[House Report 111-43]
[From the U.S. Government Publishing Office]
111th Congress Report
HOUSE OF REPRESENTATIVES
1st Session 111-43
======================================================================
WAKEFIELD ACT
_______
March 23, 2009.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______
Mr. Waxman, from the Committee on Energy and Commerce, submitted the
following
R E P O R T
[To accompany H.R. 479]
[Including cost estimate of the Congressional Budget Office]
The Committee on Energy and Commerce, to whom was referred
the bill (H.R. 479) to amend the Public Health Service Act to
provide a means for continued improvement in emergency medical
services for children, having considered the same, report
favorably thereon with an amendment and recommend that the bill
as amended do pass.
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 ``Wakefield Act''.
SEC. 2. FINDINGS AND PURPOSE.
(a) Findings.--Congress makes the following findings:
(1) There are 31,000,000 child and adolescent visits to the
Nation's emergency departments every year.
(2) Over 90 percent of children requiring emergency care are seen
in general hospitals, not in free-standing children's hospitals, with
one-quarter to one-third of the patients being children in the typical
general hospital emergency department.
(3) Severe asthma and respiratory distress are the most common
emergencies for pediatric patients, representing nearly one-third of
all hospitalizations among children under the age of 15 years, while
seizures, shock, and airway obstruction are other common pediatric
emergencies, followed by cardiac arrest and severe trauma.
(4) Up to 20 percent of children needing emergency care have
underlying medical conditions such as asthma, diabetes, sickle-cell
disease, low birth weight, and bronchopulmonary dysplasia.
(5) Significant gaps remain in emergency medical care delivered to
children. Only about 6 percent of hospitals have available all the
pediatric supplies deemed essential by the American Academy of
Pediatrics and the American College of Emergency Physicians for
managing pediatric emergencies, while about half of hospitals have at
least 85 percent of those supplies.
(6) Providers must be educated and trained to manage children's
unique physical and psychological needs in emergency situations, and
emergency systems must be equipped with the resources needed to care
for this especially vulnerable population.
(7) Systems of care must be continually maintained, updated, and
improved to ensure that research is translated into practice, best
practices are adopted, training is current, and standards and protocols
are appropriate.
(8) The Emergency Medical Services for Children (EMSC) Program
under section 1910 of the Public Health Service Act (42 U.S.C. 300w-9)
is the only Federal program that focuses specifically on improving the
pediatric components of emergency medical care.
(9) The EMSC Program promotes the nationwide exchange of pediatric
emergency medical care knowledge and collaboration by those with an
interest in such care and is depended upon by Federal agencies and
national organizations to ensure that this exchange of knowledge and
collaboration takes place.
(10) The EMSC Program also supports a multi-institutional network
for research in pediatric emergency medicine, thus allowing providers
to rely on evidence rather than anecdotal experience when treating ill
or injured children.
(11) The Institute of Medicine stated in its 2006 report,
``Emergency Care for Children: Growing Pains'', that the EMSC Program
``boasts many accomplishments ... and the work of the program continues
to be relevant and vital''.
(12) The EMSC Program is celebrating its 25th anniversary, marking
a quarter-century of driving key improvements in emergency medical
services to children, and should continue its mission to reduce child
and youth morbidity and mortality by supporting improvements in the
quality of all emergency medical and emergency surgical care children
receive.
(b) Purpose.--It is the purpose of this Act to reduce child and
youth morbidity and mortality by supporting improvements in the quality
of all emergency medical care children receive.
SEC. 3. REAUTHORIZATION OF EMERGENCY MEDICAL SERVICES FOR CHILDREN
PROGRAM.
