    [House Report 109-143]
    [From the U.S. Government Publishing Office]

    109th Congress                                                   Report
                            HOUSE OF REPRESENTATIVES
     1st Session                                                    109-143

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

      DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND
                   RELATED AGENCIES APPROPRIATION BILL, 2006

                                    _______

     June 21, 2005.--Committed to the Committee of the Whole House on the
                  State of the Union and ordered to be printed

                                    _______

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

                                  R E P O R T

                                 together with

                                 MINORITY VIEWS

                            [To accompany H.R. 3010]

        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, the Agency
    for Toxic Substances and Disease Registry and the Indian Health
    Service), and Education, Committee for Purchase from People Who
    are Blind or Severely Disabled, Corporation for National and
    Community Service, Corporation for Public Broadcasting, Federal
    Mediation and Conciliation Service, Federal Mine Safety and
    Health Review Commission, Institute of Museum and Library
    Services, Medicare Payment Advisory Commission, National
    Commission on Libraries and Information Science, National
    Council on Disability, National Labor Relations Board, National
    Mediation Board, Occupational Safety and Health Review
    Commission, Railroad Retirement Board, and the Social Security
    Administration for the fiscal year ending September 30, 2006,
    and for other purposes.

                            INDEX TO BILL AND REPORT

    _______________________________________________________________________

                                                                Page number

                                                                Bill Report
    Title I--Department of Labor:
            Employment and Training Administration.............     2
                                                                          5
            Employee Benefits Security Administration..........    10
                                                                         12
            Pension Benefit Guaranty Corporation...............    10
                                                                         13
            Employment Standards Administration................    11
                                                                         13
            Occupational Safety and Health Administration......    16
                                                                         14
            Mine Safety and Health Administration..............    19
                                                                         15
            Bureau of Labor Statistics.........................    20
                                                                         16
            Office of Disability Employment Policy.............    21
                                                                         16
            Departmental Management............................    21
                                                                         16
            Veterans Employment and Training...................    22
                                                                         18
            Office of the Inspector General....................    22
                                                                         18
            General Provisions.................................    23
                                                                         18
    Title II--Department of Health and Human Services:
            Health Resources and Services Administration.......    25
                                                                         19
            Centers for Disease Control and Prevention.........    28
                                                                         35
            National Institutes of Health......................    31
                                                                         55
            Substance Abuse and Mental Health Services
                Administration.................................    39
                                                                        113
            Agency for Healthcare Research and Quality.........    40
                                                                        119
            Centers for Medicare and Medicaid Services.........    40
                                                                        121
            Administration for Children and Families...........    44
                                                                        125
            Administration on Aging............................    52
                                                                        139
            Office of the Secretary............................    52
                                                                        141
            General Provisions.................................    56
                                                                        150
    Title III--Department of Education:
            Education for the Disadvantaged....................    65
                                                                        152
            Impact Aid.........................................    66
                                                                        157
            School Improvement Programs........................    67
                                                                        158
            Indian Education...................................    68
                                                                        162
            Innovation and Improvement.........................    68
                                                                        163
            Safe Schools and Citizenship Education.............    69
                                                                        167
            English Language Acquisition.......................    70
                                                                        168
            Special Education..................................    70
                                                                        169
            Rehabilitation Services and Disability Research....    71
                                                                        171
            Special Institutions for Persons with Disabilities.    72
                                                                        174
            Vocational and Adult Education.....................    73
                                                                        175
            Student Financial Assistance.......................    75
                                                                        178
            Student Aid Administration.........................    75
                                                                        179
            Higher Education...................................    75
                                                                        180
            Howard University..................................    77
                                                                        185
            College Housing and Academic Facilities Loans......    77
                                                                        186
            Historically Black College and University Capital
                Financing......................................    77
                                                                        186
            Institute of Education Sciences....................    78
                                                                        186
            Departmental Management............................    78
                                                                        188
            Office for Civil Rights............................    78
                                                                        190
            Office of the Inspector General....................    78
                                                                        190
            General Provisions.................................    79
                                                                        190
    Title IV--Related Agencies:
            Committee for Purchase from People Who Are Blind or
                Severely Disabled..............................    81
                                                                        191
            Corporation for National and Community Service.....    81
                                                                        191
            Corporation for Public Broadcasting................    88
                                                                        194
            Federal Mediation and Conciliation Service.........    89
                                                                        194
            Federal Mine Safety and Health Review Commission...    90
                                                                        194
            Institute of Museum and Library Services...........    91
                                                                        194
            Medicare Payment Advisory Commission...............    91
                                                                        195
            National Commission on Libraries and Information
                Science........................................    91
                                                                        195
            National Council on Disability.....................    91
                                                                        195
            National Labor Relations Board.....................    92
                                                                        196
            National Mediation Board...........................    92
                                                                        196
            Occupational Safety and Health Review Commission...    93
                                                                        196
            Railroad Retirement Board..........................    93
                                                                        197
            Social Security Administration.....................    95
                                                                        198
    Title V--General Provisions:
    House of Representatives Report Requirements

                    Summary of Estimates and Appropriations

        The following table compares on a summary basis the
    appropriations including trust funds for fiscal year 2005, the
    budget estimate for fiscal year 2006 and the Committee
    recommendation for fiscal year 2006 in the accompanying bill.

                                     2006 LABOR, HHS, EDUCATION APPROPRIATIONS BILL
                                                [In millions of dollars]
    ----------------------------------------------------------------------------------------------------------------
                                                                 Fiscal year--              2006 committee  compared
                                                    ---------------------------------------           to--
                                                                                           -------------------------
                                                         2005     2006 budget      2006         2005
                                                      comparable                committee    comparable  2006 budget
    ----------------------------------------------------------------------------------------------------------------
    Department of Labor............................      $15,309      $14,756      $14,808        -$501         +$52
        Advances...................................        2,544        2,512        2,537           -7          +25
    Department of Health and Human Services........      373,872      474,273      474,824     +100,952         +551
        Advances...................................       68,101       67,103       67,114         -987          +11
    Department of Education........................       59,213       58,939       63,715       +4,502       +4,776
        Advances...................................       15,022       15,022       15,022            0            0
    Related Agencies...............................       49,256       49,194       49,066         -190         -128
        Advances...................................       11,330       11,110       11,510         +180         +400
    Grand Total, current year......................      497,650      597,162      602,413     +104,763       +5,251
        Advances...................................       96,997       95,747       96,183         -814         +436
    Current year total using 302(b) scorekeeping...      496,900      596,798      601,942     +105,042       +5,144
        Mandatory..................................      354,222      455,208      459,428     +105,206       +4,220
        Discretionary..............................      142,678      141,590      142,514         -164         +924
    ----------------------------------------------------------------------------------------------------------------

                                               PROGRAM LEVEL DISCRETIONARY
                                                [In millions of dollars]
    ----------------------------------------------------------------------------------------------------------------
                                                                 Fiscal year--               2006 committee compared
                                                    ---------------------------------------           to--
                                                                                           -------------------------
                                                         2005     2006 budget      2006         2005
                                                      comparable                committee    comparable  2006 budget
    ----------------------------------------------------------------------------------------------------------------
    Department of Labor............................      $12,055      $11,586      $11,662        -$393          $76
    Department of Health and Human Services........       63,782       62,507       63,149         -633          642
    Department of Education........................       56,577       56,219       56,695          118          476
    Related Agencies...............................       11,046       11,608       11,479          433         -129
                                                    ----------------------------------------------------------------
          Subtotal Program Level...................      143,460      141,920      142,985         -475        1,065
    ----------------------------------------------------------------------------------------------------------------

                          General Summary of the Bill

        Funding levels in the fiscal year 2006 appropriation bill
    for the Departments of Health and Human Services, and Education
    and Related Agencies reflect the Committee's attempt to
    establish priorities within the very stringent limitations. As
    in past years, the Committee has increased funding for programs
    that work for people and represent a core Federal
    responsibility.
        Bill total.--Total funding, including offsets, for fiscal
    year 2006 in the Departments of Health, and Human Services and
    Education and Related Agencies Appropriations Act, 2006 is
    $601,942,078,000.
        Discretionary Programs.--For Discretionary accounts for
    2006 the bill provides $142,514,000,000, including offsets.
    This is $164,093,000 below the fiscal year 2005 comparable
    level. After adjusting for fluctuations in advance
    appropriations, the comparable program level decrease is
    $474,597,000.
        Mandatory programs.--The bill provides $459,428,078,000 for
    entitlement programs in fiscal year 2006. This is
    $105,206,218,000 above the fiscal year 2005 comparable level,
    or an increase of 29.7 percent. Over three quarters 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 2005
    and 2006 and the growth in these programs.

                                                        MANDATORY
                                                 [Dollars in thousands]
    ----------------------------------------------------------------------------------------------------------------
                                                                        Fiscal year     Fiscal year
                                 Program                                   2005            2006           Change
    ----------------------------------------------------------------------------------------------------------------
    Department of Labor:
        Federal Unemployment Benefits and Allowances................      $1,057,300        $966,400        -$90.900
        Advances to the UI and other trust funds....................         517,000         465,000         -52,000
        Special Benefits............................................         233,000         237,000          +4,000
        Special Benefits for Disabled Coal Miners...................         257,997         232,250         -25,747
        Energy Employees Occupational Illness Compensation Fund.....          40,321          96,081         +55,760
        Black Lung Disability Trust Fund............................       1,061,969       1,068,000          +6,031
    Department of Health and Human Services:
        Vaccine Injury Compensation Trust Fund......................          66,000          70,884          +4,884
        Medicaid current law benefits...............................     171,407,893     204,166,276     +32,758,383
        Medicaid State and local administration.....................       9,318,602       9,803,100        +484,498
        CMS Vaccines for Children...................................       1,468,799       1,502,333         +33,534
        Medicare Payments to Healthcare Trust Funds.................     114,608,900     177,742,200     +63,133,300
        Welfare Payments............................................          24,000          34,300         +10,300
        Child Support Enforcement...................................       4,066,465       4,185,816        +119,351
        Social Services Block Grant.................................       1,700,000       1,700,000               0
        Promoting Safe and Stable Families..........................         305,000         305,000               0
        Payments to States for Foster Care and Adoption.............       5,037,900       4,852,800        -185,100
        Medical Benefits for Commissioned Officers..................         330,636         328,552          -2,084
    Department of Education:
        Vocational Rehabilitation...................................       2,635,845       2,720,192         +84,347
        Pell Grant Shortfall Payoff.................................               0       4,300,000      +4,300,000
    Related Agencies:
        Payments to Social Security Trust Funds.....................          20,454          20,470             +16
        Supplemental Security Income................................      38,189,929      37,566,174        -623,755
    ----------------------------------------------------------------------------------------------------------------

                               Effect Statements

        The Committee directs the Departments of Labor, Health and
    Human Services, Education and the Corporation for National and
    Community Service, and the Social Security Administration to
    provide it with effect statements within 45 days of enactment
    of this Act.

                          TITLE I--DEPARTMENT OF LABOR

                     Employment and Training Administration

                        TRAINING AND EMPLOYMENT SERVICES

                             (INCLUDING RESCISSION)

        The Committee recommends $5,121,792,000 for this account,
    which provides funding authorized primarily by the Workforce
    Investment Act of 1998 (WIA). This is $215,980,000 below the
    fiscal year 2005 level and $66,279,000 below the budget
    request.
        The Training and Employment Services account is comprised
    of programs that enhance the employment and earnings of those
    in need of such services, operated through a decentralized
    system of skill training and related services. The account is
    mostly forward-funded on a July to June cycle, with funds
    provided for fiscal year 2006 supporting the effort from July
    1, 2006 through June 30, 2007.
        The Committee directs that Department take no action in
    fiscal year 2006 to amend, through regulatory or other
    administrative action, the definition established in 20 CFR
    667.220 for functions and activities under title I of the
    Workforce Investment Act until such time as legislation
    reauthorizing the Act is enacted.

    Adult employment and training activities

        For adult employment and training activities, the Committee
    recommends $865,736,000. This is $30,882,000 below the fiscal
    year 2005 level and the same as the budget request. Of the
    amount recommended $712,000,000 will become available on
    October 1, 2006. 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 $1,405,264,000. This is $70,800,000
    below the fiscal year 2005 level and $61,680,000 above the
    budget request. Of the amount recommended, $1,060,000,000 will
    become available on October 1, 2006. Of the total,
    $1,193,264,000 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 $212,000,000 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.
        The Committee recommendation includes, as it has in past
    years, funding for disclocated worker projects aimed at
    assisting the long-term unemployed.
        The Committee requested that the Department submit its
    report on pilot and demonstration grants as required by the
    Workforce Investment Act by March 31, 2005. The Committee
    expects this report from the Department immediately.

    Youth activities

        For youth activities, the Committee recommends
    $950,000,000. This is $36,288,000 below the fiscal year 2005
    level and the same as the budget request.
        The Workforce Investment Act of 1998 consolidated the
    Summer Youth Employment and Training Program and Youth Training
    Grants under the Job Training Partnership Act into a single
    youth training activity. The funds are allocated by formula to
    States and further distributed to local workforce investment
    boards.

    Job Corps

        For Job Corps, the Committee recommends $1,542,019,000.
    This is $9,841,000 below the fiscal year 2005 level and
    $25,000,000 above the budget request. Of the amount
    recommended, $691,000,000 will become available on October 1,
    2005. The Committee does not include a rescission of funds as
    requested within construction and rehabilitation account. The
    Committee understands that previously appropriated funds are
    available for the construction of two new centers. The
    Committee further understands that there is a backlog of
    construction and rehabilitation projects at existing centers.
        The Job Corps, authorized by the Workforce Investment Act
    of 1998, is a nationwide network of residential facilities
    chartered by Federal law to provide a comprehensive and
    intensive array of training, job placement and support services
    to at-risk young adults. The mission of Job Corps is to attract
    eligible young adults, teach them the skills they need to
    become employable and independent, and place them in meaningful
    jobs or further education. Participation in the program is open
    to economically disadvantaged young people in the 16 to 24 age
    range who are unemployed and out of school. Most Job Corps
    students come from disruptive or debilitating environments, and
    it is important that they be relocated to residential
    facilities where they can benefit from the highly structured
    and carefully integrated services provided by the Job Corps
    program. A limited number of opportunities are also available
    for non-residential participation. The Committee supports the
    effort of the Workforce Investment Act of 1998 to more fully
    integrate Job Corps centers in their local communities.
        The Committee recognizes the shortage of health care
    professionals and the need to provide access to health care
    vocational opportunities for many disadvantaged young people.
    The Committee is also aware that the Job Corps is uniquely
    qualified to utilize the Department of Health and Human
    Services (HHS) Health Resources and Services Administration
    (HRSA) grant programs to train students to pursue health
    careers while generating more health care professionals to
    serve economically disadvantaged communities.
        The Committee commends the common mission of the Job Corps
    and HRSA in exposing under-represented minorities and
    disadvantaged students to seek strategically important careers.
    Nearly three quarters of the nation's 122 Job Corps Centers
    offer health occupations training as well as training in health
    care related fields. The Committee recognizes and commends the
    Job Corps success in training students with the skills they
    need to fill critical shortages through major national employer
    partners. Through preferred access to HRSA grant funds, Job
    Corps' training can generate even more qualified and prepared
    allied health professionals in the coming decade.
        The Committee commends Job Corps for establishing
    partnerships with national employers, and encourages Job Corps
    to continue to work with both larger employers and small
    businesses to ensure that student training meets current labor
    market needs. The Committee urges Job Corps to also strengthen
    and expand the program in order to help meet our nation's needs
    for trained, entry level workers in three high growth industry
    sectors: health care, homeland security, and national defense.
    In addition, Job Corps should intensify its efforts to upgrade
    its vocational offerings and curricula to reflect industry
    standards and required certifications recognized by employers.
        The Committee is committed to promoting and expanding cost-
    effective federal programs: that have proven records of
    success; that provide consistent and positive results for the
    people they serve; and that help address national labor
    shortages. Therefore, the Committee supports the incremental
    expansion of Job Corps. The Committee supports the concept of
    ``High Growth Job Corps Centers'' that are focused on
    addressing the country's most vital workforce needs in high
    growth, high demand industries such as automotive,
    construction, financial services, health professions,
    hospitality, information technology, homeland security, and
    transportation.
        The Committee commends the Job Corps program for developing
    mutually beneficial partnerships with community colleges across
    the country. Community college partners including the
    Mississippi Gulf Coast Community College and the Cincinnati
    State and Technical Community College find that it is efficient
    to work with Job Corps because they share the same basic goals
    of providing access and opportunity for disadvantaged Americans
    and they have the ability to partner with employers looking for
    high-skilled workers. The Committee encourages the Department
    of Labor's Community College Initiative to collaborate with the
    Job Corps program to offer advanced co-enrollment programs,
    increase opportunities for disadvantaged youth pursuing a
    career in high growth areas, and maximize access to industry-
    recognized certification programs. The Committee also directs a
    minimum of $10 million of the Community College Initiative
    funding dedicated to community colleges partnerships with Job
    Corps centers. The Committee requests this portion be
    designated to: (1) develop strategic partnerships with
    community colleges, business and industry leaders, and Job
    Corps centers to train students in high, growth, high demand
    industries; and (2) design ``dual enrollment'' programs based
    on reciprocal agreements between Job Corps and adjacent
    community colleges.
        The Committee recognizes the significant impact that the
    home building industry continues to have on the health of the
    U.S. economy, and its efforts to expand opportunities for
    homeownership to all of our nation's working families. The
    Committee notes the ongoing shortage of skilled laborers in the
    residential construction industry and the industry's need to
    alleviate that shortage in order to continue to meet the demand
    for affordable housing in the United States. The Committee also
    recognizes the essential role played by the Home Builders
    Institute (HBI), the workforce development arm of the National
    Association of Home Builders, in training Job Corps youth for
    careers in this high growth industry. The Committee commends
    HBI on its 31-year partnership with Job Corps and its proven
    results in developing our nation's workforce by providing at-
    risk youth with the skills training and employment
    opportunities they need to have successful careers in
    residential construction. The Committee encourages the
    Department to identify existing and future sites for potential
    expansion of construction trades training by employer-based
    industry groups like HBI, to help alleviate the shortage of
    skilled workers and to further the goal of American
    homeownership.
        The Committee believes that Job Corps' partnerships with
    national non-profit faith founded organizations such as Joint
    Action in Community Services (JACS), Women in Community
    Services, and the YWCA are essential to the success of Job
    Corps. The Committee commends JACS and its national network of
    nearly 3,000 volunteers for their proven record in providing
    at-risk young adults supportive services as they transition
    from Job Corps back to their home communities and into the
    world of work. As such, the Committee encourages the Department
    to expand its Job Corps partnership with such national
    volunteer programs in order to ensure the continued
    availability of youth of transition services that are national
    in scope, yet local in focus.

    Native Americans

        For Native Americans, the Committee recommends $54,238,000.
    This is the same as the fiscal year 2005 level and 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 $75,759,000. This is the same as the fiscal year
    2005 level. The budget request did not include funds for this
    program. The Committee recommendation includes bill language
    directing that $4,546,000 of this amount be used for migrant
    and seasonal farmworker housing grants. The bill language
    further directs that not less than 70 percent of this amount be
    used for permanent housing grants. The recommendation also
    provides that the remaining amount be used for State service
    area grants, including funding grantees in those States
    impacted by formula reductions at no less than eighty-five
    percent of the comparable 1998 levels for such States. Within
    the National Activities/Other line item, the Committee includes
    $500,000 to be used for Section 167 training, technical
    assistance and related activities, including continuing funding
    for migrant rest center activities at the current level.
        This program, authorized by the Workforce Investment Act of
    1998, is designed to serve members of economically
    disadvantaged families whose principal livelihood is derived
    from migratory and other forms of seasonal farmwork, or
    fishing, or logging activities. Enrollees and their families
    are provided with employment training and related services
    intended to prepare them for stable, year-round employment
    within and outside of the agriculture industry.

    National programs

        This activity includes Workforce Investment Act authorized
    programs in support of the workforce system including technical
    assistance and incentive grants, evaluations, pilots,
    demonstrations and research.
        Pilots, Demonstrations and Research: The Committee
    recommends $74,000,000 for grants or contracts to conduct
    research, pilots or demonstrates that improve techniques or
    demonstrate the effectiveness of programs. This is $11,167,000
    below the fiscal year 2005 level and $44,000,000 above the
    budget request.
        Evaluation: The Committee recommends $7,936,000 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 the same as the fiscal year 2005 level and the
    budget request.
        Responsible Reintegration of Youthful Offenders: The
    Committee does not include funding for the Responsible
    Reintegration of Youthful Offenders program. The budget did not
    request funds for this program. The fiscal year 2005 level was
    $49,600,000.
        Prisoner Re-entry: The Committee recommends $19,840,000 for
    the Prisoner Re-entry initiative. The is the same as the fiscal
    year 2005 level and $15,160,000 below the budget request.
        The Committee notes the importance of providing adjudicated
    youth with opportunities to expand and cultivate job skills
    that can provide them with successful careers. The Committee
    recognizes Project CRAFT (Community, Restitution, and
    Apprenticeship-Focused Training), a program of the Home
    Builders Institute (HBI), the workforce development arm of the
    National Association of Home Builders, as a noteworthy effort
    in the rehabilitation and reduced recidivism of adjudicated
    youth. The Committee believes that Project CRAFT serves as an
    example of the success achieved during the Youth Reintegration
    pilot demonstration, and applauds HBI for its ongoing
    dedication to serving the workplace education needs of this
    segment of the youth population. The Committee also recognizes
    the role Project CRAFT plays in preparing young people to join
    the residential construction workforce and the continuing
    importance of the home building industry to our nation's
    economy. The Committee encourages the Department to replicate
    Project CRAFT so that its outcomes-oriented approach will
    assist adjudicated juveniles to become productive members of
    the industry's workforce.
        Community Based Job Training Initiative: The Committee
    recommends $125,000,000 for the Community Based Job Training
    Initiative and rescinds $125,000,000 in funds provided in
    fiscal year 2005 for this program.
        The Committee's recommendations reflect efforts to improve
    the efficiency of the workforce system and support
    opportunities to get people back to work. Therefore the
    Committee has not funded the new Community Based Job Training
    Initiative at the level requested by the Administration, but
    has instead increased funding for Dislocated Worker Assistance.
        The Committee is concerned by the Department's first
    solicitation for grant applications (SGA) under the President's
    Community Based Job Training initiative issued on May 3, 2005
    which restricts eligible applicants to community colleges. The
    Committee has on numerous occasions encouraged the Secretary to
    ensure that funds used for the Community Based Job Training
    Initiative strengthen partnerships between community colleges,
    employers, and local workforce investment boards. During the
    fiscal year 2005 budget hearings and in multiple communications
    with the Department, the Committee conveyed its interest in
    broad eligibility for application to the Community Based Job
    Training Initiative. Specifically, the Committee had made clear
    its interest that One Stop Career Centers be eligible to
    compete for these funds. The Committee is concerned that the
    Department has misunderstood or ignored the Committee's
    interest in including One Stop Career Centers as an eligible
    applicant for funding under the Community Based Job Training
    Initiative. Therefore, the Committee directs that future
    solicitations for grant applications for the Community Based
    Job Training initiative include One Stop Career Centers as an
    eligible applicant.
        Within the funds provided, the Committee encourages the
    Department of Labor to structure the Community Based Job
    Training initiative in a manner that allows community college
    to use federal funding to partner with a high school or career
    and technology center. Such partnerships would provide
    educational services to traditional and non-traditional
    students in a larger geographic area than would otherwise be
    served if the community college was not taking part in such a
    partnership.
        Technical Assistance: The Committee recommends $2,000,000.
    The funds recommended support the development of performance
    management systems, the provision of quality services, and
    promoting accountability and collaboration. This is $1,486,000
    below the fiscal year 2005 level and the same as the budget
    request.
        Rescissions: The Committee has included language rescinding
    $20,000,000 in unobligated Health Care Tax Credit Funds and
    $5,000,000 in unobligated funds provided for emergency response
    activities.

                COMMUNITY SERVICE EMPLOYMENT FOR OLDER AMERICANS

        The Committee recommends $436,678,000 for community service
    employment for older Americans. This is the same as the fiscal
    year 2005 level and the budget request.
        The community service employment for older Americans
    program provides grants to public and private nonprofit
    organizations that subsidize part-time work in community
    service activities for unemployed persons aged 55 and older,
    whose family's annual income does not exceed 125 percent of the
    poverty level.

                  FEDERAL UNEMPLOYMENT BENEFITS AND ALLOWANCES

        The Committee recommends $966,400,000. This is $90,900,000
    below the fiscal year 2005 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 $3,470,366,000 for this account.
    This is $166,343,000 below the fiscal year 2005 level and the
    same as the budget request. Included in the total availability
    is $3,339,381,000 authorized to be drawn from the Employment
    Security Administration Account of the Unemployment Trust Fund
    and $130,985,000 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 $2,632,915,000. This is $40,541,000 below the fiscal
    year 2005 level and the same as the budget request. The total
    includes $2,622,499,000 for State Operations and $10,416,000
    for national activities. Included in the amount provided for
    State Operations is up to $10,000,000 to station staff in One-
    Stop Centers to conduct Unemployment Insurance eligibility
    interviews.
        The Committee suggests that the Department encourage states
    to consider supporting Rapid Reemployment Pilot demonstration
    programs that use an already-developed tool for building
    resumes over the phone to assist unemployment insurance
    claimants to quickly move back into the job market.
        For the Employment Service, the Committee recommends
    $696,000,000, which includes $23,300,000 in general funds
    together with an authorization to spend $672,700,000 from the
    Employment Security Administration Account of the Unemployment
    Trust Fund. This is $84,592,000 below the fiscal year 2005
    level and the same as the budget request.
        The Committee recommends $33,766,000 for ES national
    activities. This is $31,210,000 below the fiscal year 2005
    level and the same as the budget request.
        The Committee recommends $87,974,000 for America's Labor
    Market Information System. This is $10,000,000 below the fiscal
    year 2005 level and the same as 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 $19,711,000 for the
    Work Incentives Grants program, the same as the 2005 level and
    the budget request, to help persons with disabilities find and
    retain jobs through the One-Stop Career Center system mandated
    by the Workforce Investment Act. Funding will support systems
    building grants intended to ensure that One-Stop systems
    integrate and coordinate mainstream employment and training
    programs with essential employment-related services for persons
    with disabilities.

            ADVANCES TO THE UNEMPLOYMENT TRUST FUND AND OTHER FUNDS

        The Committee recommends $465,000,000. This is $52,000,000
    below the fiscal year 2005 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 $206,111,000. This is $36,010,000
    below the fiscal year 2005 level and the same as the budget
    request. This includes $118,123,000 in general funds and
    authority to expend $87,988,000 from the Employment Security
    Administration Account of the Unemployment Trust Fund. Within
    the amounts provided, the Committee has included $6,993,000 for
    Executive Direction. This is $148,000 below the fiscal year
    2005 comparable level and the same as the request. General
    funds in this account provide the Federal staff to administer
    employment and training programs under the Workforce Investment
    Act of 1998, the Older Americans Act, the Trade Act, and the
    National Apprenticeship Act. Trust funds provide for the
    Federal administration of employment security functions under
    title III of the Social Security Act and the Immigration and
    Nationality Act.

                         WORKERS COMPENSATION PROGRAMS

        The Committee rescinds $120,000,000 in unobligated
    emergency response funds as requested by the Administration.

                   Employee Benefits Security Administration

                             SALARIES AND EXPENSES

        The bill provides $137,000,000 for the Employee Benefits
    Security Administration, $5,787,000 above the fiscal year 2005
    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 2005 is
    $296,978,000, which is $30,648,000 above the fiscal year 2005
    level and the same as the budget request.
        The Corporation is a wholly owned government corporation
    established by the Employee Retirement Income Security Act of
    1974 (ERISA). The law places it within the Department of Labor
    and makes the Secretary of Labor the chairperson of its board
    of directors. The Corporation receives its income from
    insurance premiums collected from covered pension plans,
    collections of employer liabilities imposed by ERISA, and
    investment earnings. It is also authorized to borrow up to
    $100,000,000 from the United States Treasury. The primary
    purpose of the Corporation is to guarantee the payment of
    pension plan benefits to participants if covered plans fail or
    go out of existence.
        The bill includes language permitting obligations in excess
    of the amount provided in the bill after approval by both the
    Office of Management and Budget as well as the Committee on
    Appropriations. The Committee has an interest in approving
    obligations that may change the total amount available to any
    agency.

                      Employment Standards Administration

                             SALARIES AND EXPENSES

        The bill includes $416,332,000 for this account. This is
    $15,485,000 above the fiscal year 2005 level and the same as
    the budget request. The bill includes $414,284,000 in general
    funds for this account and contains authority to expend
    $2,048,000 from the Special Fund established by the Longshore
    and Harbor Workers' Compensation Act.
        The Employment Standards Administration is involved in the
    administration of numerous laws, including the Fair Labor
    Standards Act, the Immigration and Nationality Act, the Migrant
    and Seasonal Agricultural Workers' Protection Act, the Davis-
    Bacon Act, the Family and Medical Leave Act, the Federal
    Employees' Compensation Act, the Longshore and Harbor Workers'
    Compensation Act, and the Federal Mine Safety and Health Act
    (black lung). The agency also administers Executive Order 11246
    related to affirmative action by Federal contractors and the
    Labor-Management Reporting and Disclosure Act.

                                SPECIAL BENEFITS

        The bill includes $237,000,000. This is $4,000,000 below
    the fiscal year 2005 appropriation and the same as the budget
    request. This appropriation primarily provides benefits under
    the Federal Employees' Compensation Act (FECA). The payments
    are required by law. In fiscal year 2005, 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.

                   SPECIAL BENEFITS FOR DISABLED COAL MINERS

        The Committee recommends an appropriation of $232,250,000
    for special benefits for disabled coal miners. This is in
    addition to the $81,000,000 appropriated last year as an
    advance for the first quarter of fiscal year 2005, 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
    $74,000,000 for the first quarter of fiscal year 2006, the same
    as the budget request. These funds will ensure uninterrupted
    benefit payments to coal miners, their widows, and dependents.
        The Black Lung Consolidation of Administrative
    Responsibility Act of 2002 amends the Black Lung Benefits Act
    to transfer part B black lung benefits responsibility from the
    Commissioner of Social Security to the Secretary of Labor.

        ADMINISTRATIVE EXPENSES, ENERGY EMPLOYEES OCCUPATIONAL ILLNESS
                               COMPENSATION FUND

        The bill includes $96,081,000 for the Energy Employees
    Occupational Illness Compensation Program authorized by Title
    XXXVI of the National Defense Authorization Act of 2001. This
    is $55,760,000 above the fiscal year 2005 level and the same as
    the budget request. Funds will be used to administer the
    program that provides compensation to employees or survivors of
    employees of the Department of Energy (DOE), its contractors
    and subcontractors, companies that provided beryllium to DOE,
    and atomic weapons employees who suffer from a radiation-
    related cancer, beryllium-related disease, or chronic silicosis
    as a result of their work in producing or testing nuclear
    weapons, and uranium workers covered under the Radiation
    Exposure Compensation Act.

                        BLACK LUNG DISABILITY TRUST FUND

        The bill includes $1,068,000,000 for this account. This is
    $6,031,000 above the comparable fiscal year 2005 level and the
    same as the budget request. The bill language provides such
    sums as may be necessary to pay for benefits.
        The Trust Fund pays all black lung compensation/medical and
    survivor benefit expenses when no responsible mine operator can
    be assigned liability for such benefits, or when coal mine
    employment ceased prior to 1970, as well as administrative
    costs which are incurred in administering the benefits program
    and operating the Trust Fund.
        The basic financing for the Trust Fund comes from a coal
    excise tax for underground and surface-mines coal. Additional
    funds come from reimbursement payments from mine operators for
    benefit payments made by the Trust Fund before the mine
    operator is found liable. The advances to the Fund assure
    availability of necessary funds when liabilities may exceed
    other income. The Omnibus Budget Reconciliation Act of 1987
    continues the current tax structure until 2014.

                 Occupational Safety and Health Administration

                             SALARIES AND EXPENSES

        The bill includes $477,199,000 for the Occupational Safety
    and Health Administration. This is $13,041,000 above the fiscal
    year 2005 level and $10,218,000 above the budget request. This
    agency is responsible for enforcing the Occupational Safety and
    Health Act of 1970 in the Nation's workplaces.
        The Committee directs OSHA to take no further action
    regarding respiratory protection for occupational exposure to
    TB until such time as the CDC has completed the ongoing
    revisions to the TB guidelines. The Committee further directs
    that upon completion of the TB guidelines OSHA should modify
    its rules so that OSHA respiratory regulations with regard to
    TB are not more strenuous than the CDC recommends. The
    Committee is disappointed that OSHA applied its general
    industry respiratory protection standard (GIRPS) to
    occupational exposure to tuberculosis (TB). Occupational
    exposure to TB is unique to healthcare facilities and currently
    is governed by the CDC's TB Guidelines, which, according to the
    CDC, have reduced the number of TB cases in the United States
    by over forty percent in recent years and controlled outbreaks
    in healthcare facilities. In light of this fact, and the CDC's
    Advisory Council for the Elimination of Tuberculosis' (ACET)
    letter urging OSHA not to apply the general industry
    respiratory standard to occupational exposure to TB, the
    Committee feels that this arbitrary regulation is unnecessarily
    burdensome for healthcare facilities, who have already shown
    success in reducing the number of TB cases.
        The Committee is once again 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 six 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. Despite some recent promising trends in workplace
    injury and death rates for Hispanic workers, the Department
    cannot attribute the trends to better provision of personal
    protective equipment because the Department has not issued the
    regulation. The Committee expects the Secretary to report to
    the Committee, within 30 days of the enactment of the bill, the
    definitive status of this regulation, the agency's reasons for
    not issuing the regulation sooner, and a timetable for its
    issuance.

                     Mine Safety and Health Administration

                             SALARIES AND EXPENSES

        The bill includes $280,490,000 for this agency. This is
    $1,354,000 above the fiscal year 2005 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.
        The Committee includes a provision granting authority for
    continued MSHA participation with the Holmes Safety Association
    to continue to promote miner safety and welfare.

                           Bureau of Labor Statistics

                             SALARIES AND EXPENSES

        The total funding recommended by the Committee for the
    Bureau of Labor Statistics (BLS) is $542,523,000. This is
    $13,520,000 above the fiscal year 2005 comparable level and the
    same as the budget request. The bill includes $464,678,000 in
    general funds for this account and authority to spend
    $77,845,000 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.
        The Committee is aware of a report by the Government
    Accountability Office titled, ``Current Government Data Provide
    Limited Insight into Offshoring of Services'' that found that
    government data do not adequately capture business transactions
    that offshoring can encompass; and government data provide only
    limited information about the effects of offshoring on the U.S.
    employment and the U.S. economy. The Committee therefore
    encourages the Department of Labor to examine ways to improve
    data collection on the impact of offshore outsourcing on
    employment trends and the U.S. economy.

                     Office of Disability Employment Policy

                             SALARIES AND EXPENSES

        The bill includes $27,934,000 for the Office of Disability
    Employment Policy, which is $19,230,000 below the fiscal year
    2005 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 $244,423,000 for Departmental Management
    activities. This is $76,265,000 below the fiscal year 2005
    level and the same as the budget request. The bill includes
    $244,112,000 in general funds for this account along with
    authority to transfer $311,000 from the Employment Security
    Administration Account of the Unemployment Trust Fund.
        The Departmental Management appropriation finances staff is
    responsible for formulating and overseeing the implementation
    of Departmental policy and management activities. In addition,
    this appropriation includes a variety of operating programs and
    activities that are not involved in Departmental Management
    functions, but for which other salaries and expenses
    appropriations are not suitable.
        The Committee recommendation includes $29,504,000 for
    Executive Direction, $2,784,000 below the fiscal year 2005
    level and the same as the budget request.
        The bill provides $29,760,000 for the Department-wide
    information technology crosscut, the same as the fiscal year
    2005 comparable level and the budget request. The Committee
    commends the Department in streamlining its information
    technology infrastructure into a single, uniform system and
    encourages the Department in this effort.
        The bill provides $1,700,000 for the Departmental
    Management Crosscut. This is $3,260,000 below the fiscal year
    2005 level and the same as the budget request.
        The bill includes $33,197,000 for the Administration and
    Management program that provides leadership and policy guidance
    for a number of Department-wide activities. This is $783,000
    below the fiscal year 2005 level and the same as the budget
    request.
        The Committee is interested in ensuring that qualified job
    training programs of the Department of Labor fully extend
    priority of service for veterans as required by the Jobs for
    Veterans Act. Toward this effort, the Committee urges the
    Secretary to develop a guide for veterans in accessing
    workforce investment services; a guide for assisting veterans
    service organizations and homeless veteran service providers in
    accessing workforce investment funds and workforce investment
    planning processes; and a guide to inform workforce systems on
    the employment services needs of veterans and the
    responsibility of such systems to prioritize veterans for
    services and to collaborate with veterans' organizations and
    providers.
        The Committee urges the Secretary to instruct state
    workforce agencies to increase their outstationing of disabled
    veterans outreach program specialists and local veterans
    employment representatives in locations where homeless veterans
    congregate, including grantees under the homeless provider
    grant and per diem program and the homeless veterans
    reintegration program.
        The Committee is interested in better understanding the
    full impact of federal assistance programs, including the
    number of individuals who access multiple federal programs,
    either concurrently or during the course of their lifetime. As
    such, the Committee directs the U.S. Department of Labor to
    develop the infrastructure necessary to cross-reference
    individuals participating in multiple federal programs. As part
    of this effort, DOL is encouraged to partner with other federal
    agencies to develop common measures across all programs that
    will allow such cross-referencing to occur. The Department
    shall report to Congress, by March 1, 2006, on the status of
    this initiative, including a specific list of barriers that may
    preclude the agency from full compliance with this directive.
        The Committee directs that all financial service or other
    employee benefit products that are covered by the Employee
    Retirement Income Security Act (ERISA) carry the following
    warning, outlined in a box on the cover page, in nothing less
    than 16 point, bold Arial font:
        ``This product is covered by the Employee Retirement Income
    Security Act (ERISA). Under ERISA, recourse is greatly limited
    in disputes of service. It is the responsibility of the
    consumer to read all language pertaining to ERISA and/or
    consult with independent advisors prior to enrolling in this
    benefit plan.''
        The Committee is concerned about the implementation of the
    department's ``policy guidance'' pursuant to Executive Order
    13166, published on August 16, 2000, regarding limited English
    proficiency. The Committee feels it is important to keep track
    of the costs of this policy to make sure that the provision of
    language services is being done as cost effectively as
    possible. Therefore, the U.S. Department of Labor should report
    to the Committee the total funding spent on the provision of
    services in languages other than English, including
    publications costs, web site development and maintenance costs,
    outreach activities, translation activities, and language line
    contracts.

            ASSISTANT SECRETARY FOR VETERANS EMPLOYMENT AND TRAINING

        The Committee recommends $224,334,000 for veteran
    employment and training activities. This is $1,501,000 above
    the fiscal year 2005 level and the same as the budget request.
    Within this amount, the bill includes $194,834,000 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.
        Individuals leaving the military are at high risk of
    homelessness due to a lack of job skills transferable to the
    civilian sector, disrupted or dissolved family and social
    support networks, and other risk factors that preceded their
    military service. The Transition Assistance Program (TAP) has
    been established to ease the transition of separating service
    members to the civilian sector. The Committee instructs the
    Secretary of Labor to ensure that a module on homelessness
    prevention is added to the TAP curriculum. The module should
    include a presentation on risk factors for homelessness, a
    self-assessment of risk factors, and contact information for
    preventative assistance associated with homelessness.

                        OFFICE OF THE INSPECTOR GENERAL

        The bill includes $70,819,000 for the Office of the
    Inspector General (OIG). This is $1,824,000 above the fiscal
    year 2005 comparable level and the same as the budget request.
    This includes $65,211,000 in general funds for this account
    along with the authority to transfer $5,608,000 from the
    Employment Security Administration Account of the Unemployment
    Trust Fund.
        The OIG was created by law to protect the integrity of
    Departmental programs as well as the welfare of beneficiaries
    served by those programs. Through a program of audits,
    investigations, and program evaluations, the OIG attempts to
    reduce the incidence of fraud, waste, abuse, and mismanagement,
    and to promote economy, efficiency, and effectiveness
    throughout the Department.

                              Working Capital Fund

        The Committee includes $6,230,000 for a new core accounting
    system for the Department of Labor, including hardware and
    software infrastructure. This is $3,690,000 below the
    comparable fiscal year 2005 level and the same as the budget
    request.

                               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 modifies a provision permitting the
    Secretary of Labor to transfer up to one percent of any
    discretionary appropriation from an account.
        Sec. 103. The Committee includes a provision directing the
    Secretary to provide to the Department of Labor employees in
    the National Capital Region the full transit subsidy that they
    are eligible to receive.

               TITLE II--DEPARTMENT OF HEALTH AND HUMAN SERVICES

                  Health Resources and Services Administration

                         HEALTH RESOURCES AND SERVICES

        The bill includes $6,446,357,000 for health resources and
    services programs, which is $356,655,000 below the fiscal year
    2005 comparable level for these activities and $480,213,000
    above the budget request. This includes $500,000,000 that was
    previously provided in the Public Health and Social Services
    Emergency Fund for two bioterrorism programs administered by
    the Health Resources and Services Administration (HRSA)--
    $472,479,000 for hospital preparedness grants and $27,521,000
    for education incentives for medical school curricula.
        HRSA supports programs which provide health services to
    disadvantaged, medically underserved, and special populations;
    decrease infant mortality rates; assist in the education of
    health professionals; and provide technical assistance
    regarding the utilization of health resources and facilities.

    Community health centers

        The Committee provides $1,834,311,000 for community health
    centers, which is $100,000,000 above the fiscal year 2005
    comparable level and $203,560,000 below the budget request.
    These funds support programs which include community health
    centers, migrant health centers, health care for the homeless
    and public housing health service grants.
        The Committee includes bill language similar to previous
    years limiting the amount of funds available for the payment of
    claims under the Federal Tort Claims Act to $45,000,000, which
    is the same as the budget request and the limitation in the
    fiscal year 2005 bill.
        The Committee does not provide additional funds for loan
    guarantee authority for community health centers under section
    330(d) of the Public Health Service Act. The Committee notes
    that $105 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.
        The Committee supports the long-standing HRSA policy of
    approving specific qualified applications for future funding.
    This process enables high-quality applicants to take steps to
    develop and implement care delivery systems in their
    communities instead of wasting scarce resources to reapply for
    funding. The Committee intends that HRSA should use $56,000,000
    of the funding provided above the fiscal year 2005 level for
    this purpose.
        The Committee provides $26,000,000 as requested by the
    Administration for a new initiative to fund health centers in
    approximately 40 high poverty counties across the country, as
    well as 25 planning grants. The Committee includes bill
    language requested by the Administration to direct this funding
    to high-poverty counties.
        The Committee encourages community health centers to make
    ultrasound services available to their patients.

    Free clinics medical malpractice

        The Committee does not provide fiscal year 2006 funding for
    payments of claims under the Federal Tort Claims Act to be made
    available for volunteer free clinic health care professionals.
    $99,000 was provided for this purpose in fiscal year 2005 and
    claims are not expected against the fund until at least fiscal
    year 2007. The program extends Federal Tort Claims Act coverage
    to health care professional volunteers in free clinics in order
    to expand access to health care services to low-income
    individuals in medically underserved areas. According to Title
    42, Section 233(o), a free clinic must apply, consistent with
    the provisions applicable to community health centers, to have
    each health care professional `deemed' an employee of the
    Public Health Service Act, and therefore eligible for coverage
    under the Federal Tort Claims Act.

    Radiation exposure compensation act

        The Committee provides $1,900,000 for the radiation
    exposure compensation act, which is $58,000 below fiscal year
    2005 comparable level and $36,000 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.

    Healthy community access program

        The Committee does not provide funding for the healthy
    community access program, which is $82,993,000 below the fiscal
    year 2005 comparable level and the same as the Administration
    request. The program was 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. Congress has appropriated $541 million for this
    program since fiscal year 2000.

    Hansen's disease services

        The Committee provides $16,066,000 for the Hansen's disease
    program, which is $1,185,000 below the fiscal year 2005
    comparable level and the same as the budget request. This
    program offers Hansen's disease treatment to 11 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.

    Buildings and facilities

        The Committee provides $222,000 for buildings and
    facilities, which is $25,000 below fiscal year 2005 comparable
    level and the same as 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.

    Payment to Hawaii for treatment of Hansen's disease

        The Committee provides $2,016,000 for the treatment of
    persons with Hansen's disease in the State of Hawaii, which is
    $1,000 below the fiscal year 2005 comparable level and the same
    as the Administration request. The program, which provides a
    partial matching payment to the State of Hawaii, dates to the
    period of Father Damien's facility for sufferers of Hansen's
    disease. That facility now has only 40 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 247 active ambulatory Hansen's Disease
    cases.

    Black lung clinics

        The Committee provides $5,912,000 for black lung clinics,
    which is the $39,000 below the fiscal year 2005 comparable
    level and the same as budget request. The program supports
    fifteen grantees that treat a declining population of coal
    miners with respiratory and pulmonary impairments. The clinics
    presently receive more than one-third of their funding from
    other sources, such as Medicaid and Medicare. Of the fifteen
    grantees, six receive health center funding as well as black
    lung grants.

    National Health Service Corps: Field placements

        The Committee provides $40,705,000 for field placements,
    which is $4,363,000 below the fiscal year 2005 comparable level
    and the same as 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 $86,091,000 for recruitment
    activities, which is $289,000 below the fiscal year 2005
    comparable level and the same as the budget request. The
    program awards scholarships to health professions students and
    assists graduates in repaying their student loans. In return
    for every year of support, these individuals are obligated to
    provide a year of service in health professional shortage areas
    of greatest need. The minimum obligation is two years.
        The Committee believes that the inclusion of optometrists
    in the National Health Service Corps' (NHSC) Student Loan
    Repayment Program would result in the expanded accessibility of
    eye care in communities where it is most needed. Accordingly,
    the Committee encourages HRSA to take immediate steps to fully
    utilize Doctors of Optometry in the NHSC Student Loan Repayment
    Program as part of an effort to make preventive eye care
    services more accessible in community health centers within
    rural and urban primary care health professional shortage
    areas.

    Health professions

        The Committee provides $197,119,000 for all health
    professions training programs, which is $253,094,000 below the
    fiscal year 2005 comparable level and $36,585,000 above the
    budget request. The Committee was unable to restore much of the
    $289,679,000 reduction in health professions funding proposed
    by the Administration, but the Committee felt it was especially
    important to support programs for disadvantaged students and
    nurse training programs. The table at the end of the report
    identifies how funding is allocated for programs authorized by
    titles VII and VIII of the Public Health Service Act.
        The Committee commends HRSA for its efforts to address the
    growing gap between the size of the Nation's aging baby boom
    population and the number of pulmonary/critical care
    physicians. The Committee is aware that HRSA has prepared a
    report on the healthcare workforce shortage issue, and that the
    portion of the report that will attempt to identify the causes
    of, and potential responses to, the critical care workforce
    shortage will be informed, in part, by The Critical Care
    Medicine Crisis: A Call for Federal Action prepared by the
    Critical Care Workforce Partnership. The Committee expects HRSA
    to provide a copy of this report to the Committee within 120
    days.

    Centers of excellence

        The Committee provides $12,000,000 for centers of
    excellence, which is $21,609,000 below the fiscal year 2005
    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. 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.

    Scholarships for disadvantaged students

        The Committee provides $35,128,000 for scholarships for
    disadvantaged students, which is $12,000,000 below the fiscal
    year 2005 comparable level and $25,297,000 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.

    Advanced education nursing

        The Committee provides $57,637,000 for advanced education
    nursing, which is $523,000 below the fiscal year 2005
    comparable level and $14,831,000 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 level for nurse anesthetist
    education.

    Nurse education, practice and retention

        The Committee provides $36,468,000 for nurse education,
    practice and retention, which is the same as fiscal year 2005
    comparable level and 9,857,000 below the budget request. As
    amended by the Nurse Reinvestment Act of 2002, the nurse
    education, practice and retention program is a broad authority
    with targeted purposes under three priority areas--education,
    practice and retention--in response to the growing nursing
    shortage.

    Nursing workforce diversity

        The Committee provides $16,270,000 for nursing workforce
    diversity, which is the same as the fiscal year 2005 comparable
    level and $4,974,000 below the budget request. The program
    provides grants and contracts to schools of nursing and other
    eligible entities to meet the costs of special projects to
    increase nursing education opportunities for individuals who
    are from disadvantaged backgrounds, including racial and ethnic
    minorities, by providing student scholarships or stipends, pre-
    entry preparation, and retention activities. The program also
    contributes to the basic preparation of disadvantaged and
    minority nurses for leadership positions within the nursing and
    health care community.

    Loan repayment and scholarship program

        The Committee provides $31,369,000 for the nurse loan
    repayment and scholarship program, which is $113,000 below the
    fiscal year 2005 comparable level and the same as the budget
    request. This program offers student loan repayment to nurses
    or scholarships to nursing students in exchange for an
    agreement to serve not less than two years at a health care
    facility with a critical shortage of nurses.
        The Committee recognizes the ongoing nursing shortage
    crisis and believes that new strategies are needed to increase
    the numbers of nursing faculty to prepare the future nursing
    workforce. The Committee encourages the Secretary to designate
    schools of nursing as health care facilities for the purposes
    the Nurse Loan Repayment and Scholarship Program as authorized
    by the Public Health Service Act. The Committee further urges
    the Secretary to give increased consideration to eligible
    nurses in the loan repayment program with a commitment to
    working in a faculty setting.

    Comprehensive geriatric nurse education

        The Committee provides $3,426,000 for comprehensive
    geriatric nurse education, which is $24,000 below the fiscal
    year 2005 comparable level and the same as the Administration
    request. The comprehensive geriatric education program supports
    grants for (1) providing training to individuals who will
    provide geriatric care for the elderly; (2) develop and
    disseminate curricula relating to the treatment of the health
    care problems of elderly individuals; (3) train faculty members
    in geriatrics; or (4) provide continuing education to
    individuals who provide geriatric care.

    Nurse faculty loan program

        The Committee provides $4,821,000 for the nurse faculty
    loan program, which is $10,000 below the fiscal year 2005
    comparable level and the same as the Administration request.
    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.

    Children's hospitals graduate medical education program

        The Committee provides $300,000,000 for the children's
    hospitals graduate medical education program, which is $730,000
    below the fiscal year 2005 comparable bill and $100,000,000
    above the budget request. The program provides support for
    health professions training in children's teaching hospitals
    that have a separate Medicare provider number (``free-
    standing'' children's hospitals). 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. The Committee
    believes this program is vital to restoring the reimbursement
    inequity faced by pediatric hospitals, which provide very high
    quality care to children with difficult and expensive
    conditions.

    National practitioner data bank

        The Committee does not provide funding for the national
    practitioner data bank for fiscal year 2006, which is the same
    as both the fiscal year 2005 action on appropriations and the
    budget request. The Committee recommendation and the budget
    request assume that the data bank will be self-supporting, with
    collections of $15,700,000 in user fees. The national data bank
    receives, stores and disseminates information on paid medical
    malpractice judgments and settlements, sanctions taken by
    Boards of Medical Examiners, losses of membership in
    professional societies, and certain professional review actions
    taken by health care entities. Insurance companies, State
    licensure boards and authorities, and other health care
    entities and professional societies are required to report
    information to the data bank within 30 days of each action. The
    coverage of the data bank includes dentists and physicians,
    and, with respect to malpractice settlements and judgments,
    other categories of licensed health professionals. Hospitals
    are required to search the data bank when a health care
    provider applies for employment and once every two years
    thereafter. State licensing boards, other health care entities,
    licensing authorities, and professional societies also have
    access to the data bank. Traditional bill language is included
    to ensure that user fees are collected to cover the full costs
    of the data bank operations.

    Health care integrity and protection data bank

        The Committee does not provide funding for the health care
    integrity and protection data bank (HIPDB) for fiscal year
    2006. The Committee recommendation and the budget request
    assume that the data bank will be self-supporting, with
    collections of $4,000,000 in user fees. HIPDB receives, stores,
    and disseminates information on final adverse actions taken
    against health care providers, suppliers, and practitioners,
    health care related civil judgments and criminal convictions.
    This information is collected from and made available to
    Government agencies and health plans.

    Maternal and child health block grant

        The Committee provides $700,000,000 for the maternal and
    child health (MCH) block grant, which is $23,928,000 below both
    the fiscal year 2005 comparable level and the budget request.
        The MCH block grant provides funds to States to meet a
    broad range of basic and enabling health services, including
    personal health services; general, population-wide health
    services, such as screening; family support services; and
    integrated systems of care. The authorizing statute provides
    that, up to a funding level of $600,000,000, 85 percent of the
    funds are distributed to the States, with 15 percent of the
    funds set aside for special projects of regional and national
    significance (SPRANS). When the appropriation exceeds
    $600,000,000, 12.75 percent of the amount over $600,000,000 is
    directed to the Community Integrated Service Systems set-aside
    program. The remaining 87.25 percent is distributed by the same
    85/15 percent allocation as in the basic block grant formula.
        The Committee has included bill language identifying
    $116,124,000 for the SPRANS set-aside. Within that total,
    $5,000,000 is provided for the continuation of oral health
    programs in the States. Through grants, cooperative agreements
    or contracts, these funds may be used to increase access to
    dental care for the most vulnerable low-income children, such
    as Medicaid, SCHIP, and Head Start children and to implement
    state-identified objectives for improving oral health.
    Anticipated activities include those targeting the reduction of
    early childhood caries and strengthening school-linked dental
    sealant programs.
        The Committee has also provided $4,000,000 within the
    SPRANS set-aside to support the continuation of the community-
    based sickle cell disease outreach and supportive service
    initiative.
        In addition, the Committee provides $3,000,000 within the
    SPRANS set-aside to continue the newborn screening for
    heritable disorders demonstrations begun two years ago. Newborn
    screening is used for early identification of infants affected
    by certain genetic, metabolic, hormonal or functional
    conditions for which there is effective treatment or
    intervention. Screening detects disorders in newborns that,
    left untreated, can cause death, disability, mental retardation
    and other serious illnesses. The Committee is aware that wide
    disparities exist on the number and types of conditions
    screened for in each State. The Committee commends HRSA for
    convening the Secretary's Advisory Committee on Heritable
    Disorders and Genetic Diseases in Newborns and Children to make
    national recommendations to standardize newborn screening
    programs in the U.S. The Committee encourages HRSA to use some
    of the funds provided for the development of parental and
    provider education material and programs to promote the
    importance of newborn screening.
        The Committee has also provided $3,000,000 within the
    SPRANS set-aside to continue epilepsy demonstration programs.
    These programs are designed 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 and rural areas. The Committee is pleased
    that HRSA has partnered with a national voluntary epilepsy
    agency to carry out these activities. Of the amount provided,
    the Committee recommends that up to thirty percent be used to
    continue to fund the development and testing of a national
    public health awareness campaign to increase seizure
    recognition and improve access to care among minorities and
    underserved populations.
        The Committee reiterates its long-standing support for the
    continuation of funding that Maternal and Child Health Block
    Grant has provided to comprehensive thalassemia treatment
    centers under the SPRANS program. The Committee strongly
    encourages HRSA to continue this program and to coordinate with
    the relevant voluntary organizations.
        The Committee is aware that some States have made
    reductions in MCH resources that are allocated for children
    with special health needs. The Committee encourages HRSA to
    continue to work with State MCH programs to assure the
    availability of services for children with special health care
    needs, including medical and support services to maintain their
    physical, mental and emotional health and development.
        The Committee recognizes the critical role of hemophilia
    treatment centers funded through the SPRANS set-aside in
    providing needed comprehensive care for persons with bleeding
    disorders and the expanded role of these centers in addressing
    the needs of women with bleeding disorders and persons with
    clotting disorders such as thrombophilia. The Committee
    encourages HRSA to continue its support of this model disease
    management network.
        The Committee recognizes the contributions of the
    longstanding Provider's Partnership program and encourages HRSA
    to continue its funding. The Partnership includes a series of
    state-level projects initiated to address female psychosocial
    issues through integration of medical care with psychosocial
    services. Such partnerships enhance service integration,
    minimize demands on individual providers, and facilitate
    movement between providers and agencies to create comprehensive
    care.

    Sickle cell anemia demonstration program

        The Committee does not provide funding for the sickle cell
    anemia demonstration program, which is the same as the budget
    request and $198,000 less than the fiscal year 2005 comparable
    level. This program was funded for the first time in fiscal
    year 2005. The Committee has provided $4,000,000 within the
    Maternal and Child Health SPRANS funding for sickle cell
    demonstrations.

    Traumatic brain injury

        The Committee provides $9,000,000 for the traumatic brain
    injury (TBI) program. This is $297,000 below the fiscal year
    2005 comparable level. The budget request did not fund the
    program. 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.

    Healthy Start

        The Committee provides $97,747,000 for Healthy Start, which
    is $4,796,000 below the fiscal year 2005 comparable level and
    the same as 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 reduce
    disparities in perinatal health that contribute to the Nation's
    high infant mortality rate.
        Since 1990, the Maternal and Child Health Bureau has worked
    in cooperative agreement to run the National Fetal Infant
    Mortality Review (NFIMR) program. NFIMR provides training and
    assistance to enhance cooperative partnerships among local
    community health professionals, public health officers,
    community advocates and consumers to reduce infant mortality.
    The goal is to improve local services and resources for women,
    infants and families, to remove barriers to care, and to ensure
    culturally appropriate, family friendly services. Such efforts
    are crucial to understanding and addressing infant health
    disparities in communities at highest risk. The Committee
    encourages HRSA to continue to use Healthy Start funds to
    support the NFIMR project.

    Universal newborn hearing screening

        The Committee provides $10,000,000 for the universal
    newborn hearing screening program, which is $208,000 above the
    fiscal year 2005 comparable level. The Administration did not
    request funding for this program. The program provides
    competitive grants to States for 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.
        Currently, 52 states and territories have received
    competitive grants for the purpose of implementing statewide
    early hearing detection and intervention (EHDI) programs. Since
    these grants have only been operational for a few years, the
    Committee believes that a small amount of continued Federal
    funding is critical at this time to ensure that state EHDI
    programs become fully operational and that screening programs
    are properly linked with diagnosis, early intervention, and the
    child's routine medical care (often referred to as the child's
    medical home). The Committee is concerned that even though
    approximately 90 percent of babies are now screened for hearing
    loss before 1 month of age, about one-third of those who are
    referred from screening do not receive diagnostic evaluations
    by 3 months of age. Moreover, only about half of the infants
    and toddlers diagnosed with permanent hearing loss are enrolled
    in appropriate early intervention programs by 6 months of age.
        The Committee has provided an increase to: (a) enable
    states to institutionalize the State EHDI programs developed
    during the last 3-5 years; (b) increase the availability of
    qualified pediatric audiologists; (c) educate health care
    providers and families about the importance and procedures for
    EHDI; (d) strengthen linkages between EHDI and early
    intervention programs funded by Part C of IDEA; (e) continue
    and expand the National EHDI Technical Assistance System; (f)
    evaluate the impact of statewide EHDI programs; and (g)
    increase the capacity of states to screen children for
    progressive and late-onset hearing losses. To minimize the loss
    to follow-up, the Committee urges HRSA to ensure that all
    infants identified through the screening process are linked to
    an identifiable and ongoing source of routine health care.
        To avoid duplication, the Committee expects HRSA to
    coordinate projects funded with this appropriation with
    projects related to early hearing detection and intervention by
    the National Center on Birth Defects and Developmental
    Disabilities, the National Institute on Deafness and Other
    Communication Disorders, the National Institute on Disability
    and Rehabilitation Research, and the Office of Special
    Education and Rehabilitative Services.

    Emergency medical services for children

        The Committee provides $19,000,000 for the Emergency
    Medical Services for Children (EMSC) program, which is $830,000
    below the fiscal year 2005 comparable level. The Administration
    did not request funding for the program. The Committee
    recognizes that this program is the only Federal source of
    funding and expertise for improving EMS systems for children.
    The Committee commends the EMSC program for its twenty years of
    achievement in this arena and applauds its commitment to
    improving the delivery of emergency medical services to ill and
    injured children.

