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[House Report 110-375]
[From the U.S. Government Publishing Office]

110th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES
 1st Session                                                    110-375

======================================================================
 
   MELANIE BLOCKER-STOKES POSTPARTUM DEPRESSION RESEARCH AND CARE ACT

                                _______
                                

October 15, 2007.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

 Mr. Dingell, from the Committee on Energy and Commerce, submitted the 
                               following

                              R E P O R T

                         [To accompany H.R. 20]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Energy and Commerce, to whom was referred 
the bill (H.R. 20) to provide for research on, and services for 
individuals with, postpartum depression and psychosis, having 
considered the same, report favorably thereon with an amendment 
and recommend that the bill as amended do pass.

                                CONTENTS

                                                                   Page
Amendment........................................................     2
Purpose and Summary..............................................     4
Background and Need for Legislation..............................     4
Hearings.........................................................     6
Committee Consideration..........................................     6
Committee Votes..................................................     6
Committee Oversight Findings.....................................     6
Statement of General Performance Goals and Objectives............     6
New Budget Authority, Entitlement Authority, and Tax Expenditures     7
Earmarks and Tax and Tariff Benefits.............................     7
Committee Cost Estimate..........................................     7
Congressional Budget Office Estimate.............................     7
Federal Mandates Statement.......................................     9
Advisory Committee Statement.....................................     9
Constitutional Authority Statement...............................     9
Applicability to Legislative Branch..............................    10
Section-by-Section Analysis of the Legislation...................    10
Changes in Existing Law Made by the Bill, as Reported............    11

                               Amendment

    The amendment is as follows:
    Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE.

  This Act may be cited as the ``Melanie Blocker-Stokes Postpartum 
Depression Research and Care Act''.

SEC. 2. FINDINGS.

  The Congress finds as follows:
          (1) Postpartum depression is a devastating mood disorder 
        which strikes many women during and after pregnancy.
          (2) Postpartum mood changes are common and can be broken into 
        three subgroups: ``baby blues'', which is an extremely common 
        and the less severe form of postpartum depression; postpartum 
        mood and anxiety disorders, which are more severe than baby 
        blues and can occur during pregnancy and anytime within the 
        first year of the infant's birth; and postpartum psychosis, 
        which is the most extreme form of postpartum depression and can 
        occur during pregnancy and up to 12 months after delivery.
          (3) ``Baby blues'' is characterized by mood swings, feelings 
        of being overwhelmed, tearfulness, irritability, poor sleep, 
        mood changes, and a sense of vulnerability.
          (4) The symptoms of postpartum mood and anxiety disorders are 
        the worsening and the continuation of the baby blues beyond the 
        first days or weeks after delivery.
          (5) The symptoms of postpartum psychosis include losing touch 
        with reality, distorted thinking, delusions, auditory 
        hallucinations, paranoia, hyperactivity, and rapid speech or 
        mania.
          (6) Each year over 400,000 women suffer from postpartum mood 
        changes, with baby blues afflicting up to 80 percent of new 
        mothers; postpartum mood and anxiety disorders impairing around 
        10 to 20 percent of new mothers; and postpartum psychosis 
        striking 1 in 1,000 new mothers.
          (7) Postpartum depression is a treatable disorder if promptly 
        diagnosed by a trained provider and attended to with a 
        personalized regimen of care including social support, therapy, 
        medication, and when necessary hospitalization.
          (8) All too often postpartum depression goes undiagnosed or 
        untreated due to the social stigma surrounding depression and 
        mental illness, the myth of motherhood, the new mother's 
        inability to self-diagnose her condition, the new mother's 
        shame or embarrassment over discussing her depression so near 
        to the birth of her child, the lack of understanding in society 
        and the medical community of the complexity of postpartum 
        depression, and economic pressures placed on hospitals and 
        providers.
          (9) Untreated, postpartum depression can lead to further 
        depression, substance abuse, loss of employment, divorce and 
        further social alienation, self-destructive behavior, or even 
        suicide.
          (10) Untreated, postpartum depression impacts society through 
        its effect on the infant's physical and psychological 
        development, child abuse, neglect, or death of the infant or 
        other siblings, and the disruption of the family.

        TITLE I--RESEARCH ON POSTPARTUM DEPRESSION AND PSYCHOSIS

SEC. 101. EXPANSION AND INTENSIFICATION OF ACTIVITIES.

