasonal farmworkers, the 
bill provides $2,335,000, which is the same as the fiscal year 
2003 amount and $2,335,000 above the budget request. This 
program provides discretionary grants to make comprehensive 
vocational rehabilitation services available to migrant and 
seasonal farmworkers with vocational disabilities. Projects 
emphasize outreach activities, specialized bilingual 
rehabilitation counseling, and coordination of vocational 
rehabilitation services with services from other sources.

Recreational programs

    For recreational programs, the bill provides $2,579,000, 
the same as the fiscal year 2003 amount and $2,579,000 above 
the budget request. This program provides individuals with 
recreation and related activities to aid in their employment, 
mobility, independence, socialization, and community 
integration. Discretionary grants are made on a competitive 
basis to States, public agencies, and nonprofit private 
organizations, including institutions of higher education.

Protection and advocacy of individual rights

    For protection and advocacy for persons with severe 
disabilities, the bill provides $16,890,000, $990,000 below the 
budget request and the same as the fiscal year 2003 level. 
Grants are awarded to entities that have the authority to 
pursue legal, administrative, and other appropriate remedies 
needed to protect and advocate the rights of persons with 
severe disabilities.

Projects with industry

    For projects with industry, the bill provides $21,928,000, 
the same as the fiscal year 2003 amount and $21,928,000 above 
the budget request. This program is the primary Federal vehicle 
for promoting greater participation of business and industry in 
the rehabilitation process. The program provides training and 
experience in realistic work settings to persons with 
disabilities to prepare them for employment in the competitive 
labor market. Awards are made to a variety of agencies and 
organizations, including business and industrial corporations, 
rehabilitation facilities, labor organizations, trade 
associations, and foundations.

Supported employment State grants

    For supported employment State grants, the bill includes 
$37,904,000, which is the same as the fiscal year 2003 amount 
and $37,904,000 above the budget request. These formula grants 
assist States in developing collaborative programs with public 
agencies and nonprofit agencies for training and post-
employment services leading to supported employment. In 
supported employment programs, persons with significant 
disabilities are given special supervision and assistance to 
enable them to work in an integrated setting.

Independent living: State grants

    For State grants for independent living, the bill includes 
$22,296,000. This amount is the same as the budget request and 
$145,000 above the fiscal year 2003 level. This program 
supports formula grants to the States to provide services for 
independent living for persons with significant disabilities.

Independent living: centers

    For centers for independent living, the bill provides 
$75,000,000, which is $5,500,000 above the budget request and 
$5,455,000 above the fiscal year 2003 level. Discretionary 
grants support a network of consumer-controlled, 
nonresidential, community-based private nonprofit centers that 
provide a wide range of services to help persons with 
significant disabilities live more independently in family and 
community settings. Centers provide information and referral 
services, independent living skills training, peer counseling, 
and individual and systems advocacy. Discretionary grants are 
made to private nonprofit organizations.

Independent living: services for older blind persons

    For independent living services for older blind 
individuals, the bill provides $32,000,000. This amount is 
$4,182,000 above the fiscal year 2003 amount and $7,000,000 
above the budget request. Discretionary grants support services 
for persons 55 years old or over whose severe visual impairment 
makes gainful employment extremely difficult to obtain, but for 
whom independent living goals are feasible.

Program improvement

    For program improvement activities, the bill provides 
$894,000, which is the same as the fiscal year 2003 level and 
$44,000 above the budget request. The program: (1) provides 
technical assistance and consultative services to public and 
non-profit private agencies and organizations; (2) provides 
short-term training and technical instruction; (3) conducts 
special demonstrations; (4) collects, prepares, publishes and 
disseminates educational or informational materials; and (5) 
carries out monitoring and conducts evaluations.

Evaluation

    The bill includes $994,000 for program evaluation, the same 
as the fiscal year 2003 amount and $6,000 below the budget 
request. These funds are used to evaluate the impact and 
effectiveness of individual programs authorized under the 
Rehabilitation Act. Contracts are awarded on an annual basis 
for studies to be conducted by persons not immediately involved 
in the administration of the programs authorized by the Act.

Helen Keller National Center

    For the Helen Keller National Center for Deaf-Blind Youth 
and Adults, the bill includes $8,717,000, which is $57,000 
above the fiscal year 2003 amount and the same as the budget 
request. These funds are used for the operation of the national 
center for intensive services for deaf-blind individuals and 
their families at Sands Point, New York and a network of 10 
regional offices for referral and counseling. In addition to 
support for the national and regional staff, the Helen Keller 
Center provides seed money to public and private nonprofit 
affiliate agencies to assist them in initiating programs for 
deaf-blind persons.

National Institute on Disability and Rehabilitation Research

    The bill includes $110,000,000 for the National Institute 
on Disability and Rehabilitation Research, the same as the 
budget request and $715,000 above the fiscal year 2003 level. 
The Institute supports research, demonstration and training 
activities that are designed to maximize the employment and 
integration into society of individuals with disabilities of 
all ages.
    The Committee recognizes the need to significantly enhance 
support for applied research in orthotics and prosthetics to 
improve the delivery of rehabilitative care to persons with 
orthopedic impairments and neurological conditions. The 
Committee is pleased with the partnership between the 
Rehabilitation Services Administration and the American Academy 
of Orthotists and Prosthetists to support and improve the 
quality of applied orthotic and prosthetic research and help 
meet the increasing demand for provider services. The Committee 
urges the Department to continue this partnership, as well as 
to further develop the orthotic and prosthetic awareness 
campaign, which includes an educational outreach initiative 
designed to recruit and retain professionals and develop a 
series of consensus conferences and disseminate the resulting 
best practices to the field.

Assistive technology

    For assistive technology activities, the bill provides 
$11,132,000, $15,692,000 below the fiscal year 2003 amount. The 
budget request did not include funding for this program. 
Technology assistance activities are authorized under the 
Assistive Technology Act of 1998. This Act authorizes the 
following activities: discretionary grants to the States to 
assist them in developing statewide programs to facilitate the 
provision of devices for, and services to, persons with 
disabilities; protection and advocacy services related to 
assistive technology; discretionary grants to the states for 
alternative financing programs; and technical assistance 
activities.

           Special Institutions for Persons With Disabilities


                 AMERICAN PRINTING HOUSE FOR THE BLIND

    The bill provides $16,500,000 for the American Printing 
House for the Blind, an increase of $1,101,000 above the fiscal 
year 2003 appropriation and $2,500,000 above the budget 
request. This appropriation subsidizes the production of 
educational materials for legally blind persons enrolled in 
pre-college programs. The Printing House, which is chartered by 
the State of Kentucky, manufactures and maintains an inventory 
of special materials that is distributed free of charge to 
schools and States based on the number of blind students in 
each State. The Printing House also conducts research and field 
activities to inform educators about the availability of 
materials and how to use them.

               NATIONAL TECHNICAL INSTITUTE FOR THE DEAF

    The bill provides $53,867,000 for the National Technical 
Institute for the Deaf (NTID), an increase of $168,000 above 
the comparable fiscal year 2003 amount and $3,086,000 above the 
request. The NTID was established by Congress in 1965 to 
provide a residential facility for postsecondary technical 
training and education for deaf persons with the purpose of 
promoting the employment of deaf individuals. The Institute 
also conducts applied research and provides training in various 
aspects of deafness. The Secretary of Education administers 
these activities through a contract with the Rochester 
Institute of Technology in Rochester, New York.

                          GALLAUDET UNIVERSITY

    The bill provides $100,600,000 for Gallaudet University, an 
increase of $2,802,000 above the fiscal year 2003 appropriation 
and $6,154,000 above the budget request. Gallaudet is a 
private, non-profit educational institution Federally-chartered 
in 1864 providing elementary, secondary, undergraduate, and 
continuing education for deaf persons. In addition, the 
University offers graduate programs in fields related to 
deafness for deaf and hearing students, conducts various 
research on deafness, and provides public service programs for 
deaf persons.

                     VOCATIONAL AND ADULT EDUCATION

    The bill includes $2,094,475,000 for vocational and adult 
education programs. This amount is $11,779,000 below the fiscal 
year 2003 appropriation and $503,443,000 above the budget 
request. This appropriation account includes vocational 
education programs authorized by the Carl D. Perkins Vocational 
and Applied Technology Education Act. The account also includes 
adult education programs originally authorized by the Adult 
Education Act and reauthorized under the Workforce Investment 
Act of 1998.

Vocational education basic grants

    This bill includes $1,200,000,000 for basic grants to 
States under the Carl D. Perkins Vocational and Technical 
Education Act of 1998, which is $7,800,000 above the fiscal 
year 2003 amount and $200,000,000 above the comparable budget 
request. Out of the total made available for school year 2004-
2005, $409,000,000 is appropriated for fiscal year 2004 for 
obligation after July 1, 2004 and $791,000,000 is appropriated 
for fiscal year 2005 for obligation on, or after, October 1, 
2004.
    State grants support a variety of vocational education 
programs developed in accordance with the State plan. The Act 
concentrates federal resources on institutions with high 
concentrations of low-income students. The populations assisted 
by Basic Grants range from secondary students in pre-vocational 
courses to adults who need retraining to adapt to changing 
technological and labor markets.

Tech-prep

    The bill includes $107,298,000 for tech-prep, the same as 
fiscal year 2003. The budget request did not propose separate 
line item funding for this program. This appropriation includes 
activities under title II of the Carl D. Perkins Vocational and 
Technical Education Act of 1998. The tech-prep education 
program provides planning and demonstration grants to consortia 
of local educational agencies and postsecondary institutions to 
develop and operate model technical education programs. These 
programs begin in high school and provide students with the 
mathematical, science, communications and technological skills 
needed to enter a 2-year associate degree or 2-year certificate 
program in a given occupational field, and to make a successful 
transition into further postsecondary education or begin their 
careers. The purpose of tech-prep is to develop structural 
links between secondary and postsecondary institutions that 
integrate academic and vocational education and better prepares 
students to make the transition from school to careers.

National programs

    For national programs, the Committee provides $11,922,000, 
which is the same as the fiscal year 2003 amount. The budget 
did not request separate funding for this program. This 
authority supports the conduct and dissemination of research in 
vocational education, and includes support for the National 
Centers for Research and Dissemination in Career and Technical 
Education, five regional curriculum coordination centers, and 
other discretionary research.

Tech-Prep Education Demonstration

    The bill does not include funding for the Tech-Prep 
Education Demonstration. The President's budget did not request 
funding for it. Last year this program was funded at 
$4,968,000. The program makes competitive grants to consortia 
to establish Tech-prep programs in secondary schools located on 
the sites of community colleges.

Occupational and Employment Information Program

    The bill does not include funding for the Occupational and 
Employment Information Program. The President's budget did not 
request funding for it. Last year this program was funded at 
$9,438,000. The program provides career information and 
guidance services to students and adults through a network of 
state agencies.

State programs for adult education

    For state grants, the Committee recommends $584,300,000, 
which is $13,038,000 above the fiscal year 2003 amount, and the 
same as the comparable budget request. State formula grants 
support programs to enable all adults to acquire basic literacy 
skills, to enable those who so desire to complete a secondary 
education, and to make available to adults the means to become 
more employable, productive, and responsible citizens.
    Grants are provided on a formula basis to States under the 
new Adult Education and Family Literacy Act. The formula 
provides an initial allotment of $25,000 for each state and 
$100,000 to each outlying area, with additional allotments 
distributed on the basis of population aged 16 through 60 who 
are without a high school diploma or equivalent who are not 
enrolled in secondary school.
    States may use 12.5 percent of their allotments for state 
leadership activities and may use an additional 5 percent or 
$65,000 for state administration. States and localities must 
give priority to adult education and literacy activities that 
are built on a strong foundation of research on effective 
practices and that effectively employ technology. Funds are 
provided on a forward-funded basis.
    The Committee notes that over 40 percent of new adult 
education entrants are seeking English as-a-second language 
(ESL) services and that ESL accounts for 51 percent of all 
adults receiving adult education services and 76 percent of the 
hours of instruction received. The Committee expects that the 
funds provided in this program will be used by states with 
large concentrations of students who seek English language 
proficiency training to meet the needs of those individuals. 
The Committee bill retains language similar to that contained 
in last year's bill that guarantees a portion of the funds will 
be used to provide civics education services to new immigrants.

National Programs--National Leadership Activities

    The Committee provides $9,438,000 for national leadership 
activities. This amount is the same as the fiscal year 2003 
level. The budget request did not provide separate funding for 
this program.
    Through applied research, development, dissemination, 
evaluation, and program improvement activities, this program 
assists State efforts to improve the quality of adult 
education. The funds support such projects as evaluations on 
the status and effectiveness of adult education programs, 
national and international adult literacy surveys, and 
technical assistance on using technology to improve instruction 
and administration that show promise of contributing to the 
improvement and expansion of adult education.

National Institute for Literacy

    For the National Institute for Literacy, the bill provides 
$6,517,000, which is the same as the fiscal year 2003 amount 
and $215,000 below the budget request. The Institute supports 
research and development projects, tracks progress made toward 
national literacy goals, supports research fellowships, 
disseminates information through a national clearinghouse, and 
coordinates literacy information data from national and State 
sources.

Smaller learning communities

    The bill includes $175,000,000 for smaller learning 
communities, $14,053,000 above the fiscal year 2003 level. The 
President's budget did not propose funding for it. This program 
supports competitive grants to school districts to enable them 
to create smaller learning communities in large schools.

Community technology centers

    The bill does not include funding for community technology 
centers, $32,264,000 below the fiscal year 2003 level and the 
same as the request. The program provides competitive grants to 
create and expand community technology centers that offer 
disadvantaged residents of economically distressed urban and 
rural communities access to information technology and related 
training. Other Federal programs also exist that fund 
communities that want to establish and operate technology 
centers.

