79–006 

111TH CONGRESS REPORT " ! HOUSE OF REPRESENTATIVES 1st Session 111–44 

EARLY HEARING DETECTION AND INTERVENTION ACT 

OF 2009 

MARCH 23, 2009.—Committed to the Committee of the Whole House on the State 

of the Union and ordered to be printed 

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

submitted the following 

R E P O R T 

[To accompany H.R. 1246] 

[Including cost estimate of the Congressional Budget Office] 

The Committee on Energy and Commerce, to whom was referred 

the bill (H.R. 1246) to amend the Public Health Service Act regarding early detection, diagnosis, and treatment of hearing loss, having considered the same, report favorably thereon without amendment and recommend that the bill do pass. 

CONTENTS 

Page 

Purpose and Summary ............................................................................................ 1 

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 

Earmarks and Tax and Tariff Benefits .................................................................. 3 

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

Congressional Budget Office Estimate ................................................................... 4 

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

Advisory Committee Statement .............................................................................. 6 

Constitutional Authority Statement ...................................................................... 6 

Applicability to Legislative Branch ........................................................................ 6 

Section-by-Section Analysis of the Legislation ...................................................... 6 

Changes in Existing Law Made by the Bill, as Reported ..................................... 7 

PURPOSE AND SUMMARY

The purpose of H.R. 1246, the ‘‘Early Hearing Detection and 

Intervention Act of 2009’’, is to amend the Public Health Service 


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Act to establish grant programs to provide for education and outreach on newborn screening and coordinated follow-up care once 

newborn screening has been conducted, to reauthorize programs 

under part A of title III of such act, and for other purposes. 

BACKGROUND AND NEED FOR LEGISLATION

Each year in the United States, more than 12,000 babies are 

born with hearing loss. The cause of hearing loss for many babies 

is not known, and hearing loss can go undetected for years. Studies 

have shown that children who have hearing loss can have delays 

in speech, language, and cognitive development. When a child’s 

hearing loss is identified soon after birth, the child’s family and 

doctors can seek services he or she needs at an early age, increasing the likelihood of mitigating or preventing those delays. 

H.R. 1246 reauthorizes the Early Hearing Detection and Intervention (EHDI) program within the U.S. Department of Health and 

Human Services (HHS) by authorizing the appropriation of such 

sums as may be necessary for the 6-year period FY 2010 through 

FY 2015. The original legislation, which was enacted in 2000, directed federal agencies to work with states to develop newborn infant hearing screening and early intervention programs. EHDI programs include screening (the initial test of infants for hearing loss), 

diagnostic evaluations (to confirm hearing loss), and early intervention (including medical services, early intervention programs, and 

family support) to enhance language, communication, and cognitive 

and social skill development. 

When the EHDI program was first implemented, 44% of 

newborns were screened for hearing loss. With increased congressional funding, this increased to 67% by the end of 2001, and 87% 

by the end of 2002. Today, more than 93% of all newborns are 

screened, and each year there are thousands of infants with hearing loss who benefit from early identification. 

Despite the success of the EHDI program, much work remains to 

be done. Many infants do not receive timely follow-up and referrals 

due to shortages in properly trained healthcare providers, limited 

access to early intervention programs, and poor EHDI program integration with existing public healthcare systems. 

HEARINGS

The Committee on Energy and Commerce has not held hearings 

on the legislation. 

COMMITTEE CONSIDERATION

The Committee on Energy and Commerce met in open markup 

session on Wednesday, March 4, 2009, and, pursuant to a motion 

by Mr. Waxman, agreed by unanimous consent to consider and approve H.R. 1246 and several other bills en bloc. H.R. 1246 was ordered favorably reported to the House by a voice vote. No amendments were offered during full Committee consideration of H.R. 

1246. 


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COMMITTEE VOTES

Clause 3(b) of rule XIII of the Rules of the House of Representatives requires the Committee to list the record votes on the motion 

to report legislation and amendments thereto. There were no recorded votes taken during consideration or ordering H.R. 1246 reported to the House. 

COMMITTEE OVERSIGHT FINDINGS

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

of Representatives, the oversight findings of the Committee are reflected in this report. 