Section 1910 of the Public Health Service Act (42 U.S.C. 300w-9) is
amended--
(1) in subsection (a), by striking ``3-year period (with an
optional 4th year'' and inserting ``4-year period (with an optional 5th
year'';
(2) in subsection (d)--
(A) by striking ``and such sums'' and inserting ``such sums''; and
(B) by inserting before the period the following: ``, $25,000,000
for fiscal year 2010, $26,250,000 for fiscal year 2011, $27,562,500 for
fiscal year 2012, $28,940,625 for fiscal year 2013, and $30,387,656 for
fiscal year 2014'';
(3) by redesignating subsections (b) through (d) as subsections (c)
through (e), respectively; and
(4) by inserting after subsection (a) the following:
``(b)(1) The purpose of the program established under this section
is to reduce child and youth morbidity and mortality by supporting
improvements in the quality of all emergency medical care children
receive, through the promotion of projects focused on the expansion and
improvement of such services, including those in rural areas and those
for children with special health care needs. In carrying out this
purpose, the Secretary shall support emergency medical services for
children by supporting projects that--
``(A) develop and present scientific evidence;
``(B) promote existing and innovative technologies appropriate for
the care of children; or
``(C) provide information on health outcomes and effectiveness and
cost-effectiveness.
``(2) The program established under this section shall--
``(A) strive to enhance the pediatric capability of emergency
medical service systems originally designed primarily for adults; and
``(B) in order to avoid duplication and ensure that Federal
resources are used efficiently and effectively, be coordinated with all
research, evaluations, and awards related to emergency medical services
for children undertaken and supported by the Federal Government.''.
CONTENTS
Page
Purpose and Summary.............................................. 3
Background and Need for Legislation.............................. 3
Hearings......................................................... 3
Committee Consideration.......................................... 3
Committee Votes.................................................. 4
Committee Oversight Findings..................................... 4
Statement of General Performance Goals and Objectives............ 4
New Budget Authority, Entitlement Authority, and Tax Expenditures 4
Earmarks and Tax and Tariff Benefits............................. 4
Committee Cost Estimate.......................................... 4
Congressional Budget Office Estimate............................. 5
Federal Mandates Statement....................................... 6
Advisory Committee Statement..................................... 6
Constitutional Authority Statement............................... 6
Applicability to Legislative Branch.............................. 6
Section-by-Section Analysis of the Legislation................... 6
Explanation of Amendments........................................ 7
Changes in Existing Law Made by the Bill, As Reported............ 7
Purpose and Summary
The purpose of H.R. 479, the ``Wakefield Act'', is to amend
the Public Health Service Act to provide a means for continued
improvement in emergency medical services for children. The
bill revises and extends the authorization for the Emergency
Medicaid Services for Children program for the 5-year period FY
2010 through FY 2014. The amounts authorized to be appropriated
for this program are $25 million in FY 2010 and $138.14 million
over 5 years.
Background and Need for Legislation
Each year, injury alone claims more lives of children
between the ages of 1 and 19 than do all forms of illness.
Although Early Emergency Medical Services (EMS) systems were
designed to provide rapid intervention for sudden cardiac
arrest in adults and rapid transport for motor vehicle crash
victims, there has been limited recognition that children
require specialized care. In many EMS systems, children's needs
were overlooked as services were developed for adult trauma and
cardiac patients.
The Emergency Medical Services for Children (EMSC) program
began in 1984 and is designed to ensure state-of-the-art
emergency medical care for ill or injured children and
adolescents. It covers the entire spectrum of emergency medical
care. The EMSC program provides grants to states to improve
existing EMS systems and to schools of medicine to develop and
evaluate improved procedures and protocols for treating
children. Since its establishment 25 years ago, the EMSC
program has driven major improvements in emergency care for
children. Injury-related deaths among children have dropped by
40% over that period.
Although much progress has been achieved, more remains to
be done. The EMSC program's authorization expired in September
2005.
Hearings
The Committee on Energy and Commerce did not hold hearings
on the legislation.
