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[House Report 111-609]
[From the U.S. Government Publishing Office]

111th Congress                                                   Report
  2d Session            HOUSE OF REPRESENTATIVES                111-609
=======================================================================
 
                              NEWBORN ACT 

                                _______
                                

 September 16, 2010.--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. 3470]

      [Including cost estimate of the Congressional Budget Office]

  The Committee on Energy and Commerce, to whom was referred 
the bill (H.R. 3470) to authorize funding for the creation and 
implementation of infant mortality pilot programs in standard 
metropolitan statistical areas with high rates of infant 
mortality, 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
Amendment........................................................     1
Purpose and Summary..............................................     3
Background and Need for Legislation..............................     3
Committee Consideration..........................................     4
Committee Votes..................................................     4
Committee Oversight Findings and Recommendations.................     4
New Budget Authority, Entitlement Authority, and Tax Expenditures     4
Statement of General Performance Goals and Objectives............     5
Constitutional Authority Statement...............................     5
Earmarks and Tax and Tariff Benefits.............................     5
Federal Advisory Committee Statement.............................     5
Applicability of Law to Legislative Branch.......................     5
Federal Mandates Statement.......................................     5
Committee Cost Estimate..........................................     5
Congressional Budget Office Cost Estimate........................     5
Section-by-Section Analysis of the Legislation...................     7
Changes in Existing Law Made by the Bill, as Reported............     7

                               Amendment

  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 ``Nationally Enhancing the Wellbeing of 
Babies through Outreach and Research Now Act'' or the ``NEWBORN Act''.

SEC. 2. INFANT MORTALITY PILOT PROGRAMS.

  Section 330H of the Public Health Service Act (42 U.S.C. 254c-8) is 
amended--
          (1) by redesignating subsection (e) as subsection (f);
          (2) by inserting after subsection (d) the following:
  ``(e) Infant Mortality Pilot Programs.--
          ``(1) In general.--The Secretary, acting through the 
        Administrator, shall award grants to eligible entities to 
        create, implement, and oversee infant mortality pilot programs.
          ``(2) Period of a grant.--The period of a grant under this 
        subsection shall be 5 consecutive fiscal years.
          ``(3) Preference.--In awarding grants under this subsection, 
        the Secretary shall give preference to eligible entities 
        proposing to serve any of the 15 counties or groups of counties 
        with the highest rates of infant mortality in the United States 
        in the past 3 years.
          ``(4) Use of funds.--Any infant mortality pilot program 
        funded under this subsection may--
                  ``(A) include the development of a plan that 
                identifies the individual needs of each community to be 
                served and strategies to address those needs;
                  ``(B) provide outreach to at-risk mothers through 
                programs deemed appropriate by the Administrator;
                  ``(C) develop and implement standardized systems for 
                improved access, utilization, and quality of social, 
                educational, and clinical services to promote healthy 
                pregnancies, full-term births, and healthy infancies 
                delivered to women and their infants, such as--
                          ``(i) counseling on infant care, feeding, and 
                        parenting;
                          ``(ii) postpartum care;
                          ``(iii) prevention of premature delivery; and
                          ``(iv) additional counseling for at-risk 
                        mothers, including smoking cessation programs, 
                        drug treatment programs, alcohol treatment 
                        programs, nutrition and physical activity 
                        programs, postpartum depression and domestic 
                        violence programs, social and psychological 
                        services, dental care, and parenting programs;
                  ``(D) establish a rural outreach program to provide 
                care to at-risk mothers in rural areas;
                  ``(E) establish a regional public education campaign, 
                including a campaign to--
                          ``(i) prevent preterm births; and
                          ``(ii) educate the public about infant 
                        mortality; and
                  ``(F) provide for any other activities, programs, or 
                strategies as identified by the community plan.
          ``(5) Limitation.--Of the funds received through a grant 
        under this subsection for a fiscal year, an eligible entity 
        shall not use more than 10 percent for program evaluation.
          ``(6) Reports on pilot programs.--
                  ``(A) In general.--Not later than 1 year after 
                receiving a grant, and annually thereafter for the 
                duration of the grant period, each entity that receives 
                a grant under paragraph (1) shall submit a report to 
                the Secretary detailing its infant mortality pilot 
                program.
                  ``(B) Contents of report.--The reports required under 
                subparagraph (A) shall include information such as the 
                methodology of, and outcomes and statistics from, the 
                grantee's infant mortality pilot program.
                  ``(C) Evaluation.--The Secretary shall use the 
                reports required under subparagraph (A) to evaluate, 
                and conduct statistical research on, infant mortality 
                pilot programs funded through this subsection.
          ``(7) Definitions.--For the purposes of this subsection:
                  ``(A) Administrator.--The term `Administrator' means 
                the Administrator of the Health Resources and Services 
                Administration.
                  ``(B) Eligible entity.--The term `eligible entity' 
                means a State, county, city, territorial, or tribal 
                health department that has submitted a proposal to the 
                Secretary that the Secretary deems likely to reduce 
                infant mortality rates within the standard metropolitan 
                statistical area involved.
                  ``(C) Tribal.--The term `tribal' refers to an Indian 
                tribe, a Tribal organization, or an Urban Indian 
                organization, as such terms are defined in section 4 of 
                the Indian Health Care Improvement Act.''; and
          (3) by amending subsection (f), as so redesignated--
                  (A) in paragraph (1)--
                          (i) by amending the paragraph heading to 
                        read: ``Healthy Start Initiative''; and
                          (ii) by inserting after ``carrying out this 
                        section'' the following: ``(other than 
                        subsection (e))'';
                  (B) by redesignating paragraph (2) as paragraph (3);
                  (C) by inserting after paragraph (1) the following:
          ``(2) Infant mortality pilot programs.--To carry out 
        subsection (e), there is authorized to be appropriated 
        $10,000,000 for each of fiscal years 2011 through 2015.''; and
                  (D) in paragraph (3)(A), as so redesignated, by 
                striking ``the program under this section'' and 
                inserting ``the program under subsection (a)''.

