II

106TH CONGRESS

2D SESSION S. 2868

To amend the Public Health Service Act with respect to children’s health.

IN THE SENATE OF THE UNITED STATES

JULY 13, 2000

Mr. FRIST (for himself, Mr. JEFFORDS, Mr. KENNEDY, Mr. DODD, Mr.

DEWINE, Mr. REED, Mrs. MURRAY, Mr. BOND, Mr. HATCH, Mr. GORTON, Mr. ABRAHAM, and Mr. DURBIN) introduced the following bill;

which was read twice and referred to the Committee on Health, Education, Labor, and Pensions

A BILL

To amend the Public Health Service Act with respect to

children’s health.

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

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

4 (a) SHORT TITLE.—This Act may be cited as the

5 ‘‘Children’s Public Health Act of 2000’’.

6 (b) TABLE OF CONTENTS.—The table of contents of

7 this Act is as follows:

Sec. 1. Short title; table of contents.

TITLE I—INJURY PREVENTION

Subtitle A—Traumatic Brain Injury
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Sec. 100. Purposes.

Sec. 101. Programs of Centers for Disease Control and Prevention.

Sec. 102. Study and monitor incidence and prevalence.

Sec. 103. Programs of the National Institutes of Health.

Sec. 104. Programs of Health Resources and Services Administration.

Subtitle B—Child Care Safety and Health Grants

Sec. 111. Definitions.

Sec. 112. Authorization of appropriations.

Sec. 113. Programs.

Sec. 114. Amounts reserved; allotments.

Sec. 115. State applications.

Sec. 116. Use of funds.

Sec. 117. Reports.

TITLE II—MATERNAL AND INFANT HEALTH

Subtitle A—Safe Motherhood and Infant Health Promotion

Sec. 201. Short title.

Sec. 202. Establishment of programs regarding prenatal and postnatal health.

Subtitle B—Healthy Start Initiative

Sec. 211. Short title.

Sec. 212. Continuation of Healthy Start Program.

Subtitle C—National Center for Birth Defects and Developmental Disabilities

Sec. 221. National Center for Birth Defects and Developmental Disabilities.

Subtitle D—Folic Acid Education Program

Sec. 231. Program regarding effects of folic acid in prevention of birth defects.

TITLE III—PEDIATRIC PUBLIC HEALTH PROMOTION

Subtitle A—Asthma

Sec. 301. Children’s asthma relief.

Sec. 302. Preventive health and health services block grant; systems for reducing asthma and asthma-related illnesses.

Sec. 303. Coordination of Federal activities to address asthma-related health

care needs.

Sec. 304. Compilation of data by the Centers for Disease Control and Prevention.

Subtitle B—Childhood Obesity Prevention

Sec. 311. Programs operated through the Centers for Disease Control and Prevention.

Subtitle C—Early Detection and Treatment Regarding Childhood Lead

Poisoning

Sec. 321. Centers for Disease Control and Prevention efforts to combat childhood lead poisoning.

Sec. 322. Grants for lead poisoning related activities.
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Sec. 323. Training and reports by the Health Resources and Services Administration.

Subtitle D—Oral Health

Sec. 331. Identification of interventions that reduce the burden and transmission of oral, dental, and craniofacial diseases in high risk

populations; development of approaches for pediatric oral and

craniofacial assessment.

Sec. 332. Oral health professional research and training program.

Sec. 333. Grants to increase resources for community water fluoridation.

Sec. 334. Community water fluoridation.

Sec. 335. Dental sealant program.

Sec. 336. Coordinated program to improve pediatric oral health.

TITLE IV—PEDIATRIC RESEARCH

Subtitle A—Pediatric Research Initiative

Sec. 401. Establishment of a pediatric research initiative.

Sec. 402. Investment in tomorrow’s pediatric researchers.

Subtitle B—Autism

Sec. 411. Expansion, intensification, and coordination of activities of National

Institutes of Health with respect to research on autism.

Sec. 412. Developmental disabilities surveillance and research programs.

Sec. 413. Information and education.

Sec. 414. Inter-agency Autism Coordinating Committee.

Sec. 415. Report to Congress.

Subtitle C—Long-Term Child Development

Sec. 421. Long-term child development study.

Subtitle D—Research on Rare Diseases in Children

Sec. 431. Report regarding research on rare diseases in children.

Subtitle E—GME Programs in Children’s Hospitals

Sec. 441. Extension of authorization of appropriations.

1 TITLE I—INJURY PREVENTION

2 Subtitle A—Traumatic Brain Injury

3 SEC. 100. PURPOSES.

4 It is the purpose of this subtitle to—

5 (1) require the Secretary of Health and Human

6 Services, working in cooperation with other Federal

7 agencies, to study and monitor the incidence and
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1 prevalence of traumatic brain injury and conduct na2 tional education activities to increase awareness of

3 the causes and consequences of traumatic brain in4 jury;

5 (2) require the Secretary of Health and Human

6 Services to identify best practices in diagnosis, emer7 gent care, special education, and rehabilitation with

8 the ultimate goal of independent functioning within

9 the community;

10 (3) require the Secretary of Health and Human

11 Services to request that States build capacity and

12 enhance community based service delivery systems to

13 provide adequate, appropriate, and accessible serv14 ices to individuals with traumatic brain injury and

15 their families; and

16 (4) require the Director of the National Insti17 tutes of Health to conduct and support basic and

18 applied research regarding traumatic brain injury,

19 including diagnosis, treatment, and rehabilitation.

20 SEC. 101. PROGRAMS OF CENTERS FOR DISEASE CONTROL

21 AND PREVENTION.

22 Section 393A(b) of the Public Health Service Act (42

23 U.S.C. 280b–1b(b)) is amended—

24 (1) in paragraph (1), by striking ‘‘and’’ at the

25 end;
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1 (2) in paragraph (2), by striking the period and

2 inserting ‘‘; and’’; and

3 (3) by adding at the end the following:

4 ‘‘(3) the implementation of a national education

5 and awareness campaign after consultation with the

6 Administrator of the Health Resources and Services

7 Administration and the Director of the National In8 stitutes of Health, including—

9 ‘‘(A) national dissemination and distribu10 tion of incidence and prevalence findings;

11 ‘‘(B) national dissemination of information

12 relating to traumatic brain injury and the

13 sequelae of secondary conditions arising from

14 traumatic brain injury upon discharge from

15 hospitals and trauma centers; and

16 ‘‘(C) the provision of information in pri17 mary care settings, including emergency rooms

18 and trauma centers, concerning the availability

19 of State level services and resources.’’.

20 SEC. 102. STUDY AND MONITOR INCIDENCE AND PREVA21 LENCE.

22 Section 4 of Public Law 104–166 (42 U.S.C. 300d–

23 61 note) is amended—

24 (1) in subsection (a)(1)(A)—
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1 (A) by striking clause (i) and inserting the

2 following:

3 ‘‘(i)(I) determine the incidence and

4 prevalence of traumatic brain injury in all

5 age groups in the general population of the

6 United States, including institutional set7 tings; and

8 ‘‘(II) determined appropriate meth9 odological strategies to obtain data on the

10 incidence and prevalence of mild traumatic

11 brain injury and report to Congress con12 cerning such within 18 months of the date

13 of enactment of the Children’s Public

14 Health Act of 2000; and’’; and

15 (B) in clause (ii), by striking ‘‘, if the Sec16 retary determines that such a system is appro17 priate’’;

18 (2) in subsection (a)(1)(B)(i), by inserting ‘‘,

19 including return to work or school and community

20 participation,’’ after ‘‘functioning’’; and

21 (3) in subsection (d), to read as follows:

22 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There

23 is authorized to be appropriated to carry out this section,

24 such sums as may be necessary for each of the fiscal years

25 2001 through 2005.’’.
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1 SEC. 103. PROGRAMS OF THE NATIONAL INSTITUTES OF

2 HEALTH.

3 (a) INTERAGENCY PROGRAM.—Section 1261(d)(4) of

4 the Public Health Service Act (42 U.S.C. 300d–61(d)(4))

5 is amended—

6 (1) in subparagraph (A), by striking ‘‘degree of

7 injury’’ and inserting ‘‘degree of brain injury’’;

8 (2) in subparagraph (B), by striking ‘‘acute in9 jury’’ and inserting ‘‘acute brain injury’’; and

10 (3) in subparagraph (D), by striking ‘‘injury

11 treatment’’ and inserting ‘‘brain injury treatment’’.

12 (b) RESEARCH ON COGNITIVE AND NEURO13 BEHAVIORAL DISORDERS ARISING FROM TRAUMATIC

14 BRAIN INJURY.—Section 1261(d)(4) of the Public Health

15 Service Act (42 U.S.C. 300d–61(d)(4)) is amended—

16 (1) in subparagraph (C), by striking ‘‘and’’

17 after the semicolon at the end;

18 (2) in subparagraph (D), by striking the period

19 at the end and inserting ‘‘; and’’; and

20 (3) by adding at the end the following:

21 ‘‘(E) carrying out subparagraphs (A)

22 through (D) with respect to cognitive disorders

23 and neurobehavioral consequences arising from

24 traumatic brain injury, including the develop25 ment, modification, and evaluation of therapies

26 and programs of rehabilitation toward reaching
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1 or restoring normal capabilities in areas such as

2 reading, comprehension, speech, reasoning, and

3 deduction.’’.

4 (c) AUTHORIZATION OF APPROPRIATIONS.—Section

5 1261 of the Public Health Service Act (42 U.S.C. 300d–

6 61) is amended by adding at the end the following:

7 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—There is

8 authorized to be appropriated to carry out this section,

9 such sums as may be necessary for each of the fiscal years

10 2001 through 2005.’’.

11 SEC. 104. PROGRAMS OF HEALTH RESOURCES AND SERV12 ICES ADMINISTRATION.

13 Section 1252 of the Public Health Service Act (42

14 U.S.C. 300d–52) is amended—

15 (1) in the section heading by striking ‘‘DEM16 ONSTRATION’’;

17 (2) in subsection (a), by striking ‘‘demonstra18 tion’’;

19 (3) in subsection (b)(3)—

20 (A) in subparagraph (A)(iv), by striking

21 ‘‘representing traumatic brain injury survivors’’

22 and inserting ‘‘representing individuals with

23 traumatic brain injury’’; and

24 (B) in subparagraph (B), by striking ‘‘who

25 are survivors of’’ and inserting ‘‘with’’;
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1 (4) in subsection (c)—

2 (A) by striking paragraph (2) and insert3 ing the following:

4 ‘‘(2) DETERMINATION OF AMOUNT CONTRIB5 UTED.—With respect to years beginning after the

6 first fiscal year in which assistance is provided under

7 this section, non-Federal contributions under para8 graph (1) may be in cash or in kind, fairly evalu9 ated, including plant, equipment, or services.

10 Amounts provided by the Federal Government, or

11 services assisted or subsidized to any significant ex12 tent by the Federal Government, may not be in13 cluded in determining the amount of such contribu14 tion.’’; and

15 (B) by adding at the end the following:

16 ‘‘(3) EFFECTIVE DATE.—The requirements of

17 this subsection shall apply with respect to a State

18 for grant years beginning after the first year in

19 which the State receives a grant under this sec20 tion.’’;

21 (5) by redesignating subsections (e) through (h)

22 as subsections (g) through (j), respectively;

23 (6) by inserting after subsection (d), the fol24 lowing:
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1 ‘‘(e) CONTINUATION OF PREVIOUSLY AWARDED

2 DEMONSTRATION PROJECTS.—A State that received a

3 grant under this section prior to the date of enactment

4 of the Traumatic Brain Injury Act Amendments of 2000

5 may compete for new project grants under this section

6 after such date of enactment.

7 ‘‘(f) USE OF STATE GRANTS.—

8 ‘‘(1) COMMUNITY SERVICES.—A State shall use

9 amounts received under a grant under this section

10 to, directly or through grants or contracts with non11 profit entities—

12 ‘‘(A) develop, change, or enhance commu13 nity based service delivery systems that include

14 timely access to an array of comprehensive serv15 ices and supports that promote full community

16 participation by individuals with brain injury

17 and their families;

18 ‘‘(B) address the needs of brain-injured in19 dividuals of all ages;

20 ‘‘(C) provide outreach and services to un21 derserved and inappropriately served brain-in22 jured individuals, such as individuals in institu23 tional settings, individuals with low socio24 economic resources, individuals in rural commu-
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1 nities, and individuals in culturally and linguis2 tically diverse communities;

3 ‘‘(D) provide grants to nonprofit entities

4 for consumer or family service access training,

5 peer mentoring, and parent to parent or care6 taker to caretaker programs;

7 ‘‘(E) provide individual and family service

8 coordination or case management systems for

9 families of traumatic brain-injured individuals;

10 and

11 ‘‘(F) support other needs identified by a

12 State plan that is supported by its advisory

13 council.

