Appropriations, 2001	$378,019,000
Budget estimate, 2002	442,751,000
Committee recommendation	422,212,000

The Committee recommends $422,212,000 for general departmental management [GDM]. This is $20,539,000 less than the administration request and $44,193,000 above the fiscal year 2001 level. Within this amount, the Committee includes the transfer of $5,851,000 from Medicare trust funds, which is the same as the administration request and the fiscal year 2001 level. Included in these funds is $5,000,000 to be transferred to the Global Fund to Fight HIV/AIDS, Malaria, and Tuberculosis.

This appropriation supports those activities that are associated with the Secretary's role as policy officer and general manager of the Department. It supports certain health activities performed by the Office of Public Health and Science, including the Office of the Surgeon General. GDM funds also support the Department's centralized services carried out by several Office of the Secretary staff divisions, including personnel management, administrative and management services, information resources management, intergovernmental relations, legal services, planning and evaluation, finance and accounting, and external affairs.

The Office of the Surgeon General, in addition to its other responsibilities, provides leadership and management oversight for the PHS Commissioned Corps, including the involvement of the Corps in departmental emergency preparedness and response activities.

The Committee is aware that, in response to the September 11th terrorist attacks, the Department activated the National Disaster Medical System (NDMS) to provide emergency medical assistance to local officials in New York City and at the Pentagon. The Office of Emergency Preparedness deployed 328 medical personnel as part of Disaster Medical Assistance Teams (DMATS), which consisted of physicians, nurses and emergency medical technicians trained to deal with traumatic injuries. In addition, four Disaster Mortuary Operation Response Teams (DMORTS) were dispatched to New York City, and three to the Washington area. The Committee commends the Department for its quick response and for providing needed resources to local emergency personnel.

The Committee has provided $4,000,000 to support the activities of the United States-Mexico Border Health Commission as authorized by Public Law 103-400. The Commission is authorized to assess and resolve current and potential health problems that affect the general population of the United States-Mexico border area.

The Committee directs that specific information requests from the Chairman and Ranking Members of the Subcommittee on Labor, Health and Human Services, and Education, and Related Agencies, on scientific research or any other matter, shall be transmitted to the Committee on Appropriations in a prompt professional manner and within the time frame specified in the request. The Committee further directs that scientific information requested by the Committees on Appropriations and prepared by government researchers and scientists be transmitted to the Committee on Appropriations, uncensored and without delay.

The Committee is aware that the Department is undertaking an overhaul of its internal computer systems, specifically a Unified Financial Management System. The Committee is further aware that there are concerns about the process by which the Department has solicited bids for fulfilling its software needs. Therefore, the Committee urges the Department to ensure that the procurement process for any and all service and software purchases is conducted in the most open, fair, and appropriate manner in compliance with current Federal guidelines.

The Committee has included funding for the Human Services Transportation Technical Assistance Program. These funds shall be used to provide assistance to human service transportation providers on management, coordination and meeting the requirements of the Americans with Disabilities Act. Funding is also included for a Medicare Transportation Demonstration Program in Iowa. Under this demonstration, residents of an urban and rural community shall receive non-emergency transportation assistance for visits to hospitals, clinics, and physicians and for related services. The purpose of this demonstration is to ascertain the obstacles, including costs, that senior citizens encounter in securing non-emergency transportation to health care providers. The Committee notes that the technical assistance provided by the Community Transportation Association of America is vital to the success of these demonstrations.

The Committee understands that Mercy Housing, Inc., a national non-profit faith-based organization focused on improving the health care and housing opportunities available to low-income families, elderly households and individuals, would benefit from technical assistance to develop linkages between health care services and affordable housing developments.

