[Congressional Record (Bound Edition), Volume 160 (2014), Part 8]
[House]
[Pages 10795-10801]
[From the U.S. Government Publishing Office, www.gpo.gov]




AUTISM COLLABORATION, ACCOUNTABILITY, RESEARCH, EDUCATION, AND SUPPORT 
                              ACT OF 2014

  Mr. PITTS. Mr. Speaker, I move to suspend the rules and pass the bill 
(H.R. 4631) to reauthorize certain provisions of the Public Health 
Service Act relating to autism, and for other purposes, as amended.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                               H.R. 4631

       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 ``Autism Collaboration, 
     Accountability, Research, Education, and Support Act of 
     2014'' or the ``Autism CARES Act of 2014''.

     SEC. 2. NATIONAL AUTISM SPECTRUM DISORDER INITIATIVE.

       (a) In General.--The Secretary of Health and Human Services 
     shall designate an existing official within the Department of 
     Health and Human Services to oversee, in consultation with 
     the Secretaries of Defense and Education, national autism 
     spectrum disorder research, services, and support activities.
       (b) Duties.--The official designated under subsection (a) 
     shall--
       (1) implement autism spectrum disorder activities, taking 
     into account the strategic plan developed by the Interagency 
     Autism Coordinating Committee under section 399CC(b) of the 
     Public Health Service Act (42 U.S.C. 280i-2(b)); and
       (2) ensure that autism spectrum disorder activities of the 
     Department of Health and Human Services and of other Federal 
     departments and agencies are not unnecessarily duplicative.

     SEC. 3. RESEARCH PROGRAM.

       Section 399AA of the Public Health Service Act (42 U.S.C. 
     280i) is amended--
       (1) in subsection (a)(1), by inserting ``for children and 
     adults'' after ``reporting of State epidemiological data'';
       (2) in subsection (b)(1)--
       (A) by striking ``establishment of regional centers of 
     excellence'' and inserting ``establishment or support of 
     regional centers of excellence''; and
       (B) by inserting ``for children and adults'' before the 
     period at the end;
       (3) in subsection (b)(2), by striking ``center to be 
     established'' and inserting ``center to be established or 
     supported''; and
       (4) in subsection (e), by striking ``2014'' and inserting 
     ``2019''.

     SEC. 4. AUTISM INTERVENTION.

       Section 399BB of the Public Health Service Act (42 U.S.C. 
     280i-1) is amended--
       (1) in subsection (b)(1), by inserting ``culturally 
     competent'' after ``provide'';
       (2) in subsection (c)(2)(A)(ii), by inserting ``(which may 
     include respite care for caregivers of individuals with an 
     autism spectrum disorder)'' after ``services and supports'';

[[Page 10796]]

       (3) in subsection (e)(1)(B)(v), by inserting before the 
     semicolon the following: ``, which may include collaborating 
     with research centers or networks to provide training for 
     providers of respite care (as defined in section 2901)'';
       (4) in subsection (f), by striking ``grants or contracts'' 
     and all that follows through ``for individuals with'' and 
     inserting ``grants or contracts, which may include grants or 
     contracts to research centers or networks, to determine the 
     evidence-based practices for interventions to improve the 
     physical and behavioral health of individuals with''; and
       (5) in subsection (g), by striking ``2014'' and inserting 
     ``2019''.

     SEC. 5. INTERAGENCY AUTISM COORDINATING COMMITTEE.

       Section 399CC of the Public Health Service Act (42 U.S.C. 
     280i-2) is amended--
       (1) in subsection (b)--
       (A) in paragraph (1)--
       (i) by striking ``and annually update''; and
       (ii) by striking ``intervention'' and inserting 
     ``interventions, including school and community-based 
     interventions'';
       (B) by striking paragraph (2);
       (C) by redesignating paragraph (1) as paragraph (2), and 
     inserting before such redesignated paragraph the following:
       ``(1) monitor autism spectrum disorder research, and to the 
     extent practicable services and support activities, across 
     all relevant Federal departments and agencies, including 
     coordination of Federal activities with respect to autism 
     spectrum disorder;'';
       (D) in paragraph (3), by striking ``recommendations to the 
     Director of NIH'';
       (E) in paragraph (4), by inserting before the semicolon the 
     following: ``, and the process by which public feedback can 
     be better integrated into such decisions''; and
       (F) by striking paragraphs (5) and (6) and inserting the 
     following:
       ``(5) develop a strategic plan for the conduct of, and 
     support for, autism spectrum disorder research, including as 
     practicable for services and supports, for individuals with 
     an autism spectrum disorder and the families of such 
     individuals, which shall include--
       ``(A) proposed budgetary requirements; and
       ``(B) recommendations to ensure that autism spectrum 
     disorder research, and services and support activities to the 
     extent practicable, of the Department of Health and Human 
     Services and of other Federal departments and agencies are 
     not unnecessarily duplicative; and
       ``(6) submit to Congress and the President--
       ``(A) an annual update on the summary of advances described 
     in paragraph (2); and
       ``(B) an annual update to the strategic plan described in 
     paragraph (5), including any progress made in achieving the 
     goals outlined in such strategic plan.'';
       (2) in subsection (c)--
       (A) in paragraph (1)--
       (i) by striking the paragraph designation, the heading, and 
     the matter preceding subparagraph (A) and inserting the 
     following:
       ``(1) Federal membership.--The Committee shall be composed 
     of the following Federal members--'';
       (ii) in subparagraph (C)--

       (I) by inserting ``, such as the Administration for 
     Community Living, Administration for Children and Families, 
     the Centers for Medicare & Medicaid Services, the Food and 
     Drug Administration, and the Health Resources and Services 
     Administration'' before the semicolon at the end; and
       (II) by adding at the end ``and'';

       (iii) in subparagraph (D)--

       (I) by inserting ``and the Department of Defense'' after 
     ``Department of Education''; and
       (II) by striking at the end ``; and'' and inserting a 
     period; and

