[House Report 117-559]
[From the U.S. Government Publishing Office]
117th Congress } { Rept. 117-559
HOUSE OF REPRESENTATIVES
2d Session } { Part 1
======================================================================
JACKIE WALORSKI MATERNAL AND CHILD HOME VISITING REAUTHORIZATION ACT OF
2022
_______
November 15, 2022.--Ordered to be printed
_______
Mr. Neal, from the Committee on Ways and Means,
submitted the following
R E P O R T
[To accompany H.R. 8876]
[Including cost estimate of the Congressional Budget Office]
The Committee on Ways and Means, to whom was referred the
bill (H.R. 8876) to reauthorize the Maternal, Infant, and Early
Childhood Home Visiting program, and for other purposes, having
considered the same, reports favorably thereon with an
amendment and recommends that the bill as amended do pass.
CONTENTS
Page
I. SUMMARY AND BACKGROUND...........................................9
A. Purpose and Summary................................. 9
B. Background and Need for Legislation................. 9
C. Legislative History................................. 12
II. EXPLANATION OF THE BILL.........................................13
A. The Jackie Walorski Maternal and Child Home Visiting
Reauthorization Act of 2022........................ 13
III. VOTES OF THE COMMITTEE..........................................25
IV. BUDGET EFFECTS OF THE BILL......................................25
A. Committee Estimate of Budgetary Effects............. 25
B. Statement Regarding New Budget Authority and Tax
Expenditures Budget Authority...................... 25
C. Cost Estimate Prepared by the Congressional Budget
Office............................................. 26
V. OTHER MATTERS TO BE DISCUSSED UNDER THE RULES OF THE HOUSE......27
A. Committee Oversight Findings and Recommendations.... 27
B. Statement of General Performance Goals and
Objectives......................................... 27
C. Information Relating to Unfunded Mandates........... 28
D. Advisory Committee Statement........................ 28
E. Applicability to Legislative Branch................. 28
F. Congressional Earmarks, Limited Tax Benefits, and
Limited Tariff Benefits............................ 28
G. Duplication of Federal Programs..................... 28
H. Hearings............................................ 28
VI. CHANGES IN EXISTING LAW MADE BY THE BILL........................28
A. Text of Existing Law Amended or Repealed by The Bill 28
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 ``Jackie Walorski Maternal and Child
Home Visiting Reauthorization Act of 2022''.
SEC. 2. OUTCOMES DASHBOARD.
Section 511(d)(1) of the Social Security Act (42 U.S.C. 711(d)(1)) is
amended--
(1) in the paragraph heading, by striking ``benchmark areas''
and inserting ``benchmark areas related to individual family
outcomes'';
(2) in subparagraph (D)(i), by striking ``(B)'' and inserting
``(C)''; and
(3) by redesignating subparagraphs (B) through (D) as
subparagraphs (C) through (E), respectively, and inserting
after subparagraph (A) the following:
``(B) Outcomes dashboards.--The Secretary shall,
directly or by grant or contract, establish and operate
a website accessible to the public that includes an
annually updated dashboard that--
``(i) provides easy-to-understand information
on the outcomes achieved by each eligible
entity with respect to each of the benchmarks
described in subparagraph (A) of this paragraph
that apply to the eligible entity, which shall
be based on only the data elements or types of
data collected before the date of the enactment
of this section unless administering agencies
and the Secretary agree pursuant to subsection
(h)(6) that additional data is required;
``(ii) includes a template provided by the
Secretary that will enable comparison among
eligible entities not referred to in subsection
(k)(2)(A) of--
``(I) a profile of each eligible
entity showing outcome indicators and
how the outcomes compare to benchmarks
described in subclause (II);
``(II) information on the outcome
indicators and requisite outcome levels
established for each eligible entity;
``(III) information on each model
employed in the program operated by
each eligible entity, and regarding
each benchmark area described in
subsection (d)(1)(A) in which the model
used by the eligible entity is expected
to affect participant outcomes;
``(IV) the most recently available
information from the report required by
subparagraph (E) of this paragraph;
``(V) an electronic link to the State
needs assessment under subsection
(b)(1); and
``(VI) information regarding any
penalty imposed, or other corrective
action taken, by the Secretary against
a State for failing to achieve a
requisite outcome level or any other
requirement imposed by or under this
section, and an indication as to
whether the eligible entity is
operating under a corrective action
plan under subparagraph (E)(ii) of this
paragraph, and if so, a link to the
plan, an explanation of the reason for
the implementation of the plan, and a
report on any progress made in
operating under the plan;
``(iii) includes information relating to
those eligible entities for which funding is
reserved under subsection (k)(2)(A), with
modifications as necessary to reflect tribal
sovereignty, data privacy, and participant
confidentiality; and
``(iv) protects data privacy and
confidentiality of participant families.''.
SEC. 3. FUNDING.
(a) Grant Amounts.--
(1) In general.--Section 511(c)(4) of the Social Security Act
(42 U.S.C. 711(c)(4)) is amended to read as follows:
``(4) Grant amounts.--
``(A) Base grants.--
``(i) In general.--
``(I) General rule.--With respect to
each of fiscal years 2023 through 2027
for which an eligible entity not
referred to in subsection (k)(2)(A) is
awarded a base grant under this
section, the amount of the grant
payable to the eligible entity for the
fiscal year is the amount described by
clause (ii) of this subparagraph with
respect to the eligible entity, except
as provided in subclause (II) of this
clause.
``(II) Substitution of successor
eligible entity for predecessor.--If
the 1st fiscal year for which an
eligible entity is awarded a base grant
under this section for a program
operated in a State is among fiscal
years 2024 through 2027, the amount
described by clause (ii) with respect
to the eligible entity is the amount of
the base grant for which a program
operated in the State was eligible
under this subparagraph for fiscal year
2023.
``(ii) Amount described.--
``(I) General rule.--Subject to the
succeeding provisions of this clause,
the amount described by this clause
with respect to an eligible entity is--
``(aa) the amount made
available under subsection (k)
for base grants for fiscal year
2023 that remains after making
the reservations required by
subsection (k)(2) or any other
reductions required by Federal
law for fiscal year 2023;
multiplied by
``(bb) the percentage of
children in all States who have
not attained 5 years of age (as
determined by the Secretary on
the basis of the data most
recently available before
fiscal year 2023) that is
represented by the number of
such children in the State in
which the eligible entity is
operating a program pursuant to
this section (as so
determined).
``(II) Adjustments to ensure stable
funding.--If the amount otherwise
payable to an eligible entity under
subclause (I) for fiscal year 2023 is
less than 90 percent, or greater than
110 percent, of the amount payable
under this section to the eligible
entity for the program for fiscal year
2021, the Secretary shall increase the
amount otherwise so payable to 90
percent, or decrease the amount
otherwise so payable to 110 percent, as
the case may be, of the amount
otherwise so payable.
``(III) Adjustment to ensure all base
grant funds are allocated.--If the
amount described by subclause (I)(aa)
is different than the total of the
amounts otherwise described by
subclause (I) after applying subclause
(II), the Secretary shall increase or
decrease the amounts otherwise so
described after applying subclause (II)
by such equal percentage as is
necessary to reduce that difference to
zero.
``(IV) Minimum base grant amount.--
Notwithstanding the preceding
provisions of this clause, the amount
described by this clause with respect
to an eligible entity shall be not less
than $1,000,000.
``(B) Matching grants.--
``(i) Amount of grant.--
``(I) General rule.--With respect to
each of fiscal years 2024 through 2027
for which an eligible entity not
referred to in subsection (k)(2)(A) is
awarded a grant under this section, the
Secretary shall increase the amount of
the grant payable to the eligible
entity for the fiscal year under
subparagraph (A) of this paragraph by
the matching amount (if any) determined
under subclause (II) of this clause
with respect to the eligible entity for
the fiscal year and the additional
matching amount (if any) determined
under clause (iii) of this subparagraph
with respect to the eligible entity for
the fiscal year.
``(II) Matching amount.--
``(aa) In general.--Subject
to item (bb) of this subclause,
the matching amount with
respect to an eligible entity
for a fiscal year is 75 percent
of the sum of--
``(AA) the total
amount obligated by the
eligible entity for
home visiting services
in the State for the
fiscal year, from
Federal funds made
available for the
fiscal year under this
subparagraph; and
``(BB) the total
amount so obligated by
the eligible entity
from non-Federal funds,
determined under
subclause (III).
``(bb) Limitation.--The
matching amount with respect to
an eligible entity for a fiscal
year shall not exceed the
allotment under subclause (IV)
for the State in which the
eligible entity is operating a
program under this section for
the fiscal year.
``(III) Determination of obligations
from non-federal funds.--For purposes
of this clause, the total amount
obligated by an eligible entity from
non-Federal funds is the total of the
amounts that are obligated by the
eligible entity from non-Federal
sources, to the extent that--
``(aa) the services are
delivered in compliance with
subsections (d)(2) and (d)(3);
``(bb) the eligible entity
has reported the obligations to
the Secretary; and
``(cc) the amount is not
counted toward meeting the
maintenance of effort
requirement in subsection (f).
``(IV) State allotments.--The amount
allotted under this subclause for a
State in which an eligible entity is
operating a program under this section
for a fiscal year is--
``(aa) the minimum matching
grant allocation amount for the
fiscal year; plus
``(bb)(AA) the amount (if
any) by which the amount made
available under subsection (k)
for matching grants for the
fiscal year that remains after
making the reservations
required by subsection (k)(2)
or any other reduction required
by Federal law for the fiscal
year exceeds the sum of the
minimum matching grant
allocation amounts for all
eligible entities for the
fiscal year; multiplied by
``(BB) the percentage of
children in all States who have
not attained 5 years of age and
are members of families with
income not exceeding the
poverty line (as determined by
the Secretary on the basis of
the most recently available
data) that is represented by
the number of such children in
the State (as so determined).
``(V) Minimum matching grant
allocation amount.--Subject to
subclause (VI), for purposes of
subclause (IV), the minimum matching
grant allocation amount for a fiscal
year is--
``(aa) in the case of fiscal
year 2024, $776,000;
``(bb) in the case of fiscal
year 2025, $1,000,000;
``(cc) in the case of fiscal
year 2026, $1,500,000; and
``(dd) in the case of fiscal
year 2027, $2,000,000.
``(VI) Special rule.--If, after
making any reductions otherwise
required by law for a fiscal year, the
amount made available for matching
grants under this clause for the fiscal
year is insufficient to provide the
minimum matching grant allocation
amount to each eligible entity
operating a program under this section
for the fiscal year, the Secretary may
make a proportionate adjustment to the
minimum matching grant allocation
amount for the fiscal year to
accommodate the reductions.
``(ii) Submission of statement expressing
interest in additional matching funds if
available.--Before the beginning of a fiscal
year for which an eligible entity desires a
matching grant under this subparagraph for a
program operated under this section, the
eligible entity shall submit to the Secretary a
statement as to whether the eligible entity
desires additional matching grant funds that
may be made available under clause (iii) for
the fiscal year.
``(iii) Carryover and reallocation of
unobligated funds.--
``(I) In general.--If the Secretary
determines that an amount allotted
under clause (i)(IV) of this
subparagraph for a fiscal year will not
be awarded during the fiscal year, or
that an amount made available under
subsection (k)(1) for a fiscal year for
matching grants will not be obligated
by an eligible entity for the fiscal
year, the amount shall be available for
matching grants under this subparagraph
for the succeeding fiscal year for
eligible entities that have made
submissions under clause (ii) of this
subparagraph for additional matching
grant funds from the amount.
``(II) State allotments.--The
Secretary shall allot to each eligible
entity that has made such a submission
for a fiscal year--
``(aa) the total amount (if
any) made available under
subclause (I) for the fiscal
year; multiplied by
``(bb) the percentage of
children who have not attained
5 years of age and are members
of families with income not
exceeding the poverty line (as
determined by the Secretary on
the basis of the most recently
available data) in all of the
States in which any eligible
entity that has made such a
submission is so operating a
program, that is represented by
the number of such children in
the State (as so determined) in
which the eligible entity is
operating such a program.
``(III) Additional matching amount.--
``(aa) In general.--Subject
to item (bb) of this subclause,
the additional matching amount
with respect to an eligible
entity for a fiscal year is 75
percent of the sum of--
``(AA) the total
amount obligated by the
eligible entity for
home visiting services
in the State for the
fiscal year, from
Federal funds made
available for the
fiscal year under this
subparagraph; and
``(BB) the total
amount so obligated by
the eligible entity
from non-Federal funds,
determined under clause
(i)(III),
that are not taken into account
in determining the matching
amount with respect to the
eligible entity under clause
(i).
``(bb) Limitation.--The
additional matching amount with
respect to an eligible entity
for a fiscal year shall not
exceed the allotment under
subclause (II) for the State in
which the eligible entity is
operating a program under this
section for the fiscal year.''.
(2) Maintenance of effort.--Section 511(f) of such Act (42
U.S.C. 711) is amended to read as follows:
``(f) Maintenance of Effort.--
``(1) In general.--Notwithstanding any other provision of
this section, the Secretary may not make a grant to an eligible
entity under this section for a fiscal year if the total amount
of non-Federal funds obligated by the eligible entity in the
State in the fiscal year for a program operated pursuant to
this section is less than the total amount of non-Federal funds
reported to have been expended by any eligible entity for such
a program in the State in fiscal year 2019 or 2021, whichever
is the lesser.
``(2) Publication of amounts.--Not later than June 30, 2023,
the Secretary shall cause to have published in the Federal
Register the amount of non-Federal funds expended as described
in this section that has been reported by each eligible entity
not referred to in subsection (k)(2)(A) for each of fiscal
years 2019 and 2021.
``(3) Grace period.--The Secretary may, in exceptional
circumstances, allow an eligible entity a period to come into
compliance with this subsection. The Secretary shall provide
technical assistance to any eligible entity to assist the
entity in doing so.''.
(b) Reservations of Funds for Certain Purposes.--Section 511(j)(2) of
such Act (42 U.S.C. 711(j)(2)) is amended--
(1) in the matter preceding subparagraph (A), by striking
``the amount'' and inserting ``each amount made available for
base grants and each amount made available for matching
grants'';
(2) in subparagraph (A)--
(A) by striking ``3'' and inserting ``6''; and
(B) by striking ``and'' at the end; and
(3) by striking subparagraph (B) and inserting the following:
``(B) 2 percent of such amount for purposes of
providing technical assistance, directly or through
grants or contracts, for purposes as otherwise
described in subsections (c)(5), (d)(1)(C)(iii),
(d)(1)(E)(iii), and (d)(4)(E);
``(C) 2 percent of such amount for purposes of
workforce support, retention, and case management,
including workforce-related technical assistance,
research and evaluation, and program administration,
directly or through grants or contracts, of which the
Secretary shall use not more than $1,500,000 to
establish and operate the Jackie Walorski Center for
Evidence-Based Case Management; and
``(D) 3 percent of such amount for purposes of
research and evaluation (directly or through grants or
contracts), and for administering this section
(directly, through contracts, or otherwise).''.
(c) Appropriations.--Section 511(j)(1) of such Act (42 U.S.C.
711(j)(1)) is amended by striking subparagraphs (A) through (H) and
inserting the following:
``(A) for fiscal year 2023, $500,000,000 for base
grants;
``(B) for fiscal year 2024, $550,000,000, of which
$500,000,000 shall be for base grants and $50,000,000
shall be for matching grants;
``(C) for fiscal year 2025, $600,000,000, of which
$500,000,000 shall be for base grants and $100,000,000
shall be for matching grants;
``(D) for fiscal year 2026, $650,000,000, of which
$500,000,000 shall be for base grants and $150,000,000
shall be for matching grants; and
``(E) for fiscal year 2027, $800,000,000, of which
$500,000,000 shall be for base grants and $300,000,000
shall be for matching grants.''.
