S. 843

One Hundred Ninth Congress

of the

United States of America

AT THE SECOND SESSION

Begun and held at the City of Washington on Tuesday,

the third day of January, two thousand and six

An Act

To amend the Public Health Service Act to combat autism through research, screening, intervention and education.

Be it enacted by the Senate and House of Representatives of

the United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the ‘‘Combating Autism Act of 2006’’.

SEC. 2. CENTERS OF EXCELLENCE; IMPROVING AUTISM-RELATED

RESEARCH.

(a) CENTERS OF EXCELLENCE REGARDING RESEARCH ON

AUTISM.—Section 409C of the Public Health Service Act (42

U.S.C.284g) is amended—

(1) in the section heading, by striking ‘‘AUTISM’’ and

inserting ‘‘AUTISM SPECTRUM DISORDER’’;

(2) by striking the term ‘‘autism’’ each place such term

appears (other than the section heading) and inserting ‘‘autism

spectrum disorder’’; and

(3) in subsection (a)—

(A) by redesignating paragraph (2) as paragraph (3);

and

(B) by striking paragraph (1) and inserting the following:

‘‘(1) EXPANSION OF ACTIVITIES.—The Director of NIH (in

this section referred to as the ‘Director’) shall, subject to the

availability of appropriations, expand, intensify, and coordinate

the activities of the National Institutes of Health with respect

to research on autism spectrum disorder, including basic and

clinical research in fields including pathology, developmental

neurobiology, genetics, epigenetics, pharmacology, nutrition,

immunology, neuroimmunology, neurobehavioral development,

endocrinology, gastroenterology, and toxicology. Such research

shall investigate the cause (including possible environmental

causes), diagnosis or rule out, early detection, prevention, services, supports, intervention, and treatment of autism spectrum

disorder.

‘‘(2) CONSOLIDATION.—The Director may consolidate program activities under this section if such consolidation would

improve program efficiencies and outcomes.’’.

(b) CENTERS OF EXCELLENCE GENERALLY.—Part A of title IV

of the Public Health Service Act (42 U.S.C. 281 et seq.) is amended

by adding at the end the following:
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‘‘SEC. 404H. REVIEW OF CENTERS OF EXCELLENCE.

‘‘(a) IN GENERAL.—Not later than April 1, 2008, and periodically

thereafter, the Secretary, acting through the Director of NIH, shall

conduct a review and submit a report to the appropriate committees

of the Congress on the centers of excellence.

‘‘(b) REPORT CONTENTS.—Each report under subsection (a) shall

include the following:

‘‘(1) Evaluation of the performance and research outcomes

of each center of excellence.

‘‘(2) Recommendations for promoting coordination of

information among centers of excellence.

‘‘(3) Recommendations for improving the effectiveness, efficiency, and outcomes of the centers of excellence.

‘‘(c) DEFINITION.—In this section, the term ‘center of excellence’

means an entity receiving funding under this title in its capacity

as a center of excellence.’’.

SEC. 3. DEVELOPMENTAL DISABILITIES SURVEILLANCE AND

RESEARCH PROGRAM.

(a) IN GENERAL.—Title III of the Public Health Service Act

(42 U.S.C. 241 et seq.) is amended by adding at the end the

following:

‘‘PART R—PROGRAMS RELATING TO AUTISM

‘‘SEC. 399AA. DEVELOPMENTAL DISABILITIES SURVEILLANCE AND

RESEARCH PROGRAM.

‘‘(a) AUTISM SPECTRUM DISORDER AND OTHER DEVELOPMENTAL

DISABILITIES.— ‘‘(1) IN GENERAL.—The Secretary, acting through the

Director of the Centers for Disease Control and Prevention,

may award grants or cooperative agreements to eligible entities

for the collection, analysis, and reporting of State epidemiological data on autism spectrum disorder and other developmental

disabilities. An eligible entity shall assist with the development

and coordination of State autism spectrum disorder and other

developmental disability surveillance efforts within a region.