  (a) In General.--The Secretary of Health and Human Services, acting 
through the Director of the National Institutes of Health and the 
Director of the National Institute of Mental Health (in this title 
referred to as the ``Institute''), is encouraged to continue aggressive 
work on postpartum depression and postpartum psychosis.
  (b) Coordination With Other Institutes.--The Director of the 
Institute should continue to coordinate activities of the Director 
under subsection (a) with similar activities conducted by the other 
national research institutes and agencies of the National Institutes of 
Health to the extent that such Institutes and agencies have 
responsibilities that are related to postpartum conditions.
  (c) Programs for Postpartum Conditions.--In carrying out subsection 
(a), the Director of the Institute is encouraged to continue research 
to expand the understanding of the causes of, and to find a cure for, 
postpartum conditions. Activities under such subsection shall include 
conducting and supporting the following:
          (1) Basic research concerning the etiology and causes of the 
        conditions.
          (2) Epidemiological studies to address the frequency and 
        natural history of the conditions and the differences among 
        racial and ethnic groups with respect to the conditions.
          (3) The development of improved screening and diagnostic 
        techniques.
          (4) Clinical research for the development and evaluation of 
        new treatments, including new biological agents.
          (5) Information and education programs for health care 
        professionals and the public.

SEC. 102. NATIONAL PUBLIC AWARENESS CAMPAIGN.

  (a) In General.--The Director of the National Institutes of Health 
and the Administrator of the Health Resources and Services 
Administration are encouraged to carry out a coordinated national 
campaign to increase the awareness and knowledge of postpartum 
depression and postpartum psychosis.
  (b) Public Service Announcements.--Activities under the national 
campaign under subsection (a) may include public service announcements 
through television, radio, and other means.

SEC. 103. BIENNIAL REPORTING.

  Section 403(a)(5) of the Public Health Service Act (42 U.S.C. 
283(a)(5)) is amended--
          (1) by redesignating subparagraph (L) as subparagraph (M); 
        and
          (2) by inserting after subparagraph (K) the following:
                  ``(L) Depression.''.

SEC. 104. LONGITUDINAL STUDY OF RELATIVE MENTAL HEALTH CONSEQUENCES FOR 
                    WOMEN OF RESOLVING A PREGNANCY.

  (a) Sense of Congress.--It is the sense of Congress that the Director 
of the Institute may conduct a nationally representative longitudinal 
study (during the period of fiscal years 2008 through 2018) of the 
relative mental health consequences for women of resolving a pregnancy 
(intended and unintended) in various ways, including carrying the 
pregnancy to term and parenting the child, carrying the pregnancy to 
term and placing the child for adoption, miscarriage, and having an 
abortion. This study may assess the incidence, timing, magnitude, and 
duration of the immediate and long-term mental health consequences 
(positive or negative) of these pregnancy outcomes.
  (b) Report.--Beginning not later than 3 years after the date of the 
enactment of this Act, and periodically thereafter for the duration of 
the study under subsection (a), the Director of the Institute should 
prepare and submit to the Congress reports on the findings of the 
study.

  TITLE II--DELIVERY OF SERVICES REGARDING POSTPARTUM DEPRESSION AND 
                               PSYCHOSIS

SEC. 201. ESTABLISHMENT OF PROGRAM OF GRANTS.

  (a) In General.--The Secretary of Health and Human Services (in this 
title referred to as the ``Secretary'') should in accordance with this 
title make grants to provide for projects for the establishment, 
operation, and coordination of effective and cost-efficient systems for 
the delivery of essential services to individuals with postpartum 
depression or postpartum psychosis (referred to in this section as a 
``postpartum condition'') and their families.
  (b) Recipients of Grants.--A grant under subsection (a) may be made 
to an entity only if the entity is a public or nonprofit private 
entity, which may include a State or local government; a public or 
nonprofit private hospital, community-based organization, hospice, 
ambulatory care facility, community health center, migrant health 
center, or homeless health center; or any other appropriate public or 
nonprofit private entity.
  (c) Certain Activities.--To the extent practicable and appropriate, 
the Secretary shall ensure that projects under subsection (a) provide 
services for the diagnosis and management of postpartum conditions. 
Activities that the Secretary may authorize for such projects may also 
include the following:
          (1) Delivering or enhancing outpatient and home-based health 
        and support services, including case management, screening, and 
        comprehensive treatment services for individuals with or at 
        risk for postpartum conditions; and delivering or enhancing 
        support services for their families.
          (2) Delivering or enhancing inpatient care management 
        services that ensure the well-being of the mother and family 
        and the future development of the infant.
          (3) Improving the quality, availability, and organization of 
        health care and support services (including transportation 
        services, attendant care, homemaker services, day or respite 
        care, and providing counseling on financial assistance and 
        insurance) for individuals with postpartum conditions and 
        support services for their families.
  (d) Integration With Other Programs.--To the extent practicable and 
appropriate, the Secretary should integrate the program under this 
title with other grant programs carried out by the Secretary, including 
the program under section 330 of the Public Health Service Act.