(d) Disposition of Excess Funds Reserved for Research, Evaluation,
and Administration.--Section 511(j) of such Act (42 U.S.C. 711(j)) is
amended by adding at the end the following:
``(5) Disposition of excess funds reserved for research,
evaluation, and administration.--To the extent that the amounts
reserved under paragraph (2)(D) for a fiscal year are not
obligated in the fiscal year, the Secretary may use the funds
for any purpose described in this section or to offset any
reduction with respect to this section that is required by
Federal law.''.
SEC. 4. REQUIREMENT THAT HOME VISITING PROGRAMS BE TARGETED AND
INTENSIVE.
Section 511(d)(3) of the Social Security Act (42 U.S.C. 711(d)(3)) is
amended by redesignating subparagraph (B) as subparagraph (C) and
inserting after subparagraph (A) the following:
``(B) Use of grant to provide or support targeted,
intensive home visiting services.--The program uses the
grant to provide or support targeted, intensive home
visiting services for the populations described in
paragraph (5).''.
SEC. 5. LIMITATION ON USE OF FUNDS FOR ADMINISTRATION.
(a) In General.--Section 511(d) of the Social Security Act (42 U.S.C.
711(d)) is amended by adding at the end the following:
``(5) Limitation on use of funds for administrative costs.--
``(A) In general.--Except as provided in subparagraph
(B) of this paragraph, an eligible entity to which
funds are provided under subsection (c) or (h)(2)(B)
shall not use more than 10 percent of the funds to
cover the costs of administration.
``(B) Authority to grant exceptions.--
``(i) In general.--The Secretary may
authorize an eligible entity that meets a
condition of clause (ii) of this subparagraph
to exceed the percentage limitation in
subparagraph (A) with respect to a program
conducted under this subsection by not more
than 5 percentage points, subject to such terms
and conditions as the Secretary deems
appropriate.
``(ii) Conditions.--An eligible entity meets
a condition of this clause if the eligible
entity--
``(I) conducts the program by
directly providing home visits to
eligible families and without a sub-
recipient;
``(II) in the fiscal year for which
the grant for the program is made under
this section, proposes to expand
services in 1 or more communities
identified in the statewide needs
assessment under subsection (b) and in
which home visiting services are not
provided; or
``(III) has conducted the program for
fewer than 3 years.''.
(b) Conforming Amendments.--Section 511(i)(2) of such Act (42 U.S.C.
711(i)(2)) is amended by striking subparagraph (C) and redesignating
subparagraphs (D) through (G) as subparagraphs (C) through (F),
respectively.
SEC. 6. ANNUAL REPORT TO CONGRESS.
(a) In General.--Section 511 of the Social Security Act (42 U.S.C.
711) is amended by redesignating subsections (j) and (k) as subsections
(k) and (l), respectively, and inserting after subsection (i) the
following:
``(j) Annual Report to Congress.--By December 31, 2023, and annually
thereafter, the Secretary shall submit to the Congress a written report
on the grants made under this section for the then preceding fiscal
year, which shall include--
``(1) an eligible entity-by-eligible entity summary of the
outcomes measured by the entity with respect to each benchmark
described in subsection (e)(5) that apply to the entity;
``(2) information regarding any technical assistance funded
under subparagraph (B) or (C) of subsection (k)(2), including
the type of any such assistance provided;
``(3) information on the demographic makeup of families
served by each such entity to the extent possible while
respecting participant confidentiality, including race,
ethnicity, educational attainment at enrollment, household
income, and other demographic markers as determined by the
Secretary;
``(4) the information described in subsection (d)(1)(E);
``(5) the estimated share of the eligible population served
using grants made under this section;
``(6) a description of each service delivery model funded
under this section by the eligible entities in each State, and
the share (if any) of the grants expended on each model;
``(7) a description of non-Federal expenditures by eligible
entities to qualify for matching funds under subsection (c)(4);
``(8) information on the uses of funds reserved under
subsection (k)(2)(C);
``(9) information relating to those eligible entities for
which funding is reserved under subsection (k)(2)(A), with
modifications as necessary to reflect tribal data sovereignty,
data privacy, and participant confidentiality; and
``(10) a list of data elements collected from eligible
entities, and the purpose of each data element in measuring
performance or enforcing requirements under this section.''.
(b) Conforming Amendments.--
(1) Section 511 of such Act (42 U.S.C. 711) is amended--
(A) in subsection (b)(1)(B)(iii), by striking
``(k)(2)'' and inserting ``(l)(2)''; and
(B) in subsection (h)(2)(B)--
(i) by striking ``(j)'' and inserting
``(k)''; and
(ii) by striking ``(k)(1)(B)'' and inserting
``(l)(1)(B)''.
(2) Section 511A(c) of such Act (42 U.S.C. 711a(c)) is
amended in each of paragraphs (5) and (7) by striking
``511(k)(2)'' and inserting ``511(l)(2)''.
SEC. 7. REDUCTION OF ADMINISTRATIVE BURDEN.
Section 511(h) of the Social Security Act (42 U.S.C. 711(h)) is
amended by adding at the end the following:
``(6) Reduction of administrative burden.--
``(A) In general.--The Secretary shall reduce the
burden, on States and public and private implementing
agencies at the local level, of administering this
section, by--
``(i) reviewing and revising administrative
data collection instruments and forms to
eliminate duplication and streamline reporting
requirements for States, eligible entities
referred to in subsection (k)(2)(A), and
nonprofit organizations referred to in
subsection (l)(1)(B), including timelines for
submitting reports;
``(ii) conducting an analysis of the total
number of hours reported by administering
agencies on complying with paperwork
requirements, and exploring, in consultation
with administering agencies, ways to reduce the
number of hours spent by at least 15 percent;
``(iii) conducting a review of paperwork and
data collection requirements for tribal
grantees, and exploring, in consultation with
tribes and tribal organizations, ways to reduce
administrative burden, respect sovereignty, and
acknowledge the different focus points for
tribal grantees;
``(iv) collecting input from relevant State
fiscal officials to align fiscal requirements
and oversight for States and eligible entities
to ensure consistency with standards and
guidelines for other Federal formula grant
programs; and
``(v) consulting with administering agencies
and service delivery model representatives on
needed and unneeded data elements regarding the
dashboards provided for in subsection
(d)(1)(B), consistent with the data
requirements of such subsection.
``(B) Findings on paperwork reduction.--
``(i) Inclusion in report.--In the 1st report
submitted pursuant to subsection (j) more than
18 months after the date of the enactment of
this Act, the Secretary shall include the
findings of the Secretary with respect to the
matters described in subparagraph (A).
``(ii) Implementation.--Within 2 years after
complying with clause (i), the Secretary shall
implement the findings referred to in clause
(i).''.
SEC. 8. VIRTUAL HOME VISITING AUTHORIZATION AND RESTRICTIONS.
(a) Virtual Home Visits.--
(1) Application requirements.--Section 511(e) of the Social
Security Act (42 U.S.C. 711(e)) is amended by redesignating
paragraph (10) as paragraph (11) and inserting after paragraph
(9) the following:
``(10) At the option of the eligible entity--
``(A) a description of any limitations or constraints
on virtual home visits under the program, including--
``(i) a description of the plan of the
eligible entity to encourage in-person home
visits; and
``(ii) a description of the considerations to
be used in determining when a virtual home
visit is appropriate, including client consent,
client preference, geographic limitations,
model fidelity, and hazardous conditions
including public health emergencies, weather
events, health concerns for home visitors and
client families, and other local issues;
``(B) an assurance that--
``(i) the virtual home visit is implemented
as a model enhancement; or
``(ii) the Secretary has identified the home
visit as part of an effective model or model
adaptation, based on an evidence of
effectiveness review conducted using the
criteria established under subsection
(d)(3)(A)(iii); and
``(C) an assurance to the Secretary that at least 1
in-person home visit shall be conducted for each client
family under the program during the 12-month period
that begins with the entry of the client family into
the program, and during each succeeding 12-month
period, except that any such period in which a public
health emergency declared under Federal law, or under
the law of the State in which the program is conducted,
is in effect shall be extended by the length of time in
which the declaration is in effect.''.
(2) Applicable rules.--Section 511(d) of such Act (42 U.S.C.
711(d)) is amended by redesignating paragraph (4) and paragraph
(5) (as added by section 5(a) of this Act) as paragraphs (5)
and (6), respectively, and inserting after paragraph (3) the
following:
``(4) Virtual home visits.--
``(A) In general.--A virtual home visit conducted
under the program shall be considered a home visit for
purposes of this section if the application for funding
of the program submitted pursuant to this section most
recently after the effective date of this paragraph
includes the material described in subsection (e)(10).
``(B) Standards for training applicable to virtual
service delivery.--The standards for training
requirements applicable to virtual service delivery
under a home visiting model shall be equivalent to
those that apply to in-person service delivery under
the model.
``(C) Reporting requirement.--A grant made under this
section for the program may not be used for any virtual
home visit during a year, unless the eligible entity to
which the grant is made submits the report described in
subsection (e)(8)(A) for the year.
``(D) Virtual home visit defined.--In this section,
the term `virtual home visit' means a visit conducted
solely by use of electronic information and
telecommunications technologies.
``(E) Technical assistance.--If the Secretary finds
that an eligible entity has not complied with the
assurance described in subsection (e)(10)(C), the
Secretary shall, directly or through grants, contracts,
or cooperative agreements, provide the eligible entity
with such technical assistance as is necessary to
assist the eligible entity in doing so.''.
(3) Program requirement.--Section 511(d)(3)(C) of such Act
(42 U.S.C. 711(d)(3)(C)), as so redesignated by section 4 of
this Act, is amended by adding at the end the following:
``(vii) If the application submitted by the
eligible entity includes the assurance
described in subsection (e)(10)(C) with respect
to the program, the program provides in-person
service consistent with the assurances.''.
(4) Reports.--Section 511(e)(8)(A) of such Act (42 U.S.C.
711(e)(8)(A)) is amended by inserting ``, including the number
of virtual home visits conducted under the program in the year
covered by the report, disaggregated with respect to each home
visiting model under which the virtual home visits are
conducted'' before the semicolon.
(b) Transition Rule.--
(1) In general.--A virtual home visit conducted before the
effective date of the amendments made by this section under an
early childhood home visitation program funded under section
511 of the Social Security Act shall be considered a home visit
for purposes of such section.
(2) Virtual home visit defined.--In paragraph (1), the term
``virtual home visit'' means a visit conducted solely by use of
electronic information and telecommunications technologies.
SEC. 9. EFFECTIVE DATE.
(a) In General.--Except as provided in subsection (b), this Act and
the amendments made by this Act shall take effect on October 1, 2022.
(b) Virtual Home Visiting Provisions.--The amendments made by section
8 shall take effect on October 1, 2023.
I. SUMMARY AND BACKGROUND
A. Purpose and Summary
The bill, H.R. 8876, ``The Jackie Walorski Maternal and
Child Home Visiting Reauthorization Act of 2022,'' as amended
and ordered reported by the Committee on Ways and Means on
September 21, 2022, reauthorizes the Maternal, Infant, and
Early Childhood Home Visiting program through fiscal year 2027,
makes policy improvements, and gradually increases federal
funding for evidence-based home visiting.
B. Background and Need for Legislation
The Maternal, Infant, and Early Childhood Home Visiting
program (MIECHV) funds evidence-based home visiting models that
improve familial health, well-being, and stability. It
particularly focuses on child and maternal health, preventing
abuse and neglect, and supporting child development and school
readiness. After an initial ramp-up period from 2010-2013,
MIECHV's funding level stayed at $400 million a year, but was
reduced to approximately $377 million in FY 2022 by the ongoing
budget sequester.\1\ Congress has continued MIECHV with
bipartisan support several times.\2\ To help address challenges
specific to the pandemic, Congress also provided $150 million
in one-time MIECHV funding in the American Rescue Plan Act
(ARPA) (Pub. L. 117-2).\3\ Funding for MIECHV was scheduled to
expire September 30, 2022, but the program was authorized
through December 16, 2022, in the Continuing Resolution (Pub.
L. 117-43).\4\
---------------------------------------------------------------------------
\1\OMB Report of the Congress on the BBEDCA 251A Sequestration for
Fiscal Year 2022, The White House (May 28, 2021), https://
www.whitehouse.gov/wp-content/uploads/2021/05/
BBEDCA_251A_Sequestration_Report_FY2022.pdf.
\2\Protecting Access to Medicare Act of 2014, Pub. L. 113-93;
Medicare Access and CHIP Reauthorization Act of 2015, Pub. L. 114-10;
Bipartisan Budget Act of 2018, Pub. L. 115-123.
\3\American Rescue Plan Act of 2021, Pub. L. No. 117-2.
\4\Extending Government Funding and Delivering Emergency Assistance
Act, Pub. L. No. 117-43.
---------------------------------------------------------------------------
An ``eligible entity'' is designated to administer MIECHV
in each state or U.S. territory. In most cases, the eligible
entity is a state or territorial agency, but if the state or
territory declines to administer the program, the Secretary may
award the jurisdiction's grant to a qualified non-profit. Non-
profit organizations currently administer MIECHV in three
states: Florida, North Dakota, and South Carolina, and
previously administered the program in Wyoming.\5\ Some states
fund MIECHV programs to serve their tribal communities, but the
majority of tribal home visiting is awarded in competitive
grants or grant continuations funded by the tribal reservation.
Thirty tribes or tribal organizations currently operate
programs funded by tribal MIECHV grants.\6\
---------------------------------------------------------------------------
\5\Admin. For Children and Families, FY 2022 Maternal, Infant, and
Early Childhood Home Visiting Awards, U.S. Dept. of Health & Human
Servs., https://mchb.hrsa.gov/programs-
impact/programs/home-visiting/fy-2022-miechv-awards (last visited Oct.
11, 2022).
\6\Admin. For Children and Families, Tribal Home Visiting Grantees,
U.S. Dept. of Health & Human Servs., https://www.acf.hhs.gov/ecd/
tribal/tribal-home-visiting/thv-grantees (last visited Oct. 11, 2022).
---------------------------------------------------------------------------
MIECHV is a model federal program in that it directs
funding to interventions that have demonstrated that they
improve outcomes for families. Eligible entities and tribal
MIECHV programs can only receive funding if they operate a home
visiting program that has been evaluated (or, in specific,
limited cases, is under evaluation) and has shown positive
impacts in relevant measures of family and child well-being,
based on a review by the U.S. Department of Health and Human
Services (HHS). States use MIECHV grants to select among 19
models that meet a specified evidence threshold. These 19
models have been rigorously evaluated to demonstrate
significant, positive outcomes in areas such as reducing child
abuse and neglect, improving maternal and child health, and
improving family stability.
The models pair a home visitor (depending on the model,
this may be a peer educator, a social worker, a nurse, or some
other individual with specialized training) with a client
family that meets the program's qualifications for enrollment.
For example, some models serve only first-time parents or only
enroll families prenatally, at birth, or work only with
specific-aged young children. The home visitor then follows a
specific curriculum designed to help the type of family the
program enrolls. Some common outcomes of home visiting programs
include improving maternal health before and after birth,
teaching positive parenting skills, encouraging pre-literacy
activities, connecting families to medical homes, screening for
depression, and referring families to other needed services to
help support and stabilize the family. Eligible entities must
concentrate the services in areas identified in a rigorous
needs assessment based on parameters for need appropriate to
that state or territory.\7\
---------------------------------------------------------------------------
\7\42 U.S.C. Sec. 711(d)(4).
