S. Rept. 109-103 - 109th Congress (2005-2006)
July 14, 2005, As Reported by the Appropriations Committee

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Senate Report 109-103 - DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND RELATED AGENCIES APPROPRIATION BILL, 2006




[Senate Report 109-103]
[From the U.S. Government Printing Office]



                                                       Calendar No. 163
109th Congress                                                   Report
                                 SENATE
 1st Session                                                    109-103

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



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

                 July 14, 2005.--Ordered to be printed

                                _______
                                

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

                              R E P O R T

                        [To accompany H.R. 3010]

    The Committee on Appropriations, to which was referred the 
bill (H.R. 3010) making appropriations for the Departments of 
Labor, Health and Human Services, and Education and related 
agencies for the fiscal year ending September 30, 2006, and for 
other purposes, reports the same to the Senate with an 
amendment and recommends that the bill as amended do 
pass.

    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. deg.

                       Amount of budget authority
Total of bill as reported to the Senate.............    $604,436,313,000
Amount of 2005 appropriations.......................     501,344,991,000
Amount of 2006 budget estimate......................     600,212,625,000
Amount of House allowance...........................     601,592,573,000
Bill as recommended to Senate compared to--
    2005 appropriations.............................    +103,091,322,000
    2006 budget estimate............................      +4,223,688,000
    House allowance.................................      +2,843,740,000



                            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.......................     7
    Employee Benefits Security Administration....................    19
    Pension Benefit Guaranty Corporation.........................    19
    Employment Standards Administration..........................    20
    Occupational Safety and Health Administration................    23
    Mine Safety and Health Administration........................    24
    Bureau of Labor Statistics...................................    25
    Office of Disability Employment Policy.......................    25
    Departmental Management......................................    26
    Veterans Employment and Training.............................    29
    Office of the Inspector General..............................    30
    General Provisions...........................................    30
Title II--Department of Health and Human Services:
    Health Resources and Services Administration.................    32
    Centers for Disease Control and Prevention...................    57
    NIH Preamble.................................................    88
    Substance Abuse and Mental Health Services Administration....   176
    Agency for Healthcare Research and Quality...................   186
    Centers for Medicare and Medicaid Services...................   188
    Administration for Children and Families.....................   196
    Administration on Aging......................................   214
    Office of the Secretary......................................   218
    Office of the Inspector General..............................   224
    General Provisions, Department of Health and Human Services..   225
Title III--Department of Education:
    Education for the Disadvantaged..............................   228
    Impact Aid...................................................   235
    School Improvement Programs..................................   236
    Indian Education.............................................   243
    Innovation and Improvement...................................   244
    Safe Schools and Citizenship Education.......................   253
    English Language Acquisiton..................................   256
    Special Education............................................   257
    Rehabilitation Services and Disability Research..............   261
    Special Institutions for Persons With Disabilities:
        American Printing House for the Blind....................   267
        National Technical Institute for the Deaf................   267
        Gallaudet University.....................................   268
    Vocational and Adult Education...............................   268
    Student Financial Assistance.................................   273
    Student Aid Administration...................................   275
    Higher Education.............................................   276
    Howard University............................................   284
    College Housing and Academic Facilities Loans................   284
    Historically Black College and University Capital Financing 
      Program....................................................   284
    Institute of Education Science...............................   285
    Departmental Management:
        Program Administration...................................   288
        Office for Civil Rights..................................   289
        Office of the Inspector General..........................   290
    General Provisions...........................................   291
Title IV--Related Agencies:
    Committee for Purchase from People who are Blind or Severely 
      Dis- 
      abled......................................................   292
    Corporation for National and Community Service...............   292
    Corporation for Public Broadcasting..........................   297
    Federal Mediation and Conciliation Service...................   298
    Federal Mine Safety and Health Review Commission.............   299
    Institute of Museum and Library Services.....................   299
    Medicare Payment Advisory Commission.........................   301
    National Commission on Libraries and Information Science.....   301
    National Council on Disability...............................   301
    National Labor Relations Board...............................   301
    National Mediation Board.....................................   302
    Occupational Safety and Health Review Commission.............   303
    Railroad Retirement Board....................................   303
    Social Security Administration...............................   304
Title V--General Provisions......................................   308
Budgetary Impact of Bill.........................................   309
Compliance With Paragraph 7, Rule XVI of the Standing Rules of 
  the Sen- 
  ate............................................................   309
Compliance With Paragraph 7(C), Rule XXVI of the Standing Rules 
  of the Senate..................................................   310
Compliance With Paragraph 12, Rule XXVI of the Standing Rules of 
  the Senate.....................................................   310
Comparative Statement of New Budget Authority....................   313

       SUMMARY OF BUDGET ESTIMATES AND COMMITTEE RECOMMENDATIONS

    For fiscal year 2006, the Committee recommends total budget 
authority of $604,436,313,000 for the Departments of Labor, 
Health and Human Services, and Education, and Related Agencies. 
Of this amount, $141,653,000,000 is current year discretionary 
funding, including offsets.

                      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 
$5,250,806,000 for job training programs, an increase of 
$195,293,000 over the budget request, but $86,966,000 below the 
enacted 2005 level.
    Worker Protection.--The Committee bill includes 
$1,557,000,000 to ensure the health and safety of workers, 
including $252,268,000 for the National Labor Relations Board, 
$477,491,000 for the Occupational Safety and Health 
Administration and $280,490,000 for the Mine Safety and Health 
Administration. The recommendation is an increase of 
$32,000,000 over the 2005 level.
    Child Labor.--The Committee bill includes $93,248,000 for 
activities designed to end abusive child labor. This is 
$80,829,000 above the budget request, but the same as the 2005 
level.
    National Institutes of Health.--A total of $29,414,515,000 
is recommended to fund biomedical research at the 27 Institutes 
and Centers that comprise the NIH. This represents an increase 
of $1,050,000,000 over the fiscal year 2005 level and 
$904,731,000 over the budget request.
    Health Centers.--The recommendation includes $1,839,311,000 
for health centers, $105,000,000 over the fiscal 2005 level.
    Medicare Modernization Act [MMA].--The Committee 
recommendation included $880,000,000, the full amount of the 
budget request, for MMA activities, consisting of $560,000,000 
in the Program Administration account of the Centers for 
Medicare and Medicaid Services, and $320,000,000 for the Social 
Security Administration.
    Substance Abuse.--The Committee bill provides 
$3,260,783,000 for substance abuse prevention and treatment 
programs. Included in this amount is $2,186,646,000 for 
substance abuse treatment, $202,289,000 for substance abuse 
prevention and $901,334,000 for mental health programs.
    Low-income Home Energy Assistance State Grants.--The 
Committee recommends $2,183,000,000 for heating and cooling 
assistance for low-income individuals and families, 
$183,000,000 above the budget request and $601,000 more than 
the 2005 level.
    Head Start.--The Committee recommendation includes 
$6,874,314,000 for the Head Start Program. This represents an 
increase of $31,200,000 over the 2005 level.
    Persons With Disabilities.--To promote independent living 
in home and community-based settings. This includes $47,164,000 
for the Office of Disability Policy at the Department of Labor, 
$14,879,000 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 $12,839,571,000 in grants to enhance educational 
opportunities for disadvantaged children, an increase of 
$100,000,000 over the fiscal year 2005 level.
    Educator Professional Development.--The Committee 
recommends $2,916,605,000 for State grants to improve teacher 
quality and almost $3,600,000,000 in various programs 
administered by the Department of Education.
    English Language Acquisition.--The Committee recommends 
$675,765,000 for bilingual education.
    Student Financial Aid.--The Committee recommends 
$15,103,795,000 for student financial assistance, an increase 
of $838,046,000 over the fiscal year 2005 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 
$2,104,508,000 for initiatives to provide greater opportunities 
for higher education, including $836,543,000 for Federal TRIO 
programs and $306,488,000 for GEAR UP.
    Education for Individuals With Disabilities.--The Committee 
bill provides $11,515,151,000 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 
$103,500,000 over the 2005 level.
    Rehabilitation Services.--The bill recommends 
$3,133,638,000 for rehabilitation services, an increase of 
$59,064,000 above the amount provided in 2005. These funds are 
essential for families with disabilities seeking employment. 
The Committee restored funding for several important programs 
proposed for elimination, such as Supported Employment State 
Grants, Projects with Industry, Recreational programs and 
programs for migrant and seasonal farmworkers.
    Services for Older Americans.--For programs serving older 
Americans, the Committee recommendation includes 
$3,170,461,000. This recommendation includes $219,784,000 for 
senior volunteer programs, $436,678,000 for community service 
employment for older Americans, $354,136,000 for supportive 
services and centers, $160,744,000 for family caregiver support 
programs and $718,697,000 for senior nutrition programs. For 
the medical research activities of the National Institute on 
Aging, the Committee recommends $1,090,600,000. 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 2008 of 
$400,000,000 for the Corporation for Public Broadcasting. In 
addition, the Committee bill includes $35,000,000 for 
conversion to digital broadcasting and $40,000,000 for the 
replacement project of the interconnection system in fiscal 
year 2006 funding.

                  REPROGRAMMING AND TRANSFER AUTHORITY

    The Committee has included bill language delineating 
permissible transfer authority in general provisions for each 
of the Departments of Labor, Health and Human Services, and 
Education, as well as specifying reprogramming authority in a 
general provision applying to all funds provided under this 
Act.

                      TITLE I--DEPARTMENT OF LABOR

                 Employment and Training Administration

                    TRAINING AND EMPLOYMENT SERVICES

                        (INCLUDING RESCISSIONS)

Appropriations, 2005....................................  $5,337,772,000
Budget estimate, 2006...................................   5,055,513,000
House allowance.........................................   5,121,792,000
Committee recommendation................................   5,250,806,000

    The Committee recommends $5,250,806,000 for this account in 
2006 which provides funding primarily for activities under the 
Workforce Investment Act [WIA]. This is $86,966,000 less than 
the 2005 level, $129,014,000 more than the House allowance, and 
$195,293,000 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 2006 will support 
the program from July 1, 2006 through June 30, 2007.
    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.
    Pending reauthorization of the Workforce Investment Act the 
Committee is acting on a current law request, deferring without 
prejudice proposed legislative language under the jurisdiction 
of the authorizing committees.
    The Committee is aware of the High Growth Job Training 
Initiative created in 2002 to prepare workers for job 
opportunities in high growth and high demand sectors of the 
American economy. The Committee supports efforts to take a 
proactive approach to job training, tracking workforce trends 
and anticipating industry needs in communities hard-hit by 
recent economic downturns. The Committee has included 
$55,000,000 for this initiative, which shall be awarded based 
on a competitive process.
    The Committee notes that the budget request does not 
include funding for the personal re-employment account 
initiative, and expects that none of the funds provided for 
fiscal year 2006 will be utilized for this initiative unless 
specifically authorized by law.
    The Committee recommendation concurs with the House in 
retaining language from last year's bill requiring that the 
Department take no action 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. The Committee expects that, 
while the Workforce Investment Act is in the process of being 
altered and renewed, the Administration will refrain from 
unilateral changes to the administration, operation and 
financing of employment and training programs.
    Adult Employment and Training.--For Adult Employment and 
Training Activities, the Committee recommends $893,618,000, 
which is $27,882,000 more than the budget request and House 
allowance, and $3,000,000 less than the program year 2005 
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 providers fit their 
needs. The Act authorizes core services, which will be 
available to all adults with no eligibility requirements, and 
intensive services, for unemployed individuals who are not able 
to find jobs through core services alone.
    Dislocated Worker Assistance.--For Dislocated Worker 
Assistance, the Committee recommends $1,476,064,000 the same as 
the program year 2005 level, $132,480,000 more than the budget 
request, and $70,800,000 more than the House allowance. Of the 
total, $1,193,264,000 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 
$282,800,000 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 long-term unemployed.
    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.
    Community Based Job Training Initiative.--The Committee 
recommendation includes $125,000,000 to carry out the Community 
College/Community Based Job Training Grant initiative, compared 
to the $250,000,000 request. The House recommendation includes 
a rescission of $125,000,000 in funds provided in fiscal year 
2005 for this program, as well as a total of $125,000,000 for 
2006. The Committee recommendation allocates $125,000,000 from 
National Emergency Grant funds available under section 
132(a)(2)(A) of the Workforce Investment Act, and does not 
rescind funds provided in the fiscal year 2005 bill for this 
initiative. 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.
    The Committee encourages the Employment and Training 
Administration to consider, in future solicitations for grant 
applications for the Community Based Job Training Initiative, 
including One Stop Career Centers, and in rural areas and other 
communities without community colleges, eligibility of 
alternative education and training providers to apply for these 
grants.
    Youth Training.--For Youth Training, the Committee 
recommends $986,288,000, which is $36,288,000 more than the 
budget request and House allowance, and the same as the program 
year 2005. 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, the Committee recommends 
$1,582,000,000. This is $64,981,000 more than the budget 
request, and $30,140,000 more than the 2005 comparable level. 
The Committee concurs with the House in not including the 
proposed $25,000,000 rescission of funds previously 
appropriated for construction and renovation activities. 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.
    As a national training program, Job Corps is particularly 
well suited to help meet the needs of large, multi-state 
employers for skilled entry-level workers. The Committee 
commends Job Corps for establishing partnerships with national 
employers, and encourages Job Corps to continue to work with 
both larger employers and small businesses to ensure that 
student training meets current labor market needs. The 
Committee urges Job Corps to also strengthen and expand the 
program in order to help meet our Nation's needs for trained, 
entry level workers in three high growth industry sectors: 
health care, homeland security, and national defense. In 
addition, Job Corps should intensify its efforts to upgrade its 
vocational offerings and curricula to reflect industry 
standards and required certifications recognized by employers.
    The Committee commends the Job Corps program for developing 
mutually beneficial partnerships with community colleges across 
the country. Community college partners including the 
Mississippi Gulf Coast Community College and the Cincinnati 
State and Technical Community College find that it is efficient 
to work with Job Corps because they share the same basic goals 
of providing access and opportunity for disadvantaged Americans 
and they have the ability to partner with employers looking for 
high-skilled workers. The Committee encourages the Department 
of Labor's Community College Initiative to collaborate with the 
Job Corps program to offer advanced co-enrollment programs, 
increase opportunities for disadvantaged youth pursuing a 
career in high growth areas, and maximize access to industry-
recognized certification programs. The Committee also 
recommends a minimum of $10,000,000 of the program year 2005 
Community College Initiative funding be dedicated to community 
colleges partnerships with Job Corps centers. The Committee 
expects this portion be designated to: (1) develop strategic 
partnerships with community colleges, business and industry 
leaders, and Job Corps centers to train students in high, 
growth, high demand industries; and (2) design ``dual 
enrollment'' programs based on reciprocal agreements between 
Job Corps and adjacent community colleges.
    The Committee commends the work of the NJCA Foundation for 
Youth Opportunities [FYO] in its charitable and educational 
activities and programs that benefit youth, especially those 
at-risk. The FYO seeks to provide resources and research that 
helps non-profit, for-profit, and Government agencies further 
education and training opportunities for disadvantaged youth.
    The Committee recognizes the shortage of health care 
professionals and the need to provide access to health care 
vocational opportunities for many disadvantaged young people. 
The Committee is also aware that the Job Corps is uniquely 
qualified to utilize the Department of Health and Human 
Services [HHS] Health Resources and Services Administration 
[HRSA] grant programs to train students to pursue health 
careers while generating more health care professionals to 
serve economically disadvantaged communities.
    The Committee commends the common mission of the Job Corps 
and HRSA in exposing under-represented minorities and 
disadvantaged students to seek strategically important careers. 
Nearly three quarters of the Nation's 122 Job Corps Centers 
offer health occupations training as well as training in health 
care related fields. The Committee recognizes and commends the 
Job Corps success in training students with the skills they 
need to fill critical shortages through major national employer 
partners. Through preferred access to HRSA grant funds, Job 
Corps' training can generate even more qualified and prepared 
allied health professionals in the coming decade.
    The Committee is committed to promoting and expanding cost-
effective Federal programs that have a proven record of success 
provide consistent and positive results and help address 
national labor shortages. Therefore, the Committee recommends 
$10,000,000 for second year funding for the incremental 
expansion of Job Corps. This in addition to the $10,000,000 
provided in previously appropriated funds to begin the process 
of establishing additional Job Corps centers. In the selection 
process, priority should go to: States that currently do not 
have a Job Corps Center or who work in conjunction with an 
existing center serving the entire State or region; Sites that 
can be started in the short term as satellite Job Corps centers 
(residential or non-residential) and later be converted to 
stand alone facilities.
    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 recognizes that the Weber Basin and 
Clearfield, Utah Job Corps centers are among the highest ranked 
in the Nation. The Committee recognizes the State of Utah for 
its impressive contribution to the Job Corps program.
    Responsible Reintegration of Youthful Offenders.--The 
Committee recommendation includes $50,000,000, to continue 
funding for the current Reintegration of Youthful Offenders 
Program. Neither the budget request in House allowance included 
funding for this program, which was funded at $49,600,000 in 
program year 2005. 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 from formal judicial proceedings.
    Prisoner Re-entry.--The recommendation includes the 
$19,840,000 for the prisoner re-entry initiative, to extend 
assistance to a broader population of ex-offenders. This is the 
same as the enacted 2005 level and the House allowance, and 
$15,160,000 below the request.
    Native Americans.--For Native Americans, the Committee 
recommends $54,238,000. This is the same as the budget request, 
the House allowance, and the enacted program year 2005 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 $80,557,000, compared to 
the 2005 enacted level of $75,759,000. Authorized by WIA, this 
program is designed to serve members of economically 
disadvantaged families whose principal livelihood is derived 
from migratory and other forms of seasonal farmwork, or 
fishing, or logging activities. Enrollees and their families 
are provided with employment training and related services 
intended to prepare them for stable, year-round employment 
within and outside of the agriculture industry.
    There are at least 3 million hard-working migrant and 
seasonal farmworkers in America whose annual incomes are below 
$10,000. At a time when most State budgets are shrinking and 
many of the basic services provided by State and local 
governments are being cut back, the Committee recognizes the 
importance of sustaining a national commitment, dating from 
1964, to help alleviate the chronic seasonal unemployment and 
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 $80,557,000 for program 
year 2006 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 $80,053,000. The Committee recommendation 
includes bill language directing that $5,000,000 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 
Committee encourages greater emphasis on the southeast region 
for farmworker housing grants. The recommendation also provides 
that the remaining amount of $75,053,000 be used for State 
service area grants, including funding grantees in those States 
impacted by formula reductions to at least the amount they were 
alloted in program year 2004, requiring $3,840,000. 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, 
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 $3,458,000 
for the provision of technical assistance and staff 
development, an increase of $1,458,000 over the budget request 
and House allowance, but the same as the program year 2005 
level. This includes $982,000 for technical assistance to 
employers and unions to assist them in training, placing, and 
retraining women in nontraditional jobs and occupations, as 
authorized under the Women in Apprenticeship and Non-
Traditional Occupations Act of 1992, Public Law 102-530; this 
amount is specified in bill language, to prevent its being 
diverted to other purposes. As described in the Migrant and 
Seasonal Farmworker section of this report, the recommendation 
also includes $504,000 for WIA Section 167 activities.
    Pilots, Demonstrations, and Research.--The Committee 
recommends $90,367,000, an increase of $60,367,000 over the 
budget request, and $16,367,000 over the House allowance for 
grants or contracts to conduct research, pilots or 
demonstrations that improve techniques or demonstrate the 
effectiveness of programs.
    In addition, the Committee recommends $6,944,000 to 
maintain the current level of for the Denali Commission as 
authorized in Public Law 108-7, 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.
    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 Asian, Pacific Islander, and 
Caucasian families. The State's diverse multicultural 
population adds to the reliability of the research conclusions.
    Evaluation.--The Committee recommends $7,936,000 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.--The Committee concurs with the House in 
recommending rescission of $20,000,000 in unobligated Health 
Care Tax Credit Funds and $5,000,000 in unobligated funds 
provided for emergency response activities, as requested by the 
administration.

            COMMUNITY SERVICE EMPLOYMENT FOR OLDER AMERICANS

Appropriations, 2005....................................    $436,678,000
Budget estimate, 2006...................................     436,678,000
House allowance.........................................     436,678,000
Committee recommendation................................     436,678,000

    The Committee recommends $436,678,000, the same as the 
budget request, the House allowance, and the program year 2005 
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 2006 
appropriation will support the program from July 1, 2006, 
through June 30, 2007. The Committee believes that within the 
title V community service employment for older Americans, 
special attention should be paid to providing community service 
jobs for older Americans with poor employment prospects, 
including individuals with a long-term detachment from the 
labor force, older displaced homemakers, aged minorities, 
limited English-speaking persons, and legal immigrants.
    The program provides a direct, efficient, and quick means 
to assist economically disadvantaged older workers because it 
has a proven effective network in every State and in 
practically every county. Administrative costs for the program 
are low, and the vast majority of the money goes directly to 
low-income seniors as wages and fringe benefits.
    The program provides a wide range of vital community 
services that would not otherwise be available, particularly in 
low-income areas and in minority neighborhoods. Senior 
enrollees provide necessary and valuable services at Head Start 
centers, schools, hospitals, libraries, elderly nutrition 
sites, senior center, and elsewhere in the community. These 
services would not be available without the program.
    A large proportion of senior enrollees use their work 
experience and training to obtain employment in the private 
sector. This not only increases our Nation's tax base, but it 
also enables more low-income seniors to participate in the 
program.
    The Committee believes that the program should pay special 
attention to providing community service jobs for older 
Americans with poor employment prospects, including individuals 
with a long-term detachment from the labor force, older 
displaced homemakers, aged minorities, limited English-speaking 
persons, and legal immigrants.

              FEDERAL UNEMPLOYMENT BENEFITS AND ALLOWANCES

Appropriations, 2005....................................  $1,057,300,000
Budget estimate, 2006...................................     966,400,000
House allowance.........................................     966,400,000
Committee recommendation................................     966,400,000

    The Committee recommends $966,400,000 the same as the 
budget estimate and House allowance for fiscal year 2006, and a 
decrease of $90,900,000 below the fiscal year 2005 
appropriation for Federal Unemployment Benefits and Allowances. 
Trade adjustment benefit payments are expected to decline from 
$750,000,000 in fiscal year 2005 to $655,000,000 in fiscal year 
2006, while trade training in fiscal year 2006 will remain at 
the 2005 level of $259,400,000 with an estimated 80,000 
participants. Wage insurance costs are expected to increase 
form $48,000,000 in fiscal year 2005 to $52,000,000 in fiscal 
year 2006.
    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 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. Additionally, the Act provides a program of 
Alternative Trade Adjustment Assistance for Older Workers.

     STATE UNEMPLOYMENT INSURANCE AND EMPLOYMENT SERVICE OPERATIONS

Appropriations, 2005....................................  $3,636,709,000
Budget estimate, 2006...................................   3,470,366,000
House allowance.........................................   3,470,366,000
Committee recommendation................................   3,499,779,000

    The Committee recommends $3,499,779,000 for this account. 
This is $29,413,000 above the budget request as well as the 
House allowance and $136,930,000 above the 2005 comparable 
level. Included in the total availability is $3,366,954,000 
authorized to be drawn from the ``Employment Security 
Administration'' account of the unemployment trust fund, and 
$132,825,000 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 
$2,610,000,000. This includes $2,600,000,000 for State 
Operations, and $10,000,000 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 2.8 million. 
This contingency amount would fund the administrative costs of 
unemployment insurance workload over the level of 2.8 million 
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.
    The Committee has provided funds requested by the 
administration from the Unemployment Insurance Trust Fund for 
conducting in person reemployment and eligibility assessments 
of UI beneficiaries and preventing and detecting fraudulent 
claims. The Committee notes that the Social Security Act 
requires the use of merit based staff in the administration of 
the UI program and expects that States will use State merit 
staffed UI personnel to perform these functions.
    For the Employment Service allotments to States, the 
Committee recommends $746,302,000 which includes $23,114,000 in 
general funds together with an authorization to spend 
$723,188,000 from the ``Employment Security Administration'' 
account of the unemployment trust fund. This compares to the 
budget request and House allowance of $696,000,000 and the 
enacted level of $780,592,000 for allotments to States. Due to 
tight budget constraints, the Committee recommendation does not 
include Reemployment Services Grants, funded in 2005 at 
$34,291,000, but restores the additional $50,302,000 reduction 
proposed by the administration for Employment Service Grants to 
States. These funds are available for the program year of July 
1, 2006 through June 30, 2007.
    The recommendation also includes $33,766,000 for Employment 
Service national activities, a decrease of $31,210,000 from the 
fiscal year 2005 level. This recommendation reflects the 
transfer of the foreign labor certification program to the 
Employment and Training Administration Program Administration 
account, as requested by the administration. The recommendation 
maintains the 2005 enacted level of $17,856,000 for the work 
opportunity tax credit program.
    The recommendation also includes $90,000,000 for One-Stop 
Career Centers, compared to the budget request and House 
allowance of $87,974,000 and 2005 enacted level of $97,974,000. 
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 
$19,711,000 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, 2005....................................    $517,000,000
Budget estimate, 2006...................................     465,000,000
House allowance.........................................     465,000,000
Committee recommendation................................     465,000,000

    The Committee recommends $465,000,000, the same as the 
budget estimate and House allowance for fiscal year 2006, and 
$52,000,000 less than the fiscal year 2005 level. 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 2006 
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 2006 are expected to be sufficient. Should the need 
arise, due to unanticipated changes in the economic situation, 
laws, or for other legitimate reasons, advances will be made to 
the appropriate accounts to the extent funds are available. 
Funds advanced to the Black Lung Disability Trust Fund are now 
repayable with interest to the general fund of the Treasury.

                         PROGRAM ADMINISTRATION

Appropriations, 2005....................................    $170,101,000
Budget estimate, 2006...................................     206,111,000
House allowance.........................................     206,111,000
Committee recommendation................................     200,000,000

    The Committee recommendation includes $117,123,000 in 
general funds for this account, as well as authority to expend 
$82,877,000 from the ``Employment Security Administration'' 
account of the unemployment trust fund, for a total of 
$200,000,000. 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, 
the Denali Commission Act, the Women in Apprenticeship and Non-
Traditional Occupations Act of 1992, 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 and contracts to 
intergovernmental, business, labor, and community-based 
organizations dedicated to training and technical assistance in 
support of Workforce Investment Boards and their members.
    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 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.

                     WORKERS COMPENSATION PROGRAMS

                              (RESCISSION)

Appropriations, 2002....................................    $175,000,000
Appropriations, 2005....................................................
Budget estimate, 2005...................................    -120,000,000
House allowance.........................................    -120,000,000
Committee recommendation................................    -120,000,000

    The Committee concurs with the budget request and House 
allowance in rescinding $120,000,000 in unobligated emergency 
response funds.
    The Committee is aware of the long-term health concerns of 
first responders in the wake of the September 11 tragedy. The 
Nation owes a debt to these workers, who reacted with courage 
and bravery in a moment of chaos. The Committee is concerned 
that the needs of the first responders be well documented and 
funds be dispersed in a manner that quickly and efficiently 
serves the needs of these brave men and women. For that reason, 
the Committee has included bill language which retroactively 
authorizes $44,000,000 in spending on behalf of victims and 
first responders.

               Employee Benefits Security Administration


                         SALARIES AND EXPENSES

Appropriations, 2005....................................    $131,213,000
Budget estimate, 2006...................................     137,000,000
House allowance.........................................     137,000,000
Committee recommendation................................     134,900,000

    The Committee recommendation provides $134,900,000 for this 
account which is $3,687,000 above the 2005 comparable level. 
This provides sufficient resources to cover built-in cost 
increases.
    The Employee Benefits Security Administration [EBSA] is 
responsible for the enforcement of title I of the Employee 
Retirement Income Security Act of 1974 [ERISA] in both civil 
and criminal areas. 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 
2006 include single employer benefit payments of 
$5,102,000,000, multiemployer financial assistance of 
$90,000,000 and administrative expenses of $296,978,000. 
Administrative expenses are comprised of three activities: (1) 
pension insurance activities, $41,599,000; (2) operational 
support, $93,749,000; and (3) pension plan termination 
expenses, $161,630,000. 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 2006 budget does not recommend a discretionary limit on 
administrative expenditures [LAE] for PBGC. The PBGC's budget 
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 34.6 million 
participants in about 29,600 defined benefit pension plans. The 
multi-employer insurance program protects about 9.8 million 
participants in more than 1,600 plans.

                  Employment Standards Administration


                         SALARIES AND EXPENSES

Appropriations, 2005....................................    $400,847,000
Budget estimate, 2006...................................     416,332,000
House allowance.........................................     416,332,000
Committee recommendation................................     412,616,000

    The Committee recommendation includes $412,616,000 for this 
account. The bill contains authority to expend $2,048,000 from 
the special fund established by the Longshore and Harbor 
Workers' Compensation Act; the remainder of $410,568,000 are 
general funds. In addition, an amount of $33,050,000 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, to implement a program of union 
advisory services. The $15,891,000 request for Program 
Direction has been reduced to $15,375,000, an increase of 
$123,000 over the 2005 level to cover built-in costs; an 
addition of $2,000,000 is described in the following paragraph.
    The recommendation includes $2,000,000 to make available 
personnel and other resources to facilitate the expeditious 
startup of a system to resolve claims of victims for bodily 
injury caused by asbestos exposure. This may include contracts 
with individuals or entities having relevant experience to 
assist in jump starting the program, as described in S. 852, 
the Fair Act of 2005. Activities to shorten the lead-time for 
implementation of asbestos activities encompass procedures for 
the processing of claims, including procedures for the 
expediting of exigent health claims, and planning for 
promulgation of regulations.
    The Employment Standards Administration is involved in the 
administration of numerous laws, including the Fair Labor 
Standards Act, the Immigration and Nationality Act, the Migrant 
and Seasonal Agricultural Workers' Protection Act, the Davis-
Bacon Act, the Family and Medical Leave Act, the Federal 
Employees' Compensation Act [FECA], the Longshore and Harbor 
Workers' Compensation Act, and the Federal Mine Safety and 
Health Act (black lung).

                            SPECIAL BENEFITS

Appropriations, 2005....................................    $233,000,000
Budget estimate, 2006...................................     237,000,000
House allowance.........................................     237,000,000
Committee recommendation................................     237,000,000

    The Committee recommends $237,000,000, the same as the 
budget estimate for fiscal year 2006, and $4,000,000 more than 
fiscal year 2005. This appropriation primarily provides 
benefits under the Federal Employees' Compensation Act [FECA]. 
The payments are prescribed by law. In fiscal year 2006, an 
estimated 155,000 injured Federal workers or their survivors 
will file claims; 55,000 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, 2005....................................    $275,997,000
Budget estimate, 2006...................................     232,250,000
House allowance.........................................     232,250,000
Committee recommendation................................     232,250,000

    The Black Lung Consolidation of Administrative 
Responsibility Act was enacted on November 2, 2002. The Act 
amends the Black Lung Benefits Act to transfer part B black 
lung benefits responsibility from the Commissioner of Social 
Security to the Secretary of Labor, thus consolidating all 
black lung benefit responsibility under the Secretary. Part B 
benefits are based on claims filed on or before December 31, 
1973. The Secretary of Labor already responsible for the part C 
claims filed after December 31, 1973. In fiscal year 2006, an 
estimated 46,100 beneficiaries (5,100 miners and 41,000 
survivors) will receive benefits.
    The Committee recommends an appropriation of $232,250,000 
in fiscal year 2006 for special benefits for disabled coal 
miners. This is in addition to the $81,000,000 appropriated 
last year as an advance for the first quarter of fiscal year 
2006. The recommendation is the same as the administration 
request and House allowance. 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 
$74,000,000 for the first quarter of fiscal year 2007, 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, 2005....................................     $40,321,000
Budget estimate, 2006...................................      96,081,000
House allowance.........................................      96,081,000
Committee recommendation................................      96,081,000

    The Committee recommends $96,081,000, the same as the 
budget estimate for fiscal year 2005, and $55,760,000 more than 
2005.
    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 $760,515,000 are 
anticipated in fiscal year 2006.
    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.
    In 2006, the volume of incoming claims under Part B of the 
Energy Employees Occupational Illness Compensation Program is 
estimated to remain stable at about 16,500 claims from 
Department of Energy [DOE] employees or survivors, and private 
companies under contract with DOE, who suffer from a radiation-
related cancer, beryllium-related disease, or chronic silicosis 
as a result of their work in producing or testing nuclear 
weapons.

                    BLACK LUNG DISABILITY TRUST FUND

Appropriations, 2005....................................  $1,061,969,000
Budget estimate, 2006...................................   1,068,000,000
House allowance.........................................   1,068,000,000
Committee recommendation................................   1,068,000,000

    The Committee recommends $1,068,000,000 for this account in 
2006, an increase of $6,031,000 above the fiscal year 2005 
level, and the same as the budget request and House allowance. 
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 total amount available for fiscal year 2006 will 
provide $314,011,000 for benefits payments, and $57,989,000 for 
administrative expenses for the Department of Labor. Also, 
included is $696,000,000 for interest payments on advances.
    The trust fund pays all black lung compensation/medical and 
survivor benefit expenses when no responsible mine operation 
can be assigned liability for such benefits, or when coal mine 
employment ceased prior to 1970, as well as all administrative 
costs which are incurred in administering the benefits program 
and operating the trust fund.
    It is estimated that 41,400 people will be receiving black 
lung benefits financed through the end of the fiscal year 2006, 
compared to an estimated 44,500 receiving benefits in fiscal 
year 2005.
    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, 2005....................................    $464,158,000
Budget estimate, 2006...................................     466,981,000
House allowance.........................................     477,199,000
Committee recommendation................................     477,491,000

    The Committee recommendation includes $477,491,000 for this 
account. This is an increase of $10,510,000 over the budget 
request and an increase of $13,333,000 above the 2005 
comparable level. This Agency is responsible for enforcing the 
Occupational Safety and Health Act of 1970 in the Nation's 
workplaces.
    This recommendation provides sufficient funding to offset 
the impact of inflation, as well as additional resources to 
expand outreach to non-English speaking workers and small 
businesses.
    In addition, the Committee has included language to allow 
OSHA to retain up to $750,000 per fiscal year of training 
institute course tuition fees to be utilized for occupational 
safety and health training and education grants in the private 
sector.
    The Committee retains language carried in last year's bill 
effectively exempting farms employing 10 or fewer people from 
the provisions of the Act except those farms having a temporary 
labor camp. The Committee also retains language exempting small 
firms in industry classifications having a lost workday injury 
rate less than the national average from general schedule 
safety inspections. These provisions have been in the bill for 
many years.
    The Committee believes that OSHA's worker safety and health 
training and education programs, including the grant program 
that supports such training, are a critical part of a 
comprehensive approach to worker protection. The Committee is 
concerned that OSHA has again cut funding to help establish 
ongoing worker safety and health training programs and has 
therefore restored 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 $53,896,000, 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, 2005....................................    $279,136,000
Budget estimate, 2006...................................     280,490,000
House allowance.........................................     280,490,000
Committee recommendation................................     280,490,000

    The Committee recommendation includes $280,490,000 for this 
account, an increase of $1,354,000 over the 2005 enacted level, 
and the same as the budget request and House allowance.
    This recommendation provides sufficient funding to offset 
the impact of inflation, as well as additional resources for 
enforcement and compliance assistance. It deletes one-time 
funding of projects contained in the 2005 enacted level.
    The Committee recommendation also includes bill language 
providing up to $2,000,000 for mine rescue and recovery 
activities, the same as the fiscal year 2005 comparable level. 
It also retains the provision allowing the Secretary of Labor 
to use any funds available to the Department to provide for the 
costs of mine rescue and survival operations in the event of a 
major disaster.
    This Agency insures the safety and health of the Nation's 
miners by conducting inspections and special investigations of 
mine operations, promulgating mandatory safety and health 
standards, cooperating with the States in developing effective 
State programs, and improving training in conjunction with 
States and the mining industry.
    In addition, bill language is included to allow the 
National Mine Health and Safety Academy to collect not to 
exceed $750,000 for room, board, tuition, and the sale of 
training materials to be available for mine safety and health 
education and training activities. Bill language also allows 
MSHA to retain up to $1,000,000 from fees collected for the 
approval and certification of equipment, materials, and 
explosives for use in mines, and may utilize such sums for such 
activities.

                       Bureau of Labor Statistics


                         SALARIES AND EXPENSES

Appropriations, 2005....................................    $529,003,000
Budget estimate, 2006...................................     542,523,000
House allowance.........................................     542,523,000
Committee recommendation................................     542,523,000

    The Committee includes $542,523,000 for this account, 
$13,520,000 more than the 2005 comparable level. This includes 
$77,845,000 from the ``Employment Security Administration'' 
account of the unemployment trust fund, and $464,678,000 in 
Federal funds. This funding level will cover the Agency's 
built-in increases, and includes funds 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.
    The Committee urges the Bureau of Labor Statistics to 
revamp its website to make it more user friendly.

                 Office of Disability Employment Policy

Appropriations, 2005....................................     $47,164,000
Budget estimate, 2006...................................      27,934,000
House allowance.........................................      27,934,000
Committee recommendation................................      47,164,000

    The Committee recommends $47,164,000 for this account in 
2006. This is $19,230,000 more than the President's request and 
the same as 2005. The Committee intends that at least 80 
percent of these funds shall be used for demonstration and 
technical assistance grants to develop innovative and effective 
practices to increase the employment of youth and adults with 
disabilities.
    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 Committee is aware of the outstanding success of 
national non-profits working to increase self-employment among 
people with disabilities. Self-employment can provide income, 
assets and other elements of self-sufficiency to people with 
disabilities that are hard to place in traditional work 
environments because of the flexibility inherent in self-
employment. In addition to the direct benefit to the business 
owner and the savings to the Social Security Disability Income 
program resulting from self-employment, preliminary data 
suggests that business owners with disabilities are far more 
likely to hire other people with disabilities as the business 
expands.
    Within the funds provided for the Office of Disability 
Employment Policy, the Committee has included $5,000,000 for a 
national initiative focusing on self-employment as an option 
for persons with disabilities. As the centerpiece of this new 
initiative, the Committee has included $3,000,000 to assist 
State Job Training Institutions, WIA One Stops, SBA Small 
Business Development Centers, the Vocational Rehabilitation and 
Employment Services of the Department of Veterans Affairs, 
State, and Tribal Vocational Rehabilitation Agencies, and other 
related programs in implementing effective and accessible 
practices for achieving sustainable self employment outcomes 
for individuals with disabilities. Practices should include but 
not be limited to providing public education, training, 
technical assistance and accessible online and print resources 
with the purpose of advancing self employment opportunities for 
Americans with disabilities. The Committee directs that, in 
making the national technical assistance grant, priority be 
given to national non-profits with experience in delivering 
direct consumer services as well as training to public and 
private agencies. The remainder of the funds in the initiative 
should be used to undertake a thorough analysis of the 
structures currently in place that either promote or impede the 
expansion of business ownership in the disability community.
    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 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, 2005....................................    $320,688,000
Budget estimate, 2006...................................     244,423,000
House allowance.........................................     239,783,000
Committee recommendation................................     320,561,000

    The Committee recommendation includes $320,561,000 for this 
account, which is $76,138,000 more than the budget request and 
$127,000 less than the 2005 comparable level. In addition, an 
amount of $24,239,000 is available by transfer from the black 
lung disability trust fund, which is the same as the budget 
request and the House allowance.
    The primary goal of the Department of Labor is to protect 
and promote the interests of American workers. The departmental 
management appropriation finances staff responsible for 
formulating and overseeing the implementation of departmental 
policy and management activities in support of that goal. In 
addition, this appropriation includes a variety of operating 
programs and activities that are not involved in departmental 
management functions, but for which other salaries and expenses 
appropriations are not suitable.
    The Committee recommendation includes $26,720,000 for 
Executive Direction, the same as the fiscal year 2005 
comparable level.
    The Committee recommendation includes $9,764,000 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 International Labor Affairs 
Bureau [ILAB], in particular, those initiatives working with 
the International Labor Organization [ILO] to combat abusive 
and exploitative child labor.
    The Committee is aware that the administration is 
aggressively pursing multiple trade agreements that will depend 
upon the United States' ability to provide technical assistance 
on labor standards, including but not limited to the 
eradication of child labor. ILAB is the division of the U.S. 
Government with the mission and authority to provide that 
assistance. A budget request that eliminates all funding for 
multilateral and bilateral technical assistance, elimination of 
child labor, permanent reporting capacity and HIV/AIDS in the 
Workplace promotes a lack of confidence in the United States' 
trade efforts.
    The Committee commends the Department of Labor on its 
report ``Investing In Every Child'' which 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. 
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 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.
    Given the aggressive trade agenda and the recent commitment 
to capacity building in developing nations as a form of aid, 
the Committee is mystified by the Department's now annual 
effort to eliminate these programs, this year proposing an 
astounding 86 percent reduction.
    Therefore, the Committee recommendation includes 
$93,248,000 for the Bureau of International Labor Affairs. Of 
this amount, the Committee's recommendation includes 
$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]. Also included is $37,000,000 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 create a barrier to 
education.
    The Committee notes and welcomes ILAB's technical 
assistance programs that promote the goals of the Harkin-Engel 
protocol, as well as ILAB's ongoing efforts to implement 
Executive Order 13126 and its reporting under the Trade and 
Development Act of 2000. To complement these efforts, the 
Committee directs that $4,500,000 of the basic education funds 
be used to provide critical oversight of both the public and 
private investment in the protocol. The Committee expects that 
at a minimum, this will include an annual public report to both 
the Congress and the Department. The report should cite 
progress made on key points of the Protocol and Joint Statement 
including: development of a child labor monitoring system by 
industry, the effective elimination of the worst forms of child 
labor and forced labor in the supply chain, and the development 
of an industry-wide, public, transparent certification system. 
The Committee directs that funds be awarded with priority given 
to academic institutions with expertise in agriculture and the 
U.N. Norms on Business and Human Rights.
    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 duty-free 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 2006 report, all former GSP recipients that have achieved a 
Free Trade Agreement with the United States over the preceding 
2 years. The Committee has provided $1,000,000 for the 
compilation of this report, which shall be transmitted to the 
Congress no later than September 1, 2006.
    The Committee is disturbed by recent reports that the 
Department is treating commodities that were purchased with 
grant funds as a sub-grant and requiring re-payment in ways 
that undermine the original purpose of the grants. The 
Committee notes that the U.S. Government has sensible 
procedures in place for the distribution of commodities that 
retain value after the end of the grant. Therefore, the 
Committee directs that the Department adhere to the OMB 
standards for grant-making, including those standards that 
pertain to the disbursement of goods. These standards should be 
applied to all ongoing grants, as well as any new grants.
    For other ILAB programs, including 125 FTE for Federal 
Administration, the Committee recommends $10,248,000.
    Acknowledging the need to upgrade the information 
technology capability in the Department of Labor, the Committee 
recommends $29,760,000 for the information technology fund, and 
$1,700,000 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, $6,230,000 is 
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.

                    VETERANS EMPLOYMENT AND TRAINING

Appropriations, 2005....................................    $222,833,000
Budget estimate, 2006...................................     224,334,000
House allowance.........................................     229,334,000
Committee recommendation................................     224,334,000

    The Committee recommendation includes $224,334,000 for this 
account, including $194,834,000 in general revenue funding and 
$29,500,000 to be expended from the ``Employment Security 
Administration'' account of the unemployment trust fund. This 
is $1,315,000 more than the 2005 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 
$30,435,000, the same as the budget request and the House 
allowance. The Committee supports the concept of the Transition 
Assistance Program administered jointly with the Department of 
Defense which assists soon-to-be-discharged service members in 
transitioning into the civilian work force and includes funding 
to maintain 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 $1,984,000, 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 $22,000,000 for the 
Homeless Veterans Program, the same as the budget request. Also 
included is $7,500,000 for the Veterans Workforce Investment 
Program, the same as the budget request.
    The Committee is interested in ensuring that qualified job 
training programs of the Department of Labor fully extend 
priority of service for veterans as required by the Jobs for 
Veterans Act. Toward this effort, the Committee urges the 
Secretary to develop a guide for veterans in accessing 
workforce investment 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, 2005....................................     $68,995,000
Budget estimate, 2006...................................      70,819,000
House allowance.........................................      70,819,000
Committee recommendation................................      72,819,000

    The bill includes $72,819,000 for this account, $3,824,000 
above the 2005 comparable level. The bill includes $67,211,000 
in general funds and authority to transfer $5,608,000 from the 
``Employment Security Administration'' account of the 
unemployment trust fund. In addition, an amount of $344,000 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 augmenting program accountability 
activities and expanding the labor racketeering program.
    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:
    Provide for modified general transfer authority (sec. 101).
    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 in 
accordance with Executive Order 13126 (sec. 102).
    Authorize funds to be appropriated for job training for 
workers involved in construction projects funded through the 
Denali Commission (sec. 103).
    Provide that certain payments made by the New York Workers' 
Compensation Board in response to terrorist attacks shall be 
deemed to have been made for workers compensation programs 
(sec. 104).
    Require the Department of Labor to submit its fiscal year 
2007 congressional budget justifications in the same format and 
level of detail used by the Department of Education in its 
fiscal year 2006 congressional budget justification (sec. 105).

           TITLE II--DEPARTMENT OF HEALTH AND HUMAN SERVICES

              Health Resources and Services Administration

                     HEALTH RESOURCES AND SERVICES

Appropriations, 2005....................................  $6,828,012,000
Budget estimate, 2006...................................   5,991,144,000
House allowance.........................................   6,468,437,000
Committee recommendation................................   7,423,434,000

    The Committee provides a program level of $7,423,434,000 
for the Health Resources and Services Administration [HRSA]. 
The Committee recommendation includes $7,398,434,000 in budget 
authority and an additional $25,000,000 via transfers available 
under section 241 of the Public Health Services Act. The fiscal 
year 2005 comparable program level was $6,828,012,000, the 
administration request program level was $5,991,144,000, and 
the House provided $6,468,437,000.
    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.
    The Committee recognizes the unique needs of frontier and 
rural populations and applauds the Department for establishing 
competitive grants specifically aimed at programs with those 
designations. The Committee likewise recognizes the limited 
accessibility of island communities, whether rural or urban, 
and urges the Department to include an island designation to 
promote programs in areas geographically isolated from the 
mainland and neighbor islands. Criteria for island designation 
includes a clinic, federally qualified health center, or 
hospital located on a land mass surrounded by water and greater 
than 2,000 miles from the United States mainland.

                     BUREAU OF PRIMARY HEALTH CARE

                        COMMUNITY HEALTH CENTERS

    The Committee provides $1,839,311,000 for the community 
health centers. The fiscal year 2005 comparable program level 
was $1,734,311,000, the administration request program level 
was $2,037,871,000, and the House provided $1,834,311,000. This 
group of programs includes community health centers, migrant 
health centers, health care for the homeless, and public 
housing health service grants.
    Within the amount provided, $20,000,000 has been allocated 
to offset the rising cost of health care at existing centers, 
and $5,000,000 has been allocated 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 includes bill language limiting the amount of 
funds available for the payment of claims under the Federal 
Tort Claims Act to $45,000,000, which is the same as the 
administration request and in fiscal year 2005. Bill language 
has also been included clarifying that these funds are 
available until expended. The Committee has included bill 
language allowing costs associated with the health centers tort 
liability relief to be paid from the fund. The Committee 
intends that the fund be used to pay judgments and settlements, 
occasional witness fees and expenses, and the administrative 
costs of the program, which includes the cost of evaluating 
claims, defending claims, and conducting settlement activities. 
The Committee is aware of legislation that would extend FTCA 
coverage to volunteer physicians and non-grantee health centers 
(commonly referred to as ``look-alikes''). While both proposals 
would extend FTCA coverage to additional providers, the 
Committee expects the amount provided to be adequate to cover 
any increased costs in fiscal year 2006.
    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 $105,000,000 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.
    The Committee is concerned by the small number of health 
centers that have been able to utilize the loan guarantee 
program despite sufficient funding being available since fiscal 
year 1997. The Committee urges HRSA to increase the percentages 
at which loan guarantees are provided for managed care plans, 
networks, and facilities to the highest authorized levels in 
order to enhance the number of health centers participating in 
the program.
    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 budget requests.
    The Committee is concerned that HHS requires health centers 
and other facilities to have a HPSA priority score of 14 or 
above in order to obtain a J-1 Visa physician placement and 
that this additional criterion has severely limited access to 
J-1 physicians in underserved communities. The Committee 
encourages HRSA to consider using an alternative methodology 
for entities eligible for Federal J-1 Visa physician 
placements.
    The Committee recognizes an important role of the 
consolidated health centers is caring for people living with or 
at risk of hepatitis C. The committee encourages the Bureau of 
Primary Care to provide leadership and training to its grantees 
on hepatitis C prevention, medical management and treatment.
    The Committee recognizes the cultural differences inherent 
in addressing family violence prevention among minority 
populations, such as Native Hawaiians. Additionally, many 
victims of domestic violence seek care through safety net 
providers in community health centers rather than present to 
costly emergency departments. The Committee encourages the 
Department to fund demonstration projects that combine 
integrated family violence prevention models focused on 
minority populations with primary care delivery.
    The Committee commends the efforts of health centers to 
deliver culturally and linguistically appropriate care and 
encourages the Secretary to work with health centers to better 
enable them to provide, to the maximum extent feasible, 
culturally competent and linguistically appropriate services. 
The Committee also urges that attention be given to strategies 
to increase the numbers and diversity of health professionals 
at community health centers.
    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 encourages 
HRSA to research the effectiveness of nurse-managed health 
centers as a national model to reduce health disparities.
    The Committee encourages the Bureau of Primary Health Care 
to consider establishing a grant program within its community 
health center program that would support the establishment and/
or expansion of nurse practice arrangements commonly referred 
to as nurse-managed health centers that provide the medically 
underserved with access to primary care services and promote 
career advancement among nursing personnel in a variety of 
training settings.
    The Committee is concerned that Federal community health 
center funds are often not available to small, remote 
communities in Alaska, Hawaii, and other similar States because 
the population base is too small. Many of these communities 
have no health service providers and are forced to travel long 
distances by boat or plane even in emergency situations. The 
Committee supports efforts now underway to increase community 
health center funding to address the growing number of 
uninsured persons in this country. The Committee recommends 
that HRSA examine its regulations and applications procedures 
to ensure they do not unduly burden small communities 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.

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 $14,100,000 be provided 
for these activities in fiscal year 2006.

Free Clinics Medical Malpractice Coverage

    The Committee provides $99,000 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. The 
fiscal year 2005 comparable level was $99,000 and neither the 
administration nor the House provided any funding for this 
program. 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.

Radiation and Exposure Screening and Education Program

    The Committee provides $1,958,000 for the Radiation 
Exposure Compensation Act. The fiscal year 2005 comparable 
level was $1,958,000, the administration request was $1,936,000 
and the House provided $1,900,000. 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 $60,000,000 for the Community Access 
Program. The fiscal year 2005 comparable level was $82,993,000 
and the administration did not request fund for this program in 
fiscal year 2006. This program is designed to increase the 
capacity and effectiveness of community health care 
institutions and providers who serve patients, regardless of 
their ability to pay.
    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 is pleased 
that HRSA, through the H-CAP program, has prioritized 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 $17,066,000 for the National 
Hansen's Disease Program. The fiscal year 2005 comparable level 
was $17,251,000 and the administration request was $16,066,000 
in fiscal year 2006. 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 $222,000 for buildings and 
facilities. The fiscal year 2005 comparable level was $247,000 
and the administration request was $222,000. This funding 
provides for the repair and maintenance of buildings at the 
Gillis W. Long Hansen's Disease Center.

Payment to Hawaii for Hansen's Disease Treatment

    The Committee provides $2,017,000 for Hansen's disease 
services. The fiscal year 2005 comparable level was $2,017,000 
and the administration requested $2,016,000.

Black Lung Clinics

    The Committee provides $5,975,000 for black lung clinics. 
The fiscal year 2005 comparable level was $5,951,000 and the 
administration requested $5,912,000. 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 $40,705,000 for field placement 
activities. The fiscal year 2005 comparable level was 
$45,068,000 and the administration request was $40,705,000. 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 proportion of 
NHSC assignees being placed 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 has access to a sufficient level of 
health professionals through the NHSC.
    The Committee is concerned by reports that the current HPSA 
scoring process used by HRSA to place physicians disadvantages 
many health centers located in medically underserved areas of 
the country. The Committee urges HRSA to reconsider the 
decision to score FQHCs under the newly authorized automatic 
designation process based on data and criteria that virtually 
eliminate all such FQHCs 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 $86,091,000 for recruitment 
activities. The fiscal year 2005 comparable level was 
$86,380,000 and the administration request was $86,091,000. 
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 believes that the inclusion of Optometrists 
in the National Health Service Corps' [NHSC] Student Loan 
Repayment Program will result in the expanded accessibility of 
eye care in communities where it is most needed. Accordingly, 
the Committee urges the Health Resources and Services 
Administration to take immediate steps to fully utilize Doctors 
of Optometry in the NHSC Student Loan Repayment Program as part 
of an effort to make preventive eye care services more 
accessible in community health centers within rural and urban 
primary care health professional shortage areas.

                           HEALTH PROFESSIONS

    The Committee provides $454,393,000 for all HRSA health 
professions programs. The fiscal year 2005 comparable level was 
$450,213,000 and the administration requested $160,534,000 in 
fiscal year 2006.
    The Committee recognizes that physicians trained in 
combined Internal Medicine-Pediatrics [Med-Peds] residency 
training programs are particularly well suited to care for 
patients with chronic medical illnesses who transition from 
pediatric to adult-centered care. These physicians receive 
intensive training in the care of children with chronic 
illnesses as well as primary care for adults. The Committee 
believes that Med-Peds physicians may fill the emerging need of 
caring for these patients. The Committee encourages HRSA to 
consider developing model demonstration projects on transition 
care. The goal would be to address the healthcare needs of this 
underserved population and to train future physicians to 
provide care for them.
    The Committee understands that nearly three quarters of the 
Nation's 122 Job Corps Centers offer health occupations 
training as well as training in health care related fields. The 
Committee recognizes the Job Corps success in training students 
with the skills they need to fill critical shortages through 
major national employer partners. The Committee encourages HRSA 
to consider making Job Corps Centers eligible for HRSA funding 
for allied health training programs.
    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 is aware that HRSA has prepared a 
report on the healthcare workforce shortage issue, and that the 
portion of the report that will attempt to identify the causes 
of, and potential responses to, the critical care workforce 
shortage will be informed, in part, by The Critical Care 
Medicine Crisis: A Call for Federal Action prepared by the 
American College of Chest Physicians and the members of the 
Critical Care Workforce Partnership. The Committee requests 
HRSA provide a copy of this report to the Committee by July 1, 
2006. 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.

Training for Diversity

            Centers of Excellence
    The Committee provides $33,609,000 for the Centers of 
Excellence program. The fiscal year 2005 comparable level was 
$33,609,000 and the administration did not request any funds 
for this program in fiscal year 2006. 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.

            Health Careers Opportunity Program
    The Committee provides $35,647,000 for the Health Careers 
Opportunity Program. The fiscal year 2005 comparable level was 
$35,647,000 and the administration did not request any funds 
for this program in fiscal year 2006. This program provides 
funds to medical and other health professions schools for 
recruitment of disadvantaged students and pre-professional 
school preparations.
    The Committee is concerned about the reduced level of 
support provided to minority health professions schools through 
the H-COP program in recent fiscal years. For fiscal year 2006, 
the Committee urges HRSA to give priority consideration to 
awarding grants to those institutions with a historic mission 
of training minorities in the health professions. HRSA should 
report to the Committee within 6 weeks of enactment of this Act 
with the steps it has taken to address this issue.

            Faculty Loan Repayment
    The Committee provides $1,302,000 for the Faculty Loan 
Repayment program. The fiscal year 2005 comparable level was 
$1,302,000 and the administration did not request any funds for 
this program in fiscal year 2006. 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 $47,128,000 for the Scholarships for 
Disadvantaged Students program. The fiscal year 2005 comparable 
level was $47,128,000 and the administration requested 
$9,381,000 for this program in fiscal year 2006. This program 
provides grants to health professions schools for student 
scholarships to individuals who are from disadvantaged 
backgrounds and are enrolled as full-time students in such 
schools. The Committee continues to intend that all health 
professions disciplines made eligible by statute be able to 
participate in the scholarships program.

Training in Primary Care Medicine and Dentistry

    The Committee provides $90,000,000 for Training in Primary 
Care Medicine and Dentistry programs. The fiscal year 2005 
comparable level was $88,816,000 and the administration did not 
request funding for this program in fiscal year 2006.

            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.

Interdisciplinary, Community-based Linkages

            Area Health Education Centers
    The Committee provides $28,971,000 for the Area Health 
Education Centers program. The fiscal year 2005 comparable 
level was $28,971,000 and the administration did not request 
any funds for this program in fiscal year 2006. 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 $3,819,000 for the Health Education 
and Training Centers program. The fiscal year 2005 comparable 
level was $3,819,000 and the administration did not request any 
funds for this program in fiscal year 2006. 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 $11,753,000 for the Allied Health 
and Other Disciplines programs. The fiscal year 2005 comparable 
level was $11,753,000 and the administration did not request 
any funds for this program in fiscal year 2006. The Committee 
intends that these funds be used to support existing programs 
at not less than last year's level. 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 is concerned about the emerging shortage of 
occupational therapists needed to work with baby boom retirees 
and encourages HRSA to give priority consideration to projects 
for schools that address these manpower shortages by both 
training faculty and students for entry level service.
    The Committee is aware that dental disease 
disproportionately affects our Nation's most vulnerable 
populations, including many in rural America. New ways of 
bringing oral health care to rural and underserved populations 
are needed. The Committee encourages HRSA to explore 
alternative methods of delivering preventive and restorative 
oral health services in rural America. Specifically, the 
Committee encourages HRSA to explore development of an advanced 
dental hygiene practitioner who would be a graduate of an 
accredited dental hygiene program and complete an advanced 
educational curriculum, which prepares the dental hygienist to 
provide diagnostic, preventive, restorative and therapeutic 
services directly to the public in rural and underserved areas.
    The Committee notes that since 1999 HRSA has not provided a 
focus, through a request for proposals or other program 
initiatives, on pediatric occupational therapy. In view of the 
importance of this health profession to children with 
disabilities, the Committee encourages HRSA to identify a 
competitive category specifically for pediatric occupational 
therapy training grants in 2006.

            Geriatric Education Centers and Training
    The Committee provides $29,548,000 for the Geriatrics 
Education Centers and Training programs. The fiscal year 2005 
comparable level was $31,548,000 and the administration did not 
request any funds for this program in fiscal year 2006. 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.

            Quentin N. Burdick Program for Rural Health 
                    Interdisciplinary Training
    The Committee provides $6,076,000 for these programs. The 
fiscal year 2005 comparable level was $6,076,000 and the 
administration did not request any funds for this program in 
fiscal year 2006. 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.

            Podiatric Primary Care Training
    This program provides grants to hospitals and schools of 
podiatric medicine for residency training in primary care. In 
addition to providing grants to hospitals and schools of 
podiatric medicine for residency training in primary care, the 
program also permits HRSA to study and explore ways to more 
effectively administer postdoctoral training in an ever 
changing health care environment.

            Chiropractic Demonstration Grants
    This program provides grants to colleges and universities 
of chiropractic to carry out demonstration projects in which 
chiropractors and physicians collaborate to identify and 
provide effective treatment of spinal and lower back 
conditions. The Committee continues to support the chiropractic 
research and demonstration grant program, originally authorized 
under section 782 of Public Law 102-408, and funded by the 
Committee in previous years. The Committee recommends that the 
chiropractic-medical school demonstration grant program be 
continued.

Workforce Information and Analysis

    The Committee provides $712,000 for these programs. The 
fiscal year 2005 comparable level was $716,000 and the 
administration requested $712,000.

            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 $9,097,000 for these programs. The 
fiscal year 2005 comparable level was $9,097,000 and the 
administration did not request any funds for this program in 
fiscal year 2006. 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 $1,070,000 for the Health 
Administration programs. The fiscal year 2005 comparable level 
was $1,070,000 and the administration did not request any funds 
for this program in fiscal year 2006. 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.
    Although the majority of Native Hawaiians receive services 
in federally qualified community health centers, there is only 
one Native Hawaiian health care administrator working in these 
centers. The Committee is concerned that limited mentoring and 
training opportunities exist for Native Hawaiian administrators 
in health care organizations. The Committee urges that a 
portion of money appropriated for Native Hawaiian Health Care 
Act programs be used to prepare Native Hawaiians with the 
expertise to excel in administrative health care positions.

Nursing Workforce Development Programs

    The Committee provides $155,661,000 for the Nursing 
Workforce Development programs. The fiscal year 2005 comparable 
level was $150,661,000 and the administration requested 
$149,991,000 for these programs 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.

            Advanced Education Nursing
    The Committee provides $58,160,000 for the Advanced 
Education Nursing programs. The fiscal year 2005 comparable 
level was $58,160,000 and the administration requested 
$42,806,000 for this program in fiscal year 2006. 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.
    The Committee understands that advanced practice nurses 
provide high quality, cost-effective care in whatever 
geographic locations they practice and that often they are a 
patient's only option for care. The Committee requests the 
Administrator to report to the Committee within 6 weeks of 
enactment of this Act on the number of advanced practice nurse 
candidates that receive traineeships and the number that then 
work in rural, isolated or underserved areas across the United 
States.

            Nurse Education, Practice, and Retention
    The Committee provides $40,468,000 for the Nurse Education, 
Practice, and Retention Programs. The fiscal year 2005 
comparable level was $36,468,000 and the administration 
requested $46,325,000 for this program in fiscal year 2006. 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.

            Nursing Workforce Diversity
    The Committee provides $17,270,000 for the Nursing 
Workforce Diversity program. The fiscal year 2005 comparable 
level was $16,270,000 and the administration requested 
$21,244,000 for this program in fiscal year 2006. The goal of 
this program is to improve the diversity of the nursing 
workforce through increased educational opportunities for 
individuals from disadvantaged backgrounds. The Committee urges 
the Division of Nursing to develop and increase cultural 
competence in nursing and to increase the number of 
underrepresented racial and ethnic minorities in all areas of 
nursing education and practice to enhance nurses' ability to 
provide quality health care services to the increasingly 
diverse community it serves.

            Nurse Loan Repayment and Scholarship Program
    The Committee provides $31,482,000 for the Nurse Loan 
Repayment and Scholarship programs. The fiscal year 2005 
comparable level was $31,482,000 and the administration 
requested $31,369,000 for this program in fiscal year 2006. 
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 $4,831,000 for the Nursing Faculty 
Loan program. The fiscal year 2005 comparable level was 
$4,831,000 and the administration requested $4,821,000 for this 
program in fiscal year 2006. This program supports the 
development of a student loan fund in schools of nursing to 
increase the number of qualified nursing faculty.

            Comprehensive Geriatric Education
    The Committee provides $3,450,000 for Comprehensive 
Geriatric Education grants. The fiscal year 2005 comparable 
level was $3,450,000 and the administration requested 
$3,426,000 for this program in fiscal year 2006. These grants 
prepare nursing personnel to care for the aging population.

Children's Hospitals Graduate Medical Education Program

    The Committee has provided $300,000,000 for the Children's 
Hospitals Graduate Medical Education [GME] program. The fiscal 
year 2005 comparable level was $300,730,000 and the 
administration requested $200,000,000 for this program in 
fiscal year 2006.
    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 2005 comparable level 
was $15,700,000 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 2005 
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.

                    MATERNAL AND CHILD HEALTH BUREAU

Maternal and Child Health Block Grant

    The Committee provides $710,000,000 for the maternal and 
child health [MCH] block grant. The fiscal year 2005 comparable 
level was $723,928,000 and the administration request was 
$723,928,000.
    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 included bill language identifying 
$121,396,250 for the SPRANS set-aside. Within that total, the 
Committee intends that $4,000,000 be used to continue the 
sickle cell newborn screening program and its locally based 
outreach and counseling efforts; $5,000,000 be used to continue 
the oral health demonstration programs and activities in the 
States; $2,000,000 be used for mental health programs and 
activities in the States; $3,000,000 be used for epilepsy 
demonstration projects; $1,000,000 be used for a fetal alcohol 
syndrome demonstration program; and $2,000,000 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 provided $5,000,000 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 $2,000,000 for mental health 
programs and activities in the States. The Committee expects 
that the programs will include mental health grants for 
prevention and early intervention services for children and 
youth ages 0 to 24 years and for women's mental health as it 
relates to their role in the family, particularly for women 
diagnosed with postpartum depression [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.
    The Committee has provided $3,000,000 for the continuation 
of epilepsy demonstration programs to improve access to health 
and other services regarding seizures and to encourage early 
detection and treatment in children and others residing in 
medically underserved and rural areas. Of the amount provided, 
the Committee recommends 30 percent be used to continue to fund 
the development and testing of a national public health 
awareness campaign to increase seizure recognition and improve 
access to care among minorities and underserved populations. In 
implementing this program, the Committee encourages HRSA to 
partner with a national organization whose mission is to 
improve the lives of children and adults affected by seizure 
through research, education, advocacy and service.
    The Committee has included $1,000,000 to continue the 
demonstration program on fetal alcohol syndrome begun in last 
year's appropriation. Each year, 40,000 children are born with 
fetal alcohol spectrum disorders [FASD], the leading known 
cause of mental retardation and birth defects. The 
demonstration program should continue to coordinate services 
between the National Organization on Fetal Alcohol Syndrome and 
community health centers to improve the prevention, 
identification, and support of individuals with fetal alcohol 
syndrome. In addition, funds have been included to engage and 
include maternal child health sites in this successful 
demonstration.
    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.
    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 July 15, 2006 on the steps taken to validate a screening 
tool for Fragile X 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 reiterates its long-standing support for the 
continuation of funding that the Maternal and Child Health 
Block Grant has provided to comprehensive thalassemia treatment 
centers under the SPRANS program. The Committee strongly 
encourages MCHB to continue this program, expand it to include 
additional centers around the country, and to coordinate 
closely its activities with the Cooley's Anemia Foundation.
    The most crucial need for individuals suffering from 
Chronic Fatigue Syndrome is for effective, compassionate 
medical care. Through its demonstration grants program, HRSA 
has piloted effective ways of delivering health care services 
to those with emerging illnesses. The Committee encourages HRSA 
to provide demonstration grants 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 of hemophilia 
treatment centers in providing needed comprehensive care for 
persons with bleeding disorders and the expanded role of these 
centers in addressing the needs of women with bleeding 
disorders and persons with clotting disorders such as 
thrombophilia. The Committee urges HRSA to continue its support 
of this model disease management network.
    The Committee is aware that many school-age children with 
vision problems significant enough to affect their learning are 
not screened for vision problems prior to entering school. In 
an effort to stimulate a national effort to reduce the 
occurrence of vision loss and its accompanying disabilities, 
the Committee encourages HRSA to consider developing a National 
Core Performance Measure for children's vision.

Sickle Cell Anemia Demonstration Program

    The Committee provides $500,000 for the sickle cell anemia 
demonstration program. The fiscal year 2005 comparable level 
was $198,000 and the administration did not request funding for 
this program in fiscal year 2006.

Traumatic Brain Injury Program

    The Committee provides $9,297,000 for the traumatic brain 
injury program. The fiscal year 2005 comparable level was 
$9,297,000 and the administration did not request funding for 
this program in fiscal year 2006. 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 $104,000,000 for the healthy start 
infant mortality initiative. The fiscal year 2005 comparable 
level was $102,543,000 and the administration request was 
$97,747,000.
    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 2005.

Universal Newborn Hearing Screening and Early Intervention

    The Committee provides $9,792,000 for universal newborn 
hearing screening and early intervention activities. The fiscal 
year 2005 comparable level was $9,792,000 and the 
administration did not request funds for this program in fiscal 
year 2006.
    The Committee has included sufficient funding to continue 
the initiative begun several years ago to provide grants to 
States to establish universal newborn hearing screening and 
early intervention programs. The Committee is pleased by the 
success of the initiative and the substantial response from 
States.
    The Committee expects HRSA to coordinate projects funded 
with this appropriation with projects related to early hearing 
detection and intervention by the National Center on Birth 
Defects and Developmental Disabilities, the National Institute 
on Deafness and Other Communication Disorders, the National 
Institute on Disability and Rehabilitation Research, and the 
Office of Special Education and Rehabilitative Services.

Emergency Medical Services for Children

    The Committee provides $20,000,000 for emergency medical 
services for children. The fiscal year 2005 comparable level 
was $19,830,000 and the administration did not request funding 
for this program in fiscal year 2006. The program supports 
demonstration grants for the delivery of emergency medical 
services to acutely ill and seriously injured children.
    The Committee notes that this program is the only Federal 
source of funding and expertise for improving EMS systems for 
children. The Committee commends the EMSC program for its 20 
years of achievement and applauds its commitment to improving 
the delivery of emergency medical services to ill and injured 
children.

Poison Control Centers

    The Committee provides $23,301,000 for poison control 
center activities. The fiscal year 2005 comparable level was 
$23,499,000 and the administration requested $23,301,000 for 
this program in fiscal year 2006. 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.

                            HIV/AIDS BUREAU

                  ACQUIRED IMMUNE DEFICIENCY SYNDROME

Ryan White AIDS Programs

    The Committee provides $2,083,296,000 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 2005 comparable level was $2,073,296,000 and 
the administration request was $2,083,296,000.
    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 Americans, Asian Americans, Native Hawaiians, and 
Pacific Islanders continue with at least the level of funding 
provided in fiscal year 2005.
    The Committee is concerned that at least 30 percent of 
persons living with HIV are co-infected with hepatitis C, and 
that hepatitis C related complications are emerging as the 
leading cause of death among persons living with HIV/AIDS. The 
Committee requests that HRSA provide both more guidance to 
grantees on providing services to co-infected individuals, and 
more education and training to medical providers on treating 
persons co-infected with HIV and HCV.

Emergency Assistance--Title I

    The Committee provides $610,094,000 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 $1,131,836,000 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 $797,521,000 for AIDS medications.
    The Committee is concerned that Title II base award amounts 
have been reduced by $14,000,000 over the past 2 fiscal years, 
thereby reducing the ability of State and territory health 
departments to provide comprehensive health care services to 
all those living with HIV/AIDS in need. The Committee 
recognizes the unique role that State health departments play 
in coordinating HIV/AIDS care and treatment programs within 
their State, regardless of funding source. The Committee 
encourages HRSA, in collaboration with state health 
departments, to seek meaningful measures by which coordination 
between all Ryan White CARE Act grantees and other Federal HIV/
AIDS programs can occur within States and territories, with 
inclusion of State representatives in HRSA's monitoring visits 
of Title III and IV grantees, as well as notification to states 
of new grantees within their jurisdictions.
    The Committee recognizes the importance of ADAP in making 
it possible for low-income Americans to access and afford the 
drugs to treat HIV/AIDS. Today, more than 150,000 Americans 
depend on ADAP to preserve and extend their lives. 
Unfortunately, dozens of States find themselves unable to keep 
up with the demand for patients in need of coverage under ADAP, 
and many states have been forced to take drastic action to 
offset funding shortfalls. The Committee encourages HRSA to 
explore methods of redistributing unobligated funds to help 
address the ADAP crisis.

Early Intervention Program--Title III-B

    The Committee provides $195,578,000 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.

Women, Infants, Children, and Youth--Title IV

    The Committee provides $72,519,000 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 still 
not been followed, making it almost impossible for HRSA to 
impose a cap in fiscal year 2006. 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 
agreements to provide technical assistance to title IV grantees 
and to conduct policy analysis and research.

AIDS Education and Training Centers

    The Committee provides $35,051,000 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.

AIDS Dental Services

    The Committee provides $13,218,000 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.

Telehealth

    The Committee provides $3,888,000 for telehealth 
activities. The fiscal year 2005 comparable level was 
$3,916,000 and the administration request was $3,888,000. 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.

                        SPECIAL PROGRAMS BUREAU

Organ Donation and Transplantation

    The Committee provides $24,413,000 for organ transplant 
activities. The fiscal year 2005 comparable level was 
$24,413,000 and the administration request was $23,282,000. 
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 notes that Public Law 108-216, the Organ 
Donation Recovery and Improvement Act of 2004 has provided new 
program authorizations and urges efforts to implement the new 
law. Funding provided by the Committee may be used to implement 
the provisions of the new law and the Committee notes that the 
new provisions may have a direct impact on increasing the rate 
of successful transplantations.
    The Committee is concerned that pregnant women and their 
families are unaware of the benefits of umbilical cord blood in 
treating many congenital and genetic diseases. The Committee 
encourages HRSA to consider adding umbilical cord blood to 
organ and tissue donation education programs operated by HRSA 
to provide education on all options for umbilical cord blood 
storage including public donation and private banking.
    The Committee is encouraged by the continuing success of 
the 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 helping these 
hospitals achieve organ donation rates of 75 percent or higher, 
which will result in at least 6,000 additional organs available 
for transplantation. The Committee notes that this project has 
made important progress toward this goal over the last year and 
urges its continuation. 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.

