II 118th CONGRESS 2d Session S. 3981 IN THE SENATE OF THE UNITED STATES March 19, 2024 Mr. Hickenlooper (for himself and Mr. Moran ) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions A BILL To amend the Public Health Service Act to authorize the Secretary of Health and Human Services to carry out a program of research, training, and investigation related to Down syndrome, and for other purposes.

1. Short title This Act may be cited as the DeOndra Dixon INCLUDE Project Act of 2024 . 2. Findings Congress finds the following: (1) Down syndrome is the most common chromosomal disorder. Each year, about 6,000 babies born in the United States have Down syndrome, affecting about 1 in every 700 babies born. (2) Individuals with Down syndrome have a full or partial extra copy of chromosome 21 that leads to certain physical, intellectual, and developmental challenges. (3) Life expectancy of individuals with Down syndrome in the United States has increased dramatically in recent decades. In 1960, the average life expectancy was about 10 years. Today, the average life expectancy of an individual with Down syndrome is nearly 60 years. (4) Individuals with Down syndrome can attend school, work, make their own life decisions, have meaningful relationships, vote, and contribute to society. (5) Individuals with Down syndrome are at an increased risk for certain medical conditions, such as autoimmune disorders, leukemia, congenital heart disease, sleep dysfunction, and Alzheimer’s disease, but may be at a decreased risk for other conditions. (6) Research and medical care supporting individuals with Down syndrome and their unique disease profile will improve health outcomes and may potentially lead to treatments for individuals born with or without Down syndrome who suffer from diseases associated with that unique profile. 3. Down syndrome research 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: 404P. Down syndrome research (a) In general The Secretary, acting through the Office of the Director of NIH, and in consultation with other Federal agencies and partners, shall carry out, directly or through grants or contracts, a program of research, training, and investigation related to Down syndrome to be known as the INvestigation of Co-occurring conditions across the Lifespan to Understand Down syndromE Project or the INCLUDE Project. (b) Program elements The program under subsection (a) shall include research, training, and investigation related to— (1) high-risk, high reward basic science studies of the effects of chromosome 21 on human development and health; (2) assembling and maintaining a large study population of individuals with Down syndrome; (3) expanding the number of clinical trials that are inclusive of, or expressly for, individuals with Down syndrome, including novel biomedical and pharmacological interventions and other therapies designed to promote or enhance activities of daily living; (4) the biological mechanisms in individuals with Down syndrome responsible for structural and functional anomalies in cells, tissues, and organs, cognitive and behavioral dysfunction, and stunted growth; (5) the identification of biomarkers for the detection of risk factors, diagnosis, and customized interventions and treatments for conditions co-occurring with Down syndrome; (6) why several co-occurring conditions, such as Alzheimer’s disease and autoimmunity, are prevalent in individuals with Down syndrome and how such conditions can be treated concurrently with Down syndrome; and (7) improving the quality of life of individuals with Down syndrome and their families. (c) Coordination; prioritizing nonduplicative research The Secretary shall ensure that— (1) the programs and activities of the institutes, centers, agencies, and offices of the National Institutes of Health relating to Down syndrome and co-occurring conditions are coordinated, including through the Division of Program Coordination, Planning, and Strategic Initiatives under sections 402(b)(7) and 402A(c); and (2) such institutes, centers, agencies, and offices prioritize, as appropriate, Down syndrome research that does not duplicate existing research activities of the National Institutes of Health. (d) Technical assistance The Secretary shall provide technical assistance to grantees and other involved entities, as appropriate, for carrying out activities pursuant to this section. (e) Biennial reports to Congress (1) In general The Secretary shall submit, on a biennial basis, to the Committee on Energy and Commerce and the Subcommittee on Labor, Health and Human Services, Education and Related Agencies of the Committee on Appropriations of the House of Representatives and the Committee on Health, Education, Labor, and Pensions and the Subcommittee on Labor, Health and Human Services, Education, and Related Agencies of the Committee on Appropriations of the Senate, a report that catalogs the research conducted or supported under this section. (2) Contents Each report under paragraph (1) shall include— (A) identification of the institute, center, agency, office, or entity involved; (B) a statement of whether the research is or was being carried out directly by the institute, center, agency, office, or entity or by multiple institutes, centers, agencies, offices, or entities; and (C) identification of any resulting real world evidence that is or may be used for clinical research and medical care for patients with Down syndrome. (f) Authorization of appropriations (1) In general To carry out this section, there is authorized to be appropriated $250,000,000 for each of fiscal years 2025 through 2029. (2) Supplement, not supplant Funds appropriated to carry out this section shall be used to supplement, not supplant, other funds allocated by the National Institutes of Health for research and other activities relating to Down syndrome. .