II 

113TH CONGRESS 

2D SESSION S. 2449 

To reauthorize certain provisions of the Public Health Service Act relating 

to autism, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

JUNE 9, 2014 

Mr. MENENDEZ (for himself and Mr. ENZI) introduced the following bill; 

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

A BILL 

To reauthorize certain provisions of the Public Health 

Service Act relating to autism, 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 ‘‘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 

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1 the Department of Health and Human Services to oversee, 

2 in consultation with the Secretaries of Defense and Edu3 cation, national autism spectrum disorder research, serv4 ices, and support activities. 

5 (b) DUTIES.—The official designated under sub6 section (a) shall— 

7 (1) implement autism spectrum disorder activi8 ties, taking into account the strategic plan developed 

9 by the Interagency Autism Coordinating Committee 

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

11 Act (42 U.S.C. 280i–2(b)); and 

12 (2) ensure that autism spectrum disorder activi13 ties of the Department of Health and Human Serv14 ices and of other Federal departments and agencies 

15 are not unnecessarily duplicative. 

16 SEC. 3. RESEARCH PROGRAM. 

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

18 U.S.C. 280i) is amended— 

19 (1) in subsection (a)(1), by inserting ‘‘for chil20 dren and adults’’ after ‘‘reporting of State epidemio21 logical data’’; 

22 (2) in subsection (b)(1)— 

23 (A) by striking ‘‘establishment of regional 

24 centers of excellence’’ and inserting ‘‘establishmstockstill on DSK4VPTVN1PROD with BILLS

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1 ment or support of regional centers of excel2 lence’’; and 

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

4 before the period at the end; 

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

6 be established’’ and inserting ‘‘center to be estab7 lished or supported’’; and 

8 (4) in subsection (e), by striking ‘‘2014’’ and 

9 inserting ‘‘2019’’. 

10 SEC. 4. AUTISM INTERVENTION. 

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

12 U.S.C. 280i–1) is amended— 

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

14 competent’’ after ‘‘provide’’; 

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

16 ‘‘(which may include respite care for caregivers of 

17 individuals with an autism spectrum disorder)’’ after 

18 ‘‘services and supports’’; 

19 (3) in subsection (e)(1)(B)(v), by inserting be20 fore the semicolon the following: ‘‘, which may in21 clude collaborating with research centers or networks 

22 to provide training for providers of respite care (as 

23 defined in section 2901)’’; 

24 (4) in subsection (f), by striking ‘‘grants or 

25 contracts’’ and all that follows through ‘‘for indimstockstill on DSK4VPTVN1PROD with BILLS

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1 vidual with’’ and inserting ‘‘grants or contracts, 

2 which may include grants or contracts to research 

3 centers or networks, to determine the evidence-based 

4 practices for interventions to improve the physical 

5 and behavioral health of individuals with’’; and 

6 (5) in subsection (g), by striking ‘‘2014’’ and 

7 inserting ‘‘2019’’. 

8 SEC. 5. INTERAGENCY AUTISM COORDINATING COM9 MITTEE. 

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

11 U.S.C. 280i–2) is amended— 

12 (1) in subsection (b)— 

13 (A) in paragraph (1)— 

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

15 and 

16 (ii) by striking ‘‘intervention’’ and in17 serting ‘‘interventions, including school and 

18 community-based interventions’’; 

19 (B) by striking paragraph (2); 

20 (C) by redesignating paragraph (1) as 

21 paragraph (2), and inserting before such redes22 ignated paragraph the following: 

23 ‘‘(1) monitor autism spectrum disorder re24 search, and to the extent practicable services and 

25 support activities, across all Federal departments 

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1 and agencies, including coordination of Federal ac2 tivities with respect to autism spectrum disorder;’’; 

3 (D) in paragraph (3), by striking ‘‘rec4 ommendations to the Director of NIH’’; 

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

6 the semicolon the following: ‘‘, and the process 

7 by which public feedback can be better inte8 grated into such decisions’’; and 

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

10 inserting the following: 

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

12 and support for, autism spectrum disorder research 

13 and services and supports for individuals with an au14 tism spectrum disorder and the families of such indi15 viduals, which shall include— 

16 ‘‘(A) proposed budgetary requirements; 

17 and 

18 ‘‘(B) recommendations to ensure that au19 tism spectrum disorder research, services, and 

20 support activities of the Department of Health 

21 and Human Services and of other Federal de22 partments and agencies are not unnecessarily 

23 duplicative; and 

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

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

2 advances described in paragraph (2); and 

3 ‘‘(B) an annual update to the strategic 

4 plan described in paragraph (5), including any 

5 progress made in achieving the goals outlined in 

6 such strategic plan.’’; 

7 (2) in subsection (c)— 

8 (A) in paragraph (1)— 

9 (i) by striking the paragraph heading 

10 and matter preceding subparagraph (A) 

11 and inserting the following: 

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

13 shall be composed of the following Federal mem14 bers—’’; 

