```

[House Report 114-548]
[From the U.S. Government Publishing Office]

114th Congress    }                                      {      Report
                        HOUSE OF REPRESENTATIVES
 2d Session       }                                      {     114-548

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

 
                INFANT PLAN OF SAFE CARE IMPROVEMENT ACT

                                _______
                                

  May 10, 2016.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

Mr. Kline, from the Committee on Education and the Workforce, submitted 
                             the following

                              R E P O R T

                        [To accompany H.R. 4843]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Education and the Workforce, to whom was 
referred the bill (H.R. 4843) to amend the Child Abuse 
Prevention and Treatment Act to require certain monitoring and 
oversight, and for other purposes, having considered the same, 
report favorably thereon with an amendment and recommend that 
the bill as amended do pass.
    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 ``Infant Plan of Safe Care Improvement 
Act''.

SEC. 2. BEST PRACTICES FOR DEVELOPMENT OF PLANS OF SAFE CARE.

  Section 103(b) of the Child Abuse Prevention and Treatment Act (42 
U.S.C. 5104(b)) is amended--
          (1) by redesignating paragraphs (5) through (8) as paragraphs 
        (6) through (9), respectively; and
          (2) by inserting after paragraph (4), the following:
          ``(5) maintain and disseminate information about the 
        requirements of section 106(b)(2)(B)(iii) and best practices 
        relating to the development of plans of safe care as described 
        in such section for infants born and identified as being 
        affected by illegal substance abuse or withdrawal symptoms, or 
        a Fetal Alcohol Spectrum Disorder;''.

SEC. 3. STATE PLANS.

  Section 106(b)(2)(B)(iii) of the Child Abuse Prevention and Treatment 
Act (42 U.S.C. 5106a(b)(2)(B)(iii)) is amended by inserting before the 
semicolon at the end the following: ``to ensure the safety and well-
being of such infant following release from the care of healthcare 
providers, including through--''
                                  ``(I) addressing the health and 
                                substance use disorder treatment needs 
                                of the infant and affected family or 
                                caregiver; and
                                  ``(II) the development and 
                                implementation by the State of 
                                monitoring systems regarding the 
                                implementation of such plans to 
                                determine whether and in what manner 
                                local entities are providing, in 
                                accordance with State requirements, 
                                referrals to and delivery of 
                                appropriate services for the infant and 
                                affected family or caregiver''.

SEC. 4. DATA REPORTS.

  (a) In General.--Section 106(d) of the Child Abuse Prevention and 
Treatment Act (42 U.S.C. 5106a(d)) is amended by adding at the end of 
the following:
          ``(17)(A) The number of infants identified under subsection 
        (b)(2)(B)(ii).
          ``(B) The number of infants for whom a plan of safe care was 
        developed under subsection (b)(2)(B)(iii).
          ``(C) The number of infants for whom a referral was made for 
        appropriate services, including services for the affected 
        family or caregiver, under subsection (b)(2)(B)(iii).''.
  (b) Redesignation.--Effective on May 29, 2017, section 106(d) of the 
Child Abuse Prevention and Treatment Act (42 U.S.C. 5106a(d)) is 
amended by redesignating paragraph (17) (as added by subsection (a)) as 
paragraph (18).

SEC. 5. MONITORING AND OVERSIGHT.

  (a) Amendment.--Title I of the Child Abuse Prevention and Treatment 
Act (42 U.S.C. 5101 et seq.) is further amended by adding at the end 
the following:

``SEC. 114. MONITORING AND OVERSIGHT.

  ``The Secretary shall conduct monitoring to ensure that each State 
that receives a grant under section 106 is in compliance with the 
requirements of section 106(b), which--
          ``(1) shall--
                  ``(A) be in addition to the review of the State plan 
                upon its submission under section 106(b)(1)(A); and
                  ``(B) include monitoring of State policies and 
                procedures required under clauses (ii) and (iii) of 
                section 106(b)(2)(B); and
          ``(2) may include--
                  ``(A) a comparison of activities carried out by the 
                State to comply with the requirements of section 106(b) 
                with the State plan most recently approved under 
                section 432 of the Social Security Act;
                  ``(B) a review of information available on the 
                Website of the State relating to its compliance with 
                the requirements of section 106(b);
                  ``(C) site visits, as may be necessary to carry out 
                such monitoring; and
                  ``(D) a review of information available in the 
                State's Annual Progress and Services Report most 
                recently submitted under section 1357.16 of title 45, 
                Code of Federal Regulations (or successor 
                regulations).''.
  (b) Table of Contents.--The table of contents in section 1(b) of the 
Child Abuse Prevention and Treatment Act (42 U.S.C. 5101 note) is 
amended by inserting after the item relating to section 113, the 
following:

``Sec. 114. Monitoring and oversight.''.

SEC. 6. RULE OF CONSTRUCTION.

  Nothing in this Act, or the amendments made by this Act, shall be 
construed to authorize the Secretary of Health and Human Services or 
any other officer of the Federal Government to add new requirements to 
section 106(b) of the Child Abuse Prevention and Treatment Act (42 
U.S.C. 5106a(b)), as amended by this Act.

                                Purpose

    H.R. 4843, the Infant Plan of Safe Care Improvement Act, 
amends the Child Abuse Prevention and Treatment Act (CAPTA) to 
strengthen safety, protections, and interventions for infants 
and their families or caregivers by improving accountability 
and transparency and encouraging administrative efficiency.

                            Committee Action

    H.R. 4843 reflects work by the Education and the Workforce 
Committee (Committee) in the 114th Congress to amend CAPTA in 
order to address concerns about the growing number of infants 
born suffering from drug dependency, a condition known as 
Neonatal Abstinence Syndrome. The bill builds upon the 
Committee's ongoing efforts to ensure current policies are 
enforced and families receive the assistance they desperately 
need to improve infant safety and well-being.

                     114TH CONGRESS, FIRST SESSION

Full Committee Hearing on Policies and Priorities of the U.S. 
        Department of Health and Human Services

    On July 28, 2015, the Committee held a hearing in 
Washington, D.C., on ``Policies and Priorities of the U.S. 
Department of Health and Human Services.'' The purpose of the 
hearing was to address the policies and priorities of the U.S. 
Department of Health and Human Services (HHS). HHS Secretary 
Sylvia Mathews Burwell testified before the Committee. In her 
testimony, Secretary Burwell addressed the President's budget 
proposal to support access to voluntary home visiting programs 
that reduce child abuse and neglect.

                     114TH CONGRESS, SECOND SESSION

Letter to HHS Secretary Burwell

    On January 15, 2016, Committee Chairman John Kline (R-MN) 
and Early Childhood, Elementary, and Secondary Education 
Subcommittee Chairman Todd Rokita (R-IN) sent a letter to 
Secretary Burwell regarding monitoring and oversight of the 
state assurances required by CAPTA. On March 7, 2016, HHS 
responded to the letter, stating that, due to concerns raised, 
it had requested states submit more information about their 
policies or procedures for the safe care of substance-exposed 
infants in the annual state reports for FY 2016. The next 
annual state report is due in June 2016.

Full Committee Hearing Examining the Policies and Priorities of the 
        U.S. Department of Health and Human Services

    On March 15, 2016, the Committee held a hearing in 
Washington, D.C., on ``Examining the Policies and Priorities of 
the U.S. Department of Health and Human Services,'' at which 
Secretary Burwell testified. The purpose of this hearing was to 
discuss a number of HHS' policies. Chairman Kline joined other 
members in questioning Secretary Burwell about the opioid 
epidemic, including infant substance exposure and the failure 
of states and HHS to fulfill their responsibilities under 
CAPTA.