14 ‘‘(2) BEST PRACTICES.—

15 ‘‘(A) IN GENERAL.—State services and

16 supports provided under a grant under this sec17 tion shall reflect the best practices in the field

18 of traumatic brain injury, and shall be sup19 ported by quality assurance measures as well as

20 the appropriate standard of health care and in21 tegrated community supports.

22 ‘‘(B) DEMONSTRATION BY STATE AGEN23 CY.—The State agency responsible for admin24 istering amounts received under a grant under

25 this section shall demonstrate expertise and
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1 knowledge of traumatic brain injury and the

2 unique needs associated with traumatic brain

3 injury.

4 ‘‘(3) STATE CAPACITY BUILDING.—A State may

5 use amounts received under a grant under this sec6 tion to leverage State resources to—

7 ‘‘(A) educate individuals with traumatic

8 brain injury and their families;

9 ‘‘(B) train professionals in public and pri10 vate sector financing (such as third party pay11 ers, State agencies, community-based providers,

12 schools, and educators);

13 ‘‘(C) develop or improve case management

14 or service coordination systems;

15 ‘‘(D) develop best practices in areas such

16 as family support, return to work, housing or

17 supportive living, personal assistance services,

18 assistive technology, behavioral health services,

19 substance abuse services, and traumatic brain

20 injury treatment and rehabilitation;

21 ‘‘(E) tailor existing State systems to pro22 vide accommodation to the needs of individuals

23 with brain injury (including systems adminis24 tered by the State departments responsible for

25 health, mental health, labor, education, mental
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1 retardation or developmental disabilities, trans2 portation, housing, and correctional systems);

3 and

4 ‘‘(F) improve data sets coordinated across

5 systems and other needs identified by a State

6 plan supported by its advisory council.’’;

7 (7) in subsection (j) (as so redesignated), to

8 read as follows:

9 ‘‘(j) AUTHORIZATION OF APPROPRIATIONS.—For the

10 purpose of carrying out this section, there is authorized

11 to be appropriated such sums as may be necessary for

12 each of fiscal years 2001 through 2005.’’; and

13 (8) by adding at the end the following:

14 ‘‘(k) STATE.—In this section, the term ‘State’ in15 cludes territories of the United States.’’.

16 Subtitle B—Child Care Safety and

17 Health Grants

18 SEC. 111. DEFINITIONS.

19 In this subtitle:

20 (1) CHILD WITH A DISABILITY; INFANT OR

21 TODDLER WITH A DISABILITY.—The terms ‘‘child

22 with a disability’’ and ‘‘infant or toddler with a dis23 ability’’ have the meanings given the terms in sec24 tions 602 and 632 of the Individuals with Disabil25 ities Education Act (20 U.S.C. 1401 and 1431).
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1 (2) ELIGIBLE CHILD CARE PROVIDER.—The

2 term ‘‘eligible child care provider’’ means a provider

3 of child care services for compensation, including a

4 provider of care for a school-age child during non5 school hours, that—

6 (A) is licensed, regulated, registered, or

7 otherwise legally operating, under State and

8 local law; and

9 (B) satisfies the State and local require10 ments,

11 applicable to the child care services the provider pro12 vides.

13 (3) SECRETARY.—The term ‘‘Secretary’’ means

14 the Secretary of Health and Human Services.

15 (4) STATE.—The term ‘‘State’’ means any of

16 the several States of the United States, the District

17 of Columbia, the Commonwealth of Puerto Rico, the

18 United States Virgin Islands, Guam, American

19 Samoa, and the Commonwealth of the Northern

20 Mariana Islands.

21 SEC. 112. AUTHORIZATION OF APPROPRIATIONS.

22 There are authorized to be appropriated to carry out

23 this subtitle $200,000,000 for fiscal year 2001 and such

24 sums as may be necessary for each subsequent fiscal year.
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1 SEC. 113. PROGRAMS.

2 The Secretary shall make allotments to eligible States

3 under section 114. The Secretary shall make the allot4 ments to enable the States to establish programs to im5 prove the health and safety of children receiving child care

6 outside the home, by preventing illnesses and injuries as7 sociated with that care and promoting the health and well8 being of children receiving that care.

9 SEC. 114. AMOUNTS RESERVED; ALLOTMENTS.

10 (a) AMOUNTS RESERVED.—The Secretary shall reserve not more than 1 11 ⁄2 of 1 percent of the amount appro12 priated under section 112 for each fiscal year to make al13 lotments to Guam, American Samoa, the United States

14 Virgin Islands, and the Commonwealth of the Northern

15 Mariana Islands to be allotted in accordance with their

16 respective needs.

17 (b) STATE ALLOTMENTS.—

18 (1) GENERAL RULE.—From the amounts ap19 propriated under section 112 for each fiscal year

20 and remaining after reservations are made under

21 subsection (a), the Secretary shall allot to each State

22 an amount equal to the sum of—

23 (A) an amount that bears the same ratio

24 to 50 percent of such remainder as the product

25 of the young child factor of the State and the

26 allotment percentage of the State bears to the
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1 sum of the corresponding products for all

2 States; and

3 (B) an amount that bears the same ratio

4 to 50 percent of such remainder as the product

5 of the school lunch factor of the State and the

6 allotment percentage of the State bears to the

7 sum of the corresponding products for all

8 States.

9 (2) YOUNG CHILD FACTOR.—In this subsection,

10 the term ‘‘young child factor’’ means the ratio of the

11 number of children under 5 years of age in a State

12 to the number of such children in all States, as pro13 vided by the most recent annual estimates of popu14 lation in the States by the Census Bureau of the De15 partment of Commerce.

16 (3) SCHOOL LUNCH FACTOR.—In this sub17 section, the term ‘‘school lunch factor’’ means the

18 ratio of the number of children who are receiving

19 free or reduced price lunches under the school lunch

20 program established under the National School

21 Lunch Act (42 U.S.C. 1751 et seq.) in the State to

22 the number of such children in all States, as deter23 mined annually by the Department of Agriculture.

24 (4) ALLOTMENT PERCENTAGE.—
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1 (A) IN GENERAL.—For purposes of this

2 subsection, the allotment percentage for a State

3 shall be determined by dividing the per capita

4 income of all individuals in the United States,

5 by the per capita income of all individuals in

6 the State.

7 (B) LIMITATIONS.—If an allotment per8 centage determined under subparagraph (A) for

9 a State—

10 (i) is more than 1.2 percent, the allot11 ment percentage of the State shall be con12 sidered to be 1.2 percent; and

13 (ii) is less than 0.8 percent, the allot14 ment percentage of the State shall be con15 sidered to be 0.8 percent.

16 (C) PER CAPITA INCOME.—For purposes

17 of subparagraph (A), per capita income shall

18 be—

19 (i) determined at 2-year intervals;

20 (ii) applied for the 2-year period be21 ginning on October 1 of the first fiscal

22 year beginning after the date such deter23 mination is made; and

24 (iii) equal to the average of the an25 nual per capita incomes for the most re-
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1 cent period of 3 consecutive years for

2 which satisfactory data are available from

3 the Department of Commerce on the date

4 such determination is made.

5 (c) DATA AND INFORMATION.—The Secretary shall

6 obtain from each appropriate Federal agency, the most re7 cent data and information necessary to determine the al8 lotments provided for in subsection (b).

9 (d) DEFINITION.—In this section, the term ‘‘State’’

10 includes only the several States of the United States, the

11 District of Columbia, and the Commonwealth of Puerto

12 Rico.

13 SEC. 115. STATE APPLICATIONS.

14 To be eligible to receive an allotment under section

15 114, a State shall submit an application to the Secretary

16 at such time, in such manner, and containing such infor17 mation as the Secretary may require. The application shall

18 contain information assessing the needs of the State with

19 regard to child care health and safety, the goals to be

20 achieved through the program carried out by the State

21 under this subtitle, and the measures to be used to assess

22 the progress made by the State toward achieving the goals.

23 SEC. 116. USE OF FUNDS.

24 (a) IN GENERAL.—A State that receives an allotment

25 under section 114 shall use the funds made available
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1 through the allotment to carry out 2 or more activities

2 consisting of—

3 (1) providing training and education to eligible

4 child care providers on preventing injuries and ill5 nesses in children, and promoting health-related

6 practices;

7 (2) strengthening licensing, regulation, or reg8 istration standards for eligible child care providers;

9 (3) assisting eligible child care providers in

10 meeting licensing, regulation, or registration stand11 ards, including rehabilitating the facilities of the

12 providers, in order to bring the facilities into compli13 ance with the standards;

14 (4) enforcing licensing, regulation, or registra15 tion standards for eligible child care providers, in16 cluding holding increased unannounced inspections

17 of the facilities of those providers;

18 (5) providing health consultants to provide ad19 vice to eligible child care providers;

20 (6) assisting eligible child care providers in en21 hancing the ability of the providers to serve children

22 with disabilities and infants and toddlers with dis23 abilities;

24 (7) conducting criminal background checks for

25 eligible child care providers and other individuals
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1 who have contact with children in the facilities of the

2 providers;

3 (8) providing information to parents on what

4 factors to consider in choosing a safe and healthy

5 child care setting; or

6 (9) assisting in improving the safety of trans7 portation practices for children enrolled in child care

8 programs with eligible child care providers.

9 (b) SUPPLEMENT, NOT SUPPLANT.—Funds appro10 priated pursuant to the authority of this subtitle shall be

11 used to supplement and not supplant other Federal, State,

12 and local public funds expended to provide services for eli13 gible individuals.

14 SEC. 117. REPORTS.

15 Each State that receives an allotment under section

16 114 shall annually prepare and submit to the Secretary

17 a report that describes—

18 (1) the activities carried out with funds made

19 available through the allotment; and

20 (2) the progress made by the State toward

21 achieving the goals described in the application sub22 mitted by the State under section 115.
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1 TITLE II—MATERNAL AND

2 INFANT HEALTH

3 Subtitle A—Safe Motherhood and

4 Infant Health Promotion

5 SEC. 201. SHORT TITLE.

6 This subtitle may be cited as the ‘‘Pregnant Women

7 and Infants Health Protection Act’’.

8 SEC. 202. ESTABLISHMENT OF PROGRAMS REGARDING

9 PRENATAL AND POSTNATAL HEALTH.

10 Title III of the Public Health Service Act (42 U.S.C.

11 241 et seq.) is amended by adding at the end the fol12 lowing:

13 ‘‘PART P—MATERNAL AND INFANT HEALTH

14 ‘‘SEC. 399L. PROGRAMS REGARDING PRENATAL AND POST15 NATAL HEALTH.

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

17 the Director of the Centers for Disease Control and Pre18 vention, shall carry out programs—

19 ‘‘(1) to collect, analyze, and make available data

20 on prenatal smoking, alcohol and illegal drug usage,

21 including data on the implications of such activities

22 and on the incidence and prevalence of such activi23 ties and their implications;
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1 ‘‘(2) to conduct applied epidemiological research

2 on the prevention of prenatal and postnatal smoking,

3 alcohol and illegal drug usage;

4 ‘‘(3) to support, conduct, and evaluate the ef5 fectiveness of educational and cessation programs;

6 and

7 ‘‘(4) to provide information and education to

8 the public on the prevention and implications of pre9 natal and postnatal smoking, alcohol and illegal drug

10 usage.

11 ‘‘(b) GRANTS.—In carrying out subsection (a), the

12 Secretary may award grants to and enter into contracts

13 with States, local governments, territories and Indian

14 Tribes, scientific and academic institutions, Federally

15 qualified health centers, and other public and nonprofit

16 entities, and may provide technical and consultative assist17 ance to such entities.

18 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There

19 is authorized to be appropriated to carry out this section,

20 such sums as may be necessary for each of the fiscal years

21 2001 through 2005.

22 ‘‘SEC. 399M. SAFE MOTHERHOOD SURVEILLANCE.

