[House Report 110-681]
[From the U.S. Government Publishing Office]



110th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES
 2d Session                                                     110-681

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



 
     POISON CENTER SUPPORT, ENHANCEMENT, AND AWARENESS ACT OF 2008

                                _______
                                

  June 4, 2008.--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. 5669]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Energy and Commerce, to whom was referred 
the bill (H.R. 5669) to amend the Public Health Service Act to 
reauthorize the poison center national toll-free number, 
national media campaign, and grant program to provide 
assistance for poison prevention, sustain the funding of poison 
centers, and enhance the public health of people of the United 
States, having considered the same, report favorably thereon 
without amendment and recommend that the bill do pass.

                                CONTENTS

                                                                   Page
Purpose and Summary..............................................     2
Background and Need for Legislation..............................     2
Hearings.........................................................     2
Committee Consideration..........................................     3
Committee Votes..................................................     3
Committee Oversight Findings.....................................     3
Statement of General Performance Goals and Objectives............     3
New Budget Authority, Entitlement Authority, and Tax Expenditures     3
Earmarks and Tax and Tariff Benefits.............................     3
Committee Cost Estimate..........................................     3
Congressional Budget Office Estimate.............................     3
Federal Mandates Statement.......................................     4
Advisory Committee Statement.....................................     5
Constitutional Authority Statement...............................     5
Applicability to Legislative Branch..............................     5
Section-by-Section Analysis of the Legislation...................     5
Changes in Existing Law Made by the Bill, as Reported............     6

                          Purpose and Summary

    The purpose of H.R. 5669, the Poison Center Support, 
Enhancement, and Awareness Act of 2008, is to reauthorize a 
poison centers national toll-free number and provide for the 
maintenance of such a number, including appropriate 
authorizations. H.R. 5669 would also reauthorize a nationwide 
media campaign to educate the public and healthcare providers 
about poison prevention and the availability of poison center 
resources, including advertising of the nationwide toll-free 
number.

                  Background and Need for Legislation

    Unintentional poisoning is a significant problem, ranking 
second only to motor vehicle crashes as a cause of 
unintentional injury and death in 2005.\1\ The economic cost is 
also considerable as poisonings led to $26 billion in medical 
expenses in 2000.\2\ While it is widely recognized that 
unintentional exposure to hazardous household substances occurs 
among preschool-aged children, it is less well known that 
poisoning affects people across their lifespan. For instance, 
unintentional drug overdose and suicide deaths are more likely 
to occur among adolescents and young adults, while the elderly 
are at high risk for poisoning because of the possibility of 
mixing medications or taking the wrong dosage. Poison control 
centers respond to calls dealing with all of these issues.\3\
---------------------------------------------------------------------------
    \1\http://www.cdc.gov/ncipc/factsheets/poisoning.htm
    \2\http://www.cdc.gov/ncipc/factsheets/poisoning.htm
    \3\http://books.nap.edu/catalog/10971.html
---------------------------------------------------------------------------
    The Poison Control Center Enhancement and Awareness Act was 
originally enacted in 2000 and amended in 2003 to stabilize 
poison control center operations. While centers supported by 
the Act were intended to provide an emergency safety net, they 
did not always ensure consistent, effective, and efficient 
delivery of poison prevention and control services to the U.S. 
population.\4\ A 2004 Institute of Medicine (IOM) report 
revealed some of the problems with the current network of 
poison control centers. One of the key recommendations in this 
report was that Congress provides sufficient funding to support 
the Poison Prevention and Control System with its national 
network of regional poison control centers.
---------------------------------------------------------------------------
    \4\http://books.nap.edu/catalog/10971.html
---------------------------------------------------------------------------
    H.R. 5669 addresses the IOM recommendation by reauthorizing 
a grant program that allows the Secretary of Health and Human 
Services (HHS) to make grants to certified poison centers for 
evaluating best practices for poison prevention, developing 
patient management guidelines, improving national toxics-
exposure surveillance, enhancing technological capabilities of 
those in the field of poison control, fostering enhanced public 
health utilization of national poison data, expanding 
toxicologic expertise, and improving the capacity of poison 
centers. Certified poison centers are defined as centers that 
have been certified by a professional organization in the field 
of poison control and approved by the Secretary of HHS or 
centers that have been certified by State governments and 
approved by the Secretary of HHS.

                                Hearings

    No hearings were held in connection with H.R. 5669.

