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[House Report 113-559]
[From the U.S. Government Publishing Office]

 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:

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\
---------------------------------------------------------------------------
    \1\http://www.iom.edu/reports/2006/emergency-care-for-children-
growing-pains.aspx.
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    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\
---------------------------------------------------------------------------
    \2\http://mchb.hrsa.gov/programs/emergencymedical/.
---------------------------------------------------------------------------
    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 
Energy 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:

                                     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-
                                                              2015     2016     2017     2018     2019     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.
    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.

         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 [fiscal year 2014] each of fiscal years 2015 
through 2019.

           *       *       *       *       *       *       *

                                  
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