In making such awards, the Secretary may provide direct technical assistance in lieu of cash.

‘‘(2) DATA STANDARDS.—In submitting epidemiological data

to the Secretary pursuant to paragraph (1), an eligible entity

shall report data according to guidelines prescribed by the

Director of the Centers for Disease Control and Prevention,

after consultation with relevant State and local public health

officials, private sector developmental disability researchers,

and advocates for individuals with autism spectrum disorder

or other developmental disabilities.

‘‘(3) ELIGIBILITY.—To be eligible to receive an award under

paragraph (1), an entity shall be a public or nonprofit private

entity (including a health department of a State or a political

subdivision of a State, a university, or any other educational

institution), and submit to the Secretary an application at

such time, in such manner, and containing such information

as the Secretary may require.

‘‘(b) CENTERS OF EXCELLENCE IN AUTISM SPECTRUM DISORDER

EPIDEMIOLOGY.—
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‘‘(1) IN GENERAL.—The Secretary, acting through the

Director of the Centers for Disease Control and Prevention,

shall, subject to the availability of appropriations, award grants

or cooperative agreements for the establishment of regional

centers of excellence in autism spectrum disorder and other

developmental disabilities epidemiology for the purpose of collecting and analyzing information on the number, incidence,

correlates, and causes of autism spectrum disorder and other

developmental disabilities.

‘‘(2) REQUIREMENTS.—To be eligible to receive a grant or

cooperative agreement under paragraph (1), an entity shall

submit to the Secretary an application containing such agreements and information as the Secretary may require, including

an agreement that the center to be established under the grant

or cooperative agreement shall operate in accordance with the

following:

‘‘(A) The center will collect, analyze, and report autism

spectrum disorder and other developmental disability data

according to guidelines prescribed by the Director of the

Centers for Disease Control and Prevention, after consultation with relevant State and local public health officials,

private sector developmental disability researchers, and

advocates for individuals with developmental disabilities.

‘‘(B) The center will develop or extend an area of special

research expertise (including genetics, epigenetics, and

epidemiological research related to environmental exposures), immunology, and other relevant research specialty

areas.

‘‘(C) The center will identify eligible cases and controls

through its surveillance system and conduct research into

factors which may cause or increase the risk of autism

spectrum disorder and other developmental disabilities.

‘‘(c) FEDERAL RESPONSE.—The Secretary shall coordinate the

Federal response to requests for assistance from State health,

mental health, and education department officials regarding potential or alleged autism spectrum disorder or developmental disability

clusters.

‘‘(d) DEFINITIONS.—In this part:

‘‘(1) OTHER DEVELOPMENTAL DISABILITIES.—The term ‘other

developmental disabilities’ has the meaning given the term

‘developmental disability’ in section 102(8) of the Developmental

Disabilities Assistance and Bill of Rights Act of 2000 (42 U.S.C.

15002(8)).

‘‘(2) STATE.—The term ‘State’ means each of the several

States, the District of Columbia, the Commonwealth of Puerto

Rico, American Samoa, Guam, the Commonwealth of the

Northern Mariana Islands, the Virgin Islands, and the Trust

Territory of the Pacific Islands.

‘‘(e) SUNSET.—This section shall not apply after September

30, 2011.

‘‘SEC. 399BB. AUTISM EDUCATION, EARLY DETECTION, AND INTERVENTION.

‘‘(a) PURPOSE.—It is the purpose of this section— ‘‘(1) to increase awareness, reduce barriers to screening

and diagnosis, promote evidence-based interventions for individuals with autism spectrum disorder or other developmental
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disabilities, and train professionals to utilize valid and reliable

screening tools to diagnose or rule out and provide evidencebased interventions for children with autism spectrum disorder

and other developmental disabilities; and ‘‘(2) to conduct activities under this section with a focus

on an interdisciplinary approach (as defined in programs developed under section 501(a)(2) of the Social Security Act) that

will also focus on specific issues for children who are not

receiving an early diagnosis and subsequent interventions.

