[House Report 118-448]
[From the U.S. Government Publishing Office]


118th Congress   }                                      {       Report
                        HOUSE OF REPRESENTATIVES
 2d Session      }                                      {      118-448

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



 
     VIRGINIA GRAEME BAKER POOL AND SPA SAFETY REAUTHORIZATION ACT

                                _______
                                

 April  5, 2024.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

Mrs. Rodgers of Washington, from the Committee on Energy and Commerce, 
                        submitted the following

                              R E P O R T

                        [To accompany H.R. 5202]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Energy and Commerce, to whom was referred 
the bill (H.R. 5202) to reauthorize the Virginia Graeme Baker 
Pool and Spa Safety Act, 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
Purpose and Summary..............................................     4
Background and Need for Legislation..............................     5
Committee Action.................................................     5
Committee Votes..................................................     5
Oversight Findings and Recommendations...........................     7
New Budget Authority, Entitlement Authority, and Tax Expenditures     7
Congressional Budget Office Estimate.............................     7
Federal Mandates Statement.......................................    17
Statement of General Performance Goals and Objectives............    17
Duplication of Federal Programs..................................    17
Related Committee and Subcommittee Hearings......................    17
Committee Cost Estimate..........................................    18
Earmark, Limited Tax Benefits, and Limited Tariff Benefits.......    18
Advisory Committee Statement.....................................    18
Applicability to Legislative Branch..............................    18
Section-by-Section Analysis of the Legislation...................    18
Changes in Existing Law Made by the Bill, as Reported............    19

    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 ``Virginia Graeme Baker Pool and Spa 
Safety Reauthorization Act''.

SEC. 2. COVERED ENTITY DEFINED.

  Section 1403 of the Virginia Graeme Baker Pool and Spa Safety Act (15 
U.S.C. 8002) is amended--
          (1) by amending paragraph (4) to read as follows:
          ``(4) Covered entity.--The term `covered entity' means--
                  ``(A) a State;
                  ``(B) an Indian Tribe; or
                  ``(C) a nonprofit organization.'';
          (2) by redesignating paragraphs (7) through (10) as 
        paragraphs (8) through (11), respectively; and
          (3) by inserting after paragraph (6) the following:
          ``(7) Nonprofit organization.--The term `nonprofit 
        organization' means an organization that--
                  ``(A) is described in section 501(c)(3) of the 
                Internal Revenue Code of 1986 and is exempt from 
                taxation under section 501(a) of such Code; and
                  ``(B) has proven experience (as determined by the 
                Commission) addressing swimming pool or spa safety and 
                drowning prevention.''.

SEC. 3. SWIMMING POOL SAFETY GRANT PROGRAM.

  Section 1405 of the Virginia Graeme Baker Pool and Spa Safety Act (15 
U.S.C. 8004) is amended to read as follows:

``SEC. 1405. SWIMMING POOL SAFETY GRANT PROGRAM.

  ``(a) In General.--Subject to the availability of appropriations 
authorized by subsection (i), the Commission shall carry out a grant 
program to provide assistance to eligible covered entities.
  ``(b) Eligibility.--To be eligible for a grant under the program, a 
covered entity shall--
          ``(1) demonstrate to the satisfaction of the Commission that, 
        as of the date on which the covered entity submits an 
        application to the Commission for a grant under this section, 
        the covered entity (if the covered entity is a State or an 
        Indian Tribe), or the State in which or the Indian Tribe in the 
        jurisdiction of which the covered entity is proposing to carry 
        out activities using grant funds (if the covered entity is a 
        nonprofit organization), has enacted and provides for the 
        enforcement of a statute that--
                  ``(A) except as provided in section 1406(a)(1)(A)(i), 
                applies to all swimming pools constructed in the State 
                or in the jurisdiction of the Indian Tribe (as the case 
                may be) on or after such date; and
                  ``(B) meets the minimum State law requirements of 
                section 1406; and
          ``(2) submit an application to the Commission at such time, 
        in such form, and containing such additional information as the 
        Commission may require.
  ``(c) Selection of Grant Recipients.--
          ``(1) Priority.--In selecting covered entities to receive 
        grants under the program, the Commission shall give priority 
        (in such order as the Commission considers appropriate) based 
        on the following factors:
                  ``(A) A covered entity not having previously been 
                awarded a grant under the program.
                  ``(B) A covered entity proposing to use grant funds 
                to expand educational activities described in paragraph 
                (1)(B)(i) or (2)(A) of subsection (e) that the covered 
                entity is carrying out at the time when the covered 
                entity submits the application for the grant.
                  ``(C) A covered entity proposing to use grant funds 
                to build on prior expertise and activities aimed at 
                preventing drownings.
                  ``(D) A covered entity proposing to use grant funds 
                to carry out activities in a geographic area that has a 
                greater number per capita of drowning or entrapment 
                incidents.
                  ``(E) A covered entity proposing to use grant funds 
                in underserved, minority, or rural communities to 
                provide services that address and target racial, 
                ethnic, or rural drowning disparities.
                  ``(F) Such other factors as the Commission considers 
                appropriate.
          ``(2) Geographic diversity.--
                  ``(A) In general.--In selecting covered entities to 
                receive grants under the program, the Commission shall, 
                to the maximum extent practicable, ensure geographic 
                diversity in the areas where activities will be carried 
                out using grant funds.
                  ``(B) Technical assistance.--If the Commission awards 
                grants to two or more covered entities that will carry 
                out activities using grant funds in the same geographic 
                area, the Commission shall provide technical assistance 
                to such entities regarding how such entities may 
                collaborate in carrying out such activities.
  ``(d) Amount of Grant.--The Commission shall determine the amount of 
a grant awarded under this section, and shall consider--
          ``(1) in the case of a covered entity that is a State or an 
        Indian Tribe--
                  ``(A) the population of such State or Indian Tribe;
                  ``(B) the enforcement and implementation needs of 
                such State or Indian Tribe; or
                  ``(C) the education needs of such State or Indian 
                Tribe proposing to use grant funds pursuant to 
                subsection (e)(1)(B)(i);
          ``(2) in the case of a covered entity that is a nonprofit 
        organization, the number of individuals to whom such nonprofit 
        organization is proposing to provide education described in 
        subsection (e)(2)(A) using grant funds, taking into 
        consideration any increased costs of providing such education 
        due to the rural or remote nature of the area where such 
        nonprofit organization is proposing to provide such education; 
        and
          ``(3) allocation of grant funds in a manner designed to 
        provide the maximum benefit from the program in terms of 
        protecting children from drowning or entrapment.
  ``(e) Use of Grant Funds.--
          ``(1) States and indian tribes.--A State or an Indian Tribe 
        receiving a grant under this section shall use--
                  ``(A) at least 25 percent of amounts made available--
                          ``(i) to hire and train personnel for--
                                  ``(I) implementation and enforcement 
                                of standards under the swimming pool 
                                and spa safety law of the State or 
                                Indian Tribe; and
                                  ``(II) inspecting and repairing or 
                                replacing swimming pool and spa drain 
                                covers to ensure compliance with 
                                applicable Federal, State, and Tribal 
                                law; and
                          ``(ii) to defray administrative costs 
                        associated with the hiring and training 
                        programs under clause (i); and
                  ``(B) the remainder--
                          ``(i) to educate pool owners, pool operators, 
                        and other members of the public about the 
                        standards under the swimming pool and spa 
                        safety law of the State or Indian Tribe and 
                        about the prevention of drowning or entrapment 
                        of children using swimming pools and spas; and
                          ``(ii) to defray administrative costs 
                        associated with the education programs under 
                        clause (i).
          ``(2) Nonprofit organizations.--A nonprofit organization 
        receiving a grant under this section shall use the amounts made 
        available--
                  ``(A) to educate pool owners, pool operators, and 
                other members of the public about the prevention of 
                drowning or entrapment of children using swimming pools 
                and spas; and
                  ``(B) to defray administrative costs associated with 
                the education programs under subparagraph (A).
  ``(f) Recipient Reporting.--Not later than 90 days after the end of 
the pool and spa grant program project period covered by the grants 
awarded under this section, each covered entity that received such a 
grant shall submit to the Commission a report that includes the 
following:
          ``(1) The amount of grant funds received by the covered 
        entity.
          ``(2) The purpose or purposes for which the covered entity 
        proposed to use grant funds in the grant application of the 
        covered entity.
          ``(3) The purpose or purposes for which the covered entity 
        used grant funds.
          ``(4) Whether the purposes identified under paragraphs (2) 
        and (3) were achieved.
          ``(5) Any barriers encountered in carrying out activities 
        using grant funds.
          ``(6) Any best practices or recommendations for future 
        recipients of grant funds.
          ``(7) Any other information requested by the Commission.
  ``(g) Grant Awareness Campaign.--The Commission shall carry out a 
campaign to conduct outreach to covered entities to ensure covered 
entities are aware of the availability and importance of the grants 
under this section.
  ``(h) Employees.--
          ``(1) Director of drowning prevention.--The Commission shall 
        have a Director of Drowning Prevention to coordinate the 
        swimming pool and spa safety and drowning prevention activities 
        at the Commission, including carrying out duties under this 
        title.
          ``(2) Full-time equivalents.--The Commission shall ensure 
        that more than 1 full-time equivalent is dedicated to carrying 
        out swimming pool and spa safety and drowning prevention 
        activities at the Commission, including the grant program under 
        this section.
  ``(i) Authorization of Appropriations.--There are authorized to be 
appropriated to the Commission for each of the fiscal years 2024 
through 2028 $2,500,000 to carry out this section.''.