    Poison control centers

        The Committee provides $23,301,000 for poison control
    centers, which is $198,000 below the fiscal year 2005
    comparable level and the same as the Administration request.
    These funds support a grant program for poison control centers.
    In addition, funds are used to maintain a national toll-free
    number and to 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.

    Ryan White AIDS programs

        The Committee provides $2,058,296,000 for Ryan White AIDS
    programs, which is $10,000,000 above the fiscal year 2005
    comparable level and the same as the budget request. The bill
    also makes available $25,000,000 in program evaluation funding
    under section 241 of the Public Health Service for special
    projects of national significance. Within the total provided,
    the Committee expects that Ryan White AIDS activities that are
    targeted to address the growing HIV/AIDS epidemic and its
    disproportionate impact upon communities of color, including
    African Americans, Latinos, Native Americans, Asian Americans,
    Native Hawaiians, and Pacific Islanders will be supported at no
    less than the fiscal year 2005 level.
        The Committee is aware that over thirty percent of HIV-
    infected persons in the United States are also chronically
    infected with the hepatitis C virus (HCV). Chronic hepatitis C
    infection may lead to cirrhosis of the liver and liver cancer,
    and is the leading cause of liver transplantation in the U.S.
    In addition, chronic hepatitis C disease progresses more
    rapidly in HIV-infected persons, and end stage liver disease
    resulting from chronic hepatitis C infection is now a leading
    cause of death for people with HIV/AIDS. The Committee
    encourages HRSA to provide guidance to CARE Act grantees to
    encourage them to proactively address HCV care and treatment
    among their HIV/HCV co-infected patient populations, and
    encourages State AIDS Assistance Programs to provide coverage
    of therapies approved by the FDA for the treatment of HCV in
    HIV/HCV co-infected patients.

    Emergency assistance

        The Committee provides $610,094,000 for the Part A,
    emergency assistance program, which is the same as the fiscal
    year 2005 comparable level and the budget request. These funds
    provide grants to metropolitan areas with very high numbers of
    AIDS cases for outpatient and ambulatory health and social
    support services. Half of the amount appropriated is allocated
    by formula and half is allocated to eligible areas
    demonstrating additional need through a competitive grant
    process.

    Comprehensive care programs

        The Committee provides $1,131,836,000 for Part B,
    comprehensive care programs, which is $10,000,000 above the
    fiscal year 2005 comparable level and the same as 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
    $797,521,000 specifically to support State AIDS Drug Assistance
    Programs (ADAP) as requested by the Administration. In fiscal
    year 2005, $787,521,000 was designated for this purpose.
        The Committee is aware of the success HIV therapies have
    had on prolonging and enhancing the quality of life for those
    infected with HIV/AIDS. As the infected population lives longer
    and becomes increasingly resistant to current treatment
    regimens, there is a growing need to focus on access to newer
    therapies for treatment-experienced or ``later stage''
    patients. The Committee encourages HRSA and state ADAPs to
    prioritize coverage of treatments for later stage patients so
    that there is parity of access to effective treatments for
    patients across the HIV disease spectrum.

    Early intervention program

        The Committee provides $195,578,000 for Part C, the early
    intervention program, which is the same as the fiscal year 2005
    comparable level and the budget request. Funds are used for
    discretionary grants to migrant and community health centers,
    health care for the homeless grantees, family planning
    grantees, hemophilia centers and other private non-profit
    entities that provide comprehensive primary care services to
    populations with or at risk for HIV disease. The grantees
    provide testing, risk reduction counseling, transmission
    prevention, and clinical care; case management, outreach, and
    eligibility assistance are optional services.

    Pediatric HIV/AIDS

        The Committee provides $72,519,000 for Part D, pediatric
    AIDS demonstrations, which is the same as the fiscal year 2005
    comparable level and the budget request. The program supports
    demonstration grants to foster collaboration between clinical
    research institutions and primary community-based medical and
    social service providers for the target population of HIV-
    infected children, pregnant women and their families. The
    projects are intended to increase access to comprehensive care,
    as well as voluntary participation in NIH and other clinical
    trials.

    AIDS dental services

        The Committee provides $13,218,000 for AIDS dental
    services, which is the same as the fiscal year 2005 comparable
    level and the budget request. The program provides
    reimbursements to dental schools and postdoctoral dental
    education programs to assist with the cost of providing
    unreimbursed oral health care to patients with human
    immunodeficiency virus disease. Dental students and residents
    participating in this program receive extensive training in the
    understanding and management of the oral health care needs of
    people living with HIV/AIDS.

    Education and training centers

        The Committee provides $35,051,000 for AIDS education and
    training centers (AETCs), which is the same as the fiscal year
    2005 comparable level and the budget request. The centers train
    health care personnel who care for AIDS patients and develop
    model education programs.

    Telehealth

        The Committee provides $3,888,000 for telehealth, which is
    $28,000 below the fiscal year 2005 comparable level and the
    same as 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 populations that are isolated from
    health care, and health-related education to the practitioners
    who serve them.

    Organ transplantation

        The Committee provides $23,282,000 for organ
    transplantation activities, which is $1,131,000 below the
    fiscal year 2005 comparable level and same as 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. Several of the new authorities created in the Organ
    Donation Recovery and Improvement Act are funded in the
    Administration request, including demonstration grants for
    reimbursement of travel and subsistence expenses toward living
    organ donation.
        The Committee encourages the Administration to provide
    priority consideration to hospitals serving rural, medically
    underserved communities and those who have a long history of
    transplant surgery but whose accreditation is in jeopardy due
    to their declining number of transplant surgeries.
        The Committee is encouraged by the continuing success of
    the Organ Donation Breakthrough Collaborative and has included
    funds for its continuation, as requested by the Administration.
    This project is focused on increasing organ donation consent
    rates among the nation's hospitals where the greatest number of
    donors exist. As a result, an additional 4,000 organs annually
    are expected to be made available for transplant.
        The Committee commends HRSA for its leadership in promoting
    increased organ and tissue donations across the nation and
    encourages the Division of Transplantation to continue its
    partnership with the pulmonary hypertension (PH) community in
    this important area. Moreover, the Committee encourages the
    Organ Procurement and Transplantation Network/United Network
    for Organ Sharing to continue to work with the PH community to
    address concerns regarding the methodology used to determine
    transplantation eligibility for PH patients.

    Cord blood bank

        The Committee does not provide additional funding for the
    cord blood program pending the HRSA response to the Institute
    of Medicine report on the structure and administration of such
    a program. $19,800,000 was provided for this purpose in fiscal
    years 2004 and 2005, to remain available until expended. The
    Administration budget did not request funding for fiscal year
    2006.

    Bone marrow program

        The Committee provides $25,416,000 for the bone marrow
    program, which is the same as the fiscal year 2005 comparable
    level and $2,500,000 above the budget request. In addition to
    funding from HRSA in fiscal year 2006, the National Marrow
    Donor Program (NMDP) is expected to receive $17,500,000 from
    the U.S. Navy. Funds are used for donor medical costs, donor
    centers, tissue typing, research, minority recruitment, and
    program administration. The Committee recognizes the important
    life-saving role of the Registry in the lives of thousands of
    Americans. The NMDP, which operates the Registry through a
    contract with HRSA, has facilitated more than 20,000
    transplants since its inception. The Committee understands that
    the Registry lists three sources of blood forming non-embryonic
    stem cells used in transplantation: marrow and peripheral blood
    from adult donors, and umbilical cord blood units. The NMDP now
    lists 5,500,000 potential volunteer, adult donors of marrow and
    peripheral blood stem cells on the Registry. In addition, 17 of
    the 20 public cord blood banks are, or have applied to be, NMDP
    network members. The Committee strongly urges the NMDP to
    continue innovative, technological, and scientific advances in
    non-embryonic cell therapies that have the potential to help
    some of the hundreds of thousands of Americans with leukemia or
    other life threatening blood diseases. The Committee also
    strongly encourages the NMDP to continue the expansion of the
    Registry through its umbilical cord blood program to reduce
    racial and ethnic disparities and improve access for all
    Americans for this lifesaving therapy. The Committee encourages
    the NMDP to implement an education effort on the use of
    umbilical cord blood from all sources to increase donation and
    awareness of this resource. In addition, the Committee supports
    the NMDP's important and expanding role in conducting and
    supporting research to improve the availability, efficiency,
    safety, and cost of transplants and the effectiveness of
    Registry operations; maintaining and expanding its medical
    emergency contingency response capabilities for national
    security; and increasing donor and patient outreach programs,
    especially for minorities and medically underserved population
    groups.

    Trauma care

        The Committee does not provide funding for the trauma care
    program, which is the same as the Administration request and
    $3,418,000 below fiscal year 2005 comparable level. The program
    has provided small grants to States to establish State offices
    to coordinate trauma systems within the States. Almost $17
    million has been provided for these State grants in the past
    five years.

    State planning grants for health care

        The Committee does not provide funding for state planning
    grants, which is $10,910,000 below the fiscal year 2005
    comparable level. The Administration did not request funding
    for this program. The program has made grants to States to
    gather and analyze information on problems of access to health
    insurance within the State and to develop plans for providing
    access to affordable health insurance coverage to all their
    residents. Almost $71 million has been provided for this
    demonstration program in the last five years.

    Rural outreach grants

        The Committee provides $10,767,000 for rural outreach
    grants, which is $28,511,000 below the fiscal year 2005
    comparable level and the same as 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 does not provide funding for rural health
    research, which is $8,825,000 below the fiscal year 2005
    comparable level and $8,528,000 below the budget request. This
    activity supports several rural health research centers and the
    Secretary's rural health advisory committee.

    Rural hospital flexibility grants

        The Committee provides $39,180,000 for rural hospital
    flexibility grants, which is the same as the fiscal year 2005
    comparable level and $39,180,000 above the budget request. The
    program is comprised of two components: (1) flexibility grants
    to States to assist small, at risk rural hospitals that wish to
    convert to Critical Access Hospitals and receive cost-based
    payments from Medicare and (2) small hospital improvement
    grants that provide modest amounts to hospitals to assist them
    in automation and compliance with confidentiality requirements.
    Funding is to be allocated between the two programs consistent
    with the fiscal year 2005 distribution.

    Rural and community access to emergency devices

        The Committee provides $1,960,000 for the public access
    defibrillation demonstration grant program, which is $6,967,000
    below the fiscal year 2005 comparable level and the same as the
    budget request. The program assists both urban and rural
    communities in increasing survivability from sudden cardiac
    arrest by providing funding for the purchase, placement, and
    training in the use of automated external defibrillators
    (AEDs).

    Rural EMS

        The Committee does not provide funding for the new rural
    emergency training and equipment assistance program, which is
    $496,000 lower than the fiscal year 2005 comparable level and
    the same as the budget request. The Committee does not believe
    the program at its current level can provide adequate
    assistance nationwide and believes there are other emergency
    programs funded in the bill that can address some of these
    problems in rural areas.

    State offices of rural health

        The Committee provides $8,223,000 for State offices of
    rural health, which is $98,000 below the fiscal year 2005
    comparable level and the same as the budget request. The State
    office of rural health program creates a focal point for rural
    health within each of the fifty States. In each State, the
    office collects and disseminates information on rural health,
    coordinates rural health resources and activities, provides
    technical assistance to rural providers and communities, and
    helps communities recruit and retain health professionals.

    Denali Commission

        The Committee has not included funding for the Denali
    Commission, which is $39,680,000 below the fiscal year 2005
    comparable level and the same as the budget request.

    Family planning

        The Committee provides $285,963,000 for the family planning
    program, which is the same as the fiscal year 2005 comparable
    level and the budget request. The program provides grants to
    public and private non-profit agencies to support a range of
    family planning and reproductive services, as well as related
    preventive health services such as patient education and
    counseling, breast and cervical cancer examinations, STD and
    HIV prevention education, counseling and testing and referral,
    and pregnancy diagnosis and counseling. The program also
    supports training for providers, an information and education
    program, and a research program which focuses on family
    planning service delivery improvements. The Committee
    encourages HRSA to work with CDC to implement HIV/AIDS testing
    and counseling as a part of the services provided in family
    planning centers.
        The bill repeats language from the 2005 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.

    Health care facilities and other programs

        The Committee has not provided funding for health care
    facilities. A total of $482,729,000 was provided for this
    purpose in fiscal year 2005; 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.

    Bioterrorism hospital grants to States

        The Committee provides $500,000,000 for bioterrorism
    hospital grants to States. The Administration requested
    $510,000,000 for this program in the Public Health and Social
    Services Emergency Fund. Within this total, $472,479,000 is
    provided for hospital preparedness grants and $27,521,000 is
    provided for education incentives for medical school
    curriculum. The Committee intends that these bioterrorism
    activities continue to be coordinated with those in other parts
    of HHS and directs HRSA to work with the Office of the
    Secretary in the development of the Department-wide operating
    plan requested in the Public Health and Social Services
    Emergency Fund section of this report.
        The Committee includes $8,000,000 as requested by the
    Administration within the hospital grants program to continue
    the credentialing emergency system for advance registration of
    volunteer health professionals. The Committee directs HRSA to
    explore expansion of this program to provide cross-State
    information on volunteer health professionals. The Committee
    believes expansion of this ongoing program is preferable to the
    proposed new credentialing program within the Office of the
    Secretary and does not provide funding for that effort.

    Program management

        The Committee provides $145,992,000 for the cost of Federal
    staff and related activities to coordinate, direct and manage
    the programs of the Health Resources and Services
    Administration, which is $1,088,000 below the comparable fiscal
    year 2005 level and the same as the budget request.

                   HEALTH EDUCATION ASSISTANCE LOANS PROGRAM

        The Health Education Assistance Loans (HEAL) program
    insured loans provided by non-Federal lenders to students in
    health professions schools. Under the accounting rules
    established in the Budget Enforcement Act of 1990, one account
    is maintained to pay the obligations arising from loans
    guaranteed prior to fiscal year 1992. A second account pays
    obligations and collects income from premiums on loans
    guaranteed in fiscal year 1992 and beyond. Each annual cohort
    of loans is independently tracked in this account. The
    authority for this program expired in fiscal year 1999. Fiscal
    year 1998 was the last year in which loans were obligated to
    previous borrowers under the HEAL authority.
        The Committee provides $4,000,000 to liquidate obligations
    from loans guaranteed prior to 1992, which is the same as
    fiscal year 2005 level and the budget request.
        The Committee provides $2,916,000 for HEAL program
    management, which is $328,000 below the fiscal year 2005
    comparable level and the same as the budget request.

                  NATIONAL VACCINE INJURY COMPENSATION PROGRAM

        The Committee makes available the release of $74,384,000
    from the Vaccine Injury Compensation Trust Fund in fiscal year
    2006, which is $5,233,000 above the fiscal year 2005 level and
    $668,000 above 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 $3,500,000 in costs incurred
    by the agency in the operation of the program, which is
    $349,000 above the comparable fiscal year 2005 level and
    $668,000 above the budget request.

                          Centers for Disease Control

                     DISEASE CONTROL, RESEARCH AND TRAINING

        The Committee provides a program level of $6,103,786,000
    for the Centers for Disease Control and Prevention (CDC), which
    is $294,781,000 below the fiscal year 2005 comparable level and
    $181,000,000 above the comparable request. Of the funds
    provided, $157,795,000 shall be derived from evaluation set-
    aside funds available under Section 241 of the Public Health
    Service Act, as proposed in the request.
        The Committee notes that it has included the $1,616,723,000
    requested for CDC Terrorism Preparedness and Response within
    this account. These funds were provided in fiscal year 2005,
    and requested by the President for fiscal year 2006, within the
    Public Health and Social Services Emergency Fund.
        The budget request included an information technology
    reduction of $10,000,000, which is realized in project-specific
    areas across CDC's budget. The Committee recommendation assumes
    the realization of these savings, including the reduction of
    $4,903,000 in information technology efficiencies within HIV/
    AIDS, STD and TB Prevention activities within Infectious
    Diseases.
        The CDC assists State and local health authorities and
    other non-governmental health-related organizations to
    understand, control, and reduce disease and other health
    problems affecting their people and communities. 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 public health infrastructure to
    insure our national security against bioterrorist threats,
    promoting health throughout each life-stage, 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
    and the numbers identified in the paragraphs that follow to be
    determinative of the CDC budget. Funds should be apportioned
    and allocated accordingly, and any changes in funding are
    subject to the normal reprogramming and notification
    procedures.

                              INFECTIOUS DISEASES

        The Committee provides a program level of $1,717,323,000
    for infectious diseases, which is $34,434,000 above the fiscal
    year 2005 comparable level and $7,565,000 above the request. Of
    the funds provided, $12,794,000 shall be derived from
    evaluation set-aside funds available under Section 241 of the
    Public Health Service Act, as proposed in the request.

    Infectious diseases control

        The Committee provides $229,471,000 for infectious diseases
    control, which is $3,882,000 above the fiscal year 2005
    comparable level and $4,710,000 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.
        Botulinum Neurotoxin Research.--The Committee understands
    that botulinum neurotoxin is one of the most toxic substances
    known to mankind and that a recent technological breakthrough,
    using fluorescent sensors, may for the first time enable the
    detection of neurotoxin activity in a person's body and in
    living cells on a near real-time basis. The Committee
    encourages CDC to evaluate, develop, and validate the
    fluorescence resonance energy transfer assay for the detection
    of botulinum toxins to meet its mission requirements, and to
    incorporate it into its bioterrorism preparedness program. The
    Committee also encourages CDC to continue to investigate new
    and advanced methods for measuring botulinum toxins and other
    toxins using mass spectrometry.
        Emerging Infectious Diseases.--The Committee provides
    $102,650,000 to support CDC's emerging infectious disease
    activities, which is $3,498,000 above fiscal year 2005.
        Hepatitis.--The Committee has included $17,912,000 to
    support activities of the Viral Hepatitis Division and to
    implement the National Hepatitis C Prevention Strategy. The
    Committee urges that this funding be focused on supporting the
    capability of state health departments, particularly to
    maintain resources available to the hepatitis C state
    coordinators.
        The Committee is concerned that more than 75% of the 4
    million HCV positive individuals are unaware of their condition
    and therefore urges a public education campaign to urge
    appropriate screening and medical follow up of target
    populations. The Committee also is concerned with increasing
    rates of adult infections of Hepatitis A & B and urges an
    expanded vaccination program be launched in response to this
    critical public health issue. Finally, CDC is encouraged to
    focus on education and awareness programs targeted at specific
    populations where there is a high prevalence of hepatitis B and
    where therapeutic interventions are increasingly effective.
        Meningococcal Disease.--Meningococcal disease is one of the
    few diseases that can be fatal or severely debilitating to a
    victim within a matter of hours of initial onset and yet is
    vaccine-preventable in most cases. The Committee is aware of
    the recent improvements in the meningitis vaccine and of recent
    CDC efforts to increase the availability and focus of
    information on meningococcal disease and ways to prevent it so
    that the general public will be better educated on the symptoms
    and prevention methods. The Committee encourages the CDC to
    improve meningicocccal education and adolescent immunization
    programs, including giving consideration to partnering with
    relevant professional and voluntary health associations to
    ensure that all families, especially those with adolescents and
    young adults, are effectively educated on this disease, vaccine
    availability, and all methods of prevention.
        Prion Disease.--Within the funds provided, not less than
    $5,500,000 is for activities related to Prion diseases,
    including the work of the National Prion Disease Pathology
    Surveillance Center.
        Sepsis.--The Committee is aware that sepsis kills more than
    215,000 Americans every year. Despite new, increasingly
    effective treatments and a new diagnosis protocol, sepsis
    remains a leading cause of death because too few medical
    personnel know how to identify and diagnose it. The Committee
    applauds the CDC's ongoing demonstration program to reduce
    hospital-based transmission of sepsis and other infections, but
    recognizes that significant reductions in morbidity and
    mortality could be achieved through improved, timely diagnosis
    and treatment. Within the funds provided, the Committee
    encourages CDC to consider establishing an education program to
    train critical care nurses, emergency room physicians, and
    infectious disease specialists, especially those in rural and
    traditionally underserved areas, in use of the new protocol to
    identify sepsis and improve patient outcomes. The Committee
    encourages CDC to work towards this end in collaboration with
    the relevant voluntary health organizations, such as the
    American Sepsis Alliance.
        West Nile Virus.--Within the funds provided, not less than
    $37,809,000 is for activities to detect, prevent and control
    the West Nile Virus.

    HIV/AIDS, STD and TB prevention

        The Committee provides $956,138,000 for HIV/AIDS, STD and
    TB prevention, which is $4,573,000 below the fiscal year 2005
    comparable level and $145,000 below the request. Of the amount
    provided, $657,694,000 is for HIV/AIDS programs (the same as
    the request); $159,633,000 is for the STD program; and
    $138,811,000 is for the TB program. The Committee
    recommendation assumes the $4,903,000 in information technology
    savings proposed in the budget within HIV/AIDS, STD and TB
    Prevention activities.
        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.
        Minority HIV/AIDS Initiative.--Within the total provided,
    not less than the fiscal year 2005 amount is provided 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.
        Partner Notification.--The Committee supports CDC's efforts
    to require state, territorial, and municipal grantees of HIV/
    AIDS prevention programs to conduct partner counseling and
    referral services of newly diagnosed individuals, with strong
    linkages to prevention and care services. The Committee
    understands that all states, territories, and large cities with
    HIV/AIDS prevention cooperative agreements with CDC must
    provide partner notification and counseling services. The
    Committee encourages CDC to ensure that all grantees are in
    compliance with this requirement.
        Tuberculosis.--The Committee understands that the CDC plans
    to undertake a new initiative, the Intensified Support and
    Activities to Accelerate Control (ISAAC). ISAAC targets
    tuberculosis in African Americans, tuberculosis along the U.S./
    Mexico border, allows for universal genotyping of all culture
    positive TB cases, and expands clinical trials for new tools
    for the diagnosis and treatment of TB. The Committee encourages
    the CDC to implement ISSAC to enhance and maximize strategies
    to accelerate the control and elimination of TB.
        Tuberculosis is an enormous public health crisis in the
    developing world, killing millions of people in the prime of
    their lives every year. To help stem this growing pandemic, the
    Committee encourages CDC to enhance ongoing efforts involving
    the TB vaccine research cooperative agreement.

    Immunization

        The Committee provides a program level of $531,714,000 for
    immunization, which is $38,126,000 over the fiscal year 2005
    comparable level and $3,000,000 above the request. Of the
    amount provided, $12,794,000 is to be derived from section 241
    evaluation set-aside funds, as proposed in the request. In
    addition, the Vaccines for Children (VFC) program is expected
    to provide $1,502,333,000 in vaccine purchases and distribution
    support in fiscal year 2005, for a total of $2,034,047,000 for
    immunization activities in fiscal year 2006.
        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.
        Immunization Safety.--The committee commends the CDC for
    moving the Immunization Safety Branch (ISB) out from under the
    National Immunization Program (NIP) to the office of the
    Director of Science. This is a positive step. The committee
    urges the CDC to carefully review and implement the
    recommendations in the Institute of Medicine report: Vaccine
    Safety Research, Data Access and Public Trust. The Committee is
    particularly interested in the CDC prioritizing IOM
    recommendations that the CDC (1) establish an independent
    oversight board to review CDC's vaccine safety research agenda,
    study protocols, and changes in study protocols, and (2)
    initiate conversations with Managed Care Organizations involved
    in the Vaccine Safety Datalink to ensure that independent
    researchers have access to all VSD data, particularly post-2000
    data through the National Center for Health Statistics.
        Vaccine Safety Research.--The Committee recognizes the
    importance of directing additional funding toward vaccine
    safety research, specifically funding to develop better
    screening methods for children at risk for serious adverse
    reactions. The Committee recommendation includes $3,000,000
    above the request for the CDC to expand funding for vaccine
    safety research, particularly with respect to investigator
    initiated, peer-reviewed, extramural research. Furthermore, the
    Committee urges that this funding be used for non-epidemiology
    research, to better understand risk factors for serious adverse
    reactions, to develop screening tools to eliminate from
    vaccination those children at greater risk for such reactions,
    and to develop effective treatments and interventions for
    children suffering severe adverse reactions.

                                HEALTH PROMOTION

        The Committee provides $983,647,000 for health promotion,
    which is $38,062,000 below the fiscal year 2005 comparable
    level and $19,226,000 above the request.

    Chronic disease prevention and health promotion

        The Committee provides $856,468,000 for chronic disease
    prevention and health promotion, which is $40,665,000 below the
    fiscal year 2005 comparable level and $15,610,000 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 supports research and programs to
    prevent the leading causes of death and disability (e.g., heart
    disease and stroke, cancer, diabetes, and arthritis) that 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.
        The Committee urges the CDC to examine ways of maximizing
    the federal investments in prevention, such as incorporating
    performance measures into state and local health department
    cooperative agreements where they may not currently exist,
    including incentives or requirements for state and local
    matches of federal funds, and/or streamlining funding
    mechanisms to focus on common risk factors among the leading
    chronic conditions.
        Within the total provided, the Committee includes the
    following amounts for chronic disease prevention and health
    promotion activities: $46,120,000 for heart disease and stroke,
    $1,502,000 above fiscal year 2005; $64,960,000 for diabetes,
    $1,503,000 above fiscal year 2005; $312,600,000 for Cancer
    Prevention and Control, $2,895,000 above fiscal year 2005
    (including not less then $204,425,000 for the National Breast
    and Cervical Cancer Early Detection program); $22,920,000 for
    Arthritis and Other Chronic Diseases, $433,000 above fiscal
    year 2005; $104,370,000 for Tobacco, $25,000 above fiscal year
    2005; $41,930,000 for Nutrition and Physical Activity, the same
    as fiscal year 2005; $25,870,000 for Health Promotion, $276,000
    below fiscal year 2005; $56,760,000 for School Health, $14,000
    above fiscal year 2005; $44,740,000 for Safe Motherhood/Infant
    Health, the same as fiscal year 2005; $12,000,000 for Oral
    Health, $796,000 above fiscal year 2005; $29,700,000 for
    Prevention Centers, the same as fiscal year 2005; $11,200,000
    for Verb, $47,595,000 below fiscal year 2005; $44,300,000 for
    Steps for a Healthier U.S., $24,000 above fiscal year 2005;
    $34,513,000 for REACH, the same as fiscal year 2005; and
    $4,485,000 for Genomics.
        Adolescent Health.--The Committee encourages the CDC to
    maintain a focus on public health issues confronting
    adolescents, including maintaining support of the National
    Network of State Adolescent Health Coordinators (NNSAHC) Annual
    Meeting, which brings together specific expertise on the health
    issues that face adolescents and on the special programmatic
    considerations for this population.
        Alzheimer's disease.--A growing body of evidence suggests
    that many of the same strategies that preserve overall health
    may also help prevent or delay the onset of Alzheimer's disease
    and dementia. In fiscal year 2005, CDC, in cooperation with the
    Alzheimer's Association, launched a new program aimed at
    educating the general public and health professionals on ways
    to reduce the risks of developing Alzheimer's disease by
    maintaining a healthy lifestyle. The Committee supports this
    initiative and urges CDC to consider expanding it within the
    funds made available for fiscal year 2006.
        Breast and Cervical Cancer Screening.--The Committee
    commends the CDC for creating partnerships to address the early
    detection of breast cancer, particularly in historically
    underserved communities, including the Native American,
    Hispanic and African American populations. As part of this
    initiative, the Committee is very interested in the innovative
    approach of the Men Against Breast Cancer Partners In Survival
    Program focusing on the role of the male support-giver as an
    integral component of the early detection, patient care and
    survivorship of breast cancer. The Committee encourages CDC's
    continued support of programs of this type that might also have
    secondary benefits, such as greater participation of the male
    support-giver in their own health management, including early-
    detection and health screening activities.
        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 the CDC to continue to expand its
    partnerships with state health departments, professional and
    patient organizations, and private industry to combat this
    devastating disease.
        Cancer Survivorship.--The Committee supports the ongoing
    partnership between CDC and the Lance Armstrong Foundation
    (LAF) to address the needs of the nearly 10 million cancer
    survivors. The Committee encourages CDC to enhance support for
    the Live Strong, National Cancer Survivorship Resource Center,
    to serve cancer survivors and their families across the
    country.
        Diabetes.--The Committee commends CDC for implementation of
    SEARCH, a pilot study to determine the incidence and prevalence
    of diabetes in youth under the age of 20 years in six locations
    around the United States. The Committee encourages the CDC to
    consider developing a plan to use the information gathered from
    SEARCH to create a national registry of patients afflicted with
    juvenile diabetes. In addition, the Committee urges the CDC to
    examine the feasibility of collecting information about the
    standard of care available to people with diabetes nationwide
    and consider making samples from this study available to the
    research community. CDC should be prepared to report to the
    Committee on these issues during the fiscal year 2007 budget
    hearings.
        Epilepsy.--The Committee provides $8,000,000 for Epilepsy
    activities, which is $440,000 above fiscal year 2005. The
    Committee supports the CDC's epilepsy program and applauds the
    collaboration the Agency developed with the Epilepsy Foundation
    in crafting the recommendations of Living Well With Epilepsy
    II. The Committee encourages CDC to maintain support for
    ongoing epilepsy public health programs as well to begin
    implementation of the new recommendations from Living Well With
    Epilepsy II as funds become available. It is also expected that
    CDC be prepared to report on the current results on
    implementation of those recommendations and future plans,
    including those involving coordination with other agencies,
    during the fiscal year 2007 budget hearings.
        Genomic Medicine.--The Committee understands that steps
    need to be taken now to prepare the public health system for
    the expected widespread future use of genetic technologies in
    healthcare. The Committee encourages CDC to move forward
    aggressively with the creation and implementation of
    partnerships with industry and the nonprofit sector to achieve
    the widest benefits from the coming era of genomic medicine.
        Heart Disease and Stroke.--The Committee understands that
    the CDC is creating a Heart Disease and Stroke Division to
    consolidate and elevate its efforts to prevent and control
    heart disease, stroke and other cardiovascular diseases and is
    supportive of this effort. The Committee supports the goal of
    implementing statewide heart disease and stroke prevention
    programs and urges the CDC to maintain and expand its support
    for these activities within the funds provided for fiscal year
    2006.
        Infertility Prevention.--The Committee understands that
    there are other causes of infertility beyond sexually
    transmitted diseases, such as delayed child bearing, smoking,
    low or excessive body weight, exposure to hazardous
    environmental toxins, drug and alcohol abuse and, particularly
    for men, exposure to high temperatures. The Committee
    encourages CDC to consider expanding the scope of the Agency's
    efforts regarding the prevention of infertility and to
    providing greater support to public education on the broader
    risks to fertility.
        Inflammatory Bowel Disease.--In fiscal year 2005, the
    Committee provided funds to continue a national IBD
    epidemiology program established through a partnership between
    CDC and the Crohn's and Colitis Foundation of America. The
    Committee encourages the CDC to continue this initiative in
    fiscal year 2006.
        Interstitial Cystitis (IC).--The Committee is pleased by
    the establishment of a cooperative agreement between the CDC
    and the Interstitial Cystitis Association and has provided
    sufficient funds to continue the campaign to educate the public
    and professional community about IC.
        Kidney Disease.--The Committee urges the CDC to develop the
    capacity and infrastructure for a kidney disease surveillance,
    epidemiology, and health outcomes program, including awarding
    grants to support several state-based demonstration projects
    for chronic kidney disease prevention and control. Furthermore,
    the Committee urges CDC, in partnership with the relevant
    national voluntary health organization, or organizations,
    convene a consensus conference of experts in the area of kidney
    disease and other stakeholders to lay the groundwork for a
    formal Public Health Kidney Disease Action Plan for prevention
    and control of kidney disease. The Committee provides
    $1,800,000 to undertake this initiative.
        Oral Health.--The Committee is concerned about the rising
    obesity rate among America's youth. Some eating habits can
    adversely affect not only body weight but also oral health. The
    Committee understands that the dental community has developed
    some instructional materials and encourages the CDC to work
    with the American Dental Association in producing an
    instructional video for school-aged children on the harmful
    effects of excessive consumption of high sugar products, such
    as soda.
        Obesity Prevention.--The multiple factors contributing to
    the overweight and obesity epidemic took years to develop.
    Reversing the epidemic will require a long-term, well-
    coordinated, concerted approach to reach Americans were they
    live, work, play, and pray. Effective collaboration among the
    public, voluntary, and private sectors is critical to reshape
    the social and physical environment of our nation's communities
    and provide the necessary support, information, tools, and
    realistic strategies needed to reverse the current obesity
    trends nationwide.
        To reduce consumer confusion about the myriad of health
    messages about obesity, diabetes, and cardiovascular disease,
    the Committee strongly urges CDC to design and develop
    mechanisms for fast-tracked translation of research into
    reasoned guidance for the American public.
        In addition, the Committee urges CDC to develop evidenced-
    based recommendations on body fat measurement to be used in the
    evaluation of obesity prevention programs.
        The Committee also is very concerned about the adverse
    health toll that the twin epidemics of diabetes and obesity are
    taking on the health of minorities. The Committee encourages
    CDC to collaborate with organizations directed by and serving
    individuals from communities with disproportionate diabetes and
    obesity rates to ensure that the Agency's prevention efforts
    effectively reach all communities.
        To prevent unhealthy weight gain and maintain healthy
    weight among children and adolescents, CDC is urged to work
    with the U.S. Department of Education to issue a report with
    recommendations about reintroducing school physical education
    into the school day.
        Finally, the Committee supports research into the link
    between disadvantaged or physically and sexually abused youth,
    and obesity programs that target the physical health of
    children who have been abused and are in treatment programs.
    The CDC is encouraged to partner with organizations that treat
    or otherwise serve youth who have been abused in efforts to
    identify links between abuse and obesity and programs to
    address childhood obesity among this population.
        Osteoporosis.--The Committee is aware of the report issued
    by the Surgeon General on Bone Health and Osteoporosis
    requested in the fiscal year 2002 Appropriations bill. In the
    report, the Surgeon General calls for a national action plan
    for bone health. The Committee urges the CDC to consider
    supporting the development of an action plan and to ensure that
    all relevant federal agencies and public and private
    stakeholders, including the National Osteoporosis Foundation,
    be involved in the development of any such plan.
        Pulmonary Hypertension.--The Committee continues to be
    interested in pulmonary hypertension (PH), a rare, progressive
    and fatal disease that predominantly affects women, regardless
    of age or race. Because early detection of PH is critical to a
    patient's survival and quality of life, the Committee continues
    to encourage CDC to work in partnership with the pulmonary
    hypertension community to foster greater awareness of the
    disease.
        REACH.--The Committee recognizes the strengths that
    national/multi-geographical minority organizations can provide
    to the REACH Initiative. Such organizations often have the
    capacity to influence communities through coalitions and
    collaborative relationships that have already been established
    and provide essential support to local organizations that may
    lack the infrastructure needed to implement the full scale of
    programmatic activities required for this important program.
    The Committee urges CDC to include such organizations among the
    entities that are eligible to compete for funding without
    preventing other applicants from receiving these grants.
        School Health.--The Committee urges the CDC to prioritize
    obesity prevention in proportion to its burden on childhood and
    adolescent health through the Division of Adolescent School
    Health (DASH). CDC should urge states to use existing program
    funds to address this critical epidemic.
        Sleep Disorders.--The Committee remains concerned about the
    prevalence of sleep disorders and recognizes the need for
    enhanced public and professional awareness on sleep and sleep
    disorders. The Committee encourages CDC to work with other
    agencies, such as the National Center on Sleep Disorders
    Research, and voluntary health organizations, such as the
    National Sleep Foundation, to support the development of a
    sleep education and public awareness initiative.
        VERB.--The Committee provides $11,200,000 for the Verb
    program, a national multi-ethnic media campaign that promotes
    regular physical activity among youth ages 9-13. The campaign
    was launched in June 2002. Evaluation results over the first
    two years show that the Verb campaign has contributed to higher
    levels of physical activity among targeted youth. The funds
    provided for fiscal year 2006 are to be used to augment funding
    available in fiscal year 2005 in order to secure a national
    media program commensurate with the first three years of the
    program.
        Vision Screening and Education.--The Committee commends CDC
    for its partnership with a leading voluntary health association
    dedicated to fighting blindness and saving sight, to improve
    education and early detection of potentially blinding eye
    diseases and encourages CDC to continue and expand this
    partnership. Despite the fact that half of all blindness can be
    prevented through education, early detection and treatment, it
    is estimated that the number of blind and visually impaired
    people will double by 2030 if nothing is done to curb vision
    problems. To address this growing public health problem, the
    Committee provides $2,500,000 to enhance the CDC national
    vision screening and education program and the CDC partnership
    with Prevent Blindness America.

    Birth defects, developmental disabilities, disability and health

        The Committee provides $127,179,000 for birth defects,
    developmental disabilities, disability and health, which is
    $2,603,000 above the fiscal year 2005 comparable level and
    $3,616,000 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, the Committee provides the following
    amounts for birth defects, developmental disabilities,
    disability, and health activities: $39,130,000 for birth
    defects and developmental disabilities, which is $109,000 below
    fiscal year 2005; $67,868,000 for Human Development and
    Disability, which is $2,757,000 above fiscal year 2005; and
    $20,180,000 for Hereditary Blood Disorders, which is $46,000
    below fiscal year 2005.
        Alpha-1 Antitrypsin Deficiency.--The Committee is aware
    that Alpha-1 Antitrypsin Deficiency (Alpha-1) is the major
    genetic risk factor for Chronic Obstructive Pulmonary Disease
    (COPD) and cryptogenic liver disease. Early detection allows
    individuals to engage in preventative health measures and
    receive appropriate therapies that significantly improve their
    health status. The Committee encourages CDC to consider
    collaborating with appropriate patient and professional
    organizations, such as the Alpha-1 Foundation, to actively
    support Alpha-1 targeted detection efforts that utilize public
    and professional education regarding obstructive lung disease,
    both genetic and tobacco related.
        Attention Deficit/Hyperactivity Disorder (AD/HD).--The
    Committee continues to support the National Resource Center on
    AD/HD and has provided sufficient funds in fiscal year 2006 to
    continue the activities at the Center, such as responding to
    requests for information and support services; reaching out to
    special populations in need; and educating health and education
    professionals on AD/HD.
        Autism.--The Committee is aware of the progress that has
    been made with the autism programs. The Committee acknowledges
    the importance of this work by the CDC in the area of autism
    surveillance and research, and urges this work to continue in a
    timely manner. Within funds provided, $15,500,000 is for autism
    activities, which is $627,000 above fiscal year 2005. Within
    that amount, $14,900,000 is provided for surveillance and
    research programs including the CADDRE and ADDM Network. The
    Committee is pleased to see the work being done in the area of
    the national awareness campaign and provides $600,000 for the
    Center to expand its work on this initiative.
        Birth Defects Surveillance, Research and Prevention.--The
    Committee commends the CDC's work in the area of birth defects
    surveillance, research and prevention and encourages the CDC to
    continue its support for birth defects related programs.
        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. Six
    treatment centers throughout the nation handle the medical
    monitoring and treatment; the Cooley's Anemia Foundation
    provides education and awareness, patient recruitment, and
    other services; and, CDC has created an archive of tested and
    analyzed blood samples. As the program moves forward and start-
    up costs are met, the Committee expects CDC to direct an
    increasing amount of the funds available to education and
    awareness, patient recruitment and other services.
        Down Syndrome.--The Committee understands that CDC has
    undertaken a study to estimate the number of people in the
    United States living with Down syndrome and identify them by
    age and ethnic group and that it is expected to have
    preliminary estimates of prevalence of Down syndrome among
    children and adolescents by the end of fiscal year 2005. The
    Committee further understands that a second study, to document
    the onset and course of secondary and related developmental and
    mental disorders in individuals with Down syndrome, will be
    initiated by the end of this fiscal year. The Committee
    recognizes the importance of this research and has provided
    sufficient funding to further develop the study relating to the
    onset of secondary and related developmental mental disorders
    in fiscal year 2006.
        Duchenne and Becker Muscular Dystrophy.--The Committee
    remains concerned with the pace of the development of the CDC
    Birth Defects Surveillance program covering the muscular
    dystrophies and is aware that the agency has made the
    commitment to enhance the internal staff commitment to the
    program. The Committee is encouraged by that new commitment and
    expects that CDC dedicate its efforts to organize, coordinate
    and implement the agency's Duchenne MD surveillance program.
    The Committee provides $7,000,000 for fiscal year 2006, which
    is $1,073,000 above fiscal year 2005. Within that amount, the
    Committee recommends that $750,000 be used to continue a
    coordinated education and outreach initiative through the
    Parent Project Muscular Dystrophy. Finally, the Committee
    requests that the CDC develop and submit to the Committees on
    Appropriations in the House and Senate by June 1, 2006 a five-
    year strategic plan for the Duchenne and Becker Muscular
    Dystrophy programs.
        Early Hearing Detection and Intervention.--Within the total
    provided, $7,000,000, $839,000 over fiscal year 2005, is
    designated for the Early Hearing Detection and Intervention
    (EHDI) program for newborns, infants and young children with
    hearing loss. Currently, 32 states are in the midst of
    completing projects funded through Cooperative Agreements from
    CDC to assist in developing strong surveillance and tracking
    systems to ensure that infants referred from newborn hearing
    screening programs receive appropriate and timely diagnostic
    and early intervention services. The Committee is concerned
    that about one-third of the babies who are referred from
    hearing screening programs do not receive diagnostic
    evaluations by the time they are 3 months of age. Moreover,
    only about half of the infants and toddlers diagnosed with
    hearing loss are enrolled in appropriate early intervention
    programs by 6 months of age. The Committee believes that
    increased funding is required to ensure that states develop
    appropriate surveillance and tracking systems to provide timely
    and appropriate diagnostic and intervention services to infants
    and toddlers.
        Funding may also be used to support applied research
    projects related to increasing the accuracy of newborn hearing
    screening, improving the effectiveness of tracking and
    surveillance programs, determining the etiology and
    epidemiology of childhood hearing loss, and analyzing the costs
    and benefits of such programs. The Committee encourages CDC to
    assist states in clarifying how EHDI surveillance, tracking,
    and data management programs are affected by the Health
    Insurance Portability and Accountability Act and the Family
    Education Rights and Privacy Act
        To avoid duplication and interference, the Committee urges
    CDC to coordinate projects funded with this appropriation with
    EHDI projects conducted by the Health Resources Services
    Administration, the National Institute on Deafness and Other
    Communication Disorders, the National Institute on Disability
    and Rehabilitation Research, and the Office of Special
    Education and Rehabilitative Services.
        Fetal Alcohol.--The Committee is concerned about the
    prevalence of Fetal Alcohol Syndrome (FAS) in the United States
    and notes that drinking during pregnancy is the nation's
    leading known preventable cause of mental retardation and birth
    defects. The Committee commends the U.S. Surgeon General for
    releasing an updated advisory in February, 2005, on alcohol use
    in pregnancy, urging women who are pregnant or who may become
    pregnant to abstain from alcohol. The Committee urges CDC to
    work with partner organizations, such as the National
    Organization on Fetal Alcohol Syndrome, to generate awareness
    of the Surgeon General's new FAS prevention advisory,
    especially among high-risk communities.
        Folic Acid.--The Committee provides $2,400,000 to support
    and expand the folic acid educational campaign, which is
    $212,000 above fiscal year 2005. The Committee is pleased since
    fortification of U.S. grain products with folic acid, the rate
    of neural tube defects has decreased by 26% and encourages CDC
    to enhance the national campaign to increase the number of
    women taking folic acid daily. The Committee also encourages
    CDC to continue to support collaboration among the states on
    issues related to surveillance, research and prevention through
    support of the National Birth Defects Prevention Network.
        Fragile X.--The Committee is encouraged by the CDC's
    progress in establishing a Fragile X public health program to
    expand surveillance and epidemiological research of Fragile X,
    as well as provide patient and provider outreach on Fragile X
    and other developmental disabilities. The Committee has
    provided sufficient funding to support the continuation of
    these activities.
        Hemophilia.--The Committee supports CDC's efforts, in
    collaboration with the National Hemophilia Foundation, to carry
    out needed education, prevention, blood safety surveillance,
    and outreach programs for the millions of people in the United
    States affected by bleeding and clotting disorders, including
    hemophilia, women's bleeding disorders, and thrombophilia. The
    Committee recognizes the strain these additional efforts place
    on the national hemophilia treatment center network. Within the
    resources provided, the Committee urges CDC to enhance its
    support where possible of the network to ensure continued
    access to this comprehensive chronic care model for all persons
    with bleeding and clotting disorders.
        Hereditary Hemorrhagic Telangiectasia (HHT).--The Committee
    is aware of interest in the establishment of an HHT National
    Resource Center through a partnership between the CDC and the
    national voluntary agency representing HHT families. The
    Committee encourages the CDC to examine carefully proposals to
    establish such a center and give every appropriate
    consideration to supporting it within the funds provided.
        Limb Loss Information Center.--The Committee recognizes
    that one of the greatest challenges facing individuals with
    limb loss is access to necessary health and rehabilitative
    services. The Committee applauds CDC for its partnerships with
    governmental, academic and voluntary health organizations, such
    as the Amputee Coalition of America, to advance the quality of
    life through research and support programs for people living
    with limb loss. The Committee continues to strongly support the
    CDC's resource and information center which assist individuals
    living with disabilities, and their families, in need of
    information on medical, physical, and emotional needs, and
    resources and support to reintegrate socially and economically
    into society. The Committee urges CDC to continue its support
    of the Center at no less than the fiscal year 2005 level.
        Spina Bifida.--The Committee provides $5,300,000, which is
    $475,000 above fiscal year 2005 for the National Spina Bifida
    Program in coordination with its external partners, such as the
    Spina Bifida Association of America. The Committee continues to
    support the partnerships CDC has developed and encourages CDC
    to allocate a portion of the increase provided for the
    maintenance and expansion of the National Spina Bifida
    Clearinghouse and Resource Center. In addition, the Committee
    supports the Memorandum of Understanding between CDC and the
    Agency for Healthcare Research and Quality to examine clinical
    treatment of Spina Bifida and improve quality of life.
        The Committee recognizes that the Agent Orange database of
    health and educational services composes the largest repository
    of longitudinal treatment information of people with Spina
    Bifida and can provide much-needed insight and understanding
    into the needs of people with Spina Bifida. The Committee
    commends the CDC and the Department of Veterans Affairs for
    their collaborative efforts to review and analyze the Agent
    Orange database to gain better understanding of the treatment,
    educational, and vocational benefits needs and utilization by
    people with Spina Bifida. The Committee encourages the on-going
    collaboration to analyze this data and requests a report
    summarizing the analysis of the data, including recommendations
    based on the analysis as to how to improve treatment and
    quality-of-life for people with Spina Bifida.
        Tourette Syndrome.--The Committee commends CDC for its work
    regarding Tourette Syndrome and supports the continuation of
    its external partnership with the Tourette Syndrome Association
    to develop and implement a public health education and research
    program. The Committee provides $1,800,000 for fiscal year 2006
    to continue to educate parents, physicians, educators and other
    health care workers about Tourette Syndrome disorder and to
    expand on the scientific knowledge base on prevalence, risk
    factors and co-morbidities of Tourette Syndrome. The Committee
    intends that these resources be used to support the existing
    partnership.
        Tuberous Sclerosis Complex.--Tuberous sclerosis complex
    (TSC) is a genetic disorder that causes uncontrollable tumor
    growth. Because this disorder can affect multiple organs of the
    body, it is difficult to diagnose, track and properly treat.
    The Committee is aware of interest in developing a joint
    initiative between the CDC and a relevant voluntary health
    organization, such as the Tuberous Sclerosis Alliance, to
    collect and analyze data from the nationwide network of TSC
    clinics; support surveillance and epidemiological studies; and
    to educate health care professionals and teachers who come into
    contact with TSC patients. The Committee encourages the CDC to
    examine the feasibility of undertaking this initiative from
    within the funds provided.
        Vision Loss.--The Committee is aware of interest in the
    creation of a National Information Center on Vision Loss to
    address the need for appropriate public health information to
    prevent further impairment and disability among individuals who
    are blind or who have low vision. The Committee encourages CDC
    to consider this proposal, including partnering with a national
    non-profit organization that is recognized for leadership in
    providing information to persons who are blind or visually
    impaired, including published resource guides, directories of
    services for consumers in the field, scholarly journals on
    blindness and vision loss, assistive technology magazines, and
    talking books.

                         HEALTH INFORMATION AND SERVICE

        The Committee provides a program level of $223,799,000 for
    Health Information and Service, which is $4,874,000 below the
    fiscal year 2005 comparable level and the same as the request.
    Within the total, $28,730,000 is to be derived from section 241
    evaluation set aside funds and is included to carry out
    National Center for Health Statistics surveys, Public Health
    Informatics evaluations, and health marketing evaluations.

    Health statistics

        The Committee provides a total of $109,021,000 for health
    statistics, which is the same as the fiscal year 2005
    comparable level and the request. Within the amount provided
    $3,516,000 shall be derived from section 241 evaluation set-
    aside funds, as proposed in the request.
        The Health Statistics program is responsible for
    collecting, interpreting, and disseminating data on the health
    status of the U.S. population and the use of health services.
    Surveys include the National Vital Statistics System, the
    National Health Interview Survey, the National Survey of Family
    Growth, the National Health and Nutrition Examination Survey,
    and the National Health Care Survey.
        Chronic Obstructive Pulmonary Disease.--Chronic Obstructive
    Pulmonary Disease (COPD) is the fourth leading cause of death
    in the United States and the only one of the top ten causes of
    death that is on the increase. The Committee urges the CDC to
    expand its data collection efforts on COPD. Specifically, the
    Committee encourages the CDC to include questions on COPD in
    the National Health and Nutrition Examination Survey, the
    National Health Interview Study and the Behavioral Risk Factor
    Surveillance Survey that asks about COPD by name.
        Nontuberculous Mycobacteria.--The Committee is concerned
    that Nontuberculous Mycobacteria [NTM] incidence continues to
    rise. Mycobacteria are environmental organisms found in both
    water and soil that cause significant respiratory damage. The
    Committee encourages NCHS to include questions regarding NTM
    testing in ongoing surveys to gain a better understanding of
    the epidemiology of this emergent disease.

    Informatics and Health Marketing

        The Committee provides a total of $114,778,000 for
    informatics and health marketing, which is $4,874,000 below the
    fiscal year 2005 comparable level and the same as the request.
    Within the total, $25,214,000 shall be derived from section 241
    evaluation set-aside funds, as proposed in the request.

                   ENVIRONMENTAL HEALTH AND INJURY PREVENTION

        The Committee provides $285,721,000 for environmental
    health and injury prevention, which is the same as the fiscal
    year 2005 comparable level and $901,000 above the request.

    Environmental health

        The Committee provides $147,483,000 for environmental
    health, which is the same as fiscal year 2005 comparable level
    and $595,000 above the request.
        Asthma.--The Committee is pleased with the work that the
    CDC has done to address the increasing prevalence of asthma.
    However, the increase in asthma among children remains
    alarming. The Committee urges CDC to expand its outreach aimed
    at increasing public awareness of asthma control and prevention
    strategies, particularly among at-risk populations in
    underserved communities. To further facilitate this effort, CDC
    is urged to partner with relevant voluntary health
    organizations, such as the American Lung Association, to
    support program activity consistent with the CDC's efforts to
    fund community-based interventions that apply effective
    approaches demonstrated in research projects within the
    scientific and public health community.
        Biomonitoring.--The CDC's National Report on Human Exposure
    to Environmental Chemicals is a significant new exposure tool
    that provides invaluable information for setting research
    priorities and for tracking trends in human exposures over
    time. Accordingly, the Committee continues to support the CDC
    environmental health laboratory's efforts to provide exposure
    information about environmental chemicals. In addition, the
    Committee encourages CDC to consider devoting a greater
    proportion of program resources to develop the necessary
    methods to interpret human biomonitoring concentrations in the
    context of potential health risks. The Committee applauds the
    CDC's biomonitoring efforts and encourages the agency to
    continue this program and as well as improve its efforts to
    communicate these results in context.
        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. The Committee understands that further
    development of this device will help ensure its application in
    community health settings.
        Dioxin Emission Reduction.--The Committee encourages the
    CDC to establish a public health awareness effort to inform the
    public of dioxin emissions that may originate from non-point
    sources and methods and/or techniques that the public can use
    to reduce the emissions of non-point source dioxins to the
    environment.
        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 no
    less than FY 2005 levels, to expand peer support networks and
    the number of survivors that are reached in network and non-
    network countries; strengthen the capacity of medical and
    rehabilitative care facilities to address the needs of
    amputees; enhance economic opportunities for survivors; and
    further CDC programs and research for victims of landmines,
    civil strife and warfare.

    Injury prevention and control

        The Committee provides $138,237,000 for the injury control
    program, which is the same as the fiscal year 2005 comparable
    level and $306,000 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 2005 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.

                         OCCUPATIONAL SAFETY AND HEALTH

        The Committee provides $251,241,000 for occupational safety
    and health, which is $34,800,000 below fiscal year 2005 and
    $34,689,000 below the request. Of the amount provided,
    $87,071,000 is to be derived from section 241 evaluation set-
    aside funds, as proposed in the request. The Committee notes
    that after adjusting for the transfer of $34,800,000 for
    central business services and support outlined below, the
    recommendation is the same as fiscal year 2005 and $111,000
    above the request.
        The National Institute for Occupational Safety and Health
    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.
        The Committee understands that in the reorganization of CDC
    that NIOSH has been recognized as one of the agency's 5
    coordinating centers. Given its unique statutory requirements,
    the Committee concurs that this is the appropriate placement of
    NIOSH within CDC's current structure. It is the expectation of
    the Committee that CDC will afford NIOSH all the rights and
    privileges of this status in the organization including
    participating on CDC's Executive Leadership Board as well as
    the Management Council given that these are the policy and
    decision-making bodies of the Agency.
        The Committee recommendation includes a permanent transfer
    of $34,800,000 from the NIOSH budget activity to CDC's
    centralized business services budget activity. This transfer,
    which is equal to the central business systems assessment for
    fiscal years 2004 and 2005, brings NIOSH in line with the other
    coordinating centers and obviates the need for continued
    central business services assessments, except those required by
    the Department. Finally, the Committee directs CDC to treat any
    additional CDC assessment on the NIOSH budget activity as a
    reprogramming of funds and to comply with the process set forth
    in section 517 of this Act.

                                 GLOBAL HEALTH

        The Committee provides $309,076,000 for global health,
    which is $213,000 above the fiscal year 2005 comparable level
    and $2,997,000 above the request.
        Through its Global Health activities, CDC coordinates,
    cooperates, participates with, and provides consultation to
    other nations, U.S. agencies, and international organizations
    to prevent and contain diseases and environmental health
    problems and to develop and apply health promotion activities.
    In cooperation with Ministries of Health and other appropriate
    organizations, CDC tracks and assesses evolving global health
    issues and identifies and develops activities to apply CDC's
    technical expertise to be of maximum public health benefit.
    Program areas include: the Global AIDS Program, the Global
    Immunization Program, the Global Malaria Program, the Global
    Disease Detection Initiative, and Other Global Disease
    Activities.
        Within the total, the following amounts are included for
    global health activities: $123,883,000 for Global AIDS, which
    is $54,000 above fiscal year 2005; $137,194,000 for Global
    Immunization, which is $68,000 above fiscal year 2005;
    $36,500,000 for Global Disease Detection, which is the same as
    fiscal year 2005, after adjusting for the avian flu funding in
    the Emergency Supplemental Appropriations Act for Defense, the
    Global War on Terror, and Tsunami Relief Act, 2005; $9,113,000
    for the Global Malaria Program, which is the same as fiscal
    year 2005; and $2,386,000 for Other Global Disease Activities,
    which is the same as fiscal year 2005.

             TERRORISM AND PUBLIC HEALTH PREPAREDNESS AND RESPONSE

        The Committee provides $1,616,723,000 for CDC terrorism
    preparedness and response activities, which is the same as the
    request and $6,034,000 below the fiscal year 2005 comparable
    level.
        Since fiscal year 2002, CDC terrorism and preparedness
    funds were requested and provided within the Public Health and
    Social Services Emergency Fund (PHSSEF). Now that these
    programs and activities are a part of the CDC's annual
    appropriations, the Committee believes the funding more
    appropriately belongs within the managing Agency's account.
        The Committee seeks to ensure that CDC's bioterrorism
    activities continue to be coordinated with those in other parts
    of HHS and directs CDC to work with the Office of the Secretary
    in the development of the requested Department-wide operating
    plan.
        Within the funds provided, $853,300,000 is for Upgrading
    State and Local Capacity, including $790,000,000 to be provided
    to State and local health departments through grants and
    cooperative agreements (this amount is $67,337,000 below fiscal
    year 2005 and 54,609,000 above the request), and $31,400,000
    for Centers for Public Health Preparedness; $140,200,000 is for
    Upgrading CDC Capacity; $14,000,000 is for Anthrax; $79,223,000
    is for the Biosurveillance Initiative; and $530,000,000 is for
    the Strategic National Stockpile (this amount is $63,300,000
    above fiscal year 2005 and $70,000,000 below the request).
        The Committee also understands that within the above
    amounts for terrorism preparedness and response, up to
    $34,400,000 will be used for CDC business services and support.
    In addition, $8,589,000 of the amounts available for the
    Strategic National Stockpile are to be transferred for the
    administration and management costs within the Office of the
    Secretary related to the BioShield program.
        Pandemic Preparedness and Avian Flu.--The Committee is
    increasingly concerned about the threat posed to public health
    by avian flu and pandemic influenza, which public health
    authorities estimate could kill 90,000 to 300,000 people in the
    United States. Public health preparedness with respect to a
    pandemic influenza cuts across a broad array of federal public
    health activities. As a result, the Committee recommendation
    includes funding to enhance several of CDC's functions to
    assist in improving our nation's capability of detecting,
    controlling, and responding to potential health threats related
    to influenza in general, and novel influenza strains in
    particular. Included is:
              $102,500,000, which is $3,498,000 above fiscal year
            2005, within Infectious Diseases Control to, among
            other things, enhance the sentinel physician
            surveillance system, assist state and local health
            departments to improve vaccine delivery, and conduct
            research aimed at developing rapid molecular methods
            for characterizing influenza viruses;
              $36,500,000 for Global Disease Detection, which is
            $15,074,000 above the fiscal year 2005 enacted level,
            to build upon the $15,000,000 provided in the Emergency
            Supplemental Appropriations Act for Defense, the Global
            War on Terror, and Tsunami Relief Act, 2005, for
            combating the spread of the avian influenza virus in
            Southeast Asia, and to enhance the global surveillance
            and response network for infectious diseases;
              $265,680,000 for vaccine purchase grants, which is
            $35,441,000 above the fiscal year 2005 comparable
            level, to help improve the stability of the influenza
            vaccine market and ensure a plentiful supply of
            influenza vaccine for the 2004/2005 flu season; and
              $530,000,000 for the Strategic National Stockpile,
            which is $63,300,000 above the fiscal year 2005
            comparable level, to maintain and expand the
            Stockpile's supplies and countermeasures for assisting
            State and local governments in responding to both
            terrorist and naturally occurring public health
            emergencies, including the purchase of influenza
            countermeasures.
        In addition, $120,000,000, which is $20,802,000 above
    fiscal year 2005, is provided within the Public Health and
    Social Services Emergency fund for pandemic preparedness. The
    purpose of these funds is to ensure a year-round influenza
    vaccine production capacity in the U.S. and the development and
    implementation of rapidly expandable influenza vaccine
    production technologies.
        The Committee recognizes that although a combination of
    efforts will be needed to address an influenza pandemic, early
    in an outbreak, especially before a vaccine is available, use
    of antiviral drugs may ease some of the symptoms of individuals
    infected and might slow the spread of the pandemic. Given the
    lag time in production and the high demand from other
    countries, the CDC must commit now to purchasing an adequate
    stockpile. The Committee is aware that the World Health
    Organization has recommended that nations stockpile enough
    antiviral treatments to cover 25% of their population. The
    Committee is concerned that the United States currently has
    enough antiviral treatments stockpiled to treat only 1% of the
    population and urges the CDC, in conjunction with HHS and NVPO,
    to determine what percentage of the U.S. population antiviral
    stockpiles should have the capacity to treat and how many doses
    are needed to meet this benchmark and report back to the
    Committee with these findings by no later than January 1, 2006.
        The Committee understands antiviral treatments have
    repeatedly been shown to reduce the duration and severity of
    symptoms when given in the first 48 hours of influenza
    symptoms. Although there are gaps in knowledge about the
    efficacy of antivirals in a pandemic, it appears that these
    gaps should not be used as a reason for inaction. The Committee
    urges the Department to undertake an analysis to define optimal
    antiviral use, potential health impacts and cost-effectiveness
    of antiviral drugs in the setting of a pandemic and directs the
    Secretary to be prepared to report on the findings during the
    Committee hearings on the fiscal year 2007 budget request.
        The Committee urges CDC to review and approve state
    pandemic influenza plans in order to ensure nationwide
    preparedness standards and to facilitate regional coordination.
    Further, CDC should recommend that States make approved plans
    publicly available.
        In addition, the Committee urges CDC to develop and
    implement a public education campaign about pandemic influenza
    and preparedness, including information concerning the
    potential need for general vaccination and personal
    precautionary measures. CDC should also develop a strategy for
    communicating with the business community to provide
    information about the economic disruptions and communiy needs
    that may arise during a pandemic period.
        Modified Vaccinia Ankara.--The Committee is concerned that
    individuals with weak immune systems, an estimated 20% of the
    U.S. population, cannot take the existing animal-derived and
    cell-derived smallpox vaccines currently stored in the
    Strategic National Stockpile for emergency purposes. Funds have
    already been appropriated for the planned stockpiling of the
    Modified Vaccinia Ankara (MVA) Smallpox Vaccine for immuno-
    compromised Americans. The Committee supports the Department's
    plans to purchase 60 million doses of the new vaccine.