                      STUDENT FINANCIAL ASSISTANCE

    The bill provides $14,247,432,000 for student financial 
assistance programs, an increase of $884,360,000 over the 
comparable fiscal year 2003 appropriation and $271,068,000 
below the budget request.

Pell grants

    The bill maintains the maximum Pell Grant at $4,050, $50 
above the budget request and the same as the comparable fiscal 
year 2003 amount. The bill provides $12,250,000,000 in new 
budget authority for the Pell Grant program, $465,000,000 below 
the request and $885,354,000 above the comparable fiscal year 
2003 amount. Pell Grants provide portable education vouchers to 
postsecondary students who may use them at any of over 6,000 
eligible schools.

Federal Supplemental Educational Opportunity Grants

    The bill provides $760,028,000 for federal supplemental 
educational opportunity grants, $35,028,000 above the request 
and the same as the fiscal year 2003 level. The SEOG program 
provides grants through postsecondary institutions to qualified 
students who demonstrate exceptional financial need. 
Institutions have broad flexibility within the eligibility 
criteria for awarding these grants with the exception that 
priority must be given to Pell Grant recipients.

Work-study

    The bill provides $1,004,428,000 for the work-study 
program, the same as the comparable fiscal year 2003 
appropriation and $6,572,000 below the budget request. Funding 
for this program is provided through institutions to students 
who work part-time to meet the cost of education. Institutions 
receive funding according to a statutory formula and may 
allocate it for job location and job development centers.

Perkins loans capital contributions

    The Committee bill provides $99,350,000 in funding for new 
capital contributions to federal Perkins revolving loan funds, 
$99,350,000 above the budget request and the same as the 
comparable fiscal year 2003 appropriation.

Perkins loans cancellations

    The bill provides $67,061,000 for federal Perkins loans 
cancellations, $439,000 below the budget request and the same 
as the fiscal year 2003 amount. The Federal Government 
reimburses institutional Perkins revolving loan funds for loan 
cancellations permitted under Federal law. Loans may be 
canceled when the borrower pursues a career in one of 12 
statutorily-designated professions including corrections, 
medical technical work, and peace corps or VISTA service.

Leveraging educational assistance partnership

    The bill includes $66,565,000 for the leveraging 
educational assistance partnership (LEAP) program, the same as 
the fiscal year 2003 level and $66,565,000 above the budget 
request. LEAP provides dollar-for-dollar matching funds to 
States as an incentive for providing need-based grant and work 
study assistance to eligible postsecondary students. Federally 
supported grants and job earnings are limited to $5,000 per 
award year for full-time students. By law, each State's 
allocation is based on its relative share of the total national 
population of students eligible to participate in the programs, 
except that no state is to receive less than it received in 
1979. If LEAP amounts are below this level, each State is 
allocated an amount proportional to the amount of funds it 
received in 1979. If a state does not use all of its 
allocation, the excess funds are distributed to other States in 
the same proportion as the original distribution. States must, 
at a minimum, match LEAP grants dollar for dollar with state 
funds provided through direct state appropriations for this 
purpose.

Loan forgiveness for child care

    The bill does not include funding for loan forgiveness for 
child care, the same as the budget request and $994,000 below 
the fiscal year 2003 amount. This program was designed to 
retain and encourage more highly trained individuals to enter 
into the early childcare profession. Under this program, 
borrowers who have earned a degree in early childhood education 
and who work for two full years as a child care provider in a 
low-income community may have a portion of their loan 
obligation forgiven. Additional forgiveness is awarded for each 
additional consecutive year of service, up to a total of 100 
percent of the borrower's outstanding balance after five full 
years.

                       STUDENT AID ADMINISTRATION

    The bill includes $120,010,000 in discretionary resources 
for the Student Aid Administration account. The Committee 
recommendation is $15,307,000 more than the comparable fiscal 
year 2003 funding level and the same as the request, when 
adjusted for discretionary-scored spending. Funds appropriated 
to the Student Aid Administration account, in addition to 
mandatory funding available through Section 458 of the Higher 
Education Act, will support the Department's student aid 
management expenses. The organization administering Federal 
Student Aid and the Office of Postsecondary Education have 
primary responsibility for administering Federal student 
financial assistance programs. The Committee bill does not 
include the Administration's legislative proposal to fund this 
new account solely through annual appropriations.

                            HIGHER EDUCATION

    The bill provides $1,985,991,000 for higher education 
programs, a decrease of $107,460,000 below the fiscal year 2003 
appropriation and $81,553,000 above the budget request.

Strengthening institutions

    The bill provides $81,467,000 for the regular strengthening 
institutions program, $5,192,000 above the budget request and 
the same as the fiscal year 2003 level. This program provides 
general operating subsidies to institutions with low average 
educational and general expenditures per student and 
significant percentages of low-income students. Awards may be 
used for faculty and academic program development, management, 
joint use of libraries and laboratories, acquisition of 
equipment, and student services.

Hispanic serving institutions

    The bill provides $93,551,000 for the Hispanic serving 
institutions program, the same as the budget request and 
$1,155,000 above the fiscal year 2003 level. The HSI program 
provides operating subsidies to schools that serve at least 25 
percent Hispanic students of whom at least half are low-income 
students.

Strengthening historically black colleges and universities

    The bill provides $224,086,000 for strengthening 
historically black colleges and universities (HBCUs), 
$10,071,000 above the fiscal year 2003 appropriation and the 
same as the budget request.
    This program provides operating subsidies to accredited, 
legally authorized HBCUs established prior to 1964 whose 
principal mission is the education of black Americans. Funds 
may be used to support both programs and management and are 
distributed through a formula grant based on the enrollment of 
Pell Grant recipients, number of graduates, and the number of 
graduates entering graduate or professional schools in which 
blacks are underrepresented. The minimum grant is $500,000.

Strengthening historically black graduate institutions

    The bill provides $53,415,000 for the strengthening 
historically black graduate institutions program, the same as 
the fiscal year 2003 appropriation and $113,000 above the 
budget request.
    The program provides 5-year grants to the following 18 
post-secondary institutions that are specified in section 
326(e)(1) of the Higher Education Act: Morehouse School of 
Medicine, Meharry Medical School, Charles R. Drew Postgraduate 
Medical School, Clark-Atlanta University, Tuskegee University 
School of Veterinary Medicine, Xavier University School of 
Pharmacy, Southern University School of Law, Texas Southern 
University Schools of Law and Pharmacy, Florida A&M University 
School of Pharmaceutical Sciences, North Carolina Central 
University School of Law, Morgan State University qualified 
graduate program, Hampton University qualified graduate 
program, Alabama A&M qualified graduate program, North Carolina 
A&T State University qualified graduate program, University of 
Maryland Eastern Shore qualified graduate program, Jackson 
State qualified graduate program, Norfolk State University and 
Tennessee State University. Of the amount appropriated, the 
first $26,600,000 is used to make grants to the first 16 
institutions listed above. Any amount appropriated in excess of 
$26,600,000 but less than $28,600,000 is used to make grants to 
Norfolk State University and Tennessee State University and any 
remaining appropriation is made available to each of the 18 
institutions based on a formula. Awards may be used for 
building endowments as well as the same purposes for which the 
strengthening HBCU grants may be used.

Strengthening Alaska Native and Native Hawaiian-serving institutions

    The Committee recommends $8,180,000 for strengthening 
Alaska Native and Native Hawaiian-serving institutions, the 
same as the fiscal year 2003 level and $4,132,000 above the 
budget request.

Strengthening tribally controlled colleges and universities

    The Committee recommends $22,850,000 for the strengthening 
tribally controlled colleges and universities program, 
$3,813,000 above the budget request and the same as the fiscal 
year 2003 level.

International education and foreign languages studies

            Domestic programs
    The bill provides $93,240,000 for the domestic activities 
of the international education and foreign languages studies 
programs, the same as the fiscal year 2003 appropriation and 
$5,240,000 above the budget request. The program assists 
graduate and undergraduate foreign language and area studies 
programs and students at institutions of postsecondary 
education. Programs include national resource centers, foreign 
language and area studies fellowships, undergraduate 
international studies and foreign language programs, 
international research and studies projects, business and 
international education projects, international business 
education centers, language resource centers, American overseas 
research centers, and technological innovation and cooperation 
for foreign information access. In general, the Secretary has 
discretion to allocate funding among these various activities.
            Overseas programs
    The bill provides $12,916,000 for the overseas programs in 
international education and foreign language studies authorized 
under the Mutual Educational and Cultural Exchange Act of 1961, 
popularly known as the Fulbright-Hays Act. The appropriation is 
$84,000 below the budget request and the same as the fiscal 
year 2003 appropriation. Funding for these programs support 
group projects abroad, faculty research abroad, special 
bilateral projects, and doctoral dissertation research abroad.

Institute for International Public Policy

    The bill provides $1,639,000 for the Institute for 
International Public Policy, $139,000 above the budget request 
and the same as the fiscal year 2003 appropriation. This 
program provides a grant to an eligible recipient to operate 
the Institute through sub-grantees chosen among minority 
serving institutions.

Fund for the improvement of postsecondary education

    The Committee recommends $39,138,000 for the fund for the 
improvement of postsecondary education (FIPSE), the same as the 
budget request and $131,930,000 below the fiscal year 2003 
amount. FIPSE awards grants and contracts to a variety of 
postsecondary institutions and other organizations to improve 
the quality and delivery of postsecondary education.

Minority science and engineering improvement

    The bill provides $8,942,000 for the minority science and 
engineering improvement program (MSEIP), the same as the fiscal 
year 2003 appropriation and $442,000 above the budget request.
    The MSEIP program awards grants to improve mathematics, 
science, and engineering programs at institutions serving 
primarily minority students and to increase the number of 
minority students who pursue advanced degrees and careers in 
those fields. The Committee encourages the Department to 
develop specific numerical goals and baseline data for this 
program.

Interest subsidy grants

    The bill provides $2,000,000 for interest subsidy grants 
authorized under section 121 of the Higher Education Act, the 
same amount requested in the budget and $980,000 below the 
fiscal year 2003 appropriation. This program provides loan 
subsidies to higher education institutions for facilities 
acquisition, construction and renovation loans taken prior to 
1974. All loans will terminate by the fiscal year 2013. The 
authority to initiate new loan subsidy commitments was repealed 
in the 1992 amendments to the Higher Education Act. Interest 
subsidies provide institutions the difference between the 
interest they pay on commercially-obtained loans and 3 percent 
of the loan balance. The bill provides funding sufficient to 
meet the Federal Government's commitments on the 52 loans 
expected to be in repayment status in fiscal year 2004.

Tribally controlled postsecondary vocational and technical institutions

    The bill includes $6,955,000 for grants for tribally 
controlled postsecondary vocational and technical institutions, 
$455,000 above the budget request and the same as the fiscal 
year 2003 amount. This program provides grants for the 
operation and improvement of training programs to ensure 
continuation and expansion of vocational training opportunities 
for Indian youth.

TRIO

    The bill provides $835,000,000 for the TRIO programs, 
$32,500,000 above the budget request and $7,911,000 above the 
fiscal year 2003 appropriation. The TRIO programs provide a 
variety of outreach and support services to encourage low-
income, potential first-generation college students to enter 
and complete college. Discretionary grants of up to four or 
five years are awarded competitively to institutions of higher 
education and other agencies. At least two-thirds of the 
eligible participants in TRIO must be low-income, first-
generation college students.
    The Committee understands that the grant applications of 
several colleges and universities were not considered in the 
fiscal year 2003 TRIO funding competitions for the Upward 
Bound, Upward Bound Math/Science, and McNair Postbaccalaureate 
Achievement programs due to problems with the applications 
being received after the closing date. The Committee directs 
the Department to peer review these applications by July 31, 
2003, and to report back to the Committee on any meritorious 
applications that fall within previously-established cut off 
scores for the three competitions.

GEAR UP

    The bill includes $300,000,000 for the GEAR UP program, 
$6,918,000 above last year's level and $15,000,000 above the 
budget request. GEAR UP provides grants to states and 
partnerships of low-income middle and high schools, 
institutions of higher education and community organizations to 
target entire grades of students and give them the skills and 
encouragement to successfully pursue postsecondary education.

Byrd scholarships

    The bill includes $40,734,000 for the Byrd scholarships 
program, $267,000 below the budget request and the same as the 
fiscal year 2003 appropriation. The Byrd scholarship program 
provides formula grants to States to award $1,500 scholarships 
to students who demonstrate academic excellence in high school.

Javits fellowships

    The Committee recommends $9,935,000 for the Javits 
fellowship program, $65,000 below the budget request and the 
same as the fiscal year 2003 appropriation. Under the Javits 
program, institutions receive Federal support to make 
fellowship awards to students pursuing doctoral study in the 
arts, humanities, and social sciences.

Graduate assistance in areas of national need program

    The Committee recommends $30,798,000 for the graduate 
assistance in areas of national need (GAANN) program, $202,000 
below the budget request and the same as the fiscal year 2003 
appropriation. The GAANN program awards grants to institutions 
of higher education to provide fellowships to economically 
disadvantaged students who have demonstrated academic 
excellence and who are pursuing graduate education in 
designated areas of national need.

