[Senate Report 108-81]
[From the U.S. Government Publishing Office]
Calendar No. 175
108th Congress Report
SENATE
1st Session 108-81
======================================================================
DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND
RELATED AGENCIES APPROPRIATION BILL, 2004
_______
June 26, 2003.--Ordered to be printed
_______
Mr. Specter, from the Committee on Appropriations,
submitted the following
R E P O R T
[To accompany S. 1356]
The Committee on Appropriations reports the bill (S. 1356)
making appropriations for Departments of Labor, Health and
Human Services, and Education and related agencies for the
fiscal year ending September 30, 2004, and for other purposes,
reports favorably thereon and recommends that the bill do pass.
Amount of budget authority
Total bill as reported to Senate........................$472,167,787,000
Amount of adjusted appropriations, 2003................. 430,990,474,000
Budget estimates, 2004.................................. 469,697,048,000
The bill as reported to the Senate:
Over the adjusted appropriations for 2003........... +41,177,313,000
Over the budget estimates for 2004.................. +2,470,739,000
C O N T E N T S
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Page
Summary of Budget Estimates and Committee Recommendations........ 4
Overview and Bill Highlights..................................... 4
Highlights of the Bill........................................... 4
Title I--Department of Labor:
Employment and Training Administration....................... 21
Employee Benefit Security Administration..................... 31
Pension Benefit Guaranty Corporation......................... 32
Employment Standards Administration.......................... 33
Occupational Safety and Health Administration................ 36
Mine Safety and Health Administration........................ 37
Bureau of Labor Statistics................................... 38
Office of Disability Policy.................................. 38
Departmental Management...................................... 39
Veterans Employment and Training............................. 41
Office of the Inspector General.............................. 41
Title II--Department of Health and Human Services:
Health Resources and Services Administration................. 43
Centers for Disease Control and Prevention................... 70
National Institutes of Health................................ 101
Substance Abuse and Mental Health Services Administration.... 176
Agency for Healthcare Research and Quality................... 187
Centers for Medicare & Medicaid Services..................... 190
Administration for Children and Families..................... 194
Administration on Aging...................................... 213
Office of the Secretary...................................... 217
Title III--Department of Education:
Education for the disadvantaged.............................. 228
Impact aid................................................... 234
School improvement programs.................................. 235
Indian education............................................. 243
Innovation and Improvement................................... 244
Safe Schools and Citizenship Education....................... 252
English language acquisiton.................................. 259
Special education............................................ 259
Rehabilitation services and disability research.............. 262
Special institutions for persons with disabilities:
American Printing House for the Blind.................... 268
National Technical Institute for the Deaf................ 268
Gallaudet University..................................... 269
Vocational and adult education............................... 269
Student financial assistance................................. 273
Student aid administration................................... 275
Higher education............................................. 276
Howard University............................................ 383
College housing and academic facilities loans................ 284
Historically black college and university capital financing
program.................................................... 284
Institute of Education Science............................... 284
Departmental management:
Program administration................................... 287
Office for Civil Rights.................................. 288
Office of the Inspector General.......................... 288
General provisions........................................... 288
Title IV--Related agencies:
Armed Forces Retirement Home................................. 290
Domestic Volunteer Service Programs.......................... 290
Corporation for National and Community Service............... 290
Corporation for Public Broadcasting.......................... 292
Federal Mediation and Conciliation Service................... 293
Federal Mine Safety and Health Review Commission............. 293
Institute of Museum and Library Services..................... 294
Medicare Payment Advisory Commission......................... 295
National Commission on Libraries and Information Science..... 296
National Council on Disability............................... 296
National Labor Relations Board............................... 296
National Mediation Board..................................... 297
Occupational Safety and Health Review Commission............. 297
Railroad Retirement Board.................................... 297
Social Security Administration............................... 299
U.S. Institute of Peace...................................... 302
Title V--General provisions...................................... 303
Budgetary impact of bill......................................... 304
Compliance with paragraph 7, rule XVI of the standing rules of
the Senate..................................................... 304
Compliance with paragraph 7(C), rule XXVI of the standing rules
of the Senate.................................................. 305
Compliance with paragraph 12, rule XXVI of the standing rules of
the Sen-
ate............................................................ 305
Comparative statement of new budget authority.................... 307
SUMMARY OF BUDGET ESTIMATES AND COMMITTEE RECOMMENDATIONS
For fiscal year 2003, the Committee recommends total budget
authority of $472,167,787,000 for the Departments of Labor,
Health and Human Services, and Education, and Related Agencies.
Of this amount, $137,601,000,000 is current year discretionary
funding.
OVERVIEW AND BILL HIGHLIGHTS
The Labor, HHS, and Education and Related Agencies bill
constitutes the largest of the non-defense Federal
appropriations bills being considered by Congress this year. It
is the product of extensive deliberations, driven by the
realization that no task before Congress is more important than
safeguarding and improving the health and well-being of all
Americans. This bill is made up of over 300 programs, spanning
three Federal Departments and numerous related agencies. But
the bill is more than its component parts. Virtually every
element of this bill reflects the traditional ideal of
democracy: that every citizen deserves the right to a basic
education and job skills training; protection from illness and
want; and an equal opportunity to reach one's highest
potential.
This bill at the same time provides a safety net of social
protections for the needy while stimulating advances in human
achievement and the life sciences. At its core, this bill
embodies those defining principles by which any free society
must be guided: compassion for the less fortunate; respect for
family and loved ones; acceptance of personal responsibility
for one's actions; character development; and the avoidance of
destructive behavior.
HIGHLIGHTS OF THE BILL
Job Training.--The Committee recommendation includes
$5,115,588,000 for job training programs, an increase of
$163,602,000 over the budget request.
Worker Protection.--The Committee bill includes
$1,493,485,000 to ensure the health and safety of workers,
including $463,324,000 for the Occupational Safety and Health
Administration and $270,711,000 for the Mine Safety and Health
Administration. The recommendation is an increase of
$33,841,000 over the 2003 level.
Child Labor.--The Committee bill includes $108,000,000 for
activities designed to end abusive child labor. This is
$95,730,000 above the budget request.
National Institutes of Health.--A total of $27,982,604,000
is recommended to fund biomedical research at the 27 Institutes
and Centers that comprise the NIH. This represents an increase
of $1,000,000,000 over the fiscal year 2003 level and
$318,613,000 over the budget request.
Centers for Disease Control.--The Committee bill provides
$4,432,496,000 for the Centers for Disease Control and
Prevention, an increase of $147,856,000 over the fiscal 2003
level. Included in this amount is $801,844,000 for chronic
disease prevention and health promotion of which $50,000,000
for obesity prevention.
Physical Activity and Nutrition.--The Committee
recommendation includes a total of $944,702,000 for programs to
increase physical activity, improve nutrition, and reduce
obesity and overweight, an increase of $34,221,000 over the
fiscal year 2003 appropriation.
Infectious Disease Initiative.--The Committee bill includes
$2,138,960,000 for infectious disease research, prevention and
control. Included in this amount is $422,760,000,000 for
infectious disease control at the Centers for Disease Control
of which $50,000,000 is targeted to areas where new infectious
diseases tend to occur and $25,000,000 for containment of
disease outbreaks such as SARS and monkeypox. For emerging
infectious diseases at the National Institutes of Health, the
Committee has included $1,686,200,000, an increase of
$599,000,000 over the fiscal year 2003 appropriation.
Preventing and Reversing Heart Disease.--The Committee bill
includes $5,758,686,000 for research and prevention programs to
address heart and related diseases. This amount is $166,497,000
over the fiscal year 2003 level. Included in this amount is
$2,897,595,000 for research programs at the National Heart,
Lung and Blood Institute and $45,963,000 for programs at the
Centers for Disease Control.
Health Centers.--The recommendation includes $1,627,164,000
for health centers, the same as the budget request and
$122,358,000 over the fiscal 2003 level.
AIDS.--The Committee bill includes $6,058,688,000 for AIDS
research, prevention, and services. This includes
$2,041,599,000 for Ryan White programs, an increase of
$23,634,000 over the fiscal year 2003 level, $932,189,000 for
AIDS prevention programs at the Centers for Disease Control and
Prevention and $2,869,900,000 for AIDS research programs at the
National Institutes of Health. For global AIDS programs, the
bill includes $90,000,000 for international mother to child
transmission prevention and $150,000,000 for the Global Fund
for AIDS.
Bioterrorism.--The Committee bill includes $1,896,149,000
to fund efforts to address bioterrorism threats.
Substance Abuse.--The Committee bill provides
$3,274,590,000 for substance abuse prevention and treatment
programs. Included in this amount is $2,051,803,000 for
substance abuse treatment, $194,306,000 for substance abuse
prevention and $855,711,000 for mental health programs.
Head Start.--The Committee recommendation includes
$6,815,570,000 for the Head Start Program. This represents an
increase of $148,037,000 over the 2003 level and is the same as
the request.
Low-income Home Energy Assistance State Grants.--The
Committee recommends $2,000,000,000 for heating and cooling
assistance for low-income individuals and families, the same as
the budget request and $311,050,000 more than the 2003 level.
Persons With Disabilities.--To promote independent living
in home and community-based settings, the Committee has
included $6,671,308,000 for services to persons with
disabilities. This includes $26,824,000 for programs authorized
under the Assistive Technology Act. Also included is
$47,333,000 for the Office of Disability Policy at the
Department of Labor, $15,000,000 for Disabled Voter Services
and $40,000,000 for Real Choice Systems Change Grants through
the Center for Medicaid and Medicare Services.
Education for the Disadvantaged.--The Committee has
provided $14,103,356,000 in grants to enhance educational
opportunities for disadvantaged children, an increase of
$365,083,000 over the fiscal year 2003.
Teacher Quality.--The Committee recommends $2,850,000,000
for State grants to improve teacher quality. This is the same
as the budget request.
English Language Acquisition.--The Committee recommends
$665,000,000 for bilingual education, the same as the budget
request.
Student Financial Aid.--The Committee recommends
$14,174,115,000 for student financial assistance, the same
level provided in 2003. The amount provided for the Pell Grant
Program will allow for a maximum grant award of $4,050.
Higher Education Initiatives.--The Committee bill provides
$1,974,247,000 for initiatives to provide greater opportunities
for higher education, including $840,000,000 for Federal TRIO
programs and $300,000,000 for GEAR UP.
Education for Individuals With Disabilities.--The Committee
bill provides $11,027,464,000 to help ensure that all children
have access to a free and appropriate education, and that all
infants and toddlers with disabilities have access to early
intervention services. This represents an increase of
$993,547,000 over the 2003 level and $337,360,000 above the
budget request.
Rehabilitation Services.--The bill recommends
$3,004,360,000 for rehabilitation services, an increase of
$50,727,000 above the amount provided in 2003. These funds are
essential for families with disabilities seeking employment.
The Committee restored funding for several important programs
proposed for elimination, such as Supported Employment State
Grants, Projects with Industry, Recreational programs and
programs for migrant and seasonal farmworkers.
Services for Older Americans.--For programs serving older
Americans, the Committee recommendation totals $2,924,508,000,
an increase of $41,199,000 over the fiscal year 2003 level.
This recommendation includes $216,619,000 for senior volunteer
programs, $442,306,000 for community service employment for
older Americans, $355,673,000 for supportive services and
centers, $149,025,000 for family caregiver support programs and
$716,974,000 for senior nutrition programs. For the medical
research activities of the National Institute on Aging, the
Committee recommends $1,031,411,000. The Committee
recommendation also includes $12,500,000 for the Medicare
insurance counseling program.
Corporation for Public Broadcasting.--The Committee bill
recommends an advance appropriation for fiscal year 2006 of
$400,000,000 for the Corporation for Public Broadcasting. This
amount is $10,000,000 over advance appropriation provided in
fiscal year 2005. In addition, the Committee bill includes
$55,000,000 for conversion to digital broadcasting and
$10,000,000 for the replacement project of the interconnection
system in fiscal year 2004 funding.
Obesity Prevention and Nutrition Initiative
Obesity has become our Nation's fastest rising public
health threat with the disease affecting nearly one-third of
the adult American population. The number of overweight and
obese Americans have reached epidemic proportions. It is
estimated 127 million people or 64.5 percent of adults are
overweight and nearly 30.5 percent are obese. A recent study
found that obesity is more detrimental to health than smoking
and alcohol abuse and leads to increased risk for chronic and
life-threatening diseases such as heart disease, stroke, cancer
and diabetes. An estimated 300,000 premature deaths a year are
associated with obesity and overweight, an amount second only
to tobacco-related deaths. The total direct and indirect costs
attributed to overweight and obesity totals $100,000,000,000 in
annual health care costs.
The problem is not limited to adults. Approximately 30.3
percent of children, between the ages of 6 and 11, are
overweight and 15.3 percent are obese. For adolescents, ages 12
to 19, approximately 30.4 percent are overweight and 15.5
percent are obese. Excess weight at these early ages has been
found to predict overweight in adults. The prevalence of
obesity in children and young adults has quadrupled over the
past 25 years. In a recent study, hospital costs for diseases
related to childhood obesity have increased threefold in the
past 20 years. The study confirms that Americans are becoming
obese at younger ages: approximately 27 percent of U.S. adults
are obese by the time they reach their mid-30s, about twice the
rate in the early 1960s.
This dramatic upsurge in obesity has been associated with a
nationwide increase in diabetes. At least 80 percent of
patients with type 2 diabetes are overweight or obese. Type 2
diabetes was commonly known in the past as ``adult onset''
diabetes. However, research is showing a dramatic escalation in
the number of children diagnosed with type 2 diabetes. Problems
with obesity and diabetes also disproportionately affect
minority communities. According to the CDC, African Americans
are considered to have the highest rates of both obesity and
diabetes among all races and ethnic groups. Among all groups,
however, Native Americans have some of the highest prevalence
rates of overweight.
The good news is that many of the chronic diseases linked
to obesity are preventable. Recent studies provide strong
evidence that prevention efforts focusing on diet, exercise and
other lifestyle changes can result in substantially reduced
risk among high-risk groups. A recent clinical trial reported
that Americans at high risk for type 2 diabetes can
dramatically reduce their risk of getting the disease with
improvements to their diet and exercise.
On February 17, 2003, the Subcommittee held a hearing on
improving health through lifestyle modifications. Testimony was
heard from medical professionals and community organizations on
steps that can be taken to motivate people so that they can
make responsible health choices. Witnesses agreed that there is
a great need to increase prevention and research initiatives to
address obesity and overweight through lifestyle modifications.
Witnesses discussed the geography and demographics of obesity
and highlighted the link between poverty and obesity. To
address weight management programs for children, the
Subcommittee heard from professionals who have designed
successful programs utilizing a structured diet, exercise
participation, parent support, and behavior modification. The
program also has a counseling component to emphasize the
importance of nutrition counseling and physical activity to
teach children good eating habits. Community organizations also
discussed the need to improve the availability of nutritious
foods in public schools and for the food industry to adopt
guidelines for responsible marketing of food and entertainment
to eliminate promotion of unhealthy behaviors, and to provide
healthy foods in our health care system.
The Committee strongly believes a commitment to improving
physical activity and nutrition is imperative if we are to
reduce chronic disease, premature deaths and related health
care costs. For this reason, the Committee has included a total
of $944,702,000 for programs designed to increase physical
activity, healthy lifestyles and nutrition, an increase of
$34,221,000 over the fiscal year 2003 appropriation.
The Committee urges agencies receiving funds for this
purpose under this bill to take special measures to coordinate
their activities. In particular, the CDC's Division of
Nutrition and Physical Activity should develop mechanisms such
as interagency committees to coordinate with the Department of
Education in administering such programs as the Carol M. White
Physical Education for Progress in order to leverage resources
at the local level.
Nutrition and Physical Activity
The Committee commends the substantial efforts that CDC is
directing to stem the obesity epidemic across all life stages.
CDC is coordinating national, State, and school-based programs
to research and implement health promotion and public health
education strategies and interventions to increase physical
activity levels and good nutrition at all ages, to provide
important health information, and to monitor health and healthy
behaviors in the population. The Committee recommends
$123,651,000 for primary prevention activities related to
Nutrition, Physical Activity, and Obesity at CDC, an increase
of $15,651,000 over fiscal year 2003. The Committee also
includes $746,174,000, in the Administration on Aging for
programs to address preventive health and nutrition of the
elderly.
School Health
Obesity rates were significantly reduced among girls in
grades 6-8 who participated in a school-based intervention
program. The Committee applauds CDC for establishing effective
coordinated school health programs and has provided an increase
of $5,227,000 for a total of $63,112,000 to expand these
efforts. School health programs address risk behaviors such as
tobacco use, unhealthy diets, and physical inactivity at CDC.
The Committee urges CDC and the Department of Education to
continue to coordinate activities relating to nutrition and
physical activity which will help to reduce obesity and prevent
heart disease.
Head Start
The Committee commends the Department for its efforts to
focus on prevention as a key to improving the overall health
and well-being of our Nation. The Committee also recognizes the
importance of good nutrition and physical activity among young
children for developing a fertile atmosphere for cognitive
development and school readiness. The Committee urges the Head
Start Bureau to review the scope of good nutrition and physical
activities which are presently being undertaken in response to
the Head Start Performance Standards, as well as the current
knowledge based on good nutrition and physical activities for
young children. The Committee once again encourages the Head
Start Bureau, in collaboration with the National Head Start
Association, to devise a plan for implementing a locally-
determined but coordinated effort to achieve the goals of a
stronger, more effective nutritional and physical activity
component within Head Start programs.
Physical Education
Despite the well-publicized benefits of exercise, more than
60 percent of American adults do not get enough physical
activity to provide health benefits. This trend is not limited
to adults. Nearly one-half of American youths aged 12-21 years
are not vigorously active on a regular basis. Physical
education [PE] classes are important for ensuring that young
people have a minimal, regular amount of physical activity and
for establishing physical activity patterns that may be carried
into adulthood. Yet the Committee notes that daily enrollment
in physical education classes dropped from 42 percent to 25
percent among high school students between 1991 and 1995. In
order to help reverse this trend, the Committee recommendation
includes $70,000,000 for the Carol M. White Physical Education
for Progress program. This is an increase of $10,390,000 over
the fiscal year 2003 level and $70,000,000 over the request.
This program provides grants to local educational agencies and
community-based organizations to initiate, expand, and improve
physical education programs for students in kindergarten
through 12th grade. The PEP program will help curb this
Nation's increasing obesity problem, which will in turn reduce
the risk of developing heart disease later in life.
Disability Initiative
It will soon be 13 years since Congress passed the
Americans with Disabilities Act. During that time, the Nation
has made much progress in advancing the civil rights of
individuals with disabilities. Americans living with
disabilities are exercising their freedoms with continually
expanding opportunities and a growing acceptance by the public
at large. Services like curb cuts and closed captioning, once
envisioned solely for use by individuals with disabilities,
have proven a benefit to us all. And as the barriers have
fallen for people with disabilities, the expertise, energy, and
determination that these Americans have contributed to society
has grown significantly.
However, it is important to remember that these Americans
still face significant challenges in their effort to
participate fully in American life. The Committee strongly
believes that it has a unique responsibility to ensure that all
Americans experience the promise that has defined our Nation
from its very inception--the promise of opportunity. The
programs in this bill represent our effort to fulfill that
responsibility. Many of them relate specifically to breaking
down the barriers that impede the quality of life for Americans
with disabilities. In this year's bill, the Committee has made
a special effort to target resources to a few of the programs
that are at a critical turning point in our national debate on
disability. In addition to administrative funds allocated to
the Social Security Administration for the processing of
disability claims, the Committee dedicates $16,529,841,000 of
its allocation to its major disability programs. A notable few
are listed here.
Education
The Individuals with Disabilities Education Act [IDEA] was
first enacted in 1975. This landmark legislation was created to
help States and school districts meet their legal obligations
to provide children with disabilities with a free and
appropriate public education. In this statute, Congress
recognized that school districts would incur higher costs in
educating children with disabilities. Despite the limited
resources available in this bill, the Committee increased
funding for IDEA grants to local school districts by
$984,000,000.
Income
In 2003, the Social Security Administration will distribute
benefits to 5.5 million workers with disabilities and 1.7
million dependents. These benefits are an irreplaceable source
of income for those members of our society who are no longer
able to work. While some of these disabilities stem from birth,
studies show that a 20-year-old worker has a 3-in-10 chance of
becoming disabled before reaching retirement age. The average
processing time for initial disability claims is 104 days--over
3 months with no income. If the case is appealed, an average of
352 additional days is required, bringing the decision to 456
days, or 15 months without income. More than 50 percent of the
wait time is due to the backlog of cases. The Committee has
provided a $636,000,000 increase, or 7.1 percent, in
administrative funding to the SSA in order to work down this
backlog.
Workforce
When a worker with a disability is able to transition into
employment, the individual experiences an increase in income,
and self-sufficiency while contributing to the community and
providing a positive learning experience for others in the
workplace. In addition, the State saves money in benefit
payments. For these reasons, the Committee created the Office
of Disability Employment Policy [ODEP] in fiscal year 2001 with
the goal of bringing a heightened and permanent long-term focus
to the goal of increasing employment of persons with
disabilities. The Committee has allocated $47,333,000 this year
for this important office.
Specifically, the Committee believes that telework and
electronic networking can be of immense benefit to individuals
with disabilities, opening employment opportunities to persons
who cannot commute to their workplace. Within the Office of
Disability Employment Policy, the Committee has funded
$2,500,000 for increased telecommuting opportunities for
individuals with disabilities so they can gain economic
independence. These funds are to be used to enable Government
agencies to explore the feasibility of employing home-based
workers with significant disabilities.
Community Integration
In 1999, the Supreme Court recognized in the Olmstead
decision that needless institutionalization was discrimination
and that States were continuing to segregate individuals with
disabilities in institutional settings. According to the most
recent data available, Medicaid funding continues to favor
institutional care over community services. Data from 2001
indicate that 70 percent of Medicaid funding for long-term
services is spent on institutions and only 30 percent is spent
on community-based services.
Therefore, the Committee has allocated $40,000,000 for
Systems Change grants in the Centers for Medicare and Medicaid
Services [CMS] to continue the effort in States to develop and
reform their service systems to encourage community-based
services and supports.
Direct Service Workers
The Committee recognizes that direct service workers are
the backbone of the community service system, yet they face
increasing challenges. The Bureau of Labor Statistics predicts
a 39 percent growth in the need for direct service workers in
the next 10 years. In order to meet this need, there must be
improvements in recruitment, training, supervision, retention,
and benefits.
The Committee strongly believes that a commitment to
improving the long-term community service system in States is
imperative to allow individuals with disabilities to truly gain
the freedom and independence envisioned in the Americans with
Disabilities Act. For this reason, the Committee has funded
$6,000,000 for the Service Worker Demonstration Projects, an
increase of $3,000,000 over the President's budget request.
Developmental Disabilities
Nearly 4 million Americans have developmental
disabilities--severe, chronic disabilities attributable to
mental and/or physical impairment, which manifest before age 22
and are likely to continue indefinitely. The Committee is
deeply committed to providing increased capacity for assisting
the families and individuals with disabilities. For that
reason, the Committee has restored the funding for these
important programs and provided a 4 percent increase overall.
Families of children with disabilities provide support,
care, and training that not only encourages and enables their
children to become active members of our communities but also
save States millions of dollars. Unfortunately, most families
of children with disabilities, especially families in
underserved areas, do not have access to support services to
help them in their efforts to care for such children at home.
Within the Projects of National Significance, the Committee has
provided $4,000,000 for family support services, recognizing
that families often play a critical role in supporting
individuals with disabilities so they can live in their home
communities.
Disabled Voter Services
There should be no issue of greater importance to a
democratic government than the right to vote. The Help America
Vote Act of 2002 had as its goal the improvement of access to
voting places and the ability of communities to record and
transmit the votes of their citizens. Persons with disabilities
often experience barriers to voting that include proper
physical access to polling places and voting machines that are
not accessible to individuals with disabilities. The Committee
strongly believes that any barrier to the right of citizens to
vote endangers our democracy. For that reason, the Committee
has included $15,000,000 in funding for the Disabled Voter
Services program.
Gallaudet University
Gallaudet University, founded in 1864, is the world's only
university that brings together deaf, hard of hearing, and
hearing students as well as faculty in the common pursuit of
education. The Committee maintains its commitment to this
institution by including funding for its operating budget and
endowment and at an increase of $3,002,000.
American Printing House for the Blind
The American Printing House for the Blind [APH] was founded
in Louisville, Kentucky in 1858 and in 1879 became the official
supplier of educational materials for students with visual
impairments below the college level in the United States and
its territories. The Committee recognizes the important role
this institution plays in the lives of visually impaired
Americans and therefore has provided an increase of 6 percent.
National Council on Disability
The National Council on Disability [NCD] is an independent
Federal agency making recommendations to the President and
Congress on issues affecting Americans with disabilities. NCD
is currently coordinating a multi-year study on the
implementation and enforcement of the Americans with
Disabilities Act and other civil rights laws. The Committee
appreciates this work and has included an additional $500,000
to continue and expand the survey.
Preventing and Reversing Heart Disease Initiative
Nearly 63 million Americans, young and old, live with the
effects of cardiovascular disease. Heart disease and related
disorders account for 960,000 deaths each year--the Nation's
number one killer. The economic losses are more than any other
disease costing society over $330,000,000,000 annually in
medical costs and lost productivity. Challenges to combating
this disease include persistent geographic, racial, and ethnic
disparities, the increased prevalence of sedentary lifestyles,
obesity rates, and deficiencies in the use of proven and
effective treatments for those already afflicted with
cardiovascular disease.
On May 16, 2002, the Subcommittee on Labor, Health and
Human Services and Education convened a hearing to more closely
examine the factors contributing to cardiovascular disease, and
to explore possible approaches to prevent, control, and reverse
its effects. Testimony heard from a variety of top medical
experts reflected a common theme: All agreed that stress
management, in conjunction with diet modification, exercise,
and pharmacological and/or surgical intervention, can
significantly improve the quality of life for those confronted
with cardiovascular disease. Witnesses confirmed that
cardiovascular disease usually begins several years before
symptoms appear. Due to the body's compensation mechanisms many
individuals function normally for years in an asymptomatic
state, unaware that the disease is taking hold. Once symptoms
become apparent, a disproportionate amount of medical resources
are devoted to dealing with those symptomatic events, rather
than taking preventive measures at a much earlier stage.
Integrating technology, behavioral and metabolic medicine, and
lifestyle modifications at an early age would shift that focus
from reactive medicine to preventive medicine. For example,
relatively simple lifestyle modifications, including exercise,
nutrition plans and learning a relaxation response to stress,
such as yoga techniques, have led to successful outcomes for
individuals who are otherwise at risk. Individuals who have
adopted these changes have experienced positive results,
including weight loss, lower blood pressure and cholesterol
levels, improved clinical symptoms and reduction in
psychological distress. For many years the National Heart,
Lung, and Blood Institute has supported a vigorous program of
research on the behavioral and psychological impact of
cardiovascular disease. Data obtained by NHLBI confirmed that
mental stress could cause myocardial ischemia or reduced blood
flow.
Current evidence suggests that all individuals at risk for
cardiovascular disease can benefit from stress reduction, but
that general health and well-being are greatly improved if the
first steps are taken during childhood. Among children, in
fact, stress management programs have been shown to improve
self-esteem, grade-point average and work habits while reducing
violent behavior. To that end, the educational system in this
country should be encouraged to incorporate stress management
programs into school curriculum.
To address the prevention and reversing heart disease
initiative, the Committee has included $5,758,686,000 in
addition to the amounts provided as part of the physical
activity and nutrition initiative.
Obesity and nutrition programs work hand in hand in
preventing and reducing heart disease. The Committee encourages
the Departments of Health and Human Services and Education to
coordinate the above programs and activities to address both
initiatives.
Fund for Innovative Education
As part of the preventing and reversing heart disease
initiative, the Committee has included $1,000,000 to design
programs to teach school children and teachers coping skills to
help ease both the short- and long-term effects of stress. The
Committee directs the Department to implement this initiative
as soon as possible. Programs such as these have been
scientifically proven to improve students' self-esteem, self-
efficacy, control, grade point average, work habits, memory and
cooperation.
National Heart, Lung, and Blood Institute
For research into the prevention, causes and cures for
heart disease and related disorders at the National Heart,
Lung, and Blood Institute, the Committee has included
$2,897,595,000, an increase of $103,862,000 over the fiscal
year 2003 level.
The Committee strongly encourages the NHLBI, in conjunction
with Walter Reed Medical Center, to conduct a controlled,
prospective, randomized trial to compare the outcomes of
utilizing a demanding vegetarian diet versus a more liberal
diet that would also utilize lipid-lowering drugs, as well as
the impact of relaxation response-based stress management
programs. Such a trial could take place over a long period of
time to allow a long-term assessment of outcomes.
Centers for Medicare and Medicaid Service
The Committee commends the Centers for Medicare and
Medicaid Service [CMS] for continuing their work on a lifestyle
modification study comparing the efficacy and costs of two
cardiac approaches to reversing heart disease.
The Committee understands that recent research indicates
there are significant health and economic benefits from
incorporating psychological interventions, such as stress
management and other cognitive behavioral interventions, in the
overall treatment of cardiovascular disease. If proven, this
would greatly benefit Medicare and Medicaid Services patients
with heart disease while saving money. Heart disease is the
number one cause of death in the Nation and is particularly
prevalent among the elderly. A demonstration of this research
is critically important. Therefore, the Committee expects the
Centers for Medicare & Medicaid Services to conduct a study of
the cost savings and quality of care benefits from
incorporating stress management and other cognitive behavioral
interventions in the treatment of Medicare beneficiaries with
cardiovascular disease.
Centers for Disease Control
The Committee has provided $45,963,000 to increase CDC's
cardiovascular programs as part of the Committee's initiative
to prevent and reverse heart disease. The Committee urges the
CDC to initiate research to examine strategies to prevent and
reverse heart disease, including mind/body approaches to stress
management, yoga, diet modifications, and exercise programs.
To improve the health of racial and ethnic populations
through the development of effective health policies and
programs to eliminate disparities in health, the Committee has
provided $192,824,000 for the National Center on Minority
Health and Health Disparities and $37,561,000 to eliminate
racial and ethnic health disparities. Also included, to address
areas hardest hit by the HIV-AIDS epidemic, is $131,884,000
specifically targeted for minority AIDS programs and
$585,900,000 for minority AIDS research at the National
Institutes of Health.
To aid institutions with a significant percentage of
financially needy students, the Committee has provided an
increase of $487,519,000, an increase of $15,196,000 over the
fiscal year 2003 appropriation. Included in this amount is
$81,467,000 for strengthening institutions, $93,551,000 for
Hispanic-serving institutions, $224,086,000 for historically
black colleges and universities, $53,415,000 for strengthening
historically black graduate institutions, and Native Alaskan
and Native Hawaiian institutions are funded at $11,000,000.
To assist States, colleges, middle and high schools serving
high percentages of low income students and improve
postsecondary education opportunities for low-income
individuals and first-generation college students, the
Committee has included $840,000,000 for TRIO and $300,000,000
for GEAR UP programs. To assist Howard University with academic
programs and the administration of the University hospital, the
Committee recommends $238,440,000.
The increases provided for the above-mentioned programs,
along with funding for the National Institutes of Health, the
Centers for Disease Control and Prevention, and education
programs will go a long way towards eliminating health and
education disparities.
Prostate Cancer Research and Prevention
Prostate cancer is the most common cancer, with the
exception of skin cancer, in men. It is the second leading
cause of cancer death in American men, exceeded only by lung
cancer. This year over 198,100 new cases of prostate cancer
will be diagnosed and 31,500 men will die from it. African-
American men are more likely both to have prostate cancer and
twice as likely to die from it than are white or Asian men.
Among men diagnosed with prostate cancer, 97 percent survive at
least 5 years, 79 percent survive at least 10 years, and 57
percent survive at least 15 years.
The Committee commends the National Institutes of Health
for preparing a prostate cancer research plan which will enable
the National Cancer Institute and the other institutes at the
NIH to respond to new discoveries and research opportunities.
The Committee supports the goals and objectives outlined in the
plan which focus on discovering genetic, biochemical,
environmental, and lifestyle factors and how they relate to
prostate cancer risks.
Over the past decade, significant progress has been made in
characterizing molecular and cellular changes and the
mechanisms responsible for malignant transformation and cancer
progression. Progress is also being made in understanding the
interactions between the cancer cell and its environment that
influence organ invasion, metastases, hormone-independent
growth, and resistance to cell death.
The Committee is strongly committed to improving research
and prevention efforts in the area of prostate cancer and has
included $4,770,519,000, an increase of $178,171,000 over the
fiscal year 2003 appropriation, for cancer research programs at
the National Institutes of Health. The Committee understands
that of this amount, the National Cancer Institute plans to
devote approximately $399,900,000 specifically for prostate
cancer research.
Prostate Cancer and Minority Health
The Committee is also encouraged by the efforts of the
National Center on Minority Health and Health Disparities to
collaborate with the National Human Genome Research Institute
to fund research to determine the environmental and familial/
genetic risk factors for prostate cancer. This collaborative
effort will lead to a better understanding of the genetic basis
of this disease and its disproportionate impact on African
Americans.
The Centers for Disease Control and Prevention is also
working to better understand prostate cancer. The CDC is also
emphasizing the high incidence of the disease in the African-
American community. The Committee is supportive of CDC's
efforts to enhance prostate cancer data in State cancer
registries, especially with regard to stage of diagnosis,
quality of care and racial and ethnic information. To address
prostate cancer initiatives at the CDC, the Committee has
included $15,583,000, an increase of $1,628,000 over the fiscal
year 2003 appropriation.
Diet and Prostate Cancer
The Committee is interested in the correlation between diet
and prostate cancer. Some studies suggest that saturated fat or
red meat maybe associated with a higher risk of prostate
cancer. But so far, studies have not proven components in meat
or dairy foods could cause prostate cells to go haywire. In a
Harvard study, conducted in 1993, researchers reported that men
who ate red meat most frequently had more than double the risk
of advanced prostate cancer compared to men who ate little or
no red meat.
Increasing scientific evidence indicates that what you
include in your diet may be as important as what you exclude.
Scientists estimate that at least 30-40 percent of all cancers
are linked to diet and related lifestyle factors. Some foods
contain substances known to increase the risk of cancer,
including saturated fat, cholesterol, and oxidants. Avoiding
these foods may reduce the risk of many of the most common
forms of cancer, including prostate cancer, breast cancer, and
colon cancer. Other foods contain substances that help protect
against cancer and heart disease, and these are sometimes known
as functional foods. These include phytochemicals,
bioflavinoids, retinols, isoflavones, genestein, lycopene
(found in tomatoes), and sulforaphanes (in broccoli). With few
exceptions, these protective substances are found in fruits,
vegetables, whole grains, legumes, and soy products. A growing
number of compounds in fruits, vegetables, and cereal grains
have been found to interfere with the process of cancer
development in laboratory research. Epidemiologists have found
that populations that consume large amounts of plant-derived
foods have lower incidence rates of some types of cancer.
Eating vegetables and fruits is associated with a decreased
risk of cancers of the esophagus, oral cavity, stomach, colon,
rectum, lung, prostate, and larynx and possibly other cancers.
The Committee is aware of randomized controlled trials that
are being conducted to determine if prostate cancer may be
affected by making changes in diet and lifestyle. In these
studies 90 men with biopsy-proven prostate cancer--who had
elected not to undergo conventional treatment--for reasons
unrelated to the study were randomly assigned into experimental
groups--one group was asked to make comprehensive lifestyle
changes and the other group was assigned to a non-intervention
control group. The study found that the progression of prostate
cancer may be stopped or perhaps even reversed by making
comprehensive lifestyle changes alone. After 1 year, PSA levels
worsened in the control group but improved in the experimental
group. These differences were statistically significant after 1
year. Also, tumor growth in tissue culture was inhibited nine
times more in the experimental group than in the control group.
There was a strong and statistically significant correlation
between adherence to the lifestyle program and changes in PSA
across both groups after 1 year. The more people changed, the
more their PSA decreased. This is the first time that a diet
and lifestyle intervention has been demonstrated to affect the
progression of any type of cancer in a randomized controlled
trial.
If these trials prove to be effective, and heart disease
and prostate cancer can be stopped or reversed, then the
implications for preventing them in the next generation may be
even more important. Also, it may not require such intensive
changes in diet and lifestyle to prevent these diseases as it
does to stop or reverse their progression once a person has
already developed them. These patients will be followed for at
least 5 more years to determine the long-term effects of diet
and lifestyle changes on rate of recurrence, metastasis, number
of patients requiring conventional treatment, and survival.
The Committee encourages the National Institutes to monitor
the trials currently being conducted and to support research in
the area of diet and lifestyle modifications to prevent or
reverse prostate cancer.
Infectious Disease Initiative
Infectious diseases are a leading cause of death worldwide
and contribute significantly to the escalating costs of health
care. Earlier predictions of the elimination of infectious
diseases often did not take into account changes in
demographics and human behaviors and the extraordinary ability
of microbes to adapt, evolve, and develop resistance to drugs.
More than 35 newly emerging infectious diseases were identified
between 1973 and 2002, and new infectious diseases continue to
be identified. Disease outbreaks endanger U.S. citizens at home
and abroad. To address these needs the Committee has included
$2,238,960,000 to improve this Nation's research capabilities
and to detect and control emerging infectious disease threats
in the United States and around the world.
Emerging Infectious Disease
Emerging infectious diseases, like West Nile virus, SARS
and monkeypox, continue to pose a serious threat to the
public's health. Outbreaks of these diseases cause great
suffering and death and impose an enormous financial burden on
societies around the world. The Committee recognizes the
necessity of a strong domestic public health infrastructure and
robust partnerships between CDC, the National Institutes of
Health, the World Health Organization, and other global
stakeholders to counter the threat posed by emerging
infections. Recent experiences with SARS, West Nile virus and
monkeypox illustrate the vital necessity of strengthening this
Nation's capacity to identify and combat emerging infectious
diseases. The Committee had included $372,760,000,000 for
infectious disease control at the Centers for Disease Control
including $25,000,000 for containment of disease outbreaks such
as SARS and monkeypox. For emerging infectious diseases at the
National Institutes of Health, the Committee has included
$1,686,200,000, an increase of $599,000,000 over the fiscal
year 2003 appropriation.
Public Health Research
Our Nation's substantial economic investment in biomedical
research has identified causes of and methods to prevent
illness, allowing medical practitioners to diagnose and treat
an astonishing array of medical conditions. In order to have a
public health impact commensurate with this level of
investment, however, the information generated in biomedical
laboratories must be translated into effective public health
programs. Public health research conducted by CDC is solution-
oriented, designed to bridge the gap between medical research
discoveries and behaviors people adopt. Specifically, public
health research helps to define the best strategies for
detecting new diseases, assessing the health status of
populations, motivating healthy lifestyles, communicating
effective health promotion messages, and acquiring and
disseminating information in times of crisis. This kind of
practical, applied research seeks to overcome barriers that
prevent people from adopting healthy behaviors proven effective
by biomedical research. The Committee has included $30,000,000
for public health research to improve the health status of the
Nation.
Global Disease Detection System
The Committee commends CDC for its role in strengthening
the capacity of the public health community, both at home and
abroad, to respond to global threats, such as West Nile virus,
SARS, monkeypox, pandemic flu and bioterrorism. CDC's Global
Disease Detection System, designed to provide worldwide
technical support to ensure rapid and accurate diagnoses of
emerging infectious disease events, is integral to these
efforts. These capacities are critical to mitigate the
consequences of a catastrophic public health event, whether the
cause is an intentional act of terrorism or the natural
emergence of a deadly infectious virus. The Committee has
provided $50,000,000 for CDC to develop the Global Disease
Detection System to full capacity to assure a rapid and
appropriate response to global infectious disease threats.
Pandemic Flu
Pandemic influenza represents both a naturally-occurring
and potentially man-made threat to our Nation's health. The
influenza pandemic of 1918 claimed more than 25 million lives
globally and more than 500,000 in the United States in less
than 10 months. Most scientists agree that it is not a question
of whether there will be another influenza pandemic, but rather
when it will occur. Once a pandemic begins, it will be too late
to accomplish the activities required to minimize its toll.
Vaccines cannot be prepared in advance and stockpiled, but
planning and implementation of preparatory activities can be
started well in advance. Currently, the Nation's influenza
vaccine supply totals about 90 million doses. Preparing for a
severe pandemic could require more than 280 million doses of
vaccine. The Committee has included $100,000,000 to provide
resources to produce an adequate supply of vaccine in the event
of a severe flu outbreak.
REPROGRAMMING AND INITIATION OF NEW PROGRAMS
Reprogramming is the utilization of funds for purposes
other than those contemplated at the time of appropriation
enactment. Reprogramming actions do not represent requests for
additional funds from the Congress, rather, the reapplication
of resources already available.
The Committee has a particular interest in approving
reprogrammings which, although they may not change either the
total amount available in an account or any of the purposes for
which the appropriation is legally available, represent a
significant departure from budget plans presented to the
Committee in an agency's budget justification.
Consequently, the Committee directs that the Departments
and agencies funded through this bill make a written request to
the chairman of the Committee prior to reprogramming of funds
in excess of 10 percent, or $500,000, whichever is less,
between programs, activities, or elements unless an alternate
amount for the agency in question is specified elsewhere in
this report. The Committee desires to have the requests for
reprogramming actions which involve less than the above-
mentioned amounts if such actions would have the effect of
changing an agency's funding requirements in future years, if
programs or projects specifically cited in the Committee's
reports are affected or if the action can be considered to be
the initiation of a new program.
The Committee directs that it be notified regarding
reorganization of offices, programs, or activities prior to the
planned implementation of such reorganizations.
The Committee further directs that each agency under its
jurisdiction submit to the Committee statements on the effect
of this appropriation act within 60 days of final enactment of
this Act.
TRANSFER AUTHORITY
The Committee has included bill language permitting
transfers up to 1 percent between discretionary appropriations
accounts, as long as no such appropriation is increased by more
than 3 percent by such transfer; however, the Appropriations
Committees of both Houses of Congress must be notified at least
15 days in advance of any transfer. Similar bill language was
carried in last year's bill for all three Departments.
Prior Committee notification is also required for actions
requiring the use of general transfer authority unless
otherwise provided for in this Act. Such transfers specifically
include taps, or other assessments made between agencies, or
between offices within agencies. Funds have been appropriated
for each office funded by this Committee; it is not the
intention of this Committee to augment those funding levels
through the use of special assessments. This directive does not
apply to working capital funds or other fee-for-service
activities.
TITLE I--DEPARTMENT OF LABOR
Employment and Training Administration
TRAINING AND EMPLOYMENT SERVICES
Appropriations, 2003.................................... $5,200,161,000
Budget estimate, 2004................................... 4,951,986,000
Committee recommendation................................ 5,115,588,000
The Committee recommends $5,115,588,000 for this account in
2004 which provides funding authorized primarily by the
Workforce Investment Act [WIA]. This is $84,573,000 less than
the 2003 level, and $163,602,000 above the administration
request.
Training and employment services is comprised of programs
designed to enhance the employment and earnings of economically
disadvantaged and dislocated workers, operated through a
decentralized system of skill training and related services.
This appropriation is generally forward-funded on a July-to-
June cycle. Funds provided for fiscal year 2004 will support
the program from July 1, 2004, through June 30, 2005.
Beginning with the fiscal year 2000 appropriation, budget
constraints required that a portion of this account's funding
be advance appropriated, with obligations for a portion of
Adult and Dislocated Worker Employment and Training Activities
and Job Corps delayed until the following fiscal year. This
practice will continue in this year's appropriation.
Fiscal year 2000 was the first full year of operations
under the Workforce Investment Act, beginning July 1, 2000
through June 30, 2001. This legislation significantly enhanced
employment and training services, consolidating, coordinating,
and improving programs utilizing a local level one-stop
delivery system.
The legislation is due for reauthorization for fiscal year
2004, and therefore, the Committee is acting on a current law
request, deferring without prejudice proposed legislative
language that should be addressed by the authorizing
Committees.
Adult Employment and Training Activities.--For Adult
Employment and Training Activities, the Committee recommends
$900,000,000. This program is authorized by the Workforce
Investment Act and is formula-funded to States and further
distributed to local workforce investment boards. Services for
adults will be provided through the One-Stop system and most
customers receiving training will use their individual training
accounts to determine which programs and providers fit their
needs. The Act authorizes core services, which will be
available to all adults with no eligibility requirements, and
intensive services, for unemployed individuals who are not able
to find jobs through core services alone.
Dislocated Worker Employment and Training Activities.--For
Dislocated Worker Employment and Training Activities, the
Committee recommends $1,431,760,000. Of the total,
$1,155,152,000 is designated for State formula grants, the same
as the fiscal year 2003 level. This program, authorized by WIA,
is a State-operated effort which provides core services,
intensive services, training, and supportive services to help
permanently separated workers return to productive,
unsubsidized employment. In addition, States use these funds
for rapid response assistance to help workers affected by mass
layoffs and plant closures. The recommendation includes
$276,608,000 available to the Secretary for activities
specified in WIA, primarily to respond to mass layoffs, plant
and/or military base closings, and natural disasters across the
country, which cannot be otherwise anticipated, as well as
technical assistance and training and demonstration projects.
The Committee bill continues language authorizing the use
of funds under the dislocated workers program for projects that
provide assistance to new entrants in the workforce and
incumbent workers.
The Committee recommendation includes, as it has in past
years, funding for dislocated worker projects aimed at
assisting the long-term unemployed.
The Committee expects the Department to abide by its August
2002 agreement to provide sufficient funds to the State of
Alaska from within available amounts to mitigate negative
effects on Alaskan fishermen stemming from passage of the Trade
Adjustment Assistance Act in 2002 as provided in the agreement
with the Secretary.
Due to economic reasons and family dysfunction, elderly
caregivers care for thousands of preschool Hawaiian and part-
Hawaiian children with little or no preparation. The Committee
urges the Department to expand funding to programs which work
to train and assist these caregivers and the children they
serve. The Committee was pleased to learn from the Secretary
that the administration has established an interagency effort
to address our Nation's nursing shortage. The shortage is
especially critical in rural America and within various ethnic
minority populations, such as native Hawaiians. The Department
is accordingly strongly urged to work with nursing programs
serving such populations, and in particular, to ensure that
summer employment opportunities exist for nursing students.
The Committee is aware of the substantial worker
dislocation brought on by the closure of sugarcane plantations
and the rapidly increasing demand for food safety training at
all levels of food production. To meet these needs, the
Committee reiterates its recommendation in last year's report
to provide on-farm and off-farm food safety training for
dislocated sugarcane workers employed in the agricultural and
food sector. To facilitate the transition from large-scale
plantation agriculture to smaller scale diversified
agricultural operations, workers displaced by plantation
closures must be trained in both the production and financial
aspects of agricultural businesses. The Committee recommends
continuing funding for the programs to provide agricultural
production and business training to dislocated sugarcane
workers.
The Committee is troubled by the length of time it takes
for the Department to approve applications for National
Emergency Grants. The purpose of this program is to provide
emergency help to workers who have recently lost their jobs get
training to quickly find a new job. However, it routinely takes
the Department several months to respond to emergency requests.
The Committee expects the Department to submit a report to the
Committee on the timeline of the National Emergency Grant
process over the last 3 fiscal years. The report should detail
the length of time between the Department's receipt of a
National Emergency Grant application to the decision to award
that grant and finally to the release of those funds. The
Committee is also concerned by a shortfall in the Trade
Adjustment Assistance program over the last few years and would
like the report to include the percentage of National Emergency
Grant funding that has been awarded to Trade Adjustment
Assistance-eligible entities over the same period of time. The
Department should submit this report to the Committee within 90
days after enactment of this bill.
Youth Activities.--For Youth Activities, the Committee
recommends $1,000,965,000. The Committee recommendation does
not address the administration's legislative proposals for
these activities. Youth Activities, authorized by WIA,
consolidates the Summer Youth Employment and Training Program
under JTPA Title IIB, and Youth Training Grants under JTPA
Title IIC. In addition to consolidating programs, WIA also
requires Youth Activities to be connected to the One-Stop
system as one way to link youth to all available community
resources. The purpose of Youth Activities is to provide
eligible youth with assistance in achieving academic and
employment success through improving educational and skill
competencies and providing connections to employers. Other
activities include providing mentoring opportunities,
opportunities for training, supportive services, summer
employment opportunities that are directly linked to academic
and occupational learning, incentives for recognition and
achievement, and activities related to leadership development,
citizenship, and community service.
Youth Opportunity Grants.--For Youth Opportunity Grants,
the Committee the concurs with the budget request discontinuing
funding for this demonstration program. During its 5 year
demonstration period, Youth Opportunity Grants were aimed at
increasing the long-term employment of youth who live in
empowerment zones, enterprise communities, and other high-
poverty areas.
Job Corps.--For Job Corps, the Committee recommends
$1,541,216,000. This is $24,667,000 less than the budget
request, but $28,045,000 more than the 2003 comparable level.
The Committee applauds Job Corps for establishing partnerships
with national employers, and encourages Job Corps to continue
to work with both large employers and small businesses to
ensure that student training meets current labor market needs.
Job Corps should continue its efforts to upgrade its vocational
offerings and curricula to reflect industry standards and skill
shortages. Job Corps, authorized by WIA, is a nationwide
network of residential facilities chartered by Federal law to
provide a comprehensive and intensive array of training, job
placement and support services to at-risk young adults. The
mission of Job Corps is to attract eligible young adults, teach
them the skills they need to become employable and independent,
and place them in meaningful jobs or further education.
Participation in the program is voluntary and is open to
economically disadvantaged young people in the 16-24 age range
who are unemployed and out of school. Most Job Corps students
come from disruptive or debilitating environments, and it is
important that they be relocated to residential facilities
where they can benefit from the highly structured and carefully
integrated services provided by the Job Corps program. A
limited number of opportunities are also available for non-
residential participation.
The Committee encourages Job Corps to strengthen working
relationships with work force development entities, including
employers, that will enhance services to students and increase
students' career opportunities. The Department is encouraged to
continue its efforts to meet industry standards in its
occupational offerings through a multi-year process to review,
upgrade, and modernize its vocational curricula, equipment, and
programs in order to create career opportunities for students
in appropriate growth industries. The Committee also continues
to encourage the Department of Labor's Employment and Training
Administration to encourage Job Corps centers to coordinate
with community-based organizations, such as substance abuse
treatment centers, in innovative ways.
The Committee supports the goal of the Workforce Investment
Act of 1998 to integrate our Nation's many diverse job training
programs, and its approach of retraining the national character
of the Job Corps program within the new framework. The
Committee encourages the Department to continue its work to
develop national partnerships with major regional and national
employers to increase employment opportunities for Job Corps
graduates. The Department should also continue to establish
connections between Job Corps and State workforce development
programs, and between Job Corps and other national and
community partners, to provide the most efficient, cost-
effective services possible.
The Committee recognizes Project CRAFT (Community,
Restitution, and Apprenticeship-Focused Training), a program of
the Home Builders Institute, the workforce development arm of
the National Association of Home Builders, as a modern
intervention technique in the rehabilitation and reduced
recidivism of adjudicated youth. The Committee also
acknowledges the importance of housing to our Nation's economy
and the role Project CRAFT plays in preparing young people to
join the residential construction industry's workforce. The
Committee therefore encourages the Department to replicate
Project CRAFT to bring its outcomes-oriented approach to
adjudicated juveniles throughout the country in order to help
them become members of this vibrant industry's workforce and
spur the nation's economy.
The Committee believes that Job Corps' partnerships with
National Training Contractors, such as the Home Builders
Institute [HBI], the workforce development arm of the National
Association of Home Builders, are essential to the success of
Job Corps. The Committee commends HBI for its proven record in
providing at-risk youth with the craft skills training and
employment opportunities they need to succeed while helping the
building industry meets its workforce needs. As such, the
Committee encourages the Department to expand its Job Corps
partnership with the building industry in order to ensure the
continued availability of skilled workers for this thriving
industry.
The Committee commends the Job Corps program for
establishing cost-effective national and local partnerships
with the United States Army, Navy, and Coast Guard to recruit
high quality military personnel. Job Corps students' average
scores on military entrance exams exceed the national average.
Last year, the Army recruited more than 2,000 Job Corps
graduates. The Committee also recognizes that the Job Corps is
training young people with skills that are in high demand by
civilian support contractors who service the military,
including computer technology, nursing, and welding.
Responsible Reintegration for Youthful Offenders.--The
Committee recommends $54,642,000 for Responsible Reintegration
for Youthful Offenders, the same as the fiscal year 2003 level,
to address youth offender issues. This large scale WIA Pilot
and Demonstration initiative will link offenders under age 35
with essential services that can help make the difference in
their choices in the future, such as education, training, job
placement, drug counseling, drug demand reduction activities,
and mentoring, in order to reintegrate them into the mainstream
economy. Through local competitive grants, this program would
establish partnerships between the criminal justice system and
local workforce investment systems, complementing a similar
program in the Department of Justice. To maximize the impact of
these initiatives, the Labor and Justice Department funds will
be targeted to the same communities and populations. An
estimated 10,400 youth will be served, and it is expected that
65 percent of program graduates will get jobs, re-enroll in
high school, or be enrolled in post-secondary education or
training.
Native Americans.--For Native Americans, the Committee
recommends $55,636,000. This is the same as the 2003 comparable
level. This program, authorized by WIA, is designed to improve
the economic well-being of Native Americans (Indians, Eskimos,
Aleuts, and Native Hawaiians) through the provision of
training, work experience, and other employment-related
services and opportunities that are intended to aid the
participants to secure permanent, unsubsidized jobs.
Migrant and Seasonal Farmworkers.--For Migrant and Seasonal
Farmworkers, the Committee recommends $77,330,000. This is the
same as the 2003 comparable level. This program, authorized by
WIA, is designed to serve members of economically disadvantaged
families whose principal livelihood is derived from migratory
and other forms of seasonal farmwork, or fishing, or logging
activities. Enrollees and their families are provided with
employment training and related services intended to prepare
them for stable, year-round employment within and outside of
the agriculture industry.
There are at least 3 million hard-working migrant and
seasonal farmworkers in America whose annual incomes are below
$10,000. At a time when most State budgets are shrinking and
many of the basic services provided by State and local
governments are being cut back, the Committee recognizes the
importance of sustaining a national commitment, dating from
1964, to help alleviate the chronic seasonal unemployment and
under-employment that traps many farmworker families in a cycle
of poverty across generations and that deprives many farmworker
children of educational opportunities and real prospects for
better jobs at higher wages. The Committee also recognizes that
many State and local government officials will be reluctant to
fund this training and related assistance for this vulnerable
portion of our Nation's workforce who migrate through many
States every year, even though the work they perform is
essential to the economic well-being of our Nation's farmers,
growers, and small businesses.
The Committee has rescinded funds available to the
Department of Labor from farmworker housing for program year
2003 because the Department proposed to use them in a manner
inconsistent with the intent of Congress. It continues to be
the intention of the Committee that funds appropriated for
farmworker housing, that is an authorized supportive service
under the Workforce Investment Act, be used to develop
permanent housing for eligible migrant and seasonal
farmworkers.
The Committee has included language that re-appropriates
the funds rescinded as well as provides an appropriation for
program year 2004. In doing so, the Committee has earmarked the
program year 2003 funds for use of farmworker housing
organizations with grants expiring June 30, 2003. The principal
purpose of these funds is to develop permanent housing and
related facilities for migrant and seasonal farmworkers.
The Committee recommendation of $77,330,000 for program
year 2004 activities authorized under Section 167 of the
Workforce Investment Act is reflected in two separate line
items on the table accompanying the Committee Report: ``Migrant
and Seasonal Farmworkers'' and ``National Activities/Other.''
Under the Migrant and Seasonal Farmworkers line item, the
Committee recommends $72,213,000. The Committee recommendation
includes bill language directing that $4,610,000 of this amount
be used for migrant and seasonal farmworker housing grants,
including activities to develop permanent housing. 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 85
percent of the comparable 1998 levels for such States. Within
the National Activities/Other line item, the Committee
recommendation includes $507,000 to be used for Section 167
training, technical assistance and related activities,
including funds for migrant rest center activities. The
Committee urges the Department to continue valuable technical
assistance services provided by the Association of Farmworker
Opportunity Programs. Finally, the Committee wishes to again
advise the Department regarding the requirements of the
Workforce Investment Act in selecting an eligible entity to
receive a State service area grant under Section 167. Such an
entity must have already demonstrated a capacity to administer
effectively a diversified program of workforce training and
related assistance for eligible migrant and seasonal
farmworkers.
National Programs.--This activity includes WIA-authorized
programs in support of the workforce system including technical
assistance and incentive grants, evaluations, pilots,
demonstrations and research, and the Women in Apprenticeship
Program.
Technical Assistance.--The Committee recommends the budget
request level of $3,000,000 for the provision of technical
assistance and staff development. This includes the current
level of $993,000 for technical assistance to employers and
unions to assist them in training, placing, and retraining
women in nontraditional jobs and occupations.
Pilots, Demonstrations, and Research.--The Committee
recommends $35,000,000, the same as the budget request, for
grants or contracts to conduct research, pilots or
demonstrations that improve techniques or demonstrate the
effectiveness of programs.
In addition, the Committee recommends $7,000,000 for the
Denali Commission for job training in rural Alaska. Funding
will allow un- and underemployed rural Alaskans to train for
high paying jobs in their villages.
The Committee is deeply concerned about the ability of the
28 million Americans who are deaf or hard-of-hearing to be
informed of critical news and information in the post-9/11/01
environment. The Committee is aware that court reporting
schools may not be able to meet the ``unfunded mandate'' set by
the Telecommunications Act of 1996 to provide closed captioning
of 100 percent of broadcast programming by January 2006. These
compelling concerns justify continued Federal support to those
schools to increase their capability to attract and train more
real time writers and to work closely with the broadcasting
industry to significantly increase the amount of programming
that is closed captioned, that 100 million Americans utilize
closed captioning in some form and the shortage of providers
need to be addressed immediately.
Evaluation.--The Committee recommends $9,039,000 to provide
for the continuing evaluation of programs conducted under WIA,
as well as of federally-funded employment-related activities
under other provisions of law.
Women in Apprenticeship.--The Committee concurs with the
administration request to discontinue separate funding of
$933,000 for the Women in Apprenticeship and Nontraditional
Occupations program. This activity is continued with technical
assistance funding under the Workforce Investment Act, to
assist employers and unions in training, placing, and
retraining women in nontraditional jobs and occupations.
COMMUNITY SERVICE EMPLOYMENT FOR OLDER AMERICANS
Appropriations, 2003.................................... $442,306,000
Budget estimate, 2004................................... 440,200,000
Committee recommendation................................ 442,306,000
The Committee recommends $442,306,000, the same as the
program year 2003 comparable level for community service
employment for older Americans. This program, authorized by
title V of the Older Americans Act, provides part-time
employment in community service activities for unemployed, low-
income persons aged 55 and over. It is forward-funded from July
to June, and the 2004 appropriation will support the program
from July 1, 2004, through June 30, 2005. The Committee
believes that within the title V community service employment
for older Americans, special attention should be paid to
providing community service jobs for older Americans with poor
employment prospects, including individuals with a long-term
detachment from the labor force, older displaced homemakers,
aged minorities, limited English-speaking persons, and legal
immigrants.
The program provides a direct, efficient, and quick means
to assist economically disadvantaged older workers because it
has a proven effective network in every State and in
practically every county. Administrative costs for the program
are low, and the vast majority of the money goes directly to
low-income seniors as wages and fringe benefits.
The program provides a wide range of vital community
services that would not otherwise be available, particularly in
low-income areas and in minority neighborhoods. Senior
enrollees provide necessary and valuable services at Head Start
centers, schools, hospitals, libraries, elderly nutrition
sites, senior center, and elsewhere in the community. These
services would not be available without the program.
A large proportion of senior enrollees use their work
experience and training to obtain employment in the private
sector. This not only increases our Nation's tax base, but it
also enables more low-income seniors to participate in the
program.
The Committee believes that the program should pay special
attention to providing community service jobs for older
Americans with poor employment prospects, including individuals
with a long-term detachment from the labor force, older
displaced homemakers, aged minorities, limited English-speaking
persons, and legal immigrants.
The Committee urges the Department to consider allowing
sponsoring organizations within their awarded grants to
participate in section 502(e) innovative projects designed to
assure second career training and placement of eligible
individuals in employment opportunities with private business
concerns.
The Committee is deeply concerned that the Labor Department
is instituting massive changes, on very short notice, that have
the potential to seriously disrupt the services to participants
in the Senior Community Service Employment Program [SCSEP].
Several organizations currently serving these participants have
expressed grave concern over the process by which the Labor
Department has awarded national SCSEP grants for the program
year commencing July 1, 2003. The Committee expects the Labor
Department to give top priority attention to assuring that
there will be no disruption of existing program operations
while these concerns are being addressed. If necessary, these
changes should be put on hold to prevent any possibility of
disrupting the vital services being provided to senior
citizens. Prior to this change, the Committee expects the Labor
Department to work with the new grantees' to allow for
subcontracting of services and programs and reallocating of
unspent State allocations to the existing grantees. If the
Department does proceed with these changes, the Committee
expects the Department to provide a complete report regarding
the transition of SCSEP participants to new grantees, including
the nature and extent of any disruption that may have affected
participants or community service organizations, any decline in
the quantity or quality of services delivered, and the specific
and total expenses incurred by grantees or the Department in
effecting the transition of SCSEP participants.
FEDERAL UNEMPLOYMENT BENEFITS AND ALLOWANCES
Appropriations, 2003.................................... $972,200,000
Budget estimate, 2004................................... 1,338,200,000
Committee recommendation................................ 1,338,200,000
The Committee recommends $1,338,200,000, the same as the
budget estimate for fiscal year 2004, an increase of
$366,000,000 over the fiscal year 2003 appropriation for
Federal Unemployment Benefits and Allowances. Trade
Readjustment Allowance [TRA] weekly benefits are estimated to
increase from 2.5 million in fiscal year 2003 to 4.2 million in
fiscal year 2004. Fiscal year 2004 will continue the
implementation and operation of the Trade Adjustment Assistance
program with an emphasis on melding the TAA program into the
workforce investment system. This is an entitlement program.
The Trade Adjustment Assistance Reform Act of 2002 that
amended the Trade Act of 1974 was signed into law on August 6,
2002 (Public Law 107-210). This Act consolidated the previous
Trade Adjustment Assistance [TAA] and NAFTA Transitional
Adjustment Assistance [NAFTA-TAA] programs, into a single,
enhanced TAA program with expanded eligibility, services, and
benefits. While the amendments generally apply to workers
covered on or after November 4, 2002, the Act includes
provisions to continue eligibility for workers certified prior
to November 4 until their eligibility under the previous
legislation is exhausted. Therefore, the amounts appropriated
to the FUBA account are to provide for services and benefits to
workers certified under the amended program as well as the
predecessor programs. Additionally, the Act provides a program
of Alternative Trade Adjustment Assistance for Older Workers.
STATE UNEMPLOYMENT INSURANCE AND EMPLOYMENT SERVICE OPERATIONS
Appropriations, 2003.................................... $3,595,381,000
Budget estimate, 2004................................... 3,646,783,000
Committee recommendation................................ 3,620,552,000
The Committee recommends $3,620,552,000 for this account.
This is $26,231,000 below the budget request and $25,171,000
above the 2003 comparable level. Included in the total
availability is $3,478,032,000 authorized to be drawn from the
``Employment Security Administration'' account of the
unemployment trust fund, and $142,520,000 to be provided from
the general fund of the Treasury.
The funds in this account are used to provide
administrative grants and assistance to State agencies which
administer Federal and State unemployment compensation laws and
operate the public employment service.
For unemployment insurance [UI] services, the bill provides
$2,645,424,000. This includes $2,634,924,000 for State
Operations, and $10,500,000 for UI national activities, which
is directed to activities that benefit the State/Federal
unemployment insurance program. The bill provides for a
contingency reserve amount should the unemployment workload
exceed an average weekly insured claims volume of 3,227,000.
This contingency amount would fund the administrative costs of
unemployment insurance workload over the level of 3,227,000
insured unemployed per week at a rate of $28,600,000 per
100,000 insured unemployed, with a pro rata amount granted for
amounts of less than 100,000 insured unemployed.
For the Employment Service grants to States, the Committee
recommends $791,557,000 which includes $23,300,000 in general
funds together with an authorization to spend $768,257,000 from
the ``Employment Security Administration'' account of the
unemployment trust fund. These funds are available for the
program year of July 1, 2004, through June 30, 2005.
The recommendation includes $64,351,000 for national
activities, an increase of $14,000,000 over the fiscal year
2003 level. This recommendation provides increased funding of
the foreign labor certification program, but not the full
amount requested by the Administration. The recommendation
includes $20,000,000 for the work opportunity tax credit
program.
The recommendation also includes $99,350,000 for One-Stop
Career Centers. This Committee recommendation includes funding
for America's Labor Market Information System, including core
employment statistics, universal access for customers,
improving efficiency in labor market transactions, and
measuring and displaying WIA performance information.
The recommendation includes $19,870,000 for the Work
Incentives Grants program, 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
Appropriations, 2003.................................... $463,000,000
Budget estimate, 2004................................... 467,000,000
Committee recommendation................................ 467,000,000
The Committee recommends $467,000,000, the same as the
budget estimate for fiscal year 2004, an increase of $4,000,000
over 2003. The appropriation is available to provide advances
to several accounts for purposes authorized under various
Federal and State unemployment compensation laws and the Black
Lung Disability Trust Fund, whenever balances in such accounts
prove insufficient. The bill anticipates that fiscal year 2004
advances will be made to the Black Lung Disability Trust Fund.
The requested amount is required to provide for loan interest
payments on Black Lung Trust Fund borrowed amounts.
The separate appropriations provided by the Committee for
all other accounts eligible to borrow from this account in
fiscal year 2004 are expected to be sufficient. Should the need
arise, due to unanticipated changes in the economic situation,
laws, or for other legitimate reasons, advances will be made to
the appropriate accounts to the extent funds are available.
Funds advanced to the Black Lung Disability Trust Fund are now
repayable with interest to the general fund of the Treasury.
PROGRAM ADMINISTRATION
Appropriations, 2003.................................... $174,511,000
Budget estimate, 2004................................... 183,365,000
Committee recommendation................................ 178,961,000
The Committee recommendation includes $115,824,000 in
general funds for this account, as well as authority to expend
$63,137,000 from the ``Employment Security Administration''
account of the unemployment trust fund, for a total of
$178,961,000.
The Committee recommendation provides a portion of the
increase requested to reduce the backlog of applications for
the permanent labor certification program.
General funds in this account provide the Federal staff to
administer employment and training programs under the Workforce
Investment Act, the Older Americans Act, the Trade Act of 1974,
and the National Apprenticeship Act. Trust funds provide for
the Federal administration of employment security functions
under title III of the Social Security Act and the Immigration
and Nationality Act, as amended. Federal staff costs related to
the Wagner-Peyser Act in this account are split 97 percent to 3
percent between unemployment trust funds and general revenue,
respectively.
The Committee expects the Labor Department to conduct a
comprehensive study, detailing the changing composition of our
manufacturing workforce, including job loss or gain by industry
sector in the United States over the last 10 years.
The study should take 1993 as a base year and include such
normal components as the duration of post lay-off job searches,
health insurance coverage, as well as industry, occupation and
earnings of the old and new jobs. The study should examine
occupational employment based on national trends, taking into
account, in reasonable detail, the level of education by
industry group and any changes in those levels from the base
year to the most recently available data. The study should also
provide information on the composition of full and part-time
employment in manufacturing for past years and, based on that
empirical evidence, to the extent possible determine what
percentage of the manufacturing workforce will be employed full
vs. part-time as of 2012. Also to the extent possible, the
study should provide a projection as to the overall
contribution of manufacturing to the U.S. GDP out to, or as of,
2012. The study should be completed by May, 2004.
Employee Benefit Security Administration
SALARIES AND EXPENSES
Appropriations, 2003.................................... $116,283,000
Budget estimate, 2004................................... 128,605,000
Committee recommendation................................ 121,316,000
The Committee recommendation provides $121,316,000 for this
account, formerly the Pension and Welfare Benefits
Administration, which is $5,033,000 above the 2003 comparable
level. This includes partial funding of requested program
increases to enhance confidence in the private sector employee
benefits system, and provide interpretive guidance to
employers.
The Employee Benefit 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. ESBA is also responsible for enforcement of
sections 8477 and 8478 of the Federal Employees' Retirement
Security Act of 1986 [FERSA]. ESBA provides funding for the
enforcement and compliance; policy, regulation, and public
services; and program oversight activities.
Pension Benefit Guaranty Corporation
The Corporation's estimated obligations for fiscal year
2004 include single employer benefit payments of
$2,961,000,000, multiemployer financial assistance of
$13,730,000 and administrative expenses of $228,772,000.
Administrative expenses are comprised of three activities: (1)
pension insurance activities, $16,553,000; (2) operational
support, $80,054,000; and (3) pension plan terminations
expenses, $132,165,000. Such expenditures will be financed by
permanent authority.
The Pension Benefit Guaranty Corporation is a wholly owned
Government corporation established by the Employee Retirement
Income Security Act of 1974. The law places it within the
Department of Labor and makes the Secretary of Labor the Chair
of its Board of Directors. The Corporation receives its income
primarily from insurance premiums collected from covered
pension plans, assets of terminated pension plans, collection
of employer liabilities imposed by the act, and investment
earnings. It is also authorized to borrow up to $100,000,000
from the Treasury. The primary purpose of the Corporation is to
guarantee the payment of pension plan benefits to participants
if covered defined benefit plans fail or go out of existence.
Unlike the 2003 budget, the 2004 budget does not recommend
a discretionary limit on administrative expenditures [LAE] for
PBGC. In 2004 and subsequent years, the PBGC's budget will
reflect--in a way that is more accountable to the Committee--
the level of administrative expenditures that the Committee
believes is appropriate to PBGC's changing responsibilities to
protect the pensions it insures. PBGC's dollar benefit levels
and workload change from year to year as specific pension plans
fail. Most of its workload involves terminating failed pension
plans, so that pension benefits can be paid. The workload of
plan termination especially fluctuates from year to year as
large plans (or a spate of small ones) terminate, and then as
the terminations are completed. The language provides the PBGC
the flexibility to respond when dictated by increased workload
and increased benefit payments, while increasing accountability
to the Committee by requiring approval by the Office of
Management and Budget and the Committees on Appropriations.
The single-employer program protects about 34 million
participants in about 35,000 defined benefit pension plans. The
multi-employer insurance program protects about 8.8 million
participants in about 1,700 plans.
Employment Standards Administration
SALARIES AND EXPENSES
Appropriations, 2003.................................... $381,113,000
Budget estimate, 2004................................... 397,753,000
Committee recommendation................................ 392,061,000
The Committee recommendation includes $392,061,000 for this
account. The bill contains authority to expend $2,016,000 from
the special fund established by the Longshore and Harbor
Workers' Compensation Act; the remainder are general funds. In
addition, an amount of $32,004,000 is available by transfer
from the black lung disability trust fund.
This recommendation provides sufficient funding to offset
the impact of inflation, and includes resources for a portion
of requested program increases. It rejects the administration's
proposed legislation that would have established a surcharge on
the amount billed to Federal agencies for workers' compensation
benefits to finance Labor Department administrative expenses of
$87,573,000. It restores proposed program reductions, including
the equal pay initiative and includes recommended program
increases.
The President's budget included a legislative proposal
under the jurisdiction of the Senate Committee on Health,
Education, Labor, and Pensions to charge individual agencies,
starting in fiscal year 2003, the administrative cost of the
Federal Employees' Compensation Act [FECA] program. Currently
Federal agencies are budgeted for and billed each year for
monetary and medical benefits that have been paid to their
employees under FECA, while the program's discretionary
administrative costs are financed in the Department of Labor
[DOL]. The authorizing committee has not acted on this
legislation, therefore the Senate Appropriations Committee will
continue to fund this administrative cost through this account.
The Employment Standards Administration is involved in the
administration of numerous laws, including the Fair Labor
Standards Act, the Immigration and Nationality Act, the Migrant
and Seasonal Agricultural Workers' Protection Act, the Davis-
Bacon Act, the Family and Medical Leave Act, the Federal
Employees' Compensation Act [FECA], the Longshore and Harbor
Workers' Compensation Act, and the Federal Mine Safety and
Health Act (black lung).
SPECIAL BENEFITS
Appropriations, 2003.................................... $163,000,000
Budget estimate, 2004................................... 163,000,000
Committee recommendation................................ 163,000,000
The Committee recommends $163,000,000, the same as the
budget estimate for fiscal year 2004, and fiscal year 2003.
This appropriation primarily provides benefits under the
Federal Employees' Compensation Act [FECA]. The payments are
prescribed by law. In fiscal year 2004, an estimated 155,000
injured Federal workers or their survivors will file claims;
55,500 will receive long-term wage replacement benefits for
job-related injuries, diseases, or deaths.
The Committee recommends continuation of appropriation
language to provide authority to require disclosure of Social
Security account numbers by individuals filing claims under the
Federal Employees' Compensation Act or the Longshore and Harbor
Workers' Compensation Act and its extensions.
The Committee recommends continuation of appropriation
language that provides authority to use the FECA fund to
reimburse a new employer for a portion of the salary of a newly
reemployed injured Federal worker. The FECA funds will be used
to reimburse new employers during the first 3 years of
employment not to exceed 75 percent of salary in the worker's
first year, declining thereafter.
The Committee again includes appropriation language that
retains the drawdown date of August 15. The drawdown authority
enables the agency to meet any immediate shortage of funds
without requesting supplemental appropriations. The August 15
drawdown date allows flexibility for continuation of benefit
payments without interruption.
The Committee recommends continuation of appropriation
language to provide authority to deposit into the special
benefits account of the employees' compensation fund those
funds that the Postal Service, the Tennessee Valley Authority,
and other entities are required to pay to cover their fair
share of the costs of administering the claims filed by their
employees under FECA. The Committee concurs with requested bill
language to allow use of fair share collections to fund capital
investment projects and specific initiatives to strengthen
compensation fund control and oversight.
SPECIAL BENEFITS FOR DISABLED COAL MINERS
Appropriations, 2003: Transferred from SSA.............. $300,177,000
Appropriations, 2004: Transferred from SSA.............. 97,000,000
Budget estimate, 2004................................... 300,000,000
Budget estimate, 2005................................... 88,000,000
Committee recommendation, 2004.......................... 300,000,000
Committee recommendation, 2005.......................... 88,000,000
The Black Lung Consolidation of Administrative
Responsibility Act was enacted on November 2, 2002. The Act
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, thus consolidating all
black lung benefit responsibility under the Secretary. Part B
benefits are based on claims filed on or before December 31,
1973. The Secretary of Labor is already responsible for the
Part C claims filed after December 31, 1973. In fiscal year
2004, an estimated 56,000 beneficiaries (7,000 miners and
49,000 survivors) will receive benefits.
The Committee recommends an appropriation of $300,000,000
in fiscal year 2004 for special benefits for disabled coal
miners. This is in addition to the $97,000,000 appropriated
last year as an advance for the first quarter of fiscal year
2004. The recommendation is the same as the administration
request. These funds are used to provide monthly benefits to
coal miners disabled by black lung disease and to their widows
and certain other dependents, as well as to pay related
administrative costs.
By law, increases in black lung benefit payments are tied
directly to Federal pay increases. The year-to-year decrease in
this account reflects a declining beneficiary population.
The Committee recommends an advance appropriation of
$88,000,000 for the first quarter of fiscal year 2005, the same
as the administration request. These funds will ensure
uninterrupted benefit payments to coal miners, their widows,
and dependents.
ENERGY EMPLOYEES OCCUPATIONAL ILLNESS COMPENSATION PROGRAM
Appropriations, 2003.................................... $104,867,000
Budget estimate, 2004................................... 55,074,000
Committee recommendation................................ 55,074,000
The Committee recommends $55,074,000, the same as the
budget estimate for fiscal year 2004, and $49,793,000 below
2003.
The mission of the Energy Employees Occupational Illness
Compensation Program is to deliver benefits to eligible
employees and former employees of the Department of Energy, its
contractors and subcontractors or to certain survivors of such
individuals, as provided in the Energy Employees Occupational
Illness Compensation Program Act. The mission also includes
delivering benefits to certain beneficiaries of the Radiation
Exposure Compensation Act. Benefit costs of $385,000,000 are
anticipated in fiscal year 2004.
The Department of Labor's Office of Workers' Compensation
Programs within the Employment Standards Administration is
responsible for adjudicating and administering claims filed by
employees or former employees (or their survivors) under the
Act. The program went into effect on July 31, 2001.
The Committee is very disappointed at the lack of progress
in completing dose reconstructions more than 2\1/2\ years after
the Energy Employees Occupational Illness Compensation Program
Act was enacted. The Committee urges the Secretary to expedite
collection of necessary information and performance of dose
reconstructions, and to set verifiable performance targets and
appropriate timelines for when claimants can expect the work on
their cases to be completed.
BLACK LUNG DISABILITY TRUST FUND
Appropriations, 2003 (Definite)......................... $55,629,000
Appropriations, 2003 (Indefinite)....................... 979,371,000
Budget estimate, 2004 (Definite)........................ 56,099,000
Budget estimate, 2004 (Indefinite)...................... 986,901,000
Committee recommendation (Definite)..................... 56,099,000
Committee recommendation (Indefinite)................... 986,901,000
The Committee recommends $1,043,000,000 for this account in
2004, of which $56,099,000 is definite authority and
$986,901,000 is indefinite authority. The appropriation
language changed beginning in fiscal year 2003 for the Black
Lung Disability Trust Fund to provide such sums as may be
necessary to pay for benefits. This change eliminated the need
for drawdowns from the subsequent year appropriation in order
to meet current year compensation, interest, and other benefit
payments. The appropriation language will continue to provide
definite budget authority for the payment of administrative
expenses for the operation and administration of the trust
fund.
The total amount available for fiscal year 2004 will
provide $346,901,000 for benefits payments, and $56,099,000 for
administrative expenses for the Department of Labor. Also,
included is $640,000,000 for interest payments on Advances.
The trust fund pays all black lung compensation/medical and
survivor benefit expenses when no responsible mine operation
can be assigned liability for such benefits, or when coal mine
employment ceased prior to 1970, as well as all administrative
costs which are incurred in administering the benefits program
and operating the trust fund.
It is estimated that 44,500 people will be receiving black
lung benefits financed through the end of the fiscal year 2004,
compared to an estimated 49,000 receiving benefits in fiscal
year 2003.
The basic financing for the trust fund comes from a coal
excise tax for underground and surface-mined coal. Additional
funds come from reimbursement from the Advances to the
Unemployment Trust Fund and Other Funds as well as 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
Appropriations, 2003.................................... $450,310,000
Budget estimate, 2004................................... 450,008,000
Committee recommendation................................ 463,324,000
The Committee recommendation includes $463,324,000 for this
account. This is an increase of $13,316,000 over the budget
request and an increase of $13,014,000 above the 2003
comparable level. This agency is responsible for enforcing the
Occupational Safety and Health Act of 1970 in the Nation's
workplaces.
This recommendation provides sufficient funding to offset
the impact of inflation, as well as additional resources to
expand outreach to non-English speaking workers and small
businesses.
In addition, the Committee has included language to allow
OSHA to retain up to $750,000 per fiscal year of training
institute course tuition fees to be utilized for occupational
safety and health training and education grants in the private
sector.
The Committee retains language carried in last year's bill
effectively exempting farms employing 10 or fewer people from
the provisions of the act except those farms having a temporary
labor camp. The Committee also retains language exempting small
firms in industry classifications having a lost workday injury
rate less than the national average from general schedule
safety inspections. These provisions have been in the bill for
many years.
The Committee believes that OSHA's worker safety and health
training and education programs, including the grant program
that supports such training, are a critical part of a
comprehensive approach to worker protection. The Committee is
concerned that OSHA has again cut funding to help establish
ongoing worker safety and health training programs and has
provided $7,175,000 in additional funds to restore the Susan
Harwood training grant program to $11,175,000. Bill language
specifies that no less than $3,200,000 shall be used to
maintain the existing institutional competency building
training grants, provided that grantees demonstrate
satisfactory performance.
The Committee has provided funding to maintain the State
consultation grant program and expects that this program will
continue to be targeted to provide compliance assistance to
small businesses.
The Committee continues to be pleased with OSHA's efforts
in placing high priority on the voluntary protection programs
[VPP] and other voluntary cooperative programs. The Committee
expects OSHA to continue to place high priority on the VPP.
Cooperative voluntary programs, especially the VPP, are an
important part of OSHA's ability to assure worker safety and
health and should be administered in conjunction with an
effective strong enforcement program.
The Committee also intends that the Office of Regulatory
Analysis continue to be funded as close as possible to its
present level.
The Committee has become increasingly concerned about a
Department of Labor reorganization proposal, which would close
the Occupational Safety and Health Administration [OSHA]
offices in Bangor and Portland, Maine, and would consolidate
the activities of those offices in Augusta, Maine. The
Committee expects the Department of Labor to maintain the
existing organizational structure with offices in Bangor and in
Portland; this includes the provision of adequate office space
for the current Bangor OSHA staff.
Mine Safety and Health Administration
SALARIES AND EXPENSES
Appropriations, 2003.................................... $272,956,000
Budget estimate, 2004................................... 266,767,000
Committee recommendation................................ 270,711,000
The Committee recommendation includes $270,711,000 for this
account, an increase of $3,944,000 over the budget request.
This recommendation provides sufficient funding to offset
the impact of inflation, as well as additional resources for
enforcement, compliance assistance, and to establish a new
office to provide technical assistance to small mine
organizations. It further includes funding to continue the
Miner's Choice X-ray Program.
The Committee recommendation also increases the requested
bill language amount for mine rescue and recovery activities
from ``up to $1,000,000'' to ``up to $2,000,000'', the same as
the fiscal year 2003 comparable level. It also retains the
provision 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 a major
disaster.
This agency insures the safety and health of the Nation's
miners by conducting inspections and special investigations of
mine operations, promulgating mandatory safety and health
standards, cooperating with the States in developing effective
State programs, and improving training in conjunction with
States and the mining industry.
In addition, bill language is included to allow the
National Mine Health and Safety Academy to collect not to
exceed $750,000 for room, board, tuition, and the sale of
training materials to be available for mine safety and health
education and training activities. Bill language also allows
MSHA to retain up to $1,000,000 from fees collected for the
approval and certification of equipment, materials, and
explosives for use in mines, and may utilize such sums for such
activities.
Bureau of Labor Statistics
SALARIES AND EXPENSES
Appropriations, 2003.................................... $492,233,000
Budget estimate, 2004................................... 512,262,000
Committee recommendation................................ 515,223,000
The Committee includes $515,223,000 for this account,
$22,990,000 more than the 2003 comparable level. This includes
$75,110,000 from the ``Employment Security Administration''
account of the unemployment trust fund, and $440,113,000 in
Federal funds. This funding level will cover the agency's
built-in increases.
The Bureau of Labor Statistics is the principal fact
finding agency in the Federal Government in the broad field of
labor economics.
The recommendation includes an increase of $7,710,000 over
the budget request to provide full year funding of Occupational
Employment Statistics; the President's budget only provided
funding for 3 months. To partially offset this increase,
reductions below the request are recommended in the
``Compensation and Working Conditions'' and ``Productivity and
Technology'' activities, but still providing more than the
current levels.
Office of Disability Policy
Appropriations, 2003.................................... $47,178,000
Budget estimate, 2004................................... 47,333,000
Committee recommendation................................ 47,333,000
The Committee recommends $47,333,000 for this account in
2004. This is the same as the President's request and $155,000
above 2003.
Congress created the Office of Disability Employment Policy
[ODEP] in the Department of Labor's fiscal year 2001
appropriation. Programs and staff of the former President's
Committee on Employment of People with Disabilities [PCEPD]
have been integrated into this new office.
The ODEP mission, under the leadership of an Assistant
Secretary, is to bring a heightened and permanent long-term
focus to the goal of increasing employment of persons with
disabilities. This will be achieved through policy analysis,
technical assistance, and development of best practices, as
well as outreach, education, constituent services, and
promoting ODEP's mission among employers.
Within the funds provided for the Office of Disability
Policy, the Committee has included $2,500,000 to expand the
telework feasibility program and to increase the number of
demonstration projects. These funds are to be used to enable
Government agencies to explore the feasibility of employing
home-based workers with significant disabilities.
Departmental Management
SALARIES AND EXPENSES
Appropriations, 2003.................................... $387,841,000
Budget estimate, 2004................................... 273,536,000
Committee recommendation................................ 351,609,000
The Committee recommendation includes $351,609,000 for this
account, which is $78,073,000 more than the budget request and
$36,232,000 less than the 2003 comparable level. In addition,
an amount of $23,401,000 is available by transfer from the
black lung disability trust fund, which is the same as the
budget request.
The primary goal of the Department of Labor is to protect
and promote the interests of American workers. The departmental
management appropriation finances staff responsible for
formulating and overseeing the implementation of departmental
policy and management activities in support of that goal. In
addition, this appropriation includes a variety of operating
programs and activities that are not involved in departmental
management functions, but for which other salaries and expenses
appropriations are not suitable.
The Committee recommendation includes $26,296,000 for
Executive Direction, the same as the fiscal year 2003
comparable level.
The Committee recommendation includes $8,926,000 for the
Women's Bureau. The Committee encourages the Women's Bureau to
support effective programs such as ``Women Work!'', to provide
technical assistance and training on programming for women in
transition.
The Committee is disappointed that the Department of Labor
has once again put forward a budget for the coming year that
eliminates all funding for the initiatives within the
International Labor Affairs Bureau [ILAB] working with the
International Labor Organization to combat abusive and
exploitative child labor. Over the past decade the United
States has been the leader in helping to reduce abusive and
exploitative child labor around the world. As a result of the
consistent and combined efforts of U.S. governmental agencies,
appropriately led by the Department of Labor and with the
strong support of Congress and specifically this Committee, the
issue of abusive and exploitative child labor has received
heightened international attention and programs have been
instituted to rehabilitate these vulnerable children. ILAB
projects funded through the ILO have given hundreds of
thousands of children the opportunity to attend school rather
than engage in hazardous work. These projects have also helped
their families break the cycle of poverty by providing the
children with an education and giving underemployed parents the
opportunity of employment. ILAB also works with governments to
help them build institutional capacity to combat abusive and
exploitative child labor and improve access to quality
education so that in time they will be able to become better
trading partners. This positive activity clearly needs to be
augmented, not stopped. The Committee strongly believes that
ILAB's core mandate is very much intertwined with the broader
trade agenda and as this trade agenda grows, ILAB's work
necessarily will grow as well. Therefore, the Committee
recommendation includes $108,000,000 for the Bureau of
International Labor Affairs. Of this amount, the Committee's
recommendation includes $82,000,000 for international child
labor prevention activities including $45,000,000 for the U.S.
contribution to sustain and to extend to more countries in
waiting the successful efforts of the ILO's International
Program for the Elimination of Child Labor [IPEC]. Within ILAB
funds, $37,000,000 is for bilateral assistance to expand upon
the program initiated by the Department in fiscal year 2001 to
help ensure access to basic education for the growing number of
children removed from the worst forms of child labor in
impoverished nations where abusive and exploitative child labor
is most acute.
The Committee notes that in the fiscal year 2003
appropriation, ILAB asked for and was granted 2 year obligating
authority due to a belief that ILAB could not obligate the
funds in a timely manner. The Committee is disappointed to see
that the Department responded to this authority by reducing the
staffing at ILAB by 40 FTEs. This reduction in staffing is
detrimental to the effort to obligate funds in a timely manner.
Therefore, the Committee has reverted to 1-year oligating
authority and expects the Secretary to allocate the appropriate
staffing levels to ILAB in order to process grant competitions
within that time frame.
The Committee deems it very important that ILAB deepen and
improve its permanent capacity to compile and report to the
Congress annually on the extent to which each foreign country
that has trade and investment agreements with the United States
enforces internationally-recognized worker rights as required
under multiple U.S. laws and promotes core labor standards as
embodied in the ILO Declaration on Fundamental Principles and
Rights at Work as adopted and reaffirmed in 1998. The Committee
expects $5,000,000 to be spent for this purpose.
The Committee recommends $10,000,000 for HIV/AIDS workplace
education, for the purpose of providing the ILO with assistance
to conduct global education and prevention programs. For other
ILAB programs, including 125 FTE for Federal Administration,
the Committee recommends $11,000,000.
Acknowledging the need to upgrade the information
technology capability in the Department of Labor, the Committee
provides $48,565,000 for the information technology fund, and
$10,000,000 for management cross cut activities. The total
provided includes support for cross-cutting investments such as
common office automation suite implementation, architecture
requirements, and web services as well as human resource
management. In addition, $9,700,000 is recommended for a
separate Working Capital Fund appropriation, to begin
implementation of a new core accounting system for the
Department of Labor.
The Committee is concerned that lower wage Department of
Labor employees are eligible for a maximum monthly transit
subsidy of $65, compared to $100 for management employees. This
disparity does not exist in the Departments of Education and
Health and Human Services, nor does it exist for the Senate
Appropriations Committee. The Committee hopes this matter can
be resolved expeditiously to provide equitable treatment for
all employees of the Labor Department.
The Committee retains bill language intended to ensure that
decisions on appeals of Longshore and Harborworker Compensation
Act claims are reached in a timely manner.
The Committee continues to urge the Department to
investigate the impact of the nursing shortage on the overall
health care labor market across the country, and engage in
constructive problem solving on the issue.
Veterans Employment and Training
Appropriations, 2003.................................... $212,819,000
Budget estimate, 2004................................... 219,993,000
Committee recommendation................................ 219,993,000
The Committee recommendation includes $219,993,000 for this
account, including $26,550,000 in general revenue funding and
$193,443,000 to be expended from the ``Employment Security
Administration'' account of the unemployment trust fund. This
is $7,174,000 more than the 2003 comparable level.
For State grants the bill provides $83,481,000 for the
Disabled Veterans Outreach Program and $78,934,000 for the
Local Veterans Employment Representative Program. The Committee
did not act on the request to consolidate these programs.
For Federal administration, the Committee recommends
$29,028,000, the same as the budget request. The Committee
supports the concept of the Transition Assistance Program
administered jointly with the Department of Defense which
assists soon-to-be-discharged service members in transitioning
into the civilian work force and includes funding to maintain
an effective program. The Committee recommendation includes
$2,000,000, the same as the budget request, for the National
Veterans Training Institute [NVTI]. This Institute provides
training to the Federal and State staff involved in the direct
delivery of employment and training related services to
veterans.
The Committee understands the Labor Department is
experimenting with displaying budget justification material of
appropriations estimates on a performance budgeting basis.
While this is a commendable goal, the Committee nevertheless
continues to rely on the traditional display of appropriations
account information provided prior to fiscal year 2004, and
expects the Department to work with the Committee to make sure
that the fiscal year 2004 budget justifications meet Committee
needs.
The Committee recommendation includes $19,000,000 for the
Homeless Veterans Program, the same as the budget request. Also
included is $7,550,000 for the Veterans Workforce Investment
Program, the same as the budget request.
Office of the Inspector General
Appropriations, 2003.................................... $61,852,000
Budget estimate, 2004................................... 66,795,000
Committee recommendation................................ 64,852,000
The bill includes $64,852,000 for this account, $3,000,000
above the 2003 comparable level. The bill includes $59,291,000
in general funds and authority to transfer $5,561,000 from the
``Employment Security Administration'' account of the
unemployment trust fund. In addition, an amount of $338,000 is
available by transfer from the black lung disability trust
fund.
The Office of the Inspector General [OIG] was created by
law to protect the integrity of departmental programs as well
as the welfare of beneficiaries served by those programs.
Through a comprehensive program of audits, investigations,
inspections, and program evaluations, the OIG attempts to
reduce the incidence of fraud, waste, abuse, and mismanagement,
and to promote economy, efficiency, and effectiveness.
General Provisions
General provision bill language is included to:
Prohibit the use of Job Corps funding for compensation of
an individual at a rate in excess of Executive Level II (sec.
101).
Permit transfers of up to 1 percent between appropriations
(sec. 102).
Prohibit funding for the procurement of goods and services
utilizing forced or indentured child labor in industries and
host countries already identified by the Labor Department (sec.
103 in accordance with Executive Order 13126).
Authorize funds to be appropriated for job training for
workers involved in construction projects funded through the
Denali Commission (sec. 104).
Rescind $210,833,000 in unspent funds from the expiring
Welfare-to-Work program (sec. 105).
TITLE II--DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Resources and Services Administration
HEALTH RESOURCES AND SERVICES
Appropriations, 2003.................................... $6,455,558,000
Budget estimate, 2004................................... 5,665,996,000
Committee recommendation................................ 5,906,322,000
The Committee provides a program level of $5,906,322,000
for the Health Resources and Services Administration. The
Committee recommendation includes $5,881,322,000 in budget
authority and an additional $25,000,000 via transfers available
under section 241 of the Public Health Services Act. The fiscal
year 2003 comparable program level was $6,455,558,000 and the
administration request program level was $5,665,996,000.
Health Resources and Services Administration [HRSA]
activities support programs to provide health care services for
mothers and infants; the underserved, elderly, homeless;
migrant farm workers; and disadvantaged minorities. This
appropriation supports cooperative programs in community
health, AIDS care, health provider training, and health care
delivery systems and facilities.
FREE CLINIC MEDICAL MALPRACTICE COVERAGE
The Committee provides $10,000,000 in first-time funding
for payments of claims under the Federal Tort Claims Act to be
made available for free clinic health professionals as
authorized by U.S.C. Title 42 Section 233(o) of the Public
Health Service Act. As required by the statute, the Secretary
shall establish a fund for the purposes of this program.
This appropriation will extend Federal Tort Claims Act
coverage to medical volunteers in free clinics in order to
expand access to health care services to low-income individuals
in medically underserved areas. Such coverage is currently
provided in the Public Health Service Act to certain community
and other health centers. 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.
HEALTH CENTERS
The Committee provides $1,627,164,000 for the consolidated
health centers. The fiscal year 2003 comparable program level
was $1,504,806,000 and the administration request program level
was $1,627,164,000. This group of programs includes community
health centers, migrant health centers, health care for the
homeless, and public housing health service grants. The
Committee has provided increased funding in fiscal year 2004
to: (1) continue the economic stabilization efforts for
existing health centers, (2) expand existing health centers,
and (3) fund new health center sites.
The Committee commends HRSA for its work to stabilize
centers in fiscal year 2003, and urges the continuation of this
important effort. Health centers, like all health providers,
have experienced growth in their costs of providing care,
including the care provided to the 5 million uninsured health
center patients that is not borne by other revenue sources.
This situation has placed many centers in declining financial
conditions and has slowed the expansion effort among existing
grantees. The Committee urges HRSA to increase these
stabilization efforts so that existing grantees can expand as
needed.
While the Committee has provided annual increases for the
consolidated health center program in order to serve more
patients across the country, the Committee is very concerned by
reports that States are reducing their support for the program,
which could negatively impact the expansion initiative. The
Committee requests that HRSA conduct a survey of State funding
for health centers, to include recent and/or proposed funding
changes, and fully assess the impact of these actions on the
expansion initiative. The Committee requests that these
findings be reported to the Committee by April 1, 2004.
The Committee is concerned that a significant portion of
the medically underserved population in Illinois continues to
lack necessary access to community or migrant health center
services. The underserved populations of Kankakee, Jefferson,
Saline, Sangamon, McHenry, Peoria, St. Clair, Menard,
Whiteside, Massac, DuPage, and Adams and the South side of
Chicago, the underserved Asian Americans and Pacific Islanders
population on the North side of Chicago, and the underserved
Latino population within suburban Cook County need new and
expanded access points to health services. The Committee
strongly urges HRSA to identify proposals from these and other
underserved areas, and work with the applicants to improve
their proposals. The Committee expects HRSA to inform the
Committee of the status of this effort no later than September
15, 2004.
The Committee urges HRSA to give full and fair
consideration to proposals to expand health access in
underserved communities in Missouri and other States.
The Committee limits the amount available for payment of
claims under the Federal Tort Claims Act to $45,000,000, which
is the same as the administration request and $5,000,000 more
than the amount provided for last year. The continued viability
of the FTCA judgment fund is critical to the continued
expansion of the health center program and the Committee renews
its request that the Department recommend future legislative
alternatives for the Fund.
The Committee does not provide additional funds for loan
guarantee authority under section 330(d) of the Public Health
Service Act. The Committee notes that $121,000,000 in loan
guarantee authority from the $160,000,000 appropriated in
fiscal years 1997 and 1998 continues to remain available for
guarantees of both loan principal and interest.
Community Health Centers
Community health centers improve the health of Americans by
providing comprehensive primary and preventive health care
services to underserved populations in rural and urban areas,
regardless of ability to pay. Of the clients served by
community health centers, over 39 percent had no insurance, 64
percent were minorities, 47 percent lived in rural areas, and
28 percent were children under 12 years of age.
The Committee is concerned that Federal community health
center funds are often not available to small, remote
communities in Alaska, Hawaii and other similar States because
the population base is too small. Many of these communities
have no health service providers and are forced to travel long
distances by boat or plane even in emergency situations. The
Committee is aware that efforts are now underway to double
community health center funding to address the growing number
of uninsured persons in this country, but, without new
approaches to providing health services, many will not benefit
from the proposed increases in funding. The Committee
recommends that HRSA examine its regulations and applications
procedures to ensure they are not unduly burdensome and are
appropriately flexible to meet the needs of these communities.
The Committee applauds the agency for its initiatives such as
the ``Alaska Frontier Health Plan,'' and encourages the agency
to continue and expand its efforts with this program.
The Committee commends HRSA for its efforts over the past
year to visit and evaluate many of the rural underserved areas
across the country. The Committee continues to believe that to
expand services offered by these centers more nurse
practitioners have to be utilized. Specifically, opportunities
that are developed for the increased use of nurses in community
health centers in collaboration with the National Institute of
Nursing Research are recommended as highly beneficial to the
underserved.
The Committee is aware that Nurse-Managed Health Centers
[NMHCs] serve a dual function in strengthening the health care
safety net by providing health care to populations in
underserved areas and by providing the clinical experiences to
nursing students that are mandatory for professional
development. Recognizing that NMHCs are frequently the only
source of health care to their patients and that a lack of
clinical education sites for nurses is a contributing factor to
the nationwide nursing shortage, the Committee urges HRSA to
work with existing NMHCs to enable them to qualify for
participation in the Community Health Center program (Public
Health Service Act, section 330) and to expand both the numbers
of students educated and the numbers of patients cared for at
NMHCs.
The Committee recognizes the critical role that translation
services, as well as culturally sensitive health care delivery,
plays in ensuring comprehensive care to patients who do speak
English as a second language. It is often the case that grants
to health centers under section 330 do not adequately cover the
full costs of providing translation services to the growing
range of diverse populations and languages these centers
target. The Committee encourages HRSA to award grants to health
centers to provide translation services or to compensate
bilingual or multilingual staff for providing language
assistance to those patients not fluent in English.
Congress recognized the need to provide mental and
behavioral health services to the underserved through the
Federal Community Health Centers in the Safety Net Legislation
of 2001. The Committee encourages the CHC Program to expand its
efforts to provide mental and behavioral health services by
increasing the number of psychologists in CHCs Nation wide.
The Committee recognizes that asthma is a growing problem
nationwide, particularly among minorities and the underserved.
The Committee encourages HRSA, through its Community Health
Centers program, to enhance its efforts aimed at reducing the
incidence of asthma among ethnic and racial minorities and
other medically underserved populations.