SEC. 202. CERTAIN REQUIREMENTS.

  A grant may be made under section 201 only if the applicant involved 
makes the following agreements:
          (1) Not more than 5 percent of the grant will be used for 
        administration, accounting, reporting, and program oversight 
        functions.
          (2) The grant will be used to supplement and not supplant 
        funds from other sources related to the treatment of postpartum 
        conditions.
          (3) The applicant will abide by any limitations deemed 
        appropriate by the Secretary on any charges to individuals 
        receiving services pursuant to the grant. As deemed appropriate 
        by the Secretary, such limitations on charges may vary based on 
        the financial circumstances of the individual receiving 
        services.
          (4) The grant will not be expended to make payment for 
        services authorized under section 201(a) to the extent that 
        payment has been made, or can reasonably be expected to be 
        made, with respect to such services--
                  (A) under any State compensation program, under an 
                insurance policy, or under any Federal or State health 
                benefits program; or
                  (B) by an entity that provides health services on a 
                prepaid basis.
          (5) The applicant will, at each site at which the applicant 
        provides services under section 201(a), post a conspicuous 
        notice informing individuals who receive the services of any 
        Federal policies that apply to the applicant with respect to 
        the imposition of charges on such individuals.

SEC. 203. TECHNICAL ASSISTANCE.

  The Secretary may provide technical assistance to assist entities in 
complying with the requirements of this title in order to make such 
entities eligible to receive grants under section 201.

                     TITLE III--GENERAL PROVISIONS

SEC. 301. AUTHORIZATION OF APPROPRIATIONS.

  To carry out this Act and the amendments made by this Act, there are 
authorized to be appropriated--
          (1) $3,000,000 for fiscal year 2008; and
          (2) such sums as may be necessary for fiscal years 2009 and 
        2010.

                          Purpose and Summary

    The purpose of H.R. 20, the Melanie Blocker-Stokes 
Postpartum Depression Research and Care Act, is to provide 
research on and services for individuals with postpartum 
depression and psychosis.

                  Background and Need for Legislation

    Depression is an exceedingly common disorder, affecting 15 
to 25 percent of the population and representing a yearly 
economic burden of $44 billion. Overall, depression is 
frequently undetected, with fewer than 25 percent of patients 
suffering from mental illness actually under the care of a 
mental health specialist. Depression is twice as common in 
women as it is in men, with its peak incidence during the 
primary reproductive years--ages 25 to 45. Because women are 
more likely to experience depression during these years, they 
are especially vulnerable to developing depression during 
pregnancy and after childbirth.
    Following childbirth, some women may experience postpartum 
disorders that can adversely affect a woman's mental health. 
The spectrum of postpartum mood disorders is generally divided 
into three distinct categories. At the mildest end of the 
spectrum is the ``maternity blues'' or ``baby blues.'' Because 
this condition arises after 40 to 85 percent of deliveries, 
practitioners and patients often view it as a normal 
phenomenon. Nonetheless, the patient and their families are 
distressed by the patient's depressed mood, irritability, 
anxiety, confusion, crying spells, mood lability (refers to 
mood swings and the changeability of a person's overall mood 
state), and disturbances in sleep and appetite. These symptoms 
peak between postpartum days 3 and 5, and typically resolve 
spontaneously within 24 to 72 hours.
    At the other end of the spectrum is the truly devastating 
postpartum psychosis. A comparatively rare disease, it 
complicates only 0.1 to 0.2 percent of deliveries. Symptoms 
generally present within the first 4 weeks of postpartum, when 
the risk of hospitalization is 22 times greater, but can 
manifest up to 90 days after delivery. A second smaller peak in 
incidence is evident at 18 to 24 months. Patients suffering 
from postpartum psychosis are severely impaired, suffering from 
hallucinations and delusions that frequently focus on the 
infant dying or being divine or demonic. These hallucinations 
often command that the patient hurt herself or others, placing 
these mothers at the highest risk for committing infanticide 
and/or suicide.
    Between these two extremes is postpartum depression, which 
is recognized as a unique and serious complication of 
childbirth. Its insidious onset and chronic course complicates 
10 to 15 percent of all deliveries and a staggering 26 to 32 
percent of all adolescent deliveries. The majority of patients 
suffer from this illness for more than 6 months and, if 
untreated, 25 percent of patients are still depressed a year 
later. Women with postpartum depression may feel restless, 
anxious, sad, or depressed. They may have feelings of guilt, 
decreased energy and motivation, and a sense of worthlessness. 
They may also have sleep difficulties and undergo unexplained 
weight loss or gain.
    Research suggests that the following factors may contribute 
to the onset of postpartum depression:

