39–006 

113TH CONGRESS REPORT " ! HOUSE OF REPRESENTATIVES 2d Session 113–490 

AUTISM COLLABORATION, ACCOUNTABILITY, RESEARCH, 

EDUCATION, AND SUPPORT ACT OF 2014 

JUNE 23, 2014.—Committed to the Committee of the Whole House on the State of 

the Union and ordered to be printed 

Mr. UPTON, from the Committee on Energy and Commerce, 

submitted the following 

R E P O R T 

[To accompany H.R. 4631] 

[Including cost estimate of the Congressional Budget Office] 

The Committee on Energy and Commerce, to whom was referred 

the bill (H.R. 4631) to reauthorize certain provisions of the Public 

Health Service Act relating to autism, and for other purposes, having considered the same, report favorably thereon with an amendment and recommend that the bill as amended do pass. 

CONTENTS 

Page 

Purpose and Summary ............................................................................................ 5 

Background and Need for Legislation .................................................................... 5 

Hearings ................................................................................................................... 7 

Committee Consideration ........................................................................................ 7 

Committee Votes ...................................................................................................... 7 

Committee Oversight Findings ............................................................................... 7 

Statement of General Performance Goals and Objectives .................................... 7 

New Budget Authority, Entitlement Authority, and Tax Expenditures ............. 7 

Earmark, Limited Tax Benefits, and Limited Tariff Benefits ............................. 7 

Committee Cost Estimate ....................................................................................... 8 

Congressional Budget Office Estimate ................................................................... 8 

Federal Mandates Statement ................................................................................. 10 

Duplication of Federal Programs ............................................................................ 10 

Disclosure of Directed Rule Makings ..................................................................... 10 

Advisory Committee Statement .............................................................................. 10 

Applicability to Legislative Branch ........................................................................ 10 

Section-by-Section Analysis of the Legislation ...................................................... 10 

Changes in Existing Law Made by the Bill, as Reported ..................................... 11 

The amendment is as follows: 

Strike all after the enacting clause and insert the following: 


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SECTION 1. SHORT TITLE. 

This Act may be cited as the ‘‘Autism Collaboration, Accountability, Research, 

Education, and Support Act of 2014’’ or the ‘‘Autism CARES Act of 2014’’. 

SEC. 2. NATIONAL AUTISM SPECTRUM DISORDER INITIATIVE. 

(a) IN GENERAL.—The Secretary of Health and Human Services shall designate 

an existing official within the Department of Health and Human Services to oversee, in consultation with the Secretaries of Defense and Education, national autism 

spectrum disorder research, services, and support activities. 

(b) DUTIES.—The official designated under subsection (a) shall— 

(1) implement autism spectrum disorder activities, taking into account the 

strategic plan developed by the Interagency Autism Coordinating Committee 

under section 399CC(b) of the Public Health Service Act (42 U.S.C. 280i–2(b)); 

and 

(2) ensure that autism spectrum disorder activities of the Department of 

Health and Human Services and of other Federal departments and agencies are 

not unnecessarily duplicative. 

SEC. 3. RESEARCH PROGRAM. 

Section 399AA of the Public Health Service Act (42 U.S.C. 280i) is amended— 

(1) in subsection (a)(1), by inserting ‘‘for children and adults’’ after ‘‘reporting 

of State epidemiological data’’; 

(2) in subsection (b)(1)— 

(A) by striking ‘‘establishment of regional centers of excellence’’ and inserting ‘‘establishment or support of regional centers of excellence’’; and 

(B) by inserting ‘‘for children and adults’’ before the period at the end; 

(3) in subsection (b)(2), by striking ‘‘center to be established’’ and inserting 

‘‘center to be established or supported’’; and 

(4) in subsection (e), by striking ‘‘2014’’ and inserting ‘‘2019’’. 

SEC. 4. AUTISM INTERVENTION. 

Section 399BB of the Public Health Service Act (42 U.S.C. 280i–1) is amended— 

(1) in subsection (b)(1), by inserting ‘‘culturally competent’’ after ‘‘provide’’; 

(2) in subsection (c)(2)(A)(ii), by inserting ‘‘(which may include respite care for 

caregivers of individuals with an autism spectrum disorder)’’ after ‘‘services and 

supports’’; 

(3) in subsection (e)(1)(B)(v), by inserting before the semicolon the following: 

‘‘, which may include collaborating with research centers or networks to provide 

training for providers of respite care (as defined in section 2901)’’; 

(4) in subsection (f), by striking ‘‘grants or contracts’’ and all that follows 

through ‘‘for individuals with’’ and inserting ‘‘grants or contracts, which may include grants or contracts to research centers or networks, to determine the evidence-based practices for interventions to improve the physical and behavioral 

health of individuals with’’; and 

(5) in subsection (g), by striking ‘‘2014’’ and inserting ‘‘2019’’. 

SEC. 5. INTERAGENCY AUTISM COORDINATING COMMITTEE. 

Section 399CC of the Public Health Service Act (42 U.S.C. 280i–2) is amended— 

(1) in subsection (b)— 

(A) in paragraph (1)— 

(i) by striking ‘‘and annually update’’; and 

(ii) by striking ‘‘intervention’’ and inserting ‘‘interventions, including 

school and community-based interventions’’; 

(B) by striking paragraph (2); 

(C) by redesignating paragraph (1) as paragraph (2), and inserting before 

such redesignated paragraph the following: 

‘‘(1) monitor autism spectrum disorder research, and to the extent practicable 

services and support activities, across all Federal departments and agencies, including coordination of Federal activities with respect to autism spectrum disorder;’’; 

(D) in paragraph (3), by striking ‘‘recommendations to the Director of 

NIH’’; 

(E) in paragraph (4), by inserting before the semicolon the following: ‘‘, 

and the process by which public feedback can be better integrated into such 

decisions’’; and 

(F) by striking paragraphs (5) and (6) and inserting the following: 

