95-685
2d Session
108-636
--DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND RELATED AGENCIES APPROPRIATION BILL, 2005
[To accompany H.R. 5006]
The Committee on Appropriations submits the following report in explanation of the accompanying bill making appropriations for the Departments of Labor, Health and Human Services (except the Food and Drug Administration and the Indian Health Service), and Education, Armed Forces Retirement Home, Committee for Purchase from People Who are Blind or Severely Disabled, Corporation for National and Community Service, Corporation for Public Broadcasting, Federal Mediation and Conciliation Service, Federal Mine Safety and Health Review Commission, Institute of Museum and Library Services, Medicare Payment Advisory Commission, National Commission on Libraries and Information Science, National Council on Disability, National Labor Relations Board, National Mediation Board, Occupational Safety and Health Review Commission, Railroad Retirement Board, and the Social Security Administration for the fiscal year ending September 30, 2005, and for other purposes.
| INDEX TO BILL AND REPORT | ||
| Page number | ||
| Bill | Report | |
| Title I--Department of Labor: | ||
| Employment and Training Administration | 2 | 8 |
| Employee Benefits Security Administration | 8 | 15 |
| Pension Benefit Guaranty Corporation | 8 | 15 |
| Employment Standards Administration | 9 | 15 |
| Occupational Safety and Health Administration | 14 | 17 |
| Mine Safety and Health Administration | 17 | 18 |
| Bureau of Labor Statistics | 18 | 18 |
| Office of Disability Employment Policy | 19 | 18 |
| Departmental Management | 19 | 19 |
| Veterans Employment and Training | 21 | 20 |
| Office of the Inspector General | 21 | 21 |
| General Provisions | 22 | 21 |
| Title II--Department of Health and Human Services: | ||
| Health Resources and Services Administration | 23 | 21 |
| Centers for Disease Control and Prevention | 26 | 43 |
| National Institutes of Health | 28 | 61 |
| Substance Abuse and Mental Health Services Administration | 35 | 116 |
| Agency for Healthcare Research and Quality | 37 | 121 |
| Centers for Medicare and Medicaid Services | 37 | 123 |
| Administration for Children and Families | 40 | 128 |
| Administration on Aging | 49 | 141 |
| Office of the Secretary | 49 | 144 |
| General Provisions | 54 | 151 |
| Title III--Department of Education: | ||
| Education for the Disadvantaged | 65 | 153 |
| Impact Aid | 66 | 157 |
| School Improvement Programs | 67 | 158 |
| Indian Education | 69 | 162 |
| Innovation and Improvement | 69 | 163 |
| Safe Schools and Citizenship Education | 70 | 167 |
| English Language Acquisition | 70 | 169 |
| Special Education | 70 | 169 |
| Rehabilitation Services and Disability Research | 71 | 171 |
| Special Institutions for Persons with Disabilities | 72 | 175 |
| Vocational and Adult Education | 72 | 175 |
| Student Financial Assistance | 74 | 178 |
| Student Aid Administration | 75 | 180 |
| Higher Education | 75 | 180 |
| Howard University | 76 | 186 |
| College Housing and Academic Facilities Loans | 77 | 186 |
| Historically Black College and University Capital Financing | 77 | 186 |
| Institute of Education Sciences | 77 | 187 |
| Departmental Management | 78 | 189 |
| Office for Civil Rights | 78 | 190 |
| Office of the Inspector General | 78 | 190 |
| General Provisions | 78 | 190 |
| Title IV--Related Agencies: | ||
| Armed Forces Retirement Home | 80 | 191 |
| Committee for Purchase from People Who Are Blind or Severely Disabled | 80 | 191 |
| Corporation for National and Community Service | 80 | 191 |
| Corporation for Public Broadcasting | 81 | 193 |
| Federal Mediation and Conciliation Service | 82 | 193 |
| Federal Mine Safety and Health Review Commission | 84 | 194 |
| Institute of Museum and Library Services | 84 | 194 |
| Medicare Payment Advisory Commission | 84 | 194 |
| National Commission on Libraries and Information Science | 84 | 195 |
| National Council on Disability | 85 | 195 |
| National Labor Relations Board | 85 | 195 |
| National Mediation Board | 86 | 195 |
| Occupational Safety and Health Review Commission | 86 | 195 |
| Railroad Retirement Board | 86 | 196 |
| Social Security Administration | 88 | 197 |
| Title V--General Provisions: | ||
| House of Representatives Report Requirements | 91 | 198 |
The following table compares on a summary basis the appropriations including trust funds for fiscal year 2005, the budget estimate for fiscal year 2005 and the Committee recommendation for fiscal year 2005 in the accompanying bill.
2005 LABOR, HHS, EDUCATION APPROPRIATIONS BILL
[In millions of dollars]
---------------------------------------------------------------------------------------------------------------------------------
Fiscal year-- 2005 committee compared to--
2004 comparable 2005 budget 2005 committee 2004 comparable 2005 budget
---------------------------------------------------------------------------------------------------------------------------------
Department of Labor $15,278 $15,186 $14,906 -$372 -$280
Advances 2,545 2,551 2,551 +6 0
Department of Health and Human Services 353,642 369,010 368,990 +15,348 -20
Advances 56,099 62,784 62,784 +6,685 0
Department of Education 58,236 59,975 60,317 +2,081 +342
Advances 15,011 15,022 15,022 +11 0
Related Agencies 44,428 48,915 48,708 +4,280 -207
Advances 11,458 12,980 12,980 +1,522 0
Grand Total, current year 471,584 493,086 492,921 +21,337 -165
Advances 85,113 93,337 93,337 +8,224 0
Current year total using 302(b) scorekeeping 471,288 492,125 492,327 +21,039 +202
Mandatory 331,864 349,801 349,801 +17,937 0
Discretionary 139,424 142,324 142,526 +3,102 +202
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PROGRAM LEVEL DISCRETIONARY
[In millions of dollars]
----------------------------------------------------------------------------------------------------------------------------
Fiscal year-- 2005 committee compared to--
2004 comparable 2005 budget 2005 committee 2004 comparable 2005 budget
----------------------------------------------------------------------------------------------------------------------------
Department of Labor $11,821 $12,003 $11,723 -$98 -$280
Department of Health and Human Services 62,201 63,231 63,210 1,009 -21
Department of Education 55,662 57,339 57,681 2,019 342
Related Agencies 10,070 10,712 10,505 435 -207
Subtotal Program Level 139,754 143,285 143,119 3,365 -166
----------------------------------------------------------------------------------------------------------------------------
Funding levels in the fiscal year 2005 appropriation bill for the Departments of Health and Human Services, and Education and Related Agencies reflect the Committee's attempt to establish priorities within the very stringent limitations. As in past years, the Committee has increased funding for programs that work for people and represent a core Federal responsibility.
Bill total- Total funding, including offsets, for fiscal year 2005 in the Departments of Health, and Human Services and Education and Related Agencies Appropriations Act, 2005 is $492,327,096,000.
Discretionary Programs- For Discretionary accounts for 2005 the bill provides $142,526,000,000, including offsets. This is $3,101,931,000 above the fiscal year 2004 comparable level. After adjusting for fluctuations in advance appropriations, the comparable program increase is $3,366,085,000, or 2.41 percent, over fiscal year 2004.
Mandatory programs- The bill provides $349,801,096,000 for entitlement programs in fiscal year 2005. This is $17,937,264,000 above the fiscal year 2004 comparable level, or an increase of 5.4 percent. Over two thirds of the funding in the bill is for these mandatory costs. Funding requirements for entitlement programs are determined by the basic authorizing statutes. Mandatory programs include general fund support for the Medicare and Medicaid programs, Supplemental Security Income, Trade Adjustment Assistance and Black Lung payments. The following chart indicates the funding levels for the major mandatory programs in fiscal years 2004 and 2005 and the growth in these programs.
MANDATORY
[Dollars in thousands]
------------------------------------------------------------------------------------------------------
Program Fiscal Year 2004 Fiscal Year 2004 Change
------------------------------------------------------------------------------------------------------
Department of Labor:
Federal Unemployment Benefits and Allowances 1,338,200 1,057,300 -280,900
Advances to the UI and other trust funds 467,000 517,000 +50,000
Special Benefits 163,000 233,000 +70,000
Special Benefits for Disabled Coal Miners 299,991 188,000 -111,991
Energy Employees Occupational Illness Compensation Fund 51,651 40,821 -10,830
Black Lung Disability Trust 1,055,000 1,059,000 +4,000
Department of Health and Human Services:
Vaccine Injury Compensation Trust fund 66,000 66,000 0
Medicaid current law benefits 172,706,067 167,013,865 -5,692,202
Medicaid State and Local Administration 9,067,320 9,318,602 +251,282
CMS Vaccines for Children 980,196 1,208,296 +228,100
Medicare Payments to Healthcare Trust Funds 95,084,100 114,608,900 +19,524,800
Child Support Enforcement 4,361,674 4,398,698 +37,024
Social Services Block Grant 1,700,000 1,700,000 0
Promoting Safe and Stable Families 305,000 305,000 0
Payments to States for Foster Care and Adoption 5,068,300 5,037,900 -30,400
Medical Benefits for Commissioned Officers 321,763 330,636 +8,873
Department of Education:
Vocaltional Rehabilitation 2,584,162 2,635,845 +51,683
Related Agencies: 34,336,000 38,181,929 +3,845,929
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Department of Labor- The bill appropriates $11,723,237,000 for the discretionary programs of the Labor Department.
Employment and Training- The Committee recommends $5,112,728,000 to carry out the provisions of the Workforce Investment Act of 1998. This is $32,736,000 below the fiscal year 2004 comparable level and $213,564,000 below the request. The Committee recommends an increase in funding over fiscal year 2004 for dislocated worker re-employment assistance of $25,000,000.
Employee Benefits Security Administration- The Committee recommends $132,345,000 for the EBSA to carry out their responsibilities to American workers and their families who are covered by private sector pension, health, and other employee benefit plans. This is $8,305,000 above the fiscal year 2004 comparable level and the same as the request.
Employment Standards Administration- The Committee recommends $402,818,000 for ESA. This level is $10,802,000 above the fiscal year 2004 comparable level and $6,476,000 below the President's program level request for the Agency.
Occupational Safety and Health Administration- The Committee recommends funding for OSHA at $461,599,000, $4,058,000 above the fiscal year 2004 comparable level and the same as the request.
Department of Health and Human Services- The bill appropriates $63,210,324,000 for discretionary programs of the Department.
Health Resources and Services Administration- Funding for the Health Resources and Services Administration (HRSA) programs is $6,330,333,000, $287,970,000 below the fiscal year 2004 comparable level and $282,500,000 above the request. Within HRSA, the community health centers funding is at $1,835,925,000, an increase of $218,544,000 above the fiscal year 2004 comparable level and the same as the request. Health professions training is funded at $416,365,000, $19,715,000 below last year's comparable level and $258,582,000 above the request. Ryan White AIDS Care Act programs are funded at $2,099,861,000, $35,000,000 above last year's comparable level and $20,000,000 above the request. In addition, $542,649,000 is recommended for HRSA's bioterrorism preparedness and response activities. This is the same as the fiscal year 2004 comparable level and $39,000,000 above the request.
