[Senate Report 109-318]
[From the U.S. Government Publishing Office]



                                                       Calendar No. 578
109th Congress                                                   Report
                                 SENATE
 2d Session                                                     109-318

======================================================================



 
                      COMBATING AUTISM ACT OF 2005

                                _______
                                

                 August 3, 2006.--Ordered to be printed

                                _______
                                

Mr. Enzi, from the Committee on Health, Education, Labor, and Pensions, 
                        submitted the following

                              R E P O R T

                         [To accompany S. 843]

    The Committee on Health, Education, Labor, and Pensions, to 
which was referred the bill (S. 843) to amend the Public Health 
Service Act to combat autism through research, screening, 
intervention and education, having considered the same, reports 
favorably thereon with an amendment in the nature of a 
substitute and recommends that the bill (as amended) do pass.

                                CONTENTS

                                                                   Page
  I. Purpose and Summary..............................................1
 II. Background and Need for Legislation..............................2
III. History of Legislation and Committee Action.....................12
 IV. Explanation of Bill and Committee Views.........................12
  V. Cost Estimate...................................................18
 VI. Application of Law to the Legislative Branch....................18
VII. Regulatory Impact Statement.....................................18
VIII.Section-by-Section Analysis.....................................18

 IX. Changes in Existing Law.........................................20

                         I. Purpose and Summary

    As part of the reauthorization of Title 1 of the Children's 
Health Act of 2000 (P.L. 106-310), the purpose of S. 843, the 
Combating Autism Act of 2006, is to improve upon our previous 
activities with respect to autism. Specifically, the 
legislation focuses on expanding research and coordination at 
the National Institutes of Health (NIH); increasing awareness 
through the Centers for Disease Control and Prevention (CDC); 
integrating health, education, and disability programs; and 
ensuring that citizens have a voice in governmental activities.
    With up to 1 in 166 children being diagnosed with autism 
within the United States, we need to understand more about the 
spectrum disorder to better differentiate the conglomerate of 
individuals identified with the disorder. In addition, given 
the increased demand on services for these individuals, we need 
to provide better integration of the health, education, and 
disability programs already available.

                II. Background and Need for Legislation

    Autism spectrum disorder (ASD) is a group of developmental 
disabilities caused by atypical brain development. People with 
ASD tend to have challenges and difficulties with social and 
communication skills. Many people with ASD also have unique 
ways of learning, paying attention, or reacting to different 
sensations. ASD begins during early childhood and lasts 
throughout a person's life.
    As the name autism spectrum disorder implies, ASD covers a 
continuum of behaviors and abilities. Individuals with ASD, 
like all people, differ greatly in their skills abilities, and 
talents. They also differ in how their disability impacts their 
social, emotional, behavioral, and academic domains. No two 
people with ASD will have the same symptoms. A symptom might 
have a mild impact in one person and a significant impact in 
another person. Some examples of the types of challenges and 
behaviors a child or adult with an ASD might have include:
    Social skills: People with ASD might not interact with 
others the way most people do, or they might not demonstrate 
interest in other people. People with ASD might not make eye 
contact and appear to want to be alone. They might have 
difficulty understanding other people's feelings, talking about 
their own feelings, or picking up on non-verbal social cues. 
Children with ASD might not like to be held or cuddled, or 
might cuddle only when they want to due to sensory integration 
sensitivities or difficulties. Some people with ASD might not 
seem to notice when other people talk to them. Others might be 
very interested in people, but not know how to interact with 
others due to a lack of understanding of verbal and non-verbal 
social cues, difficulty integrating sensory information from 
multiple modalities, and lack of predictability.
    Speech, language, and communication: About 40 percent of 
children with ASD do not talk. Others have echolalia, which is 
when they repeat something that was said to them. The repeated 
words might be said right away or at a later time. For example, 
if you ask someone with an ASD, ``Do you want some juice?'' he 
or she may repeat ``Do you want some juice?'' instead of 
answering your question. Or a person might repeat a television 
ad heard sometime in the past. People with ASD might not 
understand gestures such as waving goodbye. They might say 
``I'' when they mean ``you'', or vice versa. Their voices might 
sound flat and it might seem as though they cannot control how 
loudly or softly they speak. People with ASD might stand too 
close to people (according to acceptable western culture social 
norms) they are talking to, or might stick with one topic of 
conversation for a long period of time. Some people with ASD 
are very articulate, but have a hard time listening to what 
other people say. They might talk a lot about something they 
really enjoy, or perseverate on a specific topic rather than 
engage in a conversation with someone.
    Repetitive behaviors and routines: People with ASD might 
repeat actions multiple times, such as rocking back and forth. 
They might want to have routines where things stay the same so 
they have a sense of predictability of what will happen, for 
how long, and in what sequence or to meet sensory-based needs 
they may have. If a person with ASD does not have an effective 
approach or tool to predict and prepare for transitions or 
changes in family routines, and a coping strategy to 
effectively cope with unexpected changes in their routine, he 
or she may engage in challenging behavior. For example, if a 
child is accustomed to washing his or her face before dressing 
for bed, he or she might become very upset if asked to change 
the order, by getting dressed first and then washing his or her 
face, if he or she was not prepared for the change, the reason 
why the change occurred, or if he or she does not have a 
strategy to effectively cope with changes in routines.
    Children with ASD may develop at different rates from 
children without ASD or other developmental disabilities. 
Children without ASD or other developmental disabilities 
develop at about the same rate in areas of development such as 
language, cognitive, and social skills. Children with ASD 
develop at different rates in different areas of growth. They 
might have significant delays in language, social, cognitive, 
and gross motor skills, while their fine motor skills might be 
about the same as other children their age. They might be very 
good at activities such as putting puzzles together or solving 
computer problems, but have difficulty with activities most 
people think are easy, such as talking or making friends. 
Children with ASD might also learn a hard skill or task before 
they learn an easy one. For example, a child might be able to 
read long words, but not be able to tell you what sound a ``b'' 
makes. A child might also learn a skill and then lose it. For 
example, a child may be able to say many words, but later stop 
talking altogether.
    Data from several studies that used the current criteria 
for diagnosing autism and autism spectrum disorder (ASD), such 
as Asperger's disorder and pervasive developmental disabilities 
(PDD-NOS), found prevalence rates for ASD between 2 and 6 per 
1,000 individuals. Therefore, it can be summarized that between 
1 in 500 (2/1,000) to 1 in 166 children (6/1,000) have an ASD.
    Currently, there is not a full population count of all 
individuals with an ASD in the United States. However, using 
the prevalence data stated above, it is estimated that if 4 
million children are born in the United States every year, 
approximately 24,000 of these children will eventually be 
diagnosed with an ASD. Assuming a constant prevalence rate over 
the past 2 decades, we can estimate that up to 500,000 
individuals between the ages of 0 to 21 have an ASD. However, 
many of these individuals may not be classified as having an 
ASD until school-age or later. Since behaviors related to 
theASD usually present before the age of 3 years, it is important to 
make sure that young children are screened, and if the individual is at 
high-risk of developing an ASD that they receive an interdisciplinary, 
comprehensive evaluation to confirm or rule out the diagnosis. If the 
diagnosis is confirmed subsequently, the individual should receive 
evidence-based interventions as early as practicable.
    In a study conducted by the Centers for Disease Control and 
Prevention, the Metropolitan Atlanta Developmental Disabilities 
Surveillance Program found the rate of autism for children ages 
3 to 10 years to be 3.4 per 1,000 children which is lower than 
the rate for mental retardation/intellectual disability (9.7 
per 1,000 children); but higher than the rates for cerebral 
palsy (2.8 per 1,000 children), hearing loss (1.1 per 1,000 
children) and vision impairment (0.9 per 1,000 children) found 
in the same study.
    Approximately 2 percent of children under the age of 18 
have a significant developmental disability (DD) and these 
include intellectual disability, cerebral palsy, hearing loss 
and vision impairment. Of these significant DDs, intellectual 
disability (in the past referred to as mental retardation) is 
the most common. A genetic disorder often associated with 
having an intellectual disability (ID) that many people 
recognize is Down syndrome. Current information indicates that 
having Down syndrome occurs in 1 out of 800 births and is 
slightly less common than ASD. Approximately 17 percent of 
children have some type of developmental disability, including 
more mild challenges such as speech and language disorders, 
learning disabilities, and ADHD, which appear to be more common 
than ASD.
    While developmental disabilities may affect a child's 
speech or language, physical growth, psychological growth, 
self-care, or learning, diseases that impact adults may also 
affect children's health. A common childhood disease, juvenile 
diabetes, is prevalent in approximately 1 in every 400 to 500 
children and adolescents, which is in a similar range as ASD. 
However, ASD is more common than childhood cancer, which has a 
prevalence rate of 1.5 per 10,000 children (1 in 300 males and 
1 in 333 females have a probability of developing cancer by age 
20 according to the National Cancer Institute).
    In 2004, approximately 166,424 children received supports, 
services, and intervention under the ``Autism'' classification 
for special education services. Not all children with an ASD 
receive special education services under the classification of 
``Autism,'' often they are classified as ``other'' health 
impaired (OHI), so the education data may underestimate the 
actual prevalence of ASD. Autism was added as a special 
education exceptionality in 1991 and is now the 6th most 
commonly classified disability in the United States. The most 
common disability classifications in 2004 were: specific 
learning disabilities (2,838,694 children served), speech or 
language impairments (1,151,260 children served), intellectual 
disability (567,780 children served), emotional disturbance 
(484,488 children served), and other health impairments, which 
often includes children diagnosed with Attention Deficit 
Hyperactivity Disorder (ADHD) (511,869 children served).
    Using current standards, ASD is the second most common 
significant developmental disability after intellectual 
disability, but is still less common than other challenges that 
affect children's development, such as speech and language 
impairments, learning disabilities, and ADHD. The impact of 
having a developmental disability is immense for the families 
affected and for communities that provide services, 
interventions and supports for these families. It is important 
that we treat common DDs, and especially ASD, as areas of 
urgent public health concern, do all we can to identify 
children's learning needs, and begin intervention as early as 
practicable to enable all children to reach their full 
potential.
    There is no known cure for ASD. However, early and 
intensive intervention is important to improving the outcomes 
so that individuals can grow and learn new skills. The goal of 
these efforts is to provide interventions and supports to 
individuals with ASD and their families to improve the 
individuals' language development, social interaction and play, 
learning potential, and activities of daily living skills. 
Medicines can relieve some symptoms and be helpful for some 
individuals with ASD, but interdisciplinary interventions that 
meet the comprehensive needs of individuals with ASD are 
currently the most effective intervention. The ideal 
intervention plan integrates therapies and interventions that 
target the core symptoms of autism: delayed social interaction, 
challenges with expressive and receptive verbal and non-verbal 
communication, sensory integration dysfunction, challenging 
behavior, and obsessive or repetitive routines and interests. 
There is general consensus among most professionals that the 
earlier implementation of interdisciplinary intervention, the 
better. For many children, autism symptoms improve with 
interventions and with age. Some children with autism grow up 
to lead typical lives.
    During adolescence, some children with autism may develop, 
or show signs of depression, or experience a change or increase 
in challenging behavior. These changes may occur due to 
hormonal changes and increased social demands that typically 
occur during adolescence. Parents of children entering and 
throughout adolescence should be ready to adjust and alter the 
type, frequency and intensity of supports, services and 
interventions that their child receives as his or her needs 
change. One key fact to keep in mind is that oftentimes young 
adolescents with ASD, especially Asperger's Syndrome, will 
become more aware of the social relationships their non-
disabled peers are forming with others and develop a strong 
sense of isolation, socially and emotionally.
    According to data from the National Health Interview 
Survey, children with parent-reported autism were more likely 
than children without autism to have moderate or high levels of 
emotional symptoms, exhibit challenging behaviors, 
hyperactivity, peer problems, and overall difficulties. 
Approximately 83 percent of children reported with autism had 
moderate or high levels of overall difficulties compared with 
15 percent of children without autism. The most notable 
differences were for peer problems (82.0 percent versus 15.9 
percent) and hyperactivity (65.2 percent versus 11.9 percent). 
Substantially fewer children reported with autism had a high 
level of social skills (39.6 percent) compared with children 
without autism (82.3 percent).
    The National Survey of Children's Health found that 93.8 
percent of children with parent-reported autism were classified 
as having special health-care needs lasting or expected to last 
*12 months; 90.1 percent were reported as needing more medical, 
mental health, or educational services than usual for a child 
of the same age, or needing therapies or counseling for an 
emotional, developmental, or behavioralchallenge. These 
percentages compared with 19.6 percent and 10.5 percent, respectively, 
for children reported without autism.