School-based Health Centers
This program provides grants for comprehensive primary and
preventive health care services and health education to at-risk
and medically underserved children and youth. Grants are
awarded to public or private, nonprofit, community-based health
care providers. Through agreements with a local school or
school system, the health care entity provides the services in
the school building or on school grounds.
Migrant Health Program
The program helps provide culturally sensitive
comprehensive primary care services to migrant and seasonal
farm workers and their families. Over 80 percent of the centers
also receive funds from the community health centers program.
Health Care for the Homeless
The program provides project grants for the delivery of
primary health care services, substance abuse services, and
mental health services to homeless adults and children. About
one-half of the projects are administered by community health
centers. The other one-half are administered by nonprofit
coalitions, inner-city hospitals, and local public health
departments.
Public Housing Health Service Grants
The program awards grants to community-based organizations
to provide case-managed ambulatory primary health and social
services in clinics at or in proximity to public housing. More
than 60 percent of the programs are operated by community
health centers.
Native Hawaiian Health Care
The Committee again includes the legal citation in the bill
for the Native Hawaiian Health Care Program. The Committee has
included sufficient funding so that health care activities
funded under the Native Hawaiian Health Care Program can be
supported under the broader community health centers line. The
Committee expects that not less than $15,000,000 be provided
for these activities in fiscal year 2004.
Other Native Hawaiian and Pacific Islander Health Issues
The Committee remains committed to the concept of a
demonstration project for American Samoans in Hawaii at the
Waimanalo Health Center that will integrate social services, to
include traditional health, prevention and disease management,
and address the health disparities among Native Hawaiians and
other minority populations.
In addition, as emphasized again last year, the Committee
strongly supports the establishment of a Center of Excellence
for Indigenous Health and Healing at the University of Hawaii
and other schools that serve native peoples including American
Indians, Alaska Natives and Pacific Islanders. The
incorporation of traditional medicine and healing practices
into the training of medical, nursing, social work, psychology,
pharmacy and public health students will not only advance these
disciplines but also enhance the health care services delivered
to these populations. The Committee encourages HRSA, CDC, and
SAMSHA to support these concepts in their awarding of grants
wherever native and indigenous people reside.
The Committee believes that community health centers are a
critical source of care for the underserved, particularly in
remote rural areas in States such as Alaska and Hawaii. New
health centers in remote communities are critically needed.
Nurse practitioners could be instrumental in expanding these
critical health care services. Telemedicine technology should
be emphasized whenever possible to maximize resources and
collaborative communication. The Committee wants to applaud
HRSA for the work that has been done to re-examine regulations
and the creation of an on-line grant application process.
National Health Service Corps: Field Placements
The Committee provides $45,948,000 for field placement
activities. The fiscal year 2003 comparable level was
$45,948,000 and the administration request was $45,305,000. The
funds provided for this program are used to support the
activities of National Health Service Corps obligors and
volunteers in the field, including travel and transportation
costs of assignees, training and education, recruitment of
volunteers, and retention activities. Salary costs of most new
assignees are paid by the employing entity.
The Committee is pleased by the increasing percentage of
placements of NHSC assignees at Community, Migrant, Homeless,
and Public Housing Health Centers. The Committee encourages
HRSA to further expand this effort to ensure that the health
center expansion effort is sustainable and has access to a
sufficient level of health professionals. The Committee
requests that HRSA identify any potential problems with the
implementation of the new automatic Health Professional
Shortage Area [HPSA] designation for all health centers, and
also how the new designation process will enhance the placement
opportunities for health centers.
National Health Service Corps: Recruitment
The Committee provides $125,140,000 for recruitment
activities. The fiscal year 2003 comparable level was
$125,140,000 and the administration request was $167,542,000.
This program provides major benefits to students (full-cost
scholarships or sizable loan repayment) in exchange for an
agreement to serve as a primary care provider in a high
priority federally designated health professional shortage
area. The Committee reiterates its intention that funds support
multi-year, rather than single-year, commitments.
The Committee commends the NHSC for its focus on ensuring a
health workforce for integrated, comprehensive health care for
the underserved that includes mental and behavioral health
services. The Committee urges the NHSC to continue its efforts
and increase the number of psychologists in the Loan Repayment
Program and begin, for the first time, to support psychology
students in the Scholarship Program.
HEALTH PROFESSIONS
The Committee provides $423,765,000 for all HRSA health
professions programs. The fiscal year 2003 comparable level was
$711,305,000 and the administration request was $308,372,000.
The Committee commends HRSA for its efforts to address the
gap between the size of the Nation's aging baby boom population
and the number of pulmonary/critical care physicians. HRSA is
presently developing a report on the workforce shortage issue.
The Committee understands that a portion of this report will be
informed, in part, by the research efforts of the American
College of Chest Physicians [ACCP] and the members of the
Critical Care Workforce Partnership through its COMPACCS study.
Given the efforts of the ACCP and the members of the Critical
Care Workforce Partnership, the Committee encourages HRSA to
use the pulmonary/critical care specialty as a model for
developing and testing policy options to address workforce
shortage issues.
Recognizing previous direction from the Committee that HRSA
complete a national study on the status of pediatric
rheumatology in the United States, the Committee urges HRSA to
conclude its research in this area in partnership with the
Arthritis Foundation. As provided in the Children's Health Act
of 2000, this study assesses the current pediatric services
shortage and identifies strategies for addressing this
significant shortage for children with arthritis.
The Committee expresses concern about the increasing
population of children with complex neurological disorders and
the number of pediatric neurologists available to treat them.
The Committee therefore urges HRSA to consult with the Child
Neurology Society to develop a comprehensive action plan to
address this critical shortage.
The Committee recognizes that hospitals and health
facilities across the United States have been deeply impacted
by declines among nurses, pharmacists, radiology, and
laboratory technicians, and other workers. This health care
workforce shortage is a long-term problem, and most States are
looking for ways to address such shortages. Therefore, in an
effort to attract new entrants to the health professions by
focusing attention on young people, the Committee recommends
that the Secretary of Health and Human Services, acting through
the Bureau of Health Professions of the Health Resources and
Services Administration, award grants to accredited
universities and/or community colleges for the establishment of
summer health career introductory programs for middle and high
school students.
The Committee recommends consolidated funding for Health
Professions programs authorized under titles VII and VIII of
the Public Health Service Act. The following clusters and their
associated programs are included in this consolidated account:
A. Training for Diversity
Centers of Excellence
This program was established to fund institutions that
train a significant portion of the Nation's minority health
professionals. Funds are used for the recruitment and retention
of students, faculty training, and the development of plans to
achieve institutional improvements. The institutions that are
designated as centers of excellence are private institutions
whose mission is to train disadvantaged minority students for
service in underserved areas. Located in poor communities and
usually with little State funding, they serve the health care
needs of their patients often without remuneration.
The Committee is pleased that HRSA has re-focused the
Minority Centers of Excellence program on providing support to
historically minority health professions institutions. The
Committee recognizes the important role of this program in
supporting faculty and other academic programs at minority
institutions. The Committee encourages the Centers of
Excellence program to consider applications that are responsive
to allied health professions which are experiencing shortages
and high vacancy rates, such as laboratory personnel.
Health Careers Opportunity Program
This program provides funds to medical and other health
professions schools for recruitment of disadvantaged students
and pre-professional school preparations. The Committee is
pleased that HRSA has given priority consideration for H-COP
grants to minority health professions institutions, and
recommends that grant review committees have proportionate
representation from these institutions. The Committee continues
to encourage the H-COP program to consider applications that
are responsive to allied health professions which are
experiencing shortages and high vacancy rates, such as
laboratory personnel.
Faculty Loan Repayment
This program provides for the repayment of education loans
for individuals from disadvantaged backgrounds who are health
professions students or graduates, and who have agreed to serve
for not less than 2 years as a faculty member of a health
professions school.
Scholarships for Disadvantaged Students
The Committee intends that this program receive at least
the level of funding requested by the administration from the
consolidated health professions appropriations. This program
provides grants to health professions schools for student
scholarships to individuals who are from disadvantaged
backgrounds and are enrolled as full-time students in such
schools. The Committee continues to intend that all health
professions disciplines made eligible by statute be able to
participate in the scholarships program.
B. Training in Primary Care Medicine and Dentistry
Family Medicine Training
Family medicine activities support grants for graduate
training in family medicine, grants for pre-doctoral training
in family medicine, grants for faculty development in family
medicine, and grants for the establishment of departments of
family medicine. The Committee reiterates its support for this
program and recognizes its importance in increasing the number
of primary care physicians in underserved areas.
General Internal Medicine and Pediatrics Training
This program provides funds to public and private nonprofit
hospitals and schools of medicine and osteopathic medicine to
support residencies in internal medicine and pediatrics. Grants
may also include support for faculty.
Physician Assistants
This program supports planning, development, and operation
of physician assistant training programs.
General Dentistry and Pediatric Dental Residencies
This program assists dental schools and postgraduate dental
training institutions to meet the costs of planning,
developing, and operating residency training and advanced
education programs in general practice of dentistry and funds
innovative models for postdoctoral general dentistry and
pediatric dentistry.
The Committee recognizes that these programs play a
critical role in meeting the oral health care needs of
Americans; especially those who require specialized or complex
care and represent vulnerable populations in underserved areas.
Additionally, rural States are disproportionately underserved
by pediatric dentists. The Committee notes that several States
have fewer than 10 pediatric dentists. This clearly is not
enough to address American children's needs. The Committee
intends that at least $5,500,000 from the consolidated health
professions appropriation be used to continue and expand the
Pediatric Dental Program.
C. Interdisciplinary, Community-based Linkages
Area Health Education Centers
This program links university health science centers with
community health service delivery systems to provide training
sites for students, faculty, and practitioners. The program
supports three types of projects: Core grants to plan and
implement programs; special initiative funding for schools that
have previously received Area Health Education Centers [AHEC]
grants; and model programs to extend AHEC programs with 50
percent Federal funding.
Health Education and Training Centers
These centers provide training to improve the supply,
distribution, and quality of personnel providing health
services in the State of Florida or along the border between
the United States and Mexico and in other urban and rural areas
with populations with serious unmet health care needs.
Allied Health and Other Disciplines
These programs seek to improve access, diversity, and
distribution of allied health practitioners to areas of need.
The program improves access to comprehensive and culturally
competent health care services for underserved populations.
The Committee continues to encourage HRSA to give priority
consideration to projects for schools training allied health
professionals experiencing shortages, such as medical
technologists and cytotechnologists. The Committee is concerned
about high vacancy rates for these critical laboratory
personnel and urges HRSA to redouble efforts to address these
shortages.
The Committee understands the Graduate Psychology Education
Program is the only federally funded psychology training
program, and for this reason, considers its continuation a
priority. This competitive program will continue to provide
grant awards for work with underserved populations,
particularly in rural communities, including elderly, children,
the chronically ill, and victims of abuse or terror.
Geriatric Education Centers and Training
This program supports grants to health professions schools
to establish geriatric education centers and to support
geriatric training projects. These centers and geriatric
training programs play a vital role in enhancing the skill-base
of health care professionals to care for our Nation's growing
elderly population. The Committee is concerned about the
shortage of trained geriatricians and urges the agency to give
priority to building the workforce necessary to care for the
Nation's elderly.
Quentin N. Burdick Program for Rural Health
Interdisciplinary Training
This program addresses shortages of health professionals in
rural areas through interdisciplinary training projects that
prepare students from various disciplines to practice together,
and offers clinical training experiences in rural health and
mental health care settings to expose students to rural
practice.
The Committee supports addressing the issue of how the
delivery of chiropractic health care can be enhanced in rural
areas, and how more women and minorities can be recruited as
chiropractic health care practitioners in rural areas. The
Committee also expects the Bureau to expand its support for
telecommunications and telehealth initiatives for providing
distance education and training for nurses and allied health
professionals serving rural areas.
Podiatric Primary Care Training
This program provides grants to hospitals and schools of
podiatric medicine for residency training in primary care. In
addition to providing grants to hospitals and schools of
podiatric medicine for residency training in primary care, the
program also permits HRSA to study and explore ways to more
effectively administer postdoctoral training in an ever
changing health care environment.
Chiropractic Demonstration Grants
This program provides grants to colleges and universities
of chiropractic to carry out demonstration projects in which
chiropractors and physicians collaborate to identify and
provide effective treatment of spinal and lower back
conditions. The Committee continues to support the chiropractic
research and demonstration grant program, originally authorized
under Section 782 of Public Law 102-408, and funded by the
Committee in previous years. The Committee recommends that the
chiropractic-medical school demonstration grant program be
continued.
D. Workforce Information and Analysis
Health Professions Data and Analysis
This program supports the collection and analysis of data
on the labor supply in various health professions and on future
workforce configurations.
Research on Certain Health Professions Issues
This program supports research on the extent to which debt
has a detrimental effect on students entering primary care
specialties; the effects of federally funded education programs
for minorities attending and completing health professions
schools; and the effectiveness of State investigations in
protecting the health of the public.
E. Public Health Workforce Development
With the continued need for public health training
throughout the country, the Committee believes these programs
serve an important role in maintaining the country's public
health infrastructure.
Public Health, Preventive Medicine and Dental Public Health
Programs
This program supports awards to schools of medicine,
osteopathic medicine, public health, and dentistry for support
of residency training programs in preventive medicine and
dental public health; and for financial assistance to trainees
enrolled in such programs.
Health Administration Programs
This program provides grants to public or nonprofit private
educational entities, including schools of social work, but not
schools of public health, to expand and improve graduate
programs in health administration, hospital administration, and
health policy analysis and planning; and assists educational
institutions to prepare students for employment with public or
nonprofit private agencies.
F. Children's Hospital Graduate Medical Education Program
The Committee intends that the Children's Hospital Graduate
Medical Education [GME] program receive at least $290,102,000
from the consolidated health professions appropriation. The
administration requested $199,258,000 and the fiscal year 2003
comparable level was $290,102,000.
The program provides support for health professions
training in children's teaching hospitals that have a separate
Medicare provider number (``free-standing'' children's
hospitals). Children's hospitals are statutorily defined under
Medicare as those whose inpatients are predominantly under the
age of 18. The funds in this program are intended to make the
level of Federal Graduate Medical Education support more
consistent with other teaching hospitals, including children's
hospitals, which share provider numbers with other teaching
hospitals. Payments are determined by formula, based on a
national per-resident amount. Payments support training of
resident physicians as defined by Medicare in both ambulatory
and inpatient settings.
The Committee recognizes the success of the Children's
Hospitals Graduate Medical Education Payment Program in
providing critical support for training pediatric and other
residents in graduate medical education programs in teaching
hospitals that do not receive support through the Medicare
program. It has come to the Committee's attention that a
limited number of free-standing perinatal hospitals and
children's psychiatric hospitals have been excluded from
participation in this program despite the fact that these
teaching institutions are not eligible for Graduate Medical
Education funding under Medicare. The Committee expects HRSA to
study and report back to the Committee on this matter by April
1, 2004. The Committee expects HRSA to explore the
appropriateness of including these hospitals in the Children's
Hospitals Graduate Medical Education Program and to offer
recommendations that might allow for their inclusion.
G. Nursing Education Programs
The Committee intends that these programs be funded through
the consolidated health profession appropriation and continue
with at least the level of funding provided in fiscal year
2003. The fiscal year 2003 comparable level was $112,763,000
and the administration requested $98,214,000 for fiscal year
2004.
The Committee recognizes that the current nursing shortage
has reached a crisis state across America. The situation only
promises to worsen due to a lack of young nurses in the
profession, an aging existing workforce, and inadequate
availability of nursing faculty to prepare future nurses. The
Committee urges HRSA to support programs aimed at increasing
nursing faculty and encouraging a diverse population's entry
into nursing.
Advanced Education Nursing
The Committee intends that this program be funded through
the consolidated health profession appropriation and continue
with at least the level of funding provided in fiscal year
2003, which was $50,174,000. The administration requested
$26,548,000 for fiscal year 2004. This program funds nursing
schools to prepare nurses at the master's degree or higher
level for teaching, administration, or service in other
professional nursing specialties.
Basic Nurse Education and Practice
The Committee intends that this program be funded through
the consolidated health profession appropriation and continue
with at least the level of funding provided in fiscal year
2003, which was $26,824,000. The administration requested
$24,202,000 for fiscal year 2004. Authorized by Public Law 105-
392, the goal of this program is to improve the quality of
nursing practice. Activities under this program will initiate
new projects that will change the educational mix of the basic
nursing workforce and empower the workforce to meet the demands
of the current health care system.
Nursing Workforce Diversity
The Committee intends that this program be funded through
the consolidated health profession appropriation and continue
with at least the level of funding provided in fiscal year
2003, which was $9,935,000. The administration requested
$20,564,000 for fiscal year 2004. The goal of this program is
to improve the diversity of the nursing workforce through
increased educational opportunities for individuals from
disadvantaged backgrounds. The Committee urges the Division of
Nursing to develop and increase cultural competence in nursing
and to increase the number of underrepresented racial and
ethnic minorities in all areas of nursing education and
practice to enhance nurses' ability to provide quality health
care services to the increasingly diverse community it serves.
Nurse Loan Repayment for Shortage Area Service
The Committee intends that this program be funded through
the consolidated health profession appropriation and continue
with at least the level of funding provided in fiscal year
2003, which was $19,870,000. The administration requested
$26,900,000 for fiscal year 2004. This program offers student
loan repayment to nurses in exchange for an agreement to serve
not less than 2 years in an Indian Health Service health
center, native Hawaiian health center, public hospital,
community or migrant health center, or rural health clinic.
Comprehensive Geriatric Education
The Committee intends that this program be funded through
the consolidated health profession appropriation and continue
with at least the level of funding provided in fiscal year
2003, which was $2,980,000. The administration did not request
funding for fiscal year 2004.
Nursing Faculty Loan Program
The Committee intends that this program be funded through
the consolidated health profession appropriation and continue
with at least the level of funding provided in fiscal year
2003, which was $2,980,000. The administration did not request
funding for fiscal year 2004.
OTHER HRSA PROGRAMS
Hansen's Disease Services
The Committee has included $17,570,000 for the Hansen's
Disease Program. The fiscal year 2003 comparable level was
$18,024,000 and the administration request was $17,570,000.
This program offers Hansen's Disease treatment in Baton Rouge
at the Center, at other contract supported locations in Baton
Rouge, and in grant supported outpatient regional clinics.
These programs provide treatment to about 3,000 of the 6,000
Hansen's disease sufferers in the United States.
Maternal and Child Health Block Grant
The Committee provides $731,565,000 for the maternal and
child health [MCH] block grant. The fiscal year 2003 comparable
level was $729,965,000 and the administration request was
$750,831,000.
The Maternal and Child Health Block Grant program provides
a flexible source of funding that allows States to target their
most urgent maternal and child health needs through development
of community-based networks of preventive and primary care that
coordinate and integrate public and private sector resources
and programs for pregnant women, mothers, infants, children,
and adolescents. The program supports a broad range of
activities including prenatal care, well child services and
immunizations, reducing infant mortality, preventing injury and
violence, expanding access to oral health care, addressing
racial and ethnic disparities and providing comprehensive care
for children, adolescents, and families through clinics, home
visits and school-based health programs.
The MCH block grant funds are provided to States to support
health care for mothers and children. According to statute,
12.75 percent of funds over $600,000,000 are used for
community-integrated service systems [CISS] programs. Of the
remaining funds, 15 percent is used for special projects of
regional or national significance [SPRANS] while 85 percent is
distributed on the same percentage split as the basic block
grant formula.
The Committee has again provided $5,000,000 more for SPRANS
activities than would otherwise be the case under the statutory
formula for oral health demonstration programs and activities
in the States. The Committee understands that such programs
will include grants designed to reduce the incidence of early
childhood caries and baby bottle tooth decay, community water
fluoridation, school-linked dental sealant programs and to
implement State-identified objectives for improving oral
health.
The Committee notes that there has been a steady decline in
oral health leadership and personnel within HRSA. At the HRSA
central and regional office level, the number of dental health
professionals has declined from more than 100 to less than 20.
Of those remaining, 33 percent will reach the 30-year mandatory
retirement level for commissioned corps officers this year. The
Committee is concerned about this situation in light of recent
decreases in State dental programs and an increase in dental
disease and oral health disparities for the Nation's most
vulnerable populations. Therefore, the Committee requests that
HRSA report by April 1, 2004 on what actions it has taken to
address this situation. The Committee would like included in
the report HRSA's response to a January 2002 report submitted
by HRSA Regional Dental consultants and any other relevant
actions taken to enhance dental programs within HRSA.
The Committee also provides an additional $1,600,000 more
for SPRANS activities than would otherwise be the case under
the statutory formula for mental health programs and activities
in the States. The Committee expects that the programs will
include mental health grants for prevention and early
intervention services for children and youth ages 0 to 24 years
and for women's mental health as it relates to their role in
the family, particularly for women diagnosed with postpartum
depression. One out of every ten new mothers suffers from
postpartum depression [PPD], a treatable condition that
presents a range of emotional and physical changes.
Unfortunately, half of these women never get help. One reason
for the low treatment rate is that only approximately 10
percent of women with postpartum depression discuss their
symptoms with a health care professional. This is an important
problem with devastating affects on America's children and
families. Research shows that postpartum depression is a
significant contributing factor in child abuse and neglect.
Screening tools need to be developed for the detection of
PPD in perinatal women. In addition, recent extreme cases of
PPD involving mother-child violence illustrate the need for a
national, multilingual public education campaign to reduce the
stigma of seeking treatment for PPD. Treatment of PPD focuses
on: the development of support groups; the training of health
providers such as obstetricians, gynecologists, pediatricians,
low-income clinic general practitioners, and emergency room
nurses; the development of hotlines for women to receive
referrals to treatment; and the training of public assistance
staff (eg. HUD, WIC, Medicaid) and home health visiting
organizations to recognize symptoms and provide referrals to
women suffering from PPD. The Committee encourages the Bureau
to focus on low-income women and mothers of children with low
birth weight. The Committee recommends that funding be used on
science-based programs or models such as the Starting Early
Starting Smart Program that was funded by the Substance Abuse
and Mental Health Service Administration [SAMHSA] and the Casey
Family Programs to specifically target early intervention and
prevention.
Newborn screening is a public health activity used for
early identification of infants affected by certain genetic,
metabolic, hormonal and or functional conditions for which
there are effective treatments or interventions. Screening
detects disorders in newborns that, left untreated, can cause
death, disability, mental retardation and other serious
illnesses. Biliary atresia, a pediatric liver disease which
affects 1 in 10,000 infants, is such a condition. If identified
and treated before the infant reaches the age of 60 days,
biliary atresia has a high cure rate. If left untreated, it
will result in liver failure. Parents are often unaware that
while nearly all babies born in the United States undergo
newborn screening tests for genetic birth defects, the number
and quality of these tests vary from State to State. The
Committee supports efforts to implement the heritable disorders
program authorized in Title XXVI of the Children's Health Act.
This program is designed to strengthen States' newborn
screening programs and improve States' ability to develop,
evaluate, and acquire innovative testing technologies, and
establish and improve programs to provide screening,
counseling, testing and special services for newborns and
children at risk for heritable disorders. The Committee urges
HRSA to include additional conditions, such as biliary atresia,
Fragile X, and abnormally elevated levels of bilirubin, in this
program evaluation of testing programs with the goal of
implementing cost-effective public health screening programs
for these and other disorders.
The Committee notes that the Maternal and Child Health
Bureau has issued a program announcement that will extend
support for comprehensive treatment centers for Cooley's anemia
patients under SPRANS through fiscal year 2005. The Committee
applauds the bureau's responsiveness to earlier expressions of
interest in this program. The Committee urges the bureau to
continue to coordinate its activities with the Cooley's Anemia
Foundation and seek opportunities to expand the program to
other centers throughout the country.
The Committee also commends the Maternal and Child Health
Bureau for its support of the Sudden Infant Death Syndrome
Program Support Center, and encourages the bureau to continue
its efforts in this important area of service, and is pleased
that the SIDS and Other Infant Death Support Center is
collaborating with the National Institutes of Health to address
the disproportionately high incidence of SIDS among African
Americans.
The Committee remains very concerned about the impact of
level funding of hemophilia treatment centers on access to
needed comprehensive care for persons with bleeding disorders.
The Committee encourages HRSA to commit additional resources to
this model disease management network.
The Committee recognizes epilepsy, a chronic neurological
condition, as a significant public health concern affecting
over 2.5 million persons in the United States. As 125,000 new
cases of epilepsy are diagnosed annually, delayed diagnosis,
along with inadequate seizure treatment, greatly increases the
risk of subsequent seizures, brain damage, disability, and
death. Therefore, timely, effective treatment is essential. The
Committee is supportive of the epilepsy public health program
as described by the Children's Health Act of 2000 and of a
model demonstration program that would improve access to health
and other services to encourage early detection and treatment
for children and others residing in medically underserved
areas. The Committee encourages HRSA to partner with a national
voluntary epilepsy agency to implement an epilepsy public
awareness campaign directed toward underserved populations.
The Committee is aware that diabetes and asthma
disproportionately affect minority populations in medically
under-served areas. Rates of severe asthma continue to
disproportionately affect poor, minority, and inner-city
populations. For example, African Americans visit emergency
departments, are hospitalized, and die due to asthma at rates
three times higher than rates for white Americans. Diabetes,
now the sixth leading cause of death in America, has its
greatest effect on the elderly and certain racial and ethnic
groups. The Committee encourages HRSA to partner with
organizations, such as the Visiting Nurse Associations of
America, to implement programs that address these growing
epidemics.
The Committee recognizes that children's physiological and
psychological needs are often different from adults. The
``Bioterrorism and Emergency Preparedness and Response Act of
2001'' called for preparedness and response efforts which
addressed children's unique needs. The Committee believes that
a pediatric network on bioterrorism and emergency preparedness
could provide this focus and quickly deepen and extend both
expertise and resources to providers, States, and localities
across the country. The Committee urges HRSA to identify the
key steps, costs, and authorities necessary to establish a
national network of Pediatric Centers for Public Health and
Bioterrorism Preparedness, and report its findings to the
Committee by April 1, 2004.
Healthy Start Initiative
The Committee provides $98,346,000 for the healthy start
infant mortality initiative. The fiscal year 2003 comparable
level was $98,346,000 and the administration request was
$98,729,000.
The healthy start initiative was developed to respond to
persistently high rates of infant mortality in this Nation. The
initiative was expanded in fiscal year 1994 by a special
projects program, which supported an additional seven urban and
rural communities to implement infant mortality reduction
strategies and interventions. The Children's Health Act of 2000
fully authorized this initiative as an independent program.
Universal Newborn Hearing Screening and Early Intervention
The Committee provides $9,935,000 for universal newborn
hearing screening and early intervention activities. The fiscal
year 2003 comparable level was $9,935,000 and the
administration did not request funds for this program in fiscal
year 2004. The Committee again rejects the administration
proposal to consolidate this program into the Maternal and
Child Health Block Grant program.
The Committee continues to strongly support the initiative
it began 2 years ago to provide grants to States to establish
universal newborn hearing screening and early intervention
programs. This initiative has been quite successful and the
response from States has been substantial. Numerous studies
have demonstrated that newborn hearing screening followed by
early intervention services can greatly improve health and
educational outcomes for children.
The Committee expects HRSA to coordinate projects funded
with this appropriation with projects related to early hearing
detection and intervention by the National Center on Birth
Defects and Developmental Disabilities, the National Institute
on Deafness and Other Communication Disorders, the National
Institute on Disability and Rehabilitation Research, and the
Office of Special Education and Rehabilitative Services.
Organ Procurement and Transplantation
The Committee provides $24,828,000 for organ transplant
activities. The fiscal year 2003 comparable level was
$24,828,000 and the administration request was $24,924,000.
These funds support a scientific registry of organ transplant
recipients and the National Organ Procurement and
Transplantation Network to match donors and potential
recipients of organs. A portion of the appropriated funds may
be used for education of the public and health professionals
about organ donations and transplants, and to support agency
staff providing clearinghouse and technical assistance
functions.
The Committee considers increasing the supply of organs
available from voluntary donations to be a top public health
priority and expects that funds be committed to those
activities having the greatest demonstrable impact on donation
rates.
The Committee continues to encourage the agency to
establish linkages with State and Federal transportation
officials to improve coordination of donation following
vehicular accidents, through the establishment of donor
registries.
The Committee commends HRSA for its leadership in promoting
increased organ and tissue donations across the Nation. The
Committee encourages the Division of Transplantation to enhance
its partnership with the pulmonary hypertension community aimed
at increasing awareness about the need for increased heart and
lung donations.
The Committee is encouraged by the growing number of
transplants using living donors who contribute a portion of
their liver to a recipient. HRSA is urged to study the outcomes
for both donors and recipients, define the optimal surgical
procedure and identify eligibility criteria. Additionally, to
maximize donation of cadaveric organs for transplantation,
research is needed to study the outcomes of: preservation
modalities, preservation times, and donor and recipient risk
factors. The Agency is urged to study various models for
presumed consent and, in cooperation with nonprofit health
organizations to investigate the feasibility of implementing
presumed consent in the United States.
The Committee is aware of reports that fewer than 2,000
cadaver pancreata are available each year for transplantation
and research purposes, far fewer than other organs. Clinical
trials involving pancreatic beta cells to cure juvenile
diabetes have shown great promise, and approximately 80 percent
of patients who have received the transplants remain free from
insulin injections 1 year after transplant. The Committee urges
HRSA to develop and implement policies to encourage the
retrieval of pancreata so that additional transplants can be
conducted.
National Bone Marrow Donor Program
The Committee provides $21,891,000 for the National Bone
Marrow Donor Program. The fiscal year 2003 comparable level was
$21,891,000 and the administration request was $22,013,000. The
National Bone Marrow Donor Registry is a network, operated
under contract, which helps patients suffering from leukemia or
other blood diseases find matching volunteer unrelated bone
marrow donors for transplants. The program also conducts
research on the effectiveness of unrelated marrow transplants
and related treatments.
National Cord Blood Stem Cell Bank Program
The Committee has strongly supported medical research and
the translation of medical research into treatments and cures.
The Committee has led the way in doubling the budget of the
National Institutes of Health over 5 years and supporting
groundbreaking technologies that have the potential to relieve
the suffering of millions of Americans. The Committee strongly
supports embryonic and adult stem cell research. Adult stem
cells, including stem cells collected from umbilical cords,
have been the subject of research at the NIH for many years.
Although these cord blood stem cells are still more limited in
their ability to transform into other cell types and
proliferate indefinitely than embryonic stem cells, the
technology is useful for a range of blood disorders and
cancers. Therefore, the Committee has provided $10,000,000 to
create a National Cord Blood Stem Cell Bank with the aim of
building an inventory of the highest quality, fully
characterized cord blood units for use as unrelated donor
grafts for patients who need transplantation therapy but lack
suitably matched conventional bone marrow donors. The Committee
understands that this Cord Blood Stem Cell Bank will serve
patients suffering from high risk and refractory malignancies
(leukemia, lymphoma, myelodysplasia, neuroblastoma), congenital
and acquired bone marrow failure syndromes (aplastic anemia,
fanconi anemia), congenital immunodeficiency syndromes (SCID,
Wiscott Aldrich Syndrome CID), inborn errors of metabolism and
hemoglobinopathies (sickle cell anemia and thalassemia). The
inventory will be constructed so as to provide equal access to
this therapy for members of all the ethnic groups in the United
States, which will be further facilitated by the suitability of
partially matched cord blood stem cell grafts. These features
of the National Program will overcome the lower probabilities
of finding matched bone marrow donors for patients with rare
tissue types and members of ethnic minorities. Cord Blood Stem
cells will also serve patients who, because of the advanced
stage of their disease, must undergo transplantation therapy
within days or weeks, requiring rapid donor procurement. The
inventory will also be available for the performance of pre-
clinical and clinical research focusing on cord blood stem cell
biology and the use of umbilical cord blood stem cells for
human transplantation and cellular therapies.
Rural Health Outreach Grants
The Committee provides $39,850,000 for health outreach
grants. The fiscal year 2003 comparable level was $58,410,000
and the administration request was $37,752,000. This program
supports projects that demonstrate new and innovative models of
outreach in rural areas such as integration and coordination of
health services.
Mississippi's Delta is a community in which residents
disproportionately experience disease risk factors and children
are significantly mentally and physically developmentally
behind. The Committee recognizes that communities such as this
show positive behavioral change when community based programs
and infrastructure are in place. The Committee believes that
collaborative programs offering health education, coordination
of health services and health-related research offer the best
hope for breaking the cycle of poor health in underprivileged
areas such as the Mississippi Delta. Therefore, the Committee
recommends the continued funding of these activities as already
initiated and undertaken by the coordinated efforts of the
Mississippi Delta Health Initiative, which is a collaboration
involving Delta State University, Mississippi State University,
the University of Mississippi Medical Center, and the
Mississippi State Department of Health.
The Committee is also supportive of non-profit
organizations, such as the Children's Health Fund, that offer
mobile comprehensive medical care to uninsured and medically
underserved children. The fund is currently implementing state-
of-the-art electronic patient record systems at its project
sites and to assist Delta State University and Mississippi
Delta community health centers to implement mobile health in
this critically underserved area.
The Committee appreciates innovative programs to address
health care needs in rural underserved areas and supports the
efforts of Schools of Nursing in establishing nurse-managed
clinics. The Committee further recognizes the value of
collaborative projects involving Schools of Pharmacy, along
with rural clinics and hospitals.
The Committee understands that many primary care clinics in
isolated, remote locations are providing extended stay services
and are not staffed or receiving appropriate compensation to
provide this service. The Committee encourages the agency to
undertake a demonstration project to evaluate the effectiveness
of a new type of provider, the ``Frontier Extended Stay
Clinic,'' to provide expanded services in remote and isolated
primary care clinics to meet the needs of seriously ill or
injured patients who cannot be transferred quickly to acute
care referral centers, and patients who require monitoring and
observation for a limited time.
Rural Health Research
The Committee provides $9,935,000 for the Rural Health
Policy Development Program. The fiscal year 2003 comparable
level was $10,630,000 and the administration request was
$5,984,000. The funds provide support for the Office as the
focal point for the Department's efforts to improve the
delivery of health services to rural communities and
populations. Funds are used for rural health research centers,
the National Advisory Committee on Rural Health, and a
reference and information service.
State Offices of Rural Health
The Committee provides $8,445,000 for the State Offices of
Rural Health. The fiscal year 2003 comparable level was
$8,445,000 and the administration request was $3,990,000. The
State Office of Rural Health program helps the States
strengthen rural heath care delivery systems by allowing them
to better coordinate care and improve support and outreach in
rural areas. The Committee believes that continued funds for
this purpose are critical to improving access and quality
health care services throughout rural communities.
Telehealth
The Committee provides $3,973,000 for telehealth
activities. The fiscal year 2003 comparable level was
$26,686,000 and the administration request was $5,594,000. The
telehealth program promotes the use of technologies to improve
access to health services and distance education for health
professionals.
The Committee strongly supports HRSA's numerous rural
telehealth initiatives and continues to encourage the agency to
work in partnership with medical librarians, the National
Library of Medicine, and other health information specialists
in the development and implementation of its telehealth
projects.
The Committee also commends the Office for the Advancement
of Telehealth for its support of information infrastructure
development at minority health professions institutions and
encourages continued support for this high priority activity in
fiscal year 2004.
The Committee supports efforts to bridge the gap in
availability of clinical services between the resource-rich
metropolitan center of Shelby County, Tennessee, with the
medically underserved counties of Tennessee, Mississippi, and
Arkansas.
The Committee recognizes the efforts of organizations that
have worked to provide greater access to health care services
and providers for all patients, including rural and urban
underserved populations.
Native and Rural Alaskan Health Care
The Committee provides $40,000,000 for the Denali
Commission. The fiscal year 2003 comparable level was
$27,321,000 and the administration did not request funds for
this program in fiscal year 2004. These funds support
construction and renovation of health clinics, hospitals and
social service facilities in rural Alaska as authorized by
Public Law 106-113. Provision of the funding will help remote
communities in Alaska develop critically needed health and
social service infrastructure for which no other funding
sources are available so that health and social services may be
provided to Alaskans in remote rural communities as they are in
other communities throughout the country.
The Committee expects the Denali Commission to allocate
funds to a mix of rural hospital, clinic, long-term care and
social service facilities, rather than focusing exclusively on
clinic funding.
Critical Care Programs
The Committee has grouped the following ongoing and
proposed activities: emergency medical services for children,
the traumatic brain injury program, trauma care/emergency
medical services, and poison control centers.
Emergency Medical Services for Children
The Committee provides $20,000,000 for emergency medical
services for children. The fiscal year 2003 comparable level
was $19,373,000 and the administration requested $18,943,000
within the Public Health and Social Services Emergency Fund in
the Office of the Secretary. The Committee continues to fund
this program within HRSA. The program supports demonstration
grants for the delivery of emergency medical services to
acutely ill and seriously injured children.
The Committee is pleased with the efforts made for the
emergency medical services for children. The Committee would
like an update on this program. The 10 year Institute of
Medicine [IOM] report and study was extremely helpful and the
Committee strongly urges a 20 year program study and update to
the IOM report.
Poison Control Centers
The Committee provides $22,354,000 for poison control
center activities. The fiscal year 2003 comparable level was
$22,354,000 and the administration requested $21,166,000 within
the Public Health and Social Services Emergency Fund in the
Office of the Secretary. The Committee continues to fund this
program within HRSA. The funds provided support activities
authorized in the Poison Control Center Enforcement and
Enhancement Act as well as the development and assessment of
uniform patient management guidelines.
The Committee recognizes that poison control centers may
serve as the entry point for sickened individuals into the
public health system. Early detection of public health threats
is critical to limiting the consequences of a threat.
Therefore, the Committee strongly urges HRSA to work with the
CDC to find innovative ways to further incorporate the poison
control centers into the public health infrastructure. HRSA and
CDC should cooperate to improve real-time data collection and
analysis from the poison control centers to identify the
presence of a potential health threat, including chemical or
biological attack, as early as possible.
Traumatic Brain Injury Program
The Committee provides $9,438,000 for the traumatic brain
injury program. The fiscal year 2003 comparable level was
$9,438,000 and the administration requested $7,479,000. The
program supports implementation and planning grants to States
for coordination and improvement of services to individuals and
families with traumatic brain injuries as well as protection
and advocacy. Such services can include: pre-hospital care,
emergency department care, hospital care, rehabilitation,
transitional services, education, employment, and long-term
support. The Committee includes $3,000,000 for protection and
advocacy services, as authorized under section 1305 of Public
Law 106-310.
Black Lung Clinics
The Committee provides $6,000,000 for black lung clinics.
The fiscal year 2003 comparable level was $5,961,000 and the
administration requested $6,000,000. This program funds clinics
that treat respiratory and pulmonary diseases of active and
retired coal miners. These clinics reduce the incidence of
high-cost inpatient treatment for these conditions.
Trauma Care
The Committee provides $3,476,000 for trauma/emergency
medical services. The fiscal year 2003 comparable level was
$3,476,000 and the administration did not request funds for
this program in fiscal year 2004. The Committee again rejects
the administration proposal to consolidate this program into
the Maternal and Child Health Block Grant program. This program
is intended to improve the Nation's overall emergency medical
systems, which are constantly activated to respond to a wide
range of natural and man-made disasters, such as: earthquakes;
mass violence; riots; school shootings; motor vehicle crashes;
and terrorist attacks.
Payment to Hawaii, Hansen's Disease Treatment
The Committee provides $2,045,000 for Hansen's disease
services. The fiscal year 2003 comparable level was $2,032,000
and the administration requested $2,045,000.
ACQUIRED IMMUNE DEFICIENCY SYNDROME
Ryan White AIDS Programs
The Committee provides $2,041,599,000 for Ryan White AIDS
programs. The recommendation includes $25,000,000 in transfers
available under section 241 of the Public Health Service Act.
The fiscal year 2003 comparable level was $2,017,965,000 and
the administration request was $2,009,549,000.
Within the total provided, $131,884,000 is for 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.
Recent advances in diagnosis, treatment, and medical
management of HIV disease has resulted in dramatic improvements
in individual health, lower death rates and transmission of HIV
from mother to infant. The Committee recognizes, however, that
not all HIV-infected persons have benefited from these medical
advances and expects that the Ryan White CARE Act programs
provide social and other support services with the specific
intent of obtaining and maintaining HIV-infected individuals in
comprehensive clinical care.
The Department is encouraged to identify obstacles
confronting people with HIV/AIDS in receiving medical care
funded through the Ryan White programs and to develop
strategies to address these problems in light of the changing
medical needs of a patient population that is living longer
with current therapies.
The Committee recognizes the recent advances in the
treatment and medical care of persons with HIV disease and the
need for early access to these interventions and services.
Furthermore, the Committee understands that disparities exist
in accessing and maintaining the benefits of these recent
advances among communities highly impacted by HIV and AIDS.
Emergency Assistance--Title I
The Committee provides $618,693,000 for emergency
assistance grants to eligible metropolitan areas
disproportionately affected by the HIV/AIDS epidemic. These
funds are provided to metropolitan areas meeting certain
criteria. Half of the funds are awarded by formula and the
other half are awarded through supplemental competitive grants.
Comprehensive Care Programs--Title II
The Committee provides $1,077,027,000 for HIV health care
and support services. These funds are awarded to States to
support HIV service delivery consortia, the provision of home
and community-based care services for individuals with HIV
disease, continuation of health insurance coverage for low-
income persons with HIV disease and support for State AIDS drug
assistance programs [ADAP].
The Committee continues to be encouraged by the progress of
anti-retroviral therapy in reducing the mortality rates
associated with HIV infection and in enhancing the quality of
life of patients on medication. The Committee has approved bill
language for $739,000,000 for AIDS medications.
The Committee further urges HRSA to encourage States to
utilize Federal ADAP funding in the most cost-effective manner
to maximize access to HIV drug therapies and to eliminate cost-
shifting from Medicaid to the State ADAP programs. States with
ADAP funding should be allowed the flexibility to purchase and
maintain insurance policies for eligible clients including
covering any costs associated with these policies, or continue
to pay premiums on existing insurance policies that provide a
full range of HIV treatments and access to comprehensive
primary care services, as determined by a State. Funds should
not be committed to purchase insurance deemed inadequate by a
State in its provision of primary care or in its ability to
secure adequate access to HIV treatments.
Early Intervention Program--Title III-B
The Committee provides $198,374,000 for early intervention
grants. These funds are awarded competitively to primary health
care providers to enhance health care services available to
people at risk of HIV and AIDS. Funds are used for
comprehensive primary care, including counseling, testing,
diagnostic, and therapeutic services.
The Committee encourages HRSA to fairly allocate the
increase for title III-B between existing grantees and new
providers. By providing additional funds to current grantees,
the Committee intends to strengthen the HIV care infrastructure
already established in title III-B clinics. The Committee also
supports expansion of the number of communities receiving
assistance from this title.
Priority should be placed on funding existing and new
projects in rural, medically underserved areas, and secondary
cities outside of major metropolitan areas in order to build
clinical capacity for the delivery of HIV care among clinicians
serving high-risk populations, minorities, and those who are
unable to access clinical HIV care for economic reasons. In
building capacity, the goal is to develop knowledgeable
clinicians to improve access to quality HIV treatment based
upon the evolving HIV treatment guidelines of DHHS.
Women, Infants, Children, and Youth--Title IV
The Committee provides $73,551,000 for title IV pediatric
AIDS. Funds are awarded to community health centers, family
planning agencies, comprehensive hemophilia diagnostic and
treatment centers, federally qualified health centers under
section 1905(1)(2)(B) of the Social Security Act, county and
municipal health departments and other nonprofit community-
based programs that provide comprehensive primary health care
services to populations with or at risk for HIV disease.
The Committee intends that at least 90 percent of total
title IV funding be provided to grantees. With the exception of
funds provided through the Minority HIV/AIDS Initiative, the
Committee expects the funds will be used to support maintenance
of existing care services because of the rising costs of
providing comprehensive care. HRSA should also use a
significant portion of the remaining funds to expand existing
comprehensive services programs for youth. Due to the
longstanding accomplishments by title IV programs in reduction
of mother-to-child HIV transmission [MTCT] through family-
centered care models, the Committee expects HRSA to develop
linkages between title IV programs and international MTCT
initiatives as well as domestic MTCT programs funded by CDC.
The Committee is concerned that the existing ban on travel by
project officers is inhibiting the effectiveness of title IV
programs and urges HRSA to reevaluate this policy.
Some 5 percent of the funds appropriated under this section
may be used to provide peer-based technical assistance. The
Committee expects any funds used for peer-based technical
assistance will be primarily provided to existing Title IV
grantees. Within this amount, sufficient funds are available to
maintain and expand work being done to create a national
consumer and provider education center on the use of various
strategies and planning in the care of children, youth, women,
and families infected with or affected by HIV and AIDS.
AIDS Dental Services
The Committee provides $13,405,000 for AIDS Dental
Services. This program provides grants to dental schools,
dental hygiene schools, and postdoctoral dental education
programs to assist with the cost of providing unreimbursed oral
health care to patients with HIV disease.
The Committee recognizes the importance of oral health care
providers in the diagnosis of HIV and in treating the painful
and debilitating oral manifestations of this disease. The
Committee supports this program as it improves access to oral
health services for low-income and uninsured people living with
HIV and AIDS by providing partial reimbursement to dental
education institutions for delivering care. The Committee
recognizes that these dental services are vital because they
are often the only services available to AIDS patients since
many State Medicaid programs do not cover adult dental
services.
AIDS Education and Training Centers
The Committee provides $35,549,000 for the AIDS education
and training centers [AETC's]. AIDS education and training
centers train health care practitioners, faculty, and students
who care for AIDS patients outside of the traditional health
professions education venues, and support curriculum
development on diagnosis and treatment of HIV infection for
health professions schools and training organizations. The
targeted education efforts by AETC's are needed to ensure the
cost-effective use of the significant expenditures in Ryan
White programs and the AIDS drugs assistance program. The
agency is urged to fully utilize the AETC's to ensure the
quality of medical care and to ensure, as much as possible,
that no individual with HIV receives suboptimal therapy due to
the lack of health care provider information.
Family Planning
The Committee provides $283,350,000 for the title X family
planning program. The fiscal year 2003 comparable level was
$273,350,000 and the administration request was $264,808,000.
Title X grants support primary health care services at more
than 4,500 clinics nationwide. About 85 percent of family
planning clients are women at or below 150 percent of poverty
level. Title X of the Public Health Service Act, which
established the family planning program, authorizes the
provision of a broad range of acceptable and effective family
planning methods and preventive health services. This includes
FDA-approved methods of contraception.
The Committee has increased funding for clinics receiving
Title X funds to address increasing financial pressures in
their effort to provide high-quality, subsidized family
planning services and preventive health care to (4.4 million
each year, many of whom are uninsured) low-income and uninsured
women. These pressures include rising medical costs of newer
and longer lasting contraceptive methods, pharmaceuticals, and
screening and diagnostic technologies (as well as a rising
uninsured population). The Committee recognizes that due to
these financial pressures, it will be difficult for Title X
clinics to serve the current number of patients without a
significant funding increase. The Committee also recognizes
that the increased availability of new contraceptive methods
and screening technologies will improve women's health and
result in a decrease in unintended pregnancies nationwide.
The Committee remains concerned that programs receiving
Title X funds ought to have access to these resources as
quickly as possible. The Committee, therefore, again instructs
the Department to distribute to the regional offices all of the
funds available for family planning services no later than 60
days following enactment of this bill.
The Committee intends that at least 90 percent of funds
appropriated for Title X activities be for clinical services
authorized under section 1001 of the Act. All such funds for
section 1001 activities are to be provided to the regional
offices to be awarded to grantees to provide family planning
methods and services as specified by the Title X statute. The
Committee further expects the Office of Family Planning to
spend any remaining year-end funds in section 1001 activities.
Community Based Abstinence Education Program
The Committee provides $73,044,000 for this program, which
provides support for the development and implementation of
abstinence education programs for adolescents, ages 12 through
18. The fiscal year 2003 comparable level was $54,642,000 and
the administration request was $73,044,000. These programs are
unique in that their entire focus is to educate young people
and create an environment within communities that support teen
decisions to postpone sexual activity until marriage. The
Committee intends that the Secretary fund grantees who are
currently receiving section 510 funds, but whose project
periods were scheduled to expire at the end of fiscal year
2003.
Health Care Facilities
The Committee has provided no funding for health care
facilities. The fiscal year 2003 comparable level was
$294,700,000 and the administration did not request funds for
this program in fiscal year 2004. This account makes funds
available to public and private entities for construction and
renovation of health care and other facilities. The reduction
below last year's level is due to the funding of one-time
projects.
Buildings and Facilities
The Committee provides $248,000 for buildings and
facilities. The fiscal year 2003 comparable level was $248,000
and the administration request was $250,000.
Rural Hospital Flexibility Grants
The Committee provides $39,740,000 for rural hospital
flexibility grants. The fiscal year 2003 comparable level was
$39,740,000 and the administration request was $29,921,000.
Under this program, eligible rural hospitals may convert
themselves into limited service facilities termed Critical Care
Hospitals. Such entities are then eligible to receive cost-
based payments from Medicare. The grant component of the
program assists States with the development and implementation
of State rural health plans, conversion assistance, and
associated activities.
Of the amount provided, the Committee includes $20,000,000
to continue the Small Rural Hospital Improvement Grant Program,
as authorized by Section 1820(g)(3) of the Social Security Act
and Public Law 107-116 and outlined in House Report 107-342.
Rural Access to Emergency Devices
The Committee provides $8,000,000 for rural access to
emergency devices. The fiscal year 2003 comparable level was
$12,419,000 and the administration request was $2,009,000. This
program, which is to be administered through the Rural Health
Outreach Office, provides grants to expand placement of
automatic external defibrillators [AEDs] in rural areas and to
ensure that first responders and emergency medical personnel
are appropriately trained.
Radiogenic Diseases
The Committee provides $1,987,000 for the Radiation
Exposure Compensation Act. The fiscal year 2003 comparable
level was $1,987,000 and the administration request was
$4,006,000. This program provides grants for the education,
prevention, and early detection of radiogenic cancers and
diseases resulting from exposure to uranium during its mining
and milling at nuclear test sites.
National Practitioner Data Bank
The Committee provides $17,000,000 for the national
practitioner data bank. The fiscal year 2003 comparable level
was $19,500,000 and the administration request was $17,000,000.
The Committee and the administration assume that full funding
will be provided entirely through the collection of user fees
and will cover the full cost of operating the data bank.
Traditional bill language is included to ensure that user fees
are collected to cover all costs of processing requests and
providing such information to data bank users.
Health Care Integrity and Protection Data Bank
The Committee provides $4,000,000 for the health care
integrity and protection data bank. The fiscal year 2003
comparable level was $5,600,000 and the administration request
was $4,000,000. The Committee and the administration assume
that full funding will be provided entirely through the
collection of user fees and will cover the full cost of
operating the data bank. The data bank is intended to collect,
maintain, and report on certain actions taken against health
care providers, suppliers, and practitioners.
Healthcare Access for the Uninsured/Community Access Program
The Committee provides no funding for this activity. The
fiscal year 2003 comparable level was $119,219,000 and the
administration did not request funds for this program in fiscal
year 2004. This program is designed to increase the capacity
and effectiveness of community health care institutions and
providers who serve patients, regardless of their ability to
pay.
Program Management
The Committee provides $146,686,000 for program management
activities for fiscal year 2004. The fiscal year 2003
comparable level was $156,974,000 and the administration
request was $151,115,000.
MEDICAL FACILITIES GUARANTEE AND LOAN FUND
The Committee has not included funding for the Medical
Facilities and Guarantee and Loan Fund. This fund was
established in 1972 under the Medical Facilities Construction
Program in order to make funds available for construction of
medical facilities. The fund is established in the Treasury
without fiscal year limitation to pay interest subsidies, make
payments of principal and interest in the event of default on a
guaranteed loan, and repurchase, if necessary loans sold and
guaranteed. There are sufficient carryover funds from prior
years' appropriations to pay defaults and interest subsidy
payments; therefore, no appropriation is required to cover
these payments.
HEALTH EDUCATION ASSISTANCE LOANS
The Committee provides $4,000,000 to liquidate obligations
from loans guaranteed before 1992. The fiscal year 2003
comparable level was $7,000,000 and the administration request
was $4,000,000. For administration of the HEAL Program
including the Office of Default Reduction, the Committee
provides $3,389,000. The fiscal year 2003 comparable level was
$3,889,000 and the administration request was $3,389,000.
The HEAL Program insures loans to students in the health
professions. The Budget Enforcement Act of 1990, changed the
accounting of the HEAL Program. One account is used to pay
obligations arising from loans guaranteed prior to 1992. A
second account was created to pay obligations and collect
premiums on loans guaranteed in 1992 and after. administration
of the HEAL Program is separate from administration of other
HRSA programs.
VACCINE INJURY COMPENSATION TRUST FUND
Appropriations, 2003.................................... $88,890,000
Budget estimate, 2004................................... 68,991,000
Committee recommendation................................ 68,972,000
The Committee provides that $68,972,000 be released from
the vaccine injury compensation trust fund in fiscal year 2004,
of which $2,972,000 is for administrative costs. The total
fiscal year 2003 comparable level was $88,890,000 and the total
administration request was $68,991,000.
The National Vaccine Injury Compensation Program provides
compensation for individuals with vaccine-associated injuries
or deaths. Funds are awarded to reimburse medical expenses,
lost earnings, pain and suffering, legal expenses, and a death
benefit. The vaccine injury compensation trust fund is funded
by excise taxes on certain childhood vaccines.
Centers for Disease Control and Prevention
DISEASE CONTROL, RESEARCH, AND TRAINING
Appropriations, 2003.................................... $4,495,039,000
Budget estimate, 2004................................... 4,319,312,000
Committee recommendation................................ 4,644,630,000
The Committee provides a program level of $4,644,630,000
for the Centers for Disease Control and Prevention. The
Committee recommendation includes $4,432,496,000 in budget
authority and an additional $212,134,000 via transfers
available under section 241 of the Public Health Services Act.
The fiscal year 2003 comparable program level was
$4,495,039,000 and the administration request program level was
$4,319,312,000.
The activities of the CDC focus on several major
priorities: provide core public health functions; respond to
urgent health threats; monitor the Nation's health using sound
scientific methods; build the Nation's health infrastructure to
insure our national security against bioterrorist threats;
promote women's health; and provide leadership in the
implementation of nationwide prevention strategies to encourage
responsible behavior and adoption of lifestyles that are
conducive to good health.
BIRTH DEFECTS, DEVELOPMENTAL DISABILITIES, DISABILITY AND HEALTH
The Committee recommends $110,639,000 for birth defects,
developmental disabilities, disability and health. The fiscal
year 2003 comparable level was $98,040,000 and the
administration request was $87,462,000.
Within the total provided, the following funding levels are
for the specific program activities: autism, $12,311,000; birth
defects, $18,694,000; fetal alcohol syndrome, $12,908,000;
folic acid, $2,484,000; infant health, $11,740,000; attention
deficit resource centers, $1,748,000; spina bifida, $5,128,000;
muscular dystrophy, $4,974,000; Healthy Athletes, $4,775,000;
Paralysis Resource Center, $5,981,000; disability prevention,
$14,238,000; newborn infant hearing, $7,211,000; limb loss,
$3,580,000; facial reconstruction, $500,000; and child
development studies, $4,367,000.
Attention Deficit Hyperactivity Disorder.--The Committee
commends CDC for its Resource Center on AD/HD and has included
increased funding in fiscal year 2004 to expand the activities
at the Resource Center to respond to the overwhelming demand
for information and support services; to better reach special
populations in need, to develop on-line educational tools for
professionals; and, to enable CDC to expand its population-
based research and surveillance.
Autism.--Within the total provided, $4,110,000 above the
President's request has been provided to expand the Center's
autism epidemiology program. This is $1,500,000 over last
year's level. The Committee is concerned that the data
collection and analysis within this program is not progressing
at the anticipated pace and urges the agency within the funds
provided to allocate the resources necessary to release the
data and conclusions in a timely manner. The Committee expects
a status report on autism data before April 1, 2004.
Craniofacial Malformation.--The Committee recognizes the
importance of helping the families of children with
craniofacial malformation. These malformations include major
conditions such as cleft lip and palate; hemifacial microsomia;
atresia/microtia; hemangiomas and vascular malformations;
Pfeiffer Syndrome, Crouzon Syndrome, and Pierre Robin
Malformation Sequence as well as rarer, or orphan conditions.
The Committee encourages CDC to conduct research on the
incidence of birth defects including abnormalities of
structure, function, or body metabolism, the cost of
appropriate medical treatment, availability of insurance
coverage, and insurance coverage policies. The Committee has
included $500,000 for CDC to create a registry and database of
children nationwide with craniofacial malformation and
development of plan for an information clearinghouse for
parents and physicians regarding appropriate medical treatment.
The Center is encouraged to work with the National Foundation
for Facial Reconstruction or other such private foundation
representing children with such malformations and their
parents.
Diamond Blackfan Anemia.--The Committee understands that
the detailed evaluation of Diamond Blackfan Anemia [DBA]
patients may serve as an important model for understanding the
genetics of birth defects. The Committee has learned that more
than 50 percent of patients with DBA have a variety of
congenital malformations involving the face and head, upper arm
and hand, genitourinary, and the heart, with 21 percent of
patients having more than one birth defect. The Committee also
understands that breakthroughs in this disorder may lead to
important strides in other research especially relating to
blood cell formation (recovery from cancer chemotherapy),
cancer predisposition, gene discovery, and the effectiveness of
steroids and blood transfusions as treatment options for bone
marrow failure syndromes. The CDC is encouraged to establish a
Diamond Blackfan Anemia Clinical Care Center, which would
gather and analyze extensive data on this disease to be used
for research initiatives involving the genetics of birth
defects, cancer predisposition, gene discovery, red cell
differentiation, and a comparison of treatment approaches and
patient response to therapeutic treatments including blood
transfusion, steroids and bone marrow transplants.
Disabilities Prevention.--The Committee continues to
strongly support the CDC disabilities prevention program which
provides support to states and academic centers to reduce the
incidence and severity of disabilities, especially
developmental and secondary disabilities.
Down Syndrome.--The Committee is aware that anecdotal
evidence suggests that the number of persons with Down syndrome
who also have autism or other mental disorders may be on the
rise. Reliable data on these occurrences would help researchers
identify areas of further research and could indicate whether
the prevalence of certain dual diagnoses indicate certain risk
factors that require assessment. The Committee encourages the
CDC to assess the feasibility and goals of a national
epidemiological study for Down syndrome that would identify and
the number of persons with the disorder, and whether these
persons have also been diagnosed with either autism or other
mental disorders. This knowledge may inform research decisions
aimed at the identification of modifiable risk factors and the
possible development of interventions and approaches for
evaluating such interventions.
Duchenne and Becker Muscular Dystrophies.--Within funds
provided, the Committee has included $2,998,000 above the
administration's request for the Center's epidemiological
program in Duchenne and Becker muscular dystrophy. This is
$1,000,000 over the fiscal year 2003 level. The Committee
expects these efforts to include comparison of treatment
approaches and a plan for disseminating such information to
patients and families.
Folic Acid Education Campaign to Prevent Birth Defects.--
Within the total provided, sufficient funds have been provided
to continue the national public and health professions
education campaign designed to increase the number of women
taking folic acid daily at the same level as in fiscal year
2003. Each year, an estimated 2,500 babies are born with neural
tube defects [NTDs], birth defects of the brain and spinal
cord, including anencephaly and spina bifida. The Committee is
aware that CDC estimates that up to 70 percent of NTDs could be
prevented if all women of childbearing age consume 400
micrograms of folic acid daily, beginning before pregnancy.
Fetal Alcohol Syndrome.--Within the total provided,
$1,263,000 above the budget request is to expand activities
related to Fetal Alcohol Syndrome [FAS]. The Committee supports
CDC's efforts to reduce the rates of Fetal Alcohol Syndrome
[FAS] through surveillance and prevention programs. FAS, the
country's leading known cause of mental retardation and birth
defects, devastates the lives of as many as 12,000 newborn
children and their families each year, and is completely
preventable. This increase will allow CDC to expand
surveillance activities to document the magnitude of the
problem and to develop and implement prevention strategies.
Fragile X.--The Committee believes that the Center's focus
on maximizing prevention potential, minimizing impact on
families and promoting early intervention through developmental
screening should be expanded to incorporate individuals
affected by fragile X. The Center is encouraged to expand its
collaboration with the National Fragile X Foundation to
establish and strengthen a link between researchers and
families and to provide for the distribution of educational
materials to clinicians, educators and parents. The Committee
acknowledges the fine work being carried out by the Center in
the area of autism surveillance and research and the Center is
encouraged to broaden the scope of this work to include fragile
X, the most common known cause of autism. The Center's fine
work to improve the lives of young adults with developmental
disabilities is recognized and the Committee recommends that
these efforts to eliminate barriers to optimal functioning and
address preventable secondary or spillover conditions
specifically include fragile X.
Newborn Screening.--Title XXVI of the Children's Health Act
of 2000 provides that the Secretary shall award grants to
improve or expand the ability of State and local public health
agencies to provide screening to newborns and children having
or at risk for heritable disorders. The Committee supports
further research and demonstration projects to facilitate the
translation of new scientific knowledge into applied public
health screening programs. The Committee urges CDC to
coordinate with HRSA in translating the results of these
efforts, particularly in the areas of Autism, Duchenne and
Becker Muscular Dystrophies, Down Syndrome, fragile X Syndrome,
and Cystic Fibrosis, into guidance for public health programs,
including State newborn screening programs.
The Committee commends CDC for its early hearing detection
and intervention [EHDI] program for newborns, infants and young
children with hearing loss. These grants ensure that infants
referred from newborn hearing screening programs receive
appropriate and timely diagnostic and early intervention
services. The Committee is concerned that of babies who were
screened, only 56 percent who needed diagnostic evaluations
actually received them by 3 months of age. Moreover, only 53
percent of those diagnosed with hearing loss were enrolled in
early intervention programs by 6 months of age. The Committee
believes that increased funding is required to ensure that
States develop appropriate surveillance and tracking systems to
provide timely and appropriate diagnostic and intervention
services to infants and toddlers.
The Committee encourages the National Center on Birth
Defects and Developmental Disabilities to provide clarification
and guidance to States regarding how EHDI surveillance,
tracking, and data management programs are affected by the
Health Insurance Portability and Accountability Act and the
Family Education Rights and Privacy Act.
To avoid duplication and interference, the Committee
expects CDC to coordinate projects funded with this
appropriation with EHDI projects conducted by the Health
Resources Services Administration, the National Institute on
Deafness and Other Communication Disorders, the National
Institute on Disability and Rehabilitation Research, and the
Office of Special Education and Rehabilitative Services.
Paralysis Resource Center.--More than 2 million Americans
live with paralysis, including spinal cord injury, stroke,
multiple sclerosis, cerebral palsy, spina bifida, and ALS or
Lou Gehrig's disease. Those living with paralysis have a
desperate need for information and support to improve their
health and quality of life. Hospital and rehabilitation stays
have sharply reduced over the last decade and those living with
paralysis face astronomical medical costs, are often unemployed
and have poor health outcomes, including skin breakdowns,
obesity, pneumonia, bladder and bowel infections and
depression. In 2000, Congress established the Christopher and
Dana Reeve Paralysis Resource Center to provide information and
support to individuals living with paralysis, their caregivers
and their families. To date, more than 160,000 people have
received services and information from the Resource Center's
web portal, from information specialists and from library and
print materials. More than 90 organizations have benefited from
health promotion grants provided by the Center, such as
wheelchair basketball programs, caregiver support services and
the placing of canine companions in the home. To keep up with
the exploding demand for information and support services, the
Committee has included $3,017,000 above the administration's
request to expand the Paralysis Resource Center capacity;
provide distance learning and training; support additional
health promotion grants; and enhance university-based research.
This is $3,000,000 above the fiscal year 2003 level. Sufficient
resources are included for CDC to fund several model state
demonstration programs on paralysis and physical disability.
Regional Centers for Birth Defects Research and
Prevention.--Within the total provided, $2,284,000 above the
budget request is to expand research activities conducted by
the regional Centers for Birth Defects Research and Prevention.
This is $1,500,000 above the fiscal year 2003 level. These
centers, which are located in Arkansas, California, Georgia,
Iowa, Massachusetts, New Jersey, New York, North Carolina,
Texas, and Utah, conduct epidemiological research on the
prevention of birth defects. These centers identify cases and
obtain data for inclusion in the National Birth Defect
Prevention Study, the largest case-control study of birth
defects ever conducted. This increase will allow these centers
to expand and intensify the study of genetic and environmental
causes of birth defects and thereby increase our understanding
of key underlying factors that may cause birth defects.
Special Olympics Healthy Athletes Initiative.--To address
the unmet health needs among its athletes, Special Olympics
created the Healthy Athletes Program, which provides Special
Olympics athletes access to an array of health assessment,
education, preventive health services and supplies, and
referral for follow-up care where needed. These services are
provided to athletes without cost in conjunction with
competitions at local, State, national, and international
levels. Two years ago, this Committee established a Special
Olympics Healthy Athletes Initiative at CDC to support these
efforts. The Committee has included $2,009,000 above the
administration's request for this initiative, which is
$1,000,000 above the fiscal year 2003 level.
Spina Bifida.--The Committee recognizes that Spina Bifida
is the leading permanently disabling birth defect in the United
States. While Spina Bifida and related neural tube defects are
highly preventable through proper nutrition, including
appropriate folic acid consumption, and its secondary effects
can be mitigated through appropriate and proactive medical care
and management, such efforts have not been adequately supported
or coordinated to result in significant reductions in these
costly conditions. In an effort to improve the quality-of-life
for individuals affected by Spina Bifida and reduce and prevent
the occurrence of--and suffering from--this birth defect, the
Committee has included $3,035,000 over the administration's
request to expand the National Spina Bifida Program in
coordination with a leading national voluntary health agency
which exists to promote the prevention of, and enhance the
lives of all those affected by, spina bifida. This is
$1,000,000 over the fiscal year 2003 level.
State Cooperative Agreements for Birth Defects
Surveillance.--The Committee encourages CDC to increase support
to States to develop, implement, and/or expand community-based
birth defects tracking systems, programs to prevent birth
defects, and activities to improve access to health services
for children with birth defects. CDC is now assisting 28 States
with cooperative agreements.
Tourette Syndrome.--The Committee encourages CDC to
establish public health education and research programs in
partnership with a national voluntary health association
dedicated to assisting parents and families of children with
Tourette Syndrome. The programs should be designed to reach
parents, educators, pediatricians, physicians, and other health
workers in a campaign consistent with the authority and
direction of the Children's Health Act of 2000, and to increase
scientific knowledge on the prevalence, risk factors and co-
morbidities of Tourette Syndrome.
Chronic Disease Prevention and Health Promotion
The Committee recommends $801,884,000 for chronic disease
prevention and health promotion for fiscal year 2004. The
fiscal year 2003 comparable level was $789,972,000 and the
administration requested $834,047,000 for fiscal year 2004.
Within the total provided, the following funding levels are
for the specific program activities: heart disease and stroke,
$45,963,000; diabetes, $69,000,000; cancer prevention and
control, $316,625,000; arthritis, $14,612,000; epilepsy,
$8,478,000; iron overload, $476,000; tobacco, $100,411,000;
nutrition, physical activity, and obesity, $50,000,000; health
promotion, $24,249,000; school health, $63,112,000; safe
motherhood, $53,962,000; oral health, $12,710,000; prevention
centers, $26,830,000; and Steps to a Healthier U.S.,
$15,416,000.
The unprecedented commitment to biomedical research in
recent years represents a critical investment in the future
health of our Nation. The Committee recognizes, however, that
the benefits of basic research alone cannot be fully realized
unless results of this important work are effectively
translated into public health interventions to address costly
and prevalent conditions such as chronic diseases.
Chronic diseases have had a profound human and economic
toll on our Nation. Nearly 125 million Americans today are
living with some form of chronic condition, including cancer,
cardiovascular disease, diabetes, arthritis, and various
neurological conditions such as epilepsy. These and other
chronic diseases now account for nearly 70 percent of all
health care costs, as well as 70 percent of all deaths
annually. A few modifiable risk factors bring suffering and
early death to millions of Americans. Three such factors--
tobacco use, poor nutrition, and lack of physical activity are
major contributors to our Nation's leading causes of death.
Alpha-1 Antitypic Deficiency.--The Committee is aware that
Alpha-1 Antitypic disease is often misdiagnosed as asthma or as
Chronic Obstructive Pulmonary Disease. Individuals with Alpha-1
exhibit symptoms of advanced emphysema between 30 and 50 years
of age, even in the absence of tobacco use. As with many rare
chronic disorders, Alpha-1 patients commonly see five
physicians over 7 years, from the onset of symptoms to an
appropriate diagnosis. Early detection allows individuals to
engage in preventative health measures and receive appropriate
therapies, significantly improving their health status. The
Committee encourages CDC to promote an Alpha-1 screening and
detection program that utilizes public and professional
education regarding lung disease, both genetic and tobacco
related.
Behavioral Risk Factor Surveillance System.--The Committee
has provided $8,400,000 for the Behavioral Risk Factor
Surveillance System [BRFSS]. The Committee notes that
gathering, analyzing, and distributing data on behavioral risk
factors is key to addressing a host of health problems,
especially chronic diseases. The BRFSS program collects
behavior-related data so that scarce resources can be directed
efficiently to address chronic diseases, such as heart disease,
cancer, diabetes, obesity, and vascular diseases such as
stroke. The Committee believes the increase in BRFSS funding
should be used to increase infrastructure at the State and CDC
levels; improve the rates of response of survey questions;
increase the timeliness of data; improve CDC's web site to make
data more accessible for analysis; and create State
demonstration projects to examine and assess innovative methods
in chronic disease health tracking.
Cancer Prevention and Control.--The previous 5 years have
seen a major increase in the Nation's investment in medical
research at the NIH, resulting in significant breakthroughs for
cancer and other serious diseases. The need to reach the
public, particularly medically underserved populations, with
the message of prevention and early detection of cancer cannot
be overstated.
The programs included in the CDC's cancer line item have
proven to be highly effective, but are only a starting point if
we are to reduce the mortality from cancer. The Committee is
strongly supportive of the CDC cancer programs focused on
awareness, education and early detection and has included a
significant increase for these programs.
The significant growth of cancer prevention and control
programs within State health agencies has resulted in the
recognition that improved coordination of cancer control
activities is essential to maximizing resources and achieving
desired cancer prevention and control outcomes. The Committee
commends CDC for its work with health agencies to enhance the
number and quality of cancer-related programs that are
available to the U.S. population and to develop an integrated
and coordinated approach to reduce the cancer burden through
prevention, early detection, treatment, and rehabilitation.
Within the amounts provided, the following funding levels
are for the specific program activities: breast and cervical
cancer, $210,929,000; cancer registries, $50,000,000;
colorectal cancer, $15,000,000; comprehensive cancer,
$12,000,000; ovarian cancer, $4,950,000; prostate cancer,
$15,555,000; skin cancer, $2,197,000; Geraldine Ferraro Cancer
Education Program, $5,000,000; and lupus, $994,000.
Cancer Registries.--The Committee recognizes the importance
of data collection for all brain tumors, including data on
malignant and benign brain tumors, through the National Program
of Cancer Registries. Comprehensive data collection enhances
our understanding of brain tumors and their burden and supports
a strong research effort. The Committee commends the CDC for
moving forward with implementation of the Benign Brain Tumor
Cancer Registries Act in fiscal year 2003 (Public Law 107-260)
and strongly urges that adequate funds be provided for benign
brain tumor data collection and training in fiscal year 2004.
Cancer Survivorship.--The Committee applauds the
partnership between CDC and the Lance Armstrong Foundation
[LAF] to address the needs of the over 9 million Americans
living with, through and beyond cancer by expanding CDC's
State-based comprehensive cancer program to address cancer
survivorship, including clinical trials information and access,
quality of life issues and late effects of the disease. The
Committee supports efforts to develop a National Cancer
Survivorship Action Plan.
In addition, the Committee is aware of the need for
additional information and support for cancer survivors, from
time of diagnosis through treatment, recovery, and long-term
care issues. There are more than 9 million cancer survivors in
the United States today, and more than half have either
completed treatment or are long-term (over 5 years) survivors.
Further, more than 1.3 million people will be diagnosed with
cancer in 2003. Recognizing the significant need of this
growing population, the Committee encourages CDC to develop a
cancer survivorship resource center focused on post-treatment
needs and long-term survivorship/quality of life issues, in
partnership with the Lance Armstrong Foundation and other non-
profit organizations solely dedicated to promoting the optimal
physical, psychological, and social recovery and care of cancer
survivors and their families.
Cardiovascular and Other Chronic Diseases in African-
American Populations.--The Committee recognizes the high
prevalence and incidence of cardiovascular and other chronic
diseases in the Mississippi Delta's minority populations. The
Committee also recognizes the work of the Jackson Heart Study
and the Delta Health Alliance in research on cardiovascular and
other chronic diseases in minority populations. A needed
component of this research is the examination of
epidemiological risk factors contributing to the extremely high
prevalence and incidence of cardiovascular and other chronic
diseases in the Mississippi Delta. The Committee encourages the
CDC to establish a cardiovascular and chronic disease research
prevention center in the Mississippi Delta region for the
purpose of fostering epidemiological research among minorities
with chronic diseases. The prevention center would allow
collaboration with ongoing research activities to combat these
chronic diseases through the epidemiological identification of
risk factors and disease predictors.
Colorectal Cancer.--Colorectal cancer is the third most
commonly diagnosed cancer for both men and women in the United
States, and the second leading cause of cancer related deaths.
In 2001, approximately 148,000 new cases were diagnosed and
56,000 people died from the disease. When colorectal cancer is
detected and treated early, survival is greatly enhanced.
However, despite the availability of proven screening tests,
only 37 percent of colorectal cancers are diagnosed while the
disease is still in a localized stage.
The Committee is very pleased with the leadership of CDC's
National Colorectal Cancer Roundtable in promoting the
availability and advisability of screening to both health care
providers and the general public. The Committee encourages CDC
to continue to expand its partnerships with State health
departments, professional and patient organizations, and
private industry to combat this devastating disease.
Cooley's Anemia.--The Committee is pleased with the
progress that CDC has made with regard to the establishment of
a blood safety surveillance program for Cooley's anemia
patients, who are the largest consumers of red blood cells. The
program involves six treatment centers that handle the medical
aspects, and the Cooley's Anemia Foundation that provides
education and awareness, patient recruitment and other
services, while CDC has established an archive of tested and
analyzed blood samples. As the program moves forward and one
time start-up costs are reduced, the Committee believes that a
growing percentage of the money should be used by the centers
and the Foundation to assure the highest quality services are
available to the largest number of patients possible.
Delta Health Initiative.--The Mississippi Delta Region
experiences some of the Nation's highest rates of chronic
diseases, such as diabetes, hypertension, obesity, heart
disease and stroke. The Committee recognizes the efforts of the
Delta Health Initiative in health education, coordination of
health services and health-related research in the Mississippi
Delta. The Committee believes that such collaborative,
community-based programs offer the best hope for breaking the
cycle of poor health in underprivileged areas such as the
Mississippi Delta. The Committee recommends that the CDC
collaborate with the Delta Health Initiative in addressing the
chronic health issues of the Mississippi Delta.
Diabetes.--The Committee is concerned about the over 17
million Americans currently living with diabetes, a number that
is estimated to increase to 9 percent of the U.S. population by
2025. The Committee is aware of the Secretary's recently
announced Diabetes Detection Program, and is concerned about
meeting the treatment needs of all the newly diagnosed patients
with diabetes. The Committee is aware of the valuable services
that diabetes educators provide to newly diagnosed patients--
teaching them the necessary skills they need to self-manage the
disease throughout their life including nutrition, exercise,
blood sugar monitoring, and medication management. The
Committee urges CDC to partner with organizations with
expertise in providing diabetes education and diabetes self-
management training as a necessary step to ensuring not only
the success of diagnosing people with diabetes, but also to
ensuring the best possible treatment and care of the newly
diagnosed.
The high incidence of diabetes among Native American,
Native Alaskan, and Native Hawaiian populations persists, and
the Committee is pleased CDC's efforts to target this
population, in particular, to assist the leadership of Native
Hawaiian and Pacific Basin Islander communities. It is
important to incorporate traditional healing concepts and to
develop partnerships with community centers, and the Committee
encourages CDC to build on all its historical efforts in this
regard.
Epilepsy.--The Committee recognizes epilepsy, a chronic
neurological condition, as a significant public health concern
affecting over 2.5 million persons in the United States
including 300,000 American seniors over the age of 65. For a
long time epilepsy has been seen as a condition that affects
young people, often starting in early childhood; sometimes
lasting throughout life. The U.S. population is aging and
stroke, cardiovascular disease, brain tumors and Alzheimer's
disease are all causes of epilepsy in the elderly. Further, the
Committee acknowledges that the CDC has worked diligently over
the last couple of years to promote better public education and
treatment of people with epilepsy. Therefore, the Committee has
provided $1,965,000 above the administration's request for the
CDC to enhance its epilepsy efforts in partnership with a
leading non-profit that works on behalf of children and adults
affected by seizures through research, education, advocacy and
service. These efforts should include activities addressing the
relationship between older adults and epilepsy; and maximizing
public and provider health education programs.
Geraldine Ferraro Cancer Education Program.--In May 2002,
Congress approved and the President signed into law the
Hematological Cancer Research Investment and Education Act.
This Act authorizes the Geraldine Ferraro Cancer Education
Program, administered by the Department of Health and Human
Services. The Committee provides $5,000,000 to the CDC to
implement the Geraldine Ferraro program of education and
support services to individuals with blood-related cancers and
their families and caregivers. The Committee is aware that a
number of private organizations currently serve the blood
cancer community with educational and support services, and the
Committee encourages CDC to enter into partnerships with these
organizations to expand and strengthen their programs, ensuring
that all individuals with blood cancers receive the support and
educational resources they need.
Glaucoma and Other Vision Disorders.--Age-related threats
to sight, including age-related macular degeneration, glaucoma,
cataracts and diabetes retinopathy are expected to nearly
double by the year 2030 with the aging of the baby-boomer
generation. Recognizing this emerging public health threat, the
Committee is aware of the demonstrated success of vision
screening programs in preventing blindness and vision
impairments among many of the more than 30 million adults that
suffer from eye-related disorders.
The Committee is encouraged by the CDC's exploration of
strategies to implement a national initiative to combat the
effects of eye-related disorders, especially glaucoma. The
Committee has included $2,085,000 for CDC to expand vision
screening and education programs in partnership with national
voluntary health agencies and for CDC to develop a national
surveillance system to monitor trends over time and assess the
economic costs of vision loss especially related to glaucoma.
In addition, the Committee has included $200,000 above the
administration's request for a total of $2,984,000 to expand a
model project that is testing and evaluating the efficacy of
glaucoma screening using mobile units.
Heart Disease and Stroke.--The Committee understands that
cardiovascular diseases remain the Nation's No. 1 killer in
every State, and believes that each State should receive
funding for basic implementation of a State Heart Disease and
Stroke Prevention Program. Currently only 8 States receive
implementation-level funding from the CDC. An additional 22
States, including the District of Columbia, receive funding to
undertake planning processes, which prepare them to implement
this critical and first-ever public health program to prevent
and control our Nation's leading cause of death. Nearly 62
million Americans live with the often-disabling effects of
cardiovascular diseases at an estimated cost of
$352,000,000,000 in medical expenses and lost productivity this
year--more costly than any other disease. The Committee
recommendation includes $5,824,000 above the administration's
request for CDC's cardiovascular programs, for a total of
$45,963,000.
Stroke remains America's No. 3 killer, a major cause of
permanent disability and a key contributor to late-life
dementia. This year, about 700,000 Americans will suffer a
stroke and nearly 170,000 will die. About 50 percent of stroke
deaths occur out of the hospital. An estimated 4.7 million
Americans live with the consequences of stroke. About 1 of 4
stroke survivors is permanently disabled. Stroke will cost this
Nation an estimated $51,000,000,000 in medical expenses and
lost productivity this year. The drug TPA is the only FDA-
approved emergency treatment for clot-based stroke. Yet, less
than 5 percent of those eligible for TPA receive it.
Established by Congress during the fiscal year 2001
appropriations process, the Paul Coverdell National Acute
Stroke Registry is designed to track and improve the delivery
of care to patients with acute stroke. The CDC supports
activities to develop and test prototypes for this registry in
eight sites. The Committee encourages CDC to continue this
initiative by implementing a statewide model stroke registry
and data-based intervention plans among three State health
departments to enable them to monitor and improve stroke
emergency transport response times, delivery of acute care and
use of treatments to prevent recurrent strokes in their
communities. The Committee strongly encourages the CDC to
continue to work with the National Institute of Neurological
Disorders and Stroke, and the National Heart, Lung, and Blood
Institute at the National Institutes of Health, the Brain
Attack Coalition, and other pertinent professional
organizations, including hospitals, universities, State and
local health departments, and other appropriate partners
experienced in the treatment of stroke to further implement
this registry.
The WISEWOMAN program builds on the CDC's National Breast
and Cervical Cancer Early Detection Program to also screen
women for heart disease, stroke and other cardiovascular
disease risk factors. The CDC also provides lifestyle
counseling and education to these women to improve their health
and to prevent cardiovascular diseases, the leading cause of
death of American women. Heart disease, alone, is the No. 1
killer of American women and stroke is the No. 3 killer. Since
its inception in 1995, about 12,000 low-income and uninsured
women ages 40-64 have been screened for high blood pressure and
elevated cholesterol and have received lifestyle counseling and
education. From 50 percent to 75 percent of these women were
found to have either high blood pressure or elevated
cholesterol. With more than two-thirds of the women returning
for follow-up services, the program has been effective in
retaining participants and providing needed services.
Hemophilia.--The Committee encourages CDC to continue
working closely with the National Hemophilia Foundation to
strengthen its disease management, prevention, outreach, and
blood safety surveillance programs for meeting the needs of
persons with hemophilia, other bleeding and clotting disorders,
and, particularly, women with bleeding disorders. The Committee
has received the report on genotyping the hemophilia community,
and urges CDC to provide the additional resources necessary to
implement this important initiative.
Inflammatory Bowel Disease.--It is estimated that up to 1
million people in the United States suffer from Crohn's disease
or ulcerative colitis, collectively known as inflammatory bowel
disease [IBD]. For the past 4 years, the Committee has
encouraged CDC to work in partnership with the IBD community to
establish a national IBD epidemiology program to further our
understanding of these diseases. The Committee understands that
CDC has entered into a partnership with the Crohn's and Colitis
Foundation of America to initiate this important program. Now
that this project has been established through an investment by
the patient community, the Committee looks forward to reviewing
a report from the CDC Director (as requested in the fiscal year
2003 Senate Labor-HHS committee report) regarding the support
that CDC has provided for this important initiative.
Kidney Disease.--The Committee recognizes that while kidney
disease is the ninth leading cause of death in the United
States and 350,000 Americans have End Stage Renal Disease,
requiring dialysis or a transplant to survive, at a cost to the
Medicare program of $12,000,000,000 annually, there is mounting
evidence that kidney disease will be an even greater public
health problem in the future. Recent epidemiologic research
indicates that more than 20 million Americans have signs of
kidney disease and that an additional 20 million individuals in
this country are at increased risk of kidney disease. Moreover,
most of these individuals are unaware of this danger to their
health. The Committee believes there is a need for public
health programs to identify and educate those who are
threatened by kidney disease and thereby reduce morbidity and
improve outcomes. Therefore, the Committee urges the Centers
for Disease Control and Prevention to develop a national kidney
disease action plan and a public health strategy to combat
kidney disease in this country.
Micronutrients.--Deficiencies of micronutrients such as
iron, iodine, and vitamin A, affect nearly one-third of the
world's population, and result in reduced mental and physical
development of children, poor pregnancy outcomes, diminished
work capacity of adults, and increased morbidity and premature
mortality among populations. Effective and inexpensive
interventions such as dietary diversification, food
fortification and supplementation have eliminated most
micronutrient deficiencies in developed countries.
The Committee has provided sufficient funding for CDC to
continue its efforts to eliminate micronutrient malnutrition.
The focus of these efforts is to support a number of national
and international efforts to assess mirconutrient status of
populations and to monitor and strengthen implementation of
interventions as well as to assess the impact of the
interventions over time. CDC has extensive expertise in
epidemiology, monitoring and assessment, and laboratory
science. These efforts reflect the unique contribution that CDC
can make to eliminate micronutrient deficiencies.
Nutrition, Physical Activity and Obesity.--Obesity is
epidemic in the United States. Between 1980 and 1994, the
prevalence of obesity in the United States has increased by 100
percent in children and adolescents. More than 20 percent of
the adult population is 30 pounds or more overweight and 10 to
15 percent of children and adolescents are overweight. Risk
factors associated with obesity--physical inactivity and
unhealthy eating--account for at least 300,000 preventable
deaths each year and increase the risk for many chronic
diseases like diabetes, heart disease and cancer. The Committee
is aware that the CDC's own statistics show that native
Americans, including Native Alaskans and Native Hawaiians
suffer higher rates of obesity than other Americans.
The Committee commends the substantial, comprehensive
efforts that CDC is directing to stem the obesity epidemic
across all life stages. CDC is coordinating national, State and
school-based programs to research and implement interventions
to increase physical activity levels and good nutrition at all
ages, to provide important health information, and to monitor
health and healthy behaviors in the population. CDC currently
funds some States to promote physical activity and good
nutrition to prevent and control obesity. As part of its
physical activity, nutrition and obesity prevention initiative,
the Committee has included a significant increase for
Nutrition, Physical Activity, and Obesity at CDC.
Oral Health.--The Committee recognizes that to effectively
reduce disparities in oral disease will require improvements at
the State and local levels. The Committee has provided
additional funding to States to strengthen their capacities to
assess the prevalence of oral diseases, to target
interventions, like additional water fluoridation and school-
linked sealant programs, and resources to the underserved, and
to evaluate changes in policies, programs and disease burden.
The Committee also expects the Division to advance efforts to
reduce the disparities and the health burden from oral cancers
and oral diseases that are closely linked to chronic diseases
like diabetes and heart disease.
Prevention Centers.--The Committee encourages the continued
support of center activities aimed at improving knowledge about
the usefulness and effectiveness of health promotion programs
for persons with disabilities. The Committee also continues to
support within the prevention center program a Tobacco
Prevention Research Network to increase the knowledge base on
the most effective strategies for preventing and reducing youth
tobacco use, as well as on the social, physiological, and
cultural reasons for tobacco use among children.
Prostatitis.--The Committee urges the CDC to continue and
expand its investigation of the etiology of prostatitis. New
methods to explore the infectious etiology of chronic diseases
should be applied to chronic prostatitis. The CDC should
undertake educational efforts to overcome the stigma assumed by
prostatitis patients and the conspiracy of silence it produces
that limits the public discussion and research.
Pulmonary Hypertension.--The Committee continues to be
interested in pulmonary hypertension, a rare, progressive and
fatal disease that predominantly affects women, regardless of
age or race. Pulmonary hypertension 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 looks forward to reviewing a report (as requested in
the fiscal year 2003 omnibus appropriations bill) from the CDC
outlining the progress that has been made in establishing a
pulmonary hypertension awareness campaign focused on the
general public and health care providers. Moreover, the
Committee encourages CDC to support a cooperative agreement
with the pulmonary hypertension community designed to foster
greater awareness of the disease.
School Health.--The Committee notes that obesity rates were
cut in half among girls in grades 6-8 who participated in a
school-based intervention program. The Committee applauds CDC
for establishing effective coordinated school health programs
in 20 States and two local education agencies. As part of its
physical activity, nutrition and obesity prevention initiative,
the Committee has included sufficient funds for CDC to expand
its coordinated school health program to address risk behaviors
such as tobacco use, unhealthy diets, and physical inactivity.
Steps to a Healthier U.S.--The Committee applauds the
Department's commitment to tackling the problems of obesity,
diabetes, and asthma. The Committee agrees that these are three
of the most critical chronic conditions afflicting Americans.
The Committee is concerned that existing programs that address
these problems have not yet been implemented in all of the
States. The Committee has continued funding for this new
initiative and significantly increased existing programs with
CDC that are aimed at obesity, diabetes, and asthma. The
Committee strongly urges CDC to coordinate the efforts of these
programs such that the best possible outcome is achieved using
these funds.
The Committee recognizes the important role that private
nonprofit organizations such as YMCAs and Jewish Community
Centers play in providing millions of American youth
comprehensive health and wellness programs designed to address
risk behaviors such as physical inactivity, unhealthy diets,
and tobacco use. With only 25 percent of public schools
offering daily physical education programs, it is these
community-based organizations that are being called upon to
implement health promotion and health education strategies and
interventions to increase physical activity levels and foster
good nutrition. In addition, these community organizations are
a critical link in providing physical activity programs for
youth from charter schools, alternative schools or who are home
schooled. The Committee encourages CDC to include private
nonprofit organizations as eligible applicants under STEPS.
Funding should be used for the development and implementation
of comprehensive health and wellness programs aimed at
preventing obesity, diabetes and asthma among American youth.
To ensure fiscal responsibility and local support, the
Committee encourages these nonprofit programs to be funded at a
minimum of 50 percent from private sources. Successful
applicants should have a history of directly providing youth-
development programs in both school-based and community-based
setting, a long-standing dedication to promoting lifelong
health, and a commitment to serving all ages, incomes and
abilities.
Sudden Infant Death Syndrome.--The Committee notes the work
of CDC, the National Institute of Child Health and Human
Development and the Health Resources and Services
Administration in developing model guidelines for death scene
protocol for Sudden Infant Death Syndrome. The Committee
encourages CDC to implement projects to demonstrate the
effectiveness of the death scene protocol in a variety of
locales (urban, suburban, and rural) throughout the Nation and
has included $300,000 for this activity in the infant mortality
program. The Committee expects CDC to be prepared to report on
progress on this initiative during the fiscal year 2005
hearings.
The recently completed Aberdeen Area Infant Mortality
Study, funded by the Department of Health and Human Services,
identified protective and risk factors associated with SIDS.
Conclusions included observations that programs to reduce
alcohol consumption among women of childbearing age could
potentially reduce the high rate of SIDS. Maternal and
environmental tobacco exposures remain critical health issues
not only in reducing the risk for SIDS, but also for the health
of the baby and family overall. Further, women, who give birth
to their first child while under the age of 20 years, are at a
higher risk for pre-term birth and low birth weight babies, and
that both factors increase the risk for SIDS. In 2000, for
infants of African American mothers, the SIDS death rate is 2.4
times that for non-Hispanic white mothers. Nationwide, SIDS
rates for infants of American Indian mothers were 2.6 times
those of non-Hispanic white mothers.
Tobacco Use.--Tobacco use is the single most preventable
cause of death and disease in our society. It causes more than
400,000 deaths in the United States each year, and costs the
Nation $50,000,000,000 in medical expenses alone. Children are
especially hard hit by tobacco. Ninety percent of adult smokers
begin their habit as children. The Committee believes that a
significantly increased effort to curtail youth tobacco use is
needed. Therefore, the Committee has included sufficient funds
to maintain no less than last year's level of funding for
tobacco control. These funds are intended to expand the
capacity of all State and local health departments, education
agencies, and national organizations to build comprehensive
tobacco control programs and to develop and begin
implementation of a national public education campaign to
reduce access to and the appeal of tobacco products among young
people.
Urinary Incontinence.--The Committee is concerned that 25
million Americans suffer from Urinary Incontinence [UI].
According to the Agency for Healthcare Research and Quality
[AHRQ], 8 out of 10 patients can be treated or cured and yet
fewer than half ever discuss the condition with their health
care professional. Moreover, 1 in 4 women ages 30 to 59 have
experienced an episode of UI and $16,400,000,000 is spent every
year on incontinence related care. The Committee also views UI
as a barrier to health because many patients experience social
isolation, depression and reduced physical activity. These
consequences dramatically decrease a healthy lifestyle. The
Committee urges the CDC to formulate and implement an action
plan for health care professional education in order to ensure
those who suffer from UI will seek and receive treatment
leading to healthier lives.
Environmental Health
The Committee recommends $184,329,000 for environmental
health activities. The fiscal year 2003 comparable level was
$182,829,000, and the administration requested $150,227,000 for
fiscal year 2004.
Within the total provided, the following funding levels are
for specific funding activities: $37,518,000 is for the
environmental health laboratory; $66,928,000 is for
environmental health activities; $37,886,000 is for the asthma
program; and $41,997,000 is for the childhood lead poisoning
prevention program.
Many of the public health successes that were achieved in
the 20th century can be traced to innovations in environmental
health practices. However, emerging pathogens and environmental
toxins continue to pose risks to our health and significant
challenges to public health. The task of protecting people's
health from hazards in their environment requires a broad set
of tools. First among these tools are surveillance and data
collection to determine which substances in the environment are
getting into people and to what degree. It also must be
determined whether or not these substances are harmful to
humans, and at what level of exposure. Many scientists estimate
that about two-thirds of all cancers result from environmental
exposure, but much better data are needed to improve this
estimate and determine which exposures cause cancer and other
diseases.
Asthma.--The Committee is pleased that the CDC has taken
steps to address the increasing prevalence of childhood cases
of asthma, and has included $3,498,000 above the
administration's request to expand the CDC's asthma-related
activities, including tracking childhood asthma cases,
conducting investigations, and building partnerships for asthma
control within schools and community organizations.
The problem of asthma in Hawaii remains a serious health
threat and challenge, especially among the medically
underserved. In particular, the problem of volcanic emissions
in Hawaii contributes to this and other respiratory problems.
Community Health Centers continue to be important venues to
address this serious problem, and the CDC is encouraged to
contract with these facilities throughout Hawaii.
Environmental Health Laboratory.--The CDC environmental
health laboratory performs assessments for State investigations
of diseases (such as cancer and birth defects) and
investigations of chemical exposures, such as dioxin,
pesticides, mercury and cadmium. CDC is also working with
States to improve public health laboratories that assess State
level biomonitoring needs. CDC works closely with academic
institutions, other Federal agencies, and other partners to
measure human exposure to toxic substances and the adverse
effects of that exposure.
The Committee recognizes CDC for its commendable work in
analyzing toxic exposures throughout the United States. The
Committee further recognizes that CDC's environmental
laboratory is unprecedented in the world for measuring toxic
exposures to humans and further commends CDC for publishing the
National Report on Human Exposure to Environmental Chemicals,
which provides information about the U.S. population's exposure
to 27 toxic substances, including heavy metals and certain
pesticides.
The Committee supports the CDC biomonitoring program and
study of environmental toxins and their relationship to chronic
diseases, such as asthma, many birth defects, and cancer to
increase our understanding of the cause of many chronic
diseases and conditions and to facilitate the development of
effective prevention strategies.
Fallon Cancer Cluster.--The Committee strongly urges the
CDC to continue to investigate the cancer cluster in Fallon,
Nevada. In addition, the Committee expects the CDC to
facilitate, through the provision of scientific data collected
in Fallon and other assistance as may be required, the
independent scientific study of the Fallon cancer cluster.
Health Tracking Network.--The Committee has included
$28,000,000 to support the continued development of a Health
Tracking Network, which seeks to develop a surveillance system
that can integrate environmental hazards data with human
exposure and health effects data that have possible links to
the environment. Such a surveillance system may help scientists
to develop hypotheses for further research regarding potential
relationships between environmental hazards, exposures and
health effects. The initial efforts to establish such a Network
are now being carried out through a series of State grants to
develop pilot initiatives and projects. The Committee believes
that the CDC's Centers of Excellence may be able to provide
valuable assistance to the States in designing their health
tracking initiatives, and strongly urges the CDC to continue to
ensure that the States work with the Centers to design programs
and approaches that are grounded in a rigorous scientific
approach. In furtherance of this objective, the CDC should
ensure that the Centers provide guidance to the States on the
reporting of data and results in a manner consistent with the
objectives of the Information Quality Act. The Committee also
reaffirms the importance of ensuring that the health tracking
effort is made compatible and integrated with other CDC and
government tracking systems that focus on other environmental
factors that may be related to health effects, such as
infectious agents, behavioral risks, ultraviolet radiation,
tobacco smoke, food-borne illness, naturally occurring
substances, natural disasters and temperature extremes. The
Committee eagerly awaits the outcome of the strategic planning
process now underway. This activity was previously funded
within the Public Health Improvement account.
Primary Immunodeficiencies Diseases.--In each of the last 2
years, Congress has directed CDC to support the national
physician education and public awareness campaign developed by
the Jeffrey Modell Foundation. To date, the campaign has been a
major success featuring physician symposia throughout the
country, an advertising campaign under the auspices of the Ad
Council, development of new materials and mailings to
physicians and other providers, and more. The Committee
believes that this effort has been a model of public-private
cooperation, and should include an international component. The
Committee has included $2,200,000 to continue this campaign,
which has great importance to public health.
Epidemic Services and Response
The Committee recommends $127,494,000 for epidemic services
and response. The fiscal year 2003 comparable level was
$77,494,000 and the administration request was $76,158,000 for
fiscal year 2004.
CDC's epidemic services and response program provides
resources and scientific expertise for operating and evaluating
surveillance systems; developing and refining research methods
and strategies to the benefit of public health practice;
training public health professionals who are prepared to
respond to public health emergencies, outbreaks and other
assistance requests; and communicating with multi-faceted
audiences accurate public health information and effective
messages. The scientific basis of this program is applied
epidemiology, in concert with other components of sound public
health practice. Findings from these disciplines enable States,
health organizations, foreign ministries of health, and others
in the health field to make sound decisions and create
effective policy. Information derived from epidemiologic data
and scientific reasoning provides public health programs with
an objective rationale to set priorities, apply interventions
and policies, and evaluate public health programs. Within the
epidemic services and response program, CDC carries out a
variety of applied research and development activities. Areas
of research include: social determinants of health; aberration
detection; burden of disease; injury, and death; prevention
effectiveness; and health care quality. The Committee
recognizes that CDC maintains a keen appreciation for the fact
that local outbreaks of illness can develop rapidly into
epidemics, that previously unidentified health problems can
appear at any time, that contaminated food or defective
products may appear in the community without warning, and that
the threat of bioterrorism is present in many areas of the
world. When CDC participates in an investigation, all of the
resources of the agency are at the disposal of the affected
area, including its state-of-the-art laboratories.
Global Disease Detection System.--The Committee commends
CDC for its role in strengthening the capacity of the public
health community, both at home and abroad, to respond to global
threats, such as SARS, monkeypox, West Nile virus, pandemic flu
and bioterrorism. CDC's Global Disease Detection System is
integral to these efforts. This system is designed to provide
worldwide technical support to ensure rapid and accurate
diagnoses of emerging infectious disease events, and to provide
a secure link between clinicians and laboratories and CDC and
the World Health Organization to ensure real-time reporting of
emerging threats. The Global Disease Detection System also will
support sentinel sites in key regions around the globe to
ensure prompt disease detection and referral to a regional
laboratory service. These capacities are critical to mitigate
the consequences of a catastrophic public health event, whether
the cause is an intentional act of terrorism or the natural
emergence of a deadly infectious virus, like SARS. The
Committee has provided $50,000,000 for CDC to develop the
Global Disease Detection System to full capacity to assure a
rapid and appropriate response to global infectious disease
threats.
Landmine Survivors.--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. In 2002, outreach
workers made over 14,000 peer visits to survivors, launch more
than 280 small businesses for survivors and worked with more
than 1,800 landmine survivors and their families to improve
access to psycho-social, physical and rehabilitative care.
Health and educational materials for survivors have been and
translated into nine languages. But much remains to be done.
Less than 10 percent of survivors have access to medical care
and rehabilitation services, and 85 percent of mine victims are
civilian, often women and children. The Committee has included
funding for CDC to enhance these peer support networks to
expand 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.