Centers for Disease Control and Prevention- The bill provides a total program level of $4,477,878,000 directly to the Centers for Disease Control and Prevention (CDC). This is $101,421,000 below the fiscal year 2004 comparable level and $15,244,000 above the request. In addition, $1,637,760,000 is available for CDC homeland security activities funded through the Public Health and Social Services Emergency Fund. CDC programs and activities include: Immunization; bioterrorism preparedness and response; chronic disease prevention; domestic and Global HIV/AIDS; surveillance, prevention, and control of infectious diseases, such as hepatitis, SARS, and the West Nile Virus.
National Institutes of Health- The Committee recommends $28,441,371,000 for the biomedical research activities of the National Institutes of Health (NIH). This is $782,238,000 above the fiscal year 2004 comparable level and the same as the request. The Committee continues to support strongly the research and training activities of the NIH. The Committee has maintained its policy of resisting disease specific earmarks in the bill and report, believing that decisions as to appropriate levels of funding and appropriate avenues of research are best left to the scientific managers at NIH. It is the view of the Committee that this is the best means available for advancing our understanding of human health and disease and improving the quality of life for affected individuals and families.
Substance Abuse and Mental Health Services Administration- The bill provides $3,270,360,000 for the Substance Abuse and Mental Health Services Administration (SAMHSA), an amount $36,452,000 above the fiscal year 2004 level and $158,579,000 below the request.
Agency for Healthcare Research and Quality- The bill provides $303,695,000 for the Agency for Healthcare Research and Quality (AHRQ), an amount that is the same as the fiscal year 2004 comparable level and the request.
Medicare and Medicaid- The bill provides $177,540,763,000 for Medicaid and $114,608,900,000 in Federal funds for the Government's share of payments to Medicare in fiscal year 2005.
Low Income Home Energy Assistance- The Committee provides $1,900,000,000 for the Low Income Home Energy Assistance Program formula grants to States in fiscal year 2005. This is $110,620,000 more than the fiscal year 2004 level and $99,500,000 more than the request. The Committee includes $100,000,000 in contingent emergency funding for heating and cooling emergencies, which is $590,000 more than last year's level and $100,000,000 less than the request.
Child Care and Development Block Grant- The Committee includes $2,099,729,000 for the Child Care and Development Block Grant for fiscal year 2005. This is $12,419,000 above the fiscal year 2004 level and the same as the request.
Social Services Block Grant- The Committee provides $1,700,000,000 for the Social Services Block Grant, the same as both the fiscal year 2004 level and the request.
Head Start- The bill includes $6,898,580,000 for Head Start, $123,732,000 above last year's level and $45,000,000 below the request.
Human Embryo Research- The bill includes the same language included for the past several years to prohibit the use of federal funds for research involving human embryos. This language also has the effect of prohibiting the use of funds in the bill to support human cloning.
Needle Exchange- The bill includes a prohibition on the use of Federal funds for needle exchange programs, which is the same as last year.
Title X Family Participation in Decisions of Minors to Seek Family Planning- The bill includes language requiring recipients of title X funding, family planning funding, to certify that it encourages family participation in the decision of minors to seek family planning services and that it provides counseling to minors on how to resist attempts to coerce minors into engaging in sexual activities. This language has been included in the bill for several years.
Title X Compliance With State Laws- The bill includes a provision, continued from last year, requiring Title X clinics to comply with State laws relating to notification or reporting of child abuse, child molestation, sexual abuse, rape or incest.
Department of Education- The bill funds programmatic and support activities in the Department of Education at $57,681,171,000, an increase of $342,119,000 above the request and $2,018,710,000 above last year's comparable level (adjusted for advance appropriations in fiscal year 2004).
Education for the Disadvantaged- The bill provides $13,342,309,000, for grants to local education agencies under title I of the Elementary and Secondary Education Act. This level is $1,000,000,000 above the fiscal year 2004 amount and the same as the request level.
Impact Aid- The bill provides $1,250,893,000 for school districts that are impacted by Federal activities, such as military bases or Indian lands. This is an increase of $21,367,000 above the fiscal year 2004 level, and the President's request.
School Improvement Programs- The bill provides $5,641,401,000 for the school improvement programs. The bill includes $2,950,000,000 for state grants for improving teacher quality, $19,874,000 above last year's level and the request. The bill also includes $269,115,000 for math and science partnerships, an increase of $120,000,000 above last year's level and the same as the request.
Innovation and Improvement- The bill provides $669,936,000 for innovation and improvement programs. Included within this account is $268,702,000 for charter schools, an increase of $12,721,000 above last year's levels.
Special Education- The Committee recommends an overall program funding level for special education programs of $12,176,101,000, $1,015,393,000 above last year's level and the same as the President's request. The bill provides a $1,000,000,000 increase for grants to states under part B of the Individuals with Disabilities Education Act.
Vocational and Adult Education- Vocational education state grants are funded at $1,215,008,000 and adult education state grants are funded at $574,372,000.
Student Financial Assistance and Higher Education- For Student Financial Aid, the Committee provides $14,755,794,000, $748,498,000 above last year and $57,172,000 above the President. For Higher Education, the Committee provides $1,976,056,000. This level is $116,586,000 below last year and $972,000 below the request. The bill allows the maximum Pell grant to be maintained at $4,050--the highest in history.
Institute of Education Sciences- The Committee proposes $526,804,000 for education research and statistics. For on-going activities, this level is $30,069,000 above last year and $77,183,000 above the request level.
Institute of Museum and Library Services- Funding for the Institute of Museum and Library Services is $261,743,000 including $23,000,000 for a librarian recruitment initiative.
Social Security Administrative Costs- Funding provided for the cost of administering the Social Security programs is $8,798,100,000, $484,926,000 above the fiscal year 2004 level and $82,900,000 below the request.
The Committee commends the Departments and Agencies under its jurisdiction for the progress they have made toward the establishment of goals and other benchmarks as required by the Government Performance and Results Act. However, these Departments and Agencies remain a long way from meeting its overall intent. The Committee continues to feel that quantifiable and measurable individual performance indicators need to be developed for each program. Individual indicators need to be specific and measurable wherever possible, need to be consistent with other measures used in similar programs and need to be supported by systems that can provide annual information on the progress being made toward achieving the stated goals. There are still far too many programs with indicators using the terms `increase,' or `decrease,' or `improve' rather than specific numerical goals.
In addition, these indicators must increasingly focus on the improvements in employment and income, worker safety, health status, biomedical discoveries, the quality of life of various populations, educational achievement, and the many other goals that are the primary purpose of the programs funded by this bill. Again, the indicators are far too often related to the issuance of program guidance or focus on the number of individuals served.
Finally, the Committee continues to urge the Departments and Agencies under its jurisdiction to manage themselves based on performance and outcomes. They should use outcome and performance measures as the primary management tool for resource allocation and the evaluation of programs and individuals. The Committee expects that each Department and office funded in the bill will be prepared to testify during the fiscal year 2005 cycle on how performance and outcome measures are being used to manage their programs, including:
How outcome and performance goals are being established for individual offices within departments and how they are held accountable for the achievement of these goals;
How such data is used to establish individual performance goals; and
How actual performance is measured against these goals and the kinds of incentives, both positive and negative, that are in place to assure the achievement of overall goals.
The Committee directs the Departments and agencies identified in the report accompanying the fiscal year 1998 bill to continue to provide it with effects statements within 45 days of enactment of this Act.
The Committee recommends $5,112,728,000 for this account, which provides funding authorized primarily by the Workforce Investment Act of 1998 (WIA). This is $32,736,000 below the fiscal year 2004 level and $213,564,000 below the budget request.
The Training and Employment Services account is comprised of programs that enhance the employment and earnings of those in need of such services, operated through a decentralized system of skill training and related services. The account is mostly forward-funded on a July to June cycle, with funds provided for fiscal year 2005 supporting the effort from July 1, 2005 through June 30, 2006.
The Committee directs that Department take no action in fiscal year 2005 to amend, through regulatory or other administrative action, the definition established in 20 CFR 667.220 for functions and activities under title I of the Workforce Investment Act until such time as legislation reauthorizing the Act is enacted.
Adult employment and training activities
For adult employment and training activities, the Committee recommends $900,000,000. This is $1,109,000 above the fiscal year 2004 level and the same as the budget request. Of the amount recommended $712,000,000 will become available on October 1, 2005. This program is authorized by the Workforce Investment Act of 1998. The funds are allocated by formula to States and further distributed to local workforce investment boards. Services for adults will be provided through the One-Stop system and most customers receiving training will use their individual training accounts to determine which programs and providers fit their needs. The Act authorizes core services, available to all adults with no eligibility requirements, and intensive services, for unemployed individuals who are not able to find jobs through core services alone.
Dislocated worker employment and training activities
For dislocated worker employment and training activities, the Committee recommends $1,479,149,000. This is $25,000,000 above the fiscal year 2004 level and $96,379,000 above the budget request. Of the amount recommended, $1,060,000,000 will become available on October 1, 2005. Of the total, $1,178,192,000 is designated for State formula grants that support core services, intensive services, training, and supportive services. In addition, States use these funds for rapid response assistance to help workers affected by mass layoffs and plant closures. The bill includes $301,227,000 for the National Reserve, which supports National Emergency Grants to respond to mass layoffs, plant and/or military base closings, and natural disasters across the country, which cannot be otherwise anticipated, as well as technical assistance and training and demonstration projects.
Within funds available under the dislocated worker national reserve, the Secretary may use up to $50,000,000 to carry out the Community College/Community-Based Job Training Initiative. The Committee encourages the Secretary to ensure that funds used for Initiative strengthen partnerships between community colleges, employers, and local workforce investment boards. Within the total for the National Reserve, the Committee also intends that up to $30,000,000 shall be available to the Secretary of Labor to support health insurance coverage assistance authorized in the Trade Act of 2002.
Youth activities
For youth activities, the Committee recommends $1,000,965,000. This is $5,906,000 above the fiscal year 2004 level and the same as the budget request.
The Workforce Investment Act of 1998 consolidated the Summer Youth Employment and Training Program and Youth Training Grants under the Job Training Partnership Act into a single youth training activity. The funds are allocated by formula to States and further distributed to local workforce investment boards.
Job Corps
For Job Corps, the Committee recommends $1,542,321,000. This is $1,169,000 above the fiscal year 2004 level and $14,966,000 below the budget request. Of the amount recommended, $691,000,000 will become available on October 1, 2004.
The Job Corps, authorized by the Workforce Investment Act of 1998, is a nationwide network of residential facilities chartered by Federal law to provide a comprehensive and intensive array of training, job placement and support services to at-risk young adults. The mission of Job Corps is to attract eligible young adults, teach them the skills they need to become employable and independent, and place them in meaningful jobs or further education. Participation in the program is open to economically disadvantaged young people in the 16 to 24 age range who are unemployed and out of school. Most Job Corps students come from disruptive or debilitating environments, and it is important that they be relocated to residential facilities where they can benefit from the highly structured and carefully integrated services provided by the Job Corps program. A limited number of opportunities are also available for non-residential participation. The Committee supports the effort of the Workforce Investment Act of 1998 to more fully integrate Job Corps centers in their local communities.