       (iv) by striking subparagraph (E);
       (B) in paragraph (2)--
       (i) in the paragraph heading, by striking ``Additional'' 
     and inserting ``Non-federal'';
       (ii) in the matter preceding subparagraph (A), by striking 
     ``Not fewer than 6 members of the Committee, or 1/3 of the 
     total membership of the Committee, whichever is greater'' and 
     inserting ``Not more than \1/2\, but not fewer than 1/3, of 
     the total membership of the Committee'';
       (iii) in subparagraph (A), by striking ``one such member 
     shall be an individual'' and inserting ``two such members 
     shall be individuals'';
       (iv) in subparagraph (B), by striking ``one such member 
     shall be a parent or legal guardian'' and inserting ``two 
     such members shall be parents or legal guardians''; and
       (v) in subparagraph (C), by striking ``one such member 
     shall be a representative'' and inserting ``two such members 
     shall be representatives''; and
       (C) by adding at the end the following:
       ``(3) Period of appointment; vacancies.--
       ``(A) Period of appointment for non-federal members.--Non-
     Federal members shall serve for a term of 4 years, and may be 
     reappointed for one or more additional 4-year terms.
       ``(B) Vacancies.--A vacancy on the Committee shall be 
     filled in the manner in which the original appointment was 
     made and shall not affect the powers or duties of the 
     Committee. Any member appointed to fill a vacancy for an 
     unexpired term shall be appointed for the remainder of such 
     term. A member may serve after the expiration of the member's 
     term until a successor has been appointed.'';
       (3) in subsection (d)--
       (A) by striking paragraph (2); and
       (B) by redesignating paragraphs (3) and (4) as paragraphs 
     (2) and (3), respectively; and
       (4) in subsection (f), by striking ``2014'' and inserting 
     ``2019''.

     SEC. 6. REPORTS.

       Section 399DD of the Public Health Service Act (42 U.S.C. 
     280i-3) is amended--
       (1) in the section heading, by striking ``report'' and 
     inserting ``reports'';
       (2) in subsection (b), by redesignating paragraphs (1) 
     through (9) as subparagraphs (A) through (I), respectively, 
     and realigning the margins accordingly;
       (3) by redesignating subsections (a) and (b) as paragraphs 
     (1) and (2), respectively, and realigning the margins 
     accordingly;
       (4) by inserting after the section heading the following:
       ``(a) Progress Report.--'';
       (5) in subsection (a)(1) (as so redesignated)--
       (A) by striking ``2 years after the date of enactment of 
     the Combating Autism Reauthorization Act of 2011'' and 
     inserting ``4 years after the date of enactment of the Autism 
     CARES Act of 2014'';
       (B) by inserting ``and the Secretary of Defense'' after 
     ``the Secretary of Education''; and
       (C) by inserting ``, and make publicly available, including 
     through posting on the Internet Web site of the Department of 
     Health and Human Services,'' after ``Representatives''; and
       (6) in subsection (a)(2) (as so redesignated)--
       (A) in subparagraph (A), (as so redesignated), by striking 
     ``Combating Autism Act of 2006'' and inserting ``Autism CARES 
     Act of 2014'';
       (B) in subparagraph (B) (as so redesignated), by striking 
     ``particular provisions of Combating Autism Act of 2006'' and 
     inserting ``amendments made by the Autism CARES Act of 
     2014'';
       (C) by striking subparagraph (C) (as so redesignated), and 
     inserting the following:
       ``(C) information on the incidence and prevalence of autism 
     spectrum disorder, including available information on the 
     prevalence of autism spectrum disorder among children and 
     adults, and identification of any changes over time with 
     respect to the incidence and prevalence of autism spectrum 
     disorder;'';
       (D) in subparagraph (D) (as so redesignated), by striking 
     ``6-year period beginning on the date of enactment of the 
     Combating Autism Act of 2006'' and inserting ``4-year period 
     beginning on the date of enactment of the Autism CARES Act of 
     2014 and, as appropriate, how this age varies across 
     population subgroups'';
       (E) in subparagraph (E) (as so redesignated), by striking 
     ``6-year period beginning on the date of enactment of the 
     Combating Autism Act of 2006'' and inserting ``4-year period 
     beginning on the date of enactment of the Autism CARES Act of 
     2014 and, as appropriate, how this age varies across 
     population subgroups'';
       (F) in subparagraph (F) (as so redesignated), by inserting 
     ``and, as appropriate, on how such average time varies across 
     population subgroups'' before the semicolon at the end;
       (G) in subparagraph (G) (as so redesignated)--
       (i) by striking ``including by various subtypes,'' and 
     inserting ``including by severity level as practicable,''; 
     and
       (ii) by striking ``child may'' and inserting ``child or 
     other factors, such as demographic characteristics, may''; 
     and
       (H) by striking subparagraph (I) (as so redesignated), and 
     inserting the following:
       ``(I) a description of the actions taken to implement and 
     the progress made on implementation of the strategic plan 
     developed by the Interagency Autism Coordinating Committee 
     under section 399CC(b).''; and
       (7) by adding at the end the following new subsection:
       ``(b) Report on Young Adults and Transitioning Youth.--
       ``(1) In general.--Not later than 2 years after the date of 
     enactment of the Autism CARES Act of 2014, the Secretary of 
     Health and Human Services, in coordination with the Secretary 
     of Education and in collaboration with the Secretary of 
     Transportation, the Secretary of Labor, the Secretary of 
     Housing and Urban Development, and the Attorney General, 
     shall prepare and submit to the Committee on Health, 
     Education, Labor, and Pensions of the Senate and the 
     Committee on Energy and Commerce of the House of 
     Representatives, a report concerning young adults with autism 
     spectrum disorder and the challenges related to the 
     transition from existing school-based services to those 
     services available during adulthood.
       ``(2) Contents.--The report submitted under paragraph (1) 
     shall contain--
       ``(A) demographic characteristics of youth transitioning 
     from school-based to community-based supports;
       ``(B) an overview of policies and programs relevant to 
     young adults with autism spectrum disorder relating to post-
     secondary