Health Statistics
The Committee recommends a program level of $127,634,000
for the National Center on Health Statistics. All of these
funds are made available in transfers available under section
241 of the Public Health Service Act. The fiscal year 2003
comparable level was $125,899,000 and the administration
requested $124,621,000.
CDC's statistics give us context and perspective on which
we can base important public health decisions. By aggregating
the experience of individuals, we gain a collective
understanding of our health, our collective experience with the
health care system, and our problems and public health
challenges. NCHS data are used to create a basis for
comparisons between population groups or geographic areas, as
well as an understanding of how trends in health change and
develop over time.
The NCHS is the Nation's preeminent source of health
statistics and therefore provides the foundation for assessing
National health trends and developing sound programs and
policies to protect and enhance the Nation's health. The
Committee is concerned with the adequacy and overall
coordination of the various Federal programs that collect,
analyze, and report the health statistics necessary for policy
development and public health interventions. During this period
of rapid advance in health and welfare policy, medical
practice, and biomedical knowledge, the Committee is committed
to ensuring that timely and relevant health statistics are
available to guide policy decisions. The Committee has provided
additional funds for the NCHS to strengthen its data collection
infrastructure.
HIV, STD, and TB Prevention
The Committee recommends $1,239,388,000 for HIV, STD, and
TB Prevention. The fiscal year 2003 comparable level was
$1,186,388,000 and the administration requested $1,281,176,000
for fiscal year 2004. Of the amount provided, $932,189,000 is
for HIV/AIDS programs, of which $232,569,000 is for global HIV/
AIDS programs; $169,572,000 is for the STD program; and
$137,627,000 is for the Tuberculosis program.
Recognizing the intersection among these diseases, and the
need for a focal point for leadership and accountability, CDC
combines HIV, STD, and TB activities to provide leadership in
preventing and controlling human immunodeficiency virus
infection, other sexually transmitted diseases [STDs], and
tuberculosis. CDC works in collaboration with partners at
community, State, national, and international levels, applying
multi-disciplinary programs of research, surveillance,
technical assistance and evaluation. These diseases are not
vaccine preventable and must be controlled and prevented
through identifying, diagnosing, and treating infected persons;
through provision of confidential, culturally competent
counseling to identify and reach those who have been exposed to
infection and who may not know it; and through individual and
population level health promotion to reduce high risk
behaviors.
HIV/AIDS Prevention.--CDC's HIV/AIDS prevention programs
are working in every State and territory to prevent new
infections, link people who are already infected to medical
care, and translate scientific research findings into practical
prevention programs available to every person at risk. CDC will
continue to adapt these prevention programs to meet new and
different needs.
Global HIV/AIDS.--CDC works with governments in 25
countries in Africa, Asia and Latin America and the Caribbean
focusing on primary prevention of HIV/AIDS; care and treatment
of tuberculosis and other opportunistic infections, palliative
care and appropriate use of antiretroviral medications; and
infrastructure and capacity development.
The Committee has included bill language providing
$90,000,000 for the International Mother and Child HIV
Prevention Initiative. The Committee recognizes the importance
of this critical program, and has provided $50,000,000 above
the fiscal year 2003 level. The Committee encourages CDC to
ensure that funds provided to this program, the CDC GAP
initiative, and the Global Fund are used in a coordinated and
complementary fashion.
The Committee is strongly supportive of the
administration's efforts to address the global HIV/AIDS
epidemic. The Committee is aware that one of the stated goals
of the HIV/AIDS efforts is to bring 2 million people into
antiretroviral [ARV] treatment within 5 years. The Committee
understands that only 13 percent of the fiscal year 2003 Global
AIDS Program budget was directed toward care and treatment,
including operations research on ART. The Committee believes
that substantially more resources will be necessary to
accomplish the treatment goals. The International Mother to
Child Transmission Initiative is a good start, but does not
necessarily ensure that the parents of the children saved will
be healthy enough to care for them. The Committee urges the CDC
to evaluate the current allocation of resources in light of the
ARV treatment goals, and to carefully consider new ways to
purchase and provide ARV treatment in resource poor countries.
This could include partnering with organizations that are
already providing ARV treatment.
The Committee notes that Russia and other countries of the
Former Soviet Union are experiencing the highest growth of HIV
infections in the world today. The Committee also notes that
these countries hold tremendous scientific capacity. The
Committee encourages the CDC to seek opportunities to increase
collaborative research between the United States and countries
of the former Soviet Union in the area of HIV/AIDS research,
utilizing organizations that facilitate and support scientific
collaboration as appropriate, to maximize the impact of
scientific discovery.
The Committee recognizes that one of the ways to prevent
the transmission of HIV/AIDS in Africa is to ensure a blood
supply free of HIV. The Committee encourages CDC to find ways
to increase the safety of blood and blood products in Africa by
partnering with organizations and foundations that have a
proven track record in successfully helping African nations
monitor their blood supply.
Sexually Transmitted Diseases.--The Committee is concerned
that sexually transmitted diseases continue to rage at epidemic
levels in the United States, costing our Nation billions of
dollars each year. The United States has the highest rates of
sexually transmitted diseases in the industrialized world.
The Committee is aware that chlamydia is the most
frequently reported disease in the United States. Untreated
chlamydia is the number one cause of infertility in the Nation.
For every dollar spent to prevent chlamydia $12 is saved. The
Committee is aware that where it has been established, the
CDC's Infertility Prevention Program has reduced chlamydia
rates by 66 percent and decreased treatment costs by over 80
percent. However, it is concerned that this prevention program
still offers very limited coverage to women residing in more
than half of the States, and provides only minimal screening
services for men. The Committee is also aware that progress in
control of syphilis has been substantial as a result of State
efforts under the National Plan to Eliminate Syphilis. The
Committee recognizes the urgency of controlling syphilis
because of the impact of this STD on the spread of HIV
infection and on infant health. The Committee is concerned that
syphilis is one of the most glaring examples of racial
disparities in health. The Committee, therefore, urges CDC to
address these inequities by expanding the infertility screening
program and providing support for State efforts to control
syphilis. In addition, the Committee encourages CDC to expand
the infertility prevention project to provide screening and
testing technologies for STDs and HIV, as well as other related
women's health services that are provided by recipients of
these funds.
Tuberculosis.--The Committee commends CDC for its continued
efforts to control tuberculosis [TB] in the United States, as
demonstrated by nearly a decade of declining TB trends
reported. However, the Committee remains concerned that the
overall decline conceals large gaps in two specific
populations. African Americans and individuals born in a
foreign country account for two-thirds of TB cases in the
United States. With respect to the foreign born cases of TB,
until global control efforts are more effective and new
treatments and vaccines are developed, the global crisis on TB
will continue to directly impact the United States; therefore,
the Committee urges CDC to continue working with domestic
partners to maintain strong prevention and control programs and
to work with international partners assuring the success of
international control programs, and to encourage and support,
when possible, the development of new TB treatments and the
development of an effective TB vaccine. With respect to TB in
African Americans, the Committee notes CDC's activity to
address TB in the Southeastern U.S. and encourages CDC to
implement additional innovative programs to address this
disparity in TB.
In addition, the Committee encourages CDC to continue
implementation of recommendations from the recent Institute of
Medicine Report entitled, ``Ending Neglect: The Elimination of
Tuberculosis in the United States'' to advance efforts to
maintain control of TB in the United States by identifying and
curing active TB; to speed the decline of TB through target
testing and treatment of latent infection; and to advance
global research and control efforts. As the report recommends,
the Committee encourages CDC to partner with private
foundations in order to further research in the areas of
development of vaccines, therapeutics, diagnostic tests, and
new drugs and to test the applicability of new tools, to
achieve the recommendations.
Immunization
The Committee recommends $655,686,000 for the program
authorized under section 317 of the Public Health Service Act.
The fiscal year comparable level was $650,586,000 and the
administration requested $620,506,000 for fiscal year 2004. The
Committee recommendation includes $14,000,000 in transfers
available under section 241 of the Public Health Service Act.
The Omnibus Reconciliation Act [OBRA] of 1993 established a
new vaccine purchase and distribution system that provides,
free of charge, all pediatric vaccines recommended for routine
use by the Advisory Committee on Immunization Practices to all
Medicaid-eligible children, uninsured children, underinsured,
and native Americans through program-registered providers.
Despite great success in lowering disease levels and
raising immunization coverage rates, much remains to be done to
ensure the protection of children and adults worldwide.
Approximately 1 million 2-year-old children in the United
States have not received one or more of the more established,
recommended vaccines. New vaccines, although greatly beneficial
to public health, complicate an already complex immunization
schedule and make it increasingly difficult to ensure complete
immunization. One of our Nation's greatest challenges is
extending our success in childhood immunization to the adult
population. The burden due to the occurrence of vaccine-
preventable diseases in adults in the United States is
staggering. As many as 50,000 U.S. adults die of influenza,
pneumococcal infections and hepatitis B. CDC is addressing
these obstacles to the greatest extent possible and continues
to provide leadership to reduce disability and death resulting
from diseases that can be prevented through vaccination.
The Committee encourages CDC to increase section 317 grant
support for infrastructure development and purchase of vaccines
for the State of Alaska's universal immunization program. It
has been brought to the Committee's attention that
infrastructure costs of delivering vaccines to children in
Alaska are substantially higher than in other areas of the
country, because of the many small, remote communities which
must be served exclusively by air. The Committee encourages the
agency to give careful consideration to Alaska's request for
sufficient funding for the purchase of vaccines needed for 90
percent of Alaskan children and to provide infrastructure
support needed to deliver these vaccines at the community
level, including development of a statewide immunization
registry to ensure that all children in Alaska are immunized.
The Committee notes that failure to immunize children in remote
areas of Alaska results in deaths each year from exposure to
open sewage lagoons and contaminated water.
The Committee understands that investing in immunization is
essential to protecting our public health. Vaccines save lives,
medical, employer and personal costs. The Committee recognizes
that every person born or living in this country needs to
receive the vaccines recommended for his or her age group and
condition. With 4 million children born in the United States
each year who require 20 immunizations by age 2, with more age
groups requiring influenza vaccine, with recent outbreaks of
whooping cough, with the threat of pandemic flu, and with new
vaccines entering the market, the cost will likely continue to
rise.
The Committee expects CDC to better anticipate the public's
demand for vaccines, as in the case of pneumoccocal conjugate
vaccine [PVC-7], and make its request to OMB better conform to
that demand. The Committee wants to avoid repeating last year's
situation when 19 States were unable to purchase PCV for their
public clinics.
The Committee recognizes that immunization registries, like
all database systems, continue to require funding. The
Committee's goal is to have registries up and running in all
States. CDC must remain vigilant in offering the best technical
assistance to States. Immunization providers lose interest if
they have learned a new system that fails, and registries are
only as good as the number of accurate records they hold. The
Committee understands that immunization registries are able to
perform many of the functions required of State immunization
programs, including immunization surveillance, vaccine
inventory, VFC compliance, school surveys for compliance with
immunization requirements, reminder notices to patients,
immunization records for parents, etc.
Global Immunization Activities.--The Committee includes
$152,921,000 for global immunization activities which include
$106,400,000 for polio vaccine, surveillance, and program
operations for the highly successful, yet unfinished polio
eradication efforts; and $46,521,000 for the purchase of
measles vaccine for measles mortality reduction and regional
measles elimination initiatives and to expand epidemiologic,
laboratory, and programmatic/operational support to WHO and its
member countries. This total is $20,645,000 above the
administration's request and $5,100,000 above the fiscal year
2003 level.
The Committee appreciates CDC's contribution to global
immunization efforts to eradicate polio and eliminate measles
worldwide. Federal dollars help leverage private dollars in
both the Polio Eradication Campaign and the Measles Initiative,
partnerships among international agencies, NGOs and CDC. Polio
eradication is close to completion, however, the number of
people afflicted with polio increased in 2002 and polio is
still endemic in seven countries. Any ground lost in
maintaining ``immunization days,'' surveillance and labs is
disastrous. Immunization is respected in these developing
countries to the point that they cause temporary ceasefires in
countries at war.
Infectious Disease Control
The Committee recommends $372,760,000 for infectious
disease control. The fiscal year 2003 comparable level was
$359,225,000 and the administration requested $331,640,000 for
fiscal year 2004.
Within the total provided, the following funding levels are
for the specific program activities: hepatitis C, $22,781,000;
lyme disease, $7,313,000; West Nile virus, $36,760,000; anti-
microbial resistance, $24,768,000; hanta virus/special
pathogens, $6,957,000; HIV/AIDS, $43,437,000; malaria,
$14,379,000; patient safety, $3,963,000; pandemic flu,
$3,666,000; prion diseases, $4,477,000; and all other emerging
infectious diseases, $162,263,000.
These activities focus on: national surveillance of
infectious disease; applied research to develop new or improved
diagnoses; prevention and control strategies; working with
State and local departments and private health care providers
to transfer application of infectious disease prevention
technologies; and strengthening the capability to respond to
outbreaks of new or reemerging disease.
Disease outbreaks endanger U.S. citizens at home and
abroad, threaten U.S. Armed Forces overseas, and exacerbate
social and political instability. Outbreaks can interfere with
the global marketplace, affecting tourism, trade, and foreign
investment. CDC's strategies to combat infectious diseases
invest in and build upon both the public health system that was
established over a century ago to increase the preparedness to
address the emergence of dangerous new threats.
Emerging infectious diseases, like West Nile virus and
Severe Acute Respiratory Syndrome [SARS], continue to pose a
serious threat to the public's health. Outbreaks of these
diseases cause great suffering and death and impose an enormous
financial burden on societies around the world. The Committee
recognizes the necessity of a strong domestic public health
infrastructure and robust partnerships between CDC, the World
Health Organization, and other global stakeholders to counter
the threat posed by emerging infections. Recent experiences
with SARS and the West Nile virus illustrate the vital
necessity of strengthening CDC's capacity to identify and
combat emerging infectious diseases. The Committee has provided
an additional $25,000,000 for CDC to continue to improve its
ability to detect and control emerging infectious disease
threats in the United States and around the world.
Chronic Fatigue Syndrome.--The Committee is pleased that
CDC has branched into new and important areas of CFS research
and medical education in the 4-year period in which $12,900,000
is being restored to the CFS program at CDC. The Committee
expects CDC to extend the payback period by 2 years, through
fiscal year 2005. The Committee further encourages CDC to
provide sufficient funding, including funds allocated through
the payback program, to accelerate its CFS research plan to
identify the causes, risk factors, diagnostic markers, natural
history and economic impact of CFS; to create a CFS patient
registry; and to educate health care providers about the
detection, diagnosis and management of CFS.
Global Malaria Initiative.--The Committee continues to
recognize the tremendous impact of malaria in the developing
world, and notes malaria's increasing resistance to
antimalarial drugs designed to counter its pervasive effects.
New drugs must be developed, and the Committee urges the CDC to
continue its efforts to lead in new compound discovery. The
Committee has provided additional funding for CDC's malaria-
related activities, including sufficient funding to continue
the CDC's Global Malaria Initiative at the same level as in
fiscal year 2003. The Committee notes that the University of
Mississippi has been working collaboratively with the CDC to
address research in the area of malaria, along with TB and HIV/
AIDS. The Committee encourages CDC to give full consideration
of these projects to continue its efforts to lead to new
compound discovery.
Hepatitis C.--The Committee encourages funding for the
National Hepatitis C Prevention Strategy. This includes several
cooperative agreements with the coalition of partners, who
developed and produced health education, communication, and
training materials about the prevention, diagnosis and medical
management of hepatitis A, B, and C. While most States have
designated a State Hepatitis C Coordinator, the Committee is
concerned that coordinators have not been requested by six
States. CDC is urged to work with these States to ensure the
availability of hepatitis C coordinators. The Committee also
notes that less than 50 percent of state health departments
provide hepatitis C counseling and only 23 percent provide HCV
testing. Additionally, the Committee is concerned that States
lack the resources to provide more aggressive HCV outreach and
medical referrals, and urges CDC to require all grantee States
to identify sources for appropriate medical referral of HCV
positive persons.
The Committee is aware that the 3 year funding cycle for
several hepatitis C prevention demonstration projects expires
at the end of fiscal year 2003, and urges that priority be
given to an analysis of these demonstrations and implementation
of comprehensive programs in several States that utilize best
practices learned from the recently completed hepatitis C
prevention and control demonstrations.
Additionally, the Committee is concerned that the Advisory
Committee on Blood Safety and Availability has yet to complete
recommendations for implementing HCV ``lookback'' initiatives
regarding screening and counseling for people who may have been
infected with Hepatitis C through blood transfusions before
1992. The Committee calls on CDC to assist States in
notification of persons who have tested positive for HCV and
remain unaware of their HCV status, including those identified
through the HCV lookback and those cases reported to the States
where the patient was not informed of the results.
Pandemic Influenza.--Pandemic influenza is a particularly
virulent strain of influenza that arises spontaneously and
periodically. Examples include the outbreak of Spanish flu in
1918, that killed 500,000 people, and outbreaks in 1957 (Asian
flu) and 1968 (Hong Kong flu). The Committee has included funds
for pandemic influenza activities both here and in the Public
Health and Social Services Emergency Fund within the Office of
the Secretary. These funds will allow CDC to strengthen global
and domestic surveillance capabilities in order to increase the
likelihood of early detection of an influenza pandemic and the
effective tracking of its spread.
Prevention Epicenter Program.--The Committee applauds CDC's
support for the Prevention Epicenter Program and encourages CDC
to continue and expand this program to address patient safety
issues.
Injury Prevention and Control
The Committee recommends $152,409,000 for injury prevention
and control. The fiscal year 2003 comparable level was
$148,414,000 and the administration requested $144,796,000.
CDC is the lead Federal agency for injury prevention and
control. Programs are designed to prevent premature death and
disability and reduce human suffering and medical costs caused
by: fires and burns; poisoning; drowning; violence; lack of
bicycle helmet use; lack of seatbelt and proper baby seat use;
and other injuries. The national injury control program at CDC
encompasses non-occupational injury and applied research in
acute care and rehabilitation of the injured. Funds are
utilized for both intramural and extramural research as well as
assisting State and local health agencies in implementing
injury prevention programs. The Committee recognizes the vital
role CDC serves as a focal point for all Federal injury control
activities.
Sufficient funds have been included to continue support for
all existing Injury Control Research Centers.
National Violent Death Reporting System.--In fiscal year
2003, Congress appropriated funds to continue implementation of
a system of more timely, complete, objective and accurate
information about violent deaths and injuries to inform and
evaluate policy and program efforts. Working with private and
public partners, the CDC has entered cooperative agreements
with public health agencies in six States, Maryland,
Massachusetts, New Jersey, Oregon, South Carolina, and
Virginia, and is extending the system to as many as eight
additional States. The Committee is pleased with the progress
that has been made and has included $4,500,000 to continue to
extend implementation of this model plan for the establishment
of a national violent death reporting system [NVDRS]. NVDRS
will enable each State to understand and more effectively
address local and State violence problems.
The Committee is aware of the contributions made by the
Harvard School of Public Health, the Medical College of
Wisconsin, the University of Pennsylvania, and the University
of Maryland, among others, in developing and implementing model
population-based violent injury reporting systems, and the
Committee applauds their work in developing systems that link
information from law enforcement agencies, medical examiners
and coroners, health providers, crime laboratories and other
agencies. The Committee urges the CDC to continue to work with
private health and education agencies as well as State agencies
in the development and implementation of an injury reporting
system.
Traumatic Brain Injury.--The Committee has provided an
increase of $1,500,000 above the fiscal year 2003 level in the
TBI Prevention Program to continue and expand TBI surveillance
and registry, a One-Call Information Center, and awareness
programs with an emphasis on minority populations. This
increase will assist in filling significant gaps in information
available at State and Federal levels regarding the incidence
and prevalence of TBI, the resources available to victims of
TBI, and the nature of specific factors involving TBI in young
children and in institutionalized individuals.
Occupational Safety and Health
The Committee recommends $282,385,000 for occupational
safety and health programs. The fiscal year 2003 comparable
level was $273,385,000 and the administration requested
$246,329,000 for fiscal year 2004. The Committee recommendation
includes $41,900,000 in transfers available under section 241
of the Public Health Service Act.
The CDC's National Institute for Occupational Safety and
Health [NIOSH] is the only Federal agency responsible for
conducting research and making recommendations for the
prevention of work-related illness and injury. The NIOSH
mission spans the spectrum of activities necessary for the
prevention of work-related illness, injury, disability, and
death by gathering information, conducting scientific
biomedical research (both applied and basic), and translating
the knowledge gained into products and services that impact
workers in settings from corporate offices to construction
sites to coal mines.
The Committee recommendation is sufficient to allow funding
for CDC's National Occupational Research Agenda [NORA] at the
same level as in fiscal year 2003. The Committee believes that
NORA is a critical scientific research program that protects
employees and employers from the high personal and financial
costs of work site health and safety losses. Industries such as
agriculture, construction, health care, and mining benefit from
the scientific research supported by NORA. The program's
research agenda focuses on prevention of disease and injury
resulting from infectious diseases, cancer, asthma, hearing
loss, musculoskeletal disorders, traumatic injuries, and
allergic reactions, among others. The Committee continues to
strongly support NORA and encourages expansion of its research
program to cover additional causes of work place health and
safety problems.
Construction Safety and Health.--Injury rates in the
construction sector have continued to decline over the last 5
years, and the Committee is encouraged by the overall progress
of NIOSH's construction safety and health research initiative,
particularly the Institute's success in partnering with labor
and industry. The Committee is also pleased by NIOSH's new
focus on active intervention to prevent occupational injury and
illness in the construction industry, and the National
Occupational Research Agenda [NORA] for establishing research
priorities. The Committee supports the continuation of the
construction initiative and the NIOSH/Labor/industry
partnership. The Committee has included funding to continue the
construction program to focus on improvement in injury and
illness rates, and to also develop new programs targeting the
still unacceptable high level of fatalities in the construction
sector.
Education and Research Centers.--The Committee commends the
work of the 15 university-based Education and Research Centers
[ERC's] and the smaller single discipline Training Project
Grants [TPG's]. These regional centers are integral to the
Nation's efforts to improve the health and safety of working
men and women, and important to the future efforts of NIOSH to
implement the National Occupational Research Agenda [NORA]. The
Committee has included $19,700,000 for this activity, which is
$1,000,000 above last year and $2,300,000 above the
administration's request.
Farm Health and Safety.--The Committee has included funding
to continue the farm health and safety initiative. This
important initiative, begun in fiscal year 1990, has a primary
focus of reducing the incidence of fatal and nonfatal injuries
and occupational diseases among the millions of agricultural
workers and their families in the United States. The Committee
is particularly pleased with the research being undertaken by
the Agricultural Research Centers.
National Personal Protective Technologies Laboratory.--The
Committee recommendation includes $16,000,000 for the NIOSH
National Personal Protective Technologies Laboratory. The
additional funds should be used, in part, to expedite research
and development in, and certification of, protective equipment
for use against the hazards of terrorist agents. This includes
identification of surrogate terrorist agents to facilitate
protective equipment research in this area. Research,
development, and certification of protective equipment for use
against Chemical, Biological, Radiological, Nuclear [CBRN] and
toxic chemical hazards ensures that domestic manufacturers'
products will be available when needed.
Preventive Health and Health Services Block Grant
The Committee recommends $134,966,000 for the preventive
health and health services block grant. The fiscal year 2003
comparable level was $134,089,000 and the administration
requested $134,966,000 for fiscal year 2004.
The Preventive Health and Health Services Block Grant
provides States with funds for services to reduce preventable
morbidity and mortality to improve the quality of life. The
Block Grant is the primary source of funding to States for
health education and risk reduction activities; cholesterol,
hypertension, and cancer screening; and programs to prevent sex
offenses. The strategy of the Block Grant is to provide States
with flexibility to tailor prevention and health promotion
programs to their health priority needs. Block Grant funding
enables States to provide money for developing new programs;
fund essential services that would otherwise go unfunded; and
address urgent, rapidly developing health hazards such as
disease outbreaks or environmental disasters.
Public Health Improvement
The Committee recommends $145,389,000 for public health
improvement. The fiscal year 2003 comparable level was
$153,034,000 and the administration requested $113,677,000 for
fiscal year 2004. The Committee recommendation includes
$28,600,000 in transfers available under section 241 of the
Public Health Service Act.
Our national public health system is the first line of
defense against preventable disease, disability and
bioterrorism. Virtually every health problem in our
communities--infectious disease outbreaks, chemical hazards,
chronic diseases, and injuries--is first recognized by local
public health professionals, who must work in concert with
State and national officials to control these threats, prevent
spread, and save lives. Despite steady increases and shifts in
the U.S. population there has been a decline in the number of
public health workers per capita in the past decade. Schools of
Public Health and Preventive Medicine report that the majority
of graduates do not seek employment in public health agencies.
Prevention Research.--The Committee recommends $16,000,000
for the extramural prevention research program. This reverses
the virtual elimination of the program proposed in the
President's request. The prevention research program is in the
second year of funding 25 research projects, in which teams of
investigators from universities, private research firms, State
and local health departments, and community based organizations
work together to conduct research to prevent disease and save
lives. The Committee supports this program strongly.
Public Health Research.--Our Nation's substantial economic
investment in biomedical research has identified causes of and
methods to prevent illness, allowing medical practitioners to
diagnose and treat an astonishing array of medical conditions.
To have a public health impact commensurate with this level of
investment, however, the information generated in biomedical
laboratories must be translated into effective public health
programs. Public health research conducted by CDC is solution-
oriented, designed to bridge the gap between medical research
discoveries and behaviors people adopt. Specifically, public
health research helps to define the best strategies for
detecting new diseases, assessing the health status of
populations, motivating healthy lifestyles, communicating
effective health promotion messages, and acquiring and
disseminating information in times of crisis. This kind of
practical, applied research seeks to overcome barriers that
prevent people from adopting healthy behaviors proven effective
by biomedical research. As public health research is essential
to improving health status of the Nation, the Committee has
provided $30,000,000 for CDC to expand its efforts in this
area. The Committee expects some of these funds to be used to
support research on ways to prevent disease and disability in
rural areas and to better utilize nurses and allied health
professionals in prevention and health promotion efforts.
As more and more Americans use alternative and
complementary therapies to maintain and improve their health,
there is a growing need for better consumer information about
these therapies. The Committee expects CDC to expand their
effort in this area. Practice-based assessments and the
identification and study of promising and heavily used
complementary and alternative therapies and practices should be
undertaken and results published. The Committee expects CDC to
collaborate with the National Center for Complementary and
Alternative Medicine to assure that its efforts complements
efforts by this Center.
Buildings and Facilities
The Committee recommendation includes $250,000,000 for the
planning, design, and construction of new facilities, repair
and renovation of existing CDC facilities, and data security
and storage. The fiscal year 2003 comparable level was
$266,258,000 and the administration requested $114,000,000 for
fiscal year 2004.
The Committee recommendation includes sufficient funds for
the continuation of CDC's building program for its Atlanta and
Fort Collins facilities. The Committee has long supported the
rapid implementation of CDC's Buildings and Facilities Master
Plan and is pleased with the progress made to date for the
agency's Atlanta, Georgia facilities. The Committee notes that
continuing to implement the Master Plan as quickly as possible
is essential for the public health security of our Nation.
The Committee encourages CDC to evaluate the need for a
physical laboratory building at the NIOSH National Personal
Protective Technologies Laboratory.
The Committee has again provided bill language to allow CDC
to enter into a single contract or related contracts for the
full scope of development and construction of facilities and
instructs CDC to utilize this authority when constructing the
Atlanta and Fort Collins facilities.
Office of the Director
The Committee recommends $59,707,000 for the Office of the
Director. The fiscal year 2003 comparable level was $49,426,000
and the administration requested $59,707,000 for fiscal year
2004.
The Office of the Director [OD] manages and directs
programs of the CDC. OD provides leadership, advises on policy
matters, and develops and evaluates progress of goals and
objectives related to disease prevention and control. OD
provides direction and coordination to the epidemiologic
activities of CDC and coordinates CDC's response to health
emergencies. In addition, OD coordinates and manages programs
on global health activities, minority health, and women's
health relating to disease prevention and control.
The Committee is aware of the importance of the Prevention
Research program at the Public Health Program Office. This
program awards peer-reviewed grants to academic health centers
in partnership with community-based organizations to
demonstrate and to measure the performance of promising
prevention demonstrations. This program is an example of CDC's
commitment to extramural research in support of evidence-based
prevention programs. The Committee believes that disease
prevention and health promotion is central to better health and
longer lives for every American and that investments today in
prevention research, including research on behavioral change,
can significantly contain health care costs tomorrow.
Accordingly, the Committee urges the Director to place
prevention research at a higher priority and, in addition,
encourages the CDC to collaborate with the NIH Office of the
Director to coordinate each agency's prevention research
programs.
Air Transport.--When a public health threat emerges, CDC is
called upon to respond in an appropriate and timely manner to
investigate and contain the threat. To engage in the highest
level of outbreak response, CDC requires an aircraft capable of
being anywhere in the world in one stop or 6,500 miles in 12
hours, refitted to provide appropriate infection control
capabilities and maintained on standby near CDC headquarters. A
dedicated aircraft with a capability to retrieve specimens
rapidly, deploy key CDC personnel, or evacuate CDC personnel in
the field to appropriate health care facilities is a tool which
will optimize CDC's ability to provide timely outbreak
response. The aircraft would enable CDC to obtain specimens
early in the outbreak of a disease, which is critical.
International clearances, paperwork required to ship specimens,
and availability of a commercial carrier all contribute to
delays and sometimes failed receipt of specimens. The Committee
is very concerned by the difficulty CDC experienced in
transporting SARS specimens via commercial aircraft from Asia
to CDC's Atlanta-based headquarters for testing. Deploying key
CDC personnel early in the discovery of an outbreak is another
essential factor in identifying and containing the spread of a
disease. CDC currently lacks an effective means of safely and
efficiently transporting personnel with highly communicable
infections to locations that can provide appropriate care.
Experience has demonstrated that CDC cannot rely on commercial
companies or other Federal agencies to transport infectious
specimens or to move highly contagious patients. The Committee
believes CDC requires its own aircraft to move specimens and
emergency personnel worldwide on a moment's notice.
National Institutes of Health
This Nation's investment in biomedical research has
propelled a remarkable transformation in our understanding of
the life sciences, out of which has flowed a bounty of new ways
to prevent, cure and treat disease. Since the structure of DNA
was first discovered in 1953, for example, scientists have
identified thousands of genes linked to rare disorders as well
as common diseases that were never thought to be genetic
conditions. In all, more than 4,000 diseases are now thought to
have genetic causes. This new knowledge is helping to broaden
our understanding of how biological processes work at the
molecular level, elucidating the cause of disease not just the
symptoms, and opening the path to prevention strategies,
earlier intervention in the disease process, and new, more
effective treatments. But challenges remain. Chronic diseases
like cancer, heart disease, stroke and diabetes continue to
waste precious human resources and drain billions of dollars
from the Nation's economy. Infectious agents like SARS, Monkey
Pox, hepatitis C, and West Nile virus kindle new threats to
health; diseases like tuberculosis and malaria are re-emerging
in more virulent, drug-resistant forms; and threats of
bioterrorism impose added demands on science for rapid
detection and treatment. But even larger challenges loom on the
horizon as the population of Americans over age 65 more than
doubles--to 75 million--over the next 3 decades, resulting in
exponential increases in the number of individuals suffering
from Alzheimer's, arthritis, Parkinson's, and osteoporosis.
This Committee has long recognized the worth of the
National Institutes of Health, not only as the world's most
important biomedical research establishment, but as the taproot
that nourishes growth and progress in medical science. Along
with that recognition comes the understanding that the engine
of progress must be maintained. Although the private sector has
an important role to play, the Federal Government is the only
source able to provide sustained, long-term support. NIH-
supported research helps supply the cadre of highly skilled
investigators, stimulates investments in new technology
development, and is an important precursor to innovation. When
this Committee embarked on an historic, bipartisan effort to
double the Federal investment in NIH, it did so not as a means
to an end but as part of a continuing endeavor to strengthen
and revitalize the research enterprise in this Nation. The
funds provided in this bill represent an important step in that
continuum.
The Committee recommends $27,990,804,000 for the NIH. This
amount is $1,000,000,000 above the fiscal year 2003
appropriation and $326,813,000 over the budget request.
NATIONAL CANCER INSTITUTE
Appropriations, 2003.................................... $4,592,348,000
Budget estimate, 2004................................... 4,770,519,000
Committee recommendation................................ 4,770,519,000
The Committee recommends an appropriation of $4,770,519,000
for the National Cancer Institute [NCI]. This is equal to the
budget request. The fiscal year 2003 appropriation was
$4,592,348,000. The comparable amounts for the budget estimate
include funds to be transferred from the Office of AIDS
Research.
Mission.--The NCI conducts and supports basic and applied
cancer research in prevention, early detection, diagnosis,
treatment, and rehabilitation. The Institute provides training
support for research scientists, clinicians, and educators, and
maintains a national network of cancer centers, clinical
cooperative groups, community clinical oncology programs,
cancer prevention and control initiatives, and outreach
programs to rapidly translate basic research findings into
clinical practice.
Behavioral Research.--The Committee recognizes the enormous
progress NCI has made in the quality and breadth of cancer-
related behavioral science, ranging from basic bio-behavioral
research to health communication research and tobacco control
research. Closing the gap between research and program delivery
is both a challenge and a necessity if all populations are to
benefit from new scientific discoveries. Behavioral science can
contribute to survival, reduced morbidity and increased quality
of life, and the behavioral and cognitive sciences can be
highly applicable in answering critical questions regarding
patient care.
Blood Cancers.--The Committee urges the NCI to continue to
implement the research priorities for leukemia, lymphoma, and
multiple myeloma included in the May 2001 Progress Review Group
Report.
Bone Metastasis.--The Committee encourages NCI to continue
its emphasis on studying the bone microenvironment and bone
metastasis related to prostate cancer, breast cancer and
multiple myeloma and to support research to delineate the
mechanisms of reciprocal interactions between tumor cells and
bone. To provide an infrastructure for this research, NCI is
encouraged to establish a repository of human bone metastases
for the scientific community and support research to generate
three-dimensional in vitro and/or in vivo models that yield
bone metastases.
Brain Tumor.--In November 2000, the NCI and NINDS convened
a panel of experts to review the field of brain tumor research
and make recommendations to enhance it. The Committee is
pleased that the Institutes followed that meeting by
establishing the Neuro-Oncology Branch, an inter-institutional
initiative aimed at bringing a multidisciplinary approach to
brain tumor research. The Committee now urges the NCI and NINDS
to establish a coordinated and multi-institutional tissue bank
that would gather not only tissue but also blood and
cerebrospinal fluid from patients with all varieties of brain
tumors. The system should also be linked to a comprehensive
database of relevant clinical, demographic, pathologic,
biologic, and therapeutic information on all patients whose
tissue is banked. The Committee further strongly urges the NCI
to increase funding and the number of Specialized Programs of
Research Excellence in Brain Tumors [SPORE] grants in the
upcoming fiscal year, with particular emphasis on those
proposals which include both basic research and clinical
treatment applications.
Cancer and Minorities.--The Committee remains concerned
that cancer rates for Native Hawaiians and other Native
American Pacific Islanders are disproportionately high. The
Committee encourages the NCI to expand its research in this
area.
Cancer Genomics.--The Committee commends NCI for its
commitment to understanding the role of genomics and genetics
in the progression of cancer. Considerable effort must now be
directed toward applying those findings to tumor classification
and therapeutic choice, with a focus on breast, colorectal and
lung cancer, as well as leukemia and lymphoma. An important
component of this effort will be to build a public database of
whole genome expression profiles from various tumor types,
which includes clinical outcome information. The Committee
encourages NCI to ensure that this data is available to health
professionals to assist physicians and patients in choosing the
best treatment options.
Cancer Survivorship.--With the advances that have resulted
from the ongoing commitment and investment in biomedical
research, and the resultant advances in cancer treatment,
cancer for many has become a chronic illness. Currently, there
are over 9 million cancer survivors in the Nation, and this
number is expected to grow dramatically. More must be done to
improve the understanding of the growing cancer survivorship
population, including determinations of physiological and
psychological late effects, prevalence of secondary cancers, as
well as further development of effective survivorship
interventions. The Committee supports an aggressive expansion
of the NCI Office of Cancer Survivorship activities and urges
the NCI to continue its work to expand the Office of cancer
Survivorship within NCI, as well as advance and increases
opportunities in cancer survivorship. The Committee was pleased
to see NCI include cancer survivorship in the cancer bypass
budget and urges NCI to provide increased funding for cancer
survivorship research.
Chronic Lymphocytic Leukemia.--The Committee strongly
encourages the NCI to increase the level of research aimed at
determining the underlying cause and optimum therapies for CLL,
the most common form of adult leukemia in the United States.
The Committee is encouraged by the NCI's willingness to
consider a supplementary application for research funding for
the CLL Research Consortium. The Committee further urges the
NCI to expand funding for the Consortium to speed up the
progress in finding significant scientific breakthroughs.
Chronic Myeloproliferative Disorders.--Polycythemia vera,
idiopathic myelofibrosis and essential thrombocytosis are
malignant diseases of the bone marrow that are underserved with
respect to research funding, considering the number of people
they strike. These disorders are chronic and can transform into
acute leukemia. They offer great research promise with respect
to insights into the behavior of blood cells, since the cells
that they affect appear normal but behave abnormally. The major
obstacle to research into the causes and the treatment of these
disorders has been the lack of Federal funds designated for
this purpose. The Committee strongly believes that the NCI
should expand research into these disorders, and be prepared to
report to the Committee during the fiscal 2005 budget hearing
about existing efforts, as well as planned future efforts, to
better understand these disorders.
Complementary and Alternative Cancer Therapies.--The
Committee expects the NCI to expand its work and its
collaborative efforts with NCCAM to support research on
promising complementary and alternative cancer therapies as
well as on their integration with traditional therapies.
DES.--The Committee continues to strongly support increased
efforts to study and educate the public and health
professionals about the impact of exposure to the synthetic
hormone diethylstilbestrol [DES]. The Committee expects the NCI
to continue its support of research in this area, and to
continue to consult with organizations representing individuals
impacted by DES as they carry out DES research and education
efforts.
Diet and Nutrition.--The evidence is mounting that diet and
nutrition play a key role in causing cancer and preventing it.
For example, studies show that a diet with little fiber may be
a contributing factor in colon cancer, while lycopene found in
tomatoes may be useful in preventing prostate cancer. Likewise,
diet can play a major role in treating a variety of cancers.
The Committee encourages the National Cancer Institute to
dedicate more funding to research and education programs
focused on diet and nutrition.
Gynecologic Cancers.--The Committee is encouraged by the
success of the Gynecological Cancer SPORE program but believes
an increased investment is needed as the survival rate for
ovarian cancer remains disappointingly low--14,300 women are
expected to die this year while 25,400 will be diagnosed during
that same time. The Committee believes the CanCOR program
should be expanded to help identify barriers to receiving
optimal care among women with newly diagnosed gynecological
cancer. The NCI should also develop prophylactic and
therapeutic HPV vaccines to prevent cervical cancer and
strengthen research in the biology of endometrial cancer in
order to improve prevention and treatment, thus sparing women
the need to undergo hysterectomy and other cancer therapy. The
Committee also believes that the NCI should be partnering with
the NICHD Reproductive Sciences Program to investigate
gynecological cancer.
Health Communications.--The Committee is pleased at the
growth of this program of research, since health communications
is such a vital contributor to the public health and health
care generally. Understanding and improving communication
between health providers and patients, improving communication
with low literacy populations, and understanding what aids and
hinders public health messages is critically important for
building a healthier Nation. The Committee particularly
encourages NCI to provide additional information about the
HINTS survey that will commence this year. This will be the
first national health communications survey, involving some
8,000 adults.
Imaging Systems Technologies.--The Committee is encouraged
by progress made by the NCI following its August 1999
conference on biomedical imaging, and it urges the NCI to
continue to take a leadership role with the Centers for
Medicare and Medicaid Services [CMS] and the Food and Drug
Administration to avoid duplicative reviews of new imaging
technologies which may prevent their benefits from reaching
patients on a timely basis. The Committee is aware of the great
potential for improved patient care and disease management
represented by molecular imaging technologies, especially
positron emission tomography [PET] through its ability to image
the biology of many kinds of cancer and other diseases. The
Committee continues to support the NCI's increased emphasis on
examining the molecular basis of disease through imaging
technologies such as PET and MicroPET. The Committee continues
to encourage the large-scale testing of women for breast cancer
and men for prostate cancer to demonstrate and quantify the
increased diagnostic and staging capabilities of PET relative
to conventional diagnostic and staging technologies, including
mammography.
Kidney Cancer.--The Committee is concerned about the
growing incidence of kidney cancer. According to the American
Cancer Society, 30,800 Americans were expected to be diagnosed
with kidney cancer and 12,100 were expected to die of this
disease in 2001. Unfortunately, kidney cancer is often not
diagnosed until it has spread to other parts of the body,
decreasing chances of long-term survival from the disease. The
Committee is concerned that treatment options are very limited,
particularly for late-stage kidney cancer patients. Therefore,
the Committee strongly urges the NCI to place a greater
emphasis on and dedicate expanded resources to research on
kidney cancer. The Committee requests the NCI to convene an
expert conference by December 2003 to develop a short- and
long-term research agenda and action plan for improving the
diagnosis and treatment of kidney cancer. The Committee
recommends that the conference include patient advocates.
Liver Cancer.--The Committee is concerned that primary
liver cancer continues to be one of the few forms of cancer for
which incidence is growing. This has serious implications for
public policy, cancer being a significant factor in
transplantation. While progress is being made, much more needs
to be done. NCI is planning a joint meeting with NIDDK for
April 2004. It is critical that this meeting result in a strong
plan for future research in primary liver cancer that will
reverse the current increases.
Lymphoma Research.--The Committee recommends that NCI
increase its efforts to examine the issue of environmental and
viral links to lymphoma. Although many studies have suggested
an increased risk of lymphoma associated with environmental
factors such as chemicals, pesticides and herbicides, other
investigations have reported inconsistent results. However,
many of these studies are weakened by limited sample sizes,
flaws in study design, and imprecision in the measurement of
environmental carcinogen exposures. The Committee recommends
that NCI work to develop a well-constructed prospective study,
using a multidisciplinary, approach to examine environmental
links to lymphoma.
In a recent report (October 2002) the Institute of Medicine
concluded that there is moderate to strong biological evidence
supporting a role of Simian Virus 40 in human cancer. Recent
reports suggest that more than 40 percent of lymphomas tested
were positive for this virus. Additional research studies have
also found an association between other viruses, such as human
herpes virus 8 and hepatitis C, and lymphoma. As a result of
these studies, it is possible that more than half of all
lymphomas may be attributed to viruses. The Committee therefore
recommends that NCI also increase its efforts to examine the
viral etiology of lymphoma.
More than 61,000 Americans will be diagnosed with Hodgkin's
lymphoma and non-Hodgkin's lymphoma [NHL] in 2003. The
Committee notes that there have been significant advances in
the treatment of Hodgkin's lymphoma over the last 30 years and
some improvements in the treatment of NHL. However, NHL
treatments are not adequate, and treatment improvements are
absolutely critical for this group of cancer patients. Although
industry has recently developed several new NHL therapies, the
involvement of the National Cancer Institute in lymphoma
research is still critical. The Committee urges that NCI
increase its investment in clinical research on lymphoma and
strengthen its collaboration with industry to improve the
efficiency and timeliness of the lymphoma drug development
process.
The Committee also recommends that, in addition to
initiatives to improve the lymphoma drug development process,
NCI increase its investment in several other areas of research,
including research on nonablative transplants, immunomodulatory
regimens, central nervous system lymphoma, the late and long-
term effects of current lymphoma treatments, and lymphoma
etiology and prevention. The Committee also urges NCI to
cooperate with private organizations in the development of a
comprehensive lymphoma tissue bank.
Multiple Myeloma.--The Committee acknowledges that the
National Cancer Institute [NCI] has developed the Academic
Public Private Partnership Program to facilitate public-private
partnerships in research on orphan cancers, including but not
limited to blood-related cancers. The Committee is pleased by
this action, but in light of the serious burden associated with
the blood cancers and the limited treatment possibilities for
many blood cancers, it strongly urges additional efforts to
accelerate the development of blood cancer therapies. The
Committee encourages NCI to develop funding mechanisms for
translational blood-related cancer research that will
facilitate multi-disciplinary and multi-institutional research
collaborations instead of research focused at only one
institution. Multi-institutional cooperation is critical if new
therapies are to be efficiently developed. The Committee also
urges the NCI to increase its overall investment in blood
cancer research, including but not limited to its investment in
these multi-institutional research grants. To ensure that
progress on blood cancer research initiatives continue, the
Committee requests that NCI submit a report on the status of
its blood cancer research program by April 2004.
Myelodysplasia and Myeloproliferative Disorders.--The
Committee is pleased with NCI's efforts to address the lack of
basic knowledge about myelodysplasia and myeloproliferative
disorders, two very different types of chronic diseases of bone
marrow cells that can develop into acute leukemia. The
Committee urges NCI to carry out the recommendations of its
recent conference of experts on these diseases and advance new
research initiatives into developing effective treatments.
Nanosystems Biology.--The Committee encourages NCI to
support a collaborative effort to bring nanotechnology, systems
biology and molecular imaging together to examine the molecular
basis of cancer. Initial efforts have shown that cancers such
as breast cancer are not a single disease, but may encompass
many different diseases, when examined at the molecular level.
Many clinical trials of new drugs are now considered to fail if
only 10 percent of patients benefit, yet the 10 percent may
represent a specific type of the disease, where the drug may be
100 percent effective. Bringing these three disciplines
together may allow researchers to identify specific sub-types
of cancer and to better target new interventions. Successful
results of such an effort could lead to a molecular
classification of many types of cancer and to targeted
molecular treatments for molecular-specific diseases.
Neurofibromatosis.--Neurofibromatosis [NF] research has
significant potential for cancer patients since NF genes have
been implicated in the signaling processes that determine cell
growth and cell differentiation. It will contribute to the
development of new technologies and enhance understanding of
the fundamental processes of both cancer and NF. The Committee
encourages NCI to intensify and expand its NF research
portfolio in such areas as molecular biology, development of
animal models, natural history studies, malignant
transformation in tumors, therapeutic intervention, and
clinical trials. It recommends that NCI use all available
mechanisms, including requests for applications, program
announcements, and the national cooperative drug discovery
group program to achieve this end. The Committee expects NCI to
coordinate its efforts with other Institutes where appropriate
and to be prepared to report on its progress at the fiscal year
2005 appropriations hearings. The Committee thanks NCI for
conducting phase II clinical trials of NF1 patients with
plexiform neurofibromas. Finally the Committee encourages NCI
to increase its NF research portfolio in such areas as further
development of animal models, natural history studies,
therapeutic experimentation, and clinical trials.
Organ Cancers.--The Committee acknowledges that the
National Cancer Institute [NCI] has developed the Academic
Public Private Partnership Program to facilitate public-private
partnerships in research on orphan cancers, including but not
limited to blood-related cancers. The Committee is pleased by
this action, but in light of the serious burden associated with
the blood cancers and the limited treatment possibilities for
many blood cancers, it strongly urges additional efforts to
accelerate the development of blood cancer therapies.
The Committee encourages NCI to develop funding mechanisms
for translational blood-related cancer research that will
facilitate multi-disciplinary and multi-institutional research
collaborations instead of research focused at only one
institution. Multi-institutional cooperation is critical if new
therapies are to be efficiently developed. The Committee also
urges the NCI to increase its overall investment in blood
cancer research, including but not limited to its investment in
these multi-institutional research grants. To ensure that
progress on blood cancer research initiatives continue, the
Committee requests that NCI submit a report on the status of
its blood cancer research program by April of 2004.
Pancreatic Cancer.--Pancreatic cancer is the country's
fifth leading cause of cancer death, and 99 percent of people
diagnosed with this disease die within 6 months. The Committee
is concerned that research funding for pancreatic cancer has
not increased commensurate with the severity of this disease or
the overall increase afforded the NCI within the past 5 years.
The Committee strongly urges the NCI to complete the immediate
and short-term strategies identified in the ``Strategic Plan
for Addressing the Recommendations of the Pancreatic Cancer
Progress Review Group,'' which was issued by the NCI in
September 2002. In addition, the Committee asks the NCI to
complete a professional judgment budget to carry out those
strategies, and to provide it to the Committee by April 1,
2004.
Prostate Cancer.--The Committee is aware of the
considerable investment that has been made in prostate cancer,
the leading cause of cancer death among men, and encourages NCI
to continue to support research to improve the accuracy of
screening and early detection of prostate cancer. Emphasis
should also be placed on the development of new, more effective
therapies for cancer that was not detected early enough and is
no longer confined to the prostate capsule.
The Institute has worked with the urologic scientific
community to identify research needs in other urologic
oncology, including bladder, kidney and testis cancers. The
Committee expects the Institute to increase the research
resources directed to these other urologic cancers, which
affect thousands of men and women annually.
The success in treating prostate, and other cancers, means
that there are many individuals in society who are cancer
survivors. There are a series of distinct physical and
emotional issues facing these individuals, and the Committee
encourages NCI to develop programs that address these problems.
The report titled ``Prostate Cancer Research Plan Fiscal
Year 2003--Fiscal Year 2008'' that NCI provided to Congress in
August 2002 did not include a professional budget judgment. The
Committee requests the NCI to provide such a budget for fiscal
year 2004 through fiscal year 2008 by April 2004.
NATIONAL HEART, LUNG, AND BLOOD INSTITUTE
Appropriations, 2003.................................... $2,793,733,000
Budget estimate, 2004................................... 2,867,995,000
Committee recommendation................................ 2,897,595,000
The Committee recommendation includes $2,897,595,000 for
the National Heart, Lung, and Blood Institute [NHLBI]. The
fiscal year 2003 appropriation was $2,793,733,000 and the
budget requested $2,867,995,000. The comparable amounts for the
budget estimate include funds to be transferred from the Office
of AIDS Research.
Mission.--The National Heart, Lung, and Blood Institute
provides leadership for a national research program in diseases
of the heart, blood vessels, lungs and blood, in transfusion
medicine, and in sleep disorders through support of basic,
clinical, population-based, and health education research.
Advanced Imaging Technology for Heart Disease and Stroke.--
The Committee is aware that heart perfusion PET scans using
Rubidium-82 are considered the ``gold standard'' for
determining the extent of muscle damage to the heart following
a heart attack. The Committee encourages the NHLBI to expand
its research efforts into the role of biological imaging and
PET in delivering more accurate information to determine
appropriate treatment for heart disease patients.
Allied Health Personnel.--Given the existing and growing
shortages of qualified allied health professions who serve as
laboratory personnel, the NHLBI is encouraged to enhance
program activity at research institutions training these
individuals. This shortage is of particular concern since
laboratory personnel are critical to identifying biological
agents and, therefore, to any State or national plan for
combating bioterrorism.
Alpha-1 Antitrypsin Deficiency.--The Committee is aware
that Alpha-1 Antitrypsin Deficiency is a genetic disorder that
can result in fatal lung and/or liver disease. The disease is
often misdiagnosed as asthma or Chronic Obstructive Pulmonary
Disease [COPD]. Alpha-1 is a major cause of lung
transplantation in adults and a leading cause of liver
transplantation in children. The Committee encourages NIH to
enhance in research portfolio through all available mechanisms,
including conducting a State of the Science Conference aimed at
evaluating current science and identifying future research
priorities for a 5-year research agenda in Alpha-1. NIH is
encouraged to consult closely with the research community,
clinicians, and patient advocates regarding Alpha-1 research
and the achievement of this goal. NIH is also encouraged to
expand efforts to raise public awareness and to provide
information about Alpha-1 to the public and health
professionals.
Basic Behavioral Research.--The NHLBI is commended for its
support of basic research with animal models to better
understand the effects of various diets, exercise, and stress
on the heart and circulatory system, as well as work on gene-
environment interactions. The NHLBI is encouraged to continue
to work cooperatively with other institutes and the Office of
Behavioral and Social Sciences Research on efforts to add to
fundamental knowledge in these areas.
Blood-Related Cancer Research.--In 2003, approximately
110,000 Americans will be diagnosed with multiple myeloma,
lymphoma, or leukemia, which are considered blood-related
cancers. There are good treatment choices for some who are
diagnosed with blood cancers, but for others the treatment
options are limited. Treatment advances will only be
accomplished through the more efficient translation of basic
research findings into new therapies. In May 2002, Congress
approved and the President signed into law the Hematological
Cancer Research Investment and Education Act, which directs the
National Institutes of Health [NIH] to expand, intensify, and
coordinate the research program for blood-related cancers as
part of the Joe Moakley Research Excellence Program.
Cardiovascular Diseases.--The Committee continues to regard
research into the causes, cure, prevention and treatment of
heart disease, stroke and other cardiovascular diseases as one
of the Nation's top priorities. Cardiovascular diseases remain
the leading cause of death in the United States and a major
cause of permanent disability. The Committee continues to
strongly believe that an intensive research program on heart
disease, stroke and other cardiovascular diseases should be a
top priority of the NHLBI. The Committee urges the Institute to
expand its resources dedicated to cardiovascular disease
research through all available mechanisms, as appropriate.
Cooley's Anemia.--The Committee remains strongly supportive
of the Institute's creation of and support for the Thalassemia
Clinical Research Network, which is composed of North America's
leading experts on thalassemia, the medical term for Cooley's
anemia. The Committee believes that research into this disease
has implications far beyond this patient population and that
all reasonable steps should be taken to assure that the Network
reaches its maximum potential. In addition, the Committee
encourages NHLBI to join with CDC and FDA to enhance blood
safety.
Diagnostic Screening Test for Salt Sensitivity.--High blood
pressure is the most critical stroke risk factor and a leading
cause of heart attack and heart failure. The cause of 90 to 95
percent of the cases of high blood pressure is not known, but
high blood pressure is easily detected and usually
controllable. Excess dietary salt is an important risk factor
for high blood pressure. While public health authorities
caution all Americans to limit salt intake, the ability to
identify people who are most likely to benefit from salt
restriction would provide strong incentives for susceptible
individuals to heed the message. The Committee urges the NHLBI
to increase funding for the development of a noninvasive or
minimally invasive, rapid, practical diagnostic test for salt
sensitivity, i.e., the propensity for an individual to
experience an increase in blood pressure in response to a salt-
rich diet.
Diamond-Blackfan Anemia.--The Committee is pleased that
NHLBI is working to develop a comprehensive research initiative
to investigate the rare bone marrow deficiency disorder,
Diamond Blackfan Anemia [DBA]. The Committee understands that
breakthroughs in this disorder may lead to important strides in
research especially relating to blood cell formation (recovery
from cancer chemotherapy), cancer predisposition, gene
discovery, and the effectiveness of steroids and blood
transfusions as treatment options for all bone marrow failure
syndromes and that the detailed evaluation of DBA patients will
also serve as an important model for understanding the genetics
of birth defects. The Committee thanks NHLBI for their
attention to this important disorder.
Hematology Networks.--The Committee is very supportive of
NHLBI's Clinical Research Networks, especially with the
progress of the Transfusion Medicine/Hemostasis Network. To
address the shortage of hematology specialists, the Committee
looks forward to learning about NHLBI's plans to formalize a
training component for clinicians and researchers within the
networks.
Hemophilia.--The Committee commends NHLBI for its
leadership in advancing research on bleeding disorders and the
complications of these disorders, including inhibitor
development and improved treatments such as gene therapy. The
Committee encourages NHLBI to continue to partner with the
National Hemophilia Foundation in further expanding
opportunities for hematologic research through clinical
research networks and, where appropriate, with other NIH
Institutes. The Committee also requests a report by April 2004
on the status of research on type 1 and 2 von Willebrand
disease and how NHLBI plans to expand research in this
important area.
Juvenile Diabetes.--Vascular complications, including
cardiovascular, peripheral vascular, and cerebrovascular, are a
major cause of mortality and morbidity in persons with
diabetes, particularly in those with juvenile diabetes. The
NHLBI is urged to focus on initiatives specifically relating to
individuals with juvenile diabetes who experience accelerated
and severe complications as a result of hyperglycemia, such as
atherosclerosis, vascular inflammation, and microvascular
disease.
Marfan Syndrome.--The Committee commends the NHLBI for its
past and ongoing support of research on aortic aneurysms, which
are pathologically related to Marfan syndrome. Marfan syndrome
is a life-threatening progressive disorder affecting the heart,
lungs, skeleton and eyes. The Committee urges the NHLBI to
enhance both basic and clinical research efforts specifically
in the area of Marfan syndrome through all available mechanisms
such as recommended from a 2002 NHLBI working group meeting.
Minority Health.--The Committee notes lung diseases
disproportionately affect many minority groups. The Committee
urges NHLBI to work with other Institutes and Centers to
develop an epidemiologic approach to determine the
disproportionate impact of airway disease on minority
populations.
Myelodysplasia and Myeloproliferative Disorders.--The
Committee encourages NHLBI to fund research in myelodysplasia
and myeloproliferative disorders, specifically into the
vascular, thrombotic, and hemorrhagic abnormalities associated
with myeloproliferative disorders as well as the specific
abnormalities in cell gene expression that are responsible for
these diseases.
National Asthma Education and Prevention Program [NAEPP].--
The Committee commends NAEPP for its leadership in helping to
educate physicians, asthma patients, their families, and the
general public regarding asthma and its management. The
Committee urges NAEPP to enhance the role that its Advisory
Committee plays in helping to coordinate asthma education
throughout the United States.
The Children's Health Act of 2000 legislation included
provisions for NAEPP to develop, in conjunction with other
Federal agencies and voluntary and professional health
organizations, a Federal plan to respond to asthma. This plan
will include the roles and responsibilities of several Federal
agencies in combating asthma. The Committee would like to be
kept apprised on the progress of NAEPP's planning efforts, and
urges NHLBI to move forward as early as possible.
Neurofibromatosis.--Neurofibromatosis is a neurological
disorder that causes a variety of problems including learning
disabilities, skeletal abnormalities, disfigurement, deafness,
blindness, loss of limbs, and brain, spinal, heart, and
vascular abnormalities, and tumors on nerves anywhere on or in
the body. Research on the effects of NF on formation, growth,
and functioning of the heart and vascular system are of
relevance to the NHLBI. In addition, it has been brought to the
Committee's attention that NF research has documented the
involvement of neurofibromatosis in heart valve formation which
may lead to new opportunities and understanding of the genetic
and environmental causes of heart and vascular disease. The
Committee therefore strongly encourages NHLBI to work with
other Institutes and NF advocacy groups such as The National
Neurofibromatosis Foundation, Inc. to identify areas where
research goals may be complementary, expand its NF research
portfolio and to build appropriate partnerships.
Pediatric Asthma Network.--The Committee recognizes that
little is known about the optimal treatment for asthma in
infants and young children. The Committee urges NHLBI to use
the research amassed through the Pediatric Asthma Clinical
Research Network to provide clearer choices for childhood
asthma therapy, to encourage the development and dissemination
of new therapies, and to identify optimum asthma management
strategies for children.
Pediatric Heart Research.--Pediatric heart disease, which
includes heart defects existing at birth, disorders of heart
function and heart rhythm and other heart conditions acquired
in childhood, remain an important public health problem. Heart
defects are the most common birth defect and cause more infant
deaths than any other birth defect. The Committee urges the
NHLBI to support a program on Specialized Centers of Clinically
Oriented Research in Pediatric Heart Development and Disease,
designed to stimulate and foster multidisciplinary clinical and
basic research to enhance prevention, diagnosis and treatment
of acquired pediatric heart disease and heart defects that
exist at birth.
The Committee is also aware of the need for Pediatric
Mechanical Circulatory Support Research and Development.
Circulatory assist devices, such as left ventricular assist
devices, increase survival rates and quality of life for adult
patients. But, such devices are not available for infants and
children. The Committee urges the NHLBI to support planned
research that would develop and evaluate pediatric circulatory
assist devices that could provide short, intermediate or long-
term lifesaving support for infants and children waiting for
heart transplants or development of new surgical or other
therapies.
Peripheral Arterial Disease [PAD].--The Committee
encourages the NHLBI to develop research initiatives in the
area of PAD, including studies to improve prevention, diagnosis
and treatment. The Committee urges the NHLBI to create
informational and educational programs directed to health
professionals, patients and the public to raise awareness and
understanding of PAD as a risk factor for heart disease and
stroke and the importance of preventing, diagnosing and
treating PAD.
Pulmonary Hypertension [PH].--The Committee commends
NHLBI's efforts to promote PH related research. The Committee
urges the Institute to increase 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.
Recovery of Heart Function with Circulatory Assist.--The
Committee is aware that the only treatment for sufferers of
end-stage heart failure is a heart transplant. Since there is a
severe shortage of hearts available for transplant, mechanical
circulatory assist devices are typically used to stabilize
these patients until a suitable donor heart becomes available.
Anecdotal evidence shows that the ``rest'' provided by
circulatory assist devices, in some cases, enables the adult
heart to recover sufficiently to resume pumping on its own. The
Committee urges the NHLBI to initiate research to determine
whether sustained heart recovery is achievable through
circulatory assist devices, characterization of patients who
would likely benefit and study of other therapies that may
improve outcomes.
Scleroderma.--The Committee encourages the Institute to
undertake research initiatives to be undertaken by the NHLBI
for the study of cause and treatment options for scleroderma, a
chronic and progressive disease that predominantly strikes
women. Scleroderma is disfiguring and life-threatening,
affecting multiple systems including the heart and lungs. More
research is critically needed in order to develop safe,
effective treatments and to identify the cause or causes of the
devastating complications of scleroderma that include pulmonary
fibrosis, pulmonary hypertension, myocardial fibrosis, cardiac
arrhythmias, pericarditis, and Raynaud's Phenomenon.
Sleep Apnea (obstructive) in Adults.--Symptomatic sleep
apnea is common in middle-age adults, and far more frequent in
the elderly. Untreated sleep apnea results in mortality,
cardiovascular disease, and quality of life deficits. The
Committee recommends that the National Heart, Lung, and Blood
Institute, in collaboration with the National Institute on
Aging, support research to define useful treatments--including
surgical treatments--for the large segment of the general
population that suffers from insufficiently treated obstructive
sleep apnea.
Sleep Medicine.--The Committee commends NHLBI and the
National Center for Sleep Disorders Research on the completion
of the 2003 National Sleep Disorders Research Plan, which
provides an enormous breadth of research topics ranging from
better understanding sleep mechanisms and functions, to
improved treatments for sleep disorders, to the effect of sleep
on health outcomes. The Committee therefore expects NHLBI to
move forward on these research initiatives and looks forward to
a progress report on the implementation of the research plan at
next year's budget hearings.
Tuberculosis and AIDS.--The Committee supports the
important research on the interaction of tuberculosis and AIDS
conducted by the NHLBI AIDS research program and encourages
NHLBI to strengthen its research in this important area.
Vascular Disease and Alzheimer's.--There is a growing body
of evidence that cerebrovascular disease may be a key mechanism
in triggering the manifestation of Alzheimer's disease. The
Committee therefore is pleased to note that NHLBI, in
collaboration with NIA, is supporting cardiovascular health
studies that are examining the natural history of the
development of Alzheimer's, and identifying individuals at high
risk of developing the disease. Ancillary studies also are
underway to determine the contribution of vascular factors to
Alzheimer's. The Committee encourages NHLBI to continue to
pursue this line of research and to work collaboratively with
NIA.
NATIONAL INSTITUTE OF DENTAL AND CRANIOFACIAL RESEARCH
Appropriations, 2003.................................... $371,636,000
Budget estimate, 2004................................... 382,396,000
Committee recommendation................................ 386,396,000
The Committee recommendation includes $386,396,000 for the
National Institute of Dental and Craniofacial Research [NIDCR].
The fiscal year 2003 appropriation was $371,636,000 and the
budget requested $382,396,000. The comparable amounts for the
budget estimate include funds to be transferred from the Office
of AIDS Research.
Mission.--The NIDCR supports research and research training
to improve the oral health of the American people. The
Institute emphasizes ways to prevent disease in high-risk
groups, including the elderly, minority populations, and
individuals with medical conditions and medications that
compromise oral health. The research agenda includes studies of
craniofacial genes and birth defects; bone and joint diseases;
AIDS, other infections, and immunity; oral cancer; chronic
pain; epidemiology; biomaterials; and diagnostic systems.
Saliva as a Diagnostic Tool.--The Committee learned in
public witness testimony about the advances occurring in the
field of salivary diagnostics. In recent years dental
scientists have learned that the oral fluids in the mouth
contain a cornucopia of information about the condition of the
various systems of our body. Of particular interest is the
potential to develop a diagnostic test for early detection of
breast cancer. The Committee recognizes that considerable
clinical research must be done before a test can be approved
for use by health care professionals so that the women of this
country will have a simple non-invasive, inexpensive procedure
to alert them to the risk of breast cancer. The Committee urges
the Institute to advance the field of salivary diagnostics.
Scleroderma.--The Committee is encouraged by the NIDCR's
interest in scleroderma, a chronic and progressive disease that
predominantly strikes women. Scleroderma is often associated
with a number of potential dental and craniofacial
complications. The major and most common problems are
xerostomia and microstomia. Additional concerns are increased
frequency of caries, periodontal disease, fibrotic changes,
fungal infections, telangectasia and bone resorption of the
mandible. The Committee encourages the NIDCR to increase its
research portfolio on scleroderma and to develop safe and
effective treatments and to identify the cause or causes of the
devastating complications of this disease.
NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES
Appropriations, 2003.................................... $1,722,730,000
Budget estimate, 2004................................... 1,820,007,000
Committee recommendation................................ 1,833,007,000
The Committee recommends an appropriation of $1,833,007,000
for the National Institute of Diabetes and Digestive and Kidney
Diseases [NIDDK]. The fiscal year 2003 appropriation was
$1,722,730,000 and the administration's request is
$1,820,007,000. The comparable amounts for the budget estimates
include funds to be transferred from the Office of AIDS
Research.
Mission.--The NIDDK provides leadership for a national
program in three major disease categories: diabetes,
endocrinology, and metabolic diseases; digestive diseases and
nutrition; and kidney, urologic, and hematologic diseases. The
NIDDK plans, conducts, fosters, and supports a coordinated
program of fundamental and clinical research and demonstration
projects relating to the causes, prevention, diagnosis, and
treatment of diseases within these categories. The Institute
also supports efforts to transfer the knowledge gained from its
research program to health professionals, patients, and the
general public.
Behavioral Research.--Diabetics who have co-occurring
depressive symptoms have less success managing their illnesses.
The Committee also notes that NIDDK's recent clinical trial,
the Diabetes Prevention Program, demonstrated that diet and
exercise could be more successful than medication alone in
preventing the development of diabetes in groups who faced a
high risk of diabetes. The NIDDK is strongly encouraged to
build upon its investment in behavioral research, particularly
in areas that would add to the science base on the maintenance
of positive behavior change.
Bladder Disease.--Bladder diseases and disorders are
diverse, prevalent, economically costly and increasing with the
aging of the American population. Collectively, bladder cancer,
urinary incontinence, interstitial cystitis, and urinary tract
infections affect over 40 million people, with severe negative
impact on work and life quality. These serious needs must be
met by a strong commitment to fund research concerning bladder
disease. The Committee was pleased by the publication of the
Bladder Research Review Group Document titled ``Overcoming
Bladder Disorders: A Strategic Plan for Research,'' and it
strongly urges the NIDDK to carry out the report's
recommendations.
Cooley's Anemia.--The Committee continues to support the
outstanding research being supported by NIDDK on such issues as
iron chelation, non-invasive iron measurement, fetal
hemoglobin, and other topics of importance to Cooley's anemia
patients. The development of a less burdensome method of iron
chelation, which currently involves a daily infusion of up to
12 hours, is desperately needed. In addition, NIDDK is urged to
continue its collaboration with NIBIB on imaging issues related
to iron measurement.
Cystic Fibrosis [CF].--Advances in the treatment of CF have
resulted in significant improvements in life expectancy for
individuals with CF. This progress can be attributed to strong
public and private sector investment in CF research, including
clinical trials evaluating a wide range of possible new
treatments. The panel strongly urges the NIDDK to continue its
support for CF researchers engaged in basic and clinical
research.
Diabetes in Native Hawaiians.--As the NIDDK develops
expanded plans for diabetes research, the Committee recommends
investigating the incidence in Native American, Hawaiian, and
Alaskan populations, as well as the Mississippi Band of the
Choctaw Indians and the Eastern Band of the Cherokee Indians.
Digestive Diseases.--Diseases of the digestive system
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 that result in tremendous human suffering
and economic cost. The Committee continues to encourage NIDDK
to expand this important program with an increased emphasis on
irritable bowel syndrome.
End-Stage Renal Disease.--Diabetes is the leading cause of
kidney failure and end-stage renal disease. The Committee urges
the NIDDK to expand research into early prevention and
therapeutic intervention of kidney disease to prevent end-stage
renal failure. It has been brought to the Committee's attention
that rural Native Hawaiians with end stage renal disease have a
particularly high rate of repeated infections. The Committee
strongly urges the NIDDK to increase research targeted to end
stage renal disease in the rural Native Hawaiian population.
Glomerular Injury Research.--The Committee is pleased with
NIDDK's glomerular injury research initiatives, including a
clinical trial for patients with focal segmental
glomerulosclerosis. The Committee understands that in addition
to the clinical trial, NIDDK is collaborating on a joint
research program with the NephCure Foundation to include basic
and genetic studies. Further, the Committee continues to
encourage NIDDK to consider initiating a scientific conference
on glomerular injury research, and to explore support for
gathering prevalence data on glomerular injury.
Hepatitis C in Children.--Recent studies indicate that 1 in
every 200 children over the age of 12 is infected with the
hepatitis C virus. The Committee urges the NIDDK, with
appropriate support from the NICHD, to study the natural
history of hepatitis C in infected children to help determine
the optimal timing and medical regimen for treatment.
Hepatitis C Consensus Development Conference.--The
Committee is aware of the Hepatitis C Consensus Development
Conference that occurred in June 2002 and made 17 specific and
high-priority research recommendations that need to be pursued
to develop better treatments and a cure for hepatitis. The
Committee also notes that the Consensus Conference recommended
the creation of a Hepatitis Clinical Research Network and urges
its organization at the earliest possible time. The Committee
requests a report by April 2004, with regards to the plans and
progress to address these specific research recommendations.
Hematology.--The Committee encourages NIDDK to sponsor a
conference of experts to develop a blueprint for further study
into the microvascular and thrombotic complications of
metabolic disease, such as limb ischemia, vision loss, and
renal failure.
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], and looks forward to
reviewing the forthcoming report from the Institute on IBD
research as requested in the fiscal year 2003 Senate Labor-HHS
committee report. The Committee commends NIDDK for its strong
leadership in this area and encourages the Institute to
increase funding for research focused on; (1) the cellular,
molecular and genetic structure of IBD, (2) identification of
the genes that determine susceptibility or resistance to IBD in
various patient subgroups, and (3) translation of basic
research findings into patient clinical trails 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 and increase
funding for its successful Digestive Disease Centers program
with an emphasis on IBD.
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. These common dysfunctions strike people from all walks
of life and result in significant human suffering and
disability. The Committee encourages NIDDK to provide adequate
funding for irritable bowel syndrome/functional bowel disorders
research and to give priority consideration to funding grants
that will continue to increase the IBS portfolio. The Committee
is also pleased that NIDDK is considering the development of a
strategic plan for IBS research.
Interstitial Cystitis [IC].--The Committee commends the
NIDDK for its recent investment in IC-specific basic science
research and continuation of the IC Clinical Trials Group.
However, the Committee is concerned about the current direction
of the epidemiology studies on pelvic pain of bladder origin
and IC currently being funded by the NIDDK. In fiscal year
2000, the Committee urged the NIDDK to undertake a
comprehensive epidemiology study of IC that would include
scientifically valid statistics of the incidence of the
disease, the demographics, occurrence in minority populations,
and the health care costs. The Committee is concerned that the
current studies will not adequately address these goals.
Therefore, the Committee urges the NIDDK to rectify any
shortcomings in the epidemiology effort, including funding
additional studies if necessary.
The Committee urges the NIDDK to pursue additional studies
on bladder epithelium, bladder afferent nerve cells, and
urinary markers of IC patients. In addition, the Committee
urges the NIDDK to work with the Interstitial Cystitis
Association to undertake a national IC awareness campaign aimed
at reducing the delay in diagnosing IC, which currently takes
an average of 5 to 7 years.
Juvenile Diabetes.--The Committee commends the NIDDK for
its development of the platform technologies of genomics and
proteomics to expand clinical research capability. The
Committee urges the Institute to continue the effort to remove
the most common barriers between laboratory discoveries and
clinical trials; this effort should include making available on
a competitive basis the resources for pre-clinical development
of drugs and therapies. The Committee applauds the NIDDK for
the launch of TrialNet, which establishes an infrastructure to
coordinate and support clinical trials dealing with the
preservation of pancreatic beta cell function to prevent
juvenile diabetes in high-risk individuals.
Metabolic Bone Disease.--The Committee urges NIDDK to
expand genetic research focusing on bone mass and functional
genomics to further disease prevention and treatment of
metabolic bone diseases. The Committee encourages NIDDK to
support further research into drugs and mechanisms that can
build better bone and comparison drug trials to determine best
treatments.
Mucopolysaccharidosis [MPS].--The Committee recognizes the
efforts made by the NIDDK to achieve a greater understanding
and pursue development of effective therapies for MPS
disorders. The Committee encourages continued investment in MPS
related research and is further encouraged to enhance
collaborative efforts with the NINDS, NICHD, and appropriate
institutes and centers involved in this crucial research,
including bone and joint involvement in MPS disorders and
pathophysiology of brain damage as they related to MPS
disorders.
Pediatric Kidney Disease.--Although significant strides
have been made in understanding kidney disease in adults, much
less is known about its complications in children, including
obstacles to full growth potential and neurocognitive
development. For this reason, the Committee is encouraged that
the NIDDK has solicited proposals for a prospective cohort
study of chronic kidney insufficiency in children and looks
forward to the implementation of this study. Given the long-
term implications when children reach adulthood, the Committee
continues to urge the NIDDK to undertake research into the
history and treatment of cardiovascular problems in children
suffering from chronic kidney disease, giving careful
consideration to (1) the role of hypertension, lipid
abnormalities, obesity, cardiovascular calcification, and
cardiac arrhythmia; and (2) neurocognitive and developmental
deficits including learning disabilities, with related issues
of chronic neurological, intellectual and emotional impairment;
poor linear growth; and abnormal bone formation. Funding for
ancillary studies to determine the pathophysiology of these
problems in children, including the ongoing clinical trial for
focal segmental glomerulosclerosis, should be supported in
order to develop new approaches to their treatment and
prevention.
Pediatric Liver Disease.--The Committee is pleased that the
NIDDK has taken steps to increase research on biliary atresia,
the most common cause of liver transplantation in children. The
Committee notes that metabolic causes of liver disease and non-
alcoholic steatohepatitis [NASH] are also significant causes of
liver disease in children. Therefore, it urges additional
research focused on these diseases and other forms of pediatric
liver disease.
Pediatric Liver Disease--National Database and Registry.--
The Committee is aware of a privately funded initiative which
that follows the natural history of infants and children who
receive liver transplants until they are 18 years of age. With
increased financial support, this national database and
registry could permit more adequate hypothesis testing and
outcomes research to determine both the health and financial
impact of liver transplants on the child and the child's
family. The Committee encourages NIDDK to favorably consider a
pediatric liver disease national database and registry.
PKD (Polycystic Kidney Disease).--The Committee anticipates
important scientific advances in this exciting field of
research resulting from the NIDDK sponsored International PKD
Strategic Planning Meeting in late fiscal year 2002.
Furthermore, the Committee is pleased the ``Halt PKD
Interventional Trials Network'' is beginning and will identify
therapeutic strategies to retard the progression of PKD, the
result of which will forestall kidney failure for PKD patients,
free up more than 3,000 spots on the kidney transplant waiting
list, save $2,000,000,000 annually in PKD-caused Medicare costs
for End-Stage Renal Disease, and alleviate pain, suffering, and
premature death for 600,000 American PKD patients. Likewise,
the Committee is gratified such novel discoveries as the recent
``abnormal fluid-flow sensation'' phenomenon, involving cilia
located PKD proteins, bodes well for developing drug therapies
to decrease abnormal cell growth in the PKD disease process.
Therefore, because of such extraordinary scientific momentum,
the Committee urges NIDDK to expeditiously implement the new
PKD Strategic Plan and thus intensify its efforts to find a
treatment and cure for PKD by establishing two additional PKD
Centers and by issuing RFA's to develop Surrogate Markers of
Disease Progression and for Testing Innovative Treatment
Strategies using knowledge based studies of pathophysiology and
cellular pathobiology.
Prostatitis.--The Committee recognizes the efforts of the
CPCRN (Chronic Prostatitis Collaborative Research Network)
funded by the NIDDK. The Committee encourages inclusion of more
diverse medical specialties to supplement and build upon the
background of basic information developed. The genetic and
molecular epidemiology, the management of pelvic pain, the
infectious origins and the symptoms identical to prostate
cancer need intense scrutiny.
The Committee encourages additional funding for educational
efforts aimed at reaching primary care physicians, the patients
and general public in an effort to prevent all prostatitis from
becoming chronic and removing the stigma many patients feel
after being diagnosed with a disease of unknown origin.
Scleroderma.--The Committee encourages the NIDDK to support
scleroderma relevant research. Scleroderma is a chronic and
progressive disease that predominantly strikes women. Many
patients have Gastrointestinal involvement include
gastroesophageal reflux disease, dysphagia, Barrette's
esophagus, gastroparesis, malabsorption, and fibrosis of the
small and large intestines.
Urinary Incontinence.--The Committee is pleased that the
NIDDK has developed the Urinary Incontinence Treatment Network
and urges increased funding for this important clinical
network. Recent studies have yielded gains in understanding
these conditions but the Committee is equally concerned that
more needs to be done with basic and translational research in
order to create better foundations for clinical care. The
Committee encourages the Institute to provide more resources to
investigator-initiated applications to ensure a self-sustaining
core of ongoing research and encourages a dedicated study
section in this area.
Urology Research.--NIDDK houses the urologic basic science
program. Despite significant increases in funding for the
Institute, the Committee remains concerned that the research
portfolio in urology is not keeping pace with the impact of
these diseases on women, men, and children.
The report of the Bladder Research Progress Review Group
outlines a strategic plan for research in this neglected area.
Bladder diseases, such at interstitial cystitis, urinary tract
infections, and urinary incontinence, disproportionately affect
women, and the Committee urges NIDDK to develop a comprehensive
program to address these and other urological needs of women.
This report identifies the considerable urologic
complications of diabetes. Until the epidemic of diabetes is
conquered, the incidence of these complications will only
increase. Significant resources have been directed to diabetes
research, but this area is underfunded. The Committee urges
that a cooperative program of research be developed by the
Division of Diabetes and the Urology program to address this
unmet need.
Related to this problem is the issue of obesity and
incontinence. This particularly affects minority women and
should be given priority in the Institute's plans for the
coming fiscal year. Incontinence is also a major cause of
nursing home admissions, yet little work is being done to
address the underlying causes. The Committee recommends that
the Institute initiate an effective program to examine the
causes and remedies for incontinence.
AIDS continues to be a significant health problem in this
country and worldwide. It is well established that the disease
is readily transmitted through sexual contact, yet no work has
been done to examine the specific role of semen in this
transmission. The Committee believes that a better
understanding of these fundamental issues could contribute
significantly to research for a vaccine and more effective
treatments.
Benign diseases of the prostate affect men of all ages.
While progress has been made, the Committee encourages the
Institute to develop a comprehensive initiative on basic
prostate biology that can lead to improved diagnosis and
treatment of diseases such as prostatitis and BPH.
Urologic problems in children are often the result of
congenital anomalies at birth. The Committee urges the
Institute to organize a pediatric urology review group to
identify the priority research needs in this area and to
formulate a research plan that addresses them.
Stone disease afflicts millions of Americans each year,
particularly in certain regions of the country. While effective
treatments are available, there is little understanding of ways
to prevent the formation of kidney stones. The Committee urges
NIDDK to work with the scientific community to formulate a
research plan to address prevention needs in this area.
The Committee has heard testimony on the decrease in the
number of physician investigators. This is a particular problem
in urology, and the Institute Director is encouraged to develop
training programs especially suited to the needs of urologic
residents and fellows who might be interested in research
careers if given the right kind of support.
NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE
Appropriations, 2003.................................... $1,456,476,000
Budget estimate, 2004................................... 1,468,926,000
Committee recommendation................................ 1,510,926,000
The Committee recommends an appropriation of $1,510,926,000
for the National Institute of Neurological Disorders and Stroke
[NINDS]. The fiscal year 2003 appropriation was $1,456,476,000
and the budget request is $1,468,926,000. The comparable
amounts for the budget estimates include funds to be
transferred from the office of AIDS research.
Mission.--The NINDS conducts and supports a broad range of
research and research training on the normal function of the
brain, spinal cord, and peripheral nerves, and on neurological
and neuromuscular disorders. Neurological research includes
epidemiology studies to identify risk factors for disease;
laboratory studies to examine the structure and function of
nerve cells; and brain imaging studies to understand how the
brain is affected by disease and how it operates to carry out
tasks such as learning and memory. New approaches for the
diagnosis, treatment, and prevention of brain disorders are
evaluated in studies with patients and those at risk for brain
disorders.
Alzheimer's Disease.--Research supported by NINDS continues
to play an integral role in widening the scientific base of
knowledge about Alzheimer's disease. NINDS is working closely
with NIA in the area of immunotherapy for Alzheimer's disease,
which can involve the production of antibodies that reduce the
cellular and behavioral effects of the disease. The Committee
encourages NINDS to continue to assign a high priority to its
Alzheimer's research portfolio, and to continue to work closely
with NIA and other institutes. The Committee urges the NINDS,
in collaboration with the NIA and NIMH, to expand its research
into early diagnosis of Alzheimer's using PET imaging of the
brain, and to share its results with the Centers for Medicare
and Medicaid Services.
Amyotrophic Lateral Sclerosis [ALS].--ALS, or ``Lou
Gehrig's disease,'' is one of a family of neurodegenerative
diseases that plague millions of Americans. The Committee is
pleased by the Institute's recent efforts to intensify its
research into ALS, and it commends NINDS on its multiple
initiatives involving high-throughput screening and assay
development to identify compounds with activity in
neurodegenerative orders, including ALS. The Committee
understands that The ALS Association has been involved as a co-
sponsor in some of these activities, and urges the Institute to
continue such productive partnerships in its efforts to
understand and develop treatments for ALS, which can lead to
possible prevention and treatment interventions for other
degenerative disorders.
The Committee is also pleased by the January 2003
scientific workshop on ALS that the NINDS held with the
Department of Veterans Affairs [VA]. The Committee encourages
the Institute's further collaboration with the VA in developing
an initiative to address the scientific questions and gaps in
the knowledge of ALS and motor neuron biology discussed at the
workshop. The Committee also encourages the NINDS to coordinate
and collaborate on ALS research with other appropriate NIH
Institutes, particularly the NIEHS, and to continue its
partnership with other organizations, as appropriate, to
advance ALS research.
Ataxia Telangiectasia [A-T].--A-T is a genetic disease that
attacks in early childhood. It progressively affects
coordination and severely compromises the immune system.
Children with A-T are highly likely to develop cancer, and
rarely live beyond their teens. The Committee encourages the
NINDS to work with the NCI and other appropriate Institutes to
support research aimed at understanding the underlying causes
of A-T with the goal of translating this basic research into
treatments for the disease.
Basic Behavioral and Treatment Research.--The Committee
applauds the NINDS for its broad support of both basic and
clinical behavioral research and training in such areas as the
neural bases of cognition and behavior, including sensation/
perception, attention, learning and memory, language, and other
higher cognitive processes. The Committee notes the importance
of integrating the research across multiple levels, including
molecular, genetic and behavioral. The Committee encourages the
NINDS to continue its support of imaging technologies to study
the neural bases of cognitive processes in real time, including
studies of language, face recognition, and decision-making
ability. The Committee appreciates that understanding the
deleterious effects of neurological disorders on cognition and
behavior will allow for the design of more effective treatment
and rehabilitation strategies including behavioral
interventions. The Committee encourages the NINDS to continue
supporting research on the cognitive and behavioral deficits
associated with epilepsy, autism, stroke, Parkinson's disease,
traumatic brain injury, migraine, and neurofibromatosis.
Batten Disease.--The Committee is once again disappointed
with the pace of research regarding Batten disease. The
Committee strongly urges the Institute to increase funding for
such research by actively soliciting grant applications for
Batten disease and taking aggressive steps to assure that a
vigorous research program is established. The Committee
requests the Institute to inform the Committee of the steps
taken to increase research on Batten disease.
Brain Tumors.--The Committee continues to be concerned that
not enough attention is being given by NINDS to identifying
causes of and treatments for brain tumors and encourages NINDS
to continue working with NCI to carry out the recommendations
of the Report of the Brain Tumor Progress Review Group.
Cognitive Neuroscience.--By encouraging research on higher
brain functions that underlie complex behaviors such as
learning, memory, attention, and cognition, the NINDS will
continue to unlock secrets not only on basic brain structure
and function, but also on neural activity associated with
specific cognitive processes. The Committee is interested in
seeing progress in this research.
Down Syndrome.--Down syndrome is caused by extra genetic
material on the 21st chromosome. It is the leading genetic
cause of mental retardation in humans. The Committee urges the
NINDS to increase funding for research of Down syndrome,
particularly as it relates to cognitive enhancement. The
Committee urges NINDS to coordinate these efforts with other
Institutes working on related activities, including NICHD, NIA,
NHGRI, and NIMH.
Dushenne Muscular Dystrophy.--The Committee commends NINDS
for initiating the muscular dystrophy cooperative research
centers. The Committee expects NINDS to work cooperatively with
NIAMS and NICHD to expand the scope and level of research
undertaken by the centers program.
Dystonia.--The Committee continues to support the expansion
of research and treatment developments regarding the
neurological movement disorder dystonia, given that dystonia is
the third most common movement disorder after tremor and
Parkinson's disease. The Committee encourages NINDS to support
additional research on both focal and generalized dystonia, and
commends NINDS for its study of the DYT1 gene and encourages
expansion in this research area. In addition, the Committee
requests NINDS be prepared to report on it at the fiscal year
2005 budget hearings.
The Committee commends NINDS for the recent release of the
joint dystonia research program announcement with other
institutes. The Committee encourages the institute to continue
its collaboration with the dystonia research community in
supporting epidemiological studies on dystonia and in
increasing public and professional awareness of this disorder.
Epilepsy.--The Committee encourages NINDS to expand its
research efforts into the prevention, treatment, and eventual
cure of epilepsy. In particular, the Committee urges the
Institute to focus on the critical research issues relating to
the 30 percent of patients with intractable epilepsy, the life-
long impact of seizures on young children, and the growing
incidence of epilepsy in the elderly. The Committee encourages
the Institute to continue its anti-epileptic drug development
program, including research on therapies for the large number
of people not responding to current treatments.
Juvenile Diabetes.--The Committee commends the NINDS for
its efforts to prevent and treat hypoglycemia and neuropathy,
both of which are serious complications of diabetes and
demonstrate accelerated development in individuals with
juvenile diabetes. The Committee encourages the NINDS to expand
its research in neuropathy and to consider establishing centers
specifically for the detection and prevention of this dangerous
complication of diabetes.
Learning Disabilities.--The Committee commends NINDS for
the work conducted to explore the neurological aspects of
learning disabilities. We look forward to learning the results
of this work and encourage the Institute to continue to
coordinate with other Institutes working on related activities.
Mucoploysaccharidosis [MPS].--The Committee is encouraged
by NINDS sponsorship of a scientific conference focusing on
central nervous system issues and the barriers to and
development of effective therapies for MPS disorders. The
Committee urges the NINDS to solicit investigator proposals
resulting from the findings of the conference. The Committee
further encourages the NINDS, in collaboration with the NIDDK
and the NICHD, to support current MPS research, study the blood
brain barrier as an impediment to treatment and use all
available mechanisms to further stimulate and enhance efforts
to better understand and treat MPS disorders.
Neurofibromatosis.--Advances in NF research have linked NF
to cancer, brain tumors, learning disabilities and heart
disease. Because NF regulates both the RAS and cAMP pathways
relating to cell growth and cognition, NF plays a pivotal role
both in disorders of the brain and in cancer. The enormous
promise of NF research is now reaching fruition in the testing
of potential therapies. Therefore, the Committee encourages
NINDS to expand its NF clinical and basic research portfolios
through clinical trials, RFAs, and other funding mechanisms to
accelerate and exploit the tremendous progress in NF research.
The Committee commends NINDS for its leadership role in NF
research and in coordinating efforts with other Institutes
engaged in NF research and encourages the NINDS to work in
partnership with the NF research community, including patient
advocacy groups, in identifying and pursuing scientific
opportunities that will ultimately allow for the development of
effective treatments for NF.
Pick's Disease.--The Committee urges the NINDS in
conjunction with NIA to increase research efforts on Pick's
Disease and other frontotemporal dementias. The Committee
further urges the Institutes to consult with researchers,
clinicians, and patient advocates and report to the Committee
on progress being made in this field of research.
Spinal Muscular Atrophy.--Spinal Muscular Atrophy [SMA] is
the most common genetic killer of infants and toddlers and is
the most prevalent genetic motor neuron disease. While there is
currently no cure for the disease, the research outlook is
promising. Researchers have already identified the genes
involved in SMA as well as compounds that may lead to potential
treatments. The Committee understands that the severity of the
disease, its relatively high incidence, and the possibility of
imminent treatments have led NINDS to select SMA as a model for
a new approach to funding translational research. The Committee
strongly endorses that plan. The Committee urges NIH/NINDS to
equip the program and the personnel charged with executing the
plan with appropriate authoritative and financial resources to
maximize the chances of success.
In addition, the Committee strongly urges the Institute to
increase funding for basic and translation SMA research by
aggressively soliciting grant applications. The Committee
encourages the Institute to employ existing mechanisms such as
websites, publications, workshops, and conferences to promote
awareness of funding opportunities. In addition, the Committee
encourages the Institute to further develop opportunities for
upcoming clinical trials and to help make available all ongoing
patient care options. Lastly, the Institute is encouraged to
work with other Institutes and Federal agencies to develop
formal programs that increase public and professional awareness
of the disease.
The Committee requests that NIH report back to the
Committee, no later than April 2004 with a progress report on
all aspects of SMA translational research.
Stroke.--The Committee commends the NINDS for convening a
Stroke Progress Review Group. The Group's report identifies
critical gaps in stroke knowledge and outlines 5 research
priorities and 7 resource priorities. The Committee urges the
Institute to implement the priorities of the Progress Review
Group.
Tremor.--The Committee has been made aware of the very
common condition of essential tremor affecting millions of
Americans and causing significant physical and social
disability. Its case and underlying pathological basis is
unknown. Very little basic or clinical research on this
disorder is currently being undertaken. It appears that new
research such as technical imaging and chemical analysis may
offer promise in shedding light on this mysterious and common
disorder. The Committee was pleased to learn that NINDS
supports a tissue bank for essential tremor and the Committee
looks forward to learning of the Institute's assessment of
research opportunity and of progress through expansion of other
relevant research efforts.
NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES
Appropriations, 2003.................................... $3,706,139,000
Budget estimate, 2004................................... 4,335,255,000
Committee recommendation................................ 4,335,255,000
The Committee recommends an appropriation of $4,335,255,000
for the National Institute of Allergy and Infectious Diseases
[NIAID]. This is same as the budget request. The fiscal year
2003 appropriation was $3,706,139,000. Included in these funds
is $150,000,000 to be transferred to the Global Fund to Fight
HIV/AIDS, Malaria, and Tuberculosis. The comparable amounts for
the budget estimate include funds to be transferred from the
Office of AIDS Research.
Mission.--The NIAID is the lead NIH Institute charged with
developing vaccines and supporting research on allergies,
acquired immunodeficiency syndrome [AIDS], sexually transmitted
diseases, turberculosis, tropical diseases, and other
infectious diseases--including those likely to be used as
agents of bioterrorism. To accomplish this mission, the NIAID
supports and conducts basic and clinical research and research
training programs in infectious diseases, whether they are
naturally occurring or the result of a bioterrorist attack, and
in diseases caused by, or associated with, disorders of the
immune system.
Adverse Reactions to Smallpox Vaccine.--The Committee is
pleased that the NIAID has focused considerable attention on
research efforts aimed at reducing adverse reactions to the
smallpox vaccine. The Committee understands that the risk of
adverse reactions is particularly high in individuals who have
or have experienced atopic dermatitis. Given the high incidence
of atopic dermatitis among the growing number of Americans with
asthma and allergies, the potential for adverse reactions to
the smallpox vaccine is a major concern. The Committee is
pleased that the NIAID has undertaken a major initiative in
this area, the Atopic Dermatitis and Vaccinia Immunization
Network. The Committee believes that NIAID should take
additional steps to encourage investigator-initiated research
to complement this effort.
AIDS in the Soviet Union.--The Committee notes that Russia
and other countries of the former Soviet Union are experiencing
the highest growth of HIV infections in the world today. The
Committee also notes that these countries hold tremendous
scientific capacity. The Committee encourages the Institute to
seek opportunities to increase collaborative research between
the United States and countries of the former Soviet Union the
area of HIV/AIDS research, utilizing organizations that
facilitate and support scientific collaboration as appropriate,
to maximize the impact of scientific discovery.
Asthma Research and SARS.--The Committee encourages the
NIAID to continue its outstanding efforts in the area of asthma
research. Clearly, research in this area is closely related to
that undertaken by the NIAID with respect to Severe Acute
Respiratory Syndrome [SARS]. The therapies currently used to
treat SARS are commonly used to treat complications of asthma.
The Committee urges the NIAID to engage the asthma research
community in efforts related to SARS so that knowledge gained
from studies of immune reaction to viruses in the lung among
asthma patients can be applied.
Asthma Research and Management.--The Committee is very
pleased with NIAID's leadership regarding asthma research and
management. The Committee recognizes the role the Institute has
played in the Inner City Asthma Study and the importance of
this effort concerning morbidity and mortality among
underserved populations, particularly children. The Committee
urges NIAID to continue to improve its focus and effort on
asthma management, especially as it relates to children. The
Committee also urges the NIAID to collaborate more aggressively
with voluntary health organizations to support asthma
prevention, treatment, and research activities. Additionally,
recent studies suggest that a variety of viral and bacterial
agents, including agents used for immunization may play a role
in the development of asthma. The Committee urges the Institute
to expand research into the role that infections and vaccines
may play in the development of asthma.
Autoimmune Disease Prevention and Treatment.--The Committee
commends the NIAID for implementing a new model for clinical
research. The Autoimmunity Centers of Excellence support an
integrated basic and clinical research program focused on
approaches for the treatment or prevention of immune-mediated
diseases like Type 1 diabetes, rheumatoid arthritis, and
multiple sclerosis. The involvement of clinical specialists in
planning, performance, and evaluation of trials and studies
should lead to a more coordinated approach to the development
of new immune-based therapies for all autoimmune diseases as
well as accelerate the translation of basic advances to the
clinic.
Hemophilia.--The Committee is supportive of NIAID's efforts
with the National Hemophilia Foundation to ensure access for
persons with hemophilia to clinical trials for improving
treatment of HIV and complications of hemophilia, including
hepatitis C [HCV]. The Committee urges the Institute to
continue its efforts related to research on liver disease
progression and response to HCV treatment among HIV/HCV co-
infected persons with hemophilia.
Hepatitis.--The Committee urges NIAID to work with public
health organizations to promote liver wellness, education, and
prevention of hepatitis.
Hepatitis C Vaccine.--The Committee notes the slow progress
towards the development of a vaccine to prevent infection from
the Hepatitis C virus and urges the Institute to redouble its
efforts in this regard. The Committee requests a report by
April, 2004 reporting on progress made to date to develop a
hepatitis C vaccine and a discussion of future plans, including
and the most promising avenues of research that are needed to
meet the goal of developing a hepatitis C vaccine.
Kidney and Islet Transplantation.--The Committee commends
the NIAID for its leadership role in the evaluation of
strategies to achieve tolerance in the context of kidney and
islet transplantation. These two areas of investigation hold
significant promise for moving research into the clinical
setting.
Primary Immunodeficiencies Diseases.--The Committee notes
that more than 70 primary immune deficiency diseases have been
identified to date. These diseases, which impair the body's
immune system, strike most severely at children, many of whom
do not survive beyond their teens or early twenties. The
Committee commends NIAID for the establishment of its Primary
Immunodeficiency Disease Research Consortium. As part of this
new initiative, the Committee encourages the Institute to
provide adequate support for primary immune deficiency
research, clinical registries, and a repository for biomedical
specimens. Finally, the Committee encourages NIAID to work
closely with the primary immune deficiency patient community on
this promising new program.
The Committee remains concerned that research into
biodefense concerning smallpox vaccination focus on the
identification of immunodeficient patients. Undiagnosed
patients are at risk of suffering serious adverse reactions to
such live vaccinations. One means for NIAID to address this
issue of under-diagnosis is through active participation in the
Jeffrey Modell Foundation's national physician education and
public awareness campaign for primary immunodeficiencies.
Radiological Exposure.--The Committee urges the Institute
to increase research to identify and develop effective
countermeasures to acute nuclear and radiological exposure.
This is in keeping with the Institute's lead role in
identifying and developing countermeasures to chemical,
biological and nuclear and radiological threats. The Committee
is aware of research being carried out at the Armed Forces
Radiobiology Research Institute [AFRRI], including its leading
radioprotectant candidate, 5-androstenediol, and encourages the
Institute to work with AFRRI in this critical effort.
Tuberculosis.--Tuberculosis continues to account for more
deaths worldwide than any other infectious disease and for over
a quarter of all preventable adult deaths. The Committee
commends NIAID for its aggressive program of tuberculosis
research, and encourages greater emphasis on tuberculosis
vaccine development, as noted by the NIAID developed Blueprint
for Tuberculosis Vaccine Development.
NATIONAL INSTITUTE OF GENERAL MEDICAL SCIENCES
Appropriations, 2003.................................... $1,847,000,000
Budget estimate, 2004................................... 1,923,133,000
Committee recommendation................................ 1,917,033,000
The Committee recommendation includes $1,917,033,000 for
the National Institute of General Medical Sciences [NIGMS]. The
fiscal year 2003 appropriation was $1,847,000,000 and the
administration's request is $1,923,133,000. The comparable
amounts for the budget estimate include funds to be transferred
from the Office of AIDS Research.
Mission.--NIGMS supports research and research training in
the basic biomedical sciences. Institute grantees, working in
such fields as cell biology, biophysics, genetics,
developmental biology, pharmacology, physiology, biological
chemistry, bioinformatics, and computational biology, study
normal biological processes to better understand what goes
wrong when disease occurs. In this way, NIGMS supplies the new
knowledge, theories, and technologies that can then be applied
to the disease-targeted studies supported by other NIH
components. NIGMS-supported basic research advances also
regularly find applications in the biotechnology and
pharmaceutical industries. The Institute's training programs
help provide the scientists needed by industry and academia to
maintain United States leadership in biomedical science.
Behavioral Research.--The Committee believes that NIGMS has
a scientific mandate to support basic behavioral research
because of the clear relevance of fundamental behavioral
factors to a variety of diseases and health conditions. The
Committee encourages the NIGMS to incorporate basic behavioral
research as part of its portfolio, especially in the areas of
cognition, behavioral neuroscience, behavioral genetics,
psychophysiology, methodology and evaluation, and experimental
psychology.
