PROMOTING SAFE AND STABLE FAMILIES 
For carrying out section 436 of the Social Security 
Act, $305,000,000 and for section 437, $100,000,000. 
PAYMENTS TO STATES FOR FOSTER CARE AND ADOPTION 
ASSISTANCE 
For making payments to States or other non-Federal 
entities under title IV–E of the Social Security Act, 
$5,068,300,000. 
For making payments to States or other non-Federal 
entities under title IV–E of the Act, for the first quarter 
of fiscal year 2005, $1,767,700,000. 
For making, after May 31 of the current fiscal year, 
payments to States or other non-Federal entities under 
section 474 of title IV–E, for the last 3 months of the 
current fiscal year for unanticipated costs, incurred for the 
current fiscal year, such sums as may be necessary. 
ADMINISTRATION ON AGING 
AGING SERVICES PROGRAMS 
For carrying out, to the extent not otherwise pro-
vided, the Older Americans Act of 1965, as amended, and 
section 
398 
of 
the 
Public 
Health 
Service 
Act, 
$1,449,495,000, of which $5,000,000 shall be available for 
activities regarding medication management, screening, 
and education to prevent incorrect medication and adverse 
drug reactions; and of which $2,842,000 shall remain
available until September 30, 2006, for the White House 
Conference on Aging. 
OFFICE OF THE SECRETARY 
GENERAL DEPARTMENTAL MANAGEMENT 
For necessary expenses, not otherwise provided, for 
general departmental management, including hire of six 
sedans, and for carrying out titles III, XVII, and XX of 
the Public Health Service Act, and the United States-Mex-
ico Border Health Commission Act, $343,284,000, to-
gether with $5,813,000 to be transferred and expended 
as authorized by section 201(g)(1) of the Social Security 
Act from the Hospital Insurance Trust Fund and the Sup-
plemental Medical Insurance Trust Fund: Provided, That 
of the funds made available under this heading for car-
rying out title XX of the Public Health Service Act, 
$11,885,000 shall be for activities specified under section 
2004(b)(2), of which $10,157,000 shall be for prevention 
service demonstration grants under section 510(b)(2) of 
title V of the Social Security Act, as amended, without 
application of the limitation of section 2010(c) of said title 
XX: Provided further, That of this amount, $49,675,000 
is for minority AIDS prevention and treatment activities; 
$18,400,000 shall be for an Information Technology Secu-
rity and Innovation Fund for Department-wide activities 
involving cybersecurity, information technology security,
and related innovation projects; and $5,000,000 is to as-
sist Afghanistan in the development of maternal and child 
health clinics, consistent with section 103(a)(4)(H) of the 
Afghanistan Freedom Support Act of 2002. 
OFFICE OF INSPECTOR GENERAL 
For expenses necessary for the Office of Inspector 
General in carrying out the provisions of the Inspector 
General Act of 1978, as amended, $39,497,000: Provided, 
That, of such amount, necessary sums are available for 
providing protective services to the Secretary and inves-
tigating non-payment of child support cases for which non-
payment is a Federal offense under 18 U.S.C. 228. 
OFFICE FOR CIVIL RIGHTS 
For expenses necessary for the Office for Civil 
Rights, $30,936,000, together with not to exceed 
$3,314,000 to be transferred and expended as authorized 
by section 201(g)(1) of the Social Security Act from the 
Hospital Insurance Trust Fund and the Supplemental 
Medical Insurance Trust Fund. 
POLICY RESEARCH 
For carrying out, to the extent not otherwise pro-
vided, research studies under section 1110 of the Social 
Security Act and title III of the Public Health Service Act, 
$2,483,000: Provided, That in addition to amounts pro-
vided herein, $18,000,000 shall be available from amounts 
available under section 241 of the Public Health Service
Act to carry out national health or human services re-
search and evaluation activities: Provided further, That the 
expenditure of any funds available under section 241 of 
the Public Health Service Act are subject to the require-
ments of section 205 of this Act. 
RETIREMENT PAY AND MEDICAL BENEFITS FOR 
COMMISSIONED OFFICERS 
For retirement pay and medical benefits of Public 
Health Service Commissioned Officers as authorized by 
law, for payments under the Retired Serviceman’s Family 
Protection Plan and Survivor Benefit Plan, for medical 
care of dependents and retired personnel under the De-
pendents’ Medical Care Act (10 U.S.C. ch. 55 and 56), 
and for payments pursuant to section 229(b) of the Social 
Security Act (42 U.S.C. 429(b)), such amounts as may 
be required during the current fiscal year. The following 
are definitions for the medical benefits of the Public 
Health Service Commissioned Officers that apply to 10 
U.S.C. chapter 56, section 1116(c). The source of funds 
for the monthly accrual payments into the Department of 
Defense Medicare-Eligible Retiree Health Care Fund shall 
be the Retirement Pay and Medical Benefits for Commis-
sioned Officers account. For purposes of this Act, the term 
‘‘pay of members’’ shall be construed to be synonymous 
with retirement payments to United States Public Health 
Service officers who are retired for age, disability, or
length of service; payments to survivors of deceased offi-
cers; medical care to active duty and retired members and 
dependents and beneficiaries; and for payments to the So-
cial Security Administration for military service credits; 
all of which payments are provided for by the Retirement 
Pay and Medical Benefits for Commissioned Officers ac-
count. 