                             PUBLIC HEALTH RESEARCH

        The Committee provides $31,000,000 for public health
    research, which is the same as the fiscal year 2005 and the
    request. All funds provided shall be derived from section 241
    evaluation set-aside funds, as proposed in the request.
        Through this activity, CDC supports high-quality public
    health research that studies the best methods for making the
    transition from research to practice. Funds support research
    that is proposed by experienced investigators working with
    communities, health practitioners, and policymakers to address
    local priority health concerns.

                    PUBLIC HEALTH IMPROVEMENT AND LEADERSHIP

        The Committee provides $258,541,000 for public health
    improvement and leadership, which is $8,301,000 below fiscal
    year 2005 and $52,000,000 above the request.
        This activity supports several cross-cutting areas within
    CDC. Included is the CDC's Leadership and Management function,
    which funds the CDC Office of the Director, coordinating
    centers, and each constituent center and office. The Public
    Health Improvement and Leadership also supports the CDC's
    public health workforce and career development efforts, the
    Director's Discretionary Fund, and Congressional projects.

               PREVENTIVE HEALTH AND HEALTH SERVICES BLOCK GRANT

        The Committee provides $100,000,000 for the preventive
    health and health services block grant, which is $18,526,000
    below the fiscal year 2005 comparable level and $100,000,000
    above the request. This block grant provides flexible funds to
    States by formula for a wide range of public and preventive
    health activities. The flexibility afforded to the states,
    allows them to target funds to address chronic diseases, such
    as diabetes, arthritis, heart disease, and stroke, to direct
    funds to meet challenges of outbreaks of infectious diseases,
    such as West Nile Virus and influenza, and/or to implement
    prevention and control programs related to injury and abuse.

                            BUILDINGS AND FACILITIES

        The Committee provides $30,000,000 for buildings and
    facilities, which is $239,708,000 below the fiscal year 2005
    comparable level and the same as the request.
        These funds support construction and ongoing maintenance
    projects, as well as essential safety repairs and equipment
    purchases. Of the funds provided, $22,500,000 is to complete
    the replacement of the CDC's Vector Borne Infectious Diseases
    Laboratory in Ft. Collins, CO.
        Data Security and Storage.--Within the amount provided
    sufficient funds are available for data center storage
    infrastructure hardware and software upgrades. This funding is
    to provide further for the remote mirroring of information
    between CDC data centers and recovery sites, and to provide
    heterogeneous connectivity to existing systems in use at the
    CDC, in order to ensure the protection, recovery, and
    availability of critical resources; as well as to provide for
    enhanced security-specific technologies and services in concert
    with critical infrastructure protection requirements.

                         BUSINESS SERVICES AND SUPPORT

        The Committee provides $298,515,000 for business services
    and support, which is $19,677,000 above the fiscal year 2005
    comparable level and $34,800,000 above the request. The
    Committee notes that the recommendation includes $34,800,000
    within this budget activity that was provided in fiscal year
    2005, and in the request for fiscal year 2006, within the NIOSH
    budget activity. The result is to provide the NIOSH share of
    CDC centralized business systems and support within this
    activity and to obviate the need for additional taps and
    assessments. After making adjustment for this change, the
    recommendation is $15,123,000 below fiscal year 2005 and the
    same as the request.

                         National Institutes of Health

        The Committee provides $28,506,805,000 for the twenty-six
    appropriations which together fund the programs of the National
    Institutes of Health (NIH). The total in the bill is
    $142,290,000 above the fiscal year 2005 comparable level and
    $2,979,000 below the budget request. This amount includes
    $97,021,000 for targeted research activities to develop
    radiological, nuclear and chemical threat countermeasures. The
    Administration had requested this funding in the Public Health
    Social Services Emergency Fund.
        Roadmap.--The Committee endorses the Administration's
    proposal of supporting the NIH Roadmap for Biomedical Research
    at a funding level of $332,800,000 from funding contributed by
    the Institutes and Centers based on less than one percent of
    their budgets and out of the Director's Discretionary Fund. The
    Committee believes the Roadmap is an important step to moving
    biomedical research forward to the next level of discovery at a
    pace that hastens its delivery to patients. The Roadmap
    addresses common needs across all disease areas and should
    produce research advances that will benefit many diseases and
    conditions. The Committee expects to be notified on a quarterly
    basis if the contribution from the Institutes and Centers or
    the allocation of funding by initiative changes from what is
    presented in the congressional justification.
        Biodefense.--The Administration's fiscal year 2006 budget
    for NIH includes $1,791,000,000 for bioterrorism activities,
    including funds proposed in the Public Health and Social
    Services Emergency Fund. The Committee has included the
    $97,021,000 requested for NIH within the Emergency Fund
    directly in the NIH Office of the Director appropriation. The
    Committee has not identified a specific funding level for
    biodefense research, choosing to give the Director of NIH
    flexibility in determining what share of NIH resources should
    be considered biodefense activities.
        Balance in the research portfolio.--The Committee
    reiterates its longstanding view that NIH should distribute
    funding on the basis of scientific opportunity. The Committee
    urges the Director and the Administration to continue to resist
    pressures to earmark, set aside and otherwise politicize these
    resources. To enhance NIH's flexibility to allocate funding
    based on scientific opportunity, the Committee has attempted to
    minimize the amount of direction provided in the report
    accompanying the bill. For example, there are no directives to
    fund particular research mechanisms, such as centers or
    requests for applications, or specific amounts of funding for
    particular diseases.
        In stating that scientific opportunity should be the basis
    for allocating research funding, the Committee understands that
    other factors also are relevant to NIH's decisions, including
    such considerations as the infectious nature of a disease, the
    number of cases and deaths associated with a particular
    disease, the Federal and other costs of treating a disease, the
    years of productive life lost due to a particular disease, and
    the estimated proximity to research breakthroughs. The
    Committee does not presume to judge which criteria should take
    precedence or carry the greatest weight in individual funding
    decisions, but urges NIH to consider the full array of relevant
    criteria as it constructs its research portfolio. The Committee
    applauds the Director's focus on the need to address chronic
    diseases with preemptive interventions before symptoms appear
    and function is lost.
        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 and centers 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 $4,841,774,000 for the National
    Cancer Institute (NCI), which is $16,515,000 above the fiscal
    year 2005 comparable level and the same as the budget request.
    The bill includes language requested by the Administration
    permitting up to $8,000,000 for repairs and improvements to the
    NCI intramural facility in Frederick, Maryland.
        Mission.--The NCI conducts and supports basic and applied
    cancer research in early detection, diagnosis, prevention,
    treatment and rehabilitation. NCI provides training support for
    research scientists, clinicians and educators, and maintains a
    national network of cancer centers, clinical cooperative
    groups, and community clinical oncology programs, along with
    cancer prevention and control initiatives and outreach programs
    to rapidly translate basic research findings into clinical
    practice.
        Prostate Cancer.--The Committee recognizes NCI's commitment
    to prostate cancer research as laid forth in its ``Prostate
    Cancer Research Plan, FY 2003--FY 2008''. The Committee
    requests that NCI provide an annual update every January on its
    progress in prostate cancer research as it reflects the goals
    outlined in the plan for years fiscal years 2006-08. In
    developing this update, the Committee urges the NIH to consult
    and work closely with the research community, clinicians, and
    patient advocacy groups and the Congress.
        Breast cancer.--Breast cancer's toll continues to threaten
    the lives and the quality of life of thousands of women. In
    addition to ongoing research activities underway at the
    Institute, the Committee hope that increased attention will
    also be given to areas of research that focus on helping women
    to more fully restore and improve their quality of life after
    treatment, including further research on lymphadema, stress,
    nutrition, exercise, weight, and environment.
        The Committee remains concerned about missed opportunities
    in breast cancer screening, detection, prevention, control,
    early diagnosis, and mammogram detection, reading and analysis.
    The Committee encourages NCI to further accelerate advances in
    breast cancer screening technology and to capitalize on
    existing and create new technologies that improve early
    diagnosis, health outcomes, and survival.
        Ovarian cancer.--The Committee remains concerned that
    survival rates associated with ovarian cancer have improved
    only slightly over the past 20 years. Ovarian cancer is the
    deadliest of all gynecological cancers. For all women diagnosed
    with ovarian cancer, the five-year survival rate is 45 percent.
    More than two-thirds of the women have advanced disease at the
    time of diagnosis, and for this group, the 5-year survival rate
    is 29 percent. The Committee commends NCI for its recognition
    of the importance of studying this deadly women's disease and
    appreciates the NCI's recent investment that is helping to
    increase the understanding of the unique molecular pathways
    associated with ovarian cancer through its SPOREs program. The
    Committee encourages NCI to sustain and strengthen its
    commitment to and investment in ovarian cancer and maintain the
    specialized programs of research excellence (SPORE) initiatives
    directed toward ovarian cancer in fiscal year 2006.
        Liver Cancer.--The Committee remains concerned with the
    increasing incidence of primary liver cancer, which is in sharp
    contrast to many other forms of cancer where the incidence is
    declining and the treatment options are rapidly increasing. The
    Committee is aware that NCI, working with NIDDK, has convened
    an Experts Conference and is moving ahead with plans to
    increase resources dedicated to this disease. The Committee
    urges NCI to make a strong commitment to research on primary
    liver cancer with particular focus on the development of drugs
    that target the cancer without killing healthy cells by
    interfering with the cellular pathways of the disease. The
    Committee further urges NCI to continue to support the NIDDK
    sponsored HALT-C clinical trial which has particular relevance
    to the NCI mission.
        Pancreatic cancer.--Pancreatic cancer is the country's
    fourth leading cause of cancer death. Most patients present
    with advanced disease at diagnosis and the median overall
    survival rate for people diagnosed with metastatic disease is
    only about six months. The Committee is concerned that there
    are too few scientists researching pancreatic cancer and
    compliments the NCI's past efforts for increasing the research
    field through its program of a 50 percent formalized extended
    payline for grants that were 100 percent relevant to pancreatic
    cancer. The Committee considers this an important method for
    attracting both young and experienced investigators to develop
    careers in pancreatic cancer. In 2004, the NCI established a
    new policy for awarding additional grants in pancreatic cancer
    research and extended this initiative to research that is 50
    percent relevant to pancreatic cancer. The Committee requests
    NCI to report in February, 2006 on how the two changes in
    policy have affected the pancreatic cancer portfolio, including
    the percentage relevancy of each grant to pancreatic cancer,
    and urges NCI to continue its commitment to fertilize the
    pancreatic cancer field.
        Lymphoma.--Lymphoma is the fifth most common cancer and the
    most common hematological cancer. Unlike many other cancers,
    lymphoma often strikes individuals in young adulthood and the
    middle years, significantly impacting their professional
    productivity and individual role in the family and society. The
    Committee recommends that NCI take bold action to address
    lymphoma as a public health problem and to capitalize on
    important research advances to date. The Committee encourages
    NCI to strengthen its investment in translational and clinical
    lymphoma research.
        The Committee commends NCI and the National Institute of
    Environmental Health Sciences (NIEHS) for convening a workshop
    on the viral and environmental links to lymphoma and recommends
    that steps be taken to strengthen the NCI investment in this
    area. The Committee recommends that NCI direct resources to:
    (1) studies of adequate scope to assure the identification of
    environmental risk factors for specific subtypes of lymphoma;
    (2) small studies designed to improve detection and
    quantification of historically difficult-to-measure
    environmental factors; (3) studies that are directed toward
    enhancing the understanding of the role of the immune system in
    the initiation and progression of lymphoma; and (4) studies
    that examine the simultaneous presence of a wide profile of
    infectious agents among individuals with lymphoma.
        The Committee recommends that resources be directed to
    research related to long-term survivors of both non-Hodgkin's
    lymphoma and Hodgkin's lymphoma. The report of the Leukemia,
    Lymphoma, and Myeloma Progress Review Group (LLM PRG)
    recommended that resources be invested in identifying the
    populations of patients that are at high risk of adverse
    outcomes from their treatment for lymphoma.
        Cancer centers at minority institutions.--The Committee
    commends NCI on the success of its cancer centers program.
    Given that minority populations suffer disproportionately from
    virtually every form of cancer, the Committee encourages NCI to
    give consideration to supporting 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. The Committee is
    pleased with NCI's attention to this important matter.
        Neurofibromatosis (NF).--The Committee is pleased with
    NCI's clinical trials of NF patients and encourages NCI to
    enhance its NF research portfolio in such areas as further
    development of animal models, natural history studies,
    therapeutic experimentation, and clinical trials. The Committee
    recognizes that basic research has successfully brought NF into
    the clinical era and encourages NCI to create, fund, and
    implement NF clinical trial infrastructures including NF
    centers, patient data bases, and tissue banks. The Committee
    further encourages NCI to apply existing cancer drugs to NF
    patients in clinical trials and to develop new drugs for NF
    which could then apply to the general population because of
    NF's connection to many forms of human cancer. The Committee is
    aware of significant new advances in NF research in the past
    few years in the area of tumor suppression and encourages NCI
    to continue to coordinate its efforts with other NIH institutes
    and government agencies.
        Angiogenesis.--The Committee applauds NCI, working with
    other Institutes, for its leadership in planning and launching
    the Trans-NIH Angiogenesis Research Program (TARP) that
    promotes multidisciplinary research on the control and
    promotion of new blood vessel growth. This research has the
    potential to lead to the development of new therapeutic
    strategies for a variety of diseases, including cancer,
    diabetic eye disease, diabetic kidney disease, and others.
        Hemophilia.--The Committee understands that field work on
    the Multi-Center Hemophilia Cohort Study will be complete in
    September, 2005. This cohort offers a rich database for
    improving the understanding of hepatitis C virus and other
    concerns of major public health interest. The Committee expects
    NCI to take all necessary steps to ensure the samples obtained
    through this cohort are preserved and accessible for future
    research. The Committee also requests a report by March 31,
    2006 on possible future research opportunities using the cohort
    samples.
        Tuberous sclerosis complex (TSC).--TSC is a genetic
    disorder that triggers uncontrollable tumor growth in multiple
    organs of the body, including the brain, heart, kidneys, lungs,
    liver, eyes or skin. In light of its similarities to the
    uncontrolled growth of cancer cells, many scientists believe
    that determining the cause of tumor growth in TSC could open
    the way for cures and treatments for cancer as well. To those
    ends, the Committee strongly encourages NCI to support programs
    examining the molecular and cellular basis of TSC, and the role
    of TSC in tumor development.
        American Russian Cancer Alliance (ARCA).--The Committee
    applauds the progress of ARCA in harnessing the scientific
    strengths of its partners in pursuit of novel research
    activities that ultimately benefit cancer patients worldwide.
    The Committee notes in particular the continued development of
    the unique ARCA projects in molecular imaging and radioisotope-
    targeted therapy that have strengthened the scientific
    collaborations with the leading Russian nuclear research
    centers and American cancer centers. Moreover, the Committee
    recognizes and commends NCI for providing support to the ARCA
    infrastructure and facilitating international exchange and
    communication between the American and Russian partners. The
    Committee encourages NCI to continue and enhance its support
    for the research programs of ARCA, recognizing both the
    scientific opportunities within the partnership and the
    national interest in fostering the international effort to
    develop new, productive avenues for the use of nuclear
    stockpiles previously earmarked for weapons development.
        Cancer metastasis.--The NCI is encouraged to develop an
    interdisciplinary and integrated approach to study bone
    metastasis, by combining the expertise of oncologists, bone
    biologists and metastasis experts. Key issues to address
    include the generation of novel organ-like or mouse models
    which closely mimic tumor bone interactions that will pave the
    way for delineating novel mechanisms of how tumor cells go to
    the bone; designing novel targets for better prognosis; and
    effective therapeutic targeting. The Committee encourages NCI
    to continue supporting research that furthers the understanding
    of the causes and consequences of sarcoma. The Committee also
    recommends that NCI support research on osteosarcoma to improve
    survival and quality of life and to prevent metastatic
    osteosarcoma in children and teenagers who develop this cancer.
        Tobacco harm reduction.--The Committee recognizes and
    applauds the significant work of HHS and its agencies in the
    area of tobacco and health, particularly recent efforts aimed
    at facilitating smoking cessation. The Committee believes it is
    important to continue to explore additional methods to reduce
    smoking related mortality and morbidity in the 10 to 15 percent
    of the adult population who cannot or will not quit smoking. In
    a recent study funded by NCI, a panel of leading tobacco
    experts was asked to review scientific literature for the
    comparative mortality risks of low-nitrosamine smokeless
    tobacco products and conventional cigarettes. The panel of
    experts concluded that, based on published scientific
    literature, low-nitrosamine smokeless tobacco products pose a
    substantially lower risk to the user than conventional
    cigarettes. Given this important conclusion, the Committee
    urges NCI to continue its research into harm reduction
    strategies for cigarette smokers, and consider the role low-
    nitrosamine smokeless tobacco products may play in the overall
    effort to reduce the incidence of cigarette smoking in the U.S.
        Cancer biobank.--The Committee believes that the cancer
    biobank, because it will centralize and standardize molecular
    annotation of tissues, has the potential to greatly accelerate
    the understanding of cancer and the discovery and development
    of new biomarkers, new diagnostics and new therapeutic
    approaches. As it is established by NCI, the Committee believes
    that it will be most efficient to utilize existing technologies
    such as high-density microarrays, given the long time frame for
    the development of new technologies.
        Advanced technologies.--The Committee commends NCI for its
    goal of eliminating the suffering and death caused by cancer by
    the year 2015. The Committee encourages NCI to pursue the use
    of advanced technologies such as nanotechnology, proteomics,
    and imaging, to rapidly translate basic research discoveries
    into targeted interventions to ultimately achieve the 2015
    goal.
        Informatics grid.--The Committee is pleased with NCI's
    development of the cancer Biomedical Informatics Grid (caBIG)
    as a network to facilitate the integration of diverse data
    types and the sharing of interoperable analytic tools. NCI is
    encouraged to work with the Office of the National Coordinator
    for Health Information Technology to use CaBIG as a prototype
    for an interoperable clinical data network.

                   NATIONAL HEART, LUNG, AND BLOOD INSTITUTE

        The Committee provides $2,951,270,000 for the National
    Heart, Lung, and Blood Institute (NHLBI), which is $10,069,000
    above the fiscal year 2005 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 urge
    the Institute to place a high priority on research for heart
    disease, stroke and other cardiovascular diseases. The
    Committee encourages NHLBI to strengthen its research portfolio
    through all available mechanisms into the causes, cure,
    prevention and treatment of cardiovascular diseases.
        Heart failure clinical research network.--The Committee is
    concerned that in spite of advances in treatment, the number of
    newly diagnosed cases and the number of Americans suffering
    from heart failure continues to grow. The Committee encourages
    NHLBI to consider initiating a research network to conduct
    clinical studies using new approaches to improve outcomes for
    heart failure patients and to provide an infrastructure to
    enable rapid translation of promising research findings into
    enhanced patient care. The network would have the capability of
    implementing multiple concurrent clinical studies that may show
    promise for new therapies and provide background for larger
    clinical trials.
        Innovative technologies for engineering small blood
    vessels.--The Committee understands that the supply of natural
    blood vessels for multiple grafts does not meet the demand for
    patients undergoing heart artery bypass surgery and that
    prosthetic grafts for children born with complex heart defects
    fail at an unacceptable rate. The Committee encourages NHLBI to
    conduct research to advance the development of substitutes for
    natural blood vessels.
        Specialized centers of clinically oriented research (SCCOR)
    for vascular injury, repair, and remodeling.--Vascular diseases
    result from clogged, weakened or otherwise damaged blood
    vessels. The Committee encourages NHLBI to consider initiating
    a new SCCOR program to conduct interdependent clinical and
    multidisciplinary basic research projects on the molecular and
    cellular mechanisms of vascular injury, repair, and remodeling.
    Such a program would promote patient-oriented research to
    improve prevention, detection, and treatment of vascular
    diseases. The SCCOR would provide an environment for new
    clinical investigators to develop skills and research
    capabilities to conduct relevant research in this area.
        Cooley's anemia.--The Committee remains strongly supportive
    of the focused research effort that is being undertaken by the
    thalassemia clinical research network, which is comprised the
    leading research institutions in the field of thalassemia, or
    Cooley's anemia. The Committee believes that this network is
    just beginning to meet its promise and urges NHLBI to continue
    it and support the research projects undertaken by it.
        Hemophilia.--The Committee commends NHLBI for its
    leadership in advancing research on bleeding and clotting
    disorders and the complications of these disorders. The
    Committee encourages NHBLI to maintain its work in this area
    and applauds the Institute for its efforts, in cooperation with
    voluntary organizations, to support research on improved and
    novel therapies for these disorders.
        Pulmonary hypertension.--Pulmonary hypertension (PH) is a
    rare, progressive and fatal disease that predominantly affects
    women, regardless of age or race. PH causes deadly
    deterioration of the heart and lungs and is a secondary
    condition in many other serious disorders such as scleroderma
    and lupus. The Committee continues to view research in this
    area as a high priority and commends NHLBI's efforts to promote
    PH-related research. The Committee encourages the Institute to
    support funding for basic research, gene therapy and clinical
    trials of promising pharmaceuticals, and to take appropriate
    measures to ensure the submission of high quality proposals in
    this area.
        Cardiovascular advanced screening program.--The Committee
    encourages NHLBI to sponsor a workshop on advanced screening
    methods for cardiovascular disease. This workshop would
    incorporate the Cardiovascular Health Study data, expertise
    from the National Cholesterol Education Project, and input from
    the cardiology community. The proceedings from this workshop
    could be used in the development of a Federal plan to address
    barriers to access to these advanced screening methods.
        Transmissible spongiform encephalopathies.--The Committee
    encourages NHLBI to continue 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.
        National COPD education and prevention program.--The
    Committee is pleased that NHLBI held a preliminary workshop to
    formulate strategies towards implementing a national chronic
    obstructive pulmonary disease (COPD) education and prevention
    program. Since COPD is the fourth leading cause of death in the
    United States, the Committee urges NHLBI to continue its
    education efforts to bring advances in medical care to the
    public. Early identification of those at-risk for or who have
    COPD is essential in the effort to stem the growth of the
    population with COPD. The Committee encourages NHLBI to
    continue its efforts in this area, working with national lung
    organizations, to develop a national education campaign for
    providers and the public about COPD.
        Scleroderma.--The Committee is encouraged by NHLBI's
    growing interest in scleroderma, a chronic and progressive
    disease that predominantly strikes women. Scleroderma is
    disfiguring and can be life-threatening, affecting multiple
    systems including the heart and lungs. The Committee is pleased
    that NHLBI funded the Scleroderma Lung Study, a large multi-
    center trial whose focus is to find a therapy that may alter
    the course of the inflammation of the lungs that occurs in
    approximately 40 percent of those diagnosed with the systemic
    scleroderma. The Committee also commends NHLBI for its
    commitment to finding a cause and improved therapies for
    pulmonary arterial hypertension. Pulmonary arterial
    hypertension occurs in approximately 50 percent of those
    diagnosed with systemic scleroderma. More research is needed to
    identify the causes of the complications of scleroderma that
    include pulmonary fibrosis, pulmonary hypertension, myocardial
    fibrosis, cardiac arrhythmias, pericarditis, and Raynaud's
    Phenomenon.
        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. The Committee applauds NHLBI for its
    involvement with NF research and with NF patient advocacy
    groups and encourages NHLBI to continue to expand its NF
    research portfolio in light of the enormous implications for
    the general population.
        Sleep disorders.--The Committee continues to recommend that
    the National Center on Sleep Disorders Research partner with
    other federal agencies, such as the Centers for Disease Control
    and Prevention, as well as voluntary health organizations to
    develop a sleep education and public awareness initiative to
    serve as an ongoing, inclusive mechanism for public and
    professional awareness on sleep and sleep disorders.
        Marfan syndrome.--Marfan syndrome is characterized by
    aortic aneurysms, painful orthopedic issues, pulmonary issues
    and ocular manifestations that can result in blindness. The
    Committee commends NHLBI for its support of research
    opportunities to study this life threatening, degenerative
    genetic disorder. Recent advances in basic research are ready
    to be translated into promising clinical trials. The Committee
    suggests that NHLBI collaborate with other institutes to
    support a clinical trial for drug therapies to potentially
    reverse the cardiovascular and pulmonary manifestations of this
    disorder.
        Alpha-1 antitrypsin deficiency.--The Committee is aware
    that Alpha-1 antitrypsin deficiency is often misdiagnosed as
    asthma or Chronic Obstructive Pulmonary Disease (COPD). Alpha-1
    is a major cause of liver transplantation in adults and
    children. The Committee recommends the establishment of an
    inter-institute coordinating committee to facilitate
    cooperation between NHLBI, NIDDK, NHGRI, and other institutes
    to enhance the NIH research portfolio, encourage targeted
    detection, raise public awareness about Alpha-1 and provide
    appropriate information to health professionals.
        Duchenne muscular dystrophy (DMD).--The Committee is
    pleased that NLHBI has enhanced its research and related
    activities surrounding pulmonary complications associated with
    DMD and urges the Institute to continue to enhance its work in
    this area. The Committee hopes that NHLBI will become more
    involved with NIH muscular dystrophy activities by joining the
    Muscular Dystrophy Coordinating Committee.
        Primary immunodeficiency diseases.--The Committee
    understands that NHLBI has begun to work with voluntary
    agencies as part of a national physician education and public
    awareness campaign for primary immunodeficiency diseases. The
    Committee encourages NHLBI to take further action in this
    regard and to continue to be an active participant in the
    development of educational materials, conferences, and related
    initiatives, as appropriate.
        Novel targets and therapy development for clot-based
    stroke.--The Committee recognizes that an urgent need exists to
    develop new therapies to reduce bleeding risk and minimize
    brain damage and loss of function from stroke. The Committee
    encourages NHLBI to consider initiating a collaborative effort
    to identify new molecular targets, explore promising agents,
    and develop innovative therapies to quickly restore blood flow
    to the brain to limit stroke damage.
        Nontuberculous mycobacteria [NTM].--Mycobacteria are
    environmental organisms found in both water and soil that can
    cause significant respiratory damage. The Committee is aware of
    the increasing incidence of nontuberculous mycobacteria [NTM]
    pulmonary infections in women, particularly involving rapidly
    growing mycobacteria, an inherently resistant subspecies. The
    Committee encourages NHLBI to collaborate with NIAID and other
    institutes leading to a better understanding of NTM and
    enhancing diagnostics and treatment and promoting appropriate
    education of health care providers.
        Lymphangioleiomyomatosis (LAM).--The Committee remains very
    interested in efforts to find a cure for LAM, a progressive and
    often fatal lung disease of women with no effective treatment.
    The Committee understands that very recent scientific findings
    have presented new treatment approaches for clinical testing,
    and that experimental trials with the drug sirolimus have
    begun. The Committee encourages NHLBI to explore opportunities
    for funding clinical treatment trials through both intramural
    and extramural means and to use all available mechanisms as
    appropriate, including support of state-of-the-science
    symposia, request for applications, and facilitating access to
    human tissues, to stimulate a broad range of clinical and basic
    LAM research.

             NATIONAL INSTITUTE OF DENTAL AND CRANIOFACIAL RESEARCH

        The Committee provides $393,269,000 for the National
    Institute of Dental and Craniofacial Research (NIDCR), which is
    $1,440,000 above the fiscal year 2005 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.
        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 pursing research
    initiatives on the development of saliva as a diagnostic tool.
        Dental abnormalities.--The Committee encourages NIDCR to
    continue its support of research aimed at the health of oral
    mineralized tissues. This includes studying the role of genetic
    factors and the potential for cell-based and pharmacological
    therapy and early screening for osteoporosis. Additionally
    NIDCR is urged to continue research on fibrous dysplasia/McCune
    Albright syndrome and to focus on the dental abnormalities
    associated with Paget's disease.
        Scleroderma.--The Committee is encouraged by NIDCR's
    interest in scleroderma, a chronic and progressive disease that
    predominately strikes women. Scleroderma is often associated
    with a number of dental and craniofacial complications,
    including 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 causes of the
    serious complications from the disease.

        NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES

        The Committee provides $1,722,146,000 for the National
    Institute of Diabetes and Digestive and Kidney Diseases
    (NIDDK), which is $8,562,000 above the fiscal year 2005
    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.
        Type-2 diabetes.--Type-2 diabetes exacts an enormous human
    and economic toll on Americans. Diabetes costs the healthcare
    system more than $92 billion a year. Medical research has shown
    that achieving and maintaining a blood glucose level below 7
    percent significantly lowers the risk of blindness, amputation,
    and other serious complications of diabetes. The Committee is
    concerned that, despite these advances, only about 2 in 5
    diabetics report having a blood glucose level of less than 7
    percent. The Committee recognizes that treatment guidelines for
    diabetes exist that include recommendations for achieving and
    maintaining appropriate glucose levels, and the Committee
    encourages NIDDK to promote greater use of treatment guidelines
    in clinical practice. The Committee requests that NIDDK examine
    the disparity in available guidelines and actual treatment and
    report to Congress within six months of enactment on actions
    the government can take that will rapidly close the disparity
    between treatment guidelines and the care diabetics receive
    within the first year of being diagnosed.
        Islet transplantation.--The Committee commends NIDDK and
    NIAID for the establishment of the Clinical Islet
    Transplantation Consortium and the islet transplantation
    clinical trial that will include Medicare-eligible individuals
    whose transplant and related costs will be covered by Medicare.
    Cooperation between the NIDDK and NIAID and members of the
    Consortium is urged to ensure the timely launch of these
    clinical trials.
        Drug screening.--The Committee applauds NIDDK for convening
    an exploratory workshop to investigate the potential of
    conducting a screen of FDA-approved pharmaceutical drugs for
    hyperglycemia-induced cellular injury leading to diabetic
    complications. Screens of this type have the potential to lead
    to the identification of new treatment strategies that can be
    rapidly translated into clinical applicability. The Committee
    urges the Institute to continue to promote research in this
    promising area.
        Rapid access to intervention development.--The Committee
    commends NIDDK and NCI for extending the rapid access to
    intervention development (RAID) pre-clinical resources to
    researchers working in the field of type 1 diabetes and its
    complications. The Committee encourages NIDDK to release to the
    public information on compounds to be produced for projects
    supported by RAID, much like the NCI releases for cancer-
    related projects on its public website.
        Pediatric kidney disease.--Kidney disease remains a
    persistent and poorly understood problem among infants,
    children and adolescents, impairing normal growth and
    development and often resulting in learning disabilities and
    mental retardation. Of urgent concern today is the explosion in
    the incidence of obesity among chilren and adolescents, a
    morbidity that places more than 15 percent of America's
    children at risk for developing type 2 diabetes, hypertension,
    and chronic kidney disease (CKD). These morbidities not only
    represent a significant financial burden to the health care
    system but also are important risk factors for the development
    of cardiovascular disease. The Committee encourages NIDDK to
    continue to support research focused on the pathogenesis,
    prevention, and treatment of kidney disease in children. The
    Committee recommends that emphasis be placed on exploring the
    contributions of obesity, type 2 diabetes, and hypertension to
    progression of disease, and interventions that may limit
    cardiovascular morbidity in patients with CKD.
        Polycystic kidney disease (PKD).--The Committee recognizes
    that NIH research combined with grants from the private sector
    and the involvement of industry has produced the first clinical
    drug trial for PKD in humans, and has fostered the development
    of additional, innovative PKD therapies. The Committee
    recognizes that the four PKD centers of excellence have
    engendered a broad range of alternative model research systems
    and reagents shared worldwide among PKD investigators and have
    drawn a host of investigators from other disciplines into the
    PKD field. The Committee encourages NIDDK to facilitate PKD
    clinical trials by strengthening studies of pathophysiology and
    cellular pathobiology.
        Incontinence.--Many otherwise healthy, active individuals
    suffer from incontinence. Fecal incontinence, also called bowel
    incontinence, affects people of all ages and is associated with
    a wide variety of causes. The Committee encourages NIDDK to
    develop a standardization of scales to measure incontinence
    severity and quality of life and to develop strategies for
    primary prevention of fecal incontinence associated with
    childbirth.
        Interstitial cystitis (IC).--The Committee believes that
    the 2003 NIDDK-sponsored scientific symposium on IC was very
    successful and encourages NIDDK to convene a similar symposium
    on IC in 2006, collaborating with appropriate voluntary
    organizations. The Committee also encourages NIDDK to hold a
    separate meeting of leading international researchers involved
    in IC research to seek clarity on the definition of IC. The
    absence of a uniform definition which accurately captures the
    condition and the affected population is negatively affecting
    patients in terms of diagnosis and treatment as well as
    researchers in terms of literature review. The Committee was
    encouraged to learn that NIDDK is launching an IC awareness
    campaign and hopes that NIDDK will continue to work closely
    with the IC patient community on both developing the content
    and executing the campaign.
        Liver disease research action plan.--The Committee is
    pleased to note that NIDDK, working with the leading scientific
    experts in the field, has prepared and published a
    comprehensive liver disease research action plan to guide
    future research activities. The plan is organized into 16
    chapters and identifies numerous areas of research important to
    virtually every aspect of liver disease. The Committee
    recommends that steps be taken to begin to implement the plan
    immediately and be ready to report at next year's hearings what
    has been accomplished to date, as well as future plans.
        Hepatitis B.--The Committee is concerned that a consensus
    treatment protocol for hepatitis B does not yet exist, but is
    pleased to learn that NIDDK is actively supporting preliminary
    research in order to convene a research workshop to plan a
    hepatitis B consensus development conference. The Committee is
    pleased that NIDDK is taking all necessary steps to plan a
    successful hepatitis B consensus development conference and
    hopes that this conference is held soon.
        Hepatitis C.--The Committee is pleased to learn that there
    have been 50 patent applications filed for new therapies for
    hepatitis C and there are at least 6 drugs currently in early
    human trials. In addition to developing new drugs, the
    Committee encourages NIDDK to study the improvement of existing
    drugs to reduce their toxicity and negative side effects. The
    Committee applauds NIDDK for formally adopting the goal of a
    90% treatment effectiveness rate for hepatitis C within ten
    years.
        Fatty liver disease.--The Committee notes that there is an
    emerging obesity-related chronic liver disease, which may
    affect as many as one in four adults and a significant number
    of obese children. This diagnosis encompasses a spectrum of
    severity with many cases evolving into non-alcoholic
    steatohepatitis (NASH) and, ultimately, cirrhosis. NASH-related
    liver disease has already become an important indicator for
    liver transplantation, and in the absence of better treatments,
    the need for NASH-related liver transplantation will increase
    significantly over time. The Committee is pleased that NIDDK is
    funding a fatty liver disease clinical trial that includes both
    adult and pediatric populations. The Committee encourages NIDDK
    to focus research on the progression of fatty liver disease to
    cirrhosis and the impact of alcohol on the progression of fatty
    liver disease.
        Pediatric liver disease.--The Committee is pleased that
    NIDDK has taken steps to increase research on biliary atresia,
    the most common cause of liver transplantation in children, by
    creating ten centers within the Biliary Atresia Clinical
    Research Consortium. The Committee is also pleased that centers
    have been added with a special focus on additional neonatal
    liver diseases.
        Alpha-1 antitrypsin deficiency.--The Committee is aware
    that alpha-1 antitrypsin deficiency liver disease is a leading
    cause of pediatric transplantation and can manifest at any age.
    The Committee is encouraged that NIDDK has invested in research
    of this disorder and encourages NIDDK to collaborate with NHLBI
    and other institutes to enhance its research portfolio,
    encourage detection, raise public awareness about alpha-1 and
    provide appropriate information to health professionals.
        Digestive diseases.--Diseases of the digestive system
    continue to affect more than one-half of all Americans at some
    time in their lives. Serious disorders such as colorectal
    cancer, inflammatory bowel disease, irritable bowel syndrome,
    hemochromatosis, celiac disease, and hepatitis take a
    tremendous toll in terms of human suffering, mortality, and
    economic burden. The Committee commends NIDDK on the success of
    its Digestive Disease Centers program in addressing a wide
    range of disorders. The Committee continues to encourage NIDDK
    to strengthen this important program with an increased emphasis
    on irritable bowel syndrome.
        Irritable bowel syndrome.--The Committee remains concerned
    about the increasing frequency of irritable bowel syndrome
    (IBS), a chronic complex of disorders that malign the digestive
    system. This common disorder strikes people from all walks of
    life, affecting between 25 and 45 million Americans. The
    Committee encourages NIDDK to provide adequate funding for
    irritable bowel syndrome/functional bowel disorders research
    and to give high priority to funding grants that will continue
    to increase the IBS portfolio. The Committee requests NIDDK to
    report to the Committee by March 15, 2006 its views on the
    appropriateness of developing a strategic plan for IBS
    research.
        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 from
    intestinal illness. The Committee commends NIDDK for its strong
    leadership in this area and encourages the Institute to give
    priority consideration to the following areas of IBD research:
    the cellular, molecular and genetic structure of IBD,
    identification of the genes that determine susceptibility or
    resistance to IBD in various patient subgroups, and 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.'' The Committee also encourages NIDDK to continue to
    strengthen its partnership with the IBD community on innovative
    research projects.
        Scleroderma.--The Committee encourages NIDDK to support
    scleroderma-relevant research. Scleroderma is a chronic and
    progressive disease that predominantly strikes women. It is
    estimated that ninety percent of patients with systemic
    sclerosis have gastrointestinal (GI) involvement and that, of
    that number, fifty percent have clinically significant
    manifestations. GI involvement can manifest as gastroesophageal
    reflux disease, dysphagia, Barrett's esophagus, gastroparesis,
    ``watermelon stomach'', malabsorption, and fibrosis of the
    small and large intestines. Renal crisis affects twenty percent
    of those with systemic sclerosis often within the first five
    years after diagnosis. More research is needed in order to
    develop safe and effective treatments and to identify the
    causes of the complications of scleroderma.
        Glomerular disease research.--The Committee continues to be
    pleased with the work of NIDDK in the area of glomerular
    disease research, particularly as it relates to focal segmental
    glomerulosclerosis. The Committee commends NIDDK for conducting
    the recent glomerular disease workshop and encourages NIDDK to
    use a program announcement or other appropriate mechanism to
    ensure the initiation of grant proposals, training positions,
    and other activities to expand the NIDDK portfolio in this
    important area of research.
        Tuberous sclerosis complex.--Tuberous sclerosis complex
    (TSC) is a genetic disorder that triggers uncontrollable tumor
    growth in multiple organs of the body including the kidneys,
    where patients are at risk for polycystic kidney disease,
    cancer or, most commonly, benign growths that can result in
    kidney failure. The Committee encourages NIDDK to support
    studies examining the molecular and cellular basis of these
    manifestations of TSC as well as pre-clinical and clinical
    studies.
        Osteoporosis.--The Committee encourages NIDDK to support
    research targeting new technologies and therapies to increase
    bone mass and combat osteoporosis through focus on: (1)
    genetics, environmental and lifestyle factors, and (2) the
    effects of disease, in order to address the research questions
    highlighted in the Surgeon General's Report on Bone Health and
    Osteoporosis.
        Paget's disease.--The Committee encourages NIDDK to study
    the functional consequences of the recently identified gene
    mutations in Paget's disease as a means of identifying new
    therapeutic treatments for the disease.
        Mucopolysaccharidosis (MPS).--The Committee recognizes the
    efforts of NIDDK to enhance research efforts to achieve a
    greater understanding and pursue development of effective
    therapies for MPS disorders. In addition to the general overall
    support of broad based MPS research, the Committee supports
    efforts by NIDDK to reach out to NIAMS to improve collaborative
    bone and joint disease research in MPS disorders. Research
    focused on the underlying pathophysiology of bone and joint
    lesions, the gene mutations and substrates that are stored, and
    potential therapeutic approaches continue to be of significant
    interest of the Committee. The Committee commends NIDDK on its
    collaborations with NINDS, NICHD, NCRR, and ORD in advancing
    broad-based MPS-related research.
        Fragile X.--Fragile X mental retardation is a single-gene
    disorder that results from an unusual kind of mutation. Study
    of the chain of events set in motion by this mutation may lead
    to the identification of points in the process at which
    interventions may ameliorate symptoms. The Committee encourages
    NIDDK to enhance its research activities on fragile X and to
    coordinate these efforts with other Institutes working on
    related activities, including NIMH and NICHD.
        Cooley's anemia.--The Committee continues to support the
    high quality research being conducted by NIDDK on such issues
    as iron chelation, non-invasive iron measurement, fetal
    hemoglobin, and other topics critical to improving the lives of
    Cooley's anemia patients. The development of a less burdensome
    means of iron chelation is urgently needed. In addition, the
    Committee encourages NIDDK to continue to work closely with
    NIBIB to develop and perfect non-invasive means of iron
    measurement.
        Cystic fibrosis (CF).--The Committee commends NIDDK for
    supporting cystic fibrosis research and translational centers.
    When awarded later this year, they will provide resources for
    communication and collaboration between basic and clinical
    researchers to enhance the efficiency of research and foster
    cooperation within and among institutions with strong existing
    bases of cystic fibrosis (CF) research. The Committee also
    commends NIDDK for its support of the EPIC study, a
    longitudinal assessment of risk factors for and impact of
    Pseudomonas aeruginosa acquisition and early anti-pseudomonal
    treatment in children with CF. This study holds the promise of
    yielding critically important information about the optimal
    treatment of initial lung infections in children with CF. The
    Committee encourages NIDDK to continue its support of CF
    research efforts, including proteomics research. CF researchers
    are looking at the many proteins that play a role in CF, in
    hopes of identifying new drug targets to treat CF. The
    Committee commends NIDDK for its support of the program
    announcement for research proposals focusing on discovery and
    development of compounds that will correct protein misfolding.
    The Committee encourages NIDDK to further support this
    especially promising area of research.
        Hepatitis C virus (HCV) and bleeding disorders.--The
    Committee encourages NIDDK to work with appropriate voluntary
    organizations in developing and advancing research initiatives
    for addressing HCV within the bleeding disorders community.

            NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE

        The Committee provides $1,550,260,000 for the National
    Institute of Neurological Disorders and Stroke (NINDS), which
    is $10,812,000 above the fiscal year 2005 comparable level and
    the same as the budget request.
        Mission.--The NINDS supports and conducts basic and
    clinical neurological research and research training to
    increase understanding of the brain and improve the prevention
    and treatment of neurological and neuromuscular disorders. The
    NINDS mission encompasses over 600 disorders, including stroke;
    head and spinal cord injury; epilepsy; multiple sclerosis; and
    neurodegenerative disorders such as Parkinson's disease.
        Stroke.--The Committee continues to place a high priority
    on stroke research and encourages NINDS to allocate resources
    to basic, clinical and translational research into stroke,
    which is a major contributor to late-life dementia and a
    leading cause of permanent disability. The Committee encourages
    NINDS to continue implementing the long-range strategic plan
    for stroke research and to continue searching for novel
    approaches to improve stroke diagnosis, treatment,
    rehabilitation and prevention.
        Epilepsy.--Epilepsy remains a major, unsolved public health
    problem affecting the lives of millions of Americans and their
    families. The Committee seeks intensified efforts by the
    Institute to produce breakthroughs in the prevention,
    treatment, and eventual cure of epilepsy. The Committee
    applauds the development of benchmarks for epilepsy research
    resulting from the ``Curing Epilepsy: Focus on the Future''
    conference held in 2000 and encourages NINDS to address
    important research issues raised at the ``Living Well with
    Epilepsy II'' conference held in 2003. The Committee encourages
    NINDS to continue to allocate resources to the anti-epileptic
    drug development program, and to report to the Committee in
    next year's hearings on its activities to further these
    important areas of research.
        Alzheimer's disease.--NINDS is currently supporting both
    pre-clinical and translational research intended to expand the
    pool of therapeutic agents for treating Alzheimer's disease.
    For example, a recent NINDS-supported study tested a drug that
    interferes at a specific point in the cholesterol pathway that
    contributes to the generation of amyloid protein, a hallmark of
    Alzheimer's. The study resulted in a 99 percent reduction in
    brain amyloid in a mouse model of the disease, suggesting that
    this may provide a novel approach for developing a therapeutic
    intervention for Alzheimer's disease. The Committee encourages
    NINDS to continue to assign a high priority to Alzheimer
    research, and to work closely with NIA, NIMH and other
    institutes.
        Parkinson Disease.--The Committee supports the innovative
    multidisciplinary research and training concerning Parkinson's
    disease provided by the Morris K. Udall Parkinson's Disease
    Research Centers of Excellence. The additional research
    opportunities and discoveries made by Udall Center scientists
    are leading to improved diagnosis and treatment of patients
    with Parkinson's. The Committee commends both the basic and
    clinical objectives of the Centers that, together, enhance
    research effectiveness in a multidisciplinary setting.
        The Committee commends NINDS for participating in a
    community-wide examination of private and pubic Parkinson's
    disease research funding through the Parkinson's Community
    Research Advisory Council. The Committee recommends that NINDS
    continues to participate in this effort.
        The Committee commends the Director for participating in
    the Neuroscience Blueprint, which create new opportunities for
    collaborative research across institutes and through public-
    private partnerships. Specifically, the Committee encourages
    collaborations with other institutes in the areas of genetics,
    cell biology, pathology/epidemiology, non-human models,
    biomarkers, neuroimaging, gene therapy, surgical approaches,
    drug development, cell replacement therapy (i.e., stem cells),
    and mental health.
        Transmissible spongiform encephalopathies (TSE).--The
    Committee recognizes the efforts of NINDS, in collaboration
    with NHLBI, to fund contracts for the development of a
    biological assay for TSE. The Committee requests that the
    Director of the Institute be prepared to report on the progress
    made toward the development of a TSE bioassay at the fiscal
    year 2007 appropriations hearing. The Committee is particularly
    interested in the success in detecting disease-causing agents
    in blood, saliva, cerebrospinal fluid, and other bodily fluids,
    as well as lymphoid tissue, especially tonsils.
        Peripheral neuropathy.--As many as 20 million Americans
    suffer from peripheral neuropathy, a neurological disorder that
    causes debilitating pain, weakness in the arms and legs, and
    difficulty walking. Peripheral neuropathy affects approximately
    one-third of diabetics, or about 5.1 million people, while
    other forms of neuropathy are inherited; associated with
    cancer, kidney disease, or infections like hepatitis, HIV/AIDS,
    or Lyme disease; or caused by autoimmunity, traumatic injuries,
    poor nutrition, toxins, and certain medications. While
    significant research is underway on diabetic neuropathy and
    HIV/AIDS-related neuropathy, the Committee encourages NINDS to
    strengthen its research portfolio on other forms of neuropathy.
    The Committee is pleased to learn that NINDS plans to convene a
    workshop with distinguished scientists to identify research
    goals aimed at expanding the research knowledge base and
    identifying potential therapies.
        Juvenile diabetic neuropathy.--The Committee commends NINDS
    for its recognition of diabetic neuropathy as a serious problem
    of juvenile diabetes. The Committee encourages the Institute to
    work with other agencies on the development of new animal
    models of diabetic neuropathies to aid in the development and
    testing of novel clinical treatments for diabetic peripheral
    and autonomic neuropathies.
        Charcot-Marie-Tooth disease (CMT).--The Committee welcomes
    the upcoming NINDS workshop on peripheral neuropathies, and
    encourages NIH to focus on CMT in this workshop, with a goal of
    producing outcomes which will be directly relevant to CMT
    research. The Committee encourages all relevant institutes and
    centers, including NIAMS, NIDDK, and NICHD, to participate in
    the workshop. In addition, the Committee encourages NIH to
    incorporate CMT research into the Blueprint for Neurosciences
    initiative.
        Traumatic brain injury (TBI).--The Committee encourages
    NINDS to build upon basic and translational research in brain
    injury rehabilitation at the National Center on Medical
    Rehabilitation and Research (NCMRR). NCMRR has awarded grants
    to eight bench science research centers and a data center to
    establish the cooperative multi-center traumatic brain injury
    clinical trials network. The Committee encourages NINDS to
    participate in supporting these centers and to support training
    grants for TBI researchers.
        Dystonia.--The Committee continues to support research on
    the neurological movement disorder dystonia, given that
    dystonia is the third most common movement disorder after
    essential tremor and Parkinson's disease. The Committee
    encourages NINDS to support research on both focal and
    generalized dystonia, and to continue its study of the DYT1
    gene. The Committee is pleased with progress made in expanding
    the dystonia research portfolio as a result of the joint
    dystonia research program announcement, and hopes that NINDS
    will consider options for continued progress once the program
    announcement expires in August 2005.
        Spina bifida.--The Committee strongly encourages NINDS to
    enhance research to address issues related to the outcome and
    recommendations of the 2003 Spina Bifida Research Conference.
    NINDS is urged to strengthen and prioritize research efforts in
    the prevention and treatment of spina bifida and associated
    secondary conditions, with a particular focus on improved
    treatment of hydrocephalus. The Director should be prepared to
    testify on its efforts to advance these areas of research at
    the fiscal year 2007 appropriations hearing.
        Tuberous sclerosis complex (TSC).--TSC is a genetic
    disorder that triggers uncontrollable tumor growth in multiple
    organs of the body, including the brain, heart, kidneys, lungs,
    liver, eyes or skin. Its victims--many of whom are infants and
    young children--face a lifetime of suffering with kidney
    failure, seizures, behavioral disorders, autism and mental
    retardation. Because of the effects of TSC on multiple organ
    systems, the Committee last year called upon the NIH Director
    to formulate an NIH-wide research agenda. The Committee
    understands that NINDS is assigned to implement and coordinate
    that effort, and looks forward to a yearly report on that
    effort. In the meantime, NINDS is urged to support research
    examining the molecular and cellular basis of central nervous
    system manifestations in TSC, including studies examining TSC-
    associated epilepsy and brain tumor formation, and the effect
    of tubers and seizures on cognition and behavior.
        Neurofibromatosis (NF).--Advances in NF research have
    linked NF to cancer, brain tumors, learning disabilities,
    memory loss and heart disease affecting millions of Americans.
    The Committee encourages NINDS to strengthen its NF clinical
    and basic research portfolios. The Committee commends NINDS for
    its leadership role in NF research and in coordinating efforts
    with other Institutes engaged in NF research. The Committee
    recognizes that basic research has now successfully brought NF
    research into the clinical era. The Committee encourages NINDS
    to continue its exemplary efforts in the creation,
    implementation and funding of NF clinical trials
    infrastructures and clinical trials using existing and new
    drugs on NF patients. The Committee hope that NINDS will
    continue to coordinate its efforts with the other institutes at
    NIH as well as other government agencies.
        Spinal muscular atrophy (SMA).--SMA is the leading genetic
    killer of infants and toddlers. The Committee understands that
    the severity of the disease, its relatively high incidence, and
    the possibility of imminent treatments have led NINDS to
    initiate the SMA Therapeutics Development Program. The
    Committee commends NINDS for this initiative and encourages the
    Institute to continue to commit the resources to ensure a
    timely completion of the project to identify and complete
    preclinical research and development of candidate therapeutics
    for treating SMA by 2007. To maximize program efficiency, it is
    also important that NINDS lead efforts to integrate
    therapeutics development efforts with emerging programs in the
    biotech and pharmaceuticals industry, academic medical centers
    and collaborations with voluntary health organizations to
    ensure that duplication of effort is avoided. The Committee
    understands that the strategy for developing a treatment for
    SMA will guide therapeutics development for other diseases
    including Duchenne muscular dystrophy, ALS, Huntington's and
    Alzheimer's.
        Down syndrome.--The Committee commends NINDS for sponsoring
    a down syndrome workshop to address research priorities
    relating to optimizing synaptic structure and function in
    neuronal circuits important for cognition. The Committee
    encourages NINDS to identify opportunities for investigating
    the genetic and cellular basis for abnormalities in the
    structure and function of these circuits in both the developing
    and mature nervous system. NINDS is also encouraged to work
    with NIA to develop strategies to investigate the biology of
    age-related disorders, such as Alzheimer's disease and
    Parkinson's disease, in people with Down syndrome. NINDS is
    also encouraged to work with the Office of the Director to
    develop a strategic plan for Down syndrome research and to
    coordinate its research with NICHD, NIA, NIMH and other
    institutes.
        Mucopolysaccharidosis (MPS).--The Committee commends NINDS
    efforts in the development and release of a program
    announcement to enhance blood brain barrier research in
    lysosomal storage disorders. The Committee continues to
    encourage NINDS to collaborate with all appropriate institutes
    and centers to support ongoing MPS research, to study the blood
    brain barrier as an impediment to treatment, and to use all
    available mechanisms to further stimulate efforts to better
    understand and treat MPS disorders.
        Fragile X.--Fragile X is a single-gene disorder, but both
    its symptoms and its cellular mechanisms suggest involvement of
    multiple genes and specific brain pathways which are associated
    with other neurological disorders, such as autism and seizures.
    Recent research offers clear evidence of disruption of
    fundamental brain circuitry in Fragile X. Thus, Fragile X
    research has the potential to contribute to the understanding
    of multiple disorders, such as seizure disorders, especially in
    the context of developmental disorders, and autism. The
    Committee encourages NINDS to intensify its research into these
    issues as they relate to Fragile X, and to coordinate this
    research with other institutes working on Fragile X, including
    but not limited to NIMH and NICHD.
        FXTAS.--Fragile X-associated tremor/ataxia syndrome, or
    FXTAS, is a newly discovered, progressive neurological disorder
    that affects older men who are carriers of a premutation in the
    same gene that causes Fragile X syndrome. Nearly 1 in 800 men
    in the general population carries this premutation and as many
    as 30 percent of these carriers--roughly 1 in 3,000 men--may
    develop FXTAS later in life. Identification of older male
    carriers will lead to a better understanding of the true
    incidence of Fragile X syndrome and afford at-risk families of
    child-bearing age the opportunity to pursue genetic counseling.
    NINDS, in collaboration with NIA, is urged to strengthen
    research into FXTAS, including working with the other NIH
    institutes.
        Frontotemporal dementia (FTD).--The Committee encourages
    NINDS to support research into drug discovery efforts that
    focus on specific targets relevant to treating the mechanisms
    underlying brain degeneration due to frontotemporal dementia
    (FTD) such as Pick's disease. The Committee is interested in
    research that will focus on methods for discovering the causes
    of this family of diseases, improving diagnostic accuracy, and
    providing longitudinal characterizations so that the success of
    intervention can be determined.

             NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES

        The Committee provides $4,359,395,000 for the National
    Institute of Allergy and Infectious Diseases (NIAID), which is
    $43,445,000 below the fiscal year 2005 comparable level and
    $100,000,000 below the budget request. Bill language requested
    by the Administration is not included to permit the transfer of
    $100,000,000 to the global AIDS, tuberculosis, and malaria
    fund. Bill language requested by the Administration is included
    providing $30,000,000 for the construction of extramural
    facilities for research on infectious agents and
    countermeasures.
        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 (TB).--The World Health Organization estimates
    that nearly one billion people will become infected with TB,
    200 million will become sick, and 70 million will die worldwide
    between now and 2020 of this disease. The Committee is pleased
    with NIAID's efforts to develop an effective TB vaccine. The
    Committee encourages the Institute to continue its TB vaccine
    development work and to strengthen efforts to develop new drugs
    to treat TB.
        Hemophilia.--The Committee encourages NIAID to continue its
    efforts with voluntary organizations in developing and
    advancing research initiatives for addressing hepatitis C (HCV)
    within the bleeding disorders community. The Committee
    understands that HCV continues to have a devastating impact on
    this community, with nearly half of all persons with hemophilia
    having contracted HCV from blood clotting factor products.
        Primary immunodeficiency diseases.--NIAID is the lead
    agency for research into this class of diseases that is known
    to afflict about 500,000 Americans and may affect an equal
    amount that have not yet been diagnosed. To address the complex
    research needs of this group of about 140 separate diseases,
    the NIAID has created a research consortium comprised of the
    leading experts in primary immunodeficiency diseases. The
    Committee requests that NIAID report by February 28, 2006 on
    the management of the consortium, as well as its plans for
    future research in this field.
        Psoriasis.--The Committee encourages NIAID to support
    research on psoriasis, a chronic, immune-mediated disease that
    affects between 5.8 and 7.5 million Americans. Safe and
    effective treatments for women of child-bearing age and for
    children are particularly lacking, and new research indicates
    mothers with psoriasis have a 50 percent increased risk of
    bearing a child with autism. The Committee asks NIAID to
    investigate the possible causes of this troubling finding, as
    well as related research on causes of and treatments for
    psoriasis.
        Inflammatory bowel disease (IBD).--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''. This report identifies strong
    linkages between the functions of the immune system and IBD.
    The Committee encourages the Institute to enhance its support
    of research focused on the immunology of IBD, as well as the
    interaction of genetics and environmental factors in the
    development of the disease.
        Asthma.--The Committee is pleased with NIAID's leadership
    regarding asthma research and management. The Committee
    encourages NIAID to continue to improve its focus and effort on
    asthma management, especially as it relates to children. The
    Committee also encourages NIAID to collaborate more
    aggressively with voluntary health organizations to support
    asthma prevention, treatment, and research activities.
    Additionally, recent studies suggest that a variety of viral
    and bacterial agents may play a role in the development of
    asthma. The Committee recommends that the Institute consider
    expanding research into the role that infections and vaccines
    may play in the development of asthma.
        Hepatitis C virus (HCV) vaccine development.--The Committee
    is encouraged to learn that a small hepatitis C vaccine human
    trial has been successfully completed. The Committee urges
    NIAID to begin to implement the results of the recent workshop
    that was held to discuss and evaluate efforts toward
    development of HCV vaccines with the goal of spurring their
    development and testing. The Committee also encourages NIAID to
    proceed with phase two of the human clinical trial as soon as
    it is scientifically practicable. Additionally, NIAID is urged
    to foster the development of an in vitro culture system for HCV
    as well as new animal models for basic research. The Committee
    continues to be concerned about the prevalence of hepatitis and
    urges NIAID to work with public health organizations to promote
    liver wellness, education, and prevention of hepatitis.
        Transplantation research.--The Committee is aware that
    while one-year organ transplantation survival has improved
    remarkably over the last fifteen years, there has been little
    success in reversing the decline in long-term graft and patient
    survival. The Committee suggests that NIAID convene an expert
    conference, in collaboration with NIDDK and NHLBI, to develop a
    five-year Transplantation Research Action Plan identifying the
    most urgently needed research to facilitate an increase in the
    success of organ transplantation. The expert conference should
    also focus on promising new technologies in pre-transplant
    organ care and post-transplant patient therapies. The Committee
    also suggests the initiation of a cohort study to assess the
    health outcomes of living donors, not only for the period
    immediately following the donation, but for the quality of life
    implications in the decades post-donation.
        Coinfection research.--The Committee is concerned that
    there is growing evidence of liver toxicity resulting from HIV
    treatment protocols such as highly active antiretroviral
    therapy (HAART) in those with chronic viral hepatitis and those
    with decompensated liver disease awaiting liver
    transplantation. There also appears to be an emerging problem
    of liver cancer in co-infected patients. The Committee
    encourages NIAID to initiate research initiatives in both of
    these areas.
        Scleroderma.--The Committee commends NIAID for their
    growing commitment to understanding the cause and to finding
    improved treatments for scleroderma, a chronic and progressive
    disease that predominantly strikes woman. Scleroderma is
    disfiguring and can be life threatening, affecting multiple
    systems including the heart, lungs, kidneys, and
    gastrointestinal tract. NIAID has provided a grant to fund the
    SCOT Study (Scleroderma Cytoxan or Transplant). This study will
    compare the differences between autologous stem cell transplant
    versus high dose cytoxan for the treatment of progressive
    systemic scleroderma. The Committee encourages NIAID to
    continue this commitment through inclusion of scleroderma in
    the Autoimmune Centers of Excellence and through continued
    collaboration with the institutes that are part of the
    Autoimmune Disease Coordinating Committee.
        Atopic dermatitis (AD).--The Committee was pleased to learn
    about NIAID research efforts related to atopic dermatitis
    undertaken through projects such as the Immune Tolerance
    Network and the Atopic Dermatitis and Vaccinia Immunization
    Network. Last year, the Committee encouraged NIAID to
    complement these efforts by working with NIAMS to spearhead a
    multidisciplinary, multi-institute initiative to encourage
    investigator-initiated research projects on AD as it relates to
    smallpox vaccination as well as the progression to asthma and
    other allergic diseases. The Committee requests a report on
    efforts that have been made to foster investigator-initiated
    research in this area.
        Nasal aerosol and spray vaccine delivery systems.--The
    prevention of infectious diseases through the effective use of
    vaccines has saved mankind untold suffering and death. Recent
    developments exploring new routes of immunization such as
    delivery of measles vaccine via the aerosol route and nasal
    spray give great hope for achieving this goal, generating
    significant savings, and resulting in fewer side effects than
    immunization by injection. The Committee encourages NIAID to
    support research in developing and testing these new approaches
    and translating this research into public benefits. The
    Committee recommends that NIAID build upon the testing already
    completed in older children by investigating this delivery
    method in younger children. The Committee believes that NIAID
    and other institutes should collaborate with physicians and
    researchers working with these newer and possibly superior
    methods of vaccine delivery in the hopes of developing safer,
    more effective, and less expensive vaccine delivery modes.
        Meningococcal disease/Serogroup B immunization research.--
    Although meningococcal disease is vaccine-preventable in most
    cases, approximately 30 percent of the deaths and disabilities
    from this bacterial infection are attributed to serogroup B
    which is not vaccine-preventable. The Committee encourages
    NIAID to increase research efforts to develop an effective,
    low-cost vaccine against serogroup B that will help protect
    infants and adolescents in the near term.
        Food allergies.--The Committee is concerned about the high
    prevalence of food allergies, among children in particular,
    with up to eight percent affected. The Committee recognizes
    that 30,000 individuals require emergency room treatment for
    food allergies each year, that 100 to 200 individuals die each
    year from allergic reactions to food, and that there is
    currently no cure for food allergies. The Committee is
    encouraged by the March 2005 release of a report in The Journal
    of Allergy & Clinical Immunology containing guidelines for the
    definition of anaphylaxis, and hopes that these guidelines will
    improve the diagnosis, treatment, and understanding of food
    allergy and anaphylaxis. NIAID is encouraged to invest in
    research into the causes of food allergies and its potential
    treatments.
        Bioterrorism.--Respiratory pathogens that cause life-
    threatening pneumonia are commonly proposed agents of
    bioterrorism. The following are associated with acute
    pneumonia/lung injury: anthrax, smallpox, plague, and
    tularemia. The Committee encourages further research on the
    mechanisms of pneumonia by these respiratory pathogens and the
    development of new therapeutic interventions to reduce injury
    and death.
        Nontuberculous mycobacteria [NTM].--Mycobacteria are
    environmental organisms found in both water and soil that can
    cause significant respiratory damage. The Committee is aware of
    the increasing incidence of nontuberculous mycobacteria [NTM]
    pulmonary infections in women, particularly involving rapidly
    growing mycobacteria, an inherently resistant subspecies. The
    Committee encourages NIAID to advance diagnostic and treatment
    protocols for patients suffering from NTM diseases. Further,
    the Committee recommends additional focus on research leading
    to a better understanding of NTM by establishment of an inter-
    institute coordinating committee to facilitate cooperation
    between NIAID, NHLBI, and other institutes.
        Genetic tools for infectious disease research.--The
    Committee believes that, with regard to both biodefense and
    public health, the development by NIAID of multi-pathogen
    identification arrays that can be used to identify infectious
    agents through epidemiological outbreak surveillance is
    critically important. The use of whole genome expression, all
    exon transcription analysis and whole genome SNP analysis
    studies to identify and understand host biomarkers that may
    identify the type, severity and likely response to therapeutics
    of infectious agents holds great promise. The Committee
    encourages NIAID to pursue these lines of inquiry.
        Islet transplantation.--The Committee commends NIDDK and
    NIAID for the establishment of the Clinical Islet
    Transplantation Consortium and the islet transplantation
    clinical trial that will include Medicare-eligible individuals
    whose transplant and related costs will be covered by Medicare.
    The Committee urges cooperation between NIDDK and NIAID and
    members of the Consortium to ensure the timely launch of these
    clinical trials.
        Detection of disease and bioterror agents.--The Committee
    recognizes the potential threat to national security posed by
    terror attacks involving biological, chemical, nuclear, and
    radiological weapons. One of the challenges facing public
    health officials responding to such an attack is the limited
    ability to diagnose exposure to these agents in the non-sick-
    appearing and early illness individals. The Committee
    recognizes that disease outbreaks--such as SARS in Asia and
    Canada, avian influenza in East Asia, and Ebola and Marburg
    virus in Africa--demonstrate that the speed of diagnosis and
    implementation of public health measures can mean the
    difference between an isolated outbreak and a global pandemic.
    The Committee commends NIAID for its initiatives that provide
    comprehensive genomic, bioinformatics, functional genomics, and
    immune cell proteomic research resources to the scientific
    community conducting basic and applied research on infectious
    agents and the immune system. The Committee encourages NIAID to
    maintain its support of these programs, which provide a
    critical resource for the scientific community that could lead
    to the discovery and identification of novel targets for the
    next generation of drugs, vaccines, diagnostics and
    immunotherapeutics.

                 NATIONAL INSTITUTE OF GENERAL MEDICAL SCIENCES

        The Committee provides $1,955,170,000 for the National
    Institute of General Medical Sciences (NIGMS), which is
    $11,103,000 above the fiscal year 2005 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 provides the scientists needed by industry and
    academia.
        Training programs.--The Committee continues to be pleased
    with the quality of NIGMS's training programs, particularly
    those that have a special focus on increasing the number of
    minority scientists, such as the Minority Access to Research
    Careers (MARC) and Minority Biomedical Research Support (MBRS)
    programs. The Committee encourages NIGMS to continue to support
    these important initiatives, and is particularly pleased that
    NIGMS has supported biomedical research career opportunity
    programs for high school and undergraduate college students in
    conjunction with historically black health professions schools.
    The Committee encourages continued, long-term support of this
    program.
        Anesthesiology research.--The Committee urges NIGMS to
    continue to support and enhance research opportunities focused
    on discovering the mechanisms of anesthesia, perfecting agents
    for regional and general anesthesia, improving the safety of
    anesthesia, monitoring and protection of specific organs of
    patients under anesthesia and optimizing post-surgery
    prognosis. The Committee encourages NIGMS to continue to work
    with other appropriate Institutes to promote improvements in
    pain research. The Committee believes that NIGMS should
    strongly support training, innovation and scientific inquiry in
    these crucial areas of medical research.
        Cystic fibrosis (CF).--The Committee commends NIGMS for the
    renewal and expansion of its large-scale collaborative project
    awards. These cross-disciplinary, multi-institutional
    collaborative projects are important for moving burgeoning
    fields faster than through traditional investigator-initiated
    grants. The Committee encourages NIGMS to consider support for
    research on the barriers to productive protein folding and the
    creation of tools, reagents and advances in techniques for
    precision monitoring of folding. These tools will support
    ongoing research efforts to understand the underlying
    mechanisms of disease caused by improper protein folding, as
    well as efforts to develop therapies to correct this defect for
    CF and other diseases.

            NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT

        The Committee provides $1,277,544,000 for the National
    Institute of Child Health and Human Development (NICHD), which
    is $7,223,000 above the fiscal year 2005 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.
        Preterm birth.--Last year, the National Center for Health
    Statistics reported the first increase in the U.S. infant
    mortality rate since 1958, and 61% of this increase was due to
    an increase in the birth of premature and low birth weight
    babies. The Committee is pleased that NICHD is one of the
    sponsors of an Institute of Medicine study now underway to
    define and address the health related and economic consequences
    of premature birth and encourages NICHD to develop a plan to
    implement the study's recommendations once they are available.
        Genomic and proteomic research.--The Committee is pleased
    that NICHD has launched a major new research initiative to
    address the public health problem of premature birth, which
    affects one in eight babies born in this country and is the
    leading cause of newborn death. NICHD is encouraged to move
    forward with this initiative, which focuses on genomic and
    proteomics, in an effort to accelerate knowledge in the
    mechanisms responsible for premature birth. The Committee
    intends to closely monitor this effort because it assigns a
    high priority to promoting the birth of healthy infants.
        Stillbirth.--The Committee applauds NICHD efforts in
    addressing stillbirth, a major public health issue with
    morbidity equal to that of all infant deaths. The Committee
    understands that NICHD has established a cooperative network of
    clinical centers and a data center to address this issue with a
    standard protocol. The Committee encourages NICHD to strongly
    support this effort.
        Maternal-fetal medicine units network.--The Committee
    recognizes the efforts of NICHD, through its maternal fetal
    medicine units network (MFMU), to achieve a greater
    understanding of and pursue development of effective treatments
    for the prevention of pre-term births, low birth weight
    infants, and medical complications during pregnancy such as
    pregnancy related hypertension and diabetes. The Committee is
    pleased to learn that NICHD is proceeding with a competitive
    renewal of the MFMU network in 2006 and encourages a sustained
    research investment in this program to facilitate resolution of
    these problems and promote the birth of healthy infants.
        Spina bifida.--The Committee is pleased that the Institute
    cosponsored the 2003 spina bifida research conference. However,
    the Committee has heard concerns that NICHD has not engaged in
    adequate follow-up on the conference recommendations. The
    Committee encourages NICHD to enhance research to address
    issues related to the outcome of the conference and urges NICHD
    to jumpstart its research efforts in the prevention, and
    treatment of spina bifida and associated secondary conditions,
    with a particular focus on improved understanding of urological
    disorders among children and adults. The Director should be
    prepared to testify on its efforts to advance these areas of
    research at the fiscal year 2007 appropriations hearing.
        Drug safety for children.--The Committee recognizes the
    importance of ensuring that drugs are safe and effective for
    use by children. The Committee strongly supports continued
    implementation of the Best Pharmaceuticals for Children Act,
    which supports the pediatric testing of off-patent drugs, as
    well as on-patent drugs not being studied through existing
    mechanisms. The Committee is pleased to note that in 2004 six
    studies were initiated and five additional studies are planned
    for 2005. In implementing this provision, NICHD should act as
    coordinator for all other Institutes within NIH for which
    pediatric pharmacological drug research may have therapeutic
    relevance and should consult with the Food and Drug
    Administration to ensure that the studies conducted are
    designed to yield improved pediatric labeling. The Committee
    notes that NICHD has made numerous outreach efforts to other
    Institutes and Federal agencies to further refine the priority
    listing process. The Committee requests NICHD to provide an
    update during its annual appropriations testimony which shall
    include the role of other Federal agencies in implementing the
    Best Pharmaceuticals for Children Act; information on the
    number of studies supported through the Research Fund; the
    estimated cost of each study undertaken; the nature and type of
    studies undertaken; the number of label changes resulting from
    completed studies; the patent status of the drugs studied; the
    number of drugs remaining on the priority list; and a summary
    of NICHD's findings on the frequency of pediatric use for
    medications that may be considered for the priority list.
        The National Children's Study.--The Committee remains
    interested in NICHD efforts to launch the National Children's
    Study, which is intended to follow 100,000 children to age 21,
    examining the impacts and influences of many environmental and
    genetic factors on children's health and development.
        Neurofibromatosis (NF).--Learning disabilities occur with
    high frequency in children with NF. Enormous advances have been
    made in the past few years in the successful treatment and
    curing of learning disabilities in pre-clinical NF animal
    models. The Committee encourages NICHD to issue requests for
    applications for NF research and to pursue funding of clinical
    trials for NF patients in the area of learning disabilities.
        Down syndrome.--The Committee commends NICHD for increasing
    support in fiscal year 2005 for increased production of an
    experimental mouse model of Down syndrome, the Ts65Dn mouse.
    NICHD is encouraged to partner with NINDS and other agencies to
    define additional mouse models needed to link important
    structural and functional abnormalities that underlie cognitive
    difficulties to the actions of specific genes and gene
    pathways. The Committee also encourages NICHD to work with the
    Office of Director to develop a strategic plan for Down
    syndrome research and to coordinate its research with NICHD,
    NIA, NIMH and other institutes.
        Fragile X.--The Committee is pleased that NICHD has funded
    three Fragile X centers and encourages NICHD to enhance the
    centers and recruit new researchers to the Fragile X field. The
    Committee also encourages NICHD to coordinate its Fragile X
    research efforts and to relate Fragile X research with that in
    other developmental disorders, such as autism research.
        Autism.--The Committee is aware of the important research
    supported by NICHD into the genetic basis of autism spectrum
    disorders and of its support for the Baby Sibling study on the
    incidence of autism among children in the same families. The
    Committee encourages the Institute to strengthen its support
    for the Baby SIBS study, and encourages the Institute to expand
    its work with similar public-private partnerships.
        Childhood diseases and the growing skeleton.--The Committee
    encourages NICHD to support studies investigating the effects
    of pharmaceuticals, lifestyle, and chronic childhood diseases
    on the growing skeleton and fracture risk and bone-formation
    interventions for children. NICHD is encouraged to support
    osteogenesis imperfecta research, especially in genetic
    therapies, animal models, drug treatment and rehabilitation.
    The Committee encourages NICHD to work with NIAMS to study the
    rare disorders osteopetrosis and juvenile Paget's disease.
        Infertility and contraceptive research.--The Committee
    notes that infertility is a disease which affects over six
    million people in the United States and is concerned that the
    number appears to be growing as age, lifestyle, and
    environmental factors increasingly impact reproductive health
    outcomes. The Committee suggests that NICHD conduct additional
    research to improve reproductive health intervention outcomes.
        Demographic research.--The Committee commends NICHD for its
    strong support of demographic research. Given the tremendous
    changes occurring in the U.S. population, demographic research
    is necessary to analyze trends and determine consequences for
    the health and well-being of our nation. The Committee
    encourages the institute to ensure adequate support for
    demographic training and for critical demographic databases.
        Primary immunodeficiency diseases (PI).--The Committee
    continues to be impressed with NICHD's contributions to the
    physician education and public awareness program conducted by a
    voluntary organization to reach earliest diagnosis of this
    class of about 140 diseases. With regard to research on PI, the
    Committee is encouraged by the Institute's commitment to
    develop newborn screening procedures for PI, particularly X-
    linked SCID, utilizing microarray technologies.
        Physical therapy.--The Committee recognizes the burgeoning
    growth in rehabilitation services provided to patients,
    especially the elderly, with musculoskeletal problems and the
    urgent need to establish a solid scientific basis for clinical
    practice in this area. The Committee encourages the
    establishment of a research program in the National Center for
    Medical Rehabilitation Research (NCMRR) to: (1) evaluate the
    efficacy and establish optimal schedules and settings for
    movement-based rehabilitation interventions, such as
    therapeutic exercise, to improve physical function in
    individuals with musculoskeletal conditions, including
    arthritis, back pain, hip fracture and major joint
    replacements, and (2) further knowledge of the underlying
    mechanisms of repair, regeneration and recovery of these
    interventions. The Committee encourages NIA, NIAMS, and NIBIB
    to collaborate on these initiatives.
        Glucose monitoring.--The Committee recognizes the
    importance of independent evaluation of blood glucose
    monitoring technologies. The Committee commends NICHD for its
    support of the Diabetes Research in Children Network
    (DirecNet), which aims to improve the management of diabetes in
    children by understanding how to best apply monitoring
    technology in this patient population. The Committee notes the
    unique infrastructure that DirecNet has developed to assess
    such technologies in children and encourages continued support
    for this important clinical research program.
        Pediatric kidney disease.--The Committee encourages NICHD
    to study pre- and post-natal exposures that increase the risk
    of kidney disease, hypertension, and the progression of chronic
    kidney disease from birth to early adulthood. The Committee
    encourages NICHD to support research toward understanding the
    physiologic mechanisms responsible for these risks to further
    prevent the development of kidney disease and the antecedents
    of cardiovascular disease.
        Spinal muscular atrophy (SMA).--The Committee recognizes
    the efforts at NINDS as the leading institute against SMA in
    recent years, and strongly encourages other institutes, notably
    NICHD, to expeditiously work collaboratively to support and
    strengthen the SMA Project. The Committee fully expects that
    NICHD will explore new potential avenues to collaborate with
    NINDS, given the fact that SMA is the leading genetic killer of
    infants and toddlers.

                             NATIONAL EYE INSTITUTE

        The Committee provides $673,491,000 for the National Eye
    Institute (NEI), which is $4,421,000 above the fiscal year 2005
    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.
        Juvenile diabetes.--The Committee encourages NEI to
    continue its efforts to collaborate with other institutes on
    identification of genes that contribute to diabetic retinopathy
    by collecting and analyzing human samples through existing
    clinical studies and working to develop new animal models that
    mimic this condition.
        Diabetic retinopathy.--The Committee commends NEI for its
    continued support of the diabetic retinopathy clinical research
    network. The Committee encourages NEI to expand this network
    through collaboration with other institutes, such as NIBIB, and
    private and public partners and through the introduction of new
    treatments to prevent, treat, or cure diabetic retinopathy.
        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 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 created to help women determine if they are at
    risk of passing the disease on to their children. As
    researchers move closer to understanding how this disease
    works, and developing potential treatments that could improve
    the vision of children with the condition, the Committee
    requests NEI to be prepared to report in next year's hearing on
    advances in research on ocular albinism.

              NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES

        The Committee provides $647,608,000 for the National
    Institute of Environmental Health Science (NIEHS), which is
    $3,103,000 above the fiscal year 2005 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.
        Parkinson's disease.--The Committee encourages NIEHS to
    continue funding research into environmental influences of
    Parkinson's disease. The causes of Parkinson's and other
    neurodegenerative disorders are increasingly shown to be a
    result of the inter-relation of environment and genes. Possible
    environmental triggers of Parkinson's are pesticides and/or
    heavy metals. If these environmental toxins can be identified
    and the mechanisms elucidated, appropriate prevention or
    treatment may prevent many cases of Parkinson's, especially in
    the concerning increasingly younger persons at risk.
        Mercury.--In order to properly research gaps in the area of
    mercury exposure and brain chemistry, and given recent hearings
    on mercury exposure and relationships between autism and
    Alzheimer's disease and mercury exposure, NIEHS is encouraged
    to pursue studies of how inorganic mercury and organic mercury
    compounds (including ethyl, methyl, and other forms of mercury
    from all sources) are processed in the bodies of children and
    adults. NIEHS is also encouraged to support studies of the
    toxic effects of inorganic mercury and organic mercury
    compounds on the nervous systems of young children, adults, and
    the elderly and methods of properly removing mercury and
    mercury-containing compounds from the brains of affected
    humans.
        Toxic exposure and brain development.--Notwithstanding the
    Institute of Medicine May 2004 report on autism, the Committee
    believes it is important to develop a more complete
    understanding of the impact that toxic exposures may have on
    brain development. There is a convergence of findings from
    tissue culture studies, animal models, and clinical studies of
    immune dysfunction in children with autism and other
    neurodevelopmental disorders (NDDs) that suggests a biological
    link between genetic sensitivity and damage to developing
    brains from certain toxins. It is important that NIH continue
    this research to better understand the impact that exposures to
    mercury (including thimerosal) and other toxins have on brain
    development. A more complete understanding of the impact of
    these exposures through research, including animal models, will
    help to develop more effective interventions.
        Toxicology validation reviews.--In order for the
    Interagency Coordinating Committee for the Validation of
    Alternative Methods (ICCVAM) to carry out its responsibilities
    under the ICCVAM Authorization Act of 2000, the Committee
    encourages NIEHS to strengthen the resources for methods
    validation reviews in fiscal year 2006. The Committee is
    encouraged by the National Toxicology Program's Road Map and
    Vision for NTP's toxicology program in the twenty-first century
    and encourages NIEHS to move rapidly to implement the programs,
    especially those directly aimed at strengthening the scientific
    basis for many alternative methods (such as Quantitive
    Structure-Activity Relationships), mechanistic screens, high
    throughput assays, and toxicogenomics).
        Risk analysis.--The Committee encourages NIEHS to establish
    a competitive, peer-reviewed extramural program of centers for
    risk sciences to conduct research in risk sciences, including
    assessment, management, analysis, and communication of risks
    from exposure to environmental chemicals. NIEHS is encouraged
    to work with these centers to develop scientifically-based
    methodologies used to determine, quantify, and communicate risk
    to the public's health.
        Asthma.--Given the link between environmental factors and
    the onset of asthma, COPD, and pulmonary fibrosis, the
    Committee encourages NIEHS to further develop research
    initiatives, such as a large multi-site, long-term
    longitudinal, and maternal/birth cohort to understand the
    environmental and genetic risk factors for predisposing some
    individuals to and in controlling the severity of these lung
    diseases.

                          NATIONAL INSTITUTE ON AGING

        The Committee provides $1,057,203,000 for the National
    Institute on Aging (NIA), which is $5,213,000 above the fiscal
    year 2005 comparable level and the same as the budget request.
        Mission.--The NIA conducts biomedical, behavioral, and
    social research related to the aging process to prevent disease
    and other problems of the aged, and to maintain the health and
    independence of older Americans.
        Alzheimer's disease.--The most common cause of dementia,
    Alzheimer's disease has become a very serious threat to the
    nation's health and economic well-being. Today, an estimated
    4.5 million Americans--one in ten persons over age 65 and
    nearly half of those over 85--suffer from Alzheimer's disease.
    Over the next decade, Medicare spending on beneficiaries with
    Alzheimer's will more than triple, to $189 billion, while
    Medicaid spending over the same period will rise to $27
    billion. In light of these social and economic imperatives, the
    Committee was troubled to learn that NIA's investment in
    Alzheimer research declined in fiscal year 2004 from the
    previous year. The Committee believes that NIA should continue
    to assign the highest priority to this effort.
        Down syndrome.--The Committee commends NIA for its support
    of studies to examine the cellular, molecular and genetic bases
    for age-related neuropathological and cognitive abnormalities
    in people with Down syndrome. It encourages NIA to further
    examine these abnormalities and to devise new methods for
    diagnosing and treating them. Given that all people with Down
    syndrome develop the neuropathological changes of Alzheimer's
    disease, and that many or most go on to suffer dementia, NIA is
    encouraged to consider how studies of the Down syndrome
    population might enhance the ability to understand, diagnose
    and treat Alzheimer's disease. The Committee encourages NIA to
    coordinate its research with NICHD, NINDS, NIMH and other
    institutes.
        Parkinson's disease.--The Committee commends NIA on its
    collaboration with Parkinson's researchers at NINDS Udall
    Centers in helping to discover new Parkinson's susceptibility
    genes, including dardarin, the most recently discovered
    Parkinson's gene by a NIA scientist. This research will prove
    to be invaluable in the development of improved methods of
    diagnosis, as well as neuroprotective and neurorestorative
    treatment of Parkinson's disease. The Committee encourages
    continued collaborations, including additional intramural
    activities, between NINDS, NIMH, and NIA to enhance
    understanding of neurodegenerative diseases, particularly
    Parkinson's.
        Age-related bone health.--The Committee is aware that age-
    related bone loss costs $17 billion annually. NIA is urged to
    address cell senescence and altered cell phenotype in age-
    related bone diseases, aging's impact on bone response to
    loading, bone matrix and quality, and bone marrow; and the role
    of exercise, new anabolics, and stem cells in elderly bone.
        Quality of life.--The Committee encourages studies on
    quality of life in patients with osteoporosis before and after
    treatment, and strategies for optimizing treatment of frail
    nursing home patients at high risk for osteoporotic fracture.
    The Committee also encourages NIA to expand research on the
    role of environmental and lifestyle factors associated with
    osteoporosis and Paget's disease and to work in conjunction
    with NIAMS on models for Paget's disease.
        Roybal centers.--The Committee is very satisfied with the
    progress made by the Roybal Centers for Applied Gerontology
    Research in the application of research to direct service
    interventions resulting in the improvement in the quality of
    life for older adults. The Committee also views the
    collaboration between the Roybal Centers and the Demographic
    Centers as being very positive and encourages NIA to continue
    to promote such collaboration.
        Demographic and economic research.--The Committee commends
    NIA for supporting its Centers on the Demography of Aging
    program and expanding its program to include four new centers
    in 2004. In particular, the Committee encourages NIA to support
    the Health and Retirement Survey and the National Long-Term
    Care Survey. Data from these surveys are particularly important
    for understanding the budgetary impact of population aging and
    for Congress as it deliberates potential changes to the Social
    Security, Medicare, and Medicaid programs.

     NATIONAL INSTITUTE OF ARTHRITIS AND MUSCULOSKELETAL AND SKIN DISEASES

        The Committee provides $513,063,000 for the National
    Institute of Arthritis and Musculoskeletal and Skin Diseases
    (NIAMS), which is $1,906,000 above the fiscal year 2005
    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; orthopedic disorders, such as back pain and sports
    injuries; and numerous skin diseases.
        Scleroderma.--The Committee is encouraged by NIAMS's
    continued 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 Committee encourages NIAMS to
    continue to collaborate with other institutes, including NHLBI,
    NIAID, NIDDK, and NIDCR, and through the NIH Autoimmune
    Coordinating Committee to generate additional research
    opportunities for scleroderma that may assist to identify
    genetic risk factors and the development of safe and effective
    treatments.
        Burden of skin diseases.--The Committee notes the release
    of the recent report, Burden of Skin Diseases, which supports
    evidence gathered at the September 2002 workshop on the burden
    of skin diseases sponsored by NIAMS. Based on these findings,
    the Committee encourages NIAMS to continue to strengthen the
    research portfolio on skin disease. The Committee also
    recommends that NIAMS consider potential partnerships with the
    skin disease research community to address the challenges
    outlined by the Burden of Skin Diseases findings.
        Psoriasis.--Psoriasis is a chronic, immune-mediated disease
    that affects between 5.8 and 7.5 million Americans. The
    Committee recommends that NIAMS support additional research
    into this serious disease, both to identify the several genes
    believed to play a role in psoriasis pathogenesis, as well as
    to support additional clinical research on current and
    potential therapies for psoriasis and psoriatic arthritis.
        Vitiligo treatments for children.--Vitiligo is an
    environmental and genetic auto-immune disease of unknown origin
    which affects about three to six million Americans. Almost
    fifty percent develop the disease in childhood, with the median
    age of onset at four years of age. In its most severe forms,
    patients have milky white patches covering widespread areas of
    the body due to the loss of pigment in these areas. Especially
    for young children, the physical pain caused by severe burns
    from the harmful effects of sunlight and the emotional pain
    caused by people confusing vitiligo with an infectious disease
    diminish the quality of a patient's life. There are no FDA-
    approved treatments for children. The Committee encourages
    NIAMS to enhance research efforts through all appropriate
    mechanisms to identify the causes of this disease and develop
    pediatric treatment options for vitiligo.
        Marfan syndrome.--The Committee commends NIAMS and its
    collaborative efforts with other institutes to provide support
    of research on Marfan syndrome, a life-threatening, progressive
    and degenerative genetic disorder which is characterized by
    aortic aneurysms, orthopedic disabilities and ocular
    manifestations which can result in blindness. Years of
    investment in basic research are ready to be translated to
    clinical studies of drug therapies with the potential of
    reversing many of the life-threatening and disabling symptoms
    of Marfan syndrome. These drug therapies may also prove to
    benefit people with other connective tissue disorders. The
    Committee encourages NIAMS to support clinical trials of new
    drug therapies through all available mechanisms, as
    appropriate.
        Tuberous sclerosis complex (TSC).--TSC is a genetic
    disorder that triggers uncontrollable tumor growth in multiple
    organs of the body, including the skin. The Committee
    encourages NIAMS to support programs examining the molecular
    and cellular basis of dermatological lesions in TSC as well as
    the development of non-surgical treatments for skin
    manifestations.
        Mucopolysaccharidosis (MPS).--The Committee encourages
    NIAMS to work collaboratively with NIDDK in an effort to
    achieve a greater understanding of the bone and joint lesions
    in MPS disorders. The committee supports NIAMS research
    addressing the underlying pathophysiology of bone and joint
    lesions, the gene mutations and substrates that are stored, and
    potential therapeutic approaches to treating these debilitating
    aspects of MPS and related disorders.
        Osteogenesis imperfecta.--The Committee commends NIAMS for
    its support of promising gene-targeting stem cell research that
    could represent a potential cure for osteogenesis imperfecta
    and encourages continued support of this research.
        Osteopetrosis.--The Committee encourages NIAMS to increase
    support of research on models, methods and modalities to
    increase bone formation and alter bone remodeling, and address
    the impact of aging, genetics, obesity, inactivity and exercise
    on bone at molecular, cellular, and tissue levels. NIAMS is
    encouraged to work with NICHD and NIDDK to strengthen research
    on the genetics and new treatments for the rare disorder
    osteopetrosis.
        Lupus.--The Committee is aware that the discovery of lupus
    susceptibility genes may be a prerequisite to developing
    exciting new therapies for lupus and ultimately a way to
    prevent and cure the disease. Advanced new technologies make
    finding these genes less expensive and more feasible than ever
    before. The Committee is also aware that new consortia within
    the lupus community have been formed to facilitate genetic
    research. The Committee urges the Institute to strengthen its
    work in support of the collection of DNA, serum, genotyping and
    subject information from lupus patients, their family members
    and healthy unrelated controls so that the identification of
    the relevant genes can be explained.

        NATIONAL INSTITUTE ON DEAFNESS AND OTHER COMMUNICATION DISORDERS

        The Committee provides $397,432,000 for the National
    Institute on Deafness and Other Communication Disorders
    (NIDCD), which is $3,173,000 above the fiscal year 2005
    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.
        Hearing loss.--The Committee encourages the NIDCD to
    further research in the area of early identification of hearing
    loss and interventions strategies. The Committee urges NIDCD to
    continue to support research in the areas of inner ear
    protection, rescue, and regeneration, such as noise-induced
    hearing loss, ototoxicity and hair cell regeneration, as well
    as research on the central auditory system. In addition, the
    Committee encourages NIDCD to continue research on
    rehabilitative technologies and strategies, leading to improved
    prevention, treatment and management of hearing loss, tinnitus
    and dizziness. The Committee recommends that NICHD maintain
    support for the translation of basic research discoveries into
    better clinical diagnostic techniques and treatments.
        Early hearing detection and intervention (EHDI).--The
    Committee encourages NIDCD to enhance its EHDI research,
    especially as it pertains to the genetics of hearing loss, the
    causes of late-onset and progressive hearing loss, the benefits
    of early identification, and the identification of and
    effective intervention for children with monaural and milder
    degrees of hearing loss. To avoid duplication, NIDCD should
    coordinate its efforts with other institutes and agencies
    conducting EHDI activities.
        Neurofibromatosis (NF).--NF accounts for approximately five
    percent of genetic forms of deafness. 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,
    with important implications for patients suffering from
    meningiomas and other tumors. The Committee encourages NIDCD to
    strengthen its NF research portfolio through all suitable
    mechanisms including RFAs and clinical trials.

                     NATIONAL INSTITUTE OF NURSING RESEARCH

        The Committee provides $138,729,000 for the National
    Institute of Nursing Research (NINR), which is $657,000 above
    the fiscal year 2005 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.

               NATIONAL INSTITUTE ON ALCOHOL ABUSE AND ALCOHOLISM

        The Committee provides $440,333,000 for the National
    Institute on Alcohol Abuse and Alcoholism (NIAAA), which is
    $2,056,000 above the fiscal year 2005 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.
        Alcohol, obesity, and liver disease.--The relationship
    among the use of alcohol, the occurrence of obesity, and the
    presence of liver disease has become increasingly worrisome for
    clinicians. While alcohol's negative impact on weight and liver
    wellness is long established, the current epidemic of obesity
    and its consequent increase in liver disease creates a new
    focus for research. The Committee encourages NIAAA to focus
    greater attention to this relationship with special emphasis on
    the differentiation of impact of alcohol consumption on the
    liver for specific populations, such as women, minorities, the
    elderly, and others.
        Translation.--The Committee is interested in ensuring that
    current research on the health effects of alcohol and
    alcoholism is more effectively communicated and disseminated
    within the alcohol abuse treatment community. The Committee
    recommends that NIAAA jointly work with related alcohol
    research organizations on a plan to broaden the reach and
    timely communication of funded alcohol and alcoholism research
    to the treatment community.

                        NATIONAL INSTITUTE ON DRUG ABUSE

        The Committee provides $1,010,130,000 for the National
    Institute on Drug Abuse (NIDA), which is $3,711,000 above the
    fiscal year 2005 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.
        Drug abuse and HIV/AIDS.--The Committee understands that
    one of the most significant causes of HIV virus acquisition and
    transmission is drug taking practices and related risk factors
    in different populations. Drug abuse prevention and treatment
    interventions have been shown to be effective in reducing HIV
    risk. Therefore, the Committee encourages NIDA to continue its
    support of research focused on the development and testing of
    drug abuse-related interventions designed to reduce the spread
    of HIV/AIDS in these populations.
        Translation of research findings.--The Committee commends
    NIDA for its outreach and work with State substance abuse
    directors, also known as Single State Authorities (SSAs), to
    reduce the current 15- to 20-year lag between the discovery of
    an effective treatment intervention and its availability at the
    community level. In particular, the Committee applauds NIDA for
    working with SAMHSA on a recent RFA designed to strengthen
    State Substance Abuse agencies' capacity to support and engage
    in research that will foster statewide adoption of meritorious
    science-based policies and practices. The Committee also
    encourages NIDA to continue collaborative work with SSAs to
    ensure that research findings are relevant and adaptable by
    State Substance Abuse systems.
        Prevention research.--The Committee remains interested in
    research on preventive medicine and encourages NIDA to conduct
    research on prevention of drug abuse by focusing on the role
    environment plays on neurobiological factors such as gene
    expression.
        Drug-induced liver injury.--The Committee notes that the
    mechanisms and causes of drug-induced liver injury related to
    over-the-counter and prescription medications are not well
    understood and merit further research. The Committee encourages
    NIDA to work collaboratively with NIDDK, FDA, industry, and the
    liver research community to address these priorities.
        Impact of prescription drugs.--The Committee encourages
    NIDA to conduct research on the use of prescription
    psychoactive medication in children and adolescents and their
    impact on the development of mental health and substance abuse
    problems across the life span of individuals.
        Hepatitis and drug abuse.--The Committee is concerned about
    the prevalence of hepatitis and substance abuse and urges NIDA
    to work with voluntary health organizations to promote liver
    wellness, education, and prevention of both hepatitis and
    substance abuse.
        Drug treatment in criminal justice settings.--The Committee
    is very concerned about the well-known connections between drug
    use and crime. Research continues to demonstrate that providing
    treatment to individuals involved in the criminal justice
    system decreases future drug use and criminal behavior, while
    improving social functioning. Blending the functions of
    criminal justice supervision and drug abuse treatment and
    support services create an opportunity to have an optimal
    impact on behavior by addressing public health concerns while
    maintaining public safety. The Committee supports NIDA's
    efforts in this area, particularly the Criminal Justice Drug
    Abuse Treatment Studies (CJ-DATS), a multi-site set of research
    studies designed to improve outcomes for offenders with
    substance use disorders by improving the integration of drug
    abuse treatment with other public health and public safety
    systems.
        Reducing health disparities.--The Committee notes that the
    consequences of drug abuse disproportionately impact
    minorities, especially African American populations. The
    Committee is pleased to learn that NIDA formed a subgroup of
    its Advisory Council to address this important topic. The
    Committee applauds NIDA for working to strategically reduce the
    disproportionate burden of HIV/AIDS among the African American
    population. Researchers should be encouraged to conduct more
    studies in this population and to target their studies in
    geographic areas where HIV/AIDS is high and/or growing among
    African Americans, including in criminal justice settings.

                      NATIONAL INSTITUTE OF MENTAL HEALTH

        The Committee provides $1,417,692,000 for the National
    Institute of Mental Health (NIMH), which is $5,759,000 above
    the fiscal year 2005 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.
        Down syndrome.--The Committee encourages NIMH to develop
    new strategies for cataloging, understanding, diagnosing and
    treating behavioral disorders that are common in people with
    Down syndrome. They include autism, pervasive developmental
    disorder, obsessive compulsive disorder, depression and
    psychosis. The Committee urges NIMH to coordinate its research
    on Down syndrome with NICHD, NINDS, NIA and other institutes.
        Alzheimer's disease.--Combining imaging with genetics, a
    team of NIMH-funded scientists recently identified a possible
    genetic marker for Alzheimer's disease, a variant of the gene
    that codes for APOE, a protein involved in metabolizing
    cholesterol. PET scans of normal individuals in their fifties
    and sixties who carry this variant showed decreased activity in
    regions of the brain known to be affected by Alzheimer's. PET
    scans of younger individuals who carry this variant found
    lowered metabolism in the same brain areas, suggesting that the
    process at work in Alzheimer's starts decades before memory
    deficits become apparent. The Committee strongly encourages
    NIMH to continue to advance understanding of Alzheimer's
    disease.
        Fragile X.--Fragile X is the most common single-gene
    neuropsychiatric disease known. It causes cognitive impairment,
    mental disorders such as obsessive-compulsive disorder, and
    extreme anxiety. The Committee commends NIMH for spearheading
    three focused research meetings in the past four years devoted
    to identifying critical research needs. The Committee
    encourages NIMH to pursue the highest priority needs identified
    by the meeting panels. These include controlled studies of
    existing and new pharmacological treatments for Fragile X and
    identification of the key molecular targets which are likely
    candidates for designing drug treatments for Fragile X and
    related disorders such as autism. The Committee also recommends
    that NIMH include Fragile X in its studies of related
    neuropsychiatric disorders and to work with other Institutes
    such as NICHD and NINDS to develop cooperative research support
    mechanisms in this area. In addition, the Committee suggests
    that NIMH work with industry and academia to test available
    medications and bring new treatments to market.
        Adolescent depression and suicide.--Major depressive
    disorder in adolescence, one of the major risk factors for
    suicide, has become increasingly common. Suicide now accounts
    for 13 percent of all adolescent deaths and ranks third as a
    cause of death among teenagers. The Committee encourages NIMH
    to strengthen its investment in understanding the clinical
    epidemiology of suicidal behavior and thinking in children and
    adolescents; improving the criteria for identifying those at
    risk; and examining the outcomes of actions taken to assist
    those found to be at risk.
        Mental health for older Americans.--The Committee is aware
    that demographics will demand an increased focus on mental
    disorders in older persons. The Committee encourages NIMH to
    strengthen research in this area through all available
    mechanisms to advance the geriatric mental health research
    agenda.

                    NATIONAL HUMAN GENOME RESEARCH INSTITUTE

        The Committee provides $490,959,000 for the National Human
    Genome Research Institute (NHGRI), which is $2,351,000 above
    the fiscal year 2005 comparable level and the same as the
    budget request.
        Mission.--NHGRI coordinates extramural and intramural
    research, as well as research training, in the areas of
    genomics and genetics. The Division of Extramural Research
    supports research on sequence and function of both human and
    non-human genomes, human genetic variation, technology
    development for genome research, database management and
    analysis, and research on the ethical, legal, and social
    implications of human genome research. The Division of
    Intramural Research focuses on applying the tools and
    technologies of the successful Human Genome Project to
    understanding the genetic and environmental basis of disease,
    and developing DNA-based diagnostics and gene-based therapies.
        Targeting disease prevention.--The Committee commends NHGRI
    for its leadership of the international haplotype mapping
    (HapMap) project. The HapMap will provide a powerful new public
    resource to gain a deeper understanding of human biology, and
    discover the genetic and environmental factors that contribute
    to disease, predict potential disease risk, optimize drug
    prescribing for individuals, and identify and validate critical
    new targets for therapeutic development.
        Molecular libraries.--The Committee commends NHGRI for
    leadership in the NIH Roadmap Initiative on molecular
    libraries. This includes the founding of the NIH Chemical
    Genomics center, which will provide public sector researchers
    with access to high-throughput screens for small organic
    molecules, enabling development of new tools for exploration of
    health and disease. The Committee recognizes that advances in
    the use of these molecular libraries will enhance NIH's global
    leadership in the future.
        Genome strategic plan.--The Committee commends the
    Institute's efforts to contribute to the future possibility
    that comprehensive genome sequence information could become a
    part of each American's individual health care plan. NIH has
    assembled significant resources of well-characterized
    populations to enable the testing and validation of genotyping
    and genome sequencing in diseases that are known to have a
    strong genetic basis, such as diabetes, hypertension, and
    several others. The Committee urges NHGRI to work together with
    other appropriate Institutes in this regard to develop models
    for the new era of molecular medicine.

          NATIONAL INSTITUTE OF BIOMEDICAL IMAGING AND BIOENGINEERING

        The Committee provides $299,808,000 for the National
    Institute of Biomedical Imaging and Bioengineering (NIBIB),
    which is $1,599,000 above the fiscal year 2005 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.
        Imaging for autoimmune disease.--The Committee is
    encouraged by the recent development of imaging technology
    being evaluated in clinical trials for detection of metastatic
    cancer in human patients. The Committee encourages the
    Institute to support the translation of imaging technologies to
    the detection and diagnosis of autoimmune diseases, in
    particular juvenile diabetes and organ transplantation. Non-
    invasive imaging approaches are critical to the detection of
    progression of disease or early rejection of transplanted
    organs or cells.
        Bone imaging.--The Committee urges NIBIB to focus on
    improving musculoskeletal disease detection, monitoring and
    treatment through focused imaging and engineering advances. The
    Institute is encouraged to develop noninvasive techniques to
    measure bone quality and bone strength in humans.
        Liver imaging techniques.--Consistent with NIBIB's mission
    to improve all diagnostic imaging technologies, the Committee
    encourages NIBIB to make liver imaging techniques a primary
    focus, speeding the development of new modalities that better
    capture the early stages of various liver diseases, including
    cancer, as well as offering the potential for combinations of
    diagnosis and treatment. This is also necessary to develop less
    invasive diagnostics for liver disease patients. The Committee
    recommends that NIBIB participate actively in trans-NIH
    initiatives that address these priorities.
        Long term budgets.--The Committee acknowledges receipt of
    the Five-Year Professional Judgment Budget for the National
    Institute of Biomedical Imaging and Bioengineering (NIBIB)
    requested in House Report 108-636. The Committee notes the
    budget's central conclusion that biomedical imaging and
    bioengineering ``are dynamic and ripe with opportunities for
    major scientific advances'' that could be translated into
    dramatic improvements in health care. The Committee notes that
    the Five-Year Professional Judgment Budget recommends a
    measured, reasonable rate of growth for the NIBIB to achieve
    the goals of the important research areas enumerated in the
    report. As with all professional judgment budgets, the
    Committee considers them within the constraints of the annual
    budget, acknowledging that they represent the judgment of
    scientific opportunity but not competing demands.
        Interdisciplinary research.--The Committee also notes that
    the Five-Year Professional Judgment Budget recognizes the role
    of the NIBIB with respect to interdisciplinary research, the
    physical sciences, and technology development. NIBIB has taken
    a leadership role in efforts to examine the scientific
    questions that can be addressed by collaboration between life
    and physical scientists, the barriers to such collaboration,
    and the steps that need to be taken to bridge these
    disciplines. The Committee recommends that NIBIB serve as the
    primary home of any new NIH or interagency programs or
    initiatives at the crossroads of physical sciences and
    biomedicine.

                     NATIONAL CENTER FOR RESEARCH RESOURCES

        The Committee provides $1,100,203,000 for the National
    Center for Research Resources (NCRR), which is $14,887,000
    below the fiscal year 2005 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. $29,760,000 was
    provided in fiscal year 2005 for extramural construction.
        Mission.--The NCRR develops and supports critical research
    technologies and shared resources that underpin biomedical
    research. The NCRR programs develop a variety of research
    resources; provide resources for complex biotechnologies,
    clinical research and specialized primate research; develop
    research capacity in minority institutions; and enhance the
    science education of pre-college students and the general
    public.
        Institutional development awards (IDeA).--The Committee has
    identified $222,208,000 for this program, which is the same as
    the Administration request and the fiscal year 2005 level. The
    program is comprised of the Centers of Biomedical Research
    Excellence (COBRE) program and the IDeA Networks of Biomedical
    Research (INBRE) program. The Committee commends NCRR in its
    efforts to support the IDeA program to foster innovation and
    infrastructure in the IDeA-eligible states that have
    traditionally not been able to take advantage of biomedical
    research funding opportunities.
        Advancing clinical and translational sciences.--To
    capitalize on the revolutionary discoveries emerging from basic
    science, there is a pressing need to strengthen and accelerate
    the clinical research process, and to more efficiently transmit
    research findings to practitioners on the front lines of
    patient care. The Committee commends NIH for developing a
    proposal to overcome the challenges facing the translation of
    clinical research, which include: difficulty recruiting and
    retaining clinical researchers; increasing regulatory burden;
    fragmented training programs; and limitations/barriers due to
    NIH funding mechanisms, review and program structure. The
    Committee is supportive of NIH's efforts to help grantee
    institutions create the academic home and integrated resources
    needed to advance the new intellectual discipline of clinical
    and translational sciences, create a cadre of well-trained
    investigators, and transform basic discovery research into
    clinical practice. The Committee looks forward to hearing more
    about how this effort will integrate NIH's existing grants into
    more efficient awards, and how this will transform clinical and
    translational sciences.
        Clinical research curriculum award.--The clinical research
    curriculum award has been extremely effective in training
    successful clinical researchers. Funded programs report that
    over 60 percent of their graduates are active researchers who
    have already secured funding for their research. The Committee
    supports the NIH decision to increase the size of these awards
    from $200,000 to $300,000 and would support a decision by the
    NIH Director to increase funding from the various institutes
    and centers that support the program in order to expand the
    number of institutions receiving this important award.
        Research centers at minority institutions.--The Committee
    continues to recognize the critical role played by minority
    institutions at both the graduate and undergraduate level in
    addressing the health research and training needs of minority
    populations. These programs help facilitate the preparation of
    a new generation of scientists at these institutions. The
    Research Centers in Minority Institutions (RCMI) Program
    continues to impact significantly on these problems. The
    Committee encourages NIH to strengthen participation from
    minority institutions and the resources available in this area.
    The Committee also encourages NIH to work with minority
    institutions with a track record of producing minority scholars
    in science and technology.
        Cystic fibrosis (CF).--The Committee commends NCRR for its
    efforts to improve systems for efficient conduct of clinical
    trials. NCRR support for the CF clinical trials system
    continues to contribute to the development of data collection
    and analysis systems and data safety monitoring efforts that
    are critical elements of the CF system. The Committee
    encourages NCRR to strengthen its support for clinical trials
    systems, including CF work.
        Clinical trials technology.--The Committee encourages NCRR
    to work with grantees in the Research Centers at Minority
    Institutions (RCMI) program and the General Clinical Research
    Centers (GCRC) program to upgrade their clinical trials data
    management capabilities.
        Islet cell resource (ICRs) centers.--The Committee applauds
    the goal of the ICRs to provide human islets for
    transplantation and basic scientific research. The Committee
    encourages the NCRR to ensure that the ICRs continue to improve
    the quality and consistency of islet isolation. The NCRR is
    also urged to maximize the data collection and analysis
    potential of the Administrative and Bioinformatics Coordinating
    Center, the coordinating center for the ICR consortium.

           NATIONAL CENTER FOR COMPLEMENTARY AND ALTERNATIVE MEDICINE

        The Committee provides $122,692,000 for the National Center
    for Complementary and Alternative Medicine (NCCAM), which is
    $587,000 above the fiscal year 2005 comparable level and the
    same as the budget request.
        Mission.--The Center was established to stimulate, develop,
    and support rigorous and relevant research of high quality and
    open, objective inquiry into the safety and effectiveness of
    complementary and alternative medicine practices in order to
    provide the American public with reliable information about
    these practices.
        Ameliorating liver disease.--The Committee is pleased with
    NCCAM's efforts to conduct clinical trials in collaboration
    with NIDDK regarding the use of milk thistle as a possible
    treatment in slowing the progression of nonalcoholic
    steatohepatitis and to reduce the side effects of hepatitis C
    interferon treatments. The Committee looks forward to the
    development and dissemination of the research results
    associated with the use of milk thistle as a treatment to
    ameliorate liver disease.
        Parkinson's disease.--The Committee encourages NCCAM to
    continue exploration of aerobic exercise and Chinese exercises
    such as T'ai Chi Chuan in the treatment of Parkinson's. Recent
    studies show exercise may increase neuroprotective chemicals in
    the brain and decrease falls in the elderly. The Committee also
    encourages continued research into magnetic stimulation for
    depression and the phytomedicine Valerian for sleep
    dysfunction, as both symptoms are significant non-motor co-
    morbidities in Parkinson's. Finally, NCCAM is encouraged to
    work the Office of Dietary Supplements in investigating
    supplements which may be neuroprotective, such as berries,
    alpha lipoic acid, N-acetyl-L-cysteine, acetyl-L-carnitine,
    vitamin E, ginko biloba, vitamin D, vitamin B12,
    phosphatidylcholine, and glyconutrients.

           NATIONAL CENTER ON MINORITY HEALTH AND HEALTH DISPARITIES

        The Committee provides $197,379,000 for the National Center
    on Minority Health and Health Disparities (NCMHD), which is
    $1,220,000 above the fiscal year 2005 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.
        Glomerular injury.--The Committee understands that
    glomerular injury, a group of diseases affecting the filtering
    mechanisms of the kidneys, is more prevalent among African-
    Americans than the general population. The Committee encourages
    NCMHD to explore collaboration with NIDDK to support research
    activities related to glomerular injury and requests a report
    on progress made in this area.
        Scleroderma.--The Committee encourages NCMHD to support
    research that furthers the understanding of causes and
    consequences of scleroderma, a chronic, degenerative disease of
    collagen production, present among African-Americans, Hispanic
    and Native American men and women. NCMHD is encouraged to
    establish epidemiological studies to address the prevalence of
    scleroderma among these populations, as statistics indicate
    that African-Americans have a slightly higher incidence of
    scleroderma. This population is also likely to be diagnosed at
    a younger age and tends to be diagnosed more often with the
    diffuse form of scleroderma.
        Lung disease.--The Committee is concerned with the
    disproportionate impact of lung diseases affecting minorities.
    The Committee encourages the Center to partner with other
    agencies within the NIH, including NHLBI, to develop an
    epidemiological approach to determine the disproportionate
    impact of airway disease on minority populations.
        Psoriasis.--The Committee encourages NCMHD to support
    research that furthers the understanding of causes and
    consequences of psoriasis, a chronic, immune-mediated disease
    that affects between 5.8 and 7.5 million Americans. New
    research indicates that psoriasis is twice as common among
    African-Americans as previously believed, and the research
    found suggestions that psoriasis among African-Americans may be
    more severe than among Caucasians. NCMHD is encouraged to
    establish epidemiological studies to address the prevalence of
    psoriasis among African-Americans, Hispanics, and other
    minority populations, as well as research into the apparent
    differences in psoriasis severity among different populations.
        Liver disease.--The Committee notes that many liver
    diseases, such as hepatitis C, hepatitis B and nonalcoholic
    steatohepatitis, are more common in the African-American,
    Hispanic, Asian Pacific Islander and Native American
    populations, than in European Americans. In addition, access to
    and acceptance of care is particularly problematic in these
    populations. The Committee encourages the Center to initiate
    and participate with NIDDK, NIDA and NCI in research focused on
    addressing and reducing these disparities.
        Cancer center at minority institutions.--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.
        Research endowments.--The Committee commends NCMHD for its
    leadership in addressing the longstanding problem of health
    status disparities in minority and medically underserved
    populations. The Committee continues to encourage NCMHD to
    implement its successful Research Endowment program as an
    ongoing initiative.
        Project EXPORT.--The Committee commends NCMHD for its
    successful ``Project EXPORT'' initiative and recommends
    continued support for this important program.
        Minority community based organizations.--The Committee
    believes that implementation of recommendations stemming from
    the IOM study, ``Unequal Treatment: Confronting Racial and
    Ethnic Disparities in Health Care'' offer significant
    opportunities for improving health across communities of color.
    NCMHD is urged to support minority organizations and minority
    community-based efforts to disseminate research-based health
    information that highlights health disparities experienced by
    different racial and ethnic groups. NCMHD is encouraged to
    engage minority national organizations and minority community-
    based organizations in educating diverse communities about the
    findings and recommendations of the Institute of Medicine
    report.

                      JOHN E. FOGARTY INTERNATIONAL CENTER

        The Committee provides $67,048,000 for the Fogarty
    International Center (FIC), which is $416,000 above the fiscal
    year 2005 comparable level and the same as the budget request.
        Mission.--The FIC was established to improve the health of
    the people of the United States and other nations through
    international cooperation in the biomedical sciences. In
    support of this mission, the FIC pursues the following four
    goals: mobilize international research efforts against global
    health threats; advance science through international
    cooperation; develop human resources to meet global research
    challenges; and provide leadership in international science
    policy and research strategies.
        Chronic obstructive pulmonary disease (COPD).--The
    Committee notes that COPD is the fourth leading cause of death
    in the U.S. and encourages the Fogarty International Center to
    strengthen its COPD research and training activities.
        Tuberculosis training.--The Committee is pleased with the
    Fogarty International Center's efforts to supplement grants in
    the AIDS International Training and Research Program (AITRP) or
    International Training and Research Program in Emerging
    Infectious Diseases (ERID), which train tuberculosis experts in
    the developing world. Given the magnitude of global
    tuberculosis, the Committee encourages FIC to develop a
    specific free standing TB training program.
        Fragile X.--The Fogarty International Center addresses
    global health challenges through innovative and collaborative
    research and training programs and supports and advances the
    NIH mission through international partnerships. International
    collaboration among scientists is an essential element in
    Fragile X research. The Committee encourages the Fogarty
    International Center to consider Fragile X syndrome through all
    appropriate programs, such as the Fogarty International
    Research Collaboration Award and the FIC Brain Disorders in the
    Developing World Program.

                          NATIONAL LIBRARY OF MEDICINE

        The Committee provides $318,091,000 for the National
    Library of Medicine (NLM), which is $2,945,000 above the fiscal
    year 2005 comparable level and the same as the budget request.
    In addition, $8,200,000 is made available from program
    evaluation funds as requested by the Administration to support
    the National Center on Health Services Research. The same
    amount was provided last year.
        Mission.--The National Library of Medicine collects,
    organizes, disseminates, and preserves biomedical literature in
    all forms, regardless of country of origin, language, or
    historical period. The Library's collection is widely
    available; it may be consulted at the NLM facility on the NIH
    campus; items may be requested on interlibrary loan; and the
    extensive NLM bibliographic databases may be searched online by
    health professionals around the world. NLM has a program of
    outreach to acquaint health professions with available NLM
    services. The Library also is mandated to conduct research into
    biomedical communications and biotechnology; to award grants in
    support of health science libraries and medical informatics
    research and training; and to create specialized information
    services in such areas as health services research,
    environmental health, AIDS, hazardous substances, and
    toxicology.

                             OFFICE OF THE DIRECTOR

                              (INCLUDING TRANSFER)

        The Committee provides $482,216,000 for the Office of the
    Director (OD), which is $124,169,000 above the fiscal year 2005
    comparable level and $97,021,000 above the budget request.
    Included within funding for the Office of the Director is
    $97,021,000 for radiological, nuclear and chemical
    countermeasures. The Administration had requested these funds
    as part of the Public Health and Social Services Emergency
    Fund. It is intended that the Director allocate these funds to
    those Institutes that support these areas of countermeasure
    research.
        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 $93,000,000 within the Office of the Director for the
    Director's Discretionary Fund (DDF), which is the same as the
    Administration request and $23,560,000 above the fiscal year
    2005 comparable level. $83,000,000 of this funding is intended
    to be used for Roadmap initiatives. The Committee has repeated
    last year's bill language making up to $10,000,000 of this
    total available through the flexible research authority
    provided in section 217 of the Act. The Committee also includes
    bill language providing $10,000 for representation allowances
    when specifically approved by the Director of NIH.
        The Committee includes $2,000,000 as requested by the
    Administration for a new Office of Portfolio Analysis and
    Strategic Initiatives. The Committee strongly supports this
    effort as a needed mechanism to review the NIH research
    portfolio as a whole and to address the issues raised by
    external groups about the coding of diseases for funding
    reporting.
        The Committee includes bill language from last year's bill
    identifying the maximum funding that may be used for Roadmap
    activities and the method of calculating each Institute or
    Center's contribution. The language also permits the transfer
    of Roadmap funds to a single location for the purpose of using
    a standardized accounting structure for supporting Roadmap
    activities.
        Mission.--The Office of the Director provides leadership to
    the NIH research enterprise and coordinates and directs
    initiatives which cross-cut the NIH. The OD is responsible for
    the development and management of intramural and extramural
    research and research training policy, the review of program
    quality and effectiveness, the coordination of selected NIH-
    wide program activities, and the administration of centralized
    support activities essential to operations of the NIH.

    Office of Research on Women's Health

        The Office of Research on Women's Health (ORWH) works in
    collaboration with the Institutes and Centers of NIH to promote
    and foster efforts to address gaps in knowledge related to
    women's health through the enhancement and expansion of funded
    research and/or the initiation of new investigative studies.
    The ORWH is responsible for ensuring the inclusion of women in
    clinical research funded by NIH, including the development of a
    computerized tracking system and the implementation of
    guidelines on such inclusion. This Office is also involved in
    promoting programs to increase the number of women in
    biomedical science careers, and in the development of women's
    health and sex and gender factors in biology as a focus of
    medical/scientific research.
        The Committee is pleased with the increased focus on
    irritable bowel syndrome (IBS) at the ORWH. It is estimated
    that between 25 and 45 million Americans, disproportionately
    women, suffer from IBS.

    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 2005 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.
        Pediatric HIV research.--The Committee recognizes the
    importance of research into the long-term health implications
    of preventive HIV drug regimens in children, the psychological
    and social needs of HIV-infected children and appropriately
    targeted prevention services. The Committee requests the
    Director to identify the resources necessary for domestic and
    international research on the long-term effects of preventive
    drug regimens on HIV-exposed pediatric populations; the long-
    term health, psychosocial, and prevention needs for pediatric
    populations perinatally HIV-infected; the transition to
    adulthood for HIV-infected pediatric populations; and safer and
    more effective treatment options for pediatric populations with
    HIV disease.
        Pediatric HIV vaccine testing.--The Committee requests the
    Director of the National Institutes of Health to submit a
    report within 90 days of enactment of this bill on the status
    of activities related to the testing of potential HIV vaccine
    candidates in relevant pediatric populations, including
    infants, preadolescents, and adolescents. The report should
    include an analysis of regulatory or other barriers to
    developing an HIV vaccine and a comprehensive review of current
    and planned clinical trials in relevant pediatric populations.
    In addition, the Committee requests that the NIH Fiscal Year
    2007 Plan for HIV-Related Research and future plans include:
    plans for expanding existing capacity for HIV vaccine candidate
    testing in relevant pediatric populations; plans for increasing
    coordination in advancing pediatric HIV vaccine testing across
    Federally funded HIV vaccine research programs, including, but
    not limited to the HIV Vaccine Trials Network, the Pediatric
    AIDS Clinical Trials Group, the Food and Drug Administration,
    the Centers for Disease Control and Prevention, and the
    Partnership for AIDS Vaccine Evaluation; opportunities for
    collaboration with the Office of the Global HIV/AIDS
    Coordinator; appropriate principles for initiating HIV vaccine
    testing in relevant pediatric populations, including
    recommendations for sequencing the enrollment of adults and
    relevant pediatric populations and for addressing issues
    related to human subjects protections for children involved in
    clinical research; and proposed community education efforts in
    support of the inclusion of relevant pediatric populations in
    HIV vaccine clinical trials.

