II

103D CONGRESS

2D SESSION S. 1821

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

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

IN THE SENATE OF THE UNITED STATES

FEBRUARY 2 (legislative day, JANUARY 25), 1994

Mr. DASCHLE (for himself, Mr. BINGAMAN, Mr. CAMPBELL, Ms. MOSELEYBRAUN, Mr. MURKOWSKI, Mr. WOFFORD, Mr. INOUYE, Mrs. MURRAY,

Mr. DECONCINI, Mr. STEVENS, Mr. ROCKEFELLER, Mr. REID, Mr.

THURMOND, and Mr. HATCH) introduced the following bill; which was

read twice and referred to the Committee on Labor and Human Resources

A BILL

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

Syndrome, and for other purposes.

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

3 SECTION 1. SHORT TITLE.

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

5 Alcohol Syndrome Prevention Act’’.

6 SEC. 2. FINDINGS.

7 Congress finds that—
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1 (1) Fetal Alcohol Syndrome is the leading

2 known cause of mental retardation, and it is 100

3 percent preventable;

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

5 in the United States with Fetal Alcohol Syndrome,

6 suffering irreversible physical and mental damage;

7 (3) 50,000 more infants are born each year

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

9 defects, known as Fetal Alcohol Effects;

10 (4) Fetal Alcohol Syndrome is a national prob11 lem, it can impact any child, family, or community,

12 but its threat to American Indians and Alaska Na13 tives is especially alarming;

14 (5) in some American Indian communities,

15 where alcohol dependency rates reach 50 percent

16 and above, the chances of a newborn suffering Fetal

17 Alcohol Syndrome or Fetal Alcohol Effects are 30

18 times greater than national averages;

19 (6) researchers have determined that the possi20 bility of giving birth to a baby with Fetal Alcohol

21 Syndrome or Fetal Alcohol Effects increases in pro22 portion to the amount and frequency of alcohol

23 consumed by a pregnant woman, and that stopping

24 alcohol consumption at any point in the pregnancy
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1 reduces the risks and the emotional, physical, and

2 mental consequences of alcohol exposure to the baby;

3 (7) in addition to the immeasurable toll on

4 Fetal Alcohol Syndrome and Fetal Alcohol Effects

5 children and their families, Fetal Alcohol Syndrome

6 and Fetal Alcohol Effects pose extraordinary finan7 cial costs to the Nation, including the costs of health

8 care, education, foster care, job training, and gen9 eral support services for affected individuals;

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

11 costs are four times greater for infants who were ex12 posed to illicit substances than for infants with no

13 indication of substance exposure, and over a lifetime,

14 health care costs for one Fetal Alcohol Syndrome

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

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

17 pregnancy, or of any safe time to drink during preg18 nancy, thus, it is in the best interest of the Nation

19 for the Federal Government to take an active role in

20 encouraging all women to abstain from alcohol con21 sumption during pregnancy.

22 SEC. 3. PURPOSE.

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

24 Department of Health and Human Services, a comprehen-
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1 sive program to help prevent Fetal Alcohol Syndrome and

2 Fetal Alcohol Effects nationwide. Such program shall—

3 (1) coordinate and support epidemiologic re4 search concerning Fetal Alcohol Syndrome and Fetal

5 Alcohol Effects;

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

7 community-based public awareness, prevention, and

8 education programs on Fetal Alcohol Syndrome and

9 Fetal Alcohol Effects; and

10 (3) foster coordination among all Federal agen11 cies that conduct or support Fetal Alcohol Syndrome

12 and Fetal Alcohol Effects research, programs, and

13 surveillance and otherwise meet the general needs of

14 populations actually or potentially impacted by Fetal

15 Alcohol Syndrome and Fetal Alcohol Effects.

16 SEC. 4. ESTABLISHMENT OF PROGRAM.

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

18 (42 U.S.C. 290bb et seq.) is amended by adding at the

19 end thereof the following new subpart:

20 ‘‘Subpart 4—Provisions Relating to Fetal Alcohol

21 Syndrome and Fetal Alcohol Effects

22 ‘‘SEC. 520E. ESTABLISHMENT OF FETAL ALCOHOL SYN23 DROME PREVENTION PROGRAM.

