H. R. 4365—41
(A) in the second sentence, by striking ‘‘anoxia due
to near drowning.’’ and inserting ‘‘anoxia due to trauma.’’;
and
(B) in the third sentence, by inserting before the period
the following: ‘‘, after consultation with States and other
appropriate public or nonprofit private entities’’; and
(9) in subsection ( j) (as so redesignated), by amending
the subsection to read as follows:
‘‘( j) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of
carrying out this section, there are authorized to be appropriated
such sums as may be necessary for each of the fiscal years 2001
through 2005.’’.
SEC. 1305. STATE GRANTS FOR PROTECTION AND ADVOCACY SERV-
ICES.
Part E of title XII of the Public Health Service Act (42 U.S.C.
300d–51 et seq.) is amended by adding at the end the following:
‘‘SEC. 1253. STATE GRANTS FOR PROTECTION AND ADVOCACY SERV-
ICES.
‘‘(a) IN GENERAL.—The Secretary, acting through the Adminis-
trator of the Health Resources and Services Administration
(referred to in this section as the ‘Administrator’), shall make grants
to protection and advocacy systems for the purpose of enabling
such systems to provide services to individuals with traumatic
brain injury.
‘‘(b) SERVICES PROVIDED.—Services provided under this section
may include the provision of—
‘‘(1) information, referrals, and advice;
‘‘(2) individual and family advocacy;
‘‘(3) legal representation; and
‘‘(4) specific assistance in self-advocacy.
‘‘(c) APPLICATION.—To be eligible to receive a grant under this
section, a protection and advocacy system shall submit an applica-
tion to the Administrator at such time, in such form and manner,
and accompanied by such information and assurances as the
Administrator may require.
‘‘(d) APPROPRIATIONS LESS THAN $2,700,000.—
‘‘(1) IN GENERAL.—With respect to any fiscal year in which
the amount appropriated under subsection (i) to carry out this
section is less than $2,700,000, the Administrator shall make
grants from such amount to individual protection and advocacy
systems within States to enable such systems to plan for,
develop outreach strategies for, and carry out services author-
ized under this section for individuals with traumatic brain
injury.
‘‘(2) AMOUNT.—The amount of each grant provided under
paragraph (1) shall be determined as set forth in paragraphs
(2) and (3) of subsection (e).
‘‘(e) APPROPRIATIONS OF $2,700,000 OR MORE.—
‘‘(1) POPULATION BASIS.—Except as provided in paragraph
(2), with respect to each fiscal year in which the amount appro-
priated under subsection (i) to carry out this section is
$2,700,000 or more, the Administrator shall make a grant
to a protection and advocacy system within each State.
‘‘(2) AMOUNT.—The amount of a grant provided to a system
under paragraph (1) shall be equal to an amount bearing the
same ratio to the total amount appropriated for the fiscal
H. R. 4365—42
year involved under subsection (i) as the population of the
State in which the grantee is located bears to the population
of all States.
‘‘(3) MINIMUMS.—Subject to the availability of appropria-
tions, the amount of a grant a protection and advocacy system
under paragraph (1) for a fiscal year shall—
‘‘(A) in the case of a protection and advocacy system
located in American Samoa, Guam, the United States
Virgin Islands, or the Commonwealth of the Northern Mar-
iana Islands, and the protection and advocacy system
serving the American Indian consortium, not be less than
$20,000; and
‘‘(B) in the case of a protection and advocacy system
in a State not described in subparagraph (A), not be less
than $50,000.
‘‘(4) INFLATION ADJUSTMENT.—For each fiscal year in which
the total amount appropriated under subsection (i) to carry
out this section is $5,000,000 or more, and such appropriated
amount exceeds the total amount appropriated to carry out
this section in the preceding fiscal year, the Administrator
shall increase each of the minimum grants amount described
in subparagraphs (A) and (B) of paragraph (3) by a percentage
equal to the percentage increase in the total amount appro-
priated under subsection (i) to carry out this section between
the preceding fiscal year and the fiscal year involved.