    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.
        Pediatric liver diseases.--The Committee is pleased that
    the ORD has continued to provide significant funding to support
    10 centers within the Biliary Atresia Clinical Research
    Consortium. The Committee urges ORD to continue to address rare
    liver diseases including primary biliary cirrhosis, primary
    sclerosing cholangitis, and auto-immune hepatitis.

    Multi-Institute Research Issues

        Clinical Trials Technology.--The Committee recommends that
    the NIH Director and the Director of the NIH Clinical Center
    explore options for utilization of technology to improve
    efficiency, cost savings, and sharing of information in
    clinical trials being supported intramurally and extramurally.
    The Director is encouraged to investigate software systems that
    could reduce the administrative costs of clinical trials,
    improve the availability and transfer of clinical data for
    review or use by other researchers, and bring uniformity to the
    administration of NIH research.
        Clinical investigators.--The Committee has heard testimony
    that there is currently a shortage of adequately trained
    clinical investigators within every medical specialty who can
    translate basic science advances into the diagnosis, treatment
    and prevention of disease. This shortage inhibits clinical
    research productivity and slows the rate at which results from
    basic biomedical research efforts can be applied to the
    problems of patients. Improved clinical research will have a
    positive effect on the quality of health care and patient
    safety, and advance the application of the principles of
    evidenced-based medicine to routine patient care. The Committee
    has as a priority the training of physician-scientists through
    all NIH institutes, to support studies of patient outcomes,
    medical effectiveness, and disease- and treatment-specific
    quality of life.
        Public access.--The Committee is pleased that NIH is moving
    forward to implement its public access policy and is hopeful
    that the policy will be a first step toward providing free and
    timely access to the published results of all NIH-funded
    biomedical research. The Committee endorses NIH's expressed
    goals for the policy, namely to create an archive of NIH-funded
    research, to provide an opportunity to better manage the NIH
    research portfolio, and to provide enhanced public access to
    NIH research results. The Committee is concerned, however, that
    the final policy may not achieve these goals. For this reason,
    the Committee directs the Office of the Director to submit to
    the Committee by March 1, 2006 a comprehensive report on the
    progress achieved during the first eight months following the
    implementation of the new policy. Specifically, the Committee
    requests that the report provide: 1) the total number of
    applicable peer-reviewed articles deposited in PubMed Central
    since the May 2, 2005 implementation date; 2) the embargo
    period requested by the author for each deposited work; and 3)
    NIH's best estimate of the total number of applicable peer-
    reviewed articles available for deposit during this time frame,
    together with an explanation of the mechanisms relied upon to
    determine this estimate. Additionally, the Committee is
    concerned that grant recipients may not fully understand the
    NIH policy and the steps required to post an article in PubMed
    Central. The Committee, therefore, directs NIH to develop an
    aggressive education and outreach initiative aimed at informing
    grant recipients about the policy in an effort to maximize full
    and prompt participation.
        Duchenne muscular dystrophy.--The Committee is disappointed
    with the time the Department took to implement the provisions
    of the MD Care Act. It is pleased that the Muscular Dystrophy
    Coordinating Committee (MDCC) eventually produced an MD
    Research and Education Plan, which is to be updated every two
    years and submitted to Congress. The Committee understands that
    NIH also submits an annual report to Congress on implementation
    of the MD Care Act. The Committee requests that it be included
    in the Congressional distribution of both of these periodic
    reports. The Committee asks that the annual report state NIH's
    current research goals related to duchenne muscular dystrophy,
    the progress made toward each goal, the total amount of money
    invested toward each goal as well as projected spending for the
    present and future fiscal year, and all opportunities for
    translation research and external partnerships.
        The Committee is pleased that NIH has funded one additional
    Senator Paul Wellstone Muscular Dystrophy Cooperative Research
    Center and is working to fund two more, for a total of six. The
    Committee urges NIH to provide adequate funding and resources
    for each center. The NIH is also urged to devote separate
    resources to DMD translational research beyond the funding that
    is provided in Centers of Excellence programs.
        Duchenne muscular dystrophy translational research.--The
    Committee recognizes that several promising translational
    treatments and therapies for Duchenne and Becker muscular
    dystrophy are in development. The Committee requests NIH to
    develop a translational research initiative specific to
    muscular dystrophy to ensure the effective coordination of
    these efforts and their acceleration. The Spinal Muscular
    Atrophy [SMA] Project may be an appropriate model for the
    initiative. The Committee believes the SMA model enhances the
    dialogue between program directors and investigators,
    facilitating and accelerating review and modifications of grant
    proposals that are in the best interest of the patients and
    that show the greatest promise for success. To achieve maximum
    effectiveness, the Committee urges NIH to assess the
    background, experience, and capabilities of staff needed to
    launch, perform, and sustain such a translational research
    initiative. The Committee requests a report by March 1, 2006 on
    the timeline to establish a DMD Translational Research
    Initiative.
        As a component of the Initiative, the Committee encourages
    NIH to conduct a workshop to explore the most promising
    potential approaches to Duchenne and Becker muscular dystrophy
    no later than February 2006 and to provide a full report to the
    Committee within 3 months of the workshop.
        Autism spectrum disorders.--The Committee is pleased with
    NIH's autism research matrix and encourages NIH to devote
    sufficient resources to this research agenda. When implementing
    the autism research matrix, the Committee encourages NIH to
    coordinate with autism organizations already funding research
    initiatives to ensure the most efficient use of resources. The
    Committee also notes the promise of particular areas cited in
    the matrix, including genetic and behavioral characterization
    of the disorder, screening and early diagnosis.
        Autism and vaccines.--The Committee continues to be aware
    of concerns about reports of a possible association between the
    measles component of the measles-mumps-rubella (MMR) vaccine
    and a subset of autism termed autistic entercolitis. The
    Committee continues its interest in this issue and encourages
    the Interagency Coordinating Committee to continue to give
    serious attention to these reports. The Committee is aware that
    research is underway, supported by NIH, and encourages NIH to
    avoid further delays in this research.
        The Committee is also concerned that there is some evidence
    that infant exposures to thimerosal in the 1990s may be related
    to the epidemic of neurodevelopmental disorders in children.
    CDC's most extensive review of Vaccine Safety Datalink data
    concluded that more research needs to be conducted in this
    arena to answer these questions with certainty and the
    Committee concurs with the need for this continued research.
        The Committee encourages NIH to dedicate significant
    resources to pursue the recommended research initiatives
    outlined in the Institute of Medicine's (IOM) Immunization
    Review. These reports have identified the research needed to
    better understand why a number of children suffer severe
    adverse reactions to childhood vaccines. Continuation of this
    research to develop a better understanding of biological
    mechanisms is critical for knowing with certainty whether or
    not thimerosal and other vaccines exposures might cause
    increased risks for some children.
        Stem cell research.--Since the late 1960s bone marrow
    transplants and bone marrow stem cells have been used to treat
    cancer and blood diseases. In recent years, basic and clinical
    research has demonstrated the ability of adult stem cells to
    treat a broader range of diseases through regenerative medicine
    including autoimmune diseases and tissue repair. The Committee
    urges NIH to place a high priority on investigating the
    plasticity and expansion of adult stem cells using more
    recently discovered multipotent adult stem cells from fat,
    dental pulp, heart, umbilical cord blood, and olfactory
    neurons. Clinical research, including FDA-approved clinical
    trials applying these novel sources of stem cells to the
    treatment of Parkinson's disease, ALS, diabetes, heart disease,
    and other diseases should be pursued vigorously as well.
        The Committee requests the Director, through the new Office
    of Portfolio Analysis and Strategic Initiatives, to consider
    the distinctions between the various types of adult stem cell
    research as it develops tools to more accurately categorize and
    assess expenditures on stem cell research as a whole. By April
    2006 the Committee requests a detailed report compiling the
    complete range of diseases being treated with all adult stem
    cells (including umbilical cord blood cells). This report
    should include a breakdown of spending among the various types
    of basic and clinical human adult stem cell research in a way
    that distinguishes traditional applications of bone marrow stem
    cells in the treatment of cancer and blood diseases from
    pioneering research into the novel use of multi-potent adult
    stem cells in regenerative medicine. Within six months of the
    release of this report, the Committee also requests that NIH
    develop an initiative to strengthen its portfolio of basic and
    clinical research into novel therapeutic uses of adult stem
    cells.
        Microbicides for the prevention of HIV/AIDS.--The Committee
    urges strengthened funding for microbicide research and
    development at NIH. In addition, the Committee has long
    advocated that NIAID establish a dedicated microbicide unit
    with clearly identified leadership to accelerate microbicide
    research. The Committee understands that NIAID has established
    the Microbicide Team in the Division of AIDS (DAIDS), which
    also coordinates a broader NIAID group with representatives
    from DAIDS and the Division of Microbiology and Infectious
    Diseases (DMD). The Office of AIDS Research, within the Office
    of the NIH Director, is continuing to coordinate microbicide
    research across NIH. Greater leadership and coordination on
    this issue is especially critical given that consideration is
    being given to the possibility of a microbicide-specific
    clinical trial network.
        Public-private partnerships in support of microbicides to
    prevent HIV/AIDS.--There is an urgent need to expand the
    development pipeline with more microbicide candidate products,
    particularly those that target HIV in new ways. In addition to
    candidates that may arise from NIH-funded basic research
    efforts, possibilities may be found within pharmaceutical
    companies where there are potential compounds already developed
    as therapeutics that could be tested as potential microbicides.
    NIH has mechanisms in place to encourage partnerships among
    researchers in academia, government and the private sector. The
    Committee strongly urges the leadership at NIH to support the
    microbicide field by encouraging partnering with the
    pharmaceutical industry and non-governmental organizations. In
    the past year, the International Partnership for Microbicides
    has entered into agreements with leading pharmaceutical
    companies to jointly test and develop leading AIDS drugs as
    microbicides. More partnerships like these between the
    pharmaceutical industry and the non-profit community in
    collaboration with NIH will be critical, and should receive the
    active support of NIH leadership.
        Parkinson's disease.--The Committee understands that the
    Director has scheduled a Parkinson's disease research
    conference in June, 2005. The Committee requests the Director
    to report back to the Committee within six months of the
    conference on the conclusions from the summit, an examination
    of the existing Parkinson's research portfolio, and
    recommendations of research goals for the next three years for
    diagnosis, better treatments and a cure for Parkinson's
    disease.
        Autoimmune diseases.--Congress recognizes the cross-cutting
    nature of the NIH Autoimmune Diseases Coordinating Committee
    (ADCC) and its comprehensive Autoimmune Diseases Research Plan.
    The ADCC has been effective in fostering collaborative,
    integrated multi-Institute research on issues affecting the
    genetically related family of autoimmune diseases. The ADCC
    should focus on the role of environmental and infectious agents
    in the initiation and/or exacerbation of autoimmune diseases.
    Additionally, the Committee encourages the ADCC to be proactive
    in identifying promising areas of autoimmune research where
    collaboration among the NIH institutes enhances the potential
    for major advances.
        Heart disease research and prevention action plan.--
    Concerned that heart disease remains a major cause of permanent
    disability, the Committee encourages NIH to consider convening
    an inter-agency conference on heart disease to develop a
    comprehensive, long range research and prevention action plan.
    Participants should include representatives from all Federal
    agencies involved in heart disease research and prevention,
    including the NIH, CDC, AHRQ, DOD, and pertinent voluntary
    nonprofit organizations and experts in the field. The
    conference would be the basis for a long-range, strategic heart
    disease research and prevention action plan which would include
    quantifiable goals and benchmarks to measure progress in the
    battle against heart disease.
        Spina bifida.--The Committee recognizes that spina bifida
    is the leading permanently disabling birth defect in the U.S.
    and has heard concerns that NIH has not prioritized research
    into primary and secondary treatment of this condition. While
    spina bifida is highly preventable through proper nutrition,
    including appropriate folic acid consumption, too many
    pregnancies still are affected each year by this devastating
    birth defect. Since more than 70,000 individuals are living
    with spina bifida, the Committee urges NIH to allocate adequate
    resources to research into primary and secondary treatment of
    spina bifida. The Committee is pleased with the outcome of the
    2003 Spina Bifida Research Conference and encourages NIH to
    consider organizing a follow-up national conference involving
    NICHD, NINDS, NIDDK, and the Office of Rare Diseases along with
    the National Center on Birth Defects and Developmental
    Disabilities, the Agency for Healthcare Research and Quality,
    and the National Institute on Disability and Rehabilitation
    Research to identify and explore improved treatment and
    outcomes for adults and children with spina bifida.
        Rett syndrome.--Rett syndrome is a neurological disorder
    resulting from a mutated gene that seen worldwide in most
    racial and ethnic groups, almost exclusively in females. It is
    estimated to occur approximately one in fifteen thousand female
    births, although recent discoveries may reveal significantly
    more affected people than previously diagnosed. The Committee
    applauds NIH's continued commitment to Rett syndrome research
    and encourages support for new animal models and genotype/
    phenotype investigations of Rett syndrome. Since Rett syndrome
    is a multi-faceted disorder, the Committee encourages NIH to
    redouble its effort to integrate the appropriate Institutes
    into this program area, including NIA, NIMH, NIDCD, NHLBI,
    NIAMS, NIDDK, and NIGMS, whose mandates include areas involved
    with understanding, treating and curing Rett syndrome.
        Cystic fibrosis (CF).--One of the priorities of the NIH
    Roadmap is the re-engineering of the clinical research system.
    There are a number of clinical trials systems that might serve
    as models for the re-engineering effort. One such model is the
    clinical trials system for testing therapies for CF, which
    includes centralized data management and analysis capability,
    centralized data safety monitoring, and the participation of 18
    leading CF research centers. The Committee encourages the
    Director to evaluate and support the CF system as a model for
    the clinical trials reform effort. The structure and systems
    that achieve cost and research efficiencies in the CF network
    might be applicable to trial networks for other diseases.
        Charcot-Marie-Tooth disorder.--Charcot-Marie-Tooth disorder
    (CMT) is one of the most common inherited neurological
    disorders, affecting approximately one in 3,500 people in the
    United States. The Committee is concerned about the prevalence
    of this disease and its effect on people across the age
    spectrum and recognizes the value of CMT research for advancing
    understanding into other neuromuscular disorders. The Committee
    encourages NIH to identify new research opportunities on CMT
    that could lead to a relevant program announcement or request
    for applications. The Committee requests a report on NIH
    efforts on CMT and CMT-related disorders by March, 2006.
        Polycystic kidney disease (PKD).--The Committee is pleased
    that NIH-supported PKD research, combined with grants from the
    private sector and the involvement of industry, has not only
    produced the first clinical drug trial for PKD in humans, but
    has fostered the development of additional, innovative PKD
    therapies. Given the unprecedented momentum and therapeutic
    opportunities in PKD science, the Committee urges NIH to
    further implement its PKD Strategic Plan by facilitating PKD
    clinical trials and expanding knowledge-based studies of
    pathophysiology and cellular pathobiology.
        Lymphatic system research.--The lymphatic system is central
    to the progression of disease and the maintenance of health,
    yet scientific and medical knowledge of this important system
    has gaps. The Committee is pleased that a Trans-NIH
    Coordinating Committee on the Lymphatic System exists to ensure
    that scientific knowledge and understanding about this body
    system will be advanced and coordinated. The Committee is
    encouraged to learn that the Coordinating Committee is working
    with patient advocates to address the needs of the lymphatic
    disease and lymphedema patient communities. The Committee
    encourages NIH to consider initiatives such as a national
    lymphatic disease patient registry and tissue bank; an NIH
    partnership funding program; intramural longitudinal studies;
    and multidisciplinary centers.
        Asian American and Pacific Islander (AAPI) populations.--
    The Committee encourages NIH, particularly NIDA, NIAAA, and
    NIMH, to strengthen its support of behavioral health research
    for AAPI populations. Additional research is needed to develop
    a body of knowledge addressing the bio-psycho-social aspects of
    substance abuse as well as co-occurring disorders among AAPI
    populations. Studies are also needed to address the biological
    differences that may exist within the diverse AAPI populations
    in terms of their reaction to the range of substances used and
    abused, and nature of substance abuse; effective prevention and
    treatment strategies; and culturally appropriate ways to
    evaluate these AAPI substance abuse services.
        Dystonia.--The Committee is very pleased with progress
    demonstrated by the NIH intramural research program in the
    treatment and understanding of dystonia. NIH intramural
    researchers have successfully utilized injections of botox to
    treat many patients who otherwise would be severely debilitated
    by dystonia. The Committee urges continued work in this
    important area of study and treatment.
        Fragile X.--The Committee notes the progress made by
    Fragile X researchers in understanding the basic neural defects
    that cause this developmental disorder. However, further
    efforts are required to translate these basic science findings
    into viable treatments. Specifically, collaborative efforts
    between industry, academia and NIH Institutes are likely to be
    necessary to develop promising therapeutic options for this
    orphan indication. The Committee further notes that while
    Fragile X is a relatively common genetic disease, the
    treatments being developed for Fragile X may also be effective
    for a much larger number of people with related autism spectrum
    disorders. Research has shown many possible treatment
    strategies which merit human Fragile X clinical trials. The
    Committee encourages the Director to facilitate and support
    public/private partnerships which will enable these important
    studies to proceed. NIH is urged to convene a yearly workshop
    with the research community to develop priorities for basic,
    clinical and translational research as they relate to Fragile
    X.
        Spinal muscular atrophy (SMA).--The Committee encourages
    the Office of the Director to ensure support of the SMA Project
    by providing active and ongoing support from the OD as well as
    from other related Institute Directors, particularly NICHD,
    since SMA is the leading genetic killer of infants and
    toddlers.
        Psoriasis.--The Committee encourages NIH to strengthen its
    work on psoriasis, a chronic, immune-mediated disease that
    affects between 5.8 and 7.5 million Americans. Safe and
    effective treatments for women of child-bearing age and for
    children are particularly lacking, and new research indicates
    mothers with psoriasis have a 50% increased risk of bearing a
    child with autism. New research also indicates psoriasis is
    twice as common among African-Americans as previously believed.
    Psoriasis research involves many disciplines, and the Committee
    encourages NIH to intensify coordination of psoriasis research
    across its institutes and centers.
        Gene therapy research.--While the promise of gene therapy
    has not yet been realized, the Committee is encouraged by some
    promising research done in the area of thalassemia, or Cooley's
    anemia. It is concerned, however, that the most innovative gene
    therapy research is currently being done in Europe rather than
    in the United States. The Committee urges the Director to
    assess the prospects for the most promising areas for
    breakthroughs in this field and to develop a program to focus
    resources on it. The assessment should also include the
    prospects for successes in additional hemoglobinopathies and in
    an even broader range of diseases.
        Hereditary hemorrhagic telangiectasia.--Hereditary
    hemorrhagic telangiectasia (HHT), also known as Osler-Weber-
    Rendu Syndrome, is a multi-system vascular genetic disorder
    producing blood vessel malformations in the brain and lung
    which may result in stroke, hemorrhage, aneurysm and death.
    Sudden death or disability may occur in twenty percent of
    children and adults, but is largely preventable with proper
    intervention. Because this is a multi-system disorder, the
    Committee encourages the Director to formulate an NIH-wide
    research agenda with the participation of the NHLBI, NINDS and
    NIDDK Institutes.
        Osteoporosis.--The Committee is pleased that the Surgeon
    General has submitted the report on bone health requested in
    the FY 2002 appropriations bill. The Surgeon General's report
    on bone health and osteoporosis comes at a critical time when
    the aging population of the United States faces an increasing
    burden of musculoskeletal disease and disability. Osteoporosis,
    which the report recognizes will affect one in two Americans
    over the age of 50 by 2020, will lead to disability, loss of
    independence and early mortality. The Surgeon General calls for
    a national action plan to achieve improved bone health. To this
    end, the Committee encourages NIH to establish a ``Bone Health
    Research Blueprint'' to achieve the Surgeon General's
    objectives through enhanced cooperation between NIH institutes.
    The Blueprint should place particular emphasis on osteoporosis,
    osteogenesis imperfecta, Paget's disease, other metabolic bone
    diseases and rare bone disorders such as osteopetrosis. The
    Committee requests a report on the status of the Bone Health
    Blueprint by March 1, 2006.
        Human tissue supply.--The Committee remains interested in
    matching the increased needs of NIH grantees and intramural
    researchers who rely upon human tissues and organs to study
    disease and search for cures. The Committee is aware that NIH
    has established a multi-institute initiative on human tissue
    supply. While this is promising, there is still an unmet demand
    for the use of human tissue in research. The Committee
    encourages the Director to strengthen the core support for this
    initiative and to broaden its scope to other Institutes such as
    NCI, NHLBI, and NINDS that have not previously participated in
    the initiative's core support.
        Minority health professions schools.--The Committee
    continues to be pleased with the NIH Director's implementation
    of various programs focused on developing research
    infrastructure at minority health professions institutions,
    including Research Centers at Minority Institutions and the
    National Center on Minority Health and Health Disparities. The
    Committee encourages the NIH Director to work closely with the
    Director of the NCMHD to establish a program of coordination
    among these mechanisms to partner with minority health
    professions schools to address their infrastructure needs.
        Down syndrome.--The Committee urges the Director of NIH to
    establish an NIH Down syndrome research task force on cognition
    to develop a strategic plan for genetic and neurobiological
    research relating to the cognitive dysfunction and the
    progressive late-life dementia associated with Down syndrome.
    The purpose of the strategic plan is to provide a guide for
    coordinating Down syndrome research on cognition across NIH and
    for enhancing the development of new research efforts based on
    identification of areas of greatest scientific opportunity,
    especially as they relate to the development of future
    treatments. The plan should include short, intermediate and
    long-term goals for basic and clinical research with strategies
    for achieving goals and with specified timeframes for
    implementation. The Committee expects the NIH to report to the
    Committee by April, 2006 on the steps it is taking to develop a
    down syndrome research task force on cognition.
        Child abuse and neglect research.--The Committee recognizes
    the magnitude and significance of child abuse and neglect as a
    serious public health problem claiming an estimated 896,000
    victims in 2002, according to data reported by the Department
    of Health and Human Services. The Committee applauds NIH for
    developing a coordinated research agenda for child abuse and
    neglect involving relevant NIH institutes, including NIMH,
    NICHD, NIDA, NINR, and NIAAA, the Office of Behavioral Social
    Science and Research and other appropriate agencies, and the
    continued collaborative and cooperative efforts in child abuse
    and neglect research. In response to recommendations in the
    1993 National Research Council report which examined the
    current state of research in this area, the NIH child abuse and
    neglect initiative first addressed the knowledge gaps in child
    neglect. The Committee encourages NIH to examine current gaps
    that exist in research on the abuse of children, including
    research on treatment interventions with substantiated cases of
    child maltreatment. The Committee requests that the Director be
    prepared to report on current and proposed NIH efforts in this
    area at the fiscal year 2007 hearings.
        Science education.--The Committee recognizes the success of
    grid computing as used by the Kentucky data research
    initiative, a partnership between elementary and secondary
    schools and postsecondary education research institutions to
    maximize research capabilities through computer resources. With
    the cooperation of the state of Kentucky and its local
    education agencies, the Kentucky data research initiative uses
    computers in local schools to provide additional computing
    capacity to cancer researchers at the Brown Cancer Center at
    the University of Louisville. During the hours the computers
    are not used, the excess computing capacity is harnessed so
    that cancer researchers in Louisville have a greater capacity
    to do more complex research. In exchange for the expanded
    research capabilities, scientists visit the schools to discuss
    their research to provide support for students interested in
    math and science. The Committee recognizes the success that
    this program has had in exposing students in elementary and
    high schools to careers in science and increasing the state's
    capacity for cancer research. The Committee encourages the
    Office of Science Education within the Office of the Director
    to review the Kentucky program as a possible model to be
    transferred to other states and utilized to enhance research
    capabilities in the sciences and health-related fields or other
    appropriate fields of research.
        PubChem.--The Committee understands that the stated mission
    of the PubChem database, which is part of the NIH Roadmap
    Initiative, is to create a new and comprehensive database of
    chemical structures and their biological activities, and will
    house both compound information from the scientific literature
    as well as screening and probe data from the new NIH molecular
    libraries screening center network. The Committee is concerned
    that NIH is replicating scientific information services that
    already exist in the private sector. In order to properly focus
    PubChem, the Committee urges NIH to work with private sector
    providers to avoid unnecessary duplication and competition with
    private sector chemical databases.
        Neuroscience and the genome.--The Committee understands
    there are exciting developments in the field of neuroscience
    where integrating genomic-based methodologies with computer
    science and traditional neuroanatomy is being supported by
    private philanthropic (or voluntary could be used here)
    support. These developments could result in advancing our
    knowledge along a broad front of neurologic, psychiatric and
    neurodegenerative diseases, their causes and cures. NIH is
    encouraged to collaborate with these efforts in a public-
    private partnership as espoused in the Roadmap initiative or
    other appropriate mechanisms.
        Amyloidosis.--The Committee encourages NIH to intensify its
    research efforts into the amyloidoses, a group of rare diseases
    characterized by abnormally folded protein deposits in tissues.
    These diseases are often fatal and there is no known cure.
    Treatment involving large-dose intravenous chemotherapy
    followed by stem cell replacement or rescue is effective for
    many patients, but this procedure is risky, unsuitable for many
    patients, and not a cure. The Committee understands that NIH
    will be holding one or more conferences on amyloidosis and
    related diseases during 2005, and looks forward to receiving
    the results and recommendations (as requested in the FY 2005
    Committee report) identifying the next steps that need to be
    taken to increase the understanding, prevention and treatment
    of this devastating group of diseases.

                            BUILDINGS AND FACILITIES

        The Committee provides $81,900,000 for buildings and
    facilities, which is $28,388,000 below the fiscal year 2005
    comparable level and the same as the Administration request.
        Mission.--The Buildings and Facilities appropriation
    provides for the design, construction, improvement, and major
    repair of clinical, laboratory, and office buildings and
    supporting facilities essential to the mission of the National
    Institutes of Health. The funds in this appropriation support
    the 77 buildings on the main NIH campus in Bethesda, Maryland;
    the Animal Center in Poolesville, Maryland; the National
    Institute of Environmental Health Sciences facility in Research
    Triangle Park, North Carolina; and other smaller facilities
    throughout the United States.

           Substance Abuse and Mental Health Services Administration

                   SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES

        The Committee provides a program level of $3,352,047,000
    for the Substance Abuse and Mental Health Services
    Administration (SAMHSA), which is $39,722,000 below the fiscal
    year 2005 comparable level and $16,024,000 above the budget
    request. Within the total, $121,303,000 is provided through the
    evaluation set-aside as requested.
        SAMHSA is responsible for supporting mental health and
    alcohol and drug abuse prevention and treatment services
    nationwide through discretionary targeted capacity expansion
    and knowledge application grants, formula block grants to the
    States and associated technical assistance efforts. The agency
    consists of three principal centers: the Center for Mental
    Health Services, the Center for Substance Abuse Treatment, and
    the Center for Substance Abuse Prevention. The Office of the
    Administrator is responsible for overall agency management.
        The Committee expects that no less than the amounts
    allocated in fiscal year 2005 will be spent in fiscal year 2006
    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.
        Greater availability of a rapid HIV test can increase
    overall HIV testing and reduce the number of people, an
    estimated 225,000 Americans, who are unaware of their HIV
    infection. The Committee acknowledges that treatment services
    provided by mental and behavioral health care providers for
    individuals testing positive are a necessary component of rapid
    HIV testing. The Committee commends SAMHSA for developing the
    Rapid HIV Testing Initiative (RHTI) to train substance abuse
    and mental health service providers on rapid HIV testing and
    prevention counseling. The Committee strongly supports the
    program and provides SAMHSA an additional $1 million towards
    the RHTI.
        The Committee is concerned about the intersection of
    methamphetamine abuse and the transmission of infectious
    diseases. Methamphetamine is a very dangerous, highly
    addictive, and toxic drug and is strongly linked to risky
    behaviors, increasing the risk of transmissions of infectious
    diseases such as HIV and Hepatitis C. SAMHSA and the Centers
    for Disease Control and Prevention (CDC) have funded crucial
    programs in methamphetamine prevention and treatment and
    infectious disease prevention and treatment programs, but there
    exists a gap on collaboration between the two agencies.
    Recognizing that CDC and SAMHSA have different responsibilities
    in responding to this epidemic, the Committee directs CDC and
    SAMHSA to draft a list of priorities to address the
    intersections of these two epidemics and to jointly provide a
    written report by April 1, 2006 designating a coordinating plan
    between SAMSHA and CDC. The plan should include a proposed
    infrastructure, needed resources, mechanisms of communication,
    and community involvement representing populations at high-risk
    to coordinate prevention, community outreach, professional
    training, treatment and new and existing grant programs to
    effectively address the intersection of the crystal
    methamphetamine epidemic and rising HIV rates. The Committee
    then requests that the CDC and SAMHSA report on the
    effectiveness of the new plan by February 2007.
        The Asian American and Pacific Islander (AAPI) population
    on the continental U.S., Hawaii, and the six Pacific Island
    jurisdictions are one of the fastest growing groups in the U.S.
    However, there are less than 10 culturally competent
    comprehensive substance abuse prevention and treatment programs
    designed to serve the AAPI population in the entire United
    States, and these few programs are located in just four states
    and one Pacific Island jurisdiction. The number and capacity of
    these comprehensive programs has remained essentially the same
    for over 15 years. The need for substance abuse services for
    this population continues to increase while the gap in the
    availability and access to culturally competent services is
    ever-widening. For many in this population services do not even
    exist. The Office of National Drug Control Policy found that
    AAPI parents are the least informed of any group regarding the
    nature and hazards of substance abuse among their teenagers.
    Treatment episodes in some cases have increased by over 50% for
    AAPI clients. SAMHSA should work with appropriate National AAPI
    organizations that provide substance abuse services to create a
    comprehensive system of outreach, training, information and
    resources, and prevention and treatment services that will be
    culturally competent and accessible to all AAPI populations
    across the United States.
        The Committee is concerned about the prevalence of
    hepatitis and substance abuse and urges SAMHSA to work with
    health organizations to promote education and prevention of
    both hepatitis and substance abuse.

    Center for Mental Health Services

        The Committee provides a program level total of
    $880,294,000 for the Center for Mental Health Services (CMHS),
    which is $21,023,000 below the fiscal year 2005 comparable
    level and $43,044,000 above the budget request. Within the
    total, $21,803,000 is provided through the evaluation set-aside
    as requested.
                Programs of regional and national significance
        The Committee provides $253,257,000 for mental health
    programs of regional and national significance, which is
    $21,040,000 below the fiscal year 2005 comparable level and
    $43,044,000 above the budget request. The program includes
    studies that identify the most effective service delivery
    practices, knowledge synthesis activities that translate
    program findings into useful products for the field, and
    knowledge application projects that support adoption of
    exemplary service approaches throughout the country.
        The Committee provides $26,000,000 for the State incentive
    grants for transformation, the same level as the budget
    request. At this level, eight grants will be continued and
    three new grants will be awarded to States to plan and
    implement the transformation of their State mental health
    programs across multiple service systems. These comprehensive
    State mental health plans will enhance the use of existing
    resources at the State and local levels and expand the options
    and array of available supports. These grants are not intended
    to provide direct services, but rather are to aid States in
    developing broad systems changes to better serve persons with
    mental illness.
        The Committee provides $84,000,000 for School Violence
    programs. This is $17,187,000 more than the budget request. At
    this funding level it is the Committee's intention that
    additional grants will be awarded to school districts with the
    goals of promoting the healthy development of children and
    youth, fostering their resilience in the face of adversity, and
    preventing violence.
        Within funds provided, the Committee recommends that no
    less than the funding allocated in fiscal year 2005 be provided
    in fiscal year 2006 for the National Child Traumatic Stress
    Initiative. This program has established 54 treatment
    development and community service centers to treat children who
    have experienced trauma. It is estimated that up to 40,000
    traumatized children and their families will directly benefit
    from services delivered as a result of this initiative.
        The mental health needs of our Nation's seniors are largely
    ignored within our mental health system. While many older
    Americans experience depression, dementia, anxiety and
    substance abuse disorders, far too often these conditions are
    not recognized or treated. Outreach to elderly persons
    conducted in places frequented by seniors, such as senior
    centers, meal sites, primary care settings and other locations,
    is needed. The Elderly Treatment and Outreach Program is the
    only federally funded services program dedicated specifically
    to the mental health care of older adults. It is for this
    reason that within the funds provided, the Committee recommends
    that no less than the level allocated in fiscal year 2005 be
    allocated for the older adults program.
        Within funds provided, the Committee recommends that no
    less than level allocated in fiscal year 2005 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.
        Preliminary data collected by the Centers for Disease
    Control and Prevention's National Violent Death Reporting
    System reports a 5% increase in suicides for 2003.
    Comprehensive data from the 2002 survey indicate that the rate
    of suicides among youth is growing faster than any other age
    cohort. In order to address this, the Committee recommends that
    within the funding provided, programs that address youth
    suicide prevention strategies be funded in fiscal year 2006 at
    no less than the amounts allocated in fiscal year 2005.
        The estimated number of AIDS cases from 1999 to 2003 has
    increased for racial and ethnic minorities, including African
    Americans, Latino/as, Asian Pacific/Islanders and American
    Indians/Alaska Natives. The Committee recognizes that many
    persons with HIV have a psychological and/or substance abuse
    disorder and that mental health and substance abuse services
    can help stabilize the health and well-being of persons with
    HIV/AIDS. The Committee acknowledges that racial and ethnic
    minorities have less access and lower utilization of mental
    health and substance abuse services. The Committee recommends
    that no less than the level provided in fiscal year 2005 be
    allocated for the Minority AIDS Initiative to provide competent
    and accessible mental health and substance abuse services to
    persons of color living with HIV/AIDS.
        Over the last three years, collaboration between the
    Departments of Housing and Urban Development (HUD) and Health
    and Human Services (HHS) on homeless policy has improved
    through joint efforts such as the Policy Academies, which
    provide training for State officials on accessing mainstream
    resources for homeless people and the 2003 Collaborative
    Initiative to Help End Chronic Homelessness, a $55 million HUD,
    HHS, and Veterans Administration effort that has housed over
    550 chronically homeless persons in 11 communities across the
    country. Although the fiscal year 2006 budget request did not
    include a direct funding request within HHS for the Samaritan
    Initiative, the Committee encourages SAMHSA to continue to
    collaborate with HUD in sharing best practices information and
    in discussing ways in which resources can be maximized toward
    the goal of ending chronic homelessness.
                Mental health block grant
        The Committee provides a program level total of
    $432,756,000 for the mental health block grant, which is the
    same as the fiscal year 2005 comparable level and the budget
    request. The block grant provides funds to States to support
    mental health prevention, treatment, and rehabilitation
    services. Funds are allocated according to statutory formula
    among the States that have submitted approved annual plans. The
    Committee notes that the mental health block grant funding
    represents less than 2 percent of total State mental health
    funding and less than 3 percent of State community-based mental
    health services. Within the total, $21,803,000 is provided
    through the evaluation set-aside as requested.
        The Community Mental Health Services Block Grant Program
    distributes funds to 59 eligible States and Territories through
    a formula based upon specified economic and demographic
    factors. Applications must include an annual plan for providing
    comprehensive community mental health services to adults with a
    serious mental illness and children with a serious emotional
    disturbance. Because the mental health needs of our Nation's
    elderly population are often not met by existing programs and
    because the need for such services is dramatically and rapidly
    increasing, the Committee recommends that SAMHSA require that
    States' plans include specific provisions for mental health
    services for older adults.
                Children's mental health
        The Committee provides $105,129,000 for the grant program
    for comprehensive community mental health services for children
    with serious emotional disturbance, which is $17,000 above the
    fiscal year 2005 comparable level and the same as the budget
    request. Funding for this program supports grants and technical
    assistance for community-based services for children and
    adolescents up to age 22 with serious emotional, behavioral, or
    mental disorders. The program assists States and local
    jurisdictions in developing integrated systems of community
    care. Each individual served receives an individual service
    plan developed with the participation of the family and the
    child. Grantees are required to provide increasing levels of
    matching funds over the six-year grant period.
                Grants to states for the homeless (PATH)
        The Committee provides $54,809,000 for the grants to States
    for the homeless (PATH) program, which is the same as the
    fiscal year 2005 comparable level and 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 $34,343,000 for the protection and
    advocacy program, which is the same as the budget request and
    the fiscal year 2005 comparable level. This funding is
    distributed to States according to a formula based on
    population and income to assist State-designated independent
    advocates to provide legal assistance to mentally ill
    individuals during their residence in State-operated facilities
    and for 90 days following their discharge.

    Center for Substance Abuse Treatment

        The Committee provides a program level total of
    $2,184,986,000 for the Center for Substance Abuse Treatment
    (CSAT), which is $12,935,000 below the fiscal year 2005
    comparable level and $37,621,000 below the budget request.
    Within the total, $83,500,000 is provided through the
    evaluation set-aside as requested.
        The Committee has concerns that people who are seeking
    substance abuse treatment are unable to access services due to
    the lack of an adequate clinical treatment workforce. People
    seeking treatment often have to wait for weeks or months before
    they are accepted into a treatment facility. The Committee
    requests that SAMHSA issue a report, after consultation with
    stakeholders and other Federal partners, on workforce
    development for substance abuse treatment professionals. The
    report should focus on both the recruitment and retention of
    counselors and on improving the skills of those already
    providing services as well as ways in which States can play a
    role. The Committee requests that this report be transmitted to
    the House and Senate Committees on Appropriations by March 1,
    2006.
        The Committee is concerned about the incidence of drug
    addiction among pregnant and parenting women. The National
    treatment infrastructure has not kept pace with the demand or
    complexity of needs experienced by women and their children.
    Family-based substance abuse treatment, which addresses the
    needs of a parent, typically a mother, and her children,
    represents less than 6 percent of the overall treatment options
    available. The Committee believes that increased capacity for
    family-based treatment programs is imperative. Increased family
    treatment capacity ensures child well-being, family
    stabilization, and healthy communities.
                Programs of regional and national significance
        The Committee provides a program level total of
    $409,431,000 for substance abuse treatment programs of regional
    and national significance, which is $12,935,000 below the
    fiscal year 2005 comparable level and $37,621,000 below the
    budget request. Within the total, $4,300,000 is provided
    through the evaluation set-aside as requested. The program
    supports activities to improve the accountability, capacity and
    effectiveness of substance abuse treatment services and
    services delivery. These activities include targeted capacity
    expansion initiatives to help communities respond to serious,
    emerging and unmet treatment needs and best practices
    initiatives to translate science into services through
    monitoring and accreditation of treatment programs, training,
    dissemination and knowledge application activities. The program
    promotes the adoption of science- and evidence-based treatment
    practices by developing and field-testing new treatment models
    in order to facilitate the provision of quality treatment
    services and service delivery. These activities are undertaken
    in actual service settings rather than laboratories and results
    are disseminated to State agencies and community treatment
    providers. The goal is to promote continuous, positive
    treatment service delivery change for those people who use and
    abuse alcohol and drugs.
        The Committee provides $99,200,000 for the Access to
    Recovery (ATR) substance abuse treatment voucher initiative;
    this is the same as the fiscal year 2005 level and $50,800,000
    below the budget request. To the extent possible the Committee
    encourages SAMHSA to provide training and technical assistance
    to both current State grantees to enhance their programs and
    share best practices with States that are interested in
    establishing substance abuse treatment voucher programs in the
    future. In addition, the Committee expects that addictive
    disorder clinical treatment providers participating in the
    Access to Recovery program shall meet the certification,
    accreditation, and/or licensing standards recognized in their
    respective States.
        Within the funds provided, the Committee recommends
    $30,797,000 for the Screening, Brief Intervention, Referral,
    and Treatment (SBIRT) program as requested. This competitive
    grant program assists States, territories, and Tribes in
    targeting non-dependent drug users and is designed to avert the
    progression of patients from chronic substance abuse problems.
    The SBIRT program works in primary and general care settings to
    identify patients in need of treatment and to provide them with
    appropriate intervention and treatment options.
        Within the funds provided, the Committee has included
    $8,166,000 to maintain the funding at last year's level for the
    Addiction Technology Transfer Centers. The Addiction Technology
    Transfer Centers (ATTC) program is a Nation-wide, multi-
    disciplinary resource that provides the latest science-based
    addiction information to treatment providers in community and
    faith-based agencies. The ATTCs develop an addiction workforce
    of competent healthcare and related professionals reflective of
    the treatment population.
                Substance abuse prevention and treatment block grant
        The Committee provides a program level total of
    $1,775,555,000 for the substance abuse prevention and treatment
    (SAPT) block grant, which is the same as the fiscal year 2005
    comparable level and the budget request. Within the total,
    $79,200,000 is provided through the evaluation set-aside as
    requested. The substance abuse block grant provides 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 expresses its strong support for the SAPT
    block grant as the foundation of our publicly funded substance
    abuse system. The SAPT block grant, which provided support to
    over 10,500 community-based organizations in 2001, distributes
    formula-based funding to every State and territory. The
    authorizing statute includes certain funding set-asides,
    including a 20 percent set-aside for prevention, an HIV/AIDS
    early intervention set-aside, and others. The overall goal of
    the block grant is to support and expand substance abuse
    prevention and treatment services, while providing maximum
    flexibility to the States. The SAPT block grant is vital given
    that SAMHSA found that in 2003, approximately 22 million
    Americans abuse or are dependent upon alcohol, drugs or both
    and need some level of treatment service.

    Center for substance abuse prevention

                Programs of regional and national significance
        The Committee provides $194,950,000 for the substance abuse
    prevention programs of regional and national significance,
    which is $10,601,000 above the budget request and $3,775,000
    below the fiscal year 2005 comparable level. The program
    identifies and disseminates evidence-based substance abuse
    prevention approaches.

    Program management

        The Committee provides a program level total of $91,817,000
    for program management, of which $16,000,000 is provided
    through the evaluation set-aside as requested. The fiscal year
    2006 program level is $1,989,000 below the fiscal year 2005
    comparable level and the same as the budget request. The
    appropriation provides funding to coordinate, direct, and
    manage the agency's programs. Funds are used for salaries,
    benefits, space, supplies, equipment, travel and overhead.

                   Agency for Healthcare Research and Quality

        The Committee provides a total of $318,695,000 for the
    Agency for Healthcare Research and Quality (AHRQ), which is the
    same as the comparable fiscal year 2005 level and the budget
    request. Fiscal year 2006 support is provided by the Committee
    in budget authority, while the fiscal year 2005 level and the
    fiscal year 2006 budget request are provided in program
    evaluation tap 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 $260,695,000 for research on health
    costs, quality, and outcomes, which is the same as the fiscal
    year 2005 comparable level and the budget request. This program
    identifies the most effective and efficient approaches to
    organize, deliver, finance, and reimburse health care services;
    determines how the structure of the delivery system, financial
    incentives, market forces, and better information affects the
    use, quality, and cost of health services; and facilitates the
    translation of research findings for providers, patients,
    plans, purchasers, and policymakers. It also funds research
    that determines what works best in increasing the cost
    effectiveness and appropriateness of clinical practice;
    supports the development of tools to measure and evaluate
    health outcomes, quality of care, and consumer satisfaction
    with health care system performance; and facilitates the
    translation of information into practical uses through the
    development and dissemination of research databases.
        Within the total for research on health costs, quality, and
    outcomes, the Committee provides $84,000,000 for reducing
    medical errors, which is the same as the fiscal year 2005
    comparable level and the budget request. This amount includes
    $50,000,000 for grants to support the health information
    technology initiative. The Committee urges AHRQ to play a key
    role in the initiative being developed in the Office of the
    National Coordinator for Health Information Technology. The
    Committee encourages AHRQ to conduct pilot projects to
    demonstrate the feasibility and value of standards-based
    electronic health care data interchange.
        Within the total for research on health costs, quality and
    outcomes, the Committee provides $15,000,000 for comparative
    clinical effectiveness research. This is the same as the fiscal
    year 2005 comparable level and the budget request.
        The Committee is aware that a number of medical schools and
    medical centers in the U.S. are using high-tech patient
    simulators or medical simulators to improve doctor training,
    especially surgical and emergency room training. The Committee
    is also aware that AHRQ has a series of projects underway to
    evaluate the use of such simulators. The Committee strongly
    encourages AHRQ to continue these efforts and to expand them if
    necessary in order to evaluate effectively the utility of
    simulators in improving patient care and medical training, and
    decreasing medical mistakes.
        The Committee is pleased that AHRQ is studying care issues
    associated with patients who suffer from Duchenne muscular
    dystrophy. The Committee suggests that AHRQ build on this work
    by partnering with CDC to convene a consensus conference to
    develop these standards.
        The Committee supports the inter-agency agreement between
    AHRQ and the National Center on Birth Defects and Developmental
    Disabilities at CDC to examine clinical treatment and improve
    quality of care of patients with spina bifida.
        The Committee is concerned about the prevalence of
    undiagnosed and untreated mental illness among older Americans.
    Affective disorders, including depression, anxiety, dementia,
    and substance abuse and dependence, are often misdiagnosed or
    not recognized at all by primary and specialty care physicians
    in their elderly patients. Research has shown that the
    treatment of mental illness can improve health outcomes for
    those with other chronic diseases. While effective treatments
    for these conditions are available, there is an urgent need to
    translate advancements from biomedical and behavioral research
    to clinical practice. The Committee encourages AHRQ to support
    evidence-based research projects focused on the diagnosis and
    treatment of mental illnesses in the geriatric population, and
    to disseminate evidence-based reports to physicians and other
    health care professionals.
        Despite the Healthy People 2010 recommendations to decrease
    primary cesarean section rates to 15 percent and repeat
    cesarean section rates to 63 percent, the Committee is aware
    that rates of primary elective cesarean section are
    progressively increasing and that vaginal birth after cesarean
    rates are steadily decreasing. The Committee encourages AHRQ to
    conduct a comprehensive meta-analysis of the best available
    research studies comparing short and long term risks for
    mothers and babies of cesarean versus vaginal birth and
    requests that AHRQ report back to the Committee with this
    information by next year.
        The Committee provides $55,300,000 for the Medical
    Expenditures Panel Surveys (MEPS), which is the same as the
    fiscal year 2005 comparable level and the budget request. The
    MEPS provide data for timely national estimates of health care
    use and expenditures, private and public health insurance
    coverage, and the availability, costs, and scope of private
    health insurance benefits. This activity also provides data for
    analysis of changes in behavior as a result of market forces or
    policy changes on health care use, expenditures, and insurance
    coverage; develops cost/savings estimates of proposed changes
    in policy; and identifies the impact of changes in policy for
    subgroups of the population.
        For program support, the Committee provides $2,700,000
    which is the same as fiscal year 2005 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 $156,954,419,000 for the Federal
    share of current law State Medicaid costs, which is
    $33,175,400,000 above the fiscal year 2005 comparable level and
    the same as the budget request. This amount does not include
    $58,517,290,000 which was advance funded in the fiscal year
    2005 appropriation. In addition, the Committee provides an
    advance appropriation of $62,783,825,000 for program costs in
    the first quarter of fiscal year 2007. The Committee has also
    included indefinite budget authority for unanticipated costs in
    fiscal year 2006. Fiscal year 2006 funding increases by
    $22,910,000,000 to shift the program to accrual accounting by
    making a one-time adjustment for incurred but not reported
    obligations.
        Federal Medicaid grants reimburse States for 50 to 83
    percent (depending on per capita income) of their expenditures
    in providing health care for individuals whose income and
    resources fall below specified levels. Subject to certain
    minimum requirements, States have broad authority within the
    law to set eligibility, coverage, and payment levels. Over 46
    million low-income individuals will receive health care
    services in 2006 under the Medicaid program. State costs of
    administering the program are matched at rates that generally
    range from 50 to 90 percent, depending upon the type of cost.
    Total funding for Medicaid includes $1,502,333,000 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.
        The Committee is concerned that by permitting manufacturers
    to exclude ``authorized generics'' for purposes of best price
    calculations under the Medicaid Rebate Program, CMS and States
    may be losing millions of dollars in rebates. Therefore, the
    Committee encourages CMS to review its practices with respect
    to Medicaid rebate calculations. Specifically, CMS should
    evaluate best price calculations to ensure the Medicaid Rebate
    Program is properly reimbursed by manufacturers that produce
    brand name pharmaceuticals and their authorized generics.
        The Committee is aware that Oklahoma hospitals are in an
    overpayment dispute with CMS regarding disproportionate share
    settlement payments. The Committee strongly urges the parties
    involved in this dispute to come to a timely resolution.
        The Committee is aware of an issue regarding the definition
    of ``hospital costs'' incurred by the Commonwealth of Virginia
    for purposes of Medicaid reimbursement to the Commonwealth, and
    urges CMS to work with the Commonwealth to resolve the pending
    issue.

                      PAYMENTS TO HEALTH CARE TRUST FUNDS

        The Committee provides $177,742,200,000 for the Payments to
    the Health Care Trust Funds account, which is $63,133,300,000
    above the fiscal year 2005 comparable level and $80,000,000
    lower than the budget request. The significant funding increase
    is due to the costs of the new prescription drug benefit. This
    entitlement account includes the general fund subsidy to the
    Federal Supplementary Medical Insurance Trust Fund for Medicare
    Part B benefits and for Medicare drug benefits and
    administration as well as other reimbursements to the Federal
    Hospital Insurance Trust Fund for benefits and related
    administrative costs, which have not been financed by payroll
    taxes or premium contributions. Funds were not provided for the
    reimbursement for Health Care Fraud and Abuse Control, since
    the Committee did not fund this new account. The Committee
    includes bill language requested by the Administration
    providing indefinite authority for paying the general revenue
    portion of the Part B premium match and provides resources for
    the Part D drug benefit program in the event that the annual
    appropriation is insufficient.

                               PROGRAM MANAGEMENT

        The Committee makes available $3,180,284,000 in trust funds
    for Federal administration of the Medicare and Medicaid
    programs, which is $515,373,000 above the fiscal year 2005
    comparable level and $2,806,000 above the budget request.
    Fiscal year 2006 is the first year that the administrative
    costs for the Medicare Modernization Act are scored to this
    account, rather than being directly funded through the
    authorization. The Administration request includes $560 million
    for these activities.
                Research, demonstration, and evaluation
        The Committee provides $65,000,000 for research,
    demonstration and evaluation, which is $12,494,000 below the
    fiscal year 2005 comparable level and $19,806,000 above the
    budget request. These funds support a variety of studies and
    demonstrations in such areas as monitoring and evaluating
    health system performance; improving health care financing and
    delivery mechanisms; modernization of the Medicare program; the
    needs of vulnerable populations in the areas of health care
    access, delivery systems, and financing; and information to
    improve consumer choice and health status.
                Medicare operations
        The Committee provides $2,172,987,000 to support Medicare
    claims processing contracts, which is $450,003,000 above the
    fiscal year 2005 comparable level and $17,000,000 below the
    budget request.
        Medicare contractors partner with the Federal government to
    administer the Medicare fee-for-service program. Contractors
    pay over one billion Medicare fee-for-service claims annually,
    are the first line of defense against Medicare fraud, and are
    the primary contact for Medicare providers and beneficiaries.
    Without adequate funding, contractors are not able to pay
    claims, respond to beneficiary and provider inquiries timely,
    and effectively combat fraud and abuse. The Committee is
    pleased CMS eliminated the five percent cap on transferring
    funds among Medicare functions so that contractors have greater
    flexibility to manage their budgets in a manner that best
    matches program requirements. Budget flexibility is important
    to Medicare contractors, particularly in a tight funding
    environment. The Committee strongly recommends CMS give
    Medicare Contractors and Program Safeguard Contractors greater
    flexibility to manage their Medicare Integrity Program (MIP)
    funding in a manner that best matches program requirements
    including increases in workload. The Committee expects CMS to
    report on its plans to provide this flexibility to contractors
    in its fiscal year 2007 congressional justification.
                Revitalization plan
        The Committee provides $24,205,000 to remain available for
    two years, as the third year of investment in CMS's efforts to
    make significant improvements to key aspects of managing both
    the agency and the Medicare program. This amount is the same as
    the budget request and fiscal year 2005 comparable level.
    Funding will target information technology involving
    modernization of Medicare fee-for-service claims processing,
    modernization of the data environment, and reduction of the CMS
    security perimeter.
                State survey and certification
        The Committee provides $260,735,000 for State inspections
    of facilities serving Medicare and Medicaid beneficiaries,
    which is $2,000,000 above the fiscal year 2005 comparable level
    and the same as the budget request.
        Survey and certification activities ensure that
    institutions and agencies providing care to Medicare and
    Medicaid beneficiaries meet Federal health, safety and program
    standards. On-site surveys are conducted by State survey
    agencies, with a pool of Federal surveyors performing random
    monitoring surveys. Almost 76,000 surveys and complaint
    investigations will be performed in fiscal year 2006.
                Federal administration
        The Committee provides $657,357,000 to support Federal
    administrative activities related to the Medicare and Medicaid
    programs, which is $75,864,000 above the fiscal year 2005
    comparable level and the same as the budget request. The
    substantial increase over fiscal year 2005 is due to the costs
    of implementing the Medicare Modernization Act, which is being
    charged to this account for the first time rather than the
    authorizing bill. This amount includes $13,000,000 for the
    Healthy Start, Grow Smart program as requested by the
    Administration. The Committee includes language requested by
    the Administration that is similar to language in last year's
    enacted bill to identify $79,934,000 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 85 million
    beneficiaries. The Federal Administration budget provides funds
    for the staff and operations of CMS to administer these
    programs.
        While CMS has initiated a commendable and important
    partnership with the State Health Insurance Programs (SHIPs) to
    facilitate the initiation of the new Medicare Part D drug
    benefit and the transition of the 6.5 million dually eligible
    beneficiaries from Medicaid prescription coverage to the
    Medicare drug benefit, considerable evidence indicates that
    low-income dual eligible persons with mental disabilities will
    need direct help with Part D enrollment decisions and both
    pharmaceutical and formulary changes. The Committee urges CMS
    to support one-on-one pharmaceutical benefits counseling
    through community-based organizations and safety net mental
    health providers, if endorsed by these groups, in order to
    address this need.
        The Committee is pleased that The Quality of Life
    Chemotherapy Demonstration project, included in the Medicare
    Modernization Act, is underway. This one-year demonstration
    project will provide a better understanding from cancer
    patients receiving chemotherapy on such important issues as
    their pain control management, minimization of nausea and
    vomiting, and the reduction of fatigue. The Committee is
    concerned that CMS has excluded oral chemotherapy patients from
    being included in the demonstration's data collection.
    Regardless of the method of administering chemotherapy, the
    quality of life issues facing cancer patients are equally
    important. To gather a complete understanding of the quality of
    life issues impacting cancer patients, the Committee encourages
    CMS to permit physicians to collect quality of life data from
    patients receiving oral chemotherapy and to do so under the
    same guidelines to the extent possible as prescribed under the
    Quality of Life project.
        The Committee remains concerned about regulatory burdens on
    health care providers, which not only divert the time that can
    be spent on active patient care, but also impose large
    financial burdens on the health care industry. The Committee
    requests CMS to report to the Committee by no later than March
    1, 2006, on the regulatory burdens, identified by MedPAC in its
    December 2001 report to Congress, that were not addressed
    within the Medicare Modernization Act. As part of this report,
    the Committee requests CMS to examine the prevalence and burden
    of CMS regulations, whether in effect or under development,
    that have no statutory requirement. The Committee supports
    MedPAC's recommendation that providers and plans with sustained
    good performance should receive reductions from CMS in routine
    administrative compliance measures, and urges CMS to move
    forward in implementing this regulatory flexibility.
        The Committee requests that CMS report to the Committee
    what the expected annual costs, both administrative and
    programmatic, are for the revised Medicare obesity coverage
    policy announced in July, 2004.

                      HEALTH CARE FRAUD AND ABUSE CONTROL

        The Committee was not able to provide funding for this new
    discretionary account. The Administration had requested
    $80,000,000 as a contingent appropriation, with the funding to
    be made available as an adjustment to the 302(a) allocation for
    the Appropriations Committee. The conference budget resolution
    did not permit this scorekeeping adjustment. The Committee
    notes that $720,000,000 is available to CMS as a permanent
    appropriation for the Medicare Integrity Program, which will be
    available for the purposes of the proposed program.

                    Administration for Children and Families

      PAYMENTS TO STATES FOR CHILD SUPPORT ENFORCEMENT AND FAMILY SUPPORT
                                    PROGRAMS

        The Committee provides $2,121,643,000 for the Child Support
    Enforcement and Family Support programs, the same as the budget
    request. The bill also provides $1,200,000,000 in advance
    funding for the first quarter of fiscal year 2007 to ensure
    timely payments for the child support enforcement program, the
    same as the request. The bill provides estimated funding of
    $33,000,000 for Payments to Territories, $10,000,000 above the
    fiscal year 2005 level and the same as the budget request. The
    bill provides $1,300,000 for the repatriation program, $300,000
    more than the fiscal year 2005 level and the same as the budget
    request.

                       LOW-INCOME HOME ENERGY ASSISTANCE

        The Committee provides an appropriation of $1,984,799,000
    for the Low-Income Home Energy Assistance State formula grants.
    This is $100,000,000 more than the fiscal year 2005 comparable
    level and $184,799,000 above the budget request. The Committee
    provides all of these funds through the regular formula program
    and does not include funding for the contingent emergency
    reserve. The budget request included $1,800,000,000 in formula
    grants and $100,000,000 in contingent emergency funding.
        The low-income home energy assistance program (LIHEAP)
    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.
        The Committee is concerned that rising natural gas prices
    are limiting the effectiveness and impact of LIHEAP. While
    American consumers pay the highest natural gas prices in the
    world, the rest of the world, on average, pays many times less
    per thousand cubic feet for natural gas. The Committee directs
    that not less than 150 days after the date of enactment of this
    Act the Secretary of Health and Human Services shall submit a
    report on the estimated percentage of LIHEAP funds currently
    expended to assist consumers with natural gas bills; the degree
    to which this percentage will rise relative to future increases
    in the price of natural gas paid by American consumers; and the
    degree to which additional consumers may be served by LIHEAP
    should Congress enact policy changes which cause domestic
    natural gas prices to decrease in the future by 5 percent, 10
    percent, 20 percent, or 50 percent.

                         REFUGEE AND ENTRANT ASSISTANCE

        The Committee provides $560,919,000 for refugee assistance
    programs. This is $76,525,000 more than the fiscal year 2005
    comparable level and $8,879,000 more than the budget request.
        In addition, the bill provides the Office of Refugee
    Resettlement (ORR) the authority to carry over unexpended funds
    from fiscal year 2006 to reimburse the costs of services
    provided through September 30, 2008 for all programs within
    ORR's jurisdiction.

    Transitional and medical services

        The Committee provides $264,129,000 for transitional and
    medical services. This is $72,101,000 more than the fiscal year
    2005 comparable level and the same as the budget request. The
    transitional and medical services program provides funding for
    the State-administered cash and medical assistance program that
    assists refugees who are not categorically eligible for TANF or
    Medicaid, the unaccompanied minors program that reimburses
    States for the cost of foster care, and the voluntary agency
    grant program in which participating National refugee
    resettlement agencies provide resettlement assistance with a
    combination of Federal and matched funds.

    Victims of trafficking

        The Committee provides up to $9,915,000 for the victims of
    trafficking program. This is the same as the fiscal year 2005
    comparable level and 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 $160,000,000 for social services.
    This is $8,879,000 more than the budget request and $4,888,000
    less than the fiscal year 2005 comparable level. Funds are
    distributed by formula as well as through the discretionary
    grant making process for special projects. The Committee
    intends that funds provided above the request shall be used for
    Refugee School Impact Grants and for additional assistance in
    resettling and meeting the needs of the Hmong refugees expected
    to arrive during 2006 and 2007.
        Within the funds provided, the Committee has included
    $19,000,000 for support to communities with large
    concentrations of Cuban and Haitian entrants of varying ages
    whose cultural differences make assimilation especially
    difficult, justifying a more intense level and longer duration
    of Federal assistance.

    Preventive health

        The Committee provides $4,796,000 for preventive health
    services. This is the same as the fiscal year 2005 comparable
    level and the budget request. These funds are awarded to the
    States to ensure adequate health assessment activities for
    refugees.