‘‘(5) develop a strategic plan for the conduct of, and support for, autism spectrum disorder research and services and supports for individuals with an autism spectrum disorder and the families of such individuals, which shall include— 

‘‘(A) proposed budgetary requirements; and 


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‘‘(B) recommendations to ensure that autism spectrum disorder research, 

services, and support activities of the Department of Health and Human 

Services and of other Federal departments and agencies are not unnecessarily duplicative; and 

‘‘(6) submit to Congress and the President— 

‘‘(A) an annual update on the summary of advances described in paragraph (2); and 

‘‘(B) an annual update to the strategic plan described in paragraph (5), 

including any progress made in achieving the goals outlined in such strategic plan.’’; 

(2) in subsection (c)— 

(A) in paragraph (1)— 

(i) by striking the paragraph designation, the heading, and the matter preceding subparagraph (A) and inserting the following: 

‘‘(1) FEDERAL MEMBERSHIP.—The Committee shall be composed of the following Federal members—’’; 

(ii) in subparagraph (C)— 

(I) by inserting ‘‘, such as the Administration for Community Living, Administration for Children and Families, the Centers for 

Medicare & Medicaid Services, the Food and Drug Administration, 

and the Health Resources and Services Administration’’ before the 

semicolon at the end; and 

(II) by adding at the end ‘‘and’’; 

(iii) in subparagraph (D)— 

(I) by inserting ‘‘and the Department of Defense’’ after ‘‘Department of Education’’; and 

(II) by striking at the end ‘‘; and’’ and inserting a period; and 

(iv) by striking subparagraph (E); 

(B) in paragraph (2)— 

(i) in the paragraph heading, by striking ‘‘ADDITIONAL’’ and inserting 

‘‘NON-FEDERAL’’; 

(ii) in the matter preceding subparagraph (A), by striking ‘‘Not fewer 

than 6 members of the Committee, or 1/3 of the total membership of 

the Committee, whichever is greater’’ and inserting ‘‘Not more than 1⁄2, 

but not fewer than 1/3, of the total membership of the Committee’’; 

(iii) in subparagraph (A), by striking ‘‘one such member shall be an 

individual’’ and inserting ‘‘two such members shall be individuals’’; 

(iv) in subparagraph (B), by striking ‘‘one such member shall be a 

parent or legal guardian’’ and inserting ‘‘two such members shall be 

parents or legal guardians’’; and 

(v) in subparagraph (C), by striking ‘‘one such member shall be a representative’’ and inserting ‘‘two such members shall be representatives’’; and 

(C) by adding at the end the following: 

‘‘(3) PERIOD OF APPOINTMENT; VACANCIES.— 

‘‘(A) PERIOD OF APPOINTMENT FOR NON-FEDERAL MEMBERS.—Non-Federal 

members shall serve for a term of 4 years, and may be reappointed for one 

or more additional 4-year terms. 

‘‘(B) VACANCIES.—A vacancy on the Committee shall be filled in the manner in which the original appointment was made and shall not affect the 

power or duties of the Committee. Any member appointed to fill a vacancy 

for an unexpired term shall be appointed for the remainder of such term. 

A member may serve after the expiration of the member’s term until a successor has been appointed.’’; 

(3) in subsection (d)— 

(A) by striking paragraph (2); and 

(B) by redesignating paragraphs (3) and (4) as paragraphs (2) and (3), respectively; and 

(4) in subsection (f), by striking ‘‘2014’’ and inserting ‘‘2019’’. 

SEC. 6. REPORTS. 

Section 399DD of the Public Health Service Act (42 U.S.C. 280i–3) is amended— 

(1) in the section heading, by striking ‘‘REPORT’’ and inserting ‘‘REPORTS’’; 

(2) in subsection (b), by redesignating paragraphs (1) through (9) as subparagraphs (A) through (I), respectively, and realigning the margins accordingly; 

(3) by redesignating subsections (a) and (b) as paragraphs (1) and (2), respectively, and realigning the margins accordingly; 

(4) by inserting after the section heading the following: 

‘‘(a) PROGRESS REPORT.—’’; 


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(5) in subsection (a)(1) (as so redesignated)— 

(A) by striking ‘‘2 years after the date of enactment of the Combating Autism Reauthorization Act of 2011’’ and inserting ‘‘4 years after the date of 

enactment of the Autism CARES Act of 2014’’; 

(B) by inserting ‘‘and the Secretary of Defense’’ after ‘‘the Secretary of 

Education’’; and 

(C) by inserting ‘‘, and make publicly available, including through posting 

on the Internet Web site of the Department of Health and Human Services,’’ after ‘‘Representatives’’; and 

(6) in subsection (a)(2) (as so redesignated)— 

(A) in subparagraph (A), (as so redesignated), by striking ‘‘Combating Autism Act of 2006’’ and inserting ‘‘Autism CARES Act of 2014’’; 

(B) in subparagraph (B) (as so redesignated), by striking ‘‘particular provisions of Combating Autism Act of 2006’’ and inserting ‘‘amendments made 

by the Autism CARES Act of 2014’’; 

(C) by striking subparagraph (C) (as so redesignated), and inserting the 

following: 

‘‘(C) information on the incidence and prevalence of autism spectrum disorder, including available information on the prevalence of autism spectrum 

disorder among children and adults, and identification of any changes over 

time with respect to the incidence and prevalence of autism spectrum disorder;’’; 

(D) in subparagraph (D) (as so redesignated), by striking ‘‘6-year period 

beginning on the date of enactment of the Combating Autism Act of 2006’’ 

and inserting ‘‘4-year period beginning on the date of enactment of the Autism CARES Act of 2014 and, as appropriate, how this age varies across 

populations subgroups’’; 

(E) in subparagraph (E) (as so redesignated), by striking ‘‘6-year period 

beginning on the date of enactment of the Combating Autism Act of 2006’’ 

and inserting ‘‘4-year period beginning on the date of enactment of the Autism CARES Act of 2014 and, as appropriate, how this age varies across 

populations subgroups’’; 

