95–823 PDF 

Calendar No. 699 

108TH CONGRESS REPORT " ! SENATE 2d Session 108–345 

DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND RELATED AGENCIES APPROPRIATION BILL, 2005 

SEPTEMBER 15, 2004.—Ordered to be printed 

Mr. SPECTER, from the Committee on Appropriations, 

submitted the following 

R E P O R T 

[To accompany S. 2810] 

The Committee on Appropriations reports the bill (S. 2810) making appropriations for Departments of Labor, Health and Human 

Services, and Education and related agencies for the fiscal year 

ending September 30, 2005, and for other purposes, reports favorably thereon and recommends that the bill do pass. 

Amount of budget authority 

Total bill as reported to Senate ............................... $494,272,611,000 

Amount of adjusted appropriations, 2004 .............. 479,592,665,000 

Budget estimates, 2005 ............................................ 490,903,284,000 

The bill as reported to the Senate: 

Over the adjusted appropriations for 2004 ..... ∂14,679,946,000 

Over the budget estimates for 2005 ................. ∂3,369,327,000 
(2) 

C O N T E N T S 

Page 

Summary of Budget Estimates and Committee Recommendations .................... 4 

Overview and Bill Highlights ................................................................................. 4 

Highlights of the Bill ............................................................................................... 4 

Title I—Department of Labor: 

Employment and Training Administration .................................................... 12 

Employee Benefit Security Administration .................................................... 22 

Pension Benefit Guaranty Corporation .......................................................... 22 

Employment Standards Administration ......................................................... 23 

Occupational Safety and Health Administration ........................................... 26 

Mine Safety and Health Administration ........................................................ 27 

Bureau of Labor Statistics ............................................................................... 28 

Office of Disability Policy ................................................................................. 28 

Departmental Management ............................................................................. 29 

General Provisions ........................................................................................... 33 

Title II—Department of Health and Human Services: 

Health Resources and Services Administration ............................................. 35 

Centers for Disease Control and Prevention .................................................. 64 

NIH Preamble ................................................................................................... 95 

Substance Abuse and Mental Health Services Administration .................... 176 

Agency for Healthcare Research and Quality ................................................ 185 

Centers for Medicare & Medicaid Services .................................................... 187 

Administration for Children and Families ..................................................... 195 

Administration on Aging .................................................................................. 215 

Office of the Secretary ...................................................................................... 220 

General Provisions ........................................................................................... 227 

Title III—Department of Education: 

Education for the Disadvantaged .................................................................... 230 

Impact Aid ......................................................................................................... 236 

School Improvement Programs ........................................................................ 237 

Indian Education .............................................................................................. 246 

Innovation and Improvement .......................................................................... 246 

Safe Schools and Citizenship Education ......................................................... 254 

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 .......................................................................... 272 

Student Aid Administration ............................................................................ 275 

Higher Education ............................................................................................. 275 

Howard University ........................................................................................... 283 

College Housing and Academic Facilities Loans ............................................ 283 

Historically Black College and University Capital Financing Program ...... 283 

Institute of Education Science ......................................................................... 284 

Departmental Management: 

Program Administration ........................................................................... 286 

Office for Civil Rights ............................................................................... 286 

Office of the Inspector General ................................................................ 287 

General Provisions ........................................................................................... 287 

Title IV—Related Agencies: 

Armed Forces Retirement Home ..................................................................... 288 
Page

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Title IV—Related Agencies—Continued 

Corporation for National and Community Service ........................................ 288 

Corporation for Public Broadcasting ............................................................... 291 

Federal Mediation and Conciliation Service .................................................. 291 

Federal Mine Safety and Health Review Commission .................................. 292 

Institute of Museum and Library Services ..................................................... 292 

Medicare Payment Advisory Commission ...................................................... 294 

National Commission on Libraries and Information Science ....................... 294 

National Council on Disability ........................................................................ 294 

National Labor Relations Board ...................................................................... 295 

National Mediation Board ............................................................................... 295 

Occupational Safety and Health Review Commission ................................... 296 

Railroad Retirement Board .............................................................................. 296 

Social Security Administration ........................................................................ 297 

U.S. Institute of Peace ..................................................................................... 301 

Title V—General Provisions ................................................................................... 302 

Budgetary Impact of Bill ......................................................................................... 303 

Compliance With Paragraph 7, Rule XVI of the Standing Rules of the Senate .......................................................................................................................... 303 

Compliance With Paragraph 7(C), Rule XXVI of the standing rules of the 

Senate ................................................................................................................... 304 

Compliance With Paragraph 12, Rule XXVI of the Standing Rules of the 

Senate ................................................................................................................... 305 

Comparative Statement of New Budget Authority ............................................... 306 
(4) 

SUMMARY OF BUDGET ESTIMATES AND COMMITTEE 

RECOMMENDATIONS 

For fiscal year 2005, the Committee recommends total budget authority of $494,272,611,000 for the Departments of Labor, Health 

and Human Services, and Education, and Related Agencies. Of this 

amount, $142,317,000,000 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 

$5,377,662,000 for job training programs, an increase of 

$235,067,000 over the enacted 2004 level. In addition, 

$3,636,235,000 is recommended for State unemployment and employment service operations, an increase of $48,331,000 over the 

2004 level. 

Worker Protection.—The Committee bill includes $1,536,800,000 

to ensure the health and safety of workers, including $468,645,000 

for the Occupational Safety and Health Administration and 

$280,002,000 for the Mine Safety and Health Administration. The 

recommendation is an increase of $51,900,000 over the 2004 level. 

Child Labor.—The Committee bill includes $82,000,000 for activities designed to end abusive child labor. This is $71,000,000 

above the budget request, but the same as the 2004 level. 

National Institutes of Health.—A total of $28,900,300,000 is recommended to fund biomedical research at the 27 Institutes and 

Centers that comprise the NIH. This represents an increase of 
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$1,100,252,000 over the fiscal year 2004 level and $373,429,000 

over the budget request. 

Centers for Disease Control.—The Committee bill provides 

$4,807,692,000 for the Centers for Disease Control and Prevention, 

an increase of $228,393,000 over the fiscal 2004 level. Included in 

this amount is $862,195,000 for chronic disease prevention and 

health promotion. 

Wellness Initiative.—The Committee recommendation includes a 

total of $809,539,000 for programs to increase physical activity, improve nutrition, and reduce obesity and overweight, an increase of 

$100,568,000 over the fiscal year 2004 appropriation. 

Health Centers.—The recommendation includes $1,867,381,000 

for health centers, $31,456,000 above the budget request and 

$250,000,000 over the fiscal 2004 level. 

Substance Abuse.—The Committee bill provides $3,484,729,000 

for substance abuse prevention and treatment programs. Included 

in this amount is $2,256,222,000 for substance abuse treatment, 

$94,455,000 for substance abuse prevention and $913,279,000 for 

mental health programs. 

Head Start.—The Committee recommendation includes 

$6,935,306,000 for the Head Start Program. This represents an increase of $168,586,000 over the 2004 level and is the same as the 

request. 

Low-income Home Energy Assistance State Grants.—The Committee recommends $2,000,500,000 for heating and cooling assistance for low-income individuals and families, the same as the budget request and $111,710,000 more than the 2004 level. 

Persons With Disabilities.—To promote independent living in 

home and community-based settings, the Committee has included 

$5,135,963,000 for services to persons with disabilities. This includes $47,555,000 for the Office of Disability Policy at the Department of Labor, $14,912,000 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 

$15,500,684,000 in grants to enhance educational opportunities for 

disadvantaged children, an increase of $1,057,043,000 over the fiscal year 2004. 

Educator Professional Development.—The Committee recommends $2,975,126,000 for State grants to improve teacher quality. This is $45,000,000 more than the budget request. 

English Language Acquisition.—The Committee recommends 

$700,000,000 for bilingual education, $18,785,000 more than the 

budget request. 

Student Financial Aid.—The Committee recommends 

$14,859,694,000 for student financial assistance, an increase of 

$852,807,000 over the fiscal year 2004 level. 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 

$2,148,458,000 for initiatives to provide greater opportunities for 

higher education, including $844,500,000 for Federal TRIO programs and $302,500,000 for GEAR UP. 
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Education for Individuals With Disabilities.—The Committee bill 

provides $12,063,344,000 to help ensure that all children have access to a free and appropriate education, and that all infants and 

toddlers with disabilities have access to early intervention services. 

This represents an increase of $1,163,176,000 over the 2004 level 

and $140,958,000 above the budget request. 

Rehabilitation Services.—The bill recommends $3,077,328,000 for 

rehabilitation services, an increase of $66,058,000 above the 

amount provided in 2004. 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 Amer- icans, the Committee recommendation includes $3,018,098,000, an 

increase of $105,242,000 over the fiscal year 2004 level. This recommendation includes $218,884,000 for senior volunteer programs, 

$440,200,000 for community service employment for older Americans, $357,000,000 for supportive services and centers, 

$157,000,000 for family caregiver support programs and 

$718,814,000 for senior nutrition programs. For the medical research activities of the National Institute on Aging, the Committee 

recommends $1,094,500,000. The Committee recommendation also 

includes not less than $31,700,000 for the Medicare insurance 

counseling program. 

Corporation for Public Broadcasting.—The Committee bill recommends an advance appropriation for fiscal year 2007 of 

$400,000,000 for the Corporation for Public Broadcasting. In addition, the Committee bill includes $49,705,000 for conversion to digital broadcasting and $50,000,000 for the replacement project of the 

interconnection system in fiscal year 2005 funding. 

REPROGRAMMING AND TRANSFER AUTHORITY

Reprogramming and transfers are the utilization of funds for 

purposes other than those contemplated at the time of appropriation enactment. These actions do not represent requests for additional funds from the Congress, rather, the reapplication of resources already available. A reprogramming is the shifting of budgetary resources within a Treasury account, whereas a transfer is 

the shifting of budgetary resources between Treasury accounts. 

The Committee has a particular interest in approving transfers 

and reprogrammings which, although they may not change either 

the total amount available or any of the purposes for which appropriations are is legally available, represent a significant departure 

from budget plans presented to the Committee in an agency’s budget justification. 

For the Departments of Labor and HHS, the Committee has included bill language permitting reprogramming or transfers up to 

1 percent between discretionary programs, projects, or activities, as 

long as no such program, project, or activity is increased by more 

than 3 percent by such reprogramming or transfer; however, the 

Appropriations Committees of both Houses of Congress must be notified at least 15 days in advance of any such action. For the De-
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partment of Health and Human Services, a program, project, or activity may be increased by an additional 2 percent subject to written approval by the House and Senate Committees on Appropriations. 

For the Department of Education, the Committee directs that it 

make a written request to the chairman of the Committee prior to 

reprogramming or transfer of funds in excess of 10 percent, or 

$500,000, whichever is less, between programs, projects, or activities, unless an alternate amount for the agency in question is specified elsewhere in this report. The Committee desires to have the 

requests for 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, projects, or 

activities specifically cited in the Committee’s reports are affected 

or if the action can be considered to be the initiation of a new program or activity. 

The Committee directs that it be notified regarding reorganization of offices, agency employees programs, projects, or activities at 

least 15 days 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 45 days of final enactment of this Act. 

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-forservice activities. 

For purposes of implementing this provision, the term ‘‘program, 

project, or activity’’ shall mean the most specific level of budgetary 

resources referred to in the House or Senate Committee reports or 

conference report and accompanying statement of the managers associated with the Departments of Labor, Health and Human Services, and Education Appropriations Act for fiscal year 2005. The 1 

percent total referred to involves discretionary funds available for 

obligation in fiscal year 2005, including those available from prior 

years, user fees, offsetting collections or any other source of discretionary spending. 

WELLNESS INITIATIVE

The United States spends more than $1,500,000,000,000 each 

year on health care. That figure has doubled over the past 5 years, 

and if current patterns hold, it is expected to double again within 

6 years. 

The consequences of future increases are clear: More Americans 

will be left without access to health care, and more communities 

will suffer the closure of local hospitals and clinics. As a result, 

many Americans will forgo basic health maintenance visits, making 

it more likely that illnesses will go undiagnosed at early stages— 

a situation that will send health care costs spiraling even further. 
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Many programs in this appropriations bill, especially those designed to improve the Nation’s public health system and increase 

access to health care for underserved populations, directly confront 

the problems associated with rising health care costs, and the Committee remains committed to supporting them. But this year, the 

Committee is also placing an unprecedented emphasis on programs 

that encourage Americans to avoid getting sick in the first place— 

programs that promote the idea of ‘‘wellness.’’ 

Wellness can take many forms. It means developing healthy habits like exercising regularly and eating right in order to prevent 

major illness or injury. It also means staying healthy mentally and 

avoiding tobacco and other harmful substances. All these ideals 

have the same goal: to change the system of care in America from 

a ‘‘sick care’’ paradigm, one focused almost exclusively on providing 

payments and support for the detection and treatment of illness, to 

a prevention paradigm that will provide incentives and supports to 

Americans to remain healthy. 

This initiative has four major components: physical activity, nutrition, mental health and tobacco cessation. 

Physical Activity 

The Centers for Disease Control and Prevention recently determined that obesity is now the second leading cause of death in the 

United States, contributing to at least 400,000 deaths annually. 

More than two-thirds of Americans are now overweight or obese, 

and more than 15 percent of our children are overweight. The Surgeon General estimates that direct and indirect costs of obesity in 

the United States come close to $120,000,000,000 annually, and research shows that being obese has an effect that is roughly comparable to aging 20 years. 

Promoting regular physical activity and creating an environment 

that supports these behaviors are essential steps to reduce this epidemic of obesity. Regular physical activity helps to control weight 

and is associated with fewer hospitalizations, physician visits, and 

medications. Despite the proven benefits of physical activity, more 

than 50 percent of American adults do not get enough physical activity to provide health benefits. 

Nutrition 

Research shows that good nutrition lowers people’s risk for many 

chronic diseases, including heart disease, stroke, osteoporosis, diabetes, and certain types of cancer. Yet, a large gap currently remains between recommended dietary patterns and what Americans 

actually eat. Only about one-fourth of U.S. adults, and only onefifth of young people, eat the recommended 5 or more servings of 

fruits and vegetables each day. 

Adding to the lack of fruits and vegetables is a reported increase 

in calorie intake for both American men and women. Survey data 

collected over the last 30 years by the U.S. Department of Agriculture reports that this caloric increase can be traced to factors including an increase in consumption of food away from home, increased consumption of snacks, and increased portion sizes. 
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Mental Health 

The Surgeon General reports that mental disorders collectively 

account for 15 percent of the overall burden of disease from all 

causes—slightly more than the burden associated with all forms of 

cancer. The Substance Abuse and Mental Health Services Administration estimates that under-treated and untreated mental disorders cost the Nation over $204,000,000,000 annually. In fact, 

30,000 Americans die by suicide each year, with mental disorders 

a factor in 90 percent of those instances. 

Despite the cost and prevalence of depression, Americans still do 

not act to prevent and treat situational depression. According to 

the U.S. Surgeon General’s report on mental health, nearly half of 

all Americans with a severe mental illness fail to seek treatment. 

Many people do not receive treatment for mental health problems 

due to a lack of awareness of the problem, fear of stigma, or lack 

of access to appropriate services. 

Tobacco Cessation 

Tobacco use is the No. 1 killer of Americans, primarily due to its 

role in various cancers, and is a major contributing factor to heart 

disease, COPD and asthma. In fact, the latest Surgeon General’s 

report on smoking finds that tobacco use causes diseases in nearly 

every organ of the body. 

Despite the availability of data on lung cancer, 61 million or 1 

in 4 Americans smoke cigarettes. Every day in America, more than 

4,000 kids try their first cigarette. Another 2,000 children become 

new daily smokers. One-third of these newly addicted smokers will 

eventually die from smoking-caused diseases. 

The Committee strongly believes a commitment to wellness will 

encourage Americans to stay healthy, enhance the quality of life in 

America and reduce the demand on the Nation’s healthcare system. 

For this reason, the Committee has included a total of 

$809,539,000 for the following programs designed to encourage 

healthy lifestyles and nutrition, an increase of $100,568,000 over 

the fiscal year 2004 appropriation. The Committee urges agencies 

receiving funds for this purpose under this bill to take special 

measures to coordinate their activities. 

Carol M. White Physical Education for Progress Program.—Despite the well-publicized benefits of exercise, more than 50 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 Americans ages 12 to 21 are not vigorously active on a regular 

basis. Physical education 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. To help reverse this trend, the Committee recommendation includes 

$75,000,000 for the Carol M. White Physical Education for Progress 

program. This is an increase of $5,413,000 over the fiscal year 2004 

level. This program provides grants to local educational agencies 

and community-based organizations to initiate, expand, and im-
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prove physical education programs for students in kindergarten 

through 12th grade. 

Extramural Prevention Research.—The Committee commends 

CDC for its efforts to support research in humans that examines 

factors associated with preventing disease and promoting health. 

The Committee has included $36,000,000 for public health research 

at CDC, an increase of more than $5,000,000 over the fiscal year 

2004 level. Public health research helps to define the best strategies to motivate healthy lifestyles and to communicate that information to communities. The Committee has encouraged CDC to 

pay particular attention to research that will evaluate the effectiveness of business based wellness programs for employees and to develop and disseminate best practices in this area. 

Mental Health Surveillance.—The Committee has included 

$2,000,000 for a new initiative designed to measure mental and behavioral health needs in the Unites States. Despite the significant 

levels of Federal, State, and local funding for mental health services, there are currently no population-based sources of data on the 

mental and behavioral health needs in this country. Under this initiative, SAMHSA, in consultation with CDC, will develop ways of 

monitoring the mental health status of the population, the mental 

and behavioral health risks facing the Nation, and the immediate 

and long-term impact of emergencies on population mental health 

and behavior. The Committee envisions that when these measures 

are implemented in future years, the resulting data will be enormously useful to policymakers in deciding how to allocate mental 

health resources and reform the Nation’s mental health care system. 

Nutrition, Physical Activity, Obesity State Grants.—The Committee has included $50,702,000 for the CDC State grant program 

that addresses nutrition, physical activity and obesity. This is an 

increase of $6,000,000. Currently, 23 States are utilizing this funding for capacity-building activities including efforts to develop State 

nutrition and physical activity plans, identify community resources 

and gaps, implement small-scale interventions, and raise public 

awareness of system changes needed to help State residents 

achieve and maintain a healthy weight. 

Obesity Research.—Overall, the Committee recommendation includes $440,000,000 for research into the causes and cures for obesity. This figure is an increase of $40,000,000 over last year. This 

increase includes $22,000,000 for the development of a Strategic 

Plan for NIH Obesity Research, which will coordinate NIH obesity 

research across all of the Institutes. 

Pioneering Healthy Communities.—The Committee has included 

$2,000,000 to support the YMCA of the USA for its work in developing healthier communities through its Pioneering Healthier Communities conference. These funds will be used to support these 

healthy communities in the implementation of their community action plans. This program will be a proactive response to the surging 

epidemic of obesity and physical inactivity by supporting community-based solutions to these problems. 

Prevention Centers.—The Committee has provided $31,652,000, 

an increase of $5,000,000 for prevention research centers, which 

are a network of academic centers, public health agencies, and 
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community partners conducting applied research and practice in 

chronic disease prevention and control. Centers design, test, and 

disseminate strategies that help build evidence-based interventions 

for public health programs. These centers are working with communities to evaluate programs meant to encourage increased physical activity, reduce the prevalence of smoking, and foster better 

eating habits. 

School Mental Health Services.—The Committee has included 

$10,548,000 for a new program to support the integration of schools 

and mental health systems under the Department of Education. 

This program, which was authorized in the No Child Left Behind 

Act but has not yet been funded, is designed to promote schoolwide mental health strategies, provide training to elementary 

school and secondary school personnel to recognize early warning 

signs of mental illness, and increase student access to high-quality 

mental health services. An estimated 7 million to 10 million adolescents suffer from mental health issues that can lead to academic 

difficulties and poor life outcomes. Integrating mental health services in schools will increase the likelihood that they will receive the 

treatment they need. 

On a related note, the Committee has for the first time dedicated 

funding for the study of screening methods that are intended to 

identify students who are at risk of suicide. Some existing screening techniques show promise, but they require further testing. 

More must also be learned about ways to link at-risk students with 

appropriate treatment. The Committee has set aside $4,500,000 for 

SAMHSA to award grants for these purposes to school systems or 

nonprofit groups in conjunction with schools. 

STEPS to a Healthier U.S.—The Committee has provided 

$43,700,000, an increase of $5,000,000 over the fiscal year 2004 

level, to target obesity, diabetes, asthma, heart disease, stroke, and 

cancer. Programs should develop and implement comprehensive 

wellness programs that motivate and support responsible health 

choices, reduce the risk factors and complications of chronic disease, and encourage cooperation between agencies, policy makers, 

and the public to prevent diseases before they occur. Grants will 

be awarded to local and State health agencies, and tribal entities 

that develop community action plans which focus on community 

and school interventions for both the specific diseases and the related risk factors. 

Tobacco Cessation Activities at CDC.—The Committee has included $114,437,000 for tobacco control activities at CDC, an increase of $15,000,000. Tobacco use is the single most preventable 

cause of death and disease in our society. It causes more than 

400,000 deaths in the U.S. each year, and costs the Nation 

$50,000,000,000 in medical expenses alone. Children are especially 

hard hit by tobacco—90 percent of adult smokers begin their habit 

as children. These funds are intended to expand the capacity of all 

State and local health departments, education agencies, and national organizations to build comprehensive tobacco control programs and to develop and begin implementation of a national public education campaign to reduce access to and the appeal of tobacco products among young people. 
(12) 

TITLE I—DEPARTMENT OF LABOR 

EMPLOYMENT AND TRAINING ADMINISTRATION

TRAINING AND EMPLOYMENT SERVICES

Appropriations, 2004 ............................................................................. $5,142,595,000 

Budget estimate, 2005 ........................................................................... 5,323,203,000 

Committee recommendation ................................................................. 5,377,662,000 

The Committee recommends $5,377,662,000 for this account in 

2005 which provides funding primarily for activities under the 

Workforce Investment Act [WIA]. This is $235,067,000 more than 

the 2004 level, and $54,459,000 over 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 2005 will support the program from July 

1, 2005 through June 30, 2006. 

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, for the program year 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 2005, 

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. The Committee is deferring consideration of a proposed program initiative 

for personal re-employment accounts. 

The Committee directs that Department take no action in fiscal 

year 2005 to amend, through regulatory or other administrative action, the definition established in 20 CFR 677.220 for functions and 

activities under title I of the Workforce Investment Act until such 

time as legislation reauthorizing the Act is enacted. 

Adult Employment and Training.—For Adult Employment and Training Activities, the Committee recommends $898,107,000, the 

same as the fiscal year 2004 level. This program 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 pro-
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viders 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 Assistance.—For Dislocated Worker Assistance, the Committee recommends $1,479,419,000, an increase of 

$26,268,000 over the fiscal year 2004 level. Of the total, 

$1,196,048,000 is designated for State formula grants. This program 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 $283,371,000 available to the Secretary for 

activities such as responding 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, including community college 

initiatives. 

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, as well as to provide assistance where there have been 

dislocations across multiple sectors or local areas of a State. 

The Committee recommendation includes, as it has in past years, 

funding for dislocated worker projects aimed at assisting the longterm unemployed. 

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 ever changing agricultural worker 

training needs in Hawaii and recommends continued funding for a 

collaborative and adaptive effort involving the Hawaiian Department of Labor and Industrial Relations and the Hawaiian Cooperative Extension Service to provide multiculturally-sensitive on-farm 

food safety training, agribusiness training, and production training 

in support of a rapidly expanding landscaping and grounds keeping 

industry. 

The Committee continues to be 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 Com-
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mittee requests that the Government Accountability Office examine 

the administration of this program, and make recommendations for 

improvement. 

The Committee recommendation includes $250,000,000 requested 

by the administration to carry out the Community College/Community-Based Job Training Grant initiative. Of this amount, 

$125,000,000 is to be allocated from National Emergency Grant 

funds available under section 132(a)(2)(A) of the Workforce Investment Act. The Secretary is directed to initially use resources from 

the National Emergency Grants account for these awards that are 

designated for non-emergencies under sections 171(d) and 170(b) of 

the Workforce Investment Act. Community-Based Job Training 

Grant awards will also be subject to the limitations of sections 

171(c)(4)(A) through 171(c)(4)(C) of the Workforce Investment Act 

to ensure that these grants are awarded competitively. Funds used 

for this initiative should strengthen partnerships between workforce investment boards, community colleges, and employers, to 

train workers for high growth, high demand industries in the new 

economy. 

Youth Training.—For Youth Training, the Committee recommends $994,242,000, the same as the fiscal year 2004 level. The 

Committee recommendation does not address the administration’s 

legislative proposals for these activities. The purpose of Youth 

Training 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. 

Job Corps.—For Job Corps, now entering its 40th year, the Committee recommends $1,577,287,000. This is $20,000,000 more than 

the budget request, and $36,135,000 more than the 2004 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 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. 
15 

The Committee recommendation includes additional funds to 

begin the process of establishing up to four additional Job Corps 

centers, following up on directions contained in the conference report accompanying Public Law 108–199. In addition, consideration 

should be given to designating two of the proposed new Job Corps 

centers as ‘‘High Growth Job Corps Centers,’’ with emphasis placed 

on training students for industries facing labor shortages such as 

health care. 

The Committee recommendation includes funding to support a 

demonstration partnership with the Transportation Security Administration [TSA] at multiple Job Corps sites so that the Job 

Corps can help to fill unmet needs by providing TSA access to an 

expanded pool of job applicants. This funding will pay costs of both 

parties. The Department of Labor and the Department of Homeland Security are encouraged to develop a cooperative agreement 

that would help to leverage Federal resources, to provide TSA with 

an expanded pool of potential job applications and to utilize Job 

Corps facilities as appropriate to support the needs of TSA, including those of qualified private screening companies under contract 

to TSA. 

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 industry’s workforce and spur 

the Nation’s economy. 

The Committee encourages Job Corps to strengthen working relationships with workforce 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 urge the Employment and Training Administration to encourage Job Corps centers to coordinate 

with community-based organizations, such as substance abuse 

treatment centers, in innovative ways. 

Responsible Reintegration of Youthful Offenders.—The Committee recommendation includes $50,000,000, the same as the 

budget request, to continue funding for the current Reintegration 

of Youthful Offenders Program. The Reintegration of Youthful Offenders Program targets critical funding to help prepare and assist 

young offenders to return to their communities. The program also 

provides support, opportunities, education and training to youth 

who are court-involved and on probation, in aftercare, on parole, or 

who would benefit from alternatives to incarceration or diversion 
16 

from formal judicial proceedings. The recommendation also includes the $40,000,000 budget request for the prisoner re-entry initiative, to extend assistance to a broader population of ex-offenders. 

Native Americans.—For Native Americans, the Committee recommends $55,000,000. This is the same as the budget request 

level. This program 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 $76,874,000. This is the 

same as the 2004 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, yearround 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 underemployment that traps 

many farmworker families in a cycle of poverty across generations 

and that deprives many farmworker children of educational opportunities and real prospects for better jobs at higher wages. The 

Committee also recognizes that many State and local government 

officials will be reluctant to fund this training and related assistance for this vulnerable portion of our Nation’s workforce who migrate through many States every year, even though the work they 

perform is essential to the economic well-being of our Nation’s 

farmers, growers, and small businesses. 

The Committee recommendation of $76,874,000 for program year 

2005 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 

$76,370,000. The Committee recommendation includes bill language directing that $4,583,000 of this amount be used for migrant 

and seasonal farmworker housing grants, of which not less than 70 

percent shall be for permanent housing. The principal purpose of 

these funds is to continue the network of local farmworker housing 

organizations working on permanent housing solutions for migrant 

and seasonal farmworkers. The recommendation also provides that 

the remaining amount of $71,787,000 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 $504,000 to be used 

for Section 167 training, technical assistance and related activities, 
17 

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 $3,486,000 

for the provision of technical assistance and staff development, an 

increase of $1,486,000 over the budget request. This includes 

$996,000 for technical assistance to employers and unions to assist 

them in training, placing, and retraining women in nontraditional 

jobs and occupations. As described in the Migrant and Seasonal 

Farmworker section of this report, it also includes $504,000 for 

WIA Section 167 activities. 

Pilots, Demonstrations, and Research.—The Committee recommends $62,751,000, an increase of $32,751,000 over 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 $8,000,000, compared to the current level of $4,970,000, for the Denali Commission for job 

training in connection with infrastructure building projects it funds 

in rural Alaska. Funding will allow unemployed 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 $8,000,000 to provide 

for the continuing evaluation of programs conducted under the 

Workforce Investment Act, as well as of federally-funded employment-related activities under other provisions of law. 

Rescission.—This bill includes the cancellation of $100,100,000, 

that remains unobligated for the H–1B Technical Skills Grant program. This compares to the $100,000,000 rescission proposed in the 

President’s budget. The authority to impose fees that funded the 
18 

program lapsed on September 30, 2003, and therefore the program 

is ending. The Committee has utilized these savings to restore 

other job training programs that the administration has recommended for reduction or elimination. 

COMMUNITY SERVICE EMPLOYMENT FOR OLDER AMERICANS

Appropriations, 2004 ............................................................................. $438,650,000 

Budget estimate, 2005 ........................................................................... 440,200,000 

Committee recommendation ................................................................. 440,200,000 

The Committee recommends $440,200,000, the same as the budg- et request and $1,550,000 over the program year 2004 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 2005 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 lowincome 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 longterm detachment from the labor force, older displaced homemakers, 

aged minorities, limited English-speaking persons, and legal immigrants. 

FEDERAL UNEMPLOYMENT BENEFITS AND ALLOWANCES

Appropriations, 2004 ............................................................................. $1,338,200,000 

Budget estimate, 2005 ........................................................................... 1,057,300,000 

Committee recommendation ................................................................. 1,057,300,000 

The Committee recommends $1,057,300,000, the same as the 

budget estimate for fiscal year 2005, a decrease of $280,900,000 

below the fiscal year 2004 appropriation for Federal Unemployment 
19 

Benefits and Allowances. However, new obligations in fiscal year 

2005 are estimated to be $1,097,000,000, compared to $836,000,000 

in fiscal year 2004 due to an estimated unobligated balances of 

$549,200,000 in 2004. Trade Readjustment Allowance [TRA] weekly benefits are estimated to increase from $2,500,000 in fiscal year 

2004 to $4,200,000 in fiscal year 2005. Fiscal year 2005 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. The Committee expects the Department to provide funds to the State of Alaska to 

mitigate negative effects on Alaskan fishermen and other Alaskan 

displaced workers stemming from passage of Trade and Adjustment Assistance Act legislation in 2002. Funds should be provided 

on a flexible basis to cover costs of job training and placement programs, among other uses. 

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, 2004 ............................................................................. $3,587,904,000 

Budget estimate, 2005 ........................................................................... 3,593,434,000 

Committee recommendation ................................................................. 3,636,235,000 

The Committee recommends $3,636,235,000 for this account. 

This is $42,801,000 above the budget request and $48,331,000 

above the 2004 comparable level. Included in the total availability 

is $3,494,438,000 authorized to be drawn from the ‘‘Employment 

Security Administration’’ account of the unemployment trust fund, 

and $141,797,000 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 

$2,665,214,000. This includes $2,654,714,000 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, instead of 3,327,000 in the request. 
20 

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 rec- ommends $852,387,000 which includes $23,163,000 in general 

funds together with an authorization to spend $829,224,000 from 

the ‘‘Employment Security Administration’’ account of the unemployment trust fund. These funds are available for the program 

year of July 1, 2005 through June 30, 2006. The recommendation includes $65,500,000 for national activities, 

an increase of $1,529,000 over the fiscal year 2004 level. This recommendation provides increased funding of the foreign labor certification program, but not the full amount requested by the administration. The recommendation includes $18,000,000, the budget request level, for the work opportunity tax credit program. The recommendation also includes $98,764,000, the 2004 level, 

for One-Stop Career Centers. The 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 the budget request level of 

$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, 2004 ............................................................................. $467,000,000 

Budget estimate, 2005 ........................................................................... 517,000,000 

Committee recommendation ................................................................. 517,000,000 

The Committee recommends $517,000,000, the same as the budget estimate for fiscal year 2005, an increase of $50,000,000 over 

2004. 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 

2005 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. 
21 

PROGRAM ADMINISTRATION

Appropriations, 2004 ............................................................................. $172,349,000 

Budget estimate, 2005 ........................................................................... 181,018,000 

Committee recommendation ................................................................. 177,615,000 

The Committee recommendation includes $117,576,000 in general funds for this account, as well as authority to expend 

$60,039,000 from the ‘‘Employment Security Administration’’ account of the unemployment trust fund, for a total of $177,615,000. 

This level provides sufficient resources to cover built-in cost increases. 

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 believes that the public workforce system is 

strengthened by the effective participation of all of the stakeholders 

in the system and urges that the Department use a portion of its 

discretionary funds to support that participation through grants to 

intergovernmental, business, labor, and community-based organizations dedicated to training and technical assistance in support of 

Workforce Investment Boards and their members. Specifically, the 

Committee intends that the Employment and Training Administration renew grant funding for the Working for America Institute, at 

no less than the cost of the latest grant. In a hearing held July 22, 

2004, the Committee heard testimony strongly supporting the work 

of the Institute, which has successfully administered Labor Department awards for more than 35 years. 

It has come to the attention of the Committee that the Department of Labor has recently chosen not to renew a contract with the 

Appalachian Council serving participants in the Job Corps program. It is of concern to the Committee that the Department has 

discontinued this important effort. In a hearing held July 22, 2004, 

the Committee heard witnesses describe the unique character of 

this organization that justifies its continued eligibility for a solesource contract award at the national level. It is the Committee’s 

intent that the Employment and Training Administration renew 

funding for the Appalachian Council to continue its nearly 40 years 

of service to the employment needs of our Nation. 

The Committee is concerned that there are limited opportunities 

for Native Hawaiian administrators in health care organizations 

and encourages effective training programs to prepare Native Hawaiians with the expertise to excel in these areas. 

The Committee is aware that a study is urgently needed to obtain a comprehensive and accurate understanding of the costs of replacing workers who leave the Federal work force and to evaluate 

the changes needed to attract and retain skilled older workers and 

the costs of implementing such a program. The Committee urges 

the Department of Labor to obtain such a study. 
22 

The Committee urges the Department of Labor to work with 

leading national aging organizations with specialized expertise concerning older workers to conduct a Conference on the Aging Workforce. This Conference can be an appropriate forum to assess how 

our Nation can continue to progress economically when there will 

quite likely be a shortage of workers in a variety of present and 

future occupations. It can also evaluate the appropriate role that 

older workers can play in meeting future national skill needs. 

The Committee instructs that, for the purposes of the temporary 

visa programs, the Department of Labor shall treat loggers as agricultural workers and not as non-agricultural workers. Presently, 

the Department classifies loggers as non-agricultural; however, 

since June 1987, it has imposed upon them the same worker protections and labor standards as H–2A agricultural workers. Employers wishing to hire logger aliens must already provide transportation, housing, and meals, and must make the same benefits 

available to U.S. workers based on Department policy that predates the 1986 immigration reforms. The provision applies strictly 

to loggers, and shall not affect any other H–2B workers. 

EMPLOYEE BENEFIT SECURITY ADMINISTRATION

SALARIES AND EXPENSES

Appropriations, 2004 ............................................................................. $124,040,000 

Budget estimate, 2005 ........................................................................... 132,345,000 

Committee recommendation ................................................................. 132,345,000 

The Committee recommendation provides $132,345,000 for this account which is $8,305,000 above the 2004 comparable level. This 

includes funding of a requested program increase to enhance regional office enforcement activities. 

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]. In accordance with the requirements of FERSA, the Secretary of Labor has promulgated regulations and prohibited transactions class exemptions under the fiduciary responsibility and fiduciary bonding provisions of the law governing the Thrift Savings 

Plan for Federal employees. In addition, the Secretary of Labor 

has, pursuant to the requirement of section 8477(g)(1) of FERSA, 

established a program to carry out audits to determine the level of 

compliance with the fiduciary responsibility provisions of FERSA 

applicable to Thrift Savings Plan fiduciaries. 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 2005 include single employer benefit payments of $3,295,000,000, multiemployer financial assistance of $39,000,000 and administrative expenses of $266,330,000. Administrative expenses are comprised of 

three activities: (1) pension insurance activities, $12,211,000; (2) 

operational support, $84,380,000; and (3) pension plan termi-
23 

nations expenses, $169,739,000. 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. 

The 2005 budget does not recommend a discretionary limit on administrative expenditures [LAE] for PBGC. The PBGC’s budget 

will reflects—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 34.5 million participants in about 29,500 defined benefit pension plans. The multi-employer insurance program protects about 9.7 million participants in 

more than 1,600 plans. 

EMPLOYMENT STANDARDS ADMINISTRATION

SALARIES AND EXPENSES

Appropriations, 2004 ............................................................................. $392,016,000 

Budget estimate, 2005 ........................................................................... 409,294,000 

Committee recommendation ................................................................. 405,870,000 

The Committee recommendation includes $405,870,000 for this 

account. The bill contains authority to expend $2,058,000 from the 

special fund established by the Longshore and Harbor Workers’ 

Compensation Act; the remainder of $403,812,000 are general 

funds. In addition, an amount of $32,646,000 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. 

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, 
24 

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, 2004 ............................................................................. $163,000,000 

Budget estimate, 2005 ........................................................................... 233,000,000 

Committee recommendation ................................................................. 233,000,000 

The Committee recommends $233,000,000, the same as the budget estimate for fiscal year 2005, and $70,000,000 more than fiscal 

year 2004. This appropriation primarily provides benefits under the 

Federal Employees’ Compensation Act [FECA]. The payments are 

prescribed by law. In fiscal year 2005, an estimated 170,000 injured Federal workers or their survivors will file claims; 7,000 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, 2004 ............................................................................. $299,991,000 

Appropriations, Advanced 2005 ............................................................ 88,000,000 

Budget estimate, 2005 ........................................................................... 276,000,000 

Budget estimate, Advance 2006 ........................................................... 81,000,000 

Committee recommendation, 2005 ....................................................... 276,000,000 

Committee recommendation, Advanced 2006 ...................................... 81,000,000 

The Black Lung Consolidation of Administrative Responsibility 

Act was enacted on November 2, 2002. The Act amends the Black 
25 

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 2005, an estimated 46,100 beneficiaries (5,100 miners 

and 41,000 survivors) will receive benefits. 

The Committee recommends an appropriation of $276,000,000 in 

fiscal year 2005 for special benefits for disabled coal miners. This 

is in addition to the $88,000,000 appropriated last year as an advance for the first quarter of fiscal year 2005. 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 

$81,000,000 for the first quarter of fiscal year 2006, 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, 2004 ............................................................................. $51,651,000 

Budget estimate, 2005 ........................................................................... 40,821,000 

Committee recommendation ................................................................. 40,821,000 

The Committee recommends $40,821,000, the same as the budget 

estimate for fiscal year 2005, and $10,830,000 below 2004. 

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 $221,000,000 are anticipated in fiscal year 2005. 

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. 

BLACK LUNG DISABILITY TRUST FUND

Appropriations, 2004 (Definite) ............................................................ $56,099,000 

Appropriations, 2004 (Indefinite) ......................................................... 998,901,000 

Budget estimate, 2005 (Definite) .......................................................... 57,049,000 

Budget estimate, 2005 (Indefinite) ....................................................... 1,001,951,000 

Committee recommendation (Definite) ................................................ 57,049,000 

Committee recommendation (Indefinite) ............................................. 1,001,951,000 

The Committee recommends $1,059,000,000 for this account in 

2005, of which $57,049,000 is definite authority and $1,001,951,000 
26 

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 2005 will provide $1,001,951,000 for benefits payments, and $56,693,000 for administrative expenses for the Department of Labor. Also, included is 

$356,000 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 41,400 people will be receiving black lung 

benefits financed through the end of the fiscal year 2005, compared 

to an estimated 44,500 receiving benefits in fiscal year 2004. 

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, 2004 ............................................................................. $457,541,000 

Budget estimate, 2005 ........................................................................... 461,599,000 

Committee recommendation ................................................................. 468,645,000 

The Committee recommendation includes $468,645,000 for this 

account. This is an increase of $7,046,000 over the budget request 

and an increase of $11,104,000 above the 2004 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 
27 

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 $6,510,000 in 

additional funds to restore the Susan Harwood training grant program to $10,510,000. 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 $53,792,000, the budget request 

level, for 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. 

MINE SAFETY AND HEALTH ADMINISTRATION

SALARIES AND EXPENSES

Appropriations, 2004 ............................................................................. $268,857,000 

Budget estimate, 2005 ........................................................................... 275,567,000 

Committee recommendation ................................................................. 280,002,000 

The Committee recommendation includes $280,002,000 for this 

account, an increase of $4,435,000 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 the new office providing 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 2004 

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, 
28 

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, 2004 ............................................................................. $518,496,000 

Budget estimate, 2005 ........................................................................... 533,518,000 

Committee recommendation ................................................................. 533,518,000 

The Committee includes $533,518,000 for this account, 

$15,022,000 more than the 2004 comparable level. This includes 

$78,473,000 from the ‘‘Employment Security Administration’’ account of the unemployment trust fund, and $455,045,000 in Federal funds. This funding level will cover the agency’s built-in increases, and includes $5,000,000 to continue the Mass Layoff Statistics Program. 

The Bureau of Labor Statistics is the principal fact finding agency in the Federal Government in the broad field of labor economics. 

OFFICE OF DISABILITY EMPLOYMENT POLICY

Appropriations, 2004 ............................................................................. $47,024,000 

Budget estimate, 2005 ........................................................................... 47,555,000 

Committee recommendation ................................................................. 47,555,000 

The Committee recommends $47,555,000 for this account in 

2005. This is the same as the President’s request and $531,000 

above 2004. 

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 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 Employment Policy, the Committee has included $2,500,000 for the 

telework feasibility program. These funds are to be used to enable 

Government agencies to explore the feasibility of employing homebased workers with significant disabilities. 

The Committee recommends that the Office of Disability Employment Policy continue the existing, structured, internship program 

for undergraduate college students with disabilities, at no less than 

current appropriation levels. The Committee continues to believe 
29 

that this innovative, structured internship program will provide 

important opportunities for undergraduate students with disabilities to pursue academic and career development opportunities 

within the Department of Labor and other Federal agencies. 

DEPARTMENTAL MANAGEMENT

SALARIES AND EXPENSES

Appropriations, 2004 ............................................................................. $350,319,000 

Budget estimate, 2005 ........................................................................... 287,168,000 

Committee recommendation ................................................................. 357,050,000 

The Committee recommendation includes $357,050,000 for this 

account, which is $69,882,000 more than the budget request and 

$6,731,000 more than the 2004 comparable level. In addition, an 

amount of $23,705,000 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 $27,084,000 for Executive Direction, the same as the fiscal year 2004 comparable level. 

Within this amount, which includes cost savings in excess of 

$4,000,000, the Committee concurs with the budget request of up 

to $5,000,000 to encourage greater use of flex time and telework 

options to help ease the pressures faced by workers and their families. 

The Committee recommendation includes $9,554,000 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 to reenter the workforce. 

The Committee is pleased with efforts to investigate the impact 

of the nursing shortage on the overall health care labor market 

across the country, particularly in rural areas, such as Hawaii. The 

Committee urges the Department to work with HRSA in creating 

solutions to remedy the ongoing shortage and report on these efforts. 

The University of Hawaii Center on the Family is dedicated to 

understanding and promoting the factors that foster resiliency in 

families facing personal, social, and financial crises. The uniqueness of this program is the emphasis on the psychological and behavioral processes, family resilience and vulnerability, and includes 

Asians, Pacific Islanders and Caucasians families. The State’s diverse multicultural population adds to the reliability of the research conclusions. 

The Committee is disappointed that the Department of Labor 

has once again put forward a budget for the coming year that drastically reduces funding for the initiatives within the International 
30 

Labor Affairs Bureau [ILAB] working with the International Labor 

Organization to combat abusive and exploitative child labor. 

Last December, a report on the economic impact of child labor 

programs commissioned by the Department of Labor was released. 

‘‘Investing In Every Child’’ found that the average economic benefit 

of eliminating child labor around the world exceeds the cost of 

those efforts by a ratio of 6.7 to 1. Even in the region of the world 

whose economic benefit is the lowest, sub-Saharan Africa, the benefit is more than 5 to 1. The study also found that each year of additional education beyond the age of 14 yields an 11 percent increase in that individual’s earning power resulting in just over 

$5,000,000,000,000 in global benefits. 

The Committee is pleased to have definitive economic analysis 

proving that eradicating child labor and investing in education will 

contribute to increased economic prosperity for developing nations. 

The Committee views the investment made by the United States 

and the programs run by the Department of Labor to eliminate 

child labor as a proven method for improving the economic infrastructure of developing nations and providing a market for U.S. 

goods. In addition, the Committee is pleased to note that its investment in programs to eliminate child labor has inspired matching 

funds from countries like India, Cambodia, Lebanon, and Yemen, 

thus exponentially increasing the reach of these valuable programs. 

Given this new Department of Labor data on the value of these 

programs in reducing the need for foreign economic assistance, the 

amount needed to service debt for developing countries and the 

clear impact of these programs for advancing the ability of nations 

to form sound trade agreements, the Committee is mystified by the 

Department’s annual effort to eliminate these programs, this year 

proposing an astounding 87 percent reduction. Therefore, the Committee recommendation includes $110,500,000 

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]. The remaining 

$37,000,000 is for bilateral assistance to expand upon the program 

initiated by the Department in fiscal year 2001 to help ensure access to basic education for the growing number of children removed 

from the worst forms of child labor in impoverished nations where 

abusive and exploitative child labor is most acute. The Committee 

expects the Department of Labor to work with the governments of 

host countries to eliminate school fees that cause additional burdens to former exploited child laborers. 

The Committee notes that in the fiscal year 2003, ILAB contracted with two international aid organizations for $8,000,000 to 

create employment centers in Iraq. During this same fiscal year, 

Congress was presented with a request of $87,000,000,000 for the 

general reconstruction of Iraq and Afghanistan. Congress acted on 

this request and $87,000,000,000 in aid was approved on November 

6, 2003. The Committee is concerned that ILAB went outside the 

scope of congressional approval by diverting funds from the multilateral and bi-lateral technical assistance programs to gain addi-
31 

tional funding for the reconstruction of these two countries. The 

Committee expects a detailed report by March 31, 2005 on the use 

of the $8,000,000, including a timeline of when the funds were requested, by whom, the process by which the two aid organizations 

were selected, when the contracts were issued, and what such contracts entailed. The Committee understands that the contracts 

have changed drastically due to unforeseen events in Iraq and expect that the report will also detail the decision making process between the contractors, the CPA and ILAB on the changes and a detailed table explaining how the funds were eventually spent by the 

contractors. 

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. This report is 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 

is aware that currently this report only tracks the progress of countries that are designated as beneficiaries under the U.S. Generalized System of Preferences [GSP]. The GSP program grants dutyfree treatment to specified products imported from developing countries and territories. As the United States’ negotiates separate Free 

Trade Agreements with GSP beneficiaries, the DOL stops tracking 

their progress in the elimination of abusive and exploitative child 

labor. Therefore, the Committee directs the Secretary to include in 

the 2005 report, all former GSP recipients that have negotiated 

Free Trade Agreements with the United States over the last 2 

years. The Committee has provided $5,000,000 for the compilation 

of this report. The Committee further includes $2,500,000 for bilateral and multilateral assistance, to be used to promote the International Labor Organization’s Declaration of Fundamental Principles and Rights at Work. 

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. 

The Committee expects that the administration’s fiscal year 2006 

Departmental Management budget justification material will include detailed information on past year, current year, and budget 

year spending and estimate for international travel taken by Department of Labor employees and officials related to ILAB activities, including amounts by appropriation account throughout the 

Labor Department. 

Acknowledging the need to upgrade the information technology 

capability in the Department of Labor, the Committee provides 

$33,565,000 for the information technology fund, and $4,965,000 

for management cross cut activities. The total provided includes 

support for cross-cutting investments such as common office automation suite implementation, architecture requirements, equipment, software, and related needs, as well as human resource management. In addition, $15,000,000 of the requested $25,000,000 is 
32 

recommended for a separate Working Capital Fund appropriation, 

for implementation of a new core accounting system for the Department of Labor. 

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 notes with approval the increased attention 

being paid to the coordination of human services with transportation. The Committee notes the recent executive order issued by 

the President calling for a report on transportation coordination 

within 1 year. The Committee expects the Labor Department, as 

one of the lead agencies mentioned in the executive order to report 

its findings to the Committee as soon as the study is complete. 

VETERANS EMPLOYMENT AND TRAINING

Appropriations, 2004 ............................................................................. $218,646,000 

Budget estimate, 2005 ........................................................................... 220,648,000 

Committee recommendation ................................................................. 226,781,000 

The Committee recommendation includes $226,781,000 for this 

account, including $32,683,000 in general revenue funding and 

$194,098,000 to be expended from the ‘‘Employment Security Administration’’ account of the unemployment trust fund. This is 

$8,135,000 more than the 2004 comparable level. For State grants the bill provides $162,415,000, which includes 

funding for the Disabled Veterans Outreach Program and the Local 

Veterans Employment Representative Program. 

For Federal administration, the Committee recommends 

$29,683,000, 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 soonto-be-discharged service members in transitioning into the civilian 

work force and includes funding to maintain this effective program. 

Individuals leaving the military may be at high risk of homelessness due to a lack of job skills transferable to the civilian sector, 

disrupted or dissolved family and social support networks, and 

other risk factors that preceded their military service. The Committee expects the Secretary of Labor to ensure that a module on 

homelessness prevention is added to the Transition Assistance Program curriculum. The module should include a presentation on risk 

factors for homelessness, a self-assessment of risk factors, and contact information for preventative assistance associated with homelessness. 

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 recommendation includes $23,000,000 for the 

Homeless Veterans Program, an increase of $4,000,000 over the 

budget request. Also included is $9,683,000 for the Veterans Workforce Investment Program, an increase of $2,133,000 over the budget request. 

The Committee is interested in ensuring that qualified job training programs of the Department of Labor fully extend priority of 
33 

service for veterans as required by the Jobs for Veterans Act. Toward this effort, the Committee urges the Secretary to develop a 

guide for veterans in accessing workforce investment planning 

processes; and a guide to inform workforce systems on the employment services needs of veterans and the responsibility of such systems to prioritize veterans for services and to collaborate with veterans organizations and providers. The Committee urges the Secretary to instruct State workforce agencies to increase their 

outstationing of disabled veterans outreach program specialists and 

local veterans employment representatives in locations where 

homeless veterans congregate, including grantees under the homeless provider grant and per diem program and the homeless veterans reintegration program. 

OFFICE OF THE INSPECTOR GENERAL

Appropriations, 2004 ............................................................................. $65,339,000 

Budget estimate, 2005 ........................................................................... 69,590,000 

Committee recommendation ................................................................. 69,590,000 

The bill includes $69,590,000 for this account, $4,251,000 above 

the 2004 comparable level. The bill includes $64,029,000 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 $342,000 is available by transfer from 

the black lung disability trust fund. This level provides sufficient 

resources to cover built-in cost increases, as well as funding of requested program increases. 

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). 

Limits reprogramming and transfers of appropriated funds between programs, projects, and activities, and requires 15 days notification to both the House and Senate Appropriations Committees 

(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). 

Require the Secretary of Labor to issue a monthly transit subsidy 

of not less than the amount each employee of the National Capitol 

Region is eligible to receive, not to exceed a maximum of $100 (sec. 

105). 
34 

Require the Department of Labor to submit its fiscal year 2006 

congressional budget justifications in the traditional budget structure rather than in a ‘‘performance’’ budget structure. The Department is directed to develop and present the fiscal year 2006 budget 

justification delineated by appropriation account, providing detailed 

information on the prior year, current year, and requested budget 

year funding and Federal staffing levels for each program, project, 

or activity funded within each account; a detailed narrative description of each program, project, or activity; and any proposed 

changes to such program, project, or activity. Additional performance budget and measurement information should be submitted as 

a separate appendix in the budget justification material. The Department is encouraged to continue using outcome and performance measures as the primary management tool for resource allocation and the evaluation of programs and individuals (sec. 106). 

Require that none of the funds provided in this Act may be used 

by the Department of Labor to implement or administer any 

changes to regulations regarding overtime compensation in effect 

on July 14, 2004, except those changes in section 541.600 of the 

Department’s final regulation specifying the amount of salary required to qualify as an exempt employee. This provision requires 

the immediate re-instatement and enforcement of the old overtime 

regulations in effect on July 14, 2004, except for the new section 

541.600 salary requirements (secs. 107 and 108). 
(35) 

TITLE II—DEPARTMENT OF HEALTH AND HUMAN 

SERVICES 

HEALTH RESOURCES AND SERVICES ADMINISTRATION

HEALTH RESOURCES AND SERVICES

Appropriations, 2004 ............................................................................. $6,618,303,000 

Budget estimate, 2005 ........................................................................... 6,047,833,000 

Committee recommendation ................................................................. 6,966,280,000 

The Committee provides a program level of $6,966,280,000 for 

the Health Resources and Services Administration [HRSA]. The 

Committee recommendation includes $6,941,280,000 in budget authority and an additional $25,000,000 via transfers available under 

section 241 of the Public Health Services Act. The fiscal year 2004 

comparable program level was $6,618,303,000 and the administration request program level was $6,047,833,000. The Committee has 

also provided $503,649,000 in the Public Health and Social Services Emergency Fund for programs administered by HRSA. The 

HRSA portion of the Committee report has been organized in a 

manner consistent with the organizational structure of HRSA. 

Health Resources and Services Administration 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. 

As emphasized in past years, the Committee strongly supports 

the establishment of Centers of Excellence for Indigenous Health 

and Healing at 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 to support these concepts in their 

awarding of grants wherever native and indigenous people reside. 

The Committee urges HRSA to consider waivers for rural or isolated area demonstration projects when calculating requirements 

such as population density in the State of Hawaii. 

BUREAU OF PRIMARY HEALTH CARE

HEALTH CENTERS

The Committee provides $1,867,381,000 for the consolidated 

health centers. The fiscal year 2004 comparable program level was 

$1,617,381,000 and the administration request program level was 

$1,835,925,000. This group of programs includes community health 
36 

centers, migrant health centers, health care for the homeless, and 

public housing health service grants. Within the amount provided, $31,000,000 is for base grant adjustments for existing health centers. Funding should be used to 

offset the rising cost of health care nationwide, and also to resolve 

specific financial situations beyond the control of the local health 

center, such as unusual increases in the number of uninsured patients seeking care. 

The Committee supports the long-standing HRSA policy of approving specific qualified applications for future funding. This process enables high-quality applicants to take steps to develop and implement care delivery systems in their communities instead of 

wasting scarce resources to reapply for funding. However, HRSA 

should limit the use of this mechanism in a manner consistent with 

expected Presidential requests. 

The Committee is concerned that providers serving special populations (including migrant, homeless, school-based and frontier providers) have been largely unable to meet the current funding criteria used to determine health center funding, and encourages 

HRSA to establish distinct criteria and funding methodologies that 

recognize the unique needs of these communities and populations. 

The Committee has limited the amount of funds available for the 

payment of claims under the Federal Tort Claims Act to 

$45,000,000. This is the same as the amount provided in fiscal year 

2004, and the same as the President’s request. Bill language has 

been included to indicate that this funding is available until expended. 

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 residents are forced to travel long distances by 

boat or plane even in emergency situations. The Committee continues to support the administration’s effort 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 un-
37 

duly 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 continues to believe that community health centers are a critical source of care for the underserved in remote 

rural areas. The Committee commends HRSA for its continued efforts to visit and evaluate many rural and underserved areas 

across the country. New and expanded health centers in remote 

communities are critically needed. The Committee understands 

that nurse practitioners could be instrumental in expanding the 

services offered by new and existing centers. The Committee understands that opportunities exist for the increased use of nurses in 

rural community health centers through collaboration with the National Institute of Nursing Research. The Committee strongly urges 

such collaborations. In addition, the Committee understands that 

telemedicine technology is often used to maximize resources and 

collaborative communication, and encourages increased use of these 

technologies. The Committee applauds HRSA for the continued 

work that has been done to reexamine regulations and to create an 

on-line grant application process. 

The Committee recognizes 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 

encourages HRSA to provide alternative means to secure cost-based 

reimbursement for NMHCs, by providing that reimbursement or by 

granting university-based CHCs. In addition, the Committee urges 

HRSA to research the effectiveness of nurse-managed health centers as a national model to reduce health disparities. 

The Committee appreciates the attention paid by the HRSA Administrator to the special health care needs of Native Hawaiians 

and the medically underserved, especially to those living on the 

‘‘neighbor islands’’ of Hawaii. The diverse, rural and underserved 

Native Hawaiian populations of the island of Molokai face challenges in obtaining comprehensive primary care and prevention 

interventions. Drug abuse prevention among youth is particularly 

difficult to obtain. The Committee urges HRSA to provide technical 

assistance in the preparation and submission of grants for new 

community health centers to the community health leaders of 

Molokai, Lanai, and all other underserved areas of the country. 

The Committee believes that linking new centers to existing health 

care programs and facilities is an efficient use of resources. 

The Committee is pleased with efforts at our Nation’s community 

health centers to address the health disparities of American 

Samoans. 

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 Com-
38 

mittee encourages HRSA to expand its efforts to provide mental 

and behavioral health services by increasing the number of psychologists in Community Health Centers nationwide. 

An estimated 80 million people have a potentially blinding eye 

disease, 3 million have low vision, 1.1 million are legally blind, and 

200,000 are more severely visually impaired. While it is believed 

that half of all blindness can be prevented, the number of Americans who suffer vision loss continues to increase. To address this 

growing problem, the Committee urges the Administrator to 

strengthen the vision health services at community health centers 

by establishing partnerships with voluntary health organizations to 

improve the overall quality of eye care, including comprehensive vision screenings and appropriate follow up care. 

The Committee recognizes that prenatal alcohol exposure is the 

leading known cause of mental retardation 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. Each year, approximately 40,000 children 

are born with Fetal Alcohol Spectrum Disorders [FASD]. This 

amounts to almost 1 out of 100 live births, with a disproportionate 

impact on underserved American Indian and African American 

populations. The Committee has provided sufficient funding to coordinate, develop, and begin implementation of a program in collaboration with a national voluntary organization that incorporates 

sustainable systems in community health center delivery sites 

around the Nation focusing on the prevention, identification, and 

support of individuals with FASD. 

The Committee is concerned by the increasing disparity in the 

amount of applications received and grants awarded to States 

under section 330, in particular the Health Center grants. Because 

of this disparity, many high need States and local communities are 

not being benefited by a program specifically designed to serve 

their needs. The Committee acknowledges that this is a competitive grant program and not all grant applications submitted are of 

the quality necessary to receive funding. However, recent trends indicate that there may be other factors contributing to this problem. 

Therefore, the Committee requests that HRSA study this issue further and within 90 days of enactment of this Act, prepare and submit a report to the Committee that includes factors contributing to 

the disparity and ways that HRSA hopes to remedy these factors. 

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. 

The Committee is pleased with the success of the school-based 

health center initiative, however is concerned that in the last fiscal 

year only 3 of 43 applications were funded. The Committee expects 

HRSA to continue to target funds for school-based health centers 

operated by fully qualified organizations and expresses concern 
39 

that school-based health centers often experience difficulty completing the complex application process for community health center funding. The Committee requests that HRSA establish a separate application process for school-based health centers that recognizes the distinct patient volume, productivity, scope of service, and 

staffing requirements that are more appropriate to school-based delivery systems. 

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 2005. 

Free Clinics Medical Malpractice Coverage 

The Committee provides $4,821,000 in 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. 

This appropriation continues to 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. 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. The Committee 

urges HRSA to create a deeming process as quickly as possible to 

ensure that health professionals treating patients at free clinics 

have access to this coverage in a timely manner. HRSA should 

make every effort to make the deeming process as efficient as pos-
40 

sible and to prevent the process from becoming a barrier to use of 

the program. 

Radiation and Exposure Screening and Education Program 

The Committee provides $1,974,000 for the Radiation Exposure 

Compensation Act. The fiscal year 2004 comparable level was 

$1,974,000 and the administration request was $1,974,000. 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. 

Health Care Access for the Uninsured/Community Access Program 

The Committee provides $88,674,000 for the Community Access 

Program. The fiscal year 2004 comparable level was $83,674,000 

and the administration requested $9,998,000 for a new version of 

this program in fiscal year 2005. The Committee has provided 

these funds to continue the Community Access Program in its current form, which is designed to increase the capacity and effectiveness of community health care institutions and providers who serve 

patients, regardless of their ability to pay. The Committee does not 

approve the new use of these funds to create Health Center Networks. The Committee does approve the use of up to $4,900,000 for 

additional Chronic Disease Management activities provided by 

grantees of this program. 

Community Health Centers have the potential to serve as a valuable resource in biomedical and behavioral research aimed at reducing health status disparities among minority and medically underserved populations. The Committee continues to encourage 

HRSA, through the Community Access Program, to prioritize the 

establishment of demonstration projects between Community 

Health Centers and minority health professions schools for the purpose of health status disparities research and data collection. Such 

demonstration projects were authorized in the ‘‘Health Care Safety 

Net Amendments of 2002.’’ 

National Hansen’s Disease Program 

The Committee has included $17,413,000 for the National Hansen’s Disease Program. The fiscal year 2004 comparable level was 

$17,413,000 and the administration request was $17,413,000 in fiscal year 2005. 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. 

National Hansen’s Disease Program Buildings and Facilities 

The Committee provides $249,000 for buildings and facilities. 

The fiscal year 2004 comparable level was $249,000 and the administration request was $249,000. This funding provides for the repair and maintenance of buildings at the Gillis W. Long Hansen’s 

Disease Center. 
41 

Payment to Hawaii for Hansen’s Disease Treatment 

The Committee provides $2,033,000 for Hansen’s disease services. The fiscal year 2004 comparable level was $2,033,000 and the 

administration requested $2,033,000. 

Black Lung Clinics 

The Committee provides $6,000,000 for black lung clinics. The 

fiscal year 2004 comparable level was $5,963,000 and the administration requested $5,963,000. 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. 

BUREAU OF HEALTH PROFESSIONS

National Health Service Corps: Field Placements 

The Committee provides $45,735,000 for field placement activi- ties. The fiscal year 2004 comparable level was $45,506,000 and 

the administration request was $45,735,000. 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 is concerned by reports that the current HPSA 

scoring process used by HRSA may be disadvantaging many health 

centers located in medically underserved areas of the country. The 

Committee urges HRSA to look into these reports and reconsider 

requirements that might eliminate health centers from eligibility 

for the placement of NHSC scholars, Ready Responders, and HHS’ 

J–1 Visa waiver program. 

National Health Service Corps: Recruitment 

The Committee provides $127,397,000 for recruitment activities. 

The fiscal year 2004 comparable level was $124,397,000 and the 

administration request was $159,132,000. 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. These funds should support multi-year, rather than 

single-year, commitments. The Committee has not included bill 

language requested by the administration that would have established a Commissioned Corps reserve within the National Health 

Service Corps and the Committee does not intend for funds to be 

used for this purpose. 

Of this amount, $3,000,000 is designated for the demonstration 

program which allows chiropractors to participate in the National 

Health Service Corps student loan forgiveness program, as author-
42 

ized under section 338L of the Public Health Service Act. The Committee is concerned that funding provided for this demonstration in 

fiscal year 2003 resulted in only eight chiropractic demonstrations 

nationwide. The purpose of the demonstration program was to collect data on comprehensive patient outcomes associated with community health centers that provided chiropractic services. While 

the Committee is comfortable with conclusions drawn from the 

data collected on the 24 pharmacists in the demonstration program 

and looks forward to that information in the coming year, the Committee believes that eight chiropractors is not a statistically significant figure and conclusions cannot safely be drawn from this part 

of the demonstration. Therefore, the Committee expects HRSA to 

use these funds to conduct another demonstration on a cohort of 

exclusively chiropractors and report to the Committee on the findings. 

The Committee commends the National Health Service Corps for 

its focus on ensuring a 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, increase the number of psychologists in the Loan Repayment Program and begin, for the first time, to support psychology 

students in the Scholarship Program. 

The national nursing shortage is pervasive throughout all of the 

varied practice, educational and research settings. The United 

States Public Health Commissioned Corps is a critical aspect of our 

Nation’s public health infrastructure and will be relied upon to respond to a terrorist or bioterrorist event. With the passage of the 

Nurse Reinvestment Act in 2002, a National Nurse Corps grant 

program was established. Coupled with the National Health Service Corps, the new National Nurse Corps program may serve as a 

nurse recruiting pool for the Commissioned Corps. The Committee 

urges HRSA to establish mechanisms to encourage National Nurse 

Corps grant recipients to enter the Public Health Service Commissioned Corps. 

HEALTH PROFESSIONS

The Committee provides $465,357,000 for all HRSA health professions programs. The fiscal year 2004 comparable level was 

$436,080,000 and the administration requested $157,783,000 in fiscal year 2005. 

The Committee commends HRSA for its continuing efforts to address the growing gap between the size of the Nation’s aging baby 

boom population and the number of pulmonary/critical care physicians. The committee understands that HRSA is still developing a 

report on the healthcare workforce shortage issue, and that the 

portion of the report that will attempt to identify the causes of, and 

potential responses to, the critical care workforce shortage will be 

informed, in part, by The Critical Care Medicine Crisis: A Call For 

Federal Action prepared by the American College of Chest Physicians [ACCP] and the members of the Critical Care Workforce 

Partnership. The Committee continues to encourage HRSA to address the critical care workforce shortage issue and use the pulmonary/critical care specialty as a model for developing and testing 

policy approaches to address workforce shortage issues. 
43 

The Committee previously asked HRSA to 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. 

Training for Diversity 

Centers of Excellence 

The Committee provides $33,882,000 for the Centers of Excellence program. The fiscal year 2004 comparable level was 

$33,882,000 and the administration did not request any funds for 

this program in fiscal year 2005. 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 continues to encourage 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 

The Committee provides $35,935,000 for the Health Careers Opportunity Program. The fiscal year 2004 comparable level was 

$35,935,000 and the administration did not request any funds for 

this program in fiscal year 2005. This program provides funds to 

medical and other health professions schools for recruitment of disadvantaged students and pre-professional school preparations. 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. 

The Committee is concerned about the reduced level of support 

provided to minority health professions schools through the H–COP 

program in fiscal year 2004. For fiscal year 2005, the Committee 

encourages HRSA to give priority consideration to awarding grants 

to those institutions with a historic mission of training minorities 

in the health professions. 
44 

Faculty Loan Repayment 

The Committee provides $1,313,000 for the Faculty Loan Repayment program. The fiscal year 2004 comparable level was 

$1,313,000 and the administration did not request any funds for 

this program in fiscal year 2005. 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 provides $47,510,000 for the Scholarships for 

Disadvantaged Students program. The fiscal year 2004 comparable 

level was $47,510,000 and the administration requested $9,897,000 

for this program in fiscal year 2005. This program provides grants 

to health professions schools for student scholarships to individuals 

who are from disadvantaged backgrounds and are enrolled as fulltime 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. 

Training in Primary Care Medicine and Dentistry 

The Committee provides $90,742,000 for Training in Primary 

Care Medicine and Dentistry programs. The fiscal year 2004 comparable level was $81,742,000 and the administration did not request funding for this program in fiscal year 2005. 

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 
45 

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 the Pediatric Dental Program be continued with at least the fiscal year 2004 funding level. 

Interdisciplinary, Community-based Linkages 

Area Health Education Centers 

The Committee provides $29,206,000 for the Area Health Education Centers program. The fiscal year 2004 comparable level was 

$29,206,000 and the administration did not request any funds for 

this program in fiscal year 2005. 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 

The Committee provides $3,851,000 for the Health Education 

and Training Centers program. The fiscal year 2004 comparable 

level was $3,851,000 and the administration did not request any 

funds for this program in fiscal year 2005. 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 

The Committee provides $11,849,000 for the Allied Health and 

Other Disciplines programs. The fiscal year 2004 comparable level 

was $11,849,000 and the administration did not request any funds 

for this program in fiscal year 2005. 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, 
46 

including elderly, children, the chronically ill, and victims of abuse 

or terror. 

Geriatric Education Centers and Training 

The Committee provides $31,805,000 for the Geriatrics Education 

Centers and Training programs. The fiscal year 2004 comparable 

level was $31,805,000 and the administration did not request any 

funds for this program in fiscal year 2005. 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 

The Committee provides $6,126,000 for these programs. The fis- cal year 2004 comparable level was $6,126,000 and the administration did not request any funds for this program in fiscal year 2005. 

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. 

This program continues to be an important mechanism for addressing the shortages of health professionals in rural areas. Particularly commendable is the focus on rural health training projects 

that stimulate interdisciplinary practice and expose students to the 

unique needs of rural populations. The Committee encourages an 

emphasis on telemedicine technology to maximize accessibility to 

resources. The Committee remains concerned about the critical 

shortage of nurses and this should continue to be addressed at 

every opportunity. 

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 
47 

Committee recommends that the chiropractic-medical school demonstration grant program be continued. 

The Committee is aware that the initial authorization for this 

program indicated that the funds were to go to colleges and universities for the purpose of encouraging collaboration between chiropractors and physicians on identifying and providing effective 

treatment of spinal and lower back conditions. It is the contention 

of this Committee that interdisciplinary training programs are an 

integral component of expanding the identification and treatment 

of these conditions. The Committee is aware that a requirement of 

the program is the participation of a school of medicine or a school 

of osteopathic medicine. Given that the very purpose of these entities is to train healthcare professionals, the Committee concludes 

that training programs are well within the eligible activities of this 

program. 

Workforce Information and Analysis 

The Committee provides $993,000 for these programs. The fiscal year 2004 comparable level was $722,000 and the administration 

requested $993,000. 

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. 

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 

The Committee provides $9,170,000 for these programs. The fiscal year 2004 comparable level was $9,170,000 and the administration did not request any funds for this program in fiscal year 2005. 

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 

The Committee provides $1,079,000 for the Health Administration programs. The fiscal year 2004 comparable level was 

$1,079,000 and the administration did not request any funds for 
48 

this program in fiscal year 2005. These programs provide 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. 

Nursing Workforce Development Programs 

The Committee provides $161,890,000 for the Nursing Workforce 

Development programs. The fiscal year 2004 comparable level was 

$141,890,000 and the administration requested $146,887,000 for 

this program in fiscal year 2005. 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. 

The Committee is aware of the Labor Department’s partnership 

with the Council for Adult and Experimental Learning [CAEL] to 

address the Nation’s shortage of nurses. The Committee encourages HRSA to consider extending and expanding these, and other, 

successful nurse training partnerships. 

Advanced Education Nursing 

The Committee provides $58,636,000 for the Advanced Education 

Nursing programs. The fiscal year 2004 comparable level was 

$58,636,000 and the administration requested $43,637,000 for this 

program in fiscal year 2005. 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. 

With spiraling health care costs and the shortage of professionals, the need to prepare quality, cost effective providers such as 

nurse practitioners and nurse mid-wives continues to be acute. The 

Committee understands that Nurse Practitioners have been shown 

to provide high quality, cost effective care in whatever geographic 

environment they practice. The Committee believes that it is important to prepare enough of these providers to meet health needs 

within the current national shortages. The Committee urges HRSA 

to maximize advanced education traineeships for these two proven 

critical specialties. 

Nurse Education, Practice, and Retention 

The Committee provides $41,765,000 for the Nurse Education, 

Practice, and Retention Programs. The fiscal year 2004 comparable 

level was $31,768,000 and the administration requested 

$41,765,000 for this program in fiscal year 2005. 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 nursing workforce and empower the workforce to meet the demands of the current health care system. 
49 

Nursing Workforce Diversity 

The Committee provides $21,399,000 for the Nursing Workforce 

Diversity program. The fiscal year 2004 comparable level was 

$16,402,000 and the administration requested $21,399,000 for this 

program in fiscal year 2005. 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. 

Racial/ethnic minorities comprise about 12.3 percent of the current Registered Nurse population, compared to about 28 percent in 

the U.S. population. While efforts to deliver culturally competent 

care with our current nursing population are considerable and 

somewhat successful, there remains a unique and critical need for 

more minority registered nurses. The Committee recognizes that 

recent layoffs have disproportionately impacted minority workers, 

and that nursing recruitment efforts may naturally find emphasis 

among this population. The Committee believes that increasing the 

ethnic and cultural competence of nursing and other health professions groups is critical to decreasing the health disparities of this 

Nation. The Committee encourages HRSA to partner with professional nursing organizations to create diversity leadership programming and training as well as recruiting, retaining and mentoring minority nurses in both the nursing profession and in leadership positions within the profession. These partnerships should 

focus on the goal of providing more culturally relevant health care 

so as to decrease the national infant mortality rate. 

Nurse Loan Repayment and Scholarship Program 

The Committee provides $31,742,000 for the Nurse Loan Repayment and Scholarship programs. The fiscal year 2004 comparable 

level was $26,736,000 and the administration requested 

$31,738,000 for this program in fiscal year 2005. 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. 

Nurse Faculty Loan Program 

The Committee provides $4,870,000 for the Nursing Faculty 

Loan program. The fiscal year 2004 comparable level was 

$4,870,000 and the administration requested $4,870,000 for this 

program in fiscal year 2005. This program supports the development of a student loan fund in schools of nursing to increase the 

number of qualified nursing faculty. 

The Committee recognizes that a shortage of faculty in schools 

of nursing is contributing to the nationwide shortage of Registered 

Nurses [RNs]. The Committee understands that in 2003, nursing 

programs turned away more than 16,000 potential students due to 

a lack of faculty, clinical sites, and classroom space. The Committee 
50 

cites the Bureau of Labor Statistics projected need for 1.1 million 

new and replacement RNs by the year 2012. With the growing demand for health services and the care provided by an essential 

nursing workforce, the Committee urges HRSA to focus funding 

and efforts on resolving the growing shortage of faculty necessary 

to educate the future nursing workforce. 

Comprehensive Geriatric Education 

The Committee provides $3,478,000 for Comprehensive Geriatric 

Education grants. The fiscal year 2004 comparable level was 

$3,478,000 and the administration requested $3,478,000 for this 

program in fiscal year 2005. These grants prepare nursing personnel to care for the aging population. 

Children’s Hospitals Graduate Medical Education Program 

The Committee has provided $303,258,000 for the Children’s 

Hospitals Graduate Medical Education [GME] program. The fiscal 

year 2004 comparable level was $303,170,000 and the administration requested $303,258,000 for this program in fiscal year 2005. 

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. 

National Practitioner Data Bank 

The Committee provides $15,700,000 for the national practitioner 

data bank. The fiscal year 2004 comparable level was $16,000,000 

and the administration request was $15,700,000. 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. 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 2004 comparable level 

was $4,000,000 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. 
51 

MATERNAL AND CHILD HEALTH BUREAU

Maternal and Child Health Block Grant 

The Committee provides $734,817,000 for the maternal and child 

health [MCH] block grant. The fiscal year 2004 comparable level 

was $729,817,000 and the administration request was 

$729,817,000. 

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, 85 percent of appropriated funds up to $600,000,000 are distributed to 

States and 15 percent are set aside for special projects of regional 

and national significance [SPRANS]. Also according to statute, 

12.75 percent of funds over $600,000,000 are to be used for community-integrated service systems [CISS] programs. The remaining 

funds over $600,000,000 are distributed on the same 85/15 percent 

split as the basic block grant. The Committee has provided 

$122,530,000 for SPRANS activities. This is $17,000,000 more than 

would otherwise have been available under the statutory formula. The Committee intends that $4,000,000 of the SPRANS amount 

will be used to continue the sickle cell newborn screening program 

and its locally based outreach and counseling efforts. In addition, 

$5,000,000 of the SPRANS amount is intended to continue the oral 

health demonstration programs and activities in the States. The 

Committee also intends that $3,000,000 of the SPRANS amount 

will be used for mental health programs and activities in the 

States, $3,000,000 of the SPRANS amount will be used for epilepsy 

demonstration projects, and $2,000,000 of the SPRANS amount 

will be used for newborn and child screening for heritable disorders 

as authorized in title XXVI of the Children’s Health Act of 2000. 

The Committee has again provided $5,000,000 more for SPRANS 

activities than would otherwise be the case under the statutory formula for the continuation of oral health programs in the States. 

Through grants, cooperative agreements or contracts, these funds 

may be used to increase access to dental care for the most vulnerable low-income children, such as Medicaid, SCHIP, and Head 

Start eligible children and to implement State identified objectives 

for improving oral health. Anticipated activities include those targeting the reduction of early childhood caries, and strengthening 

school-linked dental sealant programs. 

The Committee also provides an additional $3,000,000 more for 

SPRANS activities than would otherwise be the case under the 

statutory formula for mental health programs and activities in the 
52 

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 [PPD]. One out of 

every ten new mothers suffers from PPD, a treatable condition that 

presents a range of emotional and physical changes. Unfortunately, 

half of these women never get help. The Committee encourages the 

Bureau to utilize this funding 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. 

The Committee again provides $2,000,000 within the SPRANS 

amount for 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 evaluation of testing programs with the goal of implementing cost-effective public health screening programs for these and other disorders. The Committee requests a report by March 15, 2005 on the 

steps taken to validate a screening tool for biliary atresia and to 

launch a screening program across the country. Given the potential 

of Fragile X screening as a viable prototype for newborn and infant 

screening, the Committee encourages HRSA to allocate funding 

from the heritable disorders screening program toward screening 

and epidemiological research activities related to Fragile X. 

The Committee is aware of the extreme disparities that exist 

among State newborn screening programs for metabolic and genetic disorders. Parents and healthcare providers responsible for 

the care of newborns should be able to provide the best chance at 

a healthy start on life. For this reason, the Committee strongly 

urges HRSA to include as a requirement for funding a provision 

that parents be informed in writing of the availability of additional 

tests that may not be required under State law. 

