[House Report 110-376]
[From the U.S. Government Publishing Office]



110th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES
 1st Session                                                    110-376

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



 
                    VISION CARE FOR KIDS ACT OF 2007

                                _______
                                

October 15, 2007.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

 Mr. Dingell, from the Committee on Energy and Commerce, submitted the 
                               following

                              R E P O R T

                        [To accompany H.R. 507]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Energy and Commerce, to whom was referred 
the bill (H.R. 507) to establish a grant program to provide 
vision care to children, and for other purposes, having 
considered the same, report favorably thereon with an amendment 
and recommend that the bill as amended do pass.

                                CONTENTS

                                                                   Page
Amendment........................................................     1
Purpose and Summary..............................................     3
Background and Need for Legislation..............................     3
Hearings.........................................................     4
Committee Consideration..........................................     4
Committee Votes..................................................     4
Committee Oversight Findings.....................................     4
Statement of General Performance Goals and Objectives............     4
New Budget Authority, Entitlement Authority, and Tax Expenditures     5
Earmarks and Tax and Tariff Benefits.............................     5
Committee Cost Estimate..........................................     5
Congressional Budget Office Estimate.............................     5
Federal Mandates Statement.......................................     7
Advisory Committee Statement.....................................     7
Constitutional Authority Statement...............................     7
Applicability to Legislative Branch..............................     7
Section-by-Section Analysis of the Legislation...................     7

                               AMENDMENT

    The amendment is as follows:
    Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE.

  This Act may be cited as the ``Vision Care for Kids Act of 2007''.

SEC. 2. FINDINGS.

  Congress makes the following findings:
          (1) Millions of children in the United States suffer from 
        vision problems, many of which go undetected. Because children 
        with vision problems can struggle developmentally, resulting in 
        physical, emotional, and social consequences, good vision is 
        essential for proper physical development and educational 
        progress.
          (2) Vision problems in children range from common conditions 
        such as refractive errors, amblyopia, strabismus, ocular 
        trauma, and infections, to rare but potentially life- or sight-
        threatening problems such as retinoblastoma, infantile 
        cataracts, congenital glaucoma, and genetic or metabolic 
        diseases of the eye.
          (3) Since many serious ocular conditions are treatable if 
        identified in the preschool and early school-age years, early 
        detection provides the best opportunity for effective treatment 
        and can have far-reaching implications for vision.
          (4) Various identification methods, including vision 
        screening and comprehensive eye examinations required by State 
        laws, can be helpful in identifying children needing services. 
        A child identified as needing services through vision screening 
        should receive a comprehensive eye examination followed by 
        subsequent treatment as needed. Any child identified as needing 
        services should have access to subsequent treatment as needed.
          (5) There is a need to increase public awareness about the 
        prevalence and devastating consequences of vision disorders in 
        children and to educate the public and health care providers 
        about the warning signs and symptoms of ocular and vision 
        disorders and the benefits of early detection, evaluation, and 
        treatment.

SEC. 3. GRANTS REGARDING VISION CARE FOR CHILDREN.

