[House Report 118-490]
[From the U.S. Government Publishing Office]


118th Congress    }                                     {       Report
                        HOUSE OF REPRESENTATIVES
 2d Session       }                                     {      118-490

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



 
      MATERNAL AND CHILD HEALTH STILLBIRTH PREVENTION ACT OF 2024

                                _______
                                

  May 7, 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. 4581]

    The Committee on Energy and Commerce, to whom was referred 
the bill (H.R. 4581) to amend title V of the Social Security 
Act to support stillbirth prevention and research, 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..............................................     2
Background and Need for Legislation..............................     2
Committee Action.................................................     2
Committee Votes..................................................     3
Oversight Findings and Recommendations...........................     5
New Budget Authority, Entitlement Authority, and Tax Expenditures     5
Congressional Budget Office Estimate.............................     5
Federal Mandates Statement.......................................     5
Statement of General Performance Goals and Objectives............     5
Duplication of Federal Programs..................................     5
Related Committee and Subcommittee Hearings......................     5
Committee Cost Estimate..........................................     6
Earmark, Limited Tax Benefits, and Limited Tariff Benefits.......     6
Advisory Committee Statement.....................................     6
Applicability to Legislative Branch..............................     6
Section-by-Section Analysis of the Legislation...................     6
Changes in Existing Law Made by the Bill, as Reported............     6

    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 ``Maternal and Child Health Stillbirth 
Prevention Act of 2024''.

SEC. 2. CLARIFICATION SUPPORTING PERMISSIBLE USE OF FUNDS FOR 
                    STILLBIRTH PREVENTION ACTIVITIES.

  Section 501(a) of the Social Security Act (42 U.S.C. 701(a)) is 
amended--
          (1) in paragraph (1)(B), by inserting ``to reduce the 
        incidence of stillbirth,'' after ``among children,''; and
          (2) in paragraph (2), by inserting after ``follow-up 
        services'' the following: ``, and for evidence-based programs 
        and activities and outcome research to reduce the incidence of 
        stillbirth (including tracking and awareness of fetal 
        movements, improvement of birth timing for pregnancies with 
        risk factors, initiatives that encourage safe sleeping 
        positions during pregnancy, screening and surveillance for 
        fetal growth restriction, efforts to achieve smoking cessation 
        during pregnancy, community-based programs that provide home 
        visits or other types of support, and any other research or 
        evidence-based programming to prevent stillbirths)''.

                          Purpose and Summary

    H.R. 4581 clarifies that evidence-based activities and 
research focused on reducing the incidence of stillbirth are 
permissible uses of the Maternal and Child Health Services 
Block Grant funding in Title V.

                  Background and Need for Legislation

    Stillbirth affects about 1 in 175 births, and each year 
about 21,000 babies are stillborn in the United States.\1\ 
Worldwide, there are more than 2.6 million stillbirths every 
year.\2\ While there have been incredible advances and 
improvements in medical technology over the last 30 years, 
including in prenatal care, the rate of early stillbirth has 
remained about the same.\3\ States are authorized to use their 
Maternal and Child Health Services Block Grant funding for 
stillbirth education and related activities, but due to a lack 
of clear federal guidance, states have refrained from utilizing 
this funding stream for these purposes. This legislation 
clarifies that states can use Title V funding for evidence-
based programs, activities, and outcome research to help 
prevent and reduce the incidence of stillbirths.
---------------------------------------------------------------------------
    \1\Centers for Disease Control and Prevention, ``What is 
Stillbirth?'', 2022. https://www.cdc.gov/ncbddd/stillbirth/facts.html.
    \2\Star Legacy Foundation, ``About Stillbirth'', 2024. https://
starlegacyfoundation.org/about-stillbirth/.
    \3\Centers for Disease Control and Prevention, ``What is 
Stillbirth?'', 2024.
---------------------------------------------------------------------------