The Committee continues to support the Maternal and Child 

Health Bureau’s support of comprehensive treatment centers for 
53 

thalassemia patients under the SPRANS program and notes that 

the current funding is due to expire in fiscal year 2005. The Committee strongly encourages HRSA to continue this program, expand 

it to include additional centers around the country, and to continue 

to coordinate its activities with those of the Cooley’s Anemia Foundation. 

The Committee recognizes epilepsy, a chronic neurological condition, as a significant public health concern affecting over 2,500,000 

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 the current model demonstration programs and public 

awareness campaigns funded last year that would improve access 

to health and other services to encourage early detection and treatment for children and others residing in rural, urban and otherwise 

medically underserved areas. The Committee supports the implementation of recommendations addressing access to specialty care 

for underserved and minority populations made in Living Well 

With Epilepsy II. The Committee is pleased that HRSA has 

partnered with a national voluntary epilepsy organization to carry 

out these activities and encourages HRSA to continue this partnership, the public awareness campaigns, and the demonstration programs. 

The Committee recognizes that numerous and challenging problems exist for native Hawaiian children and adolescent populations. The Committee urges children and adolescent focused initiatives be pursued to provide integrated services to this high risk 

population. 

The Committee commends the work of the Sudden Infant Death 

Syndrome Program Support Center, and encourages the Maternal 

and Child Health Bureau to continue its support of this important 

center. The Committee is pleased with the collaboration between 

the NIH and the SIDS and Other Infant Death Program Support 

Center to address the disproportionately high incidence of SIDS 

among African Americans. 

The Committee recognizes the critical role of the national network of hemophilia treatment centers in providing needed comprehensive care for bleeding disorders. The Committee urges HRSA 

to provide additional resources to ensure continued access to this 

model disease management network. 

Chronic Fatigue Syndrome [CFS] patients’ most crucial need is 

for effective, compassionate medical care. Through its demonstration grants program, HRSA has experience in piloting new, efficient ways of delivering health care services to those with emerging 

illnesses. The Committee encourages HRSA to develop model CFS 

clinical centers with the goal of delivering effective, multidisciplinary clinical care to persons with CFS. 

The Committee recognizes the critical role that Maternal and 

Child Health Centers for Leadership in Pediatric Dentistry Education provide in preparing dentists with dual training in pediatric 

dentistry and dental public health. Dentists in the three currently 
54 

funded programs concentrate on working with Federal, State and 

local programs that provide services for vulnerable populations including low-income children and women and children with special 

health care needs. Dentists trained through these centers provide 

State and community leadership in maternal and child oral health 

programs, and become future faculty specializing in pediatric dentistry and maternal and child health. The Committee encourages 

the Maternal and Child Health Bureau to extend this program to 

all regions. 

Traumatic Brain Injury Program 

The Committee provides $9,375,000 for the traumatic brain injury program. The fiscal year 2004 comparable level was 

$9,375,000 and the administration requested $9,375,000. 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. 

Healthy Start Initiative 

The Committee provides $105,000,000 for the healthy start infant mortality initiative. The fiscal year 2004 comparable level was 

$97,751,000 and the administration request was $97,751,000. 

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. 

The Committee urges HRSA to give preference to current and 

former grantees with expiring or recently expired project periods. 

This should include grantees whose grant applications were approved but not funded during fiscal year 2004. 

Universal Newborn Hearing Screening and Early Intervention 

The Committee provides $9,872,000 for universal newborn hearing screening and early intervention activities. The fiscal year 2004 

comparable level was $9,872,000 and the administration did not request funds for this program in fiscal year 2005. The Committee 

again rejects the administration proposal to consolidate this program into the Maternal and Child Health Block Grant program. 

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. 
55 

Emergency Medical Services for Children 

The Committee provides $20,360,000 for emergency medical services for children. The fiscal year 2004 comparable level was 

$19,860,000 and the administration requested $19,860,000 for this 

program in fiscal year 2005. The program supports demonstration 

grants for the delivery of emergency medical services to acutely ill 

and seriously injured children. 

The Committee continues to be pleased with the efforts made for 

the emergency medical services for children program. The 10 year 

Institute of Medicine [IOM] report and study was extremely helpful. The Committee is pleased and encouraged with the progress 

being made toward a 20 year update to the IOM report. 

Poison Control Centers 

The Committee provides $24,000,000 for poison control center activities. The fiscal year 2004 comparable level was $23,696,000 and 

the administration requested $23,696,000 for this program in fiscal 

year 2005. 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, including the new BioSense initiative. 

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. 

HIV/AIDS BUREAU

ACQUIRED IMMUNE DEFICIENCY SYNDROME

Ryan White AIDS Programs 

The Committee provides $2,079,861,000 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 2004 comparable level was $2,044,861,000 and the administration request was $2,079,861,000. 

Next to the Medicaid program, the Ryan White CARE Act (the 

CARE Act) is the largest Federal investment in the care and treatment of people living with HIV/AIDS in the United States. The 

CARE Act provides a wide range of community based services, including primary and home health care, case management, substance abuse treatment, mental health services, and nutritional 

services. 

Within the total provided, the Committee intends that Ryan 

White AIDS activities that are targeted to address the growing 

HIV/ AIDS epidemic and its disproportionate impact upon communities of color, including African Americans, Latinos, Native Ameri-
56 

cans, Asian Americans, Native Hawaiians, and Pacific Islanders 

continue with at least the level of funding provided in fiscal year 

2004. 

Advances in diagnosis, treatment, and medical management of 

HIV/AIDS 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 $615,023,000 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 $1,120,900,000 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 

$783,872,000 for AIDS medications. 

Early Intervention Program—Title III–B 

The Committee provides $197,170,000 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. 
57 

Women, Infants, Children, and Youth—Title IV 

The Committee provides $73,108,000 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. 

Title IV of the CARE Act provides a program of grants for coordinated services and access to research for women, infants, children 

and youth. Title IV grantees may engage in a broad range of activities to reduce mother-to-child transmission, including voluntary 

testing of pregnant women and treatment to reduce mother-to-child 

transmission. In addition, title IV grantees are required to provide 

individuals with information and education on opportunities to participate in HIV/AIDS clinical research. 

The Committee expects HRSA to maximize available funds under 

this part to existing grantees. The Committee is concerned that instructions to HRSA regarding the analysis of data pertaining to administrative costs in title IV have not been followed. The Committee strongly urges HRSA to collaborate with grantees under this 

title to produce necessary tools for the accurate collection of expense data. Unless HRSA can produce data regarding administrative expenses with a precise definition to ensure accuracy and comparability, the agency will be unable to impose a limitation on such 

expenses without harming the ability of grantees to provide services for women, children, youth and families infected with HIV. 

The Committee is aware of the efforts of title IV grantees to care 

for youth infected with HIV and urges HRSA to disseminate the effective practices and models of care developed by title IV grantees 

across all Ryan White CARE Act providers. 

Technical assistance may be provided to title IV grantees using 

up to 2 percent of the funds appropriated under this section. Within this amount sufficient funds exist to maintain the current activities of the national title IV grantee membership organization and 

its ability to provide technical assistance to title IV grantees and 

to conduct policy analysis and research. 

AIDS Education and Training Centers 

The Committee provides $35,335,000 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. 
58 

AIDS Dental Services 

The Committee provides $13,325,000 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. 

Telehealth 

The Committee provides $5,000,000 for telehealth activities. The 

fiscal year 2004 comparable level was $3,949,000 and the administration request was $3,949,000. The telehealth program funded 

through the Office for the Advancement of Telehealth promotes the 

effective use of technologies to improve access to health services for 

people who are isolated from healthcare and distance education for 

health professionals. 

Physician licensure is frequently identified as one of the most 

critical barriers to the increased use of telemedicine. There is a 

need to stimulate cooperation and communication among licensing 

authorities to address these issues and to facilitate multi-State 

practice, ensure public safety and create an environment for advancing telehealth services. The Committee has provided 

$1,000,000 above the fiscal year 2004 level to support incentive 

grants that would be used as authorized in the Health Care Safety 

Net Act of 2002 to develop and implement policies to reduce barriers to telehealth services. 

SPECIAL PROGRAMS BUREAU

Organ Donation and Transplantation 

The Committee provides $24,632,000 for organ transplant activi- ties. The fiscal year 2004 comparable level was $24,632,000 and 

the administration request was $24,632,000. 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 is encouraged by the initial success of Organ Donation Collaborative project and has included funds for its continuation. This project is focused on the nation’s largest hospitals and 

has adopted the goal of assisting these hospitals achieve organ donation rates of 75 percent or higher, which will result in at least 
59 

6,000 additional organs available for transplantation. The Committee also urges the agency to facilitate the adoption of a national 

system of simultaneous referrals of available organs as opposed to 

the current system of sequential or serial referrals, as this will further guarantee that all available organs are utilized. 

The Committee also urges an increase in grants or contracts to 

public and non-profit private entities for the purpose of carrying 

out studies and demonstration projects to increase and maximize 

organ donation and recovery rates, including living donation. 

The Committee commends HRSA for its leadership in promoting 

increased organ and tissue donations across the nation and encourages the Division of Transplantation to continue its partnership 

with the pulmonary hypertension community in this important 

area. Moreover, the Committee is aware that the Organ Procurement and Transplantation Network/United Network for Organ 

Sharing has issued a proposed rule governing the allocation of 

lungs for transplantation. The Committee encourages OPTN/UNOS 

to work with the pulmonary hypertension community to address its 

concerns regarding the methodology used to determine transplantation eligibility for pulmonary hypertension patients. 

National Cord Blood Stem Cell Bank Program 

The Committee has provided $9,941,000 for the National Cord 

Blood Stem Cell Bank Network. The fiscal year 2004 comparable 

level was $9,941,000 and the administration request was 

$9,941,000. 

The Committee continues to be supportive of the effort to build 

the Nation’s supply of cord blood stem cells available for therapy 

and research. The Committee is awaiting the conclusions of the Institute of Medicine study required by House Report 108–401 and 

expects fiscal year 2005 funds to be used as described in that report. 

National Bone Marrow Donor Program 

The Committee provides $22,662,000 for the National Bone Marrow Donor Registry. The fiscal year 2004 comparable level was 

$22,662,000 and the administration request was $22,662,000. 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. 

Trauma Care 

The Committee provides $4,000,000 for trauma/emergency medical services. The fiscal year 2004 comparable level was $3,449,000 

and the administration did not request funds for this program in 

fiscal year 2005. 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. 
60 

State Planning Grants for Health Care Access 

The Committee provides $8,000,000 for State Planning Grants 

for Health Care Access. The fiscal year 2004 comparable level was 

$14,810,000 and the administration did not request funding for this 

activity in fiscal year 2005. 

RURAL HEALTH PROGRAMS

Rural Health Policy Development Program 

The Committee provides $8,902,000 for the Rural Health Policy 

Development Program. The fiscal year 2004 comparable level was 

$8,902,000 and the administration request was $8,902,000. The 

funds provide support for the Office of Rural Health Policy to be 

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. 

Rural Health Care Services Outreach Grants 

The Committee provides $39,601,000 for health outreach grants. 

The fiscal year 2004 comparable level was $39,601,000 and the administration request was $11,098,000. This program supports 

projects that demonstrate new and innovative models of outreach 

in rural areas such as integration and coordination of health services. 

The Committee understands that many primary care clinics in 

isolated, remote locations are providing extended stay services and 

are not staffed or eligible to receive reimbursement for this service. 

The Committee encourages the agency to continue its support for 

a demonstration project authorized in the Medicare Modernization 

Act 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 without requiring costly 

medivacs. 

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 Alliance, 

which is a collaboration involving Delta State University, Mississippi State University, the University of Mississippi Medical 

Center, and the Mississippi State Department of Health. 
61 

Rural and Community Access to Emergency Devices 

The Committee provides $10,933,000 for rural and community 

access to emergency devices. The fiscal year 2004 comparable level 

was $10,933,000 and the administration request was $2,015,000. 

This includes $9,933,000 for the rural program under section 413 

of the Public Health Service Act and $1,000,000 for the community 

access demonstration under section 313. These programs provide 

grants to expand placement of automatic external defibrillators 

[AEDs] and to ensure that first responders and emergency medical 

personnel are appropriately trained. 

Rural Hospital Flexibility Grants 

The Committee provides $39,499,000 for rural hospital flexibility 

grants. The fiscal year 2004 comparable level was $39,499,000 and 

the administration request did not request funds for this program. 

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 $15,000,000 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. 

State Offices of Rural Health 

The Committee provides $8,390,000 for the State Offices of Rural 

Health. The fiscal year 2004 comparable level was $8,390,000 and 

the administration request was $8,390,000. 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. 

Rural Emergency Medical Services 

The Committee has provided $997,000 for the Rural EMS Training and Assistance Grants program. The comparable fiscal year 

2004 level was $497,000 and the administration did not request 

funding for this program in fiscal year 2005. 

Native and Rural Alaskan Health Care 

The Committee provides $41,794,000 for the Denali Commission. 

The fiscal year 2004 comparable level was $34,793,000 and the administration requested $22,000,000 for this program in fiscal year 

2005. 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. The Committee expects the Denali Commission to con-
62 

tinue its support of joint venture projects to replace the aging hospitals in Nome and Barrow. 

Family Planning 

The Committee provides $308,283,000 for the title X family planning program. The fiscal year 2004 comparable level was 

$278,283,000 and the administration request was $278,283,000. 

Title X grants support primary health care services at more than 

4,600 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 5 million women each year, many of whom 

are low-income and uninsured. 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). Due to these financial pressures, it 

will be difficult for title X clinics to serve the current number of 

patients, up 10 percent since 2000, 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. Any increases in funding in fiscal year 2005 are intended 

to address rising medical costs and must be spent on medical services and supplies. 

Community Based Abstinence Education Program 

The Committee has provided funding for the Community Based 

Abstinence Education and related programs in the Administration 

for Children and Families and the Office of the Secretary as proposed in the administration request. 

Health Care-related Facilities and Activities 

The Committee provides $371,536,000 for the construction and 

renovation (including equipment) of health care-related facilities 
63 

and other health care-related activities. The fiscal year 2004 comparable level was $371,536,000 and the administration did not request funds for this program in fiscal year 2005. This account 

makes funds available to public and private entities for the construction and renovation of health care-related facilities and other 

health care-related activities. 

Program Management 

The Committee provides $148,533,000 for program management 

activities for fiscal year 2005. The fiscal year 2004 comparable level 

was $148,533,000 and the administration request was 

$151,317,000. 

The Committee is pleased with the successful distribution of 

compassionate payments through the Ricky Ray Hemophilia Relief 

Fund to the many hemophilia victims who were infected with HIV/ 

AIDS through contaminated anti-hemophilia factor concentrates. 

The Ricky Ray Hemophilia Relief Fund terminated by law on November 12, 2003. The Committee has been advised of cases in 

which only one-half of the compassionate payment has been issued 

to the surviving parent. The Committee understands that HRSA 

has made budgetary arrangements in anticipation of potential additional payments. The Committee urges HRSA to work with members of the hemophilia patient community to complete this effort. 

Section 340B of the Public Health Service Act created the 340B 

Drug Discount Program to lower drug prices for over 10,000 public 

health grantees including community health centers and public 

hospitals. The Committee was disappointed to learn that participating entities were being overcharged for drugs purchased under 

the program. The Inspector General of Health and Human Services 

found that entities participating in the 340B Program did not receive the correct discount for 31 percent of sampled drug purchases 

made by the Inspector General in September of 2002 and estimated 

that grantees were overcharged over $41,000,000 during that one 

month period. The problem appears to be systemic. The Committee 

is concerned that HRSA does not have the technology or personnel 

to properly administer the program. In addition, HRSA does not 

supply entities with accurate pricing information to verify the 

charges made by the pharmaceutical industry. 

The Committee urges HRSA to allocate the necessary information technology and personnel resources needed to properly oversee 

this program. The Committee requests a report from HRSA no 

later than March 31, 2005 on how it plans to respond to the problems detailed by the Inspector General in its oversight of the 340(b) 

program. 

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 
64 

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 2004 comparable 

level was $25,000,000 and the administration request was 

$4,000,000. For administration of the HEAL Program including the 

Office of Default Reduction, the Committee provides $3,270,000. 

The fiscal year 2004 comparable level was $3,353,000 and the administration request was $3,270,000. 

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, 2004 ............................................................................. $69,190,000 

Budget estimate, 2005 ........................................................................... 69,176,000 

Committee recommendation ................................................................. 69,176,000 

The Committee provides that $69,176,000 be released from the 

vaccine injury compensation trust fund in fiscal year 2005, of which 

$3,176,000 is for administrative costs. The total fiscal year 2004 

comparable level was $69,190,000 and the total administration request was $69,176,000. 

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, 2004 ............................................................................. $4,579,299,000 

Budget estimate, 2005 ........................................................................... 4,462,654,000 

Committee recommendation ................................................................. 4,807,692,000 

The Committee provides a program level of $4,807,692,000 for 

the Centers for Disease Control and Prevention. The Committee 

recommendation includes $4,538,592,000 in budget authority and 

an additional $269,100,000 via transfers available under section 

241 of the Public Health Services Act. The fiscal year 2004 comparable program level was $4,579,299,000 and the administration 

request program level was $4,462,654,000. The Committee has also 

provided $1,239,571,000 in the Public Health and Social Services 

Emergency Fund for programs administered by CDC. 

The activities of the CDC focus on several major priorities: provide core public health functions; respond to urgent health threats; 
65 

monitor the Nation’s health using sound scientific methods; build 

the Nation’s health infrastructure to insure our national security 

against bioterrorist threats; promote women’s health; and provide 

leadership in the implementation of nationwide prevention strategies to encourage responsible behavior and adoption of lifestyles 

that are conducive to good health. 

The CDC portion of the Committee report has been organized in 

a manner that is broadly consistent with the new structure of CDC. 

To separate actual program costs from the administration of those 

programs, the Committee has reallocated all management and administrative costs (except those of the National Institute for Occupational Safety and Health) to two new accounts: Public Health 

Improvement and Leadership and Business Services Support. This 

will enable CDC to more easily interpret Congress’ intent with 

funding increases meant for either programs or administration of 

those programs. All comparisons to fiscal year 2004 levels and the 

budget request have been adjusted to reflect this reallocation. 

INFECTIOUS DISEASES

The Committee recommends $1,688,594,000 for infectious disease 

related programs at the CDC. The fiscal year 2004 comparable 

level was $1,654,394,000 and the administration requested a comparable level of $1,656,393,000 for fiscal year 2005. The Committee 

recommendation includes $12,794,000 in transfers available under 

section 241 of the Public Health Services Act. 

The Coordinating Center for Infectious Diseases includes the National Center for Infectious Diseases, the National Center for STD, 

TB, and HIV Prevention, and the National Immunization Program. 

Infectious Disease Control 

Within the total provided, the following amounts are provided for 

the specified activities above the comparable amount for fiscal year 

2004: $4,000,000 to expand west nile virus control activities; 

$6,000,000 to expand all other emerging infectious disease activities; and $1,000,000 to expand prion disease surveillance activities. 

All other activities are funded at the level of the administration’s 

request. 

These activities focus on: national surveillance of infectious disease; applied research to develop new or improved diagnoses; prevention and control strategies; working with State and local departments and private health care providers to transfer application of 

infectious disease prevention technologies; and strengthening the 

capability to respond to outbreaks of new or reemerging disease. 

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. 

Chronic Fatigue Syndrome.—The Committee commends the CDC 

for building the leading CFS program in the Nation, supporting 

crucial population studies, clinical and laboratory research and 
66 

education. The Committee directs CDC to provide sufficient resources to maintain the high caliber of this program. The Committee is very interested in CDC efforts to document the economic 

impact of the illness, to identify biomarkers using genomic and 

proteomics technology and to address health care providers’ inability to appropriately diagnose and treat CFS. Further, the Committee encourages CDC to better inform the public about this condition, its severity and magnitude and to use heightened awareness 

to create a registry of CFS patients to aid research in this field. 

Hepatitis.—The Committee has included sufficient funding for 

the National Hepatitis C Prevention Strategy, and urges that this 

funding be focused on expanding the capability of State health departments and national voluntary health organizations to provide 

hepatitis C testing and counseling as well as more aggressive outreach and medical referrals. The Committee is concerned that the 

CDC has reduced the number of hepatitis C prevention demonstration project sites from 15 sites to only 5 sites in fiscal year 2005. 

The Committee urges CDC to reconsider the closing of these 10 

sites, and encourages CDC to begin implementation of a National 

Hepatitis C Prevention and Control program. 

The Committee is concerned that more than 75 percent of the 4 

million HCV positive individuals are unaware of their condition 

and therefore urges a campaign of public announcements to urge 

appropriate screening and medical follow up of target populations. 

The Committee urges the expansion of cooperative agreement programs with national voluntary health organizations to meet this 

and other public health goals of CDC’s Division of Viral Hepatitis. 

Finally the Committee is concerned with increasing rates of adult 

infection with hepatitis A and B, and urges that an expanded vaccination program be launched in response to this health issue. 

The Committee continues to be concerned about the prevalence 

of hepatitis and urges CDC to work with voluntary organizations 

and professional societies to promote liver wellness with increased 

attention toward education and prevention. In addition, the CDC 

is urged to continue to support the activities of the National Viral 

Hepatitis Roundtable. 

Patient Safety.—The Committee encourages the CDC to continue 

the National Health Care Safety Network, a national electronic 

medical error/adverse events monitoring system. This system will 

encompass a representative sample of U.S. hospitals, managed care 

organizations, long-term care facilities, and other healthcare 

venues linked to health departments and CDC. The Committee 

also encourages the CDC to enhance the capacity for detection and 

response to medical errors and other adverse healthcare events at 

State and local levels through active monitoring, improved epidemiologic/root cause investigation, and onsite intervention to promote patient safety and improve patient outcomes. These efforts 

will enable the CDC to promote research on preventing medical errors and adverse healthcare events through feedback on adverse 

outcomes. 

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. 
67 

Sepsis.—The Committee is aware that sepsis, an overwhelming 

systemic response to infection that leads to organ dysfunction and 

death, kills more that 215,000 Americans every year. The Committee understands that new treatments have been developed 

which significantly improve prognosis when sepsis is diagnosed in 

a timely fashion. In addition, new guidelines have been developed 

to aid health care professionals in identifying the syndrome. Unfortunately, too few medical personnel know how to properly diagnose 

sepsis. To improve patient outcomes, the Committee encourages 

CDC to develop a sepsis education program to train infectious disease physicians, emergency room doctors, and critical care nurses 

in the proper identification of sepsis. 

HIV, STD, and TB Prevention 

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 yet 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. 

The Committee is concerned by the high rates of HIV infection 

among young men who have sex with men in the United States. 

Data recently reported at the International AIDS Conference in 

Barcelona indicate that infection rates are nine times higher for 

gay men than for women and heterosexual men and that African 

Americans and Latinos are at particularly high risk. The Committee urges the CDC to develop and implement new approaches 

to reach young men with life-saving HIV prevention services. 

Microbicides.—The Committee commends CDC for recognizing 

the urgent public health need to develop new HIV prevention options by supporting microbicide research and development, and has 

provided sufficient funding to continue these activities. CDC’s role 

is particularly important in the clinical evaluation of potential new 

products as set forth in CDC’s HIV Prevention Strategic Plan and 

its topical microbicide 5-year research agenda. 

Tuberculosis.—The Committee is pleased with the efforts of the 

tuberculosis control program, which has reduced the number of 

new tuberculosis cases for the past 10 years. However, the number 

of new tuberculosis cases in foreign-born individuals in the United 

States remains a concern. Although tuberculosis rates have been 
68 

falling, the Committee is aware that similar low rates have been 

achieved in the past only to see a reemergence of the disease due 

to inadequate control efforts. In the end, any savings achieved during that period were more than used to again gain control of the 

incidence of the disease. The Committee has provided $3,200,000 

over the fiscal year 2004 level to expand tuberculosis control efforts 

to prevent a similar reemergence. The Committee urges CDC to 

work with the U.S. Citizenship and Immigration Services [USCIS] 

to develop novel tuberculosis screening strategies for individuals 

emigrating from high tuberculosis incidence countries. The Committee encourages CDC to consider implementing screening programs for high-risk individuals residing in the United States for latent tuberculosis. The Committee also encourages the CDC to expand efforts to reduce racial disparities in tuberculosis incidence in 

the Southeastern United States. African-Americans in the Southeast bear a disproportionate burden of tuberculosis. 

Tuberculosis is an enormous and deadly problem in the developing world, killing millions of people in the prime of their lives 

every year. Approximately 2 billion people (30 percent) have been 

infected with Mycobacterium tuberculosis, the causative agent of 

TB. Tuberculosis is a leading cause of death in HIV-infected individuals and in women of childbearing age. Each year, TB takes the 

lives 2 million people and there are 8 million new cases; another 

million die of the combination of HIV and TB. Among infectious 

diseases, only HIV and diarrheal diseases kill more people. The 

worldwide pandemic of tuberculosis continues largely unabated in 

spite of increased attention to the disease globally, the expansion 

of DOTS (Directly Observed Therapy—Short course) therapeutic regimes, and the widespread use of an existing vaccine against tuberculosis. Clearly a better vaccine against tuberculosis is urgently 

needed. Modeling studies show that a modestly effective vaccine 

(50–70 percent efficacious) used in combination with drug therapy 

could save tens of millions of lives, and a highly effective vaccine 

could eventually control the disease. The Committee encourages 

the CDC to continue the TB vaccine research cooperative agreement in partnership with the leading private foundation conducting 

clinical field site trial work on tuberculosis vaccines. The Committee encourages CDC to provide leadership and technical assistance on field site development and surveillance. 

The Committee is aware that the Centers for Disease Control 

[CDC] has developed a new funding formula for the 2005 CDC Tuberculosis [TB] Prevention and Control. This formula calculation is 

a major step forward and the Committee recognizes CDC for taking 

into account the burden of this disease and the complexity of cases. 

The Committee also notes that CDC intends to make 20 percent of 

these funds available on a per-case basis in fiscal year 2005 and 

35 percent of these funds on a per-case basis by fiscal year 2008. 

The success of TB control in the United States depends on the ability of States to maintain past gains in TB control and move toward 

TB elimination. The Committee encourages CDC to use all of the 

increased funding provided to maximize the percentage of TB control funds available on a per-case basis while ensuring that no 

State receives less funding than it received in fiscal year 2004. The 
69 

Committee further requests that CDC identify the optimal percentage of funding that should be distributed on a per-case basis. 

Immunization 

The Committee recommends $488,789,000 for the program authorized under section 317 of the Public Health Service Act. The 

fiscal year 2004 comparable level was $468,789,000 and the administration requested $468,789,000 for fiscal year 2005. The Committee recommendation includes $12,794,000 in transfers available 

under section 241 of the Public Health Service Act. 

The Omnibus Reconciliation Act [OBRA] of 1993 established a 

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 primarily 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. 

Vaccine Stockpiles.—The Committee is concerned that recent interpretations of revenue recognition guidelines of the Securities 

and Exchange Commission may jeopardize the three-decade history 

of stockpiles and prevent the establishment and continued maintenance of stockpiles managed by the Department of Health and 

Human Services containing both childhood vaccines and bio-de-
70 

fense medical countermeasures. The Committee requests that the 

Secretary of Health and Human Services, after consultation with 

the Securities and Exchange Commission and other appropriate 

agencies, submit a report and recommendations within 90 days to 

the Committee. The report should include what administrative actions are being taken, solutions proposed, or identify what legislative clarification may be necessary to resolve this problem. 

Vaccine Tracking.—The Committee is pleased by CDC’s development of the Surveillance, Preparedness, Awareness and Response 

System and has included $5,000,000 to continue and expand these 

efforts. In light of vaccine shortages that have occurred over the 

past several flu seasons, the Committee understands that this system could serve as a valuable surveillance and tracking system for 

private and public sector inventory levels of vaccine. Increases in 

funding should be directed toward system expansion to include 

pharmaceuticals and other products that would be necessary in the 

medical treatment of disease and injury resulting from natural or 

manmade disease outbreaks beyond that currently provided by the 

strategic national stockpile. 

HEALTH PROMOTION

The Coordinating Center for Health Promotion includes the National Center for Chronic Disease Prevention and Health Promotion and the National Center for Birth Defects and Developmental Disabilities. 

The Committee recommends $988,090,000 for Health Promotion 

related activities at the CDC. The fiscal year 2004 comparable level 

was $932,067,000 and the administration requested $989,780,000. 

CHRONIC DISEASE PREVENTION AND HEALTH PROMOTION

Within the total provided, the following amounts are provided for 

the specified activities above the comparable amount for fiscal year 

2004: $5,000,000 to expand Heart Disease and Stroke related activities; $5,000,000 to expand Diabetes related activities; 

$24,300,000 to expand Cancer Prevention and Control activities; 

$2,000,000 to establish an Alzheimer’s Disease component of the 

Healthy Aging program; $800,000 to expand Inflammatory Bowel 

Disease related activities; $700,000 to initiate activities related to 

Interstitial Cystitis; $15,000,000 to expand Tobacco related activities; $6,000,000 to expand Nutrition, Physical Activity, and Obesity 

Programs; $2,000,000 to establish the Pioneering Healthier Communities Activities with the YMCA of the USA; $1,000,000 to expand the Behavioral Risk Factor Surveillance System; $200,000 to 

expand Mind-Body related activities; $1,000,000 to expand Glaucoma Screening and Visual Screening Education programs; 

$600,000 to expand oral health related activities; $5,000,000 to expand Prevention Center activities; $5,000,000 to expand the Steps 

to a Healthier U.S. program. All other activities are funded at the 

level of the administration’s request. 

Chronic diseases have had a profound human and economic toll 

on our Nation. Nearly 125 million Americans today are living with 

some form of chronic condition, including cancer, cardiovascular 

disease, diabetes, arthritis, and various neurological conditions 

such as epilepsy. These and other chronic diseases now account for 
71 

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. 

Behavioral Risk Factor Surveillance System.—The Committee 

has provided $1,000,000 above the fiscal year 2004 level 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 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 amounts are provided for the specified activities above the comparable amount for 

fiscal year 2004: $9,000,000 to expand breast and cervical cancer 

related activities; $5,000,000 to expand cancer registries; 

$2,000,000 to expand colorectal cancer activities; $7,000,000 to expand comprehensive cancer activities; $100,000 to expand ovarian 

cancer activities; $100,000 to expand prostate cancer activities; 

$100,000 to expand skin cancer activities; and $1,000,000 to establish the Cancer Survivorship Resource Center. All other activities 

are funded at the level of the administration’s request. 

Breast and Cervical Cancer.—CDC’s National Breast and Cervical Cancer Early Detection Program has provided more than 3 

million potentially life-saving screening tests for women. Despite 

its success in screening these women, the program is still only able 

to screen 15–20 percent of the eligible population due to the difficulties in finding these hard to reach women. Therefore, the Committee recommends that 50 percent of funds be used for actual provision of screening and clinical services and the remaining 50 per-
72 

cent of funds be used by States for outreach, effective management, 

public and professional education, and quality assurance to ensure 

enhancement of infrastructure development activities that will provide screening and diagnostic services to eligible women. The Committee’s recommendation will enable more women to receive these 

vital screening services. 

Cancer Survivorship Resource Center.—The Committee applauds 

the partnership between CDC and the Lance Armstrong Foundation [LAF] to address the needs of the nearly 10 million cancer survivors by expanding the agency’s State-based comprehensive cancer 

control program to include issues of survivorship, as outlined in the 

recently released National Action Plan for Cancer Survivorship. 

The Committee supports the development and expansion of Live 

Strong to serve as a national resource for cancer patients, survivors, and their family and friends. Therefore, the Committee provides $1,000,000 to enhance the Live Strong cancer survivorship resource center. 

Colorectal Cancer.—Colorectal Cancer is the third most commonly diagnosed cancer in both men and women in the United 

States, and the second leading cause of cancer related deaths. In 

2003, approximately 147,000 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 pleased with the leadership of CDC’s 

National Colorectal Cancer Roundtable in promoting the availability and advisability of screening to both health care providers 

and the general public. The Committee encourages the CDC to continue to expand its partnerships with State health departments, 

professional and patient organizations, and private industry to 

combat this devastating disease. 

Comprehensive Cancer Control.—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. CDC is funding 

States to develop comprehensive cancer control programs that help 

build the foundation for a nationwide, comprehensive cancer control program. Comprehensive cancer programs integrate the full 

range of cancer prevention activities including research, evaluation, 

health education and communication, program development, public 

policy development, surveillance, and clinical services. The Committee has provided increased funding to expand the number of 

health agencies funded for comprehensive cancer control and support research and cancer tracking to develop, implement, and 

evaluate comprehensive approaches to cancer prevention at the 

State and community level. 
73 

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 is creating an archive of tested and analyzed blood samples. As the program moves forward and one time costs are met, the Committee 

urges the CDC to direct an increasing amount of the funds available to active patient recruitment, education and awareness, and 

related services. 

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 Alliance 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 Alliance in addressing the 

chronic health issues of the Mississippi Delta. 

Diabetes.—The Division of Diabetes Translation [DDT] is charged 

with addressing diabetes public health issues across the country. 

This is done primarily through funding State Diabetes Prevention 

and Control Programs. The Committee encourages CDC to fund as 

many States as possible at the basic implementation level. 

Today, approximately 16 million Americans have diabetes, including 5.9 million who do not know they have the disease. Diagnosed diabetes rose 49 percent nationally between 1990 and 2000. 

Type 2 diabetes, once considered an adult disease, is now found in 

children. Recently released results from the largest-ever clinical 

study on diabetes prevention confirmed that diabetes can be prevented in high-risk adults. The NIH-led and CDC-supported Diabetes Prevention Program demonstrated that sustained lifestyle 

change, including modest weight loss and physical activity, resulted in prevention of diabetes in those diagnosed as ‘‘pre-diabetic’’. Sixteen million Americans are ‘‘pre-diabetic’’. The Committee has provided $5,000,000 over the fiscal year 2004 funding 

level for diabetes-related activities at the CDC. The Committee encourages CDC to work with State Diabetes Control Programs to establish pilot projects to test strategies that will become effective 

public health interventions to prevent or significantly delay the 

onset of diabetes in high-risk individuals and develop systems to 

identify and monitor the number of people who are at highest risk 

for developing diabetes. 

Diabetes Education.—The Committee is concerned about the over 

18 million Americans currently living with diabetes, a number that 

is increasing every year and is estimated to reach almost 10 percent of the total U.S. population by the year 2025. In response to 

this public health crisis, the Committee applauds CDC for its new 

cooperative agreement, which is intended to ensure early diagnoses 

of people with diabetes and the best treatment and care of those 
74 

trying to manage the disease. The Committee encourages CDC to 

work in partnership with diabetes educators to identify strategies 

for evaluating the effectiveness of diabetes education in improving 

the self-care of people with diabetes and in reducing risk factors for 

diabetes. 

Epilepsy.—The Committee continues to strongly support the CDC 

epilepsy program to make progress in research, epidemiology and 

surveillance, early detection, improved treatment, public education 

and expansion of interventions to support people with epilepsy and 

their families in their communities. The Committee understands 

that the ‘‘Living Well II’’ public health agenda conference will take 

place again this year using these funds. 

Food Marketing.—The Committee commends the CDC on the initiation of a food marketing study as requested in the fiscal year 

2004 report and has included sufficient funding for the continuation of those efforts. 

Geraldine Ferraro Cancer Education Program.—In fiscal year 

2004, Congress provided funding to initiate the Geraldine Ferraro 

Cancer Education Program, as authorized by the Hematological 

Cancer Research Investment and Education Act of 2002. The Committee is pleased that CDC has established a cooperative agreement program with national health organizations to develop strategies to provide information and education for patients, their family 

members, friends, and caregivers with respect to hematologic cancers. The Committee expects CDC to increase efforts to address 

hematologic cancer survivorship issues and improve quality of national hematologic data. The Committee strongly encourages CDC 

to support activities related to the development of interactive web 

based education for health care providers on the signs, symptoms 

and current treatment of blood cancer by comprehensive cancer 

centers. 

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 eyerelated disorders, especially glaucoma. The Committee has included 

$300,000 above the fiscal year 2004 level for CDC to expand vision 

screening and education programs in partnership with national voluntary health agencies and for CDC to continue 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 $700,000 above the fiscal 

year 2004 level to expand a model project that is testing and evaluating the efficacy of glaucoma screening using mobile units. 

Healthy Aging and Alzheimer’s Disease.—Recent preliminary 

studies suggest that some of the same strategies that preserve 

overall health may also help prevent or delay Alzheimer’s disease 

and dementia. For example, epidemiological studies have revealed 
75 

that individuals taking anti-inflammatory drugs to treat conditions 

such as arthritis appear to have a lower-than-expected occurrence 

of Alzheimer’s disease. Furthermore, a growing body of evidence 

appears to link known risk factors for diabetes, heart disease, including high blood pressure and high cholesterol, and risk factors 

for Alzheimer’s disease and dementia. Additionally, evidence supports that maintaining intellectual and physical activity and remaining socially connected may also help stave off dementia. In 

light of this information, the Committee strongly urges the CDC to 

work with the Alzheimer’s Association to design and launch an Alzheimer’s-specific segment of the Healthy Aging Program, to aggressively educate the public and health professionals as to ways to reduce the risks of developing Alzheimer’s by maintaining a healthy 

lifestyle. The Committee has provided $2,000,000 for this initiative. 

CDC should also coordinate this effort with the National Institute 

on Aging and the Administration on Aging. 

Heart Disease and Stroke.—The Committee commends the CDC 

for convening national leaders across Federal and State Governments and voluntary and professional organizations to develop and 

release A Public Health Action Plan to Prevent Heart Disease and 

Stroke. The Committee is concerned about the more than 64 million Americans who live with the often disabling consequences of 

heart disease, stroke and other cardiovascular diseases. The Committee strongly urges the CDC to expand, intensify and coordinate 

heart disease and stroke prevention activities, such as enhancing 

both the State Heart Disease and Stroke Prevention Program and 

the Paul Coverdell National Acute Stroke Registry. The funds provided will allow the CDC to initiate a health communications campaign about heart attack and stroke signs and symptoms, and public and health care provider education, and invest in standardized 

methodology on lipid and other measurements. Concerned that the 

CDC lacks a Division to address heart disease and stroke, the Committee encourages the agency to consolidate and elevate its efforts 

on these diseases by creating a Heart Disease and Stroke Division. 

The Committee is aware that many States still need a State-based 

heart disease and stroke prevention program. The Committee 

strongly believes that each State should receive funding for basic 

implementation of a State Heart Disease and Stroke Prevention 

Program and has included additional funding to move toward that 

goal. The Committee has provided $5,000,000 above the fiscal year 

2004 level for heart disease and stroke-related activities. 

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]. An epidemiological study of IBD is needed to gain a better 

understanding of the prevalence of IBD in the United States and 

the demographic characteristics of the IBD patient population. 

Over the last 3 years, the Crohn’s and Colitis Foundation of American has provided the CDC with a $750,000 to initiate this epidemiological study. Now that this project has been established 

through an investment by the patient community, the Committee 

has provided $800,000 to continue this study. 

Juvenile Diabetes.—The Committee appreciates the CDC’s participation and coordination with the National Institute of Diabetes 
76 

and Digestive and Kidney Diseases [NIDDK] on the Genetics of 

Kidneys in Diabetes [GoKinD] Study. The GoKinD Study collection 

provides a unique opportunity to study the genetics of renal disease 

in a well-defined population. CDC and NIDDK are charged with 

ensuring that the collection becomes available to the research community, to accelerate progress in the prevention and treatment of 

kidney disease in diabetes. 

Interstitial Cystitis.—The Committee is aware that it takes an 

average of 5 to 7 years for patients to obtain an accurate diagnosis 

of interstitial cystitis [IC]. The Committee has provided $700,000 

to CDC to educate the public and medical communities about interstitial cystitis. To implement this initiative, CDC should partner 

with a voluntary patient organization dedicated to assisting persons with IC to support activities targeted at disseminating information regarding IC identification, diagnosis and support services 

for both families and health care providers. 

Lung Cancer.—The Committee urges the CDC through its Cancer Registries Program and in coordination with the Comprehensive Cancer Control Program to conduct a study that would analyze 

the current trends of lung cancer screening and would evaluate the 

number of people currently screened for lung cancer; how lung cancer screening is being promoted; which screening methods are 

being promoted; how the benefits and risks of screening are communicated by health professionals to at risk populations; determine 

if shared decision making taking place; and attempt to measure 

trends in the number of biopsies being performed following screening exams and trends in the stage of lung cancer diagnosis. 

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 CDC 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. 

Nutrition, Physical Activity and Obesity.—Obesity is rampant 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 has included $6,000,000 over the fiscal year 2004 level for 

Nutrition, Physical Activity, and Obesity related activities. 

The significance of the rising epidemic of overweight and obesity 

among our Nation’s children has been widely acknowledged. The 
77 

current trajectory of its continuing increase indicates grave consequences for our young people, as being overweight in youth sets 

the stage for a lifetime of being overweight. In the U.S., more than 

6 million, or approximately 1 in 12, children are living in households headed by grandparents or other relatives. And, in some 

locales, the rate is as high as one in five. In many of these households, grandparents and other relatives are the primary caregivers. 

While some programs focusing on childhood overweight and obesity 

include a component that involves parents, grandparents and other 

caregivers often are overlooked. The Committee encourages CDC to 

develop model programs that assist African American and Hispanic 

grandparents in encouraging their grandchildren to eat more 

healthfully and be more physically active. 

Pain Management.—Millions of Americans, the vast majority of 

whom do not receive proper treatment, suffer from chronic pain. 

The Committee encourages the CDC to develop physician education 

and training programs related to optimal diagnosis and treatment 

of chronic pain. CDC should establish a plan to disseminate information to physicians and to educate patients about treatment options available for the management of chronic pain. 

Paul Coverdell National Acute Stroke Registry.—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 developed and conducted prototypes for this Registry from 

2001–2003 and plans to fund three State Registries in 2004 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 encourages the CDC to fund as many additional State Registries as 

possible. 

Pioneering Healthier Communities.—The Committee commends 

the YMCA of the USA for its work toward developing healthier 

communities through its Pioneering Healthier Communities conference. The Committee has included $2,000,000 to support these 

communities in the implementation of their community action 

plans and to support the annual Pioneering Healthier Communities 

conference to enable additional communities to benefit from this effort. 

Prader-Willi Syndrome.—Prader-Willi Syndrome is the most 

common known genetic cause of life-threatening obesity in children. The Committee encourages the CDC to initiate a study of the 

incidence rate of Prader-Willi Syndrome and to provide a system 

for tracking the complications from the syndrome including causes 

of premature death. Additionally, early diagnosis and treatment is 

crucial to the proper treatment of Prader-Willi Syndrome and can 

significantly reduce the long term care costs. The Committee encourages the CDC to develop and disseminate educational materials to clinicians, educators, and parents in collaboration with voluntary organizations. 

Pregnancy Risk Assessment Monitoring System.—The Committee 

encourages CDC to expand the Pregnancy Risk Assessment Monitoring System [PRAMS] to enable CDC to make national estimates 

on behavioral and demographic risk factors for preterm birth. Data 
78 

collected through PRAMS is used to increase understanding of maternal behaviors and experiences and their relationship to adverse 

pregnancy outcomes, to develop and modify maternal and child 

health programs, and to help incorporate the latest research findings in standards of practice. 

Prevention Research Centers.—The Committee has provided $5,000,000 over the fiscal year 2004 funding level for prevention research centers [PRCs], which are a network of academic centers, 

public health agencies, and community partners conducting applied 

research and practice in chronic disease prevention and control. 

Partners design, test, and disseminate strategies that help build 

evidence-based interventions for public health programs. In this capacity, PRCs serve a unique role to address the gaps that exist in 

putting research findings and the translation of findings into public 

health practice and policy change. Within the amount provided, the 

Committee expects that CDC will be able to ensure that all currently funded centers will continue to receive funding. 

Prostatitis.—The Committee understands that chronic prostatitis 

affects 10 percent of the male population and may act as a reservoir for bacterial resistance and contribute to the spread of 

chronic disease in men and women by various pathogens. The Committee urges the CDC to continue and expand its investigation of 

the etiology of prostatitis. 

Pulmonary Hypertension.—The Committee continues to be interested in pulmonary hypertension [PH], a rare, progressive and fatal 

disease that predominantly affects women, regardless of age or 

race. PH causes deadly deterioration of the heart and lungs and is 

a secondary condition in many other serious disorders such as 

scleroderma and lupus. Because early detection of PH is critical to 

a patient’s survival and quality of life, the Committee continues to 

encourage CDC to give priority consideration to supporting a cooperative agreement with the pulmonary hypertension community designed to foster greater awareness of the disease. 

School Health.—The Committee applauds CDC for establishing 

effective coordinated school health programs in States and local 

education agencies. The Committee has included sufficient funding 

to continue addressing risk behaviors such as tobacco use, 

unhealthy diets, and physical inactivity. 

Sleep Disorders.—The Committee is concerned about the prevalence of sleep disorders and recognizes the need for enhanced public and professional awareness on sleep and sleep disorders. The 

Committee urges CDC to work with other agencies and voluntary 

health organizations to support the development of a sleep education and public awareness initiative. Several agencies have had 

success with this collaborative model. 

Steps to a Healthier United States.—The Committee applauds the 

Department’s continued 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 increased funding for this initiative and 

also increased existing programs within CDC that are aimed at 

obesity, diabetes, and asthma. The Committee strongly urges CDC 
79 

to coordinate the efforts of these programs such that the best possible outcome is achieved using these funds. 

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 continues to encourage CDC 

to implement projects to demonstrate the effectiveness of the death 

scene protocol in a variety of locales (urban, suburban, and rural) 

throughout the Nation. The Committee looks forward to reports of 

progress on this initiative as was requested in the fiscal year 2004 

Committee report. 

Tobacco Use.—In fiscal year 2004, the Committee approved a re- programming request by the Secretary to provide $15,000,000 in 

competitive grants to States that wanted to upgrade their existing 

tobacco quitlines or initiate new ones. This reprogramming was financed in fiscal year 2004 by reducing from 12 to 9 months the 

project period for ongoing tobacco control grants to States. The 

Committee understood at that time that this would have no impact 

on ongoing State operations, as CDC would accelerate by 3 months 

the date that continuation grants are issued in fiscal year 2005. 

The Committee has provided $15,000,000 above the fiscal year 

2004 level for tobacco-related programs. This will ensure that both 

the tobacco control grants and the tobacco quitline grants are able 

to continue with at least the fiscal year 2004 funding levels. 

WISEWOMAN Program.—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, tens of thousands of 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. 

Worksite Health Promotion.—The Committee commends CDC for 

its efforts to evaluate worksite health promotion programs including the impact that such programs have on reducing health risks, 

health insurance costs, and employee absenteeism. The Committee 

encourages CDC to develop an employer wellness model program 

based on the results of these studies and disseminate that information to businesses. 

Birth Defects, Developmental Disabilities, Disability and Health 

Within the total provided, the following amounts are provided for 

the specified activities above the comparable amount for fiscal year 

2004: $1,000,000 to expand autism surveillance, awareness, and 

education activities; $250,000 to expand activities related to Fetal 
80 

Alcohol Syndrome; $1,000,000 to initiate activities related to Fragile X; $400,000 to expand the National Spina Bifida Program; 

$1,000,000 to expand the craniofacial malformation program; 

$1,000,000 to continue the Fetal Death Prevention program; 

$600,000 to establish a Diamond Blackfan Anemia public health 

outreach and surveillance program; $500,000 to expand activities 

related to Tourette Syndrome; $1,500,000 to expand surveillance 

and epidemiological efforts of Duchenne and Becker muscular dystrophies; $1,500,000 to expand support for the Special Olympics 

Healthy Athletes Initiative; $1,000,000 to expand Rehabilitation 

Treadmill Therapy activities; and $250,000 to expand the work of 

the Attention Deficit Resource Centers. All other activities are 

funded at the level of the administration’s request. 

Attention Deficit Hyperactivity Disorder.—The Committee understands that current estimates indicate that as many as 7 percent 

of school-age children have Attention-Deficit/Hyperactivity-Disorder 

[AD/HD] and more than two-thirds of these children will continue 

to experience symptoms through adulthood. Only half of all children with AD/HD receive necessary treatment with lower care 

rates among girls, minorities and children in foster care. The Surgeon General has reported a severe lack of professions trained to 

diagnose and treat the condition effectively. The Committee continues to support the National Resource Center on AD/HD and has 

provided $250,000 above the fiscal year 2004 level to expand the 

activities at the 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.—The Committee acknowledges the importance of CDC’s 

work in the area of autism surveillance, research, and awareness, 

and has provided $1,000,000 above the fiscal year 2004 level to continue and expand the autism-related programs. 

Childhood Obesity Prevention in Children with Special Health 

Care Needs.—As authorized under Title XXIV of the Children’s 

Health Act of 2000, the Committee encourages the CDC to fund 

public health research, surveillance and educational activities related to obesity among children with special health care needs, 

with a special emphasis on children with Prader-Willi Syndrome. 

Craniofacial Malformation.—The Committee has included 

$1,000,000 over the fiscal year 2004 level to build on its initiative 

to help families of children with craniofacial malformations. The 

Committee recommends that these funds be used to work with one 

or more of CDC’s Centers for Birth Defects Research and Prevention to collect data on the prevalence of these malformations, the 

ability of families to access services, and the long-term outcomes 

associated with craniofacial malformation. Funds are also available 

for CDC to work with a national voluntary organization to analyze 

and disseminate this information. 

Diamond Blackfan Anemia.—The Committee has included 

$600,000 to establish a public health outreach and surveillance 

program for Diamond Blackfan anemia. These funds should be 

used to (a) educate clinicians and blood disorder treatment centers 

about DBA and how to diagnose it and (b) collaborate with a Clin-
81 

ical Care Center, which already has significant experience in treating DBA patients, to create a critical mass of DBA expertise where 

DBA patients may be referred. 

Disability and Health.—The Committee urges the CDC to significantly expand and strengthen its investment in the public health 

research, surveillance activities, and dissemination of scientific and 

programmatic health promotion and wellness information for children and adults with disabilities. 

Down Syndrome.—The Committee encourages the CDC to conduct two epidemiological studies on Down syndrome to (1) obtain 

an accurate estimate of the number of people in the United States 

living with the disorder and to identify them by age and ethnic 

group, and (2) to document the onset and course of secondary and 

related developmental and mental disorders in individuals with 

Down syndrome. The Committee commends the National Center 

for Birth Defects and Developmental Disorders for planning and 

initiating these studies in fiscal year 2004. 

Fetal Alcohol Spectrum Disorders.—The Committee recognizes 

that prenatal alcohol exposure is the leading known cause of mental retardation 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. 

Each year, approximately 40,000 children are born with Fetal Alcohol Spectrum Disorders [FASD]. This amounts to almost 1 out of 

100 live births, with a disproportionate impact on underserved 

American Indian and African American populations. The Committee has provided $250,000 over the fiscal year 2004 level for 

FASD-related programs and recommends that the CDC expand 

surveillance efforts to document the magnitude of the problem and 

continue to support the development of an information clearinghouse on FASD and the dangers of drinking while pregnant. 

Fetal Deaths.—CDC has reported that fetal deaths at 20 weeks 

gestation or greater account for nearly as many deaths as those 

that occur to infants during the first year of life. The Committee 

understands that prevention strategies must first recognize fetal 

deaths as a public health problem, improve fetal death surveillance 

and reporting, and conduct research to understand the causes of 

fetal death. To that end, the Committee has included $1,000,000 

for a demonstration project with several States to link existing 

birth defect surveillance systems and fetal death registries and to 

use that data to help develop strategies to reduce fetal deaths. 

Fragile X.—The Committee believes that the CDC’s focus on 

maximizing prevention potential, minimizing impact on families 

and promoting early intervention through developmental screening 

should incorporate individuals affected by Fragile X. To support 

this effort, CDC is encouraged to create a Fragile X public health 

program to expand surveillance and epidemiological study of Fragile X, as well as provide patient and provider outreach on Fragile 

X and other developmental disabilities in collaboration with voluntary organizations, such as the National Fragile X Foundation. 

The Committee has provided $1,000,000 to support these activities. 

Muscular Dystrophies.—The Committee is concerned with the 

pace of the development of the CDC Birth Defects Surveillance program covering the muscular dystrophies and recommends that the 
82 

agency substantially increase the internal staff commitment to the 

program. The Committee has provided $1,500,000 above the fiscal 

year 2004 level to expand these activities. Within the increase, the 

Committee has provided $500,000 to initiate a coordinated education and outreach initiative in collaboration with a volunteer organization, such as the Parent Project Muscular Dystrophy. 

Paralysis Resource Center.—More than 2 million Americans live 

with paralysis, including spinal cord injury, stroke, multiple sclerosis, cerebral palsy, spina bifida and, ALS. Those living with paralysis have a desperate need for information and support to improve their health and quality of life. 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 keep up with the exploding 

demand for information and support services, the Committee has 

provided sufficient funds to continue to support the Paralysis Resource Center at no less than the fiscal year 2004 level. 

Regional Centers for Birth Defects Research and Prevention.—The 

Committee encourages CDC to expand research activities conducted by the 10 regional Centers for Birth Defects Research and 

Prevention. The centers are located in Arkansas, California, Georgia, Iowa, Massachusetts, New Jersey, New York, North Carolina, 

Texas, and Utah. These centers are participating in the National 

Birth Defect Prevention Study, the largest case-control study of 

birth defects ever conducted. The Committee is deeply concerned 

that for the first time since 1958, infant mortality rates have increased, and therefore encourages the expansion of studies on the 

causes of birth defects, the leading cause of infant mortality. 

Rehabilitation Treadmill Therapy.—The Committee provides 

$1,000,000 over the fiscal year 2004 level to continue and expand 

programs that translate clinical rehabilitation treadmill therapy research to community based settings and to train health care professionals to appropriately deliver this promising therapy. Within the 

additional funding provided, $500,000 is to continue and expand 

the existing demonstration programs in collaboration with the 

Christopher Reeve Paralysis Foundation. The remaining $500,000 

is to be used by CDC to evaluate the feasibility of widespread implementation of these rehabilitation programs. 

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 provides $400,000 above the 

budget request to expand the the National Spina Bifida Program. 

Within the total provided, $200,000 is to partner with a national 

voluntary organization for the creation of a National Spina Bifida 

Clearinghouse and Resource Center to meet the current and grow-
83 

ing demand for information and support services for individuals 

and families affected by Spina Bifida. 

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. The Committee has included $1,500,000 above the 

fiscal year 2004 level for this program. 

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. 

Thrombophilia.—The Committee understands that at least 1 in 

15 Americans has thrombophilia, which increases their risk of developing life threatening thrombosis (blood clots), and 60,000 

deaths annually are directly attributable to blood clots. Many more 

die from blood clot related complications. The Committee is concerned that physicians and the public are poorly informed about 

the risks of thrombosis and thrombophilia. CDC has funded eight 

sites to begin gathering information on the dimensions of this disease and related thrombosis. The Committee encourages the CDC 

to expand the number of sites to address the dimensions of this 

widespread public health problem. 

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. The Committee has provided $500,000 above the fiscal year 2004 level to expand Tourette Syndrome-related activities. 

HEALTH INFORMATION AND SERVICE

The Coordinating Center for Health Information and Services.— 

Includes the National Center for Health Statistics, a new National 

Center for Health Marketing, and a new National Center for Public 

Health Informatics. 

The Committee recommends a program level of $235,658,000 for 

Health Information and Service related activities at the CDC. This 

recommendation includes $139,209,000 in transfers available under 

section 241 of the Public Health Service Act. The fiscal year 2004 

comparable program level was $216,692,000 and the administration requested $235,658,000. 

Health Statistics 

CDC’s statistics give us context and perspective on which we can 

base important public health decisions. By aggregating the experi-
84 

ence 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. 

ENVIRONMENTAL HEALTH AND INJURY PREVENTION

As funded by the Committee, the Coordinating Center for Environmental Health and Injury Prevention includes the National 

Center for Environmental Health, the Agency for Toxic Substances 

and Disease Registry, and the National Center for Injury Prevention and Control. 

The Committee recommends $290,126,000 for environmental 

health and injury prevention related activities at the CDC. The fiscal year 2004 comparable level was $282,926,000 and the administration requested $282,926,000 for fiscal year 2005. 

Environmental Health 

Within the total provided, the following amounts are provided for 

the specified activities above the comparable amount for fiscal year 

2004: $1,000,000 to expand the Health Tracking Network; 

$1,000,000 to expand Primary Immune Deficiency activities; and 

$500,000 to expand Asthma related activities. All other activities 

are funded at the level of the administration’s request. 

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 with the work that the CDC 

has done to address the increasing prevalence of asthma. However, 

the increase in asthma among children remains alarming. The 
85 

Committee urges CDC to expand its outreach aimed at increasing 

public awareness of asthma control and prevention strategies, particularly among at-risk populations in underserved communities. 

To further facilitate this effort, CDC is urged to partner with voluntary health organizations to support program activity consistent 

with the CDC’s efforts to fund community-based interventions that 

apply effective approaches demonstrated in research projects within the scientific and public health community. 

In addition, the Committee commends CDC’s efforts to collect national and local data on the incidence and prevalence of asthma 

and to implement asthma prevention programs. The Committee encourages CDC to continue with these activities and expand its prevention programs into areas of high pediatric asthma incidence. 

Childhood Lead Poisoning Prevention.—The Committee commends the CDC for its commitment to support the enhanced development of a portable, hand-held lead screening device that holds 

great promise for increasing childhood screening rates in underserved communities. Further development of this device will help 

ensure its application in community health settings. 

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 CDC’s National Report on Human Exposure to Environmental Chemicals is a significant new exposure tool that provides 

information for setting research priorities and for tracking trends 

in human exposures over time. However, as CDC has recognized, 

this information does not by itself provide information on causes 

for effects in humans. Therefore, communicating these results in 

context is vitally important. The Committee applauds the CDC’s efforts in this regard and encourages the agency to continue to do so. 

Environmental Health Workforce.—The Committee encourages 

the CDC to begin the enhancement and revitalization of environmental health services at the National, State, and local levels. A 

1980 Health and Human Services report stated that there were 

235,000 individuals in the Nation’s environmental health work 

force and the report forecasted 137,000 additional professionals 

would be needed over the following decade. In 2000, a Health and 

Human Services report estimated that the size of our country’s environmental health work force had shrunk to 19,431. During this 

same period, the demand for environmental health services had expanded to include external and internal air quality, drinking water 

quality, food safety, childhood lead poisoning, asthma control, rodent control, and hazardous chemical control and management. In 

addition, city and State environmental health personnel are responsible for providing the initial response to acts of chemical and 

radiological terrorism. In light of this increased demand and our 

country’s reduced capacity, the Committee is concerned about the 
86 

need to enhance and revitalize environmental health services at 

the National, State, and local levels. 

Health Tracking Network.—The Committee has provided $1,000,000 over the fiscal year 2004 level to continue and expand 

the 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. With health tracking, public 

health officials can better target preventive services, health care 

providers can offer better health care, and the public will be able 

to develop a clear understanding of what is occurring in their communities and how overall health can be improved. 

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 understands that a critical component 

of the nationwide tracking program is assuring that communities 

are engaged in the process of developing the State-based networks 

and informed of the results. The Committee urges CDC and the 

State and local programs to work with the citizens in local communities. 

Perchlorate Contamination.—The Committee is concerned about 

contamination due to perchlorate, which is primarily used as an oxidizer for rocket fuel and munitions. Perchlorate contamination has 

been discovered in 34 States and is known to have adverse health 

affects on pregnant women, newborns, and young children. The 

Committee strongly urges the CDC to conduct surveys on the level 

of perchlorate in humans, to provide information for assessments 

on a national level, and to address regional concerns in areas most 

affected. 

Primary Immunodeficiency Diseases.—In each of the last 3 years, 

Congress has made available funds for CDC to support the national 

physician education and public awareness campaign developed by 

the Jeffrey Modell Foundation. The Foundation has leveraged more 

than $7 from donors and the media for every Federal dollar appropriated and is a model of public-private cooperation. The campaign 

has featured physician symposia, publications, public service announcements, and the development of website and educational materials, as well as mailings to physicians, school nurses and others. 

This very successful physician and public awareness campaign now 

must expand its reach to underserved communities, including African-American and Hispanic populations, and the Committee has 

provided sufficient funding to reach that critical goal. In addition, 

the Committee encourages CDC to expand it programmatic activity 

on primary immune deficiency diseases to include pilot programs 

focused on newborn screening and school wellness. The Committee 

has provided $1,000,000 over the fiscal year 2004 level for these 

purposes. 

Severe Combined Immune Deficiency Disease.—It has come to the 

Committee’s attention that NIH has developed the technology to 

screen newborns for severe combined immune deficiency disease 

[SCID] or ‘‘the bubble boy disease.’’ The Committee commends the 

Newborn Screening Branch at the National Center for Environmental Health at CDC for their commitment to developing a newborn screening program for SCID. The Committee encourages the 
87 

CDC to consider support for the development of a newborn screening program for SCID. 

Injury Prevention and Control 

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. 

The Committee has provided additional funding to the National 

Center for Injury Prevention and Control. In part, these funds 

should be used to strengthen the capacity of State and local health 

agencies to prevent injuries and support extramural public health 

research to conduct and translate science into practice. The increase would expand public health support for injury prevention 

programs in States and ensure provision of necessary tools for developing effective injury prevention programs in our communities. 

Sufficient funds have been included to continue support for all 

existing Injury Control Research Centers. 

Fire and Fall Injury Prevention.—CDC funds five States to implement and evaluate Remembering When, a fire and fall injury 

prevention program directed at older adults. Remembering When 

was developed by the National Fire Protection Association, with assistance from CDC, the Consumer Product Safety Commission and 

others. CDC also funds 13 States to install 10-year lithium powered smoke alarms and to provide fire-safety education in homes in 

high-risk communities. High-risk communities are those with fire 

death rates higher than State and national averages and median 

household incomes below the poverty level. Homes with children 

and older adults are especially targeted for smoke alarm installation and education outreach. The Committee encourages CDC to 

continue the implementation of this project. 

National Violent Death Reporting System.—The Committee provides an increase of $700,000 over the fiscal year 2004 level for the 

National Violent Death Reporting System [NVDRS] to allow additional States to be funded to gather and share State-level data 

about violent deaths. This State-based system collects data from 

medical examiners, coroners, police, crime labs, and death certificates to understand the circumstances surrounding violent deaths. 

The information can be used to develop, inform, and evaluate violence prevention programs. 

Rape Prevention and Education.—The CDC provides one of the 

only sources of funding for rape prevention and education. Most 

other funding sources are focused on services to survivors and the 

criminal justice system. The Committee urges CDC to ensure that 

States receiving funds from the grants for assistance to victims of 

sexual assault, as provided in the Violence Against Women Act, 
88 

support State sexual assault coalitions, community-based rape crisis centers, and other non-profit entities whose work is focused on 

ending sexual violence, operating hotlines for victims of sexual violence and their families, and those which provide crisis intervention, advocacy and support services to victims. The Committee 

urges the CDC to ensure that States work collaboratively with 

State sexual assault coalitions in planning and funding activities. 

The Committee has provided $2,000,000 over the fiscal year 2004 

level for these activities. The Committee recommends that a portion of these additional funds be used to fund awareness activities 

and materials in conjunction with Sexual Assault Awareness 

Month. 

Through its technical assistance, training and informational materials, the National Resource Center on Sexual Assault has played 

an increasingly important role in bringing direction, coordination 

and voice to a movement that was previously dispersed and disconnected. The Committee has provided sufficient resources to fund 

this Center at the statutory maximum of $1,000,000. 

Suicide Prevention.—The Committee encourages CDC to conduct 

suicide prevention research and support demonstration projects to 

identify promising and effective suicide prevention strategies. Research will enhance the knowledge base about risk and protective 

factors and the consequences of suicidal behavior in order to develop more effective prevention strategies. 

Traumatic Brain Injury.—The Committee understands that a 

National Information Center for Traumatic Brain Injury is expanding as a pilot program providing persons with brain injury, their 

families, and those who serve them with toll-free information on 

State-specific resources and linkage to service. The Committee encourages the CDC to be supportive of this National Information 

Center. The Committee also encourages the CDC to fulfill its duties 

under the TBI Act as part of the Children’s Health Act, such as 

monitoring the outcomes and services of people who sustain injuries, including TBI, during mass casualty events such as a terrorist 

attack; strengthen support for State and local efforts to collect data 

on TBI; increasing education and awareness efforts; conduct public 

health research related to TBI and collecting annual incidence and 

outcome data on ‘‘mild’’ TBI. 

Violence Against Women.—The Committee urges the CDC to increase research on the psychological consequences of violence 

against women and expand research on special populations and 

their risk for violence including adolescents, older women, ethnic 

minorities, women with disabilities, and other affected populations. 

OCCUPATIONAL SAFETY AND HEALTH

The Committee recommends $294,587,000 for occupational safety 

and health programs. The fiscal year 2004 comparable level was 

$276,988,000 and the administration requested $278,587,000 for 

fiscal year 2005. The Committee recommendation includes 

$82,097,000 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-re-
89 

lated 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. 

NIOSH has a unique legislative history that is distinct from 

other components of CDC. NIOSH was created under the Occupational Safety and Health Act of 1970, to be a separate Institute 

within what is now the Department of Health and Human Services. NIOSH was charged with carrying out the many responsibilities given the Secretary under the authorizing legislation, including conducting research, recommending criteria for standards, providing information on toxic substances and training occupational 

safety and health professionals. Since that time Congress has significantly expanded NIOSH’s role to include carrying out responsibilities given the Secretary of Health and Human Services under 

the Mine Safety and Health Act and Energy Employees Occupational Illness and Compensation Act. Today, NIOSH is responsible 

for a wide range of programs and activities to enhance workers 

safety and health. With its sister agencies, the Occupational Safety 

and Health Administration [OSHA] and the Mine Safety and 

Health Administration [MSHA], NIOSH has made significant contributions to the major reduction in workplace injuries over the last 

three decades. 

Congress established NIOSH with the expressed intent ‘‘to provide occupational safety and health research with the visibility and 

status it merits’’ and ‘‘to elevate the status of occupational safety 

and health research’’ (Legislative History of the Occupational Safety and Health Act of 1970, S. 2193, Public Law 91–596). The Committee strongly supports these principles. The Committee expects 

CDC to ensure that the ongoing CDC reorganization does not impede nor diminish NIOSH’s ability to meet its statutory responsibilities to protect the safety and health of America’s workers. The 

Committee believes that NIOSH must have the stature necessary 

to work effectively with OSHA, the Department of Labor, and the 

Department of Health and Human Services in the manner described by statute. Therefore, the Committee directs the CDC to 

maintain the status quo with respect to the direct reporting relationship of the NIOSH director to the CDC director. The Committee further directs the CDC to: (1) make no changes to NIOSH’s 

current operating procedures and organizational structure and (2) 

ensure that no funds or personnel will be transferred from NIOSH 

to other components of CDC by means other than traditional reprogramming of funds. 

Construction Safety and Health.—The Committee once again is 

very pleased with the progress that NIOSH has made in its program directed at occupational illnesses and injuries in the building 

and construction industry. However, the Committee is still concerned with the continued high fatality rate in the industry, and 

encourages NIOSH to continue studying this important issue. 

Education and Research Centers.—The Committee recognizes the 

important role Education and Research Centers [ERCs] play in pre-
90 

ventive health research and the training of occupational safety and 

health professionals, and includes an increase of $2,000,000 for 

ERCs over the amount appropriated for ERCs in fiscal 2004. 

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. 

Miners’ Choice Health Screening Program.—The Committee has 

been advised that NIOSH will begin solely administering the Miners’ Choice Health Screening Program in fiscal year 2005, and that 

funds have been included in the administration’s request to support 

these activities. This program was initiated to encourage all miners 

to obtain free and confidential chest x-rays to obtain more data on 

the prevalence of Coal Workers’ Pneumonconiosis [CWP] in support 

of development of new respirable coal dust rules. The Committee 

is strongly supportive of these efforts and urges NIOSH to work to 

improve this health screening program thereby helping to protect 

the health and safety our Nation’s miners. 

Mining Research Program.—The Committee has provided $6,000,000 over the fiscal year 2004 level for NIOSH’s Mining Research Program. The Committee recommends that $4,000,000 of 

the additional funding be used to increase base funding of the 

NIOSH in-house research programs to offset the effects of inflation. 

The Committee recommends that $1,000,000 of the additional funding be used to expand the extramural mining research program, 

and that the remaining $1,000,000 be used to respond to emerging 

issues. 

National Occupational Research Agenda.—The Committee recommendation includes an increase of $5,000,000 over the fiscal 

year 2004 level for CDC’s National Occupational Research Agenda 

[NORA]. 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. 

National Personal Protective Technologies Laboratory.—The Committee provides $3,000,000 over the fiscal year 2004 level for the 

NIOSH National Personal Protective Technologies Laboratory to 

expedite research and development in, and certification of, protective equipment, such as powered air purifying respirators, and 

combined self-contained breathing apparatus/escape sets. 

Radiation Exposure.—The Committee strongly encourages 

NIOSH to expedite decisions on petitions filed under the Procedure 
91 

for Designating Classes of Employees as Members of the Special 

Exposure Cohorts (42 CFR Part 83). It was Congress’ intent in 

passing the Energy Employees Compensation Act of 2000 to provide for timely, uniform and adequate compensation for employees 

made ill from exposure to radiation, beryllium and silica, while employed at Department of Energy nuclear facilities or while employed at beryllium vendors and atomic weapons employer facilities. The Committee encourages the Department to recognize that 

in situations where records documenting internal or external radiation doses received by workers at the specific facility are of poor 

quality or do not exist that workers should promptly be placed in 

a special exposure cohort. 

Research to Practice Initiative.—The Committee is supportive of 

NIOSH’s Research to Practice Initiative to develop and expand efforts to put research findings into practice. The Committee encourages NIOSH to use this initiative to translate useful research findings into best practices, products, and technologies and to disseminate this information to employers and employees to improve the 

health and safety of workers. 

GLOBAL HEALTH

The Committee recommends $305,239,000 for global health related activities at the CDC in fiscal year 2005. The fiscal year 2004 

comparable level was $279,944,000 and the administration requested $304,444,000 for fiscal year 2005. The Office of Global 

Health will lead and coordinate CDC’s global programs to promote 

health and prevent disease in the United States and abroad, including ensuring rapid detection and response to emerging health 

threats. 

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 understands that little attention has been given 

to the increased risk of HIV infection for individuals with disabilities in some parts of the world, including sub-Saharan Africa. Information, testing, and treatment are often inaccessible and denied 

to individuals with disabilities. The Committee encourages the 

CDC to investigate this issue and report on the problem and efforts 

to address it. The Committee also encourages the CDC to provide 

technical assistance to grantees on how to develop inclusive and accessible public awareness campaigns, educational materials, testing, treatment, palliative and preventive care to ensure that people 

with disabilities have equal access to services and supports for 

HIV/AIDS. 

The Committee encourages the CDC to assist African nations in 

developing systems to ensure that blood supplies are screened for 

HIV/AIDS and other communicable diseases. 

The Committee notes that funding for continuation of the International Mother and Child HIV Prevention Initiative [MTCT] has 

been requested in the budget for the Department of State under 

the jurisdiction of the Foreign Operations Appropriations Sub-
92 

committee. Therefore, the Committee does not providing any funding for the program in the CDC, however, the Committee remains 

supportive of this critical program. The Committee encourages 

CDC to ensure that funds provided to the MTCT program, the CDC 

GAP initiative, and the Global Fund for HIV/AIDS, Tuberculosis, 

and Malaria are used in a coordinated and complementary fashion. 

Global Disease Detection.—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 realtime 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 

$24,500,000 over the fiscal year 2004 level for these efforts. 

Global Immunization Activities.—The Committee includes 

$557,000 above the fiscal year 2004 level for polio vaccine, surveillance, and program operations for the highly successful, yet unfinished polio eradication efforts; and $238,000 above the fiscal year 

2004 level 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. 

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, polio is still endemic in six 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. 

PUBLIC HEALTH RESEARCH

Public Health Research and Prevention Research.—The Committee has provided $35,000,000 in transfers available under section 241 of the Public Health Service Act to fund the Public Health 

Research and Extramural Prevention Research programs. In fiscal 

year 2004, the combined funding for these programs was 

$29,107,000 and the administration requested $15,000,000 for 

these programs in fiscal year 2005. The Committee is strongly supportive of public health and prevention research, which bridge the 

gap between medical research discoveries and behaviors that people adopt by identifying the best strategies for detecting new diseases, assessing the health status of populations, motivating 
93 

healthy lifestyles, communicating effective health promotion messages, and acquiring and disseminating information in times of crisis. 

The Committee recognizes the need to enhance the recognition 

and understanding of mind/body medicine’s role in the practice of 

medicine. To foster and expand the uses of mind/body interactions 

in healthcare and other appropriate settings, the Committee encourages the Public Health Research Program to provide support to 

research, test, and disseminate the practices related to mind/body 

techniques. To receive appropriate technical assistance, CDC is 

strongly encouraged to consult experts in the mind/body field. 

PUBLIC HEALTH IMPROVEMENT & LEADERSHIP

The Committee provides $261,858,000 for public health improvement and leadership activities at the CDC. The fiscal year 2004 

comparable level was $232,687,000 and the administration requested a comparable program level of $200,537,000 for fiscal year 

2005. 

Leadership and Management 

To more easily identify and quantify administrative, management, and leadership costs at the CDC, the Committee has provided the administrative funds for the agency and its institutes, 

centers, and offices (except NIOSH) within this account. The Committee provides $179,977,000 for leadership and management costs 

at the CDC in fiscal year 2005. The fiscal year 2004 comparable 

level was $170,780,000 and the administration requested a comparable level of $180,444,000 for fiscal year 2005. 

Director’s Discretionary Fund.—The Committee has provided 

$18,000,000 for a Director’s Discretionary Fund. This fund will 

allow the Director to quickly respond to emerging public health 

issues and threats not contemplated at the time of enactment of 

the appropriations. 

Epidemic Services and Response.—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 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. 

Individual Learning Accounts.—The Committee commends CDC 

for its commitment to workforce development, and supports the use 

of Individual Learning Accounts to provide CDC employees with 

flexible opportunities for continuing education. In a recent assess-
94 

ment of the use of such accounts at 13 Federal agencies, the Office 

of Personnel Management recommended their implementation government-wide so as to enhance workforce development opportunities for all Federal employees. The Committee recommendation includes up to $30,000,000, within current appropriations, to establish Individual Learning Accounts for full-time equivalent employees at CDC. 

Leadership and Management Savings.—The Committee strongly 

believes that as large a portion as possible of CDC funding should 

go to programs and initiatives that improve the health and safety 

of Americans. To facilitate this goal, any savings in leadership and 

management may be reallocated to the Director’s Discretionary 

Fund upon notification of the Committee. 

Transfer Authority.—The Committee has included authority for 

the Director to transfer up to 1 percent of any CDC program, 

project, or activity to any other CDC program, project, or activity. 

No program, project, or activity may be decreased by more than 1 

percent and no program, project, or activity may be increased by 

more than 3 percent. 

PREVENTATIVE HEALTH & HEALTH SERVICES BLOCK GRANT

The Committee has provided $131,814,000 for the Preventative 

Health & Health Services Block grant. The fiscal year 2004 comparable level was $131,814,000 and the administration requested a 

comparable level of $131,814,000 for fiscal year 2005. 

The block grant provides funding for primary prevention activities and health services that address urgent health problems in 

local communities. This flexible source of funding can be used to 

target concerns where other funds do not exist or where they are 

inadequate to address the extent of the health problem. The grants 

are made to the 50 States, the District of Columbia, two American 

Indian tribes, and eight U.S. territories. 

BUILDINGS AND FACILITIES

The Committee has provided $294,500,000 for the planning, design, and construction of new facilities, repair and renovation of existing CDC facilities, and data security and storage. The fiscal year 

2004 comparable level was $260,454,000 and the administration requested $81,500,000 for fiscal year 2005. The Committee recommendation includes $250,000,000 for the 

continuation of CDC’s Buildings and Facilities Master Plan in Atlanta, Georgia and $44,400,000 to complete construction of CDC’s 

Division of Vector Borne Infectious Diseases Laboratory in Fort 

Collins, Colorado. 

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 necessary, in constructing the Atlanta 

and Fort Collins facilities. 

The Committee is aware that a number of small buildings from 

the former U.S. Bureau of Mines now comprise the current NIOSH 

National Personal Protective Technologies Laboratory. A modern 

laboratory is needed to conduct certification tests and related respiratory protection research. As CDC reviews its CDC-wide Master 
95 

Plan, the agency is urged to give priority consideration to modernizing this laboratory space. 

BUSINESS SERVICES SUPPORT

The Committee provides $282,226,000 for business services support functions at the CDC. The fiscal year 2004 comparable level 

was $282,226,000 and the administration requested a comparable 

level of $286,015,000 for fiscal year 2005. These funds will be used 

to support CDC-wide support functions. 

The Committee strongly believes that as large a portion as possible of CDC funding should go to programs and initiatives that improve the health and safety of Americans. To facilitate this goal, 

any savings in business services support may be reallocated to the 

Director’s Discretionary Fund upon notification of the Committee. 

NIH PREAMBLE

As a Nation, we can take justifiable pride in our achievements 

in the fields of science and medicine. The fruits of medical research 

have made possible the drugs, surgical techniques and prevention 

strategies that have virtually conquered many of the leading killers 

of past generations of Americans, such as tuberculosis, rheumatic 

fever, smallpox, pneumonia and many others. Much of what has 

been accomplished to help save lives and improve the quality of life 

can be attributed, directly or indirectly, to the world’s leading medical research enterprise: the National Institutes of Health. One accomplishment alone—the sequencing of the human genome—has 

opened the way to heretofore unimagined opportunities to explore 

human biology in both health and disease. Medical genetics, once 

a tool for diagnosing a handful of rare diseases, can now be used 

to predict a healthy person’s risk of diseases such as breast cancer 

and heart disease, provide new tests for diagnosing illness and determine individual responses to drugs and environmental agents. 