Children's eye exams- As 80 percent of what children learn is acquired through vision processing information, the Committee recognizes that ensuring that all children start school ready to learn is essential to their academic achievement and our Nation's economic success and urges that all children have access to comprehensive eye examinations prior to school matriculation. The Committee believes that comprehensive eye exams in children prior to entering school are an important step to assure they start their academic careers ready to learn and that the full range of visual impairments are identified and diagnosed. The Committee therefore urges the Secretary to explore and develop ways in which to assure that more children receive comprehensive eye examinations.

Chronic fatigue- The Committee is pleased that the Department has announced that it will establish a chronic fatigue syndrome advisory committee to build upon progress made by the DHHS CFS Coordinating Committee within the limits of its charter. It is this Committee's expectation that this transition to an advisory committee will not diminish the full partnership of involved agencies or the collaborative relationships among Federal agencies, scientists, and CFS advocates that have developed over recent years through the CFS Coordinating Committee. The Committee is disappointed that, despite 2 years of report language, the Department has not yet undertaken a prominent educational campaign to inform health care professionals and the general public about CFS. The Committee urges the Secretary and the Surgeon General to take a leadership role in this effort and to report back to the Committee within 90 days on plans to inform the public that CFS is a serious, prevalent, and disabling illness.

Coordination of child support enforcement activities- The flow of information between Federal and State agencies and the court system continues to be a critical factor in the success of the Child Support Enforcement program. While some States have succeeded in implementing seamless, cost-effective processes for information-sharing among their human service agencies and the courts, others have not. The Committee has been impressed with the results of ACF's efforts using the State information technology consortium to improve the information and systems reporting requirements of TANF. That success underscores the notion that States are in the best position to solve their own problems. The Committee therefore encourages the Secretary to utilize this consortium of States to identify and widely disseminate methods for improving the flow of information between agencies and the court system.

Dietary supplements- The Committee recognizes the substantial role that dietary supplements can play in improving the health status of Americans. Indeed, improved nutrition and healthful diets may mitigate the need for expensive medical procedures and reduce health care expenditures. In 1994, the Congress passed the Dietary Supplement Health and Education Act (DSHEA), which provides the regulatory framework necessary to ensure that consumers have access to safe, accurately labeled dietary supplements and information about those products. However, while the Food and Drug Administration (FDA) has spent resources to take action against a number of important healthful products, the Committee believes it has failed to take action against a number of clearly violative claims and inaccurate ingredient labels. The Committee is aware that funding for the Food and Drug Administration is in the Department of Agriculture appropriations bill. However, the Committee directs the Secretary to work with the FDA to undertake appropriate enforcement of DSHEA in areas relating to the accuracy of claims about dietary supplement ingredients, and prohibiting any dietary supplement claim that is false or misleading.

Embryo adoption awareness- During hearings devoted to Stem Cell research, the Committee became aware of approximately 100,000 spare frozen embryos stored in in vitro fertilization (IVF) clinics throughout the United States. The Committee is also aware of many infertile couples who, if educated about the possibility, may choose to implant such embryos into the woman and, potentially, bear children. The Committee therefore directs the Department to launch a public awareness campaign to educate Americans about the existence of these spare embryos and adoption options. The Committee has provided $1,000,000 for this purpose.

Homelessness- The Committee supports the ongoing efforts of the Department in its initiative to end chronic homelessness. The Committee encourages the collaboration between HHS and the Department of Housing and Urban Development (HUD) and supports the goal of ending homelessness for the estimated 150,000 chronically homeless. The Department should continue to identify funds for supportive services to supplement permanent supportive housing projects being funded by HUD.

Long-term care- The Committee notes that long-term care settings (nursing homes, assisted living, home health care, etc.) nationwide are facing a shortage of frontline caregivers including registered and licensed practical nurses, certified nurse aids (CNAs) and other direct care workers. The Committee notes that the General Accounting Office estimates that the U.S. health care system will need an additional 800,000 nurse aides by the year 2008. The Committee expects the Secretary to coordinate a study with the Administrators of HRSA and CMS to identify the causes of the shortage of frontline caregivers in long-term care settings and make comprehensive recommendations to the Committee to address the increasing demand of an aging baby-boomer generation, and report findings and recommendations to the Committee by June 1, 2002.