Teacher quality enhancement grants

    The Committee recommends $90,000,000 for teacher quality 
enhancement grants, the same as the budget request and $585,000 
above the fiscal year 2003 appropriation. Teacher quality 
enhancement grants have three components: state grants, 
partnership grants and recruitment grants. By statute, state 
and partnership grants each receive 45 percent of the 
appropriation, and recruitment grants receive 10 percent.
    Under the state grant component, states apply to receive up 
to three years of funding to improve the quality of their 
teaching force through promoting reform activities such as 
teacher licensing and certification, accountability for high 
quality teacher preparation and professional development and 
recruiting teachers for high-need schools. States must match 50 
percent of the federal award.
    Under the partnership component, partnerships apply to 
receive a five-year grant to strengthen the capacity of K-12 
educators in designing and implementing effective teacher 
education programs, and by increasing collaboration among these 
practitioners and departments of arts and sciences and schools 
of education at institutions of higher education. Partnerships 
must match 25 percent of the federal grant in the first year, 
35 percent in the second year, and 50 percent for the remaining 
years.
    The recruitment component supports the efforts to reduce 
shortages of qualified teachers in high-need school districts. 
States or partnerships may apply to receive these grants.

Child care access means parents in school

    The Committee recommends $15,000,000 for child care access 
means parents in school program, the same as the budget request 
and $1,194,000 below the fiscal year 2003 appropriation. Under 
this program, institutions may receive discretionary grants of 
up to four years to support or establish a campus-based 
childcare program primarily serving the needs of low-income 
students enrolled at the institution. Priority is given to 
childcare programs that leverage significant local or 
institutional resources and utilize a sliding fee scale. Grants 
can only be used to supplement childcare services or start new 
programs.

Demonstration projects to ensure quality higher education for students 
        with disabilities

    The Committee recommends $6,954,000 for funding for 
demonstration projects to ensure quality higher education for 
students with disabilities, the same as the fiscal year 2003 
level. The President's budget did not request funding for this 
program.
    This program provides discretionary grants for three years 
to support model demonstration projects that provide technical 
assistance and professional development activities for faculty 
and administrators in institutions of higher education in order 
to provide students with disabilities a high-quality 
postsecondary education.

Underground railroad program

    The Committee recommends $2,235,000 for the underground 
railroad program, which is the same as the fiscal year 2003 
appropriation. The budget request did not include funding for 
this program. The underground railroad program provides grants 
to non-profit institutions to research, display, interpret and 
collect artifacts relating to the history of the underground 
railroad.

GPRA data/HEA program evaluation

    The Committee recommends $994,000 for program evaluation 
and development of data required under the Government 
Performance and Results Act for Higher Education programs 
administered by the Department. This is the same as the fiscal 
year 2003 appropriation and $6,000 below the budget request.
    The Committee understands that for many higher education 
programs, baseline and performance indicator data are sparse, 
nonexistent or difficult to collect. Funding under this 
activity will support the Department in developing high-quality 
data as required under the Government Performance and Results 
Act.

Thurgood Marshall Scholarships

    The bill includes $4,968,000 for Thurgood Marshall 
Scholarships. The President's budget did not request funding 
for this program. The program was funded at $4,968,000 in 
fiscal year 2003. This program provides a single award to the 
Council on Legal Education Opportunity (CLEO) 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.

Olympic Scholarships

    The bill includes $994,000 for Olympic Scholarships, the 
same as the fiscal year 2003 level and $994,000 above the 
budget request. This program provides financial assistance to 
athletes who are training at the U.S. Olympic Education Center 
or one of the U.S. Olympic Training Centers and who are 
pursuing a postsecondary education at an institution of higher 
education.

                           HOWARD UNIVERSITY

    The bill provides $242,770,000 for Howard University, 
$5,296,000 above the budget request and $4,330,000 above the 
fiscal year 2003 appropriation. The bill includes a minimum of 
$3,600,000 for the endowment, which is $27,000 above the 
current level. The bill also includes an additional $700,000 
for Howard University Hospital to implement an emergency 
patient tracking system as a one-time expenditure related to 
homeland security measures.
    Howard University is a ``Research I'' university located in 
the District of Columbia. Direct appropriations for Howard 
University are authorized by 20 U.S.C. 123, originally enacted 
in 1867. Howard University provides undergraduate liberal arts, 
graduate and professional instruction to approximately 11,000 
students from all 50 States. Masters degrees are offered in 
over 55 fields and Doctor of Philosophy degrees in 26 fields.

         COLLEGE HOUSING AND ACADEMIC FACILITIES LOANS PROGRAM

    The bill provides $774,000 for the Federal administration 
of the college housing and academic facilities loan (CHAFL) 
program, the Higher Educational Facilities Loans program and 
the College Housing Loans program, the same as the budget 
request and $17,000 above the fiscal year 2003 appropriation.

HISTORICALLY BLACK COLLEGE AND UNIVERSITY CAPITAL AND FINANCING PROGRAM

Federal administration

    The bill provides $210,000 for the administration of the 
historically black college and university capital financing 
program authorized under part D of title III of the Higher 
Education Act, $3,000 above the fiscal year 2003 appropriation 
and the same as the budget request. The program is intended to 
make capital available for repair and renovation of facilities 
at historically black colleges and universities. In exceptional 
circumstances, capital provided under the program can be used 
for construction or acquisition of facilities.

Bond subsidies

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

                    INSTITUTE OF EDUCATION SCIENCES

    The bill includes $500,599,000 for the Institute of 
Education Sciences. This amount is $124,684,000 above the 
budget request, and $52,643,000 above the fiscal year 2003 
level. This account supports education research, statistics, 
and assessment activities.

Research

    This bill includes $185,000,000 for educational research, 
the same as the budget request and $45,910,000 above the fiscal 
year 2003 level. The Institute of Education Sciences supports 
research, development and national dissemination activities 
that are aimed at expanding fundamental knowledge of education 
and promoting the use of research and development findings in 
the design of efforts to improve education.
    The Committee directs the Institute of Education Sciences 
to compile guidance for states and school districts on research 
standards for evaluating the scientific basis and effectiveness 
of educational programs. The guidance should include guidelines 
for assessing the quality of research used to validate the 
effectiveness of educational approaches and interventions.
    The Committee directs the Secretary, in consultation with 
the Director of NICHD, to convene a panel of experts from 
teacher education, teacher education research, educators from 
the K-12 system, representatives of minority (language and 
ethnic) groups, parents, and business leaders. This panel shall 
look at the status of teacher preparation in the United States 
(individually in: elementary, secondary, and the core 
curricular areas of reading and mathematics), to include an 
analysis of the educational characteristics and academic 
preparation of candidates for both preservice and graduate 
education programs, the specific content and experiences that 
are provided candidates for degrees and certification in 
education, the consistency of the required coursework and 
experiences in reading and mathematics across teacher 
preparation programs, and the degree to which the content and 
experiences are based on converging scientific evidence. It 
shall develop a model for teacher education programs to collect 
information on their graduates' effectiveness, and review the 
needs of the No Child Left Behind Act for high quality 
teachers.

Regional educational laboratories

    The Committee has included $67,061,000 for the regional 
educational laboratories. This amount is the same as the fiscal 
year 2003 level. The budget request did not include funding for 
this program. The Committee reiterates its intent, expressed in 
the Conference Report on the fiscal year 1996 bill (Report No. 
104-537) that all work of the Regional Education Laboratories 
be based on the priorities established by their regional 
governing boards.

Statistics

    This bill includes $95,000,000 for the activities of the 
National Center for Education Statistics, exclusive of the 
National Assessment of Educational Progress. This amount is the 
same as the budget request and $5,585,000 above the fiscal year 
2003 level.
    Statistics activities are authorized under the Education 
Sciences Reform Act of 2002, title I of P.L. 107-279. The 
Center collects, analyzes, and reports statistics on all levels 
of education in the United States. Activities are carried out 
directly and through grants and contracts. Major publications 
include ``The Condition of Education'' and ``Digest of 
Education Statistics.'' Other products include projections of 
enrollments, teacher supply and demand, and educational 
expenditures. Technical assistance to state and local education 
agencies and postsecondary institutions is provided. 
International comparisons are authorized.

Assessment

    This bill includes $95,825,000 for the National Assessment 
of Educational Progress, the same as the budget request, and 
$590,000 above the fiscal year 2003 level. The Assessment is 
authorized under section 303 of the National Assessment of 
Educational Progress Authorization Act, and is the only 
nationally representative survey of educational ability and 
achievement of American students. The primary goal of the 
Assessment is to determine and report the status and trends of 
the knowledge and skills of students, subject by subject. 
Subject areas assessed in the past have included reading, 
writing, mathematics, science, and history, as well as 
citizenship, literature, art, and music. The Assessment is 
operated by contractors through competitive awards made by the 
National Center for Education Statistics; a National Assessment 
Governing Board formulates the policy guidelines for the 
program. Within the amounts provided, $5,090,000 is for the 
National Assessment Governing Board.

Multi-year grants and contracts

    The bill includes $57,623,000 for multi-year grants and 
contracts, the same as the fiscal year 2003 level. The budget 
request did not include funding for it. This line supports 
technical assistance centers and consortia.

                        DEPARTMENTAL MANAGEMENT

    The bill includes $573,906,000 for departmental management 
(salaries and expenses) at the Department of Education. This 
amount is $37,594,000 above the fiscal year 2003 appropriation 
and the same as the budget request. These activities are 
authorized by the Department of Education Organization Act, 
P.L. 96-88, and include costs associated with the management 
and operations of the Department as well as separate costs 
associated with the Office for Civil Rights and the Office of 
the Inspector General.
    The Committee continues to be pleased with the emphasis the 
Department's senior management team has placed on complying 
with the Government Performance and Results Act. The Committee 
expects the Department to continue to develop and refine GPRA 
measures for all programs, focusing particularly on student 
achievement outcomes.
    Executive Order 13270 directed federal agencies to take 
steps to enhance access to federal opportunities and resources 
for American Indian/Alaska Native students from tribal colleges 
and other postsecondary schools. The Committee believes that 
the Washington Semester American Indian Program (WINS) is an 
excellent way to advance the goals of Executive Order 13270, 
and strongly urges the Secretary to maximize the number of 
agencies that participate in the WINS program.

Program administration

    The bill includes $434,494,000 for program administration. 
This amount is $24,631,000 above the fiscal year 2003 
appropriation and the same as the budget request. These funds 
support the staff and other costs of administering programs and 
activities at the Department. Items include personnel 
compensation and health, retirement and other benefits as well 
as travel, rent, telephones, utilities, postage fees, data 
processing, printing, equipment, supplies, technology training, 
consultants and other contractual services.

Office for Civil Rights

    The bill includes $91,275,000 for the salaries and expenses 
of the Office for Civil Rights. This amount is $5,560,000 above 
the fiscal year 2003 appropriation and the same as the budget 
request. This Office is responsible for enforcing laws that 
prohibit discrimination on the basis of race, color, national 
origin, sex, disability, membership in a patriotic society, and 
age in all programs and institutions that receive funds from 
the Department. These laws extend to 50 State educational 
agencies, 16,000 local educational agencies, 3,500 institutions 
of higher education, as well as to proprietary schools, State 
rehabilitation agencies, libraries, and other institutions 
receiving Federal funds.

Office of the Inspector General

    The bill includes $48,137,000 for the Office of the 
Inspector General. This amount is $7,403,000 above the fiscal 
year 2003 appropriation and the same as the budget request. 
This Office has authority to inquire into all program and 
administrative activities of the Department as well as into 
related activities of grant and contract recipients. It 
conducts audits and investigations to determine compliance with 
applicable laws and regulations, to check alleged fraud and 
abuse, efficiency of operations, and effectiveness of results.
    The Committee is aware that the Committee on Education and 
the Workforce has asked the Department's Inspector General to 
review a grant made to the American Association of Colleges for 
Teacher Education for the Clearinghouse on Teaching and Teacher 
Education following published reports of alleged questionable 
activities. The Committee supports this request and looks 
forward to the Inspector General's report.

                           General Provisions

    Sec. 301. The Committee continues a provision which 
prohibits funds under this Act from being used for the 
transportation of students or teachers in order to overcome 
racial imbalances or to carry out a plan of racial 
desegregation.
    Sec. 302. The Committee continues a provision which 
prohibits funds under this Act from being used to require the 
transportation of any student to a school other than the school 
which is nearest the student's home in order to comply with 
title VI of the Civil Rights Act of 1964.
    Sec. 303. The Committee continues a provision which 
prohibits funds under this Act from being used to prevent the 
implementation of programs of voluntary prayer and meditation 
in public schools.
    Sec. 304. The Committee continues a provision which allows 
up to 1 percent of any discretionary funds appropriated for the 
Department of Education to be transferred between 
appropriations accounts, provided that no appropriation is 
increased by more than 3 percent by any such transfer. This 
provision requires the Secretary to notify the Appropriations 
Committees of both Houses of Congress at least 15 days in 
advance of a transfer.

                       TITLE IV--RELATED AGENCIES


                      Armed Forces Retirement Home

    The bill provides authority to expend $65,279,000 from the 
Armed Forces Retirement Home Trust Fund for operations and 
capital activities at the United States Soldiers' and Airmen's 
Home and the United States Naval Home, a decrease of $2,292,000 
below the comparable fiscal year 2003 appropriation and the 
same as the budget request.

Operations

    The bill provides authority to expend $63,296,000 from the 
Armed Forces Retirement Home Trust Fund for operations of the 
United States Soldiers' and Airmen's Home and the United States 
Naval Home, a increase of $1,457,000 above the comparable 
fiscal year 2003 appropriation and the same as the budget 
request.

Capital outlay

    The bill provides authority to expend $1,983,000 from the 
Armed Forces Retirement Home Trust Fund for capital activities 
at the Soldiers' and Airmen's Home and the United States Naval 
Home, a decrease of $3,749,000 below the comparable fiscal year 
2003 appropriation and the same as the budget request.