SEC. 4. REAUTHORIZATION OF CPSC EDUCATION AND AWARENESS PROGRAM.

  Section 1407 of the Virginia Graeme Baker Pool and Spa Safety Act (15 
U.S.C. 8006) is amended to read as follows:

``SEC. 1407. EDUCATION AND AWARENESS PROGRAM.

  ``(a) In General.--The Commission shall establish and carry out an 
education and awareness program to inform the public of methods to 
prevent drowning and entrapment in swimming pools and spas. In carrying 
out the program, the Commission shall develop--
          ``(1) educational materials designed for swimming pool and 
        spa manufacturers, service companies, and supply retail 
        outlets, including guidance on barrier and drain cover 
        inspection, maintenance, and replacement;
          ``(2) educational materials designed for swimming pool and 
        spa owners and operators, consumers, States, Indian Tribes, and 
        nonprofit organizations;
          ``(3) educational materials designed to reach historically 
        disadvantaged communities that have higher rates of drowning 
        than the nationwide average; and
          ``(4) a national media campaign to promote awareness of 
        swimming pool and spa safety.
  ``(b) Authorization of Appropriations.--There are authorized to be 
appropriated to the Commission for each of the fiscal years 2024 
through 2028 $2,500,000 to carry out the education and awareness 
program authorized by subsection (a).''.

SEC. 5. CPSC REPORT.

  Section 1408 of the Virginia Graeme Baker Pool and Spa Safety Act (15 
U.S.C. 8007) is amended to read as follows:

``SEC. 1408. CPSC REPORT.

  ``(a) In General.--Not later than 1 year after the last day of each 
fiscal year for which grants are made under section 1405, the 
Commission shall submit to Congress a report evaluating the 
implementation of the grant program authorized by that section.
  ``(b) Matters To Be Included.--Each report required by subsection (a) 
shall include, with respect to the fiscal year covered by the report, 
the following:
          ``(1) How many applicants applied for grants under the 
        program.
          ``(2) For each such applicant--
                  ``(A) name;
                  ``(B) location;
                  ``(C) prior experience in swimming pool or spa 
                safety; and
                  ``(D) such other details as the Commission considers 
                appropriate.
          ``(3) How many applicants received grants under the program 
        and the amount of the grant received by each such applicant.
          ``(4) How recipients of grants under the program were 
        selected and the purposes for which each such recipient 
        proposed to use grant funds in the grant application of the 
        recipient.
          ``(5) Any purposes, other than making grants under section 
        1405, for which the Commission used amounts appropriated under 
        subsection (i) of such section.
          ``(6) An evaluation of the effectiveness of the program, 
        including any barriers or gaps, and recommendations for 
        legislative changes, if required to increase the effectiveness 
        of the program.''.

                          Purpose and Summary

    H.R. 5202, the ``Virginia Graeme Baker Pool and Spa Safety 
Reauthorization Act,'' was introduced by Representative 
Wasserman Schultz on August 11, 2023. H.R. 5202 was referred to 
the Committee on Energy and Commerce. H.R. 5202 reauthorizes 
through fiscal year 2028 and expands swimming pool safety 
grants and educations and awareness programs.

                  Background and Need for Legislation

    The risk of drowning presents a public safety crisis with 
nearly 4,000 fatal, unintentional drowning accidents occurring 
each year.\1\ Drowning is especially dangerous for young 
children and is the leading cause of death for children ages 1 
to 4, with most incidents occurring in swimming pools.\2\ The 
Virginia Graeme Baker Pool and Spa Safety Act, signed into law 
in 2008, established the Pool Safety Grant Program, which has 
awarded over $7.3 million from 2016 to 2023 to state and local 
jurisdictions to assist in their work to prevent drownings and 
drain entrapments.\3\ By reauthorizing this program and 
creating a national education campaign, this legislation seeks 
to address harms related to drowning incidents in public and 
private pools related to suction entrapment incidents, 
injuries, and deaths.
---------------------------------------------------------------------------
    \1\Center for Disease Control and Prevention, Drowning Facts (Jan. 
2, 2024) (https://www.cdc.gov/drowning/facts/index.html).
    \2\Id.
    \3\EISA Title 14, Pub. L. 110-140; Consumer Product Safety 
Commission, Pool Safety Grants (Sept. 14, 2023) (https://
www.poolsafely.gov/grant-program/).
---------------------------------------------------------------------------

                            Committee Action

    On September 27, 2023, the Subcommittee on Innovation, 
Data, and Commerce held a hearing on H.R. 5202. The title of 
the hearing is ``Proposals to Enhance Product Safety and 
Transparency for Americans.'' The Subcommittee received 
testimony from:
           Kathleen Callahan, Owner, Xpertech Auto 
        Repair;
           Scott Benavidez, Chairman, Automotive 
        Service Association;
           Steven Michael Gentine, Counsel, Arnold & 
        Porter, LLP;
           John Breyault, Vice President of Public 
        Policy, Telecommunications and Fraud, National 
        Consumers League; and,
           David Touhey, Principal, Connett Consulting, 
        appearing on behalf of International Association of 
        Venue Managers.
    On November 2, 2023, the Subcommittee on Innovation, Data, 
and Commerce met in open markup session and forwarded H.R. 
5202, as amended, to the full Committee by a record vote of 20 
yeas and 0 nays.
    On December 5 and 6, 2023, the full Committee on Energy and 
Commerce met in open markup session and ordered H.R. 5202, as 
amended, favorably reported to the House by a record vote of 40 
yeas, 0 nays, and 1 abstention.