23 ‘‘(a) PURPOSE.—It is the purpose of this section to

24 develop surveillance systems at the local, State, and na25 tional level to better understand the burden of maternal
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1 complications and mortality and to decrease the disparities

2 among population at risk of death and complications from

3 pregnancy.

4 ‘‘(b) ACTIVITIES.—For the purpose described in sub5 section (a), the Secretary, acting through the Centers for

6 Disease Control and Prevention, may carry out the fol7 lowing activities:

8 ‘‘(1) Establish and implement a national sur9 veillance program to identify and promote the inves10 tigation of deaths and severe complications that

11 occur during pregnancy.

12 ‘‘(2) Expand the Pregnancy Risk Assessment

13 Monitoring System to provide surveillance and col14 lect data in each of the 50 States.

15 ‘‘(3) Expand the Maternal and Child Health

16 Epidemiology Program to provide technical support,

17 financial assistance, or the time-limited assignment

18 of senior epidemiologists to maternal and child

19 health programs in each of the 50 States.

20 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There

21 is authorized to be appropriated to carry out this section,

22 such sums as may be necessary for each of fiscal years

23 2001 through 2005.
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1 ‘‘SEC. 399N. PREVENTION RESEARCH TO ENSURE SAFE

2 MOTHERHOOD.

3 ‘‘(a) PURPOSE.—It is the purpose of this section to

4 provide the Secretary with the authority to further expand

5 research concerning risk factors, prevention strategies,

6 and the roles of the family, health care providers and the

7 community in safe motherhood.

8 ‘‘(b) RESEARCH.—The Secretary, acting through the

9 Centers for Disease Control and Prevention, may carry

10 out activities to expand research relating to—

11 ‘‘(1) encouraging preconception counseling, es12 pecially for at risk populations such as diabetics;

13 ‘‘(2) the identification of critical components of

14 prenatal, delivery and postpartum care;

15 ‘‘(3) the identification of outreach and support

16 services that are available for pregnant women;

17 ‘‘(4) the identification of women who are at

18 high risk for complications;

19 ‘‘(5) preventing preterm delivery;

20 ‘‘(6) preventing urinary tract infections;

21 ‘‘(7) preventing unnecessary caesarean sections;

22 ‘‘(8) an examination of the higher rates of ma23 ternal mortality among African American women;

24 ‘‘(9) an examination of the relationship between

25 domestic violence and maternal complications and

26 mortality;
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1 ‘‘(10) preventing smoking, alcohol and illegal

2 drug usage before, during and after pregnancy;

3 ‘‘(11) preventing infections that cause maternal

4 and infant complications; and

5 ‘‘(12) other areas determined appropriate by

6 the Secretary.

7 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There

8 is authorized to be appropriated to carry out this section,

9 such sums as may be necessary for each of fiscal years

10 2001 through 2005.

11 ‘‘SEC. 399O. PREVENTION PROGRAMS TO ENSURE SAFE

12 MOTHERHOOD.

13 ‘‘(a) IN GENERAL.—The Secretary may carry out ac14 tivities to promote safe motherhood, including—

15 ‘‘(1) public education campaigns on healthy

16 pregnancies and the building of partnerships with

17 organizations concerned about safe motherhood;

18 ‘‘(2) education programs for physicians, nurses

19 and other health care providers; and

20 ‘‘(3) activities to promote community support

21 services for pregnant women.

22 ‘‘(b) AUTHORIZATION OF APPROPRIATIONS.—There

23 is authorized to be appropriated to carry out this section,

24 such sums as may be necessary for each of fiscal years

25 2001 through 2005.’’.
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1 Subtitle B—Healthy Start Initiative

2 SEC. 211. SHORT TITLE.

3 This title may be cited as the ‘‘Healthy Start Initia4 tive Continuation Act’’.

5 SEC. 212. CONTINUATION OF HEALTHY START PROGRAM.

6 Subpart I of part D of title III of the Public Health

7 Service Act (42 U.S.C. 254b et seq.) is amended by adding

8 at the end the following section:

9 ‘‘SEC. 330E. HEALTHY START FOR INFANTS.

10 ‘‘(a) IN GENERAL.—

11 ‘‘(1) CONTINUATION AND EXPANSION OF PRO12 GRAM.—The Secretary, acting through the Adminis13 trator of the Health Resources and Services Admin14 istration, Maternal and Child Health Bureau, shall

15 under authority of this section continue in effect the

16 Healthy Start Initiative and may, during fiscal year

17 2001 and subsequent years, carry out such program

18 on a national basis.

19 ‘‘(2) DEFINITION.—For purposes of paragraph

20 (1), the term ‘Healthy Start Initiative’ is a reference

21 to the program that, as an initiative to reduce the

22 rate of infant mortality and improve perinatal out23 comes, makes grants for project areas with high an24 nual rates of infant mortality and that, prior to the
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1 effective date of this section, was a demonstration

2 program carried out under section 301.

3 ‘‘(3) ADDITIONAL GRANTS.— Effective upon in4 creased funding beyond fiscal year 1999 for such

5 Initiative, additional grants may be made to States

6 to assist communities with technical assistance, rep7 lication of successful projects, and State policy for8 mation to reduce infant and maternal mortality and

9 morbidity.

10 ‘‘(b) REQUIREMENTS FOR MAKING GRANTS.—In

11 making grants under subsection (a), the Secretary shall

12 require that applicants (in addition to meeting all eligi13 bility criteria established by the Secretary) establish, for

14 project areas under such subsection, community-based

15 consortia of individuals and organizations (including agen16 cies responsible for administering block grant programs

17 under title V of the Social Security Act, consumers of

18 project services, public health departments, hospitals,

19 health centers under section 330, and other significant

20 sources of health care services) that are appropriate for

21 participation in projects under subsection (a).

22 ‘‘(c) COORDINATION.—Recipients of grants under

23 subsection (a) shall coordinate their services and activities

24 with the State agency or agencies that administer block

25 grant programs under title V of the Social Security Act
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1 in order to promote cooperation and dissemination of in2 formation with Statewide systems and with other commu3 nity services funded under the Maternal and Child Health

4 Block Grant.

5 ‘‘(d) RULE OF CONSTRUCTION.—Except to the extent

6 inconsistent with this section, this section may not be con7 strued as affecting the authority of the Secretary to make

8 modifications in the program carried out under subsection

9 (a).

10 ‘‘(e) MEDICALLY APPROPRIATE SERVICES FOR AT11 RISK PREGNANT WOMEN AND INFANTS.—

12 ‘‘(1) IN GENERAL.—The Secretary may make

13 grants to health care entities to provide for pregnant

14 women or infants, other health services (including

15 ultrasound, prenatal care, genetic counseling, and

16 fetal and other surgery) that—

17 ‘‘(A) are determined by a qualified treating

18 health care professional to be medically appro19 priate in order to prevent or mitigate congenital

20 defects (including spina bifida and

21 hydrocephaly) or other serious obstetric com22 plications; and

23 ‘‘(B) are provided during pregnancy or

24 during the first year after birth.
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1 ‘‘(2) ELIGIBLE PROJECT AREA.—The Secretary

2 may make a grant under paragraph (1) only if the

3 geographic area in which services under the grant

4 will be provided is a geographic area in which a

5 project under subsection (a) is being carried out,

6 and if the Secretary determines that the grant will

7 add to or expand the level of health services avail8 able in such area to pregnant women and infants.

9 ‘‘(3) TRANSPORTATION AND SUBSISTENCE EX10 PENSES FOR CERTAIN PATIENTS.—The purposes for

11 which a grant under paragraph (1)(B) may be ex12 pended include paying, on behalf of a pregnant

13 woman who is in need of the health services de14 scribed in such paragraph, transportation and sub15 sistence expenses to assist the pregnant woman in

16 obtaining such health services from the grantee in17 volved. The Secretary may establish such restrictions

18 regarding payments under the preceding sentence as

19 the Secretary determines to be appropriate.

20 ‘‘(4) RELATIONSHIP TO PAYMENTS UNDER

21 OTHER PROGRAMS.—A grant may be made under

22 paragraph (1) only if the applicant involved agrees

23 that the grant will not be expended to pay the ex24 penses of providing any service under such para25 graph to a pregnant woman to the extent that pay-
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1 ment has been made, or can reasonably be expected

2 to be made, with respect to such expenses—

3 ‘‘(A) under any State compensation pro4 gram, under an insurance policy, or under any

5 Federal or State health benefits program; or

6 ‘‘(B) by an entity that provides health

7 services on a prepaid basis.

8 ‘‘(5) EVALUATION BY GENERAL ACCOUNTING

9 OFFICE.—

10 ‘‘(A) IN GENERAL.—During fiscal year

11 2004, the Comptroller General of the United

12 States shall conduct an evaluation of activities

13 under grants under paragraph (1) in order to

14 determine whether the activities have been ef15 fective in serving the needs of pregnant women

16 with respect to health services described in

17 paragraph (1). The evaluation shall include an

18 analysis of whether such activities have been ef19 fective in reducing the disparity in health status

20 between the general population and individuals

21 who are members of racial or ethnic minority

22 groups. Not later than January 10, 2005, the

23 Comptroller General shall submit to the Com24 mittee on Commerce in the House of Rep25 resentatives, and to the Committee on Health,
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1 Education, Labor, and Pensions in the Senate,

2 a report describing the findings of the evalua3 tion.

4 ‘‘(B) RELATION TO GRANTS REGARDING

5 MEDICALLY APPROPRIATE SERVICES FOR AT6 RISK MOTHERS AND INFANTS.—Before the date

7 on which the evaluation under subparagraph

8 (A) is submitted in accordance with such

9 subparagraph—

10 ‘‘(i) the Secretary shall ensure that

11 there are not more than three grantees

12 under paragraph (1)(B); and

13 ‘‘(ii) an entity is not eligible to receive

14 grants under such paragraph unless the

15 entity has substantial experience in pro16 viding the health services described in such

17 paragraph.

18 ‘‘(f) FUNDING.—

19 ‘‘(1) GENERAL PROGRAM.—

20 ‘‘(A) AUTHORIZATION OF APPROPRIA21 TIONS.—For the purpose of carrying out this

22 section (other than subsection (e)), there are

23 authorized to be appropriated such sums as

24 may be necessary for each of the fiscal years

25 2001 through 2005.
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1 ‘‘(B) ALLOCATIONS.—

2 ‘‘(i) PROGRAM ADMINISTRATION.—Of

3 the amounts appropriated under subpara4 graph (A) for a fiscal year, the Secretary

5 may reserve up to 5 percent for coordina6 tion, dissemination, technical assistance,

7 and data activities that are determined by

8 the Secretary to be appropriate for car9 rying out the program under this section.

10 ‘‘(ii) EVALUATION.—Of the amounts

11 appropriated under subparagraph (A) for a

12 fiscal year, the Secretary may reserve up

13 to 1 percent for evaluations of projects car14 ried out under subsection (a). Each such

15 evaluation shall include a determination of

16 whether such projects have been effective

17 in reducing the disparity in health status

18 between the general population and indi19 viduals who are members of racial or eth20 nic minority groups.

21 ‘‘(2) MEDICALLY APPROPRIATE SERVICES FOR

22 AT-RISK MOTHERS AND INFANTS.—For the purpose

23 of carrying out subsection (e), there are authorized

24 to be appropriated such sums as may be necessary

25 for each of the fiscal years 2001 through 2005.’’.
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1 Subtitle C—National Center for

2 Birth Defects and Develop3 mental Disabilities

4 SEC. 221. NATIONAL CENTER FOR BIRTH DEFECTS AND DE5 VELOPMENTAL DISABILITIES.

6 Part P of title III of the Public Health Service Act

7 (as added by section 201) is amended by adding at the

8 end the following:

9 ‘‘SEC. 399P. NATIONAL CENTER FOR BIRTH DEFECTS AND

10 DEVELOPMENTAL DISABILITIES.

11 ‘‘(a) ESTABLISHMENT.—There is established within

12 the Centers for Disease Control and Prevention a center

13 to be known as the National Center for Birth Defects and

14 Developmental Disabilities.

15 ‘‘(b) PURPOSE.—The general purpose of the National

16 Center established under subsection (a) shall be to—

17 ‘‘(1) collect, analyze, and make available data

18 on birth defects and developmental disabilities, in19 cluding data on the causes of such defects and dis20 abilities and on the incidence and prevalence of such

21 defects and disabilities;

22 ‘‘(2) conduct applied epidemiological research

23 on the prevention of such defects and disabilities;

24 and
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1 ‘‘(3) provide information and education to the

2 public on the prevention of such defects and disabil3 ities.