‘‘(f ) CARRYOVER.—Any amount paid to a protection and
advocacy system that serves a State or the American Indian consor-
tium for a fiscal year under this section that remains unobligated
at the end of such fiscal year shall remain available to such system
for obligation during the next fiscal year for the purposes for which
such amount was originally provided.
‘‘(g) DIRECT PAYMENT.—Notwithstanding any other provision
of law, the Administrator shall pay directly to any protection and
advocacy system that complies with the provisions of this section,
the total amount of the grant for such system, unless the system
provides otherwise for such payment.
‘‘(h) ANNUAL REPORT.—Each protection and advocacy system
that receives a payment under this section shall submit an annual
report to the Administrator concerning the services provided to
individuals with traumatic brain injury by such system.
‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—There are authorized
to be appropriated to carry out this section $5,000,000 for fiscal
year 2001, and such sums as may be necessary for each the fiscal
years 2002 through 2005.
‘‘( j) DEFINITIONS.—In this section:
‘‘(1) AMERICAN INDIAN CONSORTIUM.—The term ‘American
Indian consortium’ means a consortium established under part
C of the Developmental Disabilities Assistance Bill of Rights
Act (42 U.S.C. 6042 et seq.).
‘‘(2) PROTECTION AND ADVOCACY SYSTEM.—The term ‘protec-
tion and advocacy system’ means a protection and advocacy
system established under part C of the Developmental Disabil-
ities Assistance and Bill of Rights Act (42 U.S.C. 6042 et
seq.).
‘‘(3) STATE.—The term ‘State’, unless otherwise specified,
means the several States of the United States, the District
of Columbia, the Commonwealth of Puerto Rico, the United
H. R. 4365—43
States Virgin Islands, Guam, American Samoa, and the
Commonwealth of the Northern Mariana Islands.’’.
SEC. 1306. AUTHORIZATION OF APPROPRIATIONS FOR CERTAIN PRO-
GRAMS.
Section 394A of the Public Health Service Act (42 U.S.C. 280b–
3) is amended by striking ‘‘and’’ after ‘‘1994’’ and by inserting
before the period the following: ‘‘, and such sums as may be nec-
essary for each of the fiscal years 2001 through 2005.’’.
TITLE XIV—CHILD CARE SAFETY AND
HEALTH GRANTS
SEC. 1401. DEFINITIONS.
In this title:
(1) CHILD WITH A DISABILITY; INFANT OR TODDLER WITH
A DISABILITY.—The terms ‘‘child with a disability’’ and ‘‘infant
or toddler with a disability’’ have the meanings given the terms
in sections 602 and 632 of the Individuals with Disabilities
Education Act (20 U.S.C. 1401 and 1431).
(2) ELIGIBLE
CHILD
CARE
PROVIDER.—The term ‘‘eligible
child care provider’’ means a provider of child care services
for compensation, including a provider of care for a school-
age child during non-school hours, that—
(A) is licensed, regulated, registered, or otherwise
legally operating, under State and local law; and
(B) satisfies the State and local requirements,
applicable to the child care services the provider provides.
(3) SECRETARY.—The term ‘‘Secretary’’ means the Secretary
of Health and Human Services.
(4) STATE.—The term ‘‘State’’ means any of the several
States of the United States, the District of Columbia, the
Commonwealth of Puerto Rico, the United States Virgin
Islands, Guam, American Samoa, and the Commonwealth of
the Northern Mariana Islands.
SEC. 1402. AUTHORIZATION OF APPROPRIATIONS.
There are authorized to be appropriated to carry out this title
$200,000,000 for fiscal year 2001, and such sums as may be nec-
essary for each subsequent fiscal year.
SEC. 1403. PROGRAMS.
The Secretary shall make allotments to eligible States under
section 1404. The Secretary shall make the allotments to enable
the States to establish programs to improve the health and safety
of children receiving child care outside the home, by preventing
illnesses and injuries associated with that care and promoting the
health and well-being of children receiving that care.
