[Congressional Record Volume 146, Number 56 (Tuesday, May 9, 2000)]
[House]
[Pages H2698-H2720]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                     CHILDREN'S HEALTH ACT OF 2000

  Mr. BILIRAKIS. Mr. Speaker, I move to suspend the rules and pass the 
bill (H.R. 4365) to amend the Public Health Service Act with respect to 
children's health, as amended.
  The Clerk read as follows:

                               H.R. 4365

       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 Act of 
     2000''.

     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--AUTISM

Subtitle A--Surveillance and Research Regarding Prevalence and Pattern 
                               of Autism

Sec. 101. Short title.
Sec. 102. Surveillance and research programs; clearinghouse; advisory 
              committee.

  Subtitle B--Expansion, Intensification, and Coordination of Autism 
              Activities of National Institutes of Health

Sec. 111. Short title.
Sec. 112. Expansion, intensification, and coordination; information and 
              education; interagency coordinating committee.

         TITLE II--RESEARCH AND DEVELOPMENT REGARDING FRAGILE X

Sec. 201. Short title.
Sec. 202. National Institute of Child Health and Human Development; 
              research on fragile X.
Sec. 203. National Institute of Child Health and Human Development; 
              loan repayment program regarding research on fragile X.

          TITLE III--JUVENILE ARTHRITIS AND RELATED CONDITIONS

Sec. 301. National Institute of Arthritis and Musculoskeletal and Skin 
              Diseases; research on juvenile arthritis and related 
              conditions.
Sec. 302. Information clearinghouse.

     TITLE IV--REDUCING BURDEN OF DIABETES AMONG CHILDREN AND YOUTH

Sec. 401. Programs of Centers for Disease Control and Prevention.
Sec. 402. Programs of National Institutes of Health.

            TITLE V--ASTHMA TREATMENT SERVICES FOR CHILDREN

Sec. 501. Short title.

                     Subtitle A--Treatment Services

Sec. 511. Grants for children's asthma relief.
Sec. 512. Technical and conforming amendments.

                   Subtitle B--Prevention Activities

Sec. 521. Preventive health and health services block grant; systems 
              for reducing asthma-related illnesses through urban 
              cockroach management.

             Subtitle C--Coordination of Federal Activities

Sec. 531. Coordination through National Institutes of Health.

                    Subtitle D--Compilation of Data

Sec. 541. Compilation of data by Centers for Disease Control and 
              Prevention.

             TITLE VI--BIRTH DEFECTS PREVENTION ACTIVITIES

                    Subtitle A--Folic Acid Promotion

Sec. 601. Short title.
Sec. 602. Program regarding effects of folic acid in prevention of 
              birth defects.

    Subtitle B--National Center on Birth Defects and Developmental 
                              Disabilities

Sec. 611. National Center on Birth Defects and Developmental 
              Disabilities.

TITLE VII--EARLY DETECTION, DIAGNOSIS, AND TREATMENT REGARDING HEARING 
                            LOSS IN INFANTS

Sec. 701. Short title.
Sec. 702. Purposes.
Sec. 703. Programs of Health Resources and Services Administration, 
              Centers for Disease Control and Prevention, and National 
              Institutes of Health.

                   TITLE VIII--CHILDREN AND EPILEPSY

Sec. 801. National public health campaign on epilepsy; seizure disorder 
              demonstration projects in medically underserved areas.

           TITLE IX--SAFE MOTHERHOOD; INFANT HEALTH PROMOTION

     Subtitle A--Safe Motherhood Monitoring and Prevention Research

Sec. 901. Short title.
Sec. 902. Monitoring; prevention research and other activities.

       Subtitle B--Pregnant Mothers and Infants Health Promotion

Sec. 911. Short title.
Sec. 912. Programs regarding prenatal and postnatal health.

          TITLE X--REVISION AND EXTENSION OF CERTAIN PROGRAMS

               Subtitle A--Pediatric Research Initiative

Sec. 1001. Short title.

[[Page H2699]]

Sec. 1002. Establishment of pediatric research initiative.
Sec. 1003. Investment in tomorrow's pediatric researchers.

                       Subtitle B--Other Programs

Sec. 1011. Childhood immunizations.
Sec. 1012. Screenings, referrals, and education regarding lead 
              poisoning.

               TITLE XI--CHILDHOOD SKELETAL MALIGNANCIES

Sec. 1101. Programs of Centers for Disease Control and Prevention and 
              National Institutes of Health.

                     TITLE XII--ADOPTION AWARENESS

                 Subtitle A--Infant Adoption Awareness

Sec. 1201. Short title.
Sec. 1202. Grants regarding infant adoption awareness.

              Subtitle B--Special Needs Adoption Awareness

Sec. 1211. Short title.
Sec. 1212. Special needs adoption programs; public awareness campaign 
              and other activities.

                   TITLE XIII--TRAUMATIC BRAIN INJURY

Sec. 1301. Short title.
Sec. 1302. Programs of Centers for Disease Control and Prevention.
Sec. 1303. Programs of National Institutes of Health.
Sec. 1304. Programs of Health Resources and Services Administration.

             TITLE XIV--PREVENTION AND CONTROL OF INJURIES

Sec. 1401. Authorization of Appropriations for programs of Centers for 
              Disease Control and Prevention.

                   TITLE XV--HEALTHY START INITIATIVE

Sec. 1501. Short title.
Sec. 1502. Continuation of healthy start program.

        TITLE XVI--ORAL HEALTH PROMOTION AND DISEASE PREVENTION

Sec. 1601. Oral health promotion and disease prevention.

                TITLE XVII--VACCINE COMPENSATION PROGRAM

Sec. 1701. Short title.
Sec. 1702. Content of petitions.

                        TITLE XVIII--HEPATITIS C

Sec. 1801. Short title.
Sec. 1802. Surveillance and education regarding hepatitis C.

            TITLE XIX--NIH INITIATIVE ON AUTOIMMUNE DISEASES

Sec. 1901. Short title.
Sec. 1902. Juvenile diabetes, juvenile arthritis, lupus, multiple 
              sclerosis, and other autoimmune-diseases; initiative 
              through Director of National Institutes of Health.

 TITLE XX--GRADUATE MEDICAL EDUCATION PROGRAMS IN CHILDREN'S HOSPITALS

Sec. 2001. Extension of authorization of appropriations.

  TITLE XXI--SPECIAL NEEDS OF CHILDREN REGARDING ORGAN TRANSPLANTATION

Sec. 2101. Short title.
Sec. 2102. Organ Procurement and Transplantation Network; amendments
              regarding needs of children.

                  TITLE XXII--MISCELLANEOUS PROVISIONS

Sec. 2201. Report regarding research on rare diseases in children.

                      TITLE XXIII--EFFECTIVE DATE

Sec. 2301. Effective date.

                            TITLE I--AUTISM

Subtitle A--Surveillance and Research Regarding Prevalence and Pattern 
                               of Autism

     SEC. 101. SHORT TITLE.

       This subtitle may be cited as the ``Autism Statistics, 
     Surveillance, Research, and Epidemiology Act of 2000 
     (ASSURE)''.

     SEC. 102. SURVEILLANCE AND RESEARCH PROGRAMS; CLEARINGHOUSE; 
                   ADVISORY COMMITTEE.

       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:


      ``surveillance and research regarding autism and pervasive 
                        developmental disorders

       ``Sec. 317H. (a) In General.--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 disorders. 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 Disorders 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 disorders epidemiology for the 
     purpose of collecting and analyzing information on the 
     number, incidence, correlates, and causes of autism and 
     related developmental disorders.
       ``(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 disorders data according to 
     guidelines prescribed by the Director, after consultation 
     with relevant State and local public health officials, 
     private sector developmental disorder researchers, and 
     advocates for those with developmental disorders;
       ``(B) The center will assist with the development and 
     coordination of State autism and pervasive developmental 
     disorders 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 disorders; 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 
     disorders; 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).
       ``(c) 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 disorders surveillance activities through the 
     establishment of a clearinghouse for the collection and 
     storage of data generated from the monitoring programs 
     created by this section. 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 disorders.
       ``(2) The Secretary shall coordinate the Federal response 
     to requests for assistance from State health department 
     officials regarding potential or alleged autism or 
     developmental disorder clusters.
       ``(d) Advisory Committee.--
       ``(1) In general.--The Secretary shall establish an 
     Advisory Committee for Autism and Pervasive developmental 
     disorders 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--
       ``(A) the establishment of a national autism and pervasive 
     developmental disorders surveillance program;
       ``(B) the establishment of centers of excellence in autism 
     and pervasive developmental disorders epidemiology;
       ``(C) methods and procedures to more effectively coordinate 
     government and non-government programs and research on autism 
     and pervasive developmental disorders epidemiology; and
       ``(D) the effective operation of autism and pervasive 
     developmental disorders epidemiology research activities.
       ``(2) Composition.--
       ``(A) In general.--The Committee shall be composed of ex 
     officio members in accordance with subparagraph (B) and 11 
     appointed members in accordance with subparagraph (C).
       ``(B) Ex officio members.--The following officials shall 
     serve as ex officio members of the Committee:
       ``(i) The Director of the National Center for Environmental 
     Health.
       ``(ii) The Assistant Administrator of the Agency for Toxic 
     Substances and Disease Registry.
       ``(iii) The Director of the National Institute of Child 
     Health and Human Development.
       ``(iv) The Director of the National Institute of 
     Neurological Disorders and Stroke.
       ``(C) Appointed members.--Appointments to the Committee 
     shall be made in accordance with the following:
       ``(i) Two members shall be research scientists with 
     demonstrated achievements in research related to autism and 
     related developmental disorders. The scientists shall be 
     appointed by the Secretary in consultation with the National 
     Academy of Sciences.
       ``(ii) Five members shall be representatives of the five 
     national organizations whose primary emphasis is on research 
     into autism and other pervasive developmental disorders. One 
     representative from each of such organizations shall be 
     appointed by the Secretary in consultation with the National 
     Academy of Sciences.

[[Page H2700]]

       ``(iii) Two members shall be clinicians whose practice is 
     primarily devoted to the treatment of individuals with autism 
     and other pervasive developmental disorders. The clinicians 
     shall be appointed by the Secretary in consultation with the 
     Institute of Medicine and the National Academy of Sciences.
       ``(iv) Two members shall be individuals who are the parents 
     or legal guardians of a person or persons with autism or 
     other pervasive developmental disorders. The individuals 
     shall be appointed by the Secretary in consultation with the 
     ex officio members under subparagraph (B) and the five 
     national organizations referred to in clause (ii).
       ``(3) Administrative support; terms of service; other 
     provisions.--The following apply with respect to the 
     Committee:
       ``(A) The Committee shall receive necessary and appropriate 
     administrative support from the Department of Health and 
     Human Services.
       ``(B) Members of the Committee shall be appointed for a 
     term of three years, and may serve for an unlimited number of 
     terms if reappointed.
       ``(C) The Committee shall meet no less than two times per 
     year.
       ``(D) 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.
       ``(e) Report to Congress.--The Secretary shall prepare and 
     submit to the Congress, after consultation with and comment 
     by the advisory committee under subsection (d), 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.
       ``(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 2001 through 2005.''.

  Subtitle B--Expansion, Intensification, and Coordination of Autism 
   Activities of National Institutes of Health With Respect to Autism

     SEC. 111. SHORT TITLE.

       This subtitle may be cited as the ``Advancement in 
     Pediatric Autism Research Act of 2000''.

     SEC. 112. EXPANSION, INTENSIFICATION, AND COORDINATION; 
                   INFORMATION AND EDUCATION; INTERAGENCY 
                   COORDINATING COMMITTEE.

       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 (other 
     than subsection (b)) acting through the Director of the 
     National Institute of Mental Health and in collaboration with 
     any other agencies that the Director determines 
     appropriate.
       ``(b) Interagency Coordinating Committee.--
       ``(1) In general.--The Secretary shall ensure that there is 
     in operation an interagency committee to be known as the 
     `Autism Coordinating Committee' (referred to in this 
     subsection 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 under this section and activities 
     carried out through the Centers for Disease Control and 
     Prevention under section 317H.
       ``(2) Membership.--The Committee shall be composed of such 
     directors of the national research institutes, such directors 
     of centers within the Centers for Disease Control and 
     Prevention, and such other officials within the Department of 
     Health and Human Services as the Secretary determines to be 
     appropriate. The Committee may include representatives of 
     other Federal agencies that serve children with autism, such 
     as the Department of Education.
       ``(3) Meetings.--The Committee shall meet not less than 
     twice per year.
       ``(c) 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), subject to the extent of amounts 
     made available in appropriations Acts. 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.
       ``(d) 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.
       ``(e) Information and Education.--
       ``(1) In general.--The Director 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.
       ``(2) Stipends.--The Director may use amounts made 
     available under this section to provide stipends for health 
     professionals who are enrolled in training programs under 
     this section.
       ``(f) 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.
       ``(g) Annual Report to Congress.--The Director shall 
     prepare and submit to the appropriate committees of the 
     Congress reports regarding the activities carried out under 
     this section. The first report shall be submitted not later 
     than January 10, 2002, and subsequent reports shall be 
     submitted annually thereafter.
       ``(h) 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 2001 through 
     2005. Such authorizations of appropriations are in addition 
     to any other authorizations of appropriations that are 
     available for such purpose.''.

         TITLE II--RESEARCH AND DEVELOPMENT REGARDING FRAGILE X

     SEC. 201. SHORT TITLE.

       This title may be cited as the ``Fragile X Research 
     Breakthrough Act of 2000''.

     SEC. 202. 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 is amended by adding at the end the following 
     section:


                              ``fragile x

       ``Sec. 452E. (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.--

[[Page H2701]]

       ``(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 2001 through 2005.''.

     SEC. 203. 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 2001 through 2005.''.

          TITLE III--JUVENILE ARTHRITIS AND RELATED CONDITIONS

     SEC. 301. NATIONAL INSTITUTE OF ARTHRITIS AND MUSCULOSKELETAL 
                   AND SKIN DISEASES; RESEARCH ON JUVENILE 
                   ARTHRITIS AND RELATED CONDITIONS.

       Subpart 4 of part C of title IV of the Public Health 
     Service Act (42 U.S.C. 285d et seq.) is amended by inserting 
     after section 442 the following section:


              ``juvenile arthritis and related conditions

       ``Sec. 442A. (a) Expansion and Coordination of 
     Activities.--The Director of the Institute, in coordination 
     with the Director of 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) Pediatric Rheumatology.--The Secretary, acting 
     through the appropriate agencies of the Public Health 
     Service, shall develop a coordinated effort to help 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 2001 through 2005.''.

     SEC. 302. INFORMATION CLEARINGHOUSE.

       Section 438(b) of the Public Health Service Act (42 U.S.C. 
     285d-3(b)) is amended by inserting ``, including juvenile 
     arthritis and related conditions,'' after ``diseases''.

     TITLE IV--REDUCING BURDEN OF DIABETES AMONG CHILDREN AND YOUTH

     SEC. 401. PROGRAMS OF CENTERS FOR DISEASE CONTROL AND 
                   PREVENTION.

       Part B of title III of the Public Health Service Act, as 
     amended by section 102 of this Act, is amended by inserting 
     after section 317H the following section:


                    ``diabetes in children and youth

       ``Sec. 317I. (a) National Registry on Juvenile Diabetes.--
     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) Type 2 Diabetes in Youth.--The Secretary, acting 
     through the Director of the Centers for Disease Control and 
     Prevention and in consultation with the Administrator of the 
     Health Resources and Services Administration, 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;
       ``(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; and
       ``(3) developing and improving laboratory methods to assist 
     in diagnosis, treatment, and prevention of diabetes 
     including, but not limited to, developing noninvasive ways to 
     monitor blood glucose to prevent hypoglycema and improving 
     existing glucometers that measure blood glucose.
       ``(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 2001 through 2005.''.

     SEC. 402. PROGRAMS OF NATIONAL INSTITUTES OF HEALTH.

       Subpart 3 of part C of title IV of the Public Health 
     Service Act (42 U.S.C. 285c et seq.) is amended by inserting 
     after section 434 the following section:


                          ``juvenile diabetes

       ``Sec. 434A. (a) Long-Term Epidemiology Studies.--
       ``(1) In general.--The Director of the Institute 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.
       ``(b) 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.
       ``(c) 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.
       ``(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 2001 through 2005.''.

            TITLE V--ASTHMA TREATMENT SERVICES FOR CHILDREN

     SEC. 501. SHORT TITLE.

       This title may be cited as the ``Children's Asthma Relief 
     Act of 2000''.

                         Subtitle A--Treatment

     SEC. 511. GRANTS FOR CHILDREN'S ASTHMA RELIEF.

       Title III of the Public Health Service Act (42 U.S.C. 241 
     et seq.) is amended by adding at the end the following part:

[[Page H2702]]

                     ``PART P--ADDITIONAL PROGRAMS

     ``SEC. 399L. CHILDREN'S ASTHMA TREATMENT GRANTS PROGRAM.

       ``(a) 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 following purposes:
       ``(A) 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.
       ``(B) 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 treat asthma and prevent its exacerbations.
       ``(C) 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 
     management of asthma.
       ``(D) 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.
       ``(2) Certain projects.--In making grants under paragraph 
     (1), the Secretary may make grants designed to develop and 
     expand the following projects:
       ``(A) Projects to provide comprehensive asthma services to 
     children in accordance with the guidelines of the National 
     Asthma Education and Prevention Program (through the National 
     Heart, Lung and Blood Institute), including access to care 
     and treatment for asthma in a community-based setting;
       ``(B) Projects to demonstrate mobile health care clinics 
     that in accordance with such guidelines provide preventive 
     asthma care. Such projects shall be evaluated and reports 
     describing the findings of the evaluations shall be submitted 
     to the Congress.
       ``(C) Projects to conduct 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.
       ``(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 or 
     suspected high prevalence of childhood asthma or high asthma-
     related mortality (relative to the average asthma prevalence 
     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.
       ``(b) 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).
       ``(c) 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.
       ``(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 2001 through 2005.''.

     SEC. 512. TECHNICAL AND CONFORMING AMENDMENTS.