National Cord Blood Stem Cell Bank Program

    The Committee has provided $9,859,000 for the National Cord 
Blood Stem Cell Bank Network. The fiscal year 2005 comparable 
level was $9,859,000 and the administration did not request 
funds for this activity in fiscal year 2006.
    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 notes that the 
Institute of Medicine study required by House Report 108-401 
has been completed and submitted to the Committee and HRSA. The 
Committee expects HRSA to begin implementation of this program 
as soon as possible.

National Bone Marrow Donor Program

    The Committee provides $22,916,000 for the National Bone 
Marrow Donor Registry. The fiscal year 2005 comparable level 
was $25,416,000 and the administration request was $22,916,000. 
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 $3,418,000 for trauma/emergency 
medical services. The fiscal year 2005 comparable level was 
$3,418,000 and the administration did not request funds for 
this program in fiscal year 2006. 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.

State Planning Grants for Health Care Access

    The Committee has not provided funding for State Planning 
Grants for Health Care Access in fiscal year 2006. The fiscal 
year 2005 comparable level was $10,910,000 and the 
administration did not request funding for this activity in 
fiscal year 2006.

                         RURAL HEALTH PROGRAMS

Rural Health Policy Development Program

    The Committee provides $8,825,000 for the Rural Health 
Policy Development Program. The fiscal year 2005 comparable 
level was $8,825,000 and the administration request was 
$8,528,000. 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 $39,278,000 for health outreach 
grants. The fiscal year 2005 comparable level was $39,278,000 
and the administration request was $10,767,000. 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 receiving appropriate compensation to 
provide this service. The Committee encourages HRSA 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.
    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.

Rural and Community Access to Emergency Devices

    The Committee provides $8,927,000 for rural and community 
access to emergency devices. The fiscal year 2005 comparable 
level was $8,927,000 and the administration request was 
$1,960,000. This provides funding for both the rural program 
under section 413 of the Public Health Service Act and 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 $64,180,000 for rural hospital 
flexibility grants. The fiscal year 2005 comparable level was 
$39,180,000 and the administration did not request funds for 
this program in fiscal year 2006.
    Under this program, eligible rural hospitals may convert 
themselves into limited service facilities termed Critical 
Access 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.
    The Committee has included $25,000,000 for a Rural Health, 
Education, and Workforce Infrastructure Demonstration Program 
which shall solicit and fund proposals from local governments, 
hospitals, universities, and rural public health-related 
entities and organizations for research development, 
educational programs, job training, and construction of public 
health-related facilities.

State Offices of Rural Health

    The Committee provides $8,321,000 for the State Offices of 
Rural Health. The fiscal year 2005 comparable level was 
$8,321,000 and the administration request was $8,223,000. 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 $500,000 for the Rural EMS 
Training and Assistance Grants program. The comparable fiscal 
year 2005 level was $496,000 and the administration did not 
request funding for this program in fiscal year 2006.

Native and Rural Alaskan Health Care

    The Committee provides $39,680,000 for the Denali 
Commission. The fiscal year 2005 comparable level was 
$39,680,000 and the administration did not request funding for 
this program in fiscal year 2006. These funds support 
construction and renovation of health clinics, hospitals and 
social service facilities in rural Alaska, as authorized by 
Public Law 106-113, to help remote communities in Alaska 
develop critically needed health and social service 
infrastructure for which no other funding sources are 
available, thereby providing health and social services to 
Alaskans in remote rural communities as they are in other 
communities throughout the country. The Committee expects the 
Denali Commission to allocate funds to a mix of rural hospital, 
clinic, long-term care and social service facilities, rather 
than focusing exclusively on clinic funding.

Terrorism Preparedness

    The Committee provides $510,500,000 for bioterrorism 
preparedness related activities at HRSA. Within this total, 
$483,000,000 is provided for hospital preparedness grants and 
$27,500,000 is provided for education and curriculum 
development.
    The Committee intends that, at the discretion of the 
Secretary of Health and Human Services, funds provided for the 
hospital preparedness grants may be used for deployable mass 
casualty units (as requested in the Strategic National 
Stockpile), credentialing integration (as requested in the 
Office of the Secretary), and training a medical reserve corps 
(as requested in the Office of the Secretary). These deployable 
mass casualty units could provide key hospital surge capacity 
in the event of a terrorist attack or natural disaster. HRSA 
should continue to work with the Department and other HHS 
agencies to coordinate their terrorism preparedness activities.
    Within the total provided for hospital preparedness grants, 
the Committee approves the request for $25,000,000 to create a 
medical surge capacity national demonstration at Washington 
Hospital Center. The funding will increase emergency care 
capacity for the Nation's Capital, and serve as a national 
demonstration center for advanced mass casualty emergency 
facility design, training, and care.
    The Committee is concerned about the current HRSA strategy 
for providing training to health care professionals on 
bioterrorism preparedness. Many expert analyses, including 
several presented at the Secretary's Council on Public Health 
Preparedness, have stressed the need for a consistent, national 
curriculum for bioterrorism preparedness training. The 
Committee is troubled that, instead of adopting a consistent, 
national approach to training, HRSA has instead chosen to issue 
19 separate grants for continuing education on bioterrorism 
training, and a further 12 grants for curriculum development. 
The Committee believes that this approach risks producing a 
fragmented and uncoordinated bioterrorism preparedness training 
program instead of the integrated and coordinated program that 
is needed. The Committee instructs HRSA to seek ways to improve 
the coordination and consistency of its bioterrorism training 
program, and to report to the Committee on recommendations for 
achieving a consistent, national strategy for bioterrorism 
preparedness training no later than 6 weeks after the date of 
enactment of this Act.

Family Planning

    The Committee provides $285,963,000 for the title X family 
planning program. The fiscal year 2005 comparable level was 
$285,963,000 and the administration request was $285,963,000.
    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 believes 
that the authority for making grants under title X must remain 
unchanged.
    The Committee is aware of the findings of a recent HHS 
Inspector General's report, which documents efforts by the 
Office of Population Affairs to inform and periodically remind 
title X grantees of their responsibilities regarding State 
child abuse and sexual abuse reporting requirements. The report 
notes that OPA includes State reporting requirements in its 
reviews and site visits of grantees, and cites an extensive 
amount of effort and training that goes on within the program 
to ensure that clinicians are conversant with State reporting 
requirements, and trained to both recognize signs of sexual 
coercion and sexual violence and follow appropriate procedures 
when dealing with such cases.

Health Care-related Facilities and Activities

    The Committee provides $480,751,000 for the construction 
and renovation (including equipment) of health care-related 
facilities and other health care-related activities. The fiscal 
year 2005 comparable level was $482,729,000 and the 
administration did not request funds for this program in fiscal 
year 2006. 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 $143,992,000 for program management 
activities for fiscal year 2006. The fiscal year 2005 
comparable level was $147,080,000 and the administration 
request was $145,992,000.
    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 notes that the program is 
growing rapidly due the growth in the number of Community 
Health Centers and an expansion of the number of rural and 
small hospitals eligible to be recognized as disproportionate 
share hospitals, contained in the Medicare Modernization Act. 
The Committee is deeply concerned that the Department lacks the 
oversight capability to ensure that safety-net organizations 
participating in the program receive the full statutory 
discounts. The Committee agrees with the Inspector General that 
participating entities must have the ability to independently 
verify that they are receiving the mandated discounts, and 
strongly urges HRSA to develop a mechanism by which this 
verification can take place.

                   HEALTH EDUCATION ASSISTANCE LOANS

    The Committee provides $4,000,000 to liquidate obligations 
from loans guaranteed before 1992. The fiscal year 2005 
comparable level was $4,000,000 and the administration request 
was $4,000,000. For administration of the HEAL Program 
including the Office of Default Reduction, the Committee 
provides $2,916,000. The fiscal year 2004 comparable level was 
$3,244,000 and the administration request was $2,916,000.
    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.

              NATIONAL VACCINE INJURY COMPENSATION PROGRAM

    The Committee provides that $74,484,000 be released from 
the vaccine injury compensation trust fund in fiscal year 2006, 
of which $3,600,000 is for administrative costs. The total 
fiscal year 2005 comparable level was $69,151,000 and the total 
administration request was $73,716,000.
    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, 2005....................................  $4,775,810,000
Budget estimate, 2006...................................   4,306,063,000
House allowance.........................................   6,105,586,000
Committee recommendation................................   6,254,215,000

    The Committee provides a program level of $6,254,215,000 
for the Centers for Disease Control and Prevention [CDC]. The 
Committee recommendation includes $5,989,115,000 in budget 
authority and an additional $265,100,000 via transfers 
available under section 241 of the Public Health Services Act. 
The fiscal year 2005 comparable program level was 
$4,775,810,000 and the administration requested program level 
was $4,306,063,000.
    The activities of the CDC focus on several major 
priorities: provide core public health functions; respond to 
urgent health threats; monitor the Nation's health using sound 
scientific methods; build the Nation's health infrastructure to 
insure our national security against bioterrorist threats; 
promote women's health; and provide leadership in the 
implementation of nationwide prevention strategies to encourage 
responsible behavior and adoption of lifestyles that are 
conducive to good health.

                          INFECTIOUS DISEASES

    The Committee recommends $1,709,361,000 for infectious 
disease related programs at the CDC. The fiscal year 2005 
comparable level was $1,679,889,000 and the administration 
requested a comparable level of $1,709,758,000 for fiscal year 
2006. 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 Diseases Control

    The Committee has provided $3,848,000 above the comparable 
amount for fiscal year 2005 to expand infectious diseases 
control activities. The Committee intends that all infectious 
diseases control activities be funded at least at the level of 
the administration's request and that the additional funds be 
used to address emerging issues as determined by CDC.
    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.--With near-completion of the restoration 
of $12,900,000 to the Chronic Fatigue Syndrome [CFS] research 
program in response to a report from the Inspector General 
dated May 12, 1999, the Committee commends CDC for developing a 
comprehensive CFS program. The Committee encourages CDC to 
provide sufficient resources to sustain efforts to identify 
biomarkers for CFS, educate health care providers about the 
diagnosis and treatment of CFS, and better inform the public 
about it to aid early detection and improve patient care. The 
Committee requests a report by May 1, 2006 providing a detailed 
accounting of how the $12,900,000 in restored funding has been 
used.
    Collaboration With Asia.--The Committee recognizes that 
strong collaborative ties with Asian countries are among the 
mechanisms which may contribute to the stability of the Asia/
Pacific region. The multiethnic and multicultural population of 
Hawaii and its geographic location provide an ideal pathway for 
a CDC supported initiative with a focus on emerging infectious 
and chronic disease problems in Asia. The Committee also 
recognizes this has the potential for providing frontline 
protection for the United States mainland from emerging 
diseases, as well as assisting Asian countries with treatment 
for such diseases. The Committee encourages CDC to explore 
collaboration and joint funding of projects with Asian 
governments, such as Korea, to study immigrants in Hawaii as a 
mechanism for addressing both infectious and chronic disease 
burden and treatment in the Pacific.
    Hepatitis.--The Committee is concerned that more than 75 
percent of the 4 million people with hepatitis C are unaware of 
their condition. The Committee encourages CDC to collaborate 
with national voluntary health organizations to raise awareness 
of appropriate screening and medical follow up of target 
populations. The Committee is also aware of increasing rates of 
hepatitis A and B infections among select adult populations, as 
well as the alarming rate of individuals co-infected with both 
hepatitis C and HIV. The Committee encourages CDC to help 
increase hepatitis screening initiatives in the States. In 
addition, The Committee encourages CDC to consider focusing on 
education and awareness programs targeted at specific 
populations where there is a high prevalence of hepatitis B and 
where therapeutic interventions are increasingly effective.
    Liver Wellness.--The Committee continues to be concerned 
about the prevalence of hepatitis and encourages CDC to 
consider working with voluntary health organizations and 
professional societies to promote liver wellness with increased 
attention toward education and prevention.
    Meningococcal Disease.--Meningococcal disease is one of the 
few diseases that can be fatal or severely debilitating to a 
victim within a matter of hours of initial onset and yet is 
vaccine-preventable in most cases. The Committee is aware of 
the recent improvements in the meningitis vaccine and of recent 
CDC efforts to increase the availability and focus of 
information on Meningococcal disease and ways to prevent it so 
that the general public will be better educated on the symptoms 
and prevention methods. The Committee encourages the CDC to 
improve meningococcal education and adolescent immunization 
programs through partnerships with associations, such as the 
National Meningitis Association, to ensure that all families, 
especially those with adolescents and young adults, are 
effectively educated on this disease, vaccine availability, and 
all methods of prevention.
    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.
    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 by 
identifying, diagnosing, and treating infected persons; 
provision of confidential, culturally competent counseling to 
identify and reach those who have been exposed to infection and 
who may not know it; and individual and population level health 
promotion to reduce high risk behaviors.
    Within the total provided, $637,000 above the comparable 
amount for fiscal year 2005 has been provided for tuberculosis-
related activities. All other activities are funded at the 
level of the administration's request.
    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.
    Infertility Prevention.--The Committee notes that CDC is 
charged legislatively with instituting programs to help prevent 
infertility. CDC's current program activities in this matter 
are undertaken by the division of HIV/STD/TB and are limited to 
the prevention of venereal diseases. The Committee understands 
that there are numerous additional causes of infertility beyond 
sexually transmitted diseases, such as delayed child bearing, 
smoking, low or excessive body weight, exposure to hazardous 
environmental toxins, drug and alcohol abuse and, particularly 
for men, exposure to high temperatures. The Committee 
encourages CDC to consider expanding the scope of this program 
and provide greater support to public education on the risks to 
fertility.
    Oral Fluid Rapid HIV Tests.--The Committee is supportive of 
CDC's use of the oral fluid rapid HIV test in its HIV/AIDS 
activities. The Committee strongly encourages CDC to move 
forward as quickly as possible with the purchase of additional 
tests to sustain and expand these successful efforts.
    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 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 $637,000 over the fiscal 
year 2005 level to expand tuberculosis control efforts to 
prevent a similar reemergence.
    The Committee understands that TB is an enormous health 
crisis in the developing world, killing 2 million people every 
year. In recent years, several new vaccine candidates for TB 
have been developed and have shown promising results when 
tested in animals. The Committee strongly encourages CDC to 
continue and, if possible, expand the existing TB vaccine 
research cooperative agreement.
    The Committee is aware that refugees entering the United 
States with TB pose a serious public health threat. In 
particular, multidrug resistant TB cases pose the deadliest and 
costliest risk. The Committee recognizes that over the past 
year an outbreak of TB has occurred among Hmong refugees from 
Thailand who have resettled in the United States, mainly in 
California, Minnesota and Wisconsin. In California alone, local 
health departments have detected 25 TB cases among 3,400 Hmong 
refugees from Thailand in the last 10 months, four of which are 
multidrug resistant. The Committee urges CDC to make resources 
available to States facing TB outbreaks among their refugee 
population.
    The Committee understands that the CDC plans to undertake a 
new initiative, the Intensified Support and Activities to 
Accelerate Control [ISAAC]. ISAAC targets tuberculosis in 
African Americans, tuberculosis along the U.S./Mexico border, 
allows for universal genotyping of all culture positive TB 
cases, and expands clinical trials for new tools for the 
diagnosis and treatment of TB. The Committee encourages the CDC 
to implement ISSAC to enhance and maximize strategies to 
accelerate the control and elimination of TB.

Immunization

    The Committee recommends $510,706,000 for the program 
authorized under section 317 of the Public Health Service Act. 
The fiscal year 2005 comparable level was $480,794,000 and the 
administration requested $515,920,000 for fiscal year 2006. The 
Committee recommendation includes $12,794,000 in transfers 
available under section 241 of the Public Health Service Act. 
Within the total provided, all activities are funded at the 
level requested by the administration. The Committee has 
transferred $5,214,000 from Immunization to Global Health to 
continue to support global vaccination efforts. This is a 
technical change and should not result in any programmatic 
decrease in Immunization activities.
    The Omnibus Reconciliation Act 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 Tracking.--The Committee is pleased by CDC's 
development of the Surveillance, Preparedness, Awareness and 
Response System and has included sufficient resources to 
provide the same level of support of these activities as in 
fiscal year 2005. 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.

                            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 $974,080,000 for Health Promotion 
related activities at the CDC. The fiscal year 2005 comparable 
level was $1,021,709,000 and the administration requested 
$964,421,000.
    The Committee recognizes the important role national non-
governmental health organizations play in increasing the 
awareness of chronic disease prevention and birth defects and 
development disabilities issues. Therefore, the Committee has 
included $2,421,000 to allow for the award of projects to 
support the dissemination of information on the condition or 
disease and effective public health interventions or to conduct 
public and professional health awareness and education efforts. 
Using a competitive review process, each project should be 
awarded for a 3-year project period and should not exceed 
$1,000,000 per year.

            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 2005: $300,000 to expand Heart Disease 
and Stroke related activities; $300,000 to expand Diabetes 
related activities; $404,000 to expand Cancer Prevention and 
Control activities; $3,000,000 to expand Tobacco related 
activities; $50,000 to expand oral health related activities; 
$310,000 to expand Prevention Center activities; $100,000 to 
expand the Racial and Ethnic Approach to Community Health 
Program; and $84,000 to expand Primary Immune Deficiency 
Syndrome-related activites. All other activities are funded at 
the level of the administration's request or as specified 
below.
    Chronic diseases have had a profound human and economic 
toll on our Nation. Nearly 125 million Americans today are 
living with some form of chronic condition, including cancer, 
cardiovascular disease, diabetes, arthritis, and various 
neurological conditions such as epilepsy. These and other 
chronic diseases now account for nearly 70 percent of all 
health care costs, as well as 70 percent of all deaths 
annually. A few modifiable risk factors bring suffering and 
early death to millions of Americans. Three such factors--
tobacco use, poor nutrition, and lack of physical activity--are 
major contributors to our Nation's leading causes of death.
    Alzheimer's Disease and Healthy Aging.--The Committee 
understands that a growing body of evidence suggests that many 
of the same strategies that preserve overall health may also 
help prevent or delay the onset of Alzheimer's disease and 
dementia. Epidemiological studies reveal that individuals 
taking anti-inflammatory drugs to treat conditions such as 
arthritis have a lower-than-expected occurrence of Alzheimer's. 
Other studies appear to link known risk factors for diabetes 
and heart disease and risk factors for Alzheimer's and 
dementia. CDC, in cooperation with the Alzheimer's Association, 
is launching a new program aimed at educating the general 
public and health professionals on ways to reduce the risks of 
developing Alzheimer's disease by maintaining a healthy 
lifestyle. In light of the threat Alzheimer's presents as well 
as growing public interest in learning how to remain brain-
healthy, the Committee recommends $1,700,000 to continue this 
important initiative.
    Amyotrophic Lateral Sclerosis.--The Committee understands 
that a national Amyotrophic Lateral Sclerosis [ALS] registry 
may enable unprecedented progress in understanding ALS. 
Although several sources of ALS patient information currently 
exist in varying forms around the world, this information is 
not as comprehensive as required for the needed research. The 
Committee provides $1,000,000 for pilot programs to begin to 
gather data for a nationwide ALS registry that will estimate 
the incidence and prevalence of the disease, promote a better 
understanding of the epidemiology of the disease, and provide 
data that will be useful for research on improving disease 
management and developing standards of care. CDC should, to the 
extent practicable, identify and coordinate with existing data, 
surveillance systems and registries, such as state-based ALS 
registries, the Department of Veterans Affairs ALS registry and 
the National Institute for Neurological Disorders and Stroke 
repository.
    Autoimmune Diseases.--The Committee encourages CDC to 
provide resources for the awareness and prevention of 
autoimmune diseases.
    Breast and Cervical Cancer.--The Committee commends the CDC 
for creating partnerships to address the early detection of 
breast cancer, particularly in historically underserved 
communities including the Native American, Hispanic, Asian 
Pacific Islander, and African American populations. As part of 
this initiative, the Committee is very interested in the 
innovative approaches, such as that of the Men Against Breast 
Cancer Partners In Survival Program, which focuses on the role 
of the male support-giver as an integral component of the early 
detection, patient care and survivorship of breast cancer.
    Cancer Prevention and Control.--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 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 2005: $136,000 to expand comprehensive 
cancer activities and $200,000 to expand activities related to 
the Geraldine Ferraro Cancer Education Program. All other 
activities are funded at the level of the administration's 
request.
    Cancer Survivorship Resource Center.--The Committee 
supports the ongoing partnership between CDC and the Lance 
Armstrong Foundation to address the needs of the approximately 
10 million cancer survivors and their families and friends. The 
Committee has included sufficient resources to provide at least 
the same level of support for LiveStrong, the National Cancer 
Survivorship Resource Center, as was provided in fiscal year 
2005.
    Chronic Kidney Disease.--The Committee previously has 
expressed concern regarding the need to expand public health 
strategies to combat chronic kidney disease [CKD] given that 
many individuals are diagnosed too late to initiate treatment 
regimens that could reduce morbidity and mortality. Twenty 
million Americans have CKD, and another 20 million are at risk 
of developing the disease. Individuals with diabetes or 
hypertension have especially high vulnerability. Kidney disease 
is the 9th leading cause of death in the United States, and 
death by cardiovascular disease is 10 to 30 times higher in 
kidney dialysis patients than in the general population. 
Further, the number of individuals with end stage renal disease 
[ESRD], irreversible kidney failure requiring either dialysis 
or a transplant to remain alive, is expected to increase from 
372,000 patients in 2000 to over 660,000 by 2010. Therefore, 
the Committee has included an increase of $1,800,000 for CKD to 
develop capacity and infrastructure at CDC for a kidney disease 
surveillance, epidemiology, and health outcomes program; award 
grants to support several State-based demonstration projects 
for CKD prevention and control; and under the leadership of a 
national voluntary health organization and in collaboration 
with CDC, convene a consensus conference of experts in the area 
of kidney disease and other stakeholders to lay the groundwork 
for a formal Public Health Kidney Disease Action Plan for 
prevention and control of kidney disease.
    Chronic Obstructive Pulmonary Disease.--Chronic Obstructive 
Pulmonary Disease [COPD] is the fourth leading cause of death 
in the United States and the only one of the top 10 causes of 
death that is on the increase. The Committee urges the CDC to 
expand its data collection efforts on COPD. Specifically, the 
Committee encourages the CDC to include questions on COPD in 
the National Health and Nutrition Examination Survey, the 
National Health Interview Study and the Behavioral Risk Factor 
Surveillance Survey that asks about COPD by name.
    Colorectal Cancer.--The Committee understands that 
colorectal cancer is the third most commonly diagnosed cancer 
among both men and woman in the United States, and the second 
leading cause of cancer related deaths. 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 in 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.
    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 Committee commends CDC for implementation of 
SEARCH, a pilot study to determine the incidence and prevalence 
of diabetes in youth under the age of 20 years in six locations 
around the United States. The Committee encourages CDC to 
consider developing a plan to use the information gathered from 
SEARCH to create a national registry of patients afflicted with 
juvenile diabetes. In addition, the Committee encourages CDC to 
take advantage of the opportunity to also collect information 
about the standard of care available to people with diabetes 
nationwide. Samples from this study may represent a valuable 
scientific resource, and the Committee encourages CDC to 
consider making these samples and information available to the 
research community.
    The Committee encourages the CDC to continue and expand its 
efforts to standardize the measurement of C-peptide as a 
surrogate marker for pancreatic beta cell function. The 
development and validation of reliable, standard assays for C-
peptide have the potential to significantly accelerate 
regulatory approval of new therapies to prevent or reverse 
autoimmune diabetes.
    Diabetes and Obesity in Minority Populations.--The 
Committee is concerned by the toll that the twin epidemics of 
diabetes and obesity are taking on the health of minorities. An 
effective culturally-sensitive response is urgently needed to 
address this escalating epidemic. The Committee encourages CDC 
to fund initiatives of national and community organizations 
that have the capacity to carry out coordinated health 
promotion programs that will focus on diabetes and obesity in 
minority communities. The Committee encourages CDC to seek out 
organizations directed by and serving individuals from 
communities with disproportionate diabetes and obesity rates.
    The high incidence of diabetes among Native American, 
Native Alaskan, and Native Hawaiian populations persists. The 
Committee is pleased with the CDC's efforts to target this 
population, in particular, to assist the leadership of Native 
Hawaiian and Pacific Basin Islander communities. It is 
important to incorporate traditional healing concepts and to 
develop partnerships with community health centers. The 
Committee encourages CDC to build on all its historical efforts 
in this regard.
    Epilepsy.--The Committee supports the CDC epilepsy program, 
which is making 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 
applauds CDC's partnership with the Epilepsy Foundation in 
developing the recommendations of Living Well with Epilepsy II. 
Sufficient funding has been provided to continue this 
partnership and to implement ongoing epilepsy public health 
programs.
    Genomic Medicine.--The Committee is aware that steps need 
to be taken today to prepare the public health system for the 
coming widespread use of genetic technologies in healthcare. 
Failing to do so may exacerbate existing health disparities and 
seriously limit progress generated by the Human Genome Project. 
The Committee urges CDC to move forward aggressively with the 
creation and implementation of partnerships with industry and 
the nonprofit sector to achieve the widest benefits from the 
coming era of genomic medicine.
    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. With the additional funds provided, 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 diabetic retinopathy are expected to nearly 
double by the year 2030 with the aging of the baby-boomer 
generation. Recognizing this emerging public health threat, the 
Committee is aware of the demonstrated success of vision 
screening programs in preventing blindness and vision 
impairments among many of the more than 30 million adults that 
suffer from eye-related disorders.
    The Committee is encouraged by the CDC's exploration of 
strategies to implement a national initiative to combat the 
effects of eye-related disorders, especially glaucoma. The 
Committee has included sufficient resources to maintain at 
least the fiscal year 2005 level for 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 again included sufficient 
resources to maintain at least the fiscal year 2005 level of 
funding for a model project that is testing and evaluating the 
efficacy of glaucoma screening using mobile units.
    Heart Disease and Stroke.--The Committee understands that 
CDC is establishing a Heart Disease and Stroke Division to 
consolidate and elevate its efforts to prevent and control 
heart disease, stroke and other cardiovascular diseases. The 
Committee supports the goal of establishing a Heart Disease and 
Stroke Prevention program in each State. The Committee 
encourages CDC to maintain support for these activities in 
fiscal year 2006 within the funds provided.
    Inflammatory Bowel Disease.--The Committee understands that 
an estimated 1 million people in the United States may suffer 
from Crohn's disease or ulcerative colitis, collectively known 
as inflammatory bowel disease [IBD]. In fiscal year 2005, the 
Committee provided funds to continue a national IBD 
epidemiology program established through a partnership between 
CDC and the Crohn's and Colitis Foundation of America. The 
Committee encourages the CDC to continue this important 
initiative and has provided sufficient resources to do so.
    Interstitial Cystitis.--The Committee is pleased by the 
establishment of a cooperative agreement between the CDC and 
the Interstitial Cystitis Association and has included funds to 
continue the public and professional education initiative 
regarding interstitial cystitis.
    Lung Disease.--The Committee encourages the CDC to consider 
supporting efforts to validate the importance of spirometry 
screenings in early detection of lung disease. Such efforts 
include further research and development of projects to 
facilitate the translation of new scientific knowledge into 
spirometry public health screening programs. The Committee 
urges the CDC to coordinate with the National Heart, Lung and 
Blood Institute in translating the results of these efforts 
into guidance for public health programs, including vital signs 
and screening programs.
    Lupus.--The Committee recognizes that lupus is a serious, 
complex, debilitating chronic autoimmune disease that can cause 
inflammation and tissue damage to virtually any organ system in 
the body and impacts between 1.5 and 2 million individuals. The 
Committee is concerned by the lack of reliable epidemiological 
data on the incidence and prevalence of all forms of lupus 
among various ethnic and racial groups. The Committee 
encourages CDC to consider modifying the National Lupus Patient 
Registry to create a common data entry and management system 
across all study sites, to collaborate with a consortium of 
academic health centers with an expertise in lupus 
epidemiology, and to ensure that study sites represent 
different geographic regions of the United States that have a 
sufficient number of individuals of all racial and ethnic 
backgrounds disproportionately affected by Lupus, including 
Hispanics, Asians, Native Americans, and African Americans.
    Mind-Body Research.--The Committee continues to support 
mind-body research and has provided sufficient funding to 
continue these efforts in the same form and at the same level 
as in fiscal year 2005.
    National Information Center on Vision Loss.--The Committee 
encourages CDC to create a National Information Center on 
Vision Loss to address the need for access to appropriate 
public health information to improve the well being and prevent 
further disability and disease among persons who are blind or 
visually impaired. The Committee encourages CDC to partner with 
a national nonprofit organization that has regional offices 
throughout the United States and is recognized for its 
dedication and leadership in providing information to persons 
who are blind.
    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 sufficient resources to provide the same 
level of support provided in fiscal year 2005 for Nutrition, 
Physical Activity, and Obesity related activities.
    The multiple factors contributing to the overweight and 
obesity epidemic took years to develop. Reversing the epidemic 
will require a long-term, well-coordinated, concerted approach 
to reach Americans where they live, work, play, and pray. 
Effective collaboration among the public, voluntary, and 
private sectors is critical to reshape the social and physical 
environment of our Nation's communities and provide the 
necessary support, information, tools, and realistic strategies 
needed to reverse the current obesity trends nationwide.
    To reduce consumer confusion about the myriad of health 
messages about obesity, diabetes, and cardiovascular disease, 
the Committee encourages CDC to design and develop mechanisms 
for fast-tracked translation of research into reasoned guidance 
for the American public.
    To prevent unhealthy weight gain and maintain healthy 
weight among children and adolescents, CDC is encouraged to 
work with the U.S. Department of Education to issue a report 
with recommendations about reintroducing physical education 
into the school day.
    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, such as 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 encourages the CDC to advance 
efforts to reduce the disparities and health burden from oral 
cancers that are closely linked to chronic diseases such as 
diabetes and heart disease.
    The Committee is concerned about the rising obesity rate 
among American's youth. Some eating habits can adversely affect 
not only body weight but also oral health. The Committee has 
provided $50,000 above the fiscal year 2005 level for the CDC 
Division of Oral Health to develop an instructional video for 
school age children on the harmful effects of excessive 
consumption of soft drinks. The Committee understands that the 
dental community has already developed some instructional 
materials and urges CDC to work with the American Dental 
Association in producing the video.
    Osteoporosis and Bone Health Action Plan.--The Committee is 
aware of the Surgeon General's report on Bone Health and 
Osteoporosis. The Surgeon General calls for a national action 
plan for bone health. The Committee encourages CDC to 
collaborate with a leading national voluntary health 
organization focused on osteoporosis and bone health to confer 
with other relevant Federal agencies and public and private 
stakeholders to develop a National Action Plan on Bone Health 
and Osteoporosis.
    Prevention Centers.--The Committee encourages the continued 
support of center activities aimed at improving knowledge about 
the effective models for health promotion programs for persons 
with disabilities.
    The Committee continues to support within the prevention 
center program a Tobacco Prevention Research Network to 
increase the knowledge base on the most effective strategies 
for preventing and reducing youth tobacco use, as well as on 
the social, physiological, and cultural reasons for tobacco use 
among children.
    Primary Immunodeficiency Diseases.--Congress has made funds 
available for CDC to support the national physician education 
and public awareness campaign developed by the Jeffrey Modell 
Foundation. The Foundation program has generated more than 
$35,000,000 in donated media coverage, resulted in substantial 
increases in the number of diagnosed patients, and is a model 
of public-private cooperation. The campaign has featured public 
service announcements, physician symposia, publications, and 
the development of website and educational materials, as well 
as mailings to physicians, school nurses, daycare centers, and 
others. The campaign was expanded to reach the underserved 
African-American population in fiscal year 2005, and the 
Committee has provided $84,000 above the fiscal year 2005 level 
to further expand the program to Hispanic communities in fiscal 
year 2006.
    Prostatitis.--The Committee understands that up to 10 
percent of the male population worldwide may benefit from 
better methods to diagnose and prevent prostatitis. The 
Committee encourages CDC to consider expanding its 
investigation of the etiology of prostatitis.
    Psoriasis.--The Committee urges CDC to consider working 
with a national organization to develop a surveillance program 
to ascertain and monitor psoriasis and psoriatic arthritis 
prevalence and comorbidities.
    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 encourages CDC to consider supporting a 
cooperative agreement with the pulmonary hypertension community 
to foster greater awareness of the disease.
    Reorganization.--The Committee understands that the CDC is 
considering the reorganization of programs under the 
Coordinating Center on Health Promotion, particularly programs 
under the National Center on Chronic Disease Prevention and 
Health Promotion. The Committee encourages the Director to work 
closely with external partners to adopt changes that will 
streamline administrative functions, improve and strengthen 
collaboration among programs, and increase public awareness of 
these serious illnesses.
    REACH Initiative.--The Committee recognizes the strengths 
that national/multi-geographical minority organizations may be 
able to provide to the REACH Initiative. Such organizations 
could have the capacity to influence communities through pre-
existing coalitions and collaborative relationships. Such 
organizations may also be able to provide key support to local 
organizations that may lack the infrastructure needed to fully 
implement the programmatic activities required for this 
important program. The Committee urges CDC to include such 
organizations among the entities that are eligible to compete 
for funding without preventing other applicants from receiving 
these grants.
    Sleep Disorders.--The Committee continues to be concerned 
about the prevalence of sleep disorders and recognizes the need 
for enhanced public and professional awareness on sleep and 
sleep disorders. The Committee encourages CDC to consider 
working with other agencies and voluntary health organizations 
to support the development of a sleep education and public 
awareness initiative.
    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 provided 
sufficient resources to continue this initiative and existing 
programs within CDC that are aimed at obesity, diabetes, and 
asthma. The Committee strongly urges CDC to coordinate the 
efforts of these programs such that the best possible outcome 
is achieved using these funds.
    Thrombosis.--The Committee understands that thrombosis is a 
serious public health problem and that there is a great need to 
increase public awareness of thrombosis and thrombophilia among 
the public and the medical community. Information on the basic 
epidemiology of thrombosis and thrombophilia remains to be 
collected. The Committee encourages CDC to expand its efforts 
by partnering with a volunteer health organization to expand 
its outreach and education programs regarding thrombosis and 
thrombophilia.
    Tobacco Use.--The Committee recognizes the effectiveness of 
State and national counter-marketing campaigns in reducing 
youth tobacco use and the diminishing resources at the State 
and national levels for such efforts. The Committee has 
provided increased funding for tobacco activities to support 
counter marketing programs targeting areas with the highest 
rates of youth tobacco use.
    Vision Screening.--The Committee commends CDC for its 
partnership with a leading voluntary health association 
dedicated to fighting blindness and saving sight, improving 
education and early detection of potentially blinding eye 
diseases. Despite the fact that half of all blindness can be 
prevented through education, early detection and treatment, it 
is estimated that the number of blind and visually impaired 
people will double by 2030 if nothing is done to curb vision 
problems. To address this growing public health problem, the 
Committee has provided sufficient resources to continue this 
partnership with the same association.

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 2005: $200,000 to expand autism 
surveillance, awareness, and education activities; $75,000 to 
expand the National Spina Bifida Program; $73,000 to expand 
surveillance and epidemiological efforts of Duchenne and Becker 
muscular dystrophies; $48,000 to expand support for the Special 
Olympics Healthy Athletes Initiative and $500,000 to expand the 
activities of the Christopher and Dana Reeve Paralysis Resource 
Center; all other sub-activities are funded at the level of the 
administration's request. In addition, the Committee has 
provided $936,000 over the fiscal year 2005 level for 
undesignated birth defect-related activities.
    Autism.--The Committee is aware of the progress that has 
been made with the autism programs at CDC. The Committee 
acknowledges the importance of this work by the CDC in the area 
of autism surveillance and research, and urges this work to 
continue in a timely manner. Within funds provided, $100,000 in 
new funding is available to fund the Center's surveillance and 
research programs including the CADDRE and ADDM Network. The 
Committee is pleased to see the work being done in the area of 
the national awareness campaign and provides an additional 
$100,000 for the Center to expand its work on this initiative.
    Centers for Birth Defects Research and Prevention.--The 
Committee encourages CDC to consider expanding the promising 
research being conducted by the regional Centers for Birth 
Defects Research and Prevention and maintain assistance to 
States to implement and 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. The Committee also encourages CDC to 
continue to support collaboration among the States on issues 
related to surveillance, research and prevention through 
support of the National Birth Defects Prevention Network.
    CHADD Resource Center.--The Committee is aware that some 
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. The Committee has been 
informed that only half of all children with AD/HD receive 
necessary treatment with lower diagnostic and treatment rates 
among girls, minorities and children in foster care. The 
Committee continues to support the National Resource Center on 
AD/HD and has provided sufficient resources to provide the same 
level of support as was provided in fiscal year 2005.
    Christopher and Dana Reeve Paralysis Resource Center.--The 
Committee understands the growing demand for information, 
resources, and public health services by individuals with 
paralysis. The Committee has included $500,000 above the fiscal 
year 2005 level for the Paralysis Resource Center and the 
associated rehabilitation therapy program. The Committee 
encourages CDC to evaluate the public health effectiveness of 
the paralysis programs and explore the feasibility of health 
care system-wide implementation of new rehabilitation programs.
    Cooley's Anemia.--The Committee is pleased with the 
progress that CDC has made with regard to the establishment of 
a blood safety surveillance program for Cooley's anemia 
patients, who are the largest consumers of red blood cells. Six 
treatment centers throughout the Nation handle the medical 
monitoring and treatment; the Cooley's Anemia Foundation 
provides education and awareness, patient recruitment, and 
other services; and, CDC has created an archive of tested and 
analyzed blood samples. The Committee expects CDC to direct an 
increasing amount of the funds available to education and 
awareness, patient recruitment and other related services.
    Craniofacial Malformation.--The Committee has continued 
funding for CDC's initiatives to help families of children with 
craniofacial malformations. The Committee commends CDC for 
their work with the National Foundation for Facial 
Reconstruction and has provided funds to continue the 
Foundation's efforts with Arkansas, Iowa, and New York and 
possibly other States 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 to analyze 
and disseminate this information to families and health care 
professionals and to define and categorize established 
standards of optimal care.
    Diamond Blackfan Anemia.--The Committee has provided 
sufficient funds to continue CDC's public health outreach and 
surveillance program for Diamond Blackfan Anemia [DBA]. These 
funds should continue to be used to (a) educate clinicians and 
blood disorder treatment centers about DBA and how to diagnose 
it and (b) collaborate with a Clinical 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.
    Disabilities Prevention.--The Committee continues to 
strongly support the CDC disabilities prevention program, which 
provides support to States and academic centers to reduce the 
incidence and severity of disabilities, especially 
developmental and secondary disabilities.
    Down Syndrome.--The Committee understands that CDC is 
performing a study to estimate the number of people in the 
United States living with Down syndrome and identify them by 
age and ethnic group and expects to have preliminary results by 
the end of fiscal year 2005. A second study will document the 
onset and course of secondary and related developmental and 
mental disorders in individuals with Down syndrome. The 
Committee has provided sufficient resources to further develop 
this studies in fiscal year 2006.
    Duchenne and Becker Muscular Dystrophy.--The Committee has 
provided $6,000,000 to continue and expand surveillance, 
epidemiological, and education efforts for Duchenne and Becker 
muscular dystrophy. The Committee is pleased that the CDC and 
the Parent Project Muscular Dystrophy have established a 
coordinated education and outreach initiative and has provided 
sufficient resources to continue this initiative at least at 
the fiscal year 2005 level. The Committee requests that CDC 
develop and submit to the Committee a 5-year strategic plan for 
the Duchenne and Becker Muscular Dystrophy program by May 1, 
2006.
    Fetal Alcohol Spectrum Disorders.--The Committee is 
concerned by the prevalence of Fetal Alcohol Spectrum Disorders 
[FASD] in the United States and notes that drinking during 
pregnancy is the Nation's leading known preventable cause of 
mental retardation and birth defects. FASD affects 1 in 100 
live births or as many as 40,000 infants each year, and an 
individual with fetal alcohol syndrome can incur a lifetime 
health cost of over $800,000. To publicize and promote 
awareness of this critical updated public health information, 
the Committee has provided sufficient resources to continue 
these activities.
    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. In 
fiscal year 2005, the Committee included funding to implement 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. The Committee is aware that the first year of the 
demonstration project was highly successful. A review of the 
public health burden of fetal deaths, identification of data 
gaps related to surveillance and risk factors, and a plan to 
expand broader birth defects surveillance to include 
surveillance of fetal deaths were produced. The Committee 
supports continued funding of the project at the same level in 
fiscal year 2006 to develop a detailed protocol for the 
surveillance project, which should include identifying possible 
data sources, developing and testing data collection 
instruments and standard methods for surveillance of fetal 
deaths, and pilot testing and evaluating the surveillance 
project.
    Fragile X.--The Committee is encouraged by the CDC's 
progress in establishing a Fragile X public health program to 
expand surveillance and epidemiological research of Fragile X, 
as well as provide patient and provider outreach on Fragile X 
and other developmental disabilities. The Committee has 
provided sufficient resources to continue these activities.
    Genomic Medicine.--The Committee is aware that steps need 
to be taken today to prepare the public health system for the 
coming widespread use of genetic technologies in healthcare. 
Failing to do so may exacerbate existing health disparities and 
seriously limit progress generated by the Human Genome Project.
    Hemophilia.--The Committee supports CDC's continued efforts 
with the National Hemophilia Foundation to carry out needed 
education, prevention, blood safety surveillance, and outreach 
programs for the millions of people in the United States 
affected by bleeding and clotting disorders, including 
hemophilia, women's bleeding disorders, and thrombophilia. The 
Committee encourages CDC to consider enhancing its support of 
the network to ensure continued access to this comprehensive 
chronic care model for all persons with bleeding and clotting 
disorders.
    The Committee recognizes the important work of all 
voluntary organizations concerned with hemophilia, and 
encourages CDC to take steps to ensure that additional patient-
based organizations can participate in its hemophilia grant 
program on an annual basis.
    Hereditary Hemorrhagic Telangiectasia.--The Committee is 
aware of interest in the establishment of a Hereditary 
Hemorrhagic Telangiectasia [HHT] National Resource Center 
through a partnership between the CDC and the national 
voluntary agency representing HHT families. The Committee 
encourages the CDC to examine carefully proposals to establish 
such a center and give appropriate consideration to supporting 
it within the funds provided.
    Human Genome Project.--The Committee urges CDC to move 
forward aggressively with the creation and implementation of 
partnerships with industry and the nonprofit sector to achieve 
the widest benefits from the coming era of genomic medicine.
    Limb Loss Information Center.--The Committee understands 
that more than 1.5 million Americans are living with limb loss 
due to diabetes, heart disease, trauma, and cancer. A key 
challenge facing individuals with limb loss is gaining access 
to necessary health and rehabilitative services. The Committee 
commends CDC for its collaborations with voluntary 
organizations, such as the Amputee Coalition of America, to 
identify strategies to remove these barriers. The Committee 
continues to support the CDC's resource and information center, 
which assists individuals living with disabilities, and their 
families, in need of information on medical, physical, and 
emotional needs, and resources and support to reintegrate 
socially and economically into society. The Committee 
encourages CDC to continue its support of the existing Center 
at no less than the fiscal year 2005 level.
    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 $48,000 above the fiscal 
year 2005 level for this program.
    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. Also, the Committee supports the Memorandum 
of Understanding between CDC and the Agency for Healthcare 
Research and Quality to examine clinical treatment of Spina 
Bifida and improve quality of life.

                     HEALTH INFORMATION AND SERVICE

    The Coordinating Center for Health Information and Services 
includes the National Center for Health Statistics [NCHS], a 
new National Center for Health Marketing, and a new National 
Center for Public Health Informatics.
    The Committee recommends a program level of $223,799,000 
for Health Information and Service related activities at the 
CDC. This recommendation includes $134,235,000 in transfers 
available under section 241 of the Public Health Service Act. 
The fiscal year 2005 comparable program level was $228,673,000 
and the administration requested $223,799,000.

Health Statistics

    CDC's statistics give context and perspective on which we 
can base important public health decisions. By aggregating the 
experience of individuals, CDC gains a collective understanding 
of health, 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.
    Eating Disorders.--The Committee is concerned about the 
growing incidence and health consequences of eating disorders 
among the population. The extent of the problem while estimated 
by several long-term outcome studies as being high remains 
unknown. The Committee urges the CDC to research the incidence 
and morbidity and mortality rates of eating disorders, 
including anorexia nervosa, bulimia nervosa, binge eating 
disorder, and eating disorders not otherwise specified across 
age, race, and sex.

               ENVIRONMENTAL HEALTH AND INJURY PREVENTION

    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 $288,982,000 for environmental 
health and injury prevention related activities at the CDC. The 
fiscal year 2005 comparable level was $285,721,000 and the 
administration requested $284,820,000 for fiscal year 2006.

Environmental Health

    Within the total provided, $400,000 above the fiscal year 
2005 level is to expand the Health Tracking Network. 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 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 encouraged 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.
    Biomonitoring.--The CDC's National Report on Human Exposure 
to Environmental Chemicals is a significant new exposure tool 
that provides invaluable information for setting research 
priorities and for tracking trends in human exposures over 
time. The Committee continues to support the CDC environmental 
health laboratory's efforts to provide exposure information 
about environmental chemicals. The Committee understands that 
for most chemicals it is currently difficult to interpret 
biomonitoring information in a health risk context. Therefore, 
the Committee encourages CDC to develop the necessary methods 
to better interpret human biomonitoring concentrations in the 
context of potential health risks. The Committee applauds the 
CDC's biomonitoring efforts and encourages the Agency to 
continue this program and continue to improve its efforts to 
communicate these results in context.
    Childhood Lead Poisoning Prevention.--The Committee 
commends the CDC for its commitment to support the enhanced 
development of a portable, hand-held lead screening device that 
holds great promise for increasing childhood screening rates in 
underserved communities. 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.
    Health Tracking Network.--The Committee has provided 
$400,000 over the fiscal year 2005 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.
    Landmine Survivor Network.--The Committee commends CDC for 
its partnership with the Landmine Survivor Network that has 
developed peer support networks for landmine survivors in six 
mine-affected countries. The Committee has included sufficient 
resources to continue support of the network at no less than 
the fiscal year 2005 level. These funds will be used to expand 
peer support networks and the number of survivors that are 
reached in network and non-network countries; strengthen the 
capacity of medical and rehabilitative care facilities to 
address the needs of amputees; enhance economic opportunities 
for survivors; and further CDC programs and research for 
victims of landmines, civil strife and warfare.
    Volcanic Emission and Asthma.--The problem of asthma in 
Hawaii remains a serious health threat and challenge, 
especially among the medically underserved. In particular, the 
problem of volcanic emissions in Hawaii contributes to this and 
other respiratory problems. The Committee encourages CDC to 
consider potential interventions that may be helpful.

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.
    Within the total provided, the Committee has provided 
$2,500,000 over the fiscal year 2005 level for Youth Violence 
Prevention base funding; sufficient resources to support the 
National Violent Death Reporting System at the fiscal year 2005 
level; and undesignated funding of $780,000 to the National 
Center for Injury Prevention and Control. Sufficient funds have 
been included to continue or increase support for all existing 
Injury Control Research Centers.
    National Violent Death Reporting System.--The Committee is 
supportive of the National Violent Death Reporting System, 
which is a State-based system that 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. The Committee has provided 
sufficient resources to continue this program with at least the 
fiscal year 2005 level of funding. The Committee urges the CDC 
to continue to work with private health and education agencies 
as well as State agencies in the development and implementation 
of an injury reporting system.
    Suicide Prevention.--The Committee is aware that suicide 
remains the third leading cause of death among adolescents aged 
10-19. Research has determined that those adolescents most at 
risk often suffer from mental disorders, including depressive 
disorders and substance abuse. Other risk factors, which 
interact with mental disorders to increase risk for adolescent 
suicide, may include family discord, school-related problems, 
obesity, contact with the juvenile justice system and exposure 
to the suicide of others. The Committee encourages CDC to 
consider the extent to which mental health screenings 
incorporated into ongoing prevention efforts regarding obesity, 
STDs and self-injury may serve to identify youth at risk. The 
Committee requests that CDC report on its findings to the 
Committee by May 1, 2006.
    The Committee encourages CDC to consider supporting the 
evaluation of suicide prevention planning, programs, and 
communication efforts to change knowledge and attitudes and to 
reduce suicide and suicidal behavior. These evaluation efforts 
would support communities to identify promising and effective 
suicide prevention strategies that follow the public health 
model and build community resilience.
    Violence Against Women.--The Committee urges CDC to 
increase research on the psychological sequelae 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.
    Youth Violence.--The Committee has included $2,500,000 
above the fiscal year 2005 level for CDC's youth violence 
prevention activities. The Committee notes that the level of 
youth violence in cities around the Nation is troubling. The 
city of Philadelphia, in particular, has experienced a spike in 
youth violence. The Committee encourages CDC to use some of the 
increase to address the growing number and seriousness of 
violent acts committed by youth in urban areas such as 
Philadelphia.

                     OCCUPATIONAL SAFETY AND HEALTH

    The Committee recommends $257,121,000 for occupational 
safety and health programs. The fiscal year 2005 level was 
$286,041,000 and the administration requested $285,930,000 for 
fiscal year 2006. The Committee recommendation includes 
$87,071,000 in transfers available under section 241 of the 
Public Health Service Act. Sufficient funds have been included 
to maintain staffing levels at the Morgantown facility.
    The CDC's National Institute for Occupational Safety and 
Health [NIOSH] is the only Federal Agency responsible for 
conducting research and making recommendations for the 
prevention of work-related illness and injury. The NIOSH 
mission spans the spectrum of activities necessary for the 
prevention of work-related illness, injury, disability, and 
death by gathering information, conducting scientific 
biomedical research (both applied and basic), and translating 
the knowledge gained into products and services that impact 
workers in settings from corporate offices to construction 
sites to coal mines.
    The Committee recognizes NIOSH as one of the Agency's 5 
coordinating centers. Given its unique statutory requirements, 
this is the appropriate placement of NIOSH within CDC's current 
structure. It is the expectation of the Committee that CDC will 
afford NIOSH all the rights and privileges of this status in 
the organization including participation on CDC's Executive 
Leadership Board as well as the Management Council given that 
these are the policy and decision-making bodies of the Agency.
    In fiscal year 2005, the Committee separated actual program 
costs from the administration of those programs by reallocating 
all administrative costs (except those of NIOSH) to a new 
account: Business Services Support. This enabled CDC to more 
easily interpret Congress' intent with funding increases meant 
for either programs or administration of those programs. In 
fiscal year 2006, the Committee recommends reallocating 
$34,800,000 from the NIOSH line item to the Business Services 
and Support line item. This reallocation is equal to the 
administrative costs associated with NIOSH in fiscal years 2004 
and 2005 and will end the need for continued central business 
services assessments, except those that are assessed across the 
entire Department of Health & Human Services. A reprogramming 
request will be required for any additional CDC assessment on 
the NIOSH budget line. All comparisons to fiscal year 2005 
levels and the budget request have been adjusted to reflect 
this reallocation.
    The Committee recognizes that NIOSH, as the only Federal 
Agency for occupational safety and health research and 
prevention, provides national and international leadership to 
prevent work-related illness, injury, and death by gathering 
information, conducting scientific research, and translating 
the knowledge gained into products and services. Examples 
include the recently launched Research to Practice [r2p] 
initiative, which continues to gain momentum, and the next 
decade of the National Occupational Research Agenda [NORA-2]. 
The Committee applauds the goal of r2p, which is to reduce or 
eliminate occupational disease and injury by helping to ensure 
an increased impact of NIOSH-funded research in the workplace. 
The Committee notes that NIOSH is now consulting with partners 
and stakeholders to plan for NORA-2, which will be a review of 
the decade for the 21 priority research areas, examining the 
state of the science, noting key changes, identifying NORA 
contributions, discussing gaps and lessons learned, and making 
recommendations for the future.
    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 and has included funding to 
continue this important worker safety initiative.
    Education and Research Centers.--The Committee recognizes 
the important role Education and Research Centers [ERCs] play 
in preventive health research and the training of occupational 
safety and health professionals, and includes an increase of 
$500,000 for ERCs over the amount appropriated for ERCs in 
fiscal year 2005.
    Energy Employees Occupational Illnesses.--Not later than 6 
months after enactment of this Act, NIOSH should provide a 
report to the Committee which: (1) identifies the cancer types 
which are not included in the list of 22 ``specified cancers'' 
under the Energy Employees Occupational Illness Compensation 
Program Act (42 U.S.C. 7384 et seq.) but for which exposure to 
internal or external ionizing radiation of any type can be 
shown to cause or contribute to the development of a cancer; 
(2) recommend the cancer types to be added to the list of 
specified cancers for individuals covered in the Special 
Exposure Cohort, with a justification for including such 
cancers and a ranking in order of priority based on 
radiosensitivity; (3) for each Special Exposure Cohort in 
effect on the date of submission of this report to Congress, 
identify the number of cases by facility for which there is a 
Special Exposure Cohort for each cancer type listed in item 
(2). The Secretaries of Labor and Health and Human Services are 
encouraged to amend their respective implementing regulations 
to include the list of cancers covered in the above referenced 
report for purposes of defining specified cancers for members 
of special exposure cohorts.
    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 is 
concerned that sufficient resources were not allocated to 
implement the Miners' Choice Health Screening Program in fiscal 
year 2005. The Committee urges NIOSH to implement this program 
in fiscal year 2006. 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 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 
sufficient resources to maintain the fiscal year 2005 level of 
funding for NIOSH's Mining Research Program.
    National Occupational Research Agenda.--The Committee 
recommendation includes sufficient resources to maintain 
funding at the fiscal year 2005 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 Mesothelioma Registry.--The Committee has provided 
$1,000,000 for the establishment of a National Mesothelioma 
Registry to collect data regarding symptoms, pathology, 
evaluation, treatment, outcomes, and quality of life and a 
Tissue Bank to include the pre- and post-treatment blood (serum 
and blood cells) specimens as well as tissue specimens from 
biopsies and surgery. The Committee intends that not less than 
$500,000 of this amount should be allocated for the collection 
and maintenance of tissue specimens.
    National Personal Protective Technologies Laboratory.--The 
Committee provides sufficient resources to maintain the fiscal 
year 2005 level of funding 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.

                             GLOBAL HEALTH

    The Committee recommends $313,227,000 for global health 
related activities at the CDC in fiscal year 2006. The fiscal 
year 2005 comparable level was $308,863,000 and the 
administration requested $306,079,000 for fiscal year 2006. 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. Within the total provided, 
all of the programs, except the global immunization program and 
the global malaria program, have been funded at the level 
requested by the administration.
    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 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 
Subcommittee. Therefore, the Committee does not provide 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 real-time reporting of 
emerging threats. The Global Disease Detection System also will 
support sentinel sites in key regions around the globe to 
ensure prompt disease detection and referral to a regional 
laboratory service. These capacities are critical to mitigate 
the consequences of a catastrophic public health event, whether 
the cause is an intentional act of terrorism or the natural 
emergence of a deadly infectious virus, like SARS. The 
Committee has provided $12,077,000 over the fiscal year 2005 
level for these efforts.
    Global Immunization Activities.--The Committee includes 
$144,455,000 for global immunization activities, including 
$101,254,000 for polio vaccine, surveillance, and program 
operations for the highly successful, yet unfinished polio 
eradication efforts; and $43,201,000 for the purchase of 
measles vaccine for measles mortality reduction and regional 
measles elimination initiatives and to expand epidemiologic, 
laboratory, and programmatic/operational support to WHO and its 
member countries.
    The increased funding levels in Global Health and decreases 
in Immunization capture the proper alignment of programmatic 
costs within CDC under the new budget structure and will be 
directed to support programmatic activities to eradicate polio 
and eliminate measles worldwide. They do not represent a 
decrease in support of the immunization program.
    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.
    The Committee notes that the fiscal year 2006 appropriation 
recommended here assumes full funding of the Congressional 
intent in the fiscal year 2005 appropriation. Accordingly, 
funds requested in Immunization and Business Services support 
related to Global Immunization Activities have been provided 
here.

                         PUBLIC HEALTH RESEARCH

    Public Health Research.--The Committee has provided 
$31,000,000 in transfers available under section 241 of the 
Public Health Service Act to fund the Public Health Research 
program. The fiscal year 2005 comparable level was $31,000,000 
and the administration requested $31,000,000 for this program 
in fiscal year 2006. 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 healthy lifestyles, communicating effective health 
promotion messages, and acquiring and disseminating information 
in times of crisis.
    Alternative Therapies.--As more and more Americans use 
alternative and complementary therapies to maintain and improve 
their health, there is a growing need for better consumer 
information about these therapies. The Committee encourages CDC 
to consider expanding their efforts in this area. Practice-
based assessments and the identification and study of promising 
and heavily used complementary and alternative therapies and 
practices should be undertaken and results published. The 
Committee urges CDC to collaborate with the National Center for 
Complementary and Alternative Medicine [NCCAM] to assure that 
its efforts complement efforts by NCCAM.
    Food Marketing.--The Committee commends the CDC for its 
role and participation in the Food Marketing and the Diets and 
Health of Children and Youth study done in partnership with the 
Institute of Medicine through the Food and Nutrition Board and 
the Board on Children, Youth, and Families. The Committee 
encourages CDC to continue its efforts to identify the causes 
of obesity, particularly the science-based effects of food 
marketing on the diets and health of children and youth in the 
United States.
    Poor Diet and Inactivity.--Hundreds of thousands of people 
die prematurely each year from heart attack, stroke, and 
diabetes, and scientists agree that poor diet, physical 
inactivity, and being obese puts one at greater risk for those 
conditions. The Committee is concerned that the recent 
controversy regarding the estimates of the number of deaths due 
to obesity has resulted in public confusion and ignores other 
diet and physical inactivity disease rates, related deaths and 
health care costs.
    The Committee urges the CDC to conduct a study to estimate 
the number of premature deaths, diseases, and costs due to poor 
diet and physical inactivity. The study should include diet- 
and inactivity-related deaths, diseases, and costs due to heart 
disease, cancer, stroke, diabetes, and other diseases and those 
due to a range of dietary factors. The number of diet- and 
inactivity-related deaths, diseases, and costs should be 
compared to other leading causes including tobacco, alcohol, 
infectious diseases, etc.

                PUBLIC HEALTH IMPROVEMENT AND LEADERSHIP

    The Committee provides $269,055,000 for public health 
improvement and leadership activities at the CDC. The fiscal 
year 2005 comparable level was $266,842,000 and the 
administration requested a comparable program level of 
$206,541,000 for fiscal year 2006.

Leadership and Management

    The Committee provides $178,672,000 for leadership and 
management costs at the CDC in fiscal year 2006. The fiscal 
year 2005 comparable level was $178,541,000 and the 
administration requested a comparable level of $178,672,000 for 
fiscal year 2006.
    Director's Discretionary Fund.--The Committee has provided 
$10,000,000 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.
    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.

          PREVENTATIVE HEALTH AND HEALTH SERVICES BLOCK GRANT

    The Committee has provided $100,000,000 for the 
Preventative Health & Health Services Block grant. The fiscal 
year 2005 comparable level was $118,526,000 and the 
administration requested no funding for this program in fiscal 
year 2006.
    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 $225,000,000 for the planning, 
design, and construction of new facilities, repair and 
renovation of existing CDC facilities, and data security and 
storage. The fiscal year 2005 comparable level was $269,708,000 
and the administration requested $30,000,000 for fiscal year 
2006.
    The Committee recommendation includes $200,000,000 for the 
continuation of CDC's Buildings and Facilities Master Plan in 
Atlanta, Georgia and $25,000,000 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.

                     BUSINESS SERVICES AND SUPPORT

    The Committee provides $296,119,000 for business services 
support functions at the CDC. The fiscal year 2005 comparable 
level was $278,838,000 and the administration requested a 
comparable level of $263,715,000 for fiscal year 2006. These 
funds will be used to support CDC-wide support functions.
    The recommendation includes $34,800,000 within Business 
Services and Support that was provided in fiscal year 2005, and 
in the administration request, in NIOSH. The reason for this is 
to provide the NIOSH share of CDC central services and support 
within this activity and to eliminate the need for additional 
taps and assessments.
    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.

                               TERRORISM

    The Committee provides $1,566,471,000 for CDC terrorism 
preparedness activities. The comparable fiscal year 2005 level 
was $1,622,757,000 and the administration requested 
$1,616,723,000 for these activities in fiscal year 2006. 
Although these funds have been provided in the Public Health 
and Social Services Emergency Fund [PHSSEF] in past 
appropriations, they have always been managed by CDC. The 
Committee expects that CDC will continue to closely coordinate 
its terrorism preparedness activities with those of the 
Department and other HHS Agencies.
    Within the funds provided, $735,391,000 is for Upgrading 
State and Local Capacity through grants and cooperative 
agreements; $29,425,000 is for the Centers for Public Health 
Preparedness; $5,424,000 is for the Advanced Practice Centers; 
$26,899,000 is for other State and Local Capacity; $137,972,000 
is for upgrading CDC Capacity; $10,000,000 is for anthrax 
vaccine studies; $79,361,000 is for the Biosurveillance 
Initiative; and $542,000,000 is for the Strategic National 
Stockpile.
    Blood Safety.--The Committee understands that the American 
Red Cross [ARC] supplies blood to approximately one-half the 
Nation's hospitals, operates the only blood system with the 
capacity to deliver blood anywhere and anytime it is needed, 
and is the only non-governmental organization with mandated 
primary agency responsibilities under the National Response 
Plan [NRP]. Among its NRP obligations, the ARC serves as a 
support agency to HHS for the provision of blood and blood 
products. The Committee is aware that the ARC has initiated a 
Biomedical Technology Assurance Initiative to protect its 
capacity to manage national blood supplies against cyber- and 
bio-security threats. The Committee supports this effort and 
encourages CDC to consider providing support to the Initiative 
from within the funds made available for biosurvelliance, 
capacity enhancement and stockpile activities.
    Clinician Update Service.--The conferees are aware of the 
Clinician Update Service, which the CDC has begun with World 
Medical Leaders to disseminate news, information, and alerts to 
physicians who are on the front lines in the effort to 
recognize biological, chemical, and radiological events. The 
Committee encourages CDC to consider supporting the completion 
of Phase II of the project.
    Modified Vaccinia Ankara.--The Committee is concerned that 
individuals with weak immune systems, an estimated 20 percent 
of the U.S. population, cannot take the existing animal-derived 
and cell-derived smallpox vaccines currently stored in the 
Strategic National Stockpile for emergency purposes. Funds have 
already been appropriated under the Project Bioshield Act for 
the planned stockpiling of the Modified Vaccinia Ankara [MVA] 
Smallpox Vaccine for immuno-compromised Americans. The 
Committee supports plans to purchase the new vaccine.
    Pandemic Influenza.--The Committee notes that several 
outside organizations, including the Trust for America's 
Health, have made recommendations regarding pandemic 
preparedness. The Committee encourages CDC to consult with 
outside experts in its preparations for, and response to, a 
potential pandemic.
    The Committee is aware that the Department is developing a 
pandemic influenza response plan. The Committee recognizes that 
local public health departments, working with their States, 
play essential roles in responding to influenza outbreaks, 
including monitoring of local vaccine availability, 
distribution and redistribution of vaccines and antiviral 
medications to high priority populations, implementation of 
necessary epidemic containment measures, and communication to 
the public. Therefore, Committee encourages the Department to 
assure that all aspects of Federal pandemic influenza planning 
are consistent with operational realities at the local level 
and will have the intended public health results when 
implemented locally. The Committee further urges the Department 
to assure that Federal pandemic flu planning avoid duplication 
and inconsistency with other Federal directives concerning 
public health preparedness.
    State and Local Capacity.--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 notes 
that HHS' cooperative agreement guidance now includes explicit 
requirements for local concurrence with State spending plans 
for public health emergency preparedness and urges CDC to 
monitor and enforce these requirements.
    The Committee also recognizes that HHS has incorporated the 
National Response Plan into the cooperative agreement guidance 
and established new CDC Preparedness Goals. The Committee urges 
the Department to assure that the performance metrics for the 
CDC Preparedness Goals, by which local health department 
preparedness will be measured, are fully consistent with all 
requirements in the Target Capabilities being developed under 
Homeland Security Presidential Directive 8 by the Department of 
Homeland Security.
    Funds for bioterrorism prevention and response are 
distributed through grants to 50 States and four metropolitan 
areas. The Committee strongly recommends that these funds be 
distributed based on a formula that includes factors for risk 
of a terrorist event. Risk is challenging to quantify, but the 
Committee suggests that CDC, in coordination with the Secretary 
of Health and Human Services, consider the following and other 
factors: (1) Site of headquarters or major offices of 
multinational organizations; (2) site of major financial 
markets; (3) site of previous incidents of international 
terrorism; (4) some measure of population density versus just 
population; (5) internationally recognized icons; (6) percent 
of national daily mass transit riders; (7) proximity to a major 
port, including major port ranked on number of cargo containers 
arriving at the port per year.
    Strategic National Stockpile.--The Committee appreciates 
that planning and exercising plans for distribution of the 
Strategic National Stockpile is an integral aspect of overall 
local bioterrorism preparedness. The Committee urges CDC to 
assure that requirements for and evaluation of State and local 
activities with respect to the stockpile, including the Cities 
Readiness Initiative, are fully integrated into and consistent 
with requirements of the guidance for overall bioterrorism 
preparedness.

                              NIH Preamble

    No task before this country is more important than 
safeguarding and improving the health of all Americans. For 
protecting the public's health, together with educating our 
citizenry, represent the mainspring of our economic and social 
progress. Without question, the Nation's strength can be no 
greater than the health and vitality of its population. Beyond 
its human toll, needless suffering and death erode 
productivity, undermine our leadership role on the global 
stage, weaken our defenses and threaten to bankrupt Federal, 
State, and family budgets.
    History has shown that it is imperative to maintain our 
long-term commitment to medical research regardless of short-
term economic conditions. Since World War II, the life span of 
the average American has risen steadily, from 65 to nearly 77 
years. While no single entity nor action can be credited for 
that success, one organization has played a significant role--
the National Institutes of Health. The Nation's investment in 
NIH has yielded a myriad of scientific achievements that are 
helping to save lives, prevent illness and improve the quality 
of life. From drugs to control high blood pressure, lower 
cholesterol and prevent blood clots to the development of a 
vaccine that eliminates the leading cause of mental retardation 
in infants, NIH has played a significant role. But that role 
has broadened and taken on even greater immediacy, as NIH has 
taken the lead in protecting our Nation against bioterrorism 
and other public health emergencies including anthrax, plague, 
tularemia and West Nile virus. With these and other threats 
looming, now is not the time for retrenchment; rather, it is 
the time to exploit fully any opportunity that could lead to 
improved health.
    The Committee also encourages new initiatives to reshape 
the conduct of research such as the ``NIH Roadmap for Medical 
Research,'' an approach that would bring together multiple 
institutes and scientific disciplines to tackle a handful of 
public health concerns. Similarly, the Committee strongly urges 
NIH to focus greater effort and resources on transforming basic 
science discoveries into preventive measures, improved 
diagnostics, drugs and treatments. The backbone of clinical 
research in this country, the Nation's academic health centers, 
should be nurtured and new, innovative ways should be found to 
re-energize this enterprise.
    To these ends, the Committee recommends $29,414,515,000 for 
the NIH. This amount is $1,050,000,000 above the fiscal year 
2005 appropriation and $904,731,000 over the budget request.
    Biomedical Research and Development Price Index.--The 
Committee is once again disappointed that the budget request 
would require NIH to break its funding commitments to existing 
grantees. Forcing grantees to reduce the scope of research that 
is already underway would establish an unfortunate precedent 
and could erode confidence in NIH. As a result, this reduction 
would have caused a disproportionate impact on more junior 
researchers and trainees, who need continued encouragement to 
pursue careers in research. 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 purchasing the same amount of 
research as in fiscal year 2005 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 the BRDPI inflator, or 3.2 
percent, instead of being held flat, as proposed in the budget 
request.
    Human Embryonic Stem Cell Research.--The Committee 
continues to be concerned that the current administration 
policy relating to human embryonic stem cell research is so 
narrow that it is stifling the pace of stem cell research. The 
Committee strongly believes that embryonic stem cell research 
holds enormous potential for the treatment of cardiovascular 
disease, Parkinson's, spinal cord injury and a vast array of 
other diseases and injuries. After convening 16 in-depth 
hearings on the subject, the Committee believes that with the 
proper safeguards in place, this field of investigation ought 
to be widened. While it originally appeared that 78 embryonic 
stem cell lines would be available for research under the 
Federal policy, now, nearly 4 years after the President's 
announcement on August 9, 2001, only 22 lines 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 also strongly urges that the NIH explore all 
avenues of stem cell research including adult stem cells and 
alternative methods of establishing human embryonic stem cell 
lines that do not involve the destruction of an embryo.
    The Committee is also deeply concerned with the slow pace 
of implementation of the current stem cell policy. The 
Committee was informed by NIH this year that anticipated 
spending on human embryonic stem cell research is just 
$24,300,000. The Committee strongly urges the NIH to commit a 
substantial amount of resources to all methods of human 
embryonic stem cell research.