                        Committee Consideration

    On Wednesday, April 23, 2008, the Subcommittee on Health 
met in open markup session and favorably forwarded H.R. 5669 to 
the full Committee for consideration by a voice vote. No 
amendments were offered during Subcommittee consideration. On 
Wednesday, May 7, 2008, the full Committee met in open markup 
session and ordered H.R. 5669 favorably reported to the House 
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. No 
record votes were taken on amendments or in connection with 
ordering H.R. 5669 reported to the House. A motion by Mr. 
Dingell to order H.R. 5669 favorably reported to the House 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 regarding H.R. 5669 are reflected in this report.

         Statement of General Performance Goals and Objectives

    The purpose of H.R. 5669 is to amend the Public Health 
Service Act to reauthorize the poison center national toll-free 
number, national media campaign, and grant program to provide 
assistance for poison prevention, sustain the funding of poison 
centers, and enhance the public health of people of the United 
States.

   New Budget Authority, Entitlement Authority, and Tax Expenditures

    Regarding compliance with clause 3(c)(2) of rule XIII of 
the Rules of the House of Representatives, the Committee finds 
that H.R. 5669 would result in no new or increased budget 
authority, entitlement authority, or tax expenditures or 
revenues.

                  Earmarks and Tax and Tariff Benefits

    Regarding compliance with clause 9 of rule XXI of the Rules 
of the House of Representatives, H.R. 5669 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 on H.R. 
5669 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 on 
H.R. 5669 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, May 20, 2008.
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. 5669, the Poison 
Center Support, Enhancement, and Awareness Act of 2008.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Andrea Noda.
            Sincerely,
                                         Robert A. Sunshine
                                   (For Peter R. Orszag, Director).
    Enclosure.

H.R. 5669--Poison Center Support, Enhancement, and Awareness Act of 
        2008

    H.R. 5669 would reauthorize the poison control program, 
which will expire in 2009, for the 2010-2014 period. The 
program, which is administered by the Health Resources and 
Services Administration (HRSA), provides grants to poison 
centers and other organizations that focus on poison control, 
funds a national media campaign, and maintains a national toll-
free number. The Congress appropriated about $27 million for 
that purpose in 2008.
    The bill would authorize the appropriation of $37.5 million 
in each of the years 2010 through 2014 for the following 
purposes: $35 million per year for the grant program, $1.5 
million per year for the media campaign, and $1 million per 
year for the maintenance of the toll-free number. Based on past 
spending for this program, CBO estimates that implementing H.R. 
5669 would cost $11 million in 2010 and $135 million over the 
2010-2014 period, assuming appropriation of authorized amounts. 
Enacting H.R. 5669 would have no effect on direct spending or 
receipts. Costs of the legislation fall within budget function 
550 (health).

----------------------------------------------------------------------------------------------------------------
                                                                By fiscal year, in millions of dollars--
                                                      ----------------------------------------------------------
                                                        2009    2010    2011    2012    2013    2014   2009-2014
----------------------------------------------------------------------------------------------------------------
                                  CHANGES IN SPENDING SUBJECT TO APPROPRIATION

Authorization Level..................................       0      38      38      38      38      38        188
Estimated Outlays....................................       0      11      27      34      37      26       135
----------------------------------------------------------------------------------------------------------------
Note.-- Numbers may not sum to totals because of rounding.

    H.R. 5669 contains no private-sector or intergovernmental 
mandates as defined in Unfunded Mandates Reform Act. State, 
local, and tribal governments that operate poison control 
centers could benefit from some of the support activities 
authorized by the bill.
    The CBO staff contact for this estimate is Andrea Noda. 
This estimate was approved by Keith J. Fontenot, Deputy 
Assistant Director for Health and Human Resources, Budget 
Analysis Division.

                       Federal Mandates Statement

    The Committee adopts as its own the estimate of Federal 
mandates regarding H.R. 5669 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 would be created by H.R. 
5669.

                   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 H.R. 5669 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 H.R. 5669 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 of 1995.

             Section-by-Section Analysis of the Legislation


Section 1. Short title

    Section 1 establishes the short title as the ``Poison 
Center Support, Enhancement, and Awareness Act of 2008''.

Section 2. Findings

    Section 2 states Congressional findings.

Section 3. Reauthorization of poison centers national toll-free number

    Section 3 amends Section 1271 of the Public Health Service 
Act to establish a nationwide toll-free phone number to access 
poison control centers. Section 3 authorizes $2 million for 
each of fiscal years 2000 through 2009 and $1 million for each 
of fiscal years 2010 through 2014 for maintenance of the toll-
free number.