                            Committee Votes

    Clause 3(b) of rule XIII requires the Committee to list the 
record votes on the motion to report legislation and amendments 
thereto. The following reflects the record votes taken during 
the Committee consideration:

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

                 Oversight Findings and Recommendations

    Pursuant to clause 2(b)(1) of rule X and clause 3(c)(1) of 
rule XIII, the Committee held a hearing and made findings that 
are reflected in this report.

   New Budget Authority, Entitlement Authority, and Tax Expenditures

    Pursuant to clause 3(c)(2) of rule XIII, the Committee 
finds that H.R. 5202 would result in no new or increased budget 
authority, entitlement authority, or tax expenditures or 
revenues.

                  Congressional Budget Office Estimate

    Pursuant to clause 3(c)(3) of rule XIII, the following is 
the cost estimate provided by the Congressional Budget Office 
pursuant to section 402 of the Congressional Budget Act of 
1974:

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]


    Summary: On December 6, 2023, the House Committee on Energy 
and Commerce ordered 41 pieces of legislation to be reported. 
This document provides estimates for 21 bills in that package 
that are related to health care and consumer protection.
    Generally, the bills in this group that would affect direct 
spending would:
           Limit beneficiary cost sharing for certain 
        prescription drugs and add certain drugs to the group 
        of products covered by the Medicare home infusion 
        benefit;
           Prohibit pharmacy benefit managers (PBMs) 
        from collecting certain fees from prescription drug 
        manufacturers and require PBMs to provide additional 
        information to Medicare Part D plans (which provide 
        prescription drug coverage);
           Allow Part D plans more flexibility to add 
        biosimilar biological products to their formularies and 
        to change the cost-sharing status of reference 
        biological products;
           Temporarily increase Medicare payment rates 
        for durable medical equipment (DME); and
           Provide mandatory funding for implementation 
        of certain provisions in several bills.
    Estimated Federal cost: The costs of the legislation fall 
within budget functions 550 (health) and 570 (Medicare).
    Basis of estimate: For this estimate, CBO assumes that the 
bills will be enacted near the middle of fiscal year 2024 and 
that the estimated amounts will be appropriated each year. This 
cost estimate does not include any effects of interactions 
among the bills. If all 21 bills were combined and enacted as a 
single piece of legislation, the effects could be different 
from the sum of the separate estimates.
    Direct spending: Enacting 10 bills in the group would 
affect direct spending over the 2024-2034 period (see Table 1).

TABLE 1.--ESTIMATED EFFECTS ON DIRECT SPENDING OF HEALTH CARE LEGISLATION, AS ORDERED REPORTED BY THE HOUSE COMMITTEE ON ENERGY AND COMMERCE ON DECEMBER
                                                                         6, 2023
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                By fiscal year, millions of dollars--
                                           -------------------------------------------------------------------------------------------------------------
                                             2024    2025    2026    2027    2028    2029    2030    2031    2032    2033    2034   2024-2029  2024-2034
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                      INCREASES OR DECREASES (-) IN DIRECT SPENDING
 
H.R. 2880:
    Budget Authority......................       0       0       0     -29     -39     -31     -31     -28     -26     -24     -18       -99
    Outlays...............................       0       0       0     -29     -39     -31     -31     -28     -26     -24     -18       -99
H.R. 3842:
    Budget Authority......................       0       *       *       *       *       *       *       *       *       *       *         *
    Outlays...............................       0       *       *       *       *       *       *       *       *       *       *         *
H.R. 4881:
    Budget Authority......................       0       0       0       0      77      88     100     106     113     134     136       165        754
    Outlays...............................       0       0       0       0      77      88     100     106     113     134     136       165        754
H.R. 5372:
    Budget Authority......................       0      -9     -12     -12     -14     -12     -14     -16     -17     -20     -19       -59       -145
    Outlays...............................       0      -9     -12     -12     -14     -12     -14     -16     -17     -20     -19       -59       -145
H.R. 5380:
    Budget Authority......................      15       0       0       0       0       0       0       0       0       0       0        15         15
    Outlays...............................      13       1       1       0       0       0       0       0       0       0       0        15         15
H.R. 5385:
    Budget Authority......................      55       0       0     -55     -75     -60     -60     -55     -50     -46     -35      -135       -381
    Outlays...............................      49       4       2     -55     -75     -60     -60     -55     -50     -46     -35      -135       -381
H.R. 5386:
    Budget Authority......................       0       0       *       *       *       *       *       *       *       *       *         *          *
    Outlays...............................       0       0       *       *       *       *       *       *       *       *       *         *          *
H.R. 5393:
    Budget Authority......................       0       6       0       0       0       0       0       0       0       0       0         6          6
    Outlays...............................       0       6       0       0       0       0       0       0       0       0       0         6          6
H.R. 5397:
    Budget Authority......................       0       0      -9     -13     -15     -14     -15     -17     -17     -20     -19       -37       -139
    Outlays...............................       0       0      -9     -13     -15     -14     -15     -17     -17     -20     -19       -37       -139
H.R. 5555:
    Budget Authority......................     144       1       0       0       0       0       0       0       0       0       0       145        145
    Outlays...............................     144       1       0       0       0       0       0       0       0       0       0       145        145
--------------------------------------------------------------------------------------------------------------------------------------------------------
All amounts for outlays are estimates; except for H.R. 5380 and H.R. 5393, all amounts for budget authority are estimated;
= between -$500,000 and $500,000.