       Title III of the Public Health Service Act (42 U.S.C. 241 
     et seq.) is amended--
       (1) in part L, by redesignating section 399D as section 
     399A;
       (2) in part M--
       (A) by redesignating sections 399H through 399L as sections 
     399B through 399F, respectively;
       (B) in section 399B (as so redesignated), in subsection 
     (e)--
       (i) by striking ``section 399K(b)'' and inserting 
     ``subsection (b) of section 399E''; and
       (ii) by striking ``section 399C'' and inserting ``such 
     section'';
       (C) in section 399E (as so redesignated), in subsection 
     (c), by striking ``section 399H(a)'' and inserting ``section 
     399B(a)''; and
       (D) in section 399F (as so redesignated)--
       (i) in subsection (a), by striking ``section 399I'' and 
     inserting ``section 399C'';
       (ii) in subsection (a), by striking ``subsection 399J'' and 
     inserting ``section 399D''; and
       (iii) in subsection (b), by striking ``subsection 399K'' 
     and inserting ``section 399E'';
       (3) in part N, by redesignating section 399F as section 
     399G; and
       (4) in part O--
       (A) by redesignating sections 399G through 399J as sections 
     399H through 399K, respectively;
       (B) in section 399H (as so redesignated), in subsection 
     (b), by striking ``section 399H'' and inserting ``section 
     399I'';
       (C) in section 399J (as so redesignated), in subsection 
     (b), by striking ``section 399G(d)'' and inserting ``section 
     399H(d)''; and
       (D) in section 399K (as so redesignated), by striking 
     ``section 399G(d)(1)'' and inserting ``section 399H(d)(1)''.

                   Subtitle B--Prevention Activities

     SEC. 521. PREVENTIVE HEALTH AND HEALTH SERVICES BLOCK GRANT; 
                   SYSTEMS FOR REDUCING 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 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)''.

             Subtitle C--Coordination of Federal Activities

     SEC. 531. COORDINATION THROUGH NATIONAL INSTITUTES OF HEALTH.

       Subpart 2 of part C of title IV of the Public Health 
     Service Act (42 U.S.C. 285b et seq.) is amended by inserting 
     after section 424A the following section:


              ``coordination of federal asthma activities

       ``Sec. 424B (a) In General.--The Director of 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 the 
     enactment of the Children's Health Act of 2000, submit 
     recommendations to the appropriate committees of the 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).

[[Page H2703]]

       ``(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 2001 through 2005.''.

                    Subtitle D--Compilation of Data

     SEC. 541. COMPILATION OF DATA BY CENTERS FOR DISEASE CONTROL 
                   AND PREVENTION.

       Part B of title III of the Public Health Service Act, as 
     amended by section 401 of this Act, is amended by inserting 
     after section 317I the following section:


                    ``compilation of data on asthma

       ``Sec. 317J. (a) In General.--The Secretary, acting through 
     the Director of the Centers for Disease Control and 
     Prevention and in consultation with the Director of the 
     National Heart, Lung, and Blood Institute, shall--
       ``(1) conduct local asthma surveillance activities to 
     collect data on the prevalence and severity of asthma and the 
     quality of asthma management;
       ``(2) compile and annually publish data on the prevalence 
     of children suffering from asthma in each State; and
       ``(3) to the extent practicable, compile and publish data 
     on the childhood mortality rate associated with asthma 
     nationally.
       ``(b) National Coordinating Committee.--The Director of the 
     National Heart, Lung, and Blood Institute shall in carrying 
     out subsection (a) consult with the National Asthma Education 
     Prevention Program Coordinating Committee.
       ``(c) Collaborative Efforts.--The activities described in 
     subsection (a)(1) may be conducted in collaboration with 
     eligible entities awarded a grant under section 399L.''.

             TITLE VI--BIRTH DEFECTS PREVENTION ACTIVITIES

                         Subtitle A--Folic Acid

     SEC. 601. SHORT TITLE.

       This subtitle may be cited as the ``Folic Acid Promotion 
     and Birth Defects Prevention Act of 2000''.

     SEC. 602. PROGRAM REGARDING EFFECTS OF FOLIC ACID IN 
                   PREVENTION OF BIRTH DEFECTS.

       Part B of title III of the Public Health Service Act, as 
     amended by section 541 of this Act, is amended by inserting 
     after section 317J the following section:


         ``effects of folic acid in prevention of birth defects

       ``Sec. 317K. (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 2001 through 2005.''.

    Subtitle B--National Center on Birth Defects and Developmental 
                              Disabilities

     SEC. 611. NATIONAL CENTER ON BIRTH DEFECTS AND
                   DEVELOPMENTAL DISABILITIES.

       Section 317C of the Public Health Service Act (42 U.S.C. 
     247b-4) is amended--
       (1) by striking the heading for the section and inserting 
     the following:


  ``national center on birth defects and developmental disabilities'';

       (2) by striking ``Sec. 317C. (a)'' and all that follows 
     through the end of subsection (a) and inserting the 
     following:
       ``Sec. 317C. (a) In General.--
       ``(1) National center.--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 (referred to in this section as 
     the `Center'), which shall be headed by a director appointed 
     by the Director of the Centers for Disease Control and 
     Prevention.
       ``(2) General duties.--The Secretary shall carry out 
     programs--
       (A) to collect, analyze, and make available data on birth 
     defects (in a manner that facilitates compliance with 
     subsection (d)(2)), including data on the causes of such 
     defects and on the incidence and prevalence of such defects;
       (B) to operate regional centers for the conduct of applied 
     epidemiological research on the prevention of such defects; 
     and
       (C) to provide information and education to the public on 
     the prevention of such defects.
       ``(3) Folic acid.--The Secretary shall carry out section 
     317K through the Center.
       ``(4) Certain programs.--
       ``(A) Transfers.--All programs and functions described in 
     subparagraph (B) are transferred to the Center, effective on 
     the date of the enactment of the Children's Health Act of 
     2000.
       ``(B) Relevant programs.--The programs and functions 
     described in this subparagraph are all programs and functions 
     that--
       ``(i) relate to birth defects, folic acid, cerebral palsy, 
     mental retardation, child development, newborn screening, 
     autism, fragile X syndrome, fetal alcohol syndrome, pediatric 
     genetics, or disability prevention; and
       ``(ii) were carried out through the National Center for 
     Environmental Health as of the day before the date of the 
     enactment of the Act referred to in subparagraph (A).
       ``(C) Related transfers.--Personnel employed in connection 
     with the programs and functions specified in subparagraph 
     (B), and amounts available for carrying out the programs and 
     functions, are transferred to the Center, effective on the 
     date of the enactment of the Act referred to in subparagraph 
     (A). Such transfer of amounts does not affect the period of 
     availability of the amounts, or the availability of the 
     amounts with respect to the purposes for which the amounts 
     may be expended.''; and
       (3) in subsection (b)(1), in the matter preceding 
     subparagraph (A), by striking ``(a)(1)'' and inserting 
     ``(a)(2)(A)''.

TITLE VII--EARLY DETECTION, DIAGNOSIS, AND TREATMENT REGARDING HEARING 
                            LOSS IN INFANTS

     SEC. 701. SHORT TITLE.

       This title may be cited as the ``Newborn and Infant Hearing 
     Screening and Intervention Act of 2000''.

     SEC. 702. PURPOSES.

       The purposes of this title 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.

     SEC. 703. PROGRAMS OF HEALTH RESOURCES AND SERVICES 
                   ADMINISTRATION, CENTERS FOR DISEASE CONTROL AND 
                   PREVENTION, AND NATIONAL INSTITUTES OF HEALTH.

       Part P of title III of the Public Health Service Act, as 
     added by section 511 of this Act, is amended by adding at the 
     end the following section:

     ``SEC. 399M. EARLY DETECTION, DIAGNOSIS, AND TREATMENT 
                   REGARDING HEARING LOSS IN INFANTS.

       ``(a) Statewide Newborn and Infant Hearing Screening, 
     Evaluation and Intervention Programs and Systems.--The 
     Secretary, acting through the Administrator of

[[Page H2704]]

     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.
       ``(b) 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.
       ``(c) 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 (a) 
     and to develop a data collection system under subsection (b).
       ``(d) Rule of Construction.--Nothing in this section shall 
     be construed to preempt any State law.
       ``(e) Definitions.--For purposes of this section:
       ``(1) The term `audiologic evaluation' refers to 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 coordinating agencies under part C of the Individuals 
     with Disabilities Education Act 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.
       ``(2) The terms `audiologic rehabilitation' and `audiologic 
     intervention' refer to procedures, techniques, and 
     technologies to facilitate the receptive and expressive 
     communication abilities of a child with hearing loss.
       ``(3) The term `early intervention' refers to providing 
     appropriate services for the child with hearing loss, 
     including nonmedical services, 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.
       ``(4) The term `medical evaluation by a physician' refers 
     to 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.
       ``(5) The term `medical intervention' refers to 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.
       ``(6) The term `newborn and infant hearing screening' 
     refers to objective physiologic procedures to detect possible 
     hearing loss and to identify newborns and infants who, after 
     rescreening, require further audiologic and medical 
     evaluations.
       ``(f) Authorization of Appropriations.--
       ``(1) Statewide newborn and infant hearing screening, 
     evaluation and intervention programs and systems.--For the 
     purpose of carrying out subsection (a), 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 2001 through 2005.
       ``(2) Technical assistance, data management, and applied 
     research; centers for disease control and prevention.--For 
     the purpose of carrying out subsection (b)(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 2001 through 2005.
       ``(3) Technical assistance, data management, and applied 
     research; national institute on deafness and other 
     communication disorders.--For the purpose of carrying out 
     subsection (b)(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 2001 through 2005.''.

                   TITLE VIII--CHILDREN AND EPILEPSY

     SEC. 801. NATIONAL PUBLIC HEALTH CAMPAIGN ON EPILEPSY; 
                   SEIZURE DISORDER DEMONSTRATION PROJECTS IN 
                   MEDICALLY UNDERSERVED AREAS.

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

     ``SEC. 330E. EPILEPSY; SEIZURE DISORDER.

       ``(a) National Public Health Campaign.--
       ``(1) In general.--The Secretary 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.
       ``(2) Certain activities.--Activities under paragraph (1) 
     shall include--
       ``(A) expanding current surveillance activities through 
     existing monitoring systems and improving registries that 
     maintain data on individuals with epilepsy, including 
     children;
       ``(B) enhancing research activities on patient management 
     and control of epilepsy;
       ``(C) 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;
       ``(D) 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;

[[Page H2705]]

       ``(E) utilizing and expanding partnerships with 
     organizations with experience addressing the health and 
     related needs of people with disabilities; and
       ``(F) other activities the Secretary deems appropriate.
       ``(3) Coordination of activities.--The Secretary shall 
     ensure that activities under this subsection are coordinated 
     as appropriate with other agencies of the Public Health 
     Service that carry out activities regarding epilepsy and 
     seizure.
       ``(b) Seizure Disorder; Demonstration Projects in Medically 
     Underserved Areas.--
       ``(1) 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.
       ``(2) Application for grant.--The Secretary may make a 
     grant under paragraph (1) 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 subsection.
       ``(c) Definitions.--For purposes of this section:
       ``(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).
       ``(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 2001 through 2005.''.

           TITLE IX--SAFE MOTHERHOOD; INFANT HEALTH PROMOTION

     Subtitle A--Safe Motherhood Monitoring and Prevention Research

     SEC. 901. SHORT TITLE.

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

     SEC. 902. MONITORING; PREVENTION RESEARCH AND OTHER 
                   ACTIVITIES.

       Part B of title III of the Public Health Service Act, as 
     amended by section 602 of this Act, is amended by inserting 
     after section 317K the following section:


                           ``safe motherhood

       ``Sec. 317L. (a) Monitoring.--
       ``(1) Purpose.--The purpose of this subsection is 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.
       ``(2) Activities.--For the purpose described in paragraph 
     (1), the Secretary may carry out the following activities:
       ``(A) 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.
       ``(B) The Secretary may expand the Pregnancy Risk 
     Assessment Monitoring System to provide surveillance and 
     collect data in each of the 50 States.
       ``(C) 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.
       ``(b) Prevention Research.--
       ``(1) Purpose.--The purpose of this subsection is 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.
       ``(2) Research.--The Secretary may carry out activities to 
     expand research relating to--
       ``(A) encouraging preconception counseling, especially for 
     at risk populations such as diabetics;
       ``(B) the identification of critical components of prenatal 
     delivery and postpartum care;
       ``(C) the identification of outreach and support services, 
     such as folic acid education, that are available for pregnant 
     women;
       ``(D) the identification of women who are at high risk for 
     complications;
       ``(E) preventing preterm delivery;
       ``(F) preventing urinary tract infections;
       ``(G) preventing unnecessary caesarean sections;
       ``(H) an examination of the higher rates of maternal 
     mortality among African American women;
       ``(I) an examination of the relationship between domestic 
     violence and maternal complications and mortality;
       ``(J) preventing smoking, alcohol and illegal drug usage 
     before, during and after pregnancy;
       ``(K) preventing infections that cause maternal and infant 
     complications; and
       ``(L) other areas determined appropriate by the Secretary.
       ``(c) Prevention Programs.--
       ``(1) In general.--The Secretary may carry out activities 
     to promote safe motherhood, including--
       ``(A) public education campaigns on healthy pregnancies and 
     the building of partnerships with outside organizations 
     concerned about safe motherhood;
       ``(B) education programs for physicians, nurses and other 
     health care providers; and
       ``(C) activities to promote community support services for 
     pregnant women.
       ``(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 2001 through 2005.''.

       Subtitle B--Pregnant Mothers and Infants Health Promotion

     SEC. 911. SHORT TITLE.

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

     SEC. 912. PROGRAMS REGARDING PRENATAL AND POSTNATAL HEALTH.

       Part B of title III of the Public Health Service Act, as 
     amended by section 902 of this Act, is amended by inserting 
     after section 317L the following section:


                    ``prenatal and postnatal health

       ``Sec. 317M. (a) In General.--The Secretary, acting through 
     the Director of the Centers for Disease Control and 
     Prevention, 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 2001 through 2005.''.

              TITLE X--REVISION AND EXTENSION OF PROGRAMS

               Subtitle A--Pediatric Research Initiative

     SEC. 1001. SHORT TITLE.

       This subtitle may be cited as the ``Pediatric Research 
     Initiative Act of 2000''.

     SEC. 1002. ESTABLISHMENT OF PEDIATRIC RESEARCH
                   INITIATIVE.

       Part B of title IV of the Public Health Service Act, as 
     amended by section 112 of this Act, is amended by adding at 
     the end the following:


                    ``pediatric research initiative

       ``Sec. 409D. (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 provide--
       ``(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 Director of the National Institute 
     of Child Health and Human Development and the Directors of 
     the other national research institutes, in considering their 
     requests for new or expanded pediatric research efforts, and 
     consult with the Administrator of the Health Resources and 
     Services Administration and other advisors as the Director 
     determines to be 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

[[Page H2706]]

     necessary for each of the fiscal years 2001 through 2005.
       ``(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. 1003. INVESTMENT IN TOMORROW'S PEDIATRIC
                   RESEARCHERS.

       Subpart 7 of part C of title IV of the Public Health 
     Service Act, as amended by section 921 of this Act, is 
     amended by adding at the end the following:


            ``investment in tomorrow's pediatric researchers

       ``Sec. 452G. (a) In General.--In order to ensure the future 
     supply of researchers dedicated to the care and research 
     needs of children, the Director of the Institute, after 
     consultation with the Administrator of the Health Resources 
     and Services Administration, shall support activities to 
     provide for--
       ``(1) an increase in the number and size of institutional 
     training grants to pediatric departments of medical schools 
     and to children's hospitals; and
       ``(2) an increase in the number of career development 
     awards for health professionals who are in pediatric 
     specialties or subspecialties and intend to build careers in 
     pediatric basic and clinical research.
       ``(b) 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 2001 through 
     2005.''.

                       Subtitle B--Other Programs

     SEC. 1011. 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. 1012. 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.''.

               TITLE XI--CHILDHOOD SKELETAL MALIGNANCIES

     SEC. 1101. PROGRAMS OF CENTERS FOR DISEASE CONTROL AND 
                   PREVENTION AND NATIONAL INSTITUTES OF HEALTH.

       Part P of title III of the Public Health Service Act, as 
     amended by section 703 of this Act, is amended by adding at 
     the end the following section:

     ``SEC. 399N. CHILDHOOD SKELETAL MALIGNANCIES.

       ``(a) In General.--The Secretary, acting as appropriate 
     through the Director of the Centers for Disease Control and 
     Prevention and the Director of the National Institutes of 
     Health, 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 for purposes of this section 
     revise the definition of such term to the extent determined 
     by the Secretary to be appropriate.
       ``(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 2001 through 2005.''.

                     TITLE XII--ADOPTION AWARENESS

                 Subtitle A--Infant Adoption Awareness

     SEC. 1201. SHORT TITLE.

       This subtitle may be cited as the ``Infant Adoption 
     Awareness Act of 2000''.

     SEC. 1202. GRANTS REGARDING INFANT ADOPTION AWARENESS.

       Subpart I of part D of title III of the Public Health 
     Service Act, as amended by section 801 of this Act, is 
     amended by adding at the end the following section:

     ``SEC. 330F. CERTAIN SERVICES FOR PREGNANT WOMEN.

       ``(a) Infant Adoption Awareness.--
       ``(1) In general.--The Secretary shall make grants to 
     national, regional, or local adoption organizations for the 
     purpose of developing and implementing programs to train the 
     designated staff of eligible health centers in providing 
     adoption information and referrals to pregnant women on an 
     equal basis with all other courses of action included in 
     nondirective counseling.
       ``(2) Best-practices guidelines.--
       ``(A) In general.--A condition for the receipt of a grant 
     under paragraph (1) is that the adoption organization 
     involved agree that, in providing training under such 
     paragraph, the organization will follow the guidelines 
     developed under subparagraph (B).
       ``(B) Process for development of guidelines.--
       ``(i) In general.--The Secretary shall establish and 
     supervise a process described in clause (ii) in which the 
     participants are--

       ``(I) an appropriate number and variety of adoption 
     organizations that, as a group, have expertise in all models 
     of adoption practice and that represent all members of the 
     adoption triad (birth mother, infant, and adoptive parent); 
     and
       ``(II) affected public health entities.