             Corporation for National and Community Service


                  DOMESTIC VOLUNTEER SERVICE PROGRAMS

    The bill provides $352,836,000 for the Domestic Volunteer 
Service Programs that are administered by the Corporation for 
National and Community Service. The recommended amount is 
$1,052,000 below the fiscal year 2003 appropriation and 
$11,827,000 below the budget request. Appropriations for these 
programs are not authorized in law for fiscal year 2004. 
Funding for the Americorps program that is also administered by 
the Corporation for National and Community Service is provided 
in the VA/HUD and Independent Agencies appropriations bill.
    The Committee emphasizes the importance of developing 
clear, measurable outcomes for programs within the purview of 
the Corporation as outlined in the Government Performance and 
Results Act. It is vital that the Committee be provided with 
information on the actual results achieved by the programs, not 
simply the number of volunteers participating in the program or 
the number of hours served. Program outcomes should, to the 
extent possible, focus on the actual improvements in the 
health, safety, education, and quality of life of individuals 
in the community as a result of the Federal investment. 
Programs that are able to demonstrate these results over time 
will be considered higher funding priorities than programs that 
are unable to clearly demonstrate their value to the American 
public.

VISTA

    The bill provides $93,674,000 for the Volunteers in Service 
to America (VISTA) program, the same as the fiscal year 2003 
level and $613,000 below the budget request. The VISTA program 
supports individuals who recruit volunteers and organize 
community volunteer activities but who do not provide direct 
volunteer services.

Special Volunteer Programs

    The bill includes $5,000,000 for special volunteer programs 
authorized under section 122 part C of title I of the Domestic 
Volunteer Service Act of 1973, $4,935,000 below the fiscal year 
2003 level and $15,000,000 below the budget request.
    These funds are to be used to place volunteers in community 
activities that are targeted specifically at contributing to 
homeland defense. Grants will be made to states and community 
organizations on a competitive basis and will support public 
and nonprofit agencies' efforts in the areas of public safety, 
public health, and disaster relief and preparedness. The 
Committee intends that these funds be used to support volunteer 
efforts across the population, and not simply focus on 
recruiting seniors.

National Senior Volunteer Corps

    The bill provides a total of $215,933,000 for the National 
Senior Volunteer Corps, the same as the fiscal year 2003 level 
and $3,786,000 above the budget request.
    The bill provides $110,775,000 for the Foster Grandparents 
program, the same as fiscal year 2003 levels and $4,075,000 
above the budget request. This program provides volunteer 
service opportunities for low-income people aged 60 and over.
    The bill provides $46,260,000 for the Senior Companion 
program, the same as the fiscal year 2003 appropriation and 
$303,000 below the budget request. The program provides project 
grants to private, non-profit organizations and State and local 
public agencies to offer volunteer service opportunities to 
low-income individuals aged 60 and over. These volunteers 
assist older adults with physical, mental or emotional 
impairments that put them at risk for institutionalization.
    The bill provides $58,501,000 for the Retired Senior 
Volunteer Program (RSVP), the same as the fiscal year 2003 
appropriation and $383,000 below the budget request. This 
program provides part-time volunteer service opportunities for 
low-income individuals aged 55 and over to recruit volunteers 
and organize volunteer activities relating to a variety of 
social needs.
    The bill includes $397,000 for senior demonstration 
programs, the same as the fiscal year 2003 level and $397,000 
above the budget request. The Committee intends this funding to 
be used to provide training and technical assistance to assist 
local projects in performance measurement as envisioned by the 
Government Performance and Results Act.

Program administration

    The bill provides $38,229,000 for program administration, 
$3,883,000 above the fiscal year 2003 appropriation and the 
same as the budget request.

                  Corporation for Public Broadcasting

    The Committee has provided $330,000,000 in advance funding 
for fiscal year 2006 for the Corporation for Public 
Broadcasting (CPB). The Administration did not request any 
advance funding.
    The Committee has included authority for CPB to spend up to 
$80,000,000 in fiscal year 2004 funds for CPB digital 
conversion activities. The Committee has also included 
authority for CPB to spend up to $20,000,000 on the Satellite 
Interconnection system.

               Federal Mediation and Conciliation Service

    The bill provides $43,385,000 for the Federal Mediation and 
Conciliation Service (FMCS), an increase of $2,229,000 above 
the comparable fiscal year 2003 appropriation and $500,000 
above the budget request.
    The FMCS attempts to prevent and minimize labor-management 
disputes having a significant impact on interstate commerce or 
national defense, except in the railroad and airline 
industries. The agency convenes boards of inquiry appointed by 
the President in emergency disputes and conducts dispute 
mediation, preventive mediation, and arbitration. In addition, 
the Service offers alternative dispute resolution services and 
training to other Federal agencies to reduce litigation costs 
and speed Federal administrative proceedings.
    The bill also includes provisions first enacted in the 
fiscal year 1996 Appropriations Act granting the agency the 
authority to accept gifts and to charge fees for certain 
services.

            Federal Mine Safety and Health Review Commission

    The bill provides $7,774,000 for the Federal Mine Safety 
and Health Review Commission, $643,000 above the fiscal year 
2003 level and the same as the budget request. The Commission 
is responsible for reviewing the enforcement activities of the 
Secretary of Labor under the Federal Mine Safety and Health 
Act. The Commission's administrative law judges hear and decide 
cases initiated by the Secretary of Labor, mine operators, or 
miners. The five-member Commission hears appeals from 
administrative law judge decisions, rules on petitions for 
discretionary review, and may direct, of its own initiative, 
review of cases that present unusual questions of law.

                Institute of Museum and Library Services

    The Committee recommends $238,126,000 for the Institute of 
Museum and Library Services. This is $5,763,000 below the 
fiscal year 2003 level and $3,898,000 below the budget request. 
The Institute makes state formula grants for library services 
and discretionary national grants for joint library and museum 
projects.
    For Library Services, the Committee recommends $166,246,000 
for State grants, including $3,225,000 for library services to 
Native Americans and Native Hawaiians. The Committee recommends 
$11,650,000 for national leadership grants. The Committee 
commends the Administration for its second year of funding for 
an Initiative to Recruit and Educate Librarians and has 
included the full amount requested, $20,000,000 for this 
purpose.
    For Museum Services, the Committee recommends $17,950,000 
for operations grants; $3,630,000 for Conservation programs; 
and $8,200,000 for National Leadership projects.
    The Committee recommends $10,450,000 for program 
administration, the same as the budget request.

                  Medicare Payment Advisory Commission

    The Committee recommends $9,000,000 for the Medicare 
Payment Advisory Commission, an increase of $471,000 above the 
comparable fiscal year 2003 appropriation and the budget 
request. The Commission advises Congress on matters of 
physician and hospital reimbursement under the Medicare and 
Medicaid programs.

        National Commission on Libraries and Information Science

    The Committee recommends $1,000,000 for the National 
Commission on Libraries and Information Science. This is $3,000 
below the fiscal year 2003 level and the same as the budget 
request.

                     National Council on Disability

    The bill provides $2,830,000 for the National Council on 
Disability (NCD), a decrease of $9,000 below the comparable 
fiscal year 2003 level appropriation and the same as the budget 
request. The Council monitors implementation of the Americans 
with Disabilities Act and makes recommendations to the 
President, the Congress, the Rehabilitation Services 
Administration, and the National Institute on Disability and 
Rehabilitation Research on public policy issues of concern to 
individuals with disabilities.

                     National Labor Relations Board

    The bill provides $239,429,000 for the National Labor 
Relations Board (NLRB). This is $2,000,000 above the fiscal 
year 2003 level and $3,644,000 below the budget request. The 
NLRB receives, investigates, and prosecutes unfair labor 
practice charges filed by businesses, labor unions, and 
individuals. It also schedules and conducts representation 
elections. The five-member Board considers cases in which an 
administrative law judge decisions are appealed.
    In 1959, Congress passed a law to give the NLRB 
jurisdiction over businesses to settle labor disputes between 
unions and management based on gross receipts. Once a business' 
gross receipts pass a certain threshold, it is subject to NLRB 
intervention. Businesses below the threshold are subject to 
actions under State laws, instead of the NLRB.
    Because the levels of gross receipts have never been 
adjusted for inflation, businesses and the NLRB have been 
caught in a ``bracket creep'' that has dramatically expanded 
federal jurisdiction without any Congressional intent to do so. 
The NLRB has acquired jurisdiction over much smaller businesses 
than was ever intended, escalating the expense and workload for 
the NLRB, as well as for business. The cost of such 
intervention for very small business and the taxpayer is 
unbearable. For example, the NLRB has jurisdiction over non-
retail businesses with gross receipts over $50,000, adjusting 
for inflation since 1959 would raise that threshold to 
$302,001. For retail businesses and restaurants, the NLRB has 
jurisdiction over those doing above $500,000 worth of business, 
but adjusting for inflation since 1959 would raise this 
threshold to over $3 million. The committee asks the 
administration to investigate the heavy caseload taken on by 
the NLRB and how the backlog might be reduced through an 
adjustment of the jurisdictional thresholds set in 1959.

                        National Mediation Board

    The bill provides $11,421,000 for the National Mediation 
Board (NMB), $180,000 above the comparable fiscal year 2003 
appropriation and the same as the budget request. The NMB 
mediates labor disputes between employees and railroad and 
airline carriers subject to the Railway Labor Act. The Board 
also resolves representation disputes involving labor 
organizations seeking to represent railroad or airline 
employees.

            Occupational Safety and Health Review Commission

    The bill provides $10,115,000 for the Occupational Safety 
and Health Review Commission, $505,000 above the fiscal year 
2003 level and the same as the budget request. The Commission 
adjudicates contested citations issues by the Occupational 
Safety and Health Administration against employers for 
violations of safety and health standards. The Commission's 
administrative law judges settle and decide cases at the 
initial level of review. The agency's three appointed 
Commissioners also review cases, issue rulings on complicated 
issues, and may direct review of any decision by an 
administrative law judge.

                       Railroad Retirement Board


                         DUAL BENEFITS ACCOUNT

    The bill provides $119,000,000 for dual benefits, a 
decrease of $12,142,000 below the comparable fiscal year 2003 
appropriation and the same as the budget request. These funds 
are used to pay dual benefits to those retirees receiving both 
railroad retirement and social security benefits. The bill 
includes a provision permitting a portion of these funds to be 
derived from income tax receipts on dual benefits as authorized 
by law. The Railroad Retirement Board estimates that 
approximately $8,000,000 may be derived in this manner.

           FEDERAL PAYMENT TO THE RAILROAD RETIREMENT ACCOUNT

    The bill provides $150,000 for the interest earned on 
unnegotiated checks, the same as the budget request and the 
comparable amount provided for fiscal year 2003.

                      LIMITATION ON ADMINISTRATION

    The bill provides a consolidated limitation of $101,300,000 
on the expenditure of railroad retirement and railroad 
unemployment trust funds for administrative expenses of the 
Railroad Retirement Board, an increase of $1,950,000 above the 
comparable fiscal year 2003 appropriation and an increase of 
$1,480,000 above the budget request. The bill includes a 
provision from the fiscal year 1999 Appropriations Act 
prohibiting the transfer of resources formerly identified in a 
Memorandum of Understanding from the RRB to the Inspector 
General.
    The Railroad Retirement Board (RRB) administers 
comprehensive retirement-survivor and unemployment-sickness 
insurance benefit programs for railroad workers and their 
families. This account limits the amount of funds in the 
railroad retirement and railroad unemployment insurance trust 
funds that may be used by the RRB for administrative expenses. 
The Committee 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.
    The Committee is pleased with the management of the Board 
and reiterates its interest in quickly and comprehensively 
implementing the Government Performance and Results Act.

             LIMITATION ON THE OFFICE OF INSPECTOR GENERAL

    The bill provides authority to expend $6,600,000 from the 
railroad retirement and railroad unemployment insurance trust 
funds for the Office of Inspector General, a increase of 
$278,000 above the comparable fiscal year 2003 appropriation 
and the same as the budget request. This account provides 
funding for the Inspector General to conduct and supervise 
audits and investigations of programs and operations of the 
Board.
    The Committee compliments the work of the Office of the 
Inspector General of the Railroad Retirement Board for their 
work in obtaining information on actual collections, offsets, 
and funds put to better use as required in House Report 105-
635. This information is of great use to the Committee and the 
Committee understands the difficulty encountered by the OIG in 
obtaining it. The Committee expects that the Office of 
Inspector General will continue to report the information to 
it.

                     Social Security Administration


                PAYMENTS TO SOCIAL SECURITY TRUST FUNDS

    The Committee provides $21,658,000 for mandatory payments 
necessary to compensate the Old Age and Survivors Insurance 
(OASI) and Disability Insurance (DI) Trust Funds for special 
payments to certain uninsured persons (for which no payroll tax 
is received), costs incurred for administration of pension 
reform activities and interest lost on the value of benefit 
checks issued but not negotiated. This appropriation restores 
the trust funds to the position they would have been in had 
they not borne these costs properly charged to the general 
funds.

                  SUPPLEMENTAL SECURITY INCOME PROGRAM

    The Committee provides $26,221,300,000 for the Supplemental 
Security Income (SSI) program. The Committee also provides 
$12,590,000,000 in advance funding for the first quarter of 
fiscal year 2005.

Beneficiary services

    In addition to Federal benefits, SSA administers a program 
of supplementary State benefits for those States that choose to 
participate. The funds are also used to reimburse the trust 
funds for the administrative costs of the program. The 
Committee provides $100,000,000 for beneficiary services, the 
same as the budget request. This funding reimburses State 
vocational rehabilitation services agencies for successful 
rehabilitation of SSI recipients.