SEC. 1404. AMOUNTS RESERVED; ALLOTMENTS.
(a) AMOUNTS RESERVED.—The Secretary shall reserve not more
than one-half of 1 percent of the amount appropriated under section
1402 for each fiscal year to make allotments to Guam, American
Samoa, the United States Virgin Islands, and the Commonwealth
of the Northern Mariana Islands to be allotted in accordance with
their respective needs.
(b) STATE ALLOTMENTS.—
H. R. 4365—44
(1) GENERAL RULE.—From the amounts appropriated under
section 1402 for each fiscal year and remaining after reserva-
tions are made under subsection (a), the Secretary shall allot
to each State an amount equal to the sum of—
(A) an amount that bears the same ratio to 50 percent
of such remainder as the product of the young child factor
of the State and the allotment percentage of the State
bears to the sum of the corresponding products for all
States; and
(B) an amount that bears the same ratio to 50 percent
of such remainder as the product of the school lunch factor
of the State and the allotment percentage of the State
bears to the sum of the corresponding products for all
States.
(2) YOUNG CHILD FACTOR.—In this subsection, the term
‘‘young child factor’’ means the ratio of the number of children
under 5 years of age in a State to the number of such children
in all States, as provided by the most recent annual estimates
of population in the States by the Census Bureau of the Depart-
ment of Commerce.
(3) SCHOOL LUNCH FACTOR.—In this subsection, the term
‘‘school lunch factor’’ means the ratio of the number of children
who are receiving free or reduced price lunches under the
school lunch program established under the National School
Lunch Act (42 U.S.C. 1751 et seq.) in the State to the number
of such children in all States, as determined annually by the
Department of Agriculture.
(4) ALLOTMENT PERCENTAGE.—
(A) IN GENERAL.—For purposes of this subsection, the
allotment percentage for a State shall be determined by
dividing the per capita income of all individuals in the
United States, by the per capita income of all individuals
in the State.
(B) LIMITATIONS.—If an allotment percentage deter-
mined under subparagraph (A) for a State—
(i) is more than 1.2 percent, the allotment percent-
age of the State shall be considered to be 1.2 percent;
and
(ii) is less than 0.8 percent, the allotment percent-
age of the State shall be considered to be 0.8 percent.
(C) PER
CAPITA
INCOME.—For purposes of subpara-
graph (A), per capita income shall be—
(i) determined at 2-year intervals;
(ii) applied for the 2-year period beginning on
October 1 of the first fiscal year beginning after the
date such determination is made; and
(iii) equal to the average of the annual per capita
incomes for the most recent period of 3 consecutive
years for which satisfactory data are available from
the Department of Commerce on the date such deter-
mination is made.
(c) DATA AND INFORMATION.—The Secretary shall obtain from
each appropriate Federal agency, the most recent data and informa-
tion necessary to determine the allotments provided for in sub-
section (b).
H. R. 4365—45
(d) DEFINITION.—In this section, the term ‘‘State’’ includes only
the several States of the United States, the District of Columbia,
and the Commonwealth of Puerto Rico.
SEC. 1405. STATE APPLICATIONS.
To be eligible to receive an allotment under section 1404, a
State shall submit an application to the Secretary at such time,
in such manner, and containing such information as the Secretary
may require. The application shall contain information assessing
the needs of the State with regard to child care health and safety,
the goals to be achieved through the program carried out by the
State under this title, and the measures to be used to assess
the progress made by the State toward achieving the goals.
SEC. 1406. USE OF FUNDS.