       ``(ii) Description of process.--The process referred to in 
     clause (i) is a process in which the participants described 
     in such clause collaborate to develop best-practices 
     guidelines on the provision of adoption information and 
     referrals to pregnant women on an equal basis with all other 
     courses of action included in nondirective counseling.
       ``(iii) Date certain for development.--The Secretary shall 
     ensure that the guidelines described in clause (ii) are 
     developed not later than 180 days after the date of the 
     enactment of the Children's Health Act of 2000.
       ``(C) Relation to authority for grants.--The Secretary may 
     not make any grant under paragraph (1) before the date on 
     which the guidelines under subparagraph (B) are developed.
       ``(3) Use of grant.--
       ``(A) In general.--With respect to a grant under paragraph 
     (1)--
       ``(i) an adoption organization may expend the grant to 
     carry out the programs directly or through grants to or 
     contracts with other adoption organizations;
       ``(ii) the purposes for which the adoption organization 
     expends the grant may include the development of a training 
     curriculum, consistent with the guidelines developed under 
     paragraph (2)(B); and
       ``(iii) a condition for the receipt of the grant is that 
     the adoption organization agree that, in providing training 
     for the designated staff of eligible health centers, such 
     organization will make reasonable efforts to ensure that the 
     individuals who provide the training are individuals who are 
     knowledgeable on the process for adopting a child and are 
     experienced in providing adoption information and referrals 
     in the geographic areas in which the eligible health centers 
     are located, and that the designated staff receive the 
     training in such areas.
       ``(B) Rule of construction regarding training of 
     trainers.--With respect to individuals who under a grant 
     under paragraph (1) provide training for the designated staff 
     of eligible health centers (referred to in this subparagraph 
     as `trainers'), subparagraph (A)(iii) may not be construed as 
     establishing any limitation regarding the geographic area in 
     which the trainers receive instruction in being such 
     trainers. A trainer may receive such instruction in a 
     different geographic area than the area in which the trainer 
     trains (or will train) the designated staff of eligible 
     health centers.
       ``(4) Adoption organizations; eligible health centers; 
     other definitions.--For purposes of this section:
       ``(A) The term `adoption organization' means a national, 
     regional, or local organization--
       ``(i) among whose primary purposes are adoption;
       ``(ii) that is knowledgeable on the process for adopting a 
     child and on providing adoption information and referrals to 
     pregnant women; and
       ``(iii) that is a nonprofit private entity.
       ``(B) The term `designated staff', with respect to an 
     eligible health center, means staff of the center who provide 
     pregnancy or adoption information and referrals (or will 
     provide such information and referrals after receiving 
     training under a grant under paragraph (1)).
       ``(C) The term `eligible health centers' means public and 
     nonprofit private entities that provide health-related 
     services to pregnant women.
       ``(5) Training for certain eligible health centers.--A 
     condition for the receipt of a grant under paragraph (1) is 
     that the adoption organization involved agree to make 
     reasonable efforts to ensure that the eligible health centers 
     with respect to which training under the grant is provided 
     include--
       ``(A) eligible health centers that receive grants under 
     section 1001 (relating to voluntary family planning 
     projects);
       ``(B) eligible health centers that receive grants under 
     section 330 (relating to community health centers, migrant 
     health centers, and centers regarding homeless individuals 
     and residents of public housing); and
       ``(C) eligible health centers that receive grants under 
     this Act for the provision of services in schools.
       ``(6) Participation of certain eligible health clinics.--In 
     the case of eligible health centers that receive grants under 
     section 330 or 1001:
       ``(A) Within a reasonable period after the Secretary begins 
     making grants under paragraph (1), the Secretary shall 
     provide eligible

[[Page H2707]]

     health centers with complete information about the training 
     available from organizations receiving grants under such 
     paragraph. The Secretary shall make reasonable efforts to 
     encourage eligible health centers to arrange for designated 
     staff to participate in such training.
       ``(B) All costs of such centers in obtaining the training 
     shall be reimbursed by the organization that provides the 
     training, using grants under paragraph (1).
       ``(C) Not later than one year after the date of the 
     enactment the Children's Health Act of 2000, the Secretary 
     shall submit to the appropriate committees of the Congress a 
     report evaluating the extent to which adoption information, 
     and referral upon request, is provided by eligible health 
     centers. Within a reasonable time after training under this 
     section is initiated, the Secretary shall submit to the 
     appropriate committees of the Congress a report evaluating 
     the extent to which adoption information, and referral upon 
     request, is provided by eligible health centers in order to 
     determine the effectiveness of such training. In preparing 
     the reports required by this subparagraph, the Secretary 
     shall in no respect interpret the provisions of this section 
     to allow any interference in the provider-patient 
     relationship, any breach of patient confidentiality, or any 
     monitoring or auditing of the counseling process or patient 
     records which breaches patient confidentiality or reveals 
     patient identity.
       ``(b) Application for Grant.--The Secretary may make a 
     grant under subsection (a) only if an application for the 
     grant is submitted to the Secretary and the application is in 
     such form, is made in such manner, 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 2001 through 2005.''.

              Subtitle B--Special Needs Adoption Awareness

     SEC. 1211. SPECIAL NEEDS ADOPTION PROGRAMS; PUBLIC AWARENESS 
                   CAMPAIGN AND OTHER ACTIVITIES.

       Subpart I of part D of title III of the Public Health 
     Service Act, as amended by section 1202 of this Act, is 
     amended by adding at the end the following section:

     ``SEC. 330G. SPECIAL NEEDS ADOPTION PROGRAMS; PUBLIC 
                   AWARENESS CAMPAIGN AND OTHER ACTIVITIES.

       ``(a) Special Needs Adoption Awareness Campaign.--
       ``(1) In general.--The Secretary shall, through making 
     grants to nonprofit private entities, provide for the 
     planning, development, and carrying out of a national 
     campaign to provide information to the public regarding the 
     adoption of children with special needs.
       ``(2) Input on planning and development.--In providing for 
     the planning and development of the national campaign under 
     paragraph (1), the Secretary shall provide for input from a 
     number and variety of adoption organizations throughout the 
     States in order that the full national diversity of interests 
     among adoption organizations is represented in the planning 
     and development of the campaign.
       ``(3) Certain features.--With respect to the national 
     campaign under paragraph (1):
       ``(A) The campaign shall be directed at various 
     populations, taking into account as appropriate differences 
     among geographic regions, and shall be carried out in the 
     language and cultural context that is most appropriate to the 
     population involved.
       ``(B) The means through which the campaign may be carried 
     out include--
       ``(i) placing public service announcements on television, 
     radio, and billboards; and
       ``(ii) providing information through means that the 
     Secretary determines will reach individuals who are most 
     likely to adopt children with special needs.
       ``(C) The campaign shall provide information on the 
     subsidies and supports that are available to individuals 
     regarding the adoption of children with special needs.
       ``(D) The Secretary may provide that the placement of 
     public service announcements, and the dissemination of 
     brochures and other materials, is subject to review by the 
     Secretary.
       ``(4) Matching Requirement.--
       ``(A) In general.--With respect to the costs of the 
     activities to be carried out by an entity pursuant to 
     paragraph (1), a condition for the receipt of a grant under 
     such paragraph is that the entity agree 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 25 percent of such costs.
       ``(B) Determination of amount contributed.--Non-Federal 
     contributions under subparagraph (A) may be in cash or in 
     kind, fairly evaluated, including plant, 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 contributions.
       ``(b) National Resources Program.--The Secretary shall 
     (directly or through grant or contract) carry out a program 
     that, through toll-free telecommunications, makes available 
     to the public information regarding the adoption of children 
     with special needs. Such information shall include the 
     following:
       ``(1) A list of national, State, and regional organizations 
     that provide services regarding such adoptions, including 
     exchanges and other information on communicating with the 
     organizations. The list shall represent the full national 
     diversity of adoption organizations.
       ``(2) Information beneficial to individuals who adopt such 
     children, including lists of support groups for adoptive 
     parents and other postadoptive services.
       ``(c) Other Programs.--With respect to the adoption of 
     children with special needs, the Secretary shall make 
     grants--
       ``(1) to provide assistance to support groups for adoptive 
     parents, adopted children, and siblings of adopted children; 
     and
       ``(2) to carry out studies to identify the reasons for 
     adoption disruptions.
       ``(d) Application for Grant.--The Secretary may make an 
     award of a grant or contract under this section only if an 
     application for the award is submitted to the Secretary and 
     the application is in such form, is made in such manner, and 
     contains such agreements, assurances, and information as the 
     Secretary determines to be necessary to carry out this 
     section.
       ``(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 2001 through 
     2005.''.

                   TITLE XIII--TRAUMATIC BRAIN INJURY

     SEC. 1301. SHORT TITLE.

       This title may be cited as the ``Traumatic Brain Injury Act 
     Amendments of 2000''.

     SEC. 1302. PROGRAMS OF CENTERS FOR DISEASE CONTROL AND 
                   PREVENTION.

       (a) In General.--Section 393A of the Public Health Service 
     Act (42 U.S.C. 280b-1b) is amended--
       (1) in subsection (b)--
       (A) in paragraph (1), by striking ``and'' at the end;
       (B) in paragraph (2), by striking the period and inserting 
     ``; and''; and
       (C) by adding at the end the following:
       ``(3) the implementation of a national education and 
     awareness campaign regarding such injury (in conjunction with 
     the program of the Secretary regarding health-status goals 
     for 2010, commonly referred to as Healthy People 2010), 
     including the national dissemination of information on--
       ``(A) incidence and prevalence;
       ``(B) secondary conditions arising from traumatic brain 
     injury upon discharge from hospitals and trauma centers.'';
       (2) in subsection (d)--
       (A) in the second sentence, by striking ``anoxia due to 
     near drowning.'' and inserting ``anoxia.''; and
       (B) in the third sentence, by inserting before the period 
     the following: ``, after consultation with States and other 
     appropriate public or nonprofit private entities''.
       (b) National Registry.--Part J of title III of the Public 
     Health Service Act (42 U.S.C. 280b et seq.) is amended by 
     inserting after section 393A the following section:


        ``national program for traumatic brain injury registries

       ``Sec. 393B. (a) In General.--The Secretary, acting through 
     the Director of the Centers for Disease Control and 
     Prevention, may make grants to States or their designees to 
     operate the State's traumatic brain injury registry, and to 
     academic institutions to conduct applied research that will 
     support the development of such registries, to collect data 
     concerning--
       ``(1) demographic information about each traumatic brain 
     injury;
       ``(2) information about the circumstances surrounding the 
     injury event associated with each traumatic brain injury;
       ``(3) administrative information about the source of the 
     collected information, dates of hospitalization and 
     treatment, and the date of injury; and
       ``(4) information characterizing the clinical aspects of 
     the traumatic brain injury, including the severity of the 
     injury, the types of treatments received, and the types of 
     services utilized.''.

     SEC. 1303. PROGRAMS OF NATIONAL INSTITUTES OF HEALTH.

       (a) Interagency Program.--Section 1261(d)(4) of the Public 
     Health Service Act (42 U.S.C. 300d-61(d)(4)) is amended--
       (1) in subparagraph (A), by striking ``degree of injury'' 
     and inserting ``degree of brain injury'';
       (2) in subparagraph (B), by striking ``acute injury'' and 
     inserting ``acute brain injury''; and
       (3) in subparagraph (D), by striking ``injury treatment'' 
     and inserting ``brain injury treatment''.
       (b) Definition.--Section 1261(h)(4) of the Public Health 
     Service Act (42 U.S.C. 300d-61(h)(4)) is amended--
       (1) in the second sentence, by striking ``anoxia due to 
     near drowning.'' and inserting ``anoxia.''; and
       (2) in the third sentence, by inserting before the period 
     the following: ``, after consultation with States and other 
     appropriate public or nonprofit private entities''.
       (c) Authorization of Appropriations.--Section 1261 of the 
     Public Health Service Act (42 U.S.C. 300d-61) is amended by 
     adding at the end the following:
       ``(i) 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 2004.''.

     SEC. 1304. PROGRAMS OF HEALTH RESOURCES AND SERVICES 
                   ADMINISTRATION.

       Section 1252 of the Public Health Service Act (42 U.S.C. 
     300d-51) is amended--

[[Page H2708]]

       (1) in subsection (b)(3)--
       (A) in subparagraph (A)(iv), by striking ``representing 
     traumatic brain injury survivors'' and inserting 
     ``representing individuals with traumatic brain injury''; 
     and
       (B) in subparagraph (B), by striking ``who are survivors 
     of'' and inserting ``with'';
       (2) in subsection (c)--
       (A) in paragraph (1), by striking ``, in cash,''; and
       (B) in paragraph (2), by amending the paragraph to read as 
     follows:
       ``(2) Determination of amount contributed.--Non-Federal 
     contributions under paragraph (1) may be in cash or in kind, 
     fairly evaluated, including plant, 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 contributions.'';
       (3) by designating subsections (e) through (h) as 
     subsections (g) through (j), respectively; and
       (4) by inserting after subsection (d) the following 
     subsections:
       ``(e) Continuation of Previously Awarded Demonstration 
     Projects.--A State that received a grant under this section 
     prior to the date of enactment of the Children's Health Act 
     of 2000 may compete for new project grants under this section 
     after such date of enactment.
       ``(f) Use of State Grants.--
       ``(1) Community services and supports.--A State shall 
     (directly or through awards of contracts to nonprofit private 
     entities) use amounts received under a grant under this 
     section for the following:
       ``(A) To develop, change, or enhance community-based 
     service delivery systems that include timely access to 
     comprehensive appropriate services and supports. Such service 
     and supports--
       ``(i) shall promote full participation by individuals with 
     brain injury and their families in decision making regarding 
     the services and supports; and
       ``(ii) shall be designed for children and other individuals 
     with traumatic brain injury.
       ``(B) To focus on outreach to underserved and 
     inappropriately served individuals, such as individuals in 
     institutional settings, individuals with low socioeconomic 
     resources, individuals in rural communities, and individuals 
     in culturally and linguistically diverse communities.
       ``(C) To award contracts to nonprofit entities for consumer 
     or family service access training, consumer support, peer 
     mentoring, and parent to parent programs.
       ``(D) To provide individual and family service coordination 
     or case management systems.
       ``(E) To support other needs identified by the advisory 
     board under subsection (b) for the State involved.
       ``(2) Best practices.--
       ``(A) In general.--State services and supports provided 
     under a grant under this section shall reflect the best 
     practices in the field of traumatic brain injury, shall be in 
     compliance with title II of the Americans with Disabilities 
     Act of 1990, and shall be supported by quality assurance 
     measures as well as state-of-the-art health care and 
     integrated community supports, regardless of the severity of 
     injury.
       ``(B) Demonstration by state agency.--The State agency 
     responsible for administering amounts received under a grant 
     under this section shall demonstrate or express a willingness 
     to obtain expertise and knowledge of traumatic brain injury 
     and the unique needs associated with traumatic brain injury.
       ``(3) State capacity building.--A State may use amounts 
     received under a grant under this section to--
       ``(A) educate consumers and families;
       ``(B) train professionals in public and private sector 
     financing (such as third party payers, State agencies, 
     community-based providers, schools, and educators);
       ``(C) develop or improve case management or service 
     coordination systems;
       ``(D) develop best practices in areas such as family or 
     consumer support, return to work, housing or supportive 
     living personal assistance services, assistive technology and 
     devices, behavioral health services, substance abuse 
     services, and traumatic brain injury treatment and 
     rehabilitation;
       ``(E) tailor existing State systems to provide 
     accommodations to the needs of individuals with brain injury 
     (including systems administered by the State departments 
     responsible for health, mental health, labor, education, 
     mental retardation/developmental disorders, transportation, 
     and correctional systems);
       ``(F) improve data sets coordinated across systems and 
     other needs identified by a State plan supported by its 
     advisory council; and
       ``(G) develop capacity within targeted communities.'';
       (5) in subsection (g) (as so redesignated), by striking 
     ``agencies of the Public Health Service'' and inserting 
     ``Federal agencies'';
       (6) in subsection (i) (as redesignated by paragraph (3))--
       (A) in the second sentence, by striking ``anoxia due to 
     near drowning.'' and inserting ``anoxia.''; and
       (B) in the third sentence, by inserting before the period 
     the following: ``, after consultation with States and other 
     appropriate public or nonprofit private entities''; and
       (7) in subsection (j) (as so redesignated), by amending the 
     subsection to read as follows:
       ``(j) Authorization of Appropriations.--For the purpose of 
     carrying out this section, there are authorized to be 
     appropriated such sums as may be necessary for each of the 
     fiscal years 2001 through 2005.''.

             TITLE XIV--PREVENTION AND CONTROL OF INJURIES

     SEC. 1401. AUTHORIZATION OF APPROPRIATIONS FOR PROGRAMS OF 
                   CENTERS FOR DISEASE CONTROL AND PREVENTION.

       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 2001 through 
     2005.''.

                   TITLE XV--HEALTHY START INITIATIVE

     SEC. 1501. SHORT TITLE.

       This title may be cited as the ``Healthy Start Initiative 
     Continuation Act''.

     SEC. 1502. CONTINUATION OF HEALTHY START PROGRAM.

       Subpart I of part D of title III of the Public Health 
     Service Act, as amended by section 1203 of this Act, is 
     amended by adding at the end the following section:

     ``SEC. 330H. HEALTHY START FOR INFANTS.

