39–006 

113TH CONGRESS REPORT " ! HOUSE OF REPRESENTATIVES 2d Session 113–559 

WAKEFIELD ACT OF 2014 

JULY 24, 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. 4290] 

[Including cost estimate of the Congressional Budget Office] 

The Committee on Energy and Commerce, to whom was referred 

the bill (H.R. 4290) to amend the Public Health Service Act to reauthorize the Emergency Medical Services for Children Program, 

having considered the same, report favorably thereon with an 

amendment and recommend that the bill as amended do pass. 

CONTENTS 

Page 

Purpose and Summary ............................................................................................ 2 

Background and Need for Legislation .................................................................... 2 

Hearings ................................................................................................................... 2 

Committee Consideration ........................................................................................ 2 

Committee Votes ...................................................................................................... 3 

Committee Oversight Findings ............................................................................... 3 

Statement of General Performance Goals and Objectives .................................... 3 

New Budget Authority, Entitlement Authority, and Tax Expenditures ............. 3 

Earmark, Limited Tax Benefits, and Limited Tariff Benefits ............................. 3 

Committee Cost Estimate ....................................................................................... 3 

Congressional Budget Office Estimate ................................................................... 3 

Federal Mandates Statement ................................................................................. 5 

Duplication of Federal Programs ............................................................................ 5 

Disclosure of Directed Rule Makings ..................................................................... 5 

Advisory Committee Statement .............................................................................. 5 

Applicability to Legislative Branch ........................................................................ 5 

Section-by-Section Analysis of the Legislation ...................................................... 5 

Changes in Existing Law Made by the Bill, as Reported ..................................... 6 

The amendment is as follows: 

Strike all after the enacting clause and insert the following: 


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1http://www.iom.edu/reports/2006/emergency-care-for-children-growing-pains.aspx. 

2http://mchb.hrsa.gov/programs/emergencymedical/. 

SECTION 1. SHORT TITLE. 

This Act may be cited as the ‘‘Wakefield Act of 2014’’. 

SEC. 2. REAUTHORIZATION OF EMERGENCY MEDICAL SERVICES FOR CHILDREN PROGRAM. 

Section 1910(d) of the Public Health Service Act (42 U.S.C. 300w–9(d)) is amended 

by striking ‘‘fiscal year 2014’’ and inserting ‘‘each of fiscal years 2015 through 2019’’. 

PURPOSE AND SUMMARY

H.R. 4290, the ‘‘Wakefield Act of 2014’’ was introduced on March 

25, 2014, by Rep. Matheson (D-UT) and Rep. King (R-NY) to reauthorize the Emergency Medical Services for Children Program. 

BACKGROUND AND NEED FOR LEGISLATION

Children have special health care needs, especially in the field of 

emergency medical services (EMS). Despite that need, the emergency and trauma care system has been slow to develop an adequate response. Some of the problems are endemic to emergency 

services in general, such as fragmentation and poor coordination 

among pre-hospital services, hospitals, and public health. The problem is worse for children when hospitals lack the appropriate medical personnel, pediatric supplies, or transfer agreements that lead 

to better care within the ‘‘golden hour,’’ when chances of survival 

are higher. Evidence indicates that pediatric treatment patterns 

vary widely among emergency care providers. Many providers do 

not properly stabilize seriously injured children and even 

undertreat children in comparison with adults. These shortcomings 

are worse in rural areas, where necessary resources are scarcer.1

In 1984, Congress passed the Emergency Medical Services for 

Children (EMSC) as part of the Preventive Health Amendments of 

1984. Last reauthorized in 2010, the program aims to reduce child 

and youth mortality and morbidity caused by severe illness or trauma. EMSC was designed to ensure that pediatric service is well integrated into an emergency medical service system and that the entire spectrum of emergency services is provided to children and 

adolescents as well as adults.2

H.R. 4290 would reauthorize EMSC through 2019. The program 

supports the training and education of EMS providers and identifies innovative models that can increase pediatric care in rural and 

tribal communities. The bill supports the Pediatric Emergency 

Care Applied Research Network (PECARN) that facilitates collaborative research on pediatric EMSC. Data collection and quality improvements projects that help identify and address gaps in services 

are also a part of the EMSC. 

HEARINGS

The Committee on Energy and Commerce has not held hearings 

on the legislation. 

COMMITTEE CONSIDERATION

On June 19, 2014, the Subcommittee on Health met in open 

markup session and forwarded H.R. 4290 to the full Committee, as 

amended, by a voice vote. On July 15, 2014, the Committee on EnVerDate Mar 15 2010 05:52 Jul 30, 2014 Jkt 039006 PO 00000 Frm 00002 Fmt 6659 Sfmt 6602 E:\HR\OC\HR559.XXX HR559

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ergy and Commerce met in open markup session and ordered H.R. 