‘‘(b) IN GENERAL.—The Secretary shall, subject to the availability of appropriations, establish and evaluate activities to—

‘‘(1) provide information and education on autism spectrum

disorder and other developmental disabilities to increase public

awareness of developmental milestones;

‘‘(2) promote research into the development and validation

of reliable screening tools for autism spectrum disorder and

other developmental disabilities and disseminate information

regarding those screening tools;

‘‘(3) promote early screening of individuals at higher risk

for autism spectrum disorder and other developmental disabilities as early as practicable, given evidence-based screening

techniques and interventions;

‘‘(4) increase the number of individuals who are able to

confirm or rule out a diagnosis of autism spectrum disorder

and other developmental disabilities;

‘‘(5) increase the number of individuals able to provide

evidence-based interventions for individuals diagnosed with

autism spectrum disorder or other developmental disabilities;

and

‘‘(6) promote the use of evidence-based interventions for

individuals at higher risk for autism spectrum disorder and

other developmental disabilities as early as practicable.

‘‘(c) INFORMATION AND EDUCATION.—

‘‘(1) IN GENERAL.—In carrying out subsection (b)(1), the

Secretary, in collaboration with the Secretary of Education

and the Secretary of Agriculture, shall, subject to the availability of appropriations, provide culturally competent information regarding autism spectrum disorder and other developmental disabilities, risk factors, characteristics, identification,

diagnosis or rule out, and evidence-based interventions to meet

the needs of individuals with autism spectrum disorder or

other developmental disabilities and their families through—

‘‘(A) Federal programs, including—

‘‘(i) the Head Start program;

‘‘(ii) the Early Start program;

‘‘(iii) the Healthy Start program;

‘‘(iv) programs under the Child Care and Development Block Grant Act of 1990;

‘‘(v) programs under title XIX of the Social Security

Act (particularly the Medicaid Early and Periodic

Screening, Diagnosis and Treatment Program);

‘‘(vi) the program under title XXI of the Social

Security Act (the State Children’s Health Insurance

Program);

‘‘(vii) the program under title V of the Social Security Act (the Maternal and Child Health Block Grant

Program);
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‘‘(viii) the program under parts B and C of the

Individuals with Disabilities Education Act; ‘‘(ix) the special supplemental nutrition program

for women, infants, and children established under

section 17 of the Child Nutrition Act of 1966 (42 U.S.C.

1786); and ‘‘(x) the State grant program under the Rehabilitation Act of 1973.

‘‘(B) State licensed child care facilities; and

‘‘(C) other community-based organizations or points of

entry for individuals with autism spectrum disorder and

other developmental disabilities to receive services.

‘‘(2) LEAD AGENCY.—

‘‘(A) DESIGNATION.—As a condition on the provision

of assistance or the conduct of activities under this section

with respect to a State, the Secretary may require the

Governor of the State—

‘‘(i) to designate a public agency as a lead agency

to coordinate the activities provided for under paragraph (1) in the State at the State level; and

‘‘(ii) acting through such lead agency, to make

available to individuals and their family members,

guardians, advocates, or authorized representatives;

providers; and other appropriate individuals in the

State, comprehensive culturally competent information

about State and local resources regarding autism spectrum disorder and other developmental disabilities,

risk factors, characteristics, identification, diagnosis or

rule out, available services and supports, and evidencebased interventions.

‘‘(B) REQUIREMENTS OF AGENCY.—In designating the

lead agency under subparagraph (A)(i), the Governor

shall— ‘‘(i) select an agency that has demonstrated experience and expertise in— ‘‘(I) autism spectrum disorder and other

developmental disability issues; and ‘‘(II) developing, implementing, conducting,

and administering programs and delivering education, information, and referral services

(including technology-based curriculum-development services) to individuals with developmental

disabilities and their family members, guardians,

advocates or authorized representatives, providers,

and other appropriate individuals locally and

across the State; and

‘‘(ii) consider input from individuals with developmental disabilities and their family members, guardians, advocates or authorized representatives, providers, and other appropriate individuals.