But the conquest of some diseases, by increasing our life span, has 

made us more vulnerable to others. As the baby boom generation 

moves past age 50 at the rate of 10,000 per day, a large cohort of 

Americans are entering the age of high risk for cancer, cardiovascular disease, Alzheimer’s, arthritis, diabetes and oral disease. 

Emerging infectious agents such as SARS, West Nile Virus and 

hepatitis C kindle new threats to health, while with the menace of 

bioterrorism poses new challenges for rapid detection, containment 

and treatment. And despite improvements in the overall health of 

America, minority populations continue to suffer an unequal burden of disease, disability and death. 

This Committee has long recognized the role NIH can and does 

play in transforming the health status of America. In 1998, the 

Committee embarked on a 5-year endeavor to double the investment in NIH in an effort to quicken the pace and intensity of this 

transformation. Although it is impossible to predict what cures or 

new treatments will emerge as a result, it is certain that the infusion of new funds during the doubling process helped push back 

the frontiers of scientific knowledge, while attracting the best and 

brightest minds to careers in medical research. However, the accumulation of fundamental knowledge for its own sake is of little 
96 

value unless it finds its way to hospitals and physicians, where it 

can be put to use in promoting good health or diagnosing, preventing and treating disease. For that to happen requires a robust 

commitment of resources over a sustained period. The Committee 

recommends $28,900,300,000 for the NIH. This amount is 

$1,100,252,000 above the fiscal year 2004 appropriation and 

$373,429,000 over the budget request. 

Biomedical Research and Development Price Index.—The Committee is disappointed that the budget request would require NIH 

to break its funding commitments to existing grantees, contradicting the principles of the agency’s own 1992 Cost Management 

Plan. Forcing grantees to reduce the scope of research that is already underway would establish an unfortunate precedent and 

could erode confidence in NIH. Therefore, the Committee has included sufficient funding to enable NIH to fully pay the committed 

levels on its grants. The Committee is also disappointed that the 

budget request’s proposed average cost assumptions would keep 

NIH from buying the same amount of research as in fiscal year 

2004 with its new research project grants [RPGs], when biomedical 

inflation, as measured by the Department of Commerce’s Biomedical Research and Development Price Index [BRDPI], is taken 

into account. The funding level recommended by the Committee 

will permit the average cost of new and competing RPGs to rise by 

2 percent instead of the 1 percent increase proposed in the budget 

request. 

Consulting Fees.—The Committee was extremely disappointed to 

learn the extent to which NIH scientists and administrators have 

been receiving monetary compensation from pharmaceutical and 

biotechnology companies. Some NIH employees have received hundreds of thousands of dollars for their outside work, none of which 

was publicly disclosed. Even more disturbing, some of these employees did not disclose their outside work to agency officials. 

These arrangements raise questions about potential conflicts of interest, the influence that these monetary compensations could have 

on the outcome of scientific research, and whether these employees 

are more interested in procuring lucrative consulting fees than in 

meeting the responsibilities of their full-time, taxpayer-funded jobs. 

The Committee finds it difficult to understand how the most prestigious biomedical research institution in the world could allow 

these questions to be raised. The Committee commends the NIH 

Director for convening a Blue Ribbon Panel to review and make 

recommendations regarding existing laws, regulations, policies and 

procedures governing consulting fees. The Committee was also 

pleased to learn that the NIH plans to implement new regulations 

to ensure the integrity of its scientific research. While the Committee strongly supports intramural and extramural research at 

the NIH, it must be sure of the integrity of that research; therefore, the Committee directs the NIH Director to immediately put 

in place safeguards that will insure that no conflicts of interest 

exist between scientists and pharmaceutical and biotechnology 

companies, or any other entity. 

Human Embryonic Stem Cell Research.—The Committee is very 

concerned that the current administration policy relating to human 

embryonic stem cell research is extremely limiting and is signifi-
97 

cantly slowing the pace of stem cell research. The Committee 

strongly believes that embryonic stem cells have the potential to be 

used to treat or cure the 100 million Americans who are afflicted 

with diseases such as cancer, heart disease, diabetes, Parkinson’s, 

Alzheimer’s, multiple sclerosis, spinal cord injury, and many others. While it originally appeared that 78 embryonic stem cell lines 

would be available for research under the Federal policy, now, 

more than 2 years after the President’s announcement on August 

9, 2001, only 24 are available to researchers. Moreover, scientists 

have told the Committee that all available stem cell lines were 

grown with mouse feeder cells, making their therapeutic use for 

humans uncertain. The Committee strongly urges the administration to modify the current embryonic stem cell policy so that it provides this area of research the greatest opportunity to lead to the 

treatments and cures for which we are all hoping. 

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 anticipated spending on human embryonic 

stem cell research is just $24,800,000. 

NATIONAL CANCER INSTITUTE

Appropriations, 2004 ............................................................................. $4,739,255,000 

Budget estimate, 2005 ........................................................................... 4,870,025,000 

Committee recommendation ................................................................. 4,894,900,000 

The Committee recommends an appropriation of $4,894,900,000 

for the National Cancer Institute [NCI]. The budget request was 

$4,870,025,000. The fiscal year 2004 appropriation was 

$4,739,255,000. 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. 

Anticancer compounds.—The Committee encourages the National 

Cancer Institute to increase research in the area of anticancer compounds. Sources of these compounds include marine invertebrates, 

terrestrial plants, and microorganisms that may be used to develop 

small molecule anticancer drugs. The Committee further understands that little research is conducted in this area and therefore 

urges the Institute to conduct appropriate research in this area. 

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 we are to ensure that all populations 

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. The Com-
98 

mittee sees NCI’s behavioral science research program as a model 

for other institutes. 

Bladder and Renal Cancer.—The Committee is concerned about 

the poor implementation of the 2002 Progress Review Group Report 

on Bladder and Renal Cancers. The incidence and mortality of 

renal cancer has been steadily increasing over the past several decades. Renal cancers are silent killers; for many, renal cancers are 

not recognized until late in the disease, when cancer has already 

spread beyond the kidney. NCI is urged to expand studies to improve detection and diagnosis of renal cancer. For patients with 

metastatic renal cancer, survival is only 9 percent with a median 

survival time of 12 months. There are very few effective treatments. Metastatic bladder cancer also responds poorly to treatment. The Committee urges NCI to develop a novel treatment network to rapidly identify and test for new therapies for renal and 

bladder cancer in human patients and to expand studies on mechanisms of metastasis in these patients. 

Blood Cancers.—The Committee is pleased that important new 

therapies have been developed for the blood cancers—leukemia, 

lymphoma, and multiple myeloma. It has been brought to the Committee’s attention that the Leukemia, Lymphoma, and Myeloma 

Progress Review Group, a blue ribbon advisory panel of NCI recommended in May 2001 the establishment of new multi-disciplinary and multi-institutional structures to shorten the timeline for 

new blood cancer drug development. The Committee encourages 

the NCI to develop new strategies to accelerate the development of 

new blood cancer therapies, which might include, among other options, public-private partnerships, multi-disciplinary collaborations, 

and multi-institutional initiatives. The Committee further urges 

the NCI to consider flexible uses of current funding mechanisms in 

order to respond to the key recommendation of the blood cancer 

Progress Review Group. 

Bone Metastasis.—The NCI is encouraged to develop an integrated approach to study bone metastasis, leveraging the expertise 

of cancer and bone biologists, clinical oncologists and metastasis experts and representatives of the pharmaceutical industry. Key 

issues to address include the generation of novel models which 

mimic tumor/bone interaction and which delineate mechanisms to 

determine why tumor cells prefer bone for metastasis. It is clinically relevant to learn how to use information to change the bone 

microenvironment so that it is hostile to the invading tumor cells. 

The Committee also urges NCI to expand research on osteosarcoma 

to improve survival and quality of life and to prevent metastatic 

osteosarcoma in children and teenagers who develop this cancer. 

Brain Tumors.—The Committee is concerned that insufficient attention is being given by NCI and NINDS to brain tumor research. 

The Committee encourages NCI to fund at least five 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 Centers and Minorities.—The Committee commends NCI 

on the success of its cancer centers program. Given that minority 

populations suffer disproportionately from virtually every form of 
99 

cancer, the Committee encourages NCI to support the establishment of a comprehensive center at a minority institution focused 

on research, treatment, and prevention of cancer in African American and other minority communities. 

Cancer Genomics.—The Committee is pleased that the NCI has 

focused considerable attention on building innovative public/private 

partnerships to accelerate the development and deployment of new 

technologies, which will facilitate the Institute’s ambitious goal of 

dramatically altering the understanding and treatment of cancer 

by 2015. The Committee is also aware of the enormous potential 

for improved understanding and treatment of cancer presented by 

the use of microarray technology in both basic research and clinical 

setting. The Committee understands that the use of this technology 

can help accelerate the development of effective cancer drugs, the 

prediction of drug response, and ultimately the early detection and 

improved treatment of cancer. The Committee recommends that 

NCI continue to employ these enabling technologies to identify, 

characterize, and validate the gene pathways that cause cancer and 

that it continue to work cooperatively with public and private sector entities to do so. 

Cancer and Native Hawaiians.—The Committee remains concerned about the high incidence of breast, colon, and lung cancer 

among the native Hawaiian population. The Committee anticipates 

an update on the Director’s task force to explore the continuing 

unique needs of the people of Hawaii and the Pacific Basin region. 

Chronic Lymphocytic Leukemia [CLL].—This incurable disease is 

the most common form of adult leukemia in the United States. The 

Committee once again urges the NCI to increase research into 

CLL, including improved therapies and their rapid movement from 

the laboratory to the bedside. The Committee is pleased to learn 

that the unique multidisciplinary and multi-institutional research 

consortium funded by the NCI for the past 5 years is proceeding 

with a competing renewal of its initial grant to permit coordinated 

continued study of CLL at the cellular and clinical levels. The Committee strongly urges the NCI to give favorable consideration to 

continuing and expanding the scope of research activities funded 

through the the CLL Research Consortium as it works to defeat 

this devastating blood disorder. 

Complementary and Alternative Cancer Therapies.—The Committee expects 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. 

Diethylstilbestrol [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 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. 

Gynecologic Cancers.—In the last 5 years, approximately 130,000 

women in the United States have lost their lives to gynecologic cancer. The Committee commends the NCI for creating a cervical cancer and endometrial cancer SPORE, bringing the total number of 
100 

gynecologic cancers SPORES to six, and expects that the NCI will 

expand the number of centers in the future. Unfortunately, 70 percent of ovarian cancer patients continue to be diagnosed in advanced stages when 5-year survival rates remain less then 25 percent. The Committee encourages continued research by the four 

ovarian SPORES that will lead to a better understanding of prevention and the development of a screening tool offering women 

earlier diagnosis when this cancer is more curable. The Committee 

also supports the expansion of NCI’s collaboration with the NICHD 

for faculty development of gynecologic oncologists. 

Health Care Decision-making.—The Committee applauds NCI’s 

investment in staff and resources to help build the science of health 

care decision-making. Such research will improve understanding of 

human decision-making processes so that individuals can make 

more informed choices about their health, and so more useful decision support systems can be constructed. Efforts to integrate basic 

behavioral and social research in judgment and decision-making, 

and applied cancer decision making will serve to harness the work 

of basic researchers, who may not have previously applied their 

work to health settings. 

Imaging Systems Technologies.—The Committee is encouraged by 

progress made by the NCI following its August 1999 conference on 

biomedical imaging, and 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. 

Liver Cancer.—The Committee notes that in contrast to many 

other cancers, the number of people who develop and die from liver 

cancer has increased 24 percent since the year 2000. As the symptoms of liver cancer often do not appear until the disease is advanced, only a small number of liver cancer cases are found in the 

early stages of the disease, when it can be easily treated. The Committee is aware that the NCI, in collaboration with NIDDK, convened an Experts Conference that will help define the most urgent 

areas requiring additional research, professional education and 

public awareness initiatives. The Committee urges NCI to issue a 

Request for Applications based on the findings of this conference. 

Lung Cancer.—Lung cancer remains a major public health issue 

and is the leading cause of cancer death among women and minority populations. The death rate is expected to escalate as the population ages. Treatment and research now require an interdisciplinary approach and thoracic surgeons play an important role in 
101 

both. The Committee encourages the Institute to work with the 

thoracic surgical community to identify priority areas for new clinical and translational studies and to ensure their participation in 

any interdisciplinary research efforts. Thoracic surgeons should be 

included in all relevant review and advisory committees and councils. 

Molecular Cancer Diagnostics.—The Committee understands that 

the NCI is aware of the potential for molecular cancer diagnostics 

using circulating nucleic acids, including in particular extracellular 

RNA in plasma. The Committee believes that this technology could 

have enormous potential for the early detection, monitoring, and 

selection of more effective treatment of a broad array of cancers 

and therefore encourages the NCI to explore the use and clinical 

application of this technology. 

Multidisciplinary Research.—NCI is commended for its innovative support of multidisciplinary training programs to enhance the 

scientific workforce. The Committee encourages NCI to explore new 

opportunities with the Office of Behavioral and Social Sciences Research to increase the number of scientists who can bridge the 

realms of behavioral and social science research and public health 

or biomedical research. 

Myelodysplasia and Myeloproliferative Disorders.—The Committee recognizes NCI’s support for a new research initiative in 

Myeloproliferative Disorders [MPDs), which evolved from a recent 

conference involving the Institute and NHLBI. MPDs and 

Myelodysplasia [MDS] are chronic diseases of bone marrow cells 

that can develop into acute leukemia. The Committee encourages 

NCI and NHLBI to bring together scientific and clinical experts in 

these fields to explore collaborative and crosscutting research 

mechanisms to further this research agenda. The Committee also 

urges NCI to utilize the Surveillance, Epidemiology, and End Results [SEER] Program to collect data on the incidence and distribution of these diseases. 

Nanosystems Biology.—The Committee encourages NCI and the 

Office of the NIH Director to support a collaborative effort to bringing together nanotechnology, systems biology and molecular imaging 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 a failure 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.—The Committee commends NCI for conducting phase II clinical trials of NF1 patients with plexiform neurofibromas. The Committee is concerned about recent large drops 

in funding for NF research, and recognizing NF’s connection to 

many of the most common forms of human cancer, the Committee 

encourages NCI to substantially increase its NF research portfolio 
102 

in such areas as further development of animal models, natural 

history studies, therapeutic experimentation, and clinical trials. 

The Committee is mindful of NF’s rapid movement toward clinical 

research and encourages NCI to aggressively pursue clinical/ 

translational research while still maintaining a solid basic research 

portfolio. 

Pancreatic Cancer.—The Committee remains concerned about the 

lack of scientists researching pancreatic cancer, the Nation’s 

fourth-leading cause of cancer death. The NCI’s recent policy of offering a 50 percent extended payline for grants that are 100 percent related to pancreatic cancer was viewed as a critically important effort to encourage both young and experienced investigators 

to develop careers in this research field. Thus, the Committee is 

disappointed that the NCI plans to weaken that policy and adopt 

a new strategy consisting of identifying grants that are 50 percent 

directed to pancreatic cancer and then bringing them to the attention of the NCI Executive Committee. The Committee notes that 

this special consideration will not necessarily result in actual funding. Therefore, the Committee urges the NCI to maintain the 50 

percent extended payline for 100 percent relevant pancreatic cancer 

research grants as the best way to attract a critical mass of scientists to this field. 

Prostate Cancer.—The Committee commends the NCI for the considerable investment in prostate cancer, the leading cause of noncutaneous cancer death among men, and encourages NCI to continue to support research to improve the accuracy of screening and 

early detection of prostate cancer. 

Psychoneuroimmunology and Cancer.—The Committee is interested in NCI’s initiative to evaluate the complex interrelationships 

among emotional, behavioral, neural and immunological processes 

and how they may affect the etiology and progression of cancer. 

NCI’s BiMPED initiative is a good example of leveraging the institute’s resources to seed new research across NIH on fundamental 

mechanisms and processes that may affect multiple diseases and 

conditions. 

Radio Waves.—It has been brought to the Committee’s attention 

that radio waves may prove promising in reducing cancerous tumors. While current radio frequency ablation requires placing electrodes directly into the tumor, this new non-invasive technique 

would target only the cancer cells while avoiding healthy tissue. 

The Committee urges the NCI to support research using this noninvasive cancer-targeting technique. 

Tuberous Sclerosis Complex.—Tuberous sclerosis complex, or 

TSC, is a genetic disorder that triggers uncontrollable tumor 

growth in multiple organs of the body, including the brain, heart, 

kidneys, lungs, liver, eyes or skin. In light of its similarities to the 

uncontrolled growth of cancer cells, many scientists believe that determining the cause of tumor growth in TSC could open the way 

for cures and treatments for cancer as well. To those ends, the 

Committee strongly encourages NCI to support programs examining the molecular and cellular basis of TSC, and the role of TSC 

in tumor development. 
103 

NATIONAL HEART, LUNG, AND BLOOD INSTITUTE

Appropriations, 2004 ............................................................................. $2,878,691,000 

Budget estimate, 2005 ........................................................................... 2,963,953,000 

Committee recommendation ................................................................. 2,985,900,000 

The Committee recommendation includes $2,985,900,000 for the 

National Heart, Lung, and Blood Institute [NHLBI]. The fiscal year 

2004 appropriation was $2,878,691,000 and the budget request was 

$2,963,953,000. 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, populationbased, 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, NHLBI is encouraged to enhance program activity at research institutions training these individuals, as one step to alleviate this problem. 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. 

American Indians and Alaskan Natives Community-Responsive 

Interventions to Reduce Cardiovascular Risk.—The Committee is 

aware that American Indian and Alaska Native communities bear 

a heavy burden of heart disease, stroke and other cardiovascular 

diseases. But, few preventive interventions have been tested. Tribal 

leaders have urged that research in their communities focus on 

finding solutions for the most serious issues these populations face, 

including heart disease, stroke and other cardiovascular diseases. 

To address the concerns of the tribal leaders, the Committee 

strongly urges the NHLBI to start a planned initiative to evaluate 

approaches to reducing behavioral cardiovascular disease risk factors such as obesity, diet, smoking, sleep restriction, stress, and 

sedentary lifestyle in the American Indian and Alaskan Native 

populations. A central part of this research will be the development 

of interventions that can be incorporated into community patient 

care programs or delivered through other public health avenues in 

native communities. 

Behavioral Research on Long-term Exercise Benefits.—The Committee encourages NHLBI to continue its research program on 

longterm behavior change, particularly as it concerns physical activity. NHLBI-funded research showed that moderate-intensity exercise was as effective in a long-term program as high-intensity exercise in enabling patients to maintain weight loss for over a year. 

NHLBI is encouraged to continue its focus on the role of exercise 
104 

in health, and factors that increase the likelihood that sedentary 

adults and youth can initiate and maintain programs of physical 

activity to prevent obesity. 

Cardio-thoracic Surgery.—The Committee commends the Institute for its efforts to increase research in the role of cardio-thoracic 

surgery in the treatment and management of heart and lung diseases. Reestablishing the cardio-thoracic intramural program is an 

important component of this effort. To support this renewed activity, the Committee encourages the Institute to increase the representation of cardiovascular and thoracic surgeons at all levels, including the advisory council. 

Cardiovascular Diseases.—The Committee continues to regard 

research into the causes, cure, prevention and treatment of heart 

disease, stroke and other cardiovascular diseases as a major concern for our Nation and urges the NIH and the NHLBI to make 

these diseases a top priority. Cardiovascular diseases remain the 

leading cause of death in the United States and a major cause of 

permanent disability. The Committee continues to strongly support 

increased efforts to study heart disease, stroke and other cardiovascular diseases. The Committee is very concerned that funding 

over the years for cardiovascular disease research has not kept 

pace with the scientific opportunities, the number of Americans afflicted with cardiovascular diseases and the economic toll these diseases impose on our Nation. Concerned that cardiovascular disease 

research still receives disproportionately low funding, the Committee urges the Institute to aggressively expand its research portfolio and dramatically increase its resources dedicated to cardiovascular disease research through all available mechanisms. 

Cardiovascular Health Study.—The Committee is aware that the 

Cardiovascular Health Study, initiated in 1987 to determine risk 

factors for development and progression of heart disease, stroke 

and other cardiovascular diseases in nearly 6,000 Americans age 65 

and older, is scheduled to end in 2005. The wide variety and complexity of data and samples collected in the Cardiovascular Health 

Study represent an unique national research resource. The Committee urges the NHLBI to initiate a planned proposal to stimulate 

innovative use of Cardiovascular Health Study data and material, 

provide opportunities for open, efficient use of the information for 

the entire scientific community, and continue follow-up of study 

participants. 

Chronic Obstsructive Pulmonary Disease [COPD] Education and 

Prevention Program.—The Committee urges the NHLBI to implement an education and prevention program for Chronic Obstructive 

Pulmonary Disease [COPD]. To enhance the proper diagnosis and 

early detection of COPD, NHLBI is urged to launch an effort to 

reach out to the more than 13.3 million Americans living with 

COPD and the 24 million individuals yet to be diagnosed. In developing such an education and prevention program, the NHLBI is encouraged to work closely with patient and physician organizations 

and existing coalitions to coordinate with on-going activities in the 

community. 

Early identification of those at-risk for or who have COPD is essential in the effort to stem the growth of this segment of population. The Committee encourages NHLBI to enhance its efforts in 
105 

this area, through all available mechanisms, as appropriate, including working with national lung organizations, such as the American Thoracic Society and the American Lung Association to develop epidemiological studies of patients who are at-risk for or who 

have this disease as well on a national education campaign for providers and the public about COPD. 

Cooley’s Anemia.—The Committee remains strongly supportive of 

the focused research effort that is being undertaken by the Thalassemia Clinical Research Network, which is comprised the leading 

research institutions in the field of thalassemia, or Cooley’s anemia. The Committee believes that this network is just beginning to 

meet its promise and urges the institute to continue its support. In 

addition, the Committee believes that, where appropriate, consideration should be given to including patients with related 

hemoglobinopathies whenever such inclusion will enhance the scientific validity of the research being conducted. 

Cystic Fibrosis.—The Committee understands that cystic fibrosis 

researchers are evaluating a number of compounds as possible 

therapies for CF. This will require the completion of clinical trials 

enrolling a significant number of participants. The Committee encourages NHLBI, which has a long and successful record in supporting trials on therapies for chronic disease, to expand its involvement in trials to demonstrate the effective use of approved 

therapies in CF patients and especially trials to examine the use 

of approved products in pediatric patients with CF. 

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 commends 

NHLBI for their attention to this disorder. 

Duchenne Muscular Dystrophy.—The Committee encourages 

NHLBI, in collaboration with the Office of Rare Diseases, to enhance the research and related activities surrounding pulmonary 

and cardiac complications associated with Duchenne muscular dystrophy. The NHLBI is expected to report to the Committee on its 

approach to this issue not later than January 15, 2005. 

Heart Failure Management.—The Committee is concerned that 

heart failure is a major cause of hospitalization and readmission. 

Medicare recipients represent about 65 percent of repeat hospitalizations within 1 year. Yet, perhaps 50 percent of these hospitalizations are avoidable. The Committee urges NHLBI to initiate 

a planned multi-center, randomized trial to evaluate management 

strategies for heart failure patients in terms of their ability to prevent death or hospital readmission. Costs, quality of life, physician 

compliance, and patient adherence to prescribed treatment will 

also be assessed. This clinical trial will identify and disseminate 
106 

useful and effective tools for translation of proven heart failure 

therapies into patient care. 

Hemophilia.—The Committee commends NHLBI for its leadership in advancing research on bleeding disorders and the complications of these disorders. The Committee applauds NHLBI for its efforts, working with the National Hemophilia Foundation, to support research on improved and novel therapies for bleeding disorders. 

Marfan Syndrome.—The Committee commends NHLBI for its 

support of research opportunities to study this life-threatening, degenerative genetic disorder. Marfan syndrome is characterized by 

cardiovascular, skeletal and ocular manifestations, and its cardiovascular complications result in premature death. Insights gained 

from research in this area can have implications for the understanding of other connective tissue disorders, other genetically mediated diseases, and the larger population of aging adults with thoracic aneurysms. The Committee urges NHLBI to expand its collaborative efforts with other institutes to support research, awareness of aortic dissection and help reduce the number of premature 

cardiovascular deaths resulting from undiagnosed genetic conditions. 

Minority Health.—The Committee notes lung disease disproportionately affects 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 commends NHLBI for its new research initiatives in 

Myelodysplasia [MDS] and Myeloproliferative Disorders [MPDs), 

which resulted from a recent conference involving the Institute and 

NCI. MPDs and MDS are chronic diseases of bone marrow cells 

that can develop into acute leukemia. The Committee encourages 

NHLBI and NCI to bring together scientific and clinical experts in 

this field to explore collaborative research and crosscutting mechanisms to further this research agenda. 

National Asthma Education and Prevention Program [NAEPP].— 

The Committee commends the 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 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.—Significant advances continue to be made in 

research on NF’s implications with heart disease and in particular, 

its involvement with hypertension and congenital heart disease 

which together affect over 50 million Americans. The Committee 
107 

applauds NHLBI for its involvement with NF research and encourages it to continue to expand its NF research portfolio. 

Obstructive Sleep Apnea.—The Committee commends the Institute for its work on obstructive sleep apnea, a disorder that affects 

approximately 80 percent of the elderly, and which if left untreated 

significantly increases risk for hypertension, coronary artery disease, heart failure and stroke. The Institute is encouraged to include surgical treatments in its search for useful treatments for 

this disorder. 

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. 

Primary Immunodeficiency Diseases.—The Committee understands that NHLBI has begun to work with the Jeffrey Modell 

Foundation as part of its national physician education and public 

awareness campaign for primary immunodeficiency diseases, including co-sponsorship of physician conferences at the NIH. The 

Committee encourages NHLBI to take further action in this regard 

and to be an active participant in the development of educational 

materials and future conferences, as appropriate. 

Pulmonary Hypertension.—Pulmonary Hypertension [PH] is a 

rare, progressive and fatal disease that predominantly affects 

women, regardless of age or race. PH causes deadly deterioration 

of the heart and lungs and is a secondary condition in many other 

serious disorders such as scleroderma and lupus. The Committee 

continues to view research in this area as a high priority and commends NHLBI’s efforts to promote PH related research. For fiscal 

year 2005, the Committee encourages 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. 

Scleroderma.—The Committee is encouraged by NHLBI’s growing interest in scleroderma, a chronic and progressive disease that 

predominantly strikes women. Scleroderma is disfiguring and can 

be life-threatening, affecting multiple systems including the heart 

and lungs. More research is critically needed in order to develop 

safe, effective treatments and to identify the cause or causes of the 

complications of scleroderma that include pulmonary fibrosis, pulmonary hypertension, myocardial fibrosis, cardiac arrhythmias, 

pericarditis, and Raynaud’s Phenomenon. 

Sleep Disorders.—The Committee commends the National Center 

on Sleep Disorders Research for its progress and is pleased that the 

Center has sponsored the translational conference Frontiers of 

Knowledge in Sleep and Sleep Disorders. The Committee urges the 

Center to partner with other Federal agencies, such as the Centers 

for Disease Control and Prevention, as well as voluntary health organizations such as the National Sleep Foundation, to develop a 

sleep education and public awareness initiative that will provide a 

forum for dissemination of the outcomes of the sleep translational 

conference, and serve as an ongoing, inclusive mechanism for pub-
108 

lic and professional awareness on sleep and sleep disorders. Several institutes and public health service agencies have had success 

with these collaborative models. 

Thrombosis and Thrombophilia.—The Committee is concerned 

that too little is known about the basic science of thrombosis and 

thrombophilia, major causes of death and disability in this country. 

The Committee strongly urges the Institute to expand its support 

for basic research into their underlying causes in order to improve 

diagnosis and treatment for these conditions. The Committee also 

strongly urges the Institute to use all available mechanisms to support this research and urges collaboration with the thrombophilia 

centers funded by CDC. 

Tissue Engineered Blood Vessel Replacement and Repair.—The 

Committee is aware that a need exists to develop alternatives to 

natural blood vessels for the adults who endure heart artery bypass 

surgery and for the children born with complex heart defects who 

need multiple blood vessel grafts. The Committee encourages the 

NHLBI to initiate a planned initiative to complement existing tissue engineered research programs to stimulate efforts to ‘‘grow’’ 

small-diameter, functional blood vessels. 

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. 

Von Willebrand Disease.—The Committee encourages NHLBI to 

establish a universal treatment algorithm (after consultation with 

established medical associations such as the American Society of 

Hematology) for the treatment of Von Willebrand disease. At 

present there is no accepted treatment algorithm in the United 

States for this condition. The Committee also recognizes that Von 

Willebrand disease is an under-recognized and under-diagnosed 

disease. The Committee believes that there are instances where 

women who are suffering from idiopathic menorrhagia are needlessly subjected to invasive procedures such as hysterectomies. The 

Committee encourages NHLBI to launch a pilot program among obstetricians and gynecologists treating patients, especially young 

women, with idiopathic menorrhagia to provide a blood test for Von 

Willebrand Disease. Such a program would act to confirm if a link 

exists between menorrhagia and Von Willebrand Disease in additional to providing the benefits of early detection and treatment. 

NATIONAL INSTITUTE OF DENTAL AND CRANIOFACIAL RESEARCH

Appropriations, 2004 ............................................................................. $383,282,000 

Budget estimate, 2005 ........................................................................... 394,080,000 

Committee recommendation ................................................................. 399,200,000 

The Committee recommendation includes $399,200,000 for the 

National Institute of Dental and Craniofacial Research [NIDCR]. 

The fiscal year 2004 appropriation was $383,282,000 and the budget requested $394,080,000. 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 Americans. The Institute emphasizes 

ways to prevent disease in high-risk groups, including the elderly, 
109 

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.—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 the 

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 NIDCR’s interest 

in scleroderma, a chronic and progressive disease that predominantly strikes women. Scleroderma is disfiguring and life-threatening; and effective treatments are lacking. Scleroderma is often 

associated with a number of dental and craniofacial complications. 

The most major and common problems are xerostomia and 

microstomia. Additional concerns are increased frequency of caries, 

periodontal disease, fibrotic changes, fungal infections, 

telangectasia and bone resorption of the mandible. Additional research is needed to develop safe and effective treatments and to 

identify the cause or causes of the serious complications of 

scleroderma. 

Skeletal Disorders.—The Committee encourages NIDCR to continue to conduct research into the basic biology of bone cells and 

bone matrix and their roles in bone turnover and regeneration. The 

Committee also urges NIDCR to pursue research into the role of 

genes and other agents in restoring skeletal tissue, and skeletal 

disorders—including fibrous dysplasia and dental abnormalities in 

Paget’s disease patients. 

Systemic Health Risks and Oral Health.—The association between oral health and systemic health has been a topic of NIDCR 

funded research projects for many years. Early results from several 

studies indicate that there is a link between oral bacterium and 

preterm births. Still another report has shown a connection between gum disease and heart attacks, regardless of whether the 

patient uses tobacco. The Committee encourages further research 

to identify the connection between oral disease and systemic disorders. 

NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY

DISEASES

Appropriations, 2004 ............................................................................. $1,671,803,000 

Budget estimate, 2005 ........................................................................... 1,726,196,000 

Committee recommendation ................................................................. 1,739,100,000 

The Committee recommends an appropriation of $1,739,100,000 

for the National Institute of Diabetes and Digestive and Kidney 

Diseases [NIDDK]. The fiscal year 2004 appropriation was 

$1,671,803,000 and the administration’s request is $1,726,196,000. 
110 

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. 

Acute Liver Failure.—The Committee is pleased that the NIDDK 

has funded an Acute Liver Failure Study Group [ALFSG] that will 

improve medical knowledge necessary to prevent and treat acute 

liver failure. The Committee is pleased with the progress of the 

ALFSG, but notes that funding for the pediatric component of this 

initiative is limited. The Committee therefore urges increased funding for the ALFSG, particularly to permit a focus on pediatric 

issues. 

Auto-Immune Liver Diseases.—These diseases are the primary 

indication for liver transplantation in adolescents. The Committee 

urges additional research to improve the prevention and treatment 

of auto-immune liver diseases in children. 

Behavioral Research.—The Committee encourages NIDDK’s initiative to expand research on childhood obesity, particularly behavioral research on physical activity in children in various site-specific settings (schools, after-school care, or other community 

venues). The goal of such research would be to explore methods in 

pediatric populations for the prevention of inappropriate weight 

gain among those not overweight; to prevent further weight gain 

among those already overweight or obese; or treatment of overweight or obesity to prevent the complications of associated comorbidities. The Committee applauds NIDDK’s proposed long-term 

effort to address the relative contributions of the environmental 

and behavioral factors that lead to excessive weight gain and obesity among children. 

Cooley’s Anemia.—The Committee continues to support the high 

quality research being conducted by the NIDDK on such issues as 

iron chelation, non-invasive iron measurement, fetal hemoglobin, 

and other topics critical the improving the lives of Cooley’s anemia 

patients. The development of a less burdensome means of iron chelation is urgently needed. In addition, the Committee encourages 

NIDDK to continue to work closely with NIBIB to develop and perfect non-invasive means of iron measurement. 

Cystic Fibrosis.—Over the last three decades, advances in the 

treatment of cystic fibrosis have resulted in improvements in the 

life expectancy of individuals with CF. However, much more remains to be done to find new treatments for CF. One promising 

area of research is proteomics, which is focused on the CF 

Transmembrane conductance Regulator and its abnormalities, the 

many proteins that interact with CFTR, and the identification of 

novel targets for new CF drugs. The Committee encourages NIDDK 
111 

to expand its support for basic and clinical CF research and to 

place a special emphasis on proteomics in CF. 

Diabetes in Native Hawaiians.—The Committee recommends investigating the incidence of diabetes in Native American, Hawaiian 

and Alaskan populations, as well as the Mississippi Band of the 

Choctaw Indians and the Eastern Band of the Cherokee Indians. 

Digestive Diseases.—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. 

Fatty Liver Disease.—The Committee notes that there is an 

emerging obesity-related chronic liver disease, nonalcoholic fatty 

liver disease, which may affect as many as 1 in every 4 adults over 

the age of 18. This diagnosis encompasses a spectrum of severity 

with many cases evolving into non-alcoholic steatohepatitis [NASH] 

and, ultimately, cirrhosis. NASH-related liver disease has already 

become an important indicator for liver transplantation, and, in the 

absence of better treatments, the need for NASH-related liver 

transplantation will increase significantly over time. The Committee appreciates NIDDK’s existing programs in this area but 

urges expanded basic and clinical research focused both on interventions needed to prevent the onset of NASH and improved protocols for treatment of established cases. The Committee also urges 

the Institute to review opportunities to expand current clinical programs, where appropriate, to permit the enrollment and follow up 

of larger numbers of patients. Finally, the Committee urges a public awareness campaign with a national voluntary health agency 

with State and local affiliates to reverse this growing and preventable public health epidemic linked to the broader issue of obesity. 

Fragile X.—Fragile X mental retardation is one of the most common single gene disorders, and yet there exists almost no research 

on its effects outside the central nervous system. Fragile X causes 

a broad range of symptoms including premature ovarian failure, 

macroorchidism (large testicles), and malformations in the urogenital track, digestive problems including excessive vomiting and 

increased motility. The fact that these diverse symptoms arise from 

one gene mutation offers an invaluable opportunity to understand 

and develop treatments for these disorders. The Committee urges 

NIDDK to expand its research activities on Fragile X and to coordinate these efforts with other Institutes working on related activities, including NIMH and NICHD. 

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, the 

NIDDK is collaborating on a joint research program with a voluntary foundation to include basic and genetic studies. Further the 

Committee is pleased that NIDDK is sponsoring a scientific conference on glomerular injury research, and is hopeful that this important workshop will lead to a broader scope of activities and initiatives on glomerular disease research. 
112 

Hepatitis B Conference.—Hepatitis B remains a common cause of 

acute hepatitis affecting 1,250,000 Americans. Among the Asian 

and Pacific Island populations the rate of infection rate is even 

higher, affecting up to 15 percent of individuals. In order to address this health issue, the Committee urges NIDDK to convene an 

Expert Conference in fiscal year 2005 to reach consensus on the 

best treatment protocols. 

Hepatitis C in Children.—The Committee is pleased that the 

NIDDK has launched a pediatric hepatitis C trial that will permit 

long-term follow up of children enrolled in treatment protocols, particularly as these treatment regimens impact the growth and development of the children. The Committee looks forward to being informed on the progress of this trial during the fiscal year 2006 appropriations hearings. 

Incontinence.—Fecal incontinence, also called bowel incontinence, 

affects people of all ages and is associated with a wide variety of 

causes. The Committee encourages NIDDK to develop a standardization of scales to measure incontinence severity and quality of 

life, and to develop strategies for primary prevention of fecal incontinence associated with childbirth. 

Inflammatory Bowel Disease.—The Committee has been encouraged in recent years by the discoveries related to Crohn’s disease 

and ulcerative colitis, collectively known as inflammatory bowel 

disease [IBD]. These extremely complex disorders represent the 

major cause of morbidity from intestinal illness. The Committee 

commends the NIDDK for its strong leadership in this area and encourages the Institute to increase funding for research focused on: 

the cellular, molecular, and genetic structure of IBD; identification 

of the genes that determine susceptibility or resistance to IBD in 

various patient subgroups; and translation of basic research findings into patient clinical trials as outlined in the research agenda 

developed by the scientific community titled, ‘‘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. 

Interstitial Cystitis.—The Committee is pleased by recent advances in the area of interstitial cystitis research, particularly in 

the area of urinary markers. The Committee urges the NIDDK to 

continue to aggressively support IC-specific basic science initiatives, particularly through program announcements. The Committee also encourages the NIDDK to work closely with the IC patient community on developing and funding an IC awareness campaign for both the public and professional communities, and to host 

a consensus conference on the definition of IC. The absence of a 

uniform definition that accurately captures the condition and the 

affected population is negatively impacting patients in terms of diagnosis and treatment as well as researchers in terms of literature 

review and their research activities. The Committee was very encouraged by the progress reported at the 2003 NIDDK-sponsored 

scientific symposium on IC, and it urges the NIDDK to further this 

scientific momentum by hosting the next international symposium 

on IC in 2005. 
113 

Irritable Bowel Syndrome.—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 requests that NIDDK actively pursue the development 

of a strategic plan for IBS research. 

Mucopolysaccharidosis [MPS].—The Committee recognizes the 

efforts of the NIDDK to enhance research efforts to achieve a greater understanding and pursue development of effective therapies for 

MPS disorders. In addition to the general overall support of broad 

based MPS research, the Committee supports studying bone and 

joint disease in MPS disorders. Research into the underlying 

pathophysiology of bone and joint lesions, the gene mutations and 

substrates that are stored and potential therapeutic approaches are 

of interest to the Committee. The Committee encourages NIDDK’s 

continued efforts to collaborate with NIAMS on bone and joint research in Lysosomal Storage Disorders and commends the NIDDK 

on its performance in collaborating with NINDS, NICHD, NCRR, 

and ORD in advancing MPS-related research. 

Osteoporosis.—The Committee encourages NIDDK, in concert 

with other NIH institutes, to increase research into disease-related 

osteoporosis and/or bone disorders. This research should include 

studies of the role of genetics, the effects of these diseases on bone 

turnover and altered bone metabolism, the impact of environmental 

and lifestyle factors, their effects on bone quality and fracture incidence, the role of bone marrow changes, the use of agents to increase bone mass, and the therapeutic use of new technologies to 

combat osteoporosis. 

Pediatric Kidney Disease.—Chronic kidney disease is the ninth 

leading cause of death and one of the costliest illnesses in the U.S. 

Although significant strides have been made in understanding kidney disease in adults, much less is known about its manifestations 

in children. This breach has taken on greater significance in recent 

years as the number of children who are overweight and obese has 

skyrocketed, giving rise to an increased incidence of type 2 diabetes, hypertension and chronic kidney disease in this population. 

Given the long-term implications of diabetes-related kidney problems initiating in childhood, NIDDK is encouraged to undertake 

longitudinal studies of the natural history, prevention and treatment of kidney disease in type 2 diabetes and its antecedents in 

children and adolescents. The Committee is pleased that NIDDK 

has assigned priority to clinical studies related to the treatment of 

FSGS, the most common acquired cause of kidney disease in children, and to longitudinal epidemiological studies of children. In 

both instances, NIDDK is encouraged to support ancillary studies 

aimed at discovering new prevention and treatment strategies for 

children. 

Pediatric Liver Transplant National Database and Registry.— 

The Committee is pleased that NIDDK has funded the Studies in 

Pediatric Liver Transplantation Registry. This database and registry follows the natural history of infants and children who receive 

liver transplants until they are 18 years of age. This National 

Database and Registry will permit more hypothesis testing and 
114 

outcomes research to determine both the health and financial impact of liver transplants on the child and the child’s family. 

Pediatric Urology.—The Committee remains concerned with the 

lack of research dedicated to pediatric urologic conditions. According to the NIDDK Bladder Research Review Group document 

‘‘Overcoming Bladder Disorders: A Strategic Plan for Research,’’ 

the gaps and requirements for pediatric disease research remain 

substantial, particularly for conditions such as vesicoureteral reflux 

and bladder dysfunction. The Committee urges NIDDK to commit 

the necessary resources to expand research on pediatric urologic 

conditions, which may in turn provide additional insight into adult 

urologic problems. 

Polycystic Kidney Disease [PKD].—Recent breakthroughs in PKD 

research have culminated in the development of therapies to potentially halt disease progression for the 600,000 Americans who suffer from PKD. Key to such therapies is the discovery that an existing drug controlling other abnormal fluid-retention diseases in humans also retards the production of cysts and disease progression 

in all forms of PKD in the laboratory. Also, the NIDDK-funded 

CRISP study for PKD proves the value of innovative imaging methods to measure disease progression, thus reducing by forty-fold the 

number of patients needed to adequately assess clinical research 

outcomes. Moreover, the possibility that future PKD clinical trials 

can be conducted simultaneously with other research protocols 

under the NIDDK-funded Halt-PKD Interventional Trials infrastructure is also encouraging. The Committee urges the NIDDK to 

pursue clinical trials regarding these recent breakthroughs and to 

expand its infrastructure for PKD clinical research, while expeditiously implementing the new PKD Strategic Plan it recently developed. 

Prostate Diseases.—Prostate diseases are highly prevalent and 

poorly understood. 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. In particular, 

the current efforts to develop biomarkers for benign prostate diseases should be expanded. 

Prostatitis.—The Committee encourages the Institute to provide 

more diverse medical specialties to supplement and build upon the 

insufficient treatment options and the background of basic information now available. The genetic and molecular epidemiology, the 

management of pelvic pain, the infectious origins and the symptoms of prostatitis that are identical to symptoms of prostate cancer need special attention. 

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, Barrett’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 di-
115 

agnosis. More research is urgently needed in order to develop safe 

and effective treatments and to identify the cause or causes of the 

complications of scleroderma. 

Tuberous Sclerosis Complex.—Tuberous sclerosis complex, or 

TSC, is a genetic disorder that triggers uncontrollable tumor 

growth in multiple organs of the body including the kidneys, where 

patients are at risk for polycystic kidney disease, cancer or, most 

commonly, benign growths known as angiomyolipoma that can result in kidney failure. The Committee strongly urges NIDDK to 

support studies examining the molecular and cellular basis of these 

manifestations of TSC as well as pre-clinical and clinical studies. 

Urogynecology Program.—The Committee is pleased that the 

NIDDK has supported the Urinary Incontinence Treatment Network and urges increased funding and expansion for this important 

and productive clinical network. While recent studies have yielded 

gains in understanding these conditions, 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 supports the NIDDK in the creation of a team focused 

on urogynecology and encourages a dedicated study section in this 

area. 

Urology Research.—The Committee commends NIDDK’s release 

of the first report on the burden of urologic disease through its 

‘‘Urologic Diseases in America’’ project, with a final compendium 

due out in 2006. The Committee urges NIDDK to allocate resources 

to ensure that updated reports are sustained in the future and to 

provide a report on the plan for this activity. The Committee is 

pleased that NIDDK has recognized the interconnection between 

obesity and diabetes and urologic disorders as shown by the December 2003 NIDDK meeting ‘‘Urologic Complications of Diabetes’’ 

and the NIDDK Bladder Research Review Group document ‘‘Overcoming Bladder Disorders: A Strategic Plan for Research’’ that 

dedicated an entire section to the urologic problems associated with 

diabetes and obesity. The Review Group specifically addressed research goals including programs to assess the effect of obesity on 

genitourinary tract function and to clarify the biologic mechanisms 

for bladder and urethral dysfunction in diabetes. The Committee 

encourages NIDDK to ensure that the NIH Obesity Research Task 

Force includes adequate resources for research addressing oftenoverlooked urologic problems associated with diabetes and obesity. 

In particular, the Committee recommends that the Urinary Incontinence Treatment Network continue observational and interventional trials in the area of incontinence associated with obesity 

and diabetes. 

The Committee urges the NIDDK to provide to the Committee 

the reports for the urology Interagency Coordinating Committee 

meetings for the past 5 years and the collaborative initiatives that 

have resulted from these meetings, and to provide the plan for the 

next year on collaborative Interagency and Interinstitute urology 

research. In particular, treatment for prostate cancer is associated 

with significant incidence of urinary incontinence and erectile dysfunction that severely affect quality of life. NIDDK is urged to cooperate with the National Cancer Institute on studies of the cause, 

prevention, and treatment of urinary incontinence and erectile dys-
116 

function after treatment for prostate cancers. Incidence of urologic 

disorders increases with aging; for example, urinary incontinence is 

one of the leading causes of admission to nursing homes. NIDDK 

is urged to work with the National Institute on Aging to develop 

a comprehensive cooperative program to address these costly and 

pervasive urology health issues related to aging. In this regard, the 

Committee is pleased to learn that NIDDK leadership has taken 

steps to enhance integration of urologic diseases in initiatives within NIDDK and between and across the NIH, and urges continuation of these activities. A recently-appointed NIDDK Senior Advisor for Urology is working to coordinate urology research activities 

across the NIH. 

The Committee is impressed with the results produced by the 

George M. O’Brien urology research centers that bring together a 

critical mass of scientists who focus on urologic disease. The Committee recommends that NIDDK ensure adequate support to enhance the successes and to provide for collaboration among these 

centers. 

Prostate diseases are highly prevalent and poorly understood. 

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. In particular, the current efforts to 

develop biomarkers for benign prostate diseases should be expanded. 

The Committee is concerned about the continuing world-wide 

HIV epidemic. HIV is readily transmitted through sexual contact, 

yet little work is being done to examine the specific role of semen 

in this transmission. The Committee believes that a better understanding of these fundamental issues will contribute significantly 

to research for a vaccine and more effective treatments, and is 

pleased with the NIDDK’s recent initiative to encourage basic and 

clinical research studies that will elucidate the factors that determine HIV release in the male genital tract. The Committee urges 

the Institute to continue enhancing its grant portfolio on the role 

of semen in HIV transmission. 

The Committee remains concerned with the lack of research 

dedicated to pediatric urologic conditions. According to the NIDDK 

Bladder Research Review Group document ‘‘Overcoming Bladder 

Disorders: A Strategic Plan for Research,’’ the gaps and requirements for pediatric disease research remain substantial, particularly for conditions such as vesicoureteral reflux and bladder dysfunction. The Committee urges NIDDK to commit the necessary resources to expand research on pediatric urologic conditions, which 

may in turn provide additional insight into adult urologic problems. 

NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE

Appropriations, 2004 ............................................................................. $1,501,207,000 

Budget estimate, 2005 ........................................................................... 1,545,623,000 

Committee recommendation ................................................................. 1,569,100,000 

The Committee recommends an appropriation of $1,569,100,000 

for the National Institute of Neurological Disorders and Stroke 

[NINDS]. The fiscal year 2004 appropriation was $1,501,207,000 

and the budget request is $1,545,623,000. The comparable amounts 
117 

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.—NINDS continues to play an integral role 

in widening the scientific base of knowledge about Alzheimer’s disease. One emerging theme in the study of Alzheimer’s disease and 

other neurodegenerative diseases such as Parkinson’s and Huntington’s disease, is the overlap researchers have observed in the pathology underlying these conditions. Scientific reports are showing 

evidence that these disorders may be caused by similar abnormalities in protein folding and accumulation, making support for Alzheimer’s disease research more relevant than ever. On another 

front, working with NIA in the area of immunotherapy for Alzheimer’s disease, NINDS has funded a collaborative group of Alzheimer’s disease centers that will investigate the differences 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 work closely with NIA and other institutes. 

The Committee also encourages NINDS to conduct large scale clinical trials that will identify therapies and treatments capable of 

slowing or halting the onset and progression of Alzheimer’s. 

Alzheimer’s Disease and Early Diagnosis.—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. 

Ataxia Telangiectasia [A–T].—A–T is a genetic disease that attacks in early childhood. It progressively affects coordination and 

severely compromises the immune system. Children with A–T are 

highly likely to develop cancer, and rarely live beyond their teens. 

The Committee encourages the NINDS to work with the NCI and 

other appropriate Institutes to support research aimed at understanding the underlying causes of A–T with the goal of translating 

this basic research into treatments for the disease. 

Batten Disease.—The Committee is 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 expects to be informed of the steps 

taken to increase research on Batten disease. 

Behavioral Research and Measurement of Cognitive Function.— 

The Committee applauds the efforts of NINDS to understand the 
118 

mechanisms of executive function and ways to enhance cognitive 

rehabilitation for neurological disease. The Committee commends 

NINDS for its leadership in research to develop and validate neuropsychological test batteries and other instruments needed to measure executive function, including higher level cognitive processes 

such as working memory, decision-making, anticipation, and planning. Such tests are critical measurement tools for establishing the 

efficacy of interventions in NINDS clinical trials. 

Brain Tumors.—The Committee continues to be concerned that 

not enough attention and resources are devoted 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. 

Charcot-Marie-Tooth Disorder.—Charcot-Marie-Tooth Disorder 

[CMT] is one of the most common inherited neurological disorders, 

affecting approximately 1 in 2,500 people in the United States. The 

Committee is concerned abut the prevalence of this disease and its 

effect on people across the age spectrum and recognizes the value 

of CMT research for advancing understanding into other neuromuscular disorders. The Committee urges the Institutes to identify 

new research opportunities on CMT that could lead to a relevant 

program announcement or request for applications. The Committee 

requests a report on NIH efforts and research on CMT and CMTrelated disorders by April 1, 2005. 

Down Syndrome.—Recently Down syndrome research has begun 

to focus more on understanding the effect the disorder has on gene 

expression, cell function, neurons and neural systems. The Committee strongly encourages NINDS to expand its research on Down 

syndrome, particularly as it relates to gene expression in the brain 

and the development of possible biomedical interventions to improve cognition, memory, speech, behavior, and prevent early dementia. The Committee further encourages NINDS to assume a 

leadership role in coordinating this research among the Institutes 

and to work closely with NICHD to address the serious shortage 

of mice used for Down syndrome research. 

Duchenne Muscular Dystrophy.—The Committee urges NINDS, 

in collaboration with NIAMS and NICHD, to dedicate additional resources to develop a standard of care and improve treatments, accelerate clinical trials and translational research for patients with 

DMD. The Committee strongly encourages the funding of three additional Centers of Excellence and doubling of the funding for existing Centers of Excellence by the end of fiscal year 2005. In addition, the Committee notes that the NIH Interagency Coordinating 

Committee for muscular dystrophy has missed its 1-year deadline 

to submit a plan for conducting and supporting research and education on muscular dystrophy through NIH in accordance with the 

MD CARE Act of 2001. The Committee strongly urges the Coordinating Committee to finalize and submit this plan, as well as include representation from the Department of Defense on the panel, 

as soon as possible. 

The Committee was disappointed with the July 2004 ‘‘Muscular 

Dystrophy Research and Education Plan for the National Institutes 

of Health’’. The Plan developed by the MD Interagency Coordinating Committee, provides a summary of research goals, but lacks 
119 

sufficient detail into baseline research efforts, funding, and technical progress. In compliance with the provision of the Muscular 

Dystrophy Care Act of 2001 (Public Law 107–84, ‘‘MD Care Act’’), 

the report from the Coordinating Committee should be sufficient to 

support science and research objectives; thus providing an investment strategy and technical roadmap. In addition, the Committee 

notes that in accordance with the MD Care Act, the Department 

of Health and Human Services was to establish an Interagency Coordinating Committee whose responsibility was the development a 

plan on research and education on Muscular Dystrophy. The Committee is also disappointed with the speed at which the Act is being 

implemented. The Act became law in 2001 and the coordinating 

Committee did not convene until July 2003. Therefore, the Committee requests that, not later than February 1, 2005, the NIH 

shall provide an submit an additional report which should contain 

a plan which establishes research goals; the Institute or Center responsible for that research, the amount of funding spent in fiscal 

year 2000 through fiscal year 2004 and the amount of funds that 

NIH will devote to this research in fiscal year 2005 and 2006; key 

technical risk areas; integration efforts between NIH Institutes and 

Centers; and all opportunities for transition of technology to industry; translational research; major milestones and clinical trial opportunities. 

Duchene Muscular Dystrophy Translational Research.—The Committee commends the Institute for its enhanced efficiency in the 

grant review cycle to fund translational research for Spinal Muscular Atrophy [SMA]. The Committee strongly endorses this accelerated research approach and urges the Institute to evaluate the 

merits of this review model to fund translational research for 

Duchenne Muscular Dystrophy and report back to Congress no 

later than April 2005. The Committee believes the SMA model enhances the dialogue between reviewers and scientists, facilitating 

modifications of grant proposals that are in the best interest of the 

patients. In addition, the Committee strongly urges the Institute to 

increase funding for basic and translation DMD research by aggressively soliciting grant applications. The Committee encourages 

the Institute to employ existing mechanisms such as a standing 

program announcement, websites, publications, workshops and conferences to promote awareness of funding opportunities. In addition, the Committee encourages the NIH to further develop opportunities for upcoming clinical trials and to help make available all 

ongoing patient care options. The NIH is encouraged to collaborate 

with other Departments, Federal agencies and Patient Groups 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 2005 with a progress 

report on all aspects of DMD translational research. 

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 encouragaes 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 area 
120 

of research. The Committee also commends NINDS for the release 

of the joint dystonia research program announcement with other 

NIH Institutes and requests a comprehensive report on the results 

of this important mechanism for the fiscal year 2006 hearings. 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 strongly encourages the Institute to 

expand its efforts to find breakthroughs in the prevention, treatment, and eventual cure of epilepsy. The Committee applauds the 

development of benchmarks for epilepsy research resulting from 

the ‘‘Curing Epilepsy: Focus on the Future’’ conference held in 

March 2000. The Committee expects that NINDS will continue to 

update Congress and the public on progress in reaching these 

goals. The Committee further encourages the Institute to address 

critical research issues raised at the Living Well With Epilepsy II 

conference held in July 2003. These investments in our Nation’s 

health examine how epilepsy begins, ways of identifying people at 

risk and how to develop treatments that will prevent epilepsy in 

those people, as well as continuing the search for new therapies, 

free of side effects, to prevent seizures. In addition, the Committee 

urges the NINDS to focus on the critical research issues relating 

to the over 30 percent of patients with intractable epilepsy, to the 

life-long impact of seizures on young children, and to the growing 

incidence of epilepsy in the elderly. The Committee encourages the 

Institute to continue its anti-epileptic drug development program to 

discover therapies that may provide answers for the large number 

of people who do not respond to current treatments. The Institute 

is expected to update the Committee on its plans to advance these 

critical areas of research at the fiscal year 2006 appropriations 

hearing. 

Fragile X.—Fragile X is a single-gene disorder, but both its 

symptoms and its cellular mechanisms suggest involvement of multiple genes and specific brain pathways which are associated with 

other neurological disorders, such as autism and seizures. Furthermore, recent research offers clear evidence for disruption of fundamental brain circuitry in Fragile X. Research on Fragile X has the 

potential to contribute to understanding of multiple disorders. The 

Committee urges NINDS to expand its research activities on Fragile X and to coordinate these efforts with other Institutes working 

on related activities, including NIMH and NICHD. 

FXTAS.—Fragile X-associated tremor/ataxia syndrome, or 

FXTAS, is a newly discovered, progressive neurological disorder 

that affects older men who are carriers of a premutation in the 

same gene that causes Fragile X syndrome, the most common 

cause of inherited mental retardation. Nearly 1 in 800 men in the 

general population carries this premutation in the Fragile X gene, 

and as many as 30 percent of these carriers—roughly 1 in 3,000 

men—may develop FXTAS later in life. NINDS, in collaboration 

with the National Institute on Aging, is urged to commit additional 

resources and expand research into FXTAS, as identification of 

older male carriers will lead to a better understanding of the true 
121 

incidence of Fragile X syndrome and afford at-risk families of childbearing age the opportunity to pursue genetic counseling. 

Interdisciplinary Research.—The Committee encourages NINDS 

to continue exploring novel pathways by which cognitive 

neuroscientists and rehabilitation clinicians can apply new findings 

of central nervous system plasticity towards optimal treatment outcomes for patients with disorders of the brain affecting higher 

thought processes. The Committee applauds NINDS for promoting 

the establishment of multidisciplinary teams of scientists including 

neurologists, cognitive functional imaging experts and computational modelers in order to accelerate progress in the field of cognitive rehabilitation. By focusing on the limited set of neurological 

conditions (stroke, traumatic brain injury, and brain tumor) where 

these partnerships are likely to produce realistic gains in higher 

level functioning, NINDS may provide a model for interdisciplinary 

approaches to a range of conditions in which residual capacity is 

more difficult to measure. 

Juvenile Diabetes.—The Committee commends the NINDS for its 

efforts to prevent and treat hypoglycemia and neuropathy, both of 

which are serious complications of juvenile diabetes. The Committee encourages the NINDS to continue to expand its research 

into neuropathy and hypoglycemia unawareness and to consider establishing centers focused specifically on diabetic neuropathy. The 

Committee requests an update during the fiscal year 2006 hearings 

on the current status of diabetes-related research programs being 

carried out by the Institute and also urges NINDS to organize a 

workshop focusing on diabetic neuropathy. Such a workshop would 

provide the research community with an opportunity to identify 

common goals toward the development of novel clinical treatments 

for diabetic peripheral and autonomic neuropathies. 

Mucopolysaccharidosis [MPS].—The Committee is gratified at 

the release of the August 2003 PAS titled ‘‘Neuroprotective CNS 

Barriers in Neurological Diseases’’ and the stated interest in 

Lysosomal Storage Disorders [LSD] research in this initiative. The 

Committee is pleased to learn NINDS has chosen to work with the 

National MPS Society and other LSD groups in implementation of 

a new PAS initiative focused on therapeutic Central Nervous System research in Lysosomal Storage Disorders. The Committee continues to encourage NINDS to collaborate with all appropriate Institutes and Centers 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. 

Multiple Sclerosis [MS].—The Committee recognizes that more 

than 350,000 people in the United States currently suffer from 

multiple sclerosis and that approximately 200 new cases are diagnosed each week. The cause of MS remains unknown and no cure 

exists. The Committee urges NINDS to coordinate with private organizations that are working to discover effective treatment targets 

for MS. 

Neurofibromatosis.—Advances in NF research have linked NF to 

cancer, brain tumors, learning disabilities and heart disease affecting over 150 million Americans. Because NF plays a pivotal role 

both in disorders of the brain and in cancer and the enormous 
122 

promise of NF research is now reaching fruition in the testing of 

potential therapies, the Committee encourages NINDS to aggressively expand its NF clinical and basic research portfolios. The 

Committee commends NINDS for its leadership role in NF research 

and in coordinating efforts with other Institutes engaged in NF research. The Committee applauds NINDS and the Office of Rare 

Diseases for convening a major conference on NF in December 

2003. The Committee also applauds NINDS on issuing major program announcements in fiscal year 2004, pursuing the creation of 

NF research centers and NF translational research. The Committee 

encourages NINDS to follow through with the creation of these centers. 

Neuroprosthetics.—The Committee urges the Institute to expand 

research on neuroprosthetics, such as the Brain Machine Interface 

(or Human Assisted Neurological Device) project. This research offers great promise in restoring movement in individuals suffering 

from a variety of neurological disorders including paralysis, stroke 

and wound-related trauma. 

Parkinson’s Disease.—The Committee urges NINDS, in addition 

to pursuing all promising therapeutic avenues, such as gene therapy, stem cells, surgical approaches, non-human models, and biomarkers, to continue to identify and study neuroprotectant compounds, such as Coenzyme Q10, creatine, and minocycline. 

Furthermore, the Committee encourages NINDS to work with 

NIBIB to discover a biomarker (particularly a molecular one) for 

Parkinson’s. Investment by NIBIB in clinical trials could greatly 

enhance the value of these trials, as imaging technology facilitates 

a better understanding of the physical effects of tested drugs. 

Finally, the Committee commends NINDS for committing to set 

aside funds within its budget to fund the Udall Centers. The Morris K. Udall Parkinson’s Disease Research Centers of Excellence 

support additional research opportunities and discoveries that will 

lead to improved diagnosis and treatment of patients with Parkinson’s disease. The Centers vary in their basic and clinical objectives, but together they foster an environment that enhances research effectiveness in a multidisciplinary setting. 

Pick’s Disease.—The Committee requests the NINDS, in conjunction with NIA and NIMH, to provide a report to the Committee by 

March 31, 2005, on grant funding and research expenditures for 

Pick’s disease and other frontotemporal dementias. The Committee 

further requests that the NINDS conduct an epidemiology study of 

frontotemporal dementias and hold a workshop for researchers, clinicians, and advocates to assess the current state of frontotemporal 

dementia research, treatment, and needs. 

Peripheral Neuropathy.—The Committee is aware that an estimated 20 million Americans suffer from peripheral neuropathy, a 

neurological disorder that causes debilitating pain, weakness in the 

arms and legs, and difficulty walking. Peripheral neuropathy affects approximately one-third of diabetics, or about 5.1 million persons. Other forms of neuropathy are inherited; associated with cancer, kidney disease or infections like hepatitis, HIV/AIDS or Lyme 

disease; or caused by autoimmunity, traumatic injuries, poor nutrition, toxins and certain medications. For most of its victims, the 

only recourse is pain medication, physical therapy or assistive de-
123 

vices to help maintain strength and improve mobility. In light of 

the large number of individuals affected, and the attendant costs 

of this disease to society, the Committee is concerned that insufficient resources are being devoted to finding ways to cure, prevent 

and more effectively treat peripheral neuropathy. To that end, the 

Committee strongly urges NINDS to (1) determine how much NIH 

is devoting to research in this area, and (2) develop a research 

agenda that is coordinated with work being done through other institutes. The Committee expects to receive a report on this effort 

at next year’s hearings. 

Spina Bifida.—The Committee strongly encourages NINDS to 

enhance research to address issues relating the outcomes of the 

conference and urges significant expansion of prevention and treatment of Spina Bifida and associated secondary conditions. The Director should be prepared to testify on efforts to advance these 

areas of research at the fiscal year 2006 appropriations hearing. 

Spinal Muscular Atrophy.—SMA is the leading genetic killer of 

infants and toddlers. The Committee understands that the severity 

of the disease, its relatively high incidence, and the possibility of 

imminent treatments have led NINDS to initiate the SMA Therapeutics Development Program. The Committee is pleased that initial work has begun on the program and strongly urges NIH/ 

NINDS to commit the resources required to ensure a timely completion of the project mission—a treatment for SMA ready for clinical trails for current and future therapies. To maximize program 

efficiency, it is also critical that NINDS integrate Therapeutics Development efforts with the biotech and pharmaceuticals industry, 

academic medical centers and collaborations with voluntary health 

organizations. The Committee encourages NINDS to aggressively 

expand its SMA basic, translational and clinical research portfolio. 

The Committee understands that the strategy for developing a 

treatment for SMA will guide therapeutics development for other 

diseases including: Duchenne Muscular Dystrophy, ALS, Huntington’s and Alzheimer’s. The Committee strongly urges NINDS to 

successfully and expeditiously execute the SMA Therapeutics Development Program for the benefit of patients of SMA and countless other diseases. The Committee requests that NIH report back 

to the committee, no later than April 2005 with a progress report 

on all aspects of SMA research. 

Stroke.—The Committee continues to regard research into the 

causes, cure, prevention, treatment and rehabilitation of stroke as 

a major concern for our Nation and urges the NIH and the NINDS 

to make stroke a top priority. Stroke remains America’s third most 

common killer, a major contributor to late-life dementia, and a 

major cause of permanent disability. The Committee continues to 

strongly support increased efforts on stroke research. The Committee is very concerned that funding for stroke research over the 

years has not kept pace with the scientific opportunities, the number of Americans afflicted with stroke, and the economic toll this 

disease imposes on our Nation. The Committee urges the NINDS 

to aggressively expand its research portfolio and dramatically increase resources dedicated to stroke research through all available 

mechanisms. The Institute is urged to expand its stroke education 

program, to continue to implement the long-range strategic plan for 
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stroke research and to continue and expand innovative approaches 

to improve stroke diagnosis, treatment, rehabilitation, and prevention. 

Stroke Professional Judgment Budget.—The Committee commends the NINDS for convening a Stroke Progress Review Group 

which subsequently developed and released a 2002 report identifying critical gaps in stroke knowledge and outlining research priorities and resource priorities. The Committee is concerned that the 

report did not include a professional judgment budget and therefore requests that the NINDS submit to the Committee by April 

2005 a professional judgment budget for each year of the plan. The 

Committee encourages the Institute to continue to implement and 

fully fund the priorities in the Report and requests an implementation report by April 2005. 

Tuberous Sclerosis Complex.—Tuberous sclerosis complex, or 

TSC, is a genetic disorder that triggers uncontrollable tumor 

growth in multiple organs of the body, including the brain, heart, 

kidneys, lungs, liver, eyes or skin. Its victims—many of whom are 

infants and young children—face a lifetime of suffering with kidney 

failure, seizures, behavioral disorders, autism and mental retardation. Because of the effects of TSC on multiple organ systems, the 

Committee last year called upon the NIH Director to formulate an 

NIH-wide research agenda. The Committee understands that 

NINDS is assigned to implement and coordinate that effort, and 

looks forward to a yearly report on that effort. In the meantime, 

NINDS is strongly urged to support research examining the molecular and cellular basis of central nervous system manifestations in 

TSC, including studies examining TSC-associated epilepsy and 

brain tumor formation, and the effect of tubers and seizures on cognition and behavior. The Committee also looks forward to a report 

on NINDS’s coordinating activities and progress towards implementing the research agenda prior to the fiscal year 2006 hearings. 

NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES

Appropriations, 2004 ............................................................................. $4,155,447,000 

Budget estimate, 2005 ........................................................................... 4,325,507,000 

Committee recommendation ................................................................. 4,307,185,000 

The Committee recommends an appropriation of $4,307,185,000 

for the National Institute of Allergy and Infectious Diseases 

[NIAID]. The budget request was $4,325,507,000. The fiscal year 

2004 appropriation was $4,155,447,000. Included in these funds is 

$149,115,000 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 
125 

attack, and in diseases caused by, or associated with, disorders of 

the immune system. 

Arthritis.—The Committee encourages the NIAID to coordinate 

its research efforts with other NIH institutes to find a cure for arthritis and related diseases. 

Asthma.—The Committee is pleased with NIAID’s leadership regarding asthma research and management. 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 play in the development of asthma. 

Atopic Dermatitis.—Atopic dermatitis [AD] is one of the most 

common skin disorders experienced by infants and children. Patients with AD suffer with chronic skin inflammation and itching 

that disrupt sleep and reduce quality of life. Of additional concern, 

individuals who have active or dormant AD are at high risk for serious adverse reaction to the smallpox vaccine. The Committee encourages NIAID to work with NIAMS to spearhead a multidisciplinary, multi-institute initiative to encourage investigator-initiated 

research on AD as it relates to smallpox vaccination as well as the 

progression to asthma and other allergic diseases. 

Genomics.—The Committee is pleased that the NIAID has focused its attention on research efforts associated with multiple categories of pathogens. The Committee understands that commercially available research tools, such as microarray technology, can 

enhance the progress of pathogen-related research. The Committee 

urges the NIAID to utilize this technology to further support an aggressive agenda of pathogen research activities. 

Hemophilia.—The Committee appreciates NIAID’s efforts to improve HIV and hepatitis C virus [HCV] treatment for persons with 

hemophilia or other bleeding disorders. The Committee encourages 

NIAID to work with the National Hemophilia Foundation in 

strengthening its support for research on liver disease progression 

to improve HIV and HCV treatment among persons with bleeding 

disorders. 

Hepatitis.—The Committee continues to be concerned about the 

prevalence of hepatitis and urges NIAID to work with public health 

organizations to promote liver wellness, education, and prevention 

of hepatitis. 

Hepatitis C Vaccine.—The Committee is encouraged to learn that 

a small hepatitis C vaccine human trial has been launched and 

urges the consideration of other creative approaches and new paradigms including the development of DNA vaccines. 

Inflammatory Bowel Disease.—Recent research identifies strong 

linkages between Crohn’s disease and ulcerative colitis (collectively 

known as inflammatory bowel disease) and the functions of the immune system. The Committee encourages the Institute to expand 

its research partnerships with the IBD community, and to increase 

funding for research focused on the immunology of IBD and the 
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interaction of genetics and environmental factors in the development of the disease. 

Juvenile Diabetes.—The Committee is encouraged by the Institute’s efforts regarding the Autoimmune Prevention Centers, and it 

encourages the Institute to develop pilot projects, initiated with the 

support of the Prevention Centers of Autoimmunity, into full research proposals with special emphasis on pre-clinical studies related to juvenile diabetes. 

Nontuberculous Mycobacteria [NTM].—Mycobacteria are environmental organisms found in both water and soil that can cause significant respiratory damage. The Committee is aware of the increasing incidence of nontuberculous mycobacteria [NTM] pulmonary infections in women, particularly involving rapidly growing 

mycobacteria, an inherently resistant subspecies. The Committee 

encourages NIAID to advance diagnostic and treatment protocols 

for patients suffering from NTM diseases. 

Primary Immunodeficiency Diseases.—The Committee notes that 

more than 150 primary immune deficiency diseases have been 

identified to date. These diseases, which impair the body’s immune 

system, strike more severely in children, many of whom do not survive beyond their teens or early twenties. Primary immune deficiencies afflict more than 50,000 Americans, regardless of age, race, 

or gender. The Committee believes that NIAID should play a significant role in addressing this seriously under-diagnosed class of 

diseases. Research is being funded at many institutions, including 

several of the twelve Jeffrey Modell Diagnostic and Research Centers, as part of a consortium created to expand and enhance the research in this group of diseases. However, that research only helps 

people if physicians know to look for the disease; the public is 

aware of it; and, patients are diagnosed early and accurately. For 

this reason, the Committee encourages NIAID to increase its support for the public outreach campaign principally funded by the 

CDC, while maintaining its research portfolio. The Committee commends NIAID for the establishment of its primary immunodeficiency disease research consortium (USIDNet) in partnership 

with the Immune Deficiency Foundation and encourages continued 

support for this program. 

Psoriasis.—Psoriasis is a chronic, immune-mediated disease that 

affects more than 5 million Americans. A 1999 NIMH-supported 

study found that patients with psoriasis reported reduction in 

physical and mental functioning comparable to that seen in cancer, 

arthritis, hypertension, heart disease, diabetes, and depression. 

The Committee considers research on psoriasis and psoriatic arthritis very important, and is pleased that NIAMS helped create a 

psoriasis tissue bank from which the first several psoriasis genes 

have been identified. The Committee urges NIAMS to support additional research into the identification of other genes expected to 

play a role in psoriasis pathogenesis, and also to support additional 

clinical research on current and potential therapies for psoriasis 

and psoriatic arthritis. 

Scleroderma.—The Committee encourages NIAID to undertake 

research to study the cause and treatment of scleroderma, a chronic progressive disease that predominantly strikes women. 

Scleroderma is disfiguring and can be life-threatening, affecting 
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multiple systems. More research is critically needed in order to develop safe, effective treatments and to identify the cause or causes 

of scleroderma and its complications. Therefore, the Committee 

urges NIAID to include scleroderma research in the portfolio of the 

Autoimmune Centers of Excellence. 

Transplantation Research.—The Committee urges NIAID to convene an expert conference during fiscal year 2005 to develop a 

Transplantation Research Action Plan identifying the most urgently needed research to facilitate an increase in the success of 

organ transplantation. The Committee requests a report on the results of this conference including a breakdown of resources committed to this category of research. 

Tuberculosis.—The World Health Organization estimates that 

nearly 1 billion people will become infected with tuberculosis [TB], 

200 million will become sick, and 70 million will die worldwide between now and 2020. The Committee is pleased with NIAID’s efforts to develop an effective TB vaccine and encourages the Institute to continue its TB vaccine development work and to expand 

efforts to develop new drugs to treat TB. 

NATIONAL INSTITUTE OF GENERAL MEDICAL SCIENCES

Appropriations, 2004 ............................................................................. $1,904,838,000 

Budget estimate, 2005 ........................................................................... 1,959,810,000 

Committee recommendation ................................................................. 1,975,500,000 

The Committee recommendation includes $1,975,500,000 for the 

National Institute of General Medical Sciences [NIGMS]. The fiscal 

year 2004 appropriation was $1,904,838,000 and the administration’s request is $1,959,810,000. 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. 

Basic Behavioral Science.—The legislative mandate for NIGMS 

specifically includes behavioral science research, although NIGMS 

does not now support behavioral science research or training. 

Given the wide range of fundamental behavioral topics with relevance to a variety of diseases and health conditions, the Committee encourages 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 

Basic Research on Pre-Disease Pathways.—As the NIH institute 

most concerned with basic research, NIGMS has provided leader-
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ship in research on physiological and biological structures and 

functions that may play roles in numerous health conditions. The 

Committee encourages NIGMS to collaborate with other institutes 

including NCI, 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, 2004 ............................................................................. $1,242,361,000 

Budget estimate, 2005 ........................................................................... 1,280,915,000 

Committee recommendation ................................................................. 1,288,900,000 

The Committee recommends an appropriation of $1,288,900,000 

for the National Institute of Child Health and Human Development 

[NICHD]. The fiscal year 2004 appropriation was $1,242,361,000 

and the administration’s request is $1,280,915,000. 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 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 emphasizes its strong support for the broad portfolio of behavioral research at NICHD, and 

supports NICHD’s efforts to determine the biological, behavioral, 

and social factors that affect cognitive, social, and personality development of children in a variety of settings. The Committee encourages research on effective ways to promote and sustain healthy 

family formations for low-income families, including families of 

color. The Committee is particularly concerned about rising rates 

of childhood obesity and supports continued initiatives to promote 

healthy behaviors in children and adolescents and research to prevent health risk behaviors. 

Demographic Research.—The Committee commends NICHD for 

its strong support of demographic research. This research has consistently provided critical scientific knowledge on issues of greatest 

consequence for American families: work-family conflicts, family 

formation and structure, childcare, adolescent health and wellness, 

and family and household behavior. Recent findings have provided 

invaluable insights into timely issues such as the role of maternal 

employment and parental involvement on child development. The 

Committee applauds NICHD for its ongoing support of the Fragile 

Families, Three Cities Study of Welfare, and National Longitudinal 

Study of Adolescent Health studies in particular. The Committee 

encourages the Institute to ensure adequate funding for the large 

databases such as these that make advances in population research 

possible. Further, the Committee urges NICHD to maintain stable 

funding for the Population Research Infrastructure program. The 

recent retooling of this program has enhanced its ability to support 
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vital interdisciplinary collaboration and innovation in population 

research at academic and research institutions nationwide. The diverse exceptional research supported by this program has yielded 

key findings in areas such as fertility, health disparities, immigration and migration trends, and family dynamics. Given the importance of these issues to policymakers and the public, demographic 

research at the NICHD must continue to thrive. 

Down Syndrome.—The Committee encourages NICHD to increase funding for Down syndrome research as relates to gene expression of chromosome 21, the effects on cell function and cognition, and possible medical treatments to eliminate or reduce the 

cognitive abnormalities associated with the disorder. The Committee is aware of a serious shortage of mice used in the research 

of Down Syndrome and strongly encourages NICHD to increase 

funding for greater production of the Ts65Dn mouse model and for 

the research and development of other mouse models. The Committee also urges NICHD to work closely with NINDS, NIA, NIMH 

and NHGRI to establish a new, multi-year research initiative to 

fund Down syndrome biomedical research on cognition, behavior 

and early dementia. 

Drug Safety for Children.—The Committee recognizes the importance of ensuring that drugs are safe and effective for use by children and are appropriately labeled for pediatric use. The Committee strongly supports continued implementation of the Research 

Fund within the National Institutes of Health, as established in 

the Best Pharmaceuticals for Children Act of 2003 (Public Law 

107–109) within section 409I of the Public Health Service Act, 

which supports the pediatric testing of off-patent drugs, as well as 

on-patent drugs not being studied through existing mechanism. 

The Committee urges NICHD to act as the coordinating Institute 

for other Institutes within NIH for which pediatric pharmacological 

drug research may have therapeutic relevance, and urges consultation with the Food and Drug Administration to ensure that the 

studies conducted through the Fund are designed to yield improved 

pediatric labeling. The Committee expects an update prior to the 

fiscal year 2006 hearings, including 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. 

Fragile X.—Title II of the Children’s Health Act of 2000 authorized the establishment of at least three Fragile X research centers. 

The Committee is pleased that the NICHD has funded three Centers on a first-year basis, and urges the NICHD to issue an RFP 

with the goal of enhancing the Centers and recruiting new researchers to the Fragile X field. The Committee also encourages 

the NICHD to coordinate its Fragile X research efforts internally, 

by partnering with others, and by relating Fragile X research with 

that in other developmental disorders, and with autism research. 

Infertility and Contraceptive Research.—The Committee continues to place high priority on research to combat infertility and 

speed the development of improved contraceptives. NICHD is urged 
130 

to continue aggressive activities in this area, including individual 

research grants and those of the infertility and contraceptive research centers. 