[[Page 10797]]

     school transitional services, including an identification of 
     existing Federal laws, regulations, policies, research, and 
     programs;
       ``(C) proposals on establishing best practices guidelines 
     to ensure--
       ``(i) interdisciplinary coordination between all relevant 
     service providers receiving Federal funding;
       ``(ii) coordination with transitioning youth and the family 
     of such transitioning youth; and
       ``(iii) inclusion of the individualized education program 
     for the transitioning youth, as prescribed in section 614 of 
     the Individuals with Disabilities Education Act (20 U.S.C. 
     1414);
       ``(D) comprehensive approaches to transitioning from 
     existing school-based services to those services available 
     during adulthood, including--
       ``(i) services that increase access to, and improve 
     integration and completion of, post-secondary education, peer 
     support, vocational training (as defined in section 103 of 
     the Rehabilitation Act of 1973 (29 U.S.C. 723)), 
     rehabilitation, self-advocacy skills, and competitive, 
     integrated employment;
       ``(ii) community-based behavioral supports and 
     interventions;
       ``(iii) community-based integrated residential services, 
     housing, and transportation;
       ``(iv) nutrition, health and wellness, recreational, and 
     social activities;
       ``(v) personal safety services for individuals with autism 
     spectrum disorder related to public safety agencies or the 
     criminal justice system; and
       ``(vi) evidence-based approaches for coordination of 
     resources and services once individuals have aged out of 
     post-secondary education; and
       ``(E) proposals that seek to improve outcomes for adults 
     with autism spectrum disorder making the transition from a 
     school-based support system to adulthood by--
       ``(i) increasing the effectiveness of programs that provide 
     transition services;
       ``(ii) increasing the ability of the relevant service 
     providers described in subparagraph (C) to provide supports 
     and services to underserved populations and regions;
       ``(iii) increasing the efficiency of service delivery to 
     maximize resources and outcomes, including with respect to 
     the integration of and collaboration among services for 
     transitioning youth;
       ``(iv) ensuring access to all services necessary to 
     transitioning youth of all capabilities; and
       ``(v) encouraging transitioning youth to utilize all 
     available transition services to maximize independence, equal 
     opportunity, full participation, and self-sufficiency.''.

     SEC. 7. AUTHORIZATION OF APPROPRIATIONS.

       Section 399EE of the Public Health Service Act (42 U.S.C. 
     280i-4) is amended--
       (1) in subsection (a), by striking ``fiscal years 2012 
     through 2014'' and inserting ``fiscal years 2015 through 
     2019'';
       (2) in subsection (b), by striking ``fiscal years 2011 
     through 2014'' and inserting ``fiscal years 2015 through 
     2019''; and
       (3) in subsection (c), by striking ``$161,000,000 for each 
     of fiscal years 2011 through 2014'' and inserting 
     ``$190,000,000 for each of fiscal years 2015 through 2019''.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
Pennsylvania (Mr. Pitts) and the gentleman from Texas (Mr. Gene Green) 
each will control 20 minutes.
  The Chair recognizes the gentleman from Pennsylvania.


                             General Leave

  Mr. PITTS. Mr. Speaker, I ask unanimous consent that all Members may 
have 5 legislative days in which to revise and extend their remarks and 
insert extraneous materials into the Record on the bill.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Pennsylvania?
  There was no objection.
  Mr. PITTS. Mr. Speaker, I yield myself such time as I may consume.
  I rise today, Mr. Speaker, in support of H.R. 4631, the Autism 
Collaboration, Accountability, Research, Education, and Support--
CARES--Act of 2014, introduced by Congressman Chris Smith of New 
Jersey.
  Autism CARES demonstrates our continued effort to address the needs 
of children and adults with autism spectrum disorder, ASD.
  Thanks to the monitoring done by the Centers for Disease Control and 
Prevention, CDC, we know that as many as 1 in 68 children have ASD.
  With recent studies showing that ASD can be detected in the first 6 
months of life, the screening and diagnosis funded in the bill will 
mean early diagnosis and improved health and behavioral outcomes.
  Many of these children are now transitioning into adulthood and will 
need community-based services to replace those provided by the schools. 
As a part of this bill, HHS will be required to study their needs and 
available services to identify gaps and make their transition seamless 
and productive.
  The bill would also fund important research at the National 
Institutes of Health to understand and treat ASD and the operation of 
the Interagency Autism Coordinating Committee.
  I urge my colleagues to support this important legislation, and I 
reserve the balance of my time.
  Mr. GENE GREEN of Texas. Mr. Speaker, I yield myself such time as I 
may consume.
  Mr. Speaker, I rise in support of H.R. 4631, the Autism 
Collaboration, Accountability, Research, Education, and Support Act of 
2014.
  Autism spectrum disorder, or ASD, is a developmental disability that 
can lead to significant social, communication, and behavioral 
challenges.
  We still do not know all the causes of autism, and we do not have a 
cure, but we do know that early intervention services can improve a 
child's development.
  Recent data for the Centers for Disease Control and Prevention show 
more children than ever before are receiving an autism diagnosis. This 
is due, at least in part, to a broader definition of ASD and better 
diagnosis, but we cannot rule out the possibility of a true increase in 
the number of Americans with ASD.
  Continued Federal support for autism activities at HHS will help us 
learn more about the causes of autism. It will help more children 
receive early diagnosis and intervention, as well as access to services 
that they need throughout their lives.
  I want to acknowledge the sponsor of this legislation--Congressman 
Smith and Congressman Doyle; the sponsors of the Senate companion 
legislation, Senators Menendez and Enzi; and leaders on the Energy and 
Commerce Committee and on the Senate Health, Education, Labor, and 
Pensions Committee--for making it possible to have a consensus bill 
before the House today.
  I urge my colleagues to join me in supporting this bill, so we can 
send it to the Senate and on to the President for his signature, well 
in advance of the September 30 sunset provisions in current law.
  Mr. Speaker, I reserve the balance of my time.
  Mr. PITTS. Mr. Speaker, at this time, I yield 5 minutes to the 
gentleman from New Jersey, Congressman Chris Smith, the distinguished 
prime sponsor of the legislation, who has really provided the 
leadership on this issue.
  Mr. SMITH of New Jersey. I thank the chairman for yielding and thank 
him for his strong support, along with Chairman Fred Upton, former 
Chairman Henry Waxman, and so many others--Mike Doyle, my good friend 
and colleague, who together, since 2000, headed up the Coalition for 
Autism Research and Education. We have done everything bipartisan. We 
have 91 members in the coalition right now.
  I would also like to thank the staff, who have helped us move this 
bill and negotiate text, including Gary Andres, Cheryl Jaeger, Brenda 
Destro, Jean Roehrenbeck, Katie Novaria, Cate Benedetti, and, of 
course, Neil Bradley, and so many others who have been so critical to 
this legislation.
  Mr. Speaker, previous autism law, including the Combating Autism 
Reauthorization Act of 2011, made critical investments--continued by 
this bill--that are working to determine the causes of autism spectrum 
disorder, identify autistic children as early as possible to begin 
treatment, raise critical awareness, and develop new therapies and 
effective services.
  The latest prevalence data from the Centers for Disease Control and 
Prevention, Mr. Speaker, is shocking. One in every 68 American children 
are on the autism spectrum, a tenfold increase over the last 40 years. 
Boys on the spectrum outnumber girls 5 to 1.
  In my home State of New Jersey, one in every 45 children has ASD, the 
highest rate in the CDC study.
  I would note parenthetically, Mr. Speaker, I have chaired two 
congressional hearings on global autism, and this developmental 
disability is everywhere--one conservative estimate, 67 million 
worldwide.