Full Committee Markup of H.R. 4843

    On April 28, 2016, the Committee held a markup on H.R. 
4843, the Improving Safe Care for the Prevention of Infant 
Abuse and Neglect Act. There were three amendments offered:
     Amendment in the Nature of a Substitute: Rep. Lou 
Barletta (R-PA) offered an amendment in the nature of a 
substitute. The amendment (1) changed the bill title to 
``Infant Plan of Safe Care Improvement Act;'' (2) clarified HHS 
should disseminate information to states about the requirements 
of the plan of safe care; (3) clarified substance use disorder 
treatment needs should be considered as part of a plan of safe 
care to address the health of the infant and affected family 
member or caregiver; (4) clarified states should monitor the 
use of plans of safe care and whether services are offered and 
provided to the infant and family; (5) clarified the rule of 
construction to ensure the HHS Secretary does not use 
amendments made by H.R. 4843 to create new requirements for 
states; and (6) made other technical changes. The amendment was 
agreed to by voice vote.
     Amendment 1: Rep. Jared Polis (D-CO) offered an 
amendment to authorize the National Institutes of Health to 
study the medical application of marijuana for pain management. 
The amendment was ruled not germane.
     Amendment 2: Rep. Polis offered an amendment to 
allow state plans to include demonstration projects on 
prescription drug technology and unauthorized access to 
prescription drugs. The amendment was withdrawn.
    H.R. 4843, the Infant Plan of Safe Care Improvement Act, as 
amended by the amendment in the nature of a substitute, was 
reported favorably by voice vote.

                                Summary

    CAPTA was enacted in 1974 to coordinate federal efforts to 
prevent and respond to child abuse and neglect. The law 
provides states with resources to improve their child 
protective services systems. In order to receive funds under 
CAPTA, states are required to assure HHS they have implemented 
certain child welfare policies. Such policies include requiring 
health care providers to notify state child protective services 
agencies when a child is born with prenatal illegal substance 
exposure, as well as requiring the development of a ``safe care 
plan'' to protect these newborns and keep them and their 
caregivers healthy. A Reuters' investigation in December 2015 
revealed nearly all states are receiving federal funds without 
having these necessary policies in place.\1\
---------------------------------------------------------------------------
    \1\Wilson, D. and Shiffman, J. (2015, December 7). Helpless and 
Hooked. Reuters. Retrieved from http://www.reuters.com
---------------------------------------------------------------------------
    In order to strengthen protections for the nation's most 
vulnerable population, Rep. Barletta and Rep. Katherine Clark 
(D-MA), along with Chairman John Kline, Ranking Member Robert 
``Bobby'' Scott (D-VA), Rep. Tim Walberg (R-MI), and Rep. 
Polis, introduced H.R. 4843. The legislation helps to combat 
this epidemic by doing the following:
           Requiring HHS to review and confirm states 
        have put in place CAPTA policies required under the 
        law;
           Strengthening protections for infants born 
        with illegal substance exposure by clarifying the 
        intent of safe care plans and ensuring states have 
        systems in place to monitor the implementation of these 
        plans;
           Improving accountability related to the care 
        of infants and their families by requiring additional 
        information on the incidence of infants born with 
        illegal substance exposure and their care;
           Requiring HHS to provide states with best 
        practices for developing plans to keep infants and 
        their caregivers healthy and safe;
           Encouraging the use of information made 
        available through other child welfare laws in verifying 
        CAPTA compliance; and
           Clarifying that nothing in this Act 
        authorizes the HHS Secretary to add new requirements to 
        state plans required under section 106(b).

                            Committee Views

Introduction

    Our nation faces an opioid addiction crisis. According to 
the Centers for Disease Control and Prevention (CDC), 78 
Americans die every day from an opioid overdose.\2\ In 
addition, the CDC has found that more than six out of 10 drug 
overdoses in the nation involve opioids.\3\ This crisis is 
having dire consequences for a staggering number of newborns 
annually, with a baby born every 25 minutes suffering from 
opioid withdrawal.\4\ According to a year-long Reuters report 
in 2015, more than 130,000 infants born in the United States in 
the last decade have entered the world hooked on drugs--a 
dependency inherited from their mother's drug addiction.\5\
---------------------------------------------------------------------------
    \2\Centers for Disease Control and Prevention. Understanding the 
Epidemic. http://www.cdc.gov/drugoverdose/epidemic/ 
    \3\Ibid.
    \4\National Institute on Drug Abuse, Dramatic Increases in Maternal 
Opioid Use and Neonatal Abstinence Syndrome. https://www.drugabuse.gov/
related-topics/trends-statistics/infographics/dramatic-increases-in-
maternal-opioid-use-neonatal-abstinence-syndrome 
    \5\Centers for Disease Control and Prevention. Understanding the 
Epidemic. http://www.cdc.gov/drugoverdose/epidemic/
---------------------------------------------------------------------------

Addressing the epidemic

    When infants are born with an addiction, their drug 
dependency is called Neonatal Abstinence Syndrome (NAS). 
Infants born with NAS suffer through withdrawal, their bodies 
shaking and trembling as they gasp for air. Meanwhile, the 
infant's mother often continues to struggle with her own 
addiction after the child is born. To address this issue, CAPTA 
requires health care providers to notify state child protective 
services agencies when an infant is born with withdrawal 
symptoms or illegal substance exposure. In addition to the 
notification, a plan of safe care must also be developed to 
address the health and well-being of the infant, including 
treatment for the affected family or caregiver. Shockingly, 
most states are failing to uphold these statutory requirements, 
with sometimes tragic, fatal results.
    To address these failures, H.R. 4843 clarifies and 
strengthens the statutory requirements in CAPTA pertaining to 
plans of safe care and state monitoring to ensure effective 
implementation. Additionally, the bill includes important new 
data points to ensure states have the information needed to 
prevent infant abuse and neglect.
    While H.R. 4843 specifically looks at incidents of illegal 
substance exposure, the Committee remains concerned about the 
effect of legal substance use during pregnancy and the impact 
on infants after birth. In particular, opioid addiction is tied 
strongly to prescription drug abuse. In 2012, heath care 
providers wrote 259 million prescriptions to people for 
opioids.\6\ In 2009, an estimated 23,009 delivering mothers 
were using or dependent on opioids.\7\ Given this increase, the 
Committee will request that the Government Accountability 
Office study the impact and prevalence of legal substance abuse 
during pregnancy and how infants and their mothers can receive 
the best care, as well as make recommendations for the 
Committee's consideration to address this troubling issue.
---------------------------------------------------------------------------
    \6\Ibid. CDC Guideline for Prescribing Opioid for Chronic Pain--
United States, 2016. http://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm
    \7\National Institute on Drug Abuse, Dramatic Increases in Maternal 
Opioid Use and Neonatal Abstinence Syndrome. https://www.drugabuse.gov/
related-topics/trends-statistics/infographics/dramatic-increases-in-
maternal-opioid-use-neonatal-abstinence-syndrome
---------------------------------------------------------------------------

Increasing oversight and clarification

    In order to ensure states are following the law as written, 
H.R. 4843 requires HHS to increase its oversight and confirm 
states have established and implemented policies as required in 
CAPTA.
    H.R. 4843 also explicitly clarifies the intent and purpose 
of the safe care plans is to help address the health and 
treatment needs of the infant and the affected family or 
caregiver. The legislation improves the accountability system 
relating to the care of infants and their families by requiring 
crucial information related to the incidents of infants born 
with illegal substance exposure and their care be reported by 
the state. These clarifications will help ensure the infants 
are not overlooked nor neglected by the state or health care 
providers.