                  NATIONAL INSTITUTES OF HEALTH (NIH)

    NIH-sponsored research on autism spectrum disorder covers 
domains including: interventions, diagnosis, genetics, 
neurobiology, neuropsychology and services. In addition to 
individual grants for research projects, NIH sponsors training, 
small grants, career support, and program projects that involve 
autism research. NIH has also developed several networks of 
autism research centers.
    There are several network activities in autism research 
sponsored by different Institutes including:
           Collaborative Programs of Excellence in 
        Autism (CPEA) Network
           The Studies to Advance Autism Research and 
        Treatment (STAART) Network
           Children's Environmental Health Centers 
        (NIEHS)
    In 1997, the National Institute of Child Health and Human 
Development (NICHD) and the National Institute on Deafness and 
Other Communication Disorders (NIDCD), started a 5-year, $45 
million, International Network on the Neurobiology and Genetics 
of Autism. The Network included 10 Collaborative Programs of 
Excellence in Autism (CPEAs) that would conduct research to 
learn about the possible causes of autism, including genetic, 
immunological, and environmental factors.
    In 2002, the NICHD and NIDCD renewed funding for the CPEA 
Network, agreeing to provide $60 million over a period of 5 
years. The CPEAs link 129 scientists from 23 universities in 
the United States, Canada, Britain, and five other countries, 
and more than 2,000 families of people with autism. In fact, as 
a result of the CPEAs, researchers now have data on the 
genetics and outward characteristics of the largest group of 
diagnosed persons with autism in the world.
    In 2003, the CPEA Network launched a Data Coordinating 
Center in Medford, Massachusetts, to provide data management 
and statistical support for Network activities. The Center will 
also maintain a Web site to ease communication and coordinate 
activities among the CPEAs. Three groups are managing different 
tasks in the Data Coordinating Center: DMSTAT, Inc.; the Boston 
University Statistics and Consulting Unit; and the Department 
of Biostatistics at the Boston University School of Public 
Health.
    The Data Coordinating Center will provide combined support 
for the CPEA Network and for the eight sites of the Studies to 
Advance Autism Research and Treatment (STAART) Centers Program, 
a 5-year, $65 million effort supported by five NIH Institutes, 
including the NICHD. Such support will increase the volume and 
speed in which data are processed and compared, which may 
increase the speed of uncovering findings resulting from these 
research efforts.
    The STAART Network is comprised of eight centers across the 
country. Most of these centers are evaluating and treating 
patients, as well as enrolling them into NIH-funded clinical 
trials.
    In 2001, the National Institute of Environmental Health 
Sciences and the Environmental Protection Agency jointly 
announced four new children's environmental health research 
centers that will focus research on childhood autism and 
attention deficit disorder. The centers were funded at $5 
million, or approximately $1 million per year for 5 years 
(fiscal year 01 through fiscal year 05).

               CENTERS FOR DISEASE CONTROL AND PREVENTION

    The Children's Health Care Act of 2000 required the Centers 
for Disease Control and Prevention (CDC) to establish Centers 
of Excellence. The National Center on Birth Defects and 
Developmental Disabilities (NCBDDD) at CDC funded five Centers 
for Autism and Developmental Disabilities Research and 
Epidemiology (CADDRE).
    The Centers have:
     Worked with the Autism and Developmental 
Disabilities Monitoring Network (discussed further below) to 
monitor the number of children with an ASD and other 
developmental disabilities.
     Improved community and service provider awareness 
of ASD and other developmental disabilities, or improved access 
to comprehensive, community-based, family-centered care for 
children with an ASD and other developmental disabilities.
     Conducted epidemiologic research related to ASD 
and other developmental disabilities. These studies will 
address topics such as what factors (genetic, environment, and 
others) make it more likely that a child will have an ASD, what 
other disabilities children with an ASD have, biomarkers, and 
the economic costs of ASD.
    In addition to CADDRE, the CDC also funds 10 Autism and 
Developmental Disabilities Monitoring Network (ADDM) projects. 
These projects are developing or improving programs to track 
the number of children with an ASD in their States. The goal of 
the ADDM Network is to provide comparable, population-based 
estimates of the prevalence rates of autism and related 
disorders in different sites over time.
    Other CDC-funded activities related to autism include the 
following:
     The Marshall University Autism Training Center, in 
West Virginia, is conducting an intervention study with 
families of children who have an ASD. Marshall University staff 
developed an in-depth program that helps reduce stress factors 
that have a negative effect on children with an ASD and their 
families. The program includes the development of family 
support plans. These plans coordinate the activities of the 
different professionals who work with the children, provide 
positive behavior support training for parents and teachers, 
and help create community partnerships, usually with another 
family who has a child with an ASD.
     CDC funds SAFE, Inc., in Pennsylvania, to enhance 
their community-based ASD outreach and educational activities 
to help individuals with ASD live a full and independent life.
     The Christian Sarkine Autism Treatment Center 
(CSATC) and Clarian Health Partners at Riley Hospital for 
Children have joined together to develop the HANDS in Autism 
(Helping Answer Needs by Developing Specialists in Autism) 
Program through a grant provided by the Centers for Disease 
Control and Prevention (CDC).

