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[House Report 114-554]
[From the U.S. Government Publishing Office]

114th Congress   }                                             {  Report
                        HOUSE OF REPRESENTATIVES
 2d Session      }                                             { 114-554

======================================================================

 
   IMPROVING TREATMENT FOR PREGNANT AND POSTPARTUM WOMEN ACT OF 2016

                                _______
                                

  May 10, 2016.--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. 3691]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Energy and Commerce, to whom was referred 
the bill (H.R. 3691) to amend the Public Health Service Act to 
reauthorize the residential treatment programs for pregnant and 
postpartum women and to establish a pilot program to provide 
grants to State substance abuse agencies to promote innovative 
service delivery models for such women, having considered the 
same, report favorably thereon with an amendment and recommend 
that the bill as amended do pass.

                                CONTENTS

                                                                   Page
Purpose and Summary..............................................     3
Background and Need for Legislation..............................     3
Hearings.........................................................     4
Committee Consideration..........................................     4
Committee Votes..................................................     4
Committee Oversight Findings.....................................     4
Statement of General Performance Goals and Objectives............     4
New Budget Authority, Entitlement Authority, and Tax Expenditures     5
Earmark, Limited Tax Benefits, and Limited Tariff Benefits.......     5
Committee Cost Estimate..........................................     5
Congressional Budget Office Estimate.............................     5
Federal Mandates Statement.......................................     7
Duplication of Federal Programs..................................     7
Disclosure of Directed Rule Makings..............................     7
Advisory Committee Statement.....................................     7
Applicability to Legislative Branch..............................     7
Section-by-Section Analysis of the Legislation...................     7
Changes in Existing Law Made by the Bill, as Reported............     8

    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 ``Improving Treatment for Pregnant and 
Postpartum Women Act of 2016''.

SEC. 2. REAUTHORIZATION OF RESIDENTIAL TREATMENT PROGRAMS FOR PREGNANT 
                    AND POSTPARTUM WOMEN.

  Section 508 of the Public Health Service Act (42 U.S.C. 290bb-1) is 
amended--
          (1) in subsection (p), in the first sentence, by inserting 
        ``(other than subsection (r))'' after ``section''; and
          (2) in subsection (r), by striking ``such sums'' and all that 
        follows through ``2003'' and inserting ``$16,900,000 for each 
        of fiscal years 2017 through 2021''.

SEC. 3. PILOT PROGRAM GRANTS FOR STATE SUBSTANCE ABUSE AGENCIES.

  (a) In General.--Section 508 of the Public Health Service Act (42 
U.S.C. 290bb-1) is amended--
          (1) by redesignating subsection (r), as amended by section 2, 
        as subsection (s); and
          (2) by inserting after subsection (q) the following new 
        subsection:
  ``(r) Pilot Program for State Substance Abuse Agencies.--
          ``(1) In general.--From amounts made available under 
        subsection (s), the Director of the Center for Substance Abuse 
        Treatment shall carry out a pilot program under which 
        competitive grants are made by the Director to State substance 
        abuse agencies to--
                  ``(A) enhance flexibility in the use of funds 
                designed to support family-based services for pregnant 
                and postpartum women with a primary diagnosis of a 
                substance use disorder, including opioid use disorders;
                  ``(B) help State substance abuse agencies address 
                identified gaps in services furnished to such women 
                along the continuum of care, including services 
                provided to women in nonresidential based settings; and
                  ``(C) promote a coordinated, effective, and efficient 
                State system managed by State substance abuse agencies 
                by encouraging new approaches and models of service 
                delivery.
          ``(2) Requirements.--In carrying out the pilot program under 
        this subsection, the Director shall--
                  ``(A) require State substance abuse agencies to 
                submit to the Director applications, in such form and 
                manner and containing such information as specified by 
                the Director, to be eligible to receive a grant under 
                the program;
                  ``(B) identify, based on such submitted applications, 
                State substance abuse agencies that are eligible for 
                such grants;
                  ``(C) require services proposed to be furnished 
                through such a grant to support family-based treatment 
                and other services for pregnant and postpartum women 
                with a primary diagnosis of a substance use disorder, 
                including opioid use disorders;
                  ``(D) not require that services furnished through 
                such a grant be provided solely to women that reside in 
                facilities;
                  ``(E) not require that grant recipients under the 
                program make available through use of the grant all 
                services described in subsection (d); and
                  ``(F) consider not applying requirements described in 
                paragraphs (1) and (2) of subsection (f) to applicants, 
                depending on the circumstances of the applicant.
          ``(3) Required services.--
                  ``(A) In general.--The Director shall specify a 
                minimum set of services required to be made available 
                to eligible women through a grant awarded under the 
                pilot program under this subsection. Such minimum set--
                          ``(i) shall include requirements described in 
                        subsection (c) and be based on the 
                        recommendations submitted under subparagraph 
                        (B); and
                          ``(ii) may be selected from among the 
                        services described in subsection (d) and 
                        include other services as appropriate.
                  ``(B) Stakeholder input.--The Director shall convene 
                and solicit recommendations from stakeholders, 
                including State substance abuse agencies, health care 
                providers, persons in recovery from substance abuse, 
                and other appropriate individuals, for the minimum set 
                of services described in subparagraph (A).
          ``(4) Duration.--The pilot program under this subsection 
        shall not exceed 5 years.
          ``(5) Evaluation and report to congress.--The Director of the 
        Center for Behavioral Health Statistics and Quality shall fund 
        an evaluation of the pilot program at the conclusion of the 
        first grant cycle funded by the pilot program. The Director of 
        the Center for Behavioral Health Statistics and Quality, in 
        coordination with the Director of the Center for Substance 
        Abuse Treatment shall submit to the relevant committees of 
        jurisdiction of the House of Representatives and the Senate a 
        report on such evaluation. The report shall include at a 
        minimum outcomes information from the pilot program, including 
        any resulting reductions in the use of alcohol and other drugs; 
        engagement in treatment services; retention in the appropriate 
        level and duration of services; increased access to the use of 
        medications approved by the Food and Drug Administration for 
        the treatment of substance use disorders in combination with 
        counseling; and other appropriate measures.
          ``(6) State substance abuse agencies defined.--For purposes 
        of this subsection, the term `State substance abuse agency' 
        means, with respect to a State, the agency in such State that 
        manages the Substance Abuse Prevention and Treatment Block 
        Grant under part B of title XIX.''.
  (b) Funding.--Subsection (s) of section 508 of the Public Health 
Service Act (42 U.S.C. 290bb-1), as amended by section 2 and 
redesignated by subsection (a), is further amended by adding at the end 
the following new sentence: ``Of the amounts made available for a year 
pursuant to the previous sentence to carry out this section, not more 
than 25 percent of such amounts shall be made available for such year 
to carry out subsection (r), other than paragraph (5) of such 
subsection. Notwithstanding the preceding sentence, no funds shall be 
made available to carry out subsection (r) for a fiscal year unless the 
amount made available to carry out this section for such fiscal year is 
more than the amount made available to carry out this section for 
fiscal year 2016.''.