    States should not limit their efforts to address the needs 
of substance exposed infants and their families to funds 
available under CAPTA. As Dr. Cassie Statuto Bevan, a 
commissioner on the Commission to Eliminate Child Abuse and 
Neglect Fatalities (Commission), stated in her minority report 
in the Commission's final report released in March 2016:

          It is also important for states to develop 
        collaborative plans across cabinet-level departments 
        and funding streams (such as Maternal, Infant & Early 
        Childhood Home Visiting Programs (MIECHV), M[aternal] 
        C[hild] H[ealth], SAMHSA [Substance Abuse and Mental 
        Health Services Administration], and [Social Security 
        Act] IV-E and IV-B) to support substance-exposed 
        newborns and their mothers.\8\
---------------------------------------------------------------------------
    \8\Commission to Eliminate Child Abuse and Neglect Fatalities. 
Within Our Reach. https://eliminatechildabusefatalities.sites.usa.gov/
files/2016/03/CECANF-final-report.pdf

    The Commission recommended increasing funding to support 
the requirements under CAPTA.

Assisting local efforts

    In order to facilitate implementation of the requirements 
in CAPTA and subsequently H.R. 4843, the legislation requires 
the HHS Secretary to provide states with best practices on 
developing state plans that seek to ensure the safety of the 
infants and their primary caregivers. This provision will 
ensure the infants suffering from withdrawal are kept healthy 
and safe as they transition to a life without addiction.

Protecting against Federal overreach

    In order to ensure the federal government does not overstep 
its authority, H.R. 4843 includes a prohibition clarifying the 
HHS Secretary cannot add new requirements to section 106(b). 
However, the bill maintains the HHS Secretary's ability to 
issue guidance, provide technical assistance, promulgate 
regulations, and enforce compliance with the requirements of 
CAPTA.

Conclusion

    America's opioid addiction crisis is harming the livelihood 
of its most vulnerable citizens. Infants with NAS are born 
suffering constant pain, and they lack the ability to resist 
the damaging effects of their mother's addiction. The Committee 
remains committed to doing everything in its ability to prevent 
these heartbreaking situations and ensure all children have the 
protection and care they need. The Committee believes we have a 
moral responsibility to do better, and this legislation is an 
important step forward.

                           Section-by-Section

Section 1--Short title

    States the short title as the Infant Plan of Safe Care 
Improvement Act.

Section 2--Best practices for development of plans of safe care

    Further clarifies the HHS Secretary is to maintain and 
disseminate information relating to best practices and 
requirements for the development of plans of safe care of 
infants born and identified as being affected by one of the 
following: illegal substance abuse; withdrawal symptoms; or a 
Fetal Alcohol Spectrum Disorder.

Section 3--State plans

    Updates the state plan requirement to ensure states either 
have implemented a law or operate a statewide program relating 
to child abuse and neglect that includes the development of a 
plan of safe care for infants born with and identified as being 
affected by one of the following: illegal substance abuse; 
withdrawal symptoms; or a Fetal Alcohol Spectrum Disorder. The 
bill further requires the plan to address the health and 
addiction treatment needs of the infant and family or 
caregiver. It also requires the state to monitor the use of 
safe care plans.

Section 4--Data reports

    Requires states receiving grants to include in their annual 
State Data Report the total number of affected infants; infants 
for whom a plan of safe care was developed; and infants for 
whom referrals are made for appropriate services, including 
services given to the affected family or caregiver. This 
section includes a technical amendment related to the inclusion 
of an amendment made by the Justice for Victims of Trafficking 
Act (P.L. 114-22).

Section 5--Monitoring and oversight

    Requires the HHS Secretary to conduct monitoring to ensure 
states are in compliance with the requirements related to 
receiving a grant. This review will be in addition to the 
review of the state's plan upon initial submission and include 
monitoring state policies and procedures that prevent child 
abuse and neglect. In addition, in order to properly conduct 
such a review, the HHS Secretary is authorized to review or 
conduct the following, (1) a comparison of activities carried 
out by the state to comply with the requirements for state 
plans in section 432 of the Social Security Act; (2) 
information available on the state's website relating to its 
compliance with the requirements for state plans in section 
106(b); (3) site visits as necessary; and (4) information 
available in the state's most recent Annual Progress and 
Services Report.

Section 6--Rule of construction

    Prohibits the HHS Secretary or any other officer of the 
federal government from adding new requirements to the state 
plans or using amendments to CAPTA made by the Act to create 
new requirements for state plans.

                       Explanation of Amendments

    The amendments, including the amendment in the nature of a 
substitute, are explained in the body of this report.

              Application 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. H.R. 4843 will strengthen safety, protections, and 
interventions for infants and their families or caregivers by 
improving accountability and transparency and encouraging 
administrative efficiency.

                       Unfunded Mandate Statement

    Section 423 of the Congressional Budget and Impoundment 
Control Act (as amended by Section 101(a)(2) of the Unfunded 
Mandates Reform Act, P.L. 104-4) requires a statement of 
whether the provisions of the reported bill include unfunded 
mandates. This issue is addressed in the CBO letter.

                           Earmark Statement

    H.R. 4843 does not contain any congressional earmarks, 
limited tax benefits, or limited tariff benefits as defined in 
clause 9 of House Rule XXI.

                            Roll Call Votes

    Clause 3(b) of rule XIII of the Rules of the House of 
Representatives requires the Committee Report to include for 
each record vote on a motion to report the measure or matter 
and on any amendments offered to the measure or matter the 
total number of votes for and against and the names of the 
Members voting for and against. No roll call votes were 
requested.

         Statement of General Performance Goals and Objectives

    In accordance with clause (3)(c) of House Rule XIII, the 
goals of H.R. 4843 are to strengthen safety, protections, and 
interventions for infants and their families or caregivers by 
improving accountability and transparency and encouraging 
administrative efficiency.

                    Duplication of Federal Programs

    No provision of H.R. 4843 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. 4843 does not 
specifically direct the completion of any specific rule makings 
within the meaning of 5 U.S.C. 551.

  Statement of Oversight Findings and Recommendations of the Committee

    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 committee's oversight findings and recommendations are 
reflected in the body of this report.

               New Budget Authority and CBO Cost Estimate

    With respect to the requirements of clause 3(c)(2) of rule 
XIII of the Rules of the House of Representatives and section 
308(a) of the Congressional Budget Act of 1974 and with respect 
to 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 estimate for H.R. 4843 from the Director of the 
Congressional Budget Office:

                                     U.S. Congress,
                               Congressional Budget Office,
                                       Washington, DC, May 6, 2016.
Hon. John Kline,
Chairman, Committee on Education and the Workforce,
House of Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 4843, the Infant 
Plan of Safe Care Improvement Act.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Jennifer 
Gray.
            Sincerely,
                                                        Keith Hall.
    Enclosure.

H.R. 4843--Infant Plan of Safe Care Improvement Act

    Under the Child Abuse Prevention and Treatment Act (CAPTA), 
states that meet the necessary requirements, including the 
development of a plan of safe care for any drug-dependent 
infants, may receive grants to address child abuse and neglect. 
H.R. 4843 would amend CAPTA to require states to carry out 
certain activities as part of the plan of safe care, including 
determining whether local authorities have the resources 
necessary to provide services for a child and family. The 
legislation also would require states to report the number of 
drug-dependent infants, the number of infants for whom a plan 
of safe care has been developed, and the number of infants for 
whom a referral has been made for appropriate services. 
Finally, H.R. 4843 would require the Department of Health and 
Human Services (HHS) to monitor states to ensure compliance 
with the bill's requirements and, through the national 
clearinghouse for information relating to child abuse, to 
maintain and disseminate information regarding the requirements 
and best practices for the development of plans of safe care.