STATEMENT OF GENERAL PERFORMANCE GOALS AND OBJECTIVES

The objective of H.R. 1246 is to expand the EHDI program to include diagnostic services among services provided and to require 

the Secretary of HHS, acting through the Administrator of the 

Health Resources and Services Administration (HRSA), to assist in 

the recruitment, retention, education, and training of qualified personnel and healthcare providers. The bill provides that the purposes of the EHDI program include award of grants by the Secretary of HHS to develop efficient models to ensure follow-up care 

for newborns, infants, and young children identified with a hearing 

loss through screening, and to ensure an adequate supply of qualified personnel to meet the screening, evaluation, and early intervention needs of children. It also requires the Director of the National Institutes of Health (NIH) to establish a postdoctoral fellowship program to foster research and development in the area of 

early hearing detection and intervention. H.R. 1246 further requires that families be given the opportunity to obtain the full 

range of early intervention services, educational and program 

placements, and other options for their child. 

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. 1246 

would result in no new or increased budget authority, entitlement 

authority, or tax expenditures. 

EARMARKS AND TAX AND TARIFF BENEFITS

In compliance with clause 9 of rule XXI of the Rules of the House 

of Representatives, H.R. 1246 does not contain any congressional 

earmarks, limited tax benefits, or limited tariff benefits as defined 

in clause 9(d), 9(e), or 9(f) of rule XXI. 

COMMITTEE COST ESTIMATE

The Committee adopts as its own the cost estimate prepared by 

the Director of the Congressional Budget Office pursuant to section 

402 of the Congressional Budget Act of 1974. 


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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, March 20, 2009. 

Hon. HENRY A. WAXMAN, 

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. 1246, the Early Hearing 

Detection and Intervention Act of 2009. 

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

to provide them. The CBO staff contact is Jamease Kowalczyk. 

Sincerely, 

DOUGLAS W. ELMENDORF, 

Director. 

Enclosure. 

H.R. 1246—Early Hearing Detection and Intervention Act of 2009 

Summary: H.R. 1246 would amend the Public Health Service Act 

to authorize and expand research and public health activities related to the early detection, diagnosis, and treatment of hearing 

loss in newborns and infants. CBO estimates that implementing 

the bill would cost $151 million over the 2010–2014 period, assuming the appropriation of the necessary amounts. Enacting H.R.1246 

would not affect direct spending or federal revenues. 

H.R. 1246 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 impact of H.R. 1246 is shown in the following table. The costs 

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

By fiscal year, in millions of dollars— 

2010 2011 2012 2013 2014 2010– 

2014 

CHANGES IN SPENDING SUBJECT TO APPROPRIATIONS 

HRSA: 

Estimated Authorization Level ....................................................... 12 12 12 12 12 61 

Estimated Outlays ........................................................................... 6 11 12 12 12 53 

CDC: 

Estimated Authorization Level ......................................................... 11 11 11 11 11 55 

Estimated Outlays ........................................................................... 4 9 11 11 11 46 

NIH: 

Estimated Authorization Level ......................................................... 13 13 13 13 13 64 

Estimated Outlays ........................................................................... 3 11 12 13 13 51 

Total Changes: 

Estimated Authorization Level ......................................................... 36 36 36 36 36 180 

Estimated Outlays ........................................................................... 14 30 35 36 36 151 

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

of Health. 

Basis of estimate: H.R. 1246 would authorize funding for early 

hearing loss detection and intervention activities at the Health ReVerDate Nov 24 2008 06:45 Mar 25, 2009 Jkt 079006 PO 00000 Frm 00004 Fmt 6659 Sfmt 6602 E:\HR\OC\HR044.XXX HR044

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sources and Services Administration (HRSA), the Centers for Disease Control and Prevention (CDC), and the National Institutes of 

Health (NIH) for fiscal years 2010 through 2015. It also would require the Director of the National Institutes of Health to establish 

a postdoctoral research program to foster research and development in the area of early hearing detection and intervention. CBO 

estimates that those activities would require the appropriation of 

$180 million over the 2010–2014 period. Based on historical spending patterns for similar activities and assuming the appropriation 

of necessary amounts, CBO estimates that implementing H.R. 1246 

would cost $151 million over the 2010–2014 period. 