Research and demonstration

    Within the appropriation for SSI, the Committee provides 
$30,000,000 for research and demonstration activities conducted 
under section 1110 of the Social Security Act.

Administration

    Within the appropriation for SSI, the Committee provides 
$2,973,300,000 for payment to the Social Security trust funds 
for the SSI Program's share of SSA's base administrative 
expenses.

                 LIMITATION ON ADMINISTRATIVE EXPENSES

    The bill provides a limitation on administrative expenses 
for the Social Security Administration (SSA) of $8,361,800,000 
to be funded from the Social Security and Medicare trust funds. 
This is $476,663,000 more than the fiscal year 2003 comparable 
level and $168,200,000 less than the budget request.
    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 (CFS) ruling (99-2p). 
The Committee encourages SSA to continue these educational 
efforts, as many SSA employees remain unfamiliar 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, to access 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.
    The Committee is pleased with the initiative SSA has 
started in examining the population with limb loss who could 
return to work with proper prosthetic and orthotics care. The 
Committee encourages the Ticket-to-Work initiative to continue 
to pursue this vital project.

                     Social Security Advisory Board

    The bill provides that not less than $1,800,000 within the 
limitation on administrative expenses shall be available for 
the Social Security Advisory Board, the same as the fiscal year 
2003 level and the budget request.

User fees

    In addition to other amounts provided in the bill, the 
Committee provides an additional limitation of $120,000,000 for 
administrative activities funded from user fees. This is the 
same as the request.

                      OFFICE OF INSPECTOR GENERAL

    The bill provides $88,200,000 for the Office of the 
Inspector General (OIG), $5,740,000 more than the fiscal year 
2003 comparable level and $1,800,000 less than the budget 
request. The bill also provides authority to expend $63,700,000 
from the Social Security trust funds for activities conducted 
by the Inspector General, the same as the budget request.
    Within the funds provided, the OIG is encouraged to use 
this funding to expand several initiatives including the 
cooperative disability investigations team and the fugitive 
felon project. The fugitive felon project is needed to 
identify, apprehend and remove fugitive felons from the Social 
Security roles in accordance with the Welfare Reform Act. 
Evidence suggests that a number of recipients of Social 
Security funds are, in fact, fugitive felons. In addition, it 
is evident that the representative payees need to be examined 
to ensure that they are in fact representing the interests of 
these beneficiaries. This program should be targeted to those 
who represent numerous beneficiaries, and the OIG should ensure 
that the payees are not convicted felons, and that their 
beneficiaries are still alive. In addition, the funds are 
provided for continuing disability reviews and ensuring that 
the benefits being paid to beneficiaries living outside of the 
United States are still valid. These oversight responsibilities 
are very cost effective to the government and often prevent 
overpayments. The Committee urges the OIG to track the actual 
annual savings to the government for each of these activities, 
both amounts recovered, and amounts that were not paid 
erroneously, by year, and to report their findings to the 
Committee.

                    United States Institute of Peace

    The bill provides $17,200,000 for the United States 
Institute of Peace, $944,000 more than the fiscal year 2003 
comparable level and the same as the budget request. The 
Institute was created in 1984 to provide education and 
training, basic and applied research, and information services 
to promote conflict resolution.

                      TITLE V--GENERAL PROVISIONS

    Sec. 501. The Committee continues a provision to allow the 
Secretaries of Labor, Health and Human Services, and Education 
to transfer unexpended balances of prior appropriations to 
accounts corresponding to current appropriations to be used for 
the same purpose and for the same periods of time for which 
they were originally appropriated.
    Sec. 502. The Committee continues a provision to prohibit 
the obligation of funds beyond the current fiscal year unless 
expressly so provided.
    Sec. 503. The Committee continues a provision to prohibit 
appropriated funds to be used to support or defeat legislation 
pending before the Congress or any State legislature, except in 
presentation to the Congress or any State legislature itself.
    Sec. 504. The Committee continues a provision to limit the 
amount available for official reception and representation 
expenses for the Secretaries of Labor and Education, the 
Director of the Federal Mediation and Conciliation Service, and 
the Chairman of the National Mediation Board.
    Sec. 505. The Committee continues a provision to prohibit 
funds to be used to carry out a needle distribution program.
    Sec. 506. The Committee continues a Sense of the Congress 
provision related to buy American-made products.
    Sec. 507. The Committee continues a provision to require 
grantees receiving Federal funds to clearly state the 
percentage of the total cost of the program or project which 
will be financed with Federal money.
    Sec. 508. The Committee continues a provision to prohibit 
appropriated funds to be used for any abortion.
    Sec. 509. The Committee continues a provision to provide 
exceptions for Sec. 508.
    Sec. 510. The Committee continues a provision to prohibit 
the use of funds in the Act concerning research involving human 
embryos. However, this language should not be construed to 
limit federal support for research involving human embryonic 
stem cells listed on an NIH registry and carried out in 
accordance with policy outlined by the President.
    Sec. 511. The Committee continues a provision to prohibit 
the use of funds for any activity that promotes the 
legalization of any drug or substance included in schedule I of 
the schedules of controlled substances.
    Sec. 512. The Committee continues a provision related to 
annual reports to the Secretary of Labor.
    Sec. 513. The Committee continues a provision to prohibit 
the use of funds to promulgate or adopt any final standard 
providing for a unique health identifier until legislation is 
enacted specifically approving the standard.
    Sec. 514. The Committee includes a provision that prohibits 
the transfer of funds from this Act except by authority 
provided in this Act or another appropriation Act.
    Sec. 515. The Committee includes a provision that modifies 
the period of availability for certain funds provided to the 
Department of Education in the fiscal year 2003 appropriations 
bill.
    Sec. 516. The Committee includes a provision to limit funds 
in the bill for public libraries to those libraries that comply 
with the requirements of the Children's Internet Protection 
Act.
    Sec. 517. The Committee includes a provision to limit 
technology funds in the bill for elementary and secondary 
schools to those schools that comply with the requirements of 
the Children's Internet Protection Act.

                        CONSTITUTIONAL AUTHORITY

    Clause 3(d)(1) of rule XIII of the Rules of the House of 
Representatives states that:
    Each report of a committee on a public bill or public joint 
resolution shall contain the following:

          (1) A statement citing the specific powers granted to 
        Congress in the Constitution to enact the law proposed 
        by the bill or joint resolution.

    The Committee on Appropriations bases its authority to 
report this legislation on Clause 7 of Section 9 of Article I 
of the Constitution of the United States of America which 
states:

        No money shall be drawn from the Treasury but in 
        consequence of Appropriations made by law * * *.

    Appropriations contained in this Act are made pursuant to 
this specific power granted by the Constitution.

                   COMPARISON WITH BUDGET RESOLUTION

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

                                            [In millions of dollars]
----------------------------------------------------------------------------------------------------------------
                                                         302(b)allocation                    This bill
                                                 ---------------------------------------------------------------
                                                      Budget                          Budget
                                                     authority        Outlays        authority        Outlays
----------------------------------------------------------------------------------------------------------------
Discretionary...................................         138,036         134,766         138,036         134,765
Mandatory.......................................         318,766         318,694         318,766         317,694
----------------------------------------------------------------------------------------------------------------

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

                         FIVE-YEAR PROJECTIONS

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

                         [In million if dollas]

Budget authorty...............................................   382,748
Outlays:
    2004(a)...................................................   291,140
    2005......................................................    71,452
    2006......................................................    19,932
    2007......................................................     4,113
    2008 and future years.....................................       634

(a) excludes outlays from prior year budget authority.
---------------------------------------------------------------------------

          FINANCIAL ASSISTANCE TO STATE AND LOCAL GOVERNMENTS

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

                        [In millions of dollars]

Budget authority..............................................   191,071
Outlays.......................................................   144,915

                           TRANSFER OF FUNDS

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

                                 APPROPRIATION TRANSFERS RECOMMENDED IN THE BILL
----------------------------------------------------------------------------------------------------------------
                                                                 Account from which transfer is
    Account to which transfer is to be made         Amount                 to be made                 Amount
----------------------------------------------------------------------------------------------------------------
Department of Labor:                                            Department of Labor:
    Special Benefits..........................           (\1\)      Postal Service..............           (\1\)
    Various Agencies \1\......................  ..............    Energy Employees Occupational   ..............
                                                                 Illness Compensation Fund \1\.
    Employment Standards Administration--          $32,004,000    Black Lung Disability Trust        $32,004,000
     Salaries and Expenses.                                      Fund.
    Departmental Management Salaries and            23,401,000    Black Lung Disability Trust         23,401,000
     Expenses.                                                   Fund.
    Office of Inspector General...............         356,000    Black Lung Disability Trust            356,000
                                                                 Fund.
Department of Health and Human Services:
    National Institutes of Health:                               International Assistance
                                                                 Programs:
        National Institute of Allergy and          100,000,000    Global Fund to Fight HIV/AIDS,     100,000,000
         Infectious Diseases.                                    Malaria, and Tuberculosis.
Related Agencies:
    Social Security Administration: Office of       63,700,000  Social Security Administration:       63,700,000
     Inspector General.                                          Limitation on Administrative
                                                                 Expenses.
----------------------------------------------------------------------------------------------------------------
\1\Such sums.

                              RESCISSIONS

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

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

    In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italic, existing law in which no change is 
proposed is shown in roman):

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

    In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (new matter is 
printed in italic and existing law in which no change is 
proposed is shown in roman):

  DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND 
               RELATED AGENCIES APPROPRIATIONS ACT, 2003


(Pub. L. 108-7, div. G)

           *       *       *       *       *       *       *


                   TITLE III--DEPARTMENT OF EDUCATION


                    EDUCATION FOR THE DISADVANTAGED

    For carrying out title I of the Elementary and Secondary 
Education Act of 1965 (``ESEA'') and section 418A of the Higher 
Education Act of 1965, $13,853,400,000, of which 
[$4,651,199,000] $6,895,199,000 shall become available on July 
1, 2003, and shall remain available through September 30, 2004, 
and of which [$9,027,301,000] $6,783,301,000 shall become 
available on October 1, 2003, and shall remain available 
through September 30, 2004, for academic year 2003-2004: 
Provided, That $7,172,971,000 shall be available for basic 
grants under section 1124: Provided further, That up to 
$3,500,000 of these funds shall be available to the Secretary 
of Education on October 1, 2002, to obtain updated educational-
agency-level census poverty data from the Bureau of the Census: 
Provided further, That $1,365,031,000 shall be available for 
concentration grants under section 1124A: Provided further, 
That $1,670,239,000 shall be available for targeted grants 
under section 1125: Provided further, That $1,541,759,000 shall 
be available for education finance incentive grants under 
section 1125A: Provided further, That $235,000,000 shall be 
available for comprehensive school reform grants under part F 
of the ESEA.

           *       *       *       *       *       *       *


                 Changes in Application of Existing Law

    Pursuant to clause 3, rule XIII of the Rules of the House 
of Representatives, the following statements are submitted 
describing the effect of provisions in the accompanying bill 
which may directly or indirectly change the application of 
existing law.
    In some instances the bill includes appropriations for 
certain ongoing programs which are not yet authorized for 
fiscal year 2004.
    The bill provides that appropriations shall remain 
available for more than one year for some programs for which 
the basic authorizing legislation does not presently authorize 
such extended availability.
    In various places in the bill, the Committee has earmarked 
funds within appropriation accounts in order to fund specific 
sections of a law. Whether these actions constitute a change in 
the application of existing law is subject to individual 
interpretation, but the Committee felt that this fact should be 
mentioned.
    In several instances, the bill provides advance 
appropriations for fiscal year 2005 for programs for which such 
advances are not authorized by law.

                      TITLE I--DEPARTMENT OF LABOR


                    Training and Employment Services

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

     State Unemployment Insurance and Employment Service Operations

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

                  Employment Standards Administration


                         SALARIES AND EXPENSES

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

                            SPECIAL BENEFITS

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

             Occupational Safety and Health Administration


                         SALARIES AND EXPENSES

    Language establishing a maximum amount available for grants 
to States under the Occupational Safety and Health Act, which 
grants shall be no less than 50 percent of the costs of State 
programs required to be incurred under plans approved by the 
Secretary under section 18 of the Act.
    Language authorizing the Occupational Safety and Health 
Administration to retain and spend up to $750,000 of training 
institute course tuition fees for training and education 
grants.
    Language allowing the Secretary of Labor to collect and 
retain fees for services provided to Nationally Recognized 
Testing Laboratories.

                 Mine Safety and Health Administration


                         SALARIES AND EXPENSES

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

                        Departmental Management


                         SALARIES AND EXPENSES

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

           TITLE II--DEPARTMENT OF HEALTH AND HUMAN SERVICES


              Health Resources and Services Administration


                     HEALTH RESOURCES AND SERVICES

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

               Centers for Disease Control and Prevention

    Language permitting the Centers for Disease Control and 
Prevention to insure official motor vehicles in foreign 
countries.
    Language providing that collections from user fees may be 
credited to the Centers for Disease Control and Prevention 
appropriation.
    Language making amounts under section 241 of the Public 
Health Service Act available to carry out the National Center 
for Health Statistics surveys.
    Language allowing the Director of the Centers for Disease 
Control and Prevention to redirect certain funds appropriated 
under Public Law 101-502.
    Language permitting the Centers for Disease Control and 
Prevention to proceed with property acquisition, including a 
long-term ground lease for construction on non-federal land, 
for construction of a replacement laboratory.
    Language permitting the Centers for Disease Control and 
Prevention to enter into a single contract or related contracts 
for the full scope of development and construction of 
facilities, subject to available appropriations.

                     National Institutes of Health

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

                      NATIONAL LIBRARY OF MEDICINE

    Language providing that the National Library of Medicine 
may enter into certain personal services contracts.