(F) in subparagraph (F) (as so redesignated), by inserting ‘‘and, as appropriate, on how such average time varies across populations subgroups’’ before the semicolon at the end; 

(G) in subparagraph (G) (as so redesignated)— 

(i) by striking ‘‘including by various subtypes,’’ and inserting ‘‘including by severity level as practicable,’’; and 

(ii) by striking ‘‘child may’’ and inserting ‘‘child or other factors, such 

as demographic characteristics, may’’; and 

(H) by striking subparagraph (I) (as so redesignated), and inserting the 

following: 

‘‘(I) a description of the actions taken to implement and the progress 

made on implementation of the strategic plan developed by the Interagency 

Autism Coordinating Committee under section 399CC(b).’’; and 

(7) by adding at the end the following new subsection: 

‘‘(b) REPORT ON YOUNG ADULTS AND TRANSITIONING YOUTH.— 

‘‘(1) IN GENERAL.—Not later than 2 years after the date of enactment of the 

Autism CARES Act of 2014, the Secretary, in coordination with the Secretary 

of Education and in collaboration with the Secretary of Transportation, the Secretary of Labor, the Secretary of Housing and Urban Development, and the Attorney General, shall prepare and submit to the Committee on Health, Education, Labor, and Pensions of the Senate and the Committee on Energy and 

Commerce of the House of Representatives, a report concerning young adults 

with autism spectrum disorder and the challenges related to the transition from 

existing school-based services to those services available during adulthood. 

‘‘(2) CONTENTS.—The report submitted under paragraph (1) shall contain— 

‘‘(A) demographic characteristics of youth transitioning from school-based 

to community-based supports; 

‘‘(B) an overview of policies and programs relevant to young adults with 

autism spectrum disorder relating to post-secondary school transitional 

services, including an identification of existing Federal laws, regulations, 

policies, research, and programs; 

‘‘(C) proposals on establishing best practices guidelines to ensure— 

‘‘(i) interdisciplinary coordination between all relevant service providers receiving Federal funding; 

‘‘(ii) coordination with transitioning youth and the family of such 

transitioning youth; and 


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‘‘(iii) inclusion of the individualized education program for the 

transitioning youth, as prescribed in section 614 of the Individuals with 

Disabilities Education Act (20 U.S.C. 1414); 

‘‘(D) comprehensive approaches to transitioning from existing schoolbased services to those services available during adulthood, including— 

‘‘(i) services that increase access to, and improve integration and completion of, post-secondary education, peer support, vocational training 

(as defined in section 103 of the Rehabilitation Act of 1973 (29 U.S.C. 

723)), rehabilitation, self-advocacy skills, and competitive, integrated 

employment; 

‘‘(ii) community-based behavioral supports and interventions; 

‘‘(iii) community-based integrated residential services, housing, and 

transportation; 

‘‘(iv) nutrition, health and wellness, recreational, and social activities; 

‘‘(v) personal safety services for individuals with autism spectrum 

disorder related to public safety agencies or the criminal justice system; 

and 

‘‘(vi) evidence-based approaches for coordination of resources and 

services once individuals have aged out of post-secondary education; 

and 

‘‘(E) proposals that seek to improve outcomes for adults with autism spectrum disorder making the transition from a school-based support system to 

adulthood by— 

‘‘(i) increasing the effectiveness of programs that provide transition 

services; 

‘‘(ii) increasing the ability of the relevant service providers described 

in subparagraph (C) to provide supports and services to underserved 

populations and regions; 

‘‘(iii) increasing the efficiency of service delivery to maximize resources and outcomes, including with respect to the integration of and 

collaboration among services for transitioning youth; 

‘‘(iv) ensuring access to all services necessary to transitioning youth 

of all capabilities; and 

‘‘(v) encouraging transitioning youth to utilize all available transition 

services to maximize independence, equal opportunity, full participation, and self-sufficiency.’’. 

SEC. 7. AUTHORIZATION OF APPROPRIATIONS. 

Section 399EE of the Public Health Service Act (42 U.S.C. 280i–4) is amended— 

(1) in subsection (a), by striking ‘‘fiscal years 2012 through 2014’’ and inserting ‘‘fiscal years 2015 through 2019’’; 

(2) in subsection (b), by striking ‘‘fiscal years 2011 through 2014’’ and inserting ‘‘fiscal years 2015 through 2019’’; and 

(3) in subsection (c), by striking ‘‘$161,000,000 for each of fiscal years 2011 

through 2014’’ and inserting ‘‘$190,000,000 for each of fiscal years 2015 through 

2019’’. 

PURPOSE AND SUMMARY

H.R. 4631, ‘‘Autism Collaboration, Accountability, Research, Education, and Support Act of 2014’’ or the ‘‘Autism CARES Act of 

2014’’ was introduced on May 9, 2014 by Rep. Chris Smith (R-NJ) 

and Rep. Michael Doyle (D–PA) and referred to the Committee on 

Energy and Commerce. 

BACKGROUND AND NEED FOR LEGISLATION

Autism spectrum disorder (ASD) is a range of complex 

neurodevelopment disorders, characterized by social impairments, 

communication difficulties, and repetitive patterns of behavior. The 

disorder can range in severity from milder forms known as 

Asperger syndrome to more severe forms. The Centers for Disease 

Control and Prevention (CDC) estimates that about 1 in 68 children have been identified with ASD. Boys are five times more likely to have ASD. This is a tenfold increase in prevalence in ASD 


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1http://www.cdc.gov/ncbddd/autism/index.html. 