                       NATIONAL CANCER INSTITUTE

Appropriations, 2005....................................  $4,825,259,000
Budget estimate, 2006...................................   4,841,774,000
House allowance.........................................   4,841,774,000
Committee recommendation................................   4,960,828,000

    The Committee recommends an appropriation of $4,960,828,000 
for the National Cancer Institute [NCI]. The budget request was 
$4,841,774,000. The fiscal year 2005 appropriation was 
$4,825,259,000. 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.
    Blood Cancers.--The Committee acknowledges some notable 
advances in the treatment of blood cancers, including leukemia, 
lymphoma, and multiple myeloma. These include several new drugs 
that have been approved and introduced to the market in the 
last 3 years, products of a strong public-private partnership. 
Despite new treatments, these cancers represent a serious 
health crisis. Almost 115,000 Americans will be diagnosed with 
these cancers in 2005, and nearly 55,000 will die from them. 
Moreover, the 5-year survival rates for these cancers lag 
behind the 64 percent 5-year survival rate for all cancers; the 
rate for multiple myeloma is only 32 percent, and for non-
Hodgkin's lymphoma it stands at 59 percent. The Commmittee 
encourages the Institute to strengthen its support for 
translational and clinical blood cancer research. The blood 
cancers strike individuals of all ages, races, and each gender, 
and serve as valuable prototypes for the development of 
therapies for all types of malignant disorders. The Committee 
urges the institute to explore all mechanisms to support blood 
cancer research to improve treatment options and rapidly move 
discoveries from the laboratory bench to the patient's bedside.
    Bone Marrow Failure Diseases.--The Committee encourages NCI 
to expand its research efforts into bone marrow failure 
diseases, including aplastic anemia, myelodysplastic disorders 
[MDS], and paroxysmal nocturnal hemoglobinuria [PNH]. Each 
year, between 20,000 and 30,000 Americans are diagnosed with 
these diseases. In some cases, MDS, the most prevalent of these 
diseases, can progress over time to become acute leukemia. More 
research is critically needed to understand the causes of these 
diseases, develop effective treatments and cures, and prevent 
the progression of certain cases into leukemia. Furthermore, 
cancer patients who undergo chemotherapy often develop bone 
marrow failure diseases. The Committee encourages NCI to gain a 
better understanding of the link between chemotherapy and these 
diseases, and to explore the development of alternatives means 
of treating cancer without causing the subsequent development 
of bone marrow failure diseases.
    Brain Tumors.--The Committee believes that increased 
attention should be 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.
    Breast Cancer.--Breast cancer's toll continues to threaten 
the lives and the quality of life of thousands of women across 
all walks of life. In addition to ongoing research activities 
underway at the National Cancer Institute, the Committee 
strongly urges the NCI to give increased attention to areas of 
research that focus on helping women to more fully restore and 
improve their quality of life after treatment, including 
further breast cancer research on lymphadema, stress, 
nutrition, exercise, weight, and the environment.
    The Committee remains concerned about missed opportunities 
in breast cancer screening, detection, prevention, control, and 
early diagnosis including those in mammogram detection, reading 
and analysis. The Committee strongly urges the NCI to further 
accelerate advances in breast cancer screening technology and 
to capitalize on existing and create new technologies that 
improve early diagnosis, health outcomes, and survival.
    Cancer Biobank.--The Committee believes that the cancer 
biobank, because it will centralize and standardize molecular 
annotation of tissues, has the potential to greatly accelerate 
the understanding of cancer and the discovery and development 
of new biomarkers, new diagnostics and new therapeutic 
approaches. Once established, the Committee believes that it 
will be most efficient to utilize existing technologies such as 
high-density microarrays, given the long time frame for the 
development of new technologies.
    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 cancer, the Committee encourages NCI to provide 
continued support for comprehensive cancer centers at minority 
institutions focused on research, treatment, and prevention of 
cancer in African American, Native Hawaiian, and other minority 
communities.
    Cancer Metastasis.--The NCI is encouraged to develop an 
interdisciplinary and integrated approach to study bone 
metastasis, by combining the expertise of oncologists, bone 
biologists and metastasis experts. Key issues to address 
include the generation of novel organ-like or mouse models 
which closely mimic tumor bone interactions that will pave the 
way for delineating novel mechanisms of how tumor cells go to 
the bone; the development of novel targets for better 
prognosis; and effective therapeutic targeting. Designing new 
strategies to make the bone microenvironment hostile to 
invading tumor cells is of high clinical relevance. 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.
    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 strongly 
urges the NCI to give favorable consideration to continuing and 
expanding the scope of research activities funded through the 
CLL Research Consortium as it works to defeat this devastating 
blood disorder.
    Complementary and Alternative Cancer Therapies.--The 
Committee expects NCI to continue and expand its collaborative 
efforts with NCCAM to support research on promising 
complementary and alternative cancer therapies as well as on 
their integration with traditional therapies.
    DES.--The Committee continues to 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 
to consult with organizations representing individuals impacted 
by DES as it carries 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 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 Cognition.--The Committee encourages NCI's Division 
of Cancer Control and Population Sciences to continue to build 
innovative collaborations such as the Health Cognition Group. 
The activities of this group of researchers are designed to 
plumb knowledge from basic research on how people process and 
use health information and synthesize it with the development 
and evaluation of theory-based interventions to promote healthy 
behavior. Although these efforts are directed primarily to 
behaviors relevant to cancer, they will also serve the broader 
goal of developing theoretical frameworks that can be applied 
across a range of behavioral domains and conditions.
    Health Communication.--The Committee acknowledges NCI's 
Division of Cancer Control and Population Sciences for 
developing HINTS, the first-ever survey to collect nationally 
representative information on the American public's need for, 
access to, and use of cancer information. Such a database is 
useful to practicing physicians, public health departments and 
policymakers, among others. HINTS provides an invaluable 
snapshot of how adults use the many information resources 
around them to lead healthier lives and to reduce the burden of 
cancer in America.
    Hemophilia Cohort Study.--The Committee understands that 
NCI has made plans to discontinue research funding support of 
the Multi-Center Hemophilia Cohort Study. This cohort offers a 
database for improving the understanding of HCV and has served 
as the basis of significant peer-reviewed findings. The 
Committee strongly urges the NCI to take all necessary steps to 
ensure the samples obtained through this cohort are preserved 
and accessible for future research. The Committee also requests 
a report by May 1, 2006 on possible future research 
opportunities using the cohort samples.
    Imaging Systems Technologies.--The Committee is encouraged 
by progress made by the NCI following its August 1999 
conference on biomedical imaging, and it urges the NCI to 
continue to take a leadership role with the Centers for 
Medicare and Medicaid Services 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 also 
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 remains concerned with the 
increasing incidence of primary liver cancer, which is in sharp 
contrast to many other forms of cancer where the incidence is 
declining and the treatment options are rapidly increasing. The 
Committee is aware that NCI, working with NIDDK, has convened 
an Experts Conference and is moving ahead with plans to 
increase resources dedicated to this disease. The Committee 
urges NCI to make a substantial commitment to research on 
primary liver cancer with particular focus on the development 
of drugs that target the cancer without killing healthy cells 
by interfering with the cellular pathways of the disease. The 
Committee further urges NCI to continue to support the NIDDK 
sponsored HALT-C clinical trial which has particular relevance 
to the NCI mission.
    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. The Committee is encouraged by the success 
of new targeted drug therapies demonstrated in recent clinical 
trials in stage 4 patients. The Committee encourages the NCI to 
work with the thoracic surgical community to initiate new 
clinical trials that involve patients at an early stage of the 
disease when surgery is a treatment option. The trials should 
test the effectiveness of these new drugs as adjuvant therapy 
to improve the outcome of established thoracic surgical therapy 
for lung cancer.
    Lymphoma.--The Committee strongly urges that the NCI take 
bold action to address lymphoma as a public health problem and 
to capitalize on important research advances to date. While new 
treatments have become available for patients, more and 
improved treatment options are needed. The Committee strongly 
encourages the NCI to boost its investment in translational and 
clinical lymphoma research. The Committee commends the NCI and 
the NIEHS for convening a workshop on the viral and 
environmental links to lymphoma and recommends that steps be 
taken to strengthen the NCI investment in this area. The 
Committee encourages the NCI to direct resources to: (1) 
studies of adequate scope to assure the identification of 
environmental risk factors for specific subtypes of lymphoma; 
(2) small studies designed to improve detection and 
quantification of historically difficult-to-measure 
environmental factors; (3) studies that are directed toward 
enhancing the understanding of the role of the immune system in 
the initiation and progression of lymphoma; and (4) studies 
that examine the simultaneous presence of a wide profile of 
infectious agents among individuals with lymphoma. The 
Committee also encourages that resources be used for research 
related to long-term survivors of both non-Hodgkin's lymphoma 
and Hodgkin's lymphoma. The Committee strongly supports the 
recommendation of the Leukemia, Lymphoma, and Myeloma Progress 
Review Group [LLM PRG] that resources be invested in 
identifying the populations of patients that are at high risk 
of adverse outcomes from their treatment for lymphoma.
    Mesothelioma Research.--The Committee is concerned with the 
pace of mesothelimoma research. This aggressive disease invades 
the lining of the lungs, heart, or stomach resulting in death 
in 4 to 14 months. To address these concerns, the Committee 
strongly encourages the NCI to establish up to 10 mesothelioma 
centers, increase research, including clinical trials, 
detection and prevention methods, palliation of disease 
symptoms and pain management. The Committee requests that the 
NCI issue a report, by June 1, 2006 on steps taken to address 
mesothelioma research.
    Multidisciplinary Research.--The 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.
    Nanosystems Biology.--The Committee encourages NCI and the 
Office of the NIH Director to support a collaborative effort to 
bring nanotechnology, systems biology and molecular imaging 
together to examine the molecular basis of cancer. Initial 
efforts have shown that cancers such as breast cancer are not a 
single disease, but may encompass many different diseases, when 
examined at the molecular level. Many clinical trials of new 
drugs are now considered to fail if only 10 percent of patients 
benefit, yet the 10 percent may represent a specific type of 
the disease, where the drug may be 100 percent effective. 
Bringing these three disciplines together may allow researchers 
to identify specific sub-types of cancer and to better target 
new interventions. Successful results of such an effort could 
lead to a molecular classification of many types of cancer and 
to targeted molecular treatments for molecular-specific 
diseases.
    Native Hawaiians.--The Committee remains concerned about 
the high incidence of breast, colon, and lung cancer among the 
Native Hawaiian population. The Committee commends the NCI for 
its progress toward understanding and addressing the needs of 
the Hawaiian and Pacific Basin populations through its 
cooperative agreement with Papa Ola Lokahi and looks forward to 
a report of the prioritized health needs identified by those 
assessments.
    Neurofibromatosis. The Committee commends NCI for 
conducting clinical trials of NF1 patients. 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 in such areas 
as further development of animal models, natural history 
studies, therapeutic experimentation, and clinical trials. The 
Committee recognizes that basic research has successfully 
brought NF into the clinical era and encourages NCI to create, 
fund, and implement NF clinical trials infrastructures 
including NF centers, patient data bases, and tissue banks. The 
Committee further encourages NCI to apply existing cancer drugs 
to NF patients in clinical trials both extramurally and 
intramurally, and to develop new drugs for NF which could then 
apply to the general population because of NF's connection to 
most forms of human cancer. The Committee is aware of 
significant new advances in NF research in the past few years 
in the area of tumor suppression, and encourages NCI to 
continue to coordinate its efforts with other NIH institutes 
and government agencies.
    Ovarian Cancer.--Congress remains concerned that mortality 
rates associated with ovarian cancer have not seen the 
decreases that other cancer sites have experienced in the past 
5 years. As the deadliest of all gynecologic cancers, ovarian 
cancer takes the lives of three-quarters of all women diagnosed 
with it within 5 years. Congress commends the National Cancer 
Institute for its recognition of the importance of studying 
this deadly women's disease and appreciates the NCI's recent 
investment that is helping to increase the understanding of the 
unique molecular pathways associated with ovarian cancer 
through its Specialized Programs of Research Excellence 
[SPOREs] program. As such, Congress strongly encourages NCI to 
sustain and strengthen its commitment to and investment in 
ovarian cancer and maintain the SPOREs initiatives directed 
toward ovarian cancer in fiscal year 2006.
    Pancreatic Cancer.--Pancreatic cancer is the country's 
fourth leading cause of cancer death, killing over 32,000 
individuals this year. Its 99 percent mortality rate is the 
highest of all cancers, and the average life expectancy after 
diagnosis with metastatic disease is just 3 to 6 months. The 
Committee is pleased that the NCI is moving forward to 
implement the recommendations outlined in the 2001 report by 
the Pancreatic Cancer Progress Review Group [PRG] and that the 
Institute is funding three pancreatic cancer SPORE grants. 
However, the Committee is concerned that the current level of 
funding for pancreatic cancer research does not allow for the 
implementation of the PRG report and that only one of the three 
SPORE grants is fully funded. In addition, the Committee 
strongly urges the NCI to maintain or increase the number of 
pancreatic SPOREs as it undertakes a review of its 
translational research activities. Finally, the Committee notes 
that the NCI's September 2004 report titled ``Pancreatic Cancer 
Research'' includes a single, overall budget figure for 
implementing the immediate and short-term strategies of the 
Institute's strategic plan to address the PRG's 
recommendations, with no details about how the money would be 
used. Therefore, the Committee requests the NCI to develop a 
professional judgment budget that specifically details the cost 
of fully implementing the pancreatic cancer PRG and provide 
this professional judgment budget to the Committee by May 1, 
2006.
    Prostate Cancer.--The Committee commends the NCI for the 
considerable investment in prostate cancer, the leading cause 
of non-cutaneous cancer death among men, and encourages NCI to 
continue to support research to improve the accuracy of 
screening and early detection of prostate cancer.
    Radio Waves.--The Committee urges the NCI to support 
research using radio waves that could 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.
    Social Work.--The Committee encourages NCI to coordinate 
with the Centers for Disease Control and Prevention to conduct 
further research on the outcome of social work interventions to 
meet patient and family psychosocial needs in hospitals and 
cancer treatment centers.
    SPORE Program.--The Specialized Programs of Research 
Excellence [SPORE] Program at the NCI was established to 
support efforts to move laboratory findings into clinical 
practice to benefit patients in the near term. The Committee 
understands that the program has resulted in the translation of 
some exciting research into cancer clinical trials for 
vaccines, chemoprevention and dietary interventions. The 
results to date from SPORE funding include multi-center 
clinical trials, biomarker studies, prevention studies, genetic 
registries, data sharing, and tissue banking projects, all with 
critical patient focus. The Committee strongly encourages the 
NCI to continue to keep this translational goal at its 
forefront. The Committee further understands that the SPORE 
program has been extremely successful in rapidly moving science 
to practices that benefit patients; funded research that 
requires a team approach to cancer; supports collaboration 
across basic science, population science and clinical 
investigation; and provides a rapid translation from the 
laboratory to patient care. The Committee further urges that 
the translational research momentum, developed under the SPORE 
program, be maintained by the NCI.
    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. The Committee is encouraged that NCI is participating 
in a Trans-NIH Tuberous Sclerosis Coordinating Committee, and 
urges NCI's continued involvement in this process. The 
Committee also urges NCI to collaborate with NIDDK on a 
conference on nutrient sensing and insulin-signaling in cells 
with inclusion of TSC research.
    War on Cancer.--The Committee applauds the Director of the 
National Cancer Institute for setting a bold goal to eliminate 
suffering and death due to cancer by 2015. To assist Congress 
in establishing priorities, the Committee requests the Director 
to report to the Committee, by June 1, 2006, an outline of the 
progress made since the war on cancer was declared in 1971 and 
detail the specific steps that must be taken to achieve this 
goal by 2010.

               NATIONAL HEART, LUNG, AND BLOOD INSTITUTE

Appropriations, 2005....................................  $2,941,201,000
Budget estimate, 2006...................................   2,951,270,000
House allowance.........................................   2,951,270,000
Committee recommendation................................   3,023,381,000

    The Committee recommendation includes $3,023,381,000 for 
the National Heart, Lung, and Blood Institute [NHLBI]. The 
fiscal year 2005 appropriation was $2,941,201,000 and the 
budget request was $2,951,270,000. The comparable amounts for 
the budget estimate include funds to be transferred from the 
Office of AIDS Research.
    Mission.--The National Heart, Lung, and Blood Institute 
provides leadership for a national research program in diseases 
of the heart, blood vessels, lungs and blood, in transfusion 
medicine, and in sleep disorders through support of basic, 
clinical, population-based, and health education research.
    Advanced Imaging Technology for Heart Disease and Stroke.--
The Committee is aware that heart perfusion PET scans using 
Rubidium-82 are considered the ``gold standard'' for 
determining the extent of muscle damage to the heart following 
a heart attack. The Committee encourages the NHLBI to expand 
its research efforts into the role of biological imaging and 
PET in delivering more accurate information to determine 
appropriate treatment for heart disease patients.
    Behavioral Research Grants.--For many years NIH has 
required that any proposed research project grant with a budget 
over $500,000 in direct costs be subject to additional review 
and scrutiny. The Committee is interested to know whether at 
NHLBI this additional layer of review may differentially impact 
large behavioral science research grants. The Committee 
requests a report from NHLBI of all requests to fund research 
grants over $500,000, and whether they were approved, comparing 
behavioral grants to others in the pool, during fiscal years 
2000-2004. The report should be transmitted no later than May 
1, 2006.
    Bleeding and Clotting Disorders.--The Committee commends 
NHLBI for its leadership in advancing research on bleeding and 
clotting disorders and their complications. The Committee 
encourages NHBLI to maintain its work in this area and applauds 
the Institute for its efforts, in cooperation with the National 
Hemophilia Foundation, to support research on improved and 
novel therapies for these disorders.
    Bone Marrow Failure Diseases.--The Committee encourages 
NHLBI to expand its research efforts into bone marrow failure 
diseases, including aplastic anemia, myelodysplastic disorders 
[MDS], and paroxysmal nocturnal hemoglobinuria [PNH]. Each 
year, in some cases, MDS, the most prevalent of these diseases, 
can progress over time to become acute leukemia. More research 
is critically needed to understand the causes of these 
diseases, to develop effective treatments and cures, and to 
prevent the progression of certain cases into leukemia.
    Cardiothoracic Surgery.--The Committee recognizes the 
contributions of cardiothoracic surgery to the improvement in 
cardiac health in this country and looks forward to the 
advances that will come from further clinical research in the 
field. The Committee is encouraged by the steps the Institute 
is taking to establish a network for cardiothoracic surgical 
investigations, and urges rapid implementation of this plan 
with sufficient funding to continue the progress being made in 
the treatment of heart disease.
    Cardiovascular Diseases.--The Committee continues to 
strongly urge the Institute to place the highest priority on 
research for heart disease, stroke and other cardiovascular 
diseases. Therefore, the Committee urges the NHLBI to expand 
its research portfolio and increase its resources into the 
causes, cure, prevention and treatment of cardiovascular 
diseases. The Committee remains concerned that funding over the 
years for cardiovascular disease research has not kept pace 
with the scientific opportunities available, the number of 
Americans afflicted with cardiovascular diseases, or their 
economic toll. The Committee urges NHLBI to expand existing 
studies and to invest in promising initiatives.
    Cardiovascular Disease, Hypertension, and Kidney Disease.--
The Committee is aware that chronic kidney dysfunction is an 
important risk factor for the development of cardiovascular 
disease. Additionally, hypertension, or high blood pressure, is 
the second leading cause of end-stage renal disease [ESRD], 
accounting for 23.6 percent of ESRD patients. ESRD and kidney 
dysfunction together affect millions of Americans and is 
especially prevalent among elderly persons, African-Americans 
and patients with diabetes. Given the significant morbidity and 
mortality associated with cardiovascular disease among patients 
with kidney disease, the Committee recognizes the urgency to 
examine the relationship between cardiovascular disease and 
kidney disease. The Committee encourages NHBLI and NIDDK to 
work together to develop appropriate basic and clinical 
research initiatives addressing the pathogenesis of 
cardiovascular events in patients with kidney disease, while 
exploring therapeutic and preventive interventions. The 
Committee also encourages NHBLI to work with the renal 
community to support ongoing educational programs directed to 
health professionals, patients and the public to raise the 
awareness of the relationship between cardiovascular disease, 
hypertension and kidney disease.
    Cardiovascular Disease With Juvenile Diabetes.--The 
Committee commends NIDDK and NHLBI for their efforts in 
developing new opportunities for studies on the pathogenesis of 
cardiovascular disease complications among patients with 
juvenile diabetes, and to evaluate opportunities for 
intervention studies to reduce CVD complications among patients 
with juvenile diabetes. The Committee encourages the Institutes 
to closely monitor research progress in this field and to 
continue to promote the clinical translation of research 
findings into new therapies.
    Chronic Obstructive Pulmonary Disease [COPD] National 
Education and Prevention Program.--The Committee is pleased 
that NHLBI held a preliminary workshop to formulate strategies 
toward implementing a National Chronic Obstructive Pulmonary 
Disease [COPD] Education and Prevention Program. Since COPD is 
the fourth leading cause of death in the United States, the 
Committee urges the NHLBI to continue its education efforts to 
bring advances in medical care to the public.
    Early identification of those at-risk for or who have COPD 
is essential in the effort to stem the growth of the population 
with COPD. The Committee encourages NHLBI to continue its 
efforts in this area, including working with national lung 
organizations such as the American Thoracic Society and the 
American Lung Association to develop 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 of 
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 it and support the research projects undertaken by it.
    Diamond-Blackfan Anemia.--The Committee is pleased that 
NHLBI has awarded grants for research initiatives 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. The Committee commends NHLBI for its attention to 
this disorder.
    Down Syndrome.--The Committee encourages NHLBI to review 
the causes of congenital heart disease in children with Down 
Syndrome. Studies should also be encouraged in analyzing the 
increased risk of leukemia in persons with Down Syndrome.
    Duchenne Muscular Dystrophy.--The Committee is pleased that 
NLHBI has enhanced its research and related activities 
surrounding cardiac complications associated with DMD and urges 
the Institute to continue to expand and enhance this work going 
forward. The Committee urges NHLBI to become more involved with 
NIH Muscular Dystrophy activities by joining the Muscular 
Dystrophy Coordinating Committee.
    Heart Failure Clinical Research Network.--The Committee is 
concerned that in spite of advances in treatment, both the 
number of newly diagnosed cases and the number of Americans 
suffering from heart failure continues to grow, while the long-
term prognosis for patients still remains poor. The Committee 
urges the NHLBI to initiate a planned research network to 
conduct clinical studies using burgeoning new approaches to 
improve outcomes for heart failure patients, and provide an 
infrastructure to enable rapid translation of promising 
research findings into enhanced patient care. The network would 
have the capability of implementing multiple concurrent 
clinical studies that may show promise for new therapies and 
provide background for larger clinical trials.
    Hemoglobinopathies.--Sickle cell anemia and thalassemia are 
inherited blood disorders caused by mutations in the genes for 
the hemoglobin molecule, the protein in red blood cells that 
carries oxygen to all parts of the body. These conditions cause 
many problems including moderate to severe anemia, chronic 
pain, iron overload with its associated diabetes, liver and 
heart failure, enlarged spleen, bone weakness, pulmonary 
hypertension, and stroke. The Committee recognizes NHLBI's 
continued commitment to invest in basic and clinical research 
in sickle cell anemia and thalassemia, and encourages NHLBI to 
sponsor a conference of experts to develop a report focused on 
the science and management issues that are common to these 
hemoglobinopathies. The Committee supports a cooperative effort 
to identify areas of scientific collaboration and promising new 
research directions in sickle cell anemia and thalassemia.
    Hemophilia.--The Committee commends the NHLBI for its 
leadership in advancing research on bleeding and clotting 
disorders and the complications of these disorders. The 
Committee encourages the NHBLI to maintain its work in this 
area and support research on improved and novel therapies.
    Innovative Technologies for Engineering Small Blood 
Vessels.--The Committee understands that the supply of natural 
blood vessels for multiple grafts does not meet the demand for 
patients undergoing heart artery bypass surgery, and that 
prosthetic grafts for children born with complex heart defects 
fail at an unacceptable rate. To advance the development of 
substitutes for natural blood vessels, the Committee urges the 
NHLBI to continue to invest in research to address this matter.
    Lung Cancer.--Chronic Obstructive Pulmonary Disease [COPD] 
is the fourth leading cause of death in the United States. Lung 
cancer is the leading cancer killer in both men and women and 
in 2005. The Committee understands that COPD may be a predictor 
of future onset of lung cancer. With 24 million people having 
decreased lung function, and in the face of an ever-aging 
population, the need to develop better treatment and prevention 
strategies to address this linkage will only increase over the 
coming decade. The Committee encourages NHLBI to collaborate 
more extensively with NCI to develop appropriate research 
initiatives that can be undertaken cooperatively, and 
encourages NHLBI to sponsor a workshop on COPD as it relates to 
lung cancer with input from the lung community.
    Marfan Syndrome.--The Committee commends the NHLBI for its 
support of research on this life-threatening, degenerative 
genetic disorder, which is characterized by aortic aneurysms 
and dissections, painful orthopedic issues, pulmonary issues 
and ocular manifestations that can result in blindness. Years 
of basic research are ready to be translated into a clinical 
trial for a drug therapy that may potentially prevent aneurysm 
development, which may benefit not only the Marfan population 
but thousands of people who are afflicted with genetically 
triggered aneurysms and others with similar connective tissue 
disorders. The Committee urges the NHLBI to support this effort 
through all available mechanisms, as deemed appropriate.
    Novel Targets and Therapy Development for Clot-based 
Stroke.--The Committee recognizes that an urgent need exists to 
develop new therapies to reduce bleeding risk, minimize brain 
damage and loss of function from stroke. The Committee urges 
the NHLBI and the National Institute of Neurological Disorders 
and Stroke to initiate a planned collaborative effort to 
identify new molecular targets, explore promising agents, and 
develop innovative therapies to quickly restore blood flow to 
the brain to limit stroke damage.
    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 Institute also has supported the Foundation's 10 
Warning Signs Poster distribution, which is widely utilized by 
healthcare professionals in the Nation and globally. The 
Committee encourages NHLBI to take further action in this 
regard and to continue to be an active participant in the 
development of educational materials, conferences, and related 
initiatives, as appropriate.
    Pulmonary Fibrosis.--The Committee urges the NHLBI to 
increase funding for lung research, particularly in the area of 
pulmonary fibrosis, a disease that is terminal and for which 
there is currently no effective treatment.
    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 2006, 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. The Committee commends 
the NHLBI for funding the Scleroderma Lung Study, a large 
multi-center trial whose focus is to find a therapy that may 
alter the course of the inflammation of the lungs that occurs 
in approximately 40 percent of those diagnosed with systemic 
scleroderma. The Committee also commends NHLBI for its 
increasing commitment to finding a cause and improved therapies 
for pulmonary arterial hypertension. Pulmonary arterial 
hypertension occurs in approximately 50 percent of those 
diagnosed with systemic scleroderma. More research is needed 
for the continued development of safe, effective treatments 
where few exist for some and none for others and to identify 
the 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 continues to urge the 
National Center on Sleep Disorders Research 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 to serve as an ongoing, 
inclusive mechanism for public and professional awareness on 
sleep and sleep disorders.
    Specialized Centers of Clinically Oriented Research [SCCOR] 
for Vascular Injury, Repair, and Remodeling.--Vascular diseases 
result from clogged, weakened or otherwise damaged blood 
vessels. The Committee encourages the NHLBI to initiate a 
planned new SCCOR program to conduct interdependent clinical 
and multidisciplinary basic research projects on the molecular 
and cellular mechanisms of vascular injury, repair, and 
remodeling. This program would promote patient-oriented 
research to improve prevention, detection, and treatment of 
vascular diseases, such as heart attack and stroke. The SCCOR 
would provide resources to enable new clinical investigators to 
develop skills and research capabilities to conduct relevant 
research in this area.
    Thrombosis and Thrombophilia.--The Committee is very 
concerned 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 support this 
research and urges collaboration with the thrombophilia centers 
funded by CDC.
    Vascular Biology.--The Committee is very supportive of the 
Institute's research initiatives and encourages NHLBI to 
continue to advance the field of vascular biology, the study of 
blood and blood vessels and their interactions. Vascular 
biology research provides the foundation for understanding the 
underlying causes of atherosclerosis, angiogenesis, 
inflammation, and thrombosis. Venous and arterial thrombosis, 
blood clots that can lead to heart attacks, strokes, or 
respiratory dysfunction, are a particularly important and 
understudied area of vascular biology. Much remains to be 
learned about the basic mechanisms of pathologic thrombosis, 
but research has determined that age is one of the most 
important risk factors. The Committee encourages NHLBI, in 
collaboration with NIA, to develop a research agenda on 
thrombosis and its impact on the elderly, to improve the 
diagnosis and treatment of this potentially fatal complication 
of many diseases.

         NATIONAL INSTITUTE OF DENTAL AND CRANIOFACIAL RESEARCH

Appropriations, 2005....................................    $391,829,000
Budget estimate, 2006...................................     393,269,000
House allowance.........................................     393,269,000
Committee recommendation................................     405,269,000

    The Committee recommendation includes $405,269,000 for the 
National Institute of Dental and Craniofacial Research [NIDCR]. 
The fiscal year 2005 appropriation was $391,829,000 and the 
budget requested $393,269,000. 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, 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.
    Dental Abnormalities.--NIDCR is encouraged to continue its 
support of research aimed at the health of oral mineralized 
tissues. This includes studying the role of genetic factors and 
the potential for cell-based and pharmacological therapy and 
early screening for osteoporosis. Additionally, NIDCR is urged 
to continue research on fibrous dysplasia/McCune Albright 
syndrome and to focus on the dental abnormalities associated 
with Paget's disease.
    Scleroderma.--The Committee is encouraged by NIDCR's 
interest in scleroderma, a chronic and progressive disease that 
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.
    Temporomandibular Joint Disorders [TMJ].--The Committee 
agrees with and is encouraged by recent public statements by 
NIH officials that because of past and current investments in 
research and patient registries, the field is now ready to 
support a substantial new research investment in this complex 
set of disorders. The Committee therefore strongly urges that 
NIDCR take its appropriate leadership role in a substantially 
expanded effort to complete the research needs and 
opportunities agenda outlined in the June 2005 NIH TMJ Report 
to Congress. As noted previously, the Committee expects NIDCR 
to continue to collaborate and coordinate with all relevant 
ICs.
    Because patient advocacy groups are often the best sources 
of information about affected populations and have established 
mechanisms for communicating with them, the Committee urges 
NIDCR to regularly consult with the TMJ Association and other 
relevant groups as it develops and operates its patient 
registry activities. In addition, the Committee urges NIDCR to 
fund an effort to categorize and analyze the symptoms of people 
with TMJ disorders that are collected in a patient advocacy 
group database, in an effort to enhance future TMJ research 
agendas.

    NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES

Appropriations, 2005....................................  $1,713,584,000
Budget estimate, 2006...................................   1,722,146,000
House allowance.........................................   1,722,146,000
Committee recommendation................................   1,767,919,000

    The Committee recommends an appropriation of $1,767,919,000 
for the National Institute of Diabetes and Digestive and Kidney 
Diseases [NIDDK]. The fiscal year 2005 appropriation was 
$1,713,584,000 and the administration's request is 
$1,722,146,000. The comparable amounts for the budget estimates 
include funds to be transferred from the Office of AIDS 
Research.
    Mission.--The NIDDK provides leadership for a national 
program in three major disease categories: diabetes, 
endocrinology, and metabolic diseases; digestive diseases and 
nutrition; and kidney, urologic, and hematologic diseases. The 
NIDDK plans, conducts, fosters, and supports a coordinated 
program of fundamental and clinical research and demonstration 
projects relating to the causes, prevention, diagnosis, and 
treatment of diseases within these categories. The Institute 
also supports efforts to transfer the knowledge gained from its 
research program to health professionals, patients, and the 
general public.
    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 to improving the lives of 
Cooley's anemia patients. The development of a less burdensome 
means of iron chelation is urgently needed. In addition, the 
Committee encourages NIDDK to continue to work closely with 
NIBIB to develop and perfect non-invasive means of iron 
measurement.
    Cystic Fibrosis [CF].--The Committee encourages NIDDK to 
continue its support of CF research efforts, including 
proteomics research. CF researchers are looking at the many 
proteins that play a role in CF, in hopes of identifying new 
drug targets to treat CF. The Committee commends the NIDDK for 
its support of the program announcement for research proposals 
focusing on discovery and development of compounds that will 
correct protein misfolding. The Committee encourages NIDDK to 
further support this especially promising area of research.
    Diamond-Blackfan Anemia.--The Committee is pleased that 
NIDDK will be hosting a workshop to understand the state of the 
science of Diamond-Blackfan Anemia [DBA] as it relates to 
research important to NIDDK, including red cell formation, 
ribosomal proteins, DBA animal models, gene therapy, mechanisms 
of iron overload and the development of treatment options for 
patients with iron overload. The Committee strongly encourages 
NIDDK to develop grant opportunities to support DBA research 
initiatives in these areas.
    Digestive Diseases.--Serious disorders such as colorectal 
cancer, inflammatory bowel disease, irritable bowel syndrome, 
hemochromatosis, celiac disease, and hepatitis take a 
tremendous toll in terms of human suffering, mortality, and 
economic burden. The Committee commends NIDDK on the success of 
its Digestive Disease Centers program in addressing a wide 
range of disorders that result in tremendous human suffering 
and economic cost. The Committee continues to encourage NIDDK 
to expand this important program with an increased emphasis on 
irritable bowel syndrome.
    Diabetes in Native Hawaiians.--The Committee commends the 
NIDDK for its focused research on diabetes in Native American, 
Native Alaskan, and Native Hawaiian populations. The Committee 
is pleased with the innovative multicultural diabetes 
prevention campaign tailored specifically for native 
populations and the collaboration with CDC in the SEARCH 
epidemiological study. Additionally, the Committee requests an 
update in the fiscal year 2007 appropriations justification on 
recommendations resulting from the NIDDK and IHS conference 
scheduled to convene in 2005, and looks forward to similar 
conferences addressing prevention and treatment strategies in 
Native Hawaiian communities.
    Fatty Liver Disease.--The Committee notes that there is an 
emerging obesity-related chronic liver disease, which may 
affect as many as one in four adults and a significant number 
of obese children. This diagnosis encompasses a spectrum of 
severity with many cases evolving into non-alcoholic 
steatohepatitis [NASH] and, ultimately, cirrhosis. NASH-related 
liver disease has already become an important indicator for 
liver transplantation, and in the absence of better treatments, 
the need for NASH-related liver transplantation will increase 
significantly over time. The Committee is pleased that NIDDK is 
funding a fatty liver disease clinical trial that includes both 
adult and pediatric populations. The Committee urges NIDDK to 
focus research on the progression of fatty liver disease to 
cirrhosis and the impact of alcohol on the progression of fatty 
liver disease. The Committee notes that the recently published 
new USDA nutrition guidelines regarding alcohol consumption may 
not be appropriate for individuals with fatty liver disease, 
and therefore urges NIDDK to focus research on this matter to 
support a clarification of the USDA guidelines.
    Fragile X.--Fragile X mental retardation is a single-gene 
disorder that results from an unusual kind of mutation. Study 
of the chain of events set in motion by this mutation may lead 
to the identification of points in the process at which 
interventions may ameliorate symptoms. The Committee 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 Disease Research.--The Committee continues to be 
pleased with the work of NIDDK in the area of glomerular 
disease research, particularly as it relates to focal segmental 
glomerulosclerosis. The Committee commends NIDDK for conducting 
the recent Glomerular Disease Workshop in January 2005, and 
urges NIDDK to issue a program announcement or other 
appropriate mechanism to ensure the initiation of grant 
proposals, training positions, and other activities to expand 
the NIDDK portfolio in this important area of research.
    Hepatitis B.--The Committee is concerned that a consensus 
treatment protocol for hepatitis B does not yet exist, but is 
pleased to learn that NIDDK is actively supporting preliminary 
research to convene a research workshop to plan a Hepatitis B 
Consensus Development Conference. The Committee is pleased that 
NIDDK is taking all necessary steps to plan a successful 
conference, and urges that this conference be convened as soon 
as possible.
    Hepatitis C.--The Committee is pleased to learn that there 
have been 50 patent applications filed for new therapies for 
hepatitis C and there are at least six drugs currently in early 
human trials. In addition to developing new drugs, the 
Committee urges NIDDK to encourage the improvement of existing 
drugs to reduce their toxicity and negative side effects. The 
Committee applauds NIDDK for formally adopting the goal of a 90 
percent treatment effectiveness rate for hepatitis C within 10 
years. The Committee encourages NIDDK to work with the National 
Hemophilia Foundation in developing and advancing research 
initiatives for addressing HCV within the bleeding disorders 
community.
    Hematology.--The Committee is aware of the high-quality 
hematology research in iron metabolism, gene regulation, and 
stem cell plasticity currently funded by the Institute. The 
Committee encourages NIDDK to set priorities for future 
research in these and new areas that significantly impact a 
broad array of blood disorders, such as erythroid 
differentiation, oxidant injury, and metabolomics.
    Incontinence.--Many otherwise healthy, active individuals 
suffer from incontinence. Fecal incontinence, also called bowel 
incontinence, affects people of all ages and is associated with 
a wide variety of causes. The Committee is pleased that NIDDK 
is contributing to the development of standardized approaches 
to measure incontinence and urges NIDDK to continue 
collaborating with NICHD on the incontinence state-of-the-
science conference and on appropriate follow-up to this 
conference.
    Inflammatory Bowel Disease.--The Committee has been 
encouraged in recent years by discoveries related to Crohn's 
disease and ulcerative colitis, collectively known as 
inflammatory bowel disease [IBD]. These extremely complex 
disorders represent the major cause of morbidity from 
intestinal illness. The Committee commends NIDDK for its strong 
leadership in this area and encourages the Institute to 
increase funding for research focused on: (1) the cellular, 
molecular and genetic structure of IBD; (2) identification of 
the genes that determine susceptibility or resistance to IBD in 
various patient subgroups; and (3) translation of basic 
research findings into patient clinical 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.
    Integration of Type 1 Diabetes Research.--The Committee 
urges the NIH to facilitate the effective integration of the 
various research programs funded by the special funding for 
Type 1 Diabetes Research.
    Interstitial Cystitis.--The Committee notes that RFAs have 
been very helpful in stimulating scientific interest in 
interstitial cystitis [IC]. Therefore, the Committee urges the 
NIDDK to continue using this funding mechanism when investing 
in IC-specific basic science research, particularly in the area 
of urinary markers. The Committee also encourages the NIDDK to 
sponsor a scientific symposium on IC in 2006 to follow up on 
the very successful 2003 symposium. The Committee also urges 
the NIDDK to hold a separate meeting of leading international 
opinion leaders involved in IC research to seek clarity 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 encouraged to 
learn that the NIDDK is launching an IC awareness campaign, and 
it hopes the NIDDK will continue to work closely with the IC 
patient community on both developing the content and executing 
the campaign.
    Irritable Bowel Syndrome.--The Committee is pleased that 
NIDDK is formulating an action plan for digestive diseases and 
that irritable bowel syndrome [IBS] will be a focus area of 
this overall plan. However, given the increasing frequency of 
IBS and the Committee's long-standing interest in this 
condition, the Committee strongly urges the NIDDK to complete 
this digestive disease plan as quickly as possible.
    Kidney Disease.--Kidney disease is a rapidly growing health 
problem in the United States, where an estimated 15 million 
people have lost 50 percent of their kidney function and 
another 20 million more Americans are at increased risk of 
developing kidney disease. The marked increase in the end-stage 
renal disease [ESRD] population is fueled by the large number 
of patients with diabetes. Diabetes is the most common cause of 
kidney disease and accounts for 34 percent of patients on 
dialysis. Chronic kidney disease has emerged as a major 
contributing factor to cardiovascular disease. The Committee 
therefore encourages NIDDK to assign priority to expand the 
kidney disease research infrastructure through a robust program 
of kidney research core centers to promulgate collaborative 
research on a local, regional and national level. In addition, 
the Committee recommends expanded support for investigator-
initiated research projects in five priority areas of greatest 
clinical importance: acute renal failure, diabetic nephropathy, 
hypertension, transplantation, and uremic cardiovascular 
toxicity. Research grant applications in these areas should be 
encouraged with appropriate program announcements and requests 
for proposals. Continued funding of grants to support 
development of investigator-initiated clinical and basic 
studies in these areas of high priority is essential. The 
Committee wishes to commend NIDDK for moving forward with the 
Clinical Trials Cooperative Group and supports collaboration 
with the renal community to seek new strategies and energize 
clinical investigation in the above mentioned areas.
    Liver Disease Research Action Plan.--The Committee is 
pleased to note that NIDDK, working with the leading scientific 
experts in the field, has published a comprehensive Liver 
Disease Research Action Plan to guide future research 
activities. The Plan is organized into 16 chapters and 
identifies numerous areas of research important to virtually 
every aspect of liver disease. The Committee urges that steps 
be taken to implement the plan immediately and submit a report 
to the Committee prior to next year's hearings detailing what 
has been accomplished to that point, as well as future plans, 
with a specific timeline, for implementation of the balance of 
the plan.
    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 
efforts by NIDDK to reach out to NIAMS to improve collaborative 
bone and joint disease research in MPS disorders. Research 
focused on the underlying pathophysiology of bone and joint 
lesions, the gene mutations and substrates that are stored, and 
potential therapeutic approaches continue to be of significant 
interest to the Committee. The Committee commends the NIDDK on 
its collaborations with NINDS, NICHD, NCRR, and ORD in 
advancing broad-based MPS-related research.
    Osteoporosis.--NIDDK is encouraged to support research 
targeting new technologies and therapies to increase bone mass 
and combat osteoporosis, through focus on: (1) genetics, 
environmental and lifestyle factors, and (2) the effects of 
disease, in order to address the critical research questions 
highlighted in the Surgeon General's Report on Bone Health and 
Osteoporosis.
    Paget's Disease.--NIDDK is urged to study the functional 
consequences of the recently identified gene mutations in 
Paget's disease as a means of identifying new therapeutic 
treatments for the disease.
    Pediatric Kidney Disease.--Kidney disease remains a 
persistent and poorly understood problem among infants, 
children and adolescents, impairing normal growth and 
development and often resulting in learning disabilities and 
mental retardation. Of urgent concern today is the explosion in 
the incidence of obesity among children and adolescents, a 
morbidity that places more than 15 percent of America's 
children at risk for developing type 2 diabetes, hypertension, 
and chronic kidney disease [CKD]. These morbidities not only 
represent a significant financial burden to the health care 
system but also are important risk factors for the development 
of cardiovascular disease. The Committee urges NIDDK to 
continue to support research focused on the pathogenesis, 
prevention, and treatment of kidney disease in children. The 
Committee recommends that emphasis be placed on exploring the 
contributions of obesity, type 2 diabetes, and hypertension to 
progression of disease, and interventions that may limit 
cardiovascular morbidity in patients with CKD.
    Pediatric Liver Disease.--The Committee is pleased that the 
NIDDK has taken steps to increase research on biliary atresia, 
the most common cause of liver transplantation in children, by 
creating 10 centers within the Biliary Atresia Clinical 
Research Consortium. The Committee is also pleased that centers 
have been added with a special focus on additional neonatal 
liver diseases.
    Polycystic Kidney Disease.--The Committee is pleased to 
learn of the first clinical drug trial for PKD in humans and 
the development of additional, innovative PKD therapies. This 
progress directly benefits more than 600,000 Americans 
suffering from PKD and could potentially save billions of 
Medicare and Medicaid dollars for renal replacement therapy and 
free up thousands of spots on the kidney transplant waiting 
list. These discoveries have produced a cohesive, 
interdisciplinary body of scientific work benefiting PKD 
research; engendered a broad range of alternative model 
research systems and reagents shared worldwide among PKD 
investigators; and drawn a host of talented investigators from 
other disciplines into the PKD field. The Committee urges NIDDK 
to pursue fulfillment of its PKD Strategic Plan by facilitating 
PKD clinical trials, expanding studies of pathophysiology and 
cellular pathobiology, expanding the PKD research 
infrastructure, and enhancing resources to create a supportive 
environment for PKD investigators to develop new interventional 
strategies and pursue long-range planning.
    Primary Biliary Cirrhosis [PBC].--PBC is a rare, chronic 
and progressive liver disease that causes irreversible 
destruction of the bile ducts. The cause of PBC is still 
unknown, but current studies suggest it may involve 
autoimmunity, infection, or genetic predisposition, and does 
seem to appear more often in certain families. Women are 
affected 10 times more than men, and PBC is usually diagnosed 
in patients between the ages of 35 to 60 years. The Committee 
encourages NIDDK to further study this rare disease to 
determine among other things, why women are predominantly 
affected and whether there are successful treatment options 
other than liver transplantation.
    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 for prostatitis. 
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.
    The Committee applauds the work the Chronic Prostatitis 
Collaborative Research Network [CPCRN] has undertaken. The 
genetic and other possibilities linking prostate diseases is 
virtually unexplored. The Committee encourage microscopic 
studies of the prostatic fluid and tissue by infectious disease 
specialists, pathologists, immunologists and others. The 
Committee further encourages the NIDDK to increase research, 
public awareness, and public education to erase the stigma 
attached to this affliction that attacks young men.
    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 that 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 
diagnosis. More research is needed in order to develop safe and 
effective treatments and to identify the cause or causes of the 
complications of scleroderma.
    TEDDY.--The Committee commends the NIDDK for launching 
TEDDY, a long-term study to identify the environmental causes 
of autoimmune diabetes. The Committee urges the NIDDK to 
communicate details of the study to the research community, to 
provide access to study materials and data, and to develop 
mechanisms to integrate new technologies into the study design.
    TrialNet.--The Committee commends the NIDDK for its support 
of the Type 1 Diabetes TrialNet, which has launched a natural 
history study and a clinical intervention trial for juvenile 
diabetes. The Committee encourages the NIDDK to continue its 
efforts to translate basic and preclinical research on juvenile 
diabetes into a pipeline of new therapeutic strategies that can 
be evaluated through the TrialNet clinical trials network. The 
Committee urges the NIDDK to develop biomarkers for the 
evaluation of efficacy and the efficient operation of clinical 
trials and to develop more efficient approaches to subject 
recruitment for clinical trials.
    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 know as angiomyolipoma 
that can result in kidney failure. The Committee is encouraged 
that NIDDK is participating in a Trans-NIH Tuberous Sclerosis 
Coordinating Committee, and urges NIDDK's continued involvement 
in this process. The Committee also urges NIDDK to collaborate 
with NCI on a conference on nutrient sensing and insulin-
signaling in cells with inclusion of TSC research.

        NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE

Appropriations, 2005....................................  $1,539,448,000
Budget estimate, 2006...................................   1,550,260,000
House allowance.........................................   1,550,260,000
Committee recommendation................................   1,591,924,000

    The Committee recommends an appropriation of $1,591,924,000 
for the National Institute of Neurological Disorders and Stroke 
[NINDS]. The fiscal year 2005 appropriation was $1,539,448,000 
and the budget request is $1,550,260,000. The comparable 
amounts for the budget estimates include funds to be 
transferred from the Office of AIDS Research.
    Mission.--The NINDS conducts and supports a broad range of 
research and research training on the normal function of the 
brain, spinal cord, and peripheral nerves, and on neurological 
and neuromuscular disorders. Neurological research includes 
epidemiology studies to identify risk factors for disease; 
laboratory studies to examine the structure and function of 
nerve cells; and brain imaging studies to understand how the 
brain is affected by disease and how it operates to carry out 
tasks such as learning and memory. New approaches for the 
diagnosis, treatment, and prevention of brain disorders are 
evaluated in studies with patients and those at risk for brain 
disorders.
    Alzheimer's Disease.--NINDS is currently supporting both 
pre-clinical and translational research intended to expand the 
pool of therapeutic agents for treating Alzheimer's disease. 
For example, a recent NINDS-supported study tested a drug that 
interferes at a specific point in the cholesterol pathway that 
contributes to the generation of amyloid protein, a hallmark of 
Alzheimer's. The study resulted in a 99 percent reduction in 
brain amyloid in a mouse model of the disease, suggesting that 
this may provide a novel approach for developing a therapeutic 
intervention for Alzheimer's disease. The Committee encourages 
NINDS to continue to assign a high priority to Alzheimer 
research, and to work closely with NIA, NIMH and other 
institutes.
    Amyotrophic Lateral Sclerosis [ALS].--The Committee is 
pleased by the increased number of NINDS research programs on 
ALS, including participation in the NIH partnership of 14 
Institutes to accelerate neuroscience research, the NIH 
Blueprint for Neuroscience Research, plus new interdisciplinary 
collaborations with other organizations and appropriate NIH 
Institutes, particularly NIEHS. The Committee commends NINDS on 
its multiple initiatives involving high-throughput screening 
and assay development to identify compounds with activity in 
neurodegenerative disorders, including ALS. The Committee is 
gratified by the development of translational research and the 
clinical trials programs at NINDS and by the public's new 
opportunities to benefit from better access to and 
dissemination of information. The Committee is also pleased by 
the series of scientific workshops held since 2003 with the 
Department of Veterans Affairs [VA], the Department of Defense 
[DOD], and with leading scientists from academic centers 
throughout the Nation. The Committee encourages NINDS to 
continue and to grow its collaborative initiatives with 
voluntary health associations, other NIH Institutes, the DOD 
and the VA in the effort to advance ALS research and identify 
treatments and a cure for the disease.
    Ataxia Telangiectasia [A-T].--A-T is a genetic disease that 
attacks in early childhood. It progressively affects 
coordination and severely compromises the immune system. 
Children with A-T are highly likely to develop cancer, and 
rarely live beyond their teens. The Committee encourages the 
NINDS to work with the NCI and other appropriate Institutes to 
support research aimed at understanding the underlying causes 
of A-T, with the goal of translating this basic research into 
treatments for the disease.
    Basic Behavioral and Social Sciences Research.--The 
Committee encourages NINDS to participate in trans-institute 
initiatives organized by OBSSR or another institute to 
strengthen basic behavioral research and enhance opportunities 
for behavioral science research training.
    Batten Disease.--The Committee strongly urges the Institute 
to increase funding for Batten Disease research by actively 
soliciting grant applications 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.
    Brain Tumors.--The Committee continues to believe that 
additional attention should be given by NINDS to identifying 
causes of and treatments for brain tumors and encourages NINDS 
to continue working with NCI to carry out the recommendations 
of the Report of the Brain Tumor Progress Review Group.
    Charcot-Marie-Tooth Disease.--The Committee continues to be 
concerned about NIH support for research on Charcot-Marie-Tooth 
[CMT] disease. The Committee welcomes the upcoming NINDS 
workshop on peripheral neuropathies, but remains unclear as to 
the degree this workshop will focus on CMT. The Committee urges 
the NIH to include a significant focus on CMT in the upcoming 
workshop with a goal of producing outcomes which will be 
directly relevant to CMT research and lead to a relevant 
program announcement or request for applications on CMT. The 
Committee encourages that relevant Institutes and Centers will 
participate in the workshop. In addition, the Committee 
requests NIH incorporate CMT research into its Blueprint for 
the Neurosciences initiative.
    Down Syndrome.--The Committee commends NINDS for sponsoring 
a Down Syndrome Workshop to address research priorities 
relating to optimizing synaptic structure and function in 
neuronal circuits important for cognition. The Committee 
encourages NINDS to identify opportunities for investigating 
the genetic and cellular basis for abnormalities in the 
structure and function of these circuits in both the developing 
and mature nervous system. In addition, NINDS is encouraged to 
develop strategies to understand the incidence and impact on 
cognition of obstructive sleep apnea and other disorders of 
sleep. The NINDS is also encouraged to work with the NIA to 
develop strategies to investigate the biology of age-related 
disorders, such as Alzheimer's disease and Parkinson's disease, 
in people with Down syndrome. NINDS is also encouraged to work 
with the Office of the Director to develop a strategic plan for 
Down syndrome research and to coordinate its research with 
NICHD, NIA, NIMH and other institutes.
    Duchenne Muscular Dystrophy.--The Committee remains 
concerned with the amount of time taken by the NIH to comply 
with requirements of the MD Care Act, which became law in 
December 2001. However, the Committee is pleased NIH has funded 
one additional Wellstone Muscular Dystrophy Cooperative 
Research Center and is working to fund two more for a full 
complement of six. The Committee further encourages the 
Institute to provide adequate funding and resources for each 
center. The Committee further requests that NINDS coordinate 
with NIAMS on timelines for translational research, the 
consensus conference and the strategic plan.
    Epilepsy.--The Committee seeks intensified efforts by the 
NINDS to produce breakthroughs in the prevention, treatment, 
and eventual cure of epilepsy. The Committee applauds the 
development of benchmarks for epilepsy research resulting from 
the ``Curing Epilepsy: Focus on the Future'' conference held in 
March 2000 and encourages the Institute to address important 
research issues raised at the ``Living Well with Epilepsy II'' 
conference held in July 2003. The Committee encourages NINDS to 
continue to dedicate resources for carrying out its benchmark 
priorities, to develop plans and goals for the anti-epileptic 
drug development program, and to report to the Committee on its 
activities to further these important areas of research.
    Fragile X.--The Committee urges the NINDS to intensify its 
research into these issues as they relate to Fragile X, and to 
coordinate this research with other Institutes working on 
Fragile X, including but not limited to NIMH and NICHD.
    Fragile X-associated Tremor/Ataxia Syndrome [FXTAS].--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. Identification of older 
male carriers will lead to a better understanding of the true 
incidence of Fragile X syndrome and afford at-risk families of 
child-bearing age the opportunity to pursue genetic counseling. 
NINDS, in collaboration with the National Institute on Aging, 
is urged to commit additional resources and expand research 
into FXTAS, including working with the other NIH institutes as 
well as the Centers for Disease Control and Prevention in the 
development of genetic counseling protocols for families 
affected by both Fragile X and FXTAS.
    Learning Disabilities.--The Committee commends NINDS for 
the work conducted to explore the neurological aspects of 
learning disabilities. The Committee looks forward to learning 
the results of this work and encourages the Institute to 
continue to coordinate with other Institutes working on related 
activities.
    Mucopolysaccharidosis [MPS].--The Committee commends NINDS 
efforts to collaborate with the Lysosomal Storage Disorder 
Research Consortium [LSDRC] in the development and release of 
the July 2004 program announcement titled ``CNS Therapy 
Development for Lysosomal Storage Disorders'' and the stated 
intent to enhance blood brain barrier research in lysosomal 
storage disorders. The Committee continues to encourage NINDS 
to collaborate with all appropriate Institutes and Centers to 
support ongoing MPS research, including study of the blood 
brain barrier as an impediment to treatment, and use all 
available mechanisms to further stimulate and enhance efforts 
to better understand and treat MPS disorders.
    Neurofibromatosis.--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 recognizes 
that basic research has now successfully brought NF research 
into the clinical era. The Committee therefore encourages NINDS 
to continue its exemplary efforts in the creation, 
implementation and funding of NF clinical trials 
infrastructures and clinical trials using existing and new 
drugs on NF patients. The Committee calls upon NINDS to 
continue to coordinate its efforts with the other institutes at 
NIH as well as other government agencies.
    Neuroprosthetics.--The Committee strongly supports 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, and should be 
expanded.
    PET Imaging and Alzheimer's Disease.--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.
    Parkinson's Disease.--The Committee supports the innovative 
multidisciplinary research and training concerning Parkinson's 
disease provided by the Morris K. Udall Parkinson's Disease 
Research Centers of Excellence. The Committee urges NINDS to 
continue support for the Udall Centers. The Committee further 
encourages the Director to create an additional Coordinating 
Udall Center to further focus and manage the interdisciplinary 
efforts of the Udall Centers. The additional research 
opportunities and discoveries made by Udall Center scientists 
are leading to improved diagnosis and treatment of patients 
with Parkinson's. The Committee commends both the basic and 
clinical objectives of the Centers that, together, enhance 
research effectiveness in a multidisciplinary setting. The 
Committee commends the NINDS for participating in a community-
wide examination of private and public Parkinson's disease 
research funding through the Parkinson's Community Research 
Advisory Council. The Committee strongly encourages NINDS to 
continue to participate in this effort. The Committee commends 
the Director for implementing the Neuroscience Blueprint, which 
creates new opportunities for collaborative, directed research 
across institutes and through public-private partnerships. As 
the NINDS develops Blueprint initiatives for this and future 
years, the Committee encourages continued collaborations 
including additional intramural activities between NINDS, NIMH, 
and NIA to enhance understanding of neurodegenerative diseases, 
particularly Parkinson's disease. Specifically, the Committee 
encourages collaborations with other institutes in the areas of 
genetics, cell biology, pathology/epidemiology, non-human 
models, biomarkers, neuroimaging, gene therapy, surgical 
approaches, drug development, cell replacement therapy (i.e., 
stem cells), and mental health which will lead to better 
treatments or a cure for this devastating and costly disease. 
In particular, the Committee urges continued research on 
biomarkers, for early detection of Parkinson's, and 
neuroprotective compounds, to slow or stop the disease until 
cures can be found. As the results of neuroprotection trials 
become known, the Committee urges the Director to provide 
funding for Phase III clinical trials of all the 
neuroprotection compounds found to be effective, including 
combinations of them. As Parkinson's is affecting men and women 
at progressively younger ages, causing many to have to stop 
working within a few years of their diagnosis, early diagnosis 
and identification of neuroprotective compounds are critical.
    Peripheral Neuropathy.--As many as 20 million Americans 
suffer from peripheral neuropathy, a neurological disorder that 
causes debilitating pain, weakness in the arms and legs, and 
difficulty walking. Peripheral neuropathy affects approximately 
one-third of diabetics, or about 5.1 million persons, while 
other forms of neuropathy are inherited; associated with 
cancer, kidney disease or infections like hepatitis, HIV/AIDS 
or Lyme disease; or caused by autoimmunity, traumatic injuries, 
poor nutrition, toxins and certain medications. While 
significant research is underway on diabetic neuropathy and 
HIV/AIDS-related neuropathy, the Committee strongly urges NINDS 
to strengthen its research portfolio on other forms of 
neuropathy. The Committee is pleased to learn that NINDS plans 
to convene a workshop with distinguished scientists to identify 
research goals aimed at expanding the research knowledge base 
and identifying potential therapies.
    Picks Disease.--The Committee urges the NINDS to initiate 
funding for drug discovery efforts that focus on specific 
targets relevant to treating the mechanisms underlying brain 
degeneration due to frontotemporal dementia [FTD]. The 
Committee further encourages the NINDS to conduct multicenter 
treatment trials for symptomatic management of Pick's disease 
and other FTDs. The Committee encourages the Institute to focus 
on methods for discovering the causes of this family of 
diseases, improving diagnostic accuracy, and providing 
longitudinal characterizations so that the success of 
intervention can be determined.
    Rett Syndrome.--The Committee remains concerned at the 
level of funding dedicated toward research into the genetic 
cause of Rett syndrome, an incurable childhood neurological 
disorder that is the leading cause of severe neurologic 
impairment in females and the only autism spectrum disorder 
that is known to have a genetic cause. While once considered 
rare, increased diagnosis suggests that the prevalence of Rett 
syndrome may be much greater than the current estimated 
incidence of 1 in every 10,000 females. The discovery of the 
specific genetic cause of Rett syndrome could help elucidate a 
host of other disorders, including autism, schizophrenia, 
Parkinson's, anxiety and autonomic nervous system disorders. 
Accordingly, the Committee strongly urges NIH to dedicate 
enhanced resources to research on the genetic cause of Rett 
syndrome. The Committee also encourages NIH to coordinate with 
private organizations supporting research initiatives in this 
area in order to ensure the most efficient use of resources.
    Spinal Muscular Atrophy.--The Committee understands that 
the severity of SMA, its relatively high incidence, and the 
possibility of imminent treatments have led NINDS to initiate 
the SMA Therapeutics Development Program. The Committee 
commends NINDS for this initiative and strongly urges NIH/NINDS 
to continue to commit the resources to ensure a timely 
completion of the project mission--to identify and complete 
preclinical research and development of candidate therapeutics 
for treating SMA by 2007. To maximize program efficiency, it is 
also critical that NINDS lead efforts to integrate Therapeutics 
Development efforts with emerging programs in the biotech and 
pharmaceuticals industry, academic medical centers and 
collaborations with voluntary health organizations to ensure 
that duplication of effort is avoided. The Committee 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 June 1, 2006 with a progress report on 
all aspects of SMA research.
    Stroke.--The Committee continues to place a high priority 
on stroke research and strongly encourages the NINDS to 
increase resources for basic, clinical and translational 
research and related activities into stroke. The Committee 
remains 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 of this disease. Therefore, the Committee encourages the 
NINDS to aggressively expand its stroke education program, to 
implement the long-range strategic plan for stroke research and 
to continue searching for novel approaches to improve stroke 
diagnosis, treatment, rehabilitation and prevention. The 
Committee supports implementation of the Stroke Progress Review 
Group Report and expects prior to the fiscal year 2007 hearings 
a written update, including specific activities and initiatives 
in this regard.
    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 and/or skin. Individuals 
with TSC--many of whom are infants and young children--face a 
lifetime of suffering with kidney failure, seizures, behavioral 
disorders, autism and mental retardation. The Committee is 
encouraged that NINDS has organized a Trans-NIH Tuberous 
Sclerosis Coordinating Committee, and urges NINDS to continue 
to take a leadership role in convening meetings of this 
Committee, facilitating communication between the participating 
institutes, and encouraging funding of TSC-related research. 
The Committee also encourages NINDS to host a pre-clinical 
translational research workshop on TSC and to include TSC in 
the NINDS Pilot Therapeutic Network [NPTUNE].
    Vulvodynia.--The recently published findings of NIH-
supported research indicates that millions of women suffer from 
chronic pelvic and genitourinary pain conditions such as 
vulvodynia. Therefore, the Committee calls on NINDS to expand 
its support of research in this area, in coordination with 
NICHD, ORWH, the NIH Pain Consortium and other ICs, with a 
focus on etiology and multi-center therapeutic trials.

         NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES

Appropriations, 2005....................................  $4,402,840,000
Budget estimate, 2006...................................   4,459,395,000
House allowance.........................................   4,359,395,000
Committee recommendation................................   4,547,136,000

    The Committee recommends an appropriation of $4,547,136,000 
for the National Institute of Allergy and Infectious Diseases 
[NIAID]. The budget request was $4,459,395,000. The fiscal year 
2005 appropriation was $4,402,840,000. Included in these funds 
is $100,000,000 to be transferred to the Global Fund to Fight 
HIV/ AIDS, Malaria, and Tuberculosis. Also included is bill 
language permitting up to $30,000,000 for extramural facilities 
construction grants. 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, tuberculosis, tropical diseases, and other infectious 
diseases--including those likely to be used as agents of 
bioterrorism. To accomplish this mission, the NIAID supports 
and conducts basic and clinical research and research training 
programs in infectious diseases, whether they are naturally 
occurring or the result of a bioterrorist attack, and in 
diseases caused by, or associated with, disorders of the immune 
system.
    Anaphylaxis.--In recent years, the Committee has encouraged 
the NIAID to expand research in the areas of food and drug 
allergy. The Committee was pleased to learn of the Institute's 
co-sponsorship of a symposium on the definition and management 
of anaphylaxis, a particularly severe reaction often resulting 
from allergic responses to food or medications. A recent 
published report of the meeting emphasized the need for 
expanded research to improve methods for diagnosing, treating, 
and preventing the condition. The Committee urges the NIAID to 
work with interested organizations to develop a comprehensive 
research agenda on anaphylaxis. The Committee requests a report 
by May 1, 2006, on how it plans to stimulate research in this 
area.
    Asthma.--The Committee is very 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.--The Committee was pleased to learn 
about NIAID research efforts related to atopic dermatitis 
undertaken through projects such as the Immune Tolerance 
Network and the Atopic Dermatitis and Vaccinia Immunization 
Network. Last year, the Committee encouraged NIAID to 
complement these efforts by working with NIAMS to spearhead a 
multidisciplinary, multi-institute initiative to encourage 
investigator-initiated research projects on AD as it relates to 
smallpox vaccination as well as the progression to asthma and 
other allergic diseases. The Committee requests an update in 
the fiscal year 2007 appropriations justification on efforts 
that have been made to foster investigator-initiated research 
in this area.
    Autoimmune Diseases.--The Committee applauds the formation 
of two cooperative research groups, the Autoimmune Centers of 
Excellence and the Cooperative Study Group for Autoimmune 
Disease Prevention, which support multidisciplinary research to 
understand and treat autoimmune diseases. The Committee urges 
NIAID to continue its support for the prevention centers and to 
encourage the participation of the wider research community in 
this initiative.
    Bioterrorism.--Respiratory pathogens that cause life-
threatening pneumonia are commonly proposed agents of 
bioterrorism. The following are associated with acute 
pneumonia/lung injury: anthrax, smallpox, plague, and 
tularemia. The Committee encourages further research on the 
mechanisms of pneumonia by these respiratory pathogens and the 
development of new therapeutic interventions to reduce injury 
and death.
    Coinfection Research.--The Committee is concerned that 
there is growing evidence of liver toxicity of highly active 
antiretroviral therapy [HAART] in those with chronic viral 
hepatitis and in particular those with decompensated liver 
disease awaiting liver transplantation. There also appears to 
be an emerging problem of liver cancer in co-infected patients 
(HCV and/or HBV with HIV). The Committee encourages NIAID to 
initiate significant research initiatives in both of these 
areas.
    Dystonia.--The Committee continues to support the expansion 
of research and treatment developments regarding the 
neurological movement disorder dystonia, given that dystonia is 
the third most common movement disorder after tremor and 
Parkinson's disease. The Committee encourages NINDS to support 
additional research on both focal and generalized dystonia, and 
commends NINDS for its study of the DYT1 gene and encourages 
expansion in this area of research. The Committee is pleased 
with progress made in expanding the dystonia research portfolio 
resulting from the joint dystonia research program announcement 
[PA], and urges NINDS to consider options for continued 
progress once the program announcement expires in August 2005.
    Hemophilia.--The Committee urges NIAID to continue its 
efforts to develop and advance research initiatives for 
addressing HCV within the bleeding disorders community. The 
Committee understands that HCV continues to have a devastating 
impact on this community, with nearly half of all persons with 
hemophilia having contracted HCV from blood clotting factor 
products.
    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 Development.--The Committee is 
encouraged to learn that a small hepatitis C vaccine human 
trial has been successfully completed. The Committee urges 
NIAID to implement the results of the recent workshop that was 
held to discuss and evaluate efforts toward development of HCV 
vaccines with the goal of spurring their development and 
testing. The Committee also urges NIAID to proceed with phase 
two of the human clinical trial as soon as it is scientifically 
practicable. Additionally, NIAID is urged to foster the 
development of an in vitro culture system for HCV as well as 
new animal models for basic research and for adequately testing 
vaccine candidates and antiviral drugs.
    Immune Tolerance.--The Committee is encouraged by the 
progress of the Immune Tolerance Network in launching clinical 
trials of protocols to induce immune tolerance in patients with 
Type 1 diabetes. These trials have the potential to prevent the 
recurrence of autoimmunity in patients with long-standing 
diabetes who have undergone islet transplantation and halt the 
autoimmune attack in recently diagnosed Type 1 diabetes 
patients. The Committee encourages the NIAID to continue its 
strong support of this clinical network and to expand its 
clinical studies promoting the translation of promising basic 
discoveries.
    Immune Surveillance Cell Proteomes.--The Committee 
recognizes the potential threat to national security posed by 
terror attacks involving biological, chemical, nuclear, and 
radiological weapons. One of the challenges facing public 
health officials responding to such an attack is their limited 
ability to diagnose individuals who have been exposed to these 
agents and do not show illness. Recent disease outbreaks--such 
as SARS in Asia and Canada, avian influenza in East Asia, and 
Ebola and Marburg virus in Africa--demonstrate that the speed 
of diagnosis and implementation of public health measures can 
mean the difference between an isolated outbreak and a global 
pandemic. Therefore, the Committee strongly supports research 
on immune surveillance cell proteomes (e.g. monocytes, 
neutrophils, dendritic cells, B cells and NK cells) and their 
response to chemical and biological pathogens. The Committee 
also urges the NIAID to fund the development of a searchable 
electronic database for biological proteomes, the proteomics of 
immune surveillance cell interaction with pathogens (biological 
and chemical), and proteins derived from the immune 
surveillance cells themselves, as well as their interaction 
with pathogens.
    Inflammatory Bowel Disease.--The Committee continues to 
note with interest a scientific research agenda for Crohn's 
disease and ulcerative colitis (collectively known as 
inflammatory bowel disease) titled ``Challenges in Inflammatory 
Bowel Disease [IBD].'' This report identifies strong linkages 
between the functions of the immune system and IBD. The 
Committee encourages the Institute to expand its research 
partnerships with the IBD community in fiscal year 2006 and 
increase funding for research focused on: (1) the immunology of 
IBD and (2) the interaction of genetics and environmental 
factors in the development of the disease.
    Infectious Disease Research.--The Committee believes that, 
with regard to both biodefense and public health, the 
development by NIAID of multi-pathogen identification arrays 
that can be used to identify infectious agents through 
epidemiological outbreak surveillance is critically important. 
The use of whole genome expression, all exon transcription 
analysis and whole genome SNP analysis studies to identify and 
understand host biomarkers that may identify the type, severity 
and likely response to therapeutics of infectious agents hold 
great promise for the most immediate results and the Committee 
encourages NIAID to pursue these lines of inquiry.
    Lupus.--The Committee recognizes that Lupus is a serious, 
complex, debilitating chronic autoimmune disease that causes 
inflammation and tissue damage to virtually any organ system in 
the body and impacts between 1.5 and 2 million individuals. The 
Committee strongly urges the National Institute of Allergy and 
Infectious Diseases to expand and intensify research and 
related activities with respect to Lupus.
    Primary Immunodeficiency Diseases.--NIAID is the lead 
agency for research into this class of diseases that is known 
to afflict about 500,000 Americans and may affect an equal 
amount that have not yet been diagnosed. To address the complex 
research needs of this group of about 140 separate diseases, 
the Institute has created a research consortium comprised of 
the leading experts in PI. Because of the importance of these 
diseases to public health and the impact they have on the 
economics of health care in this country, the Committee 
believes that it is critical that the consortium be managed 
efficiently, from both a scientific and an economic 
perspective. The Committee requests that NIAID report to it by 
May 1, 2006 on the management of the consortium, as well as its 
plans for future research in this field.
    Psoriasis.--Psoriasis is a common, chronic, immune-mediated 
skin disease. The Committee urges NIAID to support additional 
research on psoriasis and psoriatic arthritis pathogenesis, 
research to develop diagnostic tests for psoriatic arthritis 
and clinical research to identify new safe and effective 
therapies for these diseases.
    Scleroderma.--The Committee commends the NIAID for its 
growing commitment to understanding the cause and to finding 
improved treatments for scleroderma, a chronic and progressive 
disease that predominantly strikes women. Scleroderma is 
disfiguring and can be life threatening, affecting multiple 
systems including the heart, lungs, kidneys, and 
gastrointestinal tract. NIAID has provided a grant to fund the 
SCOT Study (Scleroderma Cytoxan or Transplant). This study will 
compare the differences between autologous stem cell transplant 
(stem cells that are taken from the blood of the patient) 
versus high dose cytoxan for the treatment of progressive 
systemic scleroderma. The Committee encourages the NIAID to 
continue this commitment through expanded inclusion of 
scleroderma in the Autoimmune Centers of Excellence and for 
continued dialogue with the Institutes that are part of the 
Autoimmune Disease Coordinating Committee.
    Transplantation Research.--The Committee is aware that 
while 1-year organ transplantation survival has improved 
remarkably over the last 15 years, there has been little 
success in reversing the decline in long-term graft and patient 
survival. Therefore, the Committee urges NIAID to convene an 
expert conference during fiscal year 2006, in collaboration 
with NIDDK and NHLBI, to develop a 5-year Transplantation 
Research Action Plan identifying the most urgently needed 
research to facilitate an increase in the success of organ 
transplantation. The expert conference is also urged to focus 
on promising new technologies in pre-transplant organ care and 
post-transplant patient therapies. The Committee requests a 
report by May 1, 2006 on the results of this conference 
including a trans-NIH breakdown of resources committed to this 
category of research. The Committee also urges the initiation 
of a cohort study to assess the health outcomes of living 
donors not only for the period immediately following the 
donation, but for the quality of life implications in the 
decades post donation.
    Tuberculosis.--The World Health Organization [WHO] 
estimates that nearly one-third of the world's population will 
become infected with tuberculosis [TB]; and by 2020, 70 million 
people will die worldwide of this disease. The Committee is 
pleased with NIAID's efforts to develop an effective TB 
vaccine. The Committee encourages the Institute to continue its 
TB vaccine development work and expand efforts to develop new 
drugs, including multi-drug resistant drugs to treat TB.

             NATIONAL INSTITUTE OF GENERAL MEDICAL SCIENCES

Appropriations, 2005....................................  $1,944,067,000
Budget estimate, 2006...................................   1,955,170,000
House allowance.........................................   1,955,170,000
Committee recommendation................................   2,002,622,000

    The Committee recommendation includes $2,002,622,000 for 
the National Institute of General Medical Sciences [NIGMS]. The 
fiscal year 2004 appropriation was $1,955,170,000 and the 
administration's request is $1,944,067,000. 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 Research.--The Committee notes the lack of 
a positive response to Congressional requests that the NIH 
establish a basic behavioral research and training program 
within the National Institute of General Medical Sciences as 
authorized within the statutory language establishing the 
Institute. The Committee notes that this recommendation was 
also made to the Director of NIH by a special task force 
created by the NIH to review this matter. The Committee 
believes that this research will support important advances in 
understanding the wide range of fundamental behavioral topics 
relevant to a variety of diseases and health conditions. The 
Committee strongly urges the NIGMS to consider establishing a 
basic behavioral research and training program as part of its 
portfolio, especially in the areas of learning, memory, and 
cognition; behavioral neuroscience; behavioral genetics; the 
biological basis of behavior; behavior change; stress; 
psychophysiology; social psychology; methodology and 
evaluation; and experimental psychology.
    Basic Research on Pre-disease Pathways.--The Committee is 
pleased that NIGMS, NIMH, NCI and OBSSR are collaborating to 
identify scientific opportunities and areas of basic behavioral 
research that should be supported by NIH. The Committee 
requests a report of the recommendations from the working group 
and the NIGMS's plan for implementation of the recommendations 
by May 1, 2006.
    Basic Behavioral Research in Roadmap.--The Committee 
requests that NIGMS study the feasibility of developing one or 
more funding initiatives specific to basic behavioral and 
social sciences research, which is significantly 
underrepresented in the New Pathways to Discovery segment.
    Minorities in Research.--The Committee commends NIGMS and 
its Division of Minority Opportunities in Research for their 
success in increasing the number and capabilities of ethnic 
minority students in the educational pipeline for biomedical 
research careers in psychology and other biomedical sciences 
and for mentoring them as they make the transition to graduate 
school. The Committee notes the role of behavior in racial and 
ethnic health disparities and that six of the ten leading 
causes of death are behaviorally based. The biomedical field 
involves a wide range of psychological research that addresses 
critical health and behavior concerns, such as HIV/AIDS, 
stress, cardiovascular disease, diabetes, cancer, substance 
abuse, and mental disorders, which have disproportionately 
negative effects on the health and lifespan of ethnic 
minorities.
    Training Programs.--The Committee continues to be pleased 
with the quality of NIGMS's training programs, particularly 
those that have a special focus on increasing the number of 
minority scientists such as the Minority Access to Research 
Careers [MARC] and Minority Biomedical Research Support [MBRS] 
programs. The Committee encourages NIGMS to continue to support 
these important initiatives, and is particularly pleased that 
NIGMS has supported biomedical career opportunity programs for 
high school and undergraduate college students in conjunction 
with historically black health professions schools. The 
Committee urges continued, long-term support of this program.

        NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT

Appropriations, 2005....................................  $1,270,321,000
Budget estimate, 2006...................................   1,277,544,000
House allowance.........................................   1,277,544,000
Committee recommendation................................   1,310,989,000

    The Committee recommends an appropriation of $1,310,989,000 
for the National Institute of Child Health and Human 
Development [NICHD]. The fiscal year 2005 appropriation was 
$1,270,321,000 and the administration's request is 
$1,277,544,000. 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.
    Autism.--The Committee is aware of the important research 
into the genetic basis of autism spectrum disorders and of its 
support for the Baby SIBS study on the incidence of autism 
among children in the same families. Accordingly, the Committee 
encourages the Institute to expand its support and funding for 
the Baby SIBS study, and encourages the Institute to expand its 
work with and support for similar public-private partnerships.
    Behavioral Science.--The Committee emphasizes its strong 
support for the broad portfolio of behavioral research at NICHD 
and supports its 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 the institute to maintain 
its support for research and training in behavioral science as 
it engages in its priority setting process.
    Childhood Diseases on the Growing Skeleton.--NICHD is urged 
to support studies investigating the effects of 
pharmaceuticals, lifestyle, and chronic childhood diseases on 
the growing skeleton and fracture risk and bone-formation 
interventions for children. The Institute is encouraged to 
expand the Osteogenesis Imperfecta Clinic and osteogenesis 
imperfecta research, especially in genetic therapies, animal 
models, drug treatment and rehabilitation. To the extent 
feasible, NICHD is encouraged to work with NIAMS to study the 
rare disorders osteopetrosis and juvenile Paget's disease.
    Childhood Obesity.--The Committee continues to be concerned 
about rising rates of childhood obesity and would like to see 
additional clinical trials that focus on the effectiveness of 
behavioral interventions. The Committee recognizes the critical 
importance of prevention efforts in this area and supports 
continued initiatives to promote healthy behaviors in children 
and adolescents, and research to prevent health risk behaviors 
that contribute to this growing public health challenge.
    Demographic Research.--The Committee commends NICHD for its 
strong support of demographic research. Given the tremendous 
changes occurring in the U.S. population, demographic research 
is necessary to analyze trends and determine consequences for 
the health and well-being of our Nation. The Committee strongly 
encourages the Institute to assure adequate support for 
demographic training and for critical databases such as 
National Longitudinal Study of Adolescent Health and Fragile 
Families. NICHD-supported studies like these yield objective 
information about population trends and provide unbiased, 
accurate data to inform policy, programs, and practices to 
improve the health and productivity of the American people.
    Down Syndrome.--The Committee commends NICHD for increasing 
support for production of an experimental mouse model for Down 
Syndrome, the Ts65Dn mouse which allowed for the first time a 
pre-clinical model to test possible drugs or other treatments. 
The Committee encourages the NICHD to partner with NINDS and 
other agencies to define additional mouse models needed to link 
important structural and functional abnormalities that underlie 
cognitive difficulties to the actions of specific genes and 
gene pathways. The Committee also encourages NICHD to work with 
the Office of Director to develop a strategic plan for Down 
Syndrome research and to coordinate its research with NICHD, 
NIA, NIMH and other institutes. The Committee further 
encourages the Institute to ursue clinicl trials for Down 
Syndrome.
    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 supports continued implementation of the 
Best Pharmaceuticals for Children Act of 2003, which supports 
the pediatric testing of off-patent drugs, as well as on-patent 
drugs not being studied through existing mechanisms. The 
Committee is pleased to note that in fiscal year 2004, six 
studies were initiated and five additional studies are planned 
for fiscal year 2005. The Committee notes that NICHD has made 
numerous outreach efforts to other Institutes and Federal 
agencies to further refine the priority listing process. The 
Committee requests that NIH provide an update during its annual 
appropriations testimony that shall include the role of other 
Federal agencies in implementing the Best Pharmaceuticals for 
Children Act of 2003; 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 form completed studies; 
the patent status of the drug studies; the number of drugs 
remaining on the priority list and a summary of NICHD's 
findings on the frequency of pediatric use for medications that 
many be considered for the priority list.
    Epilepsy.--Epilepsy often begins in childhood and can have 
potentially devastating effects when seizures are not 
controlled. This disease has a severe impact on cognition and, 
even in its mildest forms, lifelong effects on employment and 
other quality of life measures. Recurring seizures are also a 
heavy burden for children with autism, brain tumors, cerebral 
palsy, mental retardation, tuberous sclerosis and a variety of 
genetic syndromes. The Committee urges the Institute to make 
research in epilepsy a priority, with particular emphasis on 
developmental effects, and to coordinate research efforts with 
the NINDS.
    Family Formation.--Families constitute the key environment 
for children's development, and parents are crucial to 
children's health and academic outcomes. The Committee 
encourages research on effective ways to promote and sustain 
healthy family formations, particularly for low-income families 
and families of color. Additional research is encouraged on the 
immediate and long-term impact of chronic and acute exposures 
to violence on child health and development. The institute is 
encouraged to include research related to family, community and 
cultural factors that serve as risk or protective factors and 
promote resilience from exposure to violence in the home, 
communities, and schools.
    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, and urges the NICHD to increase the 
funding for existing centers of excellence by the end of fiscal 
year 2006, 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, such as autism research.
    Genomics and Proteomics Research.--The Committee is pleased 
that NICHD has launched a major new initiative to address the 
public health problem of premature birth, which affects one in 
eight babies born in this country and is the leading cause of 
newborn death. NICHD is encouraged to move forward with this 
initiative, which focuses on genomic and proteomics, in an 
effort to accelerate knowledge in the mechanisms responsible 
for premature birth. The Committee intends to closely monitor 
this effort because it assigns a high priority to promoting the 
birth of healthy infants.
    Human Infertility.--The Committee understands that the 
NICHD is planning to merge its National Cooperative Program for 
Infertility Research with its Specialized Cooperative Centers 
Program in Reproduction Research to form the Specialized 
Cooperative Centers Program in Reproduction and Infertility 
Research. The Committee understands that the merger of these 
center programs will allow a greater focus on human infertility 
research by permitting more efficient translation of knowledge 
from non-human animal models to humans. This will ensure the 
rapid development of novel approaches for the diagnosis, 
treatment and amelioration of such reproductive diseases and 
disorders as polycystic ovarian syndrome, endometriosis, 
hypogonadotropic hypogoandism and idiopathic male infertility.
    Infertility and Contraceptive Research.--The Committee 
notes that infertility is a disease which affects over 6 
million people in the United States and is concerned that the 
number appears to be growing as age, lifestyle, and 
environmental factors increasingly impact reproductive health 
outcomes. The Committee urges that additional research be 
undertaken to improve reproductive health intervention 
outcomes, as this research will not only increase the efficacy 
and effectiveness of reproductive health interventions but will 
significantly lower costs by reducing the number of 
interventions necessary to achieve a successful outcome.
    Learning Disabilities.--The Committee is pleased that NICHD 
continues to place a high priority on learning disabilities 
research. The efforts to address the special needs of children 
affected by a learning disability and improve literacy are 
showing promising results. The Committee encourages NICHD to 
continue to focus on reading disability and mathematics 
development research. Additionally, the Committee urges NICHD 
to lead a cooperative effort to collaborate on research efforts 
with other Institutes working on related activities. The 
Committee encourages cooperation in areas where work can be 
shared across Institutes on behalf of individuals with learning 
disabilities.
    Learning and School Readiness.--The Committee continues to 
support NICHD's commitment to research in reading, learning 
disabilities and math and science cognition. The Committee is 
encouraged that NICHD has made progress on developing 
comprehensive, culturally neutral and developmentally 
appropriate assessments and instruments to measure cognitive, 
social and emotional skills for pre-school aged children that 
are necessary for school readiness.
    Maternal-Fetal Medicine Units Network.--The Committee 
recognizes the efforts of NICHD, through its Maternal Fetal 
Medicine Units Network [MFMU], to achieve a greater 
understanding and pursue development of effective treatments 
for the prevention of pre-term births, low birth weight 
infants, and medical complications during pregnancy such as 
pregnancy-related hypertension and diabetes. The Committee is 
pleased to learn that the NICHD is proceeding with a competing 
renewal of the MFMU's in 2006 and encourages a sustained 
research investment in this program to facilitate resolution of 
these problems and promote the birth of healthy infants.
    National Children's Study.--The Committee is pleased with 
NICHD efforts to launch the National Children's Study, which 
would be the largest study of children ever undertaken in the 
United States and is intended to follow 100,000 children to age 
21, examining the impacts and influences of many environmental 
and genetic factors on children's health and development. The 
Committee urges that the National Children's Study include an 
adequate sample of children to enable examination of the health 
and development outcomes of children conceived with the 
assistance of reproductive health technologies.
    The Committee further 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 by no later than 2007.
    National Cooperative Program for Infertility Research.--The 
Committee understands that the NICHD is planning to merge its 
National Cooperative Program for Infertility Research with its 
Specialized Cooperative Centers Program in Reproduction 
Research to form the Specialized Cooperative Centers Program in 
Reproduction and Infertility Research. The Committee 
understands that this merger will allow a greater focus on 
human infertility research and a more efficient translation of 
knowledge from non-human animal models to humans to ensure 
rapid development of novel approaches for the diagnosis, 
treatment and amelioration of such reproductive diseases and 
disorders as polycystic ovarian syndrome, endometriosis, 
hypogonadotropic, hypogoandism, and idiopathic male 
infertility. The Committee looks forward to hearing more about 
the progress towards this merger.
    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 the past few years in the 
successful treatment and curing of learning disabilities in 
pre-clinical NF animal models. Therefore the Committee 
encourages NICHD to issue RFAs for NF research and aggressively 
pursue and expand funding of clinical trials for NF patients in 
the area of learning disabilities. The Committee is mindful 
that finding a treatment and cure for learning disabilities 
will not only benefit children, but also reduce costs of 
special education.
    Pediatric Kidney Disease.--The National Children's Study 
provides a unique opportunity to identify pre- and post-natal 
exposures that increase the risk of kidney disease, 
hypertension, and the progression of chronic kidney disease 
from birth to early adulthood. The Committee urges NICHD to 
support research toward understanding the physiologic 
mechanisms responsible for these risks to further prevent the 
development of kidney diseases and the antecedents of 
cardiovascular disease.
    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.
    Preterm Birth.--Last year, the National Center for Health 
Statistics reported the first increase in the U.S. infant 
mortality rate since 1958; 61 percent of this increase is 
attributed to an increase in the birth of premature and low 
birth weight babies. An analysis of Agency for Healthcare 
Research and Quality data conducted by the March of Dimes 
Perinatal Data Center estimated that the total national 
hospital bill for premature babies was $15,500,000,000 in 2002. 
The financial burden of prematurity is expected to continue to 
worsen until prevention of preterm births is better understood 
and clinical interventions are developed. The Committee is 
pleased that NICHD is one of the sponsors of an Institute of 
Medicine study now underway to define and address the health-
related and economic consequences of premature birth.
    Primary Immunodeficiency Diseases.--The Committee continues 
to be impressed with the dedication of financial and personnel 
resources by NICHD to the physician education and public 
awareness program conducted by the Jeffrey Modell Foundation to 
reach earliest diagnosis of this class of about 140 diseases. 
With regard to research on PI, the Committee is strongly 
encouraged by the Institute's commitment to develop newborn 
screening procedures for PI, particularly X-linked SCID, 
utilizing microarray technologies. The Committee believes that 
NICHD should move ahead aggressively with this initiative, in 
partnership with the Foundation and private industry.
    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 
of the NICHD, with the NIH Roadmap initiative and its specific 
emphasis on cross-institute research integration. The Committee 
is concerned that, to date, the NICHD has not made any progress 
toward working collaboratively with NINDS to support and expand 
the SMA Project. The Committee strongly urges NICHD to do so 
expeditiously and to report back to the Committee no later than 
May 1, 2006.
    Vulvodynia.--The Committee commends NICHD for its 
commitment to chronic pain conditions including vulvodynia. 
This condition has profound impacts on the health and quality 
of life for millions of women. As a result of efforts funded by 
NICHD, the number of high-quality researchers interested in 
research on vulvodynia has increased. NICHD is strongly 
encouraged to reissue its request for applications in this area 
and to fund high-quality applications, with a particular 
emphasis on etiology and multi-center therapeutic trials.

                         NATIONAL EYE INSTITUTE

Appropriations, 2005....................................    $669,070,000
Budget estimate, 2006...................................     673,491,000
House allowance.........................................     673,491,000
Committee recommendation................................     693,559,000

    The Committee recommends an appropriation of $693,559,000 
for the National Eye Institute [NEI]. The budget request was 
$673,491,000and the fiscal year 2005 appropriation was 
$$669,070,000. 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.
    Basic Behavioral and Social Sciences Research.--Committee 
encourages NEI to participate in trans-institute initiatives 
organized by OBSSR or another institute to strengthen basic 
behavioral research and enhance opportunities for behavioral 
science research training.
    Ocular Albinism.--The Committee recognizes recent advances 
in the treatment of ocular albinism by using gene therapy. The 
Committee encourages the National Eye Institute to favorably 
consider research grant proposals that seek to expand upon 
these important findings.

          NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES

Appropriations, 2005....................................    $644,505,000
Budget estimate, 2006...................................     647,608,000
House allowance.........................................     647,608,000
Committee recommendation................................     667,372,000

    The Committee recommends an appropriation of $667,372,000 
for the National Institute of Environmental Health Sciences 
[NIEHS]. The budget request was $647,608,000 and the fiscal 
year 2005 appropriation was $644,505,000. 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.
    Asthma.--Given the link between environmental factors and 
the onset of asthma, COPD, and pulmonary fibrosis, the 
Committee encourages NIEHS to further develop research 
initiatives, such as a large multi-center, long-term 
longitudinal, and maternal/birth cohort to understand the 
environmental and genetic risk factors for predisposing some 
individuals to and in controlling the severity of these lung 
diseases.
    Basic Behavioral and Social Sciences Research.--The 
Committee encourages NIEHS to participate in trans-institute 
initiatives organized by OBSSR or another institute to 
strengthen basic behavioral or social science research, and to 
enhance opportunities for behavioral and social science 
research training.
    Breast Cancer.--The Committee believes that it is essential 
to support research on environmental factors that may be 
related to the etiology of breast cancer. The Committee 
recognizes the important first step the Institute has taken 
with its recently awarded grants to four research centers to 
begin to study the prenatal-to-adult environmental exposures 
that may predispose a woman to breast cancer. However, the 
recent awards are only a small down payment in terms of 
dollars, process, and focus on the comprehensive and 
collaborative research that is needed. The need for more 
funding and a comprehensive research strategy, as outlined by 
the Breast Cancer and Environmental Research Act, is clear. The 
Committee understands that the Institute will establish an 
advisory board to make recommendations to the Director with 
regard to the development of the research centers. The 
Committee is pleased that the board will include 
representatives from the breast cancer community who have had 
the disease. The Committee asks that the director provide an 
update in the fiscal year 2007 appropriations justification on 
the progress of the centers.
    Built Environment.--The Committee is pleased with the 
research that NIEHS is supporting on environmental factors, 
including built environment, and their relationship to the 
rising prevalence of obesity among youth and adults. The 
Committee urges NIEHS to continue work in this area, including 
transportation choices and their impact on public health 
outcomes.
    Environmental Health and Nursing.--The Committee is pleased 
with the coordination efforts of the NIEHS, NINR, CDC, HRSA and 
EPA to address the recommendations outlined in the 2002 
Roundtable Report and the IOM Report, ``Nursing, Health and 
Environment.'' The Committee encourages the establishment of a 
nursing research fellowship in environmental health issues.
    Interagency Coordinating Committee for the Validation of 
Alternative Methods [ICCVAM].--In order for the Interagency 
Coordinating Committee for the Validation of Alternative 
Methods [ICCVAM] to carry out its responsibilities under the 
ICCVAM Authorization Act of 2000, the Committee encourages the 
NIEHS to strengthen the resources for the National Toxicology 
Program's Interagency Center for the Evaluation of Alternative 
Toxicological Methods [NICEATM] for ICCVAM for methods 
validation reviews in fiscal year 2006. The Committee is 
encouraged by the National Toxicology Program's [NTP] Road Map 
and Vision for NTP's toxicology program in the 21st century and 
encourages NIEHS to move rapidly to implement the programs, 
especially those directly aimed at strengthening the scientific 
basis for many alternative methods (such as Quantitative 
Structure-Activity Relationships), mechanistic screens, high 
throughput assays, and toxicogenomics.
    Parkinson's Disease.--The Committee encourages NIEHS to 
continue funding research into environmental influences of 
Parkinson's disease. The causes of Parkinson's and other 
neurodegenerative disorders are increasingly shown to be a 
result of the inter-relation of environment and genes. Possible 
environmental triggers of Parkinson's are pesticides and/or 
heavy metals. If these environmental toxins can be identified 
and the mechanisms elucidated, appropriate prevention or 
treatment may prevent many cases of Parkinson's, especially 
concerning increasingly younger persons at risk.
    Pacific Center for Environmental Health.--The Committee 
commends the NIEHS for its prompt attention to the concerns of 
the citizens of Hawaii related to volcanic emissions, food and 
waterborne illnesses, fish contamination by pesticides and 
heavy metals, and pesticide residue in food and water. The 
Committee urges NIEHS to pursue an Environmental Health 
Sciences Center in Hawaii to research and address these 
environmental concerns and to seek workable solutions to 
improve the health of Pacific Islanders.
    Perchlorate.--The Committee encourages the Institute to 
support clinical, mechanistic, and epidemiological studies that 
focus on establishing a better understanding of the long-term 
health effects of perchlorate exposure on humans and 
determining with greater certainty what perchlorate exposures 
are safe for the most vulnerable populations. The Committee 
encourages the NIEHS to give priority in the following areas: 
(1) clinical studies on humans or primates designed to provide 
information on the effects of long-term exposures to low doses 
of perchlorate; (2) the design and implementation of innovative 
epidemiological studies that assess the possible health effects 
of perchlorate exposure on the most vulnerable populations, 
including pregnant women and their fetuses and newborns, and 
involve appropriate control populations; and/or (3) in vitro 
studies of the perchlorate influence on placental and breast 
iodide transport using human tissues and animals studies, and 
the effects of perchlorate on development independent of 
effects on iodide transport.
    Risk Sciences.--The Committee encourages NIEHS to establish 
a competitive, peer-reviewed extramural program to conduct 
research in risk sciences, including methodologies for 
assessment, management, analysis, and communication of risks 
from exposure to environmental chemicals.

                      NATIONAL INSTITUTE ON AGING

Appropriations, 2005....................................  $1,051,990,000
Budget estimate, 2006...................................   1,057,203,000
House allowance.........................................   1,057,203,000
Committee recommendation................................   1,090,600,000

    The Committee recommendation includes $1,090,600,000 for 
the National Institute on Aging [NIA]. The budget request was 
$1,057,203,000 and the fiscal year 2005 appropriation was 
$1,057,203,000. 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.
    Age-related Bone Health.--The Committee is aware that the 
costs of age-related bone loss top $17,000,000,000 annually. 
NIA is urged to address cell senescence and altered cell 
phenotype in age-related bone diseases; aging's impact on bone 
response to loading, bone matrix and quality, and bone marrow; 
and the role of exercise, new anabolics, and stem cells in 
elderly bone.
    Alzheimer's Disease.--The most common cause of dementia, 
Alzheimer's disease has become one of the most serious threats 
to the Nation's health and economic well-being. Today, an 
estimated 4.5 million Americans--1 in 10 persons over age 65 
and nearly half of those over 85--suffer from Alzheimer's 
disease. That toll will rise to 5.1 million by 2010 and 7.7 
million by 2030 unless scientists find ways to stop or slow the 
progression of the disease process. And unless answers are 
found soon, Alzheimer's disease will wreak havoc, not only on 
family budgets but public funds as well. Over the next decade, 
Medicare spending on beneficiaries with Alzheimer's will more 
than triple, to $189,000,000,000, while Medicaid spending over 
the same period will rise to $27,000,000,000. In light of these 
social and economic imperatives, the Committee was troubled to 
learn that NIA's investment in Alzheimer research actually 
declined in fiscal year 2004 from the previous year. Given the 
enormous human and financial toll this disease is exacting on 
society, the Committee strongly urges NIH to expand its 
investment in Alzheimer research toward an overall goal of 
$1,000,000,000. NIA should continue to assign the highest 
priority to this effort.
    Bone Marrow Failure Diseases.--Every year, between 20,000 
and 30,000 Americans are diagnosed with bone marrow failure 
diseases, which include aplastic anemia, myelodysplastic 
disorders [MDS], and paroxysmal nocturnal hemoglobinuria [PNH]. 
The highest incidence of these diseases occurs with people age 
60 or older, and the number of cases of these diseases will 
increase each year as the American population continues to age. 
The Committee urges NIA to collaborate with NHLBI and NCI on 
research aimed at gaining a better understanding of the causes 
of these diseases and effective treatments and cures.
    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, 
and on developing top-level experts in geriatrics.
    Demographic and Economic Research.--The Committee commends 
NIA for supporting the Centers on the Demography of Aging 
program and expanding its program to include four new centers 
in 2004 and for supporting the economic and demographic 
components of the Roybal Centers for Applied Gerontology 
program. The Committee encourages the Institute to sustain the 
economic viability of these centers programs in their quest to 
conduct essential economic and demographic population research 
as the United States and world age rapidly. The Committee 
encourages NIA to provide the scientific knowledge on 
population aging issues, especially by fully supporting the 
Health and Retirement Survey and National Long-Term Care 
Survey. Data from these surveys are particularly important for 
understanding the budgetary impact of population aging and for 
Congress as it deliberates potential changes to the Social 
Security, Medicare, and Medicaid programs.
    Down Syndrome.--The Committee commends NIA for its support 
of studies to examine the cellular, molecular and genetic bases 
for age-related neuropathological and cognitive abnormalities 
in people with Down syndrome. The Committee encourages NIA to 
further examine these abnormalities and to devise new methods 
for diagnosing and treating them. Given that all people with 
Down syndrome develop the neuropathological changes of 
Alzheimer's disease, and that many or most go on to suffer 
dementia, the NIA is encouraged to consider how studies of the 
Down syndrome population might enhance the ability to 
understand, diagnose and treat Alzheimer's disease. The 
Committee encourages NIA to coordinate its research with NICHD, 
NINDS, NIMH and other Institutes.
    Epilepsy.--As the population ages, the Committee is 
concerned about the rapidly growing incidence of epilepsy in 
senior citizens. Age-related epilepsy caused by stroke, 
cardiovascular disease, brain tumors and Alzheimer's disease 
severely impacts the well-being, independence and health care 
needs of these vulnerable patients. The Committee urges the 
Institute to make research in epilepsy a priority and to 
coordinate research efforts with the NINDS.
    Health of Older Workers.--The Committee acknowledges NIA's 
efforts to build a research agenda focused on maximizing older 
workers' safety, health, productivity and life satisfaction. 
NIA is encouraged to collaborate with other agencies, 
institutes and centers to further develop this research agenda. 
In particular, the Committee supports efforts to develop new 
surveys or piggyback on existing surveys as appropriate, to 
enhance the data available to NIA on aging workers, the designs 
and parameters of various jobs and related health information. 
Research should be conducted to assess the effectiveness, 
benefits, and costs of worksite health promotion programs and 
techniques tailored to older workers, and other workplace 
policies that may influence health and safety.
    Osteoporosis.--The Committee encourages studies on quality 
of life in patients with osteoporosis before and after 
treatment and strategies for optimizing treatment of frail 
nursing home patients at high risk for osteoporotic fracture. 
The Committee further urges NIA to expand research on the role 
of environmental and lifestyle factors associated with 
osteoporosis, Paget's disease, and osteogenesis imperfecta and 
to work in conjunction with NIAMS on models for Paget's 
disease.
    Parkinson's Disease.--The Committee commends the NIA on its 
collaboration with Parkinson's researchers at National 
Institute of Neurological Disorders and Stroke [NINDS] Udall 
Centers in helping to discover new Parkinson's susceptibility 
genes, including dardarin, the most recently discovered 
Parkinson's gene by a NIA scientist. This research will prove 
to be invaluable in the development of improved methods of 
diagnosis, as well as neuroprotective and neurorestorative 
treatment of Parkinson's disease. The Committee encourages 
continued collaborations including additional intramural 
activities between NINDS, NIMH, and NIA to enhance 
understanding of neurodegenerative diseases, particularly 
Parkinson's.
    Racial and Ethnic Health Disparities in Later Life.--The 
Committee commends NIA's systematic attempts to build a 
research agenda to help understand racial and ethnic health 
disparities in later life. NIA is encouraged to build on its 
behavioral genetics research program in order to assess genetic 
and environmental factors in racial and ethnic differences 
simultaneously, in studies that permit identification of main 
effects and of interactions.
    Social Psychology.--NIA is requested to study the 
feasibility of expanding its portfolio of basic research on 
social psychology, particularly basic research on stigma and 
race; well-being; and emotion, health and disease.
    Thrombosis.--The Committee is very pleased with the 
Institute's plans to further research on anemia and its impact 
on the elderly, and encourages NIA to continue its 
collaborative research efforts with other Institutes on the 
best strategies to diagnose and treat elderly patients with 
anemia. The Committee believes that NIA collaboration could 
also be helpful for another area of age-related hematology 
research, the study of venous and arterial thrombosis, blood 
clots that can lead to heart attacks, strokes, or respiratory 
dysfunction. In light of research findings that age is one of 
the most important risk factors for thrombosis, the Committee 
urges NIA and NHLBI to collaborate on a research agenda 
exploring the underlying causes of thrombosis and its impact on 
the elderly.

 NATIONAL INSTITUTE OF ARTHRITIS AND MUSCULOSKELETAL AND SKIN DISEASES

Appropriations, 2005....................................    $511,157,000
Budget estimate, 2006...................................     513,063,000
House allowance.........................................     513,063,000
Committee recommendation................................     525,758,000

    The Committee recommends an appropriation of $525,758,000 
for the National Institute of Arthritis and Musculoskeletal and 
Skin Diseases [NIAMS]. The budget requested $513,063,000 and 
the fiscal year 2005 appropriation was $511,157,000. 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.
    Bone Formation and Remodeling.--The Committee encourages 
NIAMS to increase support of research on models, methods and 
modalities to increase bone formation and alter bone 
remodeling, and address the impact of aging, genetics, obesity, 
inactivity and exercise on bone at molecular, cellular, and 
tissue levels. NIAMS should work with NICHD and NIDDK to expand 
research on the genetics and new treatments for the rare 
disorder osteopetrosis.
    Burden of Skin Diseases.--The Committee notes the release 
of the recent report, ``Burden of Skin Diseases'', which 
supports evidence gathered at the September 2002 workshop on 
the burden of skin diseases sponsored by NIAMS. Based on these 
findings, the Committee urges NIAMS to continue to expand the 
research portfolio on skin disease. The Committee also 
encourages that NIAMS consider potential partnerships with the 
skin disease research community to address the challenges 
outlined by the ``Burden of Skin Diseases'' findings.
    Duchenne Muscular Dystrophy.--The Committee continues to be 
concerned with the amount of time taken by NIAMS to complying 
with the MD Care Act. The Committee encourages the NIAMS to 
increase research for Duchenne Muscular Dystrophy. The 
Committee further requests that NIAMS coordinate with NINDS on 
timelines for translational research, a consensus conference 
and the strategic plan.
    Lupus.--The Committee recognizes lupus is a serious, 
complex, debilitating chronic autoimmune disease that can cause 
inflammation and tissue damage to virtually any organ system in 
the body and impacts between 1.5 and 2 million individuals. 
This autoimmune disorder affects the skin, bones, joints, 
connective tissue and vital organs. The Committee is 
disappointed with the pace of research regarding lupus and 
strongly urges the Director of the National Institute of 
Arthritis and Musculoskeletal and Skin Diseases to expand and 
intensify research and related activities with respect to 
lupus.
    Marfan Syndrome.--The Committee commends NIAMS and its 
collaborative efforts with other Institutes to provide vital 
research on Marfan syndrome, a life-threatening, progressive 
and degenerative genetic disorder that is characterized by 
aortic aneurysms, painful orthopedic issues, pulmonary issues 
and ocular manifestations. Years of basic research are ready to 
be translated into a clinical trial for a drug therapy that may 
potentially prevent and reverse many of the life-threatening 
aspects of this syndrome. In addition, it may help many of the 
disabling characteristics not only of Marfan syndrome but also 
of other connective tissue disorders. The Committee urges NIAMS 
to support this effort through all available mechanisms, as 
deemed appropriate.
    Mucopolysaccharidosis [MPS].--The Committee encourages the 
NIAMS to work collaboratively with NIDDK in an effort to 
achieve a greater understanding of the underlying 
pathophysiology of bone and joint lesions in MPS disorders, the 
gene mutations and substrates that are stored, and potential 
therapeutic approaches to treating these debilitating aspects 
of MPS and related disorders.
    Osteogenesis Imperfecta.--The Committee commends NIAMS for 
its support of the promising gene targeting stem cells research 
that represents a potential cure for osteogenesis imperfecta 
and encourages continued support of this research.
    Osteoporosis.--The Committee urges the study of genetics of 
osteoporosis, including studies to determine the causes of 
variation in peak bone mass and rates of bone loss and 
therapies to lower fracture risk in patients at high risk for 
osteoporotic fractures.
    Paget's Disease.--The Committee urges NIAMS to study the 
role of genes and the underlying abnormal functioning of cells 
involved in bone breakdown in Paget's disease patients. Further 
research is needed on the role the bone microenvironment plays 
in the development of Paget's disease and the molecular 
processes involved.
    Psoriasis.--Ten to 30 percent of psoriasis patients develop 
psoriatic arthritis, a painful and potentially destructive 
joint disease. The Committee urges NIAMS to support additional 
genetic research to identify the genes responsible for 
psoriasis susceptibility, basic research to understand the 
mechanism of disease and clinical research to identify new safe 
and effective therapies for these diseases.
    Scleroderma.--The Committee is encouraged by NIAMS's 
continued interest in scleroderma, a chronic and progressive 
disease that predominantly strikes women. Scleroderma is 
disfiguring and can be life-threatening, and effective 
treatments are lacking. The Committee encourages NIAMS to 
continue to collaborate with other Institutes, including NHLBI, 
NIAID, NIDDK, NIDCR, and through the NIH Autoimmune 
Coordinating Committee to generate additional research 
opportunities for scleroderma that may assist to identify 
genetic risk factors and the development of safe and effective 
treatments.
    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 is encouraged that NIAMS is participating in a Trans-
NIH Tuberous Sclerosis Coordinating Committee, and strongly 
encourages NIAMS to continue to assist the clinical research 
community in the development of standardized protocols for skin 
assessment and the development of pilot clinical trials.

    NATIONAL INSTITUTE ON DEAFNESS AND OTHER COMMUNICATION DISORDERS

Appropriations, 2005....................................    $394,259,000
Budget estimate, 2006...................................     397,432,000
House allowance.........................................     397,432,000
Committee recommendation................................     409,432,000

    The Committee recommends an appropriation of $409,432,000 
for the National Institute on Deafness and Other Communication 
Disorders [NIDCD]. The budget requested $397,432,000 and the 
fiscal year 2005 appropriation was $394,259,000. 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 sensorineural hearing loss, 
particularly changes in brain physiology from deafness during 
development. Understanding these mechanisms is essential to 
implementation of ameliorative strategies such as hearing aids 
and cochlear implants.
    Balance Disorders.--The Committee is aware that over 124 
million Americans have experienced dizziness or a balance 
problem, and the cost of medical care for patients with balance 
disorders exceeds $1,400,000,000 annually. Over 50 percent of 
elderly patients interviewed at home complain of balance 
disorders. Despite research into the organization and function 
of these balance receptors located in the inner ear, there is a 
need to study the genes expressed in these tissues in order to 
understand why receptors commonly fail or become dysfunctional. 
Gene discovery techniques including cDNA libraries and 
microarray expression profiling are likely to lead to new drugs 
to treat or prevent vestibular disorders and greater 
understanding of how these systems work. The Institute is urged 
to expand its support of research in this promising area.
    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.
    Early Detection and Intervention.--The Committee urges the 
NIDCD to continue to use its newsletter and website to promote 
awareness among parents and clinicians that early 
identification and treatment of hearing loss are essential for 
normal language acquisition. Therefore, the Committee 
encourages expanded research on the early detection, diagnosis 
and intervention of infants with deafness and other 
communication disorders, including progressive hearing 
impairment from cytomegalovirus exposure. 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 during the first few years of life. The Committee 
recommends that the NIDCD continue to support research to 
develop novel therapeutic preventative strategies to lessen 
dependence on antibiotic therapies.
    Environmentally-induced Hearing Loss.--The Committee 
continues to be concerned by the number of Americans who suffer 
from chemical and noise-induced hearing loss and strongly 
supports the expansion of NIDCD's Wise Ears! Campaign among 
school-age children. The Committee also supports expanded 
research on prosthetic and pharmacological therapies for 
hearing loss from noise stress and ototoxic drugs.
    Hearing Devices for Children.--Everything that is known 
about hearing aids and cochlear implants is based on adult 
needs. Hearing aids also need to be optimized for children's 
needs, because there are so many differences between adults and 
children. Therefore the Committee encourages the NIDCD to 
support a collaborative effort of researchers to participate in 
a multi-center, longitudinal research project to track auditory 
development and speech perception in hearing-impaired infants. 
Also, the Committee encourages NIDCD to explore the feasibility 
of electrical stimulation applied to the vestibular system 
(analogous to the cochlear implant) to treat balance disorders.
    Hereditary Hearing Loss.--The Committee applauds the 
remarkable progress towards understanding the molecular basis 
for hereditary hearing impairment and encourages the NIDCD to 
continue to support research to identify the structure, 
regulation and function of genes whose mutation results in 
human communication disorders, including deafness. The 
Committee continues to encourage efforts to screen for the 
single and multi-genetic bases of hearing loss through 
contemporary techniques, including diagnostic gene chips. The 
Committee encourages the development of animal models to better 
assess how gene mutations result in impaired central auditory 
function.
    Inner Ear Hair Cell Regeneration.--The Committee applauds 
past support of regenerative studies, such as those in guinea 
pigs, and urges the NIDCD to continue to give a high priority 
to new and important directions in restoring hair cells of the 
cochlea, such as gene therapy, adenovirus vectors and stem 
cells. The Committee also encourages the NIDCD to request more 
collaborative applications among scientists working on the 
isolation of stem cells in the brain and scientists working in 
the inner ear hair cell field.
    Language Acquisition.--The Committee encourages the NIDCD 
to explore the biological bases of infant speech perception and 
language acquisition. This should include studies on the impact 
of partial or profound hearing loss.
    Learning Disabilities.--The Committee is pleased that NIDCD 
continues to support research activities focused on speech 
processing and on the development of expressive and receptive 
language. The Committee encourages continued activity and looks 
forward to learning the results of this work as they hold 
significant promise for individuals with learning disabilities. 
The Committee encourages the Institute to continue to 
coordinate with other Institutes working on related activities.
    Neurofibromatosis.--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.
    Pharmaceutical Research.--Recognizing the promise of new 
technologies to deliver pharmaceutical agents to the inner ear, 
the Committee encourages the NIDCD to initiate molecular 
studies analyzing effectiveness of drugs, genes and gene 
products on cell death pathways and cascades, followed by 
trials to assess safety and benefits of pharmaceuticals to 
prevent and better treat sensorineural hearing loss from 
various causes.
    Presbycusis.--Presbycusis, the gradual loss of hearing from 
aging, is the most prevalent type of hearing loss and the third 
leading chronic disease (following hypertension and arthritis) 
in people over 65. It will become more common as the Nation's 
population grows older. To improve the quality life of millions 
of senior citizens, the Committee encourages research into 
declining stria vascularis metabolism, an important factor, as 
well as continuing studies on the central mechanisms of 
presbycusis.
    Tinnitus.--Recognizing that tinnitus compromises the lives 
of tens of millions of Americans, the Committee encourages the 
NIDCD to expand its research into causal mechanisms underlying 
peripheral and central tinnitus and continue exploring 
potential treatments for this affliction.
    Translational Research.--The Committee encourages the NIDCD 
to establish a Translational Research Branch to support 
research activities aimed at accelerating the translations of 
new findings in the molecular and basic sciences into new 
interventions and technologies clinicians can use to treat 
individuals with communication disorders.

                 NATIONAL INSTITUTE OF NURSING RESEARCH

Appropriations, 2005....................................    $138,072,000
Budget estimate, 2006...................................     138,729,000
House allowance.........................................     138,729,000
Committee recommendation................................     142,549,000

    The Committee recommends an appropriation of $142,549,000 
for the National Institute of Nursing Research [NINR]. The 
budget request was $138,729,000 and the fiscal year 2005 
appropriation was $138,072,000. 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.
    Nurse-managed Health Centers.--The Committee urges the NINR 
to increase funding for research and demonstrations projects 
involving nurse-managed health centers and advanced practice 
nurses.
    Nursing Shortage.--The nursing shortage has an adverse 
effect on the health care delivery system as well as the health 
of our Nation's citizens. A shortage of nurse faculty caused 
schools of nursing to turn away thousands of qualified students 
last year. NINR confronts this issue by directing 8 percent of 
its budget to research training to help develop the pool of 
nurse researchers who also become faculty. Training support for 
fast-track baccalaureate-to-doctoral program participants is 
one important initiative. The 17 recently-funded Nursing 
Partnership Centers to Reduce Health Disparities is another 
initiative that helps produce an adequate number of nurse 
researchers. The Committee encourages these ongoing efforts. 
The Committee also encourages NINR to fund research projects 
located in rural areas that serve minority nursing students 
through community colleges. Not only will these partnerships 
between research-intensive schools of nursing and minority 
serving schools of nursing train more minority nurses, but they 
also expand opportunities for health disparities research.

           NATIONAL INSTITUTE ON ALCOHOL ABUSE AND ALCOHOLISM

Appropriations, 2005....................................    $438,277,000
Budget estimate, 2006...................................     440,333,000
House allowance.........................................     440,333,000
Committee recommendation................................     452,271,000

    The Committee recommends an appropriation of $452,271,000 
for the National Institute on Alcohol Abuse and Alcoholism 
[NIAAA]. The budget request was $440,333,000 and the fiscal 
year 2005 appropriation was $438,277,000. The comparable 
amounts for the budget estimate include funds to be transferred 
from the Office of AIDS Research.
    Mission.--The NIAAA conducts biomedical and behavioral 
research for improving prevention and treatment and reducing or 
eliminating the associated health, economic, and social 
consequences of alcohol abuse and alcoholism. NIAAA provides 
leadership in the country's effort to combat these problems by 
developing new knowledge that will decrease the incidence and 
prevalence of alcohol abuse and alcoholism and associated 
morbidity and mortality. NIAAA addresses these questions 
through an integrated program of biomedical, behavioral, and 
epidemiologic research on alcoholism, alcohol abuse, and 
related problems. This broad-based program includes various 
areas of special emphasis such as medications development, 
fetal alcohol syndrome, genetics, neuroscience, and moderate 
drinking.
    Alaska Substance Abuse.--The Committee is aware of serious 
problems with alcohol and substance abuse, 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.
    Alcohol Abuse by College Students.--Colleges continue to 
struggle with the consequences of alcohol abuse by students. 
The Committee encourages NIAAA to continue its program of fast-
track approval for research grants to be carried out 
collaboratively by scientists and college administrators who 
express an urgent need for intervention. The Committee 
understands that NIAAA is updating the 2001 report of the NIAAA 
Task Force on College Drinking, to incorporate new findings. 
The Committee further encourages NIAAA to provide this update 
to college presidents and other relevant organizations.
    Alcohol Dependence as a Developmental Disorder.--
Epidemiology studies show that alcohol is the drug of choice 
for youth and that it is associated with a host of consequences 
in this age group, including death and increased risk of harm 
and other negative outcomes. The Committee is aware of more 
recent data showing that 18- to 24-year-olds have the highest 
prevalence of alcohol dependence of any age group. These and 
other data make it clear to the Committee that alcohol has 
become entrenched in the developmental processes of 
adolescence, and that the developmental changes of adolescence 
appear to make this age group particularly vulnerable to 
alcohol's effects. The Committee urges NIAAA to continue its 
youth initiative, to work toward understanding how to extricate 
alcohol from adolescent development and how to change 
adolescents' behaviors toward alcohol. The Committee recognizes 
the importance of including scientists from several 
disciplines, from behavior to genetics, to reflect the many 
factors that contribute to underage drinking, and encourages 
NIAAA to continue guiding the research through its team 
approach.
    Alcohol, Obesity, and Liver Disease.--The relationship 
among the use of alcohol, the occurrence of obesity, and the 
presence of liver disease has become increasingly worrisome for 
clinicians. While alcohol's negative impact on weight and liver 
wellness is long established, the current epidemic of obesity 
and its consequent increase in liver disease creates a new 
focus for research. The Committee urges NIAAA to bring greater 
attention and resources to this relationship with special 
emphasis on the differentiation of impact of alcohol 
consumption on the liver for specific populations, such as 
women, minorities, the elderly, and others.
    Brain Development.--The Committee is aware of recent 
evidence that the human brain continues to develop for a longer 
period than previously thought, and that NIAAA has found 
physical differences in how adult brains and adolescent brains 
respond to certain stimuli. Biochemical and physiological 
events in the brain translate into behaviors. NIAAA is urged to 
continue research that will reveal biological links between 
adolescent brain changes, alcohol-related behaviors, and 
capacity for alcohol, and research that will reveal alcohol's 
short- and long-term impact on developmental changes in the 
adolescent brain.
    Underage Drinking.--The Committee recognizes that alcohol 
consumption represents one of the most important public health 
problems among youth today and commends the NIAAA on its 
efforts to collect data on the influence of environment and 
genetics on adolescent drinking behaviors.
    Treatments for Alcohol-use Disorders.--The Committee is 
aware that 18 million American adults abuse or are dependent on 
alcohol. The Committee encourages NIAAA to conduct research 
that will advance behavioral and pharmaceutical treatments, 
alone and in combination, for these disorders. The Committee 
understands that NIAAA recently convened more than 40 experts 
to establish priorities for accelerating development of 
medications to treat alcohol-use disorders, and requests a copy 
of the report on the outcome of that meeting, when it is 
completed.

                    NATIONAL INSTITUTE ON DRUG ABUSE

Appropriations, 2005....................................  $1,006,419,000
Budget estimate, 2006...................................   1,010,130,000
House allowance.........................................   1,010,130,000
Committee recommendation................................   1,035,167,000

    The Committee recommends an appropriation of $1,035,167,000 
for the National Institute on Drug Abuse [NIDA]. The budget 
request was $1,010,130,000. The fiscal year 2005 appropriation 
was $1,006,419,000. 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 Brain Development.--The Committee notes 
neuroimaging research by NIDA and others showing that the human 
brain does not fully develop until about age 25. This adds to 
the rationale for referring to addiction as a ``developmental 
disease.'' The Committee encourages NIDA to continue its 
emphasis on adolescent brain development to better understand 
how developmental processes and outcomes are affected by drug 
exposure, the environment and genetics.
    Clinical Trials Network.--The Committee is pleased with the 
success and progress of NIDA's National Drug Abuse Treatment 
Clinical Trials Network [CTN]. The CTN provides an 
infrastructure to test the effectiveness of new and improved 
interventions in real-life community settings with diverse 
populations, enabling an expansion of treatment options for 
providers and patients. The Committee suggests NIDA develop 
ways to use the CTN as a vehicle to address emerging public 
health needs.
    Collaboration with Single State Authorities [SSAs].--The 
Committee commends NIDA for its outreach and work with SAMHSA's 
Center for Substance Abuse Treatment [CSAT] and State substance 
abuse directors, also known as Single State Authorities [SSAs], 
to reduce the current 15- to 20-year lag between the discovery 
of an effective treatment intervention and its availability at 
the community level. In particular, the Committee applauds NIDA 
for working with SAMHSA on a recent RFA designed to strengthen 
State Substance Abuse agencies' capacity to support and engage 
in research that will foster statewide adoption of meritorious 
science-based policies and practices. The Committee also 
encourages NIDA to continue collaborative work with SSAs, 
including its ``blending activities,'' to ensure that research 
findings are relevant and adaptable by State substance abuse 
systems.
    Co-occurring Disorders.--The Committee recognizes that 
addiction is a disorder that can affect the course of other 
diseases, including HIV/AIDS, mental illness, trauma, cancer, 
cardiovascular disease and even obesity. To adequately address 
co-occurring health problems, the Committee encourages the 
Institute to work with other agencies to stimulate new research 
to develop effective strategies and to ensure the timely 
adoption and implementation of evidence-based practices for the 
prevention and treatment of co-occurring disorders.
    Drug Abuse and HIV/AIDS.--The Committee understands that 
one of the most significant causes of HIV virus acquisition and 
transmission is drug taking practices and related risk factors 
in different populations. Drug abuse prevention and treatment 
interventions have been shown to be effective in reducing HIV 
risk. Therefore, the Committee urges NIDA to continue 
supporting research that focuses on developing and testing 
drug-abuse related interventions designed to reduce the spread 
of HIV/AIDS.
    Drug-Induced Liver Injury.--The Committee notes that the 
mechanisms and causes of Drug-Induced Liver Injury [DILI] 
related to over-the-counter and prescription medications is not 
well understood and therefore merits further research. The 
Committee is aware that NIDDK currently funds 5 centers in the 
Drug-Induced Liver Injury Network [DILIN] and encourages 
increased support for the DILIN to help identify the underlying 
mechanisms and patterns in DILI to better obtain data and find 
patterns in DILI. The Committee also encourages NIDA to work 
collaboratively with NIDDK, FDA, industry, and the liver 
research community to address these priorities.
    Drug Treatment in Criminal Justice Settings.--The Committee 
is very concerned about the well-known connections between drug 
use and crime. Research continues to demonstrate that providing 
treatment to individuals involved in the criminal justice 
system decreases future drug use and criminal behavior, while 
improving social functioning. The Committee strongly supports 
NIDA's efforts in this area, particularly the Criminal Justice 
Drug Abuse Treatment Studies.
    Emerging Drug Problems.--The Committee recognizes that drug 
use patterns are constantly changing and is pleased with NIDA's 
efforts to monitor drug use trends and to rapidly inform the 
public of emerging drug problems. The Committee encourages NIDA 
to continue supporting research that provides reliable data on 
emerging drug trends, particularly among youth and in major 
cities across the country.
    Genetics Addiction.--The Committee recognizes that not 
everyone who takes drugs becomes addicted. Research has shown 
that genetics plays a critical role in addiction, and that the 
interplay between genetics and environment is crucial. The 
Institute is urged to further investigate this phenomenon.
    Long-term Consequences of Marijuana Use.--The Committee is 
concerned with the continuing widespread use of marijuana. The 
Committee urges NIDA to continue support for efforts to assess 
the long-term consequences of marijuana use on cognitive 
abilities, achievement, and mental and physical health, as well 
as work with the private sector to develop medications focusing 
on marijuana 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.
    Primary Care Settings and Youth.--The Committee recognizes 
that primary care settings are potential key points of access 
to prevent and treat problem drug use among young people. The 
Committee encourages NIDA to support health services research 
on effective ways to educate primary care providers about drug 
abuse and develop brief behavioral interventions for preventing 
and treating drug use and related health problems; and develop 
methods to integrate drug abuse screening, assessment, 
prevention and treatment into primary health care settings.
    Reducing Health Disparities.--The Committee notes that the 
consequences of drug abuse disproportionately impact 
minorities, especially African American populations. The 
Committee is pleased to learn that NIDA formed a Subgroup of 
its Advisory Council to address this important topic. 
Researchers should be encouraged to conduct more studies in 
this population and to target their studies in geographic areas 
where HIV/AIDS is high and/or growing among African Americans, 
including in criminal justice settings.
    Reducing Inhalant Abuse.--The Committee understands and is 
alarmed that, for the second year in a row, NIDA's Monitoring 
the Future Survey has shown an increase in the use of inhalants 
by 8th graders. The Committee urges the Institute to continue 
its support of research on prevention and treatment of inhalant 
abuse, and to enhance public awareness on this issue.
    Reducing Methamphetamine Abuse.--The Committee is very 
concerned about the continued abuse of methamphetamine across 
the United States. The Committee urges NIDA to continue 
supporting research to address the medical consequences of 
methamphetamine abuse.
    Reducing Prescription Drug Abuse.--The Committee notes the 
recent increases in the numbers of people who use prescription 
drugs for non-medical purposes. Research targeting a reduction 
in prescription drug abuse, particularly among our Nation's 
youth, should continue to be a priority for NIDA.
    Translational Research.--The Committee commends NIDA for 
its broad and varied information dissemination programs. The 
Committee also understands that the Institute is focused on 
stimulating and supporting innovative research to determine the 
components necessary for adopting, adapting, delivering, and 
maintaining effective research-supported policies, programs, 
and practices. As evidence-based strategies are developed, the 
Committee urges NIDA to support research to determine how these 
practices can be best implemented at the community level.

                  NATIONAL INSTITUTE OF MENTAL HEALTH

Appropriations, 2005....................................  $1,411,933,000
Budget estimate, 2006...................................   1,417,692,000
House allowance.........................................   1,417,692,000
Committee recommendation................................   1,460,393,000

    The Committee recommends an appropriation of $1,460,393,000 
for the National Institute of Mental Health [NIMH]. The budget 
request was $1,417,692,000 and the fiscal year 2005 
appropriation was $1,411,933,000. The comparable amounts for 
the budget estimate include funds to be transferred from the 
Office of AIDS Research.
    Mission.--The National Institute of Mental Health [NIMH] 
supports research on mind, brain, and behavior with the aim of 
reducing the public health burden of mental and behavioral 
disorders. NIMH's ultimate goal is to generate research that 
will lead to the ability to effectively treat mental disorders 
so that individuals can truly recover from them, and, 
ultimately, achieve the ability to predict and prevent them 
from even occurring. A major goal for NIMH is to identify the 
biological basis of mental disorders to more precisely pinpoint 
targets for prevention and treatment. This means understanding 
the neural basis of the illness at all levels, from molecular 
to behavioral.
    Adolescent Depression and Suicide.--Major depressive 
disorder in adolescence--one of the major risk factors for 
suicide--has become increasingly common. Suicide now accounts 
for 13 percent of all adolescent deaths and ranks third as a 
cause of death among teenagers. The Committee notes that NIMH 
has conducted a major trial on adolescent depression which has 
yielded valuable knowledge about effective treatments for 
depression. The Committee strongly encourages NIMH to 
strengthen its investment in understanding the clinical 
epidemiology of suicidal behavior and thinking in children and 
adolescents; improving the criteria for identifying those at 
risk; and examining the outcomes of actions taken to assist 
those found to be at risk.
    Alzheimer's Disease.--Combining imaging with genetics, a 
team of NIMH-funded scientists recently identified a possible 
genetic marker for Alzheimer's disease, a variant of the gene 
that codes for APOE, a protein involved in metabolizing 
cholesterol. PET scans of normal individuals in their fifties 
and sixties who carry this variant showed decreased activity in 
regions of the brain known to be affected by Alzheimer's. PET 
scans of younger individuals who carry this variant found 
lowered metabolism in the same brain areas, suggesting that the 
process at work in Alzheimer's starts decades before memory 
deficits become apparent. The Committee strongly encourages 
NIMH to continue to advance understanding of Alzheimer's 
disease.
    Aging and Mental Health.--The Committee commends the NIMH 
for recently recognizing the need to place a higher priority on 
the mental health needs of older persons through the 2004 
recommendations promulgated by the NIMH Aging Research 
Workgroup and the restructuring of the Adult and Geriatric 
Treatment and Preventive Intervention Research Branch. However, 
the Committee believes it is critical that studies related to 
the elderly keep pace with the rapid growth of this cohort. The 
Committee encourages the NIMH to devote greater resources to 
research on adults over age 65 to reflect the growth in numbers 
of this population. Therefore, the Committee strongly 
encourages NIMH to significantly expand research in this area.
    The Committee is pleased with NIMH's continued emphasis on 
research involving mental disorders in the elderly population, 
especially since the causes of depression in the elderly and 
the factors affecting its course are not well understood. The 
Committee urges NIMH to continue its level of support in this 
area.
    Autism Research.--The Committee commends NIMH for its 
strong leadership of the Interagency Autism Coordinating 
Committee [IACC], and for the institute's continued emphasis on 
autism as an urgent public health problem. Autism continues to 
be a top priority for NIH. The Committee supports continued 
cross-Institute investments in several new centers and 
projects, which have produced recent findings indicating that 
the fundamental pathology may be ``miswiring'' in the brains of 
autistic children, with an excess of local circuits and a 
deficit of long-range circuits. NIMH research is helping to 
develop new tools for detecting autism early, before age 2. In 
a new study on infant siblings of children with autism, early 
findings indicate that siblings later diagnosed with autism 
show social deficits, visual attention impairments, and unusual 
temperament by 12 months of age. This work could greatly 
enhance efforts for early detection and treatment.
    Basic Behavioral Science.--The Committee encourages NIMH to 
continue its commitment to support basic behavioral research 
focused on fundamental psychological domains and factors that 
promote mental health or become disturbed in mental disorders. 
The Committee is concerned that the institute may be 
diminishing its support for some areas of relevant scientific 
inquiry and urges the institute to support a balanced program 
of grant funding and to maintain its support for research on 
the promotion of mental health and the study of psychological, 
social, and legal factors that influence behavior.
    Combat Veterans.--The Committee is concerned about the 
mental health effects of military service in Iraq and 
Afghanistan, particularly since so many of the combatants are 
members of the National Guard or Reserves who will have to 
assimilate quickly back into civilian life after service. The 
Committee urges NIMH to work closely with the Veterans 
Administration and with the Department of Defense in efforts to 
best address this looming problem.
    Demographics.--The Committee is aware that demographics 
will demand a greatly increased focus on mental disorders in 
older persons, and consequently the Committee continues to be 
concerned about funding for late-life mental health research at 
the National Institute of Mental Health [NIMH]. The Committee 
encourages NIMH to expand research in Adult and Geriatric 
Treatment and Preventive.
    Depression in the Workplace.--The Committee notes with 
interest that recent NIMH research has demonstrated the 
importance of recognizing depression in the workplace and the 
cost-effectiveness of treating those affected. Employees with 
depression--even compared to employees with rheumatoid 
arthritis, a chronic illness that can impair job performance--
were four to five times more likely to become unemployed, to 
have diminished productivity, and to exhibit increased 
absenteeism. However, appropriate treatment for depression 
resulted in positive changes in all three areas. The research 
found that offering appropriate, evidence-based depression 
treatment for employees is a cost-effective strategy for 
American businesses. Further information on cost effectiveness 
will become available at the completion of the ongoing NIMH-
funded study, ``Outreach and Treatment for Depression in the 
Labor Force,'' which is scheduled for completion in 2006.
    Disease Prevalence.--The Committee is aware that NIMH has 
supported a major study that will provide critical information 
concerning the prevalence of most mental disorders in this 
country, as well as about the availability of quality care. 
When the study is published, the Committee would like to have a 
briefing to summarize the results of that study for interested 
Members of Congress and staff.
    Down Syndrome.--The Committee encourages the NIMH to 
develop new strategies for cataloging, understanding, 
diagnosing and treating behavioral disorders that are common in 
people with Down syndrome. They include autism, pervasive 
developmental disorder, obsessive compulsive disorder, 
depression and psychosis. The Committee urges NIMH to 
coordinate its research on Down syndrome with NICHD, NINDS, NIA 
and other Institutes. The Committee encourages NIMH to continue 
their studies on imaging of the brains of persons with Down 
syndrome broadening their focus to include behavior and motor 
coordination.
    Epilepsy.--Recent evidence of connections between 
depression and epilepsy point to relationships between the two 
disorders that suggest potential common pathogenic mechanisms. 
Research could help improve care for both groups of patients. 
The Committee strongly urges the Institute to make research in 
epilepsy a priority and to coordinate research efforts with 
NINDS.
    Evidence-based Treatments for Recovery and Dissemination.--
The first of several large, NIMH-funded clinical studies 
testing various treatment options for those with serious mental 
illnesses was completed last summer: a 13-site trial aimed at 
defining the most effective and safe treatment for children and 
adolescents with major depressive disorder. There has been much 
debate about whether a class of antidepressant medications, 
selective serotonin re-uptake inhibitors [SSRIs] can actually 
increase suicidal thinking. Results of the trial revealed that 
a combination of fluoxetine (Prozac) and a type of 
psychotherapy called cognitive behavioral therapy [CBT] was the 
most effective treatment (71 percent responded). Suicidal 
thinking, which was present in 29 percent of the participants 
at the beginning of the study, improved significantly in all 
four treatment groups, with those receiving medication and 
therapy showing the greatest reduction in suicidal thinking. 
The effectiveness of these treatments over a 6-month period 
from treatment initiation will soon be known. It is critical 
for physicians and psychotherapists to closely monitor their 
young patients on antidepressant medications for signs of 
hurtful or suicidal behavior, particularly during the early 
phases of treatment.
    Fragile X.--Fragile X is the most common single-gene 
neuropsychiatric disease known. It causes cognitive impairment, 
mental disorders such as obsessive-compulsive disorder, and 
extreme anxiety. The Committee commends NIMH for spearheading 
three focused research meetings devoted to identifying critical 
research needs, in November 2001, January 2003, and 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. In addition, the Committee urges the 
NIMH to work with industry and academia to test available 
medications and bring new treatments to market.
    Frontier Mental Health Needs.--The Committee commends NIMH 
on its outreach efforts to determine the differences in mental 
health needs which may exist in remote frontier communities, 
including Alaska. The Committee encourages NIMH to expand its 
research efforts into these communities, which are often 
ignored in research projects, but which continue to suffer from 
high incidences of mental health problems including depression, 
suicide and co-occurring disorders with substance abuse.
    Health Disparities and Clinical Trials.--The Committee is 
aware of the work being done by NIMH and its National Advisory 
Mental Health Council [NAMHC] to address issues involving 
health disparities and inclusion of historically underserved 
minorities in clinical trials sponsored by the Institute. The 
Committee supports these efforts.
    Hepatitis.--The Committee urges the National Institute of 
Mental Health [NIMH] to conduct and/or facilitate research to 
explore the etiology and effective therapeutic management of 
neuropsychiatric symptoms and disorders associated with chronic 
hepatitis C and interferon-based antiviral treatment.
    Learning Disabilities.--The Committee commends NIMH for the 
work conducted to explore the neurological and behavioral 
aspects of learning disabilities. The Committee looks forward 
to learning the results of this work and encourages the 
Institute to continue to coordinate with other Institutes 
working on related activities.
    Morbidity and Mortality.--The burden of mental disorders is 
staggering, in terms of both morbidity and mortality. 
Researchers supported by NIMH have found that half of all 
lifetime cases of mental illness begin by age 14, and that 
despite effective treatments, there are long delays between the 
appearance of the first symptoms of illness and provision of 
even adequate treatment. Unlike most other disabling medical 
diseases, mental illness begins very early in life. Mental 
disorders, then, can very aptly be called the chronic diseases 
of the young. Young people with mental disorders suffer 
disability when they are in the prime of life, when they would 
normally be most productive. The NIMH study also found that 
mental disorders really are quite common--26 percent of the 
general population reported that they had symptoms sufficient 
for diagnosing a mental disorder during the past 12 months. 
Although some of these cases are mild ones that will resolve 
without formal interventions, many more will not. The Committee 
urges NIMH to continue its current efforts to focus on research 
that promises to yield effective results that can be translated 
to the benefit of patients, with the goal of finding new ways 
to intervene early in the development of disease--or even 
prevent its occurrence, and, when prevention is not possible, 
to achieve rational treatments that are tailored to be most 
effective to the individual patient.
    Parkinson's Disease.--The Committee encourages continued 
collaborations including additional intramural activities 
between NINDS, NIMH, and NIA to enhance understanding of 
neurodegenerative diseases, particularly Parkinson's.
    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 and other relationships that serve as protective 
factors.
    Psoriasis.--Psoriasis is associated with elevated rates of 
mental disability, depression and suicidal ideation. The 
Committee urges NIMH to conduct research into the mental health 
aspects of psoriasis, especially as it relates to quality of 
life and burden of the disease. Furthermore, a 2005 study of 44 
autoimmune diseases found that only psoriasis, when present in 
women around the time of pregnancy, was significantly 
associated with autism, doubling the risk of autism spectrum 
disorder in their children. The Committee urges NIMH to support 
further study of the link between psoriasis and autism.
    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.
    Suicide.--In addition to being disabling and chronic, 
mental disorders can be fatal. Depression is an important risk 
factor for suicide, the third leading cause of death among 
adolescents. The Committee notes that there are far more 
suicides each year in this country than there are homicides. 
The Committee supports NIMH efforts to enhance suicide 
awareness and prevention, and encourages the institute to 
continue its ongoing collaborative efforts with other 
institutes and with SAMHSA to address this painful topic.
    Translating Behavioral Research.--The Committee commends 
NIMH for undertaking a reorganization to promote the 
translation of basic behavioral science into treatments for 
those with mental disorders. The Committee 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 and develop preventive 
interventions. The Committee strongly supports additional 
clinical trials that examine the effectiveness of behavioral 
interventions in community-based settings. Behavioral 
interventions are especially needed for children and 
adolescents with mental disorders, including post-traumatic 
stress disorder, eating disorders, attention deficit-
hyperactivity disorder, and the most common forms of 
depression. Translational research in the behavioral and social 
sciences is especially needed 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.

                NATIONAL HUMAN GENOME RESEARCH INSTITUTE

Appropriations, 2005....................................    $488,608,000
Budget estimate, 2006...................................     490,959,000
House allowance.........................................     490,959,000
Committee recommendation................................     502,804,000

    The Committee recommendation includes $502,804,000 for the 
National Human Genome Research Institute [NHGRI]. The budget 
requested $490,959,000 and the fiscal year 2005 appropriation 
was $488,608,000. 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 Institute coordinates extramural and intramural 
research, as well as research training, in the areas of 
genomics and genetics. The Division of Extramural Research 
supports research on sequence and function of both human and 
non-human genomes, human genetic variation, technology 
development for genome research, database management and 
analysis, and research on the ethical, legal and social 
implications of human genome research. The Division of 
Intramural Research focuses on applying the tools and 
technologies of the successful Human Genome Project to 
understanding the genetic and environmental basis of disease, 
and developing DNA-based diagnostics and gene-based therapies.
    Basic Behavioral and Social Sciences Research.--The 
Committee encourages NHGRI to participate in trans-institute 
initiatives organized by OBSSR or another institute to 
strengthen basic behavioral research and enhance opportunities 
for behavioral science research training.
    Chromosome Abnormalities.--The Committee commends the NIH 
for its efforts over the past year to encourage new scientific 
work into molecular, genetic, clinical and therapeutic aspects 
of chromosome abnormalities. Because of the multisystemic 
consequences of a chromosome abnormality, multidisciplinary and 
multi-Institute support by NIH will be required in order to 
make progress that will be meaningful to those affected. The 
Committee continues to urge NIH to seek ways to expand and 
intensify such research, especially studies involving the 
syndromes of chromosome 18.
    Molecular Libraries.--The Committee commends NHGRI for 
leadership in the NIH Roadmap Initiative on molecular 
libraries. This includes the founding of the NIH Chemical 
Genomics center, which will provide public sector researchers 
with access to high-throughput screens for small organic 
molecules, enabling development of new tools for exploration of 
health and disease. The Committee recognizes that advances in 
the use of these molecular libraries will enhance NIH's global 
leadership in the future.
    Targeting Disease Prevention.--The Committee commends NHGRI 
for its leadership of the international haplotype mapping 
[HapMap] project. The HapMap will provide a powerful new public 
resource to gain a deeper understanding of human biology, and 
discover the genetic and environmental factors that contribute 
to disease, predict potential disease risk, optimize drug 
prescribing for individuals, and identify and validate critical 
new targets for therapeutic development. These new developments 
also suggest that a large-scale population-based cohort study 
in the United States could provide a critical path toward 
improved genome-based public health and the Committee urges 
NHGRI to explore the feasibility of commencing such a study.

      NATIONAL INSTITUTE OF BIOMEDICAL IMAGING AND BIOENGINEERING

Appropriations, 2005....................................    $298,209,000
Budget estimate, 2006...................................     299,808,000
House allowance.........................................     299,808,000
Committee recommendation................................     309,091,000

    The Committee recommends an appropriation of $309,091,000 
for the National Institute of Biomedical Imaging and 
Bioengineering [NIBIB]. The budget requested $299,808,000 and 
the fiscal year 2005 appropriation was $298,209,000. The 
comparable amounts for the budget estimate include funds to be 
transferred from the Office of AIDS Research.
    Mission.--The NIBIB improves health by promoting 
fundamental discoveries, design and development, and 
translation and assessment of technological capabilities in 
biomedical imaging and bioengineering, enabled by relevant 
areas of information science, physics, chemistry, mathematics, 
materials science, and computer sciences. The Institute plans, 
conducts, fosters, and supports an integrated and coordinated 
program of research and research training that can be applied 
to a broad spectrum of biological processes, disorders and 
diseases and across organ systems. The Institute coordinates 
with the biomedical imaging and bioengineering programs of 
other agencies and NIH Institutes to support imaging and 
engineering research with potential medical applications and 
facilitates the transfer of such technologies to medical 
applications.
    Professional Judgment Budget.--The Committee acknowledges 
receipt of the Five-Year Professional Judgment Budget for the 
National Institute of Biomedical Imaging and Bioengineering 
[NIBIB] requested in House Report 108-636. The Committee notes 
the Budget's central conclusion that biomedical imaging and 
bioengineering ``are dynamic and ripe with opportunities for 
major scientific advances'' that could be translated into 
dramatic improvements in health care. The Professional Judgment 
Budget recommends a measured, reasonable rate of growth for the 
NIBIB to achieve the goals of the important research areas 
enumerated in the report. The Committee commends the NIH and 
Department of Health and Human Services for this approach and 
believes that the projected rate of growth is necessary to 
enable the NIBIB to achieve the scientific advances that the 
Congress envisioned when it established the Institute.
    The Professional Judgment Budget recognizes the role of the 
NIBIB with respect to interdisciplinary research, the physical 
sciences, and technology development. The NIBIB has taken a 
leadership role in efforts to examine the scientific questions 
that can be addressed by collaboration between life and 
physical scientists, the barriers to such collaboration, and 
the steps that need to be taken to bridge these disciplines.
    The Committee is pleased with the role of the NIBIB has 
played and will continue to play in the development of 
biomedical technology related to the physical sciences.
    Imaging and Engineering Advances.--The Committee urges 
NIBIB to focus efforts on improving musculoskeletal disease 
detection, monitoring and treatment through focused imaging and 
engineering advances. The Institute also is encouraged to 
develop noninvasive techniques to measure bone quality and bone 
strength in humans.
    Liver Imaging Techniques.--Consistent with NIBIB's mission 
to improve all diagnostic imaging technologies, the Committee 
urges NIBIB to make liver imaging techniques a primary focus, 
speeding the development of new modalities that better capture 
the early stages of various liver diseases, including cancer, 
as well as offering the potential for combinations of diagnosis 
and treatment. This is also necessary to develop less invasive 
diagnostics for liver disease patients. The Committee urges 
NIBIB to participate actively in trans-NIH initiatives that 
address these priorities.
    The Committee is encouraged by the potential of image-
guided surgery to improve patient outcomes. The Committee 
supports the Institute's plans to hold a conference on image-
guided surgery and looks forward to learning about the results 
of this conference.
    PET and MicroPET Scans.--The Committee continues to 
encourage the Institute to devote significant resources to 
molecular imaging technologies such as positron emission 
tomography [PET] and microPET to take advantage of the 
capacities of molecular imaging to detect disease process at 
the molecular level and to monitor the effectiveness of 
targeted gene therapies now under development. The Committee 
also encourages the 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, 2005....................................  $1,115,090,000
Budget estimate, 2006...................................   1,100,203,000
House allowance.........................................   1,100,203,000
Committee recommendation................................   1,188,079,000

    The Committee recommends an appropriation of $1,188,079,000 
for the National Center for Research Resources [NCRR]. The 
budget request was $1,100,203,000 and the fiscal year 2005 
appropriation was $1,115,090,000. The comparable amounts for 
the budget estimate include funds to be transferred from the 
Office of AIDS Research.
    Mission.--The NCRR develops and supports critical research 
technologies and shared resources that underpin research to 
maintain and improve the health of our Nation. The NCRR 
programs develop a variety of research resources; provide 
biomaterial and resources for complex biotechnologies, clinical 
research, and specialized primate research; develop research 
capacity in minority institutions; and enhance the science 
education of pre-college students and the general public.
    Clinical Research Curriculum Award.--The Clinical Research 
Curriculum Awards or K30, has been extremely effective in 
training successful clinical investigators. Funded programs 
report that over 60 percent of their graduates are active 
researchers who have already secured funding for their 
research. The Committee supports the NIH decision to increase 
the size of these awards from $200,000 to $300,000 but is 
concerned that this was accomplished by reducing the number of 
funded institutions. The Committee would encourage increased 
support in order to expand rather than reduce the number of 
institutions receiving this important award.
    Clinical and Translational Science Awards [CTSA].--In 
September 2003, NIH launched the NIH Roadmap for Medical 
Research, a set of trans-NIH research initiatives designed to 
accelerate the pace of discovery and improve the translation of 
research findings into medical and health interventions for 
public benefit. A critical component of the Roadmap is the 
theme of re-engineering the clinical research enterprise. The 
Committee has encouraged the Director to utilize the NCRR-
funded General Clinical Research Centers as the foundation of 
NIH Roadmap activities related to clinical research. NIH is now 
poised to capitalize on the revolutionary discoveries emerging 
from basic science, and has developed an innovative proposal to 
address the current difficulty recruiting and retaining 
clinical researchers; the increasing regulatory burden; 
fragmented training programs; and limitations and barriers due 
to NIH funding mechanisms, review and programs structures. The 
Committee supports NIH's efforts to integrate NIH's General 
Clinical Research Centers [GCRCs] and other relevant clinical 
mechanisms into a new and more efficient single application 
that results in awards that combine clinical science support 
with clinical career development and training. This will 
transform clinical and translational sciences for the future. 
The Committee has a long-standing and abiding interest in the 
health of the clinical research system supported under this 
appropriation, and therefore requests that NIH submit a report 
by February 6, 2006. The report should describe NIH's new award 
for clinical and translational sciences, which NIH expects to 
fund in fiscal year 2006, describe the expected costs in fiscal 
year 2006 and fiscal year 2007, and indicate the specific 
components of the program and plans for transition from the 
current funding mechanisms to the new awards. The Committee 
expects that the new award will support the full spectrum of 
clinical research activities, from early translation between 
the laboratory and the patient to epidemiological studies and 
health services research. The report should describe how this 
will be accomplished. The Committee has included $327,000,000 
for clinical research supported by the GCRCs and the CTSAs 
combined. The Committee expects the total number of awards for 
this combined program to remain at 79 in fiscal year 2006.
    Clinical Trials Technology.--The Committee encourages NCRR 
to work with grantees in the Research Centers at Minority 
Institutions [RCMI] program and the General Clinical Research 
Centers [GCRC] program to upgrade their clinical trials data 
management capabilities.
    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, and those which have 
developed plans for enhancing their library facilities.
    Extramural Construction.--The Committee has included bill 
language identifying $30,000,000 for extramural biomedical 
facility renovation and construction. This amount is the same 
as the fiscal year 2005 appropriation. The fiscal year 2006 
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.
    General Clinical Research Centers.--The Committee is 
concerned about the growing gap between the GCRC budgets 
approved by the NCRR Advisory Council and the actual budgets 
awarded. The Committee requests a report comparing the Advisory 
Council-approved budgets and the actual funds awarded to each 
GCRC for fiscal years 2003, 2004, and 2005. The Committee 
requests this same information as soon as possible.
    IDeA Grants.--The Committee has provided $230,000,000 for 
the Institutional Development Award [IDeA] Program authorized 
by section 402(g) of the Public Health Service Act. The 
Committee recognizes the importance of the Centers of 
Biomedical Research Excellence and the IDeA Networks of 
Biomedical Research Excellence programs and expects funding to 
be maintained for both. The focus of IDeA should continue to be 
on improving the necessary infrastructure and strengthening the 
biomedical research capacity and capability of research 
institutions within the IDeA States.
    National Primate Research Centers.--The Committee values 
the critical role played by the eight National Primate Research 
Centers [NPRCs]. These Centers conduct specialized basic and 
applied biomedical research and offer essential and valuable 
services to other researchers. Primates are increasingly 
important to the Nation's public health priorities in areas 
such as biodefense, heart disease, cancer, diabetes, AIDS, 
kidney disease, Alzheimer's, Parkinson's and emerging 
infectious diseases. In fiscal year 2004, the Committee urged 
the NIH to fully commit to the NPRCs' Five Year Federal 
Advancement Initiative in order to address the upgrades and 
program expansions required to meet the demanding research 
needs of the Nation. Nevertheless, NIH has taken only 
incremental steps to increase the NPRCs' base grant funding. 
The Committee strongly urges the NIH to place a higher priority 
on funding these centers adequately.
    Research Centers at Minority Institutions.--The Committee 
continues to recognize the critical role played by minority 
institutions at both the graduate and undergraduate level in 
addressing the health research and training needs of minority 
populations. These programs help facilitate the preparation of 
a new generation of scientists at these institutions. The 
Research Centers in Minority Institutions [RCMI] Program 
continues to impact significantly on these problems. The 
Committee encourages NIH to strengthen participation from 
minority institutions and increase resources available in this 
area. The Committee also encourages NIH to work with minority 
institutions with a track record of producing minority scholars 
in science and technology.