4 ‘‘(c) DIRECTOR.—The National Center established

5 under subsection (a) shall be headed by a director to be

6 appointed by the Director of the Centers for Disease Con7 trol and Prevention.

8 ‘‘(d) TRANSFERS.—There shall be transferred to the

9 National Center established under subsection (a) all activi10 ties, budgets and personnel of the National Center for En11 vironmental Health that relate to birth defects, folic acid,

12 cerebral palsy, mental retardation, child development,

13 newborn screening, autism, Fragile X syndrome, fetal al14 cohol syndrome, pediatric genetics, disability prevention,

15 and other relevant activities.

16 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There

17 is authorized to be appropriated such sums as may be nec18 essary to carry out this section for each of fiscal years

19 2001 through 2005.’’.
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1 Subtitle D—Folic Acid Education

2 Program

3 SEC. 231. PROGRAM REGARDING EFFECTS OF FOLIC ACID

4 IN PREVENTION OF BIRTH DEFECTS.

5 Part P of title III of the Public Health Service Act

6 (as added by section 201 and amended by section 221)

7 is further amended by adding at the end the following:

8 ‘‘SEC. 399Q. EFFECTS OF FOLIC ACID IN PREVENTION OF

9 BIRTH DEFECTS.

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

11 the Director of the Centers for Disease Control and Pre12 vention, shall carry out a program (within the National

13 Center for Birth Defects and Developmental Disabilities)

14 for the following purposes:

15 ‘‘(1) To provide education and training for

16 health professionals and the general public for pur17 poses of explaining the effects of folic acid in pre18 venting birth defects and for purposes of encour19 aging each woman of reproductive capacity (whether

20 or not planning a pregnancy) to consume on a daily

21 basis a dietary supplement that provides an appro22 priate level of folic acid.

23 ‘‘(2) To conduct research with respect to such

24 education and training, including identifying effec-
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1 tive strategies for increasing the rate of consumption

2 of folic acid by women of reproductive capacity.

3 ‘‘(3) To conduct research to increase the under4 standing of the effects of folic acid in preventing

5 birth defects, including understanding with respect

6 to cleft lip, cleft palate, and heart defects.

7 ‘‘(4) To provide for appropriate epidemiological

8 activities regarding folic acid and birth defects, in9 cluding epidemiological activities regarding neural

10 tube defects.

11 ‘‘(b) CONSULTATIONS WITH STATES AND PRIVATE

12 ENTITIES.—In carrying out subsection (a), the Secretary

13 shall consult with the States and with other appropriate

14 public or private entities, including national nonprofit pri15 vate organizations, health professionals, and providers of

16 health insurance and health plans.

17 ‘‘(c) TECHNICAL ASSISTANCE.—The Secretary may

18 (directly or through grants or contracts) provide technical

19 assistance to public and nonprofit private entities in car20 rying out the activities described in subsection (a).

21 ‘‘(d) EVALUATIONS.—The Secretary shall (directly or

22 through grants or contracts) provide for the evaluation of

23 activities under subsection (a) in order to determine the

24 extent to which such activities have been effective in car25 rying out the purposes of the program under such sub-
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1 section, including the effects on various demographic pop2 ulations. Methods of evaluation under the preceding sen3 tence may include surveys of knowledge and attitudes on

4 the consumption of folic acid and on blood folate levels.

5 Such methods may include complete and timely moni6 toring of infants who are born with neural tube defects.

7 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—For the

8 purpose of carrying out this section, there are authorized

9 to be appropriated $20,000,000 for fiscal year 2001, and

10 such sums as may be necessary for each of the fiscal years

11 2002 through 2005.’’.

12 TITLE III—PEDIATRIC PUBLIC

13 HEALTH PROMOTION

14 Subtitle A—Asthma

15 SEC. 301. CHILDREN’S ASTHMA RELIEF.

16 Title III of the Public Health Service Act (42 U.S.C.

17 243 et seq.) is amended by inserting after section 317G

18 the following:

19 ‘‘SEC. 317H. ASTHMA TREATMENT GRANTS PROGRAM.

20 ‘‘(a) PURPOSES.—The purposes of this section are as

21 follows:

22 ‘‘(1) To provide access to quality medical care

23 for children who live in areas that have a high prev24 alence of asthma and who lack access to medical

25 care.
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1 ‘‘(2) To provide on-site education to parents,

2 children, health care providers, and medical teams to

3 recognize the signs and symptoms of asthma, and to

4 train them in the use of medications to prevent and

5 treat asthma.

6 ‘‘(3) To decrease preventable trips to the emer7 gency room by making medication available to indi8 viduals who have not previously had access to treat9 ment or education in the prevention of asthma.

10 ‘‘(4) To provide other services, such as smoking

11 cessation programs, home modification, and other

12 direct and support services that ameliorate condi13 tions that exacerbate or induce asthma.

14 ‘‘(b) AUTHORITY TO MAKE GRANTS.—

15 ‘‘(1) IN GENERAL.—In addition to any other

16 payments made under this title, the Secretary shall

17 award grants to eligible entities to carry out the pur18 poses of this section, including grants that are de19 signed to develop and expand projects to—

20 ‘‘(A) provide comprehensive asthma serv21 ices to children, including access to care and

22 treatment for asthma in a community-based

23 setting;

24 ‘‘(B) fully equip mobile health care clinics

25 that provide preventive asthma care including
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1 diagnosis, physical examinations, pharma2 cological therapy, skin testing, peak flow meter

3 testing, and other asthma-related health care

4 services;

5 ‘‘(C) conduct study-validated asthma man6 agement education programs for patients with

7 asthma and their families, including patient

8 education regarding asthma management, fam9 ily education on asthma management, and the

10 distribution of materials, including displays and

11 videos, to reinforce concepts presented by med12 ical teams; and

13 ‘‘(D) identify, and refer for enrollment, eli14 gible children for the medicaid program under

15 title XIX of the Social Security Act (42 U.S.C.

16 1396 et seq.), the State Children’s Health In17 surance Program under title XXI of that Act

18 (42 U.S.C. 1397aa et seq.), or other children’s

19 health programs.

20 ‘‘(2) AWARD OF GRANTS.—

21 ‘‘(A) APPLICATION.—

22 ‘‘(i) IN GENERAL.—An eligible entity

23 shall submit an application to the Sec24 retary for a grant under this section in
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1 such form and manner as the Secretary

2 may require.

3 ‘‘(ii) REQUIRED INFORMATION.—An

4 application submitted under this subpara5 graph shall include a plan for the use of

6 funds awarded under the grant and such

7 other information as the Secretary may re8 quire.

9 ‘‘(B) REQUIREMENT.—In awarding grants

10 under this section, the Secretary shall give pref11 erence to eligible entities that demonstrate that

12 the activities to be carried out under this sec13 tion shall be in localities within areas of known

14 high prevalence of childhood asthma or high

15 asthma-related mortality (relative to the aver16 age asthma incidence rates and associated mor17 tality rates in the United States). Acceptable

18 data sets used to demonstrate a high prevalence

19 of childhood asthma or high asthma-related

20 mortality may include data from Federal, State,

21 or local vital statistics, claims data from title

22 XIX or XXI of the Social Security Act (42

23 U.S.C. 1396 et seq., 1397aa), other public

24 health statistics or surveys, or other data that

25 the Secretary, in consultation with the Director
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1 of the Centers for Disease Control and Preven2 tion, deems appropriate.

3 ‘‘(3) DEFINITION OF ELIGIBLE ENTITY.—In

4 this section, the term ‘eligible entity’ means a State

5 agency or other entity receiving funds under this

6 title, a local community, a local educational agency,

7 a nonprofit children’s hospital or foundation, or a

8 nonprofit community-based organization.

9 ‘‘(c) COORDINATION WITH OTHER CHILDREN’S PRO10 GRAMS.—An eligible entity shall identify in the plan sub11 mitted as part of an application for a grant under this

12 section how the entity will coordinate operations and ac13 tivities under the grant with—

14 ‘‘(1) other programs operated in the State that

15 serve children with asthma, including any such pro16 grams operated under title V of the Social Security

17 Act (42 U.S.C. 701 et seq.), title XIX of that Act

18 (42 U.S.C. 1396 et seq.), and title XXI of that Act

19 (42 U.S.C. 1397aa et seq.); and

20 ‘‘(2) one or more of the following—

21 ‘‘(A) the child welfare and foster care and

22 adoption assistance programs under parts B

23 and E of title IV of the Social Security Act (42

24 U.S.C 620 et seq., 670 et seq.);
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1 ‘‘(B) the head start program established

2 under the Head Start Act (42 U.S.C. 9831 et

3 seq.);

4 ‘‘(C) the program of assistance under the

5 special supplemental nutrition program for

6 women, infants and children (WIC) under sec7 tion 17 of the Child Nutrition Act of 1966 (42

8 U.S.C. 1786);

9 ‘‘(D) local public and private elementary or

10 secondary schools; or

11 ‘‘(E) public housing agencies, as defined in

12 section 3 of the United States Housing Act of

13 1937 (42 U.S.C. 1437a).

14 ‘‘(d) EVALUATION.—An eligible entity that receives

15 a grant under this section shall submit to the Secretary

16 an evaluation of the operations and activities carried out

17 under the grant that includes—

18 ‘‘(1) a description of the asthma-related health

19 status outcomes of children assisted under the grant;

20 ‘‘(2) an assessment of the utilization of asthma21 related health care services as a result of activities

22 carried out under the grant;

23 ‘‘(3) the collection, analysis, and reporting of

24 asthma data according to guidelines prescribed by

25 the Director of the Centers for Disease Control and
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1 Prevention as described in section 304 of the Chil2 dren’s Public Health Act of 2000; and

3 ‘‘(4) such other information as the Secretary

4 may require.

5 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There

6 are authorized to be appropriated to carry out this section,

7 $50,000,000 for each of the fiscal years 2001 through

8 2005.’’.

9 SEC. 302. PREVENTIVE HEALTH AND HEALTH SERVICES

10 BLOCK GRANT; SYSTEMS FOR REDUCING

11 ASTHMA AND ASTHMA-RELATED ILLNESSES.

12 Section 1904(a)(1) of the Public Health Service Act

13 (42 U.S.C. 300w–3(a)(1)) is amended—

14 (1) by redesignating subparagraphs (E) and

15 (F) as subparagraphs (F) and (G), respectively;

16 (2) by adding a period at the end of subpara17 graph (G) (as so redesignated);

18 (3) by inserting after subparagraph (D), the

19 following:

20 ‘‘(E) Projects to reduce the prevalence of asth21 ma and asthma-related illnesses among urban popu22 lations, especially children, by reducing the level of

23 exposure to cockroach allergen, or other known asth24 ma triggers through the use of integrated pest man25 agement, as applied to cockroaches or other aller-
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1 gens. Such projects shall test the cost-effectiveness

2 of methods of integrated pest management. Amounts

3 expended for such systems may include the costs of

4 structural rehabilitation of housing, public schools,

5 and other public facilities to reduce cockroach infes6 tation, the costs of building maintenance, and the

7 costs of programs to promote community participa8 tion in the carrying out at such sites integrated pest

9 management, as applied to cockroaches or other

10 known asthma triggers. For purposes of this sub11 paragraph, the term ‘integrated pest management’

12 means an approach to the management of pests in

13 public facilities that minimizes or avoids the use of

14 pesticide chemicals through a combination of appro15 priate practices regarding the maintenance, cleaning,

16 and monitoring of such sites.’’;

17 (4) in subparagraph (F) (as so redesignated),

18 by striking ‘‘subparagraphs (A) through (D)’’ and

19 inserting ‘‘subparagraphs (A) through (E)’’; and

20 (5) in subparagraph (G) (as so redesignated),

21 by striking ‘‘subparagraphs (A) through (E)’’ and

22 inserting ‘‘subparagraphs (A) through (F)’’.
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1 SEC. 303. COORDINATION OF FEDERAL ACTIVITIES TO AD2 DRESS ASTHMA-RELATED HEALTH CARE

3 NEEDS.

4 The Secretary of Health and Human Services shall—

5 (1) identify all Federal programs that carry out

6 asthma research and asthma-related activities;

7 (2) develop, in consultation with appropriate

8 Federal agencies, including the Environmental Pro9 tection Agency and the Department of Housing and

10 Urban Development, and professional and voluntary

11 health organizations, a Federal plan for responding

12 to asthma; and

13 (3) not later than 12 months after the date of

14 enactment of this Act, submit recommendations to

15 the Committee on Health, Education, Labor, and

16 Pensions of the Senate and the Committee on Com17 merce of the House of Representatives, and other

18 relevant committees of Congress, on ways to

19 strengthen and improve the coordination of asthma20 related activities of the Federal Government.