SEC. 4. CUT-GO COMPLIANCE.

  Subsection (f) of section 319D of the Public Health Service Act (42 
U.S.C. 247d-4) is amended by striking ``through 2018'' and inserting 
``through 2016, $133,300,000 for fiscal year 2017, and $138,300,000 for 
fiscal year 2018''.

                          Purpose and Summary

    H.R. 3691, the ``Improving Treatment for Pregnant and 
Postpartum Women Act of 2016,'' was introduced by Rep. Ben Ray 
Lujan (D-NM), Rep. Tonko (D-NY), Rep. Clarke (D-NY), Rep. 
Matsui (D-CA), and Rep. Cardenas (D-CA). This legislation 
reauthorizes a grant program for residential treatment for 
pregnant and postpartum women who have an opioid use disorder 
and for their children, including those who may be born with 
neonatal abstinence syndrome. It creates a new pilot program to 
enhance the flexibility of the funds so states can more broadly 
support family-based services for pregnant and postpartum women 
and their children.

                  Background and Need for Legislation

    In most instances, withdrawal or detoxification is not 
clinically appropriate for pregnant women with opioid use 
disorders. The withdrawal symptoms associated with 
discontinuing opioid use in pregnant women can lead to 
miscarriage or other negative birth outcomes. Buprenorphine and 
methadone can be used to treat a woman's opioid use disorder 
while pregnant. Such treatment can result in improved outcomes 
for both mothers and babies.
    Unfortunately, babies exposed to opioids in utero may be 
born with neonatal abstinence syndrome (NAS), which refers to 
medical issues associated with opioid withdrawal in newborns. 
Mothers suffering from opioid use disorder may be sent home 
with babies who have NAS with very little guidance or support 
which can have negative consequences for their babies. In the 
United States, the incidence of NAS has risen from 1.20 per 
1,000 hospital births in 2000 to 3.9 per 1,000 hospital births 
in 2009. NAS can result from the use of prescription opioids as 
prescribed for medical reasons, abuse of prescription opioid 
medication, or the use of illegal opioids like heroin.
    The grant program reauthorized in Section 508 of the Public 
Health Service Act helps support residential treatment 
facilities where women and their children receive support, 
education, treatment, and counseling that they need. The pilot 
program will allow states more flexibility in providing these 
services for women and children in need.

                                Hearings

    The Subcommittee on Health held a hearing on H.R. 3391 on 
October 20, 2015. The Subcommittee received testimony from:
         Mr. Michael Botticelli, Director, National 
        Drug Control Policy, Executive Office of the President;
         Dr. Richard Frank, Assistant Secretary for 
        Planning and Evaluation, Department of Health and Human 
        Services;
         Mr. Jack Riley, Deputy Administrator, Drug 
        Enforcement Administration;
         Dr. Allen Anderson, President, American 
        Orthopaedic Society for Sports Medicine;
         Dr. Paul Halverson, Dean, Indiana University, 
        Richard M. Fairbanks School of Public Health;
         Dr. Kenneth Katz, Lehigh Valley Health 
        Network, Department of Emergency Medicine, Section of 
        Medical Toxicology;
         Dr. Chapman Sledge, Chief Medical Officer, 
        Cumberland Heights; and,
         Dr. Robert Corey Waller, Chair, Legislative 
        Advocacy Committee, American Society of Addiction 
        Medicine.

                        Committee Consideration

    On April 20, 2016, the Subcommittee on health met in open 
markup session and forwarded H.R. 3691, without amendment, to 
the full Committee by a voice vote. On April 26, 27, and 28, 
2016, the full Committee on Energy and Commerce met in open 
markup session and ordered H.R. 3691 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 
H.R. 3691 reported.

                      Committee Oversight Findings

    Pursuant to clause 3(c)(1) of rule XIII of the Rules of the 
House of Representatives, the Committee held a hearing and made 
findings that are reflected in this report.

         Statement of General Performance Goals and Objectives

    The goal of this legislation is to reauthorize the 
residential treatment programs for pregnant and postpartum 
women and to establish a pilot program to provide grants to 
state substance abuse agencies to promote innovative service 
delivery models for such women.

   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. 
3691 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. 3691 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:

                                                       May 9, 2016.
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. 3691, the 
Improving Treatment for Pregnant and Postpartum Women Act of 
2015.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Ellen Werble.
            Sincerely,
                                                        Keith Hall.
    Enclosure.

