```

[House Report 113-490]
[From the U.S. Government Publishing Office]

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:

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
                  ``(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.--'';
          (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
                          ``(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 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. 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 over the last 40 years, primarily 
due to better awareness, surveillance, and diagnosis.\1\
---------------------------------------------------------------------------
    \1\http://www.cdc.gov/ncbddd/autism/index.html.
---------------------------------------------------------------------------
    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\
---------------------------------------------------------------------------
    \2\http://www.ninds.nih.gov/disorders/autism/detail_autism.htm.
---------------------------------------------------------------------------
    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 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.

                        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).

----------------------------------------------------------------------------------------------------------------
                                                                  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 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 autism-related 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.''

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 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 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 
Epidemiology.--
          (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 [establishment 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 [center 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, 
[2014] 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--
          (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 [grants 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, 
[2014] 2019.

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;
          [(1)] (2) develop [and annually update] a summary of 
        advances in autism spectrum disorder research related 
        to causes, prevention, treatment, early screening, 
        diagnosis or rule out, [intervention] interventions, 
        including school and community-based interventions, and 
        access to services and supports for individuals with 
        autism spectrum disorder;
          [(2) monitor Federal activities with respect to 
        autism spectrum disorder;]
          (3) make recommendations to the Secretary regarding 
        any appropriate changes to such activities, including 
        [recommendations 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;
          [(5) develop and annually update a strategic plan for 
        the conduct of, and support for, autism spectrum 
        disorder research, including proposed budgetary 
        requirements; and
          [(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.--
          [(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 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 Education[; and] and the 
                Department of Defense.
                  [(E) the additional members appointed under 
                paragraph (2).]
          (2)  [Additional]  Non-federal members.-- [Not 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 [one such member shall be an 
                individual] two such members shall be 
                individuals with a diagnosis of autism spectrum 
                disorder;
                  (B) at least [one 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 [one 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 
                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.
  (d) Administrative Support; Terms of Service; Other 
Provisions.--The following provisions shall apply with respect 
to the Committee:
          (1) * * *
          [(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.]
          [(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.
          [(4)] (3) All meetings of the Committee shall be 
        public and shall include appropriate time periods for 
        questions and presentations by the public.

           *       *       *       *       *       *       *

  (f) Sunset.--This section shall not apply after September 30, 
[2014] 2019, and the Committee shall be terminated on such 
date.

SEC. 399DD. [REPORT]  REPORTS TO CONGRESS.

  (a) Progress Report.--
          [(a)] (1) In General.--Not later than [2 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.
          [(b)] (2) Contents.--The report submitted under 
        subsection (a) shall contain--
                  [(1)] (A) a description of the progress made 
                in implementing the provisions of the 
                [Combating Autism Act of 2006] Autism CARES Act 
                of 2014;
                  [(2)] (B) a description of the amounts 
                expended on the implementation of the 
                [particular provisions of Combating Autism Act 
                of 2006] amendments made by the Autism CARES 
                Act of 2014;
                  [(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;
                  [(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 [6-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;
                  [(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 [6-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;
                  [(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 individuals with autism 
                spectrum disorder or other developmental 
                disabilities and, as appropriate, on how such 
                average time varies across populations 
                subgroups;
                  [(7)] (G) information on the effectiveness 
                and outcomes of interventions for individuals 
                diagnosed with autism spectrum disorder, 
                [including by various subtypes,] including by 
                severity level as practicable, and other 
                developmental disabilities and how the age of 
                the [child may] child or other factors, such as 
                demographic characteristics, may affect such 
                effectiveness;
                  [(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
                  [(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);
                  (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 [fiscal 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 [fiscal 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 [$161,000,000 for each of 
fiscal years 2011 through 2014] $190,000,000 for each of fiscal 
years 2015 through 2019.

           *       *       *       *       *       *       *

                                  
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