[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3301 Introduced in House (IH)]







106th CONGRESS
  1st Session
                                H. R. 3301

   To amend the Public Health Service Act with respect to children's 
                                health.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           November 10, 1999

Mr. Bilirakis (for himself, Mr. Brown of Ohio, Mrs. Emerson, Mr. Towns, 
  Mr. Greenwood, Mr. Upton, Ms. DeGette, Mr. Smith of New Jersey, Mr. 
    Waxman, and Mr. Walsh) introduced the following bill; which was 
                 referred to the Committee on Commerce

_______________________________________________________________________

                                 A BILL


 
   To amend the Public Health Service Act with respect to children's 
                                health.

    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 ``Children's Health Research and 
Prevention Amendments of 1999''.

SEC. 2. TABLE OF CONTENTS.

    The table of contents for this Act is as follows:

Sec. 1. Short title.
Sec. 2. Table of contents.
              TITLE I--REVISION AND EXTENSION OF PROGRAMS

               Subtitle A--Pediatric Research Initiative

Sec. 101. Short title.
Sec. 102. Establishment of a pediatric research initiative.
Sec. 103. Investment in tomorrow's pediatric researchers.
                       Subtitle B--Other Programs

Sec. 111. Childhood immunizations.
Sec. 112. Screenings, referrals, and education regarding lead 
                            poisoning.
Sec. 113. Prevention and control of injuries; traumatic brain injury.
     TITLE II--CHILDREN'S HEALTH RESEARCH AND PREVENTION ACTIVITIES

Subtitle A--Early Detection, Diagnosis, and Treatment Regarding Hearing 
                            Loss in Infants

Sec. 201. Short title.
Sec. 202. Early detection, diagnosis, and interventions for newborns 
                            and infants with hearing loss.
                           Subtitle B--Autism

 Chapter 1--Surveillance and Research Regarding Prevalence and Pattern 
                               of Autism

Sec. 211. Short title.
Sec. 212. Developmental disabilities surveillance and research 
                            programs.
Sec. 213. Clearinghouse.
Sec. 214. Advisory committee.
Sec. 215. Report to Congress.
Sec. 216. Definition.
Sec. 217. Authorization of appropriations.
 Chapter 2--Expansion, Intensification, and Coordination of Activities 
   of Department of Health and Human Services With Respect to Autism

Sec. 218. Short title.
Sec. 218A. Expansion, intensification, and coordination of activities 
                            of National Institutes of Health.
Sec. 219. Developmental disabilities surveillance and research 
                            programs.
Sec. 220. Information and education.
Sec. 220A. Interagency autism coordinating committee.
Sec. 220B. Report to Congress.
      Subtitle C--Poison Control Center Enhancement and Awareness

Sec. 221. Short title.
Sec. 222. Definition.
Sec. 223. Establishment of a national toll-free number.
Sec. 224. Establishment of nationwide media campaign.
Sec. 225. Establishment of a grant program.
            Subtitle D--Birth Defects Prevention Activities

                    Chapter 1--Folic Acid Promotion

Sec. 231. Short title.
Sec. 232. Program regarding effects of folic acid in prevention of 
                            birth defects.
     Chapter 2--National Center on Birth Defects and Developmental 
                              Disabilities

Sec. 236. National Center on Birth Defects and Developmental 
                            Disabilities.
     Subtitle E--Safe Motherhood Monitoring and Prevention Research

Sec. 241. Short title.
Sec. 242. Amendment to Public Health Service Act.
       Subtitle F--Pregnant Mothers and Infants Health Promotion

Sec. 251. Short title.
Sec. 252. Establishment.
         Subtitle G--Utilization of Preventive Health Services

Sec. 261. Grants regarding utilization of preventive health services.
        Subtitle H--Research and Development Regarding Fragile X

Sec. 266. Short title.
Sec. 267. National Institute of Child Health and Human Development; 
                            research on fragile X.
Sec. 268. National Institute of Child Health and Human Development; 
                            loan repayment program regarding research 
                            on fragile X.
                   Subtitle I--Children and Epilepsy

Sec. 271. Programs of the Centers for Disease Control and Prevention; 
                            national public health campaign on 
                            epilepsy.
Sec. 272. Programs of Health Resources and Services Administration; 
                            State and local grants for seizure disorder 
                            demonstration projects in medically 
                            underserved areas.
Sec. 273. Definitions.
           Subtitle J--Asthma Treatment Services for Children

Sec. 276. Short title.
Sec. 277. Children's asthma relief.
Sec. 278. Incorporation of asthma prevention treatment and services 
                            into State children's health insurance 
                            programs.
Sec. 279. Preventive health and health services block grant; systems 
                            for reducing asthma and asthma-related 
                            illnesses through urban cockroach 
                            management.
Sec. 279A. Coordination of Federal activities to address asthma-related 
                            health care needs.
Sec. 279B. Compilation of data by the Centers for Disease Control and 
                            Prevention.
         Subtitle K--Juvenile Arthritis and Related Conditions

Sec. 281. Research on juvenile arthritis and related conditions.
              Subtitle L--Childhood Skeletal Malignancies

Sec. 286. Programs of Centers for Disease Control and Prevention.
    Subtitle M--Reducing Burden of Diabetes Among Children and Youth

Sec. 291. Programs regarding diabetes in children and youth.
                  Subtitle N--Miscellaneous Provisions

Sec. 296. Report regarding research on rare diseases in children.

              TITLE I--REVISION AND EXTENSION OF PROGRAMS

               Subtitle A--Pediatric Research Initiative

SEC. 101. SHORT TITLE.

    This subtitle may be cited as the ``Pediatric Research Initiative 
Act of 1999''.

SEC. 102. ESTABLISHMENT OF A PEDIATRIC RESEARCH INITIATIVE.

    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:

``SEC. 404F. PEDIATRIC RESEARCH INITIATIVE.

    ``(a) Establishment.--The Secretary shall establish within the 
Office of the Director of NIH a Pediatric Research Initiative (referred 
to in this section as the `Initiative'). The Initiative shall be headed 
by the Director of NIH.
    ``(b) Purpose.--The purpose of the Initiative is to provide funds 
to enable the Director of NIH to encourage--
            ``(1) increased support for pediatric biomedical research 
        within the National Institutes of Health to ensure that the 
        expanding opportunities for advancement in scientific 
        investigations and care for children are realized;
            ``(2) enhanced collaborative efforts among the Institutes 
        to support multidisciplinary research in the areas that the 
        Director deems most promising; and
            ``(3) the development of adequate pediatric clinical trials 
        and pediatric use information to promote the safer and more 
        effective use of prescription drugs in the pediatric 
        population.
    ``(c) Duties.--In carrying out subsection (b), the Director of NIH 
shall--
            ``(1) consult with the Institute of Child Health and Human 
        Development and the other Institutes, in considering their 
        requests for new or expanded pediatric research efforts, and 
        consult with other advisors as the Director determines 
        appropriate;
            ``(2) have broad discretion in the allocation of any 
        Initiative assistance among the Institutes, among types of 
        grants, and between basic and clinical research so long as 
        the--
                    ``(A) assistance is directly related to the 
                illnesses and conditions of children; and
                    ``(B) assistance is extramural in nature; and
            ``(3) be responsible for the oversight of any newly 
        appropriated Initiative funds and annually report to Congress 
        and the public on the extent of the total extramural support 
        for pediatric research across the NIH, including the specific 
        support and research awards allocated through the Initiative.
    ``(d) Authorization.--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 2000 through 2003.
    ``(e) Transfer of Funds.--The Director of NIH may transfer amounts 
appropriated under this section to any of the Institutes for a fiscal 
year to carry out the purposes of the Initiative under this section.''.

SEC. 103. INVESTMENT IN TOMORROW'S PEDIATRIC
              RESEARCHERS.

    Subpart 7 of part C of title IV of the Public Health Service Act 
(42 U.S.C. 285g et seq.) is amended by adding at the end the following:

``SEC. 452E. INVESTMENT IN TOMORROW'S PEDIATRIC
              RESEARCHERS.

    ``(a) In General.--The Secretary shall make available within the 
National Institute of Child Health and Human Development enhanced 
support for extramural activities relating to the training and career 
development of pediatric researchers.
    ``(b) Purpose.--The purpose of support provided under subsection 
(a) shall be to ensure the future supply of researchers dedicated to 
the care and research needs of children by providing for--
            ``(1) an increase in the number and size of institutional 
        training grants to medical school pediatric departments and 
        children's hospitals; and
            ``(2) an increase in the number of career development 
        awards for pediatricians building careers in pediatric basic 
        and clinical research.
    ``(c) Authorization.--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 2000 through 2003.''.

                       Subtitle B--Other Programs

SEC. 111. CHILDHOOD IMMUNIZATIONS.

    Section 317(j)(1) of the Public Health Service Act (42 U.S.C. 
247b(j)(1)) is amended in the first sentence by striking ``1998'' and 
all that follows and inserting ``1998 through 2003.''.

SEC. 112. SCREENINGS, REFERRALS, AND EDUCATION
              REGARDING LEAD POISONING.

    Section 317A(l)(1) of the Public Health Service Act (42 U.S.C. 
247b-1(l)(1)) is amended by striking ``1994'' and all that follows and 
inserting ``1994 through 2003.''.

SEC. 113. PREVENTION AND CONTROL OF INJURIES; TRAUMATIC BRAIN INJURY.

    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 necessary for each of 
the fiscal years 2000 through 2003.''.

     TITLE II--CHILDREN'S HEALTH RESEARCH AND PREVENTION ACTIVITIES

Subtitle A--Early Detection, Diagnosis, and Treatment Regarding Hearing 
                            Loss in Infants

SEC. 201. SHORT TITLE.