Minority Science Training Programs.--The Committee
continues to be pleased with the quality of NIGMS's training
programs, particularly those that have a special focus on
increasing the number of minority scientists such as the
Minority Access to Research Careers [MARC] and Minority
Biomedical Research Support [MBRS] programs. The Committee
expects NIGMS to continue to support these important
initiatives, and is particularly pleased that NIGMS has
supported biomedical career opportunity programs for high
school and undergraduate college students in conjunction with
historically black health professions schools. The Committee
urges continued, long-term support of this program.
Pharmacogenetics Research Network.--The Committee commends
NIGMS for its vision in creating the Pharmacogenetics Research
Network to address the genetic bases for differences in
patients' reactions to medications. Development of a deeper
understanding of how genetics influences whether treatments
work, don't work, or cause moderate or severe side effects is
critical. This is an emerging field that will lead to a
personalized approach to medicine. The Committee urges NIGMS to
continue to develop and expand this field further with a strong
emphasis on studying drug metabolism variation and treatment
response in those disease states that affect large numbers of
Americans, such as diabetes, mental illness and others.
Pre-Disease Pathways.--The Committee encourages the NIGMS
to collaborate with other Institutes, including NCI and NIMH,
and the Office of Behavioral and Social Sciences Research to
fund research to integrate physiological knowledge of pre-
disease pathways with behavioral studies.
NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT
Appropriations, 2003.................................... $1,205,927,000
Budget estimate, 2004................................... 1,245,371,000
Committee recommendation................................ 1,251,185,000
The Committee recommends an appropriation of $1,251,185,000
for the National Institute of Child Health and Human
Development [NICHD]. The fiscal year 2003 appropriation was
$1,205,927,000 and the administration's request is
$1,245,371,000. The comparable amounts for the budget estimate
include funds to be transferred from the Office of AIDS
Research.
Mission.--The NICHD is that component of the NIH which is
responsible for conducting and supporting research on maternal
and child health, the population sciences, and medical
rehabilitation. Research encompassed by these areas targets
infant mortality; genetic diseases, including birth defects;
mental retardation; gynecological health and contraceptive
development and evaluation; pediatric, maternal, and adolescent
AIDS; developmental biology; vaccine development; demographic
and behavioral research; and restoration or enhancement of
function in individuals experiencing physical disability due to
injury, disease, or birth defect.
Behavioral Science.--The Committee supports the NICHD's
efforts to determine the biological, behavioral, and social
factors that affect child development, particularly the
important role of family structure and fathers in child
development. The Committee is particularly concerned about
rising rates of childhood obesity and supports continued
initiatives to promote healthy behaviors in children and
adolescents and prevent health risk behaviors.
Bleeding Disorders.--The Committee expects the Institute to
work collaboratively with the National Hemophilia Foundation to
address issues related to neonatal intracranial hemorrhage and
pediatric complications of bleeding disorders, including
medical, psychosocial, and quality-of-life issues.
Cognition and Learning.--The Committee applauds NICHD's new
program in Mathematics and Science Cognition and Learning,
aimed at supporting scientifically based approaches to
improving the understanding of normal development and obstacles
to learning in these domains. Discovering the causes of
difficulties and disorders of learning in these areas will be
of considerable importance for developing strategies to improve
diagnosis and treatment of specific learning disabilities and
for designing more effective instructional interventions in
mathematics and science.
Down Syndrome.--Down syndrome is the most common genetic
cause of mental retardation. The Committee strongly encourages
NICHD to place a high priority on researching the causes and
treatment of Down syndrome and to increase funding for research
in the areas of cognitive enhancement and the early onset of
dementia. The Committee further urges NICHD to increase funding
for the production of the Ts65Dn mouse, which is used
extensively in the research of Down syndrome and Alzheimer's
disease. Current funding for the production of this mouse
strain is inadequate to produce the quantity of mice needed for
current research.
Demographic Research.--The Committee commends NICHD for its
outstanding support of demographic research. This research has
consistently provided critical scientific knowledge supporting
efforts to strengthen and empower American families through
sound public policy. Recent findings related to the effects of
maternal employment and paternal involvement on the development
of children are particularly noteworthy. The Committee
encourages NICHD to continue to invest necessary resources in
maintaining the databases that make these studies possible,
while strengthening research on the causes of trends in family
stability. Continued and adequate support for training and
infrastructure funding is necessary to sustain demographic
research on these topics and on other critical issues,
including the causes of immigration and population movement,
the impact of immigration on the American people, adolescent
health, and disparities in health among different groups within
our population.
Drug Safety for Children.--The Committee recognizes the
importance of ensuring that drugs are safe and effective for
use by children. The Committee urges the Institute to implement
the provisions of the Best Pharmaceuticals for Children Act of
2003 (Public Law 107-109) which supports the pediatric testing
of off-patent drugs, as well as on-patent drugs not being
studied through existing mechanisms. In implementing this
provision, the National Institute of Child Health and Human
Development should act as coordinator for all other Institutes
within NIH for which pediatric pharmacological drug research
may have therapeutic relevance and will consult with the Food
and Drug Administration. The Committee requests NIH to provide
an update during its annual appropriations testimony. This
update shall include 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; and the number of drugs
remaining on the priority list established through section
409I.
Duchenne Muscular Dystrophy.--The Committee commends the
Institute for initiating the muscular dystrophy cooperative
research centers. The Committee expects NICHD to work
cooperative with NIAMS and NINDS to expand the scope and level
of research undertaken by the centers program.
Fragile X Research Coordination Conferences.--To facilitate
effective coordination of research on Fragile X and related
disorders, the Committee strongly urges NICHD to regularly
convene and conduct a state-of-the-science conference on
Fragile X research and further urges the NICHD to continue to
hold Fragile X Research Coordination Conferences at least once
every 3 years or more frequently if warranted by scientific
advancement. Investigators conducting research on Fragile X and
related fields who are funded by the NIH, as well as other
researchers as appropriate, should be invited to attend and
participate in these conferences. The Committee expects the
first Fragile X Coordination Conference shall be held in 2004.
Fragile X Research Coordination Reports.--Within 6 months
after each Fragile X Research Coordination Conference is held,
the Director of the NICHD shall issue a report on the state-of-
the-science of research on Fragile X and include summaries of
Fragile X and related research being supported by NIH
Institutes and Centers, as well as plans for future Fragile X
research.
Hepatitis C in Children.--The Committee is aware that
recent studies have indicated that 1 in every 300-400 children
over the age of 12 is infected with the hepatitis C virus. The
Committee urges NIDDK, with appropriate support from NICHD, to
study the natural history of hepatitis C in infected children
to help determine the optimal timing and medical regimen for
treatment.
Infertility and Contraceptive Research.--The Committee
continues to place high priority on research to combat
infertility and speed the development of improved
contraceptives. The NICHD is urged to continue aggressive
activities in this area, including grants for individual
researchers and for infertility and contraceptive research
centers.
Juvenile Diabetes.--NICHD is encouraged to work closely
with NIDDK on the continued development of Trial Net, which was
recommended by the 1999 Congressionally-mandated Diabetes
Research Working Group to coordinate and support clinical
trials in diabetes with the ultimate goal of preventing
juvenile diabetes in high risk individuals.
Learning Disabilities.--The Committee is pleased that NICHD
continues to place high priority on learning disabilities
research. The efforts to address the special needs of children
affected by a learning disability and improve literacy are
showing promising results. The Committee encourages NICHD to
continue to focus on reading disability and mathematics
development research. Additionally, the Committee urges NICHD
to lead an effort to collaborate on research efforts with other
Institutes working on related activities. The Committee
encourages cooperation in areas where work can be shared across
Institutes on behalf of individuals with learning disabilities.
Living Donor Liver Transplants.--The Committee is aware
that more than 1,774 people died over the past year waiting for
a liver transplant due to a lack of a donor liver. As of March
6, 2003 there were almost 16,934 on the list waiting for a
liver transplant. In view of the continuing shortage of livers
available for transplantation, the Committee is pleased with
the award in the past year of funding for a study of adult-to-
adult living donor liver transplants which will compare
outcomes of living donor transplants to cadaver transplants.
The Committee urges additional research that would facilitate
the success of a living donor liver transplant and the number
of livers available for transplantation.
Maternal-Fetal Medicine Network [MFMU].--The Committee
recognizes the outstanding contributions of the Maternal-Fetal
Medicine Network [MFMU] in addressing clinical questions
related to the care and treatment of high risk and complicated
pregnancies. By studying large numbers of patients, the Network
has demonstrated that it offers the most effective and cost-
efficient way to study high-risk conditions. However, the
Committee is concerned that additional funds are needed in
order for the Network to continue to make progress in these
issues of concern to the health of women and their babies.
Therefore, the Committee urges the NICHD to expand its support
of the Network and to provide increased funds to continue to
address these important research questions, with an emphasis on
issues pertaining to pre-term births and low birth weight
deliveries.
National Children's Study.--The Committee strongly supports
full and timely implementation of the National Children's
Study. This study aims to quantify the impacts of environmental
influences, including physical, chemical, biological and social
influences, on child health and development. The Committee
urges the Director of the NICHD to continue to closely
coordinate with the CDC, EPA, other Institutes and agencies and
non-Federal partners conducting research on children's
environmental health and development, such that this study is
ready for the field by no later than 2005. To that end, in
fiscal year 2004, the Committee expects the Director of NICHD
to increase support for study planning, administration, and
initial pilots that will provide the information necessary to
develop and implement the full national study.
National Center for Medical Rehabilitation Research.--The
National Center for Medical Rehabilitation Research supports
research grants, training, centers and clinical trials in
medical rehabilitation to improve the function of persons with
physical disability and is the focal point within NIH for this
field of science. Recent initiatives have involved efforts to
expand the use of assistive technology by persons with
disabilities and clinical research to determine improved
outcomes of care for persons with Traumatic Brain Injury,
stroke, hip fracture and limb loss. The Committee encourages
the Institute and NCMRR to continue its focus on assistive
technology, clinical trials and other research on improved
outcomes. The Committee would also encourage the Institute and
NCMRR to review needs and plan to expand medical rehabilitation
research to improve outcomes for trauma victims.
Neurofibromatosis.--Learning disabilities occur with high
frequency (30-65 percent) in children with NF and in
approximately 5 percent of the entire world's population.
Enormous advances have been made in NF research in just the
past year unlocking the mysteries of how the NF gene is related
to learning disabilities which significantly advances the
prospects of finding a treatment for learning disabilities not
only in children with NF but in the general population as well.
The Committee urges the Institute to consider the progress
being made in NF research, expand the NF research portfolio and
to identify possible areas for collaboration.
Osteogenesis Imperfecta.--The Committee understands that
research is urgently needed into quantification of bone mass
and its biomechanical properties in children, and the
relationship of diet and exercise and comorbid conditions to
bone health. A greater understanding of the genetic and other
determinants of peak bone mass will help children with
Osteogenesis Imperfecta [OI], osteopetrosis, etc. The Committee
encourages NICHD to expand OI research in genetic therapies,
animal models, drug treatment and rehabilitation.
Pediatric Kidney Disease.--Kidney disease remains a
persistent and little-understood problem among infants,
children, and adolescents. The NICHD is strongly urged to
undertake research to identify factors responsible for poor
linear growth, abnormal bone formation and cognitive deficits
in children; epidemiological studies designed to quantify the
magnitude of the problem and identify which kidney diseases
present the highest risk; and initiatives aimed at maximizing
the academic potential of children with kidney disease.
Pediatric Liver Disease.--The Committee notes the
Institute's limited involvement in issues relating to pediatric
liver disease and urges the Institute to initiate research in
this area and collaborate with NIDDK on these efforts. For
example, the Committee notes the lack of involvement of NICHD
to support the collaborative network of centers established to
gather data and study specific hypothesis of the cause and
treatment of Biliary Atresia. The Committee would also
encourage NICHD to cooperate with NIDDK on research questions
relating to optimal timing and medical treatment regimens for
children infected with the hepatitis C and the need to support
a database and registry to track the outcome of children who
receive liver transplants.
Pre-term Labor and Delivery.--Pre-term labor and delivery
is the number one problem in obstetrics today and a serious
problem in pediatrics. It is the leading cause of neonatal
mortality, and many babies born prematurely have serious
physical and mental disabilities, such as cerebral palsy,
mental retardation, chronic lung disease, and vision and
hearing loss, that last a lifetime. Prematurity is also a
growing problem. The Committee strongly urges NICHD to allocate
more funds to reveal the underlying causes of pre-term delivery
and most importantly to identify prevention strategies.
Primary Immunodeficiencies Diseases.--The Committee
continues to be impressed with the commitment the NICHD has
shown to addressing PI, through its close partnership with the
Jeffrey Modell Foundation's efforts to raise the awareness of
PI and to identify undiagnosed patients. With the availability
of cutting-edge microarray technologies, the Committee strongly
encourages the NICHD to identify specific molecular biomarkers,
improve diagnostic methodologies, and develop newborn screening
procedures for PI. Rapid, cost-effective, and accurate
molecular screening procedures and strategies for PI that are
incorporated into a universal newborn screening program will
significantly enhance the early identification, treatment, and
management of PI patients. This will help reduce the morbidity
and mortality of affected children, improving their health and
well-being. The Committee strongly encourages NICHD to bring
together the stakeholders in newborn screening to assess
comprehensively the scientific, legal, social and ethical
issues associated with such screening.
Scleroderma.--The Committee encourages the NIDDK to support
scleroderma relevant research. Scleroderma is a chronic and
progressive disease that predominantly strikes women. It is
estimated that 90 percent of patients with systemic sclerosis
have Gastrointestinal [GI] involvement and of that number 50
percent have clinically significant manifestations. GI
involvement can manifest as gastroesophageal reflux disease,
dysphagia, Barrette's esophagus, gastroparesis, ``watermelon
stomach'', malabsorption, and fibrosis of the small and large
intestines. Renal Crisis affects 20 percent of those with
systemic sclerosis often within the first 5 years after
diagnosis. More research is critically needed in order to
develop safe and effective treatments and to identify the cause
or causes of the devastating complications of scleroderma.
Spina Bifida.--The Committee is pleased that the Institute
cosponsored the Spina Bifida Research Conference in May 2003.
However the Committee has concerns that, without adequate
follow-up, the conference findings and recommendations will not
come to fruition. NICHD is encouraged to enhance research to
address issues related to the outcome of the conference and
urged to significantly expand its research efforts in the
prevention and treatment of Spina Bifida and associated
secondary conditions.
Sudden Infant Death Syndrome.--The Committee is pleased
with NICHD's continued efforts to extend the reach of its
extremely successful ``Back to Sleep'' campaign to underserved
populations and daycare providers. The Committee also commends
NICHD's attempts to further its progress in SIDS research by
initiating a third SIDS 5-year research plan. This third 5-year
plan will continue the efforts of the past two 5-year plans,
which have been responsible for many of the research
breakthroughs in the effort to reduce SIDS cases in the United
States. The Committee requests that this 5-year plan be re-
examined to determine the appropriateness and scientific
validity of including research on stillbirth and miscarriage as
components of the plan.
Traumatic Brain Injury [TBI].--The Committee commends the
NICHD and the National Center for Medical Rehabilitation
Research for their efforts in establishing a TBI clinical
trials network to investigate the efficacy of rehabilitation
services for TBI victims. The Committee continues to support
research by the Center to investigate methods of improving
decision-making functions and related cognitive skills of TBI
victims.
Urogynecology Program.--Urinary incontinence and other
pelvic floor disorders serve as barriers to healthy living. The
Committee commends the NICHD for developing the Pelvic Floor
Disorder Network [PFDNO] and expects additional resources will
enable the network to excel in the quality and integrity of
clinical and basic scientific research in the field of
urogynecology. The Committee is pleased that the NICHD
continues to collaborate with the NIDDK in developing research
of urinary incontinence. Recent studies have yielded gains in
understanding these conditions but the Committee is equally
concerned that more needs to be done with basic and
translational research in order to create better foundations
for clinical care. The Committee encourages the Institute to
provide more research to investigator-initiated applications to
ensure a self-sustaining core of ongoing research and
encourages a dedicated study section in this area.
Vulvodynia.--Preliminary new research indicates that
millions of American women suffer from vulvodynia, a painful
and often debilitating disorder of the female reproductive
system. Despite its prevalence, inadequate attention has been
paid to the disorder by health professionals or researchers.
Since fiscal year 1998, the Committee has called on the NICHD
to support research on the prevalence, causes and treatment of
vulvodynia. While some initial steps have been taken, more must
be done. Therefore, the Committee expects the Institute to
provide a significant increase in funding for vulvodynia.
NATIONAL EYE INSTITUTE
Appropriations, 2003.................................... $633,148,000
Budget estimate, 2004................................... 648,299,000
Committee recommendation................................ 657,199,000
The Committee recommends an appropriation of $657,199,000
for the National Eye Institute [NEI]. The budget request was
$648,299,000 and the fiscal year 2003 appropriation was
$633,148,000. The comparable amounts for the budget estimate
include funds to be transferred from the Office of AIDS
Research.
Mission.--The NEI is the Nation's Federal resource for the
conduct and support of laboratory and clinical research,
research training, and other programs with respect to blinding
eye diseases, visual disorders, mechanisms of visual function,
preservation of sight, and the special health problems and
needs of individuals who are visually impaired or blind. In
addition, the NEI is responsible for the dissemination of
information, specifically public and professional education
programs aimed at the prevention of blindness.
Diabetic Retinopathy.--Diabetic retinopathy is a
potentially blinding complication of diabetes characterized by
the uncontrolled growth of fragile new blood vessels in the
retina that may leak fluid and blood threatening vision. It is
the leading cause of new cases of blindness in working age
adults in this country. Macular edema secondary to diabetic
retinopathy is also a major cause of visual loss in patients
with diabetes. The Committee is pleased with NEI's initiative
to develop a clinical research network that will accelerate the
evaluation of promising new approaches to treated eye and
vision-related complications of diabetes.
Degenerative Eye Diseases.--Scientists have linked a gene
on the X chromosome that is normally associated with a form of
retinitis pigmentosa that causes a blinding loss of
photoreceptor cells with a unique type of cone photoreceptor
cell degeneration of the macula. The macula is the part of the
retina responsible for sharp central vision. This type of study
in affected families may help understand the mechanism of
damage in other forms of macular degeneration and may help
prevent or more effectively treat these diseases. The Committee
urges NEI to continue this important line of research
extramurally and through the revitalization of its intramural
research on neurodegenerative and genetic forms of vision loss.
Glaucoma.--The Committee is pleased to learn of the
significant advances made in clinical research on glaucoma. The
Ocular Hypertension Treatment Study demonstrated that eye drops
used to treat elevated pressure inside the eye can be effective
in delaying the onset of glaucoma in patients at higher risk
for development of the disease. The Early Manifest Glaucoma
Trial showed that immediate therapy to lower elevated
intraocular pressure in patients with newly detected open angle
glaucoma delayed and reduced the frequency of progression. Both
studies underscore the need for early treatment of high
intraocular pressure to slow or prevent glaucoma damage and
subsequent vision loss until the means to prevent the disease
itself can be discovered. In this regard, the Committee
commends NEI for hosting a workshop on the pathophysiology of
ganglion cell and optic nerve degeneration as a means of
stimulating new approaches to the study of glaucoma and other
neurodegenerative diseases of the eye.
Health Disparities.--Scientists conducting a population-
based study in Mexican Americans in Arizona reported that the
prevalence of open-angle glaucoma was intermediate between the
high rates reported for African Americans and the lower rates
reported for whites. However, only 38 percent were aware they
had the disease. The Committee encourages NEI to expand its
glaucoma awareness activities to increase awareness of the
importance of glaucoma diagnosis and treatment in the Mexican
American population so that timely treatment can be provided
and vision can be preserved.
Intramural Research Program.--The Committee commends NEI's
efforts to revitalize its intramural research program to pursue
new research opportunities related to neurodegenerative and
genetic forms of vision loss and other complex human eye
diseases. The Committee urges that the NIH allocate required
space and positions as soon as possible, so that these new
opportunities for research can be translated for the benefit of
those afflicted with blinding eye diseases.
Neurofibromatosis.--Neurofibromatosis [NF] is a
neurological disorder that is linked to a variety of other
serious medical conditions. It has no known cure or prevention.
NF can manifest itself in one of two forms known as NF1 and
NF2. Among its possible effects are tumors of the optic nerves
which may cause bulging of the eye or visual difficulties. The
Committee encourages the Institute to expand its research
portfolio in collaboration with the NF community to address
issues that may be of mutual interest and benefit.
Ocular Albinism.--Ocular albinism is a set of diseases and
conditions characterized by deficient cellular production of
the pigment melanin that results in a cosmetic loss of ocular
and skin pigmentation. Importantly, ocular albinism limits the
development of vision in infants and children by altering the
connections between the brain and the eye. The Committee
recognizes NEI's efforts to encourage research in this
important area through the issuance of requests for
applications and funding of several grants during fiscal year
2002 and additional new grants in fiscal year 2003. The
Committee encourages the Institute to continue its efforts to
ensure continued progress toward understanding the causes of
this disease.
NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES
Appropriations, 2003.................................... $614,239,000
Budget estimate, 2004................................... 630,774,000
Committee recommendation................................ 637,074,000
The Committee recommends an appropriation of $637,074,000
for the National Institute of Environmental Health Sciences
[NIEHS]. The budget request was $630,774,000 and the fiscal
year 2003 appropriation was $614,239,000. The comparable
amounts for the budget estimate include funds to be transferred
from the Office of AIDS Research.
Mission.--The mission of the NIEHS is to define how
environmental exposures affect health; how individuals differ
in their susceptibility to these effects; and how these
susceptibilities change with time. This knowledge, coupled with
prevention and communication programs, can lead to a reduction
in environmentally associated diseases and dysfunctions.
Alternative Methods.--In order for the Interagency
Coordinating Committee for the Validation of Alternative
Methods [ICCVAM] to carry out its responsibilities under the
ICCVAM Authorization Act, the Committee urges the NIEHS to
increase the resources for ICCVAM's activities in order to
ensure that new and alternative test methods used or
recommended to Federal regulatory agencies, and those used
within the National Toxicology Program's [NTP's] toxicity
testing program, are validated prior to their use.
Breast Cancer.--The Committee commends the NIEHS for its
recent efforts to bolster research on the relationship between
the environment and breast cancer. The Committee urges the
Institute to establish a group of breast cancer and
environmental research advisers to make recommendations to the
Director with regard to research in this area, and to include
in the group representatives from the breast cancer community
who have had breast cancer. The Committee also encourages the
NIEHS to consider establishing centers to conduct multi-
disciplinary and multi-institution research on environmental
factors that may be related to breast cancer and to develop a
national strategy to address this issue.
Children's Health.--The Committee is pleased that the
NIEHS, in collaboration with the EPA, is supporting eight
children's health centers focused on the role that
environmental factors play in asthma and other respiratory
disorders. The Committee urges the NIEHS, in continued
collaboration with EPA, to support additional Centers of
Excellence with a focus on disease endpoints in children.
Environmental Health Sciences Centers.--The Committee
continues to strongly support the Environmental Health Sciences
Centers program, and it believes that a fully funded Centers
program is critical to carrying out the expanding mission of
the NIEHS. The Committee expects these Centers to be funded at
peer-reviewed levels.
Volcanic Emissions.--The Committee continues to be very
concerned about the public health aspects of volcanic emissions
in Hawaii. Such emissions present significant acute and long-
term health problems, and the Committee urges the development
of a multidisciplinary approach to this problem.
NATIONAL INSTITUTE ON AGING
Appropriations, 2003.................................... $993,598,000
Budget estimate, 2004................................... 994,411,000
Committee recommendation................................ 1,031,411,000
The Committee recommendation includes $1,031,411,000 for
the National Institute on Aging [NIA]. The budget request was
$994,411,000 and the fiscal year 2003 appropriation was
$993,598,000. The comparable amounts for the budget estimate
include funds to be transferred from the Office of AIDS
Research.
Mission.--The NIA conducts biomedical, behavioral, and
social research related to the aging process to prevent disease
and other problems of the aged, and to maintain the health and
independence of older Americans. Research in aging over the
last two decades demonstrates that aging should not be equated
with inevitable decline and disease.
Alzheimer's Disease.--An estimated 4.5 million Americans--
almost all of whom are Medicare beneficiaries--suffer from
Alzheimer's disease. Their complex health and long-term care
needs are driving Medicare and Medicaid costs to unsustainable
levels--even though 70 percent of care is provided by families.
Within 10 years, annual Medicare costs for beneficiaries with
Alzheimer's will increase by 55 percent--to nearly
$55,000,000,000; Medicaid costs will go up 80 percent to nearly
$33,000,000,000. That will happen just as baby boomers begin to
enter the age of risk. By the middle of the century, as many as
16 million Americans will have Alzheimer's--neither Federal,
State, nor family budgets can sustain the costs. The Committee
several years ago first drew attention to the challenges
presented by Alzheimer's. As a result, science is now at the
point where effective treatment and prevention of Alzheimer's
are within reach. But there is a very narrow window of time.
Scientists are now focusing on catching the disease process
early, in the 10 to 20 years before clinical symptoms become
apparent. Scientists believe that an investment of
$1,000,000,000 as soon as possible will produce the answers
necessary to conquer Alzheimer's. The Committee expects the NIA
to expand its investment in Alzheimer's disease research,
including clinical trials for the rapid translation of
laboratory findings to effective treatments and prevention, as
well as new initiatives in imaging and genetics aimed at
finding risk factors and surrogate markers.
Bone Diseases.--The Committee recognizes that little is
known about the pathophysiology of osteoporosis and Paget's
disease and the role of environmental and lifestyle factors
associated with these diseases, particularly in men and women
of diverse races and ethnicities. Tools to assess risk have
inadequate sensitivity and specificity and have not been widely
tested, resulting in limited clinical effectiveness. The
Committee urges NIA to expand research in all these areas. The
Committee also encourages NIA to coordinate research with NIAMS
into treatment for aging-related osteogenesis imperfecta
complications.
Claude D. Pepper Older American Independence Centers.--The
Committee continues to strongly support these successful
centers, which focus on developing innovative and cost-
effective ways to enhance the independence of older Americans.
The centers also play the critical role of developing top-level
experts in geriatrics. The Committee again urges NIA to make
all possible efforts to expand these centers to include a
school of nursing.
Cognitive Behavioral Research.--The Committee commends the
NIA for its research program to explore the research
recommendations in the National Academy of Sciences report
``The Aging Mind.'' The Committee encourages the NIA to
continue its own work, as well as cooperative efforts with
other Institutes, to add to fundamental and applied knowledge
of how the memory works and may be enhanced, and how age or
behavior may affect memory.
Demographic and Economic Research.--The Committee once
again commends the NIA for its demography and economic
research, with special recognition of the research undertaken
at NIA's 11 demographic research centers. The Committee also
strongly recommends that NIA provide increased funding for
these Centers to sustain their productivity and efficiency. The
Committee is impressed by the findings from NIA's Health and
Retirement Study [HRS] which provide important policy
information necessary to evaluate the costs of alternative
options. The Committee supports funding for a diverse body of
analytic research on HRS findings so that as a Nation, we might
better understand the timing of retirement, the transition from
full-time work, and the social, as well as the economic
consequences of retirement. Tracking research on the decline in
disability continues to be a high priority for the Committee.
Down Syndrome.--Research has shown that people with Down
syndrome have an increased risk of developing Alzheimer's
disease. Approximately 50 percent of individuals with Down
syndrome over the age of 35 will develop the clinical signs and
symptoms of Alzheimer's type dementia. All persons with Down
syndrome will develop the neuropathology of Alzheimer's
disease, even if they do not demonstrate dementia. Research
into the process by which Alzheimer's disease evolves in
persons with Down syndrome affords the opportunity to
understand an important link between development and aging in
all individuals. The Committee urges NIA to expand its research
into the connection between Down syndrome and Alzheimer's
disease.
Health and Behavior.--The Committee commends the NIA for
its continuing focus on behaviors that may enhance healthy
aging, especially research on physical activity among sedentary
or frail elderly. The Committee encourages the NIA to continue
efforts, through the Roybal Centers for Applied Gerontology and
other means, to move innovative behavioral interventions into
health care and other settings where they may be applied.
Hematology.--The Committee encourages NIA to develop new
initiatives to study the basic biology of blood disorders that
affect the elderly population, such as myelodysplastic
syndromes and anemias, and the adverse quality-of-life
consequences for the elderly who suffer from these disorders.
NATIONAL INSTITUTE OF ARTHRITIS AND MUSCULOSKELETAL AND SKIN DISEASES
Appropriations, 2003.................................... $486,143,000
Budget estimate, 2004................................... 502,778,000
Committee recommendation................................ 505,000,000
The Committee recommends an appropriation of $505,000,000
for the National Institute of Arthritis and Musculoskeletal and
Skin Diseases [NIAMS]. The budget requested $502,778,000 and
the fiscal year 2003 appropriation was $486,143,000. The
comparable amounts for the budget estimate include funds to be
transferred from the Office of AIDS Research.
Mission.--NIAMS conducts and supports basic and clinical
research and research training, and the dissemination of health
information on the more than 100 forms of arthritis;
osteoporosis and other bone diseases; muscle biology and muscle
diseases; orthopedic disorders, such as back pain and sports
injuries; and numerous skin diseases. The research agenda of
NIAMS addresses many devastating and debilitating diseases that
afflict millions of Americans. These diseases of the joints,
muscles, bones, connective tissues, and skin, in the aggregate,
will affect nearly every American at some point in their lives,
causing tremendous human suffering and costing the Nation
billions of dollars in both health care and lost productivity.
The research activities of this Institute serve the concerns of
many different special populations, including women,
minorities, children, and the elderly.
Bone and Cartilage Diseases.--The Committee urges NIAMS to
explore new avenues for cell- and gene-based therapies for the
treatment of bone and cartilage diseases, such as osteoporosis,
Paget's disease, and osteogenesis imperfecta. Identifying new
targets for enhancing bone formation and blocking bone
destruction should be a major focus, with studies that
integrate basic and clinical approaches regarding bone forming
cell development.
Duchenne/Becker Muscular Dystrophy.--The Committee notes
that Duchenne Muscular Dystrophy [DMD] and its milder form
Becker Muscular Dystrophy [BMD] are the most common, lethal
genetic childhood disorders known to humankind. The Committee
acknowledges that through NIH-sponsored research in 1987 the
dystrophin gene which causes DMD/BMD was discovered and each
day an average of two boys in the United States die from this
disorder. Moreover, the Committee notes that 14 years later,
there is still no effective treatment for this disease. The
Committee further acknowledges that the Muscular Dystrophy
Childhood Assistance, Research and Education Act [MD CARE ACT]
of 2001 established Muscular Dystrophy as a research priority
for the Department and NIH. The Committee requests that the
Department provide a report to Congress by April 2004, on the
implementation of the MD CARE ACT, outlining efforts to
establish an interagency committee within NIH in order to
expand opportunities for collaborative efforts, identify
Centers of Excellence through NIH, and coordination with the
Center for Disease Control [CDC]. The Committee is interested
to learn of the implementation of the proposed ``Scientific
Research Resource Cores'' within the Centers of Excellence,
their potential to coordinate and facilitate muscular dystrophy
research nation-wide, and how clinical trials are being
facilitated through these new initiatives. The report to
Congress should address all efforts by coordinating institutes,
any initiatives or programs announced in muscle research, and
efforts by the Center for Scientific Review [CSR] to create a
temporary Skeletal Muscle Biology [SMB] Special Emphasis Panel.
Additionally, the Committee is aware of the lack of information
regarding the overall economic burden for the Nation of muscle
diseases and injuries, as well as the lack of reliable data on
how many individuals in the United States are affected by these
diseases. The Committee, therefore, expects the NIAMS, in
conjunction with other PHS components, including NINDS, NCHA,
CDC, AHRQ, and HRSA, to sponsor a workshop to identify existing
information sources on the costs and scope of muscle diseases
and injuries, including Duchenne and other muscular
dystrophies, and to recommend strategies for developing new
information sources. The Institute is encouraged to work with
muscle diseases researchers and voluntary health organizations
to plan the workshop. The Committee urges the Director to
provide additional resources to expand the research and
establish at least four centers of excellence in this area and
to work collaboratively with private research foundations to
coordinate research findings. The Committee also expects NIAMS
to work with NINDS to expand the scope and level of research
undertaken by the Centers program. The Committee further
expects NIAMS to fund translational research to further
treatment for this devastating disease.
Lupus.--Lupus is a widespread, debilitating autoimmune
disease that affects up to 2 million Americans, most of whom
are women in their late teens to early 40s. Lupus is the
prototypical autoimmune disease that causes the immune system
to become hyperactive and attack the body's own tissue. The
disease can damage vital organs resulting in disability or
death. Lupus and autoimmune diseases are the fourth leading
cause of disability in women. Gaining an understanding of the
factors associated with the high prevalence of lupus in women
and minorities and the development of new and innovative
treatments should be a high priority. There are five areas in
which targeted research will yield important new insights:
susceptibility, pathogenesis, inflammation and damage, clinical
assessment and therapy. The Committee urges the Institute to
provide the highest possible funding level for lupus research
and explore all possible scientific opportunities for
prevention, treatment and cure of this devastating disease.
Neurofibromatosis.--Neurofibromatosis [NF] is a common
genetic disorder of the nervous system. Its symptoms vary in
kind and degree and may be severely disabling, mildly
disfiguring, or can even go undetected. Some individuals with
NF have many skin neurofibromas (tumors on the nerves) on the
face and body and light brown (cafe-au-lait) spots on the skin.
A variety of skeletal abnormalities may also be present such as
bowing of the legs, curvature of the spine (scoliosis), or
thinning of the shin bone. The Committee requests that NIAMS
work in partnership with the NF community to identify and
explore areas of mutual concern and to be prepared to discuss
its progress at the fiscal year 2005 appropriations hearing.
Pemphigus Registry.--The Committee urges NIAMS to establish
a National Pemphigus Registry to identify the epidemiology,
improve the understanding of the potential causes, and assess
the value of old and new therapies for the chronic, life-
threatening autoimmune disease know as pemphigus.
Scleroderma.--The Committee is encouraged by NIAMS's
growing interest in scleroderma, a chronic and progressive
disease that predominantly strikes women. Scleroderma is
disfiguring and can be life-threatening and effective
treatments are lacking. More research is critically needed in
order to identify the genetic risk factors for scleroderma and
to develop safe and effective treatments. The Committee urges
NIAMS to collaborate with other Institutes, including NHLBI,
NIDDK, and NIDCR, to generate additional research opportunities
for scleroderma.
Skin Disease.--The Committee was pleased to learn that the
NIAMS conducted a workshop on the ``Burden of Skin Diseases.''
The Committee encourages NIAMS to examine the findings from the
workshop and encourages the development of new tools to better
measure the burden of skin diseases, and the training of
researchers in this important area. The Committee further
encourages NIAMS to move forward expeditiously to generate the
required data in collaboration with Centers for Disease Control
and Prevention [CDC], Agency for Health Care Policy and
Research [AHCPR], Health Resources and Services Administration
[HRSA], as well as all other agencies and organizations which
participated in the conference.
NATIONAL INSTITUTE ON DEAFNESS AND OTHER COMMUNICATION DISORDERS
Appropriations, 2003.................................... $370,382,000
Budget estimate, 2004................................... 380,377,000
Committee recommendation................................ 384,577,000
The Committee recommends an appropriation of $384,577,000
for the National Institute on Deafness and Other Communication
Disorders [NIDCD]. The budget requested $380,377,000 and the
fiscal year 2003 appropriation was $370,382,000. The comparable
amounts for the budget estimate include funds to be transferred
from the Office of AIDS Research.
Mission.--The NIDCD funds and conducts research and
research training in the normal and disordered processes of
human communication, specifically in the areas of hearing,
balance, smell, taste, voice, speech, and language. The
Institute addresses the special biomedical and behavioral
problems of people who have communication impairments or
disorders; contributes to health promotion and disease
prevention; and supports efforts to create devices that
substitute for lost and impaired sensory and communication
functions.
Animal Models of Hearing Loss.--It is now clear that
peripheral hearing loss leads to profound changes in the
central nervous system, including cell death and loss of
synapse function. The Committee encourages research to focus on
animal models of conductive and senorineural hearing loss,
particularly the induced changes in brain physiology that
result from deafness during development. Understanding the
brain structure and function of deaf individuals is essential
to proper implementation of ameliorative strategies such as
hearing aid and cochlear implants.
Aphasia.--It has come to the Committee's attention that the
state of the science for aphasia, a common and devastating
acquired speech and language disorder, has gone virtually
unchanged for decades. Based upon previous direction, the NIH
recently hosted a symposium to discuss some of the current
issues surrounding aphasia. The Committee applauds these
initial efforts. However, the Committee also recognizes that
decades of insufficient research have resulted in numerous
shortcomings in the areas of aphasia research, standards of
care, rehabilitation and treatments. The Committee, therefore,
urges a coordinated cross-functional effort involving the NIH,
specifically NINCD, NIDCD, and NINDS, as well as other
appropriate Federal healthcare agencies, specifically AHRQ,
HRSA, and CMS, to address these concerns regarding aphasia.
Clinical Evaluation of Hearing Loss.--The Committee
realizes that the rapid advances in brain imaging should be
used to dramatically improve our understanding of the central
nervous system changes that attend hearing loss. These
approaches will necessarily extend to atypical language
development and the communication disorders experienced by
geriatric populations.
Dysphonia.--The Committee continues to be pleased with
NIDCD's expanding intramural research program with respect to
dysphonia. The Committee commends NIDCD on the release of a
joint program announcement with NINDS, which will lead to a
more active extramural research effort on dysphonia, and
collaboration with other NIH Institutes on this important
disorder.
Early Detection and Intervention.--It is now clear that
early treatment of hearing loss is essential for normal
language acquisition. The Committee notes that there are many
children who develop progressive hearing impairment in the
first few years of life, which emphasizes the need for
screening every baby born in the United States for hearing
impairment before discharge from the hospital. Therefore, the
Committee supports expanded research on the early detection,
diagnosis, and intervention of infants with deafness and other
communication disorders. This should include exploring the role
of intrauterine exposure to cytomegalovirus [CMV] in
progressive hearing impairment. It is also critical to
recognize that otitis media, or middle ear infection, is among
the most frequent reasons for a sick child to visit the doctor
within the first few years of life. The use of antibiotics to
treat this disorder is resulting in more strains of bacteria
that cause otitis media to be resistant to first and second
line antibiotics. We encourage NIDCD to explore alternative
ways to either treat or prevent otitis media, which exacts an
estimated public health burden of about $5,000,000,000 a year
in the United States.
Environmentally-induced Hearing Loss.--The Committee
continues to be concerned by the number of Americans who suffer
from chemical- and noise-induced hearing loss. The NIDCD's Wise
Ears! Campaign is making significant inroads towards educating
Americans of all ages, and the Committee strongly supports its
expansion amongst school-age children. The Committee also
supports expanded research on prosthetic and pharmacological
therapies for hearing loss from noise stress, ototoxic drugs
and other environmental traumas.
Hair Cell Regeneration.--The Committee urges NIDCD to
continue to give a high priority to new and important
directions for inner ear hair cell regeneration in mammals,
specifically in the use of gene therapy to restore hair cells
in the cochlea with adenovirus vectors and in the development
of stem cells to re-grow hair cells of the inner ear.
Hearing Devices.--The Committee encourages the NIDCD to
expand research that would improve the benefits of cochlear
prostheses and improve remediation of less-than-profound
hearing loss through hearing aids and/or new prostheses and
drug-delivery systems. We also encourage investigation into the
incidence of meningitis in children with specific cochlea
implant protocols.
Hereditary Hearing Loss.--The Committee applauds the
remarkable progress towards understanding the molecular basis
for hereditary hearing impairment. We encourage a sustained
effort to screen for the single and multigenetic basis of
hearing loss through contemporary techniques, including the
development of diagnostic genechips for auditory dysfunction.
We also encourage the development of animal models to better
assess at the level of structure and function how gene mutation
results in impaired central auditory function.
Language Acquisition.--The Committee encourages the NIDCD
to explore the biological bases of infant speech perception and
language acquisition. This should include studies on the impact
of partial or profound hearing loss.
Learning Disabilities.--The Committee is pleased that NIDCD
continues to support research activities focused on speech
processing and on the development of expressive and receptive
language. The Committee encourages continued activity and looks
forward to learning the results of this work as they hold
significant promise for individuals with learning disabilities.
The Committee encourages the Institute to continue to
coordinate with other Institutes working on related activities.
Neurofibromatosis.--Neurofibromatosis [NF] is the most
common neurological disorder caused by a single gene. It may
result in hearing loss, ringing in the ears, dizziness, balance
problems, headaches, or seizures. Early removal of small
auditory nerve tumors sometimes helps to preserve hearing.
Diagnostic magnetic resonance imaging [MRI] techniques have
improved early diagnosis of tumors. The Committee urges the
Institute to expand its research portfolio in collaboration
with the NF community to address issues that are relevant to
deafness and other communication problems associated with NF2.
Research is now being conducted to cure deafness in NF2
mice through gene therapy, with enormous implications for gene
therapy in general and for patients suffering from meningiomas
and other tumors in particular. The Committee therefore
encourages NIDCD to expand its NF2 research portfolio through
all suitable mechanisms including RFAs and clinical trials.
Presbycusis.--Presbycusis, the gradual loss of hearing from
aging, will become more common as the Nation's population grows
older. The Committee encourages research on the central and
peripheral mechanisms leading to presbycustic hearing loss and
on strategies that would prevent hearing loss in our senior
population. Studies should be undertaken to study the mechanism
underlying the premature cell death that results in many forms
of presbycusis so as to develop prevention and cure strategies.
Tinnitus.--The Committee encourages the Institute to expand
its research into mechanisms underlying peripheral and central
tinnitus.
NATIONAL INSTITUTE OF NURSING RESEARCH
Appropriations, 2003.................................... $130,584,000
Budget estimate, 2004................................... 134,579,000
Committee recommendation................................ 135,579,000
The Committee recommends an appropriation of $135,579,000
for the National Institute of Nursing Research [NINR]. The
budget request was $134,579,000 and the fiscal year 2003
appropriation was $130,584,000. The comparable amounts for the
budget estimate include funds to be transferred from the Office
of AIDS Research.
Mission.--The National Institute of Nursing Research [NINR]
supports clinical and basic research on biological and
behavioral aspects of critical national health problems. The
Institute's programs have established a scientific basis for
research that seeks to reduce the burden of acute and chronic
illness and disability for individuals of all ages; improve the
quality of life by preventing and delaying the onset of disease
or slowing its progression; and establishing better approaches
to promoting health and preventing disease. The NINR supports
programs essential to improving clinical environments by
testing interventions which influence patient health outcomes
and reduce costs and demands for care.
Alzheimer's Disease.--The Committee is pleased that NINR
has stepped up its research both on Alzheimer's patients and
those who care for them. For example, a nursing research study
is now underway comparing four interventions designed for
families coping with the effects of Alzheimer's disease and
related disorders. Two home-based and two community-based
interventions are being assessed according to the physical and
psychological well-being of the caregiver and the cognitive/
behavioral functioning and well-being of the person receiving
the care. Future findings promise valuable information for
nursing, social work and other health disciplines about each
intervention's usefulness for particular situations.
Adolescent Risk Behavior.--The Committee commends the
NINR's research in adolescent risk behavior. Recognizing that
many such behaviors are intertwined, the focus of NINR's
initiative is on developing interventions that target several
risk behaviors simultaneously. Increased understanding of
factors that facilitate healthy lifestyle behaviors as well as
the modification of risky behaviors will reduce the
consequences associated with these risks.
Collaboration With NIMH.--The Committee commends the
mentorship program established by the NINR in collaboration
with the NIMH to prepare mental health nurse scientists. The
Committee urges the NINR to continue to partner with NIMH and
psychiatric nursing to build the capacity to address research
questions in treating psychiatric populations that correlate to
enhanced patient care; and to include improving nursing care
for individuals with co-existing medical and mental illnesses
in priority areas for funding research. Such interventions are
crucial given the high prevalence of mental illness, the burden
of mental disorders on patients and their families, and the
critical role assumed by nurses in providing psychiatric
services in diverse settings and systems of care.
End-of-Life Research.--The Committee continues to strongly
support NINR's leadership in coordinating end-of-life research
at NIH. Expansion of the NINR research portfolio to include
children at the end of life is a groundbreaking research
initiative in an area that has not received the attention that
it deserves.
Genetics and Nursing Research.--NINR's efforts in genetics
emphasize the integration of genetics into nursing research,
practice, and education. The NINR Summer Genetics Institute,
which provides an 8-week intensive genetics research training
program each year, is a key component of the effort to increase
genetic expertise within the nursing knowledge base and
healthcare practice.
Health of Minority Men.--NINR is urged to continue its
successful research in promoting the health of minority men who
have a reduced life expectancy compared to women. Research on
effective health promotion strategies such as smoking
cessation, nutrition, physical activity, and increase
management of stress are critical to improving and extending
the life cycle of minority men.
Minority Health Disparities.--The Committee commends NINR
for its support of research to reduce disparities in the health
of minority populations and is pleased that this will receive
continued emphasis. It is important to reduce the rate of low
birth weight for babies of minority women, which can be 50
percent higher than for white women. NINR's focus on early
identification of risk factors and chronic diseases during
pregnancy and on health promotion for pregnant minority women
will be important to lower the unacceptably high number of low
birth weight babies in this country.
Nursing Interventions for Psychiatric Populations.--The
Committee commends the mentorship program established by NINR
in collaboration with the National Institute of Mental Health
[NIMH] to prepare mental health nurse scientists. The Committee
urges NINR to continue to partner with NIMH and with
psychiatric nursing to: (1) build the capacity to address
research questions in treating psychiatric populations, and (2)
stimulate research that develops and tests interventions for
individuals with co-existing medical and mental illnesses. Such
interventions are crucial given the high prevalence of mental
illness, the burden of mental disorders on patients and their
families, and the critical role assumed by nurses in providing
psychiatric services in diverse settings and systems of care.
Nursing Shortage.--NINR is to be commended for its forward-
thinking investment in research training as a way to address
the nursing shortage. Training support for fast-track
baccalaureate-to-doctoral program participants is one important
initiative. The 17 recently funded Nursing Partnership Centers
to Reduce Health Disparities are another initiative that helps
produce an adequate number of nurse researchers and future
faculty. Not only will these partnerships between research-
intensive schools of nursing and minority serving university
schools of nursing train more minority nurses, but they also
expand health disparities research.
Self-Management of Chronic Illness.--Self-management is
becoming a significant approach to living with illness because
it enhances the ability to retain the highest quality of life
possible. The Committee is pleased that NINR is taking new
approaches in its research on self-management of chronic
illnesses that tailors interventions to diverse and vulnerable
populations. Results from studies of technological advances
that aid self-management, such as technologies that allow
monitoring indices of illness at home, are an important adjunct
to self-management strategies.
NATIONAL INSTITUTE ON ALCOHOL ABUSE AND ALCOHOLISM
Appropriations, 2003.................................... $416,051,000
Budget estimate, 2004................................... 430,121,000
Committee recommendation................................ 431,521,000
The Committee recommends an appropriation of $431,521,000
for the National Institute on Alcohol Abuse and Alcoholism
[NIAAA]. The budget request was $430,121,000 and the fiscal
year 2003 ppropriation was $416,051,000. The comparable amounts
for the budget estimate include funds to be transferred from
the Office of AIDS Research.
Mission.--The NIAAA conducts biomedical and behavioral
research for improving prevention and treatment and reducing or
eliminating the associated health, economic, and social
consequences of alcohol abuse and alcoholism. NIAAA provides
leadership in the country's effort to combat these problems by
developing new knowledge that will decrease the incidence and
prevalence of alcohol abuse and alcoholism and associated
morbidity and mortality. NIAAA addresses these questions
through an integrated program of biomedical, behavioral, and
epidemiologic research on alcoholism, alcohol abuse, and
related problems. This broad-based program includes various
areas of special emphasis such as medications development,
fetal alcohol syndrome, genetics, neuroscience, and moderate
drinking.
Alaska Alcohol and Substance Abuse.--The Committee is aware
of serious problems with alcohol and substance abuse in Alaska,
especially among its Alaska Native population and of the need
for translating research into clinical applications for this
population. The Committee urges NIAAA to sponsor a Research to
Practice Forum with the Substance Abuse and Mental Health
Services Administration to focus on bridging the gap between
researchers and practitioners and translating scientific
research into clinical applications, and encourages NIAAA to
support the implementation of any recommendations developed at
the forum.
Alcoholic Liver Disease.--Alcoholic liver disease remains a
major cause of morbidity and mortality in the United States.
The Committee notes that recent research suggests that free
radicals are a principal vehicle through which alcohol damages
the liver, and that antioxidants look increasingly promising as
a potential treatment. The Committee encourages the Institute
to expand its research on alcoholic liver disease, particularly
regarding the interaction between hepatitis C and alcohol in
liver disease.
Behavioral Genetics of Alcoholism.--Genes and the proteins
they produce are key players in the biochemical and molecular
processes that contribute to development of alcoholism.
Identifying variations in them that predispose people to
alcohol-use disorders will contribute essential information to
design of prevention and treatment strategies. Because only
half of the risk of alcoholism appears to be genetic, it is
also critical to examine gene-environment interactions. The
Committee recognizes the value of large longitudinal,
multidisciplinary studies used to identify these risk factors
and determine how they interact with each other to result in
alcohol-use disorders. The Committee recommends that NIAAA
continue its important twin and family genetic studies, broad
epidemiological studies, and observational studies that might
help elucidate the relationship between genetic and
environmental factors particularly in cultural and ethnic
minorities.
Behavioral Treatments.--Behavioral, nonpharmacological
therapies currently are the most widely used method of treating
alcohol dependence and alcohol abuse. The Committee applauds
NIAAA's efforts to advance the effectiveness of such therapies
by examining approaches to improving clinicians' abilities to
engage and retain adults and adolescents in treatment. The
Committee recommends that NIAAA expand research to understand
the mechanisms of action of successful behavioral therapies as
well as behavioral therapies for patients with co-occurring
substance abuse and psychiatric disorders. Further, the
Committee recognizes the value of NIAAA's substantial
medications development program and research to evaluate the
use of new medications in combination with behavioral therapies
to sustain recovery.
Health Disparities.--Evidence suggests that alcohol affects
genders and subpopulations differently, and that some groups
suffer more adverse effects than others. The Committee
encourages the Institute to work collaboratively with the NCMHD
to study the role of gender, ethnicity, socioeconomic status,
and other variables in determining the effects of alcohol use
and abuse.
Medications Development for Alcoholism Treatment.--The
Committee urges the Institute to encourage studies on the
influence of psychological and social factors on the success of
treatment, and develop new medications for the treatment of
alcoholism and alcohol-related disorders.
Multidisciplinary Research on Fetal Alcohol Syndrome.--The
Committee recognizes that fetal alcohol syndrome is among the
most common preventable cause of mental impairment. The
Committee supports the Institute's efforts to understand the
biological mechanisms through which alcohol causes damage to
the developing fetus. The Committee continues to urge the
Institute to aggressively pursue research that will lead to
effective strategies for the prevention and treatment of fetal
alcohol syndrome.
NATIONAL INSTITUTE ON DRUG ABUSE
Appropriations, 2003.................................... $961,721,000
Budget estimate, 2004................................... 995,614,000
Committee recommendation................................ 997,614,000
The Committee recommends an appropriation of $997,614,000
for the National Institute on Drug Abuse [NIDA], the same as
budget request. The fiscal year 2003 appropriation was
$961,721,000. The comparable numbers for the budget estimate
include funds to be transferred from the Office of AIDS
Research.
Mission.--Created in 1974, NIDA supports about 85 percent
of the world's biomedical research in the area of drug abuse
and addiction. The Committee commends NIDA for demonstrating
through research that drug use is a preventable behavior and
that addiction is a treatable disease. NIDA's basic research
plays a fundamental role in furthering knowledge about the ways
in which drugs act on the brain to produce dependence, and
contributes to understanding how the brain works. In addition,
NIDA research identifies the most effective pharmacological and
behavioral drug abuse treatments. NIDA conducts research on the
nature and extent of drug abuse in the United States and
monitors drug abuse trends nationwide to provide information
for planning both prevention and treatment services. An
important component of NIDA's mission is also to study the
outcomes, effectiveness, and cost benefits of drug abuse
services delivered in a variety of settings and to assure
dissemination of information with respect to prevention of drug
abuse and treatment of drug abusers.
Adolescent Decision Making and Drug Abuse.--The Committee
recognizes that the scientific understanding gained by the
support of behavioral and cognitive research will lead to
improved treatment and prevention of drug abuse and addiction.
The Committee encourages NIDA to support more research on
adolescent decision making, including the cognitive, behavioral
and social processes involved in initiating and continuing drug
use.
Asian Americans and Pacific Islanders.--The Committee notes
that there is a lack of relevant research and culturally
competent service programs to address the increased incidence
of substance use and abuse among Asian American and Pacific
Islander youth and adults. The Committee urges the Director of
NIH and the Administrator of SAMHSA to increase their
collaborative efforts to address the critical need for
substance abuse research regarding these populations.
Drug Abuse and HIV Interventions.--Women, youth, and
minorities account for a growing proportion of new AIDS cases
in the United States, and increasing numbers of cases are
emerging in rural and smaller urban areas. Therefore, the
Committee encourages NIDA to support research to develop and
test developmentally and contextually appropriate drug abuse-
related HIV prevention interventions or intervention components
to reach the broad youth population.
Homeless Populations and Drug Abuse.--The Committee
recognizes that homeless adults and youth have disproportionate
rates of drug use disorders. The Committee encourages NIDA to
accelerate more research on homeless populations, especially
those that suffer from alcohol, drug abuse and/or mental
disorders, and their ability to access services and treatment.
Information Dissemination.--The Committee urges NIDA to use
both the existing National Drug Abuse Treatment Clinical Trials
Network infrastructure and the new prevention infrastructures
that are currently being established as part of NIDA's new
Prevention Research Initiative, to ensure that findings are put
into practice in communities across the country. The Committee
is pleased that NIDA and SAMHSA/CSAP are already having
discussions to make this a reality.
Methamphetamine Abuse.--The Committee continues to be
concerned with the rate of methamphetamine abuse across the
Nation. The problem is especially acute in Iowa and other
Midwestern States. The Committee again urges NIDA to expand its
research on improved methods of prevention and treatment of
methamphetamine abuse.
New Targets for Medications Development.--The Committee is
pleased that NIDA research continues to lead to new discoveries
about the brain. Recent advances have revealed new targets for
medications development. The Committee urges NIDA to continue
to support this important research to unravel the complexity of
the brain and identify new systems, molecules, proteins, and
genes that can be useful in developing new and better
medications to treat drug abuse and addiction.
Prevention Research.--The Committee is pleased that NIDA
has launched a multi-component National Prevention Research
Initiative that will involve partners at the State and local
levels. The committee urges NIDA to expand this initiative to
test the effectiveness of new and existing science-based
prevention approaches in different communities, while also
identifying the core components of effective drug abuse
prevention, so that they can be easily adapted to meet local
needs.
Relapse.--The Committee encourages NIDA to continue its
support of behavioral research that can further our
understanding about the underlying cognitive, emotional, and
behavioral factors that lead to drug abuse relapses.
Stress.--The Committee encourages NIDA to continue to
explore the effects of stress and its relationship on the
initiation of drug use and the role that stress plays in
triggering relapse to drug use. Such research may lead to
development of more effective prevention and treatment,
particularly for those who suffer from mental disorders as well
as substance abuse.
Tobacco Addiction.--The Committee recognizes the central
role that NIDA research has played in paving the way for
developing effective treatments for addiction to nicotine. The
Committee is pleased with NIDA's participation with other NIH
Institutes in activities to more rapidly translate tobacco
addiction research into new treatments. The Committee urges
NIDA to accelerate its efforts in these areas, particularly
research that focuses on prevention of adolescents from
starting to smoke.
Translational Research.--The Committee applauds NIDA's
efforts to support behavioral science research that provides
insight into drug abuse and addiction, especially in the field
of tobacco and nicotine addiction. Behavioral and cognitive
studies are needed to examine the forerunners and consequences
of nicotine use and the nature of the nicotine addiction
process, including both genetic and environmental risk factors
for nicotine abuse. The Committee encourages NIDA to continue
its innovative approaches to move basic behavioral science into
clinical application.
Treatments for Adolescent Drug Abusers.--The Committee
continues to see adolescent drug abuse as a major public health
concern and recognizes the need for developing more treatments
that are tailored to the unique needs of adolescent drug
abusers.
NATIONAL INSTITUTE OF MENTAL HEALTH
Appropriations, 2003.................................... $1,341,014,000
Budget estimate, 2004................................... 1,382,114,000
Committee recommendation................................ 1,391,114,000
The Committee recommends an appropriation of $1,391,114,000
for the National Institute of Mental Health [NIMH]. The budget
request was $1,382,114,000 and the fiscal year 2003
appropriation was $1,341,014,000. The comparable amounts for
the budget estimate include funds to be transferred from the
Office of AIDS Research.
Mission.--The mission of the NIMH is to reduce the burden
of mental illness and behavioral disorders through research on
mind, brain, and behavior. At the same time, NIMH maintains a
clear focus on its ultimate goal: to pursue an understanding
that will enable it to prevent mental illness, or to develop
rational treatments that will actually cure them once they
occur.
NIMH is leading the Federal effort to identify the causes
of, and most effective treatments for, mental illnesses. The
Committee understands that this search is vital if we hope to
be able to find the means to alleviate the pain and suffering
of millions of Americans by reducing the impact of mental
disorders on them and their families, on our healthcare system,
and on our economy. Thanks, in part, to research funded and
conducted over the last 50 years by NIMH there are effective
treatments for many of these devastating illnesses.
Through research, NIMH and the scientists it supports seek
to gain an understanding of the fundamental mechanisms
underlying thought, emotion, and behavior--and an understanding
of what goes wrong in the brain in mental illness. The
Institute strives, at the same time, to hasten the translation
of this basic knowledge into clinical research that will lead
to better treatments and ultimately be effective in our complex
world with its diverse populations and evolving health care
systems.
Adherence and Behavior Change.--The NIMH supports studies
of factors that influence decisions about adopting and adhering
to treatment and prevention interventions, including individual
personality or disease-related factors and type of treatment,
as well as factors that may enhance or interfere with adherence
to prevention, treatment, or rehabilitative regimens.
Aging Research.--The Committee is pleased that NIMH has
created a consortium specifically to oversee aging research at
the NIMH, as well as to coordinate with other NIH components
that also support research on diseases in the elderly. The
Committee is aware that demographics will demand more attention
to this area as the number of elderly in the population
increases, and supports the increase in aging research at NIMH,
and encourages the institute to continue these positive
efforts.
Alzheimer's Disease.--NIMH continues to play an important
part in efforts to develop effective treatment strategies for
Alzheimer's disease. The Institute is currently recruiting
Alzheimer's patients to participate in a clinical trial
designed to identify the best medication regimen for treating
the behavioral problems that co-occur in Alzheimer's disease.
The Committee is also pleased to note that through the efforts
of its Aging Research Consortium and its collaboration with
other NIH Institutes including NIA, NIMH is continuing to
expand efforts to develop effective treatments for reducing the
burdens of Alzheimer's disease. The Committee is also pleased
that the NIMH has taken the lead in Alzheimer's disease
biomarkers via its intramural research program.
Autism.--The Committee notes that, that under the
leadership of the NIMH, the NIH has quickly carried out the
provisions of the Children's Health Act with respect to
establishing autism centers of excellence and the Interagency
Autism Coordinating Committee. The Committee is also encouraged
by grants from the NIMH to investigate treatment options,
including pharmaceutical research targeting the unique needs of
the autism community in both children and adults. The Committee
urges the NIMH to continue to fund behavioral and clinical
research as well as other promising areas of research related
to autism spectrum disorders.
Behavioral Science.--The Committee encourages NIMH to
continue to expand and strengthen its basic behavioral science
portfolio to determine the basic psychological functions that
become disturbed in mental disorders and realize the potential
contribution of research in such areas as the bio-behavioral,
cognitive, personality, emotional, and social processes that
underlie behavioral functioning.
Clinical and Translational Science.--The Committee is
pleased that NIMH is working to expand the number of clinical
scientists conducting research in mental disorders. The
Committee understands that NIMH is currently working with the
Academy of Psychological Clinical Science to explore new
training models for clinical researchers. The Committee
commends this groundbreaking effort.
Depression and Bipolar Disorder.--The Committee is aware of
the recently published findings regarding depression: its
prevalence, its economic consequences, and its systemic nature.
Depression is now recognized as a multisystem disorder
affecting not only the brain, but the entire body. It has been
associated with alterations in endocrine, cardiovascular, and
immune systems as well as changes in bone metabolism.
Researchers funded by NIMH found that the prevalence for major
depression for lifetime was 16.2 percent; in any given year,
more than 20 million children and adults in the Nation are
affected by major depression or bipolar disorder. Depression
has been shown to be a leading cause of disability worldwide.
Although more people are currently receiving treatment, only 22
percent of respondents with major depression during the past
year reported receiving adequate treatment. This is especially
troubling in light of the fact that there has been significant
progress in the science of treating depression. The Committee
urges the NIMH to continue its efforts to understand
depression, to develop new treatments, to decrease the impact
of depression on comorbid illnesses, and--because depression
and bipolar disorders are prominently associated with suicide--
to reduce suicide. The Committee is pleased with NIMH's
leadership in public education campaign entitled Real Men. Real
Depression and encourages the institute to continue these
education and information dissemination efforts.
Down Syndrome.--Persons with Down syndrome have a greater
risk of developing disorders such as autism, attention deficit
disorder, obsessive-compulsive disorder, anxiety and
depression. The Committee urges NIMH to conduct research on the
mental health symptoms of persons with Down syndrome and to
investigate effective treatments. The Committee also urges the
Institute to include Down syndrome in its studies of related
disorders and to coordinate its work with NICHD, NINDS and the
National Center on Birth Defects and Developmental Disabilities
at the Centers for Disease Control.
Drug Metabolism.--The Committee is concerned that a high
percentage of admissions to psychiatric hospitals are
necessitated by moderate to severe adverse drug effects or
prolonged while effective drug dosage is determined for
patients. Genetic testing has been promoted as a way to improve
drug safety and efficacy; improvements in microarray technology
now allow genetic testing across drug response pathways
providing a critical tool. The practicality of applying genetic
information in clinical practice now depends on a determination
as to whether genetic information, in fact, predicts best drug
dose or adverse events. The Committee urges NIMH to create a
major research focus on the relationship between drug
metabolism variation and patients' response to psychiatric
medications.
Frontier Mental Health Needs.--The Committee commends NIMH
on its outreach efforts to determine the differences in mental
health needs which may exist in remote frontier communities,
including Alaska. The Committee encourages NIMH to expand its
research efforts into these communities, which are often
ignored in research projects, but which continue to suffer from
high incidences of mental health problems including depression,
suicide and co-occurring disorders with substance abuse. The
Committee encourages NIMH to continue its outreach efforts such
as those in Alaska and in its recent ``Dialogue Four Corners''
meeting in Albuquerque, New Mexico which focused on minority
populations in the four States comprising that area: Arizona,
Colorado, New Mexico and Utah. These efforts have involved
bringing research knowledge to the public in local communities,
but also in establishing the dialogue between local communities
and NIH that is so important to public participation in the NIH
priority-setting process. The Committee encourages NIMH to
continue these efforts that have been focused on historically
underserved populations.
Genetic Schizophrenia.--The Committee urges the NIMH to
continue research into the genetics of schizophrenia. The past
year has seen the discovery of several genes associated with
increased vulnerability to schizophrenia. For each of these
genes, vulnerability is associated with a fairly common
variation in gene sequence; none of these genes individually
will provide a diagnostic test, but collectively they are
providing the first picture of the genetic mechanisms for
schizophrenia. Understanding how and where and when these genes
are expressed in the brain now promises to provide an important
new insight into the neurobiology of this illness.
Global Effects of Mental Disorders.--The Committee
encourages the NIMH to continue and expand its important work
in the area of unipolar depressive disorders. A recent analysis
used in the development of the World Health Organization's
yearly report entitled ``The World Health Report, 2001, Mental
Health: New Understanding, New Hope'' found that unipolar
depressive disorders makes up the largest single cause of
disability in the world. Over 36 percent of all years lost to
disability in the western world are due to mental illnesses and
alcohol and drug abuse. In the world, 20.2 percent of years
lost to disability are due to mental illnesses. This is an
extraordinarily significant burden on health and productivity
in the United States and throughout the world.
Late Life Mental Health Research.--The Committee continues
to be concerned about funding for late life mental health
research at NIMH but is encouraged by some of the positive
steps the Institute has taken to address this issue.
Furthermore, the Committee expects the NIMH to provide
substantial resources to promote aging research or provide data
on existing funds targeted toward geriatric mental health
research. Therefore, this Committee strongly encourages NIMH to
expand research in this area extramurally through all available
mechanisms and to provide adequate resources to the NIMH Aging
Research Consortium to advance the geriatric mental health
research agenda.
Learning Disabilities.--The Committee commends NIMH for the
work conducted to explore the neurological and behavioral
aspects of learning disabilities. The Committee looks forward
to learning the results of this work and encourage the
Institute to continue to coordinate with other Institutes
working on related activities.
Outreach.--The Committee continues to support NIMH's
excellent outreach efforts such as the recent ``Dialogue Four
Corners'' meeting in Albuquerque, New Mexico. These efforts
have involved bringing research knowledge to the public in
local communities, but also in establishing the dialogue
between local communities and NIH that is so important to
public participation in the NIH priority-setting process. The
Committee encourages NIMH to continue these efforts that have
been focused on historically underserved populations, with an
emphasis on the co-occurrence of mental disorders with
substance abuse and with other physical illnesses such as
diabetes and heart disease--an area that the committee
encourages NIMH to continue to explore.
Prevention Research.--The Committee places a high priority
on prevention research, particularly with respect to mental
disorders among children and adolescents, in identifying
protective factors against the negative impacts of stress among
young adults, and in developing strategies to strengthen the
family.
Psychological Impacts of Terrorism.--The Committee supports
NIMH research related to the psychological impact of both acute
and chronic exposure to threats of violence, including
terrorism, bioterrorism, and war, with particular emphasis on
vulnerable populations, such as trauma survivors, children and
older adults. The Committee encourages NIMH to expand its
research portfolio to include research related to factors that
promote detection or prediction, prevention, and post-exposure
recovery and resilience.
Research Portfolio.--The Committee is pleased with NIMH's
progress in fashioning its research portfolio, which has
balanced the urgent need to focus on severe mental disorders
with the obligation to support the basic neuroscience and
behavioral research that will ultimately uncover the mechanisms
responsible for human behavior and for the development of the
entire spectrum of mental disorders.
Science in the Service of the Public.--The Committee
supports the NIMH's determination to speed the translation of
research results into practical societal benefits, including
improved mental health services for those who need them, and
commends NIMH for its focus on translating the findings from
basic research into the clinical arena.
Social Neuroscience.--The Committee is interested to learn
that NIMH is supporting research in the emerging area of social
neuroscience, focusing on the neurobiology of complex
behaviors. This trandisciplinary research holds much promise
for increasing understanding of the connections between the
brain and behavior.
Suicide.--The Committee is aware of the recent Institute of
Medicine [IOM] study on suicide--``Reducing Suicide: A National
Imperative''--which noted that nearly 30,000 people die by
suicide each year in the United States alone. Many, many more
attempt suicide. More than 90 percent of people who commit
suicide suffer from some form of mental disorder, which
emphasizes the severe emotional pain and suffering caused by
some forms of mental illness. While the body of evidence
pointing to specific risk factors has grown, and the number of
NIMH grants focused on treating suicidal patients has
increased, there are no intervention centers focused on
advancing the scientific methods necessary to efficiently test
approaches to the reduction of suicide risk. The Committee
encourages NIMH's leadership in responding to the IOM report
and urges it to address the need for building a sufficient
research infrastructure to adequately reduce the burden of
suicidality (suicide deaths, attempts and serious ideation).
Translating Behavioral Research.--The Committee strongly
supports translational research in the behavioral and social
sciences to address how basic behavioral processes, such as
cognition, emotion, motivation, development and social
interaction, inform the diagnosis, treatment and delivery of
services for mental disorders.
Traumatic Events.--The Committee supports NIMH's leadership
in working quickly to address urgent public health problems.
NIMH research has shown that, for some individuals, exposure to
violent or traumatic events can result in very significant
mental health repercussions. For example, in the area of fear,
a great deal has been learned about the neurobiology of
``extinction,'' which enables most of us to recover from a
traumatic experience. Those not able to do this develop Post
Traumatic Stress Disorder [PTSD]. By studying fear learning and
extinction in non-human animals, we now know that PTSD must
involve a well-defined specific brain circuit. This information
can be very important given our need to address potential
psychological repercussions of terrorism and terrorist acts.
The Committee is aware of NIMH's leadership in seeking
interagency coordination in addressing this urgent issue.
NATIONAL HUMAN GENOME RESEARCH INSTITUTE
Appropriations, 2003.................................... $464,995,000
Budget estimate, 2004................................... 478,072,000
Committee recommendation................................ 482,372,000
The Committee recommendation includes $482,372,000 for the
National Human Genome Research Institute [NHGRI]. The budget
requested $478,072,000 and the fiscal year 2003 appropriation
was $464,995,000. The comparable amounts for the budget
estimate include funds to be transferred from the Office of
AIDS Research.
Mission.--In April 2003, the International Human Genome
Project, led by the National Human Genome Research Institute
[NHGRI] of the National Institutes of Health, accomplished all
of its original goals of the project, ahead of schedule and
under budget. The Human Genome Project was an effort to
determine the location and sequence of the estimated 30,000
genes that constitute the human genome. This historic
achievement, in the month of the 50th anniversary of Watson and
Crick's seminal publication of the structure of DNA, opens the
genomic era of medicine. April also witnessed the publication
of a important new vision for the future of genomics research,
developed by the NHGRI. This vision, the outcome of almost 2
years of intense discussions with hundreds of scientists and
members of the public, has three major areas of focus: Genomics
to Biology, Genomics to Health, and Genomics to Society. It
will serve to guide the NHGRI and NIH efforts in the area of
genomic science in the years to come. The Committee commends
the NHGRI for developing this vision for the future of genomics
and will look to this document as a benchmark for assessment of
future investment in the institute.
The NHGRI coordinates extramural and intramural research as
well as research training in the area of genomics and genetics.
The Division of Extramural Research supports research on
genetic sequences of both human and non-human genomes, DNA
sequencing technology development, database management and
analysis, and studies of the ethical, legal, and social
implications of human genome research. The Division of
Intramural Research focuses on applying the tools and
technologies of the Human Genome Project to understanding the
genetic basis of disease and developing DNA-based diagnostics
and gene-based therapies. The intramural program has also
developed a strong clinical research program in collaboration
with several other NIH Institutes to study and better
understand rare and complex genetic diseases such as diabetes,
heart disease, breast cancer, colon cancer, and melanoma.
ELSI.--The Committee remains concerned about the proper use
of genetic information and encourages the NHGRI's ongoing
efforts, though its ELSI program, to examine the privacy and
fair use of genetic information. Other important issues related
to human genetics research and its consequences should also be
studied, including: the appropriate use of genetic tests; the
influence of gene patenting and licensing on the field of
genomics, the protection of human subjects who participate in
genetic research; the development of policies to guide research
into genetic variation; and complex social issues, such as how
genetics informs concepts of race and ethnicity.
ENCODE.--The Committee commends NHGRI for creating the
Encyclopedia of Data Elements [ENCODE] project, which has a
long-term goal of identifying and locating all protein-coding
genes, non-protein coding genes and other sequence-based
functional elements contained in human DNA sequence. This
significant undertaking will help scientists mine and fully
utilize the human sequence, gain a deeper understanding of
human biology, predict potential disease risk and stimulate new
strategies for the prevention and treatment of disease. The
Committee would like to receive a report on the progress of
this effort prior to next year's hearings, with emphasis on the
project's place within the Institute's plan for future
activities.
Gene-Environment Interactions.--The NHGRI is commended for
its partnerships with other institutes and the Office of
Behavioral and Social Sciences Research to push the frontier of
genetics research forward by examining gene-environment
interactions. Research on the environmental stimuli (such as
behaviors, experience of stress, or exposure to certain
physical conditions) that lead to the expression of genes is
critical if science is to reap the benefits of the mapped
genome. The NHGRI is encouraged to work with OBSSR on
multidisciplinary training programs to increase the number of
skilled scientists who can bridge the behavioral and genetic
realms.
HapMap.--The Committee commends NHGRI for creating the
Haplotype Map project, which will assess the multiple genetic
and environmental factors that influence many common diseases.
This new initiative, organized as an international public/
private partnership, led and managed by NHGRI, will develop a
catalog of the haplotype blocks to be known as the ``HapMap.''
This map will provide a new tool to identify genetic variations
associated with disease risk and response to environmental
factors and to drugs and vaccines. The NIH plans to require
rapid release of data that the HapMap project generates.
Ultimately, this powerful tool will allow scientist to
understand many common diseases much more completely and will
lead to improved treatments for many of these disorders.
NATIONAL INSTITUTE OF BIOMEDICAL IMAGING AND BIOENGINEERING
Appropriations, 2003.................................... $278,279,000
Budget estimate, 2004................................... 282,109,000
Committee recommendation................................ 289,300,000
The Committee recommends an appropriation of $289,300,000
for the National Institute of Biomedical Imaging and
Bioengineering [NIBIB]. The budget requested $289,300,000 and
the fiscal year 2003 appropriation was $278,279,000. The
comparable amounts for the budget estimate include funds to be
transferred from the Office of AIDS Research.
Mission.--The NIBIB improves health by promoting
fundamental discoveries, design and development, and
translation and assessment of technological capabilities in
biomedical imaging and bioengineering, enabled by relevant
areas of information science, physics, chemistry, mathematics,
materials science, and computer sciences. The Institute plans,
conducts, fosters, and supports an integrated and coordinated
program of research and research training that can be applied
to a broad spectrum of biological processes, disorders and
diseases and across organ systems. The Institute coordinates
with the biomedical imaging and bioengineering programs of
other agencies and NIH Institutes to support imaging and
engineering research with potential medical applications and
facilitates the transfer of such technologies to medical
applications.
Positron Emission Tomography [PET].--The Committee
continues to encourage the Institute to devote significant
resources to molecular imaging technologies such as positron
emission tomography [PET] and microPET to take advantage of the
capacities of molecular imaging to detect disease process at
the molecular level and to monitor the effectiveness of
targeted gene therapies now under development. The Committee
also encourages the Institute to develop its research agenda in
close collaboration with other, disease-specific Institutes at
NIH, so that new imaging technologies are closely tied to the
research projects being undertaken by the various other
Institutes of NIH.
NATIONAL CENTER FOR RESEARCH RESOURCES
Appropriations, 2003.................................... $1,138,821,000
Budget estimate, 2004................................... 1,053,926,000
Committee recommendation................................ 1,186,483,000
The Committee recommends an appropriation of $1,186,483,000
for the National Center for Research Resources [NCRR]. The
budget request was $1,053,926,000 and the fiscal year 2003
appropriation was $1,138,821,000. The comparable amounts for
the budget estimate include funds to be transferred from the
Office of AIDS Research.
Mission.--The NCRR develops and supports critical research
technologies and shared resources that underpin research to
maintain and improve the health of our Nation. The NCRR
programs develop a variety of research resources; provide
biomaterial and resources for complex biotechnologies, clinical
research, and specialized primate research; develop research
capacity in minority institutions; and enhance the science
education of pre-college students and the general public.
Animal Research Facilities.--The Committee commends NCRR
for its support of recent efforts to upgrade animal research
facilities at minority health professions schools including the
recent competitive supplement to Research Centers in Minority
Institutions for developing and improving institutional animal
resources. These upgrades are necessary to assist these
institutions in complying with Federal regulations and attain
accreditation by the appropriate scientific organizations. The
Committee encourages NCRR to continue work in partnership with
the National Center on Minority Health and Health Disparities
to support this important initiative.
Clinical Investigation.--The Committee urges NCRR to
continue its efforts to improve the efficiency of clinical
investigation by expanding the capabilities of clinical
research resources. There are novel ideas and candidate
molecules in the academic community that merit expeditious
clinical testing. The Committee encourages the NCRR to provide
the means to obtain rapid clinical proof of principle that a
new molecule or approach is a viable candidate for expanded
testing in the clinic.
Cystic Fibrosis.--The Committee strongly encourages NCRR to
evaluate clinical research partnerships with minority-serving
institutions and to expand its support for clinical trials
networks for orphan diseases, such as the cystic fibrosis
clinical trials network. This clinical trials system holds
promise as a model for other orphan diseases, and the Committee
urges that NCRR provide support for the CF network to
facilitate its expansion and also to consider strategies for
the replication of this network for other orphan diseases.
Extramural Construction.--The Committee has included bill
language identifying $119,220,000 for extramural biomedical
facility renovation and construction. This amount is the same
as the fiscal year 2003 appropriation. The fiscal year 2004
budget proposed to eliminate funding for the program. These
funds are to be awarded competitively, consistent with the
requirements of section 481A of the Public Health Service Act,
which allocates 25 percent of the total funding to institutions
of emerging excellence.
Extramural Facilities Construction at Minority
Institutions.--The Committee encourages NCRR to give priority
consideration to supporting extramural facilities construction
projects at historically minority institutions which have
developed a comprehensive plan to address the disproportionate
impact of cancer in minority communities.
General Clinical Research Centers.--The 79 NCRR-funded
General Clinical Research Centers across the country play a
critical role in NIH efforts to translate basic science
discoveries into vaccines, treatments, and cures for disease.
GCRCs provide regional access to clinical research in 32 of 50
States. Approximately 10,000 researchers use GCRCs each year
for patient-oriented research focused on a wide variety of
diseases. Over the last four decades, nearly every major
medical discovery made in the United States has involved
researchers working in the Nation's GCRCs. In recent years, the
Committee has expressed extreme concern regarding the
inadequate funding provided to the GCRCs. Since 1999, the
budget for the NCRR has grown at more than twice the rate of
increase for the GCRCs. To reverse this trend and enhance the
capacity of these Centers to support research aimed at
improving patient care, the Committee has provided $320,000,000
for the GCRC program, an increase of $10,448,000 over the
fiscal year 2003 appropriation and $7,272,000 over the budget
request. The increased funds should be used to upgrade GCRC
facilities with the sophisticated technologies needed to apply
the mapping of the human genome to the study of human disease
and respond to the threat of bioterrorism; expand staffing as
recently mandated by NCRR to assure patient safety; and support
local GCRC pilot projects as approved by the NCRR Advisory
Council.
Graduate Training in Clinical Investigation Awards.--Over
the past 2 years, the Committee has expressed concern that NIH
has not moved forward with implementation of the Graduate
Training in Clinical Investigation Awards. This program was
authorized in the Clinical Research Enhancement Act to provide
tuition and stipend support for students seeking advanced
degrees in clinical research. The awards were intended to
complement the NIH Clinical Research Curriculum Awards, a major
NIH initiative aimed at establishing training programs to
reverse the shortage of well-trained clinical investigators.
The Committee is pleased that 57 Curriculum Awards have been
provided to institutions across the country but believes the
NIH is compromising the effectiveness of these training
programs by failing to fund the complementary student stipend/
tuition awards. The General Accounting Office Report on NIH
implementation of the clinical research legislation
substantiates the Committee's concerns, noting the opinion of
several training program directors that inadequate tuition and
stipend support for students is ``a major constraint.'' The
Committee believes that the graduate training awards authorized
in the Clinical Research Enhancement Act should be implemented
in fiscal year 2004 with a budget sufficient to support 200
students.
Health Disparities Research.--The Committee commends NCRR
for its proposal to establish Comprehensive Centers for Health
Disparities Research and looks forward to learning more about
this important new initiative.
IDeA Grants.--The Committee has provided $215,000,000 for
the Institutional Development Award [IDeA] Program authorized
by section 402(g) of the Public Health Service Act. This is a
$6,365,000 increase over fiscal year 2003 and $5,000,000 over
the fiscal year 2004 budget request. Within the total provided,
$130,000,000 is for the Biomedical Research Infrastructure
Network [BRIN] initiative and $85,000,000 is for the Centers of
Biomedical Research Excellence [COBRE] initiative.
Islet Resource Centers.--The Committee commends NCRR for
establishing 10 sites for isolation, purification, and
characterization of insulin-producing cells, and it encourages
the Center to expand and extend these efforts by creating
additional sites. The Committee also encourages NCRR to
facilitate this important research by isolating insulin-
producing cells both for distribution to researchers as well as
for transplantation, and by improving methods to store and
transport insulin-producing cells.
National Primate Research Centers.--The Committee values
the critical role played by the eight National Primate Research
Centers [NPRCs] and thanks the National Center for Research
Resources [NCRR] for the two recent evaluations it sponsored to
assess the needs of the NPRCs and NPRCs Users: An Evaluation of
the Regional Primate Research Centers Program and a National
Academy of Sciences Workshop on Rhesus Monkey Demands in
Biomedical Research. Recognizing that the NPRCs have
independently developed a 5 Year Advancement Initiative to
effectively implement the recommendations set forth in these
two evaluations and to address the upgrades and program
expansions needed to meet the demanding research needs of the
Nation, the Committee expects NCRR to fully commit to the
initiative. This commitment ensures that the NPRCs will
continue to fulfill the national need for primate resources and
expertise, and contribute to the overall effectiveness of the
Federal investment in biomedical research.
Plant-Based Medicinal Products.--The Committee continues
its interest in accelerating the development and
commercialization of plant-based medicinal products, and it
encourages the NCRR to actively collaborate with plant
scientists in developing novel useful products.
Positron Emission Tomography.--The Committee continues to
urge NCRR to support research resource centers for the
development and refinement of positron emission tomography
[PET] as a unique imaging technology to diagnose and stage
diseases of the brain, including Alzheimer's disease.
Research Centers 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 increase 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.
NATIONAL CENTER FOR COMPLEMENTARY AND ALTERNATIVE MEDICINE [CCAM]
Appropriations, 2003.................................... $113,407,000
Budget estimate, 2004................................... 116,202,000
Committee recommendation................................ 117,902,000
The Committee has included $117,902,000 for the National
Center for Complementary and Alternative Medicine. The budget
request was $116,202,000 and the fiscal year 2002 appropriation
was $116,202,000. The comparable amounts for the budget
estimate include funds to be transferred from the Office of
AIDS Research.
The Committee strongly supports the work of the National
Center for Complementary and Alternative Medicine, which is
charged with assuring that complementary and alternative
therapies be rigorously reviewed to provide consumers reliable
information.
The Committee expects that funding for existing and new
centers supported by NCCAM will be maintained. The Committee
further expects NCCAM to undertake field investigations and a
program for the collection and evaluation of outcome data on
promising alternative therapies. The Committee expects NCCAM to
expand its support of CDC's field investigations program and of
AHRQ's literature reviews and data-analysis efforts and to
develop and disseminate a comprehensive set of fact sheets on
CAM therapies to inform the public and health professionals of
the state of scientific knowledge about these therapies.
The Committee calls upon NCCAM to increase the number of
research grants and centers awarded to CAM institutions. The
Committee believes that in order to assure an adequate CAM
research infrastructure and to encourage quality research at
these institutions, greater support and resources from NCCAM to
these institutions are needed.
Ameliorating Liver Disease.--The Committee is aware of
efforts to synthesize and calibrate the production of milk
thistle for use in clinical trials to demonstrate its value to
slow the progression of nonalcoholic steatohepatitis and to
reduce the side effects of hepatitis C interferon treatments.
The Committee looks forward to a report on the status of this
research initiative.
Chiropractic Research Center.--The Committee strongly urges
NCCAM to increase support for the chiropractic research center.
Office of Dietary Supplements.--The Committee is supportive
of the efforts of NCCAM and the Office of Dietary Supplements
[ODS] in the study of the beneficial effects of botanical
dietary supplements as alternative medical therapies, and
especially in the efforts to promote development and employment
of reference standards and analytical methods. The Committee
encourages the continued cooperation of NCCAM and ODS with the
programs of FDA/CFSAN to ensure the safety of botanical dietary
supplements.
NATIONAL CENTER ON MINORITY HEALTH AND HEALTH DISPARITIES
Appropriations, 2003.................................... $185,714,000
Budget estimate, 2004................................... 192,724,000
Committee recommendation................................ 192,824,000
The Committee has included $192,824,000 for the National
Center on Minority Health and Health Disparities. The budget
request was $192,724,000 and the fiscal year 2003 appropriation
was $185,714,000. The comparable amounts for the budget
estimate include funds to be transferred from the Office of
AIDS Research.
Mission.--The NCMHD advises the NIH Director and Institute
and Center [IC] directors on the development of NIH-wide policy
issues related to minority health disparities research,
research on other health disparities, and related research
training. Among other activities, the NCMHD develops, in
consultation with the NIH Director, IC directors, and the
advisory council, a comprehensive strategic plan that
identifies and establishes objectives, priorities, budgets, and
policy statements governing the conduct and support of all NIH
minority health disparities research, research on other health
disparities, and related research training activities. It also
administers funds for the support of minority health
disparities research and other health disparities research, by
awarding grants and leveraging the programs of the ICs.
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 urges
NCMHD to explore collaboration with NIDDK to conduct support
research activities related to glomerular injury.
Hepatitis C.--The Committee remains deeply concerned about
the disproportionate burden of hepatitis C among African
Americans and Hispanics. The incidence is high and the response
to treatment is low. The Committee strongly encourages NCMHHD
to work with NIDDK and NIAID to expand research to improve
treatment effectiveness and safety, and to partner with CDC and
nonprofit groups to implement a prevention and education
campaign targeted at high-risk populations.
Minority Health and Health Disparities.--The Committee
commends the National Center on Minority Health and Health
Disparities for its leadership in addressing the longstanding
problem of health status disparities in minority and medically
underserved populations. For fiscal year 2004, the Committee
continues to encourage NCMHD to implement its successful
Research Endowment program as an ongoing initiative. Moreover,
the Committee encourages NCMHD to implement the program in a
manner that is consistent with the authorizing legislation.
The Committee also commends NCMHD for its successful
``Project EXPORT'' initiative and urges continued support for
this important program. Finally, the Committee encourages the
Director of NCMHD to coordinate with the NIH Director and the
National Center for Research Resources in support of extramural
facility construction and the development of other research
infrastructure at minority health professions schools.
Scleroderma.--The Committee urges the Center to support
research that furthers the understanding of causes and
consequences of scleroderma, a chronic, degenerative disease of
collagen production, among African Americans, Hispanic and
Native American men and women. The Center is encouraged to
establish epidemiological studies to address the prevalence of
scleroderma among these populations as statistics do indicate
that African Americans have a slightly higher incidence of
scleroderma. This population is also likely to be diagnosed at
a younger age and tend to be diagnosed more often with the
diffuse form of scleroderma.
JOHN E. FOGARTY INTERNATIONAL CENTER FOR ADVANCED STUDY IN THE HEALTH
SCIENCES
Appropriations, 2003.................................... $63,465,000
Budget estimate, 2004................................... 64,266,000
Committee recommendation................................ 65,900,000
The Committee recommends an appropriation of $65,900,000
for the Fogarty International Center [FIC]. The budget request
was $64,266,000 and the fiscal year 2003 appropriation was
$65,900,000. The comparable amounts for the budget estimate
include funds to be transferred from the Office of AIDS
Research.
Mission.--Adapting research advances in biomedicine to
populations at home and abroad requires a continuing commitment
to basic science as well as rigorous clinical and applied
(epidemiological) studies. Examples are vaccines, anti-
infective agents, drugs, and more efficient diagnostic tools,
combinations of interventions, and health policies to reduce
the risk of disease and its associated human, social, and
economic consequences. These challenges will benefit from a
more coordinated and multi-disciplinary approach to global
health needs. It is the mission of the FIC to address these
challenges by forging collaborations with a range of domestic
and global partners in international research and training to
pursue three core objectives: first, to accelerate the pace of
discovery and its application by special projects enabling
scientists worldwide to share conceptual insights, analytic
methods, data sets, patient cohorts, or special environments;
second, to engage and assist young as well as more established
U.S. investigators to address scientific challenges related to
global health; and third, to help develop a cadre of highly
capable young foreign investigators positioned to cooperate
with U.S. scientists in areas of the world that, due to
geography, genetics, or disease burdens, provide unique
opportunities to understand disease pathogenesis, anticipate
disease trends, or develop interventions of relevance and
priority for both the United States and the collaborating
country.
Chronic Obstructive Pulmonary Disease.--The Committee notes
that Chronic Obstructive Pulmonary Disease [COPD] is the fourth
leading cause of death worldwide, and encourages the FIC expand
its COPD research and training activities.
Tuberculosis.--The Committee recognizes the growing
importance of international research and surveillance programs
with respect to infectious diseases such as tuberculosis [TB].
The Committee is pleased by the Center's research collaboration
with international organizations and governments on multi-drug
resistant TB and encourages the Center to continue these
important studies. The Committee is aware that FIC offers TB
supplemental training grants to recipients of AIDS
International Training and Research Program [AITRP] or
International Training and Research Program in Emerging
Infectious Diseases [ERID]. The Committee encourages FIC to
develop a specific free-standing TB training program.
The Committee recognizes the growing importance of
international research surveillance programs with respect to
infectious diseases such as tuberculosis. The Committee is
pleased by the Center's research collaboration with
international organizations and governments on multi-drug
resistant TB and encourages the Center to continue these
important studies.
NATIONAL LIBRARY OF MEDICINE
Appropriations, 2003.................................... $308,335,000
Budget estimate, 2004................................... 316,040,000
Committee recommendation................................ 320,035,000
The Committee recommends an appropriation of $320,035,000
for the National Library of Medicine [NLM]. The budget
requested $316,040,000 and the fiscal year 2003 appropriation
was $308,335,000. Included is $4,000,000 for improvement of
information systems. The recommendation includes $8,200,000 in
transfers available under section 241 of the Public Health
Service Act. The comparable amounts for the budget estimate
include funds to be transferred from the Office of AIDS
Research.
Mission.--The National Library of Medicine is the Federal
institution that for more than 150 years has collected,
organized, preserved, and disseminated the world's output of
biomedical literature in all forms. As a result of this
activity NLM is the world's largest library of the health
sciences, its holdings numbering more than 5 million items. The
NLM has pioneered innovative methods to disseminate
bibliographic information. Basic to the mission of the NLM is a
wide-ranging research program to improve how medical
information is communicated. This responsibility is aided by a
grants program and by specialized services in toxicology,
environmental health, and biotechnology.
Back-up Facility.--The increasing threat to Federal
computer systems raises serious concerns about maintaining
access to vital health information during an emergency. The
Committee supports NLM's efforts to establish a remote back-up
facility to ensure the continued availability of such critical
national biomedical resources as MEDLINE and GenBank, as well
as valuable information services to the public, including
MEDLINEplus and ClinicalTrials.gov. The Committee also
recognizes the need to provide ongoing resources to maintain
such a facility once an initial investment is made to establish
remote back-up capability.
Bioethics Research.--The Committee urges the NLM to
maintain strong support for the National Reference Center for
Bioethics Literature [NRCBL] and the Bioethics Information
Retrieval [BIR] Project. The BIR Project provides critically
important enhancement to NLM's indexing of journal articles,
thus facilitating searches on the Bioethics Subset of the NLM's
MEDLINE database.
Clinical Vocabulary Standards.--The Committee continues to
note the contribution of NLM to the development of standardized
clinical data vocabularies that play a key role in improving
interoperability of medical information systems. The Committee
supports NLM's efforts to expand the Unified Medical Language
System [UMLS] to enable it to serve as a major vehicle for
facilitating the exchange of clinical health information.
Through common standards, patient care will be improved, errors
will be reduced, and the communication of health information
among disparate health care systems will be greatly enhanced.
Digital Human.--Advances in medical research depend
increasingly on using simulations to integrate the flood of
biomedical research information in ways that can greatly
enhance research aimed at understanding human health and curing
disease, improve the practice of medicine, contribute to health
and science education and training. The Committee acknowledges
the pioneering work NIH has done in this area including at the:
NIGMS, NINDS, NHLBI, NCRR, and NLM. Stronger NIH-wide
management and coordination of this work could, however,
achieve efficiencies and speed progress, and minimize
duplication and costs in this critical and rapidly expanding
research field and coordination with all NIH institutes and
centers. The Committee encourages the NLM to develop consensus
standards, ensure that simulation components developed by
different groups work together efficiently, manage a review and
error correction process, and provide a publicly available
repository of models, simulations, and associated data. The
Committee encourages NIH to develop a plan describing how
coordination can best be achieved. The Committee further
requests NIH to consider convening a conference of experts in
biomedical simulations related fields to gather advice about
where strengthened coordination of research and information is
most needed and options for undertaking an NIH-wide effort to
implement these recommendations.
Expanding Library Facility.--The Committee was pleased to
receive the reports it requested on expanding the facility for
the National Library of Medicine, and to learn that the design
work will be completed by August 2003. If NLM's cutting-edge
biotechnology and other communications programs are to make
their maximum contribution to advancing the Nation's biomedical
research agenda, it is clear that the Library must have
adequate facilities. In this regard, the Committee believes
that construction should begin now on an expedited schedule.
The need is mission-critical and a delay could significantly
increase the cost.
Home Medical Consultations.--The Committee expects the NLM
to support an expansion of a demonstration called for in last
year's report to test the use of state-of-the-art telemedicine
technology for home medical consultations. This innovative
approach holds great promise for improving the care and
lowering health care costs for home-bound individuals who
require frequent monitoring.
Minority Health.--The Committee encourages NLM to expand
its support of annual conferences sponsored by the minority
health professions community designed to foster increased
interest among minority students in the fields of biomedical
science and bio-informatics.
Outreach.--The Committee encourages NLM to continue its
outreach activities aimed at educating health care
professionals and the general public about the Library's
products and services, in coordination with medical librarians
and other health information specialists.
PubMed Central.--The Committee commends NLM for its
leadership in developing PubMed Central, an electronic online
repository for life science articles. Because of the high level
of expertise health information specialists have in the
organization, collection, and dissemination of medical
information, the Committee believes that health sciences
librarians have a key role to play in the further development
of PubMed Central. The Committee encourages NLM to work with
the medical library community regarding issues related to
copyright, fair use, peer-review and classification of
information on PubMed Central.
Senior Citizen Outreach.--The Committee again notes that
senior citizens would benefit greatly from expanded access to
NLM's databases, and it supports NLM's efforts to pursue this
goal. The Committee encourages innovative means to reach older
Americans, including Internet access at senior centers and
congregate meal sites.
OFFICE OF THE DIRECTOR
Appropriations, 2003.................................... $266,232,000
Budget estimate, 2004................................... 317,983,000
Committee recommendation................................ 323,483,000
The Committee recommends an appropriation of $323,483,000
for the Office of the Director [OD]. The budget request was
$317,983,000 and amount appropriated in fiscal year 2003 was
$266,232,000. The comparable amounts for the budget estimate
include funds to be transferred from the Office of AIDS
Research.
Mission.--The Office of the Director provides leadership
and direction to the NIH research community, and coordinates
and directs initiatives which crosscut the NIH. The Office of
the Director is responsible for the development and management
of intramural and extramural research and research training
policy, the review of program quality and effectiveness, the
coordination of selected NIH-wide program activities, and the
administration of centralized support activities essential to
operation of the NIH.
The Committee directs the Director of NIH to make a written
request to the chairman of the Committee prior to any
reprogramming of $1,000,000 or more, between programs,
projects, activities, institutes, divisions, and centers. The
Committee desires to have the requests for reprogramming
actions which involve less than the above-mentioned amounts if
such actions would have the effect of changing funding
requirements in future years, if programs or projects
specifically cited in the Committee's reports are affected, or
if the action can be considered to be the initiation of a new
program.
Autism.--The Committee encourages NIH to expand the
research portfolios at the existing Centers for Excellence in
Autism as well as the existing collaborative programs for
excellence in autism. Pursuant to the Children's Health Act of
2000, the Committee strongly encourages NIH leadership, and
particularly participant institutes including, NICHD, NIMH, in
coordinating and financing a tissue bank program that will
synchronize autism spectrum disorder brain banking, data
management, and track research among all participants in the
tissue collection program. The Committee further encourages NIH
to work closely with its Interagency Autism Coordinating
Committee in developing, implementing, and funding its matrix
for autism spectrum disorder research. The Committee also
encourages NIH to look at collaborative opportunities for joint
projects and conferences with national autism organizations
that will foster greater participation in research activities
by investigators entering the field.
The Committee further urges the NIH to provide more
attention and resources to autism research. In particular, to
support and expand the Startt centers and ensure that all large
autism projects adhere to principles of sharing of data and
genetic material. Data sharing is one of the most effective and
economical ways to increase the rate of discovery. The
opportunity now exists to create large, integrated data sets
encompassing data from CPEA, STARTT, CADRE and NIEHS centers.
Autoimmune Diseases.--The Committee strongly urges the
Director to oversee the implementation of the December 2002 NIH
Autoimmune Diseases Research Plan, which was requested in the
Children's Health Act of 2000.
Chronic Fatigue Syndrome.--The Committee is disappointed
that since NIH released its long-awaited CFS program
announcement in December 2001, it has yet to reverse 8 years of
declining CFS research funding. The Committee urges the NIH to
issue an RFA that would emphasize multidisciplinary studies to
understand the cause and progression of CFS in adults and
children as well as identify diagnostic markers and effective
treatments.
Chronic Myeloproliferative Disorders [MPDs].--Last year,
the Committee requested a report from NIH regarding its plans
to expand research into the Chronic MPDs, specifically
identifying the disorders of Polycythemia Vera, Idiopathic
Myelofibrosis, and Essential Thrombocytosis. The Committee
notes that the NIH submitted its response to this request in
April 2003. However, the Committee believes this report is
remarkably unresponsive and blatantly fails to address the
substance of the Committee's request. In fact, the report
relies on work undertaken by the Leukemia, Lymphoma and Myeloma
Progress Review Group [LLMPRG], yet the LLMPRG failed to even
consider the Chronic MPDs in their review. The Committee also
finds it alarming that the NIH would suggest that the funding
of a clinical trial involving patients with Juvenile
Myelomonocytic Leukemia [JML] has any relationship at all to
the Committee's inquiry into Chronic MPDs, as JML is a
pediatric leukemia and not a Chronic MPD. The Committee
encourages NIH to expand research into the disorders of
Polycythemia Vera, Idiopathic Myelofibrosis and Essential
Thrombocytosis. The Committee requests that NIH submit a more
detailed report on their plans to address this disorder.
Clinical Research.--The promise of medical research is
greater now than ever before. Strong and sustained investments
of taxpayer dollars in basic biomedical research over the past
five decades have generated a wealth of knowledge about the
fundamental mechanisms of human health and disease. To reap the
full harvest of these discoveries, the public now requires
careful attention to and investment in the translation of these
fundamental scientific advances into improved patient care, a
task carried out in large part through clinical research
conducted by the Nation's academic health centers. The
Committee notes, however, that an increasing number of
impediments to the translation of these remarkable research
discoveries into practice, including rising costs, unfunded
regulatory mandates, fragmented clinical research
infrastructure, incompatible data bases, and a severe and
growing shortage of qualified clinical investigators and
willing participants. The Committee recommends that the NIH
Director develop recommendations for addressing these
impediments, with special consideration give to: providing
clinical research infrastructure support grants to eligible
institutions; support and/or restructuring of the institutional
review board system; and work with the NIH, FDA, NSF, and DOD
on regulations governing clinical research. The Committee
expects a report by April 2004.