Medical devices- The Secretary is urged to submit a report to the Committee on medical devices developed or improved by the Federal Government or in conjunction with Federal funds. The report should specifically address medical devices used in the treatment of chronic illness, including diabetes. To the extent possible, the report should address how medical devices developed or used by the Federal Government are introduced into the mainstream health care delivery system; how the use of a medical device by a chronically ill person is evaluated for efficacy; how the Federal Government can improve efforts to introduce medical device technology developed by its agencies and programs into the mainstream health care delivery system; and how the Department can improve its consideration of the needs of chronically ill patients when evaluating the efficacy of medical devices. The Secretary is urged to report to the Committee no later than May 30, 2002.

Nurse anesthetists- The Committee understands that concerns have been raised about the administration's proposed rules to address the issue of physician supervision of certified registered nurse anesthetists. The Committee urges the Secretary to take the differing views of the interested parties, including the nurse anesthetists and anesthesiologists, into consideration before issuing a final rule.

Report on osteoporosis and related bone diseases- More than 30 million Americans suffer from some form of bone disease, including osteoporosis, Paget's disease and osteogenesis imperfecta. The Committee therefore recommends that the Department commission a Surgeon General's report on osteoporosis and related bone diseases, detailing the burden bone diseases places on society, and highlighting preventive measures to improve and maintain bone health throughout life. The report should also identify best practices for collecting data about the prevalence, morbidity and disability associated with bone diseases among minority populations.

Runaway youth- The Committee is concerned with reports that runaway, throwaway, homeless, and street experiences among youth are increasing. The Committee is also troubled that the exact nature of these problems is not well defined because national statistics on the number, characteristics, and circumstances of this population are not tabulated. The Committee instructs the Secretary, acting through the Assistant Secretary of Planning and Evaluation, to prepare and submit by September 30, 2002 a plan for developing estimates of the incidences of runaway, throwaway, homeless, and street experiences among youth, as well as a plan for regularly monitoring incidence trends.

Underage drinking prevention- The Committee recommendation includes $1,000,000 for the National Academy of Sciences Institute of Medicine to conduct a comprehensive review of all existing Federal, State and non-governmental programs designed specifically to reduce the illegal purchase and consumption of alcohol, as well as media-based programs with the purpose of changing the attitudes and behaviors of youth. The Committee directs the NAS to review, evaluate and report on the effectiveness of all such programs, the results of which shall identify those programs which have been the most successful at accomplishing the goals of reducing underage drinking or successfully altering the attitudes and behaviors of youth. The NAS shall, based on its review, make recommendations on a comprehensive strategy for reducing and preventing underage drinking in the United States. The review and recommendations of the NAS shall be reported to the United States Senate Committee on Appropriations, the United States Secretary of Health and Human Services, the United States Secretary of Education and the United States Attorney General no later than 12 months after the date of enactment of this Act.

Adolescent family life

The Committee has provided $30,000,000 for the Adolescent Family Life Program [AFL]. This is $5,673,000 more than the fiscal year 2001 appropriation and $2,138,000 over the administration request.

AFL is the only Federal program focused directly on the issue of adolescent sexuality, pregnancy, and parenting. Through demonstration grants and contracts, AFL focuses on a comprehensive range of health, educational, and social services needed to improve the health of adolescents, including the complex issues of early adolescent sexuality, pregnancy, and parenting.

Within the total provided, the Committee continues the prevention projects begun in fiscal year 1998, as well as new prevention projects. The Committee again expects the Department to fund new prevention projects which enable smaller communities to begin the organization and implementation of coalitions to implement abstinence-based education programs. The Committee again expects the Department, when announcing grant competitions, to provide a reasonable length of time for applicants to complete application packages, provide extensive technical assistance to applicants, with special assistance given to new applicants, and revise the terminology and instructions in grant applications to assure that the information being requested is as clear as possible.