       ``(a) In General.--
       ``(1) Continuation and expansion of program.--The 
     Secretary, acting through the Administrator of the Health 
     Resources and Services Administration, Maternal and Child 
     Health Bureau, shall under authority of this section continue 
     in effect the Healthy Start Initiative and may, during fiscal 
     year 2001 and subsequent years, carry out such program on a 
     national basis.
       ``(2) Definition.--For purposes of paragraph (1), the term 
     `Healthy Start Initiative' is a reference to the program 
     that, as an initiative to reduce the rate of infant mortality 
     and improve perinatal outcomes, makes grants for project 
     areas with high annual rates of infant mortality and that, 
     prior to the effective date of this section, was a 
     demonstration program carried out under section 301.
       ``(3) Additional grants.-- Effective upon increased funding 
     beyond fiscal year 1999 for such Initiative, additional 
     grants may be made to States to assist communities with 
     technical assistance, replication of successful projects, and 
     State policy formation to reduce infant and maternal 
     mortality and morbidity.
       ``(b) Requirements for Making Grants.--In making grants 
     under subsection (a), the Secretary shall require that 
     applicants (in addition to meeting all eligibility criteria 
     established by the Secretary) establish, for project areas 
     under such subsection, community-based consortia of 
     individuals and organizations (including agencies responsible 
     for administering block grant programs under title V of the 
     Social Security Act, consumers of project services, public 
     health departments, hospitals, health centers under section 
     330, and other significant sources of health care services) 
     that are appropriate for participation in projects under 
     subsection (a).
       ``(c) Coordination.--Recipients of grants under subsection 
     (a) shall coordinate their services and activities with the 
     State agency or agencies that administer block grant programs 
     under title V of the Social Security Act in order to promote 
     cooperation, integrity, and dissemination of information with 
     Statewide systems and with other community services funded 
     under the Maternal and Child Health Block Grant.
       ``(d) Rule of Construction.--Except to the extent 
     inconsistent with this section, this section may not be 
     construed as affecting the authority of the Secretary to make 
     modifications in the program carried out under subsection 
     (a).
       ``(e) Medically Appropriate Ultrasound Services; Medically 
     Appropriate Services for At-Risk Mothers and Infants.--
       ``(1) In general.--The Secretary may make grants to health 
     care entities to provide--
       ``(A) for pregnant women, ultrasound services provided by 
     qualified health care professionals upon medical indication 
     and referral from health care professionals who provide 
     comprehensive prenatal services; and
       ``(B) for pregnant women or infants, other health services 
     (including prenatal care, genetic counseling, and fetal and 
     other surgery) that--
       ``(i) are determined by a qualified treating health care 
     professional to be medically appropriate in order to prevent 
     or mitigate congenital defects (including but not limited to 
     spina bifida and hydrocephaly) or other serious obstetric 
     complications (including but not limited to placenta previa, 
     premature rupture of membranes, or preeclampsia); and
       ``(ii) are provided during pregnancy or during the first 
     year after birth.
       ``(2) Eligible project area.--The Secretary may make a 
     grant under paragraph (1) only if the geographic area in 
     which services under the grant will be provided is a 
     geographic area in which a project under subsection (a) is 
     being carried out, and if the Secretary determines that the 
     grant will add to or expand the level of health services 
     available in such area to pregnant women and infants.
       ``(3) Transportation and subsistence expenses for certain 
     patients.--The purposes for which a grant under paragraph 
     (1)(B) may be expended include paying, on behalf of a 
     pregnant woman who is in need of the health services 
     described in such paragraph, transportation and subsistence 
     expenses to assist

[[Page H2709]]

     the pregnant woman in obtaining such health services from the 
     grantee involved. The Secretary may establish such 
     restrictions regarding payments under the preceding sentence 
     as the Secretary determines to be appropriate.
       ``(4) Certain conditions.--A condition for the receipt of a 
     grant under paragraph (1) is that the applicant for the grant 
     agree as follows:
       ``(A) In the case of a grant under paragraph (1)(A), if 
     ultrasound services indicate that there is a fetal anomaly or 
     other serious obstetric complication, the applicant will 
     refer the pregnant woman involved for appropriate medical 
     services, including, as appropriate, for health services 
     described in paragraph (1)(B) provided by grantees under such 
     paragraph.
       ``(B) If the applicant provides nondirective pregnancy 
     counseling to patients and is not subject to the condition 
     under section 330F(b), such counseling provided by the 
     applicant to patients will include (but is not limited to) 
     the provision of adoption information and referrals.
       ``(5) Relationship to payments under other programs.--A 
     grant may be made under paragraph (1) only if the applicant 
     involved agrees that the grant will not be expended to pay 
     the expenses of providing any service under such paragraph to 
     a pregnant woman to the extent that payment has been made, or 
     can reasonably be expected to be made, with respect to such 
     expenses--
       ``(A) under any State compensation program, under an 
     insurance policy, or under any Federal or State health 
     benefits program; or
       ``(B) by an entity that provides health services on a 
     prepaid basis.
       ``(6) Evaluation by general accounting office.--
       ``(A) In general.--During fiscal year 2004, the Comptroller 
     General of the United States shall conduct an evaluation of 
     activities under grants under paragraph (1) in order to 
     determine whether the activities have been effective in 
     serving the needs of pregnant women with respect to 
     ultrasound services and the other health services described 
     in paragraph (1)(B). The evaluation shall include an analysis 
     of whether such activities have been effective in reducing 
     the disparity in health status between the general population 
     and individuals who are members of racial or ethnic minority 
     groups. Not later than January 10, 2005, the Comptroller 
     General shall submit to the Committee on Commerce in the 
     House of Representatives, and to the Committee on Health, 
     Education, Labor, and Pensions in the Senate, a report 
     describing the findings of the evaluation.
       ``(B) Relation to grants regarding medically appropriate 
     services for at-risk mothers and infants.--Before the date on 
     which the evaluation under subparagraph (A) is submitted in 
     accordance with such subparagraph--
       ``(i) the Secretary shall ensure that there are not more 
     than three grantees under paragraph (1)(B); and
       ``(ii) an entity is not eligible to receive grants under 
     such paragraph unless the entity has substantial experience 
     in providing the health services described in such paragraph.
       ``(e) Funding.--
       ``(1) General program.--
       ``(A) Authorization of appropriations.--For the purpose of 
     carrying out this section (other than subsection (e)), there 
     are authorized to be appropriated such sums as may be 
     necessary for each of the fiscal years 2001 through 2005.
       ``(B) Allocations.--
       ``(i) Program administration.--Of the amounts appropriated 
     under subparagraph (A) for a fiscal year, the Secretary may 
     reserve up to 5 percent for coordination, dissemination, 
     technical assistance, and data activities that are determined 
     by the Secretary to be appropriate for carrying out the 
     program under this section.
       ``(ii) Evaluation.--Of the amounts appropriated under 
     subparagraph (A) for a fiscal year, the Secretary may reserve 
     up to 1 percent for evaluations of projects carried out under 
     subsection (a). Each such evaluation shall include a 
     determination of whether such projects have been effective in 
     reducing the disparity in health status between the general 
     population and individuals who are members of racial or 
     ethnic minority groups.
       ``(2) Medically appropriate ultrasound services; medically 
     appropriate services for at-risk mothers and infants.--
       ``(A) Authorization of appropriations.--For the purpose of 
     carrying out subsection (e), there are authorized to be 
     appropriated such sums as may be necessary for each of the 
     fiscal years 2001 through 2005.
       ``(B) Allocation.--Of the amounts appropriated under 
     subparagraph (A) for a fiscal year, the Secretary shall make 
     available not less than 10 percent for providing ultrasound 
     services under subsection (d)(1)(A) (provided by qualified 
     health care professionals upon medical indication and 
     referral from health care professionals who provide 
     comprehensive prenatal services) through visits by mobile 
     units to communities that are eligible for services under 
     subsection (a).''.

        TITLE XVI--ORAL HEALTH PROMOTION AND DISEASE PREVENTION

     SEC. 1601. ORAL HEALTH PROMOTION AND DISEASE
                   PREVENTION.

       Part B of title III of the Public Health Service Act, as 
     amended by section 912 of this Act, is amended by inserting 
     after section 317M the following section:


             ``oral health promotion and disease prevention

       ``Sec. 317N. (a) Grants to Increase Resources for Community 
     Water Fluoridation.--
       ``(1) In general.--The Secretary, acting through the 
     Director of the Centers for Disease Control and Prevention, 
     may make grants to States and Indian tribes for the purpose 
     of increasing the resources available for community water 
     fluoridation.
       ``(2) Use of funds.--A State shall use amounts provided 
     under a grant under paragraph (1)--
       ``(A) to purchase fluoridation equipment;
       ``(B) to train fluoridation engineers;
       ``(C) to develop educational materials on the benefits of 
     fluoridation; or
       ``(D) to support the infrastructure necessary to monitor 
     and maintain the quality of water fluoridation.
       ``(b) Community Water Fluoridation.--
       ``(1) In general.--The Secretary, acting through the 
     Director of the Centers for Disease Control and Prevention 
     and in collaboration with the Director of the Indian Health 
     Service, shall establish a demonstration project that is 
     designed to assist rural water systems in successfully 
     implementing the water fluoridation guidelines of the Centers 
     for Disease Control and Prevention that are entitled 
     ``Engineering and Administrative Recommendations for Water 
     Fluoridation, 1995'' (referred to in this subsection as the 
     `EARWF').
       ``(2) Requirements.--
       ``(A) Collaboration.--In collaborating under paragraph (1), 
     the Directors referred to in such paragraph shall ensure that 
     technical assistance and training are provided to tribal 
     programs located in each of the 12 areas of the Indian Health 
     Service. The Director of the Indian Health Service shall 
     provide coordination and administrative support to tribes 
     under this section.
       ``(B) General use of funds.--Amounts made available under 
     paragraph (1) shall be used to assist small water systems in 
     improving the effectiveness of water fluoridation and to meet 
     the recommendations of the EARWF.
       ``(C) Fluoridation specialists.--
       ``(i) In general.--In carrying out this subsection, the 
     Secretary shall provide for the establishment of fluoridation 
     specialist engineering positions in each of the Dental 
     Clinical and Preventive Support Centers through which 
     technical assistance and training will be provided to tribal 
     water operators, tribal utility operators and other Indian 
     Health Service personnel working directly with fluoridation 
     projects.
       ``(ii) Liaison.--A fluoridation specialist shall serve as 
     the principal technical liaison between the Indian Health 
     Service and the Centers for Disease Control and Prevention 
     with respect to engineering and fluoridation issues.
       ``(iii) CDC.--The Director of the Centers for Disease 
     Control and Prevention shall appoint individuals to serve as 
     the fluoridation specialists.
       ``(D) Implementation.--The project established under this 
     subsection shall be planned, implemented and evaluated over 
     the 5-year period beginning on the date on which funds are 
     appropriated under this section and shall be designed to 
     serve as a model for improving the effectiveness of water 
     fluoridation systems of small rural communities.
       ``(3) Evaluation.--In conducting the ongoing evaluation as 
     provided for in paragraph (2)(D), the Secretary shall ensure 
     that such evaluation includes--
       ``(A) the measurement of changes in water fluoridation 
     compliance levels resulting from assistance provided under 
     this section;
       ``(B) the identification of the administrative, technical 
     and operational challenges that are unique to the 
     fluoridation of small water systems;
       ``(C) the development of a practical model that may be 
     easily utilized by other tribal, state, county or local 
     governments in improving the quality of water fluoridation 
     with emphasis on small water systems; and
       ``(D) the measurement of any increased percentage of Native 
     Americans or Alaskan Natives who receive the benefits of 
     optimally fluoridated water.
       ``(c) School-Based Dental Sealant Program.--
       ``(1) In general.--The Secretary, acting through the 
     Director of the Centers for Disease Control and Prevention 
     and in collaboration with the Administrator of the Health 
     Resources and Services Administration, may award grants to 
     States and Indian tribes to provide for the development of 
     school-based dental sealant programs to improve the access of 
     children to sealants.
       ``(2) Use of funds.--A State shall use amounts received 
     under a grant under paragraph (1) to provide funds to 
     eligible school-based entities or to public elementary or 
     secondary schools to enable such entities or schools to 
     provide children in second and sixth grades with access to 
     dental care and dental sealant services. Such services shall 
     be provided by licensed dental health professionals in 
     accordance with State practice licensing laws.
       ``(3) Eligibility.--To be eligible to receive funds under 
     paragraph (1), an entity shall--
       ``(A) prepare and submit to the State an application at 
     such time, in such manner and containing such information as 
     the state may require; and
       ``(B) be a public elementary or secondary school--

[[Page H2710]]

       ``(i) that is located in an urban area in which and more 
     than 50 percent of the student population is participating in 
     federal or state free or reduced meal programs; or
       ``(ii) that is located in a rural area and, with respect to 
     the school district in which the school is located, the 
     district involved has a median income that is at or below 235 
     percent of the poverty line, as defined in section 673(2) of 
     the Community Services Block Grant Act (42 U.S.C. 9902(2)).
       ``(d) Definitions.--For purposes of this section, the term 
     `Indian tribe' means an Indian tribe or tribal organization 
     as defined in section 4(b) and section 4(c) of the Indian 
     Self-Determination and Education Assistance Act.
       ``(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 2001 through 2005.''.

                TITLE XVII--VACCINE COMPENSATION PROGRAM

     SEC. 1701. SHORT TITLE.

       This title may be cited as the ``Vaccine Injury 
     Compensation Program Amendments of 2000.''.

     SEC. 1702. CONTENT OF PETITIONS.

       (a) In General.--Section 2111(c)(1)(D) of the Public Health 
     Service Act (42 U.S.C. 300aa-11(c)(1)(D)) is amended by 
     striking ``and'' at the end and inserting ``or (iii) suffered 
     such illness, disability, injury, or condition from the 
     vaccine which resulted in inpatient hospitalization and 
     surgical intervention, and''.
       (b) Effective Date.--The amendment made by subsection (a) 
     takes effect upon the date of the enactment of this Act, 
     including with respect to petitions under section 2111 of the 
     Public Health Service Act that are pending on such date.

                        TITLE XVIII--HEPATITIS C

     SEC. 1801. SHORT TITLE.

       This title may be cited as the ``Hepatitis C and Children 
     Act of 2000''.

     SEC. 1802. SURVEILLANCE AND EDUCATION REGARDING HEPATITIS C.

       Part B of title III of the Public Health Service Act, as 
     amended by section 1601 of this Act, is amended by inserting 
     after section 317N the following section:


        ``surveillance and education regarding hepatitis c virus

       ``Sec. 317O. (a) In General.--The Secretary, acting through 
     the Director of the Centers for Disease Control and 
     Prevention, may (directly and through grants to public and 
     nonprofit private entities) provide for programs to carry out 
     the following:
       ``(1) To cooperate with the States in implementing a 
     national system to determine the incidence and prevalence of 
     cases of infection with hepatitis C virus, including the 
     reporting of chronic hepatitis C cases.
       ``(2) To identify and contact individuals who became 
     infected with such virus as a result of receiving blood 
     transfusions prior to July 1992 when the individuals were 
     infants, small children, or adolescents.
       ``(3) To provide appropriate referrals for counseling, 
     testing, and medical treatment of individuals identified 
     under paragraph (2) and to ensure, to the extent practicable, 
     the provision of appropriate follow-up services.
       ``(4) To develop and disseminate public information and 
     education programs for the detection and control of hepatitis 
     C, with priority given to recipients of blood transfusions; 
     women who gave birth by caesarean section; children who were 
     high-risk neonates; veterans of the Armed Forces; and health 
     professionals.
       ``(5) To improve the education, training, and skills of 
     health professionals in the detection and control of cases of 
     infection with hepatitis C, with priority given to 
     pediatricians and other primary care physicians.
       ``(b) Laboratory Procedures.--The Secretary may (directly 
     and through grants to public and nonprofit private entities) 
     carry out programs to provide for improvements in the quality 
     of clinical-laboratory procedures regarding hepatitis C, 
     including reducing variability in laboratory results on 
     hepatitis C antibody and PCR testing.
       ``(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 2001 through 2005.''.

            TITLE XIX--NIH INITIATIVE ON AUTOIMMUNE DISEASES

     SEC. 1901. SHORT TITLE.

       This title may be cited as the ``NIH Autoimmune Diseases 
     Initiative Act of 2000''.

     SEC. 1902. JUVENILE DIABETES, JUVENILE ARTHRITIS, LUPUS, 
                   MULTIPLE SCLEROSIS, AND OTHER AUTOIMMUNE-
                   DISEASES; INITIATIVE THROUGH DIRECTOR OF 
                   NATIONAL INSTITUTES OF HEALTH.

       Part B of title IV of the Public Health Service Act, as 
     amended by section 1002 of this Act, is amended by adding at 
     the end the following:


                         ``autoimmune diseases

       ``Sec. 409E. (a) Expansion, Intensification, and 
     Coordination of Activities.--
       ``(1) In general.--The Director of NIH shall expand, 
     intensify, and coordinate research and other activities of 
     the National Institutes of Health with respect to juvenile-
     onset diabetes, rheumatoid arthritis, systemic lupus 
     erthematosus, multiple sclerosis, Sjogren's syndrome, 
     scleroderma, chronic fatigue syndrome, Crohn's disease and 
     colitis (in this section referred to as `autoimmune 
     diseases').
       ``(2) Allocations by director of nih.--With respect to 
     amounts appropriated to carry out this section for a fiscal 
     year, the Director of NIH shall allocate the amounts among 
     the national research institutes that are carrying out 
     paragraph (1).
       ``(3) Additional diseases or disorders.--In addition to the 
     diseases or disorders specified in paragraph (1), the term 
     `autoimmune disease' includes for purposes of this section 
     such other diseases or disorders as the Secretary determines 
     to be appropriate.
       ``(b) Coordinating Committee.--
       ``(1) In general.--The Secretary shall establish a 
     committee to be known as Autoimmune Diseases Coordinating 
     Committee (referred to in this subsection as the 
     `Coordinating Committee').
       ``(2) Duties.--The Coordinating Committee shall, with 
     respect to autoimmune diseases--
       ``(A) provide for the coordination of the activities of the 
     national research institutes; and
       ``(B) coordinate the aspects of all Federal health programs 
     and activities relating to such diseases in order to assure 
     the adequacy and technical soundness of such programs and 
     activities and in order to provide for the full communication 
     and exchange of information necessary to maintain adequate 
     coordination of such programs and activities.
       ``(3) Composition.--The Coordinating Committee shall be 
     composed of the directors of each of the national research 
     institutes involved in research with respect to autoimmune 
     diseases and representatives of all other Federal departments 
     and agencies whose programs involve health functions or 
     responsibilities relevant to such diseases, including the 
     Centers for Disease Control and Prevention and the Food and 
     Drug Administration.
       ``(4) Chair.--From among the members of the Coordinating 
     Committee, the Committee shall designate an individual to 
     serve as the chair of the Committee. With respect to 
     autoimmune diseases, the Chair shall serve as the principal 
     advisor to the Secretary, the Assistant Secretary for Health, 
     and the Director of NIH, and shall provide advice to the 
     Director of the Centers for Disease Control and Prevention, 
     the Commissioner of Food and Drugs, and other relevant 
     agencies.
       ``(5) Full-time staff.--The Secretary shall ensure that the 
     Coordinating Committee is staffed and supported by not fewer 
     than three scientists or health professionals for whom such 
     service is a full-time Federal position. The Secretary shall 
     in addition ensure that the Committee is provided with such 
     administrative staff and support as may be necessary to carry 
     out the duties of the Committee.
       ``(c) Advisory Council.--
       ``(1) In general.--The Secretary shall establish an 
     advisory council to be known as the Autoimmune Diseases 
     Public Advisory Council (referred to in this subsection as 
     the `Advisory Council').
       ``(2) Duties.--The Advisory Council shall provide to the 
     Director of NIH and the Coordinating Committee under 
     subsection (b) recommendations on carrying out this section, 
     including the plan under subsection (d).
       ``(3) Composition.--The Advisory Council shall be composed 
     exclusively of not more than 18 members appointed to the 
     Council by the Secretary from among individuals who are not 
     officers or employees of the United States. The Secretary 
     shall ensure that the membership of the Advisory Council 
     includes--
       ``(A) scientists or health professionals who are 
     knowledgeable with respect to autoimmune diseases;
       ``(B) representatives of autoimmune disease patient 
     advocacy organizations, including organizations advocating on 
     behalf of diseases affecting small patient populations; and
       ``(C) patients and parents of children with such diseases, 
     including autoimmune diseases affecting small patient 
     populations.
       ``(d) Plan for NIH Activities.--
       ``(1) In general.--The Coordinating Committee shall develop 
     a plan for conducting and supporting research and education 
     on autoimmune diseases through the national research 
     institutes, shall review the plan not less frequently than 
     once each fiscal year, and shall revise the plan as 
     appropriate. The plan shall--
       ``(A) provide for a broad range of research and education 
     activities relating to biomedical, psychosocial, and 
     rehabilitative issues, including studies of the 
     disproportionate impact of such diseases on women; and
       ``(B) establish priorities among the programs and 
     activities of the National Institutes of Health regarding 
     such diseases.
       ``(2) Certain elements of plan.--The plan under paragraph 
     (1) shall, with respect to autoimmune diseases, provide for 
     the following:
       ``(A) Research to determine the reasons underlying the 
     incidence and prevalence of the diseases.
       ``(B) Basic research concerning the etiology and causes of 
     the diseases.
       ``(C) Epidemiological studies to address the frequency and 
     natural history of the diseases, including any differences 
     among the sexes and among racial and ethnic groups.
       ``(D) The development of improved screening techniques.
       ``(E) Clinical research for the development and evaluation 
     of new treatments, including new biological agents.
       ``(F) Information and education programs for health care 
     professionals and the public.