    This subtitle may be cited as the ``Newborn and Infant Hearing 
Screening and Intervention Act of 1999''.

SEC. 202. EARLY DETECTION, DIAGNOSIS, AND INTERVENTIONS FOR NEWBORNS 
              AND INFANTS WITH HEARING LOSS.

    (a) Definitions.--For the purposes of this subtitle only, the 
following terms in this section are defined as follows:
            (1) Hearing screening.--Newborn and infant hearing 
        screening consists of objective physiologic procedures to 
        detect possible hearing loss and to identify newborns and 
        infants who, after rescreening, require further audiologic and 
        medical evaluations.
            (2) Audiologic evaluation.--Audiologic evaluation consists 
        of procedures to assess the status of the auditory system; to 
        establish the site of the auditory disorder; the type and 
        degree of hearing loss, and the potential effects of hearing 
loss on communication; and to identify appropriate treatment and 
referral options. Referral options should include linkage to state IDEA 
Part C coordinating agencies or other appropriate agencies, medical 
evaluation, hearing aid/sensory aid assessment, audiologic 
rehabilitation treatment, national and local consumer, self-help, 
parent, and education organizations, and other family-centered 
services.
            (3) Medical evaluation.--Medical evaluation by a physician 
        consists of key components including history, examination, and 
        medical decision making focused on symptomatic and related body 
        systems for the purpose of diagnosing the etiology of hearing 
        loss and related physical conditions, and for identifying 
        appropriate treatment and referral options.
            (4) Medical intervention.--Medical intervention is the 
        process by which a physician provides medical diagnosis and 
        direction for medical and/or surgical treatment options of 
        hearing loss and/or related medical disorder associated with 
        hearing loss.
            (5) Audiologic rehabilitation.--Audiologic rehabilitation 
        (intervention) consists of procedures, techniques, and 
        technologies to facilitate the receptive and expressive 
        communication abilities of a child with hearing loss.
            (6) Early intervention.--Early intervention (e.g., 
        nonmedical) means providing appropriate services for the child 
        with hearing loss and ensuring that families of the child are 
        provided comprehensive, consumer-oriented information about the 
        full range of family support, training, information services, 
        communication options and are given the opportunity to consider 
        the full range of educational and program placements and 
        options for their child.
    (b) Purposes.--The purposes of this subtitle are to clarify the 
authority within the Public Health Service Act to authorize statewide 
newborn and infant hearing screening, evaluation and intervention 
programs and systems, technical assistance, a national applied research 
program, and interagency and private sector collaboration for policy 
development, in order to assist the States in making progress toward 
the following goals:
            (1) All babies born in hospitals in the United States and 
        its territories should have a hearing screening before leaving 
        the birthing facility. Babies born in other countries and 
        residing in the United States via immigration or adoption 
        should have a hearing screening as early as possible.
            (2) All babies who are not born in hospitals in the United 
        States and its territories should have a hearing screening 
        within the first 3 months of life.
            (3) Appropriate audiologic and medical evaluations should 
        be conducted by 3 months for all newborns and infants suspected 
        of having hearing loss to allow appropriate referral and 
        provisions for audiologic rehabilitation, medical and early 
        intervention before the age of 6 months.
            (4) All newborn and infant hearing screening programs and 
        systems should include a component for audiologic 
        rehabilitation, medical and early intervention options that 
        ensures linkage to any new and existing state-wide systems of 
        intervention and rehabilitative services for newborns and 
        infants with hearing loss.
            (5) Public policy in regard to newborn and infant hearing 
        screening and intervention should be based on applied research 
        and the recognition that newborns, infants, toddlers, and 
        children who are deaf or hard-of-hearing have unique language, 
        learning, and communication needs, and should be the result of 
        consultation with pertinent public and private sectors.
    (c) Statewide Newborn and Infant Hearing Screening, Evaluation and 
Intervention Programs and Systems.--The Secretary of Health and Human 
Services (in this subtitle referred to as the ``Secretary''), acting 
through the Administrator of the Health Resources and Services 
Administration, shall make awards of grants or cooperative agreements 
to develop statewide newborn and infant hearing screening, evaluation 
and intervention programs and systems for the following purposes:
            (1) To develop and monitor the efficacy of state-wide 
        newborn and infant hearing screening, evaluation and 
        intervention programs and systems. Early intervention includes 
        referral to schools and agencies, including community, 
        consumer, and parent-based agencies and organizations and other 
        programs mandated by Part C of the Individuals with 
        Disabilities Education Act, which offer programs specifically 
        designed to meet the unique language and communication needs of 
        deaf and hard of hearing newborns, infants, toddlers, and 
        children.
            (2) To collect data on statewide newborn and infant hearing 
        screening, evaluation and intervention programs and systems 
        that can be used for applied research, program evaluation and 
        policy development.
    (d) Technical Assistance, Data Management, and Applied Research.--
            (1) Centers for disease control and prevention.--The 
        Secretary, acting through the Director of the Centers for 
        Disease Control and Prevention, shall make awards of grants or 
        cooperative agreements to provide technical assistance to State 
        agencies to complement an intramural program and to conduct 
        applied research related to newborn and infant hearing 
        screening, evaluation and intervention programs and systems. 
        The program shall develop standardized procedures for data 
        management and program effectiveness and costs, such as--
                    (A) to ensure quality monitoring of newborn and 
                infant hearing loss screening, evaluation, and 
                intervention programs and systems;
                    (B) to provide technical assistance on data 
                collection and management;
                    (C) to study the costs and effectiveness of newborn 
                and infant hearing screening, evaluation and 
                intervention programs and systems conducted by State-
                based programs in order to answer issues of importance 
to state and national policymakers;
                    (D) to identify the causes and risk factors for 
                congenital hearing loss;
                    (E) to study the effectiveness of newborn and 
                infant hearing screening, audiologic and medical 
                evaluations and intervention programs and systems by 
                assessing the health, intellectual and social 
                developmental, cognitive, and language status of these 
                children at school age; and
                    (F) to promote the sharing of data regarding early 
                hearing loss with state-based birth defects and 
                developmental disabilities monitoring programs for the 
                purpose of identifying previously unknown causes of 
                hearing loss.
            (2) National institutes of health.--The Director of the 
        National Institutes of Health, acting through the Director of 
        the National Institute on Deafness and Other Communication 
        Disorders, shall for purposes of this section, continue a 
        program of research and development on the efficacy of new 
        screening techniques and technology, including clinical studies 
        of screening methods, studies on efficacy of intervention, and 
        related research.
    (e) Coordination and Collaboration.--
            (1) In general.--In carrying out programs under this 
        section, the Administrator of the Health Resources and Services 
        Administration, the Director of the Centers for Disease Control 
        and Prevention, and the Director of the National Institutes of 
        Health shall collaborate and consult with other Federal 
        agencies; State and local agencies, including those responsible 
        for early intervention services pursuant to Title XIX of the 
        Social Security Act (Medicaid Early and Periodic Screening, 
        Diagnosis and Treatment Program); Title XXI of the Social 
        Security Act (State Children's Health Insurance Program); Title 
        V of the Social Security Act (Maternal and Child Health Block 
        Grant Program; and Part C of the Individuals with Disabilities 
        Education Act); consumer groups of and that serve individuals 
        who are deaf and hard-of-hearing and their families; 
        appropriate national medical and other health and education 
        specialty organizations; persons who are deaf and hard-of-
        hearing and their families; other qualified professional 
        personnel who are proficient in deaf or hard-of-hearing 
        children's language and who possess the specialized knowledge, 
        skills, and attributes needed to serve deaf and hard-of-hearing 
        newborns, infants, toddlers, children, and their families; 
        third-party payers and managed care organizations; and related 
        commercial industries.
            (2) Policy development.--The Administrator of the Health 
        Resources and Services Administration, the Director of the 
        Centers for Disease Control and Prevention, and the Director of 
        the National Institutes of Health shall coordinate and 
        collaborate on recommendations for policy development at the 
        Federal and state levels and with the private sector, including 
        consumer, medical and other health and education professional-
        based organizations, with respect to newborn and infant hearing 
        screening, evaluation and intervention programs and systems.
            (3) State early detection, diagnosis, and intervention 
        programs and systems; data collection.--The Administrator of 
        the Health Resources and Services Administration and the 
        Director of the Centers for Disease Control and Prevention 
        shall coordinate and collaborate in assisting States to 
        establish newborn and infant hearing screening, evaluation and 
        intervention programs and systems under subsection (c) and to 
        develop a data collection system under subsection (d).
    (f) Rule of Construction.--Nothing in this subtitle shall be 
construed to preempt any State law.
    (g) Authorization of Appropriations.--
            (1) Statewide newborn and infant hearing screening, 
        evaluation and intervention programs and systems.--For the 
        purpose of carrying out subsection (c), there are authorized to 
        be appropriated to the Health Resources and Services 
        Administration such sums as may be necessary for each of the 
        fiscal years 2000 through 2003.
            (2) Technical assistance, data management, and applied 
        research; centers for disease control and prevention.--For the 
        purpose of carrying out subsection (d)(1), there are authorized 
        to be appropriated to the Centers for Disease Control and 
        Prevention such sums as may be necessary for each of the fiscal 
        years 2000 through 2003.
            (3) Technical assistance, data management, and applied 
        research; national institute on deafness and other 
        communication disorders.--For the purpose of carrying out 
        subsection (d)(2), there are authorized to be appropriated to 
        the National Institute on Deafness and Other Communication 
        Disorders such sums as may be necessary for each of the fiscal 
        years 2000 through 2003.

                           Subtitle B--Autism

 CHAPTER 1--SURVEILLANCE AND RESEARCH REGARDING PREVALENCE AND PATTERN 
                               OF AUTISM

SEC. 211. SHORT TITLE.