    Targeted assistance

        The Committee provides $49,081,000 for the targeted
    assistance program. This is the same as the fiscal year 2005
    comparable level and the budget request. These grants provide
    assistance to areas with high concentrations of refugees.

    Unaccompanied minors

        The Committee provides $63,083,000 for the unaccompanied
    minors program. This is $9,312,000 more than the fiscal year
    2005 comparable level and the same as the budget request. The
    program is designed to provide for the care and placement of
    unaccompanied alien minors who are apprehended in the U.S.
    pending resolution of their claims for relief under U.S.
    immigration law or released to an adult family member or
    responsible adult guardian.
        The Committee urges the Office of Refugee Resettlement
    (ORR) to maintain the privacy and confidentiality of all
    information gathered in the course of the care, custody and
    placement of unaccompanied alien children consistent with ORR's
    role and responsibility under the Homeland Security Act to act
    as guardian in loco parentis in the best interests of the
    unaccompanied alien child. ORR should consider the needs and
    privacy of these children to guarantee the confidentiality of
    their information in order to be trusting and truthful to ORR,
    clinicians, and its agents for purposes of receiving
    appropriate quality care and placement services.
        The Committee urges ORR to allow individual abused,
    abandoned or neglected children in its custody, when
    appropriate, to access State dependency proceedings for
    ultimate care and placement in State foster care or under legal
    guardianship as a necessary predicate for their eligibility for
    special immigrant juvenile status.
        The Committee encourages ORR to fund pilot programs to
    study and assess the benefits of providing pro bono counsel to
    children in ORR custody. The Committee also encourages ORR to
    give high priority to the availability of pro bono legal
    counsel when selecting facilities for housing unaccompanied
    children in ORR custody.
        The Committee understands that ORR carried out a successful
    pilot program in Chicago, Illinois through Heartland Alliance
    on the benefits of child advocates for unaccompanied children.
    The Committee encourages ORR to implement follow-up pilot
    programs to further develop the findings and best practices of
    the Chicago pilot program regarding the utilization of child
    advocates to identify the child's best interests from a child
    welfare perspective so that such information can be taken into
    consideration by attorneys and judges involved in a child's
    immigration proceedings.
        The Committee directs that not later than one year after
    the date of enactment of this Act the Secretary of Health and
    Human Services shall submit a report on progress made by ORR
    and programs funded under this Act to shift children from
    secured detention facilities to more age-appropriate shelter-
    based facilities for unaccompanied children in its custody.

    Victims of torture

        The Committee provides $9,915,000 to provide a
    comprehensive program of support for domestic centers and
    programs for victims of torture. This is the same as the fiscal
    year 2005 comparable level and the budget request.

                     CHILD CARE AND DEVELOPMENT BLOCK GRANT

        The Committee includes $2,082,910,000 for the Child Care
    and Development Block Grant program, $11,000 below the fiscal
    year 2005 comparable level and the same as the budget request.
        The Child Care and Development Block Grant program was
    originally enacted in the Omnibus Budget Reconciliation Act of
    1990 to increase the availability, affordability and quality of
    child care by providing funds to States, Territories and Indian
    Tribes for child care services for low-income families. The
    authorization for mandatory appropriations for childcare in the
    amount of $2,717,000,000 is also requested for fiscal year
    2006.

                          SOCIAL SERVICES BLOCK GRANT

        The bill provides $1,700,000,000 for the social services
    block grant (SSBG). This is the same as the fiscal year 2005
    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 10%.

                     CHILDREN AND FAMILY SERVICES PROGRAMS

        The Committee provides a program level total of
    $8,701,207,000 for children and family services programs. This
    is $317,063,000 less than the fiscal year 2005 comparable level
    and $304,414,000 more than the budget request. Within the total
    provided, $12,500,000 is provided through the evaluation set-
    aside. This account finances a number of programs aimed at
    enhancing the well-being of the Nation's children and families,
    particularly those who are disadvantaged or troubled.

    Head Start

        The Committee includes $6,899,000,000 for the Head Start
    program for fiscal year 2005, an increase of $55,886,000 over
    the fiscal year 2005 comparable amount and $336,000 below the
    budget request. Of this total, the Committee continues the
    policy of advancing $1,400,000,000 of this account into fiscal
    year 2007.
        Head Start provides comprehensive child development
    services to economically disadvantaged children and their
    families. Intended primarily for preschoolers from low-income
    families, the program promotes school readiness by enhancing
    the social and cognitive development of children through the
    provision of educational, health, nutritional, social and other
    services. Head Start programs engage parents in their
    children's learning and help them in making progress toward
    their educational, literacy and employment goals. 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 and for-profit agencies. Unless a
    waiver is approved grantees must contribute 20 percent of the
    total cost of the program from non-Federal funds; this is
    usually an in-kind contribution. No more than 15 percent of
    total costs may be for program administration.
        The Committee is aware that in May of 2005, the Secretary
    made $35,000,000 in additional fiscal year 2005 funds available
    to Migrant and Seasonal Head Start programs and that these
    funds, which will be awarded on competitive basis, will allow
    for at least 4,000 additional children to access Migrant and
    Seasonal Head Start. The Committee acknowledges that these
    expansion funds will increase access to this important program,
    however additional funding may be necessary to adequately serve
    this population. The Committee requests that the Secretary
    submit a report on the Head Start Bureau's ongoing plans to
    ensure that Migrant and Seasonal Head Start programs are able
    to serve a larger percentage of the children eligible for
    services. The Committee continues to point to the 2001 study
    published by the U.S. Department of Health and Human Services
    that documented that only 19 percent of eligible children were
    able to access Migrant and Seasonal Head Start.
        The Committee supports the provisions included in H.R.
    2123, the School Readiness Act of 2005 as approved by the House
    Education and Workforce Committee, which would address concerns
    about the potential funding shortfall for Migrant and Seasonal
    Head Start Programs and would require the Secretary, in
    consultation with Migrant and Seasonal Head Start Programs, to
    establish systems to document the demand for Migrant and
    Seasonal Head Start on an ongoing basis. The system should
    accurately determine the number of children who are eligible
    for services across the country and document how many of these
    children are accessing services so that quantifiable
    information is available to the Secretary upon which future
    funding decisions can be made. H.R. 2123 would ensure that
    additional resources are immediately available for these
    programs until such time that improved information is available
    to the Secretary. The Committee supports this effort that will
    enable policy makers and advocates to more effectively serve
    migrant and seasonal farmworker families and their children.
        The Committee is mindful of the conclusions of the
    Government Accountability Office in its May 17, 2005 report,
    ``Head Start: Further Development Could Allow Results of New
    Test to be Used for Decision Making.'' The Committee expects
    the Secretary to submit a report to Congress, within one year,
    that includes: (1) a detailed justification on the planned uses
    of the National Reporting System results and data, including
    its use for program evaluation, professional development,
    technical assistance, and other activities; (2) an itemization
    of the costs of development, implementation, and analysis of
    the National Reporting System, detailing by name, amount, and
    description of activities each contract or grant to persons or
    entities involved in its design, development, implementation,
    or analysis; and (3) the recommendations made by the Technical
    Working Group established by the Secretary, including an
    explanation of how the Secretary has addressed or plans to
    address the Working Group's and the GAO's recommendations.
        The Committee notes that the current Head Start Act
    includes the provision of training and technical assistance in
    the area of family literacy services--a provision that is
    retained in the House version of Head Start reauthorization
    legislation. Pending the final resolution of the Head Start
    reauthorization process, the Committee encourages the Secretary
    to ensure the continuity of the important services that are
    being provided through the Head Start Family Literacy Project.
        The Committee is aware that approximately one-third of Head
    Start programs are affiliated with public school systems and
    often combine or coordinate the transportation of Head Start,
    preschool, and K-12 students. In addition, many center-based
    Head Start programs coordinate with local transit authorities
    to provide supervised transportation to Head Start children
    whose parents work non-traditional hours or whose geographical
    distance from the parent's place of employment creates a
    barrier to Head Start participation. Differences between Head
    Start transportation regulations, promulgated by the U.S.
    Department of Health and Human Services, and those promulgated
    by State and local authorities, may have the unintended
    consequence of reducing transportation services for Head Start
    students, and in turn, decrease transportation options for
    children. These differences may leave Head Start children
    without transportation or relying on parents to provide
    transportation in their vehicles.
        The Committee recognizes that children's safety is the most
    important consideration and that many students participating in
    Head Start programs need access to safe and reliable
    transportation provided by public schools or local transit
    systems. The Committee is aware that the Department of Health
    and Human Services currently offers a waiver option to local
    education agencies that dually serve as Head Start contractors,
    which will expire on January 1, 2006. In the absence of a
    permanent solution to this problem, the Committee directs the
    U.S. Department of Health and Human Services to extend another
    waiver option to local education agency-contracted Head Start
    programs that provide integrated transportation to Head Start
    students. In cases where public schools or local transit
    authorities provide Head Start services, local educational
    agencies should have the option to comply with transportation
    standards for preschool students mandated by the State or local
    education agencies a, transit agencies, State departments of
    Transportation or the U.S. Department of Health and Human
    Services.
        Furthermore, the Committee directs the Department to work
    towards a permanent fix to this problem in order to provide
    clearer standards and options to local education agencies
    transporting both Head Start and regular preschool and K-12
    children.

    Consolidated runaway and homeless youth program

        The Committee provides $88,728,000 for runaway and homeless
    youth activities, an increase of $4,000 more than the fiscal
    year 2005 comparable level and the same as the budget request.
    The Runaway, Homeless, and Missing Children Protection Act of
    2003 reauthorized the runaway and homeless youth programs and
    established a statutory formula distribution between the Basic
    Center Program and the Transitional Living Program.
        The runaway and homeless youth programs provide grants to
    local public and private organizations to establish and operate
    runaway and homeless youth shelters to address the crisis needs
    of runaway and homeless youth and their families. Grants are
    used to develop or strengthen community-based shelters, which
    are outside the law enforcement, juvenile justice, child
    welfare, and mental health systems.
        It is the Committee's continued expectation that current
    transitional living program grantees will continue to provide
    transitional living opportunities and supports to pregnant and
    parenting homeless youth, as is their current practice. To
    further ensure that pregnant and parenting homeless youth are
    able to access transitional living opportunities and supports
    in their communities, the Committee encourages the Secretary,
    acting through the network of federally-funded runaway and
    homeless youth training and technical assistance providers, to
    offer guidance to grantees and others on the programmatic
    modifications required to address the unique needs of pregnant
    and parenting youth and on the various sources of funding
    available for residential services to this population.

    Maternity group homes

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

    Prevention grants to reduce abuse of runaway youth

        The Committee provides $15,179,000 for prevention grants to
    reduce abuse of runaway youth. This is $1,000 more than the
    fiscal year 2005 comparable level and the same as the budget
    request. This program is designed to reduce the sexual abuse of
    runaway youth by providing grants to support street-based
    outreach and education to runaway, homeless, and street youth
    who have been sexually abused or who are at-risk of sexual
    abuse, in order to connect these young people with services so
    that they have a chance for a safe and healthy future. The
    street outreach program ensures rapid engagement with young
    people in an effort to prevent the most terrible situations
    that take place when they are subjected to life on the
    streets--physical and sexual abuse, assault, commercial sexual
    exploitation, disease, long-term homelessness, and even death.

    Child abuse state grants and discretionary activities

        For child abuse State grants and discretionary activities,
    the Committee provides $58,925,000. This is $5,000 more than
    the fiscal year 2005 comparable level and the same as the
    budget request. Within this total, the recommendation includes
    $27,280,000 for State grants and $31,645,000 for child abuse
    discretionary activities.

    Community-based child abuse prevention

        The Committee provides $42,859,000 for community-based
    child abuse prevention. This is $1,000 more than the fiscal
    year 2005 comparable level and the same as the budget request.
    The Keeping Children and Families Safe Act of 2003 reauthorized
    and renamed this program and added voluntary home visiting
    programs as a core local service. Funds are provided to lead
    State agencies and are used to develop, operate, expand, and
    enhance community-based efforts to strengthen and support
    families in order to prevent child abuse and neglect.

    Abandoned infants assistance

        The Committee provides $11,955,000 for the Abandoned
    Infants Assistance program. This is the same as the fiscal year
    2005 comparable level and the budget request. The purpose of
    this program is to provide financial support to public and
    private community and faith-based entities to develop,
    implement, and operate demonstration projects that will prevent
    the abandonment of infants and young children exposed to HIV/
    AIDS and drugs; identify and address their needs; assist such
    children to reside with their natural families or in foster
    care; recruit, train and retain foster parents as well as
    health and social services personnel; provide respite care for
    families and foster families; and prevent the abandonment of
    infants and young children.

    Child welfare services and training

        The Committee provides $289,650,000 for child welfare
    services. This is the same as the fiscal year 2005 comparable
    level and the budget request. This program, authorized by title
    IV B of the Social Security Act, provides grants to States to
    assist public welfare agencies to improve child welfare
    services. State services include preventive intervention in
    order for children to stay in their homes, alternative
    placement like foster care or adoption if it is not possible
    for children to remain at home, and reunification programs so
    that, if appropriate, children can return home.
        The Committee provides $7,409,000 for child welfare
    training. This is the same as the fiscal year 2005 comparable
    level and the budget request. The Committee recognizes the need
    for trained, skilled and qualified child welfare service
    workers. This program provides grants to institutions of higher
    education to develop and improve education and training
    programs and resources for child welfare service providers as
    well as students seeking degrees in social work.

    Adoption opportunities

        The Committee provides $27,119,000 for adoption
    opportunities. This is $3,000 more than the fiscal year 2005
    comparable level and the same as the budget request. The
    Adoption Opportunities Program provides funding specifically
    targeted to improving the adoption of children, particularly
    those with special needs, and for providing innovative services
    that support families involved in adoption.

    Adoption incentives

        The Committee provides $31,846,000 for the adoption
    incentives program. This is the same as the fiscal year 2005
    comparable level and the budget request. The Adoption Promotion
    Act of 2003 reauthorized this program and now targets
    incentives specifically for older children. Funds are awarded
    to States using three baselines: one for the total number of
    children adopted, one for children with special needs under the
    age of nine, and one for children aged nine and older. The goal
    of this program is to increase the number of adoptions
    nationwide.

    Adoption awareness

        The Committee provides $12,802,000 for the adoption
    awareness program. This is the same as the fiscal year 2005
    comparable level and the budget request. This program was
    authorized in the Children's Health Act of 2000. The adoption
    awareness program provides training to designated staff of
    eligible health centers in providing adoption information and
    referrals to pregnant women on an equal basis with all other
    courses of action included in non-directive counseling to
    pregnant women.

    Compassion capital fund

        The Committee provides $75,000,000 for the compassion
    capital fund. This is $20,451,000 more than the fiscal year
    2005 comparable level and $25,000,000 less than the budget
    request. This program supports the creation of grants to
    public/private partnerships to support charitable organizations
    in expanding or emulating model social services agencies and
    provides capacity-building funds directly to faith- and
    community-based organizations.
        The Committee is pleased that the budget request included
    funding to focus on street outreach strategies to prevent youth
    gang involvement. Within the total provided for the compassion
    capital fund it is the Committee's intention that $25,000,000
    be provided for the youth gang prevention initiative.

    Social services and income maintenance research

        The Committee provides a program level total of $10,621,000
    for social services and income maintenance research, $8,000,000
    of which is through the evaluation set-aside. This is
    $4,621,000 more than the budget request and $21,391,000 less
    than the fiscal year 2005 comparable level. These funds support
    research, demonstration, evaluation and dissemination
    activities. Recent topics funded through this program include
    welfare-to-work strategies and programs to strengthen family
    relationships and promote healthy marriages.
        The Committee notes the Administration for Children and
    Family's (ACF) efforts to assist States with meeting the
    extensive record-keeping, reporting and tracking requirements
    of the Temporary Assistance for Needy Families (TANF) program.
    Working through the State information technology consortium,
    ACF is providing States with the tools necessary to strengthen
    and improve the complex IT systems required to support TANF.
    Plans are now underway to pilot test a data exchange program
    that will offer States a faster, less expensive means of
    validating, accessing, modifying and recording TANF data
    elements. Similarly, on behalf of Child Support Enforcement,
    the consortium is helping to expand data exchange capabilities
    between the courts and State child support enforcement agencies
    as well as increase collection efficiency in States and tribal
    organizations. Next steps include accessing existing databases
    used as primary sources for collection-related data of non-
    custodial parents, and enhancing data-matching capabilities to
    ensure the integrity of the information being collected.

    Developmental disabilities

        For programs authorized by the Developmental Disabilities
    Assistance and Bill of Rights Act of 2000 as well as by the
    Help America Vote Act, the Committee provides $170,561,000.
    This is $1,986,000 more than the fiscal year 2005 comparable
    level and $2,000,000 more than the budget request.
        The account total includes $72,496,000 for allotments to
    the States to fund State Councils, the same as the budget
    request and the fiscal year 2005 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, $38,109,000 will be available to the States to
    be used for operating a protection and advocacy system to
    protect the legal and human rights of the developmentally
    disabled. This is the same as the budget request and the fiscal
    year 2005 level.
        The Committee provides $14,879,000 for voting access for
    individuals with disabilities programs. This is the same as the
    fiscal year 2005 comparable level and the budget request.
    Within the funds provided, $9,919,000 is for payments to States
    to promote access for voters with disabilities and $4,960,000
    is for State protection and advocacy systems. These programs
    are intended to make polling places accessible and provide
    equal access and participation for individuals with
    disabilities. The protection and advocacy program will ensure
    that individuals can fully participate in the electoral
    process, including registering to vote, accessing polling
    places, and casting a vote.
        The Committee provides $11,529,000 for developmental
    disabilities projects of National significance. This is $13,000
    less than the fiscal year 2005 comparable level and the same as
    the budget request.
        The Committee provides a total of $33,548,000 for the
    university centers for excellence in developmental
    disabilities. This is $1,999,000 more than the fiscal year 2005
    comparable level and $2,000,000 more than the budget request.
    This funding provides discretionary grants to public or not-
    for-profit entities associated with universities. The grants
    provide basic operational and administrative core support for
    these agencies. In addition, these funds support
    interdisciplinary training, community services, research and
    technical assistance and information dissemination. Funding
    above the request is provided to fully fund the new centers
    established in fiscal year 2005 and to establish one to two new
    centers in fiscal year 2006.

    Native American programs

        The Committee provides $44,780,000 for Native American
    programs. This is the same as the budget request and $6,000
    less than the fiscal year 2005 comparable level. The Native
    American programs assist Tribal and Village governments, Native
    American institutions and organizations to support and develop
    stable, diversified local economies. In promoting social and
    economic self-sufficiency, this organization provides financial
    assistance through direct grants for individual projects,
    training and technical assistance, and research and
    demonstration programs.

    Community services

        The Committee provides $384,672,000 for community services
    activities. This is $359,973,000 more than the budget request
    and $341,834,000 less than the fiscal year 2005 comparable
    level.
                State block grant
        For the State block grant, the Committee provides
    $320,000,000. This is $316,793,000 less than the fiscal year
    2005 comparable level. No funds were requested for this
    program. This program provides grants to States, territories
    and Indian Tribes for services to meet employment, housing,
    nutrition, energy, emergency services, and health needs of low-
    income people. By law, 90 percent of these funds are passed
    directly through to local community action agencies that have
    previously received block grant funds.
                Community economic development
        The Committee provides $32,731,000 for community economic
    development grants. This is the same as the fiscal year 2005
    comparable level. No funds were requested for this program.
    These activities provide assistance to private, locally-
    initiated community development corporations that sponsor
    enterprises providing employment, training and business
    development opportunities for low-income residents in poor
    communities. Within the total, $5,436,000 is provided for the
    Job Opportunities for Low-Income Individuals program, which
    provides competitive grant to non-profit organizations to
    create new employment and business opportunities for TANF
    recipients and other low-income individuals.
                Individual development accounts
        The Committee provides $24,699,000 for individual
    development accounts. This is $5,000 less than the fiscal year
    2005 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 $7,242,000 for the rural community
    facilities program. This is the same as the fiscal year 2005
    comparable amount. No funds were requested for this program.
    The Committee includes these funds to be used solely for the
    purpose of improving water and wastewater facilities in poor,
    rural communities. As in the past, these funds should be
    allocated to regional, rural community assistance programs.
                National youth sports
        The Committee concurs with the budget request not to
    include funding for National youth sports. The fiscal year 2005
    funding level for this program is $17,856,000. 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 2005 funding level for this program is
    $7,180,000. This program provides grants to public and private
    agencies to coordinate existing food assistance programs, to
    identify sponsors of child nutrition programs and attempt to
    initiate new programs and to do advocacy work at the State and
    local levels.

    Violent crime reduction programs

        The Committee provides $125,991,000 for family violence
    prevention and services and battered women's shelters. This is
    the same as the budget request and $361,000 more than the
    fiscal year 2005 comparable level. This program is designed to
    assist States and Indian Tribes in efforts to prevent family
    violence and to provide immediate shelter and related
    assistance for victims of family violence and their dependents,
    and to provide for technical assistance and training relating
    to family violence programs to State and local public agencies
    (including law enforcement agencies), nonprofit private
    organizations, and persons seeking such assistance.
        The Committee also includes $3,000,000 to continue funding
    the National domestic violence hotline. This is $224,000 less
    than the fiscal year 2005 comparable level and the same as the
    budget request.

    Early learning fund

        The Committee concurs with the budget request and does not
    provide funding for the early learning fund. The fiscal year
    2005 level for this program is $35,712,000. This program was
    begun in fiscal year 2001 to help facilitate the development of
    learning readiness in young children.

    Mentoring children of prisoners

        The Committee provides $49,993,000 for the mentoring
    children of prisoners program. This is $395,000 above the
    fiscal year 2005 comparable level and the same as the budget
    request. This program supports competitively awarded grants to
    States and local governments, Indian tribes and consortia, and
    faith- and community-based organizations to mentor children of
    prisoners and those recently released from prison.

    Independent living training vouchers

        The Committee provides $50,000,000 for independent living
    training vouchers. This is $3,377,000 more than the fiscal year
    2005 comparable level and $9,999,000 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.

    Abstinence education

        The Committee provides a program level total of
    $114,500,000 for the community-based abstinence education
    program, which is $10,802,000 above the fiscal year 2005
    comparable level and $28,045,000 below the budget request.
    Within the total, $4,500,000 is provided through the evaluation
    set-aside as requested. The program provides support to public
    and private entities for implementation of community-based
    abstinence education programs for adolescents aged 12 through
    18 as defined in sections (A) through (H) of Title 5, section
    510(b)(2) of the Social Security Act. The entire focus of these
    programs is to educate young people and create an environment
    within communities that supports teen decisions to postpone
    sexual activity until marriage. There is no funding match
    requirement for these grants. The Committee intends that up to
    five percent of these funds be used to provide technical
    assistance and capacity-building support to grantees. Within
    the total, up to $10,000,000 may be used to carry out a
    National Abstinence Education Campaign.
        The Committee is concerned that the funding for training
    and technical assistance is not being used effectively to help
    communities develop abstinence-only programs and to support
    existing community-based programs. The Administration for
    Children and Families (ACF) should fully utilize the set-aside
    to ensure that programs around the country are using
    appropriate and approved curricula that are evidence-based and
    comply with the appropriate Federal legislation. To that end,
    the Committee directs ACF to issue a report to the House and
    Senate Committees on Appropriations by no later than 90 days of
    enactment of this Act on the use of the five percent set-aside
    since the transfer of the program from the Health Resources and
    Services Administration and the intended use of the fiscal year
    2006 funds. Also include in this report the funds from the
    National Abstinence Education Campaign that are being used for
    training and technical assistance.
        The Committee reinforces the guidance from its report
    accompanying the fiscal year 2005 appropriation with respect to
    the abstinence messages given by the public health entities
    that are grantees in the community-based abstinence education
    program and to the conduct of evaluation activities for the
    program.
        The Committee encourages ACF to seek appropriate
    partnerships with the Corporation for National and Community
    Service to utilize its corps of volunteers to support and
    strengthen the community-based abstinence education program.
    The Corporation's programs include volunteer and mentoring
    personnel that could be accessed to further bolster the goals
    of abstinence-only education.

    Faith-based center

        The Committee provides $1,400,000 for the faith-based
    center. This is the same as the budget request and $25,000 more
    than the fiscal year 2005 comparable level. The center will
    support implementation of faith-based and community initiatives
    in accordance with the President's executive order.

    Program direction

        The Committee provides $185,217,000 for program direction
    expenses for the Administration for Children and Families. This
    is $7,000 more than the fiscal year 2005 comparable level and
    the same as the budget request.

                       PROMOTING SAFE AND STABLE FAMILIES

        The Committee provides $404,000,000 for the promoting safe
    and stable families program. This is $414,000 more than the
    fiscal year 2005 comparable level and $6,000,000 less than the
    budget request.

               PAYMENTS TO STATES FOR FOSTER CARE AND ASSISTANCE

        The bill provides $4,852,800,000 for payments to States for
    foster care and adoption assistance. This is $185,100,000 less
    than the fiscal year 2005 level and the same as the budget
    request. The bill also includes an advance appropriation of
    $1,730,000,000 for the first quarter of fiscal year 2007 to
    ensure timely completion of first quarter grant awards.
        Of the total appropriation, including the advance
    appropriation from the prior year, the bill provides
    $4,685,000,000 for the foster care program to provide
    maintenance payments to States on behalf of children who must
    live outside their homes. This is the same as the budget
    request and $210,500,000 less than the fiscal year 2005 level.
        Within the total appropriation, the bill provides
    $1,795,000,000 for adoption assistance. This is $24,900,000
    more than the fiscal year 2005 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 bill
    provides $140,000,000 for the independent living program. This
    is the same as the fiscal year 2005 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 $1,376,217,000. This is
    $17,125,000 less than the fiscal year 2005 comparable level and
    $7,189,000 more than the budget request. This account finances
    all programs under the Older Americans Act in this bill, with
    the exception of the Community Services Employment Program,
    which is administered by the Department of Labor.

    Supportive services and centers

        The Committee provides $354,136,000 for supportive services
    and centers. This is the same as the fiscal year 2005
    comparable level and the budget request. Funds for supportive
    services and centers are awarded to States and territories for
    in-home and community-based services for frail elderly persons
    who are at risk of losing their self-sufficiency due to
    physical or mental impairments. The funds contained in the bill
    will support a variety of activities including transportation
    services, information and assistance, and personal care
    services.

    Preventive health

        The Committee provides $21,616,000 for preventive health
    services authorized under part F of title III of the Act. This
    is the same as the fiscal year 2005 comparable level and the
    budget request. These funds are awarded to States and
    territories to support activities that educate older adults
    about the importance of healthy lifestyles and promote healthy
    behaviors that can prevent or delay chronic disease and
    disability.

    Protection of vulnerable older americans

        The Committee provides $19,360,000 for the protection of
    vulnerable older Americans, authorized by title VII of the
    Older Americans Act. This is the same as the budget request and
    $72,000 more than the fiscal year 2005 comparable level.
    Funding is provided for both the long-term care ombudsman
    program, which protects the rights and interests of residents
    in nursing homes, board and care homes, assisted living
    facilities and similar adult care facilities, as well as for
    the prevention of elder abuse, neglect, and exploitation
    program, which trains law enforcement and medical professionals
    in how to recognize and respond to elder abuse.

    National family caregiver support program

        The Committee provides $155,744,000 for the family
    caregivers program. This is the same as the fiscal year 2005
    comparable level and the budget request. The family caregiver
    program provides formula grants to States to provide a support
    system in each State for family caregivers. All States are
    expected to put in place five basic system components,
    including: individualized information on available resources;
    assistance to families in locating services from private and
    voluntary agencies; caregiver counseling, training and peer
    support; respite care; and other supplemental services.

    Native american caregiver support program

        The Committee provides $6,304,000 for the Native American
    caregiver support program. This is the same as the fiscal year
    2005 comparable level and the budget request. The program
    assists Tribes in providing multifaceted systems of support
    services for family caregivers as well as for grandparents
    caring for grandchildren.

    Nutrition programs

        For congregate and home delivered meals, as well as the
    nutrition services incentive program, the Committee provides
    $725,885,000. This is $7,188,000 more than the fiscal year 2005
    comparable level and $7,189,000 more than the budget request.
    These programs are intended to address some of the difficulties
    confronting older individuals, namely nutrition deficiencies
    due to inadequate income, lack of adequate facilities to
    prepare food, and social isolation.

    Grants for Native Americans

        The Committee provides $26,398,000 for grants for Native
    Americans. This is the same as the fiscal year 2005 comparable
    level and the budget request. Grants are distributed to tribal
    organizations to be used to help Native American elders remain
    healthy and independent by providing transportation, nutrition,
    health screening and other services.

    Program innovations

        The Committee provides $23,843,000 for program innovations.
    This is the same as the budget request and $19,443,000 less
    than the fiscal year 2005 comparable funding level. Funds under
    this program are used for competitive grants and contracts to
    support projects that develop new and promising practices to
    serve older adults and their families.
        Within the total 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. The Committee is aware of
    innovative program models aimed at mobilizing older Americans,
    particularly the 77 million baby boomers, to serve their
    communities. The Committee encourages partnerships with
    organizations, such as Experience Corps, that enable older
    Americans to help meet critical social needs effectively.

    Aging network support activities

        The Committee provides $13,266,000 for aging network
    support activities, which include five ongoing programs: the
    Eldercare Locator, Pension Counseling, Senior Medicare Patrols,
    the National Long-Term Care Ombudsman Resource Center, and the
    National Center on Elder Abuse. This is the same as the fiscal
    year 2005 comparable level and the budget request. These
    established programs, which began as demonstration projects,
    provide critical support for the national aging services
    network.

    Alzheimer's disease demonstration grants

        The Committee provides $11,786,000 for Alzheimer's disease
    demonstration grants. This is the same as the budget request
    and the fiscal year 2005 comparable level. The program provides
    competitive grants to States to help them plan and establish
    programs to provide models of care to individuals with
    Alzheimer's disease. Funds are used for respite care and
    supportive services, clearinghouses, training, and
    administrative costs for State offices.

    White House Conference on Aging

        The Committee concurs with the budget request and does not
    provide funding for the White House Conference on Aging. The
    fiscal year 2005 level, the third and final year of funding for
    the Conference, is $4,520,000. The Committee looks forward to
    the Conference, currently scheduled to occur December 11
    through 14 of 2005. 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 $17,879,000 for program
    administration expenses for the Administration on Aging (AoA).
    This is $422,000 less than the fiscal year 2005 level and the
    same as the budget request. This activity provides
    administrative and management support for all Older Americans
    Act programs administered by AoA.

                            Office of the Secretary

                        GENERAL DEPARTMENTAL MANAGEMENT

        The Committee provides $344,546,000 for general
    departmental management, which is $29,703,000 below the fiscal
    year 2005 comparable level and $14,630,000 below the budget
    request. Included in this amount is authority to spend
    $5,851,000 from the Medicare trust funds. In addition, the
    Office of the Secretary has access to $39,552,000 of policy
    evaluation funding.
        This appropriation supports those activities that are
    associated with the Secretary's roles as policy officer and
    general manager of the Department. The Office of the Secretary
    also implements Administration and Congressional directives,
    and provides assistance, direction and coordination to the
    headquarters, regions and field organizations of the
    Department. This account also supports several small health
    promotion and disease prevention activities that are centrally
    administered.

    Adolescent Family Life

        The Committee provides $30,742,000 for the Adolescent
    Family Life program, which is $158,000 below the comparable
    2005 level and the same as the budget request. The Committee
    includes bill language requested by the Administration
    allocating all funds for prevention demonstrations to be
    available for abstinence education activities under section
    510(b)(2) of the Social Security Act. The program provides
    comprehensive and integrated approaches to the delivery of care
    services for pregnant and parenting adolescents, and prevention
    services that promote abstinence from sexual activity among
    non-parenting teens.

    Office of Minority Health

        The Committee provides $47,236,000 for the Office of
    Minority Health, which is $3,282,000 below the fiscal year 2005
    comparable amount and the same as the budget request. The
    Office of Minority Health works with Public Health Service
    agencies and other agencies of the Department in a leadership
    and policy development role to establish goals and coordinate
    other activities in the Department regarding disease
    prevention, health promotion, service delivery and research
    relating to disadvantaged and minority individuals; concludes
    interagency agreements to stimulate and undertake innovative
    projects; supports research, demonstration, and evaluation
    projects; and coordinates efforts to promote minority health
    programs and policies in the voluntary and corporate sectors.
        IOM report on unequal treatment.--The Committee is
    committed to ensuring the overall improved health of the
    American people, and encourages the Secretary to intensify HHS
    efforts to work to implement recommendations developed by 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 health disparities and improving health across
    all populations. The Committee requests the Secretary to report
    on the progress of this action during next year's
    appropriations hearings.
        Charles Drew University.--The Committee notes the
    challenges faced by Charles R. Drew University of Medicine and
    Science in Los Angeles. Because of problems with the health
    care delivery system in South Central Los Angeles, several of
    the key residency training programs sponsored by the
    institution are jeopardized. The Committee encourages the
    Office of Minority Health to take a leadership role in
    assisting the university in solving these challenges. The
    Office is urged to consider supporting faculty for the
    residency programs, and to coordinate a Public Health Service-
    wide program of support for the institution.
        HIV/AIDS for faith-based communities.--The Committee
    commends the Department for its work with the National
    Coalition of Pastors' Spouses to develop HIV/AIDS: A Manual for
    Faith Communities. The Committee encourages the Department to
    continue this partnership for the translation of this manual
    into Spanish and Swahili.
        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. In addition, the
    Committee continues to encourage OMH to support strategic
    planning and development activities at the Morehouse School of
    Medicine.

    Office on Women's Health

        The Committee provides $28,715,000 for the Office on
    Women's Health, which is $103,000 below the fiscal year 2005
    comparable level and the same as the budget request. The Office
    on Women's Health advises the Secretary and provides
    Department-wide coordination of programs focusing specifically
    on women's health.

    HIV/AIDS in minority communities

        The Committee provides $52,415,000 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 2005 comparable level and
    the same as the budget request. These funds are provided to
    promote an effective culturally competent and linguistically
    appropriate public health response to the HIV/AIDS epidemic.
        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.

    Afghanistan

        The Committee includes $5,952,000, which is the same as the
    Administration and the comparable fiscal year 2005 level. These
    funds will be used 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.

    Embryo adoption awareness campaign

        The Committee provides $992,000 for the embryo adoption
    awareness campaign, which is the same as the Administration
    request and the comparable fiscal year 2005 level. These funds
    will be used for a competitive grant program to continue embryo
    adoption public awareness activities.

    Information technology security and innovation fund

        The Committee does not provide funding for the information
    technology security and innovation fund, which is $14,695,000
    below the fiscal year 2005 comparable level and $14,630,000
    below the budget request. This fund supports HHS enterprise-
    wide investments in such areas as common IT infrastructure
    services, and security and infrastructure to enable common
    administrative systems. Almost $67 million has been
    appropriated for this function over the past four years, in
    addition to the substantial contributions made by the HHS
    operating divisions.
        Office of Population Affairs.--The Committee is concerned
    by reports that the State Attorneys General in several States
    are requesting records to determine any role family planning
    providers may have had in failing to report criminal activity
    such as statutory rape. The appropriations bill has had a
    longstanding provision (sec. 212 of the fiscal year 2005 bill)
    and continues the provision in sec. 213 of the fiscal year 2006
    bill making clear that no family planning provider is exempt
    from any State law requiring notification or reporting of child
    abuse, child molestation, sexual abuse, rape or incest. The
    Committee directs the Office of Population Affairs to send
    Title X grantees a reminder notification of this Federal
    requirement. In addition, the Committee requests the Secretary
    to conduct an audit of a sample of Title X recipients to
    determine compliance with mandatory reporting requirements.
        Salt.--The Committee is aware that the Dietary Guidelines
    for Americans 2005 (published by the Department of Health and
    Human Services and the Department of Agriculture) recommends
    that Americans consume less salt because reducing salt intake
    may reduce blood pressure, lowering an individual's risk of
    coronary heart disease, stroke, congestive heart failure, and
    kidney disease. That recommendation echoes the conclusion of
    both a 2002 report by the National Institutes of Health and a
    2004 report by the Institute of Medicine. Older persons,
    African Americans, and people with high blood pressure tend to
    be especially sensitive to the blood pressure-raising effects
    of salt. While salt occurs naturally in some foods, the great
    majority of salt is consumed by eating processed foods. The
    Committee is also aware that in some processed foods salt--in
    addition to affecting taste--performs important functions, such
    as preventing the growth of bacteria. The Committee encourages
    the Secretary to focus on ways--including both voluntary
    actions by the food industry and regulatory actions by the Food
    and Drug Administration and the Department of Agriculture--to
    reduce salt in processed and restaurant foods.
        Cross-tracking program participants.--The Committee is
    interested in better understanding the full impact of federal
    assistance programs, including the number of individuals who
    access multiple programs, either concurrently or serially. As
    such, the Committee directs the U.S. Department of Health and
    Human Services to work with the Census Bureau to improve the
    Survey of Income and Program Participation (SIPP) and other
    infrastructure necessary to cross-reference individuals
    participating in multiple federal programs. As part of this
    effort, the Department of Health and Human Services is
    encouraged to partner with other federal agencies to improve
    Census Bureau survey measures of participation across all
    programs that will allow such cross-referencing to occur. The
    Department shall report to Congress, by March 1, 2006, on the
    status of this initiative, including a specific list of
    barriers that may preclude the agency from full compliance with
    this directive.
        Limited English proficiency.--The Committee is concerned
    about the implementation of the department's ``policy
    guidance'' issued pursuant to Executive Order 13166 regarding
    limited English proficiency. The Committee feels it is
    important to track the costs of this policy to make sure that
    the provision of language services is being done as cost
    effectively as possible. Therefore, HHS, should report to the
    Committee the total funding spent on the provision of HHS-
    conducted services in languages other than English, including
    publications costs, web site development and maintenance costs,
    outreach activities, translation activities, and language line
    contracts. The Department should report the same cost
    categories as provided in the Limited English Proficiency
    Report requested in House report 108-10.
        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 be
    prepared to discuss in the fiscal year 2007 appropriations
    hearings the activities that have been undertaken with regard
    to men's health.
        Underage drinking.--The Committee strongly supports the
    efforts by the Department to combat underage drinking
    particularly the efforts by the Interagency Coordinating
    Committee to Prevent Underage Drinking (ICCPUD) to develop a
    National strategy on underage drinking. More than 7,000 teens
    under the age of 16 take their first drink every day. According
    to the latest data from Monitoring the Future, one in five
    eighth-graders report drinking in the past month, and that
    rises to one in three for 10th-graders and one in two for 12th-
    graders. The Centers for Disease Control and Prevention (CDC)
    reported that, for the last year for which data were available,
    more than 4,500 persons under the age of 21 died as a result of
    excessive drinking. In addition, NIH has reported significant
    findings about the negative consequences of underage drinking
    on adolescent brain development. The Committee therefore
    includes within the total for the Office of the Secretary the
    third year of funding necessary to continue the Ad Council's
    parent-oriented National media campaign to combat underage
    drinking. Further, the Committee expects the public service
    announcement to be based on sound scientific research.
        HIV/AIDS grants.--The Committee is concerned that agencies
    at the state and local level which currently receive funding
    from multiple HHS agencies, such as those administering
    programs to prevent and treat HIV/AIDS, are burdened with
    inconsistent data collection and reporting requirements by
    Federal grants. In order to satisfy these requirements,
    agencies often must allocate funds to cover administrative
    costs that might otherwise go to providing direct services. In
    order to decrease administrative burden and make the most
    effective use of federal health care dollars, the Committee
    urges the Secretary to direct the HHS agencies engaged in
    cooperative agreements for HIV/AIDS services with State and
    local, private and public entities to address this situation by
    moving to coordinate data collection and reporting requirements
    for grantees.
        Sleep disorders.--At the National Institutes of Health's
    Frontiers of Knowledge in Sleep and Sleep Disorders conference
    in March of 2004, the U.S. Surgeon General reported on the
    profound impact that chronic sleep loss and untreated sleep
    disorders have on Americans of all ages and that the public
    health model is well suited to translate these essential health
    messages to society. The Committee encourages the Surgeon
    General to consider development of a Surgeon General's Report
    on Sleep and Sleep Disorders.
        Prostate cancer.--The Committee encourages the Secretary to
    work with the Director of the NIH and the Administrator of the
    FDA to resolve, as quickly as possible, all issues related to
    the adoption of clinical trial surrogate endpoints for prostate
    cancer research and drug approval. The Committee requests the
    Secretary to submit a progress report to Congress by July 1,
    2006.
        Hepatitis C-HIV co-infection.--The Committee is concerned
    with the growing co-infection of individuals with both HIV and
    hepatitis C and notes that the largest single cause of death of
    individuals with HIV infection is now liver disease. The
    Committee is pleased that, in response to this high co-
    infection rate, approximately 20 of the state AIDS Drug
    Assistance Programs (ADAP) have now included Hepatitis C
    pharmaceuticals on their formularies. The Committee notes that
    the Ryan White Care Act requires the Secretary to issue
    guidelines regarding appropriate treatments under the program
    and requests that the Secretary review and re-issue these
    treatment guidelines to address the treatment issues and
    formulary requirements associated with the significant co-
    infection rate of HIV and hepatitis C.
        Biosafety laboratories.--The Committee requests the
    Secretary of HHS to study if there is a need for additional
    biosafety level four (BSL-4) laboratories to combat biological
    threats from discovery to licensed products. With emerging
    infectious diseases, such as SARS and highly pathogenic avian
    influenza, increased incidence of drug resistant disease, and
    an increased potential for their use in bio-warfare, the
    Committee wants to be certain that an adequate number of such
    facilities exists to ensure that prophylaxis, therapeutics and
    diagnostics are available to combat these threats. The
    Committee requests the Secretary to conduct a coordinated
    review with relevant agencies to: (1) assess any need for
    additional BSL-4 facilities specifically designed to conduct
    animal model studies under Good Laboratory Practice guidelines;
    and (2) define the cost, critical design features, and possible
    construction timetable to establish new high security BSL-4
    research facilities. The Committee would like a report
    outlining the results of this review by no later than 180 days
    after enactment of this Act.
        NIH Library of Medicine infrastructure.--The Committee
    continues to support the work of the National Library of
    Medicine, the largest medical library in the world and the
    leader in digitized medical information resources. Previously,
    the Committee has taken steps to ensure that adequate funding
    was available for the architectural planning and design of a
    new NLM building to house the National Center for Biotechnology
    Information and other activities related to digital information
    development. With the preliminary work complete, the Committee
    encourages the Secretary to consider the commitment of
    necessary resources to begin construction of new physical
    facilities for the NLM to enable it to keep pace with the rapid
    increase in medical publishing and biotechnology information
    research and development.
        Evidentiary standards.--The Committee encourages the
    Secretary to work across the Department to direct its limited
    funding toward programs with the highest evidentiary standards,
    such as randomized trials. For example, the Committee is aware
    of extensive evidence that Nurse-Family Partnership, an early
    home visitation program for first-time low-income mothers,
    prevents child abuse and childhood injury, helps develop
    positive parent-child relationships, and helps the brain
    development of the children served. The Committee instructs the
    Secretary to apply the hig evidentiary standards to programs
    across the Department, and to support agencies within the
    Department, such as HRSA and ACF, adopting evidence-based
    programs.
        Obesity.--The Committee notes the serious nature of rising
    obesity rates, especially among girls in underrepresented
    populations or geographic areas where higher obesity rates
    prevail. The Committee further recognizes the multi-
    institutional effort that is needed to attack the obesity
    problem in America and ensure that children and teens make
    healthy choices. The Committee understands that the Girl Scouts
    of the USA has begun a Healthy Living Initiative, which may be
    able to reach many of its members and their families with a
    healthy living, balanced lifestyle message to address obesity
    and other risky behaviors. The Committee encourages HHS to
    actively partner with organizations such as the Girl Scouts of
    the USA to promote the Department's obesity and wellness
    initiatives.

                    OFFICE OF MEDICARE HEARINGS AND APPEALS

        The Committee provides $60,000,000 for this function, which
    was previously supported under an interagency agreement between
    the Centers for Medicare and Medicaid Services and the Social
    Security Administration. Consistent with the requirements of
    the Medicare Modernization Act of 2003, this function was
    transferred to the Office of the Secretary. This amount is
    $2,464,000 above the comparable fiscal year 2005 level and
    $20,000,000 below the Administration request. This office will
    support the hearing at the administrative law judge level of
    the third level of Medicare claims appeals. 42,000 appeals are
    expected to be heard in fiscal year 2006.

      OFFICE OF THE NATIONAL COORDINATOR FOR HEALTH INFORMATION TECHNOLOGY

        The Committee provides $75,000,000 for the new health
    information technology office, of which $58,100,000 is
    available in budget authority and $16,900,000 in program
    evaluation tap funding. No budget authority was provided in
    fiscal year 2005, but $32,779,000 was made available via
    reprogramming from a combination of program evaluation tap
    funding and reallocated funds in the Agency for Healthcare
    Research and Quality and the Office of the Secretary. The
    Administration request is $2,750,000 above the amount provided
    by the Committee in the portion of the program supported by
    evaluation tap funding. In addition, $50,000,000 is available
    for health information technology activities in the Agency for
    Healthcare Research and Quality. This is the same as the
    Administration budget and the comparable fiscal year 2005
    level.
        This program is intended to bring together decision-makers
    to develop standards for modern information technology, to
    devise certification procedures, to develop electronic
    information architecture and to test privacy standards. The
    ultimate goal is the accurate and rapid transfer of a patient's
    health information electronically.
        The Committee is aware of several State e-health
    initiatives for sharing health care information among
    providers. The Committee encourages the Office of the National
    Coordinator for Health Information Technology (ONCHIT) to take
    advantage of the expertise of these States as it begins the
    process of developing standards and policies for a national
    health information network. The Committee urges the Office to
    address the information technology infrastructure needs of
    public and private non-profit community health care systems.

                        OFFICE OF THE INSPECTOR GENERAL

        The Committee provides $39,813,000 for the Office of the
    Inspector General (OIG), which is $117,000 less than the fiscal
    year 2005 comparable level and the same as the budget request.
    A permanent appropriation for this office is contained in the
    Health Insurance Portability and Accountability Act of 1996.
    Total funds provided between this bill and the permanent
    appropriation would be $199,813,000 in fiscal year 2006.
        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 $34,996,000 for the Office of Civil
    Rights (OCR), which is $17,000 less than the fiscal year 2005
    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.

                   MEDICAL BENEFITS FOR COMMISSIONED OFFICERS

        The Committee provides an estimated $328,552,000 for
    medical benefits for commissioned officers of the U.S. Public
    Health Service. This is the same as the Administration request
    and $2,084,000 below the fiscal year 2005 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.

                PUBLIC HEALTH AND SOCIAL SERVICES EMERGENCY FUND

        The Committee provides $183,589,000 for the public health
    and social services emergency fund for homeland security
    related activities within the Office of the Secretary. Within
    the amount, $63,589,000 is for homeland security preparedness
    activities within the Office of the Secretary and $120,000,000
    is for influenza preparedness.
        In addition, the Committee also provides $2,213,744,000
    within the accounts of the managing agencies of jurisdiction,
    for homeland security activities requested in this account. The
    amounts are broken out by Agency as follows: $1,616,723,000
    within the Centers for Disease Control and Prevention;
    $500,000,000 within the Health Resources and Services
    Administration; and $97,021,000 within the National Institutes
    of Health for chemical, nuclear and radiological research.
        Since fiscal year 2002, terrorism preparedness and response
    funds have been requested and provided for within the Public
    Health and Social Services Emergency Fund (PHSSEF), with the
    exception of biodefense research funds within the National
    Institute of Allergy and Infectious Diseases. However, now that
    these programs and activities have become a central part of
    these Agencies annual management responsibilities, the
    Committee believes the funding more appropriately belongs
    within the managing Agency's account.
        After adjusting for these changes, the comparable total for
    homeland security related activities in the Committee
    recommendation is $2,397,333,000 for fiscal year 2006. This is
    $10,082,000 below the comparable fiscal year 2005 amount and
    $30,500,000 below the request.
        While the Committee has, for FY 2006, provided funding for
    these activities directly to the relevant agencies, the
    Committee expects Department-wide coordination to continue. The
    Committee directs the Secretary to submit to the Committee a
    detailed operating plan for bioterrorism preparedness
    activities, now funded in large measure in the agencies, prior
    to the commitment of funds for grants, or for contracts in
    excess of $1 million.
        The Committee bill also includes language to finance HHS's
    Project BioShield procurement management costs through the
    appropriation for the Strategic National Stockpile, consistent
    with the requirements of section 319F-2(c)(7)(B)(ii) of the
    Public Health Service Act. To cover these costs, the bill
    authorizes the transfer of $8,589,000 from the SNS
    appropriation (CDC) to the Public Health and Social Services
    Emergency Fund.
        The Committee does not provide funding within the Office of
    the Secretary for healthcare provider credentialing. The
    Committee believes a better use of resources would be to expand
    the ongoing credentialing program operated by HRSA to permit
    cross-state credentialing.
        Pandemic Preparedness.--The Committee directs the
    Department to finalize its August 2004 draft Pandemic Influenza
    Preparedness and Response Plan and make it publicly available.
    The final plan should provide the operational blueprint for the
    six pandemic phases as defined by the World Health
    Organization.
        The Committee believes that pandemic preparedness includes
    much more than just public health, and urges the Secretary to
    press for the appointment of a senior official, whose primary
    responsibility is to assure Cabinet-level planning and
    coordination between civil society (non-governmental economic
    infrastructure) and government during a pandemic period.
        The Committee commends the Secretary for taking steps to
    implement the draft Pandemic Influenza Preparedness and
    Response Plan, and it notes the important roles that both
    vaccines and antivirals will play in the event of pandemic.
    Given the potential lack of a match between available vaccines
    and a particular strain of influenza that could cause a
    pandemic, the Committee supports efforts to increase domestic
    manufacturing capabilities for rapid production of vaccines and
    antivirals and the purchase of vaccines and antivirals in the
    event of a pandemic influenza outbreak.

                               General Provisions

        Sec. 201. The Committee continues a provision to limit the
    amount available for official reception and representation
    expenses.
        Sec. 202. The Committee continues a provision to limit the
    number of Public Health Service employees assigned to assist in
    child survival activities and to work in AIDS programs through
    and with funds provided by the Agency for International
    Development, the United Nations International Children's
    Emergency Fund or the World Health Organization.
        Sec. 203. The Committee continues a provision to prohibit
    the use of funds to implement section 399F(b) of the Public
    Health Service Act or section 1503 of the NIH Revitalization
    Act of 1993.
        Sec. 204. The Committee continues a provision to limit the
    salary of an individual through an NIH, AHRQ, or SAMHSA grant
    or other extramural mechanism to not more than the rate of
    Executive Level I.
        Sec. 205. The Committee includes a provision limiting the
    compensation of an individual working in Head Start to the
    Federal Executive Level II salary.
        Sec. 206. The Committee continues a provision to prohibit
    the Secretary from using evaluation set-aside funds until the
    Committee receives a report detailing the planned use of such
    funds.
        Sec. 207. The Committee continues a provision, although
    changes the percentage provided in the fiscal year 2005 bill,
    permitting the Secretary to use up to 1.3 percent of funds
    authorized under the PHS Act for the evaluation of programs.

                              (TRANSFER OF FUNDS)

        Sec. 208. The Committee modifies a provision permitting the
    Secretary of HHS to transfer up to one percent of any
    discretionary appropriation from an account.

                              (TRANSFER OF FUNDS)

        Sec. 209. The Committee continues a provision to provide
    the Director of NIH, jointly with the Director of the Office of
    AIDS Research, the authority to transfer up to three percent of
    human immunodeficiency virus funds.

                              (TRANSFER OF FUNDS)

        Sec. 210. The Committee continues a provision to make NIH
    funds available for human immunodeficiency virus research
    available to the Office of AIDS Research.
        Sec. 211. The Committee continues a provision to prohibit
    the use of Title X funds unless the applicant for the award
    certifies to the Secretary that it encourages family
    participation in the decision of minors to seek family planning
    services and that it provides counseling to minors on how to
    resist attempts to coerce minors into engaging in sexual
    activities.
        Sec. 212. The Committee continues a provision related to
    the Medicare Advantage program.
        Sec. 213. The Committee continues a provision stating that
    no provider of services under title X shall be exempt from any
    State law requiring notification or the reporting of child
    abuse, child molestation, sexual abuse, rape, or incest.
        Sec. 214. The Committee continues a provision to exempt
    States from Synar provisions if certain funding criteria are
    met.
        Sec. 215. The Committee continues a provision to allow CDC
    international HIV/AIDS and other infectious disease, chronic
    and environmental disease, and other health activities abroad
    to be spent under the State Department Basic Authorities Act of
    1956.
        Sec. 216. The Committee continues a provision to permit the
    Division of Federal Occupational Health to use personal
    services contracting to employ professional management/
    administrative and occupational health professionals.
        Sec. 217. The Committee includes a provision granting
    authority to the Office of the Director of the National
    Institutes of Health (NIH) to enter directly into transactions
    in order to implement the NIH Roadmap for medical research and
    permitting the Director to utilize peer review procedures, as
    appropriate, to obtain assessments of scientific and technical
    merit.
        Sec. 218. The Committee includes a provision that permits
    the Centers for Disease Control and Prevention and the Agency
    for Toxic Substances and Disease Registry to transfer funds
    that are available for Individual Learning Accounts to
    ``Disease Control, Research, and Training''.
        Sec. 219. The Committee includes a provision rescinding
    $15,912,000 of unobligated balances in the Health Professions
    Student Loan program.

                       TITLE III--DEPARTMENT OF EDUCATION

        The Committee's recommendations for the Department of
    Education for fiscal year 2006 will bring total departmental
    funding to $56,692,772,000, the highest level in the agency's
    history.
        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.
        The Committee notes that urban school districts employ more
    people and manage larger budgets than many Fortune 500
    companies. Yet many schools--particularly in inner cities--are
    failing to prepare students for higher education, employment
    and productive citizenship. The Committee encourages the
    Secretary to examine the effects that various local district
    governance structures, including elected and appointed school
    boards, have had on academic achievement in public schools and
    be prepared to respond to questions relating to this topic in
    the fiscal year 2007 budget hearings.
        The Committee is aware that, nationally, only 61.5 percent
    of public education operational budgets reach the classroom,
    according to the National Center for Educational Statistics.
    However four states (Maine, New York, Tennessee and Utah) spend
    over 65 percent of their budget in the classroom. The Committee
    encourages the Secretary to examine the impact this spending
    priority has had on the academic achievement of students in
    these states and to examine efforts that would result in a
    greater percentage of all school district budgets being spent
    on classroom instruction, such as classroom teachers,
    personnel, instructional aides, supplies, activities and
    tuition.

                        EDUCATION FOR THE DISADVANTAGED

        The bill includes $14,728,735,000 for the disadvantaged
    programs. This amount is $1,702,738,000 less than the budget
    request and $115,239,000 below the fiscal year 2005
    appropriation. Of the total amount available, $7,144,426,000 is
    appropriated for fiscal year 2006 for obligation after July 1,
    2006 and $7,383,301,000 is appropriated for fiscal year 2007
    for obligation on or after October 1, 2006. 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.
        The Committee is aware that the method some states
    currently employ to calculate school expenditures masks huge
    gaps in per-pupil spending within districts. State funding
    analyses, and data which drive federal funding formulas, tend
    to average teacher salaries for entire districts instead of
    calculating the actual salaries of teachers assigned to any
    particular school. Many states actually spend less on teachers
    in schools serving low-income and minority students than they
    spend on teachers in schools serving more affluent students.
    The most highly-paid teachers, and therefore the more
    experienced and highly credentialed teachers, are concentrated
    in more affluent schools, leaving high-poverty and high-
    minority schools with teachers who have less experience, less
    education, and face the most challenging assignments. The
    Education Trust has found that, in California, forty-two of the
    fifty largest school districts spend significantly more on
    teachers in their schools serving the fewest numbers of Latino
    and African-American students. For a student attending a high
    school that serves mostly Latino and African-American students,
    as much as $172,000 less may be spent on that student's
    teachers over the course of a K-12 career.
        The Committee urges the Secretary to examine this issue,
    determine how many states are using this practice, ascertain
    what effects the practice may have on title I grants to LEAs,
    and work with states to adopt data-collection policies that
    will make school-level teacher salary data publicly available,
    and to analyze and report on the factors that contribute to the
    teacher-spending gap, such as personnel and budgeting
    practices, in order to close the gap in teacher spending and
    quality within school districts. The Committee expects the
    Secretary to be prepared to report on this effort in the fiscal
    year 2007 budget hearings.

    Grants to local educational agencies

        Of the amounts provided for Title I programs,
    $6,934,854,000 is available for basic grants to local education
    agencies. This amount is the same as last year's level and the
    request. The Committee rejects the inclusion of any 100% hold
    harmless provision because it unfairly penalizes
    underprivileged and immigrant children in states with growing
    populations.
        Funding for concentration grants, which targets funds to
    Local Educational Agencies in counties with high levels of
    disadvantaged children, is $1,365,031,000, the same as last
    year and the request level. The bill includes $2,269,843,000
    for targeted grants, an increase of $50,000,000 above last year
    and $552,738,000 below the request. A total of $2,269,843,000
    is also included for education finance incentive grants,
    $50,000,000 above the request and $50,000,000 above last year's
    level.
        Financial assistance flows to school districts by formula,
    based in part on the number of school-aged children from low-
    income families. Within districts, local school officials
    target funds on school attendance areas with the greatest
    number or percentage of children from poor families. Local
    school districts develop and implement their own programs to
    meet the needs of disadvantaged students.
        Funds under this account will also be used to pay the
    Federal share of State administrative costs for title I
    programs. The maximum State administration grant is equal to 1
    percent of title I local educational agency plus State agency
    grants to the State, or $400,000, whichever is greater. These
    funds are included in the grants to local educational agencies
    account, rather than being a separate line item.
        Recent studies have demonstrated that comprehensive school-
    improvement models, when well implemented, boost student
    achievement to a greater extent than other interventions
    designed to serve similar student populations. The Committee
    believes that comprehensive school reform provides an exemplary
    approach to raising academic achievement, particularly for
    schools that do not make adequate yearly progress under the No
    Child Left Behind Act. The Committee believes that States
    should utilize their four percent school improvement set aside
    funds, estimated at over $500,000,000 in fiscal year 2006, to
    support implementation of CSR models with demonstrated success.
    Further, the Committee intends that the Secretary shall notify
    States that schools currently receiving CSR subgrants shall
    receive priority for targeted grants and/or technical
    assistance under section 1003(a) of ESEA.
        In addition, the Committee is concerned that in some cases,
    States have distributed the funds set aside within the title I
    program for school improvement purposes equally to each school
    identified in need of improvement. The Committee believes that
    this is resulting in allocations for each school that may be
    too small to effectively leverage needed reforms. The Committee
    strongly urges States to examine methods for distributing
    school improvement funds that will result in awards of
    sufficient size and scope to support the initial costs of
    comprehensive school reforms and to limit funding to programs
    that include each of the reform components described in section
    1606(a) of the No Child Left Behind Act of 2001 and have the
    capacity to improve the academic achievement of all students in
    core academic subjects within participating schools.

    Even Start

        The Committee provides $200,000,000 for Even Start,
    $25,095,000 below last year and $200,000,000 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 $1,041,600,000 for Reading First State
    grants, the same as the budget request and the same as the
    fiscal year 2005 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.
        The Committee urges the Department to ensure accountability
    of States and local education agencies through ongoing,
    reliable screening and diagnostic and classroom-based
    assessments of the literacy programs funded with Reading First
    grants.

    Early Reading First

        The bill provides $104,160,000 for Early Reading First, the
    same as the budget request and the fiscal year 2005 level. This
    is a competitive grant program targeted toward children ages
    three through five, and would support the development of verbal
    skills, phonemic awareness, pre-reading development and
    assistance for professional development for teachers in
    evidence-based strategies of instruction.

    Striving Readers

        The bill provides $30,000,000 for Striving Readers,
    $170,000,000 below the budget request and $5,200,000 above last
    year's level. Striving Readers will make competitive grants to
    develop, implement and evaluate reading interventions for
    middle- or high-school students who are reading significantly
    below grade level.