Cooperation With the Veterans Health Administration.--The
Committee applauds the increasing research collaboration
between the NIH and the Veterans Health Administration, and it
notes that the VA system of 173 hospitals and 771 clinics
represents a significant resource to facilitate and accelerate
research. The Committee urges increased cooperative efforts
between NIDDK, NCI and the Veterans Health Administration to
screen, diagnose, and manage the medical issues associated with
hepatitis C and liver cancer.
Distribution of Resources.--The Committee is concerned, in
light of the doubling of the agency's budget over the past 5
years and the rapid encroachment of new medical research
challenges such as SARS and threats of bioweapons, that the
agency has not moved more rapidly towards encouraging funding
of large scale collaborative efforts to address these and other
medical challenges. While the pace of new challenges has
increased, review time for proposals submitted to the
Institutes at NIH continues to average about 18 months. The
Committee strongly encourages the Director to develop means of
encouraging large scale multi-institution projects to address
significant areas of medical research and to devise means of
reducing the time frames between a submission of a proposal and
the grant award.
Education and Health.--The Committee is interested in the
trans-NIH request for applications, initiated by the Office of
Behavioral and Social Sciences Research [OBSSR], to better
understand how education contributes to health. Better
scientific understanding of the causal pathways between
education and health could lead to new or improved prevention
and therapeutic intervention strategies for important health
problems. In some but not all studies of clinical treatments,
those with lower levels of educational attainment demonstrated
poorer outcomes. The Committee looks forward to hearing about
new research directions in this important arena.
Epilepsy.--The Committee recognizes that while the NINDS is
the primary Institute for addressing epilepsy, several other
Institutes are also involved in related research. They include
the NICHD, the NHGRI, the NIMH, and the NIA. A
multidisciplinary approach to understanding this complex
disorder can allow the more rapid translation of research to
patient care. The Committee urges the Director to coordinate
research efforts in epilepsy among these Institutes, and to
implement the NINDS research benchmarks resulting from the
March 2000 conference ``Curing Epilepsy: Focus on the Future.''
Genomics.--The Committee has long been supportive of the
extraordinary work done by NHGRI to sequence the human genome
and to unlock the secrets held within the sequence. The
Committee recognizes the important role that genomics and
genetics plays in the progression of disease and believes that
every institute has a key role to play in moving genomics to
the clinical setting through the use of next generation
technologies. The Committee urges the Director to continue to
ensure that the institutes and centers are pursuing every
available opportunity to advance this critical research.
Human Embryonic Stem Cell Research.--The Committee believes
strongly that embryonic stem cell research offers enormous
promise for the more than 100 million Americans who suffer from
chronic diseases. The Committee remains concerned that the
current administration policy relating to embryonic stem cell
research is too limiting and is significantly slowing the pace
of this research. While the administration initially stated
that approximately 70 embryonic stem cell lines would be
available under the President's policy, only 11 are currently
available. Moreover, the Committee has heard testimony that
current embryonic stem cell lines are not sufficiently
genetically diverse for therapeutic uses. Also, most all of the
currently available stem cell lines are contaminated with mouse
feeder cells, making it uncertain whether the FDA will permit
them to be used in therapeutic applications. The Committee
urges the administration to expand its embryonic stem cell
research policy to allow additional stem cell lines to be
available for research.
The Committee is also deeply concerned with the slow pace
of implementation of the current policy. The Committee was
informed by NIH this year that NIH anticipates spending just
$17,000,000 on human embryonic stem cell research, far short of
the $100,000,000 budget originally announced by the HHS
Secretary. The Committee was particularly troubled to learn
that the National Cancer Institute is projecting no funding for
human ES cell research in fiscal year 2003. Over the past
several years, the Committee has heard from multiple witnesses,
including former NIH and NCI directors, about the promise of
human ES cell research to better understand and treat cancer.
The Committee expects to hear from NCI during the fiscal year
2005 hearings on their plan to vigorously implement a human ES
agenda.
Human Tissue Supply.--The Committee remains interested in
matching the increased needs of NIH grantees, intramural, and
university-based researchers who rely upon human tissues and
organs to study human diseases and search for cures. The
Committee is aware that one of the leaders in this competitive
field, the National Disease Research Interchange [NDRI], is
uniquely positioned to obtain this valuable and effective
alternative research resource. More than 500 peer-reviewed
research advances made by NDRI-dependent researchers have been
published during the past 4 years contributing to the research
community's fund of knowledge. The Committee is encouraged by
NDRI's role in these research advances and applauds the
Director's expanded support for NDRI by bringing NEI, NIDDK,
NIAID, NIAMS, and the Office of Rare Diseases into the multi-
institute initiative. While this is promising, more needs to be
done to match the demand for the use of human tissue in
research. The Committee, therefore, urges the Director to
increase the core support NDRI receives from NCRR, and to
continue to encourage the Institute Directors to identify and
implement program-specific initiatives intended to expand
support for NDRI.
Inflammatory Bowel Disease.--The Committee continues to
note with interest a scientific research agenda for Crohn's
disease and ulcerative colitis (collectively known as
inflammatory bowel disease) entitled ``Challenges in
Inflammatory Bowel Disease [IBD].'' This report identifies
strong linkages between the functions of the immune system and
IBD. The Committee encourages the Institute to expand its
research partnerships with the IBD community in fiscal year
2004 and increase funding for research focused on (1) the
immunology of IBD and (2) the interaction of genetics and
environmental factors in the development of the disease. The
Committee looks forward to reviewing a report from the
Institute on the progress made in these areas as requested in
the fiscal year 2003 Senate Labor-HHS Committee report.
Irritable Bowel Syndrome [IBS].--The Committee is pleased
with the increased focus on irritable bowel syndrome [IBS] at
the NIH's Office of Women's Health. It is estimated that over
60 million Americans, disproportionately women, suffer from
IBS.
Long-Term Maintenance of Behavior Change.--The Committee is
pleased that 10 Offices and Institutes have contributed to
OBSSR's trans-NIH research initiative on the challenges of
maintaining positive behavior change, particularly regarding
the strategies people use to maintain diet or exercise
regimens.
Lymphatic Diseases and Lymphedema.--The Committee commends
the NIH for its recent initiatives to support research on
lymphatic diseases and lymphedema, as described in its April
2003 Report to Congress. However, these accomplishments, while
notable, do not adequately address the current research
imperatives that can lead to effective therapeutic options for
the large, underserved patient population that is affected by
these diseases. The Committee urges the NIH to give higher
priority to this area of study. The Committee is also
disappointed that the April 2003 report did not adequately
outline short- and long-term plans to stimulate and support
basic and translational research for lymphatic diseases, as
requested in last year's Senate report language. Therefore, the
Committee requests the Director to provide another report by
April 1, 2004, that describes specific plans for lymphatic
disease research initiatives. In this regard, the Committee
urges the NIH to consider programs that will provide essential
resources to sustain this field and will stimulate the future
study of the lymphatic system, with particular emphasis on the
abnormal development thereof. The Committee notes that the key
factors limiting such study include the lack of: (a) suitable
animal models; (b) functional imaging of the lymphatic system;
(c) a national patient registry and tissue bank; and (d)
academic career development in the area of lymphatic diseases.
The Committee encourages a broad, trans-NIH involvement in all
these efforts, given that a greater understanding of lymphatic
function and disease will also contribute to a greater
understanding of many interrelated diseases, such as cancer,
AIDS, and autoimmune diseases, and of related processes, such
as inflammation and infection.
Microbicides for the Prevention of HIV.--HIV is a serious
and growing women's health issue. As of the end of 2002, half
of the world's HIV/AIDS-infected people were women. The typical
woman who gets infected with HIV has only one partner--her
husband. This trend devastates families and puts children at
risk. Consensus has emerged across the public health,
biomedical, and behavioral research communities that the range
of preventive interventions for HIV transmission must be
expanded, with particular focus on options women can control,
such as microbicides. Microbicides are a class of products
under development that would be applied topically to inactivate
or block transmission of HIV and other infections. More than 60
potential microbicides are in various stages of development at
public and private research entities around the globe. Designed
for maximum safety and effectiveness, these products are also
being designed to be inexpensive, readily available, and widely
acceptable. With increased funding and coordination, the first
such product could be available to the public in 5 to 7 years.
Microbicides would be critical both until a range of HIV-
preventive vaccines becomes available and as a necessary and
complementary preventive technology thereafter. The National
Institutes of Health, principally through the National
Institute of Allergy and Infectious Diseases [NIAID], spends
the majority of Federal dollars in this area. The Committee
commends the NIH for increasing the funds available for
microbicide research and development, and it supports
additional increases in funding for this area through OAR,
NIAID, NICHD, NIMH, NIDA, and ORWH. The Committee continues to
be concerned that microbicide research at NIH is conducted with
no single line of administrative accountability or specific
funding coordination. To address this, the Committee urges the
Director of NIAID to consider establishing a microbicides
branch dedicated to research and development, with appropriate
staff and funding. The Committee continues to request that
NIH's Office of AIDS Research provide to the Committee, not
later than 60 days after enactment of this legislation, a
Federal plan for coordination and acceleration of microbicide
research and development, as requested repeatedly by this
Committee.
Minority Health and Racial Disparities.--Research advances
should be applied more expeditiously to ensure greater
improvements in health outcomes across all communities of color
and the general public. The Committee urges the NIH to improve,
strengthen and expand its systems of information dissemination
and outreach to health care providers, minority organizations,
and the public.
Minority Institution Research Centers.--The Committee
continues to be pleased with the NIH Director's implementation
of various programs focused on developing research
infrastructure at minority health professions institutions,
including Research Centers at Minority Institutions, Extramural
Biomedical Research Facilities, and the National Center for
Minority Health and Health Disparities. Because there are a
number of new competitive mechanisms for NIH to work with these
research institutions, the Committee recommends that the NIH
Director work closely with the Director of the National Center
on Minority Health and Health Disparities to establish a
program of coordination among these various mechanisms to
partner with minority health professions schools to address
their infrastructure needs.
Multidisciplinary Research Training.--The Committee
commends the renewed emphasis NIH is placing on tailoring new
training opportunities for scientists in the 21st century. The
OBSSR is working to build a Ph.D.-Plus program that would allow
behavioral scientists to earn a masters or certificate in
another field of science, or to allow a biomedical scientist to
earn a master's in one of the behavioral or social sciences.
Such highly focused training programs can help fill gaps in
scientific knowledge by building a workforce that can bridge
the knowledge and strategies of multiple scientific
disciplines. The Committee encourages the OBSSR to continue
these efforts.
NIH/DOE Medical Technology Partnership.--The Committee
expects the NIH to continue to collaborate with the Department
of Energy to evaluate the technologies developed within the
nuclear weapons program and other DOE programs in terms of
their potential to enhance health sciences, with the goal of
achieving clinical applications and improved national health
care.
Office of Dietary Supplements.--The Committee continues to
strongly support the important work of this Office. Use of
dietary supplements has increased significantly among Americans
who want to improve their health and prevent disease. There is
a great need for additional research to better inform consumers
of the health benefits of supplements. Accordingly, the
Committee has provided additional funds to expand this Office's
efforts. In particular, the Committee expects the ODS to
continue its ongoing collaborative efforts to develop,
validate, and disseminate analytical methods and reference
materials for the most commonly used botanicals and other
dietary supplements.
The Committee also expects the Office of Dietary
Supplements to contract with industry nonprofit associations or
foundations who currently have and maintain databases of
dietary supplement labels to develop, create, regularly update,
maintain, and make available to government and research
entities a database of all supplement labels sold in the United
States. The creation of this database would allow ODS to have
access for research purposes of all known supplements
manufactured in the United States and to allow access by other
Federal agencies for ensuring safety to consumers (through the
mandatory listing of ingredients in these products on the
label) who purchase supplements manufactured and/or sold in the
United States.
Office of Rare Diseases.--The Office of Rare Diseases [ORD]
plays an important role in bringing funding and attention to
rare disease research, in cooperation with the institutes and
centers. The Committee is concerned, however, that ORD has not
directed sufficient attention to rare liver diseases such as
autoimmune hepatitis, primary sclerosing cholangitis, and
primary biliary cirrhosis. The Committee urges ORD to work
closely with NIDDK to develop an appropriate response to
address these significant diseases and to work toward a
comprehensive research agenda.
Orphan Diseases.--The Committee applauds the Office of Rare
Diseases for its efforts to support the translation of basic
research findings into improved treatments for orphan diseases.
The Committee urges the Office to increase its support for
demonstration or pilot projects aimed at the development of
interventions for orphan diseases, including cystic fibrosis.
Outreach to Hispanics.--The Committee is pleased with the
leadership that NIH has shown, through its Projecto Ciencia
initiative, to provide state-of-the-art health material to
Hispanic consumers and information to Hispanic health
professionals on NIH research opportunities. The NIH is
encouraged to increase funding for this initiative with
expanded emphasis on increasing outreach to Hispanic consumers,
Hispanic participation in clinical trials, NIH training and
research opportunities, especially as principal investigators.
These efforts will support the NIH plan for eliminating racial
and ethnic disparities.
Parkinson's Disease.--The Committee is aware that the
Parkinson's Disease Research Agenda developed by NIH in 2000
included professional judgment funding projections that totaled
an additional $1,000,000,000 over 5 years to achieve a cure.
The Committee strongly urges the NIH to come as close as
possible to fulfilling that Agenda while maintaining the
standards of peer review.
The Committee is greatly concerned, therefore, to learn
that despite strong congressional support for the aims of the
Research Agenda, the NIH's projected Parkinson's funding of
$242,000,000 for fiscal year 2004 again falls substantially
short of the $400,000,000 professional judgment budget estimate
cited by the Research Agenda for that year.
The Committee commends the Director, NIH, for stating his
commitment to develop and implement a thorough plan for
Parkinson's research, and for the initial steps taken. However,
the NIH has failed to devote the resources necessary to
implement it and has failed to date to fill a key leadership
position, Director of NINDS.
The Committee strongly urges the NIH to devote additional
resources to Parkinson's research, as recommended by the
Research Agenda, using all available mechanisms, including
RFAs, further support of initiatives such as those begun at
NINDS and NIEHS, and the Genome Institute's proteomics
initiative, among others.
The Committee expects the NIH to report to Congress by
April 2004, on the steps it is taking to fulfill the
Parkinson's Disease Research Agenda and to implement the
Director's plan for Parkinson's research.
Practice-Based Clinical Research Networks.--Clinical
research is more important now than ever before to translate
advances in basic science into better diagnosis, prevention,
treatment, and cure of disease; and to provide high-quality
evidence of diagnosis and treatment effectiveness to fully
integrate into daily practice decisions. Placing clinical
studies at the community practice level will ensure adequate
representation of patients from all age, sex, and cultural
groups in clinical studies, and will also increase the number
of practicing clinicians who are trained to undertake clinical
research. A model for such networks was established by the
Agency for Healthcare Research and Quality [AHRQ]. The
Committee urges the Director of the National Institutes of
Health to adopt the AHRQ model networks to include specialty
practitioners who care for the most common health problems of
the American people.
Scleroderma.--The Committee strongly supports the
development of new research initiatives to support
interdisciplinary research centers that will focus on
scleroderma, a chronic, degenerative disease of collagen
production, that strikes mainly women and affects multiple
systems including digestive, kidney, heart, lung, and skin
often leading to premature death.
Skeletal Diseases.--Given that skeletal diseases can lead
to or be linked to other diseases such as depression and
cancer, the Committee calls for the expansion of trans-NIH
studies investigating these linkages.
Temporomandibular joint disorders [TMJ].--The May 2003
report to Congress on Temporomandibular Joint Disorders
explains that many Institutes, Centers, and Offices at NIH
support research that, although not necessarily directed toward
TMJ disorders, relates to this complex set of conditions. But
while the research initiatives continue to grow, they lack
sufficient integration, the report concludes. The Committee
agrees with this finding. The multifaceted nature of TMJ
disorders requires an approach that coordinates the work of the
many interested parties at NIH. Unfortunately, the
Temporomandibular Joint Diseases Interagency Working Group, the
creation of which was first requested in fiscal year 1998
report language from Congress, has not yet succeeded in uniting
NIH researchers behind a common vision for addressing TMJ
disorders. While many of the individual TMJ research
initiatives launched or planned by the NIH over the past
several years are commendable, there is no clear plan to insure
that they are the most appropriate initiatives to pursue, that
they do not duplicate research that is already being supported,
or that they will actually be implemented in a timely manner.
For example, the May 2003 report to Congress states that
``[t]he NIDCR in conjunction with the ORWH has begun to work
with patient advocacy groups and professional organizations to
develop a workshop on stigmatization of the TMJ disorders.''
This is the exact same language used in the May 2002 report to
Congress, and there is still no date for the workshop.
Because of these concerns, the Committee strongly urges the
Director to oversee the development of a TMJ research agenda
that would guide further research planning at the NIH, as well
as the entire scientific community. Such an effort can draw
upon the TMJ research recommendations from recent conferences
and should include input from, at a minimum, all of the
Institutes, Centers, and Offices that support research that
could be directed toward TMJ disorders, as well as the TMJ
Association. The Committee expects this agenda to include
specific short- and long-term goals and the designation of
``primary leads'' to carry out those goals.
Translational Research Initiative.--The Committee in the
past has noted that while research supported by NIH has
produced a wealth of knowledge about the fundamentals of human
health and disease, the accumulation of scientific knowledge
for its own sake is of little value unless it finds its way to
hospitals and physicians, where it can be put to use in finding
treatments, cures and prevention strategies for patients.
Therefore, the Committee urges the Director to devote a
significant amount of resources for translational and clinical
research designed to develop and deliver new treatments and
cures with scientific and therapeutic promise to patients with
serious illnesses.
Tuberous Sclerosis Complex.--Tuberous sclerosis complex, or
TSC, is a genetic disorder that attacks many of the body's
vital organs including brain, heart, kidneys, lungs, eyes, and
skin. TSC is characterized by tumor growth and lesions of the
central nervous system that can result in seizures, autism,
mental retardation, and kidney failure. An estimated 50,000
Americans are thought to suffer from TSC, making it more
prevalent than cystic fibrosis and Lou Gehrig's disease. But
because it is not widely known by the general public, nor
commonly recognized by medical professionals, the number of
individuals with TSC could be far greater. The Committee is
concerned that insufficient funds are being devoted to research
on TSC, and that because of its far-reaching effects on
multiple organ systems the key to research breakthroughs may
rest with several institutes. The Committee therefore strongly
urges the NIH Director to formulate an NIH-wide research
agenda, including an appropriate mechanism to coordinate
research efforts across institute lines, and report by April
2004.
Young Investigators and Clinical Scientists.--The Committee
understands that there is an urgent need for more young
investigators and clinical scientists, and therefore urges NIH
to establish a trans-NIH initiative to allocate more funds for
training and transitional grants and debt repayment programs,
and revise eligibility guidelines, funding levels and scope to
further their effectiveness.
OFFICE OF AIDS RESEARCH
The Committee recommendation does not include a direct
appropriation for the Office of AIDS Research [OAR]. Instead,
funding for AIDS research is included within the appropriation
for each Institute, Center, and Division of the NIH. The
recommendation also includes a general provision which directs
that the funding for AIDS research, as determined by the
Director of the National Institutes of Health and the OAR, be
allocated directly to the OAR for distribution to the
Institutes consistent with the AIDS research plan. The
recommendation also includes a general provision permitting the
Director of the NIH and the OAR to shift up to 3 percent of
AIDS research funding among Institutes and Centers throughout
the year if needs change or unanticipated opportunities arise.
The Committee requests that the Director provide notification
to the Committee in the event the Directors exercise the 3
percent transfer authority.
The NIH Office of AIDS Research [OAR] coordinates the
scientific, budgetary, legislative, and policy elements of the
NIH AIDS research program. Congress provided new authorities to
the OAR to fulfill these responsibilities in the NIH
Revitalization Act Amendments of 1993. The law mandates the OAR
to develop an annual comprehensive plan and budget for all NIH
AIDS research and to prepare a Presidential bypass budget.
BUILDINGS AND FACILITIES
Appropriations, 2003.................................... $628,687,000
Budget estimate, 2004................................... 80,000,000
Committee recommendation................................ 89,500,000
The Committee recommends an appropriation of $89,500,000
for buildings and facilities [B&F]. The budget requested
$80,000,000 and the fiscal year 2003 appropriation was
$628,687,000.
Mission.--The buildings and facilities appropriation
provides for the NIH construction programs including design,
construction, and repair and improvement of the clinical and
laboratory buildings and supporting facilities necessary to the
mission of the NIH. This program maintains physical plants at
Bethesda, Poolesville, Baltimore, and Frederick, MD; Research
Triangle Park, NC; Hamilton, MT; Perrine, FL; New Iberia, LA;
and Sabana Seca, PR.
The Committee has included full-scope bill language within
this appropriation to give flexibility to the NIH to continue
work on the John E. Porter Neuroscience Research Center. Funds
have also been included for the building 10 transition program,
asbestos abatement, fire protection and life safety,
rehabilitation of the animal research facility and air quality
improvement programs. Funds have also been included to
eliminate barriers to persons with disabilities.
Substance Abuse and Mental Health Services Administration
Appropriations, 2003.................................... $3,211,740,000
Budget estimate, 2004................................... 3,409,315,000
Committee recommendation................................ 3,274,590,000
The Committee recommends $3,274,590,000 for the Substance
Abuse and Mental Health Services Administration [SAMHSA] for
fiscal year 2004. The comparable level for fiscal year 2003 was
$3,211,740,000 and the administration request was
$3,409,315,000. The recommendation includes $117,050,000 in
transfers available under section 241 of the Public Health
Service Act. SAMHSA is responsible for supporting mental health
programs and alcohol and other drug abuse prevention and
treatment services throughout the country, primarily through
categorical grants and block grants to States.
The Committee has provided funding for programs of regional
and national significance under each of the three SAMHSA
centers: mental health services, substance abuse treatment and
substance abuse prevention. Separate funding is available for
the children's mental health services program, projects for
assistance in transition from homelessness, the protection and
advocacy program, data collection activities undertaken by the
Office of Applied Studies and the two block grant programs: the
community mental health services block grant and the substance
abuse prevention and treatment block grant.
The Committee remains concerned by the disproportionate
presence of substance abuse in rural and native communities,
particularly for American Indian, Alaska Native and Native
Hawaiian communities. The Committee reiterates its belief that
funds for prevention and treatment programs should be targeted
to those persons and communities most in need of service.
Therefore, the Committee has provided sufficient funds to fund
projects to increase knowledge about effective ways to deliver
services to rural and native communities.
The Committee continues to strongly support the ongoing
collaboration between SAMHSA and the National Institutes of
Health, specifically the National Institute of Mental Health,
the National Institute on Drug Abuse, and the National
Institute on Alcohol Abuse and Alcoholism. The Committee urges
SAMHSA to make concerted efforts to reduce the current 15- to
20-year lag between the discovery of an effective treatment or
intervention and its availability at the community level.
The Committee is troubled by SAMHSA's letter to the
National Academy of Sciences Institute of Medicine recommending
that it include traditional advocacy groups and the alcoholic
beverage industry as peer reviewers for the NAS/IOM report on a
national strategy to reduce and prevent underage drinking prior
to the report's release. The Committee provided funding to the
NAS for this report in fiscal year 2002 because it values the
NAS's reputation for objectivity, independence, and competence,
and it has confidence that the NAS will offer the most
appropriate science-based findings and recommendations. SAMHSA
should not recommend the involvement of groups with potential
conflicts of interest in the peer review process. The Committee
believes the NAS has developed appropriate policies for the
conduct of the peer review process that will ensure a balanced,
objective and science-based report.
CENTER FOR MENTAL HEALTH SERVICES
Appropriations, 2003.................................... $856,487,000
Budget estimate, 2004................................... 834,006,000
Committee recommendation................................ 855,711,000
The Committee recommends $855,711,000 for mental health
services. The comparable level for fiscal year 2003 was
$856,487,000 and the administration request was $834,006,000.
The recommendation includes $21,850,000 in transfers available
under section 241 of the Public Health Service Act. Included in
the recommendation is funding for programs of regional and
national significance, the mental health performance
partnership block grant to the States, children's mental health
services, projects for assistance in transition from
homelessness, and protection and advocacy services for
individuals with mental illnesses.
Programs of Regional and National Significance
The Committee recommends $237,667,000 for programs of
regional and national significance. The comparable level for
fiscal year 2003 was $244,443,000 and the administration
request was $211,757,000. Programs of regional and national
significance address priority mental health needs through
developing and applying best practices, offering training and
technical assistance, providing targeted capacity expansion
grants, and changing the delivery system through family,
client-oriented and consumer-run activities.
The Committee notes that approximately 22 percent of U.S.
adults--about 44 million people--are affected by a diagnosable
mental disorder. Approximately 5 to 7 percent of adults in a
given year have a serious mental illness. Yet nearly two-thirds
of adults with diagnosable mental disorders do not seek
treatment. One in ten children and adolescents suffer from
mental illness severe enough to cause some level of impairment,
but fewer than 1 in 5 of these children receive needed
treatment. The cost of untreated mental illness is immense:
estimates show that mental illness annually costs employers
about $300,000,000,000 in absenteeism and lowered productivity.
When compared with all other diseases (such as cancer and heart
disease), mental illness ranks first in terms of causing
disability in the United States, Canada, and Western Europe.
These figures underscore the urgency of treating mental
illness. The U.S. Surgeon General's Report on Mental Health
identified stigma as a major barrier to people receiving mental
health treatment. Stigma can discourage individuals and their
families from seeking help and can also result in inadequate
insurance coverage for mental health services. The Committee
understands that the President's New Freedom Commission on
Mental Health will be issuing its final report shortly with
recommendations to improve America's mental health service
delivery system for individuals with serious mental illness and
children with serious emotional disturbances. In the interim,
the Committee believes it is time to launch a national public
awareness campaign to build public support for treatment,
recovery and community-based mental health services to overcome
the stigma associated with mental illness. The Committee has
provided $2,500,000 to SAMHSA to develop and advertise a public
service campaign to destigmatize mental illness.
The Committee continues to support funding for mental
health counselors for school-age children, as part of an effort
to reduce the incidence of youth violence. The Committee
intends that $95,000,000 be used for counseling services for
school-age youth. Among other things, the Committee believes
that mental health counseling for troubled youth can help
prevent violent acts, and therefore is providing continued
funding to help schools in that effort. It is again expected
that SAMHSA will collaborate with the Departments of Education
and Justice to continue a coordinated approach.
The Committee notes that suicide continues to claim almost
30,000 lives each year, making it one of the top 15 causes of
death in the United States. An additional 500,000 Americans
attempt suicide annually. For 15- to 24-year-olds, suicide is
the third leading cause of death. The Committee continues to
support State and local efforts to reduce the occurrence of
this premature and unfortunate loss of life. The Committee has
included $3,000,000 to continue supporting the National Suicide
Prevention Resource Center. This important initiative supports
technical assistance in developing, implementing and evaluating
effective suicide prevention programs. The Resource Center
serves as a training and field support and acts as a
clearinghouse for all pertinent best practices information
regarding suicide prevention, and it promotes evaluation of
suicide prevention programs to ensure that effective
techniques, strategies, and recommended best practices are made
available to users. The Committee also continues funding at
last year's level for the Suicide Prevention Hotline program.
The Committee appreciates CMHS's commitment to improving
the quality, effectiveness and availability of therapeutic
services delivered to traumatized children and adolescents;
furthering the understanding of the individual, familial, and
community impact of child and adolescent traumatic stress and
the methods used to prevent its consequences; and reducing the
frequency and consequences of traumatic events on children and
adolescents. The Committee recommendation includes $30,000,000
to continue and build on the National Child Traumatic Stress
Initiative.
The Committee continues to recognize the importance of
consumer/peer-run programs that help people with mental
illnesses live successfully in the community. These low-cost
services have an impressive record of assisting people with
mental disorders to decrease their dependence on expensive
social services and avoid psychiatric hospitalization. The
Committee provides $2,000,000 above the budget request to
continue the current level of funding for the consumer and
consumer-supporter national technical assistance centers. The
Committee directs CMHS to support multi-year grants to five
such national technical assistance centers.
The Committee recommendation includes funding of $4,895,000
to continue the elderly treatment and outreach program.
Demographic projections show that by the year 2010, there will
be approximately 40 million Americans over the age of 65. The
Committee notes that more than 1 in 5 will experience mental
disorders. This grant program will help local communities
establish the infrastructure necessary to better serve the
mental health needs of older adults.
The Committee supports $6,059,000 for the jail diversion
grant program. The Committee recognizes that up to 1 million
individuals with mental illnesses will spend time either in
jail or prison during the current year. This is a most
unfortunate statistic, when individuals could be more
appropriately treated in a community health setting. Therefore,
the Committee urges SAMHSA to work with the Department of
Justice, the law enforcement community, the court system and
other appropriate agencies and associations to ensure that
funding is utilized to divert inappropriate incarcerations and
link individuals with mental illnesses with the support they
need to avoid future contact with the criminal justice system.
The Committee notes that an estimated 842,000 adults and
children are homeless in the United States in any given week.
Approximately 200,000 people are chronically homeless. The
Committee supports the Department's plan released earlier this
year to end chronic homelessness. The Committee recommendation
includes funding at no less than last year's level to support
programs addressing homelessness.
The Committee remains concerned about the ongoing problem
of post-traumatic stress disorder among the refugee immigrant
population in Hawaii, and it urges vigorous attention to the
mental health problems of these future citizens.
The Committee also recognizes the urgency of training
additional minority mental health professionals, including
Native Hawaiians, and it encourages SAMHSA to provide
additional resources to the Minority Fellowship Program.
Between 7 million to 10 million teenagers suffer from a
mental health condition which, for many, may lead to serious
behavioral problems including dropping out of school, substance
abuse, violence, and suicide. The Committee is aware that some
school districts, juvenile justice facilities, and community-
based clinics have taken advantage of relatively simple
screening tools now available to detect depression, the risk of
suicide, and other mental disorders in teenagers. The Committee
believes that screening should occur with the consent of the
adolescent and his or her parents or guardian, and with a
commitment by the screener to make counseling and treatment for
those found to be at-risk. The Committee strongly urges SAMHSA
to make the availability of these screening programs more
widely known, and to collaborate with the Department of
Education, Department of Justice, CDC, HRSA, and other
pertinent agencies to encourage implementation of similar
teenage screening programs. The Committee expects to receive a
report on steps being taken to promote this effort prior to the
fiscal year 2005 appropriations hearings.
Mental Health Performance Partnership Block Grant
The Committee recommends $437,140,000 for the mental health
performance partnership block grant, the same amount as the
comparable fiscal year 2003 level. The administration's request
was $433,000,000. The recommendation includes $21,850,000 in
transfers available under section 241 of the Public Health
Service Act. States use these funds to support the development
and implementation of innovative community-based services and
maintain continuity of community programs. Funds are allocated
to States and territories by formula.
Children's Mental Health Services
The Committee recommends $98,052,000 for the children's
mental health services program, the same as the comparable
fiscal year 2003 level. The administration's request was
$106,694,000. This program provides grants and technical
assistance to support community-based services for children and
adolescents with serious emotional, behavioral or mental
disorders. Grantees must provide matching funds, and services
must involve the educational, juvenile justice, and health
systems.
Projects for Assistance in Transition From Homelessness [PATH]
The Committee recommends $47,073,000 for the PATH Program.
The comparable fiscal year 2003 level was $43,073,000 and the
administration's request was $50,055,000.
PATH is a critical program which provides outreach, mental
health, and case management services and other community
support services to individuals with serious mental illness who
are homeless or at risk of becoming homeless. The PATH Program
makes a significant difference in the lives of homeless persons
with mental illnesses. PATH services eliminate the revolving
door of episodic inpatient and outpatient hospital care.
Multidisciplinary teams address client needs within a continuum
of services, providing needed stabilization so that mental
illnesses and co-occurring substance abuse and medical issues
can be addressed. Assistance is provided to enhance access to
housing, rehabilitation and training, and other needed
supports, assisting homeless people in returning to secure and
stable lives.
The Committee notes that the PATH program has been
described by the administration in its performance assessments
as ``moderately effective.'' The administration notes that the
program's existing data indicate progress toward meeting long-
term performance measures. Additionally, evaluations have found
that PATH succeeds at targeting homeless individuals with
serious mental illness. For example, 35 percent of clients who
received funded services were diagnosed with schizophrenia or
some other psychotic disorder. An additional 30 percent were
diagnosed with an effective disorder such as major depression
or bipolar disorder. The Committee shares the administration's
assessment and intends to continue supporting this important
and effective program.
Protection and Advocacy
The Committee recommends $35,779,000 for the protection and
advocacy program. The comparable fiscal year 2003 level was
$33,779,000 and the administration's request was $32,500,000.
This program helps ensure that the rights of mentally ill
individuals are protected while they are patients in treatment
facilities, or while they are living in the community,
including their own homes. Funds are allocated to States
according to a formula based on population and relative per
capita income.
The Children's Health Act of 2000 provided additional
authorities to State P&A systems in their efforts to protect
the rights of individuals with mental illness and severe
emotional impairment. State P&A systems also have a significant
role in addressing the community integration needs of
individuals identified in the Olmstead decision. The Committee
has provided additional resources to support State P&A systems
in their effort to address these critical issues.
CENTER FOR SUBSTANCE ABUSE TREATMENT
Appropriations, 2003.................................... $2,071,210,000
Budget estimate, 2004................................... 2,341,816,000
Committee recommendation................................ 2,131,003,000
The Committee recommends $2,131,003,000 for substance abuse
treatment programs. The comparable fiscal year 2003 funding
level is $2,071,210,000 and the administration's request was
$2,341,816,000. The recommendation includes $79,200,000 in
transfers available under section 241 of the Public Health
Service Act. This amount funds substance abuse treatment
programs of regional and national significance and the
substance abuse prevention and treatment block grant to the
States.
The Committee is concerned with the devastating impact
substance abuse has on our country. A conservative estimate of
those in need of substance abuse treatment is between 13 and 16
million people. In contrast, studies conclude that
approximately 3 million receive care for substance abuse in 1
year. As a result our Nation faces a ``treatment gap'' of more
than 10 million people--those who need treatment, but do not
receive the services necessary to address their problems. It is
estimated that more than 100,000 people have sought treatment
but were unable to find it.
The Committee commends the President for highlighting
substance abuse treatment in his 2003 State of the Union
address and for providing additional funding in his budget
request to address the treatment gap. The Committee is aware
that the economic cost to society of substance abuse has
reached more than $250,000,000,000 a year. Over the next 20
years, it is estimated that substance abuse is likely to cost
the Medicare program $1,000,000,000,000 for hospital care. Yet
treatment is remarkably successful: research shows that
treatment reduces drug use, criminal activity, homelessness,
and behaviors that are high risk for developing HIV/AIDS
infection. Similarly, clients in drug addiction treatment
report increases in employment and income, as well as
improvements in mental and physical health. Treatment is also
extremely cost-effective: every $1 invested in substance abuse
treatment has a return of $7 in reduced health costs, crime and
lost productivity. The Committee believes that additional
funding for substance abuse treatment is desperately needed and
for this reason has provided $50,000,000 above last year's
level for the substance abuse prevention and treatment block
grant.
The Committee has noted with interest the administration's
Access to Recovery initiative to provide vouchers to States for
substance abuse treatment services. However, due to tight
budget constraints the Committee has not provided funding for
the administration's initiative. In addition, the Committee has
concerns that many implementation issues have not been
resolved, such as the role of professional assessment,
certification requirements, and the administrative costs of
setting up a separate voucher program for treatment. The
Committee is supportive of the administration's desire to
expand the pathways to treatment, but believes that more
details need to be resolved before major resources are provided
to a new program.
While the Committee commends SAMHSA for the work done to
address the treatment gap, it is concerned that the request for
additional treatment resources come at the expense of substance
abuse prevention activities. The Committee strongly believes
that treatment and prevention are both key to reducing
substance abuse. The Office of National Drug Control Policy has
included prevention along with treatment and market disruption
as its three priorities for its national drug control strategy.
The ONDCP has recognized prevention as our first line of
defense, and notes ``it is critical to teach young people how
to avoid drug use because of the damage drugs can inflict on
their health and on their future.'' The Committee strongly
agrees, and has made the restoration of SAMHSA's drug
prevention programs a priority.
Programs of Regional and National Significance
The Committee recommends $327,071,000 for programs of
regional and national significance [PRNS]. The comparable
fiscal year 2003 level was $317,278,000 and the
administration's request was $556,816,000.
Programs of regional and national significance include
three primary activities: best practice programs are used to
develop more information on how best to serve those most in
need; training and technical assistance supports dissemination
of information through knowledge development; and targeted
capacity expansion programs enable the agency to respond to
service needs in local communities.
The Committee has not provided funding for the Access to
Recovery initiative due to budget constraints. The Committee
also believes that more details need to be resolved before
major resources are provided to this new program.
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.
Only 21 percent of treatment facilities offer programs for
pregnant and postpartum women. In addition, only 6 percent of
treatment programs include prenatal care and only 12 percent
provide childcare. Mothers with substance abuse problems and
their children require distinct, family-oriented treatment
services that address the injuries of sexual and physical
violence, major depression and other underlying issues.
SAMHSA's evaluation of both the Residential Women and Children
[RWC] and Pregnant and Postpartum Women [PPW] programs showed
significantly reduced alcohol and drug use, as well as
decreased criminal behavior. Rates of premature delivery, low
birth weight, and infant mortality were improved for
participating women. In addition, treatment costs were offset
three to four times by savings from reduced costs of crime,
foster care, Temporary Assistance to Needy Families [TANF], and
adverse birth outcomes. The Committee believes that increased
capacity is necessary for treatment programs designed for
pregnant and parenting women and their families. Within the
funds appropriated for CSAT, the Committee recommends
$10,000,000 for treatment programs for pregnant, postpartum,
and residential women and their children. No less than last
year's funding shall be used for the Residential Treatment
Program for Pregnant and Postpartum Women [PPW], authorized
under section 508 of the Public Health Service Act.
The Committee has provided funding at no less than last
year's level for CSAT's program of clinically based treatment
and related services for adult, juvenile and family drug courts
and individuals returning from the community who are on
probation, parole, or unsupervised release. The Committee is
aware of the rapid increases in the use of drug courts
throughout the country as an alternative to the traditional
court system. These courts make substance abuse treatment
available, when appropriate, as an alternative to
incarceration, and are considered a cost-effective approach to
helping drug users regain control of their lives.
The Committee recommends funding at no less than last
year's level to CSAT's grants for homeless individuals program,
a collaboration between CSAT and CMHS addressing the substance
abuse and mental health treatment needs of homeless
individuals. The Committee notes that as many as half of
homeless adults have histories of alcohol abuse or dependence,
one-third have histories of drug abuse and one-quarter have
lifetime histories of serious mental illness. The Committee
encourages these Centers to devote as much additional funding
as possible for new awards.
Programs of regional and national significance include
critical support for substance abuse treatment services for the
Nation's homeless population. The homeless have unique needs
and life circumstances that have received inadequate attention
in terms of substance abuse treatment. Therefore, the Committee
continues to advocate coordinated and seamless service delivery
for the homeless that includes mental health, primary care, and
other social services that will support positive treatment
outcomes. The Committee recommendation includes funding at no
less than last year's level to continue to make progress in
this area.
The Committee has provided funding at no less than last
year's level on targeting specific treatment approaches for
adolescents. The Committee is aware of the lack of available
treatment programs specifically designed to address the needs
of adolescents. The Committee believes that adolescents would
respond more favorably to treatment services offered in such a
manner.
The Committee recommendation includes no less than
$35,000,000 for programs funded under targeted capacity
expansion [TCE] for general populations. These programs are
designed to address gaps in treatment capacity by supporting
rapid and strategic responses to demands for treatment services
in communities with serious, emerging drug problems.
The Committee expresses its support for the following
programs and has included funding at no less than last year's
level: minority HIV/AIDS, addiction technology transfer
centers, pharmacologic activities, young offender reentry, and
targeted treatment capacity expansion. The Committee has also
recommended funding at the administration's request for
programs addressing co-occurring disorders, aging adults,
criminal justice activities, and knowledge, development and
application activities.
The Committee is concerned that States have been declared
ineligible to apply for certain targeted capacity expansion
grants. The Committee expects SAMHSA to submit to the Committee
a plan in the fiscal year 2005 budget request to address this
issue for all TCE and other appropriate grants.
The Committee recognizes the need for a qualified and
stable workforce to staff treatment centers. The unmet need for
treatment services is exacerbated by a workforce crisis in the
field of addictions treatment and prevention. The Committee
urges SAMHSA to evaluate workforce recruitment, training
shortages and retention.
Substance Abuse Prevention and Treatment Block Grant
The Committee recommends $1,803,932,000 for the substance
abuse prevention and treatment block grant. The recommendation
includes $79,200,000 in transfers available under section 241
of the Public Health Service Act. The comparable level for
fiscal year 2003 was $1,753,932,000 and the administration
request was $1,785,000,000. The block grant provides funds to
States to support alcohol and drug abuse prevention, treatment,
and rehabilitation services. Funds are allocated to the States
according to formula. State plans must be submitted and
approved annually.
The Children's Health Act of 2000 made several changes in
SAMHSA, including the transition from the current block grant
to a performance partnership grant [PPG] framework, in which
States are granted program flexibility in exchange for
implementing a common set of performance measures. The
Committee's recommendation reflects its belief that the most
effective and efficient method to support substance abuse
programs in every State is to direct the bulk of available new
resources into the PPG. The Committee wishes to express its
strong support for preserving the current block grant and
future PPG as the foundation of our publicly funded substance
abuse system in every State and territory in the United States.
Similarly, the Committee is concerned with any effort that
could erode the strength of the current and future block grant.
At a time when States are facing fiscal crises, with some
cutting substance abuse services, the maintenance of treatment
infrastructure and capacity at the local level is extremely
important. The Committee encourages SAMHSA to make the
implementation of the PPG its number one priority for substance
abuse programming and to allocate commensurate resources to
support the transition to reflect this priority status.
CENTER FOR SUBSTANCE ABUSE PREVENTION
Appropriations, 2003.................................... $197,111,000
Budget estimate, 2004................................... 148,186,000
Committee recommendation................................ 194,306,000
The Committee recommends $194,306,000 for programs to
prevent substance abuse. The comparable fiscal year 2003 level
was $197,111,000 and the administration request was
$148,186,000. This amount funds substance abuse prevention
programs of regional and national significance.
The Committee has restored $46,120,000 to the Center for
Substance Abuse Prevention in recognition of CSAP's key role in
improving the capacity and effectiveness of substance abuse
prevention at the State and community levels. The Monitoring
the Future study showed broad decreases in drug use from 2001
to 2002, with students in all grades showing declines in
prevalence for the use of illicit drugs. The use of ecstasy
showed significant declines for the first time after rising
rapidly in recent years. The proportion of 8th and 10th graders
reporting the use of any illicit drug in the prior year
declined significantly. The use of marijuana among eighth-
graders is at its lowest rate since 1994. These findings show
that drug prevention efforts are working. With drug use finally
dropping among school-aged youth after almost a decade of
dramatic increases, the Committee believes this is not the time
to reduce CSAP's funding.
In addition, effective substance abuse prevention efforts
pay economic dividends--every dollar spent on drug use
prevention will save communities $4 to $5 in costs for drug
abuse treatment and counseling. Findings from CSAP's study of
data from its High Risk Youth program demonstrate an overall
decrease of approximately 25 percent in the frequency of
substance abuse among 11- to 17-year olds participating in the
program. New and emerging drug trends, such as ecstasy, coupled
with the need to sustain prevention efforts over time so that
each new cohort of youth has the benefit of effective
prevention, necessitate the restoration of funding for CSAP.
The Committee is concerned that the trend of the administration
to request insufficient funding levels for CSAP not only
endangers recent drug prevention efforts, it also hampers the
ability of SAMHSA to plan for and fund longer-term grants,
especially in critical areas such as emerging drug trends. With
the restored funding, the Committee expects CSAP to focus its
efforts on identifying and diffusing comprehensive community-
wide strategies to reduce youth drug use, with an emphasis on
increasing the age of first use of alcohol and illicit drugs.
Programs of Regional and National Significance
The Committee has provided $194,306,000 for programs of
regional and national significance [PRNS]. The comparable
fiscal year 2003 level was $197,111,000 and the administration
request was $148,186,000. The Center for Substance Abuse
Prevention is the sole Federal organization with responsibility
for improving accessibility and quality of substance abuse
prevention services. Through the programs of regional and
national significance activity, CSAP supports: development of
new practice knowledge on substance abuse prevention;
identification of proven effective models; dissemination of
science-based intervention information; State and community
capacity-building for implementation of proven effective
substance abuse prevention programs; and programs addressing
new needs in the prevention system.
The Committee notes that over the past 10 years there has
been an alarming increase in the use and availability of
ecstasy and other club drugs among our Nation's youth.
According to SAMHSA's Drug Abuse Warning Network, ecstasy-
related emergency room admissions in the United States
increased significantly from 253 in 1994 to 5,542 in 2001. The
Committee urges SAMHSA to pay close attention to this and other
emerging drug use issues. The Committee has included $5,000,000
to continue and expand on the program funded last year.
The Committee notes that prenatal alcohol exposure is the
leading known cause of mental retardation and birth defects in
the United States. It is associated with lifelong difficulties
with learning, memory, attention, and problem solving as well
as problems with mental health and social interactions. A
recent study showed that 15 percent of pregnant women surveyed
as they waited in clinics for prenatal care indicated they had
drunk alcohol during pregnancy. At least 5,000 infants are born
each year with Fetal Alcohol Syndrome [FAS] and another 50,000
children show symptoms of Fetal Alcohol Effect [FAE]. The
Committee has provided $10,000,000 to strengthen system-wide
approaches to identify and serve women at risk of delivering
FAS/FAE children, with an emphasis on teen mothers.
The Committee strongly supports CSAP's evidence-based
practices, especially the community-initiated prevention grant
program. This program supports field testing of effective
substance abuse interventions in the local community that
prevent, reduce, or delay substance use and substance abuse
related problems. The Committee has provided funding for this
program at no less than last year's level for identifying the
mix of environmental and other strategies to most effectively
reduce youth drug and alcohol use. The Committee also continues
to support the high risk youth program at no less than last
year's level of funding.
PROGRAM MANAGEMENT
The Committee recommends $93,570,000 for program management
activities of the agency. The recommendation includes
$16,000,000 in transfers available under section 241 of the
Public Health Service Act. The comparable level for fiscal year
2003 was $85,983,000 and the budget request was $85,307,000.
The program management activity includes resources for
coordinating, directing, and managing the agency's programs.
Program management funds support salaries, benefits, space,
supplies, equipment, travel, and departmental overhead required
to plan, supervise, and administer SAMHSA's programs.
The Committee is concerned that SAMHSA has not yet provided
Congress information detailing the resources each State will
need for data infrastructure and other needs to support a
transition to a performance partnership grant as called for in
the Children's Health Act of 2000. The Committee expects SAMHSA
to work with the State and local substance abuse community in
order to accurately determine the resources needed for the new
and expanded data collection requirements and to report this
information to Congress expeditiously.
In an effort to reach a more accurate assessment of the
substance abuse treatment gap, the Committee expects SAMHSA to
encourage other Federal agencies that fund substance abuse
treatment services to participate in a client level data system
administered by SAMHSA.
Agency for Healthcare Research and Quality
Appropriations, 2003.................................... $303,695,000
Budget estimate, 2004................................... 279,000,000
Committee recommendation................................ 303,695,000
The Committee recommends $303,695,000 for the Agency for
Healthcare Research and Quality [AHRQ]. This amount is the same
as the comparable funding level for fiscal year 2003. The
administration request was $279,000,000. The Committee has
funded AHRQ through transfers available under section 241 of
the Public Health Service Act.
The Agency for Healthcare Research and Quality was
established in 1990 to promote improvements in clinical
practice and patient outcomes, promote improvements in the
financing, organization, and delivery of health care services,
and increase access to quality care. AHRQ is the Federal agency
charged to produce and disseminate scientific and policy-
relevant information about the cost, quality, access, and
medical effectiveness of health care. AHRQ provides
policymakers, health care professionals, and the public with
the information necessary to improve cost effectiveness and
appropriateness of health care and to reduce the costs of
health care.
HEALTH COSTS, QUALITY, AND OUTCOMES
The Committee provides $245,695,000 for research on health
costs, quality and outcomes [HCQO]. The comparable amount for
fiscal year 2003 was $247,695,000. HCQO research activity is
focused upon improving clinical practice, improving the health
care system's capacity to deliver quality care, and tracking
progress toward health goals through monitoring and evaluation.
The Committee does not approve the administration's proposal to
shift $10,000,000 to the Department of Commerce for the Current
Population Survey and directs that none of AHRQ's funds be used
or transferred for this purpose.
For fiscal year 2004, the Committee directs AHRQ to devote
$84,000,000 of the total amount provided for HCQO to
determining ways to reduce medical errors. This represents an
increase of $29,000,000 over the comparable fiscal year 2003
level. The Committee understands that $50,000,000 of the
recommendation will support an initiative to promote the
development, adoption, and diffusion of information technology
[IT] in health care. The Committee fully supports the
Department's emphasis on information technology as a way to
improve patient safety. The U.S. health care system lags behind
others in the utilization of the internet and information
technology applications. Greater investments in computer
technology advances such as computerized physician order entry,
automated medication dispensing and computerized patient
records have enormous potential to greatly improve health care
safety, efficiency and quality. In addition, these types of IT
improvements have frequently been shown to have the ancillary
benefit of improving cost savings.
Since fiscal year 2001 the Committee has provided
$165,000,000 to AHRQ for research into ways to reduce medical
errors. The Committee understands that the Department is
preparing an interim report, due in September, on the results
of medical error research and demonstration projects. The
Committee looks forward to receiving this report and hopes it
will detail the effectiveness of different strategies for
reducing medical errors, as well as suggest ways of promoting
the use of effective strategies in hospitals and other clinical
settings.
While the Committee recognizes the urgency of minimizing
medical errors, it believes that improving patient safety is
only one part of a strategy to improve the overall quality of
health care in this country. In its report ``Crossing the
Quality Chasm: A New Health System for the 21st Century,'' the
Institute of Medicine noted that a gap exists between the
health care services that should be provided based on current
professional knowledge and technology, and those that many
patients actually receive. While there has been a dramatic
growth in spending on medical research and technology, the IOM
noted that ``our health care system frequently falls short in
its ability to translate knowledge into practice, and to apply
new technology safely and appropriately.'' Recent studies
indicate that fewer than half of U.S. patients with
hypertension, depression, diabetes and asthma are receiving
appropriate treatment. In addition, a recent study suggests
that while Americans pay higher prices for health care than any
other country, according to many measures we are getting less
care than people in other industrialized countries. For this
reason, the Committee is concerned that that the current
funding level will not allow AHRQ to award any new non-patient
safety grants. The Committee believes that limiting AHRQ's
research to patient safety will impair promising research into
strategies to reduce health care costs, improve access to
effective services, and translate medical research into
practice at precisely the time that such research is needed to
improve the efficiency of health care. The Committee urges the
Secretary to commit increased resources to non-patient safety
research at AHRQ in its fiscal year 2005 budget request.
Chiropractic Care.--The Committee believes additional
research is necessary to further quantify the already-known
benefits of chiropractic care. The results of several patient-
based studies suggest that chiropractic care may result in
significant savings of healthcare dollars and reduce physician
visits and hospital stays. The Committee encourages AHRQ to
develop objective outcome-based assessment tools and a
systematic data gathering and analysis process leading to the
development of ``best practices'' for enhancing the physical,
mental, and social aspects of health in a diverse patient
population.
Drug Metabolism.--The Committee is very concerned that a
high percentage of admissions to psychiatric hospitals are
necessitated by moderate to severe adverse drug effects.
Genetic testing has been promoted as a means to improve drug
safety and efficacy, particularly since microarray technology
now allows testing across various drug response pathways in a
timely and cost effective manner. The practicality of applying
genetic information in clinical practice, however, depends on
the determination of whether genotype predicts dose response or
adverse events, affects clinical outcomes, and alters the cost
of patient care significantly. The Committee urges the Agency
to support evidence-based research projects focused on the
relationship between metabolic genes and drug efficacy and
safety. The Committee also urges the Agency to disseminate
evidence-based reports to physicians and other health care
professionals.
Mental Health and Older Americans.--The Committee is
seriously concerned about the prevalence of undiagnosed and
untreated mental illness among older Americans. Affective
disorders, including depression, anxiety, dementia, and
substance abuse and dependence, are often misdiagnosed or not
recognized at all by primary and specialty care physicians in
their elderly patients. While effective treatments for these
conditions are available, there is an urgent need to translate
advancements from biomedical and behavioral research to
clinical practice. The Committee urges the Agency 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.
Primary Immunodeficiencies Diseases.--The Committee remains
concerned with the underdiagnosis of this class of diseases.
Research has shown that screening of health records in a
hospital emergency department can result in significant
increases in the identification of these patients. The
Committee urges AHRQ to support evidence-based research
projects focused on the diagnosis of PI in a large urban health
care system and to disseminate evidenced based reports to
physicians and other health care professionals.
Social Work Research.--In support of the AHRQ priority of
``translating research into practice'' the Committee recommends
that AHRQ work with social work leaders to increase the number
of social work researchers undertaking health services
research. Social work research addresses health disparities,
mental illness and co-occurring disorders, delivery of health
and mental health care in community settings and health care
for older Americans. The Committee encourages dissemination of
evidence-based reports to social work health care
professionals.
Treatment of Chronic Rhinosinusitis.--The National Health
Interview Survey indicates that ``sinusitis'' is the most
common chronic health complaint in the United States. An
estimated 31 million Americans experience rhinosinusitis each
year, accounting for 18 million annual visits to primary care
physicians at an estimated direct healthcare cost of almost
$6,000,000,000. Studies are needed of overall clinical
effectiveness of the treatment of chronic rhinosinusitis,
comparing the effectiveness of medical and surgical treatment
options, and assessing the impact of co-morbid disease such as
asthma, allergy, immunodeficiency, etc. on treatment
effectiveness. The Committee recommends that AHRQ consider
supporting research studies comparing treatment options of
chronic rhinosinusitis.
MEDICAL EXPENDITURES PANEL SURVEYS
The Committee provides $55,300,000 for health insurance and
medical expenditures panel surveys [MEPS], which is the same as
the administration request. The comparable fiscal year 2003
level was $53,300,000. MEPS is intended to obtain timely
national estimates of health care use and expenditures, private
and public health insurance coverage, and the availability,
costs and scope of private health insurance benefits. It also
develops cost and savings estimates of proposed changes in
policy and identifies impact of policy changes on payers,
providers, and patients.
Program Support
The Committee recommends $2,700,000 for program support.
This amount is the same as the administration request and the
comparable fiscal year 2003 level. This activity supports the
overall management of the Agency.
Centers for Medicare & Medicaid Services
GRANTS TO STATES FOR MEDICAID
Appropriations, 2003....................................$112,090,218,000
Budget estimate, 2004................................... 124,892,197,000
Committee recommendation................................ 124,892,197,000
The Committee recommends $124,892,197,000 for Grants to
States for Medicaid. This amount is $12,801,979,000 more than
the fiscal year 2003 appropriation and the same as the
administration's request. This amount excludes $51,861,386,000
in fiscal year 2003 advance appropriations for fiscal year
2004. In addition, $58,416,275,000 is provided for the first
quarter of fiscal year 2005, as requested by the
administration.
The Medicaid program provides medical care for eligible
low-income individuals and families. It is administered by each
of the 50 States, the District of Columbia, Puerto Rico, and
the territories. Federal funds for medical assistance are made
available to the States according to a formula, which
determines the appropriate Federal matching rate for State
program costs. This matching rate is based upon the State's
average per capita income relative to the national average, and
shall be no less than 50 percent and no more than 83 percent.
PAYMENTS TO HEALTH CARE TRUST FUNDS
Appropriations, 2003.................................... $81,462,700,000
Budget estimate, 2004................................... 95,084,100,000
Committee recommendation................................ 95,084,100,000
The Committee recommends $95,084,100,000 for Federal
payments to health care trust funds. Amount is the same as the
administration's request and is an increase of $13,621,400,000
from the fiscal year 2003 appropriation.
This entitlement account includes the general fund subsidy
to the Supplementary Medical Insurance Trust Fund (Medicare
Part B), plus other reimbursements to the Hospital Insurance
Trust Fund (Medicare Part A), for benefits and related
administrative costs that have not been financed by payroll
taxes or premium contributions.
The Committee has provided $94,518,000,000 for the Federal
payment to the Supplementary Medical Insurance Trust Fund. This
payment provides matching funds for premiums paid by Medicare
Park B enrollees. This amount is the same as the
administration's request and is $13,613,000,000 more than the
fiscal year 2003 amount. The increase includes $3,035,000,000
to cover an anticipated shortfall in the amount appropriated in
fiscal year 2003.
The recommendation also includes $197,000,000 for hospital
insurance for the uninsured. This amount is the same as the
administration's request and is $28,000,000 less than the 2003
amount.
The Committee also recommends $168,000,000 for Federal
uninsured benefit payment. This payment reimburses the Hospital
Insurance Trust Fund for the cost of benefits provided to
Federal annuitants who are eligible for Medicare. This amount
is the same as both the administration's request and the fiscal
year 2003 appropriation.
The Committee recommendation includes $201,100,000 to be
transferred to the Hospital Insurance Trust Fund as the general
fund share of CMS's program management administrative expenses.
This amount is the same as the administration's request and is
$36,400,000 more than the fiscal year 2003 level.
PROGRAM MANAGEMENT
Appropriations, 2003.................................... $2,564,891,000
Budget estimate, 2004................................... 2,733,507,000
Committee recommendation................................ 2,707,603,000
The Committee recommends $2,707,603,000 for CMS program
management, which is $25,904,000 less than the amount requested
by the administration and $142,712,000 more than the fiscal
year 2003 enacted level.
Research, Demonstrations, and Evaluations
The Committee recommends $67,400,000 for research,
demonstrations, and evaluation activities. This amount is
$4,000,000 more than the budget request.
CMS research and demonstration activities facilitate
informed, rational Medicare and Medicaid policy choices and
decision making. These studies and evaluations include projects
to measure the impact of Medicare and Medicaid policy analysis
and decision making, to measure the impact of Medicare and
Medicaid on health care costs, to measure patient outcomes in a
variety of treatment settings, and to develop alternative
strategies for reimbursement, coverage, and program management.
The Committee has included $40,000,000 for Real Choice
Systems Change Grants to States to fund initiatives that
establish specific action steps and timetables to achieve
enduring system improvements and to provide long-term services
and supports, including community-based attendant care, to
eligible individuals in the most integrated setting
appropriate.
The Committee recognizes the critical role of direct
service workers in the Nation's community based long term care
system and supports the administration's efforts to improve
recruitment, training and retention of direct service workers.
The Committee has included $3,000,000 more than the
administration requested for the national demonstration
designed to address workforce shortages of community service
direct care workers. The Committee is doing so in recognition
of the current shortage of direct service workers and the
predicted increase in the need for additional direct service
workers over the next 10 years. The Bureau of Labor Statistics
predicts a 39 percent growth in the need for direct service
workers in the next 10 years.
The funds should be used to improve recruitment, training,
supervision by managers and people with disabilities,
retention, health insurance and other benefits, career
development, education, working environments, and managers'
cultural competence. To the extent that funds are used for
direct service costs, those funds must be phased out by the end
of the grant period and the State must have a plan for
maintaining these supports that the grant made possible. CMS
should require States to involve people with disabilities and
direct service workers in the planning and implementation of
the projects funded under this initiative.
The Committee understands that States are working to
rebalance their long term care systems, but information on the
techniques and aggregate costs is lacking. Therefore, the
Committee expects CMS to work with three to eight States and
research the program management techniques used by these States
to provide adequate services while effectively managing
aggregate costs as States rebalance their long term care
systems to reduce reliance on institutional services and
increase community based services. CMS should also work with
these States to gather and report on the changes in aggregate
costs and per person expenditure to the Medicaid program and
the numbers of individuals receiving institutional care and
community based care. CMS should give preference to States
implementing statewide initiatives.
Medicare Operations
The Committee recommends $1,776,889,000 for Medicare
operations, which is the amount requested by the administration
and $110,209,000 more than the comparable fiscal year 2003
appropriation. In addition, $720,000,000 is available for the
Medicare Integrity Program within the mandatory budget as part
of the health insurance reform legislation.
The Medicare operations line item covers a broad range of
activities including claims processing and program safeguard
activities performed by Medicare contractors. These contractors
also provide information, guidance, and technical support to
both providers and beneficiaries. In addition, this line item
includes a variety of projects that extend beyond the
traditional fee-for-service arena.
State Survey and Certification
The Committee recommends $252,743,000 for Medicare State
survey and certification activities, which is the same as the
fiscal year 2003 level. The Committee understands that this
level of effort will be supplemented by support contracts
funded through the Quality Improvement Organizations activity.
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.
Federal Administration
The Committee recommends $580,571,000 for Federal
administration costs, which is an increase of $8,815,000 to the
fiscal year 2003 level. This funding level allows for a 2
percent pay raise in January 2004, as proposed by the
administration.
The Committee urges CMS to articulate clear guidelines and
to set expeditious timetables for consideration of new
technologies, procedures and products for Medicare coverage
including standards regarding Medicare coverage of positron
emission tomography [PET]. The effect of these delays in
instituting Medicare coverage could delay benefits of these
technologies and procedures to Medicare patients. The Committee
also expects CMS to avoid requiring new technologies to repeat
clinical trials and testing already successfully completed by
the new technologies in the process of gaining FDA approval or
in NIH clinical trials and which serve as signals to private
insurers to cover new technologies. The Committee urges CMS not
to require substantially different levels of evidence to
approve various new products for Medicare coverage, requiring,
for example, very little documentation for approval of MRA
(magnetic resonance angiography), while at the same time
continuing to demand voluminous amounts of data to make a
coverage decision on PET. The Committee urges the 120-person
Medicare Coverage Advisory Committee to make a decision on
coverage of PET. Because of the possible duplication of efforts
among HHS agencies and related unnecessary costs to the
Medicare program and the Department, the Committee again asks
that the Secretary take a leadership role in resolving this
matter expeditiously.
The Committee is aware that a proposed rule to revise the
Medicare hospital conditions of participation was issued in
December, 1997, and has never been finalized. Among other
things, the proposed rule would have removed many of the overly
prescriptive requirements in current regulations regarding the
types of practitioners who may perform particular functions in
a hospital, deferring instead to applicable State law; the
Committee urges the Centers for Medicare and Medicaid Services
[CMS] to finalize these regulations.
The Committee expects the Secretary to issue ``L'' codes,
with appropriate safeguards to prevent fraud and abuse, based
on fair and reasonable reimbursement levels to cover Total Body
Orthotic Management for Non-Ambulatory severely disabled
nursing home residents. This responds to a long-standing
Committee concern about an unintended consequence of HCFA
Ruling 96-1. The Committee notes the May 2002, congressionally
authorized GAO report entitled ``Orthotics Ruling Has
Implications for Beneficiary Access and Federal and States
Costs'' that identifies a nursing home population that has been
denied this care as a result of 96-1, but recommends that a
restoration of such care be accompanied by appropriate
controls, consistent with those established for existing ``L''
codes, that protect the integrity of the Medicare Program.
The Committee is pleased with recent improvements in the
rate of mispayments by the Medicare program. Additional
resources and efforts have begun to make a difference. However,
the Committee remains very concerned with the amount of money
that continues to be lost to fraud, waste and abuse in the
Medicare program. The Committee has held many hearings and
taken other corrective actions over a 13 year period to expose
and reduce these losses. The Committee held a hearing on
overpayments for certain medical supplies in June of last year.
At that time the Administrator of CMS promised to move forward
with implementation of enhanced inherent reasonableness
authority. Yet, to date no action has been taken. The Committee
calls upon the Administrator to promptly utilize the IR
authority granted to the Secretary and requests a briefing as
to his timeline for action by August 1, 2003. By October 1,
2003, the Committee would like to receive a progress report and
future work plan for all Departmental efforts to reduce fraud,
waste and abuse in Medicare.
Revitalization Plan
The Committee recommends $30,000,000, compared to
$65,000,000 requested by the administration, to remain
available for 2 years, as the first-year investment in CMS's
efforts to make significant improvements to key aspects of
managing the agency and the Medicare program. Funding in fiscal
year 2004 will target system-related improvements.
Administration for Children and Families
PAYMENTS TO STATES FOR CHILD SUPPORT ENFORCEMENT AND FAMILY SUPPORT
PROGRAMS
Appropriations, 2003.................................... $2,779,348,000
Budget estimate, 2004................................... 3,245,970,000
Committee recommendation................................ 3,292,270,000
The Committee recommends $3,292,270,000 be made available
in fiscal year 2004 for payments to States for child support
enforcement and family support programs. The comparable funding
level for fiscal year 2003 is $2,779,348,000 and the budget
request includes $3,245,970,000 for this program. The Committee
recommendation provides the full amount requested under current
law. The budget request includes savings of $47,000,000 based
on proposed legislation.
These payments support the States' efforts to promote the
self-sufficiency and economic security of low-income families.
These funds also support efforts to locate noncustodial
parents, determine paternity when necessary, and establish and
enforce orders of support. The appropriation, when combined
with the $1,100,000,000 in advance funding provided in last
year's bill and an estimated $179,300,000 from offsetting
collections, supports a program level of $4,572,270,000.
The Committee also has provided $1,200,000,000 in advance
funding for the first quarter of fiscal year 2005 for the child
support enforcement program, the same as the budget request.
LOW-INCOME HOME ENERGY ASSISTANCE PROGRAM
Appropriations, 2003.................................... $1,688,950,000
Budget estimate, 2004................................... 2,000,000,000
Committee recommendation................................ 2,000,000,000
The Committee recommends $2,000,000,000 for fiscal year
2004 for LIHEAP. The comparable funding level for fiscal year
2003 is $1,688,950,000 and the budget request includes
$2,000,000,000 for this program. LIHEAP is made up of two
components: the State grant program and the contingency fund.
The Committee recommendation includes $2,000,000,000 for
fiscal year 2004 for the State grant program. The comparable
funding level for fiscal year 2003 is $1,688,950,000 and the
budget request includes $1,700,000,000 for this program. LIHEAP
grants are awarded to States, territories, Indian tribes, and
tribal organizations to assist low-income households in meeting
the costs of home energy. States receive great flexibility in
how they provide assistance, including direct payments to
individuals and vendors and direct provision of fuel. These
resources are distributed by formula to these entities as
defined by statute, based in part on each State's share of home
energy expenditures by low-income households.
The Committee does not include resources for fiscal year
2004 for the contingency fund. The budget request includes
$300,000,000 designated as non-emergency funding for this
program. The contingency fund may be used to provide assistance
to one or more States adversely affected by extreme heat or
cold, significant price increases, or other causes of energy-
related emergencies. The Committee is committed to ensuring
that sufficient resources are available in the fund, to provide
additional assistance to households with energy burdens not met
by the regular program, and to meet the objectives of the
authorizing statute. The Committee intends to monitor household
energy burdens that might require action in future
appropriations bills.
The Committee intends that up to $27,500,000 of the amount
recommended for LIHEAP for fiscal year 2004 be used for the
leveraging incentive fund. The fund will provide a percentage
match to States for private or non-Federal public resources
allocated to low-income home energy benefits.
REFUGEE AND ENTRANT ASSISTANCE
Appropriations, 2003.................................... $478,048,000
Budget estimate, 2004................................... 461,626,000
Committee recommendation................................ 428,056,000
The Committee recommends $428,056,000 for fiscal year 2004
for refugee and entrant assistance. The comparable funding
level for fiscal year 2003 is $478,048,000 and the budget
request includes $461,626,000 for this program.
The Refugee and Entrant Assistance Program is designed to
assist States in their efforts to assimilate refugees, asylees,
Cuban and Haitian entrants, and adults and minors who are
trafficking victims, into American society as quickly and
effectively as possible. The program funds State-administered
transitional and medical assistance, the voluntary agency
matching grant program, programs for victims of trafficking and
torture, employment and social services, targeted assistance,
and preventive health.
Based on an estimated refugee admission ceiling of 80,000,
this appropriation, together with prior-year funds available
for fiscal year 2004 expenses, will enable States to continue
to provide at least 8 months of cash and medical assistance to
eligible refugees and entrants, a variety of social and
educational services, as well as foster care for refugee and
entrant unaccompanied minors.
The Committee is committed to ensuring that the American
public is safe and not exposed to potential security risks.
However, the Committee also is concerned about the additional
hardships imposed on individuals fleeing their homes from civil
strife, persecution, and torture as they await a multitude of
security procedures in potentially dangerous temporary
locations and refugee camps. As a result of these delays,
almost 40,000 refugees, who were eligible under the admissions
ceiling for fiscal year 2002, were not allowed to resettle in
the United States. In addition, current estimates indicate that
actual refugee admissions for fiscal year 2003 will be equally
short of the admissions ceiling.
These unused slots resulted in program savings due to fewer
transitional, medical, and support services provided than
estimated under prior appropriations. The Committee
recommendation will not affect the ability of programs to meet
fully the demand for services under the admissions ceiling, as
sufficient carryover funds are available to offset the proposed
reduction. The Committee intends to closely monitor the
situation to ensure that sufficient funding is available to
meet the critical needs of individuals fleeing persecution.
In order to carry out the refugee and entrant assistance
program, the Committee recommends $180,000,000 for transitional
and medical assistance, including State administration and the
voluntary agency program; $9,935,000 for victims of
trafficking; $140,000,000 for social services; $4,804,000 for
preventive health; and $49,155,000 for targeted assistance.
Due to the realignment of the former Immigration and
Naturalization Service [INS], and pursuant to section 462 of
the Homeland Security Act of 2002, funds are now provided for
the care and placement of unaccompanied alien minors in the
Office of Refugee Resettlement. Approximately 5,000
unaccompanied alien children are apprehended each year in the
United States by INS/Homeland Security agents, Border Patrol
officers, or other law enforcement agencies and taken into care
pending resolution of their claims for relief under U.S.
immigration law, released to an adult family member, or
released to a responsible adult guardian. The Committee
recommends $34,227,000 for unaccompanied children.
The Committee also recommends $9,935,000 to treat and
assist victims of torture. These funds may also be used to
provide training to healthcare providers to enable them to
treat the physical and psychological effects of torture. The
Committee acknowledges that well-established treatment centers,
such as the Center for Victims of Torture, have developed the
knowledge base that has fostered growth of treatment facilities
around the country and strengthened treatment services
generally. This positive trend may continue if leading centers
are able to expand their staffs to create more trainers and
improve evaluation and research needed to guide and develop new
programs.
Section 412(a)(7) of title IV of the Immigration and
Nationality Act authorizes the use of funds appropriated under
this account to be used to carry out monitoring, evaluation,
and data collection activities to determine the effectiveness
of funded programs and to monitor the performance of States and
other grantees.
CHILD CARE AND DEVELOPMENT BLOCK GRANT
Appropriations, 2003.................................... $2,086,344,000
Budget estimate, 2004................................... 2,099,729,000
Committee recommendation................................ 2,099,729,000
The Committee recommends $2,099,729,000 for fiscal year
2004 for child care and development block grant. The comparable
funding level for fiscal year 2003 is $2,086,344,000 and the
budget request includes $2,099,729,000 for this program.
The child care and development block grant supports grants
to States to provide low-income families with financial
assistance for child care; for improving the quality and
availability of child care; and for establishing or expanding
child development programs. The funds are used to both expand
the services provided to individuals who need child care in
order to work, or attend job training or education, and to
allow States to continue funding the activities previously
provided under the consolidated programs.
The Committee is aware that the authorization for the child
care and development block grant program expired on September
30, 2003. The block grant was last reauthorized in 1996 as part
of the Personal Responsibility and Work Opportunity
Reconciliation Act. The Act established the child care and
development fund, which consists of mandatory funding provided
under the Social Security Act and discretionary funding
supported by annual appropriations under the child care and
development block grant program. The Committee believes that
significant increases in mandatory funding for child care
should be supported by the reauthorization of the Welfare
Reform Law to pay for additional work requirements and to
respond to the needs of low income, working poor families. The
Welfare Reform Law established policies that have resulted in a
significant increase in working Americans.
The Committee recommendation continues specific earmarks in
appropriations language, also included in the budget request,
that provide targeted resources to specific policy priorities
including $19,120,000 for the purposes of supporting before and
afterschool services, as well as resource and referral
programs. This represents the Federal commitment to the
activities previously funded under the dependent care block
grant. The Committee expects that these funds will not supplant
current funding dedicated to resource and referral and school
age activities provided by the child care and development block
grant. The Committee strongly encourages States to address the
matters of before and afterschool care and the establishment of
resource and referral programs with the funds provided in this
program.
The Committee recommendation includes an additional
$272,672,000 for child care quality activities, and sets aside
$100,000,000 specifically for an infant care quality
initiative. These funds are recommended in addition to the 4
percent quality earmark established in the authorizing
legislation. The Committee has provided these additional
quality funds because of the considerable research that
demonstrates the importance of serving children in high quality
child care settings which include nurturing providers who are
educated in child development and adequately compensated. While
considerable progress has been made, the Committee believes
States should continue to invest in education and training
linked to compensation of the child care workforce in order to
improve the overall quality of child care.
The Committee recommendation also provides $10,000,000 for
child care research, demonstration and evaluation activities.
The Committee recommendation for resource and referral
activities also includes $1,000,000 to continue support for the
National Association of Child Care Resource and Referral
Agencies' information service, Child Care Aware, and the
national toll-free information hotline which links families to
local child care services and programs.
SOCIAL SERVICES BLOCK GRANT
Appropriations, 2003.................................... $1,700,000,000
Budget estimate, 2004................................... 1,700,000,000
Committee recommendation................................ 1,700,000,000
The Committee recommends $1,700,000,000 for fiscal year
2004 for the social services block grant. The comparable
funding level for fiscal year 2003 is $1,700,000,000 and the
budget request includes $1,700,000,000 for this program.
The CARE Act of 2003 included bill language allowing States
to transfer up to 10 percent of their annual allocations under
the Temporary Assistance for Needy Families to the Social
Services Block Grant program. Under current law and the budget
request, in 2004 States would be limited to transfers of up to
4.25 percent. The Committee recognizes that the block grant is
a vital source of support for many vulnerable children and
families, the elderly and single adults and continues to
support this important State flexibility.
CHILDREN AND FAMILIES SERVICES PROGRAMS
Appropriations, 2003.................................... $8,645,276,000
Budget estimate, 2004................................... 8,687,382,000
Committee recommendation................................ 8,780,002,000
The Committee recommends $8,780,002,000 for fiscal year
2004 for children and families services programs. The
comparable funding level for fiscal year 2003 is $8,645,276,000
and the budget request includes $8,687,382,000 for this
program. In addition, $6,000,000 in transfers are available
under section 241 of the Public Health Service Act.
This appropriation provides funding for programs for
children, youth, and families, the developmentally disabled,
and Native Americans, as well as Federal administrative costs.
Head Start
The Committee recommends $6,815,570,000 for fiscal year
2004 for Head Start. The comparable funding level for fiscal
year 2003 is $6,667,533,000 and the budget request includes
$6,815,570,000 for this program. The Committee recommendation
includes $1,400,000,000 in advance funding that will become
available on October 1, 2004.
Head Start provides comprehensive development services for
low-income children and families, emphasizing cognitive and
language development, socioemotional development, physical and
mental health, and parent involvement to enable each child to
develop and function at his or her highest potential. At least
10 percent of enrollment opportunities in each State are made
available to children with disabilities.
The Committee understands the serious need for additional
and expanded Head Start facilities among Native American
populations and in rural areas. The Committee believes that the
Department could help serve these needy communities by
providing minor construction funding, as authorized, in remote
Native American communities.
The Committee recommends continued support sufficient to
maintain the current funding level for existing grantees and to
provide a new grant competition in fiscal year 2004 under the
Tribal College and University Head Start Partnership program.
While current law requires that 50 percent of Head Start
teachers in center-based Head Start programs have not less than
an associate degree in early childhood education or a related
field, American Indian Head Start programs are generally
located in areas that are isolated from mainstream colleges
where such degrees can be earned. This program provides
accessible, high-quality, and accredited education
opportunities to American Indian Head Start agency staff,
enabling them to better deliver services that enhances the
social and cognitive development of low income American Indian
children. The Committee is disappointed that the Head Start
Bureau neglected to direct sufficient funding to allow current
grantees to extend their programs thus allowing them a full 5
year program, but believes that continued support of new 5-year
grant competitions can help remedy this situation and improve
outcomes for American Indian Head Start programs.
The Committee strongly supports the effort to strengthen
the qualifications of Head Start teachers. The Committee
encourages Head Start to continue to work toward the goal of
having all of their teachers in center-based Head Start
programs have an associate, baccalaureate, or advanced degree
in early childhood education, or a degree in a related field
with experience in teaching preschool children. The Committee
expects the Department to focus staff development efforts on
increasing the educational level of Head Start teachers in
order to meet this goal.
The Committee is aware that the Department's ``Descriptive
Study of Seasonal Farmworker Families'' published in September
2001 revealed that just 19 percent of eligible children of
migrant and seasonal farmworkers are served by Migrant Head
Start programs. The study also concluded ``that Migrant Head
Start agencies greatly improve the lives of migrant and
seasonal farmworker families, and in doing so, help to
strengthen local agricultural economies.'' The Committee urges
the Head Start Bureau to continue to provide sufficient funds
for Migrant Head Start programs proportionate to the overall
increase in the Head Start appropriation.
The Committee is conscious of efforts currently being
undertaken to improve pre-literacy skills in Head Start
children and lauds the administration for its commitment to
this effort. However, the Committee cautions against anything
that would detract from the comprehensive nature of the program
in delivering early childhood development and family services.
While school readiness is front and center in the goals of Head
Start, the elements necessary to achieve that readiness range
from adequate nutrition and health screening, to social and
emotional development and family building, as well as the
cognitive growth of young children.
The Committee is cognizant that the goal of the Head Start
program is to ensure the social competence and school readiness
of children upon completion of the program. It has long been
proven that investments in Head Start yield significant savings
by long-term reduction of incarceration rates and rates of
participation in public assistance. Much of these savings are
due to the social and emotional lessons learned from
participation in Head Start. The Committee expects the
Department to continue to promote learning and brain
development to accelerate and improve the cognitive development
of Head Start children. The Committee expects the Department to
monitor Head Start programs to ensure that a majority of
children participating in Head Start programs meet the minimum
educational performance measures and standards upon completion
of the program as outlined in the Head Start Act, as amended in
1998.
The Committee commends the outstanding successes of the
Head Start program and appreciates the Head Start Bureau's
dedication to the continued improvement of the comprehensive
services provided to eligible children and families. However,
the Committee is concerned that proposed assessments will focus
only on literacy and math. While these skills are an important
part of the Head Start curriculum, the Committee is concerned
that the assessments will not fully represent the comprehensive
nature of the program, specifically the nutrition, social,
emotional, and cognitive aspects of the curriculum. The
Committee is troubled by the potential use of these assessments
in deciding grant status, particularly for children in the
Early Head Start program. The Committee is aware that many
child development experts believe that testing children under
the age of 6 does not show an accurate picture of their
development, and could be potentially detrimental to them. The
Head Start Bureau shall report to the Committee by April 2004
on the steps the Bureau has taken to ensure that the proposed
assessment is age-appropriate and on the proposed use of the
assessment results. The report should include the extent to
which funding decisions will be based upon the assessments, the
impact such a decision will have on rural programs facing
greater obstacles, and the ways in which the Bureau intends to
incorporate the comprehensive physical, social, and emotional
benefits of the program into funding decisions.
Consolidated Runaway and Homeless Youth Program
The Committee recommends $89,978,000 for fiscal year 2004
for the consolidated runaway and homeless youth program. The
comparable funding level for fiscal year 2003 is $89,978,000
and the budget request includes $88,043,000 for this program.
The Committee recommends $49,473,000 for basic centers and
$40,505,000 for transitional living programs.
This program addresses the crisis needs of runaway and
homeless youth and their families through support to local and
State governments and private agencies. Basic centers and
transitional living programs help address the needs of some of
the estimated 300,000 homeless youth, many of whom are running
away from unsafe or unhealthy living environments. These
programs have been proven effective at supporting positive
youth development, securing stable and safe living arrangements
and providing the skills required to engage in positive
relationships with caring adults and contribute to society. The
Committee looks forward to the release of performance outcome
data available through the new management information system.
Under current law the Runaway and Homeless Youth Act
requires that not less than 90 percent of the funds be
allocated to States for the purpose of establishing and
operating community-based runaway and homeless youth centers,
as authorized under Parts A and B of the Act. Funds are
distributed on the basis of the State youth population under 18
years of age in proportion to the national total. The remaining
10 percent funds networking and research and demonstration
activities including the National Toll-Free Communications
Center. This section is up for reauthorization this year.
Grants are used to develop or strengthen community-based
programs which assist homeless youth in making a smooth
transition to productive adulthood and social self-sufficiency;
and to provide technical assistance to transitional living
programs for the acquisition and maintenance of resources and
services.
The basic centers program, authorized under Part A of the
Act, supports grants to community-based public and private
agencies for the provision of outreach, crisis intervention,
temporary shelter, counseling, family unification and aftercare
services to runaway and homeless youth and their families.
The transitional living program [TLP] provides grants to
local public and private organizations to address shelter and
service needs of homeless youth, ages 16-21. The program's
goals are to have youth safe at home or in appropriate
alternative settings and to help them develop into independent,
contributing members of society.
A homeless youth accepted into the program is eligible to
receive shelter and services continuously for up to 540 days.
The services include counseling; life skills training, such as
money management and housekeeping; interpersonal skill
building, such as decision-making and priority setting;
educational advancement; job preparation attainment; and mental
and physical health care.
The Committee recommendation does not include the
$10,000,000 requested in the budget for a separate maternity
group homes program. The Committee is aware of the need for and
shares the administration's interest in funding residential
services for young mothers and their children who are unable to
live with their own families because of abuse, neglect, or
other circumstances. The Committee notes that pregnant and
parenting youth are currently eligible for and served through
the TLP.
The Committee also recognizes the need for and value of
expanding transitional living opportunities for all homeless
youth. Therefore, the Committee seeks to preserve the
flexibility afforded in current law to respond to the needs of
the young people who are most at-risk and in greatest need of
transitional living opportunities in their communities by
providing additional resources to the existing portfolio of
consolidated Runaway and Homeless Youth Act programs.
It is the Committee's expectation that current and future
TLP grantees will continue to provide transitional living
opportunities and support 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 support in their
communities, the Committee encourages the Secretary, acting
through the network of federally-funded runaway and homeless
youth training and technical assistance providers, to offer
guidance to grantees and others on the programmatic
modifications required to address the unique needs of pregnant
and parenting youth and on the various sources of funding
available for residential services to this population.
Maternity Group Homes
The Committee recommendation does not include the
$10,000,000 requested in the budget for the maternity group
homes program. The Committee has deferred action on this
program pending the enactment of authorizing language. Under
this proposed program, the ACF would provide targeted funding
for community-based, adult-supervised group homes for young
mothers and their children. These homes would provide safe,
stable, nurturing environments for mothers who cannot live
safely with their own families and assist them in moving
forward with their lives by providing support so they can
finish school, acquire job skills, and learn to be good
parents.
The Committee expects the Family and Youth Services Bureau
to continue to provide the technical assistance needed to
enable TLP grantees and their community partners to address the
unique needs of young mothers and their children, as well as
helping interested entities in identifying sources of funding
currently available to provide residential services to this
population.
Child Abuse Prevention Programs
The Committee recommends $48,171,000 for fiscal year 2004
for child abuse prevention programs. The comparable funding
level for fiscal year 2003 is $55,715,000 and the budget
request includes $48,314,000 for this program The
recommendation includes $21,870,000 for State grants and
$26,301,000 for discretionary activities.
These programs seek to improve and increase activities at
all levels of government which identify, prevent, and treat
child abuse and neglect through State grants, technical
assistance, research, demonstration, and service improvement.
Abandoned Infants Assistance
The Committee recommends $12,126,000 for fiscal year 2004
for abandoned infants assistance. The comparable funding level
for fiscal year 2003 is $12,126,000 and the budget request
includes $12,086,000 for this program.
This program provides financial support to public and
private entities to develop, implement, and operate
demonstration projects that will prevent the abandonment of
infants and young children. Grants provide additional services
such as identifying and addressing the needs of abandoned
infants, especially those who are drug exposed or HIV positive;
providing respite care for families and care givers; and
assisting abandoned infants and children to reside with their
natural families or in foster care.
Child Welfare Services
The Committee recommends $290,088,000 for fiscal year 2004
for child welfare services. The comparable funding level for
fiscal year 2003 is $290,088,000 and the budget request
includes $291,986,000 for this program.
This program helps State public welfare agencies improve
their child welfare services with the goal of keeping families
together. State services include: preventive intervention, so
that, if possible, children will not have to be removed from
their homes; reunification so that children can return home;
and development of alternative placements like foster care or
adoption if children cannot remain at home. These services are
provided without regard to income.
Child Welfare Training
The Committee recommends $7,449,000 for fiscal year 2004
for child welfare training. The comparable funding level for
fiscal year 2003 is $7,449,000 and the budget request includes
$7,470,000 for this program.
Under section 426, title IV-B of the Social Security Act,
discretionary grants are awarded to public and private
nonprofit institutions of higher learning to develop and
improve education/training programs and resources for child
welfare service providers. These grants upgrade the skills and
qualifications of child welfare workers.
Adoption Opportunities
The Committee recommends $27,227,000 for fiscal year 2004
for adoption opportunities. The comparable funding level for
fiscal year 2003 is $27,227,000 and the budget request includes
$27,343,000 for this program.
This program eliminates barriers to adoption and helps find
permanent homes for children who would benefit by adoption,
particularly children with special needs.
Adoption Incentives
The Committee recommends $42,720,000 for fiscal year 2004
for adoption incentives. The comparable funding level for
fiscal year 2003 is $42,720,000 and the budget request includes
$43,000,000 for this program.
The purpose of this program is to provide incentive funds
to States to encourage an increase in the number of adoptions
of children from the public foster care system. These funds are
used to pay States bonuses for increasing their number of
adoptions. The appropriation allows incentive payments to be
made for adoptions completed prior to September 30, 2004.
Adoption Awareness
The Committee recommends $12,822,000 for fiscal year 2004
for adoption awareness. The comparable funding level for fiscal
year 2003 is $12,822,000 and the budget request includes
$12,906,000 for this program.
This program was authorized in the Children's Health Act of
2000. The program consists of two activities: the Infant
Adoption Awareness Training Program and the Special Needs
Awareness Campaign. The Infant Adoption Awareness Training
Program provides grants to support adoption organizations in
the training of designated health staff, in eligible health
centers that provide health services to pregnant women, to
inform them about adoption and make referrals on request on an
equal basis with all other courses of action. Within the
Committee recommendation, $9,841,000 is available for this
purpose.
The Special Needs Adoption Campaign supports grants to
carry out a national campaign to inform the public about the
adoption of children with special needs. The Committee
recommendation includes $2,981,000 to continue this important
activity.
Compassion Capital Fund
The Committee recommends $34,772,000 for fiscal year 2004
for the compassion capital fund. The comparable funding level
for fiscal year 2003 is $34,772,000 and the budget request
includes $100,000,000 for this program.
The Committee expects funds made available through this
program to supplement and not supplant private resources and
encourages the Secretary to require private resources to match
grant funding provided to public/private partnerships.
Funds available will support grants to charitable
organizations to emulate model social service programs and to
encourage research on the best practices of social service
organizations.
Social Services Research
The Committee recommends $31,812,000 for fiscal year 2004
for the social services research. The comparable funding level
for fiscal year 2003 is $34,749,000 and the budget request
includes $5,982,000 for this program.
The Committee has funded $6,000,000 of this program through
transfers available under section 241 of the Public Health
Service Act. These funds support cutting-edge research and
evaluation projects in areas of critical national interest.
Research includes determining services that are more cost-
effective and alternative ways to increase the economic
independence of American families.
The Committee is pleased with the results of ACF's work
with the State information technology consortium, an effort
that is helping States with the difficult task of streamlining
service delivery, while also meeting TANF record-keeping and
reporting requirements. As a result of this collaborative
effort, States and ACF are now able to share systems
information on TANF, child support enforcement, child welfare,
and child care activities. The Committee is also pleased with
the CSE program's work with the consortium, an effort that is
improving the child support collection process by using web-
based technologies to speed the flow of information between
relevant agencies and the court system. The Committee
recommends that both collaborative efforts with the State
information technology consortium be continued at their current
levels.
Community-Based Resource Centers
The Committee recommends $33,200,000 for fiscal year 2004
for community-based resource centers. The comparable funding
level for fiscal year 2003 is $33,200,000 and the budget
request includes $33,403,000 for this program.
These resources support two purposes: assisting each State
in developing, operating, expanding and enhancing a network of
community-based, prevention-focused, family resource and
support programs and supporting activities that foster an
understanding, appreciation, and knowledge of diverse
populations in order to be effective in preventing and treating
child abuse and neglect.
Disabled Voter Services
The Committee recommends $15,000,000 be made available in
fiscal year 2004 for election assistance for individuals with
disabilities. The comparable funding level for fiscal year 2003
is $15,000,000 and the budget request does not provide funds
for this program. Of these funds, $10,000,000 is to promote
disabled voter access, and the remaining $5,000,000 is for
disabled voters protection and advocacy systems.
The election assistance for individuals with disabilities
program was authorized in the Help America Vote Act of 2002.
The program enables an applicant to establish, expand, and
improve access to, and participation by, individuals with
disabilities in the election process.
Developmental Disabilities Programs
The Committee recommends $150,763,000 for fiscal year 2004
for developmental disabilities programs. The comparable funding
level for fiscal year 2003 is $144,763,000 and the budget
request includes $140,442,000 for this program.
The Administration on Developmental Disabilities supports
community-based delivery of services which promote the rights
of persons of all ages with developmental disabilities.
Developmental disability is defined as severe, chronic
disability attributed to mental or physical impairments
manifested before age 22, which causes substantial limitations
in major life activities.
State Councils
The Committee recommends $73,515,000 for fiscal year 2004
for State councils. The comparable funding level for fiscal
year 2003 is $71,135,000 and the budget request includes
$69,800,000 for this program.
State Councils on the Developmental Disabilities program
assist each State in promoting the development of a
comprehensive, statewide, consumer and family-centered system
which provides a coordinated array of culturally-competent
services, and other assistance for individuals with development
disabilities. State councils undertake a range of activities
including demonstration of new approaches, program and policy
analysis, interagency collaboration and coordination, outreach
and training.
Protection and Advocacy Grants
The Committee recommends $38,644,000 for fiscal year 2004
for protection and advocacy grants. The comparable funding
level for fiscal year 2003 is $36,263,000 and the budget
request includes $35,000,000 for this program.
This formula grant program provides funds to States to
establish protection and advocacy systems to protect the legal
and human rights of persons with developmental disabilities who
are receiving treatment, services, or rehabilitation within the
State.
Projects of National Significance
The Committee recommends $11,642,000 for fiscal year 2004
for projects of national significance to assist persons with
developmental disabilities. The comparable funding level for
fiscal year 2003 is $12,403,000 and the budget request includes
$11,642,000 for this program.
This program funds grants and contracts providing
nationwide impact by developing new technologies and applying
and demonstrating innovative methods to support the
independence, productivity, and integration into the community
of persons with developmental disabilities. The Committee
recognizes the potential benefits that assistive technology can
have for individuals with developmental disabilities.
Within the Committee recommendation, $4,000,000 is
available to expand activities of the Family Support Program.
The Committee is aware that the term ``family support'' is
defined in Title II of the Developmental Disability Act as
``supports, resources, services, and other assistance provided
to families of children with disabilities that are designed to
support families in the efforts of such families to raise their
children with disabilities in the home; strengthen the role of
the family as primary caregiver for such children; prevent
involuntary out-of-the-home placement of such children and
maintain family unity; and reunite families with children with
disabilities who have been placed out of the home, whenever
possible.'' The Committee's placement of funds for family
support within the Projects of National Significance account
does not provide ACF with discretion on this definition of
family support. The Committee makes a crucial distinction
between support services designed for families of children with
disabilities and support services designed for an individual
with a disability. The Committee intends that these funds be
used for the support and assistance of families of children
with disabilities, in accordance with the statute.
University-Affiliated Programs
The Committee recommends $26,962,000 for fiscal year 2004
for university-affiliated programs. The comparable funding
level for fiscal year 2003 is $24,962,000 and the budget
request includes $24,000,000 for this program.
This program provides operational and administrative
support for a national network of university-affiliated
programs and satellite centers. Grants are made annually to
university-affiliated programs and satellite centers for
interdisciplinary training, exemplary services, technical
assistance, and information dissemination activities.
Native American Programs
The Committee recommends $45,457,000 for fiscal year 2004
for Native American programs. The comparable funding level for
fiscal year 2003 is $45,457,000 and the budget request includes
$45,119,000 for this program.
The Administration for Native Americans [ANA] assists
Indian tribes and Native American organizations in planning and
implementing long-term strategies for social and economic
development through the funding of direct grants for individual
projects, training and technical assistance, and research and
demonstration programs.
The Committee continues its significant interest in the
revitalization of native languages through education. The
Committee encourages ANA to allocate additional resources to
support the Native American Languages program and urges the ANA
to make schools a part of this effort, consistent with the
policy expressed in the Native American Languages Act.
Community Services
The Committee recommends $717,620,000 for fiscal year 2004
for the community services programs. The comparable funding
level for fiscal year 2003 is $734,509,000 and the budget
request includes $552,312,000 for this program.
Within the funds provided, the Committee recommends
$645,762,000 for the community services block grant [CSBG].
These funds are used to make formula grants to States and
Indian tribes to provide a wide range of services and
activities to alleviate causes of poverty in communities and to
assist low-income individuals in becoming self-sufficient.
The Committee rejects the administration's recommendation
to cut the community services block grant funding. Although a
restrictive Committee allocation prevented CSBG funding from
being substantially increased this year, the Committee
continues to recognize the importance of CSBG and the Community
Action Agencies it funds in helping meet the extraordinary
challenges facing low-income communities.
The Nation's Community Action Agency network relies on CSBG
funding to help initiate and administer programs designed to
alleviate poverty. The universal characteristic of these CSBG-
funded programs is that they provide people with the resources
and the tools to become self-sufficient. The Committee
understands that the Department of Health and Human Services,
and its Office of Community Services in particular, could
better use this network in developing future policy
initiatives. The Committee notes that in a number of States,
including Iowa and Pennsylvania, CAA-initiated family
development and self-sufficiency programs are a integral
component of welfare reform efforts. The administration is
encouraged to look for further nationwide linkages between
those individuals seeking to leave the welfare system and
become self-sufficient and the many family development and
self-sufficiency strategies operated by Community Action
Agencies.
The Committee expects the Office of Community Services to
release funding to States in the most timely manner. The
Committee also expects States to make funds available promptly.
The Committee is aware that the Office of Community Services
and some States have been extraordinarily delinquent in
providing funds to local eligible entities.
In addition, the Committee again expects the Office of
Community Services to inform the State CSBG grantees of any
policy changes affecting carryover CSBG funds within a
reasonable time after the beginning of the Federal fiscal year.
Several discretionary programs are funded from this
account. Funding for these programs is recommended at the
following levels for fiscal year 2004: community economic
development, $32,546,000; individual development accounts,
$24,828,000; rural community facilities, $7,203,000; and
community food and nutrition, $7,281,000. The Committee did not
provide funds for the national youth sports program.
Community economic development grants are made to private,
nonprofit community development corporations, which in turn
provide technical and financial assistance to business and
economic development projects that target job and business
opportunities for low income citizens. The Committee has
included bill language clarifying that Federal funds made
available through this program may be used for financing for
construction and rehabilitation and loans or investments in
private business enterprises owned by Community Development
Corporations. Of the total provided, the Committee has included
$5,464,000 for the Job Creation Demonstration authorized under
the Family Support Act to target community development
activities to create jobs for people on public assistance. This
demonstration program provides grants on a competitive basis to
non-profit organizations to create new employment and business
opportunities for TANF recipients and other low-income
individuals. Funding also supports technical and financial
assistance for private employers that will result in the
creation of full-time permanent jobs for eligible individuals.
The Committee recognizes that continued funding of the Job
Creation Demonstration program would provide opportunities for
more low-income individuals. As in the past, the Committee
expects that a priority for grants under this program go to
experienced community development corporations.
Most of the drinking water and wastewater systems in the
country that are not in compliance with Federal standards are
in communities of 3,000 or fewer. Rural Community Assistance
Programs [RCAPs] use funds available from the Rural Community
Facilities Program to assist a number of communities in gaining
access to adequate community facilities, gaining financing for
new or improved water and wastewater systems and in complying
with Federal standards.
The Committee has included bill language allocating funding
to the Office of Community Services for Rural Community
Facilities Technical Assistance as authorized under section
680(3)(B) of the Community Services Block Grant Act. In
providing this funding, the Committee expects that it 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.
The Committee is concerned that many small and very small
community water and wastewater treatment systems might be most
vulnerable to terrorist attack, and yet least prepared to deal
with the issue. The Committee urges OCS to continue to support
RCAP Small Community Infrastructure Safety and Security
Training and Technical Assistance project, which provides
State, regional and national infrastructure safety and security
training workshops and on-site technical assistance targeted to
small and very small community water and wastewater treatment
systems. The goal of the project is to improve the capacity of
small systems to better prepare for emergencies, develop
emergency preparedness training manuals for small water
systems, identify appropriate technologies to secure such
systems, and provide technical assistance to small communities
struggling to deal with these issues.
Family Violence Prevention and Services
The Committee recommends $144,802,000 for fiscal year 2004
for family violence prevention and services programs. The
comparable funding level for fiscal year 2003 is $144,364,000
and the budget request includes $142,422,000 for this program.
Runaway Youth Prevention Program
The Committee recommends $15,399,000 for fiscal year 2004
for the runaway youth prevention program. The comparable
funding level for fiscal year 2003 is $15,399,000 and the
budget request includes $14,999,000 for this program. This is a
discretionary grant program open to private nonprofit agencies
for the provision of services to runaway, homeless, and street
youth. Funds may be used for street-based outreach and
education, including treatment, counseling, provision of
information, and referrals for these youths, many of whom have
been subjected to, or are at risk of being subjected to, sexual
abuse. The goal of this program is to help young people leave
the streets.
Domestic Violence Hotline
The Committee recommends $3,000,000 for fiscal year 2004
for the national domestic violence hotline. The comparable
funding level for fiscal year 2003 is $2,562,000 and the budget
request includes $3,000,000 for this program.
This is a cooperative agreement which funds the operation
of a national, toll-free, 24-hours-a-day telephone hotline to
provide information and assistance to victims of domestic
violence.
Battered Women's Shelters
The Committee recommends $126,403,000 for fiscal year 2004
for battered women's shelters program. The comparable funding
level for fiscal year 2003 is $126,403,000 and the budget
request includes $124,423,000 for this program.
This is a formula grant program to support community-based
projects which operate shelters and provide related assistance
for victims of domestic violence and their dependents. Emphasis
is given to projects which provide counseling, advocacy, and
self-help services to victims and their children.
Early Learning Opportunities Program
The Committee recommends $33,779,000 for fiscal year 2004
for early learning opportunities program. The comparable
funding level for fiscal year 2003 is $33,779,000 and the
budget request did not include funds for this program.
This program supports grants to local community councils
comprised of representatives from agencies involved in early
learning programs, parent organizations and key community
leaders. Funds are used to increase the capacity of local
organizations to facilitate development of cognitive skills,
language comprehension and learning readiness; enhance
childhood literacy; improve the quality of early learning
programs through professional development and training; and
remove barriers to early learning programs.