                          Purpose and Summary

    H.R. 3470, the ``Nationally Enhancing the Wellbeing of 
Babies through Outreach and Research Now'' or the ``NEWBORN 
Act'', was introduced by Rep. Steve Cohen (D-TN) on July 31, 
2009, and subsequently referred to the Committee on Energy and 
Commerce.
    The goal of H.R. 3470 is to authorize funding for the 
creation and implementation of infant mortality pilot programs 
in jurisdictions with the highest rates of infant mortality in 
the United States. The bill amends the Public Health Service 
Act to establish a separate program on infant mortality pilot 
projects.

                  Background and Need for Legislation

    The U.S. infant mortality rate (defined as the number of 
deaths per 1,000 live births) has been and continues to be a 
significant public health challenge. As of 2005, the nation 
ranked 30th in the world in infant mortality at a rate of 6.9 
deaths per 1,000 live births. According to the Centers for 
Disease Control and Prevention (CDC), the country's infant 
mortality rate now stands approximately 50% higher than the 
national goal of 4.5 infant deaths per 1,000 births.
    Persistent disparities in infant mortality rates among 
racial and ethnic minority groups, particularly African 
Americans, are especially disturbing. Findings from a 2005 CDC 
study indicate the infant mortality rate for non-Hispanic black 
women was 2.4 times the rate for non-Hispanic white women. In 
2005, the infant mortality rate for non-Hispanic black women 
was 13.63 infant deaths per 1,000 live births, compared to a 
rate of 5.76 for non-Hispanic white women. Rates were also 
higher for Puerto Rican and American Indian women, 8.30 and 
8.06 per 1,000 live births respectively.
    Increases in preterm birth and preterm-related infant 
mortality account for much of the lack of decline in the U.S. 
infant mortality rate from 2000 to 2005. An analysis of infant 
death data by CDC researchers demonstrate that preterm-related 
deaths accounted for more than one-third of all deaths during 
the first year of life, and more infants died from preterm 
causes than from any other cause. The reasons for preterm birth 
remain unclear; however, several risk factors have been 
identified and include infections during pregnancy, having a 
previous preterm birth, chronic health problems in the mother, 
cigarette smoking, and alcohol use.
    Various efforts based at the U.S. Department of Health and 
Human Services are targeted on the problem of infant mortality 
and its related causes. Among these is the Healthy Start for 
Infants program (authorized in section 330H of the Public 
Health Service Act), administered through the Department's 
Health Resources and Services Administration. None, however, is 
designed specifically to address the problem in areas of the 
country with the highest rates of infant mortality over the 
last three years. H.R. 3470 is intended to do just that.