       NATIONAL CENTER FOR COMPLEMENTARY AND ALTERNATIVE MEDICINE

Appropriations, 2005....................................    $122,105,000
Budget estimate, 2006...................................     122,692,000
House allowance.........................................     122,692,000
Committee recommendation................................     126,978,000

    The Committee has included $126,978,000 for the National 
Center for Complementary and Alternative Medicine. The budget 
request was $122,692,000 and the fiscal year 2005 appropriation 
was $122,105,000. 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 continues to strongly support the work of 
NCCAM. As more and more Americans are using complementary and 
alternative therapies, there is an increasing need for quality 
research into this area and for sharing research findings and 
other information with health professionals and the general 
public.
    The Committee expects that funding for existing and new 
Centers supported by the office will be maintained. The 
Committee expects NCCAM to renew its support of CDC's field 
investigations program and expand its support of AHRQ's 
literature reviews and data analysis efforts. It also commends 
NCCAM's efforts 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 and expects that to continue and expand.
    Antioxidants.--The Committee is aware that the role of 
antioxidants in maintaining health in a variety of organ 
systems has been attracting attention in recent years. Recent 
evidence suggests that the delicate inner ear structures can be 
protected against the ravages of acoustic trauma produced by 
noise such as that encountered on the battlefield, and may have 
a role to play in preventing or slowing the progression of age-
related hearing loss in the elderly by routine administration 
of commonly available antioxidant food supplements. Other 
applications may be found for these compounds in the treatment 
or prevention of auditory or vestibular disorders. The 
Committee encourages the institute to collaborate with NIDCD to 
fund research in this very promising area.
    Ameliorating Liver Disease.--The Committee is pleased with 
NCCAM's efforts to conduct clinical trials in collaboration 
with NIDDK regarding the use of milk thistle as a possible 
treatment in slowing the progression of nonalcoholic 
steatohepatitis and to reduce the side effects of hepatitis C 
interferon treatments. The Committee looks forward to the 
development and dissemination of the research results 
associated with the use of milk thistle as a treatment to 
ameliorate liver disease.
    Bone Health.--The Committee encourages NCCAM to conduct 
research on complementary and alternative medical approaches to 
bone health, bone pain and nutrition, including supplements and 
nutraceuticals, for osteoporosis and later life fractures.
    Behavioral Research on Stress.--NCCAM is encouraged to 
continue collaborations with other NIH offices, Institutes and 
centers to identify mechanisms through which various stressors 
produce adverse health effects, and the extent to which stress 
reduction interventions improve health.
    Integrative Medicine Model.--The Committee supports the 
concept of integrative medicine, which reaffirms the importance 
of the relationship between practitioner and patient, focuses 
on the whole person, is informed by evidence, and makes use of 
all appropriate therapeutic approaches, healthcare 
professionals and disciplines to achieve optimal health and 
healing. The Committee encourages NCCAM and other relevant ICs 
to accelerate the infusion of this model throughout their 
research, research training and communication activities.
    Native Hawaiian Healing.--The Committee commends the NCCAM 
for its plans to convene a working group in fiscal year 2005 to 
establish communication and facilitate research collaborations 
among traditional and conventional healing techniques.
    Parkinson's Disease.--The Committee encourages NCCAM to 
continue exploration of aerobic exercise and Chinese exercises 
such as T'ai Chi Chuan in the treatment of Parkinson's. Recent 
studies show exercise may increase neuroprotective chemicals in 
the brain and decrease falls in the elderly. The Committee also 
encourages continued research into magnetic stimulation for 
depression and the phytomedicine Valerian for sleep 
dysfunction, as both symptoms are significant non-motor co-
morbidities in Parkinson's. Finally, NCCAM is encouraged to 
work the Office of Dietary Supplements in investigating 
supplements which may be neuroprotective, such as berries, 
alpha lipoic acid, N-acetyl-L-cysteine, acetyl-L-carnitine, 
vitamin E, ginko biloba, vitamin D, vitamin B12, 
phosphatidylcholine, and glyconutrients.
    PET.--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.
    Practice-Based Research Network.--One of the major advances 
achieved through the work of NCCAM has been the development of 
CAM or integrative medicine research centers at many of the 
Nation's top medical centers. In order to build upon this 
important new research infrastructure base, the Committee 
expects NCCAM to implement one of the major recommendations of 
the recent Institute of Medicine CAM report--the development 
and utilization of an Integrative Medicine Practice-Based 
Research Network [PBRN]. The Committee concurs with the IOM 
that the PBRN model is very well-suited for the study of CAM 
therapies and would greatly enhance the ability to conduct high 
quality cost-effective clinical trials of CAM therapies and 
treatment modalities. Such a network would also allow for the 
rapid dissemination of data, which would directly affect the 
provision of health care to consumers. Key to the establishment 
of such a network would be funding for a data tracking system 
linking the network practice members and a centralized data 
coordinating center. The Committee considers the PBRN to be one 
of its top priorities for NCCAM this year.

       NATIONAL CENTER ON MINORITY HEALTH AND HEALTH DISPARITIES

Appropriations, 2005....................................    $196,159,000
Budget estimate, 2006...................................     197,379,000
House allowance.........................................     197,379,000
Committee recommendation................................     203,367,000

    The Committee has included $203,367,000 for the National 
Center on Minority Health and Health Disparities. The budget 
request was $197,379,000 and the fiscal year 2005 appropriation 
was $196,159,000. The comparable amounts for the budget 
estimate include funds to be transferred from the Office of 
AIDS Research.
    Mission.--The NCMHD advises the NIH Director and Institute 
and Center [IC] directors on the development of NIH-wide policy 
issues related to minority health disparities research, 
research on other health disparities, and related research 
training. Among other activities, the NCMHD develops, in 
consultation with the NIH Director, IC directors, and the 
advisory council, a comprehensive strategic plan that 
identifies and establishes objectives, priorities, budgets, and 
policy statements governing the conduct and support of all NIH 
minority health disparities research, research on other health 
disparities, and related research training activities. It also 
administers funds for the support of minority health 
disparities research and other health disparities research, by 
awarding grants and leveraging the programs of the ICs.
    Cancer in Minorities.--While the Committee remains 
concerned about the burden of cancer in African-Americans and 
other minorities, it is encouraged by opportunities that exist 
for addressing this devastating toll. The Committee urges the 
NCMHD to collaborate with NCRR and NCI in taking the necessary 
steps to expand comprehensive Cancer Center's with a focus on 
research, treatment, prevention and control of cancer across 
minority and other disadvantaged populations.
    Cancer in Minority Communities.--The Committee commends 
NCMHD for its leadership in addressing the disproportionate 
impact of cancer in minority communities. The Committee 
encourages NCMHD to consider collaborating with the National 
Center for Research Resources and the National Cancer Institute 
in supporting the establishment of a cancer center at a 
historically minority institution focused on research, 
treatment, and prevention of cancer in African-American and 
other minority communities.
    Community-Based Organization Partnership Prevention 
Centers.--The Committee encourages continued expansion of 
community-based prevention initiatives and looks forward to 
hearing the recommendations of the strategic planning 
subcommittee on priority areas for research funding and the 
NCMHD's plans for implementation.
    Glomerular Injury.--The Committee understands that 
glomerular injury, a group of diseases affecting the filtering 
mechanisms of the kidneys, is more prevalent among African-
Americans than the general population. The Committee urges 
NCMHD to explore collaboration with NIDDK to support research 
activities related to glomerular injury and requests a report 
on progress made in this area.
    Liver Disease.--The Committee notes that many liver 
diseases, such as hepatitis C, hepatitis B and nonalcoholic 
steatohepatitis, are more common in the African-American, 
Hispanic, Asian Pacific Islander and Native American 
populations, than in European Americans. In addition, access to 
and acceptance of care is particularly problematic in these 
populations. The Committee therefore urges the Center to 
initiate and participate with NIDDK, NIDA and NCI in research 
focused on addressing and reducing these disparities.
    Minority Health Disparities.--The Committee commends the 
National Center on Minority Health and Health Disparities for 
its leadership in addressing the long-standing problem of 
health status disparities in minority and medically underserved 
populations. For fiscal year 2006, the Committee continues to 
encourage NCMHD to implement its successful Research Endowment 
program as an ongoing initiative. Moreover, the Committee 
encourages NCMHD to implement the program in a manner that is 
consistent with the authorizing legislation.
    Project EXPORT.--The Committee commends NCMHD for its 
successful ``Project EXPORT'' initiative and urges continued 
support for this important program. Also, the Committee 
encourages the Director of NCMHD to coordinate with the NIH 
Director and the National Center for Research Resources in 
support of extramural facility construction and the development 
of other research and research library infrastructure at 
minority health professions schools.
    Scleroderma.--The Committee encourages NCMHD to support 
research that furthers the understanding of causes and 
consequences of scleroderma, a chronic, degenerative disease of 
collagen production, present among African-Americans, Hispanic 
and Native American men and women. NCMHD is encouraged to 
establish epidemiological studies to address the prevalence of 
scleroderma among these populations, as statistics indicate 
that African-Americans have a slightly higher incidence of 
scleroderma. This population is also likely to be diagnosed at 
a younger age and tends to be diagnosed more often with the 
diffuse form of scleroderma.

 JOHN E. FOGARTY INTERNATIONAL CENTER FOR ADVANCED STUDY IN THE HEALTH 
                                SCIENCES

Appropriations, 2005....................................     $66,632,000
Budget estimate, 2006...................................      67,048,000
House allowance.........................................      67,048,000
Committee recommendation................................      68,745,000

    The Committee recommends an appropriation of $68,745,000 
for the Fogarty International Center [FIC]. The budget request 
was $67,048,000 and the fiscal year 2005 appropriation was 
$66,632,000. The comparable amounts for the budget estimate 
include funds to be transferred from the Office of AIDS 
Research.
    Mission.--Adapting research advances in biomedicine to 
populations at home and abroad requires a continuing commitment 
to basic science as well as rigorous clinical and applied 
(epidemiological) studies. Examples are vaccines, anti-
infective agents, drugs, and more efficient diagnostic tools, 
combinations of interventions, and health policies to reduce 
the risk of disease and its associated human, social, and 
economic consequences. These challenges will benefit from a 
more coordinated and multi-disciplinary approach to global 
health needs. It is the mission of the FIC to address these 
challenges by forging collaborations with a range of domestic 
and global partners in international research and training to 
pursue three core objectives: first, to accelerate the pace of 
discovery and its application by special projects enabling 
scientists worldwide to share conceptual insights, analytic 
methods, data sets, patient cohorts, or special environments; 
second, to engage and assist young as well as more established 
U.S. investigators to address scientific challenges related to 
global health; and third, to help develop a cadre of highly 
capable young foreign investigators positioned to cooperate 
with U.S. scientists in areas of the world that, due to 
geography, genetics, or disease burdens, provide unique 
opportunities to understand disease pathogenesis, anticipate 
disease trends, or develop interventions of relevance and 
priority for both the United States and the collaborating 
country.
    Chronic Obstructive Pulmonary Disease.--The Committee notes 
that Chronic Obstructive Pulmonary Disease [COPD] is the fourth 
leading cause of death worldwide, and encourages the Fogarty 
International Center to expand its COPD research and training 
activities.
    Fragile X.--The Committee encourages the Fogarty 
International Center to consider Fragile X syndrome through all 
appropriate programs, such as the Fogarty International 
Research Collaboration Award and the FIC Brain Disorders in the 
Developing World Program.
    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, 2005....................................    $323,346,000
Budget estimate, 2006...................................     326,291,000
House allowance.........................................     326,291,000
Committee recommendation................................     335,422,000

    The Committee recommends an appropriation of $355,422,000 
for the National Library of Medicine [NLM]. The budget 
requested $326,291,000 and the fiscal year 2005 appropriation 
was $323,346,000. 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 million items. The 
NLM has pioneered innovative methods to disseminate 
bibliographic information. Basic to the mission of the NLM is a 
wide-ranging research program to improve how medical 
information is communicated. This responsibility is aided by a 
grants program and by specialized services in toxicology, 
environmental health, and biotechnology.
    Communication of NIH-Supported Research Findings.--One of 
the fundamental charges to NIH is to facilitate the translation 
of research findings into practice, both in terms of the care 
provided by health professionals and behavioral and lifestyle 
changes by the public. The Committee commends the excellent 
work NLM does in this regard. The Committee endorses efforts to 
launch a new magazine aimed at physician offices and their 
patients communicating the latest NIH research findings with 
authoritative content presented in a user-friendly format.
    Disease Management Technology.--The Committee urges NLM to 
conduct outreach activities to all public and private sector 
organizations which have demonstrated capabilities in health 
information technology. The Committee is particularly 
interested in disease management technology as it relates to 
saving health care dollars, and improving care for chronically 
ill individuals and the workforce.
    Health Equity Review.--The Committee congratulates NLM for 
its concern about health disparities and its sensitivity to 
native populations, such as Native Americans, Alaskans, and 
Hawaiians, and other minority communities. The Committee 
encourages NLM to fund projects to map health disparities and 
population profiles in minority communities.
    Native Hawaiian Healing.--The Committee applauds the NLM's 
leadership for conducting ``listening circles'' to discuss the 
need for preservation and documentation of traditional cultural 
healing practices. The Committee encourages the NLM to explore 
the best ways of capturing and documenting this information 
through continued collaboration with Native Hawaiians.
    Outreach.--The Committee encourages NLM to continue its 
outreach activities aimed at educating health care 
professionals and the general public about the Library's 
products and services, in coordination with medical librarians 
and other health information specialists.
    Public Access.--The Committee has noted that the National 
Institutes of Health has begun to implement its public access 
policy which is geared to ensuring that NIH-funded research 
results are made available as soon as possible to the public, 
health care providers, educators, and scientists through the 
National Library of Medicine's PubMed Central [PMC] database. 
The Committee agrees with the need for, and a goal of, issuing 
a balanced policy to help promote increased public access to 
NIH-funded research while maintaining the integrity of the peer 
review system which is essential to ensure the quality and 
accuracy of medical research in the United States. The 
Committee urges NIH to work with all stakeholders as it moves 
forward in implementing this policy. To assist the Congress in 
assessing the degree of success of this new policy, the 
Committee requests a progress report by no later than February 
1, 2006. Specifically, the Committee requests that the report 
contain the following information: (1) the total number of 
peer-reviewed articles deposited in PubMed Central since the 
May 2, 2005 implementation date and the distribution of chosen 
delay periods; (2) an assessment of the extent to which the 
implemented policy has led to improved public access; (3) an 
assessment of the impact of the policy on the peer review 
system; and (4) the cost of operating the database.
    PubChem.--The Committee is aware of the development of 
PubChem, the informatics component of the Molecular Libraries 
project of the NIH Roadmap for Medical Research. The Committee 
understands that the purpose of PubChem is to create a database 
of chemical structures and their biological activities. PubChem 
will house both data from the new NIH molecular libraries 
screening center network and compound information from the 
scientific literature. The Committee expects the NIH to work 
with private sector chemical information providers, with a 
primary goal of maximizing progress in science while avoiding 
unnecessary duplication and competition with private sector 
databases.

                         OFFICE OF THE DIRECTOR

Appropriations, 2005....................................    $358,047,000
Budget estimate, 2006...................................     385,195,000
House allowance.........................................     482,216,000
Committee recommendation................................     487,434,000

    The Committee recommends an appropriation of $487,434,000 
for the Office of the Director [OD]. The budget request was 
$385,195,000 and the amount appropriated in fiscal year 2005 
was $358,047,000. The comparable amounts for the budget 
estimate include funds to be transferred from the Office of 
AIDS Research.
    The Committee has included within the total, $97,021,000 to 
support specific targeted research activities needed to develop 
radiological/nuclear ($47,021,000) and chemical threat 
($50,000,000) countermeasures. This funding was originally 
requested in the Office of the Secretary Public health and 
Social Services Emergency Fund.
    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.

Office of Research on Women's Health

    The Office of Research on Women's Health [ORWH] works in 
collaboration with the Institutes and Center of NIH to promote 
and foster efforts to address gaps in knowledge related to 
women's health through the enhancement and expansion of funded 
research and/or ensuring the inclusion of women in clinical 
research funded by NIH, including the development of a 
computerized tracking system and the implementation of 
guidelines on such inclusion. This office also promotes the 
number of women in biomedical science careers.
    Irritable Bowel Syndrome.--The Committee is pleased with 
the increased focus on irritable bowel syndrome [IBS] at the 
NIH's Office Research on Women's Health. It is estimated that 
between 25 to 45 million Americans, disproportionately women, 
suffer from IBS.

Office of AIDS Research

    Microbicides to Prevent HIV/AIDS.--Given current scientific 
advancements, an effective microbicide could be developed by 
the end of the decade, and once available, could well change 
the course of the epidemic. According to NIH, ``the U.S. 
Government is firmly committed to accelerating the development 
of safe and effective microbicides to prevent HIV'' because 
microbicides may provide ``one of the most promising prevention 
interventions that could be inexpensive, readily available, and 
widely acceptable'' (U.S. Government Strategic Plan for 
Microbicides). Despite these statements, NIH continues to spend 
barely 2 percent of its HIV/AIDS research budget on 
microbicides. The Committee strongly urges greater funding for 
microbicide research and development at NIH. In addition, this 
Committee has long advocated that NIH establish a dedicated 
microbicide unit with clearly identified leadership to 
accelerate and coordinate federally supported microbicide 
research, and is concerned that no significant progress has 
been made towards this goal. Greater leadership and 
coordination on this issue is especially critical given that 
consideration is being given to the possibility of a 
microbicide-specific clinical trial network. If this evolves, 
the notion of a dedicated microbicide unit at the NIH would be 
essential.
    There is an urgent need to expand the development pipeline 
with more microbicide candidate products, particularly those 
that target HIV in new ways. In addition to candidates that may 
arise from basic research efforts, the best possibilities may 
be found within pharmaceutical companies where there are dozens 
of potential compounds already developed as therapeutics that 
could move into clinical development as microbicides if made 
available. As outlined in the NIH Roadmap, NIH has mechanisms 
in place to encourage partnerships among researchers in 
academia, government and the private sector. The Committee 
strongly urges the leadership at NIH to support the microbicide 
field by encouraging the pharmaceutical industry to allow its 
drug candidates to be developed as microbicides. In the past 
year, the International Partnership for Microbicides has 
entered into innovative agreements with leading pharmaceutical 
companies to jointly test and develop leading AIDS drugs as 
microbicides. More partnerships like these between the 
pharmaceutical industry and the non-profit community will be 
critical, and should receive the active support of NIH 
leadership.
    Pediatric HIV Research.--The Committee recognizes the 
importance of research into the long-term health implications 
of preventive HIV drug regimens in children, the psychological 
and social needs of HIV-infected children and appropriately 
targeted prevention services. The Committee urges the Director 
to provide the resources necessary for domestic and 
international research on the long-term effects of preventive 
drug regimens on HIV-exposed pediatric populations; the long-
term health, psychosocial, and prevention needs for pediatric 
populations perinatally HIV-infected; the transition to 
adulthood for HIV-infected pediatric populations; and safer and 
more effective treatment options for pediatric populations with 
HIV disease.
    Pediatric HIV Vaccine Testing.--The Committee requests the 
NIH Director to submit a report within 90 days of enactment of 
this bill on the status of activities related to the testing of 
potential HIV vaccine candidates in relevant pediatric 
populations, including infants, preadolescents, and 
adolescents. The report shall include an analysis of regulatory 
or other barriers to developing an HIV vaccine and a 
comprehensive review of current and planned clinical trials in 
relevant pediatric populations. In addition, the Committee 
requests that the NIH fiscal year 2007 Plan for HIV-Related 
Research and future plans include: plans for expanding existing 
capacity for HIV vaccine candidate testing in relevant 
pediatric populations; plans for increasing coordination in 
advancing pediatric HIV vaccine testing across federally funded 
HIV vaccine research programs, including, but not limited to 
the HIV Vaccine Trials Network, the Pediatric AIDS Clinical 
Trials Group, the Food and Drug Administration, the Centers for 
Disease Control and Prevention, and the Partnership for AIDS 
Vaccine Evaluation; opportunities for collaboration with the 
Office of the Global HIV/AIDS Coordinator; appropriate 
principles for initiating HIV vaccine testing in relevant 
pediatric populations, including recommendations for sequencing 
the enrollment of adults and relevant pediatric populations and 
for addressing issues related to human subjects protections for 
children involved in clinical research; and proposed community 
education efforts in support of the inclusion of relevant 
pediatric populations in HIV vaccine clinical trials.

Office of Research on Women's Health

    Stroke in Women.--As the second leading cause of death 
among women worldwide, stroke 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 61 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. Studies suggest that significant 
gender differences occur in the evaluation and treatment of 
stroke patients, with women often receiving fewer diagnostic 
tests and intervention procedures. Increased research is needed 
to understand these differences and provide a means to optimize 
stroke care for all patients. Some aspects of the disease 
unique to women include strokes related to pregnancy and the 
use of oral contraceptives; stroke in younger women requires 
increased attention. 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 gender-related 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, 
including: (1) observational research on differences in the way 
men and women present with stroke symptoms, (2) research 
addressing how stroke influences the likelihood and severity of 
cognitive impairment in women, (3) a clinical trial of carotid 
endarterectomy and angioplasty/stenting in women, (4) studies 
of differences in how men and women respond to FDA-approved 
antiplatelet agents for recurrent stroke prevention, and (5) 
basic science research to address unique brain cell death and 
repair mechanisms in females.
    The Committee also encourages and supports NIH's 
initiatives toward advancing the organization of stroke care, 
including post-stroke 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.
    Vulvodynia.--Since fiscal year 1998, the Committee has 
highlighted the need for research on the prevalence, causes and 
treatment of vulvodynia, a painful and often debilitating 
disorder of the female reproductive system. The Committee is 
pleased that some progress has been made since that time. For 
example, the NICHD has supported a major study of the 
prevalence of this disorder. The published results of this 
study found that as many as 6 million women suffer from 
vulvodynia, making it one of the most prevalent chronic pain 
conditions affecting women. The Office of Research on Women's 
Health [ORWH] was crucial in supporting an important 2003 
research conference on vulvodynia. These efforts have both 
clearly demonstrated the need for substantial additional 
research and served to heighten the research community's level 
of interest in studying vulvodynia. The Committee calls upon 
the Director to build upon these initial successes by 
coordinating through the ORWH an expanded and collaborative 
extramural and intramural research effort into the causes of 
and treatments for vulvodynia. This expanded effort should 
involve ORWH, NICHD, NINDS and other relevant ICs as well as 
the NIH Pain Consortium. In addition, the Committee notes that 
as many as 40 percent of women with vulvodynia remain 
undiagnosed after visiting three or more physicians. To address 
this shortcoming, the Committee urges that NIH include 
information about vulvodynia on its website and that it work 
with the National Vulvodynia Association, the American College 
of Obstetricians and Gynecologists and other relevant groups to 
implement a national education program for primary care health 
professionals, patients and the general public on vulvodynia's 
symptoms, diagnosis and treatment options. Finally, the 
Committee encourages the Director to work with the Center for 
Scientific Review and ICs to ensure that experts in vulvodynia 
and related chronic pain and female reproductive system 
conditions are adequately represented on peer review panels.

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.
    As in past years, the Committee strongly urges the Office 
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. This effort is a crucial underpinning for 
conducting quality research and assuring quality and 
consistency for consumers of dietary supplements.
    The Committee commends ODS for developing a request for 
proposals for a contract with industry nonprofit associations 
or foundations that 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 will allow ODS to have 
access for research purposes of all known supplements 
manufactured in the United States and to allow access by other 
Federal agencies for ensuring safety to consumers who purchase 
supplements manufactured and/or sold in the United States, 
through the mandatory listing of ingredients in these products 
on the label.
    The Committee notes that there is great potential in work 
being done on the relationship between fish oils and other 
dietary supplements in combating anti-inflammatory diseases. 
This also applies to work being done on the potential for 
selected botanicals to reverse the development of insulin 
resistance, the key pathophysiologic feature of metabolic 
syndrome. Given the growing prevalence of obesity, expansion of 
this area of research is clearly warranted.
    A number of recent studies point to the need for an 
expansion of ODS support for research into herb-drug 
interactions. ODS, NCCAM and other ICs at NIH are supporting 
important work in this area, and it should be expanded. 
Improved dissemination of results of this research to the 
public, health professionals and other interested parties is 
also needed.
    The Committee commends ODS for its efforts to seek input 
from consumers, industry, researchers and other stakeholders on 
its future agenda. ODS should continue and expand its outreach 
to industry stakeholders to share information, gather ideas and 
assure better coordination of privately and publicly funded 
research.

Office of Behavioral and Social Sciences Research

    The Office Behavioral and Social Sciences Research furthers 
the mission of the NIH by emphasizing the role that behavioral 
and social factors and their interaction with biomedical 
variables play in health. The goals of the office are to 
enhance behavioral and social sciences research and training; 
integrate a biobehavioral perspective across the NIH; and 
improve communication among health scientists and with the 
public.

Office of Rare Disease Research

    The Office of Rare Diseases was established in 1993 to 
address the conditions that affect fewer than 200,000 persons 
in the United States. The goals of the office are to stimulate 
and coordinate research on rare diseases and to support 
research to respond to the needs of patients who suffer from 
the more than 6,000 rare diseases known today.

Multi-Institute Research Initiatives

    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 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 Committee commends the NIH 
Autoimmune Diseases Coordinating Committee [ADCC] for fostering 
collaborative, integrated multi-Institute research on issues 
affecting the genetically related family of autoimmune 
diseases. Implementation of autoimmune diseases research by the 
ADCC should focus on high-priority, cross-cutting 
opportunities, including research into the role of 
environmental and infectious agents in the initiation and/or 
exacerbation of autoimmune diseases. The Committee also 
encourages the ADCC to identify and initiate promising areas of 
autoimmune research where collaboration among the NIH 
institutes enhances the potential for major advances in 
understanding the common etiology of, and developing more 
effective diagnostic and treatment tools for, this family of 
debilitating and high-cost diseases.
    Bone Health and Osteoporosis.--The Committee is pleased 
that the Surgeon General has submitted the report on bone 
health requested in the fiscal year 2002 Appropriations bill. 
The Surgeon General calls for a national action plan to achieve 
improved bone health. To this end, the Committee encourages the 
NIH to establish a ``Bone Health Research Blueprint'' to 
achieve the Surgeon General's objectives through enhanced 
cooperation between and among the NIH research institutes. The 
Blueprint should place particular emphasis on osteoporosis, 
osteogenesis imperfecta, Paget's disease, other metabolic bone 
diseases and rare bone disorders such as osteopetrosis. The 
Committee requests a report on the status of the Bone Health 
Blueprint by May 1, 2006.
    Chronic Fatigue Syndrome.--The Committee is deeply 
concerned that NIH has failed to expand research on chronic 
fatigue syndrome [CFS] and that a June 2003 commitment to issue 
a request for applications on CFS has not yet been fulfilled. 
The RFA should emphasize multi-disciplinary studies to 
understand the cause and progression of CFS in adults and 
children, identify diagnostic markers and develop effective 
treatment. The Committee also is troubled that a CFS funding 
report for fiscal years 1999-2003 issued in response to 
congressional requests included amounts for grants unrelated to 
CFS, thus artificially inflating the total dollars awarded for 
CFS research. CFS is just one condition for which this has been 
a problem. The Committee requests that NIH report back to it by 
May 1, 2006, on the number of CFS-specific grant applications 
received and funded since fiscal year 2000.
    Child Abuse and Neglect Research.--The Committee recognizes 
the magnitude and significance of child abuse and neglect as a 
serious public health problem claiming an estimated 896,000 
victims in 2002, according to data reported by the Department 
of Health and Human Services. The Committee applauds NIH for 
developing and implementing a coordinated research agenda for 
child abuse and neglect involving relevant NIH institutes, 
including NIMH, NICHD, NIDA, NINR, and NIAAA, the Office of 
Behavioral Social Science and Research and other appropriate 
agencies. In response to recommendations in the 1993 National 
Research Council report entitled Understanding Child Abuse and 
Neglect, the NIH child abuse and neglect initiative first 
addressed the knowledge gaps in child neglect. The Committee 
encourages NIH to proceed with the research agenda by examining 
current research gaps on the abuse of children, including 
research on treatment interventions with substantiated cases of 
child maltreatment. The Committee requests that the Director be 
prepared to report on current and proposed NIH efforts in this 
area at the fiscal year 2007 hearings.
    Clinical Research and Academic Health Centers.--Past 
breakthroughs in basic biomedical sciences have provided an 
unprecedented supply of information for improving health and 
preventing disease. But in recent years, the Nation's academic 
health centers, which serve as the staging ground that deploys 
the results of research to hospitals and health care providers, 
have encountered obstacles that threaten to slow the pace of 
clinical research, including unfunded mandates. Without a 
robust infrastructure, the translation of basic science into 
tangible public health improvements will be slowed. The 
Committee therefore encourages the Director to take concrete 
steps to address the problems encountered by academic health 
centers.
    Clinical Research Curriculum Award.--The Clinical Research 
Curriculum Award has been extremely effective in training 
successful clinical researchers. The Committee supports the NIH 
decision to increase the size of these awards from $200,000 to 
$300,000 but is concerned that it was accomplished by reducing 
the number of funded institutions. The Committee urges the 
Director to consider an increase in funding from Institutes and 
Centers that support the program in order to expand rather than 
reduce the number of institutions receiving this award. In 
addition, the Committee reiterates its support for 
implementation of the Congressionally authorized Graduate 
Training in Clinical Investigation award to provide tuition and 
stipend support for clinical research training program 
students.
    Clinical Research Workforce Training.--The Committee has 
heard testimony that virtually every medical specialty is 
experiencing a shortage of adequately trained clinical 
investigators capable of translating basic science advances 
into the diagnosis, treatment and prevention of disease. This 
shortage inhibits clinical research productivity and slows the 
rate at which results from basic biomedical research efforts 
can be applied to the problems of patients. Improved clinical 
research will have a positive effect on the quality of health 
care and patient safety, and advance the application of the 
principles of evidenced-based medicine to routine patient care. 
The Committee urges allocation of sufficient resources for 
training of physician-scientists throughout all NIH institutes, 
to support studies of patient outcomes, medical effectiveness, 
and disease- and treatment-specific quality of life.
    Clinical Trials Technology.--The Committee recommends that 
the NIH Director and the Director of the NIH Clinical Center 
explore options for utilization of technology to improve 
efficiency, cost savings, and sharing of information in 
clinical trials being supported intramurally and extramurally.
    Distribution of Resources.--The Committee believes, in 
light of the doubling of the NIH budget and the emergence of 
new medical research challenges such as SARS and threats of 
bioweapons, NIH should encourage funding of large scale 
collaborative efforts to address these and other medical 
challenges. In addition, while the pace of new challenges has 
increased, review time for proposals submitted to the 
Institutes at NIH continues to average about 18 months. The 
Committee strongly encourages the Director to develop means of 
encouraging large scale multi-institution projects to address 
significant areas of medical research and to devise means of 
reducing the time frames between submission of proposals and 
awarding of grants.
    Down Syndrome Research Task Force.--The Committee urges the 
Director of NIH to establish a NIH Down Syndrome Research Task 
Force to develop a strategic plan for genetic and 
neurobiological research relating to the cognitive dysfunction 
and the progressive late-life dementia associated with Down 
syndrome. The purpose of the strategic plan is to provide a 
guide for coordinating Down syndrome research on cognition 
across the NIH and for enhancing the development of new 
research efforts based on identification of areas of greatest 
scientific opportunity, especially as they relate to the 
development of future treatments. The plan should include 
short, intermediate and long-term goals for basic and clinical 
research with strategies for achieving goals and with specified 
timeframes for implementation. The Committee requests the NIH 
to report to Congress by June 1, 2006 on the steps it is taking 
to develop the Down Syndrome Research Task Force on Cognition.
    Duchenne Muscular Dystrophy.--The Committee remains 
concerned with the amount of time taken by the NIH to comply 
with requirements of the MD Care Act, which became law in 
December 2001. The Committee is pleased NIH has funded one 
additional Wellstone Muscular Dystrophy Cooperative Research 
Center and is working to fund two more for a full complement of 
six. The Committee further encourages the Institute to provide 
adequate funding and resources for each center. As the original 
report on the activities being performed pursuant to the MD 
Care Act was both late in coming and insufficient in detail, 
the Committee requests that NIH submit a report to the 
Committee no later than May 1, 2006 stating the current 
research goals and progress made toward each goal; the 
Institute or Center responsible for each goal; the total amount 
of money invested toward each goal as well as projected 
spending for the present and future fiscal year; opportunities 
for external partnerships; and a timeline for establishing a 
Duchenne/Muscular Dystrophy translational research initiative, 
modeled on the lines of the spinal muscular atrophy project. 
The Committee recognizes that several promising treatments and 
therapies for Duchenne and Becker Muscular Dystrophy are in 
development, and urges NIH to invest additional resources, 
including a coordinating mechanism, necessary to expedite their 
translation into practice. Furthermore, the Committee urges NIH 
to work with leading stakeholders to convene a consensus 
conference on translational research opportunities in early 
2006, and report back to the Committee, by September 2006, with 
a strategic plan for launching a translational research 
initiative.
    Dystonia.--The Committee is very pleased with progress 
demonstrated by the NIH intramural research program in the 
treatment and understanding of dystonia. NIH intramural 
researchers have successfully utilized injections of Botox to 
treat many patients who otherwise would be severely debilitated 
by dystonia. The Committee urges continued work in this 
important area of study and treatment.
    Epilepsy.--While NINDS is the primary Institute for 
addressing epilepsy research, several other Institutes are also 
involved in related research. The Committee urges the Director 
to intensify coordination of cross-cutting research on epilepsy 
in all Institutes.
    Fragile X.--The Committee notes the impressive progress 
made by Fragile X researchers in understanding the basic neural 
defects that cause this developmental disorder. NIH Institutes, 
units, and its National Center for Research Resources provided 
75 grants in fiscal year 2004 to find a treatment and cure for 
Fragile X. The success of these translational research efforts 
has made treatment of Fragile X a near-term possibility. 
However, further efforts are required to translate these basic 
science findings into viable treatments. Specifically, 
collaborative efforts between industry, academia and NIH 
Institutes are likely to be necessary to develop promising 
therapeutic options for this orphan indication. The Committee 
further notes that while Fragile X is a relatively common 
genetic disease, the treatments being developed for Fragile X 
may also be effective for a much larger number of people with 
related autism spectrum disorders. Research has shown many 
possible treatment strategies which merit human Fragile X 
clinical trials, including--but not limited to--mGluR5 
antagonists, Ampakines, aripiprazole, and lithium. The 
Committee strongly urges the Director to facilitate and fund 
public/private partnerships which will enable these vital 
studies to proceed. 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 regularly-scheduled meetings. To achieve this 
mandate, the NIH is urged to convene a yearly workshop with the 
research community to develop priorities for basic, clinical 
and translational research as they relate to Fragile X. The 
Committee also 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 as they relate to Fragile 
X.
    Gene Therapy Research.--While the promise of gene therapy 
has not yet been realized, the Committee is encouraged by some 
promising research done in the area of thalassemia, or Cooley's 
anemia. It is concerned, however, that the most innovative gene 
therapy research is currently being done in Europe rather than 
in the United States. The Committee urges the Director to 
assess the prospects for the most promising areas for 
breakthroughs in this field and to develop an aggressive 
program to focus resources on it. The assessment should also 
include the prospects for successes in additional 
hemoglobinopathies and in an even broader range of diseases. 
The goal of this effort should be nothing less than to cure a 
disease in the shortest possible time utilizing gene therapy 
techniques.
    Heart Disease Research and Prevention Action Plan.--
Advances have been made in the identification and treatment of 
risk factors for heart disease. The Committee encourages the 
NIH to convene a transagency national conference on heart 
disease to assess progress and opportunities and to develop a 
comprehensive, long range research and prevention action plan. 
Participants should include representatives from all Federal 
agencies involved in heart disease research and prevention, 
including the NIH and all relevant institutes and centers, CDC, 
AHRQ, DOD, and pertinent voluntary nonprofit organizations, 
foundations, and experts in the field. The Committee encourages 
the Director to develop a long-range, strategic Heart Disease 
Research and Prevention Action Plan and submit a report to the 
Committee by May 1, 2006. The plan should include quantifiable 
goals and benchmarks to measure progress in the battle against 
heart disease, and a professional judgment budget for each year 
as well as for the entire plan.
    Hereditary Hemorrhagic Telangiectasia.--Hereditary 
Hemorrhagic Telangiectasia [HHT], also known as Osler-Weber-
Rendu Syndrome, is a multi-system vascular genetic disorder 
producing blood vessel malformations in the brain and lung 
which may result in stroke, hemorrhage, aneurysm and death. 
Sudden death or disability occurs in 20 percent of children and 
adults but is largely preventable with proper intervention. 
Because this is a multi-system disorder, the Committee 
encourages the Director to formulate an NIH-wide research 
agenda with the participation of the NHLBI, NINDS and NIDDK 
Institutes.
    Hepatitis B.--Although there has been tremendous success in 
the prevention and treatment of hepatitis B, this disease 
remains a serious concern. The Committee proposes that the 
success of past research be built upon with new program 
development and the potential for new funding. The large number 
of immigrants to the United States from parts of the world 
where hepatitis B is endemic will keep this disease in the 
forefront of public health for years to come. For example, the 
more than 8 million people who are estimated to have immigrated 
from Asia to the United States in the past 10 years, alone, 
will significantly add as many as 600,000 people to the more 
than 1.2 million people already believed to be chronically 
infected, in the United States. The Committee urges the 
Director of NIH to report to Congress the amount of funding 
necessary to develop programs which would stimulate new 
research to find: (1) complements for the current therapies for 
hepatitis B, (2) improvements in the detection and treatment of 
hepatitis and liver cancer associated with hepatitis B, (3) 
improvements in the prevention of the disease by development of 
new vaccines, new outreach and population studies. Initiatives 
that promote truly innovative approaches and stimulate and 
excite new investigation in these areas is specifically 
encouraged.
    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, 
expects the Director to increase the core support NDRI receives 
from NCRR, and to broaden the scope of the multi-Institute 
initiative by strongly urging the Institute Directors of NCI, 
NHGRI, NHLBI, NICHD, NIMH, and NINDS to identify and implement 
program-specific initiatives to expand support for NDRI.
    Islet Transplantation.--The Committee commends the NIDDK 
and NIAID for the establishment of the Clinical Islet 
Transplantation Consortium and the islet transplantation 
clinical trial that will include Medicare-eligible individuals 
whose transplant and related costs will be covered by Medicare. 
The Committee encourages cooperation between the NIDDK and 
NIAID and members of the Consortium to ensure the timely launch 
of these clinical trials.
    Kidney Disease.--The Committee is aware that kidney disease 
is a major health problem in the United States, and according 
to a recent CDC study is one of the fastest growing causes of 
death in the United States. It is estimated that at least 15 
million people have lost 50 percent of their kidney function 
and another 20 million more are at increased risk of developing 
kidney disease due to diabetes, cardiovascular disease and 
hypertension. Of these individuals, a disproportionate share 
are minorities. The Committee encourages the Director to ensure 
that the NIDDK and NHBLI work closely and collaboratively to 
maximize the output of our national investment in kidney 
disease.
    Lupus.--The Committee recognizes lupus is a serious, 
complex, debilitating chronic autoimmune disease that can cause 
inflammation and tissue damage to virtually any organ system in 
the body. The Committee strongly urges the Director of the 
National Institutes of Health to expand, intensify and 
coordinate research and related activities with respect to 
lupus across all relevant institutes, centers and offices, 
especially the National Institute of Arthritis and 
Musculoskeletal and Skin Diseases, and the National Institute 
of Allergy and Infectious Diseases.
    The Committee is disappointed with the pace of research 
regarding lupus and strongly urges that the Director of the 
National Institutes of Health conduct or support research to 
expand the understanding of lupus, including: basic research to 
discover the pathogenesis and pathophysiology of the disease; 
research to determine the reasons underlying the 
disproportionate prevalence of lupus in African American, 
Hispanic, Native American, and Asian women; epidemiological 
studies to address the frequency and natural history of the 
disease and the differences between the sexes and among racial 
and ethnic groups with respect to the disease; clinical 
research for the development and evaluation of new treatments, 
including new biological agents; and research to validate lupus 
biomarkers; and research to develop improved diagnostic tests. 
The Committee strongly urges the Institute to increase funding 
for lupus research by actively soliciting grant applications 
for lupus and taking aggressive steps to assure that a vigorous 
research program is established.
    Lymphangioleiomyomatosis [LAM].--The Committee remains very 
interested in efforts to find a cure and treatments for LAM, a 
progressive and fatal lung disease that strikes women, usually 
in their childbearing years. Currently, there are no effective 
treatments. The Committee understands that recent scientific 
findings have presented new treatment approaches for clinical 
testing, and that experimental trials with the drug sirolimus 
have begun. The Committee urges the NHLBI, as well as the NCI, 
the Office of Rare Diseases, and the NINDS to fund clinical 
treatment trials through both intramural and extramural means 
and to use all available mechanisms as appropriate, including 
support of state-of-the-science symposia, request for 
applications, and facilitating access to human tissues to 
stimulate a broad range of clinical and basic LAM research. The 
Committee also commends the NCRR and ORD for their roles in 
supporting the Rare Lung Disease Consortium.
    Lymphatic Research.--The lymphatic system is central to the 
progression of disease and the maintenance of health, yet 
scientific and medical knowledge of this important system is 
woefully deficient. While the Committee is pleased that a 
Trans-NIH Coordinating Committee on the Lymphatic System exists 
to ensure that scientific knowledge and understanding about 
this neglected body system will be advanced and coordinated, 
adequate efforts and funding are lacking. ICs are urged to 
include relevant language addressing basic and clinical 
lymphatic system research in all existing and future funding 
mechanisms, where such grant applications could be responsive. 
The Trans-NIH Coordinating Committee should be informed of 
relevant lymphatic language included within such funding 
initiatives.
    The Committee is encouraged to learn that the Trans-NIH 
Coordinating Committee on the Lymphatic System, and in 
particular the NHBLI, is working with patient advocates to 
address the needs of the lymphatic disease and lymphedema 
patient communities. Initiatives such as a national lymphatic 
disease patient registry/tissue bank; an NIH lymphatic disease 
working group and national guidelines for clinical care; an NIH 
partnership funding program; intramural longitudinal studies; 
and multidisciplinary centers for research, clinical care, and 
medical training are strongly encouraged.
    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. Initial efforts have 
shown that cancers such as breast cancer are not a single 
disease, but may encompass many different diseases, when 
examined at the molecular level. Many clinical trials of new 
drugs are now considered to fail if only 10 percent of patients 
benefit, yet that 10 percent may represent a specific type of 
the disease, where the drug in question 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 disease.
    Parkinson's Disease.--The Committee understands that the 
Director, in accordance with the Udall Act, convened a research 
conference in June 2005. The Committee strongly urges the 
Director to report back to the Committee by May 1, 2006 to 
address current and ongoing Parkinson's disease research 
including the final analysis of the Parkinson's Disease 
Research Agenda that expired this year, the goals and 
conclusions from the summit held in June 2005, a thorough 
examination of the existing Parkinson's research portfolio, 
identification of shortcomings and opportunities for more 
effective treatments and a cure for Parkinson's, and 
recommendations of research goals for the next 3 years to help 
scientists better understand the causes, more quickly diagnose, 
and develop better treatments and a cure for Parkinson's 
disease.
    The Committee strongly urges the NIH to work in conjunction 
with the Centers for Disease Control and Prevention to 
investigate and report on geographic population clusters of 
incidence of Parkinson's disease. It is estimated that more 
than 1 million Americans are fighting Parkinson's disease and 
60,000 cases are newly diagnosed each year. However, these 
figures are only estimates. Further, it is believed that there 
are increasing numbers of Americans who are diagnosed with 
young onset Parkinson's disease. With a stronger understanding 
of who is impacted by this devastating disease, the NIH will be 
better able to better target critical research funds that will 
find treatments or cures for the more than 1 million Americans 
who have this progressive, neurodegenerative disease.
    Peer Review of Patient-Focused Research.--In 1998, the NIH 
Director's Panel on Clinical Research identified problems with 
NIH peer review of clinical research grant applications and 
recommended the organization of study sections capable also of 
reviewing patient-oriented research and the implementation of a 
system for tracking the review of these clinical research 
applications. Nevertheless, a 2002 General Accounting Office 
report to Congress indicated that the NIH did not have reliable 
methods for identifying and tracking patient-oriented research 
applications or reviewers. More recent analysis by the Center 
for Scientific Review has confirmed previous studies 
demonstrating that grant applications focused on patient-
oriented research are less likely to receive funding than 
laboratory research grant proposals. The Committee believes it 
is critically important that the Director take action to 
address this disparity and requests a report regarding efforts 
that are being undertaken to recruit clinical investigators to 
participate in the peer review process, to assure that patient-
oriented research applications are assigned to knowledgeable 
review groups, and to improve the system for tracking the 
review of clinical research grants to assure that shortcomings 
of the review process are identified and corrected.
    Pioneer Awards.--The Committee is pleased with the 
establishment of the NIH Director's Pioneer Award, an 
innovative program designed to encourage investigators to 
pursue high-risk research avenues of research with the 
potential to result in truly groundbreaking discoveries. The 
Committee is especially pleased that this program has attracted 
a large number of interested, high-quality applicants, but is 
concerned that relatively few awards have been made so far.
    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.
    The Committee urges the Director to support additional 
genetic research to identify the genes responsible for 
psoriasis susceptibility, basic research to understand the 
mechanism of disease and clinical research to identify new safe 
and effective therapies for these diseases.
    Rehabilitation Services.--The Committee recognizes the 
burgeoning growth in rehabilitation services provided to 
patients, especially the elderly, with musculoskeletal problems 
and the urgent need to establish a solid scientific basis for 
clinical practice in this area. The Committee urges the 
Director to establish a research program in the National Center 
for Medical Rehabilitation Research to: (1) evaluate the 
efficacy and establish optimal schedules and settings for 
movement based rehabilitation interventions, such as 
therapeutic exercise, to improve physical function in 
individuals with musculoskeletal conditions, including 
arthritis, back pain, hip fracture and major joint 
replacements, and (2) further knowledge of the underlying 
mechanisms of repair, regeneration and recovery of these 
interventions. The NCMRR is still a relatively new agency with 
a small budget and its research portfolio needs to be expanded 
particularly in the area of medical and physical rehabilitation 
and musculoskeletal conditions. The Committee urges the 
National Institute on Aging, the National Institute on 
Arthritis and Musculoskeletal and Skin Diseases, and the 
National Institute on Biomedical Imaging and Bioengineering to 
collaborate on these initiatives.
    Reproductive Health Research.--The Committee is concerned 
that the NIH does not have trans-NIH information regarding the 
amount of infertility and reproductive health research that is 
conducted in many Institutes including NICHD, NCI, NIDDK, 
NIAID, and NIEHS. The Committee is concerned that until NIH has 
accurate trans-NIH information, it is not possible to lead and 
coordinate this area of research to help ensure scientific and 
research progress. The Committee therefore urges that the 
Office of the Director ensure that such information is 
available in order to permit a vigorous scientific leadership 
with regard to this category of diseases that has devastating 
physical, social, financial and psychological consequences.
    Research Centers at Minority Health Institutions.--The 
Committee continues to be pleased with the NIH Director's 
implementation of various programs focused on developing 
research infrastructure at minority health professions 
institutions, including Research Centers at Minority 
Institutions, Extramural Biomedical Research Facilities, and 
the National Center on Minority Health and Health Disparities. 
The Committee encourages that the NIH Director work closely 
with the Director of the National Center on Minority Health and 
Health Disparities to establish a program of coordination among 
these various mechanisms to partner with minority health 
professions schools to address their infrastructure needs.
    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. While the Committee commends the active 
work and progress of NINDS on the SMA Project, the Committee 
remains concerned that other Institutes, to date, has made no 
commitment to SMA research. The Committee reiterates its 
request of last year that the OD take all necessary steps to 
ensure that relevant Institutes are fully engaged by devoting 
attention and resources to SMA and specifically to the SMA 
Project.
    Temporomandibular Joint Disorders [TMJ].--The Committee 
continues its strong support of research into TMJ disorders. 
The Committee agrees with and is encouraged by recent public 
statements by NIH officials that because of past and current 
investments in research and patient registries, the field is 
now ready to support a substantial new research investment in 
this complex set of disorders. The Committee therefore strongly 
urges that this path be followed and that a substantially 
expanded TMJ research effort be undertaken to speed up 
completion of the research needs and opportunities agenda 
outlined in the June 2005 NIH TMJ Report to Congress. As noted 
previously, the multifaceted nature of TMJ disorders requires 
an approach that coordinates the work of many interested 
parties at NIH. Therefore, this expanded effort should include 
increased efforts from all relevant ICs and should give 
priority to collaborative, cross-cutting research.
    In addition, the Committee strongly encourages the 
Director, through the NIDCR and ORWH, to undertake an effort to 
improve awareness among dentists and other relevant health 
professionals such as internists, rheumatologists, 
otolaryngologists, neurologists and other primary care 
professionals about TMJ disorders. Such an effort should 
include the development of a model symposium on this topic and 
the presentation of this symposium at relevant major medical 
society conferences.
    Trans-NIH Research Initiatives.--The Committee commends NIH 
for continuing to expand trans-NIH research initiatives that 
foster scientific collaboration and advancement. The Committee 
is particularly interested in programs like the Blueprint for 
Neuroscience Research, which pools the resources and expertise 
of 15 NIH institutes and centers to focus on disorders of the 
nervous system. The multidimensional roots of the obesity 
epidemic--encompassing behavioral, biological, and 
environmental factors--call for research efforts across 
Institutes and Centers, and the Committee commends the 
activities undertaken through the trans-NIH Strategic Plan for 
Obesity Research. The Committee urges that funds allocated to 
the NIH Institutes and Centers be used for increased support of 
the Neurosciences Blueprint and increased research in obesity.
    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 in 2003 called upon the 
NIH Director to formulate an NIH-wide research agenda. The 
Committee is encouraged by recent steps taken by the Office of 
the Director to establish a Trans-NIH Tuberous Sclerosis 
Coordinating Committee. The Committee encourages the Office to 
continue its support of this Committee and expand it to include 
other Institutes such as the NEI, NIGMS and NICHD.

                        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, 2005....................................    $110,288,000
Budget estimate, 2006...................................      81,900,000
House allowance.........................................      81,900,000
Committee recommendation................................     113,626,000

    The Committee recommends an appropriation of $113,626,000 
for buildings and facilities [B&F]. The budget requested 
$81,900,000 and the fiscal year 2005 appropriation was 
$110,288,000.
    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.

       Substance Abuse and Mental Health Services Administration

Appropriations, 2005....................................  $3,391,769,000
Budget estimate, 2006...................................   3,336,023,000
House allowance.........................................   3,352,047,000
Committee recommendation................................   3,385,086,000

    The Committee recommends $3,385,086,000 for the Substance 
Abuse and Mental Health Services Administration [SAMHSA] for 
fiscal year 2006. This amount is $6,683,000 below the 
comparable fiscal year 2005 level and $49,063,000 above 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. To further the translation of 
research knowledge into practice, the Committee supports the 
ongoing collaboration between SAMHSA and the National 
Institutes of Health (specifically with the National Institute 
of Mental Health, the National Institute on Drug Abuse, and the 
National Institute on Alcohol Abuse and Alcoholism). Through 
this partnership, services research conducted by NIH will 
identify effective treatment and prevention strategies, the 
findings of which will be promoted by SAMHSA through its 
knowledge dissemination programs to improve the quality of 
services rendered. Furthermore, outcomes from program 
evaluation research conducted by SAMHSA will be communicated as 
critical implementation feedback to NIH, and may ultimately 
lead to further improvements in the delivery of effective 
mental health and substance abuse services in community 
programs nationwide.
    The Committee expects that no less than the amounts 
allocated in fiscal year 2005 will be spent in fiscal year 2006 
on activities throughout SAMHSA addressing the needs of the 
homeless. Specifically, the Committee has provided funding at 
last year's level for programs directed at chronic homelessness 
and for programs directed at providing mental health and 
substance abuse treatment services to homeless.
    The Committee notes that, according to a study released by 
the New England Journal of Medicine, as many as one in four 
veterans of Afghanistan and Iraq treated at Veterans Affairs 
hospitals in the past 16 months have been diagnosed with mental 
disorders. While many at-risk veterans will take advantage of 
mental health services available through the Departments of 
Defense and Veterans Affairs, concern about possible 
stigmatization may lead some veterans to avoid treatment 
through these sources. The Committee believes that community 
outreach, early intervention and treatment for veterans will be 
a significant need in the coming years and encourages SAMHSA, 
through CMHS and CSAT, to develop opportunities for communities 
to prepare and coordinate mental health and addiction services 
for returning combat veterans and their families.
    Greater availability of a rapid HIV test can increase 
overall HIV testing and reduce the number of people, an 
estimated 225,000 Americans, who are unaware of their HIV 
infection. The Committee acknowledges that treatment services 
provided by mental and behavioral health care providers for 
individuals testing positive are a necessary component of rapid 
HIV testing. The Committee commends SAMHSA for developing the 
Rapid HIV Testing Initiative [RHTI] to train substance abuse 
and mental health service providers on rapid HIV testing and 
encourages SAMHSA to expand the program.
    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, 2005....................................    $901,317,000
Budget estimate, 2006...................................     837,250,000
House allowance.........................................     880,294,000
Committee recommendation................................     901,334,000

    The Committee recommends $901,334,000 for mental health 
services. This amount is $17,000 above the comparable level for 
fiscal year 2005 and $64,084,000 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.

Programs of Regional and National Significance

    The Committee recommends $274,297,000 for programs of 
regional and national significance. This amount is the same as 
the comparable level for fiscal year 2005 and $64,084,000 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 remains deeply concerned that suicide is the 
third leading cause of death among adolescents. Consistent with 
the recommendations of the President's New Freedom Commission 
on Mental Health, the Committee in fiscal year 2005 called upon 
SAMHSA to award grants to local educational systems or non-
profit entities in conjunction with local educational systems 
to test the use of screening mechanisms and to identify 
evidence-based practices for facilitating treatment for youth 
at risk. The Committee has provided funding at last year's 
level for SAMHSA to continue this effort in fiscal year 2006.
    In addition, the Committee has provided $11,000,000 for 
State and campus-based programs that address youth suicide 
prevention. This is an increase of $2,556,000 above the 
comparable level for fiscal year 2005 and the administration 
request. The Committee has included funding at last year's 
level 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 notes that the National Strategy for Suicide 
Prevention calls for the establishment of public/private 
partnerships for the purpose of advancing and coordinating the 
implementation of the National Strategy. While much progress 
has been made, many of the objectives included in the National 
Strategy have not been completed. The Committee commends SAMHSA 
for its work on examining the National Strategy objectives with 
the goal of developing a priority work plan and encourages 
SAMHSA to establish a coordinating body aimed at advancing the 
objectives of the National Strategy.
    The Committee continues to strongly support funding for 
prevention of youth violence. The Committee intends that no 
less than last year's level of funding be used for this 
initiative, which includes the Safe Schools/Healthy Students 
interdepartmental program. The administration proposed cutting 
this program by $27,427,000. The Committee believes that 
enhanced school and community-based services can strengthen 
healthy child development, thus reducing violent behavior and 
substance use. Since 1999, over 180 communities have received 
and benefited from these grants. The Committee therefore is 
providing funding at last year's level to assist 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 provides funding at last year's level 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 restores funding to the State 
Infrastructure Planning Grants activity. The administration 
request proposed to shift the funding source for this program 
to the CMHS block grant setaside. State Infrastructure Planning 
Grants are a critical initiative that informs both States and 
SAMHSA on practical implementation issues and mechanics related 
to the new performance and outcome data reporting requirements 
included in SAMHSA's Data Strategy.
    The Committee recommendation includes funding at last 
year's level for the elderly treatment and outreach program. 
The Committee notes that while many older Americans experience 
depression, dementia, anxiety and substance abuse disorders, 
far too often these conditions are not recognized or treated. 
Outreach to elderly persons conducted in places frequented by 
seniors, such as senior centers, meal sites, primary care 
settings and other locations, is needed. The elderly treatment 
and outreach program helps local communities establish the 
infrastructure necessary to better serve the mental health 
needs of older adults.
    The Committee recommendation fully funds the administration 
request for the 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, because the councils represent the consumer and 
family voice in States across the country.
    The Committee believes that research-based prevention and 
wellness promotion efforts that strengthen parenting and 
enhance child resilience in the face of adversity can have a 
significant impact on the mental health of children and youth. 
While some programs that use such a strengths-based approach 
exist for families already in contact with the juvenile justice 
system or immediate risk for dissolution, evidence suggests 
that they may be particularly effective for families that have 
one or more risk factors but are not yet in crisis and may not 
have had contact with child protective services or other 
government agencies. The Committee requests CMHS to provide it 
with a report by May 1, 2006 that reviews the effectiveness of 
such programs and the best ways to implement them so they reach 
families in need, and offers recommendations for future 
preventive efforts in this area.

Community Mental Health Services Block Grant

    The Committee recommends $432,756,000 for the community 
mental health services block grant, which is the same as the 
comparable fiscal year 2005 amount and the administration 
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 59 eligible States and Territories through a formula based 
upon specified economic and demographic factors. Applications 
must include an annual plan for providing comprehensive 
community mental health services to adults with a serious 
mental illness and children with a serious emotional 
disturbance. Because the mental health needs of our Nation's 
elderly population are often not met by existing programs and 
because the need for such services is dramatically and rapidly 
increasing, the Committee encourages SAMHSA to require that 
States' plans include specific provisions for mental health 
services for older adults.

Children's Mental Health Services

    The Committee recommends $105,129,000 for the children's 
mental health services program. This amount is $17,000 above 
the comparable fiscal year 2005 level and the same as the 
administration 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.

Projects for Assistance in Transition From Homelessness [PATH]

    The Committee recommends $54,809,000 for the PATH Program. 
This amount is the same as the comparable fiscal year 2005 
level and the administration request.
    PATH 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 $34,343,000 for the protection and 
advocacy program, which is the same as the comparable fiscal 
year 2005 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 States according to a formula 
based on population and relative per capita incomes.

                  CENTER FOR SUBSTANCE ABUSE TREATMENT

Appropriations, 2005....................................  $2,197,921,000
Budget estimate, 2006...................................   2,222,607,000
House allowance.........................................   2,184,986,000
Committee recommendation................................   2,187,646,000

    The Committee recommends $2,187,646,000 for substance abuse 
treatment programs. This amount is $10,275,000 below the 
comparable fiscal year 2005 funding level and $34,961,000 below 
the administration 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 commends the Center for Substance Treatment 
[CSAT] for its ongoing collaboration with the National 
Institute on Drug Abuse [NIDA]. The Committee continues to be 
pleased that the CSAT/NIDA collaboration with State substance 
abuse directors, also known as Single State Authorities [SSAs] 
for Substance Abuse, is improving the manner in which evidence-
based practices are used in our publicly funded system. The 
Committee encourages CSAT to continue its Blending Initiative 
with NIDA and SSAs to ensure that research findings are 
relevant and adaptable by State substance abuse systems.

Programs of Regional and National Significance

    The Committee recommends $412,091,000 for programs of 
regional and national significance [PRNS]. The recommendation 
includes $4,300,000 in transfers available under section 241 of 
the Public Health Service Act. The recommendation is 
$10,275,000 below the comparable fiscal year 2005 level and 
$34,961,000 below the administration request.
    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 expects that 
addictive disorder clinical treatment providers participating 
in the Access to Recovery program, as well as their respective 
staff, shall meet the certification, accreditation, and/or 
licensing standards recognized in their respective States.
    The Committee recommends funding at no less than last 
year's level for the Addiction Technology Transfer Centers 
[ATTCs]. The ATTC Network operates as 14 regional centers and 
one national office to translate the latest science of 
addiction, including evidence-based addiction treatment. The 
ATTCs are also an important component of the CSAT/NIDA Blending 
Initiative that seeks to improve the manner in which research 
findings are moved into every day practice.
    The Committee continues to be concerned about the incidence 
of drug addiction among pregnant and parenting women. The 
unavailability of family-based treatment is manifested in the 
overrepresentation of substance-abusing mothers in the child 
welfare system. Up to 80 percent of the families who come to 
the attention of child welfare agencies are substance abusing. 
The absence of treatment opportunities for families has also 
extended to the criminal justice system. Nearly 70 percent of 
the women behind bars are suffering from untreated addiction. 
Most of these women offenders are mothers: approximately 65 
percent of women in State prisons, and 59 percent of women in 
Federal prisons have young children.
    SAMHSA's evaluation of both the Residential Women and 
Children [RWC] and Pregnant and Postpartum Women [PPW] programs 
showed significantly reduced alcohol and drug use, as well as 
decreased criminal behavior. Rates of premature delivery, low 
birth weight, and infant mortality were improved for 
participating women. In addition, treatment costs were offset 
three to four times by savings from reduced costs of crime, 
foster care, Temporary Assistance to Needy Families [TANF], and 
adverse birth outcomes. The Committee believes that increased 
capacity for family-based treatment programs is imperative. 
Within the funds appropriated for CSAT, the Committee 
recommends $11,000,000 for treatment programs for pregnant, 
postpartum, and residential women and their children. This 
amount is $1,080,000 above the comparable level for fiscal year 
2005 and the administration request. 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. In addition, the 
Committee strongly urges SAMHSA to explore ways to increase 
family treatment capacity.

Substance Abuse Prevention and Treatment Block Grant

    The Committee recommends $1,775,555,000 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 the 
same as the comparable level for fiscal year 2005 and 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.
    The Committee wishes to express its strong support for 
increased funding for the Substance Abuse Prevention and 
Treatment [SAPT] Block Grant, an effective and efficient 
funding stream that flows to every State and territory. The 
Committee is aware that the SAPT Block Grant funds critical 
prevention and treatment services for our Nation's most 
vulnerable citizens, including those with HIV/AIDS, pregnant 
women, and others who can not afford these lifesaving services. 
The Committee continues to believe 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 SAPT Block Grant.
    The Committee is aware of SAMHSA's efforts to improve the 
quality of substance abuse prevention and treatment data by 
seeking information on a core set of National Outcome Measures 
[NOMS] across all SAMHSA funding mechanisms, including services 
funded by the SAPT Block Grant. The Committee is also aware of 
SAMHSA's work to implement a State Outcomes Measurement and 
Management System [SOMMS] as the mechanism to achieve this 
initiative. The Committee commends SAMHSA for working with 
States and territories to streamline data reporting 
requirements and reduce reporting burden while improving 
accountability. The Committee strongly encourages SAMHSA to 
continue to work with States and territories to reach consensus 
on all aspects of SOMMS planning, implementation and 
evaluation.
    The Committee recognizes that States receiving the HIV set-
aside within their Substance Abuse Prevention and Treatment 
Block Grant are well positioned to offer hepatitis prevention 
services to high risk clients, and encourages set-aside dollars 
to be used to support hepatitis prevention. The Committee 
recognizes that the majority of new hepatitis C virus 
infections are related to drug use, and asks SAMHSA to 
encourage all grantees to incorporate hepatitis prevention 
services, such as hepatitis C screening, into existing drug 
treatment programs.

                 CENTER FOR SUBSTANCE ABUSE PREVENTION

Appropriations, 2005....................................    $198,725,000
Budget estimate, 2006...................................     184,349,000
House allowance.........................................     194,950,000
Committee recommendation................................     202,289,000

    The Committee recommends $202,289,000 for programs to 
prevent substance abuse, which is $3,564,000 above the 
comparable fiscal year 2005 level and $17,940,000 above the 
administration request.
    The Committee recognizes the important role played by the 
20 percent prevention services set-aside within the Substance 
Abuse Prevention and Treatment [SAPT] Block Grant. This vital 
substance abuse prevention funding helped contribute to the 
fact that 600,000 fewer teens used drugs in 2004 compared to 
2001, according to the Monitoring the Future survey. The 
Committee also supports the need to recognize substance abuse 
prevention as a unique, separate and distinct field and 
encourages SAMHSA to promote programming consistent with this 
finding, including a strong role for CSAP as the Federal 
Government's lead agency for substance abuse prevention.
    The Committee is concerned about the intersection of 
methamphetamine abuse and the transmission of infectious 
diseases such as HIV and Hepatitis C. Both SAMHSA and the 
Centers for Disease Control and Prevention [CDC] have funded 
crucial programs targeting methamphetamine abuse and infectious 
disease prevention. However, the intersection of 
methamphetamine abuse and infectious disease has not been 
adequately addressed. Recognizing that the two agencies have 
different responsibilities in responding to the damage caused 
by the drug abuse epidemic, the Committee requests that SAMHSA 
and CDC draft a list of priorities to address the intersections 
of these two epidemics and provide a collaborative written 
report by April 1, 2006, designating a coordinating plan 
between SAMSHA and CDC. The plan should include a proposed 
infrastructure, needed resources, mechanisms of communication, 
and community involvement representing populations at high-risk 
to coordinate prevention, community outreach, professional 
training, treatment and new and existing grant programs to 
effectively address the intersection of the crystal 
methamphetamine epidemic and rising HIV rates.

Programs of Regional and National Significance

    The Committee has provided $202,289,000 for programs of 
regional and national significance [PRNS]. The recommendation 
is $3,564,000 above the comparable fiscal year 2005 level and 
$17,940,000 above the administration request. The Center for 
Substance Abuse Prevention is the sole Federal organization 
with responsibility for improving accessibility and quality of 
substance abuse prevention services. Through the programs of 
regional and national significance activity, CSAP supports: 
development of new practice knowledge on substance abuse 
prevention; identification of proven effective models; 
dissemination of science-based intervention information; State 
and community capacity-building for implementation of proven 
effective substance abuse prevention programs; and programs 
addressing new needs in the prevention system.
    The Committee recommendation includes $93,488,000 for the 
Strategic Prevention Framework State Incentive Grant [SPFSIG] 
program, which is designed to promote, bolster and sustain 
prevention infrastructure for every State in the country. The 
Committee recognizes that a linchpin of this program is State 
flexibility so that each State may tailor initiatives and 
direct resources in ways that are most appropriate for its own 
jurisdiction. The Committee encourages SAMHSA to promote 
maximum State flexibility in managing the SPFSIG program and 
the 20 percent prevention set-aside within the Substance Abuse 
Prevention and Treatment [SAPT] Block Grant so that each State 
may employ a range of effective prevention strategies to meet 
their own unique needs and local circumstances.
    The Committee expects SAMHSA to ensure that SPFSIG grantees 
do not fund duplicative sub-state anti-drug coalition 
infrastructures, but utilize those already functioning and 
funded by programs such as the Drug Free Communities program.
    The Committee remains very concerned about the prevalence 
of methamphetamine use. According to the National Survey on 
Drug Use and Health [NSDUH], approximately 12.3 million 
Americans ages 12 or over tried methamphetamine in 2003. In 
more than three-quarters of Western States, methamphetamine and 
amphetamine-related treatment admissions rates are higher than 
those for cocaine or heroin. While methamphetamine is a serious 
problem on the West Coast, in the Mountain States and in parts 
of the Midwest, recent data suggest that the problem may be 
spreading eastward. Since fiscal year 2003 the Committee has 
provided $14,000,000 to twelve States for grants aimed at 
expanding the capacity of health care and community 
organizations to address methamphetamine abuse. The Committee 
is disturbed that the administration did not request funding 
for this program in fiscal year 2006. The Committee's 
recommendation includes $4,000,000 to continue this program.
    With the consolidation of the contracts for the National 
Clearinghouse for Alcohol and Other Drug Information and the 
Mental Health Clearinghouse, the Committee expects SAMHSA to 
ensure that the funding and materials available for substance 
abuse prevention be maintained at no less than current levels.
    The Committee recommendation includes $850,000 for the 
third year of the Ad Council's parent-oriented media campaign 
to combat underage drinking. Previous funding for the campaign 
was provided through the Office of the Secretary.

                           PROGRAM MANAGEMENT

    The Committee recommends $93,817,000 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 $11,000 above 
the comparable level for fiscal year 2005 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.
    Last year the Committee included funds for SAMHSA to 
``establish surveillance measures to address the mental and 
behavioral health needs of the population of the United 
States.'' The Committee is pleased that SAMHSA decided to work 
with the Centers for Disease Control and Prevention [CDC] to 
include questions on mental health in a CDC survey known as the 
Behavioral Risk Factor Surveillance System. The funds are being 
used to test appropriate questions and to help defray the cost 
of including them in the survey. Funds are also being provided 
to help States respond to the surveys. The Committee 
recommendation for fiscal year 2006 includes $2,000,000 to 
expand on the collaborative effort by SAMHSA and CDC to 
establish a population-based source of data on the mental and 
behavioral health needs in this country. These data will help 
policymakers implement the recommendations of the President's 
New Freedom Commission on Mental Health report ``Achieving the 
Promise: Transforming Mental Health Care in America.''
    The Committee recognizes the benefits of client level data 
reporting in order to build a more accurate picture of 
Americans in need of prevention and treatment services. The 
Committee strongly encourages SAMHSA to reach out to the 
Department of Justice, Department of Education, Health 
Resources and Services Administration [HRSA] and other Federal 
agencies to ensure that all Federal grants seek client level 
data reporting in order to complement and coordinate with 
SAMHSA's National Outcomes Measurement [NOMS] and State 
Outcomes Measurement and Management Initiative [SOMMS] 
initiatives.

               Agency for Healthcare Research and Quality

Appropriations, 2005....................................    $318,695,000
Budget estimate, 2006...................................     318,695,000
House allowance.........................................     318,695,000
Committee recommendation................................     323,695,000

    The Committee recommends $323,695,000 for the Agency for 
Healthcare Research and Quality [AHRQ]. This amount is 
$5,000,000 above both the administration request and the 
comparable funding level for fiscal year 2005. 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 $265,695,000 for research on health 
costs, quality and outcomes [HCQO]. This amount is $5,000,000 
above both the administration request and the comparable amount 
for fiscal year 2005. 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.
    For fiscal year 2006, the Committee directs AHRQ to devote 
$84,000,000 of the total amount provided for HCQO to 
determining ways to reduce medical errors. Of this amount, 
$50,000,000 will support the Department's initiative to promote 
the development, adoption and diffusion of information 
technology in health care.
    The Committee recognizes the work that AHRQ has done 
regarding comparative effectiveness research. Comparative 
effectiveness research has the potential to lower health care 
costs while improving quality of care. The Committee directs 
AHRQ to devote $20,000,000 of the total amount provided to 
research authorized under Section 1013 of the Medicare 
Prescription Drug, Improvement and Modernization Act of 2003. 
The Committee's recommendation is $5,000,0000 more than the 
amount provided last year. The increased funding will allow 
AHRQ to continue and build upon the priority list of conditions 
identified in fiscal year 2005.
    Autoimmune Disease.--In order to support 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 is pleased AHRQ 
is studying standards of care issues associated with patients 
diagnosed with Duchenne Muscular Dystrophy. The Committee urges 
AHRQ to build on this work by partnering with CDC to convene a 
consensus conference to develop these standards.
    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 
evidence-based reports to physicians and other health care 
professionals.
    Health Disparities.--The Committee remains disturbed by the 
March 2002 Institute of Medicine report regarding the 
disparities of medical care delivery to minorities. The 
Committee encourages AHRQ to carefully evaluate the analysis, 
findings, and recommendations of this study in order to pursue 
creative ways to improve health care delivery for all minority 
populations, including African-Americans, those of Hispanic and 
Asian origin, Native Americans, Alaskans and Native Hawaiians.
    Hospital-based Initiative.--The Committee urges 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.
    Investigator-initiated Research.--The Committee notes that 
the Department reallocated $11,518,000 from AHRQ in fiscal year 
2005 to fund the Department's health information technology 
initiative. While the Committee strongly supports this 
initiative, it notes that this reallocation delayed the start 
of several non-patient safety grant programs. Research outside 
of targeted areas such as patient safety, health IT and 
comparative effectiveness is a critical part of AHRQ's mission 
yet these grants are a diminishing portion of the agency's 
research portfolio. The Committee notes that important 
initiatives like the patient safety program were based on 
investigator-initiated research. The Committee strongly urges 
AHRQ to maximixe investigator-initiated research.
    Nurse-Managed Health Centers.--The Committee encourages 
AHRQ to include nurse managed health centers and advanced 
practice nurses in research and demonstration projects 
conducted by the agency.

                   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 2005 level. This activity supports the 
overall management of the Agency.