    H.R. 2880, the Protecting Patients Against PBM Abuses Act, 
would modify the rules with respect to certain fees that PBMs 
collect from prescription drug manufacturers. In Medicare Part 
D (which provides prescription drug coverage), sponsors of 
private insurance plans contract with the government to deliver 
benefits to Medicare beneficiaries. Those insurance plans 
usually contract with PBMs to negotiate with drug 
manufacturers, design formularies, and perform other 
administrative functions. A PBM can be owned by the plan 
sponsor or it can be an independent corporate entity.
    H.R. 2880 would prohibit PBMs from collecting service fees 
from manufacturers that are based on drug prices, manufacturer 
discounts, or formulary placement decisions. Under the bill, 
those fees would be specific dollar amounts based on the fair 
market value of a PBM's services. Under current law, PBMs can 
be compensated for services they provide to manufacturers, but 
compensation that exceeds the fair market value of a service 
must be classified as direct and indirect remuneration and 
reported to the Centers for Medicare & Medicaid Services (CMS). 
According to the Government Accountability Office, however, CMS 
does not routinely monitor how PBMs classify those fees.\4\ 
Under the bill, CMS and the Office of Inspector General would 
more closely monitor those classifications.
---------------------------------------------------------------------------
    \4\See Government Accountability Office, Medicare Part D: Use of 
Pharmacy Benefit Managers and Efforts to Manage Drug Expenditures, GAO-
19-498 (July 2019), Appendix III, www.gao.gov/products/gao-19-498.
---------------------------------------------------------------------------
    CBO estimates that manufacturers' service fees are roughly 
1 percent of Part D retail spending under current law. CBO 
expects that under H.R. 2880, a portion of those fees would be 
reclassified as direct and indirect remuneration by PBMs and, 
because of stronger oversight, passed along to the sponsors of 
prescription drug plans. That action would reduce bid amounts 
for plans' expected benefit payments, which in turn would 
reduce spending in Part D. CBO estimates that the provision 
would decrease federal spending by $226 million over the 2024-
2034 period, or by roughly 1 percent of the amount expected to 
be collected in service fees over that period.
    H.R. 3842, the Expanding Access to Diabetes Self-Management 
Training Act of 2023, would allow more providers to refer 
eligible patients to diabetes self-management training covered 
by Medicare and would codify regulatory time limits on use of 
the training. CBO expects that enacting H.R. 3842 would result 
in more patients receiving such training, which would lead to 
increased Medicare spending. CBO expects that such training 
would reduce the use of acute-care services, at least partly 
offsetting that increase in costs. As a result, CBO estimates 
that enacting the bill would increase or decrease direct 
spending by less than $500,000 over the 2024-2034 period.
    H.R. 4881, a bill to amend title XVIII of the Social 
Security Act to limit cost sharing for drugs under the Medicare 
program, would limit cost sharing above the deductible to no 
more than the average net price for a drug, which is the list 
price minus after-sale discounts from the drug's manufacturer. 
From 2028 to 2034, CBO projects, less than 1 percent of Part D 
spending above the deductible under current law will be for 
drugs with cost sharing that exceeds net drug costs. Under the 
bill, CBO expects that some out-of-pocket spending by 
beneficiaries and some federal subsidies for low-income 
beneficiaries would shift onto Part D plans, which would 
increase the bids they submit to the federal government to 
cover expected benefits spending and therefore increase federal 
spending. CBO estimates that enacting H.R. 4881 would increase 
direct spending by $754 million over the 2024-2034 period.
    H.R. 5372, the Expanding Seniors' Access to Lower Cost 
Medications Act of 2023, would allow Part D plans to add 
biosimilar biological products to their formularies and change 
the cost-sharing status of a reference biological product after 
the first 60 days of a plan year. (A reference biological 
product is the approved product against which a proposed 
biosimilar product is compared.) Under current law, Part D 
plans must exempt beneficiaries who currently use reference 
biological products from changes in coverage and cost sharing 
for the remainder of the year. That restriction limits a plan's 
ability to promote use of a biosimilar product immediately 
following that product's entry to the market. CMS has proposed 
rules that overlap with the bill's provisions concerning 
formulary substitutions for biosimilar products.\5\ CBO's 
estimate of Medicare spending for those products under current 
law accounts for 50 percent of the effect of the proposed 
rules. As a result, CBO's estimate of the decrease in direct 
spending under H.R. 5372 is larger than it might be if CMS's 
rules had become final.
---------------------------------------------------------------------------
    \5\See Centers for Medicare & Medicaid Services, ``Medicare 
Program; Contract Year 2025 Policy and Technical Changes to the 
Medicare Advantage Program, Medicare Prescription Drug Benefit Program, 
Medicare Cost Plan Program, and Programs of All-Inclusive Care for the 
Elderly; Health Information Technology Standards and Implementation 
Specifications,'' Notice of Proposed Rulemaking, 88 Fed. Reg. 78476 
(November 15, 2023), http://tinyurl.com/wv7yprfm; and ``Medicare 
Program; Contract Year 2024 Policy and Technical Changes to the 
Medicare Advantage Program, Medicare Prescription Drug Program, 
Medicare Cost Plan Program, Medicare Parts A, B, C, and D Overpayment 
Provisions of the Affordable Care Act and Programs of All-Inclusive 
Care for the Elderly; Health Information Technology Standards and 
Implementation Specifications,'' Notice of Proposed Rulemaking, 87 Fed. 
Reg. 79452 (December 27, 2022), http://tinyurl.com/3754c49x.
---------------------------------------------------------------------------
    Under the bill, the addition of biosimilar products to 
formularies could lead to a shift away from the use of 
reference biological products. CBO estimates that the 
government will spend about $10 billion over the 2024-2034 
period to cover reference biological products under current 
law. CBO anticipates that under H.R. 5372 approximately 20 
percent of the current use of reference biological products 
would be replaced by biosimilar products. The prices for 
biosimilar products are estimated to be 15 percent lower, on 
average, than the prices for the reference products. Using 
information about spending on both types of products under 
current law and adjusting for current regulatory proposals by 
CMS that would streamline coverage for biosimilar products, CBO 
estimates that enacting H.R. 5372 would decrease direct 
spending by $145 million over the 2024-2034 period.
    H.R. 5380, a bill to amend title XVIII of the Social 
Security Act to increase data transparency for supplemental 
benefits under Medicare Advantage, would provide $15 million in 
2024 for the Department of Health and Human Services (HHS) to 
implement reporting requirements for supplemental benefits 
under Medicare Advantage plans. Based on historical spending 
patterns for HHS programs, CBO estimates that enacting H.R. 
5380 would increase direct spending by $15 million over the 
2024-2034 period.
    H.R. 5385, the Medicare PBM Accountability Act, would 
require pharmacy benefit managers to provide plan sponsors with 
information not furnished under current law. Part D plans have 
access to certain aggregate and drug-specific information from 
PBMs concerning prescriptions, prices, rebates, and out-of-
pocket charges, but may lack information about PBM-affiliated 
entities and contractors, rationales for formulary decisions, 
and explanations for benefit designs that favor certain 
pharmacies. H.R. 5385 would require PBMs to report such 
information to Part D plans but also, subject to certain 
restrictions, would allow plans to audit PBMs' business 
practices and request other information. The bill would provide 
$55 million for HHS to implement those requirements.
    H.R. 5385 also would require PBMs to make their business 
practices clearer to Part D plans, thus promoting competition 
among PBMs. CBO estimates that the increased competition would 
reduce net spending for Part D by less than 0.1 percent over 
the 2024-2034 period--reducing federal spending by $436 million 
over that period.
    CBO estimates that the net effect of the bill would be a 
reduction in direct spending of $381 million over the 2024-2034 
period.
    H.R. 5386, the Cutting Copays Act, would prohibit cost 
sharing for generic drugs for beneficiaries who are eligible 
for the low-income subsidy, which pays most or all of their 
premium and cost-sharing requirements. Under current law, plans 
have an option but not an obligation to do so. CBO expects that 
enacting the bill would increase the use of generic drugs, 
which would increase plan bid submissions for expected benefits 
payments and, therefore, federal spending. CBO expects that 
some of the increase would be offset by reduced spending on 
brand-name drugs and certain medical services. CBO estimates 
that enacting the bill would increase direct spending by less 
than $500,000 over the 2024-2034 period.
    H.R. 5393, a bill to amend title XVIII of the Social 
Security Act to ensure fair assessment of pharmacy performance 
and quality under Medicare Part D, and for other purposes, 
would provide $4 million in 2025 for CMS program management to 
implement pharmacy performance and quality measures for Part D 
and $2 million in that year to implement pharmacy transparency 
requirements. Based on historical spending patterns for CMS 
administrative costs, CBO estimates that enacting H.R. 5393 
would increase direct spending by $6 million over the 2024-2034 
period.
    H.R. 5397, the Joe Fiandra Access to Home Infusion Act of 
2023, would add drugs to the current Medicare benefit that 
allows patients to receive some drugs by infusion under nursing 
care at home. H.R. 5397 would allow other drugs to meet the 
statutory criteria for coverage in the home setting by 
establishing those products as suitable for delivery through a 
pump and requiring patients receiving those drugs also to 
receive regular nursing services.
    Based on its analysis of the beneficiary population and 
Medicare payment rates, CBO estimates that enacting the bill 
would reduce direct spending by $139 million over the 2024-2034 
period, primarily because beneficiaries would bear a larger 
share of the cost of infusions that occur at home. Under 
current law, there is a cap on beneficiary cost sharing in 
outpatient hospital settings, which is where CBO expects that 
beneficiaries receive those drugs now. There is no equivalent 
cap for the home infusion benefit.
    CBO's estimate for H.R. 5397 is subject to considerable 
uncertainty. First, it is not known how many drugs would 
qualify for coverage under the bill. CBO's estimate focused on 
three products that industry and clinical experts mentioned as 
likely candidates, but the actual number could be larger or 
smaller. In addition, given that cost sharing could increase 
significantly for patients, it is not known how many 
beneficiaries would choose to receive home infusions.\6\
---------------------------------------------------------------------------
    \6\CMS proposed a similar but not identical policy in a proposed 
rulemaking. In the regulatory impact analysis, CMS estimated that, for 
one product, beneficiaries' cost sharing would be about triple the 
amount if the product was received in a home setting. For more 
information, see Centers for Medicare & Medicaid Services, ``Medicare 
Program; Durable Medical Equipment, Prosthetics, Orthotics, and 
Supplies (DMEPOS) Policy Issues and Level II of the Healthcare Common 
Procedure Coding System (HCPCS),'' Notice of Proposed Rulemaking, 85 
Fed. Reg. 70358 (November 4, 2020), http://tinyurl.com/29djdrvz.
---------------------------------------------------------------------------
    H.R. 5555, the DMEPOS Relief Act of 2023, would temporarily 
increase Medicare rates in some areas of the country for DMEPOS 
(durable medical equipment, prosthetics, orthotics, and 
supplies). Under current law, Medicare's payments for some 
equipment are based on competitive bidding among suppliers. CMS 
uses those results to set rates (either directly or through a 
blend with the historic fee schedule) in areas of the country 
where formal bidding has not occurred. Prior legislation 
directed CMS to use a blend of fee schedule and competitively 
bid rates in some areas of the country; the use of those 
blended rates expired at the end of calendar year 2023. 
Enacting H.R. 5555 would extend the use of those blended rates 
through calendar year 2024. Based on an analysis of historic 
claim spending, CBO estimates that the DME provision of the 
bill would increase direct spending by $145 million over the 
2024-2034 period. H.R. 5555 also would reduce amounts available 
to the Medicare Improvement Fund by $177 million, however the 
Consolidated Appropriations Act, 2024 rescinded all funding 
from the Medicare Improvement Fund. As a result, the provision 
would not affect direct spending. In total, CBO estimates that 
enacting H.R. 5555 would increase net direct spending by $145 
million over the 2024-2034 period.
    Legislation with no effect on direct spending: CBO 
estimates that enacting 11 bills in this estimate would have no 
effect on direct spending over the 2024-2034 period:
           H.R. 133, the Mandating Exclusive Review of 
        Individual Treatments (MERIT) Act;
           H.R. 1797, the Setting Consumer Standards 
        for Lithium-Ion Batteries Act;
           H.R. 2365, the Dr. Emmanuel Bilirakis 
        National Plan to End Parkinson's Act;
           H.R. 4310, the Youth Poisoning Protection 
        Act;
           H.R. 5202, the Virginia Graeme Baker Pool 
        and Spa Safety Reauthorization Act;
           H.R. 5371, the Choices for Increased 
        Mobility Act of 2023;
           H.R. 5388, the Supporting Innovation for 
        Seniors Act;
           H.R. 5389, the National Coverage 
        Determination Transparency Act;
           H.R. 5396, the Coverage Determination 
        Clarity Act of 2023;
           H.R. 6132, the Awning Safety Act of 2023; 
        and
           H.R. 6364, the Medicare Telehealth Privacy 
        Act of 2023.
    Spending subject to appropriation: CBO estimates that five 
bills would increase spending subject to appropriation (see 
Table 2). Any spending would be subject to the availability of 
appropriated funds.