(a) IN GENERAL.—A State that receives an allotment under
section 1404 shall use the funds made available through the allot-
ment to carry out two or more activities consisting of—
(1) providing training and education to eligible child care
providers on preventing injuries and illnesses in children, and
promoting health-related practices;
(2) strengthening licensing, regulation, or registration
standards for eligible child care providers;
(3) assisting eligible child care providers in meeting
licensing, regulation, or registration standards, including
rehabilitating the facilities of the providers, in order to bring
the facilities into compliance with the standards;
(4) enforcing licensing, regulation, or registration standards
for eligible child care providers, including holding increased
unannounced inspections of the facilities of those providers;
(5) providing health consultants to provide advice to eligible
child care providers;
(6) assisting eligible child care providers in enhancing the
ability of the providers to serve children with disabilities and
infants and toddlers with disabilities;
(7) conducting criminal background checks for eligible child
care providers and other individuals who have contact with
children in the facilities of the providers;
(8) providing information to parents on what factors to
consider in choosing a safe and healthy child care setting;
or
(9) assisting in improving the safety of transportation prac-
tices for children enrolled in child care programs with eligible
child care providers.
(b) SUPPLEMENT, NOT SUPPLANT.—Funds appropriated pursu-
ant to the authority of this title shall be used to supplement
and not supplant other Federal, State, and local public funds
expended to provide services for eligible individuals.
SEC. 1407. REPORTS.
Each State that receives an allotment under section 1404 shall
annually prepare and submit to the Secretary a report that
describes—
(1) the activities carried out with funds made available
through the allotment; and
(2) the progress made by the State toward achieving the
goals described in the application submitted by the State under
section 1405.
H. R. 4365—46
TITLE XV—HEALTHY START INITIATIVE
SEC. 1501. CONTINUATION OF HEALTHY START PROGRAM.
Subpart I of part D of title III of the Public Health Service
Act, as amended by section 1211 of this Act, is amended by adding
at the end the following section:
‘‘SEC. 330H. HEALTHY START FOR INFANTS.
‘‘(a) IN GENERAL.—
‘‘(1) CONTINUATION AND EXPANSION OF PROGRAM.—The Sec-
retary, acting through the Administrator of the Health
Resources and Services Administration, Maternal and Child
Health Bureau, shall under authority of this section continue
in effect the Healthy Start Initiative and may, during fiscal
year 2001 and subsequent years, carry out such program on
a national basis.
‘‘(2) DEFINITION.—For purposes of paragraph (1), the term
‘Healthy Start Initiative’ is a reference to the program that,
as an initiative to reduce the rate of infant mortality and
improve perinatal outcomes, makes grants for project areas
with high annual rates of infant mortality and that, prior
to the effective date of this section, was a demonstration pro-
gram carried out under section 301.
‘‘(3) ADDITIONAL GRANTS.—Effective upon increased funding
beyond fiscal year 1999 for such Initiative, additional grants
may be made to States to assist communities with technical
assistance, replication of successful projects, and State policy
formation to reduce infant and maternal mortality and mor-
bidity.
‘‘(b) REQUIREMENTS FOR MAKING GRANTS.—In making grants
under subsection (a), the Secretary shall require that applicants
(in addition to meeting all eligibility criteria established by the
Secretary) establish, for project areas under such subsection,
community-based consortia of individuals and organizations
(including agencies responsible for administering block grant pro-
grams under title V of the Social Security Act, consumers of project
services, public health departments, hospitals, health centers under
section 330, and other significant sources of health care services)
that are appropriate for participation in projects under subsection
(a).
‘‘(c) COORDINATION.—Recipients of grants under subsection (a)
shall coordinate their services and activities with the State agency
or agencies that administer block grant programs under title V
of the Social Security Act in order to promote cooperation, integra-
tion, and dissemination of information with Statewide systems and
with other community services funded under the Maternal and
Child Health Block Grant.
‘‘(d) RULE OF CONSTRUCTION.—Except to the extent inconsistent
with this section, this section may not be construed as affecting
the authority of the Secretary to make modifications in the program
carried out under subsection (a).
‘‘(e) ADDITIONAL SERVICES FOR AT-RISK PREGNANT WOMEN AND
INFANTS.—
‘‘(1) IN GENERAL.—The Secretary may make grants to con-
duct and support research and to provide additional health
care services for pregnant women and infants, including grants
H. R. 4365—47
to increase access to prenatal care, genetic counseling,
ultrasound services, and fetal or other surgery.