    Based on information from HHS, CBO estimates that 
implementing the legislation would cost less than $500,000 
annually for additional personnel to carry out the new 
requirements; such spending would be subject to the 
availability of appropriated funds. Because enacting this bill 
would not affect direct spending or revenues, pay-as-you-go 
procedures do not apply. CBO estimates that enacting H.R. 4843 
would not increase net direct spending or on-budget deficits in 
any of the four consecutive 10-year periods beginning in 2027.
    H.R. 4843 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act and 
would impose no costs on state, local, or tribal governments. 
Any costs states incur for complying with new grant 
requirements would be incurred voluntarily as a condition of 
receiving federal assistance.
    On April 11, 2016, CBO transmitted a cost estimate for S. 
2687, the Plan of Safe Care Improvement Act, as reported by the 
Senate Committee on Health, Education, Labor, and Pensions on 
April 4, 2016. The two bills have similar requirements, and the 
estimated budgetary effects for both bills are the same.
    The CBO staff contact for this estimate is Jennifer Gray. 
This estimate was approved by H. Samuel Papenfuss, Deputy 
Assistant Director for Budget Analysis.

                        Committee Cost Estimate

    Clause 3(d)(1) of rule XIII of the Rules of the House of 
Representatives requires an estimate and a comparison of the 
costs that would be incurred in carrying out H.R. 4843. 
However, clause 3(d)(2)(B) of that rule provides that this 
requirement does not apply when the committee has included in 
its report a timely submitted cost estimate of the bill 
prepared by the Director of the Congressional Budget Office 
under section 402 of the Congressional Budget Act.

         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 (new matter is 
printed in italic and existing law in which no change is 
proposed is shown in roman):

         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):

                CHILD ABUSE PREVENTION AND TREATMENT ACT

SECTION 1. SHORT TITLE AND TABLE OF CONTENTS.

  (a) Short Title.--This Act may be cited as the ``Child Abuse 
Prevention and Treatment Act''.
  (b) Table of Contents.--The table of contents is as follows:

     * * * * * * *

                        TITLE I--GENERAL PROGRAM

     * * * * * * *
Sec. 114. Monitoring and oversight.

           *       *       *       *       *       *       *

TITLE I--GENERAL PROGRAM

           *       *       *       *       *       *       *

SEC. 103. NATIONAL CLEARINGHOUSE FOR INFORMATION RELATING TO CHILD 
                    ABUSE.

  (a) Establishment.--The Secretary shall through the 
Department, or by one or more contracts of not less than 3 
years duration let through a competition, establish a national 
clearinghouse for information relating to child abuse and 
neglect.
  (b) Functions.--The Secretary shall, through the 
clearinghouse established by subsection (a)--
          (1) maintain, coordinate, and disseminate information 
        on effective programs, including private and community-
        based programs, that have demonstrated success with 
        respect to the prevention, assessment, identification, 
        and treatment of child abuse or neglect and hold the 
        potential for broad-scale implementation and 
        replication;
          (2) maintain, coordinate, and disseminate information 
        on the medical diagnosis and treatment of child abuse 
        and neglect;
          (3) maintain and disseminate information on best 
        practices relating to differential response;
          (4) maintain and disseminate information about the 
        best practices used for achieving improvements in child 
        protective systems;
          (5) maintain and disseminate information about the 
        requirements of section 106(b)(2)(B)(iii) and best 
        practices relating to the development of plans of safe 
        care as described in such section for infants born and 
        identified as being affected by illegal substance abuse 
        or withdrawal symptoms, or a Fetal Alcohol Spectrum 
        Disorder;
          [(5)] (6) maintain and disseminate information 
        relating to--
                  (A) the incidence of cases of child abuse and 
                neglect in the United States;
                  (B) the incidence of such cases in 
                populations determined by the Secretary under 
                section 105(a)(1) of the Child Abuse 
                Prevention, Adoption, and Family Services Act 
                of 1988 (42 U.S.C. 5105 note); and
                  (C) the incidence of any such cases related 
                to substance abuse;
          [(6)] (7) provide technical assistance upon request 
        that may include an evaluation or identification of--
                  (A) various methods and procedures for the 
                investigation, assessment, and prosecution of 
                child physical and sexual abuse cases;
                  (B) ways to mitigate psychological trauma to 
                the child victim; and
                  (C) effective programs carried out by the 
                States under this Act;
          [(7)] (8) collect and disseminate information 
        relating to various training resources available at the 
        State and local level to--
                  (A) individuals who are engaged, or who 
                intend to engage, in the prevention, 
                identification, and treatment of child abuse 
                and neglect; and
                  (B) appropriate State and local officials to 
                assist in training law enforcement, legal, 
                judicial, medical, mental health, education, 
                child welfare, substance abuse treatment 
                services, and domestic violence services 
                personnel; and
          [(8)] (9) collect and disseminate information, in 
        conjunction with the National Resource Centers 
        authorized in section 310(b) of the Family Violence 
        Prevention and Services Act, on effective programs and 
        best practices for developing and carrying out 
        collaboration between entities providing child 
        protective services and entities providing domestic 
        violence services.
  (c) Coordination With Available Resources.--
          (1) In general.--In establishing a national 
        clearinghouse as required by subsection (a), the 
        Secretary shall--
                  (A) consult with other Federal agencies that 
                operate similar clearinghouses;
                  (B) consult with the head of each agency 
                involved with child abuse and neglect on the 
                development of the components for information 
                collection and management of such clearinghouse 
                and on the mechanisms for the sharing of such 
                information with other Federal agencies and 
                clearinghouses;
                  (C) develop a Federal data system involving 
                the elements under subsection (b) which, to the 
                extent practicable, coordinates existing 
                Federal, State, tribal, regional, and local 
                child welfare data systems which shall 
                include--
                          (i) standardized data on false, 
                        unfounded, unsubstantiated, and 
                        substantiated reports;
                          (ii) information on the number of 
                        deaths due to child abuse and neglect;
                          (iii) information about the incidence 
                        and characteristics of child abuse and 
                        neglect in circumstances in which 
                        domestic violence is present; and
                          (iv) information about the incidence 
                        and characteristics of child abuse and 
                        neglect in cases related to substance 
                        abuse;
                  (D) through a national data collection and 
                analysis program and in consultation with 
                appropriate State and local agencies and 
                experts in the field, collect, compile, and 
                make available State child abuse and neglect 
                reporting information which, to the extent 
                practical, shall be universal and case specific 
                and integrated with other case-based foster 
                care and adoption data collected by the 
                Secretary;
                  (E) compile, analyze, and publish a summary 
                of the research conducted under section 104(a);
                  (F) collect and disseminate information that 
                describes best practices being used throughout 
                the Nation for making appropriate referrals 
                related to, and addressing, the physical, 
                developmental, and mental health needs of 
                abused and neglected children; and
                  (G) solicit public comment on the components 
                of such clearinghouse.
          (2) Confidentiality requirement.--In carrying out 
        paragraph (1)(D), the Secretary shall ensure that 
        methods are established and implemented to preserve the 
        confidentiality of records relating to case specific 
        data.

           *       *       *       *       *       *       *

SEC. 106. GRANTS TO STATES FOR CHILD ABUSE OR NEGLECT PREVENTION AND 
                    TREATMENT PROGRAMS.

