IB 

Union Calendar No. 365 

113TH CONGRESS 

2D SESSION H. R. 4631 

[Report No. 113–490] 

To reauthorize certain provisions of the Public Health Service Act relating 

to autism, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 9, 2014 

Mr. SMITH of New Jersey (for himself, Mr. DOYLE, Mrs. MCMORRIS RODGERS, Mr. VAN HOLLEN, Mr. SESSIONS, Mr. WOLF, Mr. STIVERS, Mr. 

MEEHAN, Mr. MORAN, Mrs. BLACKBURN, Mr. MILLER of Florida, Mrs. 

WALORSKI, Mr. LARSON of Connecticut, Ms. JACKSON LEE, Mr. HARPER, Mr. LANCE, Mr. MEADOWS, Mr. MARINO, Mr. DEUTCH, Mr. ROONEY, Mr. POMPEO, Mr. ADERHOLT, Mr. BACHUS, Mr. GIBSON, Mrs. 

MILLER of Michigan, Mr. YOUNG of Alaska, Mr. KING of New York, Ms. 

SHEA-PORTER, Ms. DELAURO, Mr. MURPHY of Pennsylvania, Mr. 

FITZPATRICK, Mr. TERRY, Mr. KELLY of Pennsylvania, Mr. YODER, and 

Mr. MATHESON) introduced the following bill; which was referred to the 

Committee on Energy and Commerce 

JUNE 23, 2014 

Additional sponsors: Mr. ROE of Tennessee, Ms. JENKINS, Mr. MCGOVERN, 

Mr. ISRAEL, Ms. SLAUGHTER, Mr. VARGAS, Mr. DAVID SCOTT of Georgia, Mr. GRIMM, Mr. FORTENBERRY, Mr. BISHOP of Georgia, Ms. NORTON, Ms. ROYBAL-ALLARD, Mr. ELLISON, Mr. CARSON of Indiana, Mr. 

SCHOCK, Mr. DAINES, Mr. QUIGLEY, Mrs. CAPITO, Mr. HUFFMAN, Mr. 

FATTAH, Mr. MCINTYRE, Mr. LIPINSKI, Mr. PETERSON, Mr. BILIRAKIS, 

Mr. SHIMKUS, Mr. ROSKAM, Mr. BURGESS, Mr. GERLACH, Ms. 

SCHWARTZ, Mr. HOLDING, Mrs. CAROLYN B. MALONEY of New York, 

Mr. BRALEY of Iowa, Mr. SCHIFF, Ms. KAPTUR, Mr. GRIFFIN of Arkansas, Mr. HECK of Nevada, Mr. MCKEON, Mrs. MCCARTHY of New York, 

Mr. CARNEY, Mr. WELCH, Ms. ESTY, Ms. ESHOO, Mr. KENNEDY, Mr. 

SENSENBRENNER, Mr. JOYCE, Mr. KLINE, Mr. WALZ, Mrs. BUSTOS, Mr. 

HOLT, Mr. BARLETTA, Ms. BASS, and Ms. DUCKWORTH


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JUNE 23, 2014 

Reported with an amendment, committed to the Committee of the Whole 

House on the State of the Union, and ordered to be printed 

[Strike out all after the enacting clause and insert the part printed in italic] 

[For text of introduced bill, see copy of bill as introduced on May 9, 2014] 

A BILL 

To reauthorize certain provisions of the Public Health 

Service Act relating to autism, and for other purposes. 


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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 ‘‘Autism Collaboration, 

5 Accountability, Research, Education, and Support Act of 

6 2014’’ or the ‘‘Autism CARES Act of 2014’’. 

7 SEC. 2. NATIONAL AUTISM SPECTRUM DISORDER INITIA8 TIVE. 

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

10 Human Services shall designate an existing official within 

11 the Department of Health and Human Services to oversee, 

12 in consultation with the Secretaries of Defense and Edu13 cation, national autism spectrum disorder research, serv14 ices, and support activities. 