    This chapter may be cited as the ``Autism Statistics, Surveillance, 
Research, and Epidemiology Act of 1999 (ASSURE)''.

SEC. 212. DEVELOPMENTAL DISABILITIES SURVEILLANCE AND RESEARCH 
              PROGRAMS.

    (a) National Autism and Pervasive Developmental Disabilities 
Surveillance Program.--The Secretary of Health and Human Services (in 
this chapter referred to as the ``Secretary''), acting through the 
Director of the Centers for Disease Control and Prevention, may make 
awards of grants and cooperative agreements for the collection, 
analysis, and reporting of data on autism and pervasive developmental 
disabilities. An entity may receive such an award only if the entity is 
a public or nonprofit private entity (including health departments of 
States and political subdivisions of States, and including universities 
and other educational entities). In making such awards, the Secretary 
may provide direct technical assistance in lieu of cash.
    (b) Centers of Excellence in Autism and Pervasive Developmental 
Disabilities Epidemiology.--
            (1) In general.--The Secretary, acting through the Director 
        of the Centers for Disease Control and Prevention, shall 
        (subject to the extent of amounts made available in 
        appropriations Acts) establish not less than three, and not 
        more than five, regional centers of excellence in autism and 
        pervasive developmental disabilities epidemiology for the 
        purpose of collecting and analyzing information on the number, 
        incidence, correlates, and causes of autism and related 
        developmental disabilities.
            (2) Recipients of awards for establishment of centers.--
        Centers under paragraph (1) shall be established and operated 
        through the award of grants or cooperative agreements to public 
        or nonprofit private entities that conduct research, including 
        health departments of States and political subdivisions of 
        States, and including universities and other educational 
        entities.
            (3) Certain requirements.--An award for a center under 
        paragraph (1) may be made only if the entity involved submits 
        to the Secretary an application containing such agreements and 
        information as the Secretary may require, including an 
        agreement that the center involved will operate in accordance 
        with the following:
                    (A) The center will collect, analyze, and report 
                autism and pervasive developmental disabilities data 
                according to guidelines prescribed by the Director, 
                after consultation with relevant State and local public 
                health officials, private sector developmental 
                disability researchers, and advocates for those with 
                developmental disabilities;
                    (B) The center will assist with the development and 
                coordination of State autism and pervasive 
                developmental disabilities surveillance efforts within 
                a region;
                    (C) The center will provide education, training, 
                and clinical skills improvement for health 
                professionals aimed at better understanding and 
                treatment of autism and related developmental 
                disabilities; and
                    (D) The center will identify eligible cases and 
                controls through its surveillance systems and conduct 
                research into factors which may cause autism and 
                related developmental disabilities; each program will 
                develop or extend an area of special research expertise 
                (including, but not limited to, genetics, environmental 
                exposure to contaminants, immunology, and other 
                relevant research specialty areas).

SEC. 213. CLEARINGHOUSE.

    The Secretary, acting through the Director of the Centers for 
Disease Control and Prevention, shall carry out the following:
            (1) The Centers for Disease Control and Prevention shall 
        serve as the coordinating agency for autism and pervasive 
        developmental disabilities surveillance activities through the 
        establishment of a clearinghouse for the collection and storage 
        of data generated from the monitoring programs created by this 
        chapter. The functions of such a clearinghouse shall include 
        facilitating the coordination of research and policy 
        development relating to the epidemiology of autism and other 
        pervasive developmental disabilities.
            (2) The Secretary, acting through the Centers for Disease 
        Control and Prevention, shall coordinate the Federal response 
        to requests for assistance from State health department 
        officials regarding potential or alleged autism or 
        developmental disability clusters.

SEC. 214. ADVISORY COMMITTEE.

    (a) In General.--The Secretary shall establish an Advisory 
Committee for Autism and Pervasive Developmental Disabilities 
Epidemiology Research (in this section referred to as the 
``Committee''). The Committee shall provide advice and recommendations 
to the Director of the Centers for Disease Control and Prevention on--
            (1) the establishment of a national autism and pervasive 
        developmental disabilities surveillance program;
            (2) the establishment of centers of excellence in autism 
        and pervasive developmental disabilities epidemiology;
            (3) methods and procedures to more effectively coordinate 
        government and non-government programs and research on autism 
        and pervasive developmental disabilities epidemiology; and
            (4) the effective operation of autism and pervasive 
        developmental disabilities epidemiology research activities.
    (b) Composition.--
            (1) In general.--The Committee shall be composed of ex 
        officio members in accordance with paragraph (2) and 11 
        appointed members in accordance with paragraph (3).
            (2) Ex officio members.--The following officials shall 
        serve as ex officio members of the Committee:
                    (A) The Director of the National Center for 
                Environmental Health.
                    (B) The Assistant Administrator of the Agency for 
                Toxic Substances and Disease Registry.
                    (C) The Director of the National Institute of Child 
                Health and Human Development.
                    (D) The Director of the National Institute of 
                Neurological Disorders and Stroke.
            (3) Appointed members.--Appointments to the Committee shall 
        be made in accordance with the following:
                    (A) Two members shall be research scientists with 
                demonstrated achievements in research related to autism 
                and related developmental disabilities. The scientists 
                shall be appointed by the Secretary in consultation 
                with the National Academy of Sciences.
                    (B) Five members shall be representatives of the 
                five national organizations whose primary emphasis is 
on research into autism and other pervasive developmental disabilities. 
One representative from each of such organizations shall be appointed 
by the Secretary in consultation with the National Academy of Sciences.
                    (C) Two members shall be clinicians whose practice 
                is primarily devoted to the treatment of individuals 
                with autism and other pervasive developmental 
                disabilities. The clinicians shall be appointed by the 
                Secretary in consultation with the Institute of 
                Medicine and the National Academy of Sciences.
                    (D) Two members shall be individuals who are the 
                parents or legal guardians of a person or persons with 
                autism or other pervasive developmental disabilities. 
                The individuals shall be appointed by the Secretary in 
                consultation with the ex officio members under 
                paragraph (1) and the five national organizations 
                referred to in subparagraph (B).
    (c) Administrative Support; Terms of Service; Other Provisions.--
The following apply with respect to the Committee:
            (1) The Committee shall receive necessary and appropriate 
        administrative support from the Department of Health and Human 
        Services.
            (2) Members of the Committee shall be appointed for a term 
        of three years, and may serve for an unlimited number of terms 
        if reappointed.
            (3) The Committee shall meet no less than two times per 
        year.
            (4) Members of the Committee shall not receive additional 
        compensation for their service. Such members may receive 
        reimbursement for appropriate and additional expenses that are 
        incurred through service on the Committee which would not have 
        incurred had they not been a member of the Committee.

SEC. 215. REPORT TO CONGRESS.

    The Secretary shall prepare and submit to the Congress, after 
consultation and comment by the Advisory Committee, an annual report 
regarding the prevalence and incidence of autism and other pervasive 
developmental disorders, the results of research into the etiology of 
autism and other pervasive developmental disorders, public health 
responses to known or preventable causes of autism and other pervasive 
developmental disorders, and the need for additional research into 
promising lines of scientific inquiry.

SEC. 216. DEFINITION.

    For purposes of this chapter, 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.

SEC. 217. AUTHORIZATION OF APPROPRIATIONS.

    For the purpose of carrying out this chapter, there are authorized 
to be appropriated such sums as may be necessary for each of the fiscal 
years 2000 through 2003.

 CHAPTER 2--EXPANSION, INTENSIFICATION, AND COORDINATION OF ACTIVITIES 
   OF DEPARTMENT OF HEALTH AND HUMAN SERVICES WITH RESPECT TO AUTISM

SEC. 218. SHORT TITLE.

    This Act may be cited as the ``Advancement in Pediatric Autism 
Research Act of 1999''.

SEC. 218A. EXPANSION, INTENSIFICATION, AND COORDINATION OF ACTIVITIES 
              OF NATIONAL INSTITUTES OF HEALTH.

    Part B of title IV of the Public Health Service Act (42 U.S.C. 284 
et seq.) is amended by adding at the end the following section:

                                ``autism

    ``Sec. 409C. (a) In General.--
            ``(1) Expansion of activities.--The Director of NIH (in 
        this section referred to as the `Director') shall expand, 
        intensify, and coordinate the activities of the National 
        Institutes of Health with respect to research on autism.
            ``(2) Administration of program; collaboration among 
        agencies.--The Director shall carry out this section acting 
        through the Director of the National Institute of Mental Health 
        and in collaboration with any other agencies that the Director 
        determines appropriate.
    ``(b) Centers of Excellence.--
            ``(1) In general.--The Director shall under subsection 
        (a)(1) make awards of grants and contracts to public or 
        nonprofit private entities to pay all or part of the cost of 
        planning, establishing, improving, and providing basic 
        operating support for centers of excellence regarding research 
        on autism.
            ``(2) Research.--Each center under paragraph (1) shall 
        conduct basic and clinical research into autism. Such research 
        should include investigations into the cause, diagnosis, early 
        detection, prevention, control, and treatment of autism. These 
        centers, as a group, shall conduct research including but not 
        limited to the fields of developmental neurobiology, genetics, 
        and psychopharmacology.
            ``(3) Services for patients.--A center under paragraph (1) 
        may expend amounts provided under such paragraph to carry out a 
        program to make individuals aware of opportunities to 
        participate as subjects in research conducted by the centers. 
        The program may, in accordance with such criteria as the 
        Director may establish, provide to such subjects referrals for 
        health and other services, and such patient care costs as are 
        required for research. The extent to which the center can 
        demonstrate availability and access to clinical services shall 
        be considered by the Director in decisions about awarding the 
        grants to applicants which meet the scientific criteria for 
        funding.
            ``(4) Coordination of centers; reports.--The Director 
        shall, as appropriate, provide for the coordination of 
        information among centers under paragraph (1) and ensure 
regular communication between such centers, and may require the 
periodic preparation of reports on the activities of the centers and 
the submission of the reports to the Director.
            ``(5) Organization of centers.--Each center under paragraph 
        (1) shall use the facilities of a single institution, or be 
        formed from a consortium of cooperating institutions, meeting 
        such requirements as may be prescribed by the Director.
            ``(6) Number of centers; duration of support.--The Director 
        shall provide for the establishment of not less than five 
        centers under paragraph (1). Support of such a center may be 
        for a period not exceeding 5 years. Such period may be extended 
        for one or more additional periods not exceeding 5 years if the 
        operations of such center have been reviewed by an appropriate 
        technical and scientific peer review group established by the 
        Director and if such group has recommended to the Director that 
        such period should be extended.
    ``(c) Facilitation of Research.--The Director shall under 
subsection (a)(1) provide for a program under which samples of tissues 
and genetic materials that are of use in research on autism are 
donated, collected, preserved, and made available for such research. 
The program shall be carried out in accordance with accepted scientific 
and medical standards for the donation, collection, and preservation of 
such samples.
    ``(d) Public Input.--The Director shall under subsection (a)(1) 
provide for means through which the public can obtain information on 
the existing and planned programs and activities of the National 
Institutes of Health with respect to autism and through which the 
Director can receive comments from the public regarding such programs 
and activities.
    ``(e) Funding.--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 2000 through 2003. Such authorizations of 
appropriations are in addition to any other authorization of 
appropriations that is available for such purpose.''.