---------------------------------------------------------------------------
Participant families and local programs report that MIECHV
is life changing for parents and children who need extra
support. Erica Beck, a home visiting participant mother from
Chicago, IL, testified at the Subcommittee on Worker and Family
Support's March 2022 hearing. She said, ``I know that our lives
are changed forever and for the better because of Myia [our
home visitor] . . . For parents--moms or dads--that want and
need this kind of support, it should be there for them.''\8\
Debie Coble, President and CEO of Goodwill Industries of
Michiana, shared about a mother named Daisy at the same
hearing. She said, ``[Daisy's] Nurse-Family Partnership nurse
encouraged her to enroll at the Excel Center to obtain her high
school diploma and achieve her education goal. Daisy was the
first in her family to graduate from high school . . . We are
so proud of Daisy and the work and dedication she put in to
achieving her diploma, full-time employment, and being a great
mom to her son.''\9\
---------------------------------------------------------------------------
\8\Improving Family Outcomes through Home Visiting: Hearing Before
the Subcomm. on Worker and Family Support of the H. Comm. on Ways and
Means, 117th Cong. (2022) (Statement of Erica Beck, Healthy Families
America Program Participant at the Henry Booth House).
\9\Improving Family Outcomes through Home Visiting: Hearing Before
the Subcomm. on Worker and Family Support of the H. Comm. on Ways and
Means, 117th Cong. (2022) (Statement of Debie Coble, President and CEO
of Goodwill Industries of Michiana, Inc.).
---------------------------------------------------------------------------
The cost per home visiting client family varies widely
based on location and model implemented, but generally ranges
from $4,000 to $10,000 per year.\10\ Home visiting programs
have recently experienced challenges like high turnover,
increased staff burnout, and issues in hiring due to rising
workforce costs and the effects of the pandemic. In the current
economic environment, home visiting agencies also have reported
difficulty recruiting and retaining qualified staff. Lack of
adequate pay has forced qualified and experienced home visitors
out of these challenging jobs toward lower-stress jobs that pay
better.\11\ The Mother and Infant Home Visiting Program
Evaluation (MIHOPE) identified the quality of staff as one of
the keys to a successful home visiting program.\12\
---------------------------------------------------------------------------
\10\Admin. For Children and Families, What is Home Visiting
Evidence of Effectiveness?, U.S. Dept. of Health & Human Servs.,
https://homvee.acf.hhs.gov (last visited Sept. 19, 2022).
\11\Improving Family Outcomes through Home Visiting: Hearing Before
the Subcomm. on Worker and Family Support of the H. Comm. on Ways and
Means, 117th Cong. (2022) (Statement of Steven Pascal, Director of Home
Visiting for The Children's Trust).
\12\Office of Planning, Research and Evaluation, Admin. for
Children and Families, U.S. Dept. of Health & Human Servs., OPRE Report
2015-11, The Mother and Infant Home Visiting Program Evaluation (Jan.
2015).
---------------------------------------------------------------------------
States and territories may only use MIECHV grants to fund a
home visiting model or models that meet a high standard of
proven effectiveness and meet the standards of the Home
Visiting Evidence of Effectiveness (HomVEE) review, or in
limited cases, a promising practice that is being rigorously
evaluated.\13\ Home visiting agencies currently have the choice
of 19 HomVEE-approved models for service delivery that meet the
evidence standard and other requirements of the program, though
most use one or more of the three largest models--Parents as
Teachers, Nurse-Family Partnership, and Healthy Families
America.\14\ States also have the option of using up to 25
percent of their funds for ``promising'' approaches not yet
available in HomVEE, but if they choose that option, they must
also rigorously evaluate the model while delivering services.
Three states (Arizona, Arkansas, and Kansas) currently use
MIECHV funds to test such ``promising models.'' Tribal programs
are allowed to make adaptations to existing models to fit
tribal culture and are also required to do additional
research.\15\
---------------------------------------------------------------------------
\13\Admin. For Children and Families, What is Home Visiting
Evidence of Effectiveness?, supra note 10.
\14\Admin. For Children and Families, Models eligible for Maternal,
Infant, and Early Childhood Home Visiting (MIECHV) funding, U.S. Dept.
of Health & Human Servs., https://homvee.acf.hhs.gov/HRSA-Models-
Eligible-MIECHV-Grantees (last visited Sept. 19, 2022).
\15\Admin. For Children and Families, About Tribal Home Visiting,
U.S. Dept. of Health & Human Servs., https://www.acf.hhs.gov/ecd/
tribal/tribal-home-visiting/about-tribal-home-visiting (last visited
Oct. 12, 2022).
---------------------------------------------------------------------------
MIECHV created a strong incentive for states to increase
the use of evidence-based home visiting models, both by tying
funding to use of already-proven models and by allowing them to
use up to 25 percent of funding for promising models that are
being rigorously evaluated. At the time of initial enactment,
seven models met HomVEE evidence standards. Today, that number
has grown to 19.\16\ In 2015, MIHOPE found that many states
funded home visiting programs that were not evidence-based
prior to MIECHV, in addition to funding evidence-based
models.\17\ The majority of states used MIECHV funding to
expand the operation of existing evidence-based programs in the
state, while some funded new evidence-based programs.
Massachusetts, for example, has used MIECHV funding to expand
from using only one evidence-based model before MIECHV to using
up to three.\18\
---------------------------------------------------------------------------
\16\Admin. For Children and Families, Mother and Infant Home
Visiting Program Evaluation (MIHOPE), U.S. Dept. of Health & Human
Servs., https://www.acf.hhs.gov/opre/project/
mother-and-infant-home-visiting-program-evaluation-mihope-2011-2021
(last visited Sept. 19, 2022).
\17\Office of Planning, Research and Evaluation, OPRE Report 2015-
11, supra note 12.
\18\Improving Family Outcomes through Home Visiting: Hearing Before
the Subcomm. on Worker and Family Support of the H. Comm. on Ways and
Means, 117th Cong. (2022) (Statement of Steven Pascal, Director of Home
Visiting for The Children's Trust).
---------------------------------------------------------------------------
The COVID-19 pandemic made in-person service delivery
challenging for MIECHV programs at a time when many families
were struggling and in need of services. To deal with the
changing circumstances, many programs pivoted to new service
delivery methods and issued updated guidance\19\ to home
visitors. Many service delivery models implemented model
enhancements as part of their continuous quality improvement
process and trained their home visitors on best practices for
administering virtual visits. States reported success with this
method. For example, Virginia reported a variety of positives
in their evaluation of virtual home visits, including flexible
connection methods and more contact with home visitors.\20\
---------------------------------------------------------------------------
\19\States Modify Home Visiting Services in Response to COVID-19,
Zero to Three, https://www.zerotothree.org/resource/states-modify-home-
visiting-services-in-response-to-covid-19/ (last visited Oct. 11,
2022).
\20\HeeJu Jang-Paulsen et al., Understanding the Experience of
Virtual Home Visiting During COVID-19: Findings from Surveys of
Participating Families and Service Providers 14 (Virginia Department of
Social Services Division of Research and Planning, 2022).
---------------------------------------------------------------------------
Eligible entities also report that very extensive
administrative procedures and data collection make it
challenging for them to stay within the statutory limit of 10
percent of funding for administrative costs. Entities report
being required to provide data that is not related to program
outcomes or useful for program administration and must follow
fiscal practices that are very different from how other federal
grants to states are managed and monitored. As a result,
program staff often defer work to plan, support professional
development, provide programmatic support, and monitor service
quality in order to do administrative paperwork or respond to
federal requests for documentation and revision, and states are
unable to follow statewide fiscal processes for MIECHV.
Eligible entities are required to fill out multiple forms, some
with duplicate data, on a quarterly basis, including very
detailed expenditure reporting for every individual home
visiting site and other data not used for program management.
In some cases, entities are required to provide additional
information in timeframes as short as 48 hours. Administrators
have also reported a significant mismatch between agency
estimations of completion times and the actual time required
for the reports. For example, one state with a MIECHV budget of
$10 million reported spending the equivalent of 10.5 weeks to
collect data and fill out a form that the agency expects to
take 18 hours.\21\ The collected data is not made public or
regularly reported to Congress.
---------------------------------------------------------------------------
\21\Letter from ASTHVI members to Four Corners (June 22, 2022) (on
file with author).
---------------------------------------------------------------------------
C. Legislative History
Background
H.R. 8876 was introduced on September 19, 2022 and was
referred to the Committee on Ways and Means and additionally to
the Committee on Energy and Commerce.
Committee hearings
On March 16, 2022, the Subcommittee on Worker and Family
Support held a hearing titled ``Improving Family Outcomes
through Home Visiting.'' The hearing focused on the positive
outcomes that MIECHV achieves for families, as well as the
challenge of providing high-quality services to families in
need at current funding levels. The witnesses were Steven
Pascal, Director of Home Visiting for The Children's Trust;
Myia Smith, a Healthy Families America Family Support
Specialist at the Henry Booth House; Erica Beck, a Healthy
Families America Program Participant at the Henry Booth House;
Angela Dancer, Senior Director, Home Visitation Services for
the Choctaw Nation of Oklahoma; and Debie Coble, President and
CEO of Goodwill Industries of Michiana, Inc.
Committee action
The Committee on Ways and Means marked up H.R. 8876, ``The
Jackie Walorski Maternal and Child Home Visiting
Reauthorization Act of 2022,'' on September 21, 2022, and
ordered the bill, as amended, favorably reported (with a quorum
being present) by a vote of 41 yeas and 0 nays.
II. EXPLANATION OF THE BILL
A. The Jackie Walorski Maternal and Child Home Visiting Reauthorization
Act of 2022
Section 1: Short title
CURRENT LAW
No provision.
EXPLANATION OF PROVISION
This section provides the short title, ``The Jackie
Walorski Maternal and Child Home Visiting Act of 2022.''
REASONS FOR CHANGE
The Committee believes the title accurately reflects the
content of the bill and the late Congresswoman Walorski's key
role in crafting a bipartisan agreement. As Ranking Member of
the Worker and Family Support Subcommittee, Representative
Jackie Walorski (R-IN), was a champion of the MIECHV program in
her state, called Healthy Families Indiana, and worked closely
with Subcommittee Chair Davis to develop many of the key
provisions in the bill. During a Subcommittee hearing held on
March 16, 2022, Rep. Walorski said, ``MIECHV is a program that
gets results. It works. We know this because the program builds
upon decades of scientific research showing that home visits by
a nurse, social worker, early childhood educator, or other
trained professional during pregnancy and in the first years of
a child's life helps prevent child abuse and neglect, supports
positive parenting, improves maternal and child health, and
promotes child development and school readiness.''\22\
---------------------------------------------------------------------------
\22\Improving Family Outcomes through Home Visiting: Hearing Before
the Subcomm. on Worker and Family Support of the H. Comm. on Ways and
Means, 117th Cong. (2022) (Statement of Rep. Jackie Walorski, Subcomm.
Ranking Member).
---------------------------------------------------------------------------
Section 2. Outcomes dashboard
CURRENT LAW
Current law requires entities that receive federal funding
to administer state, tribal, or territorial MIECHV programs to
report individual and family outcomes related to the following
benchmarks to the Secretary of Health and Human Services
(hereafter referred to as ``the Secretary''):
Improved maternal and newborn health;
Prevention of child injuries, child abuse,
and neglect or maltreatment, and reduction of emergency
department visits;
Improvement in school readiness and
achievement;
Reduction in crime or domestic violence;
Improvement in family economic self-
sufficiency; or
Improvements in the coordination and
referrals for other community resources and supports.
The Secretary may publish or share relevant data but is not
required to regularly provide the reported information to
Congress or make it public.
EXPLANATION OF PROVISION
This section requires the Secretary to establish and
operate a website accessible to the public that includes
annually updated and easy-to-understand information on outcomes
achieved by state or territory MIECHV programs (including
programs administered by nonprofit entities instead of the
state). The Secretary may operate the website directly or via
grants or contracts.
The dashboard must convey outcomes for states and
territories (including those operated by a non-profit, i.e.,
``eligible entity'') using a template that includes:
A profile for each entity showing outcome
indicators and how they compare to the benchmarks
established for those outcomes;
Information on the outcome indicators and
requisite outcome levels for each entity;
Information on the evidence-based home
visiting model(s) used by the entity and specific
participant outcomes the model is intended to affect;
The most recently available information
reported in the report on performance improvement;
An electronic link to the state needs
assessment, which identifies high-need communities for
MIECHV services; and
Information regarding any penalty or other
corrective action taken by the Secretary against an
entity and, if the entity is operating under a
corrective action plan, detailed information about the
plan and progress toward improvement.
The section also requires the Secretary to provide similar
information for tribal grantees, with adjustments to protect
tribal sovereignty and data privacy, and to ensure the
dashboard preserves confidentiality of participant families.
REASON FOR CHANGE
While MIECHV is a program centered on using interventions
which have been demonstrated to improve specific maternal,
child, and family outcomes in rigorous research studies, data
provided to Congress and the public is primarily focused on
inputs like number of visits, screenings, and referrals to
other services, without linking those inputs to individual and
family outcomes. Data is also not regularly or comprehensively
shared with Congress or the public. As a result, we lack data
about the impact of interventions funded by the federal
program. The new outcomes dashboard will allow Congress,
beneficiary advocates, stakeholders, researchers, and taxpayers
to monitor the impacts of MIECHV investment in states,
territories, and tribal communities. The Committee intends this
provision to improve visibility into program results by
creating a regularly updated, easy-to-read, state-by-state,
online dashboard of MIECHV performance measures and clinical
indicators to show actual impact on maternal, family, and child
outcomes. The dashboard should be adjusted to accommodate
different model types since states use different models focused
on impacting different outcomes.
Section 3. Funding
CURRENT LAW
A pro rata share of $400 million, which was the amount of
funding provided for MIECHV in fiscal year 2022, is available
to operate the MIECHV program through December 16, 2022. Annual
funding was $100 million in fiscal year 2010, $250 million in
fiscal year 2011, $350 million in fiscal year 2012, and $400
million in fiscal years 2013-2022.
The Secretary is required to reserve three percent of
funding for grants to tribal home visiting programs and three
percent for research, evaluation, and assisting eligible
entities to demonstrate improvements in benchmark outcomes.
The Secretary is authorized to use the remainder of funds
to make grants to eligible entities to fund qualified home
visiting services, provide technical assistance, or expend for
other purposes consistent with the three purposes of Section
511, which are: (1) strengthening and improving evidence-based
early childhood home visiting; (2) improving coordination of
services to at-risk communities; and (3) identifying at-risk
families and providing them with comprehensive services to
improve outcomes.
Eligible entities are required to maintain prior state/
territory-wide spending levels for MIECHV-administered home
visiting (``maintenance of effort, or MOE'') and not reduce
that spending or replace it with federal dollars
(``supplantation'').
Grant size, duration, and allocation of funding among
purposes and eligible entities are at the discretion of the
Secretary and have varied from year to year based on that
discretion. The Health Resources and Services Administration
(HRSA), which administers MIECHV, reports that in an average
year, it spends roughly an additional three to five percent of
funding on additional technical assistance and administrative
expenses. Between fiscal years 2021 and 2022, federal funding
was constant but grant amounts increased for 15 eligible
entities and declined for the remaining 41.
EXPLANATION OF PROVISION
This section provides funding for MIECHV in fiscal years
2023 through 2027 and specifies how it is to be allocated among
eligible entities and program purposes, including providing
statutory formulas to allocate the majority of funding to
states and territories.
The funding levels are:
FY 2023: $500 million for base grants (total
$500 million);
FY 2024: $500 million for base grants, and
$50 million for matching grants (total $550 million);
FY 2025: $500 million for base grants, and
$100 million for matching grants (total $600 million);
FY 2026: $500 million for base grants, and
$150 million for matching grants (total $650 million);
and
FY 2027: $500 million for base grants, and
$300 million for matching grants (total $800 million).
Funding reservations
Thirteen percent of total funds are reserved for purposes
other than formula base and matching grants to eligible
entities. The reservation percentages are applied equally and
deducted from the total available appropriation, which includes
base grant and matching grant allocations for each fiscal year,
before the base and matching grant formulas are applied. Those
reservations are:
6 percent for grants to Indian tribes
(including consortia of tribes), tribal organizations,
or urban Indian organizations;
2 percent for technical assistance to
states, tribes, and territories;
2 percent for workforce support, retention,
and case management; and
3 percent for HHS costs related to
administering the program, research, and evaluation
activities.
