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[House Report 113-321]
[From the U.S. Government Publishing Office]

113th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES
 2d Session                                                     113-321

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

 
                       POISON CENTER NETWORK ACT

                                _______
                                

January 7, 2014.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

  Mr. Upton, from the Committee on Energy and Commerce, submitted the 
                               following

                              R E P O R T

                        [To accompany H.R. 3527]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Energy and Commerce, to whom was referred 
the bill (H.R. 3527) to amend the Public Health Service Act to 
reauthorize the poison center national toll-free number, 
national media campaign, and grant program, and for other 
purposes, having considered the same, report favorably thereon 
without amendment and recommend that the bill do pass.

                                CONTENTS

                                                                   Page
Purpose and Summary..............................................     1
Background and Need for Legislation..............................     2
Hearings.........................................................     2
Committee Consideration..........................................     3
Committee Votes..................................................     3
Committee Oversight Findings.....................................     3
Statement of General Performance Goals and Objectives............     3
New Budget Authority, Entitlement Authority, and Tax Expenditures     3
Earmark, Limited Tax Benefits, and Limited Tariff Benefits.......     3
Committee Cost Estimate..........................................     3
Congressional Budget Office Estimate.............................     3
Federal Mandates Statement.......................................     5
Duplication of Federal Programs..................................     5
Disclosure of Directed Rule Makings..............................     5
Advisory Committee Statement.....................................     5
Applicability to Legislative Branch..............................     5
Section-by-Section Analysis of the Legislation...................     6
Changes in Existing Law Made by the Bill, as Reported............     6

                          Purpose and Summary

    H.R. 3527, the ``Poison Center Network Act of 2013,'' was 
introduced on November 18, 2013, by Rep. Lee Terry (R-NE) and 
referred to the Committee on Energy and Commerce.
    The legislation would amend the Public Health Service Act 
(PHSA) to reauthorize the poison center national toll-free 
number, a national media campaign to inform the public, and 
grant programs to support the operation of poison control 
centers.

                  Background and Need for Legislation

    Mortality due to poisoning has increased in the United 
States since the 1970s. The most significant increase was 
reported in unintentional poisoning mortality rates, which more 
than tripled from 1990 to 2002. Unintentional poisoning deaths 
were most often a consequence of illicit drugs in prior 
decades. However, since the latter half of the 1990s, 
medications began to account for a greater number of fatal 
poisonings. More recent data show that the national trend of 
increased rates of overdose is continuing, and the rate has 
accelerated in recent years.\1\
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    \1\http://www.publichealthreports.org/issueopen.cfm?articleID=2463.
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    Poison Control Centers (PCC) were first established to 
provide immediate information on an exposure to poisonous or 
hazardous substances to healthcare providers. The American 
Association of PCC was then founded to promote cooperation 
between existing centers, to establish standardization, and to 
offer services to the general public.\2\ Legislation 
establishing a Federal Poison Control Program (PCP) was enacted 
in 2000, and later reauthorized in 2003 and 2008, and provided 
a toll-free number to access regional poison control centers, a 
media campaign to promote use of poison control centers, and 
for grants to assist PCCs to set standards and improve 
surveillance.
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    \2\http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2663870/.
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    In 2004, the Institute of Medicine considered the future of 
poison prevention and found that the PPC played a key role in 
injury prevention, public health, and safety. The report, 
Forging a Poison Prevention and Control System, concluded that 
``poison control centers must be more stable financially and 
better integrated and coordinated for performance of their 
public health roles.''\3\
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    \3\http://www.iom.edu/Reports/2004/Forging-a-Poison-Prevention-and-
Control-System.aspx.
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    A network of 57 PCCs currently operate across the 50 
States, the District of Columbia, and the territories. Studies 
show that these PCCs reduce the severity of illness and death 
caused by poison exposure and save money by reducing the number 
of unnecessary visits to the emergency room.\4\
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    \4\www.hrsa.gov/about/budget/budgetjustification2014.pdf.
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    H.R. 3527, the ``Poison Center Network Act of 2013,'' would 
reauthorize the Poison Center Support, Enhancement, and 
Awareness Act of 2008 and continue funding for the PCP. The 
bill would continue to provide grants to States to establish 
and operate poison centers and maintain a single, national 
toll-free number that ensures access to poison center services 
by connecting callers to the poison center serving their area. 
In addition, the bill would provide for a national media 
campaign to educate the public and health care providers about 
poison prevention, poison center services, and the 800 number.