15 (b) DUTIES.—The official designated under subsection 

16 (a) shall— 

17 (1) implement autism spectrum disorder activi18 ties, taking into account the strategic plan developed 

19 by the Interagency Autism Coordinating Committee 

20 under section 399CC(b) of the Public Health Service 

21 Act (42 U.S.C. 280i–2(b)); and 

22 (2) ensure that autism spectrum disorder activi23 ties of the Department of Health and Human Services 

24 and of other Federal departments and agencies are 

25 not unnecessarily duplicative. 


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1 SEC. 3. RESEARCH PROGRAM. 

2 Section 399AA of the Public Health Service Act (42 

3 U.S.C. 280i) is amended— 

4 (1) in subsection (a)(1), by inserting ‘‘for chil5 dren and adults’’ after ‘‘reporting of State epidemio6 logical data’’; 

7 (2) in subsection (b)(1)— 

8 (A) by striking ‘‘establishment of regional 

9 centers of excellence’’ and inserting ‘‘establish10 ment or support of regional centers of excel11 lence’’; and 

12 (B) by inserting ‘‘for children and adults’’ 

13 before the period at the end; 

14 (3) in subsection (b)(2), by striking ‘‘center to be 

15 established’’ and inserting ‘‘center to be established or 

16 supported’’; and 

17 (4) in subsection (e), by striking ‘‘2014’’ and in18 serting ‘‘2019’’. 

19 SEC. 4. AUTISM INTERVENTION. 

20 Section 399BB of the Public Health Service Act (42 

21 U.S.C. 280i–1) is amended— 

22 (1) in subsection (b)(1), by inserting ‘‘culturally 

23 competent’’ after ‘‘provide’’; 

24 (2) in subsection (c)(2)(A)(ii), by inserting 

25 ‘‘(which may include respite care for caregivers of inVerDate Mar 15 2010 02:01 Jun 24, 2014 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6203 E:\BILLS\H4631.RH H4631

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1 dividuals with an autism spectrum disorder)’’ after 

2 ‘‘services and supports’’; 

3 (3) in subsection (e)(1)(B)(v), by inserting before 

4 the semicolon the following: ‘‘, which may include col5 laborating with research centers or networks to pro6 vide training for providers of respite care (as defined 

7 in section 2901)’’; 

8 (4) in subsection (f), by striking ‘‘grants or con9 tracts’’ and all that follows through ‘‘for individuals 

10 with’’ and inserting ‘‘grants or contracts, which may 

11 include grants or contracts to research centers or net12 works, to determine the evidence-based practices for 

13 interventions to improve the physical and behavioral 

14 health of individuals with’’; and 

15 (5) in subsection (g), by striking ‘‘2014’’ and in16 serting ‘‘2019’’. 

17 SEC. 5. INTERAGENCY AUTISM COORDINATING COMMITTEE. 

18 Section 399CC of the Public Health Service Act (42 

19 U.S.C. 280i–2) is amended— 

20 (1) in subsection (b)— 

21 (A) in paragraph (1)— 

22 (i) by striking ‘‘and annually update’’; 

23 and 


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1 (ii) by striking ‘‘intervention’’ and in2 serting ‘‘interventions, including school and 

3 community-based interventions’’; 

4 (B) by striking paragraph (2); 

5 (C) by redesignating paragraph (1) as 

6 paragraph (2), and inserting before such redesig7 nated paragraph the following: 

8 ‘‘(1) monitor autism spectrum disorder research, 

9 and to the extent practicable services and support ac10 tivities, across all Federal departments and agencies, 

11 including coordination of Federal activities with re12 spect to autism spectrum disorder;’’; 

13 (D) in paragraph (3), by striking ‘‘rec14 ommendations to the Director of NIH’’; 

15 (E) in paragraph (4), by inserting before 

16 the semicolon the following: ‘‘, and the process by 

17 which public feedback can be better integrated 

18 into such decisions’’; and 

19 (F) by striking paragraphs (5) and (6) and 

20 inserting the following: 

21 ‘‘(5) develop a strategic plan for the conduct of, 

22 and support for, autism spectrum disorder research 

23 and services and supports for individuals with an au24 tism spectrum disorder and the families of such indi25 viduals, which shall include— 


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1 ‘‘(A) proposed budgetary requirements; and 

2 ‘‘(B) recommendations to ensure that au3 tism spectrum disorder research, services, and 