The reserved funding may be used directly by the Secretary
or awarded to other entities using grants or contracts.
Of the funding reserved for workforce support, retention,
and case management, up to $1.5 million per year is to be used
to create and operate the Jackie Walorski Center for Evidence-
Based Case Management, and the remainder may be used for
technical assistance, direct grants to support the home
visiting workforce, and research.
Formula grants to eligible entities
To qualify for and receive base and matching grants,
eligible entities must maintain total statewide expenditures
(``maintenance of effort,'' or MOE) for the MIECHV program at
the lesser of the level previously reported for state fiscal
year 2019 or state fiscal year 2021. Not later than June 30,
2023, the Secretary must publish those amounts. The MOE
requirement is not a measure of which specific sites are funded
within a state, and shifting which sites are funded with
federal dollars and which sites are funded with state dollars
would not be considered supplantation or a reduction in MOE. In
exceptional circumstances, the Secretary may provide an
eligible entity that fails to meet the MOE requirement with a
grace period to come back into compliance and may provide
technical assistance to the entity to assist in coming into
compliance.
Federal base grants. Starting in fiscal year 2023, and each
year through fiscal year 2027, every eligible entity qualifies
for a federal base grant, which is calculated in fiscal year
2023 and remains the same in subsequent years. If the eligible
entity changes during the 2023-2027 period (for example, a non-
profit takes over from a state, or vice versa), the new
eligible entity for that state or territory receives the same
base grant as the previous entity established fiscal year 2023.
The federal base grant amount is calculated by first
reducing the amount available for base grants to account for
reserved amounts and any required budget sequester. The
remainder is allocated by determining each state or territory's
share of children under age five in the U.S. and providing a
proportionate share of federal base funds, unless that would
result in a more than 10 percent increase or decrease over the
state or territory's fiscal year 2021 award. If that occurs,
the Secretary is required to adjust the amount to stay within
those guardrails, and any funds remaining after the guardrail
adjustments are distributed to states and territories on a pro
rata basis, with a minimum grant award of $1 million. If
necessary to achieve the $1 million minimum, the Secretary may
make pro rata adjustments in other grant amounts.
Federal matching grants. Starting in fiscal year 2024, and
each year through fiscal year 2027, federal matching grant
funds are made available to every eligible entity up to a
specified allocation based on the entity obligating non-federal
matching funds, as defined.
The maximum federal matching grant amount for each entity
in each year is calculated by first reducing the amount
available for matching grants to account for reserved funding
amounts and any required sequester. The remaining funding is
then allocated by first providing a minimum amount, which is
specified in the law, to each eligible entity. That amount is
$776,000 in fiscal year 2024, $1 million in fiscal year 2025,
$1.5 million in fiscal year 2026, and $2 million in fiscal year
2027. If the total amount were to be insufficient to provide
the full minimum amount to each eligible entity, the Secretary
is authorized to make a pro rata adjustment.
Once the minimum amount is allocated to each entity, the
remaining funding is allocated according to the state or
territory's share of children under five in the U.S. who are at
or below the federal poverty level.
In order to draw down its full allotment of federal
matching grant funds, an entity must provide non-federal funds
above their maintenance of effort requirement such that 25
percent of the combined federal and non-federal spending
consists of non-federal funds (i.e., matching funds are
available such that for every $4 spent, $3 is federal and $1
dollar is non-federal). Eligible entities that provide less
than the amount of non-federal funds needed for the full
allotment will receive federal funding proportionate to the
amount of non-federal funding provided.
To qualify as ``non-federal funds'' for the purpose of
receiving federal matching funds, the entity must demonstrate
that funds have been obligated to support home visiting that
are not being counted as part of the entity's MOE requirement
and meet the MIECHV statutory requirements related to
individual and family outcomes, evidence, and providing
targeted, intensive services. These funds do not have to be
administered by the state MIECHV agency, and may come from
state appropriations or other state funding sources, local
governments, or private entity contributions or expenditures in
coordination with the state. As with federal funds, up to 25
percent of the funds may be used for new and promising
approaches to home visiting which have not yet met the MIECHV
evidence standard but are being rigorously evaluated.
Any unobligated federal matching funds in a fiscal year
(i.e., matching fund allocations not awarded or not fully
obligated by a state) may be redistributed to eligible entities
willing to provide the required non-federal match in the
following fiscal year. Those entities are required to notify
the Secretary of their interest in reallocated funds at the
beginning of the fiscal year in which the funds were originally
appropriated. Qualified entities will receive a share of the
reallocated funds proportionate to the state or territory's
share of children under age five in the U.S. who are below the
federal poverty level among the group of states that apply and
must provide additional non-federal funds to match them in the
specified proportion (75 cents out of each dollar of combined
expenditure).
All formulas in this section are to be calculated using the
most recently available data, which, in some cases, may require
using a different data source for territories than for states.
REASON FOR CHANGE
Providing five years of rising funding and allocating it
consistently and transparently will allow for well-planned and
consistent investments in state and territory MIECHV programs,
tribal MIECHV, research, technical assistance, coordination of
services, and the home visiting workforce. The Committee
believes this predictable, targeted approach will increase the
number of families served, increase state participation and
funding support through the additional funding provided for
matching, build on the high quality of home visiting services
and coordination with existing state programs, and maintain
MIECHV's strong focus on evidence-based approaches.
Under current law, MIECHV grants are currently distributed
to eligible entities primarily based on a funding formula
developed in policy by the HRSA, but also via competitive
grants for specific purposes at the Secretary's discretion. The
Secretary also retains discretion to determine the portion of
MIECHV funding used for research and program administration.
The current state and territory formula, updated in 2018,
allocates two-thirds of HRSA allocated funds to grant funding
based on state receipt of competitive grants between 2013 and
2015, and the remaining third based on the number of poor
children under age five in the state. The formula also ensures
that no state's grant changes by more than five percent each
year, which has blunted what would otherwise be significant
funding cuts in many states that were not successful in the
relevant competitive grant period and in smaller states.\23\ In
fiscal year 2022, many states received a decreased award amount
even though the overall funding for the program was
unchanged.\24\
---------------------------------------------------------------------------
\23\Health Resources and Services Administration policy guidance.
\24\Health Resources and Services Admin., FY 2022 Maternal, Infant,
and Early Childhood Home Visiting Awards, U.S. Dept. of Health & Human
Servs., https://mchb.hrsa.gov/
programs-impact/programs/home-visiting/fy-2022-miechv-awards (last
visited Oct. 3, 2022).
---------------------------------------------------------------------------
This section enhances funding predictability and stability
by establishing Congressional domain over both the mechanism
for distributing funding as formula grants and the allocation
formula by adding language to the statute establishing base
grants and matching funds. The combination of base and matching
funds ensures that every state and territory can grow its home
visiting programs, while also providing a strong incentive for
jurisdictions to make additional investments in evidence-based
programs and evaluating new and promising approaches. Federal
matching funds are intended to increase state engagement, as
well as provide additional funding for expanding services to
families. Having local dollars as part of the pool of funding
available for evidence-based home visiting creates incentives
for states to better coordinate programs operating in the state
and ensure rigorous oversight of funds.
The matching fund allocations provided under the section
are also targeted to the amount of need by allocating to states
based on the proportion of children under five in poverty. The
section allows states to draw down its allocation of matching
funds proportionate to the state's own spending so that funding
is dialed up (up to the maximum allotment) or down relative to
the overall matching rate such that federal funds constitute
not more than 75 percent of total spending. The bill's
definition of non-federal funding available for the match is
carefully designed to support the growth of home visiting
programs, which meet the high MIECHV evidence standard, and to
align with federal MIECHV requirements related to program
design, quality, and service delivery. It also allows
contributions from state and local government, as well as the
private sector, non-profits, and community based organizations,
and incentivizes them to focus their investments on evidence-
based approaches.
The Department of Health and Human Services estimated that
MIECHV served 15 percent of families that were eligible and in
need of home visiting services in fiscal year 2021.\25\ The
Committee expects that these changes in funding amounts and
structure will, over time, meet more of the need while
continuing MIECHV's high service quality.
---------------------------------------------------------------------------
\25\Health Resources and Services Admin., The Maternal, Infant, and
Early Childhood Home Visiting Program Brief, U.S. Dept. of Health &
Human Servs., https://mchb.hrsa.gov/sites/
default/files/mchb/about-us/program-brief.pdf (Sept. 2022).
---------------------------------------------------------------------------
The Committee also expects that the substantial increase in
the reservation for tribal communities (from three percent to
six percent) will result in an increase in both the number of
successful tribal community applications for MIECHV grants and
the size of current grants to effective programs. This increase
will provide stable funding to expand the current successful
approach while respecting tribal sovereignty.
Since the program's inception, funding reserved for tribal
MIECHV has allowed HHS to fund fewer than one-third of total
applications and just over one-half of highly-qualified
applicants (those scoring over 70). Tribal administrators also
report that many tribal communities have also chosen not to
apply for funding because they know funding is capped, and they
would receive new funding at the expense of other tribal
communities currently operating MIECHV programs.\26\
---------------------------------------------------------------------------
\26\Improving Family Outcomes through Home Visiting: Hearing Before
the Subcomm. on Worker and Family Support of the H. Comm. on Ways and
Means, 117th Cong. (2022) (Statement of Angela Dancer, Senior Director,
Home Visitation Services for the Choctaw Nation of Oklahoma).
---------------------------------------------------------------------------
The Committee also expects that the new reservation for
workforce support, retention, and case management will provide
for a robust new technical assistance center named for our
colleague, Jackie Walorski. This technical assistance center
will develop evidence-based approaches to case management and
help eligible entities use them. The reservation will also
provide for additional technical assistance, grant funding, and
research to support the critically important home visiting
workforce. As Ranking Member of the Ways and Means Worker and
Family Support Subcommittee, Representative Walorski believed
strongly in the importance of case management and the MIECHV
program as a high-mark and example of successful, results-
driven, evidence-based policymaking. The Committee intends for
this center to focus on development and evaluation of evidence-
based case management practices for use by states and other
non-profit entities implementing MIECHV. A strength of the
MIECHV program is its reliance on meaningful in-person
interactions between families and qualified, trained home
visitors. Home visitors need a wide-ranging skill set and are
responsible for broad case management which ranges across
family engagement strategies, understanding of clinical
indicators of maternal depression, monitoring of child
development milestones, breastfeeding best practices, screening
for domestic violence and child abuse, and establishing
linkages with critical referral services that meet the unique
needs of each family. This technical assistance center would be
focused on evaluating best practices for effective case
management in relation to the home visiting program to
strengthen the program's impact on improving outcomes for
vulnerable families and children.
Finally, the Committee expects the Secretary to be able to
reduce some federal administrative costs by modifying data
reporting and oversight to be more consistent with other
federal formula grant programs, with a primary focus on program
outcomes and compliance with statutory requirements and less
focus on very detailed financial accounting within the amount
of administrative spending allowed under the statute.
Specifically, regarding financial management and oversight, the
Committee intends the Department to align practices and
reporting with that of other federal formula-grant programs
consistent with OMB guidance. Several states brought to our
attention that fiscal oversight and monitoring was more akin to
that of treating the state as a sub-contractor or sub-grantee,
thus triggering extensive and detailed financial reporting. For
example, one state described needing to seek prior HRSA
approval for issuing a competitive Request for Proposal (RFP)
to allow a local agency to expand services, which took six
months to obtain.
Section 4. Requirement that home visiting programs be targeted and
intensive
CURRENT LAW
MIECHV grants must be used for program purposes
(strengthening, coordinating, and providing services to at-risk
communities). More specifically, grants must be used to support
early childhood home visitation programs that make
quantifiable, measurable improvements in individual and family
outcomes in specified areas and demonstrate those improvements
in reports to the Secretary.
Service delivery must be a core component of the eligible
entity's use of funds, and the funded models must adhere to a
clear, consistent model that meets a rigorous-evidence
standard; employs well-trained, competent, and well-supervised
staff; coordinates with other programs that serve the target
population; and monitors fidelity to the evidence-based model.
The one exception to the evidence requirement is that a maximum
of 25 percent of total funds may be used for new and promising
approaches which have not yet met the MIECHV evidence standard
but are being rigorously evaluated.
Eligible entities are also required to give priority to
serving high-risk populations, as identified in a state or
territory-wide needs assessment.
EXPLANATION OF PROVISION
This section clarifies that the core component service
delivery funded by MIECHV should be targeted, intensive
services provided to at-risk populations.
REASON FOR CHANGE
The Committee wished to clarify that although eligible
entities can and may use a minority of their non-administrative
funding for program infrastructure costs that support effective
coordination and service delivery, including promoting
integration of home visiting with other early childhood systems
and operating universal or targeted intake programs, the
primary focus of the MIECHV program is targeted, intensive home
visiting programs which identify at-risk expectant parents and
families and provide ongoing services to them to improve family
outcomes.
Section 5. Limitation on use of funds for administration
CURRENT LAW
Eligible entities are limited to spending a maximum of 10
percent of their federal funding to administer their programs
by a provision in Section 504 of the Social Security Act, which
governs all programs within the Title V of the Social Security
Act.
EXPLANATION OF PROVISION
The section de-links the 10 percent limitation on
administrative funding from the rest of the Maternal and Child
Health Block Grant, which is outside of the Committee's
jurisdiction, and creates a MIECHV-specific 10 percent rule. It
also allows the Secretary to grant exceptions which increase
the allowable share to a maximum of 15 percent in three
specific circumstances in which higher administrative costs
might be expected: (1) if the eligible entity has no sub-
contractors, (2) if the eligible entity is in the process of
expanding to new communities, or (3) if the eligible entity is
new to administering MIECHV.
REASON FOR CHANGE
The Committee wanted to ensure that the administrative
limitation remained constant unless the MIECHV law specifically
was changed; one that could not be altered by a change intended
for a different program (the Maternal and Child Health Block
Grant).
Section 6. Annual report to Congress
CURRENT LAW
The Secretary is not specifically required to provide a
regular written report or other information to Congress about
MIECHV operations or program outcomes.
EXPLANATION OF PROVISION
This section requires the Secretary to provide a written
report to Congress on the MIECHV program starting with fiscal
year 2023, and to provide the report annually thereafter. The
report must include:
Information for all states and territories
on the outcomes achieved and how they compare to
applicable statutory benchmarks;
Information regarding technical assistance
provided to grantees;
Information on the demographic makeup of
families served;
Information that states, territories, and
non-profits report in their demonstration of
improvement report to HHS, in the years in which that
information is available;
Information on the estimated share of the
eligible population receiving home visiting from
MIECHV;
A description of the service delivery models
funded in each state or territory and the share of
grants used for each model;
A description of non-federal funds used to
meet match requirements;
Information on uses of funds reserved for
workforce support, retention, and case management,
including the Jackie Walorski Center for Evidence-Based
Case Management;
Information relating to tribal home visiting
programs; and
A list of data elements that HHS requires
eligible entities to report, and the purpose and use of
each element.
REASON FOR CHANGE
The Committee believes that an annual report on the MIECHV
program would allow for better program oversight by Congress
and limit our need to make repeated requests to the Secretary
for specific program data. An annual report to Congress will
facilitate increased congressional engagement and provide the
Committee with information needed to assess how the program is
working and areas for improvement or changes in the future.
Section 7. Reduction of administrative cost
CURRENT LAW
No provision.
EXPLANATION OF PROVISION
This section requires the Secretary to reduce the
administrative burden of MIECHV data reporting and compliance
with federal rules in a way that focuses more resources on
families, while maintaining accountability. Under this section,
the Secretary must review current data collection tools and
procedures, conduct an analysis of the number of hours required
to comply with federal paperwork, and explore ways to reduce
hours spent by at least 15 percent. The Secretary must also
work with tribal grantees to ensure that their requirements are
appropriate and respect tribal sovereignty and consult state
fiscal officials to ensure consistency with financial
requirements in other federal formula grant programs.