          Hormonal Changes: A woman experiences the greatest 
        hormonal fluctuation levels after giving birth. Intense 
        hormone fluctuations, such as decreased serotonin 
        levels, occur after delivery and may play a role in the 
        development of postpartum depression.
          Situational Risks: Childbirth itself is a major life 
        change and transition, and big changes can cause a 
        great deal of stress that result in depression. If a 
        major event coincides with childbirth, a mother may be 
        more susceptible to postpartum depression.
          Life Stresses: Ongoing stressful circumstances can 
        compound the pressure of having a new baby and may 
        trigger postpartum depression.

                                Hearings

    The Committee on Energy and Commerce held a legislative 
hearing on H.R. 20 on May 1, 2007. The Subcommittee heard from 
two panels of witnesses and experts. The first panel consisted 
of testimony by Catherine Roca, M.D., Chief, Women's Programs, 
National Institute of Mental Health, National Institutes of 
Health. The second panel had five witnesses: Nada Scotland, 
M.D., M.P.H., Professor of Psychiatry and Obstetrics/
Gynecology, Rush Medical College, Chicago (testifying on behalf 
of the American Psychiatric Association); Ms. Mary Jo Codey, 
Former First Lady of the State of New Jersey; Ms. Carol 
Blocker, mother of Melanie Blocker-Stokes; Priscilla K. 
Coleman, PhD., Associate Professor of Human Development and 
Family Studies, Bowling State University; and Ms. Michaelene 
Fredenburg, President, Life Perspectives.

                        Committee Consideration

    On Thursday, July 19, 2007, the Subcommittee on Health met 
in open markup session and ordered H.R. 20 favorably forwarded 
to the full Committee, amended, by a voice vote. On Thursday, 
September 27, 2007, the full Committee met in open markup 
session and ordered H.R. 20 favorably reported to the House, as 
amended by the Subcommittee, by a voice vote. No amendments 
were offered during full Committee consideration.

                            Committee Votes

    Clause 3(b) of rule XIII of the Rules of the House of 
Representatives requires the Committee to list the record votes 
on the motion to report legislation and amendments thereto. 
There were no recorded votes taken during consideration or 
reporting H.R. 20. A motion by Mr. Dingell to order H.R. 20 
favorably reported to the House, as amended, was agreed to by a 
voice vote.

                      Committee Oversight Findings

    Pursuant to clause 3(c)(1) of rule XIII of the Rules of the 
House of Representatives, the Subcommittee on Health has held 
legislative hearings on this legislation and made oversight 
findings that are reflected in this report.

         Statement of General Performance Goals and Objectives

    H.R. 20 encourages the Secretary of Health and Human 
Services (HHS), acting through the Director of the National 
Institutes of Health (NIH) and the Director of the National 
Institute of Mental Health (NIMH), to continue aggressive 
research and related activities on postpartum depression and 
postpartum psychosis. H.R. 20 encourages the Director of NIMH 
to conduct or support research to expand the understanding of 
the causes of, and to find a cure for, such conditions. H.R. 20 
states that the Secretary should make grants to establish, 
operate, and coordinate effective and cost-efficient systems 
for the delivery of essential services to individuals with such 
conditions and their families. This legislation further allows 
the Secretary to provide technical assistance to grant 
recipients.