[[Page 10798]]

  Looking back, Mr. Speaker, it was two dedicated parents from New 
Jersey who helped launch the comprehensive Federal policy we seek to 
reauthorize today.
  Almost 17 years ago, September 1997, Bobbie and Billy Gallagher of 
Brick, New Jersey, and parents of two small autistic children, walked 
into my Ocean County office looking for help.
  They believed Brick had a disproportionate number of students with 
autism and wanted action, especially for their son Austin and daughter 
Alana, so I invited CDC and other Federal agencies to Brick for an 
investigation, only to learn that prevalence rates were high not only 
in Brick, but in nearby communities as well.
  Believing we had a serious spike in prevalence, I introduced the 
ASSURE Act, and that was incorporated as title I of the Children's 
Health Act of 2000.
  Mr. Speaker, much progress has been made since. Today, the evidence 
suggests there is no single cause of autism or type. Genetic risk, 
coupled with environmental factors, including advanced parental age, 
low birth weight, and prematurity--among other factors--may be 
triggers.
  Signs of autism in a child usually manifest between 12-18 months, 
some as early as 6 months, while some regress after the age of 2, yet 
transformative early intervention continues to lag.
  According to the IACC:

       The clinical reality is that, currently, only about 20 
     percent of children with ASD are being identified early (by 3 
     years of age).

  That, Members of the House, is not good, and it has got to change. 
The research clearly shows that early diagnosis means early 
intervention and much better outcomes.
  The most recent IACC strategic plan--and I encourage Members to read 
it. It is a textbook on how the Federal Government should do anything 
when it deals with research. They have pointed out that:

       During the past few years, there has been a major 
     revolution in ASD genetics research.
       Research on the potential relationship between the immune 
     system and ASD has grown considerably, resulting in ``major 
     breakthroughs.''

  They go on to say:

       Much progress has been made in understanding the prevalence 
     and biology of conditions that commonly co-occur with ASD, 
     including epilepsy, sleep disorders, GI disturbances, 
     attention deficit hyperactivity disorder, and other 
     psychiatric comorbidities.

  They also point out:

       Particularly intriguing are the results of prenatal vitamin 
     intake through supplements and diet, showing a 40 percent 
     reduction in risk of ASD with prenatal vitamin supplements 
     taken in the 3 months before or during the first month of 
     pregnancy.

  Daily folic acid is also highly recommended.
  Mr. Speaker, there is another issue that this bill seeks to address. 
Every year, 50,000 young people on the autism spectrum matriculate to 
adulthood and are in the process of losing services.
  Jonathan Kratchman, a 16-year-old with Asperger's from New Jersey, 
was the keynote speaker at a Dare to Dream conference at Mercer County 
Community College last year. He stated:

       I know I can be a great contributor to society when I 
     graduate. However, I need continuing support to get there.

  The SPEAKER pro tempore. The time of the gentleman has expired.
  Mr. PITTS. I yield an additional minute to the gentleman.
  Mr. SMITH of New Jersey. Mr. Kratchman said:

       If you take your high school diploma at age 18, you 
     automatically lose services from your school district.

  Both individuals with autism--like Jonathan--and their parents find 
themselves confronted with almost unimaginable challenges, including 
loss of school, housing, and then they have job needs.

