I

103D CONGRESS

2D SESSION H. R. 3783

To amend the Public Health Service Act to provide a comprehensive program

for the prevention of Fetal Alcohol Syndrome, and for other purposes.

IN THE HOUSE OF REPRESENTATIVES

FEBRUARY 2, 1994

Mr. RICHARDSON (for himself, Mr. KENNEDY, Mrs. MORELLA, Mr. SYNAR,

Mr. BEREUTER, and Mr. MORAN) introduced the following bill; which was

referred to the Committee on Energy and Commerce

A BILL

To amend the Public Health Service Act to provide a comprehensive program for the prevention of Fetal Alcohol

Syndrome, and for other purposes.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,
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1 SECTION 1. SHORT TITLE.

2 This Act may be cited as the ‘‘Comprehensive Fetal

3 Alcohol Syndrome Prevention Act’’.

4 SEC. 2. FINDINGS.

5 Congress finds that—

6 (1) Fetal Alcohol Syndrome is the leading

7 known cause of mental retardation, and it is 100

8 percent preventable;

9 (2) each year, more than 5,000 infants are born

10 in the United States with Fetal Alcohol Syndrome,

11 suffering irreversible physical and mental damage;

12 (3) 50,000 more infants are born each year

13 with lesser, though still serious, alcohol-related birth

14 defects, known as Fetal Alcohol Effects;

15 (4) Fetal Alcohol Syndrome is a national prob16 lem, it can impact any child, family, or community,

17 but its threat to American Indians and Alaska Na18 tives is especially alarming;

19 (5) in some American Indian communities,

20 where alcohol dependency rates reach 50 percent

21 and above, the chances of a newborn suffering Fetal

22 Alcohol Syndrome or Fetal Alcohol Effects are 30

23 times greater than national averages;

24 (6) researchers have determined that the possi25 bility of giving birth to a baby with Fetal Alcohol

26 Syndrome or Fetal Alcohol Effects increases in pro-
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1 portion to the amount and frequency of alcohol

2 consumed by a pregnant woman, and that stopping

3 alcohol consumption at any point in the pregnancy

4 reduces the risks and the emotional, physical, and

5 mental consequences of alcohol exposure to the baby;

6 (7) in addition to the immeasurable toll on

7 Fetal Alcohol Syndrome and Fetal Alcohol Effects

8 children and their families, Fetal Alcohol Syndrome

9 and Fetal Alcohol Effects pose extraordinary finan10 cial costs to the Nation, including the costs of health

11 care, education, foster care, job training, and gen12 eral support services for affected individuals;

13 (8) as a reliable comparison, delivery and care

14 costs are four times greater for infants who were ex15 posed to illicit substances than for infants with no

16 indication of substance exposure, and over a lifetime,

17 health care costs for one Fetal Alcohol Syndrome

18 child are estimated, to be at least $1,400,000; and

19 (9) we know of no safe dose of alcohol during

20 pregnancy, or of any safe time to drink during preg21 nancy, thus, it is in the best interest of the Nation

22 for the Federal Government to take an active role in

23 encouraging all women to abstain from alcohol con24 sumption during pregnancy.
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1 SEC. 3. PURPOSE.

2 It is the purpose of this Act to establish, within the

3 Department of Health and Human Services, a comprehen4 sive program to help prevent Fetal Alcohol Syndrome and

5 Fetal Alcohol Effects nationwide. Such program shall—

6 (1) coordinate and support epidemiologic re7 search concerning Fetal Alcohol Syndrome and Fetal

8 Alcohol Effects;

9 (2) coordinate and support national, State, and

10 community-based public awareness, prevention, and

11 education programs on Fetal Alcohol Syndrome and

12 Fetal Alcohol Effects; and

13 (3) foster coordination among all Federal agen14 cies that conduct or support Fetal Alcohol Syndrome

15 and Fetal Alcohol Effects research, programs, and

16 surveillance and otherwise meet the general needs of

17 populations actually or potentially impacted by Fetal

18 Alcohol Syndrome and Fetal Alcohol Effects.

19 SEC. 4. ESTABLISHMENT OF PROGRAM.

20 Part B of title V of the Public Health Service Act

21 (42 U.S.C. 290bb et seq.) is amended by adding at the

22 end thereof the following new subpart:
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1 ‘‘Subpart 4—Provisions Relating to Fetal Alcohol

2 Syndrome and Fetal Alcohol Effects

3 ‘‘SEC. 520E. ESTABLISHMENT OF FETAL ALCOHOL SYN4 DROME PREVENTION PROGRAM.