[[Page H2711]]

       ``(3) Recommendations of advisory council.--In developing 
     the plan under paragraph (1), and reviewing and revising the 
     plan, the Coordinating Committee shall consider the 
     recommendations of the Advisory Council regarding the plan.
       ``(4) Implementation of plan.--The Director of NIH shall 
     ensure that programs and activities of the National 
     Institutes of Health regarding autoimmune diseases are 
     implemented in accordance with the plan under paragraph (1).
       ``(e) Reports to Congress.--The Coordinating Committee 
     under subsection (b)(1) shall annually submit to the 
     Committee on Commerce of the House of Representatives, and 
     the Committee on Health, Education, Labor and Pensions of the 
     Senate, a report that describes the research, education, and 
     other activities on autoimmune diseases being conducted or 
     supported through the national research institutes, and that 
     in addition includes the following:
       ``(1) The plan under subsection (d)(1) (or revisions to the 
     plan, as the case may be).
       ``(2) The recommendations of the advisory council under 
     subsection (c) regarding the plan (or revisions, as the case 
     may be).
       ``(3) Provisions specifying the amounts expended by the 
     National Institutes of Health with respect to each of the 
     autoimmune diseases included in the plan.
       ``(4) Provisions identifying particular projects or types 
     of projects that should in the future be conducted or 
     supported by the national research institutes or other 
     entities in the field of research on autoimmune diseases.
       ``(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 2001 through 2005. The authorization of 
     appropriations established in the preceding sentence is in 
     addition to any other authorization of appropriations that is 
     available for conducting or supporting through the National 
     Institutes of Health research and other activities with 
     respect to autoimmune diseases.''.

 TITLE XX--GRADUATE MEDICAL EDUCATION PROGRAMS IN CHILDREN'S HOSPITALS

     SEC. 2001. EXTENSION OF AUTHORIZATION OF APPROPRIATIONS.

       Section 340E(f) of the Public Health Service Act (42 U.S.C. 
     256e(f)) is amended--
       (1) in paragraph (1)(A)--
       (A) in clause (i), by striking ``and'' at the end;
       (B) in clause (ii), by striking the period and inserting 
     ``; and''; and
       (C) by adding at the end the following:
       ``(iii) for each of the fiscal years 2002 through 2005, 
     such sums as may be necessary.''; and
       (2) in paragraph (2)--
       (A) in subparagraph (A), by striking ``and'' at the end;
       (B) in subparagraph (B), by striking the period and 
     inserting ``; and''; and
       (C) by adding at the end the following:
       ``(C) for each of the fiscal years 2002 through 2005, such 
     sums as may be necessary.''.

  TITLE XXI--SPECIAL NEEDS OF CHILDREN REGARDING ORGAN TRANSPLANTATION

     SEC. 2101. SHORT TITLE.

       This title may be cited as the ``Pediatric Organ 
     Transplantation Improvement Act of 2000''.

     SEC. 2102. ORGAN PROCUREMENT AND TRANSPLANTATION NETWORK; 
                   AMENDMENTS REGARDING NEEDS OF CHILDREN.

       (a) In General.--Section 372(b)(2) of the Public Health 
     Service Act (42 U.S.C. 274(b)(2)) is amended--
       (1) in subparagraph (J), by striking ``and'' at the end;
       (2) in each of subparagraphs (K) and (L), by striking the 
     period and inserting a comma; and
       (3) by adding at the end the following subparagraphs:
       ``(M) recognize the differences in health and in organ 
     transplantation issues between children and adults throughout 
     the system and adopt criteria, polices, and procedures that 
     address the unique health care needs of children,
       ``(N) carry out studies and demonstration projects for the 
     purpose of improving procedures for organ donation 
     procurement and allocation, including but not limited to 
     projects to examine and attempt to increase transplantation 
     among populations with special needs, including children and 
     individuals who are members of racial or ethnic minority 
     groups, and among populations with limited access to 
     transportation, and
       ``(O) provide that for purposes of this paragraph, the term 
     `children' refers to individuals who are under the age of 
     18.''.
       (b) Study Regarding Immunosuppressive Drugs.--
       (1) In general.--The Secretary of Health and Human Services 
     (referred to in this subsection as the ``Secretary'') shall 
     provide for a study to determine the costs of 
     immunosuppressive drugs that are provided to children 
     pursuant to organ transplants and to determine the extent to 
     which health plans and health insurance cover such costs. The 
     Secretary may carry out the study directly or through a grant 
     to the Institute of Medicine (or other public or nonprofit 
     private entity).
       (2) Recommendations regarding certain issues.--The 
     Secretary shall ensure that, in addition to making 
     determinations under paragraph (1), the study under such 
     paragraph makes recommendations regarding the following 
     issues:
       (A) The costs of immunosuppressive drugs that are provided 
     to children pursuant to organ transplants and to determine 
     the extent to which health plans, health insurance and 
     government programs cover such costs.
       (B) The extent of denial of organs to be released for 
     transplant by coroners and medical examiners.
       (C) The special growth and developmental issues that 
     children have pre- and post- organ transplantation.
       (D) Other issues that are particular to the special health 
     and transplantation needs of children.
       (3) Report.--The Secretary shall ensure that, not later 
     than December 31, 2000, the study under paragraph (1) is 
     completed and a report describing the findings of the study 
     is submitted to the Congress.

                  TITLE XXII--MISCELLANEOUS PROVISIONS

     SEC. 2201. 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 2000, 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 2001 through 2005.

                      TITLE XXIII--EFFECTIVE DATE

     SEC. 2301. EFFECTIVE DATE.

       This Act and the amendments made by this Act take effect 
     October 1, 2000, or upon the date of the enactment of this 
     Act, whichever occurs later.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
Florida (Mr. Bilirakis) and the gentleman from Ohio (Mr. Brown) each 
will control 20 minutes.
  The Chair recognizes the gentleman from Florida (Mr. Bilirakis).


                             General Leave

  Mr. BILIRAKIS. Mr. Speaker, I ask unanimous consent that all Members 
may have 5 legislative days within which to revise and extend their 
remarks and include extraneous material on H.R. 4365.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Florida?
  There was no objection.
  Mr. BILIRAKIS. Mr. Speaker, I yield myself such time as I may 
consume.
  Mr. Speaker, I am very pleased to bring H.R. 4365, the Children's 
Health Act of 2000, to the floor of the House today. Every mother knows 
that America's children are its future.
  On Sunday, we will celebrate Mother's Day to honor millions of women 
for the loving care they provide. I can think of no better gift to them 
than passage of this legislation to protect children from the threat of 
disease.
  My subcommittee has examined some of the difficult barriers we face 
in working to improve children's health. Witnesses have testified about 
a number of serious childhood afflictions, including autism, childhood 
asthma and juvenile diabetes. We also discussed measures to promote 
adoption of children with special health needs.
  Mr. Speaker, H.R. 4365 is an extended version of the original 
children's health bill, H.R. 3301. I was pleased to introduce both 
bills with the ranking member of the Subcommittee on Health and 
Environment, the gentleman from Ohio (Mr. Brown). Together we have 
worked on a bipartisan basis and overcome significant, significant 
obstacles to bring this bill to the floor, and towards that end, I 
would like to personally thank the two members of our staffs, Anne 
Esposito of my staff, and Eleanor Dehoney from the staff of the 
gentleman from Ohio (Mr. Brown), and Mr. Jason Lee and Marc Wheat of 
the majority staff for all of their efforts in this regard.
  The bill before us, like its predecessor, authorizes and reauthorizes 
children's disease research and prevention activities conducted under 
the Public Health Service Act. Among its key provisions, the bill 
establishes a new pediatric research initiative within the National 
Institutes of Health to enhance opportunities for research and improve 
coordination of efforts to prevent or cure diseases affecting children.
  The bill also addresses a number of specific concerns, including 
autism, fragile X, birth defects, early hearing loss, epilepsy, asthma, 
juvenile arthritis, skeletal malignancies, juvenile diabetes, adoption 
awareness, traumatic brain injury, injury prevention,

[[Page H2712]]

Healthy Start, oral health, vaccine injury compensation, hepatitis C, 
autoimmune diseases, graduate medical education in children's 
hospitals, organ transplantation needs of children and rare diseases in 
children. Equally important, it does not include specific funding 
earmarks or other controversial provisions.
  This legislation incorporates a number of separate legislative 
proposals. I would like to acknowledge the efforts of those Members who 
worked to develop provisions that were included in the bill. I also 
want to acknowledge all of the patient advocates and cosponsors of the 
original children's health bill who lent their strong support to this 
initiative. Their dedication helped keep this legislation alive.
  We can never estimate the human toll of childhood diseases. However, 
they also have an enormous financial impact through billions of dollars 
in increased health care costs. Every dollar spent by the Federal 
Government on disease research and prevention is an extremely wise 
investment.
  Any parent can tell you that nothing is more heart wrenching than 
watching your own child suffer with an illness. As a father and 
grandfather myself, I know how terrible that can be. Today, however, we 
have a rare opportunity to do something that will give hope to families 
devastated by childhood disease.
  It is my hope that Members will put aside their personal agendas and 
political disagreements to support passage of this consensus-based 
measure. Childhood diseases inflict pain and disruption on countless 
American children and their families. For the patients, families, 
caregivers and friends whose lives have been touched by childhood 
diseases, we should demonstrate our shared commitment to ending these 
terrible afflictions by approving H.R. 4365.
  Mr. Speaker, I reserve the balance of my time.
  Mr. BROWN of Ohio. Mr. Speaker, I yield myself such time as I may 
consume.
  There are times, Mr. Speaker, when I feel especially privileged to be 
here and this is one of those times. This bill can help children I have 
met. It gives hope to parents I have met. I have two amazing daughters. 
I know how it feels when the only thing that matters is to end whatever 
it is that is causing your child pain. When the only thing that matters 
is to smooth the path for them to make sure the odds are and stay 
solidly in their favor. I can only imagine how the parents of a child 
with autism or arthritis or epilepsy must feel as they seek help for 
their children only to encounter dead end after dead end; to look for 
answers and to be told that the knowledge simply is not there, to be 
told that research is lacking.
  H.R. 4365 is not a glamorous bill. Its passage is not going to make 
or break any campaigns. You are not going to hear about it on Meet the 
Press. But H.R. 4365 responds to very real needs. It does several good 
things.
  The initiatives authorized in H.R. 4365 intensify efforts to find a 
cure for autism. The initiatives authorized could contribute to the 
cure and the prevention of juvenile diabetes, juvenile arthritis, 
epilepsy and asthma. The initiatives could contribute to the prevention 
of birth defects. It could help children with traumatic brain injury 
and protect more children from the environmental injuries like lead 
poisoning.
  H.R. 4365 promotes children's health in other important ways. It 
extends the authorization for resources to support graduate medical 
education in our Nation's freestanding children's hospitals. It 
establishes a pediatric research initiative within NIH to create a more 
level playing field for research targeting children. The bill offers 
hope to children and hope to their families and if we put the resources 
behind it as we should, this bill will deliver children in the future 
from illnesses and disabilities that compromise their health and their 
well-being.
  I feel privileged to have worked with families and community leaders 
and Members on both sides of the aisle who are committed to the goals 
of this bill and who have worked tirelessly to see that something 
actually gets done to achieve these goals.
  I thank the gentleman from Florida (Mr. Bilirakis) for his good work, 
Jason Lee and Anne Esposito in his office and Donna Pignatelli, Ellie 
Dehoney and Katie Porter in mine. I hope the House will join in 
supporting this legislation.
  Mr. Speaker, I reserve the balance of my time.
  Mr. BILIRAKIS. Mr. Speaker, I yield 3 minutes to the gentleman from 
Pennsylvania (Mr. Greenwood).
  Mr. GREENWOOD. Mr. Speaker, I thank the gentleman for yielding me 
this time. As the previous speaker, I do not think there is a moment 
that I have been more proud to be a Member of this body than I am 
today. The Children's Health Act is Congress's Mother's Day present to 
the Nation as well as an early Father's Day present. What makes us good 
mothers and fathers is our devotion to our children. Nothing so 
sharpens, focuses and deepens a parent's devotion as when their 
children are ill. When the child's illness is chronic, the parent's 
devotion becomes life long. Parents will do whatever they can for their 
children, but sometimes they need our help. They need Congress to fund 
research about the treatment and the cure for these diseases. They need 
us to help educate physicians and to monitor the incidence of these 
diseases. This bill will provide new hope to parents of children with 
the long list of diseases that the gentleman from Florida (Mr. 
Bilirakis) laid out in the beginning. In addition, it creates a brand 
new pediatric research initiative at the National Institutes of Health.
  I would like to focus my remarks on the story of autism in this bill. 
Autism is the third most common childhood disorder in America. It 
affects 400,000 people in the United States. One out of every 500 
babies born in this country has autism. Parents with children with 
autism see their children grow and develop normally and suddenly they 
seem to vanish. They lose their communication skills, their language 
skills. It is an agony for the parents.
  This disease was misdiagnosed for a generation. Parents were told 
that their children were autistic because they had been poorly parented 
or traumatized. It was a cruel misdiagnosis on the part of these 
physicians. But the parents of these children formed an organization 
called Cure Autism Now and they did what the civics books told them to. 
They came to Washington, they told their elected representatives of 
their experience and they asked for our help. We put together an autism 
bill and we began the long process.
  These parents came to press conferences, sometimes press conferences 
without press. They came and they did everything humanly possible to 
make the country and to make the Members of the United States Congress 
aware of their children's special needs. They came to the hearings and 
they testified. It is a scary thing to come to a hearing before the 
United States Congress and talk about your child, but they did that.
  Then they suffered the agonies of the congressional clock, and they 
waited month after month, year after year for Congress to slowly get 
around to this bill. Today that day has finally come. Then finally in 
the last few days, they suffered the agonies of watching the 
possibility that this bill would get hijacked by other agendas, 
perfectly good agendas but agendas that would make the bill 
controversial.

                              {time}  1415

  Finally, today, just about when they had been ready to give up hope, 
the system worked and today we take up their bill, and we should be 
proud to do so.
  Mr. BROWN of Ohio. Mr. Speaker, I yield 3 minutes to the gentlewoman 
from Colorado (Ms. DeGette), my friend who has done as much or more on 
this legislation than any Member of the House.
  Ms. DeGETTE. Mr. Speaker, I would like to thank the gentleman from 
Florida (Mr. Bilirakis), the chairman of our subcommittee and the 
gentleman from Ohio (Mr. Brown) for their tireless efforts on what was 
not an easy process here. This is a good bill, and I am proud to 
support it.
  Mr. Speaker, nothing can be more important to our Nation's future 
than our children. Numerous indicators of the well-being of our 
children paint a mixed picture of both success and shortcomings. I 
think this will give us a mixed view of what our Nation's future holds.
  Reports of both gains and continued unmet needs are also apparent 
with regard to a variety of other pediatric

[[Page H2713]]