H.R. 3691--Improving Treatment for Pregnant and Postpartum Women Act of 
        2015

    Summary: H.R. 3691 would reauthorize programs for 
residential treatment of pregnant and postpartum women. The 
bill also would require the Substance Abuse and Mental Health 
Services Administration (SAMHSA) to establish a pilot program 
to award grants to support programs that treat substance abuse 
in pregnant and postpartum women. Additionally, H.R. 3691 would 
reduce amounts authorized to be appropriated for existing 
activities related to bioterrorism and public health 
emergencies at the Centers for Disease Control and Prevention 
(CDC). Assuming appropriation actions consistent with the bill, 
CBO estimates that implementing H.R. 3691 would have a net 
discretionary cost of $65 million over the 2017-2021 period.
    Pay-as-you-go procedures do not apply because enacting H.R. 
3691 would not affect direct spending or revenues. CBO 
estimates that enacting H.R. 3691 would not increase net direct 
spending or on-budget deficits in any of the four consecutive 
10-year periods beginning in 2027
    H.R. 3691 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. 3691 is shown in the following table. 
The costs of this legislation fall within budget function 550 
(health).

----------------------------------------------------------------------------------------------------------------
                                                                 By fiscal year, in millions of dollars--
                                                         -------------------------------------------------------
                                                            2017     2018     2019     2020     2021   2017-2021
----------------------------------------------------------------------------------------------------------------
                                  CHANGES IN SPENDING SUBJECT TO APPROPRIATION
 
Substance Abuse and Mental Health Services
 Administration:
    Authorization Level.................................       17       17       17       17       17        85
    Estimated Outlays...................................        5       14       16       17       17        69
Centers for Disease Control and Prevention:
    Authorization Level.................................       -5        0        0        0        0        -5
    Estimated Outlays...................................       -2       -2       -1        *        *        -5
    Total Changes:
        Authorization Level.............................       12       17       17       17       17        80
        Estimated Outlays...............................        4       12       16       17       17        65
----------------------------------------------------------------------------------------------------------------
Notes: * = between $0 and -$500,000; details may not add to totals because of rounding.

    Basis of estimate: For this estimate, CB0 assumes that H.R. 
3691 will be enacted near the end of fiscal year 2016 and that 
spending will follow historical patterns for similar programs.

Substance abuse and mental health services administration

    H.R. 3691 would reauthorize grants for residential 
treatment programs for pregnant and postpartum women. The 
authority for those grant programs at SAMHSA expired in 2003; 
however, the Congress has continued to appropriate funds each 
year. For fiscal year 2016, SAMHSA received an appropriation of 
$15.9 million for those programs. The bill also would require 
SAMHSA to establish a pilot program to award grants to support 
programs to treat substance abuse in pregnant and postpartum 
women and to fund an evaluation of the pilot program. The bill 
would authorize the appropriation of $16.9 million for these 
activities for each of fiscal years 2017 through 2021. Assuming 
appropriation of the specified amounts, CB0 estimates that 
implementing these provisions would cost about $69 million over 
the 2017-2021 period.

Centers for Disease Control and Prevention

    Under current law, an authorization of appropriation of 
$138 million exists for 2017 for CDC activities related to 
bioterrorism and public health emergencies. H.R. 3691 would 
reduce the amount authorized by $5 million in 2017. Assuming 
appropriations are reduced accordingly, CBO estimates that 
implementing this provision would result in $5 million less in 
discretionary outlays for those activities over 2017-2021 
period.
    Pay-as-you-go considerations: None.
    Increase in long-term direct spending and deficits: CBO 
estimates that enacting H.R. 3691 would not increase net direct 
spending or on-budget deficits in any of the four consecutive 
10-year periods beginning in 2027.
    Intergovernmental and private-sector impact: H.R. 3691 
contains no intergovernmental or private-sector mandates as 
defined in UMRA. Any costs incurred by states or local 
governments that apply for grants authorized by the bill would 
be incurred voluntarily as a condition of federal assistance.
    Estimate prepared by: Federal Costs: Ellen Werble; Impact 
on State, Local, and Tribal Governments: Leo Lexi; Impact on 
the Private Sector: Amy Petz.
    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. 3691 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. 3691 
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 states that the legislation may be cited as the 
``Improving Treatment for Pregnant and Postpartum Women Act of 
2016.''

Section 2. Reauthorization of residential treatment programs for 
        pregnant and postpartum women

    Section 2 reauthorizes Section 508 of the Public Health 
Service Act, residential treatment programs for pregnant and 
postpartum women. Section 508 is reauthorized for fiscal years 
2017 to 2021 for $16.9 million a year over those five years.

Section 3. Pilot program grants for state substance abuse agencies

    Section 3 creates a pilot program under Section 508 of the 
Public Health Service Act to enhance flexibility in the use of 
funds to support family-based services for pregnant and 
postpartum women with a primary diagnosis of substance use 
disorder, including opioid use disorder, and help states 
identify gaps in service. This grant will also help promote 
coordinated, effective and efficient state systems.

Section 4. Cut-Go compliance

    Section 4 reduces the authorization of Section 319D of the 
Public Health Service Act by $5,000,000 for fiscal year 2018 to 
bring the legislation into compliance with Cut-Go. This 
reduction is equal to the increase in authorization of 
appropriations above the last appropriated level for the 
program being reauthorized in Section 2 of H.R. 3691.

         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, and 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 B--Federal-State Cooperation

           *       *       *       *       *       *       *

SEC. 319D. REVITALIZING THE CENTERS FOR DISEASE CONTROL AND PREVENTION.