Section 4. Reauthorization of nationwide media campaign to promote 
        poison center utilization

    Section 4 amends Section 1271 of the Public Health Service 
Act to direct the Secretary of HHS to carry out a national 
media campaign to educate the public and healthcare providers 
about poison prevention and the availability of poison center 
resources in local communities, including advertising for the 
nationwide toll-free number. Section 4 states that the 
Secretary of HHS may enter into contracts with a nationally 
recognized poison control organization for purposes of 
implementing this campaign.
    Section 4 also directs the Secretary of HHS to establish 
measures and benchmarks to determine the effectiveness of the 
nationwide media campaign and to submit an annual evaluation to 
Congress on its findings.
    Section 4 authorizes appropriations of such sums as may be 
necessary for each of fiscal years 2006 through 2009 and $1.5 
million for each of fiscal years 2010 through 2014.

Section 5. Reauthorization of the poison center grant program

    Section 5 directs the Secretary of HHS to award grants to 
certified poison centers for the purposes of evaluating best 
practices for poison prevention, developing patient management 
guidelines, improving national toxics-exposure surveillance, 
enhancing technological capabilities of those in the field of 
poison control, fostering enhanced public health utilization of 
national poison data, expanding toxicologic expertise, and 
improving the capacity of poison centers.
    Section 5 outlines certification requirements providing for 
either certification by an organization in the field of poison 
control and approved by the Secretary of HHS or certified by a 
State government and approved by the Secretary of HHS. This 
section also provides for a waiver of certification for a 
poison center that can reasonably demonstrate it will obtain 
certification in a reasonable amount of time as deemed 
appropriate by the Secretary of HHS.
    Section 5 also states that amounts authorized under this 
section are used to supplement, not supplant Federal, State, 
and other local funds.
    Section 5 authorizes appropriations of $27.5 million for 
each of fiscal years 2005 through 2009 and $35 million for each 
of fiscal years 2010 through 2014, $1.5 million of which must 
be used for improving technology.

         Changes in Existing Law Made by the Bill, as Reported

  In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (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 XII--TRAUMA CARE

           *       *       *       *       *       *       *



                         Part G--Poison Control


[SEC. 1271. MAINTENANCE OF A NATIONAL TOLL-FREE NUMBER.

  [(a) In General.--The Secretary shall provide coordination 
and assistance to regional poison control centers for the 
establishment of a nationwide toll-free phone number to be used 
to access such centers.
  [(b) Rule of Construction.--Nothing in this section shall be 
construed as prohibiting the establishment or continued 
operation of any privately funded nationwide toll-free phone 
number used to provide advice and other assistance for 
poisonings or accidental exposures.
  [(c) Authorization of Appropriations.--There is authorized to 
be appropriated to carry out this section $2,000,000 for each 
of the fiscal years 2000 through 2009. Funds appropriated under 
this subsection shall not be used to fund any toll-free phone 
number described in subsection (b).

[SEC. 1272. NATIONWIDE MEDIA CAMPAIGN TO PROMOTE POISON CONTROL CENTER 
                    UTILIZATION.

  [(a) In General.--The Secretary shall establish a national 
media campaign to educate the public and health care providers 
about poison prevention and the availability of poison control 
resources in local communities and to conduct advertising 
campaigns concerning the nationwide toll-free number 
established under section 1271.
  [(b) Contract With Entity.--The Secretary may carry out 
subsection (a) by entering into contracts with one or more 
nationally recognized media firms for the development and 
distribution of monthly television, radio, and newspaper public 
service announcements.
  [(c) Evaluation.--The Secretary shall--
          [(1) establish baseline measures and benchmarks to 
        quantitatively evaluate the impact of the nationwide 
        media campaign established under this section; and
          [(2) prepare and submit to the appropriate 
        congressional committees an evaluation of the 
        nationwide media campaign on an annual basis.
  [(d) Authorization of Appropriations.--There are authorized 
to be appropriated to carry out this section $600,000 for each 
of fiscal years 2000 through 2005 and such sums as may be 
necessary for each of fiscal years 2006 through 2009.

[SEC. 1273. MAINTENANCE OF THE POISON CONTROL CENTER GRANT PROGRAM.