The Committee recognizes the significant impact of the home building industry on the economic recovery, and its efforts to house our nation's working families, notwithstanding an ongoing shortage of labor in the construction trades. The Committee recognizes the essential role of the National Training Contractors (NTCs) such as the Home Builders Institute (HBI), the workforce development arm of the National Association of Home Builders, in training Job Corps youth for careers in this high growth industry. The Committee commends HBI on its 30 years of proven results in building our nation's workforce by providing at-risk youth with the skills training and employment opportunities they need to succeed. The Committee encourages the Department to identify existing and future sites for potential expansion of construction trades training by the NTCs to help alleviate the industry's worker shortages and to impel its continued prosperity.
The Committee applauds Job Corps' proactive approach to protecting America's homeland security, including offering the security trade at many of the 118 Job Corps centers. The Committee believes that the Job Corps program is in an excellent position to provide a substantial human resource pool of certified entry-level screeners for the Transportation Security Administration (TSA). The Committee recognizes that Job Corps is training a quality workforce of entry-level employees with the skills in high demand by TSA for our nation's municipal, national, and international airports. The Committee directs the U.S. Department of Labor and the U.S. Department of Homeland Security to enter into a memorandum of understanding that establishes the parameters for Job Corps and TSA to: cost-effectively leverage resources, create customized training curriculum, and enhance the labor pool. These steps will enable TSA to locate and hire qualified entry-level airport screeners from Job Corps for local, national and international airports.
The Committee commends the Job Corps program for establishing cost-effective national and local partnerships with the U.S. Army, Navy and Coast Guard to recruit high quality military personnel. Job Corps students' average scores on military entrance exams exceed the national average. Twenty-eight centers are former military installations, and many of the program's basic training and residential practices are based on a military model. The residential component of Job Corps instills discipline, responsibility, and group cohesion, preparing students in a way that is conducive to military life. The Committee encourages the Department to establish Junior Reserve Officers Training Corps (JROTC) programs that would be located near existing military installations. Together, Job Corps and the JROTC program would offer training in leadership skills, organizational management, and physical fitness for students pursuing advanced military careers. Job Corps centers that have expressed interest in a JROTC program include Shriver (MA), Cassadaga (NY), New Haven (CT) and Atterbury (IN).
The Committee commends the Job Corps for developing programs to help address the nation's shortfall of staff in health professions, including nursing, pharmacy, and lab technician trades. Private sector companies including HCR Manor Care, HCA, CVS, and Walgreens and others have formed partnerships with Job Corps to help fill nursing and other allied heath care vacancies (such as facilities maintenance and dietary management). The Committee supports training Job Corps students in the health sciences, including CNAs, LPNs, health records technicians, dieticians, pharmacy technicians, healthcare facilities maintenance, and medical billing. The Committee understands several Job Corps Centers have expressed interest in being designated health care magnet centers, including the Columbia Basin (WA), Keystone (PA), and the Miami (FL) Job Corps Centers.
The Committee believes that Job Corps' partnerships with national non-profit faith founded organizations such as Joint Action in Community Services (JACS), Women in Community Services, and the YWCA are essential to the success of Job Corps. The Committee commends JACS and its national network of nearly 3,000 volunteers for their proven record in providing at-risk young adults supportive services as they transition from Job Corps back to their home communities and into the world of work. As such, the Committee encourages the Department to expand its Job Corps partnership with such national volunteer programs in order to ensure the continued availability to youth to transition services that are national in scope, yet local in focus.
Native Americans
For Native Americans, the Committee recommends $54,675,000. This is the same as the fiscal year 2004 level and $325,000 below the budget request. This program, authorized by the Workforce Investment Act of 1998, is designed to improve the economic well being of Native Americans (Indians, Eskimos, Aleuts, and Native Hawaiians) through the provision of training, work experience, and other employment-related services and opportunities that are intended to aid the participants to secure permanent, unsubsidized jobs. The Department of Labor allocates formula grants to Indian tribes and other Native American groups whose eligibility for such grants is established in accordance with Department regulations.
Migrant and seasonal farmworkers
For Migrant and Seasonal Farmworkers, the Committee recommends $76,874,000. This is the same as the fiscal year 2004 level. The budget request did not include funds for this program. The Committee recommendation includes bill language directing that $4,583,000 for migrant and seasonal farmworker housing grants. The bill language further directs that not less than 70 percent of this amount be used for permanent housing grants. The recommendation also provides that the remaining amount be used for State service area grants, including funding grantees in those States impacted by formula reductions at no less than eighty-five percent of the comparable 1998 levels for such States. Within the National Activities/Other line item, the Committee includes $504,000 to be used for Section 167 training, technical assistance and related activities, including continuing funding for migrant rest center activities at the current level.
This program, authorized by the Workforce Investment Act of 1998, is designed to serve members of economically disadvantaged families whose principal livelihood is derived from migratory and other forms of seasonal farmwork, or fishing, or logging activities. Enrollees and their families are provided with employment training and related services intended to prepare them for stable, year-round employment within and outside of the agriculture industry.
National programs
This activity includes Workforce Investment Act authorized programs in support of the workforce system including technical assistance and incentive grants, evaluations, pilots, demonstrations and research.
Pilots, Demonstrations and Research: The Committee recommends $48,474,000 for grants or contracts to conduct research, pilots or demonstrates that improve techniques or demonstrate the effectiveness of programs. This is $9,277,000 below the fiscal year 2004 level and $18,474,000 above the budget request.
Evaluation: The Committee recommends $8,000,000 to provide for the continuing evaluation of program conducted under the Workforce Investment Act of 1998, as well as of federally funded employment-related activities under other provisions of law. This is $986,000 below the fiscal year 2004 level and the same as the budget request.
Responsible Reintegration of Youthful Offenders: The Committee does not include funding for the Responsible Reintegration of Youthful Offenders program. The fiscal year 2004 level was $49,705,000 and the budget request is $50,000,000.
Technical Assistance: The Committee recommends $2,000,000. The funds recommended support the development of performance management systems, the provision of quality services, and promoting accountability and collaboration. This is $1,486,000 below the fiscal year 2004 level and the same as the budget request.
The Committee has not included separate funding for new programs requested by the Administration. The Administration requested $50,000,000 for Personal Reemployment Accounts and $40,000,000 for the Prisoner Re-entry Initiative. The Committee has deferred action on these two new programs until after the passage of authorizing legislation. In addition, the Administration requested $250,000,000 for the Community College Initiative. The Committee has provided up to $50,000,000 of National Reserve funds for this purpose.
Rescission: The Committee has included language rescinding $100,000,000 of the unobligated funds contained in the H1-B Nonimmigrant Petitioner Account. The Committee understands that the authorization for this program has expired and that the Administration does not intend to seek reauthorization of this program.
The Committee recommends $440,200,000 for community service employment for older Americans. This is $1,550,000 above the fiscal year 2004 level and the same as the budget request.
The community service employment for older Americans program provides grants to public and private nonprofit organizations that subsidize part-time work in community service activities for unemployed persons aged 55 and older, whose family's annual income does not exceed 125 percent of the poverty level.
The Committee recommends $1,057,300,000. This is $280,900,000 below the fiscal year 2004 level and the same as the budget request.
The Trade Adjustment Assistance Program provides assistance to certified workers adversely affected by imports and trade with countries covered by the North America Free Trade Agreement. Funding will continue the implementation of the TAA program with an emphasis on integrating the program into the One-Stop System. The Trade Adjustment Assistance Reform Act of 2002 increased the possibility of training and income support benefits.
The Committee recommends $3,582,848,000 for this account. This is $5,056,000 below the fiscal year 2004 level and $10,586,000 less than the budget request. Included in the total availability is $3,440,914,000 authorized to be drawn from the Employment Security Administration Account of the Unemployment Trust Fund and $141,934,000 to be provided from the general fund of the Treasury. The funds in this account are used to provide administrative grants and assistance to State agencies that administer Federal and State unemployment compensation laws and operate the public employment service.
For Unemployment Insurance Services, the Committee recommends $2,701,214,000. This is $82,685,000 above the fiscal year 2004 level and $10,000,000 below the budget request. The total includes $2,690,714,000 for State Operations and $10,500,000 for national activities. Included in the amount provided for State Operations is up to $10,000,000 to station staff in One-Stop Centers to conduct Unemployment Insurance eligibility interviews.
For the Employment Service, the Committee recommends $763,000,000, which includes $23,300,000 in general funds together with an authorization to spend $739,700,000 from the Employment Security Administration Account of the Unemployment Trust Fund. This is $87,995,000 below the fiscal year 2004 level and the same as the budget request. Included in the bill for the Employment Service grants to States is $696,000,000, available for the program year of July 1, 2005 through June 30, 2006. This is $90,887,000 below the fiscal year 2004 level and the same as the budget request.
The Committee recommends $67,000,000 for ES national activities. This is $3,029,000 above the fiscal year 2004 level and the same as the budget request.
The Committee recommends $98,764,000 for America's Labor Market Information System. This is the same as the fiscal year 2004 level and $586,000 below the budget request. This funding supports core employment statistics, universal access for customers, improving efficiency in labor market transactions, and measuring and displaying WIA performance information.
The Committee recommendation includes $19,870,000 for the Work Incentives Grants program, $117,000 above the fiscal year 2004 level and the same as the budget request, to help persons with disabilities find and retain jobs through the One-Stop Career Center system mandated by the Workforce Investment Act. Funding will support systems building grants intended to ensure that One-Stop systems integrate and coordinate mainstream employment and training programs with essential employment-related services for persons with disabilities.
The Committee recommends $517,000,000. This is $50,000,000 above the fiscal year 2004 level and the same as the budget request. The appropriation is available to provide advances to several accounts for purposes authorized under various Federal and State unemployment compensation laws and the Black Lung Disability Trust Fund, whenever balances in such accounts prove insufficient.
The Committee recommends $170,354,000. This is $1,995,000 below the fiscal year 2004 level and $10,664,000 below the budget request. This includes $111,375,000 in general funds and authority to expend $57,479,000 from the Employment Security Administration Account of the Unemployment Trust Fund. Within the amounts provided, the Committee has included $6,900,000 for Executive Direction. This is $1,500,000 below the fiscal year 2004 comparable level and $1,818,000 below the request. General funds in this account provide the Federal staff to administer employment and training programs under the Workforce Investment Act of 1998, the Older Americans Act, the Trade Act, and the National Apprenticeship Act. Trust funds provide for the Federal administration of employment security functions under title III of the Social Security Act and the Immigration and Nationality Act.
The bill provides $132,345,000 for the Employee Benefits Security Administration, an increase of $8,305,000 over the fiscal year 2004 level and the same amount as the budget request.
The Employee Benefits Security Administration (EBSA) is responsible for the enforcement of Title I of the Employee Retirement Income Security Act of 1974 (ERISA) in both civil and criminal areas. This involves ERISA fiduciary and reporting/disclosure requirements. EBSA is also responsible for enforcement of sections 8477 and 8478 of the Federal Employees' Retirement Security Act of 1986. The agency was also given responsibilities under the Health Insurance Portability and Accountability Act of 1996.