‘‘(C) INFORMATION.—Information under subparagraph

(A)(ii) shall be provided through— ‘‘(i) toll-free telephone numbers;

‘‘(ii) Internet websites;

‘‘(iii) mailings; or

‘‘(iv) such other means as the Governor may

require.
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‘‘(d) TOOLS.—

‘‘(1) IN GENERAL.—To promote the use of valid and reliable

screening tools for autism spectrum disorder and other developmental disabilities, the Secretary shall develop a curriculum

for continuing education to assist individuals in recognizing

the need for valid and reliable screening tools and the use

of such tools. ‘‘(2) COLLECTION, STORAGE, COORDINATION, AND AVAILABILITY.—The Secretary, in collaboration with the Secretary

of Education, shall provide for the collection, storage, coordination, and public availability of tools described in paragraph

(1), educational materials and other products that are used

by the Federal programs referred to in subsection (c)(1)(A),

as well as—

‘‘(A) programs authorized under the Developmental

Disabilities Assistance and Bill of Rights Act of 2000;

‘‘(B) early intervention programs or interagency coordinating councils authorized under part C of the Individuals

with Disabilities Education Act; and

‘‘(C) children with special health care needs programs

authorized under title V of the Social Security Act.

‘‘(3) REQUIRED SHARING.—In establishing mechanisms and

entities under this subsection, the Secretary, and the Secretary

of Education, shall ensure the sharing of tools, materials, and

products developed under this subsection among entities

receiving funding under this section.

‘‘(e) DIAGNOSIS.— ‘‘(1) TRAINING.—The Secretary, in coordination with activities conducted under title V of the Social Security Act, shall,

subject to the availability of appropriations, expand existing

interdisciplinary training opportunities or opportunities to

increase the number of sites able to diagnose or rule out individuals with autism spectrum disorder or other developmental

disabilities and ensure that— ‘‘(A) competitive grants or cooperative agreements are

awarded to public or nonprofit agencies, including institutions of higher education, to expand existing or develop

new maternal and child health interdisciplinary leadership

education in neurodevelopmental and related disabilities

programs (similar to the programs developed under section

501(a)(2) of the Social Security Act) in States that do not

have such a program; ‘‘(B) trainees under such training programs— ‘‘(i) receive an appropriate balance of academic,

clinical, and community opportunities; ‘‘(ii) are culturally competent;

‘‘(iii) are ethnically diverse;

‘‘(iv) demonstrate a capacity to evaluate, diagnose

or rule out, develop, and provide evidence-based interventions to individuals with autism spectrum disorder

and other developmental disabilities; and ‘‘(v) demonstrate an ability to use a family-centered

approach; and

‘‘(C) program sites provide culturally competent services.

‘‘(2) TECHNICAL ASSISTANCE.—The Secretary may award

one or more grants under this section to provide technical
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assistance to the network of interdisciplinary training programs. ‘‘(3) BEST PRACTICES.—The Secretary shall promote

research into additional valid and reliable tools for shortening

the time required to confirm or rule out a diagnosis of autism

spectrum disorder or other developmental disabilities and

detecting individuals with autism spectrum disorder or other

developmental disabilities at an earlier age.

‘‘(f) INTERVENTION.—The Secretary shall promote research,

through grants or contracts, to determine the evidence-based practices for interventions for individuals with autism spectrum disorder

or other developmental disabilities, develop guidelines for those

interventions, and disseminate information related to such research

and guidelines.

‘‘(g) SUNSET.—This section shall not apply after September

30, 2011.

‘‘SEC. 399CC. INTERAGENCY AUTISM COORDINATING COMMITTEE.

‘‘(a) ESTABLISHMENT.—The Secretary shall establish a committee, to be known as the ‘Interagency Autism Coordinating Committee’ (in this section referred to as the ‘Committee’), to coordinate

all efforts within the Department of Health and Human Services

concerning autism spectrum disorder.