 SEC. 219. DEVELOPMENTAL DISABILITIES SURVEILLANCE AND RESEARCH 
              PROGRAMS.

    (a) National Autism and Pervasive Developmental Disabilities 
Surveillance Program.--The Secretary of Health and Human Services (in 
this chapter referred to as the ``Secretary''), acting through the 
Director of the Centers for Disease Control and Prevention, may make 
awards of grants and cooperative agreements for the collection, 
analysis, and reporting of data on autism and pervasive developmental 
disabilities. An entity may receive such an award only if the entity is 
a public or nonprofit private entity (including health departments of 
States and political subdivisions of States, and including universities 
and other educational entities). In making such awards, the Secretary 
may provide direct technical assistance in lieu of cash.
    (b) Centers of Excellence in Autism and Pervasive Developmental 
Disabilities Epidemiology.--
            (1) In general.--The Secretary, acting through the Director 
        of the Centers for Disease Control and Prevention, shall 
        establish not less than 3, regional centers of excellence in 
        autism and pervasive developmental disabilities epidemiology 
        for the purpose of collecting and analyzing information on the 
        number, incidence, correlates, and causes of autism and related 
        developmental disabilities.
            (2) Recipients of awards for establishment of centers.--
        Centers under paragraph (1) shall be established and operated 
        through the awarding of grants or cooperative agreements to 
        public or nonprofit private entities that conduct research, 
        including health departments of States and political 
        subdivisions of States, and including universities and other 
        educational entities.
            (3) Certain requirements.--An award for a center under 
        paragraph (1) may be made only if the entity involved submits 
        to the Secretary an application containing such agreements and 
        information as the Secretary may require, including an 
        agreement that the center involved will operate in accordance 
        with the following:
                    (A) The center will collect, analyze, and report 
                autism and pervasive developmental disabilities data 
                according to guidelines prescribed by the Director, 
                after consultation with relevant State and local public 
                health officials, private sector developmental 
                disability researchers, and advocates for those with 
                developmental disabilities.
                    (B) The center will assist with the development and 
                coordination of State autism and pervasive 
                developmental disabilities surveillance efforts within 
                a region.
                    (C) The center will identify eligible cases and 
                controls through its surveillance systems and conduct 
                research into factors which may cause autism and 
                related developmental disabilities. Each program will 
                develop or extend an area of special research expertise 
                (including genetics, environmental exposure to 
                contaminants, immunology, and other relevant research 
                specialty areas).
    (c) Clearinghouse.--The Secretary, acting through the Director of 
the Centers for Disease Control and Prevention, shall carry out the 
following:
            (1) The Secretary shall establish a clearinghouse within 
        the Centers for Disease Control and Prevention for the 
        collection and storage of data generated from the monitoring 
        programs created by this chapter. Through the clearinghouse, 
        such Centers shall serve as the coordinating agency for autism 
        and pervasive developmental disabilities surveillance 
        activities. The functions of such a clearinghouse shall include 
        facilitating the coordination of research and policy 
        development relating to the epidemiology of autism and other 
        pervasive developmental disabilities.
            (2) The Secretary, acting through the Centers for Disease 
        Control and Prevention, shall coordinate the Federal response 
        to requests for assistance from State health department 
        officials regarding potential or alleged autism or 
developmental disability clusters.
    (d) Definition.--In this chapter, 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) 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 2000 through 2003.

 SEC. 220. INFORMATION AND EDUCATION.

    (a) In General.--The Secretary shall establish and implement a 
program to provide information and education on autism to health 
professionals and the general public, including information and 
education on advances in the diagnosis and treatment of autism and 
training and continuing education through programs for scientists, 
physicians, and other health professionals who provide care for 
patients with autism.
    (b) Stipends.--The Secretary may use amounts made available under 
this section to provide stipends for health professionals who are 
enrolled in training programs under this section.
    (c) 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 2000 through 2003.

 SEC. 220A. INTERAGENCY AUTISM COORDINATING COMMITTEE.

    (a) Establishment.--The Secretary shall establish a committee to be 
known as the ``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, including 
activities carried out through the National Institutes of Health and 
the Centers for Disease Control and Prevention under this chapter (and 
the amendment made by this chapter).
    (b) Membership.--
            (1) In general.--The Committee shall be composed of the 
        Directors of such national research institutes, of the Centers 
        for Disease Control and Prevention, and of such other agencies 
        and such other officials as the Secretary determines 
        appropriate.
            (2) Additional members.--If determined appropriate by the 
        Secretary, the Secretary may appoint to the Committee--
                    (A) parents or legal guardians of individuals with 
                autism or other pervasive developmental disorders; and
                    (B) representatives of other governmental agencies 
                that serve children with autism such as the Department 
                of Education.
    (c) Administrative Support; Terms of Service; Other Provisions.--
The following shall apply with respect to the Committee:
            (1) The Committee shall receive necessary and appropriate 
        administrative support from the Department of Health and Human 
        Services.
            (2) Members of the Committee appointed under subsection 
        (b)(2)(A) shall serve for a term of 3 years, and may serve for 
        an unlimited number of terms if reappointed.
            (3) The Committee shall meet not less than 2 times per 
        year.

 SEC. 220B. REPORT TO CONGRESS.

    Not later than January 1, 2000, and each January 1 thereafter, the 
Secretary shall prepare and submit to the appropriate committees of 
Congress, a report concerning the implementation of this chapter and 
the amendments made by this chapter.

      Subtitle C--Poison Control Center Enhancement and Awareness

SEC. 221. SHORT TITLE.

    This subtitle may be cited as the ``Poison Control Center 
Enhancement and Awareness Act''.

SEC. 222. DEFINITION.

    For purposes of this subtitle, the term ``Secretary'' means the 
Secretary of Health and Human Services.

SEC. 223. ESTABLISHMENT OF A NATIONAL TOLL-FREE NUMBER.

    (a) In General.--The Secretary shall provide coordination and 
assistance to regional poison control centers for the establishment of 
a nationwide toll-free phone number to be used to access such centers.
    (b) Rule of Construction.--Nothing in this section shall be 
construed as prohibiting the establishment or continued operation of 
any privately funded nationwide toll-free phone number used to provide 
advice and other assistance for poisonings or accidental exposures.
    (c) 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 2000 through 2003. Funds 
appropriated under this subsection shall not be used to fund any toll-
free phone number described in subsection (b).

SEC. 224. ESTABLISHMENT OF NATIONWIDE MEDIA
              CAMPAIGN.

    (a) In General.--The Secretary shall establish a national media 
campaign to educate the public and health care providers about poison 
prevention and the availability of poison control resources in local 
communities and to conduct advertising campaigns concerning the 
nationwide toll-free number established under section 223.
    (b) Contract With Entity.--The Secretary may carry out subsection 
(a) by entering into contracts with 1 or more nationally recognized 
media firms for the development and distribution of monthly television, 
radio, and newspaper public service announcements.
    (c) 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 2000 through 2003.

SEC. 225. ESTABLISHMENT OF A GRANT PROGRAM.

    (a) Regional Poison Control Centers.--The Secretary shall award 
grants to certified regional poison control centers for the purposes of 
achieving the financial stability of such centers, and for preventing 
and providing treatment recommendations for poisonings.
    (b) Other Improvements.--The Secretary shall also use amounts 
received under this section to--
            (1) develop standard education programs;
            (2) develop standard patient management protocols for 
        commonly encountered toxic exposures;
            (3) improve and expand the poison control data collection 
        systems;
            (4) improve national toxic exposure surveillance; and
            (5) expand the physician/medical toxicologist supervision 
        of poison control centers.
    (c) Certification.--Except as provided in subsection (d), the 
Secretary may make a grant to a center under subsection (a) only if--
            (1) the center has been certified by a professional 
        organization in the field of poison control, and the Secretary 
        has approved the organization as having in effect standards for 
        certification that reasonably provide for the protection of the 
        public health with respect to poisoning; or
            (2) the center has been certified by a State government, 
        and the Secretary has approved the State government as having 
        in effect standards for certification that reasonably provide 
        for the protection of the public health with respect to 
        poisoning.
    (d) Waiver of Certification Requirements.--
            (1) In general.--The Secretary may grant a waiver of the 
        certification requirement of subsection (c) with respect to a 
        noncertified poison control center or a newly established 
        center that applies for a grant under this section if such 
        center can reasonably demonstrate that the center will obtain 
        such a certification within a reasonable period of time as 
        determined appropriate by the Secretary.
            (2) Renewal.--The Secretary may only renew a waiver under 
        paragraph (1) for a period of 3 years.
    (e) Supplement Not Supplant.--Amounts made available to a poison 
control center under this section shall be used to supplement and not 
supplant other Federal, State, or local funds provided for such center.
    (f) Maintenance of Effort.--A poison control center, in utilizing 
the proceeds of a grant under this section, shall maintain the 
expenditures of the center for activities of the center at a level that 
is not less than the level of such expenditures maintained by the 
center for the fiscal year preceding the fiscal year for which the 
grant is received.
    (g) Matching Requirement.--The Secretary may impose a matching 
requirement with respect to amounts provided under a grant under this 
section if the Secretary determines appropriate.
    (h) 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 2000 through 2003.