                                Hearings

    The Subcommittee on Health held a hearing on Wednesday, 
November 20, 2013, entitled ``Examining Public Health 
Legislation to Help Local Communities.'' The Subcommittee 
received testimony from: Dr. Marsha Ford of the American 
Association of Poison Control Centers, Dr. Edward R.B. McCabe 
of the March of Dimes Foundation, Ms. Laura Crandall of CJ 
Foundation for SIDS, Mr. Robert Mt. Joy of Cornerstone Care 
Inc., Dr. Drew Nagele from the Brain Injury Association of 
America, Ms. Pat Smith, President of the Lyme Disease 
Association Inc., and Dr. Steven Stack of the American Medical 
Association. H.R. 3527, the ``Poison Center Network Act of 
2013,'' was one of the bills discussed at the hearing.

                        Committee Consideration

    On December 10, 2013, the Subcommittee on Health met in 
open markup session and approved H.R. 3527 for full Committee 
consideration by a voice vote. On December 10 and 11, 2013, the 
Energy and Commerce Committee met in open markup session and 
approved H.R. 3527 by a voice vote.

                            Committee Votes

    Clause 3(b) of rule XIII of the Rules of the House of 
Representatives requires the Committee to list the record votes 
on the motion to report legislation and amendments thereto. 
There were no record votes taken in connection with ordering 
approved H.R. 3527. A motion by Mr. Upton to order H.R. 3527 
reported to the House, without amendment, was agreed to by a 
voice vote.

                      Committee Oversight Findings

    Pursuant to clause 3(c)(1) of rule XIII of the Rules of the 
House of Representatives, the Committee held a hearing on 
November 20, 2013, and made findings that are reflected in this 
report.

         Statement of General Performance Goals and Objectives

    Pursuant to clause 3(c)(1) of rule XIII of the House of 
Representatives, the goal of the legislation is the 
continuation of the poison center national toll-free number, 
the national media campaign, and the grant program for poison 
centers.

   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. 
3527 would result in no new or increased budget authority, 
entitlement authority, or tax expenditures or revenues.

       Earmark, Limited Tax Benefits, and Limited Tariff Benefits

    In compliance with clause 9(e), 9(f), and 9(g) of rule XXI, 
the Committee finds that H.R. 3527 contains no earmarks, 
limited tax benefits, or limited tariff benefits.

                        Committee Cost Estimate

    The Committee adopts as its own the cost estimate prepared 
by the Director of the Congressional Budget Office pursuant to 
section 402 of the Congressional Budget Act of 1974.

                  Congressional Budget Office Estimate

    Pursuant to clause 3(c)(3) of rule XIII of the Rules of the 
House of Representatives, the following is the cost estimate 
provided by the Congressional Budget Office pursuant to section 
402 of the Congressional Budget Act of 1974:

                                     U.S. Congress,
                               Congressional Budget Office,
                                   Washington, DC, January 7, 2014.
Hon. Fred Upton,
Chairman, Committee on Energy and Commerce,
House of Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 3527, the Poison 
Center Network Act.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Lisa Ramirez-
Branum.
            Sincerely,
                                              Douglas W. Elmendorf.
    Enclosure.

H.R. 3527--Poison Center Network Act

    Summary: H.R. 3527 would reauthorize the poison control 
program, currently scheduled to expire in 2014, for the 2015-
2019 period. The program, which is administered by the Health 
Resources and Services Administration (HRSA), provides grants 
to poison centers and other organizations that focus on poison 
control, funds a national media campaign, and maintains a 
national toll-free number.
    The bill would authorize the appropriation of about $30 
million a year for each of fiscal years 2015 through 2019 for 
the poison control program. CBO estimates that implementing the 
bill would cost about $125 million over the 2015-2019 period, 
assuming appropriation of the authorized amounts. Pay-as-you-go 
procedures do not apply to this legislation because it would 
not affect direct spending or revenues.
    The bill contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act (UMRA).
    Estimated cost to the Federal Government: The estimated 
budgetary impact of H.R. 3527 is shown in the following table. 
The costs of this legislation fall within budget function 550 
(health).

----------------------------------------------------------------------------------------------------------------
                                                               By fiscal year, in millions of dollars--
                                                    ------------------------------------------------------------
                                                       2015      2016      2017      2018      2019    2015-2019
----------------------------------------------------------------------------------------------------------------
                                  CHANGES IN SPENDING SUBJECT TO APPROPRIATION

Authorization Level................................        30        30        30        30        30        151
Estimated Outlays..................................        12        25        29        29        29       125
----------------------------------------------------------------------------------------------------------------
Note: Numbers may not sum to totals because of rounding.

