House Report 109-143 - DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND RELATED AGENCIES APPROPRIATION BILL, 2006

[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.