15 (ii) in subparagraph (C)— 

16 (I) by inserting ‘‘, such as the 

17 Administration for Community Living, 

18 Administration for Children and Fam19 ilies, the Centers for Medicare & Med20 icaid Services, the Food and Drug Ad21 ministration, and the Health Re22 sources and Services Administration’’ 

23 before the semicolon at the end; and 

24 (II) by adding at the end ‘‘and’’; 

25 (iii) in subparagraph (D)— 

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1 (I) by inserting ‘‘and the Depart2 ment of Defense’’ after ‘‘Department 

3 of Education’’; and 

4 (II) by striking at the end ‘‘; 

5 and’’ and inserting a period; and 

6 (iv) by striking subparagraph (E); 

7 (B) in paragraph (2)— 

8 (i) in the paragraph heading, by strik9 ing ‘‘ADDITIONAL’’ and inserting ‘‘NON10 FEDERAL’’; 

11 (ii) in the matter preceding subpara12 graph (A), by striking ‘‘Not fewer than 6 

members of the Committee, or 1 13 ⁄3 of the 

14 total membership of the Committee, which15 ever is greater’’ and inserting ‘‘Not more 

than 1⁄2, but not fewer than 1 16 ⁄3, of the total 

17 membership of the Committee’’; 

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

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

20 and inserting ‘‘two such members shall be 

21 individuals’’; 

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

23 ‘‘one such member shall be a parent or 

24 legal guardian’’ and inserting ‘‘two such 

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1 members shall be parents or legal guard2 ians’’; and 

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

4 ‘‘one such member shall be a representa5 tive’’ and inserting ‘‘two such members 

6 shall be representatives’’; and 

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

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

9 ‘‘(A) PERIOD OF APPOINTMENT FOR NON10 FEDERAL MEMBERS.—Non-Federal members 

11 shall serve for a term of 4 years, and may be 

12 reappointed for one or more additional 4-year 

13 term. 

14 ‘‘(B) VACANCIES.—A vacancy on the Com15 mittee shall be filled in the manner in which the 

16 original appointment was made and shall not 

17 affect the powers or duties of the Committee. 

18 Any member appointed to fill a vacancy for an 

19 unexpired term shall be appointed for the re20 mainder of such term. A member may serve 

21 after the expiration of the member’s term until 

22 a successor has been appointed.’’; 

23 (3) in subsection (d)— 

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

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1 (B) by redesignating paragraphs (3) and 

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

3 (4) in subsection (f), by striking ‘‘2014’’ and 

4 inserting ‘‘2019’’. 

5 SEC. 6. REPORTS. 

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

7 U.S.C. 280i–3) is amended— 

8 (1) in the section heading, by striking ‘‘RE9 PORT’’ and inserting ‘‘REPORTS’’; 

10 (2) in subsection (b), by redesignating para11 graphs (1) through (9) as subparagraphs (A) 

12 through (I), respectively, and realigning the margins 

13 accordingly; 

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

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

16 the margins accordingly; 

17 (4) by inserting after the section heading the 

18 following: 

19 ‘‘(a) PROGRESS REPORT.—’’; 

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

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

22 enactment of the Combating Autism Reauthor23 ization Act of 2011’’ and inserting ‘‘4 years 

24 after the date of enactment of the Autism 

25 CARES Act of 2014’’; 

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1 (B) by inserting ‘‘and the Secretary of De2 fense’’ after ‘‘the Secretary of Education’’; and 

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

4 available, including through posting on the 

5 Internet Web site of the Department of Health 

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

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

8 (A) in subparagraph (A), (as so redesig9 nated), by striking ‘‘Combating Autism Act of 

10 2006’’ and inserting ‘‘the Autism CARES Act 

11 of 2014’’; 

12 (B) in subparagraph (B) (as so redesig13 nated), by striking ‘‘particular provision of 

14 Combating Autism Act of 2006’’ and inserting 

15 ‘‘amendments made by the Autism CARES Act 

16 of 2014’’; 

17 (C) by striking subparagraph (C) (as so 

18 redesignated), and inserting the following: 

19 ‘‘(C) information on the incidence and 

20 prevalence of autism spectrum disorder, includ21 ing available information on the prevalence of 

22 autism spectrum disorder among children and 

23 adults, and identification of any changes over 

24 time with respect to the incidence and preva25 lence of autism spectrum disorder;’’; 

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1 (D) in subparagraph (D) (as so redesig2 nated), by striking ‘‘6-year period beginning on 

3 the date of enactment of the Combating Autism 

4 Act of 2006’’ and inserting ‘‘4-year period be5 ginning on the date of enactment of the Autism 

6 CARES Act of 2014 and, as appropriate, how 

7 this age varies across populations subgroups’’; 

8 (E) in subparagraph (E) (as so redesig9 nated), by striking ‘‘6-year period beginning on 