            Subtitle D--Birth Defects Prevention Activities

                         CHAPTER 1--FOLIC ACID

SEC. 231. SHORT TITLE.

    This chapter may be cited as the ``Folic Acid Promotion and Birth 
Defects Prevention Act of 1999''.

SEC. 232. PROGRAM REGARDING EFFECTS OF FOLIC ACID IN PREVENTION OF 
              BIRTH DEFECTS.

    Part B of title III of the Public Health Service Act (42 U.S.C. 243 
et seq.) is amended by inserting after section 317G the following 
section:

         ``effects of folic acid in prevention of birth defects

    ``Sec. 317H. (a) In General.--The Secretary, acting through the 
Director of the Centers for Disease Control and Prevention, shall carry 
out a program (directly or through grants or contracts) for the 
following purposes:
            ``(1) To provide education and training for health 
        professionals and the general public for purposes of explaining 
        the effects of folic acid in preventing birth defects and for 
        purposes of encouraging each woman of reproductive capacity 
        (whether or not planning a pregnancy) to consume on a daily 
        basis a dietary supplement that provides an appropriate level 
        of folic acid.
            ``(2) To conduct research with respect to such education 
        and training, including identifying effective strategies for 
        increasing the rate of consumption of folic acid by women of 
        reproductive capacity.
            ``(3) To conduct research to increase the understanding of 
        the effects of folic acid in preventing birth defects, 
        including understanding with respect to cleft lip, cleft 
        palate, and heart defects.
            ``(4) To provide for appropriate epidemiological activities 
        regarding folic acid and birth defects, including 
        epidemiological activities regarding neural tube defects.
    ``(b) Consultations With States and Private Entities.--In carrying 
out subsection (a), the Secretary shall consult with the States and 
with other appropriate public or private entities, including national 
nonprofit private organizations, health professionals, and providers of 
health insurance and health plans.
    ``(c) Technical Assistance.--The Secretary may (directly or through 
grants or contracts) provide technical assistance to public and 
nonprofit private entities in carrying out the activities described in 
subsection (a).
    ``(d) Evaluations.--The Secretary shall (directly or through grants 
or contracts) provide for the evaluation of activities under subsection 
(a) in order to determine the extent to which such activities have been 
effective in carrying out the purposes of the program under such 
subsection, including the effects on various demographic populations. 
Methods of evaluation under the preceding sentence may include surveys 
of knowledge and attitudes on the consumption of folic acid and on 
blood folate levels. Such methods may include complete and timely 
monitoring of infants who are born with neural tube defects.
    ``(e) 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 2000 through 2003.''.

     CHAPTER 2--NATIONAL CENTER ON BIRTH DEFECTS AND DEVELOPMENTAL 
                              DISABILITIES

SEC. 236. NATIONAL CENTER ON BIRTH DEFECTS AND
              DEVELOPMENTAL DISABILITIES.

    Title III of the Public Health Service Act (42 U.S.C. 241 et seq.) 
is amended--
            (1) in part O--
                    (A) by redesignating sections 399G through 399J as 
                sections 399M through 399P, respectively;
                    (B) in section 399O(b) (as so redesignated), by 
                striking ``section 399G(d)'' and inserting ``section 
                399M(d)''; and
                    (C) in section 399P (as so redesignated), by 
                striking ``section 399G(d)(1)'' and inserting ``section 
                399M(d)(1)''; and
            (2) by adding at the end the following part:

              ``Part P--Pediatric Public Health Promotion

``SEC. 399Q. NATIONAL CENTER ON BIRTH DEFECTS AND DEVELOPMENTAL 
              DISABILITIES.

    ``(a) Establishment.--There is established within the Centers for 
Disease Control and Prevention a center to be known as the National 
Center on Birth Defects and Developmental Disabilities.
    ``(b) Purpose.--The general purpose of the National Center 
established under subsection (a) shall be to--
            ``(1) collect, analyze, and make available data on birth 
        defects, including data on the causes of such defects and on 
        the incidence and prevalence of such defects;
            ``(2) conduct applied epidemiological research on the 
        prevention of such defects; and
            ``(3) provide information and education to the public on 
        the prevention of such defects.
    ``(c) Director.--The National Center established under subsection 
(a) shall be headed by a director to be appointed by the Secretary.
    ``(d) Transfers.--There shall be transferred to the National Center 
established under subsection (a) all activities, budgets and personnel 
of the National Center for Environmental Health that relate to birth 
defects, folic acid, cerebral palsy, mental retardation, child 
development, newborn screening, autism, fragile X syndrome, fetal 
alcohol syndrome, pediatric genetics, and disability prevention.
    ``(e) 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 2000 through 2003.''.

     Subtitle E--Safe Motherhood Monitoring and Prevention Research

SEC. 241. SHORT TITLE.

    This subtitle may be cited as the ``Safe Motherhood Monitoring and 
Prevention Research Act''.

SEC. 242. AMENDMENT TO PUBLIC HEALTH SERVICE ACT.

    Title III of the Public Health Service Act, as amended by section 
236 of this Act, is amended by adding at the end the following part:

                       ``Part Q--Safe Motherhood

``SEC. 399R. SAFE MOTHERHOOD MONITORING.

    ``(a) Purpose.--It is the purpose of this section to develop 
monitoring systems at the local, State, and national level to better 
understand the burden of maternal complications and mortality and to 
decrease the disparities among population at risk of death and 
complications from pregnancy.
    ``(b) Activities.--For the purpose described in subsection (a), the 
Secretary may carry out the following activities:
            ``(1) The Secretary may establish and implement a national 
        monitoring and surveillance program to identify and promote the 
        investigation of deaths and severe complications that occur 
        during pregnancy.
            ``(2) The Secretary may expand the Pregnancy Risk 
        Assessment Monitoring System to provide surveillance and 
        collect data in each of the 50 States.
            ``(3) The Secretary may expand the Maternal and Child 
        Health Epidemiology Program to provide technical support, 
        financial assistance, or the time-limited assignment of senior 
        epidemiologists to maternal and child health programs in each 
        of the 50 States.
    ``(c) 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 2000 through 2003.''.

``SEC. 399S. PREVENTION RESEARCH TO ENSURE SAFE MOTHERHOOD.

    ``(a) Purpose.--It is the purpose of this section to provide the 
Secretary with the authority to further expand research concerning risk 
factors, prevention strategies, and the roles of the family, health 
care providers and the community in safe motherhood.
    ``(b) Research.--The Secretary may carry out activities to expand 
research relating to--
            ``(1) encouraging preconception counseling, especially for 
        at risk populations such as diabetics;
            ``(2) the identification of critical components of prenatal 
        delivery and postpartum care;
            ``(3) the identification of outreach and support services, 
        such as folic acid education, that are available for pregnant 
        women;
            ``(4) the identification of women who are at high risk for 
        complications;
            ``(5) preventing preterm delivery;
            ``(6) preventing urinary tract infections;
            ``(7) preventing unnecessary caesarean sections;
            ``(8) an examination of the higher rates of maternal 
        mortality among African American women;
            ``(9) an examination of the relationship between domestic 
        violence and maternal complications and mortality;
            ``(10) preventing smoking, alcohol and illegal drug usage 
        before, during and after pregnancy;
            ``(11) preventing infections that cause maternal and infant 
        complications; and
            ``(12) other areas determined appropriate by the Secretary.
    ``(c) 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 2000 through 2003.

``SEC. 399T. PREVENTION PROGRAMS TO ENSURE SAFE MOTHERHOOD.

    ``(a) In General.--The Secretary may carry out activities to 
promote safe motherhood, including--
            ``(1) public education campaigns on healthy pregnancies and 
        the building of partnerships with outside organizations 
        concerned about safe motherhood;
            ``(2) education programs for physicians, nurses and other 
        health care providers; and
            ``(3) activities to promote community support services for 
        pregnant women.
    ``(b) 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 2000 through 2003.''.

       Subtitle F--Pregnant Mothers and Infants Health Promotion

SEC. 251. SHORT TITLE.

    This subtitle may be cited as the ``Pregnant Mothers and Infants 
Health Protection Act''.

SEC. 252. ESTABLISHMENT.

    Title III of the Public Health Service Act, as amended by section 
242 of this Act, is amended by adding at the end the following part:

                     ``Part R--Additional Programs

``SEC. 399U. PROGRAMS REGARDING PRENATAL AND POSTNATAL HEALTH.

