I 
116TH CONGRESS 
1ST SESSION H. R. 4801 
To amend the Public Health Service Act to reauthorize the Healthy Start 
program. 
IN THE HOUSE OF REPRESENTATIVES 
OCTOBER 23, 2019 
Mr. RYAN (for himself, Ms. UNDERWOOD, Mr. GONZALEZ of Ohio, and Mr. 
STIVERS) introduced the following bill; which was referred to the Com-
mittee on Energy and Commerce 
A BILL 
To amend the Public Health Service Act to reauthorize the 
Healthy Start program. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Healthy Start Reau-
thorization Act of 2019’’. 
SEC. 2. REAUTHORIZATION OF HEALTHY START PROGRAM. 
Section 330H of the Public Health Service Act (42 
U.S.C. 254c–8) is amended— 
(1) in subsection (a)— 
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(A) in paragraph (1), by striking ‘‘, during 
fiscal year 2001 and subsequent years,’’; and 
(B) in paragraph (2), by inserting ‘‘or in-
creasing above the national average’’ after 
‘‘areas with high’’; 
(2) in subsection (b)— 
(A) in paragraph (1), by striking ‘‘con-
sumers of project services, public health depart-
ments, hospitals, health centers under section 
330’’ and inserting ‘‘participants and former 
participants of project services, public health 
departments, hospitals, health centers under 
section 330, State substance abuse agencies’’; 
and 
(B) in paragraph (2)— 
(i) in subparagraph (A), by striking 
‘‘such as low birthweight’’ and inserting 
‘‘including poor birth outcomes (such as 
low birthweight and preterm birth) and so-
cial determinants of health’’; 
(ii) by redesignating subparagraph 
(B) as subparagraph (C); 
(iii) by inserting after subparagraph 
(A), the following: 
‘‘(B) Communities with— 
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‘‘(i) high rates of infant mortality or 
poor perinatal outcomes; or 
‘‘(ii) high rates of infant mortality or 
poor perinatal outcomes in specific sub-
populations within the community.’’; and 
(iv) in subparagraph (C) (as so redes-
ignated)— 
(I) by redesignating clauses (i) 
and (ii) as clauses (ii) and (iii), re-
spectively; 
(II) by inserting before clause (ii) 
(as so redesignated) the following: 
‘‘(i) collaboration with the local com-
munity in the development of the project;’’; 
(III) in clause (ii) (as so redesig-
nated), by striking ‘‘and’’ at the end; 
(IV) in clause (iii) (as so redesig-
nated), by striking the period and in-
serting ‘‘; and’’; and 
(V) by adding at the end the fol-
lowing: 
‘‘(iv) the use and collection of data 
demonstrating the effectiveness of such 
program in decreasing infant mortality 
rates and improving perinatal outcomes, as 
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applicable, or the process by which new ap-
plicants plan to collect this data.’’; 
(3) in subsection (c)— 
(A) by striking ‘‘Recipients of grants’’ and 
inserting the following: 
‘‘(1) IN GENERAL.—Recipients of grants’’; and 
(B) by adding at the end the following: 
‘‘(2) OTHER PROGRAMS.—The Secretary shall 
ensure coordination of the program carried out pur-
suant to this section with other programs and activi-
ties related to the reduction of the rate of infant 
mortality and improved perinatal and infant health 
outcomes supported by the Department.’’; 
(4) in subsection (e)— 
(A) in paragraph (1), by striking ‘‘appro-
priated—’’ and all that follows through the end 
and inserting ‘‘appropriated $135,000,000 for 
each of fiscal years 2020 through 2024.’’; and 
(B) in paragraph (2)(B), by adding at the 
end the following: ‘‘Evaluations may also in-
clude, to the extent practicable, information re-
lated to— 
‘‘(i) progress toward achieving any 
grant metrics or outcomes related to re-
ducing infant mortality rates, improving 
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perinatal outcomes, or reducing the dis-
parity in health status; 
‘‘(ii) recommendations on potential 
improvements that may assist with ad-
dressing gaps, as applicable and appro-
priate; and 
‘‘(iii) the extent to which the grantee 
coordinated with the community in which 
the grantee is located in the development 
of the project and delivery of services, in-
cluding with respect to technical assistance 
and mentorship programs.’’; and 
(5) by adding at the end the following: 
‘‘(f) GAO REPORT.— 
‘‘(1) IN
GENERAL.—Not later than 4 years 
after the date of the enactment of this subsection, 
the Comptroller General of the United States shall 
conduct an independent evaluation, and submit to 
the appropriate Committees of Congress a report, 
concerning the Healthy Start program under this 
section. 
‘‘(2) EVALUATION.—In conducting the evalua-
tion under paragraph (1), the Comptroller General 
shall consider, as applicable and appropriate, infor-
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mation from the evaluations under subsection 
(e)(2)(B). 
‘‘(3) REPORT.—The report described in para-
graph (1) shall review, assess, and provide rec-
ommendations, as appropriate, on the following: 
‘‘(A) The allocation of Healthy Start pro-
gram grants by the Health Resources and Serv-
ices Administration, including considerations 
made by such Administration regarding dispari-
ties in infant mortality or perinatal outcomes 
among urban and rural areas in making such 
awards. 
‘‘(B) Trends in the progress made toward 
meeting the evaluation criteria pursuant to sub-
section (e)(2)(C), including programs which de-
crease infant mortality rates and improve 
perinatal outcomes, programs that have not de-
creased infant mortality rates or improved 
perinatal outcomes, and programs that have 
made an impact on disparities in infant mor-
tality or perinatal outcomes. 
‘‘(C) The ability of grantees to improve 
health outcomes for project participants, pro-
mote the awareness of the Healthy Start pro-
gram services, incorporate and promote family 
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participation, facilitate coordination with the 
community in which the grantee is located, and 
increase grantee accountability through quality 
improvement, performance monitoring, evalua-
tion, and the effect such metrics may have to-
ward decreasing the rate of infant mortality 
and improve perinatal outcomes. 
‘‘(D) The extent to which such Federal 
programs are coordinated across agencies and 
the identification of opportunities for improved 
coordination in such Federal programs and ac-
tivities.’’. 
Æ 
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