Learning and School Readiness.—The Committee commends 

NICHD on its commitment to research in reading, learning disabilities, and math and science cognition. NICHD is encouraged to support additional research on developing comprehensive, culturally 

neutral and developmentally appropriate assessments and instruments to measure cognitive, social and emotional skills for preschool-aged children that are necessary for school readiness. 

Maternal Fetal Medicine Units Network [MFMU].—The Committee was extremely encouraged by the research results from 

NICHD’s Maternal Fetal Medicine Units Network on the identification of a therapy, progesterone, that prevents recurrent preterm 

birth in high-risk women. The Committee understands that this is 

one of the first advances in this area, despite extensive efforts over 

decades, and urges the NICHD to build on this finding and to fully 

support the MFMU Network. 

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 a broad range of environment influences, including physical, chemical, biological and social influences, on child health and development. The Committee 

urges the NICHD to coordinate the involvement of the Department, 

the lead Federal partners—CDC, EPA, and NIEHS—and other interested institutes, agencies, and non-Federal partners conducting 

research on children’s environmental health and development, such 

that this study is ready for the field no later than 2006. 

The Committee is pleased that the National Children’s Study Advisory Committee is planning to utilize probability sampling in its 

design and is undertaking a strategic planning process that emphasizes collaboration between the biomedical and behavioral sciences. 

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, regarding the mysteries of how the NF gene is related to learning disabilities, raising 

hopes of finding a treatment for learning disabilities not only in 

children with NF but in the general population as well. 

Obesity in Children.—The Committee strongly urges the NICHD, 

in collaboration with other relevant Institutes, to support the initiation of a study on the metabolic, psychological, and genetic causes 

of obesity in children. The Committee requests the Institute be prepared to report on the progress being made in the development of 

such study during the fiscal year 2006 appropriation hearings. 

Pediatric AIDS.—The Committee urges the Institute to increase 

support for AIDS research, especially pediatric HIV/AIDS research. 

HIV/AIDS affects children differently than it does adults, and it is 

essential to do specific research for pediatric populations in order 

to continue making significant strides in treating children with 

HIV/AIDS. 

Pediatric Liver Disease.—The Committee urges the Institute to 

aggressively pursue and fund ancillary studies associated with the 

recently awarded NIDDK pediatric hepatitis C clinical trial. This 
131 

clinical trial will provide long term follow up for children treated 

for hepatitis C, permitting growth and development issues to be 

more fully explored. The Committee also notes that the Institute 

has provided only limited support for pediatric liver disease research and urges support to expand ongoing efforts to study biliary 

atresia and to provide expanded support for the Biliary Atresia 

Clinical Research Consortium. 

Prader-Willi Syndrome.—Prader-Willi Syndrome is the most 

common known genetic cause of life threatening obesity in children. 

The Committee strongly encourages the NICHD to place a high priority on Prader-Willi Syndrome research to study childhood obesity. 

Furthermore, the NICHD is urged to incorporate Prader-Willi Syndrome into the planning process for The National Children’s Study. 

Prematurity.—The Committee encourages NICHD to support a 

major initiative in the area of prematurity. The rates of premature 

birth have increased 29 percent since 1981 to over 480,000 babies 

in 2002. African-American infants are nearly twice as likely as nonHispanic white infants to be born prematurely. Premature birth is 

the leading cause of death in the first month of life and most recent 

data indicate the first rise in infant mortality rates since 1958. Premature birth can occur in any pregnancy; the causes of nearly half 

of all preterm births are unknown. The Committee commends 

NICHD for its work on preterm birth and strongly urges the allocation of more funds to reveal the underlying cause of preterm delivery, to identify prevention strategies and improve the treatment of 

outcomes for infants born preterm. 

In addition, the Committee is aware that genomic and proteomic 

strategies are widely used and have had a major impact on medicine. The Committee believes it is imperative that these techniques 

also be used to understand prematurity, and strongly encourages 

NICHD to support an initiative to hasten a better understanding 

of the pathophsiology of premature birth, discover novel diagnostic 

biomarkers, and ultimately aid in formulating more effective interventional strategies to prevent premature birth. 

Primary Immunodeficiency Diseases.—The Committee continues 

to be impressed with the dedication of financial and personnel resources by NICHD to address the research and awareness issues 

that surround this class of more than 100 diseases. The Committee 

is particularly encouraged by the institute’s research commitment 

to develop newborn screening procedures for PI through microarray 

technologies and urges the NICHD to press ahead aggressively 

with this initiative. 

Skeletal Development.—The Committee urges NICHD to focus on 

the effects of a wide variety of drugs on the growing skeleton and 

how to minimize these effects by working to ensure that the impact 

on the growing skeleton is investigated for all therapeutic agents 

in the implementation of the Better Pharmaceuticals for Children 

Act. The Committee also encourages NICHD to engage in transNIH research into other factors—including genetic, diet and exercise—affecting the determination of peak bone mass in children 

with and without the metabolic bone diseases of osteoporosis and 

osteogenesis imperfecta. In addition, the Committee urges support 

for basic research on the pathophysiology, genetics and treatment 

of osteopetrosis. 
132 

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. The Committee strongly encourages NICHD to enhance 

research to address issues related to the outcome of the conference 

and urges the Institute to significantly expand its research efforts 

in the prevention and treatment of Spina Bifida and associated secondary conditions. The Director should be prepared to report on efforts to advance these areas of research at the fiscal year 2006 appropriations hearing. 

Spinal Muscular Atrophy [SMA].—SMA is the leading genetic 

killer of infants and toddlers, and is the most prevalent genetic 

motor neuron disease. The severity of the disease, its relatively 

high incidence, and the possibility of imminent treatments have led 

NINDS to initiate the SMA Project. The Committee believes that 

the treatment of SMA, and the SMA Project at NINDS, is strategically consistent with the mission the NICHD. The Committee 

strongly urges the NICHD to work closely with NINDS to develop 

collaborations and programs which will support and expand the 

SMA Project. The Committee strongly urges NICHD to expand the 

scope and level of SMA research by aggressively soliciting grant applications on an expedited basis. Lastly, the Committee strongly 

urges the NICHD to develop formal programs that increase public 

and professional awareness of SMA. The Committee requests that 

the NICHD report back to the Committee during the fiscal year 

2006 appropriations hearings. 

Stillbirth.—The Committee applauds NICHD’s efforts in addressing stillbirth, a major public health issue with morbidity equal to 

that of all infant deaths. The Committee understands that NICHD 

has established a cooperative network of clinical centers and a data 

center to address this issue with a standard protocol, and strongly 

encourages the NICHD to fully fund this effort. 

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. Now that NICHD is focusing more globally on 

infant mortality, the Committee urges the Institute to transition 

from its successful SIDS 5-year research plan to a more comprehensive plan focusing on SIDS, stillbirth, and miscarriage. The 

Committee requests that NICHD determine an appropriate means 

of including research on these causes of infant mortality into one 

inclusive plan. 

Urinary Incontinence.—Urinary incontinence is one of the most 

prevalent chronic diseases in women affecting 30 percent of females; these and other pelvic floor disorders serve as obstructions 

to healthy living and contribute to depression and obesity. The 

Committee commends the NICHD for establishing the Pelvic Floor 

Disorder Network [PFDN] and expects additional resources will enable the network to expand 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 in urinary incontinence. Recent 

studies have yielded gains in understanding these conditions but 
133 

the Committee is equally concerned that more needs to be done 

with basic, clinical and translational research in order to create 

better foundations for clinical care. The Committee encourages the 

Institute to provide expanded research for investigator-initiated applications to ensure a self-sustaining base of ongoing research and 

encourages a dedicated study section in this area. The Committee 

also encourages the NICHD to include the effects of pregnancy on 

a woman’s chance for incontinence and pelvic floor disorders in the 

future National Children’s Study. 

Vulvodynia.—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. The Committee urges the Institute to fund a collaborative research network to expedite the collection of data on the efficacy of current and future treatments. In addition, the Committee 

notes that, on average, women with vulvodynia consult five physicians before receiving a correct diagnosis. Therefore, the Committee 

urges the NICHD to work with the National Vulvodynia Association to implement a national education program for primary care 

health professionals, patients and the general public to reduce this 

delay. 

NATIONAL EYE INSTITUTE

Appropriations, 2004 ............................................................................. $653,052,000 

Budget estimate, 2005 ........................................................................... 671,578,000 

Committee recommendation ................................................................. 680,300,000 

The Committee recommends an appropriation of $680,300,000 for 

the National Eye Institute [NEI]. The budget request was 

$671,578,000 and the fiscal year 2004 appropriation was 

$653,052,000. 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.—The Committee commends NEI for establishing the Diabetic Retinopathy Clinical Research Network, which 

serves to expedite the evaluation of new approaches to address vision-related complications of diabetes. The Committee encourages 

NEI to continue to expand upon its efforts to detect, prevent and 

treat diabetic retinopathy by collaborating with NIBIB on the development and application of scanning technologies that will be 

highly affordable and widely accessible to allow for early detection. 

Gene Therapy.—The Committee is aware of progress made in 

demonstrating the effectiveness of gene therapy to reverse and cure 
134 

several retinal diseases, including diabetic retinopathy, macular degeneration, and retinopathy of prematurity. diabetic retinopathy 

and macular degeneration are leading causes of blindness and visual disability in the United States, with an additional 165,000 people losing their vision each year due to these disorders. Additionally, each year more than 500 infants are blinded by retinopathy 

of prematurity. Since gene therapy intervention has been successfully demonstrated in laboratory animals, the Committee urges the 

Institute to facilitate clinical trials in primates and humans to further validate gene therapy interventions to reverse and cure retinal 

diseases. 

Juvenile Diabetes.—The Committee is aware of the serious problem of retinopathy in individuals with juvenile diabetes, and it encourages the NEI to continue to collaborate with other institutes on 

efforts to identify the genes for diabetic retinopathy by collecting 

and analyzing human samples and by developing animal models of 

diabetic retinopathy. 

NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES

Appropriations, 2004 ............................................................................. $632,392,000 

Budget estimate, 2005 ........................................................................... 650,027,000 

Committee recommendation ................................................................. 655,100,000 

The Committee recommends an appropriation of $655,100,000 for 

the National Institute of Environmental Health Sciences [NIEHS]. 

The budget request was $650,027,000 and the fiscal year 2004 appropriation was $632,392,000. 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. 

Breastfeeding and Toxins.—Recent reports on the presence of 

flame retardants and other environmental toxins in human 

breastmilk have given rise to concerns about the safety of 

breastfeeding. Recognizing that these reports may offer mixed messages about this public health concern, the Committee reaffirms 

the goal of Healthy People 2010 of ‘‘[I]ncreasing the proportion of 

mothers who breastfeed their babies.’’ The Committee also strongly 

urges the National Institute of Children’s Health and Human Development, the National Institute of Nursing Research, the National Institute of Environmental Health Sciences, the Centers for 

Disease Control and Prevention, Department of Health and Human 

Services’ Office of Women’s Health to hold a consensus meeting 

with health professionals, to include nursing and breastfeeding and 

lactation professionals. The consensus meeting should focus on environmental toxins and breastfeeding and appropriate public risk 

communication. 

Environmental Health and Nursing.—According to the final report of the Nursing and Environmental Health Roundtable, held in 

the fall of 2002, there is a significant need to build a cadre of registered nurse researchers specializing in environmental health. 
135 

During the last decade, increased emphasis has been placed on the 

impact of environment on human health and the need for nurses 

to engage in research to advance knowledge in this field. Several 

nurse researchers received funding for environmental health 

projects focused on prevention of lead exposures, environmental 

factors and asthma, pesticide exposures among workers and their 

families, environmental awareness, and occupational health. Despite these efforts, significant needs still exist. Environmental 

health nurse researchers bring knowledge in nursing research 

methods as well as more traditional areas of environmental health 

research, such as human disease manifestation, risk assessment, 

and risk management. Many of the priority areas of environmental 

health nursing research rely on methods of exposure assessment, 

risk assessment, and risk communication. This Committee urges 

the National Institute of Environmental Health Sciences to create 

specific nurse research fellowships with the goal of increasing the 

number of registered nurse researchers specializing in the area of 

environmental health. 

Pacific Center for Environmental Health.—The Committee encourages NIEHS to establish a Pacific Center for Environmental 

Health to further study the short-term and long-term health effects 

of volcanic emissions as well as other environmental issues. Such 

environmental concerns should include food and waterborne illness, 

fish contamination by pesticides and heavy metals, and pesticide 

residue in food and water. 

Parkinson’s Disease.—The Committee urges NIEHS in collaboration with NINDS to gain a greater understanding of the environmental underpinnings of Parkinson’s disease. The Committee also 

strongly urges NIEHS to intensify its efforts in the Collaborative 

Centers for Parkinson’s Disease Research Program—as this initiative facilitates significant collaboration among genetics, clinical 

medicine, epidemiology, and basic science so that the most promising leads may be investigated more quickly in pursuit of a cure 

or to reduce the incidence of harmful toxins. 

NATIONAL INSTITUTE ON AGING

Appropriations, 2004 ............................................................................. $1,024,754,000 

Budget estimate, 2005 ........................................................................... 1,055,666,000 

Committee recommendation ................................................................. 1,094,500,000 

The Committee recommendation includes $1,094,500,000 for the 

National Institute on Aging [NIA]. The budget request was 

$1,055,666,000 and the fiscal year 2004 appropriation was 

$1,024,754,000. 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.—The number of Americans with Alzheimer’s—4.5 million today—will increase to between 11.2 million 

and 16 million by 2050. Within a decade, total annual Medicare 

costs for people with Alzheimer’s will increase by almost 55 percent 
136 

to nearly $50,000,000,000. Medicaid health and long-term care expenditures will rise by 80 percent, to $33,000,000,000 annually. 

Alzheimer’s is also having a corrosive effect in the private sector, 

costing U.S. businesses $61,000,000,000 in 2002, an amount equivalent to the net profits of the top 10 Fortune 500 companies. The 

Committee notes, however, that rapid advances in basic science are 

helping to identify multiple targets for therapies that may help 

slow or halt the progression of Alzheimer’s disease. Before these 

promising advances can be put to use preventing or treating the 

disease, they must be tested and validated in controlled clinical 

trials. Given the tremendous toll Alzheimer’s disease exacts in 

human suffering, health care costs and economic loss, the Committee strongly urges NIA to launch simultaneous clinical trials on 

therapies it determines to be most promising. The Committee also 

encourages NIA to work collaboratively with other institutes and 

the CDC to educate Americans about the ways they can maintain 

their brain as they age. 

Alzheimer’s Research Caregiver, Education, and Training.—The 

Committee recommends that the NIA establish cooperative working relationships with non-profit organizations dedicated to new approaches to care-giving for patients with Alzheimer’s disease, and 

to expand the level of resources made available for Alzheimer’s disease caregiver education, research, and training. 

Behavioral Research and Older Workers.—The Committee encourages NIA to expand research on the needs of older workers. 

Since more baby boomers will be working well beyond the traditional age of retirement, more information is needed about the 

ways in which workplaces and workplace technology can be better 

designed to accommodate the needs of older workers. 

Bone Diseases.—The Committee encourages NIA to increase research into the pathophysiology of osteoporosis, Paget’s disease and 

osteogenesis imperfecta. This research should include: genetics, the 

role of cell aging and altered metabolism, environmental and lifestyle factors, bone responsiveness to weight bearing, bone quality 

and fracture incidence, bone marrow changes, new agents to increase bone mass, the therapeutic use of new technology, and the 

comorbidity of metabolic bone diseases with chronic diseases of 

aging. 

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 

a critical role in 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 Research.—The Committee has noted the results of the 

NIA-funded clinical trial, ACTIV, in which interventions to improve 

various aspects of cognition in older people were found to be effective, but did not generalize to improved cognitive performance overall. Understanding that changes in memory and cognition are troubling to older people and threaten their independence, the Committee encourages NIA to consider next steps in research to develop cognition-enhancing interventions and report back on additional efforts. 
137 

Demographic and Economic Research.—The Committee once 

again commends the NIA for supporting demographic and economic 

research and, in particular, the NIA Demography of Aging Centers 

program. Since its inception 10 years ago, the program has supported invaluable research to enhance knowledge about the well 

being of older Americans—especially information about their health 

and socioeconomic status, including their income, savings, work, 

and retirement decisions. Researchers at these Centers have initiated critical surveys, such as the Health and Retirement Survey 

and the National Long-Term Care Survey, which have, for example, identified social and economic consequences of retirement and 

the decline in disability among older Americans, respectively. After 

a decade, the Centers are poised to make significant contributions 

on numerous policy issues confronting an aging society. The Demography Centers are also now in a unique position to collaborate 

with several of the NIA Roybal Centers program to help translate 

findings into interventions and improve quality of life for older people. Therefore, the Committee urges NIA to continue its strong support of the demography centers program. 

Down Syndrome.—Research has shown that all persons with 

Down syndrome develop the neuropathological findings of Alzheimer’s disease, and that many go on in later life to show cognitive decline. The Committee strongly urges NIA to increase funding to study the connection between Alzheimer’s disease and Down 

syndrome and to work closely with NINDS, NICHD, NIMH and 

NHGRI to establish a new, multi-year research initiative to fund 

Down syndrome research on improving cognition and preventing 

early dementia through biomedical treatments. 

Hematology Research.—The Committee remains interested in advancing research opportunities into blood disorders in the elderly 

population. The Committee is particularly concerned that the incidence and prevalence of anemia increases with age; after age 85, 

one quarter of the population is anemic. Research is needed to better understand the basic biology and adverse quality of life complications of anemia and other blood diseases in the elderly. The 

Committee is supportive of the ongoing collaboration between the 

American Society of Hematology and NIA, with the participation of 

NHLBI, NCI, and NIDDK, to develop a research agenda in this 

field. 

Parkinson’s Disease.—The Committee encourages NIA to collaborate with NINDS to determine the overlap in benefits that current 

research could provide to understanding both Alzheimer’s and Parkinson’s disease. The Committee congratulates the significant investment by NIA in understanding the role of genes, including 

alpha-synuclein, in the causation and manifestation of Parkinson’s. 

Work of this nature is critical for better comprehension of the disease process, identification of potential pharmaceutical agents, improved diagnostic ability—especially during the early stages of the 

disease, and the development of accurate animal models. 
138 

NATIONAL INSTITUTE OF ARTHRITIS AND MUSCULOSKELETAL AND SKIN

DISEASES

Appropriations, 2004 ............................................................................. $501,066,000 

Budget estimate, 2005 ........................................................................... 515,378,000 

Committee recommendation ................................................................. 520,900,000 

The Committee recommends an appropriation of $520,900,000 for 

the National Institute of Arthritis and Musculoskeletal and Skin 

Diseases [NIAMS]. The budget requested $515,378,000 and the fiscal year 2004 appropriation was $501,066,000. 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 expenditures and lost productivity. The research activities of this Institute serve the concerns of many different special populations, including women, minorities, children, and the elderly. 

Arthritis.—Arthritis is the leading cause of disability in the 

United States, with 70 million Americans living with some form of 

the disease of chronic joint symptoms. The NIAMS is a leader in 

the field of arthritis research. The committee urges NIAMS to collaborate with other NIH Institutes toward a cure for arthritis and 

related diseases. 

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 Muscular Dystrophy [DMD].—The Committee urges 

NIAMS, in collaboration with NINDS, to dedicate additional resources to improve treatments for patients with DMD. 

Juvenile Arthritis.—The Committee urges the NIAMS, in collaboration with NICHD and NIAID, to strengthen its investment in, 

and commit additional resources to, basic, clinical, and 

translational research efforts and related activities specific to juvenile arthritis, as authorized by the Children’s Health Act. The 

Committee expects the NIH to provide Congress with a report on 

efforts underway and progress made in achieving this goal by February 2005. 

Lupus.—The Committee is aware of the importance of lupus susceptibility genes. Voluntary health organizations have established 

a collaboration among many individual research teams throughout 

the country to accelerate the search for these genes. The Com-
139 

mittee urges the Institute to pursue this collaboration and to provide increased funding so that sufficiently large patient cohorts can 

be developed that will facilitate research in this area. Because 

lupus is disorder that disproportionately affects women of African 

American, Hispanic and Asian ancestry, appropriate numbers of 

samples from these populations should be included in these cohorts. The Committee also urges the Institute to consider the importance of creating repositories that might aid research into the 

genetic aspects of lupus. 

Marfan Syndrome.—The Committee commends NIAMS and its 

collaborative efforts with other institutes to provide vital support 

for research on Marfan syndrome, a life-threatening, progressive 

and degenerative genetic disorder. The Committee urges NIAMS to 

focus on research opportunities that have the potential to advance 

non-surgical treatment options, through all available mechanisms, 

as appropriate. 

Metabolic Bone Diseases.—The Committee urges NIAMS to support trans-NIH research into all aspects of genetics and gene therapies for the treatment of metabolic bone diseases, the role of environmental and lifestyle factors in bone disease, the effects of depression and cardiovascular disease on bone disease, the impact of 

mechanical loading of bone, translational research to bring the recent exciting basic discoveries about bone in to clinical practice, 

and research on bone health and osteoporosis in special groups, 

such as non-Caucasian ethnic groups. 

Mucopolysaccharidosis [MPS].—The Committee is aware of recent efforts with NIDDK to facilitate communication between MPS 

and Lysosomal Storage Disorder investigators with bone pathology 

and connective tissue scientists to examine problematic issues in 

this area of study. Research in the underlying pathophysiology of 

bone and joint lesions, the gene mutations and substrates that are 

stored and potential therapeutic approaches are of interest to the 

Committee. The Committee encourages NIAMS to enhance its efforts to directly support and collaborate with NIDDK on bone and 

joint diseases in MPS disorders. 

Scleroderma.—The Committee is encouraged by NIAMS’s growing interest in scleroderma, a chronic and progressive disease that 

predominantly strikes women. Scleroderma is disfiguring and can 

be life-threatening and effective treatments are lacking. The Committee encourages NIAMS to collaborate with other institutes, including NHLBI, NIDDK, NIAID, and NIDCR to generate additional research opportunities for scleroderma to identify genetic 

risk factors and safe and effective treatments. 

Tuberous Sclerosis Complex.—Tuberous sclerosis complex, or 

TSC, is a genetic disorder that triggers uncontrollable tumor 

growth in multiple organs of the body, including the skin. The 

Committee strongly encourages NIAMS to support programs examining the molecular and cellular basis of dermatological lesions in 

TSC as well as the development of non-surgical treatments for skin 

manifestations. 
140 

NATIONAL INSTITUTE ON DEAFNESS AND OTHER COMMUNICATION

DISORDERS

Appropriations, 2004 ............................................................................. $382,053,000 

Budget estimate, 2005 ........................................................................... 393,507,000 

Committee recommendation ................................................................. 399,000,000 

The Committee recommends an appropriation of $399,000,000 for 

the National Institute on Deafness and Other Communication Disorders [NIDCD]. The budget requested $393,507,000 and the fiscal 

year 2004 appropriation was $382,053,000. 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. 

Behavioral Research.—The Committee recognizes that many behavioral problems afflict those who suffer from communication disorders, and that NIDCD research in behavioral and communication 

science is key to alleviating these conditions. Unwanted behaviors, 

as a result of autism or other disorders, can interfere with the development of communication skills, and research has shown that 

highly structured behavioral programs are effective in some cases. 

Research in cognitive processing combines behavioral and biological 

approaches to help understand the normal mechanisms of sensory 

processing, cognition and perception. This is an excellent example 

of the interdisciplinary research that should be supported at NIH. 

Clinical Evaluation of Hearing Loss.—The Committee encourages 

NIDCD to partner with other Institutes at NIH to support the development of functional neuroimaging technology with more precise 

spatial and temporal resolution, as well as better molecular probes 

to monitor brain activity. 

Deafness Research.—The Committee urges the NIDCD to continue to support research in the areas of inner ear protection, rescue, and regeneration, such as noise-induced hearing loss, 

ototoxicity and hair cell regeneration, as well as research on the 

central auditory system. In addition, NIDCD should continue research on rehabilitative technologies and strategies, leading to improved prevention, treatment and management of hearing loss, 

tinnitus and dizziness. The Committee strongly urges the NIDCD 
141 

to continue to support the translation of basic research discoveries 

into better clinical diagnostic techniques and treatments. 

Early Detection and Intervention.—It is now clear that early 

treatment of hearing loss is essential for normal language acquisition. However, the Committee notes that there are many children 

with late onset and progressive hearing loss who are not identified 

by Universal Neonatal Hearing Screening [UNHS], so parents and 

clinicians should be made aware of this in NIDCD newsletters and 

on the NIDCD website. 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. The Committee encourages 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 to 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 assign 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. Building on the successful clinical implementation of the 

cochlear implant, the Committee encourages NIDCD to explore the 

feasibility of electrical stimulation applied to the vestibular system 

to treat balance disorders. 

Hereditary Hearing Loss.—The Committee applauds the remarkable progress towards understanding the molecular basis for hereditary hearing impairment. The Committee encourages a sustained 

effort to screen for the single and multigenetic bases of hearing loss 

through contemporary techniques, including the development of diagnostic gene chips for auditory dysfunction. The Committee also 

encourages the development of animal models to better assess at 

the level of structure and function how gene mutation results in 

impaired central auditory function. 
142 

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. 

Neurofibromatosis.—NF2 accounts for approximately 5 percent of 

genetic forms of deafness. Unlike other genetic forms of deafness, 

NF2-associated deafness is potentially preventable or curable if 

tumor growth is halted before damage has been done to the adjacent nerve. Research is now being conducted to cure deafness in 

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, is the third leading chronic disease, following hypertension 

and arthritis, in individuals over age 65. It 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. NIDCD is urged to undertake research on the mechanism underlying the premature cell 

death that results in many forms of presbycusis so as to develop 

prevention and cure strategies. 

Stuttering.—The Committee received testimony concerning stuttering which affects approximately 3 million people in this country. 

It was learned that healthy individuals who stutter are often labeled as unintelligent, eccentric, mentally ill and/or emotionally 

disturbed. NIDCD is encouraged to conduct a workshop in fiscal 

year 2005 on stuttering, which will examine the current state of 

the science as well as to identify future research opportunities in 

the field of stuttering and to report to the Committee on the plans 

for the workshop at next year’s hearings. 

Tinnitus.—The Committee encourages the Institute to expand its 

research into mechanisms underlying peripheral and central 

tinnitus. 

Translational Research.—The Committee encourages NIDCD to 

support research activities aimed at accelerating the translations of 

new findings from the laboratory bench to the bedside. With the exciting new insights and findings of our molecular and basic sciences 

in understanding the mechanisms of cell death and disease processes, it is important to provide support for those activities that 

will translate these findings into new interventions and technologies to better prevent and treat deafness and other communication disorders. 

NATIONAL INSTITUTE OF NURSING RESEARCH

Appropriations, 2004 ............................................................................. $134,724,000 

Budget estimate, 2005 ........................................................................... 139,198,000 

Committee recommendation ................................................................. 140,200,000 

The Committee recommends an appropriation of $140,200,000 for 

the National Institute of Nursing Research [NINR]. The budget request was $139,198,000 and the fiscal year 2004 appropriation was 
143 

$134,724,000. 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 homebased 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 NINR’s 

research in risk behavior. 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. Recognizing that many adolescent risk behaviors are intertwined, the focus of NINR’s initiative is on developing interventions 

that target several risk behaviors simultaneously. The Committee 

hopes this research will continue to bear positive results. 

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 should. By focusing on such 

behavioral issues as stress and decision-making, as well as end-oflife care for children, the institute will continue to make strides 

that will alleviate the burdens involved with caring for those with 

terminal conditions. 

Genetics.—The Committee is pleased with NINR’s efforts in genetics and emphasis on 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 genetics expertise within the nursing knowledge base and healthcare 

practice. 

Minority Health and 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 low birth-weight rates for 

minority women, which can be 50 percent higher than for white 

women. NINR’s focus on early identification of risk factors and 
144 

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 the country. NINR 

is also urged to continue its successful research in promoting the 

health of minority men who have a reduced life expectancy compared to women. Research of effective health promotion strategies 

such as smoking cessation, nutrition, physical activity, and increased management of stress are critical to improving and extending the life cycle of minority men. 

Nurse-managed Health Centers.—The Committee urges the 

NINR to increase funding for nurse-managed health centers and 

advanced practice nurses in research and demonstration projects. 

Nursing Shortage.—NINR is to be commended for its forwardthinking investment in research training as a way to address the 

nursing shortage. Training support for fast-track baccalaureate-todoctoral program participants is one important initiative. The 17 

recently funded Nursing Partnership Centers to Reduce Health 

Disparities is another initiative that helps produce an adequate 

number of nurse researchers. 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.—Increasingly, 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, 2004 ............................................................................. $428,669,000 

Budget estimate, 2005 ........................................................................... 441,911,000 

Committee recommendation ................................................................. 444,900,000 

The Committee recommends an appropriation of $444,900,000 for 

the National Institute on Alcohol Abuse and Alcoholism [NIAAA]. 

The budget request was $441,911,000 and the fiscal year 2004 appropriation was $428,669,000. 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 medica-
145 

tions development, fetal alcohol syndrome, genetics, neuroscience, 

and moderate drinking. 

Alcohol Policy Information System.—The Committee supports the 

Alcohol Policy Information System [APIS]. This clearinghouse provides users with access to the latest and most comprehensive information to develop and implement effective policies and practices to 

combat underage drinking and other alcohol problems. The Committee strongly encourages the NIAAA to increase funding in this 

area and to report on its efforts to maintain the APIS, and to develop a plan to increase public awareness and use of this information clearinghouse. 

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. 

Co-occuring Substance Abuse Disorders.—The Committee notes 

that the Report to Congress on the Prevention and Treatment of 

Co-occurring Substance Abuse Disorders and Mental Health Disorders found that a ‘‘significant lack of prevalence data on co-occurring disorders exist.’’ The Committee encourages NIMH, NIAAA 

and NIDA to collaborate with States to develop more recent and accurate data on persons with co-occurring mental health and substance use disoders—with an emphasis on individuals with mild to 

moderate mental health disorders. 

Drinking as a Development Disorder.—The Committee understand that new NIAAA research has shown serious drinking problems previously associated with middle adulthood often begin to 

emerge during adolescence and young adulthood. The Committee 

encourages NIAAA to continue researching alcohol-related problems in a developmental context and recognizes that alcohol abuse 

and dependence are best characterized as developmental disorders 

that become manifest throughout the lifespan. 

Knowledge Transfer.—The Committee urges NIAAA to redouble 

its efforts to transfer new knowledge to communities and to primary care health providers who can apply it to prevention and 

treatment. Recognizing the developmental nature of alcohol-related 

problems, NIAAA should continue to focus intensively on the transition from childhood into adolescence, adolescence itself, and the 

transition from adolescence into young adulthood. The Committee 

looks forward to research findings that will reduce the risk to future generations of Americans and will spare countless additional 

parents from suffering the consequences of problem drinking in 

their children. 

Nonalcoholic Steatohepatitis [NASH].—The Committee notes that 

the mechanisms that cause NASH and the treatment protocols that 

are effective with regard to NASH also offer promise for treating 

alcoholic liver disease [ALD]. The Committee urges additional research focused on NASH and ALD to address both these diseases 
146 

as well as to further test the hypothesis that the mechanisms causing these diseases are similar and new research findings may address both diseases. 

Underage Drinking.—The Committee acknowledges that alcohol 

is, by far, the psychoactive substance most often used by youth, 

leading to numerous problems for themselves such as lower grades 

or school failure, social problems, physical problems, such as 

hangovers or medical illnesses, unwanted or unintended sexual activity, physical and sexual assault, memory problems, increased 

risk for suicide and homicide, alcohol-related car crashes and death 

from alcohol poisoning. The Committee recognizes that alcohol consumption represents one of the most important public health problems among youth today. 

Using an Integrative Approach.—The Committee encourages 

NIAAA to continued directing substantial effort and resources toward the achievement of a more fully integrated and comprehensive scientific understanding of the environmental, behavioral, biological, and genetic factors that promote the initiation, maintenance, and acceleration of alcohol use, and that influence the transition into harmful alcohol use, including abuse and dependence. 

NATIONAL INSTITUTE ON DRUG ABUSE

Appropriations, 2004 ............................................................................. $990,953,000 

Budget estimate, 2005 ........................................................................... 1,019,060,000 

Committee recommendation ................................................................. 1,026,200,000 

The Committee recommends an appropriation of $1,026,200,000 

for the National Institute on Drug Abuse [NIDA]. The budget request was $1,019,060,000. The fiscal year 2004 appropriation was 

$990,953,000. 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 Drug Use.—The Committee is pleased with the Institute’s focus on adolescents. The Committee notes that if drug use 

is to be reduced, there must be a better understanding of the adolescent decision-making process so that more effective prevention 

programs can be developed. NIDA is urged to increase its research 

to better understand the mechanisms underlying adolescent judgment, decision-making, impulsivity and risk-taking. 
147 

Collaboration With SAMHSA.—The Committee commends NIDA 

for its outreach and work with State substance abuse authorities 

to reduce the current 15- to 20-year lag between the discovery of 

an effective treatment of intervention and its availability at the 

community. In particular, the Committee applauds NIDA for working with SAMHSA on a recent RFA designed to strengthen State 

agencies’ capacity to support and engage in research that will foster statewide adoption of meritorious science-based policies and 

practices. The Committee also encourages NIDA to continue collaborative work with States to ensure that research findings are 

relevant and adaptable by State Substance Abuse systems. In addition, the Committee encourages NIDA to work with SAMHSA, 

NIAAA and NIMH to develop more recent and accurate data on 

persons with co-occurring mental health and substance use disorders, with an emphasis on individuals with mild to moderate 

mental health disorders. 

Co-morbidity.—Co-mortidity between drug abuse and mental illness is common and may reflect common contributing factors. The 

Committee urges NIDA to expand research efforts to better understand the neurobiological underpinnings of these co-occurring disorders; to elucidate risk and protective factors for development of 

mental health and substance abuse problems; and more specifically 

to explore the impact of stimulant therapies for mental disorders 

such as ADHD on later drug use disorders. The Committee also encourages NIDA to examine how treatment services can best accommodate the co-morbid nature of these disorders. 

Drug Abuse and HIV/AIDS.—The Committee understands HIV/ 

AIDS continues to disproportionately affect vulnerable populations 

in the United States (e.g. criminal justice populations, pregnant 

women, minorities and youth) and that drug abuse is often a factor 

in transmission of HIV/AIDS. Therefore, the Committee urges 

NIDA to continue its support of research that is focused on the development and testing of drug-abuse related interventions designed 

to reduce the spread of HIV/AIDS in these populations. 

Emerging Drugs.—The Committee is concerned regarding the 

abuse of over-the-counter medications, including dextromethorphan 

[DMS] and steroids. Recognizing the significant role that NIDA has 

played in monitoring drug trends and responding to emerging drug 

problems like methamphetamine and prescription drugs, the Institute is encouraged to continue to increase its research and dissemination efforts on emerging drug problems. 

Long-Term Consequences of Marijuana Use.—The Committee is 

concerned with the continuing widespread use of marijuana. Research shows that marijuana can be detrimental to educational attainment, work performance, and cognitive function. However, 

more information is needed in order to assess the full impact of 

long-term marijuana use. The Committee urges NIDA to support 

increased efforts to assess the long-term consequences of marijuana 

use on cognitive abilities, achievement, and mental and physical 

health. 

Medical Consequences.—The Committee recognizes that addiction 

is a disorder that affects the course of other diseases such as cancer, cardiovascular and infectious diseases. Therefore, the Com-
148 

mittee urges the NIDA to continue to support research on the medical consequences associated with drug abuse and addiction. 

Medications Development.—The Committee applauds NIDA for 

over a decade of leadership in working with private industry to develop anti-addiction medications and is pleased this collaboration 

has resulted in a new medication for opiate addiction. The Committee encourages NIDA to continue its work with the private sector to develop anti-addiction medications, particularly for cocaine, 

methamphetamine, and marijuana. 

Methamphetamine Abuse.—The Committee continues to be concerned with the rate of methamphetamine abuse across the Nation. 

The problem is especially acute in Midwestern States. The Committee again urges NIDA to expand its research on improved methods of prevention and treatment of methamphetamine abuse. 

Outreach.—The Committee commends NIDA for its outreach and 

work with State substance abuse authorities to reduce the current 

10- to 20-year lag between the discovery of an effective treatment 

of intervention and its availability at the community level. The 

Committee is pleased with NIDA’s collaboration with SAMHSA on 

strengthening State agencies’ capacity to support and engage in research that will foster statewide adoption of science-based policies 

and practices. The Committee also encourages NIDA to continue 

collaborative work with States to ensure that research findings are 

relevant and adaptable by State Substance Abuse systems. 

Primary Care Settings and Youth.—Primary care settings, such 

as offices of pediatricians and general practitioners, are potential 

key points of access to prevent and treat problem drug use among 

young people; yet primary care and drug abuse services are commonly delivered through separate systems. The Committee encourages NIDA to expand support for health services research on effective ways to educate primary care providers about drug abuse; develop brief behavioral interventions for preventing and treating 

drug use and related health problems, particularly among adolescents; and develop methods to integrate drug abuse screening, assessment, prevention and treatment into primary health care settings. 

NATIONAL INSTITUTE OF MENTAL HEALTH

Appropriations, 2004 ............................................................................. $1,381,774,000 

Budget estimate, 2005 ........................................................................... 1,420,609,000 

Committee recommendation ................................................................. 1,436,800,000 

The Committee recommends an appropriation of $1,436,800,000 

for the National Institute of Mental Health [NIMH]. The budget request was $1,420,609,000 and the fiscal year 2004 appropriation 

was $1,381,774,000. 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. 
149 

As the leading Federal agency involved in research focused on 

mental disorders, 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. Equally important are 

the Institute’s strong efforts to translate this basic knowledge into 

clinical research that will lead to better treatments and ultimately 

be effective in diverse populations and evolving health care systems. 

Aging and Mental Health.—The Committee continues to be concerned that NIMH has not provided substantial resources to promote aging research or provide data on existing funds targeted toward geriatric mental health research. Therefore, the Committee 

encourages NIMH to significantly expand research in this area 

extramurally through all available mechanisms to advance the 

geriatric mental health research agenda. 

Alzheimer’s Disease.—Recently, NIMH launched a five-site trial 

of antidepressant medications designed to help identify the best 

medication regimen for treating the behavioral problems that often 

occur in Alzheimer patients. Initial results should be available in 

late 2004. In addition, NIMH intramural researchers identified a 

promising new method for early detection of Alzheimer’s disease. 

Long-term studies now underway will determine whether this biomarker can be used as a predictive and diagnostic tool. The Committee encourages NIMH to continue to place significant priority on 

studies of Alzheimer’s disease. 

Behavioral Science.—The Committee is aware that NIMH is reviewing its portfolio in basic behavioral science and encourages 

NIMH to continue its commitment to strengthen behavioral research that examines the basic psychological functions that promote mental health or become disturbed in mental disorders. The 

Committee further recognizes the potential contribution of research 

on cognitive, personality, emotional, and social processes that underlie behavioral functioning and urges their inclusion in inter-disciplinary research. The Committee is pleased that the National 

Mental Health Advisory Council has established a basic science 

working group and looks forward to receiving a report on the working group’s conclusions regarding research opportunities in basic 

behavioral sciences relating to mental health. 

Down Syndrome.—The Committee encourages NIMH to research 

the mental health symptoms of persons with Down syndrome and 

to investigate risk factors and possible treatments for autism, obsessive-compulsive disorder, attention deficit disorder, anxiety, and 

depression. The Committee urges NIMH to include Down syndrome 

in its studies on related disorders and to coordinate its work with 

the National Center on Birth Defects and Developmental Disabilities at the Centers for Disease Control and Prevention. The Committee further urges NIMH to work closely with NINDS, NICHD, 

NIA and NHGRI to establish a new, multi-year research initiative 

to fund Down syndrome research relating to cognition and behavior 

through biomedical interventions. 

Fragile X.—Fragile X is the most common single-gene 

neuropsychiatric disease known. It causes cognitive impairment, 

mental disorders such as obsessive-compulsive disorder, and ex-
150 

treme anxiety. The Committee commends NIMH for working with 

FRAXA Research Foundation to spearhead three focused research 

meetings devoted to identifying critical research needs, in November 2001, January 2003, and a planned meeting in July 2004. The 

Committee urges NIMH to pursue the most critical needs identified 

by the meeting panels. These include controlled studies of existing 

and new pharmacological treatments for Fragile X and identification of the key molecular targets which are likely candidates for designing drug treatments for Fragile X and related disorders such 

as autism. The Committee also urges NIMH to include Fragile X 

in its studies of related neuropsychiatric disorders and to work 

with other Institutes such as NICHD and NINDS to develop cooperative research support mechanisms in this area. 

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. 

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. 

Major Depression and Bipolar Disorder.—The prevalence, economic consequences, and systemic nature of major depression is 

alarming. 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. 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 the public education campaign entitled 

‘‘Real Men. Real Depression’’ and encourages the Institute to continue these education and information dissemination efforts. 

Outreach.—The Committee commends NIMH on its outreach efforts to determine the differences in mental health needs which 

may exist in remote rural communites. The Committee encourages 

NIMH to expand its research efforts toward the unique needs of 

the Native Hawaiian community. 

Parkinson’s Disease.—The Committee encourages NIMH to increase its research on the role of depression in Parkinson’s disease. 

Particularly, depression may be a very early symptom of Parkinson’s, sometimes appearing before other traditional symptoms. 

NIMH should also continue its ongoing research into the proper 

treatment of depression and other serious mental disorders that 

often co-occur with Parkinson’s, such as dementia and anxiety. 

Portfolio Review.—The Committee is pleased with recent NIMH 

efforts to set priorities with an eye toward achieving maximum impact against mental disorders. A balanced NIMH research portfolio 
151 

ranges from the most basic molecular research to complex clinical 

and health services research—all of which contributes to the body 

of knowledge that will enable science to develop targeted and highly effective treatment interventions that can then be implemented 

through services that reach every individual who is in need. In this 

regard, the Committee understands that Working Groups of the 

National Advisory Mental Health Council [NAMHC], convened by 

the NIMH Director—including NAMHC members and outside scientific experts—have scrutinized the current NIMH portfolio related to clinical trials, to basic neurobiological research, and to 

basic behavioral research. The Committee favors these efforts at 

careful portfolio management, and looks forward to seeing the resulting recommendations of the Workgroups as to how the NIMH 

can best focus its efforts in areas that are relevant to the tremendous public health burden of mental disorders while at the same 

time promising the greatest opportunity for scientific advancement. 

Prader-Willi Syndrome.—The Committee commends the NIMH 

for its efforts to further the understanding and description of the 

mental health components of Prader-Willi Syndrome. The Committee recommends that NIMH expand its programs to develop 

practical treatment protocols, including pharmaceutical options, for 

the severe anxiety, obsessive-compulsive disorder, oppositional-defiant disorder and psychotic mental illness aspects of Prader-Willi 

Syndrome. 

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 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 Progress.—Research has led to breakthroughs in understanding the brain, how it is affected by environmental conditions, 

and how this in turn works to influence behavior. The Committee 

is pleased to see the success of research on the genetics of mental 

illness supported by NIMH, and progress made in identifying genes 

that increase one’s risk of developing schizophrenia, depression and 

bipolar disorder, and unraveling how the genes work in the brain 

to influence vulnerability. 

The Committee notes recent findings from the NIMH intramural 

research program on brain development, particular its study of normal brain development in youth ages 4 to 21. These results have 

elucidated the processes involved in the development of the normal 

brain, thus allowing more precise interpretation of what goes awry 

in neurodevelopmental disorders such as autism and schizophrenia. 

These developments are a clear illustration of the critically important work that is supported at NIH. 
152 

Schizophrenia.—The Committee supports NIMH’s recent innovative steps to hasten understanding of schizophrenia, especially the 

emphasis on its highlight successful intramural program relating to 

schizophrenia, and on developing medications that will target cognitive symptoms associated with psychotic disorders. 

Post Traumatic Stress Disorder.—The Committee supports 

NIMH’s leadership in working to address urgent public health 

problems. NIMH research has shown that, for some individuals, exposure to violent or traumatic events can result in 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 individuals 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, scientists now know that PTSD must involve a well-defined specific brain circuit. This information can be important given 

the 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. 

Selective Serotonin Reuptake Inhibitors.—The Committee urges 

the NIMH, in collaboration with the NICHD and other appropriate 

Institutes, to develop and conduct studies to examine the safety 

and efficacy of selective serotonin reuptake inhibitors [SSRIs] in 

children and adolescents. SSRIs are prescribed to millions of American children each year, and that number continues to increase 

dramatically. Yet there is conflicting information about the benefits 

and possible risks of using SSRIs to treat youth suffering from depression. Therefore, the Committee recommends that studies be designed to conclusively answer questions about the safety and efficacy of SSRIs in youth suffering from depression. The Committee 

further recommends that these studies focus on original research 

to the extent that existing data prove insufficient to answer such 

questions. 

Social Work.—The Committee commends the NIH Office of Behavioral and Social Science Research for its leadership in working 

together with NIH Institutes and centers, especially NCI, NIAAA, 

NIA, NIDA, NIMH, NICHD, and social work organizations and 

academics to implement recommendations from the NIH Plan for 

Social Work Research, including expanded technical assistance and 

outreach and a summer 2004 training institute, and encourages 

continued implementation activities including working with appropriate social work practice, education, and research groups to host 

a trans-NIH conference on social work research. 

Suicide.—The Committee supports NIMH efforts to enhance suicide awareness and prevention, and encourages the Institute to 

continue its collaborative work with other NIH Institutes to address this painful yet all-to-real topic. In 2000, 30,000 persons 

killed themselves in the United States. Suicide deaths outnumber 

homicide deaths by 5 to 3, and suicide was the third leading cause 

of death for 10- to 24-year-olds. The health conditions most consistently associated with suicide are mental illness and addictive disorders, affecting up to 90 percent of all people who die by suicide. 

The Committee is pleased with the program announcement spon-
153 

sored by NIMH, NIAAA, NIDA, and others asking for grant applications for research that will reduce the burden of suicide. This 

multi-Institute initiative is meant to intensify investigator-initiated 

research on suicide and to attract new investigators to the field. 

This work is critical, and the Committee applauds this trans-NIH 

approach. Prescriptions for psychotropic medications for children 

and youth have clearly been increasing. While many children are 

immeasurably helped by these medications—so that they can lead 

satisfying social lives, perform well in school—recent reports of a 

possible link between use of these medications and suicide have 

alarmed the Committee. NIMH is addressing this important public 

health issue through its support of the large-scale clinical trial to 

carefully evaluate safety and effectiveness of treatments for adolescents with depression. The Committee would like a brief report 

from NIMH after publication of the trial results. The Committee 

notes NIMH’s web page essay on this topic, and urges NIMH to 

continue its vital research on the effects of these medication on 

children and on developing the brain when used long-term. 

Translating Behavioral Research.—The Committee recognizes 

and strongly supports NIMH’s efforts to advance the application of 

behavioral research and interventions in clinical settings to address 

the public health burden of mental disorders. 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. Behavioral interventions are especially needed for children and adolescents with mental disorders. 

NATIONAL HUMAN GENOME RESEARCH INSTITUTE

Appropriations, 2004 ............................................................................. $479,073,000 

Budget estimate, 2005 ........................................................................... 492,670,000 

Committee recommendation ................................................................. 496,400,000 

The Committee recommendation includes $496,400,000 for the 

National Human Genome Research Institute [NHGRI]. The budget 

requested $492,670,000 and the fiscal year 2004 appropriation was 

$479,073,000. The comparable amounts for the budget estimate include funds to be transferred from the Office of AIDS Research. 

Mission.—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 opens the 

genomic era of medicine. The Committee commends the NHGRI for 

developing this vision for the future of genomics. 

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 DNAbased diagnostics and gene-based therapies. The intramural program has also developed a strong clinical research program in col-
154 

laboration 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. 

Behavioral Research.—The Committee acknowledges NHGRI’s 

leadership in establishing a social and behavioral intramural research branch within its intramural program. The new branch will 

work to translate the discoveries from the recently completed 

Human Genome Project into interventions for health promotion 

and disease prevention, and for counseling patients and families 

dealing with the impact of devastating genetic disorders. The 

SBRB also will investigate the complex social, ethical and public 

policy impact of genomic research. 

Gene-Environment Interactions.—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. 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. 

Targeting Disease Prevention.—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 sequencebased functional elements contained in human DNA sequence. 

However, other important research related to unveiling the secrets 

of the human genome should also be investigated. These include: 

the development of a comprehensive catalogue of the functional 

components encoded in the human and mouse genomes, a study of 

how microarray technology can play a role in the screening of newborn infants in conjunction with the NICHD, and the completion of 

the international haplotype mapping [HAPMAP] project. In each of 

these areas, the Committee recognizes that advances in the use of 

mircroarray technology can enhance NHGRI’s global leadership in 

meeting these goals. 

NATIONAL INSTITUTE OF BIOMEDICAL IMAGING AND BIOENGINEERING

Appropriations, 2004 ............................................................................. $287,129,000 

Budget estimate, 2005 ........................................................................... 297,647,000 

Committee recommendation ................................................................. 300,800,000 

The Committee recommends an appropriation of $300,800,000 for 

the National Institute of Biomedical Imaging and Bioengineering 

[NIBIB]. The budget requested $297,647,000 and the fiscal year 

2004 appropriation was $287,129,000. 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 in-
155 

tegrated 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. 

Artificial Tissues.—The Committee encourages the Institute to 

focus on improved tissue and organ imaging technologies and on 

the growth of artificial tissues. Progress in these fields will have 

multiple benefits including addressing issues such as invasive 

diagnostics tests now required for liver diseases and the need to 

address the shortage of livers and other organs available for transplantation. 

Cardio-vascular Surgery.—Cardio-vascular surgery depends on 

the development of new materials and tools that can be used in 

surgical management of heart and lung disease. The Committee is 

encouraged that the Institute has recognized the importance of this 

concept and implemented programs in advanced biomaterials and 

tissue engineering that have a direct bearing on these surgical 

fields. 

Imaging Techniques.—The Committee urges NIBIB to make new 

bone imaging techniques a primary focus, speeding the development of new imaging modalities that better capture bone quality, 

including bone micro- and macro-architecture, quantification of 

bone mass and crystalline composition. This is necessary to develop 

diagnostic and treatment therapies for patients with metabolic 

bone diseases. The Committee urges NIBIB to participate actively 

in trans-NIH initiatives that address these priorities. 

Pet MicroPET Scans.—The Committee continues to encourage 

this new 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 new 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, 2004 ............................................................................. $1,179,058,000 

Budget estimate, 2005 ........................................................................... 1,094,141,000 

Committee recommendation ................................................................. 1,213,400,000 

The Committee recommends an appropriation of $1,213,400,000 

for the National Center for Research Resources [NCRR]. The budget request was $1,094,141,000 and the fiscal year 2004 appropriation was $1,179,058,000. 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 
156 

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.—The Committee encourages NCRR to support 

research and development focused on improving methods for recognizing, assessing, and alleviating pain and distress in research animals. 

Cystic Fibrosis.—The Committee commends NCRR for its support of clinical trials networks, including cystic fibrosis clinical 

trials networks. A number of research institutions and private organizations are engaged in efforts to initiate or provide ongoing 

support to biospecimen repositories or specimen banks. The Committee recognizes that NCRR has supported programs to provide 

biomaterials to researches and recommends that NCRR continue 

such efforts, including collaborative efforts with private sector entities. The Committee recommends that NCRR support a cystic fibrosis biospecimen repository, which would serve as an important resource to CF researchers and function as a model for other 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 2004 appropriation. The fiscal year 2005 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 are critical to 

NIH efforts to translate basic science discoveries into vaccines, 

treatments, and cures for disease. Approximately 10,000 researchers use GCRCs each year for patient-oriented research focused on 

a wide variety of diseases. A recent publication by the members of 

the Institute of Medicine Clinical Research Roundtable described 

the GCRCs as ‘‘an extraordinarily important model for how clinical 

research can be done’’ within academic health centers and recommended an expansion of the program. To enhance the capacity 

of these Centers to support patient-oriented research, the Committee has provided $300,000,000 for GCRC Grants (M01), an increase of $14,800,000 over fiscal year 2004. To clarify its intentions, 

the Committee emphasizes that this funding should be allocated directly to NCRR-funded GCRCs through or as a supplement to the 

M01 mechanism to support clinical research infrastructure such as 

inpatient and outpatient beds, laboratory services, research nutrition services, and statistical support for publicly and privately 

funded clinical investigators. The Committee asks to be informed 
157 

in advance of any new initiatives within the GCRC program that 

entail expenditure or reallocation of funds. 

The Committee encourages the NCRR 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. 

IDeA Grants.—The Committee has provided $224,000,000 for the 

Institutional Development Award [IDeA] Program authorized by 

section 402(g) of the Public Health Service Act. This is a 

$10,000,000 increase over fiscal year 2004 and the same as the fiscal year 2005 budget request. Within the total provided, 

$81,000,000 is for Idea Networks of Biomedical Research Excellence [INBRE] and $136,000,000 is for the Centers of Biomedical 

Research Excellence [COBRE] initiative. 

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. 

Plant-Based Medicinal Products.—The Committee continues its 

interest in accelerating the development and commercialization of 

plant-based medicinal products. 

Prader-Willi Syndrome.—The Committee recognizes the commitment to establish a Rare Diseases Clinical Research Center as part 

of the Rare Diseases Clinical Research Network for the study of 

Prader-Willi Syndrome and other rare disorders. The Committee 

recommends that the RDCRC program be expanded to increase the 

level of research being conducted. 

Research Resource Centers.—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. 

NATIONAL CENTER FOR COMPLEMENTARY AND ALTERNATIVE

MEDICINE [NCCAM]

Appropriations, 2004 ............................................................................. $116,978,000 

Budget estimate, 2005 ........................................................................... 121,116,000 

Committee recommendation ................................................................. 121,900,000 

The Committee has included $121,900,000 for the National Center for Complementary and Alternative Medicine. The budget request was $121,116,000 and the fiscal year 2004 appropriation was 

$116,978,000. 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. The Center 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 
158 

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 once again 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 notes that NIDDK 

has completed efforts to synthesize and calibrate the production of 

milk thistle, which will now make possible clinical trials to demonstrate its value in slowing the progression of nonalcoholic 

steatohepatitis and to reduce the side effects of hepatitis C 

interferon treatments. The Committee urges NCCAM to pursue research to demonstrate the value of milk thistle to ameliorate liver 

disease. 

Bone Health and Nutrition.—The Committee urges NCCAM to 

conduct research on women in their 30s and 40s with respect to 

bone health and nutrition, including the use of supplements and 

nutraceuticals, in an effort to determine whether such strategies 

can prevent osteoporosis and fractures later in life. In addition the 

Committee urges support for research on the effect of complementary and alternative medicine on bones and pain management in 

people with metabolic bone diseases. 

Native Hawaiian Healing.—The Committee encourages the preservation and documentation of Native Hawaiian traditional cultural healing practices. 

Parkinson’s Disease.—The Committee encourages NCCAM to 

continue exploration of the neuroprotective qualities of B vitamins 

and antioxidant phytochemicals in berries via animal models. Research with animals has shown that diets containing berry fruits, 

such as blueberries, in addition to B vitamins may forestall and 

could reverse many of the neurological changes associated with 

age-related neurodegenerative conditions, such as Parkinson’s and 

Alzheimer’s disease. 

NATIONAL CENTER ON MINORITY HEALTH AND HEALTH DISPARITIES

Appropriations, 2004 ............................................................................. $191,471,000 

Budget estimate, 2005 ........................................................................... 196,780,000 

Committee recommendation ................................................................. 197,900,000 

The Committee has included $197,900,000 for the National Center on Minority Health and Health Disparities. The budget request 

was $196,780,000 and the fiscal year 2004 appropriation was 

$191,471,000. 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 
159 

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. 

Behavioral and Social Sciences Research.—The Committee is 

pleased with NCMHD’s efforts to reach out to and coordinate with 

the Office of Behavioral and Social Sciences Research. Cooperative 

efforts to spur research on socioeconomic status and health, experience of racism, and effective health communications are encouraged. 

Community-Based Organization Partnership Prevention Centers.—The Committee recommends expansion of community-based 

partnerships to further respond to the Department’s prevention initiatives. Efforts should be concentrated on the development of Community Prevention Partnership Centers whereby CBOs partner 

with targeted institutions of higher education. These institutions of 

higher education are HBCUs, HSIs, and API Serving Institutions. 

In American Indian, Alaska Native and Native Hawaiian communities, Tribal Colleges, Universities and health centers would serve 

as community prevention centers. All centers would provide cultural competent health promotion and disease prevention services 

and activities to promote healthy lifestyles and reduce risks for 

health problems ranging from diabetes, to cardiovascular disease, 

to substance abuse. 

Community Programs to Improve Minority Health Grants.—The 

Committee recommends funding additional minority communitybased grant projects that integrate community-based screening and 

outreach services, and include linkages for access and treatment to 

minorities in high risk or low-income communities, and address 

socio-cultural and linguistic barriers to health. The Committee 

notes that a number of meritorious grant applications in this important area are going unfunded. 

Cultural and Linguistic Best Practices Studies.—The Committee 

urges studies of best practices and effective approaches implemented by health care providers in addressing cultural and linguistic barriers that impact on diagnosis and treatment regimens, 

patient health outcomes, patient comprehension and compliance 

with care and treatment regimens, and patient safety and medical 

errors reduction. 

Hepatitis C.—The Committee notes that hepatitis C is twice as 

common in African Americans as it is in European Americans and 

standard hepatitis C treatments do not respond as well in African 

American populations. The Committee therefore urges the Center 

to initiate and participate with NIDDK in research focused on the 

Hepatitis C disparities that exist among minority populations. 

Liver Disease.—The Committee remains concerned about the disproportionate burden of liver disease among African Americans, 

Hispanics, Asians and Native Americans. Among younger Native 

Americans liver disease is the second major cause of death, and the 
160 

sixth leading cause of death among all Native American age 

groups. Furthermore, among most Asian populations hepatitis B is 

a major cause of death. The Committee strongly encourages 

NCMHD, in collaboration with NIDDK, to expand research to improve liver disease treatment effectiveness among minority populations. 

Racial and Ethnic Disparities.—The Committee believes that implementation of recommendations stemming from the Institute of 

Medicine [IOM] ‘‘Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care’’, study offer significant opportunities for improving health across communities of color. NCMHD is 

urged to support minority organizations and minority communitybased efforts to disseminate research based health information that 

highlights health disparities experienced by different racial and 

ethnic groups. NCMHD is expected to engage minority national organizations including minority community-based organizations in 

educating diverse communities about recommendations of the Institute of Medicine report in an effort to improve health. 

Scleroderma.—The Committee encourages the Center to support 

research that furthers the understanding of causes and consequences of scleroderma, a chronic, degenerative disease of collagen production, prevalent among African Americans, Hispanic 

and Native American men and women as well as other populations. 

The Center is encouraged to establish epidemiological studies to 

address the prevalence of scleroderma among these populations, as 

statistics indicate that African Americans have a slightly higher incidence of scleroderma. This population is also likely to be diagnosed at a younger age and tend to be diagnosed more often with 

the diffuse form of scleroderma. 

JOHN E. FOGARTY INTERNATIONAL CENTER FOR ADVANCED STUDY IN

THE HEALTH SCIENCES

Appropriations, 2004 ............................................................................. $65,382,000 

Budget estimate, 2005 ........................................................................... 67,182,000 

Committee recommendation ................................................................. 67,600,000 

The Committee recommends an appropriation of $67,600,000 for 

the Fogarty International Center [FIC]. The budget request was 

$67,182,000 and the fiscal year 2004 appropriation was 

$65,382,000. 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 co-
161 

horts, 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 Fogarty 

International Center to expand its COPD research and training activities. 

Tuberculosis Training.—The Committee is pleased with the 

Fogarty International Center’s efforts to supplement grants in 

AIDS International Training and Research Program [AITRP] or 

International Training and Research Program in Emerging Infectious Diseases [ERID], which trains tuberculosis experts in the developing world. Given the magnitude of global tuberculosis, the 

Committee encourages FIC to develop a specific free-standing TB 

training program. 

NATIONAL LIBRARY OF MEDICINE

Appropriations, 2004 ............................................................................. $317,245,000 

Budget estimate, 2005 ........................................................................... 325,147,000 

Committee recommendation ................................................................. 325,100,000 

The Committee recommends an appropriation of $325,100,000 for 

the National Library of Medicine [NLM]. The budget requested 

$325,147,000 and the fiscal year 2004 appropriation was 

$317,245,000. These amounts include $8,200,000 made available 

from program evaluation funds. The recommendation includes 

$4,000,000 for improvement of information systems. The comparable amounts for the budget estimate include funds to be transferred from the Office of AIDS Research. 

Mission.—The National Library of Medicine is the Federal institution that for more than 150 years has collected, organized, preserved, and disseminated the world’s output of biomedical literature in all forms. As a result of this activity NLM is the world’s 

largest library of the health sciences, its holdings numbering more 

than 5,000,000 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. 

Computational Science.—The Committee recognizes that advances in computer science and technology, and applications of 

those advances to biomedical research, underpin many of the remarkable advances in the life sciences that have been achieved 

during the last couple of decades. Biomedical research now involves 

not only experiment, but also extensive computation. Increasingly, 

shortcomings in the specific biomedical computing environment 

limit the rate of progress in biomedical research. Accordingly, the 
162 

Committee believes that a major effort must be undertaken to improve the ability of computation to serve biomedical research. The 

Committee urges that NIH develop a plan for the near, intermediate, and long term, to improve the biomedical computing environment to the point that inefficiencies in the use of computer 

power and information technology no longer limit the rate of 

progress in biomedical research. The Committee recognizes that expertise relevant to the development and implementation of such a 

plan resides in other agencies as well as the NIH, such as the National Science Foundation, the Department of Energy, DARPA, and 

others, and thus encourages the NIH work with all such agencies 

in the development and implementation of such a plan. 

Home Medical Consultations.—The Committee continues to support an expansion of a model project on 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. 

Native Hawaiian Healing.—The Committee encourages the preservation and documentation of Native Hawaiian traditional cultural healing practices. 

NLM Research Facility.—The Committee was pleased to learn 

that the design for the new research facility at the NLM has been 

completed and urges the NIH to assign a high priority to this construction project. The National Center for Biotechnology Information is the leveraging resource for much of the science that NIH 

supports. The information-handling capabilities of the Center are 

being jeopardized by a lack of adequate facilities, and for the good 

of biomedical research this expansion of NLM is needed as soon as 

possible. 

Senior Citizen Outreach.—The Committee is very pleased with 

the excellent work by NLM to expand access to NLM’s databases 

by senior citizens, and it urges the Library to continue this worthwhile effort. 

OFFICE OF THE DIRECTOR

Appropriations, 2004 ............................................................................. $327,504,000 

Budget estimate, 2005 ........................................................................... 359,645,000 

Committee recommendation ................................................................. 364,100,000 

The Committee recommends an appropriation of $364,100,000 for 

the Office of the Director [OD]. The budget request was 

$359,645,000 and amount appropriated in fiscal year 2004 was 

$327,504,000. 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. 

Amnion-derived Stem Cell [ASC].—The Committee understands 

that ASC technologies offers the potential to develop and produce 
163 

an adequate supply of cells for therapeutic cellular transplantation 

based upon isolation from placental tissue. The Committee supports all avenues of stem cell research and strongly urges the NIH 

to explore research in this area and steps necessary for the clinical 

application of this technology. 

Autism Spectrum Disorders.—The Committee is encouraged by 

the NIH’s autism research matrix and urges NIH to devote sufficient resources to this research agenda. The Committee urges the 

NIH when implementing the autism research matrix to coordinate 

with autism organizations already funding research initiatives to 

ensure the most efficient use of it resources. The Committee also 

notes the promise of particular areas cited in the matrix, including 

genetic and behavioral characterizations of the disorder and screening and early diagnosis. 

Autoimmune Diseases.—The Autoimmune Disease Coordinating 

Committee, with representation from each NIH Institute, Centers 

for Disease Control and Prevention, Food and Drug Administration, 

Veterans Administration, and patient advocacy organizations, has 

been effective in fostering collaborative, integrated multi-Institute 

research on issues affecting the entire genetically related family of 

autoimmune diseases, as recommended in the Autoimmune Diseases Research Plan. This collaboration has been a significant factor in achieving recent advances in the understanding, diagnosis 

and treatment of autoimmune diseases. Congress supports the committee’s continued efforts in implementing the Autoimmune Diseases Research Plan. 

Basic Behavioral Research.—The Committee notes with interest 

that NIH has undertaken a review of basic behavioral and social 

sciences research funded by the National Institutes of Health. The 

working group, composed of outside scientists and chaired by a 

member of the Advisory Council to the NIH Director, is charged in 

part with reviewing NIH’s portfolio and identifying areas of opportunity in basic behavioral and social sciences, consistent with 

NIH’s mission, that NIH should consider supporting. Basic research in these sciences is fundamental to an understanding of the 

mechanisms of sensation and perception, development, learning 

and memory, and group dynamics and behavior, among other 

areas. The Committee reiterates its support for NIH’s history of investment in basic behavioral and social sciences research and looks 

forward to reviewing the report of the working group. 

Center for Scientific Review [CSR].—The Committee recognizes 

that the reorganization of CSR offers the opportunity to enhance 

the quality of peer review for grant applications in the areas of cardiovascular, congenital and thoracic surgery. The Committee is encouraged by CSR’s decision to restructure the peer review of these 

applications and to ensure that cardio-thoracic surgeons are full 

participants in the peer review process. The Committee will monitor this activity to ensure that proper support is given to the development of new surgical knowledge. This is especially important 

as biomedical research evolves into a more integrated model that 

cuts across existing boundaries to incorporate the expertise of different scientific disciplines including surgery. 

Childhood Obesity, Trans-NIH Obesity Research Initiative.—The 

committee encourages the NIH to further expand the Trans-NIH 
164 

obesity research initiative to include a multi-center study of the 

metabolic, psychological, and genetic precursors of obesity in children. 

Chronic Fatigue Syndrome [CFS].—The Committee is disappointed that NIH funding for CFS has basically remained flat in 

recent years, despite repeated congressional requests for increases. 

In addition, several grants represented to be for CFS research have 

limited direct relevance to CFS. The Committee notes that the Office of Research on Women’s Health, through the Trans-NIH Working Group for Research on Chronic Fatigue Syndrome, is working 

on a request for applications [RFA] based on the findings of a June 

2003 scientific workshop on CFS. The Committee strongly urges 

the NIH to fund this RFA as soon as possible. The Committee also 

urges the NIH to expand the involvement of intramural researchers in the study of CFS. 

Clinical Investigators.—The Committee commends the Office of 

the Director for rapidly launching programs with loan repayment 

and for training clinical investigators and encourages NIH to maintain and expand these programs. These programs will be crucial for 

establishing the clinically trained work force that will translate the 

promising basic discoveries supported by NIH into clinical application to cure and prevent disease in American citizens. 

Clinical Practice Networks.—The Director of NIH is commended 

for his Roadmap efforts to re-engineer clinical research as currently 

supported by NIH. The Committee recognizes that it is essential 

that study results be rapidly disseminated into clinical practice. 

Therefore, the Director is encouraged to work directly with the 

medical community—including the surgical community—in order to 

utilize existing networks as a way to accelerate the transfer of information for the treatment of patients. The Committee requests a 

report on this effort prior to next year’s Appropriations hearing. 

Clinical Research.—The opportunities for substantial dividends 

on the Nation’s investment in medical research have never been 

greater. The Human Genome Project is providing remarkable insights into diseases and disorders that have plagued society for 

centuries. Those insights, together with the infusion of resources 

during the 5-year doubling of NIH, are opening new pathways to 

discovery. Commensurately, public expectations are growing with 

the hope that past investments will hasten the translation of new 

scientific knowledge into better health and more effective treatment and prevention strategies. But clinical research, the staging 

ground that deploys the results of research to hospitals and health 

care providers, is increasingly emerging as a bottleneck in the scientific continuum. At a time when a cohesive and coherent national 

effort is vital, the academic health centers on whose shoulders this 

work rests face unfunded regulatory mandates, fragmented clinical 

research infrastructure, incompatible data bases, and a severe and 

growing shortage of qualified clinical investigators and willing participants. While the NIH Roadmap initiative is intended to address 

some of these obstacles, more must be done to help academic 

health centers defray the costs associated with unfunded mandates; 

support infrastructure grants to modernize information technology 

systems and databases; and help modernize clinical research facilities. The Committee requests a report on these and other steps 
165 

taken to improve the clinical research enterprise prior to the fiscal 

year 2006 hearings. 

Clinical Research Loan Repayment Program.—The Committee is 

pleased that NIH has moved forward with the Clinical Research 

Loan Repayment Program. As the program completes its third 

year, the Committee would like to assess outcomes to date as well 

as areas for potential improvement. It is the Committee’s understanding that the requirement that applicants have an institutional 

guarantee of 2 years of research support has proven an insurmountable hurdle for many potential applicants, particularly those 

at the end of a training grant or career award who have not yet 

obtained outside support for the next stage of their careers. The 

Committee requests a report within 60 days after passage of this 

bill evaluating alternative strategies for assuring that recipients of 

loan repayment actually pursue careers in clinical research. Second, the Committee requests a report profiling award recipients including their training experience; degrees held; medical/scientific 

disciplines; academic positions; and the funding support by which 

they were eligible to apply. 

Cystic Fibrosis.—The NIH Roadmap identifies the re-engineering 

of the clinical research system as a top priority. One of the strategies that the Roadmap recommends to enhance clinical research is 

establishing clinical trials networks that share informatics and 

other technologies. These networks also should include a significant 

number of institutions, in order to facilitate efficient recruitment 

and rapid enrollment of trial participants. The Committee believes 

that there are important opportunities for collaboration between 

NIH and this existing clinical trials network and encourages NIH 

to pursue this potential collaboration. 

Digestive Disease Commission.—The Committee calls on the Director, in collaboration with the Secretary, to establish a national 

commission on digestive diseases composed of distinguished scientists and physicians who are experts in digestive diseases, digestive disease patient advocates and representatives of Federal departments, agencies or institutes providing support for research related to digestive diseases in order to (1) study the incidence, duration, and mortality rates of digestive diseases, as well as their social and economic impacts; (2) evaluate public and private facilities 

and resources, including trained personnel and research activities, 

for the diagnosis, prevention, and treatment of such diseases; (3) 

identify related disease management programs, including biological, behavioral, nutritional, environmental, and social programs; 

and (4) develop a long-range plan for the use and organization of 

national resources to effectively deal with digestive diseases. 

Duchenne Muscular Dystrophy.—The Committee strongly encourages the funding of three additional Centers of Excellence and to 

double the funding for existing centers of excellence by the end of 

fiscal year 2005. In addition, the Committee notes that the NIH 

Interagency Coordinating Committee for muscular dystrophy has 

missed its 1-year deadline to submit a plan for conducting and supporting research and education on muscular dystrophy through 

NIH in accordance with the MD CARE Act of 2001. The Committee 

strongly urges the Coordinating Committee to finalize and submit 
166 

this plan, as well as include representation from the Department 

of Defense on the panel, as soon as possible. 

In addition, the Committee strongly urges the NIH’s to devote 

additional resources to DMD translational research and clinical 

trials. This funding is to be separate from the Centers of Excellence 

program. Based on the severity of this disorder, its high incidence 

in children, and the prospect of important new treatments, the 

Committee strongly urges OD, through NIAMS and NINDS, to follow the accelerated model for funding DMD translational research 

that was used for motor neuron diseases, including ALS and SMA. 

The Committee strongly endorses that plan and urges the OD to 

equip the program and the personnel charged with executing the 

plan with appropriate authoritative and financial resources to 

maximize the chances of success. 

Finally, the Committee encourages the OD to further develop opportunities for upcoming clinical trials and to help make available 

all existing and emerging patient care options. The Institutes are 

encouraged to work with other Federal agencies to develop formal 

programs that increase public and professional awareness of the 

disease. 

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. The Committee requests the Director to provide a report by April 1, 2005, on the 

progress made in the coordination of research efforts in epilepsy 

among these Institutes, and on the progress made in implementing 

the NINDS research benchmarks resulting from the March 2000 

conference ‘‘Curing Epilepsy: Focus on the Future.’’ 

Fragile X.—The Committee notes that in fiscal year 2003, 75 

grants were provided by 11 separate NIH Institutes, units, and its 

National Center for Research Resources to find a treatment and 

cure for Fragile X. In addition, privately-funded Fragile X research 

is rapidly expanding, often in partnership with NIH grants. The 

Committee commends the growing breadth and diversity of this research but strongly urges the Director to establish a coordinating 

mechanism to direct and coordinate these efforts in regularlyscheduled meetings. The Committee requests that the Director report to the Congress on the progress during the fiscal year 2006 appropriations hearings. 

Fragile X Pediatric Training.—The committee encourages the Director to increase the number and size of institutional training 

grants to institutions supporting pediatric training and the number 

of grants for career development clinical research. 

Gender-Based Biology.—The Institute of Medicine [IOM] has released a study that clearly demonstrates that all biological research—from bench to bedside—must be cognizant of the differences that result from the sex of the patient, tissue or cell. One 

of the areas where such differences are most pronounced is in the 

field of neuroscience. For this reason, the Committee believes it is 

entirely appropriate that the Director assure that the ten institutes 

involved in the trans-institute initiative on brain research include 

gender-based biology as an integral part of the research conducted 

and that research results are analyzed and reported in this man-
167 

ner, when appropriate. The Committee would like a report from the 

Director on the progress of this effort prior to next year’s hearings. 

General Clinical Research Centers.—The Committee has supported expansion of the General Clinical Research Centers program 

within the National Center for Research Resources. Wherever possible, the Committee encourages the Director to utilize the GCRCs 

as the foundation of NIH Roadmap activities related to clinical research. Rather than establishing programs in isolation, the Committee believes that it will be both synergistic and cost-effective for 

NIH Roadmap clinical research programs to be sited in the GCRCs 

as practicable. 

Genomics.—The Committee recognizes that while the NHGRI is 

the primary Institute for addressing the human genome sequence, 

other Institutes should also identify the role genomics and genetics 

play in the progression of specific diseases. For example, the Committee urges the Director to encourage the various Institutes, including the NIA, NIMH, and NINDS, to take advantage of advances in microarray technology. Utilization of this technology 

could lead to improved prevention and therapeutic intervention 

strategies for Alzheimer’s and Parkinson’s diseases, as well as autism, obsessive compulsive and bi-polar disorder. 

Graduate Training in Clinical Investigation Awards.—In an effort to reverse the shortage of well-trained clinical investigators, 

Congress authorized the Clinical Research Curriculum Awards and 

the Graduate Training in Clinical Investigation Awards. The Curriculum Awards were intended to support institutional training 

programs in clinical research, with the second award intended to 

provide tuition and stipend support for enrolling students. For 3 

consecutive years, this Committee has expressed concern that NIH 

has not moved forward with implementation of the Graduate 

Training in Clinical Investigation Awards. The Committee believes 

that NIH is compromising the effectiveness of the training programs that have been established through the Curriculum Awards 

by failing to fund the complementary student stipend/tuition 

awards. The report of the General Accounting Office on NIH implementation of the clinical research legislation substantiated the 

Committee’s concerns. The Committee urges the Director to consider including these awards in the NIH Roadmap activities related 

to enhancing the clinical research workforce and provide sufficient 

funds to support 200 students in fiscal year 2005. 

Heart Disease, Stroke and Other Cardiovascular Diseases.—The 

Committee recognizes that the problems associated with heart disease, stroke and other cardiovascular diseases involve many institutes and centers, including NHLBI, NINDS, NIA, NIDCR, and 

NCRR. The Committee strongly urges the Director to expand its research portfolio and increase its resources and better coordinate 

cross-cutting research on these diseases in all institutes, centers 

and divisions, as appropriate, and through all available mechanisms. The Committee requests the Director to be prepared to report on initiatives on these diseases begun in fiscal year 2004 or 

scheduled to begin in fiscal year 2005 at the fiscal year 2006 appropriations hearings. 

Hepatitis B.—The Committee is aware that although there has 

been tremendous success in the prevention and treatment of hepa-
168 

titis B, this disease remains a serious concern. The large number 

of immigrants to the United States from countries where hepatitis 

B is endemic will keep the disease in the forefront of public health 

for years to come. The Director of NIH is urged to make hepatitis 

B a priority and to stimulate research to find complements for the 

current therapies; improvements in prevention, detection and treatment; and develop new vaccines and outreach programs. 

High-Risk Research.—As the NIH enters into a period of limited 

funding resources, the peer review system will naturally tend to reward conservative research proposals rather than bolder ideas that 

have a higher risk of succeeding. The Committee strongly urges the 

NIH to beware of this tendency, in terms of both the research 

grants that it awards and the types of researchers who receive 

them. Relying solely on tried-and-true approaches to medical research, conducted solely by veteran, established researchers, will 

not result in quantum leaps in discovery. Despite the current decline in the growth rate of NIH’s budget, the NIH must continue 

to fund high-risk research and young investigators who have innovative ideas. 

Hepatitis C Consensus Conference Implementation.—The Committee notes that the Hepatitis C Consensus Development Conference recommended the creation of a Hepatitis Clinical Research 

Network [HCRN] and commends NIDDK and NIAID for expanding 

Hepatitis C related clinical research studies. The Committee requests a report by April 2005 to incorporate the advice of NIH and 

biomedical community leaders to assess the adequacy of this arrangement along with alternative approaches to assure a complete 

response to the original recommendations of the Hepatitis C Consensus Conference regarding the creation of the Network. 

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, including for 

those researchers dedicated to the study and cure of rare diseases. 

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, strongly 

urges the Director to increase the core support NDRI receives from 

NCRR, and the Institute Directors to identify and implement program-specific initiatives intended to expand support for NDRI. 