5 ‘‘(a) IN GENERAL.—The Secretary, acting through

6 the Substance Abuse and Mental Health Services Admin7 istration, the National Institutes of Health, the Centers

8 for Disease Control and Prevention, and other relevant of9 fices, shall establish a comprehensive program to help pre10 vent Fetal Alcohol Syndrome and Fetal Alcohol Effects

11 and coordinate Federal efforts to prevent Fetal Alcohol

12 Syndrome and Fetal Alcohol Effects.

13 ‘‘(b) ELEMENTS OF PROGRAM.—Under the program

14 established under subsection (a), the Secretary shall estab15 lish a program that shall—

16 ‘‘(1) coordinate and support national and tar17 geted public awareness, prevention, and education

18 programs on Fetal Alcohol Syndrome and Fetal Al19 cohol Effects;

20 ‘‘(2) direct the Director of the Centers for Dis21 ease Control and Prevention to coordinate and sup22 port applied epidemiologic research concerning Fetal

23 Alcohol Syndrome and Fetal Alcohol Effects;

24 ‘‘(3) direct the Director of the National Insti25 tutes of Health to direct the National Institute on
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1 Alcoholism and Alcohol Abuse to establish a pro2 gram that shall conduct and support basic research

3 targeted to developing data to improve prevention

4 and treatment of Fetal Alcohol Syndrome and Fetal

5 Alcohol Effects;

6 ‘‘(4) develop a plan to disseminate diagnostic

7 criteria to health care and social services providers

8 and carry out that plan; and

9 ‘‘(5) establish an Inter-Agency Task Force on

10 Fetal Alcohol Syndrome and Fetal Alcohol Effects,

11 which shall be chaired by the Associate Adminis12 trator for Alcohol Prevention and Treatment of the

13 Substance Abuse and Mental Health Services Ad14 ministration, and which shall include representatives

15 from all relevant agencies and offices within the De16 partment of Health and Human Services (including

17 the Indian Health Service and the Centers for Dis18 ease Control and Prevention), Department of Agri19 culture, Department of Education, Department of

20 Defense, Department of the Interior (including the

21 Bureau of Indian Affairs), Department of Justice,

22 Bureau of Alcohol, Tobacco, and Firearms, Federal

23 Trade Commission, and any other relevant Federal

24 Agency.
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1 ‘‘SEC. 520F. EDUCATION AND PUBLIC AWARENESS.

2 ‘‘The Secretary shall direct the Substance Abuse and

3 Mental Health Services Administration to—

4 ‘‘(1) support, conduct and evaluate the effec5 tiveness of—

6 ‘‘(A) training programs for health care

7 providers, educators, school-based health care

8 providers, social workers, child welfare workers

9 and family members concerning the prevention,

10 diagnosis, and treatment of Fetal Alcohol Syn11 drome and Fetal Alcohol Effects;

12 ‘‘(B) prevention and education programs,

13 including health education, and school-based

14 clinic programs, for school-age children with re15 spect to Fetal Alcohol Syndrome and Fetal Al16 cohol Effects; and

17 ‘‘(C) public and community awareness pro18 grams concerning Fetal Alcohol Syndrome and

19 Fetal Alcohol Effects;

20 ‘‘(2) provide technical and consultative assist21 ance to States, Indian tribal governments, local gov22 ernments, school-based health care providers, sci23 entific and academic institutions, and non-profit or24 ganizations concerning the programs referred to in

25 paragraph (1); and
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1 ‘‘(3) award grants to and enter into cooperative

2 agreements and contracts with States, Indian tribal

3 governments, local governments, scientific and aca4 demic institutions, entities that fund school-based

5 clinics, and non-profit organizations for the purpose

6 of—

7 ‘‘(A) enabling such entities to evaluate the

8 effectiveness, with particular emphasis on the

9 cultural sensitivity and age-appropriateness, of

10 the prevention, education and community-based

11 public awareness programs referred to in para12 graph (1);

13 ‘‘(B) enabling such entities to provide

14 training to health care providers, school nurses

15 and other school health care providers, includ16 ing school-based clinic health care providers,

17 educators, family members, social workers, child

18 welfare workers, and others in the prevention,

19 diagnosis and treatment of Fetal Alcohol Syn20 drome and Fetal Alcohol Effects;

21 ‘‘(C) educating children and youth, includ22 ing pregnant and high-risk youth, concerning

23 such syndrome and effects with priority given to

24 those programs that are part of a sequential,
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1 comprehensive school health education program;

2 and

3 ‘‘(D) increasing public and community

4 awareness concerning Fetal Alcohol Syndrome

5 and Fetal Alcohol Effects through culturally

6 sensitive projects, programs, and campaigns,

7 and improving the understanding of the general

8 public and targeted groups concerning the most

9 effective methods for intervening with friends

10 and family to prevent fetal exposure to alcohol.