              EDUCATION, EARLY DETECTION, AND INTERVENTION

    Education: The NIH, CDC, and the Health Resources and 
Services Administration (HRSA) all provide a variety of 
activities to expand information and education to the general 
public and health care providers specific to autism spectrum 
disorder.
    Beyond activities which have already been described, HRSA 
supports a program to train health professionals to work with 
children who have neurodevelopmental or related disabilities, 
such as cerebral palsy, autism or spina bifida, or who may be 
at high risk of developing such disabilities. The Leadership 
Education in Neurodevelopmental and Related Disabilities (LEND) 
grants provide interdisciplinary training to improve the 
clinical expertise and leadership skills of health 
professionals who serve children with disabilities. The grants 
encourage doctors, nurses and psychologists to work together to 
prevent disabilities in children resulting from genetic or 
metabolic conditions and to identify signs of disability early 
enough for effective intervention. In addition, social workers, 
speech pathologists, pediatric dentists, dietitians, 
occupational therapists, physical therapists and genetics 
experts promote practice models that encourage cultural 
competence by health professionals and the involvement of 
families in making decisions about their children's supports 
and services. Parents and youth consultants with disabilities 
provide leadership training through the program.
    HRSA supports a network of statewide centers run by 
families of children with special health care needs (CSHCN) to 
help other families with special needs children. These centers, 
called Family-To-Family Health Care Information and Education 
Centers for Families of Children with Special Health Care 
Needs, will be designed and supervised by families in 
partnership with State Title V CSHCN programs and other 
providers.
    They offer:
           Health and related information to families 
        and providers for improving health decision-making;
           Assistance on gaining greater access to and 
        making better use of services within communities; and
           Educational and leadership opportunities to 
        family members.
    Finally, HRSA also supports the developmental-behavioral 
pediatrics training program that focuses on (1) supporting 
fellows in behavioral pediatrics to help prepare them for 
leadership roles as teachers, researchers, and clinicians; and 
(2) providing pediatric practitioners, residents, and medical 
students with essential biopsychosocial knowledge and clinical 
expertise. The purpose of the program is to enhance behavioral, 
psychosocial, and developmental aspects of general pediatric 
care. This program has three main aspects:
     Faculty and Fellows. Training grant funds support 
faculty who demonstrate leadership and expertise in behavioral 
pediatrics teaching, scholarship, and community service and 
fellows who have completed training to be board-eligible in 
pediatrics.
     Curriculum. The 3-year residency program 
curriculum includes course work and clinical exposure to 
psychosocial and biological sciences, growth and development, 
adaptation, injury prevention, disease prevention, and health 
promotion. Projects are also encouraged to cosponsor, with 
child psychiatry, an ongoing Collaborative Office Rounds (COR) 
group as a training experience for fellows and a continuing 
education experience for community providers.
     Continuing Education and Technical Assistance. 
Grantees must also provide continuing education activities for 
practicing physicians and are encouraged to offer technical 
assistance and consultation to pediatric residency training 
programs that are in the early stages of developing their own 
behavioral program components.
    To increase awareness about the early warning signs of 
developmental disabilities, such as autism, and help ensure 
that children get services at the youngest age possible, the 
Centers for Disease Control and Prevention (CDC), in 
partnership with Porter Novelli, developed a targeted social 
marketing campaign: ``Learn the Signs. Act Early.'' In its 
first year, this innovative campaign has educated parents and 
doctors about the developmental milestones that every young 
child should reach, the warning signs of a developmental delay, 
and the need to act early when a problem is suspected.
    Recent studies have shown that developmental disabilities, 
such as autism spectrum disorder, can be diagnosed as early as 
18 months; however, in an estimated 50 percent of children, 
disabilities remain unidentified until age 5 years, when most 
enter kindergarten. Why is this important? Although there are 
no cures for these disabilities, early detection and early 
intervention services have demonstrated significant improvement 
in outcomes and functioning for affected children. Early 
intervention is a child's best hope for reaching his or her 
full potential.
    The campaign targets parents of children ages 4 and younger 
and health care professionals, including pediatricians, family 
physicians, physician assistants, and nurses. These audiences 
tend to monitor a child's physical growth--height, weight and 
milestones such as crawling and walking--but pay less attention 
to the social, emotional, cognitive and language milestones 
that mark a child's overall development. To increase awareness 
of the milestones and the importance of early action when a 
delay is suspected, the campaign employed the following 
strategies:
     Build on the familiar physical developmental 
milestones, adding in information on social, emotional, 
language and cognitive milestones.
     Work with health care professionals to ensure they 
are able to initiate and respond to parent requests for 
information.
     Partner with trusted medical associations and 
leverage the CDC brand to build trust and credibility with 
providers.
     Distribute materials to parents through provider 
offices, empowering parents with questions to ask the doctor at 
the point of service.
    The first phase of the social marketing campaign launched 
in October 2004 and focused on educating health care 
professionals, arming them with information and resources to 
initiate discussions and respond to increased queries from 
parents. The second phase, launched in February 2005, focused 
on increasing awareness among parents.
    Evaluations have shown rather promising results.

                            EARLY DETECTION

    Many children with developmental disabilities, such as 
autism spectrum disorder, are missing critical opportunities 
for early detection and intervention. In the United States,17 
percent of children have a developmental disability such as autism, 
intellectual disability, or Attention-Deficit/Hyperactivity Disorder. 
In addition, many children have delays in language or other areas, 
which impacts school readiness, success in school and quality of life. 
However, less than 50 percent of these children are identified before 
starting school, by which time significant delays may have already 
occurred and opportunities for early intervention have been missed.
    Recent surveys indicate that parents want information and 
guidance from their health care provider about their child's 
development, but studies sponsored by the American Academy of 
Pediatrics show that 65 percent of pediatricians feel 
inadequately trained in assessing children's developmental 
status. Although developmental screening is widely recommended, 
there are currently no national data tracking the state of this 
practice and how it is integrated into primary care. 
Developmental screenings such as the Modified Checklist for 
Autism in Toddlers (M-CHAT)--a brief assessment designed to 
identify children who should receive more intensive evaluation 
or assessment for autism spectrum disorder--can improve child 
health and well-being, especially for children with autism 
spectrum disorders and other developmental disabilities or 
delays.
    Research has demonstrated that early detection of 
developmental disabilities and evidence-based intervention can 
significantly improve short- and long-term outcomes and reduce 
the need for lifelong interventions. For example, children with 
autism spectrum disorder identified early and enrolled in early 
intervention programs show significant improvements in their 
language, cognitive, social, and motor skills, as well as in 
their future educational attainment and decreased need for 
special education services. Thus, the committee encourages the 
Department of HHS to develop and implement activities so that 
all children are screened for autism spectrum disorder and 
other developmental disabilities before their second birthday. 
Also, children with an autism spectrum disorder diagnosis or 
who are at high risk for autism should receive evidence-based 
interdisciplinary interventions as early as practicable. 
Interventions include referral and services provided by school 
and agencies (including community, consumer, and parent-based 
agencies), along with organizations and other programs required 
by the Individuals with Disabilities Education Act (which 
offers programs specifically designed to meet the unique needs 
of children with autism and their families).
    Given this, the CDC has established the following goals to 
help children reach their full potential:
     Develop and evaluate community-based model 
programs in primary care settings (and potentially other 
settings that care for young children) to provide early 
screening for children to identify those at risk for autism and 
other developmental disabilities or delays, and ensure that 
children are referred to local and State resources, and receive 
evidence based interventions.
     Increase health care providers' knowledge and 
skills in developmental screening by incorporating 
developmental screening into professional health care training.
     Monitor the use of screening for autism and other 
developmental disabilities or delays in primary care settings.
     Raise awareness about the need for and benefits of 
developmental screening to identify and meet the needs for 
children with autism and other developmental disabilities or 
delays.
    Complementing the activities at the CDC, HRSA administers 
the Maternal and Child Health Services Title V Block Grant 
(title V). The goal of the title V program is to improve the 
health of all mothers and children consistent with the 
applicable health status goals and national health objectives 
established by the Secretary of the U.S. Department of Health 
and Human Services.
    The title V program has operated as a Federal-State 
partnership for more than 65 years. When the Social Security 
Act was passed in 1935, the Federal Government, through title 
V, pledged its support of State efforts to extend and improve 
health and welfare services for mothers and children. Title V 
has been amended many times over the years to reflect the 
expansion of the national interest in maternal and child 
health. It was converted to a block grant program as part of 
the Omnibus Budget Reconciliation Act (OBRA) of 1981. Congress 
later sought to balance the flexibility of the block grant with 
greater accountability by the States. Through the 1989 OBRA 
States were required to report on progress made toward key 
maternal and child health indicators and to provide other 
program information.
    States and jurisdictions use title V funds to design and 
implement a wide range of maternal and child health programs 
that meet national and State needs. Although specific 
initiatives may vary among the 59 States and jurisdictions 
utilizing title V funds, all programs work to do the following:
     Reduce infant mortality and incidence of 
disability among children.
     Increase the number of children appropriately 
immunized against disease.
     Increase the number of children in low-income 
households who receive assessments and follow-up diagnostic and 
treatment services.
     Provide and ensure access to comprehensive 
perinatal care for women; preventative and child care services; 
comprehensive care, including long-term care services, for 
children with special health care needs; and rehabilitation 
services for blind and disabled children under 16 years of age 
who are eligible for Supplemental Security Income.
     Facilitate the development of comprehensive, 
family-centered, community-based, culturally competent, 
coordinated systems of care for children with special health 
care needs.
    As part of title V's focus on children with special health 
care needs, the goal of that program is to support development 
and implementation of comprehensive, culturally competent, 
coordinated systems of care for the estimated 18 million U.S. 
children who have or are at risk for chronic physical, 
developmental, behavioral or emotional disorders and who also 
require health and related services of a type or amount beyond 
that required by children generally. Children with an ASD are 
specifically included within these programs.

                                  IACC

    The Children's Health Act of 2000 (P.L. 106-310), Title I, 
Section 104, mandated the establishment of an Interagency 
Autism Coordinating Committee (IACC) to coordinate autism 
research and other efforts within the Department of Health and 
Human Services (DHHS). In April 2001, Secretary Tommy Thompson 
delegated the authority toestablish the IACC to the National 
Institutes of Health (NIH). The National Institute of Mental Health 
(NIMH) at the NIH has been designated the lead for this activity.
    The IACC's primary mission is to facilitate the efficient 
and effective exchange of information on autism activities 
among the member agencies, and to coordinate autism-related 
programs and initiatives. P.L. 106-310 specifies that parents 
or legal guardians of individuals with autism or other 
pervasive developmental disorders be appointed to the 
committee. The Secretary retained the authority to select such 
public members. Such appointments are necessary and vital to 
the conduct of the committee's mission. Public members of the 
IACC will help bring to DHHS the concerns and interests of 
members of the autism community. The IACC will serve as a forum 
and assist in increasing public understanding of the member 
agencies' activities, programs, policies, and research and in 
bringing important matters of interest forward for discussion.

            III. History of Legislation and Committee Action

    On April 19, 2005, Senator Santorum and Senator Dodd 
introduced S. 843, the ``Combating Autism Act of 2005.'' Since 
that introduction, the bill has been cosponsored by 40 other 
members of Congress. After accepting a substitute amendment 
offered by Senator Enzi and cosponsored by Senators Dodd, 
Frist, Kennedy, Burr, Clinton, DeWine, Harkin, Hatch, Gregg, 
Mikulski, and Jeffords, the Committee on Health, Education, 
Labor, and Pensions reported the bill favorably by unanimous 
voice vote on July 19, 2006.