  (a) Facilities; Capacities.--
          (1) Findings.--Congress finds that the Centers for 
        Disease Control and Prevention has an essential role in 
        defending against and combatting public health threats 
        domestically and abroad and requires secure and modern 
        facilities, and expanded and improved capabilities 
        related to bioterrorism and other public health 
        emergencies, sufficient to enable such Centers to 
        conduct this important mission.
          (2) Facilities.--
                  (A) In general.--The Director of the Centers 
                for Disease Control and Prevention may design, 
                construct, and equip new facilities, renovate 
                existing facilities (including laboratories, 
                laboratory support buildings, scientific 
                communication facilities, transshipment 
                complexes, secured and isolated parking 
                structures, office buildings, and other 
                facilities and infrastructure), and upgrade 
                security of such facilities, in order to better 
                conduct the capacities described in section 
                319A, and for supporting public health 
                activities.
                  (B) Multiyear contracting authority.--For any 
                project of designing, constructing, equipping, 
                or renovating any facility under subparagraph 
                (A), the Director of the Centers for Disease 
                Control and Prevention may enter into a single 
                contract or related contracts that collectively 
                include the full scope of the project, and the 
                solicitation and contract shall contain the 
                clause ``availability of funds'' found at 
                section 52.232-18 of title 48, Code of Federal 
                Regulations.
          (3) Improving the capacities of the centers for 
        disease control and prevention.--The Secretary shall 
        expand, enhance, and improve the capabilities of the 
        Centers for Disease Control and Prevention relating to 
        preparedness for and responding effectively to 
        bioterrorism and other public health emergencies. 
        Activities that may be carried out under the preceding 
        sentence include--
                  (A) expanding or enhancing the training of 
                personnel;
                  (B) improving communications facilities and 
                networks, including delivery of necessary 
                information to rural areas;
                  (C) improving capabilities for public health 
                surveillance and reporting activities, taking 
                into account the integrated system or systems 
                of public health alert communications and 
                surveillance networks under subsection (b); and
                  (D) improving laboratory facilities related 
                to bioterrorism and other public health 
                emergencies, including increasing the security 
                of such facilities.
  (b) National Communications and Surveillance Networks.--
          (1) In general.--The Secretary, directly or through 
        awards of grants, contracts, or cooperative agreements, 
        shall provide for the establishment of an integrated 
        system or systems of public health alert communications 
        and surveillance networks between and among--
                  (A) Federal, State, and local public health 
                officials;
                  (B) public and private health-related 
                laboratories, hospitals, poison control 
                centers, and other health care facilities; and
                  (C) any other entities determined appropriate 
                by the Secretary.
          (2) Requirements.--The Secretary shall ensure that 
        networks under paragraph (1) allow for the timely 
        sharing and discussion, in a secure manner, of 
        essential information concerning bioterrorism or 
        another public health emergency, or recommended methods 
        for responding to such an attack or emergency, allowing 
        for coordination to maximize all-hazards medical and 
        public health preparedness and response and to minimize 
        duplication of effort.
          (3) Standards.--Not later than one year after the 
        date of the enactment of the Public Health Security and 
        Bioterrorism Preparedness and Response Act of 2002, the 
        Secretary, in cooperation with health care providers 
        and State and local public health officials, shall 
        establish any additional technical and reporting 
        standards (including standards for interoperability) 
        for networks under paragraph (1) and update such 
        standards as necessary.
  (c) Modernizing Public Health Situational Awareness and 
Biosurveillance.--
          (1) In general.--Not later than 2 years after the 
        date of enactment of the Pandemic and All-Hazards 
        Preparedness Reauthorization Act of 2013, the 
        Secretary, in collaboration with State, local, and 
        tribal public health officials, shall establish a near 
        real-time electronic nationwide public health 
        situational awareness capability through an 
        interoperable network of systems to share data and 
        information to enhance early detection of rapid 
        response to, and management of, potentially 
        catastrophic infectious disease outbreaks, novel 
        emerging threats, and other public health emergencies 
        that originate domestically or abroad. Such network 
        shall be built on existing State situational awareness 
        systems or enhanced systems that enable such 
        connectivity.
          (2) Strategy and implementation plan.--Not later than 
        180 days after the date of enactment of the Pandemic 
        and All-Hazards Preparedness Reauthorization Act of 
        2013, the Secretary shall submit to the appropriate 
        committees of Congress a coordinated strategy and an 
        accompanying implementation plan that identifies and 
        demonstrates the measurable steps the Secretary will 
        carry out to--
                  (A) develop, implement, and evaluate the 
                network described in paragraph (1), utilizing 
                the elements described in paragraph (3);
                  (B) modernize and enhance biosurveillance 
                activities; and
                  (C) improve information sharing, 
                coordination, and communication among disparate 
                biosurveillance systems supported by the 
                Department of Health and Human Services.
          (3) Elements.--The network described in paragraph (1) 
        shall include data and information transmitted in a 
        standardized format from--
                  (A) State, local, and tribal public health 
                entities, including public health laboratories;
                  (B) Federal health agencies;
                  (C) zoonotic disease monitoring systems;
                  (D) public and private sector health care 
                entities, hospitals, pharmacies, poison control 
                centers or professional organizations in the 
                field of poison control, community health 
                centers, health centers and clinical 
                laboratories, to the extent practicable and 
                provided that such data are voluntarily 
                provided simultaneously to the Secretary and 
                appropriate State, local, and tribal public 
                health agencies; and
                  (E) such other sources as the Secretary may 
                deem appropriate.
          (4) Rule of construction.--Paragraph (3) shall not be 
        construed as requiring separate reporting of data and 
        information from each source listed.
          (5) Required activities.--In establishing and 
        operating the network described in paragraph (1), the 
        Secretary shall--
                  (A) utilize applicable interoperability 
                standards as determined by the Secretary, and 
                in consultation with the Office of the National 
                Coordinator for Health Information Technology, 
                through a joint public and private sector 
                process;
                  (B) define minimal data elements for such 
                network;
                  (C) in collaboration with State, local, and 
                tribal public health officials, integrate and 
                build upon existing State, local, and tribal 
                capabilities, ensuring simultaneous sharing of 
                data, information, and analyses from the 
                network described in paragraph (1) with State, 
                local, and tribal public health agencies; and
                  (D) in collaboration with State, local, and 
                tribal public health officials, develop 
                procedures and standards for the collection, 
                analysis, and interpretation of data that 
                States, regions, or other entities collect and 
                report to the network described in paragraph 
                (1).
          (6) Consultation with the national biodefense science 
        board.--In carrying out this section and consistent 
        with section 319M, the National Biodefense Science 
        Board shall provide expert advice and guidance, 
        including recommendations, regarding the measurable 
        steps the Secretary should take to modernize and 
        enhance biosurveillance activities pursuant to the 
        efforts of the Department of Health and Human Services 
        to ensure comprehensive, real-time, all-hazards 
        biosurveillance capabilities. In complying with the 
        preceding sentence, the National Biodefense Science 
        Board shall--