REASON FOR CHANGE
Eligible entities report devoting very substantial staff
resources to collecting and compiling detailed data required by
the Secretary, including site-level financial reporting that is
unusual for federal grant programs and not required by the
statute or related to individual or family outcomes. As the
program shifts from one that primarily made competitive grant
awards to one in which funding is consistently distributed by
formula to states and territories, the Committee believes there
is an opportunity to reduce the share of funding allocated to
administration at both the eligible entity and federal level,
while maintaining accountability for achieving program outcomes
and staying within statutory limitations on administrative
spending.
Section 8. Virtual home visiting authorization and restrictions
CURRENT LAW
No provision. The Consolidated Appropriations Act, 2021
(Pub. L. 116-260) provided emergency flexibility in response to
the COVID-19 pandemic and allowed home visiting funds to be
used to serve families through virtual visits until September
30, 2022.
EXPLANATION OF PROVISION
This section authorizes the use of virtual visits and adds
restrictions to their use.
Beginning in fiscal year 2024, eligible entities will have
the option to provide additional information to the Secretary
demonstrating that they have met specific conditions and then
will be allowed to utilize virtual visits in specific
situations under those conditions. All service delivery models
must include at least one in-person visit a year to qualify for
federal funding. Entities that wish to provide limited virtual
visits must provide the Secretary with:
A description of limitations or constraints
on virtual home visits, including:
A description of the plan of the
eligible entity to encourage in-person home
visits; and
A description of the
considerations to be used in determining when a
virtual home visit is appropriate, including
client consent, client preference, geographic
limitations, model fidelity, hazardous
conditions (including public health
emergencies, weather events, health concerns
for home visitors and client families), and
other local issues.
An assurance that virtual visits are
implemented as a model enhancement or that the
Secretary has identified the home visit as part of an
effective model or model adaptation, based on an
evidence of effectiveness review.
An assurance to the Secretary that at least
one in-person home visit shall be conducted each year,
except during public health emergencies.
Training given to home visitors providing virtual visits
must be equivalent to training for in-person visits. This
provision also defines certain terms used in the section and
requires the Secretary to provide technical assistance to
eligible entities to ensure compliance.
The section also provides a transition rule that allows
virtual visits that were provided before the start of fiscal
year 2024, when the law was unclear, or while entities are
coming into compliance with the new rules to be paid for using
eligible entity MIECHV grants.
REASON FOR CHANGE
A strength of the MIECHV program is its reliance on home
visiting and meaningful in-person interactions between families
and qualified, trained home visitors. The Consolidated
Appropriations Act provided temporary flexibility for states to
conduct virtual home visits during the pandemic. Stakeholders
and states have said this flexibility was beneficial to the
program and recommend it be included as a permanent feature.
The Committee wished to extend this flexibility, clarify
the law regarding the use of virtual visits, and ensure that
Congress and the Secretary knew when and how they were being
used by eligible entities. This section allows home visiting
programs to use this tool when it is in the best interest of
the family and appropriate within the evidence-based model, but
maintains MIECHV's commitment to in-person visits. It is our
intent that virtual visits be used for that reason. The
provision specifies that virtual visiting is to be an
enhancement to MIECHV's evidence-based models and not replace
in-person visits. It also ensures that training for home
visitors on virtual visits is rigorous and equivalent to
training for in-person visits, guarantees at least one in-
person visit per year, and requires appropriate evaluation or
continuous quality improvement monitoring of virtual visits.
This section would allow certain visits to be conducted
remotely but with guardrails to ensure virtual visits are only
used in limited circumstances and do not replace in-person
contact and home visits. States would be required to provide
assurances that virtual visits are used as an enhancement to
current models and not as a replacement.
EFFECTIVE DATE
Virtual Home Visiting Requirements (Section 8): Effective
beginning on October 1, 2023.
All Other Provisions: Effective beginning on October 1,
2022.
III. VOTES OF THE COMMITTEE
In compliance with clause 3(b) of rule XIII of the Rules of
the House of Representatives, the following statement is made
concerning the votes of the Committee on Ways and Means in its
consideration of H.R. 8876, the ``Jackie Walorski Maternal and
Child Home Visiting Reauthorization Act of 2022''.
An amendment was offered by Dr. Wenstrup. The amendment was
agreed to by voice vote with a quorum being present.
An amendment in the nature of a substitute to H.R. 8876 was
agreed to by voice vote with a quorum being present.
H.R. 8876 as amended by an amendment in the nature of a
substitute was ordered favorably reported to the House of
Representatives by a recorded vote of 41 yeas to 0 nays with a
quorum being present. The vote was as follows:
----------------------------------------------------------------------------------------------------------------
Representative Yea Nay Present Representative Yea Nay Present
----------------------------------------------------------------------------------------------------------------
Mr. Doggett...................... X ....... ......... Mr. Brady.......... X .......
Mr. Thompson..................... X ....... ......... Mr. Buchanan....... X .......
Mr. Larson....................... X ....... ......... Mr. Smith (NE)..... X .......
Mr. Blumenauer................... X ....... ......... Mr. Kelly.......... X .......
Mr. Kind......................... X ....... ......... Mr. Smith (MO)..... X .......
Mr. Pascrell..................... X ....... ......... Mr. Rice........... X .......
Mr. Davis........................ X ....... ......... Mr. Schweikert..... X .......
Ms. Sanchez...................... X ....... ......... Mr. LaHood......... X .......
Mr. Higgins...................... X ....... ......... Dr. Wenstrup....... X .......
Ms. Sewell....................... X ....... ......... Mr. Arrington...... X .......
Ms. Delbene...................... X ....... ......... Dr. Ferguson....... X .......
Ms. Chu.......................... X ....... ......... Mr. Estes.......... X .......
Ms. Moore........................ X ....... ......... Mr. Smucker........ X .......
Mr. Kildee....................... X ....... ......... Mr. Hern........... X .......
Mr. Boyle........................ X ....... ......... Ms. Miller......... X .......
Mr. Beyer........................ X ....... ......... Dr. Murphy......... X .......
Mr. Evans........................ X ....... ......... Mr. Kustoff........ X .......
Mr. Schneider.................... X
Mr. Suozzi....................... X
Mr. Panetta...................... X
Ms. Murphy....................... X
Mr. Gomez........................ X
Mr. Horsford..................... X
Ms. Plaskett..................... X
Chairman Neal.................... X
Totals....................... 25 ....... ......... Totals......... 16
----------------------------------------------------------------------------------------------------------------
IV. BUDGET EFFECTS OF THE BILL
A. Committee Estimate of Budgetary Effects
In compliance with clause 3(d) of rule XIII of the Rules of
the House of Representatives, the following statement is made
concerning the effects on the budget of the bill, H.R. 8876, as
reported. The Committee agrees with the estimate prepared by
the Congressional Budget Office (CBO), which is included below.
B. Statement Regarding New Budget Authority and Tax Expenditures Budget
Authority
In compliance with clause 3(c)(2) of rule XIII of the Rules
of the House of Representatives, the Committee states that the
bill provides new budget authority, as described in the
included estimate from the Congressional Budget Office. The
Committee states further that the bill involves no new or
increased tax expenditures.
C. Cost Estimate Prepared by the Congressional
Budget Office
In compliance with clause 3(c)(3) of rule XIII of the Rules
of the House of Representatives, requiring a cost estimate
prepared by the CBO, the following statement by CBO is
provided.
U.S. Congress,
Congressional Budget Office,
Washington, DC, October 11, 2022.
Hon. Richard Neal,
Chairman, Committee on Ways and Means,
House of Representatives, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for H.R. 8876, the Jackie
Walorski Maternal and Child Home Visiting Reauthorization Act
of 2022.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Carolyn
Ugolino.
Sincerely,
Phillip L. Swagel,
Director.
Enclosure.
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
H.R. 8876 would reauthorize the Maternal, Infant, and Early
Childhood Home Visiting (MIECHV) program through fiscal year
2027 and appropriate funds for the program for each fiscal year
from 2023 through 2027. CBO estimates that enacting the bill
would cost about $3 billion over the 2023-2032 period.
The Health Resources and Services Administration manages
the MIECHV grant program. Program funding is distributed to
states, territories, and tribal entities to develop and
implement evidence-based, voluntary programs that aim to
improve maternal and child health, prevent child abuse and
neglect, encourage positive parenting, and promote child
development and school readiness. In fiscal year 2022, the
MIECHV program received $400 million.
H.R. 8876 would appropriate $500 million for each fiscal
year 2023 through 2027 for federal base grants for the program.
Starting in fiscal year 2024, H.R. 8876 would also appropriate
funding to make federal matching grants available subject to a
rate of 75 percent federal funds and 25 percent nonfederal
funds. Any unobligated federal matching funds in a fiscal year
would be redistributed to eligible entities subject to their
capacity to provide the required match.
The costs of the legislation, detailed in Table 1, fall
within budget function 550 (health).
TABLE 1.--ESTIMATED BUDGETARY EFFECTS OF H.R. 8876
--------------------------------------------------------------------------------------------------------------------------------------------------------
By fiscal year, millions of dollars--
-------------------------------------------------------------------------------------------
2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2023-2027 2023-2032
--------------------------------------------------------------------------------------------------------------------------------------------------------
Increases in Direct Spending
Budget Authority............................................ 500 550 600 650 800 0 0 0 0 0 3,100 3,100
Estimated Outlays........................................... 15 175 380 519 554 597 485 255 90 0 1,643 3,070
--------------------------------------------------------------------------------------------------------------------------------------------------------
The Statutory Pay-As-You-Go Act of 2010 establishes budget-
reporting and enforcement procedures for legislation affecting
direct spending or revenues. The net changes in outlays that
are subject to those pay-as-you-go procedures are shown in
Table 2.
TABLE 2.--CBO'S ESTIMATE OF THE STATUTORY PAY-AS-YOU-GO EFFECTS OF H.R. 8876, THE JACKIE WALORSKI MATERNAL AND CHILD HOME VISITING REAUTHORIZATION ACT
OF 2022, AS ORDERED REPORTED BY THE HOUSE COMMITTEE ON WAYS AND MEANS ON SEPTEMBER 21, 2022
--------------------------------------------------------------------------------------------------------------------------------------------------------
By fiscal year, millions of dollars--
-------------------------------------------------------------------------------------------
2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2023-2027 2023-2032
--------------------------------------------------------------------------------------------------------------------------------------------------------
Net Increase in Deficit
Pay-As-You-Go Effect........................................ 15 175 380 519 554 597 485 255 90 0 1,643 3,070
--------------------------------------------------------------------------------------------------------------------------------------------------------
Estimate Prepared By: Federal Costs: Carolyn Ugolino;
Mandates: Andrew Laughlin.
Estimate Reviewed By: Leo Lex, Deputy Director for Budget
Analysis.
V. OTHER MATTERS TO BE DISCUSSED UNDER THE RULES OF THE HOUSE
A. Committee Oversight Findings and Recommendations
With respect to clause 3(c)(1) of rule XIII and clause
2(b)(1) of rule X of the Rules of the House of Representatives,
the Committee made findings and recommendations that are
reflected in this report.
B. Statement of General Performance Goals and Objectives
With respect to clause 3(c)(4) of rule XIII of the Rules of
the House of Representatives, the report describes performance
goals and objectives for the which the measure authorizes
funding.
C. Information Relating to Unfunded Mandates
This information is provided in accordance with section 423
of the Unfunded Mandates Reform Act of 1995 (Pub. L. No. 104-
4).
The Committee has determined that the bill does not contain
Federal mandates on the private sector. The Committee has
determined that the bill does not impose a Federal
intergovernmental mandate on State, local, or tribal
governments.
D. Advisory Committee Statement
No advisory committees within the meaning of section 5(b)
of the Federal Advisory Committee Act were created by the bill.
E. Applicability to Legislative Branch
The Committee finds that the bill does not relate to the
terms and conditions of employment or access to public services
or accommodations within the meaning of section 102(b)(2) of
the Congressional Accountability Act.
F. Congressional Earmarks, Limited Tax Benefits, and Limited Tariff
Benefits
With respect to clause 9 of rule XXI of the Rules of the
House of Representatives, the Committee has carefully reviewed
the provisions of the bill, and states that the provisions of
the bill do not contain any congressional earmarks, limited tax
benefits, or limited tariff benefits within the meaning of the
rule.
G. Duplication of Federal Programs
In compliance with clause 3(c)(5) of rule XIII of the Rules
of the House of Representatives, the Committee states that no
provision of the bill establishes or reauthorizes: (1) a
program of the Federal Government known to be duplicative of
another Federal program; (2) a program included in any report
to Congress pursuant to section 21 of Public Law 111-139; or
(3) a program related to a program identified in the most
recent Catalog of Federal Domestic Assistance, published
pursuant section 6104 of title 31, United States Code.
H. Hearings
Pursuant to clause 3(c)(6) of rule VIII, clause 12 of rule
XXI, and sec. 3(u) of H. Res. 8 (117th Congress), the following
hearing was used to develop or consider H.R. 8876: ``Improving
Family Outcomes through Home Visiting,'' held on March 16,
2022, and described in the legislative history section.
VI. CHANGES IN EXISTING LAW MADE BY THE BILL
A. Text of Existing Law Amended or Repealed by the Bill
Pursuant to clause 3(e) of rule XIII of the Rules of the
House of Representatives, the text of changes in existing law
made by the bill, as reported, are shown below.
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 italics, and existing law in which no
change is proposed is shown in roman):
SOCIAL SECURITY ACT
* * * * * * *
TITLE V--MATERNAL AND CHILD HEALTH SERVICES BLOCK GRANT
* * * * * * *
SEC. 511. MATERNAL, INFANT, AND EARLY CHILDHOOD HOME VISITING PROGRAMS.
(a) Purposes.--The purposes of this section are--
(1) to strengthen and improve the programs and
activities carried out under this title;
(2) to improve coordination of services for at risk
communities; and
(3) to identify and provide comprehensive services to
improve outcomes for families who reside in at risk
communities.
(b) Requirement for All States To Assess Statewide Needs and
Identify at Risk Communities.--
(1) In general.--Each State shall, as a condition of
receiving payments from an allotment for the State
under section 502, conduct a statewide needs assessment
(which may be separate from but in coordination with
the statewide needs assessment required under section
505(a) and which shall be reviewed and updated by the
State not later than October 1, 2020) that identifies--
(A) communities with concentrations of--
(i) premature birth, low-birth weight
infants, and infant mortality,
including infant death due to neglect,
or other indicators of at-risk
prenatal, maternal, newborn, or child
health;
(ii) poverty;
(iii) crime;
(iv) domestic violence;
(v) high rates of high-school drop-
outs;
(vi) substance abuse;
(vii) unemployment; or
(viii) child maltreatment;
(B) the quality and capacity of existing
programs or initiatives for early childhood
home visitation in the State including--
(i) the number and types of
individuals and families who are
receiving services under such programs
or initiatives;
(ii) the gaps in early childhood home
visitation in the State; and
(iii) the extent to which such
programs or initiatives are meeting the
needs of eligible families described in
subsection [(k)(2)] (l)(2); and
(C) the State's capacity for providing
substance abuse treatment and counseling
services to individuals and families in need of
such treatment or services.
(2) Coordination with other assessments.--In
conducting the statewide needs assessment required
under paragraph (1), the State shall coordinate with,
and take into account, other appropriate needs
assessments conducted by the State, as determined by
the Secretary, including the needs assessment required
under section 505(a) (both the most recently completed
assessment and any such assessment in progress), the
communitywide strategic planning and needs assessments
conducted in accordance with section 640(g)(1)(C) of
the Head Start Act, and the inventory of current unmet
needs and current community-based and prevention-
focused programs and activities to prevent child abuse
and neglect, and other family resource services
operating in the State required under section 205(3) of
the Child Abuse Prevention and Treatment Act.