              IV. Explanation of Bill and Committee Views

    The bill has a variety of provisions, the explanation of 
and committee views on which follow below:
    Throughout the bill, the committee uses the term 
``intervention.'' In using this term, the committee believes 
that such a term encompasses a broad range of activities, 
including biomedical interventions (such as pharmaceuticals), 
behavioral interventions and therapies. Thus, it is the intent 
of the committee that the term ``intervention'' be very broadly 
construed as any activity which improves the overall health 
outcome of the individual diagnosed with autism spectrum 
disorder or other developmental disabilities.
    In addition, the committee paired language related to 
``diagnosing'' an individual with autism spectrum disorder with 
the need to also ``rule out'' a diagnosis. As with any 
determination of whether an individual has a particular 
disorder, it is important that the individual assisting with 
such process is able to distinguish between the particular 
disorder and other potential issues, hence, the need to pair 
``diagnosis'' with ``rule out.''
    Finally, the committee uses the term ``evidence-based'' at 
various points throughout the legislation. In doing so, the 
committee expects the term ``evidence-based'' to be the 
conscientious, explicit, and judicious use of current best 
evidence in making decisions about care and services for 
individuals. The practice of evidence-based care and services 
means integrating individual expertise with the best available 
external evidence from systematic research.
    To increase the accountability and focus on autism spectrum 
disorder at the National Institutes of Health (NIH), the 
committee specifically authorizes a strategic plan related to 
autism spectrum disorder. In requiring the Director of the NIH 
to develop a strategic plan for autism spectrum disorder, the 
committee wants to ensure that this plan provides not only an 
outline of key research activities and questions but also ties 
those activities to specific budgetary outlays to improve the 
transparency of the planning process. The goal of this planning 
process is to ensure broader coordination of activities among 
the Institutes and Centers (ICs) within the NIH. This is 
particularly important given the number of ICs at NIH which 
have a role to play on research related to autism spectrum 
disorder. However, the Committee committee does not expect the 
strategic plan process to deviate from similar processes that 
NIH uses during the budgetary process by putting together their 
professional judgment of the funds required for particular 
activities, recognizing that those professional judgments 
cannot be tied to obligating such funds to the research 
outlined under the strategic plan.
    In reporting on the expected spending and providing an 
analysis of what was previously expended, the committee 
strongly encourages the director to provide such dollar amounts 
using clear and consistent methods for determining the monetary 
allocation. At this point, various ICs have different policies 
for determining the budgetary allocation for a grant that has 
multiple disease impacts, and the committee would like the 
information presented for this report to use one consistent 
method for all of the information provided. The committee 
further encourages the director to use this information on the 
amount of spending on autism spectrum disorder for all of its 
dissemination purposes, including the information publicly 
available at http://www.nih.gov/news/fundingresearchareas.htm, 
regarding spending on specific disease categories.
    Further, in crafting the specific strategic plan, the 
committee encourages the director to:
           Determine and establish priorities among 
        critical scientific questions related to autism 
        spectrum disorder;
           Specify the short and long-range objectives 
        to be achieved, and estimate the resources needed to 
        achieve these objectives;
           Evaluate the sufficiency of existing 
        research programs on autism spectrum disorder to meet 
        the specified objectives and establish objectives, 
        timelines, and criteria for evaluating future research 
        programs; and
           Make recommendations for changes to existing 
        research programs on autism spectrum disorder, 
        including potential consolidation of research 
        activities if such consolidation would improve program 
        efficiencies and outcomes.
    In addition to the strategic plan, the committee requests 
that the NIH expand, intensify, and coordinate activities at 
NIH. The committee further authorizes two centers of excellence 
programs--the Autism Centers of Excellence and the Centers of 
Excellence in Environmental Health and Autism.
    The committee is encouraged by the work that the NIH has 
already performed in the past 5 years with respect to Centers 
of Excellence. In providing updated authority for those Centers 
of Excellence, the committee applauds the NIH for taking the 
proactive step to collapse two current Centers of Excellence 
programs (e.g., the Collaborative Programs of Excellence in 
Autism and the Studies to Advance Autism Research andTreatment) 
into one comprehensive Center of Excellence--the Autism Centers of 
Excellence (or ACE). This virtual network of centers across the Nation 
will build upon the work of the previous Centers of Excellence by 
focusing on treatment trials, neuroimaging, and the behavioral and 
biological components tied to genetic traits. In working with these 
centers, the committee expects the director to continue to coordinate 
activities with the directors of the National Institute of Mental 
Health, the National Institute of Child Health and Human Development, 
the National Institute of Neurological Disorders and Stroke, the 
National Institute of Environmental Health Sciences, the National 
Institute on Deafness and Other Communication Disorders, and any other 
agencies that the director determines appropriate.
    Given that the Centers of Excellence can utilize their 
grant award for making individuals aware of opportunities to 
participate as subjects in research at the Center, the 
committee strongly encourages the NIH to provide appropriate 
oversight and accounting of these activities to ensure that 
those costs are reasonable and appropriate and tied directly to 
recruitment activities. The committee allows the NIH to request 
justification from grantees for such expenditures.
    The committee also authorizes the collection of storage of 
data, including samples of tissues and genetic and other 
biological materials, to improve the availability of 
information to individuals examining questions related to 
autism spectrum disorder. Given that the NIH has already 
developed a genetic repository as part of the Autism Genome 
Resource Exchange, which includes DNA extracted from blood 
samples from families with a child with autism, the committee 
expects that the Centers of Excellence will have the 
opportunity to perform research on high-risk infant siblings.
    The committee further commends the NIH for developing the 
National Database for Autism Research. This collaboration among 
sites allows for data sharing, additional analysis, queries 
across disparate systems and data stories, and additional data 
resources. By using common reference architectures of data 
standards, vocabularies, web services, and application 
solutions, this network can link the Autism Speaks Registry, 
the Autism Treatment Network, and the Centers of Excellence at 
the Centers for Disease Control, and other autism researchers. 
In making this information available to the public and other 
autism researchers, the committee expects the NIH to share this 
information using standard protocols to appropriately protect 
patient confidentiality.
    Given that the NIH is already working to establish a 
virtual data center, the committee expects the CDC to share 
relevant data and samples of tissues and other biological 
material with the NIH so that there can be a single point of 
access within the Federal Government for all autism data-
sharing purposes.
    To ensure the maximum amount of efficiency, while still 
focusing on outcomes, the committee gives the NIH the authority 
to consolidate program activities under the direction of NIH if 
such consolidation would improve program efficiencies and 
outcomes. In promoting any consolidation, the committee expects 
the NIH to retain a separate, distinct focus on environmental 
health factors as they potentially relate to autism spectrum 
disorder.
    In addition, beyond the authorization of appropriations, 
the committee further clarifies that NIH can use up to 5 
percent of the grant amounts for administrative and other 
expenses. Although the committee understands the need for the 
NIH to have such taps, the committee is concerned about those 
taps being too high and diverting scarce resources to 
administrative expenses.
    In an effort to clarify the committee's intent that these 
provisions do indeed sunset at the end of the authorization 
period, the committee has provided specific sunset language. In 
providing this language, the committee intends to reauthorize 
this critical law within the timeframe specified to ensure that 
the committee provides appropriate oversight of these issues.
    Except for the provisions related to biomedical research at 
the NIH, the committee does not separate autism spectrum 
disorder from other developmental disabilities because the 
committee recognizes how necessary it is to continue to provide 
such services and epidemiological research in a comprehensive 
manner. However, given how little is known about ASD in 
biomedical research, the committee consciously decided to focus 
solely on ASD in that particular context.
    The committee appreciates the work that the director of the 
Centers for Disease Control and Prevention (CDC) has already 
done in implementing the provisions of section 1 of the 
Children's Health Act of 2000. Recognizing that, the committee 
updated the language related to the State epidemiological 
studies, as well as additional Centers of Excellence for Autism 
Spectrum Disorder Epidemiology.
    In continuing to implement the State epidemiology program 
and centers of excellence for autism research focused on 
epidemiological questions, the committee encourages the CDC to 
examine specific trends of autism spectrum disorder over time. 
While examining the incidence and prevalence of ASD, the 
committee encourages the CDC to use the diagnostic criteria 
established within the current edition of the Diagnostic and 
Statistical Manual (DSM) of Mental Disorders published by the 
American Psychiatric Association. If there is a change in the 
diagnostic criteria over time, due to new insights into ASD, 
then the committee expects CDC to provide a sufficient 
crosswalk between the various definitions so that it is 
possible to still follow the trends over time. Further, to 
ensure that there are standard methods for data collection, the 
committee specifically requires the CDC to provide such 
guidelines, after consultation with relevant State and local 
public health officials, for both the State epidemiology 
program and centers of excellence.
    The committee commends the CDC for continuing to coordinate 
the Federal response to requests for assistance from State 
health departments regarding potential or alleged autism 
spectrum disorder clusters. For instance, in late 1997, a 
citizen's group in Brick Township, New Jersey, told the New 
Jersey Department of Health and Senior Services (DHSS) of their 
concerns about what seemed to be a larger-than-expected number 
of children with autism in Brick Township. Because of the 
complexity of the disorder and the citizens' concern that 
environmental factors might play a role, the New Jersey DHSS 
contacted CDC and the Agency for Toxic Substances and Disease 
Registry (ATSDR) for help. CDC and ATSDR worked together on a 
project to find out how common ASD was in Brick Township and to 
study the possible relationship of environmental factors toASD 
in the community. After much review, it was determined that the 
prevalence of autism in Brick Township seems to be higher than that in 
other studies, particularly studies conducted in the United States, but 
within the range of a few recent studies in smaller populations that 
used more thorough case-finding methods.
    To truly address the issues surrounding the need for 
additional education, early detection, diagnosis, and 
intervention for individuals with autism spectrum disorder and 
other developmental disorders, there must be an 
interdisciplinary approach, combining key resources from 
health, education, and disability programs. With that in mind, 
the committee made the largest number of changes in section 
399BB autism education, early detection, and intervention to 
the original draft of S. 843. In particular, the committee 
included specific requirements for data coordination, as well 
as the designation by the Governor of a State lead agency.
    The committee added language requesting the Governor to 
designate a lead agency to coordinate activities designated to 
provide information regarding risk factors, characteristics, 
identification, diagnosis, and interventions for individuals 
with autism spectrum disorder and other developmental 
disabilities and their families through specific Federal, State 
and local programs. Methods of delivery of such information may 
include websites, toll-free numbers, pamphlets and other means 
that the Governor may require. The committee recognizes that 
such activities are occurring throughout the United States, 
however, there are often multiple points of entry to access 
such information and families have indicated difficulties 
locating beneficial information in a timely fashion. Hence, the 
committee requests the Governor to designate a lead agency to 
seek, collect, and publicize information related to services 
that are available to individuals with autism spectrum disorder 
and other developmental disabilities, and their families.
    The committee has modified the language from the original 
text of the Children's Health Act of 2000 to specify that the 
information should include information relevant to individuals 
with autism spectrum disorder and other developmental 
disabilities across the lifespan, especially transition age 
youth and adults, and with regard to college, vocational and 
labor accommodations. The committee further encourages that 
funding provided under this section include funding for 
information and education on advances in the early detection, 
diagnosis and intervention for individuals with autism spectrum 
disorder and other developmental disabilities as well as 
training and continuing education through programs for 
scientists, physicians, and other health professionals, social 
workers, and child care and education professionals and 
assistants who provide supports and services to, or are likely 
to come into professional contact with, people with autism 
spectrum disorder and other developmental disabilities, and 
their families. Activities under this section should place 
special emphasis on early identification of autism spectrum 
disorder and other developmental disabilities and those at high 
risk for ASD and other developmental disabilities, and prompt 
referral for appropriate services.
    In addition to these activities, the committee specifically 
encourages the Secretary to develop evidence-based models for 
the comprehensive medical care of individuals with autism 
spectrum disorder. Comprehensive medical care models should 
include diagnosis and evaluation of disabilities identified 
during a complete history and physical examination and through 
appropriate laboratory evaluations. When outlining the 
comprehensive medical models, the committee encourages the 
Secretary to examine these models in the context of the 
individual, not just the potential diagnosis of autism spectrum 
disorder but in the context of the other potential co- 
occurring conditions and other health aspects. Therefore, 
evaluation and diagnosis could consider all of the health 
aspects of an individual, including developmental, 
psychosocial, behavioral, nutritional, neurological, 
immunological, endocrinological, gastrointestinal, metabolic, 
and toxicological parameters.
    As part of the informational process, the committee 
requested that the Secretary, in collaboration with the 
Secretary of Education and the Secretary of Agriculture, 
provide culturally competent information regarding autism 
spectrum disorder and other developmental disabilities through 
a variety of Federal programs. In doing so, the committee 
recognizes that nutrition services are the mission of the 
Special Supplemental Nutrition Program for Women, Infants and 
Children (WIC) and is concerned that placing additional 
responsibilities upon WIC that are not central to this mission 
may potentially result in a diminished quality of nutrition 
services. At the same time, the committee recognizes the access 
that WIC provides to a significant number of children up to the 
age of 5. It is the committee's intention that the information 
and education activities carried out through WIC under 
subsection (c) be limited to the basic provision and 
dissemination of information, such as providing pamphlets or 
other materials that can easily be passed along to or picked up 
by WIC clients, rather than activities that would require WIC 
staff to actively perform duties such as providing screening, 
education, interventions, administering information surveys, 
etc., for individuals with autism spectrum disorder, that are 
unrelated to the core mission of WIC.
    The committee further re-examined the Interagency Autism 
Coordinating Committee (IACC). In particular, the committee 
wanted to increase the amount of public participation (from two 
individuals) to at least six. In addition, the IACC has been 
tasked to make recommendations to the Secretary regarding the 
public participation in decisions relating to autism spectrum 
disorder. For instance, the committee notes that the IACC may 
recommend providing other, additional, formal mechanisms, such 
as an Autism Advisory Board, to provide additional public 
feedback and interaction. Further, the Secretary may opt to 
provide such a mechanism without the recommendation of the 
IACC.
    The committee expects that the IACC will be the primary 
mechanism for the coordination of all research, surveillance, 
and early detection activities within the Department of Health 
and Human Services. As agencies implement specific activities 
related to autism spectrum disorder, they should strongly 
consider those activities outlined in the Autism Research 
Matrix.
    To provide the necessary information for an appropriate 
committee analysis of activities outlined in this legislation, 
the committee requires a specific report 4 years after the date 
of enactment of the ``Combating Autism Act of 2006.''
    Finally, the committee repeals sections of the ``Children's 
Health Act of 2000'' that were updated by the ``Combating 
Autism Act of 2006.''