11 ‘‘SEC. 520G. APPLIED EPIDEMIOLOGIC RESEARCH AND PRE12 VENTION PROGRAM.

13 ‘‘The Secretary shall direct the Centers for Disease

14 Control and Prevention and other appropriate agencies

15 within the Department of Health and Human Services

16 to—

17 ‘‘(1) conduct and support research on the

18 causes, mechanisms, diagnostic methods, and treat19 ment and prevention of Fetal Alcohol Syndrome and

20 Fetal Alcohol Effects;

21 ‘‘(2) provide technical and consultative assist22 ance and training to States, Indian tribal govern23 ments, local governments, other public entities, sci24 entific and academic institutions, and non-profit or25 ganizations engaged in the conduct of—
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1 ‘‘(A) Fetal Alcohol Syndrome prevention

2 and early intervention programs; and

3 ‘‘(B) research relating to the causes, mech4 anisms, diagnosis methods, treatment and pre5 vention, of Fetal Alcohol Syndrome and Fetal

6 Alcohol Effects; and

7 ‘‘(3) award grants to, and enter into coopera8 tive agreements and contracts with States, Indian

9 tribal governments, local governments, other public

10 entities, scientific and academic institutions, and

11 non-profit organizations to—

12 ‘‘(A) assist such entities in conducting in13 novative demonstration and evaluation projects

14 designed to determine effective strategies, in15 cluding community-based prevention programs

16 and multi-cultural education campaigns, for

17 preventing and intervening in fetal exposure to

18 alcohol;

19 ‘‘(B) improve and coordinate the surveil20 lance and ongoing assessment methods imple21 mented by such entities and the Federal Gov22 ernment, with respect to Fetal Alcohol Syn23 drome and Fetal Alcohol Effects for the pur24 pose of—
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1 ‘‘(i) tracking progress toward achiev2 ing relevant Year 2000 Prevention Objec3 tives, set forth by the Public Health Serv4 ice in the Healthy People 2000: National

5 Health Promotion and Disease Prevention

6 Objectives;

7 ‘‘(ii) identifying successful, culturally

8 sensitive prevention efforts; and

9 ‘‘(iii) identifying children who have

10 symptoms of Fetal Alcohol Syndrome and

11 Fetal Alcohol Effects and may need special

12 health, education, and support services;

13 ‘‘(C) develop and evaluate effective age-ap14 propriate and culturally-sensitive prevention

15 programs for infants, children, adolescents, and

16 adults identified as being at-risk of becoming

17 chemically dependent on alcohol and associated

18 with or developing Fetal Alcohol Syndrome and

19 Fetal Alcohol Effects; and

20 ‘‘(D) facilitate coordination and collabora21 tion among Federal, State, Tribal, and local

22 Fetal Alcohol Syndrome prevention programs.

23 ‘‘SEC. 520H. BASIC RESEARCH PROGRAM.

24 ‘‘The Director of the National Institutes of Health

25 shall direct the National Institute on Alcoholism and Alco-
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1 hol Abuse to conduct and support research on services re2 search and effective prevention treatments and interven3 tions for pregnant alcohol dependent women and individ4 uals with Fetal Alcohol Syndrome and Fetal Alcohol

5 Effects.

6 ‘‘SEC. 520I. DIAGNOSTIC CRITERIA FOR FETAL ALCOHOL

7 SYNDROME AND FETAL ALCOHOL EFFECTS.

8 ‘‘Not later than 90 days after the date of enactment

9 of this subpart, the Secretary shall direct the appropriate

10 agencies within the Department of Health and Human

11 Services to—

12 ‘‘(1) develop a plan for widely-disseminating the

13 Fetal Alcohol Syndrome/Fetal Alcohol Effects diag14 nostic criteria developed by the Department of

15 Health and Human Services under the ADAMHA

16 Reorganization Act (Public Law 102–321) to health

17 care providers, educators, social workers, child wel18 fare workers, and other individuals within 16

19 months of such date of enactment; and

20 ‘‘(2) disseminate the criteria described in para21 graph (1) in accordance with the plan developed

22 under paragraph (1).
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1 ‘‘SEC. 520J. INTER-AGENCY TASK FORCE ON FETAL ALCO2 HOL SYNDROME AND FETAL ALCOHOL EF3 FECTS.