                         OFFICE OF THE DIRECTOR

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

               Agency for Healthcare Research and Quality

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

               Centers for Medicare and Medicaid Services


                     GRANTS TO STATES FOR MEDICAID

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

                           PROGRAM MANAGEMENT

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

                Administration for Children and Families


  PAYMENTS TO STATES FOR CHILD SUPPORT ENFORCEMENT AND FAMILY SUPPORT 
                                PROGRAMS

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

                      SOCIAL SERVICES BLOCK GRANT

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

                CHILDREN AND FAMILIES SERVICES PROGRAMS

    Language providing that unexpended Community Services Block 
Grant funds may be carried over to the next fiscal year by 
local grantees.

                            POLICY RESEARCH

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

                   TITLE III--DEPARTMENT OF EDUCATION


                     VOCATIONAL AND ADULT EDUCATION

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

                      STUDENT FINANCIAL ASSISTANCE

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

                            HIGHER EDUCATION

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

                           HOWARD UNIVERSITY

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

                       TITLE IV--RELATED AGENCIES


             Corporation for National and Community Service

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

               Federal Mediation and Conciliation Service


                         SALARIES AND EXPENSES

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

                     National Labor Relations Board


                         SALARIES AND EXPENSES

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

                       Railroad Retirement Board


                     DUAL BENEFITS PAYMENTS ACCOUNT

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

                      LIMITATION ON ADMINISTRATION

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

                     Social Security Administration


                 LIMITATION ON ADMINISTRATIVE EXPENSES

    Language providing that unobligated balances at the end of 
fiscal year 2002 shall remain available until expended for the 
agency's information technology and telecommunications hardware 
and software infrastructure, including related equipment and 
non-payroll administrative expenses associated solely with this 
information technology and telecommunications infrastructure; 
language authorizing the use of up to $35,000 for official 
reception and representation expenses; and language providing 
that reimbursement to the trust funds under this heading for 
expenditures for official time for employees of the Social 
Security Administration pursuant to section 7131 of title 5, 
United States Code, and for facilities or support services for 
labor organizations pursuant to policies, regulations, or 
procedures referred to in 7135(b) of such title shall be made 
by the Secretary of the Treasury, with interest, from amounts 
in the general fund not otherwise appropriated, as soon as 
possible after such expenditures are made.
    Language providing that funds may be derived from 
administration fees collected pursuant to 1616(d) of the Social 
Security Act or 212(b)(3) of Public Law 93-66 and that, to the 
extent that the amounts collected pursuant to such sections in 
fiscal year 2004 exceed $120,000,000, the amounts shall be 
available in fiscal year 2005 only to the extent provided in 
advance in appropriations Acts.
    Language providing that unobligated funds at the end of 
fiscal year 2001 previously appropriated to continue Federal-
State partnerships to evaluate a means to promote Medicare buy-
in programs shall remain available.

                      OFFICE OF INSPECTOR GENERAL

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

                           General Provisions

    Sections 102, 201, 202, 203, 204, 205, 206, 207, 208, 209, 
210, 211, 212, 213, 214, 215, 216, 217, 218, 301, 302, 303, 
304, 501, 504, 507, 508, 509, 510, 511, 512, 513 and 514 of the 
bill are general provisions, most of which have been carried in 
previous appropriations acts, which place limitations on the 
use of funds in the bill or authorize or require certain 
activities, and which might, under some circumstances, be 
construed as changing the application of existing law.

              DEFINITION OF PROGRAM, PROJECT, AND ACTIVITY

    During fiscal year 2002 for purposes of the Balanced Budget 
and Emergency Deficit Control Act of 1985 (Public Law 99-177), 
as amended, the following information provides the definition 
of the term ``program, project, and activity'' for departments 
and agencies under the jurisdiction of the Labor, Health and 
Human Services, and Education and Related Agencies 
Subcommittee. The term ``program, project, and activity'' shall 
include the most specific level of budget items identified in 
the Departments of Labor, Health and Human Services, and 
Education, and Related Agencies Appropriations Act, 2002, the 
accompanying House and Senate Committee reports, the conference 
report and accompanying joint explanatory statement of the 
managers of the committee of conference.

         Statement of General Performance Goals and Objectives

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

                  Appropriations Not Authorized by Law

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

                          DEPARTMENT OF LABOR

Employment and Training Administration
        Training and Employment Services

                DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Resources and Services Administration
        Health Resources and Services
        Other HRSA Programs:
                Organ Transplantation
                Rural Hospital Flexibility Grants
                State Offices of Rural Health
                Telehealth
                Universal Newborn Hearing
                Health Professions
                Nursing Workforce Development
                Trauma Care
                Family Planning
Centers for Disease Control
        Birth Defects
        Preventive Health and Health Services Block Grant
                Salaries and Expenses
        Sexually Transmitted Diseases
        Program
                Salaries and Expenses
                Tuberculosis
                Loan Repayment
                CDC Foundation
                Public Health Emergencies
National Institutes of Health research training
Substance Abuse and Mental Health Services Administration
Agency for Healthcare Research and Quality
Research on Health Costs, Quality and Outcomes
Administration for Children and Families
        Head Start
        Developmental Disabilities Program
        Runaway and Homeless Youth Programs
        Maternity Group Homes
        Adoption Incentives
        Community Services Block Grant
        Community Services Discretionary Activities
        National Youth Sports
Administration on Aging
        Alzheimer's Disease Demonstrations
Office of the Secretary
        Adolescent family life (Title XX)

                        DEPARTMENT OF EDUCATION

Special Education:
        Special Education Grants to States
        Preschool Grants
        Grants for Infants and Families
        State Program Improvement Grants
        Research and Innovation
        Technical Assistance and Dissemination
        Personnel Preparation
        Parent Information Centers
        Technology and Media Services
Independent Living State Grants
Independent Living Centers
Independent Living Services for Older Blind
Helen Keller National Center for Deaf/Blind
Strengthening Tribal Colleges
Tribally Controlled Postsecondary Vocational and Technical 
Institutions
Underground Railroad Program

                            RELATED AGENCIES

Corporation for National and Community Service:
        Domestic Volunteer Service Programs, Operating Expenses
Cooperation for Public Broadcasting:
        FY 2006 Regular Appropriation
National Council on Disability
United States Institute of Peace

                          Full Committee Votes

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

    Date: June 25, 2003.
    Measure: Departments of Labor, Health and Human Services, 
and Education, and Related Agencies Appropriations Bill, FY 
2004.
    Motion by: Mr. Obey.
    Description of motion: To substitute the text of the bill 
with new text that would fund various labor, health and human 
services, and education programs above amounts recommended in 
the underlying bill; increases are offset by a reduction to tax 
cuts for certain income groups.
    Results: Rejected 28 yeas to 35 nays.
        Members Voting Yea            Members Voting Nay
Mr. Berry                           Mr. Aderholt
Mr. Bishop                          Mr. Bonilla
Mr. Boyd                            Mr. Crenshaw
Mr. Clyburn                         Mr. Culberson
Mr. Cramer                          Mr. Cunningham
Ms. DeLauro                         Mr. Doolittle
Mr. Edwards                         Mrs. Emerson
Mr. Farr                            Mr. Frelinghuysen
Mr. Fattah                          Mr. Goode
Mr. Hinchey                         Ms. Granger
Mr. Hoyer                           Mr. Hobson
Mr. Jackson                         Mr. Istook
Ms. Kaptur                          Mr. Kingston
Mr. Kennedy                         Mr. Kirk
Ms. Kilpatrick                      Mr. Knollenberg
Mrs. Lowey                          Mr. LaHood
Mr. Mollohan                        Mr. Latham
Mr. Moran                           Mr. Lewis
Mr. Murtha                          Mr. Nethercutt
Mr. Obey                            Mrs. Northup
Mr. Olver                           Mr. Peterson
Mr. Pastor                          Mr. Regula
Mr. Price                           Mr. Rogers
Mr. Rothman                         Mr. Sherwood
Ms. Roybal-Allard                   Mr. Simpson
Mr. Sabo                            Mr. Sweeney
Mr. Serrano                         Mr. Taylor
Mr. Visclosky                       Mr. Tiahrt
                                    Mr. Vitter
                                    Mr. Walsh
                                    Mr. Wamp
                                    Dr. Weldon
                                    Mr. Wicker
                                    Mr. Wolf
                                    Mr. Young
                             ROLLCALL NO. 2

    Date: June 25, 2003.
    Measure: Departments of Labor, Health and Human Services, 
and Education, and Related Agencies Appropriations Bill, FY 
2004.
    Motion by: Mr. Obey.
    Description of motion: To allow for an upward adjustment in 
Federal medical assistance percentage for those States that 
maintain coverage of children under Medicaid and SCHIP; 
increases are offset by a reduction to tax cuts for certain 
income groups.
    Results: Rejected 29 yeas to 35 nays.
        Members Voting Yea            Members Voting Nay
Mr. Berry                           Mr. Aderholt
Mr. Bishop                          Mr. Bonilla
Mr. Boyd                            Mr. Crenshaw
Mr. Clyburn                         Mr. Culberson
Mr. Cramer                          Mr. Cunningham
Ms. DeLauro                         Mr. Doolittle
Mr. Dicks                           Mrs. Emerson
Mr. Edwards                         Mr. Frelinghuysen
Mr. Farr                            Mr. Goode
Mr. Fattah                          Ms. Granger
Mr. Hinchey                         Mr. Hobson
Mr. Hoyer                           Mr. Istook
Mr. Jackson                         Mr. Kingston
Ms. Kaptur                          Mr. Kirk
Mr. Kennedy                         Mr. Knollenberg
Ms. Kilpatrick                      Mr. LaHood
Mrs. Lowey                          Mr. Latham
Mr. Mollohan                        Mr. Lewis
Mr. Moran                           Mr. Nethercutt
Mr. Murtha                          Mrs. Northup
Mr. Obey                            Mr. Peterson
Mr. Olver                           Mr. Regula
Mr. Pastor                          Mr. Rogers
Mr. Price                           Mr. Sherwood
Mr. Rothman                         Mr. Simpson
Ms. Roybal-Allard                   Mr. Sweeney
Mr. Sabo                            Mr. Taylor
Mr. Serrano                         Mr. Tiahrt
Mr. Visclosky                       Mr. Vitter
                                    Mr. Walsh
                                    Mr. Wamp
                                    Dr. Weldon
                                    Mr. Wicker
                                    Mr. Wolf
                                    Mr. Young
                             ROLLCALL NO. 3

    Date: June 25, 2003.
    Measure: Departments of Labor, Health and Human Services, 
and Education, and Related Agencies Appropriations Bill, FY 
2004.
    Motion by: Mr. Obey.
    Description of motion: To add language prohibiting the use 
of funds by the Department of Education to implement or enforce 
certain annual updates in the Federal Needs Analysis 
Methodology to determine a student's expected family 
contribution under part F of title IV of the Higher Education 
Act of 1965.
    Results: Rejected 28 yeas to 32 nays.
        Members Voting Yea            Members Voting Nay
Mr. Berry                           Mr. Aderholt
Mr. Bishop                          Mr. Bonilla
Mr. Boyd                            Mr. Crenshaw
Mr. Clyburn                         Mr. Culberson
Mr. Cramer                          Mr. Cunningham
Ms. DeLauro                         Mr. Doolittle
Mr. Dicks                           Mrs. Emerson
Mr. Edwards                         Mr. Frelinghuysen
Mr. Farr                            Mr. Goode
Mr. Fattah                          Ms. Granger
Mr. Hinchey                         Mr. Hobson
Mr. Hoyer                           Mr. Istook
Mr. Jackson                         Mr. Kingston
Ms. Kaptur                          Mr. Kirk
Mr. Kennedy                         Mr. Knollenberg
Ms. Kilpatrick                      Mr. LaHood
Mrs. Lowey                          Mr. Latham
Mr. Mollohan                        Mr. Lewis
Mr. Moran                           Mr. Nethercutt
Mr. Obey                            Mrs. Northup
Mr. Olver                           Mr. Regula
Mr. Pastor                          Mr. Rogers
Mr. Price                           Mr. Sherwood
Mr. Rothman                         Mr. Simpson
Ms. Roybal-Allard                   Mr. Sweeney
Mr. Sabo                            Mr. Taylor
Mr. Serrano                         Mr. Tiahrt
Mr. Visclosky                       Mr. Walsh
                                    Mr. Wamp
                                    Dr. Weldon
                                    Mr. Wolf
                                    Mr. Young
                             ROLLCALL NO. 4

    Date: June 25, 2003.
    Measure: Departments of Labor, Health and Human Services, 
and Education, and Related Agencies Appropriations Bill, FY 
2004.
    Motion by: Mr. Edwards.
    Description of motion: To add language prohibiting the use 
of funds in the Act from going to any organizations that base 
hiring decisions on a job candidate's religion when using 
federal funds.
    Results: Rejected 27 yeas to 32 nays.
        Members Voting Yea            Members Voting Nay
Mr. Berry                           Mr. Aderholt
Mr. Bishop                          Mr. Bonilla
Mr. Clyburn                         Mr. Crenshaw
Ms. DeLauro                         Mr. Culberson
Mr. Dicks                           Mr. Cunningham
Mr. Edwards                         Mr. Doolittle
Mr. Farr                            Mrs. Emerson
Mr. Fattah                          Mr. Frelinghuysen
Mr. Hinchey                         Mr. Goode
Mr. Hoyer                           Ms. Granger
Mr. Jackson                         Mr. Hobson
Ms. Kaptur                          Mr. Istook
Mr. Kennedy                         Mr. Kingston
Ms. Kilpatrick                      Mr. Knollenberg
Mr. Kirk                            Mr. LaHood
Mrs. Lowey                          Mr. Latham
Mr. Moran                           Mr. Lewis
Mr. Obey                            Mr. Nethercutt
Mr. Olver                           Mrs. Northup
Mr. Pastor                          Mr. Regula
Mr. Price                           Mr. Rogers
Mr. Rothman                         Mr. Simpson
Ms. Roybal-Allard                   Mr. Sweeney
Mr. Sabo                            Mr. Taylor
Mr. Serrano                         Mr. Tiahrt
Mr. Sherwood                        Mr. Vitter
Mr. Visclosky                       Mr. Walsh
                                    Mr. Wamp
                                    Dr. Weldon
                                    Mr. Wicker
                                    Mr. Wolf
                                    Mr. Young
                             ROLLCALL NO. 5