                            Committee Action

    On February 14, 2024, the Subcommittee on Health held a 
hearing on H.R. 4581. The title of the hearing was 
``Legislative Proposals to Support Patients and Caregivers.'' 
The Subcommittee received testimony from:
           Andy Shih, PhD, Chief Science Officer, 
        Autism Speaks;
           Corey Feist, JD, MBA, Co-Founder and CEO, 
        Dr. Lorna Breen Heroes' Foundation;
           Joanne Pike, DrPH, President and CEO, 
        Alzheimer's Association;
           Gordon Tomaselli, MD, Former President, 
        American Heart Association; Marilyn and Stanley M. Katz 
        Dean, Emeritus and Professor of Medicine, Albert 
        Einstein College of Medicine; Adjunct Professor of 
        Medicine, Johns Hopkins University School of Medicine;
           Michelle Whitten, President, CEO, and Co-
        Founder, Global Down Syndrome Foundation;
           Randy Strozyk, President, American Ambulance 
        Association; and
           Christina Annunziata, MD, PhD, Senior Vice 
        President of Extramural Discovery Science, American 
        Cancer Society.
    On March 12, 2024, the Subcommittee on Health met in open 
markup session and forwarded H.R. 4581, as amended, to the full 
Committee by a record vote of 25 yeas and 0 nays.
    On March 20, 2024, the full Committee on Energy and 
Commerce met in open markup session and ordered H.R. 4581, as 
amended, favorably reported to the House by a record vote of 44 
yeas and 0 nays.

                            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. 4581 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, at the time this 
report was filed, the cost estimate prepared by the Director of 
the Congressional Budget Office pursuant to section 402 of the 
Congressional Budget Act of 1974 was not available.

                       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 reduce 
the rate of stillbirths by supporting research into evidence-
based preventative measures.

                    Duplication of Federal Programs

    Pursuant to clause 3(c)(5) of rule XIII, no provision of 
H.R. 4581 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. 4581:
           On February 14, 2024, the Subcommittee on 
        Health held a hearing on H.R. 4581. The title of the 
        hearing was ``Legislative Proposals to Support Patients 
        and Caregivers.'' The Subcommittee received testimony 
        from:
                   Andy Shih, PhD, Chief Science 
                Officer, Autism Speaks;
                   Corey Feist, JD, MBA, Co-Founder 
                and CEO, Dr. Lorna Breen Heroes' Foundation;
                   Joanne Pike, DrPH, President and 
                CEO, Alzheimer's Association;
                   Gordon Tomaselli, MD, Former 
                President, American Heart Association; Marilyn 
                and Stanley M. Katz Dean, Emeritus and 
                Professor of Medicine, Albert Einstein College 
                of Medicine; Adjunct Professor of Medicine, 
                Johns Hopkins University School of Medicine;
                   Michelle Whitten, President, 
                CEO, and Co-Founder, Global Down Syndrome 
                Foundation;
                   Randy Strozyk, President, 
                American Ambulance Association; and
                   Christina Annunziata, MD, PhD, 
                Senior Vice President of Extramural Discovery 
                Science, American Cancer Society.

                        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. At the time this report was 
filed, the estimate was not available.

       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. 4581 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 provides that the Act may be cited as the 
``Maternal and Child Health Stillbirth Prevention Act of 
2024''.

Section 2. Clarification supporting permissible use of funds for 
        stillbirth prevention activities

    Section 2 amends the Maternal and Child Health Services 
Block Grant by expanding the scope and purpose to include 
stillbirth research and prevention.

         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 (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