Interdisciplinary Research and Training.—The committee notes 

OBSSR’s efforts to develop new mechanisms for training scientists 

in more than one academic discipline to create a scientific workforce better prepared to research multi-faceted problems. OBSSR is 

directed to report back to the committee on interdisciplinary re-
169 

search issues such as cross-disciplinary support for the new mechanisms, numbers of applicants, and any barriers encountered in implementing the new program. 

Irritable Bowel Syndrome.—The Committee is pleased with the 

increased focus on irritable bowel syndrome [IBS] at the NIH’s Office of Research on Women’s Health. It is estimated that over 

60,000,000 Americans, disproportionately women, suffer from IBS. 

Juvenile Arthritis.—The Committee urges the Director, in collaboration with NIAMS, NICHD and NIAID, to strengthen its investment in, and commit additional resources to, basic, clinical, and 

translational research efforts and related activities specific to juvenile arthritis as authorized by the Children’s Health Act. The Committee requests the NIH to provide Congress with a report on efforts underway and progress made in achieving this goal by April 

2005. 

Liver Disease and the Veterans Health Administration.—The 

Committee believes that closer collaboration with the Veterans 

Health Administration will significantly facilitate, accelerate, and 

leverage research to develop more effective treatments and cures 

for liver disease. The Committee notes that the Veterans Health 

Administration [VHA] has developed a significant database of veterans with hepatitis C that includes demographic, diagnostic, laboratory, drug treatment and co-morbidity population statistics that 

could be used to support a large number of NIH funded research 

efforts. The Committee is pleased that NIDDK, as the lead NIH Institute, has begun efforts to develop a cooperative agreement with 

the Veterans Health Administration as a vehicle for cost-sharing 

collaborative efforts to facilitate liver disease research on a transNIH basis. The Committee requests the Institute be prepared to report at the fiscal year 2006 Appropriation the progress and status 

of cooperative research efforts with the VHA to address hepatitis 

C. 

Lymphatic System Research.—Despite the central role of the lymphatic system in human health and disease, this focus of research 

and medical care has, until recently, been relatively neglected. The 

lack of research has created barriers to effective delivery of health 

care and limited the interest of biomedical investigators to pursue 

prospective studies in this area. Therefore, the Committee urges 

the Trans-NIH Coordinating Committee for the Lymphatic System 

to work with its member ICs to implement a comprehensive lymphatic research awareness campaign that is designed to target academia, governmental agencies, industry, scientific and medical professional organizations, and the public at large. 

The Committee also urges the OD to consider targeted initiatives 

regarding the lymphatic system, such as: (a) the development of 

suitable reagents, including monoclonal antibodies, to facilitate 

lymphatic investigation in vitro and in vivo; (b) the development of 

transgenic and knockout animal models; (c) the functional imaging 

of the lymphatic system; (d) academic career development; and (e) 

a national patient registry and tissue bank for lymphatic diseases. 

Finally, the Committee encourages the Coordinating Committee to 

work with the Center for Scientific Review and ICs to ensure that 

experts in the lymphatic system are adequately represented on 

peer review panels. 
170 

Microbicides for the Prevention of HIV.—Microbicides, a class of 

products that would be applied topically to prevent HIV, represent 

a promising prevention strategy, with the potential to be especially 

significant in preventing HIV in women, who now account for more 

than half of the individuals newly infected with HIV globally. Once 

developed, microbicides and vaccines would serve as complementary HIV prevention technologies. 

NIH, principally through NIAID, spends the majority of Federal 

dollars in this area. The Committee remains concerned that 

microbicide research at NIH is currently conducted with no single 

line of administrative accountability or specific funding coordination. The Director of NIH, in consultation with OAR and in coordination with NIAID, NICHD, NIDA, NIMH, and ORWH, is urged 

to establish a microbicides branch or comparable dedicated unit 

specifically for microbicides research and development, with appropriate staff and funding. 

Minority Health and Racial Disparities.—The Nation has invested greatly in the NIH providing tremendous opportunities for 

accelerated improvements in health and quality of life. Research 

advances must be applied more expeditiously to ensure greater improvements in health outcomes across all communities of color and 

the general public. The Committee strongly urges the NIH to improve, strengthen and expand its systems of information dissemination and outreach to health care providers, minority organizations, 

and the public. Knowing that one-size does not fit all as it relates 

to the public, communities, and the Institutes and Centers, the 

Committee strongly urges the Director of NIH, and the director of 

each of the Institutes and Centers to report on their respective improved systems across these areas during next year’s appropriations hearings. 

Nanosystems Biology.—The Committee encourages the director, 

along with NCI, to support a collaborative effort to bring 

nanotechnology, systems biology and molecular imaging together to 

examine the molecular basis of cancer, consistent with the Director’s Roadmap Initiative. 

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 speed up ongoing collaborative efforts to develop, validate and disseminate analytical 

methods and reference materials for the most commonly used 

botanicals and other dietary supplements. The Committee also expects the ODS to contract with industry non-profit associations or 

foundations which currently have and maintain a database of dietary supplement labels to develop, create, continually 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 en-
171 

suring 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 Science Education.—The Committee is pleased with the 

work of the Office of Science Education and encourages all of the 

NIH Institutes to work with the Office to support supplemental 

curricular and training project for K–12 science education. The support from the NIH Institutes and centers greatly enhance the capacity of this Office to provide the critical investment in science literacy among young people throughout the Nation. 

Office of Research on Women’s Health.—The Committee recognizes the critical role played by the Specialized Centers of Research 

on Sex and Gender Factors Affecting Women’s Health and encourages the Office to continue programmatic initiatives to further this 

work. The Committee also supports the development of an intramural women’s health program at NIH. 

Parkinson’s Disease.—The Committee commends the Director for 

his strong support and facilitation of collaboration with patient advocacy groups, health non-profits, and international organizations. 

The Committee is also aware that the Parkinson’s Disease Research Agenda [PDRA] developed by NIH in 2000 included professional judgments funding projections that totaled an additional 

$1,000,000,000 over 5 years to achieve a cure. The Committee 

strongly urges NIH to come as close as possible to fulfilling that 

Agenda while maintaining the standards of peer review. Furthermore, the Committee is also aware that the Director has prepared 

his own ‘‘matrix’’ for Parkinson’s which, while laudable, falls short 

of the ambitious goal of the Parkinson’s Disease Research Agenda 

to find a cure for Parkinson’s by developing a roadmap and projections of the resources needed to achieve that goal. 

The Committee strongly urges the NIH to devote additional resources to Parkinson’s research, as recommended by the Parkinson’s disease Research Agenda, using all available mechanisms, including RFAs. 

The Committee expects the NIH to report to Congress by April 

2005, not only on the steps it is taking to fulfill the Parkinson’s disease Research Agenda, but also its progress towards finding a cure 

for this devastating disease. Additionally, as 5 years have elapsed 

since the last NIH conference on Parkinson’s disease, the Committee strongly urges the Director to hold another conference, similar to the one held in November 1999, to examine the path to a 

cure, working with patient advocacy, scientific, and non-profit communities. The results of the conference should produce a strategic 

plan setting forth the research funding and programs required to 

secure the earliest possible development of effective therapies, prevention, and a cure for Parkinson’s disease. 

Pediatric Research Initiative.—The Committee urges the Office of 

the Director to expand the Pediatric Research Initiative, as authorized by the Children’s Health Act of 2000. The Committee strongly 

supports the growth of support for pediatric research across Institutes and encourages activities which stimulate new and promising 

areas of pediatric research. Additionally, the Committee urges NIH 

to collaborate with the CDC and HRSA in research areas related 

to heritable and genetic disorders affecting children. 
172 

Population-Based Prevention Research.—The Committee commends NIH for its efforts to support research in humans that examines factors associated with preventing disease and promoting 

health. The Committee urges the NIH to seek ways to remove barriers that prevent research findings from being translated into population-wide health improvements and to expand its support for 

studies that include examination in human populations of biological, behavioral and environmental factors associated with disease 

and means to ameliorate them. As part of these efforts, the Committee requests the NIH to submit a report by April 1, 2005, that 

indicates total funding by institute, and where applicable by disease, for prevention research among human populations that reduces disease risk through social, behavioral and environmental 

change. 

Prader-Willi Syndrome.—The Committee commends the NIH for 

creation of an Obesity Research Task Force and for NIH’s recognition of the need to prevent and treat obesity beginning in childhood. However, the committee strongly urges the Task Force to explicitly include, across the six proposed trans-NIH obesity initiatives, investigations into the genetic causes of obesity beginning 

with study of Prader-Willi Syndrome. Furthermore, the Committee 

urges the Director of NIH to conduct outreach to the Prader-Willi 

Syndrome community to participate in research at the proposed 

‘‘Obesity Clinical Research Center.’’ The NIH should be prepared to 

report on the progress made by the Obesity Research Task Force, 

and the trans-NIH research efforts to appropriately incorporate 

both children and genetics into the overall obesity research agenda 

during the fiscal year 2006 appropriations hearings. 

Public Health Relevance of Research Awards.—The Committee is 

encouraged by steps the National Institutes of Health [NIH] is taking to improve communications regarding the public health relevance of its research awards. Specifically, the Committee is 

pleased NIH has proposed a modification to its standard grant application, PHS Form 398, requiring all grantees to include a statement of public health significance. The Committee urges the Department of Health and Human Services and the Office of Management and Budget to approve the proposed revision and support the 

agency in its efforts to implement this important change in the 

grant application form. 

Rare Liver Diseases.—The Committee is pleased that the Office 

of Rare Diseases has provided significant co-funding, along with 

NIDDK, for the Biliary Atresia Research Network. The Committee 

urges ORD to continue to address rare liver diseases including primary biliary cirrhosis, primary sclerosing cholangitis, and auto-immune hepatitis. 

Saliva Research.—The Committee has learned that saliva is 

gaining value as a diagnostic tool and potential monitor of disease 

progression in systemic disorders, including Alzheimer’s disease, 

Sjogren’s syndrome, cystic fibrosis, and diabetes; moreover, studies 

have uncovered the presence of a cancer-related protein whose concentration increases in the presence of breast cancer—thus, having 

the potential as a diagnostic marker for the early detection of 

breast cancer. The Director of NIH is urged, working with the 
173 

NIDCR, to find ways to expand and accelerate research in this area 

and report back to the Committee prior to next year’s hearing. 

Sepsis.—The Committee is aware that sepsis kills more than 

215,000 Americans each year. To improve health care provider education in correctly diagnosing sepsis, the Committee urges the Director to work with outside organizations to create and implement 

a program to train infectious disease physicians, emergency room 

doctors, critical care nurses, and oncologists, especially those serving in rural and underserved areas, in the use of new guidelines 

to identify sepsis to improve patient outcomes. The Committee further encourages the Director to work with the NIAID, NHLBI and 

NCI in these provider education efforts. 

Spina Bifida.—The Committee recognizes that Spina Bifida is 

the leading permanently disabling birth defect in the United States 

and has concerns that the NIH has not prioritized research into 

primary and secondary prevention of this condition. While Spina 

Bifida is highly preventable through proper nutrition, including appropriate folic acid consumption, too many pregnancies are still affected each year by this devastating birth defect. The Committee 

also acknowledges that prevention does not assist the more than 

70,000 individuals living with Spina Bifida and therefore urges the 

NIH/NINDS/NICHD to allocate adequate and additional resources 

to prioritize research into primary and secondary prevention for 

Spina Bifida. 

Spinal Muscular Atrophy.—The Committee strongly urges the 

OD to ensure the success of the SMA Project by providing active 

and ongoing support from the OD as well as from other related Institute Directors, most notably NICHD. The OD is urged to take all 

necessary steps to ensure that the NICHD is fully engaged by expanding their scope and level of resources dedicated to SMA. 

Stroke in Women.—As the second leading cause of death among 

women worldwide, stroke in women is a major health problem. 

Stroke kills more than twice as many women as do breast cancer 

and AIDS combined. Acute care of women stroke victims is often 

delayed, and 62 percent of all stroke-related deaths occur in 

women. Recognizing that women are the single largest group at 

risk for death from stroke, the Committee believes that special attention should be focused on better understanding the gender-related differences in stroke. Some aspects of the disease unique to 

women include strokes related to pregnancy and the use of oral 

contraceptives. Stroke is additionally a leading cause of serious disability among women and may contribute to late-life cognitive decline. The Committee supports the funding of new and continuing 

NIH studies that investigate the impact of postmenopausal hormone replacement therapy on stroke risk. Continued support of 

clinical and basic research on hormone physiology in women is necessary to understanding the impact of hormones on women’s vascular systems. The Committee urges NIH to increase research in 

stroke among women of all ages, with specific attention to genderrelated differences in stroke risk, and to stroke prevention interventions, acute stroke management, post-stroke recovery, long-term 

outcomes, and quality of care. The Committee further urges NIH 

to increase research into new therapies for stroke in women as well 

as into ways of enhancing the vascular health of all Americans. 
174 

The Committee also encourages and supports NIH’s initiatives 

toward advancing the organization of stroke care, including poststroke rehabilitation, and the identification of stroke treatment and 

research centers that would provide rapid, early, continuous 24- 

hour treatment to stroke victims, including the use of the clot-buster t-PA, when appropriate. Designated areas in medical facilities 

equipped with the resources and personnel for treating stroke 

would also promote the early evaluation of innovative stroke treatments. 

Temporomandibular Joint [TMJ] Disorders.—The Committee 

commends the NIH for holding a scientific meeting in May 2004 on 

the co-morbidities of TMJ. This meeting highlighted the complexity 

of TMJ diseases and disorders, the research opportunities available 

and the importance of inter-institute collaborations to further the 

understanding, treatment, and prevention of this condition. The 

Committee is disappointed, however, that the NIH 

Temporomandibular Disorders Interagency Working Group 

[TMJDIWG] has not yet developed a trans-NIH research agenda on 

TMJ disorders, as discussed in the fiscal year 2005 congressional 

budget justification. The Committee strongly urges the Director to 

ensure that this plan is completed as soon as possible. The plan 

should incorporate input from patients and should include listings 

of the specific research opportunities that have been identified by 

the TMJDIWG. It should also include summaries from each Institute in the working group regarding which research opportunities 

it plans to pursue, with approximate timeframes. The Committee 

requests a report on this plan by April 1, 2005. Finally, the Committee urges the NIH to develop informational materials on TMJ 

disorders for distribution to patients, the media, health care organizations, and the public. 

Tuberous Sclerosis Complex.—In its report accompanying the fiscal year 2004 appropriations, the Committee called upon the Office 

of the Director to formulate an NIH-wide research agenda on tuberous sclerosis complex, and to report back to the Committee on 

this effort. While a research agenda was developed, the Committee 

is disappointed by the failure to act upon it. The report to the Committee cited research studies were carried out several years ago or 

which only generally relate to TSC, and failed to establish a mechanism to coordinate research activities across several Institutes. 

The Committee strongly urges the OD to establish such coordinating mechanism as soon as possible, and to undertake TSC-specific research. 

Vascular Biology.—The Committee recognizes the importance of 

advancing research in the field of vascular biology, the study of 

blood and blood vessels and their interactions. Not only is the 

maintenance of the blood supply critical to the functioning of all organs of the body, understanding the mechanisms and treatment of 

diseases that interrupt the blood supply is relevant to all organ 

systems and their disorders. Research into vascular biology can 

provide the scientific basis for new therapies to prevent thrombosis; 

therapies that are important to the prevention and control of heart 

disease, stroke, recurrent fetal loss, and complications associated 

with sickle cell anemia and diabetes; and therapies related to the 

interruption of the blood supply to tumors and cancers. Because of 
175 

the cross-cutting aspects of this research, the Committee urges the 

NIH Director to develop a comprehensive NIH-wide approach to 

identify and pursue research opportunities in this field. 

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, 2004 ............................................................................. $88,972,000 

Budget estimate, 2005 ........................................................................... 99,500,000 

Committee recommendation ................................................................. 114,500,000 

The Committee recommends an appropriation of $114,500,000 for 

buildings and facilities [B&F]. The budget requested $99,500,000 

and the fiscal year 2004 appropriation was $88,972,000. 

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 for which 

$15,000,000 has been included. Funds have also been included for 

the Animal Research Center, the Rocky Mountain Laboratories 

Buffer Replacement Facility, asbestos abatement, fire protection 

and health and safety compliance, air quality improvement programs and to eliminate barriers to persons with disabilities. 
176 

SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION

Appropriations, 2004 ............................................................................. $3,350,958,000 

Budget estimate, 2005 ........................................................................... 3,550,242,000 

Committee recommendation ................................................................. 3,484,729,000 

The Committee recommends $3,484,729,000 for the Substance 

Abuse and Mental Health Services Administration [SAMHSA] for 

fiscal year 2005. This amount is $133,771,000 above the comparable fiscal year 2004 level and $65,513,000 below the administration request. The recommendation includes $123,303,000 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 strongly supports SAMHSA’s Federal leadership 

role to improve the quality and availability of empirically-based 

prevention and treatment services in the areas of mental health 

and substance abuse. The Committee commends SAMHSA for its 

ongoing collaboration with the National Institutes of Health, specifically with the National Institute of Mental Health [NIMH], the 

National Institute on Drug Abuse [NIDA], and the National Institute on Alcohol Abuse and Alcoholism [NIAAA]. As one example of 

this partnership, the Committee notes that SAMHSA collaborated 

with NIDA on the recent NIH Request for Applications [RFA] designed to strengthen the capacity of State Alcohol and Drug Abuse 

Agencies to support and engage in research that will foster adoption of science-based policies and practices. The Committee urges 

that SAMHSA and NIH continue its collaboration 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 particularly interested in recent brain imaging research being conducted and supported by NIH. The Committee believes this research will have a significant impact on the 

development of new science-based treatment and prevention strategies for those suffering from mental illness and substance abuse. 

The Committee requests that SAMHSA work with the Centers 

for Medicare and Medicaid Services to maximize reimbursement of 

a more complete continuum of treatment and prevention services, 

including recovery support services, through the Medicaid program. 

Medicaid is an important but under-utilized funding stream for 

drug and alcohol treatment and prevention services that complements the funding provided through SAMHSA programs, espe-
177 

cially when evidence shows that when treatment is provided other 

health care costs can be reduced by as much as 50 percent. 

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. 

CENTER FOR MENTAL HEALTH SERVICES

Appropriations, 2004 ............................................................................. $862,220,000 

Budget estimate, 2005 ........................................................................... 912,502,000 

Committee recommendation ................................................................. 935,082,000 

The Committee recommends $935,082,000 for mental health 

services. This amount is $72,862,000 above the comparable level for 

fiscal year 2004 and $22,580,000 above the administration request. 

The recommendation includes $21,803,000 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. 

The Committee notes that that SAMHSA’s 2002 ‘‘Report to Congress on the Prevention and Treatment of Co-occurring Substance 

Abuse Disorders and Mental Health Disorders’’ found that a ‘‘significant lack of prevalence data on co-occurring disorders exist.’’ 

The Committee encourages SAMHSA to work with NIMH, NIAAA, 

and NIDA to collaborate with States to develop more recent and accurate data on persons with co-occurring mental health and substance use disorders, with an emphasis on individuals with mild to 

moderate mental health disorders. 

Programs of Regional and National Significance 

The Committee recommends $303,128,000 for programs of regional and national significance. This amount is $62,332,000 above 

the comparable level for fiscal year 2004 and $32,580,000 above the 

administration request. Programs of regional and national significance address priority mental health needs through developing and 

applying best practices, offering training and technical assistance, 

providing targeted capacity expansion grants, and changing the delivery system through family, client-oriented and consumer-run activities. 

The Committee is deeply concerned that between 5 percent to 9 

percent of all children suffer from a mental, behavioral or emotional disorder which, if undiagnosed and untreated, can substantially interfere with academic achievement, or lead to student dropout, substance abuse, violent behavior, or suicide. Because most 

youth aged 15 to 19 are in school, the educational system is the 

best environment to identify those youth at risk for suicide and to 

facilitate the services that the individual needs. The Committee is 
178 

aware that SAMHSA is overseeing a pilot study in one school system, utilizing evidence-based screening techniques and tools to 

screen and identify teenagers who are at risk. Several promising 

screening techniques to identify youth at risk exist but they need 

further testing. There also is a need to develop evidence-based 

interventions to work with students found to be at risk and their 

families so as to facilitate treatment. The Committee has included 

$4,500,000 for SAMHSA to make grants to local educational systems or non-profit entities in conjunction with local educational 

systems both to further test the use of the screening mechanisms 

and to identify evidence-based practices for facilitating treatment 

for youth at risk. 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 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 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 provides $2,000,000 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 $5,000,000 to continue 

the elderly treatment and outreach program. The administration 

did not request funding for this program. The Committee notes 

that this is the only federally funded services program dedicated 

specifically to the mental health care of older adults. From 15 to 

25 percent of elderly people in the United States suffer from significant symptoms of mental illness. In addition, the highest suicide rate in America is among those aged 65 and older. This grant 
179 

program will help local communities establish the infrastructure 

necessary to better serve the mental health needs of older adults. 

The Committee supports $7,000,000 for the jail diversion grant 

program. The Department of Justice estimates that 16 percent of 

all inmates in local and state jails suffer from a mental illness. The 

Committee recognizes that as many as 700,000 persons suffering 

from a mental illness are jailed each year. Recognizing these troubling statistics, the President’s New Freedom Commission on Mental Health called for the adoption of diversion strategies to avoid 

unnecessary criminalization and incarceration of non-violent offenders with mental illness. The Committee urges SAMHSA to 

work with the Department of Justice, the law enforcement community, the court system and other appropriate agencies and associations to ensure that funding is utilized to divert inappropriate incarcerations and link individuals with mental illnesses with the 

support they need to avoid future contact with the criminal justice 

system. 

The Committee recommendation fully funds the administration 

request for the new State Incentive Grants for Transformation program. The Committee directs SAMHSA to ensure that State mental health planning and advisory councils play a significant role in 

the development of comprehensive State plans under this new program. The Committee believes that the councils must play a key 

role in the development of these new plans because the councils 

represent the consumer and family voice in States across the country. 

The Committee recognizes the urgent need to train increasing 

numbers of minority mental health professionals, including Native 

Hawaiians, to provide competent, accessible mental health and 

substance abuse services for diverse populations. It encourages 

SAMHSA to provide additional resources for the Minority Fellowship program. 

The Committee recognizes the need to support grants to community-based providers operating in traditional and non-traditional 

settings who provide direct mental health services to racial and 

ethnic minorities suffering from HIV/AIDS and associated mental 

health problems. Individuals suffering from HIV/AIDS and co-occurring disorders present unique and unmet treatment needs necessitating specialized training for providers. The Committee encourages SAMHSA to provide additional funding for training mental health professionals to provide integrated mental health and 

substance abuse services for persons suffering from HIV/AIDS and 

co-occurring disorders. 

Due to lack of authorizing legislation for the Samaritan Initiative, the Committee has included $10,000,000 in this account for 

grants to fund services in permanent supportive housing to help 

end chronic homelessness. The Committee encourages CMHS to 

award these grants to applicants that operate permanent supportive housing funded by HUD’s Homeless Assistance Programs, 

section 8, or comparable programs administered by States or local 

governments. 
180 

Mental Health Performance Partnership Block Grant 

The Committee recommends $436,070,000 for the mental health 

performance partnership block grant, which is $1,380,000 above 

the comparable fiscal year 2004 amount and the same as the administration’s request. The recommendation includes $21,803,000 

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 $106,013,000 for the children’s mental health services program. This amount is $3,659,000 above the 

comparable fiscal year 2004 level and the same as the administration’s request. This program provides grants and technical assistance to support community-based services for children and adolescents with serious emotional, behavioral or mental disorders. 

Grantees must provide matching funds, and services must involve 

the educational, juvenile justice, and health systems. 

The Committee encourages SAMHSA to expand this program 

into new States and localities. Such a financial investment is vital 

given the increased number of young children diagnosed with mental disorders, the rising teen suicide rate, incidents of school violence, and the psychological consequences of terrorism and war. 

These factors all indicate that our Nation’s children and youth need 

appropriate, quality mental health services. 

Projects for Assistance in Transition From Homelessness [PATH] 

The Committee recommends $55,251,000 for the PATH Program. 

This amount is $5,491,000 above the comparable fiscal year 2004 

level and is the same as the administration’s request. 

PATH is a critical program which provides outreach, mental 

health, and case management services and other community support services to individuals with serious mental illness who are 

homeless or at risk of becoming homeless. The PATH Program 

makes a significant difference in the lives of homeless persons with 

mental illnesses. PATH services eliminate the revolving door of episodic inpatient and outpatient hospital care. Multidisciplinary 

teams address client needs within a continuum of services, providing needed stabilization so that mental illnesses and co-occurring substance abuse and medical issues can be addressed. Assistance is provided to enhance access to housing, rehabilitation and 

training, and other needed supports, assisting homeless people in 

returning to secure and stable lives. 

Protection and Advocacy 

The Committee recommends $34,620,000 for the protection and 

advocacy program, which is the same as the comparable fiscal year 

2004 level and the administration request. This program helps ensure that the rights of mentally ill individuals are protected while 

they are patients in treatment facilities, or while they are living in 

the community, including their own homes. Funds are allocated to 
181 

States according to a formula based on population and relative per 

capita income. 

Samaritan Initiative 

The Committee has not included funding for the Samaritan Initiative due to lack of authorizing legislation. The administration requested $10,000,000 for this new program, which would provide the 

full range of services needed by chronically homeless people, such 

as housing, health care, mental health and substance abuse treatment, supportive and other services. The Committee has included 

$10,000,000 in funding for homeless programs within the Programs 

of Regional and National Significance account. The Committee will 

reconsider the administration’s request for the Samaritan Initiative 

once authorizing legislation is enacted. 

CENTER FOR SUBSTANCE ABUSE TREATMENT

Appropriations, 2004 ............................................................................. $2,198,365,000 

Budget estimate, 2005 ........................................................................... 2,349,267,000 

Committee recommendation ................................................................. 2,256,252,000 

The Committee recommends $2,256,252,000 for substance abuse 

treatment programs. This amount is $57,887,000 above the comparable fiscal year 2004 funding level and $93,015,000 below the 

administration’s request. The recommendation includes 

$83,500,000 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 remains concerned with the negative impact substance abuse has on our country. The National Survey on Drug Use 

and Health [NSDUH] estimated that 22 million Americans suffered 

from substance dependence or abuse due to drugs, alcohol or both 

in 2002. In contrast, studies conclude that approximately 3 million 

receive care in any given year. As a result, our Nation continues 

to face a severe ‘‘treatment gap’’—those who need treatment but do 

not receive the services necessary to address their problems. The 

Committee is concerned that, according to SAMHSA, approximately 

40 percent of those not receiving treatment reported cost as the 

reason why they did not receive appropriate services. 

The Committee recognizes that the effectiveness of alcohol and 

drug treatment programs and the sustained recovery of individuals 

require an appropriately trained workforce. The Committee encourages SAMHSA to prioritize the development and implementation of 

a workforce action plan. This plan could include recommendations, 

survey instruments, studies, training, and technical assistance, and 

incentive programs that would improve the recruitment, training 

and retention of the alcohol and drug treatment workforce. The 

Committee requests that SAMSHA consult closely with drug and 

alcohol programs, States, drug and alcohol recovery organizations, 

other experts and stakeholders in the development of its recommendations. 

The Committee commends SAMHSA’s recent efforts to develop 

performance measures and further demonstrate the efficacy of prevention and treatment programs in order to manage for results and 

further improve the effectiveness of these critical programs. The 
182 

Committee requests that SAMHSA continue to consult with States, 

drug and alcohol programs, drug and alcohol recovery organizations, other stakeholders and experts to develop and implement 

reasonable and meaningful performance measures that can be applied by SAMHSA and State governments consistently across programs. The Committee also requests that States receiving 

SAMHSA funds consult with local alcohol and drug programs, recovery organizations, stakeholders and experts in order to improve 

the implementation of these performance measures at the local 

level. 

Programs of Regional and National Significance 

The Committee recommends $424,017,000 for programs of regional and national significance [PRNS]. The comparable fiscal 

year 2004 level was $419,219,000 and the administration’s request 

was $517,032,000. The recommendation includes $4,300,000 in 

transfers available under section 241 of the Public Health Service 

Act. 

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 recommendation includes $100,000,000 for the 

Access to Recovery program. 

The Committee commends SAMHSA for including States as eligible applicants for all new Targeted Capacity Expansion [TCE] 

grants. The Committee believes States must be eligible to apply for 

all appropriate grants in order to assist States in planning, coordinating, and implementing a comprehensive Statewide service delivery system. 

The Committee continues to be concerned about the incidence of 

drug addiction among pregnant and parenting women. 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. 

Substance Abuse Prevention and Treatment Block Grant 

The Committee recommends $1,832,235,000 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 recommendation is $53,089,000 

more than the comparable level for fiscal year 2004 and is the 

same as the administration request. The block grant provides funds 

to States to support alcohol and drug abuse prevention, treatment, 

and rehabilitation services. Funds are allocated to the States according to formula. State plans must be submitted and approved 

annually. 
183 

The Children’s Health Act of 2000 made several changes in 

SAMHSA, including transforming the current Block Grant to a 

Performance Partnership Grant [PPG], in which States are granted 

program flexibility and reduced reporting burden in exchange for 

implementing a set of common performance measures. The Committee is concerned that SAMHSA failed to issue a report to Congress by the October 2002 deadline set in the Children’s Health Act 

outlining a suggested roadmap for the PPG transition. The Committee once again strongly urges SAMHSA to make the PPG implementation its number one priority for substance abuse programming and to allocate commensurate resources to support the transition to reflect this priority status. 

The Committee’s recommendation reflects its continued belief 

that the most effective and efficient way to support substance 

abuse programs in every State and territory is to direct the bulk 

of available new resources into the Block Grant and the PPG. The 

Committee also continues to express its strong support for preserving the current Block Grant and PPG as the foundation of our 

publicly funded substance abuse system in every State and territory in the United States. The Committee remains very concerned 

with any effort that could erode the strength of this vital funding 

stream. 

CENTER FOR SUBSTANCE ABUSE PREVENTION

Appropriations, 2004 ............................................................................. $198,458,000 

Budget estimate, 2005 ........................................................................... 196,018,000 

Committee recommendation ................................................................. 198,940,000 

The Committee recommends $198,940,000 for programs to prevent substance abuse. The comparable fiscal year 2004 level was 

$198,458,000 and the administration request was $196,018,000. 

This amount funds substance abuse prevention programs of regional and national significance. 

The Committee notes that 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 the Monitoring the Future study showed an 11 percent decrease in illicit teen drug use 

between 2001 and 2003. Ecstasy use, which soared between 1998 

and 2001, fell by more than half among high school students. 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 reiterates its support for prevention programs and is pleased that the administration has requested a funding level sufficient to continue CSAP’s existing programs. 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 $198,940,000 for programs of regional and national significance [PRNS]. The comparable fiscal 

year 2004 level was $198,458,000 and the administration request 

was $196,018,000. The Center for Substance Abuse Prevention is 
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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. 

In implementing the Strategic Prevention Framework State Incentive Grant program [SPFSIG], CSAP and the States should give 

priority in the use of funds to support drug and alcohol prevention 

community coalition efforts to plan and implement comprehensive 

local strategies to address specific local needs. The Committee expects States receiving funding under the SPFSIG to give priority 

in the use of the 20 percent prevention set-aside in the Substance 

Abuse Prevention and Treatment Block Grant to funding the specific priorities identified in the comprehensive community strategies developed by the communities in their States. 

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 

$11,000,000 to strengthen system-wide approaches to identify and 

serve women at risk of delivering FAS/FAE children, with an emphasis on teen mothers. 

PROGRAM MANAGEMENT

The Committee recommends $94,455,000 for program management activities of the agency. The recommendation includes 

$18,000,000 in transfers available under section 241 of the Public 

Health Service Act. The recommendation is $2,540,000 above the 

comparable level for fiscal year 2004 and $2,000,000 above the 

budget request. 

The program management activity includes resources for coordinating, directing, and managing the agency’s programs. Program 

management funds support salaries, benefits, space, supplies, 

equipment, travel, and departmental overhead required to plan, supervise, and administer SAMHSA’s programs. 

The Committee has included $2,000,000 to establish surveillance 

measures to address the mental and behavioral health needs of the 

population of the United States. Despite the significant levels of 

Federal, State, and local funding for mental health services, and a 

growing consensus that the Nation’s mental health care system 

must be reformed, there are currently no population-based sources 

of data on the mental and behavioral health needs in this country. 

The Committee believes that such data would help policymakers 

implement the recommendations in the President’s New Freedom 
185 

Commission on Mental Health report ‘‘Achieving the Promise: 

Transforming Mental Health Care in America.’’ Therefore, the 

Committee urges SAMHSA, in consultation with the Centers for 

Disease Control and Prevention, to develop ways of monitoring the 

mental health status of the population, the mental and behavioral 

health risks facing the Nation, and the immediate and long-term 

impact of emergencies on population mental health and behavior. 

Such measures could include new survey instruments or enhancements to existing public health surveillance systems that do not 

currently address mental and behavioral health. The Committee 

envisions that when these measures are implemented in future 

years, they will allow SAMHSA and CDC to document the health 

status of the population and of important subgroups; identify disparities in health status and use of health care by race/ethnicity, 

socio-economic status, region, and other population characteristics; 

and monitor trends in health status, access, and health care delivery. 

The Committee remains concerned that SAMHSA has not yet 

provided to Congress information detailing the resources each 

State will need for data infrastructure and other needs relating to 

the transition from the current Block Grant to the emerging PPG. 

The Committee directs SAMHSA to work with the States to assess 

the costs regarding data infrastructure needs and report its findings to the Committee. 

AGENCY FOR HEALTHCARE RESEARCH AND QUALITY

Appropriations, 2004 ............................................................................. $303,695,000 

Budget estimate, 2005 ........................................................................... 303,695,000 

Committee recommendation ................................................................. 318,695,000 

The Committee recommends $318,695,000 for the Agency for 

Healthcare Research and Quality [AHRQ]. This amount is 

$15,000,000 above the administration request and the comparable 

funding level for fiscal year 2004. 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 $260,695,000 for research on health 

costs, quality and outcomes [HCQO]. The comparable amount for 

fiscal year 2004 was $245,695,000. 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. 
186 

For fiscal year 2005, 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 

$4,500,000 over the comparable fiscal year 2004 level. The Committee also directs AHRQ to devote $15,000,000 of the 

total amount provided for HCQO to research on outcomes, comparative clinical effectiveness and appropriateness of prescription 

drugs and other health care items as authorized in Section 1013 of 

the Medicare Prescription Drug, Improvement and Modernization 

Act of 2003. 

Autoimmune Disease.—In support of continued HHS-wide implementation of the HHS Autoimmune Diseases Research Plan, the 

Committee encourages AHRQ to estimate the annual treatment 

and societal costs of autoimmune diseases in the United States, in 

order to project their future impact and burden on the healthcare 

system. 

Duchenne Muscular Dystrophy.—The Committee urges AHRQ to 

study and develop recommendations on the need for standards of 

care for individuals with Duchenne muscular dystrophy, allowing 

for input from external entities including parent advocacy programs. In addition, the Committee encourages AHRQ to conduct a 

workshop on standards of care for the muscular dystrophies and coordinate this activity with national advocacy organizations dedicated to this condition. 

Elderly Mental Health.—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 AHRQ to support evidence-based research projects focused on the diagnosis and treatment of mental 

illnesses in the geriatric population, and to disseminate evidencebased reports to physicians and other health care professionals. 

Hospital-Based Patient Initiative.—The Committee encourages 

AHRQ to work with multi-site academic medical centers to identify 

and implement programs to improve patient safety in a hospital 

setting. The Committee is interested in patient safety improvements that are designed for rapid turnaround and for developing 

practical and replicable projects in the future. 

Multiple Sclerosis.—The Committee is aware of an increasing 

number of non-chemotherapy infused biologicals that are under 

FDA review or are currently available for the treatment of diseases 

such as multiple sclerosis. The Committee urges AHRQ to conduct 

a study examining changes in the market involving infused 

biologicals. The report should examine changes in market demand 

for non-chemotherapy infused therapies, whether health care providers have adequate capacity to meet increased demand, the cost 

to providers for meeting increased demand, as well as geographical 

and subspecialty variations in access and demand. 

Nurse-Managed Health Centers.—The Committee encourages 

AHRQ to include nurse-managed health centers and advanced 
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practice nurses in research and demonstration projects conducted 

by the agency. 

Organ Donation.—The Committee recognizes that there is presently no formal mechanism to scientifically evaluate the efficacy of 

many new medications, devices, surgical techniques, and technical 

innovations that are being developed to improve organ preservation 

and maximize organ usage. The Committee encourages AHRQ to 

study and develop scientific evidence in support of efforts to increase organ donation and improve the recovery, preservation, and 

transportation of organs. 

Provider Level Data.—The Committee understands that policies 

on databases and data elements are being developed in many State 

and local jurisdictions. The Committee urges AHRQ to conduct a 

study on the role and importance of provider level data for patient 

safety, quality of care, electronic health data interchange, and development of evidence-based practice standards. The Committee believes that such a report could serve as an important benchmark 

for jurisdictions developing database policies both in the United 

States and abroad. 

Unequal Treatment.—The Committee encourages the Agency to 

carefully evaluate the analysis, findings, and recommendations of 

the March 2002 Institute of Medicine report regarding the disparities of medical care delivery to minorities. In particular, the Agency 

should pursue creative ways to address this serious finding and improve health care delivery for African-Americans, those of Hispanic 

and Asian origin, Native-Americans, Alaskans and Native Hawaiians. 

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 and the comparable fiscal year 2004 

level. MEPS is intended to obtain timely national estimates of 

health care use and expenditures, private and public health insurance coverage, and the availability, costs and scope of private 

health insurance benefits. It also develops cost and savings estimates of proposed changes in policy and identifies impact of policy 

changes on payers, providers, and patients. 

Program Support 

The Committee recommends $2,700,000 for program support. 

This amount is the same as the administration request and the 

comparable fiscal year 2004 level. This activity supports the overall 

management of the Agency. 

CENTERS FOR MEDICARE AND MEDICAID SERVICES

GRANTS TO STATES FOR MEDICAID

Appropriations, 2004 .............................................................................$130,892,197,000 

Budget estimate, 2005 ........................................................................... 119,124,488,000 

Committee recommendation ................................................................. 119,124,488,000 

The Committee recommends $119,124,488,000 for Grants to 

States for Medicaid. This amount is $11,767,709,000 less than the 

fiscal year 2004 appropriation and the same as the administration’s 
188 

request. This amount excludes $58,416,275,000 in fiscal year 2004 

advance appropriations for fiscal year 2005. In addition, 

$58,517,290,000 is provided for the first quarter of fiscal year 2006, 

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, 2004 ............................................................................. $95,084,100,000 

Budget estimate, 2005 ........................................................................... 114,608,900,000 

Committee recommendation ................................................................. 114,608,900,000 

The Committee recommends $114,608,900,000 for Federal payments to health care trust funds. This amount is the same as the 

administration’s request and is an increase of $19,524,800,000 from 

the fiscal year 2004 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 $114,002,000,000 for the Federal 

payment to the Supplementary Medical Insurance Trust Fund. 

This payment provides matching funds for premiums paid by Medicare Part B enrollees. This amount is the same as the administration’s request and is $19,484,000,000 more than the fiscal year 

2004 amount. The increase includes $5,742,000,000 to cover an anticipated shortfall in the amount appropriated in fiscal year 2004. 

The recommendation also includes $87,000,000 for hospital insurance for the uninsured. This amount is the same as the administration’s request and is $110,000,000 less than the 2004 amount. 

The Committee also recommends $199,000,000 for Federal uninsured benefit payment. This payment reimburses the Hospital Insurance Trust Fund for the cost of benefits provided to Federal annuitants who are eligible for Medicare. This amount is the same as 

the administration’s request and an increase of $31,000,000 over 

the fiscal year 2004 level, reflecting an increase on the number of 

covered individuals who are currently enrolled. The recommendation also includes the budget estimate of $105,900,000 for General 

Revenue for the Medicare Prescription Drug account, a new funding requirement. This account was established by Public Law 108– 

173; the Medicare Prescription Drug, Improvement and Modernization Act of 2003. The general fund will finance $105,900,000 in 

State low-income determination activities through the Prescription 

Drug Account. Requested bill language is also included to ensure 

prompt payments of Medicare prescription drug benefits as pro-
189 

vided under section 1860 D–16 of the Social Security Act, of 

$5,216,900,000 for fiscal year 2006. The Committee recommendation includes $215,000,000 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 $13,900,000 more than the fiscal year 2004 level. 

PROGRAM MANAGEMENT

Appropriations, 2004 ............................................................................. $2,636,846,000 

Budget estimate, 2005 ........................................................................... 2,746,127,000 

Committee recommendation ................................................................. 2,756,644,000 

The Committee recommends $2,756,644,000 for CMS program management, which is $10,517,000 more than the amount requested by the administration and $119,798,000 more than the fiscal year 2004 enacted level. 

Research, Demonstrations, and Evaluations 

The Committee recommends $77,791,000 for research, demonstrations, and evaluation activities. This amount is $9,517,000 

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 Secretary shall report to Congress on measurable outcomes 

for these grants and shall work in collaboration with the technical 

assistance provider to do so. The Committee further recommends 

that the technical assistance funding shall be used solely to fund 

technical assistance for the systems change grants, including ongoing technical assistance to ensure continuous quality improvement 

and progress on measurable outcomes. The Committee acknowledges the work of the consumer-controlled consortium and recommends continued funding for technical assistance for the State 

system change consumer task forces. 

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 
190 

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. 

Medicare Operations 

The Committee recommends $1,796,879,000 for Medicare operations, which is the amount requested by the administration, adjusted to reflect the $3,000,000 transfer of BIPA section 522 funding to the Medicare Operations line from the Federal Administration line. Based on current operations, the Committee believes that 

both national and local coverage determinations are more appropriately funded from the Medicare Operations line. In addition, 

$720,000,000 is available for the Medicare Integrity Program within the mandatory budget as part of the health insurance reform 

legislation. 

The Medicare operations line item covers a broad range of activities including claims processing and program safeguard activities 

performed by Medicare contractors. These contractors also provide 

information, guidance, and technical support to both providers and 

beneficiaries. In addition, this line item includes a variety of 

projects that extend beyond the traditional fee-for-service arena. The Committee recommends that not less than $31,700,000 be 

made available for the State Health Insurance Counseling Program, which has expanded responsibilities related to providing assistance to services concerning prescription drug benefits. Of this 

amount, at least $14,100,000 would come from this Program Management account, with additional amounts from Medicare Modernization Act funding. 

State Survey and Certification 

The Committee recommends $270,392,000 for Medicare State 

survey and certification activities, which is $19,140,000 more than 

the fiscal year 2004 level. 

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 $587,182,000 for Federal administration costs, which is an increase of $10,036,000, over the fiscal 

year 2004 level and reflects the shift of $3,000,000 requested for 

BIPA section 522 funding to the Medicare Operations activity. This 
191 

funding level allows for fixed cost increases associated with the current staffing level of 4,398 full-time equivalent positions. An additional $1,000,000 over the request is included for the cost of an Institute of Medicine study and report described under general provision language in section 221, pertaining to the Medicare 75 percent 

rule. 

The Committee recommends continuing the current level of $13,000,000 for the Healthy Start, Grow Smart program. The 

Healthy Start, Grow Smart program develops, prints, and disseminates a series of 13 informational brochures in English and Spanish to new Medicaid-eligible mothers. These brochures are distributed at the time of birth, an then monthly over the first year of 

each child’s life. Each publication focuses on activities that stimulate infant brain development and build the skills these children 

need to be successful in school. In addition to these educational 

suggestions, each Healthy Start pamphlet includes vital health and 

safety information for new parents. Content for each brochure is 

tied to the developmental stage of the child at the time it is sent. 

The Committee is pleased with the demonstration project at participating sites licensed by the Program for Reversing Heart Disease and encourages its continuation. The Committee further urges 

CMS to continue with the demonstration project being conducted at 

the Mind Body Institute of Boston, Massachusetts. 

The Committee is aware of the importance of providing vision rehabilitation services and is interested in ensuring that vision rehabilitation services are available on a nationwide basis, and that 

they may be provided by vision rehabilitation professionals acting 

under a physician’s general supervision. The Secretary of the Department of Health and Human Services, with funding included in 

this bill, is urged to continue the nationwide 5-year outpatient vision rehabilitation services demonstration project authorized in the 

fiscal year 2004 omnibus report, under which vision rehabilitation 

professionals may deliver services in the home under the general 

supervision of a qualified physician. 

The Committee first addressed the issue of proper coding within 

the Medicare outpatient Ambulatory Procedure Classification system for cobalt60 stereotactic neurosurgery in its fiscal year 2000 report. The Committee is pleased that CMS subsequently separated 

stereotactic radiosurgery by industry segment. However, in doing 

so CMS has changed the clinical definition of one segment—cobalt60 stereotactic neurosurgery—and its acceptable coding has 

been divided and positioned with radiation therapy and not neurosurgery. This has resulted in significant reimbursement issues between insurers and the hospitals providing the surgery since early 

2002, including development of secondary ‘‘in-house’’ coding systems, and the delay and/or denials of patient treatments. The Committee strongly urges CMS to reinstate one neurosurgical billing 

code for cobalt60 outpatient stereotactic neurosurgery, beginning as 

soon as possible, to alleviate the hospital burden in this area and 

to represent the way hospitals are set up and staffed to provide 

this neurosurgical procedure. The Committee again encourages 

CMS to work with the International Radiosurgery Association 

which represents hospitals, professionals and patients, and the 

neurosurgical community before designating, defining or changing 
192 

coding for cobalt60 stereotactic neurosurgery. CMS is also urged to 

consult these groups when making changes or additions to 

radiosurgery coding in the future. 

The Committee understands the CMS Ambulatory Procedure 

Classification [APC] system is a method to provide proper coding 

and reimbursement to hospitals for outpatient Medicare treatments. The Committee also understands that at this time, the APC 

panel is primarily composed of physicians and representatives of 

physician associations who are not subject to hospital coding. These 

members may have self interests in coding that is in conflict with 

and not in the best interests of hospitals. The Committee urges 

CMS to add hospital and hospital trade association representatives 

to the APC panel as vacancies arise. The Committee is concerned 

that CMS work with hospitals and their representatives and that 

the APC panel be responsive to hospital issues when a hospital industry segment is bringing issues before the panel. 

The Committee notes that when hospitals are routinely performing procedures in the outpatient setting, CMS may restrict reimbursement to the inpatient setting. This penalizes hospitals for 

reducing costs and avoiding overnight hospital stays. The Committee encourages CMS through its APC panel to allow coding in 

the setting that hospitals are providing the treatment procedures 

and to use established clinical definitions for the coding. 

The Committee recommendation includes funding to study the 

cost-effectiveness of innovative State dental Medicaid programs for 

children. The study should focus on those programs that reported 

improvements in access to care through innovative designs that 

have attracted adequate numbers of dentists and assured improved 

access for patients. 

The Committee is very pleased with the efforts of CMS to address the extraordinary adverse health status of Native Hawaiians 

in Waimanalo, Hawaii. The Committee continues to urge additional 

focus upon American Samoan residents in that geographical area 

utilizing the expertise of the Waimanalo Health Center. 

The Committee urges the Centers for Medicare and Medicaid 

Services to consider waivers for rural or isolated area demonstration projects when calculating such requirements as population 

density in the State of Hawaii. 

The Committee has been informed about recent CMS data which 

shows that less than one-third of Medicare beneficiaries eligible for 

diabetes self-managed training are receiving the care they need. To 

identify the primary barriers to access in urban and rural settings, 

the Committee recommends that CMS conduct demonstrations in 

partnership with an association that has expertise in providing diabetes self-management training to determine the effectiveness of 

diabetes self-management training and the various obstacles to access. 

The Committee is aware of changes being developed by CMS to 

alter the Medicare coverage policy for power mobility devices including power wheelchairs. The Committee strongly encourages 

CMS to use its resources toward development of a coverage policy 

firmly based on a functional standard of nonambulatory. The Committee believes beneficiaries who cannot perform their basic acts of 

daily living, toileting, food preparation and emergency egress, are 
193 

nonambulatory and must have access to this mobility benefit to 

function independently. The committee supports controlling fraud 

and abuse through requirements that ensure proper substantiation 

of medical need for this equipment but does not support narrowing 

the definition of nonambulatory to exclude the elderly and disabled 

dependent on these devices to function in the home. The Committee believes that the medically necessary application of this mobility benefit can save Medicare money through cost-avoidance associated with expensive institutional care or hospitalization resulting from falls by the growing elderly population. 

The Committee encourages CMS to examine the unintended consequences current reimbursement policies have on restricting access and utilization of oral anticancer therapies through the Part 

B drug payment policies. CMS is encouraged to evaluate reimbursement policies for such oral therapies. 

The Committee is concerned that the current Medicare payment 

cap for federally-qualified health centers [FQHC] has had a detrimental impact on the financial stability of these safety net providers that jeopardizes access to care in underserved areas. The 

Committee understands that the payment cap has not been adjusted in more than 10 years, the data used to initially create the 

cap was not based on FQHC data, increases in health centers costs 

have not been accounted for, and more than one half of all health 

centers are now negatively impacted. The Committee urges the 

Secretary to recalculate the payment cap for FQHCs to take into 

account these issues. 

The Committee urges CMS to provide for reimbursement for 

services rendered to Native Hawaiians in federally qualified health 

centers in the same manner that it currently does for American Indians and Alaskan Natives. Further, the Committee requests a report on this matter by next year’s budget hearings. 

The Committee remains extremely concerned over CMS’ continuing failure to articulate clear guidelines and to set expeditious 

timetables for consideration of new technologies, procedures and 

products for Medicare coverage. However, the Committee applauds 

CMS’ decision to expand Medicare coverage of Positron Emission 

Tomography [PET] in cases of suspected Alzheimer’s disease, when 

a specific diagnosis remains uncertain despite a thorough clinical 

evaluation, and in cases where patients with early dementia or unexpected memory loss are enrolled in clinical trials containing certain patient safeguards. The Committee is also pleased to note that 

CMS will collaborate with the National Institutes of Health and 

the Food and Drug Administration to develop needed evidence on 

the role of PET scans in guiding the diagnosis and treatment of, 

and predicting the course of, Alzheimer’s disease. In choosing panels to develop criteria and evaluate use of PET scans for Alzheimer’s disease, the Committee expects the agencies involved to 

name members familiar with PET technology and its uses. The 

Committee does not expect that the Agency for Healthcare Research and Quality will direct or be involved in this effort. The 

Committee firmly believes that these steps will increase Medicare 

beneficiaries’ access to innovative technologies and will ultimately 

lead to improved health outcomes. 
194 

The Committee expects CMS to continue to gather pertinent information relative to model practices of quality chronic care management by implementing Section 721 of the Medicare Prescription 

Drug, Improvement, and Modernization Act of 2003. The Committee recommends that CMS support independently financed demonstration projects for serious illnesses and coordinated care. 

The Committee is aware of innovative information technology 

that promises substantial advances such as more fully informing 

and educating patients and numerous potential applications. The 

Committee encourages a demonstration of the ways in which this 

technology may improve the health care system. 

The Committee is aware that a recent study by the General Accountability Office has revealed that Medicare Call Centers need to 

improve responses to policy-oriented questions from providers. According to the study, only 4 percent of the responses received from 

GAO test calls were correct and complete. The Committee understands that CMS generally agrees with the GAO’s findings, and 

urges that it expedite efforts to implement the recommendations, 

including: a process to route policy inquiries to staff with appropriate expertise; clear and easily accessible policy-oriented material 

to assist customer service representatives; and an effective monitoring program for call centers. The Committee expects CMS to 

provide a report on its actions to improve responses to policy-oriented inquiries from providers as part of its fiscal year 2006 congressional budget justification material. 

The Committee believes that in the Medicare continuum of care 

there is a vital role for long-term acute care hospitals [LTACHs], 

including hospitals set up in other hospitals to provide that care. 

On August 2, 2004 CMS promulgated a rule which, over 4 years, 

establishes a patient quota rule setting limits on the percentage of 

patients which can go into an LTACH from the host facility. The 

Committee believes that the decision as to which patients should 

go into a LTACH should be made by physicians based on well-defined patient and hospital admissions criteria—not on an arbitrary 

quota and therefore, that this rule should be replaced with a rule 

developed on clinically-based criteria. The Committee recommends 

that CMS commission a comprehensive study on what patient and 

hospital admissibility criteria should be put in place to assure the 

responsible growth and development of this important part of medical services for the elderly. 

The Committee commends CMS for removing barriers to reimbursement for treatment of obesity. CMS is encouraged to work 

with the Centers for Disease Control and Prevention in reviewing 

scientific evidence in order to determine coverage of obesity treatment and prevention, and also in establishing a national public 

health action plan on obesity. The Committee also recommends 

that CMS work with State health educators and health promotion 

directors to assure that people receive relevant information to their 

life-stage on how obesity should be treated and prevented. 

Reducing Medicare Mispayments.—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 
195 

abuse in the Medicare program. The Committee has held many 

hearings and taken other corrective actions over a 15 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 request a briefing as to his timeline for action by December 1, 2004. By March 1, 2005, 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 the budget request of $24,400,000, 

as the second-year investment in CMS’s efforts to make significant 

improvements to key aspects of managing the agency and the 

Medicare program. First-year funding is fiscal year 2004 was 

$29,619,000. Funding in fiscal year 2005 will target system-related 

improvements. 

HMO Loan and Loan Guarantee Fund 

The Committee concurs with requested bill language making receipts of this fund available for payment of obligations, but prohibiting the issuance of additional direct loans or loan guarantees to 

health maintenance organizations from this fund. 

ADMINISTRATION FOR CHILDREN AND FAMILIES

PAYMENTS TO STATES FOR CHILD SUPPORT ENFORCEMENT AND

FAMILY SUPPORT PROGRAMS

Appropriations, 2004 ............................................................................. $3,312,970,000 

Budget estimate, 2005 ........................................................................... 2,825,802,000 

Committee recommendation ................................................................. 2,873,802,000 

The Committee recommends $2,873,802,000 be made available in 

fiscal year 2005 for payments to States for child support enforcement and family support programs. The comparable funding level 

for fiscal year 2004 is $2,825,802,000 and the budget request includes $2,873,802,000 for this program. The Committee recommendation provides the full amount requested under current 

law. The budget request includes net savings of $48,000,000 based 

on proposed legislation. 

These payments support the States’ efforts to promote the selfsufficiency and economic security of low-income families. These 

funds also support efforts to locate non-custodial parents, determine paternity when necessary, and establish and enforce orders of 

support. The appropriation, when combined with the 

$1,200,000,000 in advance funding provided in last year’s bill and 

an estimated $194,800,000 from offsetting collections, supports a 

program level of $4,268,602,000. 

The Committee also has provided $1,200,000,000 in advance 

funding for the first quarter of fiscal year 2006 for the child support enforcement program, the same as the budget request. 
196 

LOW-INCOME HOME ENERGY ASSISTANCE PROGRAM

Appropriations, 2004 ............................................................................. $1,888,790,000 

Budget estimate, 2005 ........................................................................... 2,000,500,000 

Committee recommendation ................................................................. 2,000,500,000 

The Committee recommends $2,000,500,000 for fiscal year 2005 

for LIHEAP. The comparable funding level for fiscal year 2004 is 

$1,888,790,000 and the budget request includes $2,000,500,000 for 

this program. LIHEAP is made up of two components: the State 

grant program and the contingency fund. 

The Committee recommendation includes $1,901,090,000 for fiscal year 2005 for the State grant program. The comparable funding 

level for fiscal year 2004 is $1,789,380,000 and the budget request 

includes $1,800,500,000 for this program. Within the funds provided, the Committee recommends $500,000 for evaluation purposes, as requested by the administration. 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 recommends $99,410,000 for fiscal year 2005 for 

the contingency fund. The comparable funding level for fiscal year 

2004 is $99,410,000 and the budget request includes $200,000,000 

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 2005 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, 2004 ............................................................................. $447,598,000 

Budget estimate, 2005 ........................................................................... 473,239,000 

Committee recommendation ................................................................. 477,239,000 

The Committee recommends $477,239,000 for fiscal year 2005 for 

refugee and entrant assistance. The comparable funding level for 

fiscal year 2004 is $447,598,000 and the budget request includes 

$473,239,000 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 pos-
197 

sible. 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 70,000, this 

appropriation, together with prior-year funds available for fiscal 

year 2005 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. 

In order to carry out the refugee and entrant assistance program, 

the Committee recommends $193,577,000 for transitional and medical assistance, including State administration and the voluntary 

agency program; $10,000,000 for victims of trafficking; 

$155,121,000 for social services; $4,835,000 for preventive health; 

and $49,477,000 for targeted assistance. 

The Committee has included $19,000,000 within the funds provided for social services for increased support to communities with 

large concentrations of refugees whose cultural differences make 

assimilation especially difficult justifying a more intense level and 

longer duration of Federal assistance. 

The Committee is aware that the State Department has made arrangements for 15,000 Hmong refugees to enter the United States 

starting in 2004 and carrying over into 2005. The Committee is 

concerned that unlike prior groups of Hmong refugees, which were 

made up of military and political leaders with the means and education to succeed in America, these immigrants have spent their 

lives in a refugee camp. Few, if any, speak English. Most are under 

18 and have little schooling. Even with the greater level of education and skills possessed by prior refugees, current statistics indicate that about 38 percent of current Hmong-Americans live in poverty. In addition, the Committee has become aware of efforts by the 

State Department to admit a significant number of Bantu refugees 

from camps along the Somali-Kenya border. A persecuted minority 

in Somalia, the Bantus were barred from school and so are largely 

illiterate. The Committee is concerned that the Bantus only recently began arriving in the United States, thus there is no currently existing Bantu population in the United States to welcome 

the newcomers. In addition, the Bantus represent the largest cohesive refugee group presented for resettlement screening since the 

mid-1990s. For these reasons, the Committee has set aside 

$8,000,000 within the ORR appropriation for the resettlement of 

unanticipated arrivals. 

The Committee recommends $54,229,000 for unaccompanied children pursuant to section 462 of the Homeland Security Act of 2002. 

Funds are 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. 
198 

The Committee is encouraged by steps taken by the Office of Refugee Resettlement to improve access to legal representation for 

children served through this program, as called for by Congress in 

the statement of the managers accompanying the Department of 

Health and Human Services Appropriations Act, 2004. The Committee encourages the Office to continue efforts in this area, in particular focusing on developing an infrastructure for identifying, assigning, coordinating and tracking competent pro bono counsel in 

addition to independent guardians ad litem for all such children. 

Furthermore, the Committee strongly encourages the Office of Refugee Resettlement to give high priority to the location of immigration courts and services when electing ORR contracted facilities. 

The Committee requests a full discussion of efforts taken in this 

area to be included in the 2006 congressional justification. The Committee also recommends $10,000,000 to treat and assist 

victims of torture. These funds may also be used to provide training to healthcare providers to enable them to treat the physical and 

psychological effects of torture. The Committee acknowledges that 

well-established treatment centers, such as the Center for Victims 

of Torture, have developed the knowledge base that has fostered 

growth of treatment facilities around the country and strengthened 

treatment services generally. This positive trend may continue if 

leading centers are able to expand their staffs to create more trainers and improve evaluation and research needed to guide and develop new programs. The Committee urges the Office of Refugee 

Resettlement to place a priority on continued and sufficient grant 

support for services provided by existing centers before using funds 

to expand communities served through this program. 

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, 2004 ............................................................................. $2,087,310,000 

Budget estimate, 2005 ........................................................................... 2,099,729,000 

Committee recommendation ................................................................. 2,099,729,000 

The Committee recommends $2,099,729,000 for fiscal year 2005 

for child care and development block grant. The comparable funding level for fiscal year 2004 is $2,087,310,000 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 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 
199 

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 continue 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, 2004 ............................................................................. $1,700,000,000 

Budget estimate, 2005 ........................................................................... 1,700,000,000 

Committee recommendation ................................................................. 1,700,000,000 

The Committee recommends $1,700,000,000 for fiscal year 2005 

for the social services block grant. The comparable funding level for 

fiscal year 2004 is $1,700,000,000 and the budget request includes 

$1,700,000,000 for this program. The Committee has included bill 

language that allows States to transfer up to 10 percent of their 

TANF allotment to the social services block grant. 

CHILDREN AND FAMILIES SERVICES PROGRAMS

Appropriations, 2004 ............................................................................. $8,833,371,000 

Budget estimate, 2005 ........................................................................... 9,097,897,000 

Committee recommendation ................................................................. 9,094,146,000 

The Committee recommends $9,094,146,000 for fiscal year 2005 

for children and families services programs. The comparable funding level for fiscal year 2004 is $8,833,371,000 and the budget request includes $9,097,897,000 for this program. In addition, 

$10,500,000 in transfers are available under section 241 of the 

Public Health Service Act. 
200 

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 $6,935,452,000 for fiscal year 2005 

for Head Start. The comparable funding level for fiscal year 2004 

is $6,774,980,000 and the budget request includes $6,935,452,000 

for this program. The Committee recommendation includes 

$1,400,000,000 in advance funding that will become available on 

October 1, 2005. The Committee recommendation does not include 

the $45,000,000 requested in the budget for the grant program for 

those States that directly administer the Head Start program. 

The Committee is aware that studies on early childhood that provide clear evidence that the brain undergoes its most dramatic development during the first 3 years of life, when children acquire 

the ability to think, speak, learn, and reason. Disparities in children’s cognitive and social abilities become evident well before they 

enter Head Start or pre-kindergarten programs at age 4. Early 

Head Start minimizes these disparities so that children are ready 

to enter school and learn. The National Evaluation of Early Head 

Start concluded that Early Head Start is making a positive difference in areas associated with children’s success in school, family 

self-sufficiency, and parental support of child development. Currently only 3 percent of estimated eligible infants and toddlers are 

enrolled in Early Head Start. Over the past 5 years, the Committee 

has significantly increased funding for Early Head Start, to provide 

more low-income infants and toddlers with the positive experiences 

they need for later school and life successes. The Committee intends to continue this important investment. 

Given the recent changes in the overall Head Start training and 

technical assistance system and the special training and technical 

assistance needs of programs working with infants, toddlers, and 

their families, the Committee is concerned about the maintenance 

of the Early Head Start Training and Technical Assistance System. 

In particular, the Committee is concerned that long distance, technology-based technical assistance is taking the place of providing 

programs with support from qualified on-site people. The Committee believes that in order to sustain the positive outcomes generated by the program, Early Head Start programs and staff need 

to continue to receive ongoing training opportunities and technical 

assistance from organizations with specialized expertise relating to 

infants, toddlers and families and the demonstrated capacity needed to provide direction and support to the Head Start national 

training and technical assistance system. 

Head Start provides comprehensive development services for lowincome 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 
201 

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. 

Tribal colleges and universities [TCUs) play a central role in 

strengthening education, economic development, and self-sufficiency to American Indian communities. The Committee recognizes 

the success of the Head Start-TCU partnership formed in 1999 to 

foster educational, health, nutritional, and social services for Indian children, and recommends that this program be continued and 

expanded. The Committee supports the Department’s commitment 

to continue to award 5-year grants to tribal colleges and universities. 

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 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 examine this issue and develop a plan to ensure that sufficient funds are 

provided for Migrant Head Start programs. 

The Head Start Bureau shall provide the Committee with the 

number and cost of buses purchased, by region, in fiscal years 

2002, 2003, and the first half of 2004 with Head Start funds no 

later than March 31, 2005. 

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 continues to caution 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 nu-
202 

trition and health screening, to social and emotional development 

and family building, as well as the cognitive growth of young children. 

The Committee encourages ACF’s Head Start Bureau and 

HRSA’s Maternal and Child Health Bureau to continue and expand 

their successful interagency agreement to jointly address dental 

disease, a significant unmet health need of Head Start children. 

This partnership has brought together Head Start and the dental 

community at the national, State and local levels to seek solutions 

to improve access to oral health care for these children through the 

public and private sectors. 

The Committee recognizes that assessing the effectiveness of 

Head Start nationwide is an important goal and that by sponsoring 

the development of the National Reporting System [NRS] the U.S. 

Department of Health and Human Services hopes to aggregate and 

report data nationally. The Committee commends the efforts of the 

Administration for Children and Families [ACF] to measure the effectiveness of Head Start and to assess progress among Head Start 

children. In order to ensure that the National Reporting System is 

effectively meeting its objective, the Committee urges ACF to utilize an independent organization to review the test’s validity and 

its impact on instruction. 

The Committee acknowledges Head Start’s effort to test both 

English and Spanish language speakers. Currently, the determining factor for which language version will be administered is 

the child’s repeated failure to comprehend questions posed in 

English. The Committee urges ACF to review this policy in order 

to minimize any potential unintended consequences for children 

and the teacher-child relationship. 

The Committee intends that no Head Start agency, Head Start 

center, or Early Head Start center receiving financial assistance 

available through this Act shall provide compensation for any of its 

employees (including program directors) in excess of the salary of 

the Secretary of the Department of Health and Human Services 

and that each Head Start agency, Head Start center, or Early Head 

Start center receiving financial assistance available through this 

Act shall maintain and annually submit to the Secretary, a complete accounting of its administrative expenses, including expenses 

for salaries and compensation funded under this subchapter 

disaggregated by employee. 

It has come to the Committee’s attention that one Head Start 

grantee did not adequately obtain parental consent before performing a health screening on Head Start students which included 

intrusive physical examinations. The Committee believes that Head 

Start agencies receiving financial assistance available through this 

Act should obtain written parental consent before administration 

of, or referral for, any health care service provided or arranged to 

be provided, including any non-emergency intrusive physical examination of a child in connection with participation in a Head Start 

program. This should not in any way be interpreted to prohibit 

agencies from using established methods for handing cases of suspected or known child abuse and neglect that are in compliance 

with applicable Federal, State, or tribal law. 
203 

The Committee is interested meeting the goal of this important 

program through the efficient and effective expenditure of Head 

Start program funds. With respect to training activities of Head 

Start agencies and providers, the Committee is concerned that 

funds provided under this section shall not be used for long-distance travel expenses for training activities that are substantially 

similar to training activities that are locally or regionally available. 

The Committee would like to note that this is not intended to automatically prevent attendance in National Conferences within the 

50 United States. 

Consolidated Runaway and Homeless Youth Program 

The Committee recommends $95,000,000 for fiscal year 2005 for 

the consolidated runaway and homeless youth program. The comparable funding level for fiscal year 2004 is $89,431,000 and the 

budget request includes $89,447,000 for this program. The Committee recommends $49,181,000 for basic centers and $46,819,000 

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 

500,000 to 1.5 million and 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. 

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 communitybased 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 TollFree Communications Center. 

Grants are used to develop or strengthen community-based programs which assist homeless youth in making a smooth transition 

to productive adulthood and social self-sufficiency; and to provide 

technical assistance to transitional living programs for the acquisition and maintenance of resources and services. 

The basic centers program, authorized under Part A of the Act, 

supports grants to community-based public and private agencies for 

the provision of outreach, crisis intervention, temporary shelter, 

counseling, family unification and aftercare services to runaway 

and homeless youth and their families. 

The transitional 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. 
204 

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 decisionmaking and priority setting; educational advancement; job preparation attainment; and mental and physical health care. 

Under the new authorization, the maximum age limit for youth 

seeking shelter is reduced from 21 to 18, however there is an exception that allows youth in the program who have not reached age 

18 to remain in the program after 540 days. Centers are now able 

to exceed the 20 youth capacity limit if the State requires a higher 

limit in order to be licensed under the Basic Center program. Finally, the allotment for Transitional Living Programs is increased 

to 45 percent and, under warranted conditions, to 55 percent. 

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. 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. 
205 

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. 

Runaway Youth Prevention Program 

The Committee recommends $15,802,000 for fiscal year 2005 for 

the runaway youth prevention program. The comparable funding 

level for fiscal year 2004 is $15,302,000 and the budget request includes $15,302,000 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. 

Child Abuse Prevention Programs 

The Committee recommends $61,886,000 for fiscal year 2005 for 

child abuse prevention programs. The comparable funding level for 

fiscal year 2004 is $56,269,000 and the budget request includes 

$68,279,000 for this program. The recommendation includes 

$27,500,000 for State grants and $34,386,000 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 $12,052,000 for fiscal year 2005 for 

abandoned infants assistance. The comparable funding level for fiscal year 2004 is $12,052,000 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 $291,986,000 for fiscal year 2005 for 

child welfare services. The comparable funding level for fiscal year 

2004 is $289,320,000 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, 
206 

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 $7,470,000 for fiscal year 2005 for 

child welfare training. The comparable funding level for fiscal year 

2004 is $7,411,000 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 $27,343,000 for fiscal year 2005 for 

adoption opportunities. The comparable funding level for fiscal year 

2004 is $27,103,000 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 $32,103,000 for fiscal year 2005 for 

adoption incentives. The comparable funding level for fiscal year 

2004 is $7,456,000 and the budget request includes $32,103,000 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, 2005. 

Adoption Awareness 

The Committee recommends $12,906,000 for fiscal year 2005 for 

adoption awareness. The comparable funding level for fiscal year 

2004 is $12,785,000 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, 

$9,906,000 is available for this purpose. 
207 

The Special Needs Adoption Campaign supports grants to carry 

out a national campaign to inform the public about the adoption of 

children with special needs. The Committee recommendation includes $3,000,000 to continue this important activity. 

Compassion Capital Fund 

The Committee recommends $47,702,000 for fiscal year 2005 for 

the compassion capital fund. The comparable funding level for fiscal year 2004 is $47,702,000 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 $19,168,000 for fiscal year 2005 for 

the social services research. The comparable funding level for fiscal 

year 2004 is $19,168,000 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 notes ACF’s efforts to assist States with meeting 

the extensive record-keeping, reporting, and tracking requirements 

of the TANF program. Working through the state information technology consortium, ACF is providing States with the tools necessary to strengthen and improve the complex IT systems required 

to support TANF. Similarly, on behalf of Child Support Enforcement, the consortium is helping to expand data exchange capabilities between the courts and State child support enforcement agencies as well as increase collection efficiency in States and tribal organizations. 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 $43,205,000 for fiscal year 2005 for 

community-based resource centers. The comparable funding level 

for fiscal year 2004 is $33,205,000 and the budget request includes 

$65,002,000 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. 
208 

Abstinence Education 

The Committee recommends $154,500,000 for fiscal year 2005 for 

community based abstinence education. The comparable funding 

level for fiscal year 2004 is $124,549,000 and the budget request 

includes $236,426,000 for this program. Within the funds provided, 

$100,000,000 is provided for community-based abstinence education, $4,500,000 is provided through an evaluation set-aside as 

requested by the administration, and $50,000,000 is provided as 

pre-appropriated mandatory funds. 

This program provides support for the development and implementation of abstinence education programs for adolescents, ages 

12 through 18. These programs are unique in that their entire 

focus is to educate young people and create an environment within 

communities that supports teen decisions to postpone sexual activity until marriage. 

Developmental Disabilities 

The Committee recommends $171,438,000 for fiscal year 2005 for 

programs administered by the Administration on Developmental 

Disabilities. The comparable funding level for fiscal year 2004 is 

$164,772,000 and the budget request includes $164,854,000 for 

these programs. Within the funds provided, $156,526,000 is for carrying out the Developmental Disability Act, and $14,912,000 is for 

carrying out the Help America Vote Act of 2002. 

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. The ADD also administers monies for election assistance for individuals with disabilities. This program is for individuals with any type of disability. Of the funds provided, the Committee recommends $73,081,000 

for State councils. These councils 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. The Committee recommends $40,000,000 for protection and advocacy grants. 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. 

The Committee recommends $11,642,000 for projects of national 

significance to assist persons with developmental disabilities. This 

program funds grants and contracts providing nationwide impact 

by developing new technologies and applying and demonstrating innovative methods to support the independence, productivity, and 

integration into the community of persons with developmental disabilities. The Committee recognizes the potential benefits that as-
209 

sistive technology can have for individuals with developmental disabilities. Of these funds, $4,000,000 is available to expand activities of the Family Support Program. 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 as defined in Title II of the Developmental 

Disability Act. 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. 

The Committee recommends $31,803,000 for university-affiliated 

programs. This program consists of a network of centers that are 

interdisciplinary education, research and public service units of a 

university system, or are public or non-profit entities associated 

with universities. These centers conduct research, develop evidence 

based practices and teach thousands of parents, professionals, students, and people with disabilities about critical disability areas 

such as early intervention, health care, community-based services, 

inclusive and meaningful education, transition from school to work, 

employment, housing, assistive technology, aging with a disability 

and transportation. The centers serve as the major vehicle to translate disability related research into community practice and service 

systems and to train the next cohort of future professionals who 

will provide services and supports to an increasingly diverse population of people with disabilities. The increase provided in the bill 

will allow funding for existing centers to reach the authorized level, 

support new center grants in five States that currently have 

unserved or underserved populations, and establish four new centers that specialize in minority health disparities and education 

issues. 

The Committee recommends $14,912,000 for disabled voter services. Of these funds, $10,000,000 is to promote disabled voter access, and the remaining $4,912,000 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, any individual with a 

disability in the election process. 

Native American Programs 

The Committee recommends $45,157,000 for fiscal year 2005 for 

Native American programs. The comparable funding level for fiscal 

year 2004 is $45,157,000 and the budget request includes 

$45,155,000 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 encour-
210 

ages 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 $727,650,000 for fiscal year 2005 for 

the community services programs. The comparable funding level 

for fiscal year 2004 is $731,284,000 and the budget request includes $552,350,000 for this program. 

Within the funds provided, the Committee recommends $650,000,000 for the community services block grant [CSBG]. 

These funds are used to make formula grants to States and Indian 

tribes to provide a wide range of services and activities to alleviate 

causes of poverty in communities and to assist low-income individuals in becoming self-sufficient. 

The Committee rejects the administration’s recommendation to 

cut the community services block grant funding. Although a restrictive Committee allocation prevented CSBG funding from being substantially increased this year, the Committee continues to recognize the importance of CSBG and the Community Action Agencies 

it funds in helping meet the extraordinary challenges facing lowincome 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 2005: community economic development, 

$38,000,000, of which $2,000,000 is for neighborhood innovation 

projects; individual development accounts, $24,912,000; rural community facilities, $7,500,000; and community food and nutrition, 
211 

$7,238,000. The Committee did not provide funds for the national 

youth sports program. 

The Committee continues to support strongly the Community 

Economic Development program because of the substantial record 

of achievement that Community Development Corporations have 

complied in working in distressed urban and rural communities. 

The Committee, in particular, notes that Federal funds leverage 

substantial non-Federal resources in meeting the objectives of this 

program. Therefore, it is the Committee’s intent that appropriated 

funds should be allocated to the maximum extent possible in the 

form of grants to qualified Community Development Corporations 

in order to maximize the leveraging power of the Federal investment and the number and amount of set-asides should be reduced 

to the most minimal levels. 

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. 

The Committee recognizes that manufacturing is an important 

part of the economic base in urban communities and rural areas. 

The Committee notes that recent research indicates that very little 

venture or equity capital makes it into this sector and this is particularly the case for manufacturing businesses located in economically distressed communities. The Committee is aware that a number of community development corporations [CDCs] have provided 

financing to manufacturing businesses in low income areas. 

A principal source of capital for CDCs is Community Economic 

Development Grants. The Committee recommendation includes an 

additional $3,500,000 above the budget request for the purpose of 

providing technical and financial assistance to manufacturing enterprises. The Committee intends that these funds be made available to experienced CDCs with a record of lending or investing in 

manufacturing. Further, the Committee intends these funds to be 

used for providing technical assistance and financial assistance— 

including loans and investments for plants, equipment and working 

capital—to manufacturing businesses. Of the total provided, the 

Committee has included $5,481,000 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 
212 

grants under this program go to experienced community development corporations. 

Within the funds provided, the Committee has also included $2,000,000 for neighborhood innovation projects (42 USC 

9921(a)(4)) to enable the Office of Community Services to participate with the Department of Housing and Urban Development, 

foundations, and financial institutions. 

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. 

Domestic Violence Hotline 

The Committee recommends $3,500,000 for fiscal year 2005 for 

the national domestic violence hotline. The comparable funding 

level for fiscal year 2004 is $2,982,000 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 $128,000,000 for fiscal year 2005 for 

battered women’s shelters program. The comparable funding level 

for fiscal year 2004 is $125,648,000 and the budget request includes $125,648,000 for this program. 

This is a formula grant program to support community-based 

projects which operate shelters and provide related assistance for 
213 

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 $36,000,000 for fiscal year 2005 for 

early learning opportunities program. The comparable funding 

level for fiscal year 2004 is $33,580,000 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 $1,386,000 for fiscal year 2005 for 

the operation of the Department’s Center for Faith-Based and Community Initiatives. The comparable funding level for fiscal year 

2004 is $1,386,000 and the budget request includes $1,400,000 for 

this program. 

Mentoring Children of Prisoners 

The Committee recommends $50,000,000 for fiscal year 2005 for 

mentoring children of prisoners. The comparable funding level for 

fiscal year 2004 is $49,701,000 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 $44,734,000 for fiscal year 2005 for 

independent living training vouchers. The comparable funding level 

for fiscal year 2004 is $44,734,000 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. 
214 

Promotion of Responsible Fatherhood and Healthy Marriage 

The Committee does not provide funds for fiscal year 2005 for 

promotion of responsible fatherhood and healthy marriage. The 

budget request includes $50,000,000 for this new program designed 

to promote responsible fatherhood and responsible marriage. The 

purpose of this proposed program, for which authorizing legislation 

is pending, is 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 $190,206,000 for fiscal year 2005 for 

program administration. The comparable funding level for fiscal 

year 2004 is $177,894,000 and the budget request includes 

$190,206,000 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 2006 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, 2004 ............................................................................. $404,383,000 

Budget estimate, 2005 ........................................................................... 505,000,000 

Committee recommendation ................................................................. 404,383,000 

The Committee recommends $404,383,000 for fiscal year 2005 for 

promoting safe and stable families. The comparable funding level 

for fiscal year 2004 is $404,383,000 and the budget request includes $505,000,000 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 Sta-
215 

ble 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 $99,383,000 in discretionary appropriations. 