The Committee is interested in policy initiatives that enhance personal retirement readiness and security of the Nation's workforce. The Committee is aware of an innovative proposal of the International Foundation for Retirement Education to identify the real rate of retirement readiness of the workforce and the Committee encourages EBSA to consider supporting such a project.
The Corporation's budget for fiscal year 2004 is $266,330,000, which is $33,558,000 above the fiscal year 2004 level and the same as the budget request.
The Corporation is a wholly owned government corporation established by the Employee Retirement Income Security Act of 1974 (ERISA). The law places it within the Department of Labor and makes the Secretary of Labor the chairperson of its board of directors. The Corporation receives its income from insurance premiums collected from covered pension plans, collections of employer liabilities imposed by ERISA, and investment earnings. It is also authorized to borrow up to $100,000,000 from the United States Treasury. The primary purpose of the Corporation is to guarantee the payment of pension plan benefits to participants if covered plans fail or go out of existence.
The bill includes language permitting obligations in excess of the amount provided in the bill after approval by both the Office of Management and Budget as well as the Committee on Appropriations. The Committee has an interest in approving obligations that may change the total amount available to any agency.
The bill includes $402,818,000 for this account. This is $10,802,000 above the budget request and $6,476,000 below the fiscal year 2004 comparable level. The bill includes $400,797,000 in general funds for this account and contains authority to expend $2,021,000 from the Special Fund established by the Longshore and Harbor Workers' Compensation Act.
The Employment Standards Administration is involved in the administration of numerous laws, including the Fair Labor Standards Act, the Immigration and Nationality Act, the Migrant and Seasonal Agricultural Workers' Protection Act, the Davis-Bacon Act, the Family and Medical Leave Act, the Federal Employees' Compensation Act, the Longshore and Harbor Workers' Compensation Act, and the Federal Mine Safety and Health Act (black lung). The agency also administers Executive Order 11246 related to affirmative action by Federal contractors and the Labor-Management Reporting and Disclosure Act.
The Committee requests the Department submit a report that details: (1) the specific changes that have been made to the wage determination process, the costs associated with those changes, and the effectiveness of those changes; (2) what additional changes are planned for the future and the proposed schedule for implementation; and (3) any recommendations for further changing the wage determination process.
The bill includes $233,000,000. This is the same $70,000,000 above the fiscal year 2004 appropriation and the same as the budget request. This appropriation primarily provides benefits under the Federal Employees' Compensation Act (FECA). The payments are required by law. In fiscal year 2004, an estimated 155,000 injured Federal workers or their survivors will file claims; 55,500 will receive long-term wage replacement benefits for job-related injuries, diseases, or deaths.
The total amount to be available in fiscal year 2004 for FECA payments is expected to be $3,561,963,000, an increase of $113,202,000 over the fiscal year 2004 comparable level.
The Committee recommends an appropriation of $276,000,000 for special benefits for disabled coal miners. This is in addition to the $88,000,000 appropriated last year as an advance for the first quarter of fiscal year 2004, the same as the budget request. These funds are used to provide monthly benefits to coal miners disabled by black lung disease and to their widows and certain other dependents, as well as to pay related administrative costs.
The Committee recommends an advance appropriation of $81,000,000 for the first quarter of fiscal year 2005, the same as the budget request. These funds will ensure uninterrupted benefit payments to coal miners, their widows, and dependents.
The Black Lung Consolidation of Administrative Responsibility Act of 2002 amends the Black Lung Benefits Act to transfer part B black lung benefits responsibility from the Commissioner of Social Security to the Secretary of Labor.
The bill includes $40,821,000 for the Energy Employees Occupational Illness Compensation Program authorized by Title XXXVI of the National Defense Authorization Act of 2001. This is $10,830,000 below the fiscal year 2004 level and the same as the budget request. Funds will be used to administer the program that provides compensation to employees or survivors of employees of the Department of Energy (DOE), its contractors and subcontractors, companies that provided beryllium to DOE, and atomic weapons employees who suffer from a radiation-related cancer, beryllium-related disease, or chronic silicosis as a result of their work in producing or testing nuclear weapons, and uranium workers covered under the Radiation Exposure Compensation Act.
The bill includes $1,058,644,000 for this account, of which $57,049,000 is definite budget authority and $1,001,951,000 is indefinite budget authority. The bill language provides such sums as may be necessary to pay for benefits.
The Trust Fund pays all black lung compensation/medical and survivor benefit expenses when no responsible mine operator can be assigned liability for such benefits, or when coal mine employment ceased prior to 1970, as well as administrative costs which are incurred in administering the benefits program and operating the Trust Fund.
The basic financing for the Trust Fund comes from a coal excise tax for underground and surface-mines coal. Additional funds come from reimbursement payments from mine operators for benefit payments made by the Trust Fund before the mine operator is found liable. The advances to the Fund assure availability of necessary funds when liabilities may exceed other income. The Omnibus Budget Reconciliation Act of 1987 continues the current tax structure until 2014.
The bill includes $461,599,000 for the Occupational Safety and Health Administration. This is $4,058,000 above the fiscal year 2004 level and the same as the budget request. This agency is responsible for enforcing the Occupational Safety and Health Act of 1970 in the Nation's workplaces.
The Committee has included language prohibiting OSHA from obligating or expending any of these funds to enforce the annual fit test requirement of the General Industry Respiratory Protection Standard with respect to exposure to tuberculosis.
The Committee commends OSHA, EPA and the private-sector participants who are supporting the Alliance on Identification and Management of Chemical Reactivity Hazards as an outstanding example of joint cooperative public/private efforts to improve health and safety in the workplace and community. The Committee directs the Director of the Occupational Safety and Health Administration to assure that sufficient resources will be made available to support this Alliance's objectives to develop and disseminate materials to assist in the identification and management of reactive chemical hazards, including electronic assistance resources (e.g., interactive software e-Tools, technology-based training), training and materials for OSHA staff, and the customization of these tools and resources for specific workplace sectors, such as small and medium enterprises.
The Committee is disappointed by OSHA's decision to proceed with enforcement of the General Industry Respiratory Protection Standard as it applies to occupational exposure to tuberculosis (TB). The Committee strongly urges the agency to delay enforcement of the Respiratory Standard as it applies to TB. Personal respiratory protections have been in place in healthcare facilities for over 10 years, as recommended by the Centers for Disease Control and Prevention (CDC), and as enforced through OSHA's General Duty Clause. Additionally, the Committee strongly advises OSHA to take no further action with regard to occupational exposure to TB until such time as the CDC has completed the ongoing revisions of its TB guidelines. Subsequent actions should only be taken in accordance with the CDC's recommendations.
The Committee continues to be concerned with the lack of progress on the agency's regulation concerning Employer Payment for Personal Protective Equipment, the public comment period for which ended over five years ago. The Committee is especially concerned because the rate of worker deaths and injuries, which has decreased in the last decade for all American workers, has increased during that same time among Hispanic workers, many of whom work in the nation's most dangerous professions, including the construction industry. The Committee urges the agency to move expeditiously toward the completion of this regulation.
The bill includes $275,567,000 for this agency. This is $6,710,000 above the fiscal year 2004 comparable level and the same as the budget request. This agency enforces the Federal Mine Safety and Health Act in underground and surface coal and metal and non-metal mines.
The total funding recommended by the Committee for the Bureau of Labor Statistics (BLS) is $533,518,000. This is $15,022,000 above the fiscal year 2004 comparable level and the same as the budget request. The bill includes $455,045,000 in general funds for this account and authority to spend $78,473,000 from the Employment Security Administration Account of the Unemployment Trust Fund. The BLS is the principal fact-finding agency in the Federal government in the broad field of labor economics. Its principal surveys include the Consumer Price Index and the monthly unemployment series.
The bill includes $47,555,000 for the Office of Disability Employment Policy, which is $531,000 above the fiscal year 2004 comparable level and the same as the budget request. The Office provides leadership to eliminate employment barriers to people with disabilities.
The bill includes $259,967,000 for Departmental Management activities. This is $90,352,000 below the fiscal year 2004 level and $27,201,000 below the budget request. The bill includes $259,653,000 in general funds for this account along with authority to transfer $314,000 from the Employment Security Administration Account of the Unemployment Trust Fund.
The Departmental Management appropriation finances staff is responsible for formulating and overseeing the implementation of Departmental policy and management activities. In addition, this appropriation includes a variety of operating programs and activities that are not involved in Departmental Management functions, but for which other salaries and expenses appropriations are not suitable.
The Committee recommendation includes $27,084,000 for Executive Direction, the same as the fiscal year 2004 level and $6,122,000 below the budget request.
The bill provides $30,000,000 for the Department-wide information technology crosscut, which is $18,219,000 below the fiscal year 2004 comparable level and $3,565,000 below the budget request. The Committee commends the Department in streamlining its information technology infrastructure into a single, uniform system and encourages the Department in this effort.
The bill provides $5,000,000 for the Departmental Management Crosscut. This is $35,000 above the fiscal year 2004 level and $5,100,000 below the budget request.
The bill includes $32,675,000 for the Administration and Management program that provides leadership and policy guidance for a number of Department-wide activities. This is $478,000 above the fiscal year 2004 level and the same as the budget request.
The bill includes $35,545,000 for the Bureau of International Labor Affairs (ILAB), which is $5,000,000 above the budget request and $74,317,000 below the fiscal year 2004 comparable level. At the level in this bill, ILAB will continue to coordinate the Department's global responsibilities in 2004 and to provide expert support for many of the Administration's international initiatives, including the promotion of core labor standards and the elimination of exploitative child labor.
The Committee recognizes the importance of fostering economic growth in developing regions of the world and recommends that the International Labor Affairs Bureau ensure that the United States Government recognizes and promotes international standards of excellence, and encourages public-private partnerships that focus on capacity building in priority areas such as labor standards and human rights, rule of law, trade facilitation, and workforce training and education. The Committee is aware of the work being performed by the Global Training Partnership (GTP) to promote capacity building for jobs and economic growth in developing regions globally. The Committee recommends that the agency expand the work of the Global Training Partnership to build regional capacity in Sub-Saharan Africa, Central America, the Caribbean and Andean regions, in order to maximize benefits from improvement of sound policies and practices conducive to economic growth, poverty reduction, and the rule of law.
The Committee intends that the Women's Bureau increase funding for Women Work! training and technical assistance services for programs that assist women in transition to reenter the workforce. Women Work! has valuable experience, is uniquely qualified to deliver these services through its national network, and has demonstrated results through outcome assessments. An increase in funding is needed to meet the needs of more than 1,000 programs in the Women Work! Network.
The Committee is aware of ongoing discussions concerning the mandatory expensing of stock options and believes that further information is needed about the possible consequences of such expensing for the high technology workforce. The Committee has provided $50,000 to initiate this study to examine the role of broad-based stock option plans in the recruitment and retention of skilled workers. The study shall be provided to the Committee on Appropriations by December 31, 2004.