21 SEC. 304. COMPILATION OF DATA BY THE CENTERS FOR

22 DISEASE CONTROL AND PREVENTION.

23 (a) IN GENERAL.—The Director of the Centers for

24 Disease Control and Prevention, in consultation with the

25 National Asthma Education Prevention Program Coordi26 nating Committee, shall—
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1 (1) conduct local asthma surveillance activities

2 to collect data on the prevalence and severity of

3 asthma and the quality of asthma management,

4 including—

5 (A) surveys to collect sample household

6 data on the local burden of asthma; and

7 (B) health care facility specific surveillance

8 to collect asthma data on the prevalence and se9 verity of asthma, and on the quality of asthma

10 care; and

11 (2) compile and annually publish data on—

12 (A) the prevalence of children suffering

13 from asthma in each State; and

14 (B) the childhood mortality rate associated

15 with asthma nationally and in each State.

16 (b) AUTHORIZATION OF APPROPRIATIONS.—There

17 are authorized to be appropriated to carry out this section,

18 such sums as may be necessary for each of the fiscal years

19 2001 through 2005.’’.
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1 Subtitle B—Childhood Obesity

2 Prevention

3 SEC. 311. PROGRAMS OPERATED THROUGH THE CENTERS

4 FOR DISEASE CONTROL AND PREVENTION.

5 Title III of the Public Health Service Act (42 U.S.C.

6 241 et seq.), as amended by section 221, is further amend7 ed by adding at the end the following:

8 ‘‘PART Q—PROGRAMS TO IMPROVE THE HEALTH

9 OF CHILDREN

10 ‘‘SEC. 399R. GRANTS TO PROMOTE CHILDHOOD NUTRITION

11 AND PHYSICAL ACTIVITY.

12 ‘‘(a) IN GENERAL.—The Secretary, acting though

13 the Director of the Centers for Disease Control and Pre14 vention, shall award competitive grants to States and po15 litical subdivisions of States for the development and im16 plementation of State and community-based intervention

17 programs to promote good nutrition and physical activity

18 in children and adolescents.

19 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant

20 under this section a State or political subdivision of a

21 State shall prepare and submit to the Secretary an appli22 cation at such time, in such manner, and containing such

23 information as the Secretary may require, including a plan

24 that describes—
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1 ‘‘(1) how the applicant proposes to develop a

2 comprehensive program of school- and community3 based approaches to encourage and promote good

4 nutrition and appropriate levels of physical activity

5 with respect to children or adolescents in local com6 munities;

7 ‘‘(2) the manner in which the applicant shall

8 coordinate with appropriate State and local authori9 ties, such as State and local school departments,

10 State departments of health, chronic disease direc11 tors, State directors of programs under section 17 of

12 the Child Nutrition Act of 1966, 5-a-day coordina13 tors, governors councils for physical activity and

14 good nutrition, and State and local parks and recre15 ation departments;

16 ‘‘(3) the manner in which the applicant will

17 evaluate the effectiveness of the program carried out

18 under this section.

19 ‘‘(c) USE OF FUNDS.—A State or political subdivi20 sion of a State shall use amount received under a grant

21 under this section to—

22 ‘‘(1) develop, implement, disseminate, and

23 evaluate school- and community-based strategies in

24 States to reduce inactivity and improve dietary

25 choices among children and adolescents;
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1 ‘‘(2) expand opportunities for physical activity

2 programs in school- and community-based settings;

3 and

4 ‘‘(3) develop, implement, and evaluate programs

5 that promote good eating habits and physical activ6 ity including opportunities for children with cog7 nitive and physical disabilities.

8 ‘‘(d) TECHNICAL ASSISTANCE.—The Secretary may

9 set-aside an amount not to exceed 10 percent of the

10 amount appropriated for a fiscal year under subsection (h)

11 to permit the Director of the Centers for Disease Control

12 and Prevention to—

13 ‘‘(1) provide States and political subdivisions of

14 States with technical support in the development

15 and implementation of programs under this section;

16 and

17 ‘‘(2) disseminate information about effective

18 strategies and interventions in preventing and treat19 ing obesity through the promotion of good nutrition

20 and physical activity.

21 ‘‘(e) LIMITATION ON ADMINISTRATIVE COSTS.—Not

22 to exceed 1 percent of the amount of a grant awarded to

23 the State or political subdivision under subsection (a) for

24 a fiscal year may be used by the State or political subdivi25 sion for administrative expenses.
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1 ‘‘(f) TERM.—A grant awarded under subsection (a)

2 shall be for a term of 3 years.

3 ‘‘(g) DEFINITION.—In this section, the term ‘children

4 and adolescents’ means individuals who do not exceed 18

5 years of age.

6 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—There

7 are authorized to be appropriated, such sums as may be

8 necessary to carry out this section for each of fiscal years

9 2001 through 2005.

10 ‘‘SEC. 399S. APPLIED RESEARCH PROGRAM.

11 ‘‘The Secretary, acting through the Centers for Dis12 ease Control and Prevention and in consultation with the

13 Director of the National Institutes of Health, shall—

14 ‘‘(1) conduct research to better understand the

15 relationship between physical activity, diet, and

16 health and factors that influence health-related be17 haviors;

18 ‘‘(2) develop and evaluate strategies for the pre19 vention and treatment of obesity to be used in com20 munity-based interventions and by health profes21 sionals;

22 ‘‘(3) develop and evaluate strategies for the pre23 vention and treatment of eating disorders, such as

24 anorexia and bulimia;
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1 ‘‘(4) conduct research to establish the preva2 lence, consequences, and costs of childhood obesity

3 and its effects in adulthood;

4 ‘‘(5) identify behaviors and risk factors that

5 contribute to obesity;

6 ‘‘(6) evaluate materials and programs to pro7 vide nutrition education to parents and teachers of

8 children in child care or pre-school and the food

9 service staff of such child care and pre-school enti10 ties; and

11 ‘‘(7) evaluate materials and programs that are

12 designed to educate and encourage physical activity

13 in child care and pre-school facilities.

14 ‘‘SEC. 399T. EDUCATION CAMPAIGN.

15 ‘‘The Secretary, acting through the Director of the

16 Centers for Disease Control and Prevention, and in col17 laboration with national, State, and local partners, phys18 ical activity organizations, nutrition experts, and health

19 professional organizations, shall develop a national public

20 campaign to promote and educate children and their par21 ents concerning—

22 ‘‘(1) the health risks associated with obesity, in23 activity, and poor nutrition;

24 ‘‘(2) ways in which to incorporate physical ac25 tivity into daily living; and
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1 ‘‘(3) the benefits of good nutrition and strate2 gies to improve eating habits.

3 ‘‘SEC. 399U. HEALTH PROFESSIONAL EDUCATION AND

4 TRAINING.

5 ‘‘The Secretary, acting through the Director of the

6 Centers for Disease Control and Prevention, in collabora7 tion with the Administrator of the Health Resources and

8 Services Administration and the heads of other agencies,

9 and in consultation with appropriate health professional

10 associations, shall develop and carry out a program to edu11 cate and train health professionals in effective strategies

12 to—

13 ‘‘(1) better identify and assess patients with

14 obesity or an eating disorder or patients at-risk of

15 becoming obese or developing an eating disorder;

16 ‘‘(2) counsel, refer, or treat patients with obe17 sity or an eating disorder; and

18 ‘‘(3) educate patients and their families about

19 effective strategies to improve dietary habits and es20 tablish appropriate levels of physical activity.’’.
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1 Subtitle C—Early Detection and

2 Treatment Regarding Childhood

3 Lead Poisoning

4 SEC. 321. CENTERS FOR DISEASE CONTROL AND PREVEN5 TION EFFORTS TO COMBAT CHILDHOOD

6 LEAD POISONING.

7 (a) REQUIREMENTS FOR LEAD POISONING PREVEN8 TION GRANTEES.—Section 317A of the Public Health

9 Service Act (42 U.S.C. 247b–1) is amended—

10 (1) in subsection (d)—

11 (A) by redesignating paragraph (7) as

12 paragraph (8); and

13 (B) by inserting after paragraph (6) the

14 following:

15 ‘‘(7) Assurances satisfactory to the Secretary

16 that the applicant will ensure complete and con17 sistent reporting of all blood lead test results from

18 laboratories and health care providers to State and

19 local health departments in accordance with guide20 lines of the Centers for Disease Control and Preven21 tion for standardized reporting as described in sub22 section (m).’’; and

23 (2) in subsection (j)(2)—

24 (A) in subparagraph (F) by striking ‘‘(E)’’

25 and inserting ‘‘(F)’’;
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1 (B) by redesignating subparagraph (F) as

2 subparagraph (G); and

3 (C) by inserting after subparagraph (E)

4 the following:

5 ‘‘(F) The number of grantees that have es6 tablished systems to ensure mandatory report7 ing of all blood lead tests from laboratories and

8 health care providers to State and local health

9 departments.’’.

10 (b) GUIDELINES FOR STANDARDIZED REPORTING.—

11 Section 317A of the Public Health Service Act (42 U.S.C.

12 247b–1) is amended by adding at the end the following:

13 ‘‘(m) GUIDELINES FOR STANDARDIZED REPORT14 ING.—The Secretary, acting through the Director of the

15 Centers for Disease Control and Prevention, shall develop

16 national guidelines for the uniform and complete reporting

17 of all blood lead test results to State and local health de18 partments.’’.

19 (c) DEVELOPMENT AND IMPLEMENTATION OF EF20 FECTIVE DATA MANAGEMENT BY THE CENTERS FOR DIS21 EASE CONTROL AND PREVENTION.—

22 (1) IN GENERAL.—The Director of the Centers

23 for Disease Control and Prevention shall—

24 (A) assist with the improvement of data

25 linkages between State and local health depart-
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1 ments and between State health departments

2 and the Centers for Disease Control and Pre3 vention;

4 (B) assist States with the development of

5 flexible, comprehensive State-based data man6 agement systems for the surveillance of children

7 with lead poisoning that have the capacity to

8 contribute to a national data set;

9 (C) assist with the improvement of the

10 ability of State-based data management systems

11 and federally-funded means-tested public ben12 efit programs (including the special supple13 mental food program for women, infants and

14 children (WIC) under section 17 of the Child

15 Nutrition Act of 1966 (42 U.S.C. 1786) and

16 the early head start program under section

17 645A of the Head Start Act (42 U.S.C

18 9840a(h)) to respond to ad hoc inquiries and

19 generate progress reports regarding the lead

20 blood level screening of children enrolled in

21 those programs that may be used in training

22 and education programs conducted by the Cen23 ters for health care providers;

24 (D) assist States with the establishment of

25 a capacity for assessing how many children en-
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1 rolled in the medicaid, WIC, early head start,

2 and other federally-funded means-tested public

3 benefit programs are being screened for lead

4 poisoning at age-appropriate intervals;

5 (E) use data obtained as result of activities

6 under this section to formulate or revise exist7 ing lead blood screening and case management

8 policies; and

9 (F) establish performance measures for

10 evaluating State and local implementation of

11 the requirements and improvements described

12 in subparagraphs (A) through (E).

13 (2) AUTHORIZATION OF APPROPRIATIONS.—

14 There is authorized to be appropriated to carry out

15 this subsection, such sums as may be necessary for

16 each of fiscal years 2001 through 2005.

17 (3) EFFECTIVE DATE.—This subsection takes

18 effect on the date of enactment of this Act.

19 SEC. 322. GRANTS FOR LEAD POISONING RELATED ACTIVI20 TIES.

21 (a) IN GENERAL.—Part B of title III of the Public

22 Health Service Act (42 U.S.C. 243 et seq.) is amended—

23 (1) by redesignating sections 317B through

24 317H as sections 317C through 317I, respectively;

25 and
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1 (2) by inserting after section 317A the fol2 lowing:

3 ‘‘SEC. 317B. GRANTS FOR LEAD POISONING RELATED AC4 TIVITIES.