Physical fitness and sports

The Committee recommends $1,139,000 for the Federal staff which supports the President's Council on Physical Fitness and Sports. This is the same as the budget request and $48,000 more than the fiscal year 2001 appropriation.

The President's Council on Physical Fitness and Sports serves as a catalyst for promoting increased physical activity/fitness and sports participation for Americans of all ages and abilities, in accordance with Executive Order 12345, as amended. The programs sponsored by PCPFS are supported largely through private sector partnerships.

Minority health

The Committee recommends $43,084,000 for the Office of Minority Health. This is the same as the budget request and $5,935,000 less than the fiscal year 2001 appropriation.

The Office of Minority Health [OMH] focuses on strategies designed to decrease the disparities and to improve the health status of racial and ethnic minority populations in the United States. OMH establishes goals, and coordinates all departmental activity related to improving health outcomes for disadvantaged and minority individuals. OMH supports several demonstration projects, including the Minority Community Health Coalition, the Bilingual/Bicultural Service, the Center for Linguistic and Cultural Competency in Health Care, and the Family and Community Violence Prevention Program.

The Committee has provided $1,000,000, the same as the budget request, to support a national program to assess and reduce health disparities affecting minority males. The Committee urges the Department, when launching the new National Minority Male Health Project, to do so through a consortium of historically black colleges and universities with a demonstrated relationship that will contribute to educating minority males about their health. The Committee further urges the Department to directly involve historically black colleges and universities in the community-based health strategies affecting minority males.

The Committee encourages the Office of Minority Health to provide support to historically black serving institutions and other minority-serving institutions to enhance their efforts in HIV/AIDS and other disease prevention.

The Committee recommends continuation of the following fiscal year 2001 projects and activities referenced in the fiscal year 2001 conference agreement:

--Trinity Health in Detroit, Michigan for its primary care clinic that serves underserved, low-income and minority individuals

--the Community Lead Education and Reduction Corps (CLEARCorps) at the University of Maryland Baltimore County to prevent lead poisoning among low-income and minority children.

The Committee is aware of the following projects and urges the Department to give them full and fair consideration:

--the American Association of Physicians of Indian Origin (AAPI) efforts to study bone mineral density (BMD) in the Indian American community

--the AIDS Foundation of Chicago's efforts to expand current prevention programs

--the Center for Hispanic Community and Family Health at the University of North Carolina at Greensboro

--Padres Contra El Cancer, a non-profit organization that serves Latino children with cancer in Los Angeles, CA

--the Institute for the Elimination of Health Disparities at the University of Medicine and Dentistry of New Jersey (UMDNJ) for focusing on minority health issues

--the California Teratogen Information Service in San Diego, CA for its outreach and education program directed at Hispanic women of reproductive age

--the Chronic Disease Prevention for Hispanic Children Project being sponsored through the Texas Agricultural Extension Service, Baylor Children's Hospital and the Texas A&M; Health Sciences Center

--the Baltimore City Health Department for HIV/AIDS testing for high-risk individuals.

--the Thomas Jefferson University Hospital for providing linguistically competent and culturally sensitive health care services to the Chinese community.

Office on Women's Health

The Committee recommends $27,396,000 for the Office on Women's Health. This is the same as the administration request and $10,126,000 more than the fiscal year 2001 appropriation.

The PHS Office on Women's Health [OWH] develops, stimulates, and coordinates women's health research, health care services, and public and health professional education and training across HHS agencies. It advances important crosscutting initiatives and develops public-private partnerships, providing leadership and policy direction, and initiating and synthesizing program activities to redress the disparities in women's health.

The Committee remains strongly supportive of the various women's health-related offices in NIH, CDC, HRSA, FDA, SAMHSA, AHRQ, and HCFA. These offices are essential to the mission of the Department and must be adequately supported to accomplish their goals in line with the expanded role planned for OWH. The Secretary should notify the Committee in advance of any significant changes in the status of any of these offices.