2http://www.ninds.nih.gov/disorders/autism/detaillautism.htm. 

over the last 40 years, primarily due to better awareness, surveillance, and diagnosis.1

Although the cause of ASD is unclear, science has determined 

that genetics and environment are factors. Researchers have identified a number of genes associated with the disorder. Studies of people with ASD have found irregularities in several regions of the 

brain along with abnormal levels of brain chemicals that could affect normal brain development during gestation. This research is 

preliminary, and further study is needed.2

In 2000, Congress passed the Children’s Health Act to address 

the growing need for research and resources directed toward ASD 

and other developmental disorders. Activities included surveillance, 

education, and research. It also established the Interagency Autism 

Coordinating Committee (IACC). In 2006, Congress passed the 

Combating Autism Act (CAA) that reauthorized provisions in the 

Children’s Health Act related to ASD and required the development of an overall strategic plan. In 2011, CAA was reauthorized 

again to continue research at the National Institutes of Health 

(NIH), surveillance at the CDC, and education and early detection 

activities at the Health Resources and Services Administration 

(HRSA). The IACC also was reauthorized. It expires in 2014. 

The Autism CARES Act 2014 would reauthorize the Combating 

Autism Reauthorization Act (CARA) of 2011. The bill would continue current Federal activities related to autism, including biomedical research, surveillance, and education. The bill would require the Secretary to appoint an existing Federal official to oversee the Federal activities related to ASD, including the strategic 

plan, and ensure that activities are not unnecessarily duplicative. 

In addition, within 2 years, the Secretary would prepare a report 

that studies the needs of autistic youth transitioning into adulthood. The IACC would be reauthorized and include requirements 

for Federal and non-Federal membership. 

In implementing the programmatic and research initiatives funded by this Act, the Committee strongly encourages Federal agencies 

to pay particular attention to the need to focus on early diagnosis 

and intervention in children ages 5 or younger. With new advances 

in scientific research relating to autism, it is important that Federal agencies are aware of and taking into account that the average 

age of diagnosis could drop, in the very near term, from ages 4 and 

5 to toddlers and younger. The Committee is aware that there is 

evidence-based science that will make it possible to identify signs 

of autism present in the first year or two of life, thereby opening 

a window for even earlier diagnosis and intervention in the future. 

The Committee is aware that such scientific progress could create 

significant societal and economic benefits if intervention and treatment can start earlier than previously thought possible. This could 

improve dramatically the quality of life for children with autism, 

permit them to have more fulfilling and productive lives, and could 

lower substantially the costs associated with their education and 

health care over their lifetimes. 

The Committee appreciates the diverse makeup of IACC, and 

would like the panel to continue to represent the diversity within 


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the autism community and remain a place where all viewpoints 

can be heard. Current members include parents and legal guardians, individuals with an autism diagnosis, advocacy organizations, 

and medical researchers. The Committee believes that these groups 

should continue to be represented. After previous reauthorizations 

of the Combating Autism Act, IACC has been dissolved and reconstituted. The Committee believes that this is unproductive and disruptive, and would like IACC to remain active, as the changes in 

this bill are instituted to ensure continuity. 

HEARINGS

The Committee on Energy and Commerce has not held hearings 

on the legislation. 

COMMITTEE CONSIDERATION

On May 28, 2014, the Subcommittee on Health met in open 

markup session and forwarded H.R. 4631 to the full Committee, as 

amended, by a voice vote. On June 10, 2014, the full Committee 

met in open markup session and ordered H.R. 4631 reported to the 

House, as amended, by voice vote. 

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 

record votes taken in connection with ordering H.R. 4631 reported. 

A motion by Mr. Upton to order H.R. 4631 reported to the House, 

with amendment, 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 Committee has not held hearings on this 

legislation. 

STATEMENT OF GENERAL PERFORMANCE GOALS AND OBJECTIVES

H.R. 4631 reauthorizes Federal activities related to ASD and provides direction to the relevant agencies to improve these activities. 

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. 4631, 

would result in no new or increased budget authority, entitlement 

authority, or tax expenditures or revenues. 

EARMARK, LIMITED TAX BENEFITS, AND LIMITED TARIFF BENEFITS

In compliance with clause 9(e), 9(f), and 9(g) of rule XXI of the 

Rules of the House of Representatives, the Committee finds that 

H.R. 4631 contains no earmarks, limited tax benefits, or limited 

tariff benefits. 


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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, June 20, 2014. 

Hon. FRED UPTON, 

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. 4631, the Autism Collaboration, Accountability, Research, Education, and Support Act of 

2014. This estimate supersedes CBO’s original estimate that was 

transmitted on June 18, 2014. It corrects an error in stating the 

bill’s authorization amount of $190 million a year for the National 

Institutes of Health. There is no change to CBO’s estimate of outlays under the bill. 

If you wish further details on this estimate, we will be pleased 

to provide them. The CBO staff contact is Lisa Ramirez-Branum. 

Sincerely, 

DOUGLAS W. ELMENDORF. 

Enclosure. 

H.R. 4631—Autism Collaboration, Accountability, Research, Education, and Support Act of 2014 

Summary: H.R. 4631 would amend the Public Health Service Act 

to reauthorize research, surveillance, and education activities related to autism spectrum disorders (autism) conducted by various 

agencies within the Department of Health and Human Services 

(HHS). Those activities are conducted by the Centers for Disease 

Control and Prevention (CDC), the Health Resources and Services 

Administration (HRSA), and the National Institutes of Health 

(NIH). 

The bill would authorize appropriations for autism activities at 

HHS of $260 million in 2015 and $1.3 billion over the 2015–2019 

period. CBO estimates that implementing H.R. 4631 would cost 

$1.1 billion over the 2015–2019 period, assuming appropriation of 

the authorized amounts. Pay-as-you-go procedures do not apply to 

this legislation because it 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). 

Estimated cost to the Federal Government: The estimated budgetary effect of H.R. 4631 is shown in the following table. The costs 

of this legislation fall within budget function 550 (health). 