               Centers for Medicare and Medicaid Services


                     GRANTS TO STATES FOR MEDICAID

Appropriations, 2005

                                                        $123,779,019,000

Budget estimate, 2006

                                                         156,954,419,000

House allowance

                                                         156,954,419,000
Committee recommendation
                                                         156,954,419,000

    The Committee recommends $156,954,419,000 for Grants to 
States for Medicaid. This amount is $33,175,400,000 more than 
the fiscal year 2005 appropriation and the same as the 
administration's request and House allowance. This amount 
excludes $58,517,290,000 in fiscal year 2005 advance 
appropriations for fiscal year 2006. In addition, 
$62,783,825,000 is provided for the first quarter of fiscal 
year 2007, as requested by the administration. Fiscal year 2006 
funding increases by $22,910,109,000 to fund obligations 
incurred but not reported in fiscal year 2005, thus reflecting 
the shift in the program from a cash basis of accounting to 
accrual-based accounting. 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, 2005

                                                        $114,608,900,000

Budget estimate, 2006

                                                         177,822,200,000

House allowance

                                                         177,742,200,000
Committee recommendation
                                                         177,822,200,000

    The Committee recommends $177,822,200,000 for Federal 
payments to health care trust funds. This amount is the same as 
the administration's request, $80,000,000 more than the House 
allowance, and is an increase of $63,213,300,000 from the 
fiscal year 2005 appropriation. The significant funding 
increase is largely due to the cost of the new prescription 
drug benefit. This entitlement account includes the general 
fund subsidy to the Federal Supplementary Medical Insurance 
Trust Fund for Medicare Part B benefits and for Medicare Part D 
drug benefits and administration, plus other reimbursements to 
the Federal Hospital Insurance Trust Fund for Part A benefits 
and related administrative costs that have not been financed by 
payroll taxes or premium contributions. The Committee has 
provided $128,015,000,000 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 $14,013,000,000 more than the fiscal year 2005 
amount. The Committee further provides $53,596,000,000 for the 
general fund share of benefits paid under Public Law 108-173, 
the Medicare Prescription Drug, Improvement and Modernization 
Act of 2003. The Committee includes bill language requested by 
the administration providing indefinite authority for paying 
the General Revenue portion of the Part B premium match and 
provides resources for the Part D drug benefit program in the 
event that the annual appropriation is insufficient. The 
recommendation also includes $202,000,000 for hospital 
insurance for the uninsured. This amount is the same as the 
administration's request and is $115,000,000 more than the 
fiscal year 2005 amount. The Committee also recommends 
$206,000,000 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 $7,000,000 over the 
fiscal year 2005 level, reflecting an increase on the number of 
covered individuals who are currently enrolled. The Committee 
recommendation includes $164,000,000 to be transferred to the 
Hospital Insurance Trust Fund as the general fund share of CMS 
Program Management administrative expenses. This amount is the 
same as the administration's request and is $51,000,000 less 
than the fiscal year 2005 amount. The Committee recommendation 
also includes $677,000,000 to be transferred to the 
Supplementary Insurance Trust Fund as the general fund share of 
Part D administrative expenses. This amount is the same as the 
administration's request. The recommendation also provides 
$99,100,000 for State low-income determination activities 
through the prescription drug account. This amount is the same 
as the administration's request and is $6,800,000 less than the 
2005 amount. The Committee recommends $80,000,000 as 
reimbursement to the Health Care Fraud and Abuse Control 
[HCFAC] fund, described in a separate account, for new program 
integrity activities to be funded as discretionary spending. 
The House did not fund this account.

                  HEALTH CARE FRAUD AND ABUSE CONTROL

Appropriations, 2005....................................................
Budget estimate, 2006...................................     $80,000,000
House allowance.........................................................
Committee recommendation................................      80,000,000

    The Committee recommends $80,000,000 for program integrity 
activities to be funded in fiscal year 2006 through a 
discretionary cap adjustment. These funds will be reimbursed 
from the Payment to the Health Care Trust Funds appropriation. 
Of this total, $75,000,000 is for program integrity activities 
related to the new Part D prescription drug benefit and 
$5,000,000 for enhanced Medicaid financial management. The 
House did not fund this account.
    The Committee notes that mandatory funding for program 
integrity activities has not increased since fiscal year 2003 
and that the Part D prescription drug legislation did not 
include resources for program oversight. The Committee 
recommends $75,000,000 to be used to initiate program integrity 
efforts related to the new prescription drug benefit in the 
Medicare Integrity Program. The Committee recommends $5,000,000 
to augment the role of the CMS in financial management and 
oversight of program integrity efforts in the Medicaid and 
SCHIP grant programs.
    The Committee encourages CMS to consider implementing a 
Medicare analysis and detection system, aimed at reducing 
fraud, waste, and abuse through use of supercomputing 
technology.

                           PROGRAM MANAGEMENT

Appropriations, 2005....................................  $2,664,911,000
Budget estimate, 2006...................................   3,177,478,000
House allowance.........................................   3,180,284,000
Committee recommendation................................   3,203,418,000

    The Committee recommends $3,203,418,000 for CMS program 
management, which is $25,940,000 more than the amount requested 
by the administration $23,134,000 more than the House 
allowance, and $538,507,000 more than the fiscal year 2005 
enacted level. Fiscal year 2006 marks the first year that 
funding for ongoing Medicare Modernization Act [MMA] activities 
is included in the CMS Program Management appropriation. The 
Committee recommends the budget request of $560,000,000 for 
ongoing MMA activities in fiscal year 2006.

Research, Demonstrations, and Evaluations

    The Committee recommends $78,494,000 for research, 
demonstrations, and evaluation activities. This amount is 
$33,300,000 more than the budget request, and $1,000,000 more 
than the 2005 level.
    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, projects to measure the impact of Medicare 
and Medicaid on health care costs, projects to measure patient 
outcomes in a variety of treatment settings, and projects to 
develop alternative strategies for reimbursement, coverage, and 
program management.
    The Committee has included $40,000,000 for Real Choice 
Systems Change Grants for Community Living to States to fund 
initiatives that establish enduring and systemic improvements 
in long-term services and supports. Given the progress to date, 
the Committee recommends the issuance of a grant solicitation 
designed to provide a greater level of support to grantees to 
effectively identify and target requisite components of a 
coherent and integrated system of long-term care supports. The 
Secretary shall also allocate a portion of funding to: provide 
technical assistance to grantees on the development of a 
strategic plan to achieve systems transformation; maintain an 
information system that facilitates acquisition of data and 
information necessary to assess the progress of states in 
transforming their long-term care systems; and conduct an 
evaluation that would provide specific, measurable indicators 
of whether systems transformation has been achieved.
    The Committee commends CMS for implementing section 1860d-
4(c)(2) of the Medicare Modernization Act requiring Part D 
prescription drug sponsors to provide medication therapy 
management services [MTMP] to targeted Medicare Part D 
enrollees. MTMP are critical to improving health outcomes and 
to reducing medication errors for targeted Medicare 
beneficiaries with chronic conditions and high drug costs. The 
Committee encourages CMS to conduct a demonstration project to 
identify effective MTMP models for targeted Medicare Part D 
enrollees, capable of implementation on a large scale. This 
demonstration project should include approaches that emphasize 
evidence-based prescribing, prospective medication management, 
technological innovation, and outcomes reporting.

Medicare Operations

    The Committee recommends $2,184,984,000 for Medicare 
operations, which is $5,003,000 less than the amount requested 
by the administration. In addition, $720,000,000 is available 
for the Medicare Integrity Program within the mandatory budget 
as well as $80,000,000 recommended in this bill for a new 
Health Care Fraud and Abuse Control account.
    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. SHIPs provide one-on-one counseling to beneficiaries 
on complex Medicare-related topics, including Medicare 
entitlement and enrollment, health plan options, prescription 
drug benefits, Medigap and long-term care insurance, and 
Medicaid.
    The Committee recommends that $79,934,000 be made available 
for obligation over a 2-year period ending September 30, 2007, 
for contract costs pursuant to the development of the 
Healthcare Integrated General Ledger Accounting System 
[HIGLAS].
    CMS is encouraged to explore alternative approaches for 
recruiting, training and employing the severely disabled for 1-
800-MEDICARE. The outcome will identify work activities 
performed by severely disabled individuals that fully support 
the needs of the 1-800-MEDICARE program and promote the 
employment of people with disabilities. CMS is encouraged to 
work directly with the National Industries for the Severely 
Handicapped [NISH] organization to develop the approach and to 
subsequently implement within the 1-800-MEDICARE program.
    Medicare contractors partner with Federal Government to 
administer the Medicare fee-for-service program. Contractors 
pay over 1 billion Medicare fee-for-service claims annually, 
are the first line of defense against Medicare fraud, and are 
the primary contact for Medicare providers and beneficiaries. 
Without adequate funding, contractors are not able to pay 
claims, respond to beneficiary and provider inquiries timely, 
and effectively combat fraud and abuse. The Committee is 
pleased CMS eliminated the 5 percent cap on transferring funds 
among Medicare functions so that contractors have greater 
flexibility to manage their budgets in a manner that best 
matches program requirements. Budget flexibility is important 
to Medicare contractors, particularly in a tight funding 
environment. The Committee understands an existing statute 
capped Medicare Integrity Program [MIP] funding at $720,000,000 
in fiscal year 2003. The Committee believes that Medicare 
contractors must be given greater flexibility to effectively 
manage their MIP resources given the continuing increases in 
claims volume. In fact claims have risen by more than 16 
percent since MIP was last increased. The Committee strongly 
recommends CMS give Medicare Contractors and Program Safeguard 
Contractors greater flexibility to manage their Medicare 
Integrity Program [MIP] funding in a manner that best matches 
program requirements including increases in workload. The 
Committee expects CMS to report on its plans to provide this 
flexibility to contractors in its fiscal year 2007 
congressional justification.

State Survey and Certification

    The Committee recommends $260,735,000, the budget estimate 
and House allowance, for Medicare State survey and 
certification activities, which is $2,000,000 more than the 
fiscal year 2005 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 $655,000,000 for Federal 
administration costs, which is an increase of $73,507,000, over 
the fiscal year 2005 level. This funding level allows for fixed 
cost increases associated with the current staffing level of 
4,398 full-time equivalent positions. Savings from the request 
level of $657,357,000 are expected to be made in travel 
expenses and such administrative costs as printing and postage.
    The Committee recommends continuing the Healthy Start, Grow 
Smart program, which disseminates informational brochures to 
new Medicaid-eligible mothers. These brochures are distributed 
at the time of birth, 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, Healthy Start pamphlets include vital 
health and safety information for new parents.
    During last year's consideration of the Omnibus 
Appropriations Act, the Committee expressed its concerns with 
the lack of adequate funding for section 508 of the Medicare 
Modernization Act. The Committee directed CMS to report back on 
the number of hospitals that qualified for reclassification 
under section 508; the number of hospitals that qualified but 
received no funding; and a cost estimate, by year, of the 
amounts needed to fully fund these hospitals over 3 years. The 
Committee recently received the required report from CMS, 
several months late and well into this year's appropriations 
process. The report finds the cost to fully fund section 508 
reclassification for hospitals that qualified for funding but 
received no funds to be approximately $1,050,000,000 to 
$1,080,000,000 for 3 years or $350,000,000 to $360,000,000 for 
1 year. The Committee believes that it is important to find 
resources to expand section 508 reclassifications to as many 
unfunded hospitals as possible as a necessary first step in 
addressing the inequities caused by the existing wage index 
determinations, while a long-term solution is developed.
    The Committee expects that programs funded under the 
authority of the Ryan White Act (title XXVI of the Public 
Health Service Act) continue to be considered as payors of last 
resort in any Federal or State health benefits program. The 
Committee expects CMS to conform its program guidance to 
preserve the status of Ryan White funds as the payor of last 
resort. The Committee further requests that the Government 
Accountability Office study the legislative intent regarding 
the interaction of Ryan White and Medicare Part D spending, and 
report its findings by October 1, 2005. The report should 
examine whether Ryan White spending should be able to provide 
``wrap around'' coverage which counts toward true out-of-pocket 
costs and thus catastrophic coverage under Part D of the 
Medicare Modernization Act.
    The Committee commends CMS for its outreach efforts to help 
dually eligible beneficiaries transfer from Medicaid 
prescription drug coverage to the new Medicare Part D program. 
However, the Committee believes that low-income dual eligible 
persons with mental disabilities will need additional 
assistance with Part D enrollment decisions and both 
pharmaceutical and formulary changes. The Committee urges CMS 
to support one-on-one pharmaceutical benefits counseling 
through community-based organizations and safety net mental 
health providers in order to address this need.
    The Committee is very 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 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 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 is aware that legislation authorizing direct 
Medicare reimbursement to nurse practitioners providing 
reimbursable Medicare Services, was passed by Congress and 
signed into law, effective January 1, 1998. Since that time 
nurse practitioners have been providing reimbursable care to 
patients as Part B providers. Despite their ability to provide 
and bill for services rendered in all of these areas, they are 
still unable to refer patients to home health or hospice care. 
The apparent reason is that an expanded interpretation of the 
word ``physician'' is needed in Part A, Section 1814, of the 
Medicare law in order for home health agencies and hospice 
centers to accept these referrals.
    The Committee is very aware that nurse practitioners have 
been demonstrated to provide safe and responsible care to the 
patients they serve. They have expert knowledge that allows 
them to provide high level assessments of patients needs and 
recognize when additional care, such as home health and hospice 
care is needed or not needed by their patients. The Committee 
urges CMS to reinterpret the statute that will authorize home 
health agencies and hospices to accept orders from nurse 
practitioners.
    The Committee recognizes that rural residents account for 
25 percent of the general population in the United States with 
a disproportionate number of them being seniors. Additionally, 
67 percent of the country's primary care health professional 
shortage areas are located in rural areas and access to 
specialized care is limited for seniors. The Committee urges 
CMS to consider funding projects with a focus on rural 
healthcare, specifically those serving minority populations 
such as Native Hawaiians, Native Alaskans, and Native 
Americans.
    The Committee expects CMS to promulgate regulations 
providing the option of direct access to licensed audiologists 
under similar terms and conditions used by the Department of 
Veterans Affairs and the Office of Personnel Management. The 
Department of Veterans Affairs reports that direct access 
provides high-quality, efficient, and cost-effective hearing 
care.
    The Secretary of HHS is encouraged to include, in 
negotiating Prime contracts supporting the Medicare 
Prescription Drug Plan Program Part D, small business and small 
disadvantaged business subcontracting plan requirements. These 
subcontract plans should achieve a participation rate of not 
less than 5 percent of the total value of prime contract award 
for each fiscal year.
    The Committee expects CMS to conduct a demonstration to 
develop a pilot program to assist patients with expensive 
chronic illnesses, including hepatitis, in securing private 
health insurance. Non-profit organizations such as Patient 
Services, Inc. have had success on a State level in assisting 
families burdened by chronic illness in retaining or obtaining 
insurance coverage. This transitional support has saved State 
dollars by reducing reliance on Medicaid and keeping patients 
with expensive chronic illnesses insured. The Committee is 
hopeful that this model can be expanded to achieve savings on a 
national level.
    Those State Pharmaceutical Assistance Programs (SPAPs) 
whose outreach plans have been approved and awarded outreach 
grants by CMS may rollover any unspent fiscal year 2005 grant 
monies into the next Federal fiscal year to be used to bring 
the initiative to completion (section 221).
    A qualified pharmacy workforce is necessary to fully 
implement efforts to improve the quality of care received by 
our Nation's seniors, particularly high-risk seniors who have 
multiple chronic conditions and are taking multiple 
medications. The committee therefore urges CMS to carefully 
review its decision to cut Medicare funding for second-year, 
specialized pharmacy residency programs, which provide 
specialized training to medication use experts in areas like 
geriatrics, oncology, and critical care, taking into account 
new data submitted by national pharmacist associations, and 
provide a full report back to the Committee within 3 months 
with the Agency's rationale for any decision that results in 
these programs remaining un-funded.
    Deep-vein thrombosis affects more than 2 million Americans 
each year and its complications also take a toll on our 
Nation's hospital systems, costing approximately $860,000,000 
annually. It has been brought to the Committee's attention that 
there is a large gap between knowledge and practice where deep-
vein thrombosis and associated morbidity and mortality 
including Pulmonary Embolus and Post Thrombotic Syndrome are 
concerned. In order to identify ways to reduce the burden of 
deep-vein thrombosis and associated complications including 
death in the inpatient setting, the Center for Medicare and 
Medicaid Services is encouraged to develop a demonstration 
project, with from experts in the field to: analyze ongoing 
practices to appropriately assess and prophylax ``at risk'' 
surgical and medical patients; implement a process within 
demonstration study sites to improve appropriate prophylaxis; 
and, create a follow-up report on steps of implementation and 
an outcomes report, to define the impact of the program.
    The Committee supports programs that can demonstrate the 
feasibility of achieving quality improvement as well as cost 
savings to the Medicare program through improved quality of 
care. In this regard, the Committee encourages CMS to consider 
a quality-focused cost containment in cardiac surgery for 
Medicare beneficiaries pilot program to demonstrate and 
quantify cost savings possible through quality improvement 
efforts.

Revitalization Plan

    The Committee recommends the budget request and House 
allowance of $24,205,000 in 2-year budget authority, as the 
third-year investment in CMS's efforts to make significant 
improvements to key aspects of managing the Agency and the 
Medicare program. First-year funding in fiscal year 2004 was 
$29,619,000 and second-year funding was $24,205,000 for fiscal 
year 2005. Funding in fiscal year 2006 will target system-
related improvements, and continue addressing long-term 
information technology issues, including Medicare claims 
processing redesign activities. The Committee urges CMS to 
augment information technology activities utilizing resources 
available under the Quality Improvement Organization program.

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, 2005....................................  $2,873,802,000
Budget estimate, 2006...................................   2,071,943,000
House allowance.........................................   2,121,643,000
Committee recommendation................................   2,121,643,000

    The Committee recommends $2,121,643,000 be made available 
in fiscal year 2006 for payments to States for child support 
enforcement and family support programs. The comparable funding 
level for fiscal year 2005 is $2,873,802,000 and the budget 
request includes $2,071,943,000 for this program. The Committee 
recommendation provides the full amount requested under current 
law. The budget request includes net savings of $49,700,000 
based on proposed legislation.
    These payments support the States' efforts to promote the 
self-sufficiency and economic security of low-income families. 
These funds also support efforts to locate 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, an estimated $208,000,000 from offsetting 
collections, and an estimated carryover of $740,173,000, 
supports a program level of $4,269,816,000.
    The Committee also has provided $1,200,000,000 in advance 
funding for the first quarter of fiscal year 2007 for the child 
support enforcement program, the same as the budget request.

               LOW-INCOME HOME ENERGY ASSISTANCE PROGRAM

Appropriations, 2005....................................  $2,182,399,000
Budget estimate, 2006...................................   2,000,000,000
House allowance.........................................   2,006,799,000
Committee recommendation................................   2,183,000,000

    The Committee recommends $2,183,000,000 for fiscal year 
2006 for LIHEAP. The comparable funding level for fiscal year 
2005 is $2,182,399,000 and the budget request includes 
$2,000,000,000 for this program. LIHEAP is made up of two 
components: the State grant program and the contingency fund.
    The Committee recommendation includes $1,883,000,000 for 
fiscal year 2006 for the State grant program. The comparable 
funding level for fiscal year 2005 is $1,884,799,000 and the 
budget request includes $1,800,000,000 for this program. Within 
the funds provided, the Committee recommends $500,000 for a 
feasibility study, 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 recommendation includes $300,000,000 for 
fiscal year 2006 for an emergency fund to meet the additional 
home energy assistance needs arising from a natural disaster or 
other emergencies. The comparable funding level for fiscal year 
2005 is $297,600,000 and the budget request does not include 
funds designated as emergency for this program, but did request 
$200,000,000 for the contingency fund.
    The Committee intends that up to $27,500,000 of the amount 
recommended for LIHEAP for fiscal year 2006 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, 2005....................................    $484,394,000
Budget estimate, 2006...................................     552,040,000
House allowance.........................................     560,919,000
Committee recommendation................................     571,140,000

    The Committee recommends $571,140,000 for fiscal year 2006 
for refugee and entrant assistance. The comparable funding 
level for fiscal year 2005 is $484,394,000 and the budget 
request includes $552,040,000 for this program.
    The Refugee and Entrant Assistance Program is designed to 
assist States in their efforts to assimilate refugees, asylees, 
Cuban and Haitian entrants, and adults and minors who are 
trafficking victims, into American society as quickly and 
effectively as possible. The program funds State-administered 
transitional and medical assistance, the voluntary agency 
matching grant program, programs for victims of trafficking and 
torture, employment and social services, targeted assistance, 
and preventive health. Based on an estimated refugee admission 
ceiling of 70,000, this appropriation enables States 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 $268,229,000 for transitional 
and medical assistance including State administration and the 
voluntary agency program, of which $4,100,000 is from emergency 
funds; $9,915,000 for victims of trafficking; $151,121,000 for 
social services; $4,796,000 for preventive health; and 
$49,081,000 for targeted assistance.
    For unaccompanied children, pursuant to section 462 of the 
Homeland Security Act of 2002, the Committee recommends 
$78,083,000, of which $15,000,000 is from emergency funds. 
Funds are provided for the care and placement of unaccompanied 
alien minors in the Office of Refugee Resettlement. In fiscal 
year 2006 there will be approximately 9,600 placements for 
unaccompanied alien children apprehended in the United States 
by INS/Homeland Security agents, Border Patrol officers, or 
other law enforcement agencies. These children are then taken 
into care pending resolution of their claims for relief under 
U.S. immigration law, released to an adult family member, or 
released to a responsible adult guardian.
    The Committee also recommends $9,915,000 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 recommends ORR support core funding of 
strong regional programs that invest carefully in building 
their rehabilitation programs that produce research and 
knowledge in this new field. Those organizations can then be 
expected to organize training for mainstream health care 
providers.
    The Committee bill includes $19,100,000 in emergency funds 
for the unanticipated and significantly increased demand for 
services to individuals eligible for assistance, of which 
$4,100,000 is for transitional and medical services and 
$15,000,000 is for unaccompanied alien children programs. An 
increasing share of refugee admissions are coming from Africa 
and Thailand and these refugees have far more costly medical 
needs than previous arrivals from Russia and Southeast Asian 
countries due in part to increased health screening tests and 
lab cultures, increased medical treatment for parasites, HIV, 
and multiple drug-resistant TB, and increased prostheses and 
rehabilitation for machete victims. These refugees also tend to 
stay on refugee cash assistance longer because they require 
more intensive services for reading and writing in their native 
language, English as a Second Language, and job placement. 
There also has been a much higher than anticipated increase in 
unaccompanied alien children entering the United States and 
being placed in the care of ORR. While the fiscal year 2005 
appropriation assumed an increase of 20 percent in this 
program, the actual increases are close to 30 percent. These 
additional funds are needed to address these unanticipated 
situations.
    The Committee is deeply concerned that accompanied 
children, even as young as nursing infants, who are apprehended 
by the Department of Homeland Security [DHS] are being 
separated from their parents and being placed in the 
unaccompanied alien children program while their parents are 
held in separate adult facilities. The Committee is pleased 
that ORR has taken the initiative to work with DHS to correct 
this problem and anticipates a prompt resolution.
    The Committee is aware that at times ORR allows individual 
abused, abandoned, or neglected children in its custody to 
access State dependency proceedings for ultimate care and 
placement in State foster care or under legal guardianship. The 
Committee urges ORR to continue this practice in such cases as 
it is appropriate.
    The Committee is pleased with the steps the ORR has taken 
to improve access to legal representation for children served 
through this program. ORR has participated in roundtables, and 
met with various groups to better understand the issue. They 
have also put together a comprehensive list of pro bono 
attorneys and guardians to ensure that the children's needs are 
being served and are currently working on a program that would 
ensure that resources are available to unaccompanied alien 
children. The Committee commends ORR for their commitment to 
providing unaccompanied alien children in its care access to a 
comprehensive range of services, from legal representatives to 
access to necessary unique medical care.
    The Committee directs that not later than 1 year after the 
date of enactment of this Act the Secretary of Health and Human 
Services shall submit a report on progress made by ORR to 
deinstitutionalize the care provided to unaccompanied children 
in its custody, including the utilization of community-based, 
child welfare centered services.
    The Committee is pleased that the majority of the 15,000 
Hmong refugees that were admitted will have arrived by the end 
of fiscal year 2005. The Committee was 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 had spent their lives in a refugee 
camp. Few, if any, spoke English. Most are under 18 and have 
little schooling. Even with the greater level of education and 
skills possessed by prior refugees, statistics indicated that 
about 38 percent of current Hmong-Americans live in poverty.
    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, 2005....................................  $2,082,921,000
Budget estimate, 2006...................................   2,082,910,000
House allowance.........................................   2,082,910,000
Committee recommendation................................   2,082,910,000

    The Committee recommends $2,082,910,000 for fiscal year 
2006 for the child care and development block grant. The 
comparable funding level for fiscal year 2005 is $2,082,921,000 
and the budget request includes $2,082,910,000 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 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, 2005....................................  $1,700,000,000
Budget estimate, 2006...................................   1,700,000,000
House allowance.........................................   1,700,000,000
Committee recommendation................................   1,700,000,000

    The Committee recommends $1,700,000,000 for fiscal year 
2006 for the social services block grant. The comparable 
funding level for fiscal year 2005 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, 2005....................................  $9,007,770,000
Budget estimate, 2006...................................   8,386,293,000
House allowance.........................................   8,688,707,000
Committee recommendation................................   9,000,832,000

    The Committee recommends $9,000,832,000 for fiscal year 
2006 for children and families services programs. The 
comparable funding level for fiscal year 2005 is $9,007,770,000 
and the budget request includes $8,386,293,000 for this 
program. In addition, $10,500,000 in transfers are available 
under section 241 of the Public Health Service Act.
    This appropriation provides funding for programs for 
children, youth, and families, the developmentally disabled, 
and Native Americans, as well as Federal administrative costs.

Head Start

    The Committee recommends $6,874,314,000 for fiscal year 
2006 for Head Start. The comparable funding level for fiscal 
year 2005 is $6,843,114,000 and the budget request includes 
$6,899,336,000 for this program. The Committee recommendation 
includes $1,388,800,000 in advance funding that will become 
available on October 1, 2007. The Committee recommendation does 
not include the $45,000,000 requested in the budget for a State 
pilot project that would allow States to directly administer 
the Head Start program.
    Head Start provides comprehensive development services for 
low-income children and families, emphasizing cognitive and 
language development, socioemotional development, physical and 
mental health, and parent involvement to enable each child to 
develop and function at his or her highest potential. At least 
10 percent of enrollment opportunities in each State are made 
available to children with disabilities.
    The Committee 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.
    The Committee understands the serious need for additional 
and expanded Head Start facilities among Native American 
populations and in rural areas. The Committee believes that the 
Department could help serve these needy communities by 
providing minor construction funding, as authorized, in remote 
Native American communities.
    The Committee strongly supports the effort to strengthen 
the qualifications of Head Start teachers. While the Committee 
is pleased that the percentage of teachers with an associate, 
baccalaureate, or advanced degree in early childhood education, 
or a degree in a related field with experience in teaching 
preschool children has reached 65 percent, the Committee 
encourages Head Start to continue to work toward the goal of 
100 percent. 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 in May 2005, the Secretary made 
$35,000,000 in additional fiscal year 2005 funds available to 
Migrant and Seasonal Head Start programs and that these funds, 
which will be awarded on competitive basis, will allow for at 
least 4,000 additional children to access Migrant and Seasonal 
Head Start. The Committee acknowledges that these expansion 
funds will increase access to this important program, however 
additional funding may be necessary to adequately serve this 
population. The Committee requests that the Secretary submit a 
report on the Bureau's ongoing plans to ensure that Migrant and 
Seasonal Head Start programs are able to serve a larger 
percentage of the children eligible for services. The Committee 
continues to point to the 2001 study published by the U.S. 
Department of Health and Human Services which documented that 
only 19 percent of eligible children were able to access 
Migrant and Seasonal Head Start.
    The Head Start Bureau shall continue to provide the 
Committee with the number and cost of buses purchased, by 
region with Head Start in the annual congressional budget 
justification.
    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 nutrition and health 
screening, to social and emotional development and family 
building, as well as the cognitive growth of young children.
    The Committee is aware that the Government Accountability 
Office came out on May 17 with the report, ``Head Start: 
Further Development Could Allow Results of New Test to be Used 
for Decision Making,'' on the National Reporting System [NRS] 
test. The report stated that analysis was currently incomplete 
to support its use for the purposes of accountability and 
targeting training and technical assistance, that grantees have 
not yet shown that the NRS provides the scope and quality of 
assessment information needed for holding grantees accountable, 
and that language experts raised serious concerns about whether 
the Spanish version of the NRS adequately measures the skills 
of Spanish-speaking children and whether results from the 
English and Spanish. Therefore, the Committee directs the 
Secretary to submit a report to House and Senate Committees on 
Appropriations, not later than 90 days after enactment of this 
Act, addressing: (1) a detailed justification to Congress 
regarding the planned uses of the NRS results and data in terms 
of program evaluation, professional development, technical 
assistance, and other activities; (2) an itemization of the 
costs of development, implementation, and analysis of the NRS, 
detailing by name, amount, and description of activities each 
contract or grant to persons or entities involved in its 
design, development, implementation, or analysis; and (3) the 
recommendations made by the Technical Working Group established 
by the Secretary, including an explanation of how the Secretary 
has addressed or plans to address the Working Group's and the 
GAO's recommendations.

Consolidated Runaway and Homeless Youth Program

    The Committee recommends $88,724,000 for fiscal year 2006 
for the consolidated runaway and homeless youth program. The 
comparable funding level for fiscal year 2005 is $88,724,000 
and the budget request includes $88,728,000 for this program. 
This program was reauthorized under the Runaway, Homeless, and 
Missing Children Protection Act of 2003. In this 
reauthorization a statutory formula was established to 
distribute funds between the Basic Center Program and the 
Transitional Living Program.
    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.
    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.
    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 $15,179,000 for fiscal year 2006 
for the runaway youth prevention program. The comparable 
funding level for fiscal year 2005 is $15,178,000 and the 
budget request includes $15,179,000 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 Programs

    The Committee recommends $101,779,000 for fiscal year 2006 
for child abuse programs. The comparable funding level for 
fiscal year 2005 is $101,778,000 and the budget request 
includes $101,784,000 for this program. The recommendation 
includes $27,280,000 for State grants, $31,640,000 for 
discretionary activities, and $42,859,000 for community based 
child abuse prevention.
    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 $11,955,000 for fiscal year 2006 
for abandoned infants assistance. The comparable funding level 
for fiscal year 2005 is $11,955,000 and the budget request 
includes $11,955,000 for this program.
    This program provides grants to public and private non-
profit agencies, State and county child welfare agencies, 
universities, and community-based organizations to develop, 
implement, and operate demonstration projects that will prevent 
the abandonment of infants and young children, especially those 
impacted by substance abuse and HIV and who are at-risk of 
being or are currently abandoned. By providing respite care for 
families and care givers and assisting abandoned infants and 
children to reside with their natural families or in foster 
care. The Committee recognizes that the rates of prenatal 
substance abuse and maternal HIV/AIDS have increased, that the 
related problem of infants abandoned or boarding in hospitals 
has grown, and that existing grantees have experienced a large 
increase in demand for services nationwide.

Child Welfare Services

    The Committee recommends $289,650,000 for fiscal year 2006 
for child welfare services. The comparable funding level for 
fiscal year 2005 is $289,650,000 and the budget request 
includes $289,650,000 for this program.
    This program helps State public welfare agencies improve 
their child welfare services with the goal of keeping families 
together. State services include: preventive intervention, so 
that, if possible, children will not have to be removed from 
their homes; reunification so that children can return home; 
and development of alternative placements like foster care or 
adoption if children cannot remain at home. These services are 
provided without regard to income.

Child Welfare Training

    The Committee recommends $7,409,000 for fiscal year 2006 
for child welfare training. The comparable funding level for 
fiscal year 2005 is $7,409,000 and the budget request includes 
$7,409,000 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.
    Given research on failings in the Child and Family Services 
Reviews [CFSRs] and the States' continuing challenges in 
recruiting and retaining qualified child welfare personnel, 
particularly those who hold a degree in social work, the 
Committee encourages ACF to continue to provide grants to 
schools of social work and traineeships to social work students 
being trained in the specialty of child welfare. The Committee 
also encourages ACF to provide funding for research into how 
specially trained social work personnel affect outcomes for 
children and families.

Adoption Opportunities

    The Committee recommends $27,119,000 for fiscal year 2006 
for adoption opportunities. The comparable funding level for 
fiscal year 2005 is $27,116,000 and the budget request includes 
$27,119,000 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 $22,846,000 for fiscal year 2006 
for adoption incentives. The comparable funding level for 
fiscal year 2005 is $31,846,000 and the budget request includes 
$31,846,000 for this program. Fewer resources were needed in 
fiscal year 2005 to make bonus payments to States for the full 
amount for which they were eligible under this program, so the 
reduction recommended by the Committee will not have any impact 
on this program, unused funds will supplement the fiscal year 
2006 appropriation in order to maintain a robust incentives 
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, 2007.

Adoption Awareness

    The Committee recommends $12,802,000 for fiscal year 2006 
for adoption awareness. The comparable funding level for fiscal 
year 2005 is $12,802,000 and the budget request includes 
$12,802,000 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, $9,826,000 is available for this 
purpose.
    The Special Needs Adoption Campaign supports grants to 
carry out a national campaign to inform the public about the 
adoption of children with special needs. The Committee 
recommendation includes $2,976,000 to continue this important 
activity.

Compassion Capital Fund

    The Committee recommends $95,000,000 for fiscal year 2006 
for the compassion capital fund. The comparable funding level 
for fiscal year 2005 is $54,549,000 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.
    Of the funds provided, $45,000,000 is for a new anti-gang 
initiative. Competitive grants will be awarded to community and 
faith-based organizations that will foster supportive 
relationships with youths ages 8-17 through targeted street 
outreach, direct youths to social services, and present 
alternatives to gang involvement. These grants will be 
especially helpful in urban areas such as Philadelphia that 
have experienced alarming increases in youth gang violence.

Social Services Research

    The Committee recommends $32,012,000 for fiscal year 2006 
for the social services research. The comparable funding level 
for fiscal year 2005 is $32,012,000 and the budget request 
includes $6,000,000 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. Plans are now underway to 
pilot test a data exchange program that will offer States a 
faster, less expensive means of validating, accessing, 
modifying and recording TANF data elements. Similarly, on 
behalf of Child Support Enforcement, the consortium is helping 
to expand data exchange capabilities between the courts and 
State child support enforcement agencies as well as increase 
collection efficiency in States and tribal organizations. Next 
steps include accessing existing databases used as primary 
sources for collection-related data of non-custodial parents, 
and enhancing data-matching capabilities to ensure the 
integrity of the information being collected. The Committee 
recommends that both collaborative efforts with the State 
information technology consortium be continued at their current 
levels.

Abstinence Education

    The Committee recommends $105,500,000 for fiscal year 2006 
for community based abstinence education. The comparable 
funding level for fiscal year 2005 is $103,698,000 and the 
budget request includes $142,545,000 for this program. Within 
the Committee recommendation, $101,000,000 is provided for 
community-based abstinence education, $4,500,000 is provided 
through an evaluation set-aside, as requested by the 
administration. In addition, $50,000,000 is available from 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.
    Of the funds provided up to $10,000,000 may be available 
for a national abstinence media campaign. The Committee 
understands that a portion of fiscal year 2005 funds will be 
used for evaluation purposes. The Committee intends that ACF 
use available funds to continue support for an independent 
group to conduct a thorough and rigorous evaluation of this 
campaign.

Developmental Disabilities

    The Committee recommends $171,561,000 for fiscal year 2006 
for programs administered by the Administration on 
Developmental Disabilities. The comparable funding level for 
fiscal year 2005 is $168,575,000 and the budget request 
includes $168,561,000 for these programs. Within the funds 
provided, $156,682,000 is for carrying out the Developmental 
Disability Act, and $14,879,000 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 $72,496,000 
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 $39,109,000 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 $14,879,000 for disabled voter 
services. Of these funds, $10,000,000 is to promote disabled 
voter access, and the remaining $4,879,000 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.
    The Committee recommends $11,529,000 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 assistive 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 $33,548,000 for the University 
Centers for Excellence in Developmental Disabilities [UCEDDs] 
which is a network of 61 centers that are interdisciplinary 
education, research and public service units of a university 
system or are public or non-profit entities associated with 
universities. UCEDDs 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 
the three new Centers established in fiscal year 2005 to be 
increased to the same grant award level as the existing 61 
Centers, as well as to establish additional Center grants in 
the States that currently have unserved and underserved 
populations, and support additional training initiatives.

Native American Programs

    The Committee recommends $44,780,000 for fiscal year 2006 
for Native American programs. The comparable funding level for 
fiscal year 2005 is $44,786,000 and the budget request includes 
$44,780,000 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.

Community Services

    The Committee recommends $708,895,000 for fiscal year 2006 
for the community services programs. The comparable funding 
level for fiscal year 2005 is $726,506,000 and the budget 
request includes $24,699,000 for this program.
    Within the funds provided, the Committee recommends 
$636,793,000 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 eliminate the community services block grant funding. 
Although a restrictive Committee allocation prevented CSBG 
funding from being increased this year, the Committee continues 
to recognize the importance of CSBG and the Community Action 
Agencies it funds in helping meet the extraordinary challenges 
facing low-income communities.
    The Nation's Community Action Agency network relies on CSBG 
funding to help initiate and administer programs designed to 
alleviate poverty. The universal characteristic of these CSBG-
funded programs is that they provide people with the resources 
and the tools to become self-sufficient. The Committee 
understands that the Department of Health and Human Services, 
and its Office of Community Services in particular, could 
better use this network in developing future policy 
initiatives. The Committee notes that in a number of States, 
including Iowa and Pennsylvania, CAA-initiated family 
development and self-sufficiency programs are a integral 
component of welfare reform efforts. The administration is 
encouraged to look for further nationwide linkages between 
those individuals seeking to leave the welfare system and 
become self-sufficient and the many family development and 
self-sufficiency strategies operated by Community Action 
Agencies.
    The Committee expects the Office of Community Services 
[OCS] to release funding to States in the most timely manner 
and 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 other discretionary programs are funded from this 
account. Funding for these programs is recommended at the 
following levels for fiscal year 2006: community economic 
development, $32,731,000; individual development accounts, 
$24,699,000; rural community facilities, $7,492,000; and 
community food and nutrition, $7,180,000. 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. The 
Committee requests an operation plan for how OCS plans to use 
appropriated funds consistent with the Committee's 
expectations. This plan should include a detailed breakdown of 
planned expenditures for program support, technical assistance, 
contracts, and research and grants.
    Community economic development grants are made to private, 
nonprofit community development corporations, which in turn 
provide technical and financial assistance to business and 
economic development projects that target job and business 
opportunities for low income citizens. The Committee has 
included bill language clarifying that Federal funds made 
available through this program may be used for financing for 
construction and rehabilitation and loans or investments in 
private business enterprises owned by Community Development 
Corporations.
    Of the total provided, the Committee has included 
$5,436,000 for the Job Opportunities for Low-Income Individuals 
[JOLI] program 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 this program 
would provide opportunities for more low-income individuals. 
The Committee expects that experienced community development 
corporations be given appropriate consideration for grants 
under this program.
    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. The Committee intends 
that funds provided above the request shall be made available 
to the six regional RCAPs.
    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 $3,000,000 for fiscal year 2006 
for the national domestic violence hotline. The comparable 
funding level for fiscal year 2005 is $3,224,000 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 $125,991,000 for fiscal year 2006 
for battered women's shelters program. The comparable funding 
level for fiscal year 2005 is $125,630,000 and the budget 
request includes $125,991,000 for this program.
    This is a formula grant program to support community-based 
projects which operate shelters and provide related assistance 
for victims of domestic violence and their dependents. Emphasis 
is given to projects which provide counseling, advocacy, and 
self-help services to victims and their children.

Early Learning Opportunities Program

    The Committee does not include funds for fiscal year 2006 
for the early learning opportunities program. The comparable 
funding level for fiscal year 2005 is $35,712,000 and the 
budget request did not include funds for this program.
    This program supports grants to local community councils 
comprised of representatives from agencies involved in early 
learning programs, parent organizations and key community 
leaders. Funds are used to increase the capacity of local 
organizations to facilitate development of cognitive skills, 
language comprehension and learning readiness; enhance 
childhood literacy; improve the quality of early learning 
programs through professional development and training; and 
remove barriers to early learning programs.

Faith-Based Center

    The Committee recommends $1,400,000 for fiscal year 2006 
for the operation of the Department's Center for Faith-Based 
and Community Initiatives. The comparable funding level for 
fiscal year 2005 is $1,375,000 and the budget request includes 
$1,400,000 for this program.

Mentoring Children of Prisoners

    The Committee recommends $49,993,000 for fiscal year 2006 
for mentoring children of prisoners. The comparable funding 
level for fiscal year 2005 is $49,598,000 and the budget 
request includes $49,993,000 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 $46,623,000 for fiscal year 2006 
for independent living training vouchers. The comparable 
funding level for fiscal year 2005 is $46,623,000 and the 
budget request includes $59,999,000 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.

Program Administration

    The Committee recommends $186,000,000 for fiscal year 2006 
for program administration. The comparable funding level for 
fiscal year 2005 is $185,210,000 and the budget request 
includes $185,217,000 for this program.
    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. The 
Committee directs ACF to continue to provide information on the 
progress of the reviews in the annual congressional 
justification.

                   PROMOTING SAFE AND STABLE FAMILIES

Appropriations, 2005....................................    $403,586,000
Budget estimate, 2006...................................     410,000,000
House allowance.........................................     404,000,000
Committee recommendation................................     395,000,000

    The Committee recommends $395,000,000 for fiscal year 2006 
for promoting safe and stable families. The comparable funding 
level for fiscal year 2005 is $403,586,000 and the budget 
request includes $410,000,000 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 Stable Families program are focused on 
supporting those activities that can prevent family crises from 
emerging which might require the temporary or permanent removal 
of a child from his or her own home.
    The Promoting Safe and Stable Families program is comprised 
of $305,000,000 in capped entitlement funds authorized by the 
Social Security Act and $90,000,000 in discretionary 
appropriations.

       PAYMENTS TO STATES FOR FOSTER CARE AND ADOPTION ASSISTANCE

Appropriations, 2005....................................  $5,037,900,000
Budget estimate, 2006...................................   4,852,800,000
House allowance.........................................   4,852,800,000
Committee recommendation................................   4,852,800,000

    The Committee recommends $4,852,800,000 for fiscal year 
2006 for payments to States for foster care and adoption 
assistance. The comparable funding level for fiscal year 2005 
is $5,037,900,000 and the budget request includes 
$4,852,800,000 for this program. In addition, the Committee 
recommendation concurs with the administration's request of 
$1,730,000 for an advance appropriation for the first quarter 
of fiscal year 2007.
    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, 2005....................................  $1,393,342,000
Budget estimate, 2006...................................   1,369,028,000
House allowance.........................................   1,376,217,000
Committee recommendation................................   1,391,699,000

    The Committee recommends an appropriation of $1,391,699,000 
for aging programs. This amount is $1,643,000 below the 
comparable fiscal year 2005 level and $22,671,000 above the 
administration request.

Supportive Services and Senior Centers

    The Committee recommends an appropriation of $354,136,000 
for supportive services and senior centers, which is the same 
as the comparable fiscal year 2005 level and 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 $21,616,000 for preventive health 
services, which is the same as the comparable fiscal year 2005 
level and the administration request. 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.

Protection of Vulnerable Older Americans

    The Committee recommends $20,360,000 for grants to States 
for protection of vulnerable older Americans. This is 
$1,072,000 above the comparable fiscal year 2005 level and 
$1,000,000 above the administration request. Within the 
Committee recommendation, $15,162,000 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.

National Family Caregiver Support Program

    The Committee recommends $160,744,000 for the national 
family caregiver support program, which is $5,000,000 above the 
comparable fiscal year 2005 level and 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 $6,304,000 to carry 
out the Native American Caregiver Support Program, which is the 
same as the comparable fiscal year 2005 level and the 
administration request. 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.

Congregate and Home-delivered Nutrition Services

    For congregate nutrition services, the Committee recommends 
an appropriation of $387,274,000, which is the same as the 
comparable fiscal year 2005 level and the administration 
request. For home-delivered meals, the Committee recommends 
$182,827,000, which is the same as the comparable fiscal year 
2005 level and $1,000 above 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 one-third of the minimum daily dietary requirements. 
While States receive separate allotments of funds for 
congregate and home-delivered nutrition services and support 
services, they are permitted to transfer up to 40 percent of 
funds between these programs.

Nutrition Services Incentives Program

    The Committee recommendation includes $148,596,000 for the 
nutrition services incentives program [NSIP], the same as the 
comparable fiscal year 2005 funding level and the 
administration request. This program 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 $26,398,000 for grants to Native 
Americans, which is the same as the comparable fiscal year 2005 
funding level and 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 $40,513,000 for training, 
research, and discretionary projects, which is $2,773,000 below 
the comparable fiscal year 2005 level and $16,670,000 above the 
administration request. 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 2006 that address a variety of issues, 
including elder abuse, Native American issues, and legal 
services.
    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 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.
    The Committee is aware of innovative program models aimed 
at mobilizing older Americans, particularly the 77 million baby 
boomers, to serve their communities. The Committee encourages 
the agency to develop partnerships with organizations that 
enable older Americans to help meet critical social needs 
effectively.

Aging Network Support Activities

    The Committee recommends $13,266,000 for aging network 
support activities, the same as the comparable amount for 
fiscal year 2005 and the administration request. The Committee 
recommendation includes funding at the administration request 
level for the Eldercare Locator and for the Pension Information 
and Counseling Program.
    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 $11,786,000 for Alzheimer's disease demonstration 
grants to States. This is the same as the comparable fiscal 
year 2005 funding level and 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 38 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 recommendation does not include funding for 
the White House Conference on Aging. This conference will be 
held in December 2005 and is required by the Older Americans 
Act Amendments of 2000. White House Conferences on Aging are 
decennial events held to develop recommendations for the 
President and Congress on issues, policy, and research in the 
field of aging.

Program Administration

    The Committee recommends $17,879,000 for program 
administration, which is $422,000 below the comparable fiscal 
year 2005 funding level and the same as the administration 
request. These funds support salaries and related expenses for 
program management and oversight activities.

                        Office of the Secretary


                    GENERAL DEPARTMENTAL MANAGEMENT

Appropriations, 2005....................................    $369,931,000
Budget estimate, 2006...................................     359,176,000
House allowance.........................................     344,546,000
Committee recommendation................................     359,465,000

    The Committee recommends $359,465,000 for general 
departmental management [GDM]. This amount is $10,466,000 below 
the comparable level for fiscal year 2005 and $289,000 above 
the administration request. The Committee recommendation 
includes the transfer of $5,851,000 from Medicare trust funds, 
which is the same as the administration request. In addition, 
for policy evaluation activities the Committee recommends 
$39,552,000 in transfers available under section 241 of the 
Public Health Service Act.
    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 recommendation includes $3,000,000 for the 
Citizens' Health Care Working Group which was authorized by the 
Medicare Prescription Drug, Improvement, and Modernization Act 
of 2003. These funds are available for all activities of the 
Working Group, including preparation and distribution of 
reports.
    Advance Directives.--The Committee believes that through 
the execution of advance directives, including living wills and 
durable powers of attorney for health care according to the 
laws of the State in which they reside, individuals can better 
protect their right to express their wishes about end-of-life 
care and have those wishes respected. The Committee directs the 
Secretary to conduct a study to determine the best way to 
promote the use of advance directives among competent adults as 
a means of specifying their wishes about end of life care, and 
provide recommendations to Congress on changes to Federal law 
needed to ensure appropriate use of advance directives. As part 
of that study, the Department shall consider that decisions 
relating to advance directives are often made without adequate 
information about what it is like to live with a significant 
disability. The Committee intends that the study directly 
involve persons with disabilities, family members, disability 
experts and organizations in assessing this reality and 
identifying what information and support is necessary. This 
study should also review options related to those individuals 
whose significant cognitive disabilities limit or prohibit them 
from making decisions about directing their care and treatment.
    Childhood Drinking.--In April 2004 the Secretary created, 
at the request of Congress, an Interagency Coordinating 
Committee on the Prevention of Underage Drinking [ICCPUD], 
chaired by the Administrator of SAMHSA. Since then the ICCPUD 
has developed a draft plan for combating underage drinking 
which contained a complete listing of Federal programs related 
to underage drinking prevention. However, the Committee is 
concerned that the ICCPUD has not made more progress; it has 
not produced meaningful coordination among Federal agencies, 
identified effective and underperforming programs, or created a 
plan for improving Federal data collection. In addition, the 
ICCPUD has not identified the resources currently available for 
programs targeting underage drinking or made recommendations on 
the allocation of additional resources. Finally, the interim 
plan lacks measurable goals or benchmarks which would serve to 
monitor the progress and accountability of the ICCPUD's 
efforts. The Committee looks forward to the ICCPUD's final plan 
to be issued later this year and hopes that it will address 
these issues.
    Chiropractic Care.--The Committee notes that chiropractic 
health care services are now available to beneficiaries within 
the Department of Veterans' Affairs health care system, the 
Department of Defense health care program for active duty 
military personnel and, through a demonstration, within the 
Medicare health program. Despite this broad integration of 
chiropractic care into the mainstream of Federal and private 
sector health care systems, the Committee notes that there are 
not Doctors of Chiropractic Medicine commissioned to serve 
within the U.S. Public Service Commissioned Corps. The 
Committee notes that authority for the Surgeon General to 
appoint such commissioned officers exists under current law, 
but that none have been appointed. The Committee encourages the 
Surgeon General to begin to develop a plan to commission 
Doctors of Chiropractic into the U.S. Public Health Service 
Commissioned Corps and directs the Surgeon General to update 
the Committee on its progress within 6 months after enactment 
of this Act.
    Chronic Fatigue.--The Committee is pleased that the 
Department's Chronic Fatigue Syndrome Advisory Committee 
[CFSAC] has been meeting quarterly. This advisory committee 
serves an important role in setting priorities for Federal 
research and education programs related to chronic fatigue 
syndrome [CFS] and in keeping the Department abreast of the 
needs of persons with CFS. The Committee awaits the Secretary's 
written response to the CFSAC's recommendations dated August 
23, 2004.
    Health Disparities.--The Committee is committed to ensuring 
the overall improved health of the American people, and 
strongly urges the Secretary to intensify efforts to implement 
recommendations developed by the Institute of Medicine's 
Unequal Treatment: Confronting Racial and Ethnic Disparities in 
Health Care study. The recommendations offer significant 
guidelines and opportunities for eliminating health disparities 
and improving health across all populations. The Committee 
expects the Secretary to report on the progress of this action 
during next year's appropriations hearings.
    Hepatitis C-HIV Co-infection.--The Committee is concerned 
with the growing co-infection of individuals with both HIV and 
hepatitis C and notes that the largest single cause of death of 
individuals with HIV infection is now liver disease. The 
Committee is pleased that, in response to this high co-
infection rate, approximately 20 of the State AIDS Drug 
Assistance Programs [ADAP] have now included Hepatitis C 
pharmaceuticals on their formularies. The Committee notes that 
the Ryan White Care Act requires the Secretary to issue 
guidelines regarding appropriate treatments under the program 
and requests that the Secretary review and re-issue these 
treatment guidelines to address the treatment issues and 
formulary requirements associated with the significant co-
infection rate of HIV and hepatitis C.
    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.
    Parental Website.--It has come to the Committee's attention 
that an independent study reviewed 4parents.gov, the 
Department's website created to help parents counsel their 
teenagers about risky health behaviors. While noting positive 
aspects about the website, the study found numerous examples of 
inaccurate information. The Committee is aware that this web 
site was designed by outside contractors, not by the 
Department's public health experts. The Committee directs the 
Department to review the findings of the study, undertake a 
review of the website by Departmental public health and 
scientific experts, and make any necessary changes to conform 
with scientific evidence. The Committee also directs the 
Department to include scientifically accurate information about 
underage drinking and tobacco use.
    Sleep Disorders.--At the National Institutes of Health's 
Frontiers of Knowledge in Sleep and Sleep Disorders conference 
in March of 2004, the U.S. Surgeon General reported on the 
profound impact that chronic sleep loss and untreated sleep 
disorders have on Americans of all ages and that the public 
health model is well suited to translate these essential health 
messages to society. The Committee urges the Surgeon General to 
consider development of a Surgeon General's Report on Sleep and 
Sleep Disorders.

Adolescent Family Life

    The Committee has provided $30,742,000 for the Adolescent 
Family Life Program [AFL], which is the same as the 
administration request. This is $158,000 below the comparable 
fiscal year 2005 level.
    AFL is the only Federal program focused directly on the 
issue of adolescent sexuality, pregnancy, and parenting. 
Through demonstration grants and contracts, AFL focuses on a 
comprehensive range of health, educational, and social services 
needed to improve the health of adolescents, including the 
complex issues of early adolescent sexuality, pregnancy, and 
parenting.

Minority Health

    The Committee recommends $50,980,000 for the Office of 
Minority Health, which is $462,000 above the comparable level 
for fiscal year 2005 and $3,744,000 above the administration 
request.
    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 expects OMH and the National Center for 
Minority Health and Health Disparities at the National 
Institutes of Health to play a joint role in coordinating and 
monitoring the implementation of the Department's elimination 
of health disparities initiatives and strategic plans. The 
Committee expects the Secretary to report on the progress and 
implementation of the strategic plans during next year's 
appropriations hearings, and to include a progress update in 
the Department's Budget Justification.

Office on Women's Health

    The Committee recommends $28,715,000 for the Office on 
Women's Health. This is $103,000 below the comparable level for 
fiscal year 2005 and the same as the administration request.
    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.
    Bodywise.--The Committee is impressed with the efforts of 
the OWH to address the growing problem of negative body image 
and eating disorders through the Bodywise Project. This has 
been a widely successful project and the Committee urges the 
Secretary to continue this educational initiative and broaden 
the efforts by collaborating with the Department of Education 
to disperse the educational materials resulting from Bodywise 
and expand the educational project to target all levels of 
education from elementary to high school.
    Lupus.--The Committee understands that Lupus is a serious, 
complex, debilitating chronic autoimmune disease that can cause 
inflammation and tissue damage to virtually any organ system in 
the body and impacts an estimated 1.5 and 2 million 
individuals. The Committee is aware that public and 
professional recognition and understanding of lupus is 
extremely low, contributing to misdiagnoses or late diagnoses 
that can result in disability or death. The Committee strongly 
urges OWH to develop and implement a sustained lupus awareness 
and education campaign aimed at reaching health care 
professionals and the general public, with an emphasis on 
reaching women at greatest risk for developing Lupus.
    Offices of Women's Health.--The Committee has great 
interest in women's health and wants to encourage further 
health research, education, and services for women. The 
Committee also recognizes that the Offices of Women's Health 
within the Department, the Food and Drug Administration, the 
Centers for Disease Control and Prevention, the Health 
Resources and Services Administration, and the Agency for 
Healthcare Research and Quality provide critical services in 
support of these needs. The Committee strongly encourages the 
Secretary to see that these offices continue to receive 
sufficient funding to assure their ability to continue to meet 
their missions.

Afghanistan

    The Committee recommendation includes $5,952,000 for the 
Secretary's Afghanistan health initiative. This amount is the 
same as the comparable fiscal year 2005 funding level and the 
administration request. Funds will be used in partnership with 
the Department of Defense for medical training activities at 
the Rabia Balkhi Women's Hospital in Kabul, and for support of 
maternal and child health throughout Afghanistan.

Embryo Adoption

    The Committee continues to believe that increasing public 
awareness of embryo donation and adoption remains an important 
goal. The Committee has provided $2,000,000 for the 
Department's embryo adoption awareness campaign, which is 
$1,008,000 more than the comparable fiscal year 2005 funding 
level and the administration request.

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 $52,415,000. This amount is the same as 
the comparable fiscal year 2005 level and 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.

Information Technology Security and Innovation Fund

    The Committee recommendation does not include funding for 
the Information Technology Security and Innovation Fund, which 
is $14,695,000 below the comparable fiscal year 2005 level and 
$14,630,000 below the administration request. This activity 
funds investments such as information technology services, 
security and infrastructure that enable common administrative 
systems throughout the Department.

                OFFICE OF MEDICARE HEARINGS AND APPEALS

Appropriations, 2005....................................     $57,536,000
Budget estimate, 2006...................................      80,000,000
House allowance.........................................      60,000,000
Committee recommendation................................      75,000,000

    The Committee provides $75,000,000 for the Office of 
Medicare Hearings and Appeals, which is $17,464,000 above the 
comparable fiscal year 2005 level and $5,000,000 below the 
administration request.
    The Office of Medicare Hearings and Appeals is responsible 
for hearing Medicare appeals at the administrative law judge 
level, which is the third level of Medicare claims appeals. 
Since fiscal year 1995 these appeals have been processed by the 
Social Security Administration under an interagency agreement 
with the Centers for Medicare and Medicaid Services. This 
function was transferred to the Office of the Secretary by the 
Medicare Prescription Drug, Improvement and Modernization Act 
of 2003.

  OFFICE OF THE NATIONAL COORDINATOR FOR HEALTH INFORMATION TECHNOLOGY

Appropriations, 2005....................................     $24,011,000
Budget estimate, 2006...................................      77,750,000
House allowance.........................................      75,000,000
Committee recommendation................................      45,150,000

    The Committee provides $45,150,000 to the Office of the 
National Coordinator for Health Information Technology 
[ONCHIT]. This amount is $21,139,000 above the comparable 
fiscal year 2005 level and $32,600,000 below the administration 
request. The Committee recommendation includes $12,350,000 in 
transfers available under section 241 of the Public Health 
Service Act. In addition, the Committee has provided 
$50,000,000 for health information technology to the Agency for 
Healthcare Research and Quality.
    The Office of The National Coordinator for Health 
Information Technology is responsible for promoting the use of 
electronic health records in clinical practice, coordinating 
Federal health information systems and collaborating with the 
private sector to develop standards for a nationwide 
interoperable health information technology infrastructure.
    The Committee urges the Coordinator for the ONCHIT to 
conduct outreach activities to all public and private sector 
organizations which have demonstrated capabilities in health 
information technology. The Committee is particularly 
interested in disease management technology as it relates to 
saving health care dollars, and improving care for chronically 
ill individuals and the workforce.
    Interoperability.--The Committee commends the efforts by 
the Secretary to increase interoperability within healthcare. 
Through the Consolidated Health Informatics [CHI] Project, 24 
electronic standards have been identified to allow sharing of 
clinical information. The Committee urges the Secretary to 
implement procedures to enable the Department to accept the 
optional submission of data derived from health care reporting 
requirements for the purposes of quality, surveillance, 
epidemiology, adverse event reporting, or research using the 
electronic standards identified under the CHI project.

                      OFFICE OF INSPECTOR GENERAL

Appropriations, 2005....................................     $39,930,000
Budget estimate, 2006...................................      39,813,000
House allowance.........................................      39,813,000
Committee recommendation................................      39,813,000

    The Committee recommends an appropriation of $39,813,000 
for the Office of Inspector General, which is the same as the 
administration request. The fiscal year 2005 comparable level 
was $39,930,000. 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 2006; the total funds provided to the 
Office by this bill and the authorizing bill would be 
$199,813,000 in fiscal year 2006.
    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.

                        OFFICE FOR CIVIL RIGHTS

Appropriations, 2005....................................     $35,013,000
Budget estimate, 2006...................................      34,996,000
House allowance.........................................      34,996,000
Committee recommendation................................      34,996,000

    The Committee recommends $34,996,000 for the Office for 
Civil Rights [OCR]. This is the same as the administration 
request. The comparable fiscal year 2005 level was $35,013,000. 
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.

     RETIREMENT PAY AND MEDICAL BENEFITS FOR COMMISSIONED OFFICERS

Appropriations, 2005....................................    $330,636,000
Budget estimate, 2006...................................     328,552,000
House allowance.........................................     328,552,000
Committee recommendation................................     328,552,000

    The Committee provides an estimated $328,552,000 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 
2005 was $330,636,000.
    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.

            PUBLIC HEALTH AND SOCIAL SERVICES EMERGENCY FUND

Appropriations, 2005....................................  $2,407,415,000
Budget estimate, 2006...................................   2,427,833,000
House allowance.........................................     183,589,000
Committee recommendation................................     183,589,000

    The Committee provides $183,589,000 to the Public Health 
and Social Services Emergency Fund. This is $2,223,826,000 
below the comparable fiscal year 2005 level and $2,244,244,000 
below the administration request. The Committee's 
recommendation for fiscal year 2006 includes $63,589,000 for 
bioterrorism preparedness within the Office of the Secretary 
and $120,000,000 for pandemic flu activities.
    The Committee has provided funding for bioterrorism 
preparedness directly to other agencies within the Department 
instead of to this account as it has done in the past. When 
these funding levels are included, the Committee has provided a 
total of $2,357,581,000 for bioterrorism preparedness, which is 
$49,834,000 less than the comparable fiscal year 2005 level and 
$70,252,000 less than the administration request.
    The Committee is aware that a recent study projected that 
over half a million Americans could die and over 2.3 million 
could be hospitalized if a moderately severe strain of a 
pandemic flu virus hits the United States. Given the potential 
for such a scenario, the Committee urges the Department to 
finalize its August 2004 draft Pandemic Influenza Preparedness 
and Response Plan and make it publicly available. In addition, 
the Committee urges the Department to examine the study's key 
recommendations, including those relating to stockpiling 
medical supplies, and developing emergency communications 
plans; stockpiling additional antivirals and developing surge 
capacity plans for hospitals and health care providers; and 
increasing vaccine production and the development of new 
technologies for vaccines.

      General Provisions, Department of Health and Human Services

    The Committee recommendation continues a provision placing 
a $50,000 ceiling on official representation expenses (sec. 
201).
    The Committee recommendation continues a provision which 
limits the assignment of certain public health personnel (sec. 
202).
    The Committee recommendation retains language regarding 
set-asides in the authorizing statute of the National 
Institutes of Health (sec. 203).
    The Committee recommendation continues a provision limiting 
the use of grant funds to pay individuals no more than an 
annual rate of Executive Level I (sec. 204).
    The Committee recommendation continues a provision 
restricting the Secretary's use of taps for program evaluation 
activities unless a report is submitted 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 modifies a provision restricting transfers of 
appropriated funds and requires a 15 day notification to both 
the House and Senate Appropriations Committees (sec. 207).
    The Committee recommendation continues a provision 
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 continues a provision 
regarding requirements for family planning applicants (sec. 
210).
    The Committee recommendation retains language which 
restricts the use of funds to carry out the Medicare Advantage 
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 which 
prohibits the Secretary from withholding substance abuse 
treatment funds (sec. 213).
    The Committee recommendation continues a provision which 
facilitates the expenditure of funds for international AIDS 
activities (sec. 214).
    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. 215).
    The Committee recommendation retains a provision 
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. 
216).
    The Committee includes a provision that permits the Centers 
for Disease Control and Prevention and the Agency for Toxic 
Substances and Disease Registry to transfer funds that are 
available for Individual Learning Accounts to ``Disease 
Control, Research, and Training'' (sec. 217).
    The Committee recommendation includes bill language 
allowing use of funds to continue operating the Council on 
Graduate Medical Education (sec. 218).
    The Committee recommendation includes a general provision, 
which rescinds $10,000,000 in unobligated balances from amounts 
appropriated in Public Law 108-11 under the heading ``Public 
Health and Social Services Emergency Fund'', the smallpox 
compensation program (sec. 219).
    The Committee recommendation rescinds $15,912,000 of 
unobligated balances in the Health Professions Student Loan 
Program (sec. 220).
    The Committee recommendation extends availability of funds 
for the State Pharmaceutical Assistance Programs (sec. 221).

                   TITLE III--DEPARTMENT OF EDUCATION

                    Education for the Disadvantaged

Appropriations, 2005.................................... $14,843,974,000
Budget estimate, 2006...................................  16,431,473,000
House allowance.........................................  14,728,735,000
Committee recommendation................................  14,525,135,000

    The Committee recommends an appropriation of 
$14,525,135,000 for education for the disadvantaged. The 
comparable funding level for fiscal year 2005 is 
$14,843,974,000 and the budget request includes $16,431,473,000 
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 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 2013-2014 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 2006-2007 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 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, unless such 
action would require a State to reduce the grant award of a 
local educational agency to an amount below the preceding year. 
At the funding level recommended by the Committee for fiscal 
year 2006, this set-aside could generate up to $504,000,000 for 
this purpose. States must distribute 95 percent of these 
reserved funds to local educational agencies for schools 
identified for improvement, corrective action, or 
restructuring. The Committee is concerned about the effect of 
the authorizing language, which in some States is requiring 
high-poverty districts to receive much less funding than they 
would otherwise receive, in order for States to ``hold 
harmless'' other districts and redistribute the required amount 
of school improvement funds. As a result, districts with the 
most eligible children in those States are not receiving the 
funds needed to serve their students adequately. In addition, 
some States are not able to set aside the full 4 percent, which 
means fewer resources to help struggling schools implement 
school improvement plans, support public school choice or offer 
supplemental education services.
    More than any other Federal program, Title I grants to LEAs 
are critical to the success of the No Child Left Behind Act. 
The Committee recommends $12,839,571,000 for this program. The 
comparable funding level for fiscal year 2005 is 
$12,739,571,000 and the budget request includes $13,342,309,000 
for Title I grants to LEAs. The Committee recommendation 
proposes an increase of 46.5 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 appropriation for Title I grants to LEAs primarily 
supports activities associated with the 2006-2007 academic 
year. Of the funds available for this program, up to $3,472,000 
shall be available on October 1, 2005, not less than 
$5,452,798,000 will become available on July 1, 2006 and 
$7,383,301,000 will become available on October 1, 2006. The 
funds that become available on July 1, 2006 and October 1, 2006 
will remain available for obligation until September 30, 2007.
    Title I grants are distributed through four formulas: 
basic, concentration, targeted, and education finance incentive 
grant [EFIG].
    For Title I basic grants, including up to $3,472,000 
transferred to the Census Bureau for poverty updates, the 
Committee recommends an appropriation of $6,934,854,000. The 
comparable funding level for fiscal year 2005 and the budget 
request are both $6,934,854,000 for the basic grants funding 
stream. Basic grants are awarded to school districts with at 
least 10 poor children who make up more than 2 percent of 
enrollment.
    For concentration grants, the Committee recommends an 
appropriation of $1,365,031,000. The comparable funding level 
for fiscal year 2005 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 2004 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 $2,269,843,000. The comparable 
funding level for fiscal year 2005 is $2,219,843,000 and the 
budget request includes $2,822,581,000 for this funding stream.
    The Committee recommends an appropriation of $2,269,843,000 
for education finance incentive grants. The comparable funding 
level for fiscal year 2005 and the budget request both are 
$2,219,843,000 for the EFIG funding stream.

William F. Goodling Even Start Family Literacy Program

    The Committee does not recommend additional funds for the 
Even Start program. The comparable funding level for fiscal 
year 2005 is $225,095,000 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. 
Funding is provided to States based on their relative share of 
Title I, Part A funds and States use these resources to make 
competitive subgrants to partnerships comprised of local 
educational agencies and other organizations serving families 
in high-poverty areas.

Reading First State Grants

    The Committee recommends $1,041,600,000 for the Reading 
First State Grants program, the same amount as the comparable 
funding level for fiscal year 2005 and the budget request.
    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.
    The Committee intends for funds available under the Reading 
First program to encourage and support the use of reading 
programs with the strongest possible scientific evidence of 
effectiveness. The Committee urges the Department to provide 
clear guidance to its technical assistance centers and the 
States to: fully consider scientific evidence of effectiveness 
in rating programs for use under Reading First; contemplate 
expanded lists of allowable programs that include innovative 
programs with scientific evidence of effectiveness; when 
awarding new grants, consider giving preference to those 
schools that select programs with strong, scientific evidence 
of effectiveness; emphasize that the Department has not 
established a predetermined approved list of reading materials; 
and allow comprehensive reading programs that have scientific 
evidence of effectiveness to be implemented in full, as they 
have been researched, without modification to conform to other 
models of instruction. The Committee also is concerned that 
certain practices under the Reading First program may unduly 
interfere with local control of curriculum. The Committee notes 
that Reading First materials decisions are to be made at the 
school level, subject to the approval of the State.

Early Reading First

    The Committee recommends $104,160,000 for the Early Reading 
First program, the same amount as the comparable funding level 
for fiscal year 2005 and the budget request.
    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 $35,000,000 for the Striving 
Readers initiative. The comparable fiscal year 2005 funding 
level is $24,800,000 and the budget request includes 
$200,000,000 for the Striving Readers program. This program 
supports grants to develop, implement, and evaluate reading 
interventions for middle- or high-school students reading 
significantly below grade level. Under this program, awards 
will be made to local educational agencies eligible to receive 
funds under Part A of Title I with one or more high schools or 
middle schools serving a significant number of students reading 
below grade level. Awards also may be made to partnerships 
including institutions of higher education and eligible 
nonprofit or for-profit organizations. The Committee intends 
that funds provided in this bill be utilized in accordance with 
the priorities established in the statement of the managers 
accompanying the fiscal year 2005 appropriations Act that 
relate to a rigorous evaluation requirement and parity in 
funding for middle schools and high schools.

Improving Literacy Through School Libraries

    The Committee recommends $19,683,000 for the Improving 
Literacy Through School Libraries program, the same amount as 
the comparable funding level for fiscal year 2005 and the 
budget request.
    This program provides funds for urgently needed, up-to-date 
school library books and training for school library media 
specialists in order to support the scientifically based 
reading programs authorized by the Reading First initiative. 
LEAs with a child-poverty rate of at least 20 percent are 
eligible for the competitive awards. Funds may be used to 
acquire school library media resources, including books and 
advanced technology; facilitate resource-sharing networks among 
schools and school libraries; provide professional development 
for school library media specialists; and provide students with 
access to school libraries during non-school hours.
    The Committee is concerned that funds provided under this 
program are not reaching those schools that are most in need of 
financial assistance for updating their school libraries, 
either because they are not applying for funds or are 
unsuccessful in writing their grant applications. The Committee 
encourages the Department to work with the Institute of Museum 
and Library Services and other relevant organizations to 
improve awareness, among the most needy schools, of the 
availability of this financial assistance, and to help them 
increase their success rates in competing for available funds. 
The Committee requests that the Department explain in its 
fiscal year 2007 congressional budget justification the actions 
it has taken or will take to address this issue with respect to 
the 2006 and future grant competitions.

High School Intervention

    The Committee recommendation does not include any funding 
for the new High School Intervention initiative. The budget 
proposed $1,240,000,000 for this new initiative. Funds would 
have been used to develop, implement and evaluate interventions 
that increase the achievement of all high school students, 
particularly those at risk of failing to meet challenging State 
academic content standards; eliminate achievement gaps between 
student from different socioeconomic backgrounds; and help all 
students graduate with the education, skills, and knowledge to 
succeed in postsecondary education and a high-technology 
economy. The proposed initiative would have provided funds to 
States based on a formula and SEAs would then make competitive 
grants to LEAs using 95 percent of appropriated funds.
    The budget request proposes bill language that would 
authorize this new high school initiative and require each 
State to participate in 12th grade State National Assessment of 
Educational Progress reading and math assessments. The 
Committee bill does not include the requested language.
    The Committee is supportive of the administration's goal of 
preparing all students for postsecondary education and the 
high-technology economy. However, the Committee notes that this 
initiative has not been acted on by the appropriate authorizing 
committees of Congress and would have been funded by the 
elimination of GEAR-UP, certain TRIO activities and the Perkins 
Vocational and Technical Education program, each of which have 
been restored to their fiscal year 2005 funding levels.

Migrant Education Program

    The Committee recommends $390,428,000 for the Migrant 
Education program, the same amount as the comparable fiscal 
year 2005 funding level and the budget request.
    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 $51,000,000 for the Title I 
neglected and delinquent program. The comparable funding level 
for fiscal year 2005 and the budget request both are 
$49,600,000 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.
    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 
continues to urge the Secretary to fully utilize this authority 
to support capacity building in and dissemination of best 
practices to State agency programs and to develop a uniform 
model for evaluating State performance under this program.

Evaluation

    The Committee recommends $9,424,000 for evaluation of Title 
I programs, the same amount as the comparable funding level for 
fiscal year 2005 and the budget request.
    Evaluation funds are used to support large-scale national 
surveys that examine how the Title I programs are contributing 
to student academic achievement. Funds also are used to 
evaluate State assessment and accountability systems and 
analyze the effectiveness of educational programs supported 
with Title I funds.

Comprehensive School Reform Demonstration

    The Committee does not recommend additional funds for the 
comprehensive school reform demonstration program. The 
comparable funding level for fiscal year 2005 is $205,344,000 
and the budget request did not include any funds for the 
comprehensive school reform program.
    This program provided schools with funding to develop or 
adopt, and implement, comprehensive school reforms that will 
enable children in participating schools to meet State 
standards. The Department allocated funds to States based on 
their relative shares of the previous year's Title I basic 
grants funds.