                              {time}  1830

  We are in the midst of a huge yet largely invisible crisis that begs 
serious focus and remedies.
  The Autism CARES Act tasks multiple Federal agencies to 
comprehensively study and report back to Congress on the special needs 
of autistic young adults and transitioning youth.
  Additionally, Chairman Upton and Chairman Pitts are in the process of 
requesting a comprehensive aging-out GAO report that will include key 
stakeholder involvement.
  Passage of this bill, Mr. Speaker, is an important investment in a 
very important special group of people who, along with their families, 
caregivers, and friends, face seemingly endless challenges and 
struggles.
  I strongly urge Members to support this legislation.
  Mr. Speaker, I rise today to urge passage of H.R. 4631, the Autism 
Collaboration, Accountability, Research, Education and Support Act of 
2014--Autism CARES ACT of 2014.
  Mr. Speaker, previous autism law including the Combatting Autism Act 
of 2011 made critical investments--continued by this bill--that are 
working to determine the causes of autism spectrum disorder (ASD), 
identify autistic children as early as possible to begin treatment, 
raise critical awareness and develop new therapies and effective 
services.
  According to the National Institutes of Health (NIH), ``ASD is a 
range of complex neurodevelopment disorders, characterized by social 
impairments, communication difficulties, and restricted, repetitive, 
and stereotyped patterns of behavior. Autistic disorder, sometimes 
called autism or classical ASD, is the most severe form of ASD, while 
other conditions along the spectrum include a milder form known as 
Asperger syndrome . . .''
  The latest prevalence data from the Centers for Disease Control and 
Prevention (CDC) is shocking: 1 in every 68 American children are on 
the autism spectrum--a tenfold increase over the last 40 years. Boys on 
the autism spectrum outnumber girls 5 to 1.
  In my home state of New Jersey, 1 in every 45 children has ASD, the 
highest rate in the CDC study.
  I've chaired two congressional hearings on global autism--and this 
developmental disability is everywhere. One conservative estimate: 67 
million worldwide.
  Looking back, it was two dedicated parents from New Jersey who helped 
launch the comprehensive federal policy we seek to reauthorize today.
  Almost 17 years ago--September 13, 1997--Bobbie and Billy Gallagher 
of Brick, New Jersey and parents of two small children with autism, 
walked into my Ocean County district office looking for help. They 
believed Brick had a disproportionate number of students with autism 
and wanted action especially for their son Austin and daughter Alana. 
So I invited CDC and other federal agencies to Brick for an 
investigation only to learn that prevalence rates were high not only in 
Brick but in nearby communities as well. Believing we had a serious 
spike in the prevalence of autism, I introduced H.R. 274--the Autism 
Statistics, Surveillance, Research and Epidemiology Act (ASSURE) which 
was enacted as Title 1 of the Children Health Act of 2000.
  Much progress has been made since. Today, the evidence suggests that 
there is no single cause or type of autism. Genetic risk coupled with 
environmental factors including advanced parental age, low birth weight 
and prematurity among other factors may be triggers. Signs of autism in 
a child usually manifest between 12-18 months--some as early as 6 
months--while some ``regress'' after 2.
  Yet, transformative early intervention continues to lag. According to 
the Interagency Autism Coordinating Committee (IACC): ``The clinical 
reality is that currently only about 20 percent of children with ASD 
are being identified early (by 3 years of age)'' and that members of 
the House is not good and has got to change. Early diagnosis means 
early intervention and better outcomes. IACC says ``More needs to be 
done to raise awareness in the practitioner community of the current 
capabilities and benefits of early, repeated screenings, early 
diagnosis, and early intervention.''
  Research on autism is showing tremendous promise. The most recent 
IACC strategic plan--which is reauthorized for five years by Section 
5--is filled with insight and actionable information:
  ``During the past few years there has been a major revolution in ASD 
genetics research. Using the newest molecular and epidemiological 
methods, recent data continues to strongly support the role of genes in 
ASD, and the understanding of this role has been greatly refined.''
  ``In infants at high genetic risk for ASD due to having an older 
sibling with autism, symptoms of autism begin to emerge as young as 6 
months of age in those who later develop ASD. These new findings 
suggest that it may someday be possible to screen for children at risk 
for ASD before the emergence of the full symptoms of autism and early 
enough to facilitate even more effective intervention.''

[[Page 10799]]