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

25 the Substance Abuse and Mental Health Services Admin-
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1 istration, the National Institutes of Health, the Centers

2 for Disease Control and Prevention, the Indian Health

3 Service, and other relevant offices, shall establish a com4 prehensive program to help prevent Fetal Alcohol Syn5 drome and Fetal Alcohol Effects and coordinate Federal

6 efforts to prevent Fetal Alcohol Syndrome and Fetal Alco7 hol Effects.

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

9 established under subsection (a), the Secretary shall estab10 lish a program that shall—

11 ‘‘(1) coordinate and support national and tar12 geted public awareness, prevention, and education

13 programs on Fetal Alcohol Syndrome and Fetal Al14 cohol Effects;

15 ‘‘(2) coordinate and support applied epidemio16 logic research concerning Fetal Alcohol Syndrome

17 and Fetal Alcohol Effects;

18 ‘‘(3) conduct and support basic research tar19 geted to developing data to improve prevention and

20 treatment of Fetal Alcohol Syndrome and Fetal Al21 cohol Effects;

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

23 criteria to health care and social services providers

24 and carry out that plan; and
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1 ‘‘(5) establish an Inter-Agency Task Force on

2 Fetal Alcohol Syndrome and Fetal Alcohol Effects,

3 which shall be chaired by the Associate Adminis4 trator for Alcohol Prevention and Treatment of the

5 Substance Abuse and Mental Health Services Ad6 ministration, and which shall include representatives

7 from all relevant agencies and offices within the De8 partment of Health and Human Services (including

9 the Indian Health Service) Department of Agri10 culture, Department of Education, Department of

11 Defense, Department of the Interior (including the

12 Bureau of Indian Affairs), Department of Justice,

13 Bureau of Alcohol, Tobacco, and Firearms, Federal

14 Trade Commission, and any other relevant Federal

15 Agency.

16 ‘‘SEC. 520F. EDUCATION AND PUBLIC AWARENESS.

17 ‘‘The Secretary shall direct the appropriate agencies

18 within the Department of Health and Human Services

19 to—

20 ‘‘(1) support, conduct and evaluate the effec21 tiveness of—

22 ‘‘(A) training programs for health care

23 providers, educators, school-based health care

24 providers, social workers, child welfare workers

25 and family members concerning the prevention,
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1 diagnosis, and treatment of Fetal Alcohol Syn2 drome and Fetal Alcohol Effects;

3 ‘‘(B) prevention and education programs,

4 including health education, and school-based

5 clinic programs, for school-age children with re6 spect to Fetal Alcohol Syndrome and Fetal Al7 cohol Effects; and

8 ‘‘(C) public and community awareness pro9 grams concerning Fetal Alcohol Syndrome and

10 Fetal Alcohol Effects;

11 ‘‘(2) provide technical and consultative assist12 ance to States, Indian tribal governments, local gov13 ernments, school-based health care providers, sci14 entific and academic institutions, and non-profit or15 ganizations concerning the programs referred to in

16 paragraph (1); and

17 ‘‘(3) award grants to and enter into cooperative

18 agreements and contracts with States, Indian tribal

19 governments, local governments, scientific and aca20 demic institutions, entities that fund school-based

21 clinics, and non-profit organizations for the purpose

22 of—

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

24 effectiveness, with particular emphasis on the

25 cultural sensitivity and age-appropriateness, of
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1 the prevention, education and community-based

2 public awareness programs referred to in para3 graph (1);

4 ‘‘(B) enabling such entities to provide

5 training to health care providers, school nurses

6 and other school health care providers, includ7 ing school-based clinic health care providers,

8 educators, family members, social workers, child

9 welfare workers, and others in the prevention,

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

12 ‘‘(C) educating children and youth, includ13 ing pregnant and high-risk youth, concerning

14 such syndrome and effects with priority given to

15 those programs that are part of a sequential,

16 comprehensive school health education program;

17 and

18 ‘‘(D) increasing public and community

19 awareness concerning Fetal Alcohol Syndrome

20 and Fetal Alcohol Effects through culturally

21 sensitive projects, programs, and campaigns,

22 and improving the understanding of the general

23 public and targeted groups concerning the most

24 effective methods for intervening with friends

25 and family to prevent fetal exposure to alcohol.
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1 ‘‘SEC. 520G. APPLIED EPIDEMIOLOGIC RESEARCH AND PRE2 VENTION PROGRAM.