Faith-Based Center
The Committee recommends $1,400,000 for fiscal year 2004
for the operation of the Department's Center for Faith-Based
and Community Initiatives. The comparable funding level for
fiscal year 2003 is $1,490,000 and the budget request includes
$1,400,000 for this program.
Mentoring Children of Prisoners
The Committee recommends $9,935,000 for fiscal year 2004
for mentoring children of prisoners. The comparable funding
level for fiscal year 2003 is $9,935,000 and the budget request
includes $50,000,000 for this program.
The mentoring children of prisoners program was authorized
in 2001 under section 439 of the Social Security Act. The
purpose of this program is to help children while their parents
are imprisoned and includes activities that keep children
connected to a parent in prison in order to increase the
chances that the family will come together successfully when
the parent is released. As a group, children of prisoners are
less likely than their peers to succeed in school and more
likely to become engaged in delinquent behavior.
Independent Living Training Vouchers
The Committee recommends $41,727,000 for fiscal year 2004
for independent living training vouchers. The comparable
funding level for fiscal year 2003 is $41,727,000 and the
budget request includes $60,000,000 for this program.
These funds will support vouchers of up to $5,000 for
college tuition, or vocational training for individuals who age
out of the foster care system so they can be better prepared to
live independently and contribute productively to society.
Studies have shown that 25,000 youth leave foster care each
year at age 18 and just 50 percent will have graduated high
school, 52 percent will be unemployed and 25 percent will be
homeless for one or more nights.
Promotion of Responsible Fatherhood and Healthy Marriage
The Committee does not provide funds for fiscal year 2004
for promotion of responsible fatherhood and healthy marriage.
The budget request includes $20,000,000 for this new program
designed to promote responsible fatherhood and responsible
marriage. Legislation has not been enacted that would create
this new program. The purpose of this proposed program was to
spur approaches at State and community levels to assist fathers
to be more actively and productively involved in the lives of
their children.
Program Administration
The Committee recommends $179,584,000 for fiscal year 2004
for program administration. The comparable funding level for
fiscal year 2003 is $171,873,000 and the budget request
includes $179,584,000 for this program.
The Committee urges ACF to continue to make progress in
improving its Annual Performance Plan and Annual Performance
Report. The Committee notes that many programs proposed for
funding do not have solid data for baselines or performance
outcome measures. This lack of objective data makes more
difficult the Committee's decisions regarding the allocation of
limited resources. The Committee believes that the Agency
should work with program grantees and relevant associations to
identify the most objective ways in which to evaluate the
effectiveness of ACF programs and establish a timeline for
producing meaningful data by which programs can be assessed.
The Committee urges that steps be taken to improve this
situation and expects information regarding such actions to be
included in the fiscal year 2005 congressional justification.
The Committee continues its interest in the Department's
Child and Family Services reviews. These reviews are an
effective method for monitoring the progress States are making
in assuring the safety, health, and permanency for children in
child welfare and foster care as required in the Adoption and
Safe Families Act. The Committee encourages the Department to
make available sufficient resources to ensure full
implementation of the new collaborative monitoring system.
PROMOTING SAFE AND STABLE FAMILIES
Appropriations, 2003.................................... $404,350,000
Budget estimate, 2004................................... 504,978,000
Committee recommendation................................ 404,350,000
The Committee recommends $404,350,000 for fiscal year 2004
for promoting safe and stable families. The comparable funding
level for fiscal year 2003 is $404,350,000 and the budget
request includes $504,978,000 for this program.
Funding available provides grants to States in support of:
(1) family preservation services; (2) time-limited family
reunification services (3) community-based family support
services and (4) adoption promotion and support services. The
Committee notes that most of the Federal funding related to
child welfare is provided for the removal and placement of
children outside of their own homes. Funds available through
the Promoting Safe and Stable Families program are focused on
supporting those activities that can prevent family crises from
emerging which might require the temporary or permanent removal
of a child from his or her own home.
The Promoting Safe and Stable Families program is comprised
of $305,000,000 in capped entitlement funds authorized by the
Social Security Act and $99,350,000 in discretionary
appropriations.
PAYMENTS TO STATES FOR FOSTER CARE AND ADOPTION ASSISTANCE
Appropriations, 2003.................................... $4,855,000,000
Budget estimate, 2004................................... 5,068,300,000
Committee recommendation................................ 5,068,300,000
The Committee recommends $5,068,300,000 for fiscal year
2004 for payments to States for foster care and adoption
assistance. The comparable funding level for fiscal year 2003
is $4,855,000,000 and the budget request includes
$5,068,300,000 for this program. In addition, the Committee
recommendation concurs with the administration's request of
$1,767,700,000 for an advance appropriation for the first
quarter of fiscal year 2005. The Committee's recommendation
assumes enactment of proposed legislation creating an
alternative funding option for States.
The Foster Care Program provides Federal reimbursement to
States for: maintenance payments to families and institutions
caring for eligible foster children, matched at the Federal
medical assistance percentage [FMAP] rate for each State; and
administration and training costs to pay for the efficient
administration of the Foster Care Program, and for training of
foster care workers and parents.
The Adoption Assistance Program provides funds to States
for maintenance costs and the nonrecurring costs of adoption
for children with special needs. The goal of this program is to
facilitate the placement of hard-to-place children in permanent
adoptive homes, and thus prevent long, inappropriate stays in
foster care. As in the Foster Care Program, State
administrative and training costs are reimbursed under this
program.
The Independent Living Program provides services to foster
children under 18 and foster youth ages 18-21 to help them make
the transition to independent living by engaging in a variety
of services including educational assistance, life skills
training, health services and room and board. States are
awarded grants from the annual appropriation proportionate to
their share of the number of children in foster care, subject
to a matching requirement.
Administration on Aging
Appropriations, 2003.................................... $1,367,057,000
Budget estimate, 2004................................... 1,343,701,000
Committee recommendation................................ 1,360,193,000
The Committee recommends an appropriation of $1,360,193,000
for aging programs. The fiscal year 2003 comparable level was
$1,367,057,000 and the administration request was
$1,343,701,000.
Supportive Services and Senior Centers
The Committee recommends an appropriation of $355,673,000
for supportive services and senior centers, which is the same
as the comparable level for fiscal year 2003. The
administration request was $357,000,000. This State formula
grant program funds a wide range of social services for the
elderly, including multipurpose senior centers, adult day care
and ombudsman activities. State agencies on aging award funds
to designated area agencies on aging who in turn make awards to
local services providers. All individuals age 60 and over are
eligible for services, although, by law, priority is given to
serving those who are in the greatest economic and social need,
with particular attention to low-income minority older
individuals and those residing in rural areas. Under the basic
law, States have the option to transfer up to 30 percent of
funds appropriated between the senior centers program and the
nutrition programs, which allows the State to determine where
the resources are most needed.
Preventive Health Services
The Committee recommends $21,919,000 for preventive health
services, which is the same as the comparable fiscal year 2003.
The administration requested $21,562,000 for this program.
Funds appropriated for this activity are part of the
comprehensive and coordinated service systems targeted to those
elderly most in need. Preventive health services include
nutritional counseling and education, exercise programs, health
screening and assessments, and prevention of depression.
Within the appropriation for this program, $5,500,000 is
provided to expand medication management, screening and
education activities, including the use of new medication
management devices, to prevent incorrect medication and adverse
drug reactions among the elderly. These activities will help
older adults learn more about managing medications safely and
help reduce unnecessary hospitalizations and illnesses.
Protection of Vulnerable Older Americans
The Committee recommends $18,559,000 for grants to States
for protection of vulnerable older Americans. Within the
Committee recommendation, $13,361,000 is for the ombudsman
services program and $5,198,000 is for the prevention of elder
abuse program. The amount recommended for each of these
programs is the same as the comparable fiscal year 2003 level.
Both programs provide formula grants to States to prevent the
abuse, neglect, and exploitation of older individuals. The
ombudsman program focuses on the needs of residents of nursing
homes and board and care facilities, while elder abuse
prevention targets its message to the elderly community at
large.
The Committee encourages the Administration on Aging to
fund a demonstration grant program in support of the activities
authorized under Title VII, Subtitle B of the Older Americans
Act for programs directed toward preventing abuse, neglect and
exploitation of older individuals in Indian Country. Funds
should be used for education programs directed toward
increasing awareness of elder abuse in Indian Country and on
developing enforceable codes at the tribal level.
National Family Caregiver Support Program
The Committee recommends $149,025,000 for the national
family caregiver support program, which is the same as the
comparable fiscal year 2003 level. The administration request
was $141,500,000. Funds appropriated for this activity
established a multifaceted support system in each State for
family caregivers. All States are expected to implement the
following five components into their program: individualized
referral information services; assistance to caregivers in
locating services from a variety of private and voluntary
agencies; caregiver counseling, training and peer support;
respite care provided in the home, an adult day care center or
other residential setting located in an assisted living
facility; and limited supplemental services that fill remaining
service gaps.
Native American Caregiver Support Program
The Committee recommendation includes $6,209,000 to carry
out the Native American Caregiver Support Program, which is the
same as the comparable fiscal year 2003 amount. The
administration requested $5,500,000 as part of its request for
the National Family Caregiver Support Program. The program will
assist tribes in providing multifaceted systems of support
services for family caregivers and for grandparents or older
individuals who are relative caregivers. In fiscal year 2003,
funds were used to provide both discretionary and formula
grants to support the goals of this program.
Congregate and Home-delivered Nutrition Services
For congregate nutrition services, the Committee recommends
an appropriation of $387,292,000. The comparable level for
fiscal year 2003 was $384,592,000 and the budget request was
$390,000,000. For home-delivered meals, the Committee
recommends $180,985,000, which is the same as the comparable
level for fiscal year 2003. The administration request was
$178,500,000. These programs address the nutritional need of
older individuals. Projects funded must make home-delivered and
congregate meals available at least once a day, 5 days a week,
and each meal must meet one-third of the minimum daily dietary
requirements. While States receive separate allotments of funds
for congregate and home-delivered nutrition services and
support services, they are permitted to transfer up to 40
percent of funds between these programs.
Nutrition Services Incentives Program
The Committee recommendation includes $148,697,000 for the
nutrition services incentives program, the same as the
comparable fiscal year 2003 funding level. The administration
request was $149,670,000.
This program, which was transferred from the Department of
Agriculture in fiscal year 2003, augments funding for
congregate and home-delivered meals provided to older adults.
The Committee commends the administration for recognizing that
the NSIP should remain distinct from existing nutrition
programs. Funds provided under this program are dedicated
exclusively to the provision of meals. NSIP rewards effective
performance by States and Tribal organizations in the efficient
delivery of nutritious meals to older individuals through the
use of cash or commodities. The Committee believes that funds
should continue to be allocated based on the number of meals
served in a State in the previous year and States should
continue to have the option to receive commodities in lieu of
cash if they choose. In addition, funds should not be subject
to transfer and to administrative match requirements.
Aging Grants to Indian Tribes and Native Hawaiian Organizations
The Committee recommends $27,495,000 for grants to native
Americans, which is the same as the fiscal year 2003 comparable
level. Under this program awards are made to tribal and Alaskan
Native organizations and to public or nonprofit private
organizations serving native Hawaiians which represent at least
50 percent Indians or Alaskan Natives 60 years of age or older
to provide a broad range of supportive services and assure that
nutrition services and information and assistance are
available.
Training, Research and Discretionary Projects
The Committee recommends $17,843,000 for training,
research, and discretionary projects. The comparable fiscal
year 2003 level was $29,336,000. The Committee has provided
funding in Aging Network Support Activities for several items
that in previous years were funded in this account.
These funds support activities designed to expand public
understanding of aging and the aging process, apply social
research and analysis to improve access to and delivery of
services for older individuals, test innovative ideas and
programs to serve older individuals, and provide technical
assistance to agencies that administer the Older Americans Act.
Given the enormous demands on Alzheimer's family caregivers,
the Committee has included $1,000,000 to support an Alzheimer's
family contact center for round-the-clock help to Alzheimer's
families in crisis.
The Committee continues to support funding at no less than
last year's level for national programs scheduled to be
refunded in fiscal year 2004 that address a variety of issues,
including elder abuse, native American issues and legal
services.
Aging Network Support Activities
The Committee recommends $13,373,000 for aging network
support activities. The comparable amount for fiscal year 2003
was $13,286,000. The Committee recommendation includes
$1,199,000 for the Eldercare Locator and $1,180,000 for the
pension information and counseling projects. In addition, the
Committee has provided funding at no less than last year's
level for the National Long Term Care Ombudsman Resource Center
and the National Center on Elder Abuse. These programs were
funded as demonstration activities through the fiscal year 2003
appropriation. The reauthorization of the Older Americans Act
authorized both of these activities under section 202 of the
Act. The Committee recommendation includes funding at no less
than last year's level for the Health Care Anti-Fraud, Waste
and Abuse Program, which uses the skills of retired nurses,
doctors, accountants and other professionals to train other
seniors and to serve as expert resources to detect and stop
Medicare fraud, waste and abuse. This program was funded as a
demonstration activity through fiscal year 2003. The Committee
expects that these funds will be used to make grants and that
administrative costs will be minimized. In addition, the
Committee expects that an improved system will be developed and
implemented in coordination with CMS and the OIG to track cases
referred by this initiative.
The Eldercare Locator, a toll-free, nationwide directory
assistance service for older Americans and their caregivers, is
operated by the National Association of Area Agencies on Aging.
Since 1991, the service has linked more than 700,000 callers to
an extensive network of resources for aging Americans and their
caregivers.
Pension counseling projects provide information, advice,
and assistance to workers and retirees about pension plans,
benefits, and how to pursue claims when pension problems arise.
The information dissemination and outreach activities of the
pension counseling projects have served over 13,000 people in
14 States and has helped recoup more than $40,000,000 on behalf
of older individuals.
Alzheimer's Disease Demonstration Grants to States
As a result of the aging of the baby boom generation, the
number of individuals affected by Alzheimer's disease will
double in the next 20 years. The Committee recommends a funding
level of $12,412,000, for Alzheimer's disease demonstration
grants to States.
Currently, an estimated 70 percent of individuals with
Alzheimer's disease live at home, where families provide the
preponderance of care. For these families, caregiving comes at
enormous physical, emotional and financial sacrifice. The
Alzheimer's disease demonstration grant program currently
provides matching grants to 35 States to stimulate and better
coordinate services for families coping with Alzheimer's. With
a relatively small amount of Federal support to provide the
stimulus, States have found innovative ways to adapt existing
health, long-term care, and community services to reach
previously underserved populations, particularly minorities and
those living in rural communities.
White House Conference on Aging
The Committee recommends $2,842,000 for the White House
Conference on Aging, which is the same level as the
administration request. These funds are available until
September 30, 2006. Funds will be used for start up costs for
the Conference, which will be held prior to December 31, 2005
and is required by the Older Americans Act Amendments of 2000.
Program Administration
The Committee recommends $17,869,000 to support Federal
staff that administer the programs in the Administration on
Aging, which is the same as the comparable 2003 level. These
funds provide administrative and management support for
programs administered by the agency.
Office of the Secretary
GENERAL DEPARTMENTAL MANAGEMENT
Appropriations, 2003.................................... $350,973,000
Budget estimate, 2004................................... 353,951,000
Committee recommendation................................ 348,659,000
The Committee recommends $348,659,000 for general
departmental management [GDM]. The comparable level for fiscal
year 2003 was $350,973,000 and the administration request was
$353,951,000. The Committee recommendation includes the
transfer of $5,851,000 from Medicare trust funds, which is the
same as the administration request.
The Committee directs that specific information requests
from the chairman and ranking member of the Subcommittee on
Labor, Health and Human Services, and Education, and Related
Agencies, on scientific research or any other matter, shall be
transmitted to the Committee on Appropriations in a prompt
professional manner and within the time frame specified in the
request. The Committee further directs that scientific
information requested by the Committees on Appropriations and
prepared by Government researchers and scientists be
transmitted to the Committee on Appropriations, uncensored and
without delay.
This appropriation supports those activities that are
associated with the Secretary's role as policy officer and
general manager of the Department. It supports certain health
activities performed by the Office of Public Health and
Science, including the Office of the Surgeon General. GDM funds
also support the Department's centralized services carried out
by several Office of the Secretary staff divisions, including
personnel management, administrative and management services,
information resources management, intergovernmental relations,
legal services, planning and evaluation, finance and
accounting, and external affairs.
The Office of the Surgeon General, in addition to its other
responsibilities, provides leadership and management oversight
for the PHS Commissioned Corps, including the involvement of
the Corps in departmental emergency preparedness and response
activities.
The Committee has provided $4,015,000 to support the
activities of the United States-Mexico Border Health Commission
as authorized by Public Law 103-400. The Commission is
authorized to assess and resolve current and potential health
problems that affect the general population of the United
States-Mexico border area.
The Committee has included a new general provision which
prohibits the Department from carrying out or administering the
Department's human resources consolidation plan. This
prohibition also extends to the Indian Health Service and the
Food and Drug Administration. This action was taken at the
request of the Subcommittees on the Interior and on Agriculture
and Rural Development because of their concerns regarding the
impact that the human resources consolidation would have on the
agencies in their Subcommittees' jurisdiction. The agencies
within the jurisdiction of the Labor-HHS Subcommittee have
unique personnel requirements necessary to carry out the
research and health missions mandated by the Public Health
Service Act. The Committee believes that centralizing human
resource offices, at the same time that the Department is
implementing the Federal Government's plan to outsource various
support activities, could disrupt critical research at the
National Institutes of Health and public health functions at
the Centers for Disease Control and Prevention and other public
health agencies. The Committee believes that centralizing human
resource offices may lessen the special expertise needed to
hire the best public health personnel and dilute the
independence of decision-making within the agencies. The
Committee believes that before the Department undertakes a
human resources consolidation plan, a study should be conducted
to determine best practices in improving efficiencies in human
resources and administrative functions to achieve the cost-
saving aspects of the plan without disputing the hiring
decisions made by the public health agencies. Therefore the
Committee directs the Secretary to contract with the National
Academy of Public Administration to undertake such a study and
has included sufficient funds for this purpose.
Commissioned Corps.--The Committee has provided $3,000,000
within the total for activities related to the transformation
and modernization of the Public Health Service [PHS]
Commissioned Corps. The Committee provided $2,000,000 in fiscal
year 2003, bringing the total provided for the transformation
of the Commissioned Corps to $5,000,000. These funds will allow
an increase in recruitment for Corps health professionals,
expand and enhance the Commissioned Corps Readiness Force,
provide medical readiness education and training to Corps
personnel, and establish a PHS Auxiliary system to provide
locally-grouped professionals who can be deployed along with
Corps teams.
Data Collection.--The Committee is aware that much of the
health data used by the public and private sectors is provided
by the Department, especially by the National Center for Health
Statistics. The Department plays a leadership role in assuring
the collection and reporting of racial, ethnic and primary
health-related data through written policy and sustained
action. The Committee expects the Secretary to designate a
central authority within the Department to oversee its policies
in this area, as well as in dissemination, implementation and
compliance activities. Federal datasets must meet at least the
minimum standards set by the Office of Management and Budget in
1997 and subsequent standards for maintaining, collecting and
presenting Federal data on race and ethnicity. In addition, the
Committee reminds the Department of OMB's requirements that the
standards be adopted for use in household surveys,
administrative forms and records, and other data collection
purposes.
Direct Support Professionals.--The Committee recognizes the
growing crisis in recruiting and retaining quality Direct
Support Professionals [DSPs] to serve people with mental
retardation and other developmental disabilities living in the
community. The Committee encourages the Secretary, acting
through the Assistant Secretary for Planning and Evaluation, to
conduct a study on the shortage of DSPs, including an
examination of root causes, vacancy and turnover rates, and the
impact this shortage is having on community services for people
with mental retardation and other developmental disabilities.
Embryo Adoption Awareness.--A recent study has shown that
there are nearly 400,000 frozen embryos in fertility clinics in
the United States, a figure several times higher than previous
estimates. The Committee understands that only approximately 2
percent of these frozen embryos are donated to other couples in
order to bear children. The Committee believes that, if
educated about the possibility, many more couples may chose to
donate their embryos and more infertile couples may chose to
adopt such embryos. In fiscal year 2002 the Committee directed
the Department to launch a public awareness campaign regarding
the existence of these spare embryos. The Committee believes
that increasing public awareness of this option remains an
important goal and therefore directs the Department to continue
its embryo adoption awareness campaign. The Committee has
provided $1,000,000 for this purpose.
Mammography.--The Committee believes it is important to
improve the quality of mammography, particularly the
interpretation of mammograms, and to ensure access to
mammography for women. The Committee strongly urges the
Department to enter into an agreement with the Institute of
Medicine to conduct a study and make recommendations on ways to
improve the Mammography Quality Standards Act, mammography
quality and access, and physicians' interpretation of
mammograms. The study should also address recruitment and
retention of personnel, improvements in data collection, and
making available safe and effective new screening and
diagnostic tools for breast cancer.
Racial and Ethnic Disparities.--The Committee is strongly
committed to ensuring the overall improved health of the
American people, and urges the Department to take the steps
necessary 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 improving health and eliminating health disparities. The
Committee expects the Secretary to report on the progress of
this action during next year's appropriations hearings, and to
include a progress update in the Department's Budget
Justification.
Social Worker Shortage.--The Committee urges the Department
to study and quantify the current and future supply and demand
for professional social workers serving older adults across the
continuum of long-term care services. The Department should
report these findings to the Committee and furnish
recommendations for addressing any identified future shortage
areas, including cooperative strategies involving Federal
agencies, professional associations, and schools of social
work.
Adolescent Family Life
The Committee has provided $31,241,000 for the Adolescent
Family Life Program [AFL], which is the same as the
administration request. The comparable fiscal year 2003 level
was $30,922,000.
AFL is the only Federal program focused directly on the
issue of adolescent sexuality, pregnancy, and parenting.
Through demonstration grants and contracts, AFL focuses on a
comprehensive range of health, educational, and social services
needed to improve the health of adolescents, including the
complex issues of early adolescent sexuality, pregnancy, and
parenting.
Within the total provided, the Committee continues the
prevention projects begun in fiscal year 1998, as well as new
prevention projects. The Committee again expects the Department
to fund new prevention projects which enable smaller
communities to begin the organization and implementation of
coalitions to implement abstinence-based education programs.
The Committee again expects the Department, when announcing
grant competitions, to provide a reasonable length of time for
applicants to complete application packages, provide extensive
technical assistance to applicants, with special assistance
given to new applicants, and revise the terminology and
instructions in grant applications to assure that the
information being requested is as clear as possible.
Physical Fitness and Sports
The Committee recommends $1,222,000 for the Federal staff
which supports the President's Council on Physical Fitness and
Sports. The comparable fiscal year 2003 level was $1,215,000
and the administration request was $1,230,000.
The President's Council on Physical Fitness and Sports
serves as a catalyst for promoting increased physical activity/
fitness and sports participation for Americans of all ages and
abilities, in accordance with Executive Order 13265, as
amended. The programs sponsored by PCPFS are supported largely
through private sector partnerships.
Minority Health
The Committee recommends $48,740,000 for the Office of
Minority Health. The comparable level for fiscal year 2003 was
$56,224,000 and the administration request was $47,010,000.
The Office of Minority Health [OMH] focuses on strategies
designed to decrease the disparities and to improve the health
status of racial and ethnic minority populations in the United
States. OMH establishes goals, and coordinates all departmental
activity related to improving health outcomes for disadvantaged
and minority individuals. OMH supports several demonstration
projects, including the Minority Community Health Coalition,
the Bilingual/Bicultural Service, the Center for Linguistic and
Cultural Competency in Health Care, and the Family and
Community Violence Prevention Program.
The Committee continues to support the National Minority
Male Health Project in the Office of Minority Health which
funds the New Minority Males Consortium. This consortium is
composed of five historically black colleges and universities
[HBCUs] and has begun implementation of campus and community-
based projects to educate and inform minority males about
certain diseases prevalent among African American, Latino, and
other minority males. The Committee encourages OMH to dedicate
adequate funds to support institutional activities and to
further expand this effort to include additional HBCUs and
other minority serving institutions.
The Committee continues to recognize the need to recruit
and train more minorities in the health professions. The
Committee encourages the Office of Minority Health to support
annual conferences that have a proven record of increasing the
number of under-represented minorities entering the health
professions.
The Committee commends the Secretary for designating the
elimination of health disparities as a major priority for the
Department, and is encouraged that the agencies within DHHS are
moving forward in this area as they implement, monitor and
evaluate strategic plans for eliminating health disparities.
The Committee expects the Office of Minority Health and the
National Center for Minority Health and Health Disparities at
the National Institutes of Health to play a joint role in
coordinating and monitoring the implementation of the
Department's elimination of health disparities strategic plans.
The Committee expects the Secretary to report to Congress on
the implementation of the strategic plans during next year's
appropriations hearings, and to include a progress update in
future Budget Justifications.
Office on Women's Health
The Committee recommends $29,721,000 for the Office on
Women's Health. The comparable level for fiscal year 2003 was
$28,658,000 and the administration request was $28,908,000.
The PHS Office on Women's Health [OWH] develops,
stimulates, and coordinates women's health research, health
care services, and public and health professional education and
training across HHS agencies. It advances important
crosscutting initiatives and develops public-private
partnerships, providing leadership and policy direction, and
initiating and synthesizing program activities to redress the
disparities in women's health.
The Committee remains strongly supportive of the work done
by the Office on Women's Health in the Office of the Secretary.
In addition to its own work advancing women's health, it
provides critical coordinating services with offices located in
NIH, CDC, HRSA, FDA, SAMHSA, AHRQ, and CMS. In totality, these
offices assure that issues related to research, treatment,
services, training, and education efforts by HHS reflect the
distinct needs of women. The Secretary should notify the
Committee in advance of any changes planned for the status,
location, or reporting structure of this office or any of the
offices enumerated above.
HIV/AIDS in Minority Communities
To address high-priority HIV prevention and treatment needs
of minority communities heavily impacted by HIV/AIDS, the
Committee recommends $50,000,000. These funds are available to
key operating divisions of the Department with capability and
expertise in HIV/AIDS services to assist minority communities
with education, community linkages, and technical assistance.
OFFICE OF INSPECTOR GENERAL
Appropriations, 2003.................................... $36,808,000
Budget estimate, 2004................................... 39,497,000
Committee recommendation................................ 39,497,000
The Committee recommends an appropriation of $39,497,000
for the Office of Inspector General. The fiscal year 2003
comparable level was $36,808,000 and the administration request
was $39,497,000. In addition to discretionary funds, the Health
Insurance Portability and Accountability Act of 1996 provides
$160,000,000 in mandatory funds for the Office of the Inspector
General in fiscal year 2004; the total funds provided to the
Office by this bill and the authorizing bill would be
$199,497,000 in fiscal year 2004.
The Office of Inspector General conducts audits,
investigations, inspections, and evaluations of the operating
divisions within the Department of Health and Human Services.
The OIG functions with the goal of reducing the incidence of
waste, abuse, and fraud. It also pursues examples of
mismanagement toward the goal of promoting economy and
efficiency throughout the Department.
The Committee commends the Office of Inspector General for
their continued good work to reduce waste, fraud and abuse in
Department programs. The Committee expects efforts to reduce
Medicare mispayments will be continued and expanded. With the
possible introduction of a outpatient prescription drug
benefit, the Committee asks the OIG to prepare for its
consideration any needed oversight to minimize potential
program losses due to fraud, waste and abuse in the
administration of this important new benefit.
OFFICE FOR CIVIL RIGHTS
Appropriations, 2003.................................... $33,423,000
Budget estimate, 2004................................... 34,250,000
Committee recommendation................................ 34,250,000
The Committee recommends $34,250,000 for the Office for
Civil Rights. This is the same as the administration request.
The comparable fiscal year 2003 level was $33,423,000. The
recommendation includes the transfer of $3,314,000 from the
Medicare trust funds.
The Office for Civil Rights is responsible for enforcing
civil rights-related statutes in health care and human services
programs. To enforce these statutes, OCR investigates
complaints of discrimination, conducts program reviews to
correct discriminatory practices, and implements programs to
generate voluntary compliance among providers and constituency
groups of health and human services.
POLICY RESEARCH
Appropriations, 2003.................................... $2,483,000
Budget estimate, 2004................................... 2,499,000
Committee recommendation................................................
The Committee does not recommend appropriated funds for
policy research. The Committee has provided $23,499,000 through
transfers available under section 241 of the Public Health
Service Act. The comparable program level for fiscal year 2003
was $20,483,000.
Funds appropriated under this title provide resources for
research programs that examine broad issues which cut across
agency and subject lines, as well as new policy approaches
outside the context of existing programs. This research can be
categorized into three major areas: health policy, human
services policy, and disability, aging and long-term care
policy.
RETIREMENT PAY AND MEDICAL BENEFITS FOR COMMISSIONED OFFICERS
Appropriations, 2003.................................... $310,017,000
Budget estimate, 2004................................... 316,365,000
Committee recommendation................................ 329,868,000
The Committee provides an estimated $329,868,000 for
retirement pay and medical benefits for commissioned officers
of the U.S. Public Health Service. The fiscal year 2003
comparable level was $310,017,000 and the administration
request was $316,365,000.
This account provides for: retirement payments to U.S.
Public Health Service officers who are retired for age,
disability, or length of service; payments to survivors of
deceased officers; medical care to active duty and retired
members and dependents and beneficiaries; and for payments to
the Social Security Administration for military service
credits.
The Committee notes that, according to the budget request,
the various agencies and operating divisions across the
Department are expected to absorb $22,371,000 in retirement
medical cost payments for Commissioned Corps Officers. Medical
cost payments have been funded by this account in the past. The
transfer of responsibility for these payments to the
Department's discretionary budgets was mandated in the
Department of Defense Reauthorization Act of Fiscal Year 2002.
However, the Committee recognizes that the corresponding funds
were not transferred to the operating divisions to cover these
costs. Therefore, the Committee has included bill language
mandating that the Retirement Pay and Medical Benefits for
Commissioned Officers account continue to cover these costs in
fiscal year 2004 as it has done in the past.
PUBLIC HEALTH AND SOCIAL SERVICES EMERGENCY FUND
Appropriations, 2003.................................... $1,887,247,000
Budget estimate, 2004................................... 1,896,149,000
Committee recommendation................................ 1,856,040,000
The Committee recommends $1,856,040,000 for the Public
Health and Social Services Emergency Fund. The comparable level
for fiscal year 2003 was $1,887,247,000. The Committee has
provided funding for Poison Control and Emergency Medical
Services for Children in HRSA instead of in this account as
proposed by the administration. The Committee has fully funded
the administration request when these amounts are included.
The Committee provides $940,000,000 to CDC for upgrading
State and local capacity. This amount maintains funding at the
level provided last year. The Committee recognizes that
bioterrorism events will occur at the local level and will
continue to require local capacity, preparedness and initial
response. It was the intent of the Congress that significant
funding for State and local public health infrastructure be
used to improve local public health capacity and meet the needs
determined by local public health agencies. The Committee's
intent remains firm. The threats posed by bioterrorism and
other public health emergencies (as evidenced by the outbreak
of Severe Acute Respiratory Syndrome--SARS) have not abated.
Because it is essential to the Nation's public health readiness
that bioterrorism funding be made available at the local level,
the Committee encourages the CDC and the Department to ensure
that monies appropriated for State and local capacity building
be spent to improve local public health readiness in a manner
with which local public health officials concur. It is expected
that local public health agencies are and will continue to be
full partners in developing State plans.
The Committee is concerned over reports that some Federal
bioterrorism dollars have been used to supplant State and local
funding for public health. The intent of the Congress has
always been clear--funding for bioterrorism efforts is to
supplement, not supplant State and funding of public health
programs. During this crucial time, bioterrorism funding has
been made available to build public health capacity at both
State and local levels. Use of these funds to supplant State
and local dollars only endangers efforts to build a system to
respond to threats.
Within the total for State and local capacity, the
Committee has included $40,000,000 for the Health Alert Network
[HAN]. Prior to HAN, one-half of local public health
departments did not even have e-mail. Now, HAN is a well-
functioning system and has been used regularly, most recently
to distribute current information about SARS and monkeypox.
Continued expansion and refinement of HAN now falls under the
umbrella of the Public Health Information Network under
development by CDC. The Committee believes that this is
appropriate. To ensure that these funds continue to be used to
improve local capacity for electronic communications and data
exchange, the Committee encourages CDC to provide adequate
funding to improve public health capacity for electronic
communication and data exchange at the local level in a manner
consistent with the Public Health Information Network and with
which local public health officials concur. This will enable
enhanced local capacity that has resulted from HAN funding to
continue.
The Committee intended that one function of HAN was to
assure that essential, time-sensitive public health information
become available to both State and local public health agencies
in a timely manner. The Committee is concerned about reports
from localities, including large cities, participating in HAN
that they are not receiving all CDC-generated messages promptly
because such messages are going only to their State agencies.
Recognizing that both timeliness and redundancy in
communications are important in addressing urgent public health
concerns, the Committee strongly urges CDC to ensure that all
local public health agencies receive CDC information on the
same timely basis as do States.
Of the total amount, the Committee recommends $158,116,000
for upgrading CDC capacity and $18,040,000 for anthrax vaccine
research.
The Committee has included bill language to exempt
employees of the CDC or the Public Health Service, detailed as
field assignees for purposes related to homeland security, from
full-time equivalent [FTE] employment limitations,
administrative ceilings, or targets. The effect of the bill
language is to furnish States, municipalities, and other
organizations with a sufficient number of field assignees to
implement important public health programs related to homeland
security.
The Committee's recommendation includes $61,820,000 for the
Office of the Secretary. The Committee recommendation also
includes $100,000,000 for activities to ensure an adequate
supply of vaccine in the event of an influenza pandemic.
The Committee provides $578,064,000 to HRSA for
bioterrorism activities. Of this amount, $518,052,000 is for
hospital preparedness and infrastructure improvements related
to bioterrorism. The Committee intends that States use these
funds to develop hospital preparedness in a manner that is
consistent with State and local bioterrorism preparedness
plans. The Committee expects the Department will ensure that
hospitals receiving funds have consulted with the local public
health agency (or State agency where no local agency exists)
and that the hospitals' uses of these funds are fully
coordinated with local, regional and State bioterrorism
preparedness plans. The Committee provides $60,012,000 for
curriculum development and training on the detection and
treatment of diseases caused by bioterrorism.
Funds for bioterrorism prevention and response are
distributed through grants to 50 States and four metropolitan
areas. The Committee strongly recommends that these funds be
distributed based on a formula that includes factors for risk
of a terrorist event. Risk is challenging to quantify, but the
Committee suggests that the Secretary consider the following,
among other factors: (1) Site of headquarters or major offices
of multinational organizations; (2) site of major financial
markets; (3) site of previous incidents of international
terrorism; (4) some measure of population density versus just
population; (5) internationally recognized icons; (6) percent
of national daily mass transit riders; (7) proximity to a major
port, including major port ranked on number of cargo containers
arriving at the port per year.
The Committee understands that it is the responsibility of
HRSA to obtain guidance from the National Institute for
Occupational Safety and Health [NIOSH] and the Occupational
Safety and Health Administration [OSHA] on the appropriate
personal protective equipment, including respiratory
protection, and decontamination equipment for hospitals in the
event of a terrorist incident. Such guidance will primarily
focus on preparedness for biological terrorism, but also will
include preparedness for a chemical or radiological incident.
The Committee believes that uniform guidance will minimize
hospital guesswork, assure uniformity in preparedness across
jurisdictions, and allow for greater ease of mutual aid.
General Provisions, Department of Health and Human Services
The Committee recommendation includes language placing a
$50,000 ceiling on official representation expenses (sec. 201).
The Committee recommendation includes language carried in
fiscal year 2003 which limits the assignment of certain public
health personnel (sec. 202).
The Committee recommendation retains language regarding
set-asides in the authorizing statute of the National
Institutes of Health (sec. 203).
The Committee recommendation retains a provision carried in
fiscal year 2003 to limit the use of grant funds to pay
individuals no more than an annual rate of Executive Level I
(sec. 204).
The Committee recommendation retains language carried in
fiscal year 2003 restricting the Secretary's use of taps for
program evaluation activities unless he submits a report to the
Appropriations Committees on the proposed use of funds (sec.
205).
The Committee recommendation includes language authorizing
the transfer of up to 2.2 percent of Public Health Service
funds for evaluation activities (sec. 206).
The Committee recommendation retains language restricting
transfers of appropriated funds among accounts and requiring 15
day notification to both the House and Senate Appropriations
Committees (sec. 207).
The Committee recommendation retains language carried in
fiscal year 2003 permitting the transfer of up to 3 percent of
AIDS funds among Institutes and Centers by the Director of NIH
and the Director of the Office of AIDS Research at NIH (sec.
208).
The Committee recommendation retains language which
requires that the use of AIDS research funds be determined
jointly by the Director of the National Institutes of Health
and the Director of the Office of AIDS Research and that those
funds be allocated directly to the Office of AIDS Research for
distribution to the Institutes and Centers consistent with the
AIDS research plan (sec. 209).
The Committee recommendation retains language carried in
fiscal year 2003 regarding requirements for family planning
applicants (sec. 210).
The Committee recommendation retains language which
restricts the use of funds to carry out the Medicare+Choice
Program if the Secretary denies participation to an otherwise
eligible entity (sec. 211).
The Committee recommendation retains language which States
that no provider services under Title X of the PHS Act may be
exempt from State laws regarding child abuse (sec. 212).
The Committee recommendation retains language carried in
fiscal year 2003 extending the refugee status of persecuted
religious groups (sec. 213).
The Committee recommendation retains language which
prohibits the Secretary from withholding substance abuse
treatment funds (sec. 214).
The Committee recommendation includes language carried in
fiscal year 2003 which facilitates the expenditure of funds for
international AIDS activities (sec. 215).
The Committee recommendation includes a provision allowing
the Division of Federal Occupational Health to use personal
services contracting to employ professional, administrative,
and occupational health professionals (sec. 216).
The Committee recommendation includes bill language that
allows the NIH to expand the number of Morris K. Udall
Parkinson's Disease Centers (sec. 217).
The Committee has included a new general provision which
prohibits the Department from carrying out or administering the
Department's human resources consolidation plan (sec. 218).
TITLE III--DEPARTMENT OF EDUCATION
EDUCATION FOR THE DISADVANTAGED
Appropriations, 2003.................................... $13,738,273,000
Budget estimate, 2004................................... 14,184,000,000
Committee recommendation................................ 14,103,356,000
The Committee recommends an appropriation of
$14,103,356,000 for education for the disadvantaged. The
comparable funding level for fiscal year 2003 is
$13,738,273,000 and the budget request includes $14,184,000,000
for this account.
The programs in the education for the disadvantaged account
help ensure that poor and low-achieving children are not left
behind in the Nation's effort to raise the academic performance
of all children and youth. That goal is more pressing than ever
since the passage of the No Child Left Behind Act, which
incorporates numerous accountability measures into Title I
programs, especially part A grants to local educational
agencies--the largest Federal elementary and secondary
education program.
In particular, the new law strengthens Title I
accountability by requiring States to implement statewide
accountability systems covering all public schools and
students. These systems must be based on challenging State
standards in reading and mathematics, annual statewide progress
objectives ensuring that all groups of students reach
proficiency in reading and math within 12 years, and annual
testing for all students in grades 3-8. State progress
objectives and assessment results must be broken out by
poverty, race and ethnicity, disability, and limited English
proficiency. States, school districts, and schools must report
annually on their progress toward statewide proficiency goals.
Districts and schools that fail to make adequate yearly
progress [AYP] toward these goals will, over time, be subject
to increasingly rigorous improvement, corrective action, and
restructuring measures aimed at getting them back on course to
meet State standards. Students attending schools that fail to
meet annual State AYP objectives for 2 consecutive years will
be permitted to transfer to a better public school or, if the
school continues to fail to meet AYP for 3 years or more, to
use Title I funds to obtain educational services from a public-
or private-sector provider selected by their parents.
Grants to Local Educational Agencies
Title I Grants to Local Educational Agencies [LEAs] provide
supplemental education funding, especially in high-poverty
areas, for local programs that provide extra academic support
to help raise the achievement of eligible students or, in the
case of schoolwide programs, help all students in high-poverty
schools to meet challenging State academic standards. The
program serves more than 15,000,000 students in nearly all
school districts and more than half of all public schools--
including two-thirds of the Nation's elementary schools.
Title I schools help students reach challenging State
standards through one of two models: ``targeted assistance''
that supplements the regular education program of individual
children deemed most in need of special assistance, or a
``schoolwide'' approach that allows schools to use Title I
funds--in combination with other Federal, State, and local
funds--to improve the overall instructional program for all
children in a school.
Starting with the fiscal year 2004 appropriation, States
are required to reserve 4 percent of their allocation under
this program for school improvement activities, double the
requirement in fiscal year 2003. States must distribute 95
percent of these reserved funds to local educational agencies
for schools identified for improvement, corrective action, or
restructuring.
More than any other Federal program, Title I grants to LEAs
are critical to the success of the No Child Left Behind Act.
The Committee recommends $12,350,000,000 for this program. The
comparable funding level for fiscal year 2003 is
$11,684,311,000 and the budget request includes $12,350,000,000
for Title I grants to LEAs. Since the No Child Left Behind Act
was passed in 2001, the Committee has supported an increase of
41 percent in the appropriation for this program. These Federal
resources represent the significant commitment this Committee
has made to provide the resources necessary to help all
children succeed in school.
The Committee has included bill language that requires the
Secretary to use the most appropriate and reliable data
available on July 1, 2003 for calculating grants under the
Title I Grants to LEAs program.
The grants are distributed through four formulas: basic,
concentration, targeted, and education finance incentive grant
[EFIG].
For Title I basic grants, including the amount transferred
to the Census Bureau for poverty updates, the Committee
recommends an appropriation of $7,107,282,000. The comparable
funding level for fiscal year 2003 is $7,107,282,000 and the
budget request includes $7,172,971,000 for the basic grants
funding stream. Basic grants are awarded to school districts
with at least 10 poor children who make up more than 2 percent
of enrollment.
For concentration grants, the Committee recommends an
appropriation of $1,365,031,000. The comparable funding level
for fiscal year 2003 and the budget request are both
$1,365,031,000. Funds under this program are distributed
according to the basic grants formula, except that they go only
to LEAs where the number of poor children exceeds 6,500 or 15
percent of the total school-aged population.
Last year, Congress provided all of the additional funding
for Title I grants to LEAs above the fiscal year 2002 level
through the EFIG and targeted formulas. The Committee
recommends allocating all of the increase proposed this year
through the EFIG formula. The Committee notes that analysis
conducted by the Congressional Research Service has
demonstrated that the EFIG formula delivers a larger share of
Title I funds to high-poverty school districts--those with
child poverty rates in excess of 25 percent--than any other
Title I formula, followed closely by the targeted grants
formula. In addition, the EFIG formula uses State-level
``equity'' and ``effort'' factors to make allocations to States
that are intended to encourage States to spend more on
education and to improve the equity of State funding systems.
Once State allocations are determined, suballocations to the
LEA level are based on a modified version of the targeted
grants formula, described below.
The Committee recommends an appropriation of $2,207,448,000
for education finance incentive grants. The comparable funding
level for fiscal year 2003 is $1,541,759,000 and the budget
request includes $793,499,000 for the EFIG funding stream.
The targeted grants formula weights child counts to make
higher payments to school districts with high numbers or
percentages of poor students. For these grants, the Committee
recommends an appropriation of $1,670,239,000. The comparable
funding level for fiscal year 2003 is $1,670,239,000 and the
budget request includes $3,018,499,000 for this funding stream.
William F. Goodling Even Start Family Literacy Program
The Committee recommends $175,000,000 for fiscal year 2004
for the Even Start program. The comparable funding level for
fiscal year 2003 is $248,375,000 and the budget request
includes $175,000,000 for this program.
The Even Start program provides grants for family literacy
programs that serve disadvantaged families with children under
8 years of age and adults eligible for services under the Adult
Education and Family Literacy Act. Programs combine early
childhood education, adult literacy, and parenting education.
States receive funds on the basis of their proportion of
Title I LEA grant allocations and make competitive 4-year
grants to partnerships of local educational agencies and
community-based organizations. Grant funds must be equitably
distributed among urban and rural areas. The local share of
program costs must increase from 10 percent in the first year
to 40 percent in the 4th year, 50 percent in years 5 through 8,
and 65 percent after 8 years.
The Committee notes with interest the results from the
Program Assessment Rating Tool used with respect to the Even
Start program. In particular, the Committee is concerned that
while State educational agencies and local grantees have
developed a framework for monitoring and evaluating program
performance, the Department has yet to utilize fully this
framework in order to establish benchmarks and numerical
targets by which program performance can be measured. The
Committee encourages the Department to move expeditiously to
address these deficiencies. The Committee requests that the
Department include in its 2005 Congressional Justification a
complete description of steps taken and planned to develop a
robust program performance system for the Even Start program.
Reading First State Grants
The Committee recommends $1,000,000,000 for the Reading
First State Grants program. The comparable funding level for
fiscal year 2003 is $993,500,000 and the budget request
includes $1,050,000,000 for the Reading First State Grants
program. The Committee remains very supportive of the
President's goal of providing $5,000,000,000 over a 5-year
period for the Reading First program. Since President Bush took
office, Federal funding for reading programs has grown by
almost 250 percent.
Reading First is a comprehensive effort to provide States
and LEAs with funds to implement comprehensive reading
instruction for children in grades K-3. The purpose of the
program is to help ensure that every child can read by the end
of third grade. LEAs and schools that receive funds under this
program should use the money to provide professional
development in reading instruction for teachers and
administrators, adopt and use reading diagnostics for students
in grades K-3 to determine where they need help, implement
reading curricula that are based on scientific research, and
provide reading interventions for children who are not reading
at grade level. Under the budget request, $5,650,000 is
available to support Targeted Assistance Grants to those SEAs
and LEAs that meet specified performance outcome goals.
The Committee encourages the Department to move quickly to
develop performance targets and an evaluation framework for
assessing the effectiveness of this program. The Committee
requests that the Department include in its 2005 Congressional
justification a summary report of implementation issues and
performance outcomes identified in State annual performance
reports or in other evaluation and monitoring activities
undertaken by the Department.
Early Reading First
The Committee recommends $85,000,000 for the Early Reading
First program. The comparable funding level for fiscal year
2003 is $74,512,000 and the budget request includes
$100,000,000 for Early Reading First.
Early Reading First complements Reading First State Grants
by providing competitive grants to school districts and
nonprofit groups to support activities in existing preschool
programs that are designed to enhance the verbal skills,
phonological awareness, letter knowledge, pre-reading skills,
and early language development of children ages 3 through 5.
Funds are targeted to communities with high numbers of low-
income families.
The Committee encourages the Department to move quickly to
develop performance targets and an evaluation framework for
assessing the effectiveness of this program. The Committee
requests that the Department include in its 2005 Congressional
Justification a summary report, based on State annual
performance reports of basic program information, including the
percentage of young children participating in the program with
the skills they need to be successful readers. In addition, the
Committee requests that this report provide information on how
grantees are using Early Reading First funds in coordination
with other federally-funded and supported programs that address
early care and development of children.
Improving Literacy Through School Libraries
The Committee recommends $12,419,000 for the Improving
Literacy Through School Libraries program. The comparable
funding level for fiscal year 2003 is $12,419,000 and the
budget request includes $27,500,000 for the Improving Literacy
Through School Libraries program.
This program provides funds for urgently needed, up-to-date
school library books and training for school library media
specialists in order to support the scientifically based
reading programs authorized by the Reading First initiative.
LEAs with a child-poverty rate of at least 20 percent are
eligible for the competitive awards. Funds may be used to
acquire school library media resources, including books and
advanced technology; facilitate resource-sharing networks among
schools and school libraries; provide professional development
for school library media specialists; and provide students with
access to school libraries during non-school hours.
The Committee encourages the Department to establish
performance targets and an evaluation framework for assessing
the effectiveness of this program. The Committee is aware that
the authorizing statute allows the Secretary to use up to one
percent of the appropriation for evaluation activities and
notes that these funds would be helpful in developing a
framework for evaluating the effectiveness of this program.
Migrant Education Program
The Committee recommends $395,413,000 for the Migrant
Education program. The comparable fiscal year 2003 funding
level is $395,413,000 and the budget request includes
$396,000,000 for the Migrant Education program.
The Title I Migrant Education program authorizes grants to
State educational agencies for programs to meet the special
educational needs of the children of migrant agricultural
workers and fishermen. Funds are allocated to the States
through a statutory formula based on each State's average per-
pupil expenditure for education and actual counts of migratory
children ages 3 through 21 residing within the States in the
previous year. Only migratory children who have moved within
the last 3 years are generally eligible to be counted and
served by the program.
This appropriation also supports activities to improve
interstate and intrastate coordination of migrant education
programs, as well as identifying and improving services to the
migrant student population.
Neglected and Delinquent
The Committee recommends $48,682,000 for the Title I
neglected and delinquent program. The comparable funding level
for fiscal year 2003 is $46,682,000 and the budget request
includes $48,000,000 for the neglected and delinquent program.
This program provides financial assistance to State
educational agencies for education services to neglected and
delinquent children and youth in State-run institutions and for
juveniles in adult correctional institutions. Funds are
allocated to individual States through a formula based on the
number of children in State-operated institutions and per-pupil
education expenditures for the State.
States are authorized to set aside up to 15, but not more
than 30, percent of their neglected and delinquent funds to
help students in State-operated institutions make the
transition into locally operated programs and to support the
successful reentry of youth offenders, who are age 20 or
younger and have received a secondary school diploma or its
recognized equivalent. Reentry activities may include
strategies designed to expose the youth to, and prepare the
youth for, postsecondary education, or vocational and technical
training programs. The Committee urges the Secretary to provide
appropriate technical assistance to States in identifying and
implementing best practices for effectively utilizing funds
available for transition services and other activities.
Under the No Child Left Behind Act, the Congress provided
the Secretary with the authority to reserve up to 2.5 percent
of the appropriation for national activities. The Committee
urges the Secretary to fully utilize this authority to support
capacity building in and dissemination of best practices to
State agency programs and to develop a uniform model for
evaluating State performance under this program. The Committee
is aware that a study by the National Council on Crime and
Delinquency concluded, with assistance, States could provide
meaningful outcome data including recidivism, diploma and
degree completions and employment.
Evaluation
The Committee recommends $8,842,000 for evaluation of Title
I programs. The comparable funding level for fiscal year 2003
is $8,842,000 and the budget request includes $9,500,000 for
such activities. The budget request includes bill language that
would allow the Secretary to use up to $1,000,000 from the
appropriation to respond to technical assistance requests from
States and school districts regarding implementation of Part A
of Title I. The Committee has provided the requested authority.
Evaluation funds are used to support large-scale national
surveys that examine how the Title I programs are contributing
to student academic achievement. Funds also are used to
evaluate State assessment and accountability systems and
analyze the effectiveness of educational programs supported
with Title I funds.
Comprehensive School Reform
The Committee recommends no funds for this program. The
comparable funding level for fiscal year 2003 is $233,473,000
and the budget request did not include any funds for the
comprehensive school reform program.
This program has provided schools with funding to develop
or adopt, and implement, comprehensive school reforms that will
enable children in participating schools to meet State
standards. The Department has allocated funds to States based
on their relative shares of the previous year's Title I basic
grants funds.
High School Equivalency Program
The Committee recommends $13,000,000 for the high school
equivalency program [HEP]. The comparable funding level for
fiscal year 2003 is $23,347,000 and the budget request is
$13,000,000 for the HEP.
This program provides 5-year grants to institutions of
higher education and other nonprofit organizations to recruit
migrant students ages 16 and over and provide the academic and
support services needed to help them obtain a high school
equivalency certificate and subsequently gain employment, win
admission to a postsecondary institution or a job-training
program, or join the military. Projects provide counseling,
health services, stipends, and placement assistance. At the
budget request, HEP will serve roughly 5,500 migrants.
College Assistance Migrant Program
For the College Assistance Migrant Program [CAMP], the
Committee recommends $15,000,000. The comparable funding level
for fiscal year 2003 is $15,399,000 and the budget request is
$15,000,000 for the CAMP.
Funds provide 5-year grants to institutions of higher
education and nonprofit organizations for projects that provide
tutoring, counseling, and financial assistance to migrant
students during their first year of postsecondary education.
Projects also may use up to 10 percent of their grants for
follow-up services after students have completed their first
year of college, including assistance in obtaining student
financial aid.
IMPACT AID
Appropriations, 2003.................................... $1,188,226,000
Budget estimate, 2004................................... 1,015,500,000
Committee recommendation................................ 1,188,226,000
The Committee recommends an appropriation of $1,188,226,000
for impact aid for the Department of Education. The comparable
funding level for fiscal year 2003 is $1,188,226,000 and the
budget request includes $1,015,500,000 for the impact aid
account.
Impact aid provides financial assistance to school
districts for the costs of educating children when enrollments
and the availability of revenues from local sources have been
adversely affected by the presence of Federal activities.
Children who reside on Federal or Indian lands generally
constitute a financial burden on local school systems because
these lands do not generate property taxes--a major revenue
source for elementary and secondary education in most
communities. In addition, realignments of U.S. military forces
at bases across the country often lead to influxes of children
into school districts without producing the new revenues
required to maintain an appropriate level of education.
Basic Support Payments.--The Committee recommends
$1,025,292,000 for basic support payments. The comparable
funding level for fiscal year 2003 is $1,025,292,000 and the
budget request includes $867,500,000. Under statutory formula,
payments are made on behalf of all categories of federally
connected children. However, the budget includes a legislative
proposal which would eliminate Federal aid provided for certain
categories of federally connected students. The categories of
students affected by this proposal include: students who do not
live on Federal property but who have a parent on active duty
in the uniformed services of the United States, or a parent who
is a foreign military officer accredited by a foreign
government; students who reside in a low-rent housing project
assisted under the United States Housing Act of 1937; students
who live on Federal property but otherwise do not fit into any
of the categories described above; and students who do not
reside on Federal property but who have a parent employed on
Federal property located partly or wholly in the same State as
the LEA. This proposal would eliminate Federal aid for roughly
800,000 federally connected students. The Committee rejects
this proposed change.
Payments for Children with Disabilities.--Under this
program, additional payments are made for certain federally
connected children eligible for services under the Individuals
with Disabilities Education Act. The Committee bill includes
$50,668,000 for this purpose. The comparable funding level is
$50,668,000 and the budget request includes $40,000,000. The
budget request includes a legislative proposal to eliminate
funding for ``b'' children who are disabled. The Committee
rejects this approach and notes that roughly 20,000 such
students currently generate Federal payments associated with
the excess cost of educating these eligible children.
Facilities Maintenance.--This activity provides funding for
emergency repairs and comprehensive capital improvements to
certain school facilities owned by the Department of Education
and used by local educational agencies to serve federally
connected military dependent students. The Committee recommends
$7,948,000. The comparable funding level for fiscal year 2003
is $7,948,000 and the budget request proposes $8,000,000 for
this purpose.
Construction.--Payments are made to eligible LEAs to be
used for construction and renovation of school facilities, or
for debt service related to the construction of school
facilities. The Committee recommends $44,708,000 for this
program. The comparable fiscal year 2003 funding level is
$44,708,000 and the budget request includes $45,000,000 for
construction activities.
Payments for Federal Property.--These payments compensate
local educational agencies in part for revenue lost due to the
removal of Federal property from local tax rolls. Payments are
made to LEAs that have a loss of tax base of at least 10
percent of assessed value due to the acquisition since 1938 of
real property by the U.S. Government. The Committee recommends
$59,610,000 for this activity. The comparable funding level for
fiscal year 2003 is $59,610,000 and the budget request proposes
to fund this program at $55,000,000.
SCHOOL IMPROVEMENT PROGRAMS
Appropriations, 2003.................................... $5,883,092,000
Budget estimate, 2004................................... 5,042,834,000
Committee recommendation................................ 5,731,453,000
The Committee recommends an appropriation of $5,731,453,000
for school improvement programs. The comparable funding level
in fiscal year 2003 for this account is $5,883,092,000 and the
budget request includes $5,042,834,000.
State Grants for Improving Teacher Quality
The No Child Left Behind Act requires States to ensure that
all teachers teaching in core academic subjects are ``highly
qualified'' by the end of the 2005-2006 school year. The
Committee recommends $2,850,000,000 for State grants for
improving teacher quality. The comparable funding level for
fiscal year 2003 is $2,930,825,000 and the budget request
proposes $2,850,000,000.
Since the No Child Left Behind Act was enacted, the
Committee has increased funding by more than 32 percent for
programs that specifically support high quality professional
development for teachers and school leadership. The Committee
recommendation for fiscal year 2004 includes roughly
$3,400,000,000 for such activities in recognition of the
critical role that these individuals occupy in educating the
Nation's children and the significant academic benefit that
students may derive from the presence of a highly qualified
teacher in their classroom. In addition, State and local
educational agencies have considerable flexibility to use funds
from their Title I grants to LEAs allocations, as well as other
State grant program dollars in support of high-quality
professional development opportunities.
States and LEAs may use the funds for a range of activities
related to the certification, recruitment, professional
development, and support of teachers and administrators.
Activities may include reforming teacher certification and
licensure requirements, addressing alternative routes to State
certification of teachers, recruiting teachers and principals,
and implementing teacher mentoring systems, teacher testing,
merit pay, and merit-based performance systems.
These funds may also be used by districts to hire teachers
to reduce class sizes. The Committee recognizes that smaller
classes, particularly in the early grades, can have a positive
impact on students by improving classroom discipline, providing
students with more individualized attention, and allowing
parents and teachers to work more closely together. Funds
within the teacher quality State grants program may be used to
continue this commitment to our Nation's students, parents, and
teachers, without taking away from other efforts to invest in
professional development.
Early Childhood Educator Professional Development
The Committee recommends $14,902,000 to support
professional development activities for early childhood
educators and caregivers in high-poverty communities. The
comparable funding level for fiscal year 2003 is $14,902,000
and the budget request includes $15,000,000 for this program.
From this appropriation, the Secretary makes competitive grants
to partnerships of early childhood and family literacy
caregivers and educators in order to provide high quality,
sustained and intensive professional development for early
childhood educators to help them provide developmentally
appropriate school-readiness services for preschool-age
children.
The Committee is aware that the first round of grantees
will be submitting performance reports to the Department this
year. The Committee urges the Department to review the
performance reports as soon as they are available and include
in its 2005 Congressional Justification a summary report on
grantee progress on each of the achievement indicators
established under the program. In addition, the Committee urges
the Department to identify any implementation issues that
grantees face in meeting the objectives of this program, as
well as describe how these funds are coordinated with other
Federal funds available for early care and development
programs.
Mathematics and Science Partnerships
The Committee recommends $100,344,000 for the mathematics
and science partnerships program. The comparable funding level
for fiscal year 2003 is $100,344,000 and the budget request
includes $12,500,000 for this purpose. These funds will be used
to improve the performance of students in the areas of math and
science by bringing math and science teachers in elementary and
secondary schools together with scientists, mathematicians, and
engineers to increase the teachers' subject-matter knowledge
and improve their teaching skills. When the appropriation for
this program is $100,000,000 or greater, the Secretary is
authorized to award grants to States by a formula which
includes consideration of the number of children aged 5 to 17
below the poverty line. States then are required to make grants
competitively to eligible partnerships to enable the entities
to pay the Federal share of the costs of developing or
redesigning more rigorous mathematics and science curricula
that are aligned with State and local standards; creating
opportunities for enhanced professional development that
improves the subject-matter knowledge of math and science
teachers; recruiting math and science majors; and improving and
expanding training of math and science teachers, including the
effective integration of technology into curricula and
instruction.
The Committee notes that the authorizing statute requires
grantees to develop an evaluation and accountability plan to
measure their performance and to submit annual reports to the
Department on such plans. The Committee encourages the
Department to work with the National Science Foundation,
States, and local grantees to develop a framework for
evaluating this program. The Committee requests that the 2005
Congressional Justification include a description of steps
taken and planned for using annual reports and other means as a
basis for evaluating this program (including developing a
baseline and performance targets.)
Innovative Education Program Strategies State Grants
The Committee recommends $345,000,000 for innovative
education program strategies State grants. The comparable
funding level for fiscal year 2003 is $382,498,000 and the
budget request includes $385,000,000 for this purpose.
The innovative education program is a flexible source of
Federal funds that provides support to States and LEAs in
developing education reform initiatives that will improve the
performance of students, schools, and teachers.
The Committee notes that each State receiving Federal
assistance under this program is required to compile and
summarize evaluation information submitted by local educational
agencies, which includes a description of how Federal financial
assistance affected student academic achievement and
information on the use of funds, the types of services
furnished, and students served. The Committee requests that the
Department include in the 2005 Congressional Justification a
summary report of such evaluation information, a summary of
actions taken or planned to help States evaluate the affect of
this program on student achievement and its plan for developing
a baseline and performance indicators for this program.
Educational Technology State Grants
The Committee recommends $695,947,000 for educational
technology State grants. The comparable funding level for
fiscal year 2003 is $695,947,000 and the budget request
proposes $700,500,000 for this program.
Educational technology State grants program supports
efforts to integrate technology into curricula to improve
student learning. Funds flow by formula to States and may be
used for the purchase of hardware and software, teacher
training on integrating technology into the curriculum, and
efforts to use technology to improve communication with
parents, among other related purposes. An LEA must use at least
25 percent of its formula allocation for professional
development in the integration of technology into the curricula
unless it can demonstrate that it already provides such
professional development.
The Committee encourages the Department to develop
baselines and performance targets for this program, so the
impact of Federal funds can be assessed. The Committee looks
forward to reviewing such information as part of the 2005
Congressional Justification.
Preparing Tomorrow's Teachers to use Technology
The Committee recommendation does not include any funds for
this program. Last year's bill included $62,094,000 for this
program and the budget request proposed to eliminate the
Preparing Tomorrow's Teachers to use Technology [PT3] program.
Funds available are used to assist consortia of private and
public entities to prepare prospective teachers to use
technology effectively in the classroom. Consortia consist of
at least one institution of higher education, one State or
local educational agency, and one other entity.
The Committee notes that under the primary source of
Federal funding for educational technology--the Educational
Technology State Grants program--LEAs must use at least 25
percent of its formula allocation for high-quality professional
development in the integration of technology into curricula,
unless it can demonstrate to the satisfaction of the State that
it already provides such professional development opportunities
to all teachers in core academic subjects. The Committee
encourages the Department to work with States to ensure that
this provision of the No Child Left Behind Act is implemented
appropriately.
21st Century Community Learning Centers
The Committee recommends an appropriation of $1,000,000,000
for the 21st Century Community Learning Centers program. The
comparable funding level for fiscal year 2003 is $993,500,000
and the budget request includes $600,000,000 for this program.
Funds are allocated to States by formula, which in turn,
award at least 95 percent of their allocations to local
educational agencies, community-based organizations and other
public and private entities. Grantees uses these resources to
establish or expand community learning centers that provide
activities offering significant extended learning
opportunities, such as before-and after-school programs,
recreational activities, drug and violence prevention and
family literacy programs for students and related services to
their families. Centers must target their services on students
who attend schools that are eligible to operate a schoolwide
program under Title I of the Elementary and Secondary Education
Act or serve high percentages of students from low-income
families.
The Committee understands that the purpose of the 21st
Century Community Learning Centers program is to provide
participating students with opportunities for academic
enrichment and a broad array of services and programs that
reinforce the regular school day curriculum and facilitate
social development. The Committee recognizes the importance of
such opportunities, including youth development activities,
drug and violence prevention programs, arts education, civic
engagement, and character education programs in reinforcing
students' academic performance and attracting them to
participate in after-school programs. The Committee is aware
that the students most in need of academic improvement are the
least likely to participate in an after-school program if they
perceive it to be little more than an extension of the school
day.
The Committee rejects the proposed reduction in this
program, which was based on the initial findings from an
evaluation of centers funded in the first 3 years of the
program. While the Committee appreciates and is committed to
the notion that the allocation of Federal resources should be
based on high-quality, science-based evaluations, it does not
agree that more than 500,000 children and their families should
be denied the opportunity to receive educational, developmental
and related services based on the first-year findings from the
Department's evaluation. The Committee looks forward to
subsequent reports, which will include a more complete data set
and additional information upon which to make a more informed
assessment of the impact of the 21st-Century Community Learning
Centers program.
The Committee notes the positive impact and implementation
findings from the report, and therefore urges the Department to
utilize this information, as well as those from other
evaluations to strengthen the program. Under the No Child Left
Behind Act, the Department may retain up to 1 percent to
carryout national activities, including technical assistance to
States in implementing the State-based competitive grant
program and for assistance to local program operators, while
State Educational Agencies may reserve up to 3 percent for
training and technical assistance and local program evaluation.
The Committee encourages the Department to work with States in
helping them most effectively use these funds to strengthen
centers funded through this program. In particular, the
Committee urges the Department to take appropriate actions to
ensure that 21st Century Community Learning Centers provide a
wide array of proven and effective services and opportunities
for students that both complement their regular academic
program and provide additional opportunities for students to be
safe and successful during non-school hours. The Committee
requests that, as part of the 2005 Congressional Justification,
the Department include a discussion of the actions undertaken
and planned for addressing these issues and strengthening this
program.
The Committee also urges the Department to include
developmental and prevention indicators, in addition to
academic indicators, in any performance goal, objective or
indicator for the 21st Century Community Learning Centers
program. The Committee looks forward to reviewing such
information in the program performance information section of
the 2005 Congressional Justification and the Department's
annual program performance report.
State Assessments and Enhanced Assessment Instruments
The Committee recommends $390,000,000 for State
assessments. The comparable funding level for fiscal year 2003
is $384,484,000 and the budget request includes $390,000,000
for such activities.
A key accountability measure in the No Child Left Behind
Act requires annual State assessments in reading and
mathematics for all students in grades 3-8 beginning in the
2005-2006 school year. The new assessments will be used to
determine whether States, LEAs, and schools are making adequate
yearly progress toward the goal of helping all students attain
proficiency within 12 years of the 2001-2002 school year.
This program has two components. The first provides formula
grants to States to pay the cost of developing standards and
assessments required by the new law. The statute includes
funding ``trigger amounts'' for fiscal years 2002-2007; States
may defer the new assessments if the appropriation falls below
the trigger level. The trigger for fiscal year 2003 is
$380,000,000 and it rises to $390,000,000 in fiscal year 2004.
Under the second component of State assessments--Grants for
Enhanced Assessment Instruments--appropriations in excess of
the trigger level are used for a competitive grant program
designed to support efforts by States to improve the quality
and fairness of their assessment systems.
Javits Gifted and Talented Education
The Committee recommends $11,177,000 for the Javits Gifted
and Talented Students Education Program. The comparable fiscal
year 2003 funding level is $11,177,000 and the President's
budget proposes to eliminate this program. Funds are used for
awards to State and local education agencies, institutions of
higher education, and other public and private agencies for
research, demonstration, and training activities designed to
enhance the capability of elementary and secondary schools to
meet the special educational needs of gifted and talented
students.
Foreign Language Assistance
The Committee recommends $17,144,000 for the Foreign
Language Assistance program. The comparable funding level for
fiscal year 2003 is $16,144,000 and the budget request proposes
eliminating funds for foreign language assistance activities.
Funds from this program support competitive grants to
increase the quality and quantity of foreign language
instruction. At least 75 percent of the appropriation must be
used to expand foreign language education in the elementary
grades. The Committee intends that none of the Foreign Language
Assistance program funds shall be used for the Foreign Language
Incentive program. The Committee is concerned that the only
Federal program designed to help schools meet the need for
foreign language instruction is unavailable to the poorest
schools. The Committee encourages the Secretary to use his
ability to waive the matching requirement for qualifying
schools and to increase awareness of this accommodation among
the affected school population.
The Committee notes that the Department asserts that it has
no information indicating that the Foreign Language Assistance
program is having a significant impact on the quality of
foreign language instruction. However, the Committee is aware
that applicants under this program must demonstrate to the
Secretary that they have a project evaluation plan. Further,
the Secretary requires successful applicants to submit annual
performance reports that document the grantee's yearly progress
toward meeting expected programmatic outcomes, which are used
to measure the success of the grantee's project, and contribute
to a broader knowledge base about high-quality, effective
foreign language programs. The Committee encourages the
Department to work with current and future grantees under this
program to better utilize performance outcome data provided by
grantees and to establish a framework (including a baseline and
performance targets) for evaluating this program. The Committee
expects to see more complete program performance information
included in the 2005 Congressional Justification.
Education for Homeless Children and Youth
For carrying out education activities authorized by Title
VII, subtitle B of the Stewart B. McKinney Homeless Assistance
Act, the Committee recommends $60,000,000. The comparable
fiscal year 2003 funding level is $54,642,000 and the budget
request includes $50,000,000 for this program.
This program provides assistance to each State to support
an office of the coordinator of education for homeless children
and youth, to develop and implement State plans for educating
homeless children, and to make subgrants to LEAs to support the
education of those children. Grants are made to States based on
the total that each State receives in Title I grants to LEAs.
Under the McKinney-Vento Homeless Children and Youths
Program, State educational agencies [SEAs] must ensure that
homeless children and youth have equal access to the same free
public education, including a public preschool education, as is
provided to other children and youth. States must review and
undertake steps to revise any laws, regulations, practices, or
policies that may act as barriers to the enrollment,
attendance, or success in school of homeless children and
youth.
The latest estimates indicate that more than 900,000
children and youth in the United States experience
homelessness. While the Committee notes the significant
progress States and local educational agencies have made in
increasing enrollment of homeless children and youth from 55
percent in 1996 to 87 percent in 2001, the Committee is aware
that significant enrollment barriers--from transportation
issues to lack of school records--continue to limit access to a
free and appropriate education for homeless children and youth.
The Committee urges the Department to reserve sufficient funds
to work with States, as requested, in reducing barriers
remaining and also to address the issue of data collection
related to the education of homeless children and youth.
Training and Advisory Services
For training and advisory services authorized by Title IV
of the Civil Rights Act, the Committee recommends $7,286,000.
The comparable fiscal year 2003 funding level is $7,286,000 and
the budget request includes $7,334,000 for these services.
The funds provided will continue operation of the 10
regional equity assistance centers [EACs]. Each EAC provides
services to school districts upon request. Activities include
disseminating information on successful practices and legal
requirements related to nondiscrimination on the basis of race,
color, sex, or national origin in education programs.
Education for Native Hawaiians
For programs for the education of Native Hawaiians, the
Committee bill includes $36,000,000. The comparable fiscal year
2003 funding level is $30,798,000 and the budget request
includes $18,300,000 for these programs.
The Committee urges the Department to provide at least
$1,000,000 for the early childhood education program and at
least $1,000,000 for school construction/renovation activities.
The Committee also encourages the Department to consider
funding educational activities regarding the historical
underpinnings of Native Hawaiian law.
The Committee bill includes language allowing funds to be
used for construction and renovation of Native Hawaiian
educational facilities.
Alaska Native Educational Equity
The Committee recommends $36,000,000 for the Alaska Native
educational equity assistance program. The comparable fiscal
year 2003 funding level is $31,798,000 and the budget request
includes $14,200,000 for this purpose.
These funds address the severe educational handicaps of
Alaska Native schoolchildren. Funds are used for the
development of supplemental educational programs to benefit
Alaska Natives. The Committee bill includes language which
allows funding provided by this program to be used for
construction.
Rural Education
The Committee recommends $167,653,000 for rural education
programs. The comparable fiscal year 2003 funding level is
$167,653,000 and the budget request proposed to eliminate
funding for these programs.
The Committee strongly supports the continued use of
Federal funding specifically for rural education. Rural schools
face difficult challenges in meeting the mandates in the No
Child Left Behind Act, particularly in the areas of attracting
highly qualified teachers and adapting to new assessment
requirements and reporting expectations. The rural education
programs are intended to help level the playing field for small
and high-poverty rural school systems that typically receive
less Federal formula funding than their urban and suburban
counterparts, and are frequently unable to compete for
competitive grants. In addition to providing more total funding
for such districts, the program also allows the districts to
combine funds from four categorical programs and use the money
to address their highest priorities, such as recruiting
teachers, purchasing technology, or upgrading curricula.
The Committee expects that rural education funding will be
equally divided between the Small, Rural Schools Achievement
Program, which provides funds to LEAs that serve a small number
of students, and the Low-Income and Rural Schools Program,
which provides funds to LEAs that serve concentrations of poor
students, regardless of the number of students served.
INDIAN EDUCATION
Appropriations, 2003.................................... $121,573,000
Budget estimate, 2004................................... 122,368,000
Committee recommendation................................ 121,573,000
The Committee recommends $121,573,000 for Indian Education
programs. The comparable fiscal year 2003 funding level is
$121,573,000 and the budget request includes $122,368,000 for
such activities.
Grants to Local Education Agencies
For grants to local education agencies, the Committee
recommends $96,502,000. The comparable fiscal year 2003 funding
level is $96,502,000 and the budget request includes
$97,133,000. These funds provide financial support to
elementary and secondary school programs that serve Indian
students, including preschool children. Funds are awarded on a
formula basis to local educational agencies, schools supported
and operated by the Bureau of Indian Affairs and in some cases
directly to Indian Tribes.
Special Programs for Indian Children
The Committee recommends $19,870,000 for special programs
for Indian children. The comparable fiscal year 2003 funding
level is $19,870,000 and the budget request includes
$20,000,000 for authorized activities. Funds are used for
demonstration grants to improve Indian student achievement
through early childhood and preschool education programs, and
for professional development grants for training Indians who
are preparing to begin careers in teaching and school
administration.
National Activities
The Committee recommends $5,201,000 for national
activities. The comparable fiscal year 2003 amount is
$5,201,000 and the budget request includes $5,235,000 for
authorized activities. Funds will be used to expand efforts to
improve research, evaluation, and data collection on the status
and effectiveness of Indian education programs.
INNOVATION AND IMPROVEMENT
Appropriations, 2003.................................... $1,099,049,000
Budget estimate, 2004................................... 807,400,000
Committee recommendation................................ 774,133,000
The Committee recommends an appropriation of $774,133,000
for programs within the innovation and improvement account. The
comparable fiscal year 2003 funding level for these programs is
$1,099,049,000 and the budget request includes $807,400,000.
Troops-to-Teachers
This program supports the Defense Department's Troops to
Teachers program, which helps prepare retiring and former
military personnel to teach in high-poverty school districts.
The Secretary of Education transfers program funds to the
Department of Defense for the Defense Activity for Non-
Traditional Education Support to provide assistance, including
stipends of up to $5,000 and bonuses of up to $10,000, to
eligible members of the Armed Forces so that they can obtain
teacher certification or licensing. In addition, the program
helps these individuals find employment in a school.
The Committee recommendation does not include additional
resources for the Troops-to-Teachers program. The Committee
takes this action because of the recent military activity,
which has reduced the supply of available retiring and former
military personnel; the fact that last year's appropriation is
available for obligation for 2 fiscal years; and the tight
budget constraints under which the Committee must operate. The
comparable funding level for fiscal year 2003 is $28,812,000
and the budget request includes $25,000,000 for this program.
The Committee continues to support activities designed to
support the goal of ensuring that every child is taught by a
highly qualified teacher, and that support is demonstrated by
the significant increases in this program and others that
contribute to achievement of that goal. Since fiscal year 2001,
funding for this program has grown by more than 800 percent.
The Committee notes that the Department has acknowledged
that a rigorous, scientific evaluation of the program has not
yet been conducted. The Committee encourages the Department to
undertake such an evaluation and to develop program performance
information, including benchmarks and performance indicators,
which can be used to assess the effectiveness of this program.
The Committee looks forward to seeing a discussion of such
issues in the 2005 congressional justification.
Transition to Teaching
The Committee recommends $41,727,000 for the transition to
teaching program. The comparable fiscal year 2003 funding level
is $41,727,000 and the budget request includes $49,400,000 for
this program. This program provides grants to help support
efforts to recruit, train, and place nontraditional teaching
candidates into teaching positions and to support them during
their first years in the classroom. In particular, this program
is intended to attract mid-career professionals and recent
college graduates. Program participants are placed in high-need
schools in high-need LEAs.
The Committee notes that program performance information,
including benchmarks and performance indicators, are not
available for this program. The Committee encourages the
Department to work with current grantees to develop such
information and to utilize grantee interim and final evaluation
reports during this activity. The Committee looks forward to a
more complete discussion of program performance for this
program in the 2005 congressional justification.
National Writing Project
The Committee recommends $18,890,000 for the national
writing project. The comparable funding level for fiscal year
2003 is $16,890,000 and the budget request proposes to
eliminate Federal funding for this program.
These funds are awarded to the National Writing Project, a
nonprofit organization that supports and promotes K-16 teacher
training programs in the effective teaching of writing. From
the additional funds provided over the fiscal year 2003
appropriation, the Committee intends that $500,000 shall be
used to support a pilot program on the integration of
technology training in the NWP program.
The Committee is aware that the NWP has contracted for two
evaluations of the program, both of which have identified
significant benefits to teachers and students exposed to the
NWP. A survey by Inverness Research Associates found that more
than 95 percent of National Writing Project teachers stated
that what they learned during their writing project training
translates into improved writing skills for their students
teachers survey. The survey also found that National Writing
Project programs leveraged more than $5 in other investment for
each $1 in Federal money during the 2000-2001 program year.
Teaching of Traditional American History
The Committee recommends $120,000,000 for the teaching of
traditional American history program. The comparable fiscal
year 2003 funding level is $99,350,000 and the budget request
includes $100,000,000 for this activity. This program supports
competitive grants to LEAs, and funds may be used only to
undertake activities that are related to American history, and
cannot be used for social studies coursework. Grant awards are
designed to augment the quality of American history instruction
and to provide professional development activities and teacher
education in the area of American history. The Committee
directs the Department to continue its current policy of
awarding 3-year grants.
The Committee is aware that performance data generated by
the first cohort of grant recipients will be available to the
Department this year. The Committee encourages the Department
to use these reports, as well as other information, to develop
a framework for evaluating the effectiveness of this program.
School Leadership
The Committee recommends $12,419,000 for the school
leadership program. The comparable fiscal year 2003 funding
level is $12,419,000 and the budget request proposes to
eliminate funding for this program. This program provides
competitive grants to assist high-need LEAs to recruit and
train principals and assistant principals through activities
such as professional development and training programs. The
Committee recognizes the critical role that principals play in
creating an environment that fosters effective teaching and
high academic achievement. The Committee encourages the
Department to utilize program performance data available in
grantee performance reports in order to develop a framework for
evaluating this program. The Committee looks forward to
reviewing such information in the 2005 congressional
justification.
Advanced Credentialing
The Committee recommends $9,935,000 for the National Board
for Professional Teaching Standards. The comparable fiscal year
2003 funding level is $9,935,000 and the budget request
proposes to eliminate funding for the National Board. Funds
available assist the Board's work in providing financial
support to States for teachers applying for certification,
increasing the number of minority teachers seeking
certification and developing outreach programs about the
advanced certification program. The fiscal year 2004
appropriation will support the 5th year of its current 5-year
grant.
The Committee is aware of recent research which has
documented the value of National Board Certification.
Researchers at the University of North Carolina at Greensboro
demonstrated that teachers with the National Board
Certification outperformed their non-certified peers on 11 of
the 13 key dimensions of teaching expertise measured by their
study. The Committee also is aware of actions the National
Board has taken to provide objective, scientifically based
research into the effects realized by its activities. The
Committee looks forward to additional information that will be
provided through high-quality evaluation studies, including one
that will compare the learning gains made by the students of
National Board Certified Teachers, teachers who sought but did
not achieve National Board Certification, and a random sample
of teachers who have never gone through the National Board
Certification process.
Charter Schools Grants
The Committee recommends $220,000,000 for the support of
charter schools. The comparable fiscal year 2003 funding level
is $198,700,000 and the budget request proposes $220,000,000
for this program. The Committee has been very supportive of
charter schools; the Committee has more than doubled funding
for this program since the fiscal year 1999 appropriation of
$100,000,000. This support has helped increase the number of
charter schools in operation during 2002 to roughly 2,700, from
the 1,010 in existence during the 1999-2000 school year.
This program supports the planning, development, and
initial implementation of charter schools, which are public
schools that receive exemption from many statutory and
regulatory requirements in exchange for promising to meet
agreed-upon accountability measures. State educational agencies
that have the authority under State law to approve charter
schools are eligible to compete for grants. If an eligible SEA
does not participate, charter schools from the State may apply
directly to the Secretary.
Credit Enhancement for Charter School Facilities
The Committee does not recommend funds to assist charter
schools with their facility needs. The comparable funding level
for fiscal year 2003 is $24,838,000 and the budget request
includes $100,000,000 for this purpose.
This program provides assistance to help charter schools
meet their facility needs. Funds are provided on a competitive
basis to public and non-profit entitities, to leverage non-
Federal funds that help charter schools obtain school
facilities through purchase, lease, renovation and
construction.
Voluntary Public School Choice
The Committee recommends $28,000,000 for the voluntary
public school choice program. The comparable funding level for
fiscal year 2003 is $25,831,000 and the budget request includes
$25,000,000 for this purpose.
This program supports efforts by States and school
districts to establish or expand State- or district-wide public
school choice programs, especially for parents whose children
attend low-performing public schools.
The Committee encourages the Department to utilize grantee
annual performance reports to establish a framework for
evaluating the effectiveness of this program and looks forward
to reviewing such information in the 2005 congressional
justification. The Committee also notes that the Department
plans to reserve $1,000,000 to continue an evaluation of this
program, which at a minimum, must include how, and the extent
to which, the program promotes educational equity and
excellence; the characteristics of the students participating
in the programs; and the effect of the programs on the academic
achievement of students participating in the programs, and on
the overall quality of participating schools and districts. The
Committee encourages the Department to move quickly to complete
this evaluation and looks forward to reviewing information from
it as soon as possible.
Magnet Schools Assistance
The Committee recommends $109,285,000 for the magnet
schools assistance program. The comparable fiscal year 2003
funding level is $109,285,000 and the budget request includes
$110,000,000 for this purpose.
This program supports grants to local educational agencies
to establish and operate magnet schools that are part of a
court-ordered or federally approved voluntary desegregation
plan. Magnet schools are designed to attract substantial
numbers of students from different social, economic, ethnic,
and racial backgrounds. Grantees may use funds for planning and
promotional materials, teacher salaries, purchase of computers,
and other educational materials and equipment.
The Committee notes that grantees' application are required
to describe, among other things, how a grant awarded under this
part will be used to promote desegregation, including how the
proposed magnet school programs will increase interaction among
students of different social, economic, ethnic, and racial
backgrounds; the manner and extent to which the magnet school
program will increase student academic achievement in the
instructional area or areas offered by the school; and how
grant funds under this part will be used to improve student
academic achievement for all students attending the magnet
school programs and to implement services and activities that
are consistent with other programs under the NCLB Act.
Therefore, the Committee expects the Department to provide
meaningful program performance information on the extent to
which this program improves student academic achievement, as
well as eliminates, reduces, and prevents minority group
isolation. The Committee looks forward to reviewing more
complete program performance information in the 2005
congressional justification.
Choice Incentive Fund
The Committee recommends no funding for this proposed new
program. The budget request includes $75,000,000 for this
purpose.
Fund for the Improvement of Education
The Committee recommends an appropriation of $165,877,000
for the Fund for the Improvement of Education [FIE]. The
comparable funding level for fiscal year 2003 is $472,646,000
and the budget request includes $59,000,000 for comparable
activities.
The recommendation includes no funds for comprehensive
school reform demonstrations, as requested by the
administration.
Within the recommendation, the Committee includes funds for
the Education Publications Center, Recognition Programs, and
Helping Your Child Learn. The Committee notes that the mandated
studies authorized by section 5414 of the No Child Left Behind
Act are required to be completed within 18 months of enactment
of that Act. Therefore, the Committee does not provide
additional resources in fiscal year 2004 for this work, as
these studies are required to be completed prior to the
beginning of fiscal year 2004. The Committee recommendation
includes $4,000,000 for Reach Out and Read, as requested by the
administration.
The Committee recommendation includes $700,000 for the
National Institute of Building Sciences to continue operation
of the National Clearinghouse for Educational Facilities, the
Nation's sole source for comprehensive information about school
planning, design, financing, construction and maintenance. The
Committee expects that the Department will provide an
additional $300,000 for this purpose to address issues related
to school safety and healthy school buildings, as described in
the administration's budget request for Safe and Drug-Free
Schools and Communities National Programs.
The administration recommended eliminating funding for
activities listed below.
The Committee recommends $25,334,000 to award a contract to
Reading Is Fundamental, Inc. [RIF] to provide reading-
motivation activities. The comparable funding level for fiscal
year 2003 is $25,334,000 and the budget request includes
$24,000,000 for this purpose. RIF, a private nonprofit
organization, encourages reading both inside and outside school
by allowing youngsters to select books to keep at home. Federal
funds provide up to 75 percent of the costs of books. The
Committee notes that positive work that this program has done
in leveraging private resources, targeting priority populations
and generating greater interest in reading among program
participants.
The Committee recommends $20,483,000 for the Star Schools
program. The comparable funding level for fiscal year 2003 is
$27,341,000. The Star Schools program is designed to improve
instruction in math, science, foreign languages, and other
subjects such as vocational education, to underserved
populations by means of telecommunications technologies. The
Committee notes that the Department based its proposal to
eliminate this program on the grounds that the program has
limited impact, lacks evidence of effectiveness and is
duplicative of the education technology and improving teacher
quality State grant programs. However, the Department's 2002
Annual Program Performance Report shows that this program
exceeded its 2002 performance target for the number of courses
with challenging content aligned with academic standards.
Further, the Committee notes that the Star Schools is unique
because it fosters services across State and regional
boundaries to deliver direct support for classrooms,
particularly in isolated and underserved areas, which is cost
effective and provides services that individual States would
have a difficult time replicating.
The Committee recommends $14,406,000 for the Ready to Teach
programs administered by the Department of Education. The
comparable funding level for fiscal year 2003 is $14,406,000.
Ready to Teach is the successor to the Public Broadcasting
Service's Mathline program, which was one of the first to
provide online professional development and continuing
education for teachers. Ready to Teach was reauthorized by the
No Child Left Behind Act of 2001 and continues to evolve to
enhance teacher quality and meet the goals of that Act. Ready
to Teach encompasses funding for PBS TeacherLine and one or
more nonprofit entities, for the purpose of continuing to
develop telecommunications-based programs to improve teacher
quality in core areas. It also includes the digital educational
programming grant program, which encourages community
partnerships among local public television stations, State and
local educational agencies, and other institutions to develop
and distribute digital instructional content based on State and
local standards.
The Committee notes that the Department has stated that no
Federal funding is requested to continue the Ready to Teach
programs because there is no basis for determining their
effectiveness and States may use funds from block grants to
fund similar activities. The Committee reiterates that the No
Child Left Behind Act requires grantees under this program to
submit an annual report that ``contains such information as the
Secretary may require.'' The Committee encourages the
Department to utilize information available from grantees to
assess the effectiveness of this program.
The Committee has provided $9,000,000 for the Education
through Cultural and Historical Organizations [ECHO] Act of
2001, as authorized by Public Law 107-110. Programs authorized
under ECHO provide a broad range of educational, cultural and
job training opportunities for students from communities across
the Nation, including Alaska, Hawaii, and Massachusetts. The
comparable funding level for fiscal year 2003 is $6,954,000.
The Committee has included $35,279,000 for arts in
education. The comparable funding level for fiscal year 2003 is
$33,779,000. Within the total, $6,225,000 is for the John F.
Kennedy Center for the Performing Arts; $7,250,000 is for VSA
arts; $10,000,000 is for the competitive art education model
grant program for the development and model projects that
effectively strengthen and integrate the arts and cultural
partnerships into the core curriculum; $7,500,000 is for grants
for professional development for music, dance, drama, and
visual arts educators to be administered by the U.S. Department
of Education; $304,000 is for national evaluation and
dissemination of information regarding funded model programs
and professional development projects; and $4,000,000 is for
cultural partnerships for at-risk youth. When awarding grants
for professional development of music educators, the Department
is urged to put a priority on preparing and retaining teachers
in underserved rural and urban areas, including music teachers
who enter the profession through alternative certification.
The Committee is aware that numerous high-quality studies
have demonstrated the positive academic and social effects of
learning in the arts. However, this work also has suggested
additional areas of research that need to be explored in
greater detail, including the longitudinal effects and nature
of learning in the arts. The Committee again recommends
additional funding for evaluation and dissemination activities
in order to explore these issues, as well as to disseminate
information about best practices in effective arts education
and arts-integrated instruction.
The Committee recommends $42,224,000 for Parental
Information and Resource Centers, which provide training,
information, and support to parents, State and local education
agencies, and other organizations that carry out parent
education and family involvement programs. The comparable
funding level for fiscal year 2003 is $42,224,000. The
Committee is aware that research overwhelmingly demonstrates
that parent involvement in children's learning is positively
related to student achievement.
The No Child Left Behind Act requires grantees to use at
least 30 percent of their awards to establish, expand, or
operate Parents as Teachers, Home Instruction Program for
Preschool Youngsters, or other early childhood parent education
programs. The Committee is concerned that the Department is not
implementing effectively this provision and notes that the
grant announcement for fiscal year 2003 funds does not even
mention this statutory requirement. The Committee directs the
Department to take appropriate steps to ensure that this
statutory requirement is met in current and all future grant
competitions. Further, the Committee is concerned about the
ability of grantees to achieve the purpose of this program.
Under the current competition, a novice applicant--essentially
an organization that has not received Federal funds within the
past 5 years--receives a bonus of 10 points, while an applicant
that demonstrates that it has quality project personnel with
relevant training and experience is eligible for up to 10
points. The Committee supports efforts to reach a broader
applicant audience and believes workshops, technical assistance
and outreach are appropriate ways to assist novice applicants
in understanding and meeting the requirements of Federal grant
programs. However, the Committee does not believe that
unqualified organizations should receive bonus points under
discretionary grant competitions.
The Committee includes $2,980,000 for the women's
educational equity program. The comparable funding level for
fiscal year 2003 is $2,980,000. This program supports projects
that assist in the local implementation of gender equity
policies and practices.
Ready to Learn Television
The Committee recommends an appropriation of $24,000,000
for the Ready to Learn Television program. The comparable
funding level for fiscal year 2003 is $22,850,000 and the
budget request includes $22,000,000 for this purpose.
Ready to Learn Television supports the development and
distribution of educational television programming designed to
improve the readiness of preschool children to enter
kindergarten and elementary school. The program also supports
the development, production, and dissemination of educational
materials designed to help parents, children, and caregivers
obtain the maximum advantage from educational programming.
The Committee strongly supports the objectives of the Ready
To Learn Program and is pleased with the success of its two
original children's productions, Between the Lions and Dragon
Tales, and recommends continued support of these two programs.
The Committee is concerned, however, that not all programs
acquired by Ready To Learn meet the education, research, and
curriculum-based goals that Congress envisioned for the
program. The Committee is aware of the PBS/Markle Foundation
Study which finds that in its PBS Kids television lineup,
including Ready to Learn shows, too many shows are animated,
easy to finance, but fail to advance PBS's educational mission.
Of particular concern is the study's finding that in 2001,
``Over half (58 percent) of its series were classified as
Social/Emotional, the same `soft' curriculum claimed by nearly
all the commercial broadcast series made to meet the FCC's
educational programming mandate.'' Ready to Learn is a mission
beyond entertainment, and all shows in the Ready to Learn
viewing block should adhere not only to a high production
value, but a worthiness of purpose which meets the original
intent of the program.
The Committee also is concerned about the accountability of
funds appropriated thus far for Ready To Learn broadcast
programs and requests that the Department provide a detailed
accounting of these funds to the Committee not later than 60
days after the enactment of the Department of Education
Appropriations Act, 2004.
Dropout Prevention
The Committee recommends no funds for the dropout
prevention program. The comparable funding level for fiscal
year 2003 is $10,929,000 and the budget request did not include
any funding for the dropout prevention program. These funds are
used to help schools implement effective school dropout
prevention and re-entry programs. The Committee notes that in
fiscal year 2002, States reserved roughly $76,000,0000 from
their Title I, Part A allocations to operate State-administered
projects in LEAs with the highest dropout rates and in areas
serving a large number of children in local correctional
facilities, as is required by law. Under the No Child Left
Behind Act, each State agency and local educational agency that
conducts dropout prevent and reentry programs under Part D of
Title I is required to submit evaluation results to the State
educational agency and the Secretary and use the results of
such evaluations to plan and improve subsequent programs for
participating children and youth. The Committee encourages the
Department to utilize required evaluation reports in providing
technical assistance and support to State and local educational
agencies to ensure that these reserved funds are targeted to
and effectively used in preventing school dropout and promoting
successful reentry.
Close Up Fellowships
The Committee recommendation does not include any funding
for this program. The comparable funding level for fiscal year
2003 is $1,490,000 and the budget request did not include any
funds for this purpose. The Close Up Fellowships, formerly
called Ellender, which is administered by the Close Up
Foundation of Washington, DC, provides fellowships to students
from low-income families and their teachers to enable them to
attend 1 week in Washington attending seminars and meeting with
representatives of the three branches of the Federal
Government.
In response to congressional interest, the Committee is
aware that the Close Up Foundation has made considerable
efforts to identify and develop non-Federal sources of funding
for sustaining its operations. The Committee notes that the
Close Up Foundation raised more than $1,047,340 during the
2001-2002 program year in non-Federal funds dedicated to
economically disadvantaged students and their teachers, almost
10 percent more than their performance target for that period.
Advanced Placement
The Committee recommends $24,000,000 for Advanced
Placement. The comparable funding level for fiscal year 2003 is
$23,347,000 and the budget request includes $22,000,000 for the
Advanced Placement program
The first priority of the program is to subsidize test fees
for low-income students who are enrolled in an Advanced
Placement class and plan to take an Advanced Placement test.
The balance of the funds are allocated for Advanced Placement
Incentive Program grants, which are used to expand access for
low-income individuals to Advanced Placement programs. Eligible
activities include teacher training and participation in online
Advanced Placement courses, among other related purposes.
SAFE SCHOOLS AND CITIZENSHIP EDUCATION
Appropriations, 2003.................................... $884,925,000
Budget estimate, 2004................................... 756,250,000
Committee recommendation................................ 818,547,000
Safe and Drug-Free Schools and Communities
The Committee recommends a total of $818,547,000 for
activities to promote Safe Schools and Citizenship Education.
The comparable fiscal year 2003 funding level is $884,925,000
and the budget request includes $756,250,000 for these
activities.
State Grant Program.--The Committee recommends $422,017,000
for the safe and drug-free schools and communities State grant
program. The comparable fiscal year 2003 funding level is
$468,949,000 and the budget request includes $422,017,000. Due
to budget constraints, the Committee reluctantly accepts the
administration's proposed reduction in funding for the State
Grants portion of the Safe and Drug Free Schools and
Communities [SDFSC] program. The Committee understands that the
changes authorized by the No Child Left Behind Act were
intended to strengthen State and local efforts funded by this
program and should show improved results in safe and drug free
learning environments. The Committee intends to review this
program's funding throughout the current budget process and in
future years, as it recognizes the critical role that such
funding plays in establishing safe and drug free learning
environments.
The Committee fully expects that the Uniform Management
Information and Reporting System, required by the No Child Left
Behind Act, will be developed and implemented so that data and
other pertinent information is collected in a uniform manner
both within a particular State and across all States, and that
it be reported by every State to the Secretary of Education.
The Committee looks forward to reviewing such information in
future program performance reports and congressional
justifications.
The Committee embraces the notion that federally-funded
activities should be undertaken to the extent that they are
science-based and appropriate, given the issues identified by a
local needs assessment. However, the Committee is concerned
about the apparent, undue emphasis on the implementation of
specific programs deemed to be science-based. The Committee
notes that the Principles of Effectiveness are intended to be
implemented as a whole, with States and local education
agencies conducting needs assessment and choosing programs,
strategies, and activities that actually meet their particular
needs and are adjusted over time. Such agencies should not
simply adopt a specific program because it has been proven to
be effective under the right conditions. The Committee expects
the 2005 congressional justification to include information
about the actions taken by the Department to implement this
provision of NCLB, consistent with this intent.
National Programs.--The Committee has included $155,180,000
for the national programs portion of the safe and drug-free
schools program. The comparable funding level for fiscal year
2003 is $155,180,000 and the budget request includes
$172,233,000 for these programs. The Committee does not
recommend additional funding for Project SERV (School Emergency
Response to Violence), which provides education-related
services to LEAs in which the learning environment has been
disrupted due to a violent or traumatic crisis. The budget
request included $10,000,000 for Project SERV. However, the
Committee notes that the Department currently has roughly
$9,000,000 available for this purpose. These funds are
available until expended. The Committee will monitor the
availability of funding and consider action in subsequent
appropriations bills.
The Committee continues to be concerned about the
increasing problem of alcohol and drug abuse on college
campuses. The Committee is disappointed that the Department
once again refused to provide funding for the National
Recognition Awards in fiscal year 2003, despite an explicit
recommendation to do so in last year's Senate report language.
Therefore, the Committee has included bill language requiring
the Department to spend $850,000 on this program under the
guidelines in section 120(f) of Public Law 105-244. This
program identifies and provides models of alcohol and drug
abuse prevention and education programs in higher education.
The Committee is troubled by the Department's
implementation of the Department of Education Appropriations
Act, 2003. Contrary to congressional intent as expressed in
House Report 108-10, the Department created a new drug testing
initiative under Safe and Drug Free National Programs that was
neither proposed in the President's budget nor contemplated by
congressional action with respect to fiscal year 2003
appropriations. The Committee expects the Deputy Under
Secretary to suspend activities related to this new initiative
until the requirements related to reprogramming and new
programs are met.
The Committee expects that the Department will provide
$300,000 for the continued operation of the National
Clearinghouse for Educational Facilities, the Nation's sole
source for comprehensive information about school planning,
design, financing, construction and maintenance. These funds
will be used to address issues related to school safety and
healthy school buildings, as described in the administration's
budget request. The Committee has included additional funds for
the Clearinghouse through the Fund for the Improvement of
Education.
The Committee notes that by the time they reach
adolescence, most young people have been tested and protected
from a wide array of diseases and health disorders. But very
few are screened for one of the most devastating threats
teenagers face: depression and the serious, often life-
threatening problems it foments. Between 7 million to 10
million teenagers suffer from a mental health condition which,
for many, may lead to serious problems including dropping out
of school, substance abuse, violence and suicide. Two-thirds of
these young people receive no counseling or treatment, usually
because their illness is undetected by parents, friends, and
teachers. The Committee is aware that some school districts
have taken advantage of relatively simple screening tools now
available to detect depression, the risk of suicide, and other
mental disorders in teenagers. The Committee believes that
screening should occur with parental and student consent, and
with a commitment to make counseling and treatment available
for students found to be at-risk. The Committee strongly urges
the Secretary to make the availability of screening programs
more widely known, and to encourage school districts, juvenile
justice facilities and community-based organizations to
implement similar teenage screening programs. The Committee
expects to receive a report on steps being taken to promote
this effort prior to the fiscal year 2005 appropriations
hearings.
Community Service for Expelled or Suspended Students
The Committee recommends no additional funds for formula
grants to States to carry out programs under which students who
are expelled or suspended from school are required to perform
community service. The comparable funding level for fiscal year
2003 is $49,675,000 and the budget request did not include any
funds for this purpose.
Alcohol Abuse Reduction
The Committee recommends $30,000,000 for grants to LEAs to
develop and implement programs to reduce underage drinking in
secondary schools. The comparable funding level for fiscal year
2003 is $24,838,000 and the budget request did not include any
funds for this purpose. The Committee directs the Department
and the Substance Abuse and Mental Health Services
Administration [SAMHSA] in the Department of Health and Human
Services to work together on this effort.