                            V. Cost Estimate

    Due to time constraints the Congressional Budget Office 
estimate was not included in the report. When received by the 
committee, it will appear in the Congressional Record at a 
later time.

            VI. Application of Law to the Legislative Branch

    The committee has determined that there is no impact of 
this law on the Legislative Branch.

                    VII. Regulatory Impact Statement

    In accordance with paragraph 11(b) of rule XXVI of the 
Standing Rules of the Senate, the committee has determined that 
there will be minimal increases in the regulatory burden 
imposed by this bill.

                   VIII. Section-by-Section Analysis


Section 2--Activities to improve autism-related research

    Section 409C--This section authorizes the director of NIH 
to develop and implement a strategic plan for research related 
to autism spectrum disorder. The director will take into 
consideration the recommendations of the Interagency Autism 
Coordinating Committee (IACC). Oversight of the strategic plan 
and budget for research is based on the existing Autism 
Research Roadmap and Matrix developed by the IACC. The 
strategic plan shall require identification of the total 
expenditures of NIH research activities related to autism 
spectrum disorder.
    This section promotes the expansion, intensification and 
coordination of activities at NIH related to autism spectrum 
disorder. It reauthorizes the Autism Centers of Excellence 
which were originally created in the Children's Health Act of 
2000. The funding may support both basic and clinical research 
in the fields of developmental neurobiology, genetics, 
epigenetics, pharmacology, nutrition, immunology, 
neuroimmunology, neurobehavioral development, endocrinology, 
gastroenterology, psychopharmacology or toxicology. It will 
also support continued investigations into the causation, 
diagnosis, early detection, prevention, control, intervention 
and cure for autism spectrum disorder. Centers of Excellence 
will also receive funding for coordination of services and 
information for patients. The director of NIH shall promote 
research to determine evidence-based best practices for 
diagnosis and intervention strategies for individuals with 
autism spectrum disorder.
    This section authorizes $500 million for NIH research 
funding over 5 years ($68 million for 2007, $82 million for 
2008, $96 million for 2009, $120 million for 2010 and $134 
million for 2011) and $195 million for funding the Autism 
Centers of Excellence over 5 years ($26 million for 2007, $32.5 
million for 2008, $38 million for 2009, $45.5 million for 2010, 
$52 million for 2011).
    This section promotes research initiatives for basic and 
clinical research of a broad array of environmental factors. 
The research will be coordinated through the Centers of 
Excellence in Environmental Health and will have the same 
requirements concerning coordinating, reporting and 
organization as applied to the other Centers of Excellence.
    It authorizes $45 million in funding for the National 
Institutes of Environmental Health over 5 years ($6 million for 
2007, $7.5 million for 2008, $9 million for 2009, $10.5 million 
for 2010, and $12 million for 2011).
    This section also authorizes the Secretary to establish and 
provide funding for the collection, storage, coordination, and 
public availability of data generated from public and private 
research partnerships. It will also establish a program under 
which tissue samples, genetic material or biological materials 
are available for research.

Section 3--Developmental disabilities surveillance and research 
        programs

    Section 399AA--This section reauthorizes CDC's 
epidemiologic surveillance programs and establishes regional 
Centers of Excellence for collection, analysis and reporting of 
epidemiological data on autism spectrum disorder and other 
developmental disabilities. The Centers will also assist with 
the development and coordination of State autism spectrum 
disorder and other developmental disabilities efforts within a 
region. This section authorizes CDC to promote research to 
determine evidence-based best practices for diagnosis and 
interventions for individuals with autism spectrum disorder and 
other developmental disabilities. This section authorizes $75 
million for years 2007 through 2011.
    Section 399BB--This section increases awareness, reduces 
barriers to screening and diagnosis, and promotes evidence-
based early interventions for individuals with autism spectrum 
disorder and other developmental disabilities. It also promotes 
the training of professionals to utilize valid and reliable 
screening tools to diagnose and provide evidence based 
interventions. Information will be provided through Federal 
programs that target individuals and their families (such as 
Head Start, Early Start, Healthy Start and Medicaid and SCHIP). 
This section also requires the designation of a lead agency 
with demonstrated experience and expertise in autism by the 
Governor of each State to coordinate and provide comprehensive 
information, education and referral services regarding autism 
spectrum disorder and other developmental disabilities. It also 
promotes the development and implementation of valid and 
reliable screening tools for autism spectrum disorder and other 
developmental disabilities. Both the Secretary of HHS and the 
Secretary of Education shall collaborate to provide collection, 
storage, and coordination of screening tools, educational 
materials and other products used by Federal programs. The 
Secretary of HHS shall also expand the interdisciplinary 
training opportunities through the Health Resources and 
Services Administration (HRSA) grants to public and non-profit 
agencies and promote grants to determine the evidence-based 
practices for interventions for autism spectrum disorder and 
other developmental disabilities. They shall also develop 
guidelines for these interventions and disseminate such 
information. It authorizes $210 million in funding over 5 years 
($32 million for 2007, $37 million for 2008, $42 million for 
2009, $47 million for 2010, and $52 million for 2011).
    Section 399CC--This section reauthorizes the ``Autism 
Coordinating Committee'' established in the Children's Health 
Act of 2000. The Interagency Autism Coordinating Committee 
(IACC) shall make recommendations concerning the strategic plan 
for the Autism Matrix. The IACC will also develop and annually 
update advances in autism spectrum disorder research related to 
causes, early screening, diagnosis, intervention and access to 
services for individuals with autism spectrum disorder. The 
public member participation in the IACC will be comprised of 1/
3 (or 6 members) of the committee. The IACC will be funded by 
such sums as necessary each year through 2011.
    Section 399DD--This section requires a report from the 
Secretary of HHS in coordination with the Secretary of 
Education no later than 4 years after the date of enactment of 
this bill. The report shall be submitted to the Health, 
Education, Labor, and Pension Committee in the Senate and 
Energy and Commerce Committee of the House of Representatives 
on the progress of activities related to autism spectrum 
disorder and other developmental disabilities.
    Repeals--The respective sections of the Children's Health 
Act of 2000 are repealed.

                      IX. Changes in Existing Law

    In compliance with rule XXVI paragraph 12 of the Standing 
Rules of the Senate, the following provides a print of the 
statute or the part or section thereof to be amended or 
replaced (existing law proposed to be omitted is enclosed in 
black brackets, new matter is printed in italic, existing law 
in which no change is proposed is shown in roman):

PUBLIC HEALTH SERVICE ACT

           *       *       *       *       *       *       *


     TITLE III--GENERAL POWERS AND DUTIES OF PUBLIC HEALTH SERVICE

                   PART A--RESEARCH AND INVESTIGATION


                               IN GENERAL

    Sec. 301 *  *  *

           *       *       *       *       *       *       *


           PART Q--PROGRAMS TO IMPROVE THE HEALTH OF CHILDREN


SEC. 399W. [280H] GRANTS TO PROMOTE CHILDHOOD NUTRITION AND PHYSICAL 
                    ACTIVITY.