  (a) Development and Operation Grants.--The Secretary shall 
make grants to the States, from allotments made under 
subsection (f) for each State that applies for a grant under 
this section, for purposes of assisting the States in improving 
the child protective services system of each such State in--
          (1) the intake, assessment, screening, and 
        investigation of reports of child abuse or neglect;
          (2)(A) creating and improving the use of 
        multidisciplinary teams and interagency, intra-agency, 
        interstate, and intrastate protocols to enhance 
        investigations; and
          (B) improving legal preparation and representation, 
        including--
                  (i) procedures for appealing and responding 
                to appeals of substantiated reports of child 
                abuse or neglect; and
                  (ii) provisions for the appointment of an 
                individual appointed to represent a child in 
                judicial proceedings;
          (3) case management, including ongoing case 
        monitoring, and delivery of services and treatment 
        provided to children and their families;
          (4) enhancing the general child protective system by 
        developing, improving, and implementing risk and safety 
        assessment tools and protocols, including the use of 
        differential response;
          (5) developing and updating systems of technology 
        that support the program and track reports of child 
        abuse and neglect from intake through final disposition 
        and allow interstate and intrastate information 
        exchange;
          (6) developing, strengthening, and facilitating 
        training including--
                  (A) training regarding research-based 
                strategies, including the use of differential 
                response, to promote collaboration with the 
                families;
                  (B) training regarding the legal duties of 
                such individuals;
                  (C) personal safety training for case 
                workers; and
                  (D) training in early childhood, child, and 
                adolescent development;
          (7) improving the skills, qualifications, and 
        availability of individuals providing services to 
        children and families, and the supervisors of such 
        individuals, through the child protection system, 
        including improvements in the recruitment and retention 
        of caseworkers;
          (8) developing, facilitating the use of, and 
        implementing research-based strategies and training 
        protocols for individuals mandated to report child 
        abuse and neglect;
          (9) developing, implementing, or operating programs 
        to assist in obtaining or coordinating necessary 
        services for families of disabled infants with life-
        threatening conditions, including--
                  (A) existing social and health services;
                  (B) financial assistance;
                  (C) services necessary to facilitate adoptive 
                placement of any such infants who have been 
                relinquished for adoption; and
                  (D) the use of differential response in 
                preventing child abuse and neglect;
          (10) developing and delivering information to improve 
        public education relating to the role and 
        responsibilities of the child protection system and the 
        nature and basis for reporting suspected incidents of 
        child abuse and neglect, including the use of 
        differential response;
          (11) developing and enhancing the capacity of 
        community-based programs to integrate shared leadership 
        strategies between parents and professionals to prevent 
        and treat child abuse and neglect at the neighborhood 
        level;
          (12) supporting and enhancing interagency 
        collaboration between the child protection system and 
        the juvenile justice system for improved delivery of 
        services and treatment, including methods for 
        continuity of treatment plan and services as children 
        transition between systems;
          (13) supporting and enhancing interagency 
        collaboration among public health agencies, agencies in 
        the child protective service system, and agencies 
        carrying out private community-based programs--
                  (A) to provide child abuse and neglect 
                prevention and treatment services (including 
                linkages with education systems), and the use 
                of differential response; and
                  (B) to address the health needs, including 
                mental health needs, of children identified as 
                victims of child abuse or neglect;, including 
                supporting prompt, comprehensive health and 
                developmental evaluations for children who are 
                the subject of substantiated child maltreatment 
                reports; or
          (14) developing and implementing procedures for 
        collaboration among child protective services, domestic 
        violence services, and other agencies in--
                  (A) investigations, interventions, and the 
                delivery of services and treatment provided to 
                children and families, including the use of 
                differential response, where appropriate; and
                  (B) the provision of services that assist 
                children exposed to domestic violence, and that 
                also support the caregiving role of their 
                nonabusing parents.
  (b) Eligibility Requirements.--
          (1) State plan.--
                  (A) In general.--To be eligible to receive a 
                grant under this section, a State shall submit 
                to the Secretary a State plan that specifies 
                the areas of the child protective services 
                system described in subsection (a) that the 
                State will address with amounts received under 
                the grant.
                  (B) Duration of plan.--Each State plan 
                shall--
                          (i) remain in effect for the duration 
                        of the State's participation under this 
                        section; and
                          (ii) be periodically reviewed and 
                        revised as necessary by the State to 
                        reflect changes in the State's 
                        strategies and programs under this 
                        section.
                  (C) Additional information.--The State shall 
                provide notice to the Secretary--
                          (i) of any substantive changes, 
                        including any change to State law or 
                        regulations, relating to the prevention 
                        of child abuse and neglect that may 
                        affect the eligibility of the State 
                        under this section; and
                          (ii) of any significant changes in 
                        how funds provided under this section 
                        are used to support activities 
                        described in this section, which may 
                        differ from the activities described in 
                        the current State application.
          (2) Contents.--A State plan submitted under paragraph 
        (1) shall contain a description of the activities that 
        the State will carry out using amounts received under 
        the grant to achieve the objectives of this title, 
        including--
                  (A) an assurance that the State plan, to the 
                maximum extent practicable, is coordinated with 
                the State plan under part B of title IV of the 
                Social Security Act (42 U.S.C. 621 et seq.) 
                relating to child welfare services and family 
                preservation and family support services;
                  (B) an assurance in the form of a 
                certification by the Governor of the State that 
                the State has in effect and is enforcing a 
                State law, or has in effect and is operating a 
                statewide program, relating to child abuse and 
                neglect that includes--
                          (i) provisions or procedures for an 
                        individual to report known and 
                        suspected instances of child abuse and 
                        neglect, including a State law for 
                        mandatory reporting by individuals 
                        required to report such instances;
                          (ii) policies and procedures 
                        (including appropriate referrals to 
                        child protection service systems and 
                        for other appropriate services) to 
                        address the needs of infants born with 
                        and identified as being affected by 
                        illegal substance abuse or withdrawal 
                        symptoms resulting from prenatal drug 
                        exposure, or a Fetal Alcohol Spectrum 
                        Disorder, including a requirement that 
                        health care providers involved in the 
                        delivery or care of such infants notify 
                        the child protective services system of 
                        the occurrence of such condition in 
                        such infants, except that such 
                        notification shall not be construed 
                        to--
                                  (I) establish a definition 
                                under Federal law of what 
                                constitutes child abuse or 
                                neglect; or
                                  (II) require prosecution for 
                                any illegal action;
                          (iii) the development of a plan of 
                        safe care for the infant born and 
                        identified as being affected by illegal 
                        substance abuse or withdrawal symptoms, 
                        or a Fetal Alcohol Spectrum Disorder to 
                        ensure the safety and well-being of 
                        such infant following release from the 
                        care of healthcare providers, including 
                        through--
                                  (I) addressing the health and 
                                substance use disorder 
                                treatment needs of the infant 
                                and affected family or 
                                caregiver; and
                                  (II) the development and 
                                implementation by the State of 
                                monitoring systems regarding 
                                the implementation of such 
                                plans to determine whether and 
                                in what manner local entities 
                                are providing, in accordance 
                                with State requirements, 
                                referrals to and delivery of 
                                appropriate services for the 
                                infant and affected family or 
                                caregiver;
                          (iv) procedures for the immediate 
                        screening, risk and safety assessment, 
                        and prompt investigation of such 
                        reports;
                          (v) triage procedures, including the 
                        use of differential response, for the 
                        appropriate referral of a child not at 
                        risk of imminent harm to a community 
                        organization or voluntary preventive 
                        service;
                          (vi) procedures for immediate steps 
                        to be taken to ensure and protect the 
                        safety of a victim of child abuse or 
                        neglect and of any other child under 
                        the same care who may also be in danger 
                        of child abuse or neglect and ensuring 
                        their placement in a safe environment;
                          (vii) provisions for immunity from 
                        prosecution under State and local laws 
                        and regulations for individuals making 
                        good faith reports of suspected or 
                        known instances of child abuse or 
                        neglect;
                          (viii) methods to preserve the 
                        confidentiality of all records in order 
                        to protect the rights of the child and 
                        of the child's parents or guardians, 
                        including requirements ensuring that 
                        reports and records made and maintained 
                        pursuant to the purposes of this Act 
                        shall only be made available to--
                                  (I) individuals who are the 
                                subject of the report;
                                  (II) Federal, State, or local 
                                government entities, or any 
                                agent of such entities, as 
                                described in clause (ix);
                                  (III) child abuse citizen 
                                review panels;
                                  (IV) child fatality review 
                                panels;
                                  (V) a grand jury or court, 
                                upon a finding that information 
                                in the record is necessary for 
                                the determination of an issue 
                                before the court or grand jury; 
                                and
                                  (VI) other entities or 
                                classes of individuals 
                                statutorily authorized by the 
                                State to receive such 
                                information pursuant to a 
                                legitimate State purpose;
                          (ix) provisions to require a State to 
                        disclose confidential information to 
                        any Federal, State, or local government 
                        entity, or any agent of such entity, 
                        that has a need for such information in 