The Committee recommends $220,648,000 for veteran employment and training activities. This is $2,002,000 above the fiscal year 2004 level and the same as the budget request. Within this amount, the bill includes $194,098,000 to be expended from the Employment Security Administration account of the Unemployment Trust Fund for the traditional State and Federal administration of veterans' employment and training activities.
For State grants the Committee recommends $162,415,000. This is $1,007,000 above the fiscal year 2004 level and the same as the budget request.
For Federal administration, the Committee recommends $29,683,000. This is $826,000 above the fiscal year 2004 level and the same as the budget request. The Committee recommends $2,000,000 for the National Veterans Training Institute, the same as the budget request. The Committee recommends $19,000,000 for the homeless veterans reintegration program assisting homeless veterans to find jobs, the same as the budget request. The Committee recommends $7,550,000 for veterans workforce investment programs, the same as the budget request.
The Committee is interested in ensuring that qualified job training programs of the Department of Labor fully extend priority of service for veterans as required by the Jobs for Veterans Act. Toward this effort, the Committee urges the Secretary to develop a guide for veterans in accessing workforce investment services; a guide for assisting veterans service organizations and homeless veteran service providers in accessing workforce investment funds and workforce investment planning processes; and a guide to inform workforce systems on the employment services needs of veterans and the responsibility of such systems to prioritize veterans for services and to collaborate with veterans organizations and providers.
The Committee urges the Secretary to instruct state workforce agencies to increase their outstationing of disabled veterans outreach program specialists and local veterans employment representatives in locations where homeless veterans congregate, including grantees under the homeless provider grant and per diem program and the homeless veterans reintegration program.
Individuals leaving the military are at high risk of homelessness due to a lack of job skills transferable to the civilian sector, disrupted or dissolved family and social support networks, and other risk factors that preceded their military service. The Transition Assistance Program (TAP) has been established to ease the transition of separating service members to the civilian sector. The Committee instructs the Secretary of Labor to ensure that a module on homelessness prevention is added to the TAP curriculum. The module should include a presentation on risk factors for homelessness, a self-assessment of risk factors, and contact information for preventative assistance associated with homelessness.
The bill includes $69,590,000 for the Office of the Inspector General (OIG). This is $4,251,000 above the fiscal year 2004 comparable level and the same as the budget request. This includes $64,029,000 in general funds for this account along with the authority to transfer $5,561,000 from the Employment Security Administration Account of the Unemployment Trust Fund.
The OIG was created by law to protect the integrity of Departmental programs as well as the welfare of beneficiaries served by those programs. Through a program of audits, investigations, and program evaluations, the OIG attempts to reduce the incidence of fraud, waste, abuse, and mismanagement, and to promote economy, efficiency, and effectiveness throughout the Department.
The Committee includes $10,000,000 for a new core accounting system for the Department of Labor, including hardware and software infrastructure.
Sec. 101. The Committee continues a provision to prohibit the use of Job Corps funding for compensation of an individual at a rate in excess of Executive Level II.
Sec. 102. The Committee includes a provision to permit transfers of up to one percent between appropriations, the same as the budget request.
Sec. 103. The Committee includes a provision directing the Secretary to provide to the Department of Labor employees in the National Capital Region the full transit subsidy that they are eligible to receive.
The bill includes $6,266,982,000 for health resources and services programs, which is $326,321,000 below the fiscal year 2004 comparable level for these activities and $244,149,000 above the budget request. In addition, the Committee provides $542,649,000 in the Public Health and Social Services Emergency Fund for two programs administered by the Health Resources and Services Administration (HRSA)--$514,944,000 for hospital preparedness and $27,705,000 for education incentives for medical school curriculum.
HRSA supports programs which provide health services to disadvantaged, medically undeserved, and special populations; improve infant mortality rates; direct the education, supply, and distribution of a wide range of health professionals; and provide technical assistance regarding the utilization of health resources and facilities.
Community health centers
The Committee provides $1,835,925,000 for community health centers, which is $218,544,000 above the fiscal year 2004 comparable level and the same as the budget request. These funds support programs which include community health centers, migrant health centers, health care for the homeless and public housing health service grants.
The Committee includes bill language similar to previous years limiting the amount of funds available for the payment of claims under the Federal Tort Claims Act to $45,000,000, which is the same as the budget request and the limitation in the fiscal year 2004 bill. The Committee recognizes the value of this program for health centers and as additional health centers participate in the program, the number of claims submitted and paid also increases.
The Committee does not provide additional funds for loan guarantee authority under section 330(d) of the Public Health Service Act. The Committee notes that $121 million remains, of the $160 million appropriated in fiscal years 1997 and 1998, for loan guarantee authority for guarantees of both loan principal and interest.
Although the Committee continues to support the expansion of the health center program to double the number of patients served, the Committee is concerned that current funding methodologies may not recognize the increased cost of providing services for current patients at existing health centers. The Committee urges HRSA to use a portion of the increased funding provided to increase support for existing health centers based on performance-related criteria in addition to site and service expansion applications.
The Committee supports the long-standing HRSA policy of approving specific qualified applications for future funding. This process enables high-quality applicants to take steps to develop and implement care delivery systems in their communities instead of wasting scarce resources to reapply for funding. However, HRSA should limit the use of this mechanism in a manner consistent with expected Presidential requests.
The Committee is pleased with the success of the school-based health center initiative, but is concerned that in the last fiscal year only 3 of 43 applications were funded. The Committee expects HRSA to continue to target funds for school-based health centers operated by fully qualified organizations and expresses concern that school-based health centers often experience difficulty completing the complex application process for community health center funding. The Committee requests that HRSA establish a separate application process for school-based health centers that recognizes the distinct patient volume, productivity, scope of service, and staffing requirements that are more appropriate to school-based delivery systems.
Community health centers are encouraged to make ultrasound services available to their patients.
Free clinics medical malpractice
The Committee does not provide fiscal year 2005 funding for payments of claims under the Federal Tort Claims Act to be made available for volunteer free clinic health care professionals. $4,821,000 was provided for this purpose in fiscal year 2004 and claims are not expected against the fund until at least fiscal year 2006. The program extends Federal Tort Claims Act coverage to health care professional volunteers in free clinics in order to expand access to health care services to low-income individuals in medically underserved areas. According to Title 42, Section 233(o), a free clinic must apply, consistent with the provisions applicable to community health centers, to have each health care professional `deemed' an employee of the Public Health Service Act, and therefore eligible for coverage under the Federal Tort Claims Act. The Committee will be interested to learn how many health care professionals apply to be deemed for coverage under the program as it begins operation this year.
National Health Service Corps: Field placements
The Committee provides $45,506,000 for field placements, which is the same as the fiscal year 2004 comparable level and $229,000 below the budget request. These funds are used to support the activities of National Health Service Corps (NHSC) obligors and volunteers in the field, including travel and transportation costs of assignees, training and education, recruitment of students, residents and clinicians and retention activities. Salary costs of most new assignees are paid by the employing entity.
National Health Service Corps: Recruitment
The Committee provides $124,397,000 for recruitment activities, which is the same as the fiscal year 2004 comparable level and $34,735,000 below the budget request. The program awards scholarships to health professions students and assists graduates in repaying their student loans. In return for every year of support, these individuals are obligated to provide a year of service in health professional shortage areas of greatest need. The minimum obligation is two years. The Committee does not include the bill language requested by the Administration to establish a flexible Commissioned Corps reserve within the NHSC and does not expect funds to be used for this purpose.
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 that the current HPSA scoring process used by HRSA may disadvantage some health centers located in medically underserved areas of the country. The Committee encourages HRSA to consider using alternative data to score Federally qualified health centers under the automatic designation process.
Health professions
The Committee provides $416,365,000 for all health professions training programs, which is $19,715,000 below the fiscal year 2004 comparable level and $258,582,000 above the budget request. The Committee was unable to restore completely the $278,297,000 reduction in health professions funding proposed by the Administration, but intends to continue all the programs at manageable operating levels with the funds provided. The Committee felt it was especially important to support diversity and nurse training programs. The Bureau of Health Professions provides both policy leadership and support for health professions workforce enhancement and educational infrastructure development.
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 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.
The Committee is concerned that too few clinics and physicians are prepared to treat patients with rare diseases. Therefore, the Committee encourages HRSA to include `treatment of patients with rare diseases' and `training of health professionals to recognize and treat patients with rare diseases' as priority areas in its selection of health professions training grants.
Centers of excellence
The Committee provides $33,882,000 for centers of excellence, which is the same as the fiscal year 2004 comparable level. The Administration did not request funding for this program. The program is designed to strengthen the national capacity to educate underrepresented minority (URM) students in the health professions by offering special support to those institutions which train a significant number of URM individuals, including African-Americans, Hispanics and Native Americans. Funds are used for the recruitment and retention of students and faculty, information resources and curricula, faculty and student research, and the development of plans to achieve institutional improvements.
The Committee is pleased that HRSA has re-focused the minority centers of excellence program on providing support to historically minority health professions institutions. The Committee recognizes the important role of this program in supporting faculty and other academic programs at minority institutions. The Committee encourages the program to consider applications that are responsive to allied health professions that are experiencing shortages and high vacancy rates, such as laboratory personnel.
Health careers opportunity program
The Committee provides $35,935,000 for the health careers opportunity program, which is the same as the fiscal year 2004 comparable level. The Administration did not request funding for this program. This program provides grants and contracts to eligible health professions schools for identifying, recruiting, and selecting individuals from the various racial and ethnic populations who are from disadvantaged backgrounds for education and training in a health profession and facilitating their entry into, retention and completion of their education at a health professions school.
The Committee encourages HRSA to give priority consideration to awarding grants to those institutions with a historic mission of training minorities in the health professions. The Committee encourages the program to consider applications that are responsive to allied health professions that are experiencing shortages and high vacancy rates, such as laboratory personnel.
Faculty loan repayments
The Committee provides $1,313,000 for loan repayments and fellowships regarding faculty positions, which is the same as the fiscal year 2004 comparable level. The Administration did not request funding for this program. The program provides for the repayment of educational loans of individuals from disadvantaged backgrounds who are health professions students or graduates, and who have agreed to serve for not less than two years as a faculty member of an eligible health professions school. The school matches the Federal contribution toward loan repayment. The program also supports fellowships for URM faculty members.
Scholarships for disadvantaged students
The Committee provides $47,510,000 for scholarships for disadvantaged students, which is the same as the fiscal year 2004 comparable level and $37,613,000 above the budget request. The program provides grants to eligible health professions and nursing schools to provide scholarships to eligible individuals from disadvantaged backgrounds, including students who are members of racial and ethnic minority groups. By statute, not less than 16 percent of the funds must go to schools of nursing.
Training in primary care medicine and dentistry
The Committee provides $63,857,000 for training in primary care medicine and dentistry, which is $17,885,000 below the fiscal year 2004 comparable level. The Administration did not request funding for this program. The program is comprised of four elements: (1) family medicine programs; (2) general internal medicine and general pediatrics (GIM/GP) training; (3) physician assistants (PA) training; and (4) general or pediatric dentistry training. Family medicine grants and contracts promote the predoctoral training of medical students, support family medicine residency programs and their trainees, train physicians who plan to teach in family medicine programs, and assist in establishing or improving family medicine academic administrative units. GIM/GP grants and contracts are to plan and operate residency programs and to provide financial assistance for residents, meet the costs of training programs for physicians who plan to teach in GIM/GP, as well as to support the faculty trainees, and develop programs to support predoctoral activities. PA training grants and contracts are to plan, develop, and operate programs for the training of PAs and for the training of individuals who will teach in programs to provide such training. General or pediatric dentistry training grants and contracts are to meet the costs of planning, developing, or operating programs and to provide financial assistance to residents in such programs.