    Basis of estimate: H.R. 3527 would authorize annual 
appropriations of about $30 million for each of the fiscal 
years 2015 through 2019 for HRSA to administer the poison 
control program. The Congress appropriated about $19 million 
for the program for fiscal year 2013. Sequestration under the 
Budget Control Act of 2011 reduced the 2013 funding to about 
$18 million. That reduced funding level has been continued in 
fiscal year 2014 through January 15, 2014. For this estimate, 
CBO assumes that the bill will be enacted by the end of fiscal 
year 2014 and that the authorized amounts will be appropriated 
for each year.
    H.R. 3527 would authorize the appropriation of $28.6 
million a year for 2015 through 2019 for grant assistance to 
poison control centers that offer the public and health care 
providers treatment advice on poisonings. The bill also would 
authorize the appropriation of $1.5 million a year for 2015 
through 2019 to maintain a national toll-free number that 
assists poison control centers and to fund a national media 
campaign to educate the public and health care providers about 
poison prevention.
    Based on historical patterns of spending for the program, 
CBO estimates that implementing the bill would cost about $125 
million over the 2015-2019 period, assuming appropriation of 
the specified amounts.
    Pay-As-You-Go considerations: None.
    Intergovernmental and private-sector impact: H.R. 3527 
contains no intergovernmental or private-sector mandates as 
defined in UMRA. State, local, and tribal governments that 
operate poison control centers could benefit from grant funds 
authorized by the bill.
    Estimate prepared by: Federal Costs: Lisa Ramirez-Branum; 
Impact on State, Local, and Tribal Governments: Lisa Ramirez-
Branum; Impact on the Private Sector: Alexia Diorio.
    Estimate approved by: Holly Harvey, Deputy Assistant 
Director for Budget Analysis.

                       Federal Mandates Statement

    The Committee adopts as its own the estimate of Federal 
mandates prepared by the Director of the Congressional Budget 
Office pursuant to section 423 of the Unfunded Mandates Reform 
Act.

                    Duplication of Federal Programs

    No provision of H.R. 3527 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. 3527 would not 
specifically direct a rulemaking within the meaning of 5 U.S.C. 
551.

                      Advisory Committee Statement

    No advisory committees within the meaning of section 5(b) 
of the Federal Advisory Committee Act were created by this 
legislation.

                  Applicability to Legislative Branch

    The Committee finds that the legislation does not relate to 
the terms and conditions of employment or access to public 
services or accommodations within the meaning of section 
102(b)(3) of the Congressional Accountability Act.

             Section-by-Section Analysis of the Legislation

    Section 1. Short Title. Section 1 states the legislation 
may be cited as the ``Poison Center Network Act of 2013.''
    Section 2. Reauthorization of the Poison Control Centers 
National Toll-Free Number. Section 2 would amend the 
authorization of appropriations for section 1271 of the Public 
Health Service Act.
    Section 3. Reauthorization of Nationwide Media Campaign to 
Promote Poison Control Center Utilization. Section 3 would 
extend the authorization of appropriations for section 1272 of 
the Public Health Service Act.
    Section 4. Reauthorization of the Poison Control Center 
Grant Program. Section 4 would extend authorization of 
appropriations for section 1273 and modify certification of a 
poison control center to ensure that accreditation be 
consistent with standards and by extending the waiver period 
for a nonaccredited PCC.

         Changes in Existing Law Made by the Bill, as Reported

  In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italic, existing law in which no change is 
proposed is shown in roman):

PUBLIC HEALTH SERVICE ACT

           *       *       *       *       *       *       *

TITLE XII--TRAUMA CARE

           *       *       *       *       *       *       *

                         Part G--Poison Control

SEC. 1271. MAINTENANCE OF THE NATIONAL TOLL-FREE NUMBER.

  (a) * * *
  [(b) Authorization of Appropriations.--There is authorized to 
be appropriated $2,000,000 for fiscal year 2009 to carry out 
this section, and $700,000 for each of fiscal years 2010 
through 2014 for the maintenance of the nationwide toll free 
phone number under subsection (a).]
  (b) Authorization of Appropriations.--There is authorized to 
be appropriated to carry out this section, $700,000 for each of 
fiscal years 2015 through 2019 for the maintenance of the 
nationwide toll free phone number under subsection (a).

SEC. 1272. NATIONWIDE MEDIA CAMPAIGN TO PROMOTE POISON CONTROL CENTER 
                    UTILIZATION.

  (a) * * *

           *       *       *       *       *       *       *

  [(d) Authorization of Appropriations.--There is authorized to 
be appropriated to carry out this section, such sums as may be 
necessary for fiscal year 2009, and $800,000 for each of fiscal 
years 2010 through 2014.]
  (d) Authorization of Appropriations.--There is authorized to 
be appropriated to carry out this section, $800,000 for each of 
fiscal years 2015 through 2019.

SEC. 1273. MAINTENANCE OF THE POISON CONTROL CENTER GRANT PROGRAM.