‘‘(2) ELIGIBLE PROJECT AREA.—The Secretary may make
a grant under paragraph (1) only if the geographic area in
which services under the grant will be provided is a geographic
area in which a project under subsection (a) is being carried
out, and if the Secretary determines that the grant will add
to or expand the level of health services available in such
area to pregnant women and infants.
‘‘(3) EVALUATION BY GENERAL ACCOUNTING OFFICE.—
‘‘(A) IN GENERAL.—During fiscal year 2004, the Comp-
troller General of the United States shall conduct an
evaluation of activities under grants under paragraph (1)
in order to determine whether the activities have been
effective in serving the needs of pregnant women with
respect to services described in such paragraph. The evalua-
tion shall include an analysis of whether such activities
have been effective in reducing the disparity in health
status between the general population and individuals who
are members of racial or ethnic minority groups. Not later
than January 10, 2004, the Comptroller General shall
submit to the Committee on Commerce in the House of
Representatives, and to the Committee on Health, Edu-
cation, Labor, and Pensions in the Senate, a report
describing the findings of the evaluation.
‘‘(B) RELATION TO GRANTS REGARDING ADDITIONAL SERV-
ICES FOR AT-RISK PREGNANT WOMEN AND INFANTS.—Before
the date on which the evaluation under subparagraph (A)
is submitted in accordance with such subparagraph—
‘‘(i) the Secretary shall ensure that there are not
more than five grantees under paragraph (1); and
‘‘(ii) an entity is not eligible to receive grants under
such paragraph unless the entity has substantial
experience in providing the health services described
in such paragraph.
‘‘(f ) FUNDING.—
‘‘(1) GENERAL PROGRAM.—
‘‘(A) AUTHORIZATION OF APPROPRIATIONS.—For the pur-
pose of carrying out this section (other than subsection
(e)), there are authorized to be appropriated such sums
as may be necessary for each of the fiscal years 2001
through 2005.
‘‘(B) ALLOCATIONS.—
‘‘(i) PROGRAM
ADMINISTRATION.—Of the amounts
appropriated under subparagraph (A) for a fiscal year,
the Secretary may reserve up to 5 percent for coordina-
tion, dissemination, technical assistance, and data
activities that are determined by the Secretary to be
appropriate for carrying out the program under this
section.
‘‘(ii) EVALUATION.—Of the amounts appropriated
under subparagraph (A) for a fiscal year, the Secretary
may reserve up to 1 percent for evaluations of projects
carried out under subsection (a). Each such evaluation
shall include a determination of whether such projects
have been effective in reducing the disparity in health
H. R. 4365—48
status between the general population and individuals
who are members of racial or ethnic minority groups.
‘‘(2) ADDITIONAL SERVICES FOR AT-RISK PREGNANT WOMEN
AND INFANTS.—
‘‘(A) AUTHORIZATION OF APPROPRIATIONS.—For the pur-
pose of carrying out subsection (e), there are authorized
to be appropriated such sums as may be necessary for
each of the fiscal years 2001 through 2005.
‘‘(B) 
ALLOCATION
FOR
COMMUNITY-BASED
MOBILE
HEALTH
UNITS.—Of the amounts appropriated under
subparagraph (A) for a fiscal year, the Secretary shall
make available not less than 10 percent for providing serv-
ices under subsection (e) (including ultrasound services)
through visits by mobile units to communities that are
eligible for services under subsection (a).’’.
TITLE XVI—ORAL HEALTH PROMOTION
AND DISEASE PREVENTION
SEC. 1601. IDENTIFICATION OF INTERVENTIONS THAT REDUCE THE
BURDEN AND TRANSMISSION OF ORAL, DENTAL, AND
CRANIOFACIAL DISEASES IN HIGH RISK POPULATIONS;
DEVELOPMENT OF APPROACHES FOR PEDIATRIC ORAL
AND CRANIOFACIAL ASSESSMENT.