(3) Submission to the secretary.--Each State shall
submit to the Secretary, in such form and manner as the
Secretary shall require--
(A) the results of the statewide needs
assessment required under paragraph (1); and
(B) a description of how the State intends to
address needs identified by the assessment,
particularly with respect to communities
identified under paragraph (1)(A), which may
include applying for a grant to conduct an
early childhood home visitation program in
accordance with the requirements of this
section.
(c) Grants for Early Childhood Home Visitation Programs.--
(1) Authority to make grants.--In addition to any
other payments made under this title to a State, the
Secretary shall make grants to eligible entities to
enable the entities to deliver services under early
childhood home visitation programs that satisfy the
requirements of subsection (d) to eligible families in
order to promote improvements in maternal and prenatal
health, infant health, child health and development,
parenting related to child development outcomes, school
readiness, and the socioeconomic status of such
families, and reductions in child abuse, neglect, and
injuries.
(2) Authority to use initial grant funds for planning
or implementation.--An eligible entity that receives a
grant under paragraph (1) may use a portion of the
funds made available to the entity during the first 6
months of the period for which the grant is made for
planning or implementation activities to assist with
the establishment of early childhood home visitation
programs that satisfy the requirements of subsection
(d).
(3) Authority to use grant for a pay for outcomes
initiative.--An eligible entity to which a grant is
made under paragraph (1) may use up to 25 percent of
the grant for outcomes or success payments related to a
pay for outcomes initiative that will not result in a
reduction of funding for services delivered by the
entity under a childhood home visitation program under
this section while the eligible entity develops or
operates such an initiative.
[(4) Grant duration.--The Secretary shall determine
the period of years for which a grant is made to an
eligible entity under paragraph (1).]
(4) Grant amounts.--
(A) Base grants.--
(i) In general.--
(I) General rule.--With
respect to each of fiscal years
2023 through 2027 for which an
eligible entity not referred to
in subsection (k)(2)(A) is
awarded a base grant under this
section, the amount of the
grant payable to the eligible
entity for the fiscal year is
the amount described by clause
(ii) of this subparagraph with
respect to the eligible entity,
except as provided in subclause
(II) of this clause.
(II) Substitution of
successor eligible entity for
predecessor.--If the 1st fiscal
year for which an eligible
entity is awarded a base grant
under this section for a
program operated in a State is
among fiscal years 2024 through
2027, the amount described by
clause (ii) with respect to the
eligible entity is the amount
of the base grant for which a
program operated in the State
was eligible under this
subparagraph for fiscal year
2023.
(ii) Amount described.--
(I) General rule.--Subject to
the succeeding provisions of
this clause, the amount
described by this clause with
respect to an eligible entity
is--
(aa) the amount made
available under
subsection (k) for base
grants for fiscal year
2023 that remains after
making the reservations
required by subsection
(k)(2) or any other
reductions required by
Federal law for fiscal
year 2023; multiplied
by
(bb) the percentage
of children in all
States who have not
attained 5 years of age
(as determined by the
Secretary on the basis
of the data most
recently available
before fiscal year
2023) that is
represented by the
number of such children
in the State in which
the eligible entity is
operating a program
pursuant to this
section (as so
determined).
(II) Adjustments to ensure
stable funding.--If the amount
otherwise payable to an
eligible entity under subclause
(I) for fiscal year 2023 is
less than 90 percent, or
greater than 110 percent, of
the amount payable under this
section to the eligible entity
for the program for fiscal year
2021, the Secretary shall
increase the amount otherwise
so payable to 90 percent, or
decrease the amount otherwise
so payable to 110 percent, as
the case may be, of the amount
otherwise so payable.
(III) Adjustment to ensure
all base grant funds are
allocated.--If the amount
described by subclause (I)(aa)
is different than the total of
the amounts otherwise described
by subclause (I) after applying
subclause (II), the Secretary
shall increase or decrease the
amounts otherwise so described
after applying subclause (II)
by such equal percentage as is
necessary to reduce that
difference to zero.
(IV) Minimum base grant
amount.--Notwithstanding the
preceding provisions of this
clause, the amount described by
this clause with respect to an
eligible entity shall be not
less than $1,000,000.
(B) Matching grants.--
(i) Amount of grant.--
(I) General rule.--With
respect to each of fiscal years
2024 through 2027 for which an
eligible entity not referred to
in subsection (k)(2)(A) is
awarded a grant under this
section, the Secretary shall
increase the amount of the
grant payable to the eligible
entity for the fiscal year
under subparagraph (A) of this
paragraph by the matching
amount (if any) determined
under subclause (II) of this
clause with respect to the
eligible entity for the fiscal
year and the additional
matching amount (if any)
determined under clause (iii)
of this subparagraph with
respect to the eligible entity
for the fiscal year.
(II) Matching amount.--
(aa) In general.--
Subject to item (bb) of
this subclause, the
matching amount with
respect to an eligible
entity for a fiscal
year is 75 percent of
the sum of--
(AA) the
total amount
obligated by
the eligible
entity for home
visiting
services in the
State for the
fiscal year,
from Federal
funds made
available for
the fiscal year
under this
subparagraph;
and
(BB) the
total amount so
obligated by
the eligible
entity from
non-Federal
funds,
determined
under subclause
(III).
(bb) Limitation.--The
matching amount with
respect to an eligible
entity for a fiscal
year shall not exceed
the allotment under
subclause (IV) for the
State in which the
eligible entity is
operating a program
under this section for
the fiscal year.
(III) Determination of
obligations from non-federal
funds.--For purposes of this
clause, the total amount
obligated by an eligible entity
from non-Federal funds is the
total of the amounts that are
obligated by the eligible
entity from non-Federal
sources, to the extent that--
(aa) the services are
delivered in compliance
with subsections (d)(2)
and (d)(3);
(bb) the eligible
entity has reported the
obligations to the
Secretary; and
(cc) the amount is
not counted toward
meeting the maintenance
of effort requirement
in subsection (f).
(IV) State allotments.--The
amount allotted under this
subclause for a State in which
an eligible entity is operating
a program under this section
for a fiscal year is--
(aa) the minimum
matching grant
allocation amount for
the fiscal year; plus
(bb)(AA) the amount
(if any) by which the
amount made available
under subsection (k)
for matching grants for
the fiscal year that
remains after making
the reservations
required by subsection
(k)(2) or any other
reduction required by
Federal law for the
fiscal year exceeds the
sum of the minimum
matching grant
allocation amounts for
all eligible entities
for the fiscal year;
multiplied by
(BB) the percentage
of children in all
States who have not
attained 5 years of age
and are members of
families with income
not exceeding the
poverty line (as
determined by the
Secretary on the basis
of the most recently
available data) that is
represented by the
number of such children
in the State (as so
determined).
(V) Minimum matching grant
allocation amount.--Subject to
subclause (VI), for purposes of
subclause (IV), the minimum
matching grant allocation
amount for a fiscal year is--
(aa) in the case of
fiscal year 2024,
$776,000;
(bb) in the case of
fiscal year 2025,
$1,000,000;
(cc) in the case of
fiscal year 2026,
$1,500,000; and
(dd) in the case of
fiscal year 2027,
$2,000,000.
(VI) Special rule.--If, after
making any reductions otherwise
required by law for a fiscal
year, the amount made available
for matching grants under this
clause for the fiscal year is
insufficient to provide the
minimum matching grant
allocation amount to each
eligible entity operating a
program under this section for
the fiscal year, the Secretary
may make a proportionate
adjustment to the minimum
matching grant allocation
amount for the fiscal year to
accommodate the reductions.
(ii) Submission of statement
expressing interest in additional
matching funds if available.--Before
the beginning of a fiscal year for
which an eligible entity desires a
matching grant under this subparagraph
for a program operated under this
section, the eligible entity shall
submit to the Secretary a statement as
to whether the eligible entity desires
additional matching grant funds that
may be made available under clause
(iii) for the fiscal year.
(iii) Carryover and reallocation of
unobligated funds.--
(I) In general.--If the
Secretary determines that an
amount allotted under clause
(i)(IV) of this subparagraph
for a fiscal year will not be
awarded during the fiscal year,
or that an amount made
available under subsection
(k)(1) for a fiscal year for
matching grants will not be
obligated by an eligible entity
for the fiscal year, the amount
shall be available for matching
grants under this subparagraph
for the succeeding fiscal year
for eligible entities that have
made submissions under clause
(ii) of this subparagraph for
additional matching grant funds
from the amount.
(II) State allotments.--The
Secretary shall allot to each
eligible entity that has made
such a submission for a fiscal
year--
(aa) the total amount
(if any) made available
under subclause (I) for
the fiscal year;
multiplied by
(bb) the percentage
of children who have
not attained 5 years of
age and are members of
families with income
not exceeding the
poverty line (as
determined by the
Secretary on the basis
of the most recently
available data) in all
of the States in which
any eligible entity
that has made such a
submission is so
operating a program,
that is represented by
the number of such
children in the State
(as so determined) in
which the eligible
entity is operating
such a program.
(III) Additional matching
amount.--
(aa) In general.--
Subject to item (bb) of
this subclause, the
additional matching
amount with respect to
an eligible entity for
a fiscal year is 75
percent of the sum of--
(AA) the
total amount
obligated by
the eligible
entity for home
visiting
services in the
State for the
fiscal year,
from Federal
funds made
available for
the fiscal year
under this
subparagraph;
and
(BB) the
total amount so
obligated by
the eligible
entity from
non-Federal
funds,
determined
under clause
(i)(III),
that are not taken into
account in determining
the matching amount
with respect to the
eligible entity under
clause (i).
(bb) Limitation.--The
additional matching
amount with respect to
an eligible entity for
a fiscal year shall not
exceed the allotment
under subclause (II)
for the State in which
the eligible entity is
operating a program
under this section for
the fiscal year.
(5) Technical assistance.--The Secretary shall
provide an eligible entity that receives a grant under
paragraph (1) with technical assistance in
administering programs or activities conducted in whole
or in part with grant funds.
(d) Requirements.--The requirements of this subsection for an
early childhood home visitation program conducted with a grant
made under this section are as follows:
(1) Quantifiable, measurable improvement in
[benchmark areas] benchmark areas related to individual
family outcomes.--
(A) In general.--The eligible entity
establishes, subject to the approval of the
Secretary, quantifiable, measurable 3- and 5-
year benchmarks for demonstrating that the
program results in improvements for the
eligible families participating in the program
in the following areas:
(i) Improved maternal and newborn
health.
(ii) Prevention of child injuries,
child abuse, neglect, or maltreatment,
and reduction of emergency department
visits.
(iii) Improvement in school readiness
and achievement.
(iv) Reduction in crime or domestic
violence.
(v) Improvements in family economic
self-sufficiency.
(vi) Improvements in the coordination
and referrals for other community
resources and supports.
(B) Outcomes dashboards.--The Secretary
shall, directly or by grant or contract,
establish and operate a website accessible to
the public that includes an annually updated
dashboard that--
(i) provides easy-to-understand
information on the outcomes achieved by
each eligible entity with respect to
each of the benchmarks described in
subparagraph (A) of this paragraph that
apply to the eligible entity, which
shall be based on only the data
elements or types of data collected
before the date of the enactment of
this section unless administering
agencies and the Secretary agree
pursuant to subsection (h)(6) that
additional data is required;
(ii) includes a template provided by
the Secretary that will enable
comparison among eligible entities not
referred to in subsection (k)(2)(A)
of--
(I) a profile of each
eligible entity showing outcome
indicators and how the outcomes
compare to benchmarks described
in subclause (II);
(II) information on the
outcome indicators and
requisite outcome levels
established for each eligible
entity;
(III) information on each
model employed in the program
operated by each eligible
entity, and regarding each
benchmark area described in
subsection (d)(1)(A) in which
the model used by the eligible
entity is expected to affect
participant outcomes;
(IV) the most recently
available information from the
report required by subparagraph
(E) of this paragraph;
(V) an electronic link to the
State needs assessment under
subsection (b)(1); and
(VI) information regarding
any penalty imposed, or other
corrective action taken, by the
Secretary against a State for
failing to achieve a requisite
outcome level or any other
requirement imposed by or under
this section, and an indication
as to whether the eligible
entity is operating under a
corrective action plan under
subparagraph (E)(ii) of this
paragraph, and if so, a link to
the plan, an explanation of the
reason for the implementation
of the plan, and a report on
any progress made in operating
under the plan;
(iii) includes information relating
to those eligible entities for which
funding is reserved under subsection
(k)(2)(A), with modifications as
necessary to reflect tribal
sovereignty, data privacy, and
participant confidentiality; and
(iv) protects data privacy and
confidentiality of participant
families.
[(B)] (C) Demonstration of improvements after
3 years.--
(i) Report to the secretary.--Not
later than 30 days after the end of the
3rd year in which the eligible entity
conducts the program, the entity
submits to the Secretary a report
demonstrating improvement in at least 4
of the areas specified in subparagraph
(A).
(ii) Corrective action plan.--If the
report submitted by the eligible entity
under clause (i) fails to demonstrate
improvement in at least 4 of the areas
specified in subparagraph (A), the
entity shall develop and implement a
plan to improve outcomes in each of the
areas specified in subparagraph (A),
subject to approval by the Secretary.
The plan shall include provisions for
the Secretary to monitor implementation
of the plan and conduct continued
oversight of the program, including
through submission by the entity of
regular reports to the Secretary.
(iii) Technical assistance.--
(I) In general.--The
Secretary shall provide an
eligible entity required to
develop and implement an
improvement plan under clause
(ii) with technical assistance
to develop and implement the
plan. The Secretary may provide
the technical assistance
directly or through grants,
contracts, or cooperative
agreements.
(II) Advisory panel.--The
Secretary shall establish an
advisory panel for purposes of
obtaining recommendations
regarding the technical
assistance provided to entities
in accordance with subclause
(I).
(iv) No improvement or failure to
submit report.--If the Secretary
determines after a period of time
specified by the Secretary that an
eligible entity implementing an
improvement plan under clause (ii) has
failed to demonstrate any improvement
in the areas specified in subparagraph
(A), or if the Secretary determines
that an eligible entity has failed to
submit the report required under clause
(i), the Secretary shall terminate the
entity's grant and may include any
unexpended grant funds in grants made
to nonprofit organizations under
subsection (h)(2)(B).
[(C)] (D) Final report.--Not later than
December 31, 2015, the eligible entity shall
submit a report to the Secretary demonstrating
improvements (if any) in each of the areas
specified in subparagraph (A).
[(D)] (E) Demonstration of improvements in
subsequent years.--
(i) Continued measurement of
improvement in applicable benchmark
areas.--The eligible entity, after
demonstrating improvements for eligible
families as specified in subparagraphs
(A) and [(B)] (C), shall continue to
track and report, not later than 30
days after the end of fiscal year 2020
and every 3 years thereafter,
information demonstrating that the
program results in improvements for the
eligible families participating in the
program in at least 4 of the areas
specified in subparagraph (A) that the
service delivery model or models
selected by the entity are intended to
improve.
(ii) Corrective action plan.--If the
eligible entity fails to demonstrate
improvement in at least 4 of the areas
specified in subparagraph (A), as
compared to eligible families who do
not receive services under an early
childhood home visitation program, the
entity shall develop and implement a
plan to improve outcomes in each of the
areas specified in subparagraph (A)
that the service delivery model or
models selected by the entity are
intended to improve, subject to
approval by the Secretary. The plan
shall include provisions for the
Secretary to monitor implementation of
the plan and conduct continued
oversight of the program, including
through submission by the entity of
regular reports to the Secretary.
(iii) Technical assistance.--The
Secretary shall provide an eligible
entity required to develop and
implement an improvement plan under
clause (ii) with technical assistance
to develop and implement the plan. The
Secretary may provide the technical
assistance directly or through grants,
contracts, or cooperative agreements.