PAYMENTS TO STATES FOR FOSTER CARE AND ADOPTION ASSISTANCE

Appropriations, 2004 ............................................................................. $5,068,300,000 

Budget estimate, 2005 ........................................................................... 5,037,900,000 

Committee recommendation ................................................................. 5,037,900,000 

The Committee recommends $5,037,900,000 for fiscal year 2005 

for payments to States for foster care and adoption assistance. The 

comparable funding level for fiscal year 2004 is $5,068,300,000 and 

the budget request includes $5,037,900,000 for this program. In addition, the Committee recommendation concurs with the administration’s request of $1,767,200,000 for an advance appropriation for 

the first quarter of fiscal year 2006. 

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, 2004 ............................................................................. $1,373,917,000 

Budget estimate, 2005 ........................................................................... 1,376,527,000 

Committee recommendation ................................................................. 1,395,117,000 

The Committee recommends an appropriation of $1,395,117,000 

for aging programs. This amount is $21,200,000 above the comparable fiscal year 2004 level and $18,590,000 above the administration request. 

Supportive Services and Senior Centers 

The Committee recommends an appropriation of $357,000,000 for 

supportive services and senior centers, which is $3,111,000 above 
216 

the comparable fiscal year 2004 level and the same as the administration request. This State formula grant program funds a wide 

range of social services for the elderly, including multipurpose senior centers, adult day care and ombudsman activities. State agencies on aging award funds to designated area agencies on aging 

who in turn make awards to local services providers. All individuals age 60 and over are eligible for services, although, by law, priority is given to serving those who are in the greatest economic and 

social need, with particular attention to low-income minority older 

individuals and those residing in rural areas. Under the basic law, 

States have the option to transfer up to 30 percent of funds appropriated between the senior centers program and the nutrition programs, which allows the State to determine where the resources 

are most needed. 

Preventive Health Services 

The Committee recommends $21,919,000 for preventive health 

services, which is the same as the administration request. The 

comparable fiscal year 2004 level was $21,790,000. 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. 

The Committee is pleased that the budget request includes 

$5,500,000 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. 

Protection of Vulnerable Older Americans 

The Committee recommends $20,474,000 for grants to States for 

protection of vulnerable older Americans. This is $1,030,000 above 

the comparable fiscal year 2004 level and $1,915,000 above the administration request. Within the Committee recommendation, 

$15,276,000, an increase of $1,000,000 over the fiscal year 2004 

level, is for the ombudsman services program and $5,198,000 is for 

the prevention of elder abuse program. 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 to 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. 
217 

National Family Caregiver Support Program 

The Committee recommends $157,000,000 for the national family caregiver support program, which is $4,262,000 above the comparable fiscal year 2004 level and $1,488,000 above the administration request. Funds appropriated for this activity established a 

multifaceted support system in each State for family caregivers. All 

States are expected to implement the following five components 

into their program: individualized referral information services; assistance to caregivers in locating services from a variety of private 

and voluntary agencies; caregiver counseling, training and peer 

support; respite care provided in the home, an adult day care center or other residential setting located in an assisted living facility; 

and limited supplemental services that fill remaining service gaps. 

Native American Caregiver Support Program 

The Committee recommendation includes $6,355,000 to carry out 

the Native American Caregiver Support Program, which is the 

same as the administration request. The comparable fiscal year 

2004 level was $6,318,000. 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 2004, 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 $388,646,000, which is $2,293,000 above the comparable fiscal year 2004 level and the same as the administration 

request. For home-delivered meals, the Committee recommends 

$180,985,000, which is $1,068,000 above the comparable fiscal year 

2004 level and the same as the administration request. These programs address the nutritional need of older individuals. Projects 

funded must make home-delivered and congregate meals available 

at least once a day, 5 days a week, and each meal must meet onethird 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 $149,183,000 for the 

nutrition services incentives program, the same as the administration request. The comparable fiscal year 2004 funding level was 

$148,191,000. 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. 

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. 

Aging Grants to Indian Tribes and Native Hawaiian Organizations 

The Committee recommends $26,612,000 for grants to native 

Americans, which is $159,000 above the fiscal year 2004 com-
218 

parable level and the same as the administration request. Under 

this program awards are made to tribal and Alaskan Native organizations and to public or nonprofit private organizations serving 

native Hawaiians which represent at least 50 percent Indians or 

Alaskan Natives 60 years of age or older to provide a broad range 

of supportive services and assure that nutrition services and information and assistance are available. 

The Committee recognizes that this program is the primary vehicle for providing nutrition and other supportive services to Indian, 

Alaska Native, and Native Hawaiian elders. The Committee urges 

the Administration on Aging to devote its attention toward this 

purpose. 

Training, Research and Discretionary Projects 

The Committee recommends $37,647,000 for training, research, 

and discretionary projects. The comparable fiscal year 2004 level 

was $33,509,000. 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 2005 that address a variety of issues, including elder abuse, 

native American issues and legal services. 

The Committee is aware of the high incidence of chronic diseases 

among elders in Indian Country. The Committee encourages the 

agency to carry out a demonstration program directed at decreasing health disparities through prevention and wellness outreach. 

The Committee also recommends that the agency continue and expand programs that focus on improving access to social services by 

elders in Indian Country. 

The Committee encourages the Administration on Aging to facilitate the expansion of demonstration projects gauging the efficiency 

of nurse-managed Geriatric Wellness Centers. 

The Committee is concerned about the prevalence of undiagnosed 

and untreated mental illness among older Americans. Disorders 

such as anxiety, depression, and dementia are common in older patients, but often go undetected. The Committee urges the Administration on Aging to study the benefits of integrating mental health 

treatment for older adults with primary medical treatment, commonly referred to as collaborative care. 

The Committee expects the Administration on Aging to continue 

to fund the national program of statewide senior legal services hotlines (also called legal helplines) at their current levels and ideally 

to provide an increase in the number of States served by these 

legal hotlines. 
219 

Aging Network Support Activities 

The Committee recommends $13,373,000 for aging network support activities, the same as the administration request. The comparable amount for fiscal year 2004 was $13,294,000. The Committee recommendation includes $1,199,000 for the Eldercare Locator and $1,180,000 for the pension information and counseling 

projects. 

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 25,000 people and has helped obtain 

more than $50,000,000 in retirement benefits for older individuals. 

The Committee has provided funding at the administration request level for the National Long Term Care Ombudsman Resource 

Center, the National Center on Elder Abuse and the Health Care 

Anti-Fraud, Waste and Abuse Program. 

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 

$12,883,000 for Alzheimer’s disease demonstration grants to States. 

This is $1,000,000 above the comparable fiscal year 2004 level and 

$1,383,000 above the administration request. 

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 37 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 $4,558,000 for the White House 

Conference on Aging, which is the same level as the administration 

request. These funds are available until September 30, 2007. 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 $18,482,000 to support Federal staff 

that administer the programs in the Administration on Aging, 

which is the same as the administration request. These funds pro-
220 

vide administrative and management support for programs administered by the agency. 

OFFICE OF THE SECRETARY

GENERAL DEPARTMENTAL MANAGEMENT

Appropriations, 2004 ............................................................................. $360,069,000 

Budget estimate, 2005 ........................................................................... 437,822,000 

Committee recommendation ................................................................. 382,555,000 

The Committee recommends $382,555,000 for general departmental management [GDM]. The comparable level for fiscal year 

2004 was $360,069,000 and the administration request was 

$437,822,000. 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 $3,634,000 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 understands that there are nearly 400,000 frozen 

embryos in fertility clinics in the United States and only approximately 2 percent of these are donated to other couples in order to 

bear children. The Committee continues to believe that increasing 

public awareness of embryo donation and adoption 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. 
221 

The Committee recommendation includes $3,000,000 for the Secretary to establish a Citizens’ Health Care Working Group as authorized in Section 1014 of the Medicare Prescription Drug, Improvement and Modernization Act of 2003. 

Childhood Drinking.—The Committee understands that new research from the National Institute on Alcohol Abuse and Alcoholism shows that serious drinking problems previously associated 

with adulthood actually begin to emerge during childhood and adolescence. In this context, alcohol abuse and dependence are best 

characterized as developmental disorders that begin during ages 

that are a critical time for cognitive and physiological growth. 

These findings underscore the public health challenge of preventing 

childhood drinking, as well as raising the age of first use of alcohol. 

The Committee commends the Secretary for establishing the 

Interagency Coordinating Committee on the Prevention of Underage Drinking [ICCPUD] and applauds the SAMHSA Administrator 

for taking a strong leadership role. The ICCPUD’s interim report 

describes the steps involved in developing a coordinated plan for 

combating underage drinking and lists the related current and 

planned activities by the numerous Federal agencies involved in 

this effort. The Committee was disappointed to see that the Surgeon General is not engaged in any activities specifically intended 

to reduce underage drinking, nor does he plan any such activities 

in the near future. The Committee notes that the Surgeon General 

has a unique role that involves advocating for effective disease prevention and health promotion programs, as well as providing a 

highly recognized symbol of national commitment to combating 

public health threats. The Surgeon General, as the Nation’s top 

doctor, has issued Reports and Calls to Action in the past to focus 

National attention on important public health issues such as suicide prevention, youth violence and obesity. The Committee believes that the Surgeon General must be fully engaged in the effort 

to combat childhood drinking. Therefore, the Committee strongly 

urges the Surgeon General, in coordination with SAMHSA, to issue 

a Call to Action on the health crisis of underage drinking. 

Diabetes.—The Committee is aware and very supportive of the 

Secretary’s recently announced Diabetes Detection Initiative, but is 

concerned about meeting the treatment needs of all the newly diagnosed patients with diabetes. The Committee is aware of the valuable services that certified 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 the Secretary to dedicate appropriate resources to 

conduct demonstrations to measure the effectiveness of diabetes 

self-management training in preventing diabetes and the complications it causes. 

HIV1–2 Rapid Testing.—The Committee is aware that wide-scale 

deployment of new oral fluid testing for AIDS is a significant step 

towards helping citizens, throughout the United States and around 

the world, to know their HIV status. The Committee urges the Secretary to significantly increase the use of bulk purchasing and 

wide-scale deployment of FDA-approved oral fluid HIV1–2 rapid 

tests for domestic and international programs. 
222 

National Children’s Study.—The Committee strongly supports 

full and timely implementation of the National Children’s Study, 

which aims to quantify the impacts of a broad range of environmental influences on child health and development. The Committee 

urges the Department to coordinate the involvement of the CDC 

and the NICHD, and to work closely with the EPA and other interested institutes, agencies and non-Federal partners conducting research on children’s environmental health and development so that 

this study is ready for the field by no later than 2006. 

Pharmacy Services.—The Committee encourages the Department 

to begin a study on comprehensive pharmacy services in light of 

changes in technology, distance and distributive learning models, 

the aging of the population and the Department’s study on the severe pharmacist shortage in order to analyze how they may influence the nature of pharmaceutical education and interventions in 

healthcare. 

Public Health Training.—The Committee is aware that public 

health physicians play an important role in the Federal, State and 

local public health infrastructure and are critical for public health 

preparedness. However, currently there is not a generally agreed 

upon model for training physicians for public health careers. Therefore, the Committee has included $500,000 for a study by the Institute of Medicine to determine what knowledge and skills are needed by public health physicians; what type of training program 

would prepare physicians for public health careers; how many 

training programs are needed to maintain an adequate public 

health physician workforce; and how these training programs 

should be funded. 

Transportation Coordination.—The Committee notes with approval the increased attention being paid to the coordination of 

human services with transportation. The Committee notes the recent executive order issued by the President calling for a report on 

transportation coordination within 1 year. The Committee expects 

the Department, as a lead agency mentioned in the executive order, 

to report its finding to the Committee as soon as the study is finished. 

Vision Screening.—The Committee is concerned that many children in the United States have uncorrected vision problems, such 

as amblyopia, that can lead to difficulty in school and permanent 

vision loss. Amblyopia, also known as ‘‘lazy eye,’’ is the leading 

cause of vision loss in young Americans, yet many children do not 

receive timely diagnosis or treatment for the condition. The Committee encourages the Secretary to examine ways to increase the 

number of children that receive an eye exam from an eye doctor in 

order to reduce vision loss in children. 

Adolescent Family Life 

The Committee has provided $37,500,000 for the Adolescent 

Family Life Program [AFL], which is $6,554,000 above the comparable fiscal year 2004 level. The administration request was 

$54,349,000. 

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 
223 

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 has included 

$2,500,000 for the development of a National Abstinence Education 

Campaign. This campaign will help parents communicate with 

their children about the health risks associated with premarital activity. 

Minority Health 

The Committee recommends $53,351,000 for the Office of Minority Health. The comparable level for fiscal year 2004 was 

$55,190,000 and the administration request was $47,236,000. 

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 and urges the Office of Minority Health to fund a 

consortium of historically black colleges and universities [HBCUs] 

to plan for the implementation of this project. The Committee understands that Bowie State University, Lincoln University, Morehouse College, Morgan State University and Wilberforce University 

will be part of the initial group of demonstration institutions. The 

Committee urges OMH to dedicate adequate funds to expand support to the existing HBCUs and to add other minority-serving institutions. 

The Committee commends the OMH for establishing in 2003 a 

public and private partnership to address the protective and risk 

factors identified in the Aberdeen Area Infant Mortality Study. In 

2004 the Committee included $1,000,000 to reduce SIDS disparity 

rates and provide risk reduction education to African American and 

American Indian populations in the United States. The Committee 

was pleased that the Deputy Secretary chose to supplement the 

Committee’s effort, resulting in an $8,650,000 infant mortality reduction initiative. However the Committee is disappointed to note 

the lack of any notification about the change in scope and direction 

of the $1,000,000 provided by the Committee, nor of the diversion 

of funds from other maternal and child health programs. In addition, the Committee is concerned that the fiscal year 2005 budget 

justifications include no information about the future of this initiative. The Committee directs the Secretary to report on the progress 

of the Deputy Secretary’s infant mortality initiative and specifically 

on the SIDS portion of that initiative no later than July 1, 2005, 

and to include adequate information pertaining to the initiative in 

the Department’s fiscal year 2006 budget request. 
224 

Office on Women’s Health 

The Committee recommends $29,103,000 for the Office on Women’s Health, the same as the administration request. The comparable level for fiscal year 2004 was $28,915,000. 

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 $52,838,000. This amount is $3,294,000 above 

the comparable fiscal year 2004 level and the same as the administration request. 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, 2004 ............................................................................. $39,094,000 

Budget estimate, 2005 ........................................................................... 40,323,000 

Committee recommendation ................................................................. 40,323,000 

The Committee recommends an appropriation of $40,323,000 for 

the Office of Inspector General, which is the same as the administration request. The fiscal year 2004 comparable level was 

$39,094,000. 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 Inspector General in fiscal year 2005; the total funds provided to the Office by 

this bill and the authorizing bill would be $200,323,000 in fiscal 

year 2005. 

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. 
225 

OFFICE FOR CIVIL RIGHTS

Appropriations, 2004 ............................................................................. $33,901,000 

Budget estimate, 2005 ........................................................................... 35,357,000 

Committee recommendation ................................................................. 35,357,000 

The Committee recommends $35,357,000 for the Office for Civil 

Rights. This is the same as the administration request. The comparable fiscal year 2004 level was $33,901,000. 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, 2004 ............................................................................. $20,750,000 

Budget estimate, 2005 ........................................................................... 28,750,000 

Committee recommendation ................................................................. 28,750,000 

The Committee recommends $28,750,000 for policy research 

funded through transfers available under section 241 of the Public 

Health Service Act. The comparable program level for fiscal year 

2004 was $20,750,000. The increase in funding in fiscal year 2005 

will provide support for the National Electronic Health Information 

Initiative and the Current Population Survey. 

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, 2004 ............................................................................. $321,763,000 

Budget estimate, 2005 ........................................................................... 330,636,000 

Committee recommendation ................................................................. 330,636,000 

The Committee provides an estimated $330,636,000 for retirement pay and medical benefits for commissioned officers of the U.S. 

Public Health Service, the same as the administration request. The 

comparable level for fiscal year 2004 was $321,763,000. 

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. 
226 

PUBLIC HEALTH AND SOCIAL SERVICES EMERGENCY FUND

Appropriations, 2004 ............................................................................. $2,164,003,000 

Budget estimate, 2005 ........................................................................... 2,225,058,000 

Committee recommendation ................................................................. 2,330,058,000 

The Committee recommends $2,330,058,000 for the Public 

Health and Social Services Emergency Fund, which is $105,000,000 

above the administration request and $166,055,000 above the comparable level for fiscal year 2004. 

The Committee provides $934,454,000 to CDC for upgrading 

State and local capacity. This amount is $105,106,000 above the 

administration request and the same as the comparable level for 

fiscal year 2004. The Committee continues to recognize that bioterrorism events will occur at the local level and will require local capacity, preparedness and initial response. It is the Committee’s intent 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. Because it is essential to the Nation’s 

public health readiness that bioterrorism funding be made available at the local level, the Committee urges 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. 

Within the total for State and local capacity, the Committee has 

included at least the same amount as last year for the Health Alert 

Network [HAN]. 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 provided, the Committee recommends 

$400,000,000 for the Strategic National Stockpile, $157,183,000 for 

upgrading CDC capacity, $17,934,000 for anthrax vaccine research, 

and $130,000,000 for biosurveillance activities. 

The Committee remains concerned about the emergence of new 

infectious diseases and the increasing zoonotic disease transmission 

between animals and humans. As noted in last year’s report, some 
227 

thirty previously unheard of infectious diseases have been discovered in the last 30 years. Increases in human and animal air travel 

and global commerce provide more opportunities for infectious diseases like SARS, monkey pox and avian flu to spread. The Committee notes that wild animal veterinarians, often located at zoos 

in populated urban areas, are sometimes the first to see these diseases and can contribute significantly to the detection and understanding of these diseases. The Committee commends the CDC’s efforts to merge surveillance systems of State diagnostic labs, veterinary labs, wildlife health agencies and zoos, and urge the CDC to 

consider the usefulness of including institutions with live animal 

collections in the new biosurveillance initiative. 

The Committee has again 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 $64,438,000 for the 

Office of the Secretary and $75,000,000 for activities to ensure an 

adequate supply of vaccine in the event of an influenza pandemic. 

The Committee provides $503,649,000 to HRSA for bioterrorism 

activities. Of this amount, $27,705,000 is for curriculum development and training, and $475,944,000 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 recognizes the role community health centers 

play in bioterrorism preparedness and response for millions of underserved individuals, and therefore continues to support the inclusion of both health centers and State and regional primary care associations in bioterrorism preparedness and response funding at 

the Federal, State and local levels. 

The Committee’s recommendation includes $47,400,000 for the 

National Institutes of Health. These funds will be used for research 

into the development of nuclear and radiological countermeasures. 

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). 
228 

The Committee recommendation retains language regarding setasides in the authorizing statute of the National Institutes of 

Health (sec. 203). 

The Committee recommendation retains a provision carried in 

fiscal year 2003 and 2004 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 2.5 percent of Public Health Service funds for 

evaluation activities (sec. 206). 

The Committee recommendation contains language restricting 

transfers or reprogramming of appropriated funds between programs, projects, and activities, and requires 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 MedicareChoice 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 2004 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 allowing 

use of funds to continue operating the Council on Graduate Medical 

Education (sec. 217). 
229 

The Committee recommendation retains a provision carried in 

fiscal year 2004 authorizing the Director of the National Institutes 

of Health to enter into certain transactions to carry out research 

in support of the NIH Roadmap Initiative of the Director (sec. 218). 

The Committee recommendation includes a provision that $10,000 of the amount provided under the Public Health Services 

but may be used for official representation expenses under sections 

399 and 499 of that Act (sec. 219). 

The Committee recommendation rescinds $199,900,000 of the unobligated balance of funds appropriated by section 1016 of the 

Medicare Modernization Act for a facilities loan fund. The Committee recommendation includes funding for such activities directly 

in appropriations accounts, rather than through authorizing Committee action (sec. 220). 

The Committee recommendations includes a requirement that 

none of the funds provided in this Act may be expended to apply 

the criteria, commonly known as the Medicare ‘‘75 percent rule’’, 

that are used to determine whether a hospital or unit of a hospital 

is an inpatient rehabilitation facility. The Committee is concerned 

that this new rule has severe consequences for access to inpatient 

services. The Committee directs the Secretary of Health and 

Human Services to contract with the Institute of Medicine of the 

National Academy of Sciences to study and make recommendations 

on a clinical consensus on how to modernize the Medicare criteria 

used to distinguish an inpatient rehabilitation facility from an 

acute care hospital and other providers of intensive medical rehabilitation, and the appropriate medical necessity criteria for determining clinical appropriateness of inpatient rehabilitation facility 

admissions. Under the contract, the Institute is expected to use a 

panel that includes a multi-disciplinary group of expert researchers 

and clinicians in the field of medical rehabilitation, and report its 

recommendations to the Secretary and Congress not later than October 1, 2005 (sec. 221). 

The Committee recommendation includes language authorizing 

the Secretary of Health and Human Services to make demonstration grants to accredited universities and/or community colleges to 

establish summer health career introductory programs for middle 

school and high school students (sec. 222). 

The Committee recommendation includes a provision transferring $35,000,000 from the $1,000,000,000 appropriated to HHS 

under the Medicare Modernization Act to the Office of the Inspector General for work related to the oversight of that Act (sec. 223). 
(230) 

TITLE III—DEPARTMENT OF EDUCATION 

EDUCATION FOR THE DISADVANTAGED

Appropriations, 2004 ............................................................................. $14,443,641,000 

Budget estimate, 2005 ........................................................................... 15,202,466,000 

Committee recommendation ................................................................. 15,500,684,000 

The Committee recommends an appropriation of $15,500,684,000 

for education for the disadvantaged. The comparable funding level 

for fiscal year 2004 is $14,443,641,000 and the budget request includes $15,202,466,000 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 by the end of the 

2013–14 school year, 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. 

Funds appropriated in this account primarily support activities 

in the 2005–2006 school year. 

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 
231 

programs, help all students in high-poverty schools to meet challenging State academic standards. The program serves more than 

15 million students in nearly all school districts and more than half 

of all public schools—including two-thirds of the Nation’s elementary schools. 

Title I schools help students reach challenging State standards 

through one of two models: ‘‘targeted assistance’’ that supplements 

the regular education program of individual children deemed most 

in need of special assistance, or a ‘‘schoolwide’’ approach that allows schools to use Title I funds—in combination with other Federal, State, and local funds—to improve the overall instructional 

program for all children in a school. 

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. At the level of the 

Committee recommendation, this set-aside will generate more than 

$520,000,000 for school improvement activities. 

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 $13,457,607,000 for this program. The comparable funding level for fiscal year 2004 is $12,339,607,000 and 

the budget request includes $13,339,607,000 for Title I grants to 

LEAs. The Committee recommendation proposes an increase of 54 

percent over the amount provided prior to passage of the No Child 

Left Behind Act. These Federal resources represent the significant 

commitment this Committee has made to provide the resources 

necessary to help all children succeed in school. 

The budget request includes bill language that authorizes the use of $10,000,000 of Title I grants to LEAs by the Secretary to 

support National Leadership activities, including identifying and 

disseminating best practices undertaken by school districts for closing the achievement gap and for ensuring and supporting compliance with the No Child Left Behind Act. The Committee bill does 

not include the requested language. 

Title I 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 $7,104,447,000. The comparable funding level for 

fiscal year 2004 and the budget request are both $7,034,890,000 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. 

The Committee bill includes language which provides 

$71,557,000 from the amount made available under basic grants to 

those States scheduled to receive, in aggregate, less funds under 

the title I grants program for the 2004–2005 school year than they 

received for the 2003–2004 school year. These funds supplement 

funds previously appropriated for the 2004–2005 school year. The 

Committee has taken this action because of the statutorily required 

change from bi-annual to annual updates for poverty estimates 
232 

that occurred this year and the significant shifts that resulted from 

that statuary change. These additional funds will allow affected 

States to allocate funds for the 2004–2005 school year to offset partially reduced allocations to many LEAs under Title I formulas. 

For concentration grants, the Committee recommends an appro- priation of $1,365,031,000. The comparable funding level for fiscal 

year 2004 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 2003 level through the 

EFIG and targeted formulas. The Committee recommends allocating all of the increase proposed this year in a similar manner. 

The Committee notes that analysis conducted by the Congressional 

Research Service has demonstrated that these formulas deliver a 

larger share of Title I funds to high-poverty school districts than 

any other Title I 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 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 $2,231,954,000. The comparable funding level for fiscal year 2004 is $1,969,843,000 and the budget request includes 

$4,146,187,000 for this funding stream. The Committee recommends an appropriation of $2,756,175,000 

for education finance incentive grants. The comparable funding 

level for fiscal year 2004 is $1,969,843,000 and the budget request 

includes $793,499,000 for the EFIG funding stream. 

William F. Goodling Even Start Family Literacy Program 

The Committee does not recommend any funding in fiscal year 

2005 for the Even Start program. The comparable funding level for 

fiscal year 2004 is $246,910,000 and the budget request does not 

include any funds 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. 

Reading First State Grants 

The Committee recommends $1,062,000,000 for the Reading 

First State Grants program. The comparable funding level for fiscal 

year 2004 is $1,023,923,000 and the budget request includes 

$1,125,000,000 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 
233 

program. The Committee recommendation, in addition to amounts 

previously appropriated for this program, brings the 4-year total up 

to $3,979,423,000. Since President Bush took office, Federal funding for reading programs has grown by more than 290 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. 

Early Reading First 

The Committee recommends $110,000,000 for the Early Reading 

First program. The comparable funding level for fiscal year 2004 is 

$94,439,000 and the budget request includes $132,000,000 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. 

Striving Readers 

The Committee recommends $25,000,000 for the Striving Read- ers initiative. The budget request includes $100,000,000 for a new 

program intended to improve the reading skills of secondary school 

students. This new initiative would help develop, implement, and 

evaluate reading interventions for middle- or high-school students 

reading significantly below grade level. To carry out this proposed 

initiative, awards will be made to partnership including institutions of higher education, eligible nonprofit or for-profit organization and school districts with one or more high or middle schools 

that include a significant number or students reading below grade 

level. 

Improving Literacy Through School Libraries 

The Committee recommends $22,842,000 for the Improving Literacy Through School Libraries program. The comparable funding 

level for fiscal year 2004 and the budget request both are 

$19,842,000 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 re-
234 

sources, 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 nonschool hours. 

Migrant Education Program 

The Committee recommends $393,577,000 for the Migrant Education program. The comparable fiscal year 2004 funding level and 

the budget request are both $393,577,000 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 $52,000,000 for the Title I neglected 

and delinquent program. The comparable funding level for fiscal 

year 2004 and the budget request both are $48,395,000 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 at least 15 percent, 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 
235 

to develop a uniform model for evaluating State performance under 

this program. 

Evaluation 

The Committee recommends $9,500,000 for evaluation of Title I 

programs. The comparable funding level for fiscal year 2004 is 

$8,790,000 and the budget request includes $9,500,000 for such activities. 

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. 

The Committee bill includes language that provides the Secretary with authority to use funds for technical assistance to State 

and local educational agencies. The Committee encourages the Secretary to focus these funds on disseminating best practices through 

school leadership, supporting professional development, and identifying and disseminating exceptional methods used to communicate 

with parents. 

Assistance for Local School Improvement 

The Committee recommendation includes $100,000,000 for the 

Assistance for Local School Improvement program. This program 

has not been funded previously and the budget request did not include any funds for this purpose. 

The Assistance for Local School Improvement program was authorized by the No Child Left Behind Act. This program authorizes 

the Secretary to make grants to States for additional assistance to 

school districts identified for improvement. Funds may be used to 

support the implementation of school improvement plans, public 

school choice, supplemental services or other activities related to 

schools identified for improvement. 

Together with more than $520,000,000 available through the 

school improvement set aside required from State Title I allocations, these funds will provide a record level of Federal support for 

assisting schools identified for improvement and supporting public 

school choice and supplemental services for students in low performing schools. 

Comprehensive School Reform Demonstration 

The Committee recommends $233,613,000 for the comprehensive 

school reform demonstration program. The comparable funding 

level for fiscal year 2004 is $233,613,000 and the budget request 

did not include any funds for the comprehensive school reform program. 

This program provides schools with funding to develop or adopt, 

and implement, comprehensive school reforms that will enable children in participating schools to meet State standards. The Department allocates funds to States based on their relative shares of the 

previous year’s Title I basic grants funds. 
236 

High School Equivalency Program 

The Committee recommends $18,888,000 for the high school 

equivalency program [HEP]. The comparable funding level for fiscal year 2004 and the budget request both are $18,888,000 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 $15,657,000. The comparable funding level for 

fiscal year 2004 and the budget request both are $15,657,000 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, 2004 ............................................................................. $1,229,527,000 

Budget estimate, 2005 ........................................................................... 1,229,527,000 

Committee recommendation ................................................................. 1,229,527,000 

The Committee recommends an appropriation of $1,229,527,000 

for impact aid for the Department of Education. The comparable 

funding level for fiscal year 2004 and the budget request both are 

$1,229,527,000 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. 

The Committee notes that the administration is working to develop an ‘‘analysis plan’’ to measure the performance of the Impact 

Aid program. The Committee is committed to utilizing performance 

outcome information to assess the effectiveness of Federal programs and to determine their appropriate funding levels. Therefore, the Committee requests a copy of the ‘‘analysis plan’’ as soon 
237 

as it is available, and also expects appropriate discussion of activities related to the plan to be included in the fiscal year 2006 Justifications of Appropriation Estimates to the Congress. 

Basic Support Payments.—The Committee recommends 

$1,063,687,000 for basic support payments. The comparable funding level for fiscal year 2004 and the budget request both are 

$1,063,687,000. Under this statutory formula, payments are made 

on behalf of all categories of federally connected children, with a 

priority placed on making payments first to heavily impacted 

school districts and providing any remaining funds for regular 

Basic Support Payments. 

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 $50,369,000 for this 

purpose. The comparable funding level and the budget request both 

are $50,369,000. 

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 $7,901,000. The 

comparable funding level for fiscal year 2004 and the budget request both are $7,901,000 for this purpose. Funds appropriated for 

this purpose are available until expended. 

Construction.—Formula and competitive grants are awarded to 

eligible LEAs for emergency repairs and modernization of school facilities. The Committee recommends $45,936,000 for this program. 

Funds appropriated for the construction activity are available for 

obligation for a period of 2 years. The comparable fiscal year 2004 

funding level and the budget request both are $45,936,000 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 $61,634,000 for 

this activity. The comparable funding level for fiscal year 2004 and 

the budget request both are $61,634,000 for this program. 

SCHOOL IMPROVEMENT PROGRAMS

Appropriations, 2004 ............................................................................. $5,872,847,000 

Budget estimate, 2005 ........................................................................... 5,955,561,000 

Committee recommendation ................................................................. 5,770,632,000 

The Committee recommends an appropriation of $5,770,632,000 

for school improvement programs. The comparable funding level in 

fiscal year 2004 for this account is $5,872,846,000 and the budget 

request includes $5,955,561,000. 

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 rec-
238 

ommends $2,975,126,000 for State grants for improving teacher 

quality. The comparable funding level for fiscal year 2004 and the 

budget request both are $2,930,126,000. 

Under the Committee recommendation, funding for programs 

that specifically support high-quality professional development for 

teachers and school leadership will have increased by 43 percent 

since passage of the No Child Left Behind Act. The Committee recommendation for fiscal year 2005 includes $3,640,034,000 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 $14,814,000 to support professional 

development activities for early childhood educators and caregivers 

in high-poverty communities. The comparable funding level for fiscal year 2004 and the budget request are both $14,814,000 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 schoolreadiness services for preschool-age children. 

Mathematics and Science Partnerships 

The Committee recommends $200,000,000 for the mathematics 

and science partnerships program. The comparable funding level 

for fiscal year 2004 is $149,115,000 and the budget request includes $269,115,000 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 en-
239 

gineers 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 budget request includes a legislative proposal to allow the Secretary to use $120,000,000 in appropriated funds to make competitive awards to projects designed to improve the mathematics 

learning of secondary students. The Committee has not provided 

this requested authority. 

Innovative Education Program Strategies State Grants 

The Committee does not recommend any funding for innovative 

education program strategies State grants. The comparable funding 

level for fiscal year 2004 and the budget request both are 

$296,549,000 for this purpose. The Committee recommendation 

does not provide an appropriation for this source of funding due to 

the significantly enhanced flexibility authorized under No Child 

Left Behind, the lack of evidence of effectiveness in contributing to 

improved student learning and the importance of investments in 

other areas where a system for measuring program performance is 

in place. 

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 States and LEAs may transfer funds 

into this State grant program for authorized activities described in 

Part A of Title V of the Elementary and Secondary Education Act, 

even though no funding is provided in this fiscal year 2005 appropriations bill. The Committee encourages States and LEAs to 

transfer funds from one of the eligible State grant programs if they 

believe Federal funds can be better utilized under this authority to 

improve the academic achievement of all students. 

Educational Technology State Grants 

The Committee recommends $691,841,000 for educational technology State grants. The comparable funding level for fiscal year 

2004 and the budget request both are $691,841,000 for this program. 

The 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 
240 

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 highquality professional development. 

21st Century Community Learning Centers 

The Committee recommends an appropriation of $1,007,000,000 

for the 21st Century Community Learning Centers program. The 

comparable funding level for fiscal year 2004 and the budget request both are $999,070,000 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 use 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. 

State Assessments and Enhanced Assessment Instruments 

The Committee recommends $420,000,000 for State assessments. 

The comparable funding level for fiscal year 2004 is $390,000,000 

and the budget request includes $410,000,000 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 2004 is $390,000,000 and it rises to 

$400,000,000 in fiscal year 2005. The Committee recommendation 

includes $400,000,000 for this purpose. 

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. The Committee recommendation for the 

second component is $20,000,000. The budget request included 

$10,000,000 for enhanced assessment instruments. No funds were 

appropriated for this purpose in fiscal year 2004. 

The Committee is concerned that many schools are unable to 

properly assess the performance of students with disabilities and 

students with limited English proficiency. Therefore, the Com-
241 

mittee urges the Department to place a high priority on grant applications that aim to improve the quality of State assessments for 

these two groups of students and to ensure the most accurate 

means of measuring their performance on these assessments. 

The Committee recommends that grants should be used for such 

activities as developing alternate assessments for students with 

disabilities and for students with limited English proficiency; developing appropriate accommodations to ensure the full participation 

of these two groups of students in State assessments; and developing universally designed assessments that are accessible and 

valid for the widest possible range of students, including students 

with disabilities and students with limited English proficiency. 

The Committee also recommends that States that receive grants 

should submit a report to the Secretary regarding the participation 

of students with disabilities and/or students with limited English 

proficiency in State assessment programs and changes, if any, in 

these students’ achievement levels as a result of more accurate assessments. 

Statewide Data Systems 

The Committee recommendation includes $40,000,000 for Statewide Data Systems. This program was not funded previously and 

the budget request did not include any funds for this purpose. 

The Educational Technical Assistance Act authorized a competitive grant program to State Educational Agencies to enable such 

agencies to design, develop, and implement statewide, longitudinal 

data systems to manage, analyze, disaggregate, and use individual 

student data. The Committee believes these funds are necessary to 

help States measure individual student performance, particularly 

as it relates to adequate yearly progress goals, more efficiently and 

accurately. The Committee urges the Department to establish a 

priority for those States that currently have the most limited ability to collect, analyze and report student achievement data when 

considering applications for funds available through this program. 

Javits Gifted and Talented Education 

The Committee recommends $12,111,000 for the Javits Gifted 

and Talented Students Education Program. The comparable fiscal 

year 2004 funding level is $11,111,000 and the President’s budget 

proposes to eliminate funding for 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 $19,000,000 for the Foreign Language Assistance program. The comparable funding level for fiscal 

year 2004 is $16,546,000 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 lan-
242 

guage 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 this program, which is the only Federal 

program designed to help schools meet the need for foreign language instruction, is unavailable to the poorest schools because 

grant recipients must provide a 50 percent match from non-Federal 

sources. The Committee, therefore, 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. 

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 $62,000,000. The comparable fiscal year 

2004 funding level and the budget request both are $59,646,000. 

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. 

Training and Advisory Services 

For training and advisory services authorized by Title IV of the 

Civil Rights Act, the Committee recommends $7,243,000. The comparable fiscal year 2004 funding level and the budget request both 

are $7,243,000 for these services. 

The funds provided will support a new competition for awards to 

operate 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 2004 

funding level and the budget request are both $33,302,000 for these 

programs. 

The Committee bill includes language allowing funds to be used 

for construction and renovation of Native Hawaiian educational facilities. 

The Committee recognizes the important role that the Native 

Hawaiian Education Council plays in coordinating services, con-
243 

ducting needs assessments, and providing direction and guidance 

on educational and related services available to Native Hawaiians, 

including the activities assisted under this program. The Committee urges the Secretary to continue working with the Council to 

help it meet its congressionally-mandated mission, and, in particular, focus on helping create an appropriate mechanism for 

prioritizing activities within the Council’s jurisdiction. 

The Committee encourages opportunities and educational programs be provided to restore cultural pride and stimulate the development of leadership skills by celebrating the Native Hawaiian 

heritage and seafaring traditions as long distance voyagers and 

ocean navigators. 

Of all the indigenous languages of the United States, the Hawaiian language has the most extensive written resources preserved. 

It has come to the attention of the Committee that a number of Hawaiian academic, cultural, and educational organizations have 

joined together to preserve and develop these written resources for 

contemporary use. Many of these traditional perspectives and practices could have practical application in resolving environmental 

management, medical and natural resource challenges. The Committee urges attention in this area. 

The Committee is interested in the preservation and recording of 

Hawaiian history through storytelling and encourages support for 

efforts underway in Hawaii to perpetuate these collections. The 

Committee also encourages efforts toward the preservation and 

documentation of Native Hawaiian traditional cultural healing 

practices. 

Fathering Programs.—In 1997, a Department of Education study 

found that children realize greater educational success when fathers are involved in their child’s education. The Committee urges 

the Secretary devote special attention to this subject through this 

grant program, as there are no competitive grants for fathering 

programs. The Committee realizes great value in fathering programs as they seek to improve the lives of children by inspiring 

and equipping men to be more effectively engaged in the lives of 

children. 

Native Hawaiian Law Center of Excellence.—The Committee is 

very pleased with the efforts underway to establish a Center of Excellence in Native Hawaiian Law. 

Prisoner Education.—Native Hawaiians continue to represent a 

major, if not the largest, ethnic group in the State’s prison system. 

The Committee recognizes the importance of reintegrating Native 

Hawaiian youth into school settings or onto a career path and job 

placement through comprehensive, culturally sensitive individual 

and family counseling; educational skills training; and employment 

training/job placement. Significant progress has resulted over the 

past several years. Efforts should target Native Hawaiian youth in 

districts with high percentages of school dropouts and youth offenders. 

The numbers of Hawaiian language immersion schools and Hawaiian charter schools continue to increase as more families are 

opting to more closely integrate culture, language and education. 

The Committee is interested in greater development of curriculum 

especially at the early education and secondary levels, increasing 
244 

the number of teachers certified in Hawaiian language, and disseminating best practices to this growing community of schools 

from pre-K through 12th grade. 

Alaska Native Educational Equity 

The Committee recommends $36,000,000 for the Alaska Native 

educational equity assistance program. The comparable fiscal year 

2004 funding level and the budget request both are $33,302,000 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. The Committee expects 

the Department to use some of these funds to address the construction needs of rural schools. 

Rural Education 

The Committee recommends $175,000,000 for rural education 

programs. The comparable fiscal year 2004 funding level and budget request both are $167,831,000 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 these 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. 

Comprehensive Centers 

The Committee recommends $57,283,000 for the comprehensive 

centers program. The comparable fiscal year 2004 funding level 

and budget request are both $27,654,000 for such activities. 

The budget request would support a new comprehensive centers 

program, which would be comprised of not less than 20 centers 

with at least one in each of the 10 regions of the United States. 

The centers, which would be operated by research organizations, 

agencies, institutions of higher education or partnerships thereof, 

would provide training and technical assistance to States, LEAs, 

and schools as identified through needs assessments undertaken in 

each region. 
245 

The new comprehensive centers program, as authorized by the 

Educational Technical Assistance Act of 2002, would replace the 

comprehensive regional assistance centers, the Eisenhower regional 

mathematics and science consortia, the Eisenhower National Clearinghouse for Mathematics and Science Education, and the regional 

technology in education consortia which are no longer authorized 

activities. The comprehensive regional assistance centers provide 

technical assistance and training through a network of 15 university-based or non-profit centers. The Eisenhower regional mathematics and science consortia program supports 10 regional centers 

that disseminate information about exemplary mathematics and 

science instructional materials, provide technical assistance on 

teaching methods and assessment tools and build networks of 

mathematics and science resources. The Mathematics and Science 

Clearinghouse is a resource for mathematics and science educators. 

The regional technology in education consortia program supports 

10 regional centers that disseminate information and resources and 

provide training to States, school districts, and schools with a large 

number of disadvantaged students with limited access to technology. 

Fiscal year 2005 funds will be used to continue funding for existing grantees and support grants to carry out the new comprehensive centers program. The Committee believes it is important that 

training and technical assistance continue to be of high-quality and 

accessible to school districts during this transition year. 

Supplemental Education Grants 

The Committee recommendation includes $17,214,000 for the 

supplemental education grants program. The comparable funding 

level for fiscal year 2004 and the budget request both are 

$15,068,000. This grant program was authorized by the Compact of 

Free Association Amendments Act of 2003. The Act discontinued 

the eligibility of Republic of Marshall Islands and the Federated 

States of Micronesia for funding available from Adult, Dislocated 

Worker and Youth Workforce Investment Act programs, Head 

Start, Title I Grants to LEAs, Adult and Vocational Education 

State Grants, Federal Work-Study and Federal Supplemental Educational Opportunities Grants. In place of funding from these 

sources, the Act provided a separate supplemental education grant 

program that provides these entities with a more flexible source of 

funds that can be tailored to local needs. These funds will be transferred from the Department of Education to the Secretary of Interior for grants to these entities, and up to 10 percent may be used 

for oversight and technical assistance, which may include reimbursement of the Departments of Labor, Health and Human Services and Education for such services. Of the funds appropriated, 

$11,717,000 is for the Federated States of Micronesia and 

$5,497,000 is for the Republic of the Marshall Islands. 

The Committee also has included bill language to clarify the intent of section 105(f)(1)(B)(ix) of the Compact of Free Association 

Amendments Act that the government, institutions, and people of 

Palau shall continue to be eligible, and to receive assistance in fiscal year 2005, as they have up to and including fiscal year 2004. 
246 

INDIAN EDUCATION

Appropriations, 2004 ............................................................................. $120,856,000 

Budget estimate, 2005 ........................................................................... 120,856,000 

Committee recommendation ................................................................. 120,856,000 

The Committee recommends $120,856,000 for Indian Education 

programs. The comparable fiscal year 2004 funding level and the 

budget request both are $120,856,000 for such activities. 

Grants to Local Education Agencies 

For grants to local education agencies, the Committee recommends $95,933,000. The comparable fiscal year 2004 funding 

level and the budget both are $95,933,000. 

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 $19,753,000 for special programs for 

Indian children. The comparable fiscal year 2004 funding level and 

the budget request both are $19,753,000. 

Funds are used for demonstration grants to improve Indian student achievement through early childhood education and college 

preparation 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 $5,170,000 for national activities. 

The comparable fiscal year 2004 amount and the budget request 

both are $5,170,000 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, 2004 ............................................................................. $1,102,627,000 

Budget estimate, 2005 ........................................................................... 885,181,000 

Committee recommendation ................................................................. 1,144,346,000 

The Committee recommends an appropriation of $1,144,346,000 

for programs within the innovation and improvement account. The 

comparable fiscal year 2004 funding level for these programs is 

$1,102,627,000 and the budget request includes $885,181,000 for 

this account. 

Troops-to-Teachers 

The Committee recommends an appropriation of $14,912,000 for 

the Troops-to-Teachers program. The comparable funding level for 

fiscal year 2004 and the budget request both are $14,912,000 for 

this program. 

This program supports the Defense Department’s Troops to 

Teachers program, which helps recruit and prepare retiring and 

former military personnel to become highly qualified teachers serv-
247 

ing 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. 

Transition to Teaching 

The Committee recommends $45,295,000 for the transition to 

teaching program. The comparable fiscal year 2004 funding level 

and the budget request both are $45,295,000 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. 

National Writing Project 

The Committee recommends $24,000,000 for the national writing 

project. The comparable funding level for fiscal year 2004 is 

$17,894,000 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 funds 

provided by the fiscal year 2005 appropriation, the Committee intends that $500,000 shall be used to continue support for the pilot 

program on the integration of technology training in the NWP program. 

Teaching of Traditional American History 

The Committee recommends $120,000,000 for the teaching of traditional American history program. The comparable fiscal year 

2004 funding level and the budget request are both $119,292,000 

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. 

School Leadership 

The Committee recommends $16,000,000 for the school leadership program. The comparable fiscal year 2004 funding level is 

$12,346,000 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 continues to recognize the critical role that principals and assistant principals play in creating an 
248 

environment that fosters effective teaching and high academic 

achievement. 

Advanced Credentialing 

The Committee recommends $17,000,000 for the advanced 

credentialing program. The comparable fiscal year 2004 funding 

level is $18,391,000 and the budget request includes $7,000,000 for 

one component of the authorized program. The Committee recommendation includes $10,000,000 for the National Board for Professional Teaching Standards [NBPTS]. The 

comparable fiscal year 2004 funding level is $9,941,000 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 2005 appropriation will support a new grant 

for the National Board for Professional Teaching Standards. 

The Committee notes that a new independent study, in part 

funded by the U.S. Department of Education and released in March 

2004, found that the NBPTS assessment process is effectively identifying those teachers who contribute to relatively larger student 

learning gains, particularly in the early grades and among the 

poorest of students. The Committee continues its strong support for 

the NBPTS due to its proven success in identifying teachers who 

make significant gains in student learning and achievement, which 

has been established through a higher standard of research and 

validation than any other professional board in the United States. 

Federal funds are a critical supplement to the 50 States and more 

than 500 school districts across the nation that have implemented 

policies, regulations and financial incentives to recruit, reward and 

retain National Board Certified Teachers. 

The Committee recommendation also includes $7,000,000 for the 

American Board for the Certification of Teacher Excellence 

[ABCTE] to continue development of its Initial Certification and 

Master Certification programs. Fiscal year 2005 funding represents 

the third year of a 5-year grant to the ABCTE. The Committee expects the Department to continue to prepare for an independent 

evaluation of the activities undertaken by the ABCTE. The Committee expects the Department to include information in the 2006 

Congressional Justification about actions taken to evaluate 

ABCTE’s activities. 

Charter Schools Grants 

The Committee recommends $218,702,000 for the support of 

charter schools. The comparable fiscal year 2004 funding level and 

the budget request both are $218,702,000 for this program. 

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 
249 

from the State may apply directly to the Secretary. The authorizing 

statute requires that amounts appropriated in excess of 

$200,000,000 and less than $300,000,000 be used for 5-year competitive grants to States that operate per-pupil facilities aid programs for charters schools. Federal funds are used to match State 

funded programs in order to provide charter schools with additional 

resources for charter school facilities financing. 

Credit Enhancement for Charter School Facilities 

The Committee recommends $37,279,000 to assist charter schools 

with their facility needs. The comparable funding level for fiscal 

year 2004 is $37,279,000 and the budget request includes 

$100,000,000 for this purpose. The Committee notes that the authorization for this program expires during fiscal year 2004. 

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 $26,757,000 for the voluntary public 

school choice program. The comparable funding level for fiscal year 

2004 and the budget request both are $26,757,000 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. 

Magnet Schools Assistance 

The Committee recommends $108,640,000 for the magnet schools 

assistance program. The comparable fiscal year 2004 funding level 

and the budget request are both $108,640,000 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. 

Choice Incentive Fund 

The Committee does not recommend any funding for this proposed program, which is not specifically authorized. The budget request includes $50,000,000 for this purpose. Through this proposed 

program, funds would be used to award competitive grants to establish or expand public or private school choice opportunities. 

Fund for the Improvement of Education 

The Committee recommends an appropriation of $446,746,000 for 

the Fund for the Improvement of Education [FIE]. The comparable 

funding level for fiscal year 2004 is $430,270,000 and the budget 

request includes $120,185,000 for comparable activities. 
250 

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 recommends an additional $300,000 for this purpose within Safe and 

Drug-Free Schools and Communities National Programs to address 

issues related to school safety and healthy school buildings. The Committee recommends $27,000,000 to award a contract to 

Reading Is Fundamental, Inc. [RIF] to provide reading-motivation 

activities. The comparable funding level for fiscal year 2004 and 

the budget request both are $25,185,000 for this purpose. RIF, a 

private nonprofit organization, helps prepare young children and 

motivate older children to read, through activities including the 

distribution of books. Federal funds provide up to 75 percent of the 

costs of books, except for migrant and seasonal farmworker programs which may receive up to 100 percent of the costs of books. The administration proposes $10,000,000 for a military families 

initiative under the fund for the improvement of education program. Under this new categorical grant program, the Department 

of Education would make competitive grants to consortia of States, 

local educational agencies, and other public and non-profit organizations, to address the challenges faced by students from military 

families and ease their transitions to new schools. Due to budget 

constraints, the Committee recommendation does not include funds 

for this purpose. The administration proposes $40,000,000 for a new adjunct 

teacher corps initiative. Through this new categorical grant program, the Department of Education would make competitive grants 

to partnerships of school districts and public and private institutions to create opportunities for professionals to teach secondaryschool courses in the core academic subjects, particularly math and 

science. Due to budget constraints, the Committee recommendation 

does not include funds for this purpose. 

The administration recommended eliminating funding for activities listed below. 

The Committee recommends $24,000,000 for the Star Schools 

program. The comparable funding level for fiscal year 2004 is 

$20,362,000. The Star Schools program is designed to improve instruction in math, science, foreign languages, and other areas such 

as vocational education, to underserved populations by means of 

telecommunications technologies. 

The Committee recommends $14,500,000 for the Ready to Teach 

program. The comparable funding level for fiscal year 2004 is 

$14,321,000. 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 telecommunicationsbased programs to improve teacher quality in core areas. It also includes digital educational programming grants, which encourages 
251 

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 recommendation for FIE includes $10,000,000 for 

the Education through Cultural and Historical Organizations 

[ECHO] Act of 2001, as authorized by Public Law 107–110. Activities 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 2004 is 

$8,450,000. 

The Committee has included $40,500,000 for arts in education. 

The comparable funding level for fiscal year 2004 is $35,071,000. 

Within the total, $6,420,000 is for the John F. Kennedy Center for 

the Performing Arts; $7,500,000 is for VSA arts; $14,100,000 is for 

the competitive art education model grant program for the development of model projects that effectively strengthen and integrate 

arts and cultural partnerships into the core curriculum, of which 

not less than $3,500,000 shall be for new awards under a grant 

competition conducted during fiscal year 2005; $8,000,000 is for 

grants for professional development for music, dance, drama, and 

visual arts educators to be administered by the U.S. Department 

of Education; $500,000 is for the evaluation and national dissemination of information regarding model programs and professional 

development projects funded through the Arts in Education section, 

including dissemination of information regarding projects which received awards in fiscal year 2001, fiscal year 2002, and subsequent 

years. Such information should include resources regarding effective self-evaluation methods for model arts programs; and 

$3,980,000 is for cultural partnerships for at-risk youth. 

The Committee again recommends additional funding for evaluation and national dissemination activities as specified in the previous paragraph. The Committee urges the Department to focus 

first on dissemination activities related to model programs before 

using these resources for other purposes. The Committee directs 

that such information include resources regarding effective selfevaluation methods for model arts programs. 

The Committee recommends $41,975,000 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 

2004 is $41,975,000. The Committee notes that research overwhelmingly demonstrates that parent involvement in children’s 

learning is positively related to student achievement. 

The Committee also notes that 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 includes $3,000,000 for the women’s educational 

equity program. The comparable funding level for fiscal year 2004 
252 

is $2,962,000. This program supports projects that assist in the 

local implementation of gender equity policies and practices. 

The Committee recommendation also includes resources for the 

following activities: $9,517,000 to support teacher quality initiatives; $74,073,000 for comprehensive school reform demonstration 

grants; $10,000,000 requested by the administration to continue 

support for Reach Out and Read; $1,500,000 for activities authorized by the Excellence in Economics Education Act; and 

$13,260,000 for discretionary grants and associated expenses, including voter participation programs authorized under the Fund for 

the Improvement of Education. 

The Committee strongly believes that parental involvement is a 

key to the success of No Child Left Behind Act. The Committee 

urges the Department, in carrying out discretionary parental involvement initiatives, to engage groups that are committed to improving public schools and are experienced in carrying out grassroots efforts with parents in local school districts. 

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 2004 and the budget request both are 

$22,864,000 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 continues to strongly support the educational 

and outreach objectives of the ‘‘Ready to Learn’’ television program. 

The Committee is especially pleased that television programs such 

as ‘‘Dragon Tales’’ and ‘‘Between the Lions’’ developed with funding 

from Ready to Learn have been recognized with national parent 

and television production awards. The Committee reiterates the 

unique mission of Ready to Learn, which is to use the television 

medium to help prepare pre-school age children for school. The television programs that must fulfill this mission are to be specifically 

designed for this purpose, with the highest attention to production 

quality and validity of research-based educational objectives, content, and materials. Therefore, the Committee expects that the 

grant competition administered for a new award under this program will emphasize the importance of investing Ready to Learn 

resources in those programs that have proven to fulfill this mission, acquiring new programs with scrutiny, and distinguishing 

Ready to Learn programs from content easily available on commercial and cable television. 

Dropout Prevention 

The Committee recommendation includes $10,000,000 for the 

dropout prevention program. The comparable funding level for fiscal year 2004 is $4,970,000 and the budget request did not include 

any funding for the dropout prevention program. These funds are 
253 

used to help schools implement effective school dropout prevention 

and re-entry programs. 

In addition, the Committee notes that in fiscal year 2003, States reserved roughly $96,000,000 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 strongly urges 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. The Committee requests that the Department 

provide a letter report to the Committee on actions it has taken 

and developed for addressing this issue, which also was raised in 

the fiscal year 2004 Committee report. The Committee expects to 

receive this report not later than March 1, 2005. 

Close Up Fellowships 

The Committee recommendation includes $1,481,000. The comparable funding level for fiscal year 2004 is $1,481,000 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 undertaken actions to identify 

and develop non-Federal sources of funding for sustaining its operations. The Committee notes that, according to the Department of 

Education, the amount of funding allocated for teachers and economically disadvantaged students available from non-Federal 

sources increased more than 10 percent annually in each year 

1999–2002. 

The Committee also notes that the Close Up Foundation, in collaboration with the Secretary of Education, is required to develop 

and implement procedures for measuring the efficacy of the Foundation’s authorized programs, including the extent to which the 

programs are providing young people with an increased understanding of the Federal Government; heightening a sense of civic 

responsibility among young people; and enhancing the skills of educators in teaching young people about civic responsibility, the Federal Government, and attaining citizenship competencies. The 

Committee expects to see a more complete discussion of the actions 

taken to meet this statutory requirement, as well as program performance information, in the fiscal year 2006 congressional justification. 
254 

Advanced Placement 

The Committee recommends $33,534,000 for Advanced Placement. The comparable funding level for fiscal year 2004 is 

$23,534,000 and the budget request includes $51,534,000 for the 

Advanced Placement program. 

The first priority of the program is to subsidize test fees for lowincome 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, 2004 ............................................................................. $855,775,000 

Budget estimate, 2005 ........................................................................... 838,897,000 

Committee recommendation ................................................................. 902,008,000 

Safe and Drug-Free Schools and Communities 

The Committee recommends a total of $902,008,000 for activities 

to promote Safe Schools and Citizenship Education. The comparable fiscal year 2004 funding level is $855,775,000 and the 

budget request includes $838,897,000 for these activities. 

State Grant Program.—The Committee recommends 

$440,908,000 for the safe and drug-free schools and communities 

State grant program. The comparable fiscal year 2004 funding level 

and budget request are both $440,908,000. The State grant program is the backbone of youth drug prevention efforts in the 

United States. This formula-based State grant program provides 

resources to Governors, State educational agencies and local educational agencies for developing and implementing activities that 

help create and maintain safe and drug-free learning environments 

in and around schools. 

National Programs.—The Committee has included $156,219,000 

for the national programs portion of the safe and drug-free schools 

program. The comparable funding level for fiscal year 2004 is 

$153,767,000 and the budget request includes $175,069,000 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 $5,000,000 for Project 

SERV. However, the Committee notes that the Department currently has roughly $8,000,000 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 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 
255 

models of alcohol and drug abuse prevention and education programs in higher education. 

The Committee expects that the Department will provide $300,000 for the continued operation of the National Clearinghouse 

for Educational Facilities. These funds will be used to address 

issues related to school safety and healthy school buildings. The 

Committee has included additional funds for the Clearinghouse 

through the Fund for the Improvement of Education. The Committee recommendation includes $10,000,000 for schoolbased drug testing programs for students. This amount is 

$8,012,000 more than the comparable funding level for fiscal year 

2004 and $15,000,000 less than the budget request. The Committee 

expects that funding should be awarded only to LEAs or other entities that require the written consent of the student and his or her 

parent or guardian. In addition, students who do not consent to 

random drug testing should not be prohibited from participating in 

school or extracurricular activities. Participating school districts 

should be prohibited from disclosing drug test results to law enforcement officials, and all results relating to drug testing of a student should be destroyed when the student graduates or otherwise 

leaves the LEA or private school involved. Finally, the testing 

agency in programs that receive Federal drug testing funds should 

be prohibited from disclosing to school officials any information 

about legal medications that the students may be taking. 

The Committee is deeply concerned that between 5 percent to 9 

percent of all children suffer from a mental, behavioral or emotional disorder which, if undiagnosed and untreated, can substantially interfere with academic achievement, or lead to student dropout, substance abuse, violent behavior, or suicide. The Committee 

notes that, in its July 2003 report, the President’s New Freedom 

Commission on Mental Health concluded that greater reliance on 

early detection, assessment and links with adequate treatment and 

support systems can help avoid or ameliorate these outcomes. The 

report concluded that schools are in a unique position to identify 

mental health problems in their early stages, and to provide a link 

to appropriate services, citing examples of evidence-based screening 

techniques and tools already being utilized by some schools. The 

Committee reiterates language contained in the fiscal year 2004 

Committee report with respect to this issue, and calls upon the Office of Safe and Drug-Free Schools to work with the Substance 

Abuse and Mental Health Services Administration to take concrete 

steps to promote and help implement early detection and assessment programs in our Nation’s schools. 

Integration of Schools and Mental Health Systems 

The Committee has included $10,548,000 for the integration of 

schools and mental health systems, a program that was authorized 

in the No Child Left Behind Act but has not yet been funded. This 

is a competitive grant program designed to promote school-wide 

mental health strategies, provide training to elementary school and 

secondary school personnel to recognize early warning signs of 

mental illness, and increase student access to high-quality mental 

health services. Research has found that early detection, assessment, and linkage with treatment and supports can prevent mental 
256 

health problems and encourage high-risk children to develop into 

good students, workers, and members of their families and communities. Unfortunately, many children and their families do not 

know where to turn for services. Integrating mental health services 

in schools would increase the likelihood that they will receive the 

treatment they need. Schools are encouraged to work with community health systems as well as institutions of higher learning and/ 

or other relevant entities. The Committee urges the Department to 

give preference to applicants that intend to use evidence-based or 

promising early interventions. 

Alcohol Abuse Reduction 

The Committee recommends $35,000,000 for grants to LEAs to 

develop and implement programs to reduce underage drinking in 

secondary schools. The comparable funding level for fiscal year 

2004 is $29,823,000 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 $65,000,000 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 2004 funding level is $49,705,000 and the 

budget request includes $100,000,000 for this purpose. 

Character Education 

The Committee recommends $24,691,000 to provide support for 

the design and implementation of character education programs. 

The comparable funding level for fiscal year 2004 and the budget 

request both are $24,691,000 for this purpose. 

Elementary and Secondary School Counseling 

The Committee recommends $36,000,000 to establish or expand 

counseling programs in elementary schools. The comparable fiscal 

year 2004 funding level is $33,799,000 and the President’s budget 

proposes to eliminate funding for this program. As authorized by 

the No Child Left Behind Act, all amounts appropriated up to 

$40,000,000 are used only for elementary school counseling programs. 

The No Child Left Behind Act [NCLBA] requires the Secretary 

to produce a report on school counseling programs ‘‘not later than 

2 years after assistance is made available to local educational agencies.’’ The Committee is disappointed that this deadline has not 

been met, and it urges the Secretary to fulfill this requirement as 

soon as possible. As described in the NCLBA, the report should 

evaluate the counseling programs that receive funds and contain 

information from LEAs regarding the ratios of students to school 

counselors, school social workers, and school psychologists. The 

Committee also encourages the Department to include questions in 

the Schools and Staffing Survey that would allow the collection and 
257 

publication of accurate and timely data about the ratios of students 

to each of the following: school counselors, school social workers, 

and school psychologists. 

Carol M. White Physical Education for Progress Program 

The Committee recommends $75,000,000 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 2004 and the budget request both are 

$69,587,000 for this program. The Carol M. White Physical Education for Progress Program, authorized by the NCLB Act, established funding for 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. 

The budget request also includes bill language earmarking $2,000,000 to support Special Olympics’ mission of promoting access to physical education for mentally disabled persons through 

sports training and competition, health initiatives, and other services. The Committee supports this request. This funding should be 

used for the Special Olympics National Summer Games, to be held 

in 2006. This will be the first event of its kind in the United States, 

and it represents a unique physical education opportunity for 

young people with disabilities across the Nation. 

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 $30,642,000 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 2004 funding level and the 

budget request both are $28,642,000 for this purpose. 

Civic Education program funds support both the We the People 

programs and the Cooperative Education Exchange. The Committee recommends $17,970,000 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 
258 

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 for the We the People program, the Com- mittee recommends the following: that $3,170,000 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 Democracy at the National Conference of 

State Legislatures; and that $1,585,000 be used for continuation 

and expansion of the school violence prevention demonstration program including the Native American program. The Committee recommends $12,672,000 for the Cooperative 

Education Exchange program. Within this amount, the Committee 

has included $4,752,000 for the Center for Civic Education and 

$4,752,000 for the National Council on Economic Education. The 

remaining $3,168,000 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 $28,000,000 for education and 

training for incarcerated youth offenders. The comparable funding 

level for fiscal year 2004 is $24,853,000. 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 
259 

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 is disappointed by the lack of a sufficient response to language included in last year’s Committee report 

regarding the actions planned and taken by the Department to 

meet this goal. The Committee requests a letter report, not later 

than March 1, 2005, from the Department which includes a detailed discussion of 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. 

ENGLISH LANGUAGE ACQUISITION

Appropriations, 2004 ............................................................................. $681,215,000 

Budget estimate, 2005 ........................................................................... 681,215,000 

Committee recommendation ................................................................. 700,000,000 

The Committee recommends an appropriation of $700,000,000 for 

English language acquisition. The comparable funding level for fiscal year 2004 and the budget request both are $681,215,000 for authorized activities. The Department makes formula grants to 

States based on each State’s share of the Nation’s limited-Englishproficient 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. The No Child Left Behind 

Act also requires that 6.5 percent of the appropriation be used to 

support national activities, which include professional development 

activities designed to increase the number of highly qualified teachers serving limited English proficient students; a National Clearinghouse for English Language Acquisition and Language Instructional Programs; and evaluation activities. 

At the level of the Committee recommendation, the State grant 

portion of this account will increase by more than $56,000,000, 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, 2004 ............................................................................. $11,160,707,000 

Budget estimate, 2005 ........................................................................... 12,176,101,000 

Committee recommendation ................................................................. 12,406,516,000 

The Committee recommends $12,406,516,000 for special education programs authorized by the Individuals with Disabilities 
260 

Education Act [IDEA]. The comparable fiscal year 2004 funding 

level is $11,160,707,000 and the budget request includes 

$12,176,101,000 for such programs. 

The Committee recognizes that Fetal Alcohol Spectrum Disorders 

[FASD], the most common known cause of mental retardation, result from maternal alcohol consumption during pregnancy. Affected 

children have a lifelong disability of mental impairments, behavioral problems, and developmental delays that reduce their ability 

to respond to the educational system. The burden to society is estimated at $5,400,000,000 from Fetal Alcohol Syndrome, one type of 

FASD alone, in 2003. The Committee is pleased with the efforts of 

the Office of Special Education and Rehabilitative Services to collaborate with other Federal agencies represented on the Interagency Coordinating Committee on Fetal Alcohol Syndrome, especially with respect to the involvement of educational psychologists 

and other educational and childcare professionals in developing 

awareness about FASD. The Committee encourages the Department of Education to expand activities related to FASD, specifically 

the early identification and care plan development of affected children. 

Grants to States 

The Committee recommends $11,228,981,000 for special education grants to States, as authorized under part B of the IDEA. 

The comparable fiscal year 2004 funding level is $10,068,106,000 

and the budget request includes $11,068,106,000. 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 more 

than 20 percent of the average per-pupil expenditure, compared 

with almost 19 percent under the fiscal year 2004 appropriation. 

Since fiscal year 2000, increasing appropriations have raised the 

Federal share of average per pupil expenditures from 12 percent to 

an estimated 20 percent in fiscal year 2005—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 2004 funding level and the budget request both are $387,699,000. 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 $444,363,000 for grants for the infants and families program under part C of the IDEA. The comparable fiscal year 2004 funding level is $444,363,000 and the 

budget request includes $466,581,000 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. 
261 

State Program Improvement 

The Committee recommends $51,061,000 for State program improvement grants. The comparable fiscal year 2004 funding level 

and the budget request both are $51,061,000 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 in Special Education 

The Committee recommends $78,125,000 for research and innovation in special education. The comparable funding level for fiscal 

year 2004 and the budget request both are $78,125,000 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. 

Technical Assistance and Dissemination 

The Committee recommends $54,000,000 for technical assistance 

and dissemination. The comparable fiscal year 2004 funding level 

and the budget request both are $52,819,000 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 $93,357,000 for the personnel preparation program. The comparable fiscal year 2004 funding level 

and the budget request both are $91,357,000 for this program. 

Funds support competitive awards to help address State-identified 

needs for personnel who are qualified to work with children with 

disabilities, including special education teachers and related services personnel. 

The Committee continues to be particularly concerned about the 

shortages of qualified special education teachers and of higher education faculty to train those teachers. It intends that these funds 

be used to address both shortages. 

Parent Information Centers 

The Committee recommends $27,500,000 for parent information 

centers. The comparable fiscal year 2004 funding level and the 

budget request both are $26,173,000 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 $39,129,000 for technology and 

media services. The comparable fiscal year 2004 funding level is 

$39,129,000 and the budget request includes $32,305,000 for such 
262 

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. (RFB&D). 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 administration proposed eliminating support of RFB&D for these activities. The Committee also recommends $1,500,000 to continue support 

of the Reading Rockets program. Last year, this program received 

$1,491,000. The administration proposed eliminating support for 

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 Reading Rockets 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, 2004 ............................................................................. $3,011,270,000 

Budget estimate, 2005 ........................................................................... 3,047,197,000 

Committee recommendation ................................................................. 3,077,328,000 

The Committee recommends $3,077,328,000 for rehabilitation 

services and disability research. The comparable fiscal year 2004 

funding level is $3,011,270,000 and the budget request includes 

$3,047,197,000 for programs in this account. 

Vocational Rehabilitation State Grants 

The Committee provides $2,635,845,000 for vocational rehabilitation grants to States. The Committee recommendation provides the 

full amount authorized by the Rehabilitation Act of 1973. The comparable funding level for fiscal year 2004 is $2,584,162,000. The 

budget request proposes to eliminate separate funding of several 

categorical programs and redirect these resources to the State 

grant program. The Committee rejects this approach and believes 

changes of this nature should be considered during reauthorization 

of the Act. 

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. 
263 

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 $13,000,000 for the client assistance 

program. The comparable fiscal year 2004 funding level and the 

budget request both are $11,997,000 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 $39,139,000 for training rehabilitation personnel. The comparable fiscal year 2004 funding level and 

the budget request both are $39,139,000 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, shortterm, 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 orthotics and prosthetics programs. 

Demonstration and Training Programs 

The Committee bill includes $24,286,000 for demonstration and 

training programs for persons with disabilities. The comparable fiscal year 2004 funding level is $24,286,000 and the budget request 

includes $18,784,000 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 
264 

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. 

Migrant and Seasonal Farmworkers 

The Committee recommends $2,500,000 for migrant and seasonal 

farmworkers. The comparable fiscal year 2004 funding level is 

$2,321,000. 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. 

Recreational Programs 

The Committee provides $2,750,000 for recreational Programs. 

The comparable fiscal year 2004 funding level is $2,564,000 and 

the budget request does 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. 

Protection and Advocacy of Individual Rights 

The Committee recommends $18,000,000 for protection and advocacy of individual rights. The comparable fiscal year 2004 funding 

level is $16,790,000 and the budget request includes $19,570,000. 

However, included in the budget request is $2,780,000 to continue 

funding for the Protection and Advocacy for Assistive Technology 

program. This amount is less than the $4,419,000 for such activities provided in fiscal year 2004. 

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. 
265 

Projects with Industry 

The Committee recommends $22,000,000 for projects with Indus- try. The comparable fiscal year 2004 funding level is $21,799,000 

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 $38,000,000 for the supported employment State grant program. The comparable fiscal year 2004 

funding level is $37,680,000 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 $23,000,000 for independent living 

State grants. The comparable funding level for fiscal year 2004 and 

the budget request both are $22,020,000 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 $75,000,000 for independent living 

centers. The comparable fiscal year 2004 funding level and the 

budget request both are $73,563,000 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 $31,811,000 for independent living services to older blind individuals. The comparable fiscal year 2004 

funding level and the budget request both are $31,811,000 for these 

activities. Through this program, 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. 
266 

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 $850,000 for program improvement 

activities. The comparable fiscal year 2004 funding level is 

$889,000 and the budget request includes $850,000. In fiscal year 

2005, funds for these activities will continue to support technical 

assistance efforts to improve the efficiency and effectiveness of the 

vocational rehabilitation program and improve accountability efforts. The funds provided are sufficient to support ongoing program 

improvement activities and to support ongoing dissemination and 

performance measurement activities. 

Evaluation 

The Committee recommends $1,500,000 for evaluation activities. 

The comparable fiscal year 2004 funding level is $988,000 and the 

budget request includes $1,500,000 for such activities. 

These funds support evaluations of the impact and effectiveness 

of programs authorized by the Rehabilitation Act. The Committee 

recommendation provides the requested increase for the initiation 

of a new longitudinal study of the State Vocational Rehabilitation 

Services program. 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 $9,000,000 for the Helen Keller National Center for Deaf-Blind Youth and Adults. The comparable fiscal year 2004 funding level and the budget request both are 

$8,666,000 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 agencies. At the recommended level, the center would serve more than 110 persons with deaf-blindness at its 

headquarters facility and provide field services to approximately 

2,150 individuals and families and more than 1,000 organizations. 
267 

National Institute on Disability and Rehabilitation Research 

The Committee recommends $109,152,000 for the National Institute on Disability and Rehabilitation Research [NIDRR]. The comparable fiscal year 2004 funding level and the budget request both 

are $106,652,000 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 recommendation includes $2,500,000 above the 

budget request to support NIDRR’s model spinal cord injury centers program. These funds, in addition to the $7,200,000 available 

within the budget request, will support $8,500,000 in new awards 

in fiscal year 2005. The Committee intends that these funds should 

be used to support investments that would facilitate multi-center 

research and encourages NIDRR to continue its collaboration with 

other Federal agencies in order to leverage Federal investments in 

this area. 

The Committee acknowledges that physical rehabilitation services are essential to the functional status and independence of individuals, particularly those dealing with musculoskeletal conditions. 

The Committee directs the Interagency Committee on Disability 

Research to report on the existing, agency-wide research activities 

relating to physical rehabilitation, opportunities for future physical 

rehabilitation research, and recommendations on how physical rehabilitation research can be enhanced within the departments and 

agencies, including suggestions for those areas that need to be addressed through statutory changes. 

Assistive Technology 

The Committee recommends $31,495,000 for assistive technology. 

The comparable fiscal year 2004 funding level is $25,943,000 and 

the budget request includes $15,000,000 for the alternative financing program, but does not request funding for title I State tech act 

projects or protection and advocacy for assistive technology. However, under the PAIR program, the administration proposes to fund 

protection and advocacy activities previously funded through this 

program at $2,780,000. 

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. 
268 

The Committee recommendation includes $26,000,000 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 2004 

and supports continued funding under this program for protection 

and advocacy for assistive technology. 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 

2004 bill. 

The Committee recommendation also includes $5,495,000 for the 

alternative financing program. The Committee recommendation includes bill language requested by the administration designed to 

encourage States to support alternative financing programs. These 

changes allow States to receive less than $500,000 for an award, 

requires a match of 25 percent and enables States to receive more 

than one grant. The Committee urges the Department to ensure 

that grantees design and operate their programs in a consumer-directed fashion. 

SPECIAL INSTITUTIONS FOR PERSONS WITH DISABILITIES

AMERICAN PRINTING HOUSE FOR THE BLIND

Appropriations, 2004 ............................................................................. $16,403,000 

Budget estimate, 2005 ........................................................................... 16,403,000 

Committee recommendation ................................................................. 17,000,000 

The Committee recommends $17,000,000 for the American Printing House for the Blind [APH]. The comparable fiscal year 2004 

funding level and the budget request both are $16,403,000 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 60 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. 

NATIONAL TECHNICAL INSTITUTE FOR THE DEAF

Appropriations, 2004 ............................................................................. $53,483,000 

Budget estimate, 2005 ........................................................................... 53,803,000 

Committee recommendation ................................................................. 55,790,000 

The Committee recommends $55,790,000 for the National Technical Institute for the Deaf [NTID]. The comparable fiscal year 

2004 funding level is $53,483,000 and the budget request includes 

$53,803,000 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 
269 

for persons who are deaf. NTID also provides support services for 

students who are deaf, trains professionals in the field of deafness, 

and conducts applied research. Within the amount provided, 

$1,685,000 is for construction. The Committee recommendation includes $1,000,000 more than the budget request to provide partial 

support for the new Student Development Center. The Committee 

is aware that NTID plans to leverage this Federal support with approximately $3,000,000 from private sources in order to complete 

this important construction project. At the discretion of the Institute, funds may be used for the Endowment Grant program. 

GALLAUDET UNIVERSITY

Appropriations, 2004 ............................................................................. $100,205,000 

Budget estimate, 2005 ........................................................................... 100,205,000 

Committee recommendation ................................................................. 105,400,000 

The Committee recommends $105,400,000 for Gallaudet University. The comparable fiscal year 2004 funding level and the budget 

request are both $100,205,000 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 continue to offer competitive pay increase for 

faculty and staff, strengthen the training of social workers and 

other clinical service providers in order to increase the educational 

achievement of deaf and hard of hearing students in the school setting, provide for expanded training and information dissemination 

programs and support other program improvements. Funds also 

are available, at the discretion of the university, for the Endowment Grant program. 

VOCATIONAL AND ADULT EDUCATION

Appropriations, 2004 ............................................................................. $2,101,027,000 

Budget estimate, 2005 ........................................................................... 1,601,273,000 

Committee recommendation ................................................................. 2,102,086,000 

The Committee recommendation includes a total of 

$2,102,086,000 for vocational and adult education, consisting of 

$1,326,992,000 for vocational education, $590,137,000 for adult 

education and $184,967,000 for other activities. The comparable 

funding level in fiscal year 2004 is $2,101,027,000 and the budget 

request includes $1,601,273,000 for this account. 
270 

VOCATIONAL EDUCATION

The Committee recommends $1,326,992,000 for vocational education. The comparable fiscal year 2004 funding level is 

$1,326,992,000 and the budget request is $1,011,146,000 for these 

activities. 

Basic Grants.—The Committee recommends $1,194,295,000 for 

basic grants. The comparable fiscal year 2004 funding level is 

$1,194,295,000 and the budget request includes $1,011,146,000 for 

this purpose. 

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 $106,665,000 

for tech-prep programs. The comparable fiscal year 2004 funding 

level is $106,665,000 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 

$11,852,000 for national research programs and other national activities. The comparable fiscal year 2004 funding level is 

$11,852,000 and the budget request proposes to eliminate separate 

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. 
271 

Tech-Prep Education Demonstration Program.—The Committee 

recommendation includes $4,939,000 for this program. The comparable fiscal year 2004 funding level is $4,939,000 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 $9,241,000 to continue activities authorized by 

section 118 of the Carl Perkins Act. The comparable fiscal year 

2004 funding level is $9,241,000 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 $590,127,000 for adult education. 

The comparable fiscal year 2004 funding level and the budget request both are $590,127,000 for this purpose. 

Adult Education State Programs.—For adult education State pro- grams, the Committee recommends $574,266,000. The comparable 

fiscal year 2004 funding level and the budget request both are 

$574,266,000 for authorized activities. 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, $69,135,000 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 $9,169,000 for 

national leadership activities. The comparable funding level for fiscal year 2004 and the budget request both are $9,169,000 for this 

purpose. 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 

$6,692,000 for the National Institute for Literacy, authorized under 

section 242 of the Adult Education and Family Literacy Act. The 
272 

comparable fiscal year 2004 funding level and the budget request 

both are $6,692,000 for this purpose. 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. 

Smaller Learning Communities 

The Committee recommends $173,967,000 for smaller learning 

communities. The comparable fiscal year 2004 funding level is 

$173,967,000 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. The Committee bill includes language 

which makes these funds available on July 1, 2005, except for up 

to 5 percent which will become available on October 1, 2004 and 

may be used for technical assistance, program outreach, evaluation, 

school networking, and peer review of applications. 