    ``(a) In General.--The Secretary shall carry out programs--
            ``(1) to collect, analyze, and make available data on 
        prenatal smoking, alcohol and illegal drug usage, including 
        data on the implications of such activities and on the 
        incidence and prevalence of such activities and their 
        implications;
            ``(2) to conduct applied epidemiological research on the 
        prevention of prenatal and postnatal smoking, alcohol and 
        illegal drug usage;
            ``(3) to support, conduct, and evaluate the effectiveness 
        of educational and cessation programs; and
            ``(4) to provide information and education to the public on 
        the prevention and implications of prenatal and postnatal 
        smoking, alcohol and illegal drug usage.
    ``(b) Grants.--In carrying out subsection (a), the Secretary may 
award grants to and enter into contracts with States, local 
governments, scientific and academic institutions, Federally qualified 
health centers, and other public and nonprofit entities, and may 
provide technical and consultative assistance to such entities.
    ``(c) 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 2000 through 2003.''.

         Subtitle G--Utilization of Preventive Health Services

SEC. 261. GRANTS REGARDING UTILIZATION OF PREVENTIVE HEALTH SERVICES.

    Part D of title III of the Public Health Service Act (42 U.S.C. 
254b et seq.) is amended by adding at the end the following section:

``SEC. 330D. CENTERS FOR STRATEGIES ON FACILITATING UTILIZATION OF 
              PREVENTIVE HEALTH SERVICES AMONG VARIOUS POPULATIONS.

    ``(a) In General.--The Secretary, acting through the appropriate 
agencies of the Public Health Service, shall make grants to public or 
nonprofit private entities for the establishment and operation of 
regional centers whose purpose is to identify particular populations of 
patients and facilitate the appropriate utilization of preventive 
health services by patients in the populations through developing and 
disseminating strategies to improve the methods used by public and 
private health care programs and providers in interacting with such 
patients.
    ``(b) Research and Training.--The activities carried out by a 
center under subsection (a) may include establishing programs of 
research and training with respect to the purpose described in such 
subsection, including the development of curricula for training 
individuals in implementing the strategies developed under such 
subsection.
    ``(c) Quality Management.--A condition for the receipt of a grant 
under subsection (a) is that the applicant involved agree that, in 
order to ensure that the strategies developed under such subsection 
take into account principles of quality management with respect to 
consumer satisfaction, the applicant will make arrangements with one or 
more private entities that have experience in applying such principles.
    ``(d) Priority Regarding Infants and Children.--In carrying out the 
purpose described in subsection (a), the Secretary shall give priority 
to various populations of infants, young children, and their mothers.
    ``(e) Evaluations.--The Secretary, acting through the appropriate 
agencies of the Public Health Service, shall (directly or through 
grants or contracts) provide for the evaluation of strategies under 
subsection (a) in order to determine the extent to which the strategies 
have been effective in facilitating the appropriate utilization of 
preventive health services in the populations with respect to which the 
strategies were developed.
    ``(f) 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 2000 through 2003.''.

        Subtitle H--Research and Development Regarding Fragile X

SEC. 266. SHORT TITLE.

    This subtitle may be cited as the ``Fragile X Research Breakthrough 
Act of 1999''.

SEC. 267. NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT; 
              RESEARCH ON FRAGILE X.

    Subpart 7 of part C of title IV of the Public Health Service Act, 
as amended by section 103 of this Act, is amended by adding at the end 
the following section:

                              ``fragile x

    ``Sec. 452F. (a) Expansion and Coordination of Research 
Activities.--The Director of the Institute, after consultation with the 
advisory council for the Institute, shall expand, intensify, and 
coordinate the activities of the Institute with respect to research on 
the disease known as fragile X.
    ``(b) Research Centers.--
            ``(1) In general.--The Director of the Institute, after 
        consultation with the advisory council for the Institute, shall 
        make grants to, or enter into contracts with, public or 
        nonprofit private entities for the development and operation of 
centers to conduct research for the purposes of improving the diagnosis 
and treatment of, and finding the cure for, fragile X.
            ``(2) Number of centers.--In carrying out paragraph (1), 
        the Director of the Institute shall, to the extent that amounts 
        are appropriated, provide for the establishment of at least 
        three fragile X research centers.
            ``(3) Activities.--
                    ``(A) In general.--Each center assisted under 
                paragraph (1) shall, with respect to fragile X--
                            ``(i) conduct basic and clinical research, 
                        which may include clinical trials of--
                                    ``(I) new or improved diagnostic 
                                methods; and
                                    ``(II) drugs or other treatment 
                                approaches; and
                            ``(ii) conduct research to find a cure.
                    ``(B) Fees.--A center may use funds provided under 
                paragraph (1) to provide fees to individuals serving as 
                subjects in clinical trials conducted under 
                subparagraph (A).
            ``(4) Coordination among centers.--The Director of the 
        Institute shall, as appropriate, provide for the coordination 
        of the activities of the centers assisted under this section, 
        including providing for the exchange of information among the 
        centers.
            ``(5) Certain administrative requirements.--Each center 
        assisted under paragraph (1) shall use the facilities of a 
        single institution, or be formed from a consortium of 
        cooperating institutions, meeting such requirements as may be 
        prescribed by the Director of the Institute.
            ``(6) Duration of support.--Support may be provided to a 
        center under paragraph (1) for a period not exceeding 5 years. 
        Such period may be extended for one or more additional periods, 
        each of which may not exceed 5 years, if the operations of such 
        center have been reviewed by an appropriate technical and 
        scientific peer review group established by the Director and if 
        such group has recommended to the Director that such period be 
        extended.
            ``(7) Authorization of appropriations.--For the purpose of 
        carrying out this subsection, there are authorized to be 
        appropriated such sums as may be necessary for each of the 
        fiscal years 2000 through 2003.''.

SEC. 268. NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT; 
              LOAN REPAYMENT PROGRAM REGARDING RESEARCH ON FRAGILE X.

    Part G of title IV of the Public Health Service Act (42 U.S.C. 288 
et seq.) is amended by inserting after section 487E the following 
section:

        ``loan repayment program regarding research on fragile x

    ``Sec. 487F. (a) In General.--The Secretary, in consultation with 
the Director of the National Institute of Child Health and Human 
Development, shall establish a program under which the Federal 
Government enters into contracts with qualified health professionals 
(including graduate students) who agree to conduct research regarding 
fragile X in consideration of the Federal Government's agreement to 
repay, for each year of such service, not more than $35,000 of the 
principal and interest of the educational loans owed by such health 
professionals.
    ``(b) Applicability of Certain Provisions.--With respect to the 
National Health Service Corps Loan Repayment Program established in 
subpart III of part D of title III, the provisions of such subpart 
(including section 338B(g)(3)) shall, except as inconsistent with 
subsection (a) of this section, apply to the program established in 
such subsection in the same manner and to the same extent as such 
provisions apply to the National Health Service Corps Loan Repayment 
Program established in such subpart.
    ``(c) 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 2000 through 2003.''.

                   Subtitle I--Children and Epilepsy

SEC. 271. PROGRAMS OF THE CENTERS FOR DISEASE CONTROL AND PREVENTION; 
              NATIONAL PUBLIC HEALTH CAMPAIGN ON EPILEPSY.

    (a) In General.--The Secretary of Health and Human Services (in 
this subtitle referred to as the ``Secretary''), acting through the 
Director of the Centers for Disease Control and Prevention, shall 
develop and implement public health surveillance, education, research, 
and intervention strategies to improve the lives of persons with 
epilepsy, with a particular emphasis on children. Such projects may be 
carried out by the Secretary directly and through awards of grants or 
contracts to public or nonprofit private entities. The Secretary may 
directly or through such awards provide technical assistance with 
respect to the planning, development, and operation of such projects.
    (b) Certain Activities.--Activities under subsection (a) shall 
include--
            (1) expanding current surveillance activities through 
        existing monitoring systems and improving registries that 
        maintain data on individuals with epilepsy, including children;
            (2) enhancing research activities on the management and 
        control of epilepsy;
            (3) implementing public and professional information and 
        education programs regarding epilepsy, including initiatives 
        which promote effective management and control of the disease 
        through children's programs which are targeted to parents, 
        schools, daycare providers, patients;
            (4) undertaking educational efforts with the media, 
        providers of health care, schools and others regarding stigmas 
        and secondary disabilities related to epilepsy and seizures, 
        and also its affects on youth;
            (5) utilizing and expanding partnerships with organizations 
        with experience addressing the health and related needs of 
        people with disabilities; and
            (6) other activities the Secretary deems appropriate.
    (c) Coordination of Activities.--The Secretary shall ensure that 
activities under this section are coordinated as appropriate with other 
agencies of the Public Health Service that carry out activities 
regarding epilepsy and seizure.
    (d) 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 2000 through 2003.

SEC. 272. PROGRAMS OF HEALTH RESOURCES AND SERVICES ADMINISTRATION; 
              STATE AND LOCAL GRANTS FOR SEIZURE DISORDER DEMONSTRATION 
              PROJECTS IN MEDICALLY UNDERSERVED AREAS.

    (a) In General.--The Secretary, acting through the Administrator of 
the Health Resources and Services Administration, may make grants to 
States and local governments for the purpose of carrying out 
demonstration projects to improve access to health and other services 
regarding seizures to encourage early detection and treatment in 
children and others residing in medically underserved areas.
    (b) Application for Grant.--The Secretary may make a grant under 
subsection (a) only if the application for the grant is submitted to 
the Secretary and the application is in such form, is made in such 
matter, and contains such agreements, assurances, and information as 
the Secretary determines to be necessary to carry out this section.
    (c) 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 2000 through 2003.

SEC. 273. DEFINITIONS.

    For purposes of this subtitle:
            (1) The term ``epilepsy'' refers to a chronic and serious 
        neurological condition which produces excessive electrical 
        discharges in the brain causing recurring seizures affecting 
        all life activities. The Secretary may revise the definition of 
        such term as the Secretary.
            (2) The term ``medically underserved'' has the meaning 
        applicable under section 799B(6) of the Public Health Service 
        Act.