                        Committee Consideration

    H.R. 3470, the ``Nationally Enhancing the Wellbeing of 
Babies through Outreach and Research Now Act'' or the ``NEWBORN 
Act'', was introduced by Rep. Steve Cohen (D-TN) on July 31, 
2009, and referred to the Committee on Energy and Commerce. The 
bill was subsequently referred to the Subcommittee on Health on 
September 8, 2009. The Subcommittee met in open markup session 
to consider H.R. 3470 on July 22, 2010. An amendment in the 
nature of a substitute (manager's amendment) by Subcommittee 
Chairman Pallone was adopted by a voice vote. Subsequently, 
H.R. 3470 was forwarded to the full Committee, amended, by a 
voice vote.
    On July 28, 2010, the Committee on Energy and Commerce met 
in open markup session and considered H.R. 3470 as approved by 
the Subcommittee. There were no amendments offered in full 
Committee and subsequently the Committee ordered H.R. 3470 
favorably reported to the House, as amended by the Subcommittee 
on Health, 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 each record vote 
on the motion to report legislation and amendments thereto. A 
motion by Mr. Waxman ordering H.R. 3470 reported to the House, 
as amended, was approved by a voice vote. There were no record 
votes taken during consideration of this bill.

            Committee Oversight Findings and Recommendations

    In compliance with clause 3(c)(1) of rule XIII and clause 
(2)(b)(1) of rule X of the Rules of the House of 
Representatives, the oversight findings and recommendations of 
the Committee are reflected in the descriptive portions of this 
report, including the finding that the U.S. infant mortality 
rate has been and continues to be a significant public health 
challenge.

   New Budget Authority, Entitlement Authority, and Tax Expenditures

    Regarding compliance with clause 3(c)(2) of rule XIII of 
the Rules of the House of Representatives, the Committee finds 
that H.R. 3470 would result in no new budget authority, 
entitlement authority, or tax expenditures or revenues.

         Statement of General Performance Goals and Objectives

    In accordance with clause 3(c)(4) of rule XIII of the Rules 
of the House of Representatives, the performance goals and 
objectives of the Committee are reflected in the descriptive 
portions of this report, including the goal to support efforts 
to address infant mortality in areas of the country with the 
highest rates of infant mortality over the last three years.

                   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 H.R. 3470 is provided under 
Article I, section 8, clauses 3 and 18 of the Constitution of 
the United States.

                  Earmarks and Tax and Tariff Benefits

    H.R. 3470 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 of the Rules of the 
House of Representatives.

                  Federal Advisory Committee Statement

    The Committee finds that the legislation does not establish 
or authorize the establishment of an advisory committee within 
the definition of 5 U.S.C. App., section 5(b) of the Federal 
Advisory Committee Act.

             Applicability of Law to the Legislative Branch

    Section 102(b)(3) of Public Law 104-1 requires a 
description of the application of this bill to the legislative 
branch where the bill relates to terms and conditions of 
employment or access to public services and accommodations. 
H.R. 3470 contains no such provisions.

                       Federal Mandates Statement

    Section 423 of the Congressional Budget and Impoundment 
Control Act of 1974 (as amended by section 101(a)(2) of the 
Unfunded Mandates Reform Act, P.L. 104-4) requires a statement 
on whether the provisions of the report include unfunded 
mandates. In compliance with this requirement the Committee 
adopts as its own the estimates of federal mandates prepared by 
the Director of the Congressional Budget Office.

                        Committee Cost Estimate

    Pursuant to clause 3(d)(2) of rule XIII of the Rules of the 
House of Representatives, the Committee adopts as its own the 
cost estimate of H.R. 3470 prepared by the Director of the 
Congressional Budget Office pursuant to section 402 of the 
Congressional Budget Act of 1974.