3 ‘‘The Secretary shall direct the appropriate agencies

4 within the Department of Health and Human Services

5 to—

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

7 causes, mechanisms, diagnostic methods, and treat8 ment and prevention of Fetal Alcohol Syndrome and

9 Fetal Alcohol Effects;

10 ‘‘(2) provide technical and consultative assist11 ance and training to States, Indian tribal govern12 ments, local governments, other public entities, sci13 entific and academic institutions, and non-profit or14 ganizations engaged in the conduct of—

15 ‘‘(A) Fetal Alcohol Syndrome prevention

16 and early intervention programs; and

17 ‘‘(B) research relating to the causes, mech18 anisms, diagnosis methods, treatment and pre19 vention, of Fetal Alcohol Syndrome and Fetal

20 Alcohol Effects; and

21 ‘‘(3) award grants to, and enter into coopera22 tive agreements and contracts with States, Indian

23 tribal governments, local governments, other public

24 entities, scientific and academic institutions, and

25 non-profit organizations to—
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1 ‘‘(A) assist such entities in conducting in2 novative demonstration and evaluation projects

3 designed to determine effective strategies, in4 cluding community-based prevention programs

5 and multi-cultural education campaigns, for

6 preventing and intervening in fetal exposure to

7 alcohol;

8 ‘‘(B) improve and coordinate the surveil9 lance and ongoing assessment methods imple10 mented by such entities and the Federal Gov11 ernment, with respect to Fetal Alcohol Syn12 drome and Fetal Alcohol Effects for the pur13 pose of—

14 ‘‘(i) tracking progress toward achiev15 ing relevant Year 2000 Prevention Objec16 tives, set forth by the Public Health Serv17 ice in the Healthy People 2000: National

18 Health Promotion and Disease Prevention

19 Objectives;

20 ‘‘(ii) identifying successful, culturally

21 sensitive prevention efforts; and

22 ‘‘(iii) identifying children who have

23 symptoms of Fetal Alcohol Syndrome and

24 Fetal Alcohol Effects and may need special

25 health, education, and support services;
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1 ‘‘(C) develop and evaluate effective age-ap2 propriate and culturally-sensitive prevention

3 programs for infants, children, adolescents, and

4 adults identified as being at-risk of becoming

5 chemically dependent on alcohol and associated

6 with or developing Fetal Alcohol Syndrome and

7 Fetal Alcohol Effects; and

8 ‘‘(D) facilitate coordination and collabora9 tion among Federal, State, Tribal, and local

10 Fetal Alcohol Syndrome prevention programs.

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

12 ‘‘The Secretary shall direct the appropriate agencies

13 within the Department of Health and Human Services to

14 conduct and support research on services research and ef15 fective prevention treatments and interventions for preg16 nant alcohol dependent women and individuals with Fetal

17 Alcohol Syndrome and Fetal Alcohol Effects.

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

19 SYNDROME AND FETAL ALCOHOL EFFECTS.

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

21 of this subpart, the Secretary shall direct the appropriate

22 agencies within the Department of Health and Human

23 Services to—

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

25 Fetal Alcohol Syndrome/Fetal Alcohol Effects diag-
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1 nostic criteria developed by the Department of

2 Health and Human Services under the ADAMHA

3 Reorganization Act (Public Law 102-321) to health

4 care providers, educators, social workers, child wel5 fare workers, and other individuals within 16

6 months of such date of enactment; and

7 ‘‘(2) disseminate the criteria described in para8 graph (1) in accordance with the plan developed

9 under paragraph (1).