‘‘(b) RESPONSIBILITIES.—In carrying out its duties under this

section, the Committee shall— ‘‘(1) develop and annually update a summary of advances

in autism spectrum disorder research related to causes, prevention, treatment, early screening, diagnosis or rule out, intervention, and access to services and supports for individuals with

autism spectrum disorder; ‘‘(2) monitor Federal activities with respect to autism spectrum disorder; ‘‘(3) make recommendations to the Secretary regarding any

appropriate changes to such activities, including recommendations to the Director of NIH with respect to the strategic plan

developed under paragraph (5); ‘‘(4) make recommendations to the Secretary regarding

public participation in decisions relating to autism spectrum

disorder; ‘‘(5) develop and annually update a strategic plan for the

conduct of, and support for, autism spectrum disorder research,

including proposed budgetary requirements; and ‘‘(6) submit to the Congress such strategic plan and any

updates to such plan.

‘‘(c) MEMBERSHIP.—

‘‘(1) IN GENERAL.—The Committee shall be composed of— ‘‘(A) the Director of the Centers for Disease Control

and Prevention; ‘‘(B) the Director of the National Institutes of Health,

and the Directors of such national research institutes of

the National Institutes of Health as the Secretary determines appropriate; ‘‘(C) the heads of such other agencies as the Secretary

determines appropriate; ‘‘(D) representatives of other Federal Governmental

agencies that serve individuals with autism spectrum disorder such as the Department of Education; and
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‘‘(E) the additional members appointed under paragraph (2).

‘‘(2) ADDITIONAL MEMBERS.—Not fewer than 6 members

of the Committee, or 1/3 of the total membership of the Committee, whichever is greater, shall be composed of non-Federal

public members to be appointed by the Secretary, of which—

‘‘(A) at least one such member shall be an individual

with a diagnosis of autism spectrum disorder;

‘‘(B) at least one such member shall be a parent or

legal guardian of an individual with an autism spectrum

disorder; and

‘‘(C) at least one such member shall be a representative

of leading research, advocacy, and service organizations

for individuals with autism spectrum disorder.

‘‘(d) ADMINISTRATIVE SUPPORT; TERMS OF SERVICE; OTHER

PROVISIONS.—The following provisions shall apply with respect to

the Committee:

‘‘(1) The Committee shall receive necessary and appropriate

administrative support from the Secretary.

‘‘(2) Members of the Committee appointed under subsection

(c)(2) shall serve for a term of 4 years, and may be reappointed

for one or more additional 4 year term. Any member appointed

to fill a vacancy for an unexpired term shall be appointed

for the remainder of such term. A member may serve after

the expiration of the member’s term until a successor has

taken office.

‘‘(3) The Committee shall meet at the call of the chairperson

or upon the request of the Secretary. The Committee shall

meet not fewer than 2 times each year.

‘‘(4) All meetings of the Committee shall be public and

shall include appropriate time periods for questions and presentations by the public.

‘‘(e) SUBCOMMITTEES; ESTABLISHMENT AND MEMBERSHIP.—In

carrying out its functions, the Committee may establish subcommittees and convene workshops and conferences. Such subcommittees

shall be composed of Committee members and may hold such

meetings as are necessary to enable the subcommittees to carry

out their duties.

‘‘(f) SUNSET.—This section shall not apply after September 30,

2011, and the Committee shall be terminated on such date.

‘‘SEC. 399DD. REPORT TO CONGRESS.

‘‘(a) IN GENERAL.—Not later than 4 years after the date of

enactment of the Combating Autism Act of 2006, the Secretary,

in coordination with the Secretary of Education, shall prepare and

submit to the Health, Education, Labor, and Pensions Committee

of the Senate and the Energy and Commerce Committee of the

House of Representatives a progress report on activities related

to autism spectrum disorder and other developmental disabilities.