               Congressional Budget Office Cost Estimate

    With respect to the requirements of clause (3)(c)(3) of 
rule XIII of the Rules of the House of Representatives and 
section 402 of the Congressional Budget Act of 1974, the 
Committee has received the following cost estimate for H.R. 
3470 from the Director of Congressional Budget Office:

                                                   August 26, 2010.
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. 3470, the 
Nationally Enhancing the Wellbeing of Babies through Outreach 
and Research Now Act.
    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. 3470--Nationally Enhancing the Wellbeing of Babies Through 
        Outreach and Research Now Act

    Summary: H.R. 3470 would amend the Public Health Service 
Act to authorize a grant program to provide funds to qualified 
entities to create, implement, and oversee pilot programs in 
areas with high rates of infant mortality.
    The bill would authorize the appropriation of $10 million 
for fiscal year 2011 and $50 million over the 2011-2015 period. 
Assuming the appropriation of those amounts, CBO estimates that 
implementing the act would cost $4 million in 2011 and $45 
million over the 2011-2015 period. Enacting H.R. 3470 would not 
affect direct spending or revenues; therefore, pay-as-you-go 
procedures do not apply.
    H.R. 3470 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. 3470 is shown in the following table. 
The costs of this legislation fall within budget function 550 
(health).

----------------------------------------------------------------------------------------------------------------
                                                                    By fiscal year, in millions of dollars--
                                                              --------------------------------------------------
                                                                2011    2012    2013    2014    2015   2011-2015
----------------------------------------------------------------------------------------------------------------
                                  CHANGES IN SPENDING SUBJECT TO APPROPRIATIONAuthorization Level..........................................      10      10      10      10      10        50
Estimated Outlays............................................       4       9      10      11      10        45
----------------------------------------------------------------------------------------------------------------

    Basis of estimate: For this estimate, CBO assumes that H.R. 
3470 will be enacted near the beginning of fiscal year 2011 and 
that the full amounts authorized will be appropriated near the 
beginning of each year. H.R. 3470 would authorize $10 million 
in fiscal year 2011 and for each fiscal year through 2015. The 
activities authorized under the act would be carried out by the 
Health Resources and Services Administration (HRSA). The 
estimate of outlays is based on historical spending patterns 
for similar activities.
    The bill would direct HRSA to award grants to eligible 
entities to conduct infant mortality pilot programs giving 
preference to projects serving counties or groups of counties 
with the highest rates of infant mortality in the past three 
years. Grant funds would be available for activities that may 
include developing and implementing plans that identify the 
needs of the communities and strategies to address those needs; 
outreach, education and counseling for at-risk mothers; and 
developing and implementing systems to improve access and 
quality of services for women and their infants.
    Intergovernmental and private-sector impact: H.R. 3470 
contains no intergovernmental or private-sector mandates as 
defined in UMRA. Funds authorized in the bill would benefit 
state, local, and tribal governments that carry out activities 
to reduce infant mortality.
    Estimate prepared by: Federal Costs and Impact on State, 
Local, and Tribal Governments: Lisa Ramirez-Branum, Impact on 
the Private Sector: Jimmy Jin.
    Estimate approved by: Holly Harvey, Deputy Assistant 
Director for Budget Analysis.

             Section-by-Section Analysis of the Legislation

Section 1. Short title

    Section 1 designates the short title of the Act as the 
``Nationally Enhancing the Wellbeing of Babies through Outreach 
and Research Now Act'' or the ``NEWBORN Act''.

Section 2. Infant mortality pilot programs

    Section 2 amends section 330H of the Public Health Service 
Act to establish a separate program on infant mortality pilot 
projects. Under this program, the Secretary of Health and Human 
Services (acting through the Health Resources and Services 
Administrator, Maternal and Child Health Bureau) is required to 
award grants to eligible entities to create, implement, and 
oversee infant mortality pilot programs. Among other 
activities, grant funds may be used to (1) provide outreach to 
at-risk mothers, including at-risk mothers in rural areas; (2) 
develop and implement standardized systems for improved access, 
utilization, and quality of services to promote healthy 
pregnancies, full-term births, and healthy infancies delivered 
to women and their infants; and (3) establish a regional public 
education campaign. The section also authorizes $10 million in 
each of FY 2011 through FY 2015 to carry out these efforts.

         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 D--Primary Health Care

Subpart I--Health Centers

           *       *       *       *       *       *       *

SEC. 330H. HEALTHY START FOR INFANTS.