 health care needs. Infant mortality, immunization rates, pediatric 
asthma care, youth violence, and the critically important fact that we 
still have 11 million children in this country who do not have health 
insurance.
  Mr. Speaker, H.R. 4365 will increase research and prevention efforts 
targeted to improve the lives of the children. I do not think that we 
can question such a focus, but some have. If we have any doubt, 
according to a report issued by the President's National Science and 
Technology Council, the combined research spending for children in 
adolescence throughout the Federal Government represents less than 3 
percent of the total Federal research enterprise. Thus, the Federal 
Government commits less than 3 percent of its research focused on the 
lives of children, despite the fact that they are 30 percent of our 
population and they are our future.
  I would like to take the opportunity to highlight 2 important 
provisions of this bill. First of all, diabetes affects 16 million 
Americans and their families, often striking in childhood and becoming 
a lifelong disease. Type 1 diabetes is one of the most costly, chronic 
diseases of childhood. Now we are seeing Type 2 diabetes increasing 
among children.
  I am pleased that this bill includes a provision authorizing the 
Centers for Disease Control and Prevention to implement a national 
public health effort to address Type 2 in youth. It also expands 
clinical trials for children with diabetes to move some of the 
remarkable research on diabetes from the laboratory bench to the 
patient's bedside.
  Today's bill also incorporates the provisions from my legislation, 
H.R. 4008, that will require the Organ Transplantation Network to adopt 
criteria policies and procedures that will address the unique health 
care needs of children and organ transplantation. Virtually identical 
language was passed by this House just last month by a vote of 420 to 
zero. It improves the lives of children by requiring the Organ 
Transplantation Network to adopt criteria policies and procedures that 
address the unique needs of children.
  Through the passage of this bill, we have the opportunity to help 
millions of children in this country. We owe to our children, our 
families, and our Nation nothing less than this sound investment in our 
future.
  Mr. BILIRAKIS. Mr. Speaker, I yield 2 minutes to the gentleman from 
New Jersey (Mr. Smith).
  Mr. SMITH of New Jersey. Mr. Speaker, I thank my friend for yielding 
me this time.
  Mr. Speaker, H.R. 4365, the Child Health Act of 2000, must be passed 
today and sent swiftly to the President for his signature.
  Mr. Speaker, I would like to focus a few moments on the silent 
epidemic of autism, we are in the midst of a silent epidemic of autism. 
No State, no county, no Federal agency systematically tracks cases of 
autism, but even faint glimpses of the truth are terrifying to behold.
  According to the Federal Department of Education, autistic special 
education students have increased by 153 percent from 1994 to 1999. In 
my home State of New Jersey, the Department of Education has said the 
number of kids classified as autistic in our school system has 
increased from 241 in 1991 to an incredible, astonishing 2,354 in 1999, 
an 876 percent increase.
  Mr. Speaker, at my request, the CDC conducted a ground-breaking 
autism prevalence investigation in Brick Township in New Jersey. The 
findings of the 2-year investigation were released just last month. We 
are informed that Brick's rate of classic autism was a whopping 4 per 
1,000 children between ages 3 and 10, and the rate of autism spectrum 
disorders was 6.7 cases per 1,000. That is higher than most people had 
thought. Normally it is about 2 per 1,000. We had an incidence of 4 per 
1,000.
  Mr. Speaker, I want to thank the gentleman from Florida (Mr. 
Bilirakis) for including the essence of my ASSURE bill which will 
create 3 to 5 ``Centers of Excellence in Autism'' under the auspices of 
the CDC so that the Federal Government will now be able to monitor the 
prevalence of autism at the national level and develop, hopefully, 
better teaching methods and health professionals to improve the 
treatment. It also authorizes CDC to create a National Autism and 
Pervasive Developmental Disability Surveillance Program. This program 
would use a combination of grants, cooperative agreements, and 
technical assistance to improve the collection, analysis and reporting 
on this very serious anomaly that is afflicting so many of our 
children.
  Mr. Speaker, once again, I want to congratulate the gentleman from 
Florida (Mr. Bilirakis) on a great bill and I hope all of my colleagues 
will support it.
  Most experts in autism research believe that while genetics are a 
major determinant in developing autism, something else is at work. The 
epidemiological research provided under H.R. 4365 will help researchers 
sort out how much of the problem is genetic and how much is 
environmental or developmental. If autism has a link to certain 
environmental pollutants, the surveillance programs established under 
ASSURE will be able to tell us more about these links. If autism is 
related to an immunological response to certain vaccines, the data 
provided by ASSURE can be used to support or dismiss this hypothesis.
  Regardless of one's opinion on what causes autism, the bottom line is 
that we will never be able to get the answers parents need without the 
data generated by this bill. Once the CDC has established the centers 
of excellence, they will serve as a model for states to copy and form 
their own registries and surveillance programs. The centers will also 
improve the standard of care for autistic persons by providing 
education and training for health professionals, so that the latest 
proven treatments and interventions can be utilized to the maximum 
possible extent.
  Also included in the Children's Health Act are provisions of H.R. 
997, introduced by Congressman Jim Greenwood and myself, to improve 
autism research programs at the National Institutes of Health (NIH). 
This proposal, Section (B) of Title I, boosts the biomedical research 
needed to help solve the puzzle of autism.
  And that's just Title I. In addition, there are a host of vital 
initiatives to improve surveillance efforts of children with diabetes, 
promote adoption, and reduce asthma and enhance services to asthmatics. 
All of these other provisions deserve out full support.
  Today, Congress has an enormous opportunity to speak out on behalf of 
those whose voices have been silenced by autism. Kids like Alanna and 
Austin Gallagher in Brick Township, New Jersey.
  Today, we can help restore breath to kids afflicted with asthma. 
People like Tommy Farese of Spring Lake, and my own two daughters 
Melissa and Elyse.
  Today, we may save and extend the lives of children stricken by 
juvenile diabetes, such as young Charlie Coats of East Windsor.
  It is for these children, their mothers and fathers, and the 
countless others like them across out nation, that we enact H.R. 4365. 
Join with me in supporting this legislation.
  Ms. DeGETTE. Mr. Speaker, I yield 2 minutes to the gentleman from New 
Jersey (Mr. Rothman).
  Mr. ROTHMAN. Mr. Speaker, I thank the gentlewoman for yielding me 
this time.
  I rise today in strong support of H.R. 4365, the Children's Health 
Act of 2000. In particular, I want to commend the authors of this 
legislation for the great strides it makes in autism research.
  Mr. Speaker, autism is not rare. Four hundred thousand people in the 
United States, mostly children, are affected by this terrible disease. 
While 5 percent of those with autism may gain some progress with early 
intervention, 95 percent of them, or more than 350,000 people, will 
still suffer. They will never marry, they will never live on their own, 
and more than half of them will never even learn to speak.
  Families affected by autism are forced to bear an extraordinary 
burden. Parents and siblings and friends have to learn to try to 
communicate with a child, many of whom are incapable of either verbal 
or nonverbal communication, and children who have often erratic 
behavior. It is a disease little understood. I have been trying since I 
came to Congress for find funding for autism research for the various 
autism clusters that we believe are occurring throughout New Jersey. I 
am proud that this bill lays the foundation for a comprehensive 
research effort on autism.
  Mr. Speaker, this day has been a long time in coming, and I know 
those families who have been affected are grateful that it is now here. 
I urge all of my colleagues on behalf of my nephew, Jack, who suffers 
with autism and on behalf of a girl by the name of Heather Simms, who 
has been in confinement

[[Page H2714]]

for 5 years, having been brought into an institution at the age of 12, 
who today celebrates her 17th birthday, that this is a special day for 
all of the autistic children in the United States, their parents and 
loved ones. I urge my colleagues to support H.R. 4365 for its dramatic 
increase in national funding and attention for autism research.
  Mr. BILIRAKIS. Mr. Speaker, I yield 2 minutes to the gentlewoman from 
Ohio (Ms. Pryce).
  Ms. PRYCE of Ohio. Mr. Speaker, let me first congratulate the 
gentleman from Florida (Mr. Bilirakis) and my colleague, the gentleman 
from Ohio (Mr. Brown) for their very, very important work.
  We all hope that the wealth of our Nation and the amazing 
technological advances that have been made in medicine will give us the 
necessary resources to protect our children from harm. We have made 
tremendous progress, but the sad fact is that there are still so many 
diseases that affect our children for which there is no cure, or even 
effective treatment.
  The legislation before us will give child victims and their families 
hope by devoting more Federal resources to diseases such as autism, 
Fragile X, asthma, skeletal malignancies, juvenile diabetes, the list 
goes on and on. Sadly, it is quite long.
  This legislation will also focus on prevention by encouraging healthy 
pregnancies, analyzing data about birth defects, and investigating the 
deaths and severe complications through pregnancy. In addition, a new 
pediatric research initiative at NIH, along with reauthorization for 
money to train physicians at children's hospitals, will help us better 
understand the way in which diseases attack children and how to give 
them the most effective and appropriate care. There are critical 
differences between medical care for adults and medical care for 
children, which must be reflected in training of physicians and 
treatments designed for a child's system, which is still developing. 
This legislation recognizes and focuses on these important differences.
  Mr. Speaker, while we may never be able to make a child understand 
why they are sick or are made to suffer, we can invest in the research 
that will allow our best and brightest scientists to solve the 
mysteries of childhood disease so that more children can live the 
carefree youths to which they are entitled. What better way to invest 
our Nation's resources.
  Mr. Speaker, I urge my colleagues to support this important child 
health initiative that will give hope to children and families across 
America who are searching for answers and praying for a return to the 
normalcy that will come with good health. As America's leaders, this 
investment in our children's health is really the least we can do to 
secure a better future for our Nation.
  Ms. DeGETTE. Mr. Speaker, I yield 2 minutes to the gentleman from 
Texas (Mr. Green), a distinguished member of the committee.
  (Mr. GREEN of Texas asked and was given permission to revise and 
extend his remarks.)
  Mr. GREEN of Texas. Mr. Speaker, I want to thank the gentleman from 
Florida (Mr. Bilirakis), the chairman of our Subcommittee on Health of 
the Committee on Commerce, and the gentleman from Ohio (Mr. Brown), the 
ranking member, for this legislation.
  Just two weeks ago during our Easter Passover break at Texas 
Children's Hospital in Houston, the gentleman from Texas (Mr. Bentsen) 
and I held a juvenile diabetes forum to hear from parents and experts 
on that terrible disease. Every member of the audience cried, 
literally, as we heard from the parents of 3-year-old Larry Baltazar 
who has recently been diagnosed with this disease. This legislation 
will help Larry, along with helping millions of other children who are 
diagnosed with juvenile diabetes, asthma, Fragile X and autism. It will 
help children who are diagnosed with birth defects and those who suffer 
a traumatic brain injury.
  One thing that this legislation does not do, and I hope we can get 
this remedied in the conference committee, is increase funds to States 
for immunizations. Despite gains in recent years, we still are not 
doing enough to make sure that children get the right immunizations 
when they need it. In States like Texas, Michigan and Nevada, one in 
four children are not receiving the proper immunizations. In Houston, 
over 44 percent of the children do not receive at least one of their 
immunizations. In California, 27 percent do not receive at least one of 
their immunizations.
  Over the past 5 years, Federal infrastructure funding to States, used 
by States and cities to identify needs, conduct community outreach, 
establish registries, deal with disease outbreaks and undertake 
educational and tracking efforts, among other things, has been cut from 
$271 million in 1995 to $139 million for the past 3 years. The 
gentleman from Pennsylvania (Mr. Greenwood) and I have introduced H. 
Con. Res. 315, which calls for an increase in funds to section 317, and 
we hope this increase will be included in the final version of the 
children's health legislation as it comes out of conference.
  Mr. BILIRAKIS. Mr. Speaker, I yield 2 minutes to the gentleman from 
Oklahoma (Mr. Watkins).
  Mr. WATKINS. Mr. Speaker, I rise today in strong support of H.R. 
4365, the Children'S Health Act of 2000. More specifically, I would 
like to call to the attention of my colleagues one very important 
aspect of this legislation that authorizes further research into a 
disease known as Fragile X, the most commonly inherited cause of mental 
retardation.
  Fragile X affects one in every 2,000 newborn boys, and one in every 
4,000 newborn girls. One in every 260 women is a carrier and has a 50 
percent chance with each pregnancy of having a child with Fragile X. 
Most of these afflicted children will require a lifetime of special 
loving care at a cost of over $2 million each.
  However, there is good news. One of the first discoveries of the 
human genome project, the cause of Fragile X has been linked to the 
absence of a single protein.

                              {time}  1430

  Since that time, great strides have been made in understanding how 
this disease causes mental retardation, seizures, aggressive outbursts, 
and severe anxiety.
  This research has led Dr. James Watson, who shared the Nobel Peace 
Prize with Dr. Francis Crick on their discovery of DNA, to believe that 
a cure for this heartbreaking disease is within sight.
  H.R. 4365 authorizes the establishment of at least three fragile X 
research centers through grants or contracts with public or private 
institutions. It also provides a program encouraging health 
professionals to conduct fragile X research by repaying a portion of 
the educational costs.
  Mr. Speaker, I dedicate this day and legislation to my friends, David 
and Mary Beth Busby, who have two mentally retarded sons who suffer 
because of fragile X and, along with many good people of the FRAXA 
Research Foundation and many fine scientists within the National 
Institutes of Health, have completely devoted themselves to finding a 
cure for this disease.
  I also dedicate this legislation to the mentally retarded children of 
McCall's Chapel in Ada, Oklahoma, and to Harman Samples, a childhood 
friend, mentally retarded from fragile X, with whom I shared many noon 
hours in school and shared two-stick nickel popsicle with as a boy in 
elementary and high school. Harmon's mother, Christine Sample, told me 
Harmon provided the physical strength to move and lift his invalid 
father before his death.
  Much more remains to be done, however, and having co-sponsored 
legislation authorizing more research into Fragile X in the past, I 
whole heartedly offer my support for H.R. 4365 and encourage my 
colleagues to do likewise.
  Ms. DeGETTE. Mr. Speaker, I am very pleased to yield 2 minutes to the 
gentleman from California (Mr. Waxman), someone who has worked on these 
issues for many, many years.
  Mr. WAXMAN. Mr. Speaker, I thank the gentlewoman for yielding time to 
me.
  Mr. Speaker, I rise in support of this bill. I want to commend the 
gentleman from Florida (Mr. Bilirakis) and the gentleman from Ohio (Mr. 
Brown), our chairman and ranking member, for their work on this 
legislation.

[[Page H2715]]

  Mr. Speaker, this bill includes many important provisions which will 
advance the treatment, the cure, and prevention of childhood diseases 
and disorders. I am also pleased to point out that this bill includes 
two titles which I have authored. Both titles promise to make 
significant advances in the treatment and prevention of childhood 
asthma and of autoimmune diseases like multiple sclerosis, juvenile 
diabetes, and lupus.
  Title V of the bill, the Children Asthma Relief Act of 1999, was 
introduced by the gentleman from Michigan (Mr. Upton) and myself, and 
title XIX is based on H.R. 2573, the NIH Autoimmune Disease Initiative 
Act of 1999, which was authored by the gentlewoman from Maryland (Mrs. 
Morella) and myself.
  Today more than 5 million children suffer from asthma. It is one of 
the most significant and prevalent chronic diseases in America. That is 
why this bill provides new funding for pediatric asthma prevention and 
treatment programs, allowing States and local communities to target and 
improve the health of low-income children suffering from asthma.
  As regards the autoimmune diseases, this would expand, intensify, and 
coordinate the efforts of NIH in research and education on autoimmune 
diseases. There are more than 80 autoimmune diseases, including 
multiple sclerosis, lupus, and rheumatoid arthritis, in which the 
body's immune system mistakenly attacks healthy tissues.
  These diseases affect more than 13.5 million Americans and are major 
causes of disability. Most striking of all, three-quarters of those 
infected with an autoimmune disease are women.
  The research efforts at NIH will be coordinated as a result of an 
office that would look at the activities throughout the NIH.
  I do want to point out some serious concerns over one section of the 
bill, title XII's adoption awareness provisions. This title was the 
subject of great controversy and debate. The original language raised 
many serious objections regarding adoption and abortion policy.
  I hope we will continue to look at this part of the bill, because it 
does offer some troublesome issues to be resolved.
  Mr. BILIRAKIS. Mr. Speaker, I am pleased to yield 2 minutes to the 
gentlewoman from New Jersey (Mrs. Roukema).
  (Mrs. ROUKEMA asked and was given permission to revise and extend her 
remarks.)
  Mrs. ROUKEMA. Mr. Speaker, I certainly thank the chairman for 
yielding time to me, and thank him most deeply and sincerely for all 
his leadership on this.
  Mr. Speaker, all of us recognize the trauma and heartbreak that 
parents and all family members endure when serious illness strikes a 
child in the family. We must take this step today to set us on the way 
to making a happier, healthy life for all our children and for future 
generations.
  I specifically want to thank Mary Higgins Clark, the notable author, 
and her son, David Clark, for reaching out to me on behalf of not only 
of her son and grandson, but for the millions of the dear children who 
suffer from fragile X.
  As has been noted, fragile X is the most common inherited cause of 
mental retardation. With this legislation, we are clearly on the brink 
of a breakthrough against this tragic mental defect. The research 
models that have been identified here in this legislation would put us 
well on the road to researching recovery and a cure.
  Again, I want to thank those who have brought this to my attention. I 
want to thank all those who did the work on this legislation, but 
specifically, let me dedicate this research in the name of David 
Frederick Clark of Hillsdale, New Jersey.
  Ms. DeGETTE. Mr. Speaker, I am pleased to yield 1\1/2\ minutes to the 
gentlewoman from California (Mrs. Capps), our distinguished colleague 
on the committee.
  Mrs. CAPPS. Mr. Speaker, I rise in strong support of H.R. 4365, the 
Children's Health Act of 2000.
  As a school nurse, a mother, a grandmother, children's health is an 
issue that has been of great concern to me throughout my life. This 
bill would dedicate more Federal spending to childhood diseases, 
including autism, early hearing loss, juvenile diabetes, and many 
others.
  I want to highlight the new focus on infant hearing loss. I recently 
served as a panelist at a briefing on infant hearing held by the 
National Campaign for Hearing Health. Every day, 33 newborns leave 
hospitals in this country with undiagnosed hearing loss. Yet, only one-
third of all infants are tested for this most common birth defect. More 
than half of the infants born today with hearing impairments go 
undetected until age two or three, which can have a long-term impact on 
language, social, and cognitive skills.
  We can do better than that for our children, especially since new and 
effective treatments are now available. This legislation will provide 
needed grants to develop statewide newborn and infant hearing screening 
evaluations and intervention programs and systems.
  Mr. Speaker, I urge my colleagues to join parents and grandparents 
with children and grandchildren who suffer from these childhood 
diseases in supporting this very important bill.
  Mr. BILIRAKIS. Mr. Speaker, I am pleased to yield 2 minutes to the 
gentleman from South Carolina (Mr. DeMint).
  Mr. DeMINT. Mr. Speaker, I thank the gentleman for yielding time to 
me.
  As the original sponsor of H.R. 2511, the Adoption Awareness Act, 
along with the gentleman from Virginia (Chairman Bliley), a champion of 
adoption issues, I am pleased to endorse the Infant Adoption Awareness 
Act included in the child health bill.
  While this language is not as broad as the original legislation, it 
does reflect significant efforts to advance the purpose of the Adoption 
Awareness Act. This language was drafted with input from a wide variety 
of organizations, including those in the adoption and public health 
communities.
  Women facing unplanned pregnancies deserve to hear about their 
options from a well-trained counselor who can provide accurate, up-to-
date information on adoption. This Act provides professional 
development for pregnancy counselors in adoption counseling. The 
training will enable pregnancy counselors to feel confident in their 
knowledge of the adoption process, relevant State and local laws, and 
the legal, medical, and financial resources which can be provided to 
women with unplanned pregnancies.
  Furthermore, there are true experts in the field of adoption 
counseling who are extremely familiar with the adoption process from 
the viewpoint of the birth mother placing a child for adoption. These 
individuals should be the trainers for the pregnancy counselors 
receiving the training.
  I am pleased to support the Infant Adoption Awareness Act as a step 
in the right direction to bring complete and accurate adoption 
information to women facing unplanned pregnancies. I hope that this 
step significantly advances our Nation in the direction of eliminating 
a perceived anti-adoption bias in pregnancy counseling in providing 
lasting answers to difficult circumstances.
  I truly believe that in our great Nation, while there may be unwanted 
pregnancies, there are no unwanted children.
  Ms. DeGETTE. Mr. Speaker, I am pleased to yield 1 minute to our 
colleague, the gentleman from Iowa (Mr. Ganske), a member of the 
committee.
  Mr. GANSKE. Mr. Speaker, I thank the gentlewoman for yielding time to 
me.
  Mr. Speaker, I will vote for this bill. It does many good things. But 
Mr. Speaker, I have to ask, if we are going to legislate on this floor 
on fragile X, autism, juvenile diabetes, then why do we not address on 
this floor the number one public health issue before the country, and 
that is the use of tobacco?
  It has been well recognized that tobacco companies for a long time 
have been targeting kids to get them to smoke. Why? Because nicotine is 
one of the most addicting substances known. It is as addicting as 
morphine. Those tobacco companies know if they get kids hooked early it 
is very, very difficult to get them to quit.
  Three thousand kids today will start smoking. One thousand of those 
kids will eventually die of a tobacco-related disease. I think it is a 
travesty that we