4 support activities of the Department of Health 

5 and Human Services and of other Federal de6 partments and agencies are not unnecessarily 

7 duplicative; and 

8 ‘‘(6) submit to Congress and the President— 

9 ‘‘(A) an annual update on the summary of 

10 advances described in paragraph (2); and 

11 ‘‘(B) an annual update to the strategic plan 

12 described in paragraph (5), including any 

13 progress made in achieving the goals outlined in 

14 such strategic plan.’’; 

15 (2) in subsection (c)— 

16 (A) in paragraph (1)— 

17 (i) by striking the paragraph designa18 tion, the heading, and the matter preceding 

19 subparagraph (A) and inserting the fol20 lowing: 

21 ‘‘(1) FEDERAL MEMBERSHIP.—The Committee 

22 shall be composed of the following Federal members— 

23 ’’; 

24 (ii) in subparagraph (C)— 


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1 (I) by inserting ‘‘, such as the Ad2 ministration for Community Living, 

3 Administration for Children and Fam4 ilies, the Centers for Medicare & Med5 icaid Services, the Food and Drug Ad6 ministration, and the Health Resources 

7 and Services Administration’’ before 

8 the semicolon at the end; and 

9 (II) by adding at the end ‘‘and’’; 

10 (iii) in subparagraph (D)— 

11 (I) by inserting ‘‘and the Depart12 ment of Defense’’ after ‘‘Department of 

13 Education’’; and 

14 (II) by striking at the end ‘‘; and’’ 

15 and inserting a period; and 

16 (iv) by striking subparagraph (E); 

17 (B) in paragraph (2)— 

18 (i) in the paragraph heading, by strik19 ing ‘‘ADDITIONAL’’ and inserting ‘‘NON20 FEDERAL’’; 

21 (ii) in the matter preceding subpara22 graph (A), by striking ‘‘Not fewer than 6 

23 members of the Committee, or 1/3 of the 

24 total membership of the Committee, which25 ever is greater’’ and inserting ‘‘Not more 


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than 1 1 ⁄2, but not fewer than 1/3, of the total 

2 membership of the Committee’’; 

3 (iii) in subparagraph (A), by striking 

4 ‘‘one such member shall be an individual’’ 

5 and inserting ‘‘two such members shall be 

6 individuals’’; 

7 (iv) in subparagraph (B), by striking 

8 ‘‘one such member shall be a parent or legal 

9 guardian’’ and inserting ‘‘two such mem10 bers shall be parents or legal guardians’’; 

11 and 

12 (v) in subparagraph (C), by striking 

13 ‘‘one such member shall be a representative’’ 

14 and inserting ‘‘two such members shall be 

15 representatives’’; and 

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

17 ‘‘(3) PERIOD OF APPOINTMENT; VACANCIES.— 

18 ‘‘(A) PERIOD OF APPOINTMENT FOR NON19 FEDERAL MEMBERS.—Non-Federal members 

20 shall serve for a term of 4 years, and may be re21 appointed for one or more additional 4-year 

22 terms. 

23 ‘‘(B) VACANCIES.—A vacancy on the Com24 mittee shall be filled in the manner in which the 

25 original appointment was made and shall not 


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1 affect the power or duties of the Committee. Any 

2 member appointed to fill a vacancy for an unex3 pired term shall be appointed for the remainder 

4 of such term. A member may serve after the expi5 ration of the member’s term until a successor has 

6 been appointed.’’; 

7 (3) in subsection (d)— 

8 (A) by striking paragraph (2); and 

9 (B) by redesignating paragraphs (3) and 

10 (4) as paragraphs (2) and (3), respectively; and 

11 (4) in subsection (f), by striking ‘‘2014’’ and in12 serting ‘‘2019’’. 