Mentoring
The Committee recommends $28,700,000 to support mentoring
programs and activities for children who are at risk of failing
academically, dropping out of school, getting involved in
criminal or delinquent activities, or who lack strong positive
role models. The comparable fiscal year 2003 funding level is
$17,386,000 and the budget request includes $100,000,000 for
this purpose.
The Committee is aware of the positive effects of mentoring
programs that have been identified in prior evaluations of such
activities. In particular, the Committee notes the findings
from an evaluation conducted by Public/Private Ventures [P/PV],
which include: mentored children were 46 percent less likely
than other youth to initiate drug use, 27 percent less likely
to initiate alcohol use, skipped half as many days of school as
similar youth, received slightly higher grades and reported
more positive relationships with their friends and parents. In
addition, the Committee notes that evaluations have found that
certain best practices in mentoring programs--such as high
quality screening of and training for mentors, support and
guidance in establishing strong mentoring relationships, and
monitoring of program implementation--have led to better
outcomes for mentored youth. The Committee encourages the
Department to consider these issues when considering
applications submitted for program funds.
Character Education
The Committee recommends $24,838,000 to provide support for
the design and implementation of character education programs.
The comparable funding level for fiscal year 2003 is
$24,838,000 and the budget request includes $25,000,000 for
this purpose. The Committee notes that the Department is still
developing program performance information for the character
education program. The Committee encourages the Department to
utilize its discretionary funds to conduct a national
evaluation on this program. Further, the Committee expects the
Department to utilize grantee evaluations to develop baselines
and performance targets for evaluating the effectiveness of
this program.
Elementary and Secondary School Counseling
The Committee recommends $34,000,000 to establish or expand
counseling programs in elementary schools. The comparable
fiscal year 2003 funding level is $32,289,000 and the
President's budget proposes to eliminate funding for this
program. The Committee notes that the American School Counselor
Association recommends a maximum student-to-counselor ratio of
250 to 1, while the current average student-to-counselor ratio
in America's public schools is 490 to 1. The Committee
appreciates the additional flexibility provided by the NCLB
Act, but does not believe this flexibility alone is sufficient
to help close this gap. The Committee notes that grantees
funded during fiscal year 2001 met 86 percent of their stated
results-based goals and objectives.
Carole M. White Physical Education Program
The Committee recommends $70,000,000 to help LEAs and
community-based organizations initiate, expand and improve
physical education programs for students in grades K-12. The
comparable funding level for fiscal year 2003 is $59,610,000
and the administration's budget proposes to eliminate funding
for this program. The Carol M. White Physical Education
Program, authorized by the NCLB Act, established physical
education programs for students in grades K-12. Provision of
this funding will help schools and communities nationwide
improve their structured physical education programs for
students and help children develop healthy lifestyles to combat
the epidemic of obesity in the Nation.
Numerous studies have documented that the combination of
regular exercise and healthy eating are crucial both to
improving health and well-being as well as to reducing
preventable health care costs. The Committee believes more must
be done to encourage these behaviors at the earliest age
possible. Therefore, the Committee calls for steps to be taken
to better coordinate physical education programs, such as PEP,
and child nutrition programs and nutrition education efforts,
such as those funded by the Department of Agriculture.
The Committee notes that in the past 15 years, obesity has
increased by over 50 percent among adults and in the past 20
years, obesity has increased by 100 percent among children and
adolescents. A recent analysis by the National Institute of
Child Health and Human Development [NICHD] Study of Early Child
Care and Youth Development found that third grade children in
the study received an average of 25 minutes per week in school
of moderate to vigorous activity, while experts in the United
States have recommended that young people should participate in
physical activity of at least moderate intensity for 30 to 60
minutes each day. While not nationally represented, this
information is consistent with the 2002 Youth Risk Behavior
Surveillance System which found that only roughly one-half of
all students report attending a physical education class one or
more time a week. The Committee believes Federal funding is
critical to the effort to reducing these trends and helping
improve the health of the American public.
Civic Education
The Committee recommends $28,812,000 for grants to improve
the quality of civics and government education, to foster civic
competence and responsibility, and to improve the quality of
civic and economic education through exchange programs with
emerging democracies. The comparable fiscal year 2003 funding
level is $28,812,000 and the administration request includes
$27,000,000 for this purpose.
Civic Education program funds support both the We the
People programs and the Cooperative Education Exchange. The
Committee recommends $16,890,000 for the nonprofit Center for
Civic Education to support the We the People programs. We the
People has two primary components: the Citizen and the
Constitution which provides teacher training, curriculum
materials, and classroom instruction for upper elementary,
middle and high school students; and Project Citizen, a program
for middle school students that focuses on the role of State
and local governments in the American Federal system.
Within the amount total for the We the People program, the
Committee recommends the following: that $2,980,000 be reserved
to continue the comprehensive program to improve public
knowledge, understanding, and support of American democratic
institutions which is a cooperative project among the Center
for Civic Education, the Center on Congress at Indiana
University, and the Trust for Representative Democratic at the
National Conference of State Legislatures; that $1,490,000 be
used for continuation and expansion of the school violence
prevention demonstration program; and that $500,000 be used for
the Native American civic education program.
The Committee recommends $11,922,000 for the Cooperative
Education Exchange program. Within this amount, the Committee
has included $4,470,750 for the Center for Civic Education and
$4,470,750 for the National Council on Economic Education. The
remaining $2,980,500 should be used for a competitive grant
program for civics and government education, and for economic
education.
State Grants for Incarcerated Youth Offenders
The Committee has included $25,000,000 for education and
training for incarcerated youth offenders. The comparable
funding level for fiscal year 2003 is $23,348,000. The
administration, once again, proposes to eliminate funding for
these activities. This program provides grants to State
correctional education agencies to assist and encourage
incarcerated youth to acquire functional literacy, life and job
skills, through the pursuit of a postsecondary education
certificate or an associate of arts or bachelor's degree.
Grants also assist correction agencies in providing employment
counseling and other related services that start during
incarceration and continue through prerelease and while on
parole. Each student is eligible for a grant of not more than
$1,500 annually for tuition, books, and essential materials,
and not more than $300 annually for related services such as
career development, substance abuse counseling, parenting
skills training, and health education. In order to participate
in a program, a student must be no more than 25 years of age
and be eligible to be released from prison within 5 years.
Youth offender grants are for a period not to exceed 5 years, 1
year of which may be devoted to study in remedial or graduate
education.
The Committee notes that State performance information
derived from annual performance reports indicate that the
percentage of students obtaining vocational skill certificates
in 2001 was 60 percent and that less than 10 percent of program
participants returned to prison within 1 year of release.
According to the Bureau of Justice Statistics, most former
State prisoners were rearrested shortly after getting out of
prison: 30 percent within 6 months, 44 percent within 1 year,
59 percent within 2 years and 67 percent by the end of 3 years.
This important program not only helps make the Nation's streets
safer for all Americans, but it reduces pressure on taxpayers
as fewer contacts are made with the more expensive criminal
justice system and former prisoners become employed, tax-paying
and productive members of society.
The Committee encourages the Department to continue to work
toward developing a more consistent and reliable system for
collecting performance outcome data. The Committee believes
that additional training and technical assistance for States
would help improve the collection by which the effectiveness of
this program can be measured. The Committee expects a detailed
report in the 2005 congressional justification on actions
planned and taken by the Department to meet this goal.
Within the appropriation for State grants for incarcerated
youth offenders, the Committee includes $5,000,000 to continue
the prisoner literacy initiative. The Committee notes that the
extremely high rates of illiteracy or marginal reading skills
among inmates is a national problem and therefore encourages
the development of a uniform model to evaluate such literacy
programs across the country.
Physical Education Initiative
The Committee does not recommend any funding for this new,
proposed program. The administration proposed $10,000,000 for
this new program. The Committee notes that this proposed
program is not specifically authorized, unlike the existing
Carol M. White Physical Education Program that was created when
the Congress enacted and the President signed the No Child Left
Behind Act. Further, the Committee notes that this initiative
is duplicative of the existing Carol M. White Physical
Education Program, which funds the initiation, expansion, and
improvement of physical education programs for all kindergarten
through 12th grade students, which may include program elements
addressing healthy eating habits and good nutrition and
professional development for teachers of physical education to
stay abreast of the latest research, issues, and trends in the
field of physical education.
ENGLISH LANGUAGE ACQUISITION
Appropriations, 2003.................................... $685,515,000
Budget estimate, 2004................................... 665,000,000
Committee recommendation................................ 665,000,000
The Committee recommends an appropriation of $665,000,000
for English language acquisition. The comparable funding level
for fiscal year 2003 is $685,515,000 and the budget request
includes $665,000,000 for related activities. The Department
makes formula grants to States based on each State's share of
the Nation's limited-English-proficient and recent immigrant
student population. The program is designed to increase the
capacity of States and school districts to address the needs of
these students. While the appropriation is $20,515,000 less
than the fiscal year 2003 appropriation, the State grant
portion of this account will increase by more than $50,000,000
as funding for expiring projects is redirected to the State
grant program. These additional funds will help States improve
the educational outcomes for limited English proficient
students.
SPECIAL EDUCATION
Appropriations, 2003.................................... $10,033,917,000
Budget estimate, 2004................................... 10,690,104,000
Committee recommendation................................ 11,027,464,000
The Committee recommends $11,027,464,000 for special
education programs authorized by the IDEA. The comparable
fiscal year 2003 funding level is $10,033,917,000 and the
budget request includes $10,690,104,000 for such programs.
Grants to States
The Committee recommends $9,858,533,000 for special
education grants to States, as authorized under part B of the
IDEA. The comparable fiscal year 2003 funding level is
$8,874,398,000 and the budget request includes $9,528,533,000.
This program provides formula grants to assist States in
meeting the costs of providing special education and related
services for children with disabilities.
The Committee's recommended funding level represents
approximately 19 percent of the average per-pupil expenditure,
compared with roughly 17 percent under the fiscal year 2003
appropriation. Since fiscal year 2000, increasing
appropriations have raised the Federal share of average per
pupil expenditures from 12 percent to an estimated 19 percent
in fiscal year 2004--almost half way to the 40 percent maximum
established in the IDEA.
Preschool Grants
The Committee recommends $390,000,000 for preschool grants.
The comparable fiscal year 2003 funding level is $387,465,000
and the budget request includes $390,000,000. The preschool
grants program provides formula grants to States to make
available special education and related services for children
with disabilities aged 3 through 5.
Grants for Infants and Families
The Committee recommends $447,000,000 for grants for the
infants and families program under part C of the IDEA. The
comparable fiscal year 2003 funding level is $434,159,000 and
the budget request includes $447,000,000 for this activity.
This program provides formula grants to States to implement
statewide systems of coordinated, comprehensive,
multidisciplinary interagency programs to make available early
intervention services to all children with disabilities, ages 2
and under, and their families.
State Improvement
The Committee recommends $44,000,000 for State improvement
grants. The comparable fiscal year 2003 funding level is
$51,364,000 and the budget request includes $44,000,000 for
these grants. This program provides competitive grants to State
educational agencies to assist them, in partnership with
parents, teachers, institutions of higher education, interest
groups, and others, to improve results for children with
disabilities by reforming and improving their educational
systems.
Research and Innovation
The Committee recommends $77,210,000 for research and
innovation. The comparable funding level for fiscal year 2003
is $77,210,000 and the budget request includes $78,380,000 for
this purpose. This program supports competitive awards to
produce and advance the use of knowledge to improve services
and results for children with disabilities.
The Committee commends the Office of Special Education
Programs [OSEP] for its consistent efforts to support and
conduct work on behalf of individuals with learning
disabilities. The Committee expects OSEP to ensure that the
National Research Center on Learning Disabilities [NRCLD]
conducts and synthesizes research on how to best implement and
take to scale identification methods that rely on students'
response to scientific research-based instruction. The Center
also should disseminate to and assist the local education
agencies with replicable models that produce measurable
positive improvements in student learning. The Committee looks
forward to learning more about effective instruction and
interventions to enhance student learning. The Committee
encourages OSEP to coordinate efforts within the Department of
Education, NIH, NSF and other Federal agencies working on
related activities.
Technical Assistance and Dissemination
The Committee recommends $53,133,000 for technical
assistance and dissemination. The comparable fiscal year 2003
funding level is $53,133,000 and the budget request includes
$53,481,000 for these activities. Awards support institutes,
regional resource centers, clearinghouses, and other efforts to
build State and local capacity to make systemic changes and
improve results for children with disabilities.
Personnel Preparation
The Committee recommends $91,899,000 for the personnel
preparation program. The comparable fiscal year 2003 funding
level is $91,899,000 and the budget request includes
$90,000,000 for this program. Funds support competitive awards
to help address State-identified needs for qualified personnel
to work with children with disabilities, and to ensure that
these personnel have the skills and knowledge they need to
serve these children.
The Committee is particularly concerned about the shortage
of qualified special education teachers and higher education
faculty. Therefore, it urges the Department to use funds
available from expiring awards under this program to make new
grants above the 2003 funding level for leadership personnel.
The Committee also urges the Department to use a portion of
such funding for the preparation of personnel who serve
children with low-incidence disabilities, particularly those
with sensory disabilities such as low vision, blindness, and
deafness.
Parent Information Centers
The Committee recommends $26,328,000 for parent information
centers. The comparable fiscal year 2003 funding level is
$26,328,000 and the budget request includes $26,000,000 for
authorized activities. This program makes awards to parent
organizations to support parent training and information
centers, including community parent resource centers. These
centers provide training and information to meet the needs of
parents of children with disabilities living in the areas
served by the centers, particularly underserved parents, and
parents of children who may be inappropriately identified.
Technology and Media Services
The Committee recommends $39,361,000 for technology and
media services. The comparable fiscal year 2003 funding level
is $37,961,000 and the budget request includes $32,710,000 for
such activities. This program makes competitive awards to
support the development, demonstration, and use of technology,
and educational media activities of value to children with
disabilities.
The Committee recommendation includes $11,400,000 for
Recording for the Blind and Dyslexic, Inc. These funds support
the continued production and circulation of recorded textbooks,
increased outreach activities to print-disabled students and
their teachers, and accelerated use of digital technology.
The Committee also recommends $1,500,000 for the Readline
Program. Last year, this program received $1,490,000. The
administration proposed eliminating this program.
This activity is authorized by section 687(b)(2)(G) of the
Individuals With Disabilities Education Act, as amended. The
Committee recognizes the progress of the Readline Program,
which is developing a wide range of media resources to
disseminate research conducted by the National Institutes of
Health, as well as other research concerning effective teaching
strategies, early diagnosis of, and intervention for, young
children with reading disabilities. These resources include an
extensive web site, videos, and programming for television and
radio broadcast. The Committee includes funding for the
continued development and distribution of media resources to
reach the parents and teachers of children with reading
disabilities.
REHABILITATION SERVICES AND DISABILITY RESEARCH
Appropriations, 2003.................................... $2,953,633,000
Budget estimate, 2004................................... 2,918,423,000
Committee recommendation................................ 3,004,360,000
The Committee recommends $3,004,360,000 for rehabilitation
services and disability research. The comparable fiscal year
2003 funding level is $2,953,633,000 and the budget request
includes $2,918,423,000.
Vocational Rehabilitation State Grants
The Committee provides $2,584,162,000 for vocational
rehabilitation grants to States. The Committee recommendation
provides the full amount authorized by the Rehabilitation Act
of 1973. The budget request proposes to eliminate separate
funding of several categorical programs. The Committee rejects
this approach and believes changes of this nature should be
considered during the reauthorization process.
Basic State grant funds assist States in providing a range
of services to help persons with physical and mental
disabilities prepare for and engage in meaningful employment.
Authorizing legislation requires States to give priority to
persons with significant disabilities. Funds are allotted to
States based on a formula that takes into account population
and per capita income. States must provide a 21.3 percent match
of Federal funds, except the State's share is 50 percent for
the cost of construction of a facility for community
rehabilitation program purposes.
The Rehabilitation Act requires that no less than 1 percent
and not more than 1.5 percent of the appropriation in fiscal
year 2004 for vocational rehabilitation State grants be set
aside for grants for Indians. Service grants are awarded to
Indian tribes on a competitive basis to help tribes develop the
capacity to provide vocational rehabilitation services to
American Indians with disabilities living on or near
reservations.
Client Assistance
The Committee recommends $12,068,000 for the client
assistance program. The comparable fiscal year 2003 funding
level is $12,068,000 and the budget request includes
$11,897,000 for authorized activities.
The client assistance program funds State formula grants to
assist vocational rehabilitation clients or client applicants
in understanding the benefits available to them and in their
relationships with service providers. Funds are distributed to
States according to a population-based formula, except that
increases in minimum grants are guaranteed to each of the 50
States, the District of Columbia, and Puerto Rico, and
guaranteed to each of the outlying areas, by a percentage not
to exceed the percentage increase in the appropriation. States
must operate client assistance programs in order to receive
vocational rehabilitation State grant funds.
Training
The Committee recommends $39,371,000 for training
rehabilitation personnel. The comparable fiscal year 2003
funding level is $39,371,000 and the budget request includes
$42,629,000 for training activities.
The purpose of this program is to ensure that skilled
personnel are available to serve the rehabilitation needs of
individuals with disabilities. It supports training,
traineeships, and related activities designed to increase the
numbers of qualified personnel providing rehabilitation
services. The program awards grants and contracts to States and
public or nonprofit agencies and organizations, including
institutions of higher education, to pay all or part of the
cost of conducting training programs. Long-term, in-service,
short-term, experimental and innovative, and continuing
education programs are funded, as well as special training
programs and programs to train interpreters for persons who are
deaf, hard of hearing and deaf-blind.
The Committee remains concerned over the reduction in
funding for rehabilitation long-term training programs, and in
particular those that require orthotic and prosthetic care.
Therefore, the Committee urges RSA to utilize available funds
to support not less than four university O+P programs.
Demonstration and Training Programs
The Committee bill includes $20,895,000 for demonstration
and training programs for persons with disabilities. The
comparable fiscal year 2003 funding level is $20,895,000 and
the budget request includes $24,492,000 for authorized
activities. This program awards grants to States and nonprofit
agencies and organizations to develop innovative methods and
comprehensive services to help individuals with disabilities
achieve satisfactory vocational outcomes. Demonstration
programs support projects for individuals with a wide array of
disabilities. Within the Committee recommendation, $1,000,000
supports continuation of activities designed to establish an
applied research agenda, improve the quality of applied
orthotic and prosthetic research and help meet the increasing
demand for provider services. Funds are to be used to further
develop the orthotic and prosthetic awareness campaign, which
includes an educational outreach initiative designed to recruit
and retain professionals and develop a series of consensus
conferences and disseminate the resulting best practices to the
field.
The Committee recognizes that Fetal Alcohol Syndrome, the
most preventable cause of mental retardation, results from
maternal alcohol consumption during pregnancy. Affected
children have a life long disability of mental impairments and
behavioral problems that reduce their ability to respond to
education. The burden to society is estimated at $4,000,000,000
per year. The Committee is pleased with the efforts of the
Office of Special Education and Rehabilitative Services within
the Department of Education to collaborate with other
government organizations represented on the Interagency
Coordinating Committee on Fetal Alcohol Syndrome. The Committee
is encouraged by the progress made to involve educational
psychologists and other educational and childcare professionals
in developing awareness about FAS. The Committee encourages the
Department of Education to expand activities related to Fetal
Alcohol Syndrome; specifically the early identification of
affected children.
Migrant and Seasonal Farmworkers
The Committee recommends $2,335,000 for migrant and
seasonal farmworkers. The comparable fiscal year 2003 funding
level is $2,335,000. The Department proposes eliminating
separate funding for this program.
This program provide grants limited to 90 percent of the
costs of the projects providing comprehensive rehabilitation
services to migrant and seasonal farm workers with disabilities
and their families. Projects also develop innovative methods
for reaching and serving this population. The program
emphasizes outreach, specialized bilingual rehabilitation
counseling, and coordination of vocational rehabilitation
services with services from other sources. The Committee
understands that States will begin reporting on migrant and
seasonal farmworkers served through the basic State grant
program. The Committee looks forward to reviewing such
information as it will provide more concrete information upon
which to determine whether a separate funding stream is still
required to adequately serve this population.
Recreational Programs
The Committee provides $2,579,000 for recreational
Programs. The comparable fiscal year 2003 funding level is
$2,579,000 and the budget request did not include funding for
this program.
Recreational programs help finance activities such as
sports, music, dancing, handicrafts, and art to aid in the
employment, mobility, and socialization of individuals with
disabilities. Grants are awarded to States, public agencies,
and nonprofit private organizations, including institutions of
higher education. Grants are awarded for a 3-year period with
the Federal share at 100 percent for the first year, 75 percent
for the second year, and 50 percent for the third year.
Programs must maintain the same level of services over the 3-
year period.
The Committee notes that the primary purpose of this
program is to initiate recreational and related activities for
individuals with disabilities. These programs are designed to
aid individuals with disabilities in employment, mobility,
independence and community integration. The Committee notes
that almost three out of four programs whose last year of
Federal funding ended in fiscal years 1998 through 2000 are
still in operation and continue to meet the recreational needs
of individuals with disabilities. These results show that this
limited investment is having a national impact, as each new
grant supports seed money for recreational programs throughout
the United States.
Protection and Advocacy of Individual Rights
The Committee recommends $16,890,000 for protection and
advocacy of individual rights. The comparable fiscal year 2003
funding level is $16,890,000 and the budget request includes
$17,880,000. However, included in the request is $2,680,000 to
continue funding for the Protection and Advocacy for Assistive
Technology program.
This program provides grants to agencies to protect and
advocate for the legal and human rights of persons with
disabilities who are not eligible for protection and advocacy
services available through the Developmental Disabilities
Assistance and Bill of Rights Act or the Protection and
Advocacy for Individuals with Mental Illness Act.
Projects with Industry
The Committee recommends $21,928,000 for projects with
Industry. The comparable fiscal year 2003 funding level is
$21,928,000 and the administration proposes eliminating
separate funding for this program.
The projects with industry [PWI] program promotes greater
participation of business and industry in the rehabilitation
process. PWI provides training and experience in realistic work
settings to prepare individuals with disabilities for
employment in the competitive job market. Postemployment
support services are also provided. The program makes grants to
a variety of agencies and organizations, including
corporations, community rehabilitation programs, labor and
trade associations, and foundations.
Supported Employment State Grants
The Committee's bill includes $37,904,000 for the supported
employment State grant program. The comparable fiscal year 2003
funding level is $37,904,000 and the administration proposes
eliminating separate funding for this program.
This program assists persons who may have been considered
too severely disabled to benefit from vocational rehabilitation
services by providing the ongoing support needed to obtain
competitive employment. Short-term vocational rehabilitation
services are augmented with extended services provided by State
and local organizations. Federal funds are distributed on the
basis of population.
Independent Living State Grants
The Committee recommends $22,151,000 for independent living
State grants. The comparable funding level for fiscal year 2003
is $22,151,000 and the budget request includes $22,296,000 for
authorized activities.
The independent living State formula grants program
provides funding to improve independent living services,
support the operation of centers for independent living,
conduct studies and analysis, and provide training and
outreach.
Independent Living Centers
The Committee recommends $69,545,000 for independent living
centers. The comparable fiscal year 2003 funding level is
$69,545,000 and the budget request includes $69,500,000 for the
centers.
These funds support consumer-controlled, cross-disability,
nonresidential, community-based centers that are designed and
operated within local communities by individuals with
disabilities. These centers provide an array of independent
living services.
Independent Living Services for Older Blind Individuals
The Committee provides $27,818,000 for independent living
services to older blind individuals. The comparable fiscal year
2003 funding level is $27,818,000 and the budget request
includes $25,000,000 for these activities.
States participating in the program must match every $9 of
Federal funds with not less than $1 in non-Federal resources.
Assistance is provided to persons aged 55 or older to adjust to
their blindness, continue living independently and avoid
societal costs associated with dependent care. Services may
include the provision of eyeglasses and other visual aids,
mobility training, braille instruction and other communication
services, community integration, and information and referral.
These services help older individuals age with dignity,
continue to live independently and avoid significant societal
costs associated with dependent care. The services most
commonly provided by this program are daily living skills
training, counseling, the provision of low-vision devices
community integration, information and referral, communication
devices, and low-vision screening.
The Committee notes that there are 5 million Americans in
this country age 55 and older who are experiencing vision loss
and that the number of Americans in this category is expected
to double in the next 30 years. The Committee recognizes the
very important and cost-effective work carried out through this
program. By allowing older individuals to remain in their homes
and communities, substantial savings are achieved.
Program Improvement Activities
The Committee recommends $894,000 for program improvement
activities. The comparable fiscal year 2003 funding level is
$894,000 and the budget request includes $850,000. In fiscal
year 2004, funds for these activities will continue to support
technical assistance efforts to improve the efficiency and
effectiveness of the vocational rehabilitation program and
improve accountability efforts. The funds provided are
sufficient to support ongoing program improvement activities
and to support ongoing dissemination and performance
measurement activities.
Evaluation
The Committee recommends $994,000 for evaluation
activities. The comparable fiscal year 2003 funding level is
$994,000 and the budget request includes $1,000,000 for such
activities.
These funds support evaluations of the impact and
effectiveness of programs authorized by the Rehabilitation Act.
The Department awards competitive contracts for studies to be
conducted by persons not directly involved with the
administration of Rehabilitation Act programs.
Helen Keller National Center
The Committee recommends $8,717,000 for the Helen Keller
National Center for Deaf-Blind Youth and Adults. The comparable
fiscal year 2003 funding level is $8,660,000 and the budget
request includes $8,717,000 for this purpose.
The Helen Keller National Center consists of a national
headquarters in Sands Point, NY, with a residential training
and rehabilitation facility where deaf-blind persons receive
intensive specialized services; a network of 10 regional field
offices which provide referral and counseling assistance to
deaf-blind persons; and an affiliate network of 48 agencies. At
the recommended level, the center would serve approximately 102
persons with deaf-blindness at its headquarters facility and
provide field services to approximately 1,850 individuals and
families.
National Institute on Disability and Rehabilitation Research
The Committee recommends $109,285,000 for the National
Institute on Disability and Rehabilitation Research [NIDRR].
The comparable fiscal year 2003 funding level is $109,285,000
and the budget request includes $110,000,000 for authorized
activities.
NIDRR develops and implements a comprehensive and
coordinated approach to the conduct of research, demonstration
projects, and related activities that enable persons with
disabilities to better function at work and in the community,
including the training of persons who provide rehabilitation
services or who conduct rehabilitation research. The Institute
awards competitive grants to support research in federally
designated priority areas, including rehabilitation research
and training centers, rehabilitation engineering research
centers, research and demonstration projects, and dissemination
and utilization projects. NIDRR also supports field-initiated
research projects, research training, and fellowships.
The Committee is disappointed by NIDRR's actions to adjust
fiscal year 2002 program performance targets downward after the
end of the fiscal year. These actions diminish the value of the
program performance measurement process. If such actions are
required in the future, the Committee expects NIDRR to
highlight and fully explain in all appropriate documents the
need for adjusting a performance target after it has been
established.
Assistive Technology
The Committee recommends $26,824,000 for assistive
technology. The comparable fiscal year 2003 funding level is
$26,824,000 and the budget request proposes to eliminate
funding for this program. However, under the PAIR program, the
administration proposes to fund Protection and Advocacy
activities previously funded through this program at
$2,680,000.
The Assistive Technology Program is designed to improve
occupational and educational opportunities and the quality of
life for people of all ages with disabilities through increased
access to assistive technology services and devices. It
provides grants to States to develop comprehensive, consumer-
responsive statewide programs that increase access to, and the
availability of, assistive technology devices and services. The
National Institute on Disability and Rehabilitation Research
administers the program.
The Committee recommendation includes $26,824,000 for
activities authorized under title I of the Assistive Technology
Act [AT Act]. The Committee has included bill language which
allows all State projects funded currently under title I of the
AT Act to receive not less than the amount they received in
fiscal year 2003. The budget request proposes to eliminate
State Tech Act funding in fiscal year 2004, at a time when
States are operating in a new policy landscape that includes
the Olmstead decision, final section 508 standards and the
Ticket to Work and Work Incentives Improvement Act. The
Committee expects funds to be allocated under Title I,
consistent with the way in which they were allocated during
implementation of the fiscal year 2003 bill.
The Committee recommendation does not include additional
resources for title III programs, as requested by the
administration. The Committee will review the program funding
level in the fiscal year 2005 budget, once appropriated funds
have been awarded through a grant competition. The Committee
will ensure that sufficient resources are available to continue
this important program, once it becomes more clear how funds
have been expended under this program. Loan programs offer
individuals with disabilities attractive options that
significantly enhance their ability to purchase assistive
technology devices and services.
Special Institutions for Persons With Disabilities
AMERICAN PRINTING HOUSE FOR THE BLIND
Appropriations, 2003.................................... $15,399,000
Budget estimate, 2004................................... 14,000,000
Committee recommendation................................ 16,500,000
The Committee recommends $16,500,000 for the American
Printing House for the Blind [APH]. The comparable fiscal year
2003 funding level is $15,399,000 and the budget request
includes $14,000,000 for this purpose.
This appropriation helps support the American Printing
House for the Blind, which provides educational materials to
students who are legally blind and enrolled in programs below
the college level. The Federal subsidy provides almost 51
percent of APH's total sales income. Materials are distributed
free of charge to schools and States through per capita
allotments based on the total number of students who are blind.
Materials provided include textbooks and other educational aids
in braille, large type, and recorded form and microcomputer
applications. Appropriated funds may be used for staff salaries
and expenses, as well as equipment purchase and acquisition
consistent with the purpose of the Act to Promote the Education
of the Blind.
The Committee commends the APH for continuing to develop a
more complete system for measuring the impact of services
provided.
NATIONAL TECHNICAL INSTITUTE FOR THE DEAF
Appropriations, 2003.................................... $53,669,000
Budget estimate, 2004................................... 50,781,000
Committee recommendation................................ 53,800,000
The Committee recommends $53,800,000 for the National
Technical Institute for the Deaf [NTID]. The comparable fiscal
year 2003 funding level is $53,669,000 and the budget request
includes $50,781,000 for this purpose.
The Institute, located on the campus of the Rochester
Institute of Technology, was created by Congress in 1965 to
provide a residential facility for postsecondary technical
training and education for persons who are deaf. NTID also
provides support services for students who are deaf, trains
professionals in the field of deafness, and conducts applied
research. Within the amount provided, $367,000 is for
construction. At the discretion of the Institute, funds may be
used for the Endowment Grant program.
GALLAUDET UNIVERSITY
Appropriations, 2003.................................... $97,798,000
Budget estimate, 2004................................... 94,446,000
Committee recommendation................................ 100,800,000
The Committee recommends $100,800,000 for Gallaudet
University. The comparable fiscal year 2003 funding level is
$97,798,000 and the budget request includes $94,446,000 for the
university.
Gallaudet University is a private, nonprofit institution
offering undergraduate, and continuing education programs for
students who are deaf, as well as graduate programs in fields
related to deafness for students who are hearing-impaired and
who are deaf. The university conducts basic and applied
research related to hearing impairments and provides public
service programs for the deaf community.
The Model Secondary School for the Deaf serves as a
laboratory for educational experimentation and development,
disseminates models of instruction for students who are deaf,
and prepares adolescents who are deaf for postsecondary
academic or vocational education. The Kendall Demonstration
Elementary School develops and provides instruction for
children from infancy through age 15.
The Committee recommendation includes funding to enable
Gallaudet University to maintain and enhance information
technology infrastructure and campus security, continue
investments in faculty and staff, and further develop honors
and interpreting programs and support. Funds also are
available, at the discretion of the University, for the
Endowment Grant program.
VOCATIONAL AND ADULT EDUCATION
Appropriations, 2003.................................... $2,106,254,000
Budget estimate, 2004................................... 1,591,032,000
Committee recommendation................................ 2,093,990,000
The Committee recommendation includes a total of
$2,093,990,000 for vocational and adult education, consisting
of $1,325,826,000 for vocational education, $587,217,000 for
adult education and $180,947,000 for other activities. The
comparable funding level in fiscal year 2003 is $2,106,254,000
and the budget request includes $1,591,032,000 for this
account.
VOCATIONAL EDUCATION
The Committee recommends $1,325,826,000 for vocational
education. The comparable fiscal year 2003 funding level is
$1,325,826,000 and the budget request is $1,000,000,000 for
these activities. The Committee recommendation is based on
current law, which is in effect for these program through
September 30,2004 because of the GEPA authority.
Basic Grants.--The Committee recommends $1,192,200,000 for
basic grants. The comparable fiscal year 2003 funding level is
$1,192,200,000 and the budget request includes $1,000,000,000
for this purpose.
Under current law, funds provided under the State grant
program assist States, localities, and outlying areas to expand
and improve their programs of vocational education and provide
equal access to vocational education for populations with
special needs. Persons assisted range from secondary students
in prevocational courses through adults who need retraining to
adapt to changing technological and labor market conditions.
Funds are distributed according to a formula based on State
population and State per capita income.
Under the Indian and Hawaiian Natives programs, competitive
grants are awarded to federally recognized Indian tribes or
tribal organizations and to organizations primarily serving and
representing Hawaiian Natives for services that are in addition
to services such groups are eligible to receive under other
provisions of the Perkins Act.
Tech-Prep Education.--The Committee recommends $107,298,000
for tech-prep programs. The comparable fiscal year 2003 funding
level is $107,298,000 and the budget request proposes to
eliminate funding for this program. This program is designed to
link academic and vocational learning and to provide a
structured link between secondary schools and postsecondary
education institutions. Funds are distributed to the States
through the same formula as the basic State grant program.
States then make planning and demonstration grants to consortia
of local educational agencies and postsecondary institutions to
develop and operate model 4-year programs that begin in high
school and provide students with the mathematical, science,
communication, and technological skills needed to earn a 2-year
associate degree or 2-year certificate in a given occupational
field.
National Programs, Research.--The Committee recommends
$11,922,000 for national research programs and other national
activities. The comparable fiscal year 2003 funding level is
$11,922,000 and the budget request proposes to eliminate
funding for this program. The National Research Center for
Career and Technical Education and the National Dissemination
Center for Career and Technical Education are the only
federally funded centers charged with the responsibility to
conduct research and provide technical assistance to vocational
educators. The results of the applied research done by these
Centers inform technical assistance to reform and improve
vocational education instruction in schools and colleges.
Resources made available through this program also are used to
support a variety of activities to identify and promote
effective research-based programs and practice in vocational
education.
Vocational training tied to real economic opportunities and
rooted in endangered traditional crafts is a significant need
in rural Hawaiian and part-Hawaiian communities. The Committee
urges the Department to fund programs that support the
development of mentoring programs pairing secondary students
with individuals who have succeeded in commercially developing
traditional Hawaiian arts and crafts. These mentoring programs
can provide young Hawaiian and Part-Hawaiian students with
training in important crafts while also teaching them how to
successfully turn these skills into economic gain.
Tech-Prep Education Demonstration Program.--The Committee
recommendation includes $4,968,000 for this program. The
comparable fiscal year 2003 funding level is $4,968,000 and the
budget request proposes to eliminate funding for this program.
Under this demonstration authority, the Secretary awards grants
competitively to consortia that involve a business as a member,
locate a secondary school on the site of a community college,
and seek voluntary participation of secondary school students
enrolled such a high school. The purpose of the demonstration
program is to support development of the ``middle college''
model of high school, which promotes higher student achievement
and postsecondary enrollment. Funds may be used for curriculum,
professional development, equipment, and other start-up and
operational costs.
Occupational and Employment Information Program.--The
Committee recommends $9,438,000 to continue activities
authorized by section 118 of the Carl Perkins Act. The
comparable fiscal year 2003 funding level is $9,438,000 and the
budget request proposes to eliminate this program. The Act
requires that at least 85 percent of the amount be provided
directly to State entities to develop and deliver occupational
and career information to students, job seekers, employers,
education, employment and training programs.
ADULT EDUCATION
The Committee recommends $587,217,000 for adult education.
The comparable fiscal year 2003 funding level is $587,217,000
and the budget request includes $591,032,000 for this purpose.
The Committee recommendation is based on current law, which is
in effect for these program through September 30, 2004 because
of the GEPA authority.
Adult Education State Programs.--For adult education State
programs, the Committee recommends $571,262,000. The comparable
fiscal year 2003 funding level is $571,262,000 and the budget
request includes $584,300,000 for authorized activities. Under
current law, these funds are used by States for programs to
enable economically disadvantaged adults to acquire basic
literacy skills, to enable those who so desire to complete a
secondary education, and to make available to adults the means
to become more employable, productive, and responsible
citizens.
The Committee recommendation continues the English literacy
and civics education State grants set aside within the Adult
Education State grant appropriation. Within the total,
$69,545,000 is available to help States or localities affected
significantly by immigration and large limited-English
populations to implement programs that help immigrants acquire
English literacy skills, gain knowledge about the rights and
responsibilities of citizenship and develop skills that will
enable them to navigate key institutions of American life.
National Activities.--The Committee recommends $9,223,000
for national leadership activities. The comparable funding
level for fiscal year 2003 is $9,438,000 and the budget request
does not include funds within this program for this purpose.
Under current law, the Department supports applied research,
development, dissemination, evaluation and program improvement
activities to assist States in their efforts to improve the
quality of adult education programs.
National Institute for Literacy.--The Committee recommends
$6,732,000 for the National Institute for Literacy, authorized
under section 242 of the Adult Education and Family Literacy
Act. The comparable fiscal year 2003 funding level is
$6,517,000 and the budget request includes $6,732,000 for this
purpose. Under current law, the Institute provides leadership
and coordination for national literacy efforts by conducting
research and demonstrations on literacy, establishing and
maintaining a national center for adult literacy and learning
disabilities, and awarding fellowships to outstanding
individuals in the field to conduct research activities under
the auspices of the Institute.
The Committee recognizes and continues to support the
unique mandate of the National Institute for Literacy to serve
as a national resource for adult education and literacy
programs. The Committee supports the focus on adult literacy
that has been provided through NIFL programs, such as the
Bridges to Practice initiative that informs and trains adult
educators on proper assessments and interventions for low
literate adults who have learning disabilities, and the
Equipped for the Future initiative that works to improve the
quality and results of adult learning programs by focusing
instruction and assessment on the skills and knowledge adults
need to accomplish their goals as citizens, parents, and
workers.
Smaller Learning Communities
The Committee recommends $160,947,000 for smaller learning
communities. The comparable fiscal year 2003 funding level is
$160,947,000 and the budget request does not include any funds
for this purpose. This program supports competitive grants to
local educational agencies to enable them to create smaller
learning communities in large schools. Funds may be used to
study, research, develop and implement strategies for creating
smaller learning communities, as well as professional
development for staff. Two types of grants are made under this
program: 1-year planning grants, which help LEAs plan smaller
learning communities and 3-year implementation grants, which
help create or expand such learning environments.
Community Technology Centers
The Committee recommends $20,000,000 for community
technology centers. The comparable funding level for fiscal
year 2003 is $32,264,000 and the budget request proposes to
eliminate funding for this program. Community technology
centers provide disadvantaged residents of economically
distressed urban and rural communities with access to
information technology and related training. They can provide,
among other things, preschool and after-school programs, adult
education and literacy, and workforce development and training.
STUDENT FINANCIAL ASSISTANCE
Appropriations, 2003.................................... $13,363,072,000
Budget estimate, 2004................................... 14,518,500,000
Committee recommendation................................ 14,174,115,000
The Committee recommends an appropriation of
$14,174,115,000 for student financial assistance. The
comparable fiscal year 2003 funding level is $13,363,072,000
and the budget request includes $14,518,500,000 for this
purpose.
Federal Pell Grant Program
For Pell grant awards in the 2004-2005 academic year, the
Committee recommends $12,176,683,000 to maintain the record
maximum Pell Grant award level of $4,050.
Pell grants provide need-based financial assistance that
helps low- and middle-income undergraduate students and their
families pay the costs of postsecondary education and
vocational training. Awards are determined according to a
statutory need analysis formula that takes into account a
student's family income and assets, household size, and the
number of family members, excluding parents, attending
postsecondary institutions. Pell grants are considered the
foundation of Federal postsecondary student aid.
The Committee has made significant gains in supporting
increases in funding for the Pell Grant Program. Since fiscal
year 2000, the maximum Pell grant has been increased from
$3,300 to the current recommendation of $4,050. Also, the
number of students receiving Pell grant awards will have
increased by more than 500,000 over the past 4 years.
The Committee has not included bill language requested by
the administration that would allow the Secretary to establish
the Pell grant maximum award after enactment of the
appropriations bill.
Federal Supplemental Educational Opportunity Grants
The Committee recommends $760,028,000 for Federal
supplemental educational opportunity grants [SEOG]. The
comparable fiscal year 2003 funding level is $760,028,000 and
the budget request includes $725,000,000. This program provides
funds to postsecondary institutions for need-based grants to
undergraduate students. Institutions must contribute 25 percent
of SEOG awards, which are subject to a maximum grant level of
$4,000. School financial aid officers have flexibility to
determine student awards, though they must give priority to
Pell grant recipients.
Federal Work-Study Programs
The Committee bill provides $1,004,428,000 for the Federal
Work-Study Program. The comparable fiscal year 2003 funding
level is $1,004,428,000 and the administration request includes
$1,011,000,000 for authorized activities. This program provides
grants to more than 3,300 institutions to help an estimated 1
million undergraduate, graduate, and professional students meet
the costs of postsecondary education through part-time
employment. Work-study jobs must pay at least the Federal
minimum wage and institutions must provide at least 25 percent
of student earnings. Institutions also must use at least 7
percent of their grants for community-service jobs.
The Committee strongly supports continued funding for the
work colleges program authorized in section 448 of the Higher
Education Act of 1965. These funds help support comprehensive
work-service learning programs at seven work colleges, and
cooperative efforts among the work colleges to expose other
institutions of higher education to the work college concept.
Of the amount recommended by the Committee, $4,500,000 is
available for this program.
Federal Perkins Loans
The Committee bill includes $99,350,000 for Federal Perkins
loans capital contributions. The comparable fiscal year 2003
funding level is $99,350,000 and the budget request does not
include any funds for this purpose. The amount recommended,
when combined with institutional revolving funds, would
maintain the 2004 loan volume at the current estimated level of
$1,200,000,000. At this funding level roughly 700,000 loans
would be made.
The Federal Perkins Loan Program supports student loan
revolving funds built up with capital contributions to about
2,000 participating institutions. Institutions use these
revolving funds, which also include Federal capital
contributions [FCC], institutional contributions equal to one-
third of the FCC, and student repayments, to provide low-
interest (5 percent) loans that help financially needy students
pay the costs of postsecondary education. The Committee has
included the amount necessary to maintain the current loan
volume level.
The Committee also recommends $67,061,000 for Loan
Cancellations. The comparable funding level for fiscal year
2003 is $67,061,000 and the budget request includes $67,500,000
for this activity. These funds reimburse institutional
revolving funds on behalf of borrowers whose loans are
cancelled in exchange for statutorily specified types of public
or military service, such as teaching in a qualified low-income
school, working in a Head Start Program, serving in the Peace
Corps or VISTA, or nurses and medical technicians providing
health care services.
Leveraging Educational Assistance Partnership Program
For the leveraging educational assistance partnership
[LEAP] program, the Committee recommends $66,565,000. The
comparable funding level for fiscal year 2003 is $66,565,000
and the budget proposes to eliminate funding for this program.
The leveraging educational assistance partnership program
provides a Federal match to States as an incentive for
providing need-based grant and work-study assistance to
eligible postsecondary students. When the appropriation exceeds
$30,000,000, amounts above this threshold must be matched by
States on a 2:1 basis. Federally supported grants and job
earnings are limited to $5,000 per award year for full-time
students.
The Committee recognizes the important role that the LEAP
program plays in maintaining a Federal-State partnership for
ensuring that postsecondary education is available to all
academically-qualified Americans. The Committee notes that a
recent Advisory Committee on Student Financial Aid report
recommended that Federal policy should encourage a far more
substantial State and institutional commitment to need-based
grant aid. The Committee notes that this important program
leverages almost $1,000,000,000 in State spending for need-
based student grant programs. Therefore, it is the Committee's
intent to continue this important program.
Loan Forgiveness for Child Care Providers
The Committee does not recommend additional resources for
this demonstration Program. The comparable fiscal year 2003
funding level is $994,000 and the budget request did not
include any funds for this activity. Under this demonstration
program, Stafford and Unsubsidized Stafford Loan borrowers
under the Federal Family Education Loan Program and the William
D. Ford Direct Loan program who have earned a degree in early
childhood education and work for 2 full years as a child care
provider in a low-income community may have a portion of their
loan obligation forgiven.
STUDENT AID ADMINISTRATION
Appropriations, 2003.................................... $104,703,000
Budget estimate, 2004................................... 152,010,000
Committee recommendation................................ 104,703,000
The Committee recommends $104,703,000 in discretionary
resources for the new Student Aid Administration account. The
comparable fiscal year 2003 discretionary funding level is
$104,703,000 and the budget request includes $152,010,000 in
such funding. However, the budget request assumes enactment of
the proposal to rescind $795,000,000 in mandatory budget
authority available in Section 458 of the Higher Education Act
and to provides these funds through discretionary
appropriations.
Funds appropriated for the Student Aid Administration
account, in addition to mandatory funding available through
Section 458 of the Higher Education Act, will support the
Department's student aid management expenses. The Office of
Student Financial Assistance and Office of Postsecondary
Education have primary responsibility for administering Federal
student financial assistance programs.
The Committee does not agree with the administration's
legislative proposal to fund this new account solely through
annual appropriations. The Committee notes the Higher Education
Act is up for reauthorization and a change of this magnitude
should be considered during that process.
The Committee is aware that the Department has successfully
implemented a system for facilitating and authenticating the
use of electronic signatures on Federal student loan
applications through the use of the Federal PIN number provided
to applicants for Federal student financial assistance. The
Committee understands that this PIN system could also be used
for other forms of government-sponsored student financial
assistance and that the use of a single PIN for Federal and
State-sponsored assistance will simplify the financial aid
application process for students and schools. The Committee
urges the Department and the Social Security Administration to
work cooperatively and promptly to allow State government
agencies to utilize this PIN system, as appropriate, for
facilitating and authenticating electronic signatures on
documents relevant to the application for and awarding of
student financial aid administered by State government
agencies.
HIGHER EDUCATION
Appropriations, 2003.................................... $2,093,455,000
Budget estimate, 2004................................... 1,904,438,000
Committee recommendation................................ 1,974,247,000
The Committee recommends an appropriation of $1,974,247,000
for higher education programs. The comparable fiscal year 2003
funding level is $2,093,455,000 and the budget request includes
$1,904,438,000 for such activities.
Aid for Institutional Development
The Committee recommends $487,519,000 for aid for
institutional development authorized by titles III and V of the
Higher Education Act. The comparable funding level for fiscal
year 2003 is $472,323,000 and the budget request includes
$470,299,000 for authorized activities.
The Committee encourages the Department to provide
technical assistance and conduct research on issues germane to
predominately and Historically Black Colleges and Universities
[HBCUs] and other institutions of higher education that have
large minority student populations, including disseminating
best practices information on the most efficient and cost-
effective uses of title III funding, reducing student loan
default rates, increasing graduation rates, and grant writing
training.
Strengthening Institutions.--The Committee bill includes
$81,467,000 for the part A strengthening institutions program.
The comparable fiscal year 2003 funding level is $81,467,000
and the budget request includes $76,275,000 for this activity.
The part A program supports competitive, 1-year planning and 5-
year development grants for institutions with a significant
percentage of financially needy students and low educational
and general expenditures per student in comparison with similar
institutions. Applicants may use part A funds to develop
faculty, strengthen academic programs, improve institutional
management, and expand student services. Institutions awarded
funding under this program are not eligible to receive grants
under other sections of part A or part B.
Hispanic-Serving Institutions [HSI].--The Committee
recommends $93,551,000 for institutions at which Hispanic
students make up at least 25 percent of enrollment. The
comparable fiscal year 2003 funding level is $92,396,000 and
the budget request includes $93,551,000 for these institutions.
Institutions applying for title V funds must meet the regular
part A requirements and show that at least one-half of their
Hispanic students are low-income college students. Funds may be
used for acquisition, rental or lease of scientific or
laboratory equipment, renovation of instructional facilities,
development of faculty, support for academic programs,
institutional management, and purchase of educational
materials. Title V recipients are not eligible for other awards
provided under title III, parts A and B.
Strengthening Historically Black Colleges and
Universities.--The Committee recommends $224,086,000 for part B
grants. The comparable fiscal year 2003 funding level is
$214,015,000 and the budget request includes $224,086,000 for
authorized activities. The part B strengthening historically
black colleges and universities [HBCU] program makes formula
grants to HBCUs that may be used to purchase equipment,
construct and renovate facilities, develop faculty, support
academic programs, strengthen institutional management, enhance
fundraising activities, provide tutoring and counseling
services to students, and conduct outreach to elementary and
secondary school students. The minimum allotment is $500,000
for each eligible institution. Part B recipients are not
eligible for awards under part A.
Strengthening Historically Black Graduate Institutions.--
The Committee recommends $53,415,000 for the part B, section
326 program. The comparable fiscal year 2003 funding level is
$53,415,000 and the budget request includes $53,302,000 for
such activities. The section 326 program provides 5-year grants
to strengthen historically black graduate institutions [HBGIs].
The Higher Education Amendments of 1998 increased the number of
recipients to 18 named institutions, but reserved the first
$26,600,000 appropriated each year to the 16 institutions
included in the previous authorization. Grants may be used for
any part B purpose and to establish an endowment.
Strengthening Alaska Native and Native Hawaiian-Serving Institutions
The Committee recommends $11,000,000 for this program. The
comparable funding level for fiscal year 2003 is $8,180,000 and
the budget request includes $4,048,000 for authorized
activities. The purpose of this program is to improve and
expand the capacity of institutions serving Alaska Native and
Native Hawaiian students. Funds may be used to plan, develop,
and implement activities that encourage: faculty and curriculum
development; better fund and administrative management;
renovation and improvement of educational facilities; student
services; and the purchase of library and other educational
materials. As initial funding cycles expire, the Committee
encourages the Department to use simplified application forms
to permit participating institutions to obtain continuation
funding for successful programs funded under this program.
Strengthening Tribally Controlled Colleges and Universities
The Committee recommends $24,000,000 for strengthening
tribal colleges and universities [TCUs]. The comparable funding
level for fiscal year 2003 is $22,850,000 and the budget
request includes $19,037,000 for this program. Tribal colleges
and universities rely on a portion of the funds provided to
address developmental needs, including faculty development,
curriculum and student services. In fiscal year 2001, the
Committee supported the establishment of a competitive grant
program to assist institutions in addressing long overdue and
high-priority infrastructure and facilities requirements. The
funds provided are to be used to support continuation of
existing basic grants and new planning or implementation grant
awards. The remaining funds shall be available for grants for
renovation and construction of facilities to help address
urgently needed facilities repair and expansion.
International Education and Foreign Language Studies
The bill includes a total of $100,795,000 for international
education and foreign language programs. The comparable fiscal
year 2003 funding level is $107,795,000 and the budget request
includes $102,500,000 for such activities.
Domestic Programs.--The Committee recommends $86,240,000
for domestic program activities related to international
education and foreign language studies, including international
business education, under title VI of the HEA. The comparable
fiscal year 2003 funding level is $93,240,000 and the budget
request includes $88,000,000 for authorized activities.
Domestic programs include national resource centers,
undergraduate international studies and foreign language
programs, international research and studies projects,
international business education projects and centers, American
overseas research centers, language resource centers, foreign
language and area studies fellowships, and technological
innovation and cooperation for foreign information access.
Overseas Programs.--The bill includes $12,916,000 for
overseas programs authorized under the Mutual Educational and
Cultural Exchange Act of 1961, popularly known as the
Fulbright-Hays Act. The comparable fiscal year 2003 funding
level is $12,916,000 and the budget request is $13,000,000 for
these programs. Under these overseas programs, grants are
provided for group and faculty research projects abroad,
doctoral dissertation research abroad, and special bilateral
projects. Unlike other programs authorized by the Fulbright-
Hays Act and administered by the Department of State, these
Department of Education programs focus on training American
instructors and students in order to improve foreign language
and area studies education in the United States.
Institute for International Public Policy.--The Committee
bill recommends $1,639,000 for the Institute for International
Public Policy. The comparable funding level for fiscal year
2003 is $1,639,000 and the budget request includes $1,500,000
for authorized activities. This program is designed to increase
the number of minority individuals in foreign service and
related careers by providing a grant to a consortium of
institutions for undergraduate and graduate level foreign
language and international studies. An institutional match of
50 percent is required.
Fund for the Improvement of Postsecondary Education
The Committee recommends $32,201,000 for the Fund for the
Improvement of Postsecondary Education [FIPSE]. The comparable
fiscal year 2003 funding level is $171,068,000 and the budget
request includes $39,138,000. FIPSE stimulates improvements in
education beyond high school by supporting exemplary, locally
developed projects that have potential for addressing problems
and recommending improvements in postsecondary education. The
fund is administered by an independent board that provides
small, competitive grants and contracts to a variety of
postsecondary institutions and agencies, including 2- and 4-
year colleges and universities, State education agencies,
community-based organizations, and other non-profit
institutions and organizations concerned with education beyond
high school.
The Committee recommendation includes $25,587,000, the full
amount requested for the comprehensive program. The Committee
rejects the budget request to consolidate the Demonstration
Projects to Ensure Quality Higher Education for Students with
Disabilities program within the FIPSE program.
Minority Science and Engineering Improvement
The Committee recommends $8,942,000 for the Minority
Science and Engineering Improvement program [MSEIP]. The
comparable fiscal year 2003 funding level is $8,942,000 and the
budget request includes $8,500,000 for this program. Funds are
used to provide discretionary grants to institutions with
minority enrollments greater than 50 percent to purchase
equipment, develop curricula, and support advanced faculty
training. Grants are intended to improve science and
engineering education programs and increase the number of
minority students in the fields of science, mathematics, and
engineering.
Interest Subsidy Grants
The Committee recommends $2,000,000 for interest subsidy
grants. The comparable fiscal year 2003 funding level is
$2,980,000 and the budget request includes $2,000,000 for these
grants. This appropriation is required to meet the Federal
commitment to pay interest subsidies on 52 loans made in past
years for constructing, renovating, and equipping postsecondary
academic facilities. No new interest subsidy commitments have
been entered into since 1973 but subsidy payments on existing
loans are expected to continue until the year 2013.
Tribally Controlled Postsecondary Vocational Institutions
The Committee recommends $7,500,000 on a current-funded
basis for tribally controlled postsecondary vocational
institutions. The comparable fiscal year 2003 funding level is
$6,955,000 and the budget request includes $6,500,000 for this
purpose. This program provides grants for the operation and
improvement of two tribally controlled postsecondary vocational
institutions to ensure continued and expanding opportunities
for Indian students: United Tribes Technical College in
Bismarck, North Dakota, and Crownpoint Institute of Technology
in Crownpoint, New Mexico.
Federal TRIO Programs
The Committee recommends $840,000,000 for Federal TRIO
Programs. The comparable fiscal year 2003 funding level is
$827,089,000 and the budget request includes $802,500,000 for
authorized activities.
TRIO programs provide a variety of services to improve
postsecondary education opportunities for low-income
individuals and first-generation college students: Upward Bound
offers disadvantaged high school students academic services to
develop the skills and motivation needed to continue their
education; Student Support Services provides remedial
instruction, counseling, summer programs and grant aid to
disadvantaged college students to help them complete their
postsecondary education; Talent Search identifies and counsels
individuals between ages 11 and 27 regarding opportunities for
completing high school and enrolling in postsecondary
education; Educational Opportunity Centers provide information
and counseling on available financial and academic assistance
to low-income adults who are first-generation college students;
and the Ronald E. McNair Postbaccalaureate Achievement Program
supports research internships, seminars, tutoring, and other
activities to encourage disadvantaged college students to
enroll in graduate programs.
The Committee urges the Department to use a funding
allocation strategy in making awards under TRIO that balances
the need to fund a larger number of grantees with the need for
projects to improve the quality of student services and expand
to serve all eligible students.
Gaining Early Awareness and Readiness for Undergraduate Programs [GEAR
UP]
The Committee recommends $300,000,000 for GEAR UP. The
comparable fiscal year 2003 funding level is $293,082,000 and
the budget request includes $285,000,000 for this purpose.
Under this program funds are used by States and partnerships of
colleges, middle and high schools, and community organizations
to assist middle and high schools serving a high percentage of
low-income students. Services provided help students prepare
for and pursue a postsecondary education.
The Committee has provided funds above the fiscal year 2003
level and the budget request for the Department to fund a new
grant competition under the GEAR UP program. The Committee
believes that grants should not be fully-funded, but instead
should be awarded on an annual basis from the fiscal year 2004
and subsequent appropriations during the period of the grant,
contingent upon grantee performance. The Committee notes that
grants were awarded using this approach during the first 2
years of the program. The Committee expects the Department to
consult with it prior to the announcement of this new grant
competition.
Byrd Honors Scholarships
The Committee recommends $41,000,000 for the Byrd honors
scholarship program. The comparable fiscal year 2003 funding
level is $40,734,000 and the budget request includes
$41,001,000.
The Byrd honors scholarship program is designed to promote
student excellence and achievement and to recognize
exceptionally able students who show promise of continued
excellence. Funds are allocated to State education agencies
based on each State's school-aged population. The State
education agencies select the recipients of the scholarships in
consultation with school administrators, teachers, counselors,
and parents. The funds provided will support a new cohort of
first-year students in 2004, and continue support for the 2001,
2002, and 2003 cohorts of students in their fourth, third and
second years of study, respectively. The amount recommended
will provide scholarships of $1,500 to 27,334 students.
Javits Fellowships
The Committee recommends $9,935,000 for the Javits
Fellowships program. The comparable fiscal year 2003 funding
level is $9,935,000 and the budget request includes $10,000,000
for this program.
The Javits Fellowships program provides fellowships of up
to 4 years to students of superior ability who are pursuing
doctoral degrees in the arts, humanities, and social sciences
at any institution of their choice. Each fellowship consists of
a student stipend to cover living costs, and an institutional
payment to cover each fellow's tuition and other expenses.
Funds provided in the fiscal year 2004 appropriation support
fellowships for the 2005-2006 academic year.
Graduate Assistance in Areas of National Need [GAANN]
The Committee recommends $30,798,000 for graduate
assistance in areas of national need. The comparable fiscal
year 2003 funding level is $30,798,000 and the budget request
includes $31,000,000 for GAANN. This program awards competitive
grants to graduate academic departments and programs for
fellowship support in areas of national need as determined by
the Secretary. In fiscal year 2002, the Secretary designated
the following areas of national need: biology, chemistry,
computer and information sciences, engineering, geological and
related sciences, mathematics and physics. Recipients must
demonstrate financial need and academic excellence, and seek
the highest degree in their fields.
Teacher Quality Enhancement Grants
The Committee recommends $89,415,000 for the teacher
quality enhancement grants program. The comparable fiscal year
2003 funding level is $89,415,000 and the budget request
includes $90,000,000. The program was established to support
initiatives that best meet specific teacher preparation and
recruitment needs. Further, the Act provides and designates
funding for the program in three focus areas: 45 percent of
resources support a State grant program, 45 percent of funds
are used for a partnership program, and 10 percent are
designated for a recruitment grant program.
The budget request includes bill language that would allow
the Department to fund awards under the three program areas at
the discretion of the Department, instead of as mandated by the
Higher Education Act. The Committee has not provided the
requested authority.
Under the State grant program, funds may be used for a
variety of State-level reforms, including more rigorous teacher
certification and licensure requirements; provision of high-
quality alternative routes to certification; development of
systems to reward high-performing teachers and principals; and
development of efforts to reduce the shortage of qualified
teachers in high-poverty areas.
Teacher training partnership grants, which are awarded to
local partnerships comprised of at least one school of arts and
science, one school or program of education, a local education
agency, and a K-12 school, may be used for a variety of
activities designed to improve teacher preparation and
performance, including efforts to provide increased academic
study in a proposed teaching specialty area; to prepare
teachers to use technology effectively in the classroom; to
provide preservice clinical experiences; and to integrate
reliable research-based teaching methods into the curriculum.
Partnerships may work with other entities, with those involving
businesses receiving priority consideration. Partnerships are
eligible to receive a one-time-only grant to encourage reform
and improvement at the local level.
The recruitment grant program supports efforts to reduce
shortages of qualified teachers in high-need school districts
as well as provide assistance for high-quality teacher
preparation and induction programs to meet the specific
educational needs of the local area.
Child Care Access Means Parents in Schools
The Committee recommends an appropriation of $16,194,000
for the Child Care Access Means Parents in School [CCAMPIS]
program. The comparable fiscal year 2003 funding level is
$16,194,000 and the budget request includes $15,000,000 for
this program. CCAMPIS was established in the Higher Education
Amendments of 1998 to support the efforts of a growing number
of non-traditional students who are struggling to complete
their college degrees at the same time that they take care of
their children. Discretionary grants of up to 4 years are made
to institutions of higher education to support or establish a
campus-based childcare program primarily serving the needs of
low-income students enrolled at the institution.
Demonstration Projects to Ensure Quality Higher Education for Students
With Disabilities
The Committee recommends $6,954,000 for this program. The
comparable fiscal year 2003 funding level is $6,954,000. The
budget proposes to continue funding this authorized program
under FIPSE. This program's purpose is to ensure that students
with disabilities receive a high-quality postsecondary
education. Grants are made to support model demonstration
projects that provide technical assistance and professional
development activities for faculty and administrators in
institutions of higher education.
Underground Railroad Program
The Committee does not recommend additional funding for the
Underground Railroad program. The comparable fiscal year 2003
funding level is $2,235,000 and the administration also
proposes to eliminate funding for this activity. The program
was authorized by the Higher Education Amendments of 1998 and
was funded for the first time in fiscal year 1999. Grants are
provided to research, display, interpret, and collect artifacts
relating to the history of the underground railroad.
Educational organizations receiving funds must demonstrate
substantial private support through a public-private
partnership, create an endowment fund that provides for ongoing
operation of the facility, and establish a network of satellite
centers throughout the United States to share information and
teach people about the significance of the Underground Railroad
in American history.
GPRA/Higher Education Act Program Evaluation
The Committee recommends $994,000 for data collection
associated with the Government Performance and Results Act data
collection and to evaluate programs authorized by the Higher
Education Act. The comparable fiscal year 2003 funding level is
$994,000 and the budget request includes $1,000,000 for these
activities. These funds are used to comply with the Government
Performance and Results Act, which requires the collection of
data and evaluation of Higher Education programs and the
performance of recipients of Higher Education funds.
Thurgood Marshall Legal Educational Opportunity Program
The Committee does not recommend additional funds for this
program. The comparable fiscal year 2003 funding level is
$4,968,000 and the administration also proposes to eliminate
funding for this program. Federal funds are used to provide
minority, low-income or disadvantaged college students with the
information, preparation, and financial assistance needed to
gain access to and complete law school study.
B.J. Stupak Olympic Scholarships
The Committee recommendation does not include funding for
this program. The comparable fiscal year 2003 funding level is
$994,000 and the budget request did not include funds for this
activity. Funds appropriated in fiscal year 2003 will be used
to provide financial assistance to athletes who are training at
the United States Olympic Education Center or one of the United
States Olympic Training Centers and who are pursuing a
postsecondary education at an institution of higher education.
Unlike most other Federal student aid programs, scholarships
are provided without consideration of expected family
contributions.
National Security Education Trust Fund
The budget request includes a legislative proposal that
would transfer the administration of this program from the
Department of Defense to the Department of Education.
Legislation authorizing such a transfer has not been enacted
effecting such a change, so the Committee defers action on this
proposal.
HOWARD UNIVERSITY
Appropriations, 2003.................................... $238,440,000
Budget estimate, 2004................................... 237,474,000
Committee recommendation................................ 238,440,000
The Committee recommends an appropriation of $238,440,000
for Howard University. The comparable fiscal year 2003 funding
level is $238,440,000 and the budget request includes
$237,474,000 for this purpose. Howard University is located in
the District of Columbia and offers undergraduate, graduate,
and professional degrees through 12 schools and colleges. The
university also administers the Howard University Hospital,
which provides both inpatient and outpatient care, as well as
training in the health professions. Federal funds from this
account support about 59 percent of the university's projected
educational and general expenditures, excluding the hospital.
The Committee recommends, within the funds provided, not less
than $3,573,000 shall be for the endowment program.
Howard University Hospital.--Within the funds provided, the
Committee recommends $30,177,000 for the Howard University
Hospital. The comparable fiscal year 2003 funding level is
$30,177,000 and the budget request includes $30,374,000 for
this purpose. The hospital serves as a major acute and
ambulatory care center for the District of Columbia and
functions as a major teaching facility attached to the
university. The Federal appropriation provides partial funding
for the hospital's operations.
COLLEGE HOUSING AND ACADEMIC FACILITIES LOANS
Appropriations, 2003.................................... $757,000
Budget estimate, 2004................................... 774,000
Committee recommendation................................ 774,000
Federal Administration.--The Committee bill includes
$774,000 for Federal administration of the CHAFL program. The
comparable fiscal year 2003 funding level is $757,000 and the
budget request includes $774,000 for such expenses.
These funds will be used to reimburse the Department for
expenses incurred in managing the existing CHAFL loan portfolio
during fiscal year 2004. These expenses include salaries and
benefits, travel, printing, contracts (including contracted
loan servicing activities), and other expenses directly related
to the administration of the CHAFL Program.
HISTORICALLY BLACK COLLEGE AND UNIVERSITY CAPITAL FINANCING PROGRAM
Appropriations, 2003.................................... $207,000
Budget estimate, 2004................................... 210,000
Committee recommendation................................ 210,000
Federal Administration.--The Committee recommends $210,000
for Federal administration of the Historically Black College
and University [HBCU] Capital Financing Program. The comparable
fiscal year 2003 funding level is $207,000 and the budget
request includes $210,000 for this activity.
The HBCU Capital Financing Program makes capital available
to HBCUs for construction, renovation, and repair of academic
facilities by providing a Federal guarantee for private sector
construction bonds. Construction loans will be made from the
proceeds of the sale of the bonds.
INSTITUTE OF EDUCATION SCIENCE
Appropriations, 2003.................................... $447,956,000
Budget estimate, 2004................................... 375,915,000
Committee recommendation................................ 452,956,000
The bill includes $452,956,000 for the Institute of
Education Sciences. The comparable fiscal year 2003 funding
level is $447,956,000 and the budget request includes
$375,915,000. This account supports education research, data
collection and analysis activities, and the assessment of
student progress.
Research, Development and Dissemination
The Committee recommends $144,090,000 for education
research, development and national dissemination activities.
The comparable fiscal year 2003 amount is $139,090,000 and the
budget request includes $185,000,000 for these activities.
Funds are available for obligation for 2 fiscal years. These
funds support research, development, and dissemination
activities that are aimed at expanding fundamental knowledge of
education and promoting the use of research and development
findings in the design of efforts to improve education.
The Committee has provided $24,362,000 for the National
Research and Development Centers program in recognition of the
need for the Department of Education to implement the Education
Sciences Reform Act of 2002. The funding is sufficient to
provide continued funding for current centers' awards as
requested by the administration and an additional $5,000,000 to
begin awarding new research and development centers in fiscal
year 2004 in accordance with the requirements of Section 133(c)
of Public Law 107-279. The Committee expects the Department to
implement the law by addressing the topics required in the
statute, with particular attention to rural education.
The Committee strongly supports the premise that
developing, identifying and implementing scientifically based
research is critical to the success of the No Child Left Behind
Act [NCLB] and to the increased effectiveness generally of
education programs and interventions. The Committee recognizes
the current scarcity of educational interventions that have
been proven effective in research that meets the rigorous
standards set out in the NCLB. In particular, the Committee
believes that a greater focus must be placed on the use of
randomized controlled trials, longitudinal studies, and other
research that meets the standards set by the National Research
Council.
The Committee requests a report within 90 days of enactment
of this Act, which includes a detailed description of the
Department's specific plans for the Department's research
agenda.
The Committee is concerned about the potential for
duplication that can result from multiple Federal agencies
developing and publicizing lists or registries of science-based
programs and best practices. In particular, the Committee notes
that SAMHSA's Center for Substance Abuse Prevention has the
expertise and an established process for identifying promising,
effective and model substance abuse prevention programs,
strategies and activities. The Committee urges IES to avoid
such duplication by determining whether other Federal agencies
already provide such information, and then identifying an
approach for working with such organizations to ensure that the
user community is best served. The Committee requests that the
IES provide the Committee with a letter report within 90 days
of enactment of this bill on the steps taken to avoid such
duplication on this issue as well as its procedures for
ensuring that no future duplication takes place.
Regional Educational Laboratories
The Committee recommends $67,061,000 to continue support
for the regional educational laboratories. The comparable
fiscal year 2003 funding level is $67,061,000 and the budget
request includes no funds for this purpose. Funding supports a
network of 10 laboratories that are responsible for promoting
the use of broad-based systemic strategies to improve student
achievement.
Statistics
The Committee recommends $89,415,000 for data-gathering and
statistical-analysis activities of the National Center for
Education Statistics [NCES]. The comparable fiscal year 2003
funding level is $89,415,000 and the budget request includes
$95,000,000 for this purpose.
The NCES collects, analyzes, and reports statistics on
education in the United States. Activities are carried out
directly and through grants and contracts. The Center collects
data on educational institutions at all levels, longitudinal
data on student progress, and data relevant to public policy.
The NCES also provides technical assistance to State and local
education agencies and postsecondary institutions.
Assessment
The Committee recommends $94,767,000 for assessment. The
comparable fiscal year 2003 funding level is $94,767,000 and
the budget request includes $95,915,000 for authorized
activities.
These funds provide support for the National Assessment of
Educational Progress [NAEP], a congressionally mandated
assessment created to measure the educational achievement of
American students. The primary goal of NAEP is to determine and
report the status and trends over time in educational
achievement, subject by subject. Beginning in 2002, the
Department will pay for State participation in biennial reading
and mathematics assessments in grades 4 and 8.
Within the funds appropriated, the Committee recommends
$4,532,000 for the National Assessment Governing Board [NAGB],
which is responsible for formulating policy for NAEP. The
comparable fiscal year 2003 amount is $4,532,000 and the budget
request includes $5,090,000 for NAGB.
Multi-Year Grants and Contracts
The Committee recommends $57,623,000 to continue multi-year
grants and contracts to comprehensive regional assistance
centers, Eisenhower regional mathematics and science consortia,
the Eisenhower Math and Science Clearinghouse and regional
technology in education consortia [R*TECs]. The administration
requested no funds for this purpose.
Within the funds appropriated, the Committee recommends:
$27,818,000 for the comprehensive regional assistance centers
program, which funds 15 university-based or nonprofit centers
that offer technical assistance to States, school districts,
and schools on a variety of topics; $14,902,000 for Eisenhower
regional mathematics and science consortia, which disseminate
exemplary mathematics and science education instruction
materials and provide technical assistance for the
implementation of teaching methods and assessment tools;
$4,968,000 for the Eisenhower Math and Science Clearinghouse;
and $9,935,000 for R*TECs, which are regional centers that help
States, local educational agencies, teachers, school library
and media personnel, administrators, and other education
entities successfully integrate technologies into K-12
classrooms, library media centers, and other educational
settings, including adult literacy centers.
Departmental Management
PROGRAM ADMINISTRATION
Appropriations, 2003.................................... $409,863,000
Budget estimate, 2004................................... 434,494,000
Committee recommendation................................ 409,863,000
The Committee recommends $409,863,000 for program
administration. The comparable fiscal year 2003 funding level
is $409,863,000 and the budget request includes $434,494,000
for this purpose.
Funds support personnel compensation and benefits, travel,
rent, communications, utilities, printing, equipment and
supplies, automated data processing, and other services
required to award, administer, and monitor approximately 170
Federal education programs. Support for program evaluation and
studies and advisory councils is also provided under this
activity.
The Committee continues to be concerned about the delay
applicants are experiencing in receiving awards under
competitive grant programs. It is the Committee's strong belief
that every action should be taken to reduce the time it takes
for applicants to learn whether their program has been renewed
or whether they have been funded for the first time, while
still maintaining a strong peer and grant review framework.
The Committee also is very concerned about the growth in
administrative staff in positions that do not appear to
contribute to the overall mission of the Department. In
particular, staffing levels for communications-related
activities appear to have increased significantly in the past
year. The Committee expects that funds provided for program
administration will be utilized efficiently in efforts to
improve the administration and oversight of competitive and
formula grant programs; monitor and report on program
performance; provide high quality technical assistance, as
needed, to help implement effective programs and to prevent,
identify, and reduce fraud, waste, and abuse in Department
programs. The Committee requests that the Department provide a
report on the staffing levels at the Department over the past 5
years, that includes a breakdown by office, program and grade.
Further, the report should identify steps the Department has
taken or planned for increasing the efficiency of its
administrative operations and improving the effectiveness of
efforts to meet its program administration responsibilities.
The Committee requests this report not later than 90 days after
the enactment of the 2004 appropriations bill.
The Committee has included $13,644,000, requested by the
administration, to support costs associated with the relocation
of staff from the Mary E. Switzer and ROB-3 buildings to
permanent space at Potomac Center Plaza. These funds are
available until expended.
OFFICE FOR CIVIL RIGHTS
Appropriations, 2003.................................... $85,715,000
Budget estimate, 2004................................... 91,275,000
Committee recommendation................................ 91,275,000
The Committee bill includes $91,275,000 for the Office for
Civil Rights [OCR]. The comparable fiscal year 2003 amount is
$85,715,000 and the budget request includes $91,275,000 for
this purpose.
The Office for Civil Rights is responsible for the
enforcement of laws that prohibit discrimination on the basis
of race, color, national origin, sex, disability, and age in
all programs and institutions funded by the Department of
Education. To carry out this responsibility, OCR investigates
and resolves discrimination complaints, monitors desegregation
and equal educational opportunity plans, reviews possible
discriminatory practices by recipients of Federal education
funds, and provides technical assistance to recipients of funds
to help them meet civil rights requirements.
OFFICE OF THE INSPECTOR GENERAL
Appropriations, 2003.................................... $40,734,000
Budget estimate, 2004................................... 48,137,000
Committee recommendation................................ 44,137,000
The Committee recommends $44,137,000 for the Office of the
Inspector General. The comparable fiscal year 2003 amount is
$40,734,000 and the budget request includes $48,137,000 for
authorized activities.
The Office of the Inspector General has the authority to
investigate all departmental programs and administrative
activities, including those under contract or grant, to prevent
and detect fraud and abuse, and to ensure the quality and
integrity of those programs. The Office investigates alleged
misuse of Federal funds, and conducts audits to determine
compliance with laws and regulations, efficiency of operations,
and effectiveness in achieving program goals.
General Provisions
The Committee bill contains language which has been
included in the bill since 1974, prohibiting the use of funds
for the transportation of students or teachers in order to
overcome racial imbalance (sec. 301).
The Committee bill contains language included in the bill
since 1977, prohibiting the transportation of students other
than to the school nearest to the student's home (sec. 302).
The Committee bill contains language which has been
included in the bill since 1980, prohibiting the use of funds
to prevent the implementation of programs of voluntary prayer
and meditation in public schools (sec. 303).
The Committee bill includes a provision giving the
Secretary of Education authority to transfer up to 1 percent of
any discretionary funds between appropriations (sec. 304).
The Committee bill includes a provision which adjusts the
availability of $2,244,000,000 for the Education for the
Disadvantaged account by making these funds available on July
1, 2003 instead of October 1, 2003. This provision does not
change the total amount available for the 2003-2004 school
year. This provision shall become effective immediately upon
enactment. The Committee has included bill language to ensure
that this adjustment shall not trigger an additional rescission
under section 601 of Division N of Public Law 108-7 (sec. 305).
TITLE IV--RELATED AGENCIES
Armed Forces Retirement Home Board
Appropriations, 2003.................................... $67,571,000
Budget estimate, 2004................................... 65,279,000
Committee recommendation................................ 65,279,000
The Committee recommends authority to expend $65,279,000
from the Armed Forces Home Trust Fund to operate and maintain
the Armed Forces Retirement Home--Washington, and the Armed
Forces Retirement Home--Gulfport. This amount is equal to the
budget request.
Corporation for National and Community Service
DOMESTIC VOLUNTEER SERVICE PROGRAMS
Appropriations, 2003.................................... $353,888,000
Budget estimate, 2004................................... 364,663,000
Committee recommendation................................ 350,187,000
The Committee recommends $350,187,000 for fiscal year 2004
for the domestic volunteer service programs of the Corporation
for National and Community Service. The comparable funding
level for fiscal year 2003 is $353,888,000 and the budget
request includes $364,663,000 for this program.
VISTA
The Committee recommends $94,287,000 for fiscal year 2004
for the Volunteers in Service to America [VISTA] Program. The
comparable funding level for fiscal year 2003 is $93,674,000
and the budget request includes $94,287,000 for this program.
VISTA, created in 1964 by the Johnson Administration under
the Economic Opportunity Act, is a program which provides
capacity building for small community-based organizations.
VISTA volunteers raise resources for local projects, recruit
and organize volunteers, and establish and expand local
community-based programs in housing, employment, health, and
economic development activities.
Special Volunteer Programs
The Committee recommends $4,935,000 for fiscal year 2004
for the Special Volunteer programs. The comparable funding
level for fiscal year 2003 is $9,935,000 and the budget request
includes $20,000,000 for this program.
These funds will be used to carry out Part C of Title I of
the Domestic Volunteer Service Act of 1973, which authorizes
grants to volunteer organizations to encourage and enable
persons from all age groups to perform volunteer service in
agencies, institutions, and situations of need. Grants are
awarded to organizations that strengthen and support volunteer
efforts, with a particular emphasis on anti-poverty efforts.
The Committee commends the CNCS for its stated goal of
recruiting new Senior Corps volunteers and strongly supports
this effort. The Committee is aware that one of the most
important factors in the decision to continue volunteering is
the quality of the first volunteer experience and the ongoing
presence of the volunteer organization. For this reason, the
Committee to urge the Corporation to coordinate this newly
funded program with the Senior Corps direct service programs.
No funds have been included for the proposed Parent Drug Corps.
National Senior Volunteer Corps
The Committee recommends $216,619,000 for fiscal year 2004
for the National Senior Volunteer Corps programs. The
comparable funding level for fiscal year 2003 is $215,933,000
and the budget request includes $212,147,000 for this program.
The Committee recognizes the valuable contributions of
seniors participating in the Foster Grandparent [FGP], Retired
and Senior Volunteer Program [RSVP], and Senior Companion
Programs [SCP]. In accordance with the Domestic Volunteer
Service Act [DVSA], the Committee intends that at least one-
third of each program's increase over the fiscal year 2001
level shall be used to fund Program of National Significance
[PNS] expansion grants to allow existing FGP, RSVP, and SCP
programs to expand the number of volunteers serving in areas of
critical need as identified by Congress in the DVSA. Remaining
funds should be used to begin new FGP, RSVP, and SCP programs
in geographic areas currently underserved. The Committee
expects these projects to be awarded via a nationwide
competition among potential community-based sponsors.
The Committee has included $397,000 for senior
demonstration programs. The comparable funding level for fiscal
year 2003 is $397,000 and the budget request did not include
funds for this program.
Foster Grandparent Program
The Committee recommends $110,775,000 for fiscal year 2004
for the Foster Grandparent Program. The comparable funding
level for fiscal year 2003 is $110,775,000 and the budget
request includes $106,700,000 for this program.
This program provides volunteer opportunities to seniors
age 60 and over who serve at-risk youth. This program not only
involves seniors in their communities, but it also provides a
host of services to children.
Senior Companion Program
The Committee recommends $46,563,000 for fiscal year 2004
for the Senior Companion Program. The comparable funding level
for fiscal year 2003 is $46,260,000 and the budget request
includes $46,563,000 for this program.
This program enables senior citizens to provide personal
assistance and companionship to adults with physical, mental,
or emotional difficulties. Senior companions provide vital in-
home services to elderly Americans who would otherwise have to
enter nursing homes. The volunteers also provide respite care
to relieve care givers.
Retired and Senior Volunteer Program
The Committee recommends $58,884,000 for fiscal year 2004
for the Retired and Senior Volunteer Program. The comparable
funding level for fiscal year 2003 is $58,501,000 and the
budget request includes $58,884,000 for this program.
This program involves persons age 55 and over in volunteer
opportunities in their communities such as tutoring youth,
responding to natural disasters, teaching parenting skills to
teen parents, and mentoring troubled youth.
Program Administration
The Committee recommends $34,346,000 for fiscal year 2004
for program support administration. The comparable funding
level for fiscal year 2003 is $34,346,000 and the budget
request includes $38,229,000 for this program.
The Committee is disappointed by the Corporation's
continued consolidation of State Offices. Contrary to the
administration's repeated assurances that there is no plan to
reduce the number of State offices, the Corporation has pursued
a concerted effort to consolidate State Director positions
through attrition. Many of these consolidations, such as the
one between Iowa and Nebraska, have created extreme geographic
distances for Directors to traverse in order to fulfill their
oversight responsibilities. For that reason, the Committee
expects the Corporation to submit a 5-year plan in the fiscal
year 2005 budget justification detailing the number, location
of State offices, and staffing plans of each.
Corporation for Public Broadcasting
Appropriations, 2004.................................... $380,000,000
Appropriations, 2005.................................... 390,000,000
Budget estimate, 2006...................................................
Committee recommendation................................ 400,000,000
The Committee recommends $400,000,000 be made available for
the Corporation for Public Broadcasting [CPB], an advance
appropriation for fiscal year 2006. The comparable funding
level for fiscal year 2005 is $390,000,000 and the budget
request does not include advance funds for this program.
In addition, the Committee recommends $55,000,000 be made
available in fiscal year 2004 for the conversion to digital
broadcasting. The comparable funding level for fiscal year 2003
is $48,427,000 and the budget request includes $60,000,000 out
of the funds appropriated in 2002 for fiscal year 2004.
The Committee notes that less than half of the Nation's 356
public television stations met the May 1, 2003 deadline for
transmitting a digital broadcast signal. Station waivers
extended the deadline to May 1, 2004. However, even of those
stations that did meet the deadline, many will be transmitting
at low power, reaching only a portion of their analog service
area. The majority of these stations are seeking digital
production equipment to remedy the situation. To date, Federal
funding for this conversion totals $206,427,000 out of the
total estimated cost of $1,700,000,000. The Committee
recognizes that there remains a great need for federally
matched funding of digital broadcast equipment beyond, as well
as for, basic transmission capability. The Committee is
concerned that public television stations' ability to deliver
full universal digital service to communities will be delayed
if such funding is not made available.
In addition, the Committee recommends $10,000,000 be made
available in fiscal year 2004 for the replacement project of
the interconnection system. There were no funds provided in
fiscal year 2003 for this purpose and the budget request
includes $20,000,000 out of the funds appropriated in 2002 for
fiscal year 2004.
The current interconnection system is entirely satellite
based. This satellite is currently nearing the end of its
useful life, and while satellite technology is currently the
most cost-effective method for distribution in a point-to-
multipoint system, terrestrial technology is far more
economical when data is distributed between single points. The
Next Generation Interconnection System will utilize a
combination of satellite and terrestrial technologies for a
more flexible system. In addition, a portion of the provided
funds will be used to upgrade existing ground station and
transmit/receive equipment to be compatible with the new
system.
Federal Mediation and Conciliation Service
Appropriations, 2003.................................... $41,156,000
Budget estimate, 2004................................... 42,885,000
Committee recommendation................................ 43,385,000
The Committee recommends $43,385,000 for fiscal year 2004
for the Federal Mediation and Conciliation Service [FMCS]. The
comparable funding level for fiscal year 2003 is $41,156,000
and the budget request includes $42,885,000 for this program.
The FMCS was established by Congress in 1947 to provide
mediation, conciliation, and arbitration services to labor and
management. FMCS is authorized to provide dispute resolution
consultation and training to all Federal agencies.
The Committee continues to support the FMCS program to
prevent youth violence and is especially pleased with the
initiative to train educators in conflict resolution. The
Committee is also impressed with the development of a CD-ROM
that will address conflict resolution among preschool and
elementary age children. The Committee has included $500,000
for the continuation of these innovative programs for youth
violence prevention.
Federal Mine Safety and Health Review Commission
Appropriations, 2003.................................... $7,131,000
Budget estimate, 2004................................... 7,774,000
Committee recommendation................................ 7,774,000
The Committee recommends $7,774,000 for fiscal year 2004
for the Federal Mine Safety and Health Review Commission. The
comparable funding level for fiscal year 2003 is $7,131,000 and
the budget request includes $7,774,000 for this program.
The Federal Mine Safety and Health Review Commission
provides administrative trial and appellate review of legal
disputes under the Federal Mine Safety and Health Act of 1977.
The five-member Commission provides review of the Commission's
administrative law judge decisions. A number of vacant
positions on the Commission have resulted in the absence of a
quorum. Consequently, parties seeking such a review must either
be put on hold until the quorum has been filled or appeal their
cases to the appropriate Federal circuit court. The Committee
is concerned that the Commission's current inability to
consider and decide cases is adversely affecting the
Commission's ability to meet its goals.
Institute of Museum and Library Services
Appropriations, 2003.................................... $243,889,000
Budget estimate, 2004................................... 242,024,000
Committee recommendation................................ 243,889,000
The Committee recommends $243,889,000 for fiscal year 2004
for the Institute of Museum and Library Services. The
comparable funding level for fiscal year 2003 is $243,889,000
and the budget request includes $242,024,000 for this program.
Office of Museum Services Operations Grants
The Committee recommends $15,828,000 for operations grants.
These funds support grants to museums for building increased
public access, expanding educational services, reaching
families and children, and using technology more effectively in
support of these goals. In addition, non-competitive grants are
awarded for technical assistance in four types of assessments:
Institutional, Collections Management, Public Dimension, and
Governance.
Museum Conservation Programs
The Committee recommends $3,607,000 for Conservation
programs. These funds support grants to allow museums to survey
collections, perform training, research, treatment and
environmental improvements. In addition, grantees may receive
additional funds to develop an education component that relates
to their conservation project. In addition, non-competitive
grants are awarded for technical assistance in conservation
efforts.
Museum National Leadership Projects
The Committee recommends $5,663,000 for National Leadership
projects. The National Leadership Grants encourage innovation
in meeting community needs, widespread and creative use of new
technologies, greater public access to museum collections, and
an extended impact of Federal dollars through collaborative
projects.
Office of Museum Services Administration
The Committee recommends $3,539,000 for program
administration, the same as the budget request. Funds support
personnel compensation and benefits, travel, rent,
communications, utilities, printing, equipment and supplies,
automated data processing, and other services.
Office of Library Services State Grants
The Committee recommends $150,435,000 for State grants.
Funds are provided to States by formula to carry out 5-year
State plans. These plans must set goals and priorities for the
State consistent with the purpose of the act, describe
activities to meet the goals and priorities and describe the
methods by which progress toward the goals and priorities and
the success of activities will be evaluated. States may
apportion their funds between two activities, technology and
targeted services. For technology, States may use funds for
electronic linkages among libraries, linkages to educational,
social and information services, accessing information through
electronic networks, or link different types of libraries or
share resources among libraries. For targeted services, States
may direct library and information services to persons having
difficulty using a library, underserved urban and rural
communities, and children from low income families. Within the
total recommended, $3,055,000 has been provided for library
services to Native Americans and Native Hawaiians.
Library National Leadership Projects
The Committee recommends $11,009,000 for national
leadership projects. These funds support activities of national
significance to enhance the quality of library services
nationwide and to provide coordination between libraries and
museums. Activities are carried out through grants and
contracts awarded on a competitive basis to libraries,
agencies, institutions of higher education and museums.
Priority is given to projects that focus on education and
training of library personnel, research and development for the
improvement of libraries, preservation, digitization of library
materials, partnerships between libraries and museums and other
activities that enhance the quality of library services
nationwide.
The Committee commends the administration for proposing an
Initiative to Recruit and Educate Librarians and has included
$9,935,000 for this purpose. The Nation is facing an impending
retirement wave of librarians. The Bureau of Labor Statistics
reports that 57 percent of current librarians are 45 and older
and 50 percent of librarians are expected to leave the
profession in the next 10 years. In addition, current
librarians are being asked to take on expanded duties as
information technology advances and our society experiences an
ever-increasing need for the dissemination of public safety and
public health data.
Office of Library Services Administration
The Committee recommends $5,663,000 for program
administration, the same as the budget request. Funds support
personnel compensation and benefits, travel, rent,
communications, utilities, printing, equipment and supplies,
automated data processing, and other services.
Medicare Payment Advisory Commission
Appropriations, 2003.................................... $8,529,000
Budget estimate, 2004................................... 9,000,000
Committee recommendation................................ 9,000,000
The Committee recommends $9,000,000 for fiscal year 2004
for the Medicare Payment Advisory Commission. The comparable
funding level for fiscal year 2003 is $8,529,000 and the budget
request includes $9,000,000 for this program.
The Medicare Payment Advisory Commission [MedPAC] was
established by Congress as part of the Balanced Budget Act of
1997 (Public Law 105-33). Congress merged the Physician Payment
Review Commission with the Prospective Payment Assessment
Commission to create MedPAC.
National Commission on Libraries and Information Science
Appropriations, 2003.................................... $1,003,000
Budget estimate, 2004................................... 1,000,000
Committee recommendation................................ 1,000,000
The Committee recommends $1,000,000 for fiscal year 2004
for the National Commission on Libraries and Information
Science. The comparable funding level for fiscal year 2003 is
$1,003,000 and the budget request includes $1,000,000 for this
program.
The Commission determines the need for, and makes
recommendations on, library and information services, and
advises the President and Congress on the development and
implementation of national policy in library and information
sciences.
National Council on Disability
Appropriations, 2003.................................... $2,839,000
Budget estimate, 2004................................... 2,830,000
Committee recommendation................................ 3,339,000
The Committee recommends $3,339,000 for fiscal year 2004
for the National Council on Disability. The comparable funding
level for fiscal year 2003 is $2,839,000 and the budget request
includes $2,830,000 for this program.
The Council is mandated to make recommendations to the
President, the Congress, the Rehabilitation Services
Administration, and the National Institute on Disability and
Rehabilitation Research, on the public issues of concern to
individuals with disabilities. The Council gathers information
on the implementation, effectiveness, and impact of the
Americans with Disabilities Act and looks at emerging policy
issues as they affect persons with disabilities and their
ability to enter or reenter the Nation's work force and to live
independently.
The Committee strongly supports the Americans with
Disabilities Act and is concerned that recent court decisions
have undermined the congressionally intended degree of civil
rights protections afforded individuals with disabilities. The
Committee has included additional resources to allow the
Council to continue to seek input and develop approaches
addressing these decisions and ensuring that people with
disabilities are adequately protected from discrimination.
National Labor Relations Board
Appropriations, 2003.................................... $237,429,000
Budget estimate, 2004................................... 243,073,000
Committee recommendation................................ 246,073,000
The Committee recommends $246,073,000 for fiscal year 2004
for the National Labor Relations Board [NLRB]. The comparable
funding level for fiscal year 2003 is $237,429,000 and the
budget request includes $243,073,000 for this program.
The NLRB is a law enforcement agency which adjudicates
disputes under the National Labor Relations Act.
The Committee is disappointed that, for the past 2 years,
the administration has repeatedly underestimated the funding
necessary to process the increase in case intakes occurring as
a result of the economic downturn. The Committee has repeatedly
included additional funds to reduce the backlog but progress on
that front has been stymied by the increase in cases. The
backlog at the end of fiscal year 2001 was approximately 970
cases and grew to 1,496 cases by the end of fiscal year 2002.
It is estimated that the backlog will be 2,346 cases by the end
of fiscal year 2003. The Committee is concerned about the
impact this backlog has on workplace conditions. The Committee
has again included additional funds to address this serious
situation, however, the Committee encourages the administration
to develop more accurate estimates on which to base their
request.
National Mediation Board
Appropriations, 2003.................................... $11,241,000
Budget estimate, 2004................................... 11,421,000
Committee recommendation................................ 11,421,000
The Committee recommends $11,421,000 for fiscal year 2004
for the National Mediation Board. The comparable funding level
for fiscal year 2003 is $11,241,000 and the budget request
includes $11,421,000 for this program.
The National Mediation Board protects interstate commerce
as it mediates labor-management relations in the railroad and
airline industries under the Railway Labor Act. The Board
mediates collective bargaining disputes, determines the choice
of employee bargaining representatives through elections, and
administers arbitration of employee grievances.
Occupational Safety and Health Review Commission
Appropriations, 2003.................................... $9,610,000
Budget estimate, 2004................................... 10,115,000
Committee recommendation................................ 9,610,000
The Committee recommends $9,610,000 for fiscal year 2004
for the Occupational Safety and Health Review Commission. The
comparable funding level for fiscal year 2003 is $9,610,000 and
the budget request includes $10,115,000 for this program.
The Commission serves as a court to justly and
expeditiously resolve disputes between the Occupational Safety
and Health Administration [OSHA] and employers charged with
violations of health and safety standards enforced by OSHA.
Railroad Retirement Board
DUAL BENEFITS PAYMENTS ACCOUNT
Appropriations, 2003.................................... $123,194,000
Budget estimate, 2004................................... 119,000,000
Committee recommendation................................ 119,000,000
The Committee recommends $119,000,000 for fiscal year 2004
for the Dual Benefits Payments Account. The comparable funding
level for fiscal year 2003 is $123,194,000 and the budget
request includes $119,000,000 for this program.
This appropriation provides for vested dual benefit
payments authorized by the Railroad Retirement Act of 1974, as
amended by the Omnibus Reconciliation Act of 1981. This
separate account, established for the payment of dual benefits,
is funded by general fund appropriations and income tax
receipts of vested dual benefits.
FEDERAL PAYMENTS TO THE RAILROAD RETIREMENT ACCOUNT
Appropriations, 2003.................................... $150,000
Budget estimate, 2004................................... 150,000
Committee recommendation................................ 150,000
The Committee recommends $150,000 for fiscal year 2004 for
interest earned on unnegotiated checks. The comparable funding
level for fiscal year 2003 is $150,000 and the budget request
includes $150,000 for this program.
LIMITATION ON ADMINISTRATION
Appropriations, 2003.................................... $99,350,000
Budget estimate, 2004................................... 99,820,000
Committee recommendation................................ 99,350,000
The Committee recommends $99,350,000 for fiscal year 2004
for the administration of railroad retirement/survivor benefit
programs. The comparable funding level for fiscal year 2003 is
$99,350,000 and the budget request includes $99,820,000 for
this program.
The Board administers comprehensive retirement-survivor and
unemployment-sickness insurance benefit programs for the
Nation's railroad workers and their families. This account
limits the amount of funds in the railroad retirement and
railroad unemployment insurance trust funds which may be used
by the Board for administrative expenses.
The Committee is concerned by the administration's lack of
a consistent policy on the payment of commercial rent by trust
fund agencies. The Committee requests that the Office of
Management and Budget clarify its policy in the fiscal year
2004 budget. In the meantime, the Committee has included
language to prohibit funds from the railroad retirement trust
fund from being spent on any charges over and above the actual
cost of administering the trust fund, including commercial
rental rates.
The Committee encourages the RRB to continue to use the
Department of the Treasury to process railroad retirement
benefit payments versus contracting with a non-governmental
disbursement agent thereby incurring $2,100,000 in cost
savings.
LIMITATION ON THE OFFICE OF THE INSPECTOR GENERAL
Appropriations, 2003.................................... $6,322,000
Budget estimate, 2004................................... 6,600,000
Committee recommendation................................ 6,322,000
The Committee recommends $6,322,000 for fiscal year 2004
for the Office of the Inspector General. The comparable funding
level for fiscal year 2003 is $6,322,000 and the budget request
includes $6,600,000 for this program.
The Committee has included bill language to allow the
Office of the Inspector General to use funds to conduct audits,
investigations, and reviews of the Medicare program. The
Committee finds that as long as the RRB has the authority to
negotiate and administer the separate Medicare contract, the
RRB Inspector General should not be prohibited from using funds
to review, audit, or investigate the RRB's separate Medicare
contract.
Social Security Administration
PAYMENTS TO SOCIAL SECURITY TRUST FUNDS
Appropriations, 2003.................................... $20,400,000
Budget estimate, 2004................................... 21,658,000
Committee recommendation................................ 21,658,000
The Committee recommends an appropriation of $21,658,000
for payments to Social Security trust funds. The comparable
fiscal year 2003 funding level is $20,400,000 and the budget
request includes $21,658,000 for this purpose. This amount
reimburses the old age and survivors and disability insurance
trust funds for special payments to certain uninsured persons,
costs incurred administering pension reform activities, and the
value of the interest for benefit checks issued but not
negotiated. This appropriation restores the trust funds to the
same financial position they would have been in had they not
borne these costs, properly charged to the general funds.
SUPPLEMENTAL SECURITY INCOME
Appropriations, 2003.................................... $24,025,392,000
Budget estimate, 2004................................... 26,402,000,000
Committee recommendation................................ 26,410,000,000
The Committee recommends an appropriation of
$26,410,000,000 for supplemental security income. This is in
addition to the $11,080,000,000 appropriated last year as an
advance for the first quarter of fiscal year 2004. The
comparable fiscal year 2003 funding level is $24,025,392,000
and the budget request includes $26,402,000,000. The Committee
also recommends an advance appropriation of $12,590,000,000 for
the first quarter of fiscal year 2005 to ensure uninterrupted
benefits payments.
These funds are used to pay benefits under the SSI Program,
which was established to ensure a Federal minimum monthly
benefit for aged, blind, and disabled individuals, enabling
them to meet basic needs. It is estimated that approximately
6.7 million persons will receive SSI benefits each month during
fiscal year 2004. In many cases, SSI benefits supplement income
from other sources, including Social Security benefits. The
funds are also used to reimburse the Social Security trust
funds for the administrative costs for the program with a final
settlement by the end of the subsequent fiscal year as required
by law, to reimburse vocational rehabilitation agencies for
costs incurred in successfully rehabilitating SSI recipients
and for research and demonstration projects.
Beneficiary Services
The Committee recommendation includes $100,000,000 for
beneficiary services. The comparable funding level in fiscal
year 2003 is $45,728,000 and the budget request includes
$100,000,000 for these services. This amount is available for
payments to Employment Networks for successful outcomes or
milestone payments under the Ticket to Work program and for
reimbursement of State vocational rehabilitation agencies and
alternate public or private providers.
Research and Demonstration Projects
The Committee recommendation includes $38,000,000 for
research and demonstration projects conducted under sections
1110 and 1115 of the Social Security Act. The comparable fiscal
year 2003 funding level is $38,000,000 and the budget request
includes $30,000,000 for authorized activities.
This amount will support SSA's efforts to strengthen its
policy evaluation capability and focus on research of: program
issues, the impact of demographic changes on future workloads
and effective return-to-work strategies for disabled
beneficiaries.
The Committee commends the administration on their stated
goal of preventing and ending homelessness for people with
disabilities within 10 years. The Committee believes that
increasing the Social Security Administration's outreach and
application assistance to homeless people as well as others who
are economically disadvantaged is an important part of this
effort. The Committee is aware that SSA operated an effective
outreach program in the early 1990's, where grants were awarded
to local non-profits to provide SSI outreach and application
assistance. In light of the ongoing need for SSI outreach and
application assistance, the Committee has included an
additional $8,000,000 to provide and to administer a
competitive demonstration grants demonstration program,
targeted toward providing outreach and application assistance
to homeless persons and other underserved populations.