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By fiscal year, in million of dollars— 

2015 2016 2017 2018 2019 2015– 

2019 

CHANGES IN SPENDING SUBJECT TO APPROPRIATION 

CDC: 

Authorization Level .............................................................. 22 22 22 22 22 110 

Estimated Outlays ............................................................... 10 20 20 20 20 90 

HRSA: 

Authorization Level .............................................................. 48 48 48 48 48 240 

Estimated Outlays ............................................................... 25 45 45 50 50 215 

NIH: 

Authorization Level .............................................................. 190 190 190 190 190 950 

Estimated Outlays ............................................................... 50 150 180 185 190 755 

Total Changes: 

Authorization Level ..................................................... 260 260 260 260 260 1,300 

Estimated Outlays ...................................................... 85 215 245 255 260 1,060 

Note: CDC = Centers for Disease Control and Prevention; HRSA = Health Resources and Services Administration; NIH = National Institutes of Health. 

Basis of estimate: The CDC, HRSA, and NIH administer programs that support activities to prevent, diagnose, and treat autism. The Congress appropriated $259 million for such activities in 

2014; however, authority to operate those programs expires at the 

end of fiscal year 2014. H.R. 4631 would reauthorize funding for 

these activities through 2019 at a level of $260 million per year. 

For this estimate, CBO assumes that H.R. 4631 will be enacted 

near the end of fiscal year 2014 and that the authorized amounts 

will be appropriated near the beginning of each fiscal year. The estimate of outlays is based on historical spending patterns for CDC, 

HRSA, and NIH activities. 

The CDC currently administers several surveillance and research 

programs directed at determining the prevalence of autism and the 

risk factors for developing autism, as well as raising awareness of 

the signs of autism for families, health care providers, and 

childcare educators. The Congress appropriated approximately $22 

million for those activities in fiscal year 2014. The bill would authorize the appropriation of $22 million annually over the 2015– 

2019 period for such programs. CBO estimates that implementing 

those provisions would cost $90 million over the 2015–2019 period. 

HRSA currently operates several programs to train health care 

providers in the delivery of care to children with autism and other 

developmental disabilities. The Congress appropriated approximately $47 million for those activities in fiscal year 2014. The legislation would authorize the appropriation of $48 million for each 

of fiscal years 2015 through 2019 for HRSA to continue such activities. CBO estimates that implementing those provisions would cost 

$215 million over the 2015–2019 period. 

H.R. 4631 also would reauthorize programs and activities carried 

out by NIH to advance autism research and treatment including 

the Autism Centers of Excellence program. The Congress appropriated $190 million for those activities in fiscal year 2014. The bill 

would authorize the appropriation of $190 million for each of fiscal 

years 2015 through 2019 for NIH to continue such activities. CBO 

estimates that implementing those provisions would cost $755 million over the 2015–2019 period. 

Pay-As-You-Go considerations: None. 

Intergovernmental and private-sector impact: H.R. 4631 contains 

no intergovernmental or private-sector mandates as defined in 


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UMRA. The bill would benefit state, local, and tribal governments 

that receive grants related to autism spectrum disorders. 

Previous CBO estimate: On June 18, 2014, CBO transmitted a 

cost estimate for H.R. 4631, the Autism Collaboration, Accountability, Research, Education, and Support Act of 2014, as ordered 

reported by the House Committee on Energy and Commerce on 

June 10, 2014. That previous estimate incorrectly stated that the 

legislation authorized the appropriation of $191 million a year for 

each of fiscal years 2015 through 2019 for NIH to carry out autismrelated activities. This revised estimate corrects the amounts authorized to be equal to $190 million a year for each of fiscal years 

2015 through 2019. There is no change to CBO’s estimate of outlays under the bill. 

Estimate prepared by: Federal costs: Lisa Ramirez-Branum and 

Santiago Vallinas; Impact on state, local, and tribal governments: 

J’nell L. Blanco; Impact on the private sector: Sam Trachtman. 

Estimate approved by: Holly Harvey, Deputy Assistant Director 

for Budget Analysis. 

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. 

DUPLICATION OF FEDERAL PROGRAMS

No provision of H.R. 4631 establishes or reauthorizes a program 

of the Federal Government known to be duplicative of another Federal program, a program that was included in any report from the 

Government Accountability Office to Congress pursuant to section 

21 of Public Law 111–139, or a program related to a program identified in the most recent Catalog of Federal Domestic Assistance. 

DISCLOSURE OF DIRECTED RULE MAKINGS

The Committee estimates that enacting H.R. 4631 specifically directs to be completed 0 rule makings within the meaning of 5 

U.S.C. 551. 

ADVISORY COMMITTEE STATEMENT

No advisory committees within the meaning of section 5(b) of the 

Federal Advisory Committee Act were created by this legislation. 

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 provides the short title of ‘‘Autism Collaboration, Accountability, Research, Education, and Support Act of 2014’’ or the 

‘‘Autism CARES Act of 2014.’’ 


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Section 2. National Autism Spectrum Disorder Initiative 

Section 2 would require the Secretary to appoint an existing official to oversee the activities related to autism including the strategic plan and ensure the elimination of unnecessary duplication in 

activities. 

Section 3. Research program 

Section 3 would require the CDC to collect data on both children 

and adults with autism. 

Section 4. Autism intervention 

Section 4 would require that activities related to autism early 

education, early detection, and intervention be culturally competent. The bill also would provide for the identification of evidence-based practices and the training of respite caregivers. 

Section 5. Interagency Autism Coordinating Committee 

Section 5 would require the IACC, as part of its responsibilities, 

to include school and community-based interventions in the summary of advances; monitor research, services, and support activities 

across Federal departments and agencies; and include a plan for 

the conduct of and support for ASD research and services and supports for individuals with ASD and their families in the strategic 

plan. Federal members of the IACC can include the Department of 

Defense, the Department of Education, the Administration for 

Community Living, the Administration for Children and Families, 

the Centers for Medicare and Medicaid Services, the Food and 

Drug Administration, and the Health Resources and Services Administration. Non-Federal members would include at least 2 members from each of the following groups: parents, persons with ASD, 

and advocacy groups. 

Section 6. Reports 

Section 6 would extend the time frame for the progress report 

from 2 to 4 years and coordinate with the Secretary of Defense in 

the preparation of the report. The report would include data on the 

incidence and prevalence of ASD among children and adults and 

any changes over time and a description of actions made on the implementation of the strategic plan. The section would require the 

Secretary to prepare and submit a report on the needs and challenges of autistic youth transitioning from school-based services to 

adult, community-based services. 