    (a) In General.--*  *  *

           *       *       *       *       *       *       *


                  PART R--PROGRAMS RELATING TO AUTISM

SEC. 399AA. DEVELOPMENTAL DISABILITIES SURVEILLANCE AND RESEARCH 
                    PROGRAM.

      (a) Autism Spectrum Disorder and Other Developmental 
Disabilities.--
          (1) In general.--The Secretary, acting through the 
        Director of the Centers for Disease Control and 
        Prevention, may award grants or cooperative agreements 
        to eligible entities for the collection, analysis, and 
        reporting of State epidemiological data on autism 
        spectrum disorder and other developmental disabilities. 
        An eligible entity shall assist with the development 
        and coordination of State autism spectrum disorder and 
        other developmental disability surveillance efforts 
        within a region. In making such awards, the Secretary 
        may provide direct technical assistance in lieu of 
        cash.
          (2) Data standards.--In submitting epidemiological 
        data to the Secretary pursuant to subsection (a), an 
        eligible entity shall report data according to 
        guidelines prescribed by the Director of the Centers 
        for Disease Control and Prevention, after consultation 
        with relevant State and local public health officials, 
        private sector developmental disability researchers, 
        and advocates for individuals with autism spectrum 
        disorder or other developmental disabilities.
          (3) Eligibility.--To be eligible to receive an award 
        under paragraph (1), an entity shall be a public or 
        nonprofit private entity (including a health department 
        of a State or a political subdivision of a State, a 
        university, or any other educational institution), and 
        submit to the Secretary an application at such time, in 
        such manner, and containing such information as the 
        Secretary may require.
      (b) Centers of Excellence in Autism Spectrum Disorder 
Epidemiology.--
          (1) In general.--The Secretary, acting through the 
        Director of the Centers for Disease Control and 
        Prevention, shall, subject to the availability of 
        appropriations, award grants or cooperative agreements 
        for the establishment of regional centers of excellence 
        in autism spectrum disorder and other developmental 
        disabilities epidemiology for the purpose of collecting 
        and analyzing information on the number, incidence, 
        correlates and causes of autism spectrum disorder and 
        other developmental disabilities.
          (2) Requirements.--To be eligible to receive a grant 
        or cooperative agreement under paragraph (1), an entity 
        shall submit to the Secretary an application containing 
        such agreements and information as the Secretary may 
        require, including an agreementthat the center to be 
established under the grant or cooperative agreement shall operate in 
accordance with the following:
                  (A) The center will collect, analyze, and 
                report autism spectrum disorder and other 
                developmental disability data according to 
                guidelines prescribed by the Director of the 
                Centers for Disease Control and Prevention, 
                after consultation with relevant State and 
                local public health officials, private sector 
                developmental disability researchers, and 
                advocates for individuals with developmental 
                disabilities.
                  (B) The center will develop or extend an area 
                of special research expertise (including 
                genetics, epigenetics, epidemiological research 
                related to environmental exposures), 
                immunology, and other relevant research 
                specialty areas.
                  (C) The center will identify eligible cases 
                and controls through its surveillance system 
                and conduct research into factors which may 
                cause or increase the risk of autism spectrum 
                disorder and other developmental disabilities.
    (c) Federal Response.--The Secretary shall coordinate the 
Federal response to requests for assistance from State health, 
mental health, and education department officials regarding 
potential or alleged autism spectrum disorder or developmental 
disability clusters.
    (d) Definitions.--In this part:
          (1) Other developmental disabilities.--The term 
        ``other developmental disabilities'' has the meaning 
        given the term ``developmental disability'' in section 
        102(8) of the Developmental Disabilities Assistance and 
        Bill of Rights Act of 2000 (42 U.S.C. 15002(8)).
          (2) State.--The term ``State'' means each of the 
        several States, the District of Columbia, the 
        Commonwealth of Puerto Rico, American Samoa, Guam, the 
        Commonwealth of the Northern Mariana Islands, the 
        Virgin Islands, and the Trust Territory of the Pacific 
        Islands.
    (e) Authorization of Appropriations.--To carry out this 
section, there is authorized to be appropriated, $15,000,000 
for fiscal year 2007, and such sums as may be necessary for 
each of fiscal years 2008 through 2011.
    (f) Sunset.--This section shall not apply after September 
30, 2011.

SEC. 399BB. AUTISM EDUCATION, EARLY DETECTION, AND INTERVENTION .

    (a) Purpose.--It is the purpose of this section--
          (1) to increase awareness, reduce barriers to 
        screening and diagnosis, promote evidence-based 
        interventions for individuals with autism spectrum 
        disorder or other developmental disabilities, and train 
        professionals to utilize valid and reliable screening 
        tools to diagnose or rule out and provide evidence-
        based interventions for children with autism spectrum 
        disorder and other developmental disabilities; and
          (2) to conduct activities under this section with a 
        focus on an interdisciplinary approach (as defined in 
        programs developed under section 501(a)(2) of the 
        Social Security Act) that will also focus on specific 
        issues for children who are not receiving an early 
        diagnosis and subsequent interventions.
    (b) In General.--The Secretary shall, subject to the 
availability of appropriations, establish and evaluate 
activities to--
          (1) provide information and education on autism 
        spectrum disorder and other developmental disabilities 
        to increase public awareness of developmental 
        milestones;
          (2) promote research into the development and 
        validation of reliable screening tools for autism 
        spectrum disorder and other developmental disabilities 
        and disseminate information regarding those screening 
        tools;
          (3) promote early screening of individuals at higher 
        risk for autism spectrum disorder and other 
        developmental disabilities as early as practicable, 
        given evidence-based screening techniques and 
        interventions;
          (4) increase the number of individuals who are able 
        to confirm or rule out a diagnosis of autism spectrum 
        disorder and other developmental disabilities;
          (5) increase the number of individuals able to 
        provide evidence-based interventions for individuals 
        diagnosed with autism spectrum disorder or other 
        developmental disabilities; and
          (6) promote the use of evidence-based interventions 
        for individuals at higher risk for autism spectrum 
        disorder and other developmental disabilities as early 
        as practicable.
    (c) Information and Education.--
          (1) In general.--In carrying out subsection (b)(1), 
        the Secretary, in collaboration with the Secretary of 
        Education and the Secretary of Agriculture, shall, 
        subject to the availability of appropriations, provide 
        culturally competent information regardingautism 
spectrum disorder and other developmental disabilities, risk factors, 
characteristics, identification, diagnosis or rule out, and evidence-
based interventions to meet the needs of individuals with autism 
spectrum disorder or other developmental disabilities and their 
families through--
                  (A) Federal programs, including--
                          (i) the Head Start program;
                          (ii) the Early Start program;
                          (iii) the Healthy Start program;
                          (iv) programs under the Child Care 
                        and Development Block Grant Act of 
                        1990;
                          (v) programs under title XIX of the 
                        Social Security Act (particularly the 
                        Medicaid Early and Periodic Screening, 
                        Diagnosis and Treatment Program);
                          (vi) the program under title XXI of 
                        the Social Security Act (the State 
                        Children's Health Insurance Program);
                          (vii) the program under title V of 
                        the Social Security Act (Maternal and 
                        Child Health Block Grant Program);
                          (viii) the program under parts B and 
                        C of the Individuals with Disabilities 
                        Education Act;
                          (ix) the special supplemental 
                        nutrition program for women, infants, 
                        and children established under section 
                        17 of the Child Nutrition Act of 1966 
                        (42 U.S.C. 1786); and
                          (x) the State grant program under the 
                        Rehabilitation Act of 1973.
                  (B) State licensed child care facilities; and
                  (C) other community-based organizations or 
                points of entry for individuals with autism 
                spectrum disorder and other developmental 
                disabilities to receive services.
          (2) Lead agency.--
                  (A) Designation.--The governor of a State 
                shall designate a public agency as a lead 
                agency to coordinate the activities provided 
                for under paragraph (1) in the State at the 
                State level.
                  (B) Information.--The Governor or a State, 
                acting through the lead agency under 
                subparagraph (A), shall make available to 
                individuals and their family members, 
                guardians, advocates, or authorized 
                representatives, providers, and other 
                appropriate individuals in the State, 
                comprehensive culturally competent information 
                about State and local resources regarding 
                autism spectrum disorder and other 
                developmental disabilities, risk factors, 
                characteristics, identification, diagnosis or 
                rule out, available services and supports, and 
                evidence-based interventions. Such information 
                shall be provided through--
                          (i) toll-free telephone numbers;
                          (ii) Internet websites;
                          (iii) mailings; or
                          (iv) other means as the Governor may 
                        require.
                  (C) Requirements of agency.--In designating 
                the lead agency under subparagraph (A), the 
                Governor shall--
                          (i) select an agency that has 
                        demonstrated experience and expertise 
                        in--
                                  (I) autism spectrum disorder 
                                and other developmental 
                                disability issues; and
                                  (II) developing, 
                                implementing, conducting, and 
                                administering programs and 
                                delivering education, 
                                information, and referral 
                                services (including technology-
                                based curriculum-development 
                                services) to individuals with 
                                developmental disabilities and 
                                their family members, 
                                guardians, advocates or 
                                authorized representatives, 
                                providers, and other 
                                appropriate individuals locally 
                                and across the State; and
                          (ii) consider input from individuals 
                        with developmental disabilities and 
                        their family members, guardians, 
                        advocates or authorized 
                        representatives, providers, and other 
                        appropriate individuals.
    (d) Tools.--
          (1) In general.--To promote the use of valid and 
        reliable screening tools for autism spectrum disorder 
        and other developmental disabilities, the Secretary 
        shall develop a curriculum for continuing education to 
        assist individuals in recognizing the need for valid 
        and reliable screening tools and the use of such tools.
          (2) Collection, storage, coordination, and 
        availability.--The Secretary, in collaboration with the 
        Secretary of Education, shall provide for the 
        collection, storage, coordination, and public 
        availability of tools described in paragraph (1), 
        educational materials and other products that are used 
        by the Federalprograms referred to in subsection 
(c)(1)(A), as well as--
                          (A) programs authorized under the 
                        Developmental Disabilities Assistance 
                        and Bill of Rights Act of 2000;
                          (B) early intervention programs or 
                        interagency coordinating council's 
                        authorized under part C of the 
                        Individuals with Disabilities Education 
                        Act; and
                          (C) children with special health care 
                        needs programs authorized under title V 
                        of the Social Security Act.
                  (3) Required sharing.--In establishing 
                mechanisms and entities under this subsection, 
                the Secretary, and the Secretary of Education, 
                shall ensure the sharing of tools, materials, 
                and products developed under this subsection 
                among entities receiving funding under this 
                section.
  (e) Diagnosis.--
          (1) Training.--The Secretary, in coordination with 
        activities conducted under title V of the Social 
        Security Act, shall, subject to the availability of 
        appropriations, expand existing interdisciplinary 
        training opportunities or opportunities to increase the 
        number of sites able to diagnose or rule out 
        individuals with autism spectrum disorder or other 
        developmental disabilities and ensure that--
                  (A) competitive grants or cooperative 
                agreements are awarded to public or non-profit 
                agencies, including institutions of higher 
                education, to expanding existing or develop new 
                maternal and child health interdisciplinary 
                leadership education in neurodevelopmental and 
                related disabilities programs (similar to the 
                programs developed under section 501(a)(2) of 
                the Social Security Act) in States that do not 
                have such a program;
                  (B) trainees under such training programs--
                          (i) receive an appropriate balance of 
                        academic, clinical, and community 
                        opportunities;
                          (ii) are culturally competent;
                          (iii) are ethnically diverse;
                          (iv) demonstrate a capacity to 
                        evaluate, diagnose or rule out, 
                        develop, and provide evidence-based 
                        interventions to individuals with 
                        autism spectrum disorder and other 
                        developmental disabilities; and
                          (v) demonstrate an ability to use a 
                        family-centered approach; and
                  (C) program sites provide culturally 
                competent services.
          (2) Technical assistance.--The Secretary may award 
        one or more grants under this section to provide 
        technical assistance to the network of 
        interdisciplinary training programs.
          (3) Best practices.--The Secretary shall promote 
        research into additional valid and reliable tools for 
        shortening the time required to confirm or rule out a 
        diagnosis of autism spectrum disorder or other 
        developmental disabilities and detecting individuals 
        with autism spectrum disorder or other developmental 
        disabilities at an earlier age.
  (f) Intervention.--The Secretary shall promote research, 
through grants or contracts, to determine the evidence-based 
practices for interventions for individuals with autism 
spectrum disorder or other developmental disabilities, develop 
guidelines for those interventions, and disseminate information 
related to such research and guidelines.
  (g) Authorization of Appropriations.--To carry out this 
section, there is authorized to be appropriated, $32,000,000 
for fiscal year 2007, $37,000,000 for fiscal year 2008, 
$42,000,000 for fiscal year 2009, $47,000,000 for fiscal year 
2010, and $52,000,000 for fiscal year 2011, of which--
          (1) $5,000,000 shall be made available in each fiscal 
        year for activities described in subsection (c); and
          (2) $3,000,000 shall be made available in fiscal year 
        2007, $6,000,000 in fiscal year 2008, $9,000,000 in 
        fiscal year 2009, $12,000,000 in fiscal year 2010, and 
        $15,000,000 in fiscal year 2011, for activities 
        described in subsection (f).
  (h) Sunset.--This section shall not apply after September 30, 
2011.