    Literacy through school libraries

        The bill provides $19,683,000 for literacy through school
    libraries, the same as the budget request and the fiscal year
    2005 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.

    High school intervention

        The bill does not include funding for the high school
    intervention program proposed by the Administration at
    $1,240,000,000. The Committee supports the Administration's
    goals in this program which are to increase the achievement of
    high school students, particularly students at risk of failing
    to meet challenging State academic content standards; eliminate
    gaps in achievement between students from different ethnic and
    racial groups and between disadvantaged students and their more
    advantaged peers; and enable all high school students to
    graduate with the education, skills, and knowledge necessary to
    succeed in postsecondary education and in a demanding, high-
    technology economy. However, the Committee notes that this
    program has not been authorized.

    State agency programs: migrant

        The bill includes $390,428,000 for the migrant education
    program, the same as the budget request and the fiscal year
    2005 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 $49,600,000, the same as the budget
    request and the fiscal year 2005 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 $9,424,000 for evaluation, the same
    as the 2004 appropriation and 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 $10,000,000 for the Comprehensive School
    Reform (CSR) Program, $10,000,000 above the request and
    $195,344,000 below last year's level, due to budget
    constraints. The Committee has provided sufficient funding to
    meet estimated continuation costs for the program in fiscal
    year 2006. The CSR program authorizes incentive grants of at
    least $50,000 per year, for 3 years, for schools to implement
    effective, research-driven strategies for schoolwide reform.
    Recent studies have demonstrated that comprehensive school-
    improvement models, when well implemented, boost student
    achievement to a greater extent than other interventions
    designed to serve similar student populations. The Committee
    believes that comprehensive school reform provides an exemplary
    approach to raising academic achievement, particularly for
    schools that do not make adequate yearly progress under the No
    Child Left Behind Act. The Committee believes that States
    should utilize their four percent school improvement set aside
    funds, estimated at over $500,000,000 in fiscal year 2006, to
    support implementation of CSR models with demonstrated success.
    Further, the Committee intends that the Secretary shall notify
    States that schools currently receiving CSR subgrants shall
    receive priority for targeted grants and/or technical
    assistance under section 1003(a) of ESEA.
        In addition, the Committee is concerned that in some cases,
    States have merely divided the funds for school improvement
    purposes by the number of schools identified in need of
    improvement and that this is resulting in allocations for each
    school that may be too small to effectively leverage needed
    reforms. The Committee strongly urges States to examine methods
    for distributing school improvement funds that will result in
    awards of sufficient size and scope to support the initial
    costs of comprehensive school reforms and to limit funding to
    programs that include each of the reform components described
    in section 1606(a) of the No Child Left Behind Act of 2001 and
    have the capacity to improve the academic achievement of all
    students in core academic subjects within participating
    schools.

    Migrant education, high school equivalency program

        The bill includes $18,737,000 for the high school
    equivalency program. This amount is the same as the budget
    request and the fiscal year 2005 level. The high school
    equivalency program recruits migrant students aged 16 and over
    and provides academic and support services to help those
    students obtain a high school equivalency certificate and
    subsequently to gain employment or admission to a postsecondary
    institution or training program.

    College assistance migrant programs

        The bill includes $15,532,000 for the college assistance
    migrant programs. This amount is the same as the fiscal year
    2005 level and the budget request. The college assistance
    migrant program (CAMP) provides tutoring and counseling
    services to first-year, undergraduate migrant students and
    assists those students in obtaining student financial aid for
    their remaining undergraduate years.

                                   IMPACT AID

        The bill provides $1,240,862,000 for Federal impact aid
    programs in fiscal year 2006, a decrease of $3,001,000 below
    the fiscal year 2005 appropriation and the same as the budget
    request. This account supports payments to school districts
    affected by Federal activities. Impact Aid represents a federal
    responsibility to local schools educating children whose
    families are connected with the military or who live on Indian
    land.
        The bill also includes language ensuring that schools
    serving the children of military personnel continue to receive
    Impact Aid funds when the military parents who live on-base are
    deployed and the child continues to attend the same school and
    in cases in which an on-base military parent is killed while on
    active duty and the child continues to attend the same school.
        The Committee notes that the Department of Defense is
    making plans to bring back to the continental United States
    over 70,000 U.S. military personnel currently stationed
    overseas, along with an estimated 100,000 family members. The
    Committee is concerned about the effect this action will have
    on the Impact Aid program and the schools enrolling
    approximately 32,000 military dependent students new to the
    Impact Aid Program. The Committee requests the Secretary to
    procure from the Secretary of Defense a timeline for this
    anticipated action along with the estimated total dollar
    savings this move will have on the Department of Defense
    Overseas Schools system and the financial impact the influx of
    these additional students will have on the Impact Aid Program
    and to report this information to the House and Senate
    authorizing and appropriation committees beginning October 1,
    2005 and every six months thereafter.

    Basic support payments

        The bill includes $1,102,896,000 for basic support payments
    to local educational agencies, an increase of $27,878,000 above
    the fiscal year 2005 appropriation and the budget request.
    Basic support payments compensate school districts for lost tax
    revenue and are made on behalf of Federally-connected children
    such as children of members of the uniformed services who live
    on Federal property.

    Payments for children with disabilities

        The Committee recommends $49,966,000 for payments on behalf
    of Federally-connected children with disabilities, the same as
    the budget request and the fiscal year 2005 appropriation.
    These payments compensate school districts for the increased
    costs of serving Federally-connected children with
    disabilities.

    Facilities maintenance

        The Committee recommends $5,000,000 for facilities
    maintenance, $2,838,000 below the fiscal year 2005 amount and
    the budget request. These capital payments are authorized for
    maintenance of certain facilities owned by the Department of
    Education.

    Construction

        The Committee recommends $18,000,000 for the construction
    program, $27,544,000 below the budget request and $30,545,000
    below the fiscal year 2005 level. This program provides formula
    and competitive grants to eligible locally owned school
    districts for building and renovating school facilities.

    Payments for Federal property

        The bill provides $65,000,000 for payments related to
    Federal property, an increase of $2,504,000 above the fiscal
    year 2005 appropriation and the budget request. Funds are
    awarded to school districts to compensate for lost tax revenue
    as the result of Federal acquisition of real property since
    1938.

                          SCHOOL IMPROVEMENT PROGRAMS

        The bill includes $5,393,765,000 for school improvement
    programs. This amount is $225,891,000 less than the comparable
    fiscal year 2005 appropriation and $61,546,000 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, title IV-A of the Civil
    Rights Act, and section 105 of the Compact of Free Association
    Amendments Act of 2003.

    State grants for improving teacher quality

        The bill includes $2,916,605,000 for state grants for
    improving teacher quality, which is the same as the budget
    request and the fiscal year 2005 level. This program gives
    states and districts a flexible source of funding with which to
    meet their particular needs in strengthening the skills and
    knowledge of teachers and administrators to enable them to
    improve student achievement. States are authorized to retain
    2.5 percent of funds for state activities, including reforming
    teacher certification, re-certification or licensure
    requirements; expanding, establishing or improving alternative
    routes to state certification; carrying out programs that
    include support during the initial teaching and leadership
    experience, such as mentoring programs; assisting school
    districts in effectively recruiting and retaining highly
    qualified and effective teachers and principals; reforming
    tenure systems; and developing professional development
    programs for principals.
        States send funding to the local level by formula and by
    competitive grant. Among other things, local uses of funds
    include initiatives to assist recruitment of principals and
    fully qualified teachers; initiatives to promote retention of
    highly qualified teachers and principals; programs designed to
    improve the quality of the teacher force; teacher opportunity
    payments; professional development activities; teacher
    advancement initiatives and hiring fully qualified teachers in
    order to reduce class size.
        The Committee is aware that funding under the teacher
    quality program can be used for professional development and
    support for principals as well as teachers. The Committee
    recognizes the unique role that the principal plays as the
    instructional leader and CEO of a school, and strongly
    encourages states and school districts to devote a significant
    portion of professional development funds to providing high-
    quality, ongoing professional development opportunities to
    principals. Particularly recommended is professional
    development to enhance principals' ability to work productively
    with families, provide staff development to teachers and other
    professionals, and to utilize data in decision-making. The
    Committee also encourages states and school districts to
    develop principals' professional development that is based on
    sound research on the most current models of leadership.

    Early childhood educator professional development

        The bill includes $14,696,000 for early childhood educator
    professional development, the same as the budget request and
    the fiscal year 2005 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 $190,000,000 for mathematics and science
    partnerships, $79,000,000 below the budget request and
    $11,440,000 above the fiscal year 2005 level. This program
    promotes strong math and science teaching skills for elementary
    and secondary school teachers. Grantees may use program funds
    to develop rigorous math and science curricula, establish
    distance learning programs, and recruit math, science and
    engineering majors into the teaching profession. They may also
    provide professional development opportunities. Grants are made
    to States by formula based on the number of children aged 5 to
    17 who are from families with incomes below the poverty line,
    and States then award the funds competitively to partnerships
    which must include the State agency, and engineering, math or
    science department of an institution of higher education, and a
    high-need school district. Other partners may also be involved.

    Innovative Education Program Strategies State Grants

        The bill includes $198,400,000 for State grants under
    Innovative Education Program Strategies, $98,400,000 above the
    budget request and the same as the fiscal year 2005 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 $300,000,000 for education technology
    activities. This amount is $196,000,000 below the comparable
    fiscal year 2005 level. The President's budget proposed to
    terminate this program. 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.

    Supplemental education grants

        The bill provides $12,132,000 for supplemental education
    grants to the Federated States of Micronesia and $6,051,000 for
    supplemental education grants to the Republic of the Marshall
    Islands, the same as the budget request and the fiscal year
    2005 level. The Compact of Free Association Amendments Act of
    2003 (P.L. 108-188) authorizes these countries to receive
    funding for general education assistance.

    21st century community learning centers

        The bill provides $991,077,000 for 21st century community
    learning centers, the same as the budget request and the fiscal
    year 2005 level. This program is a formula grant to states.
    Ninety-five percent of funds are distributed on a competitive
    basis from the state to local school districts, community-based
    organizations and other public entities and private
    organizations. Grantees must target students who attend low-
    performing schools. Funds may be used for before and after
    school activities that advance student academic achievement
    including remedial education and academic enrichment
    activities; math, science, arts, music, entrepreneurial and
    technology education; tutoring and mentoring; recreational
    activities; and expanded library service hours.

    State assessments

        The bill includes $411,680,000 for state assessments, the
    same as the budget request and the fiscal year 2005 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.

    High school assessments

        The bill does not include funding for the high school
    assessment initiative, proposed for funding by the
    Administration at $250,000,000. The Committee notes that this
    program is not authorized.

    Javits gifted and talented education

        The bill does not include funding for gifted and talented
    education, the same as the budget request and $11,022,000 below
    fiscal year 2005 level. 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 $17,856,000 in fiscal year 2005. 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 $62,496,000, the same as the budget
    request and the fiscal year 2005 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 $7,185,000 for training and advisory
    services authorized by title IV-A of the Civil Rights Act. This
    amount is the same as the budget request and the same as the
    fiscal year 2005 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 $24,770,000 for education for
    Native Hawaiians, $7,854,000 below the budget request and
    $9,454,000 below the fiscal year 2005 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 $31,224,000 for the Alaska Native
    education equity program, the same as the budget request and
    $3,000,000 below the fiscal year 2005 amount. These funds are
    used to develop supplemental educational programs to benefit
    Alaska Natives.

    Rural Education

        The bill includes $170,624,000 for rural education
    programs, the same as the fiscal year 2005 level and the budget
    request. This fund includes two programs to assist rural school
    districts to improve teaching and learning in their schools.
    The small, rural schools achievement program provides funds to
    rural districts that serve a small number of students; the
    rural and low-income schools program provides funds to rural
    districts that serve concentrations of poor students,
    regardless of the number of students served by the district.

    Comprehensive Centers

        The bill includes $56,825,000 for comprehensive centers,
    the same as the fiscal year 2005 level and the budget request.
    The Committee intends these funds to be used for the new
    comprehensive centers that will provide training, technical
    assistance, and professional development in reading,
    mathematics, and technology, particularly to schools that fail
    to meet their State's definition of adequate yearly progress.
        The Committee is pleased that the Department has decided to
    establish a Comprehensive Center in California and urges
    consideration be given for establishing such a center in
    southern California. Southern California has more than 60
    percent of California's 6.3 million students, the majority of
    schools in need of program improvement, the highest number of
    English Language Learner students, and the largest number of
    schools targeted for restructuring. In addition, southern
    California has 1.6 million Title I students--12 percent of the
    national total; 2,400 Title I schools--6 percent of the
    national total; and over 1 million Limited English Proficient
    students--22 percent of the national total.

                                INDIAN EDUCATION

        The bill includes $119,889,000 for Indian education. This
    amount is the same as the fiscal year 2005 appropriation and
    the budget request. This account supports programs authorized
    by part A of Title VII of the Elementary and Secondary
    Education Act and section 215 of the Department of Education
    Organization Act.

    Grants to local educational agencies

        The bill provides $96,294,000 for grants to local education
    agencies, the same as the budget request and $1,128,000 above
    the fiscal year 2005 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 $19,595,000 for special programs
    for Indian children, the same as fiscal year 2005 and the
    budget request. These programs make competitive awards to
    improve the quality of education for Indian students. This
    program also funds a new Indian Teacher Corps, which hopes to
    train over 1,000 Indian teachers over a five-year period to
    take positions in schools that serve concentrations of Indian
    children.

    National activities

        The bill provides $4,000,000 for national activities,
    $1,129,000 below fiscal year 2005 and the same as 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 $708,522,000 for innovation and
    improvement programs. This amount is $384,121,000 less than the
    comparable fiscal year 2005 appropriation and $599,349,000
    below the budget request for comparable programs. This
    appropriation account includes programs authorized under part G
    of title I and portions of titles II and V of the Elementary
    and Secondary Education Act.

    Troops to teachers

        The bill includes $14,793,000 for troops to teachers, the
    same as the budget request and the fiscal year 2005 level. This
    program is designed to assist eligible members of the armed
    forces to obtain certification or licensure as elementary and
    secondary school teachers, or vocational or technical teachers.
    The transition to teachers program is based on the model of the
    troops to teachers program and would address the need of high-
    need school districts for highly qualified teachers.

    Transition to teaching

        The bill includes $44,933,000 for transition to teaching,
    the same as the budget request and the fiscal year 2005 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 $20,336,000 for the National Writing
    Project, the same as the fiscal year 2005 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, $69,040,000 below the budget
    request and the fiscal year 2005 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 $14,880,000 for school leadership
    activities, the same as the fiscal year 2005 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 $16,864,000 for advanced credentialing,
    the same as the fiscal year 2005 level and $8,864,000 above the
    budget request. The program authorizes competitive grants to
    states, school districts, the National Board for Professional
    Teaching Standards (NBPTS) working with a district or states,
    the American Board for the Certification of Teacher Excellence
    working with a district or state, or another certification or
    credentialing organization working with a district or state.
    The program supports activities to encourage and support
    teachers seeking advanced certification or credentialing.
        The Committee intends that $9,920,000 of the funds be
    awarded to the National Board for Professional Teaching
    Standards and that $6,944,000 be awarded to the American Board
    for the Certification of Teacher Excellence. The Committee
    expresses concern that the National Board for Professional
    Teaching Standards has begun to move away from its primary
    focus of improving classroom teacher quality and into other
    arenas within the education field, such as school counseling.
    The Committee encourages the Board to retain its focus on
    improving the skills and credentials of classroom teachers.

    Charter schools

        The Committee recommends $216,952,000 for support of
    charter schools, $1,750,000 below the budget request and the
    same as the fiscal year 2005 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.
        The demand for enrollment in charter schools is likely to
    increase substantially as a result of the focus on school
    choice created by the No Child Left Behind Act. The Committee
    is aware that both charter schools that operate within a school
    district, as well as those that operate as a separate school
    district, have had difficulty obtaining funds on a basis equal
    to traditional school districts and public schools. In
    addition, charter schools usually do not receive funding for
    facilities equivalent to traditional school districts. The
    Committee encourages the Secretary to examine means by which
    charter schools can receive their fair share of taxpayer
    dollars, particularly where federal funds are involved.

    Credit enhancement for charter school facilities

        The bill includes $36,981,000 for credit enhancement for
    charter school facilities, the same as the budget request and
    fiscal year 2005. This program helps charter schools meet their
    facility needs by providing funding on a competitive basis to
    leverage other funds and help charter schools obtain school
    facilities by means such as purchase, lease and donation.
    Charter schools are more likely than traditional schools to
    have problems obtaining adequate facilities because they are
    perceived as more financially risky than other schools, and
    unlike traditional school districts, charter schools generally
    lack the ability to issue general obligation bonds backed by
    property taxes.

    Voluntary public school choice

        The bill includes $26,543,000 for voluntary public school
    choice, the same as the budget request and the fiscal year 2005
    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 $107,771,000 for the magnet schools
    assistance program, the same as the budget request and the
    fiscal year 2005 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.

    Fund for the improvement of education

        The bill includes $27,000,000 for the fund for the
    improvement of education, $387,079,000 below the fiscal year
    2005 level and $129,296,000 below the comparable 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, including
    Foundations for Learning grants. The Committee has included
    language allowing the Secretary to use funds under FIE to carry
    out an evaluation of the DC School Choice Incentive Act of
    2003.

    Teacher Incentive Fund

        The Committee has included $100,000,000 for a pilot program
    to develop and implement innovative ways to provide financial
    incentives for teachers and principals who raise student
    achievement and close the achievement gap in some of our
    Nation's highest-need schools. The President requested
    $500,000,000 for this initiative.
        The Committee intends that the Secretary use this funding
    to award competitive grants to local educational agencies
    (LEAs), including charter schools that are LEAs, States, or
    partnerships of (1) a local educational agency, a State, or
    both and (2) at least one non-profit organization to design and
    implement fair, differentiated compensation systems for public
    school teachers and principals based primarily on measures of
    gains in student achievement, in addition to other factors, for
    teachers and principals in high-need areas.
        The Committee intends that each applicant demonstrate a
    significant investment in, and ensure the sustainability of,
    its project by committing to pay for an increasing share of the
    total cost of the project, for each year of the grant, with
    State, local, or other non-Federal funds. The Committee further
    intends that the Department assess each funded project through
    an outside, independent evaluator, to inform others interested
    in implementing similar reforms. The Department may use a
    portion of the funds available for this initiative to pay the
    costs of this evaluation.

    Ready To Learn Television

        The bill does not include funding for the Ready to Learn
    Television program, $23,312,000 below both the budget request
    and the fiscal year 2005 level. Ready to Learn supports the
    development and distribution of educational video programming
    for preschool children, elementary school children and their
    parents. Only public telecommunications entities are eligible
    to receive awards.

    Dropout prevention programs

        The bill does not include funding for the dropout
    prevention program, the same as the budget request. This
    program was funded at $4,930,000 in fiscal year 2005. The
    dropout prevention program provides assistance to help schools
    implement effective school dropout prevention and reentry
    programs. This program has only been funded for two years, and
    has made only about two dozen awards. The Committee notes that
    districts desiring to implement dropout prevention programs can
    use funds under title I for innovative programs to support such
    efforts; hence there is no need for a separately funded line-
    item to accomplish this purpose.

    Ellender fellowships/Close-Up

        The bill includes $1,469,000 for Ellender fellowships, the
    same as the fiscal year 2005 level. The budget did not propose
    funding for this program. The Ellender fellowship program makes
    an award to the Close-Up Foundation of Washington D.C. This
    organization provides fellowships to students from low income
    families and their teachers to enable them to participate with
    other students and teachers for a week of seminars on
    government and meetings with representatives of the three
    branches of the Federal government.

    Advanced placement test fee program

        The Committee recommends $30,000,000 for advanced placement
    fees. This recommendation is $21,500,000 below the budget
    request and $240,000 above the fiscal year 2005 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 $763,870,000 for school improvement
    programs. This amount is $96,901,000 less than the comparable
    fiscal year 2005 appropriation and $367,103,000 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 $400,000,000 for the State
    grants program, $400,000,000 above the budget request and
    $37,381,000 below the fiscal year 2005 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.

    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 $152,537,000,
    the same as the fiscal year 2005 amount and $115,430,000 below
    the budget request. Under this program, the Secretary of
    Education administers a variety of activities to prevent the
    illegal use of drugs and violence among, and promote safety and
    discipline for, students at all educational levels, preschool
    through postsecondary. Within the amount provided, the
    Committee intends that the student drug testing pilot program
    be funded at a level of at least $10,000,000.

    Alcohol abuse reduction

        The bill does not include funding for grants to reduce
    alcohol abuse, the same as the budget request and $32,736,000
    below the fiscal year 2005 level. This program awards
    competitive grants to districts to develop and implement
    innovative and effective programs to reduce alcohol abuse in
    secondary schools.

    Mentoring programs

        The bill includes $49,307,000 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 the same as the budget request
    and the fiscal year 2005 level.

    Character education

        The bill includes $24,493,000 for character education, the
    same as the fiscal year 2005 level and the budget request. This
    program provides support for the design and implementation of
    character education programs in elementary and secondary
    schools. Grantees may select the elements of character that
    will be taught, and must consider the views of parents and
    students to be served by the program.

    Elementary and secondary school counseling

        The bill includes $34,720,000 for elementary and secondary
    school counseling, the same as the fiscal year 2005 level. The
    budget did not propose funding for this program. This program
    provides grants to school districts to enable them to establish
    or expand elementary school and secondary school counseling
    programs.

    Physical education for progress

        The bill includes $73,408,000 for the physical education
    for progress program, $18,408,000 above the budget request and
    the same as the fiscal year 2005 level. The Committee expects
    that funds will be used to develop programs that can provide
    information to states, school districts and other youth
    organizations on the most effective methods for encouraging all
    students--not simply those who are already participating in
    competitive sports--to develop positive attitudes about fitness
    and increased levels of personal fitness.

    Civic education

        The bill includes $29,405,000 for civic education, the same
    as the fiscal year 2005 level. The budget did not propose
    funding for this program. 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 $26,784,000 below the fiscal year 2005 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 $675,765,000 for English language
    acquisition programs. This amount is the same as the budget
    request and the comparable fiscal year 2005 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 $11,813,783,000 for programs for children
    with disabilities authorized under the Individuals with
    Disabilities Education Act (IDEA). This funding level is
    $312,347,000 below the budget request and $140,177,000 above
    the comparable fiscal year 2005 appropriation.

    State Grants: Grants to States for special education

        The bill provides $10,739,746,000 for grants to States,
    $358,000,000 below the budget request and $150,000,000 above
    the fiscal year 2005 level. Out of the total made available for
    school year 2006-2007, $5,326,746,000 is appropriated for
    fiscal year 2006 for obligation after July 1, 2006 and
    $5,413,000,000 is appropriated for fiscal year 2007 for
    obligation on, or after, October 1, 2006.
        This program provides formula grants to assist the States
    in meeting the excess costs of providing special education and
    related services to children with disabilities. In order to be
    eligible for funds, States must make free appropriate public
    education available to all children with disabilities. Funds
    are distributed based on the amount that each State received
    from the fiscal year 1999 appropriation, and the numbers of
    children in the general population and who live in poverty in
    the age range for which each State mandates free appropriate
    public education for children with disabilities.

    State grants: Preschool grants

        The bill provides $384,597,000 for preschool grants, the
    same as the fiscal year 2005 level and the budget request. This
    program provides grants to States on the basis of their
    proportionate share of the total number of children in the 3
    through 5 age range and the number of these children living in
    poverty. These funds are provided in order to assist States to
    make a free appropriate public education available to all
    children with disabilities in the 3 through 5 age range.

    State Grants: Grants for infants and families

        The bill provides $440,808,000 for grants for infants and
    families, the same as the fiscal year 2005 level and 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 $50,653,000 for State improvement, the
    same as the fiscal year 2005 appropriation. The budget did not
    request funding for this program. 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.

    Special Education--Vocational Rehabilitation Transition Initiative

        The bill does not include funding for a new program
    proposed by the Administration to develop systems for using
    data on secondary, employment and postsecondary school outcomes
    for students with disabilities. The Administration requested
    $5,000,000 for this initiative.

    IDEA National Activities: Technical assistance and dissemination

        The bill includes $49,397,000 for technical assistance and
    dissemination, the same as the budget request and $2,999,000
    below the fiscal year 2005 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 $90,626,000 for personnel preparation,
    which is the same as the budget request and the fiscal year
    2005 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 $25,964,000 for parent information
    centers, the same as the fiscal year 2005 level and the budget
    request. This program makes awards to parent organizations to
    support parent training and information centers, including
    community parent resource centers. These centers provide
    training and information to meet the needs of parents of
    children with disabilities living in the areas served by the
    centers, particularly underserved parents and parents of
    children who may be inappropriately identified. Technical
    assistance is also provided under this program for developing,
    assisting and coordinating centers receiving assistance under
    this program.

    IDEA National Activities: Technology and media services

        The bill includes $31,992,000 for technology and media
    services, which is $6,824,000 below the fiscal year 2005
    appropriation and the same as the budget request. This program
    makes competitive awards to support the development,
    demonstration, and use of technology and educational media
    activities of educational value to children with disabilities.
        The bill includes $11,400,000 for Recording for the Blind
    and Dyslexic Inc. These funds support continued production and
    circulation of recorded textbooks, increased outreach
    activities to print-disabled students and their teachers and
    accelerated use of digital technology. The Committee believes
    that the funds recommended will enable RFB&D to significantly
    expand its service to students with print disabilities and to
    continue the digital production and use of its extensive
    library of educational materials.
        The Committee continues to recognize the importance of very
    small businesses in increasing the quality and cost
    effectiveness of the television-captioning program. As this
    program transitions into a mandated program as authorized by
    the Telecommunications Act, the Department shall give full and
    fair consideration to the applications for very small
    businesses.

                REHABILITATION SERVICES AND DISABILITY RESEARCH

        The bill includes $3,128,638,000 for rehabilitation
    services and disability research. This amount is $69,340,000
    above the budget request and $54,064,000 above the fiscal year
    2005 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 $2,720,192,000, the same as the budget request and
    $84,347,000 above fiscal year 2005. This program supports basic
    vocational rehabilitation services through formula grants to
    the States. These grants support a wide range of services
    designed to help persons with physical and mental disabilities
    prepare for and engage in gainful employment to the extent of
    their capabilities. Emphasis is placed on providing vocational
    rehabilitation services to persons with the most significant
    disabilities.

    Client assistance

        The bill includes $11,901,000 for the client assistance
    program, the same as the budget request and the fiscal year
    2005 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 $38,826,000,
    the same as the budget request and the fiscal year 2005 amount.
    The program supports long-term and short-term training, in-
    service personnel training, and training of interpreters for
    deaf persons. Projects in a broad array of disciplines are
    funded to ensure that skilled personnel are available to serve
    the vocational needs of persons with disabilities.

    Demonstration and training programs

        The bill includes $6,577,000 for demonstration and training
    programs, the same as the budget request and $19,030,000 below
    the fiscal year 2005 level. These programs authorize
    discretionary awards on a competitive basis to public and
    private organizations to support demonstrations, direct
    services, and related activities for persons with disabilities.

    Migrant and seasonal farmworkers

        For programs serving migrant and seasonal farmworkers, the
    bill provides $2,302,000, which is the same as the fiscal year
    2005 amount and $2,302,000 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 $2,543,000,
    the same as the fiscal year 2005 amount and $2,543,000 above
    the budget request. This program provides individuals with
    recreation and related activities to aid in their employment,
    mobility, independence, socialization, and community
    integration. Discretionary grants are made on a competitive
    basis to States, public agencies, and nonprofit private
    organizations, including institutions of higher education.

    Protection and advocacy of individual rights

        For protection and advocacy for persons with disabilities,
    the bill provides $16,656,000, the same as the budget request
    and the fiscal year 2005 level. Grants are awarded to entities
    that have the authority to pursue legal, administrative, and
    other appropriate remedies needed to protect and advocate the
    rights of persons with disabilities.
        The Committee notes that returning military personnel who
    have sustained disabilities in the course of active service
    often encounter barriers that impede their ability to reenter
    civilian life. The Committee further notes that families of
    active duty service members that include children and other
    members with disabilities face many stresses and need
    assistance with accessing appropriate educational as well as
    health and other support services, such as respite care. The
    Committee urges the Secretary to provide outreach and advocacy
    services that supplement services and supports provided by the
    Veteran's Administration and other veteran and military family
    organizations.

    Projects with industry

        For projects with industry, the bill provides $19,735,000,
    $1,890,000 below the fiscal year 2005 amount and $19,735,000
    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
    $30,000,000, which is $7,379,000 below the fiscal year 2005
    amount and $30,000,000 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
    $22,816,000. This amount is the same as the budget request and
    the fiscal year 2005 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
    $75,392,000, which is the same as the budget request and the
    fiscal year 2005 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 $33,227,000. This amount is the
    same as the fiscal year 2005 amount and the budget request.
    Discretionary grants support services for persons 55 years old
    or over whose severe visual impairment makes gainful employment
    extremely difficult to obtain, but for whom independent living
    goals are feasible.

    Program improvement

        For program improvement activities, the bill provides
    $843,000, which is the same as the fiscal year 2005 level and
    the same as the budget request. The program: (1) provides
    technical assistance and consultative services to public and
    non-profit private agencies and organizations; (2) provides
    short-term training and technical instruction; (3) conducts
    special demonstrations; (4) collects, prepares, publishes and
    disseminates educational or informational materials; and (5)
    carries out monitoring and conducts evaluations.

    Evaluation

        The bill includes $1,488,000 for program evaluation, the
    same as the budget request and the fiscal year 2005 level.
    These funds are used to evaluate the impact and effectiveness
    of individual programs authorized under the Rehabilitation Act.
    Contracts are awarded on an annual basis for studies to be
    conducted by persons not immediately involved in the
    administration of the programs authorized by the Act.

    Helen Keller National Center

        For the Helen Keller National Center for Deaf-Blind Youth
    and Adults, the bill includes $8,597,000, $1,984,000 below the
    comparable fiscal year 2005 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 and technical
    assistance.

    National Institute on Disability and Rehabilitation Research

        The bill includes $107,783,000 for the National Institute
    on Disability and Rehabilitation Research, the same as the
    budget request and the fiscal year 2005 level. The Institute
    supports research, demonstration and training activities that
    are designed to maximize the employment and integration into
    society of individuals with disabilities of all ages.

    Assistive technology

        For assistive technology activities, the bill provides
    $29,760,000, the same as the fiscal year 2005 amount and
    $14,760,000 above the budget request. Technology assistance
    activities are authorized under the Assistive Technology Act of
    1998. This Act authorizes the following activities:
    discretionary grants to the States to assist them in developing
    statewide programs to facilitate the provision of devices for,
    and services to, persons with disabilities; protection and
    advocacy services related to assistive technology;
    discretionary grants to the states for alternative financing
    programs; and technical assistance activities.

               Special Institutions for Persons With Disabilities

                     AMERICAN PRINTING HOUSE FOR THE BLIND

        The bill provides $17,000,000 for the American Printing
    House for the Blind, an increase of $136,000 above the fiscal
    year 2005 appropriation and the budget request. This
    appropriation subsidizes the production of educational
    materials for legally blind persons enrolled in pre-college
    programs. The Printing House, which is chartered by the State
    of Kentucky, manufactures and maintains an inventory of special
    materials that is distributed free of charge to schools and
    States based on the number of blind students in each State. The
    Printing House also conducts research and field activities to
    inform educators about the availability of materials and how to
    use them.

                   NATIONAL TECHNICAL INSTITUTE FOR THE DEAF

        The bill provides $56,137,000 for the National Technical
    Institute for the Deaf (NTID), an increase of $793,000 above
    the comparable fiscal year 2005 amount and $1,665,000 above the
    request. Within the total, $800,000 is specified for
    construction. The NTID was established by Congress in 1965 to
    provide a residential facility for postsecondary technical
    training and education for deaf persons with the purpose of
    promoting the employment of deaf individuals. The Institute
    also conducts applied research and provides training in various
    aspects of deafness. The Secretary of Education administers
    these activities through a contract with the Rochester
    Institute of Technology in Rochester, New York.

                              GALLAUDET UNIVERSITY

        The bill provides $107,657,000 for Gallaudet University, an
    increase of $3,100,000 above the fiscal year 2005 appropriation
    and the budget request. Gallaudet is a private, non-profit
    educational institution Federally-chartered in 1864 providing
    elementary, secondary, undergraduate, and continuing education
    for deaf persons. In addition, the University offers graduate
    programs in fields related to deafness for deaf and hearing
    students, conducts various research on deafness, and provides
    public service programs for deaf persons.

                         VOCATIONAL AND ADULT EDUCATION

        The bill includes $1,991,782,000 for vocational and adult
    education programs. This amount is $19,166,000 below the fiscal
    year 2005 appropriation and $1,776,048,000 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 $1,194,331,000 for basic grants to
    States under the Carl D. Perkins Vocational and Technical
    Education Act of 1998, which is the same as the fiscal year
    2005 amount. The budget request proposed elimination of this
    program and moved the funds into the high school reform
    proposal. Out of the total for basic grants to States made
    available for school year 2004-2005, $403,331,000 is
    appropriated for fiscal year 2006 for obligation after July 1,
    2006 and $791,000,000 is appropriated for fiscal year 2007 for
    obligation on, or after, October 1, 2006.
        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.
        The Committee is concerned with instances where State
    agencies are not adequately communicating about the needs and
    supports for students with disabilities, especially those
    student with disabilities who participate in vocational and
    technical education curriculums housed either on-site at the
    local education agency (LEA) or at a career and technology
    center (CTC) apart from the LEA. State Educational Agencies
    have an obligation under the Individuals with Disabilities
    Education Act to ensure that all students with disabilities
    receive a free appropriate public education in the least
    restrictive environment. The Committee strongly encourages
    States to improve collaboration between State agencies and
    programs to ensure that appropriate resources are provided to
    ensure that all students are able to participate appropriately
    in vocational and technical education programs.

    Tech-prep

        The bill includes $105,812,000 for tech-prep, the same as
    fiscal year 2005. 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 $11,757,000,
    which is the same as the fiscal year 2005 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
    $4,899,000. 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
    $9,307,000. 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 $569,672,000,
    which is the same as the fiscal year 2005 amount, and
    $369,672,000 above 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 $9,096,000 for national leadership
    activities. This amount is the same as the fiscal year 2005
    level and the budget request. Through applied research,
    development, dissemination, evaluation, and program improvement
    activities, this program assists State efforts to improve the
    quality of adult education. The funds support such projects as
    evaluations on the status and effectiveness of adult education
    programs, national and international adult literacy surveys,
    and technical assistance on using technology to improve
    instruction and administration that show promise of
    contributing to the improvement and expansion of adult
    education.

    National Institute for Literacy

        For the National Institute for Literacy, the bill provides
    $6,638,000, which is the same as the fiscal year 2005 amount
    and the budget request. The Institute supports research and
    development projects, tracks progress made toward national
    literacy goals, supports research fellowships, disseminates
    information through a national clearinghouse, and coordinates
    literacy information data from national and State sources.

    Smaller learning communities

        The bill includes $94,476,000 for the smaller learning
    program, the same as the fiscal year 2005 level. The
    Administration did not request funding for this program. As in
    past years, the bill specifies that these funds shall be used
    only for activities related to the redesign of large high
    schools enrolling 1,000 or more students.

    Community technology centers

        The bill does not include funding for community technology
    centers, $4,960,000 below the fiscal year 2005 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 $15,283,752,000 for student financial
    assistance programs, an increase of $1,018,003,000 over the
    comparable fiscal year 2005 appropriation and $232,775,000
    above the budget request.

    Pell grants

        The bill increases the maximum Pell Grant to $4,100, $50
    below the budget request and $50 above the fiscal year 2005
    amount. The bill provides $13,383,000,000 in new budget
    authority for the Pell Grant program, $184,000,000 above the
    request and $1,018,003,000 above the comparable fiscal year
    2005 amount. Pell Grants provide portable education vouchers to
    postsecondary students who may use them at any of over 6,000
    eligible schools. The bill does not include funding for
    enhanced Pell grants for state scholars, which the
    administration requested at $33,000,000. The Committee notes
    that this program has not been authorized.

    Federal Supplemental Educational Opportunity Grants

        The bill provides $778,720,000 for federal supplemental
    educational opportunity grants, the same as the request and the
    fiscal year 2005 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 $990,257,000 for the work-study program,
    the same as the comparable fiscal year 2005 appropriation and
    the budget request. Funding for this program is provided
    through institutions to students who work part-time to meet the
    cost of education. Institutions receive funding according to a
    statutory formula and may allocate it for job location and job
    development centers.

    Perkins loans cancellations

        The bill provides $66,132,000 for federal Perkins loans
    cancellations, $66,132,000 above the budget request and the
    same as the fiscal year 2005 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 $65,643,000 for the leveraging
    educational assistance partnership (LEAP) program, the same as
    the fiscal year 2005 level and $65,643,000 above the budget
    request. LEAP provides dollar-for-dollar matching funds to
    States as an incentive for providing need-based grant and work
    study assistance to eligible postsecondary students. Federally
    supported grants and job earnings are limited to $5,000 per
    award year for full-time students. By law, each State's
    allocation is based on its relative share of the total national
    population of students eligible to participate in the programs,
    except that no state is to receive less than it received in
    1979. If LEAP amounts are below this level, each State is
    allocated an amount proportional to the amount of funds it
    received in 1979. If a state does not use all of its
    allocation, the excess funds are distributed to other States in
    the same proportion as the original distribution. States must,
    at a minimum, match LEAP grants dollar for dollar with state
    funds provided through direct state appropriations for this
    purpose.

                           STUDENT AID ADMINISTRATION

        The bill includes $124,084,000 in discretionary resources
    for the Student Aid Administration account. The Committee
    recommendation is $5,000,000 more than the comparable fiscal
    year 2005 funding level and $20,201,000 below the request, when
    adjusted for discretionary-scored spending. Funds appropriated
    to the Student Aid Administration account, in addition to
    mandatory funding available through Section 458 of the Higher
    Education Act, will support the Department's student aid
    management expenses. The Federal Student Aid Office and the
    Office of Postsecondary Education have primary responsibility
    for administering Federal student financial assistance
    programs. The Committee bill does not include the
    Administration's legislative proposal to fund this new account
    solely through annual appropriations.

                         LOANS FOR SHORT-TERM TRAINING

        The bill does not include a new program to provide loans
    for short-term training proposed for funding by the
    Administration at $11,000,000. This program would help
    dislocated, unemployed, transitioning or older workers and
    students acquire or upgrade specific job-related skills through
    short-term training programs of less than 10 weeks. The
    Committee notes that this program is not authorized.

                                HIGHER EDUCATION

        The bill provides $1,936,936,000 for higher education
    programs, a decrease of $179,762,000 below the fiscal year 2005
    appropriation and $734,621,000 above the budget request.

    Strengthening institutions

        The bill provides $80,338,000 for the regular strengthening
    institutions program, the same as the budget request and the
    fiscal year 2005 level. This program provides general operating
    subsidies to institutions with low average educational and
    general expenditures per student and significant percentages of
    low-income students. Awards may be used for faculty and
    academic program development, management, joint use of
    libraries and laboratories, acquisition of equipment, and
    student services.

    Hispanic-serving institutions

        The bill provides $95,873,000 for the Hispanic-serving
    institutions program, the same as the budget request and
    $767,000 above the fiscal year 2005 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.
        Despite the gains by Hispanics in higher education,
    including a 300 percent increase over the past 25 years in the
    enrollment of Hispanic-Americans at degree-granting
    institutions of higher education, the Committee is concerned
    that Hispanics continue to lag behind their non-Hispanic peers
    in overall education achievement. In 2001, only 21.7 percent of
    all Hispanics in the age group 18-24 years were enrolled in
    degree-granting institutions, versus 39.3 percent of all non-
    Hispanic white students. In 2001-2002, Hispanics earned only
    6.4 percent of the bachelor's degrees, 4.6 percent of the
    master's degrees, and 3.2 percent of the PhDs awarded in the
    U.S. despite the fact that Hispanics comprise over 13 percent
    of the population. The Committee supports legislative efforts
    in the reauthorization of the Higher Education Act to expand
    graduate opportunities for Hispanic-serving institutions and
    encourages the Department to submit a budget request for
    graduate programs for HSIs in the event that such a program
    expanding graduate opportunities is authorized.

    Strengthening historically black colleges and universities

        The bill provides $240,500,000 for strengthening
    historically black colleges and universities (HBCUs),
    $1,924,000 above the fiscal year 2005 appropriation and the
    same as the budget request.
        This program provides operating subsidies to accredited,
    legally authorized HBCUs established prior to 1964 whose
    principal mission is the education of black Americans. Funds
    may be used to support both programs and management and are
    distributed through a formula grant based on the enrollment of
    Pell Grant recipients, number of graduates, and the number of
    graduates entering graduate or professional schools in which
    blacks are underrepresented. The minimum grant is $500,000.

    Strengthening historically black graduate institutions

        The bill provides $58,500,000 for the strengthening
    historically black graduate institutions program, the same as
    the budget request and $468,000 above the fiscal year 2005
    appropriation.
        The program provides 5-year grants to the following 18
    post-secondary institutions that are specified in section
    326(e)(1) of the Higher Education Act: Morehouse School of
    Medicine, Meharry Medical School, Charles R. Drew Postgraduate
    Medical School, Clark-Atlanta University, Tuskegee University
    School of Veterinary Medicine, Xavier University School of
    Pharmacy, Southern University School of Law, Texas Southern
    University Schools of Law and Pharmacy, Florida A&M University
    School of Pharmaceutical Sciences, North Carolina Central
    University School of Law, Morgan State University qualified
    graduate program, Hampton University qualified graduate
    program, Alabama A&M qualified graduate program, North Carolina
    A&T State University qualified graduate program, University of
    Maryland Eastern Shore qualified graduate program, Jackson
    State qualified graduate program, Norfolk State University and
    Tennessee State University. Of the amount appropriated, the
    first $26,600,000 is used to make grants to the first 16
    institutions listed above. Any amount appropriated in excess of
    $26,600,000 but less than $28,600,000 is used to make grants to
    Norfolk State University and Tennessee State University and any
    remaining appropriation is made available to each of the 18
    institutions based on a formula. Awards may be used for
    building endowments as well as the same purposes for which the
    strengthening HBCU grants may be used.

    Strengthening Alaska Native and Native Hawaiian-serving institutions

        The Committee recommends $6,500,000 for strengthening
    Alaska Native and Native Hawaiian-serving institutions,
    $5,404,000 below the fiscal year 2005 level and the same as the
    budget request.

    Strengthening tribally controlled colleges and universities

        The Committee recommends $23,808,000 for the strengthening
    tribally controlled colleges and universities program, the same
    as the budget request and the fiscal year 2005 level.

    International education and foreign languages studies

                Domestic programs
        The bill provides $92,466,000 for the domestic activities
    of the international education and foreign languages studies
    programs, the same as the fiscal year 2005 appropriation and
    the budget request. The program assists graduate and
    undergraduate foreign language and area studies programs and
    students at institutions of postsecondary education. Programs
    include national resource centers, foreign language and area
    studies fellowships, undergraduate international studies and
    foreign language programs, international research and studies
    projects, business and international education projects,
    international business education centers, language resource
    centers, American overseas research centers, and technological
    innovation and cooperation for foreign information access. In
    general, the Secretary has discretion to allocate funding among
    these various activities.
                Overseas programs
        The bill provides $12,737,000 for the overseas programs in
    international education and foreign language studies authorized
    under the Mutual Educational and Cultural Exchange Act of 1961,
    popularly known as the Fulbright-Hays Act. The appropriation is
    the same as the budget request and the fiscal year 2005
    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 $1,616,000 for the Institute for
    International Public Policy, the same as the budget request and
    the fiscal year 2005 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 $49,211,000 for the fund for the
    improvement of postsecondary education (FIPSE), $27,000,000
    above the budget request and $112,897,000 below the fiscal year
    2005 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 $8,818,000 for the minority science and
    engineering improvement program (MSEIP), the same as the fiscal
    year 2005 appropriation and the budget request.
        The MSEIP program awards grants to improve mathematics,
    science, and engineering programs at institutions serving
    primarily minority students and to increase the number of
    minority students who pursue advanced degrees and careers in
    those fields.

    Interest subsidy grants

        The bill does not include funding for interest subsidy
    grants authorized under section 121 of the Higher Education
    Act, the same amount requested in the budget and $1,488,000
    below the fiscal year 2005 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.

    Tribally controlled postsecondary vocational and technical institutions

        The bill includes $7,440,000 for grants for tribally
    controlled postsecondary vocational and technical institutions,
    the same as the budget request and the fiscal year 2005 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 $836,543,000 for the TRIO programs,
    $467,153,000 above the budget request and the same as the
    fiscal year 2005 appropriation. The TRIO programs provide a
    variety of outreach and support services to encourage low-
    income, potential first-generation college students to enter
    and complete college. Discretionary grants of up to four or
    five years are awarded competitively to institutions of higher
    education and other agencies. At least two-thirds of the
    eligible participants in TRIO must be low-income, first-
    generation college students.

    GEAR UP

        The bill includes $306,488,000 for the GEAR UP program, the
    same as last year's level and $306,488,000 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 does not include funding for the Byrd scholarships
    program, the same as the budget request and $40,672,000 below
    the fiscal year 2005 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 $9,797,000 for the Javits
    fellowship program, the same as the budget request and the
    fiscal year 2005 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 $30,371,000 for the graduate
    assistance in areas of national need (GAANN) program, the same
    as the budget request and the fiscal year 2005 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 $58,000,000 for teacher quality
    enhancement grants, $58,000,000 above the budget request and
    $10,337,000 below the fiscal year 2005 appropriation. Teacher
    quality enhancement grants have three components: state grants,
    partnership grants and recruitment grants. By statute, state
    and partnership grants each receive 45 percent of the
    appropriation, and recruitment grants receive 10 percent.
        Under the state grant component, states apply to receive up
    to three years of funding to improve the quality of their
    teaching force through promoting reform activities such as
    teacher licensing and certification, accountability for high
    quality teacher preparation and professional development and
    recruiting teachers for high-need schools. States must match 50
    percent of the federal award.
        Under the partnership component, partnerships apply to
    receive a five-year grant to strengthen the capacity of K-12
    educators in designing and implementing effective teacher
    education programs, and by increasing collaboration among these
    practitioners and departments of arts and sciences and schools
    of education at institutions of higher education. Partnerships
    must match 25 percent of the federal grant in the first year,
    35 percent in the second year, and 50 percent for the remaining
    years.
        The recruitment component supports the efforts to reduce
    shortages of qualified teachers in high-need school districts.
    States or partnerships may apply to receive these grants.
        The Committee believes that colleges of education play a
    key role in improving teacher quality. The Committee urges
    colleges receiving teacher quality enhancement grants to
    consider the recommendations made by the Teaching Commission,
    including recruiting stronger students from all major fields of
    study, requiring education majors to receive at least a minor
    in an academic subject in addition to education, using
    research-based practices and pedagogy and offering
    opportunities to learn and observe in a real world setting.

    Child care access means parents in school

        The Committee recommends $15,970,000 for child care access
    means parents in school program, the same as the budget request
    and the fiscal year 2005 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.

    Community college access

        The bill does not include funding for a proposed community
    college access program, which was requested by the
    Administration at $125,000,000. This program would support
    competitive awards to States providing dual-enrollment programs
    through which high school students take college-level courses
    through community colleges and receive both high school and
    postsecondary credit. The Committee notes that this program has
    not been authorized.

    Demonstration projects to ensure quality higher education for students
            with disabilities

        The Committee does not recommend funding for demonstration
    projects in disabilities, the same as the budget request. The
    program was funded at $6,944,000 in fiscal year 2005.
        This program provides discretionary grants for three years
    to support model demonstration projects that provide technical
    assistance and professional development activities for faculty
    and administrators in institutions of higher education in order
    to provide students with disabilities a high-quality
    postsecondary education. A number of models have now been
    developed and are being disseminated to other institutions.

    Underground railroad program

        The Committee does not recommend funding for the
    underground railroad program, which is the same as the budget
    request. This program was funded at $2,204,000 in fiscal year
    2005. 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 $980,000 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 2005 appropriation and the budget request.
        The Committee understands that for many higher education
    programs, baseline and performance indicator data are sparse,
    nonexistent or difficult to collect. Funding under this
    activity will support the Department in developing high-quality
    data as required under the Government Performance and Results
    Act.

    Olympic Scholarships

        The bill includes $980,000 for Olympic Scholarships, the
    same as the fiscal year 2005 level. The budget did not request
    funding for this program. This program provides financial
    assistance to athletes who are training at the U.S. Olympic
    Education Center or one of the U.S. Olympic Training Centers
    and who are pursuing a postsecondary education at an
    institution of higher education.

    Thurgood Marshall legal education opportunity program

        The bill does not include funding for the Thurgood Marshall
    legal education opportunity program, the same as the budget
    request. The program was funded at $2,976,000 in fiscal year
    2005. This program provides low-income, minority and
    disadvantaged college students with the information,
    preparation and financial assistance needed to gain access to
    and complete law school study.

                               HOWARD UNIVERSITY

        The bill provides $240,790,000 for Howard University,
    $2,000,000 above the budget request and the fiscal year 2005
    appropriation. The bill includes a minimum of $3,524,000 for
    the endowment, which is the same as the current level.
        Howard University is a ``Research I'' university located in
    the District of Columbia. Direct appropriations for Howard
    University are authorized by 20 U.S.C. 123, originally enacted
    in 1867. Howard University provides undergraduate liberal arts,
    graduate and professional instruction to approximately 11,000
    students from all 50 States. Masters degrees are offered in
    over 55 fields and Doctor of Philosophy degrees in 26 fields.

             COLLEGE HOUSING AND ACADEMIC FACILITIES LOANS PROGRAM

        The bill provides $573,000 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 the fiscal year 2005 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, the same as the fiscal year 2005 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 $522,696,000 for the Institute of
    Education Sciences. This amount is $43,632,000 above the budget
    request, and $538,000 below the fiscal year 2005 level. This
    account supports education research, statistics, and assessment
    activities.

    Research

        This bill includes $164,194,000 for educational research,
    the same as the fiscal year 2005 level and the budget request.
    The Institute of Education Sciences supports research,
    development and national dissemination activities that are
    aimed at expanding fundamental knowledge of education and
    promoting the use of research and development findings in the
    design of efforts to improve education.

    Statistics

        This bill includes $90,931,000 for the activities of the
    National Center for Education Statistics, exclusive of the
    National Assessment of Educational Progress. This amount is the
    same as the budget request and the fiscal year 2005 level.
        Statistics activities are authorized under the Education
    Sciences Reform Act of 2002, title I of P.L. 107-279. The
    Center collects, analyzes, and reports statistics on all levels
    of education in the United States. Activities are carried out
    directly and through grants and contracts. Major publications
    include ``The Condition of Education'' and ``Digest of
    Education Statistics.'' Other products include projections of
    enrollments, teacher supply and demand, and educational
    expenditures. Technical assistance to state and local education
    agencies and postsecondary institutions is provided.
    International comparisons are authorized.

    Regional educational laboratories

        The Committee has included $66,132,000 for the regional
    educational laboratories. This amount is the same as the fiscal
    year 2005 level. The budget request did not include funding for
    this program. The Committee believes that the regional
    educational laboratories can play a key role in supporting the
    achievement of all children by focusing and aligning their work
    to help states and education practitioners implement the
    requirements contained in the No Child Left Behind Act (NCLB).
    This assistance should include product development, applied
    research, technical assistance and professional development.
    The Committee intends that each regional educational laboratory
    identify priority NCLB issues in their designated region and
    provide assistance with the implementation of NCLB. Particular
    focus should be placed on helping states and schools implement
    the provisions contained in the Highly Qualified Teacher
    regulations.

    IDEA National Activities: Research and innovation

        The bill includes $72,566,000 for research and innovation,
    $10,538,000 below the fiscal year 2005 level and the same as
    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.

    Special education studies and evaluations

        The bill includes $10,000,000 for special education studies
    and evaluations, the same as the budget request and $6,000,000
    below the comparable fiscal year 2005 level. This program
    awards competitive grants, contracts and cooperative agreements
    to assess the implementation of the Individuals with
    Disabilities Education Act and the effectiveness of State and
    local efforts to provide special education and early
    intervention programs and services to infants, toddlers, and
    children with disabilities. Funding for this activity was
    previously supported through funds set aside under the special
    education grants to states program.

    Statewide data systems

        The bill includes $24,800,000 for statewide data systems
    development, the same as the budget request and the fiscal year
    2005 level. This program awards grants, on a competitive basis,
    to State educational agencies to enable such agencies to
    design, develop, and implement statewide, longitudinal data
    systems to efficiently and accurately manage, analyze,
    disaggregate, and use individual student data, consistent with
    the No Child Left Behind Act.
        The Committee supports the design, development and
    implementation of longitudinal data systems that will enable
    States to use data to close achievement gaps. The Committee
    notes that much of this data is already being collected and is
    available for free on various websites, such as
    www.schoolmatters.com, and the Committee encourages the
    Department, states, school districts, researchers and the
    public to make use of available data to improve education and
    management of taxpayer resources.

    Assessment

        This bill includes $94,073,000 for the National Assessment
    of Educational Progress, $22,500,000 below the budget request,
    and the same as the fiscal year 2005 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, $5,088,000 is for the
    National Assessment Governing Board.
        The Committee is concerned that a key purpose of public
    education is being neglected: the civic mission of schools to
    educate our young people for democracy and to prepare them to
    be engaged citizens. The National Assessments of Educational
    Progress in civics and history are the best way we have to
    measure how well schools are doing in fulfilling this purpose.
    Therefore, the Committee requests that the National Assessment
    Governing Board, in consultation with the Commissioner,
    National Center for Education Statistics, prepare a report on
    the feasibility of the National Assessment of Educational
    Progress conducting state level assessments in the subjects of
    U.S. history and civics at grades 8 and 12 and, if feasible,
    the earliest schedule under which such assessments could be
    administered. The Governing Board shall, within 180 days of
    enactment of the FY 2006 appropriation, submit the feasibility
    report to the House and Senate Appropriations Committees, the
    House Education and the Workforce Committee, the Senate Health,
    Education, Labor and Pensions Committee, and the Secretary of
    Education.

                            DEPARTMENTAL MANAGEMENT

        The bill includes $559,518,000 for departmental management
    (salaries and expenses) at the Department of Education. This
    amount is $3,536,000 above the fiscal year 2005 appropriation
    and $408,000 below the budget request. These activities are
    authorized by the Department of Education Organization Act,
    P.L. 96-88, and include costs associated with the management
    and operations of the Department as well as separate costs
    associated with the Office for Civil Rights and the Office of
    the Inspector General.
        The Committee continues to be pleased with the emphasis the
    Department's senior management team has placed on complying
    with the Government Performance and Results Act. The Committee
    expects the Department to continue to develop and refine GPRA
    measures for all programs, focusing particularly on student
    achievement outcomes.
        The Committee urges the Department of Education to fully
    investigate whether Xavier University of Louisiana is entitled
    to approximately $1,142,465 as a result of errors by the
    Department of Education with respect to Federal Cash
    Transaction Reports (ED-PMS-272) and the Grant Administrative
    and Payment System (GAPS) from the period of March 31, 1987
    through June 30, 2002. If the results of an investigation
    determine that such errors were made by the Department of
    Education, the Committee urges the Department of Education to
    reimburse all funds owed to Xavier University as a result of
    such errors.

    Program administration

        The bill includes $418,992,000 for program administration.
    This amount is $288,000 below the fiscal year 2005
    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.
        The Committee recognizes the invaluable role that the
    Communities Can program has served over the last five years and
    the important financial support for this endeavor arranged by
    the Federal Interagency Coordinating Council (FICC) through the
    Departments of Education and of Health and Human Services,
    among others. Communities Can efforts have proven valuable in
    ensuring the integration into their communities of children and
    youth with disabilities and their families by promoting models
    of coordinated services that have ensured effective utilization
    of scarce resources. The models have generated support from the
    private sector, including faith-based organizations, which has
    amplified the impact of public resources. In light of the
    dissolution of the FICC, the Committee is concerned that
    Communities Can be able to continue its work in promoting
    effective models of coordinated services for this population.
    Therefore, the Committee requests the Office of Special
    Education and Rehabilitative Services to provide it a plan of
    action for carrying forward this activity in the absence of the
    FICC.
        The Committee is aware that the Department of Education is
    taking steps to restructure the Rehabilitation Services
    Administration's system for providing oversight and monitoring
    of the Vocational Rehabilitation program. The Committee is
    interested in ensuring that the Department have a replacement
    system and plan in place for accountability, monitoring and
    technical assistance of these programs prior to the dismantling
    of the current system. The Committee directs the Department to
    develop such a plan and discuss such a plan with state
    vocational Rehabilitation agencies and stakeholders in advance
    of further staffing reductions.

    Office for Civil Rights

        The bill includes $91,526,000 for the salaries and expenses
    of the Office for Civil Rights. This amount is $2,151,000 above
    the fiscal year 2005 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 $49,000,000 for the Office of the
    Inspector General. This amount is $1,673,000 above the fiscal
    year 2005 appropriation and $408,000 below the budget request.
    This Office has authority to inquire into all program and
    administrative activities of the Department as well as into
    related activities of grant and contract recipients. It
    conducts audits and investigations to determine compliance with
    applicable laws and regulations, to check alleged fraud and
    abuse, efficiency of operations, and effectiveness of results.

                               General Provisions

        Sec. 301. The Committee continues a provision which
    prohibits funds under this Act from being used for the
    transportation of students or teachers in order to overcome
    racial imbalances or to carry out a plan of racial
    desegregation.
        Sec. 302. The Committee continues a provision which
    prohibits funds under this Act from being used to require the
    transportation of any student to a school other than the school
    which is nearest the student's home in order to comply with
    title VI of the Civil Rights Act of 1964.
        Sec. 303. The Committee continues a provision which
    prohibits funds under this Act from being used to prevent the
    implementation of programs of voluntary prayer and meditation
    in public schools.
        Sec. 304. The Committee continues a provision which allows
    up to 1 percent of any discretionary funds appropriated for the
    Department of Education to be transferred between
    appropriations accounts, provided that no appropriation is
    increased by more than 3 percent by any such transfer. This
    provision requires the Secretary to notify the Appropriations
    Committees of both Houses of Congress at least 15 days in
    advance of a transfer.
        Sec. 305. The Committee includes a provision, pursuant to
    section 303 of H. Con. Res. 95, the concurrent resolution on
    the budget for fiscal year 2006, which provides $4,300,000,000
    for the purpose of eliminating the estimated Pell grant
    shortfall.

                           TITLE IV--RELATED AGENCIES

     Committee for Purchase From People Who Are Blind or Severely Disabled

        The bill provides $4,669,000 for the Committee for Purchase
    From People Who Are Blind or Severely Disabled, the same as the
    comparable fiscal year 2005 appropriation and the budget
    request.
        The Committee for Purchase From People Who Are Blind or
    Severely Disabled was established by the Wagner-O'Day Act of
    1938 as amended. Its primary objective is to increase the
    employment opportunities for people who are blind or have other
    severe disabilities and, whenever possible, to prepare them to
    engage in competitive employment.

                 Corporation for National and Community Service

        The Corporation for National and Community Service was
    established by the National and Community Service Trust Act of
    1993 to enhance opportunities for national and community
    service and provide national service educational awards. The
    Corporation makes grants to States, institutions of higher
    education, public and private nonprofit organizations, and
    others to create service opportunities for a wide variety of
    individuals through full-time national and community service
    programs. The Committee requests that the Chief Executive
    Officer of the Corporation be prepared to discuss the economic
    impact of its programs at the fiscal year 2007 appropriations
    hearing.

                      DOMESTIC VOLUNTEER SERVICE PROGRAMS

        The Committee recommends $357,962,000 for the Domestic
    Volunteer Service Programs that are administered by the
    Corporation for National and Community Service. This is
    $4,217,000 above the fiscal year 2005 appropriation and
    $2,000,000 below the budget request. Appropriations for these
    programs are not authorized in law for fiscal year 2006.

    VISTA

        The Committee recommends $96,428,000 for the Volunteers in
    Service to America (VISTA) program, this is $2,188,000 above
    the fiscal year 2005 level and the same as the budget request.
    The VISTA program supports individuals who recruit volunteers
    and organize community volunteer activities but who do not
    provide direct volunteer services.