(a) IN GENERAL.—The Secretary of Health and Human Services,
through the Maternal and Child Health Bureau, the Indian Health
Service, and in consultation with the National Institutes of Health
and the Centers for Disease Control and Prevention, shall—
(1) support community-based research that is designed to
improve understanding of the etiology, pathogenesis, diagnosis,
prevention, and treatment of pediatric oral, dental, craniofacial
diseases and conditions and their sequelae in high risk popu-
lations;
(2) support demonstrations of preventive interventions in
high risk populations including nutrition, parenting, and
feeding techniques; and
(3) develop clinical approaches to assess individual patients
for the risk of pediatric dental disease.
(b) COMPLIANCE WITH STATE PRACTICE LAWS.—Treatment and
other services shall be provided pursuant to this section by licensed
dental health professionals in accordance with State practice and
licensing laws.
(c) AUTHORIZATION OF APPROPRIATIONS.—There are authorized
to be appropriated such sums as may be necessary to carry out
this section for each the fiscal years 2001 through 2005.
SEC. 1602. ORAL HEALTH PROMOTION AND DISEASE PREVENTION.
Part B of title III of the Public Health Service Act, as amended
by section 911 of this Act, is amended by inserting after section
317L the following section:
‘‘ORAL HEALTH PROMOTION AND DISEASE PREVENTION
‘‘SEC. 317M. (a) GRANTS TO INCREASE RESOURCES FOR COMMU-
NITY WATER FLUORIDATION.—
H. R. 4365—49
‘‘(1) IN
GENERAL.—The Secretary, acting through the
Director of the Centers for Disease Control and Prevention,
may make grants to States and Indian tribes for the purpose
of increasing the resources available for community water
fluoridation.
‘‘(2) USE OF FUNDS.—A State shall use amounts provided
under a grant under paragraph (1)—
‘‘(A) to purchase fluoridation equipment;
‘‘(B) to train fluoridation engineers;
‘‘(C) to develop educational materials on the benefits
of fluoridation; or
‘‘(D) to support the infrastructure necessary to monitor
and maintain the quality of water fluoridation.
‘‘(b) COMMUNITY WATER FLUORIDATION.—
‘‘(1) IN
GENERAL.—The Secretary, acting through the
Director of the Centers for Disease Control and Prevention
and in collaboration with the Director of the Indian Health
Service, shall establish a demonstration project that is designed
to assist rural water systems in successfully implementing the
water fluoridation guidelines of the Centers for Disease Control
and Prevention that are entitled ‘Engineering and Administra-
tive Recommendations for Water Fluoridation, 1995’ (referred
to in this subsection as the ‘EARWF’).
‘‘(2) REQUIREMENTS.—
‘‘(A) COLLABORATION.—In collaborating under para-
graph (1), the Directors referred to in such paragraph
shall ensure that technical assistance and training are
provided to tribal programs located in each of the 12 areas
of the Indian Health Service. The Director of the Indian
Health Service shall provide coordination and administra-
tive support to tribes under this section.
‘‘(B) GENERAL USE OF FUNDS.—Amounts made available
under paragraph (1) shall be used to assist small water
systems in improving the effectiveness of water fluoridation
and to meet the recommendations of the EARWF.
‘‘(C) FLUORIDATION SPECIALISTS.—
‘‘(i) IN GENERAL.—In carrying out this subsection,
the Secretary shall provide for the establishment of
fluoridation specialist engineering positions in each of
the Dental Clinical and Preventive Support Centers
through which technical assistance and training will
be provided to tribal water operators, tribal utility
operators and other Indian Health Service personnel
working directly with fluoridation projects.
‘‘(ii) LIAISON.—A fluoridation specialist shall serve
as the principal technical liaison between the Indian
Health Service and the Centers for Disease Control
and Prevention with respect to engineering and fluori-
dation issues.
‘‘(iii) CDC.—The Director of the Centers for Dis-
ease Control and Prevention shall appoint individuals
to serve as the fluoridation specialists.
‘‘(D) IMPLEMENTATION.—The project established under
this subsection shall be planned, implemented and evalu-
ated over the 5-year period beginning on the date on which
funds are appropriated under this section and shall be