HRSA administers the Universal Newborn Screening program, 

which makes grants to states to support testing of infants prior to 

hospital discharge, audiologic evaluation by three months of age, 

and early intervention activities. CBO estimates that those activities would require the appropriation of $61 million over the 2010– 

2014 period. Assuming the appropriation of the necessary amounts, 

CBO estimates that implementing that grant program would cost 

$53 million over the 2010–2014 period. 

H.R. 1246 would authorize CDC to make grants to states and 

provide technical assistance to states to promote screening, surveillance, and research into the causes of hearing loss among newborns 

and infants. To fund that grant program, CBO estimates that the 

CDC would require the appropriation of $55 million over the 2010– 

2014 period. Assuming the appropriation of the necessary amounts, 

CBO estimates that implementing the program would cost $46 million over the 2010–2014 period. 

H.R. 1246 would authorize the NIH to conduct research on early 

detection and treatment of hearing loss. The bill would direct the 

NIH to establish a postdoctoral fellowship program to train researchers in the field of detecting and intervening in early hearing 

loss. Based on information provided by the NIH, CBO expects that 

the new postdoctoral program would fund three postdoctoral fellows at an annual cost of approximately $120,000 per fellow. Based 

on that information, historical program expenditures at NIH, and 

adjustments for inflation, CBO estimates that NIH would require 

the appropriation of $64 million over the 2010–2014 period. CBO 

estimates that implementing those programs would cost $51 million over the 2010–2014 period, assuming appropriation of the necessary amounts. 

Intergovernmental and private-sector impact: H.R. 1246 contains 

no intergovernmental or private-sector mandates as defined in 

UMRA. States that participate in programs to detect, diagnose, and 

treat hearing loss in newborns and infants would benefit from activities and grants authorized in the bill. 

Estimate prepared by: Federal Costs: Jamease Kowalczyk, Stephanie Cameron, and Lisa Ramirez-Branum; Impact on State, Local, 

and Tribal Governments: Lisa Ramirez-Branum; Impact on Private 

Sector: Patrick Bernhardt. 

Estimate approved by: Peter H. Fontaine, Assistant Director for 

Budget Analysis. 

FEDERAL MANDATES STATEMENT

The Committee adopts as its own the estimate of federal mandates regarding H.R. 1246 prepared by the Director of the CongresVerDate Nov 24 2008 06:45 Mar 25, 2009 Jkt 079006 PO 00000 Frm 00005 Fmt 6659 Sfmt 6602 E:\HR\OC\HR044.XXX HR044

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sional Budget Office pursuant to section 423 of the Unfunded Mandates Reform Act. 

ADVISORY COMMITTEE STATEMENT

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

Federal Advisory Committee Act were created by H.R. 1246. 

CONSTITUTIONAL AUTHORITY STATEMENT

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

of Representatives, the Committee finds that the Constitutional authority for this legislation is provided in Article I, section 8, clause 

1, that relates to expending funds to provide for the general welfare of the United States. 

APPLICABILITY TO LEGISLATIVE BRANCH

The Committee finds that H.R. 1246 does not relate to the terms 

and conditions of employment or access to public services or accommodations within the meaning of section 102(b)(3) of the Congressional Accountability Act. 

SECTION-BY-SECTION ANALYSIS OF THE LEGISLATION

Section 1. Short title 

Section 1 establishes the short title of the Act as the ‘‘Early 

Hearing Detection and Intervention Act of 2009’’. 

Section 2. Early detection, diagnosis, and treatment of hearing loss 

Section 2 of this legislation amends Section 399M of the Public 

Health Service Act (42 U.S.C. 280g–1). In the Section 399M heading, H.R. 1246 strikes ‘‘infants’’ and inserts ‘‘newborns and infants.’’ 

Section 2 expands the purpose of the grant program to say that 

grants and cooperative agreements will be given to: (1) develop 

statewide newborn, infant hearing screening, evaluation, diagnosis, 

and intervention programs and systems; (2) assist in the recruitment, retention, education, and training of qualified personnel and 

healthcare providers; (3) ensure the prompt evaluation of children 

referred from screening programs; (4) provide appropriate educational, audiological, and medical interventions for children identified with hearing loss; (5) establish and foster family-to-family support mechanisms; (6) develop efficient models to ensure that 

newborns and infants who are identified with a hearing loss 

through screening receive follow-up by a qualified health care provider; and (7) ensure an adequate supply of qualified personnel to 

meet the screening, evaluation, diagnosis, and early intervention 

needs of children. 