                        order to carry out its responsibilities 
                        under law to protect children from 
                        child abuse and neglect;
                          (x) provisions which allow for public 
                        disclosure of the findings or 
                        information about the case of child 
                        abuse or neglect which has resulted in 
                        a child fatality or near fatality;
                          (xi) the cooperation of State law 
                        enforcement officials, court of 
                        competent jurisdiction, and appropriate 
                        State agencies providing human services 
                        in the investigation, assessment, 
                        prosecution, and treatment of child 
                        abuse and neglect;
                          (xii) provisions requiring, and 
                        procedures in place that facilitate the 
                        prompt expungement of any records that 
                        are accessible to the general public or 
                        are used for purposes of employment or 
                        other background checks in cases 
                        determined to be unsubstantiated or 
                        false, except that nothing in this 
                        section shall prevent State child 
                        protective services agencies from 
                        keeping information on unsubstantiated 
                        reports in their casework files to 
                        assist in future risk and safety 
                        assessment;
                          (xiii) provisions and procedures 
                        requiring that in every case involving 
                        a victim of child abuse or neglect 
                        which results in a judicial proceeding, 
                        a guardian ad litem, who has received 
                        training appropriate to the role, 
                        including training in early childhood, 
                        child, and adolescent development, and 
                        who may be an attorney or a court 
                        appointed special advocate who has 
                        received training appropriate to that 
                        role (or both), shall be appointed to 
                        represent the child in such 
                        proceedings--
                                  (I) to obtain first-hand, a 
                                clear understanding of the 
                                situation and needs of the 
                                child; and
                                  (II) to make recommendations 
                                to the court concerning the 
                                best interests of the child;
                          (xiv) the establishment of citizen 
                        review panels in accordance with 
                        subsection (c);
                          (xv) provisions, procedures, and 
                        mechanisms--
                                  (I) for the expedited 
                                termination of parental rights 
                                in the case of any infant 
                                determined to be abandoned 
                                under State law; and
                                  (II) by which individuals who 
                                disagree with an official 
                                finding of child abuse or 
                                neglect can appeal such 
                                finding;
                          (xvi) provisions, procedures, and 
                        mechanisms that assure that the State 
                        does not require reunification of a 
                        surviving child with a parent who has 
                        been found by a court of competent 
                        jurisdiction--
                                  (I) to have committed murder 
                                (which would have been an 
                                offense under section 1111(a) 
                                of title 18, United States 
                                Code, if the offense had 
                                occurred in the special 
                                maritime or territorial 
                                jurisdiction of the United 
                                States) of another child of 
                                such parent;
                                  (II) to have committed 
                                voluntary manslaughter (which 
                                would have been an offense 
                                under section 1112(a) of title 
                                18, United States Code, if the 
                                offense had occurred in the 
                                special maritime or territorial 
                                jurisdiction of the United 
                                States) of another child of 
                                such parent;
                                  (III) to have aided or 
                                abetted, attempted, conspired, 
                                or solicited to commit such 
                                murder or voluntary 
                                manslaughter;
                                  (IV) to have committed a 
                                felony assault that results in 
                                the serious bodily injury to 
                                the surviving child or another 
                                child of such parent;
                                  (V) to have committed sexual 
                                abuse against the surviving 
                                child or another child of such 
                                parent; or
                                  (VI) to be required to 
                                register with a sex offender 
                                registry under section 113(a) 
                                of the Adam Walsh Child 
                                Protection and Safety Act of 
                                2006 (42 U.S.C. 16913(a));
                          (xvii) an assurance that, upon the 
                        implementation by the State of the 
                        provisions, procedures, and mechanisms 
                        under clause (xvi), conviction of any 
                        one of the felonies listed in clause 
                        (xvi) constitute grounds under State 
                        law for the termination of parental 
                        rights of the convicted parent as to 
                        the surviving children (although case-
                        by-case determinations of whether or 
                        not to seek termination of parental 
                        rights shall be within the sole 
                        discretion of the State);
                          (xviii) provisions and procedures to 
                        require that a representative of the 
                        child protective services agency shall, 
                        at the initial time of contact with the 
                        individual subject to a child abuse or 
                        neglect investigation, advise the 
                        individual of the complaints or 
                        allegations made against the 
                        individual, in a manner that is 
                        consistent with laws protecting the 
                        rights of the informant;
                          (xix) provisions addressing the 
                        training of representatives of the 
                        child protective services system 
                        regarding the legal duties of the 
                        representatives, which may consist of 
                        various methods of informing such 
                        representatives of such duties, in 
                        order to protect the legal rights and 
                        safety of children and families from 
                        the initial time of contact during 
                        investigation through treatment;
                          (xx) provisions and procedures for 
                        improving the training, retention, and 
                        supervision of caseworkers;
                          (xxi) provisions and procedures for 
                        referral of a child under the age of 3 
                        who is involved in a substantiated case 
                        of child abuse or neglect to early 
                        intervention services funded under part 
                        C of the Individuals with Disabilities 
                        Education Act (20 U.S.C. 1431 et seq.);
                          (xxii) provisions and procedures for 
                        requiring criminal background record 
                        checks that meet the requirements of 
                        section 471(a)(20) of the Social 
                        Security Act (42 U.S.C. 671(a)(20)) for 
                        prospective foster and adoptive parents 
                        and other adult relatives and non-
                        relatives residing in the household; 
                        and
                          (xxiii) provisions for systems of 
                        technology that support the State child 
                        protective service system described in 
                        subsection (a) and track reports of 
                        child abuse and neglect from intake 
                        through final disposition;
                  (C) an assurance that the State has in place 
                procedures for responding to the reporting of 
                medical neglect (including instances of 
                withholding of medically indicated treatment 
                from infants with disabilities who have life-
                threatening conditions), procedures or 
                programs, or both (within the State child 
                protective services system), to provide for--
                          (i) coordination and consultation 
                        with individuals designated by and 
                        within appropriate health-care 
                        facilities;
                          (ii) prompt notification by 
                        individuals designated by and within 
                        appropriate health-care facilities of 
                        cases of suspected medical neglect 
                        (including instances of withholding of 
                        medically indicated treatment from 
                        infants with disabilities who have 
                        life-threatening conditions); and
                          (iii) authority, under State law, for 
                        the State child protective services 
                        system to pursue any legal remedies, 
                        including the authority to initiate 
                        legal proceedings in a court of 
                        competent jurisdiction, as may be 
                        necessary to prevent the withholding of 
                        medically indicated treatment from 
                        infants with disabilities who have 
                        life-threatening conditions;
                  (D) a description of--
                          (i) the services to be provided under 
                        the grant to individuals, families, or 
                        communities, either directly or through 
                        referrals aimed at preventing the 
                        occurrence of child abuse and neglect;
                          (ii) the training to be provided 
                        under the grant to support direct line 
                        and supervisory personnel in report 
                        taking, screening, assessment, decision 
                        making, and referral for investigating 
                        suspected instances of child abuse and 
                        neglect;
                          (iii) the training to be provided 
                        under the grant for individuals who are 
                        required to report suspected cases of 
                        child abuse and neglect;
                          (iv) policies and procedures 
                        encouraging the appropriate involvement 
                        of families in decisionmaking 
                        pertaining to children who experienced 
                        child abuse or neglect;
                          (v) policies and procedures that 
                        promote and enhance appropriate 
                        collaboration among child protective 
                        service agencies, domestic violence 
                        service agencies, substance abuse 
                        treatment agencies, and other agencies 
                        in investigations, interventions, and 
                        the delivery of services and treatment 
                        provided to children and families 
                        affected by child abuse or neglect, 
                        including children exposed to domestic 
                        violence, where appropriate; and
                          (vi) policies and procedures 
                        regarding the use of differential 
                        response, as applicable;
                  (E) an assurance or certification that the 
                programs or projects relating to child abuse 
                and neglect carried out under part B of title 
                IV of the Social Security Act (42 U.S.C. 621 et 
                seq.) comply with the requirements set forth in 
                paragraph (1) and this paragraph;
                  (F) an assurance or certification that 
                programs and training conducted under this 
                title address the unique needs of unaccompanied 
                homeless youth, including access to enrollment 
                and support services and that such youth are 
                eligible for under parts B and E of title IV of 
                the Social Security Act (42 U.S.C. 621 et seq., 
                670 et seq.) and meet the requirements of the 
                McKinney-Vento Homeless Assistance Act (42 
                U.S.C. 11301 et seq.); and
                  (G) an assurance that the State, in 
                developing the State plan described in 
                paragraph (1), has collaborated with community-
                based prevention agencies and with families 
                affected by child abuse or neglect.