  ``Research on the potential relationship between the immune system 
and ASD has grown considerably over the past 2 years, resulting in 
several major breakthroughs. In the realm of basic developmental 
research, immune cells and immune signaling molecules have been 
identified as essential for establishing stable connections between 
neurons during early brain development.''
  ``Much progress has been made in understanding the prevalence and 
biology of conditions that commonly co-occur with ASD, including 
epilepsy, sleep disorders, gastrointestinal (GI) disturbances, 
attention deficit hyperactivity disorder, and other psychiatric 
comorbidities.''
  ``The time around conception and during pregnancy are likely the most 
important time windows of heightened vulnerability for the development 
of the brain with supporting evidence from early reports linking autism 
symptoms to maternal ingestion of drugs.''
  ``Particularly intriguing are the results of prenatal vitamin intake 
through supplements and diet, showing a 40 percent reduction in risk of 
ASD with prenatal vitamin supplements taken in the 3 months before or 
during the first month of pregnancy.''
  ``A trend of decreasing ASD risk as mothers consumed greater daily 
folic acid intake from foods, vitamins, and supplements in the first 
month of pregnancy was also reported.''
  Over the past 5 years, progress has been made toward developing tools 
and practices for more effective screening and early diagnosis--and I 
am pleased that the Committee report includes language that will ensure 
federal agencies pay particular attention to the need to focus on early 
diagnosis and intervention in children.
  While biological differences in individuals with ASD were 
hypothesized earlier, there is now ``data demonstrating specific 
changes in the genome and epigenome, gene expression, cell structure 
and function, brain connectivity, and behavior that have been linked to 
the causes and underlying biology of ASD.''
  I mentioned Bobbie and Billy Gallagher's children earlier because 
they represent a generation of young men and women who are aging out--
both are now over 21 years old, which means far too much of their 
support system no longer exists.
  Mr. Speaker, every year 50,000 young people on the autism spectrum 
matriculate to adulthood.
  Jonathan Kratchman, a 16-year-old with Asperger's from New Jersey, 
was the keynote speaker at a ``Dare To Dream Conference'' at Mercer 
County Community College last year, where he stated: ``I know I can be 
a great contributor to society when I graduate. However, I need 
continuing support to get there. . . . Here is a fast fact. If you take 
your high school diploma at age 18, you automatically lose services 
from your school district.''
  Both individuals with autism, like Jonathan, and their parents find 
themselves confronted with almost unimaginable challenges including 
loss of school instruction, housing and job needs. We are in the midst 
of huge yet largely invisible crisis that begs serious focus and 
remedies.
  The Autism CARES Act tasks multiple federal agencies to 
comprehensively study and report back to Congress on the special needs 
of autistic young adults and transitioning youth.
  While studies show that young adults with autism appear to fare worse 
in employment outcomes--including when compared to young adults with 
other types of disabilities--there is evidence that with specialized 
support programs employment is feasible even among individuals with 
higher support needs.
  I'm planning a congressional hearing next month in my global health 
committee on employers like software giant SAP which has actively 
recruited and hired over 700 young adults on the autism spectrum and 
recently told me these diligent young employees are extraordinarily 
effective workers.
  Well planned transition programs will not only assist families and 
help shape a brighter future for individuals with ASD, they are also a 
smart investment that will reduce government spending in the long-term. 
The University Centers for Excellence in Developmental Disabilities 
recently estimated that: ``Diverting just one young person into living-
wage employment could save an average of $150,000 in SSI benefits over 
their lifetime. According
to the Social Security Administration, transitioning just one half of 
one percent of current SSDI and SSI beneficiaries from benefits to 
self-sustaining employment would save $3.5 billion in cash benefits 
over the work-life of those individuals.''
  IACC recently concluded that since 2009, the adult services research 
field has made some important advances, including gathering of new data 
on the services available across the states, information about how 
adults are interacting with the service system, and data on the service 
needs of adults on the autism spectrum.
  But in light of the severity of the aging out crisis, we must do more 
and do it fast and ensure we are providing a comprehensive and thorough 
review of available services--and those that need to be established. 
Additionally, Chairman Upton and Chairman Pitts are in the process of 
requesting a comprehensive autism aging-out GAO report that will 
include key stakeholder involvement.
  We are making real progress, but we still don't have all the answers.
  Specifically, the Autism Cares Act of 2014 authorizes funding for 
each of fiscal years 2015 through 2019 at $22 million for the CDC, $48 
million for the Health Resources and Services Administration (HRSA) and 
$190 million for the National Institutes of Health (NIH) and IACC 
activities--for a total of $1.3 billion.
  I especially want to thank Majority Leader Eric Cantor, Chairman Fred 
Upton and former Chairman Henry Waxman as well as Chairman Joe Pitts--
all strong and committed friends of persons with autism--for their 
critical support of this legislation.
  Special thanks to my friend Mike Doyle. Since 2000, Mike and I have 
co-chaired the 91 member congressional autism caucus--the Coalition on 
Autism Research and Education (CARE).
  I am very grateful to the many excellent, professional staff who 
played key roles in helping move the bill and negotiate text including 
Gary Andres, Cheryl Jaeger, Brenda Destro, Jean Roehrenbeck, Katie 
Novaria, Cate Benedetti, and of course Neil Bradley.
  I also want to express my deep appreciation for the extraordinary 
contributions made by Autism Speaks, the Autism Society, the 
Association of University Centers on Disabilities and the American 
Academy of Pediatrics--all of whom strongly endorse H.R. 4631.
  Mr. Speaker, passage of this bill today is an investment in a very 
important group of people who, along with their families, caregivers 
and friends, face seemingly endless challenges and struggles. I urge 
support.
  Mr. GENE GREEN of Texas. Mr. Speaker, I yield such time as he may 
consume to the gentleman from Pennsylvania (Mr. Doyle), my good friend 
and colleague.
  Mr. DOYLE. Thank you, Mr. Green, for yielding and for your support of 
the Autism CARES Act.
  First off, I want to thank my good friend and Autism Caucus cochair 
Chris Smith for his leadership and work on this critical legislation 
over the past 11 years. It has been a real pleasure and a labor of love 
to work with Chris on these issues. He is truly a champion in the 
autism community. I look forward to continuing that great working 
relationship with him.
  Mr. Chairman, it seems that every time new data is released on autism 
spectrum disorders, the numbers become more and more troubling. In 
fact, the Centers for Disease Control's most recent data show a 
continued rise in autism prevalence rates: 1 in every 68 American 
children. That is 1 in 189 girls and 1 in 42 boys.
  These are staggering numbers with serious implications for many 
aspects of American life. That is why passage of the Autism CARES Act 
today is so important: to continue research into the causes of autism, 
to educate health care providers and the public, to improve early 
diagnosis and intervention, to identify effective treatments, and to 
evaluate the types of services available to young adults with ASD. We 
can and must do better for the millions of Americans living with ASD 
and their families.
  Many Federal autism programs were first authorized by the Combating 
Autism Act of 2006, which has made a huge difference in the lives of 
autistic Americans and their families. Since its inception, Congress 
has reauthorized these Federal autism programs twice. Without new 
legislation to reauthorize them, the funding for these important 
programs will expire on September 30 of this year.
  We have made tremendous advances in understanding autism spectrum 
disorders, but this progress will be lost if Congress allows these 
programs to expire. This is why it is so important that Congress pass 
this commonsense, bipartisan, bicameral legislation like the bill that 
is before us today.
  The autism programs this legislation would reauthorize are vitally 
important to many families and individuals across the country. Early 
diagnosis and