   New Budget Authority, Entitlement Authority, and Tax Expenditures

    In compliance with clause 3(c)(2) of rule XIII of the Rules 
of the House of Representatives, the Committee finds that H.R. 
20 would result in no new or increased budget authority, 
entitlement authority, or tax expenditures.

                  Earmarks and Tax and Tariff Benefits

    In compliance with clause 9 of rule XXI of the Rules of the 
House of Representatives, H.R. 20 does not contain any 
congressional earmarks, limited tax benefits, or limited tariff 
benefits as defined in clause 9(d), 9(e), or 9(f) of rule XXI.

                        Committee Cost Estimate

    The Committee adopts as its own the cost estimate prepared 
by the Director of the Congressional Budget Office pursuant to 
section 402 of the Congressional Budget Act of 1974.

                  Congressional Budget Office Estimate

    Pursuant to clause 3(c)(3) of rule XIII of the Rules of the 
House of Representatives, the following is the cost estimate 
provided by the Congressional Budget Office pursuant to section 
402 of the Congressional Budget Act of 1974:

                                     U.S. Congress,
                               Congressional Budget Office,
                                  Washington, DC, October 12, 2007.
Hon. John D. Dingell,
Chairman, Committee on Energy and Commerce,
House of Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 20, the Melanie 
Blocker-Stokes Postpartum Depression Research and Care Act.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Sarah Evans.
            Sincerely,
                                         Robert A. Sunshine
                                   (For Peter R. Orszag, Director).
    Enclosure.

H.R. 20--Melanie Blocker-Stokes Postpartum Depression Research and Care 
        Act

    Summary: H.R. 20 would encourage the Secretary of Health 
and Human Services (HHS) to continue ongoing activities at the 
National Institutes of Health (NIH) and the Health Resources 
and Services Administration (HRSA) related to research and 
dissemination of information concerning postpartum depression 
or postpartum psychosis. The bill also would direct the 
Secretary to provide grants to public or nonprofit entities to 
establish and operate programs that provide health care and 
support services to individuals with postpartum depression or 
postpartum psychosis.
    The bill would authorize the appropriation for those 
purposes of $3 million for fiscal year 2008 and such sums as 
necessary for fiscal years 2009 and 2010. CBO estimates that 
implementing the bill would cost less than $500,000 in 2008 and 
$18 million over the 2008-2012 period, assuming the 
appropriation of the authorized amounts. Enacting H.R. 20 would 
not affect direct spending or revenues.
    The bill contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act (UMRA); 
any costs to state and local governments would be incurred 
voluntarily.
    Estimated cost to the Federal government: The estimated 
budgetary impact of H.R. 20 is shown in the following table. 
The costs of this legislation fall within budget function 550 
(health).

------------------------------------------------------------------------
                                      By fiscal year, in millions of
                                                 dollars--
                                 ---------------------------------------
                                   2008    2009    2010    2011    2012
------------------------------------------------------------------------
              CHANGES IN SPENDING SUBJECT TO APPROPRIATION

Estimated Authorization Level...       3       3      13       0       0
Estimated Outlays...............       *       2       6       8       2
------------------------------------------------------------------------
Note: * = less than $500,000.

    Basis of estimate: For this estimate, CBO assumes that H.R. 
20 will be enacted near the start of the fiscal year 2008, that 
the authorized amounts will be appropriated for each year, and 
that outlays will follow historical spending patterns for 
similar programs.