           *       *       *       *       *       *       *



                    authorization of appropriations

  Sec. 501. (a) To improve the health of all mothers and 
children consistent with the applicable health status goals and 
national health objectives established by the Secretary under 
the Public Health Service Act for the year 2000, there are 
authorized to be appropriated $850,000,000 for fiscal year 2001 
and each fiscal year thereafter--
          (1) for the purpose of enabling each State--
                  (A) to provide and to assure mothers and 
                children (in particular those with low income 
                or with limited availability of health 
                services) access to quality maternal and child 
                health services;
                  (B) to reduce infant mortality and the 
                incidence of preventable diseases and 
                handicapping conditions among children, to 
                reduce the incidence of stillbirth, to reduce 
                the need for inpatient and long-term care 
                services, to increase the number of children 
                (especially preschool children) appropriately 
                immunized against disease and the number of low 
                income children receiving health assessments 
                and follow-up diagnostic and treatment 
                services, and otherwise to promote the health 
                of mothers and infants by providing prenatal, 
                delivery, and postpartum care for low income, 
                at-risk pregnant women, and to promote the 
                health of children by providing preventive and 
                primary care services for low income children;
                  (C) to provide rehabilitation services for 
                blind and disabled individuals under the age of 
                16 receiving benefits under title XVI, to the 
                extent medical assistance for such services is 
                not provided under title XIX; and
                  (D) to provide and to promote family-
                centered, community-based, coordinated care 
                (including care coordination services, as 
                defined in subsection (b)(3)) for children with 
                special health care needs and to facilitate the 
                development of community-based systems of 
                services for such children and their families;
          (2) for the purpose of enabling the Secretary 
        (through grants, contracts, or otherwise) to provide 
        for special projects of regional and national 
        significance, research, and training with respect to 
        maternal and child health and children with special 
        health care needs (including early intervention 
        training and services development), for genetic disease 
        testing, counseling, and information development and 
        dissemination programs, for grants (including funding 
        for comprehensive hemophilia diagnostic treatment 
        centers) relating to hemophilia without regard to age, 
        and for the screening of newborns for sickle cell 
        anemia, and other genetic disorders and follow-up 
        services, and for evidence-based programs and 
        activities and outcome research to reduce the incidence 
        of stillbirth (including tracking and awareness of 
        fetal movements, improvement of birth timing for 
        pregnancies with risk factors, initiatives that 
        encourage safe sleeping positions during pregnancy, 
        screening and surveillance for fetal growth 
        restriction, efforts to achieve smoking cessation 
        during pregnancy, community-based programs that provide 
        home visits or other types of support, and any other 
        research or evidence-based programming to prevent 
        stillbirths); and
          (3) subject to section 502(b) for the purpose of 
        enabling the Secretary (through grants, contracts, or 
        otherwise) to provide for developing and expanding the 
        following--
                  (A) maternal and infant health home visiting 
                programs in which case management services as 
                defined in subparagraphs (A) and (B) of 
                subsection (b)(4), health education services, 
                and related social support services are 
                provided in the home to pregnant women or 
                families with an infant up to the age one by an 
                appropriate health professional or by a 
                qualified nonprofessional acting under the 
                supervision of a health care professional,
                  (B) projects designed to increase the 
                participation of obstetricians and 
                pediatricians under the program under this 
                title and under state plans approved under 
                title XIX,
                  (C) integrated maternal and child health 
                service delivery systems (of the type described 
                in section 1136 and using, once developed, the 
                model application form developed under section 
                6506(a) of the Omnibus Budget Reconciliation 
                Act of 1989),
                  (D) maternal and child health centers which 
                (i) provide prenatal, delivery, and postpartum 
                care for pregnant women and preventive and 
                primary care services for infants up to age 
                one, and (ii) operate under the direction of a 
                not-for-profit hospital,
                  (E) maternal and child health projects to 
                serve rural populations, and
                  (F) outpatient and community based services 
                programs (including day care services) for 
                children with special health care needs whose 
                medical services are provided primarily through 
                inpatient institutional care.
Funds appropriated under this section may only be used in a 
manner consistent with the Assisted Suicide Funding Restriction 
Act of 1997.
  (b) For purposes of this title:
          (1) The term ``consolidated health programs'' means 
        the programs administered under the provisions of--