Section 7. Authorization of appropriations 

Section 7 would reauthorize CDC activities at $22 million for 

each of FY 2015 through FY 2019; HRSA activities at $48 million 

for each of FY 2015 through FY 2019; and NIH/IACC activities at 

$190 million for each of FY 2015 through FY 2019. 

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 omitVerDate Mar 15 2010 04:03 Jun 26, 2014 Jkt 039006 PO 00000 Frm 00011 Fmt 6659 Sfmt 6602 E:\HR\OC\HR490.XXX HR490

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ted 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 III—GENERAL POWERS AND DUTIES OF PUBLIC 

HEALTH SERVICE 

* * * * * * * 

PART R—PROGRAMS RELATING TO AUTISM 

SEC. 399AA. DEVELOPMENTAL DISABILITIES SURVEILLANCE AND RESEARCH PROGRAM. 

(a) AUTISM SPECTRUM DISORDER AND OTHER DEVELOPMENTAL

DISABILITIES.— (1) IN GENERAL.—The Secretary, acting through the Director 

of the Centers for Disease Control and Prevention, may award 

grants or cooperative agreements to eligible entities for the collection, analysis, and reporting of State epidemiological data 

for children and adults on autism spectrum disorder and other 

developmental disabilities. An eligible entity shall assist with 

the development and coordination of State autism spectrum 

disorder and other developmental disability surveillance efforts 

within a region. In making such awards, the Secretary may 

provide direct technical assistance in lieu of cash. 

* * * * * * * 

(b) CENTERS OF EXCELLENCE IN AUTISM SPECTRUM DISORDER EP- IDEMIOLOGY.— (1) IN GENERAL.—The Secretary, acting through the Director 

of the Centers for Disease Control and Prevention, shall, subject to the availability of appropriations, award grants or cooperative agreements for the øestablishment of regional centers 

of excellence¿ establishment or support of regional centers of excellence in autism spectrum disorder and other developmental 

disabilities epidemiology for the purpose of collecting and analyzing information on the number, incidence, correlates, and 

causes of autism spectrum disorder and other developmental 

disabilities for children and adults. (2) REQUIREMENTS.—To be eligible to receive a grant or cooperative agreement under paragraph (1), an entity shall submit 

to the Secretary an application containing such agreements 

and information as the Secretary may require, including an 

agreement that the øcenter to be established¿ center to be established or supported under the grant or cooperative agreement shall operate in accordance with the following: 

(A) * * * 

* * * * * * * 

(e) SUNSET.—This section shall not apply after September 30, 

ø2014¿ 2019. 

SEC. 399BB. AUTISM EDUCATION, EARLY DETECTION, AND INTERVENTION. 

(a) * * * 

(b) IN GENERAL.—The Secretary shall, subject to the availability 

of appropriations, establish and evaluate activities to— 


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(1) provide culturally competent information and education 

on autism spectrum disorder and other developmental disabilities to increase public awareness of developmental milestones; 

* * * * * * * 

(c) INFORMATION AND EDUCATION.— (1) * * * 

(2) LEAD AGENCY.— (A) DESIGNATION.—As a condition on the provision of assistance or the conduct of activities under this section with 

respect to a State, the Secretary may require the Governor 

of the State— 

(i) * * * 

(ii) acting through such lead agency, to make available to individuals and their family members, guardians, advocates, or authorized representatives; providers; and other appropriate individuals in the State, 

comprehensive culturally competent information about 

State and local resources regarding autism spectrum 

disorder and other developmental disabilities, risk factors, characteristics, identification, diagnosis or rule 

out, available services and supports (which may include respite care for caregivers of individuals with an 

autism spectrum disorder), and evidence-based interventions. 

* * * * * * * 

(e) DIAGNOSIS.— 

(1) TRAINING.—The Secretary, in coordination with activities 

conducted under title V of the Social Security Act, shall, subject to the availability of appropriations, expand existing interdisciplinary training opportunities or opportunities to increase 

the number of sites able to diagnose or rule out individuals 

with autism spectrum disorder or other developmental disabilities and ensure that— 

(A) * * * 

(B) trainees under such training programs— 

(i) * * * 

* * * * * * * 

(v) demonstrate an ability to use a family-centered 

approach, which may include collaborating with research centers or networks to provide training for providers of respite care (as defined in section 2901); and 

* * * * * * * 

(f) INTERVENTION.—The Secretary shall promote research, 

through øgrants or contracts, to determine the evidence-based practices for interventions for individuals with¿ grants or contracts, 

which may include grants or contracts to research centers or networks, to determine the evidence-based practices for interventions to 

improve the physical and behavioral health of individuals with autism spectrum disorder or other developmental disabilities, develop 

guidelines for those interventions, and disseminate information related to such research and guidelines. 

(g) SUNSET.—This section shall not apply after September 30, 

ø2014¿ 2019. 


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SEC. 399CC. INTERAGENCY AUTISM COORDINATING COMMITTEE. 