High School Equivalency Program

    The Committee recommends $18,737,000 for the high school 
equivalency program [HEP], the same amount as the comparable 
funding level for fiscal year 2005 and the budget request.
    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 
funding level recommended by the Committee, HEP will serve 
roughly 7,000 migrants.

College Assistance Migrant Program

    For the College Assistance Migrant Program [CAMP], the 
Committee recommends $15,532,000, the same amount as the 
comparable funding level for fiscal year 2005 and the budget 
request.
    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.
    The Committee encourages the Department to consider 
efficient and effective means for collecting performance 
outcome data related to postsecondary persistence and 
completion rates of CAMP program participants beyond those 
measures currently employed. The Committee notes that the 
follow-up services set aside may be used to monitor and report 
on the progress of students participating in projects during 
such students' subsequent years in college.

                               Impact Aid

Appropriations, 2005....................................  $1,243,862,000
Budget estimate, 2006...................................   1,240,862,000
House allowance.........................................   1,240,862,000
Committee recommendation................................   1,240,862,000

    The Committee recommends an appropriation of $1,240,862,000 
for impact aid for the Department of Education. The comparable 
funding level for fiscal year 2005 is $1,243,862,000 and the 
budget request proposes $1,240,862,000 for this purpose.
    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 bill includes language that provides for 
continued eligibility for students affected by the deployment 
or death of their military parent, as long as these children 
still attend the same school district. This language was 
included in the budget request and last year's appropriation 
bill.
    Basic Support Payments.--The Committee recommends 
$1,102,896,000 for basic support payments. The comparable 
funding level for fiscal year 2005 and the budget request both 
are $1,075,018,000. 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.--The Committee 
bill includes $49,966,000 for this purpose, the same amount as 
the comparable funding level for fiscal year 2005 and the 
budget request. Under this program, additional payments are 
made for certain federally connected children eligible for 
services under the Individuals with Disabilities Education Act.
    Facilities Maintenance.--The Committee recommends 
$5,000,000 for facilities maintenance. The comparable funding 
level for fiscal year 2005 and the budget request both are 
$7,838,000 for this purpose. 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. Funds appropriated for 
this purpose are available until expended.
    Construction.--The Committee recommends $18,000,000 for 
this program. The comparable fiscal year 2005 funding level is 
$48,544,000 and the budget request includes $45,544,000 for 
this purpose. Formula and competitive grants are awarded to 
eligible LEAs for emergency repairs and modernization of school 
facilities. Funds appropriated for the construction activity 
are available for obligation for a period of 2 years.
    While the Committee recommendation is less than last year, 
formula and competitive grant funds will still be made 
available under this appropriation for those districts in need 
of and eligible for additional financial assistance to improve 
their school facilities. In addition, funds are still remaining 
from the fiscal year 2005 appropriation for competitive grants 
under this program.
    Payments for Federal Property.--The Committee recommends 
$65,000,000 for this activity. The comparable funding level for 
fiscal year 2005 and the budget request both are $62,496,000 
for this program. 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.

                      School Improvement Programs

Appropriations, 2005....................................  $5,619,657,000
Budget estimate, 2006...................................   5,332,219,000
House allowance.........................................   5,393,765,000
Committee recommendation................................   5,457,953,000

    The Committee recommends an appropriation of $5,457,953,000 
for school improvement programs. The comparable funding level 
in fiscal year 2005 for this account is $5,619,657,000 and the 
budget request includes $5,332,219,000.

State Grants for Improving Teacher Quality

    The No Child Left Behind Act requires States to ensure that 
all teachers teaching in core academic subjects are ``highly 
qualified'' by the end of the 2005-2006 school year. The 
Committee recommends $2,916,605,000 for State grants for 
improving teacher quality, the same as both the comparable 
funding level for fiscal year 2005 and the budget request.
    The appropriation for this program primarily supports 
activities associated with the 2006-2007 academic year. Of the 
funds provided, $1,481,605,000 will become available on July 1, 
2006 and $1,435,000,000 will become available on October 1, 
2006. These funds will remain available for obligation until 
September 30, 2007.
    Under the Committee recommendation, funding for programs 
that specifically support high-quality professional development 
for teachers and school leadership will have increased by 40 
percent since passage of the No Child Left Behind Act. The 
Committee recommendation for fiscal year 2006 includes nearly 
$3,600,000,000 for such activities in recognition of the 
critical role that these individuals occupy in educating the 
Nation's children and the significant academic benefit that 
students may derive from the presence of a highly qualified 
teacher in their classroom. In addition, State and local 
educational agencies have considerable flexibility to use funds 
from their Title I grants to LEAs allocations, as well as other 
State grant program dollars in support of high-quality 
professional development opportunities.
    States and LEAs may use the funds for a range of activities 
related to the certification, recruitment, professional 
development, and support of teachers and administrators. 
Activities may include reforming teacher certification and 
licensure requirements, addressing alternative routes to State 
certification of teachers, recruiting teachers and principals, 
and implementing teacher mentoring systems, teacher testing, 
merit pay, and merit-based performance systems.
    These funds may also be used by districts to hire teachers 
to reduce class sizes. The Committee recognizes that smaller 
classes, particularly in the early grades, can have a positive 
impact on students by improving classroom discipline, providing 
students with more individualized attention, and allowing 
parents and teachers to work more closely together. Funds 
within the teacher quality State grants program may be used to 
continue this commitment to our Nation's students, parents, and 
teachers, without taking away from other efforts to invest in 
professional development.

Early Childhood Educator Professional Development

    The Committee recommends $14,696,000 to support 
professional development activities for early childhood 
educators and caregivers in high-poverty communities. The 
comparable funding level for fiscal year 2005 and the budget 
request are both $14,696,000 for this program. From this 
appropriation, the Secretary makes competitive grants to 
partnerships of early childhood and family literacy caregivers 
and educators in order to provide high quality, sustained and 
intensive professional development for early childhood 
educators to help them provide developmentally appropriate 
school-readiness services for preschool-age children.

Mathematics and Science Partnerships

    The Committee recommends $178,560,000 for the mathematics 
and science partnerships program. The comparable funding level 
for fiscal year 2005 is $178,560,000 and the budget request 
includes $269,000,000 for this purpose. These funds will be 
used to improve the performance of students in the areas of 
math and science by bringing math and science teachers in 
elementary and secondary schools together with scientists, 
mathematicians, and engineers to increase the teachers' 
subject-matter knowledge and improve their teaching skills. 
When the appropriation for this program is $100,000,000 or 
greater, the Secretary is authorized to award grants to States 
by a formula which includes consideration of the number of 
children aged 5 to 17 below the poverty line. States then are 
required to make grants competitively to eligible partnerships 
to enable the entities to pay the Federal share of the costs of 
developing or redesigning more rigorous mathematics and science 
curricula that are aligned with State and local standards; 
creating opportunities for enhanced professional development 
that improves the subject-matter knowledge of math and science 
teachers; recruiting math and science majors; and improving and 
expanding training of math and science teachers, including the 
effective integration of technology into curricula and 
instruction.
    The budget request includes legislative language that would 
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 recommends $100,000,000 for innovative 
education program strategies State grants. The comparable 
funding level for fiscal year 2005 is $198,400,000 and the 
budget request is $100,000,000 for this purpose.
    The innovative education program is a flexible source of 
Federal funds that provides support to States and LEAs for 
developing education reform initiatives that will improve the 
performance of students, schools, and teachers.

Educational Technology State Grants

    The Committee recommends $425,000,000 for educational 
technology State grants. The comparable funding level for 
fiscal year 2005 is $496,000,000 and the budget request did not 
include any funds 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 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 high-
quality professional development.

Supplemental Education Grants

    The Committee recommendation includes $18,183,000 for the 
supplemental education grants program, the same as both the 
comparable funding level for fiscal year 2005 and the budget 
request. 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 [RMI] and the 
Federated States of Micronesia [FSM] 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. The Committee bill includes language 
that allows up to 5 percent to be used by the FSM and RMI to 
purchase 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, $12,132,000 is for the Federated States of 
Micronesia and $6,051,000 is for the Republic of the Marshall 
Islands.

21st Century Community Learning Centers

    The Committee recommends an appropriation of $991,077,000 
for the 21st Century Community Learning Centers program, the 
same as both the comparable level for fiscal year 2005 and the 
budget request.
    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 $411,680,000 for State 
assessments, the same as both the comparable funding level for 
fiscal year 2005 and the budget request.
    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 for each year the appropriation 
falls below the trigger level. The trigger for fiscal year 2006 
is $400,000,000. 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 $11,680,000, the 
same as both the comparable funding level for fiscal year 2005 
and the budget request.
    The Committee continues to be concerned that many schools 
are unable to properly assess the performance of students with 
disabilities and students with limited English proficiency. 
Therefore, the Committee 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.

High School Assessments

    The Committee recommendation does not include funds for the 
proposed High School Assessments program. The budget request 
includes $250,000,000 for this new activity. This proposed 
program was designed to complement the administration's High 
School Reform initiative. Funds requested under this program 
would be used to provide grants to States to pay for the 
reading and math assessments that would be required in two 
additional grades during high school by school year 2009-2010. 
The budget request includes legislative language which would 
authorize this program. As noted earlier, the High School 
Reform proposal has not been considered by the appropriate 
authorizing committees of Congress, so the Committee has not 
included the legislative language or provided the requested 
funds.

Javits Gifted and Talented Education

    The Committee recommends $11,022,000 for the Javits Gifted 
and Talented Students Education Program, the same as the 
comparable fiscal year 2005 funding level. 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 $25,000,000 for the Foreign 
Language Assistance program. The comparable funding level for 
fiscal year 2005 is $17,856,000 and the budget request proposes 
eliminating funds for foreign language assistance activities.
    The Committee recommendation provides funds above what is 
needed for continuation costs for current activities. These 
additional funds shall be used for a new grant competition to 
school districts with poverty rates of 15 percent or more, to 
help the highest-need elementary schools within such districts 
establish foreign language instruction programs.
    Funds from this program support competitive grants to 
increase the quality and quantity of foreign language 
instruction. At least 75 percent of the appropriation must be 
used to expand foreign language education in the elementary 
grades. The Committee has included bill language that prohibits 
Foreign Language Assistance program funds from being 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, 
strongly urges the Secretary to use her ability to waive the 
matching requirement for qualifying schools and to increase 
awareness of this accommodation among the affected school 
population. The Committee also believes that the sustainability 
preference established in the authorizing legislation should 
not prohibit the highest-need applicants from receiving one or 
more grants under this program or from being eligible to have 
the matching requirement waived during their initial or 
subsequent grants.

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 $62,496,000. The comparable 
fiscal year 2005 funding level and the budget request both are 
$62,496,000.
    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 $7,185,000. 
The comparable fiscal year 2005 funding level and the budget 
request both are $7,185,000 for these services.
    The funds provided will support 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 recommends $34,500,000. The comparable fiscal year 
2005 funding level is $34,224,000 and the budget request is 
$32,624,000 for these programs.
    The Committee bill includes language allowing $1,250,000 of 
the funds recommended to be used for construction and 
renovation of Native Hawaiian educational facilities.
    Education for Native Hawaiians.--The Committee recognizes 
the Department's continuing support in working with the Native 
Hawaiian Education Council as a vehicle for assessing, 
evaluating, and coordinating all education programs for Native 
Hawaiians. The Committee urges the Secretary to work with the 
Executive Director of the Council to ensure adequate funds are 
set aside to perform the tasks assigned to the Council in title 
VII of the No Child Left Behind Act. In addition, the Committee 
requests that the Department provide the Council with the 
grantee reports on a timely basis to allow the Council to fully 
undertake the assessment, evaluation and issuance of 
recommendations, as required by law.
    Native Hawaiian Law Center of Excellence.--The Committee 
commends the Department's support in establishing a Center of 
Excellence in Native Hawaiian Law at the University of Hawaii. 
This Center will provide a forum for the examination and 
preservation of law with respect to the Native Hawaiian culture 
and spirit. The Committee bill includes language stipulating 
that $1,250,000 shall be used for a grant to the Center of 
Excellence at the University of Hawaii School of Law.

Alaska Native Educational Equity

    The Committee recommends $34,500,000 for the Alaska Native 
educational equity assistance program. The comparable fiscal 
year 2005 funding level is $34,224,000 and the budget request 
includes $31,224,000 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 $170,624,000 for rural education 
programs, the same as both the comparable fiscal year 2005 
funding level and the budget request.
    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 Rural and Low-Income 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 $56,825,000 for the comprehensive 
centers program, the same as both the comparable fiscal year 
2005 funding level and the budget request.
    These funds will provide continued support to 10-20 
comprehensive centers expected to be established before 
September 2005. At least one center will operate 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 on various issues to States, 
LEAs, and schools as identified through needs assessments 
undertaken in each region. Grantees will develop 5-year plans 
for undertaking authorized activities that address the needs of 
States in a region and develop an advisory board to advise the 
center on allocation of resources, maintaining a high standard 
of quality in services delivery and ensuring that activities 
promote progress toward improving student achievement. The 
National Center for Education Evaluation and Regional 
Assistance will provide for ongoing independent evaluation of 
each center to assess whether each is meeting its objectives.

                            Indian Education

Appropriations, 2005....................................    $119,889,000
Budget estimate, 2006...................................     119,889,000
House allowance.........................................     119,889,000
Committee recommendation................................     119,889,000

    The Committee recommends $119,889,000 for Indian Education 
programs. The comparable fiscal year 2005 funding level and the 
budget request both are $119,889,000 for such activities.

Grants to Local Education Agencies

    For grants to local education agencies, the Committee 
recommends $96,294,000. The comparable fiscal year 2005 funding 
level is $95,165,000 and the budget request includes 
$96,294,000 for authorized activities.
    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 $19,595,000 for special programs 
for Indian children, the same as the comparable fiscal year 
2005 funding level and the budget request.
    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 $4,000,000 for national 
activities. The comparable fiscal year 2005 amount is 
$5,129,000 and the budget request is $4,000,000 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, 2005....................................  $1,092,642,000
Budget estimate, 2006...................................   1,307,871,000
House allowance.........................................     708,522,000
Committee recommendation................................   1,057,385,000

    The Committee recommends an appropriation of $1,057,385,000 
for programs within the innovation and improvement account. The 
comparable fiscal year 2005 funding level for these programs is 
$1,092,642,000 and the budget request includes $1,307,871,000 
for this account.

Troops-to-Teachers

    The Committee recommends an appropriation of $14,793,000 
for the Troops-to-Teachers program, the same as both the 
comparable funding level for fiscal year 2005 and the budget 
request.
    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 
serving in high-poverty school districts. The Secretary of 
Education transfers program funds to the Department of Defense 
for the Defense Activity for Non-Traditional Education Support 
to provide assistance, including stipends of up to $5,000 and 
bonuses of up to $10,000, to eligible members of the Armed 
Forces so that they can obtain teacher certification or 
licensing. In addition, the program helps these individuals 
find employment in a school.
    The Committee notes that the GAO and Department are 
required to report to Congress on the effectiveness of this 
program in placing highly-qualified teachers in high-need 
districts. The Committee looks forward to receiving a copy of 
the report and urges the Department to utilize the findings in 
implementing this program.

Transition to Teaching

    The Committee recommends $44,933,000 for the transition to 
teaching program, the same as both the comparable fiscal year 
2005 funding level and the budget request.
    This program provides grants to help support efforts to 
recruit, train, and place nontraditional teaching candidates 
into teaching positions and to support them during their first 
years in the classroom. In particular, this program is intended 
to attract mid-career professionals and recent college 
graduates. Program participants are placed in high-need schools 
in high-need LEAs.
    The Committee encourages the Department to continue to work 
with grantees to ensure that appropriated funds are used 
effectively to recruit highly qualified teachers to and retain 
them in employment in high need schools. The Committee looks 
forward to receiving more performance outcome information 
regarding this program, and, in particular, the results of the 
ongoing evaluation of grantee progress toward their goals and 
objectives.

National Writing Project

    The Committee recommends $23,000,000 for the National 
Writing Project. The comparable funding level for fiscal year 
2005 is $20,336,000 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 2006 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 $121,000,000 for the teaching of 
traditional American history program. The comparable fiscal 
year 2005 funding level is $119,040,000 and the budget request 
is $119,040,000 for this activity. This program supports 
competitive grants to LEAs, and funds may be used only to 
undertake activities that are related to American history, and 
cannot be used for social studies coursework. Grant awards are 
designed to augment the quality of American history instruction 
and to provide professional development activities and teacher 
education in the area of American history. The Committee 
directs the Department to continue its current policy of 
awarding 3-year grants.
    The budget request includes bill language that would allow 
the Department to reserve up to 3 percent of funds appropriated 
for this program for national activities. The Committee bill 
includes the requested language. The Committee requests that 
the Department prepare and submit an operating plan to the 
House and Senate Committees on Appropriations, within 30 days 
of enactment of this Act, on how these reserved funds will be 
used to support the intent of this program.

School Leadership

    The Committee recommends $15,000,000 for the school 
leadership program. The comparable fiscal year 2005 funding 
level is $14,880,000 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 
environment that fosters effective teaching and high academic 
achievement for students.

Advanced Credentialing

    The Committee recommends $10,000,000 for the advanced 
credentialing program. The comparable fiscal year 2005 funding 
level is $16,864,000 and the budget request includes $8,000,000 
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 2005 funding level is $9,920,000 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 2006 
appropriation will support continuation of an award to the 
National Board for Professional Teaching Standards.
    The Committee continues its strong support of the National 
Board for Professional Teaching Standards, based on the 
significant body of rigorous research that has demonstrated the 
benefits to students from being taught by a Board-certified 
educator. The Committee notes that the National Board has 
developed standards that describe the knowledge and skills 
characterizing effective teaching in 24 different areas, 
including school counseling. The accomplished educators who 
achieve certification in these standards do so by demonstrating 
their understanding through actual teaching, as well as through 
a written exam and teaching portfolio. The Committee believes 
that these activities are consistent with the mission of the 
National Board, which is to advance the quality of teaching and 
learning in the United States.

Charter Schools Grants

    The Committee recommends $216,952,000 for the support of 
charter schools. The comparable fiscal year 2005 funding level 
is $216,952,000 and the budget request is $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 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. At the 
Committee recommendation, almost $17,000,000 will be available 
to continue support for per-pupil facilities aid grants.
    The Committee notes that the Department plans to use 
$8,000,000 in appropriated funds for national activities, which 
may include support for a rigorous evaluation of charter 
schools and the expansion of State capacity to administer their 
charter schools. The Committee encourages the Department to 
support such efforts and requests that additional information 
on these activities be included in the fiscal year 2007 
congressional budget justification.

Credit Enhancement for Charter School Facilities

    The Committee does not recommend additional for this 
program. The comparable funding level for fiscal year 2005 and 
the budget request both are $36,981,000 for this purpose. The 
Committee notes that the authorization for this program expired 
in fiscal year 2005, and due to limited resources, does not 
fund this unauthorized activity. The budget request includes 
bill language that would continue to authorize this activity in 
fiscal year 2006.
    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 $26,543,000 for the voluntary 
public school choice program, the same as both the comparable 
funding level for fiscal year 2005 and the budget request.
    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 $107,771,000 for the magnet 
schools assistance program, the same as both the comparable 
fiscal year 2005 funding level and the budget request.
    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 $417,924,000 
for the Fund for the Improvement of Education [FIE]. The 
comparable funding level for fiscal year 2005 is $414,078,000 
and the budget request includes $106,296,000 for comparable 
activities.
    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 $25,296,000 to award a contract to 
Reading Is Fundamental, Inc. [RIF] to provide reading-
motivation activities. The comparable funding level for fiscal 
year 2005 and the budget request both are $25,296,000 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 $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 secondary-school 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 Committee recommendation does not include any funds for 
State scholars capacity building. The comparable funding level 
for fiscal year 2005 is $2,500,000 and the budget request 
includes $12,000,000 for this program. This program supports 
State-level business and education partnerships that encourage 
high school students to complete a rigorous curriculum in core 
academic subjects.
    The administration recommended eliminating funding for 
activities listed below.
    The Committee recommends $21,000,000 for the Star Schools 
program. The comparable funding level for fiscal year 2005 is 
$20,832,000. 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 $11,000,000 for the Ready to Teach 
program. The comparable funding level for fiscal year 2005 is 
$14,291,000. Ready to Teach is the successor to the Public 
Broadcasting Service's Mathline program, which was one of the 
first to provide online professional development and continuing 
education for teachers. Ready to Teach was reauthorized by the 
No Child Left Behind Act of 2001 and continues to evolve to 
enhance teacher quality and meet the goals of that Act. Ready 
to Teach encompasses funding for PBS TeacherLine and one or 
more nonprofit entities, for the purpose of continuing to 
develop telecommunications-based programs to improve teacher 
quality in core areas. It also includes digital educational 
programming grants, which encourages community partnerships 
among local public television stations, State and local 
educational agencies, and other institutions to develop and 
distribute digital instructional content based on State and 
local standards.
    The Committee recommendation includes $10,000,000 for the 
Education through Cultural and Historical Organizations [ECHO] 
Act of 2001, as authorized by the No Child Left Behind Act. The 
comparable funding level for fiscal year 2005 is $8,631,000 and 
the budget request did not include any funds for this purpose. 
Programs authorized under ECHO provide a broad range of 
educational, cultural, and job training opportunities for 
students from communities across the Nation, including Alaska, 
Hawaii and Massachusetts. Funds also are available to support a 
range of services to the Mississippi Band of Choctaw Indians.
    The Committee has included $35,700,000 for arts in 
education. The comparable funding level for fiscal year 2005 is 
$35,633,000. Within the total, $6,369,000 is for the John F. 
Kennedy Center for the Performing Arts; $7,440,000 is for VSA 
arts; $13,455,000 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; $7,936,000 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 to continue the evaluation and 
national dissemination of information regarding model programs 
and professional development projects funded through the Arts 
in Education section, including dissemination promising 
practices from funded projects and technical assistance for 
self-evaluation.
    The Committee recommends $42,000,000 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 2005 is $41,886,000. 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 recommends $5,000,000 to continue support for 
the Mental Health Integration in School program. The comparable 
funding level for fiscal year 2005 is $4,960,000. This program 
supports grants to or contracts with State educational 
agencies, local educational agencies or Indian tribes to 
increases student access to mental health care by linking 
schools with their local mental health systems. The Committee 
expects this program to continue to be carried out by the 
Office of Safe and Drug-Free Schools.
    The Committee includes $3,000,000 for the women's 
educational equity program. The comparable funding level for 
fiscal year 2005 is $2,956,000. This program supports projects 
that assist in the local implementation of gender equity 
policies and practices.
    The Committee recommendation includes $1,500,000 for 
activities authorized by the Excellence in Economics Education 
Act. The comparable fiscal year 2005 funding is $1,488,000. 
These funds will support a grant to a non profit educational 
organization to promote economic and financial literacy among 
kindergarten through 12th grade students.
    The Committee is pleased that, according to a nationwide 
survey of more than 4,000 high school seniors conducted by the 
Jump$tart Coalition, the level of financial literacy among 12th 
grade students has increased. However, with an average score of 
just 52.3 percent on the national exam, there is still much 
room for improvement. The Committee urges the Department to 
continue funding programs that improve the money management 
skills of young people through the inclusion of financial 
literacy materials, standards and assessments in high school 
math, economics and business courses.
    The Committee recommendation includes $10,000,000 to carry 
out the American History and Civics Education Act of 2004. From 
the amount available, $5,000,000 shall be used to establish 
Presidential Academies for Teaching of American History and 
Civics. These Presidential Academies will strengthen the 
knowledge and teaching capacity of K-12 teachers of American 
history and civics. The remaining $5,000,000 will support the 
establishment of Congressional Academies for Students of 
American History and Civics. These Congressional Academies will 
help outstanding students of American history and civics 
develop a broader and deeper understanding of these subject 
matters.
    The Committee expects funds to be awarded on a competitive 
basis to institutions of higher education, non-profit 
educational institutions, and consortia thereof, to establish 
and operate such Academies. The Committee further intends grant 
awards to last for a period of 2 years. The Committee urges the 
Secretary to give considerable weight to sustainability plans, 
which shall be required of applicants to show how they plan to 
sustain their project after their grant expires, when 
considering awards under this program.
    The Committee recommendation also includes resources for 
the following activities: teacher quality initiatives; 
evaluation and data quality initiatives designed to improve the 
quality of data collected from, and evaluations conducted by, 
grantees under elementary and secondary education programs; 
Reach Out and Read; and peer review.

Teacher Incentive Fund

    The Committee recommendation does not include any funds for 
this new program. The budget request includes $500,000,000 for 
this new activity.
    Under the budget request, $450,000,000 would be available 
for formula grants to States for monetary awards to teachers 
who raise student achievement or reduce the achievement gap, 
and to ``highly qualified'' teachers who teach in high-need 
schools. Under the proposed program, States would be required 
to spend at least 25 percent of their funds for each of these 
two activities. The remaining $50,000,000 proposed in the 
budget request would be available for competitive grants from 
the U.S. Department of Education to partnerships of State 
educational agencies, local educational agencies and non-profit 
organizations for the development and implementation of 
performance-based teacher compensation systems in States and 
school districts.
    The budget request includes bill language that would 
authorize this new program. However, the Committee notes that 
this program was not specifically authorized under the No Child 
Left Behind Act, so it is not included in the Committee bill.

Ready to Learn Television

    The Committee recommends an appropriation of $25,000,000 
for the Ready to Learn Television program. The comparable 
funding level for fiscal year 2005 and the budget request both 
are $23,312,000 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 original objective of RTL was to place educational 
programming within the reach of every American child, 
especially those in culturally disadvantaged households or 
communities.
    The Committee commends the research collaboration of WGBH 
Between the Lions, Sesame Workshop, and the National Center for 
Rural Early Childhood Education regarding Ready to Learn 
television shows and outreach programming. This new research 
for the first time shows the unique learning that occurs in 
rural areas and how they can be best addressed with 
technologically accessible enhancing programming coupled with 
regular public broadcasting of a variety of RTL television 
shows.
    The Committee notes that awards have yet to be made with 
fiscal year 2005 funds available for this program. The 
Committee understands that the competition placed a priority on 
reading programming, but does not intend to restrict program 
content to that subject only. The Committee appreciates the 
Department's commitment to creating high-quality learning 
environments for children through this program and intends that 
funds provided in last year's bill and this Act will support 
the Department's broad view of the educational value of this 
program. While successful reading is clearly an important 
foundation that will allow children to achieve at grade level 
in future years, it is not the only factor that will help them 
reach that goal.
    The Committee appreciates and continues to support the 
community outreach efforts that support programming developed 
and delivered through the Ready to Learn partnership during 
prior funding cycles. While not all of the local outreach 
activities achieved their goal of adequately supporting Ready 
to Learn programming, many leveraged significant local 
resources, fostered broad community collaboration with a small 
amount of Federal funding, and led to more frequent and longer 
periods of reading and other learning activities by those 
adults who attended local training workshops. The Committee 
notes that this small investment in local community outreach 
greatly extended the scope and educational value of this 
program, not only through the services offered to parents but 
also because of the incentive that it created for local 
stations to air Ready to Learn programming. The Committee 
believes this framework should continue to be supported and 
strongly urges the Department to utilize funds appropriated in 
fiscal year 2005 and continued in fiscal year 2006 for this 
purpose.

Dropout Prevention

    The Committee does not recommend additional funds for the 
dropout prevention program. The comparable funding level for 
fiscal year 2005 is $4,930,000 and the budget request did not 
include any funding for the dropout prevention program. These 
funds are used to help schools implement effective school 
dropout prevention and re-entry programs.
    In addition, the Committee notes that in fiscal year 2005, 
States reserved more than $105,000,000 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.

Close Up Fellowships

    The Committee recommendation includes $1,469,000 for Close 
Up Fellowships. The comparable funding level for fiscal year 
2005 is $1,469,000 and the budget request did not include any 
funds for this purpose. The Close Up Fellowships, formerly 
called Ellender Fellowships, 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 spend 1 week in Washington attending seminars and 
meeting with representatives of the three branches of the 
Federal Government.
    The Committee 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 requests a more 
complete discussion of the actions taken to meet this statutory 
requirement, as well as program performance information, in the 
fiscal year 2007 Congressional Budget Justification.

Advanced Placement Program

    The Committee recommends $33,000,000 for Advanced 
Placement. The comparable funding level for fiscal year 2005 is 
$29,760,000 and the budget request includes $51,500,000 for the 
Advanced Placement program.
    The first priority of the program is to subsidize test fees 
for low-income students who are enrolled in an Advanced 
Placement class and plan to take an Advanced Placement test. 
The balance of the funds are allocated for Advanced Placement 
Incentive Program grants, which are used to expand access for 
low-income individuals to Advanced Placement programs. Eligible 
activities include teacher training and participation in online 
Advanced Placement courses, among other related purposes.

                 Safe Schools and Citizenship Education

Appropriations, 2005....................................    $833,987,000
Budget estimate, 2006...................................     396,767,000
House allowance.........................................     763,870,000
Committee recommendation................................     697,300,000

Safe and Drug-Free Schools and Communities

    The Committee recommends a total of $697,300,000 for 
activities to promote Safe Schools and Citizenship Education. 
The comparable fiscal year 2005 funding level is $833,987,000 
and the budget request includes $396,767,000 for these 
activities.
    State Grant Program.--The Committee recommends $300,000,000 
for the safe and drug-free schools and communities State grant 
program. The comparable fiscal year 2005 funding level is 
$437,381,000 and the budget request did not include any funds 
for this purpose. 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 $150,000,000 
for the national programs portion of the safe and drug-free 
schools and communities program. The comparable funding level 
for fiscal year 2005 is $152,537,000 and the budget request 
includes $267,967,000 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 includes $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 a program under the 
guidelines in section 120(f) of Public Law 105-244. This 
program identifies and provides models of alcohol and drug 
abuse prevention and education programs in higher education. 
The Committee includes these funds within the requested 
$10,000,000 for post-secondary alcohol prevention efforts 
proposed in the budget request.
    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 does not include $87,500,000 
as requested by the Department for a new grant program for 
local educational agencies. This program was proposed to 
replace the State grant program, a proposal rejected by the 
Commmittee.
    The Committee recommendation includes $30,000,000 to 
continue the school safety initiative. The budget request 
includes $30,000,000 to support grants and technical assistance 
to elementary and secondary schools for responding to emergency 
response challenges identified in the Department of Homeland 
Security's Critical Infrastructure plan. The Committee notes 
that not all districts in need of planning funds previously 
provided have received them, so the Department is encouraged to 
consider running an additional planning grant competition to 
ensure that the most at-risk districts receive planning grants 
before moving to this next phase. The Committee expects to 
receive a letter report on the plan for fiscal year 2006 funds, 
prior to the announcement of the next grant competition under 
this program.
    The Committee recommendation includes $7,492,000 for 
school-based drug testing programs for students. The comparable 
fiscal year 2005 funding level is $9,920,000 and the budget 
request includes $25,000,000. The Committee expects that this 
funding will be used to continue and evaluate current drug 
testing grants.
    The Committee recommendation also includes $9,372,000 to 
continue data management improvement grants and related 
technical assistance; $82,336,000 for safe schools healthy 
students; $2,000,000 for the required impact evaluation; 
$2,000,000 for information and materials; $2,000,000 for data 
collection and analysis; $1,500,000 for other joint project 
with Federal agencies; and $3,000,000 for other program 
improvement activities.
    Research studies have found that mental health greatly 
affects academic achievement and educational outcomes. The 
Committee recognizes the negative impact that depression, 
anxiety, substance abuse, and other mental disorders can have 
on a youth's academic performance and urges the Office of Safe 
and Drug Free Schools to join the Substance Abuse and Mental 
Health Services Administration, the Centers for Disease 
Control, and other Federal agency efforts to take concrete 
steps to improve the mental health of America's youth through 
the early identification of mental health problems, including 
the use of voluntary, evidence-based mental health screening of 
adolescents. The Committee urges the Department to continue to 
promote school-wide mental health strategies, provide training 
to school personnel to recognize early warning signs of mental 
illness, and increase access to high-quality mental health 
services. In addition, the Department is encouraged to include 
an evaluation component to determine the most effective 
programs and practices for the early identification of youth 
mental illness.

Alcohol Abuse Reduction

    The Committee recommends $33,500,000 for grants to LEAs to 
develop and implement programs to reduce underage drinking in 
secondary schools. The comparable funding level for fiscal year 
2005 is $32,736,000 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 $49,307,000 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 2005 funding level and 
the budget request both are $49,307,000 for this purpose.

Character Education

    The Committee recommends $24,493,000 to provide support for 
the design and implementation of character education programs. 
The comparable funding level for fiscal year 2005 and the 
budget request both are $24,493,000 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 2005 funding level is $34,720,000 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.

Carol M. White Physical Education for Progress Program

    The Committee recommends $74,000,000 to help LEAs and 
community-based organizations initiate, expand and improve 
physical education programs for students in grades K-12, as 
authorized by Public Law 107-110. The comparable funding level 
for fiscal year 2005 is $73,408,000 and the budget request 
includes $55,000,000 for this program. 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 Committee does not agree with the 
administration's proposal to phase-out and eventually eliminate 
funding for this program.
    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. 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 times 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 $30,000,000 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 2005 funding 
level is $29,405,000 and the budget request proposed to 
eliminate funding for this purpose.
    Civic Education program funds support both the We the 
People programs and the Cooperative Education Exchange. The 
Committee recommends $17,560,000 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 program, 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 
Committee recommends the following: that $3,087,000 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 $1,543,000 
be used for continuation and expansion of the school violence 
prevention demonstration program including the Native American 
program.
    The Committee recommends $12,440,000 for the Cooperative 
Education Exchange program. Within this amount, the Committee 
has included $4,665,000 for the Center for Civic Education and 
$4,665,000 for the National Council on Economic Education. The 
remaining $3,110,000 should be used for a competitive grant 
program for civics and government education, and for economic 
education.

                      English Language Acquisition

Appropriations, 2005....................................    $675,765,000
Budget estimate, 2006...................................     675,765,000
House allowance.........................................     675,765,000
Committee recommendation................................     675,765,000

    The Committee recommends an appropriation of $675,765,000 
for English language acquisition. The comparable funding level 
for fiscal year 2005 and the budget request both are 
$675,765,000 for authorized activities.
    The Department makes formula grants to States based on each 
State's share of the Nation's limited-English-proficient and 
recent immigrant student population. The program is designed to 
increase the capacity of States and school districts to address 
the needs of these students. The No Child Left Behind Act also 
requires that 6.5 percent of the appropriation, an amount equal 
to $43,925,000 at the Committee recommendation funding level, 
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. The budget request includes language 
that would allow national activities funds to be available for 
2 years. The Committee bill includes the requested language.
    At the level of the Committee recommendation, the State 
grant portion of this account will increase by more than 
$44,000,000, as funding for expiring projects under the prior 
law are redirected to the State grant program. These additional 
funds will help States improve the educational outcomes for 
limited English proficient students.

                           Special Education

Appropriations, 2005.................................... $11,673,606,000
Budget estimate, 2006...................................  12,126,130,000
House allowance.........................................  11,813,783,000
Committee recommendation................................  11,774,107,000

    The Committee recommends $11,774,107,000 for special 
education programs authorized by the Individuals with 
Disabilities Education Act [IDEA]. The comparable fiscal year 
2005 funding level is $11,673,606,000 and the budget request 
includes $12,126,130,000 for such programs.

Office of Special Education and Rehabilitative Services [OSERS]

    No Child Left Behind [NCLB].--The Committee notes that the 
Department recently announced changes in NCLB policy regarding 
students with disabilities who have shown academic 
difficulties. The Department estimates that 2 percent of 
students with academic disabilities can make progress toward 
grade-level standards when they receive high-quality 
instruction and when their assessments are based on modified 
academic achievement standards assessments. The Committee is 
concerned that States do not yet have the tools and resources 
to appropriately implement the new policy in the 2005-2006 
school year. To help States prepare for future implementation 
based on the promulgation of final regulations, the Committee 
strongly urges OSERS to provide support guidance to States, and 
LEAs, and parents that will define how students are identified 
for this category and ensure that eligible students have every 
possible opportunity for full and consistent participation in 
the general education curriculum and be on track to graduate 
with a regular diploma.

Office of Special Education Programs [OSEP]

    Specific Learning Disabilities [SLD].--The Committee urges 
OSEP to ensure that the National Research Center on Learning 
Disabilities [NRCLD] continues to conduct and synthesize 
research on how to best implement and take to scale 
identification methods that rely on students' responses to 
scientific research-based instruction. OSEP, through the NRCLD, 
should assist States and LEAs in identifying the criteria for 
determining an SLD and ensuring the consistency and integrity 
of the classification system across the States, and provide 
guidance and technical assistance systems for the improvement 
of SLD identification and eligibility. The NRCLD should 
disseminate to and assist both States and LEAs with replicable 
models that produce measurable positive improvements in student 
learning. The NRCLD should coordinate with the PTIs, the 
National Dissemination Center for Children with Disabilities 
and other national partners to disseminate information about 
accurate identification of SLDs to parents. The Committee 
encourages OSEP to coordinate efforts within the Department of 
Education, NIH, NSF and other Federal agencies working on 
related activities.
    No Child Left Behind [NCLB] and the Individuals with 
Disabilities Education Improvement Act of 2004.--The Committee 
urges OSEP to educate parents of students with learning 
disabilities with the critical information they need to 
understand the impact of decisions made by the IEP team 
regarding assessments required by NCLB, school choice, 
supplemental education services, and other provisions of NCLB.

Grants to States

    The Committee recommends $10,689,746,000 for special 
education grants to States, as authorized under part B of the 
IDEA. The comparable fiscal year 2005 funding level is 
$10,589,746,000 and the budget request includes 
$11,097,746,000. This program provides formula grants to assist 
States, Outlying Areas, and other entities in meeting the costs 
of providing special education and related services for 
children with disabilities. States pass along most of these 
funds to local educational agencies, but may reserve some for 
program monitoring, enforcement, technical assistance and other 
activities.
    The appropriation for this program primarily supports 
activities associated with the 2006-2007 academic year. Of the 
funds available for this program, $5,265,546,000 will become 
available on July 1, 2006 and $5,424,200,000 will become 
available on October 1, 2006. These funds will remain available 
for obligation until September 30, 2007.
    The reauthorization established a new activity under this 
program, which allows funds to be used by the Secretary for 
grants to and contracts with States that improve their capacity 
to collect data required under the Act. The reauthorization 
also established a separate program for IDEA studies and 
evaluations, which is now funded as a separate program under 
the Institute of Education Sciences. Studies and evaluations 
were funded previously under this program, in accordance with 
the former law.
    The Committee's recommended funding level represents 
approximately 18 percent of the average per-pupil expenditure, 
an increase of 50 percent from the level in fiscal year 2000 
when the Federal share of average per-pupil expenditure was 12 
percent.
    The budget request includes language capping the Department 
of Interior set-aside at the prior year level, adjusted by the 
increase in inflation. The Committee bill includes this 
language.

Preschool Grants

    The Committee recommends $384,597,000 for preschool grants. 
The comparable fiscal year 2005 funding level and the budget 
request both are $384,597,000. 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. States are eligible for funds, which they in 
turn pass on to local educational agencies, if they serve all 
eligible children with disabilities aged 3 through 5 and have 
an approved application under the Individuals with Disabilities 
Education Act.

Grants for Infants and Families

    The Committee recommends $444,308,000 for grants for the 
infants and families program under part C of the IDEA. The 
comparable fiscal year 2005 funding level and the budget 
request both are $440,808,000. This program provides formula 
grants to States, Outlying Areas and other entities 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.
    The Individuals with Disabilities Education Improvement Act 
of 2004 created a new State Incentive Grant program, triggered 
when the appropriation for this program exceeds $460,000,000. 
Under this new authority, 15 percent of the appropriation is 
reserved by the Secretary for grants to States that have chosen 
to extend Part C services to 3-year-old children through their 
enrollment in kindergarten or elementary school who otherwise 
would be eligible for services under the Preschool Grants 
program.

State Personnel Development

    The Committee recommends $50,653,000 for the State 
personnel development program. The comparable fiscal year 2005 
funding level is $50,653,000 and the budget request does not 
include any funds for this program. The program formerly was 
known as the State improvement grant program, until it was 
changed by the Individuals with Disabilities Education 
Improvement Act of 2004. Under the reauthorization, this 
program focuses on the professional development needs in States 
by requiring that 90 percent of funds be used for professional 
development activities. The program supports grants to State 
educational agencies to help them reform and improve their 
personnel preparation and professional development related to 
early intervention, educational and transition services that 
improve outcomes for students with disabilities.
    Under this program, competitive grants are made when the 
appropriation is less than $100,000,000, but are made by 
formula to States when the appropriation exceeds this amount 
and $100,000,000 is remaining after covering continuation 
costs.

Transition Initiative

    The Committee recommendation does not include any funds for 
this new program. The budget request includes $5,000,000 for 
this new initiative. Funds would be used to help States improve 
high school graduation rates, transition activities, and post-
school outcomes, establish better data collection systems, and 
analyze and use student information. Grants would be made to 
State educational agencies on a competitive basis.
    The Committee notes that the budget request includes 
$2,000,000 under the demonstration and training program in the 
Rehabilitation Services and Disability Research account to 
support this initiative. Funds are available under that program 
for this initiative, but the Committee is unable to provide the 
additional special education funds requested for the new 
program given budgetary constraints.

Technical Assistance and Dissemination

    The Committee recommends $49,397,000 for technical 
assistance and dissemination. The comparable fiscal year 2005 
funding level is $52,396,000 and the budget request is 
$49,397,000 for these activities. This program supports awards 
for technical assistance, model demonstration projects, the 
dissemination of useful information and other activities. 
Funding supports activities that are designed to improve the 
services provided under IDEA.

Personnel Preparation

    The Committee recommends $90,626,000 for the personnel 
preparation program. The comparable fiscal year 2005 funding 
level and the budget request both are $90,626,000 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 is particularly concerned about the shortage 
of qualified occupational therapists available to work in 
school systems, to assist children with disabilities, and with 
the shortage of leadership-level faculty to train such 
professionals. The Committee intends that funds be used to 
address these shortages.

Parent Information Centers

    The Committee recommends $25,964,000 for parent information 
centers. The comparable fiscal year 2005 funding level and the 
budget request both are $25,964,000 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 $38,816,000 for technology and 
media services. The comparable fiscal year 2005 funding level 
is $38,816,000 and the budget request includes $31,992,000 for 
such activities. This program makes competitive awards to 
support the development, demonstration, and use of technology, 
and educational media activities of value to children with 
disabilities.
    The Committee recommendation includes $12,000,000 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 $1,488,000. 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.
    The Committee notes that, within the budget request, funds 
are available to provide better access to educational media and 
materials for individuals with disabilities, including 
activities related to the National Instructional Materials 
Accessibility Standard. The Committee supports these efforts, 
and encourages the Department to provide sufficient funds to 
fulfill the requirements related to this standard established 
by the Individuals with Disabilities Education Improvement Act 
of 2004.

            Rehabilitation Services and Disability Research

Appropriations, 2005....................................  $3,074,574,000
Budget estimate, 2006...................................   3,059,298,000
House allowance.........................................   3,128,638,000
Committee recommendation................................   3,133,638,000

    The Committee recommends $3,133,638,000 for rehabilitation 
services and disability research. The comparable fiscal year 
2005 funding level is $3,074,574,000 and the budget request 
includes $3,059,298,000 for programs in this account.
    The authorizing statute for programs funded in this 
account, except for those authorized under the Assistive 
Technology Act, expired September 30, 2004. The program 
descriptions provided below assume the continuation of current 
law.
    The Committee recognizes the importance, efficiency, and 
return on the taxpayer dollar of community rehabilitation 
programs and other nonprofit organizations in providing support 
for people with disabilities. The Committee urges the 
Rehabilitation Services Administration to support the 
utilization of community rehabilitation programs to the maximum 
extent possible in the delivery of employment and other support 
services to people with disabilities.

Vocational Rehabilitation State Grants

    The Committee provides $2,720,192,000 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 2005 is 
$2,635,845,000.
    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 the most significant disabilities. Funds are 
allotted to States based on a formula that takes into account 
population and per capita income. States must provide a 21.3 
percent match of Federal funds, except the State's share is 50 
percent for the cost of construction of a facility for 
community rehabilitation program purposes.
    The Rehabilitation Act requires that no less than 1 percent 
and not more than 1.5 percent of the appropriation in fiscal 
year 2006 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 $11,901,000 for the client 
assistance program. The comparable fiscal year 2005 funding 
level and the budget request both are $11,901,000 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 $38,826,000 for training 
rehabilitation personnel. The comparable fiscal year 2005 
funding level and the budget request both are $38,826,000 for 
training activities.
    The purpose of this program is to ensure that skilled 
personnel are available to serve the rehabilitation needs of 
individuals with disabilities. It supports training, 
traineeships, and related activities designed to increase the 
numbers of qualified personnel providing rehabilitation 
services. The program awards grants and contracts to States and 
public or nonprofit agencies and organizations, including 
institutions of higher education, to pay all or part of the 
cost of conducting training programs. Long-term, in-service, 
short-term, experimental and innovative, and continuing 
education programs are funded, as well as special training 
programs and programs to train interpreters for persons who are 
deaf, hard of hearing and deaf-blind.

Demonstration and Training Programs

    The Committee bill includes $6,577,000 for demonstration 
and training programs for persons with disabilities. The 
comparable fiscal year 2005 funding level is $25,607,000 and 
the budget request includes $6,577,000 for authorized 
activities. This program awards grants to States and nonprofit 
agencies and organizations to develop innovative methods and 
comprehensive services to help individuals with disabilities 
achieve satisfactory vocational outcomes. Demonstration 
programs support projects for individuals with a wide array of 
disabilities.
    The Committee is pleased with the partnership between RSA 
and the American Academy of Orthotists and Prosthetists to 
support and improve the quality of applied orthotic and 
prosthetic research and help meet the increasing demand for 
provider services. The Committee has provided sufficient funds 
to support this partnership at its current level. 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. Funds 
also will continue to support a series of consensus conferences 
and the dissemination of best practices to the field.

Migrant and Seasonal Farmworkers

    The Committee recommends $2,302,000 for migrant and 
seasonal farmworkers, the same amount as the comparable fiscal 
year 2005 funding level. The Department proposes eliminating 
separate funding for this program.
    This program provides 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 $2,543,000 for recreational 
programs, the same amount as the comparable fiscal year 2005 
funding level. 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 $16,656,000 for protection and 
advocacy of individual rights. The comparable fiscal year 2005 
funding level and the budget request both are $16,656,000.
    This program provides grants to agencies to protect and 
advocate for the legal and human rights of persons with 
disabilities who are not eligible for protection and advocacy 
services available through the Developmental Disabilities 
Assistance and Bill of Rights Act or the Protection and 
Advocacy for Individuals with Mental Illness Act.

Projects with Industry

    The Committee recommends $19,735,000 for projects with 
industry. The comparable fiscal year 2005 funding level is 
$21,625,000 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 supports 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 $30,000,000 for the supported 
employment State grant program. The comparable fiscal year 2005 
funding level is $37,379,000 and the administration proposes 
eliminating separate funding for this program.
    This program assists the most severely disabled individuals 
by providing the ongoing support needed to obtain competitive 
employment. Short-term vocational rehabilitation services are 
augmented with extended services provided by State and local 
organizations. Federal funds are distributed on the basis of 
population.

Independent Living State Grants

    The Committee recommends $22,816,000 for independent living 
State grants. The comparable funding level for fiscal year 2005 
and the budget request both are $22,816,000 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 $75,392,000 for independent living 
centers. The comparable fiscal year 2005 funding level and the 
budget request both are $75,392,000 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 $33,227,000 for independent living 
services to older blind individuals. The comparable fiscal year 
2005 funding level and the budget request both are $33,227,000 
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. 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 $843,000 for program improvement 
activities. The comparable fiscal year 2005 funding level and 
the budget request both are $843,000 for authorized activities. 
In fiscal year 2006, 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 technical assistance and other 
ongoing program improvement activities, such as improved 
program performance measurement.

Evaluation

    The Committee recommends $1,488,000 for evaluation 
activities. The comparable fiscal year 2005 funding level and 
the budget request both are $1,488,000 for such activities.
    These funds support evaluations of the impact and 
effectiveness of programs authorized by the Rehabilitation Act. 
The Committee recommendation continues to support a new multi-
year 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 $8,597,000 for the Helen Keller 
National Center for Deaf-Blind Youth and Adults. The comparable 
fiscal year 2005 funding level is $10,581,000 and the budget 
request includes $8,597,000 for this purpose. The difference 
between fiscal year 2005 funding and the Committee 
recommendation relates to earmarked funds provided in the 
Consolidated Appropriations Act, 2005. These funds are still 
available for expenditure and it is estimated it could take 
another 2 years before they are exhausted.
    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 2,500 individuals and 
families and approximately 1,100 organizations.

National Institute on Disability and Rehabilitation Research

    The Committee recommends $107,783,000 for the National 
Institute on Disability and Rehabilitation Research [NIDRR]. 
The comparable fiscal year 2005 funding level and the budget 
request both are $107,783,000 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 $11,863,000, as 
proposed in the budget request, for NIDRR's spinal cord injury 
model systems projects. 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.

Assistive Technology

    The Committee recommends $34,760,000 for assistive 
technology. The comparable fiscal year 2005 funding level is 
$29,760,000. The budget request includes $15,000,000 solely for 
the alternative financing program.
    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. The 
program support various activities that help States to develop 
comprehensive, consumer-responsive statewide programs that 
increase access to, and the availability of, assistive 
technology devices and services. Under the recent 
reauthorization, the administration of this program was moved 
to the Rehabilitation Services Administration from the National 
Institute on Disability and Rehabilitation Research. The 
reauthorization also requires that an annual report be 
submitted to Congress by December 31 of each year.
    The Committee recommendation includes $25,300,000 for State 
grant activities authorized under section 4, $4,500,000 for 
protection and advocacy systems authorized by section 5, and 
$1,200,000 for technical assistance activities authorized under 
section 6.
    The Committee recommendation also includes $3,760,000 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, require a match of 25 percent and enable 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. The Committee also urges the 
Department to utilize these funds to expand the number of 
States operating alternative financing programs.

           Special Institutions for Persons With Disabilities


                 AMERICAN PRINTING HOUSE FOR THE BLIND

Appropriations, 2005....................................     $16,864,000
Budget estimate, 2006...................................      16,864,000
House allowance.........................................      17,000,000
Committee recommendation................................      18,500,000

    The Committee recommends $18,500,000 for the American 
Printing House for the Blind [APH]. The comparable fiscal year 
2005 funding level is $16,864,000 and the budget request 
includes $16,864,000 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 purchases and other 
acquisitions consistent with the purpose of the Act to Promote 
the Education of the Blind.
    In addition to its ongoing activities, the Individuals with 
Disabilities Education Improvement Act assigned to the American 
Printing House for the Blind the responsibility of establishing 
and maintaining a National Instructional Materials Access 
Center. The Center will serve as a national clearinghouse, 
maintaining a repository of textbook files provided in the 
National Instructional Materials Accessibility Standard format 
by textbook publishers. The Center will manage the transfer of 
these files to State Education Agencies for production in media 
that are readily accessible to the blind, visually impaired, 
and print disabled. The Committee supports this effort, and 
encourages the Department to provide sufficient funds to 
fulfill the requirements of the law.

               NATIONAL TECHNICAL INSTITUTE FOR THE DEAF

Appropriations, 2005....................................     $55,344,000
Budget estimate, 2006...................................      54,472,000
House allowance.........................................      56,137,000
Committee recommendation................................      57,279,000

    The Committee recommends $57,279,000 for the National 
Technical Institute for the Deaf [NTID]. The comparable fiscal 
year 2005 funding level is $55,344,000 and the budget request 
includes $54,472,000 for this purpose.
    The Institute, located on the campus of the Rochester 
Institute of Technology, was created by Congress in 1965 to 
provide a residential facility for postsecondary technical 
training and education for persons who are deaf. NTID also 
provides support services for students who are deaf, trains 
professionals in the field of deafness, and conducts applied 
research. Within the amount provided, $800,000 is for 
construction. At the discretion of the Institute, funds may be 
used for the Endowment Grant program.

                          GALLAUDET UNIVERSITY

Appropriations, 2005....................................    $104,557,000
Budget estimate, 2006...................................     104,557,000
House allowance.........................................     107,657,000
Committee recommendation................................     108,500,000

    The Committee recommends $108,500,000 for Gallaudet 
University. The comparable fiscal year 2005 funding level and 
the budget request both are $104,557,000 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 
increases for faculty and staff, support investments in 
information technology and address other cost increases and 
program improvements. Funds also are available, at the 
discretion of the University, for the Endowment Grant program.

                     Vocational and Adult Education

Appropriations, 2005....................................  $2,037,733,000
Budget estimate, 2006...................................     215,734,000
House allowance.........................................   1,991,782,000
Committee recommendation................................   1,923,766,000

    The Committee recommendation includes a total of 
$1,923,766,000 for vocational and adult education, consisting 
of $1,309,400,000 for vocational education, $585,406,000 for 
adult education and $28,960,000 for other activities. The 
comparable funding level in fiscal year 2005 is $2,037,733,000 
and the budget request includes $215,734,000 for this account.
    The authorizing statute for vocational and adult education 
programs and the State grants for incarcerated youth offenders 
program funded in this account expired September 30, 2004. 
Descriptions for these programs provided below assume the 
continuation of current law.

                          VOCATIONAL EDUCATION

    The Committee recommends $1,309,400,000 for vocational 
education. The comparable fiscal year 2005 funding level is 
$1,326,107,000 and the budget request does not include any 
funds for these activities. The administration proposed to 
redirect the funds currently allocated for vocational education 
to a new High School initiative. The Committee notes that this 
initiative has not been acted on by the appropriate authorizing 
committees of Congress.
    Basic Grants.--The Committee recommends $1,194,331,000 for 
basic grants, the same amount as the comparable fiscal year 
2005 funding level. The budget request does not include any 
funds 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.
    Of the funds available for this program, $403,331,000 will 
become available on July 1, 2006 and $791,000,000 will become 
available on October 1, 2006. These funds will remain available 
for obligation until September 30, 2007.
    Tech-Prep Education.--The Committee recommends $105,812,000 
for tech-prep programs. The comparable fiscal year 2005 funding 
level is $105,812,000 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 
$9,257,000 for national research programs and other national 
activities. The comparable fiscal year 2005 funding level is 
$11,757,000 and the budget request proposes to eliminate 
separate funding for this program. The Committee recommendation 
maintains the current spending on national programs because 
$2,500,000 has been utilized under this appropriation for the 
State Scholars program. Funding for State Scholars was 
requested under the Fund for the Improvement of Education.
    Funds provided under this program support research, 
development, dissemination, evaluation and assessment designed 
to improve the quality and effectiveness of vocational and 
technical education. Funds have been provided to the National 
Research Center for Career and Technical Education and the 
National Dissemination Center for Career and Technical 
Education 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.
    Tech-Prep Education Demonstration Program.--The Committee 
recommendation does not include additional funding for this 
program. The comparable fiscal year 2005 funding level is 
$4,900,000 and the budget request proposes to eliminate funding 
for this program. Under this demonstration authority, the 
Secretary has awarded 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 have been used for curriculum, professional 
development, equipment, and other start-up and operational 
costs.
    The Committee notes that evaluations for the first round of 
funded grantees will be available this year. The Committee 
urges the Department to identify effective programs from these 
projects that have positive findings, based on rigorous 
evaluations, and disseminate them to States, so they can 
further benefit from the investment made in this program.
    Occupational and Employment Information Program.--The 
Committee does not recommend additional funds for activities 
authorized by section 118 of the Carl Perkins Act. The 
comparable fiscal year 2005 funding level is $9,307,000, and 
the budget request proposes to eliminate this program. The Act 
requires that at least 85 percent of the amount appropriated 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 $585,406,000 for adult education, 
the same amount as the comparable fiscal year 2005 funding 
level. The budget request includes $215,734,000 for this 
purpose.
    Adult Education State Programs.--For adult education State 
programs, the Committee recommends $569,672,000, the same 
amount as the comparable fiscal year 2005 funding level. The 
budget request includes $200,000,000 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, 
$68,582,000 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.
    The Committee is pleased with the progress States are 
making in reporting on and improving performance outcomes 
generated by this program and urges the Department to continue 
to work with States to assist them in these efforts. The 
Commmittee recognizes the diverse population eligible for 
services under this program, ranging from adults striving to 
complete their secondary education to workers requiring better 
English skills to benefit from employer-provided job training 
and to grandparents desiring the skills necessary to help 
grandchildren to learn to read. The Committee also notes that 
while some participants cite employment as their reason for 
enrolling in an adult education program, many program 
participants do not establish this as a goal. Furthermore, even 
if employment is a goal, increased earnings might not be 
associated with the career goals of the more than one-third of 
adult education participants currently employed. Therefore, the 
Committee has recommended level funding for this program, and 
urges the Department to consider these facts when assessing 
program performance under the Adult Education program and the 
appropriateness of including this education program under the 
Administration's initiative to identify common measures for job 
training and employment programs.
    National Activities.--The Committee recommends $9,096,000 
for national leadership activities. The comparable funding 
level for fiscal year 2005 and the budget request both are 
$9,096,000 for this purpose. Under this program, 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 
$6,638,000 for the National Institute for Literacy, authorized 
under section 242 of the Adult Education and Family Literacy 
Act. The comparable fiscal year 2005 funding level and the 
budget request both are $6,638,000 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 does not recommend additional funds for this 
program. The comparable fiscal year 2005 funding level is 
$94,476,000 and the budget request does not include any funds 
for this purpose. This program has supported competitive grants 
to local educational agencies to enable them to create smaller 
learning communities in large schools. Funds have been used to 
study, research, develop and implement strategies for creating 
smaller learning communities, as well as professional 
development for staff. Two types of grants were 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 notes that the fiscal year 2004 and 2005 
appropriations are still available for obligation and the 
Department lapsed more than $26,000,000 from the fiscal year 
2003 appropriation because of a lack of fundable applications.

Community Technology Centers

    The Committee recommends $4,960,000 for community 
technology centers, the same amount as the comparable funding 
level for fiscal year 2005. 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.

State Grants for Incarcerated Youth Offenders

    The Committee has included $24,000,000 for education and 
training for incarcerated youth offenders. The comparable 
funding level for fiscal year 2005 is $21,824,000. The 
Administration 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. Under current 
law, 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 expects the Department to administer this 
program through the Office of Correctional Education within the 
Office of Vocational and Adult Education. The Committee notes 
that this would be consistent with the Department's recent 
reorganization, which designated the Under Secretary with the 
authority to coordinate the efforts of postsecondary programs 
and initiatives.

Literacy Programs for Prisoners

    The Committee recommendation does not include funds for 
this program. The comparable funding level for fiscal year 2005 
is $4,960,000 and the budget request does not include any funds 
for this purpose. Under this program, grants have been made to 
State and local correctional education agencies and 
correctional education agencies to establish and operate 
programs that develop and improve the life skills of prisoners 
so they may more effectively reintegrate into society.

                      Student Financial Assistance

Appropriations, 2005.................................... $14,265,749,000
Budget estimate, 2006...................................  15,050,977,000
House allowance.........................................  15,283,752,000
Committee recommendation................................  15,103,795,000

    The Committee recommends an appropriation of 
$15,103,795,000 for student financial assistance. The 
comparable fiscal year 2005 funding level is $14,265,749,000 
and the budget request includes $15,050,977,000 for this 
purpose.
    Programs in this account are authorized through September 
30, 2005. Program authorities and descriptions assume the 
continuation of current law.

Federal Pell Grant Program

    For Pell grant awards in the 2006-2007 academic year, the 
Committee recommends $13,177,000,000 to maintain the record 
maximum Pell Grant award level of $4,050. The Committee is very 
supportive of the President's proposal to increase the Pell 
Grant maximum award using mandatory funds. This proposal would 
have guaranteed $100 increases in the Pell Grant maximum award 
for each of the next 5 years. Unfortunately, the Budget 
Resolution rejected this proposal and proposed that an increase 
in the maximum award should compete against funding for other 
student aid programs, vocational and technical education and 
other activities funded in this bill. The Committee encourages 
the Administration to make this worthwhile proposal again next 
year and take necessary action to ensure its adoption.
    Pell grants provide need-based financial assistance that 
helps low- and middle-income undergraduate students and their 
families defray a portion of 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 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.
    The Committee bill also includes language in section 305 of 
the general provisions to pay off the estimated $4,300,000,000 
accumulated shortfall in the Pell Grant program. The 
administration provided mandatory funds within its budget 
request for this purpose. These funds are provided pursuant to 
section 303 of the Concurrent Resolution on the Budget for 
fiscal year 2006 (H. Con. Res. 95, House Report 109-62) and are 
not reflected in the totals for this program or account.

Federal Supplemental Educational Opportunity Grants

    The Committee recommends $804,763,000 for Federal 
supplemental educational opportunity grants [SEOG]. The 
comparable fiscal year 2005 funding level and the budget 
request both are $778,720,000 for this purpose. This program 
provides funds to postsecondary institutions for need-based 
grants to undergraduate students. Institutions must contribute 
25 percent towards 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 $990,257,000 for the Federal 
work-study program, the same amount as both the comparable 
fiscal year 2005 funding level and the budget request.
    This program provides grants to more than 3,300 
institutions to help an estimated 800,000 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.

Federal Perkins Loans

    The Committee bill does not include additional funds for 
Federal Perkins loans capital contributions. The comparable 
fiscal year 2005 funding level did not include such funds and 
the budget request does not provide any funds for this purpose.
    The Federal Perkins loan program supports student loan 
revolving funds built up with capital contributions to nearly 
1,900 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 recommends $66,132,000 for loan 
cancellations, the same amount as the comparable funding level 
for fiscal year 2005. The budget request did not include any 
funds for this purpose. 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.
    The Committee recommendation will maintain a robust loan 
program that will support more than $1,100,000,000 in loans to 
more than 550,000 individuals.

Presidential Math and Science Scholars

    The Committee recommendation does not include funds for 
this new program. The budget request includes $50,000,000 for 
this purpose, based on proposed legislation.
    This proposed program would support a public-private 
partnership designed to provide grant aid to low-income math 
and science students. Grants of up to $5,000 for each eligible 
student would be available through this proposed partnership.

Leveraging Educational Assistance Partnership Program

    For the leveraging educational assistance partnership 
[LEAP] program, the Committee recommends $65,643,000, the same 
amount as the comparable funding level for fiscal year 2005. 
The budget proposes to eliminate funding for this program.
    The leveraging educational assistance partnership program 
provides a Federal match to States as an incentive for 
providing need-based grant and work-study assistance to 
eligible postsecondary students. When the appropriation exceeds 
$30,000,000, amounts above this threshold must be matched by 
States on a 2:1 basis. Federally supported grants and job 
earnings are limited to $5,000 per award year for full-time 
students.

                       Student Aid Administration

Appropriations, 2005....................................    $119,084,000
Budget estimate, 2006...................................     939,285,000
House allowance.........................................     124,084,000
Committee recommendation................................     120,000,000

    The Committee recommends $120,000,000 in discretionary 
resources for the Student Aid Administration account. The 
comparable fiscal year 2005 discretionary funding level is 
$119,084,000 and the budget request includes $939,285,000 in 
such funding. However, the budget request assumes enactment of 
a proposal to rescind mandatory budget authority available in 
Section 458 of the Higher Education Act and to provide these 
funds through discretionary appropriations. The Committee does 
not agree with the administration's legislative proposal to 
fund this new account solely through annual 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.

                     Loans for Short-Term Training

Appropriations, 2005....................................................
Budget estimate, 2006...................................     $11,000,000
House allowance.........................................................
Committee recommendation................................................

    The Committee defers action on this program, which is to be 
established by proposed legislation. The budget request 
includes $11,000,000 for this new activity. Under this proposed 
program, dislocated workers, the unemployed, transitioning and 
older workers, and students would be eligible to borrow funds 
to engage in training needed to acquire new or upgraded skills 
through short-term training programs. Such training programs 
must lead to an industry credential, certificate, or employer-
endorsed technical or occupational skill.

                            Higher Education

Appropriations, 2005....................................  $2,116,698,000
Budget estimate, 2006...................................   1,202,315,000
House allowance.........................................   1,936,936,000
Committee recommendation................................   2,104,508,000

    The Committee recommends an appropriation of $2,104,508,000 
for higher education programs. The comparable fiscal year 2005 
funding level is $2,116,698,000 and the budget request includes 
$1,202,315,000 for such activities.
    Except for the activities authorized by the Mutual 
Educational and Cultural Exchange Act of 1961, programs in this 
account are authorized through September 30, 2005. Program 
authorities and descriptions assume the continuation of current 
law.

Aid for Institutional Development

    The Committee recommends $510,923,000 for aid for 
institutional development authorized by titles III and V of the 
Higher Education Act. The comparable funding level for fiscal 
year 2005 is $507,764,000 and the budget request includes 
$505,519,000 for authorized activities.
    Strengthening Institutions.--The Committee bill includes 
$80,338,000 for the part A strengthening institutions program. 
The comparable fiscal year 2005 funding level and the budget 
request both are $80,338,000 for this activity. The part A 
program supports competitive, 1-year planning and 5-year 
development grants for institutions with a significant 
percentage of financially needy students and low educational 
and general expenditures per student in comparison with similar 
institutions. Applicants may use part A funds to develop 
faculty, strengthen academic programs, improve institutional 
management, and expand student services. Institutions awarded 
funding under this program are not eligible to receive grants 
under other sections of part A or part B.
    Hispanic-Serving Institutions [HSI].--The Committee 
recommends $95,873,000 for institutions at which Hispanic 
students make up at least 25 percent of enrollment. The 
comparable fiscal year 2005 funding level is $95,106,000 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 2005 funding level is 
$238,576,000 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 2005 funding level is 
$58,032,000 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 $11,904,000 for this 
program, the same amount as last year. The budget request 
includes $6,500,000 for authorized activities. The purpose of 
this program is to improve and expand the capacity of 
institutions serving Alaska Native and Native Hawaiian 
students. Funds may be used to plan, develop, and implement 
activities that encourage: faculty and curriculum development; 
better fund and administrative management; renovation and 
improvement of educational facilities; student services; and 
the purchase of library and other educational materials. As 
initial funding cycles expire, the Committee encourages the 
Department to use simplified application forms to permit 
participating institutions to obtain continuation funding for 
successful programs funded under this program.
    Strengthening Tribally Controlled Colleges and 
Universities.--The Committee recommends $23,808,000 for 
strengthening tribal colleges and universities [TCUs]. The 
comparable funding level for fiscal year 2005 and the budget 
request both are $23,808,000 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.

International Education and Foreign Language Studies

    The bill includes a total of $106,819,000 for international 
education and foreign language programs. The comparable fiscal 
year 2005 funding level is $106,818,000 and the budget request 
includes $106,819,000 for such activities.
    The Committee bill includes language allowing funds to be 
used to support visits and study in foreign countries by 
individuals who plan to utilize their language skills in world 
areas vital to the United States national security in the 
fields of government, international development and the 
professions. Bill language also allows up to 1 percent of the 
funds provided to be used for program evaluation, national 
outreach and information dissemination activities. This 
language is continued from last year's bill.
    Domestic Programs.--The Committee recommends $92,466,000 
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 2005 funding level is $92,465,000 and the budget 
request includes $92,466,000 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 $12,737,000 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 2005 funding 
level and the budget request both are $12,737,000 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 $1,616,000 for the Institute for International 
Public Policy. The comparable funding level for fiscal year 
2005 and the budget request both are $1,616,000 for authorized 
activities. This program is designed to increase the number of 
minority individuals in foreign service and related careers by 
providing a grant to a consortium of institutions for 
undergraduate and graduate level foreign language and 
international studies. An institutional match of 50 percent is 
required.

Fund for the Improvement of Postsecondary Education

    The Committee recommends $162,211,000 for the Fund for the 
Improvement of Postsecondary Education [FIPSE]. The comparable 
fiscal year 2005 funding level is $162,108,000 and the budget 
request includes $22,211,000 for this purpose. 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 the 
Department with advice from an independent board and provides 
small, competitive grants and contracts to a variety of 
postsecondary institutions and agencies, including 2- and 4-
year colleges and universities, State education agencies, 
community-based organizations, and other non-profit 
institutions and organizations concerned with education beyond 
high school.
    The Committee recommendation includes $17,423,000, the full 
amount requested for the comprehensive program, as well as 
funds for international consortia programs.

Minority Science and Engineering Improvement

    The Committee recommends $8,818,000 for the Minority 
Science and Engineering Improvement program [MSEIP]. The 
comparable fiscal year 2005 funding level and the budget 
request both are $8,818,000 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 does not recommend additional funds for 
interest subsidy grants. The comparable fiscal year 2005 
funding level is $1,488,000 and the budget request does not 
include funds for these grants. Unobligated balances from prior 
year appropriations are available to meet the Federal 
commitment to pay interest subsidies on 13 loans made in past 
years for constructing, renovating, and equipping postsecondary 
academic facilities. No new interest subsidy commitments have 
been entered into since 1973 but subsidy payments on existing 
loans are expected to continue until the year 2013.

Tribally Controlled Postsecondary Vocational Institutions

    The Committee recommends $7,440,000 on a current-funded 
basis for tribally controlled postsecondary vocational 
institutions. The comparable fiscal year 2005 funding level and 
the budget request both are $7,440,000 for this purpose. This 
program provides grants for the operation and improvement of 
two tribally controlled postsecondary vocational institutions 
to ensure continued and expanding opportunities for Indian 
students: United Tribes Technical College in Bismarck, North 
Dakota, and Crownpoint Institute of Technology in Crownpoint, 
New Mexico.
    The Committee bill includes language carried over from last 
year's bill that allows grantees to charge the regular indirect 
cost rate to their grants.

Federal TRIO Programs

    The Committee recommends $836,543,000 for Federal TRIO 
Programs. The comparable fiscal year 2005 funding level is 
$836,543,000 and the budget request includes $369,390,000 for 
authorized activities. The budget request redirects the savings 
from the reduction proposed for TRIO programs to provide 
support for a proposed High School initiative.
    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.

Gaining Early Awareness and Readiness for Undergraduate Programs 
        [GEARUP]

    The Committee recommends $306,488,000 for GEARUP. The 
comparable fiscal year 2005 funding level is $306,488,000 and 
the budget request does not include any funds for this purpose. 
The budget proposes to redirect these funds to provide support 
for a proposed High School intiative.
    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.

Byrd Honors Scholarships

    The Committee recommends $41,000,000 for the Byrd honors 
scholarship program. The comparable fiscal year 2005 funding 
level is $40,672,000 and the budget request does not include 
any funds 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 school-aged population. The State 
education agencies select the recipients of the scholarships in 
consultation with school administrators, teachers, counselors, 
and parents. The funds provided will support a new cohort of 
first-year students in 2006, and continue support for the 2003, 
2004, and 2005 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 $9,797,000 for the Javits 
Fellowships program. The comparable fiscal year 2005 funding 
level and the budget request both are $9,797,000 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 2006 appropriation support 
fellowships for the 2007-2008 academic year.

Graduate Assistance in Areas of National Need [GAANN]

    The Committee recommends $30,371,000 for graduate 
assistance in areas of national need. The comparable fiscal 
year 2005 funding level and the budget request both are 
$30,371,000 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 2004, 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 $58,000,000 for the teacher 
quality enhancement grants program. The comparable fiscal year 
2005 funding level is $68,337,000 and the budget request 
proposes to eliminate funding for this program.
    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 Committee bill includes language that would allow the 
Department to fund awards under the three program areas at the 
discretion of the Department, instead of as mandated by the 
Higher Education Act. The Committee continues this language 
from last year's bill in order to prevent funds available under 
this program from going unused.
    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 $15,970,000 
for the Child Care Access Means Parents in School [CCAMPIS] 
program. The comparable fiscal year 2005 funding level and the 
budget request both are $15,970,000 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.

Community College Access

    The Committee recommendation does not include any resources 
for this proposed program. The budget request includes 
$125,000,000 for this purpose.
    Under this proposed program, funds would support 
competitive awards that serve as an incentive for States and 
partnerships to increases access, particularly for low-income 
and minority students, to a college education. Two main 
activities would be supported under this proposed program, 
community college access grants and state consortia 
initiatives. Community college access grants would create 
incentives for community colleges to create dual enrollment 
programs. Grants under the state consortia initiative would 
provide incentives to States to establish credit transfer 
programs across State lines.