(iv) No improvement or failure to
submit report.--If the Secretary
determines after a period of time
specified by the Secretary that an
eligible entity implementing an
improvement plan under clause (ii) has
failed to demonstrate any improvement
in at least 4 of the areas specified in
subparagraph (A), or if the Secretary
determines that an eligible entity has
failed to submit the report required by
clause (i), the Secretary shall
terminate the grant made to the entity
under this section and may include any
unexpended grant funds in grants made
to nonprofit organizations under
subsection (h)(2)(B).
(2) Improvements in outcomes for individual
families.--
(A) In general.--The program is designed,
with respect to an eligible family
participating in the program, to result in the
participant outcomes described in subparagraph
(B) that the eligible entity identifies on the
basis of an individualized assessment of the
family, are relevant for that family.
(B) Participant outcomes.--The participant
outcomes described in this subparagraph are the
following:
(i) Improvements in prenatal,
maternal, and newborn health, including
improved pregnancy outcomes
(ii) Improvements in child health and
development, including the prevention
of child injuries and maltreatment and
improvements in cognitive, language,
social-emotional, and physical
developmental indicators.
(iii) Improvements in parenting
skills.
(iv) Improvements in school readiness
and child academic achievement.
(v) Reductions in crime or domestic
violence.
(vi) Improvements in family economic
self-sufficiency.
(vii) Improvements in the
coordination of referrals for, and the
provision of, other community resources
and supports for eligible families,
consistent with State child welfare
agency training.
(3) Core components.--The program includes the
following core components:
(A) Service delivery model or models.--
(i) In general.--Subject to clause
(ii), the program is conducted using 1
or more of the service delivery models
described in item (aa) or (bb) of
subclause (I) or in subclause (II)
selected by the eligible entity:
(I) The model conforms to a
clear consistent home
visitation model that has been
in existence for at least 3
years and is research-based,
grounded in relevant
empirically-based knowledge,
linked to program determined
outcomes, associated with a
national organization or
institution of higher education
that has comprehensive home
visitation program standards
that ensure high quality
service delivery and continuous
program quality improvement,
and has demonstrated
significant, (and in the case
of the service delivery model
described in item (aa),
sustained) positive outcomes,
as described in the benchmark
areas specified in paragraph
(1)(A) and the participant
outcomes described in paragraph
(2)(B), when evaluated using
well-designed and rigorous--
(aa) randomized
controlled research
designs, and the
evaluation results have
been published in a
peer-reviewed journal;
or
(bb) quasi-
experimental research
designs.
(II) The model conforms to a
promising and new approach to
achieving the benchmark areas
specified in paragraph (1)(A)
and the participant outcomes
described in paragraph (2)(B),
has been developed or
identified by a national
organization or institution of
higher education, and will be
evaluated through well-designed
and rigorous process.
(ii) Majority of grant funds used for
evidence-based models.--An eligible
entity shall use not more than 25
percent of the amount of the grant paid
to the entity for a fiscal year for
purposes of conducting a program using
the service delivery model described in
clause (i)(II).
(iii) Criteria for evidence of
effectiveness of models.--The Secretary
shall establish criteria for evidence
of effectiveness of the service
delivery models and shall ensure that
the process for establishing the
criteria is transparent and provides
the opportunity for public comment.
(B) Use of grant to provide or support
targeted, intensive home visiting services.--
The program uses the grant to provide or
support targeted, intensive home visiting
services for the populations described in
paragraph (5).
[(B)] (C) Additional requirements.--
(i) The program adheres to a clear,
consistent model that satisfies the
requirements of being grounded in
empirically-based knowledge related to
home visiting and linked to the
benchmark areas specified in paragraph
(1)(A) and the participant outcomes
described in paragraph (2)(B) related
to the purposes of the program.
(ii) The program employs well-trained
and competent staff, as demonstrated by
education or training, such as nurses,
social workers, educators, child
development specialists, or other well-
trained and competent staff, and
provides ongoing and specific training
on the model being delivered.
(iii) The program maintains high
quality supervision to establish home
visitor competencies.
(iv) The program demonstrates strong
organizational capacity to implement
the activities involved.
(v) The program establishes
appropriate linkages and referral
networks to other community resources
and supports for eligible families.
(vi) The program monitors the
fidelity of program implementation to
ensure that services are delivered
pursuant to the specified model.
(vii) If the application submitted by
the eligible entity includes the
assurance described in subsection
(e)(10)(C) with respect to the program,
the program provides in-person service
consistent with the assurances.
(4) Virtual home visits.--
(A) In general.--A virtual home visit
conducted under the program shall be considered
a home visit for purposes of this section if
the application for funding of the program
submitted pursuant to this section most
recently after the effective date of this
paragraph includes the material described in
subsection (e)(10).
(B) Standards for training applicable to
virtual service delivery.--The standards for
training requirements applicable to virtual
service delivery under a home visiting model
shall be equivalent to those that apply to in-
person service delivery under the model.
(C) Reporting requirement.--A grant made
under this section for the program may not be
used for any virtual home visit during a year,
unless the eligible entity to which the grant
is made submits the report described in
subsection (e)(8)(A) for the year.
(D) Virtual home visit defined.--In this
section, the term ``virtual home visit'' means
a visit conducted solely by use of electronic
information and telecommunications
technologies.
(E) Technical assistance.--If the Secretary
finds that an eligible entity has not complied
with the assurance described in subsection
(e)(10)(C), the Secretary shall, directly or
through grants, contracts, or cooperative
agreements, provide the eligible entity with
such technical assistance as is necessary to
assist the eligible entity in doing so.
[(4)] (5) Priority for serving high-risk
populations.--The eligible entity gives priority to
providing services under the program to the following:
(A) Eligible families who reside in
communities in need of such services, as
identified in the statewide needs assessment
required under subsection (b)(1)(A), taking
into account the staffing, community resource,
and other requirements to operate at least one
approved model of home visiting and demonstrate
improvements for eligible families.
(B) Low-income eligible families.
(C) Eligible families who are pregnant women
who have not attained age 21.
(D) Eligible families that have a history of
child abuse or neglect or have had interactions
with child welfare services.
(E) Eligible families that have a history of
substance abuse or need substance abuse
treatment.
(F) Eligible families that have users of
tobacco products in the home.
(G) Eligible families that are or have
children with low student achievement.
(H) Eligible families with children with
developmental delays or disabilities.
(I) Eligible families who, or that include
individuals who, are serving or formerly served
in the Armed Forces, including such families
that have members of the Armed Forces who have
had multiple deployments outside of the United
States.
(6) Limitation on use of funds for administrative
costs.--
(A) In general.--Except as provided in
subparagraph (B) of this paragraph, an eligible
entity to which funds are provided under
subsection (c) or (h)(2)(B) shall not use more
than 10 percent of the funds to cover the costs
of administration.
(B) Authority to grant exceptions.--
(i) In general.--The Secretary may
authorize an eligible entity that meets
a condition of clause (ii) of this
subparagraph to exceed the percentage
limitation in subparagraph (A) with
respect to a program conducted under
this subsection by not more than 5
percentage points, subject to such
terms and conditions as the Secretary
deems appropriate.
(ii) Conditions.--An eligible entity
meets a condition of this clause if the
eligible entity--
(I) conducts the program by
directly providing home visits
to eligible families and
without a sub-recipient;
(II) in the fiscal year for
which the grant for the program
is made under this section,
proposes to expand services in
1 or more communities
identified in the statewide
needs assessment under
subsection (b) and in which
home visiting services are not
provided; or
(III) has conducted the
program for fewer than 3 years.
(e) Application Requirements.--An eligible entity desiring a
grant under this section shall submit an application to the
Secretary for approval, in such manner as the Secretary may
require, that includes the following:
(1) A description of the populations to be served by
the entity, including specific information regarding
how the entity will serve high risk populations
described in subsection (d)(4).
(2) An assurance that the entity will give priority
to serving low-income eligible families and eligible
families who reside in at risk communities identified
in the statewide needs assessment required under
subsection (b)(1)(A).
(3) The service delivery model or models described in
subsection (d)(3)(A) that the entity will use under the
program and the basis for the selection of the model or
models.
(4) A statement identifying how the selection of the
populations to be served and the service delivery model
or models that the entity will use under the program
for such populations is consistent with the results of
the statewide needs assessment conducted under
subsection (b).
(5) The quantifiable, measurable benchmarks
established by the State to demonstrate that the
program contributes to improvements in the areas
specified in subsection (d)(1)(A) that the service
delivery model or models selected by the entity are
intended to improve.
(6) An assurance that the entity will obtain and
submit documentation or other appropriate evidence from
the organization or entity that developed the service
delivery model or models used under the program to
verify that the program is implemented and services are
delivered according to the model specifications.
(7) Assurances that the entity will establish
procedures to ensure that--
(A) the participation of each eligible family
in the program is voluntary; and
(B) services are provided to an eligible
family in accordance with the individual
assessment for that family.
(8) Assurances that the entity will--
(A) submit annual reports to the Secretary
regarding the program and activities carried
out under the program that include such
information and data as the Secretary shall
require, including the number of virtual home
visits conducted under the program in the year
covered by the report, disaggregated with
respect to each home visiting model under which
the virtual home visits are conducted; and
(B) participate in, and cooperate with, data
and information collection necessary for the
evaluation required under subsection (g)(2) and
other research and evaluation activities
carried out under subsection (h)(3).
(9) A description of other State programs that
include home visitation services, including, if
applicable to the State, other programs carried out
under this title with funds made available from
allotments under section 502(c), programs funded under
title IV, title II of the Child Abuse Prevention and
Treatment Act (relating to community-based grants for
the prevention of child abuse and neglect), and section
645A of the Head Start Act (relating to Early Head
Start programs).
(10) At the option of the eligible entity--
(A) a description of any limitations or
constraints on virtual home visits under the
program, including--
(i) a description of the plan of the
eligible entity to encourage in-person
home visits; and
(ii) a description of the
considerations to be used in
determining when a virtual home visit
is appropriate, including client
consent, client preference, geographic
limitations, model fidelity, and
hazardous conditions including public
health emergencies, weather events,
health concerns for home visitors and
client families, and other local
issues;
(B) an assurance that--
(i) the virtual home visit is
implemented as a model enhancement; or
(ii) the Secretary has identified the
home visit as part of an effective
model or model adaptation, based on an
evidence of effectiveness review
conducted using the criteria
established under subsection
(d)(3)(A)(iii); and
(C) an assurance to the Secretary that at
least 1 in-person home visit shall be conducted
for each client family under the program during
the 12-month period that begins with the entry
of the client family into the program, and
during each succeeding 12-month period, except
that any such period in which a public health
emergency declared under Federal law, or under
the law of the State in which the program is
conducted, is in effect shall be extended by
the length of time in which the declaration is
in effect.
[(10)] (11) Other information as required by the
Secretary.
[(f) Maintenance of Effort.--Funds provided to an eligible
entity receiving a grant under this section shall supplement,
and not supplant, funds from other sources for early childhood
home visitation programs or initiatives.]
(f) Maintenance of Effort.--
(1) In general.--Notwithstanding any other provision
of this section, the Secretary may not make a grant to
an eligible entity under this section for a fiscal year
if the total amount of non-Federal funds obligated by
the eligible entity in the State in the fiscal year for
a program operated pursuant to this section is less
than the total amount of non-Federal funds reported to
have been expended by any eligible entity for such a
program in the State in fiscal year 2019 or 2021,
whichever is the lesser.
(2) Publication of amounts.--Not later than June 30,
2023, the Secretary shall cause to have published in
the Federal Register the amount of non-Federal funds
expended as described in this section that has been
reported by each eligible entity not referred to in
subsection (k)(2)(A) for each of fiscal years 2019 and
2021.
(3) Grace period.--The Secretary may, in exceptional
circumstances, allow an eligible entity a period to
come into compliance with this subsection. The
Secretary shall provide technical assistance to any
eligible entity to assist the entity in doing so.
(g) Evaluation.--
(1) Independent, expert advisory panel.--The
Secretary, in accordance with subsection (h)(1)(A),
shall appoint an independent advisory panel consisting
of experts in program evaluation and research,
education, and early childhood development--
(A) to review, and make recommendations on,
the design and plan for the evaluation required
under paragraph (2) within 1 year after the
date of enactment of this section;
(B) to maintain and advise the Secretary
regarding the progress of the evaluation; and
(C) to comment, if the panel so desires, on
the report submitted under paragraph (3).
(2) Authority to conduct evaluation.--On the basis of
the recommendations of the advisory panel under
paragraph (1), the Secretary shall, by grant, contract,
or interagency agreement, conduct an evaluation of the
statewide needs assessments submitted under subsection
(b) and the grants made under subsections (c) and
(h)(3)(B). The evaluation shall include--
(A) an analysis, on a State-by-State basis,
of the results of such assessments, including
indicators of maternal and prenatal health and
infant health and mortality, and State actions
in response to the assessments; and
(B) an assessment of--
(i) the effect of early childhood
home visitation programs on child and
parent outcomes, including with respect
to each of the benchmark areas
specified in subsection (d)(1)(A) and
the participant outcomes described in
subsection (d)(2)(B);
(ii) the effectiveness of such
programs on different populations,
including the extent to which the
ability of programs to improve
participant outcomes varies across
programs and populations; and
(iii) the potential for the
activities conducted under such
programs, if scaled broadly, to improve
health care practices, eliminate health
disparities, and improve health care
system quality, efficiencies, and
reduce costs.
(3) Report.--Not later than March 31, 2015, the
Secretary shall submit a report to Congress on the
results of the evaluation conducted under paragraph (2)
and shall make the report publicly available.
(h) Other Provisions.--
(1) Intra-agency collaboration.--The Secretary shall
ensure that the Maternal and Child Health Bureau and
the Administration for Children and Families
collaborate with respect to carrying out this section,
including with respect to--
(A) reviewing and analyzing the statewide
needs assessments required under subsection
(b), the awarding and oversight of grants
awarded under this section, the establishment
of the advisory panels required under
subsections (d)(1)(B)(iii)(II) and (g)(1), and
the evaluation and report required under
subsection (g); and
(B) consulting with other Federal agencies
with responsibility for administering or
evaluating programs that serve eligible
families to coordinate and collaborate with
respect to research related to such programs
and families, including the Office of the
Assistant Secretary for Planning and Evaluation
of the Department of Health and Human Services,
the Centers for Disease Control and Prevention,
the National Institute of Child Health and
Human Development of the National Institutes of
Health, the Office of Juvenile Justice and
Delinquency Prevention of the Department of
Justice, and the Institute of Education
Sciences of the Department of Education.
(2) Grants to eligible entities that are not
states.--
(A) Indian tribes, tribal organizations, or
urban indian organizations.--The Secretary
shall specify requirements for eligible
entities that are Indian Tribes (or a
consortium of Indian Tribes), Tribal
Organizations, or Urban Indian Organizations to
apply for and conduct an early childhood home
visitation program with a grant under this
section. Such requirements shall, to the
greatest extent practicable, be consistent with
the requirements applicable to eligible
entities that are States and shall require an
Indian Tribe (or consortium), Tribal
Organization, or Urban Indian Organization to--
(i) conduct a needs assessment
similar to the assessment required for
all States under subsection (b); and
(ii) establish quantifiable,
measurable 3- and 5-year benchmarks
consistent with subsection (d)(1)(A).
(B) Nonprofit organizations.--If, as of the
beginning of fiscal year 2012, a State has not
applied or been approved for a grant under this
section, the Secretary may use amounts
appropriated under paragraph (1) of subsection
[(j)] (k) that are available for expenditure
under paragraph (3) of that subsection to make
a grant to an eligible entity that is a
nonprofit organization described in subsection
[(k)(1)(B)] (l)(1)(B) to conduct an early
childhood home visitation program in the State.
The Secretary shall specify the requirements
for such an organization to apply for and
conduct the program which shall, to the
greatest extent practicable, be consistent with
the requirements applicable to eligible
entities that are States and shall require the
organization to--
(i) carry out the program based on
the needs assessment conducted by the
State under subsection (b); and
(ii) establish quantifiable,
measurable 3- and 5-year benchmarks
consistent with subsection (d)(1)(A).