           Subtitle J--Asthma Treatment Services for Children

SEC. 276. SHORT TITLE.

    This subtitle may be cited as the ``Children's Asthma Relief Act of 
1999''.

SEC. 277. CHILDREN'S ASTHMA RELIEF.

    Title III of the Public Health Service Act, as amended by section 
252 of this Act, is amended by adding at the end the following:

                   ``Part S--Children's Asthma Relief

``SEC. 399V. ASTHMA TREATMENT GRANTS PROGRAM.

    ``(a) Purposes.--The purposes of this section are as follows:
            ``(1) To provide access to quality medical care for 
        children who live in areas that have a high prevalence of 
        asthma and who lack access to medical care.
            ``(2) To provide on-site education to parents, children, 
        health care providers, and medical teams to recognize the signs 
        and symptoms of asthma, and to train them in the use of 
        medications to prevent and treat asthma.
            ``(3) To decrease preventable trips to the emergency room 
        by making medication available to individuals who have not 
        previously had access to treatment or education in the 
        prevention of asthma.
            ``(4) To provide other services, such as smoking cessation 
        programs, home modification, and other direct and support 
        services that ameliorate conditions that exacerbate or induce 
        asthma.
    ``(b) Authority To Make Grants.--
            ``(1) In general.--In addition to any other payments made 
        under this Act or title V of the Social Security Act, the 
        Secretary shall award grants to eligible entities to carry out 
        the purposes of this section, including grants that are 
        designed to develop and expand projects to--
                    ``(A) provide comprehensive asthma services to 
                children, including access to care and treatment for 
                asthma in a community-based setting;
                    ``(B) fully equip mobile health care clinics that 
                provide preventive asthma care including diagnosis, 
                physical examinations, pharmacological therapy, skin 
                testing, peak flow meter testing, and other asthma-
                related health care services;
                    ``(C) conduct study validated asthma management 
                education programs for patients with asthma and their 
                families, including patient education regarding asthma 
                management, family education on asthma management, and 
                the distribution of materials, including displays and 
                videos, to reinforce concepts presented by medical 
                teams; and
                    ``(D) identify eligible children for the medicaid 
                program under title XIX of the Social Security Act, the 
                State Children's Health Insurance Program under title 
                XXI of such Act, or other children's health programs.
            ``(2) Award of grants.--
                    ``(A) Application.--
                            ``(i) In general.--An eligible entity shall 
                        submit an application to the Secretary for a 
                        grant under this section in such form and 
                        manner as the Secretary may require.
                            ``(ii) Required information.--An 
                        application submitted under this subparagraph 
                        shall include a plan for the use of funds 
                        awarded under the grant and such other 
                        information as the Secretary may require.
                    ``(B) Requirement.--In awarding grants under this 
                section, the Secretary shall give preference to 
                eligible entities that demonstrate that the activities 
                to be carried out under this section shall be in 
                localities within areas of known high prevalence of 
                childhood asthma or high asthma-related mortality 
                (relative to the average asthma incidence rates and 
                associated mortality rates in the United States). 
                Acceptable data sets to demonstrate a high prevalence 
                of childhood asthma or high asthma-related mortality 
                may include data from Federal, State, or local vital 
                statistics, claims data under title XIX or XXI of the 
                Social Security Act, other public health statistics or 
                surveys, or other data that the Secretary, in 
                consultation with the Director of the Centers for 
                Disease Control and Prevention, deems appropriate.
            ``(3) Definition of eligible entity.--For purposes of this 
        section, the term `eligible entity' means a State agency or 
        other entity receiving funds under title V of the Social 
        Security Act, a local community, a nonprofit children's 
        hospital or foundation, or a nonprofit community-based 
        organization.
    ``(c) Coordination With Other Children's Programs.--An eligible 
entity shall identify in the plan submitted as part of an application 
for a grant under this section how the entity will coordinate 
operations and activities under the grant with--
            ``(1) other programs operated in the State that serve 
        children with asthma, including any such programs operated 
        under titles V, XIX, or XXI of the Social Security Act; and
            ``(2) one or more of the following--
                    ``(A) the child welfare and foster care and 
                adoption assistance programs under parts B and E of 
                title IV of such Act;
                    ``(B) the head start program established under the 
                Head Start Act (42 U.S.C. 9831 et seq.);
                    ``(C) the program of assistance under the special 
                supplemental nutrition program for women, infants and 
                children (WIC) under section 17 of the Child Nutrition 
                Act of 1966 (42 U.S.C. 1786);
                    ``(D) local public and private elementary or 
                secondary schools; or
                    ``(E) public housing agencies, as defined in 
                section 3 of the United States Housing Act of 1937 (42 
                U.S.C. 1437a).
    ``(d) Evaluation.--An eligible entity that receives a grant under 
this section shall submit to the Secretary an evaluation of the 
operations and activities carried out under the grant that includes--
            ``(1) a description of the health status outcomes of 
        children assisted under the grant;
            ``(2) an assessment of the utilization of asthma-related 
        health care services as a result of activities carried out 
        under the grant;
            ``(3) the collection, analysis, and reporting of asthma 
        data according to guidelines prescribed by the Director of the 
        Centers for Disease Control and Prevention; and
            ``(4) such other information as the Secretary may require.
    ``(e) Applicability of Certain Provisions.--The following 
provisions of title V of the Social Security Act shall apply to a grant 
made under this section to the same extent and in the same manner as 
such provisions apply to allotments made under section 502(c) of such 
Act:
            ``(1) Section 504(b)(4) (relating to expenditures of funds 
        as a condition of receipt of Federal funds).
            ``(2) Section 504(b)(6) (relating to prohibition on 
        payments to excluded individuals and entities).
            ``(3) Section 506 (relating to reports and audits, but only 
        to the extent determined by the Secretary to be appropriate for 
        grants made under this section).
            ``(4) Section 508 (relating to nondiscrimination).
    ``(f) 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 2000 through 2003.''.

SEC. 278. INCORPORATION OF ASTHMA PREVENTION TREATMENT AND SERVICES 
              INTO STATE CHILDREN'S HEALTH INSURANCE PROGRAMS.

    (a) In General.--The Secretary of Health and Human Services (in 
this section referred to as the ``Secretary'') shall, in accordance 
with subsection (b), carry out a program to encourage States to 
implement plans to carry out activities to assist children with respect 
to asthma in accordance with guidelines of the National Asthma 
Education and Prevention Program (NAEPP) and the National Heart, Lung 
and Blood Institute.
    (b) Relation to Children's Health Insurance Program.--
            (1) In general.--Subject to paragraph (2), if a State child 
        health plan under title XXI of the Social Security Act (42 
        U.S.C. 1397aa et seq.) provides for activities described in 
        subsection (a) to an extent satisfactory to the Secretary, the 
        Secretary shall, with amounts appropriated under 
subsection (c), make a grant to the State involved to assist the State 
in carrying out such activities.
            (2) Criteria regarding eligibility for grant; rule of 
        construction regarding authority of secretary.--The Secretary 
        shall publish in the Federal Register criteria describing the 
        circumstances in which the Secretary will consider a State plan 
        to be satisfactory for purposes of paragraph (1), subject to 
        the condition that this section may not be construed as 
        modifying (or authorizing the Secretary to modify) any 
        requirement or authority established in or under title XXI of 
        the Social Security Act.
            (3) Requirement of matching funds.--
                    (A) In general.--With respect to the costs of the 
                activities to be carried out by a State pursuant to 
                paragraph (1), the Secretary may make a grant under 
                such paragraph only if the State agrees to make 
                available (directly or through donations from public or 
                private entities) non-Federal contributions toward such 
                costs in an amount that is not less than 15 percent of 
                the costs.
                    (B) Determination of amount contributed.--Non-
                Federal contributions required in subparagraph (A) may 
                be in cash or in kind, fairly evaluated, including 
                equipment or services. Amounts provided by the Federal 
                Government, or services assisted or subsidized to any 
                significant extent by the Federal Government, may not 
                be included in determining the amount of such non-
                Federal contributions.
            (4) Technical assistance.--With respect to State child 
        health plans under title XXI of the Social Security Act (42 
        U.S.C. 1397aa et seq.), the Secretary, acting through the 
        Director of the Centers for Disease Control and Prevention, in 
        consultation with the heads of other Federal agencies involved 
        in asthma treatment and prevention, shall make available to the 
        States technical assistance in developing the provision of such 
        plans that will provide for activities pursuant to paragraph 
        (1).
    (c) Funding.--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 2000 through 2003.

SEC. 279. PREVENTIVE HEALTH AND HEALTH SERVICES BLOCK GRANT; SYSTEMS 
              FOR REDUCING ASTHMA AND ASTHMA-RELATED ILLNESSES THROUGH 
              URBAN COCKROACH MANAGEMENT.

    Section 1904(a)(1) of the Public Health Service Act (42 U.S.C. 
300w-3(a)(1)) is amended--
            (1) by redesignating subparagraphs (E) and (F) as 
        subparagraphs (F) and (G), respectively;
            (2) by adding a period at the end of subparagraph (G) (as 
        so redesignated);
            (3) by inserting after subparagraph (D), the following:
            ``(E) The establishment, operation, and coordination of 
        effective and cost-efficient systems to reduce the prevalence 
        of asthma and asthma-related illnesses among urban populations, 
        especially children, by reducing the level of exposure to 
        cockroach allergen through the use of integrated pest 
        management, as applied to cockroaches. Amounts expended for 
        such systems may include the costs of structural rehabilitation 
        of housing, public schools, and other public facilities to 
        reduce cockroach infestation, the costs of building 
        maintenance, and the costs of programs to promote community 
        participation in the carrying out at such sites of integrated 
        pest management, as applied to cockroaches. For purposes of 
        this subparagraph, the term `integrated pest management' means 
        an approach to the management of pests in public facilities 
        that combines biological, cultural, physical, and chemical 
        tools in a way that minimizes economic, health, and 
        environmental risks.'';
            (4) in subparagraph (F) (as so redesignated), by striking 
        ``subparagraphs (A) through (D)'' and inserting ``subparagraphs 
        (A) through (E)''; and
            (5) in subparagraph (G) (as so redesignated), by striking 
        ``subparagraphs (A) through (E)'' and inserting ``subparagraphs 
        (A) through (F)''.