Demonstration Projects to Ensure Quality Higher Education for Students 
        With Disabilities

    The Committee recommends $6,944,000 for this program, the 
same amount as the comparable fiscal year 2005 funding level. 
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.
    The Committee recognizes that the Department has made 
limited efforts to work with grantees to collect the type of 
outcome data that would demonstrate the value of this program. 
The Committee is aware of the significant progress that 
grantees have made in developing standards for information 
dissemination, faculty and staff awareness, policies and 
procedures, and program administration and evaluation that 
institutions of higher education can adopt to more effectively 
support students with disabilities. The Committee urges the 
Department to utilize resources available under the GPRA/data 
collection program to support a rigorous evaluation of outcomes 
achieved by grantees funded under this program and to identify 
the impact that these funds are having on improving 
opportunities for students with disabilities at institutions of 
higher education throughout the United States.

Underground Railroad Program

    The Committee recommendation includes $2,204,000 for the 
Underground Railroad program, the same amount as the comparable 
fiscal year 2005 funding level. The budget request does not 
include any funds 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 $980,000 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 2005 funding level 
and the budget request both are $980,000 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 2005 funding level is 
$980,000 and the budget request did not include funds for this 
activity. Funds appropriated in fiscal year 2005 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 does not include any funds for 
the Thurgood Marshall Legal Educational Opportunity Program. 
The comparable funding level for fiscal year 2005 is $2,976,000 
and the budget request does not include any funds for this 
purpose.
    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.

                           Howard University

Appropriations, 2005....................................    $238,790,000
Budget estimate, 2006...................................     238,789,000
House allowance.........................................     240,790,000
Committee recommendation................................     238,789,000

    The Committee recommends an appropriation of $238,789,000 
for Howard University. The comparable fiscal year 2005 funding 
level is $238,790,000 and the budget request includes 
$238,789,000 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 $29,759,000 for the Howard University 
Hospital. The comparable fiscal year 2005 funding level and the 
budget request both are $29,759,000 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, 2005....................................        $573,000
Budget estimate, 2006...................................         573,000
House allowance.........................................         573,000
Committee recommendation................................         573,000

    Federal Administration.--The Committee bill includes 
$573,000 for Federal administration of the CHAFL program. The 
comparable fiscal year 2005 funding level and the budget 
request both are $573,000 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 2006. 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, 2005....................................        $210,000
Budget estimate, 2006...................................         210,000
House allowance.........................................         210,000
Committee recommendation................................         210,000

    Federal Administration.--The Committee recommends $210,000 
for Federal administration of the Historically Black College 
and University [HBCU] Capital Financing Program. The comparable 
fiscal year 2005 funding level and the budget request both are 
$210,000 for this activity.
    The HBCU Capital Financing Program makes capital available 
to HBCUs for construction, renovation, and repair of academic 
facilities by providing a Federal guarantee for private sector 
construction bonds. Construction loans will be made from the 
proceeds of the sale of the bonds.

                     Institute of Education Science

Appropriations, 2005....................................    $523,234,000
Budget estimate, 2006...................................     479,064,000
House allowance.........................................     522,696,000
Committee recommendation................................     522,695,000

    The bill includes $522,695,000 for the Institute of 
Education Sciences. The comparable fiscal year 2005 funding 
level is $523,234,000 and the budget request includes 
$479,064,000 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 $164,194,000 for education 
research, development and national dissemination activities. 
The comparable fiscal year 2005 amount and the budget request 
both are $164,194,000 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 commends the Department for its efforts 
in this area.
    The Committee strongly supports the Department's efforts to 
carry out authorized evaluations of Federal education programs 
using rigorous methodologies, particularly random assignment, 
that are capable of producing scientifically valid knowledge 
regarding which program activities are effective. To ensure 
that such evaluations have sufficient participation required to 
make them scientifically valid, the Committee urges the 
Department, wherever feasible and not specifically prohibited 
by the authorizing legislation, to take appropriate action to 
secure grantee involvement, which may include requests to be 
randomly assigned to intervention and control groups. The 
Committee notes that the National Board for Education Sciences 
recently recommended such a policy.
    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 would like to see increased 
support for programs that bring advances in cognitive, 
developmental, educational and neuroscience research 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, reasoning, and cognitive styles 
are essential for learning and are likely to produce 
substantial gains in academic achievement.

Statistics

    The Committee recommends $90,931,000 for data-gathering and 
statistical-analysis activities of the National Center for 
Education Statistics [NCES]. The comparable fiscal year 2005 
funding level and the budget request both are $90,931,000 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 $66,131,000 to continue support 
for the regional educational laboratories. The comparable 
fiscal year 2005 funding level is $66,132,000 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.
    Fiscal year 2006 funding will support a new competition 
under this program. The Committee believes it is important that 
the research, development, dissemination, and technical 
assistance activities carried out by the regional educational 
laboratories be consistent with the standards for 
scientifically based research prescribed in the Education 
Sciences Reform Act of 2002. The Committee therefore urges IES 
to ensure, through its competitive selection and evaluation of 
the laboratories and system of peer review of laboratory 
activities, that the laboratories adhere to these rigorous 
research standards. The Committee believes that the 
laboratories have an important role to play in helping parents, 
States and school districts improve student achievement as 
called for in No Child Left Behind.

Research and Innovation in Special Education

    The Committee recommends $72,566,000 for research and 
innovation in special education. The comparable funding level 
for fiscal year 2005 is $83,104,000 and the budget request 
includes $72,566,000 for this purpose. The reauthorization of 
the Individuals with Disabilities Education Act created a new 
National Center for Special Education Research. This new center 
will address gaps in scientific knowledge in order to improve 
special education and early intervention services and outcomes 
for infants, toddlers, and children with disabilities. Funds 
provided to the center will be available for obligation for 2 
fiscal years.
    Similarly, the Committee recognizes the new role IES will 
play in special education research with the enactment and 
implementation of the Individuals with Disabilities Education 
Improvement Act of 2004. The Committee encourages IES to 
investigate alternative assessment models for determining 
learning disabilities for the purposes of special education 
placement in the absence of the discrepancy criterion 
requirement and the effectiveness of behavioral interventions 
and early intervening services. The Committee encourages IES to 
commit funding for research focusing on pupil services and 
related services providers.

Special Education Studies and Evaluations

    The Committee recommends $10,000,000 for special education 
studies and evaluations. Funding for this activity was made 
available previously as a set-aside from the Special Education 
State Grants program until this new authority was created by 
the Individuals with Disabilities Education Improvement Act of 
2004. The budget request includes $10,000,000 for this purpose.
    This program will support competitive grants, contracts and 
cooperative agreements to assess the implementation of the 
Individuals with Disabilities Education Act. Funds also will be 
used to evaluate the effectiveness of State and local efforts 
to deliver special education services and early intervention 
programs. Funds are available for obligation for 2 fiscal 
years.
    The Committee is concerned that school districts across the 
country are inadequately prepared to provide appropriate 
educational services to students with intellectual disabilities 
(mental retardation and related disabilities). This lack of 
preparedness is particularly acute as it relates to the 
universal design of standards, curriculum, instructional 
strategies and materials, and assessments. This too often 
results in a lack of access to the general education curriculum 
and families and teachers developing curricula, instructional 
materials and assessments on an ad hoc basis. The Committee 
urges the Department to prepare a comprehensive plan to address 
this matter that would be sufficiently detailed to serve as an 
outline for proposals for K-12 projects to meet the needs of 
intellectual disabilities. Consideration should be given to 
research, model demonstration, technical assistance and 
dissemination, technology innovations, personnel preparation 
and other means to develop and apply universally designed 
standards, curriculum instructional strategies and materials, 
and assessments. The plan also shall include proposed funding 
levels and timelines for implementing the various research, 
development and dissemination activities and other components 
of the plan. The Department is urged to consult with experts in 
the field, including the several national organizations 
representing the interests of children with intellectual 
disabilities in the development of this plan. Finally, the 
Committee requests the Department to submit a report to the 
House and Senate Committees on Appropriations not later than 
April 15, 2006 on this issue.

Statewide Data Systems

    The Committee recommendation includes $24,800,000 for 
Statewide Data Systems. The comparable funding level for fiscal 
year 2005 and the budget request both are $24,800,000.
    Under this program, the Department awards grants 
competitively 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. Funds are available for obligation 
for 2 fiscal years. 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 continue to support 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.

Assessment

    The Committee recommends $94,073,000 for assessment. The 
comparable fiscal year 2005 funding level is $94,073,000 and 
the budget request includes $116,573,000 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 began paying for State participation in biennial 
reading and mathematics assessments in grades 4 and 8.
    The budget request includes an increase of $22,500,000 to 
expand the State NAEP to reading and mathematics in the 12th 
grade. The Committee recommendation does not include these 
funds.
    Within the funds appropriated, the Committee recommends 
$5,088,000 for the National Assessment Governing Board [NAGB], 
which is responsible for formulating policy for NAEP. The 
comparable fiscal year 2005 amount and the budget request both 
are $5,088,000 for NAGB.

                        Departmental Management


                         PROGRAM ADMINISTRATION

Appropriations, 2005....................................    $419,280,000
Budget estimate, 2006...................................     418,992,000
House allowance.........................................     410,612,000
Committee recommendation................................     418,992,000

    The Committee recommends $418,992,000, for program 
administration. The comparable fiscal year 2005 funding level 
is $419,280,000 and the budget request includes $418,992,000 
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 is concerned that the Department, in 
implementing Reading First and other programs authorized by the 
No Child Left Behind Act which are required to implement 
activities that are backed by scientifically based research, 
may not be effectively helping States and local educational 
agencies implement programs shown to work in randomized 
controlled trials and other rigorous studies. The Committee 
therefore requests the Secretary to submit a report to the 
Committee, within 90 days of the enactment of this Act, on the 
actions that program offices have taken or will take in the 
selection, oversight, and evaluation of grantees, to ensure 
that grantees effectively implement such research-based 
programs, including close replication of the specific elements 
of these programs.
    The Committee understands that the Department is taking 
steps to implement the proposed reorganization of the regional 
office structure within the Rehabilitation Services 
Administration [RSA] that was described in the fiscal year 2006 
congressional budget justification. The Committee is concerned 
about the impact that this proposal will have on regional 
office staff, as well as the ability of the Department to 
effectively administer RSA programs. The Committee understands 
that the Department believes that its proposed reorganization 
will result in more consistent, timely and higher quality 
policy guidance, technical assistance and program monitoring. 
The Committee believes these are worthy goals, given the 
millions of individuals served through RSA programs. Therefore, 
the Committee requests a report that describes the steps taken 
to reach out to stakeholder groups on this issue; a detailed 
plan for ensuring that policy guidance, technical assistance 
and program monitoring will be of higher quality and more 
timely than that currently available; and the specific 
performance goals under the proposed reorganization for 
frequency of monitoring visits, and timeliness and relevancy of 
technical assistance, compared to the actual performance under 
the current administrative structure. The Committee expects to 
receive this report not later than 60 days after enactment of 
this Act, but urges the Department to make it available as soon 
as possible.

                        OFFICE FOR CIVIL RIGHTS

Appropriations, 2005....................................     $89,375,000
Budget estimate, 2006...................................      91,526,000
House allowance.........................................      91,526,000
Committee recommendation................................      91,526,000

    The Committee bill includes $91,526,000 for the Office for 
Civil Rights [OCR]. The comparable fiscal year 2005 amount was 
$89,375,000 and the budget request is $91,526,000 for this 
purpose.
    The Office for Civil Rights is responsible for the 
enforcement of laws that prohibit discrimination on the basis 
of race, color, national origin, sex, disability, and age in 
all programs and institutions funded by the Department of 
Education. To carry out this responsibility, OCR investigates 
and resolves discrimination complaints, monitors desegregation 
and equal educational opportunity plans, reviews possible 
discriminatory practices by recipients of Federal education 
funds, and provides technical assistance to recipients of funds 
to help them meet civil rights requirements.
    The Committee understands that Title IX of the Education 
Amendments of 1972 and their implementing regulations, which 
prohibit discrimination on the basis of sex in federally funded 
education programs or activities, have been instrumental in 
providing unprecedented opportunities for women in the Nation's 
classrooms and athletic programs. While much progress has been 
made, the Committee continues to recognize that more needs to 
be done to ensure equal access for women. The Committee 
believes that the intent of the Department's clarification is 
to provide institutions with additional guidance on compliance 
with the third part of the three-part test, as stated in the 
Department's March 17, 2005 Dear Colleague. The Committee 
acknowledges this effort, but is concerned that confusion has 
been created with regard to the use of interest surveys to 
demonstrate compliance. The Committee believes survey results 
are not sufficient to demonstrate compliance if other evidence 
exists, such as requests for athletic teams, that contradicts 
the conclusions drawn from the survey. The Committee urges the 
Department to clarify that a presumption of compliance is not 
achieved by a survey if evidence to the contrary exists, 
whether that knowledge is known or it is reasonable to expect 
an institution to have known. Further, the Committee urges that 
the Department clarify that institutions must show that they 
have made reasonable, good faith efforts to explore such 
evidence if they choose to use part three of the three-part 
test to comply with Title IX. The Committee also encourages the 
Department to provide additional technical assistance to 
institutions on the appropriate use of interest surveys to 
comply with Title IX.
    The Committee requests that the Department prepare a 
report, based on random compliance reviews of institutions 
utilizing interest surveys, to determine what actions, if any, 
they take to gather and consider other sources of information 
for assessing student interest used in demonstrating compliance 
with part three of the Title IX test. The report should include 
what other information was considered in assessing student 
interest, if any, and the decisions made about athletic 
opportunities at these institutions. The Committee requests to 
receive this report no later than March 17, 2006.

                    OFFICE OF THE INSPECTOR GENERAL

Appropriations, 2005....................................     $47,327,000
Budget estimate, 2006...................................      49,408,000
House allowance.........................................      49,000,000
Committee recommendation................................      49,408,000

    The Committee recommends $49,408,000 for the Office of the 
Inspector General. The comparable fiscal year 2005 amount is 
$47,327,000 and the budget request includes $49,408,000 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 new provision, pursuant to 
section 303 of the Congressional Budget Resolution, to 
eliminate the accumulated shortfall in the Pell Grant program 
(sec. 305).
    The Committee bill includes a new provision which expands 
the programs authorized under subpart 12 of part D of title V 
of the Elementary and Secondary Education Act of 1965 (sec. 
306).

                       TITLE IV--RELATED AGENCIES

 Committee for Purchase from People Who Are Blind or Severely Disabled

Appropriations, 2005....................................      $4,669,000
Budget estimate, 2006...................................       4,669,000
House allowance.........................................       4,669,000
Committee recommendation................................       4,669,000

    The Committee recommends $4,669,000 for fiscal year 2006 
for Committee for Purchase from People Who Are Blind or 
Severely Disabled. The comparable funding level for fiscal year 
2005 is $4,669,000 and the budget request includes $4,669,000 
for this program.
    The Committee for Purchase From People Who Are Blind or 
Severely Disabled was established by the Javits, Wagner-O'Day 
Act of 1938 as amended. Its primary objective is to increase 
the employment opportunities for people who are blind or have 
other severe disabilities and, whenever possible, to prepare 
them to engage in competitive employment.

             Corporation for National and Community Service

Appropriations, 2005....................................    $927,006,000
Budget estimate, 2006...................................     921,049,000
House allocation........................................     909,049,000
Committee recommendation................................     935,205,000

    The Committee recommends $935,205,000 for the Corporation 
for National and Community Service, an increase of $8,199,000 
over the fiscal year 2005 enacted level and $14,156,000 above 
the budget request.
    The Committee requests that the Corporation include 
information in the fiscal year 2007 budget justification on the 
economic impact of its programs.
    The Corporation for National and Community Service, a 
Corporation owned by the Federal Government, was established by 
the National and Community Service Trust Act of 1993 (Public 
Law 103-82) to enhance opportunities for national and community 
service and provide national service education awards. The 
Corporation makes grants to States, institutions of higher 
education, public and private nonprofit organizations, and 
others to create service opportunities for students, out-of-
school youth, and adults.

                  DOMESTIC VOLUNTEER SERVICE PROGRAMS

    The Committee recommends $316,212,000 for fiscal year 2006 
for the domestic volunteer service programs of the Corporation 
for National and Community Service. The comparable funding 
level for fiscal year 2005 is $353,745,000 and the budget 
request includes $359,962,000 for these programs. Programs 
authorized under the Domestic Volunteer Service Act include: 
the Volunteers in Service to America Program [VISTA]; the 
Foster Grandparent Program; the Senior Companion Program; and 
the Retired and Senior Volunteer Program.

VISTA

    The Committee recommends $96,428,000 for fiscal year 2006 
for the Volunteers in Service to America [VISTA] Program. The 
comparable funding level for fiscal year 2005 is $94,240,000 
and the budget request includes $96,428,000 for this program.
    VISTA, created in 1964 under the Economic Opportunity Act, 
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 pleased by reports that the Corporation is 
moving toward integrating grant writing and issue specific 
presentations into the training sessions currently given to all 
new VISTA members. The Committee feels that more substantive 
training is needed to enhance the effectiveness of VISTA 
members in their placements. As part of their capacity-building 
mission, VISTA members are increasingly called upon to write 
grant applications and to raise funds 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. The Committee looks forward to a report in the fiscal 
year 2007 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 has included no funding for the Special 
Volunteer programs. The comparable funding level for fiscal 
year 2005 was $4,960,000. The budget requested $4,000,000 for 
an expansion of Teach For America under the Special Volunteer 
Programs. Teach for America has been a long-standing grantee 
under the Americorps State and National Program. Therefore, the 
Committee has recommended that funds for this expansion be 
allocated within the appropriation for the National and 
Community Service Act programs.
    The Special Volunteer Program is authorized under Part C of 
Title I of the Domestic Volunteer Service Act of 1973, which 
provides grants to volunteer organizations to encourage and 
enable persons from all age groups to perform volunteer service 
in agencies, institutions, and situations of need.

National Senior Volunteer Corps

    The Committee recommends $219,784,000 for fiscal year 2006 
for the National Senior Volunteer Corps programs. The 
comparable funding level for fiscal year 2005 is $215,857,000 
and the budget request includes $219,784,000 for these 
programs. 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 
2005 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. All remaining funds shall be used to fund an 
administrative cost increase for each existing program 
nationwide. The amount to be allocated to individual grantees 
shall be calculated based on a percentage of the entire Federal 
grant award in fiscal year 2005, including the amount specified 
for payment of non-taxable stipends. The Committee directs that 
the Corporation shall comply with the directive that use of PNS 
funding increases in the FGP, RSVP, SCP, and VISTA shall not be 
restricted to any particular activity. The Committee further 
directs that the Corporation shall not stipulate a minimum or 
maximum for PNS grant augmentation.
    In addition, the maximum dollars CNCS may use in fiscal 
year 2006 for Communications and Training, Technical 
Assistance, and Recruitment and Retention activities shall not 
exceed the amount enacted for these two activities in fiscal 
year 2005. Funds appropriated for fiscal year 2006 may not be 
used to implement or support service collaboration agreements 
or any other changes in the administration and/or governance of 
national service programs prior to passage of a bill by the 
authorizing committee of jurisdiction specifying such changes. 
In addition, none of these increases may be used to fund 
demonstration activities.

Foster Grandparent Program

    The Committee recommends $112,058,000 for fiscal year 2006 
for the Foster Grandparent Program. The comparable funding 
level for fiscal year 2005 is $111,424,000 and the budget 
request includes $112,058,000 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 $47,438,000 for fiscal year 2006 
for the Senior Companion Program. The comparable funding level 
for fiscal year 2005 is $45,905,000 and the budget request 
includes $47,438,000 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 $60,288,000 for fiscal year 2006 
for the Retired and Senior Volunteer Program. The comparable 
funding level for fiscal year 2005 is $58,528,000 and the 
budget request includes $60,288,000 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 included funds for the administration of the 
DVSA program administration in the NCSA Salaries and Expenses 
account. The Committee believes that the integration of these 
accounts will streamline the management of the Corporation and 
increase efficiency and accountability across the agency. The 
comparable funding level for fiscal year 2005 is $38,688,000 
and the budget request includes $39,750,000 for program 
administration.

                NATIONAL AND COMMUNITY SERVICE PROGRAMS

    The Committee recommends $546,243,000 for the programs 
authorized under the National Community Service Act of 1990, an 
increase of $4,726,000 over the fiscal year 2005 enacted level 
and $18,156,000 above the budget request.
    The National and Community Service Programs of the 
Corporation for National and Community Service include: the 
AmeriCorps program (including AmeriCorps State and National and 
the National Civilian Community Corps); Learn and Serve 
America, Innovation, Demonstration, Assistance and Evaluation 
activities; State Commission Administration grants; and the 
National Service Trust.
    The Committee recommendation includes: $546,243,000 for the 
Corporation's programs operating expenses. This appropriation 
provides $280,000,000 for AmeriCorps State and National 
operating grants (including $12,642,000 for State 
administrative expenses); $149,000,000 for the National Service 
Trust; $15,945,000 for subtitle H fund activities; $27,000,000 
for AmeriCorps NCCC; $42,656,000 for Learn and Serve; 
$4,000,000 for audits and evaluations; $10,000,000 for the 
Points of Light Foundation; $5,000,000 for America's Promise.

AmeriCorps Grants Program (not including NCCC)

    Within the amount provided for AmeriCorps grants, the 
Committee is providing $55,000,000 for national direct 
grantees.
    The Committee requests that the Corporation continue 
providing monthly reports to the Committee on Appropriations 
and the Corporation's Inspector General on the actual and 
projected year-end level of AmeriCorps membership enrollment, 
usage, and earnings, and the financial status of the Trust fund 
(revenue, expenses, outstanding liabilities, reserve, etc.).
    To keep the Committee better informed of the recipients 
receiving AmeriCorps funding, the Committee directs the 
Corporation to publish in its fiscal year 2007 budget 
justifications a list of recipients that have received more 
than $500,000 from the Corporation, delineated by program, and 
the amount and source of both other Federal and non-Federal 
funds that were received by each recipient.

Innovation, Assistance and Other Activities

    Within the amount recommended for innovation, 
demonstration, and assistance activities, the Committee 
recommends $1,300,000 for next generation grants; $500,000 for 
Martin Luther King Jr. Day grants; $725,000 for Service 
Learning Clearinghouse and Exchange; $2,250,000 for training 
and technical assistance; $4,338,000 for disability programs; 
$400,000 for Presidential Freedom Scholarships; $125,000 for 
Faith-Based and Community Initiatives; $52,000 for the 
Presidential Council on Service; $250,000 for Presidential 
Volunteer Service Award; $5,000 for the National Volunteer 
Hotline; $4,000,000 for Teach for America; and $2,000,000 for 
Communities in Schools, Inc. The Committee is not allocating 
any money for the challenge grant programs in fiscal year 2006, 
in accordance with the budget request and House allocation.

AmeriCorps National Civilian Community Corps

    Within the amount provided, $1,500,000 is to conduct an 
evaluation of current NCCC site placement and expansion of new 
sites in the Southern and Midwestern United States, in 
accordance with the report issued on March 1, 2005.

                         SALARIES AND EXPENSES

    The Committee recommends an appropriation of $66,750,000 
for the Corporation's salaries and expenses. This amount is 
equal to the budget request and $2,270,000 above the fiscal 
year 2005 enacted level. This includes $39,750,000 for 
administration of the DVSA programs. The Committee reiterates 
the directive under the program account that the Corporation 
must fund all staffing needs from the salaries and expenses 
account.
    The salaries and expenses appropriation provides funds for 
staff salaries, benefits, travel, training, rent, advisory and 
assistance services, communications and utilities expenses, 
supplies, equipment, and other operating expenses necessary for 
management of the Corporation's activities under the National 
and Community Service Act of 1990 and the Domestic Volunteer 
Service Act of 1973.
    The Committee is disappointed in the quality of assistance 
provided by the Corporation during the reorganization of the 
Corporation's appropriation. Periodically, the Committee 
requires technical assistance from officers of the Corporation. 
The Committee expects that such assistance will be provided 
without prejudice in a straightforward and timely manner.
    The Committee is aware that local administrative support 
offices are critical to the success of programs such as the 
National Senior Volunteer Corps, especially in areas that are 
difficult to reach such as rural areas and islands like Hawaii. 
Mainland United States is over 1,500 miles from the State of 
Hawaii and the Committee is concerned that program support 
would suffer from locating that support across this distance. 
The Committee urges the Department to continue funding existing 
full-time, local administrative CNCS offices.

                      OFFICE OF INSPECTOR GENERAL

    The Committee recommends an appropriation of $6,000,000 for 
the Office of Inspector General [OIG]. This amount is equal to 
the budget request and $48,000 above the fiscal year 2005 
enacted level.
    The Committee directs the OIG to continue reviewing the 
Corporation's management of the National Service Trust fund. 
The Committee directs the OIG to review the monthly Trust 
reports and to notify the Committees on Appropriations on the 
accuracy of the reports.
    The goals of the Office of Inspector General are to 
increase organizational efficiency and effectiveness and to 
prevent fraud, waste, and abuse. The Office of Inspector 
General within the Corporation for National and Community 
Service was transferred to the Corporation from the former 
ACTION agency when ACTION was abolished and merged into the 
Corporation in April 1994.

                       ADMINISTRATIVE PROVISIONS

    The Committee has included four administrative provisions 
carried in prior year appropriations acts as follows: language 
regarding: qualified student loans eligible for education 
awards; the availability of funds for the placement of 
volunteers with disabilities; the Inspector General to levy 
sanctions in accordance with standard Inspector General audit 
resolutions procedures; and language regarding the Corporation 
to make significant changes to program requirements or policy 
through public rulemaking and public notice and grant selection 
process.

                  Corporation for Public Broadcasting

Appropriations, 2006....................................    $400,000,000
Appropriations, 2007....................................     400,000,000
Budget estimate, 2008...................................................
House allowance.........................................     400,000,000
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 2008. The comparable funding 
level provided last year was $400,000,000 for fiscal year 2007. 
The budget request does not include advance funds for this 
program.
    In addition, the Committee recommends $35,000,000 be made 
available in fiscal year 2006 for the conversion to digital 
broadcasting. The comparable funding level for fiscal year 2005 
was $39,387,000. The budget request included no funding for 
this purpose. The House included authority to permit CPB to 
spend up to $30,000,000 in previously appropriated fiscal year 
2006 funds for digital conversion activities.
    In addition, the Committee recommends $40,000,000 be made 
available in fiscal year 2006 for the replacement project of 
the interconnection system. In fiscal year 2005, $39,680,000 
was appropriated for this purpose. The House included authority 
to permit CPB to spend up to $52,000,000 in previously 
appropriated fiscal year 2006 funds for the Satellite 
Interconnection system.
    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 recognizes the importance of the partnership 
CPB has with the National Minority Public Broadcasting 
Consortia, which helps develop, acquire, and distribute public 
television programming to serve the needs of African American, 
Asian American, Latino, Native American, Pacific Islander, and 
many other viewers. As many communities in the Nation welcome 
increased numbers of citizens of diverse ethnic backgrounds, 
the local public television stations should strive to meet 
these viewers' needs. With an increased focus on programming to 
meet local community needs, the Committee encourages CPB to 
continue to support and expand this critical partnership.
    The Committee is aware that public radio stations are 
taking advantage of experimental authority to develop their 
digital operations including multicasting. We encourage the 
Corporation to work with the Federal Communications Commission 
to enable public radio and television stations to utilize the 
full range of digital broadcasting technology as soon as 
possible, including the use of multicasting for public radio 
stations.

               Federal Mediation and Conciliation Service

Appropriations, 2005....................................     $44,439,000
Budget estimate, 2006...................................      42,331,000
House allowance.........................................      42,331,000
Committee recommendation................................      43,439,000

    The Committee recommends $43,439,000 for fiscal year 2006 
for the Federal Mediation and Conciliation Service [FMCS]. The 
comparable funding level for fiscal year 2005 is $44,439,000 
and the budget request includes $42,331,000 for this program.
    The FMCS was established by Congress in 1947 to provide 
mediation, conciliation, and arbitration services to labor and 
management. FMCS is authorized to provide dispute resolution 
consultation and training to all Federal agencies.
    The Committee continues to support the FMCS program to 
prevent youth violence and is especially pleased with the 
initiative to train educators in conflict resolution. The 
Committee commends FMCS for their innovative look at youth 
violence conflict resolution and their development of a CD-ROM 
that will address this issue among preschool and elementary age 
children.

            Federal Mine Safety and Health Review Commission

Appropriations, 2005....................................      $7,809,000
Budget estimate, 2006...................................       7,809,000
House allowance.........................................       7,809,000
Committee recommendation................................       7,809,000

    The Committee recommends $7,809,000 for fiscal year 2006 
for the Federal Mine Safety and Health Review Commission. The 
comparable funding level for fiscal year 2005 is $7,809,000 and 
the budget request includes $7,809,000 for this program.
    The Federal Mine Safety and Health Review Commission 
provides administrative trial and appellate review of legal 
disputes under the Federal Mine Safety and Health Act of 1977. 
The five-member Commission provides review of the Commission's 
administrative law judge decisions.

                Institute of Museum and Library Services

Appropriations, 2005....................................    $280,564,000
Budget estimate, 2006...................................     262,240,000
House allowance.........................................     249,640,000
Committee recommendation................................     290,129,000

    The Committee recommends $290,129,000 for fiscal year 2006 
for the Institute of Museum and Library Services. The 
comparable funding level for fiscal year 2005 is $280,564,000 
and the budget request includes 262,240,000 for this program.

Office of Museum Services Operations Grants

    The Committee recommends $17,500,000 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, $992,000 has 
been provided for the 21st Century Museum Professionals 
program, $446,000 for museum assessment, $850,000 for Native 
American Museum service grants, and $850,000 for Museum Grants 
for African American History and Culture.

Museum Conservation Programs

    The Committee recommends $3,615,000 for Conservation 
programs. These funds support grants to allow museums to survey 
collections, perform training, research, treatment, and 
environmental improvements. In addition, grantees may receive 
additional funds to develop an education component that relates 
to their conservation project. In addition, non-competitive 
grants are awarded for technical assistance in conservation 
efforts.

Museum National Leadership Projects

    The Committee recommends $29,000,000 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 $165,000,000 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, $3,675,000 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 $33,284,000 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. In addition to the total recommended, $23,000,000 
has been provided for the 21st Century Librarian Initiative.

Museum and Library Services Administration

    The Committee recommends $11,917,000 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, 2005....................................      $9,899,000
Budget estimate, 2006...................................      10,168,000
House allowance.........................................      10,168,000
Committee recommendation................................      10,168,000

    The Committee recommends $10,168,000 for fiscal year 2006 
for the Medicare Payment Advisory Commission. The comparable 
funding level for fiscal year 2005 is $9,899,000 and the budget 
request includes $10,168,000 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, 2005....................................        $993,000
Budget estimate, 2006...................................         993,000
House allowance.........................................         993,000
Committee recommendation................................         993,000

    The Committee recommends $993,000 for fiscal year 2006 for 
the National Commission on Libraries and Information Science. 
The comparable funding level for fiscal year 2005 is $993,000 
and the budget request includes $993,000 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, 2005....................................      $3,344,000
Budget estimate, 2006...................................       2,800,000
House allowance.........................................       2,800,000
Committee recommendation................................       3,344,000

    The Committee recommends $3,344,000 for fiscal year 2006 
for the National Council on Disability. The comparable funding 
level for fiscal year 2005 is $3,344,000 and the budget request 
includes $2,800,000 for this program.
    The Council is mandated to make recommendations to the 
President, the Congress, the Rehabilitation Services 
Administration, and the National Institute on Disability and 
Rehabilitation Research, on the public issues of concern to 
individuals with disabilities. The Council gathers information 
on the implementation, effectiveness, and impact of the 
Americans with Disabilities Act and looks at emerging policy 
issues as they affect persons with disabilities and their 
ability to enter or reenter the Nation's work force and to live 
independently.

                     National Labor Relations Board

Appropriations, 2005....................................    $249,860,000
Budget estimate, 2006...................................     252,268,000
House allowance.........................................     252,268,000
Committee recommendation................................     252,268,000

    The Committee recommends $252,268,000 for fiscal year 2006 
for the National Labor Relations Board [NLRB]. The comparable 
funding level for fiscal year 2005 is $249,860,000 and the 
budget request includes $252,268,000 for this program.
    The Committee continues to be concerned that the NLRB's 
plan to restructure its regional offices will slow the decision 
making process in some regions and hurt workers access to a 
fair and timely hearing. The Committee reiterates its 
opposition to 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.
    The NLRB is a law enforcement agency which adjudicates 
disputes under the National Labor Relations Act.
    The Committee is aware that the mission of the NLRB is to 
carry out the statutory responsibilities of the National Labor 
Relations Act as efficiently as possible and in a manner that 
gives full effect to the rights afforded to employees, unions, 
and employers under the Act. The Committee strongly supports 
this mission and understands that the caseload fluctuates based 
on economic conditions and changes in labor regulations. The 
Committee continues to be disappointed that the Administration 
has repeatedly underestimated the funding necessary to process 
the increase in case intakes, but stands firm in its commitment 
to ensure that all cases are heard and given due process.

                        National Mediation Board

Appropriations, 2005....................................     $11,628,000
Budget estimate, 2006...................................      11,628,000
House allowance.........................................      11,628,000
Committee recommendation................................      11,628,000

    The Committee recommends $11,628,000 for fiscal year 2006 
for the National Mediation Board. The comparable funding level 
for fiscal year 2005 is $11,628,000 and the budget request 
includes $11,628,000 for this program.
    The National Mediation Board protects interstate commerce 
as it mediates labor-management relations in the railroad and 
airline industries under the Railway Labor Act. The Board 
mediates collective bargaining disputes, determines the choice 
of employee bargaining representatives through elections, and 
administers arbitration of employee grievances.
    The Committee notes that the National Mediation Board has 
yet to issue a final rule regarding certain administrative 
changes to case management. The Committee has made repeated 
statements that the institution of a fee, such as the one 
outlined in the initial proposed rule, would require statutory 
authorization that the Board currently lacks. The fiscal year 
2006 President's Budget included no request to change the 
authorization of the Board to include the collection of any 
fees. Therefore, the Committee concludes that the Board has 
abandoned the effort to institute new fees in the coming year 
and expects that any final rule the Board may publish will omit 
the fee proposal.

            Occupational Safety and Health Review Commission

Appropriations, 2005....................................     $10,510,000
Budget estimate, 2006...................................      10,510,000
House allowance.........................................      10,510,000
Committee recommendation................................      10,510,000

    The Committee recommends $10,510,000 for fiscal year 2006 
for the Occupational Safety and Health Review Commission. The 
comparable funding level for fiscal year 2005 is $10,510,000 
and the budget request includes $10,510,000 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, 2005....................................     $99,200,000
Budget estimate, 2006...................................      97,000,000
House allowance.........................................      97,000,000
Committee recommendation................................      97,000,000

    The Committee recommends $97,000,000 for fiscal year 2006 
for the Dual Benefits Payments Account, of these funds 
$7,000,000 is from income taxes on vested dual benefits. The 
comparable funding level for fiscal year 2005 is $99,200,000 
and the budget request includes $97,000,000 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, 2005....................................        $150,000
Budget estimate, 2006...................................         150,000
House allowance.........................................         150,000
Committee recommendation................................         150,000

    The Committee recommends $150,000 for fiscal year 2006 for 
interest earned on unnegotiated checks. The comparable funding 
level for fiscal year 2005 is $150,000 and the budget request 
includes $150,000 for this program.

                      LIMITATION ON ADMINISTRATION

Appropriations, 2005....................................    $102,543,000
Budget estimate, 2006...................................     102,543,000
House allowance.........................................     102,543,000
Committee recommendation................................     102,543,000

    The Committee recommends $102,543,000 for fiscal year 2006 
for the administration of railroad retirement/survivor benefit 
programs. The comparable funding level for fiscal year 2005 is 
$102,543,000 and the budget request includes $102,543,000 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, 2005....................................      $7,196,000
Budget estimate, 2006...................................       7,196,000
House allowance.........................................       7,196,000
Committee recommendation................................       7,196,000

    The Committee recommends $7,196,000 for fiscal year 2006 
for the Office of the Inspector General. The comparable funding 
level for fiscal year 2005 is $7,196,000 and the budget request 
includes $7,196,000 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, 2005....................................     $20,454,000
Budget estimate, 2006...................................      20,470,000
House allowance.........................................      20,470,000
Committee recommendation................................      20,470,000

    The Committee recommends an appropriation of $20,470,000 
for payments to Social Security trust funds. The comparable 
fiscal year 2005 funding level is $20,454,000 and the budget 
request includes $20,470,000 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, 2005.................................... $28,586,829,000
Budget estimate, 2006...................................  29,533,174,000
House allowance.........................................  29,533,174,000
Committee recommendation................................  29,510,574,000

    The Committee recommends an appropriation of 
$29,510,574,000 for supplemental security income. This is in 
addition to the $10,930,000,000 appropriated last year as an 
advance for the first quarter of fiscal year 2006. The 
comparable fiscal year 2005 funding level is $28,586,829,000 
and the budget request includes $29,533,174,000. The Committee 
also recommends an advance appropriation of $11,110,000,000 for 
the first quarter of fiscal year 2007 to ensure uninterrupted 
benefits payments. The program level supported by the Committee 
recommendation is $40,440,574,000, compared to the total 
program level requested in the budget of $40,463,174,000. The 
Committee recommendation also includes bill language which 
adjusts the timing of the October 2006 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 7 
million persons will receive SSI benefits each month during 
fiscal year 2006. 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 $52,000,000 for 
beneficiary services. The comparable funding level in fiscal 
year 2005 is $45,929,000 and the budget request includes 
$52,000,000 for these services. This amount is available for 
payments to Employment Networks for successful outcomes or 
milestone payments under the Ticket to Work program and for 
reimbursement of State vocational rehabilitation agencies and 
alternate public or private providers. Carryover budget 
authority of more than $130,000,000 is available for 
obligations made during fiscal years 2005 and 2006.

Research and Demonstration Projects

    The Committee recommendation includes $27,000,000 for 
research and demonstration projects conducted under sections 
1110 and 1115 of the Social Security Act. The comparable fiscal 
year 2005 funding level is $35,000,000 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.

Administration

    The Committee recommendation includes $2,874,400,000 for 
payment to the Social Security trust funds for the SSI 
Program's share of SSA's base administrative expenses. The 
comparable fiscal year 2005 amount is $2,986,900,000 and the 
budget request includes $2,897,000,000 for such activities.

                 LIMITATION ON ADMINISTRATIVE EXPENSES

Appropriations, 2005....................................  $8,729,901,000
Budget estimate, 2006...................................   9,388,400,000
House allowance.........................................   9,279,700,000
Committee recommendation................................   9,329,400,000

    The Committee recommends a program funding level of 
$9,329,400,000 for the limitation on administrative expenses. 
The comparable fiscal year 2005 funding level is $8,729,901,000 
and the budget request includes $9,388,400,000 for this 
purpose.
    This account provides resources from the Social Security 
trust funds to administer the Social Security retirement and 
survivors and disability insurance programs, and certain Social 
Security health insurance functions. As authorized by law, it 
also provides resources from the trust funds for certain 
nontrust fund administrative costs, which are reimbursed from 
the general funds. These include administration of the 
supplemental security income program for the aged, blind and 
disabled; work associated with the Pension Reform Act of 1984; 
and the portion of the annual wage reporting work done by the 
Social Security Administration for the benefit of the Internal 
Revenue Service. The dollars provided also support automated 
data processing activities and fund the State disability 
determination services which make initial and continuing 
disability determinations on behalf of the Social Security 
Administration. Additionally, the limitation provides funding 
for computer support, and other administrative costs.
    The Committee recommendation includes $9,209,400,000 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 $412,000,000 of funds available within this account 
for continuing disability reviews under Social Security's 
disability programs. The Committee bill language includes this 
earmark and also includes an additional $189,000,000 for this 
purpose requested in the budget and provided for by section 
404(b)(1) of the Concurrent Resolution on the Budget for fiscal 
year 2006. The Committee requests that the Social Security 
Administration provide reports to the Committee for each fiscal 
year 2005, 2006, and 2007 that detail the amount of funds spent 
on continuing disability reviews for each year and the number 
of such reviews, by category of review; the results of such 
continuing disability reviews in terms of cessation of benefits 
or determinations of continuing eligibility, by programs; and 
the amount of savings generated over the short-, medium-, and 
long-term by each program administered by the Agency. The 
Committee notes that during the last period of special funding 
for continuing disability reviews the benefit to cost ratio was 
more than $10 for each $1 spent on this workload.
    The Committee bill also includes language that authorizes 
fiscal year 2006 funds available to SSA to be used to complete 
Medicare appeals received by the Agency prior to July 1, 2005. 
Medicare appeals filed after this date were transferred to the 
Department of Health and Human Services, as required by the 
Medicare Prescription Drug, Improvement and Modernization Act 
of 2003. The Committee bill also allows the Commissioner of 
Social Security to enter into a reimbursable agreement with the 
Secretary of Health and Human Services to provide assistance 
with and process Medicare appeals work received prior to 
October 1, 2005. This language will ensure that Medicare 
beneficiaries are not impacted negatively by the transfer of 
this workload.
    The Committee recommendation also includes $320,000,000, 
the full amount included in the budget request, to support the 
implementation of the Medicare Prescription Drug Benefit 
program. These resources will be used to identify low-income 
beneficiaries who may be eligible for financial assistance with 
their prescription drug costs; to make eligibility 
determinations for those individuals eligible for financial 
assistance; and to withhold premiums associated with 
beneficiaries' plans; and to calculate Medicare Part B premiums 
for high-income beneficiaries.
    The Committee encourages 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 that results from this condition. The Committee 
encourages SSA to examine obstacles to benefits for persons 
with CFS 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 2006.

User Fees

    In addition to other amounts provided, the Committee 
recommends $120,000,000 for administrative activities funded 
from user fees. Of this amount, $119,000,000 is derived from 
fees paid to SSA by States that request SSA to administer State 
SSI supplementary payments. The remaining $1,000,000 will be 
generated from a fee payment process for non-attorney 
representatives of claimants.

                    OFFICE OF THE INSPECTOR GENERAL

Appropriations, 2005....................................     $90,378,000
Budget estimate, 2006...................................      93,000,000
House allowance.........................................      92,805,000
Committee recommendation................................      93,000,000

    The Committee recommends $93,000,000 for activities for the 
Office of the Inspector General. The comparable fiscal year 
2005 funding level is $90,378,000 and the budget request 
includes $93,000,000 for this office. This includes a general 
fund appropriation of $26,000,000 together with an obligation 
limitation of $67,000,000 from the Federal old-age and 
survivors insurance trust fund and the Federal disability 
insurance trust fund.

                      TITLE V--GENERAL PROVISIONS

    The Committee recommendation includes 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); 
clarify Federal funding as a component of State and local grant 
funds (sec. 506); limit use of funds for abortion (sec. 507 and 
sec. 508); restrict human embryo research (sec. 509); limit the 
use of funds for promotion of legalization of controlled 
substances included last year (sec. 510); 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. 511); prohibits the use of funds to promulgate 
regulations regarding the individual health identifier (sec. 
512); 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. 513); prohibits funds for the Railroad Retirement 
Board from being used for a non-governmental disbursing agent 
(sec. 514); maintains a provision clarifying procedures for 
reprogramming of funds (sec. 515); and specifies that none of 
the funds made available by this Act may be used to reimburse, 
or provide reimbursement for drugs approved to treat erectile 
dysfunction (sec. 516).

                                            BUDGETARY IMPACT OF BILL
  PREPARED IN CONSULTATION WITH THE CONGRESSIONAL BUDGET OFFICE PURSUANT TO SEC. 308(a), PUBLIC LAW 93-344, AS
                                                     AMENDED
                                            [In millions of dollars]
----------------------------------------------------------------------------------------------------------------
                                                                  Budget authority               Outlays
                                                             ---------------------------------------------------
                                                               Committee    Amount  of   Committee    Amount  of
                                                               allocation      bill      allocation      bill
----------------------------------------------------------------------------------------------------------------
Comparison of amounts in the bill with Committee allocations
 to its subcommittees of amounts in the Budget Resolution
 for 2006: Subcommittee on Labor-HHS-Education.
    Discretionary...........................................      141,344      141,653      142,975  \1\ 141,350
    Mandatory...............................................      405,311      405,311      405,171  \1\ 405,171
Projection of outlays associated with the recommendation:
    2006....................................................  ...........  ...........  ...........  \2\ 368,096
    2007....................................................  ...........  ...........  ...........       58,074
    2008....................................................  ...........  ...........  ...........       15,470
    2009....................................................  ...........  ...........  ...........        3,789
    2010 and future years...................................  ...........  ...........  ...........          542
Financial assistance to State and local governments for                NA      221,957           NA      159,755
 2006.......................................................
----------------------------------------------------------------------------------------------------------------
\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; Title VII and Title VIII 
of the Public Health Services Act; National Cord Blood Stem 
Cell Bank Program; Universal Newborn Hearing Screening; Organ 
Transplantation; Rural Hospital Flexibility Grants; Denali 
Commission; Family Planning; State Offices of Rural Health; 
Rural and Community Access to Emergency Devices; Trauma/EMS; 
Infectious Diseases; Health Promotion; Health Information and 
Services; Environmental Health and Injury; Occupational Safety 
and Health; Global Health; Public Health Research; Public 
Health Improvement and Leadership; Preventive Health and Health 
Services Block Grant; CDC Business Services; Title V of the 
Public Health Services Act; Adolescent Family Life; Office of 
Minority Health; Office of Disease Prevention and Health 
Promotion; Low Income Home Energy Assistance Program; Refugee 
and Entrant Assistance; Child Care and Development Block Grant; 
Head Start; Abstinence Education; Native American Programs; 
Community Services; Alzheimer's Disease Demonstration Grants to 
States; High school equivalency program; College assistance 
migrant program; State grants for incarcerated youth offenders; 
Rehabilitation Services and Disability Research, except 
sections 4, 5 and 6 of the Assistive Technology Program; 
National Technical Institute for the Deaf; Gallaudet 
University; Vocational Education; Adult Education; Student 
Financial Assistance; Student Aid Administration; Higher 
Education, except for section 102(b)(6) of the Mutual 
Educational and Cultural Exchange Act; Corporation for National 
and Community Service; National Council on Disability.

COMPLIANCE WITH PARAGRAPH 7(C), RULE XXVI OF THE STANDING RULES OF THE 
                                 SENATE

    Pursuant to paragraph 7(c) of rule XXVI, on July 14, 2005, 
the Committee ordered reported, H.R. 3010, making 
appropriations for the Departments of Labor, Health and Human 
Services, and Education, and related agencies for the fiscal 
year ending September 30, 2006, and for other purposes, with an 
amendment in the nature of a substitute, provided that the bill 
be subject to further amendment and the bill be consistent with 
its budget allocation, by a recorded vote of 27-0, a quorum 
being present. The vote was as follows:
        Yeas                          Nays
Chairman Cochran
Mr. Stevens
Mr. Specter
Mr. Domenici
Mr. Bond
Mr. McConnell
Mr. Burns
Mr. Shelby

Mr. Gregg deg.
Mr. Bennett
Mr. Craig
Mrs. Hutchison
Mr. DeWine
Mr. Brownback
Mr. Allard
Mr. Byrd
Mr. Inouye
Mr. Leahy
Mr. Harkin
Ms. Mikulski
Mr. Reid
Mr. Kohl
Mrs. Murray
Mr. Dorgan
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. deg.

NO CHILD LEFT BEHIND ACT OF 2001, PUBLIC LAW 107-110

           *       *       *       *       *       *       *



   ``Subpart 12--Educational, Cultural, Apprenticeship, and Exchange 
  Programs for Alaska Natives, Native Hawaiians, and Their Historical 
             Whaling and Trading Partners in Massachusetts

``SEC. 5521. SHORT TITLE.

    ``This subpart may be cited as the `Alaska Native and 
Native Hawaiian Education Through Cultural and Historical 
Organizations Act'.

``SEC. 5522. FINDINGS AND PURPOSES.

    ``(a) * * *

           *       *       *       *       *       *       *

    ``(b) Purposes.--The purposes of this subpart are the 
following:
            ``(1) To authorize and develop innovative 
        culturally-based educational programs and cultural 
        exchanges to assist Alaska Natives, Native Hawaiians, 
        and children and families of Massachusetts linked by 
        history and tradition to Alaska and Hawaii to learn 
        about shared culture and traditions.
            ``(2) To authorize and develop internship and 
        apprentice programs to assist Alaska Natives, Native 
        Hawaiians, and children and families of Massachusetts 
        linked by history and tradition with Alaska and Hawaii 
        to prepare for careers with cultural institutions.
            ``(3) To supplement programs and authorities in the 
        area of education to further the objectives of this 
        subpart.
            ``(4) To authorize and develop cultural and 
        educational programs relating to the Mississippi Band 
        of Choctaw Indians.''

``SEC. 5523. PROGRAM AUTHORIZATION.

    ``(a) Grants and Contracts.--In order to carry out programs 
that fulfill the purposes of this subpart, the Secretary is 
authorized to make grants to, or enter into contracts with, the 
following:
            ``(1) The Alaska Native Heritage Center in 
        Anchorage, Alaska.
            ``(2) The Inupiat Heritage Center in Barrow, 
        Alaska.
            ``(3) The Bishop Museum in Hawaii.
            ``(4) The Peabody-Essex Museum in Salem, 
        Massachusetts.
            ``(5) The New Bedford Whaling Museum and the New 
        Bedford Oceanarium in New Bedford, Massachusetts.
            ``(6) The Mississippi Band of Choctaw Indians in 
        Choctaw, Mississippi.''
            ``[(6)] (7) Other Alaska Native and Native Hawaiian 
        cultural and educational organizations.
            ``[(7)] (8) Cultural and educational organizations 
        with experience in developing or operating programs 
        that illustrate and interpret the contributions of 
        Alaska Natives, Native Hawaiians, the whaling industry, 
        and the China trade to the economic, social, and 
        environmental history of the United States.
            ``[(8)] (9) Consortia of the organizations and 
        entities described in this subsection.

           *       *       *       *       *       *       *


``SEC. 5525. AVAILABILITY OF FUNDS.

    ``If sufficient funds are made available under section 5401 
to carry out this subpart for a fiscal year, the Secretary 
shall make available, to support activities described in 
section 5523(b), the following amounts:
            ``(1) Not less than $2,000,000 each to--
                    ``(A) the New Bedford Whaling Museum, in 
                partnership with the New Bedford Oceanarium, in 
                Massachusetts; and
                    ``(B) the Inupiat Heritage Center in 
                Alaska.
            ``(2) For the New Trade Winds project, not less 
        than $1,000,000 each to--
                    ``(A) the Alaska Native Heritage Center in 
                Alaska;
                    ``(B) the Bishop Museum in Hawaii; and
                    ``(C) the Peabody-Essex Museum in 
                Massachusetts.
            ``(3) For internship and apprenticeship programs 
        (including the Museum Action Corps of the Peabody-Essex 
        Museum), not less than $1,000,000 each to--
                    ``(A) the Alaska Native Heritage Center in 
                Alaska;
                    ``(B) the Bishop Museum in Hawaii; and
                    ``(C) the Peabody-Essex Museum in 
                Massachusetts.
            ``(4) For cultural and educational programs, not 
        less than $2,000,000 to the Mississippi Band of Choctaw 
        Indians in Choctaw, Mississippi.''

                 COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2005 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL FOR FISCAL YEAR 2006
                                                                                    [In thousands of dollars]
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                                                            Senate Committee recommendation compared with (+ or
                                                                                                                              Committee                               )
                               Item                                  2005 comparable   Budget estimate   House allowance   recommendation  -----------------------------------------------------
                                                                                                                                             2005 comparable   Budget estimate   House allowance
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                   TITLE I--DEPARTMENT OF LABOR

              EMPLOYMENT AND TRAINING ADMINISTRATION

                 TRAINING AND EMPLOYMENT SERVICES
Grants to States:
    Adult Training, current year..................................          184,618           153,736           153,736           181,618            -3,000           +27,882           +27,882
        Advance from prior year...................................         (706,304)         (712,000)         (712,000)         (712,000)          (+5,696)  ................  ................
        Fiscal year 2007..........................................          712,000           712,000           712,000           712,000   ................  ................  ................
                                                                   -----------------------------------------------------------------------------------------------------------------------------
          Adult Training..........................................          896,618           865,736           865,736           893,618            -3,000           +27,882           +27,882

    Youth Training................................................          986,288           950,000           950,000           986,288   ................          +36,288           +36,288
    Dislocated Worker Assistance, current year....................          345,264           226,867           345,264           345,264   ................         +118,397   ................
        Advance from prior year...................................         (841,216)         (848,000)         (848,000)         (848,000)          (+6,784)  ................  ................
        Fiscal year 2007..........................................          848,000           848,000           848,000           848,000   ................  ................  ................
                                                                   -----------------------------------------------------------------------------------------------------------------------------
          Dislocated Worker Assistance............................        1,193,264         1,074,867         1,193,264         1,193,264   ................         +118,397   ................

Federally Administered Programs:
    Dislocated Worker Assistance National Reserve:
        Current year..............................................           70,800            56,717   ................           70,800   ................          +14,083           +70,800
        Advance from prior year...................................         (210,304)         (212,000)         (212,000)         (212,000)          (+1,696)  ................  ................
        Fiscal year 2007..........................................          212,000           212,000           212,000           212,000   ................  ................  ................
                                                                   -----------------------------------------------------------------------------------------------------------------------------
          Dislocated Worker Assistance Nat'l Reserve..............          282,800           268,717           212,000           282,800   ................          +14,083           +70,800

        Less funding reserved for Community College Initiative            (-125,000)  ................  ................        (-125,000)  ................        (-125,000)        (-125,000)
         (NA).....................................................
                                                                   -----------------------------------------------------------------------------------------------------------------------------
            Dislocated Worker Assistance Nat'l Reserve............          157,800           268,717           212,000           157,800   ................         -110,917           -54,200
                                                                   -----------------------------------------------------------------------------------------------------------------------------
            Total, Dislocated Worker Assistance...................        1,476,064         1,343,584         1,405,264         1,476,064   ................         +132,480           +70,800

    Native Americans..............................................           54,238            54,238            54,238            54,238   ................  ................  ................

    Migrant and Seasonal Farmworkers..............................           75,759   ................           75,759            80,053            +4,294           +80,053            +4,294

    Job Corps:
        Operations................................................          844,670           851,019           851,019           881,000           +36,330           +29,981           +29,981
            Advance from prior year...............................         (586,272)         (591,000)         (591,000)         (591,000)          (+4,728)  ................  ................
            Fiscal year 2007......................................          591,000           591,000           591,000           591,000   ................  ................  ................
        Construction and Renovation...............................           16,190   ................  ................           10,000            -6,190           +10,000           +10,000
            Advance from prior year...............................          (99,200)         (100,000)         (100,000)         (100,000)            (+800)  ................  ................
            Fiscal year 2007......................................          100,000            75,000           100,000           100,000   ................          +25,000   ................
                                                                   -----------------------------------------------------------------------------------------------------------------------------
              Subtotal, Job Corps.................................        1,551,860         1,517,019         1,542,019         1,582,000           +30,140           +64,981           +39,981

    National Activities:
        Pilots, Demonstrations and Research.......................           85,167            30,000            74,000            90,367            +5,200           +60,367           +16,367
        Responsible Reintegration of Youthful Offender............           49,600   ................  ................           50,000              +400           +50,000           +50,000
        Evaluation................................................            7,936             7,936             7,936             7,936   ................  ................  ................
        Prisoner Re-entry.........................................           19,840            35,000            19,840            19,840   ................          -15,160   ................
        Community College initiative..............................          124,000           250,000           125,000   ................         -124,000          -250,000          -125,000
            Community College initiative (NA) \1\.................         (125,000)  ................  ................         (125,000)  ................        (+125,000)        (+125,000)
                                                                   -----------------------------------------------------------------------------------------------------------------------------
              Subtotal, CC initiative, program level..............          249,000           250,000           125,000           125,000          -124,000          -125,000   ................

        Denali Commission.........................................            6,944   ................  ................            6,944   ................           +6,944            +6,944
        Other.....................................................            3,458             2,000             2,000             3,458   ................           +1,458            +1,458
                                                                   -----------------------------------------------------------------------------------------------------------------------------
          Subtotal, National activities...........................          296,945           324,936           228,776           178,545          -118,400          -146,391           -50,231
                                                                   =============================================================================================================================
          Subtotal, Federal activities............................        2,261,602         2,164,910         2,112,792         2,177,636           -83,966           +12,726           +64,844
              Current Year........................................        1,358,602         1,286,910         1,209,792         1,274,636           -83,966           -12,274           +64,844
              Fiscal year 2007....................................          903,000           878,000           903,000           903,000   ................          +25,000   ................
                                                                   =============================================================================================================================
          Total, Training and Employment Services.................        5,337,772         5,055,513         5,121,792         5,250,806           -86,966          +195,293          +129,014
              Current Year........................................       (2,874,772)       (2,617,513)       (2,658,792)       (2,787,806)         (-86,966)        (+170,293)        (+129,014)
              Fiscal year 2007....................................       (2,463,000)       (2,438,000)       (2,463,000)       (2,463,000)  ................         (+25,000)  ................

COMMUNITY SERVICE EMPLOYMENT FOR OLDER AMERICANS..................          436,678           436,678           436,678           436,678   ................  ................  ................
FEDERAL UNEMPLOYMENT BENEFITS AND ALLOWANCES......................        1,057,300           966,400           966,400           966,400           -90,900   ................  ................

  STATE UNEMPLOYMENT INSURANCE AND EMPLOYMENT SERVICE OPERATIONS

Unemployment Compensation:
    State Operations..............................................        2,663,040         2,622,499         2,622,499         2,600,000           -63,040           -22,499           -22,499
    National Activities...........................................           10,416            10,416            10,416            10,000              -416              -416              -416
                                                                   -----------------------------------------------------------------------------------------------------------------------------
      Subtotal, Unemployment Compensation.........................        2,673,456         2,632,915         2,632,915         2,610,000           -63,456           -22,915           -22,915

Employment Service:
    Allotments to States:
        Federal Funds.............................................           23,114            23,300            23,300            23,114   ................             -186              -186
        Trust Funds...............................................          757,478           672,700           672,700           723,188           -34,290           +50,488           +50,488
                                                                   -----------------------------------------------------------------------------------------------------------------------------
          Subtotal, allotments to States..........................          780,592           696,000           696,000           746,302           -34,290           +50,302           +50,302

    ES National Activities........................................           64,976            33,766            33,766            33,766           -31,210   ................  ................
                                                                   =============================================================================================================================
      Subtotal, Employment Service................................          845,568           729,766           729,766           780,068           -65,500           +50,302           +50,302
          Federal Funds...........................................           23,114            23,300            23,300            23,114   ................             -186              -186
          Trust Funds.............................................          822,454           706,466           706,466           756,954           -65,500           +50,488           +50,488

One-Stop Career Centers/Labor Market Information..................           97,974            87,974            87,974            90,000            -7,974            +2,026            +2,026
Work Incentives Grants............................................           19,711            19,711            19,711            19,711   ................  ................  ................
                                                                   =============================================================================================================================
      Total, State Unemployment & Employment Srvcs................        3,636,709         3,470,366         3,470,366         3,499,779          -136,930           +29,413           +29,413
          Federal Funds...........................................          140,799           130,985           130,985           132,825            -7,974            +1,840            +1,840
          Trust Funds.............................................        3,495,910         3,339,381         3,339,381         3,366,954          -128,956           +27,573           +27,573

ADVANCES TO THE UI AND OTHER TRUST FUNDS \2\......................          517,000           465,000           465,000           465,000           -52,000   ................  ................

                      PROGRAM ADMINISTRATION

Adult Employment and Training.....................................           38,874            44,631            44,631            43,631            +4,757            -1,000            -1,000
    Trust Funds...................................................            6,901             7,925             7,925             7,925            +1,024   ................  ................
Youth Employment and Training.....................................           39,627            38,805            38,805            38,805              -822   ................  ................
Employment Security...............................................            6,045             6,039             6,039             6,039                -6   ................  ................
    Trust Funds...................................................           48,235            77,952            77,952            72,841           +24,606            -5,111            -5,111
Apprenticeship Services...........................................           21,136            21,655            21,655            21,655              +519   ................  ................
Executive Direction...............................................            6,845             6,993             6,993             6,993              +148   ................  ................
    Trust Funds...................................................            2,065             2,111             2,111             2,111               +46   ................  ................
Welfare to Work...................................................              373   ................  ................  ................             -373   ................  ................
                                                                   -----------------------------------------------------------------------------------------------------------------------------
      Total, Program Administration...............................          170,101           206,111           206,111           200,000           +29,899            -6,111            -6,111
          Federal Funds...........................................          112,900           118,123           118,123           117,123            +4,223            -1,000            -1,000
          Trust Funds.............................................           57,201            87,988            87,988            82,877           +25,676            -5,111            -5,111
                                                                   =============================================================================================================================
      Total, Employment and Training Administration...............       11,155,560        10,600,068        10,666,347        10,818,663          -336,897          +218,595          +152,316
          Federal Funds...........................................        7,602,449         7,172,699         7,238,978         7,368,832          -233,617          +196,133          +129,854
              Current Year........................................       (5,139,449)       (4,734,699)       (4,775,978)       (4,905,832)        (-233,617)        (+171,133)        (+129,854)
              Fiscal year 2007....................................       (2,463,000)       (2,438,000)       (2,463,000)       (2,463,000)  ................         (+25,000)  ................
          Trust Funds.............................................        3,553,111         3,427,369         3,427,369         3,449,831          -103,280           +22,462           +22,462

             EMPLOYEE BENEFITS SECURITY ADMINISTRATION

                       SALARIES AND EXPENSES

Enforcement and Participant Assistance............................          109,374           114,462           114,462           112,362            +2,988            -2,100            -2,100
Policy and Compliance Assistance..................................           17,357            17,458            17,458            17,458              +101   ................  ................
Executive Leadership, Program Oversight and Admin.................            4,482             5,080             5,080             5,080              +598   ................  ................
                                                                   -----------------------------------------------------------------------------------------------------------------------------
      Total, EBSA.................................................          131,213           137,000           137,000           134,900            +3,687            -2,100            -2,100

               PENSION BENEFIT GUARANTY CORPORATION

Pension insurance activities......................................          (12,211)          (42,122)          (42,122)          (42,122)         (+29,911)  ................  ................
Pension plan termination..........................................         (169,739)         (161,117)         (161,117)         (161,117)          (-8,622)  ................  ................
Operational support...............................................          (84,380)          (93,739)          (93,739)          (93,739)          (+9,359)  ................  ................
                                                                   -----------------------------------------------------------------------------------------------------------------------------
      Total, PBGC (Program level).................................         (266,330)         (296,978)         (296,978)         (296,978)         (+30,648)  ................  ................

                EMPLOYMENT STANDARDS ADMINISTRATION

                       SALARIES AND EXPENSES

Enforcement of Wage and Hour Standards............................          164,493           167,359           167,359           167,359            +2,866   ................  ................
Office of Labor-Management Standards..............................           41,681            48,799            48,799            43,599            +1,918            -5,200            -5,200
Federal Contractor EEO Standards Enforcement......................           80,059            82,106            82,106            82,106            +2,047   ................  ................
Federal Programs for Workers' Compensation........................           97,339           100,129           100,129           100,129            +2,790   ................  ................
    Trust Funds...................................................            2,023             2,048             2,048             2,048               +25   ................  ................
Program Direction and Support.....................................           15,252            15,891            15,891            17,375            +2,123            +1,484            +1,484
                                                                   -----------------------------------------------------------------------------------------------------------------------------
      Total, ESA salaries and expenses............................          400,847           416,332           416,332           412,616           +11,769            -3,716            -3,716
          Federal Funds...........................................          398,824           414,284           414,284           410,568           +11,744            -3,716            -3,716
          Trust Funds.............................................            2,023             2,048             2,048             2,048               +25   ................  ................

                         SPECIAL BENEFITS

Federal employees compensation benefits...........................          230,000           234,000           234,000           234,000            +4,000   ................  ................
Longshore and harbor workers' benefits............................            3,000             3,000             3,000             3,000   ................  ................  ................
                                                                   -----------------------------------------------------------------------------------------------------------------------------
      Total, Special Benefits.....................................          233,000           237,000           237,000           237,000            +4,000   ................  ................

             SPECIAL BENEFITS FOR DISABLED COAL MINERS

Benefit payments..................................................          358,806           308,000           308,000           308,000           -50,806   ................  ................
Administration....................................................            5,191             5,250             5,250             5,250               +59   ................  ................
                                                                   -----------------------------------------------------------------------------------------------------------------------------
      Subtotal, Fiscal year 2006 program level....................          363,997           313,250           313,250           313,250           -50,747   ................  ................

          Less funds advanced in prior year.......................          -88,000           -81,000           -81,000           -81,000            +7,000   ................  ................
                                                                   -----------------------------------------------------------------------------------------------------------------------------
            Total, Current Year, Fiscal year 2006.................          275,997           232,250           232,250           232,250           -43,747   ................  ................
          New advances, 1st quarter Fiscal year 2007..............           81,000            74,000            74,000            74,000            -7,000   ................  ................
                                                                   -----------------------------------------------------------------------------------------------------------------------------
            Total, Special Benefits for Disabled Coal Miners......          356,997           306,250           306,250           306,250           -50,747   ................  ................

ENERGY EMPLOYEES OCCUPATIONAL ILLNESS COMPENSATION FUND, Part B              40,321            96,081            96,081            96,081           +55,760   ................  ................
 Administrative Expenses..........................................

                 BLACK LUNG DISABILITY TRUST FUND

Benefit payments and interest on advances.........................        1,004,951         1,010,011         1,010,011         1,010,011            +5,060   ................  ................
Employment Standards Adm. S&E.....................................           32,615            33,050            33,050            33,050              +435   ................  ................
Departmental Management S&E.......................................           23,705            24,239            24,239            24,239              +534   ................  ................
Departmental Management, Inspector General........................              342               344               344               344                +2   ................  ................
                                                                   -----------------------------------------------------------------------------------------------------------------------------
      Subtotal, Black Lung Disability.............................        1,061,613         1,067,644         1,067,644         1,067,644            +6,031   ................  ................

Treasury Administrative Costs.....................................              356               356               356               356   ................  ................  ................
                                                                   -----------------------------------------------------------------------------------------------------------------------------
      Total, Black Lung Disability Trust Fund.....................        1,061,969         1,068,000         1,068,000         1,068,000            +6,031   ................  ................
                                                                   =============================================================================================================================
      Total, Employment Standards Administration..................        2,093,134         2,123,663         2,123,663         2,119,947           +26,813            -3,716            -3,716
          Federal Funds...........................................        2,091,111         2,121,615         2,121,615         2,117,899           +26,788            -3,716            -3,716
              Current year........................................       (2,010,111)       (2,047,615)       (2,047,615)       (2,043,899)         (+33,788)          (-3,716)          (-3,716)
              Fiscal year 2007....................................          (81,000)          (74,000)          (74,000)          (74,000)          (-7,000)  ................  ................
          Trust Funds.............................................            2,023             2,048             2,048             2,048               +25   ................  ................

           OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION

                       SALARIES AND EXPENSES

Safety and Health Standards.......................................           16,003            16,628            16,628            16,628              +625   ................  ................
Federal Enforcement...............................................          169,652           174,318           174,318           174,318            +4,666   ................  ................
State Programs....................................................           91,013            92,013            92,013            92,013            +1,000   ................  ................
Technical Support.................................................           20,742            21,652            21,652            21,652              +910   ................  ................

Compliance Assistance:
    Federal Assistance............................................           70,859            73,278            73,278            73,278            +2,419   ................  ................
    State Consultation Grants.....................................           53,362            53,896            53,896            53,896              +534   ................  ................
    Training Grants...............................................           10,218   ................           10,218            10,510              +292           +10,510              +292
                                                                   -----------------------------------------------------------------------------------------------------------------------------
      Subtotal, Compliance Assistance.............................          134,439           127,174           137,392           137,684            +3,245           +10,510              +292

Safety and Health Statistics......................................           22,203            24,498            24,498            24,498            +2,295   ................  ................
Executive Direction and Administration............................           10,106            10,698            10,698            10,698              +592   ................  ................
                                                                   =============================================================================================================================
      Total, OSHA.................................................          464,158           466,981           477,199           477,491           +13,333           +10,510              +292

               MINE SAFETY AND HEALTH ADMINISTRATION

                       SALARIES AND EXPENSES

Coal Enforcement..................................................          115,251           118,335           118,335           118,335            +3,084   ................  ................
Metal/Non-Metal Enforcement.......................................           66,752            68,750            68,750            68,750            +1,998   ................  ................
Standards Development.............................................            2,334             2,506             2,506             2,506              +172   ................  ................
Assessments.......................................................            5,238             5,445             5,445             5,445              +207   ................  ................
Educational Policy and Development................................           31,255            32,021            32,021            32,021              +766   ................  ................
Technical Support.................................................           25,111            25,736            25,736            25,736              +625   ................  ................
Program evaluation and information resources (PEIR)...............           17,525            15,671            15,671            15,671            -1,854   ................  ................
Program Administration............................................           15,670            12,026            12,026            12,026            -3,644   ................  ................
                                                                   -----------------------------------------------------------------------------------------------------------------------------
      Total, Mine Safety and Health Administration................          279,136           280,490           280,490           280,490            +1,354   ................  ................

                    BUREAU OF LABOR STATISTICS

                       SALARIES AND EXPENSES

Employment and Unemployment Statistics............................          162,714           167,047           167,047           167,047            +4,333   ................  ................
Labor Market Information (Trust Funds)............................           77,845            77,845            77,845            77,845   ................  ................  ................
Prices and Cost of Living.........................................          169,370           174,779           174,779           174,779            +5,409   ................  ................
Compensation and Working Conditions...............................           78,942            81,532            81,532            81,532            +2,590   ................  ................
Productivity and Technology.......................................           10,503            10,847            10,847            10,847              +344   ................  ................
Executive Direction and Staff Services............................           29,629            30,473            30,473            30,473              +844   ................  ................
                                                                   -----------------------------------------------------------------------------------------------------------------------------
      Total, Bureau of Labor Statistics...........................          529,003           542,523           542,523           542,523           +13,520   ................  ................
          Federal Funds...........................................          451,158           464,678           464,678           464,678           +13,520   ................  ................
          Trust Funds.............................................           77,845            77,845            77,845            77,845   ................  ................  ................

              OFFICE OF DISABILITY EMPLOYMENT POLICY

Ofce of Disability Employ. Policy, Salaries & expenses............           47,164            27,934            27,934            47,164   ................          +19,230           +19,230

                      DEPARTMENTAL MANAGEMENT

                       SALARIES AND EXPENSES

Executive Direction...............................................           26,720            29,504            24,864            26,720   ................           -2,784            +1,856
Departmental IT Crosscut..........................................           29,760            29,760            29,760            29,760   ................  ................  ................
Departmental Management Crosscut..................................            4,960             1,700             1,700             1,700            -3,260   ................  ................
Legal Services....................................................           79,769            81,907            81,907            80,000              +231            -1,907            -1,907
    Trust Funds...................................................              311               311               311               311   ................  ................  ................
International Labor Affairs.......................................           93,248            12,419            12,419            93,248   ................          +80,829           +80,829
Administration and Management.....................................           32,414            33,197            33,197            33,197              +783   ................  ................
Frances Perkins building security enhancements....................            6,944             6,944             6,944             6,944   ................  ................  ................
Adjudication......................................................           25,665            27,126            27,126            27,126            +1,461   ................  ................
Women's Bureau....................................................            9,478             9,764             9,764             9,764              +286   ................  ................
Civil Rights Activities...........................................            6,237             6,451             6,451             6,451              +214   ................  ................
Chief Financial Officer...........................................            5,182             5,340             5,340             5,340              +158   ................  ................
                                                                   -----------------------------------------------------------------------------------------------------------------------------
      Total, Salaries and expenses................................          320,688           244,423           239,783           320,561              -127           +76,138           +80,778
          Federal Funds...........................................          320,377           244,112           239,472           320,250              -127           +76,138           +80,778
          Trust Funds.............................................              311               311               311               311   ................  ................  ................

                 VETERANS EMPLOYMENT AND TRAINING

State administration, Grants......................................          161,097           162,415           162,415           162,415            +1,318   ................  ................
Federal Administration............................................           30,438            30,435            31,935            30,435                -3   ................           -1,500
National Veterans Training Institute..............................            1,984             1,984             2,484             1,984   ................  ................             -500
Homeless Veterans Program.........................................           20,832            22,000            25,000            22,000            +1,168   ................           -3,000
Veterans Workforce Investment Programs............................            8,482             7,500             7,500             7,500              -982   ................  ................
                                                                   -----------------------------------------------------------------------------------------------------------------------------
      Total, Veterans Employment and Training.....................          222,833           224,334           229,334           224,334            +1,501   ................           -5,000
          Federal Funds...........................................           29,314            29,500            32,500            29,500              +186   ................           -3,000
          Trust Funds.............................................          193,519           194,834           196,834           194,834            +1,315   ................           -2,000

                  OFFICE OF THE INSPECTOR GENERAL

Program Activities.......................