The Committee recognizes the important role that HRSA centers for leadership in pediatric dentistry education provide in preparing dentists with dual training in pediatric dentistry and dental public health. Dentists in the three currently funded programs concentrate on working with federal, state and local programs that provide services for vulnerable populations including low-income children and women and children with special health care needs. Dentists trained through these centers provide State and community leadership in maternal and child oral health programs, and become future faculty specializing in pediatric dentistry and maternal and child health.
The Committee recognizes there will be a major increase in the pediatric population through 2020 and an increased percentage of the children will be under-privileged. The roughly one of every six children living in poverty today has about five times the level of untreated dental disease compared to their more affluent peers. Pediatric dentistry residency programs provide both treatments for underprivileged children and training opportunities for pediatric dentists. In fact, two-thirds of the patients treated in these programs are Medicaid recipients. Recruitment and retention of pediatric dental educators is vital to pediatric dental residency programs. While pediatric dentists treat about 30 percent of the children in this country, they train 100 percent of the dentists who treat children. The Committee encourages HRSA to develop innovative programs, such as faculty development initiatives and a faculty loan repayment pilot program.
Area health education centers
The Committee provides $29,206,000 for area health education centers (AHEC), which is the same as the fiscal year 2004 comparable level. The Administration did not request funding for this program. The program links university health science centers with community health service delivery systems to provide community-based training sites for students, faculty, and practitioners. The program supports two types of projects: (1) basic/core AHEC cooperative agreement projects to plan and implement new and developing programs; and (2) model programs to extend AHEC cooperative agreement projects, with not less than 50 percent of the project costs supported by non-Federal monetary contributions. The Committee encourages AHEC programs to coordinate with the rural health outreach program for the greater effectiveness of both programs.
Health education and training centers
The Committee has provided $3,851,000 for health education and training centers, the same as fiscal year 2004. The Administration did not request funds for this program. The program funds schools of medicine and osteopathy to conduct training and education programs for health professions students to improve the access, diversity, and quality of health personnel along the border between the United States and Mexico, in the State of Florida, and in other urban and rural areas with populations with serious unmet health care needs. The program also provides educational support to health professionals, including nursing, practicing in the area.
Allied health and other disciplines
The Committee provides $11,849,000 for allied health and other disciplines, which is the same as the fiscal year 2004 comparable level. The Administration did not request funding for this program. The program is comprised of three elements: (1) allied health special projects; (2) podiatric primary care residency training; and (3) chiropractic demonstration projects. Allied health special projects assist entities in meeting the costs associated with expanding or establishing programs that will increase the number of individuals trained in allied health professions. Activities included are those that: (1) expand enrollments; (2) provide rapid transition and career advancement training programs; (3) establish community-based training programs; (4) expand or establish interdisciplinary training programs, demonstration centers, and clinical training sites in medically underserved or rural communities; (5) provide traineeships to students; and (6) plan, develop, and operate or maintain graduate programs in behavioral and mental health practice. Podiatric primary care residency training grants and contracts are for planning and implementing projects in residency programs and providing traineeships to residents who plan to specialize in primary care. Chiropractic demonstration grants and contracts are 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 intends that the same amounts as in fiscal year 2004 be provided for the graduate psychology education program to train health service psychologists as well as the geropsychology training program. The Committee understands that this is the only federally funded psychology training program, and for this reason, considers its continuation a high priority. This competitive program will continue to provide grant awards for work with underserved populations, particularly in rural communities, including elderly, children, the chronically ill, and victims of abuse or terror.
The Committee continues to encourage HRSA to give priority consideration to projects for schools training allied health professionals experiencing shortages, such as medical technologists and cytotechnologists. The Committee is concerned about high vacancy rates for these laboratory personnel and urges HRSA to redouble efforts to address these shortages.
Geriatric programs
The Committee provides $31,805,000 for geriatric programs, which is the same as the fiscal year 2004 comparable level. The Administration did not request funding for this program. The program provides grants and contracts to eligible entities to: (1) establish geriatric education centers to provide training for health care professionals who provide treatment and for training and retraining of faculty who teach geriatrics; (2) provide support for geriatric training projects to train physicians, dentists, and behavioral and mental health professionals who plan to teach geriatrics; and (3) establish a program to provide Geriatric Academic Career Awards to eligible individuals to promote the career development of such individuals as academic geriatricians.
The Committee intends that the same amounts as in fiscal year 2004 be provided to geriatric education centers, geriatric training programs, and geriatric academic career awards. The Committee is concerned that there is an insufficient number of health care providers trained to address the health care needs of the growing older population. With only a small number of new physicians going into the field and those already in the field approaching retirement age, incentives are needed to increase the number of academic geriatricians to competently train health professionals from a variety of disciplines, including geriatric medicine. The Committee believes that to meet the needs of an aging population, HRSA needs to improve the training of all health professionals in geriatrics.
Quentin N. Burdick program for rural interdisciplinary training
The Committee provides $2,255,000 for the Quentin N. Burdick program for rural interdisciplinary training, which is $3,871,000 below the fiscal year 2004 comparable level. The Administration did not request funding for this program. The program provides grants and contracts to entities for the purpose of funding interdisciplinary training projects that are designed to train, recruit, and retain teams of interdisciplinary professionals to work in underserved areas.
Health professions workforce information and analysis
The Committee has not provided funding for health professions workforce information and analysis. The Administration requested $999,000 for this program, and the fiscal year 2004 comparable level is $722,000. The Department is encouraged to use policy evaluation funds to support this program. The program provides grants and contracts to eligible entities to provide for the collection and analysis of targeted information, research on high priority workforce questions, the development of a non-Federal analytic and research infrastructure, and the conduct of program evaluation and assessment.
Public health, preventive medicine and dental public health programs
The Committee provides $6,970,000 for public health, preventive medicine and dental public health programs, which is $2,200,000 below the fiscal year 2004 comparable level. The Administration did not request funding for this program. The program is comprised of three elements: (1) public health training centers; (2) public health traineeships; and (3) preventive medicine and dental public health residencies. Grants or contracts for the operation of public health training centers are awarded to an accredited school of public health, or another public or nonprofit private institution accredited for the provision of graduate or specialized training in public health, that plans, develops, operates, and evaluates projects in the areas of preventive medicine, health promotion and disease prevention, or improving access to and quality of health services in medically underserved communities. Public health traineeship grants provide graduate or specialized public health training to individuals in the fields of epidemiology, environmental health, biostatistics, toxicology, nutrition, and maternal and child health. Preventive medicine and dental public health residency grants and contracts assist schools in developing new residency training programs or improving existing programs and in providing financial assistance to residency trainees.
Health administration programs
The Committee provides $1,045,000 for health administration programs, which is $34,000 below the fiscal year 2004 comparable level. The Administration did not request funds for this program. These programs provide grants to eligible entities with an accredited program in health administration, hospital administration, or health policy analysis and planning to provide traineeships to students and to assist accredited health administration programs in the development or improvement of programs to prepare students for employment with public or nonprofit private agencies.
Advanced education nursing
The Committee provides $53,634,000 for advanced education nursing, which is $5,002,000 below the fiscal year 2004 comparable level and $9,997,000 above the budget request. The program provides grants and contracts to eligible entities to meet the costs of: (1) projects that support the enhancement of advanced nursing education and practice; and (2) traineeships for individuals in advanced nursing education programs. The program prepares nurse practitioners, clinical nurse specialists, nurse midwives, nurse anesthetists, nurse educators, nurse administrators, public health nurses or other nurse specialists for advanced practice roles. Within the allocation, the Committee encourages HRSA to allocate funding at least at the fiscal year 2001 levels for nurse anesthetist education.
Nurse education, practice and retention
The Committee provides $36,765,000 for nurse education, practice and retention, which is $4,997,000 above the fiscal year 2004 comparable level and $5,000,000 below the budget request. As amended by the Nurse Reinvestment Act of 2002, the nurse education, practice and retention program is a broad authority with targeted purposes under three priority areas--education, practice and retention--in response to the growing nursing shortage. Under this authority, purposes identified under the Education Priority Area include: (1) expanding enrollment in baccalaureate nursing programs to increase the number of registered nurses; (2) developing and implementing internship and residency programs with mentoring components designed to retain new nurses, bring nurses back into the workforce and support the development of specialties for experienced nurses; and (3) providing education in new technologies, including distance learning methodologies. Purposes identified under the Practice Priority Area include: (1) establishing or expanding nursing practice arrangements, commonly referred to as nurse managed centers, in noninstitutional settings to demonstrate methods to improve access to primary health care in medically underserved communities; (2) providing care for underserved populations and other high risk groups such as the elderly, individuals with HIV/AIDS, substance abusers, the homeless, and victims of domestic violence; (3) providing managed care, quality improvement, and other skills needed to practice in existing and emerging organized health care systems; and (4) developing cultural competencies among nurses. Purposes identified under the Retention Priority Area include: (1) career ladder programs to promote advancement in a variety of training settings and assisting individuals in obtaining education and training required to enter the nursing profession; and (2) projects to improve the retention of nurses and enhance patient care that is directly related to nursing activities.
Nursing workforce diversity
The Committee provides $16,402,000 for nursing workforce diversity, which is the same as the fiscal year 2004 comparable level and $4,997,000 below the budget request. The program provides grants and contracts to schools of nursing and other eligible entities to meet the costs of special projects to increase nursing education opportunities for individuals who are from disadvantaged backgrounds, including racial and ethnic minorities, by providing student scholarships or stipends, pre-entry preparation, and retention activities. The program also contributes to the basic preparation of disadvantaged and minority nurses for leadership positions within the nursing and health care community.
Loan repayment and scholarship program
The Committee provides $31,738,000 for nurse loan repayment for shortage area service, which is $5,002,000 above the fiscal year 2004 comparable level and the same as the budget request. This program offers student loan repayment to nurses in exchange for an agreement to serve not less than two years in an Indian Health Service health center, Native Hawaiian health center, public hospital, community or migrant health center, or rural health clinic.
Comprehensive geriatric education
The committee provides $3,478,000 for comprehensive education, which is the same as the fiscal year 2004 comparable level and the Administration request. The comprehensive geriatric education program supports grants to develop and implement, in coordination with Title VII geriatric education programs, to train and educate individuals providing care for the elderly. Funds are to be used for (1) providing training to individuals who will provide geriatric care for the elderly; (2) develop and disseminate curricula relating to the treatment of the health care problems of elderly individuals; (3) train faculty members in geriatrics; or (4) provide continuing education to individuals who provide geriatric care.