(a) * * * 

(b) RESPONSIBILITIES.—In carrying out its duties under this section, the Committee shall— 

(1) monitor autism spectrum disorder research, and to the extent practicable services and support activities, across all Federal departments and agencies, including coordination of Federal activities with respect to autism spectrum disorder; 

ø(1)¿ (2) develop øand annually update¿ a summary of advances in autism spectrum disorder research related to causes, 

prevention, treatment, early screening, diagnosis or rule out, 

øintervention¿ interventions, including school and communitybased interventions, and access to services and supports for individuals with autism spectrum disorder; 

ø(2) monitor Federal activities with respect to autism spectrum disorder;¿ 

(3) make recommendations to the Secretary regarding any 

appropriate changes to such activities, including ørecommendations to the Director of NIH¿ with respect to the strategic plan 

developed under paragraph (5); 

(4) make recommendations to the Secretary regarding public 

participation in decisions relating to autism spectrum disorder, and the process by which public feedback can be better integrated into such decisions; 

ø(5) develop and annually update a strategic plan for the 

conduct of, and support for, autism spectrum disorder research, 

including proposed budgetary requirements; and 

ø(6) submit to the Congress such strategic plan and any updates to such plan.¿ 

(5) develop a strategic plan for the conduct of, and support 

for, autism spectrum disorder research and services and supports for individuals with an autism spectrum disorder and the 

families of such individuals, which shall include— 

(A) proposed budgetary requirements; and 

(B) recommendations to ensure that autism spectrum disorder research, services, and support activities of the Department of Health and Human Services and of other Federal departments and agencies are not unnecessarily duplicative; and 

(6) submit to Congress and the President— 

(A) an annual update on the summary of advances described in paragraph (2); and 

(B) an annual update to the strategic plan described in 

paragraph (5), including any progress made in achieving 

the goals outlined in such strategic plan. 

(c) MEMBERSHIP.— 

ø(1) IN GENERAL.—The Committee shall be composed of—¿ 

(1) FEDERAL MEMBERSHIP.—The Committee shall be composed of the following Federal members— 

(A) * * * 

* * * * * * * 

(C) the heads of such other agencies as the Secretary determines appropriate, such as the Administration for Community Living, Administration for Children and Families, 

the Centers for Medicare & Medicaid Services, the Food 


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and Drug Administration, and the Health Resources and 

Services Administration; and 

(D) representatives of other Federal Governmental agencies that serve individuals with autism spectrum disorder 

such as the Department of Educationø; and¿ and the Department of Defense. 

ø(E) the additional members appointed under paragraph 

(2).¿ 

(2) øADDITIONAL¿ NON-FEDERAL MEMBERS.— øNot fewer 

than 6 members of the Committee, or 1/3 of the total membership of the Committee, whichever is greater¿ Not more than 1/ 

2, but not fewer than 1/3, of the total membership of the Committee, shall be composed of non-Federal public members to be 

appointed by the Secretary, of which— 

(A) at least øone such member shall be an individual¿ 

two such members shall be individuals with a diagnosis of 

autism spectrum disorder; 

(B) at least øone such member shall be a parent or legal 

guardian¿ two such members shall be parents or legal 

guardians of an individual with an autism spectrum disorder; and 

(C) at least øone such member shall be a representative¿ 

two such members shall be representatives of leading research, advocacy, and service organizations for individuals 

with autism spectrum disorder. 

(3) PERIOD OF APPOINTMENT; VACANCIES.— (A) PERIOD OF APPOINTMENT FOR NON-FEDERAL MEM- BERS.—Non-Federal members shall serve for a term of 4 

years, and may be reappointed for one or more additional 

4-year terms. 

(B) VACANCIES.—A vacancy on the Committee shall be 

filled in the manner in which the original appointment was 

made and shall not affect the power or duties of the Committee. Any member appointed to fill a vacancy for an unexpired term shall be appointed for the remainder of such 

term. A member may serve after the expiration of the member’s term until a successor has been appointed. 

(d) ADMINISTRATIVE SUPPORT; TERMS OF SERVICE; OTHER PROVI- SIONS.—The following provisions shall apply with respect to the 

Committee: 

(1) * * * 

ø(2) Members of the Committee appointed under subsection 

(c)(2) shall serve for a term of 4 years, and may be reappointed 

for one or more additional 4 year term. Any member appointed 

to fill a vacancy for an unexpired term shall be appointed for 

the remainder of such term. A member may serve after the expiration of the member’s term until a successor has taken office.¿ 

ø(3)¿ (2) The Committee shall meet at the call of the chairperson or upon the request of the Secretary. The Committee 

shall meet not fewer than 2 times each year. 

ø(4)¿ (3) All meetings of the Committee shall be public and 

shall include appropriate time periods for questions and presentations by the public. 

* * * * * * * 


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(f) SUNSET.—This section shall not apply after September 30, 

ø2014¿ 2019, and the Committee shall be terminated on such date. 

SEC. 399DD. øREPORT¿ REPORTS TO CONGRESS. 

(a) PROGRESS REPORT.— ø(a)¿ (1) IN GENERAL.—Not later than ø2 years after the 

date of enactment of the Combating Autism Reauthorization 

Act of 2011¿ 4 years after the date of enactment of the Autism 

CARES Act of 2014, the Secretary, in coordination with the 

Secretary of Education and the Secretary of Defense, shall prepare and submit to the Health, Education, Labor, and Pensions 

Committee of the Senate and the Energy and Commerce Committee of the House of Representatives, and make publicly 

available, including through posting on the Internet Web site of 

the Department of Health and Human Services, a progress report on activities related to autism spectrum disorder and 

other developmental disabilities. 

ø(b)¿ (2) CONTENTS.—The report submitted under subsection 

(a) shall contain— 

ø(1)¿ (A) a description of the progress made in implementing the provisions of the øCombating Autism Act of 

2006¿ Autism CARES Act of 2014; 

ø(2)¿ (B) a description of the amounts expended on the 

implementation of the øparticular provisions of Combating 

Autism Act of 2006¿ amendments made by the Autism 

CARES Act of 2014; 

ø(3) information on the incidence of autism spectrum 

disorder and trend data of such incidence since the date of 

enactment of the Combating Autism Act of 2006;¿ 

(C) information on the incidence and prevalence of 

autism spectrum disorder, including available information on the prevalence of autism spectrum disorder 

among children and adults, and identification of any 

changes over time with respect to the incidence and 

prevalence of autism spectrum disorder; 

ø(4)¿ (D) information on the average age of diagnosis for 

children with autism spectrum disorder and other disabilities, including how that age may have changed over the 

ø6-year period beginning on the date of enactment of the 

Combating Autism Act of 2006¿ 4-year period beginning on 

the date of enactment of the Autism CARES Act of 2014 

and, as appropriate, how this age varies across populations 

subgroups; 