5 ‘‘(a) AUTHORITY TO MAKE GRANTS.—

6 ‘‘(1) IN GENERAL.—The Secretary shall make

7 grants to States to support public health activities in

8 States and localities where data suggests that at

9 least 5 percent of preschool-age children have an ele10 vated blood lead level through—

11 ‘‘(A) effective, ongoing outreach and com12 munity education targeted to families most like13 ly to be at risk for lead poisoning;

14 ‘‘(B) individual family education activities

15 that are designed to reduce ongoing exposures

16 to lead for children with elevated blood lead lev17 els, including through home visits and coordina18 tion with other programs designed to identify

19 and treat children at risk for lead poisoning;

20 and

21 ‘‘(C) the development, coordination and

22 implementation of community-based approaches

23 for comprehensive lead poisoning prevention

24 from surveillance to lead hazard control.
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1 ‘‘(2) STATE MATCH.—A State is not eligible for

2 a grant under this section unless the State agrees to

3 expend (through State or local funds) $1 for every

4 $2 provided under the grant to carry out the activi5 ties described in paragraph (1).

6 ‘‘(3) APPLICATION.—To be eligible to receive a

7 grant under this section, a State shall submit an ap8 plication to the Secretary in such form and manner

9 and containing such information as the Secretary

10 may require.

11 ‘‘(b) PERFORMANCE MEASURES.—The Secretary

12 shall establish needs indicators and performance measures

13 to evaluate the activities carried out under grants awarded

14 under this section. Such indicators shall be commensurate

15 with national measures of maternal and child health pro16 grams and shall be developed in consultation with the Di17 rector of the Centers for Disease Control and Prevention.

18 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There

19 is authorized to be appropriated to carry out this section,

20 such sums as may be necessary for each of fiscal years

21 2001 through 2005.’’.

22 (b) CONFORMING AMENDMENT.—Section 340D of

23 the Public Health Service Act (42 U.S.C. 256d(c)(1)) is

24 amended by striking ‘‘317E’’ and inserting ‘‘317F’’.
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1 SEC. 323. TRAINING AND REPORTS BY THE HEALTH RE2 SOURCES AND SERVICES ADMINISTRATION.

3 (a) TRAINING.—The Secretary of Health and Human

4 Services, acting through the Administrator of the Health

5 Resources and Services Administration and in collabora6 tion with the Administrator of the Health Care Financing

7 Administration and the Director of the Centers for Dis8 ease Control and Prevention, shall conduct education and

9 training programs for physicians and other health care

10 providers regarding childhood lead poisoning, current

11 screening and treatment recommendations and require12 ments, and the scientific, medical, and public health basis

13 for those policies.

14 (b) REPORT.—The Secretary of Health and Human

15 Services, acting through the Administrator of the Health

16 Resources and Services Administration, annually shall re17 port to Congress on the number of children who received

18 services through health centers established under section

19 330 of the Public Health Service Act (42 U.S.C. 254b)

20 and received a blood lead screening test during the prior

21 fiscal year, noting the percentage that such children rep22 resent as compared to all children who received services

23 through such health centers.

24 (c) AUTHORIZATION OF APPROPRIATIONS.—There is

25 authorized to be appropriated to carry out this section,
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1 such sums as may be necessary for each of fiscal years

2 2001 through 2005.

3 Subtitle D—Oral Health

4 SEC. 331. IDENTIFICATION OF INTERVENTIONS THAT RE5 DUCE THE BURDEN AND TRANSMISSION OF

6 ORAL, DENTAL, AND CRANIOFACIAL DIS7 EASES IN HIGH RISK POPULATIONS; DEVEL8 OPMENT OF APPROACHES FOR PEDIATRIC

9 ORAL AND CRANIOFACIAL ASSESSMENT.

10 (a) IN GENERAL.—The Secretary of Health and

11 Human Services, through the Maternal and Child Health

12 Bureau, the Indian Health Service, and in consultation

13 with the National Institutes of Health and the Centers

14 for Disease Control and Prevention, shall—

15 (1) support community-based research that is

16 designed to improve understanding of the etiology,

17 pathogenesis, diagnosis, prevention, and treatment

18 of pediatric oral, dental, craniofacial diseases and

19 conditions and their sequelae in high risk popu20 lations;

21 (2) support demonstrations of preventive inter22 ventions in high risk populations including nutrition,

23 parenting, and feeding techniques; and
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1 (3) develop clinical approaches to assess indi2 vidual patients for the risk of pediatric dental dis3 ease.

4 (b) COMPLIANCE WITH STATE PRACTICE LAWS.—

5 Treatment and other services shall be provided pursuant

6 to this section by licensed dental health professionals in

7 accordance with State practice and licensing laws.

8 (c) AUTHORIZATION OF APPROPRIATIONS.—There is

9 authorized to be appropriated, such sums as may be nec10 essary to carry out this section for each of fiscal years

11 2001 through 2005.

12 SEC. 332. ORAL HEALTH PROFESSIONAL RESEARCH AND

13 TRAINING PROGRAM.

14 Part G of title IV of the Public Health Service Act

15 (42 U.S.C. 288 et seq.) is amended by inserting after sec16 tion 487E the following:

17 ‘‘SEC. 487F. ORAL HEALTH PROFESSIONAL RESEARCH AND

18 TRAINING PROGRAM.

19 ‘‘(a) IN GENERAL.—The Secretary, in consultation

20 with the Director of the National Institute of Dental and

21 Craniofacial Research and professional dental organiza22 tions, shall establish a program under which the Secretary

23 will enter into contracts with qualified oral health profes24 sionals and such professionals will agree to conduct re25 search or provide training with respect to pediatric oral,
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1 dental, and craniofacial diseases and conditions and in ex2 change the Secretary will agree to repay, for each year

3 of service, not more than $35,000 of the principal and in4 terest of the educational loans of such professionals.

5 ‘‘(b) QUALIFIED ORAL HEALTH PROFESSIONAL.—

6 ‘‘(1) DEFINITION.—In this section, the term

7 ‘qualified oral health professional’ includes dentists

8 and allied dental personnel serving in faculty posi9 tions.

10 ‘‘(2) SPECIAL PREFERENCE.—In entering into

11 contacts under subsection (a), the Secretary shall

12 give preference to qualified oral health

13 professionals—

14 ‘‘(A) who are serving, or who have served

15 in research or training programs of the Na16 tional Institute of Dental and Craniofacial Re17 search; or

18 ‘‘(B) who are providing services at institu19 tions that provide oral health care to under20 served pediatric populations in rural areas.

21 ‘‘(c) PRIORITIES.—The Secretary shall annually de22 termine the clinical and basic research and training prior23 ities for contracts under subsection (a), including dental

24 caries, orofacial accidents or traumas, birth defects such
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1 as cleft lip and palate and severe malocclusions, and new

2 techniques and approaches to treatment.

3 ‘‘(d) CONTRACTS, OBLIGATED SERVICE, AND

4 BREACH OF CONTRACT.—The provisions of section 338B

5 concerning contracts, obligated service, and breach of con6 tract, except as inconsistent with this section, shall apply

7 to contracts under this section to the same extent and in

8 the same manner as such provisions apply to contracts

9 under such section 338B.

10 ‘‘(e) AVAILABILITY OF FUNDS.—Amounts available

11 for carrying out this section shall remain available until

12 the expiration of the second fiscal year beginning after the

13 fiscal year for which such amounts were made available.’’.

14 SEC. 333. GRANTS TO INCREASE RESOURCES FOR COMMU15 NITY WATER FLUORIDATION.

16 (a) IN GENERAL.—The Secretary of Health and

17 Human Services, acting through the Director of the Divi18 sion of Oral Health of the Centers for Disease Control

19 and Prevention, may make grants to State or locality for

20 the purpose of increasing the resources available for com21 munity water fluoridation.

22 (b) USE OF FUNDS.—A State shall use amounts pro23 vided under a grant under subsection (a)—

24 (1) to purchase fluoridation equipment;

25 (2) to train fluoridation engineers; or
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1 (3) to develop educational materials on the ad2 vantages of fluoridation.

3 (c) AUTHORIZATION OF APPROPRIATIONS.—There is

4 authorized to be appropriated to carry out this section,

5 $25,000,000 for fiscal year 2001, and such sums as may

6 be necessary for each subsequent fiscal year.

7 SEC. 334. COMMUNITY WATER FLUORIDATION.

8 (a) IN GENERAL.—The Secretary of Health and

9 Human Services (referred to in this section as the ‘‘Sec10 retary’’), acting through the Director of the Indian Health

11 Service and the Director of the Centers for Disease Con12 trol and Prevention, shall establish a demonstration

13 project that is designed to assist rural water systems in

14 successfully implementing the Centers for Disease Control

15 and Prevention water fluoridation guidelines entitled ‘‘En16 gineering and Administrative Recommendations for Water

17 Fluoridation’’ (referred to in this section as the

18 ‘‘EARWF’’).

19 (b) REQUIREMENTS.—

20 (1) COLLABORATION.—The Director of the In21 dian Health Services shall collaborate with the Di22 rector of the Centers for Disease Control and Pre23 vention in developing the project under subsection

24 (a). Through such collaboration the Directors shall

25 ensure that technical assistance and training are
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1 provided to tribal programs located in each of the 12

2 areas of the Indian Health Service. The Director of

3 the Indian Health Service shall provide coordination

4 and administrative support to tribes under this sec5 tion.

6 (2) GENERAL USE OF FUNDS.—Amounts made

7 available under this section shall be used to assist

8 small water systems in improving the effectiveness of

9 water fluoridation and to meet the recommendations

10 of the EARWF.

11 (3) FLUORIDATION SPECIALISTS.—

12 (A) IN GENERAL.—In carrying out this

13 section, the Secretary shall provide for the es14 tablishment of fluoridation specialist engineer15 ing positions in each of the Dental Clinical and

16 Preventive Support Centers through which tech17 nical assistance and training will be provided to

18 tribal water operators, tribal utility operators

19 and other Indian Health Service personnel

20 working directly with fluoridation projects.

21 (B) LIAISON.—A fluoridation specialist

22 shall serve as the principal technical liaison be23 tween the Indian Health Service and the Cen24 ters for Disease Control and Prevention with

25 respect to engineering and fluoridation issues.
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1 (C) CDC.—The Director of the Centers

2 for Disease Control and Prevention shall ap3 point individuals to serve as the fluoridation

4 specialists.

5 (4) IMPLEMENTATION.—The project established

6 under this section shall be planned, implemented

7 and evaluated over the 5-year period beginning on

8 the date on which funds are appropriated under this

9 section and shall be designed to serve as a model for

10 improving the effectiveness of water fluoridation sys11 tems of small rural communities.

12 (c) EVALUATION.—In conducting the ongoing evalua13 tion as provided for in subsection (b)(4), the Secretary

14 shall ensure that such evaluation includes—

15 (1) the measurement of changes in water fluori16 dation compliance levels resulting from assistance

17 provided under this section;

18 (2) the identification of the administrative,

19 technical and operational challenges that are unique

20 to the fluoridation of small water systems;

21 (3) the development of a practical model that

22 may be easily utilized by other tribal, State, county

23 or local governments in improving the quality of

24 water fluoridation with emphasis on small water sys25 tems; and
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1 (4) the measurement of any increased percent2 age of Native Americans or Alaskan Natives who re3 ceive the benefits of optimally fluoridated water.

4 (d) AUTHORIZATION OF APPROPRIATIONS.—There is

5 authorized to be appropriated to carry out this section,

6 $25,000,000 for fiscal year 2001, and such sums as may

7 be necessary for each of fiscal years 2002 through 2005.

8 SEC. 335. DENTAL SEALANT PROGRAM.

9 (a) IN GENERAL.—The Secretary of Health and

10 Human Services, acting through the Director of the Ma11 ternal and Child Health Bureau of the Health Resources

12 and Services Administration, may award grants to States

13 or localities, and the Indian Health Service and tribally

14 managed programs, to provide for the development of

15 school-based dental sealant programs to improve the ac16 cess of children to sealants.