                  (A) identify the steps necessary to achieve a 
                national biosurveillance system for human 
                health, with international connectivity, where 
                appropriate, that is predicated on State, 
                regional, and community level capabilities and 
                creates a networked system to allow for two-way 
                information flow between and among Federal, 
                State, and local government public health 
                authorities and clinical health care providers;
                  (B) identify any duplicative surveillance 
                programs under the authority of the Secretary, 
                or changes that are necessary to existing 
                programs, in order to enhance and modernize 
                such activities, minimize duplication, 
                strengthen and streamline such activities under 
                the authority of the Secretary, and achieve 
                real-time and appropriate data that relate to 
                disease activity, both human and zoonotic; and
                  (C) coordinate with applicable existing 
                advisory committees of the Director of the 
                Centers for Disease Control and Prevention, 
                including such advisory committees consisting 
                of representatives from State, local, and 
                tribal public health authorities and 
                appropriate public and private sector health 
                care entities and academic institutions, in 
                order to provide guidance on public health 
                surveillance activities.
  (d) State and Regional Systems To Enhance Situational 
Awareness in Public Health Emergencies.--
          (1) In general.--To implement the network described 
        in subsection (c), the Secretary may award grants to 
        States or consortia of States to enhance the ability of 
        such States or consortia of States to establish or 
        operate a coordinated public health situational 
        awareness system for regional or Statewide early 
        detection of, rapid response to, and management of 
        potentially catastrophic infectious disease outbreaks 
        and public health emergencies, in collaboration with 
        appropriate public health agencies, sentinel hospitals, 
        clinical laboratories, pharmacies, poison control 
        centers, other health care organizations, and animal 
        health organizations within such States.
          (2) Eligibility.--To be eligible to receive a grant 
        under paragraph (1), the State or consortium of States 
        shall submit to the Secretary an application at such 
        time, in such manner, and containing such information 
        as the Secretary may require, including an assurance 
        that the State or consortium of States will submit to 
        the Secretary--
                  (A) reports of such data, information, and 
                metrics as the Secretary may require;
                  (B) a report on the effectiveness of the 
                systems funded under the grant; and
                  (C) a description of the manner in which 
                grant funds will be used to enhance the 
                timelines and comprehensiveness of efforts to 
                detect, respond to, and manage potentially 
                catastrophic infectious disease outbreaks and 
                public health emergencies.
          (3) Use of funds.--A State or consortium of States 
        that receives an award under this subsection--
                  (A) shall establish, enhance, or operate a 
                coordinated public health situational awareness 
                system for regional or Statewide early 
                detection of, rapid response to, and management 
                of potentially catastrophic infectious disease 
                outbreaks and public health emergencies;
                  (B) may award grants or contracts to entities 
                described in paragraph (1) within or serving 
                such State to assist such entities in improving 
                the operation of information technology 
                systems, facilitating the secure exchange of 
                data and information, and training personnel to 
                enhance the operation of the system described 
                in subparagraph (A); and
                  (C) may conduct a pilot program for the 
                development of multi-State telehealth network 
                test beds that build on, enhance, and securely 
                link existing State and local telehealth 
                programs to prepare for, monitor, respond to, 
                and manage the events of public health 
                emergencies, facilitate coordination and 
                communication among medical, public health, and 
                emergency response agencies, and provide 
                medical services through telehealth initiatives 
                within the States that are involved in such a 
                multi-State telehealth network test bed.
          (4) Limitation.--Information technology systems 
        acquired or implemented using grants awarded under this 
        section must be compliant with--
                  (A) interoperability and other technological 
                standards, as determined by the Secretary; and
                  (B) data collection and reporting 
                requirements for the network described in 
                subsection (c).
          (5) Independent evaluation.--Not later than 3 years 
        after the date of enactment of the Pandemic and All-
        Hazards Preparedness Reauthorization Act of 2013, the 
        Government Accountability Office shall conduct an 
        independent evaluation, and submit to the Secretary and 
        the appropriate committees of Congress a report 
        concerning the activities conducted under this 
        subsection and subsection (c).
  (e) Telehealth Enhancements for Emergency Response.--
          (1) Evaluation.--The Secretary, in consultation with 
        the Federal Communications Commission and other 
        relevant Federal agencies, shall--
                  (A) conduct an inventory of telehealth 
                initiatives in existence on the date of 
                enactment of the Pandemic and All-Hazards 
                Preparedness Act, including--
                          (i) the specific location of network 
                        components;
                          (ii) the medical, technological, and 
                        communications capabilities of such 
                        components;
                          (iii) the functionality of such 
                        components; and
                          (iv) the capacity and ability of such 
                        components to handle increased volume 
                        during the response to a public health 
                        emergency;
                  (B) identify methods to expand and 
                interconnect the regional health information 
                networks funded by the Secretary, the State and 
                regional broadband networks funded through the 
                rural health care support mechanism pilot 
                program funded by the Federal Communications 
                Commission, and other telehealth networks;
                  (C) evaluate ways to prepare for, monitor, 
                respond rapidly to, or manage the events of, a 
                public health emergency through the enhanced 
                use of telehealth technologies, including 
                mechanisms for payment or reimbursement for use 
                of such technologies and personnel during 
                public health emergencies;
                  (D) identify methods for reducing legal 
                barriers that deter health care professionals 
                from providing telemedicine services, such as 
                by utilizing State emergency health care 
                professional credentialing verification 
                systems, encouraging States to establish and 
                implement mechanisms to improve interstate 
                medical licensure cooperation, facilitating the 
                exchange of information among States regarding 
                investigations and adverse actions, and 
                encouraging States to waive the application of 
                licensing requirements during a public health 
                emergency;
                  (E) evaluate ways to integrate the practice 
                of telemedicine within the National Disaster 
                Medical System; and
                  (F) promote greater coordination among 
                existing Federal interagency telemedicine and 
                health information technology initiatives.
          (2) Report.--Not later than 12 months after the date 
        of enactment of the Pandemic and All-Hazards 
        Preparedness Act, the Secretary shall prepare and 
        submit a report to the Committee on Health, Education, 
        Labor, and Pensions of the Senate and the Committee on 
        Energy and Commerce of the House of Representatives 
        regarding the findings and recommendations pursuant to 
        subparagraphs (A) through (F) of paragraph (1).
  (f) Authorization of Appropriations.--There are authorized to 
be appropriated to carry out this section, $138,300,000 for 
each of fiscal years 2014 [through 2018] through 2016, 
$133,300,000 for fiscal year 2017, and $138,300,000 for fiscal 
year 2018.
  (g) Definition.--For purposes of this section the term 
``biosurveillance'' means the process of gathering near real-
time biological data that relates to human and zoonotic disease 
activity and threats to human or animal health, in order to 
achieve early warning and identification of such health 
threats, early detection and prompt ongoing tracking of health 
events, and overall situational awareness of disease activity.