10 the date of enactment of the Combating Autism 

11 Act of 2006’’ and inserting ‘‘4-year period be12 ginning on the date of enactment of the Autism 

13 CARES Act of 2014 and, as appropriate, how 

14 this age varies across populations subgroups’’; 

15 (F) in subparagraph (F) (as so redesig16 nated), by inserting ‘‘and, as appropriate, how 

17 this average time varies across populations sub18 groups’’ after ‘‘disabilities’’; 

19 (G) in subparagraph (G) (as so redesig20 nated)— 

21 (i) by striking ‘‘including by various 

22 subtypes,’’ and inserting ‘‘including by se23 verity level as practicable,’’; and 

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1 (ii) by striking ‘‘child may’’ and in2 serting ‘‘child or other factors, such as de3 mographic characteristics, may’’; and 

4 (H) by striking subparagraph (I) (as so re5 designated), and inserting the following: 

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

7 implement and the progress made on implemen8 tation of the strategic plan developed by the 

9 Interagency Autism Coordinating Committee.’’; 

10 and 

11 (7) by adding at the end the following new sub12 section: 

13 ‘‘(b) REPORT ON YOUNG ADULTS AND

14 TRANSITIONING YOUTH.— 

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

16 after the date of enactment of the Autism CARES 

17 Act of 2014, the Secretary of Health and Human 

18 Services, in coordination with the Secretary of Edu19 cation and in collaboration with the Secretary of 

20 Transportation, the Secretary of Labor, the Sec21 retary of Housing and Urban Development, and the 

22 Attorney General, shall prepare and submit to the 

23 Committee on Health, Education, Labor, and Pen24 sions of the Senate and the Committee on Energy 

25 and Commerce of the House of Representatives, a 

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1 report concerning young adults with autism spec2 trum disorder and the challenges related to the tran3 sition from existing school-based services to those 

4 services available during adulthood. 

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

6 paragraph (1) shall contain— 

7 ‘‘(A) an overview of policies and programs 

8 relevant to young adults with autism spectrum 

9 disorder relating to post-secondary school tran10 sitional services, including an identification of 

11 existing Federal laws, regulations, policies, re12 search, and programs; 

13 ‘‘(B) demographic characteristics of youth 

14 transitioning from school-based to community15 based supports; 

16 ‘‘(C) proposals on establishing best prac17 tices guidelines to ensure— 

18 ‘‘(i) interdisciplinary coordination be19 tween all relevant services providers receiv20 ing Federal funding; 

21 ‘‘(ii) coordination with transitioning 

22 youth and the family of such transitioning 

23 youth; and 

24 ‘‘(iii) the inclusion of the transitioning 

25 youth’s Individualized Education Program 

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1 as prescribed in section 614 of the Individ2 uals with Disabilities Education Act (20 

3 U.S.C. 1414); 

4 ‘‘(D) comprehensive approaches to 

5 transitioning from existing school-based services 

6 to services available during adulthood, includ7 ing— 

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

9 and improve integration and completion of, 

10 post-secondary education, peer support, vo11 cational training (as defined in section 103 

12 of the Rehabilitation Act of 1973 (29 

13 U.S.C. 723)), rehabilitation, self-advocacy 

14 skills, and competitive, integrated employ15 ment; 

16 ‘‘(ii) community-based behavioral sup17 ports and interventions; 

18 ‘‘(iii) community-based integrated res19 idential services, housing, and transpor20 tation; 

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

22 recreational, and social activities; 

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1 lated to public safety agencies or the crimi2 nal justice system; and 

3 ‘‘(vi) evidence-based approaches for 

4 coordination of resources and services once 

5 individuals have aged out of post-secondary 

6 education; and 

7 ‘‘(E) proposals that seek to improve out8 comes for adults with autism spectrum disorder 

9 making the transition from a school-based sup10 port system to adulthood by— 

11 ‘‘(i) increasing the effectiveness of 

12 programs that provide transition services; 

13 ‘‘(ii) increasing the ability of relevant 

14 service providers to provide supports and 

15 services to underserved populations and re16 gions; 

17 ‘‘(iii) increasing the efficiency of serv18 ice delivery to maximize resources and out19 comes, including with respect to the inte20 gration of and collaboration among services 

21 for transitioning youth; 

22 ‘‘(iv) ensuring access to all services 

23 necessary to transitioning youth of all ca24 pabilities; and 

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1 ‘‘(v) encouraging transitioning youth 

2 to utilize all available transition services to 

3 maximize independence, equal opportunity, 

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

5 SEC. 7. AUTHORIZATION OF APPROPRIATIONS. 

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

7 U.S.C. 280i–4) is amended— 

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

9 2012 through 2014’’ and inserting ‘‘fiscal years 

10 2015 through 2019’’; 

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

12 2011 through 2014’’ and inserting ‘‘fiscal years 

13 2015 through 2019’’; and 

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

15 for each of fiscal years 2011 through 2014’’ and in16 serting ‘‘$190,000,000 for each of fiscal years 2015 

17 through 2019’’. 

Æ 

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