    Date: June 25, 2003.
    Measure: Departments of Labor, Health and Human Services, 
and Education, and Related Agencies Appropriations Bill, FY 
2004.
    Motion by: Mr. Lewis.
    Description of Motion: To report the bill, to authorize the 
Chairman to seek a rule on such terms and conditions as he may 
deem appropriate, and to authorize the Chairman to move that 
the House disagree to the amendments of the Senate and agree to 
the conference requested by the Senate on the bill.
    Results: Adopted 33 yeas to 23 nays.
        Members Voting Yea            Members Voting Nay
Mr. Aderholt                        Mr. Berry
Mr. Bonilla                         Mr. Bishop
Mr. Crenshaw                        Ms. DeLauro
Mr. Culberson                       Mr. Dicks
Mr. Cunningham                      Mr. Edwards
Mr. Doolittle                       Mr. Farr
Mrs. Emerson                        Mr. Hinchey
Mr. Frelinghuysen                   Mr. Hoyer
Mr. Goode                           Mr. Jackson
Ms. Granger                         Ms. Kaptur
Mr. Hobson                          Mr. Kennedy
Mr. Istook                          Ms. Kilpatrick
Mr. Kingston                        Mrs. Lowey
Mr. Kirk                            Mr. Moran
Mr. Knollenberg                     Mr. Obey
Mr. LaHood                          Mr. Olver
Mr. Latham                          Mr. Pastor
Mr. Lewis                           Mr. Price
Mr. Nethercutt                      Mr. Rothman
Mrs. Northup                        Ms. Roybal-Allard
Mr. Regula                          Mr. Sabo
Mr. Rogers                          Mr. Serrano
Mr. Sherwood                        Mr. Visclosky
Mr. Simpson
Mr. Sweeney
Mr. Taylor
Mr. Tiahrt
Mr. Walsh
Mr. Wamp
Dr. Weldon
Mr. Wicker
Mr. Wolf
Mr. Young



                     DISSENTING VIEWS OF DAVID OBEY

    Within the last several months, the Congress has made 
dramatic choices that are already changing the course of 
government and the kind of society in which we live. Only weeks 
ago work was completed on another round of large tax cuts 
targeted at the nation's highest income individuals. Now we are 
considering a variety of appropriation measures, and the impact 
of those tax cuts is becoming apparent in the funding levels 
provided for programs ranging from school improvement to 
homeland security, cancer research and adequate housing for the 
military.
    The bill that accompanies this report is the largest of the 
domestic appropriation measures. It provides the resources 
necessary to improve our local schools, protect our public 
health, ensure the safety of our workforce, provide for our 
elderly and disabled, expand the opportunity for higher 
education and seek cures for the dreaded diseases that threaten 
the health and life of all Americans. Regrettably, the bill 
falls far short of what is needed in each of these areas.
    In order to meet the commitment to lower taxes we are 
abandoning commitments in almost every other area of federal 
responsibility. This bill fails not only to provide the 
resources that my party would support for these activities, it 
also fails to honor the promises made by the Majority party 
only three months ago when they adopted a budget resolution for 
the coming fiscal year. It falls dramatically short of the 
commitments that were made two years ago with the enactment of 
the ``Leave No Child Behind Act.''
    The failure of this legislation is not the fault of the 
Chairman of the Labor, Health and Human Services, and Education 
subcommittee or the Chairman of the Appropriations Committee. 
They fought long and hard to convince their leadership that the 
allocations being provided to the committee were inadequate and 
would result in legislation that would be embarrassing to the 
committee, and to the Congress. They made reasonable decisions 
about allocating the inadequate sum of money they were given to 
work with. There was simply no way to produce an adequate bill 
with the inadequate funds available to them.
    The core of the problem lies with the budgetary policies of 
the Republican Majority that controls the Congress--policies 
that favor repeated rounds of tax cuts, targeted at the highest 
income levels, ahead of all other national priorities.
    While the funds necessary to provide an adequate level of 
services through the programs contained in this bill are 
substantial, they represent only a tiny fraction of the $136 
billion in FY 2004 tax cuts just voted into law by this 
Congress.
    During the Appropriations Committee's consideration of this 
bill, an amendment was offered adding $5.5 billion for the most 
pressing underfunded priorities in education, health and human 
services. The $5.5 billion was fully offset by simply scaling 
back a small portion of the most recent tax cuts. If the 
amendment had been adopted the 200,000 taxpayers with incomes 
of $1 million per year would have received tax cuts of about 
$60,000 a year rather than the $88,000 tax breaks provided by 
the legislation President Bush signed on May 28th. (Attachment 
B provides further details on the substitute.) The substitute 
was defeated on a roll call vote that is published in this 
report.
    The cost of meeting the underfunded priorities in all of 
the appropriation bills pales not only in comparison to the 
revenue that is lost to the Treasury but also to the spending 
which the American people must assume in order to finance these 
tax cuts. Of the $167 billion in government interest payments 
that CBO projects for next year, $23.6 billion is required to 
pay the interest associated with tax cuts enacted since 2001.

                               EDUCATION

    If there were one issue that provided credibility to the 
slogan ``compassionate conservatism'' it was without question 
education. The passage of the ``Leave No Child Behind'' 
legislation resonated with the broadly held view that good 
schools were critical to expanding the economy, improving 
living standards and healing the rifts that divide societies 
between economic, social and racial groups. However, there is 
little that one can find in this bill that could be labeled 
``compassionate.''
    There are a number of ways to gauge just how inadequate 
this bill is.
    One way is to look at the Majority's own promises made in 
its 2004 budget resolution.
    The Majority made a promise in its FY 2004 budget 
resolution to provide a ``$3-billion increase from the previous 
year for the Department of Education.'' Yet the Majority's bill 
provides only a $2.3 billion increase over FY 2003--far less 
than the promise they made.
    The most glaring example of the Majority's broken promises 
to the nation's school children concerns funding for the Title 
1 Program. There is little disagreement within the education 
community that our schools with large enrollments of low-income 
children schools have the greatest challenges in meeting the No 
Child Left Behind Act's accountability and academic mandates. 
These schools enroll students with the greatest academic 
deficits, but they have the least experienced teachers, less 
competitive teacher salaries, higher teacher turnover, less 
rigorous curriculum, and less than their fair share of 
resources--all factors with a negative correlation with student 
achievement.
    For the Title 1 program, the Majority's FY 2004 budget 
resolution promised a $1 billion increase over last year. That 
was the way the Majority was able to get the votes from the 
Republican moderates. However, instead of sticking to their 
promise, the Majority stuck to the President's budget, which 
provides only a $666 million increase. The result of the 
Committee's action is that this bill falls $334 million short 
of the Majority's own promise.
    For special education, again to appease the moderate 
Republicans, the Majority promised in the FY 2004 budget 
resolution to provide $2.2 billion over the current level. This 
promise was repeated in H.R. 1350--the bill reauthorizing the 
Individuals with Disabilities Act, adopted on April 30th on the 
House floor. Indeed, the Republican floor managers of H.R. 1350 
made a point of highlighting the promised money for IDEA. 
Subcommittee Chairman Castle commented,

          H.R. 1350 authorizes dramatic increase in funding for 
        special education, creates a clear path to attain full 
        funding of the Federal Government's 40 percent goal 
        within 7 years * * * In this year's budget resolution, 
        that funding number will take us up to 21 percent. The 
        President of the United States has indicated his 
        complete willingness to fund this in rapid increases to 
        get us to that 40 percent in a 7-year glidepath. This 
        Congress, in the form of the Committee on 
        Appropriations, has indicated doing it the same way. 
        This is all under the discretionary spending * * *

    Chairman Boehner commented:

          And the budget resolution that we passed just several 
        weeks ago brings an increase this year of over $2 
        billion and authorizes an additional $2.5 billion next 
        year.

    Instead, because the Majority's top priority is tax cuts, 
this bill falls $1.2 billion short of that promise. It took 
just seven weeks for the Republican Majority to conclude that 
its gargantuan tax cuts were more important than sticking to 
its promise on special education. The funding shortfall in the 
Majority's bill will force schools to continue to absorb the 
extraordinary costs of providing special education for nearly 
6.7 million school children and, consequently, to reduce other 
education programs or raise local taxes to offset the 
shortfall.
    There is a second way to look at what happens in 
education--the No Child Left Behind Act. The President's 
philosophy was that we would provide additional funding when 
education programs were reformed. Congress reformed the 
programs. It added a slew of new Federal mandates for states 
and school districts. The NCLB act set up a schedule for new 
Federal resources that would put more Federal money in the 
hands of local educators to pay for the mandates of the new 
law, especially the rigorous requirement that every student 
become academically proficient. But, because the Majority put 
tax cut wishes ahead of education promises, the Committee bill 
falls a stunning $8 billion short of the FY 2004 funding 
targets in the No Child Left Behind Act.
    On higher education, because of the economic mismanagement 
over the past two years, all but about eight States are in a 
budget crisis. A worsening State fiscal crisis has forced 
States to make huge cuts in the budgets of public colleges and 
universities. That crisis is crushing working families who want 
to send their kids to college. College tuition costs increased 
by about ten percent last year at four-year public 
institutions, and additional tuition increases have been 
announced for this fall. For example:
         In-State undergraduates in Georgia will pay 15 
        percent more at the State's research universities, 10 
        percent more at other four-year colleges and 
        universities, and 5 percent more at two-year colleges 
        this fall;
         Several Kentucky colleges have announced 
        tuition increases for 2003-04; community colleges will 
        raise tuition by 23 percent, and increases for Kentucky 
        universities range from 9 percent to 16 percent for in-
        State undergraduates;
         The University of Missouri System voted in May 
        to raise tuition by nearly 20 percent to accommodate a 
        State budget cut; and
           The State University of New York voted on June 29th 
        to raise tuition this fall by 28 percent for in-State 
        undergraduates, the first time the system has increased 
        the rate since 1995, in order to absorb State budget 
        cuts.
    Meanwhile, Pell Grant applications continue to swell at 
four to five times the historical rate as record numbers of 
high school graduates seek a college education, and as 
unemployed individuals and other non-traditional students 
pursue advanced training.
    At the same time that more Americans struggle to finance a 
college education, the returns from a higher education have 
never been greater. A college graduate can expect to earn 80 
percent more than a high school graduate, or $1 million over 
the course of a lifetime, paving the way toward a higher 
quality of life.
    The Majority, however, has decided to given token help to 
States and no help at all to families with college students. 
The Majority's bill freezes the maximum Pell Grant award at the 
current level of $4,050. When the program was started in 1975, 
Pell Grants paid about 84 percent of college costs at a four-
year public university. How much progress have we made? Under 
the Majority'sbill, the share of four-year public college 
expenses paid by Pell Grants will drop to 38 percent or lower.

                              HEALTH CARE

    Health care is another area in which the Majority's bill 
falls short of meeting urgent national needs.
    To properly judge the bill's impact, we need to consider 
the context in which it comes. This context includes the 
economic recession and high unemployment, which is causing 
people to lose their job-based health coverage. The context 
also includes a second effect of the recession: the severe 
fiscal crisis now facing State governments. That fiscal crisis 
is leading many States to cut back on eligibility and benefits 
under health care programs like Medicaid and the State Child 
Health Insurance Program (SCHIP), as well as on public health 
protection. Programs funded by the Labor, Health and Human 
Services, and Education appropriations bill help provide a 
crucial health care safety net for people without other access 
to care, and also help States and localities provide basic 
public health services.

                   HEALTH SERVICES AND PUBLIC HEALTH

    Yet despite the obviously growing need, the Majority's bill 
provides few additional resources for health programs. It has 
essentially no increase for the Maternal and Child Health Block 
Grant and no increase at all for the National Health Service 
Corps (which provides student loan repayment aid and 
scholarships for doctors and dentists who work in areas with a 
shortage of health providers)--even though the Administration 
requested additional funds for both programs. In fact, the only 
health care safety net program that receives any real funding 
growth under the Majority's bill is grants for Community Health 
Centers, which gets the 8 percent increase proposed by the 
President. That would be the smallest percentage increase in 
this program since 1998 and not enough to both fund the 
President's expansion initiative and give on-going health 
centers an increase to help offset their rising costs.
    The Committee bill also provides no increase at all for 
childhood immunization grants. That program has had trouble 
keeping up with the rising cost of vaccinating children, and 
the bill will lead to further shortfalls. Further, while the 
Administration asked for $100 million to help us get better 
prepared to deal with an influenza pandemic, the bill provides 
only half of that request. For the Ryan White AIDS Care 
programs, the bill actually cuts funding for most components 
(other than AIDS drug assistance) below the current year level.