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TITLE V--SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION

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                      Part B--Centers and Programs

Subpart 1--Center for Substance Abuse Treatment

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    residential treatment programs for pregnant and postpartum women

  Sec. 508. (a) In General.--The Director of the Center for 
Substance Abuse Treatment shall provide awards of grants, 
cooperative agreement, or contracts to public and nonprofit 
private entities for the purpose of providing to pregnant and 
postpartum women treatment for substance abuse through programs 
in which, during the course of receiving treatment--
          (1) the women reside in facilities provided by the 
        programs;
          (2) the minor children of the women reside with the 
        women in such facilities, if the women so request; and
          (3) the services described in subsection (d) are 
        available to or on behalf of the women.
  (b) Availability of Services for Each Participant.--A funding 
agreement for an award under subsection (a) for an applicant is 
that, in the program operated pursuant to such subsection--
          (1) treatment services and each supplemental service 
        will be available through the applicant, either 
        directly or through agreements with other public or 
        nonprofit private entities; and
          (2) the services will be made available to each woman 
        admitted to the program.
  (c) Individualized Plan of Services.--A funding agreement for 
an award under subsection (a) for an applicant is that--
          (1) in providing authorized services for an eligible 
        woman pursuant to such subsection, the applicant will, 
        in consultation with the women, prepare an 
        individualized plan for the provision to the woman of 
        the services; and
          (2) treatment services under the plan will include--
                  (A) individual, group, and family counseling, 
                as appropriate, regarding substance abuse; and
                  (B) follow-up services to assist the woman in 
                preventing a relapse into such abuse.
  (d) Required Supplemental Services.--In the case of an 
eligible woman, the services referred to in subsection (a)(3) 
are as follows:
          (1) Prenatal and postpartum health care.
          (2) Referrals for necessary hospital services.
          (3) For the infants and children of the woman--
                  (A) pediatric health care, including 
                treatment for any perinatal effects of maternal 
                substance abuse and including screenings 
                regarding the physical and mental development 
                of the infants and children;
                  (B) counseling and other mental health 
                services, in the case of children; and
                  (C) comprehensive social services.
          (4) Providing supervision of children during periods 
        in which the woman is engaged in therapy or in other 
        necessary health or rehabilitative activities.
          (5) Training in parenting.
          (6) Counseling on the human immunodeficiency virus 
        and on acquired immune deficiency syndrome.
          (7) Counseling on domestic violence and sexual abuse.
          (8) Counseling on obtaining employment, including the 
        importance of graduating from a secondary school.
          (9) Reasonable efforts to preserve and support the 
        family units of the women, including promoting the 
        appropriate involvement of parents and others, and 
        counseling the children of the women.
          (10) Planning for and counseling to assist reentry 
        into society, both before and after discharge, 
        including referrals to any public or nonprofit private 
        entities in the community involved that provide 
        services appropriate for the women and the children of 
        the women.
          (11) Case management services, including--
                  (A) assessing the extent to which authorized 
                services are appropriate for the women and 
                their children;
                  (B) in the case of the services that are 
                appropriate, ensuring that the services are 
                provided in a coordinated manner; and
                  (C) assistance in establishing eligibility 
                for assistance under Federal, State, and local 
                programs providing health services, mental 
                health services, housing services, employment 
                services, educational services, or social 
                services.
  (e) Minimum Qualifications For Receipt of Award.--
          (1) Certification by relevant state agency.--With 
        respect to the principal agency of the State involved 
        that administers programs relating to substance abuse, 
        the Director may make an award under subsection (a) to 
        an applicant only if the agency has certified to the 
        Director that--
                  (A) the applicant has the capacity to carry 
                out a program described in subsection (a);
                  (B) the plans of the applicant for such a 
                program are consistent with the policies of 
                such agency regarding the treatment of 
                substance abuse; and
                  (C) the applicant, or any entity through 
                which the applicant will provide authorized 
                services, meets all applicable State licensure 
                or certification requirements regarding the 
                provision of the services involved.
          (2) Status as medicaid provider.--
                  (A) Subject to subparagraphs (B) and (C), the 
                Director may make an award under subsection (a) 
                only if, in the case of any authorized service 
                that is available pursuant to the State plan 
                approved under title XIX of the Social Security 
                Act for the State involved--
                          (i) the applicant for the award will 
                        provide the service directly, and the 
                        applicant has entered into a 
                        participation agreement under the State 
                        plan and is qualified to receive 
                        payments under such plan; or
                          (ii) the applicant will enter into an 
                        agreement with a public or nonprofit 
                        private entity under which the entity 
                        will provide the service, and the 
                        entity has entered into such a 
                        participation agreement plan and is 
                        qualified to receive such payments.
                  (B)(i) In the case of an entity making an 
                agreement pursuant to subparagraph (A)(ii) 
                regarding the provision of services, the 
                requirement established in such subparagraph 
                regarding a participation agreement shall be 