        Nothing in subparagraph (B) shall be construed to limit 
        the State's flexibility to determine State policies 
        relating to public access to court proceedings to 
        determine child abuse and neglect, except that such 
        policies shall, at a minimum, ensure the safety and 
        well-being of the child, parents, and families.
          (3) Limitation.--With regard to clauses (vi) and 
        (vii) of paragraph (2)(B), nothing in this section 
        shall be construed as restricting the ability of a 
        State to refuse to disclose identifying information 
        concerning the individual initiating a report or 
        complaint alleging suspected instances of child abuse 
        or neglect, except that the State may not refuse such a 
        disclosure where a court orders such disclosure after 
        such court has reviewed, in camera, the record of the 
        State related to the report or complaint and has found 
        it has reason to believe that the reporter knowingly 
        made a false report.
          (4) Definitions.--For purposes of this subsection--
                  (A) the term ``near fatality'' means an act 
                that, as certified by a physician, places the 
                child in serious or critical condition; and
                  (B) the term ``serious bodily injury'' means 
                bodily injury which involves substantial risk 
                of death, extreme physical pain, protracted and 
                obvious disfigurement, or protracted loss or 
                impairment of the function of a bodily member, 
                organ, or mental faculty.
  (c) Citizen Review Panels.--
          (1) Establishment.--
                  (A) In general.--Except as provided in 
                subparagraph (B), each State to which a grant 
                is made under this section shall establish not 
                less than 3 citizen review panels.
                  (B) Exceptions.--
                          (i) Establishment of panels by states 
                        receiving minimum allotment.--A State 
                        that receives the minimum allotment of 
                        $175,000 under section 203(b)(1)(A) for 
                        a fiscal year shall establish not less 
                        than 1 citizen review panel.
                          (ii) Designation of existing 
                        entities.--A State may designate as 
                        panels for purposes of this subsection 
                        one or more existing entities 
                        established under State or Federal law, 
                        such as child fatality panels or foster 
                        care review panels, if such entities 
                        have the capacity to satisfy the 
                        requirements of paragraph (4) and the 
                        State ensures that such entities will 
                        satisfy such requirements.
          (2) Membership.--Each panel established pursuant to 
        paragraph (1) shall be composed of volunteer members 
        who are broadly representative of the community in 
        which such panel is established, including members who 
        have expertise in the prevention and treatment of child 
        abuse and neglect, and may include adult former victims 
        of child abuse or neglect.
          (3) Meetings.--Each panel established pursuant to 
        paragraph (1) shall meet not less than once every 3 
        months.
          (4) Functions.--
                  (A) In general.--Each panel established 
                pursuant to paragraph (1) shall, by examining 
                the policies, procedures, and practices of 
                State and local agencies and where appropriate, 
                specific cases, evaluate the extent to which 
                State and local child protection system 
                agencies are effectively discharging their 
                child protection responsibilities in accordance 
                with--
                          (i) the State plan under subsection 
                        (b);
                          (ii) the child protection standards 
                        set forth in subsection (b); and
                          (iii) any other criteria that the 
                        panel considers important to ensure the 
                        protection of children, including--
                                  (I) a review of the extent to 
                                which the State and local child 
                                protective services system is 
                                coordinated with the foster 
                                care and adoption programs 
                                established under part E of 
                                title IV of the Social Security 
                                Act (42 U.S.C. 670 et seq.); 
                                and
                                  (II) a review of child 
                                fatalities and near fatalities 
                                (as defined in subsection 
                                (b)(4)).
                  (B) Confidentiality.--
                          (i) In general.--The members and 
                        staff of a panel established under 
                        paragraph (1)--
                                  (I) shall not disclose to any 
                                person or government official 
                                any identifying information 
                                about any specific child 
                                protection case with respect to 
                                which the panel is provided 
                                information; and
                                  (II) shall not make public 
                                other information unless 
                                authorized by State statute.
                          (ii) Civil sanctions.--Each State 
                        that establishes a panel pursuant to 
                        paragraph (1) shall establish civil 
                        sanctions for a violation of clause 
                        (i).
                  (C) Public outreach.--Each panel shall 
                provide for public outreach and comment in 
                order to assess the impact of current 
                procedures and practices upon children and 
                families in the community and in order to meet 
                its obligations under subparagraph (A).
          (5) State assistance.--Each State that establishes a 
        panel pursuant to paragraph (1)--
                  (A) shall provide the panel access to 
                information on cases that the panel desires to 
                review if such information is necessary for the 
                panel to carry out its functions under 
                paragraph (4); and
                  (B) shall provide the panel, upon its 
                request, staff assistance for the performance 
                of the duties of the panel.
          (6) Reports.--Each panel established under paragraph 
        (1) shall prepare and make available to the State and 
        the public, on an annual basis, a report containing a 
        summary of the activities of the panel and 
        recommendations to improve the child protection 
        services system at the State and local levels. Not 
        later than 6 months after the date on which a report is 
        submitted by the panel to the State, the appropriate 
        State agency shall submit a written response to State 
        and local child protection systems and the citizen 
        review panel that describes whether or how the State 
        will incorporate the recommendations of such panel 
        (where appropriate) to make measurable progress in 
        improving the State and local child protective system.
  (d) Annual State Data Reports.--Each State to which a grant 
is made under this section shall annually work with the 
Secretary to provide, to the maximum extent practicable, a 
report that includes the following:
          (1) The number of children who were reported to the 
        State during the year as victims of child abuse or 
        neglect.
          (2) Of the number of children described in paragraph 
        (1), the number with respect to whom such reports 
        were--
                  (A) substantiated;
                  (B) unsubstantiated; or
                  (C) determined to be false.
          (3) Of the number of children described in paragraph 
        (2)--
                  (A) the number that did not receive services 
                during the year under the State program funded 
                under this section or an equivalent State 
                program;
                  (B) the number that received services during 
                the year under the State program funded under 
                this section or an equivalent State program; 
                and
                  (C) the number that were removed from their 
                families during the year by disposition of the 
                case.
          (4) The number of families that received preventive 
        services, including use of differential response, from 
        the State during the year.
          (5) The number of deaths in the State during the year 
        resulting from child abuse or neglect.
          (6) Of the number of children described in paragraph 
        (5), the number of such children who were in foster 
        care.