[[Page 10800]]

intervention can make a huge difference in an autistic individual's 
life and can have a dramatic impact on the individual's family and 
community as well.
  With the prevalence of autism spectrum disorders much higher than we 
thought just a few years ago, inaction is simply not an option.
  I urge my colleagues to support the Autism CARES legislation.
  Mr. PITTS. Mr. Speaker, at this time I yield 1 minute to the 
distinguished gentleman from Florida (Mr. Bilirakis), a valued member 
of the Health Subcommittee.
  Mr. BILIRAKIS. Mr. Speaker, I rise today in support of H.R. 4631, the 
Autism CARES Act, of which I am an original cosponsor. I want to 
commend a sponsor, Mr. Smith from New Jersey, as well as a Democratic 
prime cosponsor, Mr. Mike Doyle from the great State of Pennsylvania, 
for sponsoring this bill.
  Autism is serious and it does not discriminate. People in all racial, 
socioeconomic, and ethnic groups are impacted, Mr. Speaker. Autism 
awareness and research is something people from all walks of life can 
support.
  One in 68 children is diagnosed with autism. That is a disturbing 
statistic. This legislation will help direct autism research on a 
Federal level. This research is vital, and I am glad my colleagues and 
I have come together in a bipartisan manner to continue autism 
research, early identification, intervention, and education.
  I am proud to support this legislation, and I urge my colleagues to 
support final passage of this legislation.
  Mr. GENE GREEN of Texas. Mr. Speaker, I yield such time as he may 
consume to the gentleman from New York (Mr. Engel), my good friend and 
desk mate on the Energy and Commerce Committee and the ranking member 
of the Foreign Affairs Committee.
  Mr. ENGEL. Mr. Speaker, I want to thank my good friend from Texas 
(Mr. Gene Green) for yielding me the time. I want to thank my good 
friend, Mr. Smith from New Jersey. I have so much respect for his hard 
work in doing this. Anyone who knows Chris knows that when he wants 
something done, he is tenacious. Mike Doyle has been his really good 
partner. We all take pride in this legislation.
  I rise to support the Autism Collaboration, Accountability, Research, 
Education, and Support Act, or the Autism CARES Act. I am pleased that 
we have an opportunity to pass this today.
  Autism, as my colleagues have said, affects more than 2 million 
individuals and their families across our country. The rate of 
diagnosis has climbed dramatically in recent years. Today, 1 out of 
every 68 American children is diagnosed with autism spectrum disorder 
by the age of 8. That is really shocking. These individuals and their 
families are counting on us to pass this bill.
  The Autism CARES Act will extend and strengthen the efforts we 
established under the Combating Autism Act of 2006 and the Combating 
Autism Reauthorization Act of 2011. I was proud to support both of 
these bills on the Foreign Affairs Committee, the Energy and Commerce 
Committee, and the full House. I am pleased to see that this 
legislation will give our autism programs the continued support they 
deserve.
  With this bill, we will extend Federal autism programs for another 5 
years, including vital autism research and prevalence monitoring, as 
well as training for medical professionals. This bill will also provide 
valuable updates to the law. It will increase coordination across 
Federal agencies and improve our understanding of the issues youth and 
young adults face as they transition out of school-based services.
  These changes will advance our understanding of autism spectrum 
disorder and allow us to better assist the millions of Americans it 
impacts.
  The programs provided for this in bill have traditionally enjoyed 
strong bipartisan support in the Energy and Commerce Committee. It 
enjoyed strong bipartisan support, as I guess it will as well here, 
because this is a strong bipartisan issue.
  So I urge my colleagues to continue this commitment by voting for the 
Autism CARES Act today.
  Mr. PITTS. Mr. Speaker, I yield 1 minute to the distinguished 
gentleman from Illinois (Mr. Roskam), one of our distinguished leaders.
  Mr. ROSKAM. Mr. Speaker, I thank the gentleman for yielding.
  One in 68 is diagnosed with autism, Mr. Speaker, and we have an 
opportunity to come alongside those families that are dealing with this 
diagnosis by supporting the Autism CARES Act. It is a holistic 
approach, one that takes on research, education, early detection, and 
intervention for those all across the autism spectrum.
  There are so many times that we can get into dollars and cents and 
chapter and verse and future savings in all of these things, but think 
about it. Beyond all of that is something that is much more important, 
and it is this: we can be a part of helping children reach their 
potential as adults. It is the desire of every parent to see their 
child reach full potential. So we can do that by coming together with 
this legislation. Think about the joy that is involved in that.
  I am pleased to associate myself with the work of Congressman Smith 
in this effort and to be a cosponsor of the Autism CARES Act.
  Mr. GENE GREEN of Texas. Mr. Speaker, I have no further speakers, and 
I yield back the balance of my time.
  Mr. PITTS. Mr. Speaker, I am very pleased to support this very 
important bipartisan legislation. I urge all Members to do so, and I 
yield back the balance of my time.
  Mr. MESSER. Mr. Speaker, I rise in support of H.R. 4631, the Autism 
CARES Act, which reauthorizes the Combating Autism Reauthorization Act. 
I want to commend my colleague, Representative Chris Smith, for 
bringing this measure forward.
  Our understanding of autism remains an unsolved puzzle. More children 
than ever are being diagnosed with communication and behavior disorders 
that lead to a diagnosis of autism.
  Though our understanding of autism is limited, what we do know is 
that autism affects too many children, strains families, costs too 
much, and puts those it afflicts at an educational, professional, and 
social disadvantage compared to their peers.
  Families with autistic children do everything they can to help their 
kids maximize their God-given abilities whatever those may be. But it's 
not always easy especially in a world where many don't understand the 
unique challenges autism presents. Helping these families better 
navigate this treacherous world would make a huge difference.
  The Autism CARES Act provides federal support for critical autism 
research by reauthorizing research programs at the National Institute 
of Health, Centers for Disease Control and Prevention and the 
Department of Health and Human Services. The bill will help better 
coordinate federal autism research and ensure more focused efforts to 
maximize the benefits of the resources we invest in such research.
  This bill also will begin efforts to determine how best to meet the 
needs of young adults with autism as they face the new challenges that 
come with being an adult.
  These investments are extremely important because autism imposes 
tremendous emotional and financial costs on families and economic 
impact on the health care system. The investments called for by this 
bill will pale in comparison to the personal and financial benefits 
they will yield in the future.
  Families struggling with autism face challenges many of us can't 
imagine. They need and deserve our help. It is time to commit ourselves 
to solving this puzzle today so autism can be prevented, treated, and 
cured tomorrow.
  I urge all of my colleagues to join me in supporting this bipartisan 
measure.
  Mr. GINGREY of Georgia. Mr. Speaker, I rise in strong support of H.R. 
4631--the Autism CARES Act of 2014. As a member of the Energy and 
Commerce Committee, I would like to commend the author of this 
legislation, Chris Smith of New Jersey, for his leadership on this 
issue. I would also like to commend Full Committee Chairman Fred Upton 
of Michigan and Health Subcommittee Chairman Joe Pitts from 
Pennsylvania for moving this important, bipartisan, bill through 
regular order.
  Mr. Speaker, throughout the consideration of H.R. 4631, I have been 
pleased to collaborate with Atlanta's Marcus Autism Center. Those of us 
from Georgia and leaders in the Congressional Autism Caucus are very 
familiar with the innovative treatment offered to