‘‘(b) CONTENTS.—The report submitted under subsection (a)

shall contain—

‘‘(1) a description of the progress made in implementing

the provisions of the Combating Autism Act of 2006;

‘‘(2) a description of the amounts expended on the

implementation of the particular provisions of Combating

Autism Act of 2006;
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‘‘(3) information on the incidence of autism spectrum disorder and trend data of such incidence since the date of enactment of the Combating Autism Act of 2006;

‘‘(4) information on the average age of diagnosis for children

with autism spectrum disorder and other disabilities, including

how that age may have changed over the 4-year period beginning on the date of enactment of this Act;

‘‘(5) information on the average age for intervention for

individuals diagnosed with autism spectrum disorder and other

developmental disabilities, including how that age may have

changed over the 4-year period beginning on the date of enactment of this Act;

‘‘(6) information on the average time between initial

screening and then diagnosis or rule out for individuals with

autism spectrum disorder or other developmental disabilities,

as well as information on the average time between diagnosis

and evidence-based intervention for individuals with autism

spectrum disorder or other developmental disabilities;

‘‘(7) information on the effectiveness and outcomes of interventions for individuals diagnosed with autism spectrum disorder, including by various subtypes, and other developmental

disabilities and how the age of the child may affect such

effectiveness;

‘‘(8) information on the effectiveness and outcomes of

innovative and newly developed intervention strategies for

individuals with autism spectrum disorder or other developmental disabilities; and

‘‘(9) information on services and supports provided to

individuals with autism spectrum disorder and other developmental disabilities who have reached the age of majority (as

defined for purposes of section 615(m) of the Individuals with

Disabilities Education Act (20 U.S.C. 1415(m)).’’.

(b) REPEALS.—The following sections of the Children’s Health

Act of 2000 (Public Law 106–310) are repealed:

(1) Section 102 (42 U.S.C. 247b–4b), relating to the Developmental Disabilities Surveillance and Research Program.

(2) Section 103 (42 U.S.C. 247b–4c), relating to information

and education.

(3) Section 104 (42 U.S.C. 247b–4d), relating to the InterAgency Autism Coordinating Committee.

(4) Section 105 (42 U.S.C. 247b–4e), relating to reports.

SEC. 4. AUTHORIZATION OF APPROPRIATIONS.

(a) IN GENERAL.—Part R of title III of the Public Health Service

Act, as added by section 3, is amended by adding at the end

the following:

‘‘SEC. 399EE. AUTHORIZATION OF APPROPRIATIONS.

‘‘(a) DEVELOPMENTAL DISABILITIES SURVEILLANCE AND

RESEARCH PROGRAM.—To carry out section 399AA, there are authorized to be appropriated the following:

‘‘(1) For fiscal year 2007, $15,000,000.

‘‘(2) For fiscal year 2008, $16,500,000.

‘‘(3) For fiscal year 2009, $18,000,000.

‘‘(4) For fiscal year 2010, $19,500,000.

‘‘(5) For fiscal year 2011, $21,000,000.
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‘‘(b) AUTISM EDUCATION, EARLY DETECTION, AND INTERVEN- TION.—To carry out section 399BB, there are authorized to be

appropriated the following: ‘‘(1) For fiscal year 2007, $32,000,000.

‘‘(2) For fiscal year 2008, $37,000,000.

‘‘(3) For fiscal year 2009, $42,000,000.

‘‘(4) For fiscal year 2010, $47,000,000.

‘‘(5) For fiscal year 2011, $52,000,000. ‘‘(c) INTERAGENCY AUTISM COORDINATING COMMITTEE; CERTAIN

OTHER PROGRAMS.—To carry out section 399CC, 409C, and section

404H, there are authorized to be appropriated the following:

‘‘(1) For fiscal year 2007, $100,000,000.

‘‘(2) For fiscal year 2008, $114,500,000.

‘‘(3) For fiscal year 2009, $129,000,000.

‘‘(4) For fiscal year 2010, $143,500,000.

‘‘(5) For fiscal year 2011, $158,000,000.’’.

(b) CONFORMING AMENDMENT.—Section 409C of the Public

Health Service Act (42 U.S.C. 284g) is amended by striking subsection (e) (relating to funding).

Speaker of the House of Representatives.

Vice President of the United States and

President of the Senate.