SEC. 399CC. INTERAGENCY AUTISM COORDINATING COMMITTEE.

  (a) Establishment.--The Secretary shall establish a 
committee, to be known as the ``Interagency Autism Coordinating 
Committee'' (in this section referred to as the ``Committee''), 
to coordinate all efforts within the Department of Health and 
Human Services concerning autism spectrum disorder.
  (b) Responsibilities.--In carrying out its duties under this 
section, the Committee shall--
          (1) make recommendations concerning the strategic 
        plan described in section 409C(a);
          (2) develop and annually update advances in autism 
        spectrum disorder research related to causes, early 
        screening, diagnosis or rule out, intervention, and 
        access to services and supports for individuals with 
        autism spectrum disorder; and
          (3) make recommendations to the Secretary regarding 
        the public participation in decisions relating to 
        autism spectrum disorder.
  (c) Membership.--
          (1) In general.--The Committee shall be composed of--
                  (A) the Director of the Centers for Disease 
                Control and Prevention;
                  (B) the Director of the National Institutes 
                of Health, and the Directors of such national 
                research institutes of the National Institutes 
                of Health as the Secretary determines 
                appropriate;
                  (C) the heads of such other agencies as the 
                Secretary determines appropriate;
                  (D) representatives of other Federal 
                Governmental agencies that serve individuals 
                with autism spectrum disorder such as the 
                Department of Education; and
                  (E) the additional members appointed under 
                paragraph (2).
          (2) Additional members.--Not fewer than 6 members of 
        the Committee, or 1/3 of the total membership of the 
        Committee, whichever is greater, shall be composed of 
        non-federal public members to be appointed by the 
        Secretary, of which--
                  (A) at least one such member shall be an 
                individual with a diagnosis of autism spectrum 
                disorder;
                  (B) at least one such member shall be a 
                parent or legal guardian of an individual with 
                an autism spectrum disorder; and
                  (C) at least one such member shall be a 
                representative of leading research, advocacy, 
                and service organizations for individuals with 
                autism spectrum disorder.
  (d) Administrative Support; Terms of Service; Other 
Provisions.--The following provisions shall apply with respect 
to the Committee:
          (1) The Committee shall receive necessary and 
        appropriate administrative support from the Secretary.
          (2) Members of the Committee appointed under 
        subsection (c)(2) shall serve for a term of 4 years, 
        and may be reappointed for one or more additional 4 
        year term. 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 taken 
        office.
          (3) The Committee shall meet at the call of the 
        chairperson or upon the request of the Secretary. The 
        Committee shall meet not fewer than 2 times each year.
          (4) All meetings of the Committee shall be public and 
        shall include appropriate time periods for questions 
        and presentations by the public.
  (e) Compensation and Expenses.--Members of the Committee who 
are officers or employees of the Federal Government shall serve 
as members of the Committee without compensation in addition to 
that received in their regular government employment. Other 
members of the Committee shall receive compensation at rates 
not to exceed the daily equivalent of the annual rate in effect 
for grade GS-18 of the General Schedule for each day (including 
travel time) they are engaged in the performance of their 
duties as members of the Committee.
  (f) Subcommittees; Establishment and Membership.--In carrying 
out its functions, the Committee may establish subcommittees 
and convene workshops and conferences. Such subcommittees shall 
be composed of Committee members and may hold such meetings as 
are necessary to enable the subcommittees to carry out their 
duties.
  (g) Authorization of Appropriations.--To carry out this 
section, there is authorized to be appropriated, such sums as 
may be necessary for each of fiscal years 2007 through 2011.
  (h) Sunset.--This section shall not apply after September 30, 
2011 and the Committee shall be terminated on such date.

SEC. 399DD. REPORT TO CONGRESS.

  (a) In General.--Not later than 4 years after the date of 
enactment of the Combating Autism Act of 2006, the Secretary, 
in coordination with the Secretary of Education, shall prepare 
and submit to the Health, Education, Labor, and Pensions 
Committee of the Senate and the Energy and Commerce Committee 
of the House of Representatives a progress report on activities 
related to autism spectrum disorder and other developmental 
disabilities.
  (b) Contents.--The report submitted under subsection (a) 
shall contain--
          (1) a description of the progress made in 
        implementing the provisions of the Combating Autism Act 
        of 2006;
          (2) a description of the amounts expended on the 
        implementation of the particular provisions of 
        Combating Autism Act of 2006;
          (3) information on the incidence of autism spectrum 
        disorder and trend data of such incidence since the 
        date of enactment of the Combating Autism Act of 2006;
          (4) information on the average age of diagnosis for 
        children with autism spectrum disorder and other 
        disabilities, including how that age may have changed 
        over the 4-year period beginning on the date of 
        enactment of this Act;
          (5) information on the average age for intervention 
        for individuals diagnosed with autism spectrum disorder 
        and other developmental disabilities, including how 
        that age may have changed over the 4-year period 
        beginning on the date of enactment of this Act;
          (6) information on the average time between initial 
        screening and then diagnosis or rule out for 
        individuals with autism spectrum disorder or other 
        developmental disabilities, as well as information on 
        the average time between diagnosis and evidence-based 
        intervention for individuals with autism spectrum 
        disorder or other developmental disabilities;
          (7) information on the effectiveness and outcomes of 
        interventions for individuals diagnosed with autism 
        spectrum disorder, including by various subtypes, and 
        other developmental disabilities and how the age of the 
        child may affect such effectiveness;
          (8) information on the effectiveness and outcomes of 
        innovative and newly developed intervention strategies 
        for individuals with autism spectrum disorder or other 
        developmental disabilities; and
          (9) information on services and supports provided to 
        individuals with autism spectrum disorder and other 
        developmental disabilities who have reached the age of 
        majority (as defined for purposes of section 615(m) of 
        the Individuals with Disabilities Education Act (20 
        U.S.C. 1415(m)).