17 (b) USE OF FUNDS.—A State shall use amounts re18 ceived under a grant under subsection (a) to provide funds

19 to eligible school-based entities or to public elementary or

20 secondary schools to enable such entities or schools to pro21 vide children with access to dental care and dental sealant

22 services. Such services shall be provided by licensed dental

23 health professionals in accordance with State practice li24 censing laws.
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1 (c) ELIGIBILITY.—To be eligible to receive funds

2 under this section an entity shall—

3 (1) prepare and submit to the State an applica4 tion at such time, in such manner and containing

5 such information as the State may require; and

6 (2) be a public elementary or secondary

7 school—

8 (A) that is located in an urban area and

9 in which more than 50 percent of the student

10 population is participating in Federal or State

11 free or reduced meal programs; or

12 (B) that is located in a rural area and,

13 with respect to the school district in which the

14 school is located, the district involved has a me15 dian income that is at or below 235 percent of

16 the poverty line, as defined in section 673(2) of

17 the Community Services Block Grant Act (42

18 U.S.C. 9902(2)).

19 (d) COORDINATION WITH OTHER PROGRAMS.—An

20 entity that receives funds from a State under this section

21 shall provide information regarding enrollment in the

22 State plan under title XIX of the Social Security Act (42

23 U.S.C. 1396 et seq.) or in the State Children’s Health

24 Insurance Program under title XXI of such Act (42

25 U.S.C. 1397aa et seq.).
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1 (e) AUTHORIZATION OF APPROPRIATIONS.—There is

2 authorized to be appropriated to carry out this section,

3 $5,000,000 for fiscal year 2001, and such sums as may

4 be necessary for each subsequent fiscal year.

5 SEC. 336. COORDINATED PROGRAM TO IMPROVE PEDI6 ATRIC ORAL HEALTH.

7 Part B of the Public Health Service Act (42 U.S.C.

8 243 et seq.) is amended by adding at the end the fol9 lowing:

10 ‘‘SEC. 320A. COORDINATED PROGRAM TO IMPROVE PEDI11 ATRIC ORAL HEALTH.

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

13 the Administrator of the Health Resources and Services

14 Administration, shall establish a program to fund innova15 tive oral health activities that improve the oral health of

16 children under 6 years of age who are eligible for services

17 provided under a Federal health program, to increase the

18 utilization of dental services by such children, and to de19 crease the incidence of early childhood and baby bottle

20 tooth decay.

21 ‘‘(b) GRANTS.—The Secretary shall award grants to

22 or enter into contracts with public or private nonprofit

23 schools of dentistry or accredited dental training institu24 tions or programs, community dental programs, and pro25 grams operated by the Indian Health Service (including
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1 federally recognized Indian tribes that receive medical

2 services from the Indian Health Service, urban Indian

3 health programs funded under title V of the Indian Health

4 Care Improvement Act, and tribes that contract with the

5 Indian Health Service pursuant to the Indian Self-Deter6 mination and Education Assistance Act) to enable such

7 schools, institutions, and programs to develop programs

8 of oral health promotion, to increase training of oral

9 health services providers in accordance with State practice

10 laws, or to increase the utilization of dental services by

11 eligible children.

12 ‘‘(c) DISTRIBUTION.—In awarding grants under this

13 section, the Secretary shall, to the extent practicable, en14 sure an equitable national geographic distribution of the

15 grants, including areas of the United States where the in16 cidence of early childhood caries is highest.

17 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There

18 is authorized to be appropriated to carry out this section,

19 $10,000,000 for each of fiscal years 2001 through 2005.’’.
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1 TITLE IV—PEDIATRIC

2 RESEARCH

3 Subtitle A—Pediatric Research

4 Initiative

5 SEC. 401. ESTABLISHMENT OF A PEDIATRIC RESEARCH INI6 TIATIVE.

7 Part A of title IV of the Public Health Service Act

8 (42 U.S.C. 281 et seq.) is amended by adding at the end

9 the following:

10 ‘‘SEC. 404F. PEDIATRIC RESEARCH INITIATIVE.

11 ‘‘(a) ESTABLISHMENT.—The Secretary shall estab12 lish within the Office of the Director of NIH a Pediatric

13 Research Initiative (referred to in this section as the ‘Ini14 tiative’). The Initiative shall be headed by the Director

15 of NIH. Amounts appropriated under subsection (d) shall

16 be used under the Initiative to conduct and support re17 search that is directly related to the illnesses and condi18 tions of children.

19 ‘‘(b) FUNDING OF ACTIVITIES.—The Initiative shall

20 provide funds that will enable the Director of NIH to—

21 ‘‘(1) increase support for pediatric biomedical

22 research within the National Institutes of Health to

23 ensure that the expanding opportunities for advance24 ment in scientific investigations and care for chil25 dren are realized;
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1 ‘‘(2) increase collaborative efforts among the

2 Institutes to conduct and support multidisciplinary

3 research in the areas that the Director deems most

4 promising; and

5 ‘‘(3) in coordination with the Food and Drug

6 Administration, increase the development of ade7 quate pediatric clinical trials and pediatric use infor8 mation to promote the safer and more effective use

9 of prescription drugs in the pediatric population.

10 ‘‘(c) DUTIES.—In carrying out subsection (b), the Di11 rector of NIH shall—

12 ‘‘(1) consult with the Institute of Child Health

13 and Human Development and the other Institutes,

14 in considering their requests for new or expanded

15 pediatric research efforts, and consult with other ad16 visors as the Director determines appropriate;

17 ‘‘(2) have broad discretion in the allocation of

18 any Initiative funds among the Institutes, among

19 types of grants, and between basic and clinical re20 search;

21 ‘‘(3) be responsible for the oversight of any

22 newly appropriated Initiative funds; and

23 ‘‘(4) annually report to Congress and the public

24 on the extent of the total extramural support for pe25 diatric research across the NIH, including the spe-
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1 cific support and research awards allocated through

2 the Initiative.

3 ‘‘(d) AUTHORIZATION.—To carry out this section,

4 there is authorized to be appropriated, $50,000,000 for

5 each of the fiscal years 2001 through 2005.

6 ‘‘(e) TRANSFER OF FUNDS.—The Director of NIH

7 may transfer amounts appropriated under this section to

8 any of the Institutes for a fiscal year to carry out the pur9 poses of the Initiative under this section.’’.

10 SEC. 402. INVESTMENT IN TOMORROW’S PEDIATRIC RE11 SEARCHERS.

12 Subpart 7 of part C of title IV of the Public Health

13 Service Act (42 U.S.C. 285g et seq.) is amended by adding

14 at the end the following:

15 ‘‘SEC. 452E. INVESTMENT IN TOMORROW’S PEDIATRIC RE16 SEARCHERS.

17 ‘‘(a) ENHANCED SUPPORT.—

18 ‘‘(1) IN GENERAL.—The Secretary shall make

19 available within the National Institute of Child

20 Health and Human Development enhanced support

21 for extramural activities relating to the training and

22 career development of pediatric researchers.

23 ‘‘(2) PURPOSE.—The purpose of support pro24 vided under paragraph (1) shall be to ensure the fu-
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1 ture supply of researchers dedicated to the care and

2 research needs of children by providing for—

3 ‘‘(A) an increase in the number and size of

4 institutional training grants to medical school

5 pediatric departments and children’s hospitals;

6 and

7 ‘‘(B) an increase in the number of career

8 development awards for pediatricians building

9 careers in pediatric basic and clinical research.

10 ‘‘(3) AUTHORIZATION.—To carry out this sub11 section, there is authorized to be appropriated such

12 sums as may be necessary for each of fiscal year

13 2001 through 2005.

14 ‘‘(b) PEDIATRIC RESEARCH LOAN REPAYMENT PRO15 GRAM.—

16 ‘‘(1) IN GENERAL.—The Secretary, in consulta17 tion with the Director of the National Institute of

18 Child Health and Human Development, may estab19 lish a pediatric research loan repayment program.

20 Through such program—

21 ‘‘(A) the Secretary shall enter into con22 tracts with qualified pediatricians under which

23 such pediatricians will agree to conduct pedi24 atric research in consideration of the Federal

25 government agreeing to repay, for each year of
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1 such service, not more than $35,000 of the

2 principal and interest of the educational loans

3 of such pediatricians; and

4 ‘‘(B) the Secretary shall, for the purpose

5 of providing reimbursements for tax liability re6 sulting from payments made under paragraph

7 (1) on behalf of an individual, make payments,

8 in addition to payments under such paragraph,

9 to the individual in an amount equal to 39 per10 cent of the total amount of loan repayments

11 made for the taxable year involved.

12 ‘‘(2) APPLICATION OF OTHER PROVISIONS.—

13 The provisions of sections 338B, 338C, and 338E

14 shall, except as inconsistent with paragraph (1),

15 apply to the program established under such para16 graph to the same extent and in the same manner

17 as such provisions apply to the National Health

18 Service Corps Loan Repayment Program established

19 under subpart III of part D of title III.

20 ‘‘(3) AVAILABILITY OF FUNDS.—Amounts made

21 available to carry out this subsection shall remain

22 available until the expiration of the second fiscal

23 year beginning after the fiscal year for which such

24 amounts were made available.
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1 ‘‘(4) AUTHORIZATION OF APPROPRIATIONS.—

2 To carry out this subsection, there is authorized to

3 be appropriated such sums as may be necessary for

4 each of the fiscal years 2001 through 2005.’’.

5 Subtitle B—Autism

6 SEC. 411. EXPANSION, INTENSIFICATION, AND COORDINA7 TION OF ACTIVITIES OF NATIONAL INSTI8 TUTES OF HEALTH WITH RESPECT TO RE9 SEARCH ON AUTISM.

10 Part B of title IV of the Public Health Service Act

11 (42 U.S.C. 284 et seq.) is amended by adding at the end

12 the following section:

13 ‘‘SEC. 409C. EXPANSION, INTENSIFICATION, AND COORDI14 NATION OF ACTIVITIES OF NATIONAL INSTI15 TUTES OF HEALTH WITH RESPECT TO RE16 SEARCH ON AUTISM.

17 ‘‘(a) IN GENERAL.—

18 ‘‘(1) EXPANSION OF ACTIVITIES.—The Director

19 of NIH (in this section referred to as the ‘Director’)

20 shall expand, intensify, and coordinate the activities

21 of the National Institutes of Health with respect to

22 research on autism.

23 ‘‘(2) ADMINISTRATION OF PROGRAM; COLLABO24 RATION AMONG AGENCIES.—The Director shall carry

25 out this section acting through the Director of the
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1 National Institute of Mental Health and in collabo2 ration with any other agencies that the Director de3 termines appropriate.

4 ‘‘(b) CENTERS OF EXCELLENCE.—

5 ‘‘(1) IN GENERAL.—The Director shall under

6 subsection (a)(1) make awards of grants and con7 tracts to public or nonprofit private entities to pay

8 all or part of the cost of planning, establishing, im9 proving, and providing basic operating support for

10 centers of excellence regarding research on autism.

11 ‘‘(2) RESEARCH.—Each center under para12 graph (1) shall conduct basic and clinical research

13 into autism. Such research should include investiga14 tions into the cause, diagnosis, early detection, pre15 vention, control, and treatment of autism. The cen16 ters, as a group, shall conduct research including the

17 fields of developmental neurobiology, genetics, and

18 psychopharmacology.

19 ‘‘(3) SERVICES FOR PATIENTS.—

20 ‘‘(A) IN GENERAL.—A center under para21 graph (1) may expend amounts provided under

22 such paragraph to carry out a program to make

23 individuals aware of opportunities to participate

24 as subjects in research conducted by the cen25 ters.
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1 ‘‘(B) REFERRALS AND COSTS.—A program

2 under subparagraph (A) may, in accordance

3 with such criteria as the Director may establish,

4 provide to the subjects described in such sub5 paragraph, referrals for health and other serv6 ices, and such patient care costs as are required

7 for research.

8 ‘‘(C) AVAILABILITY AND ACCESS.—The ex9 tent to which a center can demonstrate avail10 ability and access to clinical services shall be

11 considered by the Director in decisions about

12 awarding grants to applicants which meet the

13 scientific criteria for funding under this section.

14 ‘‘(4) COORDINATION OF CENTERS; REPORTS.—

15 The Director shall, as appropriate, provide for the

16 coordination of information among centers under

17 paragraph (1) and ensure regular communication

18 between such centers, and may require the periodic

19 preparation of reports on the activities of the centers

20 and the submission of the reports to the Director.