  [(a) Regional Poison Control Centers.--The Secretary shall 
award grants to certified regional poison control centers for 
the purposes of achieving the financial stability of such 
centers, and for preventing and providing treatment 
recommendations for poisonings.
  [(b) Other Improvements.--The Secretary shall also use 
amounts received under this section to--
          [(1) develop standardized poison prevention and 
        poison control promotion programs;
          [(2) develop standard patient management guidelines 
        for commonly encountered toxic exposures;
          [(3) improve and expand the poison control data 
        collection systems, including, at the Secretary's 
        discretion, by assisting the poison control centers to 
        improve data collection activities;
          [(4) improve national toxic exposure surveillance by 
        enhancing activities at the Centers for Disease Control 
        and Prevention and the Agency for Toxic Substances and 
        Disease Registry;
          [(5) expand the toxicologic expertise within poison 
        control centers; and
          [(6) improve the capacity of poison control centers 
        to answer high volumes of calls during times of 
        national crisis.
  [(c) Certification.--Except as provided in subsection (d), 
the Secretary may make a grant to a center under subsection (a) 
only if--
          [(1) the center has been certified by a professional 
        organization in the field of poison control, and the 
        Secretary has approved the organization as having in 
        effect standards for certification that reasonably 
        provide for the protection of the public health with 
        respect to poisoning; or
          [(2) the center has been certified by a State 
        government, and the Secretary has approved the State 
        government as having in effect standards for 
        certification that reasonably provide for the 
        protection of the public health with respect to 
        poisoning.
  [(d) Waiver of Certification Requirements.--
          [(1) In general.--The Secretary may grant a waiver of 
        the certification requirement of subsection (c) with 
        respect to a noncertified poison control center or a 
        newly established center that applies for a grant under 
        this section if such center can reasonably demonstrate 
        that the center will obtain such a certification within 
        a reasonable period of time as determined appropriate 
        by the Secretary.
          [(2) Renewal.--The Secretary may renew a waiver under 
        paragraph (1).
          [(3) Limitation.--In no instance may the sum of the 
        number of years for a waiver under paragraph (1) and a 
        renewal under paragraph (2) exceed 5 years. The 
        preceding sentence shall take effect as if enacted on 
        February 25, 2000.
  [(e) Supplement Not Supplant.--Amounts made available to a 
poison control center under this section shall be used to 
supplement and not supplant other Federal, State, or local 
funds provided for such center.
  [(f) Maintenance of Effort.--A poison control center, in 
utilizing the proceeds of a grant under this section, shall 
maintain the expenditures of the center for activities of the 
center at a level that is not less than the level of such 
expenditures maintained by the center for the fiscal year 
preceding the fiscal year for which the grant is received.
  [(g) Matching Requirement.--The Secretary may impose a 
matching requirement with respect to amounts provided under a 
grant under this section if the Secretary determines 
appropriate.
  [(h) Authorization of Appropriations.--There are authorized 
to be appropriated to carry out this section $25,000,000 for 
each of the fiscal years 2000 through 2004 and $27,500,000 for 
each of fiscal years 2005 through 2009.]

SEC. 1271. MAINTENANCE OF THE NATIONAL TOLL-FREE NUMBER.

  (a) In General.--The Secretary shall provide coordination and 
assistance to poison centers for the establishment of a 
nationwide toll-free phone number, and the maintenance of such 
number, to be used to access such centers.
  (b) Authorization of Appropriations.--There are authorized to 
be appropriated $2,000,000 for each of the fiscal years 2000 
through 2009 to carry out this section; and $1,000,000 for each 
of the fiscal years 2010 through 2014 for the maintenance of 
the nationwide toll-free phone number under subsection (a).

SEC. 1272. NATIONWIDE MEDIA CAMPAIGN TO PROMOTE POISON CENTER 
                    UTILIZATION.

  (a) In General.--The Secretary shall carry out, and expand 
upon, a national media campaign to educate the public and 
health care providers about poison prevention and the 
availability of poison center resources in local communities 
and to conduct advertising campaigns concerning the nationwide 
toll-free number established under section 1271(a).
  (b) Contract With Entity.--The Secretary may carry out 
subsection (a) by entering into contracts with a nationally 
recognized organization in the field of poison control for the 
development and implementation of a nationwide poison 
prevention and poison center awareness campaign, which may 
include the development and distribution of poison prevention 
and poison center awareness materials; television, radio, 
Internet, and newspaper public service announcements; and other 
means of public and professional awareness and education.
  (c) Evaluation.--The Secretary shall--
          (1) establish baseline measures and benchmarks to 
        quantitatively evaluate the impact of the nationwide 
        media campaign carried out under this section; and
          (2) prepare and submit to the appropriate 
        congressional committees an evaluation of the 
        nationwide media campaign on an annual basis.
  (d) Authorization of Appropriations.--There are authorized to 
be appropriated to carry out this section $600,000 for each of 
the fiscal years 2000 through 2005, such sums as may be 
necessary for each of the fiscal years 2006 through 2009, and 
$1,500,000 for each of the fiscal years 2010 through 2014.