4 ‘‘(a) ESTABLISHMENT.—Not later than 30 days after

5 the date of enactment of this subpart, the Secretary shall

6 establish an Inter-Agency Task Force on Fetal Alcohol

7 Syndrome and Fetal Alcohol Effects to foster coordination

8 among all Federal agencies that conduct or support Fetal

9 Alcohol Syndrome and Fetal Alcohol Effects research, pro10 grams, and surveillance and otherwise meet the general

11 needs of populations actually or potentially impacted by

12 Fetal Alcohol Syndrome and Fetal Alcohol Effects.

13 ‘‘(b) MEMBERSHIP.—The Task Force established

14 under subsection (a) shall—

15 ‘‘(1) be chaired by the Associate Administrator

16 for Alcohol Prevention and Treatment of the Sub17 stance Abuse and Mental Health Services Adminis18 tration and staffed by the Administration; and

19 ‘‘(2) include representatives from all relevant

20 agencies and offices within the Department of

21 Health and Human Services, Department of Agri22 culture, Department of Education, Department of

23 Defense, Department of Interior, Department of

24 Justice, Bureau of Alcohol, Tobacco and Firearms,

25 Federal Trade Commission, and any other relevant

26 Federal agency.
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1 ‘‘(c) FUNCTIONS.—The Task Force established under

2 subsection (a) shall—

3 ‘‘(1) coordinate all Federal programs and re4 search concerning Fetal Alcohol Syndrome, Fetal Al5 cohol Effects, and other forms of maternal substance

6 abuse, including those programs—

7 ‘‘(A) targeting individuals, families, and

8 populations identified as being at risk of acquir9 ing Fetal Alcohol Syndrome, Fetal Alcohol Ef10 fects, or other maternal substance abuse; and

11 ‘‘(B) providing health, education, treat12 ment, and social services to infants, children,

13 and adults with Fetal Alcohol Syndrome, Fetal

14 Alcohol Effects, and other drug exposures and

15 their families; and

16 ‘‘(2) coordinate its efforts with existing Depart17 ment of Health and Human Services task forces on

18 substance abuse prevention and maternal and child

19 health;

20 ‘‘(3) report on an annual basis to the Secretary

21 and relevant Committees of Congress on the current

22 and planned activities of the participating agencies.
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1 ‘‘SEC. 520K. ADMINISTRATIVE PROVISIONS WITH RESPECT

2 TO GRANTS, COOPERATIVE AGREEMENTS

3 AND CONTRACTS.

4 ‘‘(a) ELIGIBILITY.—To be eligible to receive a grant,

5 cooperative agreement or contract under this subpart, an

6 entity shall—

7 ‘‘(1) be a State, Indian tribal government, local

8 government, entity that funds a school-based health

9 clinic scientific or academic institution or non-profit

10 organization;

11 ‘‘(2) prepare and submit to the Secretary an

12 application at such time, in such manner, and con13 taining such information as the Secretary may pre14 scribe, including a description of the activities that

15 the entity intends to carry out using amounts re16 ceived under a grant, cooperative agreement, or con17 tract; and

18 ‘‘(3) provide assurances that amounts received

19 under such grants, cooperative agreements or con20 tracts will be used in accordance with this subpart.

21 ‘‘(b) MAINTENANCE OF EFFORT.—No grant, cooper22 ative agreement, or contract may be awarded to an entity

23 under this subpart unless the entity agrees to maintain

24 the expenditures of the entity for activities of the type for

25 which the amounts to be received under a grant, coopera26 tive agreement, or contract are to be used, at a level equal
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1 to not less than the level of such expenditures maintained

2 by the entity for the fiscal year preceding the fiscal year

3 for which the entity is applying to receive the grant, coop4 erative agreement or contract.

5 ‘‘(c) AMOUNTS IN LIEU OF CASH.—At the request

6 of a recipient of a grant, cooperative agreement, or con7 tract under this subpart, the Secretary may reduce the

8 amount provided under such grant, agreement, or contract

9 by—

10 ‘‘(1) an amount equal to the fair market value

11 of any supplies or equipment furnished the recipient;

12 and

13 ‘‘(2) an amount equal to the amount of the pay,

14 allowances, and travel expenses of any officer or em15 ployee of the Federal Government which was de16 tailed to the recipient and the amount of any other

17 cost incurred in connection with the detail of such

18 officer or employee.

19 ‘‘SEC. 520L. AUTHORIZATION OF APPROPRIATIONS.

20 ‘‘There are authorized to be appropriated to carry out

21 this subpart, such sums as are necessary for each of the

22 fiscal years 1994 through 1997.’’.

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