Research on postpartum depression and psychosis

    H.R. 20 would encourage the Secretary of HHS, acting 
through the Director of the NIH, to continue research efforts 
related to postpartum depression and postpartum psychosis. Such 
research includes basic research, epidemiological research, the 
development of improved diagnostic techniques, clinical 
research, and information and education programs. According to 
officials at the NIH, the institutes currently support all of 
those activities.
    The bill also would encourage the Director of the NIH and 
the Administrator of HRSA carry out a national campaign, 
potentially including public service announcements, to raise 
awareness of postpartum depression. According to officials at 
the NIH, the institutes already communicate and disseminate 
their research findings as required by law. Both the NIH and 
HRSA sponsor Web sites devoted to postpartum depression. 
According to officials at HHS, HRSA frequently uses public 
service announcements to communicate messages to the public.
    CBO estimates that there would be no cost to HRSA to 
implement those provisions, because they would not involve any 
change in the agency's activities. Likewise, CBO estimates that 
the NIH would incur no costs in 2008 or 2009, because those 
provisions would not require any new activities at the NIH. 
However, under current law (title IV of the Public Health 
Service Act) authorization for the activities of the NIH 
expires at the end of fiscal year 2009. Based on the proportion 
of grants for depression-related research that is specifically 
for postpartum-related depression, CBO estimates that NIH would 
require about $10 million for 2010 to continue its research and 
information-dissemination programs on postpartum depression and 
psychosis. Assuming the appropriation of the necessary amount, 
CBO estimates that implementing those programs would cost $9 
million over the 2010-2012 period.

Grants for services related to postpartum depression and psychosis

    H.R. 20 would authorize the Secretary of HHS to make grants 
to public or nonprofit entities for the establishment, 
operation, and coordination of systems for delivery of services 
to individuals with postpartum depression or postpartum 
psychosis. Not more than 5 percent of these grants could be 
used for administration, accounting, reporting, or program 
oversight. These grants would not be permitted to supplant 
funds from other sources, including federal and state health 
programs.
    For carrying the activities in the entire bill, H.R. 20 
would authorize the appropriation of $3 million in fiscal year 
2008 and such sums as necessary in fiscal years 2009 and 2010. 
CBO estimates that the $3 million authorized for appropriation 
in 2008 would fund a postpartum services grant program 
consistent with the requirements of the bill (none of the $3 
million would be required for the other activities under the 
bill as described above). CBO estimates that an additional $3 
million a year would be necessary to fund the grant program in 
2009 and 2010. Implementing the grant program would cost less 
than $500,000 in 2008 and $9 million over the 2008-2012 period, 
CBO estimates.
    Intergovernmental and Private-Sector Impact: HR. 20 
contains no intergovernmental or private-sector mandates as 
defined in UMRA. Grants authorized in the bill for the study 
and treatment of paralysis and other physical disabilities 
would benefit state and local governments that provide services 
for diagnosing and managing postpartum depression. Any costs to 
those governments to comply with grant conditions would be 
incurred voluntarily.
    Estimate prepared by: Federal Costs: Sarah Evans; Impact on 
State, Local, and Tribal Governments: Lisa Ramirez-Branum; 
Impact on the Private Sector: Keisuke Nakagawa.
    Estimate approved by: Keith J. Fontenot, Deputy Assistant 
Director for Health and Human Resources, Budget Analysis 
Division.

                       Federal Mandates Statement

    The Committee adopts as its own the estimate of Federal 
mandates prepared by the Director of the Congressional Budget 
Office pursuant to section 423 of the Unfunded Mandates Reform 
Act.

                      Advisory Committee Statement

    No advisory committees within the meaning of section 5(b) 
of the Federal Advisory Committee Act were created by this 
legislation.

                   Constitutional Authority Statement

    Pursuant to clause 3(d)(1) of rule XIII of the Rules of the 
House of Representatives, the Committee finds that the 
Constitutional authority for this legislation is provided in 
the provisions of Article I, section 8, clause 1 that relate to 
expending funds to provide for the general welfare of the 
United States.

                  Applicability to Legislative Branch

    The Committee finds that the legislation does not relate to 
the terms and conditions of employment or access to public 
services or accommodations within the meaning of section 
102(b)(3) of the Congressional Accountability Act.

             Section-by-Section Analysis of the Legislation

Section 1. Short title

    Section 1 establishes the short title of the Act as the 
``Melanie Blocker-Stokes Postpartum Depression Research and 
Care Act.''

Section 2. Findings

    Section 2 sets out the findings of the Act.