SEC. 1273. MAINTENANCE OF THE POISON CENTER GRANT PROGRAM.

  (a) Authorization of Grant Program.--The Secretary shall 
award grants to poison centers certified under subsection (c) 
(or granted a waiver under subsection (d)) and professional 
organizations in the field of poison control for the purposes 
of preventing, and providing treatment recommendations for, 
poisonings and complying with the operational requirements 
needed to sustain the certification of the center under 
subsection (c).
  (b) Additional Uses of Grant Funds.--In addition to the 
purposes described in subsection (a), a poison center or 
professional organization awarded a grant under such subsection 
may also use such grant for the following purposes:
          (1) To establish and evaluate best practices in the 
        United States for poison prevention, poison center 
        outreach, and emergency and preparedness programs.
          (2) To research, develop, implement, revise, and 
        communicate standard patient management guidelines for 
        commonly encountered toxic exposures.
          (3) To improve national toxic exposure surveillance 
        by enhancing cooperative activities between poison 
        centers in the United States and the Centers for 
        Disease Control and Prevention.
          (4) To develop, support, and enhance technology and 
        capabilities of professional organizations in the field 
        of poison control to collect national poisoning, toxic 
        occurrence, and related public health data.
          (5) To develop initiatives to foster the enhanced 
        public health utilization of national poison data 
        collected by organizations described in paragraph (4).
          (6) To support and expand the toxicologic expertise 
        within poison centers.
          (7) To improve the capacity of poison centers to 
        answer high volumes of calls and respond during times 
        of national crisis or other public health emergencies.
  (c) Certification.--Except as provided under subsection (d), 
the Secretary may make a grant to a poison center under 
subsection (a) only if--
          (1) the center has been certified by a professional 
        organization in the field of poison control, and the 
        Secretary has approved the organization as having in 
        effect standards for certification that reasonably 
        provide for the protection of the public health with 
        respect to poisoning; or
          (2) the center has been certified by a State 
        government, and the Secretary has approved the State 
        government as having in effect standards for 
        certification that reasonably provide for the 
        protection of the public health with respect to 
        poisoning.
  (d) Waiver of Certification Requirements.--
          (1) In general.--The Secretary may grant a waiver of 
        the certification requirement of subsection (c) with 
        respect to a noncertified poison center that applies 
        for a grant under this section if such center can 
        reasonably demonstrate that the center will obtain such 
        a certification within a reasonable period of time as 
        determined appropriate by the Secretary.
          (2) Renewal.--The Secretary may renew a waiver under 
        paragraph (1).
          (3) Limitation.--In no instance may the sum of the 
        number of years for a waiver under paragraph (1) and a 
        renewal under paragraph (2) exceed 5 years. The 
        preceding sentence shall take effect as of the date of 
        the enactment of the Poison Center Support, 
        Enhancement, and Awareness Act of 2008.
  (e) Supplement Not Supplant.--Amounts made available to a 
poison center under this section shall be used to supplement 
and not supplant other Federal, State, or local funds provided 
for such center.
  (f) Maintenance of Effort.--A poison center, in utilizing the 
proceeds of a grant under this section, shall maintain the 
expenditures of the center for activities of the center at a 
level that is not less than the level of expenditures 
maintained by the center for the fiscal year preceding the 
fiscal year for which the grant is received.
  (g) Authorization of Appropriations.--There are authorized to 
be appropriated to carry out this section--
          (1) for each of the fiscal years 2000 through 2004, 
        $25,000,000;
          (2) for each of the fiscal years 2005 through 2009, 
        $27,500,000; and
          (3) for each of the fiscal years 2010 through 2014, 
        $35,000,000, of which $1,500,000 shall be used to award 
        grants for the purpose described in subsection (b)(4).

           *       *       *       *       *       *       *


                                  