[[Page H2716]]

are not bringing that issue to this floor. I and the gentleman from 
Michigan (Mr. Dingell) have a bipartisan bill, the tobacco authorities 
bill, that gives the FDA authority to regulate tobacco. It is not a tax 
bill, it is not a liability bill. It simply says that those tobacco 
companies that have been targeting kids have to stop.
  Mr. BILIRAKIS. Mr. Speaker, I yield 1\1/2\ minutes to the gentleman 
from Florida (Mr. Stearns).
  (Mr. STEARNS asked and was given permission to revise and extend his 
remarks.)
  Mr. STEARNS. Mr. Speaker, I thank the gentleman for yielding me the 
time.
  Mr. Speaker, I rise in support of H.R. 4365 and applaud the chairman 
for the work he is doing here. He has lots of Members who want 
priorities. I think this is a very important bill.
  Part of the bill is this adoption awareness, and specifically infant 
adoption awareness ensures that family planning counselors have access 
to training on presenting complete and accurate adoption information 
and referrals to women facing unplanned pregnancies.
  Two, the special needs adoption awareness directs the Secretary of 
Health and Human Services to make grants to carry out a national 
campaign to provide information to the public on adoption of special 
needs children, establishes a toll-free telephone line for providing 
information, makes grants to support groups for adoptive parents, and 
for research on reasons for adoption disruptions.
  I think this is extremely important here in Congress to realize that 
adoption awareness is a solution for many women. I applaud the chairman 
for all the work he is doing. I am pleased to be a cosponsor and to 
provide support.
  Mr. BROWN of Ohio. Mr. Speaker, I yield 2 minutes to my friend, the 
gentlewoman from California (Ms. Roybal-Allard).
  Ms. ROYBAL-ALLARD. Mr. Speaker, I rise in support of H.R. 4365, and 
would like to focus on one element of this bill, the Folic Acid 
Promotion and Birth Defects Prevention Act, which I introduced last 
year with the gentlewoman from Missouri (Mrs. Emerson).
  This provision will help prevent an estimated 2,500 U.S. babies a 
year from being born with serious birth defects of the brain and spine, 
such as spina bifida. Added to this tragedy is the fact that up to 70 
percent of these birth defects can be prevented if women of 
childbearing age consume 400 micrograms of folic acid daily.
  Unfortunately, thousands of U.S. women are unaware of this fact. The 
Folic Acid Promotion and Birth Defects Prevention Act in this bill 
addresses this problem by authorizing the Centers for Disease Control 
to launch a national education and public awareness campaign to inform 
women of the benefits of folic acid.
  Like so many public health needs, common sense tells us that devoting 
a few extra dollars to this problem today will save thousands of 
dollars in future health care costs, but more importantly, will prevent 
the occurrence of these tragic birth defects.
  On behalf of our Nation's families, I urge my colleagues to support 
H.R. 4365.
  Mr. BROWN of Ohio. Mr. Speaker, I yield 2 minutes to the gentleman 
from Texas (Mr. Bentsen).
  (Mr. BENTSEN asked and was given permission to revise and extend his 
remarks.)
  Mr. BENTSEN. Mr. Speaker, I rise in strong support of H.R. 4365, the 
Children's Health Act of 2000.
  I want to focus on one point of this bill. While I support every part 
of it, particularly the pediatric research, I want to talk a little bit 
about the graduate medical education part of this bill, because I have 
the honor of representing the Texas Medical Center, which is the 
largest Medical Center in the world and includes the largest children 
hospital, Texas Children's Hospital, as well as Hermann Children's 
Hospital in the Harris County Hospital District.

                              {time}  1445

  That being said, there is a great deal of clinical research that is 
done through graduate medical education at Children's Hospital which is 
not reimbursed because our medical education system is funded through 
the Medicare program and really does need to be restructured.
  This bill is the first step following up on what we did last year in 
funding, at least in part, some of that medical education that is 
conducted at children's hospitals. Congress should go a lot further, 
frankly, but I am pleased that this bill includes that.
  Mr. Speaker, let me say what I regret about this bill. What I regret 
is where it is lacking, and that is in the Medicaid program itself. 
There are 3 million children, including 800,000 children in my home 
State of Texas, who are eligible for Medicaid but not enrolled in the 
program. Texas leads the Nation in the number of children, nearly a 
million children, not enrolled in the program.
  The gentlewoman from Colorado (Ms. DeGette) and myself have both 
offered bills that would begin to address this problem and bring these 
children into the system. This creates an even greater burden in our 
children's hospitals because when these kids get sick, they end up at 
the children's hospitals and we pay for it through the disproportionate 
share program. The fact is they ought to be enrolled in the Medicaid 
program and getting the preventive health care they need, instead of 
showing up at the emergency room at the last minute at a much higher 
cost structure.
  So I regret the fact that the committee chose not to include these 
bills in this bill. I think overall, this is a good bill. But I would 
hope that the Committee on Commerce will move swiftly to bring these 
children into the Medicaid program and start to address this problem. 
And I think by doing that, we will not only be doing a lot for these 
kids, but we will be doing a lot for our children's hospitals 
throughout the country.
  Mr. BILIRAKIS. Mr. Speaker, I yield 2 minutes to the gentlewoman from 
Maryland (Mrs. Morella).
  Mrs. MORELLA. Mr. Speaker, I thank the gentleman from Florida (Mr. 
Bilirakis) for yielding the time to me, and I certainly commend the 
gentleman for his leadership, along with the leadership of the 
gentleman from Ohio (Mr. Brown), ranking member, for this legislation, 
the Children's Health Act of 2000. I strongly support it.
  Mr. Speaker, the bill attempts to foster Federal and State 
cooperation in creating public awareness about some of the devastating 
effects of disorders such as autism, epilepsy, fragile X, asthma and 
skeletal cancer in children.
  I am pleased that it authorizes the Director of NIH to expand 
programs and activities dealing with autoimmune diseases, including the 
formation of coordinating committee and advisory councils to develop 
NIH activities in this area and report to Congress on how funds are 
being spend on autoimmune diseases.
  Mr. Speaker, let me put a face on these dreaded diseases. They 
include juvenile diabetes, juvenile arthritis, rheumatic fever, Crohn's 
disease, pediatric lupus, Grave's disease, Evans syndrome, autoimmune 
hepatitis, primary biliary cirrhosis, and the list goes on and on.
  There have been so few epidemiology studies on the prevalence of 
these diseases in children that we can only give a best effort estimate 
that upwards of 9 million pediatric and adolescent children are 
afflicted with one or more autoimmune diseases. The lack of 
epidemiology studies clearly shows that there is a need for 
comprehensive approach to research in these areas.
  This is a comprehensive approach; this is a comprehensive bill. It is 
a bill that I urge my colleagues to support unanimously, H.R. 4365.
  Mr. BROWN of Ohio. Mr. Speaker, I yield 2 minutes to the gentlewoman 
from New York (Mrs. Lowey).
  Mrs. LOWEY. Mr. Speaker, I rise in strong support of H.R. 4365. By 
expanding pediatric research efforts and providing additional resources 
for a number of diseases which afflict children, this bill will go a 
long way toward improving health care for our children and enhancing 
their health and safety.
  As the main Democratic sponsor of the Safe Motherhood Monitoring and 
Prevention Research Act, I am particularly pleased that H.R. 4365 
includes provisions to ensure that maternal health and safe motherhood 
research and programs are top public health priorities.
  As we all know, the CDC is the premier source of health surveillance 
in

[[Page H1717]]

this country, and for the past 13 years they have been monitoring the 
maternal deaths, risks, and complications through the Pregnancy 
Mortality Surveillance System. The CDC also assists States in 
determining which women may be at increased risk for pregnancy-related 
complications and what types of interventions can decrease these risks 
through the Pregnancy Risk Assessment Monitoring System or PRAMS.
  While most of us think that childbirth and pregnancy are completely 
safe, CDC's research tells us otherwise. According to the CDC, two to 
three women die each day from pregnancy-related conditions and nearly 
5,000 women experience major complications either before or after labor 
begins. Even more disturbing is the news that black women are four 
times more likely and Hispanic women 1.7 times per likely to die during 
pregnancy than their white counterparts and that access to prenatal 
care does not close this gap.
  That is why it is critical that we give the CDC the tools they need 
to collect data, investigate maternal deaths, research risks, and 
examine problems like domestic violence during pregnancy. Armed with 
that information and research, the CDC will also get the word out to 
women who need it most and the doctors who serve them.
  Mr. Speaker, no woman should die due to pregnancy in 2000. So as we 
approach Mother's Day, I am delighted that this bill will enable CDC to 
do its good work.
  The SPEAKER pro tempore (Mr. Barrett of Nebraska). The gentleman from 
Ohio (Mr. Brown) is advised that he has 30 seconds remaining, as does 
the gentleman from Florida (Mr. Bilirakis).
  Mr. BROWN of Ohio. Mr. Speaker, I yield myself such time as I may 
consume.
  Mr. Speaker, I ask House support of H.R. 4365. This legislation has 
been a good faith effort with the gentleman from Florida (Mr. 
Bilirakis), my office, and this committee working together. It will 
mean an absolute difference in children's lives; children who have 
often been ignored by the system in juvenile arthritis or juvenile 
diabetes and tests conducted not always for children and the unique 
diseases they have.
  Mr. Speaker, I ask House support of this legislation.
  Mr. Speaker, I yield back the balance of my time.
  Mr. BILIRAKIS. Mr. Speaker, I yield myself the balance of my time.
  Mr. Speaker, an awful lot of blood, sweat and tears has gone into 
trying to secure a better future for our children by helping to reduce 
the incidence of disease and illness. I thank my Committee on Commerce 
colleagues, particularly the gentleman from Ohio (Mr. Brown) and I 
applaud all the Members for having the good sense to set aside some of 
our partisan agendas in order to improve the lives of our children and 
all of their families throughout this country. I ask all of the Members 
to support this legislation.
  Mr. WEYGAND. Mr. Speaker, while I am in support of H.R. 4365, the 
Child Health Research and Prevention Amendments, this bill should not 
be on the floor today under the suspension of the rules--where no 
member can offer an amendment to strengthen and improve this bill.
  I commend those of my colleagues who drafted this bill in the back 
rooms of Congress. They have drafted a good piece of legislation. But 
Congress works best when more than a minority of the members are 
involved in developing legislation. As a cosponsor of H.R. 3301, the 
base bill for this new draft legislation, I will vote in favor of the 
bill on the floor today. Make no mistake, however, that thousands of 
extremely ill children are being ignored by the House of 
Representatives today.
  Well over a month ago, my staff contacted the Commerce Committee--
both the majority and the minority--asking if this bill could also 
direct the NIH to review their work on children with the rare illness 
``Hutchinson-Gilford Progeria Syndrome,'' similar to the study being 
asked for in the bill regarding Friedreich's ataxia. Other members of 
the House worked with me on this effort. I also joined with a member of 
the Majority to inquire if we could similarly add Spinal Muscular 
Atrophy to the same section of the bill. These measures are not in the 
bill today, and this process--which bars amendments--has kept these 
children and thousands of others from being heard, and helped by this 
bill.
  In fact, this bill has not been open to amendments at any point since 
its introduction. Two committee mark-up sessions for this bill were 
canceled, and yet we are here voting for final passage! I ask you, Mr. 
Speaker, why has the leadership forgone the democratic process in order 
to pass a children's health bill? I would say it is because of tobacco 
and guns, the soft spot on the heart of the Republican leadership.
  The failure of the leadership with regard to this bill represents a 
terrible missed opportunity for thousands of sick children. Because the 
Republican leadership couldn't stomach a vote on tobacco or gun 
safety--both huge problems for children's health--we bypassed regular 
order. That act has forced the House to forgo working together to 
develop a bill that could have helped even more children. My efforts to 
improve the bill are only one of 435 stories of members in this body. 
We have not only ignored the democratic process, we have ignored the 
needs of thousands of children in order to avoid some tough votes.
  Shame on the leadership for failing our nation's children--not 
through the good of this bill, but through the leadership's failure to 
do even more for children.
  Mrs. EMERSON. Mr. Speaker, it is with pleasure that I speak in 
support of this essential Children's Health Act of 2000. There are many 
of us who have worked very hard to get to this day, and I applaud the 
Commerce Committee and Mr. Bilirakis and Mr. Brown for getting a 
consensus on this bill so it could come to the floor.
  I represent 26 rural counties in Southern Missouri. These counties 
are home to some of the most poverty stricken communities in the State. 
Most of them lack even basic health care services. And many lack decent 
roads and reliable phone service. Many people in these communities find 
themselves isolated from their extended family, their friends and their 
neighbors.
  Many young mothers-to-be in my rural district are isolated from 
family and friends--and they live miles away from nurses and doctors. 
This isolation often prevents them from getting prenatal care and adds 
to the fears and uncertainties that come along with being a new or 
expectant mother. Many American women fall through the cracks of our 
health system. Women throughout our nation face great challenges in 
securing healthy pregnancies and healthy children.
  Consider the following: At the turn of this century more American 
women died in childbirth than from any other cause except for 
tuberculosis. At the close of this century, after all of the medical 
advances made in this country, it's easy to assume that today pregnancy 
and childbirth are safer for American women and their babies.
  But this is a false assumption.
  Last June, the CDC released a report that makes it painfully clear 
that the promise of safe motherhood is eluding too many women. In fact, 
during the past 15 years alone, total maternal deaths have not declined 
one bit in our nation. Just think of it. Today, tuberculosis claims 
about one American life out of 1,000 a year. But 2-3 women out of 
10,000 lose their lives each day due to pregnancy-related conditions. 
And out of 1,000 live births in our country each year, 8 babies die. 
More infants die each year in the United States than in 24 other 
developed nations.
  As a Member of Congress and as a mother of four daughters, this 
maternal and infant mortality rate is simply unacceptable. We've got to 
find out why safe motherhood is still out of reach for so many American 
women. I am very proud to join many of my esteemed colleagues in 
supporting this legislation that will have significant progress of 
maternal and infant health in this country.
  The legislation includes several provisions that my colleague Nita 
Lowey and I introduced as a stand alone bill, Safe Motherhood 
Monitoring and Prevention Research Act of 1999, which are especially 
beneficial to pregnant women, infants, and children.
  The Safe Motherhood Portion of the bill achieves 3 key goals, all 
necessary components to true progress in the enhancement of material 
and infant care.
  First, it expands CDC's Pregnancy Risk Assessment Monitoring System 
(PRAMA) so that all 50 states will benefit from a public health 
monitoring system of pregnancy-risk related factors.
  Second, this bill authorizes an increase in federal funding for 
preventive research, so we can identify basic health prevention 
activities to improve maternal health.
  The third and final component of this section of the bill directs the 
Secretary to help states and localities create public education and 
prevention programs to prevent poor maternal outcomes for American 
women.
  In addition, this bill emphasizes the need to expand existing 
prevention programs and pregnancy risk assessment systems to include 
those areas of the country where underserved and at-risk populations 
reside.
  Finally, I am also pleased that this bill includes many of the 
provisions in a bill I introduced last year called the Healthy Kids 
2000

[[Page H2718]]