[[Page 10801]]

children with autism at the Marcus Autism Center and the cutting-edge 
research its scientists are conducting there. I am proud to say the 
Marcus Autism Center--which is part of the Children's Healthcare of 
Atlanta system--is one of three National Institutes of Health Autism 
Centers of Excellence.
  Furthermore, I have enjoyed working with the Center's leadership, 
particularly Executive Director Don Mueller, to make sure that H.R. 
4631--once implemented--will facilitate new breakthroughs in early 
diagnosis and intervention for children with autism. I have been 
impressed by the recent study authored by Marcus Autism Center 
researchers, Dr. Ami Klin and Dr. Warren Jones, which was published in 
Nature, a leading international scientific journal. This study showed 
that they detected signs of autism in the first two to six months of 
life using eye-tracking technology. This study opens a window for even 
earlier diagnosis and intervention in the future. By diagnosing and 
intervening earlier, we can reduce the most challenging disabilities 
related to autism and maximize the potential of children with autism.
  Mr. Speaker, today, the average age for diagnosing children with 
autism in the United States is around five years old. I have been 
informed by Marcus Autism Center officials that this study is the first 
step towards transformational future change and that if the medical 
profession can identify signs of autism in toddlers and then infants, 
we can capitalize on this window of opportunity to change the very 
course of autism.
  Therefore, as this reauthorization is being implemented, agencies 
must recognize the priority we place on facilitating improvements in 
early diagnosis and intervention of autism. I made this very point 
during the Energy and Commerce Committee mark-up, and I am pleased that 
Chairman Upton was willing to include important language to this effect 
in the Committee Report to accompany H.R. 4631.
  Mr. Speaker, I look forward to the continued advancements made at 
places like the Marcus Autism Center as we diagnosis and treat people 
with autism with the help of H.R. 4631. I urge all of my colleagues to 
support this legislation.
  Ms. FRANKEL of Florida. Mr. Speaker, I rise today in support of H.R. 
4631, The Autism Collaboration, Accountability, Research, Education, 
and Support (CARES) Act of 2014. This legislation will reauthorize 
research and education activities related to autism spectrum disorders, 
allowing us to continue making progress toward understanding how autism 
works and assisting those who are impacted by it.
  Autism affects 70 million families worldwide, and one in 68 children 
born in the United States. The bill we are considering today will help 
to give hope to every mother and father whose sweet baby doesn't smile 
or babble, to the child who rocks obsessively, to the teen locked in 
his own mind who is shunned by classmates, and to the aging parents who 
fear for their adult child's care when they are gone. All of these 
families need our continued support to thrive.
  I would like to thank Autism Speaks South Florida and all of the 
advocates who work tirelessly to support autism families and research, 
and I am glad that this legislation will help them continue their 
fantastic work. This is a bipartisan effort to fund autism research and 
help reduce the strains on families dealing with autism. I urge a 
``yes'' vote.
  Mr. DANNY K. DAVIS of Illinois. Mr. Speaker, I offer my strong 
support for the Autism CARES Act of 2014, a bill that continues the 
much-needed research and educational activities related to autism. I 
strongly support our nation's autistic community; this bill helps to 
promote and facilitate the good work being done related to autism by 
federal entities, including the Centers for Disease Control and 
Prevention, the National Institutes of Health, the Health Resources and 
Services Administration, and the Interagency Autism Coordinating 
Committee. Autism is a disorder that has a tremendous effect on the 
lives of the people with it and their families, including challenges 
with education, communication, and employment.
  The Centers for Disease Control and Prevention identifies autism as 
one of our nation's leading public health crises. An autism-related 
diagnosis is more common today than the diagnosis of pediatric cancer, 
diabetes, and AIDS combined. More research on this complex 
neurobiological disorder is still needed because we do not fully 
understand the cause or course of this disorder.
  The Autism CARES Act of 2014 will facilitate autism research by 
reauthorizing $190 million annually through 2019. In addition, it 
focuses attention on the important issue of transitioning autistic 
youth from school to adulthood. I have heard from constituents with 
autism about the need to improve the transition of services to consider 
life after high school graduation to ensure that students are supported 
as they move to work or higher education. I am well aware of the 
benefits of services and research dedicated to autism. I am proud that 
Chicago is home to the Therapeutic School and Center for Autism 
Research run by the Easter Seals Metropolitan Chicago. The Center 
provides care and advances research on autism. It provides multiple 
services--research, training, early intervention, school-to-work 
transition training, and independent living training--all under one 
roof. It is an amazing resource for Chicago, Illinois, and the nation. 
I strongly support this program and any federal efforts to support and 
expand these services. Therefore, I strongly urge my colleagues to 
support the Autism CARES Act of 2014.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from Pennsylvania (Mr. Pitts) that the House suspend the 
rules and pass the bill, H.R. 4631, as amended.
  The question was taken; and (two-thirds being in the affirmative) the 
rules were suspended and the bill, as amended, was passed.
  A motion to reconsider was laid on the table.

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