  (a) Authorization of Program.--The Secretary shall award 
grants to poison control centers [certified] accredited under 
subsection (c) (or granted a waiver under subsection (d)) and 
professional organizations in the field of poison control for 
the purposes of preventing, and providing treatment 
recommendations for, poisonings and complying with the 
operational requirements needed to sustain the [certification] 
accreditation of the center under subsection (c).
  (b) Additional Uses of Funds.--In addition to the purposes 
described in subsection (a), a poison center or professional 
organization awarded a grant, contract, or cooperative 
agreement under such subsection may also use amounts received 
under such grant, contract, or cooperative agreement--
          (1) to [establish] research, establish, implement and 
        evaluate best practices in the United States for poison 
        prevention, poison control center outreach, and 
        emergency and preparedness programs;

           *       *       *       *       *       *       *

          (4) to research, improve, and enhance the 
        communications and response capability and capacity of 
        the nation's network of poison control centers to 
        facilitate increased access to the Centers through the 
        integration and modernization of the current poison 
        control centers communications and data system, 
        including enhancing the network's telephony, Internet, 
        data and social networking technologies;
          [(4)] (5) to develop, support, and enhance technology 
        and capabilities of professional organizations in the 
        field of poison control to collect national poisoning, 
        toxic occurrence, and related public health data;
          [(5)] (6) to develop initiatives to foster the 
        enhanced public health utilization of national poison 
        data collected by organizations described in [paragraph 
        (4)] paragraph (5);
          [(6)] (7) to support and expand the toxicologic 
        expertise within poison control centers; and
          [(7)] (8) to improve the capacity of poison control 
        centers to answer high volumes of calls [and respond] 
        and Internet communications, and to sustain and enhance 
        the poison control center's network capability to 
        respond during times of national crisis or other public 
        health emergencies.
  (c) [Certification] Accreditation.--Except as provided in 
subsection (d), the Secretary may award a grant to a poison 
control center under subsection (a) only if--
          (1) the center has been [certified] accredited by a 
        professional organization in the field of poison 
        control, and the Secretary has approved the 
        organization as having in effect standards for 
        [certification] accreditation that reasonably provide 
        for the protection of the public health with respect to 
        poisoning; or
          (2) the center has been [certified] accredited by a 
        State government, and the Secretary has approved the 
        State government as having in effect standards for 
        [certification] accreditation that reasonably provide 
        for the protection of the public health with respect to 
        poisoning.
  (d) Waiver of [Certification] Accreditation Requirements.--
          (1) In general.--The Secretary may grant a waiver of 
        [the certification] the accreditation requirements of 
        subsection (c) with respect to [a noncertified] a 
        nonaccredited poison control center that applies for a 
        grant under this section if such center can reasonably 
        demonstrate that the center will obtain such [a 
        certification] an accreditation within a reasonable 
        period of time as determined appropriate by the 
        Secretary.

           *       *       *       *       *       *       *

          (3) Limitation.--In no case may the sum of the number 
        of years for a waiver under paragraph (1) and a renewal 
        under paragraph (2) [exceed 5 years. The preceding 
        sentence shall take effect as of the date of the 
        enactment of the Poison Center Support, Enhancement, 
        and Awareness Act of 2008.]  exceed--
                  (A) 5 years; or
                  (B) in the case of a nonaccredited poison 
                control center operating pursuant to a waiver 
                under this subsection as of October 1, 2014, 6 
                years.

           *       *       *       *       *       *       *

  (f) Maintenance of Effort.--A poison control center, in 
utilizing the proceeds of a grant under this section, shall 
maintain the expenditures of the center [for activities of the 
center] for its activities at a level that is not less than the 
level of expenditures maintained by the center for the fiscal 
year preceding the fiscal year for which the grant is received.
  [(g) Authorization of Appropriations.--There is authorized to 
be appropriated to carry out this section, $27,500,000 for 
fiscal year 2009, and $28,600,000 for each of fiscal years 2010 
through 2014. The Secretary may utilize not to exceed 8 percent 
of the amount appropriated under this preceding sentence in 
each fiscal year for coordination, dissemination, technical 
assistance, program evaluation, data activities, and other 
program administration functions that do not include grants, 
contracts, or cooperative agreements under subsections (a) and 
(b), which are determined by the Secretary to be appropriate 
for carrying out the program under this section.]
  (g) Authorization of Appropriations.--There is authorized to 
be appropriated to carry out this section, $28,600,000 for each 
of fiscal years 2015 through 2019. The Secretary may utilize an 
amount not to exceed 6 percent of the amount appropriated under 
this preceding sentence in each fiscal year for coordination, 
dissemination, technical assistance, program evaluation, data 
activities, and other program administration functions, which 
are determined by the Secretary to be appropriate for carrying 
out the program under this section.

           *       *       *       *       *       *       *

                                  
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