ø(5)¿ (E) information on the average age for intervention 

for individuals diagnosed with autism spectrum disorder 

and other developmental disabilities, including how that 

age may have changed over the ø6-year period beginning 

on the date of enactment of the Combating Autism Act of 

2006¿ 4-year period beginning on the date of enactment of 

the Autism CARES Act of 2014 and, as appropriate, how 

this age varies across populations subgroups; 

ø(6)¿ (F) information on the average time between initial 

screening and then diagnosis or rule out for individuals 

with autism spectrum disorder or other developmental disabilities, as well as information on the average time between diagnosis and evidence-based intervention for indiVerDate Mar 15 2010 04:03 Jun 26, 2014 Jkt 039006 PO 00000 Frm 00016 Fmt 6659 Sfmt 6601 E:\HR\OC\HR490.XXX HR490

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viduals with autism spectrum disorder or other developmental disabilities and, as appropriate, on how such average time varies across populations subgroups; 

ø(7)¿ (G) information on the effectiveness and outcomes 

of interventions for individuals diagnosed with autism 

spectrum disorder, øincluding by various subtypes,¿ including by severity level as practicable, and other developmental disabilities and how the age of the øchild may¿ 

child or other factors, such as demographic characteristics, 

may affect such effectiveness; 

ø(8)¿ (H) information on the effectiveness and outcomes 

of innovative and newly developed intervention strategies 

for individuals with autism spectrum disorder or other developmental disabilities; and 

ø(9) information on services and supports provided to individuals with autism spectrum disorder and other developmental disabilities who have reached the age of majority 

(as defined for purposes of section 615(m) of the Individuals with Disabilities Education Act (20 U.S.C. 1415(m)).¿ 

(I) a description of the actions taken to implement 

and the progress made on implementation of the strategic plan developed by the Interagency Autism Coordinating Committee under section 399CC(b). 

(b) REPORT ON YOUNG ADULTS AND TRANSITIONING YOUTH.— (1) IN GENERAL.—Not later than 2 years after the date of enactment of the Autism CARES Act of 2014, the Secretary, in coordination with the Secretary of Education and in collaboration 

with the Secretary of Transportation, the Secretary of Labor, 

the Secretary of Housing and Urban Development, and the Attorney General, shall prepare and submit to the Committee on 

Health, Education, Labor, and Pensions of the Senate and the 

Committee on Energy and Commerce of the House of Representatives, a report concerning young adults with autism spectrum 

disorder and the challenges related to the transition from existing school-based services to those services available during 

adulthood. 

(2) CONTENTS.—The report submitted under paragraph (1) 

shall contain— 

(A) demographic characteristics of youth transitioning 

from school-based to community-based supports; 

(B) an overview of policies and programs relevant to 

young adults with autism spectrum disorder relating to 

post-secondary school transitional services, including an 

identification of existing Federal laws, regulations, policies, 

research, and programs; 

(C) proposals on establishing best practices guidelines to 

ensure— 

(i) interdisciplinary coordination between all relevant 

service providers receiving Federal funding; 

(ii) coordination with transitioning youth and the 

family of such transitioning youth; and 

(iii) inclusion of the individualized education program for the transitioning youth, as prescribed in section 614 of the Individuals with Disabilities Education 

Act (20 U.S.C. 1414); 


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(D) comprehensive approaches to transitioning from existing school-based services to those services available during 

adulthood, including— 

(i) services that increase access to, and improve integration and completion of, post-secondary education, 

peer support, vocational training (as defined in section 

103 of the Rehabilitation Act of 1973 (29 U.S.C. 723)), 

rehabilitation, self-advocacy skills, and competitive, integrated employment; 

(ii) community-based behavioral supports and interventions; 

(iii) community-based integrated residential services, 

housing, and transportation; 

(iv) nutrition, health and wellness, recreational, and 

social activities; 

(v) personal safety services for individuals with autism spectrum disorder related to public safety agencies 

or the criminal justice system; and 

(vi) evidence-based approaches for coordination of resources and services once individuals have aged out of 

post-secondary education; and 

(E) proposals that seek to improve outcomes for adults 

with autism spectrum disorder making the transition from 

a school-based support system to adulthood by— 

(i) increasing the effectiveness of programs that provide transition services; 

(ii) increasing the ability of the relevant service providers described in subparagraph (C) to provide supports and services to underserved populations and regions; 

(iii) increasing the efficiency of service delivery to 

maximize resources and outcomes, including with respect to the integration of and collaboration among 

services for transitioning youth; 

(iv) ensuring access to all services necessary to 

transitioning youth of all capabilities; and 

(v) encouraging transitioning youth to utilize all 

available transition services to maximize independence, 

equal opportunity, full participation, and self-sufficiency. 

SEC. 399EE. AUTHORIZATION OF APPROPRIATIONS. 

(a) DEVELOPMENTAL DISABILITIES SURVEILLANCE AND RESEARCH

PROGRAM.—To carry out section 399AA, there is authorized to be 

appropriated $22,000,000 for each of øfiscal years 2012 through 

2014¿ fiscal years 2015 through 2019. 

(b) AUTISM EDUCATION, EARLY DETECTION, AND INTERVENTION.— 

To carry out section 399BB, there is authorized to be appropriated 

$48,000,000 for each of øfiscal years 2011 through 2014¿ fiscal 

years 2015 through 2019. 

(c) INTERAGENCY AUTISM COORDINATING COMMITTEE; CERTAIN

OTHER PROGRAMS.—To carry out sections 399CC, 404H, and 409C, 

there is authorized to be appropriated ø$161,000,000 for each of fisVerDate Mar 15 2010 04:03 Jun 26, 2014 Jkt 039006 PO 00000 Frm 00018 Fmt 6659 Sfmt 6601 E:\HR\OC\HR490.XXX HR490

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cal years 2011 through 2014¿ $190,000,000 for each of fiscal years 

2015 through 2019. 

* * * * * * * 

Æ 


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