          (7)(A) The number of child protective service 
        personnel responsible for the--
                  (i) intake of reports filed in the previous 
                year;
                  (ii) screening of such reports;
                  (iii) assessment of such reports; and
                  (iv) investigation of such reports.
          (B) The average caseload for the workers described in 
        subparagraph (A).
          (8) The agency response time with respect to each 
        such report with respect to initial investigation of 
        reports of child abuse or neglect.
          (9) The response time with respect to the provision 
        of services to families and children where an 
        allegation of child abuse or neglect has been made.
          (10) For child protective service personnel 
        responsible for intake, screening, assessment, and 
        investigation of child abuse and neglect reports in the 
        State--
                  (A) information on the education, 
                qualifications, and training requirements 
                established by the State for child protective 
                service professionals, including for entry and 
                advancement in the profession, including 
                advancement to supervisory positions;
                  (B) data on the education, qualifications, 
                and training of such personnel;
                  (C) demographic information of the child 
                protective service personnel; and
                  (D) information on caseload or workload 
                requirements for such personnel, including 
                requirements for average number and maximum 
                number of cases per child protective service 
                worker and supervisor.
          (11) The number of children reunited with their 
        families or receiving family preservation services 
        that, within five years, result in subsequent 
        substantiated reports of child abuse or neglect, 
        including the death of the child.
          (12) The number of children for whom individuals were 
        appointed by the court to represent the best interests 
        of such children and the average number of out of court 
        contacts between such individuals and children.
          (13) The annual report containing the summary of the 
        activities of the citizen review panels of the State 
        required by subsection (c)(6).
          (14) The number of children under the care of the 
        State child protection system who are transferred into 
        the custody of the State juvenile justice system.
          (15) The number of children referred to a child 
        protective services system under subsection 
        (b)(2)(B)(ii).
          (16) The number of children determined to be eligible 
        for referral, and the number of children referred, 
        under subsection (b)(2)(B)(xxi), to agencies providing 
        early intervention services under part C of the 
        Individuals with Disabilities Education Act (20 U.S.C. 
        1431 et seq.).
          (17)(A) The number of infants identified under 
        subsection (b)(2)(B)(ii).
          (B) The number of infants for whom a plan of safe 
        care was developed under subsection (b)(2)(B)(iii).
          (C) The number of infants for whom a referral was 
        made for appropriate services, including services for 
        the affected family or caregiver, under subsection 
        (b)(2)(B)(iii).
[Section 4(a) of H.R. 4843 (as reported) provides for an 
amendment to add at the end of section 106(d) of the Child 
Abuse Prevention and Treatment Act a new paragraph (17) (shown 
above). Subsection (b) of such section 4 provides that 
effective on May 29, 2017, paragraph (17) (as added by 
subsection (a)) is redesignated as paragraph (18). The 
following reflects the proposed amendment as in effect on such 
date.]
          [(17)] (18)(A) The number of infants identified under 
        subsection (b)(2)(B)(ii).
          (B) The number of infants for whom a plan of safe 
        care was developed under subsection (b)(2)(B)(iii).
          (C) The number of infants for whom a referral was 
        made for appropriate services, including services for 
        the affected family or caregiver, under subsection 
        (b)(2)(B)(iii).
  (e) Annual Report by the Secretary.--Within 6 months after 
receiving the State reports under subsection (d), the Secretary 
shall prepare a report based on information provided by the 
States for the fiscal year under such subsection and shall make 
the report and such information available to the Congress and 
the national clearinghouse for information relating to child 
abuse and neglect.
  (f) Allotments.--
          (1) Definitions.--In this subsection:
                  (A) Fiscal year 2009 grant funds.--The term 
                ``fiscal year 2009 grant funds'' means the 
                amount appropriated under section 112 for 
                fiscal year 2009, and not reserved under 
                section 112(a)(2).
                  (B) Grant funds.--The term ``grant funds'' 
                means the amount appropriated under section 112 
                for a fiscal year and not reserved under 
                section 112(a)(2).
                  (C) State.--The term ``State'' means each of 
                the several States, the District of Columbia, 
                and the Commonwealth of Puerto Rico.
                  (D) Territory.--The term ``territory'' means 
                Guam, American Samoa, the United States Virgin 
                Islands, and the Commonwealth of the Northern 
                Mariana Islands.
          (2) In general.--Except as otherwise provided in this 
        section, the Secretary shall make allotments to each 
        State and territory that applies for a grant under this 
        section in an amount equal to the sum of--
                  (A) $50,000; and
                  (B) an amount that bears the same 
                relationship to any grant funds remaining after 
                all such States and territories have received 
                $50,000, as the number of children under the 
                age of 18 in the State or territory bears to 
                the number of such children in all States and 
                territories that apply for such a grant.
          (3) Allotments for decreased appropriation years.--In 
        the case where the grant funds for a fiscal year are 
        less than the fiscal year 2009 grant funds, the 
        Secretary shall ratably reduce each of the allotments 
        under paragraph (2) for such fiscal year.
          (4) Allotments for increased appropriation years.--
                  (A) Minimum allotments to states for 
                increased appropriations years.--In any fiscal 
                year for which the grant funds exceed the 
                fiscal year 2009 grant funds by more than 
                $1,000,000, the Secretary shall adjust the 
                allotments under paragraph (2), as necessary, 
                such that no State that applies for a grant 
                under this section receives an allotment in an 
                amount that is less than--
                          (i) $100,000, for a fiscal year in 
                        which the grant funds exceed the fiscal 
                        year 2009 grant funds by more than 
                        $1,000,000 but less than $2,000,000;
                          (ii) $125,000, for a fiscal year in 
                        which the grant funds exceed the fiscal 
                        year 2009 grant funds by at least 
                        $2,000,000 but less than $3,000,000; 
                        and
                          (iii) $150,000, for a fiscal year in 
                        which the grant funds exceed the fiscal 
                        year 2009 grant funds by at least 
                        $3,000,000.
                  (B) Allotment adjustment.--In the case of a 
                fiscal year for which subparagraph (A) applies 
                and the grant funds are insufficient to satisfy 
                the requirements of such subparagraph (A), 
                paragraph (2), and paragraph (5), the Secretary 
                shall, subject to paragraph (5), ratably reduce 
                the allotment of each State for which the 
                allotment under paragraph (2) is an amount that 
                exceeds the applicable minimum under 
                subparagraph (A), as necessary to ensure that 
                each State receives the applicable minimum 
                allotment under subparagraph (A).
          (5) Hold harmless.--Notwithstanding paragraphs (2) 
        and (4), except as provided in paragraph (3), no State 
        or territory shall receive a grant under this section 
        in an amount that is less than the amount such State or 
        territory received under this section for fiscal year 
        2009.

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SEC. 114. MONITORING AND OVERSIGHT.

  The Secretary shall conduct monitoring to ensure that each 
State that receives a grant under section 106 is in compliance 
with the requirements of section 106(b), which--
          (1) shall--
                  (A) be in addition to the review of the State 
                plan upon its submission under section 
                106(b)(1)(A); and
                  (B) include monitoring of State policies and 
                procedures required under clauses (ii) and 
                (iii) of section 106(b)(2)(B); and
          (2) may include--
                  (A) a comparison of activities carried out by 
                the State to comply with the requirements of 
                section 106(b) with the State plan most 
                recently approved under section 432 of the 
                Social Security Act;
                  (B) a review of information available on the 
                Website of the State relating to its compliance 
                with the requirements of section 106(b);
                  (C) site visits, as may be necessary to carry 
                out such monitoring; and
                  (D) a review of information available in the 
                State's Annual Progress and Services Report 
                most recently submitted under section 1357.16 
                of title 45, Code of Federal Regulations (or 
                successor regulations).

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