                  (A) this title (relating to maternal and 
                child health and services for children with 
                special health care needs),
                  (B) section 1615(c) of this Act (relating to 
                supplemental security income for disabled 
                children),
                  (C) sections 316 (relating to lead-based 
                paint poisoning prevention programs), 1101 
                (relating to genetic disease programs), 1121 
                (relating to sudden infant death syndrome 
                programs) and 1131 (relating to hemophilia 
                treatment centers) of the Public Health Service 
                Act, and
                  (D) title VI of the Health Services and 
                Centers Amendments of 1978 (Public Law 95-626; 
                relating to adolescent pregnancy grants),
        as such provisions were in effect before the date of 
        the enactment of the Maternal and Child Health Services 
        Block Grant Act.
          (2) The term ``low income'' means, with respect to an 
        individual or family, such an individual or family with 
        an income determined to be below the income official 
        poverty line defined by the Office of Management and 
        Budget and revised annually in accordance with section 
        673(2) of the Omnibus Budget Reconciliation Act of 
        1981.
          (3) The term ``care coordination services'' means 
        services to promote the effective and efficient 
        organization and utilization of resources to assure 
        access to necessary comprehensive services for children 
        with special health care needs and their families.
          (4) The term ``case management services'' means--
                  (A) with respect to pregnant women, services 
                to assure access to quality prenatal, delivery, 
                and postpartum care; and
                  (B) with respect to infants up to age one, 
                services to assure access to quality preventive 
                and primary care services.
  (c)(1)(A) For the purpose of enabling the Secretary (through 
grants, contracts, or otherwise) to provide for special 
projects of regional and national significance for the 
development and support of family-to-family health information 
centers described in paragraph (2), there is appropriated to 
the Secretary, out of any money in the Treasury not otherwise 
appropriated--
          (i) $3,000,000 for fiscal year 2007;
          (ii) $4,000,000 for fiscal year 2008;
          (iii) $5,000,000 for each of fiscal years 2009 
        through 2013;
          (iv) $2,500,000 for the portion of fiscal year 2014 
        before April 1, 2014;
          (v) $2,500,000 for the portion of fiscal year 2014 on 
        or after April 1, 2014;
          (vi) $5,000,000 for each of fiscal years 2015 through 
        2017;
          (vii) $6,000,000 for each of fiscal years 2018 
        through 2024; and
          (vii) $1,500,000 for the portion of the fiscal year 
        2025 before January 1, 2025.
  (B) Funds appropriated or authorized to be appropriated under 
subparagraph (A) shall--
          (i) be in addition to amounts appropriated under 
        subsection (a) and retained under section 502(a)(1) for 
        the purpose of carrying out activities described in 
        subsection (a)(2); and
          (ii) remain available until expended.
  (2) The family-to-family health information centers described 
in this paragraph are centers that--
          (A) assist families of children with disabilities or 
        special health care needs to make informed choices 
        about health care in order to promote good treatment 
        decisions, cost-effectiveness, and improved health 
        outcomes for such children;
          (B) provide information regarding the health care 
        needs of, and resources available for, such children;
          (C) identify successful health delivery models for 
        such children;
          (D) develop with representatives of health care 
        providers, managed care organizations, health care 
        purchasers, and appropriate State agencies, a model for 
        collaboration between families of such children and 
        health professionals;
          (E) provide training and guidance regarding caring 
        for such children;
          (F) conduct outreach activities to the families of 
        such children, health professionals, schools, and other 
        appropriate entities and individuals; and
          (G) are staffed--
                  (i) by such families who have expertise in 
                Federal and State public and private health 
                care systems; and
                  (ii) by health professionals.
  (3) The Secretary shall develop family-to-family health 
information centers described in paragraph (2) in accordance 
with the following:
          (A) With respect to fiscal year 2007, such centers 
        shall be developed in not less than 25 States.
          (B) With respect to fiscal year 2008, such centers 
        shall be developed in not less than 40 States.
          (C) With respect to fiscal year 2009 and each fiscal 
        year thereafter, such centers shall be developed in all 
        States, and with respect to fiscal year 2018 and each 
        fiscal year thereafter, such centers shall also be 
        developed in all territories and at least one such 
        center shall be developed for Indian tribes.
  (4) The provisions of this title that are applicable to the 
funds made available to the Secretary under section 502(a)(1) 
apply in the same manner to funds made available to the 
Secretary under paragraph (1)(A).
  (5) For purposes of this subsection--
          (A) the term ``Indian tribe'' has the meaning given 
        such term in section 4 of the Indian Health Care 
        Improvement Act (25 U.S.C. 1603);
          (B) the term ``State'' means each of the 50 States 
        and the District of Columbia; and
          (C) the term ``territory'' means Puerto Rico, Guam, 
        American Samoa, the Virgin Islands, and the Northern 
        Mariana Islands.

           *       *       *       *       *       *       *


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