(3) Research and other evaluation activities.--
(A) In general.--The Secretary shall carry
out a continuous program of research and
evaluation activities in order to increase
knowledge about the implementation and
effectiveness of home visiting programs, using
random assignment designs to the maximum extent
feasible. The Secretary may carry out such
activities directly, or through grants,
cooperative agreements, or contracts.
(B) Requirements.--The Secretary shall ensure
that--
(i) evaluation of a specific program
or project is conducted by persons or
individuals not directly involved in
the operation of such program or
project; and
(ii) the conduct of research and
evaluation activities includes
consultation with independent
researchers, State officials, and
developers and providers of home
visiting programs on topics including
research design and administrative data
matching.
(4) Report and recommendation.--Not later than
December 31, 2015, the Secretary shall submit a report
to Congress regarding the programs conducted with
grants under this section. The report required under
this paragraph shall include--
(A) information regarding the extent to which
eligible entities receiving grants under this
section demonstrated improvements in the areas
specified in subsection (d)(1)(A);
(B) information regarding any technical
assistance provided under subsection
(d)(1)(B)(iii)(I), including the type of any
such assistance provided; and
(C) recommendations for such legislative or
administrative action as the Secretary
determines appropriate.
(5) Data exchange standards for improved
interoperability.--
(A) Designation and use of data exchange
standards.--
(i) Designation.--The head of the
department or agency responsible for
administering a program funded under
this section shall, in consultation
with an interagency work group
established by the Office of Management
and Budget and considering State
government perspectives, designate data
exchange standards for necessary
categories of information that a State
agency operating the program is
required to electronically exchange
with another State agency under
applicable Federal law.
(ii) Data exchange standards must be
nonproprietary and interoperable.--The
data exchange standards designated
under clause (i) shall, to the extent
practicable, be nonproprietary and
interoperable.
(iii) Other requirements.--In
designating data exchange standards
under this paragraph, the Secretary
shall, to the extent practicable,
incorporate--
(I) interoperable standards
developed and maintained by an
international voluntary
consensus standards body, as
defined by the Office of
Management and Budget;
(II) interoperable standards
developed and maintained by
intergovernmental partnerships,
such as the National
Information Exchange Model; and
(III) interoperable standards
developed and maintained by
Federal entities with authority
over contracting and financial
assistance.
(B) Data exchange standards for federal
reporting.--
(i) Designation.--The head of the
department or agency responsible for
administering a program referred to in
this section shall, in consultation
with an interagency work group
established by the Office of Management
and Budget, and considering State
government perspectives, designate data
exchange standards to govern Federal
reporting and exchange requirements
under applicable Federal law.
(ii) Requirements.--The data exchange
reporting standards required by clause
(i) shall, to the extent practicable--
(I) incorporate a widely
accepted, nonproprietary,
searchable, computer-readable
format;
(II) be consistent with and
implement applicable accounting
principles;
(III) be implemented in a
manner that is cost-effective
and improves program efficiency
and effectiveness; and
(IV) be capable of being
continually upgraded as
necessary.
(iii) Incorporation of nonproprietary
standards.--In designating data
exchange standards under this
paragraph, the Secretary shall, to the
extent practicable, incorporate
existing nonproprietary standards, such
as the eXtensible Mark up Language.
(iv) Rule of construction.--Nothing
in this paragraph shall be construed to
require a change to existing data
exchange standards for Federal
reporting about a program referred to
in this section, if the head of the
department or agency responsible for
administering the program finds the
standards to be effective and
efficient.
(6) Reduction of administrative burden.--
(A) In general.--The Secretary shall reduce
the burden, on States and public and private
implementing agencies at the local level, of
administering this section, by--
(i) reviewing and revising
administrative data collection
instruments and forms to eliminate
duplication and streamline reporting
requirements for States, eligible
entities referred to in subsection
(k)(2)(A), and nonprofit organizations
referred to in subsection (l)(1)(B),
including timelines for submitting
reports;
(ii) conducting an analysis of the
total number of hours reported by
administering agencies on complying
with paperwork requirements, and
exploring, in consultation with
administering agencies, ways to reduce
the number of hours spent by at least
15 percent;
(iii) conducting a review of
paperwork and data collection
requirements for tribal grantees, and
exploring, in consultation with tribes
and tribal organizations, ways to
reduce administrative burden, respect
sovereignty, and acknowledge the
different focus points for tribal
grantees;
(iv) collecting input from relevant
State fiscal officials to align fiscal
requirements and oversight for States
and eligible entities to ensure
consistency with standards and
guidelines for other Federal formula
grant programs; and
(v) consulting with administering
agencies and service delivery model
representatives on needed and unneeded
data elements regarding the dashboards
provided for in subsection (d)(1)(B),
consistent with the data requirements
of such subsection.
(B) Findings on paperwork reduction.--
(i) Inclusion in report.--In the 1st
report submitted pursuant to subsection
(j) more than 18 months after the date
of the enactment of this Act, the
Secretary shall include the findings of
the Secretary with respect to the
matters described in subparagraph (A).
(ii) Implementation.--Within 2 years
after complying with clause (i), the
Secretary shall implement the findings
referred to in clause (i).
(i) Application of Other Provisions of Title.--
(1) In general.--Except as provided in paragraph (2),
the other provisions of this title shall not apply to a
grant made under this section.
(2) Exceptions.--The following provisions of this
title shall apply to a grant made under this section to
the same extent and in the same manner as such
provisions apply to allotments made under section
502(c):
(A) Section 504(b)(6) (relating to
prohibition on payments to excluded individuals
and entities).
(B) Section 504(c) (relating to the use of
funds for the purchase of technical
assistance).
[(C) Section 504(d) (relating to a limitation
on administrative expenditures).]
[(D)] (C) Section 506 (relating to reports
and audits), but only to the extent determined
by the Secretary to be appropriate for grants
made under this section.
[(E)] (D) Section 507 (relating to penalties
for false statements).
[(F)] (E) Section 508 (relating to
nondiscrimination).
[(G)] (F) Section 509(a) (relating to the
administration of the grant program).
(j) Annual Report to Congress.--By December 31, 2023, and
annually thereafter, the Secretary shall submit to the Congress
a written report on the grants made under this section for the
then preceding fiscal year, which shall include--
(1) an eligible entity-by-eligible entity summary of
the outcomes measured by the entity with respect to
each benchmark described in subsection (e)(5) that
apply to the entity;
(2) information regarding any technical assistance
funded under subparagraph (B) or (C) of subsection
(k)(2), including the type of any such assistance
provided;
(3) information on the demographic makeup of families
served by each such entity to the extent possible while
respecting participant confidentiality, including race,
ethnicity, educational attainment at enrollment,
household income, and other demographic markers as
determined by the Secretary;
(4) the information described in subsection
(d)(1)(E);
(5) the estimated share of the eligible population
served using grants made under this section;
(6) a description of each service delivery model
funded under this section by the eligible entities in
each State, and the share (if any) of the grants
expended on each model;
(7) a description of non-Federal expenditures by
eligible entities to qualify for matching funds under
subsection (c)(4);
(8) information on the uses of funds reserved under
subsection (k)(2)(C);
(9) information relating to those eligible entities
for which funding is reserved under subsection
(k)(2)(A), with modifications as necessary to reflect
tribal data sovereignty, data privacy, and participant
confidentiality; and
(10) a list of data elements collected from eligible
entities, and the purpose of each data element in
measuring performance or enforcing requirements under
this section.
[(j)] (k) Appropriations.--
(1) In general.--Out of any funds in the Treasury not
otherwise appropriated, there are appropriated to the
Secretary to carry out this section--
[(A) $100,000,000 for fiscal year 2010;
[(B) $250,000,000 for fiscal year 2011;
[(C) $350,000,000 for fiscal year 2012;
[(D) $400,000,000 for fiscal year 2013;
[(E) $400,000,000 for fiscal year 2014;
[(F) for fiscal year 2015, $400,000,000;
[(G) for fiscal year 2016, $400,000,000; and
[(H) for each of fiscal years 2017 through
2022, $400,000,000.]
(A) for fiscal year 2023, $500,000,000 for
base grants;
(B) for fiscal year 2024, $550,000,000, of
which $500,000,000 shall be for base grants and
$50,000,000 shall be for matching grants;
(C) for fiscal year 2025, $600,000,000, of
which $500,000,000 shall be for base grants and
$100,000,000 shall be for matching grants;
(D) for fiscal year 2026, $650,000,000, of
which $500,000,000 shall be for base grants and
$150,000,000 shall be for matching grants; and
(E) for fiscal year 2027, $800,000,000, of
which $500,000,000 shall be for base grants and
$300,000,000 shall be for matching grants.
(2) Reservations.--Of [the amount] each amount made
available for base grants and each amount made
available for matching grants appropriated under this
subsection for a fiscal year (or portion of a fiscal
year), the Secretary shall reserve--
(A) [3] 6 percent of such amount for purposes
of making grants to eligible entities that are
Indian Tribes (or a consortium of Indian
Tribes), Tribal Organizations, or Urban Indian
Organizations; [and]
[(B) 3 percent of such amount for purposes of
carrying out subsections (d)(1)(B)(iii), (g),
and (h)(3).]
(B) 2 percent of such amount for purposes of
providing technical assistance, directly or
through grants or contracts, for purposes as
otherwise described in subsections (c)(5),
(d)(1)(C)(iii), (d)(1)(E)(iii), and (d)(4)(E);
(C) 2 percent of such amount for purposes of
workforce support, retention, and case
management, including workforce-related
technical assistance, research and evaluation,
and program administration, directly or through
grants or contracts, of which the Secretary
shall use not more than $1,500,000 to establish
and operate the Jackie Walorski Center for
Evidence-Based Case Management; and
(D) 3 percent of such amount for purposes of
research and evaluation (directly or through
grants or contracts), and for administering
this section (directly, through contracts, or
otherwise).
(3) Availability.--
(A) In general.--Except as provided in
subparagraph (B), funds made available to an
eligible entity under this section for a fiscal
year (or portion of a fiscal year) shall remain
available for expenditure by the eligible
entity through the end of the second succeeding
fiscal year after award. Any funds that are not
expended by the eligible entity during the
period in which the funds are available under
the preceding sentence may be used for grants
to nonprofit organizations under subsection
(h)(2)(B).
(B) Funds for pay for outcomes initiatives.--
Funds made available to an eligible entity
under this section for a fiscal year (or
portion of a fiscal year) for a pay for
outcomes initiative shall remain available for
expenditure by the eligible entity for not more
than 10 years after the funds are so made
available.
(4) Allocation of funds.--To the extent that the
grant amount awarded under this section to an eligible
entity is determined on the basis of relative
population or poverty considerations, the Secretary
shall make the determination using the most accurate
Federal data available for the eligible entity.
(5) Disposition of excess funds reserved for
research, evaluation, and administration.--To the
extent that the amounts reserved under paragraph (2)(D)
for a fiscal year are not obligated in the fiscal year,
the Secretary may use the funds for any purpose
described in this section or to offset any reduction
with respect to this section that is required by
Federal law.
[(k)] (l) Definitions.--In this section:
(1) Eligible entity.--
(A) In general.--The term ``eligible entity''
means a State, an Indian Tribe, Tribal
Organization, or Urban Indian Organization,
Puerto Rico, Guam, the Virgin Islands, the
Northern Mariana Islands, and American Samoa.
(B) Nonprofit organizations.--Only for
purposes of awarding grants under subsection
(h)(2)(B), such term shall include a nonprofit
organization with an established record of
providing early childhood home visitation
programs or initiatives in a State or several
States.
(2) Eligible family.--The term ``eligible family''
means--
(A) a woman who is pregnant, and the father
of the child if the father is available; or
(B) a parent or primary caregiver of a child,
including grandparents or other relatives of
the child, and foster parents, who are serving
as the child's primary caregiver from birth to
kindergarten entry, and including a
noncustodial parent who has an ongoing
relationship with, and at times provides
physical care for, the child.
(3) Indian tribe; tribal organization.--The terms
``Indian Tribe'' and ``Tribal Organization'', and
``Urban Indian Organization'' have the meanings given
such terms in section 4 of the Indian Health Care
Improvement Act.
(4) Pay for outcomes initiative.--The term ``pay for
outcomes initiative'' means a performance-based grant,
contract, cooperative agreement, or other agreement
awarded by a public entity in which a commitment is
made to pay for improved outcomes achieved as a result
of the intervention that result in social benefit and
direct cost savings or cost avoidance to the public
sector. Such an initiative shall include--
(A) a feasibility study that describes how
the proposed intervention is based on evidence
of effectiveness;
(B) a rigorous, third-party evaluation that
uses experimental or quasi-experimental design
or other research methodologies that allow for
the strongest possible causal inferences to
determine whether the initiative has met its
proposed outcomes as a result of the
intervention;
(C) an annual, publicly available report on
the progress of the initiative; and
(D) a requirement that payments are made to
the recipient of a grant, contract, or
cooperative agreement only when agreed upon
outcomes are achieved, except that this
requirement shall not apply with respect to
payments to a third party conducting the
evaluation described in subparagraph (B).
SEC. 511A. EMERGENCY ASSISTANCE TO FAMILIES THROUGH HOME VISITING
PROGRAMS.
(a) Supplemental Appropriation.--In addition to amounts
otherwise appropriated, out of any money in the Treasury of the
United States not otherwise appropriated, there are
appropriated to the Secretary $150,000,000, to remain available
through September 30, 2022, to enable eligible entities to
conduct programs in accordance with section 511 and subsection
(c) of this section.
(b) Eligibility for Funds.--To be eligible to receive funds
made available by subsection (a) of this section, an entity
shall--
(1) as of the date of the enactment of this section,
be conducting a program under section 511;
(2) ensure the modification of grants, contracts, and
other agreements, as applicable, executed under section
511 under which the program is conducted as are
necessary to provide that, during the period that
begins with the date of the enactment of this section
and ends with the end of the 2nd succeeding fiscal year
after the funds are awarded, the entity shall--
(A) not reduce funding for, or staffing
levels of, the program on account of reduced
enrollment in the program; and
(B) when using funds to provide emergency
supplies to eligible families receiving grant
services under section 511, ensure coordination
with local diaper banks to the extent
practicable; and
(3) reaffirm that, in conducting the program, the
entity will focus on priority populations (as defined
in section 511(d)(4)).
(c) Uses of Funds.--An entity to which funds are provided
under this section shall use the funds--
(1) to serve families with home visits or with
virtual visits, that may be conducted by the use of
electronic information and telecommunications
technologies, in a service delivery model described in
section 511(d)(3)(A);
(2) to pay hazard pay or other additional staff costs
associated with providing home visits or administration
for programs funded under section 511;
(3) to train home visitors employed by the entity in
conducting a virtual home visit and in emergency
preparedness and response planning for families served,
and may include training on how to safely conduct
intimate partner violence screenings, and training on
safety and planning for families served to support the
family outcome improvements listed in section
511(d)(2)(B);
(4) for the acquisition by families served by
programs under section 511 of such technological means
as are needed to conduct and support a virtual home
visit;
(5) to provide emergency supplies (such as diapers
and diapering supplies including diaper wipes and
diaper cream, necessary to ensure that a child using a
diaper is properly cleaned and protected from diaper
rash, formula, food, water, hand soap and hand
sanitizer) to an eligible family (as defined in section
[511(k)(2)] 511(l)(2));
(6) to coordinate with and provide reimbursement for
supplies to diaper banks when using such entities to
provide emergency supplies specified in paragraph (5);
or
(7) to provide prepaid grocery cards to an eligible
family (as defined in section [511(k)(2)] 511(l)(2))
participating in the maternal, infant, and early
childhood home visiting program under section 511 for
the purpose of enabling the family to meet the
emergency needs of the family.
* * * * * * *
[all]