Committee Consideration
The Committee on Energy and Commerce met in open markup
session on Wednesday, March 4, 2009, and, pursuant to a motion
by Mr. Waxman, agreed by unanimous consent to consider and
approve H.R. 479 and several other bills en bloc. H.R. 479 was
ordered favorably reported, amended, to the House by a voice
vote. A manager's amendment to H.R. 479 offered by Mr. Waxman
was adopted by unanimous consent.
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 or
ordering H.R. 479 reported to the House.
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
The objective of H.R. 479 is to extend by one year the
length of time for which a grant may be awarded under the EMSC
grant program, which allows the Secretary of Health and Human
Services (HHS) to make grants to states or schools of medicine
to support projects to expand and improve EMS for children who
need treatment for trauma or critical care. Furthermore, H.R.
479 sets forth as the purpose of the program the reduction of
child and youth morbidity and mortality by supporting
improvements in the quality of all emergency medical care
children receive. H.R. 479 requires the Secretary of HHS to
support emergency medical services for children by supporting
projects that: (1) develop and present scientific evidence; (2)
promote existing innovative technologies appropriate for the
care of children; and (3) provide information on health
outcomes and effectiveness and cost-effectiveness. Lastly, H.R.
479 states that the EMSC program shall strive to enhance the
pediatric capability of EMS systems and must be coordinated
with all research, evaluations, and awards undertaken by the
federal government related to EMS for children.
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. 479 would result in no new or increased budget
authority, entitlement authority, or tax expenditures or
revenues.
Earmarks and Tax and Tariff Benefits
In compliance with clause 9 of rule XXI of the Rules of the
House of Representatives, H.R. 479 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.
479 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. 479 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, March 18, 2009.
Hon. Henry A. Waxman,
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. 479, the Wakefield
Act.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Lisa Ramirez-
Branum.
Sincerely,
Douglas W. Elmendorf,
Director.
Enclosure.
H.R. 479--Wakefield Act
H.R. 479 would amend the Public Health Service Act to
direct the Secretary of Health and Human Services to provide
grants to states and medical schools for several activities
intended to reduce child morbidity and mortality by improving
emergency medical services for children.
The bill would authorize the appropriation of $25 million
for 2010 and $138 million over the 2010-2014 period for those
purposes. Based on historical patterns of spending for similar
activities, CBO estimates that implementing H.R. 479 would cost
$4 million in 2010 and $96 million over the 2010-2014 period,
assuming appropriation of the specified amounts. Enacting H.R.
479 would have no effect on direct spending or revenues.
H.R. 479 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act.
The estimated budgetary impact of H.R. 479 is shown in the
following table. The costs of the legislation fall within
budget function 550 (health).
----------------------------------------------------------------------------------------------------------------
By fiscal year, in millions of dollars--
--------------------------------------------------
2010 2011 2012 2013 2014 2010-2014
----------------------------------------------------------------------------------------------------------------
CHANGES IN SPENDING SUBJECT TO APPROPRIATION
Authorization Level.......................................... 25 26 28 29 30 138
Estimated Outlays............................................ 4 15 23 27 28 96
----------------------------------------------------------------------------------------------------------------
The CBO staff contact for this estimate is Lisa Ramirez-
Branum. This estimate was approved by Peter H. Fontaine,
Assistant Director for Budget Analysis.
Federal Mandates Statement
The Committee adopts as its own the estimate of federal
mandates regarding H.R. 479 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 H.R. 479.
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. 479 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. 479 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 of the Act as the
``Wakefield Act''.
Section 2. Findings and purpose
Section 2 states the congressional findings.
Section 3. Reauthorization of emergency medical services for children
program
Section 3 of this legislation amends Section 1910 of the
Public Health Service Act (42 U.S.C. 300w-9).
Section 3 extends by 1 year the length of time for which a
grant may be awarded under the EMSC program. The Secretary of
HHS awards these grants to states or schools of medicine to
support projects to expand and improve emergency medical
services for children who need treatment for trauma or critical
care.