  (a) In General.--The Secretary of Health and Human Services (referred 
to in this section as the ``Secretary''), acting through the Director 
of the Centers for Disease Control and Prevention, may award grants to 
States on the basis of an established review process for the purpose of 
complementing existing State efforts for--
          (1) providing comprehensive eye examinations by a licensed 
        optometrist or ophthalmologist for children who have been 
        previously identified through a vision screening or eye 
        examination by a licensed health care provider or vision 
        screener as needing such services, with priority given to 
        children who are under the age of 9 years;
          (2) providing treatment or services, subsequent to the 
        examinations described in paragraph (1), necessary to correct 
        vision problems; and
          (3) developing and disseminating, to parents, teachers, and 
        health care practitioners, educational materials on recognizing 
        signs of visual impairment in children.
  (b) Criteria and Coordination.--
          (1) Criteria.--The Secretary, in consultation with 
        appropriate professional and patient organizations including 
        individuals with knowledge of age appropriate vision services, 
        shall develop criteria--
                  (A) governing the operation of the grant program 
                under subsection (a); and
                  (B) for the collection of data related to vision 
                assessment and the utilization of follow-up services.
          (2) Coordination.--The Secretary shall, as appropriate, 
        coordinate the program under subsection (a) with the program 
        under section 330 of the Public Health Service Act (relating to 
        health centers) (42 U.S.C. 254b), the program under title XIX 
        of the Social Security Act (relating to the Medicaid program) 
        (42 U.S.C. 1396 et seq.), the program under title XXI of such 
        Act (relating to the State children's health insurance program) 
        (42 U.S.C. 1397aa et seq.), and with other Federal or State 
        programs that provide services to children.
  (c) Application.--To be eligible to receive a grant under subsection 
(a), a State shall submit to the Secretary an application in such form, 
made in such manner, and containing such information as the Secretary 
may require, including--
          (1) information on existing Federal, Federal-State, or State-
        funded children's vision programs;
          (2) a plan for the use of grant funds, including how funds 
        will be used to complement existing State efforts (including 
        possible partnerships with non-profit entities);
          (3) a plan to determine if a grant eligible child has been 
        identified as provided for in subsection (a); and
          (4) a description of how funds will be used to provide items 
        or services, only as a secondary payer--
                  (A) for an eligible child, to the extent that the 
                child is not covered for the items or services under 
                any State compensation program, under an insurance 
                policy, or under any Federal or State health benefits 
                program; or
                  (B) for an eligible child, to the extent that the 
                child receives the items or services from an entity 
                that provides health services on a prepaid basis.
  (d) Evaluations.--To be eligible to receive a grant under subsection 
(a), a State shall agree that, not later than 1 year after the date on 
which amounts under the grant are first received by the State, and 
annually thereafter while receiving amounts under the grant, the State 
will submit to the Secretary an evaluation of the operations and 
activities carried out under the grant, including--
          (1) an assessment of the utilization of vision services and 
        the status of children receiving these services as a result of 
        the activities carried out under the grant;
          (2) the collection, analysis, and reporting of children's 
        vision data according to guidelines prescribed by the 
        Secretary; and
          (3) such other information as the Secretary may require.
  (e) Limitations in Expenditure of Grant.--A grant may be made under 
subsection (a) only if the State involved agrees that the State will 
not expend more than 20 percent of the amount received under the grant 
to carry out the purpose described in paragraph (3) of such subsection.
  (f) Matching Funds.--
          (1) In general.--With respect to the costs of the activities 
        to be carried out with a grant under subsection (a), a 
        condition for the receipt of the grant is that the State 
        involved agrees to make available (directly or through 
        donations from public or private entities) non-Federal 
        contributions toward such costs in an amount that is not less 
        than 25 percent of such costs.
          (2) Determination of amount contributed.--Non-Federal 
        contributions required in paragraph (1) may be in cash or in 
        kind, fairly evaluated, including plant, equipment, or 
        services. Amounts provided by the Federal Government, or 
        services assisted or subsidized to any significant extent by 
        the Federal Government, may not be included in determining the 
        amount of such non-Federal contributions.
  (g) Definition.--For purposes of this section, the term 
``comprehensive eye examination'' includes an assessment of a patient's 
history, general medical observation, external and ophthalmoscopic 
examination, visual acuity, ocular alignment and motility, refraction, 
and as appropriate, binocular vision or gross visual fields, performed 
by an optometrist or an ophthalmologist.
  (h) Authorization of Appropriations.--For the purpose of carrying out 
this section, there is authorized to be appropriated $65,000,000 for 
the period of fiscal years 2009 through 2013.

                          PURPOSE AND SUMMARY

    The purpose of H.R. 507, the Vision Care for Kids Act of 
2007, is to establish a grant program to provide care for 
children with visual impairment.

                  BACKGROUND AND NEED FOR LEGISLATION

    Vision impairment affects approximately 1.2 out of every 
1,000 children who are 8 years of age. Vision problems can 
occur at any point during a lifetime, but tend to be 
particularly damaging to school age children because 
developmental struggles may result in physical, emotional, and 
social consequences. For instance, a child may miss learning 
opportunities by failing to explore his or her environment. 
Additionally, if a child is visually impaired, he or she may be 
unable to imitate social behavior or understand nonverbal cues.
    A component of Healthy People, Healthy Vision 2010 
underscores the need for correcting children's vision problems 
at a young age. Healthy Vision 2010 recommends that all 
children receive a vision-screening exam from their healthcare 
provider before they reach the age of 5. Early recognition of 
eye disease results in more effective treatment that can be 
sight-saving or even life-saving. Yet, in 2002, 36 percent of 
children under the age of 5 did not receive any vision 
screening.
    In addition to the psychological costs, the economic costs 
for people with impaired vision are very high. It is estimated 
that the lifetime costs for all people with vision impairment 
who were born in 2000 will total $2.5 billion. These costs 
include both direct and indirect costs. Direct medical costs 
include doctor visits, prescription drugs, and inpatient 
hospital stays; direct non-medical expenses can include home 
modifications and special education. Indirect costs account for 
the majority of costs, and include the value of lost wages when 
a person dies early, cannot work, or is limited in the amount 
or type of work he or she can perform.