PUBLIC HEALTH AND SOCIAL SERVICES EMERGENCY 
FUND 
For expenses necessary to support activities related 
to countering potential biological, disease and chemical 
threats to civilian populations, $1,896,846,000: Provided, 
That this amount is distributed as follows: Centers for 
Disease Control and Prevention, $1,286,156,000; Office 
of the Secretary, $64,820,000; and Health Resources and 
Services Administration; $545,870,000; Provided further, 
That at the discretion of the Secretary, these amounts 
may be transferred between categories subject to normal 
reprogramming procedures: Provided further, That em-
ployees of the Centers for Disease Control and Prevention 
or the Public Health Service, both civilian and Commis-
sioned Officers, detailed to States, municipalities or other 
organizations under authority of section 214 of the Public 
Health Service Act for purposes related to homeland secu-
rity, shall be treated as non-Federal employees for report-
ing purposes only and shall not be included within any
personnel ceiling applicable to the Agency, Service, or the 
Department of Health and Human Services during the pe-
riod of detail or assignment. 
In addition, for activities to ensure a year-round in-
fluenza vaccine production capacity and the development 
and implementation of rapidly expandable influenza vac-
cine production technologies, $100,000,000, to remain 
available until expended. 
GENERAL PROVISIONS 
SEC. 201. Funds appropriated in this title shall be 
available for not to exceed $50,000 for official reception 
and representation expenses when specifically approved by 
the Secretary. 
SEC. 202. The Secretary shall make available through 
assignment not more than 60 employees of the Public 
Health Service to assist in child survival activities and to 
work in AIDS programs through and with funds provided 
by the Agency for International Development, the United 
Nations International Children’s Emergency Fund or the 
World Health Organization. 
SEC. 203. None of the funds appropriated under this 
Act may be used to implement section 399F(b) of the Pub-
lic Health Service Act or section 1503 of the National In-
stitutes of Health Revitalization Act of 1993, Public Law 
103–43.
SEC. 204. None of the funds appropriated in this Act 
for the National Institutes of Health, the Agency for 
Healthcare Research and Quality, and the Substance 
Abuse and Mental Health Services Administration shall 
be used to pay the salary of an individual, through a grant 
or other extramural mechanism, at a rate in excess of Ex-
ecutive Level I. 
SEC. 205. None of the funds appropriated in this Act 
may be expended pursuant to section 241 of the Public 
Health Service Act, except for funds specifically provided 
for in this Act, or for other taps and assessments made 
by any office located in the Department of Health and 
Human Services, prior to the Secretary’s preparation and 
submission of a report to the Committee on Appropria-
tions of the Senate and of the House detailing the planned 
uses of such funds. 
SEC. 206. Notwithstanding section 241(a) of the 
Public Health Service Act, such portion as the Secretary 
shall determine, but not more than 1.25 percent, of any 
amounts appropriated for programs authorized under said 
Act shall be made available for the evaluation (directly, 
or by grants or contracts) of the implementation and effec-
tiveness of such programs. 
(TRANSFER OF FUNDS) 
SEC. 207. Not to exceed 1 percent of any discre-
tionary funds (pursuant to the Balanced Budget and
Emergency Deficit Control Act of 1985, as amended) 
which are appropriated for the current fiscal year for the 
Department of Health and Human Services in this or any 
other Act may be transferred between appropriations, but 
no such appropriation shall be increased by more than 3 
percent by any such transfer: Provided, That an appro-
priation may be increased by up to an additional 2 percent 
subject to approval by the House and Senate Committees 
on Appropriations: Provided further, That the Appropria-
tions Committees of both Houses of Congress are notified 
at least 15 days in advance of any transfer. 
SEC. 208. The Director of the National Institutes of 
Health, jointly with the Director of the Office of AIDS 
Research, may transfer up to 3 percent among institutes, 
centers, and divisions from the total amounts identified 
by these two Directors as funding for research pertaining 
to the human immunodeficiency virus: Provided, That the 
Congress is promptly notified of the transfer. 