Nurse faculty loan program
The Committee provides $4,870,000 for the nurse faculty loan program, which is the same as the fiscal year 2004 comparable level and the Administration request. The nurse faculty loan program addresses the problem of a growing shortage of nursing faculty. Both the National League for Nursing and the American Association of Colleges of Nursing have published data on the severity of the shortage and the implications. Potential nursing students are being turned away from nursing schools because faculty are not available. The nurse faculty loan program supports the development of a student loan fund in schools of nursing to increase the number of qualified nursing faculty. Students may receive loans up to $30,000 per year for a maximum of 5 years. The program has a cancellation provision for up to 85 percent of the loan for recipients working full-time as nursing faculty for a period of 4 years. Twenty percent of the principal and interest may be canceled for each of the first, second and third year, and 25 percent may be canceled for the fourth year of full-time employment as nursing faculty.
Hansen's disease services
The Committee provides $17,413,000 for the Hansen's disease program, which is the same as the fiscal year 2004 comparable level and the budget request. This program offers Hansen's disease treatment to about 35 long term residents who continue to receive care from the National Hansen's Disease Center and to others who receive care from grant-supported outpatient regional clinics. Other former long term residents have been offered and elected to receive a living allowance from the program and now live independently. These programs provide treatment to about 3,000 of the 6,000 Hansen's disease sufferers in the continental United States.
Maternal and child health block grant
The Committee provides $729,817,000 for the maternal and child health (MCH) block grant, which is the same as the fiscal year 2004 comparable level and the budget request. The MCH block grant provides funds to States to meet a broad range of basic and enabling health services, including personal health services; general, population-wide health services, such as screening; family support services; and integrated systems of care. The authorizing statute provides that, up to a funding level of $600,000,000, 85 percent of the funds are distributed to the States, with 15 percent of the funds set aside for special projects of regional and national significance (SPRANS). When the appropriation exceeds $600,000,000, 12.75 percent of the amount over $600,000,000 is directed to the Community Integrated Service Systems set-aside program. The remaining 87.25 percent is distributed by the same 85/15 percent allocation as in the basic block grant formula.
The Committee has included bill language identifying $119,158,000 for the SPRANS set-aside. Within that total, $5,000,000 is provided for the continuation of oral health programs in the States. Through grants, cooperative agreements or contracts, these funds may be used to increase access to dental care for the most vulnerable low-income children, such as Medicaid, SCHIP, and Head Start children and to implement state identified objectives for improving oral health. Anticipated activities include those targeting the reduction of early childhood caries and strengthening school-linked dental sealant programs. The Committee has also provided $4,000,000 within the SPRANS set-aside to support the continuation of the locally based newborn screening follow-up and community based sickle cell disease outreach and supportive service initiative. The Committee also provides $3,000,000 for the continuation of model demonstration programs and public awareness campaigns on epilepsy. The Committee recognizes epilepsy, a chronic neurological condition, as a significant public health concern affecting over 2.5 million persons in the United States. As 125,000 new cases of epilepsy are diagnosed annually, delayed diagnosis, along with inadequate seizure treatment, greatly increases the risk of subsequent seizures, brain damage, disability, and death. Therefore, timely, effective treatment is essential. The Committee is supportive of services that would improve access to health and other services to encourage early detection and treatment for children and others residing in rural, urban and otherwise medically underserved areas. The Committee is pleased that HRSA has partnered with a national voluntary epilepsy agency to carry out these activities. In addition, the Committee provides $2,000,000 to continue the newborn screening for heritable disorders demonstrations begun last year. Newborn screening is used for early identification of infants affected by certain genetic, metabolic, hormonal and or functional conditions for which there is effective treatment or intervention. Screening detects disorders in newborns that, left untreated, can cause death, disability, mental retardation and other serious illnesses. The Committee is aware of the wide disparity that exists between state newborn screening programs that can result in children suffering irreversible injury or death versus children receiving successful diagnosis and treatment, depending upon whether their state tests for certain disorders. The Committee encourages HRSA to work with States to facilitate the development of educational materials that inform parents and health care providers of the benefits of newborn screening, about which conditions are screened for in their state, and about options to have babies screened for additional conditions that are not covered by their state programs. The Committee commends the department on the establishment of the Advisory Committee on Heritable Disorders and Genetic Diseases in Newborns and Children and the appointment by the Secretary of fifteen members. The Committee urges the advisory committee to work promptly in order to provide States with valuable guidance and recommendations regarding newborn screening.
Biliary atresia is a pediatric liver disease which affects one in 10,000 infants. If identified and treated before the infant reaches the age of 60 days, biliary atresia has a high cure rate. If left untreated, it will result in liver failure, a liver transplant or death. The Committee is aware that other nations, such as Japan, have instituted infant screening for biliary atresia. The Committee requests a report by March 15, 2005 on the steps taken to validate a screening tool.
It has come to the Committee's attention that NIH has developed a technology to screen newborns for severe combined immune deficiency disease (SCID). The Committee commends the work that the Advisory Committee on Heritable Disorders and Newborn Screening under HRSA is doing in developing a list of recommended diseases to be screened for at birth. Since SCID is a pediatric emergency that can now be detected at birth and successfully treated, and is fatal without immediate diagnosis and treatment, the Committee recommends that the Advisory Committee include SCID newborn screening in its list of recommended newborn screening tests.
The Committee continues to recognize the critical role of the national network of hemophilia treatment centers in providing needed comprehensive care for bleeding disorders and urges HRSA to strengthen resources for the centers to ensure continued access to this model disease management network.
The Committee commends HRSA for its support of the Sudden Infant Death Syndrome (SIDS) program support center and encourages the Maternal and Child Health Bureau to continue its efforts in this area of service. The Committee is pleased that the SIDS and Other Infant Death Support Center is collaborating with the National Institutes of Health to address the disproportionately high incidence of SIDS among African Americans.
The Committee restates its long-standing interest in the support that MCHB has provided to comprehensive treatment centers for thalassemia patients under the SPRANS program and notes that the current funding is due to expire in FY05. The Committee encourages MCHB to continue this program and to coordinate its activities with relevant voluntary health organizations.
The Committee recognizes the contributions of the long-standing Provider's Partnership program. The Partnership includes a series of state-level projects initiated to address female psychosocial issues. The morbidity and mortality attributed to these issues such as a woman's depression, tobacco use, substance abuse and domestic violence are becoming increasingly apparent. Obstetrician-gynecologists can play a critical role in addressing these problems within their current practice, however because of their complexity, and the importance of promptly linking at-risk women with appropriate services, responsibility for full psychosocial assessment and treatment cannot fall solely to obstetrician-gynecologists. Partnerships between these women's health care providers and community programs are needed that allow for integration of medical care with psychosocial services. The Committee encourages continued funding of the Provider's Partnership program.
Since 1990, the Maternal and Child Health Bureau has worked in cooperative agreement to run the National Fetal Infant Mortality Review (NFIMR) program. NFIMR provides training and assistance to enhance cooperative partnerships among local community health professionals, public health officers, community advocates and consumers to reduce infant mortality. The goal is to improve local services and resources for women, infants and families, to remove barriers to care, and to ensure culturally appropriate, family friendly services. Such efforts are crucial to understanding and addressing infant health disparities in communities at highest risk. The Committee encourages HRSA to continue to use Healthy Start funds to support the NFIMR project.
The Committee encourages ACF's Head Start Bureau and the Maternal and Child Health Bureau to continue and expand their successful interagency agreement to jointly address dental disease, the number one unmet health need of Head Start children. This partnership has brought together Head Start and the dental community at the national, state and local levels to seek solutions to improve access to oral health care for these children through the public and private sectors.
Abstinence education
The Committee does not provide funding for abstinence education within the Health Resources and Services Administration. As requested by the Administration, this account is now funded within the Administration for Children and Families.
Healthy Start
The Committee provides $97,751,000 for Healthy Start, which is the same as the fiscal year 2004 comparable level and the budget request. Healthy Start provides grants to select communities with high rates of infant mortality to help them identify, plan, and implement a diverse range of community-driven strategies that can successfully and significantly reduce disparities in perinatal health that contribute to the Nation's high infant mortality rate.
Universal newborn hearing
The Committee provides $9,872,000 for the universal newborn hearing screening program, which is the same as the fiscal year 2004 comparable level. The Administration did not request funding for this program. The program provides competitive grants to States for the purpose of implementing a national program of universal newborn hearing screening by means of physiologic testing prior to hospital discharge, audiologic evaluation by three months of age, and entry into a program of early intervention by six months of age.
Organ transplantation
The Committee provides $24,632,000 for organ transplantation activities, which is the same as the fiscal year 2004 comparable level and the budget request. The program supports a scientific registry of organ transplant recipients; the National Organ Procurement and Transplantation Network, which matches organ donors with potential recipients; and grants and contracts with public and private non-profit organizations to promote and improve organ donation.
The Committee is encouraged by the initial success of the organ donation collaborative project. This project is focused on the nation's largest hospitals and has adopted the goal of assisting these hospitals achieve organ donation rates of 75% or higher, which will result in at least 6,000 additional organs available for transplantation. The Committee also encourages HRSA to consider adopting a national system of simultaneous referrals of available organs as opposed to the current system of sequential or serial referrals, as this will further guarantee that all available organs are utilized.
The Committee also encourages HRSA to continue to support studies and demonstration projects to increase and maximize organ donation and recovery rates, including living donation.
The Committee encourages the Division of Transplantation to enhance its partnership with the pulmonary hypertension (PH) community aimed at increasing awareness about the need for increased heart and lung donations. The Committee is aware that the Organ Procurement and Transplantation Network/United Network for Organ Sharing has issued a proposed rule governing the allocation of lungs for transplantation. The Committee encourages OPTN/UNOS to work with the PH community to address its concerns regarding the methodology used to determine transplantation eligibility for PH patients.
Cord blood bank
The Committee does not provide additional funding for the cord blood program pending the completion of the Institute of Medicine report on the structure and administration of such a program. $9,941,000 was provided for this purpose in fiscal year 2004 to remain available until expended and requested by the President's budget.
Bone marrow program
The Committee provides $25,662,000 for the bone marrow program, which is $3,000,000 above the fiscal year 2004 comparable level and the budget request. In addition to funding from HRSA in fiscal year 2004, the National Marrow Donor Program (NMDP) is expected to receive $17,350,000 from the U.S. Navy. Funds are used for donor medical costs, donor centers, tissue typing, research, minority recruitment, and program administration. The Committee recognizes the important life-saving role of the Registry in the lives of thousands of Americans. The National Marrow Donor Program (NMDP), which operates the Registry through a contract with HRSA, anticipates facilitating its 20,000th transplant by November 2004. The Committee understands that the Registry lists three sources of blood forming non-embryonic stem cells used in transplantation: marrow and peripheral blood from adult donors, and umbilical cord blood units. The NMDP now lists 5,000,000 potential volunteer, adult donors of marrow and peripheral blood stem cells on the Registry. In addition, 16 of the 19 public cord banks are or have applied to become NMDP network members. The Committee urges the NMDP to continue innovative, technological, and scientific advances in non-embryonic cell therapies that have the potential to help some of the hundreds of thousands of Americans with leukemia or other life threatening blood diseases. The Committee also strongly encourages the NMDP to continue the enhancement of the Registry through its umbilical cord blood program. In addition, the Committee supports the NMDP's important role in conducting and supporting research to improve the availability, efficiency, safety, and cost of transplants and the effectiveness of Registry operations; maintaining and expanding its medical emergency contingency response capabilities for our nation's national security; and increasing donor and patient outreach programs, especially for minorities and medically underserved population groups.