                                HEARINGS

    The Committee on Energy and Commerce has not held hearings 
on the legislation.

                        COMMITTEE CONSIDERATION

    On Thursday, July 19, 2007, the Subcommittee on Health met 
in open markup session and favorably forwarded H.R. 507 to the 
full Committee, amended, by a voice vote. On Thursday, 
September 27, 2007, the full Committee met in open markup 
session and ordered H.R. 507 favorably reported to the House, 
as amended by the Subcommittee, by a voice vote. No amendments 
were offered during full Committee consideration.

                            COMMITTEE VOTES

    Clause 3(b) of rule XIII of the Rules of the House of 
Representatives requires the Committee to list the record votes 
on the motion to report legislation and amendments thereto. 
There were no recorded votes taken during consideration of H.R. 
507 or in connection with ordering the bill reported. A motion 
by Mr. Dingell to order H.R. 507 favorably reported to the 
House, as amended, was agreed to by a voice vote.

                      COMMITTEE OVERSIGHT FINDINGS

    Regarding clause 3(c)(1) of rule XIII of the Rules of the 
House of Representatives, the oversight findings of the 
Committee are reflected in this report.

         STATEMENT OF GENERAL PERFORMANCE GOALS AND OBJECTIVES

    H.R. 507 would allow the Secretary of Health and Human 
Services, acting through the Director of the Centers for 
Disease Control and Prevention (CDC), to award grants to States 
to: (1) provide comprehensive eye examinations by a licensed 
optometrist or ophthalmologist for children identified by a 
licensed healthcare provider or vision screener, with priority 
to children under age 9; (2) provide treatment or services to 
correct vision problems of such children; and (3) develop and 
disseminate educational materials on recognizing signs of 
visual impairment in children.

   NEW BUDGET AUTHORITY, ENTITLEMENT AUTHORITY, AND TAX EXPENDITURES

    In compliance with clause 3(c)(2) of rule XIII of the Rules 
of the House of Representatives, the Committee finds that H.R. 
507 would result in no new or increased budget authority, 
entitlement authority, or tax expenditures.

                  EARMARKS AND TAX AND TARIFF BENEFITS

    In compliance with clause 9 of rule XXI of the Rules of the 
House of Representatives, H.R. 507 does not contain any 
congressional earmarks, limited tax benefits, or limited tariff 
benefits as defined in clause 9(d), 9(e), or 9(f) of rule XXI.

                        COMMITTEE COST ESTIMATE

    The Committee adopts as its own the cost estimate prepared 
by the Director of the Congressional Budget Office pursuant to 
section 402 of the Congressional Budget Act of 1974.

                  CONGRESSIONAL BUDGET OFFICE ESTIMATE

    Pursuant to clause 3(c)(3) of rule XIII of the Rules of the 
House of Representatives, the following is the cost estimate 
provided by the Congressional Budget Office pursuant to section 
402 of the Congressional Budget Act of 1974:
                                     U.S. Congress,
                               Congressional Budget Office,
                                  Washington, DC, October 10, 2007.
Hon. John D. Dingell,
Chairman, Committee on Energy and Commerce,
House of Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 507, the Vision 
Care for Kids Act of 2007.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contacts are Tim 
Gronniger and Jeanne De Sa.
            Sincerely,
                                         Robert A. Sunshine
                                   (for Peter R. Orszag, Director).
    Enclosure.

H.R. 507--Vision Care for Kids Act of 2007

    Summary: H.R. 507 would direct the Centers for Disease 
Control and Prevention (CDC) to administer grants to states to 
increase examinations of children for vision problems, arrange 
for treatment of any problems detected, and conduct education 
to promote detection of vision disorders. For those purposes it 
would authorize the appropriation of $65 million over the 2009-
2013 period. Based on historical patterns of spending for 
similar activities, CBO estimates that implementing H.R. 507 
would cost $38 million over the 2009-2012 period and $65 
million over the 2009-2017 period, assuming appropriation of 
the authorized amount. In addition to those discretionary 
costs, CBO estimates that the additional eye examinations 
resulting from H.R. 507 would lead to some additional spending 
for Medicaid, which pays for vision services for eligible 
children. Any such increase in Medicaid spending would depend 
upon future appropriations for the CDC grant program.
    The bill contains no intergovernmental or private-sector 
mandates, as defined in the Unfunded Mandates Reform Act 
(UMRA). Any costs to states would be incurred voluntarily.
    The estimated budgetary impact of H.R. 507 is shown in the 
following table. The costs of this legislation fall within 
budget function 550 (health).