Section 2 directs the Director of the NIH, acting through the Director of the National Institute on Deafness and Other Communication Disorders to establish a postdoctoral fellowship program to foster research and development in the area of early hearing detection 

and intervention. 

Section 2 amends the definition of the term ‘‘early intervention’’. 

As amended by H.R. 1246, the term ‘‘early intervention’’ ensures 

that families of the child are provided comprehensive, consumerVerDate Nov 24 2008 06:45 Mar 25, 2009 Jkt 079006 PO 00000 Frm 00006 Fmt 6659 Sfmt 6602 E:\HR\OC\HR044.XXX HR044

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oriented information about the full range of family support, training, information services, and language and communication options 

and are given the opportunity to consider and obtain the full range 

of such appropriate services, educational and program placements, 

and other options for their child from highly qualified providers. 

Finally, Section 2 updates the authorization of appropriation sections to strike ‘‘fiscal year 2002’’ everywhere that such term appears and replace it with ‘‘fiscal years 2010 through 2015’’. 

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): 

SECTION 399M OF THE PUBLIC HEALTH SERVICE ACT 

SEC. 399M. EARLY DETECTION, DIAGNOSIS, AND TREATMENT REGARDING HEARING LOSS IN øINFANTS¿ NEWBORNS AND INFANTS. 

(a) STATEWIDE NEWBORN AND INFANT HEARING SCREENING, 

EVALUATION AND INTERVENTION PROGRAMS AND SYSTEMS.—The 

Secretary, acting through the Administrator of the Health Resources and Services Administration, shall make awards of grants 

or cooperative agreements to develop statewide newborn and infant 

hearing øscreening, evaluation and intervention programs and systems¿ screening, evaluation, diagnosis, and intervention programs 

and systems, and to assist in the recruitment, retention, education, 

and training of qualified personnel and health care providers, for 

the following purposes: 

ø(1) To develop and monitor the efficacy of state-wide newborn and infant hearing screening, evaluation and intervention 

programs and systems. Early intervention includes referral to 

schools and agencies, including community, consumer, and parent-based agencies and organizations and other programs mandated by part C of the Individuals with Disabilities Education 

Act, which offer programs specifically designed to meet the 

unique language and communication needs of deaf and hard of 

hearing newborns, infants, toddlers, and children.¿ 

(1) To develop and monitor the efficacy of statewide programs 

and systems for hearing screening of newborns and infants; 

prompt evaluation and diagnosis of children referred from 

screening programs; and appropriate educational, audiological, 

and medical interventions for children identified with hearing 

loss. Early intervention includes referral to and delivery of information and services by schools and agencies, including community, consumer, and parent-based agencies and organizations and other programs mandated by part C of the Individuals with Disabilities Education Act, which offer programs specifically designed to meet the unique language and communication needs of deaf and hard of hearing newborns, infants, toddlers, and children. Programs and systems under this paragraph shall establish and foster family-to-family support mechVerDate Nov 24 2008 06:45 Mar 25, 2009 Jkt 079006 PO 00000 Frm 00007 Fmt 6659 Sfmt 6603 E:\HR\OC\HR044.XXX HR044

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anisms that are critical in the first months after a child is identified with hearing loss. 

* * * * * * * 

(3) To develop efficient models to ensure that newborns and 

infants who are identified with a hearing loss through screening receive follow-up by a qualified health care provider. These 

models shall be evaluated for their effectiveness, and State 

agencies shall be encouraged to adopt models that effectively increase the rate of occurrence of such follow-up. 

(4) To ensure an adequate supply of qualified personnel to 

meet the screening, evaluation, diagnosis, and early intervention needs of children. 