  TABLE 2.--ESTIMATED INCREASES IN SPENDING SUBJECT TO APPROPRIATION UNDER HEALTH CARE LEGISLATION, AS ORDERED
                   REPORTED BY THE HOUSE COMMITTEE ON ENERGY AND COMMERCE ON DECEMBER 6, 2023
----------------------------------------------------------------------------------------------------------------
                                                                   By fiscal year, millions of dollars--
                                                         -------------------------------------------------------
                                                                                                           2024-
                                                           2024    2025    2026    2027    2028    2029    2029
----------------------------------------------------------------------------------------------------------------
H.R. 1797:
    Estimated Authorization.............................       *       1       1       1       1       2       6
    Estimated Outlays...................................       *       1       1       1       1       2       6
H.R. 2365:
    Estimated Authorization.............................       *       1       *       1       *       1       3
    Estimated Outlays...................................       *       1       *       1       *       1       3
H.R. 4310:
    Estimated Authorization.............................       *       *       *       1       *       1       2
    Estimated Outlays...................................       *       *       *       1       *       1       2
H.R. 5202:
    Authorization.......................................       5       5       5       5       5       0      25
    Estimated Outlays...................................       4       4       4       5       5       0      22
H.R. 6132:
    Estimated Authorization.............................       *       1       *       1       *       1       3
    Estimated Outlays...................................       *       1       *       1       *       1       3
----------------------------------------------------------------------------------------------------------------
* = between zero and $500,000.