Act. This bill expands the opportunities for Pediatric Research by 
creating a pediatric research initiative within NIH, promotes the use 
of folic acid as a way to prevent birth defects, and creates a national 
Center on Birth Defects and Developmental Disabilities.
  There are so many wonderful parts of this bill. On behalf of our 
youngest and most vulnerable citizens, I urge my colleagues to Vote for 
the Children's Health Act of 2000, and I urge the Senate to take action 
on this bill to move the process forward.
  Mr. TIERNEY, Mr. Speaker, I commend the bipartisan effort that has 
produced this important bill, H.R. 4365, the Children's Health Act of 
2000. I understand that in the spirit of cooperation, many amendments 
to this bill were laid aside in order to bring this legislation to the 
floor and ensure that the urgently needed programs included in H.R. 
4365 were not jeopardized by disagreements on other matters.
  I would like to mention one change to the bill that I believe is 
quite worthy and would not raise controversy. Had this bill come up 
under a rule rather than as a suspension, Mr. Weygand and I would have 
sought an amendment to include Hutchinson-Gilford Progeria Syndrome 
under Section 2201 of the bill as one of the rare childhood diseases on 
which NIH would have to report its activities.
  This syndrome, commonly known as Progeria, is a genetic condition 
that manifests itself as accelerated aging in children. While it is 
quite rare, with an estimated incidence of roughly one in every 8 
million newborns, Progeria is devastating. The average life span of an 
affected child is 13 years, and the disease is, without exception, 
fatal. Up until now, there has been little to no NIH research directly 
in this area. However, such research has the potential to benefit many 
individuals in addition to the victims of Progeria. According to Dr. 
Ted Brown, Professor and Chairman of the Department of Human Genetics 
at the New York State institute for Basic Research, ``Finding a cure 
for Progeria may provide keys for treating millions of people with 
heart disease associated with natural aging.''
  Requiring the NIH report on activities relating to rare childhood 
diseases to include Progeria as one of those conditions is thoroughly 
consistent with the purpose of the bill before us today, and we thank 
the sponsors and managers of the bill who have been sympathetic to our 
suggested change. However, because of the process by which H.R. 4365 
came to the floor, it was not possible to include this important and 
justified amendment. Mr. Weygand and I hope that the Senate's 
consideration of this legislation will proceed in a more deliberative 
manner, and we will work with our Senate counterparts to include 
Progeria language when this bill moves in the other Congressional 
chamber. It is our hope that the bill that emerges from conference will 
contain language bringing much-needed attention to this underrecognized 
and tragic condition.
  Mr. BLILEY. Mr. Speaker, I commend the gentlemen from Florida and 
Ohio for introducing H.R. 4365, the Children's Health Act of 2000. This 
important legislation, introduced by Representatives Bilirakis and 
Brown, contains a host of significant provisions that, when enacted 
into law, will improve the lives of untold numbers of children and 
families throughout this country.
  Though too numerous to mention each provision individually, I want to 
comment on a few that I believe are parrticularly important. This Act 
makes important strides in the fight against autism--a heart-breaking 
condition. Autism is a serious disease, affecting 1 in every 500 
children born today. More prevalent than Down's syndrome, childhood 
cancer or cystic fibrosis, it hits children during the first two years 
of life and causes severe impairment in language, cognition and 
communication.
  As a proud adoptive father of two, I am pleased that this Act also 
advances adoption policy in this country by ensuring family planning 
counselors have access to training on presenting complete and accurate 
adoption information to women facing unplanned pregnancies. In the 
interest of time, I ask that I be permitted to extend my remarks for a 
more full discussion of this aspect of the legislation. Moreover, this 
bill contains several initiatives that will foster the adoption of 
special needs children. The Act also authorizes the Healthy Start 
program for the first time. For at-risk pregnant women served by this 
program, it authorizes ultra-sound screening and expands access to 
surgical services to the fetus, mother, and infant during the first 
year after birth.
  The Act will enable the families of children who have had an adverse 
reaction to rotavirus vaccine to receive compensation under the vaccine 
injury compensation program. It extends the authorization of 
appropriations for graduate medical education in children's hospitals--
an authorization that the Commerce Committee initiated in a bill signed 
into law last year.
  The list goes on: the Act will bring help to children suffering from 
juvenile diabetes, pediatric asthma, juvenile arthritis, birth defects, 
hearing loss, epilepsy, skeletal malignancies, traumatic brain injury, 
dental disease, and a wide range of autoimmune diseases. It also 
ensures that our nation's organ transplantation system recognizes 
children's unique health care needs.
  It is important that the Members of this House vote for passage of 
this critically important bill to secure a better future for America's 
children by helping to reduce the incidence of disease and illness. We 
know we can lessen the incidence of these diseases through heightened 
research activities, and through the use of successful interventions 
that still remain out of reach by many in our society.
  Again, I thank my Commerce Committee colleagues and many other 
Members who have contributed to this bill. By voting to pass this bill, 
I applaud those Members for having the good sense to set aside some of 
our more partisan agendas in order to do a good work for our children 
and all of their families throughout this country.
  Ten months ago, Congressman Jim DeMint of South Carolina and I 
introduced H.R. 2511, the Adoption Awareness Act. During consideration 
by the Committee on Commerce, the language of H.R. 2511 changed but the 
central purpose remained the same: the Infant Adoption Awareness Act 
ensures that counselors in health clinics and other settings provide 
women who have unplanned pregnancies complete and accurate information 
on adoption.
  As Chairman of the Commerce Committee, I have been responsible for 
the negotiations leading to the Infant Adoption Awareness Act for these 
many months, and I want to take this opportunity to explain the bill at 
length to my colleagues in case there is any confusion with the text of 
the original Adoption Awareness Act, H.R. 2511.
  What struck Congressman DeMint and me was that the studies and 
statistics available in this field show a lack of activity which may 
well reflect an anti-adoption bias in pregnancy counseling. According 
to a University of Illinois study by Professor Edmund Mech, 
Orientations of Pregnancy Counselors Toward Adoption, 40 percent of 
self-identified ``pregnancy counselors'' in settings such as health, 
family planning, and social service agencies do not even raise the 
issue of adoption with their pregnant clients. Of the 60 percent who 
raise the issue of adoption in some form, 40 percent provide inaccurate 
or incomplete information. Furthermore, while pregnancy counselors 
themselves may not have a negative bias towards adoption, they 
presuppose that their client is not interested and therefore do not 
present adoption as a true option for women facing unplanned 
pregnancies (Source: Mech, Pregnant Adolescents: Communicating the 
Adoption Option). The Infant Adoption Awareness Act would set up a 
training program by which clinic workers and others could receive 
professional inservice training in educational adoption counseling. By 
being properly trained, these counselors would be equipped to provide 
valuable information on adoption to their clients.
  While many societal factors have changed in the last twenty years, 
including the acceptance of non-marital teen parenting, the 
availability of welfare, and increased availability of abortion 
services, there has been a dramatic drop in the number of adoptions 
among live births to unwed mothers. Prior to 1973, an adoption 
placement occurred for almost one of every ten premarital births. By 
the 1990s, the number had dropped to an adoption placement for one of 
less than every hundred premarital births. A long-term study of the 
Adolescent Family Life (AFL) pregnancy programs which included an 
adoption counseling component showed that--given necessary adjustments 
for client and community characteristics--more women chose to place 
their child for adoption when enrolled in an AFL Care project which 
provided adoption counseling as a part of pregnancy resolution 
decision-making (Source: McLaughlin and Johnson, Battelle Human Affairs 
Research Centers, The Relationship of Client and Project 
Characteristics to the Relinquishment Rates of the AFL Care 
Demonstration Projects). Thus, this Act intends to ensure that the 
public health and other professionals coming in contact with a high 
percentage of women facing unplanned pregnancies--often unwed 
adolescents--are properly prepared to have a complete and accurate 
discussion of adoption.
  The Act allows for a six month period in which representatives of the 
adoption community come together to adopt or develop best-practices 
guidelines for counseling on adoption to women facing unplanned 
pregnancies. Specifically, the Secretary should include representatives 
of diverse viewpoints in the adoption community, including 
organizations representing agencies arranging infant adoptions, 
adoption attorneys, adoptive parents, social services, and appropriate 
groups representing the adoption triad (birth parents, infant, and 
adoptive parents). Organizations with significant expertise and history 
in this arena include

[[Page H2719]]

the National Council For Adoption, Loving and Caring, Bethany Christian 
Services, the American Academy of Adoption Attorneys, and the American 
Bar Association Family Law Section's Adoption Committee and these 
organizations should be represented on the panel. While recognizing the 
sensitivity of making an adoption decision, the organizations 
represented should be those which promote adoption in a realistic, 
positive manner as beneficial to the birth parents, child, and adoptive 
parents. The best-practices guidelines should focus on the essential 
components of adoption information and counseling to be presented 
during a pregnancy counseling session. Furthermore, the guidelines 
should include important variables to be presented, such as state laws 
on adoption, and available medical, legal, and financial resources. 
Previous curricula developed for these purposes should be the starting 
point and, as an interim set of guidelines, be determinative.
  The role of the public health clinics on the panel developing the 
best practices guidelines (and organizations representing their 
interests, such as the Family Planning Councils of America) is to 
ensure the guidelines are relevant to the health clinic setting. The 
experts in adoption counseling, including those who have a history of 
developing and delivering training or tools to teach adoption 
counseling, should shape the best-practices guidelines to provide an 
excellent model for presenting adoption to women facing unplanned 
pregnancies. Since different attitudes towards adoption exist 
throughout the country which can be attributed to racial, ethnic, 
religious, social, and geographic differences, the best-practices 
guidelines should act as a blueprint or model while still allowing 
localities the flexibility to address their local situation. Therefore, 
the best-practices guidelines would be a model which could be tailored 
to address the individual needs of the pregnant woman.
  After the best-practices guidelines are developed, the Secretary 
shall make grants to adoption organizations to carry out training, 
which will often be training trainers, to teach pregnancy counselors 
how to present complete and accurate information on adoption. The 
guidelines are meant to be the basis for the adoption, improvement, or 
development of a training curriculum by grantees. Furthermore, the 
grantees can carry out the training programs directly or through grants 
or contracts with other adoption organizations. For instance, a 
national office could subgrant or contract with local affiliates 
throughout the nation or a region thereof. The Secretary should use 
discretion in ensuring that all regions of the nation will have 
adequate access to the training without having duplicate services in an 
area with a small number of eligible health clinics. There are no 
geographic limitations on where the trainers should be trained. The 
intent is to provide for training of trainers, often on a statewide or 
regional basis, so truly expert trainers can teach others.
  The trainers should be highly qualified individuals with an expertise 
in adoption counseling. ``Adoption counseling'' in the adoption 
community implies an in-depth discussion of adoption which includes 
knowledge of various types of adoption and familiarity with the 
viewpoint and challenges of birth mothers, putative fathers, adoptive 
parents, and the best interest of the child. Trainers should have 
experience in providing adoption information and referrals in the 
geographic area of the eligible health centers. With a knowledge of 
state laws and access to local support networks, a trainer will be able 
to provide a more extensive review of local information and resources 
to the pregnancy counselors. The most essential component of the 
training, however, is to teach pregnancy counselors how to accurately 
and completely present adoption as an option to their clients and to 
ensure counselors are able to answer the frequently asked questions 
clients have regarding adoption.

  The Infant Adoption Awareness Act refers to pregnancy counselors 
providing adoption information and referrals as a part of pregnancy 
counseling. It is important to note that handing a client a piece of 
paper or booklet explaining the adoption process and providing phone 
numbers of agencies or attorneys for adoption referrals does not 
constitute adoption information and referrals. Adoption information 
means a counselor is able to fully explore the option of adoption with 
a client. This includes answering relevant questions such as the types 
of adoptions, financial and medical resources for birth mothers, and 
state laws regarding relinquishment procedures and putative father 
involvement. Referral upon request includes following the procedures of 
the health clinic to make an appointment for the client and follow-up 
as necessary. Referral may be made to an in-house adoption provider, 
such as a staff member of a licensed adoption agency. Since adoption is 
explored in the context of pregnancy counseling sessions in which 
counselors and clients have a limited amount of time, it is essential 
that the counselors provide complete and accurate summary information 
to their clients at that time.
  The intent of this Act is to ensure that pregnancy counselors are 
well-trained, knowledgeable and comfortable presenting adoption to 
their clients. While adoption may not be the right choice for every 
woman facing an unplanned pregnancy, each woman should be presented 
adoption information to make a well-informed decision. Many women have 
not thought of the possibility of adoption, do not know how to explore 
the details of adoption, or have misconceptions of the adoption process 
which hinder their consideration of the alternative of adoption. Since 
pregnancy counselors act as an important resource for these women, they 
must be equipped to fully address the option of adoption with their 
clients.
  The adoption organizations eligible to receive grants for training 
(or subgrants or contracts) are those national, regional, or local 
private, non-profit institutions among whose primary purposes is 
adoption, and are knowledgeable on the process of adopting a child and 
on providing adoption information and referrals to pregnant women. 
These adoption organizations must work in collaboration with existing 
Health Resources Services Administration (HRSA) funded ``training 
centers.'' Of particular importance is the organization's experience in 
explaining the process involved to the birth mother placing the child 
for adoption. It is essential that adoption is among the primary 
purposes of the entity, as it should be organizations with true experts 
in adoption counseling who are training pregnancy counselors.
  Health centers which are eligible to have staff receive training are 
public and nonprofit private entities that provide health-related 
services to pregnant women. The designated staff of the health centers 
means the counselors who will interact and provide counseling to women 
with unplanned pregnancies. The designated staff members are those who 
provide pregnancy or adoption information and referrals (or will 
provide such information and referrals after receiving training). 
Furthermore, while the Act sets out those health centers which should 
receive priority in being trained, nothing should be construed to 
prohibit those who provide counseling in other settings, such as on 
military bases and corrections facilities, to be eligible to 
participate in the adoption counseling training sessions.
  The grant is conditioned on the agreement of the adoption 
organization to make reasonable efforts to ensure that the eligible 
health centers which may receive training under this grant include, but 
are not limited to, those that receive federal family planning funding, 
community health centers, migrant health centers, centers for homeless 
individuals and residents of public housing and school-based clinics.
  The Secretary has the duty to provide eligible health centers (which 
receive funding under Section 330 and 1001) with complete information 
about the training available from the adoption organizations receiving 
the training grants. Furthermore, the Secretary has the duty to 
encourage eligible health centers to have their designated staff 
participate in the training. The Secretary must make reasonable efforts 
to encourage staff to undergo training within a reasonable period after 
the Secretary begins making grants for such training. The grantees will 
cover the costs of training the designated staff and reimbursing the 
health center for costs associated with receiving the training. 
Adoption counseling training is a type of professional development for 
pregnancy counselors and should be reimbursed on a similar basis as 
other professional development activities which staff receive in the 
local area.
  Within one year, the Secretary shall submit to the appropriate 
Committees of Congress a report prepared by an independent evaluator, 
paid for by funds set aside under this Act evaluating the extent to 
which adoption information, and referral upon request, is provided by 
eligible health centers. The study should be scientifically-based and 
sufficiently broad so as to gain an understanding of the current 
practices of providing adoption information in Federally funded health 
clinics throughout the country. This should include the attention given 
to adoption relative to other options discussed in pregnancy 
counseling. Further, the study should indicate how often and in what 
form (written, verbal) adoption information is offered, the 
completeness and accuracy of the adoption information provided, and 
non-identifying information about the options ultimately chosen by 
clients.
  Within a reasonable period of time, the Secretary shall submit to the 
appropriate Committees of Congress a report evaluating the extent to 
which adoption information, and referral upon request, is provided by 
eligible health centers to determine the effectiveness of the training. 
The study should be scientifically-based, that is, more than a 
checklist asserting that adoption counseling, information, or referral 
has been provided, and focus on those health centers in which 
designated staff have been provided training through this Act. In 
conducting these studies, the Secretary shall ensure that the research 
does not allow any interference in the provider-patient relationship, 
any breach of patient confidentiality, or

[[Page H2720]]

any monitoring or auditing of the counseling process which breaches 
patient confidentiality or reveals patient identity.
  Funding for research in adoption counseling practices has been 
sporadic at best. Despite the acknowledged need to ensure pregnancy 
counselors can present adoption in a positive, accurate manner, funding 
for such studies has not materialized in proportion to the need. The 
Adolescent Family Life Program in the Office of Population Affairs 
provided for limited studies in the 1980s and follow-up studies on the 
effectiveness of the AFL Demonstration Programs into the early 1990s. 
The Office of Adolescent Pregnancy Programs in the 1990s proposed an 
objective of increasing to 90 percent the number of pregnancy 
counselors who are able to counsel on adoption in a complete, accurate 
manner. With a change of Administration, this goal never materialized 
as one of the priorities of the Public Health Service. Furthermore, 
plans for follow-up study by the Department of Health and Human 
Services to determine if the orientations of pregnancy counselors 
toward adoption had changed were dropped in 1995. Thus, research in 
this area is of critical importance.
  Additionally, there is an understanding that this Act would include 
``charitable choice'' language allowing faith-based organizations to 
compete for grants on the same basis as any other non-governmental 
provider without impairing the religious character of such institution, 
upon agreement by the White House and House Leadership on ``charitable 
choice'' language for other legislation. Under charitable choice, the 
Federal Government cannot discriminate against an organization that 
applies to receive such a grant on the basis that the organization has 
a religious character and programs must be implemented consistent with 
the Establishment and Free Exercise Clauses of the United States 
Constitution. While following the agreed upon charitable choice model, 
the language must be crafted to conform it to the purpose and structure 
of this Act.
  While we have come a long way, much work remains to be done. I look 
forward to working with my colleagues on the Appropriations Committee 
on this adoption priority and with members of the other body to enact 
this important provision into law this year, on which better and more 
humane Federal policies can be built in the future.
  Mr. DINGELL. Mr. Speaker, I am in support of H.R. 4365, the 
Children's Health Act of 2000. This bill is an important first step 
toward improving the health and well-being of our nation's next 
generation.
  H.R. 4365 enhances the national research infrastructure and 
reinforces surveillance and prevention initiatives for such conditions 
as fragile X, autism, asthma, juvenile arthritis, childhood 
malignancies, traumatic brain injury, hepatitis C, and immediate 
adverse reactions to vaccines. I am particularly pleased to see two 
provisions that reflect the tireless efforts of my colleague Diana 
DeGette: one to advance the quest for a treatment and cure for 
juvenile-onset diabetes, and the second to improve pediatric organ 
transplant services. H.R. 4365 also strengthens existing activities to 
promote the use of folic acid in the prevention of certain birth 
defects, a measure that will reduce human suffering and save healthcare 
dollars.
  Other highlights of the bill include the expansion of oral health and 
epilepsy treatment services to undeserved children, and the 
reauthorization of the Healthy Start initiative, a demonstration 
program established to reduce infant mortality and improve pregnancy 
outcomes.
  Investments in America's researchers are also evidenced in H.R. 4365 
through the extension of authorized appropriations to children's 
hospitals for the cost of graduate medical education. The bill enhances 
biomedical pediatric research by establishing a Pediatric Research 
Initiative within NIH, and centralizes the coordination of NIH research 
activities in the area of pediatric autoimmune disorders. Finally, to 
attract the most promising young research minds in the country to work 
on often overlooked childhood disorders, the bill contains loan 
repayment programs for biomedical researchers and physician-scientists.
  Regrettably, however, this children's health bill is not the best we 
could do for America's children. A number of my colleagues had 
amendments that would have strengthened H.R. 4365, but the irregular 
procedures used by the majority for the bill blocked their 
consideration. These include, but are not limited to: (1) supplementing 
S-CHIP and Medicaid to provide seamless access to state-of-the-art 
prenatal services to all pregnant women; (2) assuring equal access to 
pediatric specialists, medically necessary drugs and clinical trials 
for children with rare and/or serious health problems; (3) attending to 
state-by-state disparities in new born screening for genetic diseases 
by authorizing HHS to carry out the recommendations of the Task Force 
on Newborn Screening, an issue of deep concern to my colleague Mr. 
Pallone; and (4) an excellent proposal by my good friend Mr. Towns for 
establishing guidelines for the administration of psychotropic 
medications to children under five.
  An even more glaring omission from this bill is the lack of a 
provision to restore FDA's jurisdiction over the regulation of youth 
tobacco use. This issue was thoughtfully raised in legislation 
introduced by my colleague, Dr. Greg Ganske, which enjoys a broad base 
of bipartisan support. The process by which the legislation comes 
before us today is characterized by the majority's determination to 
block any discussion of this important issue.
  I have additional concerns about the difficulties that will arise for 
this particular Children's Health bill, H.R. 4365, as companion 
legislation is crafted by the Senate. Title XII, the Infant Adoption 
Awareness Act of 2000, has drafting problems, and leaves the bill 
vulnerable to a host of family planning and adoption issues that are 
beyond the agreed upon scope of this Children's Health bill.
  I will be one of the first to suggest that adoption is an important 
national issue. As of March 31, 1999, America had 117,000 children in 
the public foster care system who are awaiting adoptive parents and a 
permanent place to call ``home.'' This represents an increase of over 
7,000 children since 1998, perhaps in part because Public Law 105-89, 
the Adoption and Safe Families Act has made more foster children, who 
are unable to return home safely, available for adoption. Something is 
wrong, however, when adoptive parents tell us that it is easier to 
pursue an international adoption than to adopt a special needs child 
from America.
  If we wanted to address adoption issues, we should have considered 
legislation sponsored by Senator Levin that the Senate has passed three 
times. It would facilitate the creation of a national voluntary reunion 
registry. In the era of genetic medicine, with its emphasis on family 
medical history information, this not only makes sense as public 
policy, but addresses the life-long psychological issues that often 
shroud the adoption process. Again, irregular procedures blocked mere 
discussion of this issue.
  Mr. Speaker, I will support this bill. I do so, however, with the 
fervent belief that we can, and should, do more for America's children 
than is reflected in H.R. 4365. The children of every district in this 
nation have waited too long for the many laudable provisions in the 
bill; but they also deserve more, and they deserve it soon.
  Mr. Bilirakis. Mr. Speaker, I yield back the balance of my time.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from Florida (Mr. Bilirakis) that the House suspend the rules 
and pass the bill, H.R. 4365, as amended.
  The question was taken.
  Mr. BILIRAKIS. Mr. Speaker, on that I demand the yeas and nays.
  The yeas and nays were ordered.
  The SPEAKER pro tempore. Pursuant to clause 8 of rule XX and the 
Chair's prior announcement, further proceedings on this motion will be 
postponed.

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