SEC. 209. Of the amounts made available in this Act 
for the National Institutes of Health, the amount for re-
search related to the human immunodeficiency virus, as 
jointly determined by the Director of the National Insti-
tutes of Health and the Director of the Office of AIDS 
Research, shall be made available to the ‘‘Office of AIDS 
Research’’ account. The Director of the Office of AIDS
Research shall transfer from such account amounts nec-
essary to carry out section 2353(d)(3) of the Public 
Health Service Act. 
SEC. 210. None of the funds appropriated in this Act 
may be made available to any entity under title X of the 
Public Health Service Act unless the applicant for the 
award certifies to the Secretary that it encourages family 
participation in the decision of minors to seek family plan-
ning services and that it provides counseling to minors on 
how to resist attempts to coerce minors into engaging in 
sexual activities. 
SEC. 211. None of the funds appropriated by this Act 
(including funds appropriated to any trust fund) may be 
used to carry out the Medicare+Choice program if the 
Secretary denies participation in such program to an oth-
erwise eligible entity (including a Provider Sponsored Or-
ganization) because the entity informs the Secretary that 
it will not provide, pay for, provide coverage of, or provide 
referrals for abortions: Provided, That the Secretary shall 
make appropriate prospective adjustments to the capita-
tion payment to such an entity (based on an actuarially 
sound estimate of the expected costs of providing the serv-
ice to such entity’s enrollees): Provided further, That noth-
ing in this section shall be construed to change the Medi-
care program’s coverage for such services and a
Medicare+Choice organization described in this section 
shall be responsible for informing enrollees where to obtain 
information about all Medicare covered services. 
SEC. 212. Notwithstanding any other provision of 
law, no provider of services under title X of the Public 
Health Service Act shall be exempt from any State law 
requiring notification or the reporting of child abuse, child 
molestation, sexual abuse, rape, or incest. 
SEC. 213. (a) Except as provided by subsection (e) 
none of the funds appropriated by this Act may be used 
to withhold substance abuse funding from a State pursu-
ant to section 1926 of the Public Health Service Act (42 
U.S.C. 300x–26) if such State certifies to the Secretary 
of Health and Human Services by May 1, 2004 that the 
State will commit additional State funds, in accordance 
with subsection (b), to ensure compliance with State laws 
prohibiting the sale of tobacco products to individuals 
under 18 years of age. 
(b) The amount of funds to be committed by a State 
under subsection (a) shall be equal to 1 percent of such 
State’s substance abuse block grant allocation for each 
percentage point by which the State misses the retailer 
compliance rate goal established by the Secretary of 
Health and Human Services under section 1926 of such 
Act.
(c) The State is to maintain State expenditures in 
fiscal year 2004 for tobacco prevention programs and for 
compliance activities at a level that is not less than the 
level of such expenditures maintained by the State for fis-
cal year 2003, and adding to that level the additional 
funds for tobacco compliance activities required under 
subsection (a). The State is to submit a report to the Sec-
retary on all fiscal year 2003 State expenditures and all 
fiscal year 2004 obligations for tobacco prevention and 
compliance activities by program activity by July 31, 
2004. 
(d) The Secretary shall exercise discretion in enforc-
ing the timing of the State obligation of the additional 
funds required by the certification described in subsection 
(a) as late as July 31, 2004. 
(e) None of the funds appropriated by this Act may 
be used to withhold substance abuse funding pursuant to 
section 1926 from a territory that receives less than 
$1,000,000. 
SEC. 214. In order for the Centers for Disease Con-
trol and Prevention to carry out international health ac-
tivities, including HIV/AIDS and other infectious disease, 
chronic and environmental disease, and other health ac-
tivities abroad during fiscal year 2004, the Secretary of 
Health and Human Services is authorized to provide such
funds by advance or reimbursement to the Secretary of 
State as may be necessary to pay the costs of acquisition, 
lease, alteration, renovation, and management of facilities 
outside of the United States for the use of the Department 
of Health and Human Services. The Department of State 
shall cooperate fully with the Secretary of Health and 
Human Services to ensure that the Department of Health 
and Human Services has secure, safe, functional facilities 
that comply with applicable regulation governing location, 
setback, and other facilities requirements and serve the 
purposes established by this Act. The Secretary of Health 
and Human Services is authorized, in consultation with 
the Secretary of State, through grant or cooperative agree-
ment, to make available to public or nonprofit private in-
stitutions or agencies in participating foreign countries, 
funds to acquire, lease, alter, or renovate facilities in those 
countries as necessary to conduct programs of assistance 
for international health activities, including activities re-
lating to HIV/AIDS and other infectious diseases, chronic 
and environmental diseases, and other health activities 
abroad. 
SEC. 215. (a) In addition to the authority provided 
in section 214, in order for the Centers for Disease Con-
trol and Prevention to carry out international health ac-
tivities, including HIV/AIDS and other infectious disease,