    H.R. 1797, the Setting Consumer Standards for Lithium-Ion 
Batteries Act, would require the Consumer Product Safety 
Commission (CPSC) to issue a final safety standard to reduce 
the risk of fire from rechargeable lithium-ion batteries that 
are used to power electric-assist bicycles and electric 
scooters, for example. Based on information provided by the 
commission, CBO expects that CPSC would need less than two 
employees for the first two years after enactment and six 
employees thereafter, at an average annual cost of $190,000 per 
employee, to issue and enforce the standard. In total, CBO 
estimates that it would cost $6 million over the 2024-2029 
period for CPSC to implement H.R. 1797, assuming appropriation 
of the necessary amounts.
    H.R. 2365, the Dr. Emmanuel Bilirakis National Plan to End 
Parkinsons Act, would require HHS to establish an advisory 
council and to create and update several plans and reports as 
part of a national project to prevent, diagnose, treat, and 
cure Parkinson's disease. Using information about similar 
activities, CBO expects that HHS would need two employees for 
the first year after enactment and three employees thereafter, 
at an average annual cost in 2024 of $160,000 per employee, to 
carry out activities required under the act. In total, CBO 
estimates that it would cost $3 million over the 2024-2029 
period for HHS to implement H.R. 2365, assuming appropriation 
of the necessary amounts.
    H.R. 4310, the Youth Poisoning Protection Act, would ban 
the sale of consumer products containing 10 percent or more of 
sodium nitrite by weight. Using information from CPSC, CBO 
expects the commission would need less than one employee for 
the first two years after enactment and around two employees 
thereafter, at an average annual cost of $190,000 per employee, 
to enforce the standard. In total, CBO estimates it would cost 
about $2 million over the 2024-2029 period for CPSC to 
implement H.R. 4310, assuming appropriation of the necessary 
amounts.
    H.R. 5202, the Virginia Graeme Baker Pool and Spa Safety 
Reauthorization Act, would authorize the appropriation of $5 
million annually over the 2024-2028 period for CPSC to continue 
a grant program and public outreach concerning the safety of 
children in pools and spas. The bill would require CPSC to 
extend grant eligibility to nonprofit organizations, appoint a 
Director of Drowning Prevention, and report to the Congress 
annually on the program's results. Using information from CPSC, 
CBO estimates that the cost of implementing the bill would be 
$22 million over the 2024-2029 period, assuming appropriation 
of the necessary amounts.
    H.R. 6132, the Awning Safety Act of 2023, would require 
CPSC to issue a final safety standard for retractable awnings. 
Using information from that agency, CBO expects the commission 
would need an average of two employees per year, at an average 
annual cost of $190,000 per employee, to issue and enforce the 
standard. In total, CBO estimates it would cost about $3 
million over the 2024-2029 period for CPSC to implement H.R. 
6132, assuming appropriation of the necessary amounts.
    Pay-As-You-Go considerations: 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 for the 10 bills that are 
subject to those pay-as-you-go procedures are shown in Table 1.
    Increase in long-term net direct spending and deficits: CBO 
estimates that enacting H.R. 4881 would increase long-term net 
direct spending and that such spending would increase by more 
than $5 billion in at least one of the four consecutive 10-year 
periods beginning in 2035.
    CBO estimates that none of the other bills discussed in 
this estimate would increase net direct spending or deficits in 
any of the four consecutive 10-year periods beginning in 2035.
    Mandates: H.R. 1797 would impose a private-sector mandate 
as defined in the Unfunded Mandates Reform Act (UMRA) by 
requiring manufacturers of electric-assist bicycles and 
electric scooters, for example, to comply with a prospective 
CPSC safety standard concerning the risk of fire in lithium-ion 
batteries. Limited data are available about the extent of 
industry compliance with the current voluntary standards or 
about the cost of bringing products into compliance. Therefore, 
CBO cannot determine whether the cost of the mandate would 
exceed the private-sector threshold established in UMRA ($200 
million in 2024, adjusted annually for inflation).
    H.R. 1797 would not impose any intergovernmental mandates.
    H.R. 4310 would impose a private-sector mandate as defined 
in UMRA by banning the sale of consumer products containing 10 
percent or more of sodium nitrite by weight. The prohibition 
would not apply to industrial uses or to food preservation. 
Because there is only a small market for consumer products 
containing more than 10 percent by weight and some states 
already have curtailed the sale of products containing sodium 
nitrite, CBO estimates that the cost of the mandate would not 
exceed the private-sector threshold established in UMRA.
    H.R. 4310 would not impose any intergovernmental mandates.
    H.R. 6132 would impose a private-sector mandate as defined 
in UMRA by requiring awning manufacturers to comply with a 
prospective CPSC safety standard concerning fixed and 
freestanding retractable awnings. CBO expects that the standard 
could require awnings to be equipped with safety clips and to 
issue visual or audible alerts when in motion. Based on the 
cost of such additional equipment and the number of such 
awnings likely to be sold, CBO estimates that the cost of the 
mandate would not exceed the private-sector threshold 
established in UMRA.
    H.R. 6132 would not impose any intergovernmental mandates.
    CBO has determined that none of the other bills in this 
estimate would impose intergovernmental or private-sector 
mandates as defined in UMRA.
    Estimate prepared by: Federal Costs: Austin Barselau 
(Medicare); Ezra Cohn (public health); Cornelia Hall 
(Medicare); Hudson Osgood (Medicare); Lara Robillard 
(Medicare); Sarah Sajewski (Medicare); Katie Zhang (public 
health); Noah Zwiefel (Medicare); Mandates: Andrew Laughlin.
    Estimate reviewed by: Sean Dunbar, Chief, Low-Income Health 
Programs and Prescription Drugs Cost Estimates Unit; Kathleen 
FitzGerald, Chief, Public and Private Mandates Unit; Sarah 
Masi, Senior Adviser, Budget Analysis Division; Asha Saavoss, 
Chief, Medicare and Health Systems Cost Estimates Unit; Chad 
Chirico, Director of Budget Analysis.
    Estimate approved by: Phillip L. Swagel, Director, 
Congressional Budget Office.

                       Federal Mandates Statement

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

         Statement of General Performance Goals and Objectives

    Pursuant to clause 3(c)(4) of rule XIII, the general 
performance goal or objective of this legislation is to 
reauthorize the Virginia Graeme Baker Pool and Spa Safety Grant 
Program and widen the scope of eligible grantees.

                    Duplication of Federal Programs

    Pursuant to clause 3(c)(5) of rule XIII, no provision of 
H.R. 5202 is known to be duplicative of another Federal 
program, including any program that was included in a report to 
Congress pursuant to section 21 of Public Law 111-139 or the 
most recent Catalog of Federal Domestic Assistance.

              Related Committee and Subcommittee Hearings

    Pursuant to clause 3(c)(6) of rule XIII, the following 
related hearing was used to develop or consider H.R. 5202:
           On September 27, 2023, the Subcommittee on 
        Innovation, Data, and Commerce held a hearing on H.R. 
        5202. The title of the hearing is ``Proposals to 
        Enhance Product Safety and Transparency for 
        Americans.'' The Subcommittee received testimony from:
                   Kathleen Callahan, Owner, 
                Xpertech Auto Repair;
                   Scott Benavidez, Chairman, 
                Automotive Service Association;
                   Steven Michael Gentine, Counsel, 
                Arnold & Porter, LLP;
                   John Breyault, Vice President of 
                Public Policy, Telecommunications and Fraud, 
                National Consumers League; and,
                   David Touhey, Principal, Connett 
                Consulting, appearing on behalf of 
                International Association of Venue Managers.

                        Committee Cost Estimate

    Pursuant to clause 3(d)(1) of rule XIII, the Committee 
adopts as its own the cost estimate prepared by the Director of 
the Congressional Budget Office pursuant to section 402 of the 
Congressional Budget Act of 1974.

       Earmark, Limited Tax Benefits, and Limited Tariff Benefits

    Pursuant to clause 9(e), 9(f), and 9(g) of rule XXI, the 
Committee finds that H.R. 5202 contains no earmarks, limited 
tax benefits, or limited tariff benefits.

                      Advisory Committee Statement

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

                  Applicability to Legislative Branch

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

             Section-by-Section Analysis of the Legislation


Section 1. Short title

    Section 1 allows the Act to be cited as the ``Virginia 
Graeme Baker Pool and Spa Safety Reauthorization Act.''

Section 2. Covered entity defined

    Section 2 adds Indian Tribes and nonprofit organizations 
with experience addressing pool or spa safety and drowning 
prevention to the definition of covered entity in the 
underlying act.

Section 3. Swimming pool safety grant program

    Section 3 requires the Consumer Product Safety Commission 
(CPSC) to consider geographic location, previous awards and 
educational efforts, per capita drownings and entrapments, and 
targeting underserved, minority, or rural populations in the 
selection of grantees and the grant amount. This section also 
institutes a reporting requirement for grantees detailing the 
success of the program funded by the grant. Section 3 requires 
CPSC to name a Director of Drowning Prevention to coordinate 
the program and is required to maintain one full time 
equivalent employee responsible for the program. This section 
authorizes appropriations of $2,500,000 per year for 2024 to 
2028 for the swimming pool safety grant program.

Section 4. Reauthorization of CPSC education and awareness program

    Section 4 authorizes to be appropriated to the Commission 
$2,500,000 per year from 2024 to 2028 to carry out the Virginia 
Graeme Baker Pool and Spa Safety education and awareness 
program. This section also inserts explicit language relating 
to inspecting, fixing, and replacing drain covers to ensure 
compliance, as well as educational materials designed to reach 
historically disadvantaged communities, which have higher rates 
of drowning than the nationwide average.

Section 5. CPSC report

    Section 5 requires the CPSC to submit an annual report to 
Congress evaluating the implementation of the authorized grant 
program. The evaluation shall include: the number of applicants 
and identifying information of each applicant, the number of 
grantees selected, the selection criteria for grantees, the 
purpose of the funds used for purposes other than making 
grants, and the effectiveness of the program.

         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):

             VIRGINIA GRAEME BAKER POOL AND SPA SAFETY ACT


                     TITLE XIV--POOL AND SPA SAFETY

SEC. 1401. SHORT TITLE.