SEC. 279A. COORDINATION OF FEDERAL ACTIVITIES TO ADDRESS ASTHMA-RELATED 
              HEALTH CARE NEEDS.

    (a) In General.--The Director of the National Heart, Lung, and 
Blood Institute shall, through the National Asthma Education Prevention 
Program Coordinating Committee--
            (1) identify all Federal programs that carry out asthma-
        related activities;
            (2) develop, in consultation with appropriate Federal 
        agencies and professional and voluntary health organizations, a 
        Federal plan for responding to asthma; and
            (3) not later than 12 months after the date of enactment of 
        this Act, submit recommendations to Congress on ways to 
        strengthen and improve the coordination of asthma-related 
        activities of the Federal Government.
    (b) Representation of the Department of Housing and Urban 
Development.--A representative of the Department of Housing and Urban 
Development shall be included on the National Asthma Education 
Prevention Program Coordinating Committee for the purpose of performing 
the tasks described in subsection (a).
    (c) 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 2000 through 2003.

SEC. 279B. COMPILATION OF DATA BY THE CENTERS FOR DISEASE CONTROL AND 
              PREVENTION.

    (a) In General.--The Director of the Centers for Disease Control 
and Prevention, in consultation with the National Asthma Education 
Prevention Program Coordinating Committee, shall--
            (1) conduct local asthma surveillance activities to collect 
        data on the prevalence and severity of asthma and the quality 
of asthma management, including--
                    (A) telephone surveys to collect sample household 
                data on the local burden of asthma; and
                    (B) health care facility specific surveillance to 
                collect asthma data on the prevalence and severity of 
                asthma, and on the quality of asthma care; and
            (2) compile and annually publish data on--
                    (A) the prevalence of children suffering from 
                asthma in each State; and
                    (B) the childhood mortality rate associated with 
                asthma nationally and in each State.
    (b) Collaborative Efforts.--The activities described in subsection 
(a)(1) may be conducted in collaboration with eligible entities awarded 
a grant under section 399V of the Public Health Service Act (as added 
by section 277 of this Act).

         Subtitle K--Juvenile Arthritis and Related Conditions

SEC. 281. RESEARCH ON JUVENILE ARTHRITIS AND RELATED CONDITIONS.

    (a) Establishment.--The Directors of the National Institute of 
Arthritis and Musculoskeletal and Skin Diseases and the National 
Institute of Allergy and Infectious Diseases shall expand and intensify 
the programs of such Institutes with respect to research and related 
activities concerning juvenile arthritis and related conditions.
    (b) Coordination.--The Directors referred to in subsection (a) 
shall jointly coordinate the programs referred to in such subsection 
and consult with the Arthritis and Musculoskeletal Diseases Interagency 
Coordinating Committee.
    (c) Information Resource Center.--
            (1) In general.-- In order to assist in carrying out the 
        purpose described in subsection (a), the Director of the 
        National Institutes of Health shall provide for the 
        establishment of an information resource center on arthritis 
        and related conditions, including juvenile arthritis, to 
        facilitate and enhance knowledge and understanding on the part 
        of patients, health professionals, and the public through the 
        effective dissemination of information.
            (2) Establishment through grant or contract.--For the 
        purpose of carrying out paragraph (1), the Director of the 
        National Institutes of Health shall enter into a grant, 
        cooperative agreement, or contract with a national, nonprofit 
        private entity involved in activities regarding the prevention 
        and control of arthritis and related conditions through the 
        National Arthritis Action Plan.
    (c) Pediatric Rheumatology.--The Secretary of Health and Human 
Services, acting through the Director of the National Institutes of 
Health and the Administrator of the Health Resources and Services 
Administration, shall develop a coordinated effort to ensure that a 
national infrastructure is in place to train and develop pediatric 
rheumatologists to address the health care services requirements of 
children with arthritis and related conditions.
    (d) 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 2000 through 2003.

              Subtitle L--Childhood Skeletal Malignancies

SEC. 286. PROGRAMS OF CENTERS FOR DISEASE CONTROL AND PREVENTION.

    (a) In General.--The Secretary of Health and Human Services (in 
this section referred to as the ``Secretary''), acting through the 
Director of the Centers for Disease Control and Prevention, shall study 
environmental and other risk factors for childhood skeletal cancers, 
and carry out projects to improve outcomes among children with 
childhood skeletal cancers and resultant secondary conditions, 
including limb loss. Such projects shall be carried out by the 
Secretary directly and through awards of grants or contracts to public 
or nonprofit entities.
    (b) Certain Activities.--Activities under subsection (a) include--
            (1) the expansion of current demographic data collection 
        and population surveillance efforts to include childhood 
        skeletal cancers nationally;
            (2) the development of a uniform reporting system under 
        which treating physicians, hospitals, clinics, and states 
        report the diagnosis of childhood skeletal cancers, including 
        relevant associated epidemiological data; and
            (3) support for the National Limb Loss Information Center 
        to address, in part, the primary and secondary needs of persons 
        who experience childhood skeletal cancers in order to prevent 
        or minimize the disabling nature of these cancers.
    (c) Coordination of Activities.--The Secretary shall assure that 
activities under this section are coordinated as appropriate with other 
agencies of the Public Health Service that carry out activities focused 
on childhood cancers and limb loss.
    (d) Definition.--For purposes of this section, the term ``childhood 
skeletal cancer'' refers to any malignancy originating in the 
connective tissue of a person before skeletal maturity including the 
appendicular and axial skeleton. The Secretary may revise the 
definition of such term as determined necessary to carry out the intent 
of this effort.
    (e) 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 2000 through 2003.

    Subtitle M--Reducing Burden of Diabetes Among Children and Youth

SEC. 291. PROGRAMS REGARDING DIABETES IN CHILDREN AND YOUTH.

    (a) National Registry on Juvenile Diabetes.--The Secretary of 
Health and Human Services (in this section referred to as the 
``Secretary''), acting through the Director of the Centers for Disease 
Control and Prevention, shall develop a system to collect data on 
juvenile diabetes, including with respect to incidence and prevalence, 
and shall establish a national database for such data.
    (b) Long-Term Epidemiology Studies on Juvenile Diabetes.--
            (1) In general.--The Secretary, acting through the Director 
        of the National Institutes of Health, shall conduct or support 
        long-term epidemiology studies in which individuals with type 
        1, or juvenile, diabetes are followed for 10 years or more. 
        Such studies shall, in order to provide a valuable resource for 
        the purposes specified in paragraph (2), provide for complete 
        characterization of disease manifestations, appropriate medical 
        history, elucidation of environmental factors, delineation of 
        complications, results of usual medical treatment and a variety 
        of other potential valuable (such as samples of blood).
            (2) Purposes.--The purposes referred to in paragraph (1) 
        with respect to type 1 diabetes are the following:
                    (A) Delineation of potential environmental triggers 
                thought precipitating or causing type 1 diabetes.
                    (B) Delineation of those clinical characteristics 
                or lab measures associated with complications of the 
                disease.
                    (C) Potential study population to enter into 
                clinical trials for prevention and treatment, as well 
                as genetic studies.
    (c) Type 2 Diabetes in Youth.--The Secretary, acting through the 
Director of the Centers for Disease Control and Prevention, shall 
implement a national public health effort to address type 2 diabetes in 
youth, including--
            (1) enhancing surveillance systems and expanding research 
        to better assess the prevalence of type 2 diabetes in youth and 
        determine the extent to which type 2 diabetes is incorrectly 
        diagnosed as type 1 diabetes among children; and
            (2) assisting States in establishing coordinated school 
        health programs and physical activity and nutrition 
        demonstration programs to control weight and increase physical 
        activity among youth.
    (d) Clinical Trial Infrastructure/Innovative Treatments for 
Juvenile Diabetes.--The Secretary, acting through the Director of the 
National Institutes of Health, shall support regional clinical centers 
for the cure of juvenile diabetes and shall through such centers 
provide for--
            (1) well-characterized population of children appropriate 
        for study;
            (2) well-trained clinical scientists able to conduct such 
        trials;
            (3) appropriate clinical settings able to house such 
        studies; and
            (4) appropriate statistical capability, data, safety and 
        other monitoring capacity.
    (e) Development of Vaccine.--The Secretary, acting through the 
appropriate agencies of the Public Health Service, shall provide for a 
national effort to develop a vaccine for type 1 diabetes. Such effort 
shall provide for a combination of increased efforts in research and 
development of candidate vaccines, coupled with appropriate ability to 
conduct large clinical trials in children.
    (f) 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 2000 through 2003.

                  Subtitle N--Miscellaneous Provisions

SEC. 296. REPORT REGARDING RESEARCH ON RARE DISEASES IN CHILDREN.

    Not later than 180 days after the date of the enactment of this 
Act, the Director of the National Institutes of Health shall submit to 
the Congress a report on--
            (1) the activities that, during fiscal year 1999, were 
        conducted and supported by such Institutes with respect to rare 
        diseases in children, including Friedreich's ataxia; and
            (2) the activities that are planned to be conducted and 
        supported by such Institutes with respect to such diseases 
        during the fiscal years 2000 through 2003.
                                 <all>