Section 3 sets forth as the purpose of the program the
reduction of child and youth morbidity and mortality by
supporting improvements in the quality of all emergency medical
care children receive.
Section 3 requires that the Secretary of HHS support
emergency medical services for children by supporting projects
that develop and present scientific evidence which promotes
existing innovative technologies appropriate for the care of
children and which provides information on health outcomes,
effectiveness, and cost-effectiveness.
Section 3 states that the EMSC program shall strive to
enhance the pediatric capability of EMS systems and, in order
to avoid duplication, coordinate with all research,
evaluations, and awards undertaken by the federal government
related to EMS for children.
Finally, Section 3 amends the authorization of
appropriations for the EMSC program. H.R. 479 changes ``and
such sums'' to ``such sums'' and inserts ``$25,000,000 for
fiscal year 2010, $26,250,000 for fiscal year 2011, $27,562,500
for fiscal year 2012, $28,940,625 for fiscal year 2013, and
$30,387,656 for fiscal year 2014''.
Explanation of Amendments
Mr. Waxman offered a manager's amendment to restore certain
provisions to H.R. 479 that had appeared in H.R. 2464 in the
110th Congress. These include certain program requirements as
well as requirements regarding how the Secretary will, through
projects the Department funds, support emergency medical
services for children.
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 XIX--BLOCK GRANTS
Part A--Preventive Health and Health Services Block Grant
* * * * * * *
EMERGENCY MEDICAL SERVICES FOR CHILDREN
Sec. 1910. (a) For activities in addition to the activities
which may be carried out by States under section 1904(a)(1)(F),
the Secretary may make grants to States or accredited schools
of medicine in States to support a program of demonstration
projects for the expansion and improvement of emergency medical
services for children who need treatment for trauma or critical
care. Any grant made under this subsection shall be for not
more than a [3-year period (with an optional 4th year] 4-year
period (with an optional 5th year based on performance),
subject to annual evaluation by the Secretary. Only 3 grants
under this subsection may be made in a State (to a State or to
a school of medicine in such State) in any fiscal year.
(b)(1) The purpose of the program established under this
section is to reduce child and youth morbidity and mortality by
supporting improvements in the quality of all emergency medical
care children receive, through the promotion of projects
focused on the expansion and improvement of such services,
including those in rural areas and those for children with
special health care needs. In carrying out this purpose, the
Secretary shall support emergency medical services for children
by supporting projects that--
(A) develop and present scientific evidence;
(B) promote existing and innovative technologies
appropriate for the care of children; or
(C) provide information on health outcomes and
effectiveness and cost-effectiveness.
(2) The program established under this section shall--
(A) strive to enhance the pediatric capability of
emergency medical service systems originally designed
primarily for adults; and
(B) in order to avoid duplication and ensure that
Federal resources are used efficiently and effectively,
be coordinated with all research, evaluations, and
awards related to emergency medical services for
children undertaken and supported by the Federal
Government.
[(b)] (c) The Secretary may renew a grant made under
subsection (a) for one additional one-year period only if the
Secretary determines that renewal of such grant will provide
significant benefits through the collection, analysis, and
dissemination of information or data which will be useful to
States in which grants under such subsection have not been
made.
[(c)] (d) For purposes of this section--
(1) * * *
* * * * * * *
[(d)] (e) To carry out this section, there are authorized to
be appropriated $2,000,000 for fiscal year 1985 and for each of
the two succeeding fiscal years, $3,000,000 for fiscal year
1989, $4,000,000 for fiscal year 1990, $5,000,000 for each of
the fiscal years 1991 and 1992, [and such sums] such sums as
may be necessary for each of the fiscal years 1993 through
2005, $25,000,000 for fiscal year 2010, $26,250,000 for fiscal
year 2011, $27,562,500 for fiscal year 2012, $28,940,625 for
fiscal year 2013, and $30,387,656 for fiscal year 2014.
* * * * * * *