  This title may be cited as the ``Virginia Graeme Baker Pool 
and Spa Safety Act''.

           *       *       *       *       *       *       *


SEC. 1403. DEFINITIONS.

  In this title:
          (1) ASME/ANSI.--The term ``ASME/ANSI'' as applied to 
        a safety standard means such a standard that is 
        accredited by the American National Standards Institute 
        and published by the American Society of Mechanical 
        Engineers.
          (2) Barrier.--The term ``barrier'' includes a natural 
        or constructed topographical feature that prevents 
        unpermitted access by children to a swimming pool, and, 
        with respect to a hot tub, a lockable cover.
          (3) Commission.--The term ``Commission'' means the 
        Consumer Product Safety Commission.
          [(4) Covered entity.--The term ``covered entity'' 
        means--
                  [(A) a State; or
                  [(B) an Indian Tribe.]
          (4) Covered entity.--The term ``covered entity'' 
        means--
                  (A) a State;
                  (B) an Indian Tribe; or
                  (C) a nonprofit organization.
          (5) Indian tribe.--The term ``Indian Tribe'' has the 
        meaning given that term in section 4(e) of the Indian 
        Self-Determination and Education Assistance Act (25 
        U.S.C. 5304(e)).
          (6) Main drain.--The term ``main drain'' means a 
        submerged suction outlet typically located at the 
        bottom of a pool or spa to conduct water to a 
        recirculating pump.
          (7) Nonprofit organization.--The term ``nonprofit 
        organization'' means an organization that--
                  (A) is described in section 501(c)(3) of the 
                Internal Revenue Code of 1986 and is exempt 
                from taxation under section 501(a) of such 
                Code; and
                  (B) has proven experience (as determined by 
                the Commission) addressing swimming pool or spa 
                safety and drowning prevention.
          [(7)] (8) Safety vacuum release system.--The term 
        ``safety vacuum release system'' means a vacuum release 
        system capable of providing vacuum release at a suction 
        outlet caused by a high vacuum occurrence due to a 
        suction outlet flow blockage.
          [(8)] (9) Swimming pool; spa.--The term ``swimming 
        pool'' or ``spa'' means any outdoor or indoor structure 
        intended for swimming or recreational bathing, 
        including in-ground and above-ground structures, and 
        includes hot tubs, spas, portable spas, and non-
        portable wading pools.
          [(9)] (10) Unblockable drain.--The term ``unblockable 
        drain'' means a drain of any size and shape that a 
        human body cannot sufficiently block to create a 
        suction entrapment hazard.
          [(10)] (11) State.--The term ``State'' has the 
        meaning given suchterm in section 3(a) of the Consumer 
        Product Safety Act(15 U.S.C. 2052(a)), and includes the 
        Northern MarianaIslands. For purposes of eligibility 
        for the grantsauthorized under section 1405, such term 
        shall also include anypolitical subdivision of a State.

           *       *       *       *       *       *       *


[SEC. 1405. SWIMMING POOL SAFETY GRANT PROGRAM.

  [(a) In General.--Subject to the availability of 
appropriations authorized by subsection (e), the Commission 
shall carry out a grant program to provide assistance to 
eligible covered entities.
  [(b) Eligibility.--To be eligible for a grant under the 
program, a covered entity shall--
          [(1) demonstrate to the satisfaction of the 
        Commission that, as of the date on which the covered 
        entity submits an application to the Commission for a 
        grant under this section, the covered entity has 
        enacted and provides for the enforcement of a statute 
        that--
                  [(A) except as provided in section 
                1406(a)(1)(A)(i), applies to all swimming pools 
                constructed in the State or in the jurisdiction 
                of the Indian Tribe (as the case may be) on or 
                after such date; and
                  [(B) meets the minimum State law requirements 
                of section 1406; and
          [(2) submit an application to the Commission at such 
        time, in such form, and containing such additional 
        information as the Commission may require.
  [(c) Amount of Grant.--The Commission shall determine the 
amount of a grant awarded under this section, and shall 
consider--
          [(1) the population of the covered entity;
          [(2) the relative enforcement and implementation 
        needs of the covered entity; and
          [(3) allocation of grant funds in a manner designed 
        to provide the maximum benefit from the program in 
        terms of protecting children from drowning or 
        entrapment.
  [(d) Use of Grant Funds.--A State or an Indian Tribe 
receiving a grant under this section shall use--
          [(1) at least 25 percent of amounts made available--
                  [(A) to hire and train personnel for 
                implementation and enforcement of standards 
                under the swimming pool and spa safety law of 
                the State or Indian Tribe; and
                  [(B) to defray administrative costs 
                associated with the hiring and training 
                programs under subparagraph (A); and
          [(2) the remainder--
                  [(A) to educate pool owners, pool operators, 
                and other members of the public about the 
                standards under the swimming pool and spa 
                safety law of the State or Indian Tribe and 
                about the prevention of drowning or entrapment 
                of children using swimming pools and spas; and
                  [(B) to defray administrative costs 
                associated with the education programs under 
                subparagraph (A).
  [(e) Authorization of Appropriations.--There are authorized 
to be appropriated to the Commission for fiscal year 2023 
$2,500,000 to carry out this section.]

SEC. 1405. SWIMMING POOL SAFETY GRANT PROGRAM.