    Teach for America

        The Committee recommends $2,000,000 for capacity building
    for Teach for America. This is $2,000,000 less than the budget
    request.

    National Senior Volunteer Corps

        The Committee recommends a total of $219,784,000 for the
    National Senior Volunteer Corps, $3,927,000 above the fiscal
    year 2005 level and the same as the budget request.
        The Committee recommends $112,058,000 for the Foster
    Grandparents program, $634,000 above the fiscal year 2005 level
    and the same as the budget request. This program provides
    volunteer service opportunities for low-income people aged 60
    and over.
        The Committee recognizes the valuable contributions of
    seniors participating in the Foster Grandparent Program [FGP].
    In accordance with the Domestic Volunteer Service Act [DVSA],
    the Committee intends that one-third of the increase over the
    fiscal year 2005 level shall be used to fund Program of
    National Significance [PNS] expansion grants to allow existing
    FGP programs to expand the number of volunteers serving in
    areas of critical need as identified by Congress in the DVSA.
    All remaining funds shall be used to fund an administrative
    cost increase for each Foster Grandparent Program nationwide.
    The amount to be allocated to individual grantees shall be
    calculated based on a percentage of the entire federal grant
    award in fiscal year 2005, including the amount specified for
    payment of non-taxable stipends to Foster Grandparent
    volunteers. The Corporation for National and Community Service
    (CNCS) shall comply with the directive that use of PNS funding
    increases in the FGP shall not be restricted to any particular
    activity. The Committee further directs that CNS shall not
    stipulate a minimum or maximum amount for PNS grant
    augmentation.
        In addition, the maximum dollars CNCS may use in FY 2006
    for Communications and Training, Technical Assistance, and
    Recruitment and Retention activities shall not exceed the
    amount enacted for these two activities in FY 2005.
        Funds appropriated for FY 2006 may not be used to implement
    or support service collaboration agreements or any other
    changes in the administration and/or governance of national
    service programs prior to passage of a bill by the authorizing
    committee of jurisdiction specifying such changes.
        The CNCS shall comply with the directive that use of
    funding increases in the FGP, RSVP, SCP and VISTA not be
    restricted to any particular activity. In addition, none of
    these increases may be used to fund demonstration activities.
        The Committee recommends $47,438,000 for the Senior
    Companion program, $1,533,000 above the fiscal year 2005
    appropriation and the same as 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 $60,288,000 for the Retired Senior
    Volunteer Program (RSVP), $1,760,000 above the fiscal year 2005
    appropriation and the same as 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.

    Program administration

        The Committee recommends $39,750,000 for program
    administration, $1,062,000 above the fiscal year 2005
    appropriation and the same as the budget request.

          NATIONAL AND COMMUNITY SERVICE PROGRAMS, OPERATING EXPENSES

                         (INCLUDING TRANSFER OF FUNDS)

        The Committee recommends $523,087,000 for National and
    Community Service Programs operating expenses, including the
    Trust. This is $18,430,000 less than the comparable fiscal year
    2005 level and $5,000,000 less than the budget request. The
    Committee recommends $270,000,000 for AmeriCorps State and
    National grants (authorized under subtitle C) and education
    awards only grants (authorized under subtitle H), plus an
    additional $146,000,000 for the Trust, including $10,000,000 to
    be held in reserve, and $4,000,000 for the President's Freedom
    Scholarships.
        The Committee recommendation includes the following program
    levels:

    Learn and Serve.........................................     $40,000,000
    National Civilian Community Corps.......................      25,500,000
    Innovation and Demonstration............................       9,945,000
    Evaluation..............................................       4,000,000
    State Commissions.......................................      12,642,000
    Points of Light Foundation..............................      10,000,000
    America's Promise.......................................       5,000,000

                             SALARIES AND EXPENSES

        The Committee recommends $27,000,000 for salaries and
    expenses associated with the administrative activities of the
    Corporation. This is $1,208,000 more than the comparable fiscal
    year 2005 level and the same as the budget request.

                          OFFICE OF INSPECTOR GENERAL

        The Committee recommends $6,000,000 for Office of Inspector
    General, $48,000 more than the comparable fiscal year 2005
    level and the same as the budget request. The Committee directs
    the Inspector General to continue to review the Corporation's
    management of the National Service Trust.
        The Office of Inspector General is authorized by the
    Inspector General Act of 1978, as amended. This Office provides
    an independent assessment of all Corporation operations and
    programs, including those of the Volunteers in Service to
    America and the National Senior Service Corps, through audits,
    investigations, and other proactive projects.

                           ADMINISTRATIVE PROVISIONS

        The Committee recommendation includes a number of
    administrative provisions carried previous years: (1) language
    regarding qualified student loans eligible for education
    awards; (2) language regarding the availability of funds for
    the placement of volunteers with disabilities; (3) language
    directing the Inspector General to levy sanctions in accordance
    with standard Inspector General audit resolution procedures,
    which include, but are not limited to, debarment of any grantee
    found to be in violation of AmeriCorps' program requirements,
    including using grant or program funds to lobby the Congress;
    (4) language which requires the Corporation to ensure that
    significant changes to program requirements or policy are made
    only through public notice and comment rulemaking; and (5)
    language prohibiting an officer or employee of the Corporation
    from disclosing any grant selection information to any person
    not authorized to receive such information.

                      Corporation for Public Broadcasting

        The Committee has provided $400,000,000 in advance funding
    for fiscal year 2008 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
    $30,000,000 in previously appropriated fiscal year 2006 funds
    for digital conversion activities. The Committee has also
    included authority for CPB to spend up to $52,000,000 in fiscal
    year 2006 funds the Satellite Interconnection system.
        The Committee rescinds $100,000,000 in funds previously
    appropriated for fiscal year 2006.

                   Federal Mediation and Conciliation Service

        The bill provides $42,331,000 for the Federal Mediation and
    Conciliation Service (FMCS), a decrease of $2,108,000 below the
    comparable fiscal year 2005 appropriation the same as the
    budget request.
        The FMCS attempts to prevent and minimize labor-management
    disputes having a significant impact on interstate commerce or
    national defense, except in the railroad and airline
    industries. The agency convenes boards of inquiry appointed by
    the President in emergency disputes and conducts dispute
    mediation, preventive mediation, and arbitration. In addition,
    the Service offers alternative dispute resolution services and
    training to other Federal agencies to reduce litigation costs
    and speed Federal administrative proceedings.
        The bill also includes provisions first enacted in the
    fiscal year 1996 Appropriations Act granting the agency the
    authority to accept gifts and to charge fees for certain
    services.

                Federal Mine Safety and Health Review Commission

        The bill provides $7,809,000 for the Federal Mine Safety
    and Health Review Commission, which is the same as the fiscal
    year 2005 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 $249,640,000 for the Institute of
    Museum and Library Services. This is $30,924,000 below the
    fiscal year 2005 level and $8,965,000 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 $165,500,000
    for State Grants and $3,500,000 for library services to Native
    Americans and Native Hawaiians. The Committee recommends
    $12,500,000 for national leadership grants.
        In honor of her career as a librarian and lifelong
    dedication to early learning, early reading, and literacy, the
    Committee has renamed the Librarians for the 21st Century
    program, the Laura Bush 21st Century Librarian Program. The
    Committee has included $24,000,000 for this program that
    recruits and educates librarians. This program is helping
    recruit new professionals for public, academic, research and
    school libraries; building the capacity of library schools
    through faculty and curriculum development; and updating the
    skills of current library workers. The Committee is
    particularly interested in the program's work in enhancing
    school library media centers. Research has established the
    value of the school library media center to student
    achievement, but there is a great need to raise awareness among
    teachers and school administrators about the role that the
    library and librarian can play. School library media centers
    can contribute to improved student achievement by providing
    instructional materials aligned to the curriculum; by
    collaborating with teachers, administrators and parents; and by
    extending their hours of operation beyond the school day. The
    Committee encourages IMLS to establish a priority within the
    Laura Bush 21st Century Librarian Program to develop or enhance
    programs to promote collaboration between educators and
    librarians employed in educational institutions.
        For Museum Services, the Committee recommends $17,325,000
    for the Museums for America program, $992,000 for the 21st
    Museum Professionals program, and $446,000 for Museum
    Assessment programs. The Committee recommends $2,800,000 for
    Conservation Project Support; $815,000 for the Conservation
    Assessment Program; $8,000,000 for National Leadership Grants
    for Museums, and $845,000 for Native American and Native
    Hawaiian Museum Services. The Committee has included $1,000,000
    and in first time funding for Museum Grants for African
    American History and Culture.
        The Committee recommends $11,917,000 for program
    administration, the same as the budget request.

                      Medicare Payment Advisory Commission

        The Committee recommends $10,168,000 for the Medicare
    Payment Advisory Commission, an increase of $269,000 above the
    comparable fiscal year 2005 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 $993,000 for the National
    Commission on Libraries and Information Science. This is the
    same as the fiscal year 2005 level and the budget request.

                         National Council on Disability

        The bill provides $2,800,000 for the National Council on
    Disability (NCD), a decrease of $544,000 below the comparable
    fiscal year 2005 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 $252,268,000 for the National Labor
    Relations Board (NLRB). This is $2,408,000 above the fiscal
    year 2005 level and the same as the budget request. The NLRB
    receives, investigates, and prosecutes unfair labor practice
    charges filed by businesses, labor unions, and individuals. It
    also schedules and conducts representation elections. The five-
    member Board considers cases in which an administrative law
    judge decisions are appealed.
        The Committee remains concerned about the involuntary
    expansion of the mandatory jurisdiction of the National Labor
    Relations Board (NLRB) and its ever increasing burden on small
    businesses. 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. The Committee urges NLRB
    to examine the scope of its original jurisdiction, and report
    to the Committee by March 1, 2006 on how its jurisdiction has
    increased since 1959 due to the absence of adjustments on the
    mandatory jurisdiction thresholds to account for inflation.
    Additionally, the Committee urges NLRB to report on the number
    of cases brought before NLRB annually, delineated by
    incremental thresholds of gross receipts and/or purchases, and
    bargaining unit size, with special attention paid to cases
    involving small businesses. Inasmuch as current NLRB reporting
    requirements may not capture this information in such detail,
    the Committee urges the NLRB to revise all necessary forms and
    regulations to capture such data on an individual basis (or, at
    a minimum, in an appropriate ``banded'' aggregate).

                            National Mediation Board

        The bill provides $11,628,000 for the National Mediation
    Board (NMB), the same as the comparable fiscal year 2005
    appropriation and 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 $10,510,000 for the Occupational Safety
    and Health Review Commission, the same as the fiscal year 2005
    level and 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 $97,000,000 for dual benefits, a decrease
    of $10,136,000 below the comparable fiscal year 2005
    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 $7,000,000 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 2005.

                          LIMITATION ON ADMINISTRATION

        The bill provides a consolidated limitation of $102,543,000
    on the expenditure of railroad retirement and railroad
    unemployment trust funds for administrative expenses of the
    Railroad Retirement Board, the same as the comparable fiscal
    year 2005 appropriation and the budget request. The bill
    includes a provision from the fiscal year 1999 Appropriations
    Act prohibiting the transfer of resources formerly identified
    in a Memorandum of Understanding from the RRB to the Inspector
    General.
        The Railroad Retirement Board (RRB) administers
    comprehensive retirement-survivor and unemployment-sickness
    insurance benefit programs for railroad workers and their
    families. This account limits the amount of funds in the
    railroad retirement and railroad unemployment insurance trust
    funds that may be used by the RRB for administrative expenses.
    The Committee prohibits funds from the railroad retirement
    trust fund from being spent on any charges over and above the
    actual cost of administering the trust fund, including
    commercial rental rates.
        The bill includes language (Sec. 516) limiting the
    availability of funds to the Railroad Retirement Board to enter
    into an arrangement with a nongovernmental financial
    institution to serve as disbursing agent for benefits payable
    under the Railroad Retirement Act of 1974.
        The Committee is pleased with the management of the Board
    and reiterates its interest in quickly and comprehensively
    implementing the Government Performance and Results Act.

                 LIMITATION ON THE OFFICE OF INSPECTOR GENERAL

        The bill provides authority to expend $7,196,000 from the
    railroad retirement and railroad unemployment insurance trust
    funds for the Office of Inspector General, the same as the
    comparable fiscal year 2005 appropriation and 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 bill provides $20,470,000 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 $29,533,174,000 for the Supplemental
    Security Income (SSI) program. The Committee also provides
    $11,110,000,000 in advance funding for the first quarter of
    fiscal year 2007.

    Beneficiary services

        In addition to Federal benefits, the Social Security
    Administration (SSA) administers a program of supplementary
    State benefits for those States that choose to participate. The
    funds are also used to reimburse the trust funds for the
    administrative costs of the program. The bill provides
    $52,000,000 for beneficiary services, the same as the budget
    request, within the total appropriation for SSI. This funding
    reimburses State vocational rehabilitation services agencies
    for successful rehabilitation of SSI recipients.

    Research and demonstration

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

    Administration

        Within the appropriation for SSI, the Committee provides
    $2,897,000,000 for payment to the Social Security trust funds
    for the SSI Program's share of SSA's base administrative
    expenses. This is the same funding level as the budget request.

                     LIMITATION ON ADMINISTRATIVE EXPENSES

        The Committee provides a limitation on administrative
    expenses for the Social Security Administration (SSA) of
    $9,159,700,000 to be funded from the Social Security and
    Medicare trust funds. This is $554,799,000 more than the fiscal
    year 2005 comparable level and $108,700,000 less than the
    budget request.

    Social Security Advisory Board

        The Committee provides that not less than $2,000,000 within
    the limitation on administrative expenses shall be available
    for the Social Security Advisory Board, the same as both the
    fiscal year 2005 level 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
    $5,000,000 less than the fiscal year 2005 level and the same as
    the request.

                          OFFICE OF INSPECTOR GENERAL

                         (INCLUDING TRANSFER OF FUNDS)

        The Committee provides $92,805,000 for the Office of the
    Inspector General (OIG), $2,427,000 more than the fiscal year
    2005 comparable level and $195,000 less than the budget
    request. The bill also provides authority to expend $66,805,000
    from the Social Security trust funds for activities conducted
    by the Inspector General, $1,969,000 more than the fiscal year
    2005 comparable level and $195,000 less than the budget
    request.

                          TITLE V--GENERAL PROVISIONS

        Sec. 501. The Committee continues a provision to allow the
    Secretaries of Labor, Health and Human Services, and Education
    to transfer unexpended balances of prior appropriations to
    accounts corresponding to current appropriations to be used for
    the same purpose and for the same periods of time for which
    they were originally appropriated.
        Sec. 502. The Committee continues a provision to prohibit
    the obligation of funds beyond the current fiscal year unless
    expressly so provided.
        Sec. 503. The Committee continues a provision to prohibit
    appropriated funds to be used to support or defeat legislation
    pending before the Congress or any State legislature, except in
    presentation to the Congress or any State legislature itself.
        Sec. 504. The Committee continues a provision to limit the
    amount available for official reception and representation
    expenses for the Secretaries of Labor and Education, the
    Director of the Federal Mediation and Conciliation Service, and
    the Chairman of the National Mediation Board.
        Sec. 505. The Committee continues a provision to prohibit
    funds to be used to carry out a needle distribution program.
        Sec. 506. The Committee continues a provision to require
    grantees receiving Federal funds to clearly state the
    percentage of the total cost of the program or project that
    will be financed with Federal money.
        Sec. 507. The Committee continues a provision to prohibit
    appropriated funds to be used for any abortion.
        Sec. 508. The Committee continues a provision to provide
    exceptions for Sec. 507 and adds a limitation prohibiting funds
    from the bill to be made available to a Federal, State or local
    government or program if they discriminate against
    institutional or individual health care entities if they do not
    provide, pay for, or refer for abortions.
        Sec. 509. 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. 510. 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. 511. The Committee continues a provision related to
    annual reports to the Secretary of Labor.
        Sec. 512. 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. 513. The Committee continues a provision that
    prohibits the transfer of funds from this Act except by
    authority provided in this Act or another appropriation Act.
        Sec. 514. 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. 515. The Committee includes a provision to limit
    technology funds in the bill for elementary and secondary
    schools to those schools that comply with the requirements of
    the Children's Internet Protection Act.
        Sec. 516. The Committee includes language limiting the
    availability of funds to the Railroad Retirement Board to enter
    into an arrangement with a nongovernmental financial
    institution to serve as disbursing agent for benefits payable
    under the Railroad Retirement Act of 1974.
        Sec. 517. The Committee maintains a provision clarifying
    the procedures for reprogramming of funds. The Committee notes
    that this provision is consistent with reprogramming language
    included in other bills within the Committee's jurisdiction.
        Sec. 518. The Committee includes a provision extending the
    availability of funds appropriated under section 1015 of P.L.
    108-173 for an additional year, allowing CMS and SSA more
    flexibility to implement the Medicare Prescription Drug,
    Improvement, and Modernization Act of 2003.

                            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...............................................      142,514      143,702      142,514      143,802
    Mandatory...................................................      402,591      404,083      402,591      404,083
    ----------------------------------------------------------------------------------------------------------------

        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:

    Outlays:                [In millions of dollars]
            2006..................................................   370,337
            2007..................................................    58,474
            2008..................................................    15,470
            2009..................................................     3,789
            2010 and beyond.......................................       542

              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]

    New budget authority..........................................   220,961
    Fiscal Year 2006 outlays resulting therefrom..................   159,308

                               TRANSFER OF FUNDS

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

                                     APPROPRIATION TRANSFERS RECOMMENDED IN THE BILL
    ----------------------------------------------------------------------------------------------------------------
                                                                     Account from which transfer is
          Account to which transfer is made             Amount                    made                    Amount
    ----------------------------------------------------------------------------------------------------------------
    Department of Labor:                           ...............  Department of Labor
        Special Benfits..........................            (\1\)    Postal Service...............            (\1\)
        Various Agencies \1\.....................                     Energy Employee Occupational   ...............
                                                                       Illness Compensation Fund
                                                                       \1\.
        Employment Standards Administration--          $33,050,000  Black Lung Disability Trust          $33,050,000
         Salaries and Expenses.                                      Fund.
        Departmental Management--Salaries and           24,239,000  Black Lung Disability Trust           24,239,000
         Expenses.                                                   Fund.
        Office of Inspector General..............          344,000  Black Lung Disability Trust              344,000
                                                                     Fund.
    Department of Health and Human Services:                        Department of Health and Human
                                                                     Services:
        National Institutes of Health:                              National Institutes of Health
            Various Institutes and centers for            up to 3%  Various institutes and centers          up to 3%
             AIDS.                                                   for AIDS.
            Various institutes and centers for               (\2\)  Office of AIDS Research........            (\2\)
             AIDS.
            Various institutes and centers.......         up to 1%  Various institutes and centers.         up to 1%
    Related Agencies:
        National Service Trust...................      146,000,000  Corp. for National and               146,000,000
                                                                     Community Service.
        National Service Trust...................            (\1\)  Corp. for National and                     (\1\)
                                                                     Community Service.
        Social Security Administration:..........
            Office of Inspector General..........       66,805,000  Federal Old-Age and Survivors         66,805,000
                                                                     Insurance Trust Fund and
                                                                     Federal Disability Insurance
                                                                     Trust Fund.
    ----------------------------------------------------------------------------------------------------------------
    \1\ Such sums.
    \2\ Amount det'd to be AIDS.

                                  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.

    ------------------------------------------------------------------------
                           Account                               Amount
    ------------------------------------------------------------------------
    Department of Labor, National Emergency Grants.......       -$20,000,000
    Department of Labor, Training and Employment Service.         -5,000,000
    Department of Labor, Training and Employment Service.       -125,000,000
    Department of Labor, Workers Compensation Programs...       -120,000,000
    Department of HHS, Health Professions Student Loans..        -15,912,000
    Corporation of Public Broadcasting, Fiscal Year 2006        -100,000,000
     Advance.............................................
    ------------------------------------------------------------------------

                     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 2006.
        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 2007 or 2008 for programs for
    which such advances are not authorized by law.

                          TITLE I--DEPARTMENT OF LABOR

                        Training and Employment Services

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

         State Unemployment Insurance and Employment Service Operations

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

                      Employment Standards Administration

                             SALARIES AND EXPENSES

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

                                SPECIAL BENEFITS

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

                 Occupational Safety and Health Administration

                             SALARIES AND EXPENSES

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

                     Mine Safety and Health Administration

                             SALARIES AND EXPENSES

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

                               General Provisions

        Language is included deeming certain payments for workers
    compensation to be consistent with P.L. 107-17.

               TITLE II--DEPARTMENT OF HEALTH AND HUMAN SERVICES

                  Health Resources and Services Administration

                         HEALTH RESOURCES AND SERVICES

        Language providing that $39,180,000 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 $26,000,000 of the funding provided
    for community health centers is to be allocated to high-poverty
    counties, notwithstanding current law.
        Language providing that all pregnancy counseling under the
    family planning program shall be nondirective.
        Language making $25,000,000 available under section 241 of
    the Public Health Service Act to fund special programs for the
    care and treatment of individuals with HIV disease.
        Language identifying a specific amount for maternal and
    child health SPRANS activities, notwithstanding current law.

                   Centers for Disease Control and Prevention

        Language permitting the Centers for Disease Control and
    Prevention to purchase and insure official motor vehicles in
    foreign countries.
        Language providing the Centers for Disease Control and
    Prevention to purchase, hire, maintain and operate aircraft.
        Language providing that $30,000,000 is available until
    expended for equipment and construction and renovation of
    facilities.
        Language providing that $123,883,000 is available until
    September 30, 2006 for International HIV/AIDS.
        Language providing that collections from user fees may be
    credited to the Centers for Disease Control and Prevention
    appropriation.
        Language making specific amounts under section 241 of the
    Public Health Service Act available to carry out: National
    Immunization Surveys; National Center for health Statistics
    surveys; information systems standards development and
    architecture and applications-based research used at local
    public health levels; Public Health Research; and the National
    Occupational Research Agenda.
        Language allowing the Director of the Centers for Disease
    Control and Prevention to redirect certain funds appropriated
    under Public Law 101-502.
        Language providing that not to exceed $12,500,000 may be
    made available for grants under section 1509 of the Public
    Health Service Act to not more than 15 States, tribes, or
    tribal organizations.
        Language permitting the Centers for Disease Control and
    Prevention to proceed with property acquisition, including a
    long-term ground lease for construction on non-federal land,
    for construction of a replacement laboratory in the Ft.
    Collins, Colorado area.
        Language permitting the Centers for Disease Control and
    Prevention to exempt from any personnel ceiling applicable to
    the Agency both civilian and Commissioned Officers detailed to
    the States, municipalities, or other organizations under
    authority of section 214 of the Public Health Service Act for
    purposes related to homeland security during the period of
    detail or assignment.

                         National Institutes of Health

                          NATIONAL LIBRARY OF MEDICINE

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

                             OFFICE OF THE DIRECTOR

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

           Substance Abuse and Mental Health Services Administration

                   SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES

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

                   Agency for Healthcare Research and Quality

        Language is included to permit the Agency for Healthcare
    Research and Quality to retain and expend amounts received from
    Freedom of Information Act fees, reimbursable and interagency
    agreements and the sale of data tapes.

                   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.

                    PAYMENTS TO THE HEALTH CARE TRUST FUNDS

        Language providing indefinite authority for paying benefits
    if the annual appropriation is insufficient.

                               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.
        Language providing that funds under this heading are
    available for the Healthy Start, Grow Smart program.

                    Administration for Children and Families

      PAYMENTS TO STATES FOR CHILD SUPPORT ENFORCEMENT AND FAMILY SUPPORT
                                    PROGRAMS

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

                          SOCIAL SERVICES BLOCK GRANT

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

                    CHILDREN AND FAMILIES SERVICES PROGRAMS

        Language making $6,000,000 available under section 241 of
    the Public Health Service Act to carry out provisions of
    section 1110 of the Social Security Act.
        Language providing that unexpended Community Services Block
    Grant funds may be carried over to the next fiscal year by
    local grantees.
        Language making $4,500,000 available under section 241 of
    the Public Health Service Act to carry out evaluations of
    adolescent pregnancy prevention approaches.

                            Office of the Secretary

                        GENERAL DEPARTMENTAL MANAGEMENT

        Language making $39,552,000 available under section 241 of
    the Public Health Service Act to carry out national health or
    human services research and evaluation activities.
        Language providing $13,120,000 for prevention service
    demonstration grants under the Adolescent Family Life program,
    notwithstanding current law.

                    HEALTH INFORMATION TECHNOLOGY INITIATIVE

        Language making $16,900,000 available under section 241 of
    the Public Health Service Act to carry out health information
    technology network development activities.

                PUBLIC HEALTH AND SOCIAL SERVICES EMERGENCY FUND

        Language providing for the transfer of $8,589,000 from
    amounts appropriated to the Centers for Disease Control and
    Prevention for activities authorized by Section 319F-2(a) of
    the Public Health Service Act.

                       TITLE III--DEPARTMENT OF EDUCATION

                                   IMPACT AID

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

                          SCHOOL IMPROVEMENT PROGRAMS

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

                         VOCATIONAL AND ADULT EDUCATION

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

                          STUDENT FINANCIAL ASSISTANCE

        Language providing that the maximum Pell grant a student
    may receive in the 2005-2006 academic year shall be $4,100.

                                HIGHER EDUCATION

        Language providing that funds are available to fund
    fellowships for academic year 2006-2007 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 $3,524,000 for the endowment program pursuant to the
    Howard University Endowment Act.

                           TITLE IV--RELATED AGENCIES

                 Corporation for National and Community Service

            DOMESTIC VOLUNTEER SERVICE PROGRAMS, OPERATING EXPENSES

        Language prohibiting certain funds from being used for
    stipends or other monetary incentives for volunteers or
    volunteer leaders whose incomes exceed 125 percent of the
    national poverty level.

          NATIONAL AND COMMUNITY SERVICE PROGRAMS, OPERATING EXPENSES

        Language allowing certain funds to be used for education
    award-only grants.
        Language allowing certain additional funds to be
    transferred to the National Service Trust, upon a determination
    that it is necessary to support the activities of national
    service participants and after notice is transmitted to the
    Congress.
        Language prohibiting certain funds from being used to
    support salaries and related expenses (including travel)
    attributable to employees of the Corporation for National and
    Community Service.
        Language requiring certain funds to be provided in an
    manner that is consistent with the recommendations of peer
    review panels in order to ensure that priority is given to
    programs that demonstrate quality, innovation, replicability,
    and sustainability.
        Language allowing certain funds to support an endowment
    fund, and permitting certain investments of the endowment fund.
        Language prohibiting funds for national service programs
    run by certain other Federal agencies.
        Language requiring the Corporation for National and
    Community Service to increase significantly the level of
    matching funds and in-kind contributions provided by the
    private sector, and to reduce the total Federal costs per
    participant in all programs.
        Language allowing certain funds to be made available to
    provide assistant to State commissions on national and
    community service.
        Language allowing certain funds to be used for grant
    application reviews.

                           ADMINISTRATION PROVISIONS

        Language allowing certain loans to be considered qualified
    student loans.
        Language allowing certain grantees to be eligible for
    grants targeted to individuals with disabilities.
        Language requiring the Inspector General of the Corporation
    for National and Community Service to conduct random audits of
    the grantees that administer activities under the AmeriCorps
    programs, to levy sanctions for violations, and to obtain
    reimbursements of misused funds from grantees committing
    substantial violations.
        Language requiring the Corporation for National and
    Community Service to make significant changes to program
    requirements or policies only through public notice and comment
    rulemaking.
        Language prohibiting personnel of the Corporation for
    National and Community Service from making unauthorized
    disclosures of covered grant selection information.

                   Federal Mediation and Conciliation Service

                             SALARIES AND EXPENSES

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

                         National Labor Relations Board

                             SALARIES AND EXPENSES

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

                           Railroad Retirement Board

                         DUAL BENEFITS PAYMENTS ACCOUNT

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

                          LIMITATION ON ADMINISTRATION

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

                         Social Security Administration

                     LIMITATION ON ADMINISTRATIVE EXPENSES

        Language providing that unobligated balances at the end of
    fiscal year 2006 shall remain available until expended for the
    agency's information technology and telecommunications hardware
    and software infrastructure, including related equipment and
    non-payroll administrative expenses associated solely with this
    information technology and telecommunications infrastructure;
    language authorizing the use of up to $15,000 for official
    reception and representation expenses; and language providing
    that reimbursement to the trust funds under this heading for
    expenditures for official time for employees of the Social
    Security Administration pursuant to section 7131 of title 5,
    United States Code, and for facilities or support services for
    labor organizations pursuant to policies, regulations, or
    procedures referred to in 7135(b) of such title shall be made
    by the Secretary of the Treasury, with interest, from amounts
    in the general fund not otherwise appropriated, as soon as
    possible after such expenditures are made.
        Language providing that funds may be derived from
    administration fees collected pursuant to 1616(d) of the Social
    Security Act or 212(b)(3) of Public Law 93-66 and that, to the
    extent that the amounts collected pursuant to such sections in
    fiscal year 2006 exceed $119,000,000, the amounts shall be
    available in fiscal year 2007 only to the extent provided in
    advance in appropriations Acts.
        Language providing that funds may be derived from fees
    collected pursuant to section 303(c) of the Social Security
    Protection Act of Public Law 108-203 and shall remain available
    until expended.
        Language providing that unobligated funds previously
    appropriated for Federal-State partnerships shall be
    transferred to the Supplemental Security Income Program and
    remain available until expended.

                          OFFICE OF INSPECTOR GENERAL

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

                               General Provisions

        Sections 102, 201, 202, 203, 204, 205, 206, 207, 208, 209,
    210, 211, 212, 213, 214, 215, 216, 217, 218, 219, 301, 302,
    303, 304, 501, 504, 505, 507, 508, 509, 510, 511, 512, 513,
    514, 516, 517, 518 and 519 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 2006 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, 2006, the
    accompanying House and Senate Committee reports, the conference
    report and accompanying joint explanatory statement of the
    managers of the committee of conference.

             Statement of General Performance Goals and Objectives

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

                      Appropriations Not Authorized by Law

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

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

    Employment and Training        2003.................  Such Sums...........     $5,217,070,000         $5,121,792
     Administration--Training and
     Employment Services.

       DEPARTMENT OF HEALTH AND
            HUMAN SERVICES

    HRSA:

    Health Professions, except     2002.................  Such Sums...........       $295,111,000        $47,128,000
     certain nursing programs.
    Healthy Start................  1995.................  Such Sums...........       $102,543,000        $97,747,000
    Newborn Hearing Screening....  2002.................  Such Sums...........         $9,995,000        $10,000,000
    Organ Transplantation........  1993.................  Such Sums...........        $24,990,000        $23,282,000
    Bone Marrow Donor Registry...  2003.................  Such Sums...........        $21,891,000        $25,416,000
    Rural and Community Access to  2003.................  25,000,000..........        $12,500,000         $1,960,000
     Emergency Devices.
    State Offices of Rural Health  2002.................  Such Sums...........         $7,996,000         $8,223,000
    Family Planning..............  1985.................  158,400,000.........       $142,500,000       $285,963,000

    CDC:

    Birth Defects................  2002.................  Such Sums...........        $98,040,000       $127,179,000
    Cancer Registries............  2003.................  Such Sums...........        $45,649,000        $48,584,000
    Prostate Cancer..............  2004.................  Such Sums...........        $15,452,000        $14,071,000
    Breast and Cervical Cancer     2003.................  Such Sums...........       $199,371,000       $204,425,000
     Prevention.
    Wisewoman....................  2003.................  Such Sums...........        $12,500,000        $12,500,000
    Prevention Centers...........  2003.................  Such Sums...........        $26,830,000        $29,700,000
    Health Statistics............  2003.................  Such Sums...........       $125,899,000       $109,021,000
    Infectious Disease Control...  2005.................  Such Sums...........       $225,589,000       $229,471,000
    Diabetes.....................  2005.................  Such Sums...........        $63,457,000        $64,960,000
    Safe Motherhood/Infant Health  2005.................  Such Sums...........        $44,738,000        $44,740,000
     Promotion.
    Childhood Obesity............  2005.................  Such Sums...........        $41,930,000        $41,930,000
    Oral Health Promotion........  2005.................  Such Sums...........        $11,204,000        $12,000,000
    Preventive Health Services     1998.................  Such Sums...........       $149,092,000       $100,000,000
     Block Grant.
    HIV/AIDS Prevention..........  2005.................  Such Sums...........       $662,267,000       $657,694,000
    Sexually Transmitted Diseases  1998.................  Such Sums...........       $112,117,000       $159,633,000
     Grants.
    Tuberculosis Grants..........  2002.................  Such Sums...........       $132,689,000       $138,811,000
    Asthma Prevention............  2005.................  Such Sums...........        $32,422,000        $32,422,000
    Lead Poisoning Prevention....  2005.................  Such Sums...........        $36,474,000        $36,474,000
    Injury Prevention and Control  2005.................  Such Sums...........       $138,237,000       $138,237,000
    Loan Repayment...............  2002.................  Such Sums...........           $500,000           $500,000

    NIH:

    National Institutes of         1996.................  Such Sums...........       $416,992,000                 $0
     Health--Research Training.
    National Cancer Institute....  1996.................  Such Sums...........     $2,248,000,000     $4,841,774,000
    National Heart, Lung, and      1996.................  Such Sums...........     $1,354,945,000     $2,951,270,000
     Blood Institute.
    National Institute on Aging..  1996.................  Such Sums...........       $453,541,000     $1,057,203,000
    National Institute on Alcohol  1994.................  Such Sums...........       $185,538,000       $440,333,000
     Abuse and Alcoholism.
    National Institute on Drug     1994.................  Such Sums...........       $424,315,000     $1,010,130,000
     Abuse.
    National Institute of Mental   1994.................  Such Sums...........       $613,352,000     $1,417,692,000
     Health.
    National Institute of          2003.................  Such Sums...........       $280,100,000       $299,808,000
     Biomedical Imaging and
     Bioengineering.
    National Library of Medicine.  1996.................  Such Sums...........       $140,936,000       $318,091,000

    SAMSHA:

    Substitute Abuse and Mental    FY 2003..............  Such Sums...........     $3,158,068,000     $3,230,744,000
     Health Services
     Administration programs.

    ACF:

    Low Income Home Energy         FY 2004..............  2,605,300,000.......     $1,888,790,000     $1,984,799,000
     Assistance.
    Office of Refugee              FY 2002..............  Such Sums...........       $439,894,000       $478,006,000
     Resettlement, except:
     Unaccompanied Alien
     Children, Trafficking
     Victims and Torture Victims.
    Trafficking Victims..........  FY 2005..............  15,000,000..........   up to $9,915,000   up to $9,915,000
    Torture Victims..............  FY 2005..............  20,000,000..........         $9,915,000         $9,915,000
    Child Care Development Block   FY 2002..............  1,000,000,000.......     $2,099,994,000     $2,082,910,000
     Grant.
    Head Start...................  FY 2003..............  Such Sums...........     $6,815,570,000     $6,899,000,000
    Voting Access for individuals  FY 2005..............  35,000,000..........        $14,879,000        $14,879,000
     with Disabilities.
    Native American programs.....  FY 2002..............  Such Sums...........        $45,946,000        $44,780,000
    Community Services Block       FY 2003..............  Such Sums...........       $739,315,000       $389,672,000
     Grant programs.

    AOA:

    Aging Services Programs......  FY 2005..............  Such Sums...........     $1,393,342,000     $1,376,217,000

    OFFICE OF THE SECRETARY

    Adolescent Family Life (Title  1985.................  30,000,000..........        $14,716,000        $30,742,000
     XX).

    DEPARTMENT OF EDUCATION

    Education for the              FY 2003..............  Such Sums...........        $34,750,000        $34,269,000
     Disadvantaged--Migrant
     Education.
    Innovation and Improvement--   FY 2003..............  Such Sums...........        $24,838,000        $36,981,000
     Credit Enhancement for
     Charter School Facilities.

    Special Education:

    Grants to States Part B......  FY 2002..............  Such Sums...........     $7,528,533,000    $10,739,746,000
    Preschool Grants.............  FY 2002..............  Such Sums...........       $390,000,000       $384,597,000
    Grants for Infants and         FY 2002..............  Such Sums...........       $417,000,000       $440,808,000
     Families.
    IDEA National Activities.....  FY 2002..............  Such Sums...........       $337,271,000       $248,632,000
    Rehabilitation Services and    FY 2003..............  Such Sums...........     $3,013,305,000     $3,128,638,000
     Disability Research.

    Special Institutions for
     Persons with Disabilities:

    National Technical Institute   FY 2003..............  Such Sums...........        $53,800,000        $56,137,000
     for the Deaf.
    Gallaudet University.........  FY 2003..............  Such Sums...........       $100,800,000       $107,657,000
    Vocational and Adult           FY 2003..............  Such Sums...........     $2,121,690,000     $1,991,782,000
     Education.
    Student Financial Assistance.  FY 2004..............  Such Sums...........    $14,007,296,000    $15,281,752,000
    Student Aid Administration...  FY 2004..............  Such Sums...........       $116,727,000       $124,084,000

    Higher Education:

    Aid for Institutional          FY 2004..............  Such Sums...........       $485,065,000       $505,519,000
     Development.
    International Education and    FY 2004..............  Such Sums...........       $103,680,000       $106,819,000
     Foreign Language.
    Domestic Program.............  FY 2004..............  Such Sums...........        $89,211,000        $92,466,000
    Institute for International    FY 2004..............  Such Sums...........         $1,629,000         $1,616,000
     Public Policy.
    Fund for Improvement of Post   FY 2004..............  Such Sums...........       $157,700,000        $59,211,000
     Secondary Education.
    Minority Science and           FY 2004..............  Such Sums...........         $8,889,000         $8,818,000
     Engineering Improvement.
    Tribally Controlled Post-      FY 2004..............  $4,000,000..........         $7,185,000         $7,440,000
     Secondary Vocational and
     Technical Institutions.
    Federal TRIO Programs........  FY 2004..............  Such Sums...........       $832,559,000       $836,543,000
    GEAR UP......................  FY 2004..............  Such Sums...........       $298,230,000       $306,488,000
    Javitts Fellowships..........  FY 2004..............  Such Sums...........         $9,876,000         $9,797,000
    Graduate Assistance in Areas   FY 2004..............  Such Sums...........        $30,616,000        $30,371,000
     of National Need.
    Teacher Quality Enhancement    FY 2004..............  Such Sums...........        $88,887,000        $58,000,000
     Grants.
    Child Care Access Means        FY 2004..............  Such Sums...........        $16,098,000        $15,970,000
     Parents in School.
    GPRA Data/HEA program          FY 2004..............  Such Sums...........           $988,000           $980,000
     evaluation.
    B.J. Stupak Olympic            FY 2004..............  Such Sums...........           $988,000           $980,000
     Scholarships.
    Howard University--Endowment   FY 1985..............  $2,000,000..........         $2,000,000         $3,524,000
     Program.
    Institute of Education         FY 2002..............  Such Sums...........        $78,380,000        $72,566,000
     Sciences--Research and
     Innovation in Special
     Education.

    RELATED AGENCIES

    Corporation for National and   FY 1996..............  Such Sums...........       $600,385,000       $918,949,000
     Community Service.
    Corporation for Public         FY 1993..............  $200,000,000........        $65,327,000        $52,000,000
     Broadcasting,
     Interconnection.
    Corporation for Public         FY 2001..............  $20,000.............        $20,000,000        $30,000,000
     Broadcasting, Digitalization.
    National Council on            FY 2003..............  Such Sums...........         $2,858,000         $2,800,000
     Disability.
    ----------------------------------------------------------------------------------------------------------------

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

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

       SECTION 1015 OF THE MEDICARE PRESCRIPTION DRUG, IMPROVEMENT, AND
                           MODERNIZATION ACT OF 2003

                              (Public Law 108-173)

    SEC. 1015. FUNDING START-UP ADMINISTRATIVE COSTS FOR MEDICARE REFORM.

        (a) * * *
        (b) Availability.--Amounts provided under subsection (a)
    shall remain available until September 30, [2005] 2006.

               *       *       *       *       *       *       *

                                 MINORITY VIEWS

        This bill is the clearest demonstration of what happens
    when Congress puts $140,000 tax cuts for those making more than
    a million dollars a year ahead of basic investments in
    education, healthcare, job training and job protection.
        As Majority Leader Tom DeLay pointed out two months ago
    during debate on the conference report on the FY 2006 budget
    resolution,

              This is the budget that the American people voted for
            when they returned a Republican House, a Republican
            Senate and a Republican White House last November.

        The average American family wants Congress to focus on
    creating conditions that make it easier for them to get a good
    education for their kids; keep secure and decent paying jobs at
    home; and provide affordable healthcare so that everyone has
    access to a doctor.
        This bill is the most visible and recent evidence that this
    Congress isn't doing that.
        Because the Republican Majority has already made a decision
    to borrow huge sums to provide super-sized, six-digit tax cuts
    to the most fortunate people in our society, they have to
    produce the kind of cuts we see in this bill.
        This spring, the Majority party in the House passed a
    budget resolution that provides $16 billion less than the
    amount necessary just to maintain current service levels for
    non-defense programs. At the same time, that budget resolution
    extended and expanded on the four years of successive tax cut
    bills that have reduced overall federal revenues to the lowest
    level since at least 1965, measured relative to the size of the
    economy. This bill implements that budget plan.
        On the budget resolution, the House Majority voted to cut
    an abstract category called ``domestic discretionary
    spending''. This bill, and other domestic appropriations bills,
    contains the very real cuts in specific programs that the House
    previously voted for in the abstract.
        In nominal dollar terms, this bill provides $1.6 billion
    less than the comparable FY 2005 level.* After adjusting for
    inflation and population growth, it represents a $5.7 billion
    cut in real purchasing power. As a result, this bill cuts
    ongoing services that Americans rely on to have a decent
    quality of life, engaging fully in work, family and their
    communities.
    ---------------------------------------------------------------------------
        * In computing the comparable level for FY 2005, we include about
    $1 billion in costs for administration of the new Medicare drug benefit
    that were covered in FY 2005 by a one-time special appropriation made
    in the authorizing legislation but which must be covered through
    regular discretionary appropriations in this bill starting in FY 2006.
    The figure used in the text refers to spending on programs, leaving
    aside rescissions, FY 2005 emergency designations, and other
    ``scorekeeping adjustments''.
    ---------------------------------------------------------------------------
        This bill is so inadequate it even cuts deeply into the
    President's signature programs in training, healthcare and
    education. The bill cuts his Community College skills training
    initiative in half. It cuts the $300 million increase he
    proposed for Community Health Centers by two-thirds, and it
    completely eliminates his $1.5 billion High School reform
    initiative.
        We do not doubt that Chairman Regula and the Majority
    members of the Subcommittee tried to do the best they could
    with the budget figure they were given. The problem does not
    lie so much with how the Majority selected the particular
    education or health care or job training programs to be cut, as
    with the overall budget policy that mandates cuts in such high
    priority programs.

                                    WORKERS

         The bill disinvests in job training and help for
    the unemployed--cutting these programs by $346 million below
    the current level while 7.6 million Americans remain out of
    work.
         It again cuts Adult Training Grants by another $31
    million (3.4 percent) below the 2005 level to $866 million--a 9
    percent cut below the $955 million provided in FY 1998 and the
    lowest funding level in 10 years.
         It cuts the U.S. Employment Service, which
    provides essential information about job openings to people
    looking for work, by $116 million (13.7 percent) below the
    current level and $67 million (8.4 percent) below the FY 2001
    level. The bill would eliminate job search assistance for 2.5
    million people.
         It further cuts critical services for at-risk
    youth--the very group the President says he and the First Lady
    are making a priority. Youth Training Grants serving high
    school drop outs are cut by $36 million (3.7 percent) below the
    current level to $950 million, eliminating training and work
    experience for 12,000 youth. The bill provides nearly 33
    percent less funding for youth training than provided in FY
    2001.
         It even cuts Job Corps below its current funding
    level. Job Corps is one of the most successful job training
    programs ever--placing 85 percent of disadvantaged, young
    adults into jobs and college, and taking them off the street.
         The bill eliminates the $50 million Youthful
    Offender initiative, eliminating skills training for 9,500
    young people who have gotten in trouble with the law.
         On the worker protection front, the Republican
    Majority has gutted the program that is supposed to act as a
    whistle blower on countries that compete for American jobs with
    child and slave labor. Eleven years after NAFTA, labor abuses
    continue in Mexico, China, and Central America. But, this bill
    takes the cop off the beat by cutting International Labor
    Affairs by 87 percent.

                                     HEALTH

        On healthcare, the Committee bill--like the President's
    budget--takes a step backward in efforts to maintain basic
    health services for the 45 million people without health
    insurance. In fact, it includes slightly less than proposed by
    the President for the Health Resources and Services
    Administration, the HHS agency whose mission it is to improve
    access to health care.
         The bill wipes out almost all of the HHS Title VII
    health professions training programs. In total, these programs
    see a reduction from $300 million to $47 million, a cut of 84
    percent. Of 12 programs in this category, only two remain. Some
    of the grants being terminated help students from minority and
    disadvantaged backgrounds attend health professions schools to
    alleviate the shortage of doctors and dentists in low-income
    and minority communities. Others provide training opportunities
    for medical students and residents in rural and other under-
    served areas, to encourage them to go into practice in those
    areas.
         It also eliminates the Healthy Communities Access
    Program, which tries to repair some of the holes in the health
    care safety net and help health centers and public hospitals
    and other providers build more effective local systems of care
    for the uninsured.
         The bill cuts funding to help improve health care
    in rural areas by 41 percent. This includes a 73 percent cut in
    Rural Health Outreach grants, meaning no new grants and a big
    cut in ongoing projects.
         It cuts the Maternal and Child Health Block Grant
    by $24 million--producing a 20 percent reduction in per-capita
    purchasing power relative to four years earlier. This program
    helps states provide prenatal care for mothers and preventive
    health services and medical treatment for children lacking
    other sources of health care, including children with
    disabilities and other special needs.
         The bill reduces the increase requested by the
    President for Community Health Centers by two-thirds, from $304
    million to $100 million. More than half of the remaining
    increase has already been committed by the Department of HHS to
    fund applications for new health center sites and services that
    have been approved but for which FY 2005 funds were not
    available. Under the bill, relatively small amounts will be
    available in FY 2006 to cover rising health care costs at
    existing centers or to fund additional applications for new or
    expanded health centers.
         The measure eliminates the $100 million
    contribution to the Global Fund to Fight HIV/AIDS, Malaria and
    Tuberculosis, which had been included in the NIH budget for the
    past four years.
         With just a couple of exceptions, most health care
    programs that aren't cut by the bill have their funding frozen,
    with no increases to cover rising health care costs or
    caseloads or anything else. For example, the Ryan White AIDS
    programs--other than drug assistance--receive slightly less
    funding (in nominal dollars) than three years earlier, even
    though the number of patients with AIDS has been rising by more
    than 6 percent per year.
        As for research at the National Institutes of Health to try
    to find cures for diseases like Parkinson's disease or
    Alzheimer's, the Committee essentially adopted the President's
    budget. It provided an increase of only 0.5 percent--the
    smallest percentage increase in 36 years, and 2.6 percent short
    of what NIH estimates would be needed just to keep up with
    inflation in research costs. One result will be that NIH can
    support about 505 fewer research grants than just two years
    earlier.
        For the programs of the Centers for Disease Control that
    help protect the public against infectious and other diseases,
    some of the largest cuts come in assistance to state and local
    health departments. In particular, the Preventive Health Block
    Grant is cut by $31 million or 24 percent, relative to the FY
    2005 enacted level. These grants are used by states and
    localities for basic public health functions such as responding
    to disease outbreaks, immunizing children, and improving care
    for people with chronic diseases like diabetes and asthma.
    Further, grants that help health departments improve their
    preparedness against bio-terrorism and other public health
    emergencies are cut by $75 million.
        Most other CDC programs have their funding frozen. This
    includes prevention and control of HIV/AIDS, sexually
    transmitted diseases, tuberculosis, and most other infectious
    diseases, as well as environmental health. There is a welcome
    addition of $50 million for immunization against the flu, but
    no increase at all is provided for childhood immunization,
    despite rising vaccine costs.

                                 HUMAN SERVICES

        In the human services area, the Committee cuts in half the
    Community Services Block Grant, a program aimed at helping the
    poorest people in our communities who often have no other place
    to turn. This is an improvement over the President's plan to
    abolish the program entirely, but it still leaves more than
    1,000 local community services agencies seriously short of
    resources to assist low-income people. The purpose of this
    block grant is to provide flexible funds to meet whatever a
    local community considers their most important needs, whether
    it be for job training, emergency food aid, programs for low-
    income seniors, or home weatherization.
        The bill also cuts the Low-Income Energy Assistance Program
    (LIHEAP) by almost $200 million--even though there's no reason
    to expect that we won't have another winter of sky-high heating
    oil and natural gas prices. Over the past four years, the
    average cost of heating a home with oil has almost doubled, and
    the share of that cost covered by the average LIHEAP grant has
    fallen by half, from 49 percent to 25 percent.
        Further, the legislation includes an increase of just 0.7
    percent for Head Start--less than what would be needed to keep
    up with rising costs for teacher salaries, heating,
    transportation for children and other necessary expenses. It
    freezes appropriations for the Child Care Block Grant--marking
    the fourth year in a row that this block grant has been either
    frozen or cut and leading to a 13 percent reduction below FY
    2002 in terms of inflation-adjusted per capita purchasing
    power. It provides only a one percent increase for seniors'
    nutrition programs, such as Meals on Wheels, and no increase at
    all for other key programs at the Administration on Aging.

                                   EDUCATION

        On the education front, the Republican Majority has
    essentially imposed the first freeze on education funding in a
    decade. At the same time, No Child Left Behind requires our
    schools to do more for a record 55 million school children.
    This bill, however, offers them little additional help. It
    takes a number of actions that shift more of the burden of
    financing education to the local property tax, even as Federal
    mandates to those same communities grow.
         It cuts No Child Left Behind by $806 million (3.3
    percent) below the current level. Under this bill, the NCLB
    funding shortfall will be $13.2 billion next year and over $40
    billion since enactment.
         The bill cuts the $603 million increase the
    Administration proposed for Title 1 to help low-income children
    improve their reading and math skills to only $100 million. The
    Administration's request was already inadequate. However, under
    this bill, Title 1 funding will be $9.9 billion below NCLB's
    funding promise for FY 2006.
         The Republican Majority again breaks its funding
    promise on IDEA, the program that is aimed at helping local
    communities pay for the costs of educational services to
    disabled children mandated by Federal law. The bill is $3.9
    billion below the Republican promise in the IDEA Improvement
    Act of 2004 to put special education funding on a glidepath to
    full funding. It even cuts the $508 million increase requested
    by the Administration to only $150 million. The entire idea of
    IDEA was to raise the federal share of special education costs
    to 40 percent over time. Under this bill, the federal share of
    special education costs will actually drop from 18.6 percent
    this year to 18.1 percent next year.
         The bill freezes After School Centers, virtually
    for the fourth year in a row at $991 million even though only
    38 percent of all after school applications nationwide could be
    funded last year. We are turning away children when more than
    14 million kids are unsupervised after school each day.
         It slashes Education Technology by $196 million
    (39.5 percent) on top of a $196 million cut last year. One in
    four states have no other dedicated technology funds to track
    NCLB student achievement data, improve teachers' use of
    technology, and close the achievement gap through online
    learning.
         It eliminates Comprehensive School Reform grants
    to 1,000 high-poverty schools by eliminating the program.
    Rigorous independent evaluations have shown that comprehensive
    school reform models such as Success for All, America's Choice,
    High Schools That Work, First Things First, and Talent
    Development are making a significant difference in helping
    schools implement integrated, schoolwide reform strategies.
    This bill turns its back on these schools.
         The bill cuts investments in teachers. It freezes
    the main NCLB program to put qualified teachers in every
    classroom--Teacher Quality State Grants--at $2.9 billion for
    the 3rd consecutive year of a freeze or cut. The bill denies 80
    percent of the Administration's $500 million request to provide
    an incentive for the best teachers to teach in the most
    challenging high-poverty schools. It cuts funds requested for
    math and science teachers by $79 million (29 percent). It even
    cuts teacher training in American history by $69 million (58
    percent).
         It freezes Impact Aid payments to 1,300 school
    districts for over 1 million military and other Federally-
    connected children, funding Impact Aid at approximately 35
    percent below the maximum payments authorized for FY 2006. The
    bill also freezes flexible innovative education grants, English
    language training, civic education, State assessments, and
    rural education. Some of these programs have been frozen for
    four years in a row.
         Although the Republican Majority promised low-
    income students a $100 increase in the maximum Pell Grant in
    the 2006 Budget Resolution, this bill provides only half that.
    The $50 increase would offset only 2 percent of the additional
    $2,300 in four-year public college costs since 2001.

                              PUBLIC BROADCASTING

        While we are pleased that the Committee adopted the
    Democratic amendment to restore $400 million in fiscal year
    2008 advance appropriations for the Corporation for Public
    Broadcasting, this bill still includes harmful cuts in Federal
    support for local television and radio stations, and for
    acclaimed children's programs such as Sesame Street, Mr.
    Rogers, and Reading Rainbow.
        This bill rescinds $100 million or 25 percent of the funds
    Congress has already enacted for the Corporation for Public
    Broadcasting for FY 2006. In addition, out of this reduced
    appropriation, the bill asks public broadcasters to absorb up
    to $82 million for the mandatory costs of digital conversion
    and replacement of the public television satellite
    interconnection system. In all, the bill would cut federal
    assistance to stations by as much 46 percent below the prior FY
    2006 enacted level. These cuts come at a time when commercial
    broadcasters are engaged in a race to the bottom to bolster
    ratings, while public broadcasting offers us refreshing,
    innovative, educational and in-depth alternative programming.

                                   CONCLUSION

        What is at stake in this bill is not just the question of
    how much money will be provided. We are really facing the
    larger question of how well we will meet our obligations to the
    country's future. The President wants to blow up Social
    Security's guarantees as we know them and force Americans to
    count on their personal investments for their retirement. He
    has expended great time and energy to convince Americans they
    must invest for their future.
        The country needs to do the same thing. We have to count on
    our investments. However, this bill walks away from the
    investment we should be making in our human capital. One year
    of cuts might be tolerated. But, the LHHS bill is targeted for
    deeper and deeper cuts over time. One needs to look no further
    than No Child Left Behind.
               Four years ago, we fell $4.2 billion short
            of the NCLB funding promise.
               Three years ago, we fell $5.4 billion short.
               Two years ago, the gap was $7.6 billion.
               Last year, the gap grew to $9.8 billion.
               Under this bill, the gap will exceed $13
            billion.
        The same disinvestment is now occurring in programs such as
    job training, health professions training, child care, after
    school centers, and teacher training. And, this quiet erosion
    in these needed investments will get worse under the Majority's
    long-term plan.
        This is a prescription for America walking away from our
    commitment to equal opportunity and a better quality of life
    for all Americans. The only guarantee we are providing them in
    this bill is that greater access to better jobs and higher
    wages, affordable healthcare and quality educational and
    lifetime opportunities will not be achieved.

                           THE DEMOCRATIC ALTERNATIVE

        The Democratic Amendment offered during Appropriations
    Committee consideration of this bill would have invested an
    additional $11.8 billion for priority job training, education
    and health programs, and fully offset these funds by reducing
    super-sized, six-digit tax cuts that provide the greatest
    benefit to those who need it the least. It also included $11.8
    billion for deficit reduction. Under the Democratic Amendment,
    the average tax cut of a person making more than a million
    dollars would have been reduced from about $140,000 to $36,500.
    Unfortunately, the Democratic Amendment was defeated on a party
    line vote of 29 to 35.
        The Democratic Amendment invested an additional $7.8
    billion to provide real educational opportunity. The Amendment
    provided:
               $3 billion more for Title 1 reading and math
            services for nearly 1 million additional low-income
            students;
               $250 million more for teacher and school
            improvement, which would have resulted in 22,000
            additional teachers receiving high-quality professional
            development and prevented 1,000 high-poverty schools
            from losing ongoing comprehensive school reform grants;
               $939 million more for after school centers,
            child care and Head Start centers to help working
            families obtain high-quality childcare, an early
            ``headstart'' on education, and after-school learning
            opportunities for their children;
               $1.56 billion more for special education to
            keep us on a glidepath toward full funding, instead of
            losing ground as this bill would do; and
               A $450 increase in the maximum Pell Grant
            for the lowest income students.
        The Democratic Amendment invested an additional $738
    million to provide more unemployed Americans with the job
    search assistance and training they need for the Jobs of the
    21th Century. The Amendment:
               Restored the $125 million cut from the
            President's signature job training initiative so that
            workers can qualify for the high-skills jobs that
            employers in growth industries have found difficult to
            fill;
               lnvested more in science, math and
            technology education programs today so that we will
            have a technologically proficient workforce tomorrow;
            and
               Reversed the 87 percent cut in the Labor
            Department funding that helps countries improve their
            labor standards and eliminate abusive child labor.
        In terms of heath care and human services, the Democratic
    Amendment avoided most of the cuts made in the Committee bill
    and included additional funds for certain high priority
    investments. The Amendment:
               Restored funding for the health professions
            programs, which help increase the number of minorities
            in medical and dental schools and encourage medical
            students to go into primary care and consider practice
            in rural and underserved areas;
               Fully funded the President's request for
            Community Health Centers, so that the many communities
            applying for funds to start or expand a health center
            have a better chance of actually receiving assistance;
               Expanded programs to address the special
            health needs of rural areas, rather than cutting these
            programs 41 percent as the Committee's bill does;
               Restored funding for grants to state and
            local health departments to help combat infectious
            diseases and other health threats and improve
            preparedness against bioterrorist attack or natural
            epidemic;
               Invested in biomedical research at NIH by
            providing a sufficient increase to keep up with
            inflation in research costs and to avoid the need to
            reduce the number of research grants supported;
               Restored the $100 million contribution to
            the Global AIDS Fund;
               Reversed cuts in the LlHEAP energy
            assistance program, in order to help low-income
            families and senior citizens avoid having to choose
            between heating and eating next winter; and
               Raised funding for Community Services Block
            Grant to its FY 2002 level of $650 million to help
            local organizations operating in almost every county in
            the U.S. provide basic services to poor people.
        One particular focus of the Democratic Amendment was
    increases in a series of programs that help young mothers and
    families in difficult circumstances care for infants and
    children, in part to reduce some of the economic pressures that
    might cause a woman to decide not to carry a pregnancy to term.
    We hear many expressions of concern for life. These concerns
    need to go beyond the rhetorical and attack the real life
    conditions that can lead a woman to make another choice.
    Lectures from politicians will not help unless we extend a hand
    to assist women to overcome economic pressures and other life
    challenges that sometimes make a pregnancy and the thought of
    another child seem overwhelming. Concern about life cannot end
    at the checkbook's edge.
        That is why the Amendment--
               Added $175 million to the Maternal and Child
            Health Block Grant, to restore its purchasing power to
            the FY 2002 level, and added $98 million to double the
            Healthy Start program; both of these programs support
            prenatal and infant health services and help young,
            low-income mothers learn to care for their babies and
            gain access to the services they need.
               Added $300 million to Child Care grants,
            restoring purchasing power to FY 2002, to help low-
            income families secure safe and affordable child care.
               Added $418 million to restore the purchasing
            power of the Community Services Block Grant, to help
            local community-based agencies meet basic needs of low-
            income families, such as emergency assistance with food
            and other needs, parenting education, child care, and
            job training and placement.
               Added $126 million to double grants to
            states and tribes for family violence prevention
            programs and to provide shelter to victims of violence
            and their children.
               Added $212 million to restore the purchasing
            power of adult job training grants to FY 2002 levels,
            to help parents acquire the skills needed to obtain
            well-paying jobs to support their families.
        This Amendment also would have reversed a number of harmful
    cuts that would result in costs passed down to state and local
    governments, already squeezed by a wide array of cuts in
    programs across the Federal government that provide important
    services to the public.
        What is at stake in this bill is not just the question of
    how much money will be provided for education, healthcare, or
    job training. We are really facing the larger question of who
    we are as a people and what kind of nation we want to be. The
    Democratic Amendment sought to move us in the right direction.
                                       David R. Obey.
                                       Steny Hoyer.
                                       Rosa DeLauro.
                                       Jesse Jackson, Jr.
                                       Lucille Roybal-Allard.