10 ‘‘SEC. 520J. INTER-AGENCY TASK FORCE ON FETAL ALCO11 HOL SYNDROME AND FETAL ALCOHOL EF12 FECTS.

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

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

15 establish an Inter-Agency Task Force on Fetal Alcohol

16 Syndrome and Fetal Alcohol Effects to foster coordination

17 among all Federal agencies that conduct or support Fetal

18 Alcohol Syndrome and Fetal Alcohol Effects research, pro19 grams, and surveillance and otherwise meet the general

20 needs of populations actually or potentially impacted by

21 Fetal Alcohol Syndrome and Fetal Alcohol Effects.

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

23 under subsection (a) shall—

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

25 for Alcohol Prevention and Treatment of the Sub-
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1 stance Abuse and Mental Health Services Adminis2 tration and staffed by the Administration; and

3 ‘‘(2) include representatives from all relevant

4 agencies and offices within the Department of

5 Health and Human Services, Department of Agri6 culture, Department of Education, Department of

7 Defense, Department of Interior, Department of

8 Justice, Bureau of Alcohol, Tobacco and Firearms,

9 Federal Trade Commission, and any other relevant

10 Federal agency.

11 ‘‘(c) FUNCTIONS.—The Task Force established under

12 subsection (a) shall—

13 ‘‘(1) coordinate all Federal programs and re14 search concerning Fetal Alcohol Syndrome, Fetal Al15 cohol Effects, and other forms of maternal substance

16 abuse, including those programs—

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

18 populations identified as being at risk of acquir19 ing Fetal Alcohol Syndrome, Fetal Alcohol Ef20 fects, or other maternal substance abuse; and

21 ‘‘(B) providing health, education, treat22 ment, and social services to infants, children,

23 and adults with Fetal Alcohol Syndrome, Fetal

24 Alcohol Effects, and other drug exposures and

25 their families; and
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1 ‘‘(2) coordinate its efforts with existing Depart2 ment of Health and Human Services task forces on

3 substance abuse prevention and maternal and child

4 health;

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

6 and relevant Committees of Congress on the current

7 and planned activities of the participating agencies.

8 ‘‘SEC. 520K. ADMINISTRATIVE PROVISIONS WITH RESPECT

9 TO GRANTS, COOPERATIVE AGREEMENTS

10 AND CONTRACTS.

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

12 cooperative agreement or contract under this subpart, an

13 entity shall—

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

15 government, entity that funds a school-based health

16 clinic, scientific or academic institution or non-profit

17 organization;

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

19 application at such time, in such manner, and con20 taining such information as the Secretary may pre21 scribe, including a description of the activities that

22 the entity intends to carry out using amounts re23 ceived under a grant, cooperative agreement, or con24 tract; and
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1 ‘‘(3) provide assurances that amounts received

2 under such grants, cooperative agreements or con3 tracts will be used in accordance with this subpart.

4 ‘‘(b) MAINTENANCE OF EFFORT.—No grant, cooper5 ative agreement, or contract may be awarded to an entity

6 under this subpart unless the entity agrees to maintain

7 the expenditures of the entity for activities of the type for

8 which the amounts to be received under a grant, coopera9 tive agreement, or contract are to be used, at a level equal

10 to not less than the level of such expenditures maintained

11 by the entity for the fiscal year preceding the fiscal year

12 for which the entity is applying to receive the grant, coop13 erative agreement or contract.

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

15 of a recipient of a grant, cooperative agreement, or con16 tract under this subpart, the Secretary may reduce the

17 amount provided under such grant, agreement, or contract

18 by—

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

20 of any supplies or equipment furnished the recipient;

21 and

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

23 allowances, and travel expenses of any officer or em24 ployee of the Federal Government which was de25 tailed to the recipient and the amount of any other
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1 cost incurred in connection with the detail of such

2 officer or employee.

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

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

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

6 fiscal years 1994 through 1997.’’.

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