21 ‘‘(5) ORGANIZATION OF CENTERS.—Each cen22 ter under paragraph (1) shall use the facilities of a

23 single institution, or be formed from a consortium of

24 cooperating institutions, meeting such requirements

25 as may be prescribed by the Director.
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1 ‘‘(6) NUMBER OF CENTERS; DURATION OF SUP2 PORT.—

3 ‘‘(A) IN GENERAL.—The Director shall

4 provide for the establishment of not less than 5

5 centers under paragraph (1).

6 ‘‘(B) DURATION.—Support for a center es7 tablished under paragraph (1) may be provided

8 under this section for a period of not to exceed

9 5 years. Such period may be extended for 1 or

10 more additional periods not exceeding 5 years if

11 the operations of such center have been re12 viewed by an appropriate technical and sci13 entific peer review group established by the Di14 rector and if such group has recommended to

15 the Director that such period should be ex16 tended.

17 ‘‘(c) FACILITATION OF RESEARCH.—The Director

18 shall under subsection (a)(1) provide for a program under

19 which samples of tissues and genetic materials that are

20 of use in research on autism are donated, collected, pre21 served, and made available for such research. The pro22 gram shall be carried out in accordance with accepted sci23 entific and medical standards for the donation, collection,

24 and preservation of such samples.
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1 ‘‘(d) PUBLIC INPUT.—The Director shall under sub2 section (a)(1) provide for means through which the public

3 can obtain information on the existing and planned pro4 grams and activities of the National Institutes of Health

5 with respect to autism and through which the Director can

6 receive comments from the public regarding such pro7 grams and activities.

8 ‘‘(e) FUNDING.—There are authorized to be appro9 priated such sums as may be necessary to carry out this

10 section. Amounts appropriated under this subsection are

11 in addition to any other amounts appropriated for such

12 purpose.’’.

13 SEC. 412. DEVELOPMENTAL DISABILITIES SURVEILLANCE

14 AND RESEARCH PROGRAMS.

15 (a) NATIONAL AUTISM AND PERVASIVE DEVELOP16 MENTAL DISABILITIES SURVEILLANCE PROGRAM.—

17 (1) IN GENERAL.—The Secretary of Health and

18 Human Services (in this section referred to as the

19 ‘‘Secretary’’), acting through the Director of the

20 Centers for Disease Control and Prevention, may

21 make awards of grants and cooperative agreements

22 for the collection, analysis, and reporting of data on

23 autism and pervasive developmental disabilities. In

24 making such awards, the Secretary may provide di25 rect technical assistance in lieu of cash.
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1 (2) ELIGIBILITY.—To be eligible to receive an

2 award under paragraph (1) an entity shall be a pub3 lic or nonprofit private entity (including health de4 partments of States and political subdivisions of

5 States, and including universities and other edu6 cational entities).

7 (b) CENTERS OF EXCELLENCE IN AUTISM AND PER8 VASIVE DEVELOPMENTAL DISABILITIES EPIDEMI9 OLOGY.—

10 (1) IN GENERAL.—The Secretary, acting

11 through the Director of the Centers for Disease

12 Control and Prevention, shall establish not less than

13 3 regional centers of excellence in autism and perva14 sive developmental disabilities epidemiology for the

15 purpose of collecting and analyzing information on

16 the number, incidence, correlates, and causes of au17 tism and related developmental disabilities.

18 (2) RECIPIENTS OF AWARDS FOR ESTABLISH19 MENT OF CENTERS.—Centers under paragraph (1)

20 shall be established and operated through the award21 ing of grants or cooperative agreements to public or

22 nonprofit private entities that conduct research, in23 cluding health departments of States and political

24 subdivisions of States, and including universities and

25 other educational entities.
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1 (3) CERTAIN REQUIREMENTS.—An award for a

2 center under paragraph (1) may be made only if the

3 entity involved submits to the Secretary an applica4 tion containing such agreements and information as

5 the Secretary may require, including an agreement

6 that the center involved will operate in accordance

7 with the following:

8 (A) The center will collect, analyze, and re9 port autism and pervasive developmental dis10 abilities data according to guidelines prescribed

11 by the Director, after consultation with relevant

12 State and local public health officials, private

13 sector developmental disability researchers, and

14 advocates for those with developmental disabil15 ities.

16 (B) The center will assist with the develop17 ment and coordination of State autism and per18 vasive developmental disabilities surveillance ef19 forts within a region.

20 (C) The center will identify eligible cases

21 and controls through its surveillance systems

22 and conduct research into factors which may

23 cause autism and related developmental disabil24 ities.
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1 (D) The center will develop or extend an

2 area of special research expertise (including ge3 netics, environmental exposure to contaminants,

4 immunology, and other relevant research spe5 cialty areas).

6 (c) CLEARINGHOUSE.—The Secretary, acting

7 through the Director of the Centers for Disease Control

8 and Prevention, shall carry out the following:

9 (1) The Secretary shall establish a clearing10 house within the Centers for Disease Control and

11 Prevention for the collection and storage of data

12 generated from the monitoring programs established

13 by this title. Through the clearinghouse, such Cen14 ters shall serve as the coordinating agency for au15 tism and pervasive developmental disabilities surveil16 lance activities. The functions of such a clearing17 house shall include facilitating the coordination of

18 research and policy development relating to the epi19 demiology of autism and other pervasive develop20 mental disabilities.

21 (2) The Secretary shall coordinate the Federal

22 response to requests for assistance from State health

23 department officials regarding potential or alleged

24 autism or developmental disability clusters.
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1 (d) DEFINITION.—In this subtitle, the term ‘‘State’’

2 means each of the several States, the District of Columbia,

3 the Commonwealth of Puerto Rico, American Samoa,

4 Guam, the Commonwealth of the Northern Mariana Is5 lands, the Virgin Islands, and the Trust Territory of the

6 Pacific Islands.

7 (e) AUTHORIZATION OF APPROPRIATIONS.—There

8 are authorized to be appropriated such sums as may be

9 necessary to carry out this section.

10 SEC. 413. INFORMATION AND EDUCATION.

11 (a) IN GENERAL.—The Secretary shall establish and

12 implement a program to provide information and edu13 cation on autism to health professionals and the general

14 public, including information and education on advances

15 in the diagnosis and treatment of autism and training and

16 continuing education through programs for scientists, phy17 sicians, and other health professionals who provide care

18 for patients with autism.

19 (b) STIPENDS.—The Secretary may use amounts

20 made available under this section to provide stipends for

21 health professionals who are enrolled in training programs

22 under this section.

23 (c) AUTHORIZATION OF APPROPRIATIONS.—There

24 are authorized to be appropriated such sums as may be

25 necessary to carry out this section.
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1 SEC. 414. INTER-AGENCY AUTISM COORDINATING COM2 MITTEE.

3 (a) ESTABLISHMENT.—The Secretary shall establish

4 a committee to be known as the ‘‘Autism Coordinating

5 Committee’’ (in this section referred to as the ‘‘Com6 mittee’’) to coordinate all efforts within the Department

7 of Health and Human Services concerning autism, includ8 ing activities carried out through the National Institutes

9 of Health and the Centers for Disease Control and Pre10 vention under this title (and the amendment made by this

11 title).

12 (b) MEMBERSHIP.—

13 (1) IN GENERAL.—The Committee shall be

14 composed of the Directors of such national research

15 institutes, of the Centers for Disease Control and

16 Prevention, and of such other agencies and such

17 other officials as the Secretary determines appro18 priate.

19 (2) ADDITIONAL MEMBERS.—If determined ap20 propriate by the Secretary, the Secretary may ap21 point to the Committee—

22 (A) parents or legal guardians of individ23 uals with autism or other pervasive develop24 mental disorders; and
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1 (B) representatives of other governmental

2 agencies that serve children with autism such

3 as the Department of Education.

4 (c) ADMINISTRATIVE SUPPORT; TERMS OF SERVICE;

5 OTHER PROVISIONS.—The following shall apply with re6 spect to the Committee:

7 (1) The Committee shall receive necessary and

8 appropriate administrative support from the Depart9 ment of Health and Human Services.

10 (2) Members of the Committee appointed under

11 subsection (b)(2)(A) shall serve for a term of 3

12 years, and may serve for an unlimited number of

13 terms if reappointed.

14 (3) The Committee shall meet not less than 2

15 times each year.

16 SEC. 415. REPORT TO CONGRESS.

17 Not later than January 1, 2001, and each January

18 1 thereafter, the Secretary shall prepare and submit to

19 the appropriate committees of Congress, a report con20 cerning the implementation of this subtitle and the amend21 ments made by this subtitle.
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1 Subtitle C—Long-Term Child

2 Development

3 SEC. 421. LONG-TERM CHILD DEVELOPMENT STUDY.

4 (a) PURPOSE.—It is the purpose of this section to

5 authorize the National Institute of Child Health and

6 Human Development to conduct a national longitudinal

7 study of environmental influences on children’s health.

8 (b) IN GENERAL.—The Director of the National In9 stitute of Child Health and Human Development shall es10 tablish a consortium of representatives from appropriate

11 Federal agencies (including the Centers for Disease Con12 trol and Prevention, the Environmental Protection Agen13 cy) to—

14 (1) plan, develop, and implement a prospective

15 cohort study to evaluate the effects of both chronic

16 and intermittent exposures on human development;

17 and

18 (2) investigate basic mechanisms of develop19 mental disorders and environmental factors, both

20 risk and protective, that influence growth and devel21 opmental processes.

22 (c) REQUIREMENT.—The study under subsection (b)

23 shall—

24 (1) incorporate behavioral, emotional, edu25 cational, and contextual consequences to enable a
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1 complete assessment of the physical, chemical, bio2 logical and psychosocial environmental influences on

3 children’s well-being;

4 (2) gather data on environmental influences

5 and outcomes on diverse populations of children,

6 which may include the consideration of prenatal ex7 posures;

8 (3) consider health disparities among children

9 which may include the consideration of prenatal ex10 posures.

11 (d) REPORT.—Not later than 3 years after the date

12 of enactment of this Act, the Director of the National In13 stitute of Child Health and Human Development shall

14 prepare and submit to the appropriate committees of Con15 gress a report on the findings and conclusions made under

16 the study conducted under this section.

17 (e) AUTHORIZATION OF APPROPRIATIONS.—There is

18 authorized to be appropriated to carry out this section,

19 $18,000,000 for fiscal year 2001, and such sums as may

20 be necessary for each of fiscal years 2002 through 2005.
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1 Subtitle D—Research on Rare

2 Diseases in Children

3 SEC. 431. REPORT REGARDING RESEARCH ON RARE DIS4 EASES IN CHILDREN.

5 Not later than 180 days after the date of the enact6 ment of this Act, the Director of the National Institutes

7 of Health shall submit to the Congress a report on—

8 (1) the activities that, during fiscal year 2000,

9 were conducted and supported by such Institutes

10 with respect to rare diseases in children; and

11 (2) the activities that are planned to be con12 ducted and supported by such Institutes with respect

13 to such diseases during the fiscal years 2001

14 through 2005.

15 Subtitle E—GME Programs in

16 Children’s Hospitals

17 SEC. 441. EXTENSION OF AUTHORIZATION OF APPROPRIA18 TIONS.

19 (a) PAYMENTS.—Section 340E(a) of the Public

20 Health Service Act (42 U.S.C. 256e(a)) is amended by

21 striking ‘‘and 2001’’ and inserting ‘‘through 2005’’.

22 (b) AUTHORIZATION OF APPROPRIATIONS.—Section

23 340E(f) of the Public Health Service Act (42 U.S.C.

24 256e(f)) is amended—

25 (1) in paragraph (1)(A)—
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1 (A) in clause (i), by striking ‘‘and’’ at the

2 end;

3 (B) in clause (ii), by striking the period

4 and inserting ‘‘; and’’; and

5 (C) by adding at the end the following:

6 ‘‘(iii) for each of the fiscal years 2002

7 through 2005, such sums as may be nec8 essary.’’; and

9 (2) in paragraph (2)—

10 (A) in subparagraph (A), by striking

11 ‘‘and’’ at the end;

12 (B) in subparagraph (B), by striking the

13 period and inserting ‘‘; and’’; and

14 (C) by adding at the end the following:

15 ‘‘(C) for each of the fiscal years 2002

16 through 2005, such sums as may be nec17 essary.’’.

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