Rural outreach grants
The Committee provides $30,124,000 for rural outreach grants, which is $9,477,000 below the fiscal year 2004 comparable level and $19,026,000 above the budget request. The program supports projects that provide health services to rural populations not currently receiving them and that enhance access to existing services.
Rural health research
The Committee provides $8,902,000 for rural health research, which is the same as the fiscal year 2004 comparable level and the budget request. The activity supports several rural health research centers and the Secretary's rural health advisory committee as well as staffing for the Secretary's rural initiative.
Telehealth
The Committee provides $3,949,000 for telehealth, which is the same as the fiscal year 2004 comparable level and the budget request. The telehealth program works with and supports communities in their efforts to develop cost-effective uses of telehealth technologies. These technologies bring health services to residents of the Nation who are isolated from health care, and health-related education to the practitioners who serve them.
The Committee strongly supports HRSA's numerous rural telehealth initiatives and continues to encourage the agency to work in partnership with medical librarians, the National Library of Medicine, and other health information specialists in the development and implementation of its telehealth projects.
Rural hospital flexibility grants
The Committee provides $32,500,000 for rural hospital flexibility grants, which is $6,999,000 below the fiscal year 2004 comparable level and $32,500,000 above the budget request. The program is comprised of two parts: (1) flexibility grants to States to assist small, at risk rural hospitals that wish to convert to Critical Access Hospitals and receive cost-based payments from Medicare and (2) small hospital improvement grants that provide very modest amounts to hospitals to assist them in automation and compliance with confidentiality requirements. $25,000,000 is provided for the flexibility grants and $7,500,000 is provided for the small hospital improvement grants.
Rural and community access to emergency devices
The Committee provides $5,000,000 for the public access defibrillation demonstration grant program, which is $5,933,000 below the fiscal year 2004 comparable level and $2,985,000 above the budget request. The program assists both urban and rural communities in increasing survivability from sudden cardiac arrest by providing funding for the purchase, placement, and training in the use of automated external defibrillators (AEDs). The Committee intends that $1,000,000 of this total should be allocated to the community program and $4,000,000 should be directed to the rural program.
Rural EMS
The Committee does not provide funding for the new rural emergency training and equipment assistance program, which is $497,000 lower than the fiscal year 2004 comparable level and the same as the budget request. The Committee does not believe the program at its current level can provide adequate assistance nationwide and believes there are other emergency programs funded in the bill that can address some of these problems in rural areas.
State offices of rural health
The Committee provides $8,390,000 for State offices of rural health, which is the same as the fiscal year 2004 comparable level and the budget request. The State office of rural health program creates a focal point for rural health within each of the fifty States. In each State, the office collects and disseminates information on rural health, coordinates rural health resources and activities, provides technical assistance to rural providers and communities, and helps communities recruit and retain health professionals.
Denali Commission
The Committee has not included funding for the Denali Commission, which is $34,793,000 below the fiscal year 2004 comparable level and $22,000,000 below the budget request.
Emergency medical services for children
The Committee provides $19,860,000 for emergency medical services for children, which is the same as the fiscal year 2004 comparable level and the Administration request. The program supports grants for the delivery of emergency medical services to acutely ill and seriously injured children.
Poison control centers
The Committee provides $23,696,000 for poison control centers, which is the same as the fiscal year 2004 comparable level and the Administration request. These funds support a grant program for poison control centers. In addition, funds are used to maintain a national toll-free number and implement a media campaign to advertise that number, as well as to support the development of uniform patient management guidelines and the improvement of data collection.
Traumatic brain injury
The Committee provides $9,375,000 for the traumatic brain injury (TBI) program, which is the same as the fiscal year 2004 comparable level and the budget request. The TBI program funds the development and implementation of statewide systems to ensure access to care including prehospital care, emergency department care, hospital care, rehabilitation, transitional services, and long-term community support. Grants also go to State protection and advocacy systems.
Black lung clinics
The Committee provides $5,963,000 for black lung clinics, which is the same as the fiscal year 2004 comparable level and the budget request. The program supports fifteen grantees that treat a declining population of coal miners with respiratory and pulmonary impairments. The clinics presently receive more than one-third of their funding from other sources, such as Medicaid and Medicare. Of the fifteen grantees, seven actually receive health center funding as well as black lung grants.
Trauma care
The Committee provides $3,449,000 for the trauma care program, which is the same as the fiscal year 2004 comparable level. The Administration did not request funds for this program. The program provides small grants to States to establish State offices to coordinate trauma systems within the States.
Payment to Hawaii for treatment of Hansen's disease
The Committee provides $2,033,000 for the treatment of persons with Hansen's disease in the State of Hawaii, which is the same as the fiscal year 2004 comparable level and the Administration request. The program, which provides a partial matching payment to the State of Hawaii, dates to the period of Father Damien's facility for sufferers of Hansen's disease (leprosy). That facility now has only 43 residents who live there by choice, and the grounds have been converted to a historical site. Most patients diagnosed with Hansen's disease in Hawaii are now treated in the same manner as new patients on the mainland; their care is handled on an out-patient basis, with the program paying for about 300 active ambulatory Hansen's Disease cases.
Ryan White AIDS programs
The Committee provides $2,074,861,000 for Ryan White AIDS programs, which is $35,000,000 above the fiscal year 2004 comparable level and $20,000,000 above the budget request. The bill also makes available $25,000,000 in program evaluation funding under section 241 of the Public Health Service for special projects of national significance. The Committee's allocation among the various titles of the Ryan White program reflect the high priority the Committee places on providing resources for the AIDS drug assistance program. Within the total provided, the Committee expects that Ryan White AIDS activities that are targeted to address the growing HIV/AIDS epidemic and its disproportionate impact upon communities of color, including African Americans, Latinos, Native Americans, Asian Americans, Native Hawaiians, and Pacific Islanders will be supported at no less than the fiscal year 2004 level.
The Committee is aware that, for a number of eligible metropolitan areas, the amount of their supplemental grant under title I of the Ryan White CARE Act has fluctuated markedly from year to year, thereby disrupting ongoing programs and services. Accordingly, the Committee directs HRSA to review the processes it uses to evaluate applications and award supplemental grants and to take appropriate steps to reduce such fluctuations and disruptions.
Emergency assistance
The Committee provides $615,023,000 for the Part A, emergency assistance program, which is the same as the fiscal year 2004 comparable level and the budget request. These funds provide grants to metropolitan areas with very high numbers of AIDS cases for outpatient and ambulatory health and social support services. Half of the amount appropriated is allocated by formula and half is allocated to eligible areas demonstrating additional need through a competitive grant process.
Comprehensive care programs
The Committee provides $1,140,900,000 for Part B, comprehensive care programs, which is $35,000,000 above the fiscal year 2004 comparable level and $20,000,000 above the budget request. The funds provided support formula grants to States for the operation of HIV service delivery consortia in the localities most heavily affected, for the provision of home and community-based care, for continuation of health insurance coverage for infected persons, and for purchase of therapeutic drugs.
The Committee has included bill language identifying $803,872,000 specifically to support State AIDS Drug Assistance Programs. In fiscal year 2004, $768,872,000 was designated for this purpose.
Early intervention program
The Committee provides $197,170,000 for Part C, the early intervention program, which is the same as the fiscal year 2004 comparable level and the budget request. Funds are used for discretionary grants to migrant and community health centers, health care for the homeless grantees, family planning grantees, hemophilia centers and other private non-profit entities that provide comprehensive primary care services to populations with or at risk for HIV disease. The grantees provide testing, risk reduction counseling, transmission prevention, and clinical care; case management, outreach, and eligibility assistance are optional services.
Pediatric HIV/AIDS
The Committee provides $73,108,000 for Part D, pediatric AIDS demonstrations, which is the same as the fiscal year 2004 comparable level and the budget request. The program supports demonstration grants to foster collaboration between clinical research institutions and primary community-based medical and social service providers for the target population of HIV-infected children, pregnant women and their families. The projects are intended to increase access to comprehensive care, as well as voluntary participation in NIH and other clinical trials.
AIDS dental services
The Committee provides $13,325,000 for AIDS dental services, which is the same as the fiscal year 2004 comparable level and the budget request. The program provides reimbursements to dental schools and postdoctoral dental education programs to assist with the cost of providing unreimbursed oral health care to patients with human immunodeficiency virus disease. Dental students and residents participating in this program receive extensive training in the understanding and management of the oral health care needs of people living with HIV/AIDS.
Education and training centers
The Committee provides $35,335,000 for AIDS education and training centers (AETCs), which is the same as the fiscal year 2004 comparable level and the budget request. The centers train health care personnel who care for AIDS patients and develop model education programs.
Family planning
The Committee provides $278,283,000 for the family planning program, which is the same as the fiscal year 2004 comparable level and the budget request. The program provides grants to public and private non-profit agencies to support a range of family planning and reproductive services, as well as related preventive health services such as patient education and counseling, breast and cervical cancer examinations, STD and HIV prevention education, counseling and testing and referral, and pregnancy diagnosis and counseling. The program also supports training for providers, an information and education program, and a research program which focuses on family planning service delivery improvements. The Committee encourages HRSA to work with CDC to implement HIV/AIDS testing and counseling as a part of the services provided in family planning centers.
The bill repeats language from the 2004 appropriations bill making clear that these funds shall not be expended for abortions, that all pregnancy counseling shall be nondirective, and that these funds shall not be used to promote public opposition to or support of any legislative proposal or candidate for public office.
Children's hospitals graduate medical education program
The Committee provides $303,258,000 for the children's hospitals graduate medical education program, which is $88,000 above the fiscal year 2004 comparable bill and the same as the budget request. The program provides a more adequate level of 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 funding in this program is intended to make the level of Federal Graduate Medical Education support more consistent with other teaching hospitals, including children's hospitals which share provider numbers with other teaching hospitals. Payments are determined by formula, based on a national per-resident amount. Payments support training of resident physicians as defined by Medicare in both ambulatory and inpatient settings.
Health care facilities and other programs
The Committee has not included funding for health care facilities. A total of $371,536,000 was provided for this purpose in fiscal year 2004; no funding was included in the budget request. This program provides funds to public and private nonprofit entities for construction or modernization of outpatient medical facilities.
Buildings and facilities
The Committee provides $249,000 for buildings and facilities, which is the same as the fiscal year 2004 comparable level and the budget request. These funds are used to finance the repair and upkeep of buildings at the Gillis W. Long Hansen's Disease Center at Carville, Louisiana.
Radiation exposure compensation act
The Committee provides $1,974,000 for the radiation exposure compensation act, which is the same as the fiscal year 2004 comparable level and the budget request. This program provides grants for the education, prevention and early detection of radiogenic cancers and diseases resulting from exposure to uranium during its mining and milling at nuclear test sites.
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