13 SEC. 6. REPORTS. 

14 Section 399DD of the Public Health Service Act (42 

15 U.S.C. 280i–3) is amended— 

16 (1) in the section heading, by striking ‘‘RE17 PORT’’ and inserting ‘‘REPORTS’’; 

18 (2) in subsection (b), by redesignating para19 graphs (1) through (9) as subparagraphs (A) through 

20 (I), respectively, and realigning the margins accord21 ingly; 

22 (3) by redesignating subsections (a) and (b) as 

23 paragraphs (1) and (2), respectively, and realigning 

24 the margins accordingly; 


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1 (4) by inserting after the section heading the fol2 lowing: 

3 ‘‘(a) PROGRESS REPORT.—’’; 

4 (5) in subsection (a)(1) (as so redesignated)— 

5 (A) by striking ‘‘2 years after the date of 

6 enactment of the Combating Autism Reauthor7 ization Act of 2011’’ and inserting ‘‘4 years after 

8 the date of enactment of the Autism CARES Act 

9 of 2014’’; 

10 (B) by inserting ‘‘and the Secretary of De11 fense’’ after ‘‘the Secretary of Education’’; and 

12 (C) by inserting ‘‘, and make publicly 

13 available, including through posting on the 

14 Internet Web site of the Department of Health 

15 and Human Services,’’ after ‘‘Representatives’’; 

16 and 

17 (6) in subsection (a)(2) (as so redesignated)— 

18 (A) in subparagraph (A), (as so redesig19 nated), by striking ‘‘Combating Autism Act of 

20 2006’’ and inserting ‘‘Autism CARES Act of 

21 2014’’; 

22 (B) in subparagraph (B) (as so redesig23 nated), by striking ‘‘particular provisions of 

24 Combating Autism Act of 2006’’ and inserting 


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1 ‘‘amendments made by the Autism CARES Act 

2 of 2014’’; 

3 (C) by striking subparagraph (C) (as so re4 designated), and inserting the following: 

5 ‘‘(C) information on the incidence and 

6 prevalence of autism spectrum disorder, includ7 ing available information on the prevalence of 

8 autism spectrum disorder among children and 

9 adults, and identification of any changes over 

10 time with respect to the incidence and prevalence 

11 of autism spectrum disorder;’’; 

12 (D) in subparagraph (D) (as so redesig13 nated), by striking ‘‘6-year period beginning on 

14 the date of enactment of the Combating Autism 

15 Act of 2006’’ and inserting ‘‘4-year period begin16 ning on the date of enactment of the Autism 

17 CARES Act of 2014 and, as appropriate, how 

18 this age varies across populations subgroups’’; 

19 (E) in subparagraph (E) (as so redesig20 nated), by striking ‘‘6-year period beginning on 

21 the date of enactment of the Combating Autism 

22 Act of 2006’’ and inserting ‘‘4-year period begin23 ning on the date of enactment of the Autism 

24 CARES Act of 2014 and, as appropriate, how 

25 this age varies across populations subgroups’’; 


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1 (F) in subparagraph (F) (as so redesig2 nated), by inserting ‘‘and, as appropriate, on 

3 how such average time varies across populations 

4 subgroups’’ before the semicolon at the end; 

5 (G) in subparagraph (G) (as so redesig6 nated)— 

7 (i) by striking ‘‘including by various 

8 subtypes,’’ and inserting ‘‘including by se9 verity level as practicable,’’; and 

10 (ii) by striking ‘‘child may’’ and in11 serting ‘‘child or other factors, such as de12 mographic characteristics, may’’; and 

13 (H) by striking subparagraph (I) (as so re14 designated), and inserting the following: 

15 ‘‘(I) a description of the actions taken to 

16 implement and the progress made on implemen17 tation of the strategic plan developed by the 

18 Interagency Autism Coordinating Committee 

19 under section 399CC(b).’’; and 

20 (7) by adding at the end the following new sub21 section: 

22 ‘‘(b) REPORT ON YOUNG ADULTS AND TRANSITIONING

23 YOUTH.— 

24 ‘‘(1) IN GENERAL.—Not later than 2 years after 

25 the date of enactment of the Autism CARES Act of 


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1 2014, the Secretary, in coordination with the Sec2 retary of Education and in collaboration with the 

3 Secretary of Transportation, the Secretary of Labor, 

4 the Secretary of Housing and Urban Development, 

5 and the Attorney General, shall prepare and submit 

6 to the Committee on Health, Education, Labor, and 

7 Pensions of the Senate and the Committee on Energy 

8 and Commerce of the House of Representatives, a re9 port concerning young adults with autism spectrum 

10 disorder and the challenges related to the transition 

11 from existing school-based services to those services 

12 available during adulthood. 