           *       *       *       *       *       *       *


EXPANSION, INTENSIFICATION, AND COORDINATION OF ACTIVITIES OF NATIONAL 
        INSTITUTES OF HEALTH WITH RESPECT TO RESEARCH ON AUTISM

    [Sec. 409C. [284g] (a) In General.--
          [(1) Expansion of activities.--The Director of NIH 
        (in this section referred to as the ``Director'') shall 
        expand, intensify, and coordinate the activities of the 
        National Institutes of Health with respect to research 
        on autism.
          [(2) Administration of program; collaboration among 
        agencies.--The Director shall carry out this section 
        acting through the Director of the National Institute 
        of Mental Health and in collaboration with any other 
        agencies that the Director determines appropriate.
    [(b) Centers of Excellence.--
          [(1) In general.--The Director shall under subsection 
        (a)(1) make awards of grants and contracts to public or 
        non-profit 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. The centers, as a group, shall 
        conduct research including he fields of developmental 
        neurobiology, genetics, and psychopharmacology.
          [(3) Services for patients.--
                  [(A) In general.--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.
                  [(B) Referrals and costs.--A program under 
                subparagraph (A) may, in accordance with such 
                criteria as the Director may establish, provide 
                to the subjects described in such subparagraph, 
                referrals for health and other services, and 
                such patient care costs as are required for 
                research.
                  [(C) Availability and access.--The extent to 
                which a center can demonstrate availability and 
                access to clinical services shall be considered 
                by the Director in decisions about awarding 
                grants to applicants which meet the scientific 
                criteria for funding under this section.
          [(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.--
                  [(A) In general.--The Director shall provide 
                for the establishment of not less than five 
                centers under paragraph (1).
                  [(B) Duration.--Support for a center 
                established under paragraph (1) may be provided 
                under this section for a period of not to 
                exceed 5 years. Such period may be extended for 
                one or more additional periods not exceeding 5 
                years if the operations of such center have 
                been reviewed by an appropriate technical and 
                scientific peer review group established by the 
                Director and if such group has recommended to 
                the Director that such period should be 
                extended.
    [(c) Facilitation of Research.--The Director shall under 
subsection (a)(1) provide for a program under which samples of 
tissues and genetic materials that are of use in research on 
autism are donated, collected, preserved, and made available 
for such research. The program shall be carried out in 
accordance with accepted scientific and medical standards for 
the donation, collection, and preservation of such samples.
    [(d) Public Input.--The Director shall under subsection 
(a)(1) provide for means through which the public can obtain 
information on the existing and planned programs and activities 
of the National Institutes of Health with respect to autism and 
through which the Director can receive comments from the public 
regarding such programs and activities.
    [(e) Funding.--There are authorized to be appropriated such 
sums as may be necessary to carry out this section. Amounts 
appropriated under this subsection are in addition to any other 
amounts appropriated for such purpose.]

SEC. 409C. AUTHORITY OF THE DIRECTOR OF THE NATIONAL INSTITUTES OF 
                    HEALTH RELATING TO AUTISM.

  (a) Strategic Plan for Autism Research.--
          (1) In general.--The Secretary, acting through the 
        Director, shall develop and implement a strategic plan 
        for the conduct and support of research related to 
        autism spectrum disorder.
          (2) Requirements.--The strategic plan developed under 
        paragraph (1)--
                  (A) shall--
                          (i) be updated annually;
                          (ii) take into account the research 
                        recommendations of the Interagency 
                        Autism Coordinating Committee under 
                        section 399CC; and
                          (iii) using professional judgment, 
                        outline the proposed budgetary 
                        requirements of the strategic plan, 
                        including specific funding expectations 
                        for continued multi-year program 
                        activities, as well as new and 
                        complementary program activities, 
                        subject to the availability of 
                        appropriations; and
                  (B) may include investigator-initiated 
                research.
          (3) Report.--Not later than April 1, 2008, and 
        annually thereafter, the Secretary, acting through the 
        Director, shall prepare and submit to the appropriate 
        committees of Congress a report that contains--
                  (A) the strategic plan under paragraph (1) 
                that will be applicable to the upcoming fiscal 
                year; and
                  (B) a description of the actual dollar 
                expenditures for autism spectrum disorder 
                during the previous fiscal year.
  (b) Expansion, Intensification, and Coordination of 
Activities.--The Secretary, acting through the Director, shall, 
subject to the availability of appropriations, expand, 
intensify, and coordinate the activities of the National 
Institutes of Health with respect to autism spectrum disorder.
  (c) Centers of Excellence.--
          (1) Autism centers of excellence.--
                  (A) In general.--The Secretary, acting 
                through the Director, shall, subject to the 
                availability of appropriations, award grants or 
                contracts to public or nonprofit private 
                entities to assist such entities in paying all 
                or part of the costs of planning, establishing, 
                improving, and providing basic operating 
                support for centers of excellence concerning 
                research on autism spectrum disorder.
                  (B) Research activities.--A center of 
                excellence that receives funding under this 
                paragraph shall conduct basic and clinical 
                research into autism spectrum disorder. Such 
                research shall--
                          (i) be conducted in the fields of 
                        developmental neurobiology, genetics, 
                        epigenetics, pharmacology, nutrition, 
                        immunology, neuroimmunology, 
                        neurobehavioral development, 
                        endocrinology, gastroenterology, 
                        psychopharmacology, or toxicology; and
                          (ii) include investigations into the 
                        causation, diagnosis or rule out, early 
                        detection, prevention, services, 
                        supports, or intervention of autism 
                        spectrum disorder.
                  (C) Services.--
                          (i) In general.--A center of 
                        excellence that receives funding under 
                        this paragraph may expend amounts 
                        provided under a grant or contract 
                        under such paragraph to carry out a 
                        program to make individuals aware of 
                        opportunities to participate as 
                        subjects in research conducted by the 
                        center.
                          (ii) Referrals and costs.--A program 
                        carried out under clause (i) may, in 
                        accordance with such criteria as the 
                        Director may establish, provide to the 
                        subjects described in such clause, 
                        referrals for health and other services 
                        and reimbursement of care for 
                        individuals as are required for such 
                        research.
                          (iii) Availability and access.--The 
                        extent to which a center of excellence 
                        that receives funding under this 
                        paragraph can demonstrate the 
                        availability of and access to clinical 
                        services shall be considered by the 
                        Director in making decisions concerning 
                        the awarding of grants or contracts to 
                        applicants that meet the scientific 
                        criteria for funding under this 
                        section.
                  (D) Coordination of centers of excellence.--
                The Director shall provide for the appropriate 
                coordination of information among centers of 
                excellence that receive funding under this 
                paragraph and ensure regular communication 
                between such centers.
                  (E) Organization.--A center of excellence 
                that receives funding under this paragraph 
                shall use the facilities of a single 
                institution, or be formed through a consortium 
                of cooperating institutions, that meets such 
                requirements as may be required by the 
                Director.
                  (F) Duration.--The term of a grant or 
                contract awarded under this paragraph shall not 
                exceed a period of 5 years. Such period may be 
                extended for 1 or more additional periods not 
                exceeding 5 years if the operations of the 
                center of excellence involved have been 
                reviewed by an appropriate technical and 
                scientific peer review group established by the 
                Director and the group has recommended to the 
                Director the extension of such period.
                  (G) Geographic diversity.--The Director shall 
                consider geographic diversity in awarding 
                centers of excellence.
          (2) Centers of excellence in environmental health and 
        autism.--
                  (A) In general.--The Director shall, subject 
                to the availability of appropriations, award 
                grants or 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 environmental health 
                and autism spectrum disorder.
                  (B) Research.--A center of excellence 
                established under this paragraph shall conduct 
                basic and clinical research of a broad array of 
                environmental factors that may have a possible 
                role in autism spectrum disorder.
                  (C) Coordination and organization.--The 
                Secretary, acting through the Director of NIH, 
                shall apply to the centers under this paragraph 
                the same requirements concerning coordination, 
                reporting, and organization as the requirements 
                applied to the centers of excellence under 
                subparagraphs (D), (E), (F), and (G) of 
                paragraph (1).
  (d) Collection and Storage of Data.--
          (1) In general.--The Secretary, acting though the 
        Director and in coordination with the Director of the 
        Centers for Disease Control and Prevention, shall, 
        subject to the availability of appropriations, 
        establish and provide funding for mechanisms and 
        entities that provide for the collection, storage, 
        coordination, and public availability of data that is 
        collected by the centers of excellence under this 
        section, under section 399AA(b), and under section 
        409C(c) and, to the extent possible, data generated 
        from public and private research partnerships. In 
        establishing such mechanisms and entities, the 
        Secretary--
                  (A) shall ensure that there is data sharing 
                among autism spectrum disorder researchers; and
                  (B) may utilize existing facilities.
          (2) Facilitation of research.--
                  (A) Establishment of program.--The Secretary 
                shall establish a program under which samples 
                of tissues and genetic and other biological 
                materials that are of use in research on autism 
                spectrum disorder are donated, collected, 
                preserved, and made available for such 
                research.
                  (B) Accepted scientific standards.--The 
                program established under paragraph (1) shall 
                be--
                          (i) carried out in accordance with 
                        accepted scientific and medical 
                        standards for the donation, collection, 
                        and preservation of such samples; and
                          (ii) conducted so that the tissues 
                        and other materials saved, as well as 
                        any database compiled from such tissues 
                        and materials, are available to 
                        researchers at a reasonable cost and on 
                        an expedited basis.
  (e) Consolidation.--The Secretary, acting through the 
Director, may consolidate program activities under this section 
if such consolidation would improve program efficiencies and 
outcomes.
  (f) Authorization of Appropriations.--
          (1) In general.--There is authorized to be 
        appropriated--
                  (A) $68,000,000 for fiscal year 2007, 
                $82,000,000 for fiscal year 2008, $96,000,000 
                for fiscal year 2009, $120,000,000 for fiscal 
                year 2010, and $134,000,000 for fiscal year 
                2011, to carry out subsections (a), (b), and 
                (d);
                  (B) $26,000,000 for fiscal year 2007, 
                $32,500,000 for fiscal year 2008, $39,000,000 
                for fiscal year 2009, $45,500,000 for fiscal 
                year 2010, and $52,000,000 for fiscal year 
                2011, to carry out subsection (c)(1); and
                  (C) $6,000,000 for fiscal year 2007, 
                $7,500,000 for fiscal year 2008, $9,000,000 for 
                fiscal year 2009, $10,500,000 for fiscal year 
                2010, and $12,000,000 for fiscal year 2011, to 
                carry out subsection (c)(2).
          (2) General usage.--Of the amounts appropriated under 
        subparagraphs (B) and (C) of paragraph (1), not to 
        exceed 5 percent of such amounts may be utilized by the 
        National Institutes of Health for administrative and 
        other expenses.
  (g) Sunset.--This section shall not apply after September 30, 
2011.

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