                waived by the Director if the entity does not, 
                in providing health care services, impose a 
                charge or accept reimbursement available from 
                any third-party payor, including reimbursement 
                under any insurance policy or under any Federal 
                or State health benefits plan.
                  (ii) A determination by the Director of 
                whether an entity referred to in clause (i) 
                meets the criteria for a waiver under such 
                clause shall be made without regard to whether 
                the entity accepts voluntary donations 
                regarding the provision of services to the 
                public.
                  (C) With respect to any authorized service 
                that is available pursuant to the State plan 
                described in subparagraph (A), the requirements 
                established in such subparagraph shall not 
                apply to the provision of any such service by 
                an institution for mental diseases to an 
                individual who has attained 21 years of age and 
                who has not attained 65 years of age. For 
                purposes of the preceding sentence, the term 
                ``institution for mental diseases'' has the 
                meaning given such term in section 1905(i) of 
                the Social Security Act.
  (f) Requirement of Matching Funds.--
          (1) In general.--With respect to the costs of the 
        program to be carried out by an applicant pursuant to 
        subsection (a), a funding agreement for an award under 
        such subsection is that the applicant will make 
        available (directly or through donations from public or 
        private entities) non-Federal contributions toward such 
        costs in an amount that--
                  (A) for the first fiscal year for which the 
                applicant receives payments under an award 
                under such subsection, is not less than $1 for 
                each $9 of Federal funds provided in the award;
                  (B) for any second such fiscal year, is not 
                less than $1 for each $9 of Federal funds 
                provided in the award; and
                  (C) for any subsequent such fiscal year, is 
                not less than $1 for each $3 of Federal funds 
                provided in the award.
          (2) Determination of amount contributed.--Non-Federal 
        contributions required in paragraph (1) may be in cash 
        or in kind, fairly evaluated, including plant, 
        equipment, or services. Amounts provided by the Federal 
        Government, or services assisted or subsidized to any 
        significant extent by the Federal Government, may not 
        be included in determining the amount of such non-
        Federal contributions.
  (g) Outreach.--A funding agreement for an award under 
subsection (a) for an applicant is that the applicant will 
provide outreach services in the community involved to identify 
women who are engaging in substance abuse and to encourage the 
women to undergo treatment for such abuse.
  (h) Accessibility of Program; Cultural Context of Services.--
A funding agreement for an award under subsection (a) for an 
applicant is that--
          (1) the program operated pursuant to such subsection 
        will be operated at a location that is accessible to 
        low-income pregnant and postpartum women; and
          (2) authorized services will be provided in the 
        language and the cultural context that is most 
        appropriate.
  (i) Continuing Education.--A funding agreement for an award 
under subsection (a) is that the applicant involved will 
provide for continuing education in treatment services for the 
individuals who will provide treatment in the program to be 
operated by the applicant pursuant to such subsection.
  (j) Imposition of Charges.--A funding agreement for an award 
under subsection (a) for an applicant is that, if a charge is 
imposed for the provision of authorized services to on behalf 
of an eligible woman, such charge--
          (1) will be made according to a schedule of charges 
        that is made available to the public;
          (2) will be adjusted to reflect the income of the 
        woman involved; and
          (3) will not be imposed on any such woman with an 
        income of less than 185 percent of the official poverty 
        line, as established by the Director of the Office for 
        Management and Budget and revised by the Secretary in 
        accordance with section 673(2) of the Omnibus Budget 
        Reconciliation Act of 1981.
  (k) Reports to Director.--A funding agreement for an award 
under subsection (a) is that the applicant involved will submit 
to the Director a report--
          (1) describing the utilization and costs of services 
        provided under the award;
          (2) specifying the number of women served, the number 
        of infants served, and the type and costs of services 
        provided; and
          (3) providing such other information as the Director 
        determines to be appropriate.
  (l) Requirement of Application.--The Director may make an 
award under subsection (a) only if an application for the award 
is submitted to the Director containing such agreements, and 
the application is in such form, is made in such manner, and 
contains such other agreements and such assurances and 
information as the Director determines to be necessary to carry 
out this section.
  (m) Equitable Allocation of Awards.--In making awards under 
subsection (a), the Director shall ensure that the awards are 
equitably allocated among the principal geographic regions of 
the United States, subject to the availability of qualified 
applicants for the awards.
  (n) Duration of Award.--The period during which payments are 
made to an entity from an award under subsection (a) may not 
exceed 5 years. The provision of such payments shall be subject 
to annual approval by the Director of the payments and subject 
to the availability of appropriations for the fiscal year 
involved to make the payments. This subsection may not be 
construed to establish a limitation on the number of awards 
under such subsection that may be made to an entity.
  (o) Evaluations; Dissemination of Findings.--The Director 
shall, directly or through contract, provide for the conduct of 
evaluations of programs carried out pursuant to subsection (a). 
The Director shall disseminate to the States the findings made 
as a result of the evaluations.
  (p) Reports to Congress.--Not later than October 1, 1994, the 
Director shall submit to the Committee on Energy and Commerce 
of the House of Representatives, and to the Committee on Labor 
and Human Resources of the Senate, a report describing programs 
carried out pursuant to this section (other than subsection 
(r)). Every 2 years thereafter, the Director shall prepare a 
report describing such programs carried out during the 
preceding 2 years, and shall submit the report to the 
Administrator for inclusion in the biennial report under 