Community Technology Centers 

The Committee recommends $11,000,000 for community technology centers. The comparable funding level for fiscal year 2004 

is $9,941,000 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. 

The Committee directs the Secretary to work with the Department of Commerce’s Technology Opportunities Program, the Department of Housing and Urban Development’s Neighborhood Networks programs, and other Federal agencies to share the tools, research, best practices, and other outcomes generated by program 

grants with community-based organizations that are working to ensure equitable access to information and communications technology tools and the skills and opportunities to use them for all 

Americans. 

STUDENT FINANCIAL ASSISTANCE

Appropriations, 2004 ............................................................................. $14,006,887,000 

Budget estimate, 2005 ........................................................................... 14,698,213,000 

Committee recommendation ................................................................. 14,859,694,000 

The Committee recommends an appropriation of $14,859,694,000 

for student financial assistance. The comparable fiscal year 2004 

funding level is $14,006,887,000 and the budget request includes 

$14,698,213,000 for this purpose. 
273 

Federal Pell Grant Program 

For Pell grant awards in the 2005–2006 academic year, the Committee recommends $12,830,000,000 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 

one million over the past 4 years. 

The Committee has deferred action on the proposed enhanced 

Pell grants for State scholars program. This program is not currently authorized. The budget request includes $33,000,000 to provide additional Pell grant support to students completing specific 

challenging coursework while in secondary school. 

Federal Supplemental Educational Opportunity Grants 

The Committee recommends $799,850,000 for Federal supplemental educational opportunity grants [SEOG]. The comparable fiscal year 2004 funding level and the budget request both are 

$770,305,000 for this purpose. 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 $998,243,000 for the Federal workstudy program. The comparable fiscal year 2004 funding level and 

the budget request both are $998,243,000 for authorized activities. 

This program provides grants to more than 3,300 institutions to 

help an estimated 1,000,000 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, $6,000,000 is available for this program. 
274 

Federal Perkins Loans 

The Committee bill includes $98,764,000 for Federal Perkins 

loans capital contributions. The comparable fiscal year 2004 funding level is $98,764,000 and the budget request does not include 

any funds for this purpose. The amount recommended, when combined with institutional revolving funds, would maintain the 2005 

loan volume at the current estimated level of $1,200,000,000. At 

this funding level more than 600,000 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 $66,665,000 for loan cancellations. The comparable funding level for fiscal year 2004 and the 

budget request both are $66,665,000 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 $66,172,000. The comparable 

funding level for fiscal year 2004 is $66,172,000 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 needbased 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 academicallyqualified 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. 
275 

STUDENT AID ADMINISTRATION

Appropriations, 2004 ............................................................................. $116,727,000 

Budget estimate, 2005 ........................................................................... 934,639,000 

Committee recommendation ................................................................. 121,000,000 

The Committee recommends $121,000,000 in discretionary resources for the Student Aid Administration account. The comparable fiscal year 2004 discretionary funding level is $116,727,000 

and the budget request includes $934,639,000 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 provide 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 Federal Student Aid 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. 

HIGHER EDUCATION

Appropriations, 2004 ............................................................................. $2,092,644,000 

Budget estimate, 2005 ........................................................................... 1,977,028,000 

Committee recommendation ................................................................. 2,148,458,000 

The Committee recommends an appropriation of $2,148,458,000 

for higher education programs. The comparable fiscal year 2004 

funding level is $2,092,644,000 and the budget request includes 

$1,977,028,000 for such activities. 

Aid for Institutional Development 

The Committee recommends $522,000,000 for aid for institutional development authorized by titles III and V of the Higher 

Education Act. The comparable funding level for fiscal year 2004 

is $485,065,000 and the budget request includes $505,749,000 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 

$85,000,000 for the part A strengthening institutions program. The 

comparable fiscal year 2004 funding level and the budget request 

both are $80,986,000 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 stu-
276 

dents 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 $100,000,000 for institutions at which Hispanic students 

make up at least 25 percent of enrollment. The comparable fiscal 

year 2004 funding level is $93,993,000 and the budget request includes $95,873,000 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 $240,500,000 for part B grants. The comparable fiscal year 2004 funding level is $222,764,000 and the 

budget request includes $240,500,000 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 $58,500,000 for the part B, section 326 

program. The comparable fiscal year 2004 funding level is 

$53,100,000 and the budget request includes $58,500,000 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 $13,000,000 for this program. The comparable funding level for fiscal year 2004 is 

$10,935,000 and the budget request includes $6,137,000 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 
277 

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 $25,000,000 for strengthening tribal 

colleges and universities [TCUs]. The comparable funding level for 

fiscal year 2004 is $23,287,000 and the budget request includes 

$23,753,000 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. 

For the past 4 years, the Committee has supported 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 continue to address urgently needed facilities repair and expansion. 

International Education and Foreign Language Studies 

The bill includes a total of $103,680,000 for international education and foreign language programs. The comparable fiscal year 

2004 funding level and the budget request both are $103,680,000 

for such activities. 

Domestic Programs.—The Committee recommends $89,211,000 

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 2004 

funding level and the budget request both are $89,211,000 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 $12,840,000 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 2004 funding level and the budget request both are $12,840,000 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 $1,629,000 for the Institute for International Public Policy. The comparable funding level for fiscal year 2004 and the 

budget request both are $1,629,000 for authorized activities. This 

program is designed to increase the number of minority individuals 
278 

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 $157,700,000 for the Fund for the 

Improvement of Postsecondary Education [FIPSE], the same as the 

comparable fiscal year 2004 funding level. The budget request is 

$32,011,000. 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 nonprofit institutions and organizations concerned with education beyond high school. 

The Committee recommendation includes $24,881,000, the full 

amount requested for the comprehensive program. 

Minority Science and Engineering Improvement 

The Committee recommends $8,889,000 for the Minority Science 

and Engineering Improvement program [MSEIP]. The comparable 

fiscal year 2004 funding level and the budget request both are 

$8,889,000 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 $1,500,000 for interest subsidy 

grants. The comparable fiscal year 2004 funding level is $1,988,000 

and the budget request includes $1,500,000 for these grants. This 

appropriation is required to meet the Federal commitment to pay 

interest subsidies on 32 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 $8,000,000 on a current-funded 

basis for tribally controlled postsecondary vocational institutions. 

The comparable fiscal year 2004 funding level and the budget request both are $7,185,000 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 
279 

College in Bismarck, North Dakota, and Crownpoint Institute of 

Technology in Crownpoint, New Mexico. 

Federal TRIO Programs 

The Committee recommends $844,500,000 for Federal TRIO Programs. The comparable fiscal year 2004 funding level and the 

budget request both are $832,559,000 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 [GEARUP] 

The Committee recommends $302,500,000 for GEAR UP. The 

comparable fiscal year 2004 funding level and the budget request 

both are $298,230,000 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. Funds will support a sixth and final year award to 

grantees first funded in 2000, while continuing all other projects. 

The Committee has provided funds above the fiscal year 2004 

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. 
280 

Byrd Honors Scholarships 

The Committee recommends $41,000,000 for the Byrd honors 

scholarship program. The comparable fiscal year 2004 funding level 

and the budget request both are $40,758,000 for this program. 

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 schoolaged 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 2005, and continue support 

for the 2002, 2003, and 2004 cohorts of students in their fourth, 

third and second years of study, respectively. The amount recommended will provide scholarships of $1,500 to 27,333 students. 

Javits Fellowships 

The Committee recommends $9,876,000 for the Javits Fellowships program. The comparable fiscal year 2004 funding level and 

the budget request both are $9,876,000 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 

2005 appropriation support fellowships for the 2006–2007 academic 

year. 

Graduate Assistance in Areas of National Need [GAANN] 

The Committee recommends $30,616,000 for graduate assistance 

in areas of national need. The comparable fiscal year 2004 funding 

level and the budget request both are $30,616,000 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 $88,888,000 for the teacher quality 

enhancement grants program. The comparable fiscal year 2004 

funding level and the budget request both are $88,888,000. 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 
281 

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 $16,099,000 for 

the Child Care Access Means Parents in School [CCAMPIS] program. The comparable fiscal year 2004 funding level and the budget request both are $16,099,000 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 $7,000,000 for this program. The 

comparable fiscal year 2004 funding level is $6,913,000. The budget 

proposes no funding for this program. This program’s purpose is to 

ensure that students with disabilities receive a high-quality postsecondary education. Grants are made to support model demonstration projects that provide technical assistance and professional development activities for faculty and administrators in institutions 

of higher education. 
282 

Underground Railroad Program 

The Committee recommendation includes $2,222,000 for the Underground Railroad program. The comparable fiscal year 2004 

funding level is $2,222,000 and the administration 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 $988,000 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 2004 funding level and the 

budget request both are $988,000 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. 

B.J. Stupak Olympic Scholarships 

The Committee recommendation does not include funding for this 

program. The comparable fiscal year 2004 funding level is $988,000 

and the budget request did not include funds for this activity. 

Funds appropriated in fiscal year 2004 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. 

Thurgood Marshall Legal Educational Opportunity Program 

The Committee recommendation includes $3,000,000 for the 

Thurgood Marshall Legal Educational Opportunity Program. Funding for this program was not available in fiscal year 2004 and the 

budget request did not include any funds for this purpose. According to the U.S. Department of Education, the Council for Legal 

Educational Opportunity still has available balances from appropriations provided in fiscal years 2001, 2002 and 2003. 

Under this program, funds help low-income, minority or disadvantaged college students with the information, preparation and 

financial assistance to enter and complete law school study. The 

Higher Education Act stipulates that the Secretary make an award 

to or contract with the Council on Legal Education Opportunity to 

carry out authorized activities. 
283 

HOWARD UNIVERSITY

Appropriations, 2004 ............................................................................. $238,763,000 

Budget estimate, 2005 ........................................................................... 238,763,000 

Committee recommendation ................................................................. 239,763,000 

The Committee recommends an appropriation of $239,763,000 for 

Howard University. The comparable fiscal year 2004 funding level 

and the budget request both are $238,763,000 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 more than 50 percent of the university’s 

projected educational and general expenditures, excluding the hospital. The Committee recommends, within the funds provided, not 

less than $3,600,000 shall be for the endowment program. 

Howard University Hospital.—Within the funds provided, the Committee recommends $29,999,000 for the Howard University 

Hospital. The comparable fiscal year 2004 funding level and the 

budget request both are $29,999,000 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, 2004 ............................................................................. $769,000 

Budget estimate, 2005 ........................................................................... 578,000 

Committee recommendation ................................................................. 578,000 

Federal Administration.—The Committee bill includes $578,000 

for Federal administration of the CHAFL program. The comparable 

fiscal year 2004 funding level is $769,000 and the budget request 

includes $578,000 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 2005. 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, 2004 ............................................................................. $209,000 

Budget estimate, 2005 ........................................................................... 212,000 

Committee recommendation ................................................................. 212,000 

Federal Administration.—The Committee recommends $212,000 

for Federal administration of the Historically Black College and 

University [HBCU] Capital Financing Program. The comparable 

fiscal year 2004 funding level is $209,000 and the budget request 

includes $212,000 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 con-
284 

struction bonds. Construction loans will be made from the proceeds 

of the sale of the bonds. 

INSTITUTE OF EDUCATION SCIENCE

Appropriations, 2004 ............................................................................. $496,735,000 

Budget estimate, 2005 ........................................................................... 449,621,000 

Committee recommendation ................................................................. 418,679,000 

The bill includes $418,679,000 for the Institute of Education 

Sciences. The comparable fiscal year 2004 funding level is 

$496,735,000 and the budget request includes $449,621,000 for 

comparable activities. This account supports education research, 

data collection and analysis activities, and the assessment of student progress. 

Research, Development and Dissemination 

The Committee recommends $165,518,000 for education research, 

development and national dissemination activities. The comparable 

fiscal year 2004 amount is $165,518,000 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 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 recognizes the critical role that IES plays in 

achieving the important goals set by the No Child Left Behind Act 

and encourages IES to continue its progress in translating scientifically based research findings into classroom practice. The Committee is interested in support for programs that bring advances in 

cognitive, developmental, educational science and neuroscience into 

the classroom by informing curriculum development in schools and 

in graduate schools of education. Research that focuses on the key 

processes of attention, memory, and reasoning are essential for 

learning and are likely to produce substantial gains in academic 

achievement. The Committee also supports the Institute’s research 

investments in reading comprehension, teacher quality, English 

language learners, and educational interventions in mathematics, 

science and reading. 

The Committee is concerned that the Department plans to 

underfund the National Research and Development Centers program. The Committee notes that the three existing centers that are 

slated to receive continuation funding in fiscal year 2005 will each 

receive at least $3,600,000. Under the Department’s new request 
285 

for center proposals, published in February 2004, centers will be 

funded at just $1,000,000 to $2,000,000 per year. The Committee 

questions whether these funding levels will be of ‘‘sufficient size 

and scope to be effective,’’ as mandated in section 133(c)(4) of the 

Education Sciences Reform Act of 2002. The Committee believes 

that the centers must have sufficient funding to enable them to fulfill their missions to support long-term programs of research that 

address the topics of critical national interest on which each center 

is focused. The Committee also believes it is essential that the centers not be restricted to researching limited issues that are not 

broadly applicable. 

The Committee urges the Department to fund each center in the 

next round of competition at levels that are comparable to those of 

existing centers. It also urges the Department to reexamine the 

current level of funding offered for the four centers being competed 

in 2004 to consider whether they might be more effective if funded 

at this higher level and with a broader mandate. 

Statistics 

The Committee recommends $91,664,000 for data-gathering and 

statistical-analysis activities of the National Center for Education 

Statistics [NCES]. The comparable fiscal year 2004 funding level 

and the budget request both are $91,664,000 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. 

Regional Educational Laboratories 

The Committee recommends $66,665,000 to continue support for 

the regional educational laboratories. The comparable fiscal year 

2004 funding level is $66,665,000 and the budget request proposes 

to eliminate funding for this purpose. Program funds support a network of 10 laboratories that are responsible for promoting the use 

of broad-based systemic strategies to improve student achievement. 

Assessment 

The Committee recommends $94,832,000 for assessment. The 

comparable fiscal year 2004 funding level and the budget request 

both are $94,832,000 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 

$5,129,000 for the National Assessment Governing Board [NAGB], 

which is responsible for formulating policy for NAEP. The com-
286 

parable fiscal year 2004 amount is $5,060,000 and the budget request includes $5,129,000 for NAGB. 

DEPARTMENTAL MANAGEMENT

PROGRAM ADMINISTRATION

Appropriations, 2004 ............................................................................. $420,379,000 

Budget estimate, 2005 ........................................................................... 429,778,000 

Committee recommendation ................................................................. 420,379,000 

The Committee recommends $420,379,000 for program administration. The comparable fiscal year 2004 funding level is 

$420,379,000 and the budget request includes $429,778,000 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 180 Federal education programs. Support for program evaluation and studies and advisory 

councils is also provided under this activity. 

The Committee notes with approval the increased attention 

being paid to the coordination of human services with transportation. The Committee notes the recent Executive Order issued by 

the President calling for a report on transportation coordination 

within 1 year. The Committee expects the Department, as a key 

agency mentioned in the Executive Order, to report the findings to 

the Committee as soon as the study is complete. The Committee 

understands that the Interagency Transportation Coordinating 

Council on Access and Mobility, housed in the Department of 

Transportation, will produce the report called for in the executive 

order. 

The Committee acknowledges that although the Committee included language prohibiting the use of updated tax tables in 

awarding Pell Grants for the 2005–2006 award year, that the issue 

of the best methodology for Federal need analysis remains in question. Therefore, the Committee looks forward to reviewing the recommendations of the Advisory Committee on Student Financial Assistance regarding the efficiency, effectiveness and fairness of the 

current procedures for determining a family’s available income and 

assets. The Committee intends that the needs analysis for Pell 

Grants accurately represents the relative distribution of eligible 

students across the Nation. 

OFFICE FOR CIVIL RIGHTS

Appropriations, 2004 ............................................................................. $88,305,000 

Budget estimate, 2005 ........................................................................... 92,801,000 

Committee recommendation ................................................................. 92,801,000 

The Committee bill includes $92,801,000 for the Office for Civil 

Rights [OCR]. The comparable fiscal year 2004 amount is 

$88,305,000 and the budget request includes $92,801,000 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 re-
287 

sponsibility, 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, 2004 ............................................................................. $46,624,000 

Budget estimate, 2005 ........................................................................... 50,576,000 

Committee recommendation ................................................................. 50,576,000 

The Committee recommends $50,576,000 for the Office of the Inspector General. The comparable fiscal year 2004 amount is 

$46,624,000 and the budget request includes $50,576,000 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, also contained in the fiscal year 2004 Act, that prevents the Secretary from using updated 

State and other tax information in the Federal needs analysis 

methodology (sec. 305). 
(288) 

TITLE IV—RELATED AGENCIES 

ARMED FORCES RETIREMENT HOME

Appropriations, 2004 ............................................................................. $64,894,000 

Budget estimate, 2005 ........................................................................... 61,195,000 

Committee recommendation ................................................................. 61,195,000 

The Committee recommends authority to expend $61,195,000 

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. (8=5) 

CORPORATION FOR NATIONAL AND COMMUNITY SERVICE

DOMESTIC VOLUNTEER SERVICE PROGRAMS

Appropriations, 2004 ............................................................................. $354,340,000 

Budget estimate, 2005 ........................................................................... 375,335,000 

Committee recommendation ................................................................. 357,814,000 

The Committee recommends $357,814,000 for fiscal year 2005 for 

the domestic volunteer service programs of the Corporation for National and Community Service. The comparable funding level for 

fiscal year 2004 is $354,340,000 and the budget request includes 

$375,335,000 for this program. 

The Committee is concerned by the apparent inconsistencies in 

the Corporation’s budget justification. The Corporation is right to 

be concerned about unobligated funds, however the Committee 

notes that the Corporation already possesses the flexibility to redirect unused funds to grantees with additional capacity. For that 

reason, the Committee has rejected the cuts proposed by the Corporation and directs the CEO to utilize existing flexibility to resolve any volunteer retention issues. 

VISTA 

The Committee recommends $96,428,000 for fiscal year 2005 for 

the Volunteers in Service to America [VISTA] Program. The comparable funding level for fiscal year 2004 is $93,731,000 and the 

budget request includes $96,428,000 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. 

The Committee is anxious that the funding provided for training 

and technical assistance be utilized to support training that can enhance the effectiveness of VISTA members with respect to their 
289 

mission to build the capacity of local communities to support the 

projects that they develop. VISTA members are increasingly called 

upon to write grant applications and do fundraising as a way of 

making their service projects self-sufficient, requiring knowledge of 

grant writing that cannot be gained in the local organization, as 

well as training in the general field in which they are slated to 

serve. For that reason, the Committee urges the Corporation to integrate grant writing and issue specific presentations into the 

training sessions currently given to all new VISTA members. The 

Committee directs the Corporation to report in the fiscal year 2006 

budget justification on the percentage of training funds and percentage of training time spent on each of the following categories: 

organizational training, grant writing and fundraising training, 

and issue specific training (i.e. early childhood education, environment, disaster assistance, etc). 

Special Volunteer Programs 

The Committee recommends $5,000,000 for fiscal year 2005 for 

the Special Volunteer programs. The comparable funding level for 

fiscal year 2004 is $9,876,000 and the budget request includes 

$15,000,000 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 urges the Corporation to coordinate this program with the Senior Corps direct 

service programs. The budget request did not include funding for 

the Parent Drug Corps, and the Committee concurred. 

National Senior Volunteer Corps 

The Committee recommends $218,886,000 for fiscal year 2005 for 

the National Senior Volunteer Corps programs. The comparable 

funding level for fiscal year 2004 is $214,264,000 and the budget 

request includes $224,544,000 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 

Programs 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 un-
290 

derserved. The Committee expects these projects to be awarded via 

a nationwide competition among potential community-based sponsors. No funds have been included for senior demonstration programs. 

Foster Grandparent Program 

The Committee recommends $112,323,000 for fiscal year 2005 for 

the Foster Grandparent Program. The comparable funding level for 

fiscal year 2004 is $110,121,000 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 2005 for 

the Senior Companion Program. The comparable funding level for 

fiscal year 2004 is $45,987,000 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 $60,000,000 for fiscal year 2005 for 

the Retired and Senior Volunteer Program. The comparable funding level for fiscal year 2004 is $58,156,000 and the budget request 

includes $69,884,000 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 $37,500,000 for fiscal year 2005 for 

program support administration. The comparable funding level for 

fiscal year 2004 is $36,469,000 and the budget request includes 

$39,363,000 for this program. 

The Committee is pleased with action the Corporation has taken 

to reverse the consolidation of State Offices as directed in the fiscal 

year 2004 Appropriations bill. However, the Committee is troubled 

that the Corporation did not provide the requested 5-year plan in 

the fiscal year 2005 budget justification detailing the number, location of State offices, and staffing plans of each. The Committee expects the Corporation to provide this information no later than 6 

weeks after enactment of the fiscal year 2005 appropriation. 
291 

CORPORATION FOR PUBLIC BROADCASTING

Appropriations, 2005 ............................................................................. $390,000,000 

Appropriations, 2006 ............................................................................. 400,000,000 

Budget estimate, 2007 ........................................................................... ........................... 

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 2007. The comparable funding level provided last year was $400,000,000 for fiscal year 2004. The budget 

request does not include advance funds for this program. 

In addition, the Committee recommends $49,705,000 be made 

available in fiscal year 2005 for the conversion to digital broadcasting. The comparable funding level for fiscal year 2004 is the 

same amount. The budget request included no funding for this purpose. 

In addition, the Committee recommends $50,000,000 be made 

available in fiscal year 2005 for the replacement project of the 

interconnection system. In fiscal year 2004, $9,941,000 was appropriated for this purpose. 

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. 

The Committee is disturbed by the recent GAO report detailing 

the Corporation’s use of appropriated funds for the Television Future Fund, which provides funding to project-specific grants that 

have a system-wide benefit. The Corporation’s authorizing statute 

requires that 75 percent of funds be distributed to local stations 

through Community Service Grants [CSG] and 25 percent of funds 

be used to support the creation of national programming. While the 

Committee is not prepared to evaluate the possible need for such 

a fund, the Committee feels strongly that the statute does not currently permit the use of appropriated funds for this type of grant 

program. For that reason, the Committee has included bill language prohibiting funding in fiscal years 2005, 2006, and 2007 from 

being used for the Television Future Fund or any similar activity 

until such time as a specific authorization is enacted to allow it. 

FEDERAL MEDIATION AND CONCILIATION SERVICE

Appropriations, 2004 ............................................................................. $43,129,000 

Budget estimate, 2005 ........................................................................... 43,964,000 

Committee recommendation ................................................................. 44,464,000 

The Committee recommends $44,464,000 for fiscal year 2005 for 

the Federal Mediation and Conciliation Service [FMCS]. The comparable funding level for fiscal year 2004 is $43,129,000 and the 

budget request includes $43,964,000 for this program. 
292 

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, 2004 ............................................................................. $7,728,000 

Budget estimate, 2005 ........................................................................... 7,813,000 

Committee recommendation ................................................................. 7,813,000 

The Committee recommends $7,813,000 for fiscal year 2005 for 

the Federal Mine Safety and Health Review Commission. The comparable funding level for fiscal year 2004 is $7,728,000 and the 

budget request includes $7,813,000 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 fivemember Commission provides review of the Commission’s administrative law judge decisions. 

INSTITUTE OF MUSEUM AND LIBRARY SERVICES

Appropriations, 2004 ............................................................................. $262,240,000 

Budget estimate, 2005 ........................................................................... 261,743,000 

Committee recommendation ................................................................. 262,240,000 

The Committee recommends $262,240,000 for fiscal year 2005 for 

the Institute of Museum and Library Services. The comparable 

funding level for fiscal year 2004 is $262,240,000 and the budget 

request includes $261,743,000 for this program. 

Office of Museum Services Operations Grants 

The Committee recommends $19,724,000 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. In addition to 

the total recommended, $1,000,000 has been provided for Native 

American Museum service grants. 

Museum Conservation Programs 

The Committee recommends $3,630,000 for Conservation programs. These funds support grants to allow museums to survey collections, perform training, research, treatment and environmental 

improvements. In addition, grantees may receive additional funds 

to develop an education component that relates to their conserva-
293 

tion project. In addition, non-competitive grants are awarded for 

technical assistance in conservation efforts. 

Museum National Leadership Projects 

The Committee recommends $10,000,000 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 Library Services State Grants 

The Committee recommends $172,900,000 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. In addition to the total recommended, $3,800,000 has been provided for library services to 

Native Americans and Native Hawaiians. The Committee is aware 

that many traditional healers are aging and the world may soon 

lose the knowledge that they possess. For that reason, the Committee encourages IMLS to work for the preservation and documentation of Native Hawaiian traditional cultural healing practices. It is essential that these practices be documented in creative 

media formats due to the variety and complexity of the practices 

and the healers. 

Library National Leadership Projects 

The Committee recommends $20,000,000 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 

$20,000,000 for this purpose. The Nation is facing an impending retirement wave of librarians. The Bureau of Labor Statistics reports 

that 57 percent of current librarians are 45 and older and 50 percent of librarians are expected to leave the profession in the next 
294 

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. 

Museum and Library Services Administration 

The Committee recommends $11,186,000 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, 2004 ............................................................................. $9,245,000 

Budget estimate, 2005 ........................................................................... 9,905,000 

Committee recommendation ................................................................. 9,905,000 

The Committee recommends $9,905,000 for fiscal year 2005 for 

the Medicare Payment Advisory Commission. The comparable 

funding level for fiscal year 2004 is $9,245,000 and the budget request includes $9,905,000 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, 2004 ............................................................................. $994,000 

Budget estimate, 2005 ........................................................................... 1,000,000 

Committee recommendation ................................................................. 994,000 

The Committee recommends $994,000 for fiscal year 2005 for the 

National Commission on Libraries and Information Science. The 

comparable funding level for fiscal year 2004 is $994,000 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, 2004 ............................................................................. $3,021,000 

Budget estimate, 2005 ........................................................................... 2,873,000 

Committee recommendation ................................................................. 3,371,000 

The Committee recommends $3,371,000 for fiscal year 2005 for 

the National Council on Disability. The comparable funding level 

for fiscal year 2004 is $3,021,000 and the budget request includes 

$2,873,000 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 
295 

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 appreciates the effort that the Council has undertaken to gather input on the ADA from stakeholders across the 

country. For this reason, the Committee has included additional resources to allow the Council to continue to hold forums, survey 

stakeholders, develop approaches to address the current state of 

the Act and to ensure that people with disabilities are adequately 

protected from discrimination. 

NATIONAL LABOR RELATIONS BOARD

Appropriations, 2004 ............................................................................. $242,633,000 

Budget estimate, 2005 ........................................................................... 248,785,000 

Committee recommendation ................................................................. 250,000,000 

The Committee recommends $250,000,000 for fiscal year 2005 for 

the National Labor Relations Board [NLRB]. The comparable funding level for fiscal year 2004 is $242,633,000 and the budget request includes $248,633,000 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 2002 was 1,046 cases and grew to 1,193 cases by the end 

of fiscal year 2003. It is estimated that the backlog will be 1,436 

cases by the end of fiscal year 2004. 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. 

The Committee is disappointed by the NLRB’s plan to restructure its regional offices. Current consolidation proposals will slow 

the decision making process in some regions and hurt workers access to a fair and timely hearing. The Committee specifically opposes the elimination of Region 30 and the subsequent downgrading of the Region 30 Office to sub-regional status. Downgrading this office will force interested parties to travel long distances while increasing the backlog of cases in Region 18. 

NATIONAL MEDIATION BOARD

Appropriations, 2004 ............................................................................. $11,354,000 

Budget estimate, 2005 ........................................................................... 11,635,000 

Committee recommendation ................................................................. 11,635,000 

The Committee recommends $11,635,000 for fiscal year 2005 for 

the National Mediation Board. The comparable funding level for 

fiscal year 2004 is $11,354,000 and the budget request includes 

$11,635,000 for this program. 
296 

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, 2004 ............................................................................. $9,805,000 

Budget estimate, 2005 ........................................................................... 10,516,000 

Committee recommendation ................................................................. 10,516,000 

The Committee recommends $10,516,000 for fiscal year 2005 for 

the Occupational Safety and Health Review Commission. The comparable funding level for fiscal year 2004 is $9,805,000 and the 

budget request includes $10,516,000 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, 2004 ............................................................................. $110,345,000 

Budget estimate, 2005 ........................................................................... 100,000,000 

Committee recommendation ................................................................. 100,000,000 

The Committee recommends $100,000,000 for fiscal year 2005 for 

the Dual Benefits Payments Account. The comparable funding level 

for fiscal year 2004 is $110,345,000 and the budget request includes $100,000,000 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, 2004 ............................................................................. $150,000 

Budget estimate, 2005 ........................................................................... 150,000 

Committee recommendation ................................................................. 150,000 

The Committee recommends $150,000 for fiscal year 2005 for interest earned on unnegotiated checks. The comparable funding 

level for fiscal year 2004 is $150,000 and the budget request includes $150,000 for this program. 

LIMITATION ON ADMINISTRATION

Appropriations, 2004 ............................................................................. $100,702,000 

Budget estimate, 2005 ........................................................................... 102,600,000 

Committee recommendation ................................................................. 102,600,000 

The Committee recommends $102,600,000 for fiscal year 2005 for 

the administration of railroad retirement/survivor benefit programs. The comparable funding level for fiscal year 2004 is 
297 

$100,702,000 and the budget request includes $102,600,000 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 has included language to prohibit funds from the 

railroad retirement trust fund from being spent on any charges 

over and above the actual cost of administering the trust fund, including commercial rental rates. 

LIMITATION ON THE OFFICE OF THE INSPECTOR GENERAL

Appropriations, 2004 ............................................................................. $6,561,000 

Budget estimate, 2005 ........................................................................... 7,200,000 

Committee recommendation ................................................................. 7,200,000 

The Committee recommends $7,200,000 for fiscal year 2005 for 

the Office of the Inspector General. The comparable funding level 

for fiscal year 2004 is $6,561,000 and the budget request includes 

$7,200,000 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 Railroad Retirement Board’s separate Medicare contract. 

SOCIAL SECURITY ADMINISTRATION

PAYMENTS TO SOCIAL SECURITY TRUST FUNDS

Appropriations, 2004 ............................................................................. $21,658,000 

Budget estimate, 2005 ........................................................................... 20,454,000 

Committee recommendation ................................................................. 20,454,000 

The Committee recommends an appropriation of $20,454,000 for 

payments to Social Security trust funds. The comparable fiscal year 

2004 funding level is $21,658,000 and the budget request includes 

$20,454,000 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, 2004 ............................................................................. $26,229,300,000 

Budget estimate, 2005 ........................................................................... 28,608,929,000 

Committee recommendation ................................................................. 25,327,949,000 

The Committee recommends an appropriation of $25,327,949,000 

for supplemental security income. This is in addition to the 
298 

$12,590,000,000 appropriated last year as an advance for the first 

quarter of fiscal year 2005. The comparable fiscal year 2004 funding level is $26,229,300,000 and the budget request includes 

$28,608,929,000. The Committee also recommends an advance appropriation of $14,130,000,000 for the first quarter of fiscal year 

2006 to ensure uninterrupted benefits payments. The program 

level supported by the Committee recommendation is 

$39,457,949,000, compared to the total program level requested in 

the budget of $39,538,929,000. The Committee recommendation 

also includes bill language which adjusts the timing of the October 

2005 SSI benefit payment. 

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 6,900,000 persons will receive SSI benefits each month during fiscal year 2005. 

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 $45,929,000 for beneficiary services. The comparable funding level in fiscal year 2004 

is $100,000,000 and the budget request includes $45,929,000 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. The decrease in budget authority requested and concurred in by the Committee is due to the availability of resources 

from prior years. 

Research and Demonstration Projects 

The Committee recommendation includes $35,000,000 for research and demonstration projects conducted under sections 1110 

and 1115 of the Social Security Act. The comparable fiscal year 

2004 funding level is $38,000,000 and the budget request includes 

$27,000,000 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 pro-
299 

vide 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 continue the demonstration grants demonstration program targeted toward providing outreach and application assistance to homeless persons and 

other underserved populations. 

Administration 

The Committee recommendation includes $2,928,020,000 for payment to the Social Security trust funds for the SSI Program’s share 

of SSA’s base administrative expenses. The comparable fiscal year 

2004 amount is $2,973,300,000 and the budget request includes 

$3,017,000,000 for such activities. 

LIMITATION ON ADMINISTRATIVE EXPENSES

Appropriations, 2004 ............................................................................. $8,313,174,000 

Budget estimate, 2005 ........................................................................... 8,881,000,000 

Committee recommendation ................................................................. 8,622,818,000 

The Committee recommends a program funding level of $8,622,818,000 for the limitation on administrative expenses. The 

comparable fiscal year 2004 funding level is $8,313,174,000 and the 

budget request includes $8,881,000,000 for this purpose. The budget request also includes $100,000,000 for a contingency reserve 

fund to support additional administrative costs associated with the 

Medicare Prescription Drug, Improvement, and Modernization Act 

of 2003. Due to the current availability of funds for this purpose, 

the Committee recommendation does not include the requested contingency reserve. 

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 $8,498,818,000 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 $561,000,000 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. 

The Committee recommendation supports an increase of more 

than 3.7 percent over the comparable fiscal year 2004 level for the 
300 

administrative expenses of the Social Security Administration. 

However, due to budget constraints, the Committee recommendation does not provide the full budget request for SSA’s administrative expenses. The substantial 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, 

options and program stewardship; and investing in staff. The Committee commends SSA for its continued progress related to increasing agency productivity and addressing these challenges, even 

though available resources have been less than amounts requested 

by the Commissioner. 

The Committee continues to encourage SSA officials to educate 

adjudicators at all levels about the functional impact of CFS and 

the application of the April 1999 CFS ruling (99–2p) to ensure that 

adjudicators remain up-to-date on the evaluation of disability imposed by this condition. The Committee encourages SSA to continue examining obstacles to benefits for persons with CFS, to assess the impact of the ruling on disabled 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 $2,000,000 within the 

limitation on administrative expenses account for the Social Security Advisory Board for fiscal year 2005. 

User Fees 

In addition to other amounts provided, the Committee recommends $124,000,000 for administrative activities funded from 

user fees that were authorized in fiscal year 1998. 

OFFICE OF THE INSPECTOR GENERAL

Appropriations, 2004 ............................................................................. $87,679,000 

Budget estimate, 2005 ........................................................................... 92,000,000 

Committee recommendation ................................................................. 92,000,000 

The Committee recommends $92,000,000 for activities for the Office of the Inspector General. The comparable fiscal year 2004 funding level is $87,679,000 and the budget request includes 

$92,000,000 for this office. This includes a general fund appropriation of $26,000,000 together with an obligation limitation of 

$66,000,000 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. 
301 

U.S. INSTITUTE OF PEACE

Appropriations, 2004 ............................................................................. $27,099,000 

Budget estimate, 2005 ........................................................................... 22,099,000 

Committee recommendation ................................................................. 22,099,000 

The Committee recommends $22,099,000 for fiscal year 2005 for 

the U.S. Institute of Peace. The comparable funding level for fiscal 

year 2004 is $27,099,000 which includes a one-time appropriation 

of $10,000,000 for programs in Iraq and Afghanistan. The budget 

request includes $22,099,000 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. 
(302) 

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 (sec. 504); prohibit funding of any program to carry out 

distribution of sterile needles for the hypodermic injection of any 

illegal drug (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); prohibits the use of funds to promulgate 

regulations regarding the individual health identifier (sec. 513); 

prohibits transfer of funds made available in this Act to any department, agency, or instrumentality of the U.S. Government, except as otherwise provided by this or any other Act (sec. 514); prohibits funds for the Railroad Retirement Board from being used for 

a non-governmental disbursing agent (sec. 515); relates to the Native Americans status of Native Hawaiians (sec. 516); and allows 

Southcentral Foundation in Anchorage, Alaska to sell an outdated 

Head Start facility and use the proceeds to acquire a new, updated 

facility that would better serve its children (sec. 517). 
303 

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 

allocation 

Amount 

of bill 

Committee 

allocation 

Amount 

of bill 

Comparison of amounts in the bill with Committee allocations 

to its subcommittees of amounts in the Budget Resolution 

for 2005: Subcommittee on Labor-HHS-Education. 

Discretionary ........................................................................ 142,317 142,317 140,936 1 138,896 

Mandatory ............................................................................ 342,503 342,503 342,402 1 342,402 

Projection of outlays associated with the recommendation: 

2005 ..................................................................................... .................... .................... .................... 2 311,741 

2006 ..................................................................................... .................... .................... .................... 62,532 

2007 ..................................................................................... .................... .................... .................... 16,245 

2008 ..................................................................................... .................... .................... .................... 3,918 

2009 and future years ........................................................ .................... .................... .................... 607 

Financial assistance to State and local governments for 

2005 ......................................................................................... NA 187,415 NA 147,761 

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, $5,252,662,000; Title VII and Title VIII 

of the Public Health Services Act, $466,080,000; National Cord 

Blood Stem Cell Bank Program, $9,941,000; Universal Newborn 

Hearing Screening, $9,872,000; Organ Transplantation, 

$24,632,000; Rural Hospital Flexibility Grants, $39,499,000; Denali 

Commission, $41,794,000; Family Planning, $308,283,000; State 

Offices of Rural Health, $8,390,000; Rural and Community Access 

to Emergency Devices, $10,933,000; Trauma/EMS, $4,000,000; Infectious Diseases, $1,688,594,000; Health Promotion, $864,195,000; 

Health Information and Services, $235,657,000; Environmental 

Health and Injury, $290,126,000; Occupational Safety and Health, 

$294,587,000; Global Health, $305,239,000; Public Health Research, $35,000,000; Public Health Improvement and Leadership, 

$261,858,000; Preventive Health and Health Services Block Grant, 

$131,814,000; CDC Business Services, $282,226,000; Title V of the 

Public Health Services Act, $3,356,426,000; Adolescent Family Life, 

$37,500,000; Office of Minority Health, $53,351,000; Office of Disease Prevention and Health Promotion, $7,698,000; Child Care and 

Development Block Grant, $2,099,729,000; Head Start, 

$6,935,452,000; Native American Programs, $45,157,000; Refugee 

and Entrant Assistance Programs, $477,239,000; Community Serv-
304 

ices $727,650,000; Alzheimer’s Disease Demonstration Grants to 

States, $11,883,000; Volunteers in Service to America, $96,428,000; 

Special Volunteer Programs, $5,000,000; National Senior Volunteer 

Corps, $216,684,000; High School Equivalency program, 

$18,888,000; College assistance migrant program, $15,657,000; 

Credit enhancement for charter school facilities, $32,279,000; State 

grants for incarcerated youth offenders, $28,000,000; Rehabilitation 

Services and Disability Research, except Title III of the Assistive 

Technology Program, $3,071,833,000; National Technical Institute 

for the Deaf, $55,790,000; Gallaudet University, $105,400,000; Vocational Education, $1,326,992,000; Adult Education, $590,127,000; 

Higher Education, $2,148,458,000. 

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

STANDING RULES OF THE SENATE 

Pursuant to paragraph 7(c) of rule XXVI, on September 15, 2004, 

the Committee ordered reported en bloc S. 2809, an original bill 

making appropriations for Departments of Commerce, Justice, and 

State, the Judiciary, and related agencies for the fiscal year ending 

September 30, 2005, an original bill making appropriations for the 

Foreign Operations, Export Financing, and related programs for 

the fiscal year ending September 30, 2005; and S. 2810, an original 

bill making appropriations for the Departments of Labor, Health 

and Human Services, and Education, and related agencies for the 

fiscal year ending September 30, 2005, each subject to amendment 

and each subject to the budget allocations, by a recorded vote of 

29–0, a quorum being present. The vote was as follows: 

Yeas Nays 

Chairman Stevens 

Mr. Cochran 

Mr. Specter 

Mr. Domenici 

Mr. Bond 

Mr. McConnell 

Mr. Burns 

Mr. Shelby 

Mr. Gregg 

Mr. Bennett 

Mr. Campbell 

Mr. Craig 

Mrs. Hutchison 

Mr. DeWine 

Mr. Brownback 

Mr. Byrd 

Mr. Inouye 

Mr. Hollings 

Mr. Leahy 

Mr. Harkin 

Ms. Mikulski 

Mr. Reid 

Mr. Kohl 

Mrs. Murray 

Mr. Dorgan 
305 

Mrs. Feinstein 

Mr. Durbin 

Mr. Johnson 

Ms. Landrieu 

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. 
306 

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2004 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL 

FOR FISCAL YEAR 2005 

[In thousands of dollars] 

Item 2004 comparable Budget estimate Committee rec- ommendation 

Senate Committee recommendation 

compared with (∂ or ¥) 

2004 comparable Budget estimate 

TITLE I 

DEPARTMENT OF LABOR 

EMPLOYMENT AND TRAINING ADMINISTRATION 

TRAINING AND EMPLOYMENT SERVICES 

Grants to States: 

Adult Training, current year ........................................................................................................................................ 186,107 187,153 186,107 .......................... ¥1,046 

Advance from prior year ..................................................................................................................................... (707,799 ) (712,000 ) (712,000 ) (∂4,201 ) ..........................Fiscal year 2006 ................................................................................................................................................. 712,000 712,000 712,000 .......................... ..........................

Adult Training ................................................................................................................................................ 898,107 899,153 898,107 .......................... ¥1,046 

Youth Training ............................................................................................................................................................. 994,242 1,000,025 994,242 .......................... ¥5,783 Dislocated Worker Assistance, current year ................................................................................................................ 328,924 250,367 348,048 ∂19,124 ∂97,681 

Advance from prior year ..................................................................................................................................... (842,997 ) (848,000 ) (848,000 ) (∂5,003 ) ..........................Fiscal year 2006 ................................................................................................................................................. 848,000 848,000 848,000 .......................... ..........................

Dislocated Worker Assistance ........................................................................................................................ 1,176,924 1,098,367 1,196,048 ∂19,124 ∂97,681 

Federally Administered Programs: 

Dislocated Worker Assistance National Reserve: 

Current year ........................................................................................................................................................ 64,227 71,371 71,371 ∂7,144 ..........................Advance from prior year ..................................................................................................................................... (210,749 ) (212,000 ) (212,000 ) (∂1,251 ) ..........................Fiscal year 2006 ................................................................................................................................................. 212,000 212,000 212,000 .......................... ..........................

Dislocated Worker Assistance Nat’l Reserve ................................................................................................. 276,227 283,371 283,371 ∂7,144 ..........................Total, Dislocated Worker Assistance .............................................................................................................. 1,453,151 1,381,738 1,479,419 ∂26,268 ∂97,681 

Native Americans ........................................................................................................................................................ 54,675 55,000 55,000 ∂325 ..........................Migrant and Seasonal Farmworkers ........................................................................................................................... 76,370 .......................... 76,370 .......................... ∂76,370 
307 

Job Corps: 

Operations .......................................................................................................................................................... 820,114 859,966 859,966 ∂39,852 ..........................

Advance from prior year ............................................................................................................................ (587,513 ) (591,000 ) (591,000 ) (∂3,487 ) ..........................Fiscal year 2006 ........................................................................................................................................ 591,000 591,000 591,000 .......................... ..........................

Construction and Renovation ............................................................................................................................. 30,038 6,321 26,321 ¥3,717 ∂20,000 

Advance from prior year ............................................................................................................................ (99,410 ) (100,000 ) (100,000 ) (∂590 ) ..........................Fiscal year 2006 ........................................................................................................................................ 100,000 100,000 100,000 .......................... ..........................

Subtotal, Job Corps, program level ...................................................................................................... 1,541,152 1,557,287 1,577,287 ∂36,135 ∂20,000 

National Activities: 

Pilots, Demonstrations and Research ................................................................................................................ 57,751 30,000 62,751 ∂5,000 ∂32,751 Responsible Reintegration of Youthful Offender ............................................................................................... 49,705 50,000 50,000 ∂295 ..........................Evaluation ........................................................................................................................................................... 8,986 8,000 8,000 ¥986 ..........................Prisoner Re-entry ................................................................................................................................................ .......................... 40,000 40,000 ∂40,000 ..........................Community College initiative ............................................................................................................................. .......................... 250,000 125,000 ∂125,000 ¥125,000 Program level (NA) ............................................................................................................................................. .......................... (250,000 ) (250,000 ) (∂250,000 ) ..........................Personal reemployment accounts ....................................................................................................................... .......................... 50,000 .......................... .......................... ¥50,000 Denali Commission ............................................................................................................................................. 4,970 .......................... 8,000 ∂3,030 ∂8,000 Other ................................................................................................................................................................... 3,486 2,000 3,486 .......................... ∂1,486 

Subtotal, National activities .......................................................................................................................... 124,898 430,000 297,237 ∂172,339 ¥132,763 Subtotal, Federal activities ............................................................................................................................ 2,073,322 2,325,658 2,289,265 ∂215,943 ¥36,393 

Current Year .......................................................................................................................................... 1,170,322 1,422,658 1,386,265 ∂215,943 ¥36,393 Fiscal year 2006 ................................................................................................................................... 903,000 903,000 903,000 .......................... ..........................

Total, Workforce Investment Act .................................................................................................................... 5,142,595 5,323,203 5,377,662 ∂235,067 ∂54,459 

Current Year .......................................................................................................................................... 2,679,595 2,860,203 2,914,662 ∂235,067 ∂54,459 Fiscal year 2006 ................................................................................................................................... 2,463,000 2,463,000 2,463,000 .......................... ..........................

Subtotal, National activities, TES .................................................................................................................. 124,898 430,000 297,237 ∂172,339 ¥132,763 Total, Training and Employment Services ..................................................................................................... 5,142,595 5,323,203 5,377,662 ∂235,067 ∂54,459 

Current Year .......................................................................................................................................... (2,679,595 ) (2,860,203 ) (2,914,662 ) (∂235,067 ) (∂54,459 ) Fiscal year 2006 ................................................................................................................................... (2,463,000 ) (2,463,000 ) (2,463,000 ) .......................... ..........................

COMMUNITY SERVICE EMPLOYMENT FOR OLDER AMERICANS ............................................................................................ 438,650 440,200 440,200 ∂1,550 ..........................FEDERAL UNEMPLOYMENT BENEFITS AND ALLOWANCES ..................................................................................................... 1,338,200 1,057,300 1,057,300 ¥280,900 ..........................
308 

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2004 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL 

FOR FISCAL YEAR 2005—Continued 

[In thousands of dollars] 

Item 2004 comparable Budget estimate Committee rec- ommendation 

Senate Committee recommendation 

compared with (∂ or ¥) 

2004 comparable Budget estimate 

STATE UNEMPLOYMENT INSURANCE AND EMPLOYMENT SERVICE OPERATIONS 

Unemployment Compensation: 

State Operations .......................................................................................................................................................... 2,608,653 2,700,714 2,654,714 ∂46,061 ¥46,000 National Activities ....................................................................................................................................................... 9,876 10,500 10,500 ∂624 ..........................

Subtotal, Unemployment Compensation ................................................................................................................. 2,618,529 2,711,214 2,665,214 ∂46,685 ¥46,000 

Employment Service: 

Allotments to States: 

Federal Funds ..................................................................................................................................................... 23,163 23,300 23,163 .......................... ¥137 Trust Funds ........................................................................................................................................................ 763,724 672,700 763,724 .......................... ∂91,024 

Subtotal .......................................................................................................................................................... 786,887 696,000 786,887 .......................... ∂90,887 

ES National Activities .................................................................................................................................................. 63,971 67,000 65,500 ∂1,529 ¥1,500 

Subtotal, Employment Service ................................................................................................................................ 850,858 763,000 852,387 ∂1,529 ∂89,387 

Federal Funds ................................................................................................................................................ 23,163 23,300 23,163 .......................... ¥137 Trust Funds .................................................................................................................................................... 827,695 739,700 829,224 ∂1,529 ∂89,524 

One-Stop Career Centers/Labor Market Information ............................................................................................................ 98,764 99,350 98,764 .......................... ¥586 Work Incentives Grants ........................................................................................................................................................ 19,753 19,870 19,870 ∂117 ..........................

Total, State Unemployment & Employment Srvcs .................................................................................................. 3,587,904 3,593,434 3,636,235 ∂48,331 ∂42,801 

Federal Funds ................................................................................................................................................ 141,680 142,520 141,797 ∂117 ¥723 Trust Funds .................................................................................................................................................... 3,446,224 3,450,914 3,494,438 ∂48,214 ∂43,524 

ADVANCES TO THE UI AND OTHER TRUST FUNDS 1 ............................................................................................................. 467,000 517,000 517,000 ∂50,000 ..........................

PROGRAM ADMINISTRATION 

Adult Employment and Training .......................................................................................................................................... 38,382 39,380 39,187 ∂805 ¥193 

Trust Funds ................................................................................................................................................................. 6,814 6,980 6,957 ∂143 ¥23 

Youth Employment and Training .......................................................................................................................................... 39,009 40,133 39,947 ∂938 ¥186 
309 

Employment Security ............................................................................................................................................................ 5,948 6,146 6,094 ∂146 ¥52 

Trust Funds ................................................................................................................................................................. 48,624 55,722 51,000 ∂2,376 ¥4,722 

Apprenticeship Services ....................................................................................................................................................... 20,760 21,405 21,306 ∂546 ¥99 Executive Direction ............................................................................................................................................................... 8,400 8,718 8,568 ∂168 ¥150 

Trust Funds ................................................................................................................................................................. 2,041 2,158 2,082 ∂41 ¥76 

Welfare to Work .................................................................................................................................................................... 2,371 376 2,474 ∂103 ∂2,098 

Total, Program Administration ................................................................................................................................ 172,349 181,018 177,615 ∂5,266 ¥3,403 

Federal Funds ................................................................................................................................................ 114,870 116,158 117,576 ∂2,706 ∂1,418 Trust Funds .................................................................................................................................................... 57,479 64,860 60,039 ∂2,560 ¥4,821 

Total, Employment and Training Administration .................................................................................................... 11,146,698 11,112,155 11,206,012 ∂59,314 ∂93,857 

Federal Funds ................................................................................................................................................ 7,642,995 7,596,381 7,651,535 ∂8,540 ∂55,154 

Current Year .......................................................................................................................................... (5,179,995 ) (5,133,381 ) (5,188,535 ) (∂8,540 ) (∂55,154 ) Fiscal year 2006 ................................................................................................................................... (2,463,000 ) (2,463,000 ) (2,463,000 ) .......................... ..........................

Trust Funds .................................................................................................................................................... 3,503,703 3,515,774 3,554,477 ∂50,774 ∂38,703 

EMPLOYEE BENEFITS SECURITY ADMINISTRATION 

Enforcement and Participant Assistance ............................................................................................................................. 102,730 110,330 110,330 ∂7,600 ..........................Policy and Compliance Assistance ...................................................................................................................................... 16,907 17,497 17,497 ∂590 ..........................Program Oversight and Administration ............................................................................................................................... 4,403 4,518 4,518 ∂115 ..........................

Total, EBSA ............................................................................................................................................................. 124,040 132,345 132,345 ∂8,305 ..........................

PENSION BENEFIT GUARANTY CORPORATION 

Pension insurance activities ................................................................................................................................................ (17,821 ) (12,211 ) (12,211 ) (¥5,610 ) ..........................Pension plan termination ..................................................................................................................................................... (170,504 ) (169,739 ) (169,739 ) (¥765 ) ..........................Operational support .............................................................................................................................................................. (83,547 ) (84,380 ) (84,380 ) (∂833 ) ..........................Program Adm. subject to limitation (TF) ............................................................................................................................. .......................... .......................... .......................... .......................... ..........................Termination services not subject to limitation (NA) ........................................................................................................... .......................... .......................... .......................... .......................... ..........................

Total, PBGC ............................................................................................................................................................. .......................... .......................... .......................... .......................... ..........................Total, PBGC (Program level) ................................................................................................................................... (271,872 ) (266,330 ) (266,330 ) (¥5,542 ) ..........................

EMPLOYMENT STANDARDS ADMINISTRATION 

SALARIES AND EXPENSES 

Enforcement of Wage and Hour Standards ......................................................................................................................... 160,096 165,933 165,933 ∂5,837 ..........................Office of Labor-Management Standards .............................................................................................................................. 38,580 43,545 40,646 ∂2,066 ¥2,899 Federal Contractor EEO Standards Enforcement ................................................................................................................. 79,442 82,078 82,078 ∂2,636 ..........................Federal Programs for Workers’ Compensation ..................................................................................................................... 96,754 99,528 99,528 ∂2,774 ..........................
310 

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2004 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL 

FOR FISCAL YEAR 2005—Continued 

[In thousands of dollars] 

Item 2004 comparable Budget estimate Committee rec- ommendation 

Senate Committee recommendation 

compared with (∂ or ¥) 

2004 comparable Budget estimate 

Trust Funds ................................................................................................................................................................. 2,021 2,058 2,058 ∂37 ..........................

Program Direction and Support ........................................................................................................................................... 15,123 16,152 15,627 ∂504 ¥525 

Total, ESA salaries and expenses .......................................................................................................................... 392,016 409,294 405,870 ∂13,854 ¥3,424 

Federal Funds ................................................................................................................................................ 389,995 407,236 403,812 ∂13,817 ¥3,424 Trust Funds .................................................................................................................................................... 2,021 2,058 2,058 ∂37 ..........................

SPECIAL BENEFITS 

Federal employees compensation benefits .......................................................................................................................... 160,000 230,000 230,000 ∂70,000 ..........................Longshore and harbor workers’ benefits ............................................................................................................................. 3,000 3,000 3,000 .......................... ..........................

Total, Special Benefits ............................................................................................................................................ 163,000 233,000 233,000 ∂70,000 ..........................

SPECIAL BENEFITS FOR DISABLED COAL MINERS 

Benefit payments ................................................................................................................................................................. 390,848 358,806 358,806 ¥32,042 ..........................Administration ...................................................................................................................................................................... 6,143 5,194 5,194 ¥949 ..........................

Subtotal, Black Lung, fiscal year 2005 program level .......................................................................................... 396,991 364,000 364,000 ¥32,991 ..........................

Less funds advanced in prior year ............................................................................................................... ¥97,000 ¥88,000 ¥88,000 ∂9,000 ..........................

Total, Black Lung, current request, fiscal year 2005 .............................................................................. 299,991 276,000 276,000 ¥23,991 ..........................New advances, 1st quarter fiscal year 2006 ........................................................................................... 88,000 81,000 81,000 ¥7,000 ..........................

Total, Special Benefits for Disabled Coal Miners .................................................................................................. 387,991 357,000 357,000 ¥30,991 ..........................

ENERGY EMPLOYEES OCCUPATIONAL ILLNESS COMPENSATION FUND 

Program Benefits .................................................................................................................................................................. (221,000 ) (221,000 ) (221,000 ) .......................... ..........................Administrative Expenses ...................................................................................................................................................... 51,651 40,821 40,821 ¥10,830 ..........................

Total, Energy Emp Occupational Illness Comp Fund ............................................................................................. 51,651 40,821 40,821 ¥10,830 ..........................
311 

BLACK LUNG DISABILITY TRUST FUND 

Benefit payments and interest on advances ....................................................................................................................... 998,901 1,001,951 1,001,951 ∂3,050 ..........................Employment Standards Adm. S&E ....................................................................................................................................... 32,004 32,646 32,646 ∂642 ..........................Departmental Management S&E .......................................................................................................................................... 23,401 23,705 23,705 ∂304 ..........................Departmental Management, Inspector General ................................................................................................................... 338 342 342 ∂4 ..........................

Subtotal, Black Lung Disability .............................................................................................................................. 1,054,644 1,058,644 1,058,644 ∂4,000 ..........................

Treasury Adm. Costs ............................................................................................................................................................ 356 356 356 .......................... ..........................

Total, Black Lung Disability Trust Fund ................................................................................................................. 1,055,000 1,059,000 1,059,000 ∂4,000 ..........................Total, Employment Standards Administration ........................................................................................................ 2,049,658 2,099,115 2,095,691 ∂46,033 ¥3,424 

Federal Funds ................................................................................................................................................ 2,047,637 2,097,057 2,093,633 ∂45,996 ¥3,424 

Current year .......................................................................................................................................... (1,959,637 ) (2,016,057 ) (2,012,633 ) (∂52,996 ) (¥3,424 ) Fiscal year 2006 ................................................................................................................................... (88,000 ) (81,000 ) (81,000 ) (¥7,000 ) ..........................

Trust Funds .................................................................................................................................................... 2,021 2,058 2,058 ∂37 ..........................

OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION 

SALARIES AND EXPENSES 

Safety and Health Standards ............................................................................................................................................... 15,920 16,132 16,668 ∂748 ∂536 Federal Enforcement ............................................................................................................................................................. 166,015 171,020 171,020 ∂5,005 ..........................State Programs ..................................................................................................................................................................... 91,959 91,747 91,747 ¥212 ..........................Technical Support ................................................................................................................................................................. 21,593 20,909 20,909 ¥684 ..........................Compliance Assistance: 

Federal Assistance ...................................................................................................................................................... 67,049 71,430 71,430 ∂4,381 ..........................State Consultation Grants ........................................................................................................................................... 52,211 53,792 53,792 ∂1,581 ..........................Training Grants ........................................................................................................................................................... 10,510 4,000 10,510 .......................... ∂6,510 

Subtotal, Compliance Assistance ........................................................................................................................... 129,770 129,222 135,732 ∂5,962 ∂6,510 

Safety and Health Statistics ................................................................................................................................................ 22,237 22,382 22,382 ∂145 ..........................Executive Direction and Administration ............................................................................................................................... 10,047 10,187 10,187 ∂140 ..........................

Total, OSHA ............................................................................................................................................................. 457,541 461,599 468,645 ∂11,104 ∂7,046 

MINE SAFETY AND HEALTH ADMINISTRATION 

SALARIES AND EXPENSES 

Coal Enforcement ................................................................................................................................................................. 115,339 114,889 117,769 ∂2,430 ∂2,880 
312 

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2004 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL 

FOR FISCAL YEAR 2005—Continued 

[In thousands of dollars] 

Item 2004 comparable Budget estimate Committee rec- ommendation 

Senate Committee recommendation 

compared with (∂ or ¥) 

2004 comparable Budget estimate 

Metal/Non-Metal Enforcement .............................................................................................................................................. 65,985 66,782 67,798 ∂1,813 ∂1,016 Standards Development ....................................................................................................................................................... 2,326 2,333 2,372 ∂46 ∂39 Assessments ......................................................................................................................................................................... 4,170 5,280 5,280 ∂1,110 ..........................Educational Policy and Development ................................................................................................................................... 30,356 31,507 31,507 ∂1,151 ..........................Technical Support ................................................................................................................................................................. 24,545 25,064 25,564 ∂1,019 ∂500 Program evaluation and information resources (PEIR) ....................................................................................................... 13,963 17,666 17,666 ∂3,703 ..........................Program Administration ....................................................................................................................................................... 12,173 12,046 12,046 ¥127 ..........................

Total, Mine Safety and Health Administration ....................................................................................................... 268,857 275,567 280,002 ∂11,145 ∂4,435 

BUREAU OF LABOR STATISTICS 

SALARIES AND EXPENSES 

Employment and Unemployment Statistics ......................................................................................................................... 160,431 164,026 164,026 ∂3,595 ..........................Labor Market Information (Trust Funds) .............................................................................................................................. 74,667 78,473 78,473 ∂3,806 ..........................Prices and Cost of Living .................................................................................................................................................... 166,344 170,736 170,736 ∂4,392 ..........................Compensation and Working Conditions ............................................................................................................................... 77,614 79,827 79,827 ∂2,213 ..........................Productivity and Technology ................................................................................................................................................. 10,294 10,588 10,588 ∂294 ..........................Executive Direction and Staff Services ................................................................................................................................ 29,146 29,868 29,868 ∂722 ..........................

Total, Bureau of Labor Statistics ........................................................................................................................... 518,496 533,518 533,518 ∂15,022 ..........................

Federal Funds ................................................................................................................................................ 443,829 455,045 455,045 ∂11,216 ..........................Trust Funds .................................................................................................................................................... 74,667 78,473 78,473 ∂3,806 ..........................

OFFICE OF DISABILITY EMPLOYMENT POLICY 

Office of Disability Employment Policy ................................................................................................................................ 47,024 47,555 47,555 ∂531 ..........................

DEPARTMENTAL MANAGEMENT 

SALARIES AND EXPENSES 

Executive Direction ............................................................................................................................................................... 27,084 33,206 27,084 .......................... ¥6,122 Departmental IT Crosscut .................................................................................................................................................... 48,219 33,565 33,565 ¥14,654 ..........................
313 

Departmental Management Crosscut ................................................................................................................................... 4,965 10,100 4,965 .......................... ¥5,135 Legal Services ...................................................................................................................................................................... 80,412 84,007 84,007 ∂3,595 ..........................

Trust Funds ................................................................................................................................................................. 314 322 322 ∂8 ..........................

International Labor Affairs ................................................................................................................................................... 109,862 30,545 110,500 ∂638 ∂79,955 Administration and Management ......................................................................................................................................... 33,153 32,675 33,859 ∂706 ∂1,184 Frances Perkins building security enhancements ............................................................................................................... .......................... 15,000 15,000 ∂15,000 ..........................Adjudication .......................................................................................................................................................................... 25,872 26,683 26,683 ∂811 ..........................Women’s Bureau ................................................................................................................................................................... 9,201 9,554 9,554 ∂353 ..........................Civil Rights Activities ........................................................................................................................................................... 6,114 6,287 6,287 ∂173 ..........................Chief Financial Officer ......................................................................................................................................................... 5,123 5,224 5,224 ∂101 ..........................

Total, Salaries and expenses .................................................................................................................................. 350,319 287,168 357,050 ∂6,731 ∂69,882 

Federal Funds ................................................................................................................................................ 350,005 286,846 356,728 ∂6,723 ∂69,882 Trust Funds .................................................................................................................................................... 314 322 322 ∂8 ..........................

VETERANS EMPLOYMENT AND TRAINING 

State administration, Grants ............................................................................................................................................... 161,408 162,415 162,415 ∂1,007 ..........................Federal Administration ......................................................................................................................................................... 28,857 29,683 29,683 ∂826 ..........................National Veterans Training Institute .................................................................................................................................... 1,988 2,000 2,000 ∂12 ..........................Homeless Veterans Program ................................................................................................................................................ 18,888 19,000 23,000 ∂4,112 ∂4,000 Veterans Workforce Investment Programs ........................................................................................................................... 7,505 7,550 9,683 ∂2,178 ∂2,133 

Total, Veterans Employment and Training ............................................................................................................. 218,646 220,648 226,781 ∂8,135 ∂6,133 

Federal Funds ................................................................................................................................................ 26,393 26,550 32,683 ∂6,290 ∂6,133 Trust Funds .................................................................................................................................................... 192,253 194,098 194,098 ∂1,845 ..........................

OFFICE OF THE INSPECTOR GENERAL 

Program Activities ................................................................................................................................................................ 59,643 64,029 64,029 ∂4,386 ..........................

Trust Funds ................................................................................................................................................................. 5,696 5,561 5,561 ¥135 ..........................

Total, Office of the Inspector General .................................................................................................................... 65,339 69,590 69,590 ∂4,251 ..........................

Federal funds ................................................................................................................................................. 59,643 64,029 64,029 ∂4,386 ..........................Trust funds .................................................................................................................................................... 5,696 5,561 5,561 ¥135 ..........................

Total, Departmental Management .......................................................................................................................... 634,304 577,406 653,421 ∂19,117 ∂76,015 

Federal Funds ................................................................................................................................................ 436,041 377,425 453,440 ∂17,399 ..........................Trust Funds .................................................................................................................................................... 198,263 199,981 199,981 ∂1,718 ..........................
314 

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2004 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL 

FOR FISCAL YEAR 2005—Continued 

[In thousands of dollars] 

Item 2004 comparable Budget estimate Committee rec- ommendation 

Senate Committee recommendation 

compared with (∂ or ¥) 

2004 comparable Budget estimate 

WORKING CAPITAL FUND 

Working capital fund ............................................................................................................................................................ 13,768 25,000 15,000 ∂1,232 ¥10,000 

Total, Title I, Department of Labor ......................................................................................................................... 15,260,386 15,264,260 15,432,189 ∂171,803 ∂167,929 

Federal Funds ................................................................................................................................................ 11,481,732 11,467,974 11,597,200 ∂115,468 ∂129,226 

Current Year .......................................................................................................................................... (8,930,732 ) (8,923,974 ) (9,053,200 ) (∂122,468 ) (∂129,226 ) Fiscal year 2006 ................................................................................................................................... (2,551,000 ) (2,544,000 ) (2,544,000 ) (¥7,000 ) ..........................

Trust Funds .................................................................................................................................................... 3,778,654 3,796,286 3,834,989 ∂56,335 ∂38,703 

TITLE II—DEPARTMENT OF HEALTH AND HUMAN SERVICES 

HEALTH RESOURCES AND SERVICES ADMINISTRATION 

HEALTH RESOURCES AND SERVICES 

Bureau of Primary Health Care 

Community health centers ................................................................................................................................................... 1,617,381 1,835,925 1,867,381 ∂250,000 ∂31,456 Free Clinics Medical Malpractice ......................................................................................................................................... 4,821 4,821 4,821 .......................... ..........................Radiation Exposure Compensation Act ................................................................................................................................ 1,974 1,974 1,974 .......................... ..........................Community Access Program ................................................................................................................................................. 83,674 9,998 88,674 ∂5,000 ∂78,676 Hansen’s Disease Services ................................................................................................................................................... 17,413 17,413 17,413 .......................... ..........................Buildings and Facilities ....................................................................................................................................................... 249 249 249 .......................... ..........................Payment to Hawaii, treatment of Hansen’s ......................................................................................................................... 2,033 2,033 2,033 .......................... ..........................Black lung clinics ................................................................................................................................................................ 5,963 5,963 6,000 ∂37 ∂37 

Subtotal, Bureau of Primary Health Care .............................................................................................................. 1,733,508 1,878,376 1,988,545 ∂255,037 ∂110,169 

Bureau of Health Professions 

National Health Service Corps: 

Field placements ......................................................................................................................................................... 45,506 45,735 45,735 ∂229 ..........................Recruitment ................................................................................................................................................................. 124,397 159,132 127,397 ∂3,000 ¥31,735 
315 

Subtotal, National Health Service Corps ................................................................................................................ 169,903 204,867 173,132 ∂3,229 ¥31,735 

Health Professions: 

Training for Diversity: 

Centers of excellence ......................................................................................................................................... 33,882 .......................... 33,882 .......................... ∂33,882 Health careers opportunity program .................................................................................................................. 35,935 .......................... 35,935 .......................... ∂35,935 Faculty loan repayment ...................................................................................................................................... 1,313 .......................... 1,313 .......................... ∂1,313 Scholarships for disadvantaged students ......................................................................................................... 47,510 9,897 47,510 .......................... ∂37,613 

Subtotal, Training for Diversity ..................................................................................................................... 118,640 9,897 118,640 .......................... ∂108,743 

Training in Primary Care Medicine and Dentistry ............................................................................................................... 81,742 .......................... 90,742 ∂9,000 ∂90,742 Interdisciplinary Community-Based Linkages: 

Area health education centers .................................................................................................................................... 29,206 .......................... 29,206 .......................... ∂29,206 Health education and training centers ....................................................................................................................... 3,851 .......................... 3,851 .......................... ∂3,851 Allied health and other disciplines ............................................................................................................................. 11,849 .......................... 11,849 .......................... ∂11,849 Geriatric programs ...................................................................................................................................................... 31,805 .......................... 31,805 .......................... ∂31,805 Quentin N. Burdick pgm for rural training ................................................................................................................. 6,126 .......................... 6,126 .......................... ∂6,126 

Subtotal, Interdisciplinary Comm. Linkages ........................................................................................................... 82,837 .......................... 82,837 .......................... ∂82,837 

Health Professions Workforce Info & Analysis ..................................................................................................................... 722 999 999 ∂277 ..........................Public Health Workforce Development: 

Public health, preventive med. & dental pgms ......................................................................................................... 9,170 .......................... 9,170 .......................... ∂9,170 Health administration programs ................................................................................................................................. 1,079 .......................... 1,079 .......................... ∂1,079 

Subtotal, Public Health Workforce Development .................................................................................................... 10,249 .......................... 10,249 .......................... ∂10,249 

Nursing Programs: 

Advanced Education Nursing ...................................................................................................................................... 58,636 43,637 58,636 .......................... ∂14,999 Nurse education, practice, and retention ................................................................................................................... 31,768 41,765 41,765 ∂9,997 ..........................Nursing workforce diversity ......................................................................................................................................... 16,402 21,399 21,399 ∂4,997 ..........................Loan repayment and scholarship program ................................................................................................................. 26,736 31,738 31,742 ∂5,006 ∂4 Nursing faculty loan program ..................................................................................................................................... 4,870 4,870 4,870 .......................... ..........................Comprehensive geriatric education ............................................................................................................................. 3,478 3,478 3,478 .......................... ..........................

Subtotal, Nursing programs ................................................................................................................................... 141,890 146,887 161,890 ∂20,000 ∂15,003 Subtotal, Health Professions .................................................................................................................................. 436,080 157,783 465,357 ∂29,277 ∂307,574 

Children’s Hospitals Graduate Medical Education .............................................................................................................. 303,170 303,258 303,258 ∂88 ..........................National Practitioner Data Bank .......................................................................................................................................... 16,000 15,700 15,700 ¥300 ..........................

User Fees ..................................................................................................................................................................... ¥16,000 ¥15,700 ¥15,700 ∂300 ..........................
316 

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2004 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL 

FOR FISCAL YEAR 2005—Continued 

[In thousands of dollars] 

Item 2004 comparable Budget estimate Committee rec- ommendation 

Senate Committee recommendation 

compared with (∂ or ¥) 

2004 comparable Budget estimate 

Health Care Integrity and Protection Data Bank ................................................................................................................. 4,000 4,000 4,000 .......................... ..........................

User Fees ..................................................................................................................................................................... ¥4,000 ¥4,000 ¥4,000 .......................... ..........................

Total, Bureau of Health professions ....................................................................................................................... 909,153 665,908 941,747 ∂32,594 ∂275,839 

Maternal and Child Health Bureau 

Maternal & Child Health Block Grant .................................................................................................................................. 729,817 729,817 734,817 ∂5,000 ∂5,000 Traumatic Brain Injury ......................................................................................................................................................... 9,375 9,375 9,375 .......................... ..........................Healthy Start ........................................................................................................................................................................ 97,751 97,751 105,000 ∂7,249 ∂7,249 Universal Newborn Hearing .................................................................................................................................................. 9,872 .......................... 9,872 .......................... ∂9,872 Emergency medical services for children ............................................................................................................................ 19,860 19,860 20,360 ∂500 ∂500 Poison control ....................................................................................................................................................................... 23,696 23,696 24,000 ∂304 ∂304 

Subtotal, Maternal and Child Health Bureau ........................................................................................................ 890,371 880,499 903,424 ∂13,053 ∂22,925 

HIV/AIDS Bureau 

Ryan White AIDS Programs: 

Emergency Assistance ................................................................................................................................................. 615,023 615,023 615,023 .......................... ..........................Comprehensive Care Programs ................................................................................................................................... 1,085,900 1,120,900 1,120,900 ∂35,000 ..........................

AIDS Drug Assistance Program (ADAP) (NA) ..................................................................................................... (748,872 ) (783,872 ) (783,872 ) (∂35,000 ) ..........................

Early Intervention Program .......................................................................................................................................... 197,170 197,170 197,170 .......................... ..........................Pediatric HIV/AIDS ....................................................................................................................................................... 73,108 73,108 73,108 .......................... ..........................Education and Training Centers ................................................................................................................................. 35,335 35,335 35,335 .......................... ..........................AIDS Dental Services ................................................................................................................................................... 13,325 13,325 13,325 .......................... ..........................

Subtotal, Ryan White AIDS programs ..................................................................................................................... 2,019,861 2,054,861 2,054,861 ∂35,000 ..........................

Evaluation Tap Funding (NA) ............................................................................................................................................... (25,000 ) (25,000 ) (25,000 ) .......................... ..........................

Subtotal, Ryan White AIDS program level .............................................................................................................. 2,044,861 2,079,861 2,079,861 ∂35,000 ..........................

Emergency Drug assistance ................................................................................................................................................. 20,000 .......................... .......................... ¥20,000 ..........................
317 

Telehealth ............................................................................................................................................................................. 3,949 3,949 5,000 ∂1,051 ∂1,051 

Subtotal, HIV/AIDS Bureau ...................................................................................................................................... 2,043,810 2,058,810 2,059,861 ∂16,051 ∂1,051 

Special Programs Bureau 

Organ Transplantation ......................................................................................................................................................... 24,632 24,632 24,632 .......................... ..........................Cord Blood Stem Cell Bank ................................................................................................................................................. 9,941 9,941 9,941 .......................... ..........................Bone Marrow Program .......................................................................................................................................................... 22,662 22,662 22,662 .......................... ..........................Trauma Care ......................................................................................................................................................................... 3,449 .......................... 4,000 ∂551 ∂4,000 State Planning Grants for Health Care Access ................................................................................................................... 14,810 .......................... 8,000 ¥6,810 ∂8,000 

Total, Special programs Bureau ............................................................................................................................. 75,494 57,235 69,235 ¥6,259 ∂12,000 

Rural Health Programs 

Rural Health Research ......................................................................................................................................................... 8,902 8,902 8,902 .......................... ..........................Rural outreach grants .......................................................................................................................................................... 39,601 11,098 39,601 .......................... ∂28,503 Rural and community access to emergency devices .......................................................................................................... 10,933 2,015 10,933 .......................... ∂8,918 Rural Hospital Flexibility Grants .......................................................................................................................................... 39,499 .......................... 39,499 .......................... ∂39,499 State Offices of Rural Health .............................................................................................................................................. 8,390 8,390 8,390 .......................... ..........................Rural EMS ............................................................................................................................................................................. 497 .......................... 997 ∂500 ∂997 Denali Commission ............................................................................................................................................................... 34,793 22,000 41,794 ∂7,001 ∂19,794 

Subtotal, Rural Health programs ........................................................................................................................... 142,615 52,405 150,116 ∂7,501 ∂97,711 

Family Planning .................................................................................................................................................................... 278,283 278,283 308,283 ∂30,000 ∂30,000 Health care-related facilities and activities ........................................................................................................................ 371,536 .......................... 371,536 .......................... ∂371,536 Program Management .......................................................................................................................................................... 148,533 151,317 148,533 .......................... ¥2,784 

Total, Health resources and services ..................................................................................................................... 6,593,303 6,022,833 6,941,280 ∂347,977 ∂918,447 Total, Health resources & services program level ................................................................................................. (6,618,303 ) (6,047,833 ) (6,966,280 ) (∂347,977 ) (∂918,447 ) 

Evaluation tap funding .................................................................................................................................. (25,000 ) (25,000 ) (25,000 ) .......................... ..........................

HEALTH EDUCATION ASSISTANCE LOANS (HEAL) PROGRAM: 

Liquidating account .................................................................................................................................................... (25,000 ) (4,000 ) (4,000 ) (¥21,000 ) ..........................Program management ................................................................................................................................................. 3,353 3,270 3,270 ¥83 ..........................

Total, HEAL .............................................................................................................................................................. 3,353 3,270 3,270 ¥83 ..........................

VACCINE INJURY COMPENSATION PROGRAM TRUST FUND: 

Post-fiscal year 1988 claims ...................................................................................................................................... 66,000 66,000 66,000 .......................... ..........................
318 

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2004 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL 

FOR FISCAL YEAR 2005—Continued 

[In thousands of dollars] 

Item 2004 comparable Budget estimate Committee rec- ommendation 

Senate Committee recommendation 

compared with (∂ or ¥) 

2004 comparable Budget estimate 

HRSA administration ................................................................................................................................................... 3,190 3,176 3,176 ¥14 ..........................

Total, Vaccine Injury Compensation Trust Fund .................................................................................................... 69,190 69,176 69,176 ¥14 ..........................Total, Health Resources and Services Admin ........................................................................................................ 6,665,846 6,095,279 7,013,726 ∂347,880 ∂918,447 Total, HRSA program level ...................................................................................................................................... (6,715,846 ) (6,124,279 ) (7,042,726 ) (∂326,880 ) (∂918,447 ) 

CENTERS FOR DISEASE CONTROL AND PREVENTION 

Infectious Disease ................................................................................................................................................................ 1,641,600 1,643,599 1,675,800 ∂34,200 ∂32,201 

Evaluation Tap Funding (NA) ...................................................................................................................................... (12,794 ) (12,794 ) (12,794 ) .......................... ..........................

Subtotal, Program level .......................................................................................................................................... (1,654,394 ) (1,656,393 ) (1,688,594 ) (∂34,200 ) (∂32,201 ) 

Health Promotion .................................................................................................................................................................. 932,067 989,780 988,090 ∂56,023 ¥1,690 Health Information & Service ............................................................................................................................................... 96,449 96,449 96,449 .......................... ..........................

Evaluation Tap Funding (NA) ...................................................................................................................................... (120,243 ) (139,209 ) (139,209 ) (∂18,966 ) ..........................

Subtotal, Program level .......................................................................................................................................... (216,692 ) (235,658 ) (235,658 ) (∂18,966 ) ..........................

Environmental Health & Injury ............................................................................................................................................. 282,926 282,926 290,126 ∂7,200 ∂7,200 Occupational Safety & Health .............................................................................................................................................. 241,307 242,906 212,490 ¥28,817 ¥30,416 

Evaluation Tap Funding (NA) ...................................................................................................................................... (35,681 ) (35,681 ) (82,097 ) (∂46,416 ) (∂46,416 ) 

Subtotal, Program level .......................................................................................................................................... 276,988 278,587 294,587 ∂17,599 ∂16,000 

Global Health ........................................................................................................................................................................ 279,944 304,444 305,239 ∂25,295 ∂795 Public Health Research ........................................................................................................................................................ 29,107 .......................... .......................... ¥29,107 ..........................