  (a) * * *

           *       *       *       *       *       *       *

  (e) Infant Mortality Pilot Programs.--
          (1) In general.--The Secretary, acting through the 
        Administrator, shall award grants to eligible entities 
        to create, implement, and oversee infant mortality 
        pilot programs.
          (2) Period of a grant.--The period of a grant under 
        this subsection shall be 5 consecutive fiscal years.
          (3) Preference.--In awarding grants under this 
        subsection, the Secretary shall give preference to 
        eligible entities proposing to serve any of the 15 
        counties or groups of counties with the highest rates 
        of infant mortality in the United States in the past 3 
        years.
          (4) Use of funds.--Any infant mortality pilot program 
        funded under this subsection may--
                  (A) include the development of a plan that 
                identifies the individual needs of each 
                community to be served and strategies to 
                address those needs;
                  (B) provide outreach to at-risk mothers 
                through programs deemed appropriate by the 
                Administrator;
                  (C) develop and implement standardized 
                systems for improved access, utilization, and 
                quality of social, educational, and clinical 
                services to promote healthy pregnancies, full-
                term births, and healthy infancies delivered to 
                women and their infants, such as--
                          (i) counseling on infant care, 
                        feeding, and parenting;
                          (ii) postpartum care;
                          (iii) prevention of premature 
                        delivery; and
                          (iv) additional counseling for at-
                        risk mothers, including smoking 
                        cessation programs, drug treatment 
                        programs, alcohol treatment programs, 
                        nutrition and physical activity 
                        programs, postpartum depression and 
                        domestic violence programs, social and 
                        psychological services, dental care, 
                        and parenting programs;
                  (D) establish a rural outreach program to 
                provide care to at-risk mothers in rural areas;
                  (E) establish a regional public education 
                campaign, including a campaign to--
                          (i) prevent preterm births; and
                          (ii) educate the public about infant 
                        mortality; and
                  (F) provide for any other activities, 
                programs, or strategies as identified by the 
                community plan.
          (5) Limitation.--Of the funds received through a 
        grant under this subsection for a fiscal year, an 
        eligible entity shall not use more than 10 percent for 
        program evaluation.
          (6) Reports on pilot programs.--
                  (A) In general.--Not later than 1 year after 
                receiving a grant, and annually thereafter for 
                the duration of the grant period, each entity 
                that receives a grant under paragraph (1) shall 
                submit a report to the Secretary detailing its 
                infant mortality pilot program.
                  (B) Contents of report.--The reports required 
                under subparagraph (A) shall include 
                information such as the methodology of, and 
                outcomes and statistics from, the grantee's 
                infant mortality pilot program.
                  (C) Evaluation.--The Secretary shall use the 
                reports required under subparagraph (A) to 
                evaluate, and conduct statistical research on, 
                infant mortality pilot programs funded through 
                this subsection.
          (7) Definitions.--For the purposes of this 
        subsection:
                  (A) Administrator.--The term 
                ``Administrator'' means the Administrator of 
                the Health Resources and Services 
                Administration.
                  (B) Eligible entity.--The term ``eligible 
                entity'' means a State, county, city, 
                territorial, or tribal health department that 
                has submitted a proposal to the Secretary that 
                the Secretary deems likely to reduce infant 
                mortality rates within the standard 
                metropolitan statistical area involved.
                  (C) Tribal.--The term ``tribal'' refers to an 
                Indian tribe, a Tribal organization, or an 
                Urban Indian organization, as such terms are 
                defined in section 4 of the Indian Health Care 
                Improvement Act.
  [(e)] (f) Funding.--
          (1) [Authorization of appropriations] Healthy start 
        initiative.--For the purpose of carrying out this 
        section (other than subsection (e)), there are 
        authorized to be appropriated--
                  (A) * * *

           *       *       *       *       *       *       *

          (2) Infant mortality pilot programs.--To carry out 
        subsection (e), there is authorized to be appropriated 
        $10,000,000 for each of fiscal years 2011 through 2015.
          [(2)] (3) Allocation.--
                  (A) Program administration.--Of the amounts 
                appropriated under paragraph (1) for a fiscal 
                year, the Secretary may reserve up to 5 percent 
                for coordination, dissemination, technical 
                assistance, and data activities that are 
                determined by the Secretary to be appropriate 
                for carrying out [the program under this 
                section] the program under subsection (a).

           *       *       *       *       *       *       *

                                  
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