4290 to be reported to the House, as amended, by a 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 approved H.R. 4290. 

A motion by Mr. Upton to order H.R. 4290 reported to the House, 

as amended, was agreed to by a voice vote. 

COMMITTEE OVERSIGHT FINDINGS

Pursuant to clause 3(c)(1) of rule XIII of the Rules of the House 

of Representatives, the Committee has not held hearings on this 

legislation. 

STATEMENT OF GENERAL PERFORMANCE GOALS AND OBJECTIVES

Pursuant to clause 3(c)(1) of rule XIII of the House of Representatives, the goal of H.R. 4290 is to reauthorize the EMSC. 

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. 4290, 

‘‘The Wakefield Act of 2014’’ 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, the 

Committee finds that H.R. 4290 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: 


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U.S. CONGRESS, CONGRESSIONAL BUDGET OFFICE, Washington, DC, July 22, 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. 4290, the Wakefield Act 

of 2014. 

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. 4290—Wakefield Act of 2014 

Summary: H.R. 4290 would amend the Public Health Service Act 

to reauthorize activities intended to reduce child morbidity and 

mortality by improving emergency medical services for children. 

Those activities are supported by grants administered by the 

Health Resources and Services Administration (HRSA). 

The bill would authorize appropriations of about $30 million in 

2015 and $152 million over the 2015–2019 period. CBO estimates 

that implementing H.R. 4290 would cost $135 million 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. 4290 is shown in the following table. The costs 

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

By fiscal year, in millions of dollars— 

2015 2016 2017 2018 2019 2015- 

2019 

CHANGES IN SPENDING SUBJECT TO APPROPRIATION 

Authorization Level ....................................................................... 30 30 30 30 30 152 

Estimated Outlays ........................................................................ 15 25 30 30 30 135 

Note: Numbers may not sum to totals because of rounding. 

Basis of estimate: For this estimate, CBO assumes that H.R. 

4290 will be enacted before the end of fiscal year 2014, that the 

Congress will appropriate the authorized amounts, and that spending will follow historical patterns for HRSA activities. 

H.R. 4290 would authorize the appropriation of about $30 million 

a year for fiscal years 2015 through 2019 for HRSA to provide 

grants to states, territories, and institutions of higher education. 

Those grants support research and training to improve the quality 

of emergency care services provided to children. In fiscal year 2014, 

the HRSA allocated $20 million of its appropriation for such activities. CBO estimates that implementing the bill would cost $135 

million over the 2015–2019 period. 

Pay-As-You-Go considerations: None. 


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Intergovernmental and private-sector impact: H.R. 4290 contains 

no intergovernmental or private-sector mandates as defined in 

UMRA and would impose no costs on state, local, or tribal governments. The bill would reauthorize grant funding to expand and improve emergency medical services for children in need of treatment 

for trauma or critical care. State, local, or tribal governments that 

choose to apply for those grants would benefit from the additional 

support. 

Estimate prepared by: Federal costs: Lisa Ramirez-Branum; Impact on state, local, and tribal governments: J’nell L. Blanco; Impact on the private sector: Alexia Diorio. 

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. 4290 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. 4290 would not specifically direct a rulemaking 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 states the legislation may be cited as the ‘‘Wakefield 

Act of 2014’’. 

Section 2. Reauthorization of Emergency Medical Services for Children Program 

Section 2 would reauthorize grants programs that support demonstration projects for the expansion and improvement of emergency medical services for children at $30,387,656 for each of fiscal 

years 2015 through 2019. 


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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 XIX—BLOCK GRANTS 

PART A—PREVENTIVE HEALTH AND HEALTH SERVICES BLOCK

GRANT

* * * * * * * 

EMERGENCY MEDICAL SERVICES FOR CHILDREN

SEC. 1910. (a) * * * 

* * * * * * * 

(d) To carry out this section, there are authorized to be appropriated $2,000,000 for fiscal year 1985 and for each of the two succeeding fiscal years, $3,000,000 for fiscal year 1989, $4,000,000 for 

fiscal year 1990, $5,000,000 for each of the fiscal years 1991 and 

1992, such sums as may be necessary for each of the fiscal years 

1993 through 2005, $25,000,000 for fiscal year 2010, $26,250,000 

for fiscal year 2011, $27,562,500 for fiscal year 2012, $28,940,625 

for fiscal year 2013, and $30,387,656 for øfiscal year 2014¿ each of 

fiscal years 2015 through 2019. 

* * * * * * * 

Æ 


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