Evaluation Tap Funding (NA) ...................................................................................................................................... .......................... (15,000 ) (35,000 ) (∂35,000 ) (∂20,000 ) 

Subtotal, Program level .......................................................................................................................................... 29,107 15,000 35,000 ∂5,893 ∂20,000 

Public Health Improvement & Leadership ........................................................................................................................... 220,224 188,074 261,858 ∂41,634 ∂73,784 
319 

Evaluation Tap Funding (NA) ...................................................................................................................................... (12,463 ) (12,463 ) .......................... (¥12,463 ) (¥12,463 ) 

Subtotal, Program level .......................................................................................................................................... 232,687 200,537 261,858 ∂29,171 ∂61,321 

Preventive Health and Health Services Block Grant ........................................................................................................... 131,814 131,814 131,814 .......................... ..........................Buildings and Facilities ....................................................................................................................................................... 260,454 81,500 294,500 ∂34,046 ∂213,000 Business Services Support ................................................................................................................................................... 251,273 252,062 282,226 ∂30,953 ∂30,164 

Evaluation Tap Funding (NA) ...................................................................................................................................... (30,953 ) (33,953 ) .......................... (¥30,953 ) (¥33,953 ) 

Subtotal, Program level .......................................................................................................................................... 282,226 286,015 282,226 .......................... ¥3,789 Total, Centers for Disease Control ......................................................................................................................... 4,367,165 4,213,554 4,538,592 ∂171,427 ∂325,038 

Evaluation Tap Funding (NA) ........................................................................................................................ (212,134 ) (249,100 ) (269,100 ) (∂56,966 ) (∂20,000 ) 

Total, Centers for Disease Control program level .................................................................................................. (4,579,299 ) (4,462,654 ) (4,807,692 ) (∂228,393 ) (∂345,038 ) 

NATIONAL INSTITUTES OF HEALTH 

National Cancer Institute ..................................................................................................................................................... 4,739,255 4,870,025 4,894,900 ∂155,645 ∂24,875 National Heart, Lung, and Blood Institute .......................................................................................................................... 2,878,691 2,963,953 2,985,900 ∂107,209 ∂21,947 National Institute of Dental & Craniofacial Research ........................................................................................................ 383,282 394,080 399,200 ∂15,918 ∂5,120 National Institute of Diabetes and Digestive and Kidney Diseases ................................................................................... 1,671,803 1,726,196 1,739,100 ∂67,297 ∂12,904 

Juvenile diabetes ......................................................................................................................................................... (150,000 ) (150,000 ) (150,000 ) .......................... ..........................

Subtotal, NIDDK ...................................................................................................................................................... 1,821,803 1,876,196 1,889,100 ∂67,297 ∂12,904 

National Institute of Neurological Disorders & Stroke ........................................................................................................ 1,501,207 1,545,623 1,569,100 ∂67,893 ∂23,477 National Institute of Allergy and Infectious Diseases ......................................................................................................... 4,155,447 4,325,507 4,307,185 ∂151,738 ¥18,322 

Global HIV/AIDS Fund Transfer ................................................................................................................................... 149,115 100,000 149,115 .......................... ∂49,115 

Subtotal, NIAID ........................................................................................................................................................ 4,304,562 4,425,507 4,456,300 ∂151,738 ∂30,793 

National Institute of General Medical Sciences .................................................................................................................. 1,904,838 1,959,810 1,975,500 ∂70,662 ∂15,690 National Institute of Child Health & Human Development ................................................................................................. 1,242,361 1,280,915 1,288,900 ∂46,539 ∂7,985 National Eye Institute ........................................................................................................................................................... 653,052 671,578 680,300 ∂27,248 ∂8,722 National Institute of Environmental Health Sciences .......................................................................................................... 632,392 650,027 655,100 ∂22,708 ∂5,073 National Institute on Aging .................................................................................................................................................. 1,024,754 1,055,666 1,094,500 ∂69,746 ∂38,834 National Institute of Arthritis and Musculoskeletal and Skin Diseases ............................................................................. 501,066 515,378 520,900 ∂19,834 ∂5,522 National Institute on Deafness and Other Communication Disorders ................................................................................ 382,053 393,507 399,000 ∂16,947 ∂5,493 National Institute of Nursing Research ............................................................................................................................... 134,724 139,198 140,200 ∂5,476 ∂1,002 National Institute on Alcohol Abuse and Alcoholism .......................................................................................................... 428,669 441,911 444,900 ∂16,231 ∂2,989 National Institute on Drug Abuse ........................................................................................................................................ 990,953 1,019,060 1,026,200 ∂35,247 ∂7,140 National Institute of Mental Health ..................................................................................................................................... 1,381,774 1,420,609 1,436,800 ∂55,026 ∂16,191 
320 

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2004 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL 

FOR FISCAL YEAR 2005—Continued 

[In thousands of dollars] 

Item 2004 comparable Budget estimate Committee rec- ommendation 

Senate Committee recommendation 

compared with (∂ or ¥) 

2004 comparable Budget estimate 

National Human Genome Research Institute ....................................................................................................................... 479,073 492,670 496,400 ∂17,327 ∂3,730 National Institute of Biomedical Imaging and Bioengineering ........................................................................................... 287,129 297,647 300,800 ∂13,671 ∂3,153 National Center for Research Resources ............................................................................................................................. 1,179,058 1,094,141 1,213,400 ∂34,342 ∂119,259 National Center for Complementary and Alternative Medicine ........................................................................................... 116,978 121,116 121,900 ∂4,922 ∂784 National Center on Minority Health and Health Disparities ................................................................................................ 191,471 196,780 197,900 ∂6,429 ∂1,120 John E. Fogarty International Center ................................................................................................................................... 65,382 67,182 67,600 ∂2,218 ∂418 National Library of Medicine ................................................................................................................................................ 309,045 325,147 316,900 ∂7,855 ¥8,247 

Evaluation Tap Funding .............................................................................................................................................. (8,200 ) .......................... (8,200 ) .......................... (∂8,200 ) 

Subtotal, NLM ......................................................................................................................................................... 317,245 325,147 325,100 ∂7,855 ¥47 

Office of the Director ........................................................................................................................................................... 327,504 359,645 364,100 ∂36,596 ∂4,455 Buildings and Facilities ....................................................................................................................................................... 88,972 99,500 114,500 ∂25,528 ∂15,000 

Total, N.I.H. appropriations ..................................................................................................................................... 27,800,048 28,526,871 28,900,300 ∂1,100,252 ∂373,429 

Global HIV/AIDS Fund Transfer ...................................................................................................................... ¥149,115 ¥100,000 ¥149,115 .......................... ¥49,115 Evaluation Tap Funding ................................................................................................................................. (8,200 ) .......................... (8,200 ) .......................... (∂8,200 ) 

Total, N.I.H., Program Level .................................................................................................................................... (27,659,133 ) (28,426,871 ) (28,759,385 ) (∂1,100,252 ) (∂332,514 ) 

SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMIN. 

Mental Health: 

Programs of Regional and National Significance ...................................................................................................... 240,796 270,548 303,128 ∂62,332 ∂32,580 Mental Health block grant .......................................................................................................................................... 412,840 414,267 414,267 ∂1,427 ..........................

Evaluation Tap Funding ..................................................................................................................................... (21,850 ) (21,803 ) (21,803 ) (¥47 ) ..........................

Children’s Mental Health ............................................................................................................................................ 102,354 106,013 106,013 ∂3,659 ..........................Grants to States for the Homeless (PATH) ................................................................................................................. 49,760 55,251 55,251 ∂5,491 ..........................Samaritan initiative .................................................................................................................................................... .......................... 10,000 .......................... .......................... ¥10,000 Protection and Advocacy ............................................................................................................................................. 34,620 34,620 34,620 .......................... ..........................

Subtotal, Mental Health .......................................................................................................................................... 840,370 890,699 913,279 ∂72,909 ∂22,580 
321 

Substance Abuse Treatment: 

Programs of Regional and National Significance ...................................................................................................... 419,219 512,732 419,717 ∂498 ¥93,015 

Evaluation Tap Funding ..................................................................................................................................... .......................... (4,300 ) (4,300 ) (∂4,300 ) ..........................

Substance Abuse block grant ..................................................................................................................................... 1,699,946 1,753,035 1,753,035 ∂53,089 ..........................

Evaluation Tap Funding ..................................................................................................................................... (79,200 ) (79,200 ) (79,200 ) .......................... ..........................

Subtotal, Substance Abuse Treatment .......................................................................................................... 2,119,165 2,265,767 2,172,752 ∂53,587 ¥93,015 Subtotal, Program level ................................................................................................................................. 2,198,365 2,349,267 2,256,252 ∂57,887 ¥93,015 

Substance Abuse Prevention: 

Programs of Regional and National Significance ...................................................................................................... 198,458 196,018 198,940 ∂482 ∂2,922 

Program Management and Buildings and Facilities ........................................................................................................... 75,915 76,455 76,455 ∂540 ..........................

Evaluation Tap funding (NA) ...................................................................................................................................... (16,000 ) (16,000 ) (18,000 ) (∂2,000 ) (∂2,000 ) 

Subtotal, Program level .......................................................................................................................................... 91,915 92,455 94,455 ∂2,540 ∂2,000 Total, Substance Abuse and Mental Health ........................................................................................................... 3,233,908 3,428,939 3,361,426 ∂127,518 ¥67,513 

Evaluation Tap funding ................................................................................................................................. (117,050 ) (121,303 ) (123,303 ) (∂6,253 ) (∂2,000 ) 

Total, SAMHS program level ................................................................................................................................... (3,350,958 ) (3,550,242 ) (3,484,729 ) (∂133,771 ) (¥65,513 ) 

AGENCY FOR HEALTHCARE RESEARCH AND QUALITY 

Research on Health Costs, Quality, and Outcomes: 

Federal Funds .............................................................................................................................................................. .......................... .......................... .......................... .......................... ..........................Evaluation Tap funding (NA) ...................................................................................................................................... (245,695 ) (245,695 ) (260,695 ) (∂15,000 ) (∂15,000 ) 

Health Coverage Data Improvement (CPS) ........................................................................................................ .......................... .......................... .......................... .......................... ..........................Clinical effectiveness research (NA) .................................................................................................................. .......................... .......................... (15,000 ) (∂15,000 ) (∂15,000 ) Reducing medical errors (non-add) ................................................................................................................... (79,500 ) (84,000 ) (84,000 ) (∂4,500 ) ..........................

Subtotal including Evaluation Tap funds ..................................................................................................... (245,695 ) (245,695 ) (260,695 ) (∂15,000 ) (∂15,000 ) 

Health Insurance and Expenditure Surveys: Evaluation Tap funding (NA) ......................................................................... (55,300 ) (55,300 ) (55,300 ) .......................... ..........................Program Support .................................................................................................................................................................. .......................... .......................... .......................... .......................... ..........................

Evaluation Tap funding (NA) ...................................................................................................................................... (2,700 ) (2,700 ) (2,700 ) .......................... ..........................

Total, AHRQ ............................................................................................................................................................. (303,695 ) (303,695 ) (318,695 ) (∂15,000 ) (∂15,000 ) 

Federal Funds ................................................................................................................................................ .......................... .......................... .......................... .......................... ..........................Evaluation Tap funding (NA) ......................................................................................................................... (303,695 ) (303,695 ) (318,695 ) (∂15,000 ) (∂15,000 ) 

Total, Public Health Service appropriation ............................................................................................................. 42,066,967 42,264,643 43,814,044 ∂1,747,077 ∂1,549,401 Total, Public Health Service program level ............................................................................................................ (42,608,931 ) (42,867,741 ) (44,413,227 ) (∂1,804,296 ) (∂1,545,486 ) 
322 

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2004 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL 

FOR FISCAL YEAR 2005—Continued 

[In thousands of dollars] 

Item 2004 comparable Budget estimate Committee rec- ommendation 

Senate Committee recommendation 

compared with (∂ or ¥) 

2004 comparable Budget estimate 

CENTERS FOR MEDICARE AND MEDICAID SERVICES 

GRANTS TO STATES FOR MEDICAID 

Medicaid current law benefits ............................................................................................................................................. 172,706,067 167,013,865 167,013,865 ¥5,692,202 ..........................State and local administration ............................................................................................................................................ 9,067,320 9,318,602 9,318,602 ∂251,282 ..........................Vaccines for Children ........................................................................................................................................................... 980,196 1,208,296 1,208,296 ∂228,100 ..........................

Subtotal, Medicaid program level .......................................................................................................................... 182,753,583 177,540,763 177,540,763 ¥5,212,820 ..........................

Less funds advanced in prior year ............................................................................................................... ¥51,861,386 ¥58,416,275 ¥58,416,275 ¥6,554,889 ..........................

Total, Grants to States for medicaid ..................................................................................................................... 130,892,197 119,124,488 119,124,488 ¥11,767,709 ..........................

New advance, 1st quarter ............................................................................................................................. 58,416,275 58,517,290 58,517,290 ∂101,015 ..........................

PAYMENTS TO HEALTH CARE TRUST FUNDS 

Supplemental medical insurance ......................................................................................................................................... 94,518,000 114,002,000 114,002,000 ∂19,484,000 ..........................Hospital insurance for the uninsured .................................................................................................................................. 197,000 87,000 87,000 ¥110,000 ..........................Federal uninsured payment .................................................................................................................................................. 168,000 199,000 199,000 ∂31,000 ..........................Program management .......................................................................................................................................................... 201,100 215,000 215,000 ∂13,900 ..........................Prescription drug eligibility determinations ......................................................................................................................... .......................... 105,900 105,900 ∂105,900 ..........................

Total, Payments to Trust Funds, current law ......................................................................................................... 95,084,100 114,608,900 114,608,900 ∂19,524,800 ..........................

PROGRAM MANAGEMENT 

Medicare reform funding 234 ............................................................................................................................................... (1,000,000 ) (250,000 ) (250,000 ) (¥750,000 ) ..........................Research, Demonstration, Evaluation .................................................................................................................................. 77,791 68,274 77,791 .......................... ∂9,517 Medicare Operations ............................................................................................................................................................. 1,701,038 1,793,879 1,796,879 ∂95,841 ∂3,000 

H.R. 3103 funding (NA) .............................................................................................................................................. (720,000 ) (720,000 ) (720,000 ) .......................... ..........................

Subtotal, Medicare Operations program level ........................................................................................................ (2,421,038 ) (2,513,879 ) (2,516,879 ) (∂95,841 ) (∂3,000 ) 

Revitalization plan ............................................................................................................................................................... 29,619 24,400 24,400 ¥5,219 ..........................
323 

State Survey and Certification ............................................................................................................................................. 251,252 270,392 270,392 ∂19,140 ..........................Federal Administration ......................................................................................................................................................... 577,146 589,182 587,182 ∂10,036 ¥2,000 

Total, Program management, Limitation on new BA ............................................................................................. 2,636,846 2,746,127 2,756,644 ∂119,798 ∂10,517 Total, Program management, program level .......................................................................................................... (4,356,846 ) (3,716,127 ) (3,726,644 ) (¥630,202 ) (∂10,517 ) Total, Center for Medicare and Medicaid Services ................................................................................................ 287,029,418 294,996,805 295,007,322 ∂7,977,904 ∂10,517 

Federal funds ................................................................................................................................................. 284,392,572 292,250,678 292,250,678 ∂7,858,106 ..........................

Current year .......................................................................................................................................... (225,976,297 ) (233,733,388 ) (233,733,388 ) (∂7,757,091 ) ..........................New advance, 1st quarter, fiscal year 2006 ....................................................................................... (58,416,275 ) (58,517,290 ) (58,517,290 ) (∂101,015 ) ..........................

Trust Funds .................................................................................................................................................... 2,636,846 2,746,127 2,756,644 ∂119,798 ∂10,517 

ADMINISTRATION FOR CHILDREN AND FAMILIES 

FAMILY SUPPORT PAYMENTS TO STATES 

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 ................................................................................................................................... 3,897,674 3,940,698 3,940,698 ∂43,024 ..........................Federal incentive payments ........................................................................................................................................ 454,000 446,000 446,000 ¥8,000 ..........................Access and visitation .................................................................................................................................................. 10,000 12,000 12,000 ∂2,000 ..........................

Subtotal, Child Support Enforcement ..................................................................................................................... 4,361,674 4,398,698 4,398,698 ∂37,024 ..........................

Prior year AFDC payments ........................................................................................................................................... 20,000 .......................... .......................... ¥20,000 ..........................

Total, Family support payments program level ...................................................................................................... 4,405,674 4,422,698 4,422,698 ∂17,024 ..........................

Less funds advanced in previous years ........................................................................................................ ¥1,100,000 ¥1,200,000 ¥1,200,000 ¥100,000 ..........................

Total, Family support payments, current request .................................................................................................. 3,305,674 3,222,698 3,222,698 ¥82,976 ..........................

Plus New advance, 1st quarter, fiscal year 2006 ........................................................................................ 1,200,000 1,200,000 1,200,000 .......................... ..........................

Total, Family support payments ............................................................................................................................. 4,505,674 4,422,698 4,422,698 ¥82,976 ..........................

LOW INCOME HOME ENERGY ASSISTANCE 

Formula grants ..................................................................................................................................................................... 1,789,380 1,800,500 1,901,090 ∂111,710 ∂100,590 Emergency allocation: 

Contingent non-emergency funding ............................................................................................................................ 99,410 200,000 99,410 .......................... ¥100,590 
324 

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2004 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL 

FOR FISCAL YEAR 2005—Continued 

[In thousands of dollars] 

Item 2004 comparable Budget estimate Committee rec- ommendation 

Senate Committee recommendation 

compared with (∂ or ¥) 

2004 comparable Budget estimate 

Contingent emergency funding ................................................................................................................................... .......................... .......................... .......................... .......................... ..........................

Total, Low income home energy assistance ........................................................................................................... 1,888,790 2,000,500 2,000,500 ∂111,710 ..........................

REFUGEE AND ENTRANT ASSISTANCE 

Transitional and Medical Services ....................................................................................................................................... 168,975 193,577 193,577 ∂24,602 ..........................Victims of Trafficking ........................................................................................................................................................... 9,909 10,000 10,000 ∂91 ..........................Social Services ..................................................................................................................................................................... 152,218 151,121 155,121 ∂2,903 ∂4,000 Preventive Health ................................................................................................................................................................. 4,792 4,835 4,835 ∂43 ..........................Targeted Assistance ............................................................................................................................................................. 49,025 49,477 49,477 ∂452 ..........................Unaccompanied minors ........................................................................................................................................................ 52,770 54,229 54,229 ∂1,459 ..........................Victims of Torture ................................................................................................................................................................. 9,909 10,000 10,000 ∂91 ..........................

Total, Refugee and entrant assistance .................................................................................................................. 447,598 473,239 477,239 ∂29,641 ∂4,000 

CHILD CARE AND DEVELOPMENT BLOCK GRANT ................................................................................................................. 2,087,310 2,099,729 2,099,729 ∂12,419 ..........................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 ......................................................................................................................................... 5,374,980 5,535,452 5,535,452 ∂160,472 ..........................

Advance from prior year ..................................................................................................................................... (1,391,740 ) (1,400,000 ) (1,400,000 ) (∂8,260 ) ..........................Fiscal year 2006 ................................................................................................................................................. 1,400,000 1,400,000 1,400,000 .......................... ..........................

Subtotal, Head Start, program level ............................................................................................................. 6,774,980 6,935,452 6,935,452 ∂160,472 ..........................

Consolidated Runaway, Homeless Youth Program ..................................................................................................... 89,431 89,447 95,000 ∂5,569 ∂5,553 Maternity Group Homes ............................................................................................................................................... .......................... 10,000 .......................... .......................... ¥10,000 Prevention grants to reduce abuse of runaway youth ............................................................................................... 15,302 15,302 15,802 ∂500 ∂500 Child Abuse State Grants ........................................................................................................................................... 21,883 42,013 27,500 ∂5,617 ¥14,513 Child Abuse Discretionary Activities ........................................................................................................................... 34,386 26,266 34,386 .......................... ∂8,120 Community based child abuse prevention ................................................................................................................. 33,205 65,002 43,205 ∂10,000 ¥21,797 
325 

Abandoned Infants Assistance .................................................................................................................................... 12,052 12,086 12,052 .......................... ¥34 Child Welfare Services ................................................................................................................................................ 289,320 291,986 291,986 ∂2,666 ..........................Child Welfare Training ................................................................................................................................................ 7,411 7,470 7,470 ∂59 ..........................Adoption Opportunities ................................................................................................................................................ 27,103 27,343 27,343 ∂240 ..........................Adoption Incentive (no cap adjustment) .................................................................................................................... 7,456 32,103 32,103 ∂24,647 ..........................Adoption Awareness .................................................................................................................................................... 12,785 12,906 12,906 ∂121 ..........................Compassion Capital Fund ........................................................................................................................................... 47,702 100,000 47,702 .......................... ¥52,298 

Social Services and Income Maintenance Research ........................................................................................................... 13,168 5,982 13,168 .......................... ∂7,186 

Evaluation tap funding ............................................................................................................................................... (6,000 ) .......................... (6,000 ) .......................... (∂6,000 ) 

Subtotal, Program level .......................................................................................................................................... 19,168 5,982 19,168 .......................... ∂13,186 

Developmental Disabilities Program: 

State Councils ............................................................................................................................................................. 73,081 73,081 73,081 .......................... ..........................Protection and Advocacy ............................................................................................................................................. 38,416 38,416 40,000 ∂1,584 ∂1,584 Voting access for individuals with disabilities .......................................................................................................... 14,911 14,912 14,912 ∂1 ..........................Developmental Disabilities Special Projects ............................................................................................................... 11,561 11,642 11,642 ∂81 ..........................Developmental Disabilities University Affiliated ......................................................................................................... 26,803 26,803 31,803 ∂5,000 ∂5,000 

Subtotal, Developmental disabilities ...................................................................................................................... 164,772 164,854 171,438 ∂6,666 ∂6,584 

Native American Programs ................................................................................................................................................... 45,157 45,155 45,157 .......................... ∂2 Community Services: 

Grants to States for Community Services .................................................................................................................. 641,935 494,946 650,000 ∂8,065 ∂155,054 Community Initiative Program: 

Economic Development ....................................................................................................................................... 32,338 32,492 38,000 ∂5,662 ∂5,508 Individual Development Account Initiative ........................................................................................................ 24,695 24,912 24,912 ∂217 ..........................Rural Community Facilities ................................................................................................................................ 7,184 .......................... 7,500 ∂316 ∂7,500 

Subtotal, Community Initiative Program ....................................................................................................... 64,217 57,404 70,412 ∂6,195 ∂13,008 

National Youth Sports ................................................................................................................................................. 17,894 .......................... .......................... ¥17,894 ..........................Community Food and Nutrition ................................................................................................................................... 7,238 .......................... 7,238 .......................... ∂7,238 

Subtotal, Community Services ................................................................................................................................ 731,284 552,350 727,650 ¥3,634 ∂175,300 

Domestic Violence Hotline .................................................................................................................................................... 2,982 3,000 3,500 ∂518 ∂500 Battered Women’s Shelters .................................................................................................................................................. 125,648 125,648 128,000 ∂2,352 ∂2,352 Early Learning Fund ............................................................................................................................................................. 33,580 .......................... 36,000 ∂2,420 ∂36,000 Faith-Based Center .............................................................................................................................................................. 1,386 1,400 1,386 .......................... ¥14 Mentoring Children of Prisoners .......................................................................................................................................... 49,701 50,000 50,000 ∂299 ..........................Independent Living Training Vouchers ................................................................................................................................. 44,734 60,000 44,734 .......................... ¥15,266 
326 

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2004 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL 

FOR FISCAL YEAR 2005—Continued 

[In thousands of dollars] 

Item 2004 comparable Budget estimate Committee rec- ommendation 

Senate Committee recommendation 

compared with (∂ or ¥) 

2004 comparable Budget estimate 

Promoting Responsible Fatherhood ...................................................................................................................................... .......................... 50,000 .......................... .......................... ¥50,000 Abstinence Education ........................................................................................................................................................... 70,049 181,926 100,000 ∂29,951 ¥81,926 

Evaluation Tap Funding .............................................................................................................................................. (4,500 ) (4,500 ) (4,500 ) .......................... ..........................

Program Direction ................................................................................................................................................................. 177,894 190,206 190,206 ∂12,312 ..........................

Total, Children and Families Services Programs ................................................................................................... 8,833,371 9,097,897 9,094,146 ∂260,775 ¥3,751 

Current Year ................................................................................................................................................... (7,433,371 ) (7,697,897 ) (7,694,146 ) (∂260,775 ) (¥3,751 ) Fiscal year 2006 ............................................................................................................................................ (1,400,000 ) (1,400,000 ) (1,400,000 ) .......................... ..........................Evaluation Tap funding ................................................................................................................................. (10,500 ) (4,500 ) (10,500 ) .......................... (∂6,000 ) 

PROMOTING SAFE AND STABLE FAMILIES ............................................................................................................................ 305,000 305,000 305,000 .......................... ..........................

Discretionary Funds ..................................................................................................................................................... 99,383 200,000 99,383 .......................... ¥100,617 

PAYMENTS TO STATES FOR FOSTER CARE AND ADOPTION 

Foster Care ........................................................................................................................................................................... 4,974,200 4,855,100 4,895,500 ¥78,700 ∂40,400 Adoption Assistance ............................................................................................................................................................. 1,699,700 1,770,100 1,770,100 ∂70,400 ..........................Independent living ................................................................................................................................................................ 140,000 140,000 140,000 .......................... ..........................

Total, Payments to States ...................................................................................................................................... 6,813,900 6,765,200 6,805,600 ¥8,300 ∂40,400 

Less Advances from Prior Year ..................................................................................................................... ¥1,745,600 ¥1,767,700 ¥1,767,700 ¥22,100 ..........................

Total, payments, current request .............................................................................................................. 5,068,300 4,997,500 5,037,900 ¥30,400 ∂40,400 New Advance, 1st quarter ......................................................................................................................... 1,767,700 1,767,200 1,767,200 ¥500 ..........................

Total, Administration for Children & Families ....................................................................................................... 26,703,126 27,063,763 27,003,795 ∂300,669 ¥59,968 

Current year ................................................................................................................................................... (22,335,426 ) (22,696,563 ) (22,636,595 ) (∂301,169 ) (¥59,968 ) Fiscal year 2006 ............................................................................................................................................ (4,367,700 ) (4,367,200 ) (4,367,200 ) (¥500 ) ..........................

ADMINISTRATION ON AGING 

Grants to States: 

Supportive Services and Centers ................................................................................................................................ 353,889 357,000 357,000 ∂3,111 ..........................
327 

Preventive Health ........................................................................................................................................................ 21,790 21,919 21,919 ∂129 ..........................Protection of vulnerable older Americans Title VII ..................................................................................................... 19,444 18,559 20,474 ∂1,030 ∂1,915 Family Caregivers ........................................................................................................................................................ 152,738 155,512 157,000 ∂4,262 ∂1,488 Native American Caregivers Support .......................................................................................................................... 6,318 6,355 6,355 ∂37 ..........................

Subtotal, Caregivers ............................................................................................................................................... 159,056 161,867 163,355 ∂4,299 ∂1,488 

Nutrition: 

Congregate Meals ............................................................................................................................................... 386,353 388,646 388,646 ∂2,293 ..........................Home Delivered Meals ........................................................................................................................................ 179,917 180,985 180,985 ∂1,068 ..........................Nutrition Services Incentive Program ................................................................................................................. 148,191 149,183 149,183 ∂992 ..........................

Subtotal, Nutrition ......................................................................................................................................... 714,461 718,814 718,814 ∂4,353 ..........................

Subtotal, Grants to States ...................................................................................................................................... 1,268,640 1,278,159 1,281,562 ∂12,922 ∂3,403 

Grants to Native Americans ................................................................................................................................................. 26,453 26,612 26,612 ∂159 ..........................Aging Research, Training and Special Projects .................................................................................................................. 33,509 23,843 37,647 ∂4,138 ∂13,804 Aging Network Support Activities ......................................................................................................................................... 13,294 13,373 13,373 ∂79 ..........................Alzheimer’s Initiative ............................................................................................................................................................ 11,883 11,500 12,883 ∂1,000 ∂1,383 White House Conference on Aging ....................................................................................................................................... 2,814 4,558 4,558 ∂1,744 ..........................Program Administration ....................................................................................................................................................... 17,324 18,482 18,482 ∂1,158 ..........................

Total, Administration on Aging ............................................................................................................................... 1,373,917 1,376,527 1,395,117 ∂21,200 ∂18,590 

OFFICE OF THE SECRETARY 

GENERAL DEPARTMENTAL MANAGEMENT: 

Federal Funds .............................................................................................................................................................. 174,811 180,045 189,065 ∂14,254 ∂9,020 Trust Funds ................................................................................................................................................................. 5,816 5,851 5,851 ∂35 ..........................

Subtotal ................................................................................................................................................................... (180,627 ) (185,896 ) (194,916 ) (∂14,289 ) (∂9,020 ) 

Evaluation tap funding (ASPE) (NA) ........................................................................................................................... (21,552 ) (21,552 ) (21,552 ) .......................... ..........................Adolescent Family Life (Title XX) ................................................................................................................................ 30,946 44,349 35,000 ∂4,054 ¥9,349 National abstinence education campaign .................................................................................................................. .......................... 10,000 2,500 ∂2,500 ¥7,500 Minority health ............................................................................................................................................................ 55,190 47,236 53,351 ¥1,839 ∂6,115 Office of Women’s Health ........................................................................................................................................... 28,915 29,103 29,103 ∂188 ..........................Minority HIV/AIDS ......................................................................................................................................................... 49,544 52,838 52,838 ∂3,294 ..........................Health care information technology ............................................................................................................................ .......................... 50,000 .......................... .......................... ¥50,000 IT Security and Innovation Fund ................................................................................................................................. 14,847 18,400 14,847 .......................... ¥3,553 
328 

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2004 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL 

FOR FISCAL YEAR 2005—Continued 

[In thousands of dollars] 

Item 2004 comparable Budget estimate Committee rec- ommendation 

Senate Committee recommendation 

compared with (∂ or ¥) 

2004 comparable Budget estimate 

Total, General Departmental Management ............................................................................................................. 360,069 437,822 382,555 ∂22,486 ¥55,267 

Federal Funds ................................................................................................................................................ 354,253 431,971 376,704 ∂22,451 ¥55,267 Trust Funds .................................................................................................................................................... 5,816 5,851 5,851 ∂35 ..........................

OFFICE OF THE INSPECTOR GENERAL: 

Federal Funds .............................................................................................................................................................. 39,094 40,323 40,323 ∂1,229 ..........................

HIPAA funding (NA) ............................................................................................................................................ (160,000 ) (160,000 ) (160,000 ) .......................... ..........................

Total, Inspector General program level ......................................................................................................... (199,094 ) (200,323 ) (200,323 ) (∂1,229 ) ..........................

OFFICE FOR CIVIL RIGHTS: 

Federal Funds .............................................................................................................................................................. 30,607 32,043 32,043 ∂1,436 ..........................Trust Funds ................................................................................................................................................................. 3,294 3,314 3,314 ∂20 ..........................

Total, Office for Civil Rights .................................................................................................................................. 33,901 35,357 35,357 ∂1,456 ..........................

POLICY RESEARCH: 

Federal Funds .............................................................................................................................................................. .......................... .......................... .......................... .......................... ..........................Evaluation Tap funding (NA) ...................................................................................................................................... (20,750 ) (28,750 ) (28,750 ) (∂8,000 ) ..........................

Total, Policy Research ............................................................................................................................................. 20,750 28,750 28,750 ∂8,000 ..........................

MEDICAL BENEFITS FOR COMMISSIONED OFFICERS: 

Retirement payments .................................................................................................................................................. 228,064 241,294 241,294 ∂13,230 ..........................Survivors benefits ........................................................................................................................................................ 14,298 14,750 14,750 ∂452 ..........................Dependents’ medical care ........................................................................................................................................... 79,401 74,592 74,592 ¥4,809 ..........................Military services credits .............................................................................................................................................. .......................... .......................... .......................... .......................... ..........................

Total, Medical benefits for Com Officers (indef) ................................................................................................... 321,763 330,636 330,636 ∂8,873 ..........................

PUBLIC HEALTH AND SOCIAL SERVICE EMERGENCY FUND 

HRSA Homeland security activities ...................................................................................................................................... 542,649 503,649 503,649 ¥39,000 ..........................CDC Homeland security activities ........................................................................................................................................ 1,109,571 1,109,571 1,239,571 ∂130,000 ∂130,000 
329 

Stockpile ............................................................................................................................................................................... 397,640 400,000 400,000 ∂2,360 ..........................NIH Homeland security activities ......................................................................................................................................... .......................... 47,400 47,400 ∂47,400 ..........................Office of the Secretary Homeland security activities .......................................................................................................... 64,438 64,438 64,438 .......................... ..........................Other PHSSEF Homeland security activities ........................................................................................................................ 49,705 100,000 75,000 ∂25,295 ¥25,000 

Total, PHSSEF .......................................................................................................................................................... 2,164,003 2,225,058 2,330,058 ∂166,055 ∂105,000 Total, Office of the Secretary ................................................................................................................................. 2,918,830 3,069,196 3,118,929 ∂200,099 ∂49,733 

Federal Funds ................................................................................................................................................ 2,909,720 3,060,031 3,109,764 ∂200,044 ∂49,733 Trust Funds .................................................................................................................................................... 9,110 9,165 9,165 ∂55 ..........................

Total, Title II, Dept of Health & Human Services .................................................................................................. 360,092,258 368,770,934 370,339,207 ∂10,246,949 ∂1,568,273 

Federal Funds ................................................................................................................................................ 357,446,302 366,015,642 367,573,398 ∂10,127,096 ∂1,557,756 

Current year .......................................................................................................................................... (294,662,327 ) (303,131,152 ) (304,688,908 ) (∂10,026,581 ) (∂1,557,756 ) Fiscal year 2006 ................................................................................................................................... (62,783,975 ) (62,884,490 ) (62,884,490 ) (∂100,515 ) ..........................

Trust Funds .................................................................................................................................................... 2,645,956 2,755,292 2,765,809 ∂119,853 ∂10,517 

TITLE III—DEPARTMENT OF EDUCATION 

EDUCATION FOR THE DISADVANTAGED 

Grants to Local Educational Agencies (LEAs): 

Basic Grants: 

Advance from prior year ..................................................................................................................................... (2,011,272 ) (1,883,584 ) (1,883,584 ) (¥127,688 ) ..........................Forward funded .................................................................................................................................................. 5,147,827 6,147,806 6,194,249 ∂1,046,422 ∂46,443 Current funded ................................................................................................................................................... 3,479 3,500 75,057 ∂71,578 ∂71,557 

Subtotal, Basic grants current year approp ................................................................................................. 5,151,306 6,151,306 6,269,306 ∂1,118,000 ∂118,000 Subtotal, Basic grants total funds available ............................................................................................... (7,162,578 ) (8,034,890 ) (8,152,890 ) (∂990,312 ) (∂118,000 ) 

Basic Grants Fiscal Year 2006 Advance .................................................................................................................... 1,883,584 883,584 835,141 ¥1,048,443 ¥48,443 

Subtotal, Basic grants, program level ................................................................................................................... 7,034,890 7,034,890 7,104,447 ∂69,557 ∂69,557 

Concentration Grants: 

Advance from prior year ..................................................................................................................................... (1,365,031 ) (1,365,031 ) (1,365,031 ) .......................... ..........................Fiscal Year 2006 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 ..................................................................................................................................... (1,670,239 ) (1,969,843 ) (1,969,843 ) (∂299,604 ) ..........................Fiscal Year 2006 Advance ................................................................................................................................. 1,969,843 4,146,187 2,231,954 ∂262,111 ¥1,914,233 
330 

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2004 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL 

FOR FISCAL YEAR 2005—Continued 

[In thousands of dollars] 

Item 2004 comparable Budget estimate Committee rec- ommendation 

Senate Committee recommendation 

compared with (∂ or ¥) 

2004 comparable Budget estimate 

Subtotal, Targeted Grants program level ...................................................................................................... 1,969,843 4,146,187 2,231,954 ∂262,111 ¥1,914,233 

Education Finance Incentive Grants: 

Advance from prior year ..................................................................................................................................... (1,541,759 ) (1,969,843 ) (1,969,843 ) (∂428,084 ) ..........................Fiscal Year 2006 Advance ................................................................................................................................. 1,969,843 793,499 2,756,175 ∂786,332 ∂1,962,676 

Subtotal, Education Finance Incentive Grants .............................................................................................. 1,969,843 793,499 2,756,175 ∂786,332 ∂1,962,676 Subtotal, Grants to LEAs, program level ....................................................................................................... 12,339,607 13,339,607 13,457,607 ∂1,118,000 ∂118,000 

Even Start ............................................................................................................................................................................. 246,910 .......................... .......................... ¥246,910 ..........................Reading First: 

State Grants (forward funded) .................................................................................................................................... 828,923 930,000 867,000 ∂38,077 ¥63,000 Advance from prior year .............................................................................................................................................. (195,000 ) (195,000 ) (195,000 ) .......................... ..........................Fiscal Year 2006 Advance .......................................................................................................................................... 195,000 195,000 195,000 .......................... ..........................

Subtotal, Reading First State Grants ..................................................................................................................... 1,023,923 1,125,000 1,062,000 ∂38,077 ¥63,000 

Early Reading First ............................................................................................................................................................... 94,439 132,000 110,000 ∂15,561 ¥22,000 Striving readers .................................................................................................................................................................... .......................... 100,000 25,000 ∂25,000 ¥75,000 Literacy through School Libraries ........................................................................................................................................ 19,842 19,842 22,842 ∂3,000 ∂3,000 State Agency Programs: 

Migrant ........................................................................................................................................................................ 393,577 393,577 393,577 .......................... ..........................Neglected and Delinquent/High Risk Youth ................................................................................................................ 48,395 48,395 52,000 ∂3,605 ∂3,605 

Subtotal, State Agency programs ........................................................................................................................... 441,972 441,972 445,577 ∂3,605 ∂3,605 

Evaluation ............................................................................................................................................................................. 8,790 9,500 9,500 ∂710 ..........................Assistance for local school improvement ............................................................................................................................ .......................... .......................... 100,000 ∂100,000 ∂100,000 Comprehensive School Reform Demonstration .................................................................................................................... 233,613 .......................... 233,613 .......................... ∂233,613 Migrant Education: 

High School Equivalency Program .............................................................................................................................. 18,888 18,888 18,888 .......................... ..........................College Assistance Migrant Program .......................................................................................................................... 15,657 15,657 15,657 .......................... ..........................
331 

Subtotal, Migrant Education ................................................................................................................................... 34,545 34,545 34,545 .......................... ..........................Total, Education for the disadvantaged ................................................................................................................. 14,443,641 15,202,466 15,500,684 ∂1,057,043 ∂298,218 

Current Year ................................................................................................................................................... (7,060,340 ) (7,819,165 ) (8,117,383 ) (∂1,057,043 ) (∂298,218 ) Fiscal year 2006 ............................................................................................................................................ (7,383,301 ) (7,383,301 ) (7,383,301 ) .......................... ..........................

Subtotal, forward funded ........................................................................................................................................ (6,899,245 ) (7,519,778 ) (7,840,439 ) (∂941,194 ) (∂320,661 ) 

IMPACT AID 

Basic Support Payments ...................................................................................................................................................... 1,063,687 1,063,687 1,063,687 .......................... ..........................Payments for Children with Disabilities .............................................................................................................................. 50,369 50,369 50,369 .......................... ..........................Facilities Maintenance (Sec. 8008) ..................................................................................................................................... 7,901 7,901 7,901 .......................... ..........................Construction (Sec. 8007) ..................................................................................................................................................... 45,936 45,936 45,936 .......................... ..........................Payments for Federal Property (Sec. 8002) ......................................................................................................................... 61,634 61,634 61,634 .......................... ..........................

Total, Impact aid .................................................................................................................................................... 1,229,527 1,229,527 1,229,527 .......................... ..........................

SCHOOL IMPROVEMENT PROGRAMS 

State Grants for Improving Teacher Quality ........................................................................................................................ 1,495,126 1,495,126 1,540,126 ∂45,000 ∂45,000 

Advance from prior year .............................................................................................................................................. (1,150,000 ) (1,435,000 ) (1,435,000 ) (∂285,000 ) ..........................Fiscal year 2006 .......................................................................................................................................................... 1,435,000 1,435,000 1,435,000 .......................... ..........................

Subtotal, State Grants for Improving Teacher Quality, program level .................................................................. 2,930,126 2,930,126 2,975,126 ∂45,000 ∂45,000 

Early Childhood Educator Professional Development .......................................................................................................... 14,814 14,814 14,814 .......................... ..........................Mathematics and Science Partnerships .............................................................................................................................. 149,115 269,115 200,000 ∂50,885 ¥69,115 State Grants for Innovative Education (Education Block Grant) ........................................................................................ 296,548 296,549 .......................... ¥296,548 ¥296,549 

Advance from prior year .............................................................................................................................................. (285,000 ) .......................... .......................... (¥285,000 ) ..........................Fiscal year 2006 .......................................................................................................................................................... .......................... .......................... .......................... .......................... ..........................

Subtotal, Education Block Grant, program level .................................................................................................... 296,548 296,549 .......................... ¥296,548 ¥296,549 

Educational Technology State Grants .................................................................................................................................. 691,841 691,841 691,841 .......................... ..........................21st Century Community Learning Centers ......................................................................................................................... 999,070 999,070 1,007,000 ∂7,930 ∂7,930 State Assessments/Enhanced Assessment Instruments ...................................................................................................... 390,000 410,000 420,000 ∂30,000 ∂10,000 Statewide data systems ....................................................................................................................................................... .......................... .......................... 40,000 ∂40,000 ∂40,000 Javits gifted talented education .......................................................................................................................................... 11,111 .......................... 12,111 ∂1,000 ∂12,111 Foreign language assistance ............................................................................................................................................... 16,546 .......................... 19,000 ∂2,454 ∂19,000 Education for Homeless Children & Youth .......................................................................................................................... 59,646 59,646 62,000 ∂2,354 ∂2,354 Training and Advisory Services (Civil Rights) ..................................................................................................................... 7,243 7,243 7,243 .......................... ..........................Education for Native Hawaiians .......................................................................................................................................... 33,302 33,302 36,000 ∂2,698 ∂2,698 Alaska Native Education Equity ........................................................................................................................................... 33,302 33,302 36,000 ∂2,698 ∂2,698 
332 

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2004 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL 

FOR FISCAL YEAR 2005—Continued 

[In thousands of dollars] 

Item 2004 comparable Budget estimate Committee rec- ommendation 

Senate Committee recommendation 

compared with (∂ or ¥) 

2004 comparable Budget estimate 

Rural Education .................................................................................................................................................................... 167,831 167,831 175,000 ∂7,169 ∂7,169 Comprehensive Centers ........................................................................................................................................................ 57,283 27,654 57,283 .......................... ∂29,629 Supplemental Education grants 5 ........................................................................................................................................ 15,068 15,068 17,214 ∂2,146 ∂2,146 

Total, School improvement programs ..................................................................................................................... 5,872,846 5,955,561 5,770,632 ¥102,214 ¥184,929 

Current Year ................................................................................................................................................... (4,437,846 ) (4,520,561 ) (4,335,632 ) (¥102,214 ) (¥184,929 ) Fiscal year 2006 ............................................................................................................................................ (1,435,000 ) (1,435,000 ) (1,435,000 ) .......................... ..........................

Subtotal, forward funded ........................................................................................................................................ (4,249,177 ) (4,389,178 ) (4,095,967 ) (¥153,210 ) (¥293,211 ) 

INDIAN EDUCATION 

Grants to Local Educational Agencies ................................................................................................................................. 95,933 95,933 95,933 .......................... ..........................Federal Programs: 

Special Programs for Indian Children ........................................................................................................................ 19,753 19,753 19,753 .......................... ..........................National Activities ....................................................................................................................................................... 5,170 5,170 5,170 .......................... ..........................

Subtotal, Federal Programs .................................................................................................................................... 24,923 24,923 24,923 .......................... ..........................Total, Indian Education .......................................................................................................................................... 120,856 120,856 120,856 .......................... ..........................

INNOVATION AND IMPROVEMENT 

Troops-to-Teachers ............................................................................................................................................................... 14,912 14,912 14,912 .......................... ..........................Transition to Teaching ......................................................................................................................................................... 45,295 45,295 45,295 .......................... ..........................National Writing Project ....................................................................................................................................................... 17,894 .......................... 24,000 ∂6,106 ∂24,000 Teaching of Traditional American History ............................................................................................................................ 119,292 119,292 120,000 ∂708 ∂708 School Leadership ................................................................................................................................................................ 12,346 .......................... 16,000 ∂3,654 ∂16,000 Advanced Credentialing ....................................................................................................................................................... 18,391 7,000 17,000 ¥1,391 ∂10,000 Charter Schools Grants ........................................................................................................................................................ 218,702 218,702 218,702 .......................... ..........................Credit Enhancement for Charter School Facilities .............................................................................................................. 37,279 100,000 37,279 .......................... ¥62,721 Voluntary Public School Choice ............................................................................................................................................ 26,757 26,757 26,757 .......................... ..........................Magnet Schools Assistance .................................................................................................................................................. 108,640 108,640 108,640 .......................... ..........................Choice Incentive fund .......................................................................................................................................................... .......................... 50,000 .......................... .......................... ¥50,000 
333 

Fund for the Improvement of Education (FIE): 

Current funded ............................................................................................................................................................ 356,197 .......................... 372,673 ∂16,476 ∂372,673 Forward funded ........................................................................................................................................................... 74,073 120,185 74,073 .......................... ¥46,112 

Subtotal, FIE ........................................................................................................................................................... 430,270 120,185 446,746 ∂16,476 ∂326,561 

Ready to Learn television ..................................................................................................................................................... 22,864 22,864 24,000 ∂1,136 ∂1,136 Dropout Prevention Programs ............................................................................................................................................... 4,970 .......................... 10,000 ∂5,030 ∂10,000 Close Up Fellowships ........................................................................................................................................................... 1,481 .......................... 1,481 .......................... ∂1,481 Advanced Placement Fees .................................................................................................................................................... 23,534 51,534 33,534 ∂10,000 ¥18,000 

Total, Innovation and Improvement ........................................................................................................................ 1,102,627 885,181 1,144,346 ∂41,719 ∂259,165 Subtotal, forward funded ........................................................................................................................................ (74,073 ) (120,185 ) (74,073 ) .......................... (¥46,112 ) 

SAFE SCHOOLS AND CITIZENSHIP EDUCATION 

Safe and Drug Free Schools and Communities: 

State Grants, current funded ...................................................................................................................................... 440,908 440,908 440,908 .......................... ..........................

Advance from prior year ..................................................................................................................................... (330,000 ) .......................... .......................... (¥330,000 ) ..........................Fiscal year 2006 ................................................................................................................................................. .......................... .......................... .......................... .......................... ..........................

State Grants, program level ........................................................................................................................................ 440,908 440,908 440,908 .......................... ..........................

National Programs ................................................................................................................................................................ 153,767 175,069 166,767 ∂13,000 ¥8,302 Alcohol Abuse Reduction ...................................................................................................................................................... 29,823 .......................... 35,000 ∂5,177 ∂35,000 Mentoring Programs ............................................................................................................................................................. 49,705 100,000 65,000 ∂15,295 ¥35,000 Character education ............................................................................................................................................................. 24,691 24,691 24,691 .......................... ..........................Elementary and Secondary School Counseling .................................................................................................................... 33,799 .......................... 36,000 ∂2,201 ∂36,000 Carol M. White Physical Education for Progress ................................................................................................................. 69,587 69,587 75,000 ∂5,413 ∂5,413 Civic Education .................................................................................................................................................................... 28,642 28,642 30,642 ∂2,000 ∂2,000 State Grants for Incarcerated Youth Offenders ................................................................................................................... 24,853 .......................... 28,000 ∂3,147 ∂28,000 

Total, Safe Schools and Citizenship Education ..................................................................................................... 855,775 838,897 902,008 ∂46,233 ∂63,111 

Current Year ................................................................................................................................................... (855,775 ) (838,897 ) (902,008 ) (∂46,233 ) (∂63,111 ) Fiscal year 2006 ............................................................................................................................................ .......................... .......................... .......................... .......................... ..........................

Subtotal, forward funded ........................................................................................................................................ (465,761 ) (440,908 ) (468,908 ) (∂3,147 ) (∂28,000 ) 

ENGLISH LANGUAGE ACQUISITION 

Current funded ..................................................................................................................................................................... 124,220 85,500 85,500 ¥38,720 ..........................Forward funded .................................................................................................................................................................... 556,995 595,715 614,500 ∂57,505 ∂18,785 

Total, English Language Acquisition ...................................................................................................................... 681,215 681,215 700,000 ∂18,785 ∂18,785 
334 

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2004 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL 

FOR FISCAL YEAR 2005—Continued 

[In thousands of dollars] 

Item 2004 comparable Budget estimate Committee rec- ommendation 

Senate Committee recommendation 

compared with (∂ or ¥) 

2004 comparable Budget estimate 

SPECIAL EDUCATION 

State Grants: 

Grants to States Part B advance funded ................................................................................................................... 5,413,000 5,413,000 5,413,000 .......................... ..........................

Part B advance from prior year ......................................................................................................................... (5,672,000 ) (5,413,000 ) (5,413,000 ) (¥259,000 ) ..........................

Grants to States Part B current year ......................................................................................................................... 4,655,106 5,655,106 5,815,981 ∂1,160,875 ∂160,875 

Subtotal, Grants to States, program level ............................................................................................................. 10,068,106 11,068,106 11,228,981 ∂1,160,875 ∂160,875 

Preschool Grants ......................................................................................................................................................... 387,699 387,699 390,000 ∂2,301 ∂2,301 Grants for Infants and Families ................................................................................................................................. 444,363 466,581 444,363 .......................... ¥22,218 

Subtotal, State grants, program level .................................................................................................................... 10,900,168 11,922,386 12,063,344 ∂1,163,176 ∂140,958 

IDEA National Activities (current funded): 

State Program Improvement Grants ........................................................................................................................... 51,061 51,061 51,061 .......................... ..........................Research and innovation in special education .......................................................................................................... 78,125 78,125 78,125 .......................... ..........................Technical Assistance and Dissemination ................................................................................................................... 52,819 52,819 54,000 ∂1,181 ∂1,181 Personnel Preparation ................................................................................................................................................. 91,357 91,357 93,357 ∂2,000 ∂2,000 Parent Information Centers ......................................................................................................................................... 26,173 26,173 27,500 ∂1,327 ∂1,327 Technology and Media Services .................................................................................................................................. 39,129 32,305 39,129 .......................... ∂6,824 

Subtotal, IDEA special programs ............................................................................................................................ 338,664 331,840 343,172 ∂4,508 ∂11,332 Total, Special education ......................................................................................................................................... 11,238,832 12,254,226 12,406,516 ∂1,167,684 ∂152,290 

Current Year ................................................................................................................................................... (5,825,832 ) (6,841,226 ) (6,993,516 ) (∂1,167,684 ) (∂152,290 ) Fiscal year 2006 ............................................................................................................................................ (5,413,000 ) (5,413,000 ) (5,413,000 ) .......................... ..........................

Subtotal, Forward funded ....................................................................................................................................... (5,538,229 ) (6,560,447 ) (6,701,405 ) (∂1,163,176 ) (∂140,958 ) 

REHABILITATION SERVICES AND DISABILITY RESEARCH 

Vocational Rehabilitation State Grants ............................................................................................................................... 2,584,162 2,635,845 2,635,845 ∂51,683 ..........................Vocational Rehabilitation Incentive Grants ......................................................................................................................... .......................... 61,800 .......................... .......................... ¥61,800 Client Assistance State grants ............................................................................................................................................ 11,997 11,997 13,000 ∂1,003 ∂1,003 
335 

Training ................................................................................................................................................................................ 39,139 39,139 39,139 .......................... ..........................Demonstration and training programs ................................................................................................................................ 24,286 18,784 24,286 .......................... ∂5,502 Migrant and seasonal farmworkers ..................................................................................................................................... 2,321 .......................... 2,500 ∂179 ∂2,500 Recreational programs ......................................................................................................................................................... 2,564 .......................... 2,750 ∂186 ∂2,750 Protection and advocacy of individual rights (PAIR) .......................................................................................................... 16,790 19,570 18,000 ∂1,210 ¥1,570 Projects with industry .......................................................................................................................................................... 21,799 .......................... 22,000 ∂201 ∂22,000 Supported employment State grants ................................................................................................................................... 37,680 .......................... 38,000 ∂320 ∂38,000 Independent living: 

State grants ................................................................................................................................................................ 22,020 22,020 23,000 ∂980 ∂980 Centers ........................................................................................................................................................................ 73,563 73,563 75,000 ∂1,437 ∂1,437 Services for older blind individuals ............................................................................................................................ 31,811 31,811 31,811 .......................... ..........................

Subtotal, Independent living .................................................................................................................................. 127,394 127,394 129,811 ∂2,417 ∂2,417 

Program Improvement .......................................................................................................................................................... 889 850 850 ¥39 ..........................Evaluation ............................................................................................................................................................................. 988 1,500 1,500 ∂512 ..........................Helen Keller National Center for Deaf/Blind ........................................................................................................................ 8,666 8,666 9,000 ∂334 ∂334 National Inst. Disability and Rehab. Research (NIDRR) ..................................................................................................... 106,652 106,652 109,152 ∂2,500 ∂2,500 Assistive Technology ............................................................................................................................................................. 25,943 15,000 31,495 ∂5,552 ∂16,495 

Subtotal, discretionary programs ........................................................................................................................... 427,108 411,352 441,483 ∂14,375 ∂30,131 Total, Rehabilitation services ................................................................................................................................. 3,011,270 3,047,197 3,077,328 ∂66,058 ∂30,131 

SPECIAL INSTITUTIONS FOR PERSONS WITH DISABILITIES 

AMERICAN PRINTING HOUSE FOR THE BLIND ...................................................................................................................... 16,403 16,403 17,000 ∂597 ∂597 NATIONAL TECHNICAL INSTITUTE FOR THE DEAF (NTID): 

Operations ................................................................................................................................................................... 53,118 53,118 54,105 ∂987 ∂987 Construction ................................................................................................................................................................ 365 685 1,685 ∂1,320 ∂1,000 

Total, NTID .............................................................................................................................................................. 53,483 53,803 55,790 ∂2,307 ∂1,987 

Gallaudet University ............................................................................................................................................................. 100,205 100,205 105,400 ∂5,195 ∂5,195 

Total, Special Institutions for Persons with Disabilities ........................................................................................ 170,091 170,411 178,190 ∂8,099 ∂7,779 

VOCATIONAL AND ADULT EDUCATION 

Vocational Education: 

Basic State Grants/Secondary & Technical Education State Grants, current funded ............................................... 403,295 220,146 403,295 .......................... ∂183,149 

Advance from prior year ..................................................................................................................................... (791,000 ) (791,000 ) (791,000 ) .......................... ..........................
336 

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2004 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL 

FOR FISCAL YEAR 2005—Continued 

[In thousands of dollars] 

Item 2004 comparable Budget estimate Committee rec- ommendation 

Senate Committee recommendation 

compared with (∂ or ¥) 

2004 comparable Budget estimate 

Fiscal year 2006 ................................................................................................................................................. 791,000 791,000 791,000 .......................... ..........................

Subtotal, Basic State Grants, program level ......................................................................................................... 1,194,295 1,011,146 1,194,295 .......................... ∂183,149 

Tech-Prep Education State Grants .............................................................................................................................. 106,665 .......................... 106,665 .......................... ∂106,665 National Programs ....................................................................................................................................................... 11,852 .......................... 11,852 .......................... ∂11,852 Tech-Prep Education Demonstration ........................................................................................................................... 4,939 .......................... 4,939 .......................... ∂4,939 Occupational and Employment Information Program ................................................................................................. 9,241 .......................... 9,241 .......................... ∂9,241 

Subtotal, Vocational Education .............................................................................................................................. 1,326,992 1,011,146 1,326,992 .......................... ∂315,846 

Adult Education: 

State Grants/Adult basic and literacy education: State Grants, current funded ...................................................... 574,266 574,266 574,266 .......................... ..........................National Programs: 

National Leadership Activities ........................................................................................................................... 9,169 9,169 9,169 .......................... ..........................National Institute for Literacy ............................................................................................................................ 6,692 6,692 6,692 .......................... ..........................

Subtotal, National programs ......................................................................................................................... 15,861 15,861 15,861 .......................... ..........................

Subtotal, Adult education ....................................................................................................................................... 590,127 590,127 590,127 .......................... ..........................

Smaller Learning Communities, current funded .................................................................................................................. 8,698 .......................... 8,698 .......................... ∂8,698 Smaller Learning Communities, forward funded ................................................................................................................. 165,269 .......................... 165,269 .......................... ∂165,269 Community Technology Centers ........................................................................................................................................... 9,941 .......................... 11,000 ∂1,059 ∂11,000 

Total, Vocational and adult education ................................................................................................................... 2,101,027 1,601,273 2,102,086 ∂1,059 ∂500,813 

Current Year ................................................................................................................................................... (1,310,027 ) (810,273 ) (1,311,086 ) (∂1,059 ) (∂500,813 ) Fiscal year 2006 ............................................................................................................................................ (791,000 ) (791,000 ) (791,000 ) .......................... ..........................

Subtotal, forward funded ........................................................................................................................................ (1,291,388 ) (810,273 ) (1,291,388 ) .......................... (∂481,115 ) 

STUDENT FINANCIAL ASSISTANCE 

Pell Grants—maximum grant (NA) ..................................................................................................................................... (4,050 ) (4,050 ) (4,050 ) .......................... ..........................Pell Grants—Regular Program ............................................................................................................................................ 12,006,738 12,830,000 12,830,000 ∂823,262 ..........................
337 

Enhanced Pell grants for State scholars ............................................................................................................................. .......................... 33,000 .......................... .......................... ¥33,000 Federal Supplemental Educational Opportunity Grants ....................................................................................................... 770,305 770,305 799,850 ∂29,545 ∂29,545 Federal Work Study ............................................................................................................................................................... 998,243 998,243 998,243 .......................... ..........................Federal Perkins Loans: 

Capital Contributions .................................................................................................................................................. 98,764 .......................... 98,764 .......................... ∂98,764 Loan Cancellations ...................................................................................................................................................... 66,665 66,665 66,665 .......................... ..........................

Subtotal, Federal Perkins loans .............................................................................................................................. 165,429 66,665 165,429 .......................... ∂98,764 

LEAP program ....................................................................................................................................................................... 66,172 .......................... 66,172 .......................... ∂66,172 

Total, Student Financial Assistance ....................................................................................................................... 14,006,887 14,698,213 14,859,694 ∂852,807 ∂161,481 

STUDENT AID ADMINISTRATION 

Administrative Costs ............................................................................................................................................................ 116,727 934,639 121,000 ∂4,273 ¥813,639 Fed Direct Student Loan Reclassification (Leg prop) .......................................................................................................... .......................... ¥795,000 .......................... .......................... ∂795,000 

HIGHER EDUCATION 

Aid for Institutional Development: 

Strengthening Institutions ........................................................................................................................................... 80,986 80,986 85,000 ∂4,014 ∂4,014 Hispanic Serving Institutions ...................................................................................................................................... 93,993 95,873 100,000 ∂6,007 ∂4,127 Strengthening Historically Black Colleges (HBCUs) ................................................................................................... 222,764 240,500 240,500 ∂17,736 ..........................Strengthening historically black graduate insts ........................................................................................................ 53,100 58,500 58,500 ∂5,400 ..........................Strengthening Alaska & Hawaiian-Serving Insts ....................................................................................................... 10,935 6,137 13,000 ∂2,065 ∂6,863 Strengthening Tribal Colleges ..................................................................................................................................... 23,287 23,753 25,000 ∂1,713 ∂1,247 

Subtotal, Aid for Institutional development ........................................................................................................... 485,065 505,749 522,000 ∂36,935 ∂16,251 

International Education and Foreign Language: 

Domestic Programs ..................................................................................................................................................... 89,211 89,211 89,211 .......................... ..........................Overseas Programs ...................................................................................................................................................... 12,840 12,840 12,840 .......................... ..........................Institute for International Public Policy ...................................................................................................................... 1,629 1,629 1,629 .......................... ..........................

Subtotal, International Education & Foreign Lang ................................................................................................ 103,680 103,680 103,680 .......................... ..........................

Fund for the Improvement of Postsec. Ed. (FIPSE) ............................................................................................................. 157,700 32,011 157,700 .......................... ∂125,689 Minority Science and Engineering Improvement .................................................................................................................. 8,889 8,889 8,889 .......................... ..........................Interest Subsidy Grants ........................................................................................................................................................ 1,988 1,500 1,500 ¥488 ..........................Tribally Controlled Postsec Voc/Tech Institutions ................................................................................................................ 7,185 7,185 8,000 ∂815 ∂815 Federal TRIO Programs ......................................................................................................................................................... 832,559 832,559 844,500 ∂11,941 ∂11,941 GEAR UP ............................................................................................................................................................................... 298,230 298,230 302,500 ∂4,270 ∂4,270 Byrd Honors Scholarships .................................................................................................................................................... 40,758 40,758 41,000 ∂242 ∂242 Javits Fellowships ................................................................................................................................................................. 9,876 9,876 9,876 .......................... ..........................
338 

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2004 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL 

FOR FISCAL YEAR 2005—Continued 

[In thousands of dollars] 

Item 2004 comparable Budget estimate Committee rec- ommendation 

Senate Committee recommendation 

compared with (∂ or ¥) 

2004 comparable Budget estimate 

Graduate Assistance in Areas of National Need ................................................................................................................. 30,616 30,616 30,616 .......................... ..........................Teacher Quality Enhancement Grants .................................................................................................................................. 88,888 88,888 88,888 .......................... ..........................Child Care Access Means Parents in School ....................................................................................................................... 16,099 16,099 16,099 .......................... ..........................Demonstration in Disabilities/Higher Education .................................................................................................................. 6,913 .......................... 7,000 ∂87 ∂7,000 Underground Railroad Program ............................................................................................................................................ 2,222 .......................... 2,222 .......................... ∂2,222 GPRA data/HEA program evaluation .................................................................................................................................... 988 988 988 .......................... ..........................B.J. Stupak Olympic Scholarships ........................................................................................................................................ 988 .......................... .......................... ¥988 ..........................Thurgood Marshall legal educational opportunity program ................................................................................................ .......................... .......................... 3,000 ∂3,000 ∂3,000 

Total, Higher education .......................................................................................................................................... 2,092,644 1,977,028 2,148,458 ∂55,814 ∂171,430 

HOWARD UNIVERSITY 

Academic Program ............................................................................................................................................................... 205,212 205,164 206,164 ∂952 ∂1,000 Endowment Program ............................................................................................................................................................ 3,552 3,600 3,600 ∂48 ..........................Howard University Hospital .................................................................................................................................................. 29,999 29,999 29,999 .......................... ..........................

Total, Howard University ......................................................................................................................................... 238,763 238,763 239,763 ∂1,000 ∂1,000 

College Housing and Academic Facilities Loans Program: (CHAFL) ................................................................................... 769 578 578 ¥191 ..........................HBCU Capital Financing Program Federal Adm .................................................................................................................. 209 212 212 ∂3 ..........................

INSTITUTE OF EDUCATION SCIENCES 

Research and Statistics: 

Research, development and dissemination ................................................................................................................ 165,518 185,000 165,518 .......................... ¥19,482 Statistics ..................................................................................................................................................................... 91,664 91,664 91,664 .......................... ..........................Regional Educational Laboratories ............................................................................................................................. 66,665 .......................... 66,665 .......................... ∂66,665 Assessment: 

National Assessment .......................................................................................................................................... 89,703 89,703 89,703 .......................... ..........................National Assessment Governing Board .............................................................................................................. 5,060 5,129 5,129 ∂69 ..........................
339 

Subtotal, Assessment .................................................................................................................................... 94,763 94,832 94,832 ∂69 ..........................

Subtotal, Research and statistics .......................................................................................................................... 418,610 371,496 418,679 ∂69 ∂47,183 Total, IES ................................................................................................................................................................. 418,610 371,496 418,679 ∂69 ∂47,183 

DEPARTMENTAL MANAGEMENT 

PROGRAM ADMINISTRATION .................................................................................................................................................. 420,379 429,778 420,379 .......................... ¥9,399 OFFICE FOR CIVIL RIGHTS .................................................................................................................................................... 88,305 92,801 92,801 ∂4,496 ..........................OFFICE OF THE INSPECTOR GENERAL .................................................................................................................................. 46,624 50,576 50,576 ∂3,952 ..........................

Total, Departmental management .......................................................................................................................... 555,308 573,155 563,756 ∂8,448 ¥9,399 Total: Elementary and Secondary Education Act programs ................................................................................... 24,490,395 24,913,703 25,553,020 ∂1,062,625 ∂639,317 Total, Title III, Department of Education ................................................................................................................ 58,257,624 59,985,894 61,484,313 ∂3,226,689 ∂1,498,419 

Current Year ................................................................................................................................................... (43,235,323 ) (44,963,593 ) (46,462,012 ) (∂3,226,689 ) (∂1,498,419 ) Fiscal year 2006 ............................................................................................................................................ (15,022,301 ) (15,022,301 ) (15,022,301 ) .......................... ..........................

TITLE IV—RELATED AGENCIES 

ARMED FORCES RETIREMENT HOME 

Operations and Maintenance ............................................................................................................................................... 62,923 57,195 57,195 ¥5,728 ..........................Capital Program ................................................................................................................................................................... 1,971 4,000 4,000 ∂2,029 ..........................

Total, AFRH ............................................................................................................................................................. 64,894 61,195 61,195 ¥3,699 ..........................

CORPORATION FOR NATIONAL AND COMMUNITY SERVICE 6

Volunteers in Service to America (VISTA) ............................................................................................................................ 93,731 96,428 96,428 ∂2,697 ..........................Volunteers in Homeland Security ......................................................................................................................................... 9,876 15,000 5,000 ¥4,876 ¥10,000 National Senior Volunteer Corps: 

Foster Grandparents Program ..................................................................................................................................... 110,121 106,700 112,323 ∂2,202 ∂5,623 Senior Companion Program ......................................................................................................................................... 45,987 46,563 46,563 ∂576 ..........................Retired Senior Volunteer Program ............................................................................................................................... 58,156 69,884 60,000 ∂1,844 ¥9,884 Senior Demonstration Program ................................................................................................................................... .......................... 1,397 .......................... .......................... ¥1,397 

Subtotal, Senior Volunteers .................................................................................................................................... 214,264 224,544 218,886 ∂4,622 ¥5,658 

Program Administration ....................................................................................................................................................... 36,469 39,363 37,500 ∂1,031 ¥1,863 

Total, Domestic Volunteer Service Programs .......................................................................................................... 354,340 375,335 357,814 ∂3,474 ¥17,521 
340 

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2004 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL 

FOR FISCAL YEAR 2005—Continued 

[In thousands of dollars] 

Item 2004 comparable Budget estimate Committee rec- ommendation 

Senate Committee recommendation 

compared with (∂ or ¥) 

2004 comparable Budget estimate 

CORPORATION FOR PUBLIC BROADCASTING: 

Fiscal year 2007 (current) with fiscal year 2006 comparable .................................................................................. 400,000 .......................... 400,000 .......................... ∂400,000 Fiscal year 2006 advance with fiscal year 2005 comparable (NA) ........................................................................... (390,000 ) (400,000 ) (400,000 ) (∂10,000 ) ..........................Fiscal year 2005 advance with fiscal year 2004 comparable (NA) ........................................................................... (377,758 ) (390,000 ) (390,000 ) (∂12,242 ) ..........................Digitalization program, current funded ...................................................................................................................... 49,705 .......................... 49,705 .......................... ∂49,705 

Funds provided in Public Law 107–116 ............................................................................................................ .......................... (20,000 ) .......................... .......................... (¥20,000 ) 

Interconnection, current funded .................................................................................................................................. 9,941 .......................... 50,000 ∂40,059 ∂50,000 

Funds provided in Public Law 107–116 ............................................................................................................ .......................... (75,000 ) .......................... .......................... (¥75,000 ) 

Subtotal, fiscal year 2005 appropriation ............................................................................................................... 59,646 .......................... 99,705 ∂40,059 ∂99,705 Subtotal, fiscal year 2005 comparable .................................................................................................................. (59,646 ) (95,000 ) (99,705 ) (∂40,059 ) (∂4,705 ) 

FEDERAL MEDIATION AND CONCILIATION SERVICE .............................................................................................................. 43,129 43,964 44,464 ∂1,335 ∂500 FEDERAL MINE SAFETY AND HEALTH REVIEW COMMISSION ................................................................................................ 7,728 7,813 7,813 ∂85 ..........................INSTITUTE OF MUSEUM AND LIBRARY SERVICES ................................................................................................................. 262,240 261,743 262,240 .......................... ∂497 MEDICARE PAYMENT ADVISORY COMMISSION ..................................................................................................................... 9,245 9,905 9,905 ∂660 ..........................NATIONAL COMMISSION ON LIBRARIES AND INFO SCIENCE ................................................................................................ 994 1,000 994 .......................... ¥6 NATIONAL COUNCIL ON DISABILITY ...................................................................................................................................... 3,021 2,873 3,371 ∂350 ∂498 NATIONAL LABOR RELATIONS BOARD ................................................................................................................................... 242,633 248,785 250,000 ∂7,367 ∂1,215 NATIONAL MEDIATION BOARD ............................................................................................................................................... 11,354 11,635 11,635 ∂281 ..........................OCCUPATIONAL SAFETY AND HEALTH REVIEW COMMISSION ............................................................................................... 9,805 10,516 10,516 ∂711 ..........................

RAILROAD RETIREMENT BOARD 

Dual Benefits Payments Account ......................................................................................................................................... 118,298 108,000 108,000 ¥10,298 ..........................Less Income Tax Receipts on Dual Benefits ....................................................................................................................... ¥7,953 ¥8,000 ¥8,000 ¥47 ..........................

Subtotal, Dual Benefits .......................................................................................................................................... 110,345 100,000 100,000 ¥10,345 ..........................

Federal Payment to the RR Retirement Account ................................................................................................................. 150 150 150 .......................... ..........................Limitation on Administration ............................................................................................................................................... 100,702 102,600 102,600 ∂1,898 ..........................

Inspector General ........................................................................................................................................................ 6,561 7,200 7,200 ∂639 ..........................
341 

SOCIAL SECURITY ADMINISTRATION 

Payments to Social Security Trust Funds ............................................................................................................................ 21,658 20,454 20,454 ¥1,204 ..........................

SUPPLEMENTAL SECURITY INCOME 

Federal benefit payments ..................................................................................................................................................... 34,198,000 38,109,000 34,909,000 ∂711,000 ¥3,200,000 Beneficiary services .............................................................................................................................................................. 100,000 45,929 45,929 ¥54,071 ..........................Research and demonstration ............................................................................................................................................... 38,000 27,000 35,000 ¥3,000 ∂8,000 Administration ...................................................................................................................................................................... 2,973,300 3,017,000 2,928,020 ¥45,280 ¥88,980 

Subtotal, SSI program level .................................................................................................................................... 37,309,300 41,198,929 37,917,949 ∂608,649 ¥3,280,980 

Less funds advanced in prior year ............................................................................................................... ¥11,080,000 ¥12,590,000 ¥12,590,000 ¥1,510,000 ..........................

Subtotal, regular SSI current year .......................................................................................................................... 26,229,300 28,608,929 25,327,949 ¥901,351 ¥3,280,980 

Plus User Fee Activities ................................................................................................................................. 120,000 124,000 124,000 ∂4,000 ..........................

Total, SSI, current request ...................................................................................................................................... 26,349,300 28,732,929 25,451,949 ¥897,351 ¥3,280,980 

New advance, 1st quarter, fiscal year 2006 ................................................................................................ 12,590,000 10,930,000 14,130,000 ∂1,540,000 ∂3,200,000 

Total, SSI program .................................................................................................................................................. 38,939,300 39,662,929 39,581,949 ∂642,649 ¥80,980 

LIMITATION ON ADMINISTRATIVE EXPENSES 

OASDI Trust Funds ............................................................................................................................................................... 4,070,369 4,454,000 4,322,654 ∂252,285 ¥131,346 HI/SMI Trust Funds ............................................................................................................................................................... 1,147,705 1,284,000 1,246,144 ∂98,439 ¥37,856 Social Security Advisory Board ............................................................................................................................................. 1,800 2,000 2,000 ∂200 ..........................SSI ........................................................................................................................................................................................ 2,973,300 3,017,000 2,928,020 ¥45,280 ¥88,980 

Subtotal, regular LAE .............................................................................................................................................. 8,193,174 8,757,000 8,498,818 ∂305,644 ¥258,182 

User Fee Activities (SSI) ....................................................................................................................................................... 120,000 124,000 124,000 ∂4,000 ..........................

Total, Limitation on Administrative Expenses ........................................................................................................ 8,313,174 8,881,000 8,622,818 ∂309,644 ¥258,182 

MEDICARE REFORM FUNDING 

HI/SMI trust funds mandatory spending 7 8 ......................................................................................................................... (500,000 ) .......................... .......................... (¥500,000 ) ..........................Medicare reform contingency fund 9 .................................................................................................................................... .......................... 100,000 .......................... .......................... ¥100,000 

OFFICE OF INSPECTOR GENERAL 

Federal Funds ....................................................................................................................................................................... 24,355 26,000 26,000 ∂1,645 ..........................
342 

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2004 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL 

FOR FISCAL YEAR 2005—Continued 

[In thousands of dollars] 

Item 2004 comparable Budget estimate Committee rec- ommendation 

Senate Committee recommendation 

compared with (∂ or ¥) 

2004 comparable Budget estimate 

Trust Funds .......................................................................................................................................................................... 63,324 66,000 66,000 ∂2,676 ..........................

Total, Office of Inspector General .......................................................................................................................... 87,679 92,000 92,000 ∂4,321 ..........................

Adjustment: Trust fund transfers from general revenues ................................................................................................... ¥3,093,300 ¥3,141,000 ¥3,052,020 ∂41,280 ∂88,980 

Total, Social Security Administration ..................................................................................................................... 44,268,511 45,615,383 45,265,201 ∂996,690 ¥350,182 

Federal funds ................................................................................................................................................. 38,985,313 39,809,383 39,628,403 ∂643,090 ¥180,980 

Current year .......................................................................................................................................... (26,395,313 ) (28,879,383 ) (25,498,403 ) (¥896,910 ) (¥3,380,980 ) New advances, 1st quarter .................................................................................................................. (12,590,000 ) (10,930,000 ) (14,130,000 ) (∂1,540,000 ) (∂3,200,000 ) 

Trust funds .................................................................................................................................................... 5,283,198 5,806,000 5,636,798 ∂353,600 ¥169,202 

UNITED STATES INSTITUTE OF PEACE .................................................................................................................................. 17,099 22,099 22,099 ∂5,000 ..........................

Emergency supplemental appropriations (Public Law 108–106) ............................................................................... 10,000 .......................... .......................... ¥10,000 ..........................

Total, United States Institute of Peace .................................................................................................................. 27,099 22,099 22,099 ¥5,000 ..........................Total, Title IV, Related Agencies ............................................................................................................................ 45,982,397 46,882,196 47,016,902 ∂1,034,505 ∂134,706 

Federal Funds ................................................................................................................................................ 40,582,691 40,956,491 41,260,399 ∂677,708 ∂303,908 

Current Year .......................................................................................................................................... (27,592,691 ) (30,026,491 ) (26,730,399 ) (¥862,292 ) (¥3,296,092 ) 

Emergency appropriations ........................................................................................................... (10,000 ) .......................... .......................... (¥10,000 ) ..........................

Fiscal Year 2006 Advance .................................................................................................................... (12,590,000 ) (10,930,000 ) (14,130,000 ) (∂1,540,000 ) (∂3,200,000 ) Fiscal Year 2007 Advance .................................................................................................................... (400,000 ) .......................... (400,000 ) .......................... (∂400,000 ) 

Trust Funds .................................................................................................................................................... 5,399,706 5,925,705 5,756,503 ∂356,797 ¥169,202 

SUMMARY 

Federal Funds ....................................................................................................................................................................... 467,768,349 478,426,001 481,915,310 ∂14,146,961 ∂3,489,309 

Current year ................................................................................................................................................................. (374,421,073 ) (387,045,210 ) (386,934,519 ) (∂12,513,446 ) (¥110,691 ) 2006 advance .............................................................................................................................................................. (92,947,276 ) (91,380,791 ) (94,580,791 ) (∂1,633,515 ) (∂3,200,000 ) 2006 advance .............................................................................................................................................................. (400,000 ) .......................... (400,000 ) .......................... (∂400,000 ) 
343 

Trust Funds .......................................................................................................................................................................... 11,824,316 12,477,283 12,357,301 ∂532,985 ¥119,982 

Grand Total ............................................................................................................................................................. 479,592,665 490,903,284 494,272,611 ∂14,679,946 ∂3,369,327 

1 Two year availability. 2 Funds provided in Public Law 108–173, the Medicare Prescription Drug, Improvement & Modernization Act. 3 $1 billion available for fiscal years 2004 and 2005. 4 $250 million available for fiscal years 2005-2008. 5 Reflects fiscal year 2005 budget amendment related to certain WIA, Perkins Act, Student Financial Assistance and Head Start funding for the Compact of Free Association. 6 Appropriations for Americorps are provided in the VA–HUD bill. 7 Funds provided in Public Law 108–173, the Medicare Prescription Drug, Improvement & Modernization Act. 8 Available in fiscal years 2004 and 2005. 9 Two-year availability. Funds may be transferred between CMS and SSA. 

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