13 ‘‘(2) CONTENTS.—The report submitted under 

14 paragraph (1) shall contain— 

15 ‘‘(A) demographic characteristics of youth 

16 transitioning from school-based to community17 based supports; 

18 ‘‘(B) an overview of policies and programs 

19 relevant to young adults with autism spectrum 

20 disorder relating to post-secondary school transi21 tional services, including an identification of ex22 isting Federal laws, regulations, policies, re23 search, and programs; 

24 ‘‘(C) proposals on establishing best practices 

25 guidelines to ensure— 


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1 ‘‘(i) interdisciplinary coordination be2 tween all relevant service providers receiv3 ing Federal funding; 

4 ‘‘(ii) coordination with transitioning 

5 youth and the family of such transitioning 

6 youth; and 

7 ‘‘(iii) inclusion of the individualized 

8 education program for the transitioning 

9 youth, as prescribed in section 614 of the 

10 Individuals with Disabilities Education Act 

11 (20 U.S.C. 1414); 

12 ‘‘(D) comprehensive approaches to 

13 transitioning from existing school-based services 

14 to those services available during adulthood, in15 cluding— 

16 ‘‘(i) services that increase access to, 

17 and improve integration and completion of, 

18 post-secondary education, peer support, vo19 cational training (as defined in section 103 

20 of the Rehabilitation Act of 1973 (29 U.S.C. 

21 723)), rehabilitation, self-advocacy skills, 

22 and competitive, integrated employment; 

23 ‘‘(ii) community-based behavioral sup24 ports and interventions; 


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1 ‘‘(iii) community-based integrated resi2 dential services, housing, and transpor3 tation; 

4 ‘‘(iv) nutrition, health and wellness, 

5 recreational, and social activities; 

6 ‘‘(v) personal safety services for indi7 viduals with autism spectrum disorder re8 lated to public safety agencies or the crimi9 nal justice system; and 

10 ‘‘(vi) evidence-based approaches for co11 ordination of resources and services once in12 dividuals have aged out of post-secondary 

13 education; and 

14 ‘‘(E) proposals that seek to improve out15 comes for adults with autism spectrum disorder 

16 making the transition from a school-based sup17 port system to adulthood by— 

18 ‘‘(i) increasing the effectiveness of pro19 grams that provide transition services; 

20 ‘‘(ii) increasing the ability of the rel21 evant service providers described in sub22 paragraph (C) to provide supports and 

23 services to underserved populations and re24 gions; 


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1 ‘‘(iii) increasing the efficiency of serv2 ice delivery to maximize resources and out3 comes, including with respect to the integra4 tion of and collaboration among services for 

5 transitioning youth; 

6 ‘‘(iv) ensuring access to all services 

7 necessary to transitioning youth of all capa8 bilities; and 

9 ‘‘(v) encouraging transitioning youth 

10 to utilize all available transition services to 

11 maximize independence, equal opportunity, 

12 full participation, and self-sufficiency.’’. 

13 SEC. 7. AUTHORIZATION OF APPROPRIATIONS. 

14 Section 399EE of the Public Health Service Act (42 

15 U.S.C. 280i–4) is amended— 

16 (1) in subsection (a), by striking ‘‘fiscal years 

17 2012 through 2014’’ and inserting ‘‘fiscal years 2015 

18 through 2019’’; 

19 (2) in subsection (b), by striking ‘‘fiscal years 

20 2011 through 2014’’ and inserting ‘‘fiscal years 2015 

21 through 2019’’; and 

22 (3) in subsection (c), by striking ‘‘$161,000,000 

23 for each of fiscal years 2011 through 2014’’ and in24 serting ‘‘$190,000,000 for each of fiscal years 2015 

25 through 2019’’. 


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Union Calendar No. 365 

113TH CONGRESS 

2D SESSION H. R. 4631 

[Report No. 113–490] 

A BILL 

To reauthorize certain provisions of the Public 

other purposes. Health Service Act relating to autism, and for 

JUNE 23, 2014 

Reported with an amendment, committed to the Comand ordered to be printed mittee of the Whole House on the State of the Union, 


smartinez on DSK4TPTVN1PROD with BILLS