Title I. Research on postpartum depression and psychosis

    Title I addresses the activities and research related to 
postpartum depression and psychosis. Section 101 encourages the 
Secretary of Health and Human Services, the Director of the 
National Institute of Mental Health, and the Director of the 
National Institutes of Health to coordinate activities and 
continue aggressive work with respect to postpartum depression 
and postpartum psychosis. In addition, the Director of NIMH is 
encouraged to continue supporting research on understanding the 
causes of postpartum depressions and finding a cure through 
activities such as basic research concerning the etiology and 
causes of the conditions; epidemiological studies to address 
the frequency and natural history of the conditions and the 
differences among racial and ethnic groups with respect to the 
conditions; development of improved screening and diagnostic 
techniques; clinical research for the development and 
evaluation of new treatments; and information and education 
programs for healthcare professionals and the public.
    Section 102 encourages the Director of NIH and the 
Administrator of the Health Resources and Services 
Administration to carry out a coordinated national campaign to 
increase the awareness and knowledge of postpartum depression 
and postpartum psychosis.
    Section 103 amends a section of the Public Health Service 
Act that requires the Director of NIH to submit a biennial 
report to Congress providing summaries of the research 
activities throughout the agency with respect to certain 
diseases, conditions, and issues. Section 103 adds 
``depression'' as one of the conditions for which NIH must 
provide information about in the biennial report.
    Section 104 includes a sense of Congress that the Director 
of NIMH may conduct a nationally representative longitudinal 
study of the relative mental health consequences for women of 
resolving a pregnancy in various ways including carrying the 
pregnancy to term and parenting the child, carrying the 
pregnancy to term and placing the child for adoption, 
miscarriage, and having an abortion.

Title II. Delivery of services regarding postpartum depression and 
        psychosis

    Title II addresses the establishment of grant programs 
related to postpartum depression and psychosis. Section 201 
directs the Secretary of HHS to make grants to provide for 
projects for the establishment, operation, and coordination of 
effective and cost-efficient systems for the delivery of 
essential services to individuals with postpartum depression or 
postpartum psychosis. Recipients of these grants must be either 
a public or nonprofit private entity, which may include a State 
or local government; a public or nonprofit private hospital, 
community-based organization, hospice, ambulatory care 
facility, community health center, migrant health or homeless 
health center; or other appropriate public or nonprofit private 
entity. To the extent practicable, the Secretary shall ensure 
that these grants provide services for the diagnosis and 
management of postpartum conditions.
    Section 202 requires that grant recipients meet certain 
requirements and make the following agreements: (1) not more 
than 5 percent of the grant will be used for administration, 
accounting, reporting, and program oversight functions; (2) the 
grant will be used to supplement and not supplant funds from 
other sources related to the treatment of postpartum 
conditions; (3) the applicant will abide by any limitations 
deemed appropriate by the Secretary on any charges to 
individuals receiving services pursuant to the grant; (4) the 
grant will not be expended to make payment for services 
authorized under section 201(a) to the extent that payment has 
been made, or can reasonably be expected to be made; and (5) 
the applicant will, at each site at which the applicant 
provides services under section 201(a), post a conspicuous 
notice informing individuals who receive the services of any 
Federal policies that apply to the applicant with respect to 
the imposition of charges on such individuals.
    Section 203 states that the Secretary may provide technical 
assistance to assist entities in complying with the 
requirements of this title in order to make such entities 
eligible to receive grants under section 201.

Title III. General provisions

    Title III authorizes $3,000,000 to be appropriated for 
fiscal year 2008, and such sums as may be necessary for fiscal 
years 2009 and 2010.

         Changes in Existing Law Made by the Bill, as Reported

    In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italic, existing law in which no change is 
proposed is shown in roman):

PUBLIC HEALTH SERVICE ACT

           *       *       *       *       *       *       *

                 TITLE IV--NATIONAL RESEARCH INSTITUTES

PART A--National Institutes of Health

           *       *       *       *       *       *       *

SEC. 403. BIENNIAL REPORTS OF DIRECTOR OF NIH.

    (a) In General.--The Director of NIH shall submit to the 
Congress on a biennial basis a report in accordance with this 
section. The first report shall be submitted not later than 1 
year after the date of the enactment of the National Institutes 
of Health Reform Act of 2006. Each such report shall include 
the following information:
          (1) * * *

           *       *       *       *       *       *       *

          (5) A summary of the research activities throughout 
        the agencies, which summary shall be organized by the 
        following categories, where applicable:
                  (A) * * *

           *       *       *       *       *       *       *

                  (L) Depression.
                  [(L)] (M) Such additional categories as the 
                Director determines to be appropriate.

           *       *       *       *       *       *       *

                                  
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```