                            MEDICAL RESEARCH

    Life expectancy in this country has risen steadily for 
several generations. A significant portion of that increase is 
attributable to the effectiveness with which medical science 
can now cope with a long list of dreaded diseases.
    During the past 35 years the chances that an individual 
American will die of cardiovascular disease or stroke has 
dropped by more than 60 percent. In only the past eight years, 
the death rate for AIDS victims has dropped by 70 percent. Some 
dreaded diseases such as Haemophilius influenzae, a childhood 
disease that was a major cause of acquired mental retardation, 
have been virtually eradicated.
    Even with the most difficult of medical challenges, there 
has been significant progress. In 1975, one's chances of 
surviving for five years after being diagnosed with cancer were 
less than even. By 1993, they were better than 60 percent and, 
although we don't at this point know what the survival rates 
will be for those diagnosed with cancer this year, we are 
confident that they have improved markedly since 1993.
    Because of the remarkable success of the human genome 
project, the prospects of rapid and dramatic progress against 
these diseases has never looked brighter. That is what makes 
the funding levels contained in this bill for the National 
Institutes of Health so remarkable. The bill provides an 
increase of only 2.5 percent above the amount appropriated last 
year. That is the smallest increase in 18 years. It is about 
three quarters the amount needed simply to cover the Department 
of Health and Human Services own estimates of inflation in 
biomedical research, and it will result in a reduction in the 
number of new grants for research on cancer, ALS, Alzheimer's, 
heart disease, multiple sclerosis, muscular dystrophy, 
Parkinson Disease and most other diseases if the support 
provided to researchers takes inflation into account.
    Each year, 1.3 million people find out that they have 
cancer; more than one million people find out that they have 
diabetes; and 60,000 people find out that they have Parkinson's 
disease. The Majority's bill slams on the brakes for efforts to 
find cures for these and other diseases.

                      NURSE EDUCATION AND TRAINING

    Another health problem we hear a lot about is the growing 
shortage of nurses. Last year, with much fanfare, Congress 
passed major new authorizing legislation, the Nurse 
Reinvestment Act, to help deal with that shortage. yet the 
Majority's bill provides no increase at all in funding for 
those programs. It actually contains $7 million less than the 
President requested for one of the programs, which provides 
scholarships to nursing students who agree to work after 
graduation in areas with a serious shortage of nurses.

                   OTHER HEALTH PROFESSIONS TRAINING

    The Majority's bill also makes cuts averaging 12 percent 
(below FY 2003) in programs that help students from minority 
and disadvantaged backgrounds prepare for and do well in 
medical school and other health professions schools--despite 
these programs' demonstrated record in training health care 
providers who will practice in medically underserved areas. 
Similarly, it cuts programs to assist training of primary care 
doctors and dentists 14 percent below the FY 2003 level.

             FAILURE TO HELP THE VICTIMS OF A WEAK ECONOMY

    Since the beginning of 2001, the United States has lost 2.4 
million jobs. The number of Americans actively seeking work and 
unable to find it has climbed to more than 9 million. There has 
been a dramatic increase in the number of unemployed who head 
households and whose earnings are necessary to support 
families. Another 30,000 jobs were lost in the most recent 
month and the percentage of the workforce without jobs is now 
6.4 percent, the highest in nine years. Last year, the poverty 
rate and the number of poor people living in this country 
increased. This bill does nothing to reduce the misery that the 
poor performance of this economy has inflicted on millions of 
workers and their children.
    There is not a single safety net program contained in this 
bill that is funded at a level above that provided last year, 
meaning that the growing numbers of Americans who are jobless 
and impoverished will be served by programs that have less 
resources after allowing for inflation than they had last year. 
Many programs are actually cut below last years level in 
nominal terms. For instance, the bill cuts the Community 
Services Block Grant (CSBG) by $151 million, or 23 percent. 
CSBG funds a nationwide network of anti-poverty Community 
Action Agencies which provides a range of services to a quarter 
of all people living in the United States. These include 
community and economic development, energy assistance, 
winterization, housing, homeless assistance, nutrition, soup 
kitchens, child care, senior service, transportation, and other 
programs that help families escape and remain out of poverty. 
If this cut remains in this bill, it will have an immediate 
impact on almost every single Congressional district, reducing 
services for the growing numbers of low-income, working poor 
and the long-term unemployed.
    The bill would provide $2.1 billion for the Child Care and 
Development Block Grant program the same level of funding as 
was available in FY 2002 and FY 2003.

                                 LIHEAP

    One of the single most glaring deficiencies in this bill is 
the funding level it provides for the Low Income Home Energy 
Assistance Program or LIHEAP. During the current fiscal year $2 
billion will be spent to make sure that elderly, disabled and 
impoverished Americans are not placed in life threatening 
situations as a result of having their utilities shut off in 
the midst of severe weather conditions. The President requested 
that the same amount be made available for the current year. 
The Committee has chosen to cut the request by 10 percent. This 
is in the face of protections that natural gas prices will be 
at least 50 percent of LIHEAP recipients rely on natural gas.

                       ASSISTANCE TO THE ELDERLY

    During the first half of this decade the number of elderly 
(over 60) Americans will increase by 13 million or nearly 30 
percent. The federal government has made a very substantial 
commitment over the course of the past 50 years to permit the 
nation's senior citizens to live independent and dignified 
lives. An essential part of that effort has been the Meals on 
Wheels, Congregate Meals, Family Caregivers and other programs 
in the Administration on Aging. As the elderly population 
grows, the resources needed to support these efforts must also 
grow or the percentage of the elderly permitted to participate 
must be cut back.
    The funding provided in this bill will force a cutback in 
services even without making allowance for the growth in the 
elderly population. The $1.377 billion contained in the bill is 
essentially no increase above the current year's level. That 
means that inflation will force a cut in services of about 2.5 
to 3 percent. Meals on Wheels, which was funded at $181 million 
last year is funded at the same amount this year. Instead of 
providing homebound elderly nationwide with 183,000,000 meals 
as we are during the current year, the bill will force a cut in 
the number of meals that can be delivered of about 4.6 million. 
There will be a cut in the number of congregate meals of about 
2.9 million.
    This is not only unconscionable in terms of the treatment 
of our elderly, it is also stupid budget policy. The purpose of 
these programs is to help seniors remain independent and in 
their own homes as long as possible. Reducing this relatively 
inexpensive support will certainly increase the number of 
seniors forced to leave their homes and move into nursing 
facilities. The federal government will end up paying a 
substantial portion of that far more expensive option.

           LEVELING THE PLAYING FIELD WITH LOW WAGE COUNTRIES

    One reason for the anemic job picture in the United States 
has been the movement of both manufacturing and service jobs 
overseas. The major effort that this government has made to 
attempt to make free trade also be fair trade has been to 
develop international labor standards that pressure foreign 
producers to meet minimum requirements in the treatment of 
their workers. The unregulated use of child labor, the absence 
of minimum standards for health and safety, and the inability 
of workers in many developing countries to organize create 
conditions that permit the kind of exploitation that this 
country began addressing at beginning of the last century. In 
addition, these conditions provide even greater incentives to 
international corporations to move jobs overseas.
    This bill follows President Bush's proposal to terminate 
the International Labor Affairs Bureau within the U.S. 
Department of Labor and cease all participation in the 
development of international standards on child labor, 
workplace safety or other issues involving minimum worker 
standards in developing countries.

            ENDORSING THE SOCIAL SECURITY DISABILITY BACKLOG

    The Majority's bill also provides $170 million less than 
the President requested for the administrative expenses of the 
Social Security Administration.
    The Social Security Administration is facing growing 
backlogs of work, especially involving disability benefits. The 
backlog of pending disability claims has grown every year since 
FY 1997--from 399,000 cases awaiting decision that year to 
593,000 cases in FY 2002. The average time to make an initial 
decision is now about 3\1/2\ months. Those who appeal an 
initial denial of benefits now face a waiting period for a 
hearing and decision that averages just short of a full year. 
These delays affect people who, because of sickness or injury, 
are often in urgent need of the benefits to which they may be 
entitled.
    The Social Security Administration is trying to reduce 
these backlogs and make the process work better. They asked for 
appropriations to hire 1,000 more staff and to increase funds 
for the state agencies that make initial disability 
determinations. The Committee bill cuts that requested by $170 
million.

                         DEMOCRATIC AMENDMENTS

    The Democratic members of the Appropriations Committee 
supported three separate amendments in an attempt to improve 
this legislation.
     The first Democratic amendment--a complete 
substitute to the Committee bill--would have added $5.55 
billion to the Majority's bill, in order to meet our highest 
priorities in education, health, human services, and employment 
and training. These additions would have been offset by a 32 
percent reduction in the tax cut that will be received by 
people with incomes above $1 million as a result of the 
recently enacted tax bill. It would have had no effect 
whatsoever on tax cuts for anyone with income below $1 million. 
The Majority voted against this amendment and it failed by a 
vote of 28 to 35.
     The second Democratic amendment would have 
addressed a growing child health crisis by providing some 
additional federal assistance to state Medicaid programs--a 
further one percentage point increase in the federal matching 
rate during FY 2004. In order to receive this additional aid, 
the Democratic amendment would have required states to refrain 
from any further cutbacks in eligibility for children--under 
both the Medicaid and SCHIP progarms--and to restore 
eligibility for children to the rules that prevailed on July 1, 
2001. Thus, the higher matching rate would have been available 
to states that have not reduced eligibility for children during 
the past two years, and to states that did reduce eligibility 
but that restored the cuts. The Majority voted against this 
amendment and it failed by a vote of 29 to 35.
     The third Democratic amendment would have 
prevented the Bush Administration from shifting more college 
expenses on to students and their parents. After taking 
millionaires off the tax rolls, the Bush Administration quietly 
issued a new regulation on May 30, 2003 to collect more from 
college students and their families by cutting their deduction 
for state and local taxes in the student financial aid 
eligibility formula. As a result, many of these families can 
expect to pay more toward college expenses next year and 
receive less in federal financial aid. The Majority voted 
against the Democratic amendment and it was defeated by a vote 
of 28 to 32.

                                                         Dave Obey.
    [Attachments follow:]
    
    

               ADDITIONAL DISSENTING VIEWS OF DAVID OBEY

    In addition to under-funding high-priority education, 
health, and human services programs, the bill fails to take 
advantage of an opportunity to address another urgent need--the 
need to restore health coverage to hundreds of thousands of 
children and others who have lost access to health care because 
of state budget cuts.
    During the Committee's consideration of this bill, I 
offered an amendment that would have restored Medicaid and 
SCHIP coverage to children who have been removed from those 
programs over the past two years. Regrettably, that amendment 
was defeated, on a roll call vote that is published in this 
report.

                              THE PROBLEM

    At the same time that high unemployment is causing many 
Americans to lost their job-related health coverage, the state 
fiscal crisis is leading states to cut back health coverage 
through Medicaid, SCHIP (the State Child Health Insurance 
Program) and various state-financed programs.
    According to surveys by the Kaiser Commission on Medicaid 
and the Uninsured, 49 of the 50 states had implemented--or were 
planning to implement--cutbacks in Medicaid during fiscal year 
2003. These included reductions in eligibility (27 states), 
reductions in benefits (25 states), more stringent cost 
controls on prescription drug coverage (45 states), increased 
beneficiary co-payments (17 states), and reductions or freezes 
in provider payments (37 states).
    In March, the Center on Budget and Policy Priorities 
reported that budget reductions adopted or proposed in 22 
states would lead to the elimination of health coverage for 1.7 
million people, if all the proposals were adopted, others have 
been modified or rejected, and additional cutbacks have been 
proposed as states continue to struggle with large budget 
deficits.
    These cuts involve all categories of beneficiaries--
parents, disabled people, people who qualify for Medicaid 
because of high medical costs, and so on. A number of the cuts 
involve children.
    As part of the recently enacted tax bill, Congress did 
provide some relief to states, including a temporary increase 
in the federal matching rate for Medicaid. That measure, 
however, did very little to require states to restore benefits. 
The only condition placed on the higher federal Medicaid match 
was that states not further restrict eligibility after 
September 2, 2003. In other words, to qualify for the 
additional federal assistance, states do not need to put anyone 
back on the Medicaid rolls and they have until this coming 
September to enact further eligibility cutbacks. They just have 
to stop reducing eligibility after September 2--at least until 
the temporary higher matching rate expires in June 2004.

                             THE AMENDMENT

    The amendment that I offered during the Committee markup 
provides some additional federal assistance to state Medicaid 
programs--a further one percentage point increase in the 
federal matching rate during fiscal year 2004. (With the tax 
bill's increase in place, the matching rate now ranges from 
about 53 percent to about 80 percent, and averages about 60 
percent). The Obey amendment's additional assistance would 
amount to a bit less than $3 billion during FY 2004.
    However, in order to receive this additional aid, the 
amendment requires states to refrain from any further cutbacks 
in eligibility for children--under both the Medicaid and SCHIP 
programs--and to restore eligibility for children to the rules 
that prevailed on July 1, 2001. Thus, the higher matching rate 
would be available to states that have not reduced eligibility 
for children during the past two years, and to states that did 
reduce eligibility but that restore the cuts.
    It is certainly hoped that the state fiscal assistance 
enacted last month--plus the additional help proposed by this 
amendment--would make it possible for states to restore 
coverage to all categories of beneficiaries who have lost 
eligibility as a result of the fiscal crisis. However, the 
amendment insists that states restore coverage at least for 
children as a condition of the further aid.
    The cost of the amendment would be offset by a modest 
reduction in the benefits that the highest-income taxpayers 
receive under the 2003 tax bill--specifically, the tax cuts 
would be reduced by 18 percent for taxpayers with incomes above 
$1 million. This group receives tax cuts averaging $88,000 
under the legislation enacted last month; my amendment would 
reduce their average tax cut to $72,000. No one with income 
below $1 million per year would have their tax cut changed in 
any way by the amendment.

                                                         Dave Obey.

                                
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