  (a) In General.--Subject to the availability of 
appropriations authorized by subsection (i), the Commission 
shall carry out a grant program to provide assistance to 
eligible covered entities.
  (b) Eligibility.--To be eligible for a grant under the 
program, a covered entity shall--
          (1) demonstrate to the satisfaction of the Commission 
        that, as of the date on which the covered entity 
        submits an application to the Commission for a grant 
        under this section, the covered entity (if the covered 
        entity is a State or an Indian Tribe), or the State in 
        which or the Indian Tribe in the jurisdiction of which 
        the covered entity is proposing to carry out activities 
        using grant funds (if the covered entity is a nonprofit 
        organization), has enacted and provides for the 
        enforcement of a statute that--
                  (A) except as provided in section 
                1406(a)(1)(A)(i), applies to all swimming pools 
                constructed in the State or in the jurisdiction 
                of the Indian Tribe (as the case may be) on or 
                after such date; and
                  (B) meets the minimum State law requirements 
                of section 1406; and
          (2) submit an application to the Commission at such 
        time, in such form, and containing such additional 
        information as the Commission may require.
  (c) Selection of Grant Recipients.--
          (1) Priority.--In selecting covered entities to 
        receive grants under the program, the Commission shall 
        give priority (in such order as the Commission 
        considers appropriate) based on the following factors:
                  (A) A covered entity not having previously 
                been awarded a grant under the program.
                  (B) A covered entity proposing to use grant 
                funds to expand educational activities 
                described in paragraph (1)(B)(i) or (2)(A) of 
                subsection (e) that the covered entity is 
                carrying out at the time when the covered 
                entity submits the application for the grant.
                  (C) A covered entity proposing to use grant 
                funds to build on prior expertise and 
                activities aimed at preventing drownings.
                  (D) A covered entity proposing to use grant 
                funds to carry out activities in a geographic 
                area that has a greater number per capita of 
                drowning or entrapment incidents.
                  (E) A covered entity proposing to use grant 
                funds in underserved, minority, or rural 
                communities to provide services that address 
                and target racial, ethnic, or rural drowning 
                disparities.
                  (F) Such other factors as the Commission 
                considers appropriate.
          (2) Geographic diversity.--
                  (A) In general.--In selecting covered 
                entities to receive grants under the program, 
                the Commission shall, to the maximum extent 
                practicable, ensure geographic diversity in the 
                areas where activities will be carried out 
                using grant funds.
                  (B) Technical assistance.--If the Commission 
                awards grants to two or more covered entities 
                that will carry out activities using grant 
                funds in the same geographic area, the 
                Commission shall provide technical assistance 
                to such entities regarding how such entities 
                may collaborate in carrying out such 
                activities.
  (d) Amount of Grant.--The Commission shall determine the 
amount of a grant awarded under this section, and shall 
consider--
          (1) in the case of a covered entity that is a State 
        or an Indian Tribe--
                  (A) the population of such State or Indian 
                Tribe;
                  (B) the enforcement and implementation needs 
                of such State or Indian Tribe; or
                  (C) the education needs of such State or 
                Indian Tribe proposing to use grant funds 
                pursuant to subsection (e)(1)(B)(i);
          (2) in the case of a covered entity that is a 
        nonprofit organization, the number of individuals to 
        whom such nonprofit organization is proposing to 
        provide education described in subsection (e)(2)(A) 
        using grant funds, taking into consideration any 
        increased costs of providing such education due to the 
        rural or remote nature of the area where such nonprofit 
        organization is proposing to provide such education; 
        and
          (3) allocation of grant funds in a manner designed to 
        provide the maximum benefit from the program in terms 
        of protecting children from drowning or entrapment.
  (e) Use of Grant Funds.--
          (1) States and indian tribes.--A State or an Indian 
        Tribe receiving a grant under this section shall use--
                  (A) at least 25 percent of amounts made 
                available--
                          (i) to hire and train personnel for--
                                  (I) implementation and 
                                enforcement of standards under 
                                the swimming pool and spa 
                                safety law of the State or 
                                Indian Tribe; and
                                  (II) inspecting and repairing 
                                or replacing swimming pool and 
                                spa drain covers to ensure 
                                compliance with applicable 
                                Federal, State, and Tribal law; 
                                and
                          (ii) to defray administrative costs 
                        associated with the hiring and training 
                        programs under clause (i); and
                  (B) the remainder--
                          (i) to educate pool owners, pool 
                        operators, and other members of the 
                        public about the standards under the 
                        swimming pool and spa safety law of the 
                        State or Indian Tribe and about the 
                        prevention of drowning or entrapment of 
                        children using swimming pools and spas; 
                        and
                          (ii) to defray administrative costs 
                        associated with the education programs 
                        under clause (i).
          (2) Nonprofit organizations.--A nonprofit 
        organization receiving a grant under this section shall 
        use the amounts made available--
                  (A) to educate pool owners, pool operators, 
                and other members of the public about the 
                prevention of drowning or entrapment of 
                children using swimming pools and spas; and
                  (B) to defray administrative costs associated 
                with the education programs under subparagraph 
                (A).
  (f) Recipient Reporting.--Not later than 90 days after the 
end of the pool and spa grant program project period covered by 
the grants awarded under this section, each covered entity that 
received such a grant shall submit to the Commission a report 
that includes the following:
          (1) The amount of grant funds received by the covered 
        entity.
          (2) The purpose or purposes for which the covered 
        entity proposed to use grant funds in the grant 
        application of the covered entity.
          (3) The purpose or purposes for which the covered 
        entity used grant funds.
          (4) Whether the purposes identified under paragraphs 
        (2) and (3) were achieved.
          (5) Any barriers encountered in carrying out 
        activities using grant funds.
          (6) Any best practices or recommendations for future 
        recipients of grant funds.
          (7) Any other information requested by the 
        Commission.
  (g) Grant Awareness Campaign.--The Commission shall carry out 
a campaign to conduct outreach to covered entities to ensure 
covered entities are aware of the availability and importance 
of the grants under this section.
  (h) Employees.--
          (1) Director of drowning prevention.--The Commission 
        shall have a Director of Drowning Prevention to 
        coordinate the swimming pool and spa safety and 
        drowning prevention activities at the Commission, 
        including carrying out duties under this title.
          (2) Full-time equivalents.--The Commission shall 
        ensure that more than 1 full-time equivalent is 
        dedicated to carrying out swimming pool and spa safety 
        and drowning prevention activities at the Commission, 
        including the grant program under this section.
  (i) Authorization of Appropriations.--There are authorized to 
be appropriated to the Commission for each of the fiscal years 
2024 through 2028 $2,500,000 to carry out this section.

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[SEC. 1407. EDUCATION AND AWARENESS PROGRAM.

  [(a) In General.--The Commission shall establish and carry 
out an education and awareness program to inform the public of 
methods to prevent drowning and entrapment in swimming pools 
and spas. In carrying out the program, the Commission shall 
develop--
          [(1) educational materials designed for swimming pool 
        and spa manufacturers, service companies, and supply 
        retail outlets, including guidance on barrier and drain 
        cover inspection, maintenance, and replacement;
          [(2) educational materials designed for swimming pool 
        and spa owners and operators, consumers, States, and 
        Indian Tribes; and
          [(3) a national media campaign to promote awareness 
        of swimming pool and spa safety.
  [(b) Authorization of Appropriations.--There are authorized 
to be appropriated to the Commission for fiscal year 2023 
$2,500,000 to carry out the education and awareness program 
authorized by subsection (a).

[SEC. 1408. CPSC REPORT.

  [Not later than 1 year after the last day of each fiscal year 
for which grants are made under section 1405, the Commission 
shall submit to Congress a report evaluating the implementation 
of the grant program authorized by that section.]

SEC. 1407. EDUCATION AND AWARENESS PROGRAM.

  (a) In General.--The Commission shall establish and carry out 
an education and awareness program to inform the public of 
methods to prevent drowning and entrapment in swimming pools 
and spas. In carrying out the program, the Commission shall 
develop--
          (1) educational materials designed for swimming pool 
        and spa manufacturers, service companies, and supply 
        retail outlets, including guidance on barrier and drain 
        cover inspection, maintenance, and replacement;
          (2) educational materials designed for swimming pool 
        and spa owners and operators, consumers, States, Indian 
        Tribes, and nonprofit organizations;
          (3) educational materials designed to reach 
        historically disadvantaged communities that have higher 
        rates of drowning than the nationwide average; and
          (4) a national media campaign to promote awareness of 
        swimming pool and spa safety.
  (b) Authorization of Appropriations.--There are authorized to 
be appropriated to the Commission for each of the fiscal years 
2024 through 2028 $2,500,000 to carry out the education and 
awareness program authorized by subsection (a).

SEC. 1408. CPSC REPORT.

  (a) In General.--Not later than 1 year after the last day of 
each fiscal year for which grants are made under section 1405, 
the Commission shall submit to Congress a report evaluating the 
implementation of the grant program authorized by that section.
  (b) Matters To Be Included.--Each report required by 
subsection (a) shall include, with respect to the fiscal year 
covered by the report, the following:
          (1) How many applicants applied for grants under the 
        program.
          (2) For each such applicant--
                  (A) name;
                  (B) location;
                  (C) prior experience in swimming pool or spa 
                safety; and
                  (D) such other details as the Commission 
                considers appropriate.
          (3) How many applicants received grants under the 
        program and the amount of the grant received by each 
        such applicant.
          (4) How recipients of grants under the program were 
        selected and the purposes for which each such recipient 
        proposed to use grant funds in the grant application of 
        the recipient.
          (5) Any purposes, other than making grants under 
        section 1405, for which the Commission used amounts 
        appropriated under subsection (i) of such section.
          (6) An evaluation of the effectiveness of the 
        program, including any barriers or gaps, and 
        recommendations for legislative changes, if required to 
        increase the effectiveness of the program.

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