Administration
The Committee recommendation includes $3,034,000,000 for
payment to the Social Security trust funds for the SSI
Program's share of SSA's base administrative expenses. The
comparable fiscal year 2003 amount is $2,825,000,000 and the
budget request includes $3,034,000,000 for such activities.
LIMITATION ON ADMINISTRATIVE EXPENSES
Appropriations, 2003.................................... $7,885,137,000
Budget estimate, 2004................................... 8,530,000,000
Committee recommendation................................ 8,530,000,000
The Committee recommends a program funding level of
$8,530,000,000 for the limitation on administrative expenses.
The comparable fiscal year 2003 funding level is $7,885,137,000
and the budget request includes $8,530,000,000 for this
purpose.
This account provides resources from the Social Security
trust funds to administer the Social Security retirement and
survivors and disability insurance programs, and certain Social
Security health insurance functions. As authorized by law, it
also provides resources from the trust funds for certain
nontrust fund administrative costs, which are reimbursed from
the general funds. These include administration of the
supplemental security income program for the aged, blind and
disabled; work associated with the Pension Reform Act of 1984;
and the portion of the annual wage reporting work done by the
Social Security Administration for the benefit of the Internal
Revenue Service. The dollars provided also support automated
data processing activities and fund the State disability
determination services which make initial and continuing
disability determinations on behalf of the Social Security
Administration. Additionally, the limitation provides funding
for computer support, and other administrative costs.
The Committee recommendation includes $8,410,000,000 for
routine operating expenses of the agency, as well as the
resources derived from the user fees which are discussed below.
The budget request includes bill language earmarking not
less than $1,446,000,000 of funds available within this account
for program integrity activities, including continuing
disability reviews, SSI non-disability redeterminations of
eligibility and overpayment workloads. The Committee bill does
not include such an earmark. However, it is the Committee's
expectation that the Social Security Administration will stay
current in processing continuing disability reviews, conducting
redeterminations and undertaking other authorized activities in
order to ensure that its program stewardship obligations are
met. The Committee notes savings in fiscal year 2002 of roughly
$3,000,000,000 associated with the increased payment accuracy
achieved by the processing of continuing disability reviews.
The Committee concurs in the budget request, by providing a
significant increase of 8.2 percent over the comparable fiscal
year 2003 level for the administrative expenses of the Social
Security Administration. This investment in SSA is recommended
to continue addressing the significant challenges the agency
faces in improving the disability claims process and
eliminating the backlog in this workload; efficiently
processing increasing claims volumes, including special
workloads; enhancing service quality and options and program
stewardship; and investing in staff. The Committee is aware
that the SSA has developed a Service Delivery Budget, which is
a multi-year plan for addressing these challenges. The
Committee expects to receive a copy of this Budget as soon as
possible in order to make a more informed assessment of current
and future funding needs.
The Committee is pleased that SSA officials have continued
to educate adjudicators at all levels of the SSA process about
the April 1999 CFS ruling (99-2p). The Committee encourages SSA
to continue these educational efforts, as many SSA employees
remain unfamiliar with or misinformed about CFS and the
functional limitations it imposes. Finally, the Committee
encourages SSA to continue examining obstacles to benefits for
persons with CFS, to assess the impact of the ruling on CFS
patients' access to benefits, and to keep medical information
updated throughout all levels of the application and review
process.
Social Security Advisory Board
The Committee has included not less than $1,800,000 within
the limitation on administrative expenses account for the
Social Security Advisory Board for fiscal year 2004.
User Fees
In addition to other amounts provided, the Committee
recommends $120,000,000 for administrative activities funded
from user fees that were authorized in fiscal year 1998.
OFFICE OF THE INSPECTOR GENERAL
Appropriations, 2003.................................... $82,460,000
Budget estimate, 2004................................... 90,000,000
Committee recommendation................................ 82,460,000
The Committee recommends $82,460,000 for activities for the
Office of the Inspector General. The comparable fiscal year
2003 funding level is $82,460,000 and the budget request
includes $90,000,000 for this office. This includes a general
fund appropriation of $20,863,000 together with an obligation
limitation of $61,597,000 from the Federal old-age and
survivors insurance trust fund and the Federal disability
insurance trust fund.
The Committee continues to be very concerned with the many
challenges to protecting the privacy of individuals' Social
Security Numbers [SSNs]. The number of complaints of identity
theft and other abuses due to the inappropriate sale or misuse
of SSNs has risen dramatically. The Committee encourages the
SSA IG to expand its efforts to stop the inappropriate sale and
misuse of SSNs.
U.S. Institute of Peace
Appropriations, 2003.................................... $16,256,000
Budget estimate, 2004................................... 17,200,000
Committee recommendation................................ 17,200,000
The Committee recommends $17,200,000 for fiscal year 2004
for the U.S. Institute of Peace. The comparable funding level
for fiscal year 2003 is $16,256,000 and the budget request
includes $17,200,000 for this program.
The Institute was established by the U.S. Institute of
Peace Act (Public Law 98-525) in 1984. The Institute is an
independent, nonprofit, national organization whose primary
mission is to promote, through scholarship and education,
international peace, and the resolution of conflicts without
recourse to violence.
TITLE V--GENERAL PROVISIONS
The Committee recommendation retains provisions which:
authorize transfers of unexpended balances (sec. 501); limit
funding to 1 year availability unless otherwise specified (sec.
502); limit lobbying and related activities (sec. 503); limit
official representation expenses (amended) (sec. 504); prohibit
funding of any program to carry out distribution of sterile
needles for the hypodermic injection of any illegal drug unless
the Secretary of HHS determines such programs are effective in
preventing the spread of HIV and do not encourage the use of
illegal drugs (sec. 505); state the sense of Congress about
purchase of American-made equipment and products (sec. 506);
clarify Federal funding as a component of State and local grant
funds (sec. 507); limit use of funds for abortion (sec. 508 and
sec. 509); restrict human embryo research (sec. 510); limit the
use of funds for promotion of legalization of controlled
substances included last year (sec. 511); limits use of funds
to enter into or review contracts with entities subject to the
requirement in section 4212(d) of title 38, United States Code,
if the report required by that section has not been submitted
(sec. 512); and prohibits the use of funds to promulgate
regulations regarding the individual health identifier (sec.
513).
BUDGETARY IMPACT OF BILL
PREPARED IN CONSULTATION WITH THE CONGRESSIONAL BUDGET OFFICE PURSUANT TO SEC. 308(a), PUBLIC LAW 93-344, AS
AMENDED
[In millions of dollars]
----------------------------------------------------------------------------------------------------------------
Budget authority Outlays
---------------------------------------------------------
Committee Amount of Committee Amount of
allocation \1\ bill allocation \1\ bill
----------------------------------------------------------------------------------------------------------------
Comparison of amounts in the bill with Committee
allocations to its subcommittees of amounts in the
Budget Resolution for 2004: Subcommittee on Labor-HHS-
Education.
Discretionary..................................... 137,601 137,601 134,932 \1\ 134,932
Mandatory......................................... 318,766 318,766 318,694 \1\ 318,694
Projection of outlays associated with the
recommendation:
2004.............................................. .............. ........... .............. \2\ 294,613
2005.............................................. .............. ........... .............. 69,579
2006.............................................. .............. ........... .............. 19,903
2007.............................................. .............. ........... .............. 3,751
2008 and future years............................. .............. ........... .............. 575
Financial assistance to State and local governments NA 44,993 NA 16,217
for 2004............................................
----------------------------------------------------------------------------------------------------------------
\1\ Includes outlays from prior-year budget authority.
\2\ Excludes outlays from prior-year budget authority.
NA: Not applicable.
COMPLIANCE WITH PARAGRAPH 7, RULE XVI, OF THE STANDING RULES OF THE
SENATE
Paragraph 7 of rule XVI requires that Committee report on
general appropriations bills identify each Committee amendment
to the House bill ``which proposes an item of appropriation
which is not made to carry out the provisions of an existing
law, a treaty stipulation, or an act or resolution previously
passed by the Senate during that session.''
The following items are identified pursuant to this
requirement: Workforce Investment Act, $5,115,588,000;
Title VII and Title VIII of the Public Health Services Act,
$423,765,000; National Cord Blood Stem Cell Bank Program,
$10,000,000; Universal Newborn Hearing Screening, $9,935,000;
Abstinence Education, $73,044,000; Organ Transplantation,
$24,828,000; Rural Hospital Flexibility Grants, $39,740,000;
Denali Commission, $40,000,000; Family Planning, $283,350,000;
State Offices of Rural Health, $8,445,000; Birth Defects and
Developmental Disabilities, $110,639,000; Infant Hearing,
$6,240,000; Tuberculosis Prevention, $137,627,000; Sexually
Transmitted Diseases, $169,572,000; Infertility, $30,200,000;
Adolescent Family Life, $31,241,000; Office of Minority Health,
$48,740,000; Office of Disease Prevention and Health Promotion,
$7,620,000; Child Care and Development Block Grant,
$2,099,729,000; Head Start, $6,815,570,000; Native American
Programs, $45,457,000; Refugee and Entrant Assistance Programs,
$393,829,000; Community Services $692,792,000; Alzheimer's
Disease Demonstration Grants to States, $12,412,000; Individual
with Disabilities Education Act, $11,027,464,000; Assistive
Technology Act of 1998, $26,824,000; Volunteers in Service to
America, $94,287,000; Special Volunteer Programs, $4,935,000;
National Senior Volunteer Corps, $110,775,000; Institute of
Museum and Library Services, $243,889,000;
COMPLIANCE WITH PARAGRAPH 7(C), RULE XXVI OF THE STANDING RULES OF THE
SENATE
Pursuant to paragraph 7(c) of rule XXVI, on June 26, 2003,
the Committee ordered reported an original Labor, Health and
Human Services, Education Appropriations bill, 2004, subject to
amendment and subject to the budget allocations, by a recorded
vote of 25-4, a quorum being present. The vote was as follows:
Yeas Nays
Chairman Stevens Ms. Mikulski
Mr. Cochran Mr. Reid
Mr. Specter Mrs. Murray
Mr. Domenici Ms. Landrieu
Mr. Bond
Mr. McConnell
Mr. Burns
Mr. Shelby
Mr. Gregg
Mr. Bennett
Mr. Campbell
Mr. Craig
Mrs. Hutchison
Mr. DeWine
Mr. Brownback
Mr. Byrd
Mr. Inouye
Mr. Hollings
Mr. Leahy
Mr. Harkin
Mr. Kohl
Mr. Dorgan
Mrs. Feinstein
Mr. Durbin
Mr. Johnson
COMPLIANCE WITH PARAGRAPH 12, RULE XXVI OF THE STANDING RULES OF THE
SENATE
Paragraph 12 of rule XXVI requires that Committee reports
on a bill or a joint resolution repealing or amending any
statute include ``(a) the text of the statute or part thereof
which is proposed to be repealed; and (b) a comparative print
of that part of the bill or joint resolution making the
amendment and of the statute or part thereof proposed to be
amended, showing by stricken through type and italics, parallel
columns, or other appropriate typographical devices the
omissions and insertions which would be made by the bill or
joint resolution if enacted in the form recommended by the
committee.''
With respect to this bill, it is the opinion of the
Committee that it is necessary to dispense with these
requirements in order to expedite the business of the Senate.
COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2003 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL FOR FISCAL
YEAR 2004
[In thousands of dollars]
--------------------------------------------------------------------------------------------------------------------------------------------------------
Senate Committee recommendation
Committee compared with (+ or -)
Item 2003 comparable Budget estimate recommendation ---------------------------------
2003 comparable Budget estimate
--------------------------------------------------------------------------------------------------------------------------------------------------------
TITLE I
DEPARTMENT OF LABOR
EMPLOYMENT AND TRAINING ADMINISTRATION
TRAINING AND EMPLOYMENT SERVICES
Grants to States:
Adult Training, current year................................... 186,778 188,000 188,000 +1,222 ...............
Advance from prior year.................................... (707,372) (712,000) (712,000) (+4,628) ...............
Fiscal year 2005........................................... 712,000 712,000 712,000 ............... ...............
------------------------------------------------------------------------------------
Adult Training........................................... 898,778 900,000 900,000 +1,222 ...............
Youth Training................................................. 994,459 1,000,965 1,000,965 +6,506 ...............
Dislocated Worker Assistance \1\............................... 307,152 258,432 307,152 ............... +48,720
Advance from prior year.................................. (842,488) (848,000) (848,000) (+5,512) ...............
Fiscal year 2005......................................... 848,000 848,000 848,000 ............... ...............
------------------------------------------------------------------------------------
Dislocated Worker Assistance........................... 1,155,152 1,106,432 1,155,152 ............... +48,720
Federally Administered Programs:
Dislocated Worker Assistance Nat'l reserve \1\................. 64,188 64,608 64,608 +420 ...............
Advance from prior year.................................... (210,622) (212,000) (212,000) (+1,378) ...............
Fiscal year 2005........................................... 212,000 212,000 212,000 ............... ...............
------------------------------------------------------------------------------------
Dislocated Worker Assistance Nat'l Reserve............... 276,188 276,608 276,608 +420 ...............
Trade Health Assistance Administration......................... 29,805 ............... ............... -29,805 ...............
------------------------------------------------------------------------------------
Total, Dislocated Worker Assistance.......................... 1,431,340 1,383,040 1,431,760 +420 +48,720
Native Americans............................................... 55,636 55,000 55,636 ............... +636
Migrant and Seasonal Farmworkers............................... 76,823 ............... 76,823 ............... +76,823
Job Corps:
Operations................................................. 794,800 844,667 830,000 +35,200 -14,667
Advance from prior year................................ (587,158) (591,000) (591,000) (+3,842) ...............
Fiscal year 2005....................................... 591,000 591,000 591,000 ............... ...............
Construction and Renovation................................ 27,371 30,216 20,216 -7,155 -10,000
Advance from prior year................................ (99,350) (100,000) (100,000) (+650) ...............
Fiscal year 2005....................................... 100,000 100,000 100,000 ............... ...............
------------------------------------------------------------------------------------
Subtotal, Job Corps, program level................... 1,513,171 1,565,883 1,541,216 +28,045 -24,667
National Activities:
Pilots, Demonstrations and Research........................ 75,855 35,000 35,000 -40,855 ...............
Responsible Reintegration of Youthful Offender............. 54,642 ............... 54,642 ............... +54,642
Evaluation................................................. 9,039 9,098 9,039 ............... -59
Youth Opportunity Grants................................... 44,211 ............... ............... -44,211 ...............
Denali Commission.......................................... ............... ............... 7,000 +7,000 +7,000
Other...................................................... 15,409 3,000 3,507 -11,902 +507
------------------------------------------------------------------------------------
Subtotal, National activities............................ 199,156 47,098 109,188 -89,968 +62,090
====================================================================================
Subtotal, Federal activities............................. 2,150,779 1,944,589 2,059,471 -91,308 +114,882
Current Year......................................... 1,217,974 1,041,589 1,149,471 -68,503 +107,882
Fiscal year 2005..................................... 903,000 903,000 903,000 ............... ...............
------------------------------------------------------------------------------------
Total, Workforce Investment Act.......................... 5,199,168 4,951,986 5,115,588 -83,580 +163,602
Current Year......................................... 2,706,363 2,488,986 2,645,588 -60,775 +156,602
Fiscal year 2005..................................... 2,463,000 2,463,000 2,463,000 ............... ...............
Women in Apprenticeship........................................ 993 ............... ............... -993 ...............
------------------------------------------------------------------------------------
Subtotal, National activities, TES........................... 200,149 47,098 109,188 -90,961 +62,090
====================================================================================
Subtotal, Training and Employment Services................... 5,200,161 4,951,986 5,115,588 -84,573 +163,602
Current Year............................................. (2,737,161) (2,488,986) (2,652,588) (-84,573) (+163,602)
Fiscal year 2005......................................... (2,463,000) (2,463,000) (2,463,000) ............... ...............
COMMUNITY SERVICE EMPLOYMENT FOR OLDER AMERICANS................... 442,306 440,200 442,306 ............... +2,106
FEDERAL UNEMPLOYMENT BENEFITS AND ALLOWANCES....................... 972,200 1,338,200 1,338,200 +366,000 ...............
STATE UNEMPLOYMENT INSURANCE AND EMPLOYMENT SERVICE OPERATIONS
Unemployment Compensation:
State Operations............................................... 2,624,318 2,640,002 2,634,924 +10,606 -5,078
National Activities............................................ 9,935 10,500 10,500 +565 ...............
------------------------------------------------------------------------------------
Subtotal, Unemployment Compensation.......................... 2,634,253 2,650,502 2,645,424 +11,171 -5,078
Employment Service:
Allotments to States:
Federal Funds.............................................. 23,300 23,452 23,300 ............... -152
Trust Funds................................................ 768,257 773,283 768,257 ............... -5,026
------------------------------------------------------------------------------------
Subtotal................................................. 791,557 796,735 791,557 ............... -5,178
ES National Activities......................................... 50,351 78,546 64,351 +14,000 -14,195
====================================================================================
Subtotal, Employment Service................................. 841,908 875,281 855,908 +14,000 -19,373
Federal Funds............................................ 23,300 23,452 23,300 ............... -152
Trust Funds.............................................. 818,608 851,829 832,608 +14,000 -19,221
One-Stop Career Centers/Labor Market Information................... 99,350 101,000 99,350 ............... -1,650
Work Incentives Grants............................................. 19,870 20,000 19,870 ............... -130
====================================================================================
Total, State Unemployment & Employment Srvcs................. 3,595,381 3,646,783 3,620,552 +25,171 -26,231
Federal Funds............................................ 142,520 144,452 142,520 ............... -1,932
Trust Funds.............................................. 3,452,861 3,502,331 3,478,032 +25,171 -24,299
ADVANCES TO THE UI AND OTHER TRUST FUNDS \1\....................... 463,000 467,000 467,000 +4,000 ...............
PROGRAM ADMINISTRATION
Adult Employment and Training...................................... 42,326 38,700 38,700 -3,626 ...............
Trust Funds.................................................... 4,243 6,854 6,854 +2,611 ...............
Youth Employment and Training...................................... 38,691 39,333 39,333 +642 ...............
Employment Security................................................ 6,009 5,997 5,997 -12 ...............
Trust Funds.................................................... 47,596 58,634 54,230 +6,634 -4,404
Apprenticeship Services............................................ 20,699 20,932 20,932 +233 ...............
Executive Direction................................................ 8,230 8,469 8,469 +239 ...............
Trust Funds.................................................... 2,037 2,053 2,053 +16 ...............
Welfare to Work.................................................... 4,680 2,393 2,393 -2,287 ...............
------------------------------------------------------------------------------------
Subtotal, Program Administration............................. 174,511 183,365 178,961 +4,450 -4,404
Federal Funds............................................ 120,635 115,824 115,824 -4,811 ...............
Trust Funds.............................................. 53,876 67,541 63,137 +9,261 -4,404
====================================================================================
Total, Employment and Training Administration................ 10,847,559 11,027,534 11,162,607 +315,048 +135,073
Federal Funds............................................ 7,340,822 7,457,662 7,621,438 +280,616 +163,776
Current Year......................................... (4,877,822) (4,994,662) (5,158,438) (+280,616) (+163,776)
Fiscal year 2005..................................... (2,463,000) (2,463,000) (2,463,000) ............... ...............
Trust Funds.............................................. 3,506,737 3,569,872 3,541,169 +34,432 -28,703
EMPLOYEE BENEFITS SECURITY ADMINISTRATION
Enforcement and Compliance......................................... 91,526 106,679 100,000 +8,474 -6,679
Policy, Regulation and Public Service.............................. 20,441 17,385 17,000 -3,441 -385
Program Oversight.................................................. 4,316 4,541 4,316 ............... -225
------------------------------------------------------------------------------------
Total, EBSA.................................................. 116,283 128,605 121,316 +5,033 -7,289
PENSION BENEFIT GUARANTY CORPORATION
Program Adm. subject to limitation (TF)............................ 12,965 16,553 16,553 +3,588 ...............
Termination services not subject to limitation (NA)................ (179,844) (212,219) (212,219) (+32,375) ...............
------------------------------------------------------------------------------------
Total, PBGC.................................................. 12,965 16,553 16,553 +3,588 ...............
Total, PBGC (Program level).................................. (192,809) (228,772) (228,772) (+35,963) ...............
EMPLOYMENT STANDARDS ADMINISTRATION
SALARIES AND EXPENSES
Enforcement of Wage and Hour Standards............................. 155,867 161,294 161,294 +5,427 ...............
Office of Labor-Management Standards............................... 34,279 40,631 37,119 +2,840 -3,512
Federal Contractor EEO Standards Enforcement....................... 78,033 80,043 80,043 +2,010 ...............
Federal Programs for Workers' Compensation......................... 96,692 98,161 96,692 ............... -1,469
Trust Funds.................................................... 2,016 2,056 2,016 ............... -40
Program Direction and Support...................................... 14,226 15,568 14,897 +671 -671
------------------------------------------------------------------------------------
Total, ESA salaries and expenses............................. 381,113 397,753 392,061 +10,948 -5,692
Federal Funds............................................ 379,097 395,697 390,045 +10,948 -5,652
Trust Funds.............................................. 2,016 2,056 2,016 ............... -40
SPECIAL BENEFITS
Federal employees compensation benefits............................ 160,000 160,000 160,000 ............... ...............
Longshore and harbor workers' benefits............................. 3,000 3,000 3,000 ............... ...............
------------------------------------------------------------------------------------
Total, Special Benefits...................................... 163,000 163,000 163,000 ............... ...............
SPECIAL BENEFITS FOR DISABLED COAL MINERS \2\
Benefit payments................................................... 402,089 390,848 390,848 -11,241 ...............
Administration..................................................... 6,088 6,152 6,152 +64 ...............
------------------------------------------------------------------------------------
Subtotal, Black Lung, fiscal year 2004 program level......... 408,177 397,000 397,000 -11,177 ...............
Less funds advanced in prior year........................ -108,000 -97,000 -97,000 +11,000 ...............
------------------------------------------------------------------------------------
Total, Black Lung, current request, fiscal year 2004......... 300,177 300,000 300,000 -177 ...............
New advances, 1st quarter fiscal year 2005............... 97,000 88,000 88,000 -9,000 ...............
------------------------------------------------------------------------------------
Total, Special Benefits for Disabled Coal Miners............. 397,177 388,000 388,000 -9,177 ...............
ENERGY EMPLOYEES OCCUPATIONAL ILLNESS COMPENSATION FUND
Program Benefits................................................... (758,000) (385,000) (385,000) (-373,000) ...............
Administrative Expenses............................................ 104,867 55,074 55,074 -49,793 ...............
------------------------------------------------------------------------------------
Total, Energy Emp Occupational Illness Comp Fund............. 104,867 55,074 55,074 -49,793 ...............
BLACK LUNG DISABILITY TRUST FUND
Benefit payments and interest on advances.......................... 979,371 986,901 986,901 +7,530 ...............
Employment Standards Adm. S&E...................................... 31,987 32,004 32,004 +17 ...............
Departmental Management S&E........................................ 22,952 23,401 23,401 +449 ...............
Departmental Management, Inspector General......................... 334 338 338 +4 ...............
------------------------------------------------------------------------------------
Subtotal, Black Lung Disability.............................. 1,034,644 1,042,644 1,042,644 +8,000 ...............
Treasury Adm. Costs................................................ 356 356 356 ............... ...............
------------------------------------------------------------------------------------
Total, Black Lung Disability Trust Fund...................... 1,035,000 1,043,000 1,043,000 +8,000 ...............
====================================================================================
Total, Employment Standards Administration................... 2,081,157 2,046,827 2,041,135 -40,022 -5,692
Federal Funds............................................ 2,079,141 2,044,771 2,039,119 -40,022 -5,652
Current year......................................... 1,982,141 1,956,771 1,951,119 -31,022 -5,652
Fiscal year 2005..................................... 97,000 88,000 88,000 -9,000 ...............
Trust Funds.............................................. 2,016 2,056 2,016 ............... -40
OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION
SALARIES AND EXPENSES
Safety and Standards............................................... 16,014 14,497 16,494 +480 +1,997
Federal Enforcement................................................ 162,973 165,281 167,862 +4,889 +2,581
State Programs..................................................... 90,547 91,747 93,263 +2,716 +1,516
Technical Support.................................................. 20,102 21,721 21,721 +1,619 ...............
Compliance Assistance:
Federal Assistance............................................. 61,321 67,447 67,447 +6,126 ...............
State Consultation Grants...................................... 53,204 52,521 53,204 ............... +683
Training Grants................................................ 11,102 4,000 11,175 +73 +7,175
------------------------------------------------------------------------------------
Subtotal, Compliance Assistance.............................. 125,627 123,968 131,826 +6,199 +7,858
Safety and Health Statistics....................................... 25,894 22,369 22,369 -3,525 ...............
Executive Direction and Administration............................. 9,153 10,425 9,789 +636 -636
====================================================================================
Total, OSHA.................................................. 450,310 450,008 463,324 +13,014 +13,316
MINE SAFETY AND HEALTH ADMINISTRATION
SALARIES AND EXPENSES
Coal Enforcement................................................... 118,877 113,424 117,396 -1,481 +3,972
Metal/Non-Metal Enforcement........................................ 63,495 66,377 66,377 +2,882 ...............
Standards Development.............................................. 2,363 2,301 2,379 +16 +78
Assessments........................................................ 4,854 4,125 4,264 -590 +139
Educational Policy and Development................................. 27,733 30,536 30,536 +2,803 ...............
Technical Support.................................................. 28,489 24,691 24,691 -3,798 ...............
Program evaluation and information resources (PEIR)................ ............... 14,168 13,923 +13,923 -245
Program Administration............................................. 17,210 11,145 11,145 -6,065 ...............
Mine Mapping....................................................... 9,935 ............... ............... -9,935 ...............
------------------------------------------------------------------------------------
Total, Mine Safety and Health Administration................. 272,956 266,767 270,711 -2,245 +3,944
BUREAU OF LABOR STATISTICS
SALARIES AND EXPENSES
Employment and Unemployment Statistics............................. 147,330 149,605 156,515 +9,185 +6,910
Labor Market Information (Trust Funds)............................. 71,561 75,110 75,110 +3,549 ...............
Prices and Cost of Living.......................................... 159,671 167,602 167,602 +7,931 ...............
Compensation and Working Conditions................................ 75,925 80,169 76,285 +360 -3,884
Productivity and Technology........................................ 9,860 10,404 10,339 +479 -65
Executive Direction and Staff Services............................. 27,886 29,372 29,372 +1,486 ...............
------------------------------------------------------------------------------------
Total, Bureau of Labor Statistics............................ 492,233 512,262 515,223 +22,990 +2,961
Federal Funds............................................ 420,672 437,152 440,113 +19,441 +2,961
Trust Funds.............................................. 71,561 75,110 75,110 +3,549 ...............
OFFICE OF DISABILITY EMPLOYMENT POLICY
Office of Disability Employment Policy............................. 47,178 47,333 47,333 +155 ...............
DEPARTMENTAL MANAGEMENT
SALARIES AND EXPENSES
Executive Direction................................................ 26,296 28,260 26,296 ............... -1,964
Departmental IT Crosscut........................................... 51,142 48,565 48,565 -2,577 ...............
Departmental Management Crosscut................................... 3,500 23,500 10,000 +6,500 -13,500
Legal Services..................................................... 77,175 81,975 80,000 +2,825 -1,975
Trust Funds.................................................... 308 317 314 +6 -3
International Labor Affairs........................................ 147,053 12,270 108,000 -39,053 +95,730
Administration and Management...................................... 33,673 32,391 32,391 -1,282 ...............
Adjudication....................................................... 25,306 26,315 25,800 +494 -515
Women's Bureau..................................................... 9,608 8,626 8,926 -682 +300
Civil Rights Activities............................................ 5,930 6,158 6,158 +228 ...............
Chief Financial Officer............................................ 7,850 5,159 5,159 -2,691 ...............
------------------------------------------------------------------------------------
Total, Salaries and expenses................................. 387,841 273,536 351,609 -36,232 +78,073
Federal Funds............................................ 387,533 273,219 351,295 -36,238 +78,076
Trust Funds.............................................. 308 317 314 +6 -3
VETERANS EMPLOYMENT AND TRAINING
State Administration:
Grants......................................................... ............... 162,415 ............... ............... -162,415
Disabled Veterans Outreach Program............................. 82,078 ............... 83,481 +1,403 +83,481
Local Veterans Employment Program.............................. 77,744 ............... 78,934 +1,190 +78,934
------------------------------------------------------------------------------------
Subtotal, State Administration............................... 159,822 162,415 162,415 +2,593 ...............
Federal Administration............................................. 27,489 29,028 29,028 +1,539 ...............
National Veterans Training Institute............................... ............... 2,000 2,000 +2,000 ...............
Homeless Veterans Program.......................................... 18,131 19,000 19,000 +869 ...............
Veterans Workforce Investment Programs............................. 7,377 7,550 7,550 +173 ...............
------------------------------------------------------------------------------------
Total, Veterans Employment and Training...................... 212,819 219,993 219,993 +7,174 ...............
Federal Funds............................................ 25,508 26,550 26,550 +1,042 ...............
Trust Funds.............................................. 187,311 193,443 193,443 +6,132 ...............
OFFICE OF THE INSPECTOR GENERAL
Program Activities................................................. 56,291 60,896 59,291 +3,000 -1,605
Trust Funds.................................................... 5,561 5,899 5,561 ............... -338
------------------------------------------------------------------------------------
Total, Office of the Inspector General....................... 61,852 66,795 64,852 +3,000 -1,943
Federal funds............................................ 56,291 60,896 59,291 +3,000 -1,605
Trust funds.............................................. 5,561 5,899 5,561 ............... -338
====================================================================================
Total, Departmental Management............................... 662,512 560,324 636,454 -26,058 +76,130
Federal Funds............................................ 469,332 360,665 437,136 -32,196 +76,471
Trust Funds.............................................. 193,180 199,659 199,318 +6,138 -341
WORKING CAPITAL FUND
Working capital fund............................................... ............... 20,000 9,700 +9,700 -10,300
====================================================================================
Total, Title I, Department of Labor.......................... 14,983,153 15,076,213 15,284,356 +301,203 +208,143
Federal Funds............................................ 11,196,694 11,212,963 11,450,190 +253,496 +237,227
Current Year......................................... (8,636,694) (8,661,963) (8,899,190) (+262,496) (+237,227)
Fiscal year 2005..................................... (2,560,000) (2,551,000) (2,551,000) (-9,000) ...............
Trust Funds.............................................. 3,786,459 3,863,250 3,834,166 +47,707 -29,084
TITLE II--DEPARTMENT OF HEALTH AND HUMAN SERVICES
HEALTH RESOURCES AND SERVICES ADMINISTRATION
HEALTH RESOURCES AND SERVICES
Community health centers........................................... 1,504,806 1,627,164 1,627,164 +122,358 ...............
Free Clinics Medical Malpractice................................... ............... ............... 10,000 +10,000 +10,000
National Health Service Corps:
Field placements............................................... 45,948 45,305 45,948 ............... +643
Recruitment.................................................... 125,140 167,542 125,140 ............... -42,402
------------------------------------------------------------------------------------
Subtotal, National Health Service Corps...................... 171,088 212,847 171,088 ............... -41,759
Health Professions
Consolidated Health Professions.................................... ............... ............... 423,765 +423,765 +423,765
Training for Diversity:
Centers of excellence.......................................... 34,088 ............... ............... -34,088 ...............
Health careers opportunity program............................. 36,152 ............... ............... -36,152 ...............
Faculty loan repayment......................................... 1,321 ............... ............... -1,321 ...............
Scholarships for disadvantaged students........................ 47,795 9,900 ............... -47,795 -9,900
------------------------------------------------------------------------------------
Subtotal, Training for Diversity............................. 119,356 9,900 ............... -119,356 -9,900
Training in Primary Care Medicine and Dentistry.................... 92,432 ............... ............... -92,432 ...............
Interdisciplinary Community-Based Linkages:
Area health education centers.................................. 33,141 ............... ............... -33,141 ...............
Health education and training centers.......................... 4,371 ............... ............... -4,371 ...............
Allied health and other disciplines............................ 11,922 ............... ............... -11,922 ...............
Geriatric programs............................................. 27,818 ............... ............... -27,818 ...............
Quentin N. Burdick program for rural training.................. 6,954 ............... ............... -6,954 ...............
------------------------------------------------------------------------------------
Subtotal, Interdisciplinary Comm. Linkages................... 84,206 ............... ............... -84,206 ...............
Health Professions Workforce Info & Analysis....................... 819 1,000 ............... -819 -1,000
Public Health Workforce Development:
Public health, preventive med. & dental pgms................... 10,405 ............... ............... -10,405 ...............
Health administration programs................................. 1,222 ............... ............... -1,222 ...............
------------------------------------------------------------------------------------
Subtotal, Public Health Workforce Development................ 11,627 ............... ............... -11,627 ...............
Nursing Programs:
Advanced Education Nursing..................................... 50,174 26,548 ............... -50,174 -26,548
Nurse education, practice, and retention....................... 26,824 24,202 ............... -26,824 -24,202
Nursing workforce diversity.................................... 9,935 20,564 ............... -9,935 -20,564
Loan repayment and scholarship program......................... 19,870 26,900 ............... -19,870 -26,900
Comprehensive geriatric education.............................. 2,980 ............... ............... -2,980 ...............
Nursing faculty loan program................................... 2,980 ............... ............... -2,980 ...............
------------------------------------------------------------------------------------
Subtotal, Nursing programs................................... 112,763 98,214 ............... -112,763 -98,214
Childrens Hospital Graduate Medical Education...................... 290,102 199,258 ............... -290,102 -199,258
====================================================================================
Subtotal, Health Professions................................. 711,305 308,372 423,765 -287,540 +115,393
Other HRSA Programs:
Hansen's Disease Services...................................... 18,024 17,570 17,570 -454 ...............
Maternal & Child Health Block Grant............................ 729,965 750,831 731,565 +1,600 -19,266
Abstinence Education........................................... 54,642 73,044 73,044 +18,402 ...............
Healthy Start.................................................. 98,346 98,729 98,346 ............... -383
Universal Newborn Hearing...................................... 9,935 ............... 9,935 ............... +9,935
Organ Transplantation.......................................... 24,828 24,924 24,828 ............... -96
Cord Blood Stem Cell Bank...................................... ............... ............... 10,000 +10,000 +10,000
Bone Marrow Program............................................ 21,891 22,013 21,891 ............... -122
Rural outreach grants.......................................... 58,410 37,752 39,850 -18,560 +2,098
Rural Health Research.......................................... 10,630 5,984 9,935 -695 +3,951
Telehealth..................................................... 26,686 5,594 3,973 -22,713 -1,621
Rural Hospital Flexibility Grants.............................. 39,740 29,921 39,740 ............... +9,819
Rural Access to Emergency Devices.............................. 12,419 2,009 8,000 -4,419 +5,991
State Offices of Rural Health.................................. 8,445 3,990 8,445 ............... +4,455
Denali Commission.............................................. 27,321 ............... 40,000 +12,679 +40,000
Emergency medical services for children........................ 19,373 ............... 20,000 +627 +20,000
Poison control................................................. 22,354 ............... 22,354 ............... +22,354
Traumatic Brain Injury......................................... 9,438 7,479 9,438 ............... +1,959
Black lung clinics............................................. 5,961 6,000 6,000 +39 ...............
Trauma Care.................................................... 3,476 ............... 3,476 ............... +3,476
Payment to Hawaii, treatment of Hansen's....................... 2,032 2,045 2,045 +13 ...............
====================================================================================
Other HRSA programs--Current Year............................ 1,203,916 1,087,885 1,200,435 -3,481 +112,550
Ryan White AIDS Programs:
Emergency Assistance........................................... 618,693 618,881 618,693 ............... -188
Comprehensive Care Programs.................................... 1,053,393 1,077,027 1,077,027 +23,634 ...............
AIDS Drug Assistance Program (ADAP) (NA)................... (714,326) (739,000) (739,000) (+24,674) ...............
Early Intervention Program..................................... 198,374 193,981 198,374 ............... +4,393
Pediatric HIV/AIDS............................................. 73,551 70,917 73,551 ............... +2,634
AIDS Dental Services........................................... 13,405 13,484 13,405 ............... -79
Education and Training Centers................................. 35,549 35,259 35,549 ............... +290
------------------------------------------------------------------------------------
Subtotal, Ryan White AIDS programs........................... 1,992,965 2,009,549 2,016,599 +23,634 +7,050
Evaluation Tap Funding (NA).................................... (25,000) ............... (25,000) ............... (+25,000)
------------------------------------------------------------------------------------
Subtotal, Ryan White AIDS program level...................... 2,017,965 2,009,549 2,041,599 +23,634 +32,050
Family Planning.................................................... 273,350 264,808 283,350 +10,000 +18,542
Health Care and Other Facilities................................... 294,700 ............... ............... -294,700 ...............
Buildings and Facilities........................................... 248 250 248 ............... -2
Radiation Exposure Compensation Act................................ 1,987 4,006 1,987 ............... -2,019
National Practitioner Data Bank.................................... 19,500 17,000 17,000 -2,500 ...............
User Fees...................................................... -19,500 -17,000 -17,000 +2,500 ...............
Health Care Integrity and Protection Data Bank..................... 5,600 4,000 4,000 -1,600 ...............
User Fees...................................................... -5,600 -4,000 -4,000 +1,600 ...............
Community Access Program........................................... 119,219 ............... ............... -119,219 ...............
Program Management................................................. 156,974 151,115 146,686 -10,288 -4,429
====================================================================================
Total, Health resources and services......................... 6,430,558 5,665,996 5,881,322 -549,236 +215,326
Total, Health resources & services program level............. 6,455,558 5,665,996 5,906,322 -549,236 +240,326
HEALTH EDUCATION ASSISTANCE LOANS (HEAL) PROGRAM:
Liquidating account............................................ (7,000) (4,000) (4,000) (-3,000) ...............
Program management............................................. 3,889 3,389 3,389 -500 ...............
------------------------------------------------------------------------------------
Total, HEAL.................................................. 3,889 3,389 3,389 -500 ...............
VACCINE INJURY COMPENSATION PROGRAM TRUST FUND:
Post-fiscal year 1988 claims................................... 85,918 66,000 66,000 -19,918 ...............
HRSA administration............................................ 2,972 2,991 2,972 ............... -19
------------------------------------------------------------------------------------
Total, Vaccine Injury Compensation Trust Fund................ 88,890 68,991 68,972 -19,918 -19
====================================================================================
Total, Health Resources and Services Admin................... 6,523,337 5,738,376 5,953,683 -569,654 +215,307
Total, HRSA program level.................................... 6,555,337 5,742,376 5,982,683 -572,654 +240,307
CENTERS FOR DISEASE CONTROL
Birth Defects/Developmental Disabilities/Disability and Health..... 98,040 87,462 110,639 +12,599 +23,177
Chronic Disease Prevention and Health Promotion.................... 789,972 834,047 801,844 +11,872 -32,203
Environmental Health............................................... 182,829 150,227 184,329 +1,500 +34,102
Epidemic Services and Response..................................... 77,494 76,158 127,494 +50,000 +51,336
Health Statistics.................................................. ............... 72,639 ............... ............... -72,639
Evaluation Tap Funding......................................... (125,899) (51,982) (127,634) (+1,735) (+75,652)
------------------------------------------------------------------------------------
Program level................................................ 125,899 124,621 127,634 +1,735 +3,013
HIV/AIDS, STD and TB Prevention.................................... 1,186,388 1,281,176 1,239,388 +53,000 -41,788
Immunization....................................................... 636,586 620,506 641,686 +5,100 +21,180
Evaluation Tap Funding......................................... (14,000) ............... (14,000) ............... (+14,000)
------------------------------------------------------------------------------------
Program level................................................ 650,586 620,506 655,686 +5,100 +35,180
Infectious Disease Control......................................... 359,225 331,640 372,760 +13,535 +41,120
Injury Prevention and Control...................................... 148,414 144,796 152,409 +3,995 +7,613
Occupational Safety and Health \3\................................. 231,485 246,329 240,485 +9,000 -5,844
Evaluation Tap Funding......................................... (41,900) ............... (41,900) ............... (+41,900)
------------------------------------------------------------------------------------
Program level................................................ 273,385 246,329 282,385 +9,000 +36,056
Preventive Health and Health Services Block Grant.................. 134,089 134,966 134,966 +877 ...............
Public Health Improvement.......................................... 124,434 113,677 116,789 -7,645 +3,112
Evaluation Tap Funding......................................... (28,600) ............... (28,600) ............... (+28,600)
------------------------------------------------------------------------------------
Program level................................................ 153,034 113,677 145,389 -7,645 +31,712
Buildings and Facilities........................................... 266,258 114,000 250,000 -16,258 +136,000
Office of the Director............................................. 49,426 59,707 59,707 +10,281 ...............
------------------------------------------------------------------------------------
Total, Centers for Disease Control........................... 4,284,640 4,267,330 4,432,496 +147,856 +165,166
Evaluation Tap Funding (NA).............................. (210,399) (51,982) (212,134) (+1,735) (+160,152)
Total, Centers for Disease Control program level............. 4,495,039 4,319,312 4,644,630 +149,591 +325,318
NATIONAL INSTITUTES OF HEALTH
National Cancer Institute.......................................... 4,592,348 4,770,519 4,770,519 +178,171 ...............
National Heart, Lung, and Blood Institute.......................... 2,793,733 2,867,995 2,897,595 +103,862 +29,600
National Institute of Dental & Craniofacial Research............... 371,636 382,396 386,396 +14,760 +4,000
National Institute of Diabetes and Digestive and Kidney Diseases... 1,622,730 1,670,007 1,683,007 +60,277 +13,000
Juvenile diabetes.............................................. (100,000) (150,000) (150,000) (+50,000) ...............
------------------------------------------------------------------------------------
Subtotal, NIDDK.............................................. 1,722,730 1,820,007 1,833,007 +110,277 +13,000
National Institute of Neurological Disorders & Stroke.............. 1,456,476 1,468,926 1,510,926 +54,450 +42,000
National Institute of Allergy and Infectious Diseases.............. 3,606,139 4,235,255 4,185,255 +579,116 -50,000
Global HIV/AIDS Fund Transfer \4\.............................. 100,000 100,000 150,000 +50,000 +50,000
------------------------------------------------------------------------------------
Subtotal, NIAID.............................................. 3,706,139 4,335,255 4,335,255 +629,116 ...............
National Institute of General Medical Sciences..................... 1,847,000 1,923,133 1,917,033 +70,033 -6,100
National Institute of Child Health & Human Development............. 1,205,927 1,245,371 1,251,185 +45,258 +5,814
National Eye Institute............................................. 633,148 648,299 657,199 +24,051 +8,900
National Institute of Environmental Health Sciences................ 614,239 630,774 637,074 +22,835 +6,300
NIEHS/Superfund (NA)........................................... (76,074) ............... ............... (-76,074) ...............
National Institute on Aging........................................ 993,598 994,411 1,031,411 +37,813 +37,000
National Institute of Arthritis and Musculoskeletal and Skin 486,143 502,778 505,000 +18,857 +2,222
Diseases..........................................................
National Institute on Deafness and Other Communication Disorders... 370,382 380,377 384,577 +14,195 +4,200
National Institute of Nursing Research............................. 130,584 134,579 135,579 +4,995 +1,000
National Institute on Alcohol Abuse and Alcoholism................. 416,051 430,121 431,521 +15,470 +1,400
National Institute on Drug Abuse................................... 961,721 995,614 997,614 +35,893 +2,000
National Institute of Mental Health................................ 1,341,014 1,382,114 1,391,114 +50,100 +9,000
National Human Genome Research Institute........................... 464,995 478,072 482,372 +17,377 +4,300
National Institute of Biomedical Imaging and Bioengineering........ 278,279 282,109 289,300 +11,021 +7,191
National Center for Research Resources............................. 1,138,821 1,053,926 1,186,483 +47,662 +132,557
National Center for Complementary and Alternative Medicine......... 113,407 116,202 117,902 +4,495 +1,700
National Center on Minority Health and Health Disparities.......... 185,714 192,724 192,824 +7,110 +100
John E. Fogarty International Center............................... 63,465 64,266 65,900 +2,435 +1,634
National Library of Medicine....................................... 300,135 316,040 311,835 +11,700 -4,205
Evaluation Tap Funding......................................... (8,200) ............... (8,200) ............... (+8,200)
------------------------------------------------------------------------------------
Subtotal, NLM................................................ 308,335 316,040 320,035 +11,700 +3,995
Office of the Director............................................. 266,232 317,983 323,483 +57,251 +5,500
Buildings and Facilities........................................... 628,687 80,000 89,500 -539,187 +9,500
====================================================================================
Total, N.I.H. appropriations................................. 26,982,604 27,663,991 27,982,604 +1,000,000 +318,613
Global HIV/AIDS Fund Transfer............................ -100,000 -100,000 -150,000 -50,000 -50,000
Evaluation Tap Funding................................... (8,200) ............... (8,200) ............... (+8,200)
------------------------------------------------------------------------------------
Total, N.I.H., Program Level................................. (26,890,804) (27,563,991) (27,840,804) (+950,000) (+276,813)
SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES
Mental Health:
Programs of Regional and National Significance................. 244,443 211,757 237,667 -6,776 +25,910
Mental Health Performance Partnership.......................... 437,140 433,000 415,290 -21,850 -17,710
Evaluation Tap Funding......................................... ............... ............... (21,850) (+21,850) (+21,850)
Children's Mental Health....................................... 98,052 106,694 98,052 ............... -8,642
Grants to States for the Homeless (PATH)....................... 43,073 50,055 47,073 +4,000 -2,982
Protection and Advocacy........................................ 33,779 32,500 35,779 +2,000 +3,279
------------------------------------------------------------------------------------
Subtotal, Mental Health...................................... 856,487 834,006 833,861 -22,626 -145
Subtotal, Mental Health (program level)...................... 856,487 834,006 855,711 -776 +21,705
Substance Abuse Treatment:
Programs of Regional and National Significance................. 317,278 556,816 327,071 +9,793 -229,745
Substance Abuse Performance Partnership........................ 1,691,732 1,785,000 1,724,732 +33,000 -60,268
Evaluation Tap Funding......................................... (62,200) ............... (79,200) (+17,000) (+79,200)
------------------------------------------------------------------------------------
Subtotal, Substance Abuse Treatment.......................... 2,009,010 2,341,816 2,051,803 +42,793 -290,013
------------------------------------------------------------------------------------
Program level............................................ 2,071,210 2,341,816 2,131,003 +59,793 -210,813
Substance Abuse Prevention:
Programs of Regional and National Significance................. 197,111 148,186 194,306 -2,805 +46,120
Program Management and Buildings and Facilities................ 73,983 69,307 77,570 +3,587 +8,263
Evaluation Tap funding (NA).................................... (12,000) (16,000) (16,000) (+4,000) ...............
------------------------------------------------------------------------------------
Program level................................................ 85,983 85,307 93,570 +7,587 +8,263
St. Elizabeths..................................................... 949 ............... ............... -949 ...............
====================================================================================
Total, Substance Abuse and Mental Health..................... 3,137,540 3,393,315 3,157,540 +20,000 -235,775
Evaluation Tap funding................................... 74,200 16,000 117,050 +42,850 +101,050
Total, SAMHS program level................................... (3,211,740) (3,409,315) (3,274,590) (+62,850) (-134,725)
AGENCY FOR HEALTHCARE RESEARCH AND QUALITY
Research on Health Costs, Quality, and Outcomes:
Federal Funds.................................................. ............... ............... ............... ............... ...............
Evaluation Tap funding (NA).................................... (247,695) (221,000) (245,695) (-2,000) (+24,695)
Health Coverage Data Improvement (CPS)..................... ............... (10,000) ............... ............... (-10,000)
Portion for reducing medical errors (non-add).............. (55,000) (84,000) (84,000) (+29,000) ...............
------------------------------------------------------------------------------------
Subtotal including Evaluation Tap funds.................. (247,695) (221,000) (245,695) (-2,000) (+24,695)
Health Insurance and Expenditure Surveys:
Federal Funds.................................................. ............... ............... ............... ............... ...............
Evaluation Tap funding (NA).................................... (53,300) (55,300) (55,300) (+2,000) ...............
Program Support.................................................... ............... ............... ............... ............... ...............
Evaluation Tap funding (NA).................................... (2,700) (2,700) (2,700) ............... ...............
------------------------------------------------------------------------------------
Total, AHRQ.................................................. (303,695) (279,000) (303,695) ............... (+24,695)
Federal Funds............................................ ............... ............... ............... ............... ...............
Evaluation Tap funding (NA).............................. (303,695) (279,000) (303,695) ............... (+24,695)
====================================================================================
Total, Public Health Service program level................... 41,456,615 41,313,994 42,046,402 +589,787 +732,408
Federal Funds............................................ 40,928,121 41,063,012 41,526,323 +598,202 +463,311
CENTERS FOR MEDICARE AND MEDICAID SERVICES
GRANTS TO STATES FOR MEDICAID
Medicaid current law benefits...................................... 148,726,168 166,706,067 166,706,067 +17,979,899 ...............
State and local administration..................................... 9,142,049 9,067,320 9,067,320 -74,729 ...............
Vaccines for Children.............................................. 823,938 980,196 980,196 +156,258 ...............
------------------------------------------------------------------------------------
Subtotal, Medicaid program level............................. 158,692,155 176,753,583 176,753,583 +18,061,428 ...............
Less funds advanced in prior year........................ -46,601,937 -51,861,386 -51,861,386 -5,259,449 ...............
------------------------------------------------------------------------------------
Total, Grants to states for medicaid......................... 112,090,218 124,892,197 124,892,197 +12,801,979 ...............
New advance, 1st quarter................................. 51,861,386 58,416,275 58,416,275 +6,554,889 ...............
PAYMENTS TO HEALTH CARE TRUST FUNDS
Supplemental medical insurance..................................... 80,905,000 94,518,000 94,518,000 +13,613,000 ...............
Hospital insurance for the uninsured............................... 225,000 197,000 197,000 -28,000 ...............
Federal uninsured payment.......................................... 168,000 168,000 168,000 ............... ...............
Program management................................................. 164,700 201,100 201,100 +36,400 ...............
------------------------------------------------------------------------------------
Total, Payments to Trust Funds, current law.................. 81,462,700 95,084,100 95,084,100 +13,621,400 ...............
PROGRAM MANAGEMENT
Research, Demonstration, Evaluation: Regular Program............... 73,712 63,400 67,400 -6,312 +4,000
Medicare Operations................................................ 1,666,680 1,776,889 1,776,889 +110,209 ...............
H.R. 3103 funding (NA)......................................... (720,000) (720,000) (720,000) ............... ...............
------------------------------------------------------------------------------------
Subtotal, Medicare Operations program level.................. (2,386,680) (2,496,889) (2,496,889) (+110,209) ...............
Revitalization plan................................................ ............... 65,000 30,000 +30,000 -35,000
State Survey and Certification..................................... 252,743 247,647 252,743 ............... +5,096
Federal Administration............................................. 571,756 580,571 580,571 +8,815 ...............
====================================================================================
Total, Program management, Limitation on new BA.............. 2,564,891 2,733,507 2,707,603 +142,712 -25,904
Total, Program management, program level..................... (3,284,891) (3,453,507) (3,427,603) (+142,712) (-25,904)
====================================================================================
Total, Center for Medicare and Medicaid Services............. 247,979,195 281,126,079 281,100,175 +33,120,980 -25,904
Federal funds............................................ 245,414,304 278,392,572 278,392,572 +32,978,268 ...............
Current year......................................... (193,552,918) (219,976,297) (219,976,297) (+26,423,379) ...............
New advance, 1st quarter, fiscal year 2005........... (51,861,386) (58,416,275) (58,416,275) (+6,554,889) ...............
Trust Funds.............................................. 2,564,891 2,733,507 2,707,603 +142,712 -25,904
ADMINISTRATION FOR CHILDREN AND FAMILIES
PAYMENTS TO STATES FOR CHILD SUPPORT AND FAMILY SUPPORT PROGRAMS
Payments to territories............................................ 23,000 23,000 23,000 ............... ...............
Repatriation....................................................... 1,000 1,000 1,000 ............... ...............
------------------------------------------------------------------------------------
Subtotal, Welfare payments................................... 24,000 24,000 24,000 ............... ...............
Child Support Enforcement:
State and local administration................................. 3,541,800 4,035,270 4,084,270 +542,470 +49,000
Federal incentive payments..................................... 461,000 454,000 454,000 -7,000 ...............
Hold Harmless payments......................................... ............... ............... ............... ............... ...............
Access and visitation.......................................... 10,000 12,000 10,000 ............... -2,000
------------------------------------------------------------------------------------
Subtotal, Child Support Enforcement.......................... 4,012,800 4,501,270 4,548,270 +535,470 +47,000
====================================================================================
Total, Payments, fiscal year 2004 program level.............. 4,036,800 4,525,270 4,572,270 +535,470 +47,000
Less funds advanced in previous years.................... -1,100,000 -1,100,000 -1,100,000 ............... ...............
------------------------------------------------------------------------------------
Total, Payments, current request............................. 2,936,800 3,425,270 3,472,270 +535,470 +47,000
Plus New advance, 1st quarter, fiscal year 2005.......... 1,100,000 1,200,000 1,200,000 +100,000 ...............
LOW INCOME HOME ENERGY ASSISTANCE
Formula grants..................................................... 1,688,950 1,700,000 2,000,000 +311,050 +300,000
Emergency allocation:
Non-emergency funding.......................................... ............... 300,000 ............... ............... -300,000
Contingent emergency funding................................... ............... ............... ............... ............... ...............
------------------------------------------------------------------------------------
Total, Low income home energy assistance..................... 1,688,950 2,000,000 2,000,000 +311,050 ...............
REFUGEE AND ENTRANT ASSISTANCE
Transitional and Medical Services.................................. 219,853 200,193 180,000 -39,853 -20,193
Victims of Trafficking............................................. 9,935 10,000 9,935 ............... -65
Social Services.................................................... 150,139 153,121 140,000 -10,139 -13,121
Preventive Health.................................................. 4,804 4,835 4,804 ............... -31
Targeted Assistance................................................ 49,155 49,477 49,155 ............... -322
Unaccompanied minors............................................... 34,227 34,000 34,227 ............... +227
Victims of Torture................................................. 9,935 10,000 9,935 ............... -65
------------------------------------------------------------------------------------
Total, Refugee and entrant assistance........................ 478,048 461,626 428,056 -49,992 -33,570
CHILD CARE AND DEVELOPMENT BLOCK GRANT............................. 2,086,344 2,099,729 2,099,729 +13,385 ...............
SOCIAL SERVICES BLOCK GRANT (TITLE XX)............................. 1,700,000 1,700,000 1,700,000 ............... ...............
CHILDREN AND FAMILIES SERVICES PROGRAMS
Programs for Children, Youth and Families:
Head Start, current funded..................................... 5,267,533 5,415,570 5,415,570 +148,037 ...............
Advance from prior year.................................... (1,400,000) (1,400,000) (1,400,000) ............... ...............
Fiscal year 2004........................................... 1,400,000 1,400,000 1,400,000 ............... ...............
------------------------------------------------------------------------------------
Subtotal, Head Start, program level...................... 6,667,533 6,815,570 6,815,570 +148,037 ...............
Consolidated Runaway, Homeless Youth Prog...................... 89,978 88,043 89,978 ............... +1,935
Maternity Group Homes.......................................... ............... 10,000 ............... ............... -10,000
Prevention grants to reduce abuse of runaway youth............. 15,399 14,999 15,399 ............... +400
Child Abuse State Grants....................................... 21,870 22,013 21,870 ............... -143
Child Abuse Discretionary Activities........................... 33,845 26,301 26,301 -7,544 ...............
Abandoned Infants Assistance................................... 12,126 12,086 12,126 ............... +40
Child Welfare Services......................................... 290,088 291,986 290,088 ............... -1,898
Child Welfare Training......................................... 7,449 7,470 7,449 ............... -21
Adoption Opportunities......................................... 27,227 27,343 27,227 ............... -116
Adoption Incentive (no cap adjustment)......................... 42,720 43,000 42,720 ............... -280
Adoption Awareness............................................. 12,822 12,906 12,822 ............... -84
Compassion Capital Fund........................................ 34,772 100,000 34,772 ............... -65,228
Social Services and Income Maintenance Research.................... 28,749 5,982 25,812 -2,937 +19,830
Evaluation tap funding......................................... (6,000) ............... (6,000) ............... (+6,000)
------------------------------------------------------------------------------------
Program level................................................ 34,749 5,982 31,812 -2,937 +25,830
Community Based Resource Centers................................... 33,200 33,403 33,200 ............... -203
Disabled voter services............................................ 15,000 ............... 15,000 ............... +15,000
Developmental Disabilities Program:
State Councils................................................. 71,135 69,800 73,515 +2,380 +3,715
Protection and Advocacy........................................ 36,263 35,000 38,644 +2,381 +3,644
Developmental Disabilities Special Projects.................... 12,403 11,642 11,642 -761 ...............
Developmental Disabilities University Affiliated............... 24,962 24,000 26,962 +2,000 +2,962
------------------------------------------------------------------------------------
Subtotal, Developmental disabilities......................... 144,763 140,442 150,763 +6,000 +10,321
Native American Programs........................................... 45,457 45,119 45,457 ............... +338
Community Services:
Grants to States for Community Services........................ 645,762 494,964 645,762 ............... +150,798
Community Initiative Program:
Economic Development....................................... 32,546 32,436 32,546 ............... +110
Individual Development Account Initiative.................. 24,828 24,912 24,828 ............... -84
Rural Community Facilities................................. 7,203 ............... 7,203 ............... +7,203
------------------------------------------------------------------------------------
Subtotal, Community Initiative Program................... 64,577 57,348 64,577 ............... +7,229
National Youth Sports.......................................... 16,889 ............... ............... -16,889 ...............
Community Food and Nutrition................................... 7,281 ............... 7,281 ............... +7,281
------------------------------------------------------------------------------------
Subtotal, Community Services................................. 734,509 552,312 717,620 -16,889 +165,308
Domestic Violence Hotline.......................................... 2,562 3,000 3,000 +438 ...............
Battered Women's Shelters.......................................... 126,403 124,423 126,403 ............... +1,980
Early Learning Fund................................................ 33,779 ............... 33,779 ............... +33,779
Faith-Based Center................................................. 1,490 1,400 1,400 -90 ...............
Mentoring Children of Prisoners.................................... 9,935 50,000 9,935 ............... -40,065
Independent Living Training Vouchers............................... 41,727 60,000 41,727 ............... -18,273
Promoting Responsible Fatherhood................................... ............... 20,000 ............... ............... -20,000
Program Direction.................................................. 171,873 179,584 179,584 +7,711 ...............
====================================================================================
Total, Children and Families Services Programs............... 8,645,276 8,687,382 8,780,002 +134,726 +92,620
Current Year............................................. (7,245,276) (7,287,382) (7,380,002) (+134,726) (+92,620)
Fiscal year 2005......................................... (1,400,000) (1,400,000) (1,400,000) ............... ...............
Evaluation Tap funding................................... 6,000 ............... 6,000 ............... +6,000
PROMOTING SAFE AND STABLE FAMILIES................................. 305,000 305,000 305,000 ............... ...............
Discretionary Funds............................................ 99,350 199,978 99,350 ............... -100,628
PAYMENTS TO STATES FOR FOSTER CARE AND ADOPTION
Foster Care........................................................ 4,884,500 4,974,200 4,974,200 +89,700 ...............
Adoption Assistance................................................ 1,584,500 1,699,700 1,699,700 +115,200 ...............
Independent living................................................. 140,000 140,000 140,000 ............... ...............
------------------------------------------------------------------------------------
Total, Payments to States.................................... 6,609,000 6,813,900 6,813,900 +204,900 ...............
Less Advances from Prior Year............................ -1,754,000 -1,745,600 -1,745,600 +8,400 ...............
------------------------------------------------------------------------------------
Total, payments, current request............................. 4,855,000 5,068,300 5,068,300 +213,300 ...............
New Advance, 1st quarter................................. 1,745,600 1,767,700 1,767,700 +22,100 ...............
====================================================================================
Total, Administration for Children & Families................ 25,640,368 26,914,985 26,920,407 +1,280,039 +5,422
Current year............................................. (21,394,768) (22,547,285) (22,552,707) (+1,157,939) (+5,422)
Fiscal year 2005......................................... (4,245,600) (4,367,700) (4,367,700) (+122,100) ...............
ADMINISTRATION ON AGING
Grants to States:
Supportive Services and Centers................................ 355,673 357,000 355,673 ............... -1,327
Preventive Health.............................................. 21,919 21,562 21,919 ............... +357
Title VII...................................................... 18,559 17,681 18,559 ............... +878
Family Caregivers.............................................. 149,025 141,500 149,025 ............... +7,525
Native American Caregivers Support............................. 6,209 ............... 6,209 ............... +6,209
------------------------------------------------------------------------------------
Subtotal, Caregivers......................................... 155,234 141,500 155,234 ............... +13,734
Nutrition:
Congregate Meals........................................... 384,592 390,000 387,292 +2,700 -2,708
Home Delivered Meals....................................... 180,985 178,500 180,985 ............... +2,485
Nutrition Services Incentive Program....................... 148,697 149,670 148,697 ............... -973
------------------------------------------------------------------------------------
Subtotal, Nutrition...................................... 714,274 718,170 716,974 +2,700 -1,196
------------------------------------------------------------------------------------
Subtotal, Grants to States............................... 1,265,659 1,255,913 1,268,359 +2,700 +12,446
Grants to Indians.................................................. 27,495 25,729 27,495 ............... +1,766
Aging Research, Training and Special Projects...................... 29,336 16,843 17,843 -11,493 +1,000
Aging Network Support Activities................................... 13,286 13,373 13,373 +87 ...............
Alzheimer's Initiative............................................. 13,412 11,500 12,412 -1,000 +912
White House Conference on Aging.................................... ............... 2,842 2,842 +2,842 ...............
Program Administration............................................. 17,869 17,501 17,869 ............... +368
------------------------------------------------------------------------------------
Total, Administration on Aging............................... 1,367,057 1,343,701 1,360,193 -6,864 +16,492
OFFICE OF THE SECRETARY
GENERAL DEPARTMENTAL MANAGEMENT:
Federal Funds.................................................. 159,811 172,541 168,106 +8,295 -4,435
Trust Funds.................................................... 5,813 5,851 5,851 +38 ...............
Evaluation tap funding (ASPE) (NA)............................. (21,552) (21,552) (21,552) ............... ...............
------------------------------------------------------------------------------------
Subtotal..................................................... (187,176) (199,944) (195,509) (+8,333) (-4,435)
Adolescent Family Life (Title XX).............................. 30,922 31,241 31,241 +319 ...............
Minority health................................................ 56,224 47,010 48,740 -7,484 +1,730
Office of Women's Health....................................... 28,658 28,908 29,721 +1,063 +813
Minority HIV/AIDS.............................................. 49,675 50,000 50,000 +325 ...............
IT Security and Innovation Fund................................ 19,870 18,400 15,000 -4,870 -3,400
------------------------------------------------------------------------------------
Total, General Departmental Management....................... 350,973 353,951 348,659 -2,314 -5,292
Federal Funds............................................ 345,160 348,100 342,808 -2,352 -5,292
Trust Funds.............................................. 5,813 5,851 5,851 +38 ...............
OFFICE OF THE INSPECTOR GENERAL:
Federal Funds.................................................. 36,808 39,497 39,497 +2,689 ...............
HIPAA funding (NA)......................................... (160,000) (160,000) (160,000) ............... ...............
------------------------------------------------------------------------------------
Total, Inspector General program level................... (196,808) (199,497) (199,497) (+2,689) ...............
OFFICE FOR CIVIL RIGHTS:
Federal Funds.................................................. 30,131 30,936 30,936 +805 ...............
Trust Funds.................................................... 3,292 3,314 3,314 +22 ...............
------------------------------------------------------------------------------------
Total, Office for Civil Rights............................... 33,423 34,250 34,250 +827 ...............
POLICY RESEARCH:
Federal Funds.................................................. 2,483 2,499 ............... -2,483 -2,499
Evaluation Tap funding (NA).................................... (18,000) (21,000) (23,499) (+5,499) (+2,499)
------------------------------------------------------------------------------------
Total, Policy Research....................................... 20,483 23,499 23,499 +3,016 ...............
MEDICAL BENEFITS FOR COMMISSIONED OFFICERS:
Retirement payments............................................ 218,984 234,000 234,000 +15,016 ...............
Survivors benefits............................................. 14,102 15,001 15,001 +899 ...............
Dependents' medical care....................................... 76,931 54,391 80,867 +3,936 +26,476
Military services credits...................................... ............... ............... ............... ............... ...............
Comm. Corps Medicare Elig. Healthcare Accrual.................. ............... 12,973 ............... ............... -12,973
------------------------------------------------------------------------------------
Total, Medical benefits for comm. officers................... 310,017 316,365 329,868 +19,851 +13,503
PUBLIC HEALTH AND SOCIAL SERVICE EMERGENCY FUND.................... 1,887,247 1,896,149 1,856,040 -31,207 -40,109
====================================================================================
Total, Office of the Secretary............................... 2,620,951 2,642,711 2,608,314 -12,637 -34,397
Federal Funds............................................ 2,611,846 2,633,546 2,599,149 -12,697 -34,397
Trust Funds.............................................. 9,105 9,165 9,165 +60 ...............
====================================================================================
Total, Title II, Dept of Health & Human Services............. 318,535,692 353,090,488 353,515,412 +34,979,720 +424,924
Federal Funds............................................ 315,961,696 350,347,816 350,798,644 +34,836,948 +450,828
Current year......................................... (259,854,710) (287,563,841) (288,014,669) (+28,159,959) (+450,828)
Fiscal year 2005..................................... (56,106,986) (62,783,975) (62,783,975) (+6,676,989) ...............
Trust Funds.............................................. 2,573,996 2,742,672 2,716,768 +142,772 -25,904
TITLE III--DEPARTMENT OF EDUCATION
EDUCATION FOR THE DISADVANTAGED
Grants to Local Educational Agencies (LEAs):
Basic Grants:
Advance from prior year................................... (4,011,272) (4,255,272) (2,011,272) (-2,000,000) (-2,244,000)
Forward funded............................................. 5,092,533 5,158,199 5,158,199 +65,666 ...............
Current funded............................................. 3,477 3,500 3,500 +23 ...............
------------------------------------------------------------------------------------
Subtotal, Basic grants current year approp............... 5,096,010 5,161,699 5,161,699 +65,689 ...............
Subtotal, Basic grants total funds available............. (9,107,282) (9,416,971) (7,172,971) (-1,934,311) (-2,244,000)
Basic Grants Fiscal Year 2005 Advance.......................... 2,011,272 2,011,272 1,945,583 -65,689 -65,689
------------------------------------------------------------------------------------
Subtotal, Basic grants, program level........................ 7,107,282 7,172,971 7,107,282 ............... -65,689
Concentration Grants:
Advance from prior year.................................... (1,365,031) (1,365,031) (1,365,031) ............... ...............
Fiscal Year 2005 Advance................................... 1,365,031 1,365,031 1,365,031 ............... ...............
------------------------------------------------------------------------------------
Subtotal, Concentration Grants program level............. 1,365,031 1,365,031 1,365,031 ............... ...............
Targeted Grants:
Advance from prior year.................................... (1,018,499) (1,670,239) (1,670,239) (+651,740) ...............
Fiscal Year 2005 Advance................................... 1,670,239 3,018,499 1,670,239 ............... -1,348,260
------------------------------------------------------------------------------------
Subtotal, Targeted Grants program level.................. 1,670,239 3,018,499 1,670,239 ............... -1,348,260
Education Finance Incentive Grants:
Advance from prior year.................................... (793,499) (1,541,759) (1,541,759) (+748,260) ...............
Fiscal Year 2005 Advance................................... 1,541,759 793,499 2,207,448 +665,689 +1,413,949
------------------------------------------------------------------------------------
Subtotal, Education Finance Incentive Grants............. 1,541,759 793,499 2,207,448 +665,689 +1,413,949
====================================================================================
Subtotal, Grants to LEAs, program level.................. 11,684,311 12,350,000 12,350,000 +665,689 ...............
Even Start......................................................... 248,375 175,000 175,000 -73,375 ...............
Reading First:
State Grants................................................... 798,500 855,000 805,000 +6,500 -50,000
Advance from prior year........................................ (195,000) (195,000) (195,000) ............... ...............
Fiscal Year 2005 Advance....................................... 195,000 195,000 195,000 ............... ...............
------------------------------------------------------------------------------------
Subtotal, Reading First State Grants......................... 993,500 1,050,000 1,000,000 +6,500 -50,000
Early Reading First................................................ 74,512 100,000 85,000 +10,488 -15,000
Literacy through School Libraries.................................. 12,419 27,500 12,419 ............... -15,081
State Agency Programs:
Migrant........................................................ 395,413 396,000 395,413 ............... -587
Neglected and Delinquent/High Risk Youth....................... 48,682 48,000 48,682 ............... +682
------------------------------------------------------------------------------------
Subtotal, State Agency programs.............................. 444,095 444,000 444,095 ............... +95
Evaluation......................................................... 8,842 9,500 8,842 ............... -658
Comprehensive School Reform Demonstration.......................... 233,473 ............... ............... -233,473 ...............
Migrant Education:
High School Equivalency Program................................ 23,347 13,000 13,000 -10,347 ...............
College Assistance Migrant Program............................. 15,399 15,000 15,000 -399 ...............
------------------------------------------------------------------------------------
Subtotal, Migrant Education.................................. 38,746 28,000 28,000 -10,746 ...............
====================================================================================
Total, Education for the disadvantaged....................... 13,738,273 14,184,000 14,103,356 +365,083 -80,644
Current Year............................................. (6,954,972) (6,800,699) (6,720,055) (-234,917) (-80,644)
Fiscal year 2005......................................... (6,783,301) (7,383,301) (7,383,301) (+600,000) ...............
Subtotal, forward funded..................................... (6,816,976) (6,632,199) (6,582,294) (-234,682) (-49,905)
IMPACT AID
Basic Support Payments............................................. 1,025,292 867,500 1,025,292 ............... +157,792
Payments for Children with Disabilities............................ 50,668 40,000 50,668 ............... +10,668
Facilities Maintenance (Sec. 8008)................................. 7,948 8,000 7,948 ............... -52
Construction (Sec. 8007)........................................... 44,708 45,000 44,708 ............... -292
Payments for Federal Property (Sec. 8002).......................... 59,610 55,000 59,610 ............... +4,610
------------------------------------------------------------------------------------
Total, Impact aid............................................ 1,188,226 1,015,500 1,188,226 ............... +172,726
SCHOOL IMPROVEMENT PROGRAMS
State Grants for Improving Teacher Quality......................... 1,780,825 1,700,000 1,700,000 -80,825 ...............
Advance from prior year........................................ (1,150,000) (1,150,000) (1,150,000) ............... ...............
Fiscal year 2005............................................... 1,150,000 1,150,000 1,150,000 ............... ...............
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Subtotal, State Grants for Improving Teacher Quality, program 2,930,825 2,850,000 2,850,000 -80,825 ...............
level.......................................................
Early Childhood Educator Professional Development.................. 14,902 15,000 14,902 ............... -98
Mathematics and Science Partnerships............................... 100,344 12,500 100,344 ............... +87,844
State Grants for Innovative Education (Education Block Grant)...... 97,498 100,000 60,000 -37,498 -40,000
Advance from prior year........................................ (285,000) (285,000) (285,000) ............... ...............
Fiscal year 2005............................................... 285,000 285,000 285,000 ............... ...............
------------------------------------------------------------------------------------
Subtotal, Education Block Grant, program level............... 382,498 385,000 345,000 -37,498 -40,000
Educational Technology:
Educational Technology State Grants............................ 695,947 700,500 695,947 ............... -4,553
Preparing Tomorrow's Teachers to Use Technology................ 62,094 ............... ............... -62,094 ...............
------------------------------------------------------------------------------------
Subtotal, Educational Technology............................. 758,041 700,500 695,947 -62,094 -4,553
21st Century Community Learning Centers............................ 993,500 600,000 1,000,000 +6,500 +400,000
State Assessments/Enhanced Assessment Instruments.................. 384,484 390,000 390,000 +5,516 ...............
Javits gifted talented education................................... 11,177 ............... 11,177 ............... +11,177
Foreign language assistance........................................ 16,144 ............... 17,144 +1,000 +17,144
Education for Homeless Children & Youth............................ 54,642 50,000 60,000 +5,358 +10,000
Training and Advisory Services (Civil Rights)...................... 7,286 7,334 7,286 ............... -48
Education for Native Hawaiians..................................... 30,798 18,300 36,000 +5,202 +17,700
Alaska Native Education Equity..................................... 30,798 14,200 36,000 +5,202 +21,800
Rural Education.................................................... 167,653 ............... 167,653 ............... +167,653
====================================================================================
Total, School improvement programs........................... 5,883,092 5,042,834 5,731,453 -151,639 +688,619
Current Year............................................. (4,448,092) (3,607,834) (4,296,453) (-151,639) (+688,619)
Fiscal year 2005......................................... (1,435,000) (1,435,000) (1,435,000) ............... ...............
Subtotal, forward funded..................................... (4,274,893) (3,553,000) (4,173,944) (-100,949) (+620,944)
INDIAN EDUCATION
Grants to Local Educational Agencies............................... 96,502 97,133 96,502 ............... -631
Federal Programs:
Special Programs for Indian Children........................... 19,870 20,000 19,870 ............... -130
National Activities............................................ 5,201 5,235 5,201 ............... -34
------------------------------------------------------------------------------------
Subtotal, Federal Programs................................... 25,071 25,235 25,071 ............... -164
====================================================================================
Total, Indian Education...................................... 121,573 122,368 121,573 ............... -795
INOVATION AND IMPROVEMENT
Troops-to-Teachers................................................. 28,812 25,000 ............... -28,812 -25,000
Transition to Teaching............................................. 41,727 49,400 41,727 ............... -7,673
National Writing Project........................................... 16,890 ............... 18,890 +2,000 +18,890
Teaching of Traditional American History........................... 99,350 100,000 120,000 +20,650 +20,000
School Leadership.................................................. 12,419 ............... 12,419 ............... +12,419
Advanced Credentialing............................................. 9,935 ............... 9,935 ............... +9,935
Charter Schools Grants............................................. 198,700 220,000 220,000 +21,300 ...............
Credit Enhancement for Charter School Facilities................... 24,838 100,000 ............... -24,838 -100,000
Voluntary Public School Choice..................................... 25,831 25,000 28,000 +2,169 +3,000
Magnet Schools Assistance.......................................... 109,285 110,000 109,285 ............... -715
Choice Incentive Fund.............................................. ............... 75,000 ............... ............... -75,000
Fund for the Improvement of Education (FIE):
Current funded................................................. 398,133 59,000 165,877 -232,256 +106,877
Forward funded................................................. 74,513 ............... ............... -74,513 ...............
------------------------------------------------------------------------------------
Subtotal, FIE................................................ 472,646 59,000 165,877 -306,769 +106,877
Ready to Learn..................................................... 22,850 22,000 24,000 +1,150 +2,000
Dropout Prevention Programs........................................ 10,929 ............... ............... -10,929 ...............
Ellender Fellowships/Close Up...................................... 1,490 ............... ............... -1,490 ...............
Advanced Placement Fees............................................ 23,347 22,000 24,000 +653 +2,000
====================================================================================
Total, Innovation and Improvement............................ 1,099,049 807,400 774,133 -324,916 -33,267
Current Year............................................. (1,099,049) (807,400) (774,133) (-324,916) (-33,267)
Fiscal year 2005......................................... ............... ............... ............... ............... ...............
Subtotal, forward funded..................................... (74,513) ............... ............... (-74,513) ...............
SAFE SCHOOLS AND CITIZENSHIP EDUCATION
Safe and Drug Free Schools and Communities:
State Grants................................................... 138,949 92,017 422,017 +283,068 +330,000
Advance from prior year.................................... (330,000) (330,000) (330,000) ............... ...............
Fiscal year 2005........................................... 330,000 330,000 ............... -330,000 -330,000
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State Grants, program level.............................. 468,949 422,017 422,017 -46,932 ...............
National Programs.................................................. 155,180 172,233 155,180 ............... -17,053
Community Service for Expelled or Susp'd Students.................. 49,675 ............... ............... -49,675 ...............
Alcohol Abuse Reduction............................................ 24,838 ............... 30,000 +5,162 +30,000
Mentoring Programs................................................. 17,386 100,000 28,700 +11,314 -71,300
Character education................................................ 24,838 25,000 24,838 ............... -162
Elementary and Secondary School Counseling......................... 32,289 ............... 34,000 +1,711 +34,000
Carol E. White Physical Education for Progress..................... 59,610 ............... 70,000 +10,390 +70,000
Civic Education.................................................... 28,812 27,000 28,812 ............... +1,812
State Grants for Incarcerated Youth Offenders...................... 23,348 ............... 25,000 +1,652 +25,000
Physical Education Initiative...................................... ............... 10,000 ............... ............... -10,000
====================================================================================
Total, Safe Schools and Citizenship Education................ 884,925 756,250 818,547 -66,378 +62,297
Current Year............................................. (554,925) (426,250) (818,547) (+263,622) (+392,297)
Fiscal year 2005......................................... (330,000) (330,000) ............... (-330,000) (-330,000)
Subtotal, forward funded..................................... (211,972) (92,017) (447,017) (+235,045) (+355,000)
ENGLISH LANGUAGE ACQUISITION
Current funded..................................................... 194,726 124,000 123,741 -70,985 -259
Forward funded..................................................... 490,789 541,000 541,259 +50,470 +259
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Total, English Language Acquisition.......................... 685,515 665,000 665,000 -20,515 ...............
SPECIAL EDUCATION
State Grants:
Grants to States Part B advance funded......................... 5,672,000 5,072,000 5,402,000 -270,000 +330,000
Part B advance from prior year............................. (5,072,000) (5,672,000) (5,672,000) (+600,000) ...............
Grants to States Part B current year........................... 3,202,398 4,456,533 4,456,533 +1,254,135 ...............
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Subtotal, Grants to States, program level.................... 8,874,398 9,528,533 9,858,533 +984,135 +330,000
Preschool Grants............................................... 387,465 390,000 390,000 +2,535 ...............
Grants for Infants and Families................................ 434,159 447,000 447,000 +12,841 ...............
------------------------------------------------------------------------------------
Subtotal, State grants, program level........................ 9,696,022 10,365,533 10,695,533 +999,511 +330,000
IDEA National Activities (current funded):
State Program Improvement Grants............................... 51,364 44,000 44,000 -7,364 ...............
Research and Innovation........................................ 77,210 78,380 77,210 ............... -1,170
Technical Assistance and Dissemination......................... 53,133 53,481 53,133 ............... -348
Personnel Preparation.......................................... 91,899 90,000 91,899 ............... +1,899
Parent Information Centers..................................... 26,328 26,000 26,328 ............... +328
Technology and Media Services.................................. 37,961 32,710 39,361 +1,400 +6,651
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Subtotal, IDEA special programs.............................. 337,895 324,571 331,931 -5,964 +7,360
====================================================================================
Total, Special education..................................... 10,033,917 10,690,104 11,027,464 +993,547 +337,360
Current Year............................................. (4,361,917) (5,618,104) (5,625,464) (+1,263,547) (+7,360)
Fiscal year 2005......................................... (5,672,000) (5,072,000) (5,402,000) (-270,000) (+330,000)
Subtotal, Forward funded..................................... (4,075,386) (5,337,533) (5,337,533) (+1,262,147) ...............
REHABILITATION SERVICES AND DISABILITY RESEARCH
Vocational Rehabilitation State Grants \5\......................... 2,533,492 2,584,162 2,584,162 +50,670 ...............
Client Assistance State grants..................................... 12,068 11,897 12,068 ............... +171
Training........................................................... 39,371 42,629 39,371 ............... -3,258
Demonstration and training programs................................ 20,895 24,492 20,895 ............... -3,597
Migrant and seasonal farmworkers................................... 2,335 ............... 2,335 ............... +2,335
Recreational programs.............................................. 2,579 ............... 2,579 ............... +2,579
Protection and advocacy of individual rights (PAIR)................ 16,890 17,880 16,890 ............... -990
Projects with industry............................................. 21,928 ............... 21,928 ............... +21,928
Supported employment State grants.................................. 37,904 ............... 37,904 ............... +37,904
Independent living:
State grants................................................... 22,151 22,296 22,151 ............... -145
Centers........................................................ 69,545 69,500 69,545 ............... +45
Services for older blind individuals........................... 27,818 25,000 27,818 ............... +2,818
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Subtotal, Independent living................................. 119,514 116,796 119,514 ............... +2,718
Program Improvement................................................ 894 850 894 ............... +44
Evaluation......................................................... 994 1,000 994 ............... -6
Helen Keller National Center for Deaf/Blind........................ 8,660 8,717 8,717 +57 ...............
National Inst. Disability and Rehab. Research (NIDRR).............. 109,285 110,000 109,285 ............... -715
Assistive Technology............................................... 26,824 ............... 26,824 ............... +26,824
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Subtotal, discretionary programs............................. 420,141 334,261 420,198 +57 +85,937
====================================================================================
Total, Rehabilitation services............................... 2,953,633 2,918,423 3,004,360 +50,727 +85,937
SPECIAL INSTITUTIONS FOR PERSONS WITH DISABILITIES
AMERICAN PRINTING HOUSE FOR THE BLIND.............................. 15,399 14,000 16,500 +1,101 +2,500
NATIONAL TECHNICAL INSTITUTE FOR THE DEAF (NTID:
Operations..................................................... 52,109 49,414 53,433 +1,324 +4,019
Endowment...................................................... ............... 1,000 ............... ............... -1,000
Construction................................................... 1,590 367 367 -1,223 ...............
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Total, NTID.................................................. 53,699 50,781 53,800 +101 +3,019
GALLAUDET UNIVERSITY
Operations..................................................... 97,798 93,446 100,800 +3,002 +7,354
Endowment...................................................... ............... 1,000 ............... ............... -1,000
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Total, Gallaudet University.................................. 97,798 94,446 100,800 +3,002 +6,354
====================================================================================
Total, Special Institutions for Persons with Disabilities.... 166,896 159,227 171,100 +4,204 +11,873
VOCATIONAL AND ADULT EDUCATION
Vocational Education:
Basic State Grants/Secondary & Technical Education State 401,200 209,000 401,200 ............... +192,200
Grants, current funded \6\....................................
Advance from prior year.................................... (791,000) (791,000) (791,000) ............... ...............
Fiscal year 2005........................................... 791,000 791,000 791,000 ............... ...............
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Subtotal, Basic State Grants, program level.............. 1,192,200 1,000,000 1,192,200 ............... +192,200
Tech-Prep Education State Grants............................... 107,298 ............... 107,298 ............... +107,298
National Programs.............................................. 11,922 ............... 11,922 ............... +11,922
Tech-Prep Education Demonstration.............................. 4,968 ............... 4,968 ............... +4,968
Occupational and Employment Information Program................ 9,438 ............... 9,438 ............... +9,438
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Subtotal, Vocational Education............................... 1,325,826 1,000,000 1,325,826 ............... +325,826
Adult Education:
State Grants, current funded................................... 571,262 584,300 571,262 ............... -13,038
National Programs:
National Leadership Activities............................. 9,438 ............... 9,223 -215 +9,223
National Institute for Literacy............................ 6,517 6,732 6,732 +215 ...............
------------------------------------------------------------------------------------
Subtotal, National programs.............................. 15,955 6,732 15,955 ............... +9,223
====================================================================================
Subtotal, Adult education................................ 587,217 591,032 587,217 ............... -3,815
Smaller Learning Communities, current funded....................... 8,047 ............... 8,047 ............... +8,047
Smaller Learning Communities, forward funded....................... 152,900 ............... 152,900 ............... +152,900
Community Technology Centers....................................... 32,264 ............... 20,000 -12,264 +20,000
====================================================================================
Total, Vocational and adult education........................ 2,106,254 1,591,032 2,093,990 -12,264 +502,958
Current Year............................................. (1,315,254) (800,032) (1,302,990) (-12,264) (+502,958)
Fiscal year 2005......................................... (791,000) (791,000) (791,000) ............... ...............
Subtotal, forward funded..................................... (1,274,943) (800,032) (1,274,943) ............... (+474,911)
STUDENT FINANCIAL ASSISTANCE
Pell Grants--maximum grant (NA).................................... (4,050) (4,000) (4,050) ............... (+50)
Pell Grants--Regular Program....................................... 11,364,646 12,715,000 12,176,683 +812,037 -538,317
Federal Supplemental Educational Opportunity Grants................ 760,028 725,000 760,028 ............... +35,028
Federal Work Study................................................. 1,004,428 1,011,000 1,004,428 ............... -6,572
Federal Perkins Loans:
Capital Contributions.......................................... 99,350 ............... 99,350 ............... +99,350
Loan Cancellations............................................. 67,061 67,500 67,061 ............... -439
------------------------------------------------------------------------------------
Subtotal, Federal Perkins loans.............................. 166,411 67,500 166,411 ............... +98,911
LEAP program....................................................... 66,565 ............... 66,565 ............... +66,565
Loan Forgiveness for Child Care.................................... 994 ............... ............... -994 ...............
====================================================================================
Total, Student Financial Assistance.......................... 13,363,072 14,518,500 14,174,115 +811,043 -344,385
STUDENT AID ADMINISTRATION
Administrative Costs............................................... 104,703 947,010 104,703 ............... -842,307
Fed Direct Student Loan Reclassification (Leg prop)................ ............... -795,000 ............... ............... +795,000
HIGHER EDUCATION
Aid for Institutional Development:
Strengthening Institutions..................................... 81,467 76,275 81,467 ............... +5,192
Hispanic Serving Institutions.................................. 92,396 93,551 93,551 +1,155 ...............
Strengthening Historically Black Colleges (HBCUs).............. 214,015 224,086 224,086 +10,071 ...............
Strengthening historically black graduate insts................ 53,415 53,302 53,415 ............... +113
Strengthening Alaska & Hawaiian-Serving Insts.................. 8,180 4,048 11,000 +2,820 +6,952
Strengthening Tribal Colleges.................................. 22,850 19,037 24,000 +1,150 +4,963
------------------------------------------------------------------------------------
Subtotal, Aid for Institutional development.................. 472,323 470,299 487,519 +15,196 +17,220
International Education and Foreign Language:
Domestic Programs.............................................. 93,240 88,000 86,240 -7,000 -1,760
Overseas Programs.............................................. 12,916 13,000 12,916 ............... -84
Institute for International Public Policy...................... 1,639 1,500 1,639 ............... +139
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Subtotal, International Education & Foreign Lang............. 107,795 102,500 100,795 -7,000 -1,705
Fund for the Improvement of Postsec. Ed. (FIPSE)................... 171,068 39,138 32,201 -138,867 -6,937
Minority Science and Engineering Improvement....................... 8,942 8,500 8,942 ............... +442
Interest Subsidy Grants............................................ 2,980 2,000 2,000 -980 ...............
Tribally Controlled Postsec Voc/Tech Institutions.................. 6,955 6,500 7,500 +545 +1,000
Federal TRIO Programs.............................................. 827,089 802,500 840,000 +12,911 +37,500
GEAR UP............................................................ 293,082 285,000 300,000 +6,918 +15,000
Byrd Honors Scholarships........................................... 40,734 41,001 41,000 +266 -1
Javits Fellowships................................................. 9,935 10,000 9,935 ............... -65
Graduate Assistance in Areas of National Need...................... 30,798 31,000 30,798 ............... -202
Teacher Quality Enhancement Grants................................. 89,415 90,000 89,415 ............... -585
Child Care Access Means Parents in School.......................... 16,194 15,000 16,194 ............... +1,194
Demonstration in Disabilities/Higher Education..................... 6,954 ............... 6,954 ............... +6,954
Underground Railroad Program....................................... 2,235 ............... ............... -2,235 ...............
GPRA data/HEA program evaluation................................... 994 1,000 994 ............... -6
Thurgood Marshall Scholarships..................................... 4,968 ............... ............... -4,968 ...............
B.J. Stupak Olympic Scholarships................................... 994 ............... ............... -994 ...............
====================================================================================
Total, Higher education...................................... 2,093,455 1,904,438 1,974,247 -119,208 +69,809
NATIONAL SECURITY EDUCATION TRUST FUND (proposed leg \7\........... ............... 8,000 ............... ............... -8,000
HOWARD UNIVERSITY
Academic Program................................................... 204,690 203,500 204,690 ............... +1,190
Endowment Program.................................................. 3,573 3,600 3,573 ............... -27
Howard University Hospital......................................... 30,177 30,374 30,177 ............... -197
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Total, Howard University..................................... 238,440 237,474 238,440 ............... +966
College Housing and Academic Facilities Loans Program (CHAFL)...... 757 774 774 +17 ...............
HBCU Capital Financing Program Federal Adm......................... 207 210 210 +3 ...............
INSTITUTE OF EDUCATION SCIENCES
Research and Statistics:
Research....................................................... 139,090 185,000 144,090 +5,000 -40,910
Regional Educational Laboratories.............................. 67,061 ............... 67,061 ............... +67,061
Statistics..................................................... 89,415 95,000 89,415 ............... -5,585
Assessment:
National Assessment........................................ 90,235 90,825 90,235 ............... -590
National Assessment Governing Board........................ 4,532 5,090 4,532 ............... -558
------------------------------------------------------------------------------------
Subtotal, Assessment..................................... 94,767 95,915 94,767 ............... -1,148
====================================================================================
Subtotal, Research and statistics........................ 390,333 375,915 395,333 +5,000 +19,418
Multi-year Grants and Contracts.................................... 57,623 ............... 57,623 ............... +57,623
====================================================================================
Total, IES................................................... 447,956 375,915 452,956 +5,000 +77,041
DEPARTMENTAL MANAGEMENT
PROGRAM ADMINISTRATION............................................. 409,863 434,494 409,863 ............... -24,631
OFFICE FOR CIVIL RIGHTS............................................ 85,715 91,275 91,275 +5,560 ...............
OFFICE OF THE INSPECTOR GENERAL.................................... 40,734 48,137 44,137 +3,403 -4,000
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Total, Departmental management............................... 536,312 573,906 545,275 +8,963 -28,631
Total: Elementary and Secondary Education Act programs....... 23,851,487 22,593,352 23,640,858 -210,629 +1,047,506
Adjustment for mandatory VR proposal............................... ............... 84,490 ............... ............... -84,490
====================================================================================
Total, Title III, Department of Education.................... 55,646,255 55,807,855 57,189,922 +1,543,667 +1,382,067
Current Year............................................. (40,634,954) (40,796,554) (42,178,621) (+1,543,667) (+1,382,067)
Fiscal year 2005......................................... (15,011,301) (15,011,301) (15,011,301) ............... ...............
TITLE IV--RELATED AGENCIES
ARMED FORCES RETIREMENT HOME
Operations and Maintenance......................................... 61,839 63,296 63,296 +1,457 ...............
Capital Program.................................................... 5,732 1,983 1,983 -3,749 ...............
------------------------------------------------------------------------------------
Total, AFRH.................................................. 67,571 65,279 65,279 -2,292 ...............
CORPORATION FOR NATIONAL AND COMMUNITY SERVICE \8\
Volunteers in Service to America (VISTA)........................... 93,674 94,287 94,287 +613 ...............
Special Volunteers programs........................................ 9,935 20,000 4,935 -5,000 -15,065
National Senior Volunteer Corps:
Foster Grandparents Program.................................... 110,775 106,700 110,775 ............... +4,075
Senior Companion Program....................................... 46,260 46,563 46,563 +303 ...............
Retired Senior Volunteer Program............................... 58,501 58,884 58,884 +383 ...............
Senior Demonstration Program................................... 397 ............... 397 ............... +397
------------------------------------------------------------------------------------
Subtotal, Senior Volunteers.................................. 215,933 212,147 216,619 +686 +4,472
Program Administration............................................. 34,346 38,229 34,346 ............... -3,883
====================================================================================
Total, Domestic Volunteer Service Programs................... 353,888 364,663 350,187 -3,701 -14,476
CORPORATION FOR PUBLIC BROADCASTING:
Fiscal year 2006 (current) with fiscal year 2005 comparable.... 390,000 ............... 400,000 +10,000 +400,000
Fiscal year 2005 advance with fiscal year 2004 comparable (NA). (380,000) (390,000) (390,000) (+10,000) ...............
Fiscal year 2004 advance with fiscal year 2003 comparable (NA). (362,627) (380,000) (380,000) (+17,373) ...............
Digitalization program, current funded......................... 48,427 ............... 55,000 +6,573 +55,000
Funds provided in Public Law 107-116....................... ............... (60,000) ............... ............... (-60,000)
Interconnection, current funded................................ ............... ............... 10,000 +10,000 +10,000
Funds provided in Public Law 107-116....................... ............... (20,000) ............... ............... (-20,000)
------------------------------------------------------------------------------------
Subtotal, fiscal year 2004 appropriation................. 48,427 ............... 65,000 +16,573 +65,000
------------------------------------------------------------------------------------
Subtotal, fiscal year 2004 comparable.................... 48,427 80,000 65,000 +16,573 -15,000
FEDERAL MEDIATION AND CONCILIATION SERVICE......................... 41,156 42,885 43,385 +2,229 +500
FEDERAL MINE SAFETY AND HEALTH REVIEW COMMISSION................... 7,131 7,774 7,774 +643 ...............
INSTITUTE OF MUSEUM AND LIBRARY SERVICES........................... 243,889 242,024 243,889 ............... +1,865
MEDICARE PAYMENT ADVISORY COMMISSION............................... 8,529 9,000 9,000 +471 ...............
NATIONAL COMMISSION ON LIBRARIES AND INFO SCIENCE.................. 1,003 1,000 1,000 -3 ...............
NATIONAL COUNCIL ON DISABILITY..................................... 2,839 2,830 3,339 +500 +509
NATIONAL LABOR RELATIONS BOARD..................................... 237,429 243,073 246,073 +8,644 +3,000
NATIONAL MEDIATION BOARD........................................... 11,241 11,421 11,421 +180 ...............
OCCUPATIONAL SAFETY AND HEALTH REVIEW COMMISSION................... 9,610 10,115 9,610 ............... -505
RAILROAD RETIREMENT BOARD
Dual Benefits Payments Account..................................... 131,142 127,000 127,000 -4,142 ...............
Less Income Tax Receipts on Dual Benefits.......................... -7,948 -8,000 -8,000 -52 ...............
------------------------------------------------------------------------------------
Subtotal, Dual Benefits...................................... 123,194 119,000 119,000 -4,194 ...............
Federal Payment to the RR Retirement Account....................... 150 150 150 ............... ...............
Limitation on Administration....................................... 99,350 99,820 99,350 ............... -470
Inspector General.............................................. 6,322 6,600 6,322 ............... -278
SOCIAL SECURITY ADMINISTRATION
Payments to Social Security Trust Funds............................ 20,400 21,658 21,658 +1,258 ...............
SUPPLEMENTAL SECURITY INCOME
Federal benefit payments........................................... 31,795,664 34,198,000 34,198,000 +2,402,336 ...............
Beneficiary services............................................... 45,728 100,000 100,000 +54,272 ...............
Research and demonstration......................................... 38,000 30,000 38,000 ............... +8,000
Administration..................................................... 2,825,000 3,034,000 3,034,000 +209,000 ...............
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Subtotal, SSI program level.................................. 34,704,392 37,362,000 37,370,000 +2,665,608 +8,000
Less funds advanced in prior year........................ -10,790,000 -11,080,000 -11,080,000 -290,000 ...............
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Subtotal, regular SSI current year........................... 23,914,392 26,282,000 26,290,000 +2,375,608 +8,000
Plus User Fee Activities................................. 111,000 120,000 120,000 +9,000 ...............
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Total, SSI, current request.................................. 24,025,392 26,402,000 26,410,000 +2,384,608 +8,000
New advance, 1st quarter, fiscal year 2005............... 11,080,000 12,590,000 12,590,000 +1,510,000 ...............
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Total, SSI, current request.................................. 35,105,392 38,992,000 39,000,000 +3,894,608 +8,000
LIMITATION ON ADMINISTRATIVE EXPENSES
OASDI Trust Funds.................................................. 3,736,783 4,192,200 4,192,200 +455,417 ...............
HI/SMI Trust Funds................................................. 1,210,554 1,182,000 1,182,000 -28,554 ...............
Social Security Advisory Board..................................... 1,800 1,800 1,800 ............... ...............
SSI................................................................ 2,825,000 3,034,000 3,034,000 +209,000 ...............
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Subtotal, regular LAE........................................ 7,774,137 8,410,000 8,410,000 +635,863 ...............
User Fee Activities (SSI).......................................... 111,000 120,000 120,000 +9,000 ...............
====================================================================================
TOTAL, Limitation on Administrative Expenses................. 7,885,137 8,530,000 8,530,000 +644,863 ...............
OFFICE OF THE INSPECTOR GENERAL
Federal Funds...................................................... 20,863 25,000 20,863 ............... -4,137
Trust Funds........................................................ 61,597 65,000 61,597 ............... -3,403
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Total, Office of the Inspector General....................... 82,460 90,000 82,460 ............... -7,540
Adjustment: Trust fund transfers from general revenues............. -2,936,000 -3,154,000 -3,154,000 -218,000 ...............
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Total, Social Security Administration........................ 40,157,389 44,479,658 44,480,118 +4,322,729 +460
Federal funds............................................ 35,146,655 39,038,658 39,042,521 +3,895,866 +3,863
Current year......................................... (24,066,655) (26,448,658) (26,452,521) (+2,385,866) (+3,863)
New advances, 1st quarter............................ (11,080,000) (12,590,000) (12,590,000) (+1,510,000) ...............
Trust funds.............................................. 5,010,734 5,441,000 5,437,597 +426,863 -3,403
UNITED STATES INSTITUTE OF PEACE................................... 16,256 17,200 17,200 +944 ...............
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Total, Title IV, Related Agencies............................ 41,825,374 45,722,492 46,178,097 +4,352,723 +455,605
Federal Funds............................................ 36,700,439 40,166,072 40,625,828 +3,925,389 +459,756
Current Year......................................... (25,230,439) (27,576,072) (27,635,828) (+2,405,389) (+59,756)
Fiscal year 2005 Advance............................. (11,080,000) (12,590,000) (12,590,000) (+1,510,000) ...............
Fiscal year 2006 Advance............................. (390,000) ............... (400,000) (+10,000) (+400,000)
Trust Funds.............................................. 5,124,935 5,556,420 5,552,269 +427,334 -4,151
SUMMARY
Federal Funds...................................................... 419,505,084 457,534,706 460,064,584 +40,559,500 +2,529,878
Current year................................................... (334,356,797) (364,598,430) (366,728,308) (+32,371,511) (+2,129,878)
2005 advance................................................... (84,758,287) (92,936,276) (92,936,276) (+8,177,989) ...............
2006 advance................................................... (390,000) ............... (400,000) (+10,000) (+400,000)
Trust Funds........................................................ 11,485,390 12,162,342 12,103,203 +617,813 -59,139
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Grand Total.................................................. 430,990,474 469,697,048 472,167,787 +41,177,313 +2,470,739
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\1\ Two year availability.
\2\ Transferred from SSA to DOL (Public Law 107-275).
\3\ Includes Mine Safety and Health.
\4\ GP transfers $100,000,000 to Global HIV/AIDS fund.
\5\ Fiscal year 2004 request assumes current law increase required by the Rehab Act.
\6\ Fiscal year 2004 request assumes passage of proposed legislation renaming these State grant programs.
\7\ In fiscal years 2002 and 2003, $8,000,000 provided for this program in Defense Appropriations Acts.
\8\ Appropriations for Americorps are provided in the VA-HUD bill.