The Committee is supportive of the efforts of Wishard Health Services in Indianapolis, Indiana to establish a National Center of Excellence in Women's Health. The Center of Excellence would offer a comprehensive array of programs designed to help women take important steps toward leading positive, productive lives.

National Bone Health Campaign- The Committee commends the Office on Women's Health for their commitment to the National Bone Health Campaign aimed at girls aged 9 to 18. The Committee encourages the Office on Women's Health to increase their support of the Campaign.

Office of Emergency Preparedness

The Committee has provided $14,200,000, which is the same as the budget request and $2,532,000 more than last year, for activities to counter the adverse health and medical consequences from major terrorist events. Within this amount, sufficient funds are provided for the Office of Emergency Preparedness to staff and administer this program, as well as the other OEP activities specified in the administration's request. The amount provided by the Committee is intended to continue the formation of new metropolitan medical strike teams in key uncovered urban areas of the country.

The Department has lead responsibility for health, medical, and health-related support under the Federal response plan to catastrophic disasters. On behalf of the Department, the Office of Emergency Preparedness assesses the potential health and medical consequences of a terrorist incident and to formulate necessary responses. The funds provided would support activities to build local, State, and Federal capacity to respond to terrorist acts with public health implications. Such activities would include assisting local emergency managers through the MMST system to build an enhanced capability to detect and identify biologic and chemical agents.

Bioterrorism

The Committee recommendation includes $68,700,000 for bioterrorism activities, which is the same as the administration request and $8,670,000 above the fiscal year 2001 level. In fiscal year 2001 funds for bioterrorism were appropriated in the Public Health and Social Services Emergency Fund. The fiscal year 2002 budget request funds bioterrorism programs in the OEP and the Office of the Secretary. Additional funds for bioterrorism have been provided by the Committee within the CDC and NIH.

The Committee expects that, within the amount provided to the Secretary for biosecurity, the rebuilding of the nation's public health infrastructure be given the highest priority. Communications, information technology, laboratories and associated technologies, hospital capacity, and trained professionals are essential elements of a national public health infrastructure which protects the civilian population against both bioterrorist threats and the rapid onset of naturally occurring diseases.

The Committee is aware that the administration is submitting a supplemental budget request for additional fiscal year 2002 bioterrorism funding. The Committee looks forward to working with the administration on this request to insure that substantially increased investments are made in our public health infrastructure, and that our first-responders at the State and local level are sufficiently prepared in the event of a bioterrorist attack.

The Committee recommends continuation of the following fiscal year 2001 projects and activities in the fiscal year 2001 conference agreement:

--the West Virginia University Virtual Medical Campus to address medical community needs for weapons of mass destruction readiness and preparedness.

--University of Findlay's National Center for Terrorism Preparedness for an ALERT (Actual Learning Environment Response Training) Center.

--the Center for the Study of Bioterrorism and Emerging Infections at the St. Louis University School of Public Health.

The Committee is aware of the following projects that it encourages the Department to consider supporting:

--The Center for BioDefense at the University of Medicine and Dentistry in New Brunswick, New Jersey

--The Detroit Medical Center for an urban disaster and emergency medical response initiative

--The Center for Civilian Biodefense Studies at Johns Hopkins University

--St. Michael's Medical Center in Newark, New Jersey, for its work on bioterrorism as part of the practice and study of high risk infectious disease

--The Centers for Biopreparedness and Infectious Disease at the University of North Carolina.

HIV/AIDS in minority communities

To address high-priority HIV prevention and treatment needs of minority communities heavily impacted by HIV/AIDS, the Committee recommends $50,000,000. These funds are available to key operating divisions of the department with capability and expertise in HIV/AIDS services to assist minority communities with education, community linkages, and technical assistance.

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