(b) TECHNICAL ASSISTANCE, DATA MANAGEMENT, AND APPLIED

RESEARCH.— 

(1) CENTERS FOR DISEASE CONTROL AND PREVENTION.—The 

Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall make awards of grants or 

cooperative agreements to provide technical assistance to State 

agencies to complement an intramural program and to conduct 

applied research related to newborn and infant hearing screening, evaluation and intervention programs and systems. The 

program shall develop standardized procedures for data management and program effectiveness and costs, such as— 

(A) to ensure quality monitoring of newborn and infant 

øhearing loss screening, evaluation, and intervention programs¿ hearing loss screening, evaluation, diagnosis, and 

intervention programs and systems; 

* * * * * * * 

(2) NATIONAL INSTITUTES OF HEALTH.—The Director of the 

National Institutes of Health, acting through the Director of 

the National Institute on Deafness and Other Communication 

Disorders, shall øfor purposes of this section, continue¿ for 

purposes of this section— 

(A) continue a program of research and development on 

the efficacy of new screening techniques and technology, 

including clinical studies of screening methods, studies on 

efficacy of intervention, and related researchø.¿; and 

(B) establish a postdoctoral fellowship program to foster 

research and development in the area of early hearing detection and intervention. 

(c) COORDINATION AND COLLABORATION.— (1) * * * 

(2) POLICY DEVELOPMENT.—The Administrator of the Health 

Resources and Services Administration, the Director of the 

Centers for Disease Control and Prevention, and the Director 

of the National Institutes of Health shall coordinate and collaborate on recommendations for policy development at the 

Federal and State levels and with the private sector, including 

consumer, medical and other health and education professional-based organizations, with respect to newborn and infant 

øhearing screening, evaluation and intervention programs¿ 

hearing screening, evaluation, diagnosis, and intervention programs and systems. 


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(3) STATE EARLY DETECTION, DIAGNOSIS, AND INTERVENTION

PROGRAMS AND SYSTEMS; DATA COLLECTION.—The Administrator of the Health Resources and Services Administration 

and the Director of the Centers for Disease Control and Prevention shall coordinate and collaborate in assisting States to 

establish newborn and infant øhearing screening, evaluation 

and intervention programs¿ hearing screening, evaluation, diagnosis, and intervention programs and systems under subsection (a) and to develop a data collection system under subsection (b). 

* * * * * * * 

(e) DEFINITIONS.—For purposes of this section: 

(1) * * * 

* * * * * * * 

(3) The term ‘‘early intervention’’ refers to providing appropriate services for the child with hearing loss, including nonmedical services, and øensuring that families of the child are 

provided comprehensive, consumer-oriented information about 

the full range of family support, training, information services, 

communication options and are given the opportunity to consider the full range of educational and program placements 

and options for their child.¿ ensuring that families of the child 

are provided comprehensive, consumer-oriented information 

about the full range of family support, training, information 

services, and language and communication options and are 

given the opportunity to consider and obtain the full range of 

such appropriate services, educational and program placements, 

and other options for their child from highly qualified providers. 

* * * * * * * 

(6) The term ‘‘newborn and infant hearing screening’’ refers 

to objective physiologic procedures to detect possible hearing 

loss and to identify newborns and infants whoø, after rescreening,¿ require further audiologic and medical evaluations. 

(f) AUTHORIZATION OF APPROPRIATIONS.— 

(1) STATEWIDE NEWBORN AND INFANT HEARING SCREENING, 

EVALUATION AND INTERVENTION PROGRAMS AND SYSTEMS.—For 

the purpose of carrying out subsection (a), there are authorized 

to be appropriated to the Health Resources and Services Administration such sums as may be necessary for øfiscal year 

2002¿ fiscal years 2010 through 2015. 

(2) TECHNICAL ASSISTANCE, DATA MANAGEMENT, AND APPLIED

RESEARCH; CENTERS FOR DISEASE CONTROL AND PREVENTION.— 

For the purpose of carrying out subsection (b)(1), there are authorized to be appropriated to the Centers for Disease Control 

and Prevention such sums as may be necessary for øfiscal year 

2002¿ fiscal years 2010 through 2015. (3) TECHNICAL ASSISTANCE, DATA MANAGEMENT, AND APPLIED

RESEARCH; NATIONAL INSTITUTE ON DEAFNESS AND OTHER COM- MUNICATION DISORDERS.—For the purpose of carrying out subsection (b)(2), there are authorized to be appropriated to the 

National Institute on Deafness and Other Communication DisVerDate Nov 24 2008 06:45 Mar 25, 2009 Jkt 079006 PO 00000 Frm 00009 Fmt 6659 Sfmt 6601 E:\HR\OC\HR044.XXX HR044

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orders such sums as may be necessary for øfiscal year 2002¿ 

fiscal years 2010 through 2015. 

* * * * * * * 

Æ 


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