------------------------------------------------------------------------
                                      By fiscal year, in millions of
                                                 dollars--
                                 ---------------------------------------
                                   2008    2009    2010    2011    2012
------------------------------------------------------------------------
              CHANGES IN SPENDING SUBJECT TO APPROPRIATION

Estimated Authorization Level          0      10      13      14      14
Estimated Outlays                      0       4       9      12      13
------------------------------------------------------------------------

    Basis of estimate: H.R. 507 would authorize the 
appropriation of $65 million to the CDC for the 2009-2013 
period for purposes of detecting and treating vision disorders 
in children. In particular, the CDC would be directed to 
administer grants to States for three purposes: (1) providing 
eye examinations of children with potential eye disorders, as 
identified by screenings; (2) funding treatment of disorders 
diagnosed during those examinations; and (3) educating parents, 
teachers, and health care practitioners on symptoms of eye 
disorders to improve detection of such diseases. States would 
be required to seek reimbursement from private and other public 
payors (such as Medicaid and the State Children's Health 
Insurance Program) before applying grant funds towards 
treatment of vision disorders.
    Based on historical spending patterns for similar programs 
at CDC, and assuming appropriation of the authorized amount, 
CBO estimates that implementing H.R. 507 would cost $38 million 
over the 2009-2012 period and $65 million over the 2009-2017 
period. (There would be no budgetary effect in 2008 because the 
bill would not authorize appropriations until 2009.)
    In addition to the above discretionary costs (arising from 
appropriations), CBO estimates that H.R. 507 would generate 
some additional direct spending in the Medicaid program 
(assuming appropriation of the amount authorized for the CDC 
grant program). That spending would arise under title XIX of 
the Social Security Act, which guarantees coverage for certain 
forms of vision benefits for certain children eligible for 
Medicaid. The vision examinations authorized by H.R. 507 would 
identify some children with vision disorders who would not 
otherwise be treated, and a portion of those costs would be 
paid by the Medicaid program. Such costs, which could be 
significant, would not be directly attributable to this bill 
because they would only be triggered by a future appropriation. 
(Spending by the State Children's Health Insurance Program 
would be unaffected because its total budget authority is 
capped under current law.)
    Intergovernmental and private-sector impact: H.R. 507 
contains no intergovernmental or private-sector mandates as 
defined in UMRA. States that provide services to children for 
screening and treating vision problems would benefit from grant 
funds authorized in the bill. Any costs they incur to comply 
with grant conditions, including matching funds, would be 
incurred voluntarily.
    Estimate prepared by: Federal Costs: Tim Gronniger and 
Jeanne De Sa; Impact on State, Local, and Tribal Governments: 
Lisa Ramirez-Branum; Impact on the Private Sector: Keisuke 
Nakagawa.
    Estimate approved by: Peter H. Fontaine, Assistant Director 
for Budget Analysis.

                       FEDERAL MANDATES STATEMENT

    The Committee adopts as its own the estimate of Federal 
mandates prepared by the Director of the Congressional Budget 
Office pursuant to section 423 of the Unfunded Mandates Reform 
Act.

                      ADVISORY COMMITTEE STATEMENT

    No advisory committees within the meaning of section 5(b) 
of the Federal Advisory Committee Act were created by this 
legislation.

                   CONSTITUTIONAL AUTHORITY STATEMENT

    Pursuant to clause 3(d)(1) of rule XIII of the Rules of the 
House of Representatives, the Committee finds that the 
Constitutional authority for this legislation is provided in 
the provisions of Article I, section 8, clause 1, that relate 
to expending funds to provide for the general welfare of the 
United States.

                  APPLICABILITY TO LEGISLATIVE BRANCH

    The Committee finds that the legislation does not relate to 
the terms and conditions of employment or access to public 
services or accommodations within the meaning of section 
102(b)(3) of the Congressional Accountability Act.

             SECTION-BY-SECTION ANALYSIS OF THE LEGISLATION

Section 1. Short title.

    Section 1 establishes the short title of the Act as the 
``Vision Care for Kids Act of 2007.''

Section 2. Findings.

    Section 2 sets out the finding of the Act.

Section 3. Grants regarding vision care for children.

    Section 3 amends the Public Health Service Act to allow the 
Secretary of Health and Human Services, acting through the 
Director for the Centers for Disease Control and Prevention, to 
award grants to States to: (1) provide comprehensive eye 
examinations by a licensed optometrist or ophthalmologist for 
children identified by a licensed healthcare provider or vision 
screener, with priority to children under age 9; (2) provide 
treatment or services to correct vision problems of such 
children; and (3) develop and disseminate educational materials 
on recognizing signs of visual impairment in children.

                                  
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