section 501(k). Each report under this subsection shall include 
a summary of any evaluations conducted under subsection (m) 
during the period with respect to which the report is prepared.
  (q) Definitions.--For purposes of this section:
          (1) The term ``authorized services'' means treatment 
        services and supplemental services.
          (2) The term ``eligible woman'' means a woman who has 
        been admitted to a program operated pursuant to 
        subsection (a).
          (3) The term ``funding agreement under subsection 
        (a)'', with respect to an award under subsection (a), 
        means that the Director may make the award only if the 
        applicant makes the agreement involved.
          (4) The term ``treatment services'' means treatment 
        for substance abuse, including the counseling and 
        services described in subsection (c)(2).
          (5) The term ``supplemental services'' means the 
        services described in subsection (d).
   (r) Pilot Program for State Substance Abuse Agencies.--
          (1) In general.--From amounts made available under 
        subsection (s), the Director of the Center for 
        Substance Abuse Treatment shall carry out a pilot 
        program under which competitive grants are made by the 
        Director to State substance abuse agencies to--
                  (A) enhance flexibility in the use of funds 
                designed to support family-based services for 
                pregnant and postpartum women with a primary 
                diagnosis of a substance use disorder, 
                including opioid use disorders;
                  (B) help State substance abuse agencies 
                address identified gaps in services furnished 
                to such women along the continuum of care, 
                including services provided to women in 
                nonresidential based settings; and
                  (C) promote a coordinated, effective, and 
                efficient State system managed by State 
                substance abuse agencies by encouraging new 
                approaches and models of service delivery.
          (2) Requirements.--In carrying out the pilot program 
        under this subsection, the Director shall--
                  (A) require State substance abuse agencies to 
                submit to the Director applications, in such 
                form and manner and containing such information 
                as specified by the Director, to be eligible to 
                receive a grant under the program;
                  (B) identify, based on such submitted 
                applications, State substance abuse agencies 
                that are eligible for such grants;
                  (C) require services proposed to be furnished 
                through such a grant to support family-based 
                treatment and other services for pregnant and 
                postpartum women with a primary diagnosis of a 
                substance use disorder, including opioid use 
                disorders;
                  (D) not require that services furnished 
                through such a grant be provided solely to 
                women that reside in facilities;
                  (E) not require that grant recipients under 
                the program make available through use of the 
                grant all services described in subsection (d); 
                and
                  (F) consider not applying requirements 
                described in paragraphs (1) and (2) of 
                subsection (f) to applicants, depending on the 
                circumstances of the applicant.
          (3) Required services.--
                  (A) In general.--The Director shall specify a 
                minimum set of services required to be made 
                available to eligible women through a grant 
                awarded under the pilot program under this 
                subsection. Such minimum set--
                          (i) shall include requirements 
                        described in subsection (c) and be 
                        based on the recommendations submitted 
                        under subparagraph (B); and
                          (ii) may be selected from among the 
                        services described in subsection (d) 
                        and include other services as 
                        appropriate.
                  (B) Stakeholder input.--The Director shall 
                convene and solicit recommendations from 
                stakeholders, including State substance abuse 
                agencies, health care providers, persons in 
                recovery from substance abuse, and other 
                appropriate individuals, for the minimum set of 
                services described in subparagraph (A).
          (4) Duration.--The pilot program under this 
        subsection shall not exceed 5 years.
          (5) Evaluation and report to congress.--The Director 
        of the Center for Behavioral Health Statistics and 
        Quality shall fund an evaluation of the pilot program 
        at the conclusion of the first grant cycle funded by 
        the pilot program. The Director of the Center for 
        Behavioral Health Statistics and Quality, in 
        coordination with the Director of the Center for 
        Substance Abuse Treatment shall submit to the relevant 
        committees of jurisdiction of the House of 
        Representatives and the Senate a report on such 
        evaluation. The report shall include at a minimum 
        outcomes information from the pilot program, including 
        any resulting reductions in the use of alcohol and 
        other drugs; engagement in treatment services; 
        retention in the appropriate level and duration of 
        services; increased access to the use of medications 
        approved by the Food and Drug Administration for the 
        treatment of substance use disorders in combination 
        with counseling; and other appropriate measures.
          (6) State substance abuse agencies defined.--For 
        purposes of this subsection, the term ``State substance 
        abuse agency'' means, with respect to a State, the 
        agency in such State that manages the Substance Abuse 
        Prevention and Treatment Block Grant under part B of 
        title XIX.
  [(r)] (s) Authorization of Appropriations.--For the purpose 
of carrying out this section, there are authorized to be 
appropriated [such sums as may be necessary to fiscal years 
2001 through 2003] $16,900,000 for each of fiscal years 2017 
through 2021. Of the amounts made available for a year pursuant 
to the previous sentence to carry out this section, not more 
than 25 percent of such amounts shall be made available for 
such year to carry out subsection (r), other than paragraph (5) 
of such subsection. Notwithstanding the preceding sentence, no 
funds shall be made available to carry out subsection (r) for a 
fiscal year unless the amount made available to carry out this 
section for